Euromedim 2006 :1st European Conference on Molecular Imaging Technology

Radioisotope guided surgery with imaging probe, an hand-held High resolution gamma camera

11 May 2006, 12:15

15m

Palais du Pharo, Marseille

oral S5-S6 medecine Clinical Imaging

Speaker

Prof. Francesco Scopinaro (University "La Sapienza", Rome, Italy)

Description

Aim. Radio-isotope guidance is useful in several fields of surgery, such as sentinel node biopsy, parathyroid adenoma and of some neuroendocrine tumours, withdrawal of laterocervical lymph nodes invaded by thyroid cancer. Radioguided surgery (RGS) is generally performed with a gamma probe (GP) providing an acoustic signal proportional to the detected activity. The Imaging Probe (IP) is an hand held, small field of view (FOV) high resolution (HR) gamma camera. Our IP (Li-Tech, Italy) is based on multi-crystal and Hamamatsu position sensitive phototubes (PSPMT) technique with spatial resolution of 2 mm. IP, collimators and crystal-collimator-PSPMT matching are covered by 5 US and EU patents. We used our IP into operator theatre on different fields of surgery to validate the usefulness of HR images in RGS. Patients and Methods. We studied 100 patients with breast cancer for sentinel node detection, 5 patients with parathyroid adenoma, 5 patients operated for thyroid cancer, 5 patients undergoing fine needle aspiration of thyroid notches, 4 patients with neuroendocrine tumours. Devices: State of the art Anger cameras: Philips Skilight and GE Millennium; 1 inch2 and 4 inch2 IP ( Li-thech Italy). Radiopharmaceuticals (RPh): sentinel lymph nodes were detected with 99mTc- nanocolloids, parathyroid adenomas with 99mTc-sestamibi, thyroid nodes and metastases with 123I-Iodine or 99mTc-sestamibi. Neouroendocrine tumours were detected with 111In-octreotide or with research RPh such as 99mTc-Bombesin. Results. IP detected lesions during operations with high sensitivity and specificity in 30 ± 15 sec. this detection time was fully compatible with hand holding of IPs, without mechanical arm help. Sentinel node IP detected multiple nodes in 60% of patients with breast cancer, versus 24% of Anger camera + GP (P<0.01). Nodes detected by IP contained metastases on 30% of patients versus 22% of patients studied with Anger Camera + GP ( ns). Operation time was 7,4 ± 2.8 min with IP, 11.25± 4.25 with GP (P<0.025). IP detected cervical node metastases of thyroid cancer in 3/5 patients: metastases had been missed by Anger camera in one patient. In 5/5 IP correctly detected parathyroid adenomas during operation Anger camera + GP correctly guided the surgeon in 4/5 cases. All thyroid notches were correctly detected and surgeons were correctly addressed for removal of neuroendocrine tumours. Conclusions. HR images and hand held cameras are of valuable help in radioguided surgery. IP is of simple use and significantly decreases the operation time.