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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