Recent advances in nuclear and hybrid detection modalities for image-guided surgery

Oosterom, Matthias N. van; Rietbergen, Daphne D. D.; Welling, Mick M.; Poel, Henk G. van der; Maurer, Tobias; Leeuwen, Fijs W. B. van

doi:10.1080/17434440.2019.1642104

Cited by 79 publications

(53 citation statements)

References 247 publications

(276 reference statements)

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“…The findings presented here indicate that, similar to what has been reported for radioguided surgery (2,7,21), the accuracy of fluorescence-guided surgery regarding lesions in unknown locations is related to the availability of accurate surgical road maps in the form of preoperative imaging data. This indication not only supports the concept of using hybrid tracers for surgical guidance (22) but also strengthens the suggested use of intraoperative augmented and virtual-reality-based navigation to improve the position of the fluorescence camera relative to the lesion location (23).…”

Section: Discussionsupporting

confidence: 69%

Can Intraoperative Fluorescence Imaging Identify All Lesions While the Road Map Created by Preoperative Nuclear Imaging Is Masked?

et al. 2019

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Tracers can help visualize the lymphatic drainage patterns and sentinel nodes (SNs) of individual prostate cancer patients. To determine the role of nuclear medicine in surgical guidance, in particular the positional guidance of a SPECT/CT-based 3dimensional imaging road map, in this process we studied to what extent fluorescence guidance underestimated the number of target lesions relative to radioguidance. Methods: SPECT/CT imaging was performed after intraprostatic tracer administration of either indocyanine green (ICG)-99m Tc-nanocolloid (hybrid-tracer group) or 99m Tc-nanocolloid to create a road map that depicted all SNs. Patients who received 99m Tc-nanocolloid were injected with "free" ICG immediately before surgery. Before unmasking, fluorescence guidance was used for intraoperative SN identification. This was followed by extended pelvic lymph node dissection (ePLND). After unmasking of the SPECT/CT images, the number of missed SNs was recorded and their resection was pursued when there was no risk of intraoperative complications. Results: Preoperative SPECT/ CT revealed no differences in the SN identification rate between ICG-99m Tc-nanocolloid and 99m Tc-nanocolloid. However, fluorescence guidance allowed intraoperative removal of all SNs in only 40% of patients in the hybrid-tracer group and 20% of patients in the free-ICG group. Overall, 75.9% of the intraoperatively resected SNs in the hybrid-tracer group and 51.8% of the SNs in the free-ICG group were removed solely under fluorescence guidance. During ePLND, 22 additional SNs were resected (7 in the hybrid-tracer group and 15 in the free-ICG group). After unmasking, 18 remaining SNs were identified (6 in the hybrid group and 12 in the free-ICG group). In the free-ICG group, ex vivo evaluation of the excised specimens revealed that 14 SNs removed under ePLND or after unmasking contained radioactivity but no fluorescence. Conclusion: The preoperative imaging road map provided by SPECT/CT enhanced the detection of prostate SNs in more ectopic locations in 17 of the 25 patients, and the hybrid tracer ICG-99m Tc-nanocolloid was shown to outperform free ICG. Overall, fluorescenceguided pelvic nodal surgery underestimated the number of SNs in 60%-80% of patients.

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Section: Discussionsupporting

confidence: 69%

Can Intraoperative Fluorescence Imaging Identify All Lesions While the Road Map Created by Preoperative Nuclear Imaging Is Masked?

et al. 2019

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“…Especially, fused biochemical and anatomic information obtained through PET/CT, PET/MR, and SPECT/CT help place suspected pathologic conditions in their anatomic context (a road map) (6). Intraoperatively, real-time g-probebased tracing is currently the method of choice in radioguided surgery; however, in some cases this method is also complemented by intraoperatively acquired static images obtained using, for example, a portable g-camera or a freehand SPECT scan (7). Intraoperative radioguidance has been successfully applied in several targeted applications ( Fig.…”

Section: The Competitive and Symbiotic Aspects Of Radioguided And Flumentioning

confidence: 99%

Trending: Radioactive and Fluorescent Bimodal/Hybrid Tracers as Multiplexing Solutions for Surgical Guidance

et al. 2019

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By contributing to noninvasive molecular imaging and radioguided surgery, nuclear medicine has been instrumental in the realization of precision medicine. During the last decade, it has also become apparent that nuclear medicine (e.g., in the form of bimodal/hybrid tracers) can help to empower fluorescenceguided surgery. More specifically, when using hybrid tracers, lesions can be noninvasively identified and localized with a high sensitivity and precision (guided by the radioisotope) and ultimately resected under real-time optical guidance (fluorescent dye). This topical review discusses early clinical successes, preclinical directions, and key aspects that could have an impact on the future of this field.

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“…Nowadays, a noticeable amount of commercially available radiopharmaceuticals is used for radioguided surgery (4). Radioguidance based on low-energy (<150 keV) gamma-ray emitting radiopharmaceuticals is most commonly applied for sentinel lymph node (SN) biopsy procedures using (indocyanine green-) 99m Tc-nanocolloid (5), radioguided occult lesion localization (ROLL) procedures using 99m Tc-labeled macro-aggregates (6), radioguided 125 I-seed localization (RSL) procedures (7) and 99m Tc-PSMA-guided resection of lymph node metastases in prostate cancer patients (3).…”

Section: Introductionmentioning

confidence: 99%

A DROP-IN beta probe for robot-assisted 68Ga-PSMA radioguided surgery: first ex vivo technology evaluation using prostate cancer specimens

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Simoni

et al. 2020

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Background: Recently, a flexible DROP-IN gamma-probe was introduced for robot-assisted radioguided surgery, using traditional low-energy SPECT-isotopes. In parallel, a novel approach to achieve sensitive radioguidance using beta-emitting PET-isotopes has been proposed. Integration of these two concepts would allow to exploit the use of PET-tracers during robot-assisted tumor-receptor-targeted. In this study, we’ve engineered and validated the performance of a novel DROP-IN beta-particle (DROP-INb) detector.Methods: Seven prostate cancer patients with PSMA-PET positive tumors received an additional intraoperative injection of ~70 MBq 68Ga-PSMA-11, followed by robot-assisted prostatectomy and extended pelvic lymph node dissection. The surgical specimens from these procedures were used to validate the performance of our DROP-INb probe prototype, which merged a scintillating detector with a housing optimized for a 12 mm trocar and prograsp instruments. Results: After optimization of the detector and probe housing via Monte Carlo simulations, the resulting DROP-INb probe prototype was tested in a robotic setting. In the ex vivo setting, the probe – positioned by the robot- was able to identify 68Ga-PSMA-11 containing hot-spots in the surgical specimens: signal-to-background (S/B) was > 5 when pathology confirmed that the tumor was located <1 mm below the specimen surface. 68Ga-PSMA-11 containing (and PET positive) lymph nodes, as found in two patients, were also confirmed with the DROP-INb probe (S/B>3). The rotational freedom of the DROP-IN design and the ability to manipulate the probe with the prograsp tool allowed the surgeon to perform autonomous beta tracing. Conclusions: This study demonstrates the feasibility of beta-radioguided surgery in a robotic context by means of a DROP-INb detector. When translated to an in vivo setting in the future, this technique could provide a valuable tool in detecting tumor remnants on the prostate surface and in confirmation of PSMA-PET positive lymph nodes.

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Recent advances in nuclear and hybrid detection modalities for image-guided surgery

Cited by 79 publications

References 247 publications

Can Intraoperative Fluorescence Imaging Identify All Lesions While the Road Map Created by Preoperative Nuclear Imaging Is Masked?

Can Intraoperative Fluorescence Imaging Identify All Lesions While the Road Map Created by Preoperative Nuclear Imaging Is Masked?

Trending: Radioactive and Fluorescent Bimodal/Hybrid Tracers as Multiplexing Solutions for Surgical Guidance

A DROP-IN beta probe for robot-assisted 68Ga-PSMA radioguided surgery: first ex vivo technology evaluation using prostate cancer specimens

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