Effect of radiotracer injection volume on the success of sentinel node biopsy in early-stage breast cancer patients

Kakhki, Vahid Reza Dabbagh; Aliakbarian, Hassan; Fattahi, Asiehsadat; Jangjoo, Ali; Assadi, Mahdi; Khajeh, Mahtab; Sadeghi, Ramin

doi:10.1097/mnm.0b013e3283619d07

Cited by 7 publications

(4 citation statements)

References 13 publications

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“…This is concordant with the findings reported by other groups [272829]. However, the results are conflicting and the effect of injection volume on the nodal detection rate might be multifactorial [25]. Because the 4-injection method is surely less tolerable for patients, the 2-injection method is thus recommended for routine practice, since the detection rate is not inferior.…”

Section: Discussionsupporting

confidence: 88%

“…The injection dose, nonetheless, is reasonably regarded as a predictive variable because higher injected radioactivity theoretically produces a more intense signal from the SLN and hence is easier to detect by a gamma camera. Although most studies used a radioactivity dose <1.0 mCi, our study results imply that a 2.0 mCi total radioactivity dose might achieve a better detection rate when Tc-99m phytate is used [142223242526]. This phenomenon can be endorsed by the hypothesis we propose.…”

Section: Discussionsupporting

confidence: 60%

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Optimal imaging time for Tc-99m phytate lymphoscintigraphy for sentinel lymph node mapping in patients with breast cancer

Chen

Liu

et al. 2019

Tzu Chi Med J

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Objectives: Sentinel lymph node (SLN) sampling has become a standard practice in managing early-stage breast cancer. Lymphoscintigraphy is one of the major methods used. The radioactive tracer used in Taiwan is Tc-99m phytate. However, this agent is not commonly used around the world and the optimal imaging time has not been studied. Thus, we investigated the optimal imaging time of Tc-99m phytate lymphoscintigraphy for SLN mapping in patients with breast cancer. Materials and Methods: We retrospectively reviewed SLN Tc-99m phytate lymphoscintigraphies in 135 patients with breast cancer between August 2013 and November 2017. The time for the first SLN to be visualized after radiotracer injection was recorded to determine the optimal imaging time. If no SLN was identified on imaging, the scan was continued to 60 min. We also recorded the presurgical technical and clinical factors to analyze the risk factors for nonvisualization of SLN. Each patient's postoperative axillary lymph node status was also recorded. Results: Axillary SLNs were identified on imaging in 94.8% of the patients. All first SLNs presented within 30 min. In 6 of 7 patients with negative imaging, SLNs were identified during surgery using either blue dye or a hand-held gamma probe. Nonvisualization of SLNs on lymphoscintigraphy was significantly associated with a lower injection dose (1.0 mCi vs. 2.0 mCi), 4-injection protocol (compared to 2-injection), and injection around an outer upper quadrant tumor. In addition, patients with axillary lymph node metastasis had a higher percentage of SLN image mapping failure, with a marginally significant difference. Conclusion: Based on our study, 30 min after Tc-99m phytate injection is the optimal time for lymphoscintigraphy and delayed imaging beyond 30 min is not necessary. In addition, a lower injection dose, the 4-injection method, and an injection near the outer upper quadrant tumor should be avoided to minimize nonvisualization of SLNs.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 60%

Optimal imaging time for Tc-99m phytate lymphoscintigraphy for sentinel lymph node mapping in patients with breast cancer

Chen

Liu

et al. 2019

Tzu Chi Med J

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“…Still, this does not entirely clarify the discrepancy in the rate of identified contrast-enhanced lymph nodes by CTL using Lipiodol ® between both studies. Although larger volumes of Lipiodol ® were administered by Kim et al, the effect of larger volumes (>0.5 mL) on SLN identification is dubious and has not been recommended by EANM guidelines, as it may lead to a collapse of lymphatics and an increase in patient discomfort [ 19 , 28 , 29 ]. Presumably, differences in characteristics of the lymphatic system between tumor sites contribute to these contrasting results.…”

Section: Discussionmentioning

confidence: 99%

CT Lymphography Using Lipiodol® for Sentinel Lymph Node Biopsy in Early-Stage Oral Cancer

Mahieu

Donders

Dankbaar

et al. 2022

JCM

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This study evaluated sentinel lymph node (SLN) identification with CT lymphography (CTL) following peritumoral administration of Lipiodol® relative to conventional 99mTc-nanocolloid lymphoscintigraphy (including SPECT/CT) in 10 early-stage oral cancer patients undergoing SLN biopsy. Patients first underwent early dynamic and static scintigraphy after peritumoral administration of 99mTc-nanocolloid. Subsequently, Lipiodol® was administered at the same injection sites, followed by fluoroscopy and CT acquisition. Finally, late scintigraphy and SPECT/CT were conducted, enabling the fusion of late CTL and SPECT imaging. The next day, designated SLNs were harvested, radiographically examined for Lipiodol® uptake and histopathologically assessed. Corresponding images of CT, 99mTc-nanocolloid lymphoscintigraphy and SPECT/late CTL fusion were evaluated. 99mTc-nanocolloid lymphoscintigraphy identified 21 SLNs, of which 7 were identified with CTL (33%). CTL identified no additional SLNs and failed to identify any SLNs in four patients (40%). Out of six histopathologically positive SLNs, two were identified with CTL (33%). Radiographic examination confirmed Lipiodol® uptake in seven harvested SLNs (24%), of which five were depicted with CTL. CTL using Lipiodol® reached a sensitivity of 50% and a negative predictive value (NPV) of 75% (median follow-up: 12.3 months). These results suggest that CTL using Lipiodol® is not a reliable technique for SLN mapping in early-stage oral cancer.

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“…Usually there are a large number of different sources of radiation in these areas; however, during MIRP there is a unique source of radiation: the patient [18]. A large number of studies have been conducted to reduce the dose of radiotracers during surgeries [19][20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive radioguided parathyroid surgery using low-dose Tc-99m-MIBI — comparison with standard high dose

Jangjoo¹,

Sadeghi²,

Mousavi³

et al. 2017

Endokrynologia Polska

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Introduction: Surgery remains the most effective treatment for primary hyperparathyroidism (PHPT). Minimally invasive radioguided parathyroidectomy (MIRP) is a common technique for detecting and excising abnormal parathyroid glands. The aim of this study was to compare injections of low-dose and high-dose (99m) Tc methoxy isobutyl isonitrile (MIBI) for intraoperative localisation of parathyroid adenomas by means of a gamma probe in patients with primary hyperparathyroidism (PHPT). Material and methods: Thirty patients with PHPT and a preoperative diagnosis of parathyroid adenoma were enrolled between 2010 and 2012. They were considered as Group B and underwent MIRP using 5 mCi Tc-99m MIBI, and their perioperative data were compared with twenty patients treated with conventional 20 mCi Tc-99m MIBI previously (Group A). Results: Group A was made up of 20 patients (mean age, 41.55 years; 14 women and 6 men), and group B included 30 patients (mean age, 40.43 years; 19 women and 11 men). The mean serum parathyroid hormone (PTH) and calcium values were recorded pre-and postoperatively. The mean follow-up period for the patients in the two groups was 18.4 and 16.5 months, respectively. Pre-operative evaluation demonstrated that the groups were statistically similar. Intraoperative data and success rate of surgery showed no difference between the two groups. No significant complication was detected after surgeries and no recurrence happened in either of the two groups during the follow-up period. Conclusions: A new protocol of MIRP using low doses of Tc-99m-MIBI resulted in an excellent success rate. Comparing results of the study, we conclude that low-dose Tc-99m-MIBI may be preferred for identification of parathyroid adenomas intraoperatively by means of a gamma probe in PHPT patients because it appears to be as effective as high-dose Tc-99m-MIBI. (Endokrynol Pol 2017; 68 (4): 398-401)

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Effect of radiotracer injection volume on the success of sentinel node biopsy in early-stage breast cancer patients

Cited by 7 publications

References 13 publications

Optimal imaging time for Tc-99m phytate lymphoscintigraphy for sentinel lymph node mapping in patients with breast cancer

Optimal imaging time for Tc-99m phytate lymphoscintigraphy for sentinel lymph node mapping in patients with breast cancer

CT Lymphography Using Lipiodol® for Sentinel Lymph Node Biopsy in Early-Stage Oral Cancer

Minimally invasive radioguided parathyroid surgery using low-dose Tc-99m-MIBI — comparison with standard high dose

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