Intraoperative Use of a Portable Large Field of View Gamma Camera and Handheld Gamma Detection Probe for Radioguided Localization and Prediction of Complete Surgical Resection of Gastrinoma

Proof of Concept

Nathan C. Hall, Shawnn D. Nichols, Stephen P. Povoski, Iyore A O James, Chadwick L. Wright, Randall Harris, Carl R. Schmidt, Peter Muscarella, Nicholas Latchana, Edward W. Martin, E. Christopher Ellison

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background Surgical management of Zollinger-Ellison syndrome (ZES) relies on localization and resection of all tumor foci. We describe the benefit of combined intraoperative use of a portable large field of view gamma camera (LFOVGC) and a handheld gamma detection probe (HGDP) for indium-111 (111In)-pentetreotide radioguided localization and confirmation of gastrinoma resection in ZES. Study Design Five patients (6 cases) with 111In-pentetreotide-avid ZES were evaluated. Patients were injected with 111In-pentetreotide for diagnostic imaging the day before surgery. Intraoperatively, an HGDP and LFOVGC were used to localize 111In-pentetreotide-avid lesions, guide resection, assess specimens for 111In-pentetreotide activity, and to verify lack of abnormal post-resection surgical field activity. Results Large field of view gamma camera imaging and HGDP-assisted detection were helpful for localization and guided resection of tumor and removal of 111In-pentetreotide-avid tumor foci in all cases. In 3 of 5 patients (3 of 6 cases), these techniques led to detection and resection of additional tumor foci beyond those detected by standard surgical techniques. The 111In-pentetreotide-positive or-negative specimens correlated with neuroendocrine tumors or benign pathology, respectively. In one patient with mild residual focal activity on post-resection portable LFOVGC imaging, thought to be artifact, had recurrence of disease in the same area 5 months after surgery. Conclusions Real-time LFOVGC imaging and HGDP use for surgical management of gastrinoma improve success of localizing and resecting all neuroendocrine tumor-positive tumor foci, providing instantaneous navigational feedback. This approach holds potential for improving long-term patient outcomes in patients with ZES.

Original languageEnglish (US)
Pages (from-to)300-308
Number of pages9
JournalJournal of the American College of Surgeons
Volume221
Issue number2
DOIs
StatePublished - Aug 1 2015
Externally publishedYes

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Gastrinoma
Gamma Cameras
Zollinger-Ellison Syndrome
Radionuclide Imaging
Neuroendocrine Tumors
Neoplasms
Diagnostic Imaging
pentetreotide
Ambulatory Surgical Procedures
Artifacts
Pathology
Recurrence

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Intraoperative Use of a Portable Large Field of View Gamma Camera and Handheld Gamma Detection Probe for Radioguided Localization and Prediction of Complete Surgical Resection of Gastrinoma : Proof of Concept. / Hall, Nathan C.; Nichols, Shawnn D.; Povoski, Stephen P.; James, Iyore A O; Wright, Chadwick L.; Harris, Randall; Schmidt, Carl R.; Muscarella, Peter; Latchana, Nicholas; Martin, Edward W.; Ellison, E. Christopher.

In: Journal of the American College of Surgeons, Vol. 221, No. 2, 01.08.2015, p. 300-308.

Research output: Contribution to journalArticle

Hall, Nathan C. ; Nichols, Shawnn D. ; Povoski, Stephen P. ; James, Iyore A O ; Wright, Chadwick L. ; Harris, Randall ; Schmidt, Carl R. ; Muscarella, Peter ; Latchana, Nicholas ; Martin, Edward W. ; Ellison, E. Christopher. / Intraoperative Use of a Portable Large Field of View Gamma Camera and Handheld Gamma Detection Probe for Radioguided Localization and Prediction of Complete Surgical Resection of Gastrinoma : Proof of Concept. In: Journal of the American College of Surgeons. 2015 ; Vol. 221, No. 2. pp. 300-308.
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abstract = "Background Surgical management of Zollinger-Ellison syndrome (ZES) relies on localization and resection of all tumor foci. We describe the benefit of combined intraoperative use of a portable large field of view gamma camera (LFOVGC) and a handheld gamma detection probe (HGDP) for indium-111 (111In)-pentetreotide radioguided localization and confirmation of gastrinoma resection in ZES. Study Design Five patients (6 cases) with 111In-pentetreotide-avid ZES were evaluated. Patients were injected with 111In-pentetreotide for diagnostic imaging the day before surgery. Intraoperatively, an HGDP and LFOVGC were used to localize 111In-pentetreotide-avid lesions, guide resection, assess specimens for 111In-pentetreotide activity, and to verify lack of abnormal post-resection surgical field activity. Results Large field of view gamma camera imaging and HGDP-assisted detection were helpful for localization and guided resection of tumor and removal of 111In-pentetreotide-avid tumor foci in all cases. In 3 of 5 patients (3 of 6 cases), these techniques led to detection and resection of additional tumor foci beyond those detected by standard surgical techniques. The 111In-pentetreotide-positive or-negative specimens correlated with neuroendocrine tumors or benign pathology, respectively. In one patient with mild residual focal activity on post-resection portable LFOVGC imaging, thought to be artifact, had recurrence of disease in the same area 5 months after surgery. Conclusions Real-time LFOVGC imaging and HGDP use for surgical management of gastrinoma improve success of localizing and resecting all neuroendocrine tumor-positive tumor foci, providing instantaneous navigational feedback. This approach holds potential for improving long-term patient outcomes in patients with ZES.",
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T1 - Intraoperative Use of a Portable Large Field of View Gamma Camera and Handheld Gamma Detection Probe for Radioguided Localization and Prediction of Complete Surgical Resection of Gastrinoma

T2 - Proof of Concept

AU - Hall, Nathan C.

AU - Nichols, Shawnn D.

AU - Povoski, Stephen P.

AU - James, Iyore A O

AU - Wright, Chadwick L.

AU - Harris, Randall

AU - Schmidt, Carl R.

AU - Muscarella, Peter

AU - Latchana, Nicholas

AU - Martin, Edward W.

AU - Ellison, E. Christopher

PY - 2015/8/1

Y1 - 2015/8/1

N2 - Background Surgical management of Zollinger-Ellison syndrome (ZES) relies on localization and resection of all tumor foci. We describe the benefit of combined intraoperative use of a portable large field of view gamma camera (LFOVGC) and a handheld gamma detection probe (HGDP) for indium-111 (111In)-pentetreotide radioguided localization and confirmation of gastrinoma resection in ZES. Study Design Five patients (6 cases) with 111In-pentetreotide-avid ZES were evaluated. Patients were injected with 111In-pentetreotide for diagnostic imaging the day before surgery. Intraoperatively, an HGDP and LFOVGC were used to localize 111In-pentetreotide-avid lesions, guide resection, assess specimens for 111In-pentetreotide activity, and to verify lack of abnormal post-resection surgical field activity. Results Large field of view gamma camera imaging and HGDP-assisted detection were helpful for localization and guided resection of tumor and removal of 111In-pentetreotide-avid tumor foci in all cases. In 3 of 5 patients (3 of 6 cases), these techniques led to detection and resection of additional tumor foci beyond those detected by standard surgical techniques. The 111In-pentetreotide-positive or-negative specimens correlated with neuroendocrine tumors or benign pathology, respectively. In one patient with mild residual focal activity on post-resection portable LFOVGC imaging, thought to be artifact, had recurrence of disease in the same area 5 months after surgery. Conclusions Real-time LFOVGC imaging and HGDP use for surgical management of gastrinoma improve success of localizing and resecting all neuroendocrine tumor-positive tumor foci, providing instantaneous navigational feedback. This approach holds potential for improving long-term patient outcomes in patients with ZES.

AB - Background Surgical management of Zollinger-Ellison syndrome (ZES) relies on localization and resection of all tumor foci. We describe the benefit of combined intraoperative use of a portable large field of view gamma camera (LFOVGC) and a handheld gamma detection probe (HGDP) for indium-111 (111In)-pentetreotide radioguided localization and confirmation of gastrinoma resection in ZES. Study Design Five patients (6 cases) with 111In-pentetreotide-avid ZES were evaluated. Patients were injected with 111In-pentetreotide for diagnostic imaging the day before surgery. Intraoperatively, an HGDP and LFOVGC were used to localize 111In-pentetreotide-avid lesions, guide resection, assess specimens for 111In-pentetreotide activity, and to verify lack of abnormal post-resection surgical field activity. Results Large field of view gamma camera imaging and HGDP-assisted detection were helpful for localization and guided resection of tumor and removal of 111In-pentetreotide-avid tumor foci in all cases. In 3 of 5 patients (3 of 6 cases), these techniques led to detection and resection of additional tumor foci beyond those detected by standard surgical techniques. The 111In-pentetreotide-positive or-negative specimens correlated with neuroendocrine tumors or benign pathology, respectively. In one patient with mild residual focal activity on post-resection portable LFOVGC imaging, thought to be artifact, had recurrence of disease in the same area 5 months after surgery. Conclusions Real-time LFOVGC imaging and HGDP use for surgical management of gastrinoma improve success of localizing and resecting all neuroendocrine tumor-positive tumor foci, providing instantaneous navigational feedback. This approach holds potential for improving long-term patient outcomes in patients with ZES.

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