technetium-tc-99m-sulfur-colloid and Rectal-Neoplasms

In the surgical treatment of advanced rectal cancer, wide lymphadenectomy has been replaced by autonomic nerve preservation because of serious problems such as postoperative urinary and sexual dysfunction. This may offer a considerable clue to as whether metastasis of lateral lymph node can be diagnosed by a new technique in order to provide more benefits to many patients with advanced rectal cancer. Moreover the sentinel lymph node (SLN) concept has lately attracted attention as a new technique. We studied SLN in 40 patients with advanced lower rectal cancer using 99mTc-Sn colloid as a tracer. SLN was successfully identified in 35 (87.5%) of 40 patients, and the mean number of SLNs identified per patient was 5.6 lymph nodes (range 1-14). In this study overall accuracy was 86%, and it was suggested that lateral lymphadenectomy was excluded in 91%, thanks to application of the SLN technique. Although the role this technique plays in the individualization of the therapy for rectal cancer will be large in the near future, many problems remain to be solved in the exact identification of SLN.

Topics: Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Radionuclide Imaging; Radiopharmaceuticals; Rectal Neoplasms; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid

The value of sentinel node biopsy in visceral cancers is uncertain. We evaluated the feasibility and utility of radiocolloid lymphatic mapping and selective lymph node sampling in patients with rectal cancer.. Forty-eight patients with rectal cancer were investigated. Thirty-seven patients had already undergone preoperative radiochemotherapy for locally advanced tumors. Eleven patients underwent primary surgery. An endoscopic injection of 1 mL technetium 99m-sulfur-colloid into the peritumoral submucosa was performed 15 to 17 hours before surgery. Ex vivo identification of the nuclide-enriched "sentinel lymph nodes" (SLNs) was performed using a hand-held gamma-probe. The selected SLNs were then carefully and systematically examined using serial sections and immunohistochemistry.. One or more SLNs were found in 46 of the 48 patients. The SLN detection rate was 96%. Sixteen of the 48 patients had lymph node metastases (35%). In 7 of the 16 patients, the SLNs correctly represented the nodal status. In 9 of the 16 patients, the SLN was tumor-free whereas non-SLN harbored metastases. This result represents a sensitivity of only 44%, and a false-negative rate of 56%. Further analysis showed that the method correctly predicted the nodal status only in the small subgroup of 5 patients with early cancer without preoperative radiation. In 4 patients, juxtaregional lymph nodes were excised on the basis of intraoperative radiocolloid detection, leading to upward staging in 1 patient.. Sentinel lymph node biopsy using the radiocolloid technique with ex vivo lymph node identification shows a relatively high detection rate; however, the sensitivity in patients with locally advanced/irradiated rectal cancer is low. Nevertheless, the detection of juxtaregional metastases can improve staging in some patients. Further studies should focus on patients with early rectal cancers where the data were more promising.

Topics: False Negative Reactions; Feasibility Studies; Female; Humans; Immunohistochemistry; Lymph Nodes; Lymphatic Metastasis; Male; Radionuclide Imaging; Radiopharmaceuticals; Rectal Neoplasms; Sensitivity and Specificity; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

In order to individualize the therapy in patients with anal cancer, we evaluated the applicability of the sentinel lymph node (SLN) concept for the staging of inguinal lymph nodes in these patients.. SLN mapping using the radiocolloid technique was performed in 12 patients with histopathologically proven anal cancer. Mean age of the 4 male and 8 female patients was 62 years (range: 37-83 years). All patients underwent injection of (99m)Tc-colloid (Nanocis) in 4 portions around the tumor followed by scintigraphy after 17 h and selective lymph node biopsy in case of nuclide enrichment. The nuclide-enriched lymph node was intraoperatively identified by a hand-held gamma-camera. Histopathological assessment of the harvested SLNs included serial sections and immunohistochemical staining.. Enrichment of radiocolloid in lymph nodes was seen in 10 of the 12 patients (detection rate: 83%). SLN biopsy was performed in 9 patients, one patient refused the SLN biopsy (SLNB). 4 patients revealed tumor-infiltrated sentinel lymph nodes including one patient with bilateral biopsy, who showed metastases unilaterally. The remaining 5 patients had no evidence of metastases in the excised SLNs.. It is feasible to evaluate the nodal status of the groin in patients with anal cancer using the radiocolloid technique. Preliminary results indicate a refined diagnostic work-up for anal cancer patients, potentially improving the results of clinical and sonographical examinations. Further application of the method may lead to an individualized treatment of patients with anal cancer.

Topics: Adult; Aged; Aged, 80 and over; Anus Neoplasms; Carcinoma, Squamous Cell; Feasibility Studies; Female; Gamma Cameras; Humans; Lymph Node Excision; Lymph Nodes; Male; Middle Aged; Neoplasm Staging; Pilot Projects; Prognosis; Radionuclide Imaging; Rectal Neoplasms; Sentinel Lymph Node Biopsy; Survival Rate; Technetium Tc 99m Sulfur Colloid

Patients who have undergone low anterior resection (LAR) of the rectum occasionally complain of symptoms related to impaired neorectal evacuation. Using scintigraphy, we assessed neorectal evacuation in 22 patients who underwent LAR and straight anastomosis, and correlated the results with clinical defecatory function, clinical factors, and anorectal manovolumetric parameters.. After the introduction of an artificial stool containing 99mTc-DTPA into the neorectum, sequential lateral gamma images were obtained. From the time-activity curve of radioactivity in the whole pelvis, the time taken to evacuate half of the introduced artificial stool (T(1/2)) and the percentage of artificial stool evacuated in 1 min (Evac1) were calculated.. The Evac1 was significantly lower in the patients who had undergone LAR than in reference normal volunteers. A long T(1/2) was significantly associated with worse defecatory function. The Evac1 was also significantly lower in patients with a low anastomosis. The rectal sensory threshold was significantly greater in patients with a shorter T(1/2). The maximum tolerable volume of the neorectum was significantly greater in patients with a shorter T(1/2) and a higher Evac1.. Poor neorectal evacuation is associated with impaired defecatory function after LAR. Therefore, it is suggested that optimizing both reservoir function and evacuation of the neorectum would improve defecatory function after LAR.

Topics: Adult; Aged; Aged, 80 and over; Case-Control Studies; Defecation; Female; Gastrointestinal Motility; Humans; Male; Middle Aged; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Rectal Neoplasms; Rectum; Regression Analysis; Statistics, Nonparametric; Surveys and Questionnaires; Technetium Tc 99m Sulfur Colloid

Lymphadenectomy for rectal cancer, whether by open surgery or laparoscopy, is still a controversial subject. If we consider that approximately 20% of patients have nodal obturator metastases, then we must concede that extended lymphadenectomy is useless in the other 80% of patients. We set out to determine whether lymphoscintigraphy could show the lymphatic drainage from the cancer toward the obturator lymph nodes and thus help us to select the patients who would benefit by their removal. We also analyzed the possibility of applying the concept of the sentinel node to the treatment of rectal cancer.. Among 42 people who underwent laparoscopy for rectal cancer 11 patients with TNM stages T2-T3N0M0 were studied by CT & MRI, rectal ultrasonography, and lymphoscintigraphy with a colloidal injection of human albumin labeled with 99mTc at the base of the neoplasm. Afterward, the 11 patients underwent a lymphadenectomy that extended to the obturator nodes.. In two patients, lymphoscintigraphy showed lymphatic drainage toward the obturator nodes. In one case, there were metastases. Lymphoscintigraphy did not show lymphatic drainage toward the obturator nodes in any of the other patients, and there were no metastases among them. It was not possible to identify a sentinel node.. Lymphoscintigraphy can be used to select patients with rectal cancer who will be helped by a lymphadenectomy extended to the obturator nodes. However, the concept of the sentinel node cannot be applied to rectal cancer.

Topics: Aged; Aged, 80 and over; Female; Humans; Laparoscopy; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Staging; Radionuclide Imaging; Radiopharmaceuticals; Rectal Neoplasms; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid

Scintigraphic image of the superior rectal and inferior mesenteric lymph nodes 7-8 cm up from the anus was obtained by presacral administration of finely divided 99mTc-colloid (close to the posterior rectal wall). The results of radiometry of the lymph nodes dissected at radical operation for rectal cancer have shown that due to the above method the radioactive indicator is accumulated in these groups of lymph nodes. Several variants of a scintigraphic picture were defined on the basis of analysis of scintigrams of 23 patients with extrarectal tumors and nontumorous diseases and 40 rectal cancer patients. Evaluation of the lymphoscintigraphy results compared with the morphological findings of the lymph nodes dissected at operation in 32 rectal cancer patients, has shown that the overall accuracy of the above method is 0.81, specificity--0.63, sensitivity--1.0.

Topics: Adult; Aged; Female; Humans; Lymphatic Metastasis; Male; Mesentery; Middle Aged; Peritoneal Neoplasms; Radionuclide Imaging; Rectal Neoplasms; Technetium Tc 99m Sulfur Colloid

Isotope liver scanning is an accurate technique for detecting liver metastases from large bowel cancer. In this retrospective study of patients who had a resection for bowel cancer, the accuracy of liver scanning was 95%. However, the scan accuracy as defined by median survival time was insufficient to detect liver metastases missed by the surgeon at operation and did not alter the clinicopathological stage of the patient's disease.

Topics: Actuarial Analysis; Aged; Colonic Neoplasms; Female; Humans; Liver Neoplasms; Male; Neoplasm Staging; Predictive Value of Tests; Radionuclide Imaging; Rectal Neoplasms; Retrospective Studies; Technetium Tc 99m Sulfur Colloid

To define the "in vivo" lymphatic drainage from the rectum and the anal canal, 79 subjects (normal controls and patients with rectal cancer) underwent endoscopic rectal lymphoscintigraphy. This method consists of endoscopically injecting a radiolabelled colloid into the rectal and anal submucosa. The diffusion of the tracer, which is drained preferentially by the lymphatic vessels, was determined by means of a computerized gamma camera. Our results suggest a different pattern of lymphatic drainage from the rectum as compared to traditional anatomical studies. Moreover, analysis of our data yields a new hypothesis about the lymphatic spread of rectal cancer. Therefore, lymphoscintigraphy could be employed in the preoperative assessment of "N" staging of these neoplasms. This should provide better selection of patients for different surgical approaches and for adjuvant therapy. The results of 2 years of experience and possible future applications of this technique are discussed.

Topics: Anal Canal; Colloids; Female; Humans; Lymphoscintigraphy; Male; Middle Aged; Preoperative Care; Proctoscopy; Rectal Neoplasms; Rectum; Rhenium; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed

The importance of portal circulation in the delivery of drugs and nutrients to colorectal hepatic metastases is controversial. Using 13N (nitrogen 13) amino acids and ammonia with dynamic gamma camera imaging, we demonstrate, for the first time in human beings, a quantitative advantage of hepatic artery compared with portal vein infusion. Eleven patients were studied by hepatic artery injection, five patients were studied by portal vein injection, and two patients had injections through both routes. Data collected from the liver for 10 minutes after rapid bolus injection of 13N L-glutamate, L-glutamine, or ammonia were compared with 99mTc (technetium) macroaggregated albumin (MAA) images produced after injection through the hepatic artery or portal vein at the same session. Tumor regions defined from 99mTc sulfur colloid scans were compared with nearby liver areas of similar thickness. For the 13N compounds, the area-normalized count rate at first pass maximum (Qmax) and the tissue extraction efficiency were computed. The tumor/liver Qmax ratios for MAA and 13N compounds were highly correlated. Both tumor and liver extracted more than 70% of the nitrogenous compounds. The tumor/liver Qmax ratios reflect the relative delivery of injected tracer per unit volume of tissue. After hepatic artery injection the Qmax ratio was 1.03 +/- 0.33 (mean +/- SD), significantly exceeding the Qmax ratio of 0.50 +/- 0.34 after portal vein injection (P less than 0.003). Therefore, more than twice as much of a nutrient substrate is delivered per volume of tumor relative to liver by the hepatic artery as by the portal vein; the high extraction efficiency demonstrates that the hepatic artery flow is nutritive; and the delivery of substance in solution (such as nutrients or drugs) to tumor and liver tissue correlates with the distribution of colloids such as macroaggregated albumin after hepatic arterial and portal venous injection.

Topics: Adult; Aged; Colonic Neoplasms; Female; Glutamine; Humans; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Rectal Neoplasms; Regional Blood Flow; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Sulfur Colloid

Fifty-five consecutive patients with colorectal carcinoma and hepatic metastases on the Tc-99m sulfur colloid liver/spleen scan (TSC) were evaluated to see if the pattern of spread of colorectal metastases was affected by the venous drainage of the primary site. The results suggest that significant streaming probably exists in the portal vein and the spread of metastases to the liver is affected by it. This information has a potential clinical implication in terms of diagnostic workup and chemotherapeutic infusions. It also supports the speculation that a streaming effect exists in humans.

Topics: Aged; Colonic Neoplasms; Female; Humans; Liver Circulation; Liver Neoplasms; Male; Middle Aged; Portal Vein; Radionuclide Imaging; Rectal Neoplasms; Technetium Tc 99m Sulfur Colloid

Regional lymph nodes of the rectum are not demonstrable by pedal lymphoscintigraphy. We have evaluated the technique of rectal lymphoscintigraphy, using a technique similar to that which has been used in the assessment of lymph nodes in breast and prostatic cancer. Thirty-five patients were studied: ten normal subjects and 25 patients with rectal cancer. In normal subjects, the lymph nodes accompanying the superior hemorrhoidal artery and the inferior mesenteric artery are demonstrable in succession; after three hours the aortic lymph nodes are demonstrable. The 25 patients with rectal cancer underwent resection of their primary tumor and the stage was defined according to Dukes (1932). In five patients (stage A) no alteration was demonstrable. In 11 patients (stage B) the demonstration of regional lymph nodes was delayed vs. the control group. In nine cases (stage C) the demonstration of regional lymph nodes was delayed and defective versus the control group.

Topics: Humans; Lymph Nodes; Lymphatic Metastasis; Neoplasm Staging; Radionuclide Imaging; Rectal Neoplasms; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tin; Tin Compounds