P. Sundaram (Kochi/Cochin, India)
Amrita Institute of Medical SciencesAuthor Of 1 Presentation
156P - The Effectiveness of Intraoperative Administration Of Both Radioactive Isotope And Blue Dye Without Pre-Surgery Gamma Imaging In Comparison With The Conventional Technique For Sentinel Node Biopsy.
Abstract
Background
Our departmental audit revealed some problems associated with the conventional technique of SLNB such as scheduling issues for OT, co-ordination issues and time lost in the process. Our analysis showed us that the sentinel node was always in axilla, appeared soon after injection, the injection was painful, and the location of the node did not influence the incision. We sat with our nuclear medicine colleagues and evolved a strategy to overcome these problems: Do away with the imaging under gamma camera; shift injection venue to the operating room, thus avoiding a lot of co-ordination and scheduling issues; avoid pain by injecting isotope after induction of general anaesthesia and; train persons to inject the radioactive material. This study is looking at 200 patients of SLN biopsy done by the conventional technique compared to the next 200 patients done with the dual technique.
Methods
Intraoperative dual SLN mapping consisted of subareolar injection of technetium 99m- labelled filtered sulphur colloid (15-37 MBq) and 2 ml of 1% iso sulfan blue dye just after anaesthetic induction. The conventional technique consisted of subareolar injection of radioactive colloid in Nuclear medicine followed by SPECT imaging and subareolar injection of blue dye intraoperatively. In both cases the SLN was detected using gamma probe and blue colour. SLN’s identified during these procedures were classified as “blue-hot” nodes, “hot-only” nodes, or “blue-only” nodes.
Results
Conventional technique Dual technique P value Total patients 202 238 Sentinel node detected 196 (97%) 232 (97.47%) 0.773 Hot and blue 159 (81.12%) 204 (87.9%) 0.054 Hot only 36 (18.36%) 25 (10.7%) 0.027 (significant) Blue only 1 (0.51%) 3 (1.29%) 0.399 SLN +VE, Other nodes -VE 32 24 0.070 Only non SLN +VE 6 2 0.096 SLN +VE, NON SLN + 12 15 0.875
Conclusions
SLN detection rate of dual technique was equivalent to conventional technique. Thereby, even in the absence of Nuclear medicine facility within the hospital, the SLNB can still be performed by procuring the radioactive colloid from a source at a distant site in the same town or city and using the hand-held gamma probe without affecting sensitivity or detection rates.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.