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EJNMMI Research
Published in: EJNMMI Research 1/2020

01-12-2020 | Prostate Cancer | Original research

A DROP-IN beta probe for robot-assisted 68Ga-PSMA radioguided surgery: first ex vivo technology evaluation using prostate cancer specimens

Authors: Francesco Collamati, Matthias N. van Oosterom, Micol De Simoni, Riccardo Faccini, Marta Fischetti, Carlo Mancini Terracciano, Riccardo Mirabelli, Roberto Moretti, Judith olde Heuvel, Elena Solfaroli Camillocci, Florian van Beurden, Henk G. van der Poel, Renato A. Valdes Olmos, Pim J. van Leeuwen, Fijs W. B. van Leeuwen, Silvio Morganti

Published in: EJNMMI Research | Issue 1/2020

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Background

Recently, a flexible DROP-IN gamma-probe was introduced for robot-assisted radioguided surgery, using traditional low-energy SPECT-isotopes. In parallel, a novel approach to achieve sensitive radioguidance using beta-emitting PET isotopes has been proposed. Integration of these two concepts would allow to exploit the use of PET tracers during robot-assisted tumor-receptor-targeted. In this study, we have engineered and validated the performance of a novel DROP-IN beta particle (DROP-INβ) detector.

Methods

Seven prostate cancer patients with PSMA-PET positive tumors received an additional intraoperative injection of ~ 70 MBq 68Ga-PSMA-11, followed by robot-assisted prostatectomy and extended pelvic lymph node dissection. The surgical specimens from these procedures were used to validate the performance of our DROP-INβ probe prototype, which merged a scintillating detector with a housing optimized for a 12-mm trocar and prograsp instruments.

Results

After optimization of the detector and probe housing via Monte Carlo simulations, the resulting DROP-INβ probe prototype was tested in a robotic setting. In the ex vivo setting, the probe—positioned by the robot—was able to identify 68Ga-PSMA-11 containing hot-spots in the surgical specimens: signal-to-background (S/B) was > 5 when pathology confirmed that the tumor was located < 1 mm below the specimen surface. 68Ga-PSMA-11 containing (and PET positive) lymph nodes, as found in two patients, were also confirmed with the DROP-INβ probe (S/B > 3). The rotational freedom of the DROP-IN design and the ability to manipulate the probe with the prograsp tool allowed the surgeon to perform autonomous beta-tracing.

Conclusions

This study demonstrates the feasibility of beta-radioguided surgery in a robotic context by means of a DROP-INβ detector. When translated to an in vivo setting in the future, this technique could provide a valuable tool in detecting tumor remnants on the prostate surface and in confirmation of PSMA-PET positive lymph nodes.
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Metadata
Title
A DROP-IN beta probe for robot-assisted 68Ga-PSMA radioguided surgery: first ex vivo technology evaluation using prostate cancer specimens
Authors
Francesco Collamati
Matthias N. van Oosterom
Micol De Simoni
Riccardo Faccini
Marta Fischetti
Carlo Mancini Terracciano
Riccardo Mirabelli
Roberto Moretti
Judith olde Heuvel
Elena Solfaroli Camillocci
Florian van Beurden
Henk G. van der Poel
Renato A. Valdes Olmos
Pim J. van Leeuwen
Fijs W. B. van Leeuwen
Silvio Morganti
Publication date
01-12-2020
Publisher
Springer Berlin Heidelberg
Published in
EJNMMI Research / Issue 1/2020
Electronic ISSN: 2191-219X
DOI
https://doi.org/10.1186/s13550-020-00682-6

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