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Technetium-99m-Sulfur Colloid for Lymphoscintigraphy: Effects of Preparation Parameters

Department of Radiology, Emory University, Atlanta, Georgia
Nuclear Medicine Department, Veterans Administration Hospital, Albuquerque, New Mexico

Correspondence: For correspondence or reprints contact: Dennis Eshima, PhD, Associate Professor of Radiology, Center for Positron Emission Tomography, Emory University, 1364 Clifton Rd. NE, Atlanta, GA 30322.

ABSTRACT

There has been a resurgence in the use of lymphoscintigraphy for the external detection of lymph nodes for metastatic melanoma and breast tumors. Technetium-99m-antimony trisulfide colloid was the radiopharmaceutical developed for this procedure and was found to have a narrow distribution of small particles, 0.003–0.03 µm, but it was never approved by the FDA. Technetium-99m-sulfur colloid also forms particles and this article reports on the effects different preparation parameters have on its particle size distribution and stability. Methods: Four groups of kits were evaluated, kits which utilized: (a) a reduced heating protocol with a new ^99mTc-elution, (b) a reduced heating protocol with an old ^99mTc-elution, (c) a prolonged heating protocol with a new ^99mTc-elution and (d) a prolonged heating protocol with an old ^99mTc-elution. The particle size distribution and the stability of the different ^99mTc-sulfur colloid kit preparations were evaluated over 6 hr utilizing polycarbonate filters ranging from 0.03 to 10 µm. Results: In vitro studies demonstrated no significant change in the particle size distribution over a 6-hr period and all ^99mTc-sulfur colloid preparations had a bimodal particle size distribution pattern. Importantly, heating the kit for shorter periods of times utilizing [^99mTc]pertechnetate, which had a longer ingrowth of [^99mTc]pertechnetate, produced a formulation which had the largest percentage of particles smaller than 0.03 µm. Conclusion: In our clinical setting, ^99mTc-sulfur colloid prepared with the reduced heating protocol and utilizing [^99mTc]pertechnetate, which has the highest ingrowth of [^99mTc]pertechnetate has proved to be an excellent agent for lymphoscintigraphy studies. This preparation has demonstrated rapid movement of the particles from the primary site to the lymph nodes in over 97% (106/109) of the patients we have studied.

Key Words: technetium-99m-sulfur colloid • lymphoscintigraphy • particle size distribution

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