Intraoperative methylene blue and (99m)Tc-sulfur colloid isotope tracing for sentinel node mapping in early-stage non-small cell lung cancer / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the accuracy of intaoperative methylene blue alone and in combination with (99m)Tc-sulfur colloid isotopic tracing for detection of sentinel lymph nodes (SLNs) in early-stage non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>Sixty-one patients with operable NSCLC who did not receive previous radiotherapy or chemotherapy were enrolled. Methylene blue and (99m)Tc-sulfur colloid were injected into the subserosal layer adjacent to the tumor, and SLNs were defined as those with blue staining or those containing 3 times more radioactivity than the surrounding tissue detected with a gamma probe. The SLN were removed with systematic lymph node dissection. All the removed lymph nodes were examined histopathologically with HE staining and immunohistochemistry.</p><p><b>RESULTS</b>Methylene blue alone showed a low detection rate (60.0%) and sensitivity (58.33%) for SLNs compared with the combination of methylene blue and isotope tracing (96.15% and 92.86%, respectively).</p><p><b>CONCLUSION</b>The combination of methylene blue and (99m)Tc-sulfur colloid isotopic tracing allows accurate detection of the SLNs in early-stage NSCLC.</p>

Extramedullary Pulmonary Hematopoiesis Causing Pulmonary Hypertension and Severe Tricuspid Regurgitation Detected by Technetium-99m Sulfur Colloid Bone Marrow Scan and Single-Photon Emission Computed Tomography/CT

Extramedullary pulmonary hematopoiesis is a rare entity with a limited number of case reports in the available literature only. We report the case of a 66-year-old man with known primary myelofibrosis, in whom a Technetium-99m sulfur colloid bone marrow scan with single-photon emission computed tomography (SPECT)/CT revealed a pulmonary hematopoiesis as the cause of pulmonary hypertension and severe tricuspid regurgitation. To the best of our knowledge, this is the first description of Technetium-99m sulfur colloid SPECT/CT imaging in this rare condition.

A novel technique for scintigraphic visualization of internal mammary sentinel lymph nodes in breast cancer patients / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the effects of different injection techniques of radiotracer on the visualization rate of internal mammary sentinel lymph nodes (IMSLN) in breast cancer patients.</p><p><b>METHODS</b>A series of 137 consecutive breast cancer patients was included in this prospective study. Fifty-eight patients (group A) received the radiotracer (99)Tc(m)-sulphur colloid injected only into 1-2 points in the breast parenchyma in one quadrant, and seventy-nine patients (group B) received the radiotracer injection into the breast parenchyma in two quadrants of the breast. The differences of IMSLN visualization rates of the two groups were compared and the relevant affecting factors were analyzed.</p><p><b>RESULTS</b>The IMSLN visualization rate of the group B (70.9%, 56/79) was significantly higher than that of the group A (13.8%, 8/58) (P < 0.001). Both techniques seemed to be reliable to identify sentinel lymph node in the axilla (98.7% vs. 98.3%, P = 0.825). In addition, the visualization rate of internal mammary hotspots (82.2%) was more commonly seen in patients receiving injection of a larger volume of radiotracer ( ≥ 0.5 ml/point) than those receiving a smaller volume of radiotracer (<0.5 ml/point, 55.9%, P = 0.011).</p><p><b>CONCLUSIONS</b>The modified injection technique (two quadrants, large volume radiotraver, and ultrasound guidance) can significantly improve the visualization rate of IMSLN. Our findings should make the biopsy of IMSLN widely implemented and provide an effective and minimally invasive technique to evaluate the internal mammary lymph node status.</p>

Significance of sentinel lymph node detection for cN0 laryngeal carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>The purpose of this study was to investigate the clinical value of radiolabeled tracer method, methylene blue method and combination of these two methods in detection of sentinel lymph node (SLN), and to evaluate the accuracy of SLN in predicting the cervical lymph nodes status in laryngeal carcinoma patients with clinically negative neck lymph nodes (cN0 ).</p><p><b>METHODS</b>Forty-one patients with cN0 laryngeal neoplasms underwent SLN detection using both of radiolabeled tracer and methylene blue. SLN imaging was performed with laryngoscope-guided injection of radioactive isotope 99Tc(m)-sulfur colloid (SC) into the laryngeal carcinoma before surgery, then all these patients underwent intraoperative lymphatic mapping with a handheld gamma-detecting probe. After mapping of SLN, methylene blue was subsequently injected at the same spots around the tumor in order to identify SLN during surgery. The results of SLN detection by isotope tracer, dye and combination of both methods were compared.</p><p><b>RESULTS</b>The SLN detection rates by radiolabeled tracer, methylene blue and combined method were 87.8%, 70.7% and 92.7%, respectively (P < 0.01). The number of detected SLN was significantly different between radiolabeled tracer method and combined method (P < 0.05), and also between blue dye method and combined method (P < 0.01). However, no statistically significant difference was found between methylene blue method and radiolabeled tracer method (P > 0.05). Nine patients were found to have lymph node metastasis by final pathological examination. The sensitivity, accuracy and negative predictive values of SLN detection by the combined method using radiolabeled tracer and methylene blue were 88.9%, 97.4% and 96.7%, respectively.</p><p><b>CONCLUSION</b>The combined method using radiolabeled tracer and methylene blue can improve the accuracy of sentinel lymph node detection. Furthermore, sentinel lymph node detection can accurately predict the cervical lymph node status in cN0 laryngeal carcinoma.</p>

Localization of sentinel lymph node with radionuclide in clinically N0 laryngeal and hypopharyngeal cancers / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the characteristic of the radioactive lymph node with metastatic disease and to explore the method of the localization of sentinel lymph node (SLN) with radionuclide in N0 clinically laryngeal and hypopharyngeal cancer.</p><p><b>METHODS</b>Fourty-five patients with T1-T4 and clinically N0 laryngeal and hypopharyngeal cancer were recruited. For each patient a peritumoral submucosal injection of 99mTc-labeled sulfur colloid (99mTc-SC) was performed and lymph node mapping was performed by lymphoscintigraphy two hours afterward. The SLN was localized by a handheld gamma probe intraoperatively 10-12 hours after the injection. All hot lymph nodes accumulating activity were harvested and initially termed sentinel nodes. Selective neck dissections were performed for all patients. The specimen of SLN was sent to the pathologist for the following analysis: formal paraffin embedded section, consecutive section and immunohistochemistry assay. The results was compared to the remaining lymphadenectomy specimen. Resection of the primary tumour depended on the location and the T classification.</p><p><b>RESULTS</b>SLNs were identified in 41 of 45 patients with 51 necks, SLNs had occult metastases in 13 cases, 15 necks with SLN-positive of these 13 cases, there was one false negative case, they were found in non-SLNs of neck specimens. Each neck side was considered a single case. SLN identification rate was 92.7%, sensitivity was 93.7%, false-negative rate was 6.3%, and accuracy was 98.0%. In 11 (73.3%) of these SLN-positive necks, the SLN with the highest counts contained tumor; harvesting the first-three nodes with the highest radioactive counts, which could all patients with occult metastatic disease.</p><p><b>CONCLUSIONS</b>Excision of the first-three SLNs with the highest radioactive counts can accurately judge the presence or absence of the cervical lymph nodes metastases in patients with the clinically N0 laryngeal and hypopharyngeal cancer.</p>

Clinical significance of sentinel lymph node detection by combining the dye-directed and radioguided methods in gastric cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility and accuracy of detection of sentinel lymph nodes (SLN) with combining the dye-directed and radioguided methods in gastric cancer and assess its potential role in determining the rational extent of lymphadenectomy in gastric cancer surgery.</p><p><b>METHODS</b>Twenty-six patients of gastric cancer diagnosed as T(1)-T(3) were enrolled in this study. Endoscopic injection submucosally of (99m)Tc labeled sulfur colloid solution was performed around the primary tumor 2 - 4 h before operation. Immediately after laparotomy, patent blue violet was injected into subserosal layer adjacent to the tumor. SLNs were defined as blue stained nodes or(and) those containing 10 times more radioactivity than surrounding tissue with a gamma probe. Standard radical gastrectomy with lymphadenectomy (D(2) or D(3)) was performed in most of the patients, however, limited surgery was performed in early gastric cancer (EGC) when a rapid frozen examination indicated negative SLNs. All resected nodes were examined postoperatively by routine HE stain and those negative SLNs were examined with further cytokeratin immunohistochemistical staining. The diagnostic accuracy, sensitivity, negative predictive value and false-negative rate of regional lymph node status on the basis of SLN status were calculated respectively.</p><p><b>RESULTS</b>SLNs were dectected in 25 of 26 patients with a successful detection rate of 96%. The number of SLNs ranged from 1 to 6, with a mean value of 3.2 per case. The SLNs of gastric cancer were only found in N(1) area in 50% of the cases, and only in N(2) or N(3) in 12%. The incidence of metastasis was significantly higher in SLNs than in non-SLNs (35% vs 7%). The diagnostic accuracy, sensitivity, negative predictive value and false-negative rate were 96%, 94%, 7/8 and 6% respectively. Complete analysis of SLN upstaged 2/7 of patients of gastric cancer.</p><p><b>CONCLUSIONS</b>The SLN concept is validated in gastric cancer. Combined-agent SLN mapping is an accurate diagnostic procedure for detecting lymph node metastasis in patients with gastric cancer and may indicate rational extent of lymphadenectomy for gastric cancer.</p>

Marcación de proteínas con 99mTc / Labeling of proteins with 99mTc

Este trabajo tiene por objeto rever la marcación de proteínas con 99mTc, destacando los métodos directos e indirectos de marcación que se usan actualmente y que conducen a un producto estable in vivo, libre de contaminantes

Linfocintigrafía en quilotórax: caso clínico / Lymphoscintigraphy in chylothorax: clinical case

Se presenta un caso de quilotórax de aparición espontánea en una niña de 13 años, sus manifestaciones clínicas, exámenes de laboratorio e imágenes que contribuyeron al diagnóstico, con énfasis en el uso de la linfocintigrafía que permitió detectar el sitio de la filtración de quilo hacia la cavidad pleural y que fue posteriormente confirmado y exitosamente reparado quirúrgicamente

Sentinel lymph node detection by combined dye-isotope technique and its predictive value for cervical lymph node metastasis in patients with lingual carcinoma / 中华医学杂志(英文版)

<p><b>OBJECTIVES</b>To investigate the clinical value of combined dye-isotope technique in detecting sentinel lymph node (SLN) and to examine whether the characteristics of SLN accurately predict cervical lymph node metastasis in lingual carcinoma.</p><p><b>METHODS</b>Thirty patients with lingual carcinoma without lymph metastasis were injected with a dose of about 18.5 MBq of (99m)Tc-SC (sulfur colloid), around the tumor tissues before surgery, and lymphoscintigraphy was performed 5, 10, 30, 60 minutes, and 6 hours after injection. In the following day, all patients were injected with isosulfan blue dye around the primary tumor during surgery to trace SLN and underwent standard cervical lymph node dissection after SLN dissection. The pathological results of SLN were compared with standard lymph node dissection for their ability to accurately predict the final pathological status of the cervical lymph nodes.</p><p><b>RESULTS</b>SLN was successfully identified in 100% of the patients. Both positive and negative predictive values of SLN were 100%. The accuracy rate was 100%, and there were no false negatives.</p><p><b>CONCLUSIONS</b>The detection of SLN using combined dye-isotope technique could accurately predict cervical lymph node metastasis in lingual carcinoma.</p>

Intra-operative radionuclide lymphatic mapping in sentinel lymph node biopsy of breast cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study intra-operative radionuclide lymphatic mapping in sentinel lymph node (SLN) biopsy of breast cancer.</p><p><b>METHODS</b>Forty-two breast cancer (diameter </= 5.0 cm) patients with clinically negative axillary node were analyzed. 18.5 MBq/0.5 ml technetium-99m labeled sulfur colloid (labeling yield > 98%, size of colloid granule 100 approximately 200 nm) was injected into the mammary tissue around the tumor or biopsy site at four points. SLN in breast cancer was detected and dissected with the help of lymphoscintigraphy and intra-operative gamma probe. Routine lymph node dissection was performed for all patients.</p><p><b>RESULTS</b>The detection rate was 88.1% in lymphoscintigraphy and 97.6% in intra-operative gamma probe detection for SLN in breast cancer. The sensitivity, accuracy, false negative and specificity of SLN biopsy were 93.3% (14 in 15), 97.6% (40 in 41), 6.7% (1 in 15) and 100% (26 in 26).</p><p><b>CONCLUSION</b>Sentinel lymph node in breast cancer, detected by preoperative lymphoscintigraphy combined with intra-operative gamma probe, is able to predict regional lymph node metastasis. The successful rate of SLN biopsy can be raised by improvement in the quality of nuclear imaging agent, technic of injection and method of measurement.</p>

Funçöes do remenescente esplênico após esplenectomia subtotal para o tratamento de lesöes complexas do baço humano / Functions of the splenic remnant after subtotal splenectomy for treatment of severe splenic injuries

OBJETIVO: Verificar a possibilidade de realizar esplenectomia subtotal na presença de lesöes graves do baço por trauma ou que acometam o seu pedículo vascular principal, avaliar as repercussöes clínicas, hematológicas e imunológicas que essa operaçäo pode trazer nos pós-operatórios, viabilidade e a funçäo de filtraçäo do pólo superior do baço remanescente. MÉTODOS: Foram estudados 34 pacientes, 25 submetidos à esplenectomia subtotal (Grupo I), nove à esplenectomia total sem preservaçäo de tecido esplênico (Grupo II), 22 pessoas com baços íntegros (Grupo III). No pós-operatório tardio realizaram-se exames hematológicos (hematimetria, hemoglobina, hematócrito, plaquetas, leucócitos globais e segmentados, linfócitos e corpúsculos de Howell Jolly). Dosaram-se as imunoglobulinas (IgA, IgM e IgG) e linfócitos T totais (LTT), linfócitos T ativos (LTA) e linfócitos B. Realizou-se cintilografia esplênica com enxofre coloidal marcado com 99mTc. RESULTADOS: Em nenhum dos grupos houve leucocitose ou trombocitose. Os corpúsculos de Howell-Jolly foram observados no Grupo II e neste grupo a IgM esteve reduzida. A cintilografia demonstrou tecido esplênico captante no Grupo I. CONCLUSÄO: A esplenectomia subtotal pode ser uma alternativa cirúrgica para as lesöes graves distais do baço ou quando o seu pedículo principal estiver acometido e näo leva a repercussöes clínicas e laboratoriais nos pacientes submetidos a esse procedimento

Bilateral Inguinal Hernias Detected by Peritoneal Scintigraphy during the Evaluation of Scrotal Swelling in a Patient on Continuous Ambulatory Peritoneal Dialysis / 대한핵의학회잡지

A 47-year-old man with end-stage renal disease due to diabetic nephropathy underwent a peritoneal scintigraphy to evaluate the cause of recently developed scrotal swelling. Two liters of dialysate mixed with 111 MBq of Tc-99m sulfur colloid were administered into the peritoneal cavity via the dialysis catheter. Various anterior images of the abdomen and pelvis were obtained at 15 min, 2 hr and 4 hr after the tracer instillation. At 15 min, anterior images of the abdomen and pelvis demonstrated linear tracts of activity through both inguinal canals, which were more prominent in the right side (A). Images at 2 hr revealed a passage of the radioactive fluid into the right hemiscrotum. At the same time, there was a considerable accumulation of activity in the right inguinal canal (B). In the delayed image, there was a progressive accumulation of activity in the inguinal canals and a prominent passage of the tracer into the scrotum (C). Both abdominal and inguinal hernias are commonly associated with continuous ambulatory peritoneal dialysis (CAPD). Overall incidence of CAPD-induced hernia ranges from 2.7% to 25%.1) Inguinal hernias were frequently manifested as scrotal swelling. Leakages of dialysate fluid into the scrotum has been noted in CAPD patients with scrotal swelling, with or without clinical findings of inguinal hernia.1,2) In the present case, the right side had leakage from a clinical inguinal hernia and the left side, leakage from a subclinial inguinal hernia. A subclinical inguinal hernia was easily demonstrable with peritoneal scintigraphy. Peritoneal scintigraphy is extremely helpful in the evaluation of scrotal swelling in a patient on CAPD.

Linfonodo centinela en melanoma: informe preliminar del uso combinado de linfocintigrafía y tinta azul / Sentinel lymph node in melanoma: preliminar report of the combined use of lymphocintigraphy and blue dye

Las técnicas de detención del linfonodo centinela están siendo ampliamente utilizadas y validadas para ser incluidas en el manejo estándar de pacientes portadores de melanoma. Desde diciembre de 1998 hasta agosto 1999, hemos incluido en un estudio para detección de linfonodo centinela a nueve pacientes portadores de melanoma. En todos los pacientes se realizó linfocintigrafía con inyección previa de coloide marcado con tecnecio-99 y se marcó la piel con un tatuaje en la zona de proyección cutánea del linfonodo centinela. En ocho pacientes se inyectó tinta azul (Patent blue al 1 por ciento) intradérmica perilesional o peri-cicatriz del melanoma cutáneo primario, 5 a 10 min antes de la biopsia del linfonodo centinela. En una paciente se utilizó una sonda manual detectora de radioactividad. En los nueve pacientes se logró identificar y biopsiar el linfonodo centinela, siendo más sencillo en 7 de los 9 pacientes cuya lesión primaria se ubicaba en la extremidad inferior. La combinación de linfocintigrafía y tinta azul es un método útil y sencillo para la detección del linfonodo centinela en melanoma de extremidad inferior. En melanomas de otras localizaciones, es preferible asociar además el uso de sonda detectora de radioactividad. La inclusión de pacientes en protocolos de estudio de linfonodos centinela y su seguimiento, permitirá la validación de estas técnicas para guiar la disección linfática regional

Cáncer de mama: ganglio centinela / Breast cancer: sentinel node

Dar a conocer la importancia de la biopsia del ganglio centinela como indicador del estado de la axila en el carcinoma. Identificar el ganglio centinela inyectando 4 ml. de Tc99 unidos a un marcador de sulfuro coloidal solo o mezclado con 3 ó 4 ml. del colorante vital isosulfan azul que conduce al ganglio para su extirpación. Clínica privada Méndez Gimón. Operamos 32 casos de los cuales se analizaron 27 (84,4 por ciento). La edad de las pacientes varió entre 36 y 79 años. El promedio de ganglios rescatados osciló entre 13 por ciento y 14 por ciento. El grado nuclear 3 fue mayor en las mujeres más jóvenes y menor en las de mayor edad. En más de la mitad de los casos se realizó mastectomía segmentaria más disección radical de la axila. La asociación de sulfuro coloidal de Tc99 y linfazurin constituye el procedimiento de elección para la localización del ganglio centinela. La biopsia del mismo es un método efectivo y seguro para determinar el estado anatomopatológico de los ganglios axilares

Utilidad de la cintigrafía en la hemorragia digestiva / Useful of scintigraphy in digestive hemorrhage

Se revisan brevemente las dos técnicas isotópicas que se utilizan en la actualidad para el estudio de las hemorragias digestivas, sulfuro coloide-Tc99m y glóbulos rojos-Tc99m. Las principales ventajas incluyen alta sensibilidad a baja tasa de sangrado, capacidad de monitorizar el tracto gastrointestinal globalmente durante varias horas y de dar una información pronóstica que permite identificar los pacientes de alto riesgo. Además, es bien tolerada, fácil de realizar y no requiere preparación previa

Significance of radioisotope bone marrow uptake on 99m technetium sulphocolloid scan in portal hypertension.

A prospective study of 101 consecutive patients of portal hypertension was carried out to study the possible relationships between bone marrow activity on 99m technetium labelled sulphocolloid scan and severity of liver disease, etiology of portal hypertension and cirrhosis, as well as presence and extent of collateral circulation, including esophageal varices. The patients were divided into 4 etiological groups: alcoholic cirrhosis (ALD), (38) non-alcoholic cirrhosis (NALD) (35) non-cirrhotic portal fibrosis (NCPF) (14) and extrahepatic portal vein obstruction (EHPVO) (14). Patients of cirrhosis were categorised according to modified Child-Pugh's classification. Esophageal varices were graded endoscopically as (1) no varix (2) small varices (< 5mm) (3) large varices (> 5mm). All patients underwent radionuclide imaging using 99m Technetium labelled sulphocolloid and bone marrow activity was studied. Evaluation of portasystemic collaterals was done ultrasonically. We found that 16.6%, 44.6% and 72.72% patients with Child A, B and C cirrhosis respectively, had increased marrow activity (p < 0.05). There was no significant difference between marrow activity of patients with ALD (52.6%) and NALD (40%). None of the non-cirrhotic patients demonstrated bone marrow uptake of radioisotope. There was no significant difference between bone marrow uptake presence of lienorenal collaterals and presence or size of esophageal varices. We thus conclude the bone marrow activity on radioisotope scanning depends only on the severity of liver disease and does not vary a according to the etiology of cirrhosis, or presence and extent of portasystemic collaterals, including esophageal varices.

Empleo de leucocitos radiomarcados en la deteccion de infecciones cardiovasculares / Use of radiolabeled leukocytes for the detection of cardiovascular infections

Se exponen los principales aspectos de la gammagrafia con leucocitos marcados con 111in o 99mTc, sus ventajas y desventajas, metodos de marcaje y sus aplicaciones mas importantes relacionadas con las infecciones cardiovasculares

role of 99m Tc-sulphur colloid in detecting the relationship between hepatic kupffer cells dysfunction and intrinsic asthma

This study was carried out at both Departments of Medicine and Radiotherapy and Nuclear Medicine Ain Shams University Hospitals between January, 1992 and February 1993. It included 2 groups. The first group consisted of 20 patients having criteria suggestive of intrinsic asthma [6 males and 14 females], their ages varied between [31 and 55 years]. The second group [controls] consisted of 20 volunteers who were not complaining of any allergic manifestations. The study showed that there was a positive correlation between total half life of plasma clearance of 99mTc-sulphur colloid and Forced expiratory volume in one second [FEVl] among intrinsic asthmatic patients but there was no significant difference between intrinsic asthmatic patients and control group as regard total half life of plasma clearance of 99mTc-sulphur colloid denoting that hepatic macrophages Kupffer cells are functionally active in the intrinsic asthmatic patients