Radioguided Surgery in Oncological Surgery

  • Sergio Sandrucci
  • Rosa Moscato
  • Lina Matera
  • Alessandra Galetto
Part of the Updates in Surgery book series (UPDATESSURG)


The concept of radioguided surgery involves the use of a radiation detection probe system for the intraoperative detection of radionuclides. The use of gamma detection probe technology in radioguided surgery has expanded tremendously and has evolved into what is now considered an established discipline within the practice of surgery, revolutionizing the surgical management of many malignancies, including breast cancer, melanoma and colorectal cancer. The specific application of monoclonal antibodies to radioguided surgery has been the basis for the development of radioimmunoguided surgery; the use of oncotrophic or lymphotrophic tracers is the basic principle of radioguided surgery.


Sentinel Lymph Node Sentinel Lymph Node Biopsy Anal Cancer Lymphatic Mapping Radioguided Occult Lesion Localization 


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  1. 1.
    Povoski S, Neff RL, Mojzisik CM et al (2009) A comprehensive overview of radioguided surgery using gamma detection probe technology. World J Surg Oncol 7:11CrossRefPubMedGoogle Scholar
  2. 2.
    Rampaul RS, Bagnall M, Burrell H et al (2004) Randomized clinical trial comparing radioisotope occult lesion localization and wire-guided excision for biopsy of occult breast lesions. Br J Surg 91:1575–1577CrossRefPubMedGoogle Scholar
  3. 3.
    Ronka R, Krogerus L, Leppanen E et al (2004) Radio-guided occult lesion localization in patients undergoing breast conserving surgery and sentinel node biopsy. Am J Surg 187:491–496CrossRefPubMedGoogle Scholar
  4. 4.
    Norman J (2004) Minimally invasive parathyroid surgery. Recent trends becoming standard of care yielding smaller, more successful operations at a lower cost. Otolaryngol Clin North Am 37:683–688.CrossRefPubMedGoogle Scholar
  5. 5.
    Mariani G, Gulec SA, Rubello D et al (2003) Preoperative localisation and radioguided parathyroid surgery. J Nucl Med 44:1443–1458PubMedGoogle Scholar
  6. 6.
    Modlin IM, Lye KD, Kidd M (2003) A 5-decade analysis of 13,715 carcinoid tumors. Cancer 97:934–959CrossRefPubMedGoogle Scholar
  7. 7.
    Viola KV, Sosa JA (2005) Current advances in the diagnosis and treatment of pancreatic endocrine tumors. Curr Opin Oncol 17:24–27CrossRefPubMedGoogle Scholar
  8. 8.
    Ricke J, Klose KJ, Mignon M et al (2001) Standardization of imaging in neuroendocrine tumors: results of a European Delphi process. Eur J Radiol 37:8–17.CrossRefPubMedGoogle Scholar
  9. 9.
    Soga J (1997) Carcinoids of the rectum: an evaluation of 1271 reported cases. Surg Today 27:112–119CrossRefPubMedGoogle Scholar
  10. 10.
    Anderson CJ, Dehdashti F, Cutler PD et al (2001) 64Cu-TETAoctreotide as a PET imaging agent for patients with neuroendocrine tumors. J Nucl Med 42:213–221PubMedGoogle Scholar
  11. 11.
    Ribuffo D, Gradilone A, Vonella M et al (2003) Prognostic significance of reverse transcriptase-polymerase chain reaction-negative sentinel nodes in malignant melanoma. Ann Surg Oncol 10:396–402CrossRefPubMedGoogle Scholar
  12. 12.
    Gershenwald JE, Uren RF, Mariani G, Thompson JF (2006) Sentinel lymph node biopsy in cutaneous melanoma. In: Mariani G, Giuliano AE, Strauss HW (eds) Radioguided surgery: a comprehensive team approach. Springer, New York pp 98–116Google Scholar
  13. 13.
    Cody HS (2002) Sentinel lymph node biopsy. London: Martin Dunitz, pp 177–275Google Scholar
  14. 14.
    Wilke LG, McCall LM, Posther KE et al (2006) Surgical complications associated with sentinel lymph node biopsy: results from a prospective international cooperative group trial. Ann Surg Oncol 13:491–500CrossRefPubMedGoogle Scholar
  15. 15.
    Obenaus E, Erba PA, Chinol M et al (2006) Radiopharmaceuticals for radioguided surgery. In: Mariani G, Giuliano AE; Strauss HW (eds) Radioguided surgery: a comprehensive team approach. Springer, New York pp 3–11Google Scholar
  16. 16.
    Stoeckli SJ, Pfaltz M, Ross G et al (2005) The second international conference on sentinel node biopsy in mucosal head and neck cancer. Ann Surg Oncol 12:919–924CrossRefPubMedGoogle Scholar
  17. 17.
    Ross GL, Soutar DS, MacDonald G et al (2004) Sentinel node biopsy in head and neck cancer: preliminary results of a multi-center trial. Ann Surg Oncol 11:690–696CrossRefPubMedGoogle Scholar
  18. 18.
    De Cicco C, Trifirò G, Calabrese L et al (2006) Lymphatic mapping to tailor selective lymphadenectomy in tongue carcinoma cNO: beyond the sentinel node concept. Eur J Nucl Med Mol Imaging 33:900–905CrossRefPubMedGoogle Scholar
  19. 19.
    Kitagawa Y, Fujii H, Mukai M et al (2005) Sentinel lymph node mapping in esophageal and gastric cancer-impact on individualized minimally invasive surgery. In: Leong S, Kitajima M, Kitagawa Y (eds) Selective sentinel lymphadenectomy for human solid cancer. New York, Springer Science, pp 123–139CrossRefGoogle Scholar
  20. 20.
    Gretschel S, Bembenek A, Hünerbein M et al (2007) Efficacy of different technical procedures for sentinel lymph node biopsy in gastric cancer staging. Ann Surg Oncol 14:2028–2035CrossRefPubMedGoogle Scholar
  21. 21.
    Saikawa Y, Otani Y, Kitagawa Y et al (2006) Interim results of sentinel node biopsy during laparoscopic gastrectomy: possible role in function-preserving surgery for early cancer. World J Surg 30:1962–1968CrossRefPubMedGoogle Scholar
  22. 22.
    Kitagawa Y, Fujii H, Mukai M et al (2002) Radioguided sentinel node detection for gastric cancer. Br J Surg 89:604–608CrossRefPubMedGoogle Scholar
  23. 23.
    Uenosono Y, Natsugoe S, Ehi K et al (2005) Detection of sentinel nodes and micrometastases using radioisotope navigation and immunohistochemistry in patients with gastric cancer. Br J Surg 92:886–889CrossRefPubMedGoogle Scholar
  24. 24.
    Bilchik A, Saha S, Tsioulias G et al (2001) A berrant drainage of missed micrometastases: the value of lymphatic mapping and focused analysis of sentinel lymph nodes in gastrointestinal neoplasms. Ann Surg Oncol 8:82–85Google Scholar
  25. 25.
    Saha S, Dan AG, Viehl CT et al (2005) Sentinel lymph node mapping in colon and rectal cancer-its impact on staging, limitations, and pitfalls. In: Leong S, Kitajima M, Kitagawa Y (eds) Selective sentinel lymphadenectomy for human solid cancer. New York, Springer ScienceGoogle Scholar
  26. 26.
    Nigro ND, Vaitkeicus VK, Basil B (1974) Combined therapy for cancer of the anal canal: A preliminary report. Dis Colon Rectum 17:354–356CrossRefPubMedGoogle Scholar
  27. 27.
    Gerard J-P, Chapet O, Samiei F et al (2001) Management of inguinal lymph node metastases in patients with carcinoma of the anal canal. Experience in a series of 270 patients treated in Lyon and review of the literature. Cancer 92:77–84CrossRefPubMedGoogle Scholar
  28. 28.
    Damin DC, Rosito MA, Schwartsmann G (2006) Sentinel lymph node in carcinoma of the anal canal: A review. EJSO 32:247–252CrossRefGoogle Scholar
  29. 29.
    Mistrangelo M, Bello M, Mobiglia A et al (2009) Feasibility of the sentinel node biopsy in anal cancer. Q J Nucl Med Mol Imaging 53:3–8PubMedGoogle Scholar
  30. 30.
    Gretschel S, Warnick P, Bembenek A et al (2008) Lymphatic mapping and sentinel lymph node biopsy in epidermoid carcinoma of the anal canal. Eur J Surg Oncol 34:890–894.PubMedGoogle Scholar
  31. 31.
    Mistrangelo M, Morino M (2009) Sentinel Lymph node biopsy in anal cancer: a review Gastroeneterol clin biol 33:446–450Google Scholar
  32. 32.
    Takashima H, Egawa M, Imao T et al (2004) Validity of sentinel lymph node concept for patients with prostate cancer. J Urol 71:2268–2271CrossRefGoogle Scholar
  33. 33.
    Kroon BK, Horenblas S, Meinhardt W et al (2005) Dynamic sentinel node biopsy in penile carcinoma: evaluation of 10 years experience. Eur Urol 47:601–606CrossRefPubMedGoogle Scholar
  34. 34.
    Merisio C, Berretta R, Gualdi M et al (2005) Radioguided sentinel lymph node detection in vulvar cancer. Int J Gynecol Cancer 15:493–497CrossRefPubMedGoogle Scholar
  35. 35.
    Barranger E, Grahek D, Cortez A et al (2003) Laparoscopic sentinel lymph node procedure using a combination of patent blue and radioisotope in women with cervical carcinoma. Cancer 97:3003–3009CrossRefPubMedGoogle Scholar
  36. 36.
    Lantzsch T, Wolters M, Grimm J et al (2001) Sentinel node procedure in Ib cervical cancer: a preliminary series. Br J Cancer 14:791–794CrossRefGoogle Scholar
  37. 37.
    Waldhauer I, Steile A (2008) NK cells and cancer immunosurveillance. Oncogene 45:5932–5943CrossRefGoogle Scholar
  38. 38.
    Bryceson YT, March ME, Ljunggen HG et al (2006) Synergy among receptors on resting NK cells for the activation of natural cytotoxicity and cytokine secretion. Blood 107:159–166CrossRefPubMedGoogle Scholar
  39. 39.
    Terme M, Ullrich E, Delahaye NF et al (2008) Natural killer cell-directed therapies: moving from unexpected results to successful strategies. Nat Immunol 9:486–494CrossRefPubMedGoogle Scholar
  40. 40.
    Cooper MA, Fehniger TA, Caligiuri MA (2001) The biology of human natural killer-cell subsets. Trends Immunol 22:633–640CrossRefPubMedGoogle Scholar
  41. 41.
    Albertsson PA, Basse PH, Hokland M et al (2003) NK cells and the tumor microenvironment: implications for NK-cell function and anti-tumor activity. Trends Immunol 24:603–609CrossRefPubMedGoogle Scholar
  42. 42.
    Kjaergaard J, Hokland ME, Agger R et al (2000) Biodistribution and tumor localization of lymphokine-activated killer T cells following different routes of administration into tumorbearing animals. Cancer Immunol Immunother 48:550–560CrossRefPubMedGoogle Scholar
  43. 43.
    Goding S, Yang Q, Mi Z et al (2007) Targeting of products of genes to tumor sites using adoptively transferred A-NK and T-LAK cells. Cancer Gene Ther 14:441–450CrossRefPubMedGoogle Scholar
  44. 44.
    Hagenaars M, Ensink NG, Koelemij R et al (1998) Regional administration of natural killer cells in a rat hepatic metastasis model results in better tumor infiltration and anti-tumor response than systemic administration. Int J Cancer 75:233–238CrossRefPubMedGoogle Scholar
  45. 45.
    Matera L, Galetto A, Bello M et al (2006) In vivo migration of labeled autologous natural killer cells to liver metastases in patients with colon carcinoma. J Transl Med 14:4–49Google Scholar

Copyright information

© Springer-Verlag Italia 2010

Authors and Affiliations

  • Sergio Sandrucci
    • 1
  • Rosa Moscato
    • 1
  • Lina Matera
    • 2
  • Alessandra Galetto
    • 3
  1. 1.Surgical Oncology UnitS. Giovanni Battista University HospitalTurinItaly
  2. 2.Clinical ImmunologyS. Giovanni Battista University HospitalTurinItaly
  3. 3.Clinical OncologyOspedale della CaritàNovaraItaly

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