Abstract
BackgroundTo retrospectively analyze perilesional technetium Tc-99m MAA injection for intraoperative localization of atypical soft-tissue and bone lesions within a single tertiary referral center in order to determine technique, safety, and clinical utility of these procedures.MethodsAn IRB compliant, retrospective electronic chart review (2010–2017) exploring surgical excision of atypical (non-pulmonary, non-breast, non-sentinel node) lesions guided by Tc-99m MAA perilesional injection. Patient demographics, lesion location, lesion size, radiotracer injection technique, radiotracer injection complications, scintigraphy technique, scintigraphic quality, intraoperative time, lesion identification in surgery, and pathological diagnoses were recorded.ResultsTwenty-two atypical radiolocalization exams were identified. Lesion sites included rib (7), lymph node (4), abdominal wall (3), mesenteric (3), gallbladder fossa (1), retroperitoneum (1), parietal pleura (1), anterior mediastinum (1), and iliac bone (1). Average lesion size was 14 mm (range 5–23 mm). Eighteen (82%) radiotracer injections used computed tomography guidance and 4 (18%) used ultrasound guidance. The mean activity of Tc-99m MAA administered was 11.8 MBq (0.32 mCi). A 22-gauge needle was most often used for perilesional injection. No injection complications were reported. The lesions were identified with a hand-held gamma probe during surgery in 100% of cases. Of the samples sent to pathology, 100% were identified and given a diagnosis.ConclusionRadiolocalization of atypical lesions may be a valuable technique, guiding minimally invasive surgical removal of lesions that would otherwise be difficult to identify intraoperatively such as non-palpable rib, central mesenteric nodal, and abdominal wall lesions.
Highlights
To retrospectively analyze perilesional technetium Tc-99m Technetium m macroaggregated albumin (MAA) injection for intraoperative localization of atypical soft-tissue and bone lesions within a single tertiary referral center in order to determine technique, safety, and clinical utility of these procedures
This study evaluates technique, safety, and clinical utility of perilesional radiotracer injections for intraoperative localization: a technique that utilizes ultrasound or computed tomography (CT) to visualize a lesion, guide a needle to it, and inject Tc-99m MAA
Data collected from electronic medical record review of the final subjects included sex, age at time of radiolocalization, anatomic location and size of lesion, modality (CT versus ultrasound) utilized to guide radiotracer injection, needle gauge for injection, radioactivity of Tc-99m MAA administered, patient complications associated with radiotracer injection, post-injection scintigraphy parameters, surgery time for lesion excision, successful intraoperative lesion localization with a hand-held gamma probe, lesion identification, and diagnosis from the pathology service
Summary
To retrospectively analyze perilesional technetium Tc-99m MAA injection for intraoperative localization of atypical soft-tissue and bone lesions within a single tertiary referral center in order to determine technique, safety, and clinical utility of these procedures. Radiolocalization is a technique that most commonly utilizes a small volume (0.2–1.0 cc) of technetium 99m labeled macroaggregated albumin (Tc-99m MAA) or sulfur colloid (Tc-99m SC) to localize lymph nodes and lesions throughout the body. There are two major facets of radiolocalization: intradermal injection for sentinel lymph node localization and direct perilesional injections. The application of perilesional injections for small and non-palpable pulmonary lesions is well described [1,2,3,4]. There are several reports on perilesional breast radiolocalization, with the benefit of simultaneously localizing non-palpable breast lesions and sentinel lymph nodes [5–8]. While other applications of perilesional localizations have been described, the information is limited
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