Simultaneous use of an 125I-seed to guide tumour excision and 99mTc-nanocolloid for sentinel node biopsy in non-palpable breast-conserving surgery. Issue 1 (January 2015)

• Record Type: Journal Article
• Authors: Pouw, B.; van der Ploeg, I.M.C.; Muller, S.H.; Valdés Olmos, R.A.; Janssen-Pinkse, L.K.; Oldenburg, H.S.A.; Vrancken Peeters, M.T.F.D.
• Is Part Of: European journal of surgical oncology. Volume 41:Issue 1(2015:Jan.)
• Page Start: 71
• Page End: 78
• Publication Date: 2015-01
• Subjects: Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2014.10.046
• Languages: English
• ISSNs: 0748-7983

Abstract

<abstract xml:lang="en" abstract-type="author" id="abs0010"> <title id="sectitle0010">Abstract</title> <sec> <title id="sectitle0015">Purpose</title> <p id="abspara0010">In the present study we describe patients with non-palpable breast lesions, in which an Iodine-125 (<sup>125</sup>I)-marker (or "seed") for excision of the primary tumour and Technetium-99m nanocolloid (<sup>99m</sup>Tc-nanocolloid) for sentinel node biopsy (SNB) are used simultaneously. The purpose was to investigate any interference between <sup>125</sup>I-seeds and <sup>99m</sup>Tc-nanocolloid by an <italic>in vitro</italic> and <italic>in vivo</italic> analysis.</p> </sec> <sec> <title id="sectitle0020">Methods</title> <p id="abspara0015">Contrast/interference-ratios between <sup>125</sup>I and <sup>99m</sup>Tc count-rates were determined <italic>in vitro</italic> using a realistic simulation model. Measurements were performed with 3 gamma-probes with different crystal materials. In 25 consecutive patients <sup>99m</sup>Tc-nanocolloid was intratumourally administered at the site of a previously implanted <sup>125</sup>I-seed. Respectively, the <sup>125</sup>I-setting and <sup>99m</sup>Tc-setting of the gamma-probe guided the wide local excision and SNB and maximum counts-per-second (cps) were measured.</p> </sec> <sec> <title id="sectitle0025">Results</title> <p id="abspara0020"> <italic>In vitro</italic> the different probes varied in <sup>125</sup>I- and <sup>99m</sup>Tc-sensitivity. The contrast-ratio between <sup>125</sup>I and <sup>99m</sup>Tc in the <sup>125</sup>I-channel was 4.6 for a 3-month-old <sup>125</sup>I-seed using the most appropriate gamma-probe. <italic>In vivo</italic> the gamma-probe in the <sup>125</sup>I-setting measured a median of 16, 300 cps at the tumour site compared to 4820 cps using the <sup>99m</sup>Tc-setting. The <sup>125</sup>I-seed could be well distinguished from the <sup>99m</sup>Tc-nanocolloid in 92% of the patients and 96% required a single operation. The SNB was successful in all patients.</p> </sec> <sec> <title id="sectitle0030">Conclusions</title> <p id="abspara0025">Simultaneous use of <sup>125</sup>I-seeds and <sup>99m</sup>Tc-nanocolloid is possible under well-standardised conditions. Non-palpable breast lesions can be safely excised using the <sup>125</sup>I-seed in combination with a SN procedure. Use of <sup>125</sup>I-seeds is a next step within fine-tuning breast-conserving surgery that should lead to further investigation to confirm its value.</p> </sec> </abstract>