Bladder cancer sentinel node mapping using ICG-99mTc-nanocolloid

Radical cystectomy combined with an extended pelvic lymph node dissection is considered the gold standard for staging in non-metastatic muscle-invasive bladder cancer. The sentinel node procedure is an alternative method to locally stage bladder cancer. In this study we aim to evaluate the sentinel node procedure in bladder cancer patients who are scheduled for radical cystectomy and extended pelvic lymph node dissection.

Sentinel node mapping for bladder cancer is possible using the hybrid tracer ICG-99mTc-nanocolloid

Injection (t=0); Preoperative imaging (t=15 min, and t=2 hours); Intraoperative imaging (t=>3hours)

On the day before surgery (approximately 18 hours) patients will receive 4-6 transurethral injections with a total of 2mL hybrid tracer (240MBq) around the tumor (in case of a solitary lesion) or divided over the bladder (in case of multiple tumors). In both cases the hybrid tracer is injected into the detrusor muscle of the bladder under cystoscopy guidance using an endoscopic needle.

After the injection lymphoscintigraphy will be performed at 15 min and 2 hours, followed by SPECT/CT imaging at 2 hours.



Intraoperatively sentinel nodes will be identified via combined radio- and fluorescence guidance. For radioguidance, a (laparoscopic) gamma probe will be used. Fluorescence imaging during the operation will be performed using a fluorescence camera for open surgery or for laparoscopic surgery. Additionally, during robot-assisted procedures, the da Vinci SI integrated fluorescence camera (Firefly) will be used. The declipseSPECT navigation system will be used to locate the sentinel nodes intraoperatively.