Top

Published in:

01-05-2006

^99mTc–Evans Blue Dye for Mapping Contiguous Lymph Node Sequences and Discriminating the Sentinel Lymph Node in an Ovine Model

Authors: Chris Tsopelas, PhD, Elaine Bevington, MB, BS, James Kollias, MB, BS, Sabah Shibli, MB, BS, Gelareh Farshid, MB, BS, Brendon Coventry, MB, BS, PhD, Barry E. Chatterton, MB, BS

Published in: Annals of Surgical Oncology | Issue 5/2006

Abstract

Background

The aim of this study was to investigate the potential of ^99mTc–Evans blue for discriminating the sentinel lymph node in multitiered lymph node sequences by using an ovine model. ^99mTc–Evans blue is an agent that has both radioactive and color signals in a single dose. Previous studies in smaller animal models suggested that this agent could have advantages over the dual-injection technique of radiocolloid/blue dye.

Methods

Doses of ^99mTc–Evans blue (∼ 21 MBq) containing Evans blue dye (approximately 4 mg) were administered to the hind limbs or fore limbs of sheep to map the lymphatic drainage patterns, validate its ability to identify the sentinel lymph node, and examine the reproducibility of the technique. The study protocol was repeated with ^99mTc–antimony trisulfide colloid and Patent Blue V dye. After the operative exposure, lymph nodes were identified with the gamma probe and then excised and analyzed for radioactivity (percentage of injected dose) and blue color.

Results

After the administration of ^99mTc–Evans blue, all lymph nodes harvested (35 of 35) in either short chains or long basins were hot and blue. The sentinel lymph nodes concentrated more radioactivity than the second-tier nodes to the extent of 2:1 to 215:1. For radiocolloid/Patent Blue V, the ratios were lower, at 2:1 to 3:1.

Conclusions

^99mTc–Evans blue was found to better discriminate the sentinel lymph node than ^99mTc–antimony trisulfide colloid/Patent Blue V in variable multitier lymph node anatomy, and it is an agent that promises to have positive clinical applications.

Veronesi U, Paganelli G, Viale G, et al. Sentinel lymph node biopsy and axillary dissection in breast cancer: results in a large series. J Natl Cancer Inst 1999; 91:368–73PubMed

Krag DN, Meijer SJ, Weaver DL, et al. Minimal-access surgery for staging of malignant melanoma. Arch Surg 1995; 130:654–8PubMed

Morton DL, Wen D-R, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992; 127:392–9PubMed

Wong SL, Edwards MJ, Chao C, et al. Sentinel lymph node biopsy for breast cancer: impact of the number of sentinel nodes removed on the false-negative rate. J Am Coll Surg 2001; 192:684–9PubMed

Noguchi M. Sentinel lymph node biopsy and breast cancer. Br J Surg 2002; 89:21–34PubMed

McCarter MD, Yeung H, Fey J, Borgen PI, Cody HS. The breast cancer patient with multiple sentinel nodes: when to stop? J Am Coll Surg 2001; 192:692–7CrossRefPubMed

McMasters KM, Tuttle TM, Carlson DJ, et al. Sentinel lymph node biopsy for breast cancer: a suitable alternative to routine axillary dissection in multi-institutional practice when optimal technique is used. J Clin Oncol 2000; 18:2560–6PubMed

Martin RC II, Edwards MJ, Wong SL, et al. Practical guidelines for optimal gamma probe detection of sentinel lymph nodes in breast cancer: results of a multi-institutional study. For the University of Louisville Breast Cancer Study Group. Surgery 2000; 128:139–44CrossRefPubMed

Kern KA. Concordance and validation study of sentinel lymph node biopsy for breast cancer using subareolar injection of blue dye and technetium 99m sulfur colloid. J Am Coll Surg 2002; 195:467–75PubMed

10.

Cox CE, Haddad F, Bass S, et al. Lymphatic mapping in the treatment of breast cancer. Oncology 1998; 12:1283–92PubMed

11.

Nathanson SD, Wachna DL, Gilman D, Karvelis K, Havstad S, Ferrara J. Pathways of lymphatic drainage from the breast. Ann Surg Oncol 2001; 8:821–7

12.

Koizumi M, Nomura E, Yamada Y, et al. Radioguided sentinel node detection in breast cancer patients: comparison of ^99mTc phytate and ^99mTc rhenium colloid efficacy. Nucl Med Commun 2004; 25:1031–7PubMed

13.

Tsopelas C, Sutton R. Erratum. Nomenclature of lymphatic staining agents. J Nucl Med 2003; 44:649.

14.

Motomura K, Inaji H, Komoike Y, et al. Combination technique is superior to dye alone in identification of the sentinel node in breast cancer patients. J Surg Oncol 2001; 76:95–9CrossRefPubMed

15.

Bobin JY, Zinzindohoue C, Isaac S, Saadat M, Roy P. Tagging sentinel lymph nodes: a study of 100 patients with breast cancer. Eur J Cancer 1999; 35:569–73CrossRefPubMed

16.

Bobin JY, Spirito C, Isaac S, et al. Lymph node mapping and axillary sentinel lymph node biopsy in 243 invasive breast cancers with no palpable nodes. The south Lyon hospital center experience (in French). Ann Chir 2000; 125:861–70CrossRefPubMed

17.

Tsopelas C. Technetium-99m labeling of a molecule bearing easily reducible groups. Nucl Med Biol 2000; 27:797–802PubMed

18.

Tsopelas C, Penglis S. Visualisation of lymphatic flow in a rabbit model using ^99mTc-labelled dyes. Hellenic J Nucl Med 2000; 3:96–101

19.

Sutton R, Tsopelas C, Chatterton B, Coventry B, Kollias J. Sentinel node biopsy and lymphoscintigraphy with a technetium ^99m labeled blue dye in a rabbit model. Surgery 2002; 131:44–9CrossRefPubMed

20.

Tsopelas C, Sutton R. Why certain dyes are useful for localising the sentinel lymph node. J Nucl Med 2002; 43:1377–82PubMed

21.

Tsopelas C. Particle size analyses of ⁹⁹Tc-labelled and unlabelled rhenium sulfide and antimony trisulphide colloids intended for application in lymphoscintigraphic studies. J Nucl Med 2001; 42:467–75

22.

Uren RF, Thompson JF, Howman-Giles RB. Lymphatic Drainage of the Skin and Breast—Locating Sentinel Nodes. Singapore: Harwood Academic, 1999 :11–3

23.

El-Tamer M, Saouaf R, Wang T, Fawwaz R. A new agent, blue and radioactive, for sentinel node detection. Ann Surg Oncol 2003; 10:323–9CrossRefPubMed

24.

Farquhar WB, Hunt BE, Taylor JA, Darling SE, Freeman R. Blood volume and its relation to peak O₂ consumption and physical activity in patients with chronic fatigue. Am J Physiol Heart Circ Physiol 2002; 282:H66–71PubMed

25.

Ross MG, Devoe LD, Rosen KG. ST-segment analysis of the fetal electrocardiogram improves fetal heart rate tracing interpretation and clinical decision making. J Matern Fetal Neonatal Med 2004; 15:181–5PubMed

26.

Bernstein IM, Shapiro RE, Whitsel A, Schonberg AL. Relationship of plasma volume to sympathetic tone in nulliparous women. Am J Obstet Gynecol 2003; 188:938–42CrossRefPubMed

27.

Brady SL, Hildner CD, Hutchins BF. Simultaneous videofluoroscopic swallow study and modified Evans blue dye procedure: an evaluation of blue dye visualization in cases of known aspiration. Dysphagia 1999; 14:146–9CrossRefPubMed

28.

Amantea SL, Piva JP, Sanches PR, Palombini BC. Oropharyngeal aspiration in pediatric patients with endotracheal intubation. Pediatr Crit Care Med 2004; 5:152–6PubMed

29.

Zhang S, Wang S, Yao S. Evidence for development of capillary leak syndrome associated with cardiopulmonary bypass in pediatric patients with the homozygous C4A null phenotype. Anesthesiology 2004; 100:1387–93CrossRefPubMed

Title: 99mTc–Evans Blue Dye for Mapping Contiguous Lymph Node Sequences and Discriminating the Sentinel Lymph Node in an Ovine Model
Authors: Chris Tsopelas, PhD
Elaine Bevington, MB, BS
James Kollias, MB, BS
Sabah Shibli, MB, BS
Gelareh Farshid, MB, BS
Brendon Coventry, MB, BS, PhD
Barry E. Chatterton, MB, BS
Publication date: 01-05-2006
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 5/2006
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/ASO.2006.04.020

Keynote webinar | Spotlight on medication adherence

Springer Medicine

^99mTc–Evans Blue Dye for Mapping Contiguous Lymph Node Sequences and Discriminating the Sentinel Lymph Node in an Ovine Model

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2006

Size of Residual Lymph Node Metastasis After Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer Patients Is Prognostic

Is En-Bloc Resection of Locally Recurrent Rectal Carcinoma Involving the Urinary Tract Indicated?

Ann. Surg. Oncol., Vol. 13, No. 2, February 2006, pp. 137–139 (DOI: 10.1245/ASO.2006.05.059)

The “Alphabet Soup” of Peritoneal Dissemination From Appendiceal Neoplasms and Other Malignancies

The Evolution of Extremity Reconstruction for Soft Tissue Sarcoma

The Promise of Metastasectomy in Melanoma