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Image-, fluorescence- and radio-guided navigation for identification and localization of lymph node metastases in prostate cancer

Klaassen, N.J.M. (2018) Image-, fluorescence- and radio-guided navigation for identification and localization of lymph node metastases in prostate cancer.

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Abstract:Introduction: Prostate cancer is one of the most frequently seen types of cancer in men. The survival rates are relatively high, but decrease significantly when metastases are present. Nowadays, extended pelvic lymph node dissection is performed to remove potential metastatic lymph nodes. Although, extended pelvic lymph node dissection is associated with positive outcomes, negative results and high complication rates have been seen as well. Therefore, targeted pelvic lymph node dissection might be beneficial. Targeting could be performed in various ways e.g., using fluorescence-, radio-or image-guidance. In this study we focused on the application of radioactivity and image-guidance. Methods: A phantom, composed of the lids of a NEMA and Micro Hollow Sphere Phantom and the cylinder of a Jaszczak Phantom, was used to study the distinguishability of affected from unaffected lymph nodes. Real patient data was used as input for the phantom study. Activity calculations of lymph nodes, bladder, kidneys and lesions within the prostate were performed using 27 [68Ga]Ga-PSMA-HBED-CC PET/CT scans, these activities were used in the phantom. Seven readers were questioned to identify spheres containing radioactive solution in the phantom, via acoustic gamma detection and image-guided navigation. The first experiment was aimed at acoustic gamma detection without background activity, the second experiment was aimed at acoustic gamma detection with background activity, and the third experiment was aimed at hybrid guidance with background activity. Results: The results of our study show that positive lymph nodes are significantly better distinguishable from negative lymph nodes when the probe can be placed closer to the lymph nodes. We also observed a significant influence of background organ activity on the distinguishablity of positive and negative lymph nodes. At a distance of 0 cm to the lymph nodes a significant larger percentage of spheres was identified correctly when no background activity was present compared to the situation in which background activity was present. In case only image-guided navigation was applied, approximately half of the readers identified the active sphere incorrectly. Using hybrid navigation we observed an significant increase in correct identification. Conclusion: Both radio- and image-guidance are feasible techniques to distinguish affected form unaffected lymph nodes in the pelvic region during surgery. However, hybrid navigation seems to be feasible and superior compared to any guidance technique alone.
Item Type:Essay (Master)
Faculty:TNW: Science and Technology
Subject:44 medicine
Programme:Technical Medicine MSc (60033)
Link to this item:http://purl.utwente.nl/essays/74978
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