Comparison of two hybrid sentinel node tracers: indocyanine green (ICG)- 99m Tc-nanocolloid vs. ICG- 99m Tc-nanoscan from a nuclear medicine and surgical perspective

Lymph node (LN) metastasis is a relevant predictor for survival in patients with a.o. penile cancer (PeCa), malignant melanoma. The sentinel node (SN) procedure comprises targeted resection of the first tumour-draining SNs. Here, the hybrid tracer indocyanine green (ICG)- Tc-nanocolloid has been use...

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Veröffentlicht in:European journal of nuclear medicine and molecular imaging 2023-07, Vol.50 (8), p.2282
Hauptverfasser: Vreeburg, Manon T A, Azargoshasb, Samaneh, van Willigen, Danny, Molenaar, Tom, van Oosterom, Matthias N, Buckle, Tessa, Slof, Leon J, Klop, Martin, Karakullukcu, Baris, Donswijk, Maarten, van der Poel, Henk G, van Leeuwen, Fijs W B, Brouwer, Oscar R, Rietbergen, Daphne D D
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Sprache:eng
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Zusammenfassung:Lymph node (LN) metastasis is a relevant predictor for survival in patients with a.o. penile cancer (PeCa), malignant melanoma. The sentinel node (SN) procedure comprises targeted resection of the first tumour-draining SNs. Here, the hybrid tracer indocyanine green (ICG)- Tc-nanocolloid has been used for several years to combine optical and nuclear detection. Recently, the resource of the nanocolloid precursor stopped production and the precursor was replaced by a different but chemically comparable colloid, nanoscan. Our aim was to study the performance of ICG- Tc-nanoscan compared to ICG- Tc-nanocolloid from a nuclear and surgical perspective. Twenty-four patients with either PeCa or head-and-neck (H&N) melanoma and scheduled for a SN procedure were included. The initial group (n = 11) received ICG- Tc-nanocolloid until no longer available; the second group (n = 13) received ICG- Tc-nanoscan. Tracer uptake was assessed on lymphoscintigraphy and single-photon emission (SPECT). Intraoperatively, SNs were identified using gamma tracing and fluorescence imaging. Ex vivo (back-table) measurements were conducted to quantify the fluorescence emissions. Chemical analysis was performed to compare the ICG assembly on both precursors. The mean tracer uptake in the SNs was similar for ICG- Tc-nanocolloid (2.2 ± 4.3%ID) and ICG- Tc-nanoscan (1.8 ± 2.6%ID; p = 0.68). 3 SNs (interquartile range (IQR) 3-4) were detected on lymphoscintigraphy in PeCa patients receiving ICG- Tc-nanoscan compared to 2 SNs (IQR 2-3) in PeCa patients receiving ICG- Tc-nanocolloid (p = 0.045), no differences were observed in H&N patients. Back-table measurements of resected SNs revealed a lower total fluorescence intensity in the ICG- Tc-nanoscan group (24*10 arbitrary units (A.U) IQR 1.6*10 -14*10 in the ICG- Tc-nanocolloid group versus 4.6*10 A.U. IQR 2.4*10 -42*10 in the ICG- Tc-nanoscan group, p = 0.0054). This was consistent with a larger degree of "stacked" ICG observed in the nanoscan formulation. No tracer-related adverse events were reported. Based on this retrospective analysis, we can conclude that ICG- Tc-nanoscan has similar capacity for SN identification as ICG- Tc-nanocolloid and can safely be implemented in SN procedures.
ISSN:1619-7089