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. 2012 Dec;7(6):484-6.
doi: 10.1159/000345472.

Showcase of Intraoperative 3D Imaging of the Sentinel Lymph Node in a Breast Cancer Patient using the New Freehand SPECT Technology

Andreas Schnelzer  1 , Alexandra Ehlerding  1 , Christina Blümel  2 , Asli Okur  2 , Klemens Scheidhauer  2 , Stefan Paepke  1 , Marion Kiechle  1
Affiliations

Showcase of Intraoperative 3D Imaging of the Sentinel Lymph Node in a Breast Cancer Patient using the New Freehand SPECT Technology

Andreas Schnelzer et al. Breast Care (Basel). 2012 Dec.

Abstract
in English, German

After the development of a hand-held intraoperative device for 3D real-time imaging of radioactively labeled sentinel lymph nodes in the human body, we present our first experience with the newest version of the freehand single-photon emission computed tomography (SPECT) technology in the operating room. The freehand SPECT system combines a gamma probe and an optical infrared positioning system, and provides surgeons with 3D imaging including exact depth information of the radioactive target. This technology was used intraoperatively in a female breast cancer patient to localize the axillary sentinel lymph nodes. The data obtained with freehand SPECT correlate well with conventional lymphoscintigraphy and with data collected using a conventional hand-held probe. By offering fast real-time intraoperative imaging, the new freehand SPECT system might facilitate the detection and removal of the sentinel lymph node(s) in certain situations and can be used for documentation and quality assurance purposes.

Dieser Bericht beschreibt die ersten klinischen Erfahrungen mit der neuesten Freehand-SPECT-Technologie, die zum intraoperativen Nachweis radioaktiv markierter Lymphknoten im menschlichen Körper entwickelt wurde. Die technische Grundlage basiert auf der Kombination einer konventionellen Gammasonde mit einem optischen Infrarot-Positionierungssystem. Der Operateur erhält eine räumliche Darstellung der Radioaktivität einschließlich der exakten Tiefenangabe im menschlichen Körper. Bei einer Mammakarzinompatientin wurde das System zum Auffinden des axillären Sentinellymphknotens verwendet. Die erhobenen Messwerte korrelieren sowohl mit den Ergebnissen einer konventionellen Lymphszintigraphie als auch mit den intraoperativen Messungen der mobilen Gammasonde. Die neue Freehand-SPECT-Technologie hat das Potential, dem Operateur durch die räumliche Echtzeitdarstellung der Radioaktivität das Auffinden und Entfernen des Sentinellymphknotens in bestimmten Situationen zu erleichtern und kann zu Zwecken der Dokumentation und Qualitätssicherung dienen.

Keywords: Breast cancer; Lymph node dissection; Quality assurance; Sentinel lymph node.

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Figures

Fig. 1
Fig. 1
Overlay picture of radioactivity data obtained with an intraoperative freehand single-photon emission computed tomography (SPECT) scan in projection on the live video of the patient showing the anatomic position of the axillary lymph node with the highest uptake (left). A second freehand SPECT scan was conducted after the surgical removal of the sentinel lymph node (SLN), which confirmed that there was no residual radioactive activity in the axilla (right).
Fig. 2
Fig. 2
Zoom on the freehand SPECT image in lateral view showing higher uptake and lower uptake lymph nodes before incision. This visualization was obtained using the pre-incision acquisition data as well as other visualization parameters so that the lower uptake lymph node could be clearly separated from the higher uptake lymph node.
Fig. 3
Fig. 3
Preoperative lymphoscintigraphy showing 2 lymph nodes with considerably different uptake (arrows) 5 min post injection (upper left). For better localization, the injection spot was covered with a lead plate before taking the second frontal image (upper right). Lateral images (acquired with and without the lead plate 14 and 17 min after injection) show the depth of the nodes more clearly (lower panel).
See this image and copyright information in PMC

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