Valdés Olmos R A, Vidal-Sicart S, Giammarile F, Zaknun J J, Van Leeuwen F W, Mariani G
Diagnostic Oncology, Department of Nuclear Medicine, Netherlands Cancer Institute - Antoni van Leuwenhoek Hospital Amsterdam, The Netherlands -
Q J Nucl Med Mol Imaging. 2014 Jun;58(2):207-15.
The popularity gained by the sentinel lymph node (SLN) procedure in the last two decades did increase the interest of the surgical disciplines for other applications of radioguided surgery. An example is the gamma-probe guided localization of occult or difficult to locate neoplastic lesions. Such guidance can be achieved by intralesional delivery (ultrasound, stereotaxis or CT) of a radiolabelled agent that remains accumulated at the site of the injection. Another possibility rested on the use of systemic administration of a tumour-seeking radiopharmaceutical with favourable tumour accumulation and retention. On the other hand, new intraoperative imaging devices for radioguided surgery in complex anatomical areas became available. All this a few years ago led to the delineation of the concept Guided intraOperative Scintigraphic Tumour Targeting (GOSTT) to include the whole spectrum of basic and advanced nuclear medicine procedures required for providing a roadmap that would optimise surgery. The introduction of allied signatures using, e.g. hybrid tracers for simultaneous detection of the radioactive and fluorescent signals did amply the GOSTT concept. It was now possible to combine perioperative nuclear medicine imaging with the superior resolution of additional optical guidance in the operating room. This hybrid approach is currently in progress and probably will become an important model to follow in the coming years. A cornerstone in the GOSTT concept is constituted by diagnostic imaging technologies like SPECT/CT. SPECT/CT was introduced halfway the past decade and was immediately incorporated into the SLN procedure. Important reasons attributing to the success of SPECT/CT were its combination with lymphoscintigraphy, and the ability to display SLNs in an anatomical environment. This latter aspect has significantly been improved in the new generation of SPECT/CT cameras and provides the base for the novel mixed reality protocols of image-guided surgery. In these protocols the generated virtual SPECT/CT elements are visually superimposed in the body of the patient in the operating room to directly facilitate, by means of visualization on screen or using head-mounted devices, the localization of radioactive and/or fluorescent targets by minimal invasive approaches in areas of complex anatomy. All these technological advances will play an increasing role in the future extension and the clinical impact of the GOSTT concept.
前哨淋巴结（SLN）手术在过去二十年中获得的广泛应用确实提高了外科学科对放射性引导手术其他应用的兴趣。一个例子是γ探测器引导下对隐匿性或难以定位的肿瘤病变进行定位。这种引导可以通过在瘤内注射（超声、立体定向或CT引导）放射性标记剂来实现，该标记剂会在注射部位蓄积。另一种可能性是使用全身给药的亲肿瘤放射性药物，其在肿瘤部位有良好的蓄积和滞留。另一方面，用于复杂解剖区域放射性引导手术的新型术中成像设备也已问世。所有这些在几年前促成了“引导术中闪烁肿瘤靶向”（GOSTT）概念的形成，该概念涵盖了为优化手术提供路线图所需的全系列基础和先进核医学程序。引入联合标记，例如使用混合示踪剂同时检测放射性和荧光信号，丰富了GOSTT概念。现在可以将围手术期核医学成像与手术室中额外光学引导的高分辨率相结合。这种混合方法目前正在进行中，并且可能在未来几年成为一个重要的遵循模式。GOSTT概念的一个基石是像SPECT/CT这样的诊断成像技术。SPECT/CT在过去十年中期被引入，并立即被纳入SLN手术。SPECT/CT取得成功的重要原因在于它与淋巴闪烁显像相结合，以及能够在解剖环境中显示前哨淋巴结。在新一代SPECT/CT相机中，这后一个方面有了显著改进，并为图像引导手术的新型混合现实协议奠定了基础。在这些协议中，生成的虚拟SPECT/CT元素在手术室中直观地叠加在患者身体上，通过屏幕可视化或使用头戴式设备，直接便于在复杂解剖区域以微创方法定位放射性和/或荧光靶点。所有这些技术进步将在未来GOSTT概念的扩展和临床影响中发挥越来越重要的作用。
