TY - JOUR T1 - Cerenkov Luminescence Imaging in prostate cancer: not the only light that shines JF - Journal of Nuclear Medicine JO - J Nucl Med DO - 10.2967/jnumed.120.260034 SP - jnumed.120.260034 AU - Judith olde Heuvel AU - Berlinda Jantina de Wit - van der Veen AU - Henk G. van der Poel AU - Pim J. van Leeuwen AU - Elise M. Bekers AU - Maarten R. Grootendorst AU - Kunal N. Vyas AU - Cornelis H. Slump AU - Marcel P.M. Stokkel Y1 - 2021/04/01 UR - http://jnm.snmjournals.org/content/early/2021/04/30/jnumed.120.260034.abstract N2 - Introduction: Cerenkov luminescence imaging (CLI) is a novel imaging technology that might have the ability to assess surgical margins intra-operatively during prostatectomy using Gallium-68 prostate-specific membrane antigen ([68Ga]Ga-PSMA-11). This study evaluates the accuracy of CLI compared to histopathology and as exploratory objective investigates the characteristics of the identified chemiluminescence signal. Materials and Methods: After intravenous injection of a mean 68Ga-PSMA-11 activity of 69MBq intraoperatively, all excised specimens were imaged with CLI. Areas of increased signal were marked for histopathological comparison and scored for likelihood of being a positive surgical margin (PSM) using a 5-point Likert scale. In addition, the chemiluminescence signal was investigated in three radioactive and three non-radioactive specimens using CLI. Results: In 15 patients, the agreement between CLI and histopathology was 60%; this improved to 83% when including close surgical margins (≤1mm). In six hotspots, CLI correctly identified PSMs on histopathology, located at the apex and mid-prostate. In all 15 patients an increased signal at the prostate base was observed, without the presence of the primary tumor in this area in eight patients. This chemiluminescence signal was also observed in non-radioactive prostate specimens, with a half-life of 48±11min. The chemiluminescence hampered the visual interpretation of four PSMs at the base. Conclusion: CLI is able to correctly identify margin status, including close margins, in 83% of the cases. The presence of a diathermy-induced chemiluminescent signal hampered image interpretation, especially at the base of the prostate. In the current form, CLI is most applicable to detect PSMs and close margins in the apex and mid-prostate. ER -