Innovating image-guided surgery: Introducing multimodal approaches for sentinel node detection

Founded on Halsted’s hypothesis of sequential tumor spread, selective biopsy of the tumor draining lymph nodes enables early detection of clinically occult nodal metastases while sparing patients the morbidity of an unnecessary lymph node dissection. Originally introduced for melanoma and breast cancer, the sentinel node (SN) biopsy is a multidisciplinary diagnostic procedure based on the injection of a radiocolloid followed by lymphatic mapping using lymphoscintigraphy and SPECT/CT to identify the SNs. Intraoperatively, SNs are traditionally localized using a gamma ray detection probe and a separate injection of blue dye to visualize the SNs. Over the last decade, the procedure has expanded to malignancies with lymphatic drainage to areas of more complex anatomy or located deeply in the abdomen. SN biopsy in these patients may be challenging and may benefit from additional intraoperative tools. This thesis focuses on the clinical introduction of novel multimodal approaches in order to help optimize the SN procedure.