Abstract

IJNM

Indian Journal of Nuclear Medicine

0972-3919

Society of Nuclear Medicine, India

ijnm-19-4-session-001

Session I

122004

194126127

Sentinel Node Imaging And Biopsy In Ca Breast - AH R&R Experience

Sood

Vikas

Anand

Kumar

Sinha

Dept of Nuclear Medicine, Army Hospital R&R, Delhi Cantt-110010

Ref. No: 01VsNoA1

Abstract

Sentinel node biopsy is now emerging as a promising modality in the staging and management of patients with breast cancer. Sentinel node refers to the first node, which receives the lymphatic drainage from the tumor. It is proposed that sentinel node predicts the status of rest of the axillary nodes. Several studies have demonstrated that the absence of metastatic involvement in the sentinel node can significantly reduce the undertaking of mutilating axillary lymph node dissection and resulting complications. In our hospital we have carried out sentinel node imaging using 99mTc labeled nanocolloid and blue dye. The results have been promising. A total of 50 patients were included in the study. The total number of sentinel nodes detected in our series was 80. Over all data analysis suggests a success rate of 90%, sensitivity of 87.5%, specificity of 100% and a false negative rate of 12.5%.

Key wordsLymphoscintigraphySentinel Lymph NodeAxillary Lymph Node Dissection

Evaluation of Medullary Thyroid Ca

Krishnakumar

Lakshmanan

AV.

Priyadarshini

Shanmugasundaram

Manivannan

Department of Nuclear Medicine, Cancer Institute (WIA), Chennai-600020, India

Ref. No: 02KKNoA2

Abstract

Medullary thyroid Carcinoma (MTC) originates in parafollicular cells in thyroid and belongs to the APUDOMA group of neuroendocrine tumors. It can be hereditary or sporadic variety. Hereditary variety can present in 3 forms namely-MEN II A, MEN IIB and familial forms. All three forms have RET proto oncogene mutation. MEN II A include MTC, Pheochromocytoma and Hyperparathyroidism. MTC, Pheochromocytoma, multiple mucosal neuromas and ganglioneuromatosis of G.I.tract constitute MEN II B with marfanoid feaatures. We routinely exclude Pheochromocytoma by doing CT or US evaluation of abdomen with Urinary catecholamine estimation. To rule out familial variety we are doing serum calcitonin for the siblings and also for children. Objectives of this paper is to compare the efficiency of Tc99m DMSA (V) scan with Serum calcitonin levels. The standard treatment for MTC is total thyroidectomy (TT) with or without Radical neck dissection depending on the individual cases. We evaluate these MTC with Tc99m DMSA (V) scans 3-4 weeks after TT. Serum Calcitonin is estimated and this is correlated with DMSA findings. If DMSA is abnormal the finding is correlated with regional CT scan / bone scan. If lesion is found suitable the same is resected. Serum Calcitonin estimation forms the sheet anchor during follow-up of these patients. Whenever it is elevated DMSA scan is done. There is good correlation and high sensitivity between Calcitonin and DMSA findings. In few instances I131 MIBG scan were also done .Our experience in the past 5 years with about 25 patients are discussed.

Sentinel Node Imaging in Breast Cancer

Shagos

Bhagat

INHS Asvini, Colaba, Mumbai - 400 005

Ref. No: 03 SG No A3

AbstractObjectives

To provide the accurate staging information to the Onco surgeon / physician so as to determine correct treatment options and to help him predicting prognosis and survival.

To guide Onco Surgeon to more accurately identify the presence of metastasis and sites of regional metastasis.

To help avoid complications and morbidity associated with unwarranted radical axillary lymph node dissection in cases where sentinel node is free of tumour cells.

Materials and Methods

Eleven sentinel node imaging procedures were performed in 11 patients with clinically T1 -T3, N 0 breast cancer in the Nuclear Medicine department from Jan 2003 to Feb 2004. All had unilateral mass lesions. Patients were assigned specific serial numbers. Study was done in close association with Onco surgeons and Onco pathologists. Pre operatively patients underwent physical examination, mammography, ultrasonography, FNAC and scintimammography to establish diagnosis. The patients were in the age group 20-70 with mean age group of 45 years. Patients with prior excisional biopsy were excluded. Pregnant and lactating women were also excluded from the study.

The day before the surgery lymphoscintigraphy was performed using ^99mTc labeled antimony sulphide. Dose administered was 500 micro Currie and injection was done in sub areolar region of the corresponding quadrant were tumour involvement was there. Single sub areolar injection was given using a tuberculin syringe. Immediately after injection, simultaneous anterior and lateral images of the involved breast acquired with corresponding axilla also in the field of view. Images were acquired using siemens dual head Gamma Camera: E-Cam. Static images were then acquired every 10 minutes for next one hour. Imaging was then repeated after two hours and four hours on the same day till the sentinel node was identified. Imaging protocol was set so as to acquire a total of one million counts per image. In non visualized cases repeat injection was given and reimaging was done 24 hours later. In few cases SPECT images were also acquired. A hot spot was considered to be a sentinel node if an afferent lymphatic channel was visualized, if the hot spot was the first one seen in a sequential pattern, if the hot spot was the only one in a particular lymph node basin or when a combination of criteria was present. The location of the sentinel node was then marked on the skin.

Immediately before commencing the surgery 1 ml of patent blue dye was injected into the tumour. The injection site was then gently massaged for 3 minutes. The sentinel node was identified and harvested after careful dissection of blue lymphatic vessels. Histopathological assessment of the sentinel nodes were then carried out.

Results

Disease Status

Sentinel Node Biopsy Positive	Lymph node Metastasis present	Lymph node Metastasis absent

07	06 (True Positive)	01 (False Positive)
Sentinel Node Biopsy Negative	Lymph node Metastasis present	Lymph node Metastasis present
02	01 (False Negative)	01 (True Negative)

Conclusions

The impact of sentinel node biopsy on the management of breast cancer was quite evident. In the 07 patients who had sentinel node biopsy positive, 06 were found to have lymph node metastasis present in axillary dissection. False negative was found only in 01 patient. In the patient who did not harbour metastasis, there is no controversy that she did not benefit from axillary lymph node dissection and could have been spared from a morbid procedure like axillary dissection. So pre operative sentinel node biopsy can be used as an effective tool in staging of the metastatic disease and thus help in better patient management.

Key wordsSentinel NodeScintimammographyAntimony Sulphide