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Delgado-Oliver E, Vidal-Sicart S, Martínez D, Squarcia M, Mora M, Hanzu FA, Halperin I, Fuster D, Fondevila C, Vidal-Perez Ó. Applicability of sentinel lymph node biopsy in papillary thyroid cancer. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2018; 64:400-405. [PMID: 29999291 DOI: 10.23736/s1824-4785.18.03097-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The optimal surgical management of papillary thyroid cancer (PTC) for T1-T2 tumors without pre or intrasurgical evidence of lymph node metastasis (cN0) remains controversial, since approximately 40% of patients have lymph node involvement (pN1) which becomes evident when a prophylactic lymphadenectomy (PL) is performed. The aim of this study was to investigate the feasibility of sentinel lymph node (SLN) identification with SPECT/CT lymphoscintigraphy imaging along with intraoperatory image techniques in early stages of PTC undergoing PL of central neck compartment (CNC). METHODS A single-center, prospective consecutive study was designed for SLN mapping in patients with high suspicion of PTC (Bethesda V or VI) in early stage (cT1-2, cN0). Twenty-four patients underwent SLN identification with preoperative SPECT/CT and planar images (99mTc-nanocolloid albumin intratumoral injection). During surgery, SLN located in CNC was found by means of a gamma probe and portable gamma camera, and excised. Afterwards, CNC lymphadenectomy was performed in all cases without modifying the established protocol. RESULTS SLNs were identified and accurately located in 23 (95.8%) patients. Nodal metastases (pN1) were confirmed in 9 (37.5%) patients, with one false negative case. The sensitivity was 88.9% and negative predictive value (NPV) was 93.3%, would have allowed to avoid PL in more than half of cases, a higher proportion than those found in other similar studies. No complications associated with the procedure were observed. CONCLUSIONS Our results support that SLN biopsy by SPECT/CT along with intraoperatory image techniques is applicable in early stages of PTC (cT1-2, cN0), allowing to avoid unnecessary PL.
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Affiliation(s)
- Eduardo Delgado-Oliver
- Department of General Surgery, Institute of Digestive and Metabolic Diseases, Center for Biomedical Research in Network of Hepatic and Digestive Diseases, August Pi i Sunyer Institute of Biomedical Research, Clinical Hospital, University of Barcelona, Barcelona, Spain -
| | - Sergi Vidal-Sicart
- Department of Nuclear Medicine, Image Diagnostic Center, Clinical Hospital, University of Barcelona, Barcelona, Spain
| | - Daniel Martínez
- Department of Pathological Anatomy, Biomedical Diagnostic Center, Clinical Hospital, University of Barcelona, Barcelona, Spain
| | - Mattia Squarcia
- Department of Radiology, Image Diagnostic Center, Clinical Hospital, University of Barcelona, Barcelona, Spain
| | - Mireia Mora
- Department of Endocrinology and Nutrition, Institute of Digestive and Metabolic Diseases, Center for Biomedical Research in Network of Hepatic and Digestive Diseases, August Pi i Sunyer Institute of Biomedical Research, Clinical Hospital, University of Barcelona, Barcelona, Spain
| | - Felizia A Hanzu
- Department of Endocrinology and Nutrition, Institute of Digestive and Metabolic Diseases, Center for Biomedical Research in Network of Hepatic and Digestive Diseases, August Pi i Sunyer Institute of Biomedical Research, Clinical Hospital, University of Barcelona, Barcelona, Spain
| | - Irene Halperin
- Department of Endocrinology and Nutrition, Institute of Digestive and Metabolic Diseases, Center for Biomedical Research in Network of Hepatic and Digestive Diseases, August Pi i Sunyer Institute of Biomedical Research, Clinical Hospital, University of Barcelona, Barcelona, Spain
| | - David Fuster
- Department of Nuclear Medicine, Image Diagnostic Center, Clinical Hospital, University of Barcelona, Barcelona, Spain
| | - Constantino Fondevila
- Department of General Surgery, Institute of Digestive and Metabolic Diseases, Center for Biomedical Research in Network of Hepatic and Digestive Diseases, August Pi i Sunyer Institute of Biomedical Research, Clinical Hospital, University of Barcelona, Barcelona, Spain
| | - Óscar Vidal-Perez
- Department of General Surgery, Institute of Digestive and Metabolic Diseases, Center for Biomedical Research in Network of Hepatic and Digestive Diseases, August Pi i Sunyer Institute of Biomedical Research, Clinical Hospital, University of Barcelona, Barcelona, Spain
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Bugby SL, Lees JE, Perkins AC. Hybrid intraoperative imaging techniques in radioguided surgery: present clinical applications and future outlook. Clin Transl Imaging 2017; 5:323-341. [PMID: 28804703 PMCID: PMC5532406 DOI: 10.1007/s40336-017-0235-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 06/10/2017] [Indexed: 12/26/2022]
Abstract
PURPOSE This review aims to summarise the hybrid modality radioguidance techniques currently in clinical use and development, and to discuss possible future avenues of research. Due to the novelty of these approaches, evidence of their clinical relevance does not yet exist. The purpose of this review is to inform nuclear medicine practitioners of current cutting edge research in radioguided surgery which may enter standard clinical practice within the next 5-10 years. Hybrid imaging is of growing importance to nuclear medicine diagnostics, but it is only with recent advances in technology that hybrid modalities are being investigated for use during radioguided surgery. These modalities aim to overcome some of the difficulties of surgical imaging while maintaining many benefits, or providing entirely new information unavailable to surgeons with traditional radioguidance. METHODS A literature review was carried out using online reference databases (Scopus, PubMed). Review articles obtained using this technique were citation mined to obtain further references. RESULTS In total, 2367 papers were returned, with 425 suitable for further assessment. 60 papers directly related to hybrid intraoperative imaging in radioguided surgery are reported on. Of these papers, 25 described the clinical use of hybrid imaging, 22 described the development of new hybrid probes and tracers, and 13 described the development of hybrid technologies for future clinical use. Hybrid gamma-NIR fluorescence was found to be the most common clinical technique, with 35 papers associated with these modalities. Other hybrid combinations include gamma-bright field imaging, gamma-ultrasound imaging, gamma-β imaging and β-OCT imaging. The combination of preoperative and intraoperative images is also discussed. CONCLUSION Hybrid imaging offers new possibilities for assisting clinicians and surgeons in localising the site of uptake in procedures such as in sentinel node detection.
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Affiliation(s)
- S L Bugby
- Space Research Centre, Michael Atiyah Building, University of Leicester, Leicester, LE1 7RH UK
| | - J E Lees
- Space Research Centre, Michael Atiyah Building, University of Leicester, Leicester, LE1 7RH UK
| | - A C Perkins
- Radiological Sciences, Division of Clinical Neuroscience, School of Medical, University of Nottingham, Nottingham, NG7 2UH UK.,Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, NH7 2UH UK
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