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Effect of increased 99mTc/99Tc ratios on count rates in sentinel node procedures: a randomised study

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Abstract

The aim of this study was to evaluate the count rates of sentinel lymph nodes (SLNs) in patients with breast cancer in the operating theatre, using 99mTc-Nanocoll with different ratios of technetium-99m to technetium-99. After written informed consent had been obtained, we tested different ratios of 99mTc/99Tc-Nanocoll in a double-blinded randomised study performed in 161 patients. Twenty-five MBq/μg 99mTc-colloid albumin was prepared in vacuum. In 87 patients (group A) a 2-h elution was used and in 74 patients (group B) a 24-h elution was used. Patients were subcategorised into subgroups 1 and 3, in which an SLN procedure for breast carcinoma was performed simultaneously with lumpectomy, and subgroups 2 and 4, in which an SLN procedure was performed 2–3 weeks after prior excision biopsy. All patients were injected along the lateral border of the areola (two injections: 50 MBq/0.3 ml intradermally and 50 MBq/2 ml intraparenchymally). Ex vivo measurement of count rates was performed with a gamma probe. Comparing groups A and B in respect of registered counts per second (cps) of excised SLNs, a significant difference was found (P<0.004). When comparisons were made between subgroups 1 and 2 (2-h elution) and between subgroups 3 and 4 (24-h elution) in respect of registered cps of excised SLNs, no significant difference was found (subgroup 1 vs 2, P=0.825; subgroup 3 vs 4, P=0.915). Use of a 2-h elution in vacuum yielded a significantly higher count rate of maximum specific activity of 99mTc-colloid albumin in SLNs than was achieved using a 24-h elution in vacuum. SLN procedures performed 2–3 weeks after prior excision biopsy proved reliable as compared to SLN procedures performed simultaneously with lumpectomy.

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References

  1. Cabanas RM. An approach for the treatment of penile carcinoma. Cancer 1977; 39:456–466.

    PubMed  Google Scholar 

  2. Krag DN, Weaver DL, Alex JC, Fairbank JC. Surgical resection and radiolocalisation of the sentinel node in breast cancer using a gammaprobe. Surg Oncol 1993; 2:335–339.

    CAS  PubMed  Google Scholar 

  3. Borgstein PJ, Pijpers R, Comans EF, van Diest PJ, Boom RP, Meijer S. Sentinel lymph node biopsy in breast cancer: guidelines and pitfalls of lymphoscintigraphy and gamma probe detection. J Am Coll Surg 1998; 186:275–283.

    CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  5. Haigh PI, Hansen NM, Guilliano AE, Edwards GK, Ye W, Glass EC. Factors affecting sentinel node localisation during preoperative breast lymphoscintigraphy. J Nucl Med 2000; 41:1682–1688.

    Google Scholar 

  6. Kaufman CS, Jacobson-Kaufman L, Thorndike-Christ T, Kaufman L, Tabar L. A treatment scale for axillary management in breast cancer. Am J Surg 2001; 182:377–383.

    CAS  PubMed  Google Scholar 

  7. Van de Ent FWC, Kengen RAM, van der Poll HAG, Hoofdwijk AGM. 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 1999; 25:24–29.

    Article  PubMed  Google Scholar 

  8. Bostick PJ, Giuliano AE. Vital dues in sentinel node localisation. Semin Nucl Med 2000; 1:18–24.

    Google Scholar 

  9. Kaplan WD, Davies MA, Rose CHN. A comparison of two technetium-99m labelled radiopharmaceuticals for lymphoscintigraphy: concise communication. J Nucl Med 1979; 20:933–937.

    Google Scholar 

  10. Valdés Olmos RA, Hoefnagel CA, Nieweg OE, Jansen L, Rutgers EJT, Borger J, Horenblas S, Kroon BBR. Lymphoscintigraphy in oncology: a rediscovered challenge Eur J Nucl Med 1999; 226 (Suppl):S2–S10.

  11. Imoto S, Murakami K, Ikeda H, Fukukita H, Moriyama N. Mammary lymphoscintigraphy with various radiopharmaceuticals in breast cancer. Ann Nucl Med 1999; 13:325–329.

    CAS  PubMed  Google Scholar 

  12. Edreira MM, Colombo LL, Perez JH, Sajaroff EO, Castiglia SG. In vivo evaluation of three different 99m-Tc labelled radiopharmaceuticals for sentinel lymph node identification. Nucl Med Commun 2001; 22:499–504.

    Article  CAS  PubMed  Google Scholar 

  13. Hodgson N, Zabel P, Mattar AG, Engel CJ, Girvan D, Holliday R. A new radiopharmaceutical for sentinel node detection in breast cancer. Ann Surg Oncol 2001; 8:1333–1337.

    Google Scholar 

  14. Mariani G, Moresco L, Viaale G, et al. Radioguided sentinel lymph node biopsy in breast cancer surgery. J Nucl Med 2001; 42:1198–1215.

    CAS  PubMed  Google Scholar 

  15. Tanis PJ, van Sandick JW, Nieweg OE, Valdes Olmos RA, Rutgers EJT, Hoefnagel CA, Kroon BBR. The hidden sentinel node in breast cancer. Eur J Nucl Med 2002; 29:305–311.

    Google Scholar 

  16. Moffat Fl, Gules SA, Sittler SY, et al. Unfiltered sulphur colloid and sentinel node biopsy for breast cancer: technical and kinetic considerations. Ann Surg Oncol 1999; 6:746–755.

    PubMed  Google Scholar 

  17. Kern KA, Rosenberg RJ. Preoperative lymphoscintigraphy during lymphatic mapping for breast cancer: improved sentinel node imaging using subareolar injection of99mtechnetium sulfur colloid. Am Coll Surg Surg 2000; 191:479–489.

    Article  CAS  Google Scholar 

  18. Krag D, Weaver D, Ashikaga T, et al. The sentinel node in breast cancer—a multi center validation study. N Eng J Med 1998; 339:941–946.

    Article  CAS  Google Scholar 

  19. Wong Sl, Edwards MJ, Chao C, et al. Sentinel lymph node biopsy for breast cancer; impact of the number of sentinel nodes removed of the false negative rate. J Am Coll Surg 2001; 192:684–691.

    Article  CAS  PubMed  Google Scholar 

  20. Bergkvist L, Frisell J, Lijegren G, Celebiolglu F, Damm S, Thorns M. Multi center study of detection and false-negative rates in sentinel node biopsy for breast cancer. Br J Surg 2001; 88:1644–1648.

    Article  CAS  PubMed  Google Scholar 

  21. Meijer S, Torrenga H, van der Sijp JRM. Negative sentinel nodes in breast cancer patients: good indicator for continued absence of axillary metastasis. Ned Tijdschr Geneesk 2002; 146:942–947.

    CAS  Google Scholar 

  22. Valdes Olmos RA, Tanis PJ, Hoefnagel CA, et al. Improved sentinel node visualization in breast cancer by optimizing the colloid particle concentration and tracer dosage. Nucl Med Commun 2001; 22:579–586.

    PubMed  Google Scholar 

  23. Gommans GMM, Boer RO, van Dongen A, et al. Further optimising of technetium-99m-Nanocoll sentinel node localisation in carcinoma of the breast by improved labeling. Eur J Nucl Med 2001; 28:1450–1455.

    CAS  PubMed  Google Scholar 

  24. Krynyckyi BR, Zhang ZY, Kim CK, Lipszyc H, Mosci K, Machac J. Effect of high specific activity sulphur colloid preparations on sentinel node count rates. Clin Nucl Med 2001; 27:92–95.

    Article  Google Scholar 

  25. Nycomed Amersham Sorin S.r.l. Package Insert Nanocoll. SPC October 1999.

  26. Eshima D, Fauconnier T, Eshima L, Thornback JR. Radiopharmaceuticals for lymphoscintigraphy: including dosimetry and radiation considerations. Semin Nucl Med 2000; 1:25–32.

    Google Scholar 

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Authors and Affiliations

  1. Department of Nuclear Medicine, Westfries Gasthuis Hoorn (WFG Hospital Hoorn), P.O. Box 600, 1620 AR, Hoorn, The Netherlands

    G. M. M. Gommans, T. G. van der Schors & A. van Dongen

  2. Department of Nuclear Medicine, Medical Centre Alkmaar, The Netherlands

    G. M. M. Gommans, F. M. van der Zant & T. G. van der Schors

  3. Department of Nuclear Medicine, VUMC Amsterdam, The Netherlands

    G. J. J. Teule

  4. Department of Surgery, Gemini Hospital Den Helder, The Netherlands

    W. W. J. Clarijs

  5. Department of Surgery, Medical Centre Alkmaar, The Netherlands

    B. L. A. M. Langenhorst

  6. Department of Surgery, Westfries Hospital Hoorn, The Netherlands

    J. W. D. de Waard

Authors
  1. G. M. M. Gommans
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  2. F. M. van der Zant
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  3. T. G. van der Schors
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  4. A. van Dongen
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  5. G. J. J. Teule
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  6. W. W. J. Clarijs
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  7. B. L. A. M. Langenhorst
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  8. J. W. D. de Waard
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Correspondence to G. M. M. Gommans.

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Gommans, G.M.M., van der Zant, F.M., van der Schors, T.G. et al. Effect of increased 99mTc/99Tc ratios on count rates in sentinel node procedures: a randomised study. Eur J Nucl Med Mol Imaging 30, 1231–1235 (2003). https://doi.org/10.1007/s00259-003-1227-9

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  • DOI: https://doi.org/10.1007/s00259-003-1227-9

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