Background Radioguided surgery (RGS) for gastroenteropancreatic neuroendocrine tumours (GEP-NETs) has been suggested as a way to improve intraoperative lesion detection. This systematic literature review of reports of the use of RGS for GEP-NETs was performed to determine if there is a benefit. Methods A literature search was conducted using Google Scholar and PubMed, and snowballing from any relevant literature. Full-text studies were included if they were published in the English language and reported outcomes of RGS on human subjects with GEP-NETs. Qualitative data synthesis was performed. Results Twenty-six papers including a total of 209 patients were included. The tracers used were predominantly indium-111 pentetreotide, gallium-68 DOTA-peptides, and technetium-99m EDDA/HYNIC-peptides. Heterogeneous protocols make comparisons difficult, but most papers reported a benefit from the use of RGS in tumours in the gastrointestinal tract; utility in localisation of pancreatic tumours was less clear. Time between tracer administration and operation varied: from 16 h to 8 days with indium-111, 0–24 h with technetium-99m, and 19–193 min with gallium-68. Eight teams reported the thresholding technique used for discrimination—four used a ratio, four statistical methods, and one looked at the sensitivity and specificity of different cut-offs. Six teams performed follow-up of 24 patients (three pancreas, eight gastrinoma, 13 gastrointestinal tract) for between 3 months and 3 years. Two patients relapsed (one pancreas, one gastrinoma) between 6 and 12 months post-surgery. Conclusions RGS appears to aid in localisation of gastrointestinal NETs, but the benefit is more equivocal in pancreatic NETs. Further work into outcomes is warranted.

Patients attending for therapy with phosphorus-32 (P-32) may have problems with urinary continence requiring the use of a urinary catheter. P-32 is excreted renally and the contents of the catheter bag will impart a dose to the skin with which the bag is in contact. We simulated a catheter bag filled with P-32-contaminated urine and measured the dose rate per unit activity from the bag. A volume of 25 MBq of P-32 was added to a 500 ml bag of saline and mixed thoroughly. A personal dosimetry badge was fixed to the surface of the bag and left for 48 h before being sent for processing. To account for decay, the cumulative activity in the bag over the 48 h period was calculated and the shallow [Hp(0.07)] dose measured by the badge was divided by the cumulative activity to yield a dose rate per MBq of activity. The measured Hp(0.07) dose was 192.8 mSv, which corresponds to a dose rate per MBq of 169 μSv/h/MBq. This study has shown that the dose rate per MBq from a simulated catheter bag of radioactive phosphorus differs from the dose rates published for other containers. This value may be useful in the risk assessment of P-32 therapy in catheterized patients.

No abstract

No abstract

No abstract