Intraoperative Use of a Portable Large Field of View Gamma Camera and Handheld Gamma Detection Probe for Radioguided Localization and Prediction of Complete Surgical Resection of Gastrinoma: Proof of Concept.

Abstract

BACKGROUND:

Surgical management of Zollinger-Ellison syndrome (ZES) relies on localization and resection of all tumor foci. We describe the benefit of combined intraoperative use of a portable large field of view gamma camera (LFOVGC) and a handheld gamma detection probe (HGDP) for indium-111 ((111)In)-pentetreotide radioguided localization and confirmation of gastrinoma resection in ZES.

STUDY DESIGN:

Five patients (6 cases) with (111)In-pentetreotide-avid ZES were evaluated. Patients were injected with (111)In-pentetreotide for diagnostic imaging the day before surgery. Intraoperatively, an HGDP and LFOVGC were used to localize (111)In-pentetreotide-avid lesions, guide resection, assess specimens for (111)In-pentetreotide activity, and to verify lack of abnormal post-resection surgical field activity.

RESULTS:

Large field of view gamma camera imaging and HGDP-assisted detection were helpful for localization and guided resection of tumor and removal of (111)In-pentetreotide-avid tumor foci in all cases. In 3 of 5 patients (3 of 6 cases), these techniques led to detection and resection of additional tumor foci beyond those detected by standard surgical techniques. The (111)In-pentetreotide-positive or-negative specimens correlated with neuroendocrine tumors or benign pathology, respectively. In one patient with mild residual focal activity on post-resection portable LFOVGC imaging, thought to be artifact, had recurrence of disease in the same area 5 months after surgery.

CONCLUSIONS:

Real-time LFOVGC imaging and HGDP use for surgical management of gastrinoma improve success of localizing and resecting all neuroendocrine tumor-positive tumor foci, providing instantaneous navigational feedback. This approach holds potential for improving long-term patient outcomes in patients with ZES.

• Authors: Nathan C Hall, Shawnn D Nichols, Stephen P Povoski, Iyore A O James, Chadwick L Wright, Randall Harris, Carl R Schmidt, Peter Muscarella 2nd, Nicholas Latchana, Edward W Martin Jr, E Christopher Ellison
• Journal: Journal of the American College of Surgeons (J Am Coll Surg) Vol. 221 Issue 2 Pg. 300-8 (Aug 2015) ISSN: 1879-1190 [Electronic] United States
• PMID: 26206636 (Publication Type: Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Published by Elsevier Inc.

Chemical References

• Radiopharmaceuticals
• Somatostatin
• pentetreotide

Topics

• Adolescent
• Adult
• Aged
• Female
• Gamma Cameras
• Gastrinoma (diagnostic imaging, surgery)
• Humans
• Male
• Middle Aged
• Pancreatectomy (methods)
• Radionuclide Imaging
• Radiopharmaceuticals
• Somatostatin (analogs & derivatives)
• Treatment Outcome
• Zollinger-Ellison Syndrome (diagnostic imaging, surgery)