Clinical Evaluation of 99mTc-Rituximab for Sentinel Lymph Node Mapping in Breast Cancer Patients

Heterogeneous Distribution and Absorbed Dose of Radiolabeled Nanoparticles and Colloids in Sentinel Lymph Nodes

Background: For breast cancer staging, radiolabeled colloids and superparamagnetic iron oxide nanoparticles (SPIONs) are used for sentinel lymph node (SLN) imaging. This study characterized the intranodal activity distribution and absorbed dose distribution. Material and Methods: Six patients diagnosed with primary breast cancer were intradermally injected with 99mTc-Nanocoll. The SLNs were resected, weighed, and measured for activity. Three groups of six rats were subcutaneously injected into the hind paw with either 99mTc-Nanocoll, 99mTc-SPIONs, or 68Ga-SPIONs. Macro- and small-scale dosimetry calculations were performed using autoradiography images of cryosections of SLNs from patients and animals. Results: The mean absorbed dose in patient SLNs was 0.5 ± 0.3 mGy/MBq for 99mTc-Nanocoll and 3.4 ± 1.8 mGy/MBq, assuming a 99mTc-Nanocoll-based distribution of 68Ga-SPIONs. Due to different decay characteristics, the heterogeneity in the absorbed dose differed between 99mTc-SPIONs and 68Ga-SPIONs with a maximum to mean absorbed dose ratio of 2.7 ± 0.3 and 1.6 ± 0.2, respectively. Conclusions: This study shows that 99mTc- and 68Ga-SPIONs and 99mTc-nanocolloids have similar activity distribution in human and animal lymph nodes. Small-scale dosimetry models combined with clinical patient biokinetics may serve as a bridge between organ and tissue dosimetry and the interpretation of intrinsic geometric variation and its uncertainties in absorbed dose.

First study on the efficiency of 99mTc-rituximab for sentinel lymph node mapping and biopsy in oral squamous cell carcinoma

OBJECTIVE

To explore the clinical efficiency of using the sentinel lymph node (SLN) imaging agent 99mTc-rituximab for lymphoscintigraphy and SLN biopsy (SLNB) in oral squamous cell carcinoma (OSCC) patients.

METHODS

A retrospective study was conducted on 23 patients with OSCC who underwent 99mTc-rituximab lymphoscintigraphy and SLNB. The cohort comprised 16 men (69.6%) and 7 women (30.4%) with a median age of 64.0 years (range: 33-90 years). All patients received a preoperative peritumoral injection of 99mTc-rituximab. The SLN detection rates (SDRs) of SLN imaging and SLNB were analyzed. The localizations of SLNs were counted. Patients were followed up after surgery. Differences were considered significant for a p-value of less than 0.05.

RESULTS

The SDRs of lymphoscintigraphy and SLNB were 91.3% (21/23) and 100.0% (23/23), respectively. The SDRs of lymphoscintigraphy for patients in pathological stages I/II and III/IVa were 100.0% (15/15) and 75.0% (6/8), respectively. Among the 2 patients with negative imaging results, both were stage IVa and both had SLN metastasis. The SLNs were located in levels Ib, IIa, IIb, III, and IV, accounting for 45.0% (18/40), 40.0% (16/40), 10.0% (4/40), 2.5% (1/40), and 2.5% (1/40), respectively. The median follow-up duration was 32.0 months (range: 13.0-68.0 months). During follow-up, none of the 23 patients (100.0%) showed lymph node (LN) metastasis. As a result, the sensitivity, negative predictive value (NPV), and accuracy were all 100.0%.

CONCLUSIONS

The application of 99mTc-rituximab for SLN imaging and SLNB in OSCC patients demonstrated high detection rates and accuracy, holding significant clinical value.

Rapid, Non-Invasive, Accurate Diagnosis and Efficient Clearance of Metastatic Lymph Nodes

Sentinel lymph node (SLN) biopsy is currently the standard procedure for clinical cancer diagnosis and treatment, but still faces the risks of false negatives and tumor metastasis, as well as time-consuming pathological evaluation procedure. Herein, we proposed a near-infrared-II (NIR-II, 1000-1700 nm) theranostic nanosystem (FLAGC) for rapid, non-invasive, accurate diagnosis and efficient clearance of metastatic lymph nodes in breast cancer. Initialized by chlorin e6 (Ce6), a pH-sensitive amphiphilic amino acid fluorenylmethoxycarbonyl-L-histidine (Fmoc-His) was assembled with Gd3+, luminol, and AgAuSe quantum dots (AAS QDs) to form FLAGC. In FLAGC, luminol and AAS QDs form a NIR-II chemical resonance energy transfer (CRET) system (Luminol-AAS); Ce6 initiates the assembly and also serves as a photosensitizer. Upon subcutaneous injection, FLAGC is easily drained into SLNs, achieving their precise localization. Subsequently, the acidity of tumor microenvironment triggers the rapid disassembly of FLAGC, exposing Luminol-AAS. myeloperoxidase (MPO) secreted by tumor-associated macrophages and neutrophils in SLNs mediates the oxidation of luminol, lighting up AAS QDs through the CRET process for precise diagnosis of metastatic lymph nodes. Moreover, highly efficient clearance of positive lymph nodes is achieved through Ce6-mediated photodynamic therapy. Our strategy provides a new paradigm for identifying and eliminating clinically metastatic lymph nodes.

Role of Nuclear Sentinel Lymph Node Mapping Compared to New Alternative Imaging Methods

With the emergence of sentinel node technology, many patients can be staged histopathologically using lymphatic mapping and selective lymphadenectomy. Structural imaging by using US, CT and MR permits precise measurement of lymph node volume, which is strongly associated with neoplastic involvement. Sentinel lymph node detection has been an ideal field of application for nuclear medicine because anatomical data fails to represent the close connections between the lymphatic system and regional lymph nodes, or, more specifically, to identify the first draining lymph node. Hybrid imaging has demonstrated higher accuracy than standard imaging in SLN visualization on images, but it did not change in terms of surgical detection. New alternatives without ionizing radiations are emerging now from "non-radiological" fields, such as ophthalmology and dermatology, where fluorescence or opto-acoustic imaging, for example, are widely used. In this paper, we will analyze the advantages and limits of the main innovative methods in sentinel lymph node detection, including innovations in lymphoscintigraphy techniques that persist as the gold standard to date.

99mTc-Rituximab sentinel lymph node mapping and biopsy, the effective technique avoids axillary dissection and predicts prognosis in 533 cutaneous melanoma

OBJECTIVE

To evaluate the efficiency of a novel lymph node radiotracer ^99mTc-rituximab in sentinel lymph node (SLN) lymphoscintigraphy and SLN biopsy (SLNB), and the influence of SLNB results on the prognosis of cutaneous malignant melanoma (CMM) patients.

METHODS

A retrospective study was performed on 533 patients with CMM who underwent lymphoscintigraphy and SLNB. All patients received a preoperative peritumoral injection of 11.1-18.5 MBq of ^99mTc-rituximab 0.5 to 1 h before lymphoscintigraphy and SLNB.

RESULTS

The detection rate of lymphoscintigraphy and SLNB was both 99.81% (532/533), and the average number of detected SLNs was 2.1 (range 1 to 8) and 2.7 (range 1 to 11) per patient, respectively. 12.1% SLNs and 22.2% patients were found metastatic, with an average of 1.5 (range 1 to 5) metastatic SLNs per patient. The SLN metastatic rates were different in patients with different Breslow thickness, Clark levels, ulceration, mitotic counts, and HMB45 expression (p < 0.05). Ninety patients were proceeded with the regional lymph node dissection (RLND) after SLNB, and the sensitivity, specificity and accuracy of SLNB in metastatic diagnosis is 97.4, 100 and 96.7%, respectively. And SLNs with metastases was an independent prognostic factor for OS and PFS by multivariate prognostic analyses (HR was 5.9 and 4.3, p < 0.001). For patients with metastatic SLNs, the non-SLNs with metastasis and non-SLNs without metastasis in RLND, and observation groups showed different mean PFS as 14.9, 24.8 and 25.5 months (p = 0.018), but no statistically significant difference existed in the OS.

CONCLUSION

The novel radiotracer ^99mTc-rituximab could identify SLNs specifically in SLN lymphoscintigraphy and SLNB in CMM patients, and the pathology obtained from SLNB rather than from RLND better indicated the staging and long-term prognosis.

99mTc-rituximab tracer injection for guiding internal mammary sentinel lymph nodes biopsy in primary breast cancer: A prospective observational study

Objective

To explore the use of ^99mTc-rituximab tracer injection for internal mammary sentinel lymph node (IM-SLN) detection in patients with primary breast cancer.

Methods

This prospective observational study enrolled female patients with primary breast cancer between September 2017 and June 2022 at Fujian Provincial Hospital. The participants were divided into the peritumoral group (two subcutaneous injection points on the surface of the tumor), two-site group (injections into the glands at 6 and 12 o'clock around the areola area), and four-site group (injections into the gland at 3, 6, 9, and 12 o'clock around the areola area). The outcomes were the detection rates of the IM-SLNs and axillary sentinel lymph nodes (A-SLNs).

Results

Finally, 133 patients were enrolled, including 53 in the peritumoral group, 60 in the two-site group, and 20 in the four-site group. The detection rate of the IM-SLNs in the peritumoral group (9.4% [5/53]) was significantly lower than in the two-site (61.7% [37/60], P<0.001) and four-site (50.0% [10/20], P<0.001) groups. The detection rates of A-SLNs among the three groups were comparable (P=0.436).

Conclusion

The two-site or four-site intra-gland injection of ^99mTc-rituximab tracer might achieve a higher detection rate of IM-SLNs and a comparable detection rate of A-SLNs compared with the peritumoral method. The location of the primary focus has no impact on the detection rate of the IM-SLNs.

Nanocarbon Tracer and Areola Injection Site Are Superior in the Sentinel Lymph Node Biopsy Procedure for Breast Cancer

Background. Axillary lymph node (ALN) staging is the most effective method to evaluate the condition of patients with breast cancer, their choice of treatment options, and prognosis. The sentinel lymph node (SLN) status assessment is the key to sentinel lymph node biopsy (SLNB) in patients with breast cancer. The choice of tracer and tracer injection sites affects SLNB. Objective. This study mainly analyzes the best tracer for SLNB and the best choice of tracer injection site. Methods. A total of 165 breast cancer patients who underwent SLNB were selected and injected with methylene blue or 99mTc-labeled sodium phytate or nanocarbon 20 min before biopsy. The number of SLNs detected by different tracers in different injection sites such as peritumoral tissue (PT) and subareolar area (SA) was counted, and the sensitivity, specificity, and positive/negative prediction rates were recorded and compared. Results. The detection success rate, average detection number of SLNs, and detection accuracy of the nanocarbon tracer were higher than the other two. The detection sensitivity, specificity, and positive and negative prediction rates of nanocarbon for SLNB were also higher than those of the other two tracers. When comparing the performance of tracers in different injection sites, it was found that the detection of three tracers injected in the SA was better than the injection in the PT. Conclusion. For women with early-stage breast cancer, nanocarbon can be used as the preferred tracer for SLNB to determine the status of the patient’s ALNs, and the areola area can be used as the best injection site.

The efficacy of 99mTc-rituximab as a tracer for sentinel lymph node biopsy in cutaneous melanoma patients

Background

The sentinel lymph node (SLN) status is a vital prognostic factor for malignant melanoma (MM) patients. There is increasing evidence that a radioactive agent, rather than its combination with blue dye, is sufficient for a SLN biopsy (SLNB). Thus, we discussed the efficacy of ^99mTc-rituximab as a tracer in MM patients.

Methods

A total of 502 consecutive patients with MM who underwent SLNB were enrolled in this study. All participants were peritumorally injected with ^99mTc-rituximab before imaging, and scanned with single-photon emission computed tomography-computed tomography (SPECT-CT) to detect the number and location of the SLN. A gamma detection probe was employed to detect radioactive SLNs in operation. Follow up was conducted to observe whether nodal or distant recurrence occurred.

Results

The SLNs were successfully imaged via SPECT-CT and harvested from all 502 participants. No drainage tube was indwelled and 32 (6.3%) participants experienced the following complications: seroma (n=26, 5.2%), wound infections or lymphangitis (n=6, 1.2%), sensory nerve injuries (n=4, 0.8%). There were 380 patients who were diagnosed as SLN-negative and 122 (24.2%) were SLN-positive. A total of 85 SLN-positive patients received complete lymph node dissection, and 28 (32.9%) had additional positive lymph nodes. During a median follow-up of 24 months, 28 participants were found to have a false negative (FN) SLN. The FN rate was 18.7%. A higher T stage was a predictive factor for FN [odds ratio (OR) 1.77; P<0.05]. There was no significant difference in the positive or FN rate between the acral and cutaneous groups.

Conclusions

The radiopharmaceutical ^99mTc-rituximab could be employed as a simple and safe tracer in acral and cutaneous melanoma SLN biopsies.

Initial evaluation of 99m Tc-labeled anti-CEA scFv for micro-SPECT imaging in mice with colorectal cancer

Carcinoembryonic antigen (CEA) has emerged as an important molecular target for several neoplastic diseases, including colorectal cancer with CEA over-expression. In this study, we report the production and radiolabeling of a novel anti-CEA single-chain fragment variable (scFv-96NRT, concentration for 50% of maximal effect 46 ng/mL), and evaluation of [^99m Tc]Tc-scFv-96NRT in non-invasive detection of CEA expression. [^99m Tc]Tc-scFv-96NRT was synthesized by one step reduction in labeling yield of > 95% with radiochemical purity of > 98% and molar activity of 10-11 GBq/μmol. [^99m Tc]Tc-scFv-96NRT showed high stability in 0.01 M phosphate buffered saline (PBS), and 5% human serum albumin (HSA). It exhibited elevated uptake in CEA over-expressing cells. Bio-distribution studies in BALB/c mice revealed that the probe was cleared from blood rapidly, and the highest retention was observed in the kidneys. The micro-single photon emission computed tomography (micro-SPECT) imaging of [^99m Tc]Tc-scFv-96NRT showed a specific accumulation pattern, as blocking experiment with excess scFv-96NRT suppressed the tumor uptake. These preliminary results suggest that [^99m Tc]Tc-scFv-96NRT is a potential non-invasive molecular probe for imaging tumors with CEA over-expression.

Targeting Engineered Nanoparticles for Breast Cancer Therapy

Breast cancer (BC) is the second most common cancer in women globally after lung cancer. Presently, the most important approach for BC treatment consists of surgery, followed by radiotherapy and chemotherapy. The latter therapeutic methods are often unsuccessful in the treatment of BC because of their various side effects and the damage incurred to healthy tissues and organs. Currently, numerous nanoparticles (NPs) have been identified and synthesized to selectively target BC cells without causing any impairments to the adjacent normal tissues or organs. Based on an exploratory study, this comprehensive review aims to provide information on engineered NPs and their payloads as promising tools in the treatment of BC. Therapeutic drugs or natural bioactive compounds generally incorporate engineered NPs of ideal sizes and shapes to enhance their solubility, circulatory half-life, and biodistribution, while reducing their side effects and immunogenicity. Furthermore, ligands such as peptides, antibodies, and nucleic acids on the surface of NPs precisely target BC cells. Studies on the synthesis of engineered NPs and their impact on BC were obtained from PubMed, Science Direct, and Google Scholar. This review provides insights on the importance of engineered NPs and their methodology for validation as a next-generation platform with preventive and therapeutic effects against BC.

Techniques for sentinel node biopsy in breast cancer

INTRODUCTION

Sentinel node biopsy (SNB) is the standard of care in women with breast cancer (BC) and clinically non suspicious axillary lymph nodes (LNs), due to its high negative predictive value (NPV) in the assessment of nodal status. SNB has significantly reduced complications related to the axillary lymph node dissection, such as lymphedema and upper limb dysfunction.

EVIDENCE ACQUISITION

The gold standard technique for SNB is the blue dye (BD) and technetium labelled nanocolloid (Tc-99m) double technique. However, nuclear medicine is not available in all Institutions and several new tracers and devices have been proposed, such as indocyanine green (ICG) and superparamagnetic iron oxides (SPIO). All these techniques show an accuracy and detection rate not inferior to that of the standard technique, with different specific pros and cons. The choice of how to perform a SNB primarily depends on the surgeon's confidence with the procedure, the availability of nuclear medicine and the economic resources of the Institutions. In this setting, new tracers, hybrid tracers and imaging techniques are being evaluated in order to improve the detection rate of sentinel lymph nodes (SNs) and minimize the number of unnecessary axillary surgeries through an accurate preoperative assessment of nodal status and to guide new minimally invasive diagnostic procedures of SNs. In particular, the contrast-enhanced ultrasound (CEUS) is an active field of research but cannot be recommended for clinical use at this time.

EVIDENCE SYNTHESIS

The ICG fluorescence technique was superior in terms of DR, as well as having the lowest FNR. The DR descending order was SPIO, Tc, dual modality (Tc/BD), CEUS and BD.

CONCLUSIONS

This paper is a narrative review of the most common SNB techniques in BC with a focus on recent innovations.

Imaging technology of the lymphatic system

The lymphatic system plays critical roles in tissue fluid homeostasis and immunity and has been implicated in the development of many different pathologies, ranging from lymphedema, the spread of cancer to chronic inflammation. In this review, we first summarize the state-of-the-art of lymphatic imaging in the clinic and the advantages and disadvantages of these existing techniques. We then detail recent progress on imaging technology, including advancements in tracer design and injection methods, that have allowed visualization of lymphatic vessels with excellent spatial and temporal resolution in preclinical models. Finally, we describe the different approaches to quantifying lymphatic function that are being developed and discuss some emerging topics for lymphatic imaging in the clinic. Continued advancements in lymphatic imaging technology will be critical for the optimization of diagnostic methods for lymphatic disorders and the evaluation of novel therapies targeting the lymphatic system.

New technologies in breast cancer sentinel lymph node biopsy; from the current gold standard to artificial intelligence

Sentinel lymph node biopsy is an important diagnostic procedure performed in early breast cancer patients with clinically negative axillary lymph nodes. Detection and examination of sentinel lymph nodes determine further therapy decisions, therefore a choice of optimal technique minimising the risk of false-negative results is of great importance. Currently, the gold standard is the dual technique comprising the blue dye and radiotracer, however, this method creates a logistical problem for many medical units. The intrinsic constraints of the existing methods led to the development of a very wide range of alternatives with varying clinical efficiency and feasibility. While each method presents with its own advantages and disadvantages, many techniques have improved enough to become a non-inferior alternative in the sentinel lymph node biopsy. Along with the improvement of the existing technologies, there are evolving trends such as multimodality of the techniques maximising the diagnostic outcome or an emerging use of artificial intelligence (AI) improving the workflow of the procedure. This literature review aims to give an overview of the current status of the standard techniques and emerging cutting-edge technologies in the sentinel lymph node biopsy.

Comparative research on 99mTc-Rituximab and 99mTc-sulfur colloid in sentinel lymph node imaging of breast cancer

Background

^99mTc-Rituximab is a new specific radiopharmaceutical that binds to the CD20 receptor which is highly expressed on the surface of B cells. We conducted a study in which ^99mTc-Rituximab was compared with filtered ^99mTc-sulfur colloid (fTcSC) for sentinel lymph node (SLN) detection in patients with breast cancer.

Method

The study is divided into three parts. 1. Initially, 25 patients were selected for an internal controlled trial to received both ^99mTc-Rituximab and fTcSC, the interval time is separated by ≥2 days. 2. Then, 91 patients were selected for a randomized controlled trial (41 and 50 patients in the ^99mTc-Rituximab and fTcSC groups, respectively). All patients were administered either agent at the 6- and 12-o’ clock positions by subareolar injection technique. SLN mapping was then performed 2 h after injection. 3. Serial dynamic images were further acquired for 2 h in 31 patients (22 and 9 patients from ^99mTc-Rituximab and fTcSC cohorts, respectively).

Results

The identification rate of lymphoscintigraphy and SLNB in all and axilla regions for ^99mTc-Rituximab and ^99mTc-SC were 98.5% vs 98.7, 100% vs 98.4%, respectively. The mean number of SLNs identified by ^99mTc-Rituximab and fTcSC was respectively 2.72 and 3.28, with a significant difference of P = 0.013 (paired sample t-test). The difference exists in the internal mammary and clavicular area, not in the axillary. The mean number of axillary sentinel lymph node biopsy (SLNB) for ^99mTc-Rituximab and fTcSC was 2.95 vs 3.14, respectively, and no significant difference existed. ^99mTc-Rituximab also exhibited a significantly faster injection site clearance rate when compared with fTcSC (0.193 ± 0.057 h^− 1 vs 0.021 ± 0.007 h^− 1, respectively).

Conclusion

No significant difference was observed in identification rate and number of axillary SLN imaging and SLNB, between the two tracers. Compared to fTcSC, ^99mTc-Rituximab based imaging demonstrated a fewer number of secondary lymph nodes and had faster injection site clearance rate.

Trial registration

www.chictr.org.cn, ChiCTR1900024990 (retrospectively registered August 6, 2019).

Development of 99mTc-conjugated JS001 antibody for in vivo mapping of PD-1 distribution in murine

Here we reported the development of a novel immuno-SPECT tracer, namely ^99mTc-JS001, to non-invasively image PD-1 expression in mice. The JS001 antibody was directly labeled by the most widely used SPECT radionuclide ^99mTc with a radiochemical yield of 90%, and the specific activity was ≤74 GBq/mmol. After the radiolabeling, ^99mTc-JS001 exhibited a similar immnuoaffinity to PD-1 in vitro. ^99mTc-conjugated JS001 maintained intact in 5% HSA system for 24 h. S180 sarcoma xenograft-bearing Kunming mice and BGC823 gastric cancer orthotopic tumor model were built. Bio-distribution and/or immuno-SPECT studies with ^99mTc-JS001 showed the antibody maintained in the blood, liver, kidneys and tumors at 1.5 ID%/g, 1.4 ID%/g, 2.0 ID%/g and 0.5 ID%/g, respectively. Also, there was a higher uptake in the BGC823 orthotopic tumor than that in the adjunct stomach. These results demonstrated that ^99mTc-JS001 might have capacity to monitor the PD-1 expression in vivo, which might facilitate the anti-PD-1 antibodies treatment in preclinical models.

A new model to predict risk of nonsentinel lymph node status in Chinese sentinel lymph node-positive patients after neoadjuvant chemotherapy

There is no previous predictive model to assess risk of nonsentinel lymph node metastases (NSLN) in sentinel lymph node (SLN)-positive breast cancer patients after neoadjuvant chemotherapy (NAT). Our goal was to develop a new predictive model for SLN-positive patients after NAT, and validate this new model. A series of 513 patients with metastases in SLN who received NAT were used to evaluate factors affecting NSLN status. Logistic regression analysis was performed to develop a predictive model, which was validated by a subsequent prospective 138 patients. There were 115 (22.4%) patients with metastases in NSLN followed by axillary lymph node dissection (ALND). Multivariate analysis indicated that tumor (T) stage, number of positive SLN,micrometastases, extracapsular extension (ECE), and clinical response of primary tumor after NAT were significant independent predictors for the NSLN metastases. Area under the curve (AUC) of the model was 0.795 (95% CI, 0.734-0.861). When applied to the prospective series, the model accurately predicted the risk of NSLN disease, AUC was 0.772 (95% CI, 0.653-0.845). We present a new predictive model to assess the risk of NSLN status in Chinese SLN-positive breast cancer patients after NAT. The predictive model performed well in prospective validation but needs to be further studied in external center patients before application to clinical use.

99mTc-labeled sodium phytate and stannous chloride injection accurately detects sentinel lymph node in axillary of early stage breast cancer: a randomized, controlled study

Aim

The aim of this study was to assess the sentinel lymph node (SLN) detection rate and accuracy of ^99mTc-labeled sodium phytate and stannous chloride (^99mTc-PHY) injection versus ^99mTc-labeled sulfur colloid (^99mTc-SC) injection in sentinel lymph node biopsy (SLNB) in patients with early stage breast cancer.

Methods

A total of 146 consecutive female patients with early stage breast cancer were recruited in this open-labeled, randomized, controlled study. SLNB was conducted on all patients, and ^99mTc-PHY or ^99mTc-SC was used as the radioactive agent (RA). Axillary lymph node dissections were performed in all patients post SLN dissections.

Results

The detection rate of ^99mTc-PHY group was higher compared with that of ^99mTc-SC group (p=0.023), but no difference in the detection rate by dye alone (p=0.190) or by RAs alone (p=0.615) was found between the two groups, and the number of identified SLNs (p=0.100), number of identified SLNs by dye alone (p=0.161), and number of identified SLNs by RA alone (p=0.242) were similar between the two groups. In addition, the sensitivity, specificity, false-negative rate, false-positive rate, and accuracy rate of SLNB showed no difference between ^99mTc-PHY and ^99mTc-SC groups (sensitivity: p=0.645; specificity: p=0.511; false-negative rate: p=0.645; false-positive rate: p=0.511; accuracy rate: p=0.464).

Conclusion

Our study revealed that ^99mTc-PHY was qualified to be a convincing radiopharmaceutical in SLNB.