KleinJan G H, Brouwer O R, Mathéron H M, Rietbergen D D D, Valdés Olmos R A, Wouters M W, van den Berg N S, van Leeuwen F W B
Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC Leiden, The Netherlands; Department of Nuclear Medicine, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
Department of Nuclear Medicine, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
Rev Esp Med Nucl Imagen Mol. 2016 Sep-Oct;35(5):292-7. doi: 10.1016/j.remn.2016.04.001. Epub 2016 May 9.
To assess if combined fluorescence- and radio-guided occult lesion localization (hybrid ROLL) is feasible in patients scheduled for surgical resection of non-palpable (18)F-FDG-avid lesions on PET/CT.
Four patients with (18)F-FDG-avid lesions on follow-up PET/CT that were not palpable during physical examination but were suspected to harbor metastasis were enrolled. Guided by ultrasound, the hybrid tracer indocyanine green (ICG)-(99m)Tc-nanocolloid was injected centrally in the target lesion. SPECT/CT imaging was used to confirm tracer deposition. Intraoperatively, lesions were localized using a hand-held gamma ray detection probe, a portable gamma camera, and a fluorescence camera. After excision, the gamma camera was used to check the wound bed for residual activity.
A total of six (18)F-FDG-avid lymph nodes were identified and scheduled for hybrid ROLL. Comparison of the PET/CT images with the acquired SPECT/CT after hybrid tracer injection confirmed accurate tracer deposition. No side effects were observed. Combined radio- and fluorescence-guidance enabled localization and excision of the target lesion in all patients. Five of the six excised lesions proved tumor-positive at histopathology.
The hybrid ROLL approach appears to be feasible and can facilitate the intraoperative localization and excision of non-palpable lesions suspected to harbor tumor metastases. In addition to the initial radioguided detection, the fluorescence component of the hybrid tracer enables high-resolution intraoperative visualization of the target lesion. The procedure needs further evaluation in a larger cohort and wider range of malignancies to substantiate these preliminary findings.
评估联合荧光和放射性引导的隐匿性病变定位（混合ROLL）在计划手术切除PET/CT上不可触及的（18）F-FDG摄取病变的患者中是否可行。
纳入4例在随访PET/CT上有（18）F-FDG摄取病变的患者，这些病变在体格检查时不可触及，但怀疑有转移。在超声引导下，将混合示踪剂吲哚菁绿（ICG）-（99m）Tc-纳米胶体注入靶病变中心。使用SPECT/CT成像确认示踪剂沉积。术中，使用手持式γ射线检测探头、便携式γ相机和荧光相机对病变进行定位。切除后，使用γ相机检查伤口床是否有残留活性。
共识别出6个（18）F-FDG摄取的淋巴结并计划进行混合ROLL。将PET/CT图像与混合示踪剂注射后获得的SPECT/CT图像进行比较，证实示踪剂沉积准确。未观察到副作用。联合放射性和荧光引导能够在所有患者中定位并切除靶病变。6个切除病变中有5个在组织病理学上证实为肿瘤阳性。
混合ROLL方法似乎可行，可促进术中对怀疑有肿瘤转移的不可触及病变的定位和切除。除了最初的放射性引导检测外，混合示踪剂的荧光成分还能在术中实现对靶病变的高分辨率可视化。该方法需要在更大的队列和更广泛的恶性肿瘤范围内进行进一步评估，以证实这些初步发现。
