Simultaneous use of an125 I-seed to guide tumour excision and99m Tc-nanocolloid for sentinel node biopsy in non-palpable breast-conserving surgery

• Published in: European journal of surgical oncology Vol. 41; no. 1; pp. 71 - 78
• Main 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
• Format: Journal Article
• Language: English
• Published: 2014
• Subjects: Hematology, Oncology and Palliative Medicine; Surgery; Iodine 125; Sentinel node procedure; Breast conserving surgery; Technetium 99m; Breast cancer; Non-palpable
• ISSN: 0748-7983
• DOI: 10.1016/j.ejso.2014.10.046

Abstract Purpose In the present study we describe patients with non-palpable breast lesions, in which an Iodine-125 (125 I)-marker (or “seed”) for excision of the primary tumour and Technetium-99m nanocolloid (99m Tc-nanocolloid) for sentinel node biopsy (SNB) are used simultaneously. The purpose was to investigate any interference between125 I-seeds and99m Tc-nanocolloid by an in vitro and in vivo analysis. Methods Contrast/interference-ratios between125 I and99m Tc count-rates were determined in vitro using a realistic simulation model. Measurements were performed with 3 gamma-probes with different crystal materials. In 25 consecutive patients99m Tc-nanocolloid was intratumourally administered at the site of a previously implanted125 I-seed. Respectively, the125 I-setting and99m Tc-setting of the gamma-probe guided the wide local excision and SNB and maximum counts-per-second (cps) were measured. Results In vitro the different probes varied in125 I- and99m Tc-sensitivity. The contrast-ratio between125 I and99m Tc in the125 I-channel was 4.6 for a 3-month-old125 I-seed using the most appropriate gamma-probe. In vivo the gamma-probe in the125 I-setting measured a median of 16,300 cps at the tumour site compared to 4820 cps using the99m Tc-setting. The125 I-seed could be well distinguished from the99m Tc-nanocolloid in 92% of the patients and 96% required a single operation. The SNB was successful in all patients. Conclusions Simultaneous use of125 I-seeds and99m Tc-nanocolloid is possible under well-standardised conditions. Non-palpable breast lesions can be safely excised using the125 I-seed in combination with a SN procedure. Use of125 I-seeds is a next step within fine-tuning breast-conserving surgery that should lead to further investigation to confirm its value.