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Taruno K, Kuwahata A, Sekino M, Nakagawa T, Kurita T, Enokido K, Nakamura S, Takei H, Kusakabe M. Exploratory Study of Superparamagnetic Iron Oxide Dose Optimization in Breast Cancer Sentinel Lymph Node Identification Using a Handheld Magnetic Probe and Iron Quantitation. Cancers (Basel) 2022; 14:cancers14061409. [PMID: 35326561 PMCID: PMC8946828 DOI: 10.3390/cancers14061409] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/05/2022] [Accepted: 03/08/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Sentinel lymph node biopsy (SLNB) using super magnetic iron oxide (SPIO) and magnetic probes is expected to be a simple and safe method of detecting cancerous lymph nodes without using radioisotopes (RIs). A multicenter trial of SLNB was conducted using a handheld magnetic probe and SPIO (Rizobist®) and its non-inferiority with the conventional RI method. The quantity of iron in SLN was measured to examine the necessary dosage and administration method for sufficient SLN detection in the case of this test. Further, a clinical trial was conducted to determine the possibility of SLNB with a half-dose of SPIO (1.0 mL → 0.5 mL), and the resulting iron volume measured at that time was also examined. This study demonstrates that sufficient iron content reaches SLN even at an SPIO dose of 0.5 mL. Abstract This exploratory study compared doses of ferucarbotran, a superparamagnetic iron oxide nanoparticle, in sentinel lymph nodes (SLNs) and quantified the SLN iron load by dose and localization. Eighteen females aged ≥20 years scheduled for an SLN biopsy with node-negative breast cancer were divided into two equal groups and administered either 1 mL or 0.5 mL ferucarbotran. Iron content was evaluated with a handheld magnetometer and quantification device. The average iron content was 42.8 µg (range, 1.3–95.0; 0.15% of the injected dose) and 21.9 µg (1.1–71.0; 0.16%) in the 1-mL and 0.5-mL groups, respectively (p = 0.131). The iron content of the closest SLN compared to the second SLN was 53.0 vs. 10.0 µg (19% of the injected dose) and 34.8 vs. 4.1 µg (11.1%) for the 1-mL and 0.5-mL groups, respectively (p = 0.001 for both). The magnetic field was high in both groups (average 7.30 µT and 6.00 µT in the 1-mL and 0.5-mL groups, respectively) but was not statistically significant (p = 0.918). The magnetic field and iron content were correlated (overall SLNs, p = 0.02; 1-mL, p = 0.014; 0.5-mL, p = 0.010). A 0.5-mL dose was sufficient for SLN identification. Primary and secondary SLNs could be differentiated based on iron content. Handheld magnetometers could be used to assess the SLN iron content.
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Affiliation(s)
- Kanae Taruno
- Division of Breast Surgical Oncology, Department of Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan;
- Correspondence: ; Tel.: +81-03-3784-8000
| | - Akihiko Kuwahata
- Department of Electrical Engineering and Information Systems, Graduate School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan; (A.K.); (M.S.)
- Department of Electronic Engineering, Graduate School of Engineering, Tohoku University, 6-6 Aramaki Aza-Aoba, Aoba-ku, Sendai 980-8579, Japan
| | - Masaki Sekino
- Department of Electrical Engineering and Information Systems, Graduate School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan; (A.K.); (M.S.)
| | - Takayuki Nakagawa
- Laboratory of Veterinary Surgery, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan;
| | - Tomoko Kurita
- Department of Breast Surgery and Oncology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan; (T.K.); (H.T.)
| | - Katsutoshi Enokido
- Department of Breast Surgical Oncology, Showa University School of Medicine, Fujigaoka Hospital, 1-30 Fujigaoka, Yokohama 227-8501, Japan;
| | - Seigo Nakamura
- Division of Breast Surgical Oncology, Department of Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan;
| | - Hiroyuki Takei
- Department of Breast Surgery and Oncology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan; (T.K.); (H.T.)
| | - Moriaki Kusakabe
- Department of Medical Device, Matrix Cell Research Institute Inc., 1-3-35 Kamikashiwada, Ushiku 300-0314, Japan;
- Research Center for Food Safety, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8654, Japan
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Abstract
The magnetic technique, consisting of a magnetic tracer and a handheld magnetometer, is a promising alternative technique for sentinel lymph node dissection (SLND) and was shown to be non-inferior to the standard technique in terms of identification rates. In this study, injection characteristics (iron dose, dilution, time course and massaging) were evaluated to optimize magnetic tracer uptake in the sentinel lymph nodes (SLN) in a rat hindleg model. 202 successful SLNDs were performed. Iron uptake in the SLN is proportional (10% utilization rate) to the injection dose between 20 and 200 μg, showing a plateau uptake of 80 μg in the SLN around 1000 μg injection. Linear regression showed that time had a higher impact than dilution, on the SLN iron uptake. Massaging showed no significant change in iron uptake. The amount of residual iron at the injection site was also proportional to the injection dose without any plateau. Time was a significant factor for wash-out of residual iron. From these results, preoperative injection may be advantageous for SLN detection as well as reduction in residual iron at the injection site by potential decrease in required injection dose.
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Optimization of SPIO Injection for Sentinel Lymph Node Dissection in a Rat Model. Cancers (Basel) 2021; 13:cancers13195031. [PMID: 34638516 PMCID: PMC8508039 DOI: 10.3390/cancers13195031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/15/2021] [Accepted: 10/05/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary In this study, the following injection characteristics were evaluated to optimize magnetic tracer uptake in the sentinel lymph nodes (SLN) in a rat hindleg model: (a) iron dose, (b) effect of dilution, (c) effect of injecting at different time courses and (d) effect of massaging the injection site. In conclusion, injection dose and time were primary factors for the SLN iron uptake. The result from this study will provide a background for magnetic procedures. Abstract The magnetic technique, consisting of a magnetic tracer and a handheld magnetometer, is a promising alternative technique for sentinel lymph node dissection (SLND) and was shown to be non-inferior to the standard technique in terms of identification rates. In this study, injection characteristics (iron dose, dilution, time course and massaging) were evaluated to optimize magnetic tracer uptake in the sentinel lymph nodes (SLN) in a rat hindleg model. 202 successful SLNDs were performed. Iron uptake in the SLN is proportional (10% utilization rate) to the injection dose between 20 and 200 μg, showing a plateau uptake of 80 μg in the SLN around 1000 μg injection. Linear regression showed that time had a higher impact than dilution, on the SLN iron uptake. Massaging showed no significant change in iron uptake. The amount of residual iron at the injection site was also proportional to the injection dose without any plateau. Time was a significant factor for wash-out of residual iron. From these results, preoperative injection may be advantageous for SLN detection as well as reduction in residual iron at the injection site by potential decrease in required injection dose.
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Kuwahata A, Ahmed M, Saeki K, Chikaki S, Kaneko M, Qiu W, Xin Z, Yamaguchi S, Kaneko A, Douek M, Kusakabe M, Sekino M. Combined use of fluorescence with a magnetic tracer and dilution effect upon sentinel node localization in a murine model. Int J Nanomedicine 2018; 13:2427-2433. [PMID: 29719391 PMCID: PMC5914738 DOI: 10.2147/ijn.s153163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Sentinel node biopsy using radioisotope and blue dye remains a gold standard for axillary staging in breast cancer patients with low axillary burden. However, limitations in the use of radioisotopes have resulted in emergence of novel techniques. This is the first in vivo study to assess the feasibility of combining the two most common novel techniques of using a magnetic tracer and indocyanine green (ICG) fluorescence. Materials and methods A total of 48 mice were divided into eight groups. Groups 1 and 2, the co-localization groups, received an injection of magnetic tracers (Resovist® and Sienna+®, respectively) and ICG fluorescence; distilled water was used as the solvent of ICG. Groups 3 and 4, the diluted injection groups, received an injection of magnetic tracers (Resovist and Sienna+, respectively) and saline for dilution. Groups 5, 6, and 7, the control groups, received magnetic tracer (Resovist, Sienna+) and ICG alone, respectively. Fluorescent intensity assessment and iron quantification of excised popliteal lymph nodes were performed. Group 1', a co-localization group, received an injection of magnetic tracers (Resovist) and ICG' fluorescence: saline was used as the solvent for ICG. Results Lymphatic uptake of all tracers was confined to the popliteal nodes only, with co-localization confirmed in all cases and no significant difference in fluorescent intensity or iron content of ex vivo nodes between the groups (except for Group 1'). There was no impact of dilution on the iron content in the diluted Sienna+ group, but it significantly enhanced Resovist uptake (P=0.005). In addition, there was a significant difference in iron content (P=0.003) in Group 1'. Conclusion The combination of a magnetic tracer (Resovist or Sienna+) and ICG fluorescence is feasible for sentinel node biopsy and will potentially allow for precise transcutaneous node identification, in addition to accurate intraoperative assessment. This radioisotope-free "combined technique" warrants further assessment within a clinical trial.
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Affiliation(s)
- Akihiro Kuwahata
- Department of Electrical Engineering and Information Systems, Graduate School of Engineering, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Muneer Ahmed
- Division of Cancer Studies, King's College London, Guy's Hospital Campus, Great Maze Pond, London, UK
| | - Kohei Saeki
- Graduate School of Agriculture and Life Sciences, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Shinichi Chikaki
- Department of Electrical Engineering and Information Systems, Graduate School of Engineering, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Miki Kaneko
- Department of Electrical Engineering and Information Systems, Graduate School of Engineering, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Wenqi Qiu
- Department of Electrical Engineering and Information Systems, Graduate School of Engineering, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Zonghao Xin
- Department of Electrical Engineering and Information Systems, Graduate School of Engineering, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Shinji Yamaguchi
- Graduate School of Agriculture and Life Sciences, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Akiko Kaneko
- Department of Electrical Engineering and Information Systems, Graduate School of Engineering, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Michael Douek
- Division of Cancer Studies, King's College London, Guy's Hospital Campus, Great Maze Pond, London, UK
| | - Moriaki Kusakabe
- Graduate School of Agriculture and Life Sciences, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan.,Matrix Cell Research Institute Inc., Ibaraki, Japan
| | - Masaki Sekino
- Department of Electrical Engineering and Information Systems, Graduate School of Engineering, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
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