Opinion Paper/CommentarySentinel Node Imaging and Radioguided Surgery in the Era of SPECT/CT and PET/CT Toward New Interventional Nuclear Medicine StrategiesValdés Olmos, Renato Alfredo MD, PhD∗,†,‡; Rietbergen, Daphne D. D. MD∗,†; Rubello, Domenico MD§; Pereira Arias-Bouda, Lenka M. MD, PhD∗,∥; Collarino, Angela MD, PhD¶; Colletti, Patrick M. MD∗∗; Vidal-Sicart, Sergi MD, PhD††; van Leeuwen, Fijs W. B. PhD∗Author Information From the ∗Interventional Molecular Imaging Laboratory †Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden ‡Department of Radiology and Nuclear Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands §Nuclear Medicine Department, Santa Maria della Misericordia Hospital, Rovigo, Italy ∥Department of Nuclear Medicine, Alrijne Hospital, Leiderdorp, the Netherlands ¶Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy ∗∗Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA ††Nuclear Medicine Department, Hospital Clinic Barcelona, Universitat de Barcelona, Institut d’investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. Received for publication May 28, 2020; revision accepted May 29, 2020. Conflicts of interest and sources of funding: none declared. Correspondence to: Renato Alfredo Valdés Olmos, MD, PhD, Interventional Molecular Imaging Laboratory and Nuclear Medicine Section, Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, the Netherlands. E-mail: R.A.Valdes_Olmos@lumc.nl. Clinical Nuclear Medicine: October 2020 - Volume 45 - Issue 10 - p 771-777 doi: 10.1097/RLU.0000000000003206 Buy Metrics Abstract We review recent technological advances and new clinical indications for sentinel node (SN) and radioguided surgery in order to delineate future tendencies of interventional nuclear medicine in this field. A literature research was performed in PubMed to select relevant articles to be used as key references for analysis of the current approaches and tendencies in SN and radioguided surgery, as well as the evolving contribution of nuclear medicine intervention techniques to the various clinical applications. For classic indications such as melanoma and breast cancer, the incorporation of the SN approach based on the combined use of existing and new preoperative and intraoperative technologies in high-risk patient categories is becoming an emerging area of clinical indication. For SN biopsy staging in other malignancies with more complex lymphatic drainage, the incorporation of sophisticated tools is most helpful. The consecutive use of PET/CT and the SN procedure is increasing as a potential combined approach for the management of specific areas such as the axilla and the pelvis in patients at high risk of regional dissemination. Also, for the management of locoregional metastasis and oligometastatic disease, interventional nuclear medicine techniques are becoming valuable alternatives. The extended experience with SN biopsy is leading to technological advances facilitating the incorporation of this procedure to stage other malignancies with complex lymphatic drainage. New nuclear medicine–based approaches, incorporating SPECT/CT and PET/CT to guide resection of SNs and occult metastases, have recently been gaining ground. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.