Comparative research on 99mTc-Rituximab and 99mTc-sulfur colloid in sentinel lymph node imaging of breast cancer

Abstract

Background 99mTc-Rituximab is a new specific radiopharmaceutical that binds to the CD20 receptor which is highly expressed on the surface of B cells. We conducted a study in which 99mTc-Rituximab was compared with filtered 99mTc-sulfur colloid (fTcSC) for sentinel lymph node (SLN) detection in patients with breast cancer. Method The study is divided into three parts. 1. Initially, 25 patients were selected for an internal controlled trial to received both 99mTc-Rituximab and fTcSC, the interval time is separated by ≥2 days. 2. Then, 91 patients were selected for a randomized controlled trial (41 and 50 patients in the 99mTc-Rituximab and fTcSC groups, respectively). All patients were administered either agent at the 6- and 12-o’ clock positions by subareolar injection technique. SLN mapping was then performed 2 h after injection. 3. Serial dynamic images were further acquired for 2 h in 31 patients (22 and 9 patients from 99mTc-Rituximab and fTcSC cohorts, respectively). Results The identification rate of lymphoscintigraphy and SLNB in all and axilla regions for 99mTc-Rituximab and 99mTc-SC were 98.5% vs 98.7, 100% vs 98.4%, respectively. The mean number of SLNs identified by 99mTc-Rituximab and fTcSC was respectively 2.72 and 3.28, with a significant difference of P = 0.013 (paired sample t-test). The difference exists in the internal mammary and clavicular area, not in the axillary. The mean number of axillary sentinel lymph node biopsy (SLNB) for 99mTc-Rituximab and fTcSC was 2.95 vs 3.14, respectively, and no significant difference existed. 99mTc-Rituximab also exhibited a significantly faster injection site clearance rate when compared with fTcSC (0.193 ± 0.057 h− 1 vs 0.021 ± 0.007 h− 1, respectively). Conclusion No significant difference was observed in identification rate and number of axillary SLN imaging and SLNB, between the two tracers. Compared to fTcSC, 99mTc-Rituximab based imaging demonstrated a fewer number of secondary lymph nodes and had faster injection site clearance rate. Trial registration www.chictr.org.cn, ChiCTR1900024990 (retrospectively registered August 6, 2019).

Advanced diagnostic imaging of sentinel lymph node in early stage breast cancer

“…In 2015, a multi‐center prospective study coordinated by the International Atomic Energy Agency published the added value of SPECT/CT on planar scintigraphy in various malignant tumors, including primary breast cancer, and it showed that the visualization rate of SLN increased from 87.6% to 91.3% after adding SPECT/CT 9 . The SLN recognition rates of 99m Tc‐Rituximab and 99m Tc‐sulfur colloid guided SPECT/CT in the axillary area were 100% and 98.4%, respectively, and 98.5% and 98.7 in all areas 10 . Compared with lymphangiography alone, SPECT/CT has obvious advantages in the detection of internal breast LNs 11 and ipsilateral axillary external drainage 12,13 .…”

“… 9 The SLN recognition rates of 99m Tc‐Rituximab and 99m Tc‐sulfur colloid guided SPECT/CT in the axillary area were 100% and 98.4%, respectively, and 98.5% and 98.7 in all areas. 10 Compared with lymphangiography alone, SPECT/CT has obvious advantages in the detection of internal breast LNs 11 and ipsilateral axillary external drainage. 12 , 13 It is also useful for scanning invisible, unexplained, or unexpected SLNs (Figure 1 ).…”

“…At present, it has been widely used in many countries in Asia, Europe and North America. The development trend of SPECT/CT in the future involves the exploration of non‐radioactive tracers, molecular targeted labeling tracers, 10 and mixed tracers. 15 …”

Diagnosis of sentinel lymph nodes in patients with cancer of the larynx and laryngopharynx using a new radiopharmaceutical based on technetium-99m-labeled gamma aluminum oxide

“…Одним из таких РФЛП на данный момент является [ 99m Tc]-ритуксимаб, который связывается с рецептором CD20 активно экспрессирующихся на поверхности В-клеток. Проведенные исследования показали, что [ 99m Tc]-ритуксимаб в меньшей степени перераспределяется в дистальные лимфоузлы, по сравнению с коллоидными РФЛП, и активнее уходит из места инъекции [16]. Также на сегодняшний день в США зарегистрирован и актив-но внедряется в клинику Lymphoseek™, меченный 99m Tc, который накапливается в лимфатических узлах путем связывания с CD206 на поверхности макрофагов [17].…”

Radioactive polymeric nanoparticles for biomedical application

“…The first case is the 99mTc-colloid (99mTc-Nanocoll ® ) a nano-colloid albumin deserve attention. This radioactive nanodrug has been approved for lymph nodes imaging in EU (Gommans et al., 2001 ; Mariani et al., 2001 ; Gommans et al., 2009 ) and a modified version of the original 99mTc-Nanocoll using sulfur in the colloidal state (99mTc-Technecoll ® ) has been approved in USA for nodal detection in melanoma, prostate and breast cancer (Alazraki et al., 1997 ; Holl et al., 2009 ; Seok et al., 2010 ; Ganswindt et al., 2011 ; Seo et al., 2011 ; Zhang et al., 2019 ). Back in the 80-90’s was developed and clinically evaluated an 111In-encapsulating liposome formulation (Vescan) for detection of carcinoma and metastases of prostate, lung and breast cancer (Presant et al., 1994 ; Jensen and Bunch, 2007 ).…”