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Combining PET with optical imaging to ensure tumor margins in breast cancer surgery
About one in five women who undergo breast-conserving surgery require a follow-up operation because the tumor was not adequately removed.
By combining optical and molecular imaging, British researchers have developed a potential solution to help surgeons get the margins right the first time. A study investigating the technology was published in this month's Journal of Nuclear Medicine.
Cerenkov luminescence imaging (CLI) detects light emitted by the PET radiotracer F-18-FDG. By doing so, it can assess tumor margins during BCS to ensure no tumor tissue remains.
“By accurately assessing tumor resection margins intraoperatively with CLI, surgeons may be able to completely clear the cancer with a single operation, thereby reducing the number of breast cancer patients requiring a second, or even third, surgical procedure," Dr. Arnie Purushotham, professor at King's College London, said in a statement.
Purushotham and his team recruited 22 patients with invasive breast cancer for the study. F-18-FDG was injected 45 to 60 minutes before surgery, and immediately after, specimens were intraoperatively imaged using an investigational CLI imaging system.
The first 10 patients were used to optimize the imaging protocol and the other 12 were evaluated. The team used CLI and found that 10 of them had elevated tumor radiance and that the raters agreed on margin distance.
Technetium-99m was used to identify sentinel lymph nodes, which were successfully detected and biopsied in all of the patients.
The research team concluded that F-18-FDG CLI is a "promising, low-risk technique" for intraoperatively assessing tumor margins during BCS. However, a randomized-controlled trial is needed to evaluate the impact of this technique on re-excision rates.
Purushotham believes this research can be a catalyst for other research that investigates the effectiveness of this technique in other solid cancer types that also experience incomplete tumor resection.
“CLI offers the ability to image clinically-approved and widely used PET tracers intraoperatively by using small-sized imaging equipment, thus expanding the field of traditional nuclear medicine," he added.
