Jean-Louis Guyonnet

Precise localization of sentinel lymph nodes and estimation of their depth using a prototype intraoperative mini gamma-camera in patients with breast cancer.

The aim of this study was to evaluate the ability of a prototype intraoperative mini γ-camera, the CarolIReS, with a 50 × 50 mm field of view, to precisely localize sentinel lymph nodes (SLNs) and to determine their depth in a series of patients with infiltrative breast cancer requiring SLN excision. Methods: With the use of phantoms, the broadness of the signal of an acquired projection was shown to linearly depend on its distance from the collimator. A preclinical ex vivo study of 25 excised SLNs demonstrated that SLN size did not influence depth estimation. The minimum activity threshold for successful use of the proposed method was determined. After a preoperative radioisotope injection and lymphoscintigraphy, the SLN was localized in a series of 11 patients using both the mini γ-camera and a γ-probe. During surgery, a ruler was used to measure the depth of all SLNs before their excision. Results: Using the measured linear dependence of image broadness, we found that the expected SLN anatomic depth was compatible with its measured depth during surgery. Conclusion: This study showed that the mini γ-camera efficiently estimated the location of SLNs in 3 dimensions.

Towards an inline reconstruction architecture for micro-CT systems

Recent developments in micro-CT have revolutionized the ability to examine in vivo living experimental animal models such as mouse with a spatial resolution less than 50 microm. The main requirements of in vivo imaging for biological researchers are a good spatial resolution, a low dose induced to the animal during the full examination and a reduced acquisition and reconstruction time for screening purposes. We introduce inline acquisition and reconstruction architecture to obtain in real time the 3D attenuation map of the animal fulfilling the three previous requirements. The micro-CT system is based on commercially available x-ray detector and micro-focus x-ray source. The reconstruction architecture is based on a cluster of PCs where a dedicated communication scheme combining serial and parallel treatments is implemented. In order to obtain high performance transmission rate between the detector and the reconstruction architecture, a dedicated data acquisition system is also developed. With the proposed solution, the time required to filter and backproject a projection of 2048 x 2048 pixels inside a volume of 140 mega voxels using the Feldkamp algorithm is similar to 500 ms, the time needed to acquire the same projection.

Optimization of sentinel lymph node biopsy in breast cancer using an operative gamma camera

BackgroundSentinel lymph node (SLN) procedure is now a widely accepted method of LN staging in selected invasive breast cancers (unifocal, size ≤ 2 cm, clinically N0, without previous treatment). Complete axillary clearance is no longer needed if the SLN is negative. However, the oncological safety of this procedure remains to be addressed in randomized clinical trials. One main pitfall is the failure to visualize SLN, resulting in incorrect tumor staging, leading to suboptimal treatment or axillary recurrence. Operative gamma cameras have therefore been developed to optimize the SLN visualization and the quality control of surgery.Case presentationA 44-year-old female patient with a 14-mm infiltrative ductal carcinoma underwent the SLN procedure. An operative gamma camera was used during and after the surgery. The conventional lymphoscintigraphy showed only one SLN, which was also detected by the operative gamma camera, then removed and measured (9.6 kBq). It was analyzed by frozen sections, showing no cancer cells. During this analysis, the exploration of the axillary area with the operative gamma camera enabled the identification of a second SLN with low activity (0.5 kBq) that conventional lymphoscintigraphy, surgical probe and blue staining had failed to visualize. Histological examination revealed a macrometastasis. Axillary clearance was then performed, followed by a postoperative image proving that no SLN remained. Therefore, the use of the operative gamma camera prevented an under-estimation of staging which would have resulted in a suboptimal treatment for this patient.ConclusionThis case report illustrates that an efficient operative gamma camera may be able to decrease the risk of false negative rate of the SLN procedure, and could be an additional tool to control the quality of the surgery.Trial RegistrationClinicalTrials.gov Identifier: NCT00357487

Improvement in intramammary sentinel lymph node removal using a novel prototype hand held probe during breast conservative surgery.

SummaryIntramammary sentinel lymph node excision during breast conservative surgery was performed, in this case report, using a prototype intraoperative gamma probe. In contrast to the four axillary sentinel lymph nodes that were subnormal, the excised intramammary sentinel lymph node was massively invaded by cancer cells. Therefore this finding had profound implication for the staging of the tumor and for treatment selection. This case report illustrates that an efficient intraoperative gamma probe is useful to locate and remove intramammary sentinel lymph node in breast cancer patients treated with breast conservation.

An operative gamma camera for sentinel lymph node procedure in case of breast cancer

Large field of view gamma cameras are widely used to perform lymphoscintigraphy in the sentinel lymph nodes (SLN) procedure in case of breast cancer. However, they are not specified for this application and their sizes do not enable their use in the operative room to control the excision of the all SLN. We present the results obtained with a prototype of a new mini gamma camera developed especially for the operative lymphoscintigraphy of the axillary area in case of breast cancer. This prototype is composed of 10 mm thick parallel lead collimator, a 2 mm thick GSO:Ce inorganic scintillating crystal from Hitachi and a Hamamatsu H8500 flat panel multianode (64 channels) photomultiplier tube (MAPMT) equipped with a dedicated electronics. Its actual field of view is 50 × 50mm2. The gamma interaction position in the GSO scintillating plate is obtained by calculating the center of gravity of the fired MAPMT channels. The measurements performed with this prototype demonstrate the usefulness of this mini gamma camera for the pre, per and post-operative identification of SLNs and how its complementary role with an intraoperative handheld gamma probe enables to improve the efficiency of this practice. A 100 × 100mm2 field of view camera designated to cover the entire axillary area is under investigation

Study of 4 inorganic scintillating crystals for an operative gamma probe in radioguided surgery

In case of lymphatic cancers, the sentinel lymph node technique is performed using a gamma probe for intraoperative radioguided surgery. The inorganic scintillating crystal gamma probe developed at IPHC was equipped with 4 fast decay time inorganic scintillators: YAP, LYSO, LaCl3 and LaBr3. Energy resolutions are compared experimentally with single photon radioisotopes for small crystal cylinders (4 mm diameter, 12 mm length). The 6.1% measured energy resolution at 511 keV demonstrates the great advantage to use the high photon yield LaBr3 crystal for detection of γ-ray coming from positron annihilation using β+ radiomarked molecules.