Comparison of 3 γ-probes for simultaneous iodine-125-seed and technetium-99m breast cancer surgery: NEMA standard characterisation with extended processing

PURPOSE: Iodine-125 ((125)I) seeds can be used as landmarks to locate non-palpable breast lesions instead of implanting metal wires. This relatively new technique requires a nuclear probe usually used for technetium-99m ((99m)Tc) sentinel node detection. This study aimed to compare the performances of different probes and valid the feasibility of this technique, especially in the case of simultaneous (125)I-seed and (99m)Tc breast cancer surgery. METHODS: Three probes with different features (SOE-3211, SOE-3214 and GammaSUP-II) were characterised according to the NEMA NU3-2004 standards for a (99m)Tc source and a (125)I-seed. Several tests such as sensitivity, linearity or spatial resolution allowed an objective comparison of their performances. NEMA testing was extended to work on signals discrimination in case of simultaneous detection of two different sources (innovative figure of merit “Shift Index”) and to assess the (99m)Tc scatter fraction, a useful parameter for the improvement of the probes in terms of detector materials and electronic system. RESULTS: Although the GammaSUP-II probe saturated at a lower activity (1.6 MBq at 10 mm depth), it allowed better sensitivity and spatial resolution at the different NEMA tests performed with the (99m)Tc source (7865 cps/MBq and 15 mm FWHM at 10 mm depth). With the (125)I-seed, the GammaSUP-II was the most sensitive probe (3106 cps/MBq at 10 mm depth) and the SOE-3211 probe had the best spatial resolution (FWHM 20 mm at 10 mm depth). The SOE-3214 probe was more efficient on discriminating (125)I from (99m)Tc in case of simultaneous detection. The SOE probes were more efficient concerning (99m)Tc scatter fraction assessments. The SOE-3211 probe, with overall polyvalent performances, seemed to be an interesting trade-off for detection of both (125)I and (99m)Tc. CONCLUSION: The three probes showed heterogeneous performances but were all suitable for simultaneous (99m)Tc sentinel node and (125)I-seed detection. This study provides an objective and innovative methodology to compare probes performances and then choose the best trade-off regarding their expected use.