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128. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

03.05. - 06.05.2011, München

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Radio guided surgery in neuroendocrine tumours with 68Ga-labeled somatostatin analogues – a pilot study

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  • Daniel Kämmerer - Zentralklinik Bad Berka, Klinik für Allgemeine Chirurgie / Viszeralchirurgie, Bad Berka
  • Vikas Prasad - Zentralklinik Bad Berka, Klinik für Nuklearmedizin, Zentrum für PET/CT, Bad Berka
  • Richard Paul Baum - Zentralklinik Bad Berka, Klinik für Nuklearmedizin, Zentrum für PET/CT, Bad Berka
  • Merten Hommann - Zentralklinik Bad Berka, Klinik für Allgemeine Chirurgie / Viszeralchirurgie, Bad Berka

Deutsche Gesellschaft für Chirurgie. 128. Kongress der Deutschen Gesellschaft für Chirurgie. München, 03.-06.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11dgch631

doi: 10.3205/11dgch631, urn:nbn:de:0183-11dgch6319

Published: May 20, 2011

© 2011 Kämmerer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Introduction: Radio-guided surgery (RGS) is an intraoperative localising technique for the detection of cancer tissue using tumour-specific radionuclides.

The use of RGS has technically advanced and expanded in different kinds of tumour surgery. As of yet the experience with high energy gamma probe in the neuroendocrine tumour is very limited. Previous studies of the intraoperative use of a handheld gamma probe to localize metastases and primary tumours have shown improved assessment of tumour spread and changes in surgical management based on added information gained by radioimmunoguided surgery.The aim of this study was to test the feasibility and advantages of doing RGS using short lived positron emitters 68Gallium labelled with synthetic analogues in the intraoperative detection in NET.

Materials and methods: A total of 9 patients ([68Ga]-SMS-R-PET/CT imaging was performed preoperatively in all the patients) with ileal (7), CUP (1) and pancreatic (1) neuroendocrine tumours were included. Statistical analyses was performed to find out the correlation between the pathological size of the tumour lesions and the maximum standardised uptake value (SUVmax) on PET/CT as well as the target/non-target ratio (T/NT) of gamma probe counts.

Results: Intraoperativly, overall 72 locations in 9 patients were examined using Gamma-probes. Two operating surgeons noted marked ease in differentiating tumour tissue from scarred areas under gamma probe guidance. 14 lesions (0.4 – 2.5 cm) were surgically removed. Mean tumour size was found to be 1.47 ± 0.6 cm, T/NT was 9.1 ± 6.7, mean SUVmax: 14.3 ± 15.9. There was significant correlation between the T/NT and tumour size (p=0.05) as well as between SUVmax and tumour size (p=0.07).

Conclusion: Handheld gamma probe surgery using 68Ga- somatostatin analogues appears to be feasible and may be an attractive option for detection of small metastases and primaries of neuroendocrine tumours. The lesion detection by the surgeons using gamma probe could eased up as compared PET/CT alone or to naked eye evaluation especially in detection of peritoneal seedings and small lymph node metastases.