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World Journal of Surgical Oncology
Published in: World Journal of Surgical Oncology 1/2011

Open Access 01-12-2011 | Research

Multimodal imaging and detection approach to 18F-FDG-directed surgery for patients with known or suspected malignancies: a comprehensive description of the specific methodology utilized in a single-institution cumulative retrospective experience

Authors: Stephen P Povoski, Nathan C Hall, Douglas A Murrey Jr, Andrew Z Chow, Jay R Gaglani, Eamonn E Bahnson, Cathy M Mojzisik, Maureen P Kuhrt, Charles L Hitchcock, Michael V Knopp, Edward W Martin Jr

Published in: World Journal of Surgical Oncology | Issue 1/2011

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Abstract

Background

18F-FDG PET/CT is widely utilized in the management of cancer patients. The aim of this paper was to comprehensively describe the specific methodology utilized in our single-institution cumulative retrospective experience with a multimodal imaging and detection approach to 18F-FDG-directed surgery for known/suspected malignancies.

Methods

From June 2005-June 2010, 145 patients were injected with 18F-FDG in anticipation of surgical exploration, biopsy, and possible resection of known/suspected malignancy. Each patient underwent one or more of the following: (1) same-day preoperative patient diagnostic PET/CT imaging, (2) intraoperative gamma probe assessment, (3) clinical PET/CT specimen scanning of whole surgically resected specimens (WSRS), research designated tissues (RDT), and/or sectioned research designated tissues (SRDT), (4) micro PET/CT specimen scanning of WSRS, RDT, and/or SRDT, (5) total radioactivity counting of each SRDT piece by an automatic gamma well counter, and (6) same-day postoperative patient diagnostic PET/CT imaging.

Results

Same-day 18F-FDG injection dose was 15.1 (± 3.5, 4.6-26.1) mCi. Fifty-five same-day preoperative patient diagnostic PET/CT scans were performed. One hundred forty-two patients were taken to surgery. Three of the same-day preoperative patient diagnostic PET/CT scans led to the cancellation of the anticipated surgical procedure. One hundred forty-one cases utilized intraoperative gamma probe assessment. Sixty-two same-day postoperative patient diagnostic PET/CT scans were performed. WSRS, RDT, and SRDT were scanned by clinical PET/CT imaging and micro PET/CT imaging in 109 and 32 cases, 33 and 22 cases, and 49 and 26 cases, respectively. Time from 18F-FDG injection to same-day preoperative patient diagnostic PET/CT scan, intraoperative gamma probe assessment, and same-day postoperative patient diagnostic PET/CT scan were 73 (± 9, 53-114), 286 (± 93, 176-532), and 516 (± 134, 178-853) minutes, respectively. Time from 18F-FDG injection to scanning of WSRS, RDT, and SRDT by clinical PET/CT imaging and micro PET/CT imaging were 389 (± 148, 86-741) and 458 (± 97, 272-656) minutes, 619 (± 119, 253-846) and 661 (± 117, 433-835) minutes, and 674 (± 186, 299-1068) and 752 (± 127, 499-976) minutes, respectively.

Conclusions

Our multimodal imaging and detection approach to 18F-FDG-directed surgery for known/suspected malignancies is technically and logistically feasible and may allow for real-time intraoperative staging, surgical planning and execution, and determination of completeness of surgical resection.
Appendix
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Literature
1.
Otsuka H, Graham M, Kubo A, Nishitani H: Clinical utility of FDG PET. J Med Invest. 2004, 51: 14-19. 10.2152/jmi.51.14.CrossRefPubMed
2.
Endo K, Oriuchi N, Higuchi T, Iida Y, Hanaoka H, Miyakubo M, Ishikita T, Koyama K: PET and PET/CT using 18F-FDG in the diagnosis and management of cancer patients. Int J Clin Oncol. 2006, 11: 286-296. 10.1007/s10147-006-0595-0.CrossRefPubMed
3.
Maldonado A, González-Alenda FJ, Alonso M, Sierra JM: PET-CT in clinical oncology. Clin Transl Oncol. 2007, 9: 494-505. 10.1007/s12094-007-0093-5.CrossRefPubMed
4.
Otsuka H, Morita N, Yamashita K, Nishitani H: FDG-PET/CT for cancer management. J Med Invest. 2007, 54: 195-199. 10.2152/jmi.54.195.CrossRefPubMed
5.
Vallabhajosula S: (18)F-labeled positron emission tomographic radiopharmaceuticals in oncology: an overview of radiochemistry and mechanisms of tumor localization. Semin Nucl Med. 2007, 37: 400-419. 10.1053/j.semnuclmed.2007.08.004.CrossRefPubMed
6.
Poeppel TD, Krause BJ, Heusner TA, Boy C, Bockisch A, Antoch G: PET/CT for the staging and follow-up of patients with malignancies. Eur J Radiol. 2009, 70: 382-392. 10.1016/j.ejrad.2009.03.051.CrossRefPubMed
7.
Vriens D, de Geus-Oei LF, van der Graaf WT, Oyen WJ: Tailoring therapy in colorectal cancer by PET-CT. Q J Nucl Med Mol Imaging. 2009, 53: 224-244.PubMed
8.
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
9.
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
10.
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
11.
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
12.
Essner R, Daghighian F, Giuliano AE: Advances in FDG PET probes in surgical oncology. Cancer J. 2002, 8: 100-108. 10.1097/00130404-200203000-00004.CrossRefPubMed
13.
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. 10.1007/BF02985100.CrossRefPubMed
14.
Carrera D, Fernandez A, Estrada J, Martin-Comin J, Gamez C: [Detection of occult malignant melanoma by 18F-FDG PET-CT and gamma probe]. Rev Esp Med Nucl. 2005, 24: 410-413. 10.1016/S0212-6982(05)74186-0. [Spanish]CrossRefPubMed
15.
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
16.
Kraeber-Bodéré F, Cariou B, Curtet C, Bridji B, Rousseau C, Dravet F, Charbonnel B, Carnaille B, Le Néel JC, Mirallié E: Feasibility and benefit of fluorine 18-fluoro-2-deoxyglucose-guided surgery in the management of radioiodine-negative differentiated thyroid carcinoma metastases. Surgery. 2005, 138: 1176-1182. 10.1016/j.surg.2005.08.028.CrossRefPubMed
17.
Barranger E, Kerrou K, Petegnief Y, David-Montefiore E, Cortez A, Daraï E: Laparoscopic resection of occult metastasis using the combination of FDG-positron emission tomography/computed tomography image fusion with intraoperative probe guidance in a woman with recurrent ovarian cancer. Gynecol Oncol. 2005, 96: 241-244. 10.1016/j.ygyno.2004.09.030.CrossRefPubMed
18.
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
19.
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,
20.
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 1820CrossRefPubMed
21.
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
22.
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
23.
Hall NC, Povoski SP, Murrey DA, Knopp MV, Martin EW: 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. World J Surg Oncol. 2007, 5: 143-10.1186/1477-7819-5-143.PubMedCentralCrossRefPubMed
24.
Sun D, Bloomston M, Hinkle G, Al-Saif OH, Hall NC, Povoski SP, Arnold MW, Martin EW: Radioimmunoguided surgery (RIGS), PET/CT image-guided surgery, and fluorescence image-guided surgery: past, present, and future. J Surg Oncol. 2007, 96: 297-308. 10.1002/jso.20869.CrossRefPubMed
25.
26.
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
27.
Curtet C, Carlier T, Mirallié E, Bodet-Milin C, Rousseau C, Barbet J, Kraeber-Bodéré F: Prospective comparison of two gamma probes for intraoperative detection of 18F-FDG: in vitro assessment and clinical evaluation in differentiated thyroid cancer patients with iodine-negative recurrence. Eur J Nucl Med Mol Imaging. 2007, 34: 1556-1562. 10.1007/s00259-007-0393-6.CrossRefPubMed
28.
Povoski SP, Hall NC, Martin EW, Walker MJ: Multimodality approach of perioperative 18F-FDG PET/CT imaging, intraoperative 18F-FDG handheld gamma probe detection, and intraoperative ultrasound for tumor localization and verification of resection of all sites of hypermetabolic activity in a case of occult recurrent metastatic melanoma. World J Surg Oncol. 2008, 6: 1-10.1186/1477-7819-6-1.PubMedCentralCrossRefPubMed
29.
Cohn DE, Hall NC, Povoski SP, Seamon LG, Farrar WB, Martin EW: Novel perioperative imaging with 18F-FDG PET/CT and intraoperative 18F-FDG detection using a handheld gamma probe in recurrent ovarian cancer. Gynecol Oncol. 2008, 110: 152-157. 10.1016/j.ygyno.2008.04.026.CrossRefPubMed
30.
Moffatt-Bruce SD, Povoski SP, Sharif S, Hall NC, Ross P, Johnson MA, Martin EW: A novel approach to positron emission tomography in lung cancer. Ann Thorac Surg. 2008, 86: 1355-1357. 10.1016/j.athoracsur.2008.03.072.CrossRefPubMed
31.
Agrawal A, Hall NC, Ringel MD, Povoski SP, Martin EW: Combined use of perioperative TSH-stimulated 18F-FDG PET/CT imaging and gamma probe radioguided surgery to localize and verify resection of iodine scan-negative recurrent thyroid carcinoma. Laryngoscope. 2008, 118: 2190-2194. 10.1097/MLG.0b013e3181845738.CrossRefPubMed
32.
Hall NC, Povoski SP, Murrey DA, Knopp MV, Martin EW: Bringing advanced medical imaging into the operative arena could revolutionize the surgical care of cancer patients. Expert Rev Med Devices. 2008, 5: 663-667. 10.1586/17434440.5.6.663.CrossRefPubMed
33.
Povoski SP, Sarikaya I, White WC, Marsh SG, Hall NC, Hinkle GH, Martin EW, Knopp MV: Comprehensive evaluation of occupational radiation exposure to intraoperative and perioperative personnel from 18F-FDG radioguided surgical procedures. Eur J Nucl Med Mol Imaging. 2008, 35: 2026-2034. 10.1007/s00259-008-0880-4.CrossRefPubMed
34.
Piert M, Carey J, Clinthorne N: Probe-guided localization of cancer deposits using [(18)F]fluorodeoxyglucose. Q J Nucl Med Mol Imaging. 2008, 52: 37-49.PubMed
35.
van Baardwijk A, Bosmans G, van Suylen RJ, van Kroonenburgh M, Hochstenbag M, Geskes G, Lambin P, De Ruysscher D: Correlation of intra-tumour heterogeneity on 18F-FDG PET with pathologic features in non-small cell lung cancer: a feasibility study. Radiother Oncol. 2008, 87: 55-58. 10.1016/j.radonc.2008.02.002.CrossRefPubMed
36.
Povoski SP, Neff RL, Mojzisik CM, O'Malley DM, Hinkle GH, Hall NC, Murrey DA, Knopp MV, Martin EW: A comprehensive overview of radioguided surgery using gamma detection probe technology. World J Surg Oncol. 2009, 7: 11-10.1186/1477-7819-7-11.PubMedCentralCrossRefPubMed
37.
Murrey DA, Bahnson EE, Hall NC, Povoski SP, Mojzisik CM, Young DC, Sharif S, Johnson MA, Abdel-Misih S, Martin EW, Knopp MV: Perioperative (18)F-fluorodeoxyglucose-guided imaging using the becquerel as a quantitative measure for optimizing surgical resection in patients with advanced malignancy. Am J Surg. 2009, 198: 834-840. 10.1016/j.amjsurg.2009.08.014.CrossRefPubMed
38.
Molina MA, Goodwin WJ, Moffat FL, Serafini AN, Sfakianakis GN, Avisar E: Intra-operative use of PET probe for localization of FDG avid lesions. Cancer Imaging. 2009, 9: 59-62. 10.1102/1470-7330.2009.9025.PubMedCentralCrossRefPubMed
39.
Gollub MJ, Akhurst TJ, Williamson MJ, Shia J, Humm JL, Wong WD, Paty PB, Guillem JG, Weiser MR, Temple LK, Dauer LT, Jhanwar SC, Kronman RE, Montalvo CV, Miller AR, Larson SM, Margulis AR: Feasibility of ex vivo FDG PET of the colon. Radiology. 2009, 252: 232-239. 10.1148/radiol.2522081864.CrossRefPubMed
40.
Hall NC, Povoski SP, Murrey DA, Martin EW, Knopp MV: Ex vivo specimen FDG PET/CT imaging for oncology. Radiology. 2010, 255: 663-64. 10.1148/radiol.092400.CrossRefPubMed
41.
Nalley C, Wiebeck K, Bartel TB, Bodenner D, Stack BC: Intraoperative radiation exposure with the use of (18)F-FDG-guided thyroid cancer surgery. Otolaryngol Head Neck Surg. 2010, 142: 281-283. 10.1016/j.otohns.2009.11.005.CrossRefPubMed
42.
de Jong JS, van Ginkel RJ, Slart RH, Lemstra CL, Paans AM, Mulder NH, Hoekstra HJ: FDG-PET probe-guided surgery for recurrent retroperitoneal testicular tumor recurrences. Eur J Surg Oncol. 2010, 36: 1092-1095. 10.1016/j.ejso.2010.08.129.CrossRefPubMed
43.
Hartemink KJ, Muller S, Smulders YM, Petrousjka van den Tol M, Comans EF: [Fluorodeoxyglucose F18(FDG)-probe guided biopsy]. Ned Tijdschr Geneeskd. 2010, 154: A1884-[Dutch]PubMed
44.
Lee GO, Costouro NG, Groome T, Kashani-Sabet M, Leong SPL: The use of intraoperative PET probe to resect metastatic melanoma. BMJ Case Reports. 2010, 10.1136/bcr.12.2009.2593.
45.
García JR, Fraile M, Soler M, Bechini J, Ayuso JR, Lomeña F: [PET/CT-guided salvage surgery protocol. Results with ROLL Technique and PET probe]. Rev Esp Med Nucl. 2011, 30: 217-222. 10.1016/j.remn.2011.02.011. [Spanish]CrossRefPubMed
46.
Kim WW, Kim JS, Hur SM, Kim SH, Lee SK, Choi JH, Kim S, Choi JY, Lee JE, Kim JH, Nam SJ, Yang JH, Choe JH: Radioguided surgery using an intraoperative PET probe for tumor localization and verification of complete resection in differentiated thyroid cancer: A pilot study. Surgery. 2011, 149: 416-424. 10.1016/j.surg.2010.08.004.CrossRefPubMed
47.
Francis CL, Nalley C, Fan C, Bodenner D, Stack BC: 18F-fluorodeoxyglucose and 131I Radioguided Surgical Management of Thyroid Cancer. Otolaryngol Head Neck Surg. 2011,
48.
Manca G, Biggi E, Lorenzoni A, Boni G, Roncella M, Ghilli M, Volterrani D, Mariani G: Simultaneous detection of breast tumor resection margins and radioguided sentinel node biopsy using an intraoperative electronically collimated probe with variable energy window: a case report. Clin Nucl Med. 2011, 36: e196-e198. 10.1097/RLU.0b013e31821c9a4c.CrossRefPubMed
49.
Delbeke D, Coleman RE, Guiberteau MJ, Brown ML, Royal HD, Siegel BA, Townsend DW, Berland LL, Parker JA, Hubner K, Stabin MG, Zubal G, Kachelriess M, Cronin V, Holbrook S: Procedure guideline for tumor imaging with 18F-FDG PET/CT 1.0. J Nucl Med. 2006, 47: 885-895.PubMed
50.
51.
Metadata
Title
Multimodal imaging and detection approach to 18F-FDG-directed surgery for patients with known or suspected malignancies: a comprehensive description of the specific methodology utilized in a single-institution cumulative retrospective experience
Authors
Stephen P Povoski
Nathan C Hall
Douglas A Murrey Jr
Andrew Z Chow
Jay R Gaglani
Eamonn E Bahnson
Cathy M Mojzisik
Maureen P Kuhrt
Charles L Hitchcock
Michael V Knopp
Edward W Martin Jr
Publication date
01-12-2011
Publisher
BioMed Central
Published in
World Journal of Surgical Oncology / Issue 1/2011
Electronic ISSN: 1477-7819
DOI
https://doi.org/10.1186/1477-7819-9-152

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