{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T15:45:18Z","timestamp":1782747918170,"version":"3.54.5"},"reference-count":46,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2021,10,6]],"date-time":"2021-10-06T00:00:00Z","timestamp":1633478400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the feasibility and clinical application of fusion imaging with virtual navigation, combining <jats:sup>18<\/jats:sup>F\u2010fluorodeoxyglucose (<jats:sup>18<\/jats:sup>F\u2010FDG) positron emission tomography\/computed tomography (PET\/CT) with real\u2010time ultrasound imaging, in assessing superficial lymph nodes in breast\u2010cancer and gynecological\u2010cancer patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a pilot study of breast\u2010 and gynecological\u2010cancer patients with abnormal uptake of <jats:sup>18<\/jats:sup>F\u2010FDG by axillary or groin lymph nodes on PET\/CT scan, examined at our institution between January 2017 and May 2019. Fusion imaging was performed, uploading preacquired PET\/CT DICOM images onto the ultrasound machine and synchronizing them with real\u2010time ultrasound scanning performed at the lymph\u2010node site. In the first phase, we assessed the feasibility and reliability of fusion imaging in a series of 10 patients with suspicious lymph nodes on both PET\/CT and ultrasound, and with full correspondence between both techniques in terms of size, shape and morphology of the lymph nodes (Group\u2009A). In the second phase, we included 20 patients with non\u2010corresponding findings between PET\/CT and ultrasound: 10 patients with lymph nodes that were suspicious or pathological on PET\/CT scan but not suspicious on ultrasound assessment (Group\u2009B), and 10 patients with suspicious or pathological lymph nodes on both PET\/CT and ultrasound but with no correspondence between the two techniques in terms of number of affected lymph nodes (Group\u2009C).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the 30 selected patients, fusion imaging was assessed at 30 lymph\u2010node sites (22 inguinal and eight axillary nodes). In the first phase (Group\u2009A), the fusion technique was shown to be feasible in all 10 lymph\u2010node sites evaluated. In the second phase, fusion imaging was completed successfully in nine of 10 cases in Group\u2009B and in all 10 cases in Group\u2009C. In all groups, fusion imaging was able to identify the target lymph node, guiding the examiner to perform a core\u2010needle aspiration biopsy or to inject radiotracer for selective surgical nodal excision, according to the radio\u2010guided occult lesion localization technique.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Fusion imaging with virtual navigation, combining PET\/CT and real\u2010time ultrasound imaging, is technically feasible and able to detect target lymph nodes even when PET\/CT and ultrasound findings are inconsistent. Fusion imaging can also be used to guide the performance of core\u2010needle aspiration biopsy, avoiding further surgical diagnostic procedures, or the injection of radiotracer for selective surgical nodal excision, enabling more sparing, selective surgery. This innovative technique could open up multiple diagnostic and therapeutic opportunities in breast and gynecological oncology. \u00a9 2021 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.23613","type":"journal-article","created":{"date-parts":[[2021,2,15]],"date-time":"2021-02-15T14:55:40Z","timestamp":1613400940000},"page":"766-772","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Real\u2010time ultrasound virtual navigation in <scp>3D PET<\/scp>\/<scp>CT<\/scp> volumes for superficial lymph\u2010node evaluation: innovative fusion examination"],"prefix":"10.1002","volume":"58","author":[{"given":"G.","family":"Garganese","sequence":"first","affiliation":[{"name":"Dipartimento Scienze della Salute della Donna del Bambino e di Sanit\u00e0 Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS  Rome Italy"},{"name":"Gynecology and Breast Care Center Mater Olbia Hospital  Olbia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Bove","sequence":"additional","affiliation":[{"name":"Gynecology and Breast Care Center Mater Olbia Hospital  Olbia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0719-3322","authenticated-orcid":false,"given":"S.","family":"Fragomeni","sequence":"additional","affiliation":[{"name":"Dipartimento Scienze della Salute della Donna del Bambino e di Sanit\u00e0 Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5070-7245","authenticated-orcid":false,"given":"F.","family":"Moro","sequence":"additional","affiliation":[{"name":"Dipartimento Scienze della Salute della Donna del Bambino e di Sanit\u00e0 Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. 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