Sentinel node mapping for early breast cancer patients using 99mTc-phytate: Single center experience on 165 patients

Document Type : Original Article

Authors

1 Nuclear Medicine Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Surgical Oncology Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Endoscopic and Minimally Invasive Surgery Research Center, Faculty of Medicine, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

4 Pathology Department, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

5 Nuclear Medicine Department, Imam Hossein Hospital, Shahid Beheshti Medical University, Tehran, Iran

Abstract

Introduction: Several radiotracers are being used for sentinel node mapping in patients with breast cancer. In the current study, we reported our experience with 99m-Tc Phytate for sentinel node mapping in Mashhad University of Medical Sciences. Methods: All breast cancer patients who underwent sentinel node mapping using 99m-Tc Phytate were included. All patients received intradermal peri-areolar injection of 0.5 mCi/0.1cc 99m-Tc Phytate. Lymphoscintiraphy was performed for 145 patients 5-10 minutes post-injection. The sentinel nodes were found during surgery using a hand-held gamma probe as well as blue dye technique. Results: In total 165 patients were evaluated. Lymphoscintigraphy showed axillary sentinel nodes in 135 out of 145 patients (93%) following imaging. At least one sentinel node could be detected in all these 135 patients during surgery. In the remaining 10 patients with sentinel node non-visualization, 5 had sentinel node harvesting failure during surgery. Median number of sentinel nodes on the lymphoscintigraphy images was 1. Sentinel node detection rate was 95% (157/165). In the 8 patients with sentinel node harvesting failure, 7 had pathologically involved axilla. Median number of harvested sentinel nodes was 1. Mean sentinel node to background count ratio was 10±2. Conclusions: 99m-Tc Phytate is an effective and highly successful radiotracer for sentinel node mapping. Sentinel node can be visualized in a short time after 99m-Tc Phytate injection on the lymphoscintigraphy images. The sentinel to background count during surgery is high which results in more convenient sentinel node harvesting and high detection rate.

Keywords

Main Subjects

References

Wiatrek R, Kruper L. Sentinel lymph node biopsy indications and controversies in breast cancer. Maturitas. 2011 May;69(1):7-10.
Kaviani A, Noveiry BB, Noaparast M. Sentinel lymph node biopsy in management of early breast cancer: Is it rational to omit blue dye injection? Surgery. 2012 Jul;152(1):140.
Iida S, Haga S, Yamashita K, Yanagihara K, Kurita T, Murakami R, Kumita S, Tsuchiya S, Furukawa K, Uchida E. Evaluation of sentinel lymph node biopsy in clinically node-negative breast cancer. J Nippon Med Sch. 2011;78(2):96-100.
Bekker J, Meijer S. The historical perspective of the sentinel lymph node concept. Ned Tijdschr Geneeskd. 2008 Jan 5;152(1):38-45.
Carmon M, Olsha O, Schecter WP, Raveh D, Reinus C, Hershko DD, Beller U, Golomb E. The "Sentinel Chain": a new concept for prediction of axillary node status in breast cancer patients. Breast Cancer Res Treat. 2006 Jun;97(3):323-8.
Sadeghi R, Zakavi SR, Forghani MN, Aryana K, Kakhki VR, Ayati NK, Shandiz FH, Ghavamnasiri MR, Keshtgar M. The efficacy of Tc-99m sestamibi for sentinel node mapping in breast carcinomas: comparison with Tc-99m antimony sulphide colloid. Nucl Med Rev Cent East Eur. 2010;13(1):1-4.
Sadeghi R, Forghani MN, Zakavi SR, Jangjoo A, Shabani GA, Kakhki VRD. The need for skin pen marking for sentinel lymph node biopsy: A comparative study. Iran J Nucl Med. 2008;16(2):23-7.
Eftekhari M, Beiki D, Fallahi B, Arabi M, Memari F, Gholamrezanezhad A, Esmaili J, Akhzari F, Fard-Esfahani A. Assessment the diagnostic accuracy of sentinel lymph nodes lymphoscintigraphy using Technetium-99m phytate in breast cancer. DARU. 2009;17(2):83-7.
Sadri K, Ayati NK, Shabani G, Zakavi SR, Sadeghi R. Sentinel node detection failure due to defective labeling and large particle size of Tc-99m antimony sulfide colloid. Iran J Nucl Med. 2011;19(1):6-11.
Aliakbarian M, Memar B, Jangjoo A, Zakavi SR, Reza Dabbagh Kakhki V, Aryana K, Forghani MN, Sadeghi R. Factors influencing the time of sentinel node visualization in breast cancer patients using intradermal injection of the radiotracer. Am J Surg. 2011 Aug;202(2):199-202.
Momennezhad M, Zakavi SR, Dabbagh Kakhki VR, Jangjoo A, Ghavamnasiri MR, Sadeghi R. Scatterogram: a method for outlining the body during lymphoscintigraphy without using external flood source. Radiol Oncol. 2011 Sep;45(3):184-8.
Eshima D, Fauconnier T, Eshima L, Thornback JR. Radiopharmaceuticals for lymphoscintigraphy: including dosimetry and radiation considerations. Semin Nucl Med. 2000 Jan;30(1):25-32.
Subramanian G, McAfee JG, Mehta A, Blair RJ, Thomas ED. Tc-99m stannous phytate: a new in vivo colloid for imaging the reticuloendothelial system. J Nucl Med. 1973;14:459.
Alavi A, Staum MM, Shesol BF, Bloch PH. Technetium-99m stannous phytate as an imaging agent for lymph nodes. J Nucl Med. 1978 Apr;19(4):422-6.
Tavares MG, Sapienza MT, Galeb NA Jr, Belfort FA, Costa RR, Osório CA, Góes JC, Endo IS, Soares J Jr, Lewin S, Marone MM. The use of 99mTc-phytate for sentinel node mapping in melanoma, breast cancer and vulvar cancer: a study of 100 cases. Eur J Nucl Med. 2001 Nov;28(11):1597-604.
Ege GN, Warbick A. Lymphoscintigraphy: a comparison of 99Tc(m) antimony sulphide colloid and 99Tc(m) stannous phytate. Br J Radiol. 1979 Feb;52(614):124-9.
Campbell J, Bellen JC, Baker RJ, Cook DJ. Technetium-99m calcium phytate--optimization of calcium content for liver and spleen scintigraphy: concise communication. J Nucl Med. 1981 Feb;22(2):157-60.
Sadeghi R, Forghani MN, Memar B, Rajabi Mashhadi MT, Dabbagh Kakhki VR, Abdollahi A, Zakavi SR. How long the lymphoscintigraphy imaging should be continued for sentinel lymph node mapping? Ann Nucl Med. 2009 Aug;23(6):507-10.
Takei H, Suemasu K, Kurosumi M, Ninomiya J, Horii Y, Inoue K, Tabei T. 99mTc-phytate is better than 99mTc-human serum albumin as a radioactive tracer for sentinel lymph node biopsy in breast cancer. Surg Today. 2006;36(3):219-24.
Abdollahi A, Jangjoo A, Dabbagh Kakhki VR, Rasoul Zakavi S, Memar B, Naser Forghani M, Mehrabibahar M, Sadeghi R. Factors affecting sentinel lymph node detection failure in breast cancer patients using intradermal injection of the tracer. Rev Esp Med Nucl. 2010 Mar-Apr;29(2):73-7.
Dordea M, Colvin H, Cox P, Pujol Nicolas A, Kanakala V, Iwuchukwu O. Clinical and histopathological factors affecting failed sentinel node localization in axillary staging for breast cancer. Surgeon. 2012.
Arzoumanian A, Rosenthall L, Seto H. Clinical comparison of 99mTc-labeled preformed phytate colloid and sulfur colloid: concise communication. J Nucl Med. 1977 Feb;18(2):118-20.
 
Iranian Journal of Nuclear Medicine
Volume 20, Issue 2 - Serial Number 38
Serial number: 38
December 2012
Pages 25-29

Files

Share

How to cite

Statistics