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490
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C. Bluemel et al.
and functional information useful to provide better localization of SLNs and to detect other possible SLNs with poor or without visualization
seen at planar imaging [ 5 – 7 ]. As this case showed,
SPECT/CT plays also an important role to reduce
the false-positive rate, possibly due to external
contamination or presence of radioactivity in
enlarged lymphatic vessels. In conclusion,
a
SPECT/CT represents a useful adjunct to planar
imaging for SLN mapping in vulvar cancer.
29.4 Hybrid Tracer in Gynecology
Pilar Paredes, Jaume Pahisa, Francisco Campos,
and Sergi Vidal-Sicart
b
c
d e
Fig. 29.10 Injection of
the day before surgery. Planar lymphoscintigraphy showed
bilateral drainage ( b ), confi rmed on SPECT/CT images ( c ).
MIP reconstruction ( c, left ) and axial CT and fusion images
99m
Tc-albumin nanocolloid-ICG ( a )
( c ; mid and right ) showed the SLN location on external iliac
chains. During surgery, the laparoscopic gamma probe ( d )
allowed the identifi cation of pelvic SLNs, which showed fl uorescent emission detected by means of an optical camera ( e )
29 Case Reports
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491
A 53-year-old woman who presented with
postmenopausal metrorrhagia was referred to the
Gynecology Department for further study. Cone
biopsy revealed squamous cervical carcinoma.
Thoracoabdominal CT did not show lymph node
involvement. MR showed no evidence of parametrial invasion. The patient was diagnosed of
IB1 cervical cancer and was scheduled for lymphoscintigraphy, sentinel lymph node detection,
and potential (eventual) hysterectomy.
Lymphoscintigraphy was performed the day
before surgery to obtain a lymphatic map of
the tumor. A dose of 111 MBq of a hybrid
99m
tracer
green (ICG) was injected around the modifi ed
external cervical os. Lymphoscintigraphy
included planar images at 30 minutes and 2
hours after tracer injection and SPECT/CT
images at 2 hours p.i.
(50 % dilution) was administered with the
same protocol as the hybrid tracer. Sentinel
lymph node detection included visual inspection of blue lymph nodes and the use of a laparoscopic gamma detection probe and an optical
camera suitable for fl uorescence visualization
(Fig. 29.10 ).
Tc-albumin nanocolloid-indocyanine
At the onset of surgery, 2 ml of blue dye
29.5 Minimally Invasive,
Image- Guided Core Needle
Biopsy of Sentinel Lymph
Nodes as Nonsurgical
Method to Detect Lymph
Node Metastases
Stefan Paepke, Martin Horn,
and Thomas Wendler
For over the past 20 years, sentinel lymph node
(SLN) biopsy has become the widely accepted
method for the diagnostic evaluation of the axillary lymph nodes in early-stage breast cancer
patients [ 8 , 9 ]. Recently, a commercial SPECT/
ultrasound system (SentiGuide® by SurgicEye®,
Munich, Germany) has been made available [ 10 ].
This system allows one to identify radioactive
lymph nodes (i.e., SLNs) and distinguish them
from non-radiative lymph nodes (i.e., non-SLNs)
within the axilla. The addition of a core needle
biopsy device to this system allows the performance of a minimally invasive, image-guided
core needle biopsy procedure (i.e., nonsurgical
SLN biopsy) which is specifi cally directed
toward the SLNs (Fig.
A 52-year-old female patient with a primary
early-stage breast tumor and a clinically negative
axilla was planned for a standard SLN biopsy
procedure. The patient agreed to participate in
the MinimalSNB study, which evaluates the feasibility of a minimally invasive, image-guided
core needle biopsy to the SLNs (i.e., nonsurgical
SLN biopsy) using SPECT/ultrasound.
The day before surgery, 132 MBq of
99m
Tc-nanocolloid was injected in a periareolar
fashion into the ipsilateral breast. A single SLN was
detected after 5 minutes using dynamic lymphoscintigraphy (ECAM by Siemens, Knoxville, TN,
USA, LEHS collimator, 2-min integration time).
On the day of surgery, intraoperative SPECT/
US imaging (1-min SPECT acquisition, 12 MHz
transducer; using as detector the mini gamma
camera CrystalCam by Crystal Photonics,
Berlin, Germany) was acquired under general
anesthesia and prior to the surgical incision. A
single SLN, measuring 12.7mm × 5.3 mm, was
identifi ed at a depth of 19.9 mm. Seven core
needle biopsy specimens were taken using a
14G HistoCore system (BIP Medical,
Tuerkenfeld, Germany) in the semiautomatic
mode to avoid damage of vital structures. The 7
harvested core needle biopsy specimens were
radioactive, verifying that these specimens correctly targeted the SLN. Subsequently, a
standard surgical SLN biopsy procedure was
performed using a gamma probe (Gamma
Finder by W.O.M. World of Medicine, Berlin,
Germany), and 2 close radioactive lymph nodes
were harvested (i.e., 2 SLNs). Intraoperative
frozen section analysis of these 2 surgical
excised SLNs was negative for metastatic disease (Figs.
The resected breast tumor revealed to be invasive ductal carcinoma (pT1c, G2), measuring
15 mm in greatest dimension and which had negative surgical resection margins.
29.12 , and 29.13 ).
29.11 ).
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Fig. 29.11 Top left : intraoperative localization of SLN with gamma probe, top right : surgical resection of SLN, bot-
tom left : SLN identifi cation in ultrasound using SentiGuide® system, bottom right : needle biopsy of SLN
Fig. 29.12 Left : planar scintigraphy with lead covering of injection site with one identifi ed SLN, right : 1 SLN con-
fi rmed by SentiGuide®
29 Case Reports
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Fig. 29.13 Left : core needle biopsy of the SLN under ultrasound guidance, right : core needle inside the SLN overlaid
by the SentiGuide® SPECT fusion
493
Subsequently, the initial permanent pathological examination (using H&E, step sectioning
with 500 μm slices) of the 2 harvested SLNs was
reported to show no evidence of metastatic disease, as was previously demonstrated on intraoperative frozen section analysis. However,
permanent pathological examination of the 7 harvested core needle biopsy specimens from the
minimally invasive, image-guided core needle
biopsy procedure (i.e., nonsurgical SLN biopsy)
of the single visualized SLN revealed micrometastatic disease within that SLN. As a result, a more
thorough repeat permanent pathological examination of the 2 SLNs harvested at the time of the
standard surgical SLN biopsy procedure revealed
evidence of isolated tumor cells within one of the
2 surgically excised SLNs. Resultantly, the status
of the SLNs was changed by the nonsurgical
SLN biopsy procedure, representing a false-negative result from the standard surgical SLN
biopsy procedure.
Minimally invasive, image-guided axillary lymph
node core needle biopsy is an established diagnostic method for suspicious axillary lymph nodes
seen on ultrasound. It is performed mainly by radiologists and breast surgeons [ 11 ]. Extending this
technology to axillary SLNs using large-gauge
core needle biopsy devices represent the next step
in the evolution of the diagnostic evaluation of the
axillary lymph nodes in breast cancer patients.
As demonstrated in this particular case,
SPECT/US was shown to be a feasible and safe
method for accomplishing percutaneous, minimally invasive, image-guided SLN core needle
biopsy. However, this technology does require
proper training and established expertise/experience with axillary lymph node core needle biopsy
methods, including harvesting multiple cores
using larger-gauge core needle biopsy devices for
maximizing the diagnostic capabilities. These
issues will be addressed within a running multicentric trial (MinimalSNB).
494
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C. Bluemel et al.
References
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3. Ahmed M, Douek M. Radioactive seed localisation
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4. Kreienberg R, Albert US, Follmann M, Kopp IB, Kuhn
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MD. The role of 3D fusion imaging in sentinel lymphadenectomy for vulvar cancer. Gynecol Oncol.
2008;109(1):76–80.
6. Kraft O, Havel M. Detection of sentinel lymph nodes in
gynecologic tumours by planar scintigraphy and SPECT/
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10.1055/s-0032-1328689 .
7. Belhocine TZ, Prefontaine M, Lanvin D, Bertrand M,
Rachinsky I, Ettler H, et al. Added-value of SPECT/
CT to lymphatic mapping and sentinel lymphadenectomy in gynaecological cancers. Am J Nucl Med Mol
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8. Lyman GH, Temin S, Edge SB, Newman LA,
Turner RR, Weaver DL, Benson AB, Bosserman LD,
Burstein HJ, Cody H, Hayman J, Perkins CL,
Podoloff DA, Giuliano AE. Sentinel lymph node
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9. Kuehn T, Bembenek A, Decker T, Munz DL, Sautter‐
Bihl ML, Untch M, Wallwiener D. A concept for the
clinical implementation of sentinel lymph node
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451–61.
10. Freesmeyer M, Winkens T, Opfermann T, Elsner P,
Runnebaum I, Darr A. Real-time ultrasound
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lymph node mapping. Nuklearmedizin. 2014;53(6):
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11. Paepke S, Ohlinger R, Blohmer J-U, Thill M, Gruber
I, Hahn M, Kuehn T. Work Group on MinimallyInvasive Breast Interventions of the German Society
of Senology. Survery on axillary lymph node biopsy
in Germany. Annual meeting of the German Society
of Senology, Leipzig, June 2015.
Index
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A
Absorbed dose (D) , 104
American Association of Thoracic Surgery
(AATS) , 336
American College of Chest Physicians (ACCP) , 336
American Joint Committee on Cancer (AJCC) ,
184, 360, 467
American Society of Head and Neck Surgery
(AHNS) , 184
Antigen-directed cancer surgery
ex vivo radioimmunodetection of lymph
nodes , 409
handheld gamma detection probe , 409
H&E evaluation , 408
oncologic theranostics , 410
radioimmunoguided surgery-positive tissues ,
407–408
time-dependent multivariate Cox proportional
hazards regression analysis , 410
Axillary MRI, SPIO , 467–468
B
Biomedicine, NPs
biological , 455
carbon-based , 454–455
dendrimers , 455
gold-containing nanostructures , 454
liposomes , 455
metal oxide , 454
molecular dots , 454
nanowires , 455
polymer nanospheres , 455
quantum dots (QDs) , 454
silica NPs , 454
Bladder cancer , 234
Bleomycin , 86, 234, 342
Body mass index (BMI) , 205, 255
Bone lesions
confi rmation of histology , 354
(PET)/CT , 354, 355
1D acoustical probes success rates , 356
gamma probe-guided surgery , 354–356
percutaneous marking , 354–356
preoperative localization
imaging , 355
route of administration , 354–355
traces used , 354–355
radioguided resection , 354
radioguided surgery , 354–356
skin markings , 356
SPECT/CT , 354, 355
Breast cancer
clinical applications of radioimmunoguided
surgery , 400–401
fhSPECT/US fusion , 475–476
gamma cameras
melanoma sentinel lymph node biopsy , 46–47
radioguided occult lesion localization (ROLL) ,
45–46
sentinel lymph node biopsy , 44–45
localization of non-palpable
planar scintigraphy , 485
preinjection ultrasound , 484, 485
ROLL , 484
SLNB
axillary lymph node dissection (ALND) , 115
extra-axillary drainage , 120
isotope vs. blue dye , 119
location of injection , 118–119
lymphatic drainage patterns , 116
Memorial Sloan Kettering Cancer Center
approach , 121
neoadjuvant chemotherapy , 120–121
particle size , 116–117
radioisotope injection, volumes of ,
117–118
superfi cial vs. deep injection , 119
timing of injection , 118
C
CALGB 140203 multicenter phase II trial , 323
Cancer surgery
Doxpal® self-retaining plastic retractor , 467
metal retractors , 467
radioactive tracers , 464
radioisotope dependency , 467
© Springer International Publishing Switzerland 2016
K. Herrmann et al. (eds.), Radioguided Surgery: Current Applications and Innovative
Directions in Clinical Practice, DOI 10.1007/978-3-319-26051-8
495
496
https://t.me/med1917
Index
Carbonic anhydrase IX (CAIX) antigen ,
381–382
Carcinoembryonic antigen (CEA) , 8, 9, 85–87, 219,
372, 379, 381
Cervical cancer
blue dyes and radiotracers , 255
fl uorescent tracer , 255
ICG , 255
intraoperative detection , 255
lymphatic drainage , 254
planar and tomographic images , 254
preoperative imaging , 254
tracers and route of administration , 254
Cervical injection , 255
Clear cell renal cell cancer , 404–405
Colorectal cancer
lymphatic drainage , 283–285
SLN biopsy
blue dye , 288
En bloc resection , 281
epidemiology , 280
ESMO and NCCN treatment
standards , 280
H&E stain , 280–281
high-risk group , 280
lymphatic mapping , 281
micrometastases , 281
parameters achieved in , 282
prognostic signifi cance of micrometastases , 283
qualifying condition for , 281
radiocolloids clinical use , 289–290
using 17-1A murine MAb , 382–383
using anti-A33 transmembrane glycoprotein
antigen humanized , 397
using anti-CEA murine MAb , 394–397
using B72.3 murine MAb , 383–388
using CC49 and CC83 murine MAb , 388–393
using humanized CC49 MAb , 393–394
using multiple MAb “Cocktail,” 397–398
Colorimetric markers
administration
ex vivo mapping , 286
technical aspects , 286
in vivo lymphatic mapping , 286
fl uorescent dyes , 286
isosulfan blue , 286
limitations , 286–287
Patent Blue V , 286
soluble blue dyes , 286
D
Differentiated thyroid cancer (DTC) , 184
completion thyroidectomy , 210–212
iodine-guided resection , 212–214
non-iodine-guided resection
( see Non-iodine-guided resection)
Dosimetry , 104–105
DOTATATE , 304, 336, 342–343
E
Effective dose (E) , 105
Electron-positron annihilation , 421–424
Electron radiation
32-phosphorus , 91
90-yttrium , 91–92
Endometrial cancer
blue dye , 256–257
ICG , 257
lymphatic drainage , 255
planar and tomographic images , 256
preoperative imaging , 255
tracers and route of administration , 255–256
Endoscopic mucosal resection (EMR) , 274
Endoscopic submucosal dissection (ESD) , 274
EpCAM (Tumor-associated antigen 17-1A) , 381
Esophageal cancer
lymph node metastasis , 268
SLN
biopsy results , 269–270
future application , 270–271
mapping procedures , 268–269
Esophagogastric cancer
esophageal cancer ( see Esophageal cancer)
gastric cancer ( see Gastric cancer)
F
18
F-FDG-directed interventional procedures
anticipated surgical procedure , 434
clinical applications , 425, 432–433
inherent limitations , 422–423
multimodal imaging and detection approach , 435
real-time cancer detection and guidance , 434, 439
solid malignancies , 434
standard postoperative recovery, postanesthesia
18
F-FDG-directed surgery
care unit , 434
clinical applications , 425–431
intraoperative gamma detection probing , 435–436
occupational radiation exposure , 438–439
radiation detection devices ( see Radiation detection
18
F-FDG-guided surgery , 215–217
18
F-FDG surgery , 341–342
Fine needle aspiration (FNA) , 336
Fluorine-18 fl uorodeoxyglucose (
18
F-FDG-directed surgery ( see 18 F-FDG-directed
interventional procedures ( see
devices,
surgery)
18
F-FDG-directed surgery)
18
F-FDG)
18
F-FDG-directed
interventional procedures)
Fluorophores
clinical application, NIRF molecules , 453–454
fl uorescent-based molecularly targeted
visualization , 453
fl uorescent contrast agents , 450–452
hybrid tracers , 457–458
imaging techniques , 450
NPs, biomedicine , 454–455
Index
https://t.me/med1917
497
patient care , 449
radical cancer resection , 453
translation into clinical usage , 455–457
Follicular thyroid cancer (FTC) , 210
Follicular thyroid carcinoma (FTC) , 184
Freehand single-photon emission computed
tomography (fhSPECT)
data registration , 478
dorsal thyroid gland reconstruction artifacts , 479
examination setup , 472, 473
fusion imaging, US examination. , 474
insuffi cient fhSPECT resolution , 479
Freehand SPECT (fhSPECT) , 258–260
Full width at half maximum (FWHM) , 41
Fusion imaging, SPECT/US , 474–475
G
68
Ga-DOTATATE / 68 Ga-DOTATOC , 304
Gamma cameras
in breast cancer
melanoma sentinel lymph node biopsy , 46–47
radioguided occult lesion localization (ROLL) ,
45–46
sentinel lymph node biopsy , 44–45
camera features
“CrystalCam,” 43
“declipseSPECT,” 42
dual-isotope imaging , 41
image fi eld of view , 42
infrared technology , 43
Sentinella S102 camera , 41
software tools , 41
clinical applications , 51
detectors , 39
detector’s fi eld of view , 39
energy resolution , 41
head and neck sentinel lymph node biopsy , 47
history , 36–37
intraoperative maneuverability , 36
limitations , 36
primary hyperparathyroidism , 49–51
radioguided bone lesion localization , 51
real-time imaging , 36
sensitivity , 39, 40
spatial resolution , 39, 41
urogenital sentinel node lymph biopsy
dual-isotope imaging mode , 48
intraoperative imaging , 49
pinhole collimator , 48
Gamma detection system with bluetooth , 203
Gamma photon detection , 424–425, 436
electron-positron annihilation process , 424
“PET” probes
active electronic collimation , 424
clinical medicine , 425
crystal geometry designs , 424
ex vivo surgical specimen imaging devices ,
424–425
secondary K-alpha x-ray fl uorescence , 424
probe determination , 437–438
Gamma-radiation
57-cobalt , 86
67-gallium , 86
111-indium , 85–86
123-iodine , 86–87
125-iodine , 87–88
131-iodine , 88
99m-technetium , 82–85
201-thallium , 88
68
Ga-somatostatin analogues , 304
Gastric cancer
clinical applications , 398–399
LADG , 271
SLN mapping
dye tracers , 271, 272
EMR/ESD , 274
IREE , 272
NEWS , 274, 275
radioactive tracers , 271
results , 272–273
Gastroenteropancreatic (GEP) tumors , 299–308
GEP-NETs tumors
functional/nonfunctional tumors , 300
gamma-ray-emitting radiotracers
68
Ga-somatostatin analogues , 304
125
I-labeled somatostatin analogue , 302
123
I-MIBG , 303
111
In-pentetreotide , 301–302
99m
Tc-labeled somatostatin analogue , 302–303
HGDP , 300–301
preoperative preparation , 300
radical oncologic surgical resection , 300
SPECT/CT , 300
survival rates , 300
ZES
HGDP , 304–307
LFOVGC , 304–307
real-time imaging , 304
Gynaecological tumours
cervical cancer ( see Cervical cancer)
endometrial cancer ( see Endometrial cancer)
indications and contraindications , 250
intraoperative detection
blue dyes , 257
fhSPECT , 257–260
fl uorescent tracers , 257
PGC , 257–258
ovarian cancer , 259–260
vaginal cancer , 260
vulvar cancer ( see Vulvar cancer)
H
Handheld gamma detection probe (HGDP) , 5–11, 35, 36,
41, 190, 290, 300, 342, 363, 373, 374, 382,
383, 407–410, 424, 425
Hematoxylin and eosin (H&E) stain , 280–281, 383
498
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Index
High-energy gamma photon
electron-positron annihilation process , 424
handheld gamma detection probe systems , 424
real-time cancer detection , 439
surgical guidance , 439
Human serum albumin (HSA) , 6, 11, 83, 254,
316, 327, 346, 362, 363, 455
Hürthle cell tumor , 215
Hybridoma fusion technology , 375
Hybrid tracer, gynecology
lymphoscintigraphy , 490–491
postmenopausal metrorrhagia , 490
surgery , 491
Hybrid tracers
5-ALA target-protoporphyrin IX , 458
γ-glutamyltranspeptidase-activated fl uorescent
probe , 458
99m
Tc-nanocolloid , 457
ICG-
125
I-methylene blue , 457
multimodal mAb–trastuzumab–for Her receptor , 457
peptide-based targeting , 458
Hysteroscopy , 256
I
99m
Tc-nanocolloid , 457
ICG-
125
I-labeled somatostatin analogue , 302
Image-guided core needle biopsy, SLN
cobalt source, localization and skin marking ,
491, 492
140keV handheld probe localization , 492
123
I-MIBG-guided surgery , 220, 303
Indocyanine green (ICG) fl uorescence imaging ,
253, 327–328
Inferior mesenteric lymph nodes , 284
111
In-pentetreotide , 301–302
International phase II non-randomized SentiMAG
Multicentre Trial , 465
In-transit metastases , 360
Intraoperative gamma probe technique , 188, 190,
192, 193, 435–436
Intraoperative parathyroid hormone (ioPTH) , 198
Intraoperative radioimmunodetection
experimental animal model testing , 373
external gamma scintillation imaging , 372
handheld radiation detection device , 372
iodine-131 (
131
I)-labeled antitumor antibodies , 372
malignant cell identifi cation vs. tumor-specifi c
antigen detection , 407–410
monoclonal antibody technology ( see Monoclonal
antibody technology)
preoperative whole-body scintillation imaging , 373
tumor-associated antigens ( see Tumor-associated
antigens)
tumor-to-background ratio , 374
Iodine-125 seeds , 126–132, 134–135, 145–146, 341
Isolated limb perfusion
(TNF)-α , 361
in-transit metastases , 360
leakage monitoring , 361, 362
locoregional recurrence , 360
melphalan , 361
perfusion technique , 361–362
prognosis , 360
radioguided monitoring
131
I-HS , 363
111
In-labeled red blood cells , 363
leakage detection , 363–367
99m
Tc , 363
one-probe system , 363
portable gamma camera , 364, 365
response , 366
scintillation detector , 362, 363
three-probe system , 363
two handheld gamma detection probe system , 363
response rate , 361
satellite metastases , 360
L
Laparoscopy-assisted distal gastrectomy (LADG) ,
271, 274
Large fi eld-of-view gamma camera (LFOVGC)
imaging , 304–307
Leakage, systemic
isolated limb perfusion
description of perfusion technique , 361–362
leakage monitoring , 362
radioguided monitoring , 362–366
Locoregional recurrence , 360
Lung cancer, radionuclide-guided biopsy,
rib lesion , 486–487
Lymphatic drainage
colon , 283–286
rectum , 285–286
Lymph node metastases, nonsurgical method , 491–493
Lymphoscintigraphy , 188, 190, 192, 193
M
Magnetic resonance imaging (MRI)
Magnetic technique
applications , 466–467
trials , 465–466
Malignant cell identifi cation vs. tumor-specifi c antigen
detection
ex vivo radioimmunodetection of lymph nodes , 409
handheld gamma detection probe , 409
H&E evaluation , 408
oncologic theranostics , 410
radioimmunoguided surgery-positive tissues ,
407–408
time-dependent multivariate Cox proportional
hazards regression analysis , 410
Malignant melanoma
fhSPECT/US fusion imaging , 475, 476
radioguided monitoring techniques , 6
treatment , 253
Medullary thyroid cancer (MTC)
123
I-MIBG-guided surgery , 220
9m
Tc-(V)-DMSA-guided surgery , 219
radioimmunoguided surgery , 219–220
Index
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499
recurrence rate , 219
somatostatin receptor-based surgery , 220
MELAMAG Trial , 467
Melphalan , 361, 362
Mesocolic lymph nodes , 283
Monoclonal antibody technology
cancer radiotherapeutics , 374
clinical medicine , 377
diagnostic nuclear medicine imaging , 374
homogeneous antibody production , 376
humanization, IgG , 376
hybridoma fusion technology , 375
integrated technologies , 374
polyclonal and monoclonal antibodies , 375
pretargeting strategy , 378
radioimmunoguided strategies , 374
and radiolabeling , 377–378
99m
Tc-labeled colloids , 217–219
99m
Tc-MIBI-guided surgery , 214–215
99m
Tc-pertechnetate , 210–211
9m
Tc-(V)-DMSA-guided surgery , 219
N
National Lung Screening Trial (NLST) , 336
Near-infrared fl uorescence (NIRF) , 218
Near-infrared (NIR) fl uorescent lymphatic
imaging , 327–328
Near infrared (NIR) imaging , 228, 231
Neuroendocrine tumors (NETs) tumors , 299–308
NIRF-guided surgery
angiography , 456–457
normal tissues preservation , 457
sentinel node biopsy , 455–456
tumor imaging , 456
Node picking , 185
Non-exposed endoscopic wall-inversion surgery
(NEWS) , 274, 275
Non-iodine-guided resection
18
F-FDG-guided surgery , 215–217
99m
Tc-labeled colloids , 217–219
99m
Tc-MIBI-guided surgery , 214–215
Non-palpable breast cancer, intraoperative 3D
imaging , 484–485
Non-small cell lung cancer (NSCLC)
clinical value , 316
lymphatic mapping
dose of radiotracer , 324
intraoperative vs. preoperative
injection , 323–324
preoperative lymphoscintigraphy , 324
route of administration , 316, 323
SPECT/CT , 324–325
volume of radiotracer , 324
SLN mapping
blue dyes , 326–327
carbon nanoparticles suspension , 328
characteristics of studies on , 317–322
3D systems (fhSPECT) , 330
fl uorescent dyes , 327–328
indications for , 316
intraoperative detection , 329
magnetic particles , 327
PET radiotracers , 327
portable gamma cameras , 330
resection of , 329
Nonsurgical method, lymph node metastases , 491–493
O
Occupational radiation exposure , 438–439
Oncologic theranostics , 410, 411
Ovarian cancer , 259–260, 401–403
P
Pancreatic cancer , 399–400
Papillary thyroid cancer (PTC) , 210
Papillary thyroid carcinoma (PTC)
biopsy
combination of vital dye, lymphoscintigraphy and
intraoperative gamma probe techniques ,
190–191
intraoperative gamma probe technique ,
188–190
lymphoscintigraphy , 188–190
vital dye technique , 185–188
lymph node metastases in , 184–185
prognostic signifi cance of lymph node
metastases in , 185
results
combination of vital dye, lymphoscintigraphy
and intraoperative gamma probe techniques ,
192–193
intraoperative gamma probe technique , 192
lymphoscintigraphy , 192
vital dye technique , 192
surgical techniques , 185
Paracolic lymph nodes , 283
Parathyroid hormone (PTH) , 204
Penile cancer
clinical outcomes , 231
inguinal nodal metastases , 228–231
SLN detection
intraoperative, gamma tracing , 230
optical tracers , 230–231
preoperative visualization of lymphatic
drainage , 228–229
Perfusion technique , 361–362
Photomultiplier tubes (PMTs) , 25
Portable gamma cameras (PGC) , 257–258
Position-sensitive photomultiplier tubes (PS-PMTs) , 36
Positron imaging and detection
diagnostic clinical applications , 421
18
F-FDG
biological tissue , 422
inherent limitations , 422–423
malignant tumors , 422
radiation detection probe technologies , 422
radioactive decay pattern , 421
interventional radiology , 421
theoretical physics framework , 421
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