PT  - JOURNAL ARTICLE
AU  - Judith olde Heuvel
AU  - Berlinda J. 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
TI  - Cerenkov Luminescence Imaging in Prostate Cancer: Not the Only Light That Shines
AID  - 10.2967/jnumed.120.260034
DP  - 2022 Jan 01
TA  - Journal of Nuclear Medicine
PG  - 29--35
VI  - 63
IP  - 1
4099  - http://jnm.snmjournals.org/content/63/1/29.short
4100  - http://jnm.snmjournals.org/content/63/1/29.full
SO  - J Nucl Med2022 Jan 01; 63
AB  - Cerenkov luminescence imaging (CLI) is a novel imaging technology that might have the ability to assess surgical margins intraoperatively during prostatectomy using 68Ga-prostate-specific membrane antigen (68Ga-PSMA-11). This study evaluated the accuracy of CLI compared with histopathology and, as an exploratory objective, investigated the characteristics of the identified chemiluminescence signal. Methods: After intravenous injection of a mean 68Ga-PSMA-11 activity of 69 MBq intraoperatively, all excised specimens were imaged with CLI. Areas of increased signal were marked for histopathologic comparison and scored for the likelihood of being a positive surgical margin (PSM) using a 5-point Likert scale. In addition, the chemiluminescence signal was investigated in 3 radioactive and 3 nonradioactive specimens using CLI. Results: In 15 patients, the agreement between CLI and histopathology was 60%; this improved to 83% when including close surgical margins (≤1 mm). In 6 hot spots, 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 8 patients. This chemiluminescence signal was also observed in nonradioactive prostate specimens, with a half-life of 48 ± 11 min. The chemiluminescence hampered the visual interpretation of 4 PSMs at the base. Conclusion: CLI was 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.