Hybrid radioguided occult lesion localization (hybrid ROLL) of (18)F-FDG-avid lesions using the hybrid tracer indocyanine green-(99m)Tc-nanocolloid

G H KleinJan; O R Brouwer; H M Mathéron; D D D Rietbergen; R A Valdés Olmos; M W Wouters; N S van den Berg; F W B van Leeuwen

doi:10.1016/j.remn.2016.04.001

Hybrid radioguided occult lesion localization (hybrid ROLL) of (18)F-FDG-avid lesions using the hybrid tracer indocyanine green-(99m)Tc-nanocolloid

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.

[Article in English, Spanish]

Authors

G H KleinJan¹, O R Brouwer¹, H M Mathéron², D D D Rietbergen³, R A Valdés Olmos⁴, M W Wouters⁵, N S van den Berg⁶, F W B van Leeuwen⁷

Affiliations

¹ 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.
² Department of Nuclear Medicine, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
³ Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC Leiden, The Netherlands; Section Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
⁴ 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; Section Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
⁵ Department of Surgery, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
⁶ Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC Leiden, The Netherlands; Department of Head and Neck Surgery & Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
⁷ Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC Leiden, The Netherlands; Department of Head and Neck Surgery & Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands. Electronic address: [email protected].

PMID: 27174865
DOI: 10.1016/j.remn.2016.04.001

Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Hybrid tracer; Melanoma; Metastasis; Metástasis; ROLL; SPECT/CT; SPECT/TC; Trazador híbrido.

Publication types

Case Reports

MeSH terms

Adult
Aged
Female
Fluorodeoxyglucose F18*
Hodgkin Disease / diagnostic imaging*
Hodgkin Disease / pathology
Humans
Indocyanine Green*
Melanoma / diagnostic imaging*
Melanoma / secondary
Multimodal Imaging
Positron Emission Tomography Computed Tomography*
Radiopharmaceuticals*
Technetium Tc 99m Aggregated Albumin*

Substances

Radiopharmaceuticals
Technetium Tc 99m Aggregated Albumin
technetium Tc 99m nanocolloid
Fluorodeoxyglucose F18
Indocyanine Green