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Radioguided Surgery: New Applications, Approaches, and Strategies

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Nuclear Oncology

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Abstract

The dynamic concept Guided intraOperative Scintigraphic Tumour Targeting (GOSTT) was introduced a few years ago to encompass all developments in the area of interventional nuclear medicine. This concept includes the use of both preoperative imaging required for providing roadmaps for radioguided surgery and specific intraoperative detection modalities to accomplish surgical target resection. The subsequent incorporation of SPECT/CT and PET/CT in the last two decades has optimized the generation of specific roadmaps introducing three-dimensional information to guide surgical procedures. On the other side, new intraoperative imaging devices like portable gamma cameras have been added to standard detection modalities such as gamma probes. More recently, the development of hybrid tracers integrating radioactivity and fluorescence in one signature, has enabled the use of near-infrared cameras in addition to gamma guidance in the operating room. All these advances have led to the extension of radioguided sentinel lymph node biopsy procedures from the classical applications in cutaneous melanoma and breast cancer to other fields like oral cavity, gynecologic, gastrointestinal, and urological malignancies. At the same time these new technological tools have gradually facilitated not only more sophisticated open surgery applications but also radioguidance for robot-assisted surgical procedures. At present, four GOSTT working approaches can be delineated in relation to radiotracer administration: local administration with tracer migration for subsequent sentinel lymph node surgery, intralesional administration without tracer migration for occult lesion localization and resection, intralesional administration with tracer migration for combined occult lesion localization and sentinel lymph node biopsy, and systemic administration to enable excisional biopsy of primary lesions and recurrences as well as isolated regional and distant metastases. The latter field has a huge potential due to the continuous introduction of new PET and SPECT tracers. Novel modalities like luminescence detection and tracked image-guided navigation will further reinforce the role of GOSTT and interventional nuclear medicine. Finally, new strategies based on the consecutive use of PET/CT and radioguided procedures have gained ground by delineating specific approaches for the management of cancer patients at high risk of metastatic dissemination.

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Authors and Affiliations

  1. Nuclear Medicine Section and Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands

    Renato A. Valdés Olmos

  2. Nuclear Medicine Unit, “Maggiore della Carità” University Hospital, Novara, Italy

    Federica Orsini

  3. Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria

    Francesco Giammarile

  4. Centre Léon Bérard, Lyon, France

    Francesco Giammarile

  5. Nuclear Medicine Department, Hospital Clínic Barcelona, Barcelona, Catalonia, Spain

    Sergi Vidal-Sicart

  6. Nuclear Medicine Unit, Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy

    Giuliano Mariani

  7. Nuclear Medicine Unit, Department of Medical Sciences, University Hospital of Siena, Siena, Italy

    Federica Orsini

  8. Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain

    Sergi Vidal-Sicart

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  1. Renato A. Valdés Olmos
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  2. Federica Orsini
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  3. Francesco Giammarile
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  4. Sergi Vidal-Sicart
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  5. Giuliano Mariani
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Correspondence to Renato A. Valdés Olmos .

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Editors and Affiliations

  1. Nuclear Medicine Unit Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy

    Duccio Volterrani

  2. Nuclear Medicine Unit Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy

    Paola A. Erba

  3. Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    H. William Strauss

  4. Nuclear Medicine Unit Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy

    Giuliano Mariani

  5. Molecular Imaging and Targeted Therapy Service Department of Radiology, Sloan Kettering Institute, New York, NY, USA

    Steven M. Larson

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Valdés Olmos, R.A., Orsini, F., Giammarile, F., Vidal-Sicart, S., Mariani, G. (2022). Radioguided Surgery: New Applications, Approaches, and Strategies. In: Volterrani, D., Erba, P.A., Strauss, H.W., Mariani, G., Larson, S.M. (eds) Nuclear Oncology. Springer, Cham. https://doi.org/10.1007/978-3-031-05494-5_55

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  • DOI: https://doi.org/10.1007/978-3-031-05494-5_55

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-05493-8

  • Online ISBN: 978-3-031-05494-5

  • eBook Packages: MedicineReference Module Medicine

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