Radioguided surgery: Novel applications

Abstract

A few years ago, the concept of Guided intraOperative Scintigraphic Tumor Targeting (GOSTT) was introduced to encompass the whole spectrum of basic and advanced nuclear medicine procedures required for providing a roadmap for radioguided surgery. This concept included the use of interventional nuclear medicine imaging to depict targets to be resected by radioguided surgery. With the incorporation of SPECT/CT and PET/CT, three-dimensional roadmaps to guide surgical procedures became possible. On the other side, new intraoperative portable imaging devices (gamma cameras and other tools) were added to conventional modalities such as gamma probes and blue dye. More recently, the development of hybrid tracers integrating radioactivity and fluorescence in one single signature has enabled the additional use of near-infrared cameras. All these advances have facilitated the extension of radioguided sentinel lymph node biopsy procedures from the classical applications in cutaneous melanoma and breast cancer to other fields such as oral cavity, gastrointestinal, urological, and gynecological malignancies. At present, three GOSTT working models can be defined in relation to radiotracer administration: intralesional without tracer migration for occult lesion localization, intralesional with tracer migration for occult lesion localization and sentinel lymph node biopsy, and systemic to enable excisional biopsy of primary lesions and recurrences as well as isolated regional and distant metastases. The latter is probably the field with the largest potential due to the continuous introduction of new PET and SPECT tracers. Novel modalities like luminescence detection and tracked imageguided navigation will further reinforce the role of GOSTT and radioguided intervention procedures.