☢️ Limfoscintigrafie pentru Detecția Ganglionului Santinelă Mamar (SLND)

Updated Breast Lymphoscintigraphy 9/8/2024 ●Indication To localize sentinel lymph nodes in the setting of breast carcinoma. ●Radiopharmaceutical: Day of surgery - 500 microCi Tc-99m Lymphoseek (tilmanocept) divided into 2 syringes (each containing 0.1 mL fluid) Afternoon before surgery - 2 mCi Tc-99m Lymphoseek (tilmanocept) divided into 2 syringes (each containing 0.1 mL fluid) ●Method of Administration:  The Radiologist will inject radionuclide intradermally into the periareolar aspect of breast. The injection sites will then be massaged for a few minutes to stimulate lymphatic flow. ●Patient Preparation: No specific preparation prior to radionuclide administration. ●Conflicting Examinations/Medications: No Nuclear Medicine exams within the previous 24 hrs. ●Pregnancy/Lactation: Pregnancy status does not need to be assessed due to short t1/2, low administered activity and extremely low radiation risks. Breast feeding mothers should discard breast milk for 24 hrs following Tc-99m Lymphoseek / sulfur colloid administration. ●Imaging Technique: Collimator - LEHR or LEAP Photopeak - 140 keV 20% window for Tc-99m Image Preset Counts - 3-5 mins/image Matrix Size - 256 x 256 Zoom - none Patient Positioning - supine with the patient's arm on the cancer side over the patient's head ●Images/Views: A Co-57 sheet flood source should be placed under the patient to outline his/her anatomy. Place shielding over the injection sites to decrease scatter artifact.  Begin anterior imaging of the chest at 15-30 mins after radionuclide administration and continue imaging until lymph nodes are visualized. Obtain 45° anterior oblique and lateral static images of the chest towards the side the cancer is located once nodes are visualized. Have the Radiologist / Radiologist Assistant mark any node(s) with a permanent marker if the exam is ordered with imaging. ●Notes: Lymphoseek targets dextran-mannose receptors on the surface of macrophages / dendritic cells in lymph nodes. Axillary sentinel lymph node biopsy is now preferred to axillary lymph node dissection in most clinical scenarios.  Patients with negative axillary sentinel lymph node biopsy by routine histopathological evaluation do not require axillary lymph node dissection.  Superficial radionuclide injection (periareolar, subareolar, subdermal, intradermal) may be preferable to a deep injection for the detection of axillary lymph nodes.  Deep radionuclide injection (peritumoral, intratumoral) is recommend if the aim is to stage both axillary and extra-axillary nodal basins. Data suggest fewer than 40 % of those with positive axillary sentinel lymph nodes have metastases in non-sentinel nodes.  In approximately 1-2% of patients sentinel lymph nodes will not be detected preoperatively or intraoperatively. Causes of nonvisualization include advanced axillary nodal disease, non UOQ tumors, prior breast/axillary surgery, old age and obesity.