The next evolution in radioguided surgery: breast cancer related sentinel node localization using a freehandSPECT-mobile gamma camera combination

Thijs Engelen; Beatrice Mf Winkel; Daphne Dd Rietbergen; Gijs H KleinJan; Sergi Vidal-Sicart; Renato A Valdés Olmos; Nynke S van den Berg; Fijs Wb van Leeuwen

The next evolution in radioguided surgery: breast cancer related sentinel node localization using a freehandSPECT-mobile gamma camera combination

Am J Nucl Med Mol Imaging. 2015 Feb 15;5(3):233-45. eCollection 2015.

Authors

Thijs Engelen¹, Beatrice Mf Winkel², Daphne Dd Rietbergen², Gijs H KleinJan³, Sergi Vidal-Sicart⁴, Renato A Valdés Olmos³, Nynke S van den Berg⁵, Fijs Wb van Leeuwen⁶

Affiliations

¹ Interventional Molecular Imaging Laboratory and Nuclear Medicine section, Department of Radiology, Leiden University Medical Center Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands ; Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands.
² Interventional Molecular Imaging Laboratory and Nuclear Medicine section, Department of Radiology, Leiden University Medical Center Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands.
³ Interventional Molecular Imaging Laboratory and Nuclear Medicine section, Department of Radiology, Leiden University Medical Center Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands ; Department of Nuclear Medicine, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands.
⁴ Department of Nuclear Medicine, Hospital Clinic-Barcelona Villarroel 170. 08036 Barcelona, Spain.
⁵ Interventional Molecular Imaging Laboratory and Nuclear Medicine section, Department of Radiology, Leiden University Medical Center Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands ; Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands.
⁶ Interventional Molecular Imaging Laboratory and Nuclear Medicine section, Department of Radiology, Leiden University Medical Center Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands ; Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands ; Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands.

PMID: 26069857
PMCID: PMC4446392

Abstract

Accurate pre- and intraoperative identification of the sentinel node (SN) forms the basis of the SN biopsy procedure. Gamma tracing technologies such as a gamma probe (GP), a 2D mobile gamma camera (MGC) or 3D freehandSPECT (FHS) can be used to provide the surgeon with radioguidance to the SN(s). We reasoned that integrated use of these technologies results in the generation of a "hybrid" modality that combines the best that the individual radioguidance technologies have to offer. The sensitivity and resolvability of both 2D-MGC and 3D-FHS-MGC were studied in a phantom setup (at various source-detector depths and using varying injection site-to-SN distances), and in ten breast cancer patients scheduled for SN biopsy. Acquired 3D-FHS-MGC images were overlaid with the position of the phantom/patient. This augmented-reality overview image was then used for navigation to the hotspot/SN in virtual-reality using the GP. Obtained results were compared to conventional gamma camera lymphoscintigrams. Resolution of 3D-FHS-MGC allowed identification of the SNs at a minimum injection site (100 MBq)-to-node (1 MBq; 1%) distance of 20 mm, up to a source-detector depth of 36 mm in 2D-MGC and up to 24 mm in 3D-FHS-MGC. A clinically relevant dose of approximately 1 MBq was clearly detectable up to a depth of 60 mm in 2D-MGC and 48 mm in 3D-FHS-MGC. In all ten patients at least one SN was visualized on the lymphoscintigrams with a total of 12 SNs visualized. 3D-FHS-MGC identified 11 of 12 SNs and allowed navigation to all these visualized SNs; in one patient with two axillary SNs located closely to each other (11 mm), 3D-FHS-MGC was not able to distinguish the two SNs. In conclusion, high sensitivity detection of SNs at an injection site-to-node distance of 20 mm-and-up was possible using 3D-FHS-MGC. In patients, 3D-FHS-MGC showed highly reproducible images as compared to the conventional lymphoscintigrams.

Keywords: Sentinel node; breast cancer; freehandSPECT; mobile gamma camera; navigation; nuclear medicine; radioguided surgery.