Clinical evaluation of a novel intraoperative handheld gamma camera for sentinel lymph node biopsy

Peter Olcott; Guillem Pratx; Denise Johnson; Erik Mittra; Ryan Niederkohr; Craig S Levin

doi:10.1016/j.ejmp.2013.10.005

Clinical evaluation of a novel intraoperative handheld gamma camera for sentinel lymph node biopsy

Phys Med. 2014 May;30(3):340-5. doi: 10.1016/j.ejmp.2013.10.005. Epub 2013 Nov 14.

Authors

Peter Olcott¹, Guillem Pratx², Denise Johnson³, Erik Mittra⁴, Ryan Niederkohr⁵, Craig S Levin⁶

Affiliations

¹ Department of Bioengineering, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA. Electronic address: pdo@stanford.edu.
² Department of Radiation Oncology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA 94305, USA. Electronic address: pratx@stanford.edu.
³ St Francis and Franciscan Alliance Hospitals, Indianapolis, IN 46237, USA.
⁴ Department of Radiology-Nuclear Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA.
⁵ Department of Nuclear Medicine, Kaiser Permanente, 700 Lawrence Expressway, Santa Clara, CA 94051, USA.
⁶ Department of Bioengineering, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA; Department of Radiology-Nuclear Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA; Molecular Imaging Program at Stanford (MIPS), Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA. Electronic address: cslevin@stanford.edu.

PMID: 24239343
DOI: 10.1016/j.ejmp.2013.10.005

Abstract

Objective: Preoperative lymphoscintigraphy (PLS) combined with intraoperative gamma probe (GP) localization is standard procedure for localizing the sentinel lymph nodes (SLN) in melanoma and breast cancer. In this study, we evaluated the ability of a novel intraoperative handheld gamma camera (IHGC) to image SLNs during surgery.

Methods: The IHGC is a small-field-of-view camera optimized for real-time imaging of lymphatic drainage patterns. Unlike conventional cameras, the IHGC can acquire useful images in a few seconds in a free-running fashion and be moved manually around the patient to find a suitable view of the node. Thirty-nine melanoma and eleven breast cancer patients underwent a modified SLN biopsy protocol in which nodes localized with the GP were imaged with the IHGC. The IHGC was also used to localize additional nodes that could not be found with the GP.

Results: The removal of 104 radioactive SLNs was confirmed ex vivo by GP counting. In vivo, the relative node detection sensitivity was 88.5 (82.3, 94.6)% for the IHGC (used in conjunction with the GP) and 94.2 (89.7, 98.7)% for the GP alone, a difference not found to be statistically significant (McNemar test, p = 0.24).

Conclusion: Small radioactive SLNs can be visualized intraoperatively using the IHGC with exposure time of 20 s or less, with no significant difference in node detection sensitivity compared to a GP. The IHGC is a useful complement to the GP, especially for SLNs that are difficult to locate with the GP alone.

Keywords: Gamma camera; Intraoperative imaging; Sentinel lymph node biopsy.

Publication types

Evaluation Study
Research Support, Non-U.S. Gov't

MeSH terms

Breast Neoplasms / diagnostic imaging
Breast Neoplasms / pathology
Breast Neoplasms / surgery
Gamma Cameras*
Humans
Image Processing, Computer-Assisted
Intraoperative Period
Melanoma / diagnostic imaging
Melanoma / pathology
Melanoma / surgery
Photons
Radionuclide Imaging
Sentinel Lymph Node Biopsy / instrumentation*
Surgery, Computer-Assisted / instrumentation*