Hemosiderin: a new marker for sentinel lymph node identification

Abstract

Purpose:To evaluate and present our initial results of a new marker (hemosiderin) for mammary sentinel lymph node identification in an experimental model. Methods: Skins mapped like a lymphatic duct draining to the axilla in patients submitted to breast biopsy, in our mastology service, stimulated us to try it in an animal model (female dogs). Our theory was that some blood derivate (hemosiderin) was captured by macrophages and accessed the lymphatic ducts in direction to the axilla. Six female dogs of no defined race were studied. We injected 0,2 ml of technetium on both superior mammary glands. After ten minutes, a 2,5 ml solution of hemolized blood (hemosiderin) from the own animal was injected in the subareolar lymphatic plexus on the left superior mammary gland and 2,5 ml of patent blue concomitantly and equally on the contralateral gland. Ten minutes after, incisions on both axilas were made to search, through the lymphatic mapping and a gamma probe, the sentinel lymph nodes. Results: Seven brown sentinel lymph nodes were indentified and also radiomarked on the left axilla. Six blue sentinel lymph nodes were identified and also radiomarked on the right axilla. Conclusion: Preliminary studies of a potential new dye for sentinel lymph node identification are presented. It may be the change of the current use of the blue dyes and their severe side-effects on patients submitted to sentinel lymph node biopsies. Key words: Breast Neoplasms. Sentinel Lymph Node Biopsy. Hemosiderin. RESUMOObjetivo: Avaliar e apresentar resultados preliminares de um novo marcador (hemossiderina) para a identificação de linfonodos sentinela mamários em um modelo experimental. Métodos: Durante acompanhamento de dois casos de biópsias excisionais de tumores da mama, no nosso serviço de mastologia, observou-se trajeto pigmentado no quadrante inferior externo daquelas mamas, sugerindo ser marcação cutânea do ducto de drenagem linfática a partir da papila mamária em direção a axila homolateral. Levantamos a hipótese que um derivado sanguíneo (hemossiderina) foi capturado por macrófagos obtendo acesso aos ductos linfáticos em direção à axila. Seis cadelas sem raça definida foram estudadas. Injeção de 0,2 ml de tecnécio foi realizada em ambas as mamas superiores. Após 10 minutos, uma solução de 2,5 ml de sangue hemolizado (hemossiderina) do próprio animal foi injetado no plexo linfático subpapilar da mama esquerda e 2,5 ml de azul patente na mama contralateral concomitantemente e igualmente. Após mais 10 minutos, incisões axilares foram realizadas para a procura, pela coloração e com um gama probe, dos linfonodos sentinela. Resultados: Sete linfonodos sentinela castanhos e radiomarcados foram identificados na axila esquerda. Seis linfonodos sentinela azuis e radiomarcados foram identificados na axila direita. Conclusão: São apresentados estudos preliminares de um potencial novo marcador para identificação do linfonodo sentinela. Este poderá mudar o uso dos corantes vitais e de seus efeitos adversos em pacientes submetidos à biópsi...

Metastasis of Mammary Carcinoma in Bitches: Evaluation of the Sentinel Lymph Node Technique

“…During the preoperative, one quarter of the total volume of Patent Blue V 2.5% (Guerbert ® ) was administered in the superficial intradermal peritumoral region at a concentration of 2 mg/kg [11].…”

Analisys of Immunohistochemical Prognostic Markers in Canine Mammary Cancer and Its Relation to Postsurgical Survival

“…Adenectomy can ensure limitation of metastasis. In humans, a supravital marker is used to show the corresponding lymph nodes in each tumor in order to avoid leaving neoplasia residue on the patient [39].…”

Comparison between hemosiderin and Technetium-99 in sentinel lymph node biopsy in human breast cancer

“…Pinheiro et al 15 have tested the feasibility of hemosiderin in laboratory as an autologous dye, compared to patent blue, for breast SLNB in a canine model. Given that original study, it was possible to base and test the use of hemosiderin for SLNB in breast cancer in women, revealing an equivalence of hemosiderin and 99 Tc with a concordance rate of 100% of the cases and an average of 2.5 SLN per patients.…”

“…In 2009, Pinheiro et al 15 proved, in an experimental research with animals, the efficacy of hemosiderin (a protein resulting from the degradation of hemoglobin that is commonly found in lysosomes of histiocytes and Kupffer cells) as an autologous dye in SLNB of female dogs' breasts. In the present study, the association of hemosiderin with 99 Tc presented similar results in the SLNB when compared to patent blue and 99 Tc.…”