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99mTc–Evans Blue Dye for Mapping Contiguous Lymph Node Sequences and Discriminating the Sentinel Lymph Node in an Ovine Model

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Abstract

Background

The aim of this study was to investigate the potential of 99mTc–Evans blue for discriminating the sentinel lymph node in multitiered lymph node sequences by using an ovine model. 99mTc–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 99mTc–Evans blue (∼ 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 99mTc–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 99mTc–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

99mTc–Evans blue was found to better discriminate the sentinel lymph node than 99mTc–antimony trisulfide colloid/Patent Blue V in variable multitier lymph node anatomy, and it is an agent that promises to have positive clinical applications.

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Acknowledgments

The authors thank Glenda Summersides, Tim Kuchel, BVSc (Hons), MVS, DVA, MRCVS, and the Animal Care Facility staff at the Institute of Medical and Veterinary Sciences for their assistance in preparing sheep before surgery.

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Authors and Affiliations

  1. Nuclear Medicine Department, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000, Australia

    Chris Tsopelas PhD & Barry E. Chatterton MB, BS

  2. Department of Breast and Endocrine Surgery, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000, Australia

    Elaine Bevington MB, BS, James Kollias MB, BS & Sabah Shibli MB, BS

  3. Tissue Pathology Section, Institute of Medical and Veterinary Sciences, Frome Road, Adelaide, South Australia, 5000, Australia

    Gelareh Farshid MB, BS

  4. Department of Surgery, University of Adelaide, Frome Road, Adelaide, South Australia, 5000, Australia

    Brendon Coventry MB, BS, PhD

Authors
  1. Chris Tsopelas PhD
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  2. Elaine Bevington MB, BS
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  3. James Kollias MB, BS
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  4. Sabah Shibli MB, BS
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  5. Gelareh Farshid MB, BS
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  6. Brendon Coventry MB, BS, PhD
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  7. Barry E. Chatterton MB, BS
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Correspondence to Chris Tsopelas PhD.

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Tsopelas, C., Bevington, E., Kollias, J. et al. 99mTc–Evans Blue Dye for Mapping Contiguous Lymph Node Sequences and Discriminating the Sentinel Lymph Node in an Ovine Model. Ann Surg Oncol 13, 692–700 (2006). https://doi.org/10.1245/ASO.2006.04.020

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  • DOI: https://doi.org/10.1245/ASO.2006.04.020

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