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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.

Hall NC, Povoski SP, Murrey DA, Knopp MV, Martin EW - World J Surg Oncol (2007)

Bottom Line: 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.Immediate preoperative and postoperative PET/CT imaging, utilizing the same 18F-FDG injection dose, is feasible and image quality is acceptable.

View Article: PubMed Central - HTML - PubMed

Affiliation: Section of PET, Division of Nuclear Medicine, Department of Radiology, The Ohio State University, Columbus, OH, 43210, USA. nathan.hall@osumc.edu.

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.

No MeSH data available.


Related in: MedlinePlus

Preoperative PET maximum intensity projection in the lateral projection view (A) and cross sectional fused PET/CT images (B). The preoperative PET/CT scan revealed two hypermetabolic foci, representing the left breast primary tumor and the solitary left axillary metastasis.
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Figure 1: Preoperative PET maximum intensity projection in the lateral projection view (A) and cross sectional fused PET/CT images (B). The preoperative PET/CT scan revealed two hypermetabolic foci, representing the left breast primary tumor and the solitary left axillary metastasis.

Mentions: On the day of surgery, the preoperative clinical PET/CT demonstrated a solitary hypermetabolic lesion within the left breast with a peak SUV of 14.2 and a solitary hypermetabolic lesion in the left axilla with a peak SUV of 6.6 (Figure 1).


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.

Hall NC, Povoski SP, Murrey DA, Knopp MV, Martin EW - World J Surg Oncol (2007)

Preoperative PET maximum intensity projection in the lateral projection view (A) and cross sectional fused PET/CT images (B). The preoperative PET/CT scan revealed two hypermetabolic foci, representing the left breast primary tumor and the solitary left axillary metastasis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2235860&req=5

Figure 1: Preoperative PET maximum intensity projection in the lateral projection view (A) and cross sectional fused PET/CT images (B). The preoperative PET/CT scan revealed two hypermetabolic foci, representing the left breast primary tumor and the solitary left axillary metastasis.
Mentions: On the day of surgery, the preoperative clinical PET/CT demonstrated a solitary hypermetabolic lesion within the left breast with a peak SUV of 14.2 and a solitary hypermetabolic lesion in the left axilla with a peak SUV of 6.6 (Figure 1).

Bottom Line: 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.Immediate preoperative and postoperative PET/CT imaging, utilizing the same 18F-FDG injection dose, is feasible and image quality is acceptable.

View Article: PubMed Central - HTML - PubMed

Affiliation: Section of PET, Division of Nuclear Medicine, Department of Radiology, The Ohio State University, Columbus, OH, 43210, USA. nathan.hall@osumc.edu.

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.

No MeSH data available.


Related in: MedlinePlus