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Sayal NR, Schafer J, Jayne C, Wali A, Lindau R, Sayles H, Marr A, Aurit S, Lydiatt W, Holcomb A, Militsakh O, Coughlin A, Osmolak A, Panwar A. 99mTc-Tilmanocept vs. Sulfur Colloid for Sentinel Node Biopsy for Melanoma in the Head and Neck. Indian J Surg Oncol 2024; 15:82-87. [PMID: 38511039 PMCID: PMC10948650 DOI: 10.1007/s13193-023-01841-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/11/2023] [Indexed: 03/22/2024] Open
Abstract
The objective of the study is to compare sentinel lymph node (SLN) identification rates and performance characteristics of lymphoscintigraphy using 99mTc-sulfur colloid (SC) and 99mTc-tilmanocept (TL) for head and neck cutaneous melanoma. This study is a retrospective study, conducted at a single, tertiary care cancer center. Patients underwent sentinel lymph node biopsy (SLNB) for head and neck cutaneous melanoma, using SC or TL, between October 2014 and February 2019. Differences in SLN identification rates and performance characteristics between the groups were examined using the Mann-Whitney, or Fisher's exact test. Sixty patients underwent SLNB, of which 19 employed TL. There were no significant differences between SC vs. TL in operative duration (116 vs. 127 min, P = 0.97), radiation dose (530 vs. 547 μCi, P = 0.27), median number of SLNs removed (3 vs. 2, P = 0.32), or median follow-up (46.3 vs. 38.4 months, P = 0.11). The rates of positive SLNs (17% vs. 37%, P = 0.11), intraoperative non-localization (12% vs. 16%, P = 0.70), and false-negative SLNB (5% each, P = 1.00) were not significantly different between groups. In patients with head and neck melanoma undergoing SLNB, 99mTc-tilmanocept may not differ from 99mTc-sulfur colloid in identifying SLNs or other performance characteristics. The added expense related to 99mTc-tilmanocept and lack of favorable performance data should urge caution in its adoption and promote further examination of its value in similar patient cohorts.
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Affiliation(s)
- Navdeep R. Sayal
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Nebraska Methodist Hospital, 8303 Dodge Street, Suite 304, Omaha, NE 68114 USA
| | - Jeffrey Schafer
- Department of Otolaryngology, Naval Medical Center Portsmouth, Portsmouth, VA USA
| | | | - Ansar Wali
- Creighton University School of Medicine, Omaha, NE USA
| | - Robert Lindau
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Nebraska Methodist Hospital, 8303 Dodge Street, Suite 304, Omaha, NE 68114 USA
- Department of Surgery, Creighton University School of Medicine, Omaha, NE USA
| | - Harlan Sayles
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE USA
| | - Alissa Marr
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE USA
| | - Sarah Aurit
- Division of Clinical Research and Evaluative Sciences, Creighton University School of Medicine, Omaha, NE USA
| | - William Lydiatt
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Nebraska Methodist Hospital, 8303 Dodge Street, Suite 304, Omaha, NE 68114 USA
- Department of Surgery, Creighton University School of Medicine, Omaha, NE USA
| | - Andrew Holcomb
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Nebraska Methodist Hospital, 8303 Dodge Street, Suite 304, Omaha, NE 68114 USA
- Department of Surgery, Creighton University School of Medicine, Omaha, NE USA
| | - Oleg Militsakh
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Nebraska Methodist Hospital, 8303 Dodge Street, Suite 304, Omaha, NE 68114 USA
- Department of Surgery, Creighton University School of Medicine, Omaha, NE USA
| | - Andrew Coughlin
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Nebraska Methodist Hospital, 8303 Dodge Street, Suite 304, Omaha, NE 68114 USA
- Department of Surgery, Creighton University School of Medicine, Omaha, NE USA
| | - Angela Osmolak
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Nebraska Methodist Hospital, 8303 Dodge Street, Suite 304, Omaha, NE 68114 USA
- Department of Surgery, Creighton University School of Medicine, Omaha, NE USA
| | - Aru Panwar
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Nebraska Methodist Hospital, 8303 Dodge Street, Suite 304, Omaha, NE 68114 USA
- Department of Surgery, Creighton University School of Medicine, Omaha, NE USA
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Rovera G, de Koster EJ, Rufini V, Zollino M, Zagaria L, Giammarile F, Vidal-Sicart S, Valdés Olmos R, Collarino A. 99mTc-Tilmanocept performance for sentinel node mapping in breast cancer, melanoma, and head and neck cancer: a systematic review and meta-analysis from a European expert panel. Eur J Nucl Med Mol Imaging 2023; 50:3375-3389. [PMID: 37310426 DOI: 10.1007/s00259-023-06290-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/30/2023] [Indexed: 06/14/2023]
Abstract
PURPOSE Although multiple radiopharmaceuticals are currently available for sentinel node (SN) biopsy, 99mTc-tilmanocept is of particular interest due to its low molecular weight and specific binding capability for the mannose receptors of lymphatic reticuloendothelial cells. In the current systematic review and meta-analysis, we aimed to provide an update from a European expert panel on the performance of 99mTc-tilmanocept for SN biopsy. METHODS A systematic literature search of the PubMed/Medline and Embase databases was performed to identify studies on the use of 99mTc-tilmanocept for SN identification in oncological patients. The articles' methodological quality was assessed before inclusion. The pooled estimates of the pre-/intraoperative detection rates (DR; proportion of patients with ≥ 1 SN identified) and/or pN + sensitivity (SN + /pN + patients ratio), with 95% confidence intervals (CIs), were calculated for breast cancer, melanoma, and head and neck cancer. RESULTS Twenty-four articles were included in the systematic review, and twenty-one provided data for the meta-analysis. According to data availability, the 99mTc-tilmanocept-estimated pooled preoperative and intraoperative DRs were 0.94 (95%CI, 0.88-1.01) and 0.99 (0.98-1.00) for breast cancer, 0.98 (0.96-0.99) and 1.00 (0.99-1.00) for melanoma, and 0.97 (0.93-1.02) and 0.99 (0.96-1.01) for head and neck carcinoma. Finally, the pooled sensitivity for nodal metastasis in melanoma was 0.97 (95% CI, 0.92-1.03). CONCLUSION 99mTc-tilmanocept is a promising radiotracer for SN mapping in patients with breast cancer, melanoma, or head and neck cancer. We strongly believe that multicenter trials are still needed to assess if 99mTc-tilmanocept is superior to other radiotracers used in clinical routine.
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Affiliation(s)
- Guido Rovera
- Nuclear Medicine, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Elizabeth J de Koster
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Vittoria Rufini
- Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
- Section of Nuclear Medicine, University Department of Radiological Sciences and Hematology, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Mariella Zollino
- Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Zagaria
- Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Giammarile
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Sergi Vidal-Sicart
- Nuclear Medicine Department, Hospital Clinic Barcelona, Universitat de Barcelona, Institut d'investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Renato Valdés Olmos
- Interventional Molecular Imaging & Nuclear Medicine Section, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Angela Collarino
- Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Balkin DM, Tranah GJ, Wang F, O’Donoghue C, Morell EA, Porubsky C, Nosrati M, Vaquero EM, Kim H, Carr MJ, Montilla-Soler JL, Wu MC, Torre DM, Kashani-Sabet M, Zager JS, Leong SP. Lymphoscintigraphy Using Tilmanocept Detects Multiple Sentinel Lymph Nodes in Melanoma Patients. Cancer Control 2023; 30:10732748231153775. [PMID: 36705261 PMCID: PMC9893075 DOI: 10.1177/10732748231153775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Technetium-99m-labeled Tilmanocept, a multivalent mannose, is readily internalized by the CD206 surface receptor on macrophages and dendritic cells which are abundantly present in lymph nodes. We want to examine the drainage patterns of Technetium-99m-labeled Tilmanocept to sentinel lymph nodes (SLNs) in melanoma patients following the 10% rule. METHODS Multi-center retrospective review of patients with cutaneous melanoma undergoing SLN biopsy using Technetium-99m-labeled Tilmanocept between 2008 and 2014 was conducted. Statistical methods were used for data analyses. RESULTS Of the 564 patients (mean age of 60.3 and 62% male) with preoperative lymphoscintigraphy showing at least one SLN, several primary tumor sites were included: 27% head/neck, 33% trunk, 21% upper extremity and 19% lower extremity. For the head/neck primary site, 36.5% of patients had multiple draining basins; for the trunk site, 36.4% of patients; for the upper extremity site, 13% of patients; and for the lower extremity, 27.4% of patients. A median of 3 (range 1-18) SLNs were identified and resected. Overall, 78% of patients had >1 SLN identified by Technetium-99m-labeled Tilmanocept. In a multivariate model, patients with >1 SLN were significantly associated with age, Breslow depth, tumor location and higher AJCC tumor stage. A total of 17.7% of patients (100/564) had a positive SLN identified. A total of 145 positive SLNs were identified out of 1,812 SLNs with a positive SLN rate of 8%. Positive SLN status was significantly associated with younger age, greater Breslow depth, mitosis rate, higher AJCC tumor stage, presence of ulceration and angiolymphatic invasion. CONCLUSIONS Using the 10% rule, Technetium-99m-labeled Tilmanocept detects multiple SLNs in most melanoma patients.
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Affiliation(s)
- Daniel M. Balkin
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregory J. Tranah
- Center for Melanoma Research and Treatment, California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Frederick Wang
- Kaiser Permanente Woodland Hills Medical Center, Woodland Hills, CA, USA
| | | | - Emily A. Morell
- Department of Pediatrics, Divisions of Pediatric Critical Care and Pediatric Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Caitlin Porubsky
- Philadelphia College of Osteopathic Medicine/North Fulton Hospital Medical Campus, Roswell, GA, USA
| | - Mehdi Nosrati
- Center for Melanoma Research and Treatment, California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Edith M. Vaquero
- Center for Melanoma Research and Treatment, California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - HanKyul Kim
- Center for Melanoma Research and Treatment, California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Michael J. Carr
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Jaime L. Montilla-Soler
- Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Max C. Wu
- Department of Nuclear Medicine, California Pacific Medical Center, San Francisco, CA, USA
| | - Donald M. Torre
- Department of Nuclear Medicine, California Pacific Medical Center, San Francisco, CA, USA
| | - Mohammed Kashani-Sabet
- Center for Melanoma Research and Treatment, California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Jonathan S. Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Stanley P. Leong
- Center for Melanoma Research and Treatment, California Pacific Medical Center Research Institute, San Francisco, CA, USA
- University of California School of Medicine San Francisco, San Francisco, CA, USA
- Stanley P. Leong, MD, MS, FACS, California Pacific Medical Center, Center for Melanoma Research and Treatment Chief of Cutaneous Oncology and Associate Director of the Melanoma Program 2340 Clay Street Floor 2, San Francisco, CA 94115, USA. ;
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Ooms M, von Mallek D, Kaiser HJ, Hölzle F, Mottaghy FM, Modabber A. Comparison of [ 99mTc]Tc-tilmanocept with [ 99mTc]Tc-sulphur colloids and [ 99mTc]Tc-albumin colloids for sentinel lymph node detection in patients with cutaneous malignancies of the head. Eur J Nucl Med Mol Imaging 2023; 50:870-880. [PMID: 36305908 PMCID: PMC9852214 DOI: 10.1007/s00259-022-06017-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/18/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE Sentinel lymph node (SLN) biopsy is a staging procedure in the management of cutaneous malignancies of the head. The ideal radiopharmaceutical is controversial. This study aimed to compare [99mTc]Tc-tilmanocept (TcTM) with [99mTc]Tc-sulphur colloid (TcSC) and [99mTc]Tc-albumin colloid (TcAC) for SLN detection in the head and neck region. METHODS Data from 62 patients with cutaneous malignancies of the head who were injected with TcTM, TcSC, or TcAC before SLN imaging (SLN-I) and SLN excision (SLN-E) between 2012 and 2021 were retrospectively analysed. SLN-I was performed using planar lymphoscintigraphy and SPECT/CT, and a gamma probe was used for SLN-E. The SLN-I localisation rate (patients with SLNs) and degree (SLN number) and SLN-E relocalisation rate (patients with SLNs) and ratio (SLN number in SLN-E/SLN number in SLN-I) were compared between TcTM, TcSC, and TcAC. RESULTS TcTM showed similar SLN-I localisation rates for primaries in the anterior and posterior head region compared with TcSC (84.6% vs. 72.4%, p=0.680; both 100.0%) and TcAC (84.6% vs. 75.0%, p=1.000; both 100.0%). The SLN-I localisation degree for TcTM was higher for primaries in the anterior head region and similar for primaries in the posterior head region compared with TcSC (3.2 vs. 2.3, p=0.034; and 1.8 vs. 2.2, p=0.506) and TcAC (3.2 vs. 2.0, p=0.038; and 1.8 vs. 2.7, p=0.329). The SLN-E relocalisation rates and ratios were similar for all. CONCLUSION On the basis of a limited study design that compared three different tracers in three different patient groups, TcTM showed comparable overall performance to TcSC and TcAC.
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Affiliation(s)
- Mark Ooms
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Dirk von Mallek
- Department of Nuclear Medicine, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Hans-Jürgen Kaiser
- Department of Nuclear Medicine, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Felix M Mottaghy
- Department of Nuclear Medicine, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Ali Modabber
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
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Mwagiru D, Shivashankar P, Wong E, Farlow D, Cambden B, Abdul‐Razak M. Tilmanocept as a novel tracer for lymphatic mapping and sentinel lymph node biopsy in melanoma and oral cancer. ANZ J Surg 2022; 92:2607-2612. [PMID: 35848587 PMCID: PMC9796895 DOI: 10.1111/ans.17868] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/28/2022] [Accepted: 06/14/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) has been pivotal for pathological assessment of nodal status in cutaneous melanoma (CM) and oral cavity squamous cell carcinoma (OCSCC) thus crucial for staging. An ideal agent for lymphatic mapping should have a standardized preparation, appropriate accumulation in first-echelon nodes and no side effects. Tilmanocept, a CD206-receptor targeted novel radiotracer fulfils these properties. This study investigated Tilmanocept for lymphoscintigraphy and intraoperative identification of sentinel lymph nodes (SLN) in CM and OCSCC. METHODS This prospective cross sectional study examined patients who presented to Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney. Patients had biopsy proven tumours with clinically and radiologically negative regional lymph nodes. Tilmanocept guided lymphoscintigraphy was followed by intraoperative SLNs identification via handheld gamma probe. Primary endpoints were detection and retrieval rate of SLNs while secondary endpoints included pathological status of SLNs. RESULTS Thirty-five patients were included (26 with CM and 9 with OCSCC) with the most common primary tumour site for CM on the extremities (33.3%). Lymphoscintigraphy with Tilmanocept identified at least 1 SLN (sensitivity 100%) in all patients. SLNs were retrieved in all of patients intraoperatively (100% retrieval rate) with positive nodes found in 20% of patients. Tilmanocept also demonstrated 100% tissue specificity, with lymph nodal tissue confirmed histologically, with no false positives. CONCLUSION Tilmanocept is a reliable radiotracer for assessing the nodal status in patients with CM and OCSCC. Our group is the first to evaluate the use of Tilmanocept in the Australian setting, adding to the limited studies worldwide.
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Affiliation(s)
- Derek Mwagiru
- Department of Surgical Oncology and Head and Neck SurgeryCrown Princess Mary Cancer CentreSydneyNew South WalesAustralia
| | - Pranav Shivashankar
- Department of Surgical Oncology and Head and Neck SurgeryCrown Princess Mary Cancer CentreSydneyNew South WalesAustralia
| | - Eva Wong
- Department of Surgical Oncology and Head and Neck SurgeryCrown Princess Mary Cancer CentreSydneyNew South WalesAustralia
| | - David Farlow
- Department of Nuclear MedicineWestmead HospitalSydneyNew South WalesAustralia
| | - Brad Cambden
- Department of Nuclear MedicineWestmead HospitalSydneyNew South WalesAustralia
| | - Muzib Abdul‐Razak
- Faculty of Medicine, Department of Surgical Oncology and Head and Neck SurgeryCrown Princess Mary Cancer Centre, University of SydneySydneyNew South WalesAustralia
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The Use and Technique of Sentinel Node Biopsy for Skin Cancer. Plast Reconstr Surg 2022; 149:995e-1008e. [PMID: 35472052 DOI: 10.1097/prs.0000000000009010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Understand the indications for and prognostic value of sentinel lymph node biopsy in skin cancer. 2. Learn the advantages and disadvantages of various modalities used alone or in combination when performing sentinel lymph node biopsy. 3. Understand how to perform sentinel lymph node biopsy in skin cancer patients. SUMMARY Advances in technique used to perform sentinel lymph node biopsy to assess lymph node status have led to increased accuracy of the procedure and improved patient outcomes.
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Eckhoff A, Farrow NE, Silvestri C, Stroobant E, Intenzo C, Leddy M, Tyler DS, Berger A, Beasley GM. How much time is enough? Sentinel lymph node mapping time depends on the radiotracer agent. J Surg Oncol 2022; 125:712-718. [PMID: 34786720 PMCID: PMC9906034 DOI: 10.1002/jso.26752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 10/20/2021] [Accepted: 11/08/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND In 2014, technetium-99m tilmanocept (TcTM) replaced technetium-99m sulfur colloid (TcSC) as the standard lymphoscintigraphy (LS) mapping agent in melanoma patients undergoing sentinel lymph node biopsy (SLNB). The aim of this study was to examine differences in mapping time, intra-operative identification of sentinel lymph node (SLN), and false negative rate (FNR) between patients who underwent SLNB with TcTM compared to TcSC. METHODS Patients who underwent SLNB between 2010 and 2018 were retrospectively identified. Patient demographic, tumor, and imaging data was stratified by receipt of TcSC (n = 258) or TcTM (n = 133). Student's t test and χ2 test were used to compare characteristics and outcomes. RESULTS Both cohorts were similar in demographic, primary tumor characteristics, and total number of SLN identified (TcTM 3.56 vs. TcSC 3.28, p = 0.244). TcTM was associated with significantly shorter LS mapping times (51.8 vs. 195.1 min, p < 0.01). There was no significant difference in the number of patients with positive SLN (TcTM 11.3 vs. TcSC 17.4%, p = 0.109) and the FNR was similar between both groups (TcTM 25% vs. TcSC 22%). CONCLUSION TcTM was associated with significantly shorter LS mapping time while identifying similar numbers of SLN. Our results support further study to ensure similar FNR and oncologic outcomes between agents.
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Affiliation(s)
- Austin Eckhoff
- Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Norma E. Farrow
- Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Caitlin Silvestri
- Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Emily Stroobant
- Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Charles Intenzo
- Department of Nuclear Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Margaret Leddy
- Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Douglas S. Tyler
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Adam Berger
- Rutgers Cancer Institute, New Brunswick, New Jersey, USA
| | - Georgia M. Beasley
- Department of Surgery, Duke University, Durham, North Carolina, USA,Duke Cancer Institute, Duke University, Durham, North Carolina, USA
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Sentinel node in melanoma. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00058-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Rietbergen DDD, Pereira Arias-Bouda LM, van der Hage JA, Valdés Olmos RA. Does 99mTc-tilmanocept, as next generation radiotracer, meet with the requirements for improved sentinel node imaging? Rev Esp Med Nucl Imagen Mol 2021. [PMID: 33863695 DOI: 10.1016/j.remn.2020.07.004] [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: 11/15/2022]
Abstract
INTRODUCTION AND OBJECTIVES To evaluate the migration of 99mTc-tilmanocept from the injection site (IS) as well as the uptake in sentinel nodes (SNs) and non-SNs for lymphatic mapping in patients with breast cancer and melanoma, scheduled for SN biopsy after interstitial tracer administration. MATERIALS AND METHODS For 29 primary tumours in 28 patients (mean age: 62y, range: 45-81y) scheduled for SN biopsy planar images were acquired 10 and 120 min after administration of 74 MBq 99mTc-tilmanocept, in order to evaluate lymphatic drainage as well as uptake ratios between injection site (IS), SN and non-SN. SPECT/CT was performed immediately after delayed planar images to enable anatomical lymph node localization. RESULTS SNs were visualized in all patients (100%) with drainage to 34 basins. Uptake in non-SNs was perceived in 16 basins (47%). Number of SNs was concordant between early and delayed images in all basins excepting five (86%). In 24 patients tracer migrated to one lymph node basin (LNB), in three to 2 and in one to 4. When IS was included (n = 29) on image, IS/SN ratio could be measured per LNB. The IS/SN ratio at 2 h compared to 15 min decreased with an average of 66% (range: 15-96%). SN/non-SN 2 h ratio in LNBs with visible non-SNs averaged 6.6 (range: 2.3-15.6). In 9 patients with two SNs SN1/SN2 ratio averaged 1.9 on delayed images. At histopathology, SNs were found to be tumour positive in 7 basins (20%). CONCLUSION 99mTc-tilmanocept appears to meet the requirements for improved SN imaging in breast cancer and melanoma on the basis of early and persistent SN visualization frequently accompanied by no or markedly less non-SN uptake. This is associated to rapid migration from the injection site together with increasing SN uptake and retention as expressed by decreasing IS/SN and persistently high SN/non-SN ratios. Further head-to-head comparison of 99mTc-tilmanocept with standard SN radiotracers in larger series of patients is necessary.
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Affiliation(s)
- D D D Rietbergen
- Sección de Medicina Nuclear & Laboratorio de Imagen Molecular Intervencionista, Departamento de Radiología, Centro Médico Universidad de Leiden, Leiden, Países Bajos.
| | - L M Pereira Arias-Bouda
- Sección de Medicina Nuclear & Laboratorio de Imagen Molecular Intervencionista, Departamento de Radiología, Centro Médico Universidad de Leiden, Leiden, Países Bajos; Departamento de Medicina Nuclear, Hospital Alrijne, Leiderdorp, Países Bajos
| | - J A van der Hage
- Departamento de Cirugía, Centro Médico Universidad de Leiden, Leiden, Países Bajos
| | - R A Valdés Olmos
- Sección de Medicina Nuclear & Laboratorio de Imagen Molecular Intervencionista, Departamento de Radiología, Centro Médico Universidad de Leiden, Leiden, Países Bajos; Departamento de Radiología y Medicina Nuclear, Hospital Onze Lieve Vrouwe Gasthuis, Ámsterdam, Países Bajos
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10
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Rietbergen DD, Pereira Arias-Bouda LM, van der Hage J, Valdés Olmos RA. Does 99mTc-tilmanocept, as next generation radiotracer, meet with the requirements for improved sentinel node imaging? Rev Esp Med Nucl Imagen Mol 2021; 40:275-280. [PMID: 34425967 DOI: 10.1016/j.remnie.2020.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/20/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES To evaluate the migration of 99mTc-tilmanocept from the injection site (IS) as well as the uptake in sentinel nodes (SNs) and non-SNs for lymphatic mapping in patients with breast cancer and melanoma, scheduled for SN biopsy after interstitial tracer administration. MATERIALS AND METHODS For 29 primary tumours in 28 patients (mean age: 62y, range: 45-81y) scheduled for SN biopsy planar images were acquired 10 and 120min after administration of 74MBq 99mTc-tilmanocept, in order to evaluate lymphatic drainage as well as uptake ratios between injection site (IS), SN and non-SN. SPECT-CT was performed immediately after delayed planar images to enable anatomical lymph node localization. RESULTS SNs were visualized in all patients (100%) with drainage to 34 basins. Uptake in non-SNs was perceived in 16 basins (47%). Number of SNs was concordant between early and delayed images in all basins excepting five (86%). In 24 patients tracer migrated to one lymph node basin (LNB), in three to 2 and in one to 4. When IS was included (N=29) on image, IS/SN ratio could be measured per LNB. The IS/SN ratio at 2h compared to 15min decreased with an average of 66% (range: 15-96%). SN/non-SN 2h ratio in LNBs with visible non-SNs averaged 6.6 (range: 2.3-15.6). In 9 patients with two SNs SN1/SN2 ratio averaged 1.9 on delayed images. At histopathology, SNs were found to be tumour positive in 7 basins (20%). CONCLUSION 99mTc-tilmanocept appears to meet the requirements for improved SN imaging in breast cancer and melanoma on the basis of early and persistent SN visualization frequently accompanied by no or markedly less non-SN uptake. This is associated to rapid migration from the injection site together with increasing SN uptake and retention as expressed by decreasing IS/SN and persistently high SN/non-SN ratios. Further head-to-head comparison of 99mTc-tilmanocept with standard SN radiotracers in larger series of patients is necessary.
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Affiliation(s)
- D D Rietbergen
- Nuclear Medicine Section & Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, Netherlands.
| | - L M Pereira Arias-Bouda
- Nuclear Medicine Section & Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, Netherlands; Department of Nuclear Medicine, Alrijne Ziekenhuis, Leiderdorp, Netherlands
| | - J van der Hage
- Department of Surgery, Department of Radiology, Leiden University Medical Centre, Netherlands
| | - R A Valdés Olmos
- Nuclear Medicine Section & Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, Netherlands; Department of Radiology and Nuclear Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
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Sentinel Lymph Node Biopsy in Early Stages of Oral Squamous Cell Carcinoma Using the Receptor-Targeted Radiotracer 99mTc-Tilmanocept. Diagnostics (Basel) 2021; 11:diagnostics11071231. [PMID: 34359314 PMCID: PMC8303850 DOI: 10.3390/diagnostics11071231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 06/27/2021] [Accepted: 07/02/2021] [Indexed: 02/06/2023] Open
Abstract
Neck management in patients with early-stage, clinically node-negative oral squamous cell carcinoma (OSCC) remains a matter of discussion. Sentinel lymph node biopsy (SLNB) represents a treatment alternative to avoid elective neck dissection (END) in this cohort and different protocols and tracers exist. Here we present the clinical outcome of SLNB using 99mTc-tilmanocept in a two-day protocol in patients suffering from early-stage OSCC. A total of 13 patients (males: 6; females: 7; mean age: 65.7 years, ranging from 47 to 89 years) were included in this study. Most of the patients suffered from an OSCC of the floor of mouth (n = 6), followed by tongue (n = 5) and upper alveolar crest/hard palate (n = 2). Sentinel lymph nodes (SLNs) were successfully identified in all cases (range: 1–7). The average length of hospital stay was 4.7 days (range: 3–8 days) and mean duration of surgical intervention was 121 min (range: 74–233 min). One patient who suffered from an OSCC of the tongue was sentinel lymph node positive (SLN+). The mean follow-up for all sentinel lymph node negative (SLN-) patients (n = 12) was 20.3 months (range: 10–28 months). No local or nodal recurrences were observed within the observation period. In our patient cohort, SLNB using 99mTc-tilmanocept in a two-day protocol proved to be a reliable and safe staging method for patients suffering from early-stage, clinically node-negative OSCC. These results and their possible superiority to colloid tracers have to be confirmed in a prospective randomized controlled study.
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12
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Gorshkov NI, Murko AY, Zolotova YI, Nazarova OV, Krasikov VD, Shatik SV, Panarin EF. Introduction of Re(CO) 3+/ 99mTc(CO) 3+ Organometallic Species into Vinylpyrrolidone-Allyliminodiacetate Copolymers. Polymers (Basel) 2021; 13:polym13111832. [PMID: 34205969 PMCID: PMC8198885 DOI: 10.3390/polym13111832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/20/2021] [Accepted: 05/20/2021] [Indexed: 11/16/2022] Open
Abstract
N-vinylpyrrolidone-co-allylamine copolymers (VP-co-AA) containing iminodiacetic (IDA) chelation units were prepared in the range of molecular masses of the copolymers from 9000 to 30,000 Da depending on polymerization conditions. Non-radioactive organometallic species Re(CO)3+ were introduced into polymeric carriers under mild conditions; the prepared metal–polymeric complexes were characterized by IR, NMR, ESI-MS and HPLC. IR spectra data confirmed the coordination of M(CO)3+ moiety to the polymeric backbone via IDA chelation unit (appearance of characteristic fac-M(CO)3+ vibrations (2005, 1890 cm−1), as well as the appearance of group of signals in 1H NMR spectra, corresponding to those inequivalent to methylene protons CH2COO (dd, 4.2 ppm), coordinated to metal ions. The optimal conditions for labeling the PVP-co-AA-IDA copolymers with radioactive 99mTc(CO)3+ species were determined. The radiochemical yields reached 97%. The obtained radiolabeled polymers were stable in blood serum for 3 h. In vivo distribution experiments in intact animals showed the high primary accumulation of technetium-99m MPC (MM = 15,000 Da) in blood with subsequent excretion via the urinary tract.
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Affiliation(s)
- Nikolay Ivanovich Gorshkov
- Federal State Budgetary Institution of Science Institute of Macromolecular Compounds, Russian Academy of Sciences (IMC RAS), Russian Federation, V.O. Bolshoy pr. 31, 199004 Saint Petersburg, Russia; (A.Y.M.); (Y.I.Z.); (O.V.N.); (V.D.K.); (E.F.P.)
- Correspondence: ; Tel.: +7-(812)-323-71-01
| | - Andrei Yur'evich Murko
- Federal State Budgetary Institution of Science Institute of Macromolecular Compounds, Russian Academy of Sciences (IMC RAS), Russian Federation, V.O. Bolshoy pr. 31, 199004 Saint Petersburg, Russia; (A.Y.M.); (Y.I.Z.); (O.V.N.); (V.D.K.); (E.F.P.)
| | - Yulia Igorevna Zolotova
- Federal State Budgetary Institution of Science Institute of Macromolecular Compounds, Russian Academy of Sciences (IMC RAS), Russian Federation, V.O. Bolshoy pr. 31, 199004 Saint Petersburg, Russia; (A.Y.M.); (Y.I.Z.); (O.V.N.); (V.D.K.); (E.F.P.)
| | - Olga Vladimirovna Nazarova
- Federal State Budgetary Institution of Science Institute of Macromolecular Compounds, Russian Academy of Sciences (IMC RAS), Russian Federation, V.O. Bolshoy pr. 31, 199004 Saint Petersburg, Russia; (A.Y.M.); (Y.I.Z.); (O.V.N.); (V.D.K.); (E.F.P.)
| | - Valerii Dmitrievich Krasikov
- Federal State Budgetary Institution of Science Institute of Macromolecular Compounds, Russian Academy of Sciences (IMC RAS), Russian Federation, V.O. Bolshoy pr. 31, 199004 Saint Petersburg, Russia; (A.Y.M.); (Y.I.Z.); (O.V.N.); (V.D.K.); (E.F.P.)
| | - Sergei Vasilievich Shatik
- Federal State Budgetary Institution “Russian Research Center for Radiology and Surgical Technologies” of the Ministry of Health of the Russian Federation, Russian Federation, p. Pesochny, ul. Leningradskaya, 70, 197758 Saint Petersburg, Russia;
| | - Evgenii Fedorovich Panarin
- Federal State Budgetary Institution of Science Institute of Macromolecular Compounds, Russian Academy of Sciences (IMC RAS), Russian Federation, V.O. Bolshoy pr. 31, 199004 Saint Petersburg, Russia; (A.Y.M.); (Y.I.Z.); (O.V.N.); (V.D.K.); (E.F.P.)
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13
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Chakera AH, la Cour Sibbesen E, Schoedt M, Hölmich LR, Zerahn B, Thompson JF. The worse survival outcomes reported for melanoma patients having sentinel node biopsy after lymphoscintigraphy the previous day do not appear to be due to overnight migration of Tc99m-nanocolloid tracer. Eur J Surg Oncol 2021; 47:2450-2453. [PMID: 33775485 DOI: 10.1016/j.ejso.2021.03.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/09/2021] [Accepted: 03/12/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION It has been reported that the survival of patients having sentinel node (SN) biopsy for melanoma the day after lymphoscintigraphy using Tc99m-nanocolloid is worse than that of patients having lymphoscintigraphy and SN biopsy on the same day [1,2]. A possible explanation suggested is that overnight migration of the tracer from SNs to 2nd-tier nodes occurs, causing failure to remove true SNs. MATERIALS AND METHODS The possibility of overnight tracer migration leading to errors in SN-identification was investigated in 12 patients scheduled for lymphoscintigraphy the day before surgery by repeating SPECT-CT imaging the next morning, before their SN biopsy. The aim was to check whether onward migration of colloid from previously-identified SNs had occurred. RESULTS No significant migration of Tc99m-nanocolloid occurred overnight in any patient. All nodes reported to be SNs on day 1 imaging were also present and regarded as SNs on day 2 images. No new foci were visualised on day 2, but some that had been identified on day 1 were not seen on day 2. CONCLUSIONS Since migration of nanocolloid overnight did not occur, this cannot explain the reported survival disadvantage for patients undergoing SN biopsy the day after lymphoscintigraphy. A likely alternative possibility is that inadequate doses of radioisotope were used for next-day procedures, causing the mistaken removal of 2nd-tier nodes instead of true SNs more frequently. Further research is required to explain the reported reduction in survival of patients having next-day SN biopsy procedures, since the possibility has important clinical implications.
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Affiliation(s)
- Annette H Chakera
- Department of Plastic Surgery, Herlev and Gentofte Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark.
| | - Else la Cour Sibbesen
- Department of Clinical Physiology, Nuclear Medicine and PET, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Mette Schoedt
- Department of Radiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - Lisbet R Hölmich
- Department of Plastic Surgery, Herlev and Gentofte Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Bo Zerahn
- Department of Clinical Physiology, Nuclear Medicine and PET, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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14
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Rietbergen DD, VAN Oosterom MN, Kleinjan GH, Brouwer OR, Valdes-Olmos RA, VAN Leeuwen FW, Buckle T. Interventional nuclear medicine: a focus on radioguided intervention and surgery. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2021; 65:4-19. [PMID: 33494584 DOI: 10.23736/s1824-4785.21.03286-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Within interventional nuclear medicine (iNM) a prominent role is allocated for the sub-discipline of radioguided surgery. Unique for this discipline is the fact that an increasing number of clinical indications (e.g. lymphatic mapping, local tumor demarcation and/or tumor receptor targeted applications) have been adopted into routine care. The clinical integration is further strengthened by technical innovations in chemistry and engineering that enhance the translational potential of radioguided procedures in iNM. Together, these features not only ensure ongoing expansion of iNM but also warrant a lasting clinical impact for the sub-discipline of radioguided surgery.
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Affiliation(s)
- Daphne D Rietbergen
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, the Netherlands
| | - Matthias N VAN Oosterom
- Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, the Netherlands.,Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Gijs H Kleinjan
- Department of Urology, Leiden University Medical Center, Leiden, the Netherlands
| | - Oscar R Brouwer
- Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, the Netherlands.,Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Renato A Valdes-Olmos
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Fijs W VAN Leeuwen
- Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, the Netherlands.,Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Tessa Buckle
- Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, the Netherlands - .,Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
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15
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Gorshkov NI, Murko АY, Gavrilova II, Bezrukova МА, Kipper АI, Shatik SV, Tokarev АV, Krasikov VD, Panarin ЕF. Metal-Polymer Complexes of Gallium/Gallium-68 with Copolymers of N-Vinylpyrrolidonewith N-Vinylformamideand N-Vinyliminodiacetic Acid: A Hint for Radiolabeling of Water-Soluble Synthetic Flexible Chain Macromolecules. Polymers (Basel) 2020; 12:polym12122889. [PMID: 33276572 PMCID: PMC7761557 DOI: 10.3390/polym12122889] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 11/23/2020] [Accepted: 11/26/2020] [Indexed: 12/31/2022] Open
Abstract
Copolymer of N-vinylpyrrolidone (VP) with vinylformamide (VFA) and N-vinyliminodiacetic acid (VIDA) was synthesized; its metal-polymer complexes (MPCs) with gallium were obtained. The complexes were characterized by size exclusion chromatography, hydrodynamic and optical methods, scanning electron microscopy, and spectral methods (UV, IR, 1Н NMR spectroscopy). It was demonstrated that in going from polymer to complex, hydrodynamic parameters of macromolecules change only slightly, although the polymer contains intramolecular Ga(VIDA)2 fragments in its structure. A new method for preparation of MPCs with gallium and gallium-68 radionuclide was suggested. The obtained metal-polymer complex is stable over a wide range of pH values as well as in the histidine challenge reaction. In vivo distribution experiments in intact animals showed high primary accumulation of thegallium-68 MPC in blood with subsequent excretion via urinary tract.
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Affiliation(s)
- Nikolay I. Gorshkov
- Federal State Budgetary Institution of Science Institute of Macromolecular Compounds, Russian Academy of Sciences (IMC RAS), Russian Federation, V.O. Bolshoy pr. 31, 199004 Saint Petersburg, Russia; (A.Y.M.); (I.I.G.); (M.A.B.); (A.I.K.); (V.D.K.); (E.F.P.)
- Correspondence: ; Tel.: +7-(812)-323-71-01
| | - Аndrey Yu. Murko
- Federal State Budgetary Institution of Science Institute of Macromolecular Compounds, Russian Academy of Sciences (IMC RAS), Russian Federation, V.O. Bolshoy pr. 31, 199004 Saint Petersburg, Russia; (A.Y.M.); (I.I.G.); (M.A.B.); (A.I.K.); (V.D.K.); (E.F.P.)
| | - Iirina I. Gavrilova
- Federal State Budgetary Institution of Science Institute of Macromolecular Compounds, Russian Academy of Sciences (IMC RAS), Russian Federation, V.O. Bolshoy pr. 31, 199004 Saint Petersburg, Russia; (A.Y.M.); (I.I.G.); (M.A.B.); (A.I.K.); (V.D.K.); (E.F.P.)
| | - Мarina А. Bezrukova
- Federal State Budgetary Institution of Science Institute of Macromolecular Compounds, Russian Academy of Sciences (IMC RAS), Russian Federation, V.O. Bolshoy pr. 31, 199004 Saint Petersburg, Russia; (A.Y.M.); (I.I.G.); (M.A.B.); (A.I.K.); (V.D.K.); (E.F.P.)
| | - Аlbert I. Kipper
- Federal State Budgetary Institution of Science Institute of Macromolecular Compounds, Russian Academy of Sciences (IMC RAS), Russian Federation, V.O. Bolshoy pr. 31, 199004 Saint Petersburg, Russia; (A.Y.M.); (I.I.G.); (M.A.B.); (A.I.K.); (V.D.K.); (E.F.P.)
| | - Sergei V. Shatik
- Federal State Budgetary Institution “Russian Research Center for Radiology and Surgical Technologies” of the Ministry of Health of the Russian Federation, Russian Federation, p. Pesochny, ul. Leningradskaya, 70, 197758 Saint Petersburg, Russia; (S.V.S.); (A.V.T.)
| | - Аlexander V. Tokarev
- Federal State Budgetary Institution “Russian Research Center for Radiology and Surgical Technologies” of the Ministry of Health of the Russian Federation, Russian Federation, p. Pesochny, ul. Leningradskaya, 70, 197758 Saint Petersburg, Russia; (S.V.S.); (A.V.T.)
| | - Valerii D. Krasikov
- Federal State Budgetary Institution of Science Institute of Macromolecular Compounds, Russian Academy of Sciences (IMC RAS), Russian Federation, V.O. Bolshoy pr. 31, 199004 Saint Petersburg, Russia; (A.Y.M.); (I.I.G.); (M.A.B.); (A.I.K.); (V.D.K.); (E.F.P.)
| | - Еvgenii F. Panarin
- Federal State Budgetary Institution of Science Institute of Macromolecular Compounds, Russian Academy of Sciences (IMC RAS), Russian Federation, V.O. Bolshoy pr. 31, 199004 Saint Petersburg, Russia; (A.Y.M.); (I.I.G.); (M.A.B.); (A.I.K.); (V.D.K.); (E.F.P.)
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16
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Sentinel Node Imaging and Radioguided Surgery in the Era of SPECT/CT and PET/CT: Toward New Interventional Nuclear Medicine Strategies. Clin Nucl Med 2020; 45:771-777. [PMID: 32701805 DOI: 10.1097/rlu.0000000000003206] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We review recent technological advances and new clinical indications for sentinel node (SN) and radioguided surgery in order to delineate future tendencies of interventional nuclear medicine in this field. A literature research was performed in PubMed to select relevant articles to be used as key references for analysis of the current approaches and tendencies in SN and radioguided surgery, as well as the evolving contribution of nuclear medicine intervention techniques to the various clinical applications. For classic indications such as melanoma and breast cancer, the incorporation of the SN approach based on the combined use of existing and new preoperative and intraoperative technologies in high-risk patient categories is becoming an emerging area of clinical indication. For SN biopsy staging in other malignancies with more complex lymphatic drainage, the incorporation of sophisticated tools is most helpful. The consecutive use of PET/CT and the SN procedure is increasing as a potential combined approach for the management of specific areas such as the axilla and the pelvis in patients at high risk of regional dissemination. Also, for the management of locoregional metastasis and oligometastatic disease, interventional nuclear medicine techniques are becoming valuable alternatives. The extended experience with SN biopsy is leading to technological advances facilitating the incorporation of this procedure to stage other malignancies with complex lymphatic drainage. New nuclear medicine-based approaches, incorporating SPECT/CT and PET/CT to guide resection of SNs and occult metastases, have recently been gaining ground.
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Quartuccio N, Siracusa M, Pappalardo M, Arnone A, Arnone G. Sentinel Node Identification in Melanoma: Current Clinical Impact, New Emerging SPECT Radiotracers and Technological Advancements. An Update of the Last Decade. Curr Radiopharm 2020; 13:32-41. [PMID: 31749441 PMCID: PMC7509753 DOI: 10.2174/1874471012666191015100837] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/20/2019] [Accepted: 07/17/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Melanoma is the most lethal skin cancer with a mortality rate of 262 cases per 100.000 cases. The sentinel lymph node (SLN) is the first lymph node draining the tumor. SLN biopsy is a widely accepted procedure in the clinical setting since it provides important prognostic information, which helps patient management, and avoids the side effects of complete lymph node dissection. The rationale of identifying and removing the SLN relies on the low probability of subsequent metastatic nodes in case of a negative histological exam performed in the SLN. DISCUSSION Recently, new analytical approaches, based on the evaluation of scintigraphic images are also exploring the possibility to predict the metastatic involvement of the SLN. 99mTc-labeled colloids are still the most commonly used radiotracers but new promising radiotracers, such as 99mTc- Tilmanocept, are now on the market. In the last decades, single photon emission computed tomography- computerized tomography (SPECT/CT) has gained wider diffusion in clinical departments and there is large evidence about its superior diagnostic accuracy over planar lymphoscintigraphy (PL) in the detection of SLN in patients with melanoma. Scientists are also investigating new hybrid techniques combining functional and anatomical images for the depiction of SLN but further evidence about their value is needed. CONCLUSION This review examined the predictive and prognostic factors of lymphoscintigraphy for metastatic involvement of SLN, the currently available and emerging radiotracers and the evidence of the additional value of SPECT/CT over PL for the identification of SLN in patients with melanoma. Finally, the review discussed the most recent technical advances in the field.
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Affiliation(s)
- Natale Quartuccio
- Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, Palermo, Italy
- Address correspondence to this author at the Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, Palermo, Italy; Tel: +39091 666 2319; E-mail:
| | - Massimiliano Siracusa
- Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, Palermo, Italy
| | - Marco Pappalardo
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Annachiara Arnone
- Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, Palermo, Italy
| | - Gaspare Arnone
- Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, Palermo, Italy
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18
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Abstract
Single photon emission computed tomography (SPECT) is the state-of-the-art imaging modality in nuclear medicine despite the fact that only a few new SPECT tracers have become available in the past 20 years. Critical for the future success of SPECT is the design of new and specific tracers for the detection, localization, and staging of a disease and for monitoring therapy. The utility of SPECT imaging to address oncologic questions is dependent on radiotracers that ideally exhibit excellent tissue penetration, high affinity to the tumor-associated target structure, specific uptake and retention in the malignant lesions, and rapid clearance from non-targeted tissues and organs. In general, a target-specific SPECT radiopharmaceutical can be divided into two main parts: a targeting biomolecule (e.g., peptide, antibody fragment) and a γ-radiation-emitting radionuclide (e.g., 99mTc, 123I). If radiometals are used as the radiation source, a bifunctional chelator is needed to link the radioisotope to the targeting entity. In a rational SPECT tracer design, these single components have to be critically evaluated in order to achieve a balance among the demands for adequate target binding, and a rapid clearance of the radiotracer. The focus of this chapter is to depict recent developments of tumor-targeted SPECT radiotracers for imaging of cancer diseases. Possibilities for optimization of tracer design and potential causes for design failure are discussed and highlighted with selected examples.
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