Knowledge Hub · Europrobe™ Gamma + Fluorescence
Hybrid ICG-99mTc-nanocolloid tracer, randomised evidence that NIR fluorescence matches gamma + blue dye while reducing allergic-reaction risk, and the practical OR reason a probe-based NIR channel beats a NIR camera at the deep dissection plane. The dual platform is the world-first single probe that carries both channels.
Why this matters
Dual modality vs single modality — detection rate
The Van der Vorst, Verbeek and Schaafsma series at LUMC, and subsequent randomised work in breast cancer, established that dual-modality SLN detection using ICG-99mTc-nanocolloid as a hybrid tracer reaches near 100 % detection rate vs roughly 92–96 % with gamma alone and 80–93 % with blue dye alone. The dual modality matters most when one channel is weak — a faint deep node where the gamma count is borderline shows clearly on the ICG channel, and vice versa.
Hybrid ICG-99mTc-nanocolloid tracer
ICG can be pre-bound to the same Tc-99m-nanocolloid colloid the radiopharmacy already dispenses — one injection, two modalities. The hybrid tracer co-localises by definition (the gamma signal and the fluorescence signal come from the same colloid particle), so the surgeon never deals with disagreement between channels. Prepared at the bench from the standard nanocolloid kit; no separate ICG injection at a different time-point; no separate consent for two agents.
NIR fluorescence vs blue dye in breast SLN
A randomised trial in 100 breast-cancer SLN patients (PMC3465510) directly compared NIR ICG fluorescence + Tc-99m vs blue dye + Tc-99m and showed equivalent SLN detection rate (100 % vs 100 %) with substantially better surgical visualisation and lower allergic-reaction risk for the NIR-ICG arm. Blue dye remains a useful adjunct but is no longer the dominant non-radioactive tracer for breast SLN where ICG-equipped optics are available.
Why a probe-based NIR channel matters
A surgical NIR camera (open or laparoscopic) shows ICG fluorescence at the tissue surface — perfect for transcutaneous lymphatic-channel visualisation, less useful as the dissection deepens and the surface fluorescence falls below the camera's working range. A probe-based NIR channel reads the fluorescence at the probe tip — inside the wound, at the actual dissection depth. The probe finds the node when the camera has lost the signal in the deep plane.
Laparoscopic SLN — gynaecological cancer
Pelvic SLN in cervical, endometrial and selected vulvar cancer is increasingly done laparoscopically or robotically. A laparoscopic gamma-only probe + a separate laparoscopic NIR-camera setup is two pieces of capital and two trocar swaps per case. The SOE 3214-AF frontal laparoscopic dual probe carries both channels through a single 12 mm trocar — fewer instrument swaps, faster cycle time, the workflow that GROINSS-V (vulva), SENTI-ENDO (endometrium) and ESGO cervical-SLN guidance frame.
AERB + CDSCO joint framework
AERB governs the Tc-99m pre-injection (handling, transport, theatre log, specimen disposal). CDSCO governs ICG as the operative drug. Both clearances are independently held; the SOP combining them is the surgical-oncology department's responsibility. The joint NM-OR workflow needs to specify the injection sequence, timing and consent on both regulatory tracks before the first dual-modality case runs.
Source: AERB Safety Code for Nuclear Medicine Facility; CDSCO drug-regulatory framework for ICG.
The published comparative studies, the original dual-probe characterisation, and the AERB + CDSCO joint regulatory base for the dual-modality SLN workflow in India.
Open-access (PMC10250462) — direct comparison of two hybrid sentinel-node tracers from the nuclear medicine + surgical perspective.
Open-access (PMC3465510) — randomised comparison establishing NIR ICG fluorescence as the de-facto successor to blue dye in breast SLN.
Open-access review (PMC10599532) evaluating ICG-based fluorescence in SLN biopsy practice.
Original dual opto-nuclear probe characterisation paper — combined gamma + fluorescence detection of the sentinel node.
Van der Zee et al., JCO 2008 — sentinel-node procedure as standard of care in selected early-stage vulvar cancer.
Ballester et al., Lancet Oncology 2011 — prospective multicentre evaluation of SLN biopsy in early-stage endometrial cancer.
Open Access Journals review covering pre- and intra-operative imaging techniques for sentinel-node localisation in breast cancer.
Indian regulatory framework — pre-operative ⁹⁹ᵐTc injection authorisation, theatre handling, specimen-disposal log.
Central Drugs Standard Control Organisation reference for ICG as the operative fluorescence agent.
Gamma-only SLN technique as the baseline; the dual opto-nuclear platform layers the ICG channel on top of this same workflow.