Imaging for Lymph Node Status

Imaging Strategy Finds Cancer Cells in Lymph Nodes

By Alison McCook

New study findings released Wednesday suggest that an imaging technique involving miniscule substances that zero in on lymph nodes may represent a safe and relatively inexpensive means of measuring whether prostate cancer has spread.

Often, when a man is diagnosed with prostate cancer, he undergoes a surgical procedure in which doctors remove tissue from his lymph nodes and look for signs the disease has spread to that region of the body.

This technique is considered the "gold standard" in measuring whether cancer has spread to the lymph nodes.

However, as U.S. researchers report in The New England Journal of Medicine, any surgery carries risks, and this particular technique, which samples only some sections of the lymph nodes, can miss some errant cancer cells.

Furthermore, magnetic resonance imaging (MRI), which provides a detailed, non-invasive look at body structures, is not especially good at detecting wayward cancer cells in the lymph nodes, according to the report.

Whether or not the cancer has spread from a man's prostate to his lymph nodes affects the treatment he receives, so accurate measurements of how far cancer cells have wandered from their source are vital, the authors write.

During the current study, Dr. Mukesh G. Harisinghani of the Massachusetts General Hospital and Harvard Medical School in Boston and his colleagues compared the surgical technique to a strategy that combines MRI imaging with tiny particles that boost the abilities of MRI to find cancer cells in lymph nodes.

In an interview with Reuters Health, Harisinghani explained that the tiny particles employed in the research, known as lymphotrophic superparamagnetic nanoparticles, contain iron.

If the lymph nodes are cancer-free, Harisinghani explained, they will take up the nanoparticles, which will turn the nodes black on an MRI. If the nodes contain cancer cells, the researcher said, they will not take up the particles and will stay bright on an MRI scan.

During the study, Harisinghani and his team discovered that the nanoparticle technique correctly identified whether 80 patients with prostate cancer had cancer cells in any lymph nodes.

Furthermore, the nanoparticle technique significantly improved upon the ability of MRI alone to determine whether each individual node contained cancer cells.

"If there's any tumor going to the nodes, the nanoparticles are able to reliably detect the presence of tumor in the nodes," Harisinghani told Reuters Health.

Knowing whether the tumor has spread to the nodes is important for many tumors besides those that originate in the prostate, the researcher said, and the nanoparticle technique may one day be used for many other cancers, as well.

Currently, the nanoparticle technique is awaiting approval by the Food and Drug Administration, according to Harisinghani. If that approval occurs, he predicted that many prostate cancer patients may avoid the perils of surgery to determine if their lymph nodes carry cancer by undergoing MRI imaging instead.

Surgery "will still stay the gold standard, but it will not be used as often as it is today," Harisinghani said.

SOURCE: The New England Journal of Medicine 2003;348:2491-2499.

June, 03

Thanks to Reuters Health

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