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Lymphoscintigraphy in early-stage non-small cell lung cancer with technetium-99m nanocolloids and hybrid SPECT/CT: a pilot project

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Abstract

Objective

The goal of our study was to determine if lymph node activity could be visualized using a hybrid single-photon emission computed tomography/computed tomography (SPECT/CT) scanner with two commonly used colloidal lymphatic radiotracers—99mTc-antimony sulfide colloid (ASC) and 99mTc-filtered sulfur colloid (FSC) in the setting of low-stage non-small cell lung cancer (NSCLC).

Methods

Patients undergoing CT-guided percutaneous lung biopsies for clinically suspected early-stage lung cancer were randomized to peri-lesional injection of 37 MBq (0.5 mL) of either ASC or FSC. SPECT/CT of the thorax was performed at either 1, 2, or 3 h post-injection. The images were reviewed to determine if lymph node activity separate from the injection site could be identified.

Results

24 patients were included. Lymph node activity was identified in 50 % of patients. A total of 15 lymph nodes with activity were visualized including 5 ipsilateral hilar, 6 ipsilateral mediastinal, and 4 distant locations. No contralateral mediastinal or hilar activity was visualized. There was a tendency to improved visualization with ASC and the longer 3 h wait time. Most patients also demonstrated significant pleural, tracheobronchial, and/or systemic activity.

Conclusions

SPECT/CT imaging can demonstrate lymph node activity separate from the injection site in at least some low-stage NSCLC patients with a perilesional injection of 99mTc nanocolloid tracers. Further investigation into the role of pre-operative lymphoscintigraphy with SPECT/CT in patients with lung cancer is warranted.

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Acknowledgments

The authors would like to thank the Royal Alexandra Hospital CT and NM departments for their help in completing this project. This study was funded by the Canadian Society of Nuclear Medicine/General Electric Radiant Young Investigator’s Award 2010.

Conflict of interest

No potential conflicts of interest were disclosed.

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Authors and Affiliations

  1. Department of Radiology and Diagnostic Imaging, University of Alberta, 8440-112 St., 2A2.41 WMC, Edmonton, AB, T6G 2B7, Canada

    Jonathan T. Abele & Tracey Clare

  2. Department of Nuclear Medicine, Royal Alexandra Hospital, Edmonton, AB, Canada

    Karen Allred

  3. Division of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada

    Eric L. R. Bédard

Authors
  1. Jonathan T. Abele
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  2. Karen Allred
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  3. Tracey Clare
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  4. Eric L. R. Bédard
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Corresponding author

Correspondence to Jonathan T. Abele.

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Abele, J.T., Allred, K., Clare, T. et al. Lymphoscintigraphy in early-stage non-small cell lung cancer with technetium-99m nanocolloids and hybrid SPECT/CT: a pilot project. Ann Nucl Med 28, 477–483 (2014). https://doi.org/10.1007/s12149-014-0821-1

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  • DOI: https://doi.org/10.1007/s12149-014-0821-1

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