RESUMO
Background: Recent studies show e-cigarette (EC) users have increased rates of chronic bronchitic symptoms that may be associated with depressed mucociliary clearance (MCC). Little is known about the acute or chronic effects of EC inhalation on in vivo MCC. Methods: In vivo MCC was measured in young adult vapers (n = 5 males, mean age = 21) after controlled inhalation of a radiolabeled (Tc99m sulfur colloid) aerosol. Whole-lung clearance of radiolabeled deposited particles was measured over a 90-minute period for baseline MCC and associated with controlled periodic vaping over the first 60 minutes of MCC measurements. The vaping challenge was administered from a fourth generation box mod EC containing unflavored e-liquid (65% propylene glycol/35% vegetable glycerin, 3 mg/mL freebase nicotine). The challenge was administered at the start of each 10-minute interval of MCC measurements and consisted of 1 puff every 30 seconds for 5 minutes (i.e., 10 puffs for each 10-minute period for a total of 60 puffs during the initial 60 minutes of MCC measurements). Results: Compared with baseline, peripheral lung average clearance (%) over the 90 minutes of MCC measures was enhanced, associated with EC challenge, 12 (±6) versus 24 (±6), respectively (p < 0.05 by Wilcoxon signed-rank test). Conclusions: Acute enhancement of in vivo MCC during EC challenge is contrary to recent studies showing nicotine-associated slowing of ciliary beat and mucus transport at higher nicotine levels than those used here. However, our findings are consistent with an acute increase in fluid volume and mucin secretion to the bronchial airway surface that is likely short lived. Research reported in this publication was supported by the National Institutes of Health R01HL139369 and registered with ClinicalTrials.gov (NCT03700892).
Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Pulmão , Depuração Mucociliar , Nicotina , Vaping , Adolescente , Adulto , Feminino , Humanos , Masculino , Adulto Jovem , Administração por Inalação , Aerossóis , Glicerol/administração & dosagem , Pulmão/metabolismo , Pulmão/fisiopatologia , Depuração Mucociliar/efeitos dos fármacos , Nicotina/administração & dosagem , Nicotina/farmacocinética , Nicotina/efeitos adversos , Propilenoglicol/administração & dosagem , Coloide de Enxofre Marcado com Tecnécio Tc 99m/administração & dosagem , Fatores de Tempo , Vaping/efeitos adversosRESUMO
Sentinel lymph node (SLN) mapping by various means has become standard of care in certain types of human cancers and is receiving more attention in veterinary oncology. Current SLN mapping techniques can be costly and often require advanced imaging equipment. The objective of this prospective, method comparison study was to compare an SLN mapping protocol of lymphoscintigraphy to lymphography using water soluble iodinated contrast medium (WIC) and digital radiography for identification of an SLN. Lymphoscintigraphy and lymphography were performed on eight healthy purpose-bred dogs using technetium-99m sulfur colloid and WIC injected into the subcutaneous tissues in a four-quadrant technique around a predefined area of skin on the brachium. Images were obtained using a gamma camera and digital radiography at different time points post-injection. Image sequences were evaluated by one of two American College of Veterinary Radiology board-certified veterinary radiologists. Data obtained were compared between methods using descriptive statistics. An SLN was identified in all dogs with lymphoscintigraphy and seven of eight dogs with lymphography. Agreement between results of the lymphoscintigraphy and lymphography studies was a complete match in three dogs, a partial match in four dogs, and no match in one dog. The SLN detected differed based on the imaging modality used.
Assuntos
Cães/anatomia & histologia , Linfonodo Sentinela/diagnóstico por imagem , Animais , Axila , Vértebras Cervicais , Meios de Contraste/administração & dosagem , Linfografia/veterinária , Linfocintigrafia/veterinária , Masculino , Intensificação de Imagem Radiográfica , Valores de Referência , Coloide de Enxofre Marcado com Tecnécio Tc 99m/administração & dosagemRESUMO
OBJECTIVE: To determine the effect of surgery on lymphoscintigraphy drainage patterns from the canine brachium. STUDY DESIGN: Experimental study. ANIMALS: Eight healthy research beagles. METHODS: A predefined area of skin measuring 2 × 1.5 cm in dimension was designated on either the right or left brachium. Preoperative lymphoscintigraphy was performed with technetium sulfur colloid injected into the subcutaneous tissues around the predefined anatomic location in a four-quadrant technique. Dogs underwent surgery for excision of the predefined area of skin, subcutis, and fascia of the lateral head of the triceps muscle with 1-cm margins. Eighteen days after surgery, lymphoscintigraphy was again performed with technetium sulfur colloid injected into the subcutaneous tissues around the surgical scar in a four-quadrant technique. RESULTS: Sentinel lymph nodes were identified in eight of eight dogs preoperatively and in eight of eight dogs postoperatively. Agreement between the results of the preoperative and postoperative lymphoscintigraphy studies was identified as complete in four of eight dogs and partial in four of eight dogs. Sentinel lymph node identification occurred immediately in three of eight dogs preoperatively and in eight of eight dogs postoperatively. CONCLUSION: Sentinel lymph node identification occurred faster postoperatively. Agreement or partial agreement between the results of the preoperative and postoperative lymphoscintigraphy studies was observed in eight of eight dogs. CLINICAL SIGNIFICANCE: Surgery appears to have an effect on lymphoscintigraphy drainage patterns. Additional studies are required to compare preoperative and postoperative sentinel lymph node mapping patterns in tumor-bearing dogs. However, this study provides preliminary information regarding the effect of surgery on sentinel lymph node identification.
Assuntos
Cães/cirurgia , Drenagem/veterinária , Membro Anterior/cirurgia , Linfonodos/fisiologia , Linfocintigrafia/veterinária , Animais , Masculino , Compostos Radiofarmacêuticos/administração & dosagem , Coloide de Enxofre Marcado com Tecnécio Tc 99m/administração & dosagemRESUMO
Our aim was to investigate the feasibility of measuring antral contractions and duodenal bolus propagation (DBP) during dynamic antral contraction scintigraphy (DACS) as an assessment of antro-pyloro-duodenal coordination (APDC). Gastric emptying scintigraphy (GES) with DACS was performed with Tc-99m sulfur colloid (SC) using increasing doses of 74 MBq (2 mCi) for 10 subjects, 185 MBq (5 mCi) for 11, and 370 MBq (10 mCi) for 11. DACS was performed for 10 min after static images at 0, 30, 60, 120, 180, and 240 min in anterior and right anterior oblique (RAO) projections. Best projection and lowest dose of Tc-99m SC were assessed visually. DBP were quantified utilizing duodenal activity peaks from a region of interest in the first portion of the duodenum. DBP was better visualized in the RAO projection than anterior projection and using 185 MBq (5 mCi) and 370 MBq (10 mCi) compared with 74 MBq (2 mCi). DBP showed infrequent and irregular bolus transfers from the antrum to the duodenum. Antral activity peaks at 60 min averaged 2.91 ± 0.66 per minute and duodenum bolus peaks 0.36 ± 0.18 per minute (ratio 0.36/2.91 = 0.12). DBP activity peaks can be measured during GES with DACS but requires a 185-MBq (5 mCi) dose of Tc-99m SC radiolabeled test meal for adequate DBP signal detection and is better imaged in RAO than anterior projection. DBPs over the first 60 min postmeal ingestion are infrequent with only 12% of the antral contractions propagating into the duodenum. This methodology appears promising to assess APDC.NEW & NOTEWORTHY This study shows that duodenal bolus propagations after meal ingestion can be measured during gastric emptying scintigraphy using dynamic scintigraphy. Duodenal bolus propagation over the first 60 min postmeal ingestion are infrequent with only 12% of the antral contractions propagating into the duodenum. This methodology appears promising to assess antropyloroduodenal coordination in patients with unexplained symptoms of upper gastrointestinal dysmotility.
Assuntos
Duodeno/diagnóstico por imagem , Duodeno/fisiologia , Esvaziamento Gástrico , Trânsito Gastrointestinal , Antro Pilórico/diagnóstico por imagem , Antro Pilórico/fisiologia , Cintilografia , Compostos Radiofarmacêuticos/administração & dosagem , Coloide de Enxofre Marcado com Tecnécio Tc 99m/administração & dosagem , Adulto , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fatores de Tempo , Adulto JovemRESUMO
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.
Assuntos
Anestésicos Locais/uso terapêutico , Lidocaína/uso terapêutico , Linfocintigrafia/efeitos adversos , Dor/etiologia , Dor/prevenção & controle , Coloide de Enxofre Marcado com Tecnécio Tc 99m/administração & dosagem , Idoso , Atitude do Pessoal de Saúde , Neoplasias da Mama/cirurgia , Feminino , Humanos , Injeções , Pessoa de Meia-Idade , Satisfação do Paciente , Cuidados Pré-Operatórios/métodos , Compostos Radiofarmacêuticos/administração & dosagemRESUMO
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.
Assuntos
Metástase Linfática/diagnóstico por imagem , Melanoma/patologia , Compostos Radiofarmacêuticos/administração & dosagem , Biópsia de Linfonodo Sentinela/métodos , Neoplasias Cutâneas/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Dextranos/administração & dosagem , Feminino , Seguimentos , Humanos , Metástase Linfática/patologia , Linfedema/etiologia , Linfedema/prevenção & controle , Linfocintigrafia/métodos , Masculino , Mananas/administração & dosagem , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Biópsia de Linfonodo Sentinela/efeitos adversos , Pentetato de Tecnécio Tc 99m/administração & dosagem , Pentetato de Tecnécio Tc 99m/análogos & derivados , Coloide de Enxofre Marcado com Tecnécio Tc 99m/administração & dosagem , Adulto JovemRESUMO
BACKGROUND: Merkel cell carcinoma (MCC) is a relatively rare skin cancer with high rates of regional lymph node involvement and metastatic spread. National Comprehensive Cancer Network guidelines recommend sentinel lymph node biopsy (SLNB) for staging purposes. The goal of this study is to report our experience utilizing indocyanine green (ICG) fluorescence-based technology to aid in SLNB detection in MCC. METHODS: Consecutive MCC patients who underwent SLNB with radioisotope lymphoscintigraphy, with intraoperative handheld gamma probe, and ICG-based fluorescence imaging from 2012 to 2017 were prospectively studied (Cohort A). A group of historical controls that underwent SLNB for MCC with radioisotope lymphoscintigraphy and vital blue dye (VBD) (lymphazurin or methylene blue dye) was also analyzed (Cohort B). RESULTS: Twenty-four consecutive patients underwent SLNB with lymphoscintigraphy and ICG-based fluorescence and 11 controls underwent SLNB with lymphoscintigraphy and VBD. The localization rate by node with VBD was 63.6% and ICG-based fluorescence was 94.8%. For two patients, a positive sentinel lymph node (SLN) was detected only by ICG-based fluorescence and the nodes were not detected by gamma probe and one patient's only positive node was identified via ICG fluorescence only. VBD or gamma probe did not identify any unique positive SLNs in either cohort B or either cohort, respectively. CONCLUSIONS: In this study, we indicate that ICG-based fluorescence is not only feasible to augment SLN identification, but it has a higher node localization rate as compared to blue dye and it was able to identify positive SLNs otherwise missed by gamma probe. This study suggests the importance of utilizing two modalities to augment SLN identification and that ICG-based fluorescence may be able to identify nodes that would have been otherwise missed by gamma probe. We will continue to follow these patients and enroll more patients in this prospective study to further determine the role that ICG-based fluorescence has in identifying sentinel lymph nodes in MCC.
Assuntos
Carcinoma de Célula de Merkel/patologia , Corantes Fluorescentes/administração & dosagem , Verde de Indocianina/administração & dosagem , Metástase Linfática/diagnóstico por imagem , Linfonodo Sentinela/diagnóstico por imagem , Neoplasias Cutâneas/patologia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Célula de Merkel/diagnóstico por imagem , Estudos de Viabilidade , Feminino , Humanos , Metástase Linfática/patologia , Linfocintigrafia , Masculino , Azul de Metileno/administração & dosagem , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos , Compostos Radiofarmacêuticos/administração & dosagem , Reprodutibilidade dos Testes , Corantes de Rosanilina/administração & dosagem , Linfonodo Sentinela/patologia , Biópsia de Linfonodo Sentinela/métodos , Neoplasias Cutâneas/diagnóstico por imagem , Coloide de Enxofre Marcado com Tecnécio Tc 99m/administração & dosagemRESUMO
BACKGROUND: Injection of Tc99m to localize nodes for sentinel lymph node biopsy is reported by patients as very painful. The purpose of this study was to determine if anesthetic cream reduces pain associated with periareolar injection of Tc99m and to help elucidate conflicting literature regarding the efficacy of anesthetic cream for this procedure. METHODS: A randomized, double-blind, placebo-controlled methodology was used for adult females with breast cancer undergoing periareolar injection of Tc99m for sentinel lymph node biopsy. Pain levels were compared using anesthetic cream (2.5% lidocaine/2.5% prilocaine) vs. placebo. Patient exclusion criteria included use of opioids or adjuvant pain medication or injecting Tc99m the day before surgery. The Numerical Rating Scale was used to assess pain levels immediately after the injections. RESULTS: Comparing 23 experimental and 26 control patients, there was no significant difference between the experimental (median = 4) and the control group (median = 5) on level of pain experienced U= 0.492, P > .05. CONCLUSIONS: The experimental group had a slightly lower median pain score; however, there was no statistically significant difference between those who used the cream compared with those who used a placebo, supporting the conclusion that anesthetic cream does not reduce pain during Tc99m injections. This study adds to the current literature to provide a stronger position that there is no benefit to using anesthetic cream for this procedure.
Assuntos
Anestésicos Locais/administração & dosagem , Neoplasias da Mama/patologia , Dor/prevenção & controle , Biópsia de Linfonodo Sentinela/efeitos adversos , Coloide de Enxofre Marcado com Tecnécio Tc 99m/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Feminino , Humanos , Injeções/efeitos adversos , Metástase Linfática , Pessoa de Meia-Idade , Pomadas , Dor/etiologia , Medição da Dor/métodos , Biópsia de Linfonodo Sentinela/métodosRESUMO
Traditionally lymphoscintigrams are taken after injection of peri-areolar Technetium-99m (Tc-99m) to quantify sentinel nodes before biopsy (SNB). However, recent research suggests that scintigraphy is not an essential adjunct. For service improvement, we stopped using lymphoscintigraphy so as to minimize delay to operating theater and reduce demand on the Nuclear Medicine Department. We audited early outcomes to ensure quality was maintained. 100 consecutive patients undergoing SNB with lymphoscintigrams were investigated. Lymphoscintigrams were reported by Consultant Radiologists. Reported node count (RNC) was compared to biopsied node count (BNC) using Cohen's kappa statistic. Lymphoscintigrams were then discontinued, and the results on the next 69 consecutive patients undergoing SNB were analyzed. The BNC was then compared to BNC in patients having lymphoscintigrams. Of the first 100 patients, RNC ranged from 0-5 (mean=1.84, mode=1) and BNC from 1-4 (mean=1.89, mode=1). 90% of lymphoscintigrams were performed on the day of surgery. Cohen's Kappa statistic was 0.34 (95%CI =0.195 to 0.482, i.e., Fair agreement). RNC was zero in two cases, but SNB was successful. Of 69 patients in the second group with no scan, BNC ranged from 0-4 (mean=1.80, mode=2). There were two cases of failed localization and no significant difference between BNC with or without scans (p=0.16). Sentinel node positivity rate was 36% for those with scans and 25.3% for those without scans, which was not significant (chi-squared, p=0.11). These results correlate to previously published studies. Correlation between RNC and BNC was only in fair agreement, and negative lymphoscintigrams did not result in failed SNB localization. Our study suggests that BNC without scans is safe and effective. Removing the lymphoscintigram will result in measurable cost savings, saving of clinical time (no delay to operating room while waiting for scan or multiple journeys to hospital), freeing the scanner for other scans, and allowing additional time for radiology physicians and staff.
Assuntos
Neoplasias da Mama/diagnóstico por imagem , Linfocintigrafia/estatística & dados numéricos , Biópsia de Linfonodo Sentinela/métodos , Linfonodo Sentinela/diagnóstico por imagem , Idoso , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Compostos Radiofarmacêuticos/administração & dosagem , Estudos Retrospectivos , Corantes de Rosanilina/administração & dosagem , Linfonodo Sentinela/patologia , Linfonodo Sentinela/cirurgia , Coloide de Enxofre Marcado com Tecnécio Tc 99m/administração & dosagemRESUMO
BACKGROUND: Head and neck melanoma is associated with a high false negative (FN) sentinel lymph node biopsy (SLNB) rate. If techniques are developed that can decrease FN SLNBs, better prognostic information will be obtained, and it may be possible to improve overall survival as patients are assigned to the appropriate adjuvant management. Our group previously demonstrated that the combination of lymphoscintigraphy and indocyanine green (ICG) fluorescence-based technology was feasible for SLNB in primary melanoma. METHODS: Consecutive head and neck cutaneous melanoma patients who underwent radioisotope lymphoscintigraphy and ICG-based fluorescence imaging by the senior author (B.G.) from 2012 to 2015 were prospectively enrolled for analysis. Patients were followed postoperatively by the multidisciplinary melanoma team. Main outcome variables were FN rate of SLNB. Length of follow-up was date of surgery to the date of last follow-up/death. RESULTS: There were 10 positive SLNBs, 51 true negative SLNBs, and one FN SLNB. False negative rate was 9.1%, false negative incidence was 1.6%, sensitivity was 91%, and specificity was 100%. Mean follow-up was 27.6, 17.6, and 16.5 mo for true negative, true positive, and FN patients, respectively. CONCLUSIONS: We report the largest cohort of patients with head and neck cutaneous melanoma undergoing SLNB using both a combination of radioactive tracer, gamma probe, and ICG-based fluorescence identification. Our results demonstrate that using concomitant gamma probe-based radioactivity detection and ICG-based fluorescence for SLN identification in head and neck melanoma is reliable, reproducible and, thus far, has produced a low rate of FN SLNB.
Assuntos
Neoplasias de Cabeça e Pescoço/patologia , Metástase Linfática/diagnóstico por imagem , Melanoma/patologia , Biópsia de Linfonodo Sentinela/métodos , Neoplasias Cutâneas/patologia , Idoso , Reações Falso-Negativas , Estudos de Viabilidade , Feminino , Corantes Fluorescentes/administração & dosagem , Seguimentos , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/mortalidade , Humanos , Verde de Indocianina/administração & dosagem , Metástase Linfática/patologia , Linfocintigrafia/métodos , Masculino , Melanoma/diagnóstico por imagem , Melanoma/mortalidade , Pessoa de Meia-Idade , Imagem Óptica/métodos , Prognóstico , Estudos Prospectivos , Compostos Radiofarmacêuticos/administração & dosagem , Reprodutibilidade dos Testes , Linfonodo Sentinela/diagnóstico por imagem , Linfonodo Sentinela/patologia , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/mortalidade , Coloide de Enxofre Marcado com Tecnécio Tc 99m/administração & dosagemRESUMO
BACKGROUND: Sentinel lymph node (SLN) resection is imperative for breast cancer staging. Axillary reverse mapping (ARM) can preserve arm draining nodes and lymphatics during surgery. ARM is generally performed with isosulfan blue (ISB), restricting its use for concurrent SLN biopsy. Indocyanine green (ICG) could serve as an alternative to ISB for ARM procedures. METHODS: SLN mapping and biopsy was performed via periareolar injection of 99 technetium-sulfur colloid (99m TcSc, TSC). ISB and ICG were injected in the upper arm. Blue-stained lymphatics or nodes were visualized in the axilla; ICG was identified using the SPY Elite® system. RESULTS: Twenty-three patients underwent SLN biopsy with or without axillary node dissection and ARM procedures. Twenty of these patients had at least one hot node; 12 patients had SLNs that were only hot, 6 hot/blue/fluorescent, and 2 hot/fluorescent. Overall, crossover of ARM agents with SLNs occurred in 8 cases. Inspection of the axillary cavity after SLN biopsy revealed fluorescent lymphatics and nodes remaining in 14 and 7 patients, respectively. Blue lymphatics and blue nodes were detected in fewer cases. CONCLUSION: Nearly one-third of patients showed crossover between breast and arm draining nodes, which provides insight as to why some patients develop lymphedema symptoms after SLN biopsy. ICG and ISB identify similar numbers of SLNs. As such ICG could substitute for ISB in ARM procedures.
Assuntos
Neoplasias da Mama/diagnóstico por imagem , Biópsia de Linfonodo Sentinela/métodos , Linfonodo Sentinela/diagnóstico por imagem , Adulto , Idoso , Axila , Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Verde de Indocianina/administração & dosagem , Verde de Indocianina/farmacocinética , Excisão de Linfonodo , Metástase Linfática , Pessoa de Meia-Idade , Compostos Radiofarmacêuticos/administração & dosagem , Compostos Radiofarmacêuticos/farmacocinética , Corantes de Rosanilina/administração & dosagem , Corantes de Rosanilina/farmacocinética , Linfonodo Sentinela/metabolismo , Linfonodo Sentinela/patologia , Linfonodo Sentinela/cirurgia , Coloide de Enxofre Marcado com Tecnécio Tc 99m/administração & dosagem , Coloide de Enxofre Marcado com Tecnécio Tc 99m/farmacocinéticaRESUMO
BACKGROUND: To quantify the relationship between regional lung ventilation and coarse aerosol deposition in the supine healthy human lung, we used oxygen-enhanced magnetic resonance imaging and planar gamma scintigraphy in seven subjects. METHODS: Regional ventilation was measured in the supine posture in a 15 mm sagittal slice of the right lung. Deposition was measured by using planar gamma scintigraphy (coronal scans, 40 cm FOV) immediately postdeposition, 1 hour 30 minutes and 22 hours after deposition of 99mTc-labeled particles (4.9 µm MMAD, GSD 2.5), inhaled in the supine posture (flow 0.5 L/s, 15 breaths/min). The distribution of retained particles at different times was used to infer deposition in different airway regions, with 22 hours representing alveolar deposition. The fraction of total slice ventilation per quartile of lung height from the lung apex to the dome of the diaphragm at functional residual capacity was computed, and co-registered with deposition data-apices aligned-using a transmission scan as reference. The ratio of fractional alveolar deposition to fractional ventilation of each quartile (r) was used to evaluate ventilation and deposition matching (r > 1, regional aerosol deposition fraction larger than regional ventilation fraction). RESULTS: r was not significantly different from 1 for all regions (1.04 ± 0.25, 1.08 ± 0.22, 1.03 ± 0.17, 0.92 ± 0.13, apex to diaphragm, p > 0.40) at the alveolar level (r22h). For retention times r0h and r1h30, only the diaphragmatic region at r1h30 differed significantly from 1. CONCLUSIONS: These results support the hypothesis that alveolar deposition is directly proportional to ventilation for â¼5 µm particles that are inhaled in the supine posture and are consistent with previous simulation predictions that show that convective flow is the main determinant of aerosol transport to the lung periphery.
Assuntos
Alvéolos Pulmonares/metabolismo , Ventilação Pulmonar/fisiologia , Decúbito Dorsal , Coloide de Enxofre Marcado com Tecnécio Tc 99m/administração & dosagem , Administração por Inalação , Adulto , Aerossóis , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Cintilografia/métodos , Respiração , Coloide de Enxofre Marcado com Tecnécio Tc 99m/farmacocinética , Volume de Ventilação Pulmonar , Fatores de TempoRESUMO
PURPOSE: Significant variability in the pharmacokinetics and pharmacodynamics of PEGylated liposomal doxorubicin (PLD) exists. PLD undergoes clearance via the mononuclear phagocyte system (MPS). Technetium Tc 99m sulfur colloid (TSC) is approved for imaging MPS cells. We investigated TSC as a phenotypic probe of PLD pharmacokinetics and pharmacodynamics in women with epithelial ovarian cancer. METHODS: TSC 10 mCi IVP was administered and followed by dynamic planar and SPECT/CT imaging and blood pharmacokinetics sampling. PLD 30-40 mg/m(2) IV was administered with or without carboplatin, followed by plasma pharmacokinetics sampling. RESULTS: There was a linear relationship between TSC clearance and encapsulated doxorubicin clearance (R(2) = 0.61, p = 0.02), particularly in patients receiving PLD alone (R(2) = 0.81, p = 0.04). There was a positive relationship (ρ = 0.81, p = 0.01) between maximum grade palmar-plantar erythrodysesthesia toxicity developed and estimated encapsulated doxorubicin concentration in hands. CONCLUSIONS: TSC is a phenotypic probe for PLD pharmacokinetics and pharmacodynamics and may be used to individualize PLD therapy in ovarian cancer and for other nanoparticles in development.
Assuntos
Antibióticos Antineoplásicos/administração & dosagem , Doxorrubicina/análogos & derivados , Neoplasias Epiteliais e Glandulares/tratamento farmacológico , Neoplasias Ovarianas/tratamento farmacológico , Compostos Radiofarmacêuticos/administração & dosagem , Coloide de Enxofre Marcado com Tecnécio Tc 99m/administração & dosagem , Adulto , Idoso , Antibióticos Antineoplásicos/efeitos adversos , Antibióticos Antineoplásicos/farmacocinética , Carboplatina/administração & dosagem , Carcinoma Epitelial do Ovário , Doxorrubicina/administração & dosagem , Doxorrubicina/efeitos adversos , Doxorrubicina/farmacocinética , Feminino , Síndrome Mão-Pé/etiologia , Humanos , Pessoa de Meia-Idade , Neoplasias Epiteliais e Glandulares/patologia , Neoplasias Ovarianas/patologia , Fenótipo , Polietilenoglicóis/administração & dosagem , Polietilenoglicóis/efeitos adversos , Polietilenoglicóis/farmacocinética , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Tomografia Computadorizada por Raios X/métodosRESUMO
Although the 2009 American Joint Committee on Cancer incorporated the internal mammary sentinel lymph node biopsy (IM-SLNB) concept, there has been little change in surgical practice patterns because of the low visualization rate of internal mammary sentinel lymph nodes (IMSLN) with the traditional radiotracer injection technique. In this study, various injection techniques were evaluated in term of the IMSLN visualization rate, and the impact of IM-SLNB on the diagnostic and prognostic value were analyzed.Clinically, axillary lymph nodes (ALN) negative patients (nâ=â407) were divided into group A (traditional peritumoral intraparenchymal injection) and group B (modified periareolar intraparenchymal injection). Group B was then separated into group B1 (low volume) and group B2 (high volume) according to the injection volume. Clinically, ALN-positive patients (nâ=â63) were managed as group B2. Internal mammary sentinel lymph node biopsy was performed for patients with IMSLN visualized.The IMSLN visualization rate was significantly higher in group B than that in group A (71.1% versus 15.5%, Pâ<â0.001), whereas the axillary sentinel lymph nodes were reliably identified in both groups (98.9% versus 98.3%, Pâ=â0.712). With high injection volume, group B2 was found to have higher IMSLN visualization rate than group B1 (75.1% versus 45.8%, Pâ<â0.001). The IMSLN metastasis rate was only 8.1% (12/149) in clinically ALN-negative patients with successful IM-SLNB, and adjuvant treatment was altered in a small proportion. The IMSLN visualization rate was 69.8% (44/63) in clinically ALN-positive patients with the IMSLN metastasis rate up to 20.5% (9/44), and individual radiotherapy strategy could be guided with the IM-SLNB results.The modified injection technique (periareolar intraparenchymal, high volume, and ultrasound guidance) significantly improved the IMSLN visualization rate, making the routine IM-SLNB possible in daily practice. Internal mammary sentinel lymph node biopsy could provide individual minimally invasive staging, prognosis, and decision making of the internal mammary radiotherapy, especially for clinically ALN-positive patients.
Assuntos
Neoplasias da Mama/patologia , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Linfocintigrafia/métodos , Compostos Radiofarmacêuticos/administração & dosagem , Biópsia de Linfonodo Sentinela/métodos , Coloide de Enxofre Marcado com Tecnécio Tc 99m/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Axila , Feminino , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Estadiamento de NeoplasiasRESUMO
PURPOSE: The aim of this study was to quantify the reduction of perceived pain levels during lymphoscintigraphy for melanoma by altering the pH of the Tc-sulfur colloid to near the physiologic value of 7.40. PATIENTS AND METHODS: This is an institutional review board- and Food and Drug Administration-approved randomized, double-blinded, prospective crossover trial, registered with clinicaltrials.org. Before beginning the procedure and after signing informed consent, 60 serial enrollees presenting for sentinel lymph node imaging of melanoma of the thorax and appendicular structures completed a questionnaire addressing background information, administered by a research support nurse.An investigator (N.H.) prepared the injections to be used and labeled them such that no one else could discover which injections contained standard-of-care solution and which contained the pH-altered solution (buffered to near pH 7.40 using sodium bicarbonate).After each injection, the enrollee was asked by a research support nurse to quantify the pain of each injection using a scale of 0 to 10. The injection site location (head, thorax, appendicular structures, and other) was also recorded. RESULTS: Sixty subjects were enrolled in the study, of which 57 had complete data. On average, there was a significant mean (SD) decrease of 1.42 (2.17) points (95% confidence interval, 0.85-2.00) on a pain scale of 0 to 10 when the buffered injections were used as compared with the standard-of-care injections (P < 0.0001). Ordering of injections did not significantly affect perceived pain scores. CONCLUSIONS: The use of sodium bicarbonate to buffer the pH of Tc-sulfur colloid to near the physiologic value of 7.40 significantly reduced perceived pain levels during nonbreast lymphoscintigraphy.
Assuntos
Linfocintigrafia/efeitos adversos , Melanoma/diagnóstico por imagem , Dor/etiologia , Compostos Radiofarmacêuticos/administração & dosagem , Coloide de Enxofre Marcado com Tecnécio Tc 99m/administração & dosagem , Adulto , Feminino , Humanos , Injeções , Linfocintigrafia/métodos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Compostos Radiofarmacêuticos/efeitos adversos , Coloide de Enxofre Marcado com Tecnécio Tc 99m/efeitos adversosRESUMO
BACKGROUND AND PURPOSE: (99)TC combined with blue-dye mapping is considered the best sentinel lymph node (SLN) mapping technique in cervical cancer. Indocyanine green (ICG) with near infrared fluorescence imaging has been introduced as a new methodology for SLN mapping. The aim of this study was to compare these two techniques in the laparoscopic treatment of cervical cancer. METHODS: Medical records of patients undergoing laparoscopic SLN mapping for cervical cancer with either (99)Tc and patent blue dye (Group 1) or ICG (Group 2) from April 2008 until August 2012 were reviewed. Sensitivity, specificity, and overall and bilateral detection rates were calculated and compared. RESULTS: Fifty-eight patients were included in the study-36 patients in Group 1 and 22 patients in Group 2. Median tumor diameter was 25 and 29 mm, and mean SLN count was 2.1 and 3.7, for Groups 1 and 2, respectively. Mean non-SLN (NSLN) count was 39 for both groups. SLNs were ninefold more likely to be affected by metastatic disease compared with NSLNs (p < 0.005). Sensitivity and specificity were both 100 %. Overall detection rates were 83 and 95.5 % (p = nonsignificant), and bilateral detection rates were 61 and 95.5 % (p < 0.005), for Groups 1 and 2, respectively. In 75 % of cases, SLNs were located along the external or internal iliac nodal basins. CONCLUSIONS: ICG SLN mapping in cervical cancer provides high overall and bilateral detection rates that compare favorably with the current standard of care.
Assuntos
Adenocarcinoma/secundário , Carcinoma de Células Escamosas/secundário , Verde de Indocianina/administração & dosagem , Laparoscopia , Linfonodos/patologia , Coloide de Enxofre Marcado com Tecnécio Tc 99m/administração & dosagem , Neoplasias do Colo do Útero/patologia , Adenocarcinoma/cirurgia , Adulto , Carcinoma de Células Escamosas/cirurgia , Corantes/administração & dosagem , Feminino , Seguimentos , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Imagem Óptica/métodos , Prognóstico , Estudos Prospectivos , Compostos Radiofarmacêuticos/administração & dosagem , Biópsia de Linfonodo Sentinela , Neoplasias do Colo do Útero/cirurgiaRESUMO
BACKGROUND: This study sought to determine significance of radiocolloid injection timing for sentinel node biopsy (SNB) after neoadjuvant chemotherapy (NAC). MATERIAL AND METHODS: A retrospective comparison of intraoperative (IRCI) and preoperative (PRCI) radiocolloid injection for SNB was performed in breast cancer patients who had completed NAC. The sentinel node identification rate (SNIDR) was tested for noninferiority by a two-proportion z-test. The differences between clinical demographics, pathologic demographics, and SNIDR were evaluated by Fisher exact test. The difference in the number of sentinel nodes removed was analyzed by two-sample t-test. RESULTS: In the 6-y study period, 120 SNB were performed after NAC: 84 received PRCI and 36 received IRCI. The two groups were similar except there were fewer clinical T2 and more clinical T3 and T4 with IRCI (P = 0.0008). The SNIDR was 92.9% with PRCI and 80.6% with IRCI. By two-proportion z-test, IRCI was not "noninferior" (P = 0.5179). By Fisher exact test, the SNIDR of the two groups did not differ. The SNIDR differs only in patients who experience T downstaging (100% versus 80%, P = 0.0173). The mean number of lymph nodes removed was higher with IRCI: 3.38 versus 2.49 nodes (P = 0.0068). There were more positive SNB with IRCI: 32.1% versus 55.2%, (P = 0.0432). The incidence of nontherapeutic axillary dissection was similar between the two groups (3.6% for PRCI versus 5.6% for IRCI). CONCLUSIONS: IRCI for SNB after NAC may be inferior to PRCI.
Assuntos
Neoplasias da Mama/patologia , Biópsia de Linfonodo Sentinela , Coloide de Enxofre Marcado com Tecnécio Tc 99m/administração & dosagem , Axila , Neoplasias da Mama/terapia , Feminino , Humanos , Excisão de Linfonodo , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estudos RetrospectivosRESUMO
BACKGROUND: Understanding the regional partition of deposition of inhaled particles within the lung is important for improving targeted delivery of inhaled aerosolized drugs. One factor affecting regional deposition is gravity. As the lung deforms under its own weight, changes in lung volume, in airway geometries, and in spatial patterns of ventilation distribution between postures have the potential to alter the regional distribution of deposited particles. METHODS: Using gamma-scintigraphy, we measured regional deposition and clearance of (99m)Tc labeled particles (5 µm) in 6 healthy subjects, with aerosol inhalation occurring both in the supine and seated postures at constant flow (0.5 L/sec) and breathing rate (15 breaths/min). After aerosol deposition, mucociliary clearance data were collected in the seated posture, immediately post-particle administration, 1 h 30 min, 4 h, and 22 h post-inhalation. Relative regional deposition was computed using retention (R) at the different time points, with (1-R(1h30min)), (R(1h30min)- R(4h)), and (R(4h)- R(22h)) corresponding to deposition in the large, intermediate, and small airways, respectively. Alveolar deposition was estimated as the relative retention at 22 h (R(22h)). RESULTS: Relative deposition of coarse particles in the alveolar region decreased from 60±8% seated to 34±16% supine (p=0.04). This change was accompanied by an increase in relative deposition in the intermediate (7±3% seated to 16±17% supine, P=0.09) and small airways (19±6% seated to 34±13% supine, p=0.06) when inhalation occurred in the supine posture. No change was observed in central to peripheral deposition (C/P ratio), the skew of the deposition distribution, or the apex-to-base ratio of deposition between seated and supine postures. CONCLUSIONS: Inhalation of coarse particles in the supine posture shifts relative deposition from the alveolar to the bronchial airways, when compared to the seated posture, likely driven by changes in functional residual capacity, and airway size, as well as changes in the regional distribution of ventilation between postures.
Assuntos
Postura , Alvéolos Pulmonares/metabolismo , Compostos Radiofarmacêuticos/farmacocinética , Absorção pelo Trato Respiratório , Coloide de Enxofre Marcado com Tecnécio Tc 99m/farmacocinética , Administração por Inalação , Adulto , Aerossóis , Feminino , Gravitação , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Depuração Mucociliar , Tamanho da Partícula , Alvéolos Pulmonares/anatomia & histologia , Alvéolos Pulmonares/diagnóstico por imagem , Ventilação Pulmonar , Compostos Radiofarmacêuticos/administração & dosagem , Decúbito Dorsal , Coloide de Enxofre Marcado com Tecnécio Tc 99m/administração & dosagemRESUMO
BACKGROUND AND AIMS: With the debate over extent of lymphadenectomy in endometrial cancer, sentinel lymph node (SLN) mapping may provide a focused approach to evaluate the most relevant lymph nodes (LN) while minimizing the complications. We evaluated SLN mapping using filtered technetium(99), indocyanine green (ICG), and blue dye. METHODS: Prospective evaluation of 100 patients who underwent SLN mapping by using submucosal and deep stromal cervical injections of technetium(99), ICG, and blue dye as part of the staging for endometrial cancer. RESULTS: 286 SLNs were mapped (2.9 per patient) in 92% of patients. The bilateral detection rate was 76%. ICG had a significantly higher SLN detection rate than blue dye in both overall (87% vs 71%, respectively; p=0.005) and bilateral (65% vs 43%, respectively; p=0.002) detection, but similar SLN detection rates compared to technetium(99) in both overall (87% vs 88%, respectively; p=0.83) and bilateral (65% vs 71%, respectively; p=0.36) detection. In eight cases, the SLN was in the para-aortic area and in 14 cases in the pre-sacral, hypogastric vein, or parametrial area. In nine cases, the SLN was positive for metastasis, and in seven cases the SLN was the only positive node. One SLN was falsely negative. No complications or anaphylactic reactions occurred. CONCLUSION: Intra-operative SLN mapping using cervical injection is feasible in patients with endometrial cancer and yields adequate detection rates. It allows mapping of SLNs in areas (pre-sacral, hypogastric vein, parametrial) not routinely sampled. Given the poorer performance of blue dye, surgeons may omit its use if a combination of ICG and technetium(99) is used.
Assuntos
Corantes , Neoplasias do Endométrio/patologia , Verde de Indocianina , Linfonodos/patologia , Biópsia de Linfonodo Sentinela/métodos , Coloide de Enxofre Marcado com Tecnécio Tc 99m , Corantes/administração & dosagem , Neoplasias do Endométrio/reabilitação , Feminino , Humanos , Verde de Indocianina/administração & dosagem , Linfonodos/diagnóstico por imagem , Pessoa de Meia-Idade , Cintilografia , Compostos Radiofarmacêuticos/administração & dosagem , Coloide de Enxofre Marcado com Tecnécio Tc 99m/administração & dosagemRESUMO
Preoperative sentinel node localization (SNL) using a subareolar injection of radiotracer technetium-99m-sulfur colloid (Tc(99m)SC) is associated with significant pain. Lidocaine use during SNL is not widely adopted partly due to a concern that it can obscure sentinel node identification and reduce its diagnostic accuracy. We prospectively identified women with a biopsy-proven infiltrating breast cancer who were awaiting a SNL. The women completed the McGill pain questionnaire, Visual Analog Scale, and Wong-Baker FACES Pain Rating Scale prior to and following SNL. We identified a retrospective cohort of women with similar demographic and tumor characteristics who did not receive lidocaine before SNL. We compared sentinel lymph node identification rates in the two cohorts. We used Wilcoxon rank sum tests to compare continuous measures and Fisher's exact test for categorical measures. Between January 2011 to July 2012, 110 women consented, and 105 were eligible for and received lidocaine prior to Tc(99m)SC injection. The post-lidocaine identification rate of SNL was 95 % with Tc(99m)SC, and 100 % with the addition of intraoperative methylene blue dye/saline. Pain range prior to and following the SNL was unchanged (P = 0.703). We identified 187 women from 2005 to 2009 who did not receive lidocaine during preoperative SNL. There was no significant difference in the success rate of SNL, with or without lidocaine (P = 0.194). The administration of lidocaine during SNL prevents pain related to isotope injection while maintaining the success rate. We have changed our practice at our center to incorporate the use of lidocaine during all SNL.