Determination of sentinel lymph nodes in gynecological cancer using the radiopharmaceutical Sentiscan. A case series

封面

如何引用文章

全文:

详细

Background. Lymphadenectomy in patients with malignant female genital neoplasms is a necessary step of surgical treatment, the implementation of which allows assessing the the metastatic involvement of the removed lymph nodes and determining indications for postoperative treatment. Sentinel lymph node (SLN) biopsy with ultrastaging method appears to be a good alternative to standard regional lymph node removal with similar long-term oncologic outcomes and significantly lower rates of postoperative complications.

Aim. To present the possibility of using a domestic radiopharmaceutical labeled with technetium-99m (Sentiscan) in patients with gynecological cancer.

Materials and methods. A series of clinical cases of the use of Sentiscan during SLN biopsy in three patients suffering from cancer of the uterus and vulva is presented.

Results. 18–24 hours before the operation, 0.4 ml of the prepared solution of radiopharmaceutical 99mTc-Sentiscan with a total activity of 150 MBq was injected into the cervix of the uterus with tumors of the uterine body and into the vulva. After 2 hours, SPECT/CT was performed on the Discovery 670 DR (GE) of the abdomen and pelvis, followed by 3D reconstruction of images for better intraoperative navigation. Intraoperatively, a portable gamma detector Rad Pointer Gamma (Medikor Pharma Ural) was used to identify sentinel lymph nodes. Sentinel lymph nodes were removed in all patients, followed by a control assessment of the gamma radiation level, histological and immunohistochemical studies using panCK, CK18 markers.

Conclusion. Presented clinical cases demonstrated high efficacy of sentinel lymph node mapping using radiopharmaceutical Sentiscan. Further studies are necessary for wide implementation of this technology in clinical practice.

作者简介

Alexey Shevchuk

Blokhin National Medical Research Center of Oncology; Pirogov Russian National Research Medical University

编辑信件的主要联系方式.
Email: oncogyn@live.ru
ORCID iD: 0000-0002-9259-4525
SPIN 代码: 9125-1811

Cand. Sci. (Med.), Blokhin National Medical Research Center of Oncology, Pirogov Russian National Research Medical University

俄罗斯联邦, Moscow; Moscow

Alexander Krylov

Blokhin National Medical Research Center of Oncology

Email: krilovas@rambler.ru
ORCID iD: 0000-0002-8476-7879
SPIN 代码: 4254-3930

Cand. Sci. (Med.), Blokhin National Medical Research Center of Oncology

俄罗斯联邦, Moscow

Rostislav Knyazev

Blokhin National Medical Research Center of Oncology; Russian Medical Academy of Continuous Professional Education

Email: sluwba@mail.ru
ORCID iD: 0000-0002-6341-0897
SPIN 代码: 2512-6000

Cand. Sci. (Med.), Blokhin National Medical Research Center of Oncology, Russian Medical Academy of Continuous Professional Education

俄罗斯联邦, Moscow; Moscow

Kristina Afanasieva

Blokhin National Medical Research Center of Oncology

Email: afanassievakr@bk.ru

Cand. Sci. (Med.), Blokhin National Medical Research Center of Oncology

俄罗斯联邦, Moscow

参考

  1. Очиров М.О., Кишкина А.Ю., Коломиец Л.А., Чернов В.И. Биопсия сторожевых лимфатических узлов при хирургическом лечении рака эндометрия: история и современность. Опухоли женской репродуктивной системы. 2018;14(4):65-71 [Ochirov MO, Kishkina AIu, Kolomiets LA, Chernov VI. Biopsiia storozhevykh limfaticheskikh uzlov pri khirurgicheskom lechenii raka endometriia: istoriia i sovremennost'. Opukholi zhenskoi reproduktivnoi sistemy. 2018;14(4):65-71 (in Russian)].
  2. Чернов В.И., Медведева А.А., Синилкин И.Г., и др. Опыт разработки инновационных радиофармпрепаратов в Томском НИИ онкологии. Сибирский онкологический журнал. 2015;2:45-7 [Chernov VI, Medvedeva AA, Sinilkin IG, et al. Opyt razrabotki innovatsionnykh radiofarmpreparatov v Tomskom NII onkologii. Sibirskii onkologicheskii zhurnal. 2015;2:45-7 (in Russian)].
  3. Крживицкий П.И., Канаев С.В., Новиков С.Н., и др. Использование ОФЭКТ-КТ для визуализации сигнальных лимфатических узлов у больных РМЖ. Вопросы онкологии. 2015;4:624-8 [Krzhivitskii PI, Kanaev SV, Novikov SN, et al. Ispol'zovanie OFEKT-KT dlia vizualizatsii signal'nykh limfaticheskikh uzlov u bol'nykh RMZh. Voprosy onkologii. 2015;4:624-8 (in Russian)].
  4. NCCN Clinical Practice Guidelines in Oncology. Version 1.2023 – December 22, 2022. Available at: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1473. Acessed: 15.02.2023.
  5. Князев Р.И., Жорданиа К.И., Шевчук А.С. Хирургические факторы риска развития лимфатических кист после тазовой лимфаденэктомии у больных раком тела матки. Онкогинекология. 2021;1:57-64 [Kniazev RI, Zhordania KI, Shevchuk AS. Khirurgicheskie faktory riska razvitiia limfaticheskikh kist posle tazovoi limfadenektomii u bol'nykh rakom tela matki. Onkoginekologiia. 2021;1:57-64 (in Russian)].
  6. Скрепцова Н.С., Новикова Е.Г., Степанов С.О. Тактика ведения пациентов после тазовой лимфаденэктомии с использованием ультразвукового метода. Вопросы онкологии. 2011;57(3):327-36 [Skreptsova NS, Novikova EG, Stepanov SO. Taktika vedeniia patsientov posle tazovoi limfadenektomii s ispol'zovaniem ul'trazvukovogo metoda. Voprosy onkologii. 2011;57(3):327-36 (in Russian)].
  7. Нечушкина В.М., Морхов К.Ю., Кузнецов В.В. Хирургическое лечение рака тела матки. Злокачественные опухоли. 2014;3(10):72-80 [Nechushkina VM, Morkhov KIu, Kuznetsov VV. Khirurgicheskoe lechenie raka tela matki. Zlokachestvennye opukholi. 2014;3(10):72-80 (in Russian)].
  8. How JA, O'Farrell P, Amajoud Z, et al. Sentinel lymph node mapping in endometrial cancer: a systematic review and meta-analysis. Minerva Ginecol. 2018;70(2):194-214. doi: 10.23736/S0026-4784.17.04179-X
  9. Darai E, Dubernard G, Bats AS, et al. Sentinel node biopsy for the management of early stage endometrial cancer: long-term results of the SENTI-ENDO study. Gynecol Oncol. 2015;136(1):54-9. doi: 10.1016/j.ygyno.2014.09.011
  10. Schiavone MB, Zivanovic O, Zhou Q, et al. Survival of Patients with Uterine Carcinosarcoma Undergoing Sentinel Lymph Node Mapping. Ann Surg Oncol. 2016;23(1):196-202. doi: 10.1245/s10434-015-4612-2
  11. Stehman FB, Look KY. Carcinoma of the vulva. Obstet Gynecol. 2006;107(3):719-33. doi: 10.1097/01.AOG.0000202404.55215.72
  12. Cham S, Chen L, Burke WM, et al. Utilization and Outcomes of Sentinel Lymph Node Biopsy for Vulvar Cancer. Obstet Gynecol. 2016;128(4):754-60. doi: 10.1097/AOG.0000000000001648
  13. Huang J, Yu N, Wang X, Long X. Incidence of lower limb lymphedema after vulvar cancer: A systematic review and meta-analysis. Medicine (Baltimore). 2017;96(46):e8722. doi: 10.1097/MD.0000000000008722
  14. Van der Zee AG, Oonk MH, De Hullu JA, et al. Sentinel node dissection is safe in the treatment of early-stage vulvar cancer. J Clin Oncol. 2008;26(6):884-9. doi: 10.1200/JCO.2007.14.0566
  15. Coleman RL, Ali S, Levenback CF, et al. Is bilateral lymphadenectomy for midline squamous carcinoma of the vulva always necessary? An analysis from Gynecologic Oncology Group (GOG) 173. Gynecol Oncol. 2013;128(2):155-9. doi: 10.1016/j.ygyno.2012.11.034
  16. Slomovitz BM, Coleman RL, Oonk MH, et al. Update on sentinel lymph node biopsy for early-stage vulvar cancer. Gynecol Oncol. 2015;138(2):472-7. doi: 10.1016/j.ygyno.2015.05.017
  17. Oonk MH, Hollema H, van der Zee AG. Sentinel node biopsy in vulvar cancer: Implications for staging. Best Pract Res Clin Obstet Gynaecol. 2015;29(6):812-21. doi: 10.1016/j.bpobgyn.2015.03.007
  18. Ганцев Ш.Х., Липатов О.Н., Меньшиков К.В. Детекция сторожевого лимфатического узла при раке вульвы, современные технологии. Креативная хирургия и онкология. 2018;8(4):292-7 [Gancev ShH, Lipatov ON, Men'shikov KV. Detekciya storozhevogo limfaticheskogo uzla pri rake vulvy, sovremennye tekhnologii. Kreativnaya hirurgiya i onkologiya. 2018;8(4):292-7 (in Russian)]. doi: 10.24060/2076-3093-2018-8-4-292-297
  19. Levenback CF, Ali S, Coleman RL, et al. Lymphatic mapping and sentinel lymph node biopsy in women with squamous cell carcinoma of the vulva: a gynecologic oncology group study. J Clin Oncol. 2012;30(31):3786-91. doi: 10.1200/JCO.2011.41.2528
  20. Verbeek FP, Tummers QR, Rietbergen DD, et al. Sentinel Lymph Node Biopsy in Vulvar Cancer Using Combined Radioactive and Fluorescence Guidance. Int J Gynecol Cancer. 2015;25(6):1086-93. doi: 10.1097/IGC.0000000000000419
  21. Zigras T, Kupets R, Barbera L, et al. Uptake of sentinel lymph node procedures in women with vulvar cancer over time in a population based study. Gynecol Oncol. 2019;153(3):574-9. doi: 10.1016/j.ygyno.2019.03.010
  22. Brincat MR, Muscat Baron Y. Sentinel Lymph Node Biopsy in the Management of Vulvar Carcinoma: An Evidence-Based Insight. Int J Gynecol Cancer. 2017;27(8):1769-73. doi: 10.1097/IGC.0000000000001075
  23. Meads C, Sutton AJ, Rosenthal AN, et al. Sentinel lymph node biopsy in vulval cancer: systematic review and meta-analysis. Br J Cancer. 2014;110(12):2837-46. doi: 10.1038/bjc.2014.205
  24. Covens A, Vella ET, Kennedy EB, et al. Sentinel lymph node biopsy in vulvar cancer: Systematic review, meta-analysis and guideline recommendations. Gynecol Oncol. 2015;137(2):351-61. doi: 10.1016/j.ygyno.2015.02.014

补充文件

附件文件
动作
1. JATS XML
下载
2. Fig. 1. Sites of injection of radiopharmaceutical agent (RPA) into the cervix [4].

下载 (48KB)
索引源数据
3. Fig. 2. Injection of Sentiscan radiopharmaceutical agent, 99mTc, into the patient's cervix at 3 o'clock of the conditional dial.

下载 (156KB)
索引源数据
4. Fig. 3. Single-photon emission computed tomography (SPECT/CT) of the abdomen and pelvis of patient Ch. in the frontal (a), axial (b) planes, and 3D reconstruction (c). Image (a) shows the site of the RPA injection, a slight uptake in the bladder, and an uptake of RPA by the pelvic lymph nodes. On the right, the chain of lymph nodes with the maximum RPA uptake by the first two lymph nodes was determined; when measuring SUVmax, the uptake in them was 308; in the other two, the level was much lower, up to 38, in the lymph nodes on the left, one SLN with the level of SUVmax up to 240 is visualized. In the axial image (b) and 3D reconstruction (c), SLN is clearly visible.

下载 (128KB)
索引源数据
5. Fig. 4. Measurement of γ-radiation at the site of RPA injection (cervix).

下载 (110KB)
索引源数据
6. Fig. 5. Search and detection of sentinel lymph node (SLN) in the left iliac region.

下载 (157KB)
索引源数据
7. Fig. 6. Search and detection of SLN in the right iliac region.

下载 (170KB)
索引源数据
8. Fig. 7. Control measurement of γ-activity from removed SLN.

下载 (83KB)
索引源数据
9. Fig. 8. SPECT/CT of the abdomen and pelvis of patient A. in the frontal (a), axial (b) planes, and 3D reconstruction (c).

下载 (121KB)
索引源数据
10. Fig. 9. Control measurement of γ-activity from removed SLN.

下载 (133KB)
索引源数据
11. Fig. 10. Injection of RPA under the vulvar mucosa.

下载 (121KB)
索引源数据
12. Fig. 11. SPECT/CT of the pelvis of patient A. in the frontal (a), axial (b) planes, and 3D reconstruction (c).

下载 (131KB)
索引源数据
13. Fig. 12. Use of a γ-detector to locate the SLN in a patient with vulvar cancer.

下载 (127KB)
索引源数据
14. Fig. 13. Control measurement of γ-activity from removed SLN.

下载 (152KB)
索引源数据

版权所有 © Consilium Medicum, 2023

Creative Commons License
此作品已接受知识共享署名-非商业性使用-相同方式共享 4.0国际许可协议的许可。
 


##common.cookie##