Top

World Journal of Surgical Oncology

Published in:

Open Access 01-12-2007 | Technical innovations

Combined approach of perioperative ¹⁸F-FDG PET/CT imaging and intraoperative ¹⁸F-FDG handheld gamma probe detection for tumor localization and verification of complete tumor resection in breast cancer

Authors: Nathan C Hall, Stephen P Povoski, Douglas A Murrey, Michael V Knopp, Edward W Martin Jr

Published in: World Journal of Surgical Oncology | Issue 1/2007

Abstract

Background

¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) has become an established method for detecting hypermetabolic sites of known and occult disease and is widely used in oncology surgical planning. Intraoperatively, it is often difficult to localize tumors and verify complete resection of tumors that have been previously detected on diagnostic PET/CT at the time of the original evaluation of the cancer patient. Therefore, we propose an innovative approach for intraoperative tumor localization and verification of complete tumor resection utilizing ¹⁸F-FDG for perioperative PET/CT imaging and intraoperative gamma probe detection.

Methods

Two breast cancer patients were evaluated. ¹⁸F-FDG was administered and PET/CT was acquired immediately prior to surgery. Intraoperatively, tumors were localized and resected with the assistance of a handheld gamma probe. Resected tumors were scanned with specimen PET/CT prior to pathologic processing. Shortly after the surgical procedure, patients were re-imaged with PET/CT utilizing the same preoperatively administered ¹⁸F-FDG dose.

Results

One patient had primary carcinoma of breast and a metastatic axillary lymph node. The second patient had a solitary metastatic liver lesion. In both cases, preoperative PET/CT verified these findings and demonstrated no additional suspicious hypermetabolic lesions. Furthermore, intraoperative gamma probe detection, specimen PET/CT, and postoperative PET/CT verified complete resection of the hypermetabolic lesions.

Conclusion

Immediate preoperative and postoperative PET/CT imaging, utilizing the same ¹⁸F-FDG injection dose, is feasible and image quality is acceptable. Such perioperative PET/CT imaging, along with intraoperative gamma probe detection and specimen PET/CT, can be used to verify complete tumor resection. This innovative approach demonstrates promise for assisting the oncologic surgeon in localizing and verifying resection of ¹⁸F-FDG positive tumors and may ultimately positively impact upon long-term patient outcomes.

Available only for authorised users

Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ: Cancer statistics, 2007. CA Cancer J Clin. 2007, 57: 43-66.CrossRefPubMed

Burak WE, Agnese DM, Povoski SP: Advances in the surgical management of early stage invasive breast cancer. Curr Probl Surg. 2004, 41: 882-935. 10.1067/j.cpsurg.2004.09.001.CrossRefPubMed

Breast Cancer Facts & Figures 2005–2006. 2007, American Cancer Society, Inc

Schirrmeister H, Kuhn T, Guhlmann A, Santjohanser C, Horster T, Nussle K, Koretz K, Glatting G, Rieber A, Kreienberg R, Buck AC, Reske SN: Fluorine-18 2-deoxy-2-fluoro-D-glucose PET in the preoperative staging of breast cancer: comparison with the standard staging procedures. Eur J Nucl Med. 2001, 28: 351-358. 10.1007/s002590000448.CrossRefPubMed

Chung A, Liou D, Karlan S, Waxman A, Fujimoto K, Hagiike M, Phillips EH: Preoperative FDG-PET for axillary metastases in patients with breast cancer. Arch Surg. 2006, 141: 783-788. 10.1001/archsurg.141.8.783. discussion 788-789.CrossRefPubMed

Port ER, Yeung H, Gonen M, Liberman L, Caravelli J, Borgen P, Larson S: 18F-2-fluoro-2-deoxy-D-glucose positron emission tomography scanning affects surgical management in selected patients with high-risk, operable breast carcinoma. Ann Surg Oncol. 2006, 13: 677-684. 10.1245/ASO.2006.03.035.CrossRefPubMed

Kumar R, Zhuang H, Schnall M, Conant E, Damia S, Weinstein S, Chandra P, Czerniecki B, Alavi A: FDG PET positive lymph nodes are highly predictive of metastasis in breast cancer. Nucl Med Commun. 2006, 27: 231-236. 10.1097/00006231-200603000-00005.CrossRefPubMed

Buscombe JR, Holloway B, Roche N, Bombardieri E: Position of nuclear medicine modalities in the diagnostic work-up of breast cancer. Q J Nucl Med Mol Imaging. 2004, 48: 109-118.PubMed

Martin EW, Thurston MO: The use of monoclonal antibodies (MAbs) and the development of an intraoperative hand-held probe for cancer detection. Cancer Invest. 1996, 14: 560-571. 10.3109/07357909609076901.CrossRefPubMed

10.

Iagaru A, Masamed R, Keesara S, Conti PS: Breast MRI and 18F FDG PET/CT in the management of breast cancer. Ann Nucl Med. 2007, 21: 33-38.CrossRefPubMed

11.

Radan L, Ben-Haim S, Bar-Shalom R, Guralnik L, Israel O: The role of FDG-PET/CT in suspected recurrence of breast cancer. Cancer. 2006, 107: 2545-2551. 10.1002/cncr.22292.CrossRefPubMed

12.

Tatsumi M, Cohade C, Mourtzikos KA, Fishman EK, Wahl RL: Initial experience with FDG-PET/CT in the evaluation of breast cancer. Eur J Nucl Med Mol Imaging. 2006, 33: 254-262. 10.1007/s00259-005-1835-7.CrossRefPubMed

13.

Avril N, Dose J, Janicke F, Ziegler S, Romer W, Weber W, Herz M, Nathrath W, Graeff H, Schwaiger M: Assessment of axillary lymph node involvement in breast cancer patients with positron emission tomography using radiolabeled 2-(fluorine-18)-fluoro-2-deoxy-D-glucose. J Natl Cancer Inst. 1996, 88: 1204-1209. 10.1093/jnci/88.17.1204.CrossRefPubMed

14.

Desai D, Arnold M, Saha S, Hinkle G, Soble D, Frye J, DePalatis L, Mantil J, Satter M, Martin E: Intraoperative Gamma Detection of FDG Distribution in Colorectal Cancer. Clin Positron Imaging. 1999, 2: 325-10.1016/S1095-0397(99)00085-0.CrossRefPubMed

15.

Desai DC, Arnold M, Saha S, Hinkle G, Soble D, Fry J, DePalatis LR, Mantil J, Satter M, Martin EW: Correlative Whole-Body FDG-PET and Intraoperative Gamma Detection of FDG Distribution in Colorectal Cancer. Clin Positron Imaging. 2000, 3: 189-196. 10.1016/S1095-0397(00)00052-2.CrossRefPubMed

16.

Sarikaya I, Povoski SP, Al-Saif OH, Kocak E, Bloomston M, Marsh S, Cao Z, Murrey DA, Zhang J, Hall NC, Knopp MV, Martin EW: Combined use of preoperative 18F FDG-PET imaging and intraoperative gamma probe detection for accurate assessment of tumor recurrence in patients with colorectal cancer. World J Surg Oncol. 2007, 5: 80-10.1186/1477-7819-5-80.PubMedCentralCrossRefPubMed

17.

Zervos EE, Desai DC, DePalatis LR, Soble D, Martin EW: 18F-labeled fluorodeoxyglucose positron emission tomography-guided surgery for recurrent colorectal cancer: a feasibility study. J Surg Res. 2001, 97: 9-13. 10.1006/jsre.2001.6092.CrossRefPubMed

18.

Essner R, Hsueh EC, Haigh PI, Glass EC, Huynh Y, Daghighian F: Application of an [(18)F]fluorodeoxyglucose-sensitive probe for the intraoperative detection of malignancy. J Surg Res. 2001, 96: 120-126. 10.1006/jsre.2000.6069.CrossRefPubMed

19.

Piert M, Burian M, Meisetschlager G, Stein HJ, Ziegler S, Nahrig J, Picchio M, Buck A, Siewert JR, Schwaiger M: Positron detection for the intraoperative localisation of cancer deposits. Eur J Nucl Med Mol Imaging. 2007, 34: 1534-1544. 10.1007/s00259-007-0430-5.PubMedCentralCrossRefPubMed

20.

Essner R, Daghighian F, Giuliano AE: Advances in FDG PET probes in surgical oncology. Cancer J. 2002, 8: 100-108.CrossRefPubMed

21.

Gulec SA, Daghighian F, Essner R: PET-Probe: Evaluation of Technical Performance and Clinical Utility of a Handheld High-Energy Gamma Probe in Oncologic Surgery. Ann Surg Oncol. 2006

22.

Meller B, Sommer K, Gerl J, von Hof K, Surowiec A, Richter E, Wollenberg B, Baehre M: High energy probe for detecting lymph node metastases with 18F-FDG in patients with head and neck cancer. Nuklearmedizin. 2006, 45: 153-159.PubMed

23.

Higashi T, Saga T, Ishimori T, Mamede M, Ishizu K, Fujita T, Mukai T, Sato S, Kato H, Yamaoka Y, Matsumoto K, Senda M, Konishi J: What is the most appropriate scan timing for intraoperative detection of malignancy using 18F-FDG-sensitive gamma probe? Preliminary phantom and preoperative patient study. Ann Nucl Med. 2004, 18: 105-114.CrossRefPubMed

24.

Nwogu C, Fischer G, Tan D, Glinianski M, Lamonica D, Demmy T: Radioguided detection of lymph node metastasis in non-small cell lung cancer. Ann Thorac Surg. 2006, 82: 1815-1820. 10.1016/j.athoracsur.2006.05.104. discussion 1820.CrossRefPubMed

25.

Franc BL, Mari C, Johnson D, Leong SP: The role of a positron- and high-energy gamma photon probe in intraoperative localization of recurrent melanoma. Clin Nucl Med. 2005, 30: 787-791. 10.1097/01.rlu.0000186856.86505.96.CrossRefPubMed

26.

Gulec SA, Hoenie E, Hostetter R, Schwartzentruber D: PET probe-guided surgery: applications and clinical protocol. World J Surg Oncol. 2007, 5: 65-10.1186/1477-7819-5-65.PubMedCentralCrossRefPubMed

27.

Piert M, Carey J, Clinthorne N: Probe-guided localization of cancer deposits using [(18)F]fluorodeoxyglucose. Q J Nucl Med Mol Imaging. 2007,

Title: Combined approach of perioperative 18F-FDG PET/CT imaging and intraoperative 18F-FDG handheld gamma probe detection for tumor localization and verification of complete tumor resection in breast cancer
Authors: Nathan C Hall
Stephen P Povoski
Douglas A Murrey
Michael V Knopp
Edward W Martin Jr
Publication date: 01-12-2007
Publisher: BioMed Central
Published in: World Journal of Surgical Oncology / Issue 1/2007
Electronic ISSN: 1477-7819
DOI: https://doi.org/10.1186/1477-7819-5-143

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Combined approach of perioperative ¹⁸F-FDG PET/CT imaging and intraoperative ¹⁸F-FDG handheld gamma probe detection for tumor localization and verification of complete tumor resection in breast cancer

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2007

Nasal septal teratoma in a child

Pancreatectomy for non-pancreatic malignancies results in improved survival after R0 resection

Primary omental Gastrointestinal stromal tumor (GIST)

How do we manage the gastrectomy for gastric cancer after coronary artery bypass grafting using the right gastroepiploic artery? Report of two cases and a review of the literature

Optimization of sentinel lymph node biopsy in breast cancer using an operative gamma camera

Gastric carcinoma: review of the results of treatment in a community teaching hospital