Head-to-head comparison of the hybrid tracer indocyanine green-99mTc-nanocolloid with 99mTc-Senti-Scint using sentinel node lymphoscintigraphy and single-photon emission computed tomography combined with computer tomography in melanoma. Issue 10 (October 2020)

• Record Type: Journal Article
• Authors: Rietbergen, Daphne D.D.; Meershoek, Philippa; KleinJan, Gijs H.; Donswijk, Maarten; Valdés Olmos, Renato A.; van Leeuwen, Fijs W.B.; Klop, Martin W.M.C.; van der Hage, Jos A.
• Is Part Of: Nuclear medicine communications. Volume 41:Issue 10(2020)
• Publication Date: 2020-10
• Subjects: image-guided surgery -- melanoma -- radiocolloids -- sentinel node; Nuclear medicine -- Periodicals; 616.07575
• DOI: 10.1097/MNM.0000000000001256
• Languages: English
• ISSNs: 0143-3636

Abstract

Abstract : Objective: The hybrid tracer indocyanine green (ICG)- 99m Tc-nanocolloid has been introduced for sentinel node imaging. However, until now, a comparison of this tracer with other radiocolloids with a larger particle size has not been effectuated. Based on a head-to-head evaluation in patients with melanoma, we have compared ICG- 99m Tc-nanocolloid (particle size 5–80 nm) with 99m Tc-Senti-Scint (particle size 100–600 nm) to establish differences in drainage pattern and sentinel node localization using lymphoscintigraphy and single-photon emission computed tomography combined with computer tomography (SPECT-CT) in melanoma patients scheduled for sentinel node biopsy. Methods: Twenty-five patients (mean age: 56.9 years, range: 25–79 years) with a melanoma scheduled for SLN biopsy prior to (re)excision of the primary lesion (scar) were prospectively included following a two-day procedure. The first day, after 99m Tc-Senti-Scint injection in four intradermal depots around the primary lesion or scar, early/delayed lymphoscintigraphy and SPECT-CT images were acquired. The injection sites were marked. The second day, after assessing lymph node radioactivity using planar scintigraphy, ICG- 99m Tc-nanocolloid was injected at the previously marked skin points and imaging was performed. The paired planar and SPECT-CT images of both tracers were evaluated with respect to drainage patterns, SLN visualization and non-SLN appearing. Results: Twenty-four out of 25 patients were evaluable. SLN visualization on a patient basis was 100% for ICG- 99m Tc-nanocolloid and 96% for 99m Tc-Senti-Scint, whereas uptake in non-SLNs was found in, respectively, 71% (17/24) and 61% (14/23). Concordance in drainage to 45 lymph node basins was 91%. Discordant drainage was found for two melanomas in the head-and-neck and one in the clavicular area. Unique lymph node basins were seen in 44/45 (98%) for ICG- 99m Tc-nanocolloid and 42/45 (93%) for 99m Tc-Senti-Scint. Concerning identified SLNs, the number was similar for both tracers ( n = 58); however, more non-SLNs (65 vs 50) were visualized with ICG- 99m Tc-nanocolloid than with 99m Tc-Senti-Scint. Conclusion: A slightly higher SLN visualization accompanied by a tendency to depict more non-SLNs was found for ICG- 99m Tc-nanocolloid. Excepting the head and neck area, an overall high concordance in drainage was found for both radiotracers. With an additional value for the hybrid tracer due to the combination of preoperative imaging and the additional visual signal in the operation room, added by the fluorescent component of the hybrid tracer, there was a preference for ICG- 99m Tc-nanocolloid.