Peter Ell 2000 [1] 1977 Cabanas [2]

Transcription

1 1, Peter Ell 2000 [1] 1977 Cabanas [2] (vital blue) [3] [4] Table ;15:43-48 (Table 2) Table 1. Successful rates of sentinel node identification [34] (02) (02) wshuang@ms22.url.com.tw Method Sensitivity, % Dye 76.3 Gamma probe 91.5 Dye + Gamma probe 91.3 Lymphoscintigraphy + Gamma probe 87.8 Lymphoscintigraphy + Gamma probe + Dye 93.8

2 Yeh SDJ et al Table 2. Comparisons between dye lymphatic mapping and lymphoscintigraphy [5,35-38] Agents Lymphatic mapping Methylene blue, isosulfan blue, patent blue- V, cyalume, flourescein Lymphoscintigraphy 99m Tc-antimony trisulfide colloid, 99m Tc-nanocolloid, 99m Tc-sulfur colloid Preparations Simple and stable More complicated quality control and shorter halflife of tracer, particle size may be critical Sites of detection Lymph nodes and lymphatic channels Lymph nodes and channels if dynamic study is done Dose 0.1-5ml, depending on types and locations of tumors 0.1 ml and 0.1 mci for intra-dermal injection, larger volume and higher dose, depending on types and locations of tumors Time of exploration 3-7 min after injection, depending on types and locations of tumors Usually 1-2 h after injection or 12 h later, depending on types and locations of tumors Repeatability Repeatable 20 min after injection if unsuccessful Variable, depending on half-life, injected volume, and radiation dose Surgery required Yes No Others Unable to assess lymph node distribution before operation Lymph flow and sentinel node localization can be assessed before operation using dynamic and delayed phases of lymphoscintigraphy (nanocol nm) (FDA) loid, <80 nm, 95%) nm, 48%) (sulfur colloid, <80 Millipore [7] [5,6] 0.1 mci 0.05 ml 99m 10 nm - (antimony colloid, cobalt flood source Ann Nucl Med Sci 2002;15:43-48 Vol. 15 No. 1 March

3 Lymphoscintigraphy of sentinel node PCR GAGE isosulfan blue dye [12] Neoprobe C Trak [8,9] H&E (immunofluorescence stain) immunohistochemical stain cytokeratin RTPCR mrna [13-15] [13,16,17] [18] [13,19-21] [22] [13,23] [24-26] [13,26-32] [18,33] [13] (false negative) 5% [10] Sappey line 0.22 µm Millipore [11] cobalt flood source H&E RTPCR tyrosine kinase mrna 1. Ell PJ, Keshtgar MR. The sentinel node and lymphoscintigraphy in breast cancer. Nucl Med Commun 1999;20: Cabanas RM. The concept of the sentinel lymph node. Recent Results Cancer Res 2000;157: Cabanas RM. An approach for the treatment of penile carcinoma. Cancer 1977;39: Keshtgar MR, Ell PJ. Sentinel lymph node detection and imaging. Eur J Nucl Med 1999;26: Morton DL, Chan AD. The concept of sentinel node localization: how it started. Semin Nucl Med 2000;30: ;15:

4 Yeh SDJ et al 6. Krag D, Weaver D, Ashikaga T, et al. The sentinel node in breast cancer-a multicenter validation study. N Engl J Med 1998;339: Borgstein PJ, Pijpers R, Comans EF, van Diest PJ, Boom RP, Meijer S. Sentinel lymph node biopsy in breast cancer: guidelines and pitfalls of lymphoscintigraphy and gamma probe detection. J Am Coll Surg 1998;186: Zanzonico P, Heller S. The intraoperative gamma probe: basic principles and choices available. Semin Nucl Med 2000;30: Crossin JA, Johnson AC, Stewart PB, Turner WW Jr. Gamma-probe-guided resection of the sentinel lymph node in breast cancer. Am Surg 1998;64: Cox CE, Pendas S, Cox JM, et al. Guidelines for sentinel node biopsy and lymphatic mapping of patients with breast cancer. Ann Surg 1998;227: Goldfarb LR, Alazraki NP, Eshima D, Eshima LA, Herda SC, Halkar RK. Lymphoscintigraphic identification of sentinel lymph nodes: clinical evaluation of 0.22-micron filtration of Tc-99m sulfur colloid. Radiology 1998;208: Essner R, Conforti A, Kelley MC, et al. Efficacy of selectiven lymphadenectomy as a therapeutic procedure for early-stage melanoma. Ann Surg Oncol 1999;6: Kubo A, Nakajo M. Can sentinel node concept be applicable to malignancies other than breast carcinoma? Symposium on the 41th annual meeting of the Japanese Soceity of Nuclear Medicine, Kanazawa, Japan. 2001(supp); pp, Rodrigues LK, Leong SP, Kashani-Sabet M, Wong JH. Early experience with sentinel lymph node mapping for Merkel cell carcinoma. J Am Acad Dermatol 2001;45: Tsioulias GJ, Wood TF, Morton DL, Bilchik AJ. Lymphatic mapping and focused analysis of sentinel lymph nodes upstage gastrointestinal neoplasms. Arch Surg 2000;135: Sarewitz SJ. Evaluation of sentinel nodes in colorectal carcinoma. Arch Pathol Lab Med 2001;125: Wood TF, Saha S, Morton DL, et al. Validation of lymphatic mapping in colorectal cancer: in vivo, ex vivo, and laparoscopic techniques. Ann Surg Oncol 2001;8: Bilchik AJ, Giuliano A, Essner R, et al. Universal application of intraoperative lymphatic mapping and sentinel lymphadenectomy in solid neoplasms. Cancer J Sci Am 1998;4: Haigh PI, Giuliano AE. Sentinel lymph node dissection for thyroid malignancy. Recent Results Cancer Res 2000;157: Cabanas RM. Application of the sentinel node concept in urogenital cancer. Recent Results Cancer Res 2000;157: Kelemen PR, Van Herle AJ, Giuliano AE. Sentinel lymphadenectomy in thyroid malignant neoplasms. Arch Surg 1998;133: Beltrami V, Bertagni A, Bosco MR, et al. Lymphadenectomy in the surgical treatment of bronchogenic carcinoma. Ann Ital Chir 2000;71: [In Italian]. 23. Thorn M. Lymphatic mapping and sentinel node biopsy: is the method applicable to patients with colorectal and gastric cancer? Eur J Surg 2000;166: Shoaib T, Soutar DS, Prosser JE, et al. A suggested method for sentinel node biopsy in squamous cell carcinoma of the head and neck. Head Neck 1999;21: Shoaib T, Soutar DS, MacDonald DG, et al. The accuracy of head and neck carcinoma sentinel lymph node biopsy in the clinically N0 neck. Cancer 2001;91: Malur S, Krause N, Kohler C, Schneider A. Sentinel lymph node detection in patients with cervical cancer. Gynecol Oncol 2001;80: Akduman B, Fleshner NE, Ehrlich L, Klotz L. Early experience in intermediate-risk penile cancer with sentinel node identification using the gamma probe. Urology 2001;58: Valdes Olmos RA, Jansen L, Muller SH, Hoefnagel CA, Nieweg O. Contribution of nuclear medicine to lymphatic mapping and sentinel node identification in oncology. Rev Esp Med Nucl 1999;18: [In Spanish]. Ann Nucl Med Sci 2002;15:43-48 Vol. 15 No. 1 March

5 Lymphoscintigraphy of sentinel node 29. Dargent D, Martin X, Mathevet P. Laparoscopic assessment of the sentinel lymph node in early stage cervical cancer. Gynecol Oncol 2000;79: de Hullu JA, Hollema H, Piers DA, et al. Sentinel lymph node procedure is highly accurate in squamous cell carcinoma of the vulva. J Clin Oncol 2000;18: Horenblas S, Jansen L, Meinhardt W, Hoefnagel CA, de Jong D, Nieweg OE. Detection of occult metastasis in squamous cell carcinoma of the penis using a dynamic sentinel node procedure. J Urol 2000;163: Terada KY, Coel MN, Ko P, Wong JH. Intraoperative lymphatic mapping for vulva cancer. Gynecol Oncol 1998;70: Paganelli G, De Cicco C, Chinol M. Sentinel node localization by lymphoscintigraphy: a reliable technique with widespread applications. Recent Results Cancer Res 2000;157: Nieweg OE, Jansen L, Olmos RAV, et al. Lymphatic mapping and sentinel lymph node biopsy in breast cancer. Eur J Nucl Med 1999;26(suppl):S11-S Alazraki NP, Eshima D, Eshima LA, et al. Lymphoscintigraphy, the sentinel node concept, and the intraoperative gamma probe in melanoma, breast cancer, and other potential cancers. Semin Nucl Med 1997;27: Bostick PJ, Giuliano AE. Vital dyes in sentinel node localization. Semin Nucl Med 2000;30: Eshima D, Fauconnier T, Eshima L, Thornback JR. Radiopharceuticals for lymphoscintigraphy: including dosimetry and radiation considerations. Semin Nucl Med 2000;30: Alazraki NP, Styblo T, Grant SF, Cohen C, Larsen T, Aarsvold JN. Sentinel node staging of early breast cancer using lymphoscintigraphy and the intraoperative gammadetecting probe. Semin Nucl Med 2000;30: ;15:

6 Yeh SDJ et al Sentinel Node Localization by Lymphoscintigraphy Samue l D. J. Yeh 1,2, Hong-Da Chang 3, Wen-Sheng Huang 3 1 Cornell University, 2 Memorial Sloan-Kettering Cancer Center, New York, U.S.A. 3 Department of Nuclear Medicine, Tri-Service General Hospital, Taipei, Taiwan, R.O.C. Intra-operative lymphatic mapping and sentinel node dissection have revolutionized the management of lymph node basin in patients with many malignancies. Striking advances have been made particularly in the management of malignant melanoma and newly diagnosed early stage of breast cancer. Lymphoscintigraphy provided by nuclear medicine physicians, intra-operative detection and removal of lymph nodes by surgeons and more critical analysis in addition to the routine frozen sections, hematoxyllin-eosin stains and immuno-histological stains for tumor cells by pathologists have important impact in the management of tumor patients. Many unanswered questions related to lymphatic spread and prevention may still need more basic research by scientists with diversified training and expertise. The concept of sentinel node localization has been greatly expanded in recent years to many malignancies such as gastrointestinal cancer, thyroid cancer, head and neck cancer or urogenital cancers. Key words: sentinel node, lymphoscintigraphy, gamma probe Ann Nucl Med Sci 2002;15:43-48 Received 9/6/2001; revised 11/19/2001; accepted 12/4/2001. For correspondence or reprints contact: Wen-Sheng Huang, M.D., Department of Nuclear Medicine, Tri-Service General Hospital, 325 Section 2, Cheng-Kung Road, Taipei 114, Taiwan, R.O.C. Tel: (886) , Fax: (886) , wshuang@ms22.url.com.tw Ann Nucl Med Sci 2002;15:43-48 Vol. 15 No. 1 March