Is It Necessary to Harvest Additional Lymph Nodes after Resection of the Most Radioactive Sentinel Lymph Node in Breast Cancer?

Liu, Liang‐Chih; Lang, Julie E.; Jenkins, Tyler J.; Lu, Ying; Ewing, Cheryl A.; Hwang, Shelley; Sokol, Shima; Alvarado, Michael; Esserman, Laura J.; Morita, Eugene; Treseler, Patrick A.; Leong, Stanley P. L.

doi:10.1016/j.jamcollsurg.2008.08.008

Cited by 22 publications

(10 citation statements)

References 35 publications

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“…The SLN with the highest radioactive count may be the most likely to harbor tumor cells. Studies in patients with breast cancer reported a considerable false‐negative rate of SLNB (9% to 29%) if only the hottest SLN was removed 27–31. Atula et al32 demonstrated that, in Oropharyngeal SCC, it was sufficient to dissect the 3 hottest lymph nodes, which is in line with our results, because in all patients the occult metastases were detected in the 2 hottest SLNs of each level.…”

Section: Discussionsupporting

confidence: 89%

Occult metastases detected by sentinel node biopsy in patients with early oral and oropharyngeal squamous cell carcinomas: Impact on survival

et al. 2012

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Section: Discussionsupporting

confidence: 89%

Occult metastases detected by sentinel node biopsy in patients with early oral and oropharyngeal squamous cell carcinomas: Impact on survival

et al. 2012

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“…The (28,29). As to the location of SLNs in these studies, lymphatic drainage from the breast was described to include the axilla, internal mammary chain, supraclavicular nodes, interpectoral nodes, and intramammary LNs (30,31), which were clearly displayed using lymphoscintigraphy. The SLNs in previous studies were found in the axilla, internal mammary, and supraclavicular nodes.…”

Section: Discussionmentioning

confidence: 99%

Clinical Evaluation of ^99mTc-Rituximab for Sentinel Lymph Node Mapping in Breast Cancer Patients

Wang

Lin

et al. 2016

J Nucl Med

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The metastatic status of sentinel lymph nodes (SLNs) might be the most important prognostic factor in breast cancer. In this paper, we report to our knowledge the first study of 99m Tc-rituximab as a radiotracer for imaging of SLNs using lymphoscintigraphy in both preoperative and intraoperative breast cancer patients. Methods: 99m Tcrituximab was designed as an SLN tracer targeting the CD20 antigen, which expresses extensively in LNs. A retrospective study was performed on 2,317 patients with primary breast cancer who underwent lymphoscintigraphy and sentinel lymph node biopsy (SLNB). Before imaging, all patients were administered a preoperative peritumoral injection of 37 MBq of 99m Tc-rituximab. Results: 99m Tc-rituximab was synthesized in both high radiolabeling yield and high radiochemical purity (.95%), with molecular integrity and immune activity well maintained. The initial study of 100 breast cancer patients showed that the success rate of SLN lymphoscintigraphy by injection of 99m Tc-rituximab, as compared with SLNB, was 100%, and the sensitivity, specificity, accuracy, and false negative rate were 97.4%, 100%, 98.0%, and 2.60%, respectively. Of the following 2,217 patients studied, the success rate of lymphoscintigraphy and SLNB was 98.8% and 99.9%, and the average number of SLN was 1.78 (range, 1-10) and 2.85 (range, 1-15). Age was an independent predictor of the number of SLNs identified by lymphoscintigraphy and intraoperative handheld γ-probe (P , 0.05), and other factors-such as sex, imaging time, primary tumor site, histopathologic subtype, clinical T stage, and immunochemistry-were not (P . 0.05). However, the SLN metastatic rates were different in patients with different histopathologic subtype, clinical T stage, and immunochemistry (P , 0.05). Conclusion: Here we report the first study of the new radiotracer 99m Tc-rituximab for breast cancer lymphoscintigraphy. This tracer showed great feasibility, safety, and effectiveness for SLN mapping in breast cancer patients.

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“…Although a “stopping rule” for a receptor-targeted agent such as [ 99m Tc]tilmanocept will require a separate study and may not be at all similar to the rule used for particulate radiotracers, a comparison of our results to the “10 % rule,” which is used for unfiltered and filtered [ 99m Tc]labeled sulfur colloid may be instructive 18 , 37 – 40. The “10 % rule” and the “3-sigma rule” identified the same number of patients ( n = 146) with at least 1 “hot” lymph node.…”

Section: Discussionmentioning

confidence: 99%

Comparative Evaluation of [99mTc]Tilmanocept for Sentinel Lymph Node Mapping in Breast Cancer Patients: Results of Two Phase 3 Trials

et al. 2013

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BackgroundSentinel lymph node (SLN) surgery is used worldwide for staging breast cancer patients and helps limit axillary lymph node dissection. [99mTc]Tilmanocept is a novel receptor-targeted radiopharmaceutical evaluated in 2 open-label, nonrandomized, within-patient, phase 3 trials designed to assess the lymphatic mapping performance.MethodsA total of 13 centers contributed 148 patients with breast cancer. Each patient received [99mTc]tilmanocept and vital blue dye (VBD). Lymph nodes identified intraoperatively as radioactive and/or blue stained were excised and histologically examined. The primary endpoint, concordance (lower boundary set point at 90 %), was the proportion of nodes detected by VBD and [99mTc]tilmanocept.ResultsA total of 13 centers contributed 148 patients who were injected with both agents. Intraoperatively, 207 of 209 nodes detected by VBD were also detected by [99mTc]tilmanocept for a concordance rate of 99.04 % (p < 0.0001). [99mTc]tilmanocept detected a total of 320 nodes, of which 207 (64.7 %) were detected by VBD. [99mTc]Tilmanocept detected at least 1 SLN in more patients (146) than did VBD (131, p < 0.0001). In 129 of 131 patients with ≥1 blue node, all blue nodes were radioactive. Of 33 pathology-positive nodes (18.2 % patient pathology rate), [99mTc]tilmanocept detected 31 of 33, whereas VBD detected only 25 of 33 (p = 0.0312). No pathology-positive SLNs were detected exclusively by VBD. No serious adverse events were attributed to [99mTc]tilmanocept.Conclusion[99mTc]Tilmanocept demonstrated success in detecting a SLN while meeting the primary endpoint. Interestingly, [99mTc]tilmanocept was additionally noted to identify more SLNs in more patients. This localization represented a higher number of metastatic breast cancer lymph nodes than that of VBD.

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Is It Necessary to Harvest Additional Lymph Nodes after Resection of the Most Radioactive Sentinel Lymph Node in Breast Cancer?

Cited by 22 publications

References 35 publications

Occult metastases detected by sentinel node biopsy in patients with early oral and oropharyngeal squamous cell carcinomas: Impact on survival

Occult metastases detected by sentinel node biopsy in patients with early oral and oropharyngeal squamous cell carcinomas: Impact on survival

Clinical Evaluation of ^99mTc-Rituximab for Sentinel Lymph Node Mapping in Breast Cancer Patients

Comparative Evaluation of [99mTc]Tilmanocept for Sentinel Lymph Node Mapping in Breast Cancer Patients: Results of Two Phase 3 Trials

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Is It Necessary to Harvest Additional Lymph Nodes after Resection of the Most Radioactive Sentinel Lymph Node in Breast Cancer?

Cited by 22 publications

References 35 publications

Occult metastases detected by sentinel node biopsy in patients with early oral and oropharyngeal squamous cell carcinomas: Impact on survival

Occult metastases detected by sentinel node biopsy in patients with early oral and oropharyngeal squamous cell carcinomas: Impact on survival

Clinical Evaluation of 99mTc-Rituximab for Sentinel Lymph Node Mapping in Breast Cancer Patients

Comparative Evaluation of [99mTc]Tilmanocept for Sentinel Lymph Node Mapping in Breast Cancer Patients: Results of Two Phase 3 Trials

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Clinical Evaluation of ^99mTc-Rituximab for Sentinel Lymph Node Mapping in Breast Cancer Patients