Real‐time ultrasound virtual navigation in 3D PET/CT volumes for superficial lymph‐node evaluation: innovative fusion examination

ABSTRACT Objective To evaluate the feasibility and clinical application of fusion imaging with virtual navigation, combining 18F‐fluorodeoxyglucose (18F‐FDG) positron emission tomography/computed tomography (PET/CT) with real‐time ultrasound imaging, in assessing superficial lymph nodes in breast‐ca...

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Published in:Ultrasound in obstetrics & gynecology 2021-11, Vol.58 (5), p.766-772
Main Authors: Garganese, G., Bove, S., Fragomeni, S., Moro, F., Triumbari, E. K. A., Collarino, A., Verri, D., Gentileschi, S., Sperduti, I., Scambia, G., Rufini, V., Testa, A. C.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Biopsy
Breast
Breast cancer
Breast Neoplasms - diagnostic imaging
Cancer
Computed tomography
Computer Systems
Feasibility Studies
Female
Fluorine isotopes
Fluorodeoxyglucose F18
fusion imaging
Gynecological cancer
Gynecology
Humans
Localization
lymph node
Lymph nodes
Lymph Nodes - diagnostic imaging
Lymphatic Metastasis - diagnostic imaging
Lymphatic system
Medical imaging
Middle Aged
Morphology
Multimodal Imaging - methods
Multimodal Imaging - statistics & numerical data
Obstetrics
Patients
PET/CT
Pilot Projects
Positron emission
Positron emission tomography
Positron Emission Tomography Computed Tomography - methods
Positron Emission Tomography Computed Tomography - statistics & numerical data
Radioactive tracers
Radiopharmaceuticals
Reliability analysis
Reproducibility of Results
Synchronism
Target detection
Target recognition
Time synchronization
Tomography
Ultrasonic imaging
ultrasonography
Ultrasonography - methods
Ultrasonography - statistics & numerical data
Ultrasound
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Summary:ABSTRACT Objective To evaluate the feasibility and clinical application of fusion imaging with virtual navigation, combining 18F‐fluorodeoxyglucose (18F‐FDG) positron emission tomography/computed tomography (PET/CT) with real‐time ultrasound imaging, in assessing superficial lymph nodes in breast‐cancer and gynecological‐cancer patients. Methods This was a pilot study of breast‐ and gynecological‐cancer patients with abnormal uptake of 18F‐FDG by axillary or groin lymph nodes on PET/CT scan, examined at our institution between January 2017 and May 2019. Fusion imaging was performed, uploading preacquired PET/CT DICOM images onto the ultrasound machine and synchronizing them with real‐time ultrasound scanning performed at the lymph‐node site. In the first phase, we assessed the feasibility and reliability of fusion imaging in a series of 10 patients with suspicious lymph nodes on both PET/CT and ultrasound, and with full correspondence between both techniques in terms of size, shape and morphology of the lymph nodes (Group A). In the second phase, we included 20 patients with non‐corresponding findings between PET/CT and ultrasound: 10 patients with lymph nodes that were suspicious or pathological on PET/CT scan but not suspicious on ultrasound assessment (Group B), and 10 patients with suspicious or pathological lymph nodes on both PET/CT and ultrasound but with no correspondence between the two techniques in terms of number of affected lymph nodes (Group C). Results In the 30 selected patients, fusion imaging was assessed at 30 lymph‐node sites (22 inguinal and eight axillary nodes). In the first phase (Group A), the fusion technique was shown to be feasible in all 10 lymph‐node sites evaluated. In the second phase, fusion imaging was completed successfully in nine of 10 cases in Group B and in all 10 cases in Group C. In all groups, fusion imaging was able to identify the target lymph node, guiding the examiner to perform a core‐needle aspiration biopsy or to inject radiotracer for selective surgical nodal excision, according to the radio‐guided occult lesion localization technique. Conclusion Fusion imaging with virtual navigation, combining PET/CT and real‐time ultrasound imaging, is technically feasible and able to detect target lymph nodes even when PET/CT and ultrasound findings are inconsistent. Fusion imaging can also be used to guide the performance of core‐needle aspiration biopsy, avoiding further surgical diagnostic procedures, or the injectio
ISSN:0960-7692
1469-0705
DOI:10.1002/uog.23613