99mTc-Evans blue dye for mapping contiguous lymph node sequences and discriminating the sentinel lymph node in an ovine model.
BACKGROUND
The aim of this study was to investigate the potential of (99m)Tc-Evans blue for discriminating the sentinel lymph node in multitiered lymph node sequences by using an ovine model. (99m)Tc-Evans blue is an agent that has both radioactive and color signals in a single dose. Previous studies in smaller animal models suggested that this agent could have advantages over the dual-injection technique of radiocolloid/blue dye.


METHODS
Doses of (99m)Tc-Evans blue ( approximately 21 MBq) containing Evans blue dye (approximately 4 mg) were administered to the hind limbs or fore limbs of sheep to map the lymphatic drainage patterns, validate its ability to identify the sentinel lymph node, and examine the reproducibility of the technique. The study protocol was repeated with (99m)Tc-antimony trisulfide colloid and Patent Blue V dye. After the operative exposure, lymph nodes were identified with the gamma probe and then excised and analyzed for radioactivity (percentage of injected dose) and blue color.


RESULTS
After the administration of (99m)Tc-Evans blue, all lymph nodes harvested (35 of 35) in either short chains or long basins were hot and blue. The sentinel lymph nodes concentrated more radioactivity than the second-tier nodes to the extent of 2:1 to 215:1. For radiocolloid/Patent Blue V, the ratios were lower, at 2:1 to 3:1.


CONCLUSIONS
(99m)Tc-Evans blue was found to better discriminate the sentinel lymph node than (99m)Tc-antimony trisulfide colloid/Patent Blue V in variable multitier lymph node anatomy, and it is an agent that promises to have positive clinical applications.
Tsopelas
Chris
C
Nuclear Medicine Department, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000, Australia. ctsopela@mail.rah.sa.gov.au
Bevington
Elaine
E
Kollias
James
J
Shibli
Sabah
S
Farshid
Gelareh
G
Coventry
Brendon
B
Chatterton
Barry E
BE
D000818:Animals; D005070:Evans Blue / Q000737:chemistry; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008297:Male; D021701:Sentinel Lymph Node Biopsy; D012756:Sheep; D013670:Sodium Pertechnetate Tc 99m / Q000737:chemistry
D005070:Evans Blue; D013670:Sodium Pertechnetate Tc 99m