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Judge JM, Popovic K, Petroni GR, Kross B, McKisson J, McKisson J, Weisenberger AG, Stolin A, Majewski S, Rehm P, Slingluff CL, Williams MB, Dengel LT. Evaluation of Preoperative and Intraoperative Mobile Gamma Camera Imaging in Sentinel Lymph Node Biopsy for Melanoma Independent of Preoperative Lymphoscintigraphy. J Surg Res 2023; 285:176-186. [PMID: 36682343 PMCID: PMC11283632 DOI: 10.1016/j.jss.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 12/14/2022] [Accepted: 12/17/2022] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Sentinel lymph node biopsy (SLNB) is a standard practice for staging cutaneous melanoma. High false-negative rates have an increased interest in adjunctive techniques for localizing SLNs. Mobile gamma cameras (MGCs) represent potential tools to enhance SLNB performance. METHODS An institutional review board approval was obtained for this study (ClinicalTrials.gov ID NCT01531608). After obtaining informed consent, 20 eligible melanoma patients underwent 99mTc sulfur colloid injection and standard lymphoscintigraphy with a fixed gamma camera (FGC). A survey using a 20 cm square MGC, performed immediately preoperatively by the study surgeon, was used to establish an operative plan while blinded to the FGC results. Subsequently, SLNB was performed using a gamma probe and a novel 6 cm diameter handheld MGC. RESULTS A total of 24 SLN basins were detected by FGC. Prior to unblinding, all 24 basins were identified with the preoperative MGC and the operative plan established by preoperative MGC imaging was confirmed accurate by review of the FGC images. All individual sentinel lymph nodes were identified during intraoperative MGC imaging, and in 5/24 (21%) cases, surgeon-reported additional clinically useful information was obtained from the MGC. CONCLUSIONS Preoperative MGC images provide information consistent with FGC images for planning SLNB and in some cases provide additional information that aided in surgical decision-making.
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Affiliation(s)
- Joshua M Judge
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Kosta Popovic
- Department of Physics, University of Virginia, Charlottesville, Virginia
| | - Gina R Petroni
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Brian Kross
- Physics Division, Radiation Detector and Imaging Group, Thomas Jefferson National Accelerator Facility, Newport News, Virginia
| | - John McKisson
- Physics Division, Radiation Detector and Imaging Group, Thomas Jefferson National Accelerator Facility, Newport News, Virginia
| | - Jack McKisson
- Physics Division, Radiation Detector and Imaging Group, Thomas Jefferson National Accelerator Facility, Newport News, Virginia
| | - Andrew G Weisenberger
- Physics Division, Radiation Detector and Imaging Group, Thomas Jefferson National Accelerator Facility, Newport News, Virginia
| | - Alexander Stolin
- Department of Radiology, West Virginia University, Morgantown, West Virginia
| | - Stan Majewski
- Department of Radiology, West Virginia University, Morgantown, West Virginia
| | - Patrice Rehm
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia
| | - Craig L Slingluff
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Mark B Williams
- Department of Physics, University of Virginia, Charlottesville, Virginia; Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia; Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia
| | - Lynn T Dengel
- Department of Surgery, University of Virginia, Charlottesville, Virginia.
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Henkenberens C, Zinne N, Biancosino C, Höffler K, Schmitto JD, Bremer M, Haverich A, Krüger M. A new era of thoracic oncology? Ex-vivo stereotactic ablative radiosurgery within Ex-vivo Lung Treatment System as a hybrid therapy for unresectable locally advanced pulmonary malignancies. Med Hypotheses 2016; 92:31-4. [PMID: 27241251 DOI: 10.1016/j.mehy.2016.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/13/2016] [Accepted: 04/16/2016] [Indexed: 11/17/2022]
Abstract
The concept of oligometastases is the medical rationale for a local treatment of a limited number of metastatic tumor manifestations. Patients with pulmonary oligometastases are candidates for surgery or radiotherapy, however there are a number of technical issues that limit treatment. Technical issues relating to radiotherapy include organs at risk of irradiation, chest wall toxicity and decreased precision of tumor targeting because of breathing movements. Technical issues relating to surgery include loss of lung parenchyma and unresectability. We propose the hypothesis that ex-vivo radiosurgery as new hybrid technique in thoracic oncology has the capability to overcome these technical issues and will expand the medical spectrum in thoracic oncology. The proposed - highly complex - technique consists of surgical lung explantation, followed by stereotactic radiotherapy during ex-vivo perfusion followed by surgical re-implantation.
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Affiliation(s)
- C Henkenberens
- Department of Radiation Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - N Zinne
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - C Biancosino
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - K Höffler
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - J D Schmitto
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - M Bremer
- Department of Radiation Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - A Haverich
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - M Krüger
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
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