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01-02-2015 | Thoracic Oncology

Gallium-68 Neomannosylated Human Serum Albumin-Based PET/CT Lymphoscintigraphy for Sentinel Lymph Node Mapping in Non-small Cell Lung Cancer

Authors: Jae Seon Eo, MD, PhD, Hyun Koo Kim, MD, PhD, Sungeun Kim, MD, PhD, Yun-Sang Lee, PhD, Jae Min Jeong, PhD, Young Ho Choi, MD, PhD

Published in: Annals of Surgical Oncology | Issue 2/2015

Abstract

Purpose

To develop imaging of lymphatics with resolution greater than that of lymphoscintigraphy using technetium-99 m neomannosyl human serum albumin (^99mTc-MSA), we developed a Gallium-68 (⁶⁸Ga) MSA for positron emission tomography (PET). This study is the first clinical trial to evaluate the feasibility of sentinel node detection using this novel ⁶⁸Ga tracer for the management of non-small cell lung cancer.

Methods

We enrolled 34 patients (20 men, 14 women; mean age, 64.3 ± 10.4 years) who were candidates for lobectomy with mediastinal lymph node dissection for clinical stage I non-small cell lung cancer. ⁶⁸Ga-MSA was administered in one injection into the peritumoral region, and lymphoscintigraphy was performed by PET/CT just before surgery. All harvested lymph nodes were cut into 2 mm slices and were ultimately diagnosed using formalin-fixed and paraffin-embedded sections with hematoxylin and eosin staining.

Results

The sentinel nodes were well visualized by PET/CT imaging from 15 to 120 min, and especially within 60 min, after injection. In all patients (100 %), sentinel nodes could be identified on PET/CT. The number of sentinel nodes identified was 1.9 ± 0.9 (range 1–5) per patient. The maximum standardized uptake values were 2882.2 ± 2124.3 in the tumor and 82.5 ± 159.0 in the sentinel nodes. Eight of 34 patients (23.5 %) had metastases in 13 sentinel nodes. No false-negative sentinel nodes were detected in any of the eight patients with N1 or N2 disease (0 %).

Conclusions

⁶⁸Ga-MSA appears to be a promising tracer for sentinel node identification in non-small cell lung cancer.

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Hubbard MO, Fu P, Margevicius S, Dowlati A, Linden PA. Five-year survival does not equal cure in non-small cell lung cancer: a Surveillance, Epidemiology, and End Results-based analysis of variables affecting 10- to 18-year survival. J Thorac Cardiovasc Surg. 2012;143(6):1307–13. doi:10.1016/j.jtcvs.2012.01.078.PubMedCrossRef

Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69–90. doi:10.3322/caac.20107.PubMedCrossRef

Allen MS, Darling GE, Pechet TTV, et al. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg. 2006;81(3):1013–9; discussion 1019-20. doi:10.1016/j.athoracsur.2005.06.066.PubMedCrossRef

Taghizadeh KA, Bagheri R, Tehranian S, Shojaee P, Sadeghi R, Krag D. Accuracy of sentinel node biopsy in the staging of non-small cell lung carcinomas: systematic review and meta-analysis of the literature. Lung Cancer. 2013;80(1):5–14. doi:10.1016/j.lungcan.2013.01.001.CrossRef

Kim S, Kim HK, Kang D-Y, Jeong JM, Choi YH. Intra-operative sentinel lymph node identification using a novel receptor-binding agent (technetium-99 m neomannosyl human serum albumin, 99mTc-MSA) in stage I non-small cell lung cancer. Eur J Cardiothorac Surg. 2010;37(6):1450–6. doi:10.1016/j.ejcts.2010.01.012.PubMedCrossRef

Nomori H, Ikeda K, Mori T, et al. Sentinel node identification in clinical stage Ia non-small cell lung cancer by a combined single photon emission computed tomography/computed tomography system. J Thorac Cardiovasc Surg. 2007;134(1):182–7. doi:10.1016/j.jtcvs.2007.02.013.PubMedCrossRef

Schalin-Jäntti C, Ryhänen E, Heiskanen I, et al. Planar scintigraphy with 123I/99mTc-sestamibi, 99mTc-sestamibi SPECT/CT, 11C-methionine PET/CT, or selective venous sampling before reoperation of primary hyperparathyroidism? J Nucl Med. 2013;54(5):739–47. doi:10.2967/jnumed.112.109561.PubMedCrossRef

Franzius C, Hermann K, Weckesser M, et al. Whole-body PET/CT with 11C-meta-hydroxyephedrine in tumors of the sympathetic nervous system: feasibility study and comparison with 123I-MIBG SPECT/CT. J Nucl Med. 2006;47(10):1635–42.PubMed

Choi JY, Jeong JM, Yoo BC, et al. Development of 68 Ga-labeled mannosylated human serum albumin (MSA) as a lymph node imaging agent for positron emission tomography. Nucl Med Biol. 2011;38(3):371–9. doi:10.1016/j.nucmedbio.2010.09.010.PubMedCrossRef

10.

Jeong JM, Hong MK, Kim YJ, et al. Development of 99mTc-neomannosyl human serum albumin (99mTc-MSA) as a novel receptor binding agent for sentinel lymph node imaging. Nucl Med Commun. 2004;25(12):1211–7.PubMedCrossRef

11.

Ueda K, Suga K, Kaneda Y, et al. Radioisotope lymph node mapping in nonsmall cell lung cancer: can it be applicable for sentinel node biopsy? Ann Thorac Surg. 2004;77(2):426–30. doi:10.1016/S0003-4975(03)01351-1.PubMedCrossRef

12.

Hicks R, Lau E, Binns D. Hybrid imaging is the future of molecular imaging. Biomed Imaging Interv J. 2007;3(3):e49. doi:10.2349/biij.3.3.e49.PubMedCentralPubMedCrossRef

13.

Heuveling DA, van Schie A, Vugts DJ, et al. Pilot study on the feasibility of PET/CT lymphoscintigraphy with 89Zr-nanocolloidal albumin for sentinel node identification in oral cancer patients. J Nucl Med. 2013;54(4):585–9. doi:10.2967/jnumed.112.115188.PubMedCrossRef

14.

Heuveling DA, Visser GWM, Baclayon M, et al. 89Zr-nanocolloidal albumin-based PET/CT lymphoscintigraphy for sentinel node detection in head and neck cancer: preclinical results. J Nucl Med. 2011;52(10):1580–4. doi:10.2967/jnumed.111.089557.PubMedCrossRef

15.

Stroup SP, Kane CJ, Farchshchi-Heydari S, et al. Preoperative sentinel lymph node mapping of the prostate using PET/CT fusion imaging and Ga-68-labeled tilmanocept in an animal model. Clin Exp Metastasis. 2012;29(7):673–80. doi:10.1007/s10585-012-9498-9.PubMedCrossRef

16.

Kim HK, Kim S, Sung HK, Lee Y-S, Jeong JM, Choi YH. Comparison between preoperative versus intraoperative injection of technetium-99 M Neomannosyl human serum albumin for sentinel lymph node identification in early stage lung cancer. Ann Surg Oncol. 2012;19(4):1343–9. doi:10.1245/s10434-011-2130-4.PubMedCrossRef

17.

Shetty D, Lee YS, Jeong JM. 68 Ga-labeled radiopharmaceuticals for positron emission tomography. Nucl Med Mol Imaging. 2010;44(4):233–40.PubMedCentralPubMedCrossRef

18.

Breeman WAP, Verbruggen AM. The 68Ge/68 Ga generator has high potential, but when can we use 68 Ga-labelled tracers in clinical routine? Eur J Nucl Med Mol Imaging. 2007;34(7):978–81. doi:10.1007/s00259-007-0387-4.PubMedCentralPubMedCrossRef

19.

Kim JH, Lee JS, Kang KW, et al. Whole-body distribution and radiation dosimetry of (68)Ga-NOTA-RGD, a positron emission tomography agent for angiogenesis imaging. Cancer Biother Radiopharm. 2012;27(1):65–71. doi:10.1089/cbr.2011.1061.PubMedCrossRef

20.

Fazaeli Y, Jalilian AR, Amini MM, et al. Development of a 68 Ga-fluorinated porphyrin complex as a possible PET imaging agent. Nucl Med Mol Imaging. 2012;46(1):20–6. doi:10.1007/s13139-011-0109-5.PubMedCentralPubMedCrossRef

21.

Eo JS, Paeng JC, Lee S, et al. Angiogenesis imaging in myocardial infarction using 68 Ga-NOTA-RGD PET: characterization and application to therapeutic efficacy monitoring in rats. Coron Artery Dis. 2013;24(4):303–11. doi:10.1097/MCA.0b013e3283608c32.PubMedCrossRef

22.

Wilhelm AJ, Mijnhout GS, Franssen EJ. Radiopharmaceuticals in sentinel lymph-node detection: an overview. Eur J Nucl Med. 1999;26(4 Suppl):S36–42.PubMedCrossRef

Title: Gallium-68 Neomannosylated Human Serum Albumin-Based PET/CT Lymphoscintigraphy for Sentinel Lymph Node Mapping in Non-small Cell Lung Cancer
Authors: Jae Seon Eo, MD, PhD
Hyun Koo Kim, MD, PhD
Sungeun Kim, MD, PhD
Yun-Sang Lee, PhD
Jae Min Jeong, PhD
Young Ho Choi, MD, PhD
Publication date: 01-02-2015
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 2/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-014-3986-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Gallium-68 Neomannosylated Human Serum Albumin-Based PET/CT Lymphoscintigraphy for Sentinel Lymph Node Mapping in Non-small Cell Lung Cancer

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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