ArticleEuropean journal of nuclear medicine and molecular imaging2026
LiDAR-registered freehand SPECT combined with NIR-fluorescence enables spatial localisation of tracer-avid inguinal lymph nodes: A clinical feasibility study.
Article in European journal of nuclear medicine and molecular imaging, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeConventional ex vivo molecular assessment of nodal specimens lacks three-dimensional (3D) spatial context, making localisation of tracer-avid sentinel nodes (SNs) within large en bloc inguinal lymph node dissection (ILND) specimens challenging. We evaluated the technical feasibility of combining light detection and ranging (LiDAR)-registered freehand SPECT (fhSPECT) with near-infrared (NIR) fluorescence imaging for spatially augmented localisation of hybrid tracer uptake in solitary SNs and SNs residing within ILND specimens.
methodsFourteen patients with penile cancer (25 cN0 groins; 3 cN1 groins) underwent radio- and fluorescence-guided lymph node (LN) surgery following preoperative lymphoscintigraphy and SPECT/CT. Resected specimens underwent conventional ex vivo assessment, followed by LiDAR-registered fhSPECT with co-registered NIR-fluorescence imaging. These 3D models were compared with conventional ex vivo assessments, preoperative imaging, and histopathological outcomes.
resultsIn total, 40 solitary tracer-avid LNs and 3 ILND specimens underwent ex vivo assessment. LiDAR/fhSPECT localised radioactive hotspots in 38/40 solitary LNs, consistent with conventional gamma probe assessment, while both conventional and LiDAR-registered NIR-fluorescence imaging detected fluorescent signal in all 40 LNs. Among the 3 ILND procedures, preoperative SPECT/CT identified 6 tracer-avid hotspots within the anatomical resection template. Conventional gamma probe and NIR-fluorescence detected only 4 and 5 hotspots, respectively, whereas LiDAR/fhSPECT localised all 6 hotspots in the corresponding resected specimens. Histopathology identified 6 tumour-positive LNs, all of which were hybrid tracer-avid and effectively localised by LiDAR/fhSPECT.
conclusionLiDAR-registered 3D surface mapping provided anatomical context to radioactive and fluorescent molecular imaging signals, enabling localisation of tracer-avid LNs in complex ex vivo ILND specimens. These findings support the feasibility of spatially augmented localisation of hybrid tracer uptake and warrant validation in larger studies.
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