SF020/#652 Use of a vaginally adapted gamma probe in the videolaparoscopic sentinel lymph node research

Summary Aim of this study was to localize the sentinel lymph node by lymphoscintigraphy using technetium-99m colloidal rhenium sulphide (Nanocis®), a new commercially available radiopharmaceutical. Due to the manufacturers’ instructions it is licensed for lymphoscintigraphy. Patients, methods: 35 consecutive patients with histologically proved malignant melanoma, but without clinical evidence of metastases, were preoperatively examined by injecting 20-40 MBq Nanocis® with (mean particle size: 100 nm; range: 50-200 nm) intradermally around the lesion. Additionally blue dye was injected intaoperatively. A hand-held gamma probe guided sentinel node biopsy. Results: During surgery, the preoperatively scintigraphically detected sentinel lymph nodes were identified in 34/35 (97%) patients. The number of sentinel nodes per patient ranged from one to four (mean: n = 1.8). Histologically, metastatic involvement of the sentinel lymph node was found in 12/35 (34%) patients; the sentinel lymph node positive-rate (14/63 SLN) was 22%. Thus, it is comparable to the findings of SLN-mapping using other technetium-99m-labeled nanocolloides. Conclusion: 99mTc-bound colloidal rhenium sulphide is also suitable for sentinel node mapping.

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Development and characterization of an all-in-one gamma probe with auto-peak detection for sentinel lymph node biopsy based on NEMA NU3-2004 standard

Annals of Nuclear Medicine ◽

10.1007/s12149-021-01581-z ◽

2021 ◽

Author(s):

Aram Radnia ◽

Hamed Abdollahzadeh ◽

Behnoosh Teimourian ◽

Mohammad Hossein Farahani ◽

Mohammad Esmaeil Akbari ◽

...

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Gamma Probe ◽

Peak Detection ◽

Cesium Iodide ◽

Shielding Effectiveness ◽

Scattering Medium ◽

Silicon Photomultiplier ◽

Regional Lymph Nodes ◽

Handheld Device

Abstract Background A gamma probe is a handheld device used for intraoperative interventions following interstitial injection of a radiotracer to locate regional lymph nodes through the external detection of radiation. This work reports on the design and performance evaluation of a novel fully integrated gamma probe (GammaPen), recently developed by our group. Materials and methods GammaPen is an all-in-one pocket gamma probe with low weight and adequate dimensions, consisting of a detector, a control unit and output all together. The detector module consists of a cylindrical Thallium-activated Cesium Iodide [CsI (Tl)] crystal optically coupled to a Silicon photomultiplier (SiPM), shielded using Tungsten housing on side and back faces. The electronics of the probe consists of two small boards to handle signal processing and analog peak detection tasks. A number of parameters, including probe sensitivity in air/water, spatial resolution in air/water, angular resolution in air/water, and side and back shielding effectiveness, were measured to evaluate the performance of the probe based on NEMA NU3-2004 standards. Results The sensitivity of the probe in air at distances of 10, 30, and 50 mm is 18784, 3500, and 1575 cps/MBq. The sensitivity in scattering medium was also measured at distances of 10, 30, and 50 mm as 17,680, 3050, and 1104 cps/MBq. The spatial and angular resolutions in scattering medium were 47 mm and 87 degree at 30 mm distance from the probe, while they were 40 mm and 77 degree in air. The detector shielding effectiveness and leakage sensitivity are 99.91% and 0.09%, respectively. Conclusion The performance characterization showed that GammaPen can be used effectively for sentinel lymph node localization. The probe was successfully used in several surgical interventions by an experienced surgeon confirming its suitability in a clinical setting.

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Axillary Sentinel Lymph-Node Biopsy: Gamma Probe Assisted Sonographic Localisation

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/s-2005-858915 ◽

2006 ◽

Vol 27 (01) ◽

pp. 34-39 ◽

Cited By ~ 3

Author(s):

A Hollerweger ◽

P Macheiner ◽

E Hübner ◽

N Gritzmann

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Lymph Node Biopsy ◽

Gamma Probe ◽

Lymph Node Biopsy ◽

Node Biopsy

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Mapping Sentinel Lymph Node in Breast Cancer by Combined Lymphoscintigraphy, Blue-Dye, and Intraoperative Gamma-Probe

Cancer Biotherapy & Radiopharmaceuticals ◽

10.1089/108497800414338 ◽

2000 ◽

Vol 15 (3) ◽

pp. 245-252 ◽

Cited By ~ 18

Author(s):

Giuliano Mariani ◽

Giuseppe Villa ◽

Marco Gipponi ◽

Pietro Bianchi ◽

Ferdinando Buffoni ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Gamma Probe ◽

Blue Dye ◽

Intraoperative Gamma Probe

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Clinical application of the sentinel lymph node technique in early ovarian cancer: a pilot study

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2018-000049 ◽

2018 ◽

Vol 29 (2) ◽

pp. 377-381 ◽

Cited By ~ 11

Author(s):

V Lago ◽

P Bello ◽

B Montero ◽

L Matute ◽

P Padilla-Iserte ◽

...

Keyword(s):

Ovarian Cancer ◽

Lymph Node ◽

Pilot Study ◽

Sentinel Lymph Node ◽

Lymph Nodes ◽

Near Infrared ◽

Early Stage ◽

Gamma Probe ◽

Sentinel Lymph Nodes ◽

Near Infrared Fluorescence Imaging

IntroductionThere is limited evidence favoring the use of the sentinel lymph node technique in ovarian cancer, and no standardized approach has been studied. The objective of the present pilot study is to determine the feasibility of the sentinel lymph node technique by applying a clinical algorithm.MethodsPatients with confirmed ovarian cancer were included. 99mTc and indocyanine green were injected into the ovarian and infundubulo-pelvic ligament stump. A gamma probe and near-infrared fluorescence imaging were used for sentinel lymph node detection.ResultsThe sentinel lymph node technique was performed in ten patients with a detection rate in the pelvic and/or para-aortic region of 100%. The tracer distribution rates of sentinel lymph nodes in the pelvic and para-aortic regions were 87.5% and 70%, respectively.ConclusionThe detection of sentinel lymph nodes in early-stage ovarian cancer appears to be achievable. Based on these results, a clinical trial entitled SENTOV (SENtinel lymph node Technique in OVarian cancer) will be performed.

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The sentinel lymph node concept in prostate cancer: first results of gamma probe-guided sentinel lymph node identification.

Current Opinion in Urology ◽

10.1097/00042307-200005000-00028 ◽

2000 ◽

Vol 10 (3) ◽

pp. 263

Author(s):

Andrea Tubaro

Keyword(s):

Prostate Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Gamma Probe ◽

Sentinel Lymph Node Identification ◽

First Results ◽

Sentinel Lymph Node Concept

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Sentinel lymph node mapping for T1 esophageal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.7 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 7-7

Author(s):

Hiroya Takeuchi ◽

Hirofumi Kawakubo ◽

Yoshiro Saikawa ◽

Tadaki Nakahara ◽

Tai Omori ◽

...

Keyword(s):

Esophageal Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Lymph Node Metastasis ◽

Standard Procedure ◽

Gamma Probe ◽

Early Esophageal Cancer ◽

Radical Esophagectomy ◽

Primary Tumors ◽

Node Metastasis

7 Background: Extended radical esophagectomy with three-field lymph node dissection has been recognized as the standard procedure for thoracic esophageal cancer in Japan, even for clinically T1N0 cases. However, to eliminate the uniform application of the highly invasive surgery, we hypothesized that sentinel lymph node (SLN) mapping would play a key role to obtain individual information and allows modification of the surgical procedure for early esophageal cancer. Methods: We have established radio-guided method to detect SLNs in patient with early esophageal cancer using endoscopic injection of technetium-99m tin colloid. Preoperative lymphoscintigraphy and intra-operative use of hand held gamma probe were reliable to locate the radioactive SLNs. Intra-operative gamma probing was also feasible in thoracoscopic or laparoscopic surgery using a special gamma detector which is introducible from trocar ports. Results: SLN mapping has been performed for 70 patients with clinically N0 and early (pT1) esophageal cancer in our institute since 1999. Detection rate of hot node using our procedure was 94% (66/70). The mean number of sentinel nodes per case was 4.6. Twenty-one of 23 cases (91%) with lymph node metastasis showed positive SLNs. Accuracy of metastatic status based on SLN was 97% (64/66). SLNs widely spread from cervical to abdominal areas. In more than 80% of the cases, at least one SLN was located in the 2nd or 3rd compartment of regional lymph nodes. However, 56 (85%) of 66 patients had no lymph node metastasis or metastasis (+) only in SLNs. Conclusions: Our results suggest that SLN concept for clinically N0 and T1 esophageal cancer could be validated. Theoretically more than 80% of patients with pT1b esophageal cancer may be controlled by local treatments such as surgery and chemoradiotherapy targeting primary tumors plus their SLNs. Individualized selective and modified lymphadenectomy targeted on SLN basins for clinically N0 early esophageal cancer should become feasible and clinically useful as less invasive surgical procedures.

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Sentinel lymph node in prostate carcinoma: Methodology, feasibility, surgical, and oncological consequences: A prospective study about 93 patients.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.6_suppl.69 ◽

2013 ◽

Vol 31 (6_suppl) ◽

pp. 69-69

Author(s):

Claude Soler ◽

Yves Perraud ◽

Eric Gremillet ◽

Corine Armand ◽

Benjamin Geissler ◽

...

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Gamma Probe ◽

Lymphatic Drainage ◽

Planar Imaging ◽

Iliac Arteries ◽

Internal Iliac ◽

Metastatic Risk ◽

The Right ◽

A Prospective Study

69 Background: There are few studies in the field of prostatic sentinel lymph node (SLN) procedure: in the literature at the most 10 publications are found. However the interest of urological surgeons is growing fast. We want to evaluate the rate of SLN SPECT-CT detection, the rate of SLN involvement, and the incidence of the SLN biopsy on the surgical and oncological management of patients. Methods: 93 patients with prostate cancer were included (gleason 6-9). All patients were elected for a radical laparoscopic prostatectomy. Nanocis* was intratumorally injected, guided by transrectal ultrosonography. 2 injections 0.6 ml in each lobe of the prostate were performed. Patient underwent planar imaging and SPECT-CT 2 hours after injections. Surgery was performed 18 hours after. Results: A lymphatic pelvic drainage was seen in 95,6 % (89/93) by SPECT-CT (external or internal iliac arteries areas). For 27 patients lymphatic drainage was on the right side, for 24 patients it was on the left side, for the 37 remaining patients migration was bilateral. The radioguided lymphadenectomy was assisted by a laparoscopic gamma-probe (Clerad, France), the SLN detection rate was 97.7% (87/89); the average number of resected radioactive nodes was 1.6 (range 1 to 5). By all the ways, a limited pelvic lymph node dissection was performed (including external iliac to common iliac arteries areas) in all 93 cases. An SLN involvement was found in 6 cases (5/87= 5.75%); in these 6 cases and in the 81 cases without SLN involvement, no metastatic involvement was found in the other lymph nodes, as well as in the 6 patients for which no SLN could be selectively resected (4 with no drainage seen and 2 not detected intra-operatively although visualized on lymphoscintigraphy). Conclusions: The low rate of lymphatic involvement is not surprising considering the Gleason score range 6 to 9 (low metastatic risk). So, the preliminary results are very attractive, especially for these patients that could have been falsely considered as N0. Our study is still in progress, and if these results are confirmed on a larger scale, then SLN procedure could be considered in the routine management of low risk prostatic carcinomas.

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