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Kogler AK, Polemi AM, Nair S, Majewski S, Dengel LT, Slingluff CL, Kross B, Lee SJ, McKisson JE, McKisson J, Weisenberger AG, Welch BL, Wendler T, Matthies P, Traub J, Witt M, Williams MB. Evaluation of camera-based freehand SPECT in preoperative sentinel lymph node mapping for melanoma patients. EJNMMI Res 2020; 10:139. [PMID: 33175204 PMCID: PMC7658290 DOI: 10.1186/s13550-020-00729-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/29/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Assessment of lymphatic status via sentinel lymph node (SLN) biopsy is an integral and crucial part of melanoma surgical oncology. The most common technique for sentinel node mapping is preoperative planar scintigraphy of an injected gamma-emitting lymphatic tracer followed by intraoperative node localization using a non-imaging gamma probe with auditory feedback. In recent years, intraoperative visualization of SLNs in 3D has become possible by coupling the probe to an external system capable of tracking its location and orientation as it is read out, thereby enabling computation of the 3D distribution of the tracer (freehand SPECT). In this project, the non-imaging probe of the fhSPECT system was replaced by a unique handheld gamma camera containing an array of sodium iodide crystals optically coupled to an array of silicon photomultipliers (SiPMs). A feasibility study was performed in which preoperative SLN mapping was performed using camera fhSPECT and the number of detected nodes was compared to that visualized by lymphoscintigraphy, probe fhSPECT, and to the number ultimately excised under non-imaging probe guidance. RESULTS Among five subjects, SLNs were detected in nine lymphatic basins, with one to five SLNs detected per basin. A basin-by-basin comparison showed that the number of SLNs detected using camera fhSPECT exceeded that using lymphoscintigraphy and probe fhSPECT in seven of nine basins and five of five basins, respectively. (Probe fhSPECT scans were not performed for four basins.) It exceeded the number excised under non-imaging probe guidance for seven of nine basins and equaled the number excised for the other two basins. CONCLUSIONS Freehand SPECT using a prototype SiPM-based gamma camera demonstrates high sensitivity for detection of SLNs in a preoperative setting. Camera fhSPECT is a potential means for efficiently obtaining real-time 3D activity distribution maps in applications such as image-guided percutaneous biopsy, and surgical SLN biopsy or radioguided tumor excision.
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Affiliation(s)
- Annie K Kogler
- Department of Physics, University of Virginia, Charlottesville, VA, USA
| | - Andrew M Polemi
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Surabhi Nair
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - Stanislaw Majewski
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - Lynn T Dengel
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Craig L Slingluff
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Brian Kross
- Thomas Jefferson National Accelerator Facility, Newport News, VA, USA
| | - S J Lee
- Thomas Jefferson National Accelerator Facility, Newport News, VA, USA
| | - J E McKisson
- Thomas Jefferson National Accelerator Facility, Newport News, VA, USA
| | - John McKisson
- Thomas Jefferson National Accelerator Facility, Newport News, VA, USA
| | | | | | | | | | | | | | - Mark B Williams
- Department of Physics, University of Virginia, Charlottesville, VA, USA. .,Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA. .,Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA.
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