A gentle massage of the injection sites spreads the sulphur colloid, relieving the pain and speeding up the lymph uptake. The sulphur colloid is slightly acidic and causes minor stinging. In the UK 20 megabecquerels of nanocolloid is recommended. The injection protocols differ by doctor but the most common is a 500 μCi dose divided among 5 tuberculin syringes with 1/2 inch, 24 gauge needles. The injected substance, filtered sulfur colloid, is tagged with the radionuclide technetium-99m. To perform a sentinel lymph node biopsy, the physician performs a lymphoscintigraphy, wherein a low-activity radioactive substance is injected near the tumor. In skilled hands and in a center with sound routines, one, two or three of the listed methods can be considered sufficient. ![]() ![]() In everyday clinical activity, entailing sentinel node detection and sentinel lymph node biopsy, it is not required to include all different techniques listed above. Postoperative scintigraphy of main specimen with planar acquisition.Preoperative or intraoperative super paramagnetic iron oxide nanoparticles injection, detection by using Sentimag instrument.Intraoperative gamma probe/Geiger meter-detection.Intraoperative fluorescence detection ( fluorescence image-guided surgery).Intraoperative visual blue dye detection.Preoperative planar lymphoscintigraphy in conjunction with SPECT/CT.There are various procedures entailing the sentinel node detection: A micrograph showing an adenocarcinoma of the breast (dark pink) in a lymph node (purple) and extending into the surrounding fat (white, chicken-wire appearance). A blue stained sentinel lymph node in the axilla. It can also guide the surgeon to the appropriate therapy. This technique is used in the staging of certain types of cancer to see if they have spread to any lymph nodes, since lymph node metastasis is one of the most important prognostic signs. The concept of the sentinel lymph node is important because of the advent of the sentinel lymph node biopsy technique, also known as a sentinel node procedure. If the sentinel lymph node does not contain cancer, then there is a high likelihood that the cancer has not spread to any other area of the body. The concept of sentinel lymph node surgery is to determine if the cancer has spread to the very first draining lymph node (called the "sentinel lymph node") or not. In these cases, if the cancer spreads it will spread first to lymph nodes (lymph glands) close to the tumor before it spreads to other parts of the body. The spread of some forms of cancer usually follows an orderly progression, spreading first to regional lymph nodes, then the next echelon of lymph nodes, and so on, since the flow of lymph is directional, meaning that some cancers spread in a predictable fashion from where the cancer started. The sentinel node procedure (also termed sentinel lymph node biopsy or SLNB) is the identification, removal and analysis of the sentinel lymph nodes of a particular tumour. In case of established cancerous dissemination it is postulated that the sentinel lymph nodes are the target organs primarily reached by metastasizing cancer cells from the tumor. The sentinel lymph node is the hypothetical first lymph node or group of nodes draining a cancer. The axillary lymph nodes drain 75% of the lymph from the breasts((uncited)) and so may be the first lymph nodes affected in breast cancer. First lymph node to receive drainage from a primary tumor Image illustrating sentinel lymph nodes.
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