Topic: Intraoperative Gamma Camera use in other Malignancies Speaker: Renato Valdés Olmos

1. The Academy for Continued Healthcare Learning (ACHL) requires that the faculty
participating in a CME/CE activity disclose all affiliations or other financial relationships (1)
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demonstrates compliance with ACCME guidelines.
R A VALDE S OLMOS , MD, PhD Type of financial relations hip(s ): None
Dis cus s ion of Off-Label, Inves tigational, or E xperimental Drug Us e: None
S taff and R eviewer Dis clos ure
The Academy for Continued Healthcare Learning staff members, content reviewers, and
others involved with the planning, development, and review of the content for this activity
have no relevant affiliations or financial relationships to disclose.
Dis clos ure

2. INTRAOPERATIVE GAMMA CAMERA
USE IN OTHER MALIGNANCIES
RENATO VALDES OLMOS
Joint International Oncology
(Sentinel Node and Cancer Metastasis) Congress
May 27-29, 2013
San Francisco, CA

3. HEAD & NECK
MALIGNANCIES
UROLOGICAL
MALIGNANCIES

4. PERIAURICULAR
&
PAROTID AREA
NECK LEVEL II
FLUOR OF MOUTH
&
NECK LEVELS I - IIa
SHORT DISTANCE
BETWEEN INJECTION SITE AND
SENTINEL NODE
HEAD & NECK

6. SN
CLUSTER

7. INTRAOPERATIVE USE PORTABLE GAMMA
CAMERA

8. PERIAURICULAR MELANOMA
WITHOUT SENTINEL NODE VISUALIZATION ON
LYMPHOSCINTIGRAPHY
CHALLENGE
VISUALIZATION NEAR-THE-INJECTION-SITE
SENTINEL NODES

9. SENTINEL NODE VISUALIZATION
SPECT/CT +
PORTABLE GAMMA CAMERA
SN
SN

10. PERIAURICULAR
MELANOMA
WITHOUT SENTINEL NODE
VISUALIZATION ON
LYMPHOSCINTIGRAPHY &
SPECT/CT

11. CAMERA AT 15 cm DISTANCE
FROM SKIN
SN VISUALIZATION
WITH
HIGH RESOLUTION
PORTABLE
GAMMA CAMERA
CAMERA AT 1 cm
DISTANCE FROM SKIN SN MARKED ON SKIN
SN
SN

12. NEAR-THE-INJECTION-SITE SENTINEL NODES
VISUALIZATION IN RELATION TO DISTANCE
BETWEEN SN AND INJECTION SITE
3 mm (pinhole 2,5mm)
SPECT-CT
SENTINELLA
12 mm
PLANAR
IMAGE 14 mm
5 mm (pinhole 4mm)

13. NEW TECHNOLOGIES TO DETECT
NEAR-THE-INJECTION-SITE SENTINEL NODES
SPECT-CT
SENTINELLA
HAMAMATSU
PREOPERATIVE
PREOPERATIVE &
INTRAOPERATIVE
INTRAOPERATIVE

15. HYBRID SENTINELLA

16. UROLOGICAL
MALIGNANCIES
PROSTATE
TESTICLE
RENAL CELL

17. OBTURATOR
FOSSA
EXTENDED
AREA
EXTENDED PELVIC
LYMPH NODE DISSECTION
COMPLICATIONS
LYMFOCELE
VENOUS THROMBOSIS
EDEMA INFERIOR EXTREMITY
URETER DAMAGE
1-5 LYMPH NODES ---- 10.5%
6-10 LYMPH NODES ---- 12.4%
11-15 LYMPH NODES ---- 15.1%
16-20 LYMPH NODES ---- 24.3%
> 20 LYMPH NODES ---- 26.6%
Winter A et al. Urologe 2005; 44(suppl 1):79
PROSTATE CANCER

19. OPEN SURGERY
4 SERIES (N=23-2020)
2407 PATIENTS
LAPAROSCOPY
3 SERIES (N=28-140)
188 PATIENTS
SN IDENTIFICATION 98%
NO FALSE NEGATIVES
FALSE NEGATIVE RATE 5.5%
J eschke S et al. Eur Urol 2008; 53: 126-133
Holl G et al. Eur J Nucl Med Mo Imaging 2009; 36: 1377-82
CLINICAL INDICATION - INTERMEDIATE RISK GROUP
T2b/T3 or PSA >10ug/l
or Gleason >6
SENTINEL NODE IN PROSTATE CANCER
Sadeghi R et al. Nuklearmedizin 2011; 50: 107-15
COMBINED DETECTION RATE 94% (N = 21 studies)
COMBINED SENSITIVITY 94% (N = 15 studies)

20. TRANSRECTAL ULTRASOUND GUIDED TRACER
ADMINISTRATION
PROSTATE CANCER

21. TRACER ADMINISTRATION PROSTATE CANCER

22. TRACER ADMINISTRATION PROSTATE CANCER

23. LAPAROSCOPIC SENTINEL NODE PROCEDURE

24. SENTINEL NODES OUTSIDE AREA EXTENDED
PELVIC LYMPH NODE DISSECTION (EPLN)
Meinnhardt W. et al. Prostate Cancer 2011, E-pub, 2012, ID 751753
N=121
49 PATIENTS WITH METASTASES (40%)
37 PATIENTS WITH SN OPUTSIDE EPLN AREA (31%)
5 SN (+) OUTSIDE ELPN AREA - 2 ONLY (+)

25. SENTINEL NODE BEHIND COMMON ILIAC ARTERY

26. TRACER ADMINISTRATION IN TESTICLE CANCER

27. LEFT TESTICLE
PARA-AORTIC SN + FUNICULAR SN

28. PARA-AORTIC SN + FUNICULAR SN

29. LAPAROSCOPIC SENTINEL NODE DETECTION

30. TRACER ADMINISTRATION IN RENAL CELL CANCER

31. SENTINEL NODE RETROCAVAL

32. INTRAOPERATIVE SENTINEL NODE DETECTION

33. CONCLUSIONS
A PORTABLE GAMMA CAMERA IMAGES MAY BE USEFUL
TO DETECT SENTINEL NODES IN HEAD & NECK AND
UROLOGICAL MALIGNANCIES
HIGH RESOLUTION PORTABLE GAMMA CAMERA
IMAGES MAY DETECT SENTINEL NODES LOCATED
VERY CLOSE TO THE INJECTION SITE
THE PORTABLE GAMMA CAMERA IMAGES ENABLES
NAVIGATION TO THE SENTINEL NODES IN AREAS OF
COMPLEX ANATOMY (PELVIS, ABDOMEN)