RESUMEN
INTRODUCTION: This study investigates the incidence of extrahepatic perfusion and incomplete hepatic perfusion at intraoperative methylene blue testing and on postoperative nuclear imaging in patients undergoing hepatic arterial infusion pump (HAIP) chemotherapy. METHODS: The first 150 consecutive patients who underwent pump implantation in the Netherlands were included. All patients underwent surgical pump implantation with the catheter in the gastroduodenal artery. All patients underwent intraoperative methylene blue testing and postoperative nuclear imaging (99mTc-Macroaggregated albumin SPECT/CT) to determine perfusion via the pump. RESULTS: Patients were included between January-2018 and December-2021 across eight centers. During methylene blue testing, 29.3% had extrahepatic perfusion, all successfully managed intraoperatively. On nuclear imaging, no clinically relevant extrahepatic perfusion was detected (0%, 95%CI: 0.0-2.5%). During methylene blue testing, 2.0% had unresolved incomplete hepatic perfusion. On postoperative nuclear imaging, 8.1% had incomplete hepatic perfusion, leading to embolization in only 1.3%. CONCLUSION: Methylene blue testing during pump placement for intra-arterial chemotherapy identified extrahepatic perfusion in 29.3% of patients, but could be resolved intraoperatively in all patients. Postoperative nuclear imaging found no clinically relevant extrahepatic perfusion and led to embolization in only 1.3% of patients. The role of routine nuclear imaging after HAIP implantation should be studied in a larger cohort.
Asunto(s)
Arteria Hepática , Infusiones Intraarteriales , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Antineoplásicos/administración & dosificación , Arteria Hepática/diagnóstico por imagen , Incidencia , Bombas de Infusión Implantables , Circulación Hepática , Neoplasias Hepáticas/cirugía , Azul de Metileno/administración & dosificación , Países Bajos/epidemiología , Estudios Retrospectivos , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único , Agregado de Albúmina Marcado con Tecnecio Tc 99m/administración & dosificaciónRESUMEN
PURPOSE: To characterize estimated mean absorbed tumor dose (ADT), objective response (OR), and estimated target dose of hepatocellular carcinoma (HCC) after resin microsphere yttrium-90 (90Y) radioembolization using partition dosimetry. MATERIALS AND METHODS: In this retrospective, single-center study, multicompartment dosimetry of index tumors receiving 90Y radioembolization between October 2015 and June 2022 was performed using a commercial software package and pretreatment technetium-99m macroaggregated albumin single photon emission computed tomography (SPECT)/computed tomography (CT). In total, 101 patients with HCC underwent 102 treatments of 127 index tumors. Patients underwent imaging every 2-3 months after treatment to determine best response per modified Response Evaluation Criteria in Solid Tumors (mRECIST). Best response was defined as the greatest response category per mRECIST and categorized as OR or nonresponse (NR). A Cox proportional hazards model evaluated the probability of tumor OR and progression-free survival using ADT. RESULTS: The median follow-up period was 148 days (interquartile range [IQR], 92-273 days). The median ADT of OR was 141.9 Gy (IQR, 89.4-215.8 Gy) compared with the median ADT of NR treatments of 70.8 Gy (IQR, 42.0-135.3 Gy; P < .001). Only ADT was predictive of response (hazard ratio = 2.79 [95% confidence interval {CI}: 1.44-5.40]; P = .003). At 6 months, an ADT of 157 Gy predicted 90.0% (95% CI: 41.3%-98.3%) probability of OR. At 1 year, an ADT of 157 Gy predicted 91.6% (95% CI: 78.3%-100%) probability of progression-free survival. Partition modeling and delivered activity were predictive of progression (P = .021 and P = .003, respectively). CONCLUSIONS: For HCC treated with resin microspheres, tumors receiving higher ADT exhibited higher rates of OR. An ADT of 157 Gy predicted 90.0% OR at 6 months.
Asunto(s)
Carcinoma Hepatocelular , Embolización Terapéutica , Neoplasias Hepáticas , Microesferas , Valor Predictivo de las Pruebas , Radiofármacos , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único , Agregado de Albúmina Marcado con Tecnecio Tc 99m , Radioisótopos de Itrio , Humanos , Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/terapia , Carcinoma Hepatocelular/radioterapia , Carcinoma Hepatocelular/patología , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/terapia , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/mortalidad , Estudios Retrospectivos , Radioisótopos de Itrio/administración & dosificación , Radioisótopos de Itrio/efectos adversos , Masculino , Femenino , Persona de Mediana Edad , Radiofármacos/administración & dosificación , Radiofármacos/efectos adversos , Anciano , Embolización Terapéutica/efectos adversos , Agregado de Albúmina Marcado con Tecnecio Tc 99m/administración & dosificación , Resultado del Tratamiento , Factores de Tiempo , Planificación de la Radioterapia Asistida por Computador , Anciano de 80 o más Años , Programas Informáticos , Dosificación Radioterapéutica , AdultoRESUMEN
INTRODUCTION: The classical lymphoscintigraphic investigations of lower-limb lymphatic edema [LLLE] sometimes reveal either no or few lymph nodes [LNs] at the root of the limb[s] and/or in the abdomen. The aim of the present paper is to report the results of performing one additional injection at the root of the edematous limb[s] to force the visualization of the LNs and/or to demonstrate the collateral lymphatic pathways in such patients. METHODS AND FINDINGS: We retrospectively reviewed our database and found 99 patients [44 primary LLLE with 47 limbs injected and 55 with LLLE secondary to treatments for cancer with 64 limbs injected] where such an additional injection had been performed. In the 43 LLLE patients where no LNs were seen at the end of the classical exam [15 primary LLLE and 28 secondary LLLE], the extra injection showed lymphatic drainage toward LN[s] in all except 3 and when at least one LN was seen, the injection showed lymphatic drainage in every case toward the same ipsilateral [inguinal and/or iliac] LNs [as shown by the classical injection] and/or toward additional LNs. In 40.7% of patients, we observed one or more additional lymphatic pathways: prepubic superficial lymphatic vessels [LV] crossing the midline anteriorly toward contralateral inguinal LNs in 21 [18.9%], "posterior" LV [toward contralateral inguinal LNs and/or ipsi- or contralateral lumbo-aortic and/or para-renal LNs] in 14 [12.6%], but deep LV toward the ipsilateral common iliac LNs passing between the gluteal muscles in 32 [28.8%]. CONCLUSION: Our work pinpoints one limitation of classical bipedal radionuclide lymphangiography. In patients with primary and secondary LLLE where inguinal and/or iliac LNs cannot be seen on bipedal radionuclide lymphangiography, this additional injection reveals the true lympho-nodal status and shows unexpected collateral lymphatic pathways in 40% of cases. Such information is of the utmost importance in LLLE management and its acquisition is consequently recommended in these patients.
Asunto(s)
Vasos Linfáticos/diagnóstico por imagen , Linfedema/diagnóstico , Linfocintigrafia/métodos , Agregado de Albúmina Marcado con Tecnecio Tc 99m/administración & dosificación , Pentetato de Tecnecio Tc 99m/administración & dosificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Conducto Inguinal , Inyecciones/estadística & datos numéricos , Extremidad Inferior , Ganglios Linfáticos , Linfedema/etiología , Linfedema/terapia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
Patients with severe acute liver injury (SLI) usually recover spontaneously. However, some SLI patients progress to acute liver failure with varying degrees of hepatic encephalopathy. Acute liver failure is associated with high mortality and can be substantially reduced by liver transplantation. Therefore, distinguishing SLI patients who might progress to acute liver failure and are at a risk of death is important when evaluating patients needing liver transplantation. The present study aimed to determine whether technetium-99m-diethylenetriaminepentaacetic acid galactosyl human serum albumin (Tc-99m GSA) scintigraphy can predict the prognosis of patients with SLI. This prospective observational study included 69 SLI patients. The accuracy of Tc-99m GSA for predicting death or liver transplantation for 6 months was assessed. Between the two groups of patients stratified based on the cut-off values from the receiver operating characteristic curves, 6-month transplant-free survival was compared. Sixteen (23.2%) patients died or underwent liver transplantation from admission (poor outcome). The hepatic accumulation index was calculated by dividing the radioactivity of the liver region of interest by that of the liver-plus-heart region of interest at 15 min (i.e., LHL15). The LHL15 in the 16 patients (0.686) was significantly lower than that in survivors (0.836; P < 0.0001). The optimal LHL15 cut-off for distinguishing poor outcome and survival was 0.737 with a sensitivity of 81.3%, specificity of 88.7%, and area under the curve of 0.907 (95% CI, 0.832-0.981). When patients were divided into two groups based on the LHL15 cut-off value, the 6-month transplant-free survival was significantly lower in patients with an LHL15 level ≤ 0.737. Tc-99m GSA scintigraphy may help predict the prognosis of patients with SLI.
Asunto(s)
Encefalopatía Hepática/diagnóstico , Fallo Hepático Agudo/diagnóstico , Hígado/diagnóstico por imagen , Agregado de Albúmina Marcado con Tecnecio Tc 99m/administración & dosificación , Pentetato de Tecnecio Tc 99m/administración & dosificación , Adulto , Anciano , Hepatectomía , Encefalopatía Hepática/diagnóstico por imagen , Encefalopatía Hepática/patología , Humanos , Hígado/lesiones , Hígado/patología , Hígado/cirugía , Fallo Hepático Agudo/diagnóstico por imagen , Fallo Hepático Agudo/patología , Fallo Hepático Agudo/terapia , Pruebas de Función Hepática , Trasplante de Hígado/normas , Masculino , Persona de Mediana Edad , Pronóstico , Cintigrafía , Radiofármacos/administración & dosificaciónRESUMEN
BACKGROUND/AIM: Intraarterial Technetium-99m-Macroaggregated Albumin (99mTc-MAA) administration is an established method to predict particle distribution prior to radioembolization. This study aimed to analyse the impact of intraarterial administration of 99mTc-MAA on changes in liver-specific laboratory parameters and to assess whether such changes are associated with post-radioembolization hepatotoxicity. PATIENTS AND METHODS: A total of 202 patients treated with radioembolization received prior mapping angiography with 99mTc-MAA administration. All patients underwent clinical and laboratory examinations, including liver-specific parameters at certain times before and after mapping angiography/99mTc-MAA administration, as well as before radioembolization and during follow-up. RESULTS: Bilirubin increased temporarily after 99mTc-MAA administration (p<0.001), but was not clinically relevant, and returned close to the initial value before radioembolization. These changes showed no association with subsequent postradioembolic hepatotoxicity or shortened overall survival. CONCLUSION: 99mTc-MAA administration results in a significant, however, not clinically relevant transient increase in bilirubin levels, which does not provide a predictive value for subsequent radioembolization outcome or postradioembolic hepatotoxicity.
Asunto(s)
Enfermedad Hepática Inducida por Sustancias y Drogas/diagnóstico , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Embolización Terapéutica/efectos adversos , Neoplasias Hepáticas/complicaciones , Neoplasias Hepáticas/terapia , Radiofármacos/efectos adversos , Agregado de Albúmina Marcado con Tecnecio Tc 99m/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Angiografía por Tomografía Computarizada , Manejo de la Enfermedad , Embolización Terapéutica/métodos , Femenino , Humanos , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Pronóstico , Radiofármacos/administración & dosificación , Estudios Retrospectivos , Agregado de Albúmina Marcado con Tecnecio Tc 99m/administración & dosificación , Resultado del TratamientoRESUMEN
PURPOSE: To evaluate whether the recalculation of lung shunt fraction (LSF) is necessary prior to next-stage or same lobe repeat radioembolization. MATERIALS AND METHODS: Retrospective chart review was performed for patients who underwent radioembolization between February 2008 and December 2018. Eighty of 312 patients had repeat mapping angiograms and LSF calculations. A total of 160 LSF calculations were made using planar imaging (155, [97%]) and single-photon emission computed tomography (5 [3%]) technetium-99m macroaggregated albumin hepatic arterial injection imaging. The mean patient age was 61.8 years ± 12.7; 69 (86%) patients had metastatic disease and 11 (14%) had hepatocellular carcinoma. RESULTS: Patients had a median LSF of 5% (interquartile range [IQR] 3%-9%) with a median absolute difference of 1.25 (IQR 0.65-3.4) and a median of 76 days (IQR 42.5-120 days) between repeat LSF calculations. There was a median change in LSF of 0.2% between mapping studies (P = .11). There was no statistical significance between the repeat LSFs regardless of the arterial distribution (P = .79) or between tumor types (P = .75). No patients exceeded lung dose limits using actual or predicted prescribed dose amounts. The actual median lung dose was 2.6 Gy (IQR 1.8-4.4 Gy, maximum = 20.5) for the first radioembolization and 2.0 Gy (IQR 1.3-3.7 Gy, maximum = 10.1) for the second radioembolization. CONCLUSIONS: No significant difference in LSF was identified between different time points and arterial distributions within the same patient undergoing repeat radioembolization. In patients who receive well under 30-Gy lung dose for the initial treatment and a 50-Gy cumulative lung dose, repeat radioembolization treatments in the same patient may not require a repeat LSF calculation.
Asunto(s)
Angiografía , Carcinoma Hepatocelular/terapia , Embolización Terapéutica , Neoplasias Hepáticas/terapia , Pulmón/diagnóstico por imagen , Neumonitis por Radiación/prevención & control , Radiofármacos/administración & dosificación , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Hepatocelular/patología , Embolización Terapéutica/efectos adversos , Femenino , Humanos , Circulación Hepática , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/secundario , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Circulación Pulmonar , Dosis de Radiación , Neumonitis por Radiación/diagnóstico por imagen , Neumonitis por Radiación/etiología , Radiofármacos/efectos adversos , Retratamiento , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Agregado de Albúmina Marcado con Tecnecio Tc 99m/administración & dosificación , Resultado del TratamientoRESUMEN
Endometrial cancer is the most commonly diagnosed gynecological malignancy in developing countries, and the second malignancy after cervical cancer in developing countries. The primary treatment is based on surgical and pathologic staging including extrafascial type A radical hysterectomy bilateral salpingo-oophorectomy and pelvic and latero-aortic lymphadenectomy. Minimally invasive surgery is the most widely used technique. Sentinel node biopsy is part of this concept and has reached the management of endometrial cancer. The aim of this review was to describe the history, the different injection techniques and results of sentinel node biopsy, and analyze the future role of this technique in endometrial carcinoma.
Asunto(s)
Neoplasias Endometriales/patología , Biopsia del Ganglio Linfático Centinela/métodos , Ganglio Linfático Centinela/patología , Colorimetría/métodos , Colorantes , Neoplasias Endometriales/diagnóstico por imagen , Neoplasias Endometriales/cirugía , Femenino , Humanos , Histerectomía/métodos , Verde de Indocianina/administración & dosificación , Inyecciones/métodos , Escisión del Ganglio Linfático/métodos , Azul de Metileno , Radiofármacos/administración & dosificación , Colorantes de Rosanilina , Ganglio Linfático Centinela/diagnóstico por imagen , Biopsia del Ganglio Linfático Centinela/tendencias , Espectroscopía Infrarroja Corta , Agregado de Albúmina Marcado con Tecnecio Tc 99m/administración & dosificaciónRESUMEN
PURPOSE: The development of erratic distribution of cervical metastases from oral cavity squamous cell carcinoma (OSCC) bypassing the typical metastatic pattern can possibly challenge the role of the classic neck dissection. The purpose of this study was to assess the role of lymphoscintigraphy (LS) and radio-guided neck dissection as a simple and widely accessible method with a favorable cost/benefit ratio, able to improve the OSCC staging and possibly to tailor the surgical approach to cervical lymph node dissection. METHODS: From June 2015 to December 2018, 16 patients (5 women, 11 men, median age 59.5±12.5 years) with cN0 (10) and cN+ (6) OSCC were enrolled. The day before surgery all patients underwent LS with acquisition of planar and SPECT (Single Photon Emission Computed Tomography)/CT images, after a peritumoral injection of 99mTc-Nanocoll® (median 74±1.2 MBq). Patients underwent tumor excision and a radioguided neck dissection, using a portable gamma camera. The sentinel lymph nodes (SLNs) were isolated and separately analyzed in 200-micron sections and pancytokeratin immunohistochemistry assessment, looking for micrometastases. RESULTS: A homolateral lymphatic spread on LS was observed in all cases, whereas in 5 cases (31.3%) lymphatic drainage was contralateral to the OSCC site. In one cN0 patient, a skip micrometastasis has been identified in a SLN. CONCLUSION: The results of the present study may suggest a role of LS and radioguided neck dissection in detecting the real lymphatic spread of OSCC, in order to improve the oncological assessment and to tailor the neck dissection.
Asunto(s)
Neoplasias de la Boca/diagnóstico , Neoplasias de la Boca/cirugía , Ganglio Linfático Centinela/diagnóstico por imagen , Carcinoma de Células Escamosas de Cabeza y Cuello/diagnóstico , Carcinoma de Células Escamosas de Cabeza y Cuello/cirugía , Femenino , Humanos , Escisión del Ganglio Linfático/métodos , Ganglios Linfáticos/patología , Metástasis Linfática/diagnóstico , Metástasis Linfática/patología , Linfocintigrafia/métodos , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/patología , Disección del Cuello/métodos , Estadificación de Neoplasias/métodos , Radiofármacos/administración & dosificación , Ganglio Linfático Centinela/patología , Ganglio Linfático Centinela/cirugía , Biopsia del Ganglio Linfático Centinela/métodos , Carcinoma de Células Escamosas de Cabeza y Cuello/patología , Agregado de Albúmina Marcado con Tecnecio Tc 99m/administración & dosificación , Tomografía Computarizada de Emisión de Fotón Único/métodosRESUMEN
This report describes a technique for measuring lung shunt fraction (LSF) twice in a single session during planning arteriography for radioembolization using low and standard dose technetium-99m macroaggregated albumin (99mTc-MAA). A patient with a 16.0 cm hepatocellular carcinoma and LSF of 70% was treated with lenvatinib for 4 weeks. Planning arteriography with administration of 0.5 millicuries of 99mTc-MAA was then performed. Arterial access was maintained while the LSF was calculated, which was persistently elevated at 54%. Embolization of arteriovenous shunts was performed during the same session and 5.0 millicuries of 99mTc-MAA were administered. The repeat LSF was 29%. Successful radioembolization was subsequently performed.
Asunto(s)
Angiografía , Embolización Terapéutica , Circulación Hepática , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/radioterapia , Circulación Pulmonar , Radiofármacos/administración & dosificación , Agregado de Albúmina Marcado con Tecnecio Tc 99m/administración & dosificación , Anciano , Humanos , Neoplasias Hepáticas/fisiopatología , Masculino , Valor Predictivo de las Pruebas , Resultado del TratamientoRESUMEN
INTRODUCTION: The low accuracy of pre-operative imaging techniques for prediction of nodal status strengthens the relevance of sentinel lymph node (SLN) biopsy in endometrial cancer, although the optimal method for its detection is still under investigation. The increasing use of indocyanine green (ICG) has aroused concern about its enhanced visualization of lymphatic channels, which could lead to a specimen that is thought to be nodal tissue not subsequently yielding a lymph node on pathologic analysis ('empty node packet'). Our main objective was to compare the overall and bilateral detection rates for SLN biopsy using two combined techniques: technetium-99m-ICG (Tc-99m-ICG) versus technetium-99m-methylene blue (Tc-99m-MB). Our secondary aim was to compare the 'empty node packet' rates between the two cohorts. METHODS: A prospective, non-randomized, single-center trial including patients diagnosed with endometrial cancer (any grade or histology) in pre-operative early stage, and operated on between February 2017 and July 2019. All tracers were injected intracervically. Pelvic and aortic lymphadenectomy were performed on patients at intermediate or high risk of recurrence pre-operatively. All SLNs were sent for intra-operative frozen section and afterwards processed following an ultrastaging protocol. RESULTS: Eighty-four patients were included, 58% (n=49) in the Tc-99m-MB group and 42% (n=35) in the Tc-99m-ICG group. Overall detection rate was 93% and was not statistically different between the two groups. A better bilateral detection rate was observed among Tc-99m-ICG patients (69% vs 41%, p=0.012). The 'empty node packet' rate was 4% in the Tc-99m-ICG cohort and 0% in the Tc-99m-MB cohort (p=0.032). DISCUSSION: Tc-99m-ICG is a feasible, safe technique for SLN biopsy in early-stage endometrial cancer, and appears to be superior in terms of bilateral detection to Tc-99m-MB. The addition of Tc-99m to ICG could decrease the rate of 'empty node packets' and better define the anatomic location of SLNs in patients with endometrial cancer.
Asunto(s)
Neoplasias Endometriales/patología , Verde de Indocianina/administración & dosificación , Azul de Metileno/administración & dosificación , Biopsia del Ganglio Linfático Centinela/métodos , Ganglio Linfático Centinela/patología , Agregado de Albúmina Marcado con Tecnecio Tc 99m/administración & dosificación , Anciano , Colorantes/administración & dosificación , Neoplasias Endometriales/diagnóstico por imagen , Neoplasias Endometriales/cirugía , Femenino , Humanos , Persona de Mediana Edad , Cuidados Preoperatorios/métodos , Radiofármacos/administración & dosificación , Ganglio Linfático Centinela/diagnóstico por imagen , Ganglio Linfático Centinela/cirugía , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único/métodosRESUMEN
Importance: The metastatic status of sentinel lymph nodes (SLNs) is the most relevant prognostic factor in breast cancer, melanoma, and other tumors. The conventional standard to label SLNs is lymphoscintigraphy with technetium Tc 99m. A worldwide shortage and known disadvantages of Tc 99m have intensified efforts to establish alternative, nonradioactive imaging techniques. Objective: To assess a new nonradioactive method using multispectral optoacoustic tomographic (MSOT) imaging in comparison with conventional lymphoscintigraphic imaging for SLN biopsy (SLNB) in melanoma. Design, Setting, and Participants: Analysis of a cross-sectional study was conducted at the University Hospital-Essen, Skin Cancer Center, Essen, Germany. Between June 2, 2014, and February 22, 2019, 83 patients underwent SLNB with an additional preoperative indocyanine green (ICG) application. Sentinel lymph node basins were preoperatively identified by MSOT imaging, and ICG-labeled SLNs were intraoperatively detected using a near-infrared camera. The surgeons were blinded to the lymphoscintigraphic imaging results in the beginning of the SLNB. Use of a γ probe was restricted until the SLNB procedure was attempted by the nonradioactive method. Main Outcomes and Measures: Concordance of SLN basins and SLNs identified by MSOT imaging plus near-infrared camera vs lymphoscintigraphic imaging plus single-photon emission computed tomographic or computed tomographic imaging was assessed. Results: Of the 83 patients (mean [SD] age, 54.61 [17.53] years), 47 (56.6%) were men. In 83 surgical procedures, 165 SLNs were excised. The concordance rate of ICG-labeled and Tc 99m-marked detected SLN basins was 94.6% (n = 106 of 112). Intraoperatively, 159 SLNs were detected using a near-infrared camera and 165 were detected by a γ probe, resulting in a concordance rate of 96.4%. Multispectral optoacoustic tomographic imaging visualized SLNs in all anatomic regions with high penetration depth (5 cm). Conclusions and Relevance: The findings of this study suggest that nonradioactive SLN detection via MSOT imaging allows identification of SLNs at a frequency equivalent to that of the current radiotracer conventional standard. Multispectral optoacoustic tomographic imaging appears to be a viable nonradioactive alternative to detect SLNs in malignant tumors.
Asunto(s)
Linfocintigrafia/métodos , Melanoma/patología , Técnicas Fotoacústicas/métodos , Biopsia del Ganglio Linfático Centinela/métodos , Adulto , Anciano , Colorantes/administración & dosificación , Estudios Transversales , Femenino , Humanos , Verde de Indocianina/administración & dosificación , Masculino , Persona de Mediana Edad , Radiofármacos/administración & dosificación , Agregado de Albúmina Marcado con Tecnecio Tc 99m/administración & dosificación , Tomografía Computarizada por Rayos XRESUMEN
Radioembolization with Yttrium-90 (Y90) has been proven safe and effective for the treatment of primary and secondary hepatic malignancies. Standard protocols have necessitated planning angiography with Technetium-99m macroaggregated albumin (Tc99m MAA) administration/scan typically 1-2 weeks prior to the radioembolization therapy. The intent of this practice is to ensure appropriate patient selection and treatment candidacy while also confirming best dosimetry approaches. At our center, we started performing "same-day Y90" in 2008; in a subset of international patients with travel hardship, we performed the planning and treatment procedures consecutively on the same day. In this article, we reveal our practical approach to treating patients on the same day as planning angiography. With more than 160 same-day procedures completed between 2008 and 2017, the safety and efficacy of such a paradigm has been established at our center. This approach is appealing to patients, their families, and referring physicians. Appropriate patient selection and proper preprocedure planning based on baseline imaging are key elements in successful same-day radioembolization treatments.
Asunto(s)
Atención Ambulatoria/métodos , Carcinoma Hepatocelular/radioterapia , Embolización Terapéutica/métodos , Neoplasias Hepáticas/radioterapia , Radioisótopos de Itrio/uso terapéutico , Anciano , Angiografía/métodos , Carcinoma Hepatocelular/diagnóstico por imagen , Femenino , Humanos , Imagenología Tridimensional , Neoplasias Hepáticas/diagnóstico por imagen , Masculino , Microesferas , Selección de Paciente , Radiofármacos/administración & dosificación , Dosificación Radioterapéutica , Agregado de Albúmina Marcado con Tecnecio Tc 99m/administración & dosificación , Resultado del TratamientoRESUMEN
This paper describes a new nuclear imaging agent, 2-(4-isothiocyanatobenzyl)-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid of human albumin (HAC), potentially suitable for application in the Radio-guided Occult Lesion Localization (ROLL) of non-palpable mammalian cancerous lesions, as a tool to overtake the short radio-signal half-life of the technetium-99m based radiopharmaceutical currently used. This conjugate is a microsized powder aggregate, water-insoluble between pH 3 and 8.5, obtained by conjugating the protein with the macrocyclic chelating agent DOTA through a one-pot reaction in aqueous medium. The product has been fully characterized and is stable to the thermal conditions adopted for labeling; after radiolabeling with longer half-life radionuclides such as 177Lu or 111In, it has shown radiochemical purity (RCP) >90% and resulted stable when stored in saline or plasma for 6 days at 37 °C. A µPET/CT study, performed in vivo on adult female rats, showed that the radioactivity of HAC labeled with 64Cu remained located in the mammary glands for at least 40 h, without diffusion or drainage in healthy tissues or in the lymphatic circulation. This new imaging agent might make the ROLL procedure more accessible, safe and flexible, promoting a significant time and cost reduction of this intervention. Moreover, HAC might also be used in other radio-guided surgical procedures in oncology.
Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Compuestos Heterocíclicos/química , Isotiocianatos/química , Cintigrafía/métodos , Albúminas/administración & dosificación , Animales , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Femenino , Compuestos Heterocíclicos/administración & dosificación , Compuestos Heterocíclicos/farmacología , Isotiocianatos/administración & dosificación , Isotiocianatos/farmacología , Microesferas , Radiofármacos , Ratas , Biopsia del Ganglio Linfático Centinela/métodos , Cirugía Asistida por Computador/métodos , Agregado de Albúmina Marcado con Tecnecio Tc 99m/administración & dosificación , Agregado de Albúmina Marcado con Tecnecio Tc 99m/química , Agregado de Albúmina Marcado con Tecnecio Tc 99m/farmacologíaRESUMEN
PURPOSE: Selective internal radiation therapy (SIRT) is an effective treatment option for liver tumors, using Y-90-loaded polymer microspheres that are delivered via catheterization of the hepatic artery. Since Y-90 is a beta emitter and not conveniently imaged by standard clinical instrumentation, dosimetry is currently evaluated in each patient using a surrogate particle, 99mTechnetium-labeled macroaggregated albumin (99mTc-MAA). We report a new composite consisting of 99mTc-labeled nanoparticles attached to the same polymer microspheres as used for SIRT, which can be imaged with standard SPECT. METHODS: Carbon nanoparticles with an encapsulated core of 99mTc were coated with the polycation protamine sulfate to provide electrostatic attachment to anionic polystyrene sulfonate microspheres of different sizes (30, 12, and 8 µm). The in vivo stability of these composites was determined via intravenous injection and entrapment in the capillary network of normal rabbit lungs for up to 3 hours. Furthermore, we evaluated their biodistribution in normal rabbit livers, and livers implanted with VX2 tumors, following intrahepatic artery instillation. RESULTS: We report distribution tests for three different sizes of radiolabeled microspheres and compare the results with those obtained using 99mTc-MAA. Lung retention of the radiolabeled microspheres ranged from 72.8% to 92.9%, with the smaller diameter microspheres showing the lowest retention. Liver retention of the microspheres was higher, with retention in normal livers ranging from 99.2% to 99.8%, and in livers with VX2 tumors from 98.2% to 99.2%. The radiolabeled microspheres clearly demonstrated preferential uptake at tumor sites due to the increased arterial perfusion produced by angiogenesis. CONCLUSION: We describe a novel use of radiolabeled carbon nanoparticles to generate an imageable microsphere that is stable in vivo under the shear stress conditions of arterial networks. Following intra-arterial instillation in the normal rabbit liver, they distribute in a distinct segmented pattern, with the smaller microspheres extending throughout the organ in finer detail, while still being well retained within the liver. Furthermore, in livers hosting an implanted VX2 tumor, they reveal the increased arterial perfusion of tumor tissue resulting from angiogenesis. These novel composites may have potential as a more representative mimic of the vascular distribution of therapeutic microspheres in patients undergoing SIRT.
Asunto(s)
Arterias/diagnóstico por imagen , Neoplasias Hepáticas/irrigación sanguínea , Neoplasias Hepáticas/diagnóstico por imagen , Hígado/irrigación sanguínea , Pulmón/irrigación sanguínea , Microesferas , Tecnecio/química , Animales , Línea Celular Tumoral , Femenino , Inyecciones Intraarteriales , Inyecciones Intravenosas , Hígado/diagnóstico por imagen , Neoplasias Hepáticas/tratamiento farmacológico , Pulmón/diagnóstico por imagen , Masculino , Poliestirenos/química , Conejos , Radiofármacos/química , Agregado de Albúmina Marcado con Tecnecio Tc 99m/administración & dosificación , Agregado de Albúmina Marcado con Tecnecio Tc 99m/química , Distribución Tisular , Resultado del TratamientoRESUMEN
BACKGROUND: Hepatopulmonary syndrome (HPS) is defined as a triad characterized by arterial deoxygenation, intrapulmonary vascular dilatations (IPVDs), and liver disorder. The aims of this study were to assess the prevalence of HPS in children with cirrhosis, the clinical characteristics of patients with HPS, and the tests used for the diagnosis of IPVD. PATIENTS AND METHODS: This was a prospective, cross-sectional study of 40 children with cirrhosis (median age: 44 months). Investigations of HPS included arterial blood gas analysis, contrast-enhanced transthoracic echocardiography (CE-TTE), and perfusion lung scanning using technetium-99m-labeled macroaggregated albumin (Tc-MMA). Patients' clinical characteristics (age, etiology of cirrhosis, and severity of hepatopathy) were assessed. HPS was defined as liver disease; alveolar-arterial oxygen gradient of at least 15 mmHg and/or partial pressure of arterial oxygen less than 80 mmHg; and detection of IPVD by CE-TTE or Tc-MMA scanning. Statistical significance was indicated by a P value less than 0.05. RESULTS: The prevalence of HPS was 42.5% (17/40). Eight patients had moderate HPS (47%) and two patients had severe HPS (12%). In bivariate analysis, biliary atresia (P=0.033) and median age (10 months; P=0.005) were associated with HPS. In multivariate analysis, only age remained statistically significant (prevalence ratio=0.99; 95% confidence interval=0.98-0.99; P=0.010). Sixteen patients with HPS had IPVD detected by CE-TTE (94.1%) and six patients had IPVD detected by Tc-MMA scanning (35.3%), with no significant agreement between these methods (κ=-0.12; P=0.163). CONCLUSION: HPS is a common complication of cirrhosis in children. A combination of clinical and imaging criteria should be used to diagnose HPS.
Asunto(s)
Síndrome Hepatopulmonar/epidemiología , Cirrosis Hepática/epidemiología , Adolescente , Factores de Edad , Análisis de los Gases de la Sangre , Brasil/epidemiología , Niño , Preescolar , Estudios Transversales , Ecocardiografía , Femenino , Síndrome Hepatopulmonar/diagnóstico por imagen , Síndrome Hepatopulmonar/fisiopatología , Humanos , Lactante , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/fisiopatología , Masculino , Imagen de Perfusión/métodos , Valor Predictivo de las Pruebas , Prevalencia , Pronóstico , Estudios Prospectivos , Radiofármacos/administración & dosificación , Factores de Riesgo , Índice de Severidad de la Enfermedad , Agregado de Albúmina Marcado con Tecnecio Tc 99m/administración & dosificaciónRESUMEN
99mTc-labeled mannosylated human serum albumin (MSA) has been reported as a sentinel lymph node (SLN)-imaging agent by binding to macrophages in the LNs. By conjugating it with blue dye, we developed a new multimodal radio-nanocarrier by visual investigation, fluorescence imaging, and single photon emission computed tomography (SPECT)/computed tomography (CT). Binding affinities of seven blue dyes to MSA were tested. According to the spectroscopic study and visual inspection of MSA-bound dyes, naphthol blue black (NBB) was selected as the best candidate of multimodal agent. Thus, 99mTc-MSA-NBB conjugate was prepared and further investigated using mice. After footpad injection, it showed high popliteal LN accumulation at 1 h. SPECT/CT also showed high popliteal as well as inguinal LN uptakes at 10 min that sustained until 2 h. In conclusion, we prepared a multimodal SLN imaging radio-nanocarrier, 99mTc-MSA-NBB conjugate, and confirmed its excellency as a multimodal probe for SLN mapping.
Asunto(s)
Macrófagos/efectos de los fármacos , Nanopartículas/administración & dosificación , Ganglio Linfático Centinela/diagnóstico por imagen , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único , Animales , Compuestos Azo/química , Femenino , Humanos , Ratones , Persona de Mediana Edad , Nanopartículas/química , Naftalenosulfonatos/química , Ganglio Linfático Centinela/fisiología , Biopsia del Ganglio Linfático Centinela , Agregado de Albúmina Marcado con Tecnecio Tc 99m/administración & dosificación , Agregado de Albúmina Marcado con Tecnecio Tc 99m/químicaRESUMEN
BACKGROUND: We evaluated the clinical significance of follow-up data, including 99mTc-DTPA galactosyl human serum albumin (99mTc-GSA) liver scintigraphy data, as prognostic indicators for jaundice-free patients with biliary atresia (BA). METHODS: Of 87 patients who underwent Kasai portoenterostomy (KP) between 1991 and 2012, 45 jaundice-free patients aged 1-2â¯years underwent 99mTc-GSA scintigraphy and were classified into 2 groups: those who survived with a native liver (Group A, nâ¯=â¯34) and those who required liver transplantation (LTx) (Group B, nâ¯=â¯11). We compared 99mTc-GSA scintigraphy data (HH15, LHL15, and HH15/LHL15 [H/L15]) and liver function test (LFT) results between the groups. The patients underwent a second 99mTc-GSA scintigraphy at approximately 5â¯years of age. RESULTS: All patients survived. HH15, H/L15, total bilirubin, direct bilirubin, gamma-glutamyl transpeptidase, and alanine transaminase levels were higher in Group B than in Group A (p<0.05). Total and direct bilirubin levels were associated with H/L15 (p<0.05). There were no significant changes in results between the first and second 99mTc-GSA scintigraphy in Group A. CONCLUSIONS: Mid- and long-term prognoses may be predicted using 99mTc-GSA scintigraphy data and LFTs in patients aged 1-2â¯years. We recommend regular monitoring of postoperative data following KP, even in jaundice-free patients. LEVEL OF EVIDENCE: III.
Asunto(s)
Atresia Biliar/diagnóstico por imagen , Hígado/diagnóstico por imagen , Ácido Pentético/administración & dosificación , Agregado de Albúmina Marcado con Tecnecio Tc 99m/administración & dosificación , Atresia Biliar/cirugía , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Lactante , Ictericia , Pruebas de Función Hepática/métodos , Trasplante de Hígado/estadística & datos numéricos , Masculino , Portoenterostomía Hepática/estadística & datos numéricos , Pronóstico , Cintigrafía/métodosRESUMEN
OBJECTIVE: Multiple localization techniques to facilitate intraoperative identification of small or nonsolid pulmonary nodules have been developed. Radiotracer localization using technetium-labeled macroaggregated albumin has been our preferred localization method since 2009. We report our experience, including technical pitfalls and modifications, of our initial 77 patients who underwent this technique. METHODS: All patients undergoing preoperative radiotracer localization were identified from a prospective database. Medical records were retrospectively reviewed for patient demographic characteristics, nodule characteristics, procedure details, pathologic data, and outcomes. RESULTS: Seventy-seven patients underwent localization of 79 pulmonary nodules. Radiotracer localization had an overall success rate of 95%; however, 2 patients required a second localization procedure on the same day. Most failures occurred in nodules that were < 5 mm from the pleural surface, resulting in pleural spillage. Seventy-three patients underwent a diagnostic wedge resection, with 2 of these patients requiring 2 wedge resections. In 2 patients, the nodules were successfully localized; however, they were too deep for wedge resection and required anatomic resection. Two patients did not undergo resection. One patient developed pleural spillage and hemothorax and due to subsequent comorbidities, was never rescheduled. The second patient did not tolerate single-lung ventilation. The majority (86%) of lesions were malignant. Median length of stay was 2 days (range, 1-15 days). There was no 30-day mortality. The only morbidity was a prolonged air leak (>5 days) in 5 patients. CONCLUSIONS: Radiotracer localization is a simple and effective technique for intraoperative identification of small pulmonary nodules.
Asunto(s)
Nódulos Pulmonares Múltiples/diagnóstico por imagen , Radiofármacos/administración & dosificación , Nódulo Pulmonar Solitario/diagnóstico por imagen , Agregado de Albúmina Marcado con Tecnecio Tc 99m/administración & dosificación , Tomografía Computarizada de Emisión de Fotón Único , Adulto , Anciano , Anciano de 80 o más Años , Bases de Datos Factuales , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Nódulos Pulmonares Múltiples/cirugía , Ohio , Neumonectomía/efectos adversos , Complicaciones Posoperatorias/etiología , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Estudios Retrospectivos , Nódulo Pulmonar Solitario/cirugía , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Safety of sentinel lymph node (SLN) biopsy for breast cancer during pregnancy is insufficiently explored. We investigated efficacy and local recurrence rate in a large series of pregnant patients. PATIENTS AND METHODS: Women diagnosed with breast cancer who underwent SLN biopsy during pregnancy were identified from the International Network on Cancer, Infertility and Pregnancy, the German Breast Group, and the Cancer and Pregnancy Registry. Chart review was performed to record technique and outcome of SLN biopsy, locoregional and distant recurrence, and survival. RESULTS: We identified 145 women with clinically N0 disease who underwent SLN during pregnancy. The SLN detection techniques were as follows: 99mTc-labeled albumin nanocolloid only (n = 96; 66.2%), blue dye only (n = 14; 9.7%), combined technique (n = 15; 10.3%), or unknown (n = 20; 13.8%). Mapping was unsuccessful in one patient (0.7%) and she underwent an axillary lymph node dissection (ALND). Mean number of SLNs was 3.2 (interquartile range 1-3; missing n = 15). Positive SLNs were found in 43 (29.7%) patients and 34 subsequently underwent ALND. After a median follow-up of 48 months (range 1-177), 123 (84.8%) patients were alive and free of disease. Eleven patients experienced a locoregional relapse, including 1 isolated ipsilateral axillary recurrence (0.7%). Eleven (7.6%) patients developed distant metastases, of whom 9 (6.2%) died of breast cancer. No neonatal adverse events related to SLN procedure during pregnancy were reported. CONCLUSIONS: SLN biopsy during pregnancy has a comparably low axillary recurrence rate as in nonpregnant women. Therefore, this method can be considered during pregnancy instead of standard ALND for early-stage, clinically node-negative breast cancer.
Asunto(s)
Neoplasias de la Mama/patología , Metástasis Linfática/diagnóstico , Recurrencia Local de Neoplasia/epidemiología , Complicaciones del Embarazo/patología , Biopsia del Ganglio Linfático Centinela/efectos adversos , Adulto , Axila , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/mortalidad , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Alemania/epidemiología , Humanos , Metástasis Linfática/patología , Exposición Materna/efectos adversos , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Estudios Observacionales como Asunto , Embarazo , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/mortalidad , Resultado del Embarazo , Trazadores Radiactivos , Sistema de Registros/estadística & datos numéricos , Estudios Retrospectivos , Ganglio Linfático Centinela/patología , Biopsia del Ganglio Linfático Centinela/métodos , Agregado de Albúmina Marcado con Tecnecio Tc 99m/administración & dosificación , Agregado de Albúmina Marcado con Tecnecio Tc 99m/efectos adversosRESUMEN
BACKGROUND: Sentinel lymph node (SLN) biopsy represents a well-established diagnostic tool for the assessment of lymphatic metastasis. Correct pre- and intraoperative visualization of SLN is of the utmost importance to ensure the safety and feasibility of the procedure. Aim of this study was to evaluate the diagnostic value of preoperative SLN imaging via single photon emission computed tomography/computed tomography (SPECT/CT) and planar scintigraphy in patients with penile carcinoma with nonpalpable inguinal lymph nodes. MATERIALS AND METHODS: After peritumoral intradermal tracer injection (150MBq/4.05mCi Tc-99m nanocolloid), we acquired planar scintigraphies including indirect body contouring using a twin head gamma camera. Subsequently we acquired SPECT/CT images of the abdomen via a hybrid system. Prospective evaluation of 52 groins in 26 examined patients was done for all image files obtained with both techniques by 2 trained experts in consensual assessment. RESULTS: A total of 71 SLNs in 37 groins were identified by means of planar scintigraphy. In these images, no radiolabeled lymph nodes were visualized in 15 out of 52 groins (28.8%). The SPECT/CT images showed a total of 82 SLNs in 42 groins. In 19.2% (10 of the 52 groins), there was no visualization of lymph nodes in SPECT/CT. 8 SLNs in 7 groins that were visualized in the planar technique were found to be false positive by SPECT/CT. In total, 19 SLNs in 16 groins that were overlooked by planar imaging could only be detected by SPECT/CT. In contrast to planar scintigraphy, SPECT/CT imaging enabled clear and precise anatomical localization of SLNs in all 42 groins where radiolabeled SLNs were visible. Even under consideration of all lymphatic drainage regions, statistical evaluation showed a significantly higher number of detected SLNs with SPECT/CT in comparison to the planar technique (P = 0.0022). CONCLUSION: In these patients SPECT/CT is capable of visualizing SLNs that cannot be detected with planar imaging. The SPECT/CT technique reduces the number of false positive findings from planar SLN imaging and is able to show anatomic SLN localization more precisely. If possible, preoperative SLN imaging should be performed by means of the SPECT/CT technique in patients with this tumor entity.