Molecular image-guided surgery in gynaecological cancer: where do we stand?

Eur J Nucl Med Mol Imaging. 2024 Aug;51(10):3026-3039. doi: 10.1007/s00259-024-06604-1. Epub 2024 Jan 18.

Abstract

Purpose: The aim of this review is to give an overview of the current status of molecular image-guided surgery in gynaecological malignancies, from both clinical and technological points of view.

Methods: A narrative approach was taken to describe the relevant literature, focusing on clinical applications of molecular image-guided surgery in gynaecology, preoperative imaging as surgical roadmap, and intraoperative devices.

Results: The most common clinical application in gynaecology is sentinel node biopsy (SNB). Other promising approaches are receptor-target modalities and occult lesion localisation. Preoperative SPECT/CT and PET/CT permit a roadmap for adequate surgical planning. Intraoperative detection modalities span from 1D probes to 2D portable cameras and 3D freehand imaging.

Conclusion: After successful application of radio-guided SNB and SPECT, innovation is leaning towards hybrid modalities, such as hybrid tracer and fusion of imaging approaches including SPECT/CT and PET/CT. Robotic surgery, as well as augmented reality and virtual reality techniques, is leading to application of these innovative technologies to the clinical setting, guiding surgeons towards a precise, personalised, and minimally invasive approach.

Keywords: Gynaecological cancers; Hybrid tracer; Image-guided surgery; Robotic surgery; Sentinel node biopsy.

Publication types

  • Review

MeSH terms

  • Female
  • Genital Neoplasms, Female* / diagnostic imaging
  • Genital Neoplasms, Female* / surgery
  • Humans
  • Molecular Imaging* / methods
  • Surgery, Computer-Assisted* / methods