Axillary lymph node uptake of Tc-99m MIBI resulting from extravasation should not be misinterpretated as metastasis

Shih, Wei-Jen; Han, Jun; Coupal, John J.; Wierzbinski, Becky; Magoun, Sylvia; Groß, Kelly

doi:10.1007/bf03164904

Cited by 15 publications

(7 citation statements)

References 10 publications

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“…of patients with reported radiation injuryNo. of patients with reported follow-upMost severe injury reported[8–17]33218F-FDG00[18–31]2584 99m Tc bone tracers00[32]3 99m Tc-MAA00[33]1 99m Tc-DMSA00[34, 35]10 99m Tc-DTPA00[36]1 99m Tc-HMPAO00[37]1 99m Tc-MAG300[19, 38, 39]15 99m Tc-pertechnetate00[40, 41]2 99m Tc-sestamibi00[19]38 99m Tc-sulfurcolloid00[19]16 99m Tc-microspheres00[42]1 131 I-iodocholesterol11Erythematous plaque and pruritus.[43–45]12 201 Tl-thallous chloride22Radiation ulcerTotal301633 …”

Section: Resultsmentioning

confidence: 99%

Consequences of radiopharmaceutical extravasation and therapeutic interventions: a systematic review

Pol

Vöö

Bucerius

et al. 2017

Eur J Nucl Med Mol Imaging

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PurposeRadiopharmaceutical extravasation can potentially lead to severe soft tissue damage, but little is known about incidence, medical consequences, possible interventions, and effectiveness of these. The aims of this study are to estimate the incidence of extravasation of diagnostic and therapeutic radiopharmaceuticals, to evaluate medical consequences, and to evaluate medical treatment applied subsequently to those incidents.MethodsA sensitive and elaborate literature search was performed in Embase and PubMed using the keywords “misadministration”, “extravasation”, “paravascular infiltration”, combined with “tracer”, “radionuclide”, “radiopharmaceutical”, and a list of keywords referring to clinically used tracers (i.e. “Technetium-99m”, “Yttrium-90”). Reported data on radiopharmaceutical extravasation and applied interventions was extracted and summarised.ResultsThirty-seven publications reported 3016 cases of diagnostic radiopharmaceutical extravasation, of which three cases reported symptoms after extravasation. Eight publications reported 10 cases of therapeutic tracer extravasation. The most severe symptom was ulceration. Thirty-four different intervention and prevention strategies were performed or proposed in literature.ConclusionsExtravasation of diagnostic radiopharmaceuticals is common. 99mTc, 123I, 18F, and 68Ga labelled tracers do not require specific intervention. Extravasation of therapeutic radiopharmaceuticals can give severe soft tissue lesions. Although not evidence based, surgical intervention should be considered. Furthermore, dispersive intervention, dosimetry and follow up is advised. Pharmaceutical intervention has no place yet in the immediate care of radiopharmaceutical extravasation.

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Section: Resultsmentioning

confidence: 99%

Consequences of radiopharmaceutical extravasation and therapeutic interventions: a systematic review

Pol

Vöö

Bucerius

et al. 2017

Eur J Nucl Med Mol Imaging

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“…With 99m Tc agents, this is generally innocuous, aside from the degradation of image quality, though localized pain can occur. 95 Extravasation of 99m Tc sestamibi resulted in accumulation in axillary lymph nodes, which could have been misinterpreted as metastatic disease, 96 and with 99m Tc exametazime (HMPAO), there is an increase in extracerebral activity. 97 It is more serious with 131 I iodocholesterol 98 and 201 Tl thallous chloride, 99 where radionecrosis can occur.…”

Section: Patient Preparation: Pharmaceutical Interventionsmentioning

confidence: 98%

Pitfalls and Limitations of SPECT, PET, and Therapeutic Radiopharmaceuticals

Ballinger

2015

Seminars in Nuclear Medicine

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“…7). [29][30][31][32][33][34][35][36] However, knowledge of common sites for ectopic parathyroid tissue and use of SPECT/CT are often helpful in avoiding false positives. Asymmetric tracer activity in the submandibular glands is a normal variant and may be misinterpreted as an ectopic undescended adenoma (Fig.…”

Section: Pitfalls In Parathyroid Imagingmentioning

confidence: 99%