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The objective of this publication is to provide an updated source for professionals using guided intra- or perioperative scintigraphic tumour targeting (GOSTT). It 29 SERIES No. IAEA HUMAN HEALTH supports and facilitates both the clinical decision making process and the implementation of minimally invasive surgical procedures; the ultimate aim of both approaches is to improve the standard of health care received by patients with cancer. This publication provides an update on innovations in the use of radiopharmaceuticals for SLNM and SLNB, in combination with vital dyes, when appropriate, to facilitate the detection of sentinel lymph nodes. In addition, it provides an update on advances in the implementation of hybrid imaging technologies for the surgical management of patients with cancer in conjunction with intraoperative regional lymph node mapping. Experience with small-fi eld scintigraphic imaging devices in the operating theatre is also presented. IAEA HUMAN HEALTH SERIES IAEA HUMAN HEALTH SERIES Non-imaging Probes for Advanced Cancer Management for Advanced Cancer Management Non-imaging Probes Non-imaging Probes Implementing Advanced Hybrid Molecular Imaging and Implementing Advanced Hybrid Molecular Imaging and (GOSTT) Targeting Guided Intraoperative Scintigraphic Tumour No. 29 Guided Intraoperative Scintigraphic Tumour Targeting (GOSTT) Implementing Advanced Hybrid Molecular Imaging and Non-imaging Probes for Advanced Cancer Management INTERNATIONAL ATOMIC ENERGY AGENCY VIENNA ISBN 978–92–0–102214–1 ISSN 2075–3772 GUIDED INTRAOPERATIVE SCINTIGRAPHIC TUMOUR TARGETING (GOSTT) The following States are Members of the International Atomic Energy Agency: AFGHANISTAN GHANA OMAN ALBANIA GREECE PAKISTAN ALGERIA GUATEMALA PALAU ANGOLA HAITI PANAMA ARGENTINA HOLY SEE PAPUA NEW GUINEA ARMENIA HONDURAS PARAGUAY AUSTRALIA HUNGARY PERU AUSTRIA ICELAND PHILIPPINES AZERBAIJAN INDIA POLAND BAHAMAS INDONESIA PORTUGAL BAHRAIN IRAN, ISLAMIC REPUBLIC OF QATAR BANGLADESH IRAQ REPUBLIC OF MOLDOVA BELARUS IRELAND ROMANIA BELGIUM ISRAEL RUSSIAN FEDERATION BELIZE ITALY RWANDA BENIN JAMAICA SAN MARINO BOLIVIA JAPAN SAUDI ARABIA BOSNIA AND HERZEGOVINA JORDAN SENEGAL BOTSWANA KAZAKHSTAN SERBIA BRAZIL KENYA SEYCHELLES BRUNEI DARUSSALAM KOREA, REPUBLIC OF SIERRA LEONE BULGARIA KUWAIT SINGAPORE BURKINA FASO KYRGYZSTAN SLOVAKIA BURUNDI LAO PEOPLE’S DEMOCRATIC SLOVENIA CAMBODIA REPUBLIC SOUTH AFRICA CAMEROON LATVIA SPAIN CANADA LEBANON SRI LANKA CENTRAL AFRICAN LESOTHO SUDAN REPUBLIC LIBERIA SWAZILAND CHAD LIBYA SWEDEN CHILE LIECHTENSTEIN SWITZERLAND CHINA LITHUANIA SYRIAN ARAB REPUBLIC COLOMBIA LUXEMBOURG TAJIKISTAN CONGO MADAGASCAR THAILAND COSTA RICA MALAWI THE FORMER YUGOSLAV CÔTE D’IVOIRE MALAYSIA REPUBLIC OF MACEDONIA CROATIA MALI TOGO CUBA MALTA TRINIDAD AND TOBAGO CYPRUS MARSHALL ISLANDS TUNISIA CZECH REPUBLIC MAURITANIA, ISLAMIC TURKEY DEMOCRATIC REPUBLIC REPUBLIC OF UGANDA OF THE CONGO MAURITIUS UKRAINE DENMARK MEXICO UNITED ARAB EMIRATES DOMINICA MONACO UNITED KINGDOM OF DOMINICAN REPUBLIC MONGOLIA GREAT BRITAIN AND ECUADOR MONTENEGRO NORTHERN IRELAND EGYPT MOROCCO UNITED REPUBLIC EL SALVADOR MOZAMBIQUE OF TANZANIA ERITREA MYANMAR UNITED STATES OF AMERICA ESTONIA NAMIBIA URUGUAY ETHIOPIA NEPAL UZBEKISTAN FIJI NETHERLANDS VENEZUELA, BOLIVARIAN FINLAND NEW ZEALAND REPUBLIC OF FRANCE NICARAGUA VIET NAM GABON NIGER YEMEN GEORGIA NIGERIA ZAMBIA GERMANY NORWAY ZIMBABWE The Agency’s Statute was approved on 23 October 1956 by the Conference on the Statute of the IAEA held at United Nations Headquarters, New York; it entered into force on 29 July 1957. The Headquarters of the Agency are situated in Vienna. Its principal objective is “to accelerate and enlarge the contribution of atomic energy to peace, health and prosperity throughout the world’’. IAEA HUMAN HEALTH SERIES No. 29 GUIDED INTRAOPERATIVE SCINTIGRAPHIC TUMOUR TARGETING (GOSTT) IMPLEMENTING ADVANCED HYBRID MOLECULAR IMAGING AND NON-IMAGING PROBES FOR ADVANCED CANCER MANAGEMENT INTERNATIONAL ATOMIC ENERGY AGENCY VIENNA, 2014 COPYRIGHT NOTICE All IAEA scientific and technical publications are protected by the terms of the Universal Copyright Convention as adopted in 1952 (Berne) and as revised in 1972 (Paris). The copyright has since been extended by the World Intellectual Property Organization (Geneva) to include electronic and virtual intellectual property. Permission to use whole or parts of texts contained in IAEA publications in printed or electronic form must be obtained and is usually subject to royalty agreements. Proposals for non-commercial reproductions and translations are welcomed and considered on a case-by-case basis. Enquiries should be addressed to the IAEA Publishing Section at: Marketing and Sales Unit, Publishing Section International Atomic Energy Agency Vienna International Centre PO Box 100 1400 Vienna, Austria fax: +43 1 2600 29302 tel.: +43 1 2600 22417 email: [email protected] http://www.iaea.org/books © IAEA, 2014 Printed by the IAEA in Austria December 2014 STI/PUB/1648 IAEA Library Cataloguing in Publication Data Guided intraoperative scintigraphic tumour targeting (GOSTT) : implementing advanced hybrid molecular imaging and non-imaging probes for advanced cancer management. — Vienna : International Atomic Energy Agency, 2014. p. ; 24 cm. — (IAEA human health series, ISSN 2075–3772 ; no. 29) STI/PUB/1648 ISBN 978–92–0–102214–1 Includes bibliographical references. 1. Cancer — Diagnosis. 2. Lymph nodes — Cancer 3. Radiopharmaceuticals. 4. Positron-Emission Tomography. I. International Atomic Energy Agency. II. Series. IAEAL 14–00934 COPYRIGHT NOTICE FOREWORD All IAEA scientific and technical publications are protected by the terms of The aim of this publication is twofold. One objective is to provide an the Universal Copyright Convention as adopted in 1952 (Berne) and as revised update on the latest advances concerning sentinel lymph node mapping (SLNM) in 1972 (Paris). The copyright has since been extended by the World Intellectual and radioguided sentinel lymph node biopsy (SLNB) for the diagnosis and Property Organization (Geneva) to include electronic and virtual intellectual treatment of patients with cancer. Special emphasis is given to issues under property. Permission to use whole or parts of texts contained in IAEA publications debate, including changing indications. The second objective is to provide a in printed or electronic form must be obtained and is usually subject to royalty thorough review of the latest experience and literature, and to define procedural agreements. Proposals for non-commercial reproductions and translations are recommendations on applications of radioguided surgery other than SLNB. welcomed and considered on a case-by-case basis. Enquiries should be addressed This publication provides an update on innovations in the use of to the IAEA Publishing Section at: radiopharmaceuticals for SLNM and SLNB, in combination with vital dyes, when appropriate, to facilitate the detection of sentinel lymph nodes. In addition, Marketing and Sales Unit, Publishing Section advances in the implementation of hybrid imaging technologies for the surgical International Atomic Energy Agency management of patients with cancer in conjunction with intraoperative regional Vienna International Centre lymph node mapping are described; the use of small field scintigraphic imaging PO Box 100 devices in the operating theatre is also discussed. Advances in computer 1400 Vienna, Austria technology and data processing make it possible to integrate 3-D rendering fax: +43 1 2600 29302 systems that facilitate intraoperative localization of deep seated lesions, thus tel.: +43 1 2600 22417 allowing for minimal invasive endoscopic procedures using specially designed email: [email protected] probes. http://www.iaea.org/books The sentinel node procedure has been established for certain indications and shows a promising future in others. This procedure, however, is still associated with some controversies. It has various performance methodologies, and these options depend on the equipment available. The growing impact of positron emission tomography (PET) imaging on cancer patient management has prompted the development of intraoperative probes for detecting positron emission, thereby enabling the identification of occult tumour lesions intraoperatively, following systemic administration of tumour seeking PET agents. This publication will therefore contribute to supporting and facilitating both the clinical decision making process and the implementation of minimally invasive surgical procedures; the ultimate aim of both approaches is to improve the standard of health care received by patients with cancer. The IAEA is grateful to the contributors to this publication for sharing invaluable knowledge, time and effort, in particular to F. Giammarile, G. Mariani, R. Valdés Olmos and S. Vidal-Sicart for compiling the contents. The technical officers responsible for this publication were J.J. Zaknun, D. Paez and M. Dondi of the Division of Human Health. EDITORIAL NOTE This report does not address questions of responsibility, legal or otherwise, for acts or omissions on the part of any person. Although great care has been taken to maintain the accuracy of information contained in this publication, neither the IAEA nor its Member States assume any responsibility for consequences which may arise from its use. The use of particular designations of countries or territories does not imply any judgement by the publisher, the IAEA, as to the legal status of such
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