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

M. Weiss; R. A. Schmid; C. Kunte; B. Konz; K. Hahn

doi:10.1055/s-0038-1623908

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2004; 43(01): 10-15
DOI: 10.1055/s-0038-1623908

Original Article

Schattauer GmbH

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

^99mTc colloidal rhenium sulphideErste Erfahrungen mit einem neuen Radiopharmakon für die WächterlymphknotenDetektion beim malignen Melanom ^99mTc markiertes kolloidales Rheniumsulfid

M. Weiss

¹Klinik und Poliklinik für Nuklearmedizin (Direktor: Prof. Dr. med. K. Hahn)

,

R. A. Schmid

¹Klinik und Poliklinik für Nuklearmedizin (Direktor: Prof. Dr. med. K. Hahn)

,

C. Kunte

²Dermatologische Klinik (Direktor: Professor Dr. med. G. Plewig), Ludwig-Maximilians-Universität München

,

B. Konz

²Dermatologische Klinik (Direktor: Professor Dr. med. G. Plewig), Ludwig-Maximilians-Universität München

,

K. Hahn

¹Klinik und Poliklinik für Nuklearmedizin (Direktor: Prof. Dr. med. K. Hahn)

› Author Affiliations

Abstract

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.

Zusammenfassung

Ziel dieser Studie war es, den Wächterlymphknoten (SLN) mittels Lymphszintigraphie unter Einsatz von Technetium-99m markiertem kolloidalem Rheniumsulfid (Nanocis^®), einem neuen, kommerziell erhältlichen Radiopharmakon für lymphszintigraphische Untersuchungen zu lokalisieren. Patienten, Methoden: 35 konsekutive Patienten mit histologisch gesichertem malignen Melanom, jedoch ohne klinische Hinweise auf (Fern-) Metastasierung, wurden präoperativ nach intradermaler, peritumoraler Injektion von 20-40 MBq Nanocis^® (durchschnittliche Partikelgröße: 100 nm; Streubreite: 50-200 nm) untersucht. Zusätzlich erfolgte intraoperativ eine Blaufärbung. Die intraoperative SLN-Detektion wurde mit einer Hand-Gammasonde durchgeführt. Ergebnisse: Intraoperativ konnten bei 34/35 Patienten (97%) insgesamt 63 zuvor szintigraphisch detektierte und auf der Haut markierte Wächterlymphknoten mittels Gammasonde gefunden werden. Mittels Blaufärbung ließen sich lediglich 41/63 (65%) Wächterlymphknoten darstellen. Die Anzahl der Wächterlymphknoten pro Patient betrug 1-4 (Mittel: n = 1,8). Der histologische Befund bestätigte den metastatischen Befall der SLN bei 12/35 (34%) Patienten. Die SLN-positiv-Rate (14/63 SLN) betrug 22%. Sie ist mit den Ergebnissen der SLN-Diagnostik mittels anderer Technetium-99m markierter Nanokolloide vergleichbar. Schlussfolgerung: An Tc-99m gebundenes kolloidales Rheniumsulfid eignet sich zur SLN-Diagnostik.

Keywords

Malignant melanoma - rhenium sulphide - sentinel lymph node - scintigraphy

Schlüsselwörter

Malignes Melanom - Rheniumsulfid - Wächterlymphknoten - Szintigraphie

Full Text

References

Literatur
1 Achong DM, Tenorio LE. Smith JA SPECT demonstrating lymphatic drainage from truncal melanoma to para-aortic lymph nodes. Clin Nucl Med 2002; 27: 295-6.
2 Alazraki NP, Eshima D, Eshima LA. et al. Lymphoscintigraphy, the sentinel node concept, and the intraoperative gamma probe in melanoma, breast cancer, and other potential cancers. Semin Nucl Med 1997; 27: 55-67.
3 Bergqvist L, Strand SE, Persson BR. Particle sizing and biokinetics of interstitial lymphoscintigraphic agents. Semin Nucl Med 1983; 13: 9-19.
4 Bianchi C, Habib FA, Morita E. et al. Identification of bilateral breast sentinel lymph nodes draining primary melanoma of the back by preoperative lymphoscintigraphy and intraoperative mapping. Clin Nucl Med 1999; 24: 501-3.
5 Blocklet D, Donckier V, Vereecken P. et al. Nondetection of sentinel lymph node with lymphoscintigraphy as a result of massive malignant invasion shown by positron emission tomography. Clin Nucl Med 2001; 26: 1013-5.
6 Bongers V, Borel R, Barneveld PC. et al. Towards quality assurance of the sentinel node procedure in malignant melanoma patients: a single institution evaluation and a European survey. Eur J Nucl Med 1999; 26: 84-90.
7 Borgstein PJ, Pijpers R, Comans EF. et al. Sentinel lymph node biopsy in breast cancer: guidelines and pitfalls of lymphoscintigraphy and gamma probe detection. J Am Coll Surg 1998; 186: 275-83.
8 Boxen I, McCready D, Ballinger JR. Sentinel node detection and definition may depend on the imaging agent and timing. Clin Nucl Med 1999; 24: 390-4.
9 Chinol M, Paganelli G. Current status of commercial colloidal preparations for sentinel lymph node detection. Eur J Nucl Med 1999; 26: 560.
10 De Cicco C, Cremonesi M, Luini A. et al. Lymphoscintigraphy and radioguided biopsy of the sentinel axillary node in breast cancer. J Nucl Med 1998; 39: 2080-4.
11 Dresel S, Weiss M, Heckmann M. et al. Diagnosis of sentinel lymph node in malignant melanoma: preoperative lymphoscintigraphy and intraoperative gamma probe guidance. Nuklearmedizin 1998; 37: 177-82.
12 Edreira MM, Colombo LL, Perez JH. et al. In vivo evaluation of three different ^99mTc-labeled radiopharmaceuticals for sentinel lymph node identification. Nucl Med Comm 2001; 22: 499-504.
13 Eshima D, Fauconnier T, Eshima L. et al. Radio-pharmaceuticals for lymphoscintigraphy: including dosimetry and radiation considerations. Semin Nucl Med 2000; 30: 25-35.
14 Heidenreich P, Bares R, Brenner W. et al. Order of management for nuclear medicine for sentinel lymph node (SLN) diagnosis. Nuklearmedizin 2001; 40: 98-101.
15 Keshtgar MRS, Ell PJ. Sentinel lymph node detection and imaging. Eur J Nucl Med 1999; 26: 57-67.
16 Kropp J, Stein A, Hackert I. et al. Accuracy of the intraoperative radioguided localization of the sentinel lymph node (SLN) 24 hours after lymphoscintigraphy in patients with malignant melanoma. Nuklearmedizin 2001; 40: 86-90.
17 Lerch H, Jigalin A, Gasthaus K. et al. Three-dimensional localization of sentinel lymph nodes using combined emission and transmission SPECT data. Clin Nucl Med 2003; 28: 1-4.
18 Morton DL, Wen DR, Wong JH. et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992; 127: 392-9.
19 Munz DL, Maza S, Ivancevic V. et al. Classification of the lymphatic drainage status of a primary tumour: a proposal. Nuklearmedizin 2000; 39: 88-91.
20 Nathanson SD, Anaya P, Karvelis KC. et al. Sentinel lymph node uptake of two different technetium-labeled radiocolloids. Ann Surg Onc 1997; 4: 104-10.
21 Sera MJ, Yonehara C, Morita S. et al. Timing of sentinel lymphadenectomy in cutaneous melanoma. Clin Nucl Med 2002; 27: 648-52.
22 Stewart KC, Lyster DM. Interstitial lymphoscintigraphy for lymphatic mapping in surgical practice and research. J Invest Surg 1997; 10: 249-62.
23 Strand SE, Bergqvist L. Radiolabeled colloids and macromolecules in the lymphatic system. Crit Rev Ther Drug Carrier Syst 1989; 6: 211-38.
24 Tsopelas C. Particle size analysis of ^99mTc-labeled and unlabeled antimony trisulphide and rhenium sulphide colloids intended for lymphoscintigraphic application. J Nucl Med 2001; 42: 463-6.
25 Uren RF, Thompson JF, Howman-Giles RB. Lymphatic drainage of the skin and breast. Singapore: Harwood Academic Publishers; 1999: 40-9.
26 Uren RF, Thompson JF, Howman-Giles R. Sentinel nodes. Interval nodes, lymphatic lakes, and accurate sentinel node identification. Clin Nucl Med 2000; 25: 234-6.
27 Veronesi U, Paganelli G, Viale G. et al. Sentinel lymph node biopsy and axillary dissection in breast cancer: results in a large series. J Natl Cancer Inst 1999; 91: 368-73.
28 Vogt H, Bachter D, Buchels HK. et al. Sentinel lymph node detection by preoperative lymphoscintigraphy and intraoperative gamma probe guidance in malignant melanoma. Nuklearmedizin 1999; 38: 95-100.
29 Weiss M, Roßmüller B, Konz B. et al. Lymphoscintigraphy and intraoperative gamma probe guided detection of the sentinel lymph node – first experiences. LymphForsch 1998; 2: 23-8.
30 Weiss M, Konz B, Dresel S. et al. Metastases in patients with malignant melanoma despite of negative sentinel lymph node: Has the concept to be changed?. Nuklearmedizin 2000; 39: 214-7.
31 Wilhelm AJ, Mijnhout GS, Franssen EJ. Radio-pharmaceuticals in sentinel lymph node detection – an overview. Eur J Nucl Med 1996; 26 Suppl 36-42.