Radioguided surgery and the GOSTT concept: From pre-operative image and intraoperative navigation to image-assisted excision.

Radio-guided surgery has been developed for application in those disease scheduled for surgical management, particularly in areas of complex anatomy. This is based on the use of pre-operative scintigraphic planar, tomographic and fused SPECT/CT images, and the possibility of 3D reconstruction for the subsequent intraoperative locating of active lesions using handheld devices (detection probes, gamma cameras, etc.). New tracers and technologies have also been incorporated into these surgical procedures. The combination of visual and acoustic signals during the intraoperative procedure has become possible with new portable imaging modalities. In daily practice, the images offered by these techniques and devices combine perioperative nuclear medicine imaging with the superior resolution of additional optical guidance in the operating room. In many ways they provide real-time images, allowing accurate guidance during surgery, a reduction in the time required for tissue location and an anatomical environment for surgical recognition. All these approaches have been included in the concept known as (radio) Guided intraOperative Scintigraphic Tumour Targeting (GOSTT). This article offers a general view of different nuclear medicine and allied technologies used for several GOSTT procedures, and illustrates the crossing of technological frontiers in radio-guided surgery.

Performance of cone beam computed tomography in comparison to conventional imaging techniques for the detection of bone invasion in oral cancer.

Detecting bone invasion in oral cancer is crucial for therapy planning and the prognosis. The present study evaluated cone beam computed tomography (CBCT) for detecting bone invasion in comparison to standard imaging techniques. A total of 197 patients with diagnoses of oral cancer underwent CBCT as part of preoperative staging between January 2007 and April 2013. The sensitivity, specificity, and accuracy of CBCT were compared with panoramic radiography (PR), multi-slice computed tomography (CT) or magnetic resonance imaging (MRI), and bone scintigraphy (BS) using McNemar's test. Histopathology and clinical follow-up served as references for the presence of bone invasion. CBCT and BS (84.8% and 89.3%, respectively), as well as CBCT and CT/MRI (83.2%), showed comparable accuracy (P = 0.188 and P = 0.771). CBCT was significantly superior to PR, which was reconstructed based on a CBCT dataset (74.1%, P = 0.002). In detecting bone invasion, CBCT was significantly more accurate than PR and was comparable to BS and CT/MRI. However, each method has certain advantages, and the best combination of imaging methods must be evaluated in prospective clinic trials.

[Importance of FDG-PET/CT for surgery of rectal cancer]. / Bedeutung der FDG-PET/CT für die Chirurgie des Rektumkarzinoms.

BACKGROUND: Examinations using 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET/CT) are becoming increasingly more important in clinical practice for the diagnosis and therapy of cancer patients. QUESTION: What role does FDG-PET/CT examination play in the diagnosis and therapy of rectal cancer? RESULTS: The FDG-PET/CT method is especially valuable during postoperative care when a recurrence is suspected. Especially when tumor marker levels rise with no other symptoms, FDG-PET/CT can be used to evaluate unclear lesions in the liver and unclear tissue formations at the surgery site and distinguish between scar tissue and recurring tumors. Currently, there is increasing evidence that a survival prognosis may be possible based on the tracer uptake of FDG-PET/CT. There is also a great interest in the possibility of evaluating the success of neoadjuvant therapy with FDG-PET/CT. DISCUSSION: Despite some limitations FDG-PET/CT plays a significant role in the diagnosis and treatment of patients with rectal cancer.