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European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 11/2017

01-10-2017 | Original Article

Role of ICG-99mTc-nanocolloid for sentinel lymph node detection in cervical cancer: a pilot study

Authors: Pilar Paredes, Sergi Vidal-Sicart, Francisco Campos, Andrés Tapias, Nuria Sánchez, Sergio Martínez, Lorena Carballo, Jaume Pahisa, Aureli Torné, Jaume Ordi, Francesc Carmona, Francisco Lomeña

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 11/2017

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Abstract

Purpose

Sentinel lymph node biopsy (SLNB) can be used for nodal staging in early cervical cancer. For this purpose, the tracers most commonly used are radiotracers based on technetium. For the last decade, indocyanine green (ICG) has been used as a tracer for SLNB in other malignancies with excellent results and, more recently, a combination of ICG and a radiotracer has been shown to have the advantages of both tracers. The aim of this study was to evaluate the role of ICG-99mTc-nanocolloid in SLN detection in patients with cervical cancer.

Methods

This prospective study included 16 patients with cervical cancer. The hybrid tracer was injected the day (19–21 h) before surgery for planar and SPECT/CT lymphoscintigraphy. Blue dye was administered periorificially in 14 patients. SLNs were removed according to their distribution on lymphoscintigraphy and when radioactive, fluorescent and/or stained with blue dye. Nodal specimens were pathologically analysed for metastases including by immunochemistry.

Results

Lymphoscintigraphy and SPECT/CT showed drainage in all patients. A total of 69 SLNs were removed, of which 66 were detected by their radioactivity signal and 67 by their fluorescence signal. Blue dye identified only 35 SLNs in 12 of the 14 patients (85.7%). All patients showed bilateral pelvic drainage. Micrometastases were diagnosed in two patients, and were the only lymphatic nodes involved.

Conclusions

SLNB with ICG-99mTc-nanocolloid is feasible and safe in patients with early cervical cancer. This hybrid tracer provided bilateral SLN detection in all patients and a higher detection rate than blue dye, so it could become an alternative to the combined technique.
Literature
1.
Stehman FB, Bundy BN, DiSaia PJ, Keys HM, Larson JE, Fowler WC. Carcinoma of the cervix treated with radiation therapy. I. A multi-variate analysis of prognostic variables in the Gynecologic Oncology Group. Cancer. 1991;67:2776–85.CrossRefPubMed
2.
3.
Cibula D, Abu-Rustum NR, Dusek L, Zikán M, Zaal A, Sevcik L, et al. Prognostic significance of low volume sentinel lymph node disease in early-stage cervical cancer. Gynecol Oncol. 2012;124:496–501.CrossRefPubMed
4.
Miccò M, Sala E, Lakhman Y, Hricak H, Vargas HA. Role of imaging in the pretreatment evaluation of common gynecological cancers. Womens Health (Lond). 2014;10:299–321.CrossRef
5.
Giammarile F, Bozkurt M, Cibula D, Pahisa J, Oyen W, Paredes P, et al. The EANM clinical and technical guidelines for lymphoscintigraphy and sentinel node localization in gynaecological cancers. Eur J Nucl Med Mol Imaging. 2014;41:1463–77.CrossRefPubMed
6.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines©): Cervical Cancer. Fort Washington, PA: National Comprehensive Cancer Network; 2017.
7.
Rob L, Strnad P, Robova H, Charvat M, Pluta M, Schlegerova D, et al. Study of lymphatic mapping and sentinel node identification in early stage cervical cancer. Gynecol Oncol. 2005;98:281–8.CrossRefPubMed
8.
Paredes P, Vidal-Sicart S, García S, Pahisa J, Torné A, Ordi J, et al. Usefulness of the sentinel node in the treatment and staging of initial cervix cancer. Rev Esp Med Nucl. 2004;23:253–8.CrossRefPubMed
9.
Collarino A, Vidal-Sicart S, Perotti G, Valdes Olmos RA. The sentinel node approach in gynaecological malignancies. Clin Transl Imaging. 2016;4:411–20.CrossRefPubMedPubMedCentral
10.
Domenech B, Paredes P, Rubí S, Pahisa J, Vidal-Sicart S, Pons F. Mirror-image lymph node in FDG PET/CT and SPECT/CT for sentinel node detection. Clin Nucl Med. 2014;39:e241–2.CrossRefPubMed
11.
Jeschke S, Beri A, Grüll M, Ziegerhofer J, Prammer P, Leeb K, et al. Laparoscopic radioisotope-guided sentinel lymph node dissection in staging of prostate cancer. Eur Urol. 2008;53:126–32.CrossRefPubMed
12.
Namikawa K, Yamazaki N. Sentinel lymph node biopsy guided by indocyanine green fluorescence for cutaneous melanoma. Eur J Dermatol. 2011;21:184–90.PubMed
13.
Kitai T, Kawashima M. Transcutaneous detection and direct approach to the sentinel node using axillary compression technique in ICG fluorescence-navigated sentinel node biopsy for breast cancer. Breast Cancer. 2012;19:343–8.CrossRefPubMed
14.
Schaafsma BE, Verbeek FP, Peters AA, van der Vorst JR, de Kroon CD, van Poelgeest MI, et al. Near-infrared fluorescence sentinel lymph node biopsy in vulvar cancer: a randomised comparison of lymphatic tracers. BJOG. 2013;120:758–64.CrossRefPubMedPubMedCentral
15.
Plante M, Touhami O, Trinh X-B, Renaud M-C, Sebastianelli A, Grondin K, et al. Sentinel node mapping with indocyanine green and endoscopic near-infrared fluorescence imaging in endometrial cancer. A pilot study and review of the literature. Gynecol Oncol. 2015;137:443–7.CrossRefPubMed
16.
Stoffels I, Leyh J, Pöppel T, Schadendorf D, Klode J. Evaluation of a radioactive and fluorescent hybrid tracer for sentinel lymph node biopsy in head and neck malignancies: prospective randomized clinical trial to compare ICG-(99m)Tc-nanocolloid hybrid tracer versus (99m)Tc-nanocolloid. Eur J Nucl Med Mol Imaging. 2015;42:1631–8.CrossRefPubMed
17.
Crane LM, Themelis G, Arts HJ, Buddingh KT, Brouwers AH, Ntziachristos V, et al. Intraoperative near-infrared fluorescence imaging for sentinel lymph node detection in vulvar cancer: first clinical results. Gynecol Oncol. 2011;120:291–5.CrossRefPubMed
18.
Sinno AK, Fader AN, Roche KL, Giuntoli RL, Tanner EJ. A comparison of colorimetric versus fluorometric sentinel lymph node mapping during robotic surgery for endometrial cancer. Gynecol Oncol. 2014;134:281–6.CrossRefPubMed
19.
Diab Y. Sentinel lymph nodes mapping in cervical cancer a comprehensive review. Int J Gynecol Cancer. 2017;27:154–8.CrossRefPubMed
20.
Hutteman M, van der Vorst JR, Gaarenstroom KN, Peters AA, Mieog JS, Schaafsma BE, et al. Optimization of near-infrared fluorescent sentinel lymph node mapping for vulvar cancer. Am J Obstet Gynecol. 2013;206:89.e1–5CrossRef
21.
Mathéron HM, van den Berg NS, Brouwer OR, Kleinjan GH, van Driel WJ, Trum JW, et al. Multimodal surgical guidance towards the sentinel node in vulvar cancer. Gynecol Oncol. 2013;131:720–5.CrossRefPubMed
22.
Crane LM, Themelis G, Pleijhuis RG, Harlaar NJ, Sarantopoulos A, Arts HJ, et al. Intraoperative multispectral fluorescence imaging for the detection of the sentinel lymph node in cervical cancer: a novel concept. Mol Imaging Biol. 2011;13:1043–9.CrossRefPubMed
23.
Buckle T, Chin PT, van Leeuwen FW. (Non-targeted) radioactive/fluorescent nanoparticles and their potential in combined pre- and intraoperative imaging during sentinel lymph node resection. Nanotechnology. 2010;21:482001.CrossRefPubMed
24.
van der Poel HG, Buckle T, Brouwer OR, Valdés Olmos RA, van Leeuwen FWB. Intraoperative laparoscopic fluorescence guidance to the sentinel lymph node in prostate cancer patients: clinical proof of concept of an integrated functional imaging approach using a multimodal tracer. Eur Urol. 2011;60:826–33.CrossRefPubMed
25.
KleinJan GH, Bunschoten A, van den Berg NS, Olmos RA, Klop WM, Horenblas S, et al. Fluorescence guided surgery and tracer-dose, fact or fiction? Eur J Nucl Med Mol Imaging. 2016;43:1857–67.CrossRefPubMedPubMedCentral
26.
Brouwer OR, Buckle T, Vermeeren L, Klop WM, Balm AJ, van der Poel HG, et al. Comparing the hybrid fluorescent-radioactive tracer indocyanine green-99mTc-nanocolloid with 99mTc-nanocolloid for sentinel node identification: a validation study using lymphoscintigraphy and SPECT/CT. J Nucl Med. 2012;53:1034–40.CrossRefPubMed
27.
Brouwer OR, van den Berg NS, Mathéron HM, van der Poel HG, van Rhijn BW, Bex A, et al. A hybrid radioactive and fluorescent tracer for sentinel node biopsy in penile carcinoma as a potential replacement for blue dye. Eur Urol. 2014;65:600–9.CrossRefPubMed
28.
Verbeek FP, Tummers QR, Rietbergen DD, Peters AA, Schaafsma BE, van de Velde CJ, et al. Sentinel lymph node biopsy in vulvar cancer using combined radioactive and fluorescence guidance. Int J Gynecol Cancer. 2015;25:1086–93.CrossRefPubMedPubMedCentral
29.
Altgassen C, Hertel H, Brandstädt A, Köhler C, Dürst M, Schneider A. Multicenter validation study of the sentinel lymph node concept in cervical cancer: AGO Study Group. J Clin Oncol. 2008;26:2943–51.CrossRefPubMed
30.
Ruscito I, Gasparri ML, Braicu EI, Bellati F, Raio L, Sehouli J, et al. Sentinel node mapping in cervical and endometrial cancer: indocyanine green versus other conventional dyes – a meta-analysis. Ann Surg Oncol. 2016;23:3749–56.CrossRefPubMed
31.
Frontado LM, Brouwer OR, van den Berg NS, Mathéron HM, Vidal-Sicart S, van Leeuwen FW, et al. Added value of the hybrid tracer indocyanine green-99mTc-nanocolloid for sentinel node biopsy in a series of patients with different lymphatic drainage patterns. Rev Esp Med Nucl Imagen Mol. 2013;32:227–33.PubMed
32.
van den Berg NS, Brouwer OR, Klop WM, Karakullukcu B, Zuur CL, Tan IB, et al. Concomitant radio- and fluorescence-guided sentinel lymph node biopsy in squamous cell carcinoma of the oral cavity using ICG-(99m)Tc-nanocolloid. Eur J Nucl Med Mol Imaging. 2012;39:1128–36.CrossRefPubMed
33.
van den Berg NS, Simon H, Kleinjan GH, Engelen T, Bunschoten A, Welling MM, et al. First-in-human evaluation of a hybrid modality that allows combined radio- and (near-infrared) fluorescence tracing during surgery. Eur J Nucl Med Mol Imaging. 2015;42:1639–47.CrossRefPubMed
34.
Schaafsma BE, van der Vorst JR, Gaarenstroom KN, Peters AA, Verbeek FP, de Kroon CD, et al. Randomized comparison of near-infrared fluorescence lymphatic tracers for sentinel lymph node mapping of cervical cancer. Gynecol Oncol. 2012;127:126–30.CrossRefPubMedPubMedCentral
35.
Pandit-Taskar N, Gemignani ML, Lyall A, Larson SM, Barakat RR, Abu Rustum NR. Single photon emission computed tomography SPECT-CT improves sentinel node detection and localization in cervical and uterine malignancy. Gynecol Oncol. 2010;117:59–64.CrossRefPubMed
36.
Hoogendam JP, Veldhuis WB, Hobbelink MG, Verheijen RH, van den Bosch MA, Zweemer RP. 99mTc SPECT/CT versus planar lymphoscintigraphy for preoperative sentinel lymph node detection in cervical cancer: a systematic review and metaanalysis. J Nucl Med. 2015;56:675–80.CrossRefPubMed
37.
KleinJan GH, van den Berg NS, de Jong J, Wit EM, Thygessen H, Vegt E, et al. Multimodal hybrid imaging agents for sentinel node mapping as a means to (re)connect nuclear medicine to advances made in robot-assisted surgery. Eur J Nucl Med Mol Imaging. 2016;43:1278–87.CrossRefPubMedPubMedCentral
Metadata
Title
Role of ICG-99mTc-nanocolloid for sentinel lymph node detection in cervical cancer: a pilot study
Authors
Pilar Paredes
Sergi Vidal-Sicart
Francisco Campos
Andrés Tapias
Nuria Sánchez
Sergio Martínez
Lorena Carballo
Jaume Pahisa
Aureli Torné
Jaume Ordi
Francesc Carmona
Francisco Lomeña
Publication date
01-10-2017
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 11/2017
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-017-3706-4

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