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European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 13/2016

01-12-2016 | Original Article

Fusion of freehand SPECT and ultrasound: First experience in preoperative localization of sentinel lymph nodes

Authors: Christina Bluemel, Gonca Safak, Andreas Cramer, Achim Wöckel, Anja Gesierich, Elena Hartmann, Jan-Stefan Schmid, Franz Kaiser, Andreas K. Buck, Ken Herrmann

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 13/2016

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Abstract

Purpose

Radioguided sentinel lymph node biopsy (SLNB) is the standard of care in breast cancer and melanoma. Additional preoperative Single-photon emission computed tomography (SPECT/CT) for improved anatomical co-registration of the SLNs causes additional radiation exposure and is time-consuming and expensive. The aim of this prospective study was to evaluate a novel approach involving real-time fusion of freehand SPECT (fhSPECT) and ultrasound (US) for anatomical co-registration of SLNs.

Methods

From February 2015 to February 2016, 153 patients were included in this prospective study. All patients underwent lymphoscintigraphy according to practical guidelines and 151 (118 cases of breast cancer, 30 cutaneous malignancies, and three cases of vulvar cancer) of the 153 patients were additionally investigated with fhSPECT-US. FhSPECT connected to a hand-held gamma detector generates three-dimensional images of the radioactivity distribution in the scanned area. For co-registration and real-time fusion of fhSPECT and subsequently performed US, an infrared stereo tracking system was used.

Results

In all patients an SLN was found on lymphoscintigraphy, and the fhSPECT detected corresponding hotspots in all but one patient. In 72 % of patients and 73 % of lymph node basins, real-time anatomical co-registration with US was feasible. The rate of success in achieving good co-registration increased from 60 to 75 % after training by a radiologist specialized in breast imaging. A higher co-registration rate (78 %) was observed in patients with only one SLN than in those with two SLNs (68 %) or three or more SLNs (0 %).

Conclusions

Real-time fusion of fhSPECT and US for preoperative anatomical co-registration of SLNs is feasible. However, before this approach can completely replace preoperative lymphatic imaging, further technical developments are needed.
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Metadata
Title
Fusion of freehand SPECT and ultrasound: First experience in preoperative localization of sentinel lymph nodes
Authors
Christina Bluemel
Gonca Safak
Andreas Cramer
Achim Wöckel
Anja Gesierich
Elena Hartmann
Jan-Stefan Schmid
Franz Kaiser
Andreas K. Buck
Ken Herrmann
Publication date
01-12-2016
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 13/2016
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-016-3443-0

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