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Radioguided lung lesion localization

introducing a fluoroscopy system in a SPECT/CT scan

Durmo, Rexhepa; Lechiara, Marcob; Benetti, Diegoc; Rodella, Carlod; Camoni, Lucaa; Albano, Domenicoa; Bertagna, Francescoe; Giubbini, Raffaelee

Nuclear Medicine Communications: June 2019 - Volume 40 - Issue 6 - p 597–603
doi: 10.1097/MNM.0000000000000999
ORIGINAL ARTICLES
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Purpose The purpose was to report our experience in the use of radiotracer localization and resection of small, indistinct, or nonpalpable pulmonary lesions. We developed an innovative technique implementing a fluoroscopy system on a single-photon emission computed tomography/computed tomography (SPECT/CT) scan that allowed to perform CT-guided injection of radiotracer directly on SPECT/CT.

Patients and methods Patients were selected for the radiotracer procedure in presence of difficulties in locating nodules with video-assisted thoracoscopic surgery (VATS). Overall, 0.2 ml of technetium-99m macroaggregated albumin and 0.3 ml of nonionic iodinated contrast were injected under CT guidance. During the VATS procedure, an endoscopic gamma detecting probe was introduced to scan the lung surface. The area of major radioactivity, which matched with the area of the nodule, was resected.

Results Between January 2016 and October 2018, 37 patients underwent CT-guided radiotracer injection. The mean nodule size was 11 mm. CT nodule morphology characteristics were as follows: 15 nodules were ground glass, 12 were solid, and 10 were partly solid. No significant adverse events occurred. In one patient, the surgeons decided for an open thoracotomy after unsuccessfully VATS. Overall, lobectomy was performed in two patients, segmentectomy in one, and wedge resection in 33 patients. No mortality occurred. The pathological diagnosis was 15 (42%) primary lung cancer, eight (22%) metastases, and 13 (36%) benign lesions.

Conclusion Radioguided pulmonary nodule localization is a reliable procedure with a high rate of success, minimal complications, and lower risk of failures, with no associated mortality or significant morbidity. Our SPECT/CT system is the first to benefit from the technological improvement with successfully implementation and application of fluoroscopy to SPECT/CT.

Departments of aNuclear Medicine

bRadiology

cThoracic Surgery

dMedical Physics, Spedali Civili di Brescia

eDepartment of Nuclear Medicine, University of Brescia, Brescia, Italy

Correspondence to Rexhep Durmo, MD, Department of Nuclear Medicine, Spedali Civili di Brescia, Piazzale Spedali Civili, 1, 25123 Brescia, Italy Tel: +39 303 995 461; fax: +39 303 995 420; e-mail: rexhep.durmo@gmail.com

Received November 24, 2018

Received in revised form January 28, 2019

Accepted February 3, 2019

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