Sentinel lymph node identification with radiopharmaceuticals in patients with breast cancer: a comparison of 99mTc-tin colloid and 99mTc-phytate efficiency

Abstract

Sentinel lymph node biopsy with lymphoscintigraphy has become the standard method for the detection of axillary lymph node metastasis in breast cancer patients. However, there is no standardized radiopharmaceutical. For the detection of axillary lymph node metastasis by lymphoscintigraphy and sentinel node biopsy in patients with breast cancer, we compared the results between subareolar injection of (99m)Tc-tin colloid and injection of (99m)Tc-phytate. This study included 516 breast cancer patients who underwent surgery between 2001 and 2010. Among the 516 patients, (99m)Tc-tin colloid (37-185 MBq) was administered to 412 patients by subareolar injection, and (99m)Tc-phytate (37-185 MBq) was injected in 104 patients. Lymphoscintigraphy was performed with the patients in the supine position, and sentinel node identification was performed by hand-held gamma probe during surgery. Among 412 patients with (99m)Tc-tin colloid, the sentinel node was identified by lymphoscintigraphy in 364 cases (88.3%) and by a gamma probe in 369 cases (89.6%). Among 104 patients with (99m)Tc-phytate, 101 cases (97.1%) were identified by lymphoscintigraphy and 101 cases (97.1%) were identified by a gamma probe. The identification rates by lymphoscintigraphy and gamma probe were superior with (99m)Tc-phytate, as compared with (99m)Tc-tin colloid, with a statistically significant difference (P < 0.05 for both methods). (99m)Tc-phytate is a better choice than (99m)Tc-tin colloid for identification of the sentinel node in breast cancer patients.

The Clinical Usefulness of 99mTc HMPAO Leukocyte/99mTc Phytate Bone Marrow Scintigraphy for Diagnosis of Prosthetic Knee Infection: A Preliminary Study

“…The uptake mechanism of 99m Tc phytate is believed to rely upon in vivo colloid formation via chelation with the divalent ion Ca 2+ in the blood in a manner that is similar to the free ligand; thus, it behaves as an RE agent [24]. The 99m Tc phytate has been used for visualization of the RE system, mainly the liver [25], and for sentinel lymph node mapping in melanoma, breast cancer [14], vulvar cancer [26] and lung cancer [27]. The accumulation of the radiopharmaceutical by select organ systems depends on the chemical characteristics and the pathophysiological status of the subject under investigation.…”

“…However, 99m Tc-labeled colloid agent is difficult to obtain in our country, which necessitates the identification of valid alternatives. 99m Tc phytate is occasionally used as a substitute for lymphoscintigraphy [14]. To the best of our knowledge, no study has been conducted using 99m Tc HMPAO LS/ 99m Tc phytate BMS to diagnose infected knee joint replacements.…”

Caracterização dos padrões de drenagem linfática nas linfocintilografias de pacientes com câncer de mama

“…(INCA, 2009), (SAMPHAO et al, 2008) A média de idade dos nossos pacientes foi de aproximadamente 54 anos, o que é similar ao descrito na literatura, a qual evidencia a ocorrência de CA de mama em populações mais maduras, com média de idade variando entre 47 e 56 anos. (SEOK et al, 2010), (NALASHIMAN et al, 2010), (NOGUCHI et al, 2010), (SEOK et al, 2009) Segundo o INCA (2009) a idade continua sendo um dos principais fatores de risco do CA de mama. As taxas de incidência aumentam rapidamente até os 50 anos e posteriormente, este aumento ocorre lentamente.…”

“…Estes valores estão de acordo com a literatura, que evidencia em ordem decrescente de freqüência o CDI, seguido pelo CDIS, CLI e, então, os demais tipos histológicos. (SEOK et al, 2010), (NALASHIMAN et al, 2010), (NOGUCHI et al, 2010), (SEOK et al, 2009), (ABDOLLAHI et al, 2009) Quanto ao grau histológico do tumor presente nos pacientes submetidos ao estudo, de acordo com a classificação de Scarff-Bloom-Richardson modificado por Elston-Ellis, a maioria apresentou grau II (48,6%), seguido do grau I e grau III com 25,7% cada. Na literatura o grau histológico é variável e depende do tipo de estudo abordado.…”

“…Os dados são compatíveis com a literatura, em que a maioria das cirurgias realizadas em pacientes com CA de mama são conservadoras. (SEOK et al, 2010), (ABREU et al, 2008) Os estudos clínicos randomizados que compararam cirurgia conservadora com a mastectomia radical não demonstraram prejuízo de sobrevida global em seguimento, em longo prazo, com as cirurgias conservadoras. (FISHER et al, 2002), Quanto à localização do tumor de CA de mama, nosso estudo mostrou que a maioria dos pacientes o tumor encontrava-se no QSE, seguido do QC, QIE, 2Q, QSI e QII.…”