Sentinel Node Biopsy.ppt

1、Sentinel Node Biopsy : the way forward,Hemant Singhal MS FRCSEd FRCS(Gen) FRCSC Consultant Surgeon Northwick Park you focus on eye witnesses at the scene of the crime. Marisa Weiss, M.D.,MARCH 2005,HEMANT SINGHAL,Collective experience,ACS study 5000 patients ALMANAC UK study 18 other sizeable studie

2、s 88% LN detection 98% accuracy 7 series with 100% results,MARCH 2005,HEMANT SINGHAL,Nuclear medicine aspects,Amount of radioactivity dose of 0.1 mCi for same-day and 0.4 mCi for day-before injection Preop scintigram useful initially know that there is a localised SNB abnormal pattern - Rotters, IM,

3、 breast,MARCH 2005,HEMANT SINGHAL,Site of injection,SLN identified by intraparenchymal subdermal intradermal subareolar injections,MARCH 2005,HEMANT SINGHAL,MARCH 2005,HEMANT SINGHAL,Surgical aspects,Identify blue lymphatics track hot node intraop palpation for involved node gross disease can block

4、localisation,MARCH 2005,HEMANT SINGHAL,MARCH 2005,HEMANT SINGHAL,MARCH 2005,HEMANT SINGHAL,MARCH 2005,HEMANT SINGHAL,MARCH 2005,HEMANT SINGHAL,Inaccurate results,The scenario of a negative (non-cancerous) sentinel node and positive (cancerous) additional nodes in a patient can occur for several reas

5、ons, including: The timing of the dye injections The type of dye/tracers used The presence of more than one sentinel node The way in which the initial node was sectioned or stained in the pathology lab,MARCH 2005,HEMANT SINGHAL,Poor candidates,palpable lymph nodes Locally advanced breast cancer mult

6、i-focal breast cancer previous breast surgery (including breast reduction) previous radiation therapy to the breast,MARCH 2005,HEMANT SINGHAL,American College of Surgeons recommends,at least 30 snb followed by complete axillary node dissection, with an 85% success rate in identifying the sentinel ly

7、mph node(s) and a 5% or lower false positive rate.,MARCH 2005,HEMANT SINGHAL,Tips & Tricks,Map with probe 3D mental map Allow adequate time after blue dye inj LN is invariably lower than you think Persevere,MARCH 2005,HEMANT SINGHAL,Can we stop after negative SNB,Axillary relapse, most studies have

8、median FU that is too short melanoma about 3-4% expect 1% for breast 0.4% at median fu of 84 months Singhal 1996, MSKCC,MARCH 2005,HEMANT SINGHAL,Should you go back after SNB+,39% have further involved nodes this may be obvious at first op intraoperative analysis cytology 10% false negative frozen section,MARCH 2005,HEMANT SINGHAL,MARCH 2005,HEMANT