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Kong CY, Williams J, Hemadasa N, Murphy D, Bews-Hair M. The Introduction of Magtrace® Lymphatic Tracer for Axillary Sentinel Node Biopsy for Breast Cancer in a Rural Scottish District General Hospital: Initial Experience, Perspectives, Outcomes and Learning Curves. Clin Breast Cancer 2024:S1526-8209(24)00099-5. [PMID: 38653647 DOI: 10.1016/j.clbc.2024.03.013] [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: 02/02/2024] [Revised: 03/14/2024] [Accepted: 03/23/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Magtrace is a supraparamagnetic iron lymphatic tracer that has had increasing use in sentinel node biopsy (SNB) for breast cancer and has theoretical logistical benefits in centres where nanocolloid use may be associated with such issues. We describe our initial experience with the introduction of Magtrace into our routine practice by dual localisation with nanocolloid, comparing performance, and concordance. MATERIALS AND METHODS This was prospective study of the first patients undergoing axillary SNB using Magtrace in a single centre. These patients had dual localisation with nanocolloid and Magtrace. Subjective global assessments of Magtrace and nanocolloid performance as well as objective signal strength and anatomical concordance were compared across multiple timepoints in the operative journey. RESULTS A total of 30 consecutive patients underwent SNB within the timeframe of this study. While there were no failed SNB, 8 issues were reported including 4 issues of perceived imperfect localisation on global assessment. No patient had a failed or abandoned SNB, and only 1 case had a potential challenge in subsequent management after histopathological examination of the retrieved nodes. The majority of these issues occurred in the first half of the study period. There was overall weak to moderate positive correlation between Magtrace and nanocolloid signals of the retrieved sentinel nodes (Spearman's ρ = 0.392, P = .043). CONCLUSION This study suggests that introducing Magtrace was feasible and safe in the context of a rural breast cancer service. A possible strategy to ameliorate the learning curve associated with these procedures is the routine dual localisation in the initial phases of performing Magtrace localisation.
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Affiliation(s)
- Chia Yew Kong
- Department of Surgery, Dumfries and Galloway Royal Infirmary, Dumfries, UK; Academic Unit of Surgery, Glasgow Royal Infirmary and University of Glasgow, Glasgow, UK.
| | - Jacob Williams
- Department of Surgery, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | - Niroshini Hemadasa
- Department of Surgery, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | - Dermot Murphy
- Department of Surgery, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | - Maria Bews-Hair
- Department of Surgery, Dumfries and Galloway Royal Infirmary, Dumfries, UK
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Meng YQ, Shi YN, Zhu YP, Liu YQ, Gu LW, Liu DD, Ma A, Xia F, Guo QY, Xu CC, Zhang JZ, Qiu C, Wang JG. Recent trends in preparation and biomedical applications of iron oxide nanoparticles. J Nanobiotechnology 2024; 22:24. [PMID: 38191388 PMCID: PMC10775472 DOI: 10.1186/s12951-023-02235-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/29/2023] [Indexed: 01/10/2024] Open
Abstract
The iron oxide nanoparticles (IONPs), possessing both magnetic behavior and semiconductor property, have been extensively used in multifunctional biomedical fields due to their biocompatible, biodegradable and low toxicity, such as anticancer, antibacterial, cell labelling activities. Nevertheless, there are few IONPs in clinical use at present. Some IONPs approved for clinical use have been withdrawn due to insufficient understanding of its biomedical applications. Therefore, a systematic summary of IONPs' preparation and biomedical applications is crucial for the next step of entering clinical practice from experimental stage. This review summarized the existing research in the past decade on the biological interaction of IONPs with animal/cells models, and their clinical applications in human. This review aims to provide cutting-edge knowledge involved with IONPs' biological effects in vivo and in vitro, and improve their smarter design and application in biomedical research and clinic trials.
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Affiliation(s)
- Yu Qing Meng
- State Key Laboratory for Quality Ensurance and Sustainable Use of Dao-di Herbs, Artemisinin Research Center, and Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Ya Nan Shi
- School of Pharmacy, Yantai University, No. 30, Qingquan Road, Laishan District, Yantai, Shandong, China
| | - Yong Ping Zhu
- State Key Laboratory for Quality Ensurance and Sustainable Use of Dao-di Herbs, Artemisinin Research Center, and Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Yan Qing Liu
- State Key Laboratory for Quality Ensurance and Sustainable Use of Dao-di Herbs, Artemisinin Research Center, and Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Li Wei Gu
- State Key Laboratory for Quality Ensurance and Sustainable Use of Dao-di Herbs, Artemisinin Research Center, and Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Dan Dan Liu
- State Key Laboratory for Quality Ensurance and Sustainable Use of Dao-di Herbs, Artemisinin Research Center, and Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Ang Ma
- State Key Laboratory for Quality Ensurance and Sustainable Use of Dao-di Herbs, Artemisinin Research Center, and Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Fei Xia
- State Key Laboratory for Quality Ensurance and Sustainable Use of Dao-di Herbs, Artemisinin Research Center, and Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Qiu Yan Guo
- State Key Laboratory for Quality Ensurance and Sustainable Use of Dao-di Herbs, Artemisinin Research Center, and Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Cheng Chao Xu
- State Key Laboratory for Quality Ensurance and Sustainable Use of Dao-di Herbs, Artemisinin Research Center, and Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Jun Zhe Zhang
- State Key Laboratory for Quality Ensurance and Sustainable Use of Dao-di Herbs, Artemisinin Research Center, and Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China.
| | - Chong Qiu
- State Key Laboratory for Quality Ensurance and Sustainable Use of Dao-di Herbs, Artemisinin Research Center, and Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China.
| | - Ji Gang Wang
- State Key Laboratory for Quality Ensurance and Sustainable Use of Dao-di Herbs, Artemisinin Research Center, and Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China.
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Abidi H, Bold RJ. Assessing the Sentimag system for guiding sentinel node biopsies in patients with breast cancer. Expert Rev Med Devices 2024; 21:1-9. [PMID: 37992402 DOI: 10.1080/17434440.2023.2284790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023]
Abstract
INTRODUCTION Sentinel lymph node biopsy for breast cancer is a method to localize and excise the first draining lymph node from an invasive cancer of the breast. The histopathologic evaluation of the sentinel lymph node is used for predicting recurrence and survival and thus, guiding oncologists for treatment-decision making to administer adjuvant therapies. The ability to identify the sentinel node depends on methods to map lymphatic drainage from the breast to the sentinel node and accurately discriminate that node from other non-sentinel lymph nodes of the axilla. AREAS COVERED This review covers the clinical demand for technologies to assist the surgeon in intraoperative lymphatic mapping to specifically identify the sentinel lymph node in patients with breast cancer. Performance characteristics are reviewed for superparamagnetic iron oxide tracers used in lymphatic mapping compared to other current available technologies for lymphatic mapping. EXPERT OPINION The Magtrace (superparamagnetic iron oxide tracer) Sentimag (handheld magnetic probe) system is an FDA-approved technology for intraoperative lymphatic mapping to facilitate sentinel lymph node biopsy in breast cancer with technologic performance characteristics that are equivalent to 99Technetium-sulfur colloid. Barriers to broader utilization primarily center around the need for nonmetallic devices to be used for the conduct of surgery, which would interfere with the paramagnetic method for tracer localization.
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Affiliation(s)
- Hira Abidi
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, CA, USA
| | - Richard J Bold
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, CA, USA
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Kumar A, Kulkarni S, Pandey A, Mutalik S, Subramanian S. Nano-tracers for sentinel lymph node detection: current trends in technique and application. Nanomedicine (Lond) 2024; 19:59-77. [PMID: 38197375 DOI: 10.2217/nnm-2023-0271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
Sentinel lymph node (SLN) detection and biopsy is a critical staging component for several cancers. Apart from established methods using dyes or radiolabeled colloids, newer techniques are emerging, like near-infrared fluorescent compounds, targeted molecular radiopharmaceuticals and magnetic nano-tracers. In the overview section of this review, we categorize SLN detection tracers based on their principle of use. We discuss the merits of existing tracers and provide a glimpse of in-development formulations. A subsequent clinical section explores the expanded role of SLN detection in management of various cancers, citing current medical guidelines and the leading conclusions of long-term clinical trials. The concluding section tries to provide a perspective of promising developments and the work required to bring them to clinical fruition.
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Affiliation(s)
- Anuj Kumar
- Radiopharmaceuticals Division, Bhabha Atomic Research Centre, Mumbai, 400085, India
| | - Sanjay Kulkarni
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Abhijeet Pandey
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Srinivas Mutalik
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Suresh Subramanian
- Radiopharmaceuticals Division, Bhabha Atomic Research Centre, Mumbai, 400085, India
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Cheng W, Wu X, Yu S, Zhang C, Song Y, Li X, Yu X. Biomimetic nanoplatform with selectively positioned indocyanine green for accurate sentinel lymph node imaging. NANOSCALE 2023; 15:19168-19179. [PMID: 37982186 DOI: 10.1039/d3nr03149g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
The status of draining lymph nodes (LNs) is critical for determining the treatment and prognosis of cancer that spreads through the lymphatic system. Indocyanine green (ICG) fluorescence imaging has been widely used in sentinel LN (SLN) biopsy technology and has shown favorable effects. However, this too has its own limitations, such as fluorescence instability and diffusion imaging. In this study, we developed macrophage cell membrane-camouflaged ICG-loaded biomimetic nanoparticles (M@F127-ICG) for accurate SLN imaging. ICG selectively positioned at the hydrophobic-hydrophilic interfaces of pluronic F127 micelles protected itself from quenching in aqueous solution, thereby maintaining fluorescence stability and improving fluorescence intensity. In addition, to further improve the aggregation in SLN, the micellar surface was coated with a layer of biomimetic macrophage cell membrane to target LN-resident macrophages. In vivo fluorescence imaging demonstrated that M@F127-ICG significantly enhanced the fluorescence signal and improved the imaging efficiency of SLN. Thus, selectively positioning ICG in the biomimetic nanoplatform enhanced the fluorescence intensity and stability, providing a novel tracer for timely and accurate SLN imaging.
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Affiliation(s)
- Wenjing Cheng
- Hubei Key Laboratory of Tumor Microenvironment and Immunotherapy, China Three Gorges University, Yichang, China
| | - Xiangbai Wu
- Hubei Provincial Clinical Research Center for Precise Prevention and Treatment of Elderly Gastrointestinal Cancer, The Second People's Hospital of China Three Gorges University, Yichang, China
| | - Shi Yu
- Hubei Key Laboratory of Tumor Microenvironment and Immunotherapy, China Three Gorges University, Yichang, China
| | - Chengwei Zhang
- Hubei Key Laboratory of Tumor Microenvironment and Immunotherapy, China Three Gorges University, Yichang, China
| | - Yinhong Song
- Hubei Key Laboratory of Tumor Microenvironment and Immunotherapy, China Three Gorges University, Yichang, China
| | - Xinzhi Li
- Hubei Key Laboratory of Tumor Microenvironment and Immunotherapy, China Three Gorges University, Yichang, China
| | - Xiang Yu
- School of Biomedical Engineering, Hainan University, Haikou, Hainan 570228, China.
- Key Laboratory of Biomedical Engineering of Hainan Province, School of Biomedical Engineering, Hainan University, China
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Rocco N, Velotti N, Pontillo M, Vitiello A, Berardi G, Accurso A, Masone S, Musella M. New techniques versus standard mapping for sentinel lymph node biopsy in breast cancer: a systematic review and meta-analysis. Updates Surg 2023; 75:1699-1710. [PMID: 37326934 PMCID: PMC10435404 DOI: 10.1007/s13304-023-01560-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/03/2023] [Indexed: 06/17/2023]
Abstract
New tracers for sentinel lymph node biopsy (SLNB), as indocyanine green (ICG), superparamagnetic iron oxide (SPIO) and micro bubbles, have been recently introduced in clinical practice showing promising but variable results. We reviewed the available evidence comparing these new techniques with the standard tracers to evaluate their safety. To identify all available studies, a systematic search was performed in all electronic databases. Data regarding sample size, mean number of SLN harvested for patient, number of metastatic SLN and SLN identification rate of all studies were extracted. No significant differences were found in terms of SLNs identification rates between SPIO, RI and BD but with a higher identification rate with the use of ICG. No significant differences were also found for the number of metastatic lymph nodes identified between SPIO, RI and BD and the mean number of SLNs identified between SPIO and ICG versus conventional tracers. A statistically significant differences in favor of ICG was reported for the comparison between ICG and conventional tracers for the number of metastatic lymph nodes identified. Our meta-analysis demonstrates that the use of both ICG and SPIO for the pre-operative mapping of sentinel lymph nodes in breast cancer treatment is adequately effective.
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Affiliation(s)
- Nicola Rocco
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy
| | - Nunzio Velotti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy.
| | - Martina Pontillo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy
| | - Antonio Vitiello
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy
| | - Giovanna Berardi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy
| | - Antonello Accurso
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy
| | - Stefania Masone
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Mario Musella
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy
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Axillary sentinel lymph node identification using superparamagnetic iron oxide versus radioisotope in early stage breast cancer: The UK SentiMag trial (SMART study). Surgeon 2023; 21:128-134. [PMID: 35551871 DOI: 10.1016/j.surge.2022.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/29/2022] [Accepted: 04/10/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND & OBJECTIVES Sentinel lymph node biopsy (SLNB) is an accurate and reliable method for staging the axilla in early breast cancer. The gold standard technique for localizing the sentinel lymph node (SLN) is the use of radioisotope with or without blue dye. However, this technique has its limitations. Various alternatives have been explored to overcome the disadvantages of the standard SLNB technique and superparamagnetic iron oxide mapping agents have garnered significant attention. The SMART study aims to compare the magnetic technique using the superparamagnetic iron oxide particles (SPIO, Sienna+®) to the radioisotope technique (Tc99) +/- blue dye, for SLN identification in patients with early breast cancer. METHODS A prospective, multicenter study was done that recruited 109 clinically node-negative early-stage breast cancer patients from five centres in the United Kingdom (UK). The patients received radioisotope ± blue dye injections, followed by intraoperative injection of magnetic tracer prior to SLNB. The sentinel node identification rate was compared between the magnetic and standard techniques to evaluate detection rate (per patient and per node), non-inferiority and concordance. RESULTS Data was analysed for 107 patients. The per patient detection rate was 98.13% (105/107) when using the magnetic tracer and 92.26% (103/107) when using the standard technique. The nodal detection rate was 93.07% (188/202 nodes) when using the magnetic tracer and 96.53% (195/202) when using the standard technique. Of the 31 patients with positive sentinel lymph nodes (SLNs), all 31 (100%) were detected by both techniques. CONCLUSION Our study demonstrates that the magnetic technique is a feasible method for SLNB, with an identification rate that is not inferior to the standard technique. The magnetic technique offers a suitable alternative to the standard technique thereby avoiding the need for the complexities of nuclear medicine, the hazards of radiation and the anaphylaxis risk of blue dye.
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Man V, Suen D, Kwong A. Use of Superparamagnetic Iron Oxide (SPIO) Versus Conventional Technique in Sentinel Lymph Node Detection for Breast Cancer: A Randomised Controlled Trial. Ann Surg Oncol 2023; 30:3237-3244. [PMID: 36849573 DOI: 10.1245/s10434-023-13252-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/01/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND The objective of this study is to compare the efficacy of the superparamagnetic iron oxide (SPIO)-guided and standard techniques for sentinel lymph node (SLN) detection in early breast cancer. Multiple inferiority trials have concluded the non-inferiority of SPIO to the conventional radioisotope technique, with or without blue dye, in detecting SLNs. PATIENTS AND METHODS From July 2018 to August 2022, patients clinically diagnosed with node-negative invasive breast cancer were randomised into the study group (SPIO) and control group (radioisotope and blue dye). Patient data and disease characteristics were prospectively collected. SLN detection rates were compared between the two groups. RESULTS A total of 282 patients undergoing 288 sentinel lymph node biopsy (SLNB) procedures were recruited, and 144 SLNB procedures were randomised into each group. The baseline patient and disease characteristics were comparable. SLN localisation failed in one patient in each group; the success rate of SLNB was 99.3%. The SPIO group demonstrated a higher mean number of SLNs harvested (3.3 versus 2.8, p = 0.039) and longer mean procedure duration (33.1 min versus 22.3 min, p = 0.01) than the control group did. In the study group, the concordance rates per patient and node were 99.3% and 94.6%, respectively. Sixty-seven positive SLNs were detected in 37 patients. The concordance rates per malignant SLNB procedure and positive SLN were 97.3% and 96.8%, respectively. CONCLUSION Single-tracer SPIO-guided SLNB was non-inferior to the dual technique (radioisotope and blue dye) and could safely replace the gold standard for SLN mapping in early breast cancer.
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Affiliation(s)
- Vivian Man
- Division of Breast Surgery, Department of Surgery, Faculty of Medicine, Queen Mary Hospital, The University of Hong Kong Li Ka Shing, Hong Kong, Hong Kong SAR, China
| | - Dacita Suen
- Division of Breast Surgery, Department of Surgery, Faculty of Medicine, Queen Mary Hospital, The University of Hong Kong Li Ka Shing, Hong Kong, Hong Kong SAR, China
| | - Ava Kwong
- Division of Breast Surgery, Department of Surgery, Faculty of Medicine, Queen Mary Hospital, The University of Hong Kong Li Ka Shing, Hong Kong, Hong Kong SAR, China.
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Madan V, Mamounas EP. Is Sentinel Lymph Node Biopsy Necessary in Patients who Undergo Prophylactic Mastectomy? Clin Breast Cancer 2023; 23:231-236. [PMID: 36575101 DOI: 10.1016/j.clbc.2022.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/30/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Over the last decade, rates of risk-reducing prophylactic mastectomy (PM) have risen dramatically. A topic of debate regarding the procedure is whether to use sentinel lymph node biopsy (SLNB) at the time of PM and what factors might predict for such need. In order to assess the rate of identifying presence of occult invasive breast cancer in the PM specimen, we performed a retrospective review of the pathology findings from a single-surgeon case-series of PM. METHODS Patients undergoing PM between January 2013 and June 2019 at Orlando Health Cancer Institute were identified for a retrospective chart review. Demographic, clinical, and histopathological data from the surgical procedure were collected and analyzed for the incidence of occult invasive breast cancer in the PM specimen. RESULTS A total of 146 consecutive patients with PM were identified; 120 (82.2%) underwent contralateral PM (CPM) and 26 (17.8%) underwent bilateral PM (BPM). Final pathology of the 172 PM specimens identified 4 (3.3%) with lobular carcinoma in situ, 3 (2.5%) with atypical ductal hyperplasia, and 2 (1.7%) with atypical lobular hyperplasia and 2 (1.7%) with intraductal papilloma. No invasive malignancy was detected in any of the 172 PM specimens. CONCLUSIONS The absence of occult invasive carcinoma in 172 consecutive PM specimens suggests a limited clinical utility in routinely performing SLNB in this setting. This study also suggests that use of preoperative breast MRI imaging could offer a potential non-invasive tool to detect occult malignancy and select patients who can safely undergo omission of SLNB at the time of PM.
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Pantiora E, Tasoulis MK, Valachis A, Eriksson S, Kühn T, Karakatsanis A, Rubio IT. Evolution and refinement of magnetically guided sentinel lymph node detection in breast cancer: meta-analysis. Br J Surg 2022; 110:410-419. [PMID: 36560842 PMCID: PMC10364535 DOI: 10.1093/bjs/znac426] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/29/2022] [Accepted: 11/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Superparamagnetic iron oxide nanoparticles (SPIO) have been used as a tracer for sentinel lymph node (SLN) localization in breast cancer, demonstrating comparable performance to the combination of radioisotope (RI) and blue dye (BD). METHODS A systematic literature search and meta-analysis with subgroup and meta-regression analysis were undertaken to update the available evidence, assess technique evolution, and define knowledge gaps. Recommendations were made using the GRADE approach. RESULTS In 20 comparative studies, the detection rate was 97.5 per cent for SPIO and 96.5 per cent for RI ± BD (risk ratio 1.006, 95 per cent c.i. 0.992 to 1.019; P = 0.376, high-certainty evidence). Neoadjuvant therapy, injection site, injection volume or nodal metastasis burden did not affect the detection rate, but injection over 24 h before surgery increased the detection rate on meta-regression. Concordance was 99.0 per cent and reverse concordance 97.1 per cent (rate difference 0.003, 95 per cent c.i. -0.009 to 0.015; P = 0.656, high-certainty evidence). Use of SPIO led to retrieval of slightly more SLNs (pooled mean 1.96 versus 1.89) with a higher nodal detection rate (94.1 versus 83.5 per cent; RR 1.098, 1.058 to 1.140; P < 0.001; low-certainty evidence). In meta-regression, injection over 24 h before surgery increased the SPIO nodal yield over that of RI ± BD. The skin-staining rate was 30.8 per cent (very low-certainty evidence), and possibly prevented with use of smaller doses and peritumoral injection. CONCLUSION The performance of SPIO is comparable to that of RI ± BD. Preoperative injection increases the detection rate and nodal yield, without affecting concordance. Whether skin staining and MRI artefacts are reduced by lower dose and peritumoral injection needs to be investigated.
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Affiliation(s)
- Eirini Pantiora
- Department for Surgical Sciences, Uppsala University, Uppsala, Sweden
- Section for Breast Surgery, Department of Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Marios Konstantinos Tasoulis
- Breast Surgery Unit, Royal Marsden NHS Foundation Trust, London, UK
- Division of Breast Cancer Research, Institute of Cancer Research, London, UK
| | - Antonios Valachis
- Department of Oncology, Örebro University Hospital, School of Medicine, Örebro University, Örebro, Sweden
| | - Staffan Eriksson
- Section for Breast Surgery, Department of Surgery, Västmanland Hospital, Västerås, Sweden
- Centre for Clinical Research, Uppsala University, Västerås, Sweden
| | - Thorsten Kühn
- Department of Gynaecology and Obstetrics, Interdisciplinary Breast Centre, Hospital Esslingen, Esslingen, Germany
| | - Andreas Karakatsanis
- Department for Surgical Sciences, Uppsala University, Uppsala, Sweden
- Section for Breast Surgery, Department of Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Isabel T Rubio
- Breast Surgical Unit, Clinica Universidad de Navarra, Cancer Centre University of Navarra, Madrid, Spain
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The Application of Magnetic Nanoparticles for Sentinel Lymph Node Detection in Clinically Node-Negative Breast Cancer Patients: A Systemic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14205034. [PMID: 36291818 PMCID: PMC9599783 DOI: 10.3390/cancers14205034] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/30/2022] Open
Abstract
Superparamagnetic iron oxide (SPIO), an alternative mapping agent, can be used to identify sentinel lymph nodes in patients with clinically node-negative breast cancer. However, its performance in comparison with the standard method, using a radioisotope (technetium-99 m, Tc) alone or in combination with blue dye, remains controversial. Hence, a systematic review and meta-analysis were conducted to evaluate the diagnostic accuracy of SPIO and its clinical impact in the management of breast cancer. The PubMed, Embase, and Cochrane databases were comprehensively searched from inception to 1 May 2022. Cohort studies regarding the comparison of SPIO with standard methods for sentinel lymph node identification were included. A total of 19 prospective cohort studies, which collectively included 2298 clinically node-negative breast cancer patients undergoing sentinel lymph node identification through both the standard method and SPIO, were identified. The detection rate for sentinel lymph nodes (RR, 1.06; 95% CI, 1.05−1.08; p < 0.001) was considerably higher in the SPIO cohorts than in the standard method cohorts, although this difference was not significant in detected patients, patients with positive sentinel lymph nodes, or positive sentinel lymph nodes. Compared with the standard method, the SPIO method could be considered as an alternative standard of care for sentinel lymph node detection in patients with clinically node-negative breast cancer.
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Lorek A, Steinhof-Radwańska K, Zarębski W, Lorek J, Stojčev Z, Zych J, Syrkiewicz A, Niemiec P, Szyluk K. Comparative Analysis of Postoperative Complications of Sentinel Node Identification Using the SentiMag ® Method and the Use of a Radiotracer in Patients with Breast Cancer. Curr Oncol 2022; 29:2887-2894. [PMID: 35621625 PMCID: PMC9139760 DOI: 10.3390/curroncol29050235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 11/18/2022] Open
Abstract
(1) Background: The purpose of the study was a retrospective, comparative assessment of complications of the surgical sentinel node biopsy (SNB) procedure in breast cancer using the radiotracer method and the SentiMag® method on groups of patients after 3.5 years of use. (2) Methods: The material was a group of 345 patients with primary surgical breast cancer who underwent the SNB procedure with the use of a radiotracer in combination with wide local excision (WLE), simple amputation (SA) with SNB and an independent SNB procedure in the period from May 2018 to January 2021 in the Department of Oncological Surgery. Of the patients who were monitored in the Hospital Outpatient Clinic, 300 were enrolled. The analyzed group was compared in terms of the occurrence of the same complications with the group of 303 patients also operated on in our center in the period from January 2014 to September 2017, in which SN identification was performed using the SentiMag® method. (3) Results: The most common complications found were sensation disorders in the arm, which occurred in 16 (14.1%) patients using the radiotracer method, SentiMag®-11 (9.9%). By comparing the complication rate between the methods with the radiotracer (n = 300) and SentiMag® (n = 303), no significant differences were found. (4) Conclusions: Sentinel node (SN) identification using the radiotracer method and the SentiMag® method are comparable diagnostic methods in breast cancer, with a low risk of complications.
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Affiliation(s)
- Andrzej Lorek
- Department of Oncological Surgery, Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia in Katowice, 40-514 Katowice, Poland;
| | - Katarzyna Steinhof-Radwańska
- Department of Radiology and Nuclear Medicine, Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia in Katowice, 40-752 Katowice, Poland;
| | - Wojciech Zarębski
- Department of Oncological Surgery, Kornel Gibiński Independent Public Central Clinical Hospital, Medical University of Silesia in Katowice, 40-514 Katowice, Poland;
| | - Joanna Lorek
- Department of Surgery, Ludwig Rydygier Hospital sp. z.o.o., 31-826 Krakow, Poland;
| | - Zoran Stojčev
- Teaching Department of Oncology and Breast Diseases, Central Teaching Hospital of the Ministry of Internal Affairs and Administration, Wołoska 137, 02-507 Warsaw, Poland;
| | - Jacek Zych
- Medical Faculty, Medical University of Silesia in Katowice, 40-514 Katowice, Poland; (J.Z.); (A.S.)
| | - Aleksandra Syrkiewicz
- Medical Faculty, Medical University of Silesia in Katowice, 40-514 Katowice, Poland; (J.Z.); (A.S.)
| | - Paweł Niemiec
- Department of Biochemistry and Medical Genetics, School of Health Sciences, Medical University of Silesia in Katowice, 40-752 Katowice, Poland;
| | - Karol Szyluk
- Department of Physiotherapy, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 KatowiSce, Poland;
- Department of Orthopaedic and Trauma Surgery, District Hospital of Orthopaedics and Trauma Surgery, 41-940 Piekary Śląskie, Poland
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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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14
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Yılmaz OC, Vural V. Feasibility of Magnetic Technique for Axillary Staging after Neoadjuvant Therapy in Breast Cancer Patients. J INVEST SURG 2022; 35:1275-1278. [PMID: 35176950 DOI: 10.1080/08941939.2022.2038737] [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: 10/19/2022]
Abstract
PURPOSE Optimal axillary staging after neoadjuvant chemotherapy (NAC) in node-negative breast cancer is an area of controversy. Sentinel node biopsy with Technetium-sulphur colloid (99m Tc) alone or with blue dye is the recommended technique for evaluating axilla in these patients. However, this technique has drawbacks such as limited access to nuclear departments and timing limitations related to Tc injection exposing patients to unnecessary radiation. Superparamagnetic iron oxide nanoparticles (SPIO) may represent a valid option for SLN biopsy. In this study, we assessed the feasibility of the magnetic technique (Sentimag) with combination of isosulfan blue dye in breast cancer patients who received NAC. METHODS The study sample consisted of 54 female breast cancer patients who received NAC. Sentinel node localization was performed using magnetic technique and blue dye. Sentinel node identification rate (IFR) of magnetic technique was calculated and postoperative complications were assessed. RESULTS Sentinel lymph node was detected in 52 patients with Sentimag method (identification rate = 96.3%, 95% CI: 87.4-98.9%). Blue dye was successful to find SLN in 38 patients (identification rate = 70%). The most common histologic type was invasive ductal (n = 51; 94.4%). Mean tumor size was 2.1 cm after NAC. Most of patients had T2 (n = 30; 55.5%) and HER2 + positive (n = 49; 90.7%) cancer. CONCLUSION Sentimag which is a magnetic technique appears to be safe, easy to perform with minimal adverse effects, may be an alternative and accurate technique in patients with NAC, especially in breast units where nuclear medicine unit is not available. Supplemental data for this article is available online at https://doi.org/10.1080/08941939.2022.2038737 .
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Affiliation(s)
- Osman Cem Yılmaz
- Department of General Surgery, Akdeniz University School of Medicine, Antalya, Turkey
| | - Veli Vural
- Breast Clinic, Istanbul Oncology Hospital, İstanbul, Turkey
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15
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A Propensity Score Matched Analysis of Superparamagnetic Iron Oxide versus Radioisotope Sentinel Node Biopsy in Breast Cancer Patients after Neoadjuvant Chemotherapy. Cancers (Basel) 2022. [PMID: 35158944 DOI: 10.3390/cancers14030676.pmid:35158944;pmcid:pmc8833727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
The standard method for nodal staging in breast cancer (BC) patients after neoadjuvant chemotherapy (NAC) is sentinel lymph node biopsy (SLNB) with a radioisotope (RI) injection. However, SLNB after NAC results in high false-negative rates (FNR), and the RI method is restricted by nuclear medicine unit dependency. These limitations resulted in the development of the superparamagnetic iron oxide (SPIO) method, reducing FNR and presenting a comparable detection rate. This bi-institutional cohort comparison study aimed to assess the efficacy of SPIO and radioisotope SNLB in BC patients after NAC using Propensity Score Matching (PSM) analysis. The study group comprised 508 patients who underwent SLNB after NAC for ycT1-4N0M0 BC between 2013 and 2021 in two high volume centers. Data were retrieved from prospectively conducted databases. In the SPIO group, the median of retrieved sentinel lymph nodes (SLNs) was significantly higher than in the RI group (3 vs. 2; p < 0.0001). The SPIO method was associated with a significantly higher chance of retrieving at least three lymph nodes when compared to the RI method (71% vs. 11.3%; p < 0.0001). None of the analyzed demographic and clinical variables had a statistically significant influence on the efficacy of SLNs retrieval in the RI group, while in the SPIO group, patients with ≥three harvested SLNs had lower weight and decreased BMI. Based on this PSM analysis, SPIO-guided SLNB allowed the efficient retrieval and detection of SLNs in BC patients after NAC compared to RI.
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16
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Nieuwenhuis ER, Kolenaar B, Hof JJ, van Baarlen J, van Bemmel AJM, Christenhusz A, Scheenen TWJ, ten Haken B, de Bree R, Alic L. A Comprehensive Grading System for a Magnetic Sentinel Lymph Node Biopsy Procedure in Head and Neck Cancer Patients. Cancers (Basel) 2022; 14:cancers14030678. [PMID: 35158946 PMCID: PMC8833366 DOI: 10.3390/cancers14030678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/22/2022] [Accepted: 01/26/2022] [Indexed: 02/05/2023] Open
Abstract
Simple Summary With 30% of clinically negative early-stage oral cancer patients harboring occult metastasis, an accurate staging of metastatic lymph nodes (LN) is of utmost importance for treatment planning. A magnetic sentinel lymph node biopsy (SLNB) procedure is offered as an alternative to conventional SLNB in oral oncology, however, a grading system is missing. A proper grading system is preferred to connect the different components of the magnetic SLNB: preoperative imaging, intraoperative detection, and histopathological examination of sentinel lymph nodes (SLNs). This study aims to provide a first grading system based on the distribution of a magnetic tracer, by means of preoperative magnetic resonance imaging (MRI), intraoperative estimation of iron content, and histopathological assessment of resected nodes. Pre- and post-operative MRI and harvested SLNs of eight tongue cancer patients with successful magnetic SLNB procedure were used for analyses. Abstract A magnetic sentinel lymph node biopsy ((SLN)B) procedure has recently been shown feasible in oral cancer patients. However, a grading system is absent for proper identification and classification, and thus for clinical reporting. Based on data from eight complete magnetic SLNB procedures, we propose a provisional grading system. This grading system includes: (1) a qualitative five-point grading scale for MRI evaluation to describe iron uptake by LNs; (2) an ex vivo count of resected SLN with a magnetic probe to quantify iron amount; and (3) a qualitative five-point grading scale for histopathologic examination of excised magnetic SLNs. Most SLNs with iron uptake were identified and detected in level II. In this level, most variance in grading was seen for MRI and histopathology; MRI and medullar sinus were especially highly graded, and cortical sinus was mainly low graded. On average 82 ± 58 µg iron accumulated in harvested SLNs, and there were no significant differences in injected tracer dose (22.4 mg or 11.2 mg iron). In conclusion, a first step was taken in defining a comprehensive grading system to gain more insight into the lymphatic draining system during a magnetic SLNB procedure.
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Affiliation(s)
- Eliane R. Nieuwenhuis
- Magnetic Detection and Imaging Group, Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands; (E.R.N.); (A.C.); (B.t.H.)
- Department of Maxillofacial Surgery—Head and Neck Surgical Oncology, Medisch Spectrum Twente, 7512 KZ Enschede, The Netherlands;
| | - Barry Kolenaar
- Department of Maxillofacial Surgery—Head and Neck Surgical Oncology, Medisch Spectrum Twente, 7512 KZ Enschede, The Netherlands;
| | - Jurrit J. Hof
- Department of Radiology, Medisch Spectrum Twente, 7512 KZ Enschede, The Netherlands;
| | - Joop van Baarlen
- Laboratorium Pathologie Oost Nederland, 7555 BB Hengelo, The Netherlands;
| | - Alexander J. M. van Bemmel
- Department of Otorhinolaryngology—Head and Neck Surgical Oncology, Medisch Spectrum Twente, 7512 KZ Enschede, The Netherlands;
| | - Anke Christenhusz
- Magnetic Detection and Imaging Group, Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands; (E.R.N.); (A.C.); (B.t.H.)
- Department of Surgery, Medisch Spectrum Twente, 7512 KZ Enschede, The Netherlands
| | - Tom W. J. Scheenen
- Department of Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Bernard ten Haken
- Magnetic Detection and Imaging Group, Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands; (E.R.N.); (A.C.); (B.t.H.)
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Lejla Alic
- Magnetic Detection and Imaging Group, Technical Medical Centre, University of Twente, 7522 NB Enschede, The Netherlands; (E.R.N.); (A.C.); (B.t.H.)
- Correspondence: ; Tel.: +31-534-898-731
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17
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A Propensity Score Matched Analysis of Superparamagnetic Iron Oxide versus Radioisotope Sentinel Node Biopsy in Breast Cancer Patients after Neoadjuvant Chemotherapy. Cancers (Basel) 2022; 14:cancers14030676. [PMID: 35158944 PMCID: PMC8833727 DOI: 10.3390/cancers14030676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 12/13/2022] Open
Abstract
Simple Summary This Propensity Score Matched Analysis aimed to assess the efficacy of superparamagnetic iron oxide (SPIO) and radioisotope sentinel lymph node biopsy (SNLB) in breast cancer (BC) patients after neoadjuvant chemotherapy (NAC). One hundred and twenty-four patients were eligible for final analysis. In the SPIO group, the median of retrieved sentinel lymph nodes (SLNs) was significantly higher than in the RI group. The SPIO method was associated with a significantly higher chance of retrieving at least three SLNs when compared to the RI method. SPIO-guided SLNB allows efficient retrieval and detection of SLNs in BC patients after NAC when compared to RI. Abstract The standard method for nodal staging in breast cancer (BC) patients after neoadjuvant chemotherapy (NAC) is sentinel lymph node biopsy (SLNB) with a radioisotope (RI) injection. However, SLNB after NAC results in high false-negative rates (FNR), and the RI method is restricted by nuclear medicine unit dependency. These limitations resulted in the development of the superparamagnetic iron oxide (SPIO) method, reducing FNR and presenting a comparable detection rate. This bi-institutional cohort comparison study aimed to assess the efficacy of SPIO and radioisotope SNLB in BC patients after NAC using Propensity Score Matching (PSM) analysis. The study group comprised 508 patients who underwent SLNB after NAC for ycT1-4N0M0 BC between 2013 and 2021 in two high volume centers. Data were retrieved from prospectively conducted databases. In the SPIO group, the median of retrieved sentinel lymph nodes (SLNs) was significantly higher than in the RI group (3 vs. 2; p < 0.0001). The SPIO method was associated with a significantly higher chance of retrieving at least three lymph nodes when compared to the RI method (71% vs. 11.3%; p < 0.0001). None of the analyzed demographic and clinical variables had a statistically significant influence on the efficacy of SLNs retrieval in the RI group, while in the SPIO group, patients with ≥three harvested SLNs had lower weight and decreased BMI. Based on this PSM analysis, SPIO-guided SLNB allowed the efficient retrieval and detection of SLNs in BC patients after NAC compared to RI.
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18
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Christenhusz A, Pouw JJ, Simonis FFJ, Douek M, Ahmed M, Klaase JM, Dassen AE, Klazen CAH, van der Schaaf MC, Ten Haken B, Alic L. Breast MRI in patients after breast conserving surgery with sentinel node procedure using a superparamagnetic tracer. Eur Radiol Exp 2022; 6:3. [PMID: 35083595 PMCID: PMC8792114 DOI: 10.1186/s41747-021-00257-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 12/03/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND A procedure for sentinel lymph node biopsy (SLNB) using superparamagnetic iron-oxide (SPIO) nanoparticles and intraoperative sentinel lymph node (SLN) detection was developed to overcome drawbacks associated with the current standard-of-care SLNB. However, residual SPIO nanoparticles can result in void artefacts at follow-up magnetic resonance imaging (MRI) scans. We present a grading protocol to quantitatively assess the severity of these artefacts and offer an option to minimise the impact of SPIO nanoparticles on diagnostic imaging. METHODS Follow-up mammography and MRI of two patient groups after a magnetic SLNB were included in the study. They received a 2-mL subareolar dose of SPIO (high-dose, HD) or a 0.1-mL intratumoural dose of SPIO (low-dose, LD). Follow-up mammography and MRI after magnetic SLNB were acquired within 4 years after breast conserving surgery (BCS). Two radiologists with over 10-year experience in breast imaging assessed the images and analysed the void artefacts and their impact on diagnostic follow-up. RESULTS A total of 19 patients were included (HD, n = 13; LD, n = 6). In the HD group, 9/13 patients displayed an artefact on T1-weighted images up to 3.6 years after the procedure, while no impact of the SPIO remnants was observed in the LD group. CONCLUSIONS SLNB using a 2-mL subareolar dose of magnetic tracer in patients undergoing BCS resulted in residual artefacts in the breast in the majority of patients, which may hamper follow-up MRI. This can be avoided by using a 0.1-mL intratumoural dose.
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Affiliation(s)
- Anke Christenhusz
- Magnetic Detection & Imaging group, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
- Department of Surgery Medisch Spectrum Twente, Enschede, The Netherlands.
| | - Joost J Pouw
- Magnetic Detection & Imaging group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Frank F J Simonis
- Magnetic Detection & Imaging group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Michael Douek
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Muneer Ahmed
- Division of Surgery and Interventional Science, University College London, Royal Free Hospital, London, UK
| | - Joost M Klaase
- Department of Surgery Medisch Spectrum Twente, Enschede, The Netherlands
| | - Anneriet E Dassen
- Department of Surgery Medisch Spectrum Twente, Enschede, The Netherlands
| | | | | | - Bernard Ten Haken
- Magnetic Detection & Imaging group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Lejla Alic
- Magnetic Detection & Imaging group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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Onishi T, Mihara K, Matsuda S, Sakamoto S, Kuwahata A, Sekino M, Kusakabe M, Handa H, Kitagawa Y. Application of Magnetic Nanoparticles for Rapid Detection and In Situ Diagnosis in Clinical Oncology. Cancers (Basel) 2022; 14:cancers14020364. [PMID: 35053527 PMCID: PMC8774179 DOI: 10.3390/cancers14020364] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 12/30/2021] [Accepted: 01/10/2022] [Indexed: 12/26/2022] Open
Abstract
Screening, monitoring, and diagnosis are critical in oncology treatment. However, there are limitations with the current clinical methods, notably the time, cost, and special facilities required for radioisotope-based methods. An alternative approach, which uses magnetic beads, offers faster analyses with safer materials over a wide range of oncological applications. Magnetic beads have been used to detect extracellular vesicles (EVs) in the serum of pancreatic cancer patients with statistically different EV levels in preoperative, postoperative, and negative control samples. By incorporating fluorescence, magnetic beads have been used to quantitatively measure prostate-specific antigen (PSA), a prostate cancer biomarker, which is sensitive enough even at levels found in healthy patients. Immunostaining has also been incorporated with magnetic beads and compared with conventional immunohistochemical methods to detect lesions; the results suggest that immunostained magnetic beads could be used for pathological diagnosis during surgery. Furthermore, magnetic nanoparticles, such as superparamagnetic iron oxide nanoparticles (SPIONs), can detect sentinel lymph nodes in breast cancer in a clinical setting, as well as those in gallbladder cancer in animal models, in a surgery-applicable timeframe. Ultimately, recent research into the applications of magnetic beads in oncology suggests that the screening, monitoring, and diagnosis of cancers could be improved and made more accessible through the adoption of this technology.
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Affiliation(s)
- Tatsuya Onishi
- Department of Breast Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa 277-8577, Chiba, Japan;
| | - Kisyo Mihara
- Department of Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki-ku, Kawasaki 210-0013, Kanagawa, Japan;
| | - Sachiko Matsuda
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan;
- Correspondence: ; Tel.: +81-3-3353-1211
| | - Satoshi Sakamoto
- School of Life Science and Technology, Tokyo Institute of Technology, 4259 Nagatsuta-cho, Midori-ku, Yokohama 226-8501, Kanagawa, Japan;
| | - Akihiro Kuwahata
- Graduate School of Engineering, Tohoku University, 6-6-05 Aoba, Aramaki-aza, Aoba-ku, Sendai 980-8579, Miyagi, Japan;
| | - Masaki Sekino
- Graduate School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan;
| | - Moriaki Kusakabe
- Graduate School of Agricultural and Life Sciences, Research Center for Food Safety, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan;
- Matrix Cell Research Institute Inc., 1-35-3 Kamikashiwada, Ushiku 300-1232, Ibaraki, Japan
| | - Hiroshi Handa
- Department of Nanoparticle Translational Research, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan;
| | - Yuko Kitagawa
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan;
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20
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Alromi DA, Madani SY, Seifalian A. Emerging Application of Magnetic Nanoparticles for Diagnosis and Treatment of Cancer. Polymers (Basel) 2021; 13:4146. [PMID: 34883649 PMCID: PMC8659429 DOI: 10.3390/polym13234146] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/18/2021] [Accepted: 10/22/2021] [Indexed: 12/20/2022] Open
Abstract
Cancer is a disease that has resulted in millions of deaths worldwide. The current conventional therapies utilized for the treatment of cancer have detrimental side effects. This led scientific researchers to explore new therapeutic avenues with an improved benefit to risk profile. Researchers have found nanoparticles, particles between the 1 and 100 nm range, to be encouraging tools in the area of cancer. Magnetic nanoparticles are one of many available nanoparticles at present. Magnetic nanoparticles have increasingly been receiving a considerable amount of attention in recent years owing to their unique magnetic properties, among many others. Magnetic nanoparticles can be controlled by an external magnetic field, signifying their ability to be site specific. The most popular approaches for the synthesis of magnetic nanoparticles are co-precipitation, thermal decomposition, hydrothermal, and polyol synthesis. The functionalization of magnetic nanoparticles is essential as it significantly increases their biocompatibility. The most utilized functionalization agents are comprised of polymers. The synthesis and functionalization of magnetic nanoparticles will be further explored in this review. The biomedical applications of magnetic nanoparticles investigated in this review are drug delivery, magnetic hyperthermia, and diagnosis. The diagnosis aspect focuses on the utilization of magnetic nanoparticles as contrast agents in magnetic resonance imaging. Clinical trials and toxicology studies relating to the application of magnetic nanoparticles for the diagnosis and treatment of cancer will also be discussed in this review.
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Affiliation(s)
- Dalal A. Alromi
- School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK; (D.A.A.); (S.Y.M.)
| | - Seyed Yazdan Madani
- School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK; (D.A.A.); (S.Y.M.)
- School of Pharmacy, University of Nottingham Malaysia, Semenyih 43500, Malaysia
| | - Alexander Seifalian
- Nanotechnology and Regenerative Medicine Commercialisation Centre (NanoRegMed Ltd.), London BioScience Innovation Centre, 2 Royal College Street, London NW1 0NH, UK
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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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Sentinel lymph node biopsy in breast cancer after neoadjuvant therapy using a magnetic tracer versus standard technique: A multicentre comparative non-inferiority study (IMAGINE-II). INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.100404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Superparamagnetic Iron Oxide for Identifying Sentinel Lymph Node in Breast Cancer after Neoadjuvant Chemotherapy: Feasibility Study. J Clin Med 2021; 10:jcm10143149. [PMID: 34300315 PMCID: PMC8305632 DOI: 10.3390/jcm10143149] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/02/2021] [Accepted: 07/15/2021] [Indexed: 12/23/2022] Open
Abstract
Sentinel lymph node biopsy (SLNB) is a well-established procedure for staging clinically node-negative early breast cancer (BC). Superparamagnetic iron oxide (SPIO) demonstrated efficacy for nodal identification using a magnetic probe after local retroaeroal interstitial injection. Its benefits lie in its flexibility, which is an essential property in the global setting, where access to the isotope is difficult. To the best of our knowledge, this is the first study to evaluate the feasibility and safety of the SPIO for SLNB in BC patients treated with neoadjuvant chemotherapy (NAC). Seventy-four female patients were included. The median time of lymph node retrieval was 20 min. The median number of resected sentinel nodes (SNs) was 4. SN was detected in all patients. No serious adverse event was observed. SPIO in identifying SN in BC patients after NAC is feasible and oncologically safe.
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Kurylcio A, Pelc Z, Skórzewska M, Rawicz-Pruszyński K, Mlak R, Gęca K, Sędłak K, Kurylcio P, Małecka-Massalska T, Polkowski W. Superparamagnetic Iron Oxide for Identifying Sentinel Lymph Node in Breast Cancer after Neoadjuvant Chemotherapy: Feasibility Study. J Clin Med 2021. [PMID: 34300315 DOI: 10.3390/jcm10143149.pmid:34300315;pmcid:pmc8305632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Sentinel lymph node biopsy (SLNB) is a well-established procedure for staging clinically node-negative early breast cancer (BC). Superparamagnetic iron oxide (SPIO) demonstrated efficacy for nodal identification using a magnetic probe after local retroaeroal interstitial injection. Its benefits lie in its flexibility, which is an essential property in the global setting, where access to the isotope is difficult. To the best of our knowledge, this is the first study to evaluate the feasibility and safety of the SPIO for SLNB in BC patients treated with neoadjuvant chemotherapy (NAC). Seventy-four female patients were included. The median time of lymph node retrieval was 20 min. The median number of resected sentinel nodes (SNs) was 4. SN was detected in all patients. No serious adverse event was observed. SPIO in identifying SN in BC patients after NAC is feasible and oncologically safe.
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Affiliation(s)
- Andrzej Kurylcio
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland
| | - Zuzanna Pelc
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland
| | - Magdalena Skórzewska
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland
| | - Karol Rawicz-Pruszyński
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland
| | - Radosław Mlak
- Department of Human Physiology, Medical University of Lublin, Radziwiłłowska 11 St., 20-080 Lublin, Poland
| | - Katarzyna Gęca
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland
| | - Katarzyna Sędłak
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland
| | - Piotr Kurylcio
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland
| | - Teresa Małecka-Massalska
- Department of Human Physiology, Medical University of Lublin, Radziwiłłowska 11 St., 20-080 Lublin, Poland
| | - Wojciech Polkowski
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland
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Loosdrecht MMVD, Molenaar L, Krooshoop EJG, Haken BT, Meijerink WJHJ, Alic L, Broeders IAMJ. Laparoscopic Probe for Sentinel Lymph Node Harvesting using Magnetic Nanoparticles. IEEE Trans Biomed Eng 2021; 69:286-293. [PMID: 34170819 DOI: 10.1109/tbme.2021.3092437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Sentinel lymph node harvesting is an essential step in the surgical treatment of a growing number of malignancies. Various techniques are available to facilitate this purpose. The present study reports a new laparoscopic technique for lymph node harvesting using magnetic nanoparticles containing a superparamagnetic iron-oxide core and dextran coating. This study assesses the clinical relevance of the prototype and provides input for further technological development on the way to clinical implementation. METHODS A laparoscopic differential magnetometer prototype was built, utilizing a nonlinear detection principle (differential magnetometry) for magnetic identification of lymph nodes. The iron content sensitivity, depth & spatial sensitivity, and angular sensitivity were analyzed to investigate clinical options. RESULTS The minimum detectable amount of iron was 9.8 g at a distance of 1 mm. The detection depth was 5, 8, and 10 mm for samples containing 126, 252, and 504 g iron, respectively. The maximum lateral detection distance was 5, 7, and 8 mm for samples containing 126, 252, and 504 g iron, respectively. A sample containing 504 g iron was detectable at all angulations assessed (0, 30, 60 and 90). CONCLUSION The laparoscopic differential magnetometer demonstrates promising results for further investigation and development towards laparoscopic lymph node harvesting using magnetic nanoparticles. SIGNIFICANCE The laparoscopic differential magnetometer facilitates a novel method for sentinel lymph node harvesting, which helps to determine prognosis and treatment of cancer patients.
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Shams S, Lippold K, Blohmer JU, Röhle R, Kühn F, Karsten MM. A Pilot Study Evaluating the Effects of Magtrace® for Sentinel Node Biopsy in Breast Cancer Patients Regarding Care Process Optimization, Reimbursement, Surgical Time, and Patient Comfort Compared With Standard Technetium 99. Ann Surg Oncol 2020; 28:3232-3240. [PMID: 33263157 PMCID: PMC8119277 DOI: 10.1245/s10434-020-09280-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/03/2020] [Indexed: 11/18/2022]
Abstract
Background Sentinel lymph node biopsy after technetium-99 (Tc99) localization is a mainstay of oncologic breast surgery. The timing of Tc99 injection can complicate operating room schedules, which can cause increasing overall costs of care and patient discomfort. Methods This study compared 59 patients who underwent breast cancer surgery including sentinel lymph node biopsy. Based on the surgeon’s choice, 29 patients were treated with Tc99, and 30 patients received the iron-based tracer, Magtrace. The primary outcomes were time spent on the care pathway and operating time from commissioning of the probe to removal of the sentinel node. The secondary outcomes were patient pain levels and reimbursement. Results The mean time spent on the preoperative breast cancer care pathway was significantly shorter for the Magtrace group (5.4 ± 1.3 min) than for the Tc99 group (82 ± 20 min) (p < 0.0001). The median time from probe usage to sentinel node extirpation was slightly but not significantly shorter in the Magtrace group (5 min; interquartile range [IQR], 3–15 min vs 10 min; IQR, 7–15 min; p = 0.151). Reimbursement and pain levels remained unchanged, and the hospital length of stay was similar in the two groups (Magtrace: 5.1 ± 2.3 days vs Tc99: 4.5 ± 3.2 days). Conclusions Magtrace localization shortened the preoperative care pathway and did not affect surgical time or reimbursement. Once established, it could allow for cost reduction and improve patient comfort.
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Affiliation(s)
- Sina Shams
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Kai Lippold
- Directorate of Charité Center 17, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Jens Uwe Blohmer
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Robert Röhle
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Friedrich Kühn
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Maria Margarete Karsten
- Department of Gynecology with Breast Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
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Chapman MC, Lee AY, Hayward JH, Joe BN, Price ER. Superparamagnetic Iron Oxide Sentinel Node Tracer Injection: Effects on Breast MRI Quality. JOURNAL OF BREAST IMAGING 2020; 2:577-582. [PMID: 38424862 DOI: 10.1093/jbi/wbaa083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To evaluate the MRI artifact rendered by the typical injection of a ferromagnetic tracer now being intermittently used for intraoperative sentinel node (SN) identification at our institution, and to explore its impact on postoperative imaging and management. METHODS This study was Institutional Review Board-approved and granted a waiver of consent. A database search tool was used to identify MRI exams performed on patients who had previously undergone breast-conserving surgery with use of a superparamagnetic iron oxide (SPIO) SN tracer between January 1, 2015, and May 1, 2020. MRI reports, images, and relevant demographic, oncologic, and surgical history were collected. The presence or absence of SPIO residue on breast MRI, as well as its impact on image quality, were extracted from the prospective reports. RESULTS A total of 21 MRI exams were identified in 16 patients who had undergone breast-conservation therapy for cancer with use of SPIO SN tracer. Mean time from particle injection to baseline postoperative MRI exam was 10.8 months. All reports (21/21) noted evidence of SPIO residue. Of these, 5/21 were assessed as non-diagnostic; the remainder were assessed as limited. CONCLUSION Radiologists should be aware of the use of superparamagnetic tracers for SN identification and the impact on the quality of future MRI examinations. Alternative injection approaches are being developed and sequence parameters adjusted to minimize artifact.
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Affiliation(s)
- Molly C Chapman
- University of California San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA
| | - Amie Y Lee
- University of California San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA
| | - Jessica H Hayward
- University of California San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA
| | - Bonnie N Joe
- University of California San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA
| | - Elissa R Price
- University of California San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA
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New technologies in breast cancer sentinel lymph node biopsy; from the current gold standard to artificial intelligence. Surg Oncol 2020; 34:324-335. [DOI: 10.1016/j.suronc.2020.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/28/2020] [Accepted: 06/18/2020] [Indexed: 01/14/2023]
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Sun T, Dasgupta A, Zhao Z, Nurunnabi M, Mitragotri S. Physical triggering strategies for drug delivery. Adv Drug Deliv Rev 2020; 158:36-62. [PMID: 32589905 DOI: 10.1016/j.addr.2020.06.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/06/2020] [Accepted: 06/10/2020] [Indexed: 12/14/2022]
Abstract
Physically triggered systems hold promise for improving drug delivery by enhancing the controllability of drug accumulation and release, lowering non-specific toxicity, and facilitating clinical translation. Several external physical stimuli including ultrasound, light, electric fields and magnetic fields have been used to control drug delivery and they share some common features such as spatial targeting, spatiotemporal control, and minimal invasiveness. At the same time, they possess several distinctive features in terms of interactions with biological entities and/or the extent of stimulus response. Here, we review the key advances of such systems with a focus on discussing their physical mechanisms, the design rationales, and translational challenges.
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Affiliation(s)
- Tao Sun
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA; Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Anshuman Dasgupta
- Department of Nanomedicine and Theranostics, Institute for Experimental Molecular Imaging, RWTH Aachen University, Aachen, Germany
| | - Zongmin Zhao
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA; Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
| | - Md Nurunnabi
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Texas at El Paso, TX 79902, USA
| | - Samir Mitragotri
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA; Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA.
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31
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Rubio IT, Rodriguez-Revuelto R, Espinosa-Bravo M, Siso C, Rivero J, Esgueva A. A randomized study comparing different doses of superparamagnetic iron oxide tracer for sentinel lymph node biopsy in breast cancer: The SUNRISE study. Eur J Surg Oncol 2020; 46:2195-2201. [PMID: 32631710 DOI: 10.1016/j.ejso.2020.06.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION The non-radioactive method that uses the magnetic tracer (SPIO/Sienna) has shown to be a feasible technique for the SLN detection in breast cancer patients. The aim of this study is to assess the efficacy of different doses of a new magnetic tracer Sienna XP (Magtrace) compared to Tc-99 m and to evaluate its non-inferiority. METHODS Patients diagnosed with early-stage breast cancer cT1-3 N0, from October 2016 to August 2018 were eligible and consecutively randomized to three different doses of new SPIO used: group 1 (1 mL), group 2 (1.5 mL) and group 3 (2 mL). RESULTS A total of 135 patients were included in the study, 45 in each group. Detection of SLNs with the three doses of Sienna XP (1 mL, 1.5 mL and 2 mL) showed non-inferior rates compared to the conventional technique with radiotracer (p = 0.654). Concordance by patients with SLN positive was 100% for all groups. 83 (70.3%) patients reported skin staining at one month postoperatively, significantly lower in group 1 (p = 0.042). At 6 months follow up, group 1 remains with significantly lower skin discoloration (p = 0,01). In multivariate analysis, dose of 2 mL showed statistically significant for the skin staining. The majority of patients (70%) felt that skin discoloration does not represent a problem. CONCLUSION The use of the Sienna XP magnetic tracer at 1 mL is not inferior to higher doses of magnetic tracer neither is inferior to radiotracer. 1 mL of magnetic tracer resulted in significantly less skin discoloration compared to higher doses.
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MESH Headings
- Axilla
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/surgery
- Female
- Humans
- Magnetic Iron Oxide Nanoparticles/administration & dosage
- Middle Aged
- Postoperative Complications
- Sentinel Lymph Node/pathology
- Sentinel Lymph Node Biopsy/methods
- Skin Pigmentation
- Technetium Tc 99m Aggregated Albumin
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Affiliation(s)
- Isabel T Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Spain; Universidad de Navarra, Spain.
| | | | - Martin Espinosa-Bravo
- Breast Surgical Oncology, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Christian Siso
- Breast Surgical Oncology, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Joaquin Rivero
- Breast Surgical Oncology, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Antonio Esgueva
- Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Spain; Universidad de Navarra, Spain
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Superparamagnetic iron oxide as a tracer for sentinel lymph node detection in uterine cancer: a pilot study. Sci Rep 2020; 10:7945. [PMID: 32409660 PMCID: PMC7224276 DOI: 10.1038/s41598-020-64926-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 04/23/2020] [Indexed: 12/23/2022] Open
Abstract
Sentinel lymph node (SLN) mapping using dye or radioisotopes has been performed in patients with uterine cancer. Superparamagnetic iron oxide (SPIO) can be handled safely and is taken up by lymph nodes (LNs); however, its efficacy in detecting SLNs in uterine cancer remains unknown. This pilot study evaluated the use of SPIO as a tracer for SLN detection in patients with uterine cancer. SPIO was injected into the uterine cervixes of 15 patients with uterine cancer scheduled for pelvic LN dissection. Magnetic resonance imaging (MRI) was performed preoperatively. Five patients also underwent radioisotope injection and single-photon emission computed tomography/computed tomography. Dissected LNs were stained with iron and examined pathologically. Of the radioisotope-positive LNs, 92% were also SPIO/MRI-positive. SPIO/MRI and iron staining were positively correlated. SLNs were identified by iron staining in 93% of cases. Iron staining was strongly positive in two of the five areas of LN metastasis; these were considered SLNs. Staining was negative or very weak in the other three areas and lymph flow disturbance was considered. SPIO and radioisotopes are taken up similarly by SLNs. SPIO/MRI and iron staining may thus be useful for detection of SLNs and diagnosis of LN metastasis in patients with uterine cancer.
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Kuwahata A, Tanaka R, Matsuda S, Amada E, Irino T, Mayanagi S, Chikaki S, Saito I, Tanabe N, Kawakubo H, Takeuchi H, Kitagawa Y, Kusakabe M, Sekino M. Development of Magnetic Probe for Sentinel Lymph Node Detection in Laparoscopic Navigation for Gastric Cancer Patients. Sci Rep 2020; 10:1798. [PMID: 32019961 PMCID: PMC7000689 DOI: 10.1038/s41598-020-58530-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 01/13/2020] [Indexed: 02/06/2023] Open
Abstract
New laparoscopic sentinel lymph node navigation using a dedicated magnetic probe and magnetic nanoparticle tracer for gastric cancer patients allows minimally invasive surgeries. By identifying the sentinel lymph nodes containing magnetic nanoparticles, patients can avoid excessive lymph node extraction without nuclear facilities and radiation exposure. This paper describes the development of the laparoscopic magnetic probe, ACDC-probe, for laparoscopic sentinel lymph node identification utilizing the nonlinear response of the magnetic nanoparticles magnetized by an alternating magnetic field with a static magnetic field. For highly sensitive detection, the ratio of static to alternating magnetic fields was optimized to approximately 5. The longitudinal detection length was approximately 10 mm for 140 μg of iron, and the detectable amount of iron was approximately 280 ng at a distance of 1 mm. To demonstrate the feasibility of laparoscopic detection using the ACDC-probe and magnetic tracers, an experiment was performed on a wild swine. The gastric sentinel lymph node was clearly identified during laparoscopic navigation. These results suggest that the newly developed ACDC-probe is useful for laparoscopic sentinel lymph node detection and this magnetic technique appears to be a promising method for future sentinel lymph node navigation of gastric cancer patients.
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Affiliation(s)
- Akihiro Kuwahata
- Graduate School of Engineering, The University of Tokyo, Tokyo, 113-8656, Japan.
| | - Ryo Tanaka
- Graduate School of Engineering, The University of Tokyo, Tokyo, 113-8656, Japan
| | - Sachiko Matsuda
- Department of Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - En Amada
- Department of Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Tomoyuki Irino
- Department of Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Shuhei Mayanagi
- Department of Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Shinichi Chikaki
- Graduate School of Engineering, The University of Tokyo, Tokyo, 113-8656, Japan
| | | | - Norio Tanabe
- Graduate School of Engineering, The University of Tokyo, Tokyo, 113-8656, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Moriaki Kusakabe
- Research Center for Food Safety, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, 113-8657, Japan.,Matrix Cell Research Institute Inc., Ibaraki, 300-1232, Japan
| | - Masaki Sekino
- Graduate School of Engineering, The University of Tokyo, Tokyo, 113-8656, Japan.
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Taruno K, Kurita T, Kuwahata A, Yanagihara K, Enokido K, Katayose Y, Nakamura S, Takei H, Sekino M, Kusakabe M. Multicenter clinical trial on sentinel lymph node biopsy using superparamagnetic iron oxide nanoparticles and a novel handheld magnetic probe. J Surg Oncol 2019; 120:1391-1396. [DOI: 10.1002/jso.25747] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/06/2019] [Indexed: 01/05/2023]
Affiliation(s)
- Kanae Taruno
- Department of Breast Surgical OncologyShowa University School of MedicineTokyo Japan
| | - Tomoko Kurita
- Department of Breast SurgeryNippon Medical School HospitalTokyo Japan
| | - Akihiko Kuwahata
- Department of Electrical Engineering and Information Systems, Graduate School of EngineeringThe University of TokyoTokyo Japan
| | - Keiko Yanagihara
- Department of Breast SurgeryNippon Medical School HospitalTokyo Japan
| | - Katsutoshi Enokido
- Department of Breast Surgical Oncology, Showa University School of MedicineFujigaoka HospitalYokohama Kanagawa Japan
| | | | - Seigo Nakamura
- Department of Breast Surgical OncologyShowa University School of MedicineTokyo Japan
- The Department of Breast Cancer, Tianjin Medical University Cancer Institute and HospitalNational Clinical Research Center for CancerTianjin China
| | - Hiroyuki Takei
- Department of Breast Surgical Oncology, Showa University School of MedicineFujigaoka HospitalYokohama Kanagawa Japan
| | - Masaki Sekino
- Department of Electrical Engineering and Information Systems, Graduate School of EngineeringThe University of TokyoTokyo Japan
| | - Moriaki Kusakabe
- Research Center for Food Safety, Graduate School of Agricultural and Life SciencesThe University of TokyoTokyo Japan
- Department of Medical DeviceMatrix Cell Research Institute IncUshiku Ibaraki Japan
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Vural V, Yılmaz OC. The Turkish SentiMAG feasibility trial: preliminary results. Breast Cancer 2019; 27:261-265. [PMID: 31621053 DOI: 10.1007/s12282-019-01016-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 10/09/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sentinel node biopsy (SNB) is the standard of care for staging of the clinically and radiologically negative axillary lymph nodes in breast cancer patients. Sentinel node biopsy, with using Technetium-sulphur colloid (99 m Tc) alone or with blue dye is standard technique for evaluating axillary lymph nodes. This technique has drawbacks such as radiation exposure. Superparamagnetic iron oxide nanoparticles (SPIO) can represent a valid option for SNB. In this study; we tried to evaluate feasibility of new magnetic technique in Turkish early breast cancer patients. MATERIAL AND METHODS The study sample consists of 143 women affected by early breast carcinoma with clinically negative axillary lymph nodes. Sentinel node localization was performed using magnetic technique. Detection rate of magnetic technique was calculated and postoperative complications were assessed. RESULTS Results are based on 104 patients. Sentinel node identification rate was 99% (103/104, 95% CI 0.97-1.01) for magnetic technique. A median of two SNs per patient was removed. Major adverse reaction was the permanent skin coloration (7.1%). CONCLUSIONS The magnetic technique is a feasible method for detecting SN in breast cancer patients with minimal adverse effects. Magnetic technique may be alternative to standard technique especially in breast units, where nuclear medicine unit is not available.
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Affiliation(s)
- Veli Vural
- Department of General Surgery, Akdeniz University Hospital, Antalya, Turkey.
| | - Osman Cem Yılmaz
- Department of Breast Surgery, İstanbul Oncology Hospital, Istanbul, Turkey
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Man V, Wong TT, Co M, Suen D, Kwong A. Sentinel Lymph Node Biopsy in Early Breast Cancer: Magnetic Tracer as the Only Localizing Agent. World J Surg 2019; 43:1991-1996. [PMID: 30888473 DOI: 10.1007/s00268-019-04977-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The combined use of radioisotope and blue dye is the gold standard in sentinel lymph node (SLN) localization in early breast cancer. Superparamagnetic iron oxide (SPIO) has recently emerged as a non-inferior new tracer in sentinel lymph node mapping with fewer disadvantages. This study represents the first and the largest cohort of superparamagnetic iron oxide application in Asian population. METHODS Retrospective analysis of a prospectively maintained database was performed from August 2016 to December 2017. All patients with SLN localization by SPIO were included in this study. RESULTS A total of 328 breast cancer patients with 333 SLNB procedures were included in this study. Median age was 54 years (range 32-86). Median tumor size was 1.9 cm (range 0.1-12 cm).There were 138 breast-conserving surgeries and 195 mastectomies. All patients received injection of SPIO 1 day prior to operation. A total of 329 successful sentinel lymph node biopsy (SLNB) procedures were undertaken with 1514 sentinel lymph nodes (SLNs) identified. One hundred and fifty-three (10.1%) of the SLNs were positive for malignancy. There were 54 patients with macrometastases, 26 with micrometastases and 24 with isolated tumor cells. Sixty-seven patients underwent subsequent axillary dissection. Four patients failed sentinel lymph node identification with SPIO. The success rate of SPIO in sentinel lymph node localization was 98.8%. CONCLUSION SPIO represents a feasible alternative in sentinel lymph node mapping with comparably high nodal detection rate.
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Affiliation(s)
- Vivian Man
- Division of Breast Surgery, Department of Surgery, The University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, K1401, Hong Kong, Hong Kong SAR
| | - Ting Ting Wong
- Private Practice Breast Surgeon, The Breast Surgery, Suite 1203, 12/F East Point Center, 555 Hennessy Road, Causeway Bay, Hong Kong, Hong Kong SAR
| | - Michael Co
- Division of Breast Surgery, Department of Surgery, The University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, K1401, Hong Kong, Hong Kong SAR
| | - Dacita Suen
- Division of Breast Surgery, Department of Surgery, The University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, K1401, Hong Kong, Hong Kong SAR
| | - Ava Kwong
- Division of Breast Surgery, Department of Surgery, The University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, K1401, Hong Kong, Hong Kong SAR.
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Alvarado MD, Mittendorf EA, Teshome M, Thompson AM, Bold RJ, Gittleman MA, Beitsch PD, Blair SL, Kivilaid K, Harmer QJ, Hunt KK. SentimagIC: A Non-inferiority Trial Comparing Superparamagnetic Iron Oxide Versus Technetium-99m and Blue Dye in the Detection of Axillary Sentinel Nodes in Patients with Early-Stage Breast Cancer. Ann Surg Oncol 2019; 26:3510-3516. [PMID: 31297674 DOI: 10.1245/s10434-019-07577-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) is a highly accurate method for staging the axilla in early breast cancer. Superparamagnetic iron oxide mapping agents have been explored to overcome the disadvantages of the standard SLNB technique, which uses a radioisotope tracer with or without blue dye. One such agent, Sienna+, was shown to be non-inferior to the standard technique for SLNB in a number of studies. The SentimagIC trial was designed to establish the non-inferiority of a new formulation of this magnetic tracer, Magtrace (formerly SiennaXP). METHODS Patients with clinically node-negative early-stage breast cancer were recruited from six centers in the US. Patients received radioisotope and isosulfan blue dye injections, followed by an intraoperative injection of magnetic tracer, prior to SLNB. The sentinel node identification rate was compared between the magnetic and standard techniques to evaluate non-inferiority and concordance. RESULTS Data were collected for 146 procedures in 146 patients. The per patient detection rate was 99.3% (145/146) when using the magnetic tracer and 98.6% (144/146) when using the standard technique, while the nodal detection rate was 94.3% (348/369 nodes) when using the magnetic tracer and 93.5% (345/369) when using the standard technique (difference 0.8%, 95% binomial confidence interval lower bound - 2.1%). Of the 22 patients with positive sentinel lymph nodes (SLNs), 21 (95.4%) were detected by both the magnetic tracer and the standard technique. All malignant nodes detected by standard technique were also identified by the magnetic technique. CONCLUSION The magnetic technique is non-inferior to the standard technique of radioisotope and blue dye for axillary SLN detection in early-stage breast cancer. The magnetic technique is therefore a viable alternative.
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Affiliation(s)
- Michael D Alvarado
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
| | - Elizabeth A Mittendorf
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mediget Teshome
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alastair M Thompson
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Richard J Bold
- Division of Surgical Oncology, Department of Surgery, UC Davis Medical Center, Sacramento, CA, USA
| | | | | | - Sarah L Blair
- Department of Surgery, Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Kaisa Kivilaid
- Regulatory and Clinical Research Institute, Inc., Minneapolis, MN, USA
| | | | - Kelly K Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Forte S, Kubik-Huch R, Leo C. Improvement in breast magnetic resonance imaging after a sentinel procedure for breast cancer with superparamagnetic tracers. Eur J Radiol Open 2019; 6:215-219. [PMID: 31198820 PMCID: PMC6556706 DOI: 10.1016/j.ejro.2019.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 05/14/2019] [Indexed: 12/18/2022] Open
Abstract
The superparamagnetic iron oxide tracer Sienna+® was introduced as an alternative to the radioisotope 99Tc Nanocoll to preoperatively mark sentinel lymph nodes in breast cancer. As previously reported, this tracer causes susceptibility artifacts on magnetic resonance imaging (MRI), potentially hampering the diagnostic performance of follow-up breast MRI. This short report illustrates the temporal development of these artifacts in a patient who was followed up at 6, 12, and 18 months after administration of Sienna+® with MRI systems of different magnetic field strengths (1.5 T and 3.0 T) and using an MRI protocol with sequences optimized for artifact reduction. Although the artifacts were severe and predominant at the higher magnetic strength in the early postoperative period, they diminished over time and the image quality could be further improved by adapting the sequences. These findings indicate the possible use of MRI even after administration of a superparamagnetic tracer for post-treatment monitoring in breast cancer.
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Mok CW, Tan SM, Zheng Q, Shi L. Network meta-analysis of novel and conventional sentinel lymph node biopsy techniques in breast cancer. BJS Open 2019; 3:445-452. [PMID: 31388636 PMCID: PMC6677105 DOI: 10.1002/bjs5.50157] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 01/31/2019] [Indexed: 02/06/2023] Open
Abstract
Background The aim of this network meta‐analysis was to compare the performance of blue dye alone or in combination with radioisotope (technetium‐99m, Tc) with three novel techniques for sentinel lymph node detection in breast cancer: indocyanine green fluorescence (ICG), superparamagnetic iron oxide (SPIO) nanoparticles and contrast‐enhanced ultrasound imaging (CEUS). Methods PubMed, Embase, the Cochrane Library, China Knowledge Research Integrated Database,
ClinicalTrials.gov and OpenGrey databases were searched up to 31 November 2017, without language restriction. Studies that compared the detection performance of at least one of the novel methods (ICG, SPIO and CEUS) with that of traditional methods (blue dye and/or radioisotope) were included in network meta‐analysis. Results Thirty‐five studies were included. Pooled risk ratios (RRs) for Tc (1·09, 95 per cent c.i. 1·04 to 1·15), ICG (1·12, 1·07 to 1·16) and SPIO (1·09, 1·01 to 1·18) showed statistically better performance in detecting sentinel lymph nodes than blue dye alone. ICG had the lowest false‐negative rate, with a RR of 0·29 (0·16 to 0·54), followed by Tc (RR 0·44, 0·20 to 0·96) and SPIO (RR 0·45, 0·14 to 1·45), with blue dye alone as the reference group. Conclusion SPIO or ICG alone are superior to blue dye alone and comparable to the standard dual‐modality technique of blue dye with Tc.
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Affiliation(s)
- C W Mok
- Division of Breast Surgery, Department of Surgery Changi General Hospital Singapore
| | - S-M Tan
- Division of Breast Surgery, Department of Surgery Changi General Hospital Singapore
| | - Q Zheng
- Singapore Clinical Research Institute Singapore
| | - L Shi
- Singapore Clinical Research Institute Singapore
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40
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Casset A, Jouhannaud J, Garofalo A, Spiegelhalter C, Nguyen DV, Felder-Flesch D, Pourroy G, Pons F. Macrophage functionality and homeostasis in response to oligoethyleneglycol-coated IONPs: Impact of a dendritic architecture. Int J Pharm 2018; 556:287-300. [PMID: 30557682 DOI: 10.1016/j.ijpharm.2018.12.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 11/29/2018] [Accepted: 12/06/2018] [Indexed: 12/20/2022]
Abstract
The engineering of iron oxide nanoparticles (IONPs) for biomedical use has received great interest over the past decade. In the present study we investigated the biocompatibility of IONPs grafted with linear (2P) or generation 1 (2PG1) or 2 (2PG2) dendronized oligoethyleneglycol units in THP-1-derived macrophages. To evaluate IONP effects on cell functionality and homeostasis, mitochondrial function (MTT assay), membrane permeability (LDH release), inflammation (IL-8), oxidative stress (reduced glutathione, GSH), NLRP3 inflammasome activation (IL-1β) and nanoparticle cellular uptake (intracellular iron content) were quantified after a 4-h or 24-h cell exposure to increasing IONP concentrations (0-300 µg Fe/mL). IONPs coated with a linear molecule, NP10COP@2P, were highly taken up by cells and induced significant dose-dependent IL-8 release, oxidative stress and NLRP3 inflammasome activation. In comparison, IONPs coated with dendrons of generation 1 (NP10COP@2PG1) and 2 (NP10COP@2PG2) exhibited better biocompatibility. Effect of the dendritic architecture of the surface coating was investigated in a kinetic experiment involving cell short-term exposure (30 min or 1 h 30) to the two dendronized IONPs. NP10COP@2PG2 disrupted cellular homeostasis (LDH release, IL-1β and IL-8 secretion) to a greater extend than NP10COP@2PG1, which makes this last IONP the best candidate as MRI contrast or theranostic agent.
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Affiliation(s)
- Anne Casset
- Université de Strasbourg, CNRS, CAMB UMR 7199, F-67000 Strasbourg, France.
| | - Julien Jouhannaud
- Université de Strasbourg, CNRS, Institut de Physique et Chimie des Matériaux Strasbourg, UMR 7504, F-67000 Strasbourg, France
| | - Antonio Garofalo
- Université de Strasbourg, CNRS, Institut de Physique et Chimie des Matériaux Strasbourg, UMR 7504, F-67000 Strasbourg, France
| | - Coralie Spiegelhalter
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM, CNRS, Université de Strasbourg, F-67404 Illkirch, France
| | - Dinh-Vu Nguyen
- Université de Strasbourg, CNRS, Institut de Physique et Chimie des Matériaux Strasbourg, UMR 7504, F-67000 Strasbourg, France
| | - Delphine Felder-Flesch
- Université de Strasbourg, CNRS, Institut de Physique et Chimie des Matériaux Strasbourg, UMR 7504, F-67000 Strasbourg, France
| | - Geneviève Pourroy
- Université de Strasbourg, CNRS, Institut de Physique et Chimie des Matériaux Strasbourg, UMR 7504, F-67000 Strasbourg, France
| | - Françoise Pons
- Université de Strasbourg, CNRS, CAMB UMR 7199, F-67000 Strasbourg, France
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Pohlodek K, Foltín M, Mečiarová I, Ondriaš F. Simultaneous use of magnetic method in localization of impalpable breast cancer and sentinel lymph nodes detection: initial experience. Nanomedicine (Lond) 2018; 13:3075-3081. [DOI: 10.2217/nnm-2018-0220] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Aim: In this study we used a new technology for localization of non-palpable breast tumors using a small steel marker in conjunction of sentinel nodes (SLNs) detection through injection of SPIO nanoparticles; both detected through a magnetic probe. Materials & methods: Ten patients with biopsy-proven nonpalpable invasive breast carcinoma or premalignant lesions eligible for SLNs biopsy were enrolled in this study. Results: All tumors were removed with safe surgical margins. The mean nodal detection rate was 3.4 nodes per patient. No interferences in magnetic probe measurements due to the presence of both markers in the same breast were observed. Conclusion: Simultaneous use of the magnetic method in localization of impalpable breast tumors and SNs detection makes breast surgery convenient.
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Affiliation(s)
- Kamil Pohlodek
- Second Department of Gynecology & Obstetrics, Faculty of Medicine, Comenius University of Bratislava, 82606 Bratislava, Slovakia
| | - Martin Foltín
- Second Department of Gynecology & Obstetrics, Faculty of Medicine, Comenius University of Bratislava, 82606 Bratislava, Slovakia
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Abstract
The 'standard of care' method for sentinel node mapping is the combination technique using radioisotope and blue dye although some centres use radioisotope or blue dye alone. Radioisotope usage requires licensing, has regulatory issues around handling and disposal of waste, and logistically may be unavailable or difficult to implement in some centres or less developed country. This has led to the development of alternative methods such as superparamagnetic iron oxide (SPIO), fluorescence techniques using indocyanine green (ICG) or fluorescein, computed tomography lymphography, and contrast-enhanced ultrasound scan (CEUS) using microbubbles. The newer techniques will potentially enable a more widespread adoption of this procedure; however, a common barrier for these techniques is the lack of standardisation and no randomised trials to evaluate their effectiveness against the current standard of care. Furthermore, many of these techniques are more costly and may become redundant in node-negative patients with small tumours if ongoing trials show that sentinel node biopsy offers no additional benefit to grey-scale axillary ultrasound. This review discusses the new techniques for sentinel node mapping that have emerged including their pros and cons.
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Affiliation(s)
- Amit Goyal
- Department of Surgery, Royal Derby Hospital, Derby, UK
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43
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Steinke M, Zunhammer F, Chatzopoulou EI, Teller H, Schütze K, Walles H, Rädler JO, Grüttner C. Rapid Analysis of Cell-Nanoparticle Interactions using Single-Cell Raman Trapping Microscopy. Angew Chem Int Ed Engl 2018; 57:4946-4950. [DOI: 10.1002/anie.201713151] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/06/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Maria Steinke
- Fraunhofer Institute for Silicate Research ISC; c/o University Hospital Würzburg; Chair of Tissue Engineering and Regenerative Medicine; Röntgenring 11 97070 Würzburg Germany
| | | | - Elisavet I. Chatzopoulou
- Ludwig-Maximilians-University Munich; Faculty of Physics; Geschwister-Scholl-Platz 1 80539 München Germany
| | - Henrik Teller
- Micromod Partikeltechnologie GmbH; Friedrich-Barnewitz-Straße 4 18119 Rostock Germany
| | | | - Heike Walles
- Fraunhofer Institute for Silicate Research ISC; c/o University Hospital Würzburg; Chair of Tissue Engineering and Regenerative Medicine; Röntgenring 11 97070 Würzburg Germany
| | - Joachim O. Rädler
- Ludwig-Maximilians-University Munich; Faculty of Physics; Geschwister-Scholl-Platz 1 80539 München Germany
| | - Cordula Grüttner
- Micromod Partikeltechnologie GmbH; Friedrich-Barnewitz-Straße 4 18119 Rostock Germany
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44
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Steinke M, Zunhammer F, Chatzopoulou EI, Teller H, Schütze K, Walles H, Rädler JO, Grüttner C. Rapid Analysis of Cell-Nanoparticle Interactions using Single-Cell Raman Trapping Microscopy. Angew Chem Int Ed Engl 2018. [DOI: 10.1002/ange.201713151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Maria Steinke
- Fraunhofer Institute for Silicate Research ISC; c/o University Hospital Würzburg; Chair of Tissue Engineering and Regenerative Medicine; Röntgenring 11 97070 Würzburg Germany
| | | | - Elisavet I. Chatzopoulou
- Ludwig-Maximilians-University Munich; Faculty of Physics; Geschwister-Scholl-Platz 1 80539 München Germany
| | - Henrik Teller
- Micromod Partikeltechnologie GmbH; Friedrich-Barnewitz-Straße 4 18119 Rostock Germany
| | | | - Heike Walles
- Fraunhofer Institute for Silicate Research ISC; c/o University Hospital Würzburg; Chair of Tissue Engineering and Regenerative Medicine; Röntgenring 11 97070 Würzburg Germany
| | - Joachim O. Rädler
- Ludwig-Maximilians-University Munich; Faculty of Physics; Geschwister-Scholl-Platz 1 80539 München Germany
| | - Cordula Grüttner
- Micromod Partikeltechnologie GmbH; Friedrich-Barnewitz-Straße 4 18119 Rostock Germany
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45
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Sekino M, Kuwahata A, Ookubo T, Shiozawa M, Ohashi K, Kaneko M, Saito I, Inoue Y, Ohsaki H, Takei H, Kusakabe M. Handheld magnetic probe with permanent magnet and Hall sensor for identifying sentinel lymph nodes in breast cancer patients. Sci Rep 2018; 8:1195. [PMID: 29352214 PMCID: PMC5775278 DOI: 10.1038/s41598-018-19480-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 12/12/2017] [Indexed: 12/12/2022] Open
Abstract
The newly developed radioisotope-free technique based on magnetic nanoparticle detection using a magnetic probe is a promising method for sentinel lymph node biopsy. In this study, a novel handheld magnetic probe with a permanent magnet and magnetic sensor is developed to detect the sentinel lymph nodes in breast cancer patients. An outstanding feature of the probe is the precise positioning of the sensor at the magnetic null point of the magnet, leading to highly sensitive measurements unaffected by the strong ambient magnetic fields of the magnet. Numerical and experimental results show that the longitudinal detection length is approximately 10 mm, for 140 μg of iron. Clinical tests were performed, for the first time, using magnetic and blue dye tracers—without radioisotopes—in breast cancer patients to demonstrate the performance of the probe. The nodes were identified through transcutaneous and ex-vivo measurements, and the iron accumulation in the nodes was quantitatively revealed. These results show that the handheld magnetic probe is useful in sentinel lymph node biopsy and that magnetic techniques are widely being accepted as future standard methods in medical institutions lacking nuclear medicine facilities.
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Affiliation(s)
- Masaki Sekino
- Graduate School of Engineering, The University of Tokyo, Tokyo, 113-0032, Japan.
| | - Akihiro Kuwahata
- Graduate School of Engineering, The University of Tokyo, Tokyo, 113-0032, Japan.
| | - Tetsu Ookubo
- Graduate School of Engineering, The University of Tokyo, Tokyo, 113-0032, Japan
| | - Mikio Shiozawa
- Tochigi-Medical-Center-Shimotsuga, Tochigi, 329-4498, Japan
| | - Kaichi Ohashi
- Graduate School of Engineering, The University of Tokyo, Tokyo, 113-0032, Japan
| | - Miki Kaneko
- Graduate School of Engineering, The University of Tokyo, Tokyo, 113-0032, Japan
| | | | - Yusuke Inoue
- Graduate School of Engineering, The University of Tokyo, Tokyo, 113-0032, Japan.,Institute of Development, Aging and Cancer, Tohoku University, Miyagi, 980-8575, Japan
| | - Hiroyuki Ohsaki
- Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, 277-8561, Japan
| | - Hiroyuki Takei
- Department of Breast Oncology, Nippon Medical School Hospital, Tokyo, 113-8603, Japan
| | - Moriaki Kusakabe
- Research Center for Food Safety, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, 113-8657, Japan.,Matrix Cell Research Institute Inc, Ibaraki, 300-1232, Japan
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46
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Karakatsanis A, Daskalakis K, Stålberg P, Olofsson H, Andersson Y, Eriksson S, Bergkvist L, Wärnberg F. Superparamagnetic iron oxide nanoparticles as the sole method for sentinel node biopsy detection in patients with breast cancer. Br J Surg 2017; 104:1675-1685. [PMID: 28877348 DOI: 10.1002/bjs.10606] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/27/2016] [Accepted: 04/12/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Sentinel node biopsy (SNB) using superparamagnetic iron oxide (SPIO) nanoparticles is a novel method in breast cancer. Several studies have verified the non-inferiority of SPIO compared with the standard use of radioisotope 99m Tc with or without blue dye. The aim of the MONOS study presented here was to evaluate the use of SPIO as a sole tracer and the efficacy of tracer injection in the preoperative setting. METHODS This prospective cohort study was carried out in two hospitals, one using 99m Tc and the other SPIO. 99m Tc was injected in the morning of the day of surgery or the day before. SPIO was either injected before surgery in the outpatient clinic or 1 h before the operation. RESULTS A total of 338 consecutive patients with breast cancer underwent 343 procedures; SPIO nanoparticles were used in 184 procedures and 99m Tc-labelled tracer in 159. Detection rates for SPIO and 99m Tc were 95·6 and 96·9 per cent respectively (P = 0·537). All nodes with SPIO uptake were coloured brown. Fewer nodes were retrieved with SPIO (mean 1·35 versus 1·89), regardless of whether blue dye was used (P < 0·001). Preoperative SPIO injection (58·7 per cent of procedures), a median of 16 (range 2-27) days before the procedure, was associated with a better tracer-specific detection rate (95·3 versus 86 per cent; P = 0·031) and retrieval of more nodes (mean 1·43 versus 1·03; P < 0·001) than perioperative administration. Skin staining was present in 39·9 per cent of patients, and was related to breast-conserving surgery and periareolar injection. CONCLUSION The use of SPIO alone is a safe alternative, with results comparable to those of the standard dual technique using 99m Tc and blue dye. The efficacy of injection in the preoperative setting simplifies logistics and improves performance. Skin staining can be prevented by a deeper peritumoral injection.
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Affiliation(s)
- A Karakatsanis
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala Academic Hospital, Uppsala, Sweden
| | - K Daskalakis
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala Academic Hospital, Uppsala, Sweden
| | - P Stålberg
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala Academic Hospital, Uppsala, Sweden
| | - H Olofsson
- Department of Clinical Pathology, Uppsala University Hospital, Uppsala Academic Hospital, Uppsala, Sweden
| | - Y Andersson
- Department of Surgery, Västmanlands County Hospital, Västerås, Sweden
| | - S Eriksson
- Department of Surgery, Västmanlands County Hospital, Västerås, Sweden
| | - L Bergkvist
- Centre for Clinical Research, Uppsala University, Uppsala, Sweden.,Department of Surgery, Västmanlands County Hospital, Västerås, Sweden
| | - F Wärnberg
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala Academic Hospital, Uppsala, Sweden
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47
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Mamounas EP, Kuehn T, Rutgers EJT, von Minckwitz G. Current approach of the axilla in patients with early-stage breast cancer. Lancet 2017:S0140-6736(17)31451-4. [PMID: 28818521 DOI: 10.1016/s0140-6736(17)31451-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 02/28/2017] [Accepted: 04/10/2017] [Indexed: 02/01/2023]
Abstract
The surgical approach of the axilla in patients with early-stage breast cancer has witnessed considerable evolution during the past 25 years. The previously undisputed gold standard of axillary-lymph-node dissection for staging has now been replaced by sentinel-lymph-node biopsy for patients with clinically negative axilla. For selected patients with limited sentinel-lymph-node involvement, completion axillary-lymph-node dissection can be omitted or replaced by axillary radiotherapy, reducing morbidity. The clinical interest of axillary staging after neoadjuvant chemotherapy is increasing and this approach might contribute to morbidity reduction, and to the further tailoring of future systemic and locoregional treatment decisions by response assessment. Refinement of the sentinel-lymph-node biopsy technique might overcome the slightly impaired success rates in this setting. New techniques for lymphatic mapping attempt to further simplify the procedure. In view of the declining influence of axillary nodal status on adjuvant therapy decision-making, ongoing clinical trials will evaluate whether sentinel-lymph-node biopsy can be avoided altogether in selected patients.
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Affiliation(s)
- Eleftherios P Mamounas
- University of Florida Health Cancer Center-Orlando Health, and University of Central Florida, Orlando, FL, USA.
| | - Thorsten Kuehn
- Interdisciplinary Breast Cancer Center, Department of Gynecology and Obstetrics, Klinikum Esslingen, Esslingen, Germany
| | - Emiel J T Rutgers
- Netherlands Cancer Institute, Amsterdam, Netherlands; University of Amsterdam, Amsterdam, Netherlands
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Wáng YXJ, Idée JM. A comprehensive literatures update of clinical researches of superparamagnetic resonance iron oxide nanoparticles for magnetic resonance imaging. Quant Imaging Med Surg 2017; 7:88-122. [PMID: 28275562 DOI: 10.21037/qims.2017.02.09] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This paper aims to update the clinical researches using superparamagnetic iron oxide (SPIO) nanoparticles as magnetic resonance imaging (MRI) contrast agent published during the past five years. PubMed database was used for literature search, and the search terms were (SPIO OR superparamagnetic iron oxide OR Resovist OR Ferumoxytol OR Ferumoxtran-10) AND (MRI OR magnetic resonance imaging). The literature search results show clinical research on SPIO remains robust, particularly fuelled by the approval of ferumoxytol for intravenously administration. SPIOs have been tested on MR angiography, sentinel lymph node detection, lymph node metastasis evaluation; inflammation evaluation; blood volume measurement; as well as liver imaging. Two experimental SPIOs with unique potentials are also discussed in this review. A curcumin-conjugated SPIO can penetrate brain blood barrier (BBB) and bind to amyloid plaques in Alzheime's disease transgenic mice brain, and thereafter detectable by MRI. Another SPIO was fabricated with a core of Fe3O4 nanoparticle and a shell coating of concentrated hydrophilic polymer brushes and are almost not taken by peripheral macrophages as well as by mononuclear phagocytes and reticuloendothelial system (RES) due to the suppression of non-specific protein binding caused by their stealthy ''brush-afforded'' structure. This SPIO may offer potentials for the applications such as drug targeting and tissue or organ imaging other than liver and lymph nodes.
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Affiliation(s)
- Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, New Territories, Hong Kong SAR, China
| | - Jean-Marc Idée
- Guerbet, Research and Innovation Division, Roissy-Charles de Gaulle, France
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Abstract
In vivo imaging, which enables us to peer deeply within living subjects, is producing tremendous opportunities both for clinical diagnostics and as a research tool. Contrast material is often required to clearly visualize the functional architecture of physiological structures. Recent advances in nanomaterials are becoming pivotal to generate the high-resolution, high-contrast images needed for accurate, precision diagnostics. Nanomaterials are playing major roles in imaging by delivering large imaging payloads, yielding improved sensitivity, multiplexing capacity, and modularity of design. Indeed, for several imaging modalities, nanomaterials are now not simply ancillary contrast entities, but are instead the original and sole source of image signal that make possible the modality's existence. We address the physicochemical makeup/design of nanomaterials through the lens of the physical properties that produce contrast signal for the cognate imaging modality-we stratify nanomaterials on the basis of their (i) magnetic, (ii) optical, (iii) acoustic, and/or (iv) nuclear properties. We evaluate them for their ability to provide relevant information under preclinical and clinical circumstances, their in vivo safety profiles (which are being incorporated into their chemical design), their modularity in being fused to create multimodal nanomaterials (spanning multiple different physical imaging modalities and therapeutic/theranostic capabilities), their key properties, and critically their likelihood to be clinically translated.
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Affiliation(s)
- Bryan Ronain Smith
- Stanford University , 3155 Porter Drive, #1214, Palo Alto, California 94304-5483, United States
| | - Sanjiv Sam Gambhir
- The James H. Clark Center , 318 Campus Drive, First Floor, E-150A, Stanford, California 94305-5427, United States
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Tardelli E, Mazzarri S, Rubello D, Gennaro M, Fantechi L, Duce V, Romanini A, Chondrogiannis S, Volterrani D, Colletti PM, Manca G. Sentinel Lymph Node Biopsy in Cutaneous Melanoma: Standard and New Technical Procedures and Clinical Advances. A Systematic Review of the Literature. Clin Nucl Med 2016; 41:e498-e507. [PMID: 27749418 DOI: 10.1097/rlu.0000000000001370] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Melanoma is an important public health problem, and its incidence is increasing worldwide. The disease status of regional lymph nodes is the most important prognostic factor in early-stage melanoma patients. Sentinel lymph node biopsy (SLNB) was introduced in the early 1990s as a less invasive procedure than complete lymph node dissection to allow histopathologic evaluation of the "sentinel lymph node" (SLN), which is the first node along the lymphatic pathway from a primary tumor. Sentinel lymph node biopsy has minimal complication risks compared with standard complete lymph node dissection. Currently, SLNB is the accepted method for staging patients with clinically node-negative cutaneous melanoma and provides the most powerful prognostic information by evaluating the nodal basin status. The current practice of SLNB consists of the injection of Tc-labeled radiopharmaceutical, preoperative lymphoscintigraphy with the possibility of using the SPECT/CT hybrid imaging, and intraoperative SLN localization using a handheld gamma probe with or without the use of blue dye. Recently, the SLN localization and detection have been enhanced with the use of new tracers and new intraoperative devices, which have demonstrated to be particularly useful in melanomas of the head and neck region and in area of complex anatomy. Despite these important advances in the technology and the increasing experience in SLN mapping, major research centers have reported a false-negative rate higher than 15%. This relatively high false-negative rate, greater than those reported in the initial validation studies, points out the importance for the nuclear medicine community to continuously improve their knowledge on the biological behavior of melanoma and to improve the technical aspects that may allow more precise staging. For the SLNB procedure to be accurate, it is of critical importance that all "true" SLNs are identified and removed for examination. The aim of this article is to provide general information about the SLNB procedure in clinical practice highlighting the importance of standardization and accuracy of SLN identification in the light of the most recent technical innovations.
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Affiliation(s)
- Elisa Tardelli
- From the *Regional Center of Nuclear Medicine, University Hospital of Pisa, Pisa; †Department of Nuclear Medicine, Santa Maria della Misericordia Rovigo Hospital, Rovigo; ‡Nuclear Medicine Department, Sant'Andrea Hospital, La Spezia; §Department of Oncology, University Hospital of Pisa, Pisa, Italy; and ∥Department of Nuclear Medicine, University of Southern California, Los Angeles, CA
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