Ann Hepatobiliary Pancreat Surg.  2020 Aug;24(3):277-282. 10.14701/ahbps.2020.24.3.277.

The accuracy of sentinel node biopsy by 99mTc-sodium phytate in patients with pancreatic cancer

• Sadeghi R
• Aliakbarian M
• Shayegani H
• Memar B
• Dabbagh VR

• KMID: 2505340
• DOI: http://doi.org/10.14701/ahbps.2020.24.3.277

Abstract

Backgrounds/Aims
Pancreaticoduodenectomy is the only potentially curative treatment for pancreatic cancer. The identification of the first nodal drainage site (sentinel node) may improve the detection of metastatic nodes and can contribute to a less invasive surgery. We aimed to determine the accuracy of sentinel node mapping in patients with pancreatic cancer using intraoperative radiotracer injection technique.
Methods
At surgical exposure, peritumoral injection of 0.4-0.5 mci/0.5 ml of 99mTc- sodium phytate was performed. After umor resection, sentinel nodes were investigated in the most common areas using a hand-held gamma probe. Any lymph node with in vivo count twice the background was considered as sentinel node, thus, it was removed and sent for pathological assessment. Then a standard lymph node dissection was performed for all patients.
Results
Fourteen patients with cancer in the head of the pancreas were included in this study. Overall, 180 lymph nodes were harvested with a mean of 11.6±4.7 lymph nodes per patient. In eight patients, at least one sentinel node could be identified (detection rate about 64%). False negative rate of the study was 3/5 (60%).
Conclusions
Our study revealed insufficient diagnostic accuracy and high false negative rate for sentinel lymph node mapping with 99mTc- sodium phytate in pancreatic cancer

Keyword

Sentinel lymph node; Pancreatic neoplasms; Pancreaticoduodenectomy; Lymph node excision

Figure

• 

  Fig. 1 Peritumoral injection of 0.4-0.5 millicurie 99mTc-sodium phytate in a volume of 2.0 cc (in 4 divided doses).

• 

  Fig. 2 Gamma probe device (Surgioguide II, Parto Negar Persia Co. Ltd.) used to determine tumor and lymph node counts.

Reference

1. Shrikhande SV, Barreto SG. 2010; Extended pancreatic resections and lymphadenectomy: an appraisal of the current evidence. World J Gastrointest Surg. 2:39–46. DOI: 10.4240/wjgs.v2.i2.39. PMID: 21160848. PMCID: PMC2999214.

2. Ma J, Siegel R, Jemal A. 2013; Pancreatic cancer death rates by race among US men and women, 1970-2009. J Natl Cancer Inst. 105:1694–1700. DOI: 10.1093/jnci/djt292. PMID: 24203988.

3. Zhang J, Dhakal I, Ning B, Kesteloot H. 2008; Patterns and trends of pancreatic cancer mortality rates in Arkansas, 1969-2002: a comparison with the US population. Eur J Cancer Prev. 17:18–27. DOI: 10.1097/CEJ.0b013e32809b4ccd. PMID: 18090906.

4. American Joint Committee on Cancer. 2010. AJCC cancer staging handbook. 7th ed. Springer;New York:

5. Ishikawa O, Ohigashi H, Sasaki Y, Kabuto T, Furukawa H, Nakamori S, et al. 1997; Practical grouping of positive lymph nodes in pancreatic head cancer treated by an extended pancreatectomy. Surgery. 121:244–249. DOI: 10.1016/S0039-6060(97)90352-4. PMID: 9068665.

6. Millikan KW, Deziel DJ, Silverstein JC, Kanjo TM, Christein JD, Doolas A, et al. 1999; Prognostic factors associated with resectable adenocarcinoma of the head of the pancreas. Am Surg. 65:618–623. discussion 623–624. DOI: 10.1016/S0090-4295(99)00304-0. PMID: 10399969.

7. Ohta T, Kitagawa H, Kayahara M, Kinami S, Ninomiya I, Fushida S, et al. 2003; Sentinel lymph node navigation surgery for pancreatic head cancers. Oncol Rep. 10:315–319. DOI: 10.3892/or.10.2.315. PMID: 12579265.

8. Hirono S, Tani M, Kawai M, Okada K, Miyazawa M, Shimizu A, et al. 2012; Identification of the lymphatic drainage pathways from the pancreatic head guided by indocyanine green fluorescence imaging during pancreaticoduodenectomy. Dig Surg. 29:132–139. DOI: 10.1159/000337306. PMID: 22538463.

9. Pavlidis TE, Pavlidis ET, Sakantamis AK. 2011; Current opinion on lymphadenectomy in pancreatic cancer surgery. Hepatobiliary Pancreat Dis Int. 10:21–25. DOI: 10.1016/S1499-3872(11)60002-7. PMID: 21269930.

10. Yasuda S, Shimada H, Chino O, Tanaka H, Kenmochi T, Takechi M, et al. 2003; Sentinel lymph node detection with Tc-99m tin colloids in patients with esophagogastric cancer. Jpn J Clin Oncol. 33:68–72. DOI: 10.1093/jjco/hyg020. PMID: 12629056.

11. Murawa D, Filas V, Breborowicz J, Spychała A, Dworzecka K, Murawa P. 2007; Evaluation of the sentinel node biopsy in colorectal carcinoma including the results of immunohistochemical examinations. Acta Chir Belg. 107:45–48. DOI: 10.1080/00015458.2007.11680009. PMID: 17405597.

12. Kocher HM, Sohail M, Benjamin IS, Patel AG. 2007; Technical limitations of lymph node mapping in pancreatic cancer. Eur J Surg Oncol. 33:887–891. DOI: 10.1016/j.ejso.2007.02.037. PMID: 17433604.

13. Moncayo VM, Aarsvold JN, Alazraki NP. 2015; Lymphoscintigraphy and sentinel nodes. J Nucl Med. 56:901–907. DOI: 10.2967/jnumed.114.141432. PMID: 25931478.

14. de Bree R, Nieweg OE. 2015; The history of sentinel node biopsy in head and neck cancer: from visualization of lymphatic vessels to sentinel nodes. Oral Oncol. 51:819–823. DOI: 10.1016/j.oraloncology.2015.06.006. PMID: 26126813.

15. Durczyński A, Hogendorf P, Szymański D, Grzelak P, Strzelczyk J. 2012; Sentinel lymph node mapping in tumors of the pancreatic body: preliminary report. Contemp Oncol (Pozn). 16:206–209. DOI: 10.5114/wo.2012.29285. PMID: 23788880. PMCID: PMC3687406.

16. Beisani M, Roca I, Cardenas R, Blanco L, Abu-Suboh M, Dot J, et al. 2016; Initial experience in sentinel lymph node detection in pancreatic cancer. Rev Esp Med Nucl Imagen Mol. 35:287–291. DOI: 10.1016/j.remn.2015.10.006. PMID: 26670326.

17. Park DJ, Lee HJ, Lee HS, Kim WH, Kim HH, Lee KU, et al. 2006; Sentinel node biopsy for cT1 and cT2a gastric cancer. Eur J Surg Oncol. 32:48–54. DOI: 10.1016/j.ejso.2005.09.006. PMID: 16269225.

18. Tsioulias GJ, Wood TF, Morton DL, Bilchik AJ. 2000; Lymphatic mapping and focused analysis of sentinel lymph nodes upstage gastrointestinal neoplasms. Arch Surg. 135:926–932. DOI: 10.1001/archsurg.135.8.926. PMID: 10922254.

19. Chen SL, Iddings DM, Scheri RP, Bilchik AJ. 2006; Lymphatic mapping and sentinel node analysis: current concepts and applications. CA Cancer J Clin. 56:292–309. quiz 316-317. DOI: 10.3322/canjclin.56.5.292. PMID: 17005598.

20. Kapteijn BA, Nieweg OE, Liem I, Mooi WJ, Balm AJ, Muller SH, et al. 1997; Localizing the sentinel node in cutaneous melanoma: gamma probe detection versus blue dye. Ann Surg Oncol. 4:156–160. DOI: 10.1007/BF02303799. PMID: 9084853.