Skip to main content
SpringerLink
Log in

Radiopharmaceuticals for sentinel lymph node identification in breast cancer

  • Published:
Journal of Radioanalytical and Nuclear Chemistry Aims and scope Submit manuscript

Abstract

Breast cancer is still one of the substantial malignancies with high mortalities which early and accurate diagnosis is very decisive in providing long survival. Nuclear medicine lately introduced a novel way for evaluation of breast cancer in early and advanced stages. This method is based on sentinel lymph node scintigraphy which is more preferable over axillary lymphadenectomy, since it results in less postoperative morbidity. For this aim radiocolloids have superlative impress for detection of metastatic lymph nodes. In this short review we will try to introduce radiopharmaceuticals which play an important role in clinical application of BC lymphoscintigraphy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Bayat Z, Saeedzadeh E, Vahidfar N, Sadeghi M, Farzenefar S, Daha FJ, Salehi Y (2022) Preparation and validation of [67Ga] Ga-phytate kit and Monte Carlo dosimetry: an effort toward developing an impressive lymphoscintigraphy tracer. J Radioanal Nucl Chem 331:691–700

    Article  CAS  Google Scholar 

  2. Krynyckyi BR, Kim CK, Goyenechea MR, Chan PT, Zhang Z-Y, Machac J (2004) Clinical breast lymphoscintigraphy: optimal techniques for performing studies, image atlas, and analysis of images. Radiographics 24:121–145

    Article  PubMed  Google Scholar 

  3. Pohlodek K, Bozikova S, Meciarova I, Mucha V, Bartova M, Ondrias F (2016) Prediction of additional lymph node involvement in breast cancer patients with positive sentinel lymph nodes. Neoplasma 63:427–434

    Article  CAS  PubMed  Google Scholar 

  4. Schildberg F, Löhe F (1996) Basic principles and value of lymphadenectomy in breast carcinoma. Der Chirurg Zeitschrift fur Alle Gebiete der Operativen Medizen 67:771–778

    Article  CAS  PubMed  Google Scholar 

  5. Cools-Lartigue J, Sinclair A, Trabulsi N, Meguerditchian A, Mesurolle B, Fuhrer R, Meterissian S (2013) Preoperative axillary ultrasound and fine-needle aspiration biopsy in the diagnosis of axillary metastases in patients with breast cancer: predictors of accuracy and future implications. Ann Surg Oncol 20:819–827

    Article  PubMed  Google Scholar 

  6. Kwan W, Jackson J, Weir LM, Dingee C, McGregor G, Olivotto IA (2002) Chronic arm morbidity after curative breast cancer treatment: prevalence and impact on quality of life. J Clin Oncol 20:4242–4248

    Article  PubMed  Google Scholar 

  7. Fleissig A, Fallowfield LJ, Langridge CI, Johnson L, Newcombe RG, Dixon JM, Kissin M, Mansel RE (2006) Post-operative arm morbidity and quality of life. Results of the ALMANAC randomised trial comparing sentinel node biopsy with standard axillary treatment in the management of patients with early breast cancer. Breast Cancer Res Treat 95:279–293

    Article  PubMed  Google Scholar 

  8. Giammarile F, Alazraki N, Aarsvold JN, Audisio RA, Glass E, Grant SF, Kunikowska J, Leidenius M, Moncayo VM, Uren RF (2013) The EANM and SNMMI practice guideline for lymphoscintigraphy and sentinel node localization in breast cancer. Eur J Nucl Med Mol Imaging 40:1932–1947

    Article  CAS  PubMed  Google Scholar 

  9. Tsopelas C (2001) Particle size analysis of 99mTc-labeled and unlabeled antimony trisulfide and rhenium sulfide colloids intended for lymphoscintigraphic application. J Nucl Med 42:460–466

    CAS  PubMed  Google Scholar 

  10. Higashi H, Natsugoe S, Uenosono Y, Ehi K, Arigami T, Nakabeppu Y, Nakajo M, Aikou T (2004) Particle size of tin and phytate colloid in sentinel node identification1. J Surg Res 121:1–4

    Article  CAS  PubMed  Google Scholar 

  11. Gommans G, Van Dongen A, van der Schors T, Gommans E, Visser J, Clarijs W, de Waard J, Van de Bos J, Boer R (2001) Further optimisation of 99mTc-Nanocoll sentinel node localisation in carcinoma of the breast by improved labelling. Eur J Nucl Med 28:1450–1455

    Article  CAS  PubMed  Google Scholar 

  12. Jimenez IR, Roca M, Vega E, García ML, Benitez A, Bajén M, Martín-Comín J (2008) Particle sizes of colloids to be used in sentinel lymph node radiolocalization. Nucl Med Commun 29:166–172

    Article  PubMed  Google Scholar 

  13. Vidal-Sicart S (2013) Pre-and intra-operative imaging techniques for sentinel node localization in breast cancer. Europe 100:5–80

    Google Scholar 

  14. Hung JC, Wiseman GA, Wahner HW, Mullan BP, Taggart TR, Dunn WL (1995) Filtered technetium-99m-sulfur colloid evaluated for lymphoscintigraphy. J Nucl Med 36:1895–1901

    CAS  PubMed  Google Scholar 

  15. Wilhelm AJ, Mijnhout GS, Franssen EJ (1999) Radiopharmaceuticals in sentinel lymph-node detection–an overview. Eur J Nucl Med 26:S36–S42

    Article  CAS  PubMed  Google Scholar 

  16. Aliakbarian M, Memar B, Jangjoo A, Zakavi SR, Kakhki VRD, Aryana K, Forghani MN, Sadeghi R (2011) Factors influencing the time of sentinel node visualization in breast cancer patients using intradermal injection of the radiotracer. Am J Surg 202:199–202

    Article  PubMed  Google Scholar 

  17. Uren R, Howman-Giles R, Chung D, Spillane A, Noushi F, Gillett D, Gluch L, Mak C, West R, Briody J (2012) SPECT/CT scans allow precise anatomical location of sentinel lymph nodes in breast cancer and redefine lymphatic drainage from the breast to the axilla. The Breast 21:480–486

    Article  CAS  PubMed  Google Scholar 

  18. Frier M (2002) Radiopharmaceuticals for sentinel node detection. Braz Arch Biol Technol 45:83–86

    Article  CAS  Google Scholar 

  19. Lyman GH, Giuliano AE, Somerfield MR, Benson AB, Bodurka DC, Burstein HJ, Cochran AJ, Cody HS, Edge SB, Galper S (2005) American society of clinical oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol 23:7703–7720

    Article  PubMed  Google Scholar 

  20. David R (2001) A synthetic macromolecule for sentinel node detection:^< 99m> Tc-DTPA-Mannosyl-Dextran. Nucl Med 42:951–959

    Google Scholar 

  21. De Cicco C, Cremonesi M, Luini A, Bartolomei M, Grana C, Prisco G, Galimberti V, Calza P, Viale G, Veronesi U (1998) Lymphoscintigraphy and radioguided biopsy of the sentinel axillary node in breast cancer. J Nucl Med 39:2080–2084

    PubMed  Google Scholar 

  22. De Cicco C, Cremonesi M, Chinol M, Bartolomei M, Pizzamiglio M, Leonardi L, Fiorenza M, Paganelli G (1997) Optimization of axillary lymphoscintigraphy to detect the sentinel node in breast cancer. Tumori J 83:539–541

    Article  Google Scholar 

  23. Keshtgar M, Ell P (1999) Sentinel lymph node detection and imaging. Eur J Nucl Med 26:57–67

    Article  CAS  PubMed  Google Scholar 

  24. Giuliano AE, Kirgan DM, Guenther JM, Morton DL (1994) Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg 220:391

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Ferrucci M, Franceschini G, Douek M (2018) New techniques for sentinel node biopsy in breast cancer. Transl Cancer Res 7(3):405–417

  26. Alavi A, Staum MM, Shesol BF, Bloch PH (1978) Technetium-99m stannous phytate as an imaging agent for lymph nodes. J Nucl Med 19:422–426

    CAS  PubMed  Google Scholar 

  27. Moslehi M, Shanei A, Hakimian SMR, Mahmoudi G, Baradaran-Ghahfarokhi M (2015) 99mTc-phytate lymphoscintigraphy for detection of sentinel node: preliminary results of the first year’s clinical experience in Isfahan. Iran J Med Signals Sens 5:69

    Article  PubMed  Google Scholar 

  28. Tavares MG, Sapienza MT, Galeb NA, Belfort FA, Costa RR, Osório CA, Góes JC, Endo IS, Soares J, Lewin S (2001) The use of 99mTc-phytate for sentinel node mapping in melanoma, breast cancer and vulvar cancer: a study of 100 cases. Eur J Nucl Med 28:1597–1604

    Article  CAS  PubMed  Google Scholar 

  29. Takei H, Suemasu K, Kurosumi M, Ninomiya J, Horii Y, Inoue K, Tabei T (2006) 99mTc-phytate is better than 99mTc-human serum albumin as a radioactive tracer for sentinel lymph node biopsy in breast cancer. Surg Today 36:219–224

    Article  CAS  PubMed  Google Scholar 

  30. Eshima S, Fauconnier T, Eshima L, Thornback JR (2000) Radiopharmaceuticals for lymphoscintigraphy: including dusimetry and radiation considerations. Seminars in nuclear medicine. Elsevier, pp 25–32

    Google Scholar 

  31. Szuba A, Shin WS, Strauss HW, Rockson S (2003) The third circulation: radionuclide lymphoscintigraphy in the evaluation of lymphedema. J Nucl Med 44:43–57

    PubMed  Google Scholar 

  32. Walker LA (1950) Localization of radioactive colloids in lymph nodes. J Lab Clin Med 36:440–449

    CAS  PubMed  Google Scholar 

  33. Moreira D, Koskinas M, Dias M, Yamazaki I (2010) Determination of 198Au X-rays emission probabilities. Appl Radiat Isot 68:1566–1570

    Article  CAS  PubMed  Google Scholar 

  34. Pasqualini R, Janevik-Ivanovska E (2015) Basic description of the lymphatic system from the perspective of SLN uptake of radioactive tracers.

  35. Hultborn K, Larsson L-G, Ragnhult I (1955) The lymph drainage from the breast to the axillary and parasternal lymph nodes, studied with the aid of colloidal AU198. Acta Radiol 43:52–64

    Article  CAS  PubMed  Google Scholar 

  36. Whitman GJ, AlHalawani RH, Karbasian N, Krishnamurthy R (2019) Sentinel lymph node evaluation: what the radiologist needs to know. Diagnostics 9:12

    Article  PubMed  PubMed Central  Google Scholar 

  37. Borgstein PJ, Pijpers R, Comans EF, Van Diest PJ, Boom RP, Sybren Meijer M (1998) Sentinel lymph node biopsy in breast cancer: guidelines and pitfalls of lymphoscintigraphy and gamma probe detection. J Am Coll Surg 186:275–283

    Article  CAS  PubMed  Google Scholar 

  38. Feldman SM, Krag DN, McNally RK, Moor BB, Weaver DL, Klein P (1999) Limitation in gamma probe localization of the sentinel node in breast cancer patients with large excisional biopsy. J Am Coll Surg 188:248–254

    Article  CAS  PubMed  Google Scholar 

  39. Miner TJ, Shriver CD, Jaques DP, Maniscalco-Theberge ME, Krag DN (1999) Sentinel lymph node biopsy for breast cancer: the role of previous biopsy on patient eligibility/discussion. Am Surg 65:493

    Article  CAS  PubMed  Google Scholar 

  40. Van der Ent F, Kengen R, Van der Pol H, Hoofwijk A (1999) Sentinel node biopsy in 70 unselected patients with breast cancer: increased feasibility by using 10 mCi radiocolloid in combination with a blue dye tracer. Eur J Surg Oncol (EJSO) 25:24–29

    Article  PubMed  Google Scholar 

  41. Mariani G, Gipponi M, Moresco L, Villa G, Bartolomei M, Mazzarol G, Bagnara MC, Romanini A, Cafiero F, Paganelli G (2002) Radioguided sentinel lymph node biopsy in malignant cutaneous melanoma. J Nucl Med 43:811–827

    PubMed  Google Scholar 

  42. Mango L, Ventroni G, Michelini S (2017) Lymphoscintigraphy and clinic. Res Rev Insights 1:1

    Article  Google Scholar 

  43. Thakor AS, Jokerst JV, Ghanouni P, Campbell JL, Mittra E, Gambhir SS (2016) Clinically approved nanoparticle imaging agents. J Nucl Med 57:1833–1837

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Pijpers R, Meijer S, Hoekstra OS, Collet GJ, Comans EF, Boom RP, Van Diest PJ, Teule GJ (1997) Impact of lymphoscintigraphy on sentinel node identification with technetium-99m-colloidal albumin in breast cancer. J Nucl Med 38:366–368

    CAS  PubMed  Google Scholar 

  45. Uren RF, Howman-Giles RB, Thompson JF, Malouf D, Ramsey-Stewart G, Niesche FW, Renwick SB (1995) Mammary lymphoscintigraphy in breast cancer. J Nucl Med 36:1775–1780

    CAS  PubMed  Google Scholar 

  46. Noronha O, Sewatkar A (1986) Comparison of three RE agents—99mTc-phytate, 99mTc-sulfur colloid and 99mTc-Sb2S3 colloid in the rodent species. Int J Radiat Appl Instrum Part B Nucl Med Biology 13:67–73

    Article  CAS  Google Scholar 

  47. Shimazu K, Tamaki Y, Taguchi T, Motomura K, Inaji H, Koyama H, Kasugai T, Wada A, Noguchi S (2003) Lymphoscintigraphic visualization of internal mammary nodes with subtumoral injection of radiocolloid in patients with breast cancer. Ann Surg 237:390

    Article  PubMed  PubMed Central  Google Scholar 

  48. Dabbagh Kakhki VR, Jangjoo A, Tavassoli A, Asadi M, Sadri K, Fatahi Masoom A, Mehrabibahar M, Memar B, Ansari M, Sadeghi R (2012) Sentinel node mapping for early breast cancer patients using 99mTc-phytate: single center experience on 165 patients. Iran J Nucl Med 20:25–29

    Google Scholar 

  49. Hauser W, Atkins H, Richards P (1969) Lymph node scanning with 99mTc-sulfur colloid. Radiology 92:1369–1371

    Article  CAS  PubMed  Google Scholar 

  50. McCarter MD, Yeung H, Yeh S, Fey J, Borgen PI, Cody HS (2001) Localization of the sentinel node in breast cancer: identical results with same-day and day-before isotope injection. Ann Surg Oncol 8:682–686

    Article  CAS  PubMed  Google Scholar 

  51. Gray RJ, Pockaj BA, Roarke MC (2004) Injection of 99mTc-labeled sulfur colloid the day before operation for breast cancer sentinel lymph node mapping is as successful as injection the day of operation. Am J Surg 188:685–689

    Article  PubMed  Google Scholar 

  52. Zhang J-J, Zhang W-C, An C-X, Li X-M, Ma L (2019) Comparative research on 99mTc-Rituximab and 99mTc-sulfur colloid in sentinel lymph node imaging of breast cancer. BMC Cancer 19:1–7

    Google Scholar 

  53. Sadeghi R, Zakavi SR, Forghani MN, Aryana K, Kakhki VRD, Ayati NK, Shandiz FH, Ghavamnasiri MR, Keshtgar M (2010) The efficacy of Tc-99m sestamibi for sentinel node mapping in breast carcinomas: comparison with Tc-99m antimony sulphide colloid. Nucl Med Rev 13:1–4

    Google Scholar 

  54. Engering AJ, Cella M, Fluitsma D, Brockhaus M, Hoefsmit EC, Lanzavecchia A, Pieters J (1997) The mannose receptor functions as a high capacity and broad specificity antigen receptor in human dendritic cells. Eur J Immunol 27:2417–2425

    Article  CAS  PubMed  Google Scholar 

  55. Wallace AM, Han LK, Povoski SP, Deck K, Schneebaum S, Hall NC, Hoh CK, Limmer KK, Krontiras H, Frazier TG (2013) Comparative evaluation of [99mTc] tilmanocept for sentinel lymph node mapping in breast cancer patients: results of two phase 3 trials. Ann Surg Oncol 20:2590–2599

    Article  PubMed  PubMed Central  Google Scholar 

  56. Rietbergen D, Arias-Bouda LP, van der Hage J, Olmos RV (2021) Does 99mTc-tilmanocept, as next generation radiotracer, meet with the requirements for improved sentinel node imaging? Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) 40:275–280

    Article  CAS  PubMed  Google Scholar 

  57. Surasi DS, O’Malley J, Bhambhvani P (2015) 99mTc-Tilmanocept: a novel molecular agent for lymphatic mapping and sentinel lymph node localization. J Nucl Med Technol 43:87–91

    Article  PubMed  Google Scholar 

  58. Leong SP, Kim J, Ross M, Faries M, Scoggins CR, Rich Metz WL, Cope FO, Orahood RC (2011) A phase 2 study of 99mTc-tilmanocept in the detection of sentinel lymph nodes in melanoma and breast cancer. Ann Surg Oncol 18:961–969

    Article  PubMed  PubMed Central  Google Scholar 

  59. Tausch C, Baege A, Rageth C (2014) Mapping lymph nodes in cancer management–role of 99mTc-tilmanocept injection. Onco Targets Ther 7:1151

    Article  PubMed  PubMed Central  Google Scholar 

  60. Rezende dos Reis S, Oliveira TD, Cavalcanti da Silva L, Pinto S, Marta de Souza A, Santos-Oliveira R (2016) PET radiopharmaceuticals and PET/CT technology: comparative numbers of Brazil, India, Canada and Latin America. Austin J Nucl Med Radiother3(1):1016

  61. Crișan G, Moldovean-Cioroianu NS, Timaru D-G, Andrieș G, Căinap C, Chiș V (2022) Radiopharmaceuticals for PET and SPECT imaging: a literature review over the last decade. Int J Mol Sci 23:5023

    Article  PubMed  PubMed Central  Google Scholar 

  62. Heuveling DA, Karagozoglu KH, Van Lingen A, Hoekstra OS, Van Dongen GA, De Bree R (2018) Feasibility of intraoperative detection of sentinel lymph nodes with 89-zirconium-labelled nanocolloidal albumin PET-CT and a handheld high-energy gamma probe. EJNMMI Res 8:1–6

    Article  CAS  Google Scholar 

  63. Ankersmit M, Hoekstra O, Van Lingen A, Bloemena E, Jacobs M, Vugts D, Bonjer H, van Dongen G, Meijerink W (2019) Perioperative PET/CT lymphoscintigraphy and fluorescent real-time imaging for sentinel lymph node mapping in early staged colon cancer. Eur J Nucl Med Mol Imaging 46:1495–1505

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Mahieu R, Krijger GC, Ververs FT, de Roos R, de Bree R, de Keizer B (2021) [68Ga] Ga-tilmanocept PET/CT lymphoscintigraphy: a novel technique for sentinel lymph node imaging. 48:963–965

  65. Hou G, Jiang Y, Xu W, Zhu Z, Huo L, Chen X, Li F, Xu K-F, Cheng W (2021) 68Ga-NOTA-evans blue PET/CT findings in lymphangioleiomyomatosis compared with 99mTC-ASC lymphoscintigraphy: a prospective study. Orphanet J Rare Dis 16:279

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Fahime Shahsavari, Mohsen Bakhshi Kashi, Saeed Farzanefar & Nasim Vahidfar

  2. Faculty of Medicine, University Clinic for Radiology and Nuclear Medicine, Otto von Guericke University (OvGU), 39120, Magdeburg, Germany

    Elisabeth Eppard

Authors
  1. Fahime Shahsavari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohsen Bakhshi Kashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Saeed Farzanefar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elisabeth Eppard
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nasim Vahidfar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nasim Vahidfar.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shahsavari, F., Bakhshi Kashi, M., Farzanefar, S. et al. Radiopharmaceuticals for sentinel lymph node identification in breast cancer. J Radioanal Nucl Chem 332, 2409–2417 (2023). https://doi.org/10.1007/s10967-023-08915-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10967-023-08915-3

Keywords

Search

Navigation