Evaluation of surgical gamma probes for sentinel node localization in cervical and vulvar cancer (original) (raw)
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European Journal of Nuclear Medicine and Molecular Imaging, 2003
The aim of our study was to prospectively assess the clinical usefulness of sentinel lymphoscintigraphy and intraoperative gamma probe detection in identifying sentinel nodes (SNs) in patients with early cervical carcinoma. Between 6 and 24 h before radical hysterectomy, lymphoscintigrams were obtained following peritumoural injection of technetium-99m antimony sulphur colloid in 26 patients (mean age 45 years, range 32-71 years) with cervical cancer (FIGO I-IIa). Scanning for radioactive nodes was performed using a hand-held collimated gamma-detecting probe in the initial stages of the main operation, during and before exposure of the retroperitoneal spaces. After separation and removal of radioactive, blue nodes, specimens were submitted for pathological evaluation. SNs were successfully localised using a combination of lymphoscintigraphy and intraoperative gamma probe detection in all 26 cases. However, in two of the 26 cases, SNs were only localisable using the gamma-detecting probe. A histologically positive SN was found in only one case. It is concluded that, in cervical cancer, lymphoscintigraphy and SN biopsy using a gamma-detecting probe are easy and reliable methods for the detection of SNs and are of value in defining the necessity and extent of node dissection.
Surgical Gamma Probe for Identification of Sentinel Lymph Node
Surgical gamma probes have been widely used in oriented surgery, to locate the sentinel lymph nodes in breast cancer and malignant melanoma during the surgery. In this technique, the intra-operative localisation of the sentinel lymph node is carried out using a surgical gamma probe. A radiotracer, such as colloidal suspensions of 99m Tc in human albumin emitting γ-rays of 140 keV is administered (in the tumour site or close) in the patient, before operation, and the radiotracer travels from the tumour to the sentinel lymph node. Then the probe measures the labelled radioactivity, identifying and locating the sentinel lymph node once a visually occult disease, in order to remove it surgically. In this work, a pilot group of surgical gamma probes were developed at IPEN/CNEN-SP with high nationalisation indices, included the detector set. The probes final sizes were 14.0 mm diameter and 170 mm long and their characteristics were compared with imported probes and finally they were used in actual surgeries.
Evaluation of surgical gamma probes for radioguided sentinel node localisation
European Journal of Nuclear Medicine and Molecular Imaging, 1998
By using a surgical gamma probe after peritumoral injection of a radioactive tracer, the surgeon can identify the sentinel, or first, nodal site of regional metastasis in clinically node-negative patients. In the near future, the pathological status of this node will have an important impact on the treatment strategy in breast cancer and melanoma patients. This article reviews the necessary requirements for the instrument, such as: absolute sensitivity, spectral resolution, angular sensitivity and response ratio to the radioactive source at depth. In addition, ergonomic characteristics are important. The surgeon must consider the above characteristics, as they influence operational handling. Four commercially available surgical gamma probes were subjected to laboratory tests to appraise the extent to which they fulfilled these criteria. The results for each gamma probe are summarised and discussed.
Detection of Sentinel Nodes by Lymphoscintigraphy and Gamma Probe Guided Surgery in Vulvar Neoplasia
Tumori Journal, 2000
Background Pathologic lymph node status is the most important prognostic factor in vulvar cancer; however, complete inguinofemoral node dissection is associated with significant morbidity. Intraoperative lymphoscintigraphy associated with gamma detecting probe-guided surgery has proved to be reliable in the detection of sentinel node (SN) involvement in melanoma and breast cancer patients. The present study evaluates the feasibility of the surgical identification of inguinal sentinel nodes using lymphoscintigraphy and a gamma detecting probe in patients with early vulvar cancer. Methods Technetium-99-labeled colloid human albumin was administered perilesionally in 44 patients. Twenty patients had T1 and 23 had T2 invasive epidermoid vulvar cancer; one patient had a lower-third vaginal cancer. An intraoperative gamma detecting probe was used to identify SNs during surgery. Complete inguinofemoral node dissection was subsequently performed. SNs underwent separate pathologic evaluation...
Sentinel node detection in cervical cancer
Obstetrics & Gynecology, 2000
For superficial tumors such as melanoma, breast, and vulvar cancer, sentinel node detection prevents unnecessary extensive lymph node dissections. Sentinel node detection has not yet proved feasible in tumors, such as cervical cancer, that drain to deep pelvic lymph nodes. We injected technetium-99m colloidal albumin around the tumor allowing preoperative lymphscintigraphy and intraoperative gamma probe detection of sentinel nodes. For visual detection, blue dye was injected at the start of surgery. In six of 10 eligible women who had Wertheim-Meigs operations for cervical cancer stage Ib, one or more sentinel nodes could be detected by scintigraphy. Intraoperative gamma probe detection was successful in eight of ten women, whereas visual detection found sentinel nodes in only four. They were found as far as the common iliac level. One woman had positive lymph nodes, of which one was a sentinel node. Identification of sentinel nodes using radionuclide is possible in women with cervical cancer and potentially identifies women in whom lymph node dissection can be avoided.
The Isolated Gamma Probe Technique for Sentinel Node Penile Carcinoma Detection is Unreliable
International braz j …, 2007
Purpose: Penile carcinoma is a common disease in northeast Brazil. This paper shows the results of the use of isolated gamma probe and discusses the incidence of false negative rates. Materials and Methods: From July 2000 to September 2003, 27 newly diagnosed penile carcinoma patients (T1, T2, N0) were included in this prospective study. The isolated gamma probe technique uses the sodium phytate technetium as a tracer and inguinal scanning with probe and after identified the lymph node it is removed. Lymphadenectomies were performed for positive inguinal lymph nodes metastasis. Results: There were 27 patients (mean age 59.6). Follow up was 37 months. Patients from country were 72% and illiterate or semi-illiterate were 56.7%. The tumors were mostly located in the glans (81.4%). They were T1, 52 % and T2, 48 %. 81.4% of the patients underwent partial penectomy, and 18.6% underwent postectomy and excision with wide margins. In 48% of the patients, the highest radioactive count rate was located on the left side, while in 41% was located on the right side. Only one patient had a positive pathological lymph node metastasis at the moment of the surgery. Additionally 3 patients became inguinal lymph node positive at the follow up. This date yielded a sensibility rate of 25% and a falsenegative rate of 42.8%. Conclusion: Isolated gamma probe technique for sentinel node penile carcinoma has a very low sensibility and a high false negative rate. Therefore it is highly advisable the addition of others methods such as lymphoscintigraphy, vital blue, ultrasonography and so on. The isolated gamma probe technique for sentinel node penile carcinoma detection is unreliable.
European Journal of Surgical Oncology (EJSO), 2006
Aim: The aim of this study is to evaluate the performances of a new prototype handheld gamma probe in a series of patients with infiltrative breast cancer justifying sentinel lymph node (SLN) excision. Methods and patients: SLN excision was performed on nine patients being treated for infiltrative breast cancer. After preoperative radioisotope injection and lymphoscintigraphy, individual removal of all radioactive nodes was performed after their localisation using a novel new prototype handheld gamma intraoperative probe named CarolIReS. The activity of SLN following resection has been measured by a gamma ray counter. The mean geometrical detection efficiency of this gamma ray counter has been obtained by Monte Carlo simulation. Results: With respect to the total number of SLNs identified by the CarolIReS probe, the detection probability was 80% for the lymphoscintigraphy. A mean number of 2.2 (1-5) SLNs per patient was detected after the complete SLN procedure. Among the removed SLNs, 19 were axillary SLN, 17 were located in the level I of Berg, two were located in the Rotter area and one was an intramammary SLN (ISLN) located in the lower inner area of the breast. The detection efficiency of the CarolIReS probe ranged from 2.1 to 100.0 cps kBq K1 referred to the activity of the SLN at the time of the surgery. Conclusion: This study shows that the CarolIReS probe is well adapted to the SLN detection and allows an efficient identification of both axillary and intramammary lymph nodes.
Annals of Nuclear Medicine, 2008
Objective The objective of this prospective study was to determine the feasibility of sentinel lymph node (SLN) detection in patients with cervical cancer using lymphoscintigraphy (LS), gamma probe, and blue dye. Methods A total of 32 patients with early stage cervical cancer (FIGO IA2-IIA) who were treated with total abdominal hysterectomy and bilateral pelvic and paraortic lymphadenectomy underwent SLN biopsy. LS was performed on all the patients following the injection of 74 MBq technetium-99m-nanocolloid pericervically. The first appearing persistent focal accumulation on either dynamic or static images of LS was considered to be an SLN. Blue dye was injected just prior to surgical incision in 16 patients (50%) at the same locations as the radioactive isotope injection. During the operation, blue-stained node(s) were excised as SLNs. For gamma probe, a lymph node was accepted as an SLN, if its ex vivo radioactive counts were at least 10-fold above background radioactivity. SLNs, which were negative by routine hematoxylin and eosin (H&E) examination, were histopathologically reevaluated for the presence of micrometastases by step sectioning and immunohistochemical staining with pancytokeratin. Results At least one SLN was identified for each patient by gamma probe. Intraoperative gamma probe was the most sensitive method with a technical success rate of SLN detection of 100% (32/32), followed by LS 87.5% (28/32) and blue dye 68.8% (11/16), respectively. The average number of SLNs per patient detected by gamma probe was 2.09 (range 1–5). The localizations of the SLNs were external iliac 47.8%, obturatory 32.8%, common iliac 9%, paraaortic 4.4%, and paracervical 6%. Micrometastases, not detected by routine H&E were found by immunohistochemistry in one patient. On the basis of the histopathological analysis, the negative predictive value for predicting metastases was 100%, and there were no false-negative results. Conclusions Preoperative LS with radiocolloids, intraoperative lymphatic mapping with blue dye and gamma probe are all feasible methods comparable with each other for SLN detection in early stage cervical cancer patients, but gamma probe is the most useful method in terms of technical success.
Problems and pitfalls in vulvar and cervical cancer sentinel node scintigraphy
Brazilian Archives of Biology and Technology, 2008
After the introduction for penile cancer, the sentinel lymph node imaging is increasingly applied in various types of cancer. After the initial learning phase, 105 patients with vulvar and 24 with cervical cancer have been investigated. In vulvar cancer all the imaged sentinel nodes were discovered by the portable probe intraoperatively. No false negative sentinel node was observed. The most critical issue is the tracer application. Performed strictly intradermally, the sentinel node shows up immediately. Concomitant use of isosulfan blue dye did not improve the results and was stopped therefore. Similarly, more superficial (intra/subendothelial) application brings up better results as compared to deeper injection in cervical cancer patients. No false negative results were seen. Apparently, an almost 100% detection is possible. Our findings clearly show that tracer application is the key for successful imaging. If not done properly, sentinel node may appear later or may even more likely be missed.
Sentinel node procedure in Ib cervical cancer: a preliminary series
British Journal of Cancer, 2001
The aim of this study was to determine the diagnostic accuracy and feasibility of sentinel lymph node (SLN) detection using a gamma probe in patients with Figo IB cervical cancer. Between January 1999 and September 2000, 14 patients with cervical cancer, planned for radical hysterectomy were eligible for the study. The day before radical hysterectomy we injected technetium 99 m-labelled nanocolloid in each quadrant of the cervix. Dynamic and static images were recorded using a gamma camera. SLNs were identified intraoperatively using a handheld gamma-detection probe. After resection of SLNs a standard radical hysterectomy with pelvic lymph node dissection was performed. Patients and tumour characteristics were compared with sentinel node detection and with final histopathological and immunohistochemical results. Scintigraphy showed focal uptake in 13 of the 14 patients. Intraoperatively we detected 26 sentinel nodes by gamma probe. In 8 of 13 patients, one or more sentinel nodes were identified unilaterally, in 5 women bilaterally. Histologically positive SLNs were found in only 1 patient. We did not find any false-negative SLN in our series. In conclusion identification of sentinel nodes in cervical cancer is feasible with preoperatively administered technetium 99 m-labelled nanocolloid. A larger series will be required to establish sentinel node detection in cervical cancer for further therapy concepts and planning.