New Applications of Radioguided Surgery in Oncology

Abstract

OBJECTIVE:To report oncological cases (excluding those related to breast cancer) for which radioguided surgery has been used in combination with the Radioguided Occult Lesion Localization technique. INTRODUCTION: Radioguided surgery enables a surgeon to identify lesions or tissues that have been preoperatively marked with radioactive substances. The Radioguided Occult Lesion Localization technique has been widely used to identify the sentinel lymph node and occult lesions in patients with breast cancer. However, few studies have reported the use of this technique for non-breast cancer pathologies. METHODOLOGY: In all cases, injection of Technecium-99m sulfur colloid was performed, directly inside or near by the suspicious lesion, guided by ultrasound or computed tomography, up to 36 hours prior to the surgical procedure. Intraoperative lesion detection was carried out using a gamma-probe. RESULTS: We report five oncology cases in which preoperative markings of the lesions were carried out using the Radioguided Occult Lesion Localization technique. The patients presented with the following: recurrence of renal cell carcinoma, cervical recurrence of papillary carcinoma of the thyroid, recurrence of retroperitoneal sarcoma, lesions of the popliteal fossa, and recurrence of rhabdomyosarcoma of a thigh. In each case, the lesions that were marked preoperatively were ultimately successfully excised. CONCLUSIONS: Radioguided surgery has proven to be a safe and effective alternative for the management of oncology patients. The Radioguided Occult Lesion Localization technique can be useful in selected cases where suspect lesions may be difficult to identify intraoperatively, due to their dimensions or anatomical location. The procedure allows for more conservative excisions and reduces the surgery-related morbidity.

Preoperative Localization of Neck Recurrences from Thyroid Cancer: Charcoal Tattooing Under Ultrasound Guidance

“…Other radio-guided methods as well as other radiotracers such as FDG were recently developed for the intraoperative guidance of non-radioiodine avid cancer but cost, availability, signal-tonoise issues may limit their widespread use (23)(24)(25)(26)(27)(28)(29)(30). Other modalities such as intraoperative US exploration, hook needle insertion or tattooing using blue dye has also been described but, This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction.…”

Rescue Radioguided Laparoscopy Surgery for Meckel's Diverticulum

“…Also, it enables cost savings and optimization of material and human resources. 10 – 12 We believe that the combination of radioguided surgery and SPECT/CT could be essential for lesions in difficult surgical locations due to the characteristics of the lesion itself or the individual peculiarities of the individual patient.…”

“…However, radioguided surgery is used to treat other intraabdominal lesions. Some authors described an interest in using radioguided surgery for resection of intraabdominal metastasis 9 , 10 while others have suggested the technique could be used to identify lymph node metastases and to confirm the complete resection of metastasis. 12 …”

Radioguided lymph node biopsy of a chemoresistant lymph node detected on interim FDG PET-CT in Hodgkin lymphoma

“…Some studies have reported the successful use of the ROLL in patients with recurrent thyroid carcinoma to remove non-palpable cervical lymph nodes [6,7], for localization of pulmonary nodules during thoracoscopy [8,9] and identification of non-palpable colonic lesions [10,11]. Bitencourt et al [12] reported five oncology cases in which marking of the lesions were carried out using the ROLL technique. The patients were diagnosed with recurrent renal cell carcinoma, thyroid cancer recurrence in the cervical region, recurrent retroperitoneal sarcoma, lesions of the popliteal fossa and recurrence of a rhabdomyosarcoma.…”