Karakatsanis A, Olofsson H, Stålberg P, Bergkvist L, Abdsaleh S, Wärnberg F
1 Section for Endocrine and Breast Surgery, Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.
2 Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
Scand J Surg. 2018 Jun;107(2):130-137. doi: 10.1177/1457496917738867. Epub 2017 Nov 13.
Sentinel node is routinely localized with the intraoperative use of a radioactive tracer, involving challenging logistics. Super paramagnetic iron oxide nanoparticle is a non-radioactive tracer with comparable performance that could allow for preoperative localization, would simplify the procedure, and possibly be of value in axillary mapping before neoadjuvant treatment. The current trial aimed to determine the a priori hypothesis that the injection of super paramagnetic iron oxide nanoparticles in the preoperative period for the localization of the sentinel node is feasible.
This is a prospective feasibility trial, conducted from 9 September 2014 to 22 October 2014 at Uppsala University Hospital. In all, 12 consecutive patients with primary breast cancer planned for resection of the primary and sentinel node biopsy were recruited. Super paramagnetic iron oxide nanoparticles were injected in the preoperative visit in the outpatient clinic. The radioactive tracer (mTc) and the blue dye were injected perioperatively in standard fashion. A volunteer was injected with super paramagnetic iron oxide nanoparticles to follow the decline in the magnetic signal in the sentinel node over time. The primary outcome was successful sentinel node detection.
Super paramagnetic iron oxide nanoparticles' detection after preoperative injection (3-15 days) was successful in all cases (100%). In the volunteer, axillary signal was presented for 4 weeks. No adverse effects were noted. Conclusion and relevance: Preoperative super paramagnetic iron oxide nanoparticles' injection is feasible and leads to successful detection of the sentinel node. That may lead to simplified logistics as well as the identification, sampling, and marking of the sentinel node in patients planned for neoadjuvant treatment.
前哨淋巴结通常在术中使用放射性示踪剂进行定位，这涉及到具有挑战性的后勤工作。超顺磁性氧化铁纳米颗粒是一种性能相当的非放射性示踪剂，可实现术前定位，简化操作流程，并且可能在新辅助治疗前的腋窝定位中具有价值。当前试验旨在确定术前注射超顺磁性氧化铁纳米颗粒用于前哨淋巴结定位的先验假设是否可行。
这是一项前瞻性可行性试验，于2014年9月9日至2014年10月22日在乌普萨拉大学医院进行。总共招募了12例计划切除原发灶并进行前哨淋巴结活检的原发性乳腺癌患者。在门诊术前就诊时注射超顺磁性氧化铁纳米颗粒。术中以标准方式注射放射性示踪剂（锝）和蓝色染料。对一名志愿者注射超顺磁性氧化铁纳米颗粒，以跟踪前哨淋巴结中磁信号随时间的衰减情况。主要结局是成功检测到前哨淋巴结。
术前注射（3 - 15天）后，超顺磁性氧化铁纳米颗粒在所有病例中均成功检测到（100%）。在志愿者中，腋窝信号持续了4周。未观察到不良反应。结论及相关性：术前注射超顺磁性氧化铁纳米颗粒是可行的，并且能成功检测到前哨淋巴结。这可能会简化后勤工作，并有助于对计划接受新辅助治疗的患者的前哨淋巴结进行识别、采样和标记。
