Background: Here we review primary intrathoracic goiter (P-ITG), a rare but potentially serious congenital entity that is distinct from the much more common secondary intrathoracic goiter. The latt...

Primary intrathoracic goiter: a rare and potentially serious entity.

Radioguided surgery (RGS) is the use of radiation detection probes and handheld gamma cameras in surgery rooms to identify radioactively labeled lesions inside the body with an aim to improve surgical outcome. In today's surgery, application of these devices is a well-established practice, which provides surgeons with real-time information to guide them to the site of a lesion. In recent years, there have been several major improvements in the technology and design of gamma probes and handheld gamma cameras, enhancing their applications in surgical practices. Handheld gamma cameras, for example, are now moving from single-modality to dual-modality scanners that add anatomical data to the physiologic data, and with that provide more clinical information of the tissue under study. Also, in the last decade, a radioguided surgical technique based on the Cerenkov radiation was introduced, with more improved sensitivity in identifying radioactively labeled lesions. Additionally, recent advances in hybrid tracers have led to more efficient detection of lesions labeled with these tracers. Besides, it seems that combining medical robotics and augmented reality technology with current radioguided surgical practices potentially will change the delivery and performance of RGS in the near future. The current paper aims to give an overview of the physics of RGS and summarizes recent advances in this field that have a potential to improve the application of radioguided surgical procedures in the management of cancer.

Radioguided surgery: physical principles and an update on technological developments.

Synthesis and in vivo evaluation of 201Tl(III)–DOTA complexes for applications in SPECT imaging

OBJECTIVE Using microsurgical procedures without intraoperative imaging, Gross Total Resection (GTR) has so far only been achieved in less than 30% of all cases. Radio-guided surgery was introduced in the clinical setting in 1985 in an attempt to facilitate intraoperative tumor detection. Because of few studies in literature about this subject, we decided to use gamma probe with the hypothesis that we could increase extent of tumor resection. MATERIALS AND METHODS From January 2013 till February 2014, 22 patients with cerebral glioma were randomized equally into two groups and evaluated. In the first group, 370MBq of Technetiumc-99m was injected. The microsurgical resection of the tumor was performed as much as possible, and then the tumoral bed was examined, if the signal was more than 2 times of the background signal, more tissue resection performed if feasible until the signal was diminished. In the control group, conventional resection of the tumor was performed. The extent of tumor resection was assessed by contrast magnetic resonance imaging (MRI) study. RESULTS Before surgery the patients in the first group had average tumor volume of 81.68±9.78. In the second group the average tumor volume before surgery was 82.63±10.06cc. There is no significant difference between preoperative tumor volumes in two groups. In the first group, in the post-operative MRI, the tumor volume was 5.04±2.69cc and in the second group it was 9.5±4.8cc. Eight patients (72.7%) in the radioguided group experienced radical resection (more than 95%), but in the control group radical resection was achieved in just 3 patients (27.2%), radical resection was significantly higher in radioguided group (P<0.001). Due to the usage of the gamma detection probe, time of finding the tumor in the radioguided group was significantly less than control group (P=0.02). However total operation time in the radioguided group, was not significantly more than the control group (P=0.88). CONCLUSIONS Neuronavigation system increases the percentage of gross total resection, but it is expensive, increases duration of surgery is not considered a real-time assessment, and is not accurate in determining the borders of glioma due to brain shift. In contrast, radio-guided surgery is easy to use, real time, not expensive, and increases the extent of tumor resection.

Radioguided surgery using gamma detection probe technology for resection of cerebral glioma.

Soft tissue sarcomas are uncommon tumors. Accurate pretreatment evaluation plays an important role in treating Soft tissue sarcomas. The growth rate and relative recurrence rate of soft tissue sarcomas varies with the aggressiveness of the tumor. A 67-year-old man was diagnosed with atypical fibroxanthoma in the right lower leg, which subsequently recurred, after resection, as a myxofibrosarcoma and metastatic lymph nodes in the right lower pelvis and right groin. Close follow-up with appropriate functional imaging (such as thallium-201 scintigraphy and FDG PET) may aid in the early detection of malignant transformation and metastatic disease.

Thallium-201 scintigraphy of myxofibrosarcoma.

RATIONALE Malignant astrocytomas show thallium uptake with a high target-to-background ratio, allowing the use of radioguided surgery. METHOD We report on 6 patients (3 men) diagnosed with malignant astrocytoma. All patients signed informed consent documents. Previous thallium-201 SPECT was performed, showing uptake in tumors. In the operating room we injected 37 MBq (1 mCi) of thallium-201 at the same time the craniotomy was performed. With the gamma probe we confirmed the tumor uptake, and a biopsy sample was taken. After conventional tumor resection, we scanned the surgical bed with the gamma probe. All areas of abnormal uptake were evaluated by the surgeon and, if possible, removed. RESULTS In all patients the biopsy confirmed a high-grade astrocytoma. In all cases we found residual uptake in the surgical bed that was confirmed as residual tumor by pathologic examination. In 3 cases it was not possible to remove all the sites of pathologic uptake because critical areas were involved. In the other 3 patients, only background activity was found after the procedure. CONCLUSION Radioguided surgery in brain tumors with thallium-201 is a complex technique and expertise in radioguided surgery and neuroimaging is needed, but we think that it is promising.

https://www.researchgate.net/profile/Justo_Vicente/publication/23497618_Radioguided_surgery_in_brain_tumors_with_thallium-201/links/54cf3ea80cf24601c0931af7.pdf

Radioguided surgery in brain tumors with thallium-201.

An 81-year-old man was hospitalized for hypochromic anemia and weight loss. Abdominal ultrasound, gastrointestinal transit studies, and colonoscopy showed stenosis of the ileum near the ileocecal valve, and the presence of an ileosigmoid fistula. Differential diagnosis included a primary neoplasm of the ileum (adenocarcinoma or lymphoma) versus inflammatory bowel disease. The patient underwent a Tc-99m hexamethylpropyleneamine oxime-labeled leukocyte scan to rule out Crohn disease. Focal abdominal uptake of the tracer was seen, indicating an inflammatory process. The patient underwent surgery, and a primary neoplasm of the terminal ileum was found. Histologic examination revealed a poorly differentiated adenocarcinoma of the ileum with extensive areas of necrosis and neutrophil infiltration.

False-positive Tc-99m HMPAO leukocyte scan secondary to adenocarcinoma of the ileum.

Pineocytoma is an uncommon slow-growing tumor of the pinealgland. We present a 45-year-old man with a history of a pineocytomadiagnosed 6 years ago. Surgical excision and radiotherapy had been per-formed. The patient remained asymptomatic until a few weeks ago, when hehas began to experience an increasing slight headache. MRI was performedshowing a lesion in the tentorium that could correspond to postradiotherapychanges or tumor relapse. Thallium-201 SPECT showed minimal faintuptake at the tentorium. In-111 pentetreotide SPECT showed very intensefocal uptake at the same location. Radiation-induced meningioma wassuspected. Surgical reresection and histologic examination revealed a recur-rent pineocytoma. Key Words: pineocytoma, octreotide, SPECT( Clin Nucl Med 2009;34: 117–118) REFERENCES 1. Karl Herholz, David Coope, Alan Jackson. Metabolic and molecular imagingin neuro-oncology. Lancet Neurol. 2007;6:711–724.2. Serizawa T, Saeki N, Higuchi Y, et al. Diagnostic value of thallium-201chloride single-photon emission computerized tomography in differentiatingtumor recurrence from radiation injury after gamma knife surgery for meta-static brain tumors.

http://www.researchgate.net/profile/Justo_Vicente/publication/24263190_In-111_pentetreotide_in_recurrent_pineocytoma/links/54cf39800cf298d656630c30.pdf

In-111 pentetreotide in recurrent pineocytoma.

A 69-year-old woman with a history of goiter and thyrotoxicosis over the previous year was seen for radioiodine therapy. At the time of a previous ablation with I-131, a thyroid scan was performed after administration of Tc-99m sodium pertechnetate. Scintigraphy showed an enlarged thyroid gland with increased thyroid uptake in the neck at its normal location along with mediastinal uptake. Contrast enhanced computed tomography (CT) showed an anterior mediastinal mass. This mass was excised. Histologic study demonstrated an ectopic primary intrathoracic nodular goiter at the site of increased activity seen on Tc-99m pertechnetate imaging.

Primary intrathoracic goiter on scintigraphy

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Radioguided surgery in brain tumors with thallium-201.

False-positive Tc-99m HMPAO leukocyte scan secondary to adenocarcinoma of the ileum.

In-111 pentetreotide in recurrent pineocytoma.

Primary intrathoracic goiter on scintigraphy