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 C.pdfVIP

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 Nathan C Hall, MD, PhD, Shawnn D Nichols, MD, FACS, Stephen P Povoski, MD, FACS, Iyore AO James, MD, Chadwick L Wright, MD, PhD, Randall Harris, MD, PhD, Carl R Schmidt, MD, Peter Muscarella II, MD, Nicholas Latchana, MD, Edward W Martin Jr, MD, FACS, E Christopher Ellison, MD, FACS BACKGROUND: Surgical management of Zollinger-Ellison syndrome (ZES) relies on localization and resec- tion of all tumor foci. We describe the bene?t of combined intraoperative use of a portable large ?eld of view gamma camera (LFOVGC) and a handheld gamma detection probe (HGDP) for indium-111 (111In)-pentetreotide radioguided localization and con?rmation of gastrinoma resection in ZES. STUDY DESIGN: Five patients (6 cases) with 111In-pentetreotide-avid ZES were evaluated. Patients were injected with 111In-pentetreotide for diagnostic imaging the day before surgery. Intraoperatively, an HGDP and LFOVGC were used to localize 111In-pentetreotide-avid lesions, guide resection, assess specimens for 111In-pentetreotide activity, and to verify lack of abnormal post-resection surgical ?eld activity. RESULTS: Large ?eld of view gamma camera imaging and HGDP-assisted detection were helpful for localization and guided resection of tumor and removal of 111In-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 111In-pentetreotideepositive orenegative 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