Méndez Jeanette, Wallace Anne M, Hoh Carl K, Vera David R
Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, California 92103, USA.
J Nucl Med. 2003 Oct;44(10):1677-81.
The purpose of this study was to develop a method for the endoscopic administration of a radiopharmaceutical for sentinel node detection and to characterize its uptake by gastric and colonic sentinel nodes. (99m)Tc-Diethylenetriaminepentaacetic acid (DTPA)-mannosyl-dextran is a new radiotracer labeled with (99m)Tc and composed of multiple units of mannose attached to the polymeric backbone, dextran.
Gastric and colonic lymph node detection was studied in 4 fasting and anesthetized pigs. A flexible video endoscope was inserted into the rectum and positioned in the lower colon or advanced down the esophagus into the stomach. A standard endoscopic sclerotherapy needle and sheath filled with 0.9% saline was then loaded with 0.2 mL of a 7.4-MBq 1:1 (v/v) mixture of isosulfan blue and (99m)Tc-DTPA-mannosyl-dextran (7.4 MBq, 0.3 nmol). The needle and sheath were passed through the biopsy channel, and the radiotracer/dye solution (0.1 mL) was injected in a tangential fashion into the submucosa. Within 5-10 min after injection, all radioactive or blue lymph nodes were excised, assayed for radioactivity, and noted for color. Distal lymph nodes were also excised, assayed, and noted for color.
(99m)Tc-DTPA-mannosyl-dextran uptake by colonic sentinel nodes (n = 4) ranged from 0.54% to 2.4% of the injected dose; all radioactive nodes were stained blue. The uptake for all (n = 3) distal nodes ranged from 0.001% to 0.005%, and none of these nodes were stained blue. Uptake by gastric sentinel nodes (n = 6) ranged from 0.13% to 4.50%; all radioactive nodes were stained blue. The range for distal nodes was 0.001% to 0.050%; no distal nodes were stained blue. In 2 pigs, each gastric injection produced 2 hot and blue lymph nodes.
Within 10 min of a gastric and colonic submucosal injection, (99m)Tc-DTPA-mannosyl-dextran demonstrated high sentinel node uptake and high concordance with isosulfan blue.
本研究的目的是开发一种用于内镜注射放射性药物以检测前哨淋巴结的方法，并描述其在胃和结肠前哨淋巴结中的摄取情况。（99m）锝-二乙三胺五乙酸（DTPA）-甘露糖基葡聚糖是一种新的放射性示踪剂，用（99m）锝标记，由多个甘露糖单元连接到聚合物主链葡聚糖上组成。
在4只禁食并麻醉的猪身上研究胃和结肠淋巴结的检测。将柔性视频内窥镜插入直肠并置于结肠下部，或沿食管推进至胃内。然后将一根装有0.9%生理盐水的标准内镜硬化治疗针和鞘管装入0.2 mL的7.4 MBq异硫蓝和（99m）Tc-DTPA-甘露糖基葡聚糖1:1（v/v）混合物（7.4 MBq，0.3 nmol）。将针和鞘管通过活检通道，将放射性示踪剂/染料溶液（0.1 mL）以切线方式注入黏膜下层。注射后5-10分钟内，切除所有放射性或蓝色淋巴结，测定放射性，并记录颜色。还切除远端淋巴结，进行测定并记录颜色。
结肠前哨淋巴结（n = 4）对（99m）Tc-DTPA-甘露糖基葡聚糖的摄取量为注射剂量的0.54%至2.4%；所有放射性淋巴结均被染成蓝色。所有（n = 3）远端淋巴结的摄取量为0.001%至0.005%，这些淋巴结均未被染成蓝色。胃前哨淋巴结（n = 6）的摄取量为0.13%至4.50%；所有放射性淋巴结均被染成蓝色。远端淋巴结的摄取范围为0.001%至0.050%；没有远端淋巴结被染成蓝色。在2只猪中，每次胃内注射产生2个热的蓝色淋巴结。
在胃和结肠黏膜下注射后10分钟内，（99m）Tc-DTPA-甘露糖基葡聚糖显示出高前哨淋巴结摄取率且与异硫蓝高度一致。
