Sentinel lymph node localization and staging with a low-dose of superparamagnetic iron oxide (SPIO) enhanced MRI and magnetometer in patients with cutaneous melanoma of the extremity - The MAGMEN feasibility study
Nushin Mirzaei, Dimitrios Katsarelias, Pontus Zaar, Oscar Jalnefjord, Iva Johansson, Henrik Leonhardt, Fredrik Wärnberg, Roger Olofsson Bagge, Nushin Mirzaei, Dimitrios Katsarelias, Pontus Zaar, Oscar Jalnefjord, Iva Johansson, Henrik Leonhardt, Fredrik Wärnberg, Roger Olofsson Bagge
Abstract
Background: In patients with melanoma, sentinel lymph node (SLN) status is pivotal for treatment decisions. Current routine for SLN detection combines Technetium99m (Tc99) lymphoscintigraphy and blue dye (BD). The primary aim of this study was to examine the feasibility of using a low dose of superparamagnetic iron oxide (SPIO) injected intracutaneously to detect and identify the SLN, and the secondary aim was to investigate if a low dose of SPIO would enable a preoperative MRI-evaluation of SLN status.
Methods: Patients with melanoma of the extremities were eligible. Before surgery, a baseline MRI of the nodal basin was followed by an injection of a low dose (0.02-0.5 mL) of SPIO and then a second MRI (SPIO-MRI). Tc99 and BD was used in parallel and all nodes with a superparamagnetic and/or radioactive signal were harvested and analyzed.
Results: Fifteen patients were included and the SLNB procedure was successful in all patients (27 SLNs removed). All superparamagnetic SLNs were visualized by MRI corresponding to the same nodes on scintigraphy. Micrometastatic deposits were identified in four SLNs taken from three patients, and SPIO-MRI correctly predicted two of the metastases. There was an association between MRI artefacts in the lymph node and the dose SPIO given.
Discussion: It is feasible to detect SLN in patients with melanoma using a low dose of SPIO injected intracutaneously compared with the standard dual technique. A low dose of SPIO reduces the lymph node MRI artefacts, opening up for a non-invasive assessment of SLN status in patients with cancer.
Keywords: Cancer staging; Magnetic resonance tomography (MRI); Melanoma; Sentinel lymph node; Superparamagnetic iron oxide.
Conflict of interest statement
Declaration of competing interest ROB has received research grants from Astra Zeneca and SkylineDx, speaker honorarium from Roche and Pfizer and has served on advisory boards for Amgen, BD/BARD, Bristol-Meyers Squibb (BMS), Merck Sharp & Dohme (MSD), Novartis, Roche and Sanofi Genzyme. IJ has served on advisory boards for Merck Sharp & Dohme (MSD).
Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.
Source: PubMed