First experiences with a new radiopharmaceutical for sentinel lymph node detection in malignant melanoma

Summary

Aim of this study was to localize the sentinel lymph node by lymphoscintigraphy using technetium-99m colloidal rhenium sulphide (Nanocis^®), a new commercially available radiopharmaceutical. Due to the manufacturers’ instructions it is licensed for lymphoscintigraphy. Patients, methods: 35 consecutive patients with histologically proved malignant melanoma, but without clinical evidence of metastases, were preoperatively examined by injecting 20-40 MBq Nanocis^® with (mean particle size: 100 nm; range: 50-200 nm) intradermally around the lesion. Additionally blue dye was injected intaoperatively. A hand-held gamma probe guided sentinel node biopsy. Results: During surgery, the preoperatively scintigraphically detected sentinel lymph nodes were identified in 34/35 (97%) patients. The number of sentinel nodes per patient ranged from one to four (mean: n = 1.8). Histologically, metastatic involvement of the sentinel lymph node was found in 12/35 (34%) patients; the sentinel lymph node positive-rate (14/63 SLN) was 22%. Thus, it is comparable to the findings of SLN-mapping using other technetium-99m-labeled nanocolloides. Conclusion: ^99mTc-bound colloidal rhenium sulphide is also suitable for sentinel node mapping.

Zusammenfassung

Ziel dieser Studie war es, den Wächterlymphknoten (SLN) mittels Lymphszintigraphie unter Einsatz von Technetium-99m markiertem kolloidalem Rheniumsulfid (Nanocis^®), einem neuen, kommerziell erhältlichen Radiopharmakon für lymphszintigraphische Untersuchungen zu lokalisieren. Patienten, Methoden: 35 konsekutive Patienten mit histologisch gesichertem malignen Melanom, jedoch ohne klinische Hinweise auf (Fern-) Metastasierung, wurden präoperativ nach intradermaler, peritumoraler Injektion von 20-40 MBq Nanocis^® (durchschnittliche Partikelgröße: 100 nm; Streubreite: 50-200 nm) untersucht. Zusätzlich erfolgte intraoperativ eine Blaufärbung. Die intraoperative SLN-Detektion wurde mit einer Hand-Gammasonde durchgeführt. Ergebnisse: Intraoperativ konnten bei 34/35 Patienten (97%) insgesamt 63 zuvor szintigraphisch detektierte und auf der Haut markierte Wächterlymphknoten mittels Gammasonde gefunden werden. Mittels Blaufärbung ließen sich lediglich 41/63 (65%) Wächterlymphknoten darstellen. Die Anzahl der Wächterlymphknoten pro Patient betrug 1-4 (Mittel: n = 1,8). Der histologische Befund bestätigte den metastatischen Befall der SLN bei 12/35 (34%) Patienten. Die SLN-positiv-Rate (14/63 SLN) betrug 22%. Sie ist mit den Ergebnissen der SLN-Diagnostik mittels anderer Technetium-99m markierter Nanokolloide vergleichbar. Schlussfolgerung: An Tc-99m gebundenes kolloidales Rheniumsulfid eignet sich zur SLN-Diagnostik.

Keywords

Malignant melanoma - rhenium sulphide - sentinel lymph node - scintigraphy

Schlüsselwörter

Malignes Melanom - Rheniumsulfid - Wächterlymphknoten - Szintigraphie

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