Intraoperative radioguidance with a portable gamma camera: a novel technique for laparoscopic sentinel node localisation in urological malignancies

Vermeeren, Lenka; Olmos, Renato A. Valdés; Meinhardt, W.; Bex, Axel; Poel, Henk G. van der; Vogel, Wouter V.; Sivro, Ferida; Hoefnagel, Cornelis A.; Horenblas, Simon

doi:10.1007/s00259-009-1100-6

Cited by 79 publications

(50 citation statements)

References 16 publications

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“…37,38 This approach was useful for localizing SN in 27% of the 55 patients who had SN in difficult anatomical localizations and patients with high BMI. 39 …”

Section: Gamma Cameramentioning

confidence: 99%

Advances in sentinel node dissection in prostate cancer from a technical perspective

et al. 2015

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Abbreviations & Acronyms ePLND = extended pelvic lymph node dissection FN = false negative ICG = indocyanine green LN = lymph node MRI = magnetic resonance imaging NIR = near-infrared NR = not reported PCa = prostate cancer PET = positron emission tomography PLND = pelvic lymph node dissection SN = sentinel node SPECT-CT = single-photon emission computed tomography combined with computed tomography TRUS = transrectal ultrasound Abstract: The most important feature of sentinel node biopsy for prostate cancer procedure is that staging can be improved. Sentinel nodes might be found outside the extended pelvic lymph node dissection template what renders the sentinel node additive of extended pelvic lymph node dissection. At the same time, staging within the template can be further refined. We reviewed the literature regarding the sentinel node biopsy procedure for prostate cancer. PubMed and Embase were searched for all Englishlanguage publications from January 1999 to September 2014 by using the keywords as "prostate cancer" and "sentinel lymph node" plus "biopsy" "dissection" and/or "procedure." The present review discusses step-by-step sentinel node biopsy for prostate cancer. Topics of discussion are: (i) preoperative sentinel node mapping (tracers and imaging); (ii) intraoperative sentinel node identification (surgical procedure and outcome); and (iii) novelties to improve sentinel node identification (pre-and intraoperative approaches). Conventional sentinel node mapping is carried out after the injection of a 99m Tc-based tracer and subsequent preoperative imaging; for example, lymphoscintigraphy and singlephoton emission computed tomography/computed tomography. This approach allowed the detection of sentinel nodes outside the extended lymph node dissection template in 3.6-36% of men with intermediate-and high-risk prostate cancer. Hereby, an overall false negative rate of sentinel nodes was reported between 0% and 24.4%. To further refine the intraoperative sampling procedure, novel imaging methods such as fluorescence imaging have been introduced. Prospective randomized comparison studies are required to confirm the added benefit of sentinel template directed nodal dissection. A proper and obtainable end-point of such a study could be the number of removed positive nodes for carrying out nodal dissection with or without sentinel template directed dissection. Similarly, the clinical impact of novel imaging technologies requires further investigation.

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“…37,38 This approach was useful for localizing SN in 27% of the 55 patients who had SN in difficult anatomical localizations and patients with high BMI. 39 …”

Section: Gamma Cameramentioning

confidence: 99%

Advances in sentinel node dissection in prostate cancer from a technical perspective

et al. 2015

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“…These portable devices can be oriented to the surgical targets in the operating room based on the anatomical landmarks previously established by SPECT/CT fused images [6]. In both open surgery and laparoscopy, this small device may be used in combination with the standard gamma probe or the laparoscopic probe.…”

Section: Technological Innovationmentioning

confidence: 99%

Technological innovation in the sentinel node procedure: towards 3-D intraoperative imaging

Olmos

Vidal-Sicart

Nieweg

2010

Eur J Nucl Med Mol Imaging

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“…SNs are widely used in breast cancer, melanoma and head and neck cancer, but in the last decade, their use has expanded to additional indications, with more sophistication and complexity in the technique, including indications in urology, gynaecology and gastroenterology. The addition of PGCs has improved the SN technique, particularly when intraoperative tracer injection is needed or in laparoscopic SN localization [7][8][9].In breast cancer, the main indication for a SN procedure worldwide, usually no laparoscopic technique and no intraoperative tracer injection is needed. The utility of the PGC in breast cancer remains only when no conventional gamma camera is available, and in particular in cases with extra-axillary drainage.…”

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Portable gamma cameras: the real value of an additional view in the operating theatre

Duch

2011

Eur J Nucl Med Mol Imaging

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It has been a long time since the preliminary portable gamma cameras (PGCs) were developed [1]. During the last decade some PGCs have become available for clinical practice, and can be used in open surgery or with laparoscopy, providing information that can be combined with that coming from conventional or laparoscopic gamma probes. Some of these PGCs are not designed specifically for radioguided surgery (Dilon 6800 gamma camera, a model optimized to perform breast-specific gamma imaging, or Cardiotom 3D mobile gamma camera, optimized to perform myocardial perfusion scintigraphy), but other models are focused on sentinel node (SN) procedures [2][3][4].In this issue of the journal, Vidal-Sicart et al.[5] report on the use of the Sentinella S102 (Oncovision) camera, which is a compact scintillation camera with a 50×50× 4 mm 3 CsI crystal optically coupled through a light guide to a flat panel type position-sensitive photomultiplier tube. This model is connected to a computer via USB, which processes the output signals and provides energy to the detector system. It has three interchangeable pin-hole collimators with apertures of diameter 1.0, 2.5 and 4 mm, and is mounted in a support to facilitate transport to the operating theatre. This support also incorporates a touchsensitive screen, which allows images to be viewed with ease throughout the surgical process. The intrinsic spatial resolution is approximately 2 mm and the energy resolution is 13% at 140 keV [6]. This PGC is provided with laser devices, which can help centre the image acquisitions, and it can also acquire images from dual isotopes. It is able to use a pointer (i.e. of iodine-125) to help localize hot spots seen on the screen.The main application of these devices is in SN procedures. SNs are widely used in breast cancer, melanoma and head and neck cancer, but in the last decade, their use has expanded to additional indications, with more sophistication and complexity in the technique, including indications in urology, gynaecology and gastroenterology. The addition of PGCs has improved the SN technique, particularly when intraoperative tracer injection is needed or in laparoscopic SN localization [7][8][9].In breast cancer, the main indication for a SN procedure worldwide, usually no laparoscopic technique and no intraoperative tracer injection is needed. The utility of the PGC in breast cancer remains only when no conventional gamma camera is available, and in particular in cases with extra-axillary drainage. In breast cancer, the use of PGCs in radioguided occult lesion localization combined with a conventional gamma probe has been described [7].In head and neck cancers the usefulness of the PGC seems more clear, because of the unpredictable lymphatic drainage and the possibility of comparing the preoperative image and the intraoperative image in order to ensure that no SN is missed. This is made possible by PGCs as they can give an overview of all radioactive hot spots within the surgical field. Prior SPECT images may be mandatory in head and nec...

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Intraoperative radioguidance with a portable gamma camera: a novel technique for laparoscopic sentinel node localisation in urological malignancies

Abstract: The use of a portable gamma camera in combination with a laparoscopic gamma probe incorporates intraoperative real-time imaging with improved SN identification in urological malignancies. This procedure might also be useful for SN identification of other deep draining malignancies.

Cited by 79 publications

References 16 publications

Advances in sentinel node dissection in prostate cancer from a technical perspective

Advances in sentinel node dissection in prostate cancer from a technical perspective

Technological innovation in the sentinel node procedure: towards 3-D intraoperative imaging

Portable gamma cameras: the real value of an additional view in the operating theatre

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