Preoperative workflow for lymph nodes staging

PurposeAccurate staging of lymph nodes relies mainly on surgical exploration and manual palpation. We present a new non-invasive diagnostic approach: simulated palpation through virtual laparoscopic instruments.MethodsWe set up a diagnostic process to extract lymph nodes shape and position from CTs and to analyze the trend of pixels intensities to determine tissue properties in order to feedback the force information.ResultsWe have integrated the model, obtained from both the morphological information and stiffness values, in our laparoscopy simulator and surgeons can virtually palpate, with a haptic device, the lymph nodes. We evaluated the workflow extracting lymph nodes from a case study: the feedback provided through the simulator greatly helps the surgeon in the correct staging.ConclusionsResults show the feasibility of the approach and in the future we will clinically evaluate this new diagnostic methodology. We are studying the possibility to integrate CTs with other imaging systems to increase the accuracy.

[1]  Nikolaos Grammalidis,et al.  Head detection and tracking by 2-D and 3-D ellipsoid fitting , 2000, Proceedings Computer Graphics International 2000.

[2]  Andrew Nealen,et al.  Physically Based Deformable Models in Computer Graphics , 2005, Eurographics.

[3]  Wesley E. Snyder,et al.  Lymph node segmentation using active contours , 1997, Medical Imaging.

[4]  Yoshihiko Nakamura,et al.  Automated Extraction of Lymph Nodes from 3-D Abdominal CT Images Using 3-D Minimum Directional Difference Filter , 2007, MICCAI.

[5]  S. Kondo,et al.  CT evaluation of paraaortic lymph node metastasis in patients with biliary cancer , 2005, Journal of Gastroenterology.

[6]  K. Ryu,et al.  Candidates for Curative Resection in Advanced Gastric Cancer Patients Who Had Equivocal Para-aortic Lymph Node Metastasis on Computed Tomographic Scan , 2006, Annals of Surgical Oncology.

[7]  L. Sobin,et al.  TNM Classification of Malignant Tumours , 1987, UICC International Union Against Cancer.

[8]  L. Schwartz,et al.  Lymph node segmentation from CT images using fast marching method. , 2004, Computerized medical imaging and graphics : the official journal of the Computerized Medical Imaging Society.

[9]  R. Reznek,et al.  The optimal imaging of adrenal tumours: a comparison of different methods. , 2007, Endocrine-related cancer.

[10]  Anthony J. Yezzi,et al.  Semi-Automatic Lymph Node Segmentation in LN-MRI , 2006, 2006 International Conference on Image Processing.

[11]  A. Ahuja,et al.  Sonography of neck lymph nodes. Part II: abnormal lymph nodes. , 2003, Clinical radiology.

[12]  Grégoire Malandain,et al.  Atlas-based delineation of lymph node levels in head and neck computed tomography images. , 2008, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[13]  Paolo Fiorini,et al.  Calibration of mass spring models for organ simulations , 2007, 2007 IEEE/RSJ International Conference on Intelligent Robots and Systems.

[14]  Anil K. Jain,et al.  Deformable template models: A review , 1998, Signal Process..

[15]  M. Horger,et al.  Massive cervical and abdominal lymphadenopathy caused by localized amyloidosis. , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[16]  Bernhard Preim,et al.  Segmentation of Neck Lymph Nodes in CT Datasets with Stable 3D Mass-Spring Models , 2006, MICCAI.

[17]  Markus Gross,et al.  Simulating facial surgery using finite element models , 1996 .

[18]  Bernard Sigel,et al.  Ultrasound for surgeons , 1997 .

[19]  Gregory G. Slabaugh,et al.  Graph cuts segmentation using an elliptical shape prior , 2005, IEEE International Conference on Image Processing 2005.

[20]  Hans-Peter Meinzer,et al.  Lymph node segmentation on CT images by a shape model guided deformable surface methodh , 2008, SPIE Medical Imaging.

[21]  Demetri Terzopoulos,et al.  Physically-based facial modelling, analysis, and animation , 1990, Comput. Animat. Virtual Worlds.

[22]  Ralph Weissleder,et al.  Sensitive, Noninvasive Detection of Lymph Node Metastases , 2004, PLoS medicine.

[23]  Thomas Sangild Sørensen,et al.  A GPU accelerated spring mass system for surgical simulation. , 2005, Studies in health technology and informatics.