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18F-FDG-Directed Surgery and 18F-FDG-Directed Interventional Procedures

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Radioguided Surgery

Abstract

The use of positron-emitting and high-energy gamma photon-emitting radiopharmaceuticals, like fluorine-18 fluorodeoxyglucose (18F-FDG), for real-time cancer detection and surgical guidance within the operating room and for real-time guidance of diagnostic and therapeutic interventional procedures within the interventional radiology suite, has great clinical potential. This technology may allow for (1) real-time intraoperative staging of the extent of disease; (2) real-time intraoperative surgical planning and execution of the necessary and most appropriate operation, determination of the extent of surgical resection, and determination of the completeness of surgical resection; (3) real-time pathologic evaluation of intact surgical resected specimens for the confirmation of completeness of surgical resection and for surgical margin assessment; (4) real-time pathologic evaluation of diagnostically biopsied tissues for confirmation of correctness of tissue diagnosis; and (5) real-time guidance of diagnostic and therapeutic interventional procedures within the interventional radiology suite. This chapter discusses (1) the history and development of positron imaging and detection, (2) the fundamental basis for the use of 18F-FDG in positron imaging and detection strategies, (3) the inherent limitations of 18F-FDG in positron imaging and detection strategies, (4) radiation detection devices utilized during 18F-FDG-directed surgery, (5) the clinical applications of real-time 18F-FDG-directed surgery and real-time 18F-FDG-directed interventional procedures, (6) timing issues related to 18F-FDG-directed surgery, (7) the inherent challenge of in situ detection of 18F-FDG with a gamma photon detection device, and (8) occupational radiation exposure during 18F-FDG radioguided surgical procedures.

Portions of the contents of this chapter are adapted from 5 prior Open Access articles:

1. Povoski et al.: A comprehensive overview of radioguided surgery using gamma detection probe technology. World Journal of Surgical Oncology, 2009, 7:11.; doi:10.1186/1477-7819-7-11; http://www.wjso.com/content/pdf/1477-7819-7-11.pdf; © 2009 Povoski et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

2. Povoski et al.: Multimodal imaging and detection approach to 18F-FDG-directed surgery for patients with known or suspected malignancies: a comprehensive description of the specific methodology utilized in a single-institution cumulative retrospective experience. World Journal of Surgical Oncology, 2011, 9:152.; doi:10.1186/1477-7819-9-152; http://www.wjso.com/content/pdf/1477-7819-9-152.pdf; © 2011 Povoski et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

3. Povoski et al.: 18F-FDG PET/CT oncologic imaging at extended injection-to-scan acquisition time intervals derived from a single institution 18F-FDG-directed surgery experience: feasibility and quantification of 18F-FDG accumulation within 18F-FDG-avid lesions and background tissues. BMC Cancer 2014 14:453.; doi:10.1186/1471-2407-14-453; http://www.biomedcentral.com/content/pdf/1471-2407-14-453.pdf; © 2014 Povoski et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

4. Chapman et al.: Comparison of two threshold detection criteria methodologies for determination of probe positivity for intraoperative in situ identification of presumed abnormal 18F-FDG avid tissue sites during radioguided oncologic surgery. BMC Cancer. 2014 14:667.; doi:10.1186/1471-2407-14-667; http://www.biomedcentral.com/content/pdf/1471-2407-14-667.pdf; © 2014 Chapman et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

5. Povoski et al.: Feasibility of a multimodal 18F-FDG-directed lymph node surgical excisional biopsy approach for appropriate diagnostic tissue sampling in patients with suspected lymphoma. BMC Cancer 2015 15:378.; doi: 10.1186/s12885-015-1381-z; http://www.biomedcentral.com/content/pdf/s12885-015-1381-z.pdf; © 2015 Povoski et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, 43210, USA

    Stephen P. Povoski MD

  2. Department of Radiology, The Ohio State University, Columbus, OH, 43210, USA

    Douglas A. Murrey Jr. MD

  3. Department of Radiology, University of Pennsylvania, Philadelphia, PA, 19104, USA

    Nathan C. Hall MD, PhD

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  1. Stephen P. Povoski MD
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  2. Douglas A. Murrey Jr. MD
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  3. Nathan C. Hall MD, PhD
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Correspondence to Stephen P. Povoski MD .

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Editors and Affiliations

  1. Universitätsklinikum Würzburg, Department of Nuclear Medicine, Würzburg, Germany

    Ken Herrmann

  2. The University of Sydney, Melanoma Institute Australia, North Sydney, New South Wales, Australia

    Omgo E. Nieweg

  3. Arthur G. James Canc Hosp Richard J. Sol, The Ohio State Univ Comp Canc CTR, Columbus, Ohio, USA

    Stephen P. Povoski

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Povoski, S.P., Murrey, D.A., Hall, N.C. (2016). 18F-FDG-Directed Surgery and 18F-FDG-Directed Interventional Procedures. In: Herrmann, K., Nieweg, O., Povoski, S. (eds) Radioguided Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-26051-8_25

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