First Live-Experience Session with PET/CT Specimen Imager: A Pilot Analysis in Prostate Cancer and Neuroendocrine Tumor

Lorenzo Muraglia; Francesco Mattana; Laura Lavinia Travaini; Gennaro Musi; Emilio Bertani; Giuseppe Renne; Eleonora Pisa; Mahila Esmeralda Ferrari; Uberto Fumagalli Romario; Ottavio De Cobelli; Nicola Fusco; Francesco Ceci

doi:10.3390/biomedicines11020645

First Live-Experience Session with PET/CT Specimen Imager: A Pilot Analysis in Prostate Cancer and Neuroendocrine Tumor

Biomedicines. 2023 Feb 20;11(2):645. doi: 10.3390/biomedicines11020645.

Authors

Lorenzo Muraglia¹, Francesco Mattana¹, Laura Lavinia Travaini¹, Gennaro Musi^{2

3}, Emilio Bertani⁴, Giuseppe Renne⁵, Eleonora Pisa⁵, Mahila Esmeralda Ferrari⁶, Uberto Fumagalli Romario⁴, Ottavio De Cobelli^{2

3}, Nicola Fusco^{3

5}, Francesco Ceci^{1

3}

Affiliations

¹ Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy.
² Division of Urology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy.
³ Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy.
⁴ Division of Digestive Surgery, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy.
⁵ Division of Pathology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy.
⁶ Unit of Medical Physics, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy.

Abstract

Objective: to evaluate the feasibility of the intra-operative application of a specimen PET/CT imager in a clinical setting.

Materials and methods: this is a pilot analysis performed in three patients who received an intra-operative administration of ⁶⁸Ga-PSMA-11 (n = 2) and ⁶⁸Ga-DOTA-TOC (n = 1), respectively. Patients were administrated with PET radiopharmaceuticals to perform radio-guided surgery with a beta-probe detector during radical prostatectomy for prostate cancer (PCa) and salvage lymphadenectomy for recurrent neuroendocrine tumor (NET) of the ileum, respectively. All procedures have been performed within two ongoing clinical trials in our Institute (NCT05596851 and NCT05448157). Pathologic assessment with immunohistochemistry (PSMA-staining and SSA immunoreactivity) was considered as standard of truth. Specimen images were compared with baseline PET/CT images and histopathological analysis.

Results: Patients received 1 MBq/Kg of ⁶⁸Ga-PSMA-11 (PCa) or 1.2 MBq/Kg of ⁶⁸Ga-DOTA-TOC (NET) prior to surgery. Specimens were collected, positioned in the dedicated specimen container, and scanned to obtain high-resolution PET/CT images. In all cases, a perfect match was observed between the findings detected by the specimen imager and histopathology. Overall, the PET spatial resolution was sensibly higher for the specimen images compared to the baseline whole-body PET/CT images. Furthermore, the use of the PET/CT specimen imager did not significantly interfere with any procedures, and the overall length of the surgery was not affected using the PET/CT specimen imager. Finally, the radiation exposure of the operating theater staff was lower than 40 µSv per procedure (range 26-40 μSv).

Conclusions: the image acquisition of specimens obtained by patients who received intra-surgery injections of ⁶⁸Ga-PSMA-11 and ⁶⁸Ga-DOTA-TOC was feasible and reliable also in a live-experience session and has been easily adapted to surgery daily practice. The high sensitivity, together with the evaluation of intra-lesion tumor heterogeneity, were the most relevant results since the data derived from specimen PET/CT imaging matched perfectly with the histopathological analysis.

Keywords: PET; PET/CT; PET/CT specimen imager; radio-guided surgery.

Grants and funding

Lorenzo Muraglia is the recipient of a grant supported by the European Institute of Oncology Foundation (FIEO).