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Radio-guided occult lesion localisation using iodine 125 Seeds "ROLLIS" to guide surgical removal of an impalpable posterior chest wall melanoma metastasis.

Dissanayake S, Dissanayake D, Taylor DB - J Med Radiat Sci (2015)

Bottom Line: A new technique involves intra-lesional insertion of a low-activity iodine-125 ((125)I) seed and detection of the radioactive signal in theatre using a hand-held gamma probe to guide surgery.Whilst several studies describe using this method to guide the removal of impalpable breast lesions, only a handful of publications report its use to guide excision of lesions outside the breast.We describe a case in which radio-guided occult lesion localisation using an iodine 125 seed was used to guide excision of an impalpable posterior chest wall metastasis detected on PET-CT.

View Article: PubMed Central - PubMed

Affiliation: Western Hospital Footscray, Victoria, Australia.

ABSTRACT
Cancer screening and surveillance programmes and the use of sophisticated imaging tools such as positron emission tomography-computed tomography (PET-CT) have increased the detection of impalpable lesions requiring imaging guidance for excision. A new technique involves intra-lesional insertion of a low-activity iodine-125 ((125)I) seed and detection of the radioactive signal in theatre using a hand-held gamma probe to guide surgery. Whilst several studies describe using this method to guide the removal of impalpable breast lesions, only a handful of publications report its use to guide excision of lesions outside the breast. We describe a case in which radio-guided occult lesion localisation using an iodine 125 seed was used to guide excision of an impalpable posterior chest wall metastasis detected on PET-CT.

No MeSH data available.


Related in: MedlinePlus

Ultrasound guided seed insertion (A) Long-axis view showing seed deployment needle (arrow) within a hypoechoic posterior chest wall mass corresponding to the lesion seen on the PET-CT study. (B) Long-axis and (C) short-axis views of the lesion taken immediately after seed deployment. The seed is seen as a linear echogenic structure (arrow).
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fig03: Ultrasound guided seed insertion (A) Long-axis view showing seed deployment needle (arrow) within a hypoechoic posterior chest wall mass corresponding to the lesion seen on the PET-CT study. (B) Long-axis and (C) short-axis views of the lesion taken immediately after seed deployment. The seed is seen as a linear echogenic structure (arrow).

Mentions: On the morning of surgery an 125I seed (∼2 MBq) was inserted using US (Fig.3A, B and C). In theatre, the surgeon used a hand-held gamma probe, set to detect the energy from the 27 keV photon emitted by the 125I seed to locate and remove the lesion. Successful removal of seed and lesion was confirmed by absent radioactive counts in the wound, high counts within the specimen and visualisation of the lesion and seed on X-ray (Fig.4A). Following tissue fixation, a further grid specimen radiograph (Fig.4B) demonstrated lesion and seed co-ordinates for the pathologist. Histopathology showed a 6 mm melanoma deposit with negative tumour margins. A follow-up F-18 FDG PET/CT scan showed only faint uptake in the surgical bed consistent with post-operative change (Fig.5A and B).


Radio-guided occult lesion localisation using iodine 125 Seeds "ROLLIS" to guide surgical removal of an impalpable posterior chest wall melanoma metastasis.

Dissanayake S, Dissanayake D, Taylor DB - J Med Radiat Sci (2015)

Ultrasound guided seed insertion (A) Long-axis view showing seed deployment needle (arrow) within a hypoechoic posterior chest wall mass corresponding to the lesion seen on the PET-CT study. (B) Long-axis and (C) short-axis views of the lesion taken immediately after seed deployment. The seed is seen as a linear echogenic structure (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4592678&req=5

fig03: Ultrasound guided seed insertion (A) Long-axis view showing seed deployment needle (arrow) within a hypoechoic posterior chest wall mass corresponding to the lesion seen on the PET-CT study. (B) Long-axis and (C) short-axis views of the lesion taken immediately after seed deployment. The seed is seen as a linear echogenic structure (arrow).
Mentions: On the morning of surgery an 125I seed (∼2 MBq) was inserted using US (Fig.3A, B and C). In theatre, the surgeon used a hand-held gamma probe, set to detect the energy from the 27 keV photon emitted by the 125I seed to locate and remove the lesion. Successful removal of seed and lesion was confirmed by absent radioactive counts in the wound, high counts within the specimen and visualisation of the lesion and seed on X-ray (Fig.4A). Following tissue fixation, a further grid specimen radiograph (Fig.4B) demonstrated lesion and seed co-ordinates for the pathologist. Histopathology showed a 6 mm melanoma deposit with negative tumour margins. A follow-up F-18 FDG PET/CT scan showed only faint uptake in the surgical bed consistent with post-operative change (Fig.5A and B).

Bottom Line: A new technique involves intra-lesional insertion of a low-activity iodine-125 ((125)I) seed and detection of the radioactive signal in theatre using a hand-held gamma probe to guide surgery.Whilst several studies describe using this method to guide the removal of impalpable breast lesions, only a handful of publications report its use to guide excision of lesions outside the breast.We describe a case in which radio-guided occult lesion localisation using an iodine 125 seed was used to guide excision of an impalpable posterior chest wall metastasis detected on PET-CT.

View Article: PubMed Central - PubMed

Affiliation: Western Hospital Footscray, Victoria, Australia.

ABSTRACT
Cancer screening and surveillance programmes and the use of sophisticated imaging tools such as positron emission tomography-computed tomography (PET-CT) have increased the detection of impalpable lesions requiring imaging guidance for excision. A new technique involves intra-lesional insertion of a low-activity iodine-125 ((125)I) seed and detection of the radioactive signal in theatre using a hand-held gamma probe to guide surgery. Whilst several studies describe using this method to guide the removal of impalpable breast lesions, only a handful of publications report its use to guide excision of lesions outside the breast. We describe a case in which radio-guided occult lesion localisation using an iodine 125 seed was used to guide excision of an impalpable posterior chest wall metastasis detected on PET-CT.

No MeSH data available.


Related in: MedlinePlus