18F-FDG-Directed Surgery and 18F-FDG-Directed Interventional Procedures

Abstract

The use of positron-emitting and high-energy gamma photon-emitting radiopharmaceuticals, like fluorine-18 fluorodeoxyglucose (18F-FDG), for real-time cancer detection and surgical guidance within the operating room and for real-time guidance of diagnostic and therapeutic interventional procedures within the interventional radiology suite, has great clinical potential. This technology may allow for (1) real-time intraoperative staging of the extent of disease; (2) real-time intraoperative surgical planning and execution of the necessary and most appropriate operation, determination of the extent of surgical resection, and determination of the completeness of surgical resection; (3) real-time pathologic evaluation of intact surgical resected specimens for the confirmation of completeness of surgical resection and for surgical margin assessment; (4) real-time pathologic evaluation of diagnostically biopsied tissues for confirmation of correctness of tissue diagnosis; and (5) real-time guidance of diagnostic and therapeutic interventional procedures within the interventional radiology suite. This chapter discusses (1) the history and development of positron imaging and detection, (2) the fundamental basis for the use of 18F-FDG in positron imaging and detection strategies, (3) the inherent limitations of 18F-FDG in positron imaging and detection strategies, (4) radiation detection devices utilized during 18F-FDG-directed surgery, (5) the clinical applications of real-time 18F-FDG-directed surgery and real-time 18F-FDG-directed interventional procedures, (6) timing issues related to 18F-FDG-directed surgery, (7) the inherent challenge of in situ detection of 18F-FDG with a gamma photon detection device, and (8) occupational radiation exposure during 18F-FDG radioguided surgical procedures.