Presentation is loading. Please wait.

Presentation is loading. Please wait.

BREAST SENTINEL NODE LOCALISATION & BIOPSY Kirsten Worthington Senior Nuclear Medicine Technologist/MRT.

Similar presentations


Presentation on theme: "BREAST SENTINEL NODE LOCALISATION & BIOPSY Kirsten Worthington Senior Nuclear Medicine Technologist/MRT."— Presentation transcript:

1 BREAST SENTINEL NODE LOCALISATION & BIOPSY Kirsten Worthington Senior Nuclear Medicine Technologist/MRT

2 What is a ‘Sentinel’ lymph node (SLN)? The very first lymph node to receive drainage from a cancer containing area of the breast Typically located in: - Axilla (armpit) but can also be in: - Internal Mammary - Clavicular groups a)Axillary lymph nodes b)Internal mammary lymph nodes c)Supra & infra clavicular lymph nodes

3 Axillary Clearance (A.C) All axillary lymph nodes removed in patients with breast cancer Pathological lymph node analysis important in ‘staging’ disease Typically 10  15 nodes removed (Diehl, Chang) A.C reduces chance of cancer returning to axilla. Gold Standard Procedure

4 Side Effects from Axillary Clearance Lymphedema +/- - Stiff shoulder - Numbness (nerve damage) - Fluid collection cm surgical wound Long recovery period 70% of DCIS breast cancer cases have not metastasized to the lymphatic system (Journal of Nuclear Medicine, Vol. 42 No.8, 2001) 70% of DCIS breast cancer cases have not metastasized to the lymphatic system (Journal of Nuclear Medicine, Vol. 42 No.8, 2001)

5

6 What is ‘Sentinel Lymph Node Biopsy’ (SLNB)? Recent technique checking for lymphatic mets without performing an A.C 1  3 sentinel node/s removed only Sentinel node/s identified at surgery by: - 99m Tc Senti-scint/Geiger probe - Isosulfan Blue Dye Test Preliminary pathological analysis of nodes during surgery Negative biopsy result  operation completed Positive biopsy result  Patient will require A.C

7 Who can have Sentinel Lymph Node Biopsy? Patients with ‘in-situ’ breast carcinoma - small tumours (DCIS) SDHB: Procedure done in conjunction with lumpectomy or mastectomy

8 Who Shouldn’t have a SLNB? Women with large carcinomas - >5 cm Had R/T or surgery to breast/axilla area Present with enlarged axillary lymph glands Multifocal tumour Occult Malignancy

9 Possible Side Effects from SLNB Blue urine  24 hrs Breast stained blue  2 weeks - Mild reaction to dye: 1-2% risk (NSW Breast Cancer Institute) - Severe reaction: rare Wounds in breast, armpit & sternum Lymphedema: 1-2% risk (NSW Breast Cancer Institute) Numbness False negative result possible

10 Advantages of SLNB (over Axillary Clearance) Reduced hospital stay Smaller axillary scar Quicker recovery time Reduced risk of lymphedema, pain & numbness

11

12 How is the breast SN mapped in Nuclear Medicine? Affected breast  4 x injections 99m Tc Senti- scint Radioactive injections are placed tumour quadrant around areolar (about o’clock position) Technique 1

13 How is the breast SN mapped in Nuclear Medicine? 2 x injections 99m Tc Senti-scint placed either side of breast tumour Require Radiologist + ultrasound machine Technique 2

14 Senti-scint Localisation in Lymph Node Radioactivity travels freely in lymph vessels but trapped in lymph nodes Isotope travels from tumour location to Sentinel Node Breast massage encourages flow of radio-tracer Scanning occurs & lymph node is identified

15 Nuclear Medicine SLN Images Peri-areolar Technique Node/s identified - Anterior + 57 Co Flood Field - Lateral + 57 Co Flood Field Node/s marked on patient’s skin Patient ready to proceed to surgery

16 Nuclear Medicine SLN Images Peri-tumoral Technique Axillary nodes - Multiple IM node positive

17 SPECT / CT Images CT (top line) SPECT data (middle line) Fused data (bottom line) 3D volume rendered SPECT/CT

18

19 Surgery/Biopsy of SN Blue dye injected at commencement of surgery  turns SN blue Geiger probe detects radioactivity in SN Success of biopsy depends greatly on experience of breast Surgeon Incision at SN position and blue node removed SN analysed for metastatic spread

20 SLNB Results Pathological analysis categorizes nodes in groups: Negative (no cancer cells)  axilla treatment finished Positive (contains cancer) or Indeterminate (uncertain of cancer cells)  A.C required Pathologist report authorised

21 False-negative Result Occurs when SN has no cancer cells, but another node in axilla does Metastatic spread will go undetected 8% risk of this result with SLNB (NSW Breast Cancer Institute) Patient is undertreated as they won’t receive chemotherapy at time of biopsy ? Significance to progress of disease ? Further lumps of cancer in axilla

22 Clinical Trials Global research on SLNB has been under way for quite some time and is still on- going 18 years research for SLN Biopsy

23 Conclusion Results show that SLNB is a safe & reliable technique in appropriately selected patients Determines who should or should not require A.C

24 Thanks

25 References Bova D, Dillehay G, Halama J, Karesh S, Wagner R, Zimmer A (2006) Nuclear Medicine (2 nd Ed). China: Mosby Elsevier. Diehl KM, Chang AE. Sentinel Node Biopsy: What Breast Cancer Patients Need to Know. Available: [online] Imaginis (updated Jan 31, 2008) Sentinel Lymph Node Biopsy. Available: [online] Mariani G, Moresco L, Viale G, Vialla G, Bagnasco M, Canavese G, Buscombe J, Strauss HW, Paganelli G (2001) Radioguided Sentinel Lymph Node Biopsy in Breast Cancer Surgery. Journal of Nuclear Medicine. Vol. 42 No. 8, P The NSW Breast Cancer Institute, Sentinel Node Biopsy, An Information Guide for Patients (Jan 2008). Available: [online]

26 QUESTIONS?


Download ppt "BREAST SENTINEL NODE LOCALISATION & BIOPSY Kirsten Worthington Senior Nuclear Medicine Technologist/MRT."

Similar presentations


Ads by Google