PET probe-guided surgery: applications and clinical protocol

Güleç, Seza A.; Hoenie, Erica; Hostetter, R.; Schwartzentruber, Douglas J.

doi:10.1186/1477-7819-5-65

Cited by 60 publications

(57 citation statements)

References 11 publications

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“…In the last few years, hand-held devices for both PET and SPECT have been developed and used for intraoperative applications (137,433), and in both cases have proven successful in guiding excisions of various tumors. Van Haren and Fitzgerald (433) reported that [ 111 In]-DPTA-octreotide in combination with an intraoperative hand-held gamma camera device helped identify a nonfunctional neuroendocrine tumor that other techniques, including a CT scan and intraoperative investigation, failed to locate.…”

Section: Figure 5 Small Animal Positron Emission Tomography (Pet)mentioning

confidence: 99%

A Molecular Imaging Primer: Modalities, Imaging Agents, and Applications

James

Gambhir

2012

Physiological Reviews

940

954

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Molecular imaging is revolutionizing the way we study the inner workings of the human body, diagnose diseases, approach drug design, and assess therapies. The field as a whole is making possible the visualization of complex biochemical processes involved in normal physiology and disease states, in real time, in living cells, tissues, and intact subjects. In this review, we focus specifically on molecular imaging of intact living subjects. We provide a basic primer for those who are new to molecular imaging, and a resource for those involved in the field. We begin by describing classical molecular imaging techniques together with their key strengths and limitations, after which we introduce some of the latest emerging imaging modalities. We provide an overview of the main classes of molecular imaging agents (i.e., small molecules, peptides, aptamers, engineered proteins, and nanoparticles) and cite examples of how molecular imaging is being applied in oncology, neuroscience, cardiology, gene therapy, cell tracking, and theranostics (therapy combined with diagnostics). A step-by-step guide to answering biological and/or clinical questions using the tools of molecular imaging is also provided. We conclude by discussing the grand challenges of the field, its future directions, and enormous potential for further impacting how we approach research and medicine.

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Section: Figure 5 Small Animal Positron Emission Tomography (Pet)mentioning

confidence: 99%

A Molecular Imaging Primer: Modalities, Imaging Agents, and Applications

James

Gambhir

2012

Physiological Reviews

940

954

View full text Add to dashboard Cite

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“…Tumor-to-non-tumor and tumor-toorgan ratios are higher for delayed images than for the 1.5-hour routine images, and lesion detection is improved in nodal and hepatic metastases (20). Satisfactory count rates and TBR for surgical detection can be obtained 2-4 hours post-FDG administration, which makes this technique clinically feasible (13).…”

Section: Methodsmentioning

confidence: 87%

“…Data suggest that TBR improves over time up to 4 hours post-FDG administration (13). FDG metabolism and clearance occurs at a much faster rate in normal tissues than tumor tissue, and thus TBR improves with time, resulting in better lesion detection when imaging is delayed (19).…”

Section: Methodsmentioning

confidence: 89%

“…In addition, despite advances in diagnostic assessment using PET and the availability of new systemic treatment options, the treatment paradigm in oncology has shifted towards more aggressive therapeutic interventions, including cytoreductive techniques and metastasectomy. Intraoperative localization of PET-positive recurrent or metastatic lesions can be facilitated using a hand-held PET probe, thus improving the success of surgical exploration in selected indications (13). Locating a lesion that is not easily seen or palpated during routine surgical exploration is probably the strongest indication for PET probeguided procedure.…”

mentioning

confidence: 99%

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PET Probe-Guided Surgery in Patients with Breast Cancer: Proposal for a Methodological Approach

Orsaria

Chiaravalloti

Fiorentini

et al. 2017

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Nuclear medicine has an essential and increasing role in the management of patients with breast cancer. Sentinel node detection has achieved reliability and, at present, it has an important place in clinical management. Even in the era of gene-expression profiling, nodal status remains one of the primary prognostic discriminants in patients with breast cancer, and is of great value as an independent predictor of distant disease development. Although several institutional case series have differed in patient selection, follow-up, type of surgery, and adjuvant therapies, they have consistently shown that the percentage of positive lymph nodes is a significant indicator of survival in women with axillary metastases on final pathology (1-5). The American Society of Clinical Oncology convened an Update Committee of experts to provide evidence-based recommendations to practicing oncologists, surgeons, and radiation therapy clinicians on the use of sentinel node biopsy (SNB) for patients with early-stage breast cancer (6). The need to perform axillary lymph node dissection (ALND) when SNB is positive and administration of contemporary adjuvant treatment including radiotherapy, chemotherapy, and hormonal therapy has been questioned in recent years. On the other hand, ongoing trials are testing whether node-positive patients can be spared chemotherapy, as qualifying indications increasingly rely on breast cancer biology for decision-making regarding adjuvant systemic treatment (7). In summary, sentinel node surgery represents the next major step in reducing the extent of surgical procedures, but despite the revolution of quality-conserving care, recent data collection and analyses of anatomical techniques suggest that exact lymphatic drainage of the breast is debatable (8). Different lymphatic patterns may help explain some important unresolved clinical problems, including different detection rates between studies and high false-negative rates of about 10% in multicenter randomized controlled trials (9). Further anatomical investigation and knowledge of the exact sentinel lymphatic channels will provide more information about patterns of breast cancer in order to improve surgical strategy, locoregional recurrence, and survival.

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“…This may be difficult in case of prior surgery or chemo-or radiation therapy. To overcome this limitation, we propose to use a sensor that is small enough to be used during operations [1], while being sensitive to the same radioactive tracers utilised in PET scans [2]. This limits the radioactive dose to which the patient is exposed, to the amount required for a PET scan.…”

Section: Introductionmentioning

confidence: 99%