Clinical applications of gamma-detection probes – radioguided surgery

Abstract

& p . 1 : Radioguided surgery (RGS) is a surgical technique that enables the surgeon to identify tissue "marked" by a radionuclide before surgery, based on the tissue characteristics, the radioactive tracer and its carrying molecule, or the affinity of both. Thus, yet another tool has been added to the inspection and palpation traditionally used by the surgeon. Current clinical applications of radioguided surgery are: radioimmunoguided surgery (RIGS) for colon cancer, sentinel-node mapping for malignant melanoma (which has become state-ofthe-art), sentinel-node mapping for breast, vulvar and penile cancer, and detection of parathyroid adenoma and bone tumour (such as osteid osteoma). Although the same gamma-detecting probe (GDP) may be used for all these applications, the carrier substance and the radionuclide differ. MoAb and peptides are used for RIGS, sulphur colloid for sentinel-node mapping, iodine-125 for RIGS, technetium-99m for sentinel node, parathyroid and bone. The mode of injection also differs, but there are some common principles of gamma-guided surgery. RIGS enables the surgeon to corroborate tumour existence, find occult metastases, and assess the margins of resection; this may result in a change on the surgical plan. Sentinel lymph-node (SLN) scintigraphy for melanoma guides the surgeon to find the involved lymph nodes for lymph-node dissection. SLN for breast cancer is being investigated with promising results. This procedure has also changed the outlook of lymph-node pathology by giving the pathologist designated tissue samples for more comprehensive examination. Gamma-guided surgery will result in more accurate and less unnecessary surgery, better pathology and, hopefully, in better patient survival. & k w d : Key words: Radioimmunoguided surgery -Sentinel lymph node -Gamma-detecting probe Eur J Nucl Med (1999) 26 (Suppl): S26-S35

High-resolution hand-held gamma camera

“…Research on the use of the sentinel node procedure shows that it reduces cost and morbidity, and provides equivalent or superior accuracy to axillary lymph node dissection. This is well-documented in hundreds of articles that are cited in references [1][2][3][4][5][6][7][8][9] .…”

“…The use of gamma-detection probes for locating radiation concentrated in tissue is rapidly becoming the standard of care for surgical management of melanomas and breast tumors [1][2][3][4][5][6][7][8] . It is used for axillary staging in conjunction with removal of the primary tumor.…”

Unique molecular markers in human endometriosis: implications for diagnosis and therapy

“…The technique of radioimmunoguided surgery (RIGS) enables a surgeon to identify tissue that is 'marked' by a radionuclide before surgery, based both on the tissue characteristics, and on the radioactive tracer and its carrying molecule ( Refs 37,38). This is another diagnostic tool that requires a radiolabelled antibody to be administered intravenously before surgery.…”

CdTe compact gamma camera for coded aperture imaging in radioguided surgery

“…Radio-guided surgery (RGS) is a surgical technique that facilitates the identification, and then the surgical excision, of a tissue "marked" preoperatively by a specific radiopharmaceutical [1,2]. Detection of bone tumors and parathyroid adenoma, radioimmunoguided surgery for colon cancer, sentinel-node mapping for breast tumor or melanoma tumor therapy, are typical applications of RGS [3].…”