Superiority of Radioisotope over Blue Dye for Sentinel Lymph Node Detection in Breast Cancer

Hayashida, Tetsu; Jinno, Hiromitsu; Sakata, Michio; Takahashi, Mina; Onishi, Tatsuya; Seki, Hirohito; Sato, Tomomitsu; Nakahara, Tsutomu; Shigematsu, Naoyuki; Mukai, Makio; Hibi, Toshifumi; Kitajima, Masaki; Kitagawa, Yuko

doi:10.1159/000277937

Cited by 14 publications

(12 citation statements)

References 66 publications

(30 reference statements)

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“…SN studies in different primary tumors showed that the detection rate is highest when a radioactive isotope and the blue dye are used in combination (28,29). In the present study, blue-stained SNs were identified in only 2 of 6 patients during retroperitoneal exploration.…”

Section: Discussioncontrasting

confidence: 42%

The Detection of Sentinel Nodes in Ovarian Cancer: A Feasibility Study

et al. 2014

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Few sentinel node (SN) studies in ovarian cancer have been reported, mainly because of the risk of tumor dissemination associated with the injection of tracers into the ovarian cortex. To our knowledge, the injection of tracers into the ovarian ligaments has not been explored. The aim of this study was to determine the feasibility of the SN procedure in ovarian cancer with tracer injection into the ovarian ligaments and to establish whether the procedure is safe for the healthcare workers. Methods: The study included patients who were at high risk of ovarian malignancy. Blue dye and radioactive colloid were injected into the proper ovarian ligament and suspensory ligament of the ovary. To measure professional radiation exposure, ring dose meters were worn by the surgeon, theater nurse, and pathologist during 3 procedures. Results: An SN procedure was performed in 21 patients, and at least 1 SN location was identified in all patients using the γ probe before retroperitoneal exploration. SNs were located in the paraaortic and paracaval regions only in 67% of the patients, in the pelvic region only in 9%, and in both the paraaortic/paracaval and the pelvic regions in 24%. All but 2 SNs were found on the ipsilateral side. In 6 patients who underwent retroperitoneal exploration, 1-4 SNs were identified using the γ probe and resected. Blue-stained SNs were detected in 2 patients. Positive SNs were detected in 1 patient with lymph node metastases. The amount of radiation exposure to the surgeon, theater nurse, and pathologist did not exceed the safe limit. Conclusion: The identification of SNs in all cases suggests that the SN procedure performed by injection of tracers in the ovarian ligaments is feasible and promising. The procedure is safe for the involved personnel. Further investigation is necessary to determine the clinical application of this new technique.

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Section: Discussioncontrasting

confidence: 42%

The Detection of Sentinel Nodes in Ovarian Cancer: A Feasibility Study

et al. 2014

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“…9 In the breast, this combination method increases the detection rate from 79.6 to 93.5% for the dye alone method and ≈95% for the colloid injection to 97.7-99.2%. 10,11 For preoperative visualization, (static) lymphoscintigraphy at 15 min and 2 h after injection of 99m Tc-labeled colloidal particles has also demonstrated its use in imaging of the tumor draining LNs in the prostate. 12 In our institute, integrated single photon emission computed tomography/computed tomography (SPECT/CT) is also used to provide superior 3-D visualization for surgical planning with a detection rate of 98%.…”

Section: Introductionmentioning

confidence: 99%

Tracer-cocktail injections for combined pre- and intraoperative multimodal imaging of lymph nodes in a spontaneous mouse prostate tumor model

et al. 2011

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Abstract. To improve surgical guidance toward prostate draining lymph nodes, we investigate the potential of intraoperative fluorescence imaging and combined pre-and intraoperative multimodality imaging approaches. Transgenic adenocarcinoma mouse prostate mice with spontaneous prostate tumors are injected intratumorally with: 1. a cocktail of patent blue (Pb) and indocyanine green (ICG); 2. a cocktail of albumin radiocolloids ( 99m TcNanoColl), Pb, and ICG; or 3. a cocktail of radiolabeled albumin ( 99m Tc-Vasculosis), Pb, and ICG. The distribution of these imaging agents over the lymph nodes (LNs) are studied at different time points after injection. We find that at 60-min postinjection, ICG significantly improves the detection of the LNs compared to Pb, 53 versus 7%, respectively. Moreover, a cocktail of ICG and 99m Tc-NanoColl improves the fluorescent detection rate to 86%, equalling that of the clinically applied 99m Tc-NanoColl. A similar overlap is observed in our initial clinical pilot data. Fluorescent detection of the LNs using a ICG with 99m Tc-Vasculosis gives similar results as "free" ICG (58%; 60 min). A 99m Tc-NanoColl, Pb, and cocktail ICG enriches the standard 99m Tc-NanoColl approach by adding optical detection of the sentinel lymph nodes. Furthermore, this approach improves fluorescent-based guidance and enables both accurate surgical planning and intraoperative detection, based on a single injection. C 2011 Society of Photo-Optical Instrumentation Engineers (SPIE).

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“…28 Both studies had a high number of pT3 tumors (65% and 72%, respectively) but radiocolloid tracer is uniformly regarded as superior to the dye method for SLN biopsy in most solid tumor types. 4,13,29 There is no doubt that obesity contributed to increased difficulty in our patients with surgical resection and identification of sentinel lymph nodes. It is also noteworthy that, despite some reports to the contrary, the addition of neoadjuvant therapy prior to surgical resection did not affect our results.…”

Section: Discussionmentioning

confidence: 96%