Comparison of two hybrid sentinel node tracers: indocyanine green (ICG)-99mTc-nanocolloid vs. ICG-99mTc-nanoscan from a nuclear medicine and surgical perspective

Manon T A Vreeburg; Samaneh Azargoshasb; Danny van Willigen; Tom Molenaar; Matthias N van Oosterom; Tessa Buckle; Leon J Slof; Martin Klop; Baris Karakullukcu; Maarten Donswijk; Henk G van der Poel; Fijs W B van Leeuwen; Oscar R Brouwer; Daphne D D Rietbergen

doi:10.1007/s00259-023-06157-9

Comparison of two hybrid sentinel node tracers: indocyanine green (ICG)-^99mTc-nanocolloid vs. ICG-^99mTc-nanoscan from a nuclear medicine and surgical perspective

Eur J Nucl Med Mol Imaging. 2023 Jul;50(8):2282-2291. doi: 10.1007/s00259-023-06157-9. Epub 2023 Mar 17.

Authors

Manon T A Vreeburg^{1

2}, Samaneh Azargoshasb^{1

2}, Danny van Willigen², Tom Molenaar^{2

3}, Matthias N van Oosterom^{1

2}, Tessa Buckle^{1

2}, Leon J Slof^{1

2

4}, Martin Klop⁵, Baris Karakullukcu⁵, Maarten Donswijk⁶, Henk G van der Poel^{1

2}, Fijs W B van Leeuwen^{1

2}, Oscar R Brouwer^{1

2}, Daphne D D Rietbergen^{7

8}

Affiliations

¹ Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
² Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Hospital, Leiden, The Netherlands.
³ Radiochemistry Facility, Department of Radiology, Leiden University Medical Hospital, Leiden, The Netherlands.
⁴ Instrumentele zaken ontwikkeling, facilitair bedrijf, Leiden University Medical Centre, Leiden, The Netherlands.
⁵ Department of Head and Neck Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
⁶ Department of Nuclear Medicine, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
⁷ Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Hospital, Leiden, The Netherlands. daphnerietbergen@gmail.com.
⁸ Department of Radiology, Section Nuclear Medicine, Leiden University Medical Hospital, Leiden, The Netherlands. daphnerietbergen@gmail.com.

Abstract

Background: Lymph node (LN) metastasis is a relevant predictor for survival in patients with a.o. penile cancer (PeCa), malignant melanoma. The sentinel node (SN) procedure comprises targeted resection of the first tumour-draining SNs. Here, the hybrid tracer indocyanine green (ICG)-^99mTc-nanocolloid has been used for several years to combine optical and nuclear detection. Recently, the resource of the nanocolloid precursor stopped production and the precursor was replaced by a different but chemically comparable colloid, nanoscan. Our aim was to study the performance of ICG-^99mTc-nanoscan compared to ICG-^99mTc-nanocolloid from a nuclear and surgical perspective.

Methods: Twenty-four patients with either PeCa or head-and-neck (H&N) melanoma and scheduled for a SN procedure were included. The initial group (n = 11) received ICG-^99mTc-nanocolloid until no longer available; the second group (n = 13) received ICG-^99mTc-nanoscan. Tracer uptake was assessed on lymphoscintigraphy and single-photon emission (SPECT). Intraoperatively, SNs were identified using gamma tracing and fluorescence imaging. Ex vivo (back-table) measurements were conducted to quantify the fluorescence emissions. Chemical analysis was performed to compare the ICG assembly on both precursors.

Results: The mean tracer uptake in the SNs was similar for ICG-^99mTc-nanocolloid (2.2 ± 4.3%ID) and ICG-^99mTc-nanoscan (1.8 ± 2.6%ID; p = 0.68). 3 SNs (interquartile range (IQR) 3-4) were detected on lymphoscintigraphy in PeCa patients receiving ICG-^99mTc-nanoscan compared to 2 SNs (IQR 2-3) in PeCa patients receiving ICG-^99mTc-nanocolloid (p = 0.045), no differences were observed in H&N patients. Back-table measurements of resected SNs revealed a lower total fluorescence intensity in the ICG-^99mTc-nanoscan group (24*10⁹ arbitrary units (A.U) IQR 1.6*10⁹-14*10⁹ in the ICG-^99mTc-nanocolloid group versus 4.6*10⁹ A.U. IQR 2.4*10⁹-42*10⁹ in the ICG-^99mTc-nanoscan group, p = 0.0054). This was consistent with a larger degree of "stacked" ICG observed in the nanoscan formulation. No tracer-related adverse events were reported.

Conclusions: Based on this retrospective analysis, we can conclude that ICG-^99mTc-nanoscan has similar capacity for SN identification as ICG-^99mTc-nanocolloid and can safely be implemented in SN procedures.

Keywords: Fluorescence; Head & neck melanoma; Hybrid tracer; Image-guided surgery; Penile cancer.

MeSH terms

Humans
Indocyanine Green
Lymphatic Metastasis
Male
Melanoma* / diagnostic imaging
Melanoma* / pathology
Melanoma* / surgery
Nuclear Medicine*
Penile Neoplasms* / pathology
Radiopharmaceuticals
Retrospective Studies
Sentinel Lymph Node Biopsy / methods
Sentinel Lymph Node* / surgery
Technetium Tc 99m Aggregated Albumin

Substances

Indocyanine Green
Radiopharmaceuticals
Technetium Tc 99m Aggregated Albumin