* Corresponding author: Ramin Sadeghi, Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Tel: +985118012202; Fax: +985118933186; Email: sadeghir@mums.ac.ir; raminsadeghi1355@yahoo.com © 2014 mums.ac.ir All rights reserved. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.  

   

Inappropriate Intra‐cervical Injection of Radiotracer forSentinel Lymph Node Mapping in a Uterine Cervix CancerPatient: Importance of Lymphoscintigraphy and Blue DyeInjectionSimaKadkhodayan1,ElhamHosseiniFarahabadi1,ZohrehYousefi1,MaliheHasanzadeh1,RaminSadeghi2*1 Women’sHealthResearchCenter,MashhadUniversityofMedicalSciences,Mashhad,Iran2 NuclearMedicineResearchCenter,MashhadUniversityofMedicalSciences,Mashhad,Iran

ARTICLEINFO ABSTRACT

Articletype:Casereport

Herein,we report a caseof sentinel lymphnodemapping inauterine cervix cancerpatient, referring to the nuclear medicine department of our institute.Lymphoscintigraphy images showed inappropriate intra‐cervical injection ofradiotracer.Bluedye techniquewasapplied forsentinel lymphnodemapping,usingintra‐cervical injectionofmethyleneblue.Twoblue/coldsentinel lymphnodes,withno pathological involvement, were intra‐operatively identified, and the patient wassparedpelviclymphnodedissection.Thepresentcaseunderscorestheimportanceoflymphoscintigraphy imaging in sentinel lymphnodemapping and demonstrates theadded value of blue dye injection in selected patients. It is suggested that pre‐operative lymphoscintigraphy imaging be considered as an integral part of sentinellymph node mapping in surgical oncology. Detailed results of lymphoscintigraphyimages should be provided for surgeons prior to surgery, and in case the sentinellymphnodesarenotvisualized,useofbluedyeforsentinelnodemappingshouldbeencouraged.

Articlehistory:Received:7Mar2014Revised:2Apr2014Accepted:15May2014

Keywords:99mTc‐PhytateCervicalcancerLymphoscintigraphyMethyleneblueSentinelnode

►Pleasecitethispaperas:KadkhodayanS,HosseiniFarahabadiE,YousefiZ,HasanzadehM,SadeghiR. Inappropriate Intra‐cervical InjectionofRadiotracerforSentinelLymphNodeMappinginaUterineCervixCancerPatient:ImportanceofLymphoscintigraphyandBlueDyeInjection.AsiaOceaniaJNuclMedBiol.2014;2(2):135‐137.

IntroductionSentinel node mapping, as a useful method

for regional lymphnode staging,minimizes themorbidity associated with lymph nodedissectioninpatientswithsolidtumors.

Theconceptofsentinelnodemappingrelieson an orderly and predictable pattern oflymphaticflowfromtumors.Sentinelnodesarethefirstlymphnodesinthelymphaticdrainagesystem of tumors, and can be considered assurrogates for regional lymphnodes, regardingthepathologicalinvolvement(1,2).

Two conventional methods for sentinellymphnodemappingareinjectionofradiotracerandbluedye.Acombinationofradiotracerand

blue dye injection for lymphatic mapping isfound to increase the detection rate anddecreasethefalse‐negativerateofsentinelnodebiopsy (3). However, several authors haveproposed a more restricted use of blue dyeinjection due to potential life‐threateningcomplications, associated with this method (4‐6).

CasereportA 56‐year‐old female patient with a

histologically proven squamous cell carcinoma(2 cm in diameter) of uterine cervix wasscheduled for sentinel node mapping in the

Kadkhoday

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Figure 2.imagesofttheinjectionuclearThe pathysterecoophore

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medicine detient was pctomy andectomy.teen hoursreceived twoPhytate at 3/0.1 ccscintigraphyr and laterater the inje‐anglegammously specifiuipped withor and imagakandscatteofthepatientphoscintigraper injection oof the radioFigure1); althelymphosc

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esofthepatient.minimalactivitydbevisualizedi

ymphoscintigrapvisible.Arrows

f our instituundergo toal salping

surgery, tcal injectionsck positionsh injectionwith anteriore obtainedg a dual‐heCAM,Siemengammacamehigh‐resolutiaken by 99mks(for imagi5min).ges showr in the cervs visible in tnel nodeswemages.

.Theoriginalimy in the cervix (inthepelvis

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Two bluentra‐operativeegions. Howeetected by thxaminationoor pathologicymphnodedi

DiscussionThe impor

entinel nodey many resehindbluedegative ratencrease theentinelnodesHowever, a

with somenaphylacticome authorsse of bluedyn an importahatthemargireast cancexperience of

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nt refused toinjection

raphy images without(Figure 2).vical injectionion), and lymingagammaluedyetechne sentinel noely in the rigever, no hothe gamma pofthesentinecal involvemissectionwas

rtance of blumapping hasearchers (5ye techniqueof sentinel intra‐opers.addition of brisks includreactions (6have proposye in sentineant study, Deinalbenefitoer patientssurgeons inc

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Med Biol. 2014; 2(

wandthescatteof radiotracer in

undergo ann. Pre‐oes also shoany visibleThe patientns of methylmphatic mappaprobe(EURnique.odes were ight and leftosentinel nod

probe. Frozenelnodeswasment, and nsperformed.

ue dye techas been demo5, 8). Thee is todecrea node mapprative detec

blue dye is ading life‐thr6, 9, 10). Tsed amore rl nodemapperossis et al.fbluedyeinjdecreases

creases (12).

vical Cancer

(2):135-137.

erogramsofn thevagina

y furtheroperativeowed thesentinelreceivedlene blueping wasROPROBE,

identifiedobturatordes weren sectionnegative

no pelvic

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ssociatedreateningTherefore,restrictedping (11).reportedjectioninas the

. Another

Lymphoscintigraphy in Cervical Cancer Kadkhodayan S et al 

Asia Oceania J Nucl Med Biol. 2014; 2(2):135-137. 137

studybySadeghietal.reportedsimilarfindings,and showed the marginal benefits of blue dyetechnique incaseof sentinelnodevisualizationonlymphoscintigraphyimages(4).

The present case shows the importance oflymphoscintigraphy imagingasan integralpartof sentinel nodemapping. Lymphoscintigraphyimages indicated the inappropriate injection ofradiotracer(inourcase, failureto inject theairbubblebehind theradiotracer insyringes),andthe surgeon was informed about the resultsbefore the surgery. Blue dye technique wassuccessful for lymphatic mapping and thepatient was spared pelvic lymph nodedissection.

Therefore, non‐visualization of sentinelnodeson lymphoscintigraphy imagesshouldbereportedtosurgicaloncologists,anduseofbluedye technique should be promoted in similarclinicalsituations.

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