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PET-Probe: Evaluation of Technical Performance and Clinical Utility of a Handheld High-Energy Gamma Probe in Oncologic Surgery

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Abstract

Background

Positron emission tomography (PET) has become an invaluable part of patient evaluation in surgical oncology. PET is less than optimal for detecting lesions <1 cm, and the intraoperative localization of small PET-positive lesions can be challenging as a result of difficulties in surgical exposure. We undertook this investigation to assess the utility of a handheld high-energy gamma probe (PET-Probe) for intraoperative identification of 18F-deoxyglucose (FDG)-avid tumors.

Methods

Forty patients underwent a diagnostic whole-body FDG-PET scan for consideration for surgical exploration and resection. Before surgery, all patients received an intravenous injection of 7 to 10 mCi of FDG. At surgery, the PET-Probe was used to determine absolute counts per second at the known tumor site(s) demonstrated by whole-body PET and at adjacent normal tissue (at least 4 cm away from tumor-bearing sites). Tumor-to-background ratios were calculated.

Results

Thirty-two patients (80%) underwent PET-Probe–guided surgery with therapeutic intent in a recurrent or metastatic disease setting. Eight patients underwent surgery for diagnostic exploration. Anatomical locations of the PET-identified lesions were neck and supraclavicular (n = 8), axilla (n = 5), groin and deep iliac (n = 4), trunk and extremity soft tissue (n = 3), abdominal and retroperitoneal (n = 19), and lung (n = 2). PET-Probe detected all PET-positive lesions. The PET-Probe was instrumental in localization of lesions in 15 patients that were not immediately apparent by surgical exploration.

Conclusions

The PET-Probe identified all lesions demonstrated by PET scanning and, in selected cases, was useful in localizing FDG-avid disease not seen with conventional PET scanning.

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Acknowledgments

Supported by PET-NET Inc. F.D. is the president and the chief scientist of IntraMedical Imaging LLC., Los Angeles, CA. R.E. is a consulting physician for IntraMedical Imaging LLC. S.G. has no commercial associations with any of the products discussed in this article.

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Authors and Affiliations

  1. Center for Cancer Care at Goshen Health System, 200 High Park Avenue, Goshen, Indiana, USA, 46526

    Seza A. Gulec MD

  2. IntraMedical Imaging LLC, 12340 Santa Monica Blv. Suite 227, Los Angeles, CA, 90025, California, USA

    Farhad Daghighian PhD

  3. John Wayne Cancer Institute, 2200 Santa Monica Blv, Santa Monica, CA, 90404, California, USA

    Richard Essner MD

Authors
  1. Seza A. Gulec MD
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  2. Farhad Daghighian PhD
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  3. Richard Essner MD
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Correspondence to Seza A. Gulec MD.

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Gulec, S.A., Daghighian, F. & Essner, R. PET-Probe: Evaluation of Technical Performance and Clinical Utility of a Handheld High-Energy Gamma Probe in Oncologic Surgery. Ann Surg Oncol 23 (Suppl 5), 9020–9027 (2016). https://doi.org/10.1245/ASO.2006.05.047

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  • DOI: https://doi.org/10.1245/ASO.2006.05.047

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