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Review
. 2024 Aug;51(10):3026-3039.
doi: 10.1007/s00259-024-06604-1. Epub 2024 Jan 18.

Molecular image-guided surgery in gynaecological cancer: where do we stand?

Giusi Pisano  1 , Thomas Wendler  2   3 , Renato A Valdés Olmos  4 , Giorgia Garganese  5   6 , Daphne D D Rietbergen  4 , Francesco Giammarile  7 , Sergi Vidal-Sicart  8 , Maaike H M Oonk  9 , Michael Frumovitz  10 , Nadeem R Abu-Rustum  11 , Giovanni Scambia  5   6 , Vittoria Rufini  1   12 , Angela Collarino  13
Affiliations
Review

Molecular image-guided surgery in gynaecological cancer: where do we stand?

Giusi Pisano et al. Eur J Nucl Med Mol Imaging. 2024 Aug.

Abstract

Purpose: The aim of this review is to give an overview of the current status of molecular image-guided surgery in gynaecological malignancies, from both clinical and technological points of view.

Methods: A narrative approach was taken to describe the relevant literature, focusing on clinical applications of molecular image-guided surgery in gynaecology, preoperative imaging as surgical roadmap, and intraoperative devices.

Results: The most common clinical application in gynaecology is sentinel node biopsy (SNB). Other promising approaches are receptor-target modalities and occult lesion localisation. Preoperative SPECT/CT and PET/CT permit a roadmap for adequate surgical planning. Intraoperative detection modalities span from 1D probes to 2D portable cameras and 3D freehand imaging.

Conclusion: After successful application of radio-guided SNB and SPECT, innovation is leaning towards hybrid modalities, such as hybrid tracer and fusion of imaging approaches including SPECT/CT and PET/CT. Robotic surgery, as well as augmented reality and virtual reality techniques, is leading to application of these innovative technologies to the clinical setting, guiding surgeons towards a precise, personalised, and minimally invasive approach.

Keywords: Gynaecological cancers; Hybrid tracer; Image-guided surgery; Robotic surgery; Sentinel node biopsy.

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Conflict of interest statement

MF is consultant/speaker for Stryker and received research funding from AKesoBio. NAR is supported in part by the MSK National Cancer Institute/National Institutes of Health Cancer Center Support Grant (P30 CA008748); he reports research funding (paid to the institution) from GRAIL. MSK has equity in GRAIL. The other authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Clinical applications and modalities of image-guided surgery in gynaecological oncology
Fig. 2
Fig. 2
Some examples of the possible applications of molecular image–guided surgery in gynaecology to aid and improve surgical guidance
Fig. 3
Fig. 3
Multiple intensity projection (MIP) (top) and transverse fused PET/CT images (bottom) of four vulvar cancer patients. A A 66-year-old woman with left-side unilateral vulvar squamous cell carcinoma (SCC) of 2.5 cm diameter. PET/CT images showing [18F]-FDG uptake just in the primary tumour (arrowhead). This patient was scheduled for partial vulvectomy and ipsilateral SNB. B A 51-year-old woman with midline vulvar SCC of 3 cm diameter. PET/CT images showing [18F]-FDG uptake corresponding to the primary tumour (arrowhead) and focal [18F]-FDG uptake in bilateral inguinal lymph nodes (short arrows). This patient was scheduled for radical vulvectomy and bilateral inguinal lymphadenectomy. C A 65-year-old woman with midline vulvar SCC of 3 cm diameter previously excised. PET/CT images showing focal [18F]-FDG uptake in bilateral inguinal lymph nodes (short arrows) and bilateral pelvic nodes, which were located in the obturator and external iliac regions (long arrows). This patient was scheduled for upfront chemo-radiotherapy. D An 82-year-old woman with vulvar melanoma. MIP showing focal [18F]-FDG uptake in the primary vulvar tumour (arrowhead), in the left internal iliac node (long arrow) and bilateral pulmonary nodules (dashed arrows). Transverse fused PET/CT images showing focal [18F]-FDG uptake corresponding to a sub-centimetric pulmonary nodule localised in the right inferior lobe. This patient was scheduled for systemic therapy
See this image and copyright information in PMC

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