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Valdés Olmos RA, Vidal-Sicart S, van Leeuwen FW. Crossing technological frontiers in radioguided intervention. Eur J Nucl Med Mol Imaging 2016; 43:2301-2303. [PMID: 27503096 DOI: 10.1007/s00259-016-3479-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Renato A Valdés Olmos
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, The Netherlands. .,Nuclear Medicine Section, Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands. .,Nuclear Medicine Department, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
| | - Sergi Vidal-Sicart
- Nuclear Medicine Department, University Hospital Clínic Barcelona, Barcelona, Spain
| | - Fijs Wb van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
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Bluemel C, Safak G, Cramer A, Wöckel A, Gesierich A, Hartmann E, Schmid JS, Kaiser F, Buck AK, Herrmann K. Fusion of freehand SPECT and ultrasound: First experience in preoperative localization of sentinel lymph nodes. Eur J Nucl Med Mol Imaging 2016; 43:2304-2312. [PMID: 27311920 DOI: 10.1007/s00259-016-3443-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 06/09/2016] [Indexed: 01/12/2023]
Abstract
PURPOSE Radioguided sentinel lymph node biopsy (SLNB) is the standard of care in breast cancer and melanoma. Additional preoperative Single-photon emission computed tomography (SPECT/CT) for improved anatomical co-registration of the SLNs causes additional radiation exposure and is time-consuming and expensive. The aim of this prospective study was to evaluate a novel approach involving real-time fusion of freehand SPECT (fhSPECT) and ultrasound (US) for anatomical co-registration of SLNs. METHODS From February 2015 to February 2016, 153 patients were included in this prospective study. All patients underwent lymphoscintigraphy according to practical guidelines and 151 (118 cases of breast cancer, 30 cutaneous malignancies, and three cases of vulvar cancer) of the 153 patients were additionally investigated with fhSPECT-US. FhSPECT connected to a hand-held gamma detector generates three-dimensional images of the radioactivity distribution in the scanned area. For co-registration and real-time fusion of fhSPECT and subsequently performed US, an infrared stereo tracking system was used. RESULTS In all patients an SLN was found on lymphoscintigraphy, and the fhSPECT detected corresponding hotspots in all but one patient. In 72 % of patients and 73 % of lymph node basins, real-time anatomical co-registration with US was feasible. The rate of success in achieving good co-registration increased from 60 to 75 % after training by a radiologist specialized in breast imaging. A higher co-registration rate (78 %) was observed in patients with only one SLN than in those with two SLNs (68 %) or three or more SLNs (0 %). CONCLUSIONS Real-time fusion of fhSPECT and US for preoperative anatomical co-registration of SLNs is feasible. However, before this approach can completely replace preoperative lymphatic imaging, further technical developments are needed.
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Affiliation(s)
- Christina Bluemel
- Department of Nuclear Medicine, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
| | - Gonca Safak
- Department of Nuclear Medicine, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Andreas Cramer
- Department of Obstetrics and Gynecology, Missionsärztliches Klinikum Würzburg, Würzburg, Germany
| | - Achim Wöckel
- Department of Obstetrics and Gynecology, University Hospital of Würzburg, Würzburg, Germany
| | - Anja Gesierich
- Department of Dermatology, Venerology and Allergology, University Hospital of Würzburg, Würzburg, Germany
| | - Elena Hartmann
- Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - Jan-Stefan Schmid
- Department of Nuclear Medicine, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Franz Kaiser
- Department of Nuclear Medicine, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Andreas K Buck
- Department of Nuclear Medicine, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.,Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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