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Rinehardt HN, Longo S, Gilbert R, Shoaf JN, Edwards WB, Kohanbash G, Malek MM. Handheld PET Probe for Pediatric Cancer Surgery. Cancers (Basel) 2022; 14:cancers14092221. [PMID: 35565350 PMCID: PMC9104535 DOI: 10.3390/cancers14092221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/23/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Positron emission tomography (PET)/computed tomography (CT) scans are widely used as a form of full body imaging and allow for the early detection of small, asymptomatic tumors that may represent cancer metastasis or recurrence. Tissue diagnosis is critical in determining the choice of ongoing targeted therapy for pediatric patients with solid tumors. These small tumors may be difficult to localize in the operating room, especially in a re-operative or radiated area of the body. An adjunct such as a PET probe, used to guide intra-operative dissection, is the ideal tool to assist in cases where an occult tumor requires an excisional biopsy. Abstract 18F-fluorodeoxyglucose (FDG) is a glucose analog that acts as a marker for glucose uptake and metabolism. FDG PET scans are used in monitoring pediatric cancers. The handheld PET probe localization of FDG-avid lesions is an emerging modality for radio-guided surgery (RGS). We sought to assess the utility of PET probe in localizing occult FDG-avid tumors in pediatric patients. PET probe functionality was evaluated by using a PET/CT scan calibration phantom. The PET probe was able to detect FDG photon emission from simulated tumors with an expected decay of the radioisotope over time. Specificity for simulated tumor detection was lower in a model that included background FDG. In a clinical model, eight pediatric patients with FDG-avid primary, recurrent or metastatic cancer underwent a tumor excision, utilizing IV FDG and PET probe survey. Adequate tissue for diagnosis was present in 16 of 17 resected specimens, and pathology was positive for malignancy in 12 of the 17 FDG-avid lesions. PET probe gamma counts per second were higher in tumors compared with adjacent benign tissue in all operations. The median ex vivo tumor-to-background ratio (TBR) was 4.0 (range 0.9–12). The PET probe confirmed the excision of occult FDG-avid tumors in eight pediatric patients.
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Affiliation(s)
- Hannah N. Rinehardt
- Department of General Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
- Correspondence: (H.N.R.); (M.M.M.)
| | - Sadie Longo
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (S.L.); (R.G.)
| | - Ryan Gilbert
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; (S.L.); (R.G.)
| | - Jennifer N. Shoaf
- Division of Pediatric Radiology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA 15224, USA;
| | - Wilson B. Edwards
- Department of Biochemistry, University of Missouri, Columbia, MO 65201, USA;
| | - Gary Kohanbash
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15201, USA;
| | - Marcus M. Malek
- Division of Pediatric General and Thoracic Surgery, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA 15224, USA
- Correspondence: (H.N.R.); (M.M.M.)
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2
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Collamati F, van Oosterom MN, Hadaschik BA, Fragoso Costa P, Darr C. Beta radioguided surgery: towards routine implementation? THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2021; 65:229-243. [PMID: 34014062 DOI: 10.23736/s1824-4785.21.03358-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION In locally or locally advanced solid tumors, surgery still remains a fundamental treatment method. However, conservative resection is associated with high collateral damage and functional limitations of the patient. Furthermore, the presence of residual tumor tissue following conservative surgical treatment is currently a common cause of locally recurrent cancer or of distant metastases. Reliable intraoperative detection of small cancerous tissue would allow surgeons to selectively resect malignant areas: this task can be achieved by means of image-guided surgery, such as beta radioguided surgery (RGS). EVIDENCE ACQUISITION In this paper, a comprehensive review of beta RGS is given, starting from the physical principles that differentiate beta from gamma radiation, that has already its place in nuclear medicine current practice. Also, the recent clinical feasibility of using Cerenkov radiation is discussed. EVIDENCE SYNTHESIS Despite being first proposed several decades ago, only in the last years a remarkable interest in beta RGS has been observed, probably driven by the diffusion of PET radio tracers. Today several different approaches are being pursued to assess the effectiveness of such a technique, including both beta+ and beta- emitting radiopharmaceuticals. CONCLUSIONS Beta RGS shows some peculiarities that can present it as a very promising complementary technique to standard procedures. Good results are being obtained in several tests, both ex vivo and in vivo. This might however be the time to initiate the trials to demonstrate the real clinical value of these technologies with seemingly clear potential.
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Affiliation(s)
| | - Matthias N van Oosterom
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Boris A Hadaschik
- Department of Urology, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Pedro Fragoso Costa
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany.,Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Christopher Darr
- Department of Urology, University Hospital Essen, Essen, Germany.,German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
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3
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Rietbergen DD, VAN Oosterom MN, Kleinjan GH, Brouwer OR, Valdes-Olmos RA, VAN Leeuwen FW, Buckle T. Interventional nuclear medicine: a focus on radioguided intervention and surgery. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2021; 65:4-19. [PMID: 33494584 DOI: 10.23736/s1824-4785.21.03286-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Within interventional nuclear medicine (iNM) a prominent role is allocated for the sub-discipline of radioguided surgery. Unique for this discipline is the fact that an increasing number of clinical indications (e.g. lymphatic mapping, local tumor demarcation and/or tumor receptor targeted applications) have been adopted into routine care. The clinical integration is further strengthened by technical innovations in chemistry and engineering that enhance the translational potential of radioguided procedures in iNM. Together, these features not only ensure ongoing expansion of iNM but also warrant a lasting clinical impact for the sub-discipline of radioguided surgery.
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Affiliation(s)
- Daphne D Rietbergen
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, the Netherlands
| | - Matthias N VAN Oosterom
- Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, the Netherlands.,Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Gijs H Kleinjan
- Department of Urology, Leiden University Medical Center, Leiden, the Netherlands
| | - Oscar R Brouwer
- Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, the Netherlands.,Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Renato A Valdes-Olmos
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Fijs W VAN Leeuwen
- Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, the Netherlands.,Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Tessa Buckle
- Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, the Netherlands - .,Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
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4
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Van Oosterom MN, Rietbergen DDD, Welling MM, Van Der Poel HG, Maurer T, Van Leeuwen FWB. Recent advances in nuclear and hybrid detection modalities for image-guided surgery. Expert Rev Med Devices 2019; 16:711-734. [PMID: 31287715 DOI: 10.1080/17434440.2019.1642104] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Introduction: Radioguided surgery is an ever-evolving part of nuclear medicine. In fact, this nuclear medicine sub-discipline actively bridges non-invasive molecular imaging with surgical care. Next to relying on the availability of radio- and bimodal-tracers, the success of radioguided surgery is for a large part dependent on the imaging modalities and imaging concepts available for the surgical setting. With this review, we have aimed to provide a comprehensive update of the most recent advances in the field. Areas covered: We have made an attempt to cover all aspects of radioguided surgery: 1) the use of radioisotopes that emit γ, β+, and/or β- radiation, 2) hardware developments ranging from probes to 2D cameras and even the use of advanced 3D interventional imaging solutions, and 3) multiplexing solutions such as dual-isotope detection or combined radionuclear and optical detection. Expert opinion: Technical refinements in the field of radioguided surgery should continue to focus on supporting its implementation in the increasingly complex minimally invasive surgical setting, e.g. by accommodating robot-assisted laparoscopic surgery. In addition, hybrid concepts that integrate the use of radioisotopes with other image-guided surgery modalities such as fluorescence or ultrasound are likely to expand in the future.
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Affiliation(s)
- Matthias N Van Oosterom
- a Interventional Molecular Imaging laboratory, Department of Radiology, Leiden University Medical Center , Leiden , the Netherlands.,b Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital , Amsterdam , the Netherlands
| | - Daphne D D Rietbergen
- a Interventional Molecular Imaging laboratory, Department of Radiology, Leiden University Medical Center , Leiden , the Netherlands.,c Department of Radiology, Section Nuclear Medicine, Leiden University Medical Center , Leiden , the Netherlands
| | - Mick M Welling
- a Interventional Molecular Imaging laboratory, Department of Radiology, Leiden University Medical Center , Leiden , the Netherlands
| | - Henk G Van Der Poel
- b Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital , Amsterdam , the Netherlands
| | - Tobias Maurer
- d Martini-Clinic, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Fijs W B Van Leeuwen
- a Interventional Molecular Imaging laboratory, Department of Radiology, Leiden University Medical Center , Leiden , the Netherlands.,b Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital , Amsterdam , the Netherlands.,e Orsi Academy , Melle , Belgium
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5
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Mancini-Terracciano C, Donnarumma R, Bencivenga G, Bocci V, Cartoni A, Collamati F, Fratoddi I, Giordano A, Indovina L, Maccora D, Marafini M, Mirabelli R, Morganti S, Rotili D, Russomando A, Scotognella T, Solfaroli Camillocci E, Toppi M, Traini G, Venditti I, Faccini R. Feasibility of beta-particle radioguided surgery for a variety of "nuclear medicine" radionuclides. Phys Med 2017; 43:127-133. [PMID: 29195555 DOI: 10.1016/j.ejmp.2017.10.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 09/15/2017] [Accepted: 10/18/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Beta-particle radioguided tumor resection may potentially overcome the limitations of conventional gamma-ray guided surgery by eliminating, or at least minimizing, the confounding effect of counts contributed by activity in adjacent normal tissues. The current study evaluates the clinical feasibility of this approach for a variety of radionuclides. Nowadays, the only β- radioisotope suited to radioguided surgery is 90Y. Here, we study the β- probe prototype capability to different radionuclides chosen among those used in nuclear medicine. METHODS The counting efficiency of our probe prototype was evaluated for sources of electrons and photons of different energies. Such measurements were used to benchmark the Monte Carlo (MC) simulation of the probe behavior, especially the parameters related to the simulation of the optical photon propagation in the scintillation crystal. Then, the MC simulation was used to derive the signal and the background we would measure from a small tumor embedded in the patient body if one of the selected radionuclides is used. RESULTS Based on the criterion of detectability of a 0.1 ml tumor for a counting interval of 1 s and an administered activity of 3 MBq/kg, the current probe yields a detectable signal over a wide range of Standard Uptake Values (SUVs) and tumor-to-non-tumor activity-concentration ratios (TNRs) for 31Si, 32P, 97Zr, and 188Re. Although efficient counting of 83Br, 133I, and 153Sm proved somewhat more problematic, the foregoing criterion can be satisfied for these isotopes as well for sufficiently high SUVs and TNRs.
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Affiliation(s)
| | - Raffaella Donnarumma
- INFN Sezione di Roma, Rome, Italy; Dip. Fisica, Sapienza Univ. di Roma, Rome, Italy
| | | | | | | | | | | | | | - Luca Indovina
- UOC Fisica Sanitaria, Policlinico A. Gemelli, Rome, Italy
| | - Daria Maccora
- Ist. Medicina Nucleare, Univ. Cattolica del Sacro Cuore, Rome, Italy
| | - Michela Marafini
- Museo Storico della Fisica e Centro Studi e Ricerche "E. Fermi", Rome, Italy; INFN Sezione di Roma, Rome, Italy
| | - Riccardo Mirabelli
- INFN Sezione di Roma, Rome, Italy; Dip. Fisica, Sapienza Univ. di Roma, Rome, Italy
| | | | - Dante Rotili
- Dip. Chimica e Tecnologie del Farmaco, Sapienza Univ. di Roma, Rome, Italy
| | - Andrea Russomando
- Centro Científico Tecnológico de Valparaíso-CCTVal, Universidad Técnica Federico Santa María, Chile
| | | | | | - Marco Toppi
- Laboratori Nazionali di Frascati INFN, Frascati, Italy
| | - Giacomo Traini
- INFN Sezione di Roma, Rome, Italy; Dip. Fisica, Sapienza Univ. di Roma, Rome, Italy
| | | | - Riccardo Faccini
- INFN Sezione di Roma, Rome, Italy; Dip. Fisica, Sapienza Univ. di Roma, Rome, Italy
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Povoski SP, Hall NC, Murrey DA, Wright CL, Martin EW. Feasibility of a multimodal (18)F-FDG-directed lymph node surgical excisional biopsy approach for appropriate diagnostic tissue sampling in patients with suspected lymphoma. BMC Cancer 2015; 15:378. [PMID: 25953144 PMCID: PMC4426183 DOI: 10.1186/s12885-015-1381-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 04/28/2015] [Indexed: 11/22/2022] Open
Abstract
Background 18F-FDG PET/CT imaging is widely utilized in the clinical evaluation of patients with suspected or documented lymphoma. The aim was to describe our cumulative experience with a multimodal 18F-FDG-directed lymph node surgical excisional biopsy approach in patients with suspected lymphoma. Methods Thirteen patients (mean age 51 (±16;22–76) years), with suspected new or suspected recurrent lymphoma suggested by 18F-FDG-avid lesions seen on prior diagnostic whole-body PET/CT imaging, were injected IV with 18F-FDG prior to undergoing same-day diagnostic lymph node surgical excisional biopsy in the operating room. Various 18F-FDG detection strategies were used on the day of surgery, including, (1) same-day pre-resection patient PET/CT; (2) intraoperative gamma probe assessment; (3) clinical scanner specimen PET/CT imaging of whole surgically excised tissue specimens; (4) specimen gamma well counts; and/or (5) same-day post-resection patient PET/CT. Results Same-day 18F-FDG injection dose was 14.8 (±2.4;12.5-20.6) millicuries or 548 (±89;463–762) megabecquerels. Sites of 18F-FDG-avid lesions were 4 inguinal, 3 cervical, 3 abdominal/retroperitoneal, 2 axillary, and 1 gluteal region subcutaneous tissue. Same-day pre-resection patient PET/CT was performed on 6 patients. Intraoperative gamma probe assessment was performed on 13 patients. Clinical scanner PET/CT imaging of whole surgically excised tissue specimens was performed in 10 cases. Specimen gamma well counts were performed in 6 cases. Same-day post-resection patient PET/CT imaging was performed on 8 patients. Time from 18F-FDG injection to same-day pre-resection patient PET/CT, intraoperative gamma probe assessment, and same-day post-resection patient PET/CT were 76 (±8;64–84), 240 (±63;168–304), and 487 (±104;331–599) minutes, respectively. Time from 18F-FDG injection to clinical scanner PET/CT of whole surgically excised tissue specimens was 363 (±60;272–446) minutes. Time from 18F-FDG injection to specimen gamma well counts was 591 (±96;420–689) minutes. Intraoperative gamma probe assessment successfully identified 18F-FDG-avid lesions in 12/13 patients. Histopathologic evaluation confirmed lymphoma in 12/13 patients and benign disease in 1/13 patients. Conclusions A multimodal approach to 18F-FDG-directed lymph node surgical excisional biopsy for suspected lymphoma is technically feasible for guiding appropriate diagnostic tissue sampling of lymph nodes seen as 18F-FDG-avid lesions on diagnostic 18F-FDG PET/CT imaging.
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Affiliation(s)
- Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA.
| | - Nathan C Hall
- Division of Molecular Imaging and Nuclear Medicine, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA. .,Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA.
| | - Douglas A Murrey
- Division of Molecular Imaging and Nuclear Medicine, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA.
| | - Chadwick L Wright
- Division of Molecular Imaging and Nuclear Medicine, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA.
| | - Edward W Martin
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA.
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7
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Chapman GJ, Povoski SP, Hall NC, Murrey DA, Lee R, Martin EW. Comparison of two threshold detection criteria methodologies for determination of probe positivity for intraoperative in situ identification of presumed abnormal 18F-FDG-avid tissue sites during radioguided oncologic surgery. BMC Cancer 2014; 14:667. [PMID: 25218021 PMCID: PMC4171551 DOI: 10.1186/1471-2407-14-667] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 09/10/2014] [Indexed: 11/10/2022] Open
Abstract
Background Intraoperative in situ identification of 18F-FDG-avid tissue sites during radioguided oncologic surgery remains a significant challenge for surgeons. The purpose of our study was to evaluate the 1.5-to-1 ratiometric threshold criteria method versus the three-sigma statistical threshold criteria method for determination of gamma detection probe positivity for intraoperative in situ identification of presumed abnormal 18F-FDG-avid tissue sites in a manner that was independent of the specific type of gamma detection probe used. Methods From among 52 patients undergoing appropriate in situ evaluation of presumed abnormal 18F-FDG-avid tissue sites during 18F-FDG-directed surgery using 6 available gamma detection probe systems, a total of 401 intraoperative gamma detection probe measurement sets of in situ counts per second measurements were cumulatively taken. Results For the 401 intraoperative gamma detection probe measurement sets, probe positivity was successfully met by the 1.5-to-1 ratiometric threshold criteria method in 150/401 instances (37.4%) and by the three-sigma statistical threshold criteria method in 259/401 instances (64.6%) (P < 0.001). Likewise, the three-sigma statistical threshold criteria method detected true positive results at target-to-background ratios much lower than the 1.5-to-1 target-to-background ratio of the 1.5-to-1 ratiometric threshold criteria method. Conclusions The three-sigma statistical threshold criteria method was significantly better than the 1.5-to-1 ratiometric threshold criteria method for determination of gamma detection probe positivity for intraoperative in situ detection of presumed abnormal 18F-FDG-avid tissue sites during radioguided oncologic surgery. This finding may be extremely important for reshaping the ongoing and future research and development of gamma detection probe systems that are necessary for optimizing the in situ detection of radioisotopes of higher-energy gamma photon emissions used during radioguided oncologic surgery.
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Affiliation(s)
| | - Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, Arthur G, James Cancer Hospital and Richard J, Solove Research Institute and Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
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8
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Povoski SP, Murrey DA, Smith SM, Martin EW, Hall NC. 18F-FDG PET/CT oncologic imaging at extended injection-to-scan acquisition time intervals derived from a single-institution 18F-FDG-directed surgery experience: feasibility and quantification of 18F-FDG accumulation within 18F-FDG-avid lesions and background tissues. BMC Cancer 2014; 14:453. [PMID: 24942656 PMCID: PMC4075626 DOI: 10.1186/1471-2407-14-453] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 06/13/2014] [Indexed: 12/31/2022] Open
Abstract
Background 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) is a well-established imaging modality for a wide variety of solid malignancies. Currently, only limited data exists regarding the utility of PET/CT imaging at very extended injection-to-scan acquisition times. The current retrospective data analysis assessed the feasibility and quantification of diagnostic 18F-FDG PET/CT oncologic imaging at extended injection-to-scan acquisition time intervals. Methods 18F-FDG-avid lesions (not surgically manipulated or altered during 18F-FDG-directed surgery, and visualized both on preoperative and postoperative 18F-FDG PET/CT imaging) and corresponding background tissues were assessed for 18F-FDG accumulation on same-day preoperative and postoperative 18F-FDG PET/CT imaging. Multiple patient variables and 18F-FDG-avid lesion variables were examined. Results For the 32 18F-FDG-avid lesions making up the final 18F-FDG-avid lesion data set (from among 7 patients), the mean injection-to-scan times of the preoperative and postoperative 18F-FDG PET/CT scans were 73 (±3, 70-78) and 530 (±79, 413-739) minutes, respectively (P < 0.001). The preoperative and postoperative mean 18F-FDG-avid lesion SUVmax values were 7.7 (±4.0, 3.6-19.5) and 11.3 (±6.0, 4.1-29.2), respectively (P < 0.001). The preoperative and postoperative mean background SUVmax values were 2.3 (±0.6, 1.0-3.2) and 2.1 (±0.6, 1.0-3.3), respectively (P = 0.017). The preoperative and postoperative mean lesion-to-background SUVmax ratios were 3.7 (±2.3, 1.5-9.8) and 5.8 (±3.6, 1.6-16.2), respectively, (P < 0.001). Conclusions 18F-FDG PET/CT oncologic imaging can be successfully performed at extended injection-to-scan acquisition time intervals of up to approximately 5 half-lives for 18F-FDG while maintaining good/adequate diagnostic image quality. The resultant increase in the 18F-FDG-avid lesion SUVmax values, decreased background SUVmax values, and increased lesion-to-background SUVmax ratios seen from preoperative to postoperative 18F-FDG PET/CT imaging have great potential for allowing for the integrated, real-time use of 18F-FDG PET/CT imaging in conjunction with 18F-FDG-directed interventional radiology biopsy and ablation procedures and 18F-FDG-directed surgical procedures, as well as have far-reaching impact on potentially re-shaping future thinking regarding the “most optimal” injection-to-scan acquisition time interval for all routine diagnostic 18F-FDG PET/CT oncologic imaging.
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Affiliation(s)
- Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, Arthur G, James Cancer Hospital and Richard J, Solove Research Institute and Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
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9
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Camillocci ES, Baroni G, Bellini F, Bocci V, Collamati F, Cremonesi M, De Lucia E, Ferroli P, Fiore S, Grana CM, Marafini M, Mattei I, Morganti S, Paganelli G, Patera V, Piersanti L, Recchia L, Russomando A, Schiariti M, Sarti A, Sciubba A, Voena C, Faccini R. A novel radioguided surgery technique exploiting β(-) decays. Sci Rep 2014; 4:4401. [PMID: 24646766 PMCID: PMC3960579 DOI: 10.1038/srep04401] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 02/27/2014] [Indexed: 12/04/2022] Open
Abstract
The background induced by the high penetration power of the radiation is the main limiting factor of the current radio-guided surgery (RGS). To partially mitigate it, a RGS with β+-emitting radio-tracers has been suggested in literature. Here we propose the use of β−-emitting radio-tracers and β− probes and discuss the advantage of this method with respect to the previously explored ones: the electron low penetration power allows for simple and versatile probes and could extend RGS to tumours for which background originating from nearby healthy tissue makes probes less effective. We developed a β− probe prototype and studied its performances on phantoms. By means of a detailed simulation we have also extrapolated the results to estimate the performances in a realistic case of meningioma, pathology which is going to be our first in-vivo test case. A good sensitivity to residuals down to 0.1 ml can be reached within 1 s with an administered activity smaller than those for PET-scans thus making the radiation exposure to medical personnel negligible.
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Affiliation(s)
| | - G Baroni
- Dip. Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Italy
| | - F Bellini
- 1] Dip. Fisica, Sapienza Univ. di Roma, Roma, Italy [2] INFN Sezione di Roma, Roma, Italy
| | - V Bocci
- INFN Sezione di Roma, Roma, Italy
| | - F Collamati
- 1] Dip. Fisica, Sapienza Univ. di Roma, Roma, Italy [2] INFN Sezione di Roma, Roma, Italy
| | - M Cremonesi
- Div. Fisica Medica, Istituto Europeo di Oncologia, Milano, Italy
| | - E De Lucia
- Laboratori Nazionali di Frascati dell'INFN, Frascati, Italy
| | - P Ferroli
- Fondazione Istituto Neurologico Carlo Besta, Milano, Italy
| | - S Fiore
- 1] INFN Sezione di Roma, Roma, Italy [2] ENEA UTTMAT-IRR, Casaccia R.C., Roma, Italy
| | - C M Grana
- Div. Medicina Nucleare, Istituto Europeo di Oncologia, Milano, Italy
| | - M Marafini
- 1] INFN Sezione di Roma, Roma, Italy [2] Museo Storico della Fisica e Centro Studi e Ricerche 'E. Fermi', Roma, Italy
| | - I Mattei
- 1] Dipartimento di Matematica e Fisica, Università Roma Tre, Roma, Italy [2] Laboratori Nazionali di Frascati dell'INFN, Frascati, Italy
| | | | - G Paganelli
- Department of Nuclear Medicine and Radiometabolic Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST-IRCCS, Meldola, Italy
| | - V Patera
- 1] INFN Sezione di Roma, Roma, Italy [2] Dip. Scienze di Base e Applicate per l'Ingegneria, Sapienza Univ. di Roma, Roma, Italy
| | - L Piersanti
- 1] INFN Sezione di Roma, Roma, Italy [2] Dip. Scienze di Base e Applicate per l'Ingegneria, Sapienza Univ. di Roma, Roma, Italy
| | | | - A Russomando
- 1] Center for Life Nano Science@Sapienza, Istituto Italiano di Tecnologia, Roma, Italy [2] Dip. Fisica, Sapienza Univ. di Roma, Roma, Italy [3] INFN Sezione di Roma, Roma, Italy
| | - M Schiariti
- Fondazione Istituto Neurologico Carlo Besta, Milano, Italy
| | - A Sarti
- 1] Laboratori Nazionali di Frascati dell'INFN, Frascati, Italy [2] Dip. Scienze di Base e Applicate per l'Ingegneria, Sapienza Univ. di Roma, Roma, Italy
| | - A Sciubba
- 1] INFN Sezione di Roma, Roma, Italy [2] Dip. Scienze di Base e Applicate per l'Ingegneria, Sapienza Univ. di Roma, Roma, Italy
| | - C Voena
- INFN Sezione di Roma, Roma, Italy
| | - R Faccini
- 1] Dip. Fisica, Sapienza Univ. di Roma, Roma, Italy [2] INFN Sezione di Roma, Roma, Italy
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Povoski SP, Chapman GJ, Murrey DA, Lee R, Martin EW, Hall NC. Intraoperative detection of ¹⁸F-FDG-avid tissue sites using the increased probe counting efficiency of the K-alpha probe design and variance-based statistical analysis with the three-sigma criteria. BMC Cancer 2013; 13:98. [PMID: 23496877 PMCID: PMC3599348 DOI: 10.1186/1471-2407-13-98] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 02/25/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intraoperative detection of (18)F-FDG-avid tissue sites during 18F-FDG-directed surgery can be very challenging when utilizing gamma detection probes that rely on a fixed target-to-background (T/B) ratio (ratiometric threshold) for determination of probe positivity. The purpose of our study was to evaluate the counting efficiency and the success rate of in situ intraoperative detection of (18)F-FDG-avid tissue sites (using the three-sigma statistical threshold criteria method and the ratiometric threshold criteria method) for three different gamma detection probe systems. METHODS Of 58 patients undergoing (18)F-FDG-directed surgery for known or suspected malignancy using gamma detection probes, we identified nine (18)F-FDG-avid tissue sites (from amongst seven patients) that were seen on same-day preoperative diagnostic PET/CT imaging, and for which each (18)F-FDG-avid tissue site underwent attempted in situ intraoperative detection concurrently using three gamma detection probe systems (K-alpha probe, and two commercially-available PET-probe systems), and then were subsequently surgical excised. RESULTS The mean relative probe counting efficiency ratio was 6.9 (± 4.4, range 2.2-15.4) for the K-alpha probe, as compared to 1.5 (± 0.3, range 1.0-2.1) and 1.0 (± 0, range 1.0-1.0), respectively, for two commercially-available PET-probe systems (P < 0.001). Successful in situ intraoperative detection of 18F-FDG-avid tissue sites was more frequently accomplished with each of the three gamma detection probes tested by using the three-sigma statistical threshold criteria method than by using the ratiometric threshold criteria method, specifically with the three-sigma statistical threshold criteria method being significantly better than the ratiometric threshold criteria method for determining probe positivity for the K-alpha probe (P = 0.05). CONCLUSIONS Our results suggest that the improved probe counting efficiency of the K-alpha probe design used in conjunction with the three-sigma statistical threshold criteria method can allow for improved detection of 18F-FDG-avid tissue sites when a low in situ T/B ratio is encountered.
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Affiliation(s)
- Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus 43210, OH, USA.
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Yamamoto S, Higashi T, Senda M. A GSO tweezers-type coincidence detector for tumor detection. Radiol Phys Technol 2013; 6:293-8. [PMID: 23283753 DOI: 10.1007/s12194-012-0198-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 12/21/2012] [Accepted: 12/25/2012] [Indexed: 11/25/2022]
Abstract
A Gd2SiO5 (GSO) tweezers-type coincidence detector was developed and tested for tumor detection in procedures such as (18)F-fluorodeoxyglucose (FDG)-guided surgery. The detector consists of a pair of GSO scintillators, a pair of metal-packaged small-sized photomultiplier tubes (PMTs), and a coincidence circuit. Because the GSO scintillators are located on the tips of tweezers, a target organ such as a lymph node or the colon can be easily positioned between them. The size of a single GSO was 8 × 14 × 14 mm. The results show that the energy resolution was 30 % full-width at half-maximum (FWHM) and the timing resolution was 6 ns FWHM for 511-keV gamma photons. The point-spread function perpendicular to the detector was 4.5 mm FWHM, and the point-spread function parallel to the detector was 7.5 mm FWHM. The absolute sensitivity of the coincidence detector was 0.6% at the center of the detector when the two GSOs were 5 mm apart. Background counts due to the accidental and scatter coincidence were 2 cps up to 48 MBq from the positron source contained in a 20-cm-diameter, 20-cm-high cylindrical phantom. From these results, we conclude that the proposed tweezers-type coincidence detector is useful for tumor detection by the use of FDG, such as that in radio-guided surgery.
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Affiliation(s)
- Seiichi Yamamoto
- Department of Radiological and Medical Laboratory Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya 461-8673, Japan.
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Multimodal imaging and detection approach to 18F-FDG-directed surgery for patients with known or suspected malignancies: a comprehensive description of the specific methodology utilized in a single-institution cumulative retrospective experience. World J Surg Oncol 2011; 9:152. [PMID: 22112047 PMCID: PMC3247132 DOI: 10.1186/1477-7819-9-152] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Accepted: 11/23/2011] [Indexed: 11/10/2022] Open
Abstract
Background 18F-FDG PET/CT is widely utilized in the management of cancer patients. The aim of this paper was to comprehensively describe the specific methodology utilized in our single-institution cumulative retrospective experience with a multimodal imaging and detection approach to 18F-FDG-directed surgery for known/suspected malignancies. Methods From June 2005-June 2010, 145 patients were injected with 18F-FDG in anticipation of surgical exploration, biopsy, and possible resection of known/suspected malignancy. Each patient underwent one or more of the following: (1) same-day preoperative patient diagnostic PET/CT imaging, (2) intraoperative gamma probe assessment, (3) clinical PET/CT specimen scanning of whole surgically resected specimens (WSRS), research designated tissues (RDT), and/or sectioned research designated tissues (SRDT), (4) micro PET/CT specimen scanning of WSRS, RDT, and/or SRDT, (5) total radioactivity counting of each SRDT piece by an automatic gamma well counter, and (6) same-day postoperative patient diagnostic PET/CT imaging. Results Same-day 18F-FDG injection dose was 15.1 (± 3.5, 4.6-26.1) mCi. Fifty-five same-day preoperative patient diagnostic PET/CT scans were performed. One hundred forty-two patients were taken to surgery. Three of the same-day preoperative patient diagnostic PET/CT scans led to the cancellation of the anticipated surgical procedure. One hundred forty-one cases utilized intraoperative gamma probe assessment. Sixty-two same-day postoperative patient diagnostic PET/CT scans were performed. WSRS, RDT, and SRDT were scanned by clinical PET/CT imaging and micro PET/CT imaging in 109 and 32 cases, 33 and 22 cases, and 49 and 26 cases, respectively. Time from 18F-FDG injection to same-day preoperative patient diagnostic PET/CT scan, intraoperative gamma probe assessment, and same-day postoperative patient diagnostic PET/CT scan were 73 (± 9, 53-114), 286 (± 93, 176-532), and 516 (± 134, 178-853) minutes, respectively. Time from 18F-FDG injection to scanning of WSRS, RDT, and SRDT by clinical PET/CT imaging and micro PET/CT imaging were 389 (± 148, 86-741) and 458 (± 97, 272-656) minutes, 619 (± 119, 253-846) and 661 (± 117, 433-835) minutes, and 674 (± 186, 299-1068) and 752 (± 127, 499-976) minutes, respectively. Conclusions Our multimodal imaging and detection approach to 18F-FDG-directed surgery for known/suspected malignancies is technically and logistically feasible and may allow for real-time intraoperative staging, surgical planning and execution, and determination of completeness of surgical resection.
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13
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Performance of beta- and high-energy gamma probes for the detection of cancer tissue in experimental surgical resection beds. Ann Nucl Med 2011; 25:486-93. [DOI: 10.1007/s12149-011-0492-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 03/30/2011] [Indexed: 11/25/2022]
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Martin EW, Chapman GJ, Subramaniam VV, Povoski SP. Intraoperative detection of gamma emissions using K-alpha X-ray fluorescence. Expert Rev Med Devices 2010; 7:431-4. [PMID: 20583879 DOI: 10.1586/erd.10.33] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Povoski SP, Neff RL, Mojzisik CM, O'Malley DM, Hinkle GH, Hall NC, Murrey DA, Knopp MV, Martin EW. A comprehensive overview of radioguided surgery using gamma detection probe technology. World J Surg Oncol 2009; 7:11. [PMID: 19173715 PMCID: PMC2653072 DOI: 10.1186/1477-7819-7-11] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2008] [Accepted: 01/27/2009] [Indexed: 02/08/2023] Open
Abstract
The concept of radioguided surgery, which was first developed some 60 years ago, involves the use of a radiation detection probe system for the intraoperative detection of radionuclides. The use of gamma detection probe technology in radioguided surgery has tremendously expanded and has evolved into what is now considered an established discipline within the practice of surgery, revolutionizing the surgical management of many malignancies, including breast cancer, melanoma, and colorectal cancer, as well as the surgical management of parathyroid disease. The impact of radioguided surgery on the surgical management of cancer patients includes providing vital and real-time information to the surgeon regarding the location and extent of disease, as well as regarding the assessment of surgical resection margins. Additionally, it has allowed the surgeon to minimize the surgical invasiveness of many diagnostic and therapeutic procedures, while still maintaining maximum benefit to the cancer patient. In the current review, we have attempted to comprehensively evaluate the history, technical aspects, and clinical applications of radioguided surgery using gamma detection probe technology.
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Affiliation(s)
- Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, 43210, USA
| | - Ryan L Neff
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, 43210, USA
| | - Cathy M Mojzisik
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, 43210, USA
- Department of Radiology, The Ohio State University, Columbus, OH, 43210, USA
| | - David M O'Malley
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, 43210, USA
| | - George H Hinkle
- Department of Radiology, The Ohio State University, Columbus, OH, 43210, USA
- College of Pharmacy, The Ohio State University, Columbus, OH, 43210, USA
| | - Nathan C Hall
- Department of Radiology, The Ohio State University, Columbus, OH, 43210, USA
| | - Douglas A Murrey
- Department of Radiology, The Ohio State University, Columbus, OH, 43210, USA
| | - Michael V Knopp
- Department of Radiology, The Ohio State University, Columbus, OH, 43210, USA
| | - Edward W Martin
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, 43210, USA
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Ondik MP, Tulchinsky M, Goldenberg D. Radioguided Reoperative Thyroid and Parathyroid Surgery. Otolaryngol Clin North Am 2008; 41:1185-98, x. [DOI: 10.1016/j.otc.2008.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sarikaya I, Sarikaya A, Reba RC. Gamma probes and their use in tumor detection in colorectal cancer. ACTA ACUST UNITED AC 2008; 5:25. [PMID: 19019238 PMCID: PMC2596150 DOI: 10.1186/1477-7800-5-25] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Accepted: 11/19/2008] [Indexed: 11/17/2022]
Abstract
The purpose of this article is to summarize the role of gamma probes in intraoperative tumor detection in patients with colorectal cancer (CRC), as well as provide basic information about the physical and practical characteristics of the gamma probes, and the radiopharmaceuticals used in gamma probe tumor detection. In a significant portion of these studies, radiolabeled monoclonal antibodies (Mabs), particularly 125I labeled B72.3 Mab that binds to the TAG-72 antigen, have been used to target tumor. Studies have reported that intraoperative gamma probe radioimmunodetection helps surgeons to localize primary tumor, clearly delineate its resection margins and provide immediate intraoperative staging. Studies also have emphasized the value of intraoperative gamma probe radioimmunodetection in defining the extent of tumor recurrence and finding sub-clinical occult tumors which would assure the surgeons that they have completely removed the tumor burden. However, intraoperative gamma probe radioimmunodetection has not been widely adapted among surgeons because of some constraints associated with this technique. The main difficulty with this technique is the long period of waiting time between Mab injection and surgery. The technique is also laborious and costly. In recent years, Fluorine-18-2-fluoro-2-deoxy-D-glucose (18F-FDG) use in gamma probe tumor detection surgery has renewed interest among surgeons. Preliminary studies during surgery have demonstrated that use of FDG in gamma probe tumor detection during surgery is feasible and useful.
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Affiliation(s)
- Ismet Sarikaya
- Division of Nuclear Medicine, Georgetown University Hospital, Washington DC, 20007, USA.
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Heckathorne E, Dimock C, Dahlbom M. Radiation dose to surgical staff from positron-emitter-based localization and radiosurgery of tumors. HEALTH PHYSICS 2008; 95:220-226. [PMID: 18617803 DOI: 10.1097/01.hp.0000310962.96089.44] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Surgical tissue characterization based on radiotracer uptake has become much more common in recent years, particularly due to the advent of the sentinel lymph node biopsy technique. Radiolabeled pharmaceuticals are used with hand-held gamma-sensitive probes, which are capable of localizing small tumors and lymph nodes that are first identified via scintigraphy. The radiation safety of such radioguided procedures, which typically employ 99mTc, has been well established. Now, with the emergence of 18F-fluorodeoxyglucose (18FDG) as a widely used tracer for PET imaging of cancer patients, there is increasing interest in the possibility of utilizing 18FDG for intraoperative tumor detection. First, though, the exposure to operating room personnel must be shown to be at a safe level. Due to the short half-life of 18F, the exposure rate will vary significantly with the start time post-injection as well as the duration of the procedure. The aim of this investigation is to determine empirically an exposure rate equation that can be integrated to estimate the exposure to a surgeon and assistants, from patients injected with 18FDG, over an arbitrarily chosen time interval. The study was conducted by measuring the radiation exposure rate from hospital in-patients receiving 18FDG-PET scans at various times from one to seven hours post injection; the empirical equation was determined from the plot of exposure rate vs. time for all patients. The resulting effective dose equivalent for the surgeon for typical values of injected activity, delay time and procedure duration was approximately 60 microSv.
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Affiliation(s)
- Elena Heckathorne
- Department of Molecular & Medical Pharmacology, UCLA School of Medicine, B2-049B CHS, Box 956948, 650 Charles Young Drive S., Los Angeles, CA 90095-6948, USA.
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Povoski SP, Sarikaya I, White WC, Marsh SG, Hall NC, Hinkle GH, Martin EW, Knopp MV. Comprehensive evaluation of occupational radiation exposure to intraoperative and perioperative personnel from 18F-FDG radioguided surgical procedures. Eur J Nucl Med Mol Imaging 2008; 35:2026-34. [PMID: 18618106 DOI: 10.1007/s00259-008-0880-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2008] [Accepted: 06/21/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of the current study was to comprehensively evaluate occupational radiation exposure to all intraoperative and perioperative personnel involved in radioguided surgical procedures utilizing (18)F-fluorodeoxyglucose ((18)F-FDG). METHODS Radiation exposure to surgeon, anesthetist, scrub technologist, circulating nurse, preoperative nurse, and postoperative nurse, using aluminum oxide dosimeters read by optically stimulated luminescence technology, was evaluated during ten actual radioguided surgical procedures involving administration of (18)F-FDG. RESULTS Mean patient dosage of (18)F-FDG was 699 +/- 181 MBq (range 451-984). Mean time from (18)F-FDG injection to initial exposure of personnel to the patient was shortest for the preoperative nurse (75 +/- 63 min, range 0-182) followed by the circulating nurse, anesthetist, scrub technologist, surgeon, and postoperative nurse. Mean total time of exposure of the personnel to the patient was longest for the anesthetist (250 +/- 128 min, range 69-492) followed by the circulating nurse, scrub technologist, surgeon, postoperative nurse, and preoperative nurse. Largest deep dose equivalent per case was received by the surgeon (164 +/- 135 microSv, range 10-580) followed by the anesthetist, scrub technologist, postoperative nurse, circulating nurse, and preoperative nurse. Largest deep dose equivalent per hour of exposure was received by the preoperative nurse (83 +/- 134 microSv/h, range 0-400) followed by the surgeon, anesthetist, postoperative nurse, scrub technologist, and circulating nurse. CONCLUSION On a per case basis, occupational radiation exposure to intraoperative and perioperative personnel involved in (18)F-FDG radioguided surgical procedures is relatively small. Development of guidelines for monitoring occupational radiation exposure in (18)F-FDG cases will provide reassurance and afford a safe work environment for such personnel.
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Affiliation(s)
- Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA.
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Yamamoto S, Sakamoto Y, Matsumoto K, Senda M. Development of a tweezers-type coincidence imaging detector. Ann Nucl Med 2008; 22:387-93. [PMID: 18600416 DOI: 10.1007/s12149-008-0114-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Accepted: 01/10/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE When employing F-18-fluorodeoxyglucose (FDG)-guided surgery to detect positron accumulation in isolated small organs, sampling these organs from opposite directions is a useful way of determining a tumor's position, similar to sampling a small organ with tweezers. The coincidence method is suitable for this purpose because only the positrons between two detectors can be detected. For this purpose, we developed a tweezers-type coincidence imaging detector. METHODS The detector employs two depth-of-interaction (DOI) detectors positioned at the tip of the tweezers and images the positron distribution between them using the coincidence method. The DOI detector consists of a 4 x 3 Gd(2)SiO(5):Ce (GSO) array optically coupled to a one-dimensionally arranged quad-photomultiplier tube. These GSOs were arranged to form a DOI detector using the Anger principle. The useful field of view is 20 mm x 15 mm. With these configurations, we could resolve 4 x 3 GSO arrays on a position histogram. RESULTS Because the imaging detectors were positioned at the tip of the tweezers, one could easily sample the target part manually from opposed sides. A real-time image in coincidence between these two DOI detectors could be obtained. The point spread functions were approximately 3-mm full width at half-maximum (FWHM) parallel to the tweezers and 4-mm FWHM perpendicular to them. The sensitivity was approximately 1% when the two imaging detectors were 10 mm apart. CONCLUSIONS With these results, we conclude that the developed tweezers-type imaging detector has a potential to be a new instrument in nuclear medicine.
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Affiliation(s)
- Seiichi Yamamoto
- Kobe City College of Technology, 8-3 Gakuen-Higashi-machi, Nishi-ku, Kobe 651-2194, Japan.
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Hall NC, Povoski SP, Murrey DA, Knopp MV, Martin EW. Combined approach of perioperative 18F-FDG PET/CT imaging and intraoperative 18F-FDG handheld gamma probe detection for tumor localization and verification of complete tumor resection in breast cancer. World J Surg Oncol 2007; 5:143. [PMID: 18154677 PMCID: PMC2235860 DOI: 10.1186/1477-7819-5-143] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2007] [Accepted: 12/21/2007] [Indexed: 11/16/2022] Open
Abstract
Background 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) has become an established method for detecting hypermetabolic sites of known and occult disease and is widely used in oncology surgical planning. Intraoperatively, it is often difficult to localize tumors and verify complete resection of tumors that have been previously detected on diagnostic PET/CT at the time of the original evaluation of the cancer patient. Therefore, we propose an innovative approach for intraoperative tumor localization and verification of complete tumor resection utilizing 18F-FDG for perioperative PET/CT imaging and intraoperative gamma probe detection. Methods Two breast cancer patients were evaluated. 18F-FDG was administered and PET/CT was acquired immediately prior to surgery. Intraoperatively, tumors were localized and resected with the assistance of a handheld gamma probe. Resected tumors were scanned with specimen PET/CT prior to pathologic processing. Shortly after the surgical procedure, patients were re-imaged with PET/CT utilizing the same preoperatively administered 18F-FDG dose. Results One patient had primary carcinoma of breast and a metastatic axillary lymph node. The second patient had a solitary metastatic liver lesion. In both cases, preoperative PET/CT verified these findings and demonstrated no additional suspicious hypermetabolic lesions. Furthermore, intraoperative gamma probe detection, specimen PET/CT, and postoperative PET/CT verified complete resection of the hypermetabolic lesions. Conclusion Immediate preoperative and postoperative PET/CT imaging, utilizing the same 18F-FDG injection dose, is feasible and image quality is acceptable. Such perioperative PET/CT imaging, along with intraoperative gamma probe detection and specimen PET/CT, can be used to verify complete tumor resection. This innovative approach demonstrates promise for assisting the oncologic surgeon in localizing and verifying resection of 18F-FDG positive tumors and may ultimately positively impact upon long-term patient outcomes.
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Affiliation(s)
- Nathan C Hall
- Section of PET, Division of Nuclear Medicine, Department of Radiology, The Ohio State University, Columbus, OH, 43210, USA.
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Sarikaya I, Povoski SP, Al-Saif OH, Kocak E, Bloomston M, Marsh S, Cao Z, Murrey DA, Zhang J, Hall NC, Knopp MV, Martin EW. Combined use of preoperative 18F FDG-PET imaging and intraoperative gamma probe detection for accurate assessment of tumor recurrence in patients with colorectal cancer. World J Surg Oncol 2007; 5:80. [PMID: 17634125 PMCID: PMC1941735 DOI: 10.1186/1477-7819-5-80] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Accepted: 07/16/2007] [Indexed: 11/20/2022] Open
Abstract
Background The purpose of this study was to combine intraoperative gamma probe (GP) detection with preoperative fluorine 18-fluoro-2-deoxy-glucose positron emission tomography (18F FDG-PET) imaging in order to improve detection of tumor recurrence in colorectal cancer (CRC) patients. Methods Twenty-one patients (12 females, 9 males) with a mean age of 54 years (range 31–78) were enrolled. Patients were suspected to have recurrent CRC by elevated CEA (n = 11), suspicious CT findings (n = 1), and clinically suspicious findings (n = 9). Preoperative FDG-PET scan and intraoperative GP study were performed in all patients. Mean time interval between preoperative FDG-PET scan and surgery was 16 days (range 1–41 days) in 19 patients. For intraoperative GP studies, 19 patients were injected with a dose of 10–15 mCi 18F FDG at approximately 30 minutes before the planned surgery time. In two patients, the intraoperative GP study was performed immediately after preoperative FDG-PET scan. Results Preoperative FDG-PET and intraoperative GP detected 48 and 45 lesions, respectively. A total of 50 presumed site of recurrent disease from 20 patients were resected. Thirty-seven of 50 presumed sites of recurrent disease were histological-proven tumor positive and 13 of 50 presumed sites of recurrent disease were histological-proven tumor negative. When correlated with final histopathology, the number of true positive lesions and false positive lesions by preoperative FDG-PET and intraoperative GP were 31/9 and 35/8, respectively. Both preoperative FDG-PET and intraoperative GP were true positive in 29 lesions. Intraoperative GP detected additional small lesions in the omentum and pelvis which were not seen on preoperative FDG-PET scan. FDG-PET scan demonstrated additional liver metastases which were not detected by intraoperative GP. Preoperative FDG-PET detected distant metastasis in the lung in one patient. The estimated radiation dose received by a surgeon during a single 18F FDG GP surgery was below the occupational limit. Conclusion The combined use of preoperative FDG-PET and intraoperative GP is potentially helpful to the surgeon as a roadmap for accurately locating and determining the extent of tumor recurrence in patients with CRC. While intraoperative GP appears to be more sensitive in detecting the extent of abdominal and pelvic recurrence, preoperative FDG-PET appears to be more sensitive in detecting liver metastases. FDG-PET is also a valuable method in detecting distant metastases.
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Affiliation(s)
- Ismet Sarikaya
- Division of Nuclear Medicine, Section of PET, Department of Radiology, The Ohio State University, Columbus, OH 43210, USA
| | - Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA
| | - Osama H Al-Saif
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA
| | - Ergun Kocak
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA
| | - Mark Bloomston
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA
| | - Steven Marsh
- Division of Nuclear Medicine, Section of PET, Department of Radiology, The Ohio State University, Columbus, OH 43210, USA
| | - Zongjian Cao
- Department of Radiology, Medical College of Georgia, Augusta, GA 30912, USA
| | - Douglas A Murrey
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA
| | - Jun Zhang
- Division of Nuclear Medicine, Section of PET, Department of Radiology, The Ohio State University, Columbus, OH 43210, USA
| | - Nathan C Hall
- Division of Nuclear Medicine, Section of PET, Department of Radiology, The Ohio State University, Columbus, OH 43210, USA
| | - Michael V Knopp
- Division of Nuclear Medicine, Section of PET, Department of Radiology, The Ohio State University, Columbus, OH 43210, USA
| | - Edward W Martin
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA
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Schillaci O. PET probes and oncological surgery: a productive new marriage for nuclear medicine? Eur J Nucl Med Mol Imaging 2007; 34:1530-3. [PMID: 17546457 DOI: 10.1007/s00259-007-0482-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Curtet C, Carlier T, Mirallié E, Bodet-Milin C, Rousseau C, Barbet J, Kraeber-Bodéré F. Prospective comparison of two gamma probes for intraoperative detection of 18F-FDG: in vitro assessment and clinical evaluation in differentiated thyroid cancer patients with iodine-negative recurrence. Eur J Nucl Med Mol Imaging 2007; 34:1556-62. [PMID: 17522858 DOI: 10.1007/s00259-007-0393-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2006] [Accepted: 01/29/2007] [Indexed: 02/06/2023]
Abstract
PURPOSE This study was aimed at evaluating the spatial resolution and sensitivity of two hand-held gamma probes. Radioguided surgery was tested in seven patients with iodine-negative differentiated thyroid cancer (DTC) recurrence using (18)F-FDG PET. METHODS Two gamma probes were evaluated: Clerad's GammaSup with a collimated CsI(Tl) scintillator and Novelec's Modelo2 with a BGO scintillator. Five measurement tests were performed following the NEMA guidelines (NU3-2004). Radioguided surgery was performed in patients with recurrent DTC and abnormal (18)F-FDG uptake on preoperative (18)F-FDG PET images. Patients were injected with rTSH 2 days before surgery. A mean activity of 211 MBq of (18)F-FDG was injected 60 min before surgery. In vivo and ex vivo counts were recorded for suspected tumours and normal tissue. RESULTS Spatial resolution was higher with the CsI(Tl) than with the BGO detector: 20.2-40.6 mm vs 20.6-55.3 mm from 0 to 20 mm depth. Sensitivity in air and water and through side shielding was higher for BGO but the signal-to-noise ratio was 88 and 22 with the BGO compared to 131 and 76 with the CsI(Tl) at 10 and 30 mm depth. Median in vivo SNR (tumour/non-tumour ratio) was 1.8 with both the BGO and the CsI(Tl) detector, while ex vivo ratios of 2.3 and 2.1, respectively, were obtained. Radioguided surgery allowed detection of all of the tumours identified by (18)F-FDG PET images. CONCLUSION This study demonstrated the feasibility of high-energy photon detection with a conventional scintillator equipped with a collimator. The CsI(TI) probe detected more true events from background than did the BGO detector during surgery.
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Piert M, Burian M, Meisetschläger G, Stein HJ, Ziegler S, Nährig J, Picchio M, Buck A, Siewert JR, Schwaiger M. Positron detection for the intraoperative localisation of cancer deposits. Eur J Nucl Med Mol Imaging 2007; 34:1534-44. [PMID: 17431612 PMCID: PMC2562440 DOI: 10.1007/s00259-007-0430-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2006] [Accepted: 02/22/2007] [Indexed: 11/30/2022]
Abstract
Purpose The study investigated the feasibility of a positron-sensitive hand-held detector system for the intraoperative localisation of tumour deposits resulting from intravenous [18F]FDG administration. Methods A total of 17 patients (12 receiving preoperative [18F]FDG PET imaging) with various histologically proven malignancies were included. Radioactivity from tumours and surrounding normal tissue was measured on average 3 h after administration of 36–110 MBq [18F]FDG and the tumour-to-background (T/B) ratio was calculated. In addition, phantom studies were performed to evaluate the spatial resolution and sensitivity of the probe. Results All known targeted tumour sites were identified by the positron probe. T/B ratios were generally high, with a mean T/B ratio of 6.6, allowing easy identification of most tumour sites. In one case of a hepatic metastasis, the T/B ratio of 1.34 was below expectations, since the preoperative [18F]FDG PET scan was positive. The probe was instrumental in the localisation of three additional tumour lesions (two lymph nodes, one anastomotic ring) that were not immediately apparent at surgery. Phantom studies revealed that [18F]FDG-containing gel (simulating tumour tissue), having 10 times more [18F]FDG than surrounding “normal” background gel, was clearly detectable in quantities as low as 15 mg. As measured in two cases, the absorbed radiation doses ranged from 2.5 to 8.6 μSv/h for the surgical team to 0.8 μSv/h for the aesthetician. Conclusion [18F]FDG-accumulating tumour tissues can be localised with positron probes intraoperatively with a low radiation burden to the patient and medical personnel. The methodology holds promise for further clinical testing.
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Affiliation(s)
- Morand Piert
- Department of Nuclear Medicine, Technische Universität München, Ismaningerstrasse 22, 81675 Munich, Germany.
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Yamamoto S, Higashi T, Matsumoto K, Senda M. Development of a positron-imaging detector with background rejection capability. Ann Nucl Med 2006; 20:655-62. [PMID: 17385303 DOI: 10.1007/bf02984676] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Intra-operative probes have recently become important instruments in nuclear medicine. In such an application, the radiopharmaceutical F-18-fluorodeoxyglucose (FDG) is promising. For the FDG-guided surgery, we developed and tested a positron-imaging detector with background rejection capability. METHODS The detector consists of an array of phoswich scintillators, a multi-channel position-sensitive photo-multiplier tube (PSPMT) and an electronic circuit. The scintillators and the PSPMT are encased in a tungsten shield and replaceable collimators are mounted on the top of the detector. Positrons are detected by the plastic scintillators while annihilation photons are detected by the BGOs. By employing a pulse-shape analysis, we can distinguish the true events (positrons) from background gamma events. The dimensions of each plastic scintillator are 2 mm x 2 mm x 3 mm and those of the BGO are 2 mm x 2 mm x 15 mm. These scintillators are optically coupled to each other and combined in an 8 x 8 array, which is optically coupled to a 1-inch square 8 x 8 multi-channel PSPMT via optical fibers. Position determination of the positrons is performed by 64-channel threshold circuits while the pulse shape analysis is applied for the summing signal. RESULTS The spatial resolution was measured by positioning an F-18 point source onto one pixel of the detector and found than the spillover to the neighbor pixel was less than 20%. The background count rate was less than 2 cps for a 20-cm diameter, 20-cm long cylinder phantom containing 3.7 MBq of F-18. CONCLUSION These results indicated that the developed positron-imaging detector will be useful for FDG-guided surgery.
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Affiliation(s)
- Seiichi Yamamoto
- Department of Electrical Engineering, Kobe City College of Technology, 8-3 Gakuen-Higashi-machi, Nishi-ku, Kobe 651-2194, Japan.
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Kraeber-Bodéré F, Cariou B, Curtet C, Bridji B, Rousseau C, Dravet F, Charbonnel B, Carnaille B, Le Néel JC, Mirallié E. Feasibility and benefit of fluorine 18–fluoro-2-deoxyglucose–guided surgery in the management of radioiodine-negative differentiated thyroid carcinoma metastases. Surgery 2005; 138:1176-82; discussion 1182. [PMID: 16360406 DOI: 10.1016/j.surg.2005.08.028] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2005] [Revised: 08/16/2005] [Accepted: 08/27/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Fluorine 18-fluoro-2-deoxyglucose (FDG) positron emission tomography ((18)F-FDG PET) can be used to visualize metastases in patients with differentiated thyroid carcinoma that does not take up radioiodine ((131)I). This study was aimed at evaluating the feasibility of (18)F-FDG radio-guided surgery in patients with radioiodine-negative differentiated thyroid cancer. METHODS Ten patients received a mean activity of 265 MBq of (18)F-FDG 30 minutes before operation. Radioactivity uptake (counts per second [cps], with a pretime of 10 seconds) in tumor and normal tissues was measured before and after resection. RESULTS Patients with 1 to 5 foci detected by FDG-PET were included in the study. Six of these patients were injected with recombinant human thyroid-stimulating hormone (TSH) preoperatively. Abnormal findings detected by preoperative (18)F-FDG PET were also detected with the gamma probe in all patients. The mean tumor activity in vivo was 3,272 cps, and tumor-to-neck and tumor-to-shoulder ratios were, respectively, 1.40 and 1.73. Tumor resection was incomplete in 3 patients. When resection was complete, mean radioactivity at the tumor site was decreased by 22%. The ex vivo mean tumor-to-normal tissue ratio was 2.4. All positive tissues detected with the probe were confirmed histologically to be differentiated thyroid cancer. The surgeon's hands were exposed to 90 to 270 microSv. CONCLUSIONS These results show the feasibility and benefit of (18)F-FDG radio-guided surgery with a gamma probe in the management of differentiated thyroid cancer patients with radioiodine-negative recurrence.
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Moore TO, Griffeth LK. Oncologic positron emission tomography: a surgical perspective. Proc AMIA Symp 2005; 16:13-20. [PMID: 16278717 PMCID: PMC1200804 DOI: 10.1080/08998280.2003.11927883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Todd O Moore
- Department of Surgery, Baylor University Medical Center, Dallas, Texas 75246, USA
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Vogelsang H, Brückner T, Scheidhauer K, Schwaiger M, Siewert JR. Wiederholungseingriffe beim Schilddr�senkarzinom. Chirurg 2005; 76:238-49. [PMID: 15739058 DOI: 10.1007/s00104-005-1006-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Reoperation for thyroid cancer needs to consider patient-, tumor- and therapy-related aspects as well as present diagnostic results. Reoperation because of thyroid remnants, persistence of the primary tumor and lymph node metastasis (completion surgery) has to be distinguished from reoperation due to locoregional recurrence (primary tumor, lymph nodes). The primary surgical strategy should avoid the need for reoperation. The extent of reoperation is related to the extent of primary surgery, stage, and distant metastasis. The timing and indication of reoperation for differentiated thyroid carcinoma in an interdisciplinary multimodal treatment setting depends on diagnostic radioiodine scans and radioiodine therapy. Long-term, recurrence-free survival is achieved by sufficiently radical surgery with acceptable morbidity, including all additive or adjuvant treatment options.
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Affiliation(s)
- H Vogelsang
- Chirurgische Klinik und Poliklinik, Technische Universität München.
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Yamamoto S, Matsumoto K, Sakamoto S, Tarutani K, Minato K, Senda M. An intra-operative positron probe with background rejection capability for FDG-guided surgery. Ann Nucl Med 2005; 19:23-8. [PMID: 15770969 DOI: 10.1007/bf02986331] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
For radio-guided surgery on tumors using F-18-FDG, detection of annihilation gamma photons emanating from other parts of the body produces background radiation counts and limits its use in clinical situations. To overcome this limitation, we have developed an intra-operative positron probe with background-rejection capability. The positron probe uses a phoswich detector composed of a plastic scintillator and a bismuth germinate (BGO). A positron from a positron emitter such as F-18 is detected by the plastic scintillator and emits annihilation photons. The BGO detects one of the annihilation photons while a photo-multiplier tube (PMT) detects scintillation photons from both scintillators. The decay time differences of these two scintillators are used to distinguish whether the event is a true event where a positron and a following annihilation photon are detected simultaneously, or a background event. In this configuration, only positrons can be selectively detected, even in an environment of high background gamma photon flux. Spatial resolution was 11-mm full width at half maximum (FWHM) 5 mm from the detector surface. Measured sensitivity for the F-18 point source was 2.6 cps/kBq 5 mm from the detector surface. The background count rate was less than 0.5 cps for a 20-cm diameter cylindrical phantom containing 37 MBq of F-18 solution measured on the phantom surface, while the positron count rate was almost linear over a range of approximately 6 kcps. These results indicate that our developed intra-operative positron probe is valuable for radio-guided surgery on tumors using F-18-FDG in a high flux of background annihilation gamma photons.
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Affiliation(s)
- Seiichi Yamamoto
- Department of Electrical Engineering, Kobe City College of Technology, Japan.
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Higashi T, Saga T, Ishimori T, Mamede M, Ishizu K, Fujita T, Mukai T, Sato S, Kato H, Yamaoka Y, Matsumoto K, Senda M, Konishi J. What is the most appropriate scan timing for intraoperative detection of malignancy using 18F-FDG-sensitive gamma probe? Preliminary phantom and preoperative patient study. Ann Nucl Med 2005; 18:105-14. [PMID: 15195757 DOI: 10.1007/bf02985100] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the appropriate post-injection timing for hand-held-gamma-ray-detecting probe (GDP) scanning for the intraoperative detection of malignancy after preoperative F-18 FDG (FDG) injection. METHODS Patient study with superficially located cancer was performed on three patients before operation by dual-phase whole-body PET at 2 and 6-7 hr post-injection of FDG (370 MBq), and by probe scanning from the skin at several points at 1, 3, 5, and 7 hr after FDG injection. TNRa (tumor-adjacent-normal ratio) and TNRc (tumor-contralateral-normal ratio) were calculated. Phantom study was also performed to determine basic GDP function. RESULTS The patient study revealed that tumors showed constant TNRa (0.9-1.3) and TNRc (1.1-3.0) by GDP count rate, and that there was no tendency of an increase in TNRa with time. The standard deviations of GDP count rate were lower at 1-3 hr post-injection compared with those of delayed scans. While delayed PET showed an increase or no change in the tumor FDG uptake, the decrease of normal tissue FDG uptake was not adequate to create higher TNRs. The phantom study revealed that LN model showed TNRa of 1.7 or greater by GDP count rate (cps) when background contained no FDG, but that they showed TNRa of 1.3 or less when the background contained 4% of the LN FDG activity per ml. CONCLUSION The present study suggests that higher FDG count rate of tumors at 1-3 hr postinjection would be more suitable for the gamma-probe detection compared with lower count rate at 6-7 hr delayed scans with wide standard deviations.
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Affiliation(s)
- Tatsuya Higashi
- Department of Nuclear Medicine and Diagnostic Imaging, Kyoto University Graduate School of Medicine, Japan.
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Barranger E, Kerrou K, Petegnief Y, David-Montefiore E, Cortez A, Daraï E. Laparoscopic resection of occult metastasis using the combination of FDG-positron emission tomography/computed tomography image fusion with intraoperative probe guidance in a woman with recurrent ovarian cancer. Gynecol Oncol 2005; 96:241-4. [PMID: 15589609 DOI: 10.1016/j.ygyno.2004.09.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2004] [Indexed: 11/29/2022]
Abstract
BACKGROUND Positron emission tomography and computed tomography (PET/CT) have a potential role in detecting and locating recurrent ovarian cancer. Precise tumor location during surgical treatment is often difficult, owing to limited tumor size and post-surgical anatomic modifications. The surgical gamma probe, which has become increasing popular in recent years with the development of sentinel node mapping, may improve tumor detection and facilitate resection of occult metastases. CASE REPORT We describe the first case of laparoscopic resection of occult metastasis using the combination of FDG-PET/CT image fusion with intraoperative FDG-sensitive probing in a patient with recurrent ovarian cancer. CONCLUSION FDG-sensitive probe combined with preoperative PET/CT image fusion can help to detect occult metastasis and guide laparoscopic excision.
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Affiliation(s)
- Emmanuel Barranger
- Department of Gynecology and Obstetrics, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.
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Yamamoto S, Matsumoto K, Senda M. Optimum threshold setting for a positron-sensitive probe with background rejection capability. Ann Nucl Med 2004; 18:251-6. [PMID: 15233287 DOI: 10.1007/bf02985007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In a positron-sensitive probe composed of a plastic scintillator and a bismuth germanate (BGO), scattered annihilation photons in the plastic scintillator become background counts. Although these scattered annihilation photons can be rejected by higher threshold level settings for the scintillation pulse of the plastic scintillator and for that of the BGO, the system sensitivity is reduced. We have theoretically and experimentally optimized the threshold levels for both the plastic scintillator and the BGO. After calculating the energy loss in the plastic scintillator and the BGO for the scattered annihilation photons, we measured the background counts of a positron-sensitive probe by changing these threshold levels. Results revealed that one optimum threshold setting of the positron-sensitive probe was 0.3 of the peak level of the pulse for the plastic scintillator and 0.7 of that for the BGO. With these threshold levels, the background counts could be decreased to less than 0.2% of the true positron counts.
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Affiliation(s)
- Seiichi Yamamoto
- Department of Electrical Engineering, Kobe City College of Technology, Japan.
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Capirci C, Rubello D, Chierichetti F, Crepaldi G, Carpi A, Nicolini A, Mandoliti G, Polico C. Restaging after neoadjuvant chemoradiotherapy for rectal adenocarcinoma: role of F18-FDG PET. Biomed Pharmacother 2004; 58:451-7. [PMID: 15464875 DOI: 10.1016/j.biopha.2004.08.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2004] [Indexed: 01/30/2023] Open
Abstract
Multimodality treatment of loco-regional advanced rectal cancer has demonstrated to improve local control and overall survival. Proctoscopy, digital rectal examination (DRE), computer tomography (CT), endorectal ultrasound (ERUS), and magnetic resonance imaging (MRI) cannot correctly detect downstaging in rectal tumors after chemo radiation therapy (CRT). New imaging techniques, like 18F-FDG PET, may play some role in predicting the pathologic response to CRT before surgical resection. Aim of the present study was to further investigate the accuracy and predictive value of 18F-FDG PET in a large series of patients with rectal cancer treated with preoperative intensified CRT. Between January 2000 and December 2003, 81 patients with histologically proven adenocarcinoma in clinical stage II-III disease, according to criteria of TNM classification, were included in this study. All patients were submitted to diagnostic staging workup with DRE, proctoscopy with biopsy, ERUS, CT scan of the abdomen and pelvis or pelvic MRI plus liver ultrasonography, coloscopy or barium colonic enema. One month later the end of CRT all patients were submitted to diagnostic restaging work-up (DRW) and 18F-FDG PET. Surgery was performed 8-9 weeks after the end of CRT and pathologic stage was defined. Moreover a pathologic assessment of tumor regression was made with tumor regression grade score (TRG). PET correctly identified 22/28 (79% specificity) patients with complete pathologic response (pCR). However, sensitivity was 45% (24/53) while PPV, and NPV were equal to 77 and 43%, respectively. Total PET accuracy rate was 56%. PET sensitivity increased from 45 to 56% if the end-point was pCR, or TRG score, respectively. The best correlation was found between PET findings and pathologic stage (P <0.01) or TRG score (P <0.01). The accurate identification of rectal cancer patients with major pathological response after preoperative CRT further supports the necessity of designing prospective studies with new and more accurate was imaging technologies with the main object of offering conservative treatment in responder patients.
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Affiliation(s)
- Carlo Capirci
- Radiotherapy Department, S. Maria della Misericordia Rovigo Hospital, ASL 18, Rovigo, Italy.
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Simó M, Lomeña F, Setoain J, Pérez G, Castellucci P, Costansa JM, Setoain-Quinquer J, Doménech-Torné F, Carrió I. FDG-PET improves the management of patients with suspected recurrence of colorectal cancer. Nucl Med Commun 2002; 23:975-82. [PMID: 12352596 DOI: 10.1097/00006231-200210000-00007] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study aims to assess the influence of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) detection of recurrent disease on the management of patients with colorectal cancer and suspected recurrence. One hundred and twenty patients with suspected recurrence were studied with FDG-PET. Fifty-eight patients were referred for FDG-PET because of the elevation of serum tumour markers. Thirty-one patients were referred because of inconclusive results of conventional imaging modalities. Twenty-five patients had known recurrence and were referred for pre-surgical assessment. Six patients were referred because of abdominal pain. A major management change was considered when, as a consequence of FDG-PET results, medical treatment was changed to surgical, or surgical to medical or to no treatment. A minor management change was considered when changes were made within a treatment modality. Of the 58 patients with elevated serum carcinoembryonic antigen (CEA), FDG-PET detected recurrence and led to a major management change in 34 (58%). Eighteen underwent curative surgery and 16 were treated with systemic therapy. Of the 31 patients evaluated because of inconclusive results of conventional imaging modalities, FDG-PET was positive for recurrence in 24 and negative in seven. A major management change took place in 14 patients (45%). Of the 25 patients evaluated to rule out other sites of disease before surgery, FDG-PET did not show any other site of recurrence in 13 (52%) and showed more lesions in the remaining patients. Major management change took place in eight patients (32%). Overall, in the 120 patients studied, FDG-PET resulted in major management changes in 58 (48%), minor changes in four (3%) and no change in 54 (45%). It can be concluded that FDG-PET has a significant impact on the management of patients with suspected recurrence of colorectal cancer. FDG-PET detection of recurrence frequently allows curative surgical intervention. The early identification of distant metastases may also facilitate the implementation of systemic treatment.
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Affiliation(s)
- M Simó
- CETIR PET Center, Barcelona, Spain.
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Moadel RM, Blaufox MD, Freeman LM. The role of positron emission tomography in gastrointestinal imaging. Gastroenterol Clin North Am 2002; 31:841-61. [PMID: 12481734 DOI: 10.1016/s0889-8553(02)00035-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Although the use of PET in studies of the gastrointestinal tract is still relatively new, its value is clear. The future will provide a better definition of the indications for PET, refinement of the technology, and its relative value compared with other modalities such as peptide and antibody imaging, CT, MR imaging, and US.
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Affiliation(s)
- Renee M Moadel
- Departments of Nuclear Medicine and Medicine, Montefiore Medical Center/Jacobi Medical Center, and Albert Einstein College of Medicine, Montefiore Medical Park, 1695A Eastchester Road, Bronx, NY 10461, USA
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Abstract
The imaging of specific molecular targets that are associated with cancer should allow earlier diagnosis and better management of oncology patients. Positron emission tomography (PET) is a highly sensitive non-invasive technology that is ideally suited for pre-clinical and clinical imaging of cancer biology, in contrast to anatomical approaches. By using radiolabelled tracers, which are injected in non-pharmacological doses, three-dimensional images can be reconstructed by a computer to show the concentration and location(s) of the tracer of interest. PET should become increasingly important in cancer imaging in the next decade.
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Affiliation(s)
- Sanjiv Sam Gambhir
- Crump Institute for Molecular Imaging, Department of Molecular and Medical Pharmacology, UCLA School of Medicine, 700 Westwood Boulevard, Los Angeles, California 90095-1770, USA.
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