A Novel Approach to Positron Emission Tomography in Lung Cancer

doi:10.1016/j.athoracsur.2008.03.072

The Annals of Thoracic Surgery

Volume 86, Issue 4, October 2008, Pages 1355-1357

https://doi.org/10.1016/j.athoracsur.2008.03.072 Get rights and content

¹⁸F-fluorodeoxyglucose positron emission tomography–computed tomography is integral to the staging of lung cancer. We describe the combined use of diagnostic preoperative ¹⁸F-fluorodeoxyglucose positron emission tomography–computed tomography, intraoperative ¹⁸F-fluorodeoxyglucose handheld gamma probe detection, and immediate postoperative ¹⁸F-fluorodeoxyglucose positron emission tomography–computed tomography patient and specimen imaging for improved staging and determination of adequacy of mediastinal lymph node dissection.

Section snippets

Comment

Lung cancer is the leading cause of cancer deaths in the Western hemisphere [1]. A critical determinant of survival and therapy is the extent of disease including mediastinal lymph node status [1, 2]. Preoperatively, lung cancer patients are generally imaged with a thoracic and upper abdomen ¹⁸F-FDG PET–CT scan. Often mediastinal nodes found on ¹⁸F-FDG PET–CT scans are not accessible by cervical mediastinoscopy, or they are only mildly hypermetabolic and therefore indeterminate. No study to

References (8)

B.A. Whitson et al.
Surgical assessment and intraoperative management of mediastinal lymph nodes in non-small cell lung cancer
Ann Thorac Surg
(2007)
M. Okada et al.
Selective mediastinal lymphadenectomy for clinico-surgical stage I non-small cell lung cancer
Ann Thorac Surg
(2006)
D.C. Desai et al.
Correlative whole-body FDG-PET and intraoperative gamma detection of fdg distribution in colorectal cancer
Clin Positron Imaging
(2000)
R. Essner et al.
Application for an (18F) fluorodeoxyglucose-sensitive probe for the intraoperative detection of malignancy
J Surg Res
(2001)

There are more references available in the full text version of this article.

Cited by (14)

Intraoperative gamma cameras for radioguided surgery: Technical characteristics, performance parameters, and clinical applications
2013, Physica Medica
Citation Excerpt :
Hybrid PET-CT systems are becoming widely available, providing registered anatomic and physiologic information and improved diagnostic information overall. Radioguided surgery using 18F-FDG PET or PET/CT in combination with a gamma probe has been reported in melanoma [96–98], recurrent colorectal carcinoma [96,99], breast cancer [100], ovarian cancer [101], lung cancer [102], thyroid carcinoma [103–105], and other malignancies [97]. Gamma probes optimized to detect low-energy (99mTc, 140 keV), medium-energy (111In, 250 keV) photons [98–101,106], and high-energy photons (511 keV) [105,107] have been used for 18F-FDG radioguided surgery.
Several small gamma cameras (SGCs) intended for surgical use are now in development or currently being marketed. In this review, we discuss the characteristics, performance, and clinical use of SGCs which are hand-held and small enough to be easily managed by surgeons during their procedures. We expect that SGCs have the potential to be used more widely in radioguided surgery. As advancing molecular imaging technologies will broaden clinical indications, SGCs will likely be used and integrated with other imaging modalities into numerous types of radioguided surgery in the near future.
Sentinel Node and Positron Emission Tomography Mapping in Lung Cancer
2009, Seminars in Thoracic and Cardiovascular Surgery
Citation Excerpt :
There is also a need to decrease the size of the gamma probes to facilitate their in vivo use during mediastinoscopy, thoracoscopy, and robotic surgery. A case report by Moffatt-Bruce et al described the combination of preoperative PET-CT, intraoperative gamma probe use and immediate postoperative patient and specimen PET-CT.37 This approach seeks to maximize the assessment of the extent of intrathoracic disease and the completeness of resection. However, cost may be a limiting factor.
Radioguided lymph node mapping can potentially improve staging in locoregional non-small cell lung cancer. This is accomplished by using advanced pathologic techniques to detect micrometastases in selected thoracic lymph nodes. The use of isosulfan blue, technetium-99m and ¹⁸F-fluorodeoxyglucose (FDG) as mapping agents have been reported. Despite several limitations in this technique, it may facilitate the selection of patients for novel therapies, resulting in improved outcomes for lung cancer patients.
Perioperative <sup>18</sup>F-fluorodeoxyglucose-guided imaging using the becquerel as a quantitative measure for optimizing surgical resection in patients with advanced malignancy
2009, American Journal of Surgery
¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) scanning is a widely accepted preoperative tumor imaging modality. Herein, we evaluate the becquerel (Bq) as a potential novel quantitative PET measure for application of surgical specimen imaging.
Retrospectively, PET-avid lesions that could be followed from preoperative imaging, confidently identified in the operating room, imaged ex vivo, and correlated with histopathology were included in this study. Bq counts from both in vivo (preoperative) and ex vivo (surgical specimen) PET/CT images were measured and correlated with histopathology.
Fifty-five PET-avid lesions in 37 patients were included. Forty-six of 55 PET-avid lesions identified were found to contain malignancy on histopathology. Mean Bq counts for the PET-avid lesions were significantly higher that the adjacent PET-nonavid areas (background) within both in vivo and ex vivo imaging (P < .001 and P < .001, respectively). When analyzing all 55 lesions, we found significant increases in Bq levels. PET-avid lesions from in vivo to ex vivo images (P < .001) without significant increases in Bq levels in PET-nonavid lesions from in vivo to ex vivo images (P = .06). When comparing Bq levels between the 2 groups (malignant and benign), we found significantly higher Bq counts in the malignant group on in vivo imaging (P = .02) as well as significantly lower Bq counts in FDG-nonavid areas on ex vivo imaging (P = .04) within the malignant group. Significant differences in PET-avid to PET-nonavid Becquerels ratios within both in vivo and ex vivo images (P = .004, P = .002 respectively) were found, with ex vivo ratio being significantly higher (P < .001).
¹⁸F-FDG PET/CT imaging using Bqs is the potential to discern malignant lesions from benign tissues within both in vivo and ex vivo scans.
Nuclear-medicine probes: Where we are and where we are going
2022, Medical Physics
Feasibility of a multimodal <sup>18</sup>F-FDG-directed lymph node surgical excisional biopsy approach for appropriate diagnostic tissue sampling in patients with suspected lymphoma
2015, BMC Cancer
Cerenkov luminescence endoscopy: Improved molecular sensitivity with b2-emitting radiotracers
2014, Journal of Nuclear Medicine

View all citing articles on Scopus

View full text

Case reportA Novel Approach to Positron Emission Tomography in Lung Cancer

Section snippets

Comment

Ann Thorac Surg

Ann Thorac Surg

Clin Positron Imaging

J Surg Res

Case report
A Novel Approach to Positron Emission Tomography in Lung Cancer