Nuclear Medicine in Cancer Diagnosis and Therapy

Early cancer diagnosis remains one of the most actual problems of medicine, since it allows using the most effective methods of cancer treating. Unlike most diagnostic methods used in oncology, the methods of nuclear medicine allow assessing not so much the anatomic changes in the organ as the disturbance of metabolic processes in tumors and surrounding tissues. The authors describe the main radiopharmaceuticals used for diagnose and radiotherapy of malignant tumors

Nuclear Medicine in Breast Cancer Diagnostics: Primary Tumor and Lymphatic Metastasis

The purpose of the study: to assess the possibility of using nuclear medicine techniques at the stages of diagnosis and treatment of breast cancer. Materials and Methods: The study included 290 patients with breast cancer and 70 patients with benign breast tumors. The study was used as a radiopharmaceutical 99mTc-MIBI, 199Tl for imaging tumors and colloid 99mTc-Aloteh for visualization sentinel lymph nodes (SLN), colloid was injected peritumoral in four points to 80 MBq one day prior to the planned operation. Results: The sensitivity of SPECT using both 99mTc-MIBI and 199Tl for breast cancer detection was shown to be rather high, being 98.5% and 98%, respectively. It should be noted that the sensitivity of SPECT in detection of small tumors (less than 1 cm in diameter) and multicentric tumors was not high irrespective of the radioisotope used (60% and 65% with 99mTc-MIBI and 65% and 59% with 199Tl, respectively). The difference in the sensitivity was found between 99mTc-MIBI and 199T for the detection of regional lymph node metastasis (91% vs 70%). SLN were detected in 31 patients. The most commonly SLN were defined in the axillary region of 96.7%. In 22 (70.9%) patients there was no metastasis SLN. The sensitivity of the method was 91.2%, specificity of 100%. Conclusion: The specificity of SPECT with 199Tl was higher than that with 99mTc-MIBI. The data obtained show that SPECT with 199Tl can be recommended for its use as an additional breast cancer detection method in cases when other imaging techniques and histological findings are not accurate enough. The clinical study of 99mTc-Aloteh, a new radiopharmaceutical agent, has shown that the studied colloid has high uptake level in SLN and can be successfully used for visualization of SLN in patients with breast cancer

Nuclear Medicine in Breast Cancer Diagnostics: Primary Tumor and Lymphatic Metastasis

The purpose of the study: to assess the possibility of using nuclear medicine techniques at the stages of diagnosis and treatment of breast cancer. Materials and Methods: The study included 290 patients with breast cancer and 70 patients with benign breast tumors. The study was used as a radiopharmaceutical 99mTc-MIBI, 199Tl for imaging tumors and colloid 99mTc-Aloteh for visualization sentinel lymph nodes (SLN), colloid was injected peritumoral in four points to 80 MBq one day prior to the planned operation. Results: The sensitivity of SPECT using both 99mTc-MIBI and 199Tl for breast cancer detection was shown to be rather high, being 98.5% and 98%, respectively. It should be noted that the sensitivity of SPECT in detection of small tumors (less than 1 cm in diameter) and multicentric tumors was not high irrespective of the radioisotope used (60% and 65% with 99mTc-MIBI and 65% and 59% with 199Tl, respectively). The difference in the sensitivity was found between 99mTc-MIBI and 199T for the detection of regional lymph node metastasis (91% vs 70%). SLN were detected in 31 patients. The most commonly SLN were defined in the axillary region of 96.7%. In 22 (70.9%) patients there was no metastasis SLN. The sensitivity of the method was 91.2%, specificity of 100%. Conclusion: The specificity of SPECT with 199Tl was higher than that with 99mTc-MIBI. The data obtained show that SPECT with 199Tl can be recommended for its use as an additional breast cancer detection method in cases when other imaging techniques and histological findings are not accurate enough. The clinical study of 99mTc-Aloteh, a new radiopharmaceutical agent, has shown that the studied colloid has high uptake level in SLN and can be successfully used for visualization of SLN in patients with breast cancer

Nuclear Medicine Imaging of Locally Advanced Laryngeal and Hypopharyngeal Cancer

The diagnostic capabilities of nuclear medicine imaging in the detection and assessment of the spread of laryngeal/hypopharyngeal cancer were studied. A total of 40 patients with histologically verified laryngeal and hypopharyngeal cancer and 20 patients with benign laryngeal lesions were included into the study. Submucosal injections of {99m}Tc-MIBI and {99m}Tc-Alotech were made around the tumor. Single photon emission computed tomography (SPECT) was performed 20 minutes after the injection of {99m}Tc-MIBI. Sentinel lymph nodes (SLNs) were detected in 26 patients. In 18 hours after the injection of {99m}Tc-Alotech, SPECT was performed. In 24 hours after the injection of {99m}Tc-Alotech, intraoperative SLN detection was performed using Gamma Finder II. SPECT with {99m}Tc-MIBI revealed laryngeal and hypopharyngeal tumors in 38 of the 40 patients. The {99m}Tc-MIBI uptake in metastatic lymph nodes was visualized in 2 (17%) of the 12 patients. Twenty eight SLNs were detected by SPECT and 31 SLNs were identified using the intraoperative gamma probe. The percentage of {99m}Tc-Alotech in the SLN was 5-10% of the radioactivity in the injection site by SPECT and 18-33% by intraoperative gamma probe detection. Thus, SPECT with {99m}Tc-MIBI is an effective tool for the diagnosis of laryngeal/hypopharyngeal cancer. The sensitivity, specificity and accuracy of this technique were 95%, 80% and 92%, respectively. The use of {99m}Tc-Alotech for the detection of SLNs in patients with laryngeal/hypopharyngeal cancer is characterized by 92.8% sensitivity

The use of {99m}Tc-Al[2]O[3] for detection of sentinel lymph nodes in cervical cancer patients

The purpose of the study was to evaluate the feasibility of using {99m}Tc-Al[2]O[3]- based radiopharmaceutical, a novel molecular imaging agent for sentinel lymph node detection in patients with invasive cervical cancer. The study included 23 cervical cancer patients (TlaNxMx- T[2]bNxMx) treated at the Tomsk Cancer Research Institute. At 18 hours before surgery, 80 MBq of the {99m}Tc-Al[2]O[3] were injected peritumorally, followed by single-photon emission computed tomography (SPECT) of the pelvis and intraoperative SLN identification. Twenty-seven SLNs were detected by SPECT, and 34 SLNs were identified by intraoperative gamma probe. The total number of identified SLNs per patient ranged from 1 to 3(the mean number of SLNs was 1.4 per patient). The most common site for SLN detection was the external iliac region (57.2%), followed by the internal iliac, obturator, presacral and retrosacral regions (they amounted to 14%, respectively),and the parametrial region (1%). Sensitivity in detecting SLNs was 100% for intraoperative SLN identification and 79% for SPECT image

The first experience of using {99m}Tc-Al[2]O[3]-based radiopharmaceutical for the detection of sentinel lymph nodes in cervical cancer patients

The purpose of the study was to evaluate the feasibility of using {99m}Tc-Al[2]O[3]-based radiopharmaceutical,a novel molecular imaging agent for sentinel lymph node detection in patients with invasive cervical cancer. The study included 23 cervical cancer patients (T1aNxMx-T2bNxMx) treated at the Tomsk CancerResearch Institute. In the 18 hours before surgery, 80 MBq of the {99m}Tc-Al[2]O[3] in peritumoral injected, followed by single-photon emission computed tomography (SPECT) of the pelvis and intraoperative SLN identification. Twenty-seven SLNs were detected by SPECT, and 34 SLNs were identified by intraoperative gamma probe. The total number of identified SLNs per patient ranged from 1 to 3 (the mean number of SLNs was 1.4 per patient). The most common site for SLN detection was the external iliac region (57.2%), followed by the internal iliac (14%), obturator (14%), presacral and retrosacral regions (14%), and the parametrial region (1%). Sensitivity in detecting SLNs was 100% for intraoperative SLN identification and 79% for SPECT image

The use of (99m}Tc-Al[2]O[3] for detection of sentinel lymph nodes in breast cancer

Purpose: to study the feasibility of using the new radiopharmaceutical based on the technetium-99m-labeled gamma-alumina for identification of sentinel lymph nodes (SLNs) in breast cancer patients. The study included two groups of breast cancer patients who underwent single photon emission computed tomography (SPECT) and intraoperaive gamma probe identification of sentinel lymph nodes (SLNs). To identify SLNs, the day before surgery Group I patients (n=34) were injected with radioactive {99m}Tc-Al[2]O[3], and Group II patients (n=30) received 99mTc-labeled phytate colloid. A total of 37 SLNs were detected in Group I patients. The number of identified SLNs per patient ranged from 1 to 2 (the average number of identified SLNs was 1.08). Axillary lymph nodes were the most common site of SLN localization. 18 hours after {99m}Tc-Al[2]O[3] injection, the percentage of its accumulation in the SLN was 7-11% (of the counts in the injection site) by SPECT and 17-31% by gamma probe detection. In Group II SLNs were detected in 27 patients. 18 hours after injection of the phytate colloid the percentage of its accumulation in the SLN was 1.5-2% out of the counts in the injection site by SPECT and 4-7% by gamma probe. The new radiopharmaceutical based on the {99m}Tc-Al[2]O[3] demonstrates high accumulation in SLNs without redistribution through the entire lymphatic basin. The sensitivity and specificity of {99m}Tc-Al[2]O[3] were 100% for both SPECT and intraoperative gamma probe identification

The use of (99m}Tc-Al[2]O[3] for detection of sentinel lymph nodes in breast cancer

Purpose: to study the feasibility of using the new radiopharmaceutical based on the technetium-99m-labeled gamma-alumina for identification of sentinel lymph nodes (SLNs) in breast cancer patients. The study included two groups of breast cancer patients who underwent single photon emission computed tomography (SPECT) and intraoperaive gamma probe identification of sentinel lymph nodes (SLNs). To identify SLNs, the day before surgery Group I patients (n=34) were injected with radioactive {99m}Tc-Al[2]O[3], and Group II patients (n=30) received 99mTc-labeled phytate colloid. A total of 37 SLNs were detected in Group I patients. The number of identified SLNs per patient ranged from 1 to 2 (the average number of identified SLNs was 1.08). Axillary lymph nodes were the most common site of SLN localization. 18 hours after {99m}Tc-Al[2]O[3] injection, the percentage of its accumulation in the SLN was 7-11% (of the counts in the injection site) by SPECT and 17-31% by gamma probe detection. In Group II SLNs were detected in 27 patients. 18 hours after injection of the phytate colloid the percentage of its accumulation in the SLN was 1.5-2% out of the counts in the injection site by SPECT and 4-7% by gamma probe. The new radiopharmaceutical based on the {99m}Tc-Al[2]O[3] demonstrates high accumulation in SLNs without redistribution through the entire lymphatic basin. The sensitivity and specificity of {99m}Tc-Al[2]O[3] were 100% for both SPECT and intraoperative gamma probe identification

Experimental study of {99m}Tc-aluminum oxide use for sentinel lymph nodes detection

The purpose of the study was a comparative research in the possibility of using the radiopharmaceuticals {99m}Tc-Al[2]O[3] and {99m}Tc-Nanocis for visualizing sentinel lymph nodes. The measurement of the sizes of {99m}Tc-Al[2]O[3] and {99m}Tc-Nanocis colloidal particles was performed in seven series of radiopharmaceuticals. The pharmacokinetics of {99m}Tc-Al[2]O[3] and {99m}Tc-Nanocis was researched on 50 white male rats. The possibility of the use of {99m}Tc-Al[2]O[3] and {99m}Tc-Nanocis for lymphoscintigraphy was studied in the experiments on 12 white male rats. The average dynamic diameter of the sol particle was 52-77 nm for {99m}Tc-Al[2]O[3] and 16.7-24.5 nm for {99m}Tc-Nanocis. Radiopharmaceuticals accumulated in the inguinal lymph node in 1 hour after administration; the average uptake of {99}mTc-Al[2]O[3] was 8.6% in it, and the accumulation of {99m}Tc-Nanocis was significantly lower-1.8% (p < 0.05). In all study points the average uptake of {99m}Tc-Al[2]O[3] in the lymph node was significantly higher than {99m}Tc-Nanocis accumulation. The results of dynamic scintigraphic studies in rats showed that {99m}Tc-Al[2]O[3] and {99m}Tc-Nanocis actively accumulated into the lymphatic system. By using {99m}Tc-Al[2]O[3] inguinal lymph node was determined in 5 minutes after injection and clearly visualized in all the animals in the 15th minute, when the accumulation became more than 1% of the administered dose. Further observation indicated that the {99m}Tc-Al[2]O[3] accumulation reached a plateau in a lymph node (average 10.5%) during 2-hour study and then its accumulation remained practically at the same level, slightly increasing to 12% in 24 hours. In case of {99m}Tc-Nanocis inguinal lymph node was visualized in all animals for 15 min when it was accumulated on the average 1.03% of the administered dose. Plateau of {99m}Tc-Nanocis accumulation in the lymph node (average 2.05%) occurred after 2 hours of the study and remained almost on the same level (in average 2.3%) for 24 hours. Thus, the experimental study of a new domestic radiopharmaceutical showed that the {99m}Tc-Al[2]O[3]accumulates actively in the lymph nodes several times as compared to the imported analogue and its practical application will facilitate intraoperative identification of sentinel lymph nodes

Clinical Significance of Sentinel Lymph Node Detection in Patients with Invasive Cervical Cancer

The clinical significance of determining sentinel lymph nodes (SLN) in patients with invasive cervical cancer was studied. From 2013 to 2014, 30 cervical cancer patients (T1a1NxM0-T1b1NxM0) were treated at the Gynecological Oncology Department of the Cancer Research Institute. The day before surgery, four submucosal injections of 99mTc Al2O3 at a total dose of 80 MBq were made in each quadrant around the cervical tumor. Patients were submitted to preoperative lymphoscintigraphy and intraoperative SLN detection. The feasibility of preserving the reproductive potential in patients after radical abdominal trachelectomy was assessed. The 3-year, overall, disease-free and metastasis-free survival rates were analyzed. Thirty-four SLNs were detected by single-photon emission computed tomography (SPECT) and 42 SLNs were identified by intraoperative gamma probe. The sensitivity in detecting SLNs was 100% for intraoperative SLN identification and 80% for SPECT image. The reproductive potential was preserved in 86% of patients. The 3-year overall and metastases-free survival rates were 100%. Recurrence occurred in 8.6% of cases