Preoperative lymphoscintigraphy and triangulated patient body marking are important parts of the sentinel node process i
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Open Access
Editorial
Preoperative lymphoscintigraphy and triangulated patient body marking are important parts of the sentinel node process in breast cancer Borys R Krynyckyi*, Suk Chul Kim and Chun K Kim Address: Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA Email: Borys R Krynyckyi* - [email protected]; Suk Chul Kim - [email protected]; Chun K Kim - [email protected] * Corresponding author
Published: 24 August 2005 World Journal of Surgical Oncology 2005, 3:56 56
doi:10.1186/1477-7819-3-
Received: 17 June 2005 Accepted: 24 August 2005
This article is available from: http://www.wjso.com/content/3/1/56 © 2005 Krynyckyi et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Breast CancerSentinel Lymph NodeMorbidityLymphoscintigraphy Introduction
Failure to visualize or correctly visualize sentinel nodes (SN) during preoperative lymphoscintigraphy (LS) is a frustrating problem. Most of these instances occur due to inexperience in performing the studies, and can be realized and corrected with the use of proper technique, even in centers that do not have state of art equipment. This is now becoming a major issue, as more and more sentinel node biopsies are being performed, and will increasingly gain more importance once sentinel lymph node biopsy (SLNB) becomes the standard of care in patients with breast cancer world wide. Pandey et al. [1] has recently reported two unfortunate experiences with LS during SLNB. From the images and the description of the cases, it appears that the studies were suboptimal in both imaging and injection technique, and understandably, completely frustrating to any surgeon. In the second case, contamination of the patient by stray radioactivity from the perilesional injections is suggested by the authors as the cause of the superior focus that appeared in the supracalvicular region [1]. Actually, true contamination is very easy to realize with proper imaging technique [2-4]. When multiple angled views (0°, 45°, 90°) are obtained, including standing/sitting views and triangulated body marking (TBM), contamination is extremely unlikely to be missed, as it is always surface based. In over 2000 LS cases we have performed, the very
rare stray activity has always been picked up for what it is, before the patient is presented to the surgeons [2-4]. In the first case, a SN was hidden by the injected perilesional activity [1]. This is a known issue when the primary lesion is located near the axilla itself. Multiple strategies exist for dealing with diffusion and scatter from the injection site hiding the adjacent SNs in the axilla, and are described below: 1) When performing perilesional injections of radiotracer, multiple angled views and st
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