Role of PET gamma detection in radioguided surgery: a systematic review

PurposeThis systematic review aimed to collect published studies concerning intraoperative gamma detection of positron-emitting tracers for radioguided surgery (RGS) applications.MethodsA systematic literature search of studies published until October 2022 was performed in Pubmed, Web Of Science, Central (Cochrane Library) and Scopus databases, including the following keywords: Positron Emission Tomography OR PET AND Gamma OR gamma AND Probe AND Radioguided Surgery OR RGS. The included studies had to concern RGS procedures performed in at least 3 patients, regardless of the administered radiopharmaceutical and the field of application.ResultsAmong to the 17 selected studies, all published between 2000 and 2022, only 2 investigations were conducted with gallium-68 (Ga-68)-labeled somatostatin analogues, with fluorine-18-fluoro-2-deoxyglucose ([F-18]FDG) being the most commonly used agent for RGS applications. Almost all studies were performed in oncologic patients, with only one paper also including inflammatory and infectious findings. The analysis showed that the largest part of procedures was performed through the intraoperative use of conventional gamma probes, not specifically designed for the detection of annihilation photons (n = 9), followed by PET gamma probes (n = 5) and with only three studies involving electronic collimation.ConclusionsRegardless of the intraoperative devices, RGS with positron emitters seems to lead to significant improvements in surgeons' ability to obtain a complete resection of tumors, even if the nature of photons resulting from positron-electron collision still remains extremely challenging and requires further technical advances.

Automated summary

The purpose of this systematic review was to collect and analyze published studies on intraoperative gamma detection of positron-emitting tracers for radioguided surgery (RGS) applications. A systematic literature search was conducted in multiple databases to identify relevant studies published until October 2022. The results showed that RGS procedures using positron emitters, primarily fluorine-18-fluoro-2-deoxyglucose ([F-18]FDG), have been beneficial in improving surgeons' ability to achieve complete tumor resection. However, further technical advancements are needed to overcome the challenges associated with detecting annihilation photons resulting from positron-electron collisions.