Pre-operative sentinel lymph node localization in breast cancer with superparamagnetic iron oxide MRI: The SentiMAG Multicentre Trial imaging subprotocol

Joost J. Pouw; Maarten R. Grootendorst; Roland Bezooijen; Caroline A H Klazen; Wieger I. De Bruin; Joost M. Klaase; Margaret A. Hall-Craggs; Michael Douek; Bennie Ten Haken

doi:10.1259/bjr.20150634

Pre-operative sentinel lymph node localization in breast cancer with superparamagnetic iron oxide MRI: The SentiMAG Multicentre Trial imaging subprotocol

Joost J. Pouw, Maarten R. Grootendorst, Roland Bezooijen, Caroline A H Klazen, Wieger I. De Bruin, Joost M. Klaase, Margaret A. Hall-Craggs, Michael Douek, Bennie Ten Haken^*

^*Corresponding author for this work

Comprehensive Cancer Centre

Research output: Contribution to journal › Article › peer-review

54 Citations (Scopus)

Abstract

Objective: Sentinel lymph node biopsy (SLNB) with a superparamagnetic iron oxide (SPIO) tracer was shown to be non-inferior to the standard combined technique in the SentiMAG Multicentre Trial. The MRI subprotocol of this trial aimed to develop a magnetic alternative for preoperative lymphoscintigraphy (LS). We evaluated the feasibility of using MRI following the administration of magnetic tracer for pre-operative localization of sentinel lymph nodes (SLNs) and its potential for non-invasive identification of lymph node (LN) metastases. Methods: Patients with breast cancer scheduled to undergo SLNB were recruited for pre-operative LS, single photon emission CT (SPECT)-CT and SPIO MRI. T₁ weighted turbo spin echo and T₂ weighted gradient echo sequences were used before and after interstitial injection of magnetic tracer into the breast. SLNs on MRI were defined as LNs with signal drop and direct lymphatic drainage from the injection site. LNs showing inhomogeneous SPIO uptake were classified as metastatic. During surgery, a handheld magnetometer was used for SLNB. Blue or radioactive nodes were also excised. The number of SLNs and MR assessment of metastatic involvement were compared with surgical and histological outcomes. Results: 11 patients were recruited. SPIO MRI successfully identified SLNs in 10 of 11 patients vs 11 of 11 patients with LS/SPECT-CT. One patient had metastatic involvement of four LNs, and this was identified in one node on preoperative MRI. Conclusion: SPIO MRI is a feasible technique for preoperative localization of SLNs and, in combination with intraoperative use of a handheld magnetometer, provides an entirely radioisotope-free technique for SLNB. Further research is needed for the evaluation of MRI characterization of LN involvement using subcutaneous injection of magnetic tracer. Advances in knowledge: This study is the first to demonstrate that an interstitially administered magnetic tracer can be used both for pre-operative imaging and intraoperative SLNB, with equal performance to imaging and localization with radioisotopes.

Original language	English
Article number	20150634
Journal	British Journal of Radiology
Volume	88
Issue number	1056
Early online date	6 Nov 2015
DOIs	https://doi.org/10.1259/bjr.20150634
Publication status	E-pub ahead of print - 6 Nov 2015

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10.1259/bjr.20150634

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Pouw, J. J., Grootendorst, M. R., Bezooijen, R., Klazen, C. A. H., De Bruin, W. I., Klaase, J. M., Hall-Craggs, M. A., Douek, M., & Ten Haken, B. (2015). Pre-operative sentinel lymph node localization in breast cancer with superparamagnetic iron oxide MRI: The SentiMAG Multicentre Trial imaging subprotocol. British Journal of Radiology, 88(1056), Article 20150634. Advance online publication. https://doi.org/10.1259/bjr.20150634

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title = "Pre-operative sentinel lymph node localization in breast cancer with superparamagnetic iron oxide MRI: The SentiMAG Multicentre Trial imaging subprotocol",

abstract = "Objective: Sentinel lymph node biopsy (SLNB) with a superparamagnetic iron oxide (SPIO) tracer was shown to be non-inferior to the standard combined technique in the SentiMAG Multicentre Trial. The MRI subprotocol of this trial aimed to develop a magnetic alternative for preoperative lymphoscintigraphy (LS). We evaluated the feasibility of using MRI following the administration of magnetic tracer for pre-operative localization of sentinel lymph nodes (SLNs) and its potential for non-invasive identification of lymph node (LN) metastases. Methods: Patients with breast cancer scheduled to undergo SLNB were recruited for pre-operative LS, single photon emission CT (SPECT)-CT and SPIO MRI. T1 weighted turbo spin echo and T2 weighted gradient echo sequences were used before and after interstitial injection of magnetic tracer into the breast. SLNs on MRI were defined as LNs with signal drop and direct lymphatic drainage from the injection site. LNs showing inhomogeneous SPIO uptake were classified as metastatic. During surgery, a handheld magnetometer was used for SLNB. Blue or radioactive nodes were also excised. The number of SLNs and MR assessment of metastatic involvement were compared with surgical and histological outcomes. Results: 11 patients were recruited. SPIO MRI successfully identified SLNs in 10 of 11 patients vs 11 of 11 patients with LS/SPECT-CT. One patient had metastatic involvement of four LNs, and this was identified in one node on preoperative MRI. Conclusion: SPIO MRI is a feasible technique for preoperative localization of SLNs and, in combination with intraoperative use of a handheld magnetometer, provides an entirely radioisotope-free technique for SLNB. Further research is needed for the evaluation of MRI characterization of LN involvement using subcutaneous injection of magnetic tracer. Advances in knowledge: This study is the first to demonstrate that an interstitially administered magnetic tracer can be used both for pre-operative imaging and intraoperative SLNB, with equal performance to imaging and localization with radioisotopes.",

author = "Pouw, {Joost J.} and Grootendorst, {Maarten R.} and Roland Bezooijen and Klazen, {Caroline A H} and {De Bruin}, {Wieger I.} and Klaase, {Joost M.} and Hall-Craggs, {Margaret A.} and Michael Douek and {Ten Haken}, Bennie",

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doi = "10.1259/bjr.20150634",

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Pouw, JJ, Grootendorst, MR, Bezooijen, R, Klazen, CAH, De Bruin, WI, Klaase, JM, Hall-Craggs, MA, Douek, M & Ten Haken, B 2015, 'Pre-operative sentinel lymph node localization in breast cancer with superparamagnetic iron oxide MRI: The SentiMAG Multicentre Trial imaging subprotocol', British Journal of Radiology, vol. 88, no. 1056, 20150634. https://doi.org/10.1259/bjr.20150634

TY - JOUR

T1 - Pre-operative sentinel lymph node localization in breast cancer with superparamagnetic iron oxide MRI

T2 - The SentiMAG Multicentre Trial imaging subprotocol

AU - Pouw, Joost J.

AU - Grootendorst, Maarten R.

AU - Bezooijen, Roland

AU - Klazen, Caroline A H

AU - De Bruin, Wieger I.

AU - Klaase, Joost M.

AU - Hall-Craggs, Margaret A.

AU - Douek, Michael

AU - Ten Haken, Bennie

PY - 2015/11/6

Y1 - 2015/11/6

N2 - Objective: Sentinel lymph node biopsy (SLNB) with a superparamagnetic iron oxide (SPIO) tracer was shown to be non-inferior to the standard combined technique in the SentiMAG Multicentre Trial. The MRI subprotocol of this trial aimed to develop a magnetic alternative for preoperative lymphoscintigraphy (LS). We evaluated the feasibility of using MRI following the administration of magnetic tracer for pre-operative localization of sentinel lymph nodes (SLNs) and its potential for non-invasive identification of lymph node (LN) metastases. Methods: Patients with breast cancer scheduled to undergo SLNB were recruited for pre-operative LS, single photon emission CT (SPECT)-CT and SPIO MRI. T1 weighted turbo spin echo and T2 weighted gradient echo sequences were used before and after interstitial injection of magnetic tracer into the breast. SLNs on MRI were defined as LNs with signal drop and direct lymphatic drainage from the injection site. LNs showing inhomogeneous SPIO uptake were classified as metastatic. During surgery, a handheld magnetometer was used for SLNB. Blue or radioactive nodes were also excised. The number of SLNs and MR assessment of metastatic involvement were compared with surgical and histological outcomes. Results: 11 patients were recruited. SPIO MRI successfully identified SLNs in 10 of 11 patients vs 11 of 11 patients with LS/SPECT-CT. One patient had metastatic involvement of four LNs, and this was identified in one node on preoperative MRI. Conclusion: SPIO MRI is a feasible technique for preoperative localization of SLNs and, in combination with intraoperative use of a handheld magnetometer, provides an entirely radioisotope-free technique for SLNB. Further research is needed for the evaluation of MRI characterization of LN involvement using subcutaneous injection of magnetic tracer. Advances in knowledge: This study is the first to demonstrate that an interstitially administered magnetic tracer can be used both for pre-operative imaging and intraoperative SLNB, with equal performance to imaging and localization with radioisotopes.

AB - Objective: Sentinel lymph node biopsy (SLNB) with a superparamagnetic iron oxide (SPIO) tracer was shown to be non-inferior to the standard combined technique in the SentiMAG Multicentre Trial. The MRI subprotocol of this trial aimed to develop a magnetic alternative for preoperative lymphoscintigraphy (LS). We evaluated the feasibility of using MRI following the administration of magnetic tracer for pre-operative localization of sentinel lymph nodes (SLNs) and its potential for non-invasive identification of lymph node (LN) metastases. Methods: Patients with breast cancer scheduled to undergo SLNB were recruited for pre-operative LS, single photon emission CT (SPECT)-CT and SPIO MRI. T1 weighted turbo spin echo and T2 weighted gradient echo sequences were used before and after interstitial injection of magnetic tracer into the breast. SLNs on MRI were defined as LNs with signal drop and direct lymphatic drainage from the injection site. LNs showing inhomogeneous SPIO uptake were classified as metastatic. During surgery, a handheld magnetometer was used for SLNB. Blue or radioactive nodes were also excised. The number of SLNs and MR assessment of metastatic involvement were compared with surgical and histological outcomes. Results: 11 patients were recruited. SPIO MRI successfully identified SLNs in 10 of 11 patients vs 11 of 11 patients with LS/SPECT-CT. One patient had metastatic involvement of four LNs, and this was identified in one node on preoperative MRI. Conclusion: SPIO MRI is a feasible technique for preoperative localization of SLNs and, in combination with intraoperative use of a handheld magnetometer, provides an entirely radioisotope-free technique for SLNB. Further research is needed for the evaluation of MRI characterization of LN involvement using subcutaneous injection of magnetic tracer. Advances in knowledge: This study is the first to demonstrate that an interstitially administered magnetic tracer can be used both for pre-operative imaging and intraoperative SLNB, with equal performance to imaging and localization with radioisotopes.

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DO - 10.1259/bjr.20150634

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SN - 0007-1285

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JO - British Journal of Radiology

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Pre-operative sentinel lymph node localization in breast cancer with superparamagnetic iron oxide MRI: The SentiMAG Multicentre Trial imaging subprotocol

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