R.I. Knyazev1,2, A.S. Shevchuk1,3, K.V. Afanasieva1, A.S. Krylov1, M.N. Tikhonovskaya1, E.A. Mustafina1, M.E. Bilik1, M.A. Gomov1
1N.N. Blokhin National Medical Research Center of Oncology, Moscow
2Russian Medical Academy of Continuing Professional Education, Moscow
3Pirogov Russian National Research Medical University, Moscow
Knyazev Rostislav I. ― Cand. of Sci. (Med.), Researcher at the Department of Oncogynecology of the N.N. Blokhin National Medical Research Center of Oncology; Associate Professor of the Department of Oncology and Palliative Medicine named after A.I. Savitsky of the Russian Medical Academy of Continuing Professional Education
23 Kashirskoe highway, Moscow, 115522, Russian Federation, tel. +7-926-284-77-46, e-mail: sluwba@mail.ru, SPIN-code: 2512-6000, AuthorID: 928479, ORCID ID: 0000-0002-6341-0897
Abstract
Background. Sentinel lymph nodes biopsy (SLNB) in patients with uterine and cervical cancer continues to be actively introduced into clinical oncogynecology. In order to visualize the pathways of lymphatic outflow and the detection of sentinel lymph nodes (SLN), radionuclide or fluorescent methods with own disadvantages and advantages are used.
Aim ― testing and evaluation of the effectiveness of the hybrid ICG-99mTc-albumin for detecting SLN in case of uterine and cervical cancer.
Material and methods. Three clinical cases of the use of the combined tracer ICG-99mTc-albumin in performing SLNB for uterine and cervix cancer are presented.
Results. On the day of surgery, 0,4 ml of the prepared ICG-99mTc-albumin solution with a total activity of 90-120 MBq was injected into the cervical stroma of all patients. Lymphoscintigraphy was performed 20-30 minutes later, followed by single-photon emission computed tomography (SPECT/CT) on a Discovery 670 DR (GE) device of the abdominal cavity and pelvis and 3D reconstruction of images to assess alternative lymphatic drainage pathways. A portable gamma detector and a special camera for recording images in the infrared spectrum were used intraoperatively to determine the SLN. All patients successfully underwent SLN biopsy, followed by a control assessment of the gamma radiation level.
Conclusion. The use of the hybrid ICG-99mTc-albumin label in SLNB in patients with uterine and cervical cancer has the potential to increase the accuracy of mapping lymphatic drainage pathways by combining the advantages of radionuclide and fluorescence methods.
Key words: lymph node dissection, sentinel lymph nodes, lymphotropic radiopharmaceutical, indocyanine green, hybrid tracer, combined tracer.