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Inicio Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) Interventional nuclear medicine's contribution to molecularly targeted preci...
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Vol. 41. Issue 3.
Pages 179-187 (May - June 2022)
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Vol. 41. Issue 3.
Pages 179-187 (May - June 2022)
Special collaboration
Interventional nuclear medicine's contribution to molecularly targeted precision surgery
Aportación de la medicina nuclear intervencionista a la cirugía de precisión molecularmente dirigida
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R. Valdés Olmosa, S. Vidal-Sicartb,c, S. Fuertes Caberod, E. Goñi Gironése, P. Paredesb,f,
Corresponding author
pparedes@clinic.cat

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
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Abstract

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.

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.

Keywords:
Radioguided surgery
Robotic surgery
Radiotracers
Fluorescence
Hybrid tracers
Resumen

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.

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.

Palabras clave:
Cirugía radioguiada
Cirugía robótica
Radiotrazadores
Fluorescencia
Trazadores híbridos

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