SPECT-CT and real-time intraoperative imaging: new tools for sentinel node localization and radioguided surgery?

Excerpt

It is more than 30 years since Dr. Ramón Cabañas used lymphography to describe the “sentinel node” in patients with penile carcinoma [1]. However, it was not until 1992 that Dr. Donald Morton described the modern concept and technique of lymphatic mapping in melanoma, renewing the notion of step-wise spread of solid tumours through the lymphatic system [2]. With the addition of radioactive colloids, lymphoscintigraphy and intraoperative gamma-probe detection, the sentinel node procedure has evolved in the last decade into a technique that can be comfortably applied in any hospital. Lymphatic mapping is now routinely done in a variety of solid tumours. Lately, the common nuclear medicine tools for sentinel node detection (preoperative planar scintigraphy and intraoperative probe detection) are increasingly under pressure as they are facing more sophisticated requirements such as the search for deeply located sentinel nodes in the pelvis, abdomen and mediastinum. In this paper we discuss the role of SPECT-CT and the use of portable nuclear imaging devices as potential new tools for sentinel node localization and radioguided surgery in the coming years. …