4.7 Article

Ultra-Low Dose of Superparamagnetic Iron Oxide Nanoparticles for Sentinel Lymph Node Detection in Patients with Breast Cancer

Journal

ANNALS OF SURGICAL ONCOLOGY
Volume -, Issue -, Pages -

Publisher

SPRINGER
DOI: 10.1245/s10434-023-13722-x

Keywords

Breast cancer; Sentinel lymph node biopsy; Superparamagnetic iron oxide nanoparticles

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This study aimed to determine the feasibility of detecting sentinel lymph nodes (SLNs) in breast cancer patients using an ultra-low dose of superparamagnetic iron oxide nanoparticles (SPIO). SPIO was injected intradermally 4 days before surgery, and SLNs were detected using a handheld magnetometer during surgery. The results showed that SLNs were successfully detected in all patients using the ultra-low dose of SPIO.
BackgroundSentinel lymph node (SLN) status is pivotal for treatment decision-making in patients with breast cancer. Superparamagnetic iron oxide nanoparticles (SPIO) have been shown to be equivalent to the dual technique with technetium(99m) (Tc-99) and blue dye (BD) for SLN detection. The aim of this study was to determine the feasibility of detecting SLNs using an ultra-low dose of SPIO.MethodPatients planned for breast conserving surgery and SLN biopsy were included. An intradermal injection of 0.1 mL SPIO was administered at the areolar border up to 7 days before surgery. Tc-99/BD was administered according to clinical routine. SLNs were detected during surgery using a handheld magnetometer. All nodes with a magnetic and/or radioactive signal, as well as blue or clinically suspicious nodes, were harvested and analyzed.ResultsIn 50 patients, SPIO was injected a median of 4 days before surgery. At least one SLN was found in all patients with both methods. A total of 98 SLNs were removed; 90 were detected using SPIO and 88 using Tc-99/BD. Of the 90 SLNs detected by SPIO, 80 were Tc-99/BD positive (concordance 89%). Histopathological analysis classified 16 patients with tumor cells deposit and 9 with macro-metastasis > 2mm, where one SLN was identified only by the radioactive technique and one only by the magnetic technique.DiscussionSLN detection using 0.1 mL ultra-low dose SPIO injected intradermally was successful in all patients. A future analysis will determine whether the approach using an ultra-low dose of SPIO injected intradermally will minimize skin staining and MRI artefacts.

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