Nuclear medicine in the operating room: present and future

Area of Science:

• Oncology
• Nuclear Medicine
• Surgical Navigation

Background:

• The sentinel node (SN) biopsy, established over 30 years ago using a triple approach, revolutionized cancer staging for melanoma and breast cancer.
• This procedure fostered early multidisciplinary collaboration and skill transfer, paving the way for interventional nuclear medicine (iNM).

Purpose of the Study:

• To highlight the evolution and expanding role of nuclear medicine in the operating room, particularly through interventional nuclear medicine (iNM).
• To discuss advancements in imaging and technology that enhance surgical precision and expand the application of iNM.

Main Methods:

• Review of the historical development of the SN procedure and its integration with nuclear medicine techniques.
• Discussion of current imaging modalities like SPECT/CT and PET/CT for preoperative surgical planning.
• Exploration of iNM applications in open and robot-assisted surgery for various cancers and metastasis resection.

Main Results:

• The SN procedure, initially for melanoma and breast cancer, has expanded to include gynecological, urological, head and neck, and gastrointestinal malignancies.
• Advanced imaging (SPECT/CT, PET/CT) enables precise preoperative roadmaps for surgical navigation.
• iNM is now applicable to robot-assisted surgery for SN biopsy and oligometastasis resection.

Conclusions:

• Interventional nuclear medicine (iNM) has significantly evolved from the SN procedure, becoming integral to modern cancer surgery.
• Technological advancements and broader applications underscore the growing importance of iNM in improving surgical outcomes.
• Future developments, including hybrid tracers, are expected to further solidify iNM's role in oncologic interventions.