title: PET Probe-Guided Surgery in Patients with Breast Cancer: Proposal for a Methodological Approach.
abstract: Although it is valuable for detecting distant metastases, identifying recurrence, and evaluating responses to chemotherapy, the role of18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT) in assessing locoregional nodal status for initial staging of breast cancer has not yet been well-defined in clinical practice. In the current report, we describe a new PET probe-based clinical approach, with evaluation of the technical performance of a handheld high-energy gamma probe for intraoperative localization of breast carcinomas, and evaluation of lymph node metastases during radio-guided oncological surgery.
  
  
  
  Three patients underwent a PET/CT scan immediately prior to surgery following the standard clinical protocol. Intraoperatively, tumors were localized and resected with the assistance of a hand-held gamma probe. PET-guided assessment of the presence or absence of regional nodal spread of malignancy was compared with the reference standard of histopathological examination.
  
  
  
  In all three cases, perioperative18F-FDG PET/CT imaging and intraoperative gamma probe detection verified complete resection of the hypermetabolic lesions and demonstrated no additional suspicious occult disease.
  
  
  
  This innovative approach demonstrates great promise for providing real-time access to metabolic and morphological tumor information that may lead to an optimal disease-tailored approach. In carefully selected indications, a PET probe can be a useful adjunct in surgical practice, but further trials with a larger number of patients need to be performed to verify these findings.
authors.affiliation: Department of Surgery, Tor Vergata University Hospital, Rome, Italy orsaria@aol.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Orsaria
authors.affiliation: Department of Biomedicine and Prevention, Tor Vergata University Hospital, Rome, Italy.
authors.forename: Agostino
authors.initials: A
authors.lastname: Chiaravalloti
authors.affiliation: Department of Biomedicine and Prevention, Tor Vergata University Hospital, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fiorentini
authors.affiliation: Department of Biomedicine and Prevention, Tor Vergata University Hospital, Rome, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Pistolese
authors.affiliation: Department of Surgery, Tor Vergata University Hospital, Rome, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Vanni
authors.affiliation: Department of Surgery, Tor Vergata University Hospital, Rome, Italy.
authors.forename: Alessandra Vittoria
authors.initials: AV
authors.lastname: Granai
authors.affiliation: Department of Surgery, Tor Vergata University Hospital, Rome, Italy.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Varvaras
authors.affiliation: Department of Biomedicine and Prevention, Tor Vergata University Hospital, Rome, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Danieli
authors.affiliation: Department of Biomedicine and Prevention, Tor Vergata University Hospital, Rome, Italy.
authors.forename: Orazio
authors.initials: O
authors.lastname: Schillaci
authors.affiliation: Department of Surgery, Tor Vergata University Hospital, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Petrella
authors.affiliation: Department of Surgery, Tor Vergata University Hospital, Rome, Italy.
authors.forename: Oreste Claudio
authors.initials: OC
authors.lastname: Buonomo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics*; D006801:Humans; D008207:Lymphatic Metastasis; D015335:Molecular Probes / Q000493:pharmacokinetics*; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010865:Pilot Projects; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D011379:Prognosis; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014018:Tissue Distribution
chemical_list: D015335:Molecular Probes; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Breast cancer; nodal staging; positron-emission tomography (PET) probe; radio-guided surgery; sentinel node