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Bamforth S, James DJ, Skilton C, Smith A. Investigating a Technologist-Driven Injection Technique in Lymphoscintigraphy at a Single Rural Center: A Retrospective Audit. J Nucl Med Technol 2023; 51:220-226. [PMID: 37316302 DOI: 10.2967/jnmt.123.265442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/07/2023] [Indexed: 06/16/2023] Open
Abstract
Our aim was to investigate the effectiveness of the technologist-driven injection technique of lymphoscintigraphy used at a rural hospital in Australia to identify the correct lymph node for sentinel lymph node biopsy (SLNB) in early-stage breast cancer patients. Methods: A retrospective audit was conducted using imaging and medical record data from 145 eligible patients who underwent preoperative lymphoscintigraphy for SLNB at a single center throughout 2013 and 2014. The lymphoscintigraphy technique included a single periareolar injection with subsequent dynamic and static images as required. Descriptive statistics, sentinel node identification rates, and imaging-surgery concordance rates were generated from the data. Additionally, χ2 analysis was used to examine the relationships between age, previous surgical intervention, and injection site and time until a sentinel node is visualized. The technique and statistical results were directly compared against multiple similar studies in the literature. Results: The sentinel node identification rate was 99.3%, and the imaging-surgery concordance rate was 97.2%. The identification rate was significantly higher than those of similar studies in the literature, and concordance rates were similar across studies. The findings demonstrated that age (P = 0.508) and previous surgical intervention (P = 0.966) did not influence the time it takes to visualize a sentinel node. Injection site did appear to have a statistically significant effect (P = 0.001), with injections in the upper outer quadrant correlating with increased times between injection and visualization. Conclusion: The reported lymphoscintigraphy technique for identifying sentinel lymph nodes for SLNB in early-stage breast cancer patients can be justified as an accurate and effective method that is time-sensitive and has outcomes comparable to those of successful studies in the literature.
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Affiliation(s)
- Skyla Bamforth
- School of Health Sciences, University of Newcastle, Callaghan, New South Wales, Australia; and
| | - Daphne J James
- School of Health Sciences, University of Newcastle, Callaghan, New South Wales, Australia; and
| | - Christopher Skilton
- Hunter New England Imaging, Hunter New England Area Health Service, Newcastle, New South Wales, Australia
| | - Anthony Smith
- School of Health Sciences, University of Newcastle, Callaghan, New South Wales, Australia; and
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Yang P, Hu X, Peng S, Wang L, Yang L, Dong Y, Yang Z, Yuan L, Zhao H, He X, Bao G. Near-infrared laparoscopy with indocyanine green for axillary sentinel lymph node biopsy in early breast cancer: preliminary experience of a single unit. Gland Surg 2021; 10:1677-1686. [PMID: 34164312 DOI: 10.21037/gs-21-223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background A sentinel lymph node biopsy (SLNB) is a routine procedure for axillary staging in cN0 breast cancer (BC) patients. Indocyanine green (ICG) fluorescence can detect sentinel lymph nodes with higher sensitivity than carbon nanoparticle suspension (CNS). The present study investigated the availability and benefits of a near-infrared (NIR) laparoscopy-assisted SLNB using ICG and carbon nanoparticle suspension as tracers. Methods Forty patients with invasive BC, who had clinically negative axillary lymph nodes, participated in this observational study. ICG and CNS tracers were injected into the periareolar region simultaneously or sequentially. In the endoscopy-assisted group (n=20), the patients were given NIR laparoscopic SLNB based on ICG fluorescence and CNS staining. In the open-surgery group, the patients were given traditional SLNB using an open incision, and CNS tracers were injected into the same region as that in the endoscopy-assisted group. Results In the endoscopy-assisted group, lymphatic vessels and sentinel lymph nodes (SLNs) were successfully identified using ICG fluorescence imaging in most patients (19/20). The average number of SLNs removed was 2.85 (range, 1-4) in the endoscopy-assisted group, and 3.40 (range, 1-7) in the open-surgery group. There was no significant difference between the number of detected nodes (P=0.30). The patients who underwent endoscopy-assisted SLNBs had similar operating times, blood loss and hospital-stay lengths, but lower postoperative drainage volumes and higher satisfaction scores, as they did not have axillary incisions. Conclusions The NIR laparoscopy-assisted ICG-guided technique is a feasible and surgeon-friendly method for SLNB with good efficacy and acceptable safety. When combined with CNS, more SLNs can be detected and dissected.
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Affiliation(s)
- Ping Yang
- Department of General Surgery, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Xi'e Hu
- Department of General Surgery, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Shujia Peng
- Department of General Surgery, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Lu Wang
- Department of General Surgery, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Lin Yang
- Department of General Surgery, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Yanming Dong
- Department of General Surgery, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Zhenyu Yang
- Department of General Surgery, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Lijuan Yuan
- Department of General Surgery, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Huadong Zhao
- Department of General Surgery, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Xianli He
- Department of General Surgery, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Guoqiang Bao
- Department of General Surgery, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
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Moncrieff MD, O'Leary FM, Beadsmoore CJ, Pawaroo D, Heaton MJ, Isaksson K, Olofsson Bagge R. Effect of delay between nuclear medicine scanning and sentinel node biopsy on outcome in patients with cutaneous melanoma. Br J Surg 2020; 107:669-676. [PMID: 32077090 DOI: 10.1002/bjs.11460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 09/16/2019] [Accepted: 11/12/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) is an important staging tool for the management of melanoma. A multicentre study was done to validate previous findings that the timing of lymphoscintigraphy influences the accuracy of SLNB and patient outcomes, particularly survival. METHODS Data were reviewed on patients undergoing SLNB for melanoma at three centres in the UK and Sweden, examining the effect of timing of SLNB after nuclear medicine scanning. Kaplan-Meier survival analysis was used to assess overall (OS), disease-specific (DSS) and progression-free (PFS) survival, stratified by timing of lymphoscintigraphy. Independent risk factors for survival were identified by Cox multivariable regression analysis. RESULTS A total of 2270 patients were identified. Median follow-up was 56 months. Univariable analysis showed a 4·2 per cent absolute and 35·5 per cent relative benefit in DSS (hazard ratio 1·36, 95 per cent c.i. 1·05 to 1·74; P = 0·018) for 863 patients whose SLNB was performed up to 12 h after lymphoscintigraphy compared with 1407 patients who had surgery after more than 12 h. There were similar OS and PFS benefits (P = 0·036 and P = 0·022 respectively). Multivariable analysis identified timing of lymphoscintigraphy as an independent predictor of OS (P = 0·017) and DSS (P = 0·030). There was an excess of nodal recurrences as first site of recurrence in the group with delayed surgery (4·5 versus 2·5 per cent; P = 0·008). CONCLUSION Delaying SLNB beyond 12 h after lymphoscintigraphy with 99 Tc-labelled nanocolloid has a significant negative survival impact in patients with melanoma.
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Affiliation(s)
- M D Moncrieff
- Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Medical School, University of East Anglia Norwich Research Park, Norwich, UK
| | - F M O'Leary
- Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - C J Beadsmoore
- Department of Nuclear Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - D Pawaroo
- Department of Nuclear Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - M J Heaton
- Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - K Isaksson
- Department of Clinical Sciences, Surgery, Lund University, Skåne University Hospital, Lund, Sweden
| | - R Olofsson Bagge
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
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Taumberger N, Pernthaler B, Schwarz T, Bjelic-Radisic V, Pristauz G, Aigner RM, Tamussino K. Lymphoscintigraphy for Sentinel Lymph Node Biopsy in Breast Cancer: Do We Need a Delayed Image? Breast Care (Basel) 2019; 15:55-59. [PMID: 32231498 DOI: 10.1159/000496504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 01/02/2019] [Indexed: 11/19/2022] Open
Abstract
Background Sentinel lymph node biopsy has become a standard of care in the treatment of patients with early breast cancer, but clinical guidelines continue to be vague on details of the procedure. We were interested in the results of our 2-day protocol, which includes delayed lymphoscintigraphy at 18 h. Methods We reviewed the results of preoperative lymphoscintigrams in patients undergoing surgery for breast cancer. Lymphoscintigraphy was performed 2 h after periareolar injection of 4 × 37 MBq <sup>99m</sup>Tc nanocolloid (early lymphoscintigraphy) and 18 h following injection (delayed lymphoscintigraphy). The early results were compared with the late results. Results A total of 238 lymphoscintigraphies were performed in 232 patients (6 bilateral). At 2 h, ≥1 sentinel nodes were visualized in 154/238 (65%) cases; in 84 (35%), no sentinel node was visualized. Delayed lymphoscintigraphy visualized a sentinel node in 40 of 76 (53%) cases with no visualization at 2 h and failed to show a sentinel node in 36 (47%) of these cases (in 8 cases, no delayed lymphoscintigram was obtained). Conclusions Delayed lymphoscintigraphy was useful in about 50% of the breast cancer patients in whom immediate scintigraphy failed to demonstrate a sentinel lymph node.
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Affiliation(s)
- Nadja Taumberger
- Division of Gynecology, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Birgit Pernthaler
- Division of Nuclear Medicine, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Thomas Schwarz
- Division of Nuclear Medicine, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Vesna Bjelic-Radisic
- Division of Gynecology, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Gunda Pristauz
- Division of Gynecology, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Reingard M Aigner
- Division of Nuclear Medicine, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Karl Tamussino
- Division of Gynecology, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
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O'Leary FM, Beadsmoore CJ, Pawaroo D, Skrypniuk J, Heaton MJ, Moncrieff MD. Survival outcomes and interval between lymphoscintigraphy and SLNB in cutaneous melanoma- findings of a large prospective cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2018; 44:1768-1772. [PMID: 30343702 DOI: 10.1016/j.ejso.2018.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 04/26/2018] [Accepted: 06/12/2018] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Sentinel lymph node biopsy (SLNB) in cutaneous melanoma (CM) is performed to identify patient at risk of regional and distant relapse. We hypothesized that timing of lymphoscintigraphy may influence the accuracy of SLNB and patient outcomes. METHODS We reviewed prospective data on patients undergoing SLNB for CM at a large university cancer-center between 2008 and 2015, examining patient and tumor demographics and time between lymphoscintigraphy (LS) and SLNB. Kaplan-Meier survival analysis assessed disease-specific (DSS) and overall-survival (OS), stratified by timing of LS. Cox multivariate regression analysis assessed independent risk factors for survival. RESULTS We identified 1015 patients. Median follow-up was 45 months (IQR 26-68 months). Univariate analysis showed a 6.8% absolute DSS (HR 1.6 [1.03-2.48], p = 0.04) benefit and a 10.7% absolute OS (HR 1.64 [1.13-2.38], p = 0.01) benefit for patients whose SLNB was performed < 12 h of LS (n = 363) compared to those performed >12 h (n = 652). Multivariate analysis identified timing of LS as an independent predictor of OS (p = 0.007) and DSS (p = 0.016) when competing with age, sex, Breslow thickness (BT) and SLN status. No difference in nodal relapse rates (5.2% v 4.6%; p = 0.67) was seen. Both groups were matched for age, sex, BT and SLN status. CONCLUSION These data have significant implications for SLNB services, suggesting delaying SLNB >12 h after LS using a Tc99-labelled nanocolloid has a significant negative survival impact for patients and should be avoided. We hypothesise that temporal tracer migration is the underlying cause and advocate further trials investigating alternative, 'stable' tracer-agents.
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Affiliation(s)
- Fionnuala M O'Leary
- Department of Plastic & Reconstructive Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK. fionnuala.o'
| | - Clare J Beadsmoore
- Department of Nuclear Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK
| | - Davina Pawaroo
- Department of Nuclear Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK
| | - John Skrypniuk
- Department of Nuclear Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK
| | - Martin J Heaton
- Department of Plastic & Reconstructive Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK
| | - Marc D Moncrieff
- Department of Plastic & Reconstructive Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK; Norwich Medical School, University of East Anglia Norwich Research Park, Norwich, NR4 7TJ, UK
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Unkart JT, Proudfoot J, Wallace AM. Outcomes of "one-day" vs "two-day" injection protocols using Tc-99m tilmanocept for sentinel lymph node biopsy in breast cancer. Breast J 2018; 24:526-530. [PMID: 29498443 DOI: 10.1111/tbj.13002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 11/29/2022]
Abstract
No prior studies have compared Tc-99m tilmanocept (TcTM) one-day and two-day injection protocols for sentinel lymph node (SLN) biopsy in breast cancer (BC). We retrospectively identified patients with clinically node-negative BC undergoing SLN biopsy at our institution. Patients received a single, intradermal peritumoral injection of TcTM on day of surgery or day prior to surgery in addition to an intraoperative injection of isosulfan blue dye. Univariable and multivariable Poisson regression count models were constructed to assess the effects of injection timing, radiologist, patient and surgeon characteristics on the number of removed SLNs. A total of 617 patients underwent SLN biopsy with TcTM and blue dye. Sixty-seven (10.9%) patients were injected with the two-day protocol. Patients in the one-day protocol had a mean of 3.0 (standard deviation (SD) 1.9) SLNs removed compared with 2.7 (SD 1.4) SLNs in the two-day protocol, P-value = .13. On multivariable analysis, patient age and operating surgeon significantly affected the number of removed SLNs; however, the injection timing and the nuclear radiologist did not influence the number of removed SLNs. The performance of Tc-99m tilmanocept did not differ significantly between one-day and two-day injection protocols. These results are similar to other radiotracers used for SLN biopsy in BC.
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Affiliation(s)
- Jonathan T Unkart
- Department of Surgery, Moores Cancer Center, University of California, San Diego, CA, USA
| | - James Proudfoot
- Biostatistics Unit, Altman Clinical Translational Research Institute, University of California, San Diego, CA, USA
| | - Anne M Wallace
- Department of Surgery, Moores Cancer Center, University of California, San Diego, CA, USA
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