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REVIEW  IMAGE-GUIDED SURGERY: FROM CLASSICAL TECHNIQUES TO NOVEL ASPECTS AND APPROACHES 

The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2021 September;65(3):229-43

DOI: 10.23736/S1824-4785.21.03358-6

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Beta radioguided surgery: towards routine implementation?

Francesco COLLAMATI 1 , Matthias N. van OOSTEROM 2, 3, Boris A. HADASCHIK 4, 5, Pedro FRAGOSO COSTA 5, 6, Christopher DARR 4, 5

1 National Institute of Nuclear Physics, Rome, Italy; 2 Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands; 3 Department of Urology, the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; 4 Department of Urology, Essen University Hospital, Essen, Germany; 5 German Cancer Consortium (DKTK), Essen University Hospital, Essen, Germany; 6 Department of Nuclear Medicine, Essen University Hospital, Essen, Germany



In locally or locally advanced solid tumors, surgery still remains a fundamental treatment method. However, conservative resection is associated with high collateral damage and functional limitations of the patient. Furthermore, the presence of residual tumor tissue following conservative surgical treatment is currently a common cause of locally recurrent cancer or of distant metastases. Reliable intraoperative detection of small cancerous tissue would allow surgeons to selectively resect malignant areas: this task can be achieved by means of image-guided surgery, such as beta radioguided surgery (RGS). In this paper, a comprehensive review of beta RGS is given, starting from the physical principles that differentiate beta from gamma radiation, that already has its place in current surgical practice. Also, the recent clinical feasibility of using Cerenkov radiation is discussed. Despite being first proposed several decades ago, only in the last years a remarkable interest in beta RGS has been observed, probably driven by the diffusion of PET radiotracers. Today several different approaches are being pursued to assess the effectiveness of such a technique, including both beta+ and beta- emitting radiopharmaceuticals. Beta RGS shows some peculiarities that can present it as a very promising complementary technique to standard procedures. Good results are being obtained in several tests, both ex vivo and in vivo. This might however be the time to initiate the trials to demonstrate the real clinical value of these technologies with seemingly clear potential.


KEY WORDS: Nuclear medicine; Radionuclide imaging; Positron-emission tomography; Margins of excision; Computer-assisted surgery

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