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Purpose <p>The introduction of the drop-in gamma probe has advanced intraoperative molecular imaging during prostate cancer surgery. We have been able to convert the sensor’s numeric readout to tomographic images, so-called robotic-SPECT (<sub>Robo</sub>SPECT) and investigate how this is impacted by radiopharmaceutical avidities and drop-in scan metrics.</p> Methods <p>The gamma sensor readout was registered with its 3D position and orientation, allowing a custom reconstruction algorithm to generate <sub>Robo</sub>SPECT images. Evaluations occurred in 21 patients; 10 sentinel node procedures (SN; primary prostate cancer) and 11 PSMA-radioguided surgery (recurrent prostate cancer). <sub>Robo</sub>SPECT findings were related to respective pre- and intra-operative controls, including preoperative PSMA-PET/CT and/or SPECT/CT images and fluorescence detection (SN only).</p> Results <p><sub>Robo</sub>SPECT proved to be safe and applicable in a range of conditions. In the SN-group, 26 SN-SPECT/CT lesions were successfully identified with SN-<sub>Robo</sub>SPECT (100%); 3 were tumor positive (sensitivity 100%). Only 73% of SNs were surgically visible with fluorescence imaging. For the PSMA guided group, the 14 lesions identified on PSMA-PET/CT were all visualized with PSMA-<sub>Robo</sub>SPECT (100%); 18 specimens were tumor positive (sensitivity 78% for both PSMA-PET/CT and PSMA-<sub>Robo</sub>SPECT). Preoperative PSMA-SPECT/CT only identified 4 PSMA-lesions (29%). No false positives were seen for <sub>robo</sub>SPECT and all final resection margins were clean. At 6-months 0% of the SN-patients and 20% of PSMA-patients showed biochemical recurrence.</p> Conclusion <p><sub>Robo</sub>SPECT provides 3D context that extends the utility of drop-in gamma tracing and assists the alignment between pre- and intra-operative target perception. Here SN-<sub>Robo</sub>SPECT clearly outperformed fluorescence SN imaging and PSMA-<sub>Robo</sub>SPECT outperformed preoperative PSMA-SPECT/CT imaging.</p>

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Redefining robotic image-guidance – tomographic visualization of lesions during prostate cancer surgery via gantry-free robotic SPECT

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月1日

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  • A. C. Berrens,
  • K. Pirkovets,
  • S. Azargoshasb,
  • L. J. Slof,
  • B. A. Cakal,
  • P. J. van Leeuwen,
  • E. M. K. Wit,
  • M. Sinaasappel,
  • T. Wendler,
  • H. G. van der Poel,
  • M. N. van Oosterom,
  • F. W. B. van Leeuwen

摘要

Purpose

The introduction of the drop-in gamma probe has advanced intraoperative molecular imaging during prostate cancer surgery. We have been able to convert the sensor’s numeric readout to tomographic images, so-called robotic-SPECT (RoboSPECT) and investigate how this is impacted by radiopharmaceutical avidities and drop-in scan metrics.

Methods

The gamma sensor readout was registered with its 3D position and orientation, allowing a custom reconstruction algorithm to generate RoboSPECT images. Evaluations occurred in 21 patients; 10 sentinel node procedures (SN; primary prostate cancer) and 11 PSMA-radioguided surgery (recurrent prostate cancer). RoboSPECT findings were related to respective pre- and intra-operative controls, including preoperative PSMA-PET/CT and/or SPECT/CT images and fluorescence detection (SN only).

Results

RoboSPECT proved to be safe and applicable in a range of conditions. In the SN-group, 26 SN-SPECT/CT lesions were successfully identified with SN-RoboSPECT (100%); 3 were tumor positive (sensitivity 100%). Only 73% of SNs were surgically visible with fluorescence imaging. For the PSMA guided group, the 14 lesions identified on PSMA-PET/CT were all visualized with PSMA-RoboSPECT (100%); 18 specimens were tumor positive (sensitivity 78% for both PSMA-PET/CT and PSMA-RoboSPECT). Preoperative PSMA-SPECT/CT only identified 4 PSMA-lesions (29%). No false positives were seen for roboSPECT and all final resection margins were clean. At 6-months 0% of the SN-patients and 20% of PSMA-patients showed biochemical recurrence.

Conclusion

RoboSPECT provides 3D context that extends the utility of drop-in gamma tracing and assists the alignment between pre- and intra-operative target perception. Here SN-RoboSPECT clearly outperformed fluorescence SN imaging and PSMA-RoboSPECT outperformed preoperative PSMA-SPECT/CT imaging.