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Sentinel Lymph Node Concept; and Technique of SLN Identification in Breast Cancer Patients. Dr S.Gambhir Department of Nuclear Medicine S.G.P.G.I.M.S Lucknow. These PowerPoint presentations are free to download only for academic purposes, with due acknowledgements to authors and this website. - PowerPoint PPT Presentation
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Sentinel Lymph Node Concept; and Sentinel Lymph Node Concept; and Technique of SLN Identification in Breast Technique of SLN Identification in Breast
Cancer PatientsCancer Patients
Dr S.GambhirDr S.GambhirDepartment of Nuclear MedicineDepartment of Nuclear Medicine
S.G.P.G.I.M.SS.G.P.G.I.M.SLucknowLucknow
These PowerPoint presentations are free to download only for These PowerPoint presentations are free to download only for academic purposes, with due acknowledgements to authors and academic purposes, with due acknowledgements to authors and
this website.this website.
Axillary Lymph Node Dissection (ALND) in Axillary Lymph Node Dissection (ALND) in Carcinoma BreastCarcinoma Breast
Axillary clearance for local disease controlAxillary clearance for local disease control
PrognosisPrognosis
Early Carcinoma BreastEarly Carcinoma Breast
Histopathological positivity of axilla on ALND 30% ~40%Histopathological positivity of axilla on ALND 30% ~40%
60-70% patients of primary carcinoma breast patients are 60-70% patients of primary carcinoma breast patients are undergoing unnecessary ALNDundergoing unnecessary ALND
ALND associated morbidity ALND associated morbidity
? Adjuvant chemotherapy? Adjuvant chemotherapy
Technical Issues in SLN Detection and Technical Issues in SLN Detection and ImagingImaging
What tracer ?What tracer ?
What injection site ?What injection site ?
Large or small volume.Large or small volume.
How many MBq’s ?How many MBq’s ?
Technical Issues in SLN Detection and Technical Issues in SLN Detection and ImagingImaging
What is most appropriate site of injectionWhat is most appropriate site of injection
SubareolarSubareolar PeritumoralPeritumoral IntratumoralIntratumoral SubdermalSubdermal SubcutaneousSubcutaneous
Concept of Single InjectionConcept of Single Injection
Lymphatic drainage of breast consists of dermal and Lymphatic drainage of breast consists of dermal and parenchymal lymphatics which meet at Subareolar parenchymal lymphatics which meet at Subareolar lymphatics which meet at subareolar plexus of Sappey.lymphatics which meet at subareolar plexus of Sappey.
This further drain through one or two major lymphatic This further drain through one or two major lymphatic trunk to axilla.trunk to axilla.
Position of this lymphatic plexus gives the opportunity of Position of this lymphatic plexus gives the opportunity of single uniformally consistent subareolar injection of single uniformally consistent subareolar injection of injection of radiopharmaceutical/blue dye into breast injection of radiopharmaceutical/blue dye into breast lymphatics.lymphatics.
Adjuvant Systemic therapyAdjuvant Systemic therapy
Radioactive but non blue lymph node
Invitro demonstration of radioactive but non blue lymph node
ResultsResults Imaging + veImaging + ve 84.8%84.8%
Probe +ve Probe +ve 97.3%97.3%
Blue dye +ve Blue dye +ve 91.4%91.4%
Concordance betweenConcordance between probe and blue dyeprobe and blue dye 94.4%94.4%
SLN histopathology SLN histopathology 97.2 % (accuracy)97.2 % (accuracy) (H.E. matched with axilla nodes)(H.E. matched with axilla nodes)
Technical Issues in SLN Detection and Technical Issues in SLN Detection and ImagingImaging
Which mode of detection is preferable ?Which mode of detection is preferable ?
Probe detection and imagingProbe detection and imaging
Probe detection onlyProbe detection only
Blue dye alone or in combination with probe detectionBlue dye alone or in combination with probe detection
Best Method of SNB Mapping?Best Method of SNB Mapping?
Positive Non-Sentinel Axillary Nodes in Positive Non-Sentinel Axillary Nodes in Patients with Positive Sentinel NodesPatients with Positive Sentinel Nodes
Tumor Size
+NSN
T1a
14%
T1b
22%
T1c
30%
T2
45%
T3
57%
Technical Issues in SLN Detection and Technical Issues in SLN Detection and ImagingImaging
What pathological evidence is required?What pathological evidence is required?
Fine-needle aspiration cytologyFine-needle aspiration cytology
Imprint cytologyImprint cytology
H.E. Staining aloneH.E. Staining alone
Cytokeratin immunohistochemistryCytokeratin immunohistochemistry
ConclusionConclusion
Currently detection of SLN is highly accurate in Currently detection of SLN is highly accurate in context of carcinoma breast.context of carcinoma breast.
There is rapidly increasing database population.There is rapidly increasing database population.
Training programmers relevant to multidisciplinary Training programmers relevant to multidisciplinary teams need to be developed for this methodology.teams need to be developed for this methodology.