Introduction: Radioguided surgery is an ever-evolving part of nuclear medicine. In fact, this nuclear medicine sub-discipline actively bridges non-invasive molecular imaging with surgical care.... Show moreIntroduction: Radioguided surgery is an ever-evolving part of nuclear medicine. In fact, this nuclear medicine sub-discipline actively bridges non-invasive molecular imaging with surgical care. Next to relying on the availability of radio- and bimodal-tracers, the success of radioguided surgery is for a large part dependent on the imaging modalities and imaging concepts available for the surgical setting. With this review, we have aimed to provide a comprehensive update of the most recent advances in the field. Areas covered: We have made an attempt to cover all aspects of radioguided surgery: 1) the use of radioisotopes that emit gamma, beta(+), and/or beta(-) radiation, 2) hardware developments ranging from probes to 2D cameras and even the use of advanced 3D interventional imaging solutions, and 3) multiplexing solutions such as dual-isotope detection or combined radionuclear and optical detection. Expertopinion: Technical refinements in the field of radioguided surgery should continue to focus on supporting its implementation in the increasingly complex minimally invasive surgical setting, e.g. by accommodating robot-assisted laparoscopic surgery. In addition, hybrid concepts that integrate the use of radioisotopes with other image-guided surgery modalities such as fluorescence or ultrasound are likely to expand in the future. Show less
With the rapid expansion of robot-assisted surgical procedures, the need for robot-compliant image guidance technologies has also increased. Examples hereof are the integrated firefly fluorescence... Show moreWith the rapid expansion of robot-assisted surgical procedures, the need for robot-compliant image guidance technologies has also increased. Examples hereof are the integrated firefly fluorescence camera, the drop-in ultrasound probe, and the recently introduced DROP-IN gamma probe. Combined with Ga-68-prostate-specific membrane antigen-(PSMA)-11 PET/CT (staging) and Tc-99m-PSMA-I&S SPECT/CT (preoperative imaging), the latter DROP-IN gamma probe technology recently allowed us to perform the first clinical cases of robot-assisted PSMA-guided salvage surgery of lymphatic metastases. Show less
Broeck, T. van den; Bergh, R.C.N. van den; Arfi, N.; Gross, T.; Moris, L.; Briers, E.; ... ; Mottet, N. 2019
One of the challenges for the surgical management of prostate cancer is the lymphatic spread of metastases. Lymph node metastases vary in size (micrometastases (<2 mm) or macrometastases (>2... Show moreOne of the challenges for the surgical management of prostate cancer is the lymphatic spread of metastases. Lymph node metastases vary in size (micrometastases (<2 mm) or macrometastases (>2 mm)), and their interactions with the lymphatic environment differ (whether they are hypoxic or connected to blood flow). Thus, devising a universal imaging system and an image-guided surgical approach that supports the resection of all affected lymph nodes is difficult. Two complementary approaches to identifying affected lymph nodes have been described as alternatives to performing a traditional pelvic lymph node dissection: lymphatic mapping using radioguidance (the most widely applied modality), fluorescence guidance, integrated hybrid radioguidance and fluorescence guidance or magnetic guidance; and surgery guided by radiolabelled prostate-specific membrane antigen. Careful patient selection using preoperative imaging seems to be a crucial aspect in determining whether one of the individual image-guided surgery procedures alone would be optimal or whether a combination would be considered to be the most desirable course of action. The successful implementation and dissemination of both lymph-node-targeted and disease-targeted procedures are very much reliant on ongoing technical developments in the field and their standardization and interpretation. However, when these innovative surgical procedures are fully refined, evaluation of their influence on oncological outcome is imperative. Show less
Grivas, N.; Roest, R.C. van der; Korne, C.M. de; KleinJan, G.H.; Sikorska, K.; Schoots, I.G.; ... ; Poel, H.G. van der 2019
Background Post-radiotherapy locally recurrent prostate cancer (PCa) patients are candidates for focal salvage treatment. Multiparametric MRI (mp-MRI) is attractive for tumor localization. However,... Show moreBackground Post-radiotherapy locally recurrent prostate cancer (PCa) patients are candidates for focal salvage treatment. Multiparametric MRI (mp-MRI) is attractive for tumor localization. However, radiotherapy-induced tissue changes complicate image interpretation. To develop focal salvage strategies, accurate tumor localization and distinction from benign tissue is necessary. Purpose To quantitatively characterize radio-recurrent tumor and benign radiation-induced changes using mp-MRI, and investigate which sequences optimize the distinction between tumor and benign surroundings. Study Type Prospective case?control. Subjects Thirty-three patients with biochemical failure after external-beam radiotherapy (cases), 35 patients without post-radiotherapy recurrent disease (controls), and 13 patients with primary PCa (untreated). Field Strength/Sequences 3T; quantitative mp-MRI: T2-mapping, ADC, and Ktrans and kep maps. Assessment Quantitative image-analysis of prostatic regions, within and between cases, controls, and untreated patients. Statistical Tests Within-groups: nonparametric Friedman analysis of variance with post-hoc Wilcoxon signed-rank tests; between-groups: Mann?Whitney tests. All with Bonferroni corrections. Generalized linear mixed modeling to ascertain the contribution of each map and location to tumor likelihood. Results Benign imaging values were comparable between cases and controls (P?=?0.15 for ADC in the central gland up to 0.91 for kep in the peripheral zone), both with similarly high peri-urethral Ktrans and kep values (min?1) (median [range]: Ktrans?=?0.22 [0.14?0.43] and 0.22 [0.14?0.36], P?=?0.60, kep?=?0.43 [0.24?0.57] and 0.48 [0.32?0.67], P?=?0.05). After radiotherapy, benign central gland values were significantly decreased for all maps (P ≤ 0.001) as well as T2, Ktrans, and kep of benign peripheral zone (all with P ≤ 0.002). All imaging maps distinguished recurrent tumor from benign peripheral zone, but only ADC, Ktrans, and kep were able to distinguish it from benign central gland. Recurrent tumor and peri-urethral Ktrans values were not significantly different (P?=?0.81), but kep values were (P < 0.001). Combining all quantitative maps and voxel location resulted in an optimal distinction between tumor and benign voxels. Data Conclusion Mp-MRI can distinguish recurrent tumor from benign tissue. Level of Evidence: 2 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2018. Show less
Fernandes, C.D.; Ghobadi, G.; Poel, H.G. van der; Jong, J. de; Heijmink, S.W.T.P.J.; Schoots, I.; ... ; Heide, U.A. van der 2018
