title: Intraoperative Use of a Portable Large Field of View Gamma Camera and Handheld Gamma Detection Probe for Radioguided Localization and Prediction of Complete Surgical Resection of Gastrinoma: Proof of Concept.
abstract: BACKGROUND
  Surgical management of Zollinger-Ellison syndrome (ZES) relies on localization and resection of all tumor foci. We describe the benefit of combined intraoperative use of a portable large field of view gamma camera (LFOVGC) and a handheld gamma detection probe (HGDP) for indium-111 ((111)In)-pentetreotide radioguided localization and confirmation of gastrinoma resection in ZES.
  
  
  METHODS
  Five patients (6 cases) with (111)In-pentetreotide-avid ZES were evaluated. Patients were injected with (111)In-pentetreotide for diagnostic imaging the day before surgery. Intraoperatively, an HGDP and LFOVGC were used to localize (111)In-pentetreotide-avid lesions, guide resection, assess specimens for (111)In-pentetreotide activity, and to verify lack of abnormal post-resection surgical field activity.
  
  
  RESULTS
  Large field of view gamma camera imaging and HGDP-assisted detection were helpful for localization and guided resection of tumor and removal of (111)In-pentetreotide-avid tumor foci in all cases. In 3 of 5 patients (3 of 6 cases), these techniques led to detection and resection of additional tumor foci beyond those detected by standard surgical techniques. The (111)In-pentetreotide-positive or-negative specimens correlated with neuroendocrine tumors or benign pathology, respectively. In one patient with mild residual focal activity on post-resection portable LFOVGC imaging, thought to be artifact, had recurrence of disease in the same area 5 months after surgery.
  
  
  CONCLUSIONS
  Real-time LFOVGC imaging and HGDP use for surgical management of gastrinoma improve success of localizing and resecting all neuroendocrine tumor-positive tumor foci, providing instantaneous navigational feedback. This approach holds potential for improving long-term patient outcomes in patients with ZES.
authors.affiliation: Department of Radiology, College of Public Health, The Ohio State University, Wexner Medical Center, Columbus, OH; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA. Electronic address: nathan.hall@uphs.upenn.edu.
authors.forename: Nathan C
authors.initials: NC
authors.lastname: Hall
authors.affiliation: Department of Surgery, College of Public Health, The Ohio State University, Wexner Medical Center, Columbus, OH; Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, TX.
authors.forename: Shawnn D
authors.initials: SD
authors.lastname: Nichols
authors.affiliation: Department of Surgery, College of Public Health, The Ohio State University, Wexner Medical Center, Columbus, OH.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Povoski
authors.affiliation: Department of Surgery, College of Public Health, The Ohio State University, Wexner Medical Center, Columbus, OH.
authors.forename: Iyore A O
authors.initials: IA
authors.lastname: James
authors.affiliation: Department of Radiology, College of Public Health, The Ohio State University, Wexner Medical Center, Columbus, OH.
authors.forename: Chadwick L
authors.initials: CL
authors.lastname: Wright
authors.affiliation: Division of Epidemiology, The Ohio State University, Wexner Medical Center, Columbus, OH.
authors.forename: Randall
authors.initials: R
authors.lastname: Harris
authors.affiliation: Department of Surgery, College of Public Health, The Ohio State University, Wexner Medical Center, Columbus, OH.
authors.forename: Carl R
authors.initials: CR
authors.lastname: Schmidt
authors.affiliation: Department of Surgery, College of Public Health, The Ohio State University, Wexner Medical Center, Columbus, OH.
authors.forename: Peter
authors.initials: P
authors.lastname: Muscarella
authors.affiliation: Department of Surgery, College of Public Health, The Ohio State University, Wexner Medical Center, Columbus, OH.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Latchana
authors.affiliation: Department of Surgery, College of Public Health, The Ohio State University, Wexner Medical Center, Columbus, OH.
authors.forename: Edward W
authors.initials: EW
authors.lastname: Martin
authors.affiliation: Department of Surgery, College of Public Health, The Ohio State University, Wexner Medical Center, Columbus, OH.
authors.forename: E Christopher
authors.initials: EC
authors.lastname: Ellison
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D015902:Gamma Cameras; D015408:Gastrinoma / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D013004:Somatostatin / Q000031:analogs & derivatives*; D016896:Treatment Outcome; D015043:Zollinger-Ellison Syndrome / Q000000981:diagnostic imaging / Q000601:surgery*
chemical_list: D019275:Radiopharmaceuticals; D013004:Somatostatin; C081788:pentetreotide