Image-Guided and Radioguided Surgery

Together with PET, radioguided surgery is the nuclear medicine application that has experienced the most relevant growth in the last 15 years. The simple term “radioguided surgery” actually constitutes a wide range of combined procedures based on synergis

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Image-Guided and Radioguided Surgery Francesco Giammarile, Sergi Vidal-Sicart, Federica Orsini, Renato A. Valdés Olmos, and Giuliano Mariani

Contents 16.1      Introductory Background

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16.2      Radioguided Surgery in Breast Cancer 16.2.1  The Clinical Problem 16.2.2  Pathophysiologic Issues on Sentinel Lymph Node Mapping 16.2.3  Procedures for Sentinel Lymph Node Mapping/Biopsy 16.2.4  Radioguided Occult Lesion Localization (ROLL) with 99mTc-MAA 16.2.5  Added Value of Intraoperative Portable Gamma Cameras 16.2.6  Future Perspectives

 355  355  355  356  363  364  365

16.3      Radioguided Sentinel Lymph Node Biopsy in Cutaneous Melanoma 16.3.1  The Clinical Problem 16.3.2  Lymphatic System of the Skin 16.3.3  Tracer Injection 16.3.4  Lymphoscintigraphy 16.3.5  Intraoperative Counting/Detection 16.3.6  Accuracy of Sentinel Lymph Node Biopsy and Long-Term Prognosis 16.3.7  Indications and Contraindications

 366  366  366  366  367  369  372  373

16.4      Radioguided Sentinel Lymph Node Biopsy in Head and Neck Cancers 16.4.1  The Clinical Problem 16.4.2  Lymphatic System of the Head and Neck 16.4.3  Modalities of Tracer Injection 16.4.4  Lymphoscintigraphy 16.4.5  Intraoperative Gamma Probe Counting/Detection 16.4.6  Retrieval and Analysis of Sentinel Lymph Nodes 16.4.7  Accuracy of Sentinel Lymph Node Biopsy and Long-Term Prognosis 16.4.8  Indications and Contraindications

 373  373  374  375  376  377  378  378  379

16.5      Radioguided Sentinel Lymph Node Biopsy in Gynecological Cancers 16.5.1  The Clinical Problem 16.5.2  Lymphatic System of Intrapelvic Female Organs

 379  379  380

F. Giammarile Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria S. Vidal-Sicart Nuclear Medicine Department, University Hospital Clinic, Barcelona, Spain F. Orsini Nuclear Medicine Unit, “Maggiore della Carità” University Hospital, Novara, Italy

R. A. Valdés Olmos Nuclear Medicine Section and Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands Nuclear Medicine Department, Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, The Netherlands G. Mariani (*) Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy e-mail: [email protected]

© Springer Nature Switzerland AG 2019 D. Volterrani et al. (eds.), Nuclear Medicine Textbook, https://doi.org/10.1007/978-3-319-95564-3_16

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F. Giammarile et al. 16.5.3  16.5.4  16.5.5  16.5.6  16.5.7  16.5.8 

 odalities of Tracer Injection M Lymphoscintigraphy Intraoperative Gamma Probe/Gamma Camera Detection Retrieval and Analysis of Sentinel Lymph Nodes Accuracy of Sentinel Lymph Node Biopsy and Long-Term Prognosis Indications and Contraindications

References

Learning Objectives

• To become famili