JP2003290128A - Sentinel lymph node-detecting method - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a sentinel lymph node-detecting method by which the identification of a sentinel lymph node can be surely and quickly performed, and burden to a patient receiving a celiotomy, or the like, can be reduced as well. <P>SOLUTION: In this sentinel lymph node-detecting method, an insertion unit 2 having a thin diameter which can be inserted into a biological internal cavity, an X-ray-detecting unit 6 which two-dimensionally detects X-ray at the distal end of the insertion unit 2, and an optical imaging unit 3 which picks up a visible beam image are used. The X-ray-detecting unit 6 and the optical imaging unit 3 are arranged in the longitudinal direction Z of the insertion unit 2, and also, are arranged to be close so that the same one direction may be observed. A radioactive tracer which resides in the sentinel lymph node 14 is detected by the X-ray-detecting unit 6. In this case, the X-ray detecting image frame detects a smaller range than an image frame picked up by the optical imaging unit 3. <P>COPYRIGHT: (C)2004,JPO

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a sentinel lymph node detection method for identifying a sentinel lymph node in the vicinity of a lesion in a living body lumen.

[0002]

Examination of the presence or absence of tumor metastasis and spread has become a major determinant for effective treatment of cancer patients. The sentinel lymph node is the first lymph node to reach the tumor cells that enter the lymphatic vessel from the primary tumor lesion. 20% of lymph node metastases in early cancer
It is known that the remaining 80% has not metastasized. If there is no metastasis, the tumor can be completely cured by excision of a limited area of only the primary tumor. The above-mentioned sentinel lymph node is located in the tissue under the lesion on the surface of the body lumen wall of the stomach or large intestine, and cannot be observed directly from the surface. Therefore, it is required to indirectly detect and accurately identify the sentinel lymph node in the vicinity of the lesion site, and collect and examine the cells of the sentinel lymph node.

Then, as a system for surely identifying the above-mentioned sentinel lymph node, Japanese Patent Laid-Open No. 2001-299676.
There is a sentinel lymph node detection method disclosed in the publication. In this detection method, an infrared fluorescent dye, indocyanine green, is locally injected around the tumor as a tracer.
After a predetermined time, a laparotomy is performed to irradiate the observed area with near-infrared excitation light. Near-infrared fluorescence is emitted due to the accumulation of indocyanine green in the sentinel lymph node. The sentinel lymph node is detected by converting the near infrared fluorescence into visible light and observing it as a visualized image.

The system for identifying the position of the sentinel lymph node disclosed in Japanese Patent Laid-Open No. 9-189770 is a system for identifying the position of the sentinel lymph node by detecting a photon radiation source. In the incised state, the radioactive substance in the lymph vessel is traced with a hand-held probe, and the position of the sentinel lymph node where the concentration is high is specified. The probe is a gamma probe that uses a cadmium telluride crystal as a photon radiation detection sensor.

[0005]

DISCLOSURE OF THE INVENTION Problems to be Solved by the Invention
The sentinel lymph node detection method disclosed in Japanese Patent Publication No. 299676 has a drawback in that a laparotomy is required for the examination.

On the other hand, in the system for identifying the position of the sentinel lymph node disclosed in Japanese Unexamined Patent Publication No. 9-189770, a laparotomy is required for the examination because a probe on hand is applied, and the patient's QOL (quarity of life) )
Considering that, the invasion was great. Further, even if the sentinel lymph node was found, there was a possibility that the position of the sentinel lymph node would be lost at the stage of collecting the tissue from the site to confirm the presence or absence of cancer metastasis. There is also a problem that the time required for detection is long because the sentinel lymph nodes are identified by points.

The present invention has been made to solve the above-mentioned problems, and ensures the identification of sentinel lymph nodes,
Moreover, it is an object of the present invention to provide a sentinel lymph node detection method that can be rapidly performed and has a small burden on patients such as open surgery.

[0008]

A sentinel lymph node detecting method according to claim 1 of the present invention is such that a small-diameter insertion portion that can be inserted into a lumen of a living body and an X-ray in a two-dimensional manner at the tip of the insertion portion. In a sentinel lymph node detection method using a sentinel lymph node observation system having an X-ray detection element for detecting and an optical imaging element for picking up a visible light image, the X-ray detection element and the optical imaging element serve as an insertion portion. The sentinel lymph nodes, in which the radioactive tracer is retained, are detected by the X-ray detection element, which are arranged in the longitudinal direction and are arranged close to each other so as to observe the same direction.

The sentinel lymph node detecting method according to claim 2 of the present invention is the sentinel lymph node detecting method according to claim 1, wherein the range observed by the X-ray detecting element is more than the range observed by the optical imaging element. Is also narrow.

The method for detecting sentinel lymph nodes according to claim 3 of the present invention is the method for detecting sentinel lymph nodes according to claim 1, wherein a two-dimensional image obtained by an X-ray detection element is superimposed on a body lumen image obtained by an optical imaging element. And display it.

The sentinel lymph node detecting method according to claim 4 of the present invention is the same as the sentinel lymph node detecting method according to claim 3, wherein the two-dimensional image by the X-ray detecting element is
A portion having a high radiation density is displayed as a pseudo color image.

A method for detecting a sentinel lymph node according to a fifth aspect of the present invention is the method for detecting a sentinel lymph node according to the first aspect, wherein the X-ray detection element forms a curved surface,
It has detection directivity in the direction perpendicular to the curved surface.

The sentinel lymph node detecting method according to claim 6 of the present invention is the method for detecting sentinel lymph node according to claim 5, wherein a layer having a plurality of collimator means for obtaining directivity is included in the X-ray detecting element. It is located in front of the light-receiving surface.

[0014]

BEST MODE FOR CARRYING OUT THE INVENTION Embodiments of the present invention will be described below with reference to the drawings. FIG. 1 is a diagram showing the configuration of a sentinel lymph node observation system to which the sentinel lymph node detection method according to the first embodiment of the present invention is applied. Figure 2
Shows a display screen of the image display unit in the above system. FIG. 3 is a sectional view showing a detailed configuration of the X-ray camera section in the above system.

The sentinel lymph node observation system 1 of the present embodiment has a living body internal organs, for example, a living body lumen wall surface 12 of the stomach.
This is a system for identifying the SN by detecting the radioactive substance (tracer) that has flowed into the sentinel lymph node (hereinafter, referred to as SN) 14 located in the lower layer portion with respect to the upper lesion portion 13 by an X-ray camera. .

The above sentinel lymph node observation system 1
Is a flexible endoscope (not shown) having a small-diameter insertion part 2 that can be inserted into a body lumen, and a visible light CCU for a visible light camera.
(Camera control unit) 8, X-ray CCU (camera control unit) 9 for X-ray camera, and superimposing circuit 1 for superimposing the image output of X-ray CCU 9 to the image output of visible light CCU 8.
0 and an image display unit 11 for displaying the image output of the superimposing circuit 10 are mainly included.

The insertion portion 2 has a visible light camera portion 3 and an X-ray camera portion 6 at the tip end portion thereof which are close to each other along the insertion portion longitudinal direction Z of the insertion portion. The visible light camera unit 3 and the X-ray camera unit 6 are camera units capable of capturing a visible light image of a living body lumen at a side portion in the longitudinal direction Z and an X-ray image. Furthermore, the puncture needle 7 for marking or the biopsy puncture needle is arranged so as to project to a position between the visible light camera unit 3 and the X-ray camera unit 6 at the distal end portion of the insertion unit 2 or the forceps port 2a. It can be slidably inserted into.

The visible light camera section 3 comprises an objective lens 4 and a CCD 5 which is an optical image pickup element, and has an image pickup optical axis O1 which is inclined at a predetermined angle with respect to the longitudinal direction Z of the insertion section.
It has an imaging angle of view θ 1.

The X-ray camera section 6 comprises an X-ray detection section having directivity of a predetermined spread angle, and the X-ray detection section cuts off visible light other than X-rays as shown in FIG. A curved convex shading plate 20, a scintillator 21 which is an X-ray detection element, a collimator 22 which is a collimator means, and an inner surface side of the scintillator 21, which are converted by each scintillator 21. It has a curved CCD 23 that converts an image formed by light into an electric signal.

<< 20 >> The collimator 22 is made of a material such as lead or lead glass that does not transmit X-rays (radiation), and is a member having a large number of holes. Each scintillator 21
Is a porous member that surrounds each element.

The scintillator 21 is an X-ray detection element which is arranged in a two-dimensionally convex shape along the inner surface of the light shield plate 20 and is composed of a plurality of minute elements. Photons are generated.

Each element of the scintillator 21 has a collimator 2 for providing directivity.
Each of the two holes is two-dimensionally arranged on the curved surface. The arrangement pitch of the holes of the collimator 22 gives the resolution of the camera. Further, the scintillator 21 arranged two-dimensionally provides the X-ray imaging field angle .theta.2 which spreads two-dimensionally as the X-ray camera unit 6. The X-ray imaging angle of view θ2 is smaller than the imaging angle of view θ1 of the visible light camera section 3. Therefore, the range captured by the X-ray camera unit 6 is narrower than the range captured by the visible light camera unit 3. Further, the X-ray imaging axis O, which is the central axis of the X-ray imaging field angle θ2 of the X-ray camera unit 6,
Reference numeral 2 is substantially orthogonal to the longitudinal direction Z of the insertion portion and intersects with the imaging optical axis O1 of the visible light camera portion 3 or passes in the vicinity thereof.

The X-ray camera unit 6 detects the X-ray intensity of the RI colloid of the radioactive substance staying in the lesion or SN, and the X-ray output is captured by the CCU 9 for X-ray camera.

Display of the images picked up by the visible light camera section 3 and the X-ray camera section 6 on the image display section 11 is as shown in FIG. The image of the range imaged in 3 is displayed. Then, an X-ray is displayed on the X-ray display screen frame 16 which is a central area of the display screen frame 15 and is smaller than the display screen frame 15.
The two-dimensional X-ray captured image of the line camera unit 6 is displayed in a superimposed state (superimposed state).

The puncture needle 7 is an RI as a tracer.
It is a needle for injecting the colloidal agent around the lesioned part 13 on the wall surface of the living body cavity.

When the SN position is identified by the sentinel lymph node observation system 1 of the present embodiment having the above-mentioned configuration, first, the visible light camera section 3 of the image display section 11 is first identified.
While observing the visible light image by, the puncture needles 7 are inserted at the four corners of the lesioned portion 13 of the wall surface 12 of the living body, and the RI colloid agent is injected as a tracer for SN detection. As the RI colloid agent, for example, Tc-Sn colloid is adopted in view of the inflow property and retention property to SN.

After the lapse of a predetermined time, when the RI colloid reaches the SN site, the lesion 13 by the visible light camera section 3
The image around is displayed in the display screen frame 15 of the image display unit 11. At the same time, the X-ray image in the display screen frame 16 by the X-ray camera unit 6 is also superimposed on a part of the display screen frame 15. If the SN 14 exists within the range of the imaging angle of view θ 2 of the X-ray camera unit 6, the X-ray camera unit 6 detects the X-ray emitted from the RI colloid agent staying in the SN 14 in the display screen frame 16. The SN image 18 obtained by the X-ray camera unit 6 is superimposed on the image obtained by the visible light camera unit 3 and displayed in the display screen frame 16 as shown in FIG.
The N position is detected (identified). For the other SNs, the display screen frame 1 is moved while moving the insertion part 2 around the lesion part 13.
Identification is carried out while observing the X-ray image on 6.

The detected position of the SN is marked with the puncture needle 7, or the biopsy puncture needle is inserted into the forceps port 2a of the insertion part 2 and the puncture is performed while confirming on the display screens 15 and 16. A tissue can also be collected by inserting a needle into SN14.

According to the sentinel lymph node observation system 1 of the above-described embodiment, a visible light image is formed while simultaneously capturing an image of the body lumen of the insertion part 2 in a predetermined direction with both the visible light camera part 3 and the X-ray camera part 6. By superimposing and displaying the X-ray images, the SN position can be easily identified. Particularly in the case of the present embodiment, the directivity of the scintillator arranged two-dimensionally is widened by arranging the collimator means at the X-ray incident part of the X-ray camera 6, and the X-ray imaging in a wide range becomes possible. ing. Therefore, the SN can be detected efficiently over a wider range.

Further, in the X-ray image picked up on the display screen of the image display unit 11, a portion having a high X-ray intensity, that is, an SN portion is displayed in pseudo color, so that the SN position is changed. Detection can be made easier.

Next, a modified example of the structure of the X-ray camera 6 applied to the sentinel lymph node observation system 1 of the first embodiment will be described with reference to the sectional view of the X-ray camera of the modified example of FIG. explain.

The X-ray camera unit 24 of this modification also has an X-directional directivity with a wide angle of view, similar to the X-ray camera unit 6.
In the case of this modified example, a curved convex scintillator plate and an optical fiber plate are incorporated in place of the plurality of scintillator elements 21 applied to the X-ray camera unit 6, although the line detection unit is used. That is, the X-ray camera unit 2
As shown in FIG. 4, reference numeral 4 denotes a curved convex light-shielding plate 25 that cuts visible light other than X-rays, and a collimator 26 that is a collimator means arranged inside the light-shielding plate 25.
It comprises a scintillator plate 27 which is an X-ray detection element arranged inside the collimator 26, an optical fiber plate 28 arranged inside the scintillator plate 26, and a CCD 29 arranged inside the optical fiber plate 28. .

The collimator 26 is arranged along the inner surface of the light shielding plate 25, and the scintillator plate 27 made of an X-ray shielding material having a plurality of holes for giving directivity to the captured X-rays is a collimator plate. This is a single X-ray detection element having a curved convex shape that spreads two-dimensionally along the inside of the meter 22, and photons are generated by the X-rays that enter the scintillator plate 27.

The optical fiber plate 28 is a curved convex fiber plate along the inner surface of the scintillator plate 27, and is visible light converted from X-rays by the scintillator 27, and visible light along the directivity direction. Only transparent.

The CCD 29 is a scintillator plate 27.
It is a CCD with a curved convex shape along the inner surface of, and converts visible light of each fiber unit transmitted through the optical fiber plate 28 into an electric signal as an X-ray image signal.

In the X-ray camera section 24, the X
As in the case of the line camera unit 6, it has an X-ray image pickup angle of view θ 2 which spreads in two dimensions. This X-ray imaging angle of view θ2 is smaller than the imaging angle of view θ1 of the visible light camera section 3. Further, only visible light that is converted from X-rays by the scintillator plate 27 and is along the directivity direction passes through the optical fiber plate 28, and CC
It reaches the D plate 29 and is captured as an X-ray image signal.
Since the X-rays that are not converted into visible light and do not follow the directivity direction do not pass through the optical fiber plate 28, the CCD
The plate 29 is protected from X-rays.

According to the X-ray camera section 24 of this modification, it is possible to use, for example, one film-shaped scintillator plate 27 as a scintillator without using a large number of scintillator elements. It is easy to manufacture and a low-cost X-ray camera unit can be provided.

Next, a sentinel lymph node observation system to which the sentinel lymph node detection method according to the second embodiment of the present invention is applied will be described with reference to FIGS. 5 is a diagram showing the configuration of the sentinel lymph node observation system of the present embodiment, and FIG. 6 is a sectional view showing the configuration of the scintillator probe portion applied to the above sentinel lymph node observation system. FIG. 7 is a view on arrow B of FIG.

The sentinel lymph node observation system 30 of the present embodiment includes an endoscope (not shown) having an insertion portion 31 that can be inserted into a living body lumen as shown in FIG. 5, and a light source for illuminating the living body lumen. C for visible light camera with built-in part 48 and insertion part 31
A CCU 49 that controls the CD 36, an image display unit 50 that captures image information of the CCU 49 and displays a visible light image,
A scintillation probe 37 that is a small-diameter insertion portion,
It mainly has a scintillator output detection unit, which will be described later, and a scintillator output display unit 47.

At the tip of the insertion portion 31, illumination lenses 33 and 34, a camera lens 35, and a visible light CCD 36 are provided.
Are arranged, and the scintillation probe 37 is inserted into the forceps opening 31a of the insertion portion 31.

The scintillator output detector is composed of two photomultiplier tubes PMT (A) 44 and PMT.
(B) 45 and a differential amplifier 46 which is a detection means to which the outputs of the PMTs (A), (B) 44, 45 are input.

The scintillation probe 37 includes:
A central scintillator section 39 as an inner peripheral side detection section of a micro columnar shape having an axis parallel to the probe longitudinal direction Z at its tip, and a peripheral scintillator as an outer peripheral side detection section of the micro cylindrical shape outside the central scintillator 39. Part 40
It has an X-ray detection part 38 consisting of, and an X-ray shielding wall part 41 is formed between the scintillator parts 39 and 40. Furthermore, the central scintillator 39,
Further, the light incident portions of the optical fibers 42 and 43 are arranged at the rear positions of the peripheral scintillator 40 so as to face each other. The X-ray detection axis O3 of the X-ray detection unit 38 is Z
The direction is parallel to the direction and has a directivity parallel to the direction.

The optical fibers 42 and 43 extend to the base end portions of the endoscopes, and the light emitting portions of the optical fibers 42 and 43 are PMT (A) 44 and PM at the base end portions, respectively.
It is arranged so as to face the T (B) 45.

In the scintillation probe 37 described above, the X-rays incident on the central scintillator portion 39 along the Z direction are converted into visible light inside the scintillator, and the visible light passes through the optical fiber 42 to generate the P light.
The light is incident on the light receiving surface of the MT (A) 44, and the amount of light is detected. On the other hand, the X-rays incident on the peripheral scintillator portion 40 along the Z direction are converted into visible light inside the scintillator, and the visible light is incident on the light receiving surface of the PMT (B) 45 via the optical fiber 43. , The amount of light is detected.

The detection outputs of the PMTs (A), (B) 44, 45 are input to the + or-terminal of the differential amplifier 46. When there is a difference in the X-ray intensity incident on the central scintillator part 39 and the peripheral scintillator part 40,
The output of the differential amplifier 46 changes to + or −.
The differential output of the differential amplifier 46 is output to the output display section 47, and the output value is displayed. Depending on the displayed value, the central or peripheral scintillator section 39 or 4
It is judged which side of 0 the X-ray intensity was strong.

A method of identifying the SN position by the sentinel lymph node observation system 30 of the present embodiment having the above configuration will be described.

Also in this system, RI colloid, which is a tracer of radioactive material, is injected around the lesioned part of the body lumen, and the RI colloid is retained in the SN for the lesioned part. Under the condition, the insertion portion 31 is inserted into the living body lumen.
Insert the scintillation probe 3 in the vicinity of the lesion while observing the image on the image display unit 50 with a visible light camera.
The tips of 7 are opposed to each other. Then, the X-ray from the RI colloid staying in the SN is detected from the tip of the scintillation probe 37, and the intensity thereof is discriminated on the output display unit 47.

When the + value is displayed on the output display section 47, it is determined that the SN is located in front of the central scintillator section 39. However, on the output display 47
When the value is displayed, it is determined that the SN is not in front of the central scintillator unit 39 but in front of the peripheral scintillator unit 40, that is, in the oblique direction. Further, when 0, or +,-values are indefinite, it is determined that the SN is not located near the front of the scintillation probe 37.

While observing the output display 47 while moving the scintillation probe 37 in the body cavity, S
The state in which N is located in front of the central scintillator portion 39 is searched to identify the SN position. When the SN position is identified, the position can be marked or the tissue can be collected by directly puncturing with a puncture needle to check the metastatic state.

According to the sentinel lymph node observation system 30 of this embodiment, the SN position can be easily identified simply by checking the state of the output display unit 47 while moving the tip of the scintillation probe 37 in the living body lumen. And it can be performed accurately.

Next, a scintillation probe of a first modification of the scintillation probe 37 applied to the sentinel lymph node observation system 30 of the second embodiment will be described with reference to FIGS. In addition,
FIG. 8 is a cross-sectional view of the scintillation probe of the above modification, and FIG. 9 is a view taken in the direction of arrow C of FIG.

The scintillation probe 51 of this modified example
Is a central scintillation fiber 53 housed in the probe and a plurality of peripheral scintillation fibers 54A, 54B, 54E arranged around the central scintillation fiber 53 as shown in FIGS.
It has an X-ray detector 52 consisting of The scintillation fibers 53, 54A, 54B, 54E ...
Extends to the proximal end of the endoscope. The light emitting portion 53a of the central scintillation fiber 53 at the base end portion
To the PMT (A) 56 of the photomultiplier tube. Peripheral scintillation fibers 54A, 54B, 54E ...
In a bundled state, the light emitting portion 55a is made to face the PMT (B) 57 of the photomultiplier tube.

The detection outputs of the PMTs (A), (B) 56, 57 are input to the + or-terminal of the differential amplifier 58. The differential output of the differential amplifier 58 is the output display 59.
Is output to and the output value is displayed.

Also in the scintillation probe 51, as in the case of the scintillation probe 37, the X-rays incident on the central scintillation fiber 53 are converted into visible light inside the scintillation fiber, and the amount of light is PMT (A ) 56. On the other hand, the above peripheral scintillation fiber 5
The X-rays incident on 4A, 54B, 54E ... Are converted into visible light inside the scintillation fiber, and the amount of light is detected by the PMT (B) 57. When there is a difference in the X-ray intensities incident on the central scintillation fiber 53 and the peripheral scintillation fibers 54A, 54B, 54E, ..., The output of the differential amplifier 58 changes to + or-, and the output is displayed. The value is displayed in the section 59. It is judged from the displayed value that the X-ray intensity on either side of the central or peripheral scintillation fiber was strong.

The method of identifying the SN position by the sentinel lymph node observation system to which the scintillation probe 51 of the present modification having the above-mentioned configuration is applied is the same as that of the second sentinel lymph node observation system 30. .

The scintillation probe 51 of this modified example
According to this, by using scintillation fibers instead of scintillators and optical fibers, the number of components can be reduced, and a scintillation probe with a simple configuration that does not require an X-ray shielding wall can be provided.

In the scintillation probe 51 of the above modification, the peripheral scintillation fiber 5 is used.
The light emitting units of 4A, 54B, 54E, etc. are not bundled into one, but are divided into two or four, the respective light amounts are detected by different PMTs, and the outputs of the respective PMTs are differentiated. If the difference in the amount of light from the central scintillation fiber 53 is detected by inputting it to the amplifier, when the SN is in a vicinity position other than the central position, the direction in which the SN is located can also be detected.

Next, a scintillation probe of a second modification of the scintillation probe 37 applied to the sentinel lymph node observation system 30 of the second embodiment will be described with reference to FIG. Note that FIG. 10 is a cross-sectional view of the tip portion of the scintillation probe of this modification.

The scintillation probe 61 of this modification example
10, a suction hole 61a is provided in addition to the X-ray detection unit 38 as shown in FIG.
An opening cap 62, which is held on the inner periphery of the probe, is attached to the tip of the probe. Further, a scintillator output detection unit, which will be described later, for the X-ray detection unit 38 and a suction device 63 connected to the suction hole 61a are arranged on the proximal end side of the scintillation probe 61.

The X-ray detector 38 has the same structure as that incorporated in the scintillation probe 37 in the second embodiment.

The scintillator output detector is also the second
The PMT (A) 44 and the PMT (B) 45, which are two photomultiplier tubes and have the same configuration as that incorporated in the scintillation probe 37 of the observation system of the above embodiment, and the PMT. (A), (B) 4
And a differential amplifier 46 to which the outputs of 4, 45 are input. The differential output of the differential amplifier 46 is displayed on the output display unit 47.
The state of the X-rays that have been input to the X-ray detector 38 is displayed as in the case of the scintillation probe 37.

Scintillation probe 61 of this modification
Thus, the SN 66 under the living body lumen wall 65 can be detected by the same method as in the case of the first embodiment. After detecting the SN 66, the opening cap 62 at the tip of the probe 61 is applied to the wall surface on which the SN 66 is located. Then, as shown in FIG. 10, air is sucked by the suction device 63 to suck up the SN 66 together with the living body lumen wall portion 65. By the suction operation, the rubber ring 64 is fitted into the raised body lumen wall portion 65 surrounding the SN 66, and the SN position is marked.
After that, the SN 66 in which the rubber ring 64 is fitted can be pierced with a puncture needle to collect the tissue of the SN 66.

The scintillation probe 61 of this modification example
When using, the SN 66 can be easily marked.

Next, a scintillation probe of a third modification example of the scintillation probe 37 applied to the sentinel lymph node observation system 30 of the second embodiment will be described with reference to FIG. Note that FIG. 11 is a cross-sectional view of the tip portion of the scintillation probe of this modification.

Scintillation probe 71 of this modification
11, a suction hole 71a and a needle insertion hole 71b through which the biopsy puncture needle 72 is inserted are provided in addition to the X-ray detection unit 38, and an opening cap 73 is attached to the probe tip. ing. Further, on the base end side of the scintillation probe 71, the scintillator output detection unit for the X-ray detection unit 38 and the suction device 7 connected to the suction hole 71a.
5 are arranged.

The X-ray detector 38 has the same structure as that incorporated in the scintillation probe 37 in the second embodiment.

The scintillator output detector is also the second
The PMT (A) 44 and the PMT (B) 45, which are two photomultiplier tubes and have the same configuration as that incorporated in the scintillation probe 37 of the observation system of the above embodiment, and the PMT. (A), (B) 4
And a differential amplifier 46 to which the outputs of 4, 45 are input. The differential output of the differential amplifier 46 is displayed on the output display unit 47.
The state of the X-rays that have been input to the X-ray detector 38 is displayed as in the case of the scintillation probe 37.

The scintillation probe 71 of this modification.
Thus, the SN 66 in the lower layer of the living body lumen wall 65 can be detected by the same method as in the case of the first embodiment. After the detection, the opening cap 7 at the tip of the probe 71 is detected.
3 is applied to the wall surface on which the detected SN 66 is located. Then, as shown in FIG. 11, suction is performed by the suction device 75 to suck up the SN 66 together with the living body lumen wall portion 65. Under the suctioned state, the puncture needle 72 can be inserted into the SN 66 to collect the tissue of the SN 66.

Scintillation probe 71 of this modification
When the SN66 is used, after SN66 is detected, it is possible to surely perform the biopsy with the SN66 and the surrounding portion being sucked up.

Next, a scintillation probe of a fourth modification example of the scintillation probe 37 applied to the sentinel lymph node observation system 30 of the second embodiment will be described with reference to FIG. Note that FIG. 12 is a cross-sectional view of the tip portion of the scintillation probe of this modification.

The X-ray detector 38 of the scintillation probe 37 in the second embodiment detects X-rays from the front in the longitudinal direction Z of the probe. Line detector 8
2 can detect X-rays from the side of the probe longitudinal direction Z. That is, the X-ray detection axis O4 of the X-ray detection unit 82 is orthogonal to the probe longitudinal direction Z.

The scintillation probe 81 of this modification example
As shown in FIG. 12, an X-ray detection unit 82 that is attached to the side opening 81a of the probe and that includes an X-ray detection element that includes a scintillator, and a puncture needle 83 that is inserted along the insertion hole 81b of the probe. , The puncture needle operating portion 84, and the X
It mainly includes a detection unit 85 that detects the amount of visible light obtained by converting the X-rays captured by the line detector 82, and an output display unit 86 that displays the output of the detection unit.

Scintillation probe 81 of this modification
When the SN position is detected by the method, after injecting the RI colloid into the periphery of the lesion, the side of the probe 81 is directed to the periphery of the lesion and the change in X-ray intensity is observed on the output display unit 86. Detect the position. After detecting the SN position, the puncture needle 83 is pierced at the SN position to collect the tissue. Alternatively, marking is performed.

The scintillation probe 81 of this modification example
According to this, it is possible to detect the SN in a narrow site that is difficult to detect in a front view of the body lumen.

Next, a sentinel lymph node observation system to which the sentinel lymph node detection method according to the third embodiment of the present invention is applied will be described with reference to FIG. Note that FIG.
FIG. 3 is a diagram showing a configuration of the sentinel lymph node observation system of the present embodiment and a cross section of an X-ray detection unit constituting the system.

In the sentinel lymph node observation system 90 of the present embodiment, when the SN tissue is identified by the biopsy puncture needle after the SN position is identified, the puncture needle is arranged along the side of the X-ray detection section. The biopsy puncture needle in which an optical fiber is inserted through the inner tube is used. A portion of the tip of the puncture needle where the puncture needle is stuck due to a change in light intensity information obtained by the optical fiber is SN in which the radioactive substance remains.
It can be surely identified.

The sentinel lymph node observation system 90 of the present embodiment has a scintillation probe 91, an X-ray detector 38 arranged at the tip of the probe 91, and an X-ray detector 38.
The biopsy puncture needle 92 inserted through the insertion hole 91a on the side of the line detection unit 38, the optical fiber 93 inserted through the inner tube 92a of the puncture needle 92, and the optical fiber 93 at the proximal end of the endoscope. A half mirror 95 obliquely arranged facing each other, a light source 94 for generating white light or light of a single wavelength, a light intensity detection unit 96, and a display unit 97 for displaying an output value of the light intensity detection unit 96. Further, it further has an output display unit (not shown) of the X-ray information detected by the X-ray detection unit 38, and the like.

The X-ray detecting section 38 is composed of scintillators 39, 40 and optical fibers 42, 43, etc., similarly to the X-ray detecting section (FIG. 2) applied to the second embodiment.

The optical fiber 93 guides the light from the light source 94 to the tip of the puncture needle 92 and guides the reflected light from the tissue to the proximal end of the endoscope.

The light intensity detector 96 is the optical fiber 9
The amount of reflected light obtained in 3 is detected.

Identification of the SN position by the sentinel lymph node observation system 90 of the present embodiment having the above-mentioned configuration can be performed by the same method as the observation system 30 of the second embodiment.

After the SN position identification process, when the tissue of the SN 99 inside the wall surface 98 of the living body cavity is sampled by the observation system 90, the light from the light source 94 is emitted from the half mirror 95.
Through the optical fiber 93. In that state, the puncture needle 92 is pierced into the wall surface 98 of the body cavity. Puncture needle 92
When the tip 92b of the SN99 reaches the position of SN99, SN99
The optical fiber 93 by the RI colloid retained in the
The amount of reflected light at the tip of the changes greatly. The change in the reflected light is detected by the light intensity detector 96 via the half mirror 95 and displayed on the light intensity display unit 97. The operator can recognize that the puncture needle 92 has reached SN99 by observing the change in the display state.

The light intensity display section 97 may notify that the puncture needle 92 has reached SN99 by sounding in addition to the screen display.

After the puncture needle 92 reaches the SN99, the optical fiber 93 can be extracted from the inner tube of the puncture needle 92, and the tissue of the SN99 can be sucked and collected.

According to the sentinel lymph node observation system 90 of the present embodiment, the same effect as that of the observation system 30 of the second embodiment can be obtained, but in the case of collecting the tissue of the identified SN, the body lumen The position of the SN 99 in the wall in the depth direction can be accurately detected by the reflected light from the optical fiber 93.

Next, a modified example of the puncture needle 92 applied to the third embodiment will be described with reference to the cross-sectional view of the puncture needle portion of the present modification in FIG.

Puncture needle 9 applied to the third embodiment
In No. 2, it was necessary to insert the optical fiber 93 into the inner tube portion to specify the depth of the SN, and to move the optical fiber 93 a long distance to extract the tissue from the inner tube when the tissue was aspirated. The puncture needle 101 of the present modification is designed to improve the operability by shortening the moving distance of the optical fiber.

In the puncture needle 101 of this modified example, as shown in FIG.
As shown in FIG. 4, a branch tube 102 is connected to the needle-side inner tube portion 101a of the puncture needle 101, and the probe proximal end side of the branch tube 102 branches into a fiber insertion tube 103 and a suction tube 104. An optical fiber 105 can be inserted into the inner tube portion 103a of the fiber insertion tube 103, and a suction device (not shown) is connected to the inner tube portion 104a of the suction tube 104.

When the puncture needle 101 is inserted to the position of SN in the living body cavity wall to collect tissue, the optical fiber 105 is inserted to the tip of the inner tube portion 101a of the puncture needle 101. The puncture needle 101 is inserted into the wall of the living body, and after the SN position is confirmed by light reflection from the optical fiber 105, the optical fiber 105 is retracted to the branch pipe 102 for a relatively short distance. When the suction device is operated in the retracted state, the SN tissue can be suctioned through the inner tube portion 104a of the suction tube 104 and the inner tube portion 101a.

According to the puncture needle 101 of this modification, it is not necessary to completely pull out the optical fiber 105 from the puncture needle 101 after confirming the position of the SN by puncturing the puncture needle 101,
The tissue can be collected by the puncture needle 101 simply by moving the branch pipe 102 a short distance.

Next, a sentinel lymph node observation system to which the sentinel lymph node detection method according to the fourth embodiment of the present invention is applied will be described with reference to FIGS. Note that FIG. 15 is a perspective view of the distal end portion of the endoscope insertion portion of the sentinel lymph node observation system of the present embodiment. FIG.
FIG. 3 is a block configuration diagram of an ultrasonic transducer / X-ray detection element control unit in the present sentinel lymph node observation system.
Figure 17 shows the SN of this sentinel lymph node observation system.
The display screen of an ultrasonic / X-ray image in the state which is observing a position is shown.

The sentinel lymph node observation system 110 according to the present embodiment includes an endoscope (not shown), an endoscope insertion portion 111 attached to the endoscope, and an ultrasonic transducer / X-ray detection element control portion. It mainly has 124 (FIG. 16).

As shown in FIG. 15, a puncture needle 112, which is inserted through the forceps port 111a, and a visible light camera section 113 are arranged at the tip of the insertion section 111 on the curved surface of the front section. Convex ultrasonic transducer 11 in the center
4 and arc-shaped line type X-ray detection elements 1 on both sides thereof
15 are arranged.

The above convex type ultrasonic transducer 114
Is composed of a plurality of ultrasonic transducer units arranged in an arc shape. The line-type X-ray detection element 115 is also composed of a plurality of X-ray detection element units arranged along the arcuate surface.

The ultrasonic / X-ray detection control unit 124 drives the switching circuit unit 117 and the ultrasonic transducer 114 via the switching circuit unit 117 as shown in FIG. An ultrasonic image processing unit 119 that performs tomographic image processing, a switching circuit unit 118, an X-ray intensity processing unit 120 that captures an X-ray signal via the switching circuit unit 118, and performs image processing that indicates X-ray intensity, and A synchronization circuit unit 121 for synchronously driving the switching circuit units 117 and 118, and a synthesis circuit unit 122 for synthesizing the output of the ultrasonic image processing unit 119 and the output of the X-ray intensity processing unit 120.
And an image display unit 123 that superimposes and displays the ultrasonic tomographic image and the X-ray intensity image based on the output of the synthesizing circuit unit 122.

The switching circuit section 117 switches the connection of the ultrasonic transducer 114 with each ultrasonic transducer unit in the S direction along the arc. Also, the switching circuit unit 1
Reference numeral 18 switches the connection of the X-ray detection element 115 with each X-ray detection element unit in the S direction along the arc by the output of the synchronous circuit section 121.

The method of identifying the SN position by the sentinel lymph node observation system of the present embodiment having the above-described structure will be described. First, RI colloid, which is a radioactive substance, is injected around the lesion by the puncture needle 112. After the RI colloid flows into the SN site for a predetermined time and stays there, the distal end of the insertion section 111 is positioned in the vicinity of the lesion, and each transducer unit of the ultrasonic transducer 114 is switched in the S direction by the switching circuit section 117. The ultrasonic tomographic image information in the vicinity of the lesion of the living body is obtained by switching to drive. In the ultrasonic tomographic image information, both SN lymph nodes and non-SN lymph nodes are displayed.

On the other hand, each X-ray detecting element unit of the X-ray detecting element 115 is switched and driven in the S direction by the switching circuit section 118 in a state of being synchronized with the ultrasonic transducer 114, and on the scanning line in front of the insertion section 111. X-ray intensity information is obtained for each X-ray detection element unit. This X-ray intensity display image is displayed as a pseudo color image when the detected X-ray intensity is strong.

The ultrasonic tomographic image information and the X-ray intensity image information synchronized with the ultrasonic tomographic image information in the S direction scanning are combined by the combining circuit section 122, and the combined screen is displayed on the image display section 123. Is displayed in.

FIG. 17 shows an example of a composite screen on the image display section 123. As shown in this figure, for example,
The lymph node 12 is displayed on the partial ultrasonic tomographic image 126 by one transducer unit with the ultrasonic transducer 114 being driven.
Suppose 7 is displayed. If the lymph node 127 is S
In the case of N lymph nodes, the X-ray intensity detected by the corresponding X-ray detection element unit in the synchronously driven X-ray detection element 115 becomes high. Therefore, it is a portion that overlaps with the partial ultrasonic tomographic image 126, and the partial X-ray intensity display image 128 by the X-ray detecting element unit.
Is displayed in pseudo color, and it is easily recognized on the ultrasonic tomographic image that the lymph node 127 is SN.

If the lymph node 127 is a non-SN lymph node, the partial X-ray intensity display image 128 is not displayed in pseudo color because the X-ray intensity of that portion is low, so that the lymph node 127 is SN. Is not determined.

When the SN is specified by the above-mentioned method, the puncture needle 112 can be inserted into the site where the SN is located while observing the ultrasonic tomographic image to collect the tissue.

According to the sentinel lymph node observation system 110 of this embodiment, the convex type ultrasonic transducer 114 and the line type X-ray detecting element 115 arranged at the distal end of the insertion section 111 are driven in synchronization with each other, The ultrasonic tomographic image and the X-ray detected image are displayed in synchronization with each other, and the lymph node shown on the ultrasonic tomographic image is the SN by displaying the X-ray detected image of the portion with high X-ray intensity in pseudo color. Whether or not it can be easily determined.

Next, regarding a modified example of the endoscope insertion section 111 of the sentinel lymph node observation system 110 of the fourth embodiment, a side view of the insertion section of FIG. 18 and a display screen of the image display section of FIG. 19 are shown. It will be described with reference to the drawings.

The endoscope insertion portion 131 of this modification has a puncture needle 132 arranged at the upper end of the tip, a visible light camera portion (not shown), and a cylindrical surface parallel to the probe longitudinal direction Z of the distal end cylindrical portion. A plurality of line type X-ray detection elements 13 arranged
4 and a plurality of line type ultrasonic transducers 135 arranged along the cylindrical surface behind the X-ray detection element 134.

The plurality of X-ray detecting elements 134 and the plurality of ultrasonic transducers 135 are driven in synchronization in the same manner as in the fourth embodiment, and ultrasonic tomographic image information and X-rays in the same circumferential direction are obtained. The X-ray image information indicating the intensity is captured.

FIG. 19 shows an example of a screen 141 in which the ultrasonic tomographic image and the X-ray image are superimposed on each other on the image display section, and a lymph node 143 is displayed on the ultrasonic tomographic image. At that time, if the lymph node is SN, the X-ray image 142 of the portion where the detected X-ray intensity is high is displayed in pseudo color. Therefore, the lymph node 143 is S
It can be easily identified that it is N.

According to the endoscope insertion portion 131 of this modification,
The same effects as those of the endoscope insertion portion 111 of the fourth embodiment are obtained, and in particular, a plurality of line type ultrasonic transducers 13 are provided.
Since 5 and a plurality of line type X-ray detection elements 134 are arranged along the cylindrical surface of the probe tip, a two-dimensional ultrasonic image and X-ray image of each cross-section around the lesion can be obtained at the same time. The SN can be identified quickly.

Next, the endoscope insertion part of the sentinel lymph node observation system to which the sentinel lymph node detection method according to the fifth embodiment of the present invention is applied will be described with reference to the sectional view of the insertion part of FIG.

The endoscope insertion section 151 of the sentinel lymph node observation system 150 of this embodiment has an objective lens 153, a CCD 154, and a forceps port 151a which constitute a camera section 152 for imaging a body cavity as shown in FIG. It has a treatment instrument 155 which is inserted into the device and a suction device 161.

A suction catheter 156 connected to the suction device 161 and a snare 157 are inserted through the treatment instrument 155.

When performing SN identification, the body lumen wall 1
The tracer 160 such as RI colloid is injected around the lesioned area 159 of 58, but the tracer 160 left around the lesioned area 159 becomes an obstacle to SN detection. Therefore, in the sentinel lymph node observation system 150, the snare 157 attached to the treatment tool 155 of the insertion section 151.
The lesioned part 159 is removed with the use of a suction catheter 156, and the tracer 16 remaining around the lesioned part 159 by the suction catheter 156.
Aspirate and remove 0. In that state, the SN detection probe is inserted into the body lumen, and only the tracer retained in the SN is detected to identify the SN.

According to the sentinel lymph node observation system 150 of this embodiment, since the tracer 160 remaining around the lesion 159 is removed, the SN can be easily detected and the SN can be reliably identified. Become.

Next, the endoscope insertion part of the sentinel lymph node observation system to which the sentinel lymph node detection method according to the sixth embodiment of the present invention is applied will be described with reference to the sectional view of the insertion part of FIG.

The endoscope insertion section 171 of the sentinel lymph node observation system 170 of this embodiment has an objective lens 173, a CCD 174, and a forceps port 171a which constitute a camera section 172 for imaging a body cavity, as shown in FIG. It has a puncture needle 175 inserted through the needle and a tracer injector 176 connected to the puncture needle 175.

The tracer injector 176 is equipped with a filter 177 for filtering out the coarse particle colloid contained in the tracer 178 using colloid such as RI colloid.

When the SN is identified by the sentinel lymph node observation system 170 of the present embodiment, the endoscope insertion portion 171 is inserted into the living body lumen and the living body lumen wall portion 17 is inserted.
The puncture needle 175 is inserted around the lesioned part 180 of No. 9, and the tracer 178 is filtered by the filter 177 of the tracer injector 176 and injected around the lesioned part 180.

Since the injected tracer 178 has the coarse particle size colloid removed, the tracer 17
The state in which 8 is clogged with lymph nodes is avoided, and it reliably flows into and stays in the SN.

According to the sentinel lymph node observation system 170 of the present embodiment described above, since the tracer 178 injected at the time of identifying the SN flows into the lymph nodes without clogging, it is possible to reliably identify the SN. .

(Supplementary Note) The following configuration can be obtained based on the embodiment of the present invention described above. That is, (1) in a sentinel lymph node detection method using a sentinel lymph node observation system having a small-diameter insertion part that can be inserted into an endoscopic forceps port and an X-ray detector that detects an X-ray at the tip of the insertion part. The X-ray detector is divided into an inner peripheral side detection unit and an outer peripheral side detection unit, and has a detection means for detecting a difference in X-ray detection intensity from each of the detection units. Sentinel lymph node detection method.

(2) The sentinel lymph node detecting method according to appendix (1), characterized in that the outer peripheral detecting section is composed of a plurality of detecting elements and substantially covers the inner peripheral detecting section.

(3) Sentinel lymph node detection method using a sentinel lymph node observation system having a small-diameter insertion portion that can be inserted into a body lumen and an X-ray detection element and an ultrasonic element arranged at the tip of the insertion portion. In the above, the X-ray detection element is a line-type X-ray detection element, the ultrasonic transducer is a convex-type ultrasonic transducer, and the line-type X-ray detection element and the convex-type ultrasonic transducer are The tomographic image information obtained by the convex ultrasonic transducer and the X-ray intensity image information detected by the line X-ray detecting element are synchronously driven and scanned in the same direction, and are displayed in a synchronized state. A method for detecting a sentinel lymph node, comprising:

(4) The X-ray intensity image information detected by the line-type X-ray detecting element is displayed in pseudo color when the detected X-ray intensity is strong, and the sentinel according to (3) is described. Lymph node detection method.

(5) A small-diameter insertion part that can be inserted into a body cavity, an ultrasonic element and an X arranged at the tip of the insertion part.
In the sentinel lymph node detection method using a sentinel lymph node observation system having a line detection element, the ultrasonic transducer includes a plurality of line-type ultrasonic waves arranged along a cylindrical surface coaxial with the cylindrical surface of the tip of the insertion portion. The X-ray detection element includes a vibrator, and the X-ray detection element includes a plurality of line-type X-ray detection elements arranged along the cylindrical surface of the tip of the insertion portion. Is driven synchronously in the same direction, and the tomographic image information obtained by the line-type ultrasonic transducer and the X-ray intensity image information detected by the line-type X-ray detection element are displayed in a synchronized state. And a sentinel lymph node detection method.

(6) The X-ray intensity image information detected by the line-type X-ray detecting element is displayed in pseudo color when the detected X-ray intensity is strong, and the sentinel according to the above (5) is characterized. Lymph node detection method.

[0126]

As described above, according to the present invention, the X-ray detection element and the optical image pickup element are arranged along the longitudinal direction of the insertion portion.
Since they are arranged so as to observe in the same direction, the SN by the X-ray detection element is superimposed on the image by the optical imaging element.
It is possible to display an image of the above, and it is possible to provide a method for detecting a sentinel lymph node in which the SN position can be easily identified.

[Brief description of drawings]

FIG. 1 is a diagram showing a configuration of a sentinel lymph node observation system to which a sentinel lymph node detection method according to a first embodiment of the present invention is applied.

FIG. 2 shows a display screen of an image display unit in the sentinel lymph node observation system of FIG.

3 is a sectional view showing a detailed configuration of an X-ray camera unit in the sentinel lymph node observation system of FIG.

4 is a sectional view of a modification of the sentinel lymph node observation system of FIG. 1 with respect to an X-ray camera.

FIG. 5 is a diagram showing a configuration of a sentinel lymph node observation system according to a second embodiment of the present invention.

6 is a cross-sectional view showing a configuration of a scintillator probe unit applied to the sentinel lymph node observation system of FIG.

FIG. 7 is a view on arrow B of FIG.

8 is a cross-sectional view of a first modified example of the scintillation probe applied to the sentinel lymph node observation system of the second embodiment of FIG.

9 is a view on arrow C of FIG.

10 is a cross-sectional view of a scintillation probe tip portion of a second modification example of the scintillation probe applied to the sentinel lymph node observation system of the second embodiment of FIG. 5 described above.

11 is a cross-sectional view of a scintillation probe tip portion of a third modification example of the scintillation probe applied to the sentinel lymph node observation system of the second embodiment of FIG.

FIG. 12 is a cross-sectional view of a scintillation probe tip portion of a fourth modification example of the scintillation probe applied to the sentinel lymph node observation system of the second embodiment of FIG. 5 described above.

FIG. 13 is a diagram showing a configuration of a sentinel lymph node observation system according to a third embodiment of the present invention and a cross section of an X-ray detection unit constituting the system.

14 is a sectional view of a modified example of the puncture needle applied to the sentinel lymph node observation system of FIG.

FIG. 15 is a perspective view of the distal end portion of the endoscope insertion portion of the sentinel lymph node observation system according to the fourth embodiment of the present invention.

16 is a block configuration diagram of an ultrasonic transducer / X-ray detection element controller in the sentinel lymph node observation system of FIG.

FIG. 17 shows a display screen of an ultrasonic / X-ray image in a state where the SN position is observed by the present sentinel lymph node observation system of FIG.

FIG. 18 is a side view of a modified example of the endoscope insertion portion in the sentinel lymph node observation system of the fourth embodiment of FIG. 15 described above.

19 is a diagram showing a display screen of the image display unit when the endoscope insertion unit of the modified example of FIG. 18 is applied.

FIG. 20 is a cross-sectional view of an endoscope insertion portion of a sentinel lymph node observation system to which the sentinel lymph node detection method according to the fifth embodiment of the present invention is applied.

FIG. 21 is a cross-sectional view of an endoscope insertion portion of a sentinel lymph node observation system to which the sentinel lymph node detection method according to the sixth embodiment of the present invention is applied.

[Explanation of symbols]

2 ... Insert 5 ... CCD (optical image sensor) 12 ... Body wall surface (body lumen) 21,27 … (X-ray detector) 22, 26 ... Collimator (collimator means)

   ─────────────────────────────────────────────────── ─── Continued front page    (72) Inventor Toshihiro Shizu             2-43 Hatagaya, Shibuya-ku, Tokyo Ori             Inside Npus Optical Industry Co., Ltd. (72) Inventor Ken Sudo             2-43 Hatagaya, Shibuya-ku, Tokyo Ori             Inside Npus Optical Industry Co., Ltd. (72) Inventor Tadahiro Nakano             2-43 Hatagaya, Shibuya-ku, Tokyo Ori             Inside Npus Optical Industry Co., Ltd. F term (reference) 2G088 EE01 GG19 JJ05 MM04                 4C061 AA01 BB03 BB08 CC06 DD03                       FF35 FF43 FF50 HH51 LL02                       LL08 NN05 WW04 WW10 WW16                       WW20

Claims (6)

[Claims] 1. A small-diameter insertion portion that can be inserted into a body cavity,
A method for detecting a sentinel lymph node by a sentinel lymph node observation system having an X-ray detection element for detecting an X-ray in a two-dimensional manner at the tip of the insertion section and an optical image pickup element for picking up a visible light image, A sentinel lymph node detection method, characterized in that the element and the optical imaging element are arranged in the longitudinal direction of the insertion part and are arranged in close proximity so as to observe the same direction. 2. The sentinel lymph node detection method according to claim 1, wherein the range observed by the X-ray detection element is narrower than the range observed by the optical imaging element. 3. The sentinel lymph node detection method according to claim 1, wherein a two-dimensional image obtained by the X-ray detection element is displayed so as to be superimposed on the body lumen image obtained by the optical imaging element. 4. A two-dimensional image formed by the X-ray detection element,
The sentinel lymph node detection method according to claim 3, wherein a portion having a high radiation density is displayed as a pseudo color image. 5. The X-ray detection element constructs a curved surface,
The sentinel lymph node detection method according to claim 1, wherein the sentinel lymph node has a detection directivity in a direction perpendicular to the curved surface. 6. The sentinel lymph node detecting method according to claim 5, wherein a layer having a plurality of collimator means for obtaining directivity is arranged on the front surface of the light receiving surface in the X-ray detecting element.