Technescan lyomaa

On the day before surgery, an experienced breast radiologist at the NCI located the clip-marked lymph node with ultrasound to determine the yiN status. Suspicious lymph nodes were defined by a cortex of ≥ 2.3 mm. A 21-G needle was placed percutaneously with the tip in the center of the node (Fig 1). Subsequently, 0.2 ml Tc-99m-MAA (TechneScan LyoMAA, Mallinckrodt Medical, Petten, the Netherlands) was injected intranodally by a nuclear medicine physician (mean dose, 18.5 MBq, range 3.7-37 MBq). CT imaging was used to locate the clip and guide the ROLL-node injection when ultrasound failed to identify the clip-marked lymph node. In patients scheduled for breast-conserving surgery, a ROLL procedure of the primary tumor site was performed in the same session. An aimed dose of 37 MBq Tc-99m-MAA was injected near the biopsy clip of the primary tumor. Anterior and lateral oblique 5-min planar lymphoscintigrams were scheduled after tracer injection (Symbia T; Siemens, Erlangen, Germany). Single-photon emission computed tomography combined with CT (SPECT/CT) was only performed when the planar lymphoscintigraphy showed unexpected drainage patterns.

Before treatment, all patients underwent screening with dynamic contrast-enhanced magnetic resonance imaging (MRI), bone scintigraphy and angiography. Subsequently, a surrogate particle, ^99mTc-macroaggregated albumin (^99mTc-MAA) (TechneScan LyoMaa, Mallinckrodt Medical, Petten, The Netherlands) was intra-arterially injected, directly followed by a ^99mTc-MAA planar scintigraphy and single-photon emission computed tomography (SPECT)/CT. The ^99mTc-MAA SPECT/CT was used to calculate the lung shunt fraction (LSF) and to detect other extrahepatic deposition.
RE was performed using yttrium-90 (⁹⁰Y)-labelled glass microspheres (Theraspheres®, BTG International, London, England) according to international guidelines [11 (link)]. On the same day, a ⁹⁰Y-positron emission tomography (PET)/CT (mCT, Siemens Healthcare, Erlangen, Germany) was performed to assess the activity distribution. Our acquisition protocol was published earlier [12 ].

V/Q scans were performed with a one-day protocol (13 (link)). The V SPECT images were obtained before the Q scan. A 12-15 millicurie (444-555 megabecquerel) technetium‑99m (Tc-99m)-Technegas generated by the “TechnegasPlus” generator device (Cyclomedica Australia Pty Ltd., Australia) was used for the V phase. SPECT images of patients using a 180° dual head detector on SPECT/CT (Siemens Symbia TruePoint, Siemens Medical Solutions, USA) were acquired. Afterward, a Q SPECT with low dose CT scans was immediately obtained on the same table. After a slow (within 20-30 s) injection of 4-5 millicurie (148-185 megabecquerel). Tc-99m-macro aggregated albumin, (TechneScan LyoMAA; Mallinckrodt Medical) containing 100,000-200,000 particles, SPECT/CT was taken on the same device using similar SPECT parameters as those used for the V phase (low-energy high-resolution collimator, 128x128 matrix, 64 projections of 10 s, 1.00 zoom factor, and 140±10% keV energy window) and 13-25 mAs, 130 kV, and slice width of 5 mm for CT. Raw data of SPECT images processed with the “Tomo Reconstruction v.8.2.26.4” (Syngo‑Siemens AG) application and reconstruction was conducted with ordered subset expectation maximization method.