Sentinel Node
Detection and Imaging
*
regard to
detection, there are groups which
ad-
vocate external
detection with probes and non-
imaging, those
which combine external detection
using a probe
with radionuclide gamma camera
imaging, those
which still advocate the use of
blue dye alone
or in combination with probe
detec-
tion,those
which have aimed at detection of
the sentinel
node alone, and those which have
Introduction
The concept of
the sentinel node represents a
major new
opportunity to stratify patients
for
appropriate
surgery in cancer. Present
enthusiasm
is high judging
by the many publications in the
peer-reviewed
literature, and significant
attention
is being paid
to this subject by editorials in
the
major medical
journals [1–3]. The reports are
almost
uniformly enthusiastic about the
poten-
tial of this
technique, and guidelines have
been
published for
sentinel node detection in
carci-
noma of the
breast. Patients have become aware
of
the potential
of the technology, and it is not
uncommon for
patients to inform themselves
and
request the
views of individuals or clinical
groups
on this new
staging procedure. Despite all
this
enthusiasm,
however, there are significant
dif-
ferences in
practice relating to almost all aspects
of
the technology
involved. Interestingly, in spite
of
these
differences, in general terms groups
are
reporting
encouraging results. It is
therefore
useful to
review the subject of the detection of
the
sentinel node,
introducing readers to the
present
areas of
uncertainty and providing a critical
analy-
sis of the data
as they have appeared in the
literature.
As can be seen
from Table 1, many aspects are
being
investigated. Several instruments are
avail-
able for
detection of the sentinel node,
several
radiopharmaceuticals are available for
injec-
tion, there is
controversy as to the injection
site,
practice varies
from single to multiple injec-
tionsand
between large and small volumes
of
injectate, and
there is also considerable
variation
in the amount
of radioactivity administered.
With
chapter
1
*
First published
in
Eur J Nucl
Med
Ta ble
1.
Te c hn i c al
issues in sentinel node detection
and
imaging
What
probe?
What
tracer?
What injection
site?
Single or
multiple injection sites?
Large or small
volume of injectate?
Massage or no
massage of injection site?
How many
MBq’s?
Which mode of
detection is preferable?
–Probe
detection only
–Probe
detection and imaging
–Blue dye
alone or in combination with probe
detection
–Sentinel
lymph node detection only
–Sentinel
lymph node detection
and
lymphoscintigraphy (imaging)
Whic h form of
imaging is best?
–Dynamic
imaging
–Early
imaging
–Early and
late imaging
What is the
most appropriate site of
injection?
–Intratumoral
–Peritumoral
–Subdermal
–Subcutaneous
What
pathological evidence is
required?
–Fine-needle
aspiration cy tology
–Core cut
biopsy
–Use of
advanced breast biopsy
instrumentation
–Excisional
breast biopsy
–Imprint
cytology
–Haematoxylin
and eosin staining alone
–Cytokeratin
immunohistochemistry (e. g. MNF
116)
–Polymerase chain reaction