Intraoperative Molecular Positron Emission Tomography Imaging for Intraoperative Assessment of Radical Prostatectomy Specimens

Darr, Christopher; Costa, Pedro Fragoso; Kahl, Theresa; Moraitis, Alexandros; Engel, Jenna; Al-Nader, Mulham; Reis, Henning; Köllermann, Jens; Kesch, Claudia; Krafft, Ulrich; Maurer, Tobias; Köhler, Daniel; Klutmann, Susanne; Falkenbach, Fabian; Kleesiek, Jens; Fendler, Wolfgang P.; Hadaschik, Boris A.; Herrmann, Ken

doi:10.1016/j.euros.2023.05.017

Cited by 12 publications

(4 citation statements)

References 9 publications

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“…Promising evidence from previous studies has demonstrated a good correspondence between the lymph nodal PSMA uptake at intraoperative PET/CT imaging and the metastatic tumor involvement at histopathological analysis [ 20 , 21 ]. These findings are in agreement with the results of a preliminary case series analysis of three high-risk prostate cancer patients undergoing RARP and PLND with the use of the intraoperative PET/CT specimen imager performed at our center [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…This new device generates high-resolution 3D PET/CT specimen images within a few minutes from the excision and with a near five-fold increase in spatial resolution, thus supporting the assessment of the resection margin's status, facilitating the detection of nodal metastases and holding promise for potentially guiding surgical procedures in the future. Intraoperative PET/CT specimen imaging has shown promising results in multiple oncological settings, including 18 F-FDG avid breast cancer [17], head and neck cancer [18], pancreatic adenocarcinoma [19], as well as SSTR-expressing neuroendocrine tumors and PSMA-expressing prostate cancer [20,21].…”

Section: Introductionmentioning

confidence: 99%

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Machine Learning CT-Based Automatic Nodal Segmentation and PET Semi-Quantification of Intraoperative 68Ga-PSMA-11 PET/CT Images in High-Risk Prostate Cancer: A Pilot Study

Rovera,

Grimaldi,

Oderda

et al. 2023

Diagnostics

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High-resolution intraoperative PET/CT specimen imaging, coupled with prostate-specific membrane antigen (PSMA) molecular targeting, holds great potential for the rapid ex vivo identification of disease localizations in high-risk prostate cancer patients undergoing surgery. However, the accurate analysis of radiotracer uptake would require time-consuming manual volumetric segmentation of 3D images. The aim of this study was to test the feasibility of using machine learning to perform automatic nodal segmentation of intraoperative 68Ga-PSMA-11 PET/CT specimen images. Six (n = 6) lymph-nodal specimens were imaged in the operating room after an e.v. injection of 2.1 MBq/kg of 68Ga-PSMA-11. A machine learning-based approach for automatic lymph-nodal segmentation was developed using only open-source Python libraries (Scikit-learn, SciPy, Scikit-image). The implementation of a k-means clustering algorithm (n = 3 clusters) allowed to identify lymph-nodal structures by leveraging differences in tissue density. Refinement of the segmentation masks was performed using morphological operations and 2D/3D-features filtering. Compared to manual segmentation (ITK-SNAP v4.0.1), the automatic segmentation model showed promising results in terms of weighted average precision (97–99%), recall (68–81%), Dice coefficient (80–88%) and Jaccard index (67–79%). Finally, the ML-based segmentation masks allowed to automatically compute semi-quantitative PET metrics (i.e., SUVmax), thus holding promise for facilitating the semi-quantitative analysis of PET/CT images in the operating room.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Machine Learning CT-Based Automatic Nodal Segmentation and PET Semi-Quantification of Intraoperative 68Ga-PSMA-11 PET/CT Images in High-Risk Prostate Cancer: A Pilot Study

Rovera,

Grimaldi,

Oderda

et al. 2023

Diagnostics

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“…PSMA PET/CT has also been used for intraoperative imaging 79 . Intraoperative PET/CT imaging (AURA10; XEOS Medical, Gent, Belgium) was first used to detect specimens from RP and lymphadenectomy ex vivo in a prospective two-center feasibility study 80 , 81 . This technique can provide a quicker method to detect PSMs in resected specimens than frozen section analysis; however, this type of imaging also has obvious shortcomings.…”

Section: Psma-rgsmentioning

confidence: 99%

Prostate-specific membrane antigen-targeted surgery in prostate cancer: Accurate identification, real-time diagnosis, and precise resection

Jiao,

Zhang,

Wen

et al. 2024

Theranostics

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Radical prostatectomy (RP) combined with pelvic lymph node dissection (PLND) is the first step in multimodal treatment of prostate cancer (PCa) without distant metastases. For a long time, the surgical resection range has been highly dependent on the surgeon's visualization and experience with preoperative imaging. With the rapid development of prostate-specific membrane antigen positron emission tomography and single-photon emission computed tomography (PSMA-PET and PSMA-SPECT), PSMA-targeted surgery has been introduced for a more accurate pathological diagnosis and complete resection of positive surgical margins (PSMs) and micro-lymph node metastases (LNMs). We reviewed PSMA-targeted surgeries, including PSMA-PET-guided prostatic biopsy (PSMA-TB), PSMA-targeted radio-guided surgery (PSMA-RGS), PSMA-targeted fluorescence-guided surgery (PSMA-FGS), and multi-modality/multi-targeted PSMA-targeted surgery. We also discuss the strengths and challenges of PSMA-targeted surgery, and propose that PSMA-targeted surgery could be a great addition to existing surgery protocols, thereby improving the accuracy and convenience of surgery for primary and recurrent PCa in the near future.

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“…In a dual-centre feasibility study (Darr et al 2023), the diagnostic potential of intraoperative ex vivo specimen PET/CT imaging in RP and lymphadenectomy specimens was assessed for ten patients with high-risk PCa. Preoperative PSMA PET/CT was performed, and resected specimens were re-evaluated using AURA10® PET/CT device.…”

Section: Dedicated Pet Scanner For Specimen Imagingmentioning

confidence: 99%

Innovations in dedicated PET instrumentation: from the operating room to specimen imaging

Arabi,

Manesh,

Zaidi

2024

Phys. Med. Biol.

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This review casts a spotlight on intraoperative PET scanners and the distinctive challenges they confront. Specifically, these systems contend with the necessity of partial coverage geometry, essential for ensuring adequate access to the patient. This inherently leans them towards limited-angle PET imaging, bringing along its array of reconstruction and geometrical sensitivity challenges. Compounding this, the need for real-time imaging in navigation systems mandates rapid acquisition and reconstruction times. For these systems, the emphasis is on dependable PET image reconstruction (without significant artifacts) while rapid processing takes precedence over the spatial resolution of the system. In contrast, specimen PET imagers are unburdened by the geometrical sensitivity challenges, thanks to their ability to leverage full coverage PET imaging geometries. For these devices, the focus shifts: high spatial resolution imaging takes precedence over rapid image reconstruction. This review concurrently probes into the technical complexities of both intraoperative and specimen PET imaging, shedding light on their recent designs, inherent challenges, and technological advancements.

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Intraoperative Molecular Positron Emission Tomography Imaging for Intraoperative Assessment of Radical Prostatectomy Specimens

Cited by 12 publications

References 9 publications

Machine Learning CT-Based Automatic Nodal Segmentation and PET Semi-Quantification of Intraoperative 68Ga-PSMA-11 PET/CT Images in High-Risk Prostate Cancer: A Pilot Study

Machine Learning CT-Based Automatic Nodal Segmentation and PET Semi-Quantification of Intraoperative 68Ga-PSMA-11 PET/CT Images in High-Risk Prostate Cancer: A Pilot Study

Prostate-specific membrane antigen-targeted surgery in prostate cancer: Accurate identification, real-time diagnosis, and precise resection

Innovations in dedicated PET instrumentation: from the operating room to specimen imaging

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