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Intraoperative search for neuroblastoma by MIBG and radioguided surgery with the gamma detector
H A Heij1, E J Rutgers, J de Kraker
1Paediatric Surgical Centre Amsterdam, The Netherlands.
Abstract:
Administration of a tumour-seeking compound labeled with a low-energy isotope and intraoperative screening with the gamma probe (radioguided surgery, RGS) could be useful in reoperations for advanced neuroblastoma when the normal anatomy is altered. A pilot study was performed to test the feasibility of this technique. Five patients underwent six relaparotomies for recurrent stage III or IV neuroblastoma. All had been treated with intensive chemotherapy and/ or metaiodobenzylguanidine (MIBG)-I131 with or without hyperbaric oxygen. Reoperation was performed to achieve near-total (greater than 95%) excision. In all instances, active tumour was seen on the preoperative MIBG scan. Before the operation, a tracer dose of MIBG-I123 was given. At laparotomy, a search was made with the gamma probe for areas of increased activity. The gamma probe correctly identified active neuroblastoma tissue that was seen on the preoperative MIBG scan. There appeared to be a relationship between intensity of radioactivity and degree of maturation on histologic examination. This pilot study shows that RGS with MIBG and intraoperative use of the gamma probe is able to identify recurrent neuroblastoma. Whether this method is able to detect occult tumour and whether RGS will result in better outcome are the subjects of ongoing research.
Insights
Radioguided surgery (RGS) using a gamma probe and MIBG-I123 effectively identifies recurrent neuroblastoma during reoperations. This pilot study demonstrates RGS feasibility in complex cases with altered anatomy.
Area of Science:
- Oncology
- Nuclear Medicine
- Surgical Oncology
Background:
- Advanced neuroblastoma often requires reoperation due to altered anatomy after initial treatment.
- Metaiodobenzylguanidine (MIBG)-I131 scans are used preoperatively to assess neuroblastoma.
- Radioguided surgery (RGS) offers potential for improved tumor localization in complex surgical scenarios.
Purpose of the Study:
- To evaluate the feasibility of using radioguided surgery (RGS) with a gamma probe and MIBG-I123 for reoperations in advanced neuroblastoma.
- To determine if RGS can accurately identify recurrent neuroblastoma tissue in patients with altered anatomy.
Main Methods:
- A pilot study involving five patients with recurrent stage III or IV neuroblastoma undergoing relaparotomy.
- Administration of a tracer dose of MIBG-I123 before surgery.
- Intraoperative localization of active tumor using a gamma probe during laparotomy.
Main Results:
- The gamma probe successfully identified active neuroblastoma tissue.
- RGS correlated with areas of increased radioactivity seen on preoperative MIBG scans.
- A potential relationship was observed between radioactivity intensity and tumor histological maturation.
Conclusions:
- Radioguided surgery (RGS) with MIBG-I123 and a gamma probe is a feasible technique for identifying recurrent neuroblastoma during reoperations.
- Further research is ongoing to assess RGS's ability to detect occult tumors and improve patient outcomes.