title: Radioguided surgery in patient with pancreatic neuroendocrine tumour followed by PET/CT scan as a new approach of complete resection evaluation--case report.
abstract: Radioguided surgery using 68-gallium labelled somatostatin analogues is a promising method for detection of small, intra-abdominal, neuroendocrine neoplasm (NEN). However, due to high background activity (physiological uptake in e.g. spleen, adrenal glands and kidneys) tumours of the tail and body of pancreas might be impossible to detect with hand-held gamma probe. Therefore a new concept of intraoperative PET/CT scan of the resected tissue can be helpful in determining whether the tumour has been excised within the margins of healthy tissue. A 71-year-old woman with primary, non-metastatic NEN of the tail of pancreas is described. The tumour was diagnosed using MRI and PET/CT scan. Before operation patient was administered intravenously 80 MBq of ⁶⁸Ga-DOTATATE. The surgery procedure was performed 60-180 minutes post injection. During the procedure pancreas was visualized, but the tumour could not be localized neither with palpation nor gamma probe. The tail of the pancreas was resected en bloc with spleen and adjacent lymph nodes. PET/CT scan of the tissue specimen was performed immediately followed by pathological examination. PET/CT scan of the resected tissue showed moderate activity in the tail of pancreas, and a small focus of high activity in the tail. Area of high SSTR expression in the tail corresponded with preoperative findings in MRI and whole-body PET/CT. Histopathological examination of the specimen confirmed the presence of neuroendocrine tumour grade 1. Immediate PET/CT scan of the surgical specimen can bring new quality to intraoperative assessment of completeness of resection of neuroendocrine tumours.
authors.affiliation: Department of Nuclear Medicine, Medical University of Warsaw, Poland. jolanta.kunikowska@wum.edu.pl.
authors.forename: Jolanta
authors.initials: J
authors.lastname: Kunikowska
authors.forename: Maciej
authors.initials: M
authors.lastname: Słodkowski
authors.forename: Łukasz
authors.initials: Ł
authors.lastname: Koperski
authors.forename: Anna
authors.initials: A
authors.lastname: Kolasa
authors.forename: Jan
authors.initials: J
authors.lastname: Maryański
authors.forename: Piotr
authors.initials: P
authors.lastname: Pawliszak
authors.forename: Renata
authors.initials: R
authors.lastname: Matyskiel
authors.forename: Marek
authors.initials: M
authors.lastname: Chojnowski
authors.forename: Michał
authors.initials: M
authors.lastname: Najdzik
authors.forename: Leszek
authors.initials: L
authors.lastname: Królicki
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D064847:Multimodal Imaging; D018358:Neuroendocrine Tumors / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D009942:Organometallic Compounds; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D049268:Positron-Emission Tomography; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed
chemical_list: D009942:Organometallic Compounds; C513399:gallium Ga 68 dotatate