Sentinel lymph node in prostate carcinoma: Methodology, feasibility, surgical, and oncological consequences, about 74 patients.

e15109 Background: There are few studies in the field of prostatic sentinel lymph node (SLN) procedure: in the international literature at the most 10 publications are found. However the interest of urological surgeons and oncologists is growing fast. Goals of our study were: on the first hand to evaluate the rate of SLN SPECT-CT detection and the rate of SLN involvement, on the other hand to evaluate the incidence of the SLN biopsy results on the surgical and oncological management. Methods: 74 patients with prostate cancer were included. All patients had a Gleason score between 6 and 8. All patients were elected for a radical laparoscopic prostatectomy. Nanocis-Tc 99m was intratumorally injected, guided by transrectal ultrosonography. 2 injections of 0.6 ml in each lobe of the prostate were performed, depending on the size of the prostate. Patient underwent planar imaging and SPECT-CT 2 hours after injections. Surgery was performed 18 hours after SPECT-CT lymphoscintigraphy. Results: A lymphatic pelvic drainage was seen in 94,6 % (70/74) by SPECT-CT. Lymphatic drainage was on the right side (23), on the left side (15), or bilateral (32). The radioguided lymphadenectomy was assisted by a laparoscopic gamma-probe, the SLN detection rate was 97% (68/70); the average number of resected radioactive nodes was 1.6 (range 1 to 5). By all the ways, a limited pelvic lymph node dissection was performed in all 74 cases. An SLN involvement was found in 5 cases (5/68= 7.35%); in these 5 cases and in the 63 cases without SLN involvement, no metastatic involvement was found in the other lymph nodes, as well as in the 6 patients for which no SLN could be selectively resected (4 with no drainage seen and 2 not detected intra-operatively although visualized on lymphoscintigraphy). Conclusions: The low rate of lymphatic involvement is not surprising considering the Gleason score range 6 to 8 (low metastatic risk). So, the preliminary results are very attractive, especially for these patients that could have been falsely considered as N0. Our study is still in progress, and if these results are confirmed on a larger scale, then SLN procedure could be considered in the routine management of low risk prostatic carcinomas.

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Sentinel lymph node in prostate carcinoma: Methodology, feasibility, surgical, and oncological consequences: A prospective study about 93 patients.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.6_suppl.69 ◽

2013 ◽

Vol 31 (6_suppl) ◽

pp. 69-69

Author(s):

Claude Soler ◽

Yves Perraud ◽

Eric Gremillet ◽

Corine Armand ◽

Benjamin Geissler ◽

...

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Gamma Probe ◽

Lymphatic Drainage ◽

Planar Imaging ◽

Iliac Arteries ◽

Internal Iliac ◽

Metastatic Risk ◽

The Right ◽

A Prospective Study

69 Background: There are few studies in the field of prostatic sentinel lymph node (SLN) procedure: in the literature at the most 10 publications are found. However the interest of urological surgeons is growing fast. We want to evaluate the rate of SLN SPECT-CT detection, the rate of SLN involvement, and the incidence of the SLN biopsy on the surgical and oncological management of patients. Methods: 93 patients with prostate cancer were included (gleason 6-9). All patients were elected for a radical laparoscopic prostatectomy. Nanocis* was intratumorally injected, guided by transrectal ultrosonography. 2 injections 0.6 ml in each lobe of the prostate were performed. Patient underwent planar imaging and SPECT-CT 2 hours after injections. Surgery was performed 18 hours after. Results: A lymphatic pelvic drainage was seen in 95,6 % (89/93) by SPECT-CT (external or internal iliac arteries areas). For 27 patients lymphatic drainage was on the right side, for 24 patients it was on the left side, for the 37 remaining patients migration was bilateral. The radioguided lymphadenectomy was assisted by a laparoscopic gamma-probe (Clerad, France), the SLN detection rate was 97.7% (87/89); the average number of resected radioactive nodes was 1.6 (range 1 to 5). By all the ways, a limited pelvic lymph node dissection was performed (including external iliac to common iliac arteries areas) in all 93 cases. An SLN involvement was found in 6 cases (5/87= 5.75%); in these 6 cases and in the 81 cases without SLN involvement, no metastatic involvement was found in the other lymph nodes, as well as in the 6 patients for which no SLN could be selectively resected (4 with no drainage seen and 2 not detected intra-operatively although visualized on lymphoscintigraphy). Conclusions: The low rate of lymphatic involvement is not surprising considering the Gleason score range 6 to 9 (low metastatic risk). So, the preliminary results are very attractive, especially for these patients that could have been falsely considered as N0. Our study is still in progress, and if these results are confirmed on a larger scale, then SLN procedure could be considered in the routine management of low risk prostatic carcinomas.

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First experiences with a new radiopharmaceutical for sentinel lymph node detection in malignant melanoma

Nuklearmedizin ◽

10.1055/s-0038-1623908 ◽

2004 ◽

Vol 43 (01) ◽

pp. 10-15 ◽

Cited By ~ 4

Author(s):

R. A. Schmid ◽

C. Kunte ◽

B. Konz ◽

K. Hahn ◽

M. Weiss

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Malignant Melanoma ◽

Sentinel Node ◽

Gamma Probe ◽

Blue Dye ◽

Sentinel Nodes ◽

Technetium 99M ◽

Positive Rate ◽

Metastatic Involvement

Summary Aim of this study was to localize the sentinel lymph node by lymphoscintigraphy using technetium-99m colloidal rhenium sulphide (Nanocis®), a new commercially available radiopharmaceutical. Due to the manufacturers’ instructions it is licensed for lymphoscintigraphy. Patients, methods: 35 consecutive patients with histologically proved malignant melanoma, but without clinical evidence of metastases, were preoperatively examined by injecting 20-40 MBq Nanocis® with (mean particle size: 100 nm; range: 50-200 nm) intradermally around the lesion. Additionally blue dye was injected intaoperatively. A hand-held gamma probe guided sentinel node biopsy. Results: During surgery, the preoperatively scintigraphically detected sentinel lymph nodes were identified in 34/35 (97%) patients. The number of sentinel nodes per patient ranged from one to four (mean: n = 1.8). Histologically, metastatic involvement of the sentinel lymph node was found in 12/35 (34%) patients; the sentinel lymph node positive-rate (14/63 SLN) was 22%. Thus, it is comparable to the findings of SLN-mapping using other technetium-99m-labeled nanocolloides. Conclusion: 99mTc-bound colloidal rhenium sulphide is also suitable for sentinel node mapping.

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Characterizing an ideal experimental canine model for penile sentinel lymph node identification

Revista de Medicina da UFC ◽

10.20513/2447-6595.2018v58n2p25-30 ◽

2018 ◽

Vol 58 (2) ◽

pp. 25

Author(s):

Bruno Tigre de Arruda Leitão ◽

Willy Okoba ◽

Diego Aragão Bezerra ◽

Jose Wilson Benevides de Mesquita Neto ◽

Diego Alves Cruz ◽

...

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Ex Vivo ◽

Statistical Significance ◽

Gamma Probe ◽

Canine Model ◽

Blue Dye ◽

Kappa Index ◽

Experimental Canine ◽

The Right

Objective: Develop and evaluate a canine experimental model of penile sentinel lymph node (SLN) detection using a combination of patent blue dye (PB) and technetium99m phytate (99mTc). Methods: The experiment sampled healthy adult male mongrel dogs (N=19; 10-20 kg). After approval by the local ethics committee, we injected99mTc in the glans penis along the midline raphe. After 10 min, PB was injected in the same region. Ten minutes later, we identified hot spots within the inguinals and iliac artery areausing a gamma probe. We dissected identified sites to quantify the radiation at the SLN in vivo and ex vivo and accounted for the stained and unstained nodes. We analyzed the results for statistical significance and determined the level of agreement between the two methods. Results: SLNs were detected in 94.76% of the cases using PB and 99mTc. There was no difference (p>0.05) between the SLNs-count on the left and the right side. However, PB and 99mTc correlated well on the right side (kappa index: 0.642) and perfectly on the left side (kappa index: 1), indicating a high level of consistency. Conclusion: The experimental canine model of penile SLN, in our study, was shown to be feasible.

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Hemosiderin: a new marker for sentinel lymph node identification

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502009000600002 ◽

2009 ◽

Vol 24 (6) ◽

pp. 432-436 ◽

Cited By ~ 12

Author(s):

Luiz Gonzaga Porto Pinheiro ◽

Renato Santos de Oliveira Filho ◽

Paulo Henrique Diógenes Vasques ◽

Pedro Henrique de Oliveira Filgueira ◽

Douglas Henning Pinheiro Aragão ◽

...

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Lymph Nodes ◽

Breast Biopsy ◽

Gamma Probe ◽

Sentinel Lymph Nodes ◽

Patent Blue ◽

Sentinel Lymph Node Identification ◽

Lymphatic Duct ◽

The Right

PURPOSE: To evaluate and present our initial results of a new marker (hemosiderin) for mammary sentinel lymph node identification in an experimental model. METHODS: Skins mapped like a lymphatic duct draining to the axilla in patients submitted to breast biopsy, in our mastology service, stimulated us to try it in an animal model (female dogs). Our theory was that some blood derivate (hemosiderin) was captured by macrophages and accessed the lymphatic ducts in direction to the axilla. Six female dogs of no defined race were studied. We injected 0,2 ml of technetium on both superior mammary glands. After ten minutes, a 2,5 ml solution of hemolized blood (hemosiderin) from the own animal was injected in the subareolar lymphatic plexus on the left superior mammary gland and 2,5 ml of patent blue concomitantly and equally on the contralateral gland. Ten minutes after, incisions on both axilas were made to search, through the lymphatic mapping and a gamma probe, the sentinel lymph nodes. RESULTS: Seven brown sentinel lymph nodes were indentified and also radiomarked on the left axilla. Six blue sentinel lymph nodes were identified and also radiomarked on the right axilla. CONCLUSION: Preliminary studies of a potential new dye for sentinel lymph node identification are presented. It may be the change of the current use of the blue dyes and their severe side-effects on patients submitted to sentinel lymph node biopsies.

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Detection of the Sentinel Lymph Node With Hybrid Tracer (ICG-[99mTc]Tc-albumin Nanocolloid) in Intermediate and High Risk Endometrial Cancer. A Feasibility Study

10.21203/rs.3.rs-773719/v1 ◽

2021 ◽

Author(s):

Nuria Sánchez Izquierdo ◽

Sergi Vidal-Sicart ◽

Francisco Campos ◽

Aureli Torné ◽

Martina Aida Angeles ◽

...

Keyword(s):

Lymph Node ◽

High Risk ◽

Sentinel Lymph Node ◽

Near Infrared ◽

Transvaginal Ultrasound ◽

Gamma Probe ◽

Lymphatic Drainage ◽

Intraoperative Detection ◽

Paraaortic Lymphadenectomy ◽

Hybrid Tracer

Abstract Purpose: Indocyanine green (ICG) is frequently used for the detection of the sentinel lymph node (SLN) in gynecology, but it carries the loss of the presurgical SLN mapping provided by [99mTc]-based colloids. Hybrid tracers such as ICG-[99mTc] Tc-albumin nanocolloid combine the benefits of both components. The aim of this study was to evaluate the feasibility and applicability of this hybrid tracer injected by transvaginal ultrasound-guided myometrial injection of radiotracer (TUMIR) approach in the detection of SLNs in patients with intermediate- and high-risk EC. Methods: Fifty-two patients with intermediate- and high-risk EC underwent SLN biopsy after injection of a hybrid tracer using the TUMIR approach, followed by pelvic and paraaortic lymphadenectomy. SLNs were detected preoperatively by lymphoscintigraphic study and intraoperatively by gamma probe and near-infrared (NIR) optical laparoscopic camera. Results: Preoperative lymphatic drainage was obtained in 69% and intraoperative detection in 71.4% of patients. A total of 146 SLNs (4.17 SLNs/patient) were biopsied. Pelvic bilateral detection was observed in 57% of the women and paraaortic drainage in 34% of the patients. The radioactive component allowed the detection of SLN in 97.1% of the patients, while the fluorescent component detected 80%. In more than 17% of the patients with intraoperative detection, SLNs were detected only by the radioactive signal. Lymph node metastasis were identified in 14.3% of patients submitted to SLNB. The sensitivity and negative predictive value for metastatic involvement were 100%. Conclusion: TUMIR injection of a hybrid tracer in patients with intermediate- and high- risk EC combines the benefits of the radiotracer and the fluorescence methods with a single tracer. The method increases the paraaortic detection rate and allows a potential increase in SLN detection. Notwithstanding, based on our findings, the radioactive component of the hybrid tracer cannot be obviated.

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Detection of the sentinel lymph node with hybrid tracer (ICG-[99mTc]Tc-albumin nanocolloid) in intermediate- and high-risk endometrial cancer: a feasibility study

EJNMMI Research ◽

10.1186/s13550-021-00863-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Nuria Sánchez-Izquierdo ◽

Sergi Vidal-Sicart ◽

Francisco Campos ◽

Aureli Torné ◽

Martina Aida Angeles ◽

...

Keyword(s):

Lymph Node ◽

High Risk ◽

Sentinel Lymph Node ◽

Near Infrared ◽

Transvaginal Ultrasound ◽

Gamma Probe ◽

Lymphatic Drainage ◽

Intraoperative Detection ◽

Paraaortic Lymphadenectomy ◽

Hybrid Tracer

Abstract Purpose Indocyanine green (ICG) is frequently used for the detection of the sentinel lymph node (SLN) in gynecology, but it carries the loss of the presurgical SLN mapping provided by [99mTc]-based colloids. Hybrid tracers such as ICG-[99mTc]Tc-albumin nanocolloid combine the benefits of both components. The aim of this study was to evaluate the feasibility and applicability of this hybrid tracer injected by transvaginal ultrasound-guided myometrial injection of radiotracer (TUMIR) approach in the detection of SLNs in patients with intermediate- and high-risk EC. Methods Fifty-two patients with intermediate- and high-risk EC underwent SLN biopsy after injection of a hybrid tracer using the TUMIR approach, followed by pelvic and paraaortic lymphadenectomy. SLNs were detected preoperatively by lymphoscintigraphic study and intraoperatively by gamma probe and near-infrared (NIR) optical laparoscopic camera. Results Preoperative lymphatic drainage was obtained in 69% and intraoperative detection in 71.4% of patients. A total of 146 SLNs (4.17 SLNs/patient) were biopsied. Pelvic bilateral detection was observed in 57% of the women and paraaortic drainage in 34% of the patients. The radioactive component allowed the detection of SLN in 97.1% of the patients, while the fluorescent component detected 80%. In more than 17% of the patients with intraoperative detection, SLNs were detected only by the radioactive signal. Lymph node metastasis was identified in 14.3% of patients submitted to SLNB. The sensitivity and negative predictive value for metastatic involvement were 100%. Conclusion TUMIR injection of a hybrid tracer in patients with intermediate- and high-risk EC combines the benefits of the radiotracer and the fluorescence methods with a single tracer. The method increases the paraaortic detection rate and allows a potential increase in SLN detection. Notwithstanding, based on our findings, the radioactive component of the hybrid tracer cannot be obviated.

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Development and characterization of an all-in-one gamma probe with auto-peak detection for sentinel lymph node biopsy based on NEMA NU3-2004 standard

Annals of Nuclear Medicine ◽

10.1007/s12149-021-01581-z ◽

2021 ◽

Author(s):

Aram Radnia ◽

Hamed Abdollahzadeh ◽

Behnoosh Teimourian ◽

Mohammad Hossein Farahani ◽

Mohammad Esmaeil Akbari ◽

...

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Gamma Probe ◽

Peak Detection ◽

Cesium Iodide ◽

Shielding Effectiveness ◽

Scattering Medium ◽

Silicon Photomultiplier ◽

Regional Lymph Nodes ◽

Handheld Device

Abstract Background A gamma probe is a handheld device used for intraoperative interventions following interstitial injection of a radiotracer to locate regional lymph nodes through the external detection of radiation. This work reports on the design and performance evaluation of a novel fully integrated gamma probe (GammaPen), recently developed by our group. Materials and methods GammaPen is an all-in-one pocket gamma probe with low weight and adequate dimensions, consisting of a detector, a control unit and output all together. The detector module consists of a cylindrical Thallium-activated Cesium Iodide [CsI (Tl)] crystal optically coupled to a Silicon photomultiplier (SiPM), shielded using Tungsten housing on side and back faces. The electronics of the probe consists of two small boards to handle signal processing and analog peak detection tasks. A number of parameters, including probe sensitivity in air/water, spatial resolution in air/water, angular resolution in air/water, and side and back shielding effectiveness, were measured to evaluate the performance of the probe based on NEMA NU3-2004 standards. Results The sensitivity of the probe in air at distances of 10, 30, and 50 mm is 18784, 3500, and 1575 cps/MBq. The sensitivity in scattering medium was also measured at distances of 10, 30, and 50 mm as 17,680, 3050, and 1104 cps/MBq. The spatial and angular resolutions in scattering medium were 47 mm and 87 degree at 30 mm distance from the probe, while they were 40 mm and 77 degree in air. The detector shielding effectiveness and leakage sensitivity are 99.91% and 0.09%, respectively. Conclusion The performance characterization showed that GammaPen can be used effectively for sentinel lymph node localization. The probe was successfully used in several surgical interventions by an experienced surgeon confirming its suitability in a clinical setting.

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