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

The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2021 September;65(3):261-70

DOI: 10.23736/S1824-4785.21.03355-0

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

The role of fluorescent and hybrid tracers in radioguided surgery in urogenital malignancies

Hielke Martijn DE VRIES ^{1, 2}, Margret SCHOTTELIUS ³, Oscar R. BROUWER ^{1, 2}, Tessa BUCKLE ^{1, 2} ✉

¹ Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands; ² Department of Urology, the Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; ³ Unit of Translational Radiopharmaceutical Sciences, Department of Nuclear Medicine and Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland

The increasing availability of new imaging technologies and tracers has enhanced the application of nuclear molecular imaging in urogenital interventions. In this context, preoperative nuclear imaging and radioactivity-based intraoperative surgical guidance have become important tools for the identification and anatomical allocation of tumor lesions and/or suspected lymph nodes. Fluorescence guidance can provide visual identification of the preoperatively defined lesions during surgery. However, the added value of fluorescence guidance is still mostly unknown. This review provides an overview of the role of fluorescence imaging in radioguided surgery in urogenital malignancies. The sentinel node (SN) biopsy procedure using hybrid tracers (radioactive and fluorescent component) serves as a prominent example for in-depth evaluation of the complementary value of radio- and fluorescence guidance. The first large patient cohort and long-term follow-up studies show: 1) improvement in the SN identification rate compared to blue dye; 2) improved detection of cancer-positive SNs; and 3) hints towards a positive effect on (biochemical) recurrence rates compared to extended lymph node dissection. The hybrid tracer approach also highlights the necessity of a preoperative roadmap in preventing incomplete resection. Recent developments focus on receptor-targeted approaches that allow intraoperative identification of tumor tissue. Here radioguidance is still leading, but fluorescent and hybrid tracers are also finding their way into the clinic. Emerging multiwavelength approaches that allow concomitant visualization of different anatomical features within the surgical field may provide the next step towards even more refined procedures.

KEY WORDS: Surgery, computer-assisted; Nuclear medicine; Surgical procedures, operative