Optimization of SPIO Injection for Sentinel Lymph Node Dissection in a Rat Model

Peek, Mirjam; Saeki, Kohei; Ohashi, Kunihide; Chikaki, Shinichi; Baker, Rose; Nakagawa, Takayuki; Kusakabe, Moriaki; Douek, Michael; Sekino, Masaki

doi:10.3390/cancers13195031

Cited by 8 publications

(5 citation statements)

References 35 publications

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“…Although injection more than 24 h before surgery was shown to increase detection over peroperative or intraoperative administration, the optimal or maximum interval between SPIO administration and surgery still needs to be defined. It seems that extending the time before surgery allows increased SPIO concentration in the SLN, facilitating identification, a finding in line with experimental data 52 . Several studies 11 , 18 have reported on a time frame that extends up to 27 days in upfront SLNB.…”

Section: Discussionsupporting

confidence: 83%

Evolution and refinement of magnetically guided sentinel lymph node detection in breast cancer: meta-analysis

Pantiora

Tasoulis

Valachis

et al. 2022

British Journal of Surgery

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Background Superparamagnetic iron oxide nanoparticles (SPIO) have been used as a tracer for sentinel lymph node (SLN) localization in breast cancer, demonstrating comparable performance to the combination of radioisotope (RI) and blue dye (BD). Methods A systematic literature search and meta-analysis with subgroup and meta-regression analysis were undertaken to update the available evidence, assess technique evolution, and define knowledge gaps. Recommendations were made using the GRADE approach. Results In 20 comparative studies, the detection rate was 97.5 per cent for SPIO and 96.5 per cent for RI ± BD (risk ratio 1.006, 95 per cent c.i. 0.992 to 1.019; P = 0.376, high-certainty evidence). Neoadjuvant therapy, injection site, injection volume or nodal metastasis burden did not affect the detection rate, but injection over 24 h before surgery increased the detection rate on meta-regression. Concordance was 99.0 per cent and reverse concordance 97.1 per cent (rate difference 0.003, 95 per cent c.i. −0.009 to 0.015; P = 0.656, high-certainty evidence). Use of SPIO led to retrieval of slightly more SLNs (pooled mean 1.96 versus 1.89) with a higher nodal detection rate (94.1 versus 83.5 per cent; RR 1.098, 1.058 to 1.140; P < 0.001; low-certainty evidence). In meta-regression, injection over 24 h before surgery increased the SPIO nodal yield over that of RI ± BD. The skin-staining rate was 30.8 per cent (very low-certainty evidence), and possibly prevented with use of smaller doses and peritumoral injection. Conclusion The performance of SPIO is comparable to that of RI ± BD. Preoperative injection increases the detection rate and nodal yield, without affecting concordance. Whether skin staining and MRI artefacts are reduced by lower dose and peritumoral injection needs to be investigated.

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Section: Discussionsupporting

confidence: 83%

Evolution and refinement of magnetically guided sentinel lymph node detection in breast cancer: meta-analysis

Pantiora

Tasoulis

Valachis

et al. 2022

British Journal of Surgery

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“…The magnetic fields of SLNs in the overall participants and in each group were linearly correlated with their iron content. These data corroborated a previous canine study [13] carried out with ferucarbotran and one with porcine models with another SPIO nanoparticle (Sienna+; Sysmex, Kobe, Japan) [17,18]. The canine study [13] was a preclinical study carried out in spontaneous tumor-bearing dogs.…”

Section: Discussionsupporting

confidence: 86%

“…These data corroborated a previous canine study [13] carried out with ferucarbotran and one with porcine models with another SPIO nanoparticle (Sienna+; Sysmex, Kobe, Japan) [17,18]. The canine study [13] was a preclinical study carried out in spontaneous tumor-bearing dogs. Ferucarbotran was shown to be non-inferior to dye in detection of SLNs on veterinary clinical cases.…”

Section: Discussionsupporting

confidence: 86%

“…This study, which is part of the AMED-supported project, "Research and Development of Medical Devices and Systems for Future Medical Care, Research and Development Project for Minimally Invasive Cancer Treatment Devices" (2015-March 2019), aims to optimize our technique by evaluating whether half of the original dose of SPIO nanoparticles can lead to equivalent results in SLN localization in diagnosis and staging metastatic breast cancer via biopsy. We based this project on a canine study conducted at the Laboratory of Veterinary Surgery of the University of Tokyo that showed the accumulation of a sufficient amount of iron in dog SLNs 24 h after the administration of SPIO nanoparticles [13].…”

Section: Introductionmentioning

confidence: 99%

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Exploratory Study of Superparamagnetic Iron Oxide Dose Optimization in Breast Cancer Sentinel Lymph Node Identification Using a Handheld Magnetic Probe and Iron Quantitation

Taruno

Kuwahata

Sekino

et al. 2022

Cancers

Self Cite

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This exploratory study compared doses of ferucarbotran, a superparamagnetic iron oxide nanoparticle, in sentinel lymph nodes (SLNs) and quantified the SLN iron load by dose and localization. Eighteen females aged ≥20 years scheduled for an SLN biopsy with node-negative breast cancer were divided into two equal groups and administered either 1 mL or 0.5 mL ferucarbotran. Iron content was evaluated with a handheld magnetometer and quantification device. The average iron content was 42.8 µg (range, 1.3–95.0; 0.15% of the injected dose) and 21.9 µg (1.1–71.0; 0.16%) in the 1-mL and 0.5-mL groups, respectively (p = 0.131). The iron content of the closest SLN compared to the second SLN was 53.0 vs. 10.0 µg (19% of the injected dose) and 34.8 vs. 4.1 µg (11.1%) for the 1-mL and 0.5-mL groups, respectively (p = 0.001 for both). The magnetic field was high in both groups (average 7.30 µT and 6.00 µT in the 1-mL and 0.5-mL groups, respectively) but was not statistically significant (p = 0.918). The magnetic field and iron content were correlated (overall SLNs, p = 0.02; 1-mL, p = 0.014; 0.5-mL, p = 0.010). A 0.5-mL dose was sufficient for SLN identification. Primary and secondary SLNs could be differentiated based on iron content. Handheld magnetometers could be used to assess the SLN iron content.

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“…In contrast, the RI probe can detect the radiation beam directly from SLNs [39]. Peek et al investigated injection characteristics of the magnetic tracer on the rat model, proving that iron uptake appears to be proportional to the injection dose before reaching a plateau level [40]. This outcome suggests that each lymph node presents maximum magnetic particles load depending on the size and location of the SLN.…”

Section: Discussionmentioning

confidence: 99%

A Propensity Score Matched Analysis of Superparamagnetic Iron Oxide versus Radioisotope Sentinel Node Biopsy in Breast Cancer Patients after Neoadjuvant Chemotherapy

Pelc

Skórzewska

Kurylcio

et al. 2022

Cancers

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The standard method for nodal staging in breast cancer (BC) patients after neoadjuvant chemotherapy (NAC) is sentinel lymph node biopsy (SLNB) with a radioisotope (RI) injection. However, SLNB after NAC results in high false-negative rates (FNR), and the RI method is restricted by nuclear medicine unit dependency. These limitations resulted in the development of the superparamagnetic iron oxide (SPIO) method, reducing FNR and presenting a comparable detection rate. This bi-institutional cohort comparison study aimed to assess the efficacy of SPIO and radioisotope SNLB in BC patients after NAC using Propensity Score Matching (PSM) analysis. The study group comprised 508 patients who underwent SLNB after NAC for ycT1-4N0M0 BC between 2013 and 2021 in two high volume centers. Data were retrieved from prospectively conducted databases. In the SPIO group, the median of retrieved sentinel lymph nodes (SLNs) was significantly higher than in the RI group (3 vs. 2; p < 0.0001). The SPIO method was associated with a significantly higher chance of retrieving at least three lymph nodes when compared to the RI method (71% vs. 11.3%; p < 0.0001). None of the analyzed demographic and clinical variables had a statistically significant influence on the efficacy of SLNs retrieval in the RI group, while in the SPIO group, patients with ≥ three harvested SLNs had lower weight and decreased BMI. Based on this PSM analysis, SPIO-guided SLNB allowed the efficient retrieval and detection of SLNs in BC patients after NAC compared to RI.

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Optimization of SPIO Injection for Sentinel Lymph Node Dissection in a Rat Model

Cited by 8 publications

References 35 publications

Evolution and refinement of magnetically guided sentinel lymph node detection in breast cancer: meta-analysis

Evolution and refinement of magnetically guided sentinel lymph node detection in breast cancer: meta-analysis

Exploratory Study of Superparamagnetic Iron Oxide Dose Optimization in Breast Cancer Sentinel Lymph Node Identification Using a Handheld Magnetic Probe and Iron Quantitation

A Propensity Score Matched Analysis of Superparamagnetic Iron Oxide versus Radioisotope Sentinel Node Biopsy in Breast Cancer Patients after Neoadjuvant Chemotherapy

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