Intraoperative radioimmunodetection of colorectal tumor with a hand-held radiation detector

Gamma probe-assisted brain tumor microsurgical resection: a new technique

“…Gamma probe-assisted surgery (GPAS) or radioguided surgery (RGS), enabled by the development of the gamma probe 12 , was clinically introduced by Martin et al 4 , in 1985, in an attempt to facilitate intraoperative tumor detection and its complete removal. The principle of the procedure is quite logical: a substance, known for its affinity to a particular tumor, is labeled with a gamma-emitting radionuclide and injected in the patient, usually intravenously, some time before the operation.…”

“…The gamma-probe is resistant, portable, not too expensive and easy to use, presenting a high sensitivity and specificity, as demonstrated by the GPAS performed to remove a wide variety of tumors [3][4][5]9,10,[20][21][22][23][24][25] and sentinel-nodes [13][14][15][16][17][18][19] . In fact, its sensitivity se- ems to be greater than that of CT (Bell et al 3 : 11 of 13 patients harboring ovarian cancer underwent preoperative CT-scan, which was normal in all of them), MRI (Martinez et al 23 : one out of three patients with parathyroid disease underwent preoperative MRI and CT, being both normal) and external scintigraphy (Martin et al 4 : this procedure was normal in 11 out of 23 patients with colorectal tumor).…”

“…In fact, its sensitivity se- ems to be greater than that of CT (Bell et al 3 : 11 of 13 patients harboring ovarian cancer underwent preoperative CT-scan, which was normal in all of them), MRI (Martinez et al 23 : one out of three patients with parathyroid disease underwent preoperative MRI and CT, being both normal) and external scintigraphy (Martin et al 4 : this procedure was normal in 11 out of 23 patients with colorectal tumor).…”

“…Nuclear medicine techniques, though, conti-nued to evolve. The constant sophistication of the gamma-cameras (with two, three and four heads, and more recently, a new device named hawkeyes) and the discovery of new radionuclides (technetium99m Tc, thallium-201 Tl, iodine-123 I and 125 I) 1, 2 and of their carrying molecules [antibodies against antigens found in some tumors (B72.3, anticarcinoembryonic antigen antibody), iodo-á-methyltyrosine, hexamethylpropyleneamine-oxime (HMPAO), ethyl cysteinate dimmer -ECD, hexakis-2-methoxyisobutylisonitrile (MIBI or SESTAMIBI), tetrofosmin, furifosmin, metaiodobenzylguanidine, octreotide] greatly improved the sensitivity, specificity and quality of the images produced by this method [1][2][3][4][5][6][7][8][9][10] .…”

“…Considering that the sensitivity and specificity of radiodetection increase by minimizing the distance between the source (radiotracer) and the detector, Martin et al 12 developed, experimentally, a hand-held self-contained gamma detecting device, the gamma probe, for intraoperative use, enabling the surgeon to identify radioactive tissues targeted by a preadministered gamma-emitting tumor-associated radiolabeled substance (radiotracer). This technique, named by others as radioguided surgery (RGS) and by the present authors as gamma probe-assisted surgery (GPAS), was introduced into clinical practice in 1985 by Martin et al 3,4 , allowing them to promptly recognize the lesion in 28 patients harboring colorectal tumors. Using a variety of radiolabeled substances [1][2][3][4][5][6][7][8][9][10] , many authors have performed GPAS to map sentinelnodes of melanomas 13 , of breast 14 , vulvar 15 , cervical 16 , prostate 17 , penile 18 and thyroid 19 cancer, and to identify breast (the radiolabeled substance may be injected intravenously 20 and within 21 or around 22 the tumor), ovarian 3 , colorectal 4,5 , gastroenteropancreatic 10 , parathyroid 23 and thyroid 24,25 tumors and neuroblastomas 9 , with a significant successful rate.…”