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Schmidt M, Hohberg M, Felcht M, Kühn T, Eichbaum M, Krause BJ, Zöphel BK, Kotzerke J. [Nuclear medicine procedure guideline for sentinel lymph node localization]. Nuklearmedizin 2024. [PMID: 38788776 DOI: 10.1055/a-2319-8306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
The authors present a procedure guideline for scintigraphic detection of sentinel lymph nodes in malignant melanoma, in breast cancer, in penile and vulva tumors, in head and neck cancer, and in prostate carcinoma. Important goals of sentinel lymph node scintigraphy comprise reduction of the extent of surgery, lower postoperative morbidity and optimization of histopathological examination focussing on relevant lymph nodes. Sentinel lymph node scintigraphy itself does not diagnose tumorous lymph node involvement and is not indicated when lymph node or distant metastases have been definitely diagnosed before sentinel lymph node scintigraphy. Procedures are compiled with the aim to reliably localise sentinel lymph nodes with a high detection rate typically in early tumour stages. New aspects in this guideline are new radiopharmaceuticals such as tilmanocept and Tc-99m-PSMA and SPECT/CT allowing an easier anatomical orientation. Initial dynamic lymphoscintigraphy in breast cancer is of little significance nowadays. Radiation exposure is low so that pregnancy is not a contraindication for sentinel lymph node scintigraphy. A one-day protocol should preferentially be used. Even with high volumes of scintigraphic sentinel lymph node procedures surgeons, theatre staff and pathologists receive a radiation exposure < 1 mSv/year so that they do not require occupational radiation surveillance. Aspects of quality control were included (scintigraphy, quality control of gamma probe, 6 h SLN course for surgeons, certified breast centers, medical surveillance center).
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Affiliation(s)
- M Schmidt
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Köln
| | - M Hohberg
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Köln
| | - M Felcht
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Mannheim (Vertreter der DDG)
| | - T Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen (Vertreter der DGGG - Mamma-Ca)
| | - M Eichbaum
- Klinik für Gynäkologie und gynäkologische Onkologie, Helios Dr.-Horst-Schmidt-Kliniken Wiesbaden (Vertreter der DGGG - Genitaltumoren)
| | - B J Krause
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Rostock
| | - B K Zöphel
- Klinik für Nuklearmedizin, Klinikum Chemnitz
| | - J Kotzerke
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Dresden
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Lalhmangaihzuala S, Vanlaldinpuia K, Khiangte V, Laldinpuii Z, Liana T, Lalhriatpuia C, Pachuau Z. Therapeutic applications of carbohydrate-based compounds: a sweet solution for medical advancement. Mol Divers 2024:10.1007/s11030-024-10810-2. [PMID: 38554170 DOI: 10.1007/s11030-024-10810-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/10/2024] [Indexed: 04/01/2024]
Abstract
Carbohydrates, one of the most abundant biomolecules found in nature, have been seen traditionally as a dietary component of foods. Recent findings, however, have unveiled their medicinal potential in the form of carbohydrates-derived drugs. Their remarkable structural diversity, high optical purity, bioavailability, low toxicity and the presence of multiple functional groups have positioned them as a valuable scaffold and an exciting frontier in contemporary therapeutics. At present, more than 170 carbohydrates-based therapeutics have been granted approval by varying regulatory agencies such as United States Food and Drug Administration (FDA), Japan Pharmaceuticals and Medical Devices Agency (PMDA), Chinese National Medical Products Administration (NMPA), and the European Medicines Agency (EMA). This article explores an overview of the fascinating potential and impact of carbohydrate-derived compounds as pharmacological agents and drug delivery vehicles.
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Affiliation(s)
- Samson Lalhmangaihzuala
- Department of Chemistry, Pachhunga University College, Mizoram University, Aizawl, Mizoram, 796001, India
- Department of Chemistry, Mizoram University, Tanhril, Aizawl, Mizoram, 796004, India
| | - Khiangte Vanlaldinpuia
- Department of Chemistry, Pachhunga University College, Mizoram University, Aizawl, Mizoram, 796001, India.
| | - Vanlalngaihawma Khiangte
- Department of Chemistry, Pachhunga University College, Mizoram University, Aizawl, Mizoram, 796001, India
- Department of Chemistry, Mizoram University, Tanhril, Aizawl, Mizoram, 796004, India
| | - Zathang Laldinpuii
- Department of Chemistry, Pachhunga University College, Mizoram University, Aizawl, Mizoram, 796001, India
- Department of Chemistry, Mizoram University, Tanhril, Aizawl, Mizoram, 796004, India
| | - Thanhming Liana
- Department of Chemistry, Pachhunga University College, Mizoram University, Aizawl, Mizoram, 796001, India
| | - Chhakchhuak Lalhriatpuia
- Department of Chemistry, Pachhunga University College, Mizoram University, Aizawl, Mizoram, 796001, India
| | - Zodinpuia Pachuau
- Department of Chemistry, Mizoram University, Tanhril, Aizawl, Mizoram, 796004, India
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Guo T, Jang SS, Ogawa R, Davis M, Ashworth E, Barback CV, Hall DJ, Vera DR. Fluorescent Guided Sentinel Lymph Mapping of the Oral Cavity with Fluorescent-Labeled Tilmanocept. Laryngoscope 2024; 134:1299-1307. [PMID: 37668315 PMCID: PMC10912359 DOI: 10.1002/lary.31014] [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: 05/31/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE With the shift toward utilization of sentinel lymph node biopsy (SLNB) in oral cavity cancer, improved techniques for intraoperative sentinel node identification are needed. This study investigates the feasibility of fluorescently labeled tilmanoscept in SLNB in an oral cancer rabbit model. METHODS An animal study was designed using 21 healthy male New Zealand rabbits. Gallium-68-labeled tilmanocept labeled with IRDye800CW was injected submucosally into the buccal mucosa (n = 6) or lateral tongue (n = 7) followed by PET imaging. One hour after injection, SLNB was performed using fluorescence imaging followed by a bilateral neck dissection and sampling of non-nodal surrounding tissue. All tissues were measured for radioactivity and fluorescence. In addition, eight rabbits were injected with delayed SLNB performed 48 h after injection. RESULTS Buccal injections all had ipsilateral SLN drainage and tongue injections exhibited 18.2% contralateral drainage. An average of 1.9 ± 1.0 SLN (range 1-5) were identified. In addition, an average of 16.9 ± 3.3 non-sentinel lymph nodes were removed per animal. SLNs had an average of 0.69 ± 0.60 percent-of-injected dose (%ID) compared with non-sentinel nodes with 0.012 ± 0.025 %ID and surrounding tissue with 0.0067 ± 0.015 %ID. There was 98.0% agreement between sentinel lymph nodes identified using fluorescence compared to radioactivity with Cohen's kappa coefficient of 0.879. In 48-h delayed SLNB, results were consistent with 97.8% agreement with radioactivity and Cohen's Kappa coefficient of 0.884. Fluorescence identified additional lymph nodes that were not identified by radioactivity, and with one false negative. CONCLUSION Fluorescent-labeled Tc-99 m-tilmanocept represents a highly accurate adjunct to enhance SLNB for oral cavity cancer. LEVEL OF EVIDENCE N/A Laryngoscope, 134:1299-1307, 2024.
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Affiliation(s)
- Theresa Guo
- Department of Otolaryngology, Head and Neck Surgery, University of California, San Diego, La Jolla, CA
- Moores Cancer Center, University of California, San Diego, La Jolla, CA
| | - Sophie S. Jang
- Department of Otolaryngology, Head and Neck Surgery, University of California, San Diego, La Jolla, CA
- Moores Cancer Center, University of California, San Diego, La Jolla, CA
| | - Ryotaro Ogawa
- Moores Cancer Center, University of California, San Diego, La Jolla, CA
- Department of Radiology, University of California, San Diego, La Jolla, CA
| | - Morgan Davis
- Department of Otolaryngology, Head and Neck Surgery, University of California, San Diego, La Jolla, CA
- Moores Cancer Center, University of California, San Diego, La Jolla, CA
| | - Edward Ashworth
- Moores Cancer Center, University of California, San Diego, La Jolla, CA
- Department of Radiology, University of California, San Diego, La Jolla, CA
| | - Christopher V. Barback
- Moores Cancer Center, University of California, San Diego, La Jolla, CA
- Department of Radiology, University of California, San Diego, La Jolla, CA
| | - David J. Hall
- Moores Cancer Center, University of California, San Diego, La Jolla, CA
- Department of Radiology, University of California, San Diego, La Jolla, CA
| | - David R. Vera
- Moores Cancer Center, University of California, San Diego, La Jolla, CA
- Department of Radiology, University of California, San Diego, La Jolla, CA
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Andriana P, Makrypidi K, Liljenbäck H, Rajander J, Saraste A, Pirmettis I, Roivainen A, Li XG. Aluminum Fluoride-18 Labeled Mannosylated Dextran: Radiosynthesis and Initial Preclinical Positron Emission Tomography Studies. Mol Imaging Biol 2023; 25:1094-1103. [PMID: 37016195 PMCID: PMC10728250 DOI: 10.1007/s11307-023-01816-7] [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: 12/25/2022] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 04/06/2023]
Abstract
PURPOSE In addition to being expressed on liver sinusoidal endothelial cells, mannose receptors are also found on antigen-presenting cells, including macrophages, which are mainly involved in the inflammation process. Dextran derivatives of various sizes containing cysteine and mannose moieties have previously been labeled with 99mTc and used for single-photon emission computed tomography imaging of sentinel lymph nodes. In this study, we radiolabeled 21.3-kDa D10CM with positron-emitting 18F for initial positron emission tomography (PET) studies in rats. PROCEDURES D10CM was conjugated with 1,4,7-triazacyclononane-1,4,7-triacetic acid (NOTA) chelator and radiolabeled with the aluminum fluoride-18 method. The whole-body distribution kinetics and stability of the intravenously administered tracer were studied in healthy male Sprague-Dawley rats by in vivo PET/CT imaging, ex vivo gamma counting, and high-performance liquid chromatography analysis. RESULTS Al[18F]F-NOTA-D10CM was obtained with a radiochemical purity of >99% and molar activity of 9.9 GBq/μmol. At 60 minutes after injection, an average of 84% of the intact tracer was found in the blood, indicating excellent in vivo stability. The highest radioactivity concentration was seen in the liver, spleen, and bone marrow, in which mannose receptors are highly expressed under physiological conditions. The uptake specificity was confirmed with in vivo blocking experiments. CONCLUSIONS Our results imply that Al[18F]F-NOTA-D10CM is a suitable tracer for PET imaging. Further studies in disease models with mannose receptor CD206-positive macrophages are warranted to clarify the tracer's potential for imaging of inflammation.
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Affiliation(s)
- Putri Andriana
- Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, FI-20520, Turku, Finland
| | - Konstantina Makrypidi
- Institute of Nuclear and Radiological Science and Technology, Energy and Safety, NCSR "Demokritos", 15310, Athens, Greece
| | - Heidi Liljenbäck
- Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, FI-20520, Turku, Finland
- Turku Center for Disease Modeling, University of Turku, FI-20520, Turku, Finland
| | - Johan Rajander
- Accelerator Laboratory, Åbo Akademi University, FI-20520, Turku, Finland
| | - Antti Saraste
- Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, FI-20520, Turku, Finland
- Turku PET Centre, Turku University Hospital, FI-20520, Turku, Finland
- Heart Center, Turku University Hospital and University of Turku, FI-20520, Turku, Finland
| | - Ioannis Pirmettis
- Institute of Nuclear and Radiological Science and Technology, Energy and Safety, NCSR "Demokritos", 15310, Athens, Greece
| | - Anne Roivainen
- Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, FI-20520, Turku, Finland.
- Turku Center for Disease Modeling, University of Turku, FI-20520, Turku, Finland.
- Turku PET Centre, Turku University Hospital, FI-20520, Turku, Finland.
- InFLAMES Research Flagship Center, University of Turku, FI-20520, Turku, Finland.
| | - Xiang-Guo Li
- Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, FI-20520, Turku, Finland.
- InFLAMES Research Flagship Center, University of Turku, FI-20520, Turku, Finland.
- Department of Chemistry, University of Turku, FI-20014, Turku, Finland.
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Rovera G, de Koster EJ, Rufini V, Zollino M, Zagaria L, Giammarile F, Vidal-Sicart S, Valdés Olmos R, Collarino A. 99mTc-Tilmanocept performance for sentinel node mapping in breast cancer, melanoma, and head and neck cancer: a systematic review and meta-analysis from a European expert panel. Eur J Nucl Med Mol Imaging 2023; 50:3375-3389. [PMID: 37310426 DOI: 10.1007/s00259-023-06290-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/30/2023] [Indexed: 06/14/2023]
Abstract
PURPOSE Although multiple radiopharmaceuticals are currently available for sentinel node (SN) biopsy, 99mTc-tilmanocept is of particular interest due to its low molecular weight and specific binding capability for the mannose receptors of lymphatic reticuloendothelial cells. In the current systematic review and meta-analysis, we aimed to provide an update from a European expert panel on the performance of 99mTc-tilmanocept for SN biopsy. METHODS A systematic literature search of the PubMed/Medline and Embase databases was performed to identify studies on the use of 99mTc-tilmanocept for SN identification in oncological patients. The articles' methodological quality was assessed before inclusion. The pooled estimates of the pre-/intraoperative detection rates (DR; proportion of patients with ≥ 1 SN identified) and/or pN + sensitivity (SN + /pN + patients ratio), with 95% confidence intervals (CIs), were calculated for breast cancer, melanoma, and head and neck cancer. RESULTS Twenty-four articles were included in the systematic review, and twenty-one provided data for the meta-analysis. According to data availability, the 99mTc-tilmanocept-estimated pooled preoperative and intraoperative DRs were 0.94 (95%CI, 0.88-1.01) and 0.99 (0.98-1.00) for breast cancer, 0.98 (0.96-0.99) and 1.00 (0.99-1.00) for melanoma, and 0.97 (0.93-1.02) and 0.99 (0.96-1.01) for head and neck carcinoma. Finally, the pooled sensitivity for nodal metastasis in melanoma was 0.97 (95% CI, 0.92-1.03). CONCLUSION 99mTc-tilmanocept is a promising radiotracer for SN mapping in patients with breast cancer, melanoma, or head and neck cancer. We strongly believe that multicenter trials are still needed to assess if 99mTc-tilmanocept is superior to other radiotracers used in clinical routine.
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Affiliation(s)
- Guido Rovera
- Nuclear Medicine, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Elizabeth J de Koster
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Vittoria Rufini
- Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
- Section of Nuclear Medicine, University Department of Radiological Sciences and Hematology, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Mariella Zollino
- Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Zagaria
- Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Giammarile
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Sergi Vidal-Sicart
- Nuclear Medicine Department, Hospital Clinic Barcelona, Universitat de Barcelona, Institut d'investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Renato Valdés Olmos
- Interventional Molecular Imaging & Nuclear Medicine Section, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Angela Collarino
- Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Coxon AT, Desai R, Patel PR, Vellimana AK, Willie JT, Dowling JL, Leuthardt EC, Kim AH, Johanns TM, Siegel BA, Dunn GP. A pilot study of lymphoscintigraphy with tracer injection into the human brain. J Cereb Blood Flow Metab 2023; 43:1382-1389. [PMID: 36994857 PMCID: PMC10369147 DOI: 10.1177/0271678x231160891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/08/2023] [Accepted: 01/14/2023] [Indexed: 03/31/2023]
Abstract
Many groups have reported lymphatic and glymphatic structures in animal and human brains, but tracer injection into the human brain to demonstrate real-time lymphatic drainage and mapping has not been described. We enrolled patients undergoing standard-of-care resection or stereotactic biopsy for suspected intracranial tumors. Patients received peritumoral injections of 99mTc-tilmanocept followed by planar or tomographic imaging. Fourteen patients with suspected brain tumors were enrolled. One was excluded from analysis because of tracer leakage during injection. There was no drainage of 99mTc-tilmanocept to regional lymph nodes in any of the patients. On average, after correcting for radioactive decay, 70.7% (95% CI: 59.9%, 81.6%) of the tracer in the injection site and 78.1% (95% CI: 71.1%, 85.1%) in the whole-head on the day of surgery remained the morning after, with variable radioactivity in the subarachnoid space. The retained fraction was much greater than expected based on the clearance rate from non-brain injection sites. In this pilot study, the lymphatic tracer 99mTc-tilmanocept was injected into the brain parenchyma, and there was no drainage outside the brain to the cervical lymph nodes. Our work demonstrates an inefficiency of drainage from peritumoral brain parenchyma and highlights a therapeutic opportunity to improve immunosurveillance of the brain.
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Affiliation(s)
- Andrew T Coxon
- Washington University School of Medicine, St. Louis, MO, USA
| | - Rupen Desai
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Pujan R Patel
- Washington University School of Medicine, St. Louis, MO, USA
| | - Ananth K Vellimana
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Jon T Willie
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Joshua L Dowling
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Eric C Leuthardt
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Albert H Kim
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Tanner M Johanns
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Barry A Siegel
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Gavin P Dunn
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
- Current address: Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
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Cuccurullo V, Rapa M, Catalfamo B, Cascini GL. Role of Nuclear Sentinel Lymph Node Mapping Compared to New Alternative Imaging Methods. J Pers Med 2023; 13:1219. [PMID: 37623469 PMCID: PMC10455335 DOI: 10.3390/jpm13081219] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/22/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
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.
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Affiliation(s)
- Vincenzo Cuccurullo
- Department of Precision Medicine, Università della Campania “Luigi Vanvitelli”, 80138 Napoli, Italy
| | - Marco Rapa
- Department of Precision Medicine, Università della Campania “Luigi Vanvitelli”, 80138 Napoli, Italy
| | - Barbara Catalfamo
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy (G.L.C.)
| | - Giuseppe Lucio Cascini
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy (G.L.C.)
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Seo K, Zhang Y, Toyota T, Hayashi H, Hirata S, Yamaguchi T, Yoshida K. Release of liposomally formulated near-infrared fluorescent probes included in giant cluster vesicles by ultrasound irradiation. ULTRASONICS 2023; 134:107102. [PMID: 37454454 DOI: 10.1016/j.ultras.2023.107102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
Detection of tumors and regional lymph nodes during surgery has been proposed in the diagnosis of lymphatic metastasis and the surgical treatment of malignant diseases. Giant cluster vesicles (GCVs), including liposomally formulated indocyanine green (LP-ICG) derivatives, are a possible candidate for agents to realize the two contradictory properties, i.e., retention in tissue for lesion-marking and trace for sentinel lymph nodes (SLNs) identification. We attempted to release the LP-ICG derivatives from GCVs using ultrasound contrast agents (UCAs) under ultrasound irradiation. An absorption spectrophotometer quantitatively evaluated the amounts of released LP-ICG derivatives. As a result, we demonstrated that it depended on conditions for sound pressure, burst length, and number density of UCAs, and had a sound pressure threshold independent of burst length and number density of UCAs. The results will aid to determine appropriate conditions to maximize the released amount of LP-ICG derivatives while keeping safety.
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Affiliation(s)
- Kota Seo
- Graduate School of Science and Engineering, Chiba University, 1-33 Yayoi-cho, Inage-ku, Chiba 263-8522, Japan
| | - Yiting Zhang
- Department of Chemistry, College of Science, Rikkyo University, 3-34-1 Nishi-Ikebukuro, Toshima-ku, Tokyo 171-8501, Japan
| | - Taro Toyota
- Graduate School of Arts and Sciences, The University of Tokyo, 3-8-1 Komaba, Meguro-ku, Tokyo 153-8902, Japan
| | - Hideki Hayashi
- Center for Frontier Medical Engineering, Chiba University, 1-33 Yayoi-cho, Inage-ku, Chiba 263-8522, Japan
| | - Shinnosuke Hirata
- Center for Frontier Medical Engineering, Chiba University, 1-33 Yayoi-cho, Inage-ku, Chiba 263-8522, Japan
| | - Tadashi Yamaguchi
- Center for Frontier Medical Engineering, Chiba University, 1-33 Yayoi-cho, Inage-ku, Chiba 263-8522, Japan
| | - Kenji Yoshida
- Center for Frontier Medical Engineering, Chiba University, 1-33 Yayoi-cho, Inage-ku, Chiba 263-8522, Japan.
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Li N, Zhou X, Zhu H, Wang F, Guo R, Zhang Y, Song Y, Zhai S, Xie Q, Liu J, Li Z, Yang Z. 99mTc-Rituximab sentinel lymph node mapping and biopsy, the effective technique avoids axillary dissection and predicts prognosis in 533 cutaneous melanoma. Ann Nucl Med 2023; 37:189-197. [PMID: 36586034 DOI: 10.1007/s12149-022-01815-8] [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: 10/17/2022] [Accepted: 12/13/2022] [Indexed: 01/01/2023]
Abstract
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.
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Affiliation(s)
- Nan Li
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, 100142, China.
| | - Xin Zhou
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Hua Zhu
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Fei Wang
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Rui Guo
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Yan Zhang
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Yufei Song
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Shizhen Zhai
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Qing Xie
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Jiayong Liu
- Department of Bone and Soft Tissue Tumor, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Zhongwu Li
- Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Zhi Yang
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, 100142, China.
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Suvarna V, Sawant N, Desai N. A Review on Recent Advances in Mannose-Functionalized Targeted Nanocarrier Delivery Systems in Cancer and Infective Therapeutics. Crit Rev Ther Drug Carrier Syst 2023; 40:43-82. [PMID: 36734913 DOI: 10.1615/critrevtherdrugcarriersyst.2022041853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Unmodified nanocarriers used in the chemotherapy of cancers and various infectious diseases exhibit prolonged blood circulation time, prevent enzymatic degradation and increase chemical stability of encapsulated therapeutics. However, off-target effect and lack of specificity associated with unmodified nanoparticles (NPs) limit their applications in the health care system. Mannose (Man) receptors with significant overexpression on antigen-presenting cells and macrophages are among the most admired targets for cancer and anti-infective therapeutics. Therefore, development of Man functionalized nanocarriers targeting Man receptors, for target specific drug delivery in the chemotherapy have been extensively studied. Present review expounds diverse Man-conjugated NPs with their potential for targeted drug delivery, improved biodistribution profiles and localization. Additionally, the review gives detailed account of the interactions of mannosylated NPs with various biological systems and their characterization not discussed in earlier published reports is discussed.
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Affiliation(s)
- Vasanti Suvarna
- Department of Pharmaceutical Chemistry & Quality Assurance, SVKM's Dr. Bhanuben Nanavati College of Pharmacy, Vile Parle (W), Mumbai 400056, Maharashtra, India
| | - Niserga Sawant
- C.U. Shah College of Pharmacy, SNDT Women's University, Santacruz (W), Mumbai 400049, Maharashtra, India
| | - Namita Desai
- Department of Pharmaceutics, C. U. Shah College of Pharmacy, SNDT Women's University, Santacruz (W), Mumbai - 400049, Maharashtra, India
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11
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Balkin DM, Tranah GJ, Wang F, O’Donoghue C, Morell EA, Porubsky C, Nosrati M, Vaquero EM, Kim H, Carr MJ, Montilla-Soler JL, Wu MC, Torre DM, Kashani-Sabet M, Zager JS, Leong SP. Lymphoscintigraphy Using Tilmanocept Detects Multiple Sentinel Lymph Nodes in Melanoma Patients. Cancer Control 2023; 30:10732748231153775. [PMID: 36705261 PMCID: PMC9893075 DOI: 10.1177/10732748231153775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Technetium-99m-labeled Tilmanocept, a multivalent mannose, is readily internalized by the CD206 surface receptor on macrophages and dendritic cells which are abundantly present in lymph nodes. We want to examine the drainage patterns of Technetium-99m-labeled Tilmanocept to sentinel lymph nodes (SLNs) in melanoma patients following the 10% rule. METHODS Multi-center retrospective review of patients with cutaneous melanoma undergoing SLN biopsy using Technetium-99m-labeled Tilmanocept between 2008 and 2014 was conducted. Statistical methods were used for data analyses. RESULTS Of the 564 patients (mean age of 60.3 and 62% male) with preoperative lymphoscintigraphy showing at least one SLN, several primary tumor sites were included: 27% head/neck, 33% trunk, 21% upper extremity and 19% lower extremity. For the head/neck primary site, 36.5% of patients had multiple draining basins; for the trunk site, 36.4% of patients; for the upper extremity site, 13% of patients; and for the lower extremity, 27.4% of patients. A median of 3 (range 1-18) SLNs were identified and resected. Overall, 78% of patients had >1 SLN identified by Technetium-99m-labeled Tilmanocept. In a multivariate model, patients with >1 SLN were significantly associated with age, Breslow depth, tumor location and higher AJCC tumor stage. A total of 17.7% of patients (100/564) had a positive SLN identified. A total of 145 positive SLNs were identified out of 1,812 SLNs with a positive SLN rate of 8%. Positive SLN status was significantly associated with younger age, greater Breslow depth, mitosis rate, higher AJCC tumor stage, presence of ulceration and angiolymphatic invasion. CONCLUSIONS Using the 10% rule, Technetium-99m-labeled Tilmanocept detects multiple SLNs in most melanoma patients.
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Affiliation(s)
- Daniel M. Balkin
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregory J. Tranah
- Center for Melanoma Research and Treatment, California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Frederick Wang
- Kaiser Permanente Woodland Hills Medical Center, Woodland Hills, CA, USA
| | | | - Emily A. Morell
- Department of Pediatrics, Divisions of Pediatric Critical Care and Pediatric Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Caitlin Porubsky
- Philadelphia College of Osteopathic Medicine/North Fulton Hospital Medical Campus, Roswell, GA, USA
| | - Mehdi Nosrati
- Center for Melanoma Research and Treatment, California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Edith M. Vaquero
- Center for Melanoma Research and Treatment, California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - HanKyul Kim
- Center for Melanoma Research and Treatment, California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Michael J. Carr
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Jaime L. Montilla-Soler
- Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Max C. Wu
- Department of Nuclear Medicine, California Pacific Medical Center, San Francisco, CA, USA
| | - Donald M. Torre
- Department of Nuclear Medicine, California Pacific Medical Center, San Francisco, CA, USA
| | - Mohammed Kashani-Sabet
- Center for Melanoma Research and Treatment, California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Jonathan S. Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Stanley P. Leong
- Center for Melanoma Research and Treatment, California Pacific Medical Center Research Institute, San Francisco, CA, USA
- University of California School of Medicine San Francisco, San Francisco, CA, USA
- Stanley P. Leong, MD, MS, FACS, California Pacific Medical Center, Center for Melanoma Research and Treatment Chief of Cutaneous Oncology and Associate Director of the Melanoma Program 2340 Clay Street Floor 2, San Francisco, CA 94115, USA. ;
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12
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Technetium Tc 99m tilmanocept fails to detect sentinel lymph nodes in endometrial cancer. Gynecol Oncol Rep 2022; 43:101054. [PMID: 35958955 PMCID: PMC9361318 DOI: 10.1016/j.gore.2022.101054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 11/23/2022] Open
Abstract
Indocyanine green (ICG) is effective for sentinel lymph node detection (SLN) in endometrial cancer. Technetium Tc 99m tilmanocept is FDA-approved for SLN detection in breast cancer, melanoma, and head and neck cancers. We aimed to determine the SLN detection rate in endometrial cancer with concurrent technetium Tc 99m tilmanocept and ICG use. Technetium Tc 99m tilmanocept failed to detect sentinel lymph nodes in endometrial cancer patients in our prospective study. ICG alone remains a standard SLN detection technique in endometrial cancer, while limiting burdens from a dual agent.
Background Technetium Tc 99m tilmanocept is a synthetic radiotracer specifically designed for sentinel lymph node (SLN) mapping that has been FDA-approved in breast cancer, melanoma, and head and neck cancer. No published studies exist for the use of this radiotracer in endometrial cancer. Objective The primary objective was to determine the detection rate of bilateral SLNs in endometrial cancer with the concurrent use of technetium Tc 99m tilmanocept and ICG. Methods An open-label, single cohort, prospective feasibility study was conducted with participants receiving preoperative cervical injections of technetium Tc 99m tilmanocept followed by subsequent imaging and SPECT/CT. Intraoperative ICG injections were administered for all patients with near-infrared imaging used to visualize lymphatic vessels and nodes. A laparoscopic gamma counter was used to detect radioactive SLN intraoperatively. Results All six evaluated patients had FIGO grade 1 or 2 endometrioid histology. Stage IA/IB were in 33% and 66% of patients, respectively. Tilmanocept did not map any SLN in the first six patients but instead showed retention of the tracer in the cervical stroma, leading to study discontinuation for futility. ICG mapped bilateral SLN in all patients with the most common location being the external iliac region, followed by the obturator and common iliac areas. All patients had CD206 positive staining throughout the full wall thickness of ectocervix, transformation zone, endocervix, and lymphatic vessels. No patients experienced adverse events. Conclusion Technetium Tc 99m tilmanocept did not detect SLN in early stage endometrial cancers and is unlikely to improve bilateral detection rate compared to ICG alone. ICG remains a standard technique for SLN detection in low stage, low grade endometrial cancer.
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Cao X, Du X, Jiao H, An Q, Chen R, Fang P, Wang J, Yu B. Carbohydrate-based drugs launched during 2000 -2021. Acta Pharm Sin B 2022; 12:3783-3821. [PMID: 36213536 PMCID: PMC9532563 DOI: 10.1016/j.apsb.2022.05.020] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/18/2022] [Accepted: 05/12/2022] [Indexed: 01/09/2023] Open
Abstract
Carbohydrates are fundamental molecules involved in nearly all aspects of lives, such as being involved in formating the genetic and energy materials, supporting the structure of organisms, constituting invasion and host defense systems, and forming antibiotics secondary metabolites. The naturally occurring carbohydrates and their derivatives have been extensively studied as therapeutic agents for the treatment of various diseases. During 2000 to 2021, totally 54 carbohydrate-based drugs which contain carbohydrate moities as the major structural units have been approved as drugs or diagnostic agents. Here we provide a comprehensive review on the chemical structures, activities, and clinical trial results of these carbohydrate-based drugs, which are categorized by their indications into antiviral drugs, antibacterial/antiparasitic drugs, anticancer drugs, antidiabetics drugs, cardiovascular drugs, nervous system drugs, and other agents.
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Affiliation(s)
- Xin Cao
- Zhongshan Hospital Institute of Clinical Science, Fudan University Shanghai Medical College, Shanghai 200032, China
| | - Xiaojing Du
- Zhongshan Hospital Institute of Clinical Science, Fudan University Shanghai Medical College, Shanghai 200032, China
| | - Heng Jiao
- Zhongshan Hospital Institute of Clinical Science, Fudan University Shanghai Medical College, Shanghai 200032, China
| | - Quanlin An
- Zhongshan Hospital Institute of Clinical Science, Fudan University Shanghai Medical College, Shanghai 200032, China
| | - Ruoxue Chen
- Zhongshan Hospital Institute of Clinical Science, Fudan University Shanghai Medical College, Shanghai 200032, China
| | - Pengfei Fang
- State Key Laboratory of Bio-organic and Natural Products Chemistry, Center for Excellence in Molecular Synthesis, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, Shanghai 200032, China
| | - Jing Wang
- State Key Laboratory of Bio-organic and Natural Products Chemistry, Center for Excellence in Molecular Synthesis, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, Shanghai 200032, China
| | - Biao Yu
- State Key Laboratory of Bio-organic and Natural Products Chemistry, Center for Excellence in Molecular Synthesis, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, Shanghai 200032, China
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A Prospective Double-Blinded Randomized Controlled Trial Comparing the Intraoperative Injection of Technetium Tc 99m Tilmanocept with Technetium Tc 99m Sulfur Colloid in Breast Cancer Lymphatic Mapping. Breast J 2022. [DOI: 10.1155/2022/9421489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction. Technetium-labeled sulfur colloid (TSC) is a radiolabeled mapping agent commonly used for sentinel lymph node biopsy (SLNBx). Tilmanocept, a CD206 receptor-targeted mapping agent, has gained recent popularity due to potential advantages of rapid and quick uptake to the SLNs. The objectives of this study were to assess (1) the difference in the number of SLNs harvested using tilmanocept versus TSC and (2) the difference in time to transcutaneous localization when using an intraoperative injection approach. Methods. Patients undergoing breast conservation and SLNBx were consented and randomized to receive either 0.5 mCi of filtered TSC or 0.5 mCi of tilmanocept injected intradermally immediately after induction of anesthesia. Axillary transcutaneous gamma detector probe counts were taken at 1-minute intervals until a hot spot was identified. SLNs were then identified and excised. Additional nodes were excised if their counts per second (cps) were greater than 10% of the cps of the hottest SLN. The number of SLNs was based on both number of nodes collected intraoperatively and the number recorded in the final pathology report. Results. The study population consisted of 86 patients, 48 randomized to tilmanocept and 38 to TSC. There were no significant differences in patient or tumor characteristics between the two groups. Localization rates were 100% for both cohorts. The mean number of SLNs identified and removed was not significantly different (
, intraoperatively;
, pathology reported). Time to transcutaneous localization was 3.3 ± 2.0 minutes for tilmanocept and 3.9 ± 2.3 minutes for TSC (
). The average cps for the hottest node was 2,180.0 ± 2,460.5 in the tilmanocept group compared to 2,679.3 ± 2,687.5 in the TSC group (
). Conclusion. There was no significant difference in the number of SLNs harvested or in the time to transcutaneous localization when using tilmanocept versus TSC as the radiolabeled mapping agents for intraoperative injection and mapping. Either agent can be used without any significant difference in performance.
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Liu J, Tan Z, Xue R, Fan Z, Bai C, Li S, Gao T, Zhang L, Fang Z, Si L. The efficacy of 99mTc-rituximab as a tracer for sentinel lymph node biopsy in cutaneous melanoma patients. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:95. [PMID: 35282108 PMCID: PMC8848438 DOI: 10.21037/atm-21-6890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/20/2022] [Indexed: 12/03/2022]
Abstract
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.
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Affiliation(s)
- Jiayong Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Bone and Soft Tissue Tumor, Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhichao Tan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Bone and Soft Tissue Tumor, Peking University Cancer Hospital and Institute, Beijing, China
| | - Ruifeng Xue
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Bone and Soft Tissue Tumor, Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhengfu Fan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Bone and Soft Tissue Tumor, Peking University Cancer Hospital and Institute, Beijing, China
| | - Chujie Bai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Bone and Soft Tissue Tumor, Peking University Cancer Hospital and Institute, Beijing, China
| | - Shu Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Bone and Soft Tissue Tumor, Peking University Cancer Hospital and Institute, Beijing, China
| | - Tian Gao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Bone and Soft Tissue Tumor, Peking University Cancer Hospital and Institute, Beijing, China
| | - Lu Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Bone and Soft Tissue Tumor, Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhiwei Fang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Bone and Soft Tissue Tumor, Peking University Cancer Hospital and Institute, Beijing, China
| | - Lu Si
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
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Detection of melanoma, breast cancer and head and neck squamous cell cancer sentinel lymph nodes by Tc-99m Tilmanocept (Lymphoseek®). Clin Exp Metastasis 2021; 39:39-50. [PMID: 34962630 PMCID: PMC8967737 DOI: 10.1007/s10585-021-10137-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023]
Abstract
Technetium-99m-labeled Tilmanocept or Lymphoseek® (Cardinal Health, Dublin, Ohio) is a soluble, synthetic molecule with a small diameter (7 nm), which is comprised of technetium-99m chelated to a dextran backbone containing multiple units of mannose ligands with a high affinity for CD206, a receptor located on the surface of macrophages and dendritic cells that are found in high concentration in lymph nodes. It enables quick transit from the injection site and rapid lymph node accumulation. The binding of mannose ligand and CD206 results in the internalization of the ligand and receptor into the cell. Once the Technetium-99m-labeled Tilmanocept (Lymphoseek®) reaches the lymph node, it is readily internalized by the macrophages and dendritic cells within the draining lymph nodes. Technetium-99m-labeled Tilmanocept (Lymphoseek®) has been extensively studied as a radioisotope for detection of sentinel lymph nodes in melanoma, breast cancer and head and neck squamous cell carcinoma in clinical trials. Based on its safety and ability to detect sentinel lymph nodes satisfactorily, it has been approved by the FDA to use as a radioisotope for preoperative lymphoscintigraphy for identification of sentinel lymph nodes in these types of cancer. Further, the FDA has expanded approval of Technetium-99m-labeled for sentinel lymph node mapping of all solid tumors as well as in pediatric patients.
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Vidal-Sicart S, Rioja ME, Prieto A, Goñi E, Gómez I, Albala MD, Lumbreras L, León LF, Gómez JR, Campos F. Sentinel Lymph Node Biopsy in Breast Cancer with 99mTc-Tilmanocept: A Multicenter Study on Real-Life Use of a Novel Tracer. J Nucl Med 2021; 62:620-627. [PMID: 33037087 DOI: 10.2967/jnumed.120.252064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 09/15/2020] [Indexed: 11/16/2022] Open
Abstract
99mTc-tilmanocept is a novel radiopharmaceutical for sentinel lymph node (SLN) biopsy in breast cancer. Our aim was to describe results with 99mTc-tilmanocept in a heterogeneous group of breast cancer patients scheduled for SLN biopsy. Methods: Radiotracer preparation followed the manufacturer's indications. Local protocols for SLN detection within 9 participant centers were not changed for the entire duration of the study. In total, 344 patients with T1-T4, N0-N2 breast cancer (352 lesions) were included. Superficial (intradermal or periareolar) or deep (peritumoral or intratumoral) injections were performed. The doses were adjusted depending on the scheduled time for surgery. Results: Lymphoscintigraphy was able to depict at least 1 SLN in 339 of 352 breast lesions (96.3%), and the intraoperative SLN detection rate reached 97.2%. On univariable analysis, SLN detection rates did not differ by age, clinical T or N stage, tumor location, histologic subtype, or prior neoadjuvant therapy. Lymphoscintigraphy showed higher SLN detection in patients with a normal weight (body mass index < 25) than in those who were overweight or obese (body mass index ≥ 25), at 99.2% versus 94.6%, respectively (P = 0.031). The proportion of patients with preoperative lymphoscintigraphic detection or excised SLNs was higher with superficial than deep injections. Reinjected cases were significantly lower when superficial injection was chosen first (P < 0.001). Injection site and the tumor markers human epidermal growth factor receptor 2 and estrogen receptor had an impact on preoperative SLN visualization and intraoperative localization. In 80 cases, SLN biopsy resulted in a positive lymph node. During a mean follow-up of 19 mo, no axillary recurrences were observed. Conclusion: Whatever the protocol, 99mTc-tilmanocept showed good results in a heterogeneous breast cancer population, although the best results were achieved when a superficial injection was chosen.
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Affiliation(s)
- Sergi Vidal-Sicart
- Nuclear Medicine Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - María Eugenia Rioja
- Nuclear Medicine Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Andrea Prieto
- Nuclear Medicine Department, Hospital Puerta de Hierro, Madrid, Spain
| | - Elena Goñi
- Nuclear Medicine Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Isabel Gómez
- Nuclear Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Luis Lumbreras
- Nuclear Medicine Department, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - José Ramón Gómez
- Nuclear Medicine Department, Hospital Torrecárdenas, Almería, Spain
| | - Francisco Campos
- Nuclear Medicine Department, Hospital Clínic Barcelona, Barcelona, Spain
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Würnschimmel C, Wenzel M, Maurer T, Valdés Olmos RA, Vidal-Sicart S. Contemporary update of SPECT tracers and novelties in radioguided surgery: a perspective based on urology. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2021; 65:215-228. [PMID: 33829716 DOI: 10.23736/s1824-4785.21.03345-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Recent technical advances and implementation of novel radiotracers have further increased the potential of radioguided surgery for a broad variety of malignancies. Indeed, the possibilities for future applications of novel radiotracers in diverse oncological strategies has become more promising than ever. This literature review aims to provide a contemporary update on a selected group of radiotracers and evaluates the usability of radioguided surgery and sentinel node procedures, focusing on most promising advances. For example, the impact of targeted radiotracers on prostate specific membrane antigen (PSMA), CD206 receptor-targeted agents (99mTc-tilmanocept), and hybrid tracers adding fluorescence to radioguidance (ICG-99mTc-nanocolloid) as well as targeting hypoxia-induced carbonic anhydrase IX (CAIX) will be covered. Furthermore, future outlooks on the implementation of gold nanoparticles (AuNP's), but also technical advances in improved radiotracer detection by hybrid gamma devices will be discussed.
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Affiliation(s)
- Christoph Würnschimmel
- Martini-Klinik Prostate Cancer Center, University Hospital of Hamburg-Eppendorf, Hamburg, Germany -
| | - Mike Wenzel
- Department of Urology, University Hospital of Frankfurt, Frankfurt, Germany
| | - Tobias Maurer
- Martini-Klinik Prostate Cancer Center, University Hospital of Hamburg-Eppendorf, Hamburg, Germany.,Department of Urology, University Hospital of Hamburg-Eppendorf, Hamburg, Germany
| | - Renato A Valdés Olmos
- Section of Nuclear Medicine, Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, the Netherlands
| | - Sergi Vidal-Sicart
- Department of Nuclear Medicine, Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Manca G, Garau LM, Mazzarri S, Mazzuca L, Muccioli S, Ghilli M, Naccarato G, Colletti PM, Rubello D, Roncella M, Volterrani D, Desideri I. Novel Experience in Hybrid Tracers: Clinical Evaluation of Feasibility and Efficacy in Using ICG-99mTc Nanotop for Sentinel Node Procedure in Breast Cancer Patients. Clin Nucl Med 2021; 46:e181-e187. [PMID: 33323744 DOI: 10.1097/rlu.0000000000003478] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The clinical introduction of a radioactive and fluorescent hybrid tracer allowed for preoperative lymphatic mapping and intraoperative real-time fluorescence tracing of the sentinel lymph node (SLN) by a single injection. The aim of this feasibility study is to evaluate the first-in-human use of the hybrid tracer by combining indocyanine green (ICG) and radiocolloid based on Nanotop compound (99mTc Nanotop) for SLN biopsy (SLNB) in breast cancer patients. METHODS The day before surgery, ICG-99mTc Nanotop was injected periareolarly in breast cancer patients scheduled for SLNB. Planar lymphoscintigraphic (PL) and SPECT/CT images were then acquired. An intraoperative optonuclear probe was used to detect SLN gamma and fluorescent signals. The harvested SLNs were examined by hematoxylin-eosin staining, and patients were clinically evaluated 1 month after surgery. RESULTS Twenty-one consecutive patients were enrolled. The PL and SPECT/CT techniques identified at least 1 SLN in all patients for a preoperative sentinel detection rate of 100%. SPECT/CT revealed 3 additional lymph nodes in the same nodal basin, which had not been visualized on conventional PL (κ = 0.747; P < 0.005). All 30 preoperative SLNs were localized and excised up to 16 hours after injection. The counts measured via gamma tracing showed a very strong correlation with those measured via near-infrared fluorescent tracing (P < 0.005, r = 0.964). No adverse reactions were observed. CONCLUSIONS The SLNB technique used with the ICG-99mTc Nanotop tracer resulted to be feasible, reliable, and safe. This hybrid compound allowed us to obtain excellent performance in terms of both preoperative lymphatic mapping and intraoperative SLN detection in breast cancer patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Patrick M Colletti
- Division of Nuclear Medicine, Department of Radiology, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA
| | - Domenico Rubello
- Nuclear Medicine Department, Santa Maria della Misericordia Hospital, Rovigo, Italy
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20
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Toribio RE, Young N, Schlesinger LS, Cope FO, Ralph DA, Jarjour W, Rosol TJ. Cy3-tilmanocept labeling of macrophages in joints of mice with antibody-induced arthritis and synovium of human patients with rheumatoid arthritis. J Orthop Res 2021; 39:821-830. [PMID: 33107629 DOI: 10.1002/jor.24900] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 10/10/2020] [Accepted: 10/21/2020] [Indexed: 02/04/2023]
Abstract
γ-Tilmanocept (99m Tc-tilmanocept) is a receptor-directed, radiolabeled tracer that is FDA-approved for guiding sentinel lymph node biopsy. Tilmanocept binds the C-type lectin mannose receptor (MR, CD206) on macrophages. In this study, nonradioactive, fluorescently-labeled Cy3-tilmanocept was used to detect CD206+ mononuclear cells in the cartilage of mice with antibody-induced arthritis and in the synovial fluid and tissue of human subjects with rheumatoid arthritis (RA) for comparison with osteoarthritis (OA), and healthy volunteer (HV) controls. Murine arthritis was induced by injection of monoclonal anti-cartilage antibody followed by injection of Escherichia coli lipopolysaccharide. Post-arthritis development (7-11 days), the mice were injected intravenously with Cy3-tilmanocept followed by in vivo and ex vivo epifluorescence imaging. Two-photon imaging, immunofluorescence, and immunohistochemistry were used to identify articular and synovial macrophages (CD206, F4/80, and Cy3-tilmanocept binding) in murine tissues. Cy3-tilmanocept epifluorescence was present in arthritic knees and elbows of murine tissues; no radiographic changes were noted in the skeletons. However, inflammatory arthritic changes were apparent by histopathology and immunohistochemistry (F4/80), immunofluorescence (CD206) and Cy3-tilmanocept binding. In human RA synovial fluid, Cy3-tilmanocept staining correlated with CD206+ /CD16+ cells; negligible labeling was observed in OA samples. Cy3-tilmanocept colocalized with CD206 and staining was significantly higher in RA synovial tissue compared to OA or HV. Our results demonstrate that imaging with Cy3-tilmanocept can detect in vivo inflammatory, CD206+ macrophages in an early arthritis animal model and in human RA patients. These data establish a novel tool for preclinical research of early arthritis and have implications for early RA detection and monitoring of therapeutic efficacy in humans.
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Affiliation(s)
- Ramiro E Toribio
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Nicholas Young
- Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Larry S Schlesinger
- Department of Microbial Infection & Immunity, The Ohio State University, Columbus, Ohio, USA.,Texas Biomedical Research Institute, San Antonio, Texas, USA
| | - Fred O Cope
- Navidea Biopharmaceuticals, Inc., Dublin, Ohio, USA.,Physis International LLC, Westerville, Ohio, USA
| | | | - Wael Jarjour
- Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Thomas J Rosol
- Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, USA
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21
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Abstract
Well executed multicenter clinical trials often provide significant evidence and support for, or against, foundational aspects of clinical procedures perceived to improve clinical management of a medical condition. In this review, discussed are reports of multicenter clinical trials designed to investigate sentinel lymph node biopsy procedures in seven types of cancer: breast, melanoma, head and neck, gastric, colon, uterine, and vulvar-with focus on the most recent reports of the hypotheses, objectives, parameters, data, results, implications, and impacts of the included trials. Such trials generally enroll more subjects, in shorter time periods, than do single-center studies. Such studies generally also have greater diversities among investigator practitioners and investigative environments than do single-center studies. The greater number of subjects provides more power to statistical analyses performed in such studies. The more rapid accrual usually results in data being more consistently acquired. The diversities of practitioners and environments may produce results that are more conservative than might be obtained from more "focused" studies; however, diversities in a study often identify implicitly results that are more robust-that is results applicable by more practitioners and applicable in more environments.
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Affiliation(s)
- Valeria M Moncayo
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | - Erin E Grady
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | - Naomi P Alazraki
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA; Nuclear Medicine Service, Atlanta Veterans Affairs Healthcare System, Decatur, GA
| | - John N Aarsvold
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA; Nuclear Medicine Service, Atlanta Veterans Affairs Healthcare System, Decatur, GA.
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22
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Rietbergen DD, VAN Oosterom MN, Kleinjan GH, Brouwer OR, Valdes-Olmos RA, VAN Leeuwen FW, Buckle T. Interventional nuclear medicine: a focus on radioguided intervention and surgery. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2021; 65:4-19. [PMID: 33494584 DOI: 10.23736/s1824-4785.21.03286-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Within interventional nuclear medicine (iNM) a prominent role is allocated for the sub-discipline of radioguided surgery. Unique for this discipline is the fact that an increasing number of clinical indications (e.g. lymphatic mapping, local tumor demarcation and/or tumor receptor targeted applications) have been adopted into routine care. The clinical integration is further strengthened by technical innovations in chemistry and engineering that enhance the translational potential of radioguided procedures in iNM. Together, these features not only ensure ongoing expansion of iNM but also warrant a lasting clinical impact for the sub-discipline of radioguided surgery.
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Affiliation(s)
- Daphne D Rietbergen
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, the Netherlands
| | - Matthias N VAN Oosterom
- Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, the Netherlands.,Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Gijs H Kleinjan
- Department of Urology, Leiden University Medical Center, Leiden, the Netherlands
| | - Oscar R Brouwer
- Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, the Netherlands.,Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Renato A Valdes-Olmos
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Fijs W VAN Leeuwen
- Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, the Netherlands.,Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Tessa Buckle
- Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, the Netherlands - .,Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
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23
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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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24
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Mondal SB, O'Brien CM, Bishop K, Fields RC, Margenthaler JA, Achilefu S. Repurposing Molecular Imaging and Sensing for Cancer Image-Guided Surgery. J Nucl Med 2020; 61:1113-1122. [PMID: 32303598 DOI: 10.2967/jnumed.118.220426] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 03/05/2020] [Indexed: 12/25/2022] Open
Abstract
Gone are the days when medical imaging was used primarily to visualize anatomic structures. The emergence of molecular imaging (MI), championed by radiolabeled 18F-FDG PET, has expanded the information content derived from imaging to include pathophysiologic and molecular processes. Cancer imaging, in particular, has leveraged advances in MI agents and technology to improve the accuracy of tumor detection, interrogate tumor heterogeneity, monitor treatment response, focus surgical resection, and enable image-guided biopsy. Surgeons are actively latching on to the incredible opportunities provided by medical imaging for preoperative planning, intraoperative guidance, and postoperative monitoring. From label-free techniques to enabling cancer-selective imaging agents, image-guided surgery provides surgical oncologists and interventional radiologists both macroscopic and microscopic views of cancer in the operating room. This review highlights the current state of MI and sensing approaches available for surgical guidance. Salient features of nuclear, optical, and multimodal approaches will be discussed, including their strengths, limitations, and clinical applications. To address the increasing complexity and diversity of methods available today, this review provides a framework to identify a contrast mechanism, suitable modality, and device. Emerging low-cost, portable, and user-friendly imaging systems make the case for adopting some of these technologies as the global standard of care in surgical practice.
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Affiliation(s)
- Suman B Mondal
- Department of Radiology, Washington University, St. Louis, Missouri
| | | | - Kevin Bishop
- Department of Radiology, Washington University, St. Louis, Missouri
| | - Ryan C Fields
- Department of Surgery and Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Julie A Margenthaler
- Department of Surgery and Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Samuel Achilefu
- Department of Radiology, Washington University, St. Louis, Missouri .,Department of Biomedical Engineering, Washington University, St. Louis, Missouri; and.,Department of Biochemistry and Molecular Biophysics, Washington University, St. Louis, Missouri
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25
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Moukarzel LA, Feinberg J, Levy EJ, Leitao MM. Current and novel mapping substances in gynecologic cancer care. Int J Gynecol Cancer 2020; 30:387-393. [PMID: 31953349 PMCID: PMC7375198 DOI: 10.1136/ijgc-2019-001078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/02/2020] [Accepted: 01/06/2020] [Indexed: 01/01/2023] Open
Abstract
Many tracers have been introduced into current medical practice with the purpose of improving lymphatic mapping techniques, anatomic visualization, and organ/tissue perfusion assessment. Among them, three tracers have dominated the field: indocyanine green, technetium-99m radiocolloid (Tc99m), and blue dye. Tc99m and blue dye are used individually or in combination; however, given particular challenges with these tracers, such as the need for a preoperative procedure by nuclear medicine and cost, other options have been sought. Indocyanine green has proven to be a promising alternative for certain procedures, as it is easy to use and has quick uptake. Its use in the management of gynecologic cancers was first described for sentinel lymph node mapping in cervical cancer, and later for endometrial and vulvar cancers. This review provides an in-depth look at these mapping substances, their uses, and the potential for new discoveries.
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Affiliation(s)
- Lea A Moukarzel
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jacqueline Feinberg
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Evan J Levy
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York, United States
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26
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Moncrieff MD, O'Leary FM, Beadsmoore CJ, Pawaroo D, Heaton MJ, Isaksson K, Olofsson Bagge R. Effect of delay between nuclear medicine scanning and sentinel node biopsy on outcome in patients with cutaneous melanoma. Br J Surg 2020; 107:669-676. [PMID: 32077090 DOI: 10.1002/bjs.11460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 09/16/2019] [Accepted: 11/12/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) is an important staging tool for the management of melanoma. A multicentre study was done to validate previous findings that the timing of lymphoscintigraphy influences the accuracy of SLNB and patient outcomes, particularly survival. METHODS Data were reviewed on patients undergoing SLNB for melanoma at three centres in the UK and Sweden, examining the effect of timing of SLNB after nuclear medicine scanning. Kaplan-Meier survival analysis was used to assess overall (OS), disease-specific (DSS) and progression-free (PFS) survival, stratified by timing of lymphoscintigraphy. Independent risk factors for survival were identified by Cox multivariable regression analysis. RESULTS A total of 2270 patients were identified. Median follow-up was 56 months. Univariable analysis showed a 4·2 per cent absolute and 35·5 per cent relative benefit in DSS (hazard ratio 1·36, 95 per cent c.i. 1·05 to 1·74; P = 0·018) for 863 patients whose SLNB was performed up to 12 h after lymphoscintigraphy compared with 1407 patients who had surgery after more than 12 h. There were similar OS and PFS benefits (P = 0·036 and P = 0·022 respectively). Multivariable analysis identified timing of lymphoscintigraphy as an independent predictor of OS (P = 0·017) and DSS (P = 0·030). There was an excess of nodal recurrences as first site of recurrence in the group with delayed surgery (4·5 versus 2·5 per cent; P = 0·008). CONCLUSION Delaying SLNB beyond 12 h after lymphoscintigraphy with 99 Tc-labelled nanocolloid has a significant negative survival impact in patients with melanoma.
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Affiliation(s)
- M D Moncrieff
- Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.,Norwich Medical School, University of East Anglia Norwich Research Park, Norwich, UK
| | - F M O'Leary
- Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - C J Beadsmoore
- Department of Nuclear Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - D Pawaroo
- Department of Nuclear Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - M J Heaton
- Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - K Isaksson
- Department of Clinical Sciences, Surgery, Lund University, Skåne University Hospital, Lund, Sweden
| | - R Olofsson Bagge
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
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27
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The Basics of Sentinel Lymph Node Biopsy: Anatomical and Pathophysiological Considerations and Clinical Aspects. JOURNAL OF ONCOLOGY 2019; 2019:3415630. [PMID: 31467535 PMCID: PMC6699370 DOI: 10.1155/2019/3415630] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/03/2019] [Accepted: 07/11/2019] [Indexed: 01/31/2023]
Abstract
Sentinel lymph node (SLN) is the first node to receive the drainage directly from a tumor. Detection and pathological examination of the SLN is an important oncological procedure that minimizes morbidity related to extensive nodal dissection. SLN biopsy was first reported in 1960 but took approximately 40 years to come into general practice following reports of good outcomes in patients with melanoma. After many years of observation and research on its use in various malignancies SLN biopsy has become the standard surgical treatment in patients with malignant melanoma, breast, vulvar, and cervical cancers. Along with the introduction of new technologies, such as the fluorescent dyes indocyanine green (ICG) and near-infrared fluorescence (NIR), and pathologic ultrastaging, SLN detection rate has increased and false-negative rate has decreased. This literature review aimed to present an overview of the basic concepts and clinical aspects of SLN biopsy in the light of the current research.
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28
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Van Oosterom MN, Rietbergen DDD, Welling MM, Van Der Poel HG, Maurer T, Van Leeuwen FWB. Recent advances in nuclear and hybrid detection modalities for image-guided surgery. Expert Rev Med Devices 2019; 16:711-734. [PMID: 31287715 DOI: 10.1080/17434440.2019.1642104] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Introduction: Radioguided surgery is an ever-evolving part of nuclear medicine. In fact, this nuclear medicine sub-discipline actively bridges non-invasive molecular imaging with surgical care. Next to relying on the availability of radio- and bimodal-tracers, the success of radioguided surgery is for a large part dependent on the imaging modalities and imaging concepts available for the surgical setting. With this review, we have aimed to provide a comprehensive update of the most recent advances in the field. Areas covered: We have made an attempt to cover all aspects of radioguided surgery: 1) the use of radioisotopes that emit γ, β+, and/or β- radiation, 2) hardware developments ranging from probes to 2D cameras and even the use of advanced 3D interventional imaging solutions, and 3) multiplexing solutions such as dual-isotope detection or combined radionuclear and optical detection. Expert opinion: Technical refinements in the field of radioguided surgery should continue to focus on supporting its implementation in the increasingly complex minimally invasive surgical setting, e.g. by accommodating robot-assisted laparoscopic surgery. In addition, hybrid concepts that integrate the use of radioisotopes with other image-guided surgery modalities such as fluorescence or ultrasound are likely to expand in the future.
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Affiliation(s)
- Matthias N Van Oosterom
- a Interventional Molecular Imaging laboratory, Department of Radiology, Leiden University Medical Center , Leiden , the Netherlands.,b Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital , Amsterdam , the Netherlands
| | - Daphne D D Rietbergen
- a Interventional Molecular Imaging laboratory, Department of Radiology, Leiden University Medical Center , Leiden , the Netherlands.,c Department of Radiology, Section Nuclear Medicine, Leiden University Medical Center , Leiden , the Netherlands
| | - Mick M Welling
- a Interventional Molecular Imaging laboratory, Department of Radiology, Leiden University Medical Center , Leiden , the Netherlands
| | - Henk G Van Der Poel
- b Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital , Amsterdam , the Netherlands
| | - Tobias Maurer
- d Martini-Clinic, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Fijs W B Van Leeuwen
- a Interventional Molecular Imaging laboratory, Department of Radiology, Leiden University Medical Center , Leiden , the Netherlands.,b Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital , Amsterdam , the Netherlands.,e Orsi Academy , Melle , Belgium
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29
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Vermeulen K, Vandamme M, Bormans G, Cleeren F. Design and Challenges of Radiopharmaceuticals. Semin Nucl Med 2019; 49:339-356. [PMID: 31470930 DOI: 10.1053/j.semnuclmed.2019.07.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This review describes general concepts with regard to radiopharmaceuticals for diagnostic or therapeutic applications that help to understand the specific challenges encountered during the design, (radio)synthesis, in vitro and in vivo evaluation and clinical translation of novel radiopharmaceuticals. The design of a radiopharmaceutical requires upfront decisions with regard to combining a suitable vector molecule with an appropriate radionuclide, considering the type and location of the molecular target, the desired application, and the time constraints imposed by the relatively short half-life of radionuclides. Well-designed in vitro and in vivo experiments allow nonclinical validation of radiotracers. Ultimately, in combination with a limited toxicology package, the radiotracer becomes a radiopharmaceutical for clinical evaluation, produced in compliance with regulatory requirements for medicines for intravenous (IV) injection.
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Affiliation(s)
- Koen Vermeulen
- Laboratory for Radiopharmaceutical Research, Department of Pharmaceutical and Pharmacological Sciences, University of Leuven, Leuven, Belgium
| | - Mathilde Vandamme
- Laboratory for Radiopharmaceutical Research, Department of Pharmaceutical and Pharmacological Sciences, University of Leuven, Leuven, Belgium
| | - Guy Bormans
- Laboratory for Radiopharmaceutical Research, Department of Pharmaceutical and Pharmacological Sciences, University of Leuven, Leuven, Belgium.
| | - Frederik Cleeren
- Laboratory for Radiopharmaceutical Research, Department of Pharmaceutical and Pharmacological Sciences, University of Leuven, Leuven, Belgium
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30
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Liu M, Wen M, Shen S, Zhang Z, Chen G, Zhang W. One‐Pot, Multicomponent Strategy for Designing Lymphoseek‐Inspired Hetero‐Glycoadjuvant@AuNPs. Macromol Rapid Commun 2019; 40:e1900215. [DOI: 10.1002/marc.201900215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 05/31/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Mengjie Liu
- M. Liu, M. Wen, S. Shen, Prof. G. Chen, Prof. W. ZhangCenter for Soft Condensed Matter Physicsand Interdisciplinary Research & School of Physical Scienceand TechnologyJiangsu Key Laboratory of Thin FilmsSoochow University Suzhou 215006 P. R. China
| | - Ming Wen
- M. Liu, M. Wen, S. Shen, Prof. G. Chen, Prof. W. ZhangCenter for Soft Condensed Matter Physicsand Interdisciplinary Research & School of Physical Scienceand TechnologyJiangsu Key Laboratory of Thin FilmsSoochow University Suzhou 215006 P. R. China
| | - Shuyi Shen
- M. Liu, M. Wen, S. Shen, Prof. G. Chen, Prof. W. ZhangCenter for Soft Condensed Matter Physicsand Interdisciplinary Research & School of Physical Scienceand TechnologyJiangsu Key Laboratory of Thin FilmsSoochow University Suzhou 215006 P. R. China
| | - Zhengbiao Zhang
- State and Local Joint Engineering Laboratoryfor Novel Functional Polymeric MaterialsSoochow University Suzhou 215123 China
| | - Gaojian Chen
- M. Liu, M. Wen, S. Shen, Prof. G. Chen, Prof. W. ZhangCenter for Soft Condensed Matter Physicsand Interdisciplinary Research & School of Physical Scienceand TechnologyJiangsu Key Laboratory of Thin FilmsSoochow University Suzhou 215006 P. R. China
| | - Weidong Zhang
- M. Liu, M. Wen, S. Shen, Prof. G. Chen, Prof. W. ZhangCenter for Soft Condensed Matter Physicsand Interdisciplinary Research & School of Physical Scienceand TechnologyJiangsu Key Laboratory of Thin FilmsSoochow University Suzhou 215006 P. R. China
- State and Local Joint Engineering Laboratoryfor Novel Functional Polymeric MaterialsSoochow University Suzhou 215123 China
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31
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Holliday RM, Jain MK, Accurso JM, Sharma A, Harrison SR, Aloszka DL, Bowman AW. Buffering the Suffering of Breast Lymphoscintigraphy. J Nucl Med Technol 2019; 48:51-53. [PMID: 31182657 DOI: 10.2967/jnmt.119.230011] [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: 04/18/2019] [Accepted: 06/03/2019] [Indexed: 11/16/2022] Open
Abstract
Breast lymphoscintigraphy with 99mTc-sulfur colloid is frequently performed before breast-conserving surgery to delineate drainage to a sentinel node. Tracer injection for lymphoscintigraphy can be painful. Our aims were to determine whether administering a solution of buffered lidocaine immediately before lymphoscintigraphy injection could both reduce the patients' pain and increase nuclear medicine technologists' satisfaction with performing the procedure. Methods: A pain scale survey was obtained from patients undergoing breast lymphoscintigraphy with or without buffered lidocaine. Our nuclear medicine technologists were also surveyed for their satisfaction with the procedure, both with and without the addition of buffered lidocaine. Results: The patients' reported pain decreased by 86% with the addition of buffered lidocaine. Technologist satisfaction with performing the procedure increased by 36%. Conclusion: Lidocaine buffered with sodium bicarbonate injected before lymphoscintigraphy significantly reduces pain experienced by the patient and improves nuclear medicine technologist satisfaction in performing the procedure.
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Affiliation(s)
- Rex M Holliday
- Division of Nuclear Medicine, Mayo Clinic, Jacksonville, Florida; and
| | - Manoj K Jain
- Division of Nuclear Medicine, Mayo Clinic, Jacksonville, Florida; and
| | - Joseph M Accurso
- Division of Nuclear Medicine, Mayo Clinic, Jacksonville, Florida; and
| | - Akash Sharma
- Division of Nuclear Medicine, Mayo Clinic, Jacksonville, Florida; and
| | - Sara R Harrison
- Division of Nuclear Medicine, Mayo Clinic, Jacksonville, Florida; and
| | - Debora L Aloszka
- Division of Nuclear Medicine, Mayo Clinic, Jacksonville, Florida; and
| | - Andrew W Bowman
- Division of Hospital Radiology, Mayo Clinic, Jacksonville, Florida
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32
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Murphy BL, Woodwick AR, Murphy KM, Chandler KJ, Johnson GB, Hunt CH, Peller P, Jakub JW, Homb AC. 99mTc-Tilmanocept Versus 99mTc-Sulfur Colloid in Lymphoscintigraphy: Sentinel Lymph Node Identification and Patient-Reported Pain. J Nucl Med Technol 2019; 47:300-304. [DOI: 10.2967/jnmt.118.225342] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 03/01/2019] [Indexed: 11/16/2022] Open
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Abstract
Lymphatic surgery has become an integral and flourishing component of the field of plastic surgery. The diversity of ongoing technological innovations in perioperative imaging, including intraoperative dyes and cameras, allows plastic surgeons to work at the supermicrosurgical level. This study aims to highlight innovations that have shaped and will continue to revolutionize the perioperative management of the lymphatic surgery patient in the future. As additional advances emerge, we need a systematic and objective way to evaluate the efficacy and clinical integration readiness of such technologies. Undoubtedly, these technologies will help lymphatic surgery trend toward increasing objectivity, which will be critical for continued evolution and advancement.
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Mannose Receptor and Targeting Strategies. TARGETED INTRACELLULAR DRUG DELIVERY BY RECEPTOR MEDIATED ENDOCYTOSIS 2019. [DOI: 10.1007/978-3-030-29168-6_15] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Vidal-Sicart S, Vera DR, Valdés Olmos RA. Next generation of radiotracers for sentinel lymph node biopsy: What is still necessary to establish new imaging paradigms? Rev Esp Med Nucl Imagen Mol 2018; 37:373-379. [PMID: 30409688 DOI: 10.1016/j.remn.2018.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/08/2018] [Accepted: 09/13/2018] [Indexed: 01/16/2023]
Abstract
Sentinel lymph node (SLN) biopsy is now the standard of care for regional staging in several solid tumors. The interstitial administration of a radiotracer around the primary tumor provide the possibility to sequentially obtain images with a gamma camera and visualize lymphatic mapping and the SLN. There is, however, a large geographical variability in those radiotracers and nanocolloids ranging from 15-100nm which are most widely employed in Europe, while filtered and unfiltered 99mTc-sulfur colloid (range 20-1000nm) is usually used in the USA with different drawbacks in its use. The new radiotracer 99mTc-Tilmanocept, designed specifically for the identification of SLNs and recently becoming commercially available in USA and Europe, appears to have the potency to overcome the shortcomings described for the conventional radiotracers used until now for SLN biopsy and at the same time to transform current imaging paradigms. After delineating the challenges for the next generation of radiotracers, this paper discusses the properties of 99mTc-Tilmanocept, its validation process for SLN biopsy and its emerging clinical applications in various malignancies.
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Affiliation(s)
- S Vidal-Sicart
- Servei de Medicina Nuclear, Hospital Clínic, Barcelona, España; Servei de Medicina Nuclear, IMI, Parc de Salut Mar, Barcelona, España.
| | - D R Vera
- Department of Radiology, University of California San Diego (UCSD), San Diego, California, Estados Unidos
| | - R A Valdés Olmos
- Interventional Molecular Imaging Laboratory and Nuclear Medicine Section, Department of Radiology, Leiden University Medical Center, Leiden, Países Bajos
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Vidal-Sicart S, Vera DR, Olmos RAV. Next generation of radiotracers for sentinel lymph node biopsy: What is still necessary to establish new imaging paradigms? ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.remnie.2018.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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O'Leary FM, Beadsmoore CJ, Pawaroo D, Skrypniuk J, Heaton MJ, Moncrieff MD. Survival outcomes and interval between lymphoscintigraphy and SLNB in cutaneous melanoma- findings of a large prospective cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2018; 44:1768-1772. [PMID: 30343702 DOI: 10.1016/j.ejso.2018.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 04/26/2018] [Accepted: 06/12/2018] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Sentinel lymph node biopsy (SLNB) in cutaneous melanoma (CM) is performed to identify patient at risk of regional and distant relapse. We hypothesized that timing of lymphoscintigraphy may influence the accuracy of SLNB and patient outcomes. METHODS We reviewed prospective data on patients undergoing SLNB for CM at a large university cancer-center between 2008 and 2015, examining patient and tumor demographics and time between lymphoscintigraphy (LS) and SLNB. Kaplan-Meier survival analysis assessed disease-specific (DSS) and overall-survival (OS), stratified by timing of LS. Cox multivariate regression analysis assessed independent risk factors for survival. RESULTS We identified 1015 patients. Median follow-up was 45 months (IQR 26-68 months). Univariate analysis showed a 6.8% absolute DSS (HR 1.6 [1.03-2.48], p = 0.04) benefit and a 10.7% absolute OS (HR 1.64 [1.13-2.38], p = 0.01) benefit for patients whose SLNB was performed < 12 h of LS (n = 363) compared to those performed >12 h (n = 652). Multivariate analysis identified timing of LS as an independent predictor of OS (p = 0.007) and DSS (p = 0.016) when competing with age, sex, Breslow thickness (BT) and SLN status. No difference in nodal relapse rates (5.2% v 4.6%; p = 0.67) was seen. Both groups were matched for age, sex, BT and SLN status. CONCLUSION These data have significant implications for SLNB services, suggesting delaying SLNB >12 h after LS using a Tc99-labelled nanocolloid has a significant negative survival impact for patients and should be avoided. We hypothesise that temporal tracer migration is the underlying cause and advocate further trials investigating alternative, 'stable' tracer-agents.
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Affiliation(s)
- Fionnuala M O'Leary
- Department of Plastic & Reconstructive Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK. fionnuala.o'
| | - Clare J Beadsmoore
- Department of Nuclear Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK
| | - Davina Pawaroo
- Department of Nuclear Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK
| | - John Skrypniuk
- Department of Nuclear Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK
| | - Martin J Heaton
- Department of Plastic & Reconstructive Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK
| | - Marc D Moncrieff
- Department of Plastic & Reconstructive Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK; Norwich Medical School, University of East Anglia Norwich Research Park, Norwich, NR4 7TJ, UK
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Silvestri C, Christopher A, Intenzo C, Kairys JC, Kim S, Willis A, Berger AC. Consecutive Case Series of Melanoma Sentinel Node Biopsy for Lymphoseek Compared to Sulfur Colloids. J Surg Res 2018; 233:149-153. [PMID: 30502241 DOI: 10.1016/j.jss.2018.07.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/09/2018] [Accepted: 07/13/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) is an important adjunct in the staging of patients with melanoma. Preoperative lymphoscintigraphy with radiolabeled isotopes is essential to localize sentinel nodes for removal. Our study compared the effectiveness of Lymphoseek to standard sulfur colloids in patients with melanoma undergoing SLNB. METHODS We queried our IRB-approved melanoma database to identify 370 consecutive patients who underwent SLNB from 2012 to 2016 with at least 1 y of follow-up. There were 185 patients in each group. Data points included characteristics of the primary melanoma lymphoscintigraphy and SLNB. Student's t-test and chi-square were used to analyze the data with a P value of <0.05 being considered significant. RESULTS Patients were equally matched in regard to age, sex, and primary characteristics of their melanoma. In comparison to sulfur colloid, Lymphoseek required lower radiation dosages (P < 0.001), shorter mapping times (P = 0.008), and decreased number of sentinel nodes removed (P = 0.03). There was no difference in the number of patients with positive nodes (P = 0.5). In addition, there were no statistical differences between the two radioactive tracers in regard to the number of patients with false-negative SLNB. CONCLUSION Lymphoseek has the potential to decrease radioactivity and mapping time in patients who need SLNB. With a decrease in the number of nodes removed without loss of sensitivity, there is a potential to avoid unnecessary node removal and thus complications such as lymphedema. Longer follow-up will help to determine if there is any increase in false-negative rates despite fewer nodes removed.
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Affiliation(s)
- Caitlin Silvestri
- Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Surgery, Philadelphia, Pennsylvania
| | - Adrienne Christopher
- Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Surgery, Philadelphia, Pennsylvania
| | - Charles Intenzo
- Department of Radiology, Thomas Jefferson University Hospital, Nuclear Medicine/Radiology, Philadelphia, Pennsylvania
| | - John C Kairys
- Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Surgery, Philadelphia, Pennsylvania
| | - Sung Kim
- Department of Radiology, Thomas Jefferson University Hospital, Nuclear Medicine/Radiology, Philadelphia, Pennsylvania
| | - Alliric Willis
- Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Surgery, Philadelphia, Pennsylvania
| | - Adam C Berger
- Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Surgery, Philadelphia, Pennsylvania.
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Anderson KM, Barback CV, Qin Z, Hall DJ, Hoh CK, Vera DR, McHale MT. Molecular Imaging of endometrial sentinel lymph nodes utilizing fluorescent-labeled Tilmanocept during robotic-assisted surgery in a porcine model. PLoS One 2018; 13:e0197842. [PMID: 29965996 PMCID: PMC6028102 DOI: 10.1371/journal.pone.0197842] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 05/09/2018] [Indexed: 11/19/2022] Open
Abstract
Molecular imaging with a fluorescent version of Tilmanocept may permit an accurate and facile detection of sentinel nodes of endometrial cancer. Tilmanocept accumulates in sentinel lymph nodes (SLN) by binding to a cell surface receptor unique to macrophages and dendritic cells. Four female Yorkshire pigs underwent cervical stromal injection of IRDye800-Tilmanocept, a molecular imaging agent tagged with near-infrared fluorescent dye and radiolabeled with gallium-68 and technetium-99m. PET/CT scans 1.5 hours post-injection provided pre-operative SLN mapping. Robotic-assisted lymphadenectomy was performed two days after injection, using the FireFly imaging system to identify nodes demonstrating fluorescent signal. After removal of fluorescent nodes, pelvic and periaortic node dissections were performed. Nodes were assayed for technetium-99m activity, and SLNs were established using the “10%-rule”, requiring that the radioactivity of additional SLNs be greater than 10% of the “hottest” SLN. Thirty-four nodal samples were assayed ex vivo for radioactivity. All the SLNs satisfying the “10%-rule” were detected using the FireFly system. Five fluorescent nodes were detected, corresponding with preoperative PET/CT scan. Three pigs had one SLN and one pig had two SLNs, with 100% concordance between fluorescence and radioactivity. Fluorescent-labeled Tilmanocept permits real-time intraoperative detection of SLNs during robotic-assisted lymphadenectomy for endometrial cancer in a porcine model. When radiolabeled with gallium-68, Tilmanocept allows for preoperative localization of SLNs using PET/CT, and shows specificity to SLNs with persistent fluorescent signal, detectable using the FireFly system, for two days post-injection. In conclusion, these findings suggest that a phase I trial in human subjects is warranted, and that a long-term goal of an intra-operative administration of non-radioactive fluorescent-labeled Tilmanocept is possible.
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Affiliation(s)
- Kristen M. Anderson
- Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California, San Diego, United States of America
- * E-mail:
| | - Christopher V. Barback
- Department of Radiology, University of California, San Diego, United States of America
- UCSD Molecular Imaging Program, University of California, San Diego, United States of America
| | - Zhengtao Qin
- Department of Radiology, University of California, San Diego, United States of America
- UCSD Molecular Imaging Program, University of California, San Diego, United States of America
| | - David J. Hall
- Department of Radiology, University of California, San Diego, United States of America
- UCSD Molecular Imaging Program, University of California, San Diego, United States of America
| | - Carl K. Hoh
- Department of Radiology, University of California, San Diego, United States of America
- UCSD Molecular Imaging Program, University of California, San Diego, United States of America
| | - David R. Vera
- Department of Radiology, University of California, San Diego, United States of America
- UCSD Molecular Imaging Program, University of California, San Diego, United States of America
| | - Michael T. McHale
- Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California, San Diego, United States of America
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Blau R, Epshtein Y, Pisarevsky E, Tiram G, Dangoor SI, Yeini E, Krivitsky A, Eldar-Boock A, Ben-Shushan D, Gibori H, Scomparin A, Green O, Ben-Nun Y, Merquiol E, Doron H, Blum G, Erez N, Grossman R, Ram Z, Shabat D, Satchi-Fainaro R. Image-guided surgery using near-infrared Turn-ON fluorescent nanoprobes for precise detection of tumor margins. Am J Cancer Res 2018; 8:3437-3460. [PMID: 30026858 PMCID: PMC6037036 DOI: 10.7150/thno.23853] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 04/02/2018] [Indexed: 02/07/2023] Open
Abstract
Complete tumor removal during surgery has a great impact on patient survival. To that end, the surgeon should detect the tumor, remove it and validate that there are no residual cancer cells left behind. Residual cells at the incision margin of the tissue removed during surgery are associated with tumor recurrence and poor prognosis for the patient. In order to remove the tumor tissue completely with minimal collateral damage to healthy tissue, there is a need for diagnostic tools that will differentiate between the tumor and its normal surroundings. Methods: We designed, synthesized and characterized three novel polymeric Turn-ON probes that will be activated at the tumor site by cysteine cathepsins that are highly expressed in multiple tumor types. Utilizing orthotopic breast cancer and melanoma models, which spontaneously metastasize to the brain, we studied the kinetics of our polymeric Turn-ON nano-probes. Results: To date, numerous low molecular weight cathepsin-sensitive substrates have been reported, however, most of them suffer from rapid clearance and reduced signal shortly after administration. Here, we show an improved tumor-to-background ratio upon activation of our Turn-ON probes by cathepsins. The signal obtained from the tumor was stable and delineated the tumor boundaries during the whole surgical procedure, enabling accurate resection. Conclusions: Our findings show that the control groups of tumor-bearing mice, which underwent either standard surgery under white light only or under the fluorescence guidance of the commercially-available imaging agents ProSense® 680 or 5-aminolevulinic acid (5-ALA), survived for less time and suffered from tumor recurrence earlier than the group that underwent image-guided surgery (IGS) using our Turn-ON probes. Our "smart" polymeric probes can potentially assist surgeons' decision in real-time during surgery regarding the tumor margins needed to be removed, leading to improved patient outcome.
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Unkart JT, Proudfoot J, Wallace AM. Outcomes of "one-day" vs "two-day" injection protocols using Tc-99m tilmanocept for sentinel lymph node biopsy in breast cancer. Breast J 2018; 24:526-530. [PMID: 29498443 DOI: 10.1111/tbj.13002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 11/29/2022]
Abstract
No prior studies have compared Tc-99m tilmanocept (TcTM) one-day and two-day injection protocols for sentinel lymph node (SLN) biopsy in breast cancer (BC). We retrospectively identified patients with clinically node-negative BC undergoing SLN biopsy at our institution. Patients received a single, intradermal peritumoral injection of TcTM on day of surgery or day prior to surgery in addition to an intraoperative injection of isosulfan blue dye. Univariable and multivariable Poisson regression count models were constructed to assess the effects of injection timing, radiologist, patient and surgeon characteristics on the number of removed SLNs. A total of 617 patients underwent SLN biopsy with TcTM and blue dye. Sixty-seven (10.9%) patients were injected with the two-day protocol. Patients in the one-day protocol had a mean of 3.0 (standard deviation (SD) 1.9) SLNs removed compared with 2.7 (SD 1.4) SLNs in the two-day protocol, P-value = .13. On multivariable analysis, patient age and operating surgeon significantly affected the number of removed SLNs; however, the injection timing and the nuclear radiologist did not influence the number of removed SLNs. The performance of Tc-99m tilmanocept did not differ significantly between one-day and two-day injection protocols. These results are similar to other radiotracers used for SLN biopsy in BC.
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Affiliation(s)
- Jonathan T Unkart
- Department of Surgery, Moores Cancer Center, University of California, San Diego, CA, USA
| | - James Proudfoot
- Biostatistics Unit, Altman Clinical Translational Research Institute, University of California, San Diego, CA, USA
| | - Anne M Wallace
- Department of Surgery, Moores Cancer Center, University of California, San Diego, CA, USA
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Kraft JC, Treuting PM, Ho RJY. Indocyanine green nanoparticles undergo selective lymphatic uptake, distribution and retention and enable detailed mapping of lymph vessels, nodes and abnormalities. J Drug Target 2018; 26:494-504. [PMID: 29388438 DOI: 10.1080/1061186x.2018.1433681] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The distributed network of lymph vessels and nodes in the body, with its complex architecture and physiology, presents a major challenge for whole-body lymphatic-targeted drug delivery. To gather physiological and pathological information of the lymphatics, near-infrared (NIR) fluorescence imaging of NIR fluorophores is used in clinical practice due to its tissue-penetrating optical radiation (700-900 nm) that safely provides real-time high-resolution in vivo images. However, indocyanine green (ICG), a common clinical NIR fluorophore, is unstable in aqueous environments and under light exposure, and its poor lymphatic distribution and retention limits its use as a NIR lymphatic tracer. To address this, we investigated in mice the distribution pathways of a novel nanoparticle formulation that stabilises ICG and is optimised for lymphatic drug delivery. From the subcutaneous space, ICG particles provided selective lymphatic uptake, lymph vessel and node retention, and extensive first-pass lymphatic distribution of ICG, enabling 0.2 mm and 5-10 cell resolution of lymph vessels, and high signal-to-background ratios for lymphatic vessel and node networks. Soluble (free) ICG readily dissipated from lymph vessels local to the injection site and absorbed into the blood. These unique characteristics of ICG particles could enable mechanistic studies of the lymphatics and diagnosis of lymphatic abnormalities.
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Affiliation(s)
- John C Kraft
- a Department of Pharmaceutics , University of Washington , Seattle , WA , USA
| | - Piper M Treuting
- b Department of Comparative Medicine , University of Washington , Seattle , WA , USA
| | - Rodney J Y Ho
- a Department of Pharmaceutics , University of Washington , Seattle , WA , USA.,c Department of Bioengineering , University of Washington , Seattle , WA , USA
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99mTc-rituximab as a tracer for sentinel lymph node biopsy in breast cancer patients: a single-center analysis. Breast Cancer Res Treat 2017; 168:365-370. [DOI: 10.1007/s10549-017-4591-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 11/22/2017] [Indexed: 01/06/2023]
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Moncayo VM, Alazraki AL, Alazraki NP, Aarsvold JN. Sentinel Lymph Node Biopsy Procedures. Semin Nucl Med 2017; 47:595-617. [DOI: 10.1053/j.semnuclmed.2017.06.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Unkart JT, Wallace AM. Use of 99mTc-Tilmanocept as a Single Agent for Sentinel Lymph Node Identification in Breast Cancer: A Retrospective Pilot Study. J Nucl Med Technol 2017; 45:181-184. [PMID: 28705929 DOI: 10.2967/jnmt.117.194415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 06/01/2017] [Indexed: 02/06/2023] Open
Abstract
99mTc-tilmanocept received recent Food and Drug Administration approval for lymphatic mapping in 2013. However, to our knowledge, no prior studies have evaluated the use of 99mTc-tilmanocept as a single agent in sentinel lymph node (SLN) biopsy in breast cancer. Methods: We executed this retrospective pilot study to assess the ability of 99mTc-tilmanocept to identify sentinel nodes as a single agent in clinically node-negative breast cancer patients. Patients received a single intradermal injection overlying the tumor of either 18.5 MBq (0.5 mCi) of 99mTc-tilmanocept on the day of surgery or 74.0 MBq (2.0 mCi) on the day before surgery by a radiologist. Immediate 3-view lymphoscintigraphy was performed. Intraoperatively, SLNs were identified with a portable γ-probe. A node was classified as hot if the count (per second) of the node was more than 3 times the background count. Descriptive statistics are reported. Results: Nineteen patients underwent SLN biopsy with single-agent 99mTc-tilmanocept. Immediate lymphoscintigraphy identified at least 1 sentinel node in 13 of 17 patients (76.5%). Intraoperatively, at least 1 (mean, 1.7 ± 0.8; range, 1-3) hot node was identified in all patients. Three patients (15.8%) had 1 disease-positive SLN. Conclusion: In this small, retrospective pilot study, 99mTc-tilmanocept performed well as a single agent for intraoperative sentinel node identification in breast cancer. A larger, randomized clinical trial is warranted to compare 99mTc-tilmanocept as a single agent with other radiopharmaceuticals for sentinel node identification in breast cancer.
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Affiliation(s)
- Jonathan T Unkart
- Department of Surgery, Moores Cancer Center, University of California-San Diego, La Jolla, California
| | - Anne M Wallace
- Department of Surgery, Moores Cancer Center, University of California-San Diego, La Jolla, California
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Unkart JT, Hosseini A, Wallace AM. Tc-99m tilmanocept versus Tc-99m sulfur colloid in breast cancer sentinel lymph node identification: Results from a randomized, blinded clinical trial. J Surg Oncol 2017; 116:819-823. [PMID: 28695567 DOI: 10.1002/jso.24735] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 05/29/2017] [Indexed: 02/06/2023]
Abstract
INTRODUCTION No prior trials have compared sentinel lymph node (SLN) identification outcomes between Tc-99m tilmanocept (TcTM) and Tc-99m sulfur colloid (TcSC) in breast cancer (BC). METHODS We report on the secondary outcomes from a randomized, double-blinded, single surgeon clinical trial comparing post-injection site pain between TcTM and TcSC. Patients were randomized to receive a preoperative single, peritumoral intradermal injection of TcTM or TcSC. The number of total, "hot", and blue nodes detected and removed were compared between groups. RESULTS Fifty-two (27-TcSC and 25-TcTM) patients were enrolled and underwent definitive surgical treatment. At least one "hot" SLN was detected in all patients. Three (5.8%) patients had a disease positive-SLN. The total number of SLNs removed was 61 (mean 2.26 (standard deviation (SD) 0.90)) in the TcSC group and 54 (mean 2.16 (SD 0.90)) in the TcTM group, P = 0.69. The total number of "hot" nodes in the TcSC group was 1.96 (SD 0.76) compared to 2.04 (SD 0.73) in the TcTM group, P = 0.71. CONCLUSIONS The number of identified SLNs did not differ significantly between TcTM and TcSC. Given that no significant technical advantages exist between the two agents, surgeons should choose a radiopharmaceutical based on cost and side effect profile.
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Affiliation(s)
- Jonathan T Unkart
- Department of Surgery, Moores Cancer Center, University of California, San Diego, California
| | - Ava Hosseini
- Department of Surgery, University of California, San Francisco, California
| | - Anne M Wallace
- Department of Surgery, Moores Cancer Center, University of California, San Diego, California
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Varasteh Z, Hyafil F, Anizan N, Diallo D, Aid-Launais R, Mohanta S, Li Y, Braeuer M, Steiger K, Vigne J, Qin Z, Nekolla SG, Fabre JE, Döring Y, Le Guludec D, Habenicht A, Vera DR, Schwaiger M. Targeting mannose receptor expression on macrophages in atherosclerotic plaques of apolipoprotein E-knockout mice using 111In-tilmanocept. EJNMMI Res 2017; 7:40. [PMID: 28470406 PMCID: PMC5415447 DOI: 10.1186/s13550-017-0287-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 04/18/2017] [Indexed: 12/26/2022] Open
Abstract
Background Atherosclerotic plaque phenotypes are classified based on the extent of macrophage infiltration into the lesions, and the presence of certain macrophage subsets might be a sign for plaque vulnerability. The mannose receptor (MR) is over-expressed in activated macrophages. Tilmanocept is a tracer that targets MR and is approved in Europe and the USA for the detection of sentinel lymph nodes. In this study, our aim was to evaluate the potential of 111In-labelled tilmanocept for the detection of MR-positive macrophages in atherosclerotic plaques of apolipoprotein E-knockout (ApoE-KO) mouse model. Methods Tilmanocept was labelled with 111In. The labelling stability and biodistribution of the tracer was first evaluated in control mice (n = 10) 1 h post injection (p.i.). For in vivo imaging studies, 111In-tilmanocept was injected into ApoE-KO (n = 8) and control (n = 8) mice intravenously (i.v.). The mice were scanned 90 min p.i. using a dedicated animal SPECT/CT. For testing the specificity of 111In-tilmanocept uptake in plaques, a group of ApoE-KO mice was co-injected with excess amount of non-labelled tilmanocept. For ex vivo imaging studies, the whole aortas (n = 9 from ApoE-KO and n = 4 from control mice) were harvested free from adventitial tissue for Sudan IV staining and autoradiography. Cryosections were prepared for immunohistochemistry (IHC). Results 111In radiolabelling of tilmanocept provided a yield of greater than 99%. After i.v. injection, 111In-tilmanocept accumulated in vivo in MR-expressing organs (i.e. liver and spleen) and showed only low residual blood signal 1 h p.i. MR-binding specificity in receptor-positive organs was demonstrated by a 1.5- to 3-fold reduced uptake of 111In-tilmanocept after co-injection of a blocking dose of non-labelled tilmanocept. Focal signal was detected in atherosclerotic plaques of ApoE-KO mice, whereas no signal was detected in the aortas of control mice. 111In-tilmanocept uptake was detected in atherosclerotic plaques on autoradiography correlating well with Sudan IV-positive areas and associating with subendothelial accumulations of MR-positive macrophages as demonstrated by IHC. Conclusions After i.v. injection, 111In-tilmanocept accumulated in MR-expressing organs and was associated with only low residual blood signal. In addition, 111In-tilmanocept uptake was detected in atherosclerotic plaques of mice containing MR-expressing macrophages suggesting that tilmanocept represents a promising tracer for the non-invasive detection of macrophages in atherosclerotic plaques.
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Affiliation(s)
- Zohreh Varasteh
- Department of Nuclear Medicine, Klinikum rechts der Isar der TUM, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - Fabien Hyafil
- Department of Nuclear Medicine, Hôpital Bichat, Paris, France
| | - Nadège Anizan
- Fédération de Recherche en Imagerie Multimodalité, Université Paris Diderot, Paris, France
| | - Devy Diallo
- Fédération de Recherche en Imagerie Multimodalité, Université Paris Diderot, Paris, France
| | | | - Sarajo Mohanta
- Institute for Cardiovascular Prevention, University Hospital of Ludwig-Maximilians-University, Munich, Germany
| | - Yuanfang Li
- Institute for Cardiovascular Prevention, University Hospital of Ludwig-Maximilians-University, Munich, Germany
| | - Miriam Braeuer
- Department of Nuclear Medicine, Klinikum rechts der Isar der TUM, Ismaningerstrasse 22, 81675, Munich, Germany
| | - Katja Steiger
- Institute of Pathology, Technische Universität München, Munich, Germany
| | - Jonathan Vigne
- Department of Nuclear Medicine, Hôpital Bichat, Paris, France
| | - Zhengtao Qin
- UCSD Moores Cancer Center, University of California, San Diego, La Jolla, USA
| | - Stephan G Nekolla
- Department of Nuclear Medicine, Klinikum rechts der Isar der TUM, Ismaningerstrasse 22, 81675, Munich, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
| | - Jean-Etienne Fabre
- INSERM U1148 Laboratory of Vascular Translational Science, Paris, France
| | - Yvonne Döring
- Institute for Cardiovascular Prevention, University Hospital of Ludwig-Maximilians-University, Munich, Germany
| | | | - Andreas Habenicht
- Institute for Cardiovascular Prevention, University Hospital of Ludwig-Maximilians-University, Munich, Germany
| | - David R Vera
- UCSD Moores Cancer Center, University of California, San Diego, La Jolla, USA
| | - Markus Schwaiger
- Department of Nuclear Medicine, Klinikum rechts der Isar der TUM, Ismaningerstrasse 22, 81675, Munich, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
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48
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Lee HJ, Barback CV, Hoh CK, Qin Z, Kader K, Hall DJ, Vera DR, Kane CJ. Fluorescence-Based Molecular Imaging of Porcine Urinary Bladder Sentinel Lymph Nodes. J Nucl Med 2017; 58:547-553. [PMID: 28153955 DOI: 10.2967/jnumed.116.178582] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 10/31/2016] [Indexed: 11/16/2022] Open
Abstract
The primary objective was to test the ability of a laparoscopic camera system to detect the fluorescent signal emanating from sentinel lymph nodes (SLNs) approximately 2 d after injection and imaging of a positron-emitting molecular imaging agent into the submucosa of the porcine urinary bladder. Methods: Three female pigs underwent a submucosal injection of the bladder with fluorescent-tagged tilmanocept, radiolabeled with both 68Ga and 99mTc. One hour after injection, a pelvic PET/CT scan was acquired for preoperative SLN mapping. Approximately 36 h later, robotic SLN mapping was performed using a fluorescence-capable camera system. After identification of the fluorescent lymph nodes, a pelvic lymph node dissection was completed with robotic assistance. All excised nodal packets (n = 36) were assayed for 99mTc activity, which established a lymph node as an SLN. 99mTc activity was also used to calculate the amount of dye within each lymph node. Results: All of the SLNs defined by the ex vivo γ-well assay of 99mTc activity were detected by fluorescence mode imaging. The time between injection and robotic SLN mapping ranged from 32 to 38 h. A total of 5 fluorescent lymph nodes were detected; 2 pigs had 2 fluorescent lymph nodes and 1 pig exhibited a single lymph node. Four of the 5 SLNs exhibited increased SUVs of 12.4-139.0 obtained from PET/CT. The dye content of the injection sites ranged from 371 to 1,441 pmol, which represented 16.5%-64.1% of the injected dose; the amount of dye within the SLNs ranged from 8.5 to 88 pmol, which was equivalent to 0.38%-3.91% of the administered dose. Conclusion: Fluorescent-labeled 68Ga-tilmanocept allows for PET imaging and real-time intraoperative detection of SLNs during robotic surgery.
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Affiliation(s)
- Hak J Lee
- Department of Urology, University of California, San Diego, La Jolla, California
| | - Christopher V Barback
- Department of Radiology, University of California, San Diego, La Jolla, California; and.,UCSD Molecular Imaging Program, University of California, San Diego, La Jolla, California
| | - Carl K Hoh
- Department of Radiology, University of California, San Diego, La Jolla, California; and.,UCSD Molecular Imaging Program, University of California, San Diego, La Jolla, California
| | - Zhengtao Qin
- Department of Radiology, University of California, San Diego, La Jolla, California; and.,UCSD Molecular Imaging Program, University of California, San Diego, La Jolla, California
| | - Kareem Kader
- Department of Urology, University of California, San Diego, La Jolla, California
| | - David J Hall
- Department of Radiology, University of California, San Diego, La Jolla, California; and.,UCSD Molecular Imaging Program, University of California, San Diego, La Jolla, California
| | - David R Vera
- Department of Radiology, University of California, San Diego, La Jolla, California; and .,UCSD Molecular Imaging Program, University of California, San Diego, La Jolla, California
| | - Christopher J Kane
- Department of Urology, University of California, San Diego, La Jolla, California
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49
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Hare JI, Lammers T, Ashford MB, Puri S, Storm G, Barry ST. Challenges and strategies in anti-cancer nanomedicine development: An industry perspective. Adv Drug Deliv Rev 2017; 108:25-38. [PMID: 27137110 DOI: 10.1016/j.addr.2016.04.025] [Citation(s) in RCA: 686] [Impact Index Per Article: 98.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/20/2016] [Accepted: 04/21/2016] [Indexed: 12/12/2022]
Abstract
Successfully translating anti-cancer nanomedicines from pre-clinical proof of concept to demonstration of therapeutic value in the clinic is challenging. Having made significant advances with drug delivery technologies, we must learn from other areas of oncology drug development, where patient stratification and target-driven design have improved patient outcomes. We should evolve our nanomedicine development strategies to build the patient and disease into the line of sight from the outset. The success of small molecule targeted therapies has been significantly improved by employing a specific decision-making framework, such as AstraZeneca's 5R principle: right target/efficacy, right tissue/exposure, right safety, right patient, and right commercial potential. With appropriate investment and collaboration to generate a platform of evidence supporting the end clinical application, a similar framework can be established for enhancing nanomedicine translation and performance. Building informative data packages to answer these questions requires the following: (I) an improved understanding of the heterogeneity of clinical cancers and of the biological factors influencing the behaviour of nanomedicines in patient tumours; (II) a transition from formulation-driven research to disease-driven development; (III) the implementation of more relevant animal models and testing protocols; and (IV) the pre-selection of the patients most likely to respond to nanomedicine therapies. These challenges must be overcome to improve (the cost-effectiveness of) nanomedicine development and translation, and they are key to establishing superior therapies for patients.
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50
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Li N, Zhu H, Li Y, Wang J, Yang Z. Synthesis and evaluation of Cy5.5-Rit tracer for specific near-infrared fluorescence imaging of sentinel lymph node. Bioorg Med Chem Lett 2016; 26:4233-6. [DOI: 10.1016/j.bmcl.2016.07.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 07/05/2016] [Accepted: 07/22/2016] [Indexed: 01/19/2023]
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