Synergism of SPECT/CT and portable gamma cameras for intraoperative sentinel lymph node biopsy in melanoma, breast cancer, and other malignancies

Abstract

The anatomical localization of sentinel lymph nodes or tracer avid lesions with preoperative SPECT/CT provides imaging for accurate radioguided interventions. Surgeons can use the provided anatomic landmarks to retrieve the detected target lesions during operation. This three-dimensional roadmap generated by this hybrid molecular modality has helped to transform the initial paradigm to one of “see, open and recognize”. The approach has been reinforced with the growing synergy of preoperative SPECT/CT with intraoperative portable imaging devices. Small portable gamma cameras have been incorporated in radioguided surgery by providing real-time imaging with a larger field of detection than a gamma probe can cover. Moreover, they provide visual assistance in localization and verification of resection of the targeted tissue, and they are able to reproduce SPECT/CT findings in the intraoperative localization of sentinel nodes in complex or difficult anatomic areas like the head and neck. Moreover, to overcome the lack of anatomic information, the prototypes of a new generation of fused optical/scintigraphic imaging have been recently developed.