Theranostics 2021; 11(15):7188-7198. doi:10.7150/thno.55389 This issue Cite

Research Paper

Metastatic and sentinel lymph node mapping using intravenously delivered Panitumumab-IRDye800CW

Giri Krishnan1,2, Nynke S. van den Berg1, Naoki Nishio1, Georgina Juniper1, Jaqueline Pei1, Quan Zhou1, Guolan Lu1, Yu-Jin Lee1, Kimberly Ramos3, Andrei H. Iagaru3, Fred M. Baik1, Alexander D. Colevas4, Brock A. Martin5, Eben L. Rosenthal1✉

1. Department of Otolaryngology - Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States.
2. Department of Otolaryngology, Head and Neck Surgery, The University of Adelaide, Adelaide, SA, Australia.
3. Department of Radiology, Division of Nuclear Medicine, Stanford University School of Medicine, Stanford, CA, United States.
4. Department of Medicine, Division of Medical Oncology, Stanford University School of Medicine, Stanford, CA, United States.
5. Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States.

Citation:
Krishnan G, Berg NSvd, Nishio N, Juniper G, Pei J, Zhou Q, Lu G, Lee YJ, Ramos K, Iagaru AH, Baik FM, Colevas AD, Martin BA, Rosenthal EL. Metastatic and sentinel lymph node mapping using intravenously delivered Panitumumab-IRDye800CW. Theranostics 2021; 11(15):7188-7198. doi:10.7150/thno.55389. https://www.thno.org/v11p7188.htm
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Abstract

Graphic abstract

Rationale: Sentinel lymph node biopsy (SLNB) is a well-established minimally invasive staging procedure that maps the spread of tumour metastases from their primary site to the regional lymphatics. Currently, the procedure requires the local peri-tumoural injection of radiolabelled and/or optical agents, and is therefore operator dependent, disruptive to surgical workflow and restricted largely to a small subset of malignancies that can be readily accessed externally for local tracer injection. The present study set out to determine whether intravenous (IV) infusion of a tumor-targeted tracer could identify sentinel and metastatic lymph nodes (LNs) in order to overcome these limitations.

Methods: We examined 27 patients with oral squamous cell carcinoma (OSCC), 18 of whom were clinically node negative (cN0). Patients were infused intravenously with 50mg of Panitumumab-IRDye800CW prior to surgical resection of their primary tumour with neck dissection and/or SLNB. Lymphadenectomy specimens underwent fluorescence molecular imaging to evaluate tracer distribution to LNs.

Results: A total of 960 LNs were analysed, of which 34 (3.5%) contained metastatic disease. Panitumumab-IRDye800CW preferentially localized to metastatic and sentinel LNs as evidenced by a higher fluorescent signal relative to other lymph nodes. The median MFI of metastatic LNs was significantly higher than the median MFI of benign LNs (0.06 versus 0.02, p < 0.05).

Furthermore, selecting the highest five fluorescence intensity LNs from individual specimens resulted in 100% sensitivity, 85.8% specificity and 100% negative predictive value (NPV) for the detection of occult metastases and 100% accuracy for clinically staging the neck. In the cN+ cohort, assessment of the highest 5 fluorescence LNs per patient had 87.5% sensitivity, 93.2% specificity and 99.1% NPV for the detection of metastatic nodes.

Conclusion: When intravenously infused, a tumour-targeted tracer localized to sentinel and metastatic lymph nodes. Further validation of an IV tumor-targeted tracer delivery approach for SLNB could dramatically change the practice of SLNB, allowing its application to other malignancies where the primary tumour is not accessible for local tracer injection.

Keywords: Head and neck cancer, Oral squamous cell carcinoma, sentinel lymph node biopsy, Fluorescent molecular imaging, Translational science


Citation styles

APA
Krishnan, G., Berg, N.S.v.d., Nishio, N., Juniper, G., Pei, J., Zhou, Q., Lu, G., Lee, Y.J., Ramos, K., Iagaru, A.H., Baik, F.M., Colevas, A.D., Martin, B.A., Rosenthal, E.L. (2021). Metastatic and sentinel lymph node mapping using intravenously delivered Panitumumab-IRDye800CW. Theranostics, 11(15), 7188-7198. https://doi.org/10.7150/thno.55389.

ACS
Krishnan, G.; Berg, N.S.v.d.; Nishio, N.; Juniper, G.; Pei, J.; Zhou, Q.; Lu, G.; Lee, Y.J.; Ramos, K.; Iagaru, A.H.; Baik, F.M.; Colevas, A.D.; Martin, B.A.; Rosenthal, E.L. Metastatic and sentinel lymph node mapping using intravenously delivered Panitumumab-IRDye800CW. Theranostics 2021, 11 (15), 7188-7198. DOI: 10.7150/thno.55389.

NLM
Krishnan G, Berg NSvd, Nishio N, Juniper G, Pei J, Zhou Q, Lu G, Lee YJ, Ramos K, Iagaru AH, Baik FM, Colevas AD, Martin BA, Rosenthal EL. Metastatic and sentinel lymph node mapping using intravenously delivered Panitumumab-IRDye800CW. Theranostics 2021; 11(15):7188-7198. doi:10.7150/thno.55389. https://www.thno.org/v11p7188.htm

CSE
Krishnan G, Berg NSvd, Nishio N, Juniper G, Pei J, Zhou Q, Lu G, Lee YJ, Ramos K, Iagaru AH, Baik FM, Colevas AD, Martin BA, Rosenthal EL. 2021. Metastatic and sentinel lymph node mapping using intravenously delivered Panitumumab-IRDye800CW. Theranostics. 11(15):7188-7198.

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