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Subdermal injectionof large-size "To-labeled albumin colloids to inner lower quadrant of right breast. Early (A) and delayed (B) scintigraphic images in anterior-oblique view. Lymph vessel (black arrow) and SN (open arrow) are seen in A; only SN is evident in later scan.
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Lymphoscintigraphy associated with radioguided biopsy of the sentinel node (SN) is well established in clinical practice for melanoma. In breast cancer, the SN concept is similarly valid, and lymphoscintigraphy is a useful method for localizing the axillary SN. The aim of this study was to optimize the lymphoscintigraphy technique in association wi...
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Context 1
... tracer was administered subdermally, lymphoscintig raphy revealed one or more nodes within 30 min in 81% of patients. When tracer was administered peritumorally, the detection time was longer: in 60%, the detection time was within 30 min, and in 12%, it was 4-18 hr later (p < 0.001). When lymphoscintigraphy revealed more than one node, the first node to become active always showed the highest uptake both in the early and later images ( Figs. 1 and 2). Tracer uptake by SN as a percentage of the injected dose was lower after peritumoral injection (mean = 0.1% ± 0.04%) than after subdermal injection (mean = 0.9% ±0.5%), especially when large injection volumes were used (Fig. 3). The lymphatic channels were more often delineated after subdermal than peritumoral injection (Fig. ...
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Citations
... Aggregates of human albumin and other formulations differ in size, and thus have to be filtered to obtain dimensions suitable for specific purpose. The smaller aggregates (less than 100 nm in diameter) show higher uptake in the lymphatic district, resulting in better image quality, while larger ones (200-1000 nm) are progressively trapped in lymph nodes, allowing sentinel node mapping [10]. ...
Lymphedema is a progressive chronic condition affecting approximately 250 million people worldwide, a number that is currently underestimated. In Western countries, the most common form of lymphedema of the extremities is cancer-related and less radical surgical intervention is the main option to prevent it. Standardized protocols in the areas of diagnosis, staging and treatment are strongly required to address this issue. The aim of this study is to review the main diagnostic methods, comparing new emerging procedures to lymphoscintigraphy, considered as the golden standard to date. The roles of Magnetic Resonance Lymphangiography (MRL) or indocyanine green ICG lymphography are particularly reviewed in order to evaluate diagnostic accuracy, potential associations with lymphoscintigraphy, and future directions guided by AI protocols. The use of imaging to treat lymphedema has benefited from new techniques in the area of lymphatic vessels anatomy; these perspectives have become of value in many clinical scenarios to prevent cancer-related lymphedema.
... В последние годы попытки повышения точности инструментальной диагностики метастатическо- [3,14,17]. При выявлении первичной формы рака многими исследователями показана высокая информативность однофотонной планарной и эмиссионно-томографической сцинтиграфии рмж с помощью жирорастворимых катионов (технетрил, тетрофосмин), меченных 99mTc [8,9,18]. К сожалению, данные литературы о возможности сцинтиграфии с туморотропными радиофармпрепаратами при диагностике изменений в регионарных ЛУ больных рмж достаточно скудны [1,16]. ...
418 Включены сведения о 168 больных рМЖ, хирургическое лечение которых было до-полнено подмышечной лимфаденэктоми-ей (133 больных или 79,2%) или биопсией сигнальных лимфатических узлов (БслУ) (35 или 20,8%). У 122 первичных больных ра-ком молочной железы стадии сt1-2n0m0 про-веден ретроспективный анализ результатов радионуклидной визуализации сигнальных лимфатических узлов (рВлУ). 89 пациенткам введение коллоидного радиофармпрепарата (рФп) осуществлялось с использованием ча-стиц диаметром не более 80-100 нм, 33 па-циенткам исследование проводилось после введения радиоколлоида с диаметром частиц от 200 до 1000 нм. предложены две диагности-ческие модели: первая, при которой наличие метастатического поражения подмышечных лУ устанавливалось при наличии изменений по данным хотя бы одного из использован-ных методов диагностики-сцинтиграфии или УЗи; вторая, при которой поражение лУ определялось только в случае одновременного обнаружения сцинтиграфических и УЗи при-знаков поражения подмышечных лимфатиче-ских узлов. Чувствительность, специфичность и общая точность комбинации УЗи и пла-нарной сцинтиграфии подмышечных лУ при использовании первой модели составили 82,7%, 67,7% и 74,4% соответственно. Во вто-рой модели специфичность составила 94,6%, чувствительность 56%. Быстрый транспорт рФп из места введения, высокий градиент накопления рФп в слУ, эффективная визу-ализация слУ, приближающаяся к 100%, от-носятся к несомненным достоинствам радио-коллоидов с диаметром частиц до 100 нм. Ключевые слова: рак молочной железы, сигнальные лимфатические узлы, УЗи, сцин-тиграфия, радионуклидная визуализация лимфатических узлов В 2005 г. американское общество клиниче-ской онкологии (ASCO) впервые опубликовало руководство по биопсии сигнальных лимфатиче-ских узлов (БСЛУ) у больных раком молочной железы (рмж) [12]. Показанием к БСЛУ на се-годняшний день является рак молочной железы ранних стадий с отсутствием признаков пораже-ния регионарных лимфатических узлов. В соот-ветствии с общими рекомендациями St. Gallen 2013 и рекомендациями российского общества онкомаммологов (роом, 2014) допускается отказ от полной аксиллярной диссекции даже при наличии макрометастазов в 1-2 сигнальных лимфоузлах при условии проведения послеопе-рационной лучевой терапии на подмышечную область [4]. Кроме того, БСЛУ может быть предложена пациенткам, имеющим операбель-ный рак, но с мультицентричной или протоковой карциномой in situ и не имевшим оперативное вмешательство на молочной железе в анамнезе. Противопоказаниями для данной манипуляции принято считать распространенные формы рмж (т3/т4), воспалительный и протоковый рак [7]. активное использование биопсии сигнальных лимфатических узлов (ЛУ) у больных раком мо-лочной железы началось в 90-х годах прошлого столетия. Появление данной методики связано с определенными достижениями в области ран-ней диагностики, системной и лучевой терапии, что в первую очередь проявилось в существен-ном снижении объема хирургических вмеша-тельств как в отношении молочной железы, так и в отношении областей регионарного метаста-зирования [6, 8, 11]. роль стандартных инструментальных методов (маммографии и УЗи) предоперационной диа-гностики опухолевого поражения подмышечных ЛУ чрезвычайно высока, однако, их информа-тивность [20] остается относительной невысо-кой: чувствительность не превышает 45-70%, специфичность-70-89%, общая точность-72-86% [5,15]. метод УЗи нашел более широ-кое клиническое применение в связи с высокой экономичностью и повсеместной доступностью. В последние годы попытки повышения точности инструментальной диагностики метастатическо-©Коллектив авторов, 2015 Вопросы онкологии, 2015. том 61, № 3
... One of the first studies to identify the optimal size of nonacolloids was performed by De Cicco C. et al. The authors compared three different ranges in size of 99m-Tc-labeled colloid particles in 250 patients; they obtained the best detection rate (96%) by using a 200-1000 nm colloid, administered sub-dermally in an injection volume of 0.4 mL [53]. ...
With the emergence of sentinel node technology, many patients can be staged histopathologically using lymphatic mapping and selective lymphadenectomy. Structural imaging by using US, CT and MR permits precise measurement of lymph node volume, which is strongly associated with neoplastic involvement. Sentinel lymph node detection has been an ideal field of application for nuclear medicine because anatomical data fails to represent the close connections between the lymphatic system and regional lymph nodes, or, more specifically, to identify the first draining lymph node. Hybrid imaging has demonstrated higher accuracy than standard imaging in SLN visualization on images, but it did not change in terms of surgical detection. New alternatives without ionizing radiations are emerging now from “non-radiological” fields, such as ophthalmology and dermatology, where fluorescence or opto-acoustic imaging, for example, are widely used. In this paper, we will analyze the advantages and limits of the main innovative methods in sentinel lymph node detection, including innovations in lymphoscintigraphy techniques that persist as the gold standard to date.
... Some authors feel that the upper portion of the range (100-400 nm) is preferred because the particles should be trapped only in the first-echelon nodes, at the expense of slower and less extensive migration due to size. Others feel the lower portion of the range (5-100 nm) allows more rapid and extensive delivery, though at the expense of the possible overestimation of the number of sentinel nodes [14,15]. ...
Albumin nanocolloids have been used as radiopharmaceuticals for more than 40 years. Their main use is in lymphoscintigraphy and the detection of the sentinel lymph node as part of the surgical treatment of a variety of solid tumours. The main licensed products are labelled with the gamma emitter technetium-99m. Recently, two analogues labelled with positron emitters have been reported, using gallium-68 and zirconium-89. For about 10 years, there has been interest in dual-modal agents with both radioactive and fluorescent labels to improve the localisation of the sentinel lymph node. Indocyanine green (ICG) has been the most widely used fluorescent label, largely due to its availability as a licensed agent and its ease of application. The further development of alternative radiolabels or improved fluorescent tags will require investment in the development and licensing. There is also a vast potential for the targeting of albumin nanocolloids using existing strategies, which could be promising for the development of both diagnostic and therapeutic agents.
... Since two decades, SLN mapping and biopsy have become routine techniques in breast cancer management, contributing to the development of less-invasive surgical procedures (7)(8)(9)(10)(11)(12)(13)(14). This procedure has replaced routine staging axillary nodal dissection in patients with early-stage biopsy-proven breast carcinoma without cytologically or histologically proven axillary lymph node metastases (15,16). Our aim was to determine the feasibility of detecting the SLN and whether the SLN accurately predicts the axillary status. ...
... (Antimony trisulphide commenly used in Australia and Canada; Nanocolloid Albumin in Europe; Sulphur Colloid in USA) (23). SLNs are generally visualized within 1-2 h, and the patient should be in the operation theater (O.T.) within 2-30 h of the injection of the colloid, depending on the facility's schedule (6,15,24). If surgery is scheduled for early morning, injection and imaging may be safely performed in the previous afternoon prior to the day of surgery (25). ...
Background: The sentinel lymph node (SLN) is the first draining node from a cancer-bearing area and therefore can manifest metastasis. In breast cancer SLN has been shown to predict the axillary nodal stage. Axillary dissection provides information determining prognosis and need for adjuvant therapy but often carries certain morbidities. Our aim was to determine the feasibility of detecting the SLN and whether the SLN accurately predicts the axillary status. Materials and Methods: Twelve patients having mean age of 40.5 ± 10.9 years, ranging from 28 to 56 years with stage I and II breast cancer and non-palpable axillary nodes from November 2016 to December 2018 were included in this study. The sentinel node was detected with Tc-99m-labelled nano colloid (radiotracer). Dual Head SPECT Gamma Camera and Gamma Probe was used in the same sitting for identification and surface marking of the SLN. Surgical resection of SLN was done followed by frozen section biopsy. Results: The tumor size ranged from <2cm to ≤5cm), SLNs were identified in 11 out of 12 cases, one SLN in 9 patients and two SLNs in remaining two patients during SLN mapping. Conclusion: This was an initial experience in a single hospital, where SLN mapping and biopsy proved feasible and successful. By this method, patients who are negative on frozen section biopsy would be spared from axillary lymph node dissection. However, further practice is required to reach a firm conclusion and long term follow up is also essential. Bangladesh J. Nuclear Med. 24(1&2): 13-17, 2021
... This technique includes the preoperative injection of a radiopharmaceutical followed by the intraoperative identification of the target lesion through a handheld probe that detects radioactive signal [1]. To date, γ emitting radioisotopes like technetium-99m ( 99m Tc) are mainly used for radio-guided surgery [1,[3][4][5][6][7][8][9]. However, γ radiations are more penetrating than both α and *Address correspondence to this author at the Unit of Nuclear Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma; E-mail: teresa.scotognella@gmail.com ...
Background
Nimotuzumab is a humanized anti-epidermal growth factor receptor (EGFR) monoclonal antibody, nowadays used for tumour immunochemotherapy. This study aimed to label the conjugate DOTA-nimotuzumab with yttrium-90, in order to provide a β- emitting radioimmunoconjugate (90Y-DOTA-nimotuzumab) potentially useful to assess the feasibility of a new radio-guided surgery approach.
Methods
The synthesis of 90Y-DOTA-nimotuzumab was performed in two days. Nimotuzumab was conjugated with a 50 fold excess of DOTA and then labelled with 90Y3+. The 90Y-DOTA-nimotuzumab preparation was optimized considering several parameters such as pH, temperature and reaction volume. Moreover, the 90Y-DOTA-nimotuzumab stability was evaluated in human plasma.
Results
The radioimmunoconjugate 90Y-DOTA-nimotuzumab was obtained with a radiochemical purity greater than 96%, and showed a good stability at 20°C as well as at 37°C in human plasma.
Conclusions
The optimized conditions for a mild and easy preparation of 90Y-DOTA-nimotuzumab joined to a promising stability under physiological conditions suggest to propose this radioimmunoconjugate as a potential diagnostic radiopharmaceutical for β- radio-guided surgery.
... Si no está afectado es poco probable que otros ganglios lo puedan estar. 4 ...
OBJETIVO:
Describir las características sociodemográficas, clínicas, técnica quirúrgica y factores pronósticos de la técnica del ganglio centinela en cáncer de mama en un centro de referencia.
MATERIALES Y MÉTODOS:
Estudio retrospectivo, analítico, con fuentes secundarias de información de mujeres con cáncer de mama sin afectación clínica axilar, llevadas a cirugía con biopsia de ganglio centinela, en el registro personal de un cirujano del 1 de mayo de 2018 al 31 de octubre de 2020, en un centro de referencia en Medellín, Colombia. Se recopilaron los datos demográficos, clínicos y paraclínicos y se analizaron con estadística descriptiva.
RESULTADOS:
Se practicaron 552 cirugías axilares, 353 biopsias de ganglio centinela (63.9 %) y 199 linfadenectomías (36%). La edad media fue 60 años (DE ± 12.6). El 86.1% estaba en estadio clínico 0-I-II. El tamaño tumoral medio fue 2.6 cm. La tasa de detección del ganglio centinela fue de 98.3 % (n = 347). En promedio se resecaron 1.9 ganglios (DE ± 1.3) de los que 23.1% (n = 80) fueron metastásicos. Se evitó el vaciamiento axilar en el 83.6 % (n = 295).
CONCLUSIÓN:
En esta muestra, la técnica del ganglio centinela para la estadificación axilar tuvo una alta tasa de detección, se encontró mayor afectación del ganglio centinela en el transcurso de la mastectomía, congelación, subtipos luminal A y B y en menor proporción en la quimioterapia preparatoria.
... ALND was, and still is, a clinical burden due to the frequent high morbidity such as lymphedema, pain, nerve damage, etc. In 1990, the introduction into clinical practice of sentinel lymph node biopsy (SNB) [2] significantly reduced these problematic scenarios without impact on long-term survival [3]. In particular ALND can be avoided in cases of histologically negative SNB. ...
Axillary management in breast cancer is still controversial. Recent clinical trials have clearly demonstrated that in breast-conserving surgery, axillary dissection could be an overtreatment when metastases are present in only 1–2 sentinel lymph nodes. Nonetheless, axillary dissection remains the principal treatment in patients undergoing mastectomy with at least one metastatic sentinel lymph node and in patients eligible for breast conserving surgery with three or more positive sentinel lymph nodes.
In this analytical review, we discuss the clinical evidence, taking into account recent guidelines, for axillary management.
... Some methods exist for detecting SLNs intraoperatively. First, radio-colloid scintigraphy with intraoperative gamma probe counting or injection of blue dye is clinically useful in patients with melanoma and breast cancer; it is associated with a success rate of more than 95% and a failure rate of less than 3.4% in SLN identification [19][20][21][22][23][24][25][26]. However, the conventional methods of SLN detection have some limitations. ...
... method itself, as it requires a certain degree of operator experience with LN detection. Moreover, the high level of radioactivity at the primary injection site can hinder the detection of radioactive hot nodes by a gamma probe [22][23][24][27][28][29][30]. ...
Purpose:
The purpose of this study was to evaluate the ability of contras-enhanced ultrasonography (CEUS) with microbubbles to detect metastatic lymph nodes (LNs) for treatment planning and prognosis.
Methods:
For the metastatic LN model, ground VX2 tumor tissues were injected subcutaneously in 12 rabbits, just below the right hind limb. The rabbits were classified into three groups based on the LN area: group A (n=4, >1.9 cm2 ), group B (n=4, 1-1.9 cm2 ), and group C (n=4, <1 cm2 ). The LNs were monitored on CEUS for 10 seconds after injecting 2.5 mL of microbubbles. The percent area of metastatic LNs was calculated on pathologic images and compared with CEUS images.
Results:
In group A, the mean percent area of metastasis was 40.7%±19.4%. In all cases of metastasis, round-shaped perfusion defects were clearly observed in CEUS images. The metastatic areas were strongly correlated with pathologic findings. The mean percent area in group B was 21.5%±14.4%. The CEUS findings showed multiple nodular perfusion defects, clearly revealing the metastatic areas. In group B, the CEUS and pathologic findings were concordant for three of the four cases. The mean percent area in group C was 9.1%±6.4%. However, in this group, CEUS only detected a small perfusion defect in one case.
Conclusion:
CEUS has the potential to depict characteristic imaging features of metastatic LNs but still has limitations in early detection.
... SLNB correctly predicted the axillary node status in 234 of 240 patients (97.5%). Lymphoscintigraphy along with a gamma detection probe detected the SLN most easily and consistently when 200-1000 nm colloid particles were administered subdermally with an injection volume of 0.4 mL [21,22]. ...
... The skin marker may be useful in cases in which more than one lymph node takes up the radiopharmaceutical [31]. The rate of identification of the SLN by lymphoscintigraphy ranges from 75 to 98% [18,22,32,33]. Technical success with lymphoscintigraphy depends primarily on an adequate functional capacity of the sentinel node. ...
... There was no significant advantage with respect to SLN localization (91.7% versus 88.5%) in the group undergoing preoperative lymphoscintigraphy when compared with patients not undergoing preoperative lymphoscintigraphy [34]. Studies based on a meta-analysis of the available data suggests that a combination of preoperative lymphoscintigraphy with intraoperative dye-guided and gamma probeguided methods achieve a higher rate of identification of SLN compared to any of the techniques The rate of identification of the SLN by lymphoscintigraphy ranges from 75 to 98% [18,22,32,33]. Technical success with lymphoscintigraphy depends primarily on an adequate functional capacity of the sentinel node. ...
Axillary lymph node status is the single most important prognostic indicator in patients with breast cancer. Axillary lymph node dissection, the traditional method of staging breast cancer, is associated with significant morbidity. Sentinel lymph node biopsy has become standard in patients being treated for breast cancer with clinically negative lymph nodes. There is considerable variation in the medical literature regarding technical approaches to sentinel lymph node biopsy in patients with breast cancer. The purpose of this article is to describe our preferred approaches to sentinel lymph node biopsy with a review of the literature.
