title: Multimodality approach of perioperative 18F-FDG PET/CT imaging, intraoperative 18F-FDG handheld gamma probe detection, and intraoperative ultrasound for tumor localization and verification of resection of all sites of hypermetabolic activity in a case of occult recurrent metastatic melanoma.
abstract: BACKGROUND
  The use of diagnostic 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) imaging for the staging, restaging, and treatment monitoring of melanoma patients has become a well-recognized standard of care. It plays a key role in detecting sites of occult disease and is widely utilized in the medical and surgical planning of such patients. In the current report, we describe an innovative multimodality approach of perioperative 18F-FDG PET/CT imaging, intraoperative 18F-FDG handheld gamma probe detection, and intraoperative ultrasound for tumor localization and verification of resection of all sites of hypermetabolic tumor foci in a case of occult recurrent metastatic melanoma.
  
  
  METHODS
  This report discusses a case of occult recurrent metastatic melanoma, isolated to three separate sites within the subcutaneous tissues of the left thigh region, which was not clinically apparent but was found on diagnostic restaging whole body 18F-FDG PET/CT scan utilizing an intravenous injection of 14.8 mCi 18F-FDG. Then, on the day of surgery, the patient received an intravenous injection of 12.8 mCi 18F-FDG. A multimodality approach of intraoperative handheld gamma probe detection, intraoperative ultrasound tumor localization, specimen PET/CT imaging, and postoperative PET/CT imaging was utilized for accomplishing and verifying the excision of all three sites of occult recurrent metastatic melanoma within the left thigh region.
  
  
  CONCLUSIONS
  This innovative multimodality approach of perioperative 18F-FDG PET/CT imaging, intraoperative 18F-FDG handheld gamma probe detection, and intraoperative ultrasound is promising combined technology for aiding in tumor localization and verification of excision and may ultimately impact positively upon long-term outcome of selected patients.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Arthur G, James Cancer Hospital and Richard J, Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA. stephen.povoski@osumc.edu
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Povoski
authors.forename: Nathan C
authors.initials: NC
authors.lastname: Hall
authors.forename: Edward W
authors.initials: EW
authors.lastname: Martin
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Walker
mesh_terms: D005260:Female; D019788:Fluorodeoxyglucose F18; D015902:Gamma Cameras; D006801:Humans; D007430:Intraoperative Care; D008545:Melanoma / Q000175:diagnosis* / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000601:surgery; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000601:surgery; D013848:Thigh; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D051598:Whole Body Imaging
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18