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General Concepts on Radioguided Sentinel Lymph Node Biopsy: Preoperative Imaging, Intraoperative Gamma Probe Guidance, Intraoperative Imaging, Multimodality Imaging

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Atlas of Lymphoscintigraphy and Sentinel Node Mapping

Abstract

The sentinel lymph node biopsy (SLNB) is a diagnostic staging procedure that is applied in a variety of tumor types and aims to determine the tumor status of locoregional lymph nodes. The radiopharmaceuticals labeled with 99mTc most frequently employed for sentinel lymph node mapping are colloids (99mTc-sulfur colloid, 99mTc-albumin nanocolloid) and more recently receptor-based tracers (9mTc-tilmanocept); hybrid tracers combining the radioactive signature with a fluorescence signal have also been developed, such as 99mTc-nanocolloid conjugated with indocyanine green (ICG). Radiopharmaceutical administration is performed by tumoral or peritumoral interstitial injection. Lymphoscintigraphy is a mandatory preoperative step of the entire SLNB procedure allowing a skin marking as a general guide for the surgical incision. Hybrid SPECT/CT images are highly useful, especially in case of complex anatomical regions and/or in case of unusual lymphatic drainage patterns. The intraoperative exploration of the surgical field is performed with the widely validated procedure based on the so-called handheld gamma probe. While this instrumentation produces a numerical readout and an acoustic signal proportional to radioactivity accumulation as a guide in the surgical field, the recently developed portable gamma cameras enable real-time scintigraphic imaging of the surgical field, mostly with the purpose of assessing completeness of the SLNB procedure. All these instrumentations allow selective identification of the sentinel lymph node(s) to be removed by the surgeon and analyzed by the pathologist. Histopathology of the sentinel lymph nodes(s) so identified and resected can distinguish macrometastases (>2 mm in size), micrometastases (between 0.2 and 2 mm), isolating tumor cells (malignant cell clusters <0.2 mm), or positive molecular findings. The interactions between technologies and different medical disciplines permit to continuously refine the methodology and to improve the outcomes of radioguided surgery of the SLNB procedure.

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Author information

Authors and Affiliations

  1. Nuclear Medicine Unit, “Maggiore della Carità” University Hospital, Novara, Italy

    Federica Orsini

  2. Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy

    Federica Guidoccio & Giuliano Mariani

  3. Nuclear Medicine Department, Hospital Clinic Barcelona, Barcelona, Catalonia, Spain

    Sergi Vidal-Sicart

  4. Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Catalonia, Spain

    Sergi Vidal-Sicart

  5. Department of Radiology, Section of Nuclear Medicine and Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, The Netherlands

    Renato A. Valdés Olmos

Authors
  1. Federica Orsini
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  2. Federica Guidoccio
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  3. Sergi Vidal-Sicart
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  4. Renato A. Valdés Olmos
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  5. Giuliano Mariani
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Corresponding author

Correspondence to Federica Orsini .

Editor information

Editors and Affiliations

  1. Regional Center of Nuclear Medicine Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy

    Giuliano Mariani

  2. Nuclear Medicine Department, Hospital Clinic Barcelona, Barcelona, Catalonia, Spain

    Sergi Vidal-Sicart

  3. Department of Radiology Section of Nuclear Medicine and Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, The Netherlands

    Renato A. Valdés Olmos

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Orsini, F., Guidoccio, F., Vidal-Sicart, S., Valdés Olmos, R.A., Mariani, G. (2020). General Concepts on Radioguided Sentinel Lymph Node Biopsy: Preoperative Imaging, Intraoperative Gamma Probe Guidance, Intraoperative Imaging, Multimodality Imaging. In: Mariani, G., Vidal-Sicart, S., Valdés Olmos, R. (eds) Atlas of Lymphoscintigraphy and Sentinel Node Mapping. Springer, Cham. https://doi.org/10.1007/978-3-030-45296-4_7

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  • DOI: https://doi.org/10.1007/978-3-030-45296-4_7

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