title: Simultaneous use of an (125)I-seed to guide tumour excision and (99m)Tc-nanocolloid for sentinel node biopsy in non-palpable breast-conserving surgery.
abstract: OBJECTIVE
  In the present study we describe patients with non-palpable breast lesions, in which an Iodine-125 ((125)I)-marker (or "seed") for excision of the primary tumour and Technetium-99m nanocolloid ((99m)Tc-nanocolloid) for sentinel node biopsy (SNB) are used simultaneously. The purpose was to investigate any interference between (125)I-seeds and (99m)Tc-nanocolloid by an in vitro and in vivo analysis.
  
  
  METHODS
  Contrast/interference-ratios between (125)I and (99m)Tc count-rates were determined in vitro using a realistic simulation model. Measurements were performed with 3 gamma-probes with different crystal materials. In 25 consecutive patients (99m)Tc-nanocolloid was intratumourally administered at the site of a previously implanted (125)I-seed. Respectively, the (125)I-setting and (99m)Tc-setting of the gamma-probe guided the wide local excision and SNB and maximum counts-per-second (cps) were measured.
  
  
  RESULTS
  In vitro the different probes varied in (125)I- and (99m)Tc-sensitivity. The contrast-ratio between (125)I and (99m)Tc in the (125)I-channel was 4.6 for a 3-month-old (125)I-seed using the most appropriate gamma-probe. In vivo the gamma-probe in the (125)I-setting measured a median of 16,300 cps at the tumour site compared to 4820 cps using the (99m)Tc-setting. The (125)I-seed could be well distinguished from the (99m)Tc-nanocolloid in 92% of the patients and 96% required a single operation. The SNB was successful in all patients.
  
  
  CONCLUSIONS
  Simultaneous use of (125)I-seeds and (99m)Tc-nanocolloid is possible under well-standardised conditions. Non-palpable breast lesions can be safely excised using the (125)I-seed in combination with a SN procedure. Use of (125)I-seeds is a next step within fine-tuning breast-conserving surgery that should lead to further investigation to confirm its value.
authors.affiliation: Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX Amsterdam, The Netherlands. Electronic address: bas.pouw@gmail.com.
authors.forename: B
authors.initials: B
authors.lastname: Pouw
authors.affiliation: Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX Amsterdam, The Netherlands. Electronic address: irisvanderploeg@hotmail.com.
authors.forename: I M C
authors.initials: IM
authors.lastname: van der Ploeg
authors.affiliation: Department of Clinical Physics, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX Amsterdam, The Netherlands. Electronic address: s.muller@nki.nl.
authors.forename: S H
authors.initials: SH
authors.lastname: Muller
authors.affiliation: Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX Amsterdam, The Netherlands. Electronic address: r.valdes@nki.nl.
authors.forename: R A
authors.initials: RA
authors.lastname: Valdés Olmos
authors.affiliation: Department of Health, Safety and Environment, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX Amsterdam, The Netherlands. Electronic address: linda.janssen@nki.nl.
authors.forename: L K
authors.initials: LK
authors.lastname: Janssen-Pinkse
authors.affiliation: Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX Amsterdam, The Netherlands. Electronic address: h.oldenburg@nki.nl.
authors.forename: H S A
authors.initials: HS
authors.lastname: Oldenburg
authors.affiliation: Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX Amsterdam, The Netherlands. Electronic address: m.vrancken@nki.nl.
authors.forename: M T F D
authors.initials: MT
authors.lastname: Vrancken Peeters
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes; D008198:Lymph Nodes / Q000473:pathology*; D015412:Mastectomy, Segmental / Q000379:methods*; D019736:Prostheses and Implants; D011829:Radiation Dosage; D019275:Radiopharmaceuticals; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013668:Technetium Tc 99m Aggregated Albumin
chemical_list: D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid
keywords: Breast cancer; Breast conserving surgery; Iodine 125; Non-palpable; Sentinel node procedure; Technetium 99m