array:24 [ "pii" => "S2253808922000179" "issn" => "22538089" "doi" => "10.1016/j.remnie.2021.12.006" "estado" => "S300" "fechaPublicacion" => "2022-05-01" "aid" => "1365" "copyright" => "Sociedad Española de Medicina Nuclear e Imagen Molecular" "copyrightAnyo" => "2022" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Med Nucl Imagen Mol. 2022;41:179-87" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S2253654X2200004X" "issn" => "2253654X" "doi" => "10.1016/j.remn.2021.12.008" "estado" => "S300" "fechaPublicacion" => "2022-05-01" "aid" => "1365" "copyright" => "Sociedad Española de Medicina Nuclear e Imagen Molecular" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Med Nucl Imagen Mol. 2022;41:179-87" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Colaboración especial</span>" "titulo" => "Aportación de la medicina nuclear intervencionista a la cirugía de precisión molecularmente dirigida" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "179" "paginaFinal" => "187" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Interventional nuclear medicine's contribution to molecularly targeted precision surgery" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 543 "Ancho" => 1300 "Tamanyo" => 70834 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Plataforma giratoria ajustable, que permite el acceso multicuadrante sin reposicionar la base del carro quirúrgico. <span class="elsevierStyleItalic">Cortesía de Abex Excelencia Robótica, S. 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[<span class="elsevierStyleSup">18</span>F]FDG PET/CT (d, axial; e, coronal; f, sagittal views; g, MIP) revealed a round paraortic mass in relation to the morphological findings of the CT scan with intense peripheral radiotracer uptake (SUVmax: 11,9) and large ametabolic central area compatible with necrosis. A 8 cm linear lesion filling the azygos vein lumen (SUVmax: 13,4) suggestive of a tumor thrombus (e,f, white arrowhead). Hypermetabolic lesion in the right adrenal gland with SUVmax of 13 (e,g, white arrow). Fine-needle-biopsy containing malignant spindle-shaped cells (h, hematoxylin-eosin-stainning ×300, i,Papanicolau-staining ×600) and strong staining for Vimentin (j) compatible with a SCS of the azygos vein.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. León-Asuero-Moreno, P. Fernández-Rodríguez, J.M. Masero Carretero, Y. Herrera Martínez, J.M. Jiménez-Hoyuela García, I. Acevedo Báñez" "autores" => array:6 [ 0 => array:2 [ "nombre" => "I." 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"apellidos" => "Acevedo Báñez" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808921000550?idApp=UINPBA00004N" "url" => "/22538089/0000004100000003/v1_202205140730/S2253808921000550/v1_202205140730/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2253808921001087" "issn" => "22538089" "doi" => "10.1016/j.remnie.2021.05.007" "estado" => "S300" "fechaPublicacion" => "2022-05-01" "aid" => "1298" "copyright" => "Sociedad Española de Medicina Nuclear e Imagen Molecular" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Med Nucl Imagen Mol. 2022;41:171-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "titulo" => "Predictive value of <span class="elsevierStyleSup">18</span>F-FDG PET/CT indices on extensive residual cancer burden in breast cancer patients treated with neoadjuvant chemotherapy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "171" "paginaFinal" => "178" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Valor predictivo de los índices 18F-FDG PET/CT sobre la carga tumoral residual en en pacientes con cáncer de mama extenso tratadas con quimioterapia neoadyuvante" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1502 "Ancho" => 3333 "Tamanyo" => 369591 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Maximum intensity projection and axial PET/CT images at baseline (A) and after chemotherapy (B) in a 51-year-old woman with invasive ductal carcinoma of the left breast. The reduction rate of SUVmax, TLG, and MTV noticed after chemotherapy was 100% (primary lesion and metastatic lymph nodes are indistinguishable from the surrounding glandular tissue). After surgery, the patient was classified as RCB-0 according to the RCB classification.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Tuğba Başoğlu, Salih Özgüven, Hülya Şahin Özkan, Merve Çınar, Osman Köstek, Nazım Can Demircan, Rukiye Arıkan, Tuğba Akın Telli, Özlem Ercelep, Handan Kaya, Tunç Öneş, Tanju Yusuf Erdil, Mustafa Ümit Uğurlu, Faysal Dane, Perran Fulden Yumuk" "autores" => array:15 [ 0 => array:2 [ "nombre" => "Tuğba" "apellidos" => "Başoğlu" ] 1 => array:2 [ "nombre" => "Salih" "apellidos" => "Özgüven" ] 2 => array:2 [ "nombre" => "Hülya Şahin" "apellidos" => "Özkan" ] 3 => array:2 [ "nombre" => "Merve" "apellidos" => "Çınar" ] 4 => array:2 [ "nombre" => "Osman" "apellidos" => "Köstek" ] 5 => array:2 [ "nombre" => "Nazım Can" "apellidos" => "Demircan" ] 6 => array:2 [ "nombre" => "Rukiye" "apellidos" => "Arıkan" ] 7 => array:2 [ "nombre" => "Tuğba Akın" "apellidos" => "Telli" ] 8 => array:2 [ "nombre" => "Özlem" "apellidos" => "Ercelep" ] 9 => array:2 [ "nombre" => "Handan" "apellidos" => "Kaya" ] 10 => array:2 [ "nombre" => "Tunç" "apellidos" => "Öneş" ] 11 => array:2 [ "nombre" => "Tanju Yusuf" "apellidos" => "Erdil" ] 12 => array:2 [ "nombre" => "Mustafa Ümit" "apellidos" => "Uğurlu" ] 13 => array:2 [ "nombre" => "Faysal" "apellidos" => "Dane" ] 14 => array:2 [ "nombre" => "Perran Fulden" "apellidos" => "Yumuk" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2253654X21000962" "doi" => "10.1016/j.remn.2021.04.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X21000962?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808921001087?idApp=UINPBA00004N" "url" => "/22538089/0000004100000003/v1_202205140730/S2253808921001087/v1_202205140730/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Special collaboration</span>" "titulo" => "Interventional nuclear medicine's contribution to molecularly targeted precision surgery" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "179" "paginaFinal" => "187" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "R. Valdés Olmos, S. Vidal-Sicart, S. Fuertes Cabero, E. Goñi Gironés, P. Paredes" "autores" => array:5 [ 0 => array:3 [ "nombre" => "R." "apellidos" => "Valdés Olmos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "S." "apellidos" => "Vidal-Sicart" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "S." "apellidos" => "Fuertes Cabero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 3 => array:3 [ "nombre" => "E." "apellidos" => "Goñi Gironés" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 4 => array:4 [ "nombre" => "P." "apellidos" => "Paredes" "email" => array:1 [ 0 => "pparedes@clinic.cat" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:6 [ 0 => array:3 [ "entidad" => "Interventional Molecular Imaging Laboratory and Nuclear Medicine Section, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Nuclear, Hospital Clínic, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Nuclear, Imatge Mèdica Intercentres S. L. (IMI), Parc de Salut Mar, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Medicina Nuclear, Hospital Vall d’Hebron, Barcelona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Medicina Nuclear, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Facultad de Medicina, Universitat de Barcelona (UB), Barcelona, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Aportación de la medicina nuclear intervencionista a la cirugía de precisión molecularmente dirigida" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1429 "Ancho" => 2508 "Tamanyo" => 290773 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Possible future scenarios that illustrate the application of both the preoperative image and surgery in the operating room based on the administration of systemic hybrid radiotracers combining radioactivity with fluorescence for the detection and resection of oligometastasis (circles).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">In the last years the concept of interventional nuclear medicine has been introduced encompassing new approaches such a tailored radioguided surgery, robotic surgery, and the integration of hybrid elements. This has led to not only the use of already available imaging equipment in nuclear medicine departments but also the development of new technologies and radiotracers which have refined molecularly targeted precision surgery.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Tailored radioguided surgery</span><p id="par0010" class="elsevierStylePara elsevierViewall">Nuclear medicine is not only limited to pre- and post-operative tests and applications but it is also commonly used in determined surgical areas. The value of additional information in real time during a surgical intervention that is feasible with the use of detector probes and portable gamma cameras (PGC) is clear. This has led to notable changes in conventional procedures, especially in breast cancer, melanoma, and parathyroid disease.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Contrary to what we know as interventional radiology (based on morphological and anatomical characteristics), interventional nuclear medicine is based on biological and physiopathological features. The use of radiotracers allows obtaining molecular characteristics in the human body. This capacity to visualize radiotracer uptake, whether local, regional, or distant, facilitates different procedures such as molecularly targeted biopsy or therapy directed by the local deposit of the radioisotope (for example, radioembolization). In addition, radioguided surgery is a discipline that has notably increased in the last decades and allows selective resection of tissues previous marked with a radiotracer. While being about to celebrate the 30th anniversary of the introduction of selective SLNB in melanoma and breast cancer, an increase in the use of this procedure in the staging of other types of cancer has been observed over time. Likewise, the increase in image-guided applications has potentiated the field of radioguided surgery by the development of new radiotracers as well as the opportunity of localizing deep lesions or those with complex lymphatic drainage (in the oral cavity, gynecological, urological, the digestive tract, etc.)<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Taking breast cancer as an example, the evolution of the surgical treatment of this disease has prompted the search for minimally invasive surgery (from Halsted mastectomy to selective tumorectomy). In the field of axillary staging, over the last 30 years we have gone from axillary lymph node dissection to selective SLNB. Thus, since the first validation studies in the 90 s up to the incorporation of immunohistochemistry techniques, the one-step nucleic acid amplification, the abandonment of lymph node dissection in patients with lymph nodes with micrometastasis or isolated tumor cells and with the appearance of the results of pivotal studies such as ACOSOG Z0011<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> or EORTC AMAROS<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>, the techniques for localizing the sentinel lymph node (SLN) have become one of the cornerstones of patient-tailored surgical treatment<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The basic tool for the localization of the SLN has been lymphoscintigraphy (with the intraoperative use of detector probes and/or vital stains). Its implementation has constituted the possibility of providing surgeons with a reproducible technique that delimits the “roadmap” to follow, the lymphatic areas at risk and the situation and number of SLNs in each area. With the evaluation of sequential images, it also allows determining the patients with lymph nodes which are clearly SLN, those which are very likely SLNs or those considered as secondary lymph nodes. In the specific case of melanoma, lymphoscintigraphy can localize aberrant lymph nodes or the so-called “in transit” nodes which are observed in up to 10% of the patients and present the potential of harboring clinically occult metastasis similar to the SLNs in the usual lymph node regions (axillae and groin)<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a>.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The technique has been perfected over the last decades and numerous guidelines on not only the methodological but also technical and clinical aspects have been developed for correct performance of lymphoscintigraphy and, thus, of selective SLNB in different clinical scenarios. The great experience acquired with the SLN has constituted one of the main pillars for the expansion of radioguided surgery to other areas in which it is necessary to inject a radiotracer, whether locally or systemically. The addition of new allies (fluorescence, ultrasonography) has reinforced the use of radioguided surgery towards bimodal or hybrid detection. In this sense, the technological advances which are basic for precision molecularly targeted surgery have been based on the increasing relationships between the different tools available for nuclear medicine and oncological surgery. Hybrid imaging (single photon emission computed tomography/computerized tomography [SPECT/CT], positron emission tomography [PET]/CT), bimodal tracers, virtual navigation, and robotic surgery are included in these interactions<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">To link all the possibilities, the term guided intraoperative scintigraphic tumor targeting (GOSTT) was coined, which includes not only preoperative imaging but also intraoperative detection and localization<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>. This term encompasses all the aspects of nuclear medicine required to guide surgical and interventionist procedures using the SLN as the reference.</p><p id="par0040" class="elsevierStylePara elsevierViewall">One aspect that is common to the techniques encompassed in the GOSTT is the administration of a radiotracer to show the desired lesion or tissue (for example, the lymph nodes). Among these possibilities, the SSLNB procedures are based on local administration of a radiocolloid in the tumoral lesion or in its proximity allowing localization of the drainage SLN with the use of planar lymphoscintigraphy and, often, SPECT/CT.</p><p id="par0045" class="elsevierStylePara elsevierViewall">A second option is radioguided resection of the tumor or metastasis by intralesional administration of the radiotracer following the radioguided occult lesion localization (ROLL) technique. An alternative that has gained strength in the last years is the use of <span class="elsevierStyleSup">125</span>I (radioguided seed localization). The third approach, basically in breast cancer, is the combination of selective SLNB with radioguided resection of the lesion, known as sentinel node and occult lesion localization (SNOLL). Finally, there are the techniques that require the systemic administration of the radiotracer to selectively accumulate in the target lesions, thereby facilitating their visualization by SPECT/CT or PET/CT and their posterior resection by radioguided surgery<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a>.</p><p id="par0050" class="elsevierStylePara elsevierViewall">With all these approaches, specialists in nuclear medicine provide reliable and personalized information of each patient, based on the preoperative study which allows the identification of target tissues and their number. The surgical approaches are focused and adapt to the needs of the patient. This personalization is necessary since precision surgery in one of the primordial trends of current medicine. Guidance by molecular imaging is probably one of the most critical aspects in precision surgery<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Intraoperative molecular imaging facilitates the localization and confirmation of the structures to resect that have been previously identified with the roadmap based on the uptake of the radiotracer and their refinement with the tridimensional images provided by SPECT/CT and/or PET/CT. Intraoperative imaging is a great asset to add to the capacity of the surgeon to evaluate the tissue to resect. Open surgical procedures provide the opportunity to palpate tissues allowing the tactile sensation to complement visual inspection of the surgical field as well as the guidance offered by the detector probe. This sensitivity is altered in laparoscopic procedures and should be based on guidance provided by the pre- or post-operative images and the detector probe in these minimally invasive interventions<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Within this personalized medicine, clinical situations considered as contraindications for a technique are now considered as optional or even indicated. One example is breast cancer in which the detection of previously positive lymph nodes which are clinically negative following neoadjuvant chemotherapy. This possibility is now considered in the clinical guidelines based on the results of multicenter studies (SENTINA<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>, ACOSOG Z1071<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>, SN FNAC<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>, GANEA 2<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>) which demonstrated that the use of SSLNB is recommended in combination with staining and the resection of at least 3 lymph nodes to reduce the rate of false negatives in this situation. This challenge for nuclear medicine has led to diverse strategies for personalizing the most adequate therapy. Among these, the use of PET/CT as an indicator of axillary infiltration and its combination with GOSTT techniques (SLN and radioguided seed localization) has produced evidence to avoid unnecessary lymph node dissections (by up to 82%) and in their place apply radiotherapy in selected groups of patients, constituting a “tailored” treatment after neoadjuvant therapy<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>.</p><p id="par0065" class="elsevierStylePara elsevierViewall">In this sense, the strategies to mark previously infiltrated lymph nodes have led to numerous types of markers (hook-wires, radioactive seeds, radiofrequency markers, magnetic seeds, among others), each of which has advantages and disadvantages. In the setting of nuclear medicine, the use of radioactive seeds for this end was initiated with the marking the axilla with radioactive iodine seeds procedure, and this has been combined with post-neoadjuvant therapy SSLNB in the procedure known as targeted axillary dissection. These strategies have reduced the rate of false negative results in this group of patients by up to 2%<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>.</p><p id="par0070" class="elsevierStylePara elsevierViewall">This opening up of indications for GOSTT techniques considering the new clinical requirements has allowed expanding the options of marking target tissues to the different clinical, basically oncological, committees. For example, review of the publications in the last 2 years showed an increase in the references to radioactive seeds in different settings (breast, lymph nodes, lung, thyroid, metastasis, etc.) as well as ROLL procedures in similar scenarios. In this last section, the inclusion of this option in minimally invasive radioguided parathyroidectomy is of note, having classically been directed by the uptake of [<span class="elsevierStyleSup">99m</span>]Tc-MIBI in the parathyroid gland. The latest advances in this field have allowed even more personalized surgery with the use of PET radiotracers (<span class="elsevierStyleSup">18</span>F-choline), which increase the sensitivity in preoperative diagnosis, especially in cases with doubtful or even negative methoxyisobutylisonitrile (MIBI). On the other hand, the possibility of performing ROLL in selected cases provides an even more “tailored” surgery<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>.</p><p id="par0075" class="elsevierStylePara elsevierViewall">This personalization of the procedure also bolsters the possibility of more selective radiotracers, combinations with other radiotracers (optical, magnetic, etc.) and with strategies based on preoperative findings with PET/CT or PET/magnetic resonance (MR) and implementing similar radiotracers with gamma emission for more defined intraoperative detection. Some examples include the development of <span class="elsevierStyleSup">99m</span>Tc-tilmanocept in melanoma, breast cancer and especially in the oral cavity in which its particular properties of rapid clearance at the injection site and binding to macrophagic receptors show greater retention of the radiotracer in the SLN and more selective visualization<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The combination with optical radiotracers (basically fluorescent), such as indocyanine green (ICG), has notably increased since the first steps a decade ago. The inherent advantages of their combination (whether separately, but especially in hybrid compounds such as ICG-[<span class="elsevierStyleSup">99m</span>]Tc-albumin nanocolloid) allow linking “gross” detection of the radioactive signal with “precise” localization of the optical image (once the surrounding tissue has been dissected). This constitutes another step in precision medicine by obtaining the “best of both worlds” in one compound<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Finally, and as an introduction to robotic surgery, the current possibilities of presurgical studies with PET radiotracers with an elevated sensitivity for the detection of metastasis, propose the challenge of taking this precision to the surgical field. One example is the introduction of rescue surgery with <span class="elsevierStyleSup">99m</span>Tc- prostate-specific membrane antigen (PSMA), which combines a chemical innovation with previously validated concepts with the SLN. This opens different possibilities for interventional nuclear medicine in prostate cancer. Based on PET/CT studies with tracers bound to PSMA, patients with a negative result for lymph node infiltration can benefit from the SLN procedure. Patients with a positive PET/CT study can undergo rescue surgery with the [<span class="elsevierStyleSup">99m</span>]Tc-PSMA SPECT/CT study and posterior intraoperative detection. The new possibilities with DROP-IN probes widen the potential of detection and maneuverability within the surgical field both in the laparoscopic and the robotic surgery setting<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>.</p><p id="par0090" class="elsevierStylePara elsevierViewall">In summary, the methodology most used for interventional molecular imaging is based on radiotracers in which lymphoscintigraphy (± SPECT/CT) is the cornerstone for obtaining an adequate presurgical lymph node roadmap. There are new radiotracers for achieving more selected and accurate marking of the SLN and systemic radiotracers for interventionist images are being developed (i.e., <span class="elsevierStyleSup">68</span>Ga or <span class="elsevierStyleSup">99m</span>Tc-PSMA). On the other hand, the new clinical necessities offer the opportunity for new approaches combining different radiotracers, technologies, and methodologies (for example, ROLL/radioguided seed localization for the resection of recurrence, lymph node metastasis or isolated subclinical metastases). All of this, together with hybrid detection procedures assisted by robot with radioguided navigation and fluorescence, constitute the platform through which nuclear medicine can offer “patient tailored radioguided surgery”.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Robot-assisted laparoscopic surgery</span><p id="par0095" class="elsevierStylePara elsevierViewall">The first system of robotic surgery called Da Vinci was launched in 1999 by Intuitive Surgical Inc. and was approved by the FDA for surgical use in 2000<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>. The characteristics and functions of the Da Vinci robot were described in-depth in a previously published study<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>. The Da Vinci system is a slave robot, that is, it has no capacity of autonomous movement and is absolutely dependent on the judgment, knowledge, and ability of the physician. The Da Vinci system evolved rapidly with the introduction of a fourth arm, double console, and, most importantly, multiquadrant access which allows access to multiple quadrants without the need to move the patient, with the consequent reduction in surgical time (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Da Vinci has an adjustable rotating platform and a head able to rotate 171°, allowing access to the 4 quadrants without repositioning the base of the surgical cart which provides more flexible configuration of the operating room. With the introduction of robotic surgery, the concept of classical surgery in which the surgeon is in close contact with the patient changed to being far from the patient and without physical or visual contact. However, the 3D vision of the console provides a wide field of view with real perception of depth. With robotic surgery, tactile information has been replaced by safety tools incorporated in the console which verify the position of the surgical instruments that are being used, blocking the arms against brusque movements, and an infrared system deactivates the robotic arms when the surgeon withdraws their eyes from the binocular system. The latest systems have incorporated the detection of fluorescence which allows radioguided surgery with ICG or hybrid radiotracers controlled from the same console.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">The Da Vinci system is made of the following elements (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>): 1) console of the principal surgeon (control center): situated a few feet away from the operating table and at which the principal surgeon performs hand movements in 3 dimensions that are carried out identically by the arms of the robot; 2) patient side cart (operative component) made up of 4 universal arms, one of which contains the manipulator for the camera and the other 3 reproduce the movements of the hands of the surgeon (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A-<span class="elsevierStyleSmallCaps">C</span>), and 3) the vision cart (processing center): integration of external devices, high definition tactile screen and video processer and the Firefly® system of visualization of fluorescence. In addition, surgical instruments have been incorporated with a small system of mechanical articulation called EndoWrist®, which can have any surgical instrument as a final effector.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Surgical indications for robotic surgery approaches</span><p id="par0105" class="elsevierStylePara elsevierViewall">All these technical improvements have provided an exponential increase in the surgical indications that can be performed by robotic surgery similar to any surgery that can be carried out endoscopically. One of the principal and most extended indications in our country is gynecological surgery. In 2015, 76% of robotic surgeries were oncological hysterectomies. However, the indications have expanded to other areas such as urology general surgery (especially colorectal), otorhinolaryngology or pediatric, cardiac, and thoracic surgery (lobectomies and thymectomies). Nonetheless, the greatest advantages of robotic surgery over laparoscopic surgery are observed in radical hysterectomy with nerve preservation, paraaortic lymph node dissection in any gynecologic cancer and hysterectomy + double annexectomy ± pelvic lymph node dissection in obese women.</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Benefits and limitations of robotic surgery in gynecologic surgery</span><p id="par0110" class="elsevierStylePara elsevierViewall">Among the advantages of robotic surgery compared to open or laparoscopic surgery, of note are the excellent anatomic and tissular visualization due to the tridimensional vision and the facility to access complicated anatomical territories, leading to greater oncologic radicality enabling the performance of manipulations which up to now were impossible <a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>. With the introduction of fluorescence, greater resection in the number of lymph nodes has been described<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> during pelvic and paraaortic dissection. The elimination of tremor carries greater surgical precision which reduces hematic losses<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24,26</span></a>, enables greater reconstructive precision and, thus, reduces postoperative complications with rapid postoperative recovery<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24,25</span></a>. All these advantages produce a lower rate of reintervention.</p><p id="par0115" class="elsevierStylePara elsevierViewall">While robotic surgery is being increasingly implemented there are some limitations such as the need for additional surgical training, an increase in the cost of surgery and the limitations of instrumentation, although specific material has been developed in the last years.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Future</span><p id="par0120" class="elsevierStylePara elsevierViewall">Within the evolution of robotic surgery new models are being developed such as the Da Vinci Single Port (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>D), which has a single 2.5 cm port with the 3 side-by-side surgical instruments and the endoscopic camera which achieves up to 24 cm of depth and which can triangulate the instruments in the distal part. This configuration allows access to any anatomical localization within 360º from the location of the port.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Role of the nuclear medicine physician in robotic surgery</span><p id="par0125" class="elsevierStylePara elsevierViewall">All the technological advances described and the participation of a nuclear medicine physician guide the management of the patients towards molecularly targeted precision surgery. Specifically, nuclear medicine has a relevant role in robotic surgery of cancer of the cervix and endometrium and in the resection of pulmonary nodules since there is greater experience and more extensive application in these fields in our health care setting.</p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">SSLNB in cervical cancer</span><p id="par0130" class="elsevierStylePara elsevierViewall">Intraoperative evaluation of the SLN provides early information on lymph node status. This information is essential in the decision making process related to first line therapy. In the oncological guidelines it is well established in which stages SSLNB is indicated<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>. In the last decades there has been a tendency to performing minimally invasive surgery whether by laparoscopy or robotic surgery. Nonetheless, in the New England Journal of Medicine, in 2018, Ramirez et al.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> published the results of a phase III multicenter study designed with the hypothesis that minimally invasive radical hysterectomy was not inferior to open radical hysterectomy in the management of patients with early stage cervical cancer. Patients were randomly assigned. Patients were recruited in 33 centers (n = 631) from 2008 to 2017. Patients diagnosed with cervical cancer stage IA1, IA2 or IB1 and with a squamocellular, adenocarcinoma or adenosquamous histological type were included. It was concluded that on comparing open radical hysterectomy with minimally invasive radical hysterectomy for the management of this group of patients, the former procedure was associated with a lower rate of disease-free survival and overall survival. In 2020, this same group published a meta-analysis<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> in which they analyzed 15 studies including 9,499 patients with cervical cancer in early stages, and obtained the same conclusions as in the previous study. These results led to minimally invasive surgery including surgery by the vaginal route being included in the publication of the Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations-2019 update<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>, with a high grade of evidence, passing from a low grade of recommendation in 2016 to high grade in 2019 due to both the morbidity and the recovery of the patients. The reason was the reduction in postoperative complications<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24,25</span></a> and the more rapid return to normal, social, and work activity<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>. Nonetheless, these results have been confirmed in patients undergoing surgery for endometrial cancer<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> but not in those with early stage cervical cancer<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>. Therefore, at present, minimally invasive surgery is contraindicated in patients with early stage cervical cancer. This has led to the launching of multicenter studies to analyze if these results are confirmed. The Hospital Clinic of Barcelona has large experience in this type of patients and has recently published a study<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> including 115 patients with early stage cervical cancer (IA1 with lymphovascular invasion, IA2, IB1 and IIA < 2 cm; International Federation of Gynecology and Obstetrics, 2008), achieving a disease-free period of 96.7 and 93.5% at 3 and 4.5 years, respectively and a survival of 97.8 and 94.8%, respectively. In conclusion, laparoscopic surgery provides excellent results in a disease-free period and survival in patients with early stage cervical cancer and minimally invasive surgery can be considered adequate as an alternative to open surgery in radical hysterectomy. Nonetheless, we must wait for the results of new studies to safely offer laparoscopic or robotic surgery to this type of patients, and thereby take advantage of the benefits of less aggressive surgery with the performance of selective SLNB, which is indicated in this group of patients.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Selective SLNB in endometrial cancer</span><p id="par0135" class="elsevierStylePara elsevierViewall">At the end of 2020 the new ESGO/ESTRO/ESP<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> guidelines for the management of patients with endometrial cancer were published, which included the indication of selective SLNB in this group of patients. As in the last guideline for the management of patients with cervical cancer, the European Association of Nuclear Medicine (EANM) did not participate in this guideline of multidisciplinary consensus. SSLNB is accepted as an alternative to lymph node dissection, with a negative SLN being accepted to confirm N0. The accepted recommendations for performing SSLNB are: patients with low intermediate risk and it can be omitted in cases without myometrial invasion. Systematic lymph node dissection is not recommended in this group of patients (Grade of recommendation A). This procedure should be performed in patients with intermediate-high and high risk. It is accepted as an alternative to lymph node dissection in stages I/III (Grade of recommendation B). In relation to how SSLNB should be performed (Grade of recommendation A), it should preferentially be carried out by injection of ICG in the cervix. The reinjection of the radiotracer is an option if the SLN is not detected. Lymph node dissection should be performed in patients with intermediate-high and high risk if the SLN is not detected in any pelvic region. Pathological ultrastaging is recommended in the SLNs. Thus, the performance of SSLNB with a radiotracer is not included in these guidelines. Nonetheless, we should defend the importance of performing SSLNB with the administration of a radiotracer with allows performing lymphoscintigraphy, and thus, obtaining a presurgical image that is important for guiding surgery. In addition, at present most of the centers have SPECT/CT which provides highly accurate localization. Likewise, unexpected (for example, towards presacral, common iliac or lumboaortic stations) or occult drainages or lymph nodes difficult to approach (interiliac, retrovascular) may remain undetected even by the most meticulous pelvic dissections but may be easily detected with the SPECT/CT of lymphoscintigraphy and the gamma detector probe. This would explain why some groups report a higher sensitivity for predicting lymph node infiltration with SSLNB than with compete lymph node dissection.</p><p id="par0140" class="elsevierStylePara elsevierViewall">In this context, nuclear medicine should adapt to the new times in which ICG plays an important role in robotic and laparoscopic surgery. That is why the availability of a hybrid tracer in the near future is important. As Vidal-Sicart et al.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> predicted, it could be the radiotracer of the future for performing lymph node mapping since it combines the advantages of both radiotracers: the radiotracer for lymph node mapping by providing a presurgical image, and ICG, which reduces the shine-through effect of the radiotracer and, thus, helps to identify SLNs near the injection point and allows visual feedback regarding the exact localization of the SLN to the surgeon. In addition, the updating of the gamma detector probes with hybrid equipment which allows the detection of gamma radiation and fluorescence, wireless probes and flexible laparoscopic probes specific for robotic surgery (DROP-IN photo) with a small sized detector, or lastly, the PGC such as freehand SPECT, which calculate the depth of the target lesion, elevate nuclear medicine to the highest level comparable to the technological revolution of robotic surgery.</p><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">ROLL technique in robotic surgery</span><p id="par0145" class="elsevierStylePara elsevierViewall">In relation to molecularly targeted surgery, it is increasingly more frequent to detect lesions only visualized by PET/CT, opening a new indication for radioguided surgery, that of oncological patients with potentially resectable tumoral recurrence detected by PET/CT and, thus, candidates to radical surgery. In these cases, radioguided surgery can be performed by administering molecules specific for PET. Although there are some disadvantages such as the large size of the probe used that does not allow performing robotic surgery, the difficulty of coordinating with the surgery time and the low lesion/background activity ratio, it may be of interest when the number or the localization of the lesions is not accessible for performing intralesional injection guided by ultrasonography or CT (ROLL). To avoid the inconveniences of PET-guided surgery, performance of the ROLL technique would be ideal whenever possible since it allows radioguided surgical localization by minimally invasive surgery in non-palpable or visible lesions, reduces the surgical time and avoids reinterventions, performing a “targeted curative treatment”. ROLL in pulmonary nodules is one of the most extended indications. Radiolocalization is combined with minimally invasive robotic surgery while the surgeon sees the surgical field in 3D with high definition on the console, and thanks to the gamma detector probe knows the localization of the lesion and performs the resection by minimally invasive surgery. In the case of a malignant lesion, oncological surgery can continue, taking advantage of the benefits of minimally invasive robotic surgery.</p></span></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Integration of hybrid concepts in radioguided surgery</span><p id="par0150" class="elsevierStylePara elsevierViewall">In reference to hybrid concepts in radioguided surgery means discussing the balance of the methodology of the SLN procedure in melanoma by Morton et al. in 1999, which concluded that the so-called triple hybrid approach (lymphoscintigraphy, gamma probe and vital staining) ensured 99% of SLN detection<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a>. Since then, this triple approach has taken methodological precedence in the original applications of the SLN (breast cancer, melanoma) and according to a meta-analysis of the period 1992-2012, achieved 96% of SLN identification with a false negative rate of around 2%<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a>.</p><p id="par0155" class="elsevierStylePara elsevierViewall">Shortly after the introduction of technological advances such as SPECT/CT and PGC around the middle of the first decade of this century, the first hybrid radiotracer specific for SLN surgery was developed aggregating ICG to [<span class="elsevierStyleSup">99m</span>]Tc-nanocolloid, thereby making bimodal detection of fluorescence and radioactivity possible for the resection of the SLN in the operating room. The high reproducibility compared with the mother compound ([<span class="elsevierStyleSup">99m</span>]Tc-nanocolloid) extended the field of applications of ICG-[<span class="elsevierStyleSup">99m</span>]Tc-nanocolloid to SLN procedures in zones of complex drainage such as the head/neck, pelvis, and determined zones of the trunk. The synergy of the hybrid radiotracer with SPECT/CT and PGC<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> made it possible to methodologically validate it and demonstrate its added value in different cancers<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>. At the same time, its configuration has served as a model of application for the development of other hybrid radiotracers, including the most recent of systemic administration.</p><p id="par0160" class="elsevierStylePara elsevierViewall">In the configuration of a work protocol using hybrid radiotracers, the preoperative image is based on the radioactive component of the radiotracer. For SLN surgery this image currently involves the combination of lymphoscintigraphy with SPECT/CT and the protocols of image acquisition are similar to those used when exclusively radiocolloids are used. As mentioned previously, the contribution of the fluorescent component is reserved for the operating room and its synergy with radiodetection allows combining what is called “the best of two worlds” in the practice of SLN resection. Together with the preoperative image and the possibilities of quantification, the radioactive component of the hybrid radiotracer contributes with a high sensitivity and high penetration in the tissues which allows detecting deep SLN. The fluorescence component has high spatial resolution, real time signal visualization and the possibility of correlating the findings of the image with the pathological analysis of the specimen. In the study of KleinJan et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> which evaluated its application in 495 patients with different malignant tumors, it was concluded that ICG-[<span class="elsevierStyleSup">99m</span>]Tc-nanocolloid optimizes the intraoperative procedure based on 4 important aspects: a) bimodel identification is highly sensitive and concerns the same SLN, which was corroborated in the study mentioned (> 98% radioactive and > 95% fluorescent); b) in contrast to the unimodal use of fluorescence or blue dye, the identification of the SLN by the hybrid radiotracer does not influence operative logistics in relation to the intervals between injection and detection (prolonged diagnostic window); c) the hybrid radiotracer allows excision of the SLN without performing a previous resection of the primary tumor as in the usual practice when using only radiocolloids and the SLN is located near the primary lesion, and d) the margins of primary tumor resection can be determined without impediments in contrast to what usually occurs when using only blue dye.</p><p id="par0165" class="elsevierStylePara elsevierViewall">Another lesson gained by the use of the hybrid radiotracer ICG-[<span class="elsevierStyleSup">99m</span>]Tc-nanocolloid in SLN surgery is that the experience of its marking shows that the hybrid concept supports the use of lesser quantities of the fluorophore agent (which if used alone in these concentrations would underestimate the number of lesions); in practice, the fluorophore is directed by the radiotracer. The high specific activity of the latter allows its use on the basis of a molecular peak in contrast to the fluorophore agents which are used in a micromolecular range<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a>.</p><p id="par0170" class="elsevierStylePara elsevierViewall">The hybrid radiotracers used in the SLN procedure are administered interstitially. and thus. their application is based on their migration from the injection site by lymphatic drainage. In contrast, the use of systemic hybrid radiotracers is based on intravenous administration and the mechanism of uptake is determined by the affinity of the tumor cells with the radiotracer used. Therefore, this type of radiotracers should have specific characteristics that allows both radioactive and fluorescent labeling. The use of hybrid radiotracers is gaining increasing interest within the framework of surgery of isolated or limited tumoral lesions, and their clinical application may become a solid work base for rescue surgery in the case of oligometastatic cancer, the diagnosis of which is often based on imaging findings<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a>. Several models have been described in global terms for the development of hybrid radiotracers of systemic administration<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a>. Firstly, the functionalization of peptides using already hybrid markers or making their C and N terminal functional with separate markers. Another possibility lies in the functionalization of small molecules with hybrid markers. One example of the recently introduced hybrid radiotracer is <span class="elsevierStyleSup">111</span>In-DOTA-girentuximab-IRDye800CW for clear cell renal carcinoma with SPECT/CT as the preoperative imaging modality and a bimodal approach for intraoperative visualization<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a>. Similar models have recently been introduced allowing the use of hybrid agents focused on the PSMA to facilitate prostate cancer surgery guided by radiofluorescence<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a>, optimizing aspects such as specific uptake of the hybrid radiotracer as well as its rapid elimination and the reduction of background radioactivity<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a>. Also in development are nanoantibodies which integrate a Cy5 fluorophore and a DTPA chelator in a single structure which would allow their posterior conjugation for working with bimodal radiotracers to enable the specific visualization of tumors with HER2 expression<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a>.</p><p id="par0175" class="elsevierStylePara elsevierViewall">The possibility of working with hybrid radiotracers depends on their availability. For example, while it is true that the labeling protocol of ICG-<span class="elsevierStyleSup">99m</span>Tc-nanocolloid is relatively simple and can be reproduced in any nuclear medicine department, its commercial availability in several countries is made by the same laboratories that supply the nanocolloid (GE Healthcare) labeled or not with <span class="elsevierStyleSup">99m</span>Tc. This has led to the use of this hybrid radiotracer in SLN surgery in at least 6 European countries and several outside Europe. The use of systemically administered hybrid radiotracers has a different panorama and their development is being followed in experimental terms and their application is limited to ongoing studies in specialized centers.</p><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Hybrid work equipment in the operating room</span><p id="par0180" class="elsevierStylePara elsevierViewall">The second requisite for working with hybrid modalities combining fluorescence with radioactivity is the availability of adequate equipment in the operating room. The logistics are the same for the radioactive component as those used in the usual practice of radioguided surgery, and thus, additional investments in this regard are not necessary. The fluorescent component is different and requires near-infrared (NIR) cameras. These cameras are available in many hospitals since they are used by surgeons for work with fluorescence as an independent modality.</p><p id="par0185" class="elsevierStylePara elsevierViewall">For open SLN surgery in sites of a relatively simple approach (for example, axilla and groin), it is recommended to use a standard gamma radiation probe in combination with a simple NIR camera that allows visualizing in sites of greater acoustic signal, fluorescence in black and white with high resolution, while using attenuated room light obviously. In sites of complex lymphatic drainage (head and neck, certain regions of the trunk) a high resolution PGC can be added to the equipment mentioned above, and if available, a second generation NIR camera that allows working in real time with room light obtaining color fluorescent images.</p><p id="par0190" class="elsevierStylePara elsevierViewall">For laparoscopic surgery of the SLN, the most commonly used combination is the gamma probe and a NIR camera, both rigid models of standard laparoscopic use. Their use during the procedure is almost always alternated, with the gamma probe being actuated separately by the nuclear medicine physician. With the integration of the fluorescence signal to the console, its visualization is simplified giving functional space to the rigid laparoscopic gamma probe. The introduction of the flexible (DROP-IN) laparoscopic probe has optimized the detection of the SLN in territories of pelvic lymphatic drainage allowing a more adequate approach in combination with fluorescence<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>. At the same time, the DROP-IN probe has facilitated robotic surgery of the SLN since it can be directly actuated by the surgeon from the operative console using the robot pincers<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a>. This tendency has gained strength with the introduction of the Click-On probe which allows integrating the probe in the same pincers of the robot<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a>.</p><p id="par0195" class="elsevierStylePara elsevierViewall">Hybrid surgery aimed at the resection of metastasis or tumoral recurrence administering systemic radiotracers may be logistically performed with the same equipment used for hybrid surgery of the SLN as shown in <a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0200" class="elsevierStylePara elsevierViewall">The current practice of targeted hybrid radiotracer surgery is based on the incorporation of fluorescence in the same radioactive radiotracer and it is becoming increasing used in SLN procedures. The central axis in the anatomical preoperative localization of the SLN continues to be SPECT/CT which is a technique usually used and at the same time easy to plan in nuclear medicine departments. However, the conversion of some SPECT radiotracers to PET, which is beginning to be done, for example, with tilmanocept, may mean the use of greater spatial resolution of PET/CT at least for some applications of the SLN procedure in drainage zones near the primary tumor such as the head and neck that are usually accompanied by a greater incidence of occult SLN. Together with this, the tendency of incorporating fluorescence to systemic radiotracers (the basis of which is PSMA, small molecules, antibodies, etc.) would allow extending rescue surgery in cases of cancer with oligometastatic progression whether through the use of beta radiation probes or the same gamma probes by replacing the PET radionuclide by a SPECT radionuclide (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>)<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>.</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0205" class="elsevierStylePara elsevierViewall">Beyond this, the gradual combination of the reading of radioactive and fluorescent signals in the mode of “2 cameras, one screen” is expected for the hybrid procedure in the operating room, anticipating the real integration of a single device able to measure both signals while showing the readings separately<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a>.</p><p id="par0210" class="elsevierStylePara elsevierViewall">It can be concluded that the integration of hybrid concepts to radioguided surgery not only reinforces but also widens their field of clinical application. We must recognize that the hybrid concepts have come to stay in nuclear medicine and we are on the cusp of a true revolution in which hybrid techniques do not limit the great diagnostic imaging equipment (SPECT/CT, PET/CT, PET/MR and recently PET/SPECT/CT) but rather these concepts are reaching the field of interventional nuclear medicine based on the new hybrid radiotracers and the gradual development of portable bimodal detection devices. It is expected that both the EANM and the national societies of nuclear medicine will promote this process through their multidisciplinary diffusion, facilitating their logistic habilitation.</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0215" class="elsevierStylePara elsevierViewall">The cornerstone of interventional nuclear medicine is preoperative scintigraphic imaging obtained thanks to systemic, local or intralesional administration of a radiotracer and includes planar images and increasingly more frequently hybrid images (SPECT/CT, PET/CT). We have described the importance of the development of PGC, flexible laparoscopic probes and robotic surgery for surgery. Finally, in the third section we have highlighted that the possibility of working with hybrid radiotracers, depending on their availability, allows integrating the best of two worlds. It is always difficult to make conclusions that reflect important work in a few words, but it is even more difficult if it is a subject of constant evolution, progression, and adaptation. Perhaps, however, this is precisely the conclusion: “don’t stop”, “do not conform”. We have a wide spectrum of possibilities that we should be able to discuss and offer within the framework of a multidisciplinary team to respond to the needs of each patient: use them!</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflict of interests</span><p id="par0220" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1709431" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1512010" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1709430" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1512009" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Tailored radioguided surgery" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Robot-assisted laparoscopic surgery" "secciones" => array:3 [ 0 => array:3 [ "identificador" => "sec0020" "titulo" => "Surgical indications for robotic surgery approaches" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Benefits and limitations of robotic surgery in gynecologic surgery" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Future" ] ] ] 1 => array:3 [ "identificador" => "sec0035" "titulo" => "Role of the nuclear medicine physician in robotic surgery" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "SSLNB in cervical cancer" ] ] ] 2 => array:3 [ "identificador" => "sec0045" "titulo" => "Selective SLNB in endometrial cancer" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "ROLL technique in robotic surgery" ] ] ] ] ] 7 => array:3 [ "identificador" => "sec0055" "titulo" => "Integration of hybrid concepts in radioguided surgery" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0060" "titulo" => "Hybrid work equipment in the operating room" ] ] ] 8 => array:2 [ "identificador" => "sec0065" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0070" "titulo" => "Conflict of interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-12-13" "fechaAceptado" => "2021-12-29" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1512010" "palabras" => array:5 [ 0 => "Radioguided surgery" 1 => "Robotic surgery" 2 => "Radiotracers" 3 => "Fluorescence" 4 => "Hybrid tracers" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1512009" "palabras" => array:5 [ 0 => "Cirugía radioguiada" 1 => "Cirugía robótica" 2 => "Radiotrazadores" 3 => "Fluorescencia" 4 => "Trazadores híbridos" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The surgical approach to different pathologies, not only oncological, has evolved. As Veronesi's group has coined very graphically, we are moving from “maximum tolerable treatments to minimum effective treatments” and this journey cannot be carried out in any other way than through a multidisciplinary and multimodality approach. Multidisciplinary, because collaboration between surgeons, oncologists, radiologists, nuclear physicians, pathologists, and all those involved in patient follow-up is necessary, and multimodality, because we must move towards precision surgery tailored to each patient in which, on the part of Nuclear Medicine, hybrid imaging (SPECT/CT and PET/CT), bimodal tracers, the use of new allies such as ultrasound or our own adaptation to robotic surgery have a great deal to say.</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A wide range of possibilities is built on the solid foundation of preoperative scintigraphy, which makes it possible to identify the target tissues and whose knowledge prior to surgery allows the necessary surgical approach to be considered for each patient.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El abordaje quirúrgico de las distintas enfermedades, no solo oncológicas, ha evolucionado. Como ha sido acuñado de forma muy gráfica por el grupo de Veronesi, estamos pasando de los «tratamientos máximos tolerables a los mínimos eficaces» y este recorrido no puede ser llevado a cabo de otra forma que mediante un planteamiento de trabajo multidisciplinar y multimodalidad. Obligatoriamente multidisciplinar porque es necesaria la colaboración entre cirujanos, oncólogos, radiólogos, médicos nucleares, patólogos y todo aquel relacionado con el seguimiento de los pacientes, y obligatoriamente multimodalidad porque nos debemos encaminar hacia una cirugía de precisión a la medida de cada paciente en la que, por parte de la Medicina Nuclear, tiene mucho que decir la imagen híbrida (SPECT/TC y PET/TC), los trazadores bimodales, el empleo de nuevos aliados como la ecografía o nuestra propia adaptación a la cirugía robótica.</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Todo un amplio abanico de posibilidades construido a partir de un sólido cimiento como es la gammagrafía preoperatoria, que posibilita la identificación de los tejidos diana y cuyo conocimiento previo a la intervención permite plantear el abordaje quirúrgico necesario para cada paciente.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Valdés Olmos R, Vidal-Sicart S, Fuertes Cabero S, Goñi Gironés E, Paredes P. Aportación de la medicina nuclear intervencionista a la cirugía de precisión molecularmente dirigida. Rev Esp Med Nucl Imagen Mol. 2022;41:179–187.</p>" ] ] "multimedia" => array:5 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1616 "Ancho" => 3008 "Tamanyo" => 622779 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Temporal evolution of radioguided surgery (CRG).</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 543 "Ancho" => 1300 "Tamanyo" => 70883 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Adjustable turntable platform that allows multiquadrant access without repositioning the base of the surgical cart. <span class="elsevierStyleItalic">Courtesy of Abex Excelencia Robótica, S. L.</span></p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 514 "Ancho" => 1750 "Tamanyo" => 96071 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The Da Vinci robotic surgical system is made up of the surgeon console (A), the patient side cart (B), and the vision cart (C). The new Da Vinci Single Port model (D). <span class="elsevierStyleItalic">Courtesy of Abex Excelencia Robótica, S. L.</span></p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1303 "Ancho" => 2508 "Tamanyo" => 314080 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Work schemes for the use of hybrid equipment in the operating room. For open surgery (left), the first work level composed of a gamma probe and a near-infrared (NIR) camera of images in black and white are aggregated at a second level to a portable gamma camera and a NIR camera with color imaging and work under room lighting. For laparoscopic surgery (right), at the second level, the rigid probe and the NIR camera of the first level are replaced by a flexible DROP-IN probe and an integrated fluorescence image.</p>" ] ] 4 => array:8 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1429 "Ancho" => 2508 "Tamanyo" => 290773 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Possible future scenarios that illustrate the application of both the preoperative image and surgery in the operating room based on the administration of systemic hybrid radiotracers combining radioactivity with fluorescence for the detection and resection of oligometastasis (circles).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:45 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Radioguided surgery: Physical principles and an update on technological developments" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Pashazadeh" 1 => "M. Friebe" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Biomed Tech (Berl)" "fecha" => "2020" "volumen" => "65" "paginaInicial" => "1" "paginaFinal" => "10" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Should ACOSOG Z0011 change practice with respect to axillary lymph node dissection for a positive sentinel lymph node biopsy in breast cancer?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.E. Giuliano" 1 => "M. Morrow" 2 => "S. Duggal" 3 => "T.B. Julian" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10585-012-9515-z" "Revista" => array:6 [ "tituloSerie" => "Clin Exp Metastasis" "fecha" => "2012" "volumen" => "29" "paginaInicial" => "687" "paginaFinal" => "692" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22926446" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): A randomised, multicentre, open-label, phase 3 non-inferiority trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Donker" 1 => "G. van Tienhoven" 2 => "M.E. Straver" 3 => "P. Meijnen" 4 => "C.J.H. van de Velde" 5 => "R.E. Mansel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Lancet Oncol" "fecha" => "2014" "volumen" => "15" "paginaInicial" => "1303" "paginaFinal" => "1310" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eliminating the breast cancer surgery paradigm after neoadjuvant systemic therapy: Current evidence and future challenges" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Heil" 1 => "H. Kuerer" 2 => "A. Pfob" 3 => "G. Rauch" 4 => "H. Sinn" 5 => "M. Golatta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.annonc.2019.10.012" "Revista" => array:6 [ "tituloSerie" => "Ann Oncol" "fecha" => "2020" "volumen" => "31" "paginaInicial" => "61" "paginaFinal" => "71" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31912797" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "EANM practice guidelines for lymphoscintigraphy and sentinel lymph node biopsy in melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Bluemel" 1 => "K. Herrmann" 2 => "F. Giammarile" 3 => "O.E. Nieweg" 4 => "J. Dubreuil" 5 => "A. Testori" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00259-015-3135-1" "Revista" => array:6 [ "tituloSerie" => "Eur J Nucl Med Mol Imaging" "fecha" => "2015" "volumen" => "42" "paginaInicial" => "1750" "paginaFinal" => "1766" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26205952" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Advances in radioguided surgery in oncology" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.A. Valdés Olmos" 1 => "S. Vidal-Sicart" 2 => "G. Manca" 3 => "G. Mariani" 4 => "L.F. León-Ramírez" 5 => "D. Rubello" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.23736/S1824-4785.17.02995-8" "Revista" => array:6 [ "tituloSerie" => "Q J Nucl Med Mol Imaging." "fecha" => "2017" "volumen" => "61" "paginaInicial" => "247" "paginaFinal" => "270" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28569457" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recent advances in nuclear and hybrid detection modalities for image-guided surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Van Oosterom" 1 => "D. Rietbergen" 2 => "M. Welling" 3 => "H. van der Poel" 4 => "T. Maurer" 5 => "F. van Leeuwen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/17434440.2019.1642104" "Revista" => array:6 [ "tituloSerie" => "Expert Rev Med Devices" "fecha" => "2019" "volumen" => "16" "paginaInicial" => "711" "paginaFinal" => "734" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31287715" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Radioguided surgery and the GOSTT concept: From pre-operative image and intraoperative navigation to image-assisted excision" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Bowles" 1 => "N. Sánchez" 2 => "A. Tapias" 3 => "P. Paredes" 4 => "F. Campos" 5 => "C. Bluemel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.remn.2016.09.004" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Med Nucl Imagen Mol" "fecha" => "2017" "volumen" => "36" "paginaInicial" => "175" "paginaFinal" => "184" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27793632" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sentinel node imaging and radioguided surgery in the era of SPECT/CT and PET/CT: Toward new interventional nuclear medicine strategies" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.A. Valdés Olmos" 1 => "D.D.D. Rietbergen" 2 => "D. Rubello" 3 => "L.M. Pereira Arias-Bouda" 4 => "A. Collarino" 5 => "P.M. Colletti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/RLU.0000000000003206" "Revista" => array:6 [ "tituloSerie" => "Clin Nucl Med" "fecha" => "2020" "volumen" => "45" "paginaInicial" => "771" "paginaFinal" => "777" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32701805" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Repurposing molecular imaging and sensing for cancer image-guided surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Mondal" 1 => "C. O’Brien" 2 => "K. Bishop" 3 => "R. Fields" 4 => "J. Margenthaler" 5 => "S. Achilefu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2967/jnumed.118.220426" "Revista" => array:7 [ "tituloSerie" => "J Nucl Med" "fecha" => "2020" "volumen" => "61" "paginaInicial" => "1113" "paginaFinal" => "1122" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32303598" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1050173815002492" "estado" => "S300" "issn" => "10501738" ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Luminescence-based imaging approaches in the field of interventional molecular imaging" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F.W.B. van Leeuwen" 1 => "J.C.H. Hardwick" 2 => "A.R. van Erkel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiol.2015132698" "Revista" => array:6 [ "tituloSerie" => "Radiology" "fecha" => "2015" "volumen" => "276" "paginaInicial" => "12" "paginaFinal" => "29" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26101919" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): A prospective, multicentre cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Kuehn" 1 => "I. Bauerfeind" 2 => "T. Fehm" 3 => "B. Fleige" 4 => "M. Hausschild" 5 => "G. Helms" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1470-2045(13)70166-9" "Revista" => array:6 [ "tituloSerie" => "Lancet Oncol" "fecha" => "2013" "volumen" => "14" "paginaInicial" => "609" "paginaFinal" => "618" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23683750" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Axillary ultrasound after neoadjuvant chemotherapy and its impact on sentinel lymph node surgery: Results from the American College of Surgeons Oncology Group Z1071 Trial (Alliance)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.C. Boughey" 1 => "K.V. Ballman" 2 => "K.K. Hunt" 3 => "L.M. McCall" 4 => "E.A. Mittendorf" 5 => "G.M. Ahrendt" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Clin Oncol" "fecha" => "2015" "volumen" => "33" "paginaInicial" => "3386" "paginaFinal" => "3393" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: The SN FNAC study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.F. Boileau" 1 => "B. Poirier" 2 => "M. Basik" 3 => "C.M.B. Holloway" 4 => "L. Gaboury" 5 => "L. Sideris" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1200/JCO.2014.55.7827" "Revista" => array:6 [ "tituloSerie" => "J Clin Oncol" "fecha" => "2015" "volumen" => "33" "paginaInicial" => "258" "paginaFinal" => "263" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25452445" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sentinel lymph node biopsy without axillary lymphadenectomy after neoadjuvant chemotherapy is accurate and safe for selected patients: The GANEA 2 study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.M. Classe" 1 => "C. Loaec" 2 => "P. Gimbergues" 3 => "S. Alran" 4 => "C.T. de Lara" 5 => "P.F. Dupre" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Breast Cancer Res Treat" "fecha" => "2019" "volumen" => "173" "paginaInicial" => "343" "paginaFinal" => "352" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Major reduction in axillary lymph node dissections after neoadjuvant systemic therapy for node-positive breast cancer by combining PET/CT and the MARI procedure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Van der Noordaa" 1 => "F. van Duijnhoven" 2 => "M. Straver" 3 => "E. Groen" 4 => "M. Stokkel" 5 => "C. Loo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1245/s10434-018-6404-y" "Revista" => array:6 [ "tituloSerie" => "Ann Surg Oncol" "fecha" => "2018" "volumen" => "25" "paginaInicial" => "1512" "paginaFinal" => "1520" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29511992" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical management of the axilla in clinically node-positive breast cancer patients converting to clinical node negativity through neoadjuvant chemotherapy: Current status, knowledge gaps, and rationale for the EUBREAST-03 AXSANA study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Banys-paluchowski" 1 => "M.L. Gasparri" 2 => "J. de Boniface" 3 => "O. Gentilini" 4 => "E. Stickeler" 5 => "S. Hartmann" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Cancers (Basel)" "fecha" => "2021" "volumen" => "13" "paginaInicial" => "1565" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Radioguided surgery in primary hyperparathyroidism: A review of the different available techniques" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Goñi-Gironés" 1 => "S. Fuertes-Cabero" 2 => "I. Blanco-Sáiz" 3 => "I. Casáns-Tormo" 4 => "P. García-Talavera San Miguel" 5 => "J. Martín-Gil" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Med Nucl Imagen Mol" "fecha" => "2021" "volumen" => "40" "paginaInicial" => "57" "paginaFinal" => "66" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Does 99m Tc-tilmanocept, as next generation radiotracer, meet with the requirements for improved sentinel node imaging?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.D. Rietbergen" 1 => "L.M. Pereira Arias-Bouda" 2 => "J. van der Hage" 3 => "R.A. Valdés Olmos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.remnie.2020.09.014" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Med Nucl Imagen Mol" "fecha" => "2021" "volumen" => "40" "paginaInicial" => "275" "paginaFinal" => "280" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34425967" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The best of both worlds: A hybrid approach for optimal pre- and intraoperative identification of sentinel lymph nodes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.H. KleinJan" 1 => "E. van Werkhoven" 2 => "N.S. van den Berg" 3 => "M.B. Karakullukcu" 4 => "H.J.M.A.A. Zijlmans" 5 => "J.A. van der Hage" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00259-018-4028-x" "Revista" => array:6 [ "tituloSerie" => "Eur J Nucl Med Mol Imaging" "fecha" => "2018" "volumen" => "45" "paginaInicial" => "1915" "paginaFinal" => "1925" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29696442" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A DROP-IN gamma probe for robot-assisted radioguided surgery of lymph nodes during radical prostatectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Dell’Oglio" 1 => "P. Meershoek" 2 => "T. Maurer" 3 => "E.M.K. Wit" 4 => "P.J. van Leeuwen" 5 => "H.G. van der Poel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eururo.2020.10.031" "Revista" => array:6 [ "tituloSerie" => "Eur Urol" "fecha" => "2021" "volumen" => "79" "paginaInicial" => "124" "paginaFinal" => "132" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33203549" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The da Vinci telerobotic surgical system: The virtual operative field and telepresence surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.H. Ballantyne" 1 => "F. Moll" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0039-6109(03)00164-6" "Revista" => array:7 [ "tituloSerie" => "Surg Clin North Am" "fecha" => "2003" "volumen" => "83" "paginaInicial" => "1293" "paginaFinal" => "1304" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14712866" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0163834310001878" "estado" => "S300" "issn" => "01638343" ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Update on radioguided surgery: From international consensus on sentinel node in head and neck cancer to the advances on gynaecological tumors and localization of non-palpable lesions" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Vidal-Sicart" 1 => "S. Fuertes Cabero" 2 => "M. Danús Lainez" 3 => "R. Valdés Olmos" 4 => "P. Paredes Barranco" 5 => "J.I. Rayo Madrid" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.remn.2018.10.007" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Med Nucl Imagen Mol" "fecha" => "2019" "volumen" => "38" "paginaInicial" => "173" "paginaFinal" => "182" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30579916" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcomes and cost comparisons after introducing a robotics program for endometrial cancer surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Lau" 1 => "Z. Vaknin" 2 => "A.V. Ramana-Kumar" 3 => "D. Halliday" 4 => "E.L. Franco" 5 => "W.H. Gotlieb" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/AOG.0b013e31824c0956" "Revista" => array:6 [ "tituloSerie" => "Obstet Gynecol" "fecha" => "2012" "volumen" => "119" "paginaInicial" => "717" "paginaFinal" => "724" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22433334" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A comparative study of 3 surgical methods for hysterectomy with staging for endometrial cancer: Robotic assistance, laparoscopy, laparotomy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.F. Boggess" 1 => "P.A. Gehrig" 2 => "L. Cantrell" 3 => "A. Shafer" 4 => "M. Ridgway" 5 => "E.N. Skinner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ajog.2008.08.012" "Revista" => array:6 [ "tituloSerie" => "Am J Obstet Gynecol" "fecha" => "2008" "volumen" => "199" "paginaInicial" => "360.e1" "paginaFinal" => "360.e9" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18928974" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of outcomes and cost for endometrial cancer staging via traditional laparotomy, standard laparoscopy and robotic techniques" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.C. Bell" 1 => "J. Torgerson" 2 => "U. Seshadri-Kreaden" 3 => "A.W. Suttle" 4 => "S. Hunt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ygyno.2008.08.022" "Revista" => array:6 [ "tituloSerie" => "Gynecol Oncol" "fecha" => "2008" "volumen" => "111" "paginaInicial" => "407" "paginaFinal" => "411" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18829091" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology guidelines for the management of patients with cervical cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Cibula" 1 => "R. Pötter" 2 => "F. Planchamp" 3 => "E. Avall-lundqvist" 4 => "D. Fischerova" 5 => "C. Haie-meder" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00428-018-2362-9" "Revista" => array:6 [ "tituloSerie" => "Virchows Arch" "fecha" => "2018" "volumen" => "472" "paginaInicial" => "919" "paginaFinal" => "936" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29725757" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Minimally invasive versus abdominal radical hysterectomy for cervical cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.T. Ramirez" 1 => "M. Frumovitz" 2 => "R. Pareja" 3 => "A. Lopez" 4 => "M. Vieira" 5 => "R. Ribeiro" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "N Engl J Med" "fecha" => "2018" "volumen" => "379" "paginaInicial" => "1895" "paginaFinal" => "1904" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Survival after minimally invasive vs open radical hysterectomy for early-stage cervical cancer: A systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Nitecki" 1 => "P.T. Ramirez" 2 => "M. Frumovitz" 3 => "K.J. Krause" 4 => "A.I. Tergas" 5 => "J.D. Wright" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamaoncol.2020.1694" "Revista" => array:6 [ "tituloSerie" => "JAMA Oncol" "fecha" => "2020" "volumen" => "6" "paginaInicial" => "1019" "paginaFinal" => "1027" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32525511" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations-2019 update" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Nelson" 1 => "J. Bakkum-Gamez" 2 => "E. Kalogera" 3 => "G. Glaser" 4 => "A. Altman" 5 => "L.A. Meyer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ijgc-2019-000356" "Revista" => array:6 [ "tituloSerie" => "Int J Gynecol Cancer" "fecha" => "2019" "volumen" => "29" "paginaInicial" => "651" "paginaFinal" => "668" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30877144" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recurrence and survival after random assignment to laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group LAP2 Study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.L. Walker" 1 => "M.R. Piedmonte" 2 => "N.M. Spirtos" 3 => "S.M. Eisenkop" 4 => "J.B. Schlaerth" 5 => "R.S. Mannel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1200/JCO.2011.38.8645" "Revista" => array:6 [ "tituloSerie" => "J Clin Oncol" "fecha" => "2012" "volumen" => "30" "paginaInicial" => "695" "paginaFinal" => "700" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22291074" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0160" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Oncological results of laparoscopically assisted radical vaginal hysterectomy in early-stage cervical cancer: Should we really abandon minimally invasive surgery?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Torné" 1 => "J. Pahisa" 2 => "J. Ordi" 3 => "P. Fusté" 4 => "B. Díaz‐feijóo" 5 => "A. Glickman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Cancers (Basel)" "fecha" => "2021" "volumen" => "13" "paginaInicial" => "1" "paginaFinal" => "13" ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0165" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Concin" 1 => "X. Matias-Guiu" 2 => "I. Vergote" 3 => "D. Cibula" 4 => "M.R. Mirza" 5 => "S. Marnitz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ijgc-2020-002230" "Revista" => array:6 [ "tituloSerie" => "Int J Gynecol Cancer" "fecha" => "2021" "volumen" => "31" "paginaInicial" => "12" "paginaFinal" => "39" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33397713" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0170" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fluorescent radiocolloids: Are hybrid tracers the future for lymphatic mapping?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Vidal-Sicart" 1 => "F.W.B. van Leeuwen" 2 => "N.S. van den Berg" 3 => "R.A. Valdés Olmos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00259-015-3132-4" "Revista" => array:6 [ "tituloSerie" => "Eur J Nucl Med Mol Imaging" "fecha" => "2015" "volumen" => "42" "paginaInicial" => "1627" "paginaFinal" => "1630" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26194719" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0175" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Validation of the accuracy of intraoperative lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma: A multicenter trial. Multicenter Selective Lymphadenectomy Trial Group" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.L. Morton" 1 => "J.F. Thompson" 2 => "R. Essner" 3 => "R. Elashoff" 4 => "S.L. Stern" 5 => "O.E. Nieweg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00000658-199910000-00001" "Revista" => array:7 [ "tituloSerie" => "Ann Surg" "fecha" => "1999" "volumen" => "230" "paginaInicial" => "453" "paginaFinal" => "465" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10522715" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0165032718323875" "estado" => "S300" "issn" => "01650327" ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0180" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A systematic review and meta-analyses of sentinel lymph node identification in breast cancer and melanoma, a plea for tracer mapping" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.G. Niebling" 1 => "R.G. Pleijhuis" 2 => "E. Bastiaannet" 3 => "A.H. Brouwers" 4 => "G.M. Van Dam" 5 => "H.J. Hoekstra" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejso.2015.12.007" "Revista" => array:6 [ "tituloSerie" => "Eur J Surg Oncol" "fecha" => "2016" "volumen" => "42" "paginaInicial" => "466" "paginaFinal" => "473" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26853759" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0185" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Trending: Radioactive and fluorescent bimodal/hybrid tracers as multiplexing solutions for surgical guidance" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F.W.B. Van Leeuwen" 1 => "M. Schottelius" 2 => "O.R. Brouwer" 3 => "S. Vidal-Sicart" 4 => "S. Achilefu" 5 => "J. Klode" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Nucl Med" "fecha" => "2020" "volumen" => "61" "paginaInicial" => "13" "paginaFinal" => "19" ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0190" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characterisation and classification of oligometastatic disease: A European Society for Radiotherapy and Oncology and European Organisation for Research and Treatment of Cancer consensus recommendation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Guckenberger" 1 => "Y. Lievens" 2 => "A.B. Bouma" 3 => "L. Collette" 4 => "A. Dekker" 5 => "N.M. deSouza" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1470-2045(19)30718-1" "Revista" => array:7 [ "tituloSerie" => "Lancet Oncol" "fecha" => "2020" "volumen" => "21" "paginaInicial" => "e18" "paginaFinal" => "e28" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31908301" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0025619613004795" "estado" => "S300" "issn" => "00256196" ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0195" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tumor-targeted dual-modality imaging to improve intraoperative visualization of clear cell renal cell carcinoma: A first in man study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.C. Hekman" 1 => "M. Rijpkema" 2 => "C.H. Muselaers" 3 => "E. Oosterwijk" 4 => "C.A. Hulsbergen-Van de Kaa" 5 => "O.C. Boerman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7150/thno.23335" "Revista" => array:6 [ "tituloSerie" => "Theranostics" "fecha" => "2018" "volumen" => "8" "paginaInicial" => "2161" "paginaFinal" => "2170" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29721070" "web" => "Medline" ] ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0200" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "PSMA-targeting agents for radio- and fluorescence-guided prostate cancer surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y.H.W. Derks" 1 => "D.W.P.M. Löwik" 2 => "J.P.M. Sedelaar" 3 => "M. Gotthardt" 4 => "O.C. Boerman" 5 => "M. Rijpkema" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7150/thno.36739" "Revista" => array:6 [ "tituloSerie" => "Theranostics" "fecha" => "2019" "volumen" => "9" "paginaInicial" => "6824" "paginaFinal" => "6839" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31660071" "web" => "Medline" ] ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0205" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rational linker design to accelerate excretion and reduce background uptake of peptidomimetic PSMA-targeting hybrid molecules" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.-C. Eder" 1 => "M. Schäfer" 2 => "J. Schmidt" 3 => "U. Bauder-Wüst" 4 => "M. Roscher" 5 => "K. Leotta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2967/jnumed.120.248443" "Revista" => array:6 [ "tituloSerie" => "J Nucl Med" "fecha" => "2021" "volumen" => "62" "paginaInicial" => "1461" "paginaFinal" => "1467" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33741642" "web" => "Medline" ] ] ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0210" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The design and preclinical evaluation of a single-label bimodal nanobody tracer for image-guided surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Debie" 1 => "N.B. Declerck" 2 => "D. van Willigen" 3 => "C.M. Huygen" 4 => "B. de Sloovere" 5 => "L. Mateusiak" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Biomolecules" "fecha" => "2021" "volumen" => "11" "paginaInicial" => "1" "paginaFinal" => "14" ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0215" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "How molecular imaging will enable robotic precision surgery: The role of artificial intelligence, augmented reality, and navigation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T. Wendler" 1 => "F.W.B. van Leeuwen" 2 => "N. Navab" 3 => "M.N. van Oosterom" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00259-021-05445-6" "Revista" => array:7 [ "tituloSerie" => "Eur J Nucl Med Mol Imaging" "fecha" => "2021" "volumen" => "48" "paginaInicial" => "4201" "paginaFinal" => "4224" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34185136" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S221503661930286X" "estado" => "S300" "issn" => "22150366" ] ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0220" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Click-On gamma probe, a second-generation tethered robotic gamma probe that improves dexterity and surgical decision-making" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Azargoshasb" 1 => "S. van Alphen" 2 => "L.J. Slof" 3 => "G. Rosiello" 4 => "S. Puliatti" 5 => "S.I. van Leeuwen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00259-021-05387-z" "Revista" => array:6 [ "tituloSerie" => "Eur J Nucl Med Mol Imaging" "fecha" => "2021" "volumen" => "48" "paginaInicial" => "4142" "paginaFinal" => "4151" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34031721" "web" => "Medline" ] ] ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib0225" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "SiPM-based gamma detector with a central GRIN lens for a visible/NIRF/gamma multi-modal laparoscope" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Y.B. Han" 1 => "S.H. Song" 2 => "H.G. Kang" 3 => "H.-Y. Lee" 4 => "S.J. Hong" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Opt Express" "fecha" => "2021" "volumen" => "29" "paginaInicial" => "2364" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22538089/0000004100000003/v1_202205140730/S2253808922000179/v1_202205140730/en/main.assets" "Apartado" => array:4 [ "identificador" => "7982" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Special collaboration" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22538089/0000004100000003/v1_202205140730/S2253808922000179/v1_202205140730/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808922000179?idApp=UINPBA00004N" ]
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Interventional nuclear medicine's contribution to molecularly targeted precision surgery
Aportación de la medicina nuclear intervencionista a la cirugía de precisión molecularmente dirigida
R. Valdés Olmosa, S. Vidal-Sicartb,c, S. Fuertes Caberod, E. Goñi Gironése, P. Paredesb,f,
Corresponding author
a Interventional Molecular Imaging Laboratory and Nuclear Medicine Section, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
b Servicio de Medicina Nuclear, Hospital Clínic, Barcelona, Spain
c Servicio de Medicina Nuclear, Imatge Mèdica Intercentres S. L. (IMI), Parc de Salut Mar, Barcelona, Spain
d Servicio de Medicina Nuclear, Hospital Vall d’Hebron, Barcelona, Spain
e Servicio de Medicina Nuclear, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
f Facultad de Medicina, Universitat de Barcelona (UB), Barcelona, Spain