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در مرکز پزشکی هسته ای دکتر دباغ – دکتر صادقی در خدمت شما هستیم

در مرکز پزشکی هسته ای دکتر دباغ – دکتر صادقی در خدمت شما هستیم. مشهد، ملاصدرا 11 ، پلاک 1/4 www.DSNMC.ir Tel:+98(51) 38411524; +98(51)38472927. LYMPHOSCINTIGRAPHY Sentinel Node. Ramin Sadeghi, M.D. Nuclear Medicine Specialist Associate Professor DSNMC

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در مرکز پزشکی هسته ای دکتر دباغ – دکتر صادقی در خدمت شما هستیم

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  1. در مرکز پزشکی هسته ای دکتر دباغ – دکتر صادقی در خدمت شما هستیم مشهد، ملاصدرا 11 ، پلاک 1/4 www.DSNMC.ir Tel:+98(51) 38411524; +98(51)38472927

  2. LYMPHOSCINTIGRAPHYSentinel Node Ramin Sadeghi, M.D. Nuclear Medicine Specialist Associate Professor DSNMC Nuclear Medicine Research Center (NMRC; MUMS) www.DSNMC.ir

  3. Lymphoscintigraphy • Indications: • Evaluation of lymphedema • Sentinel node detection • Melanoma • Breast cancer • Evaluation of lymphedema • Evaluation of chyle stasis www.DSNMC.ir

  4. Lymphoscintigraphy • Normal • Prompt cephalic migration of radiocolloid to the illioinguinal lymph node groups in 10-30 min. • Primary lymphedema • Marked decreased visualization of the ilioinguinal nodes of the affected side as well as an absence of any diffuse interstitial activity. • Secondary lymphedema • Marked interstitial accumulation of radiocolloid (diffuse activity throughout the involved extremity and poor visualization of primary channels) www.DSNMC.ir

  5. SENTINEL NODE DETECTION www.DSNMC.ir

  6. Sentinel node concept Lymphatic flow is orderly and predictable Tumor

  7. Sentinel node concept Tumor cells disseminate sequentially Tumor

  8. Other lymph nodes: Not involved Sentinel node :Not involved Tumor Sentinel node concept

  9. Other lymph nodes: May be involved Sentinel node :Involved Tumor Sentinel node concept

  10. Sentinel node detection • Probe detection • Alone • With imaging • Blue dye detection • Alone • With probe detection

  11. Radiopharmaceuticals • Narrow particle size range • 99mTc labeled • Stable on storage • Lymph channel transport • Rapid transport • Retention in sentinel node

  12. Lymphatics capillary < 4 nm 80-1000 nm >1000 nm Retention in site Radiopharmaceuticals

  13. Radiopharmaceuticals • Non-particulate (< 4nm): • 99mTc-HSA • 99mTc-Dextran • Particulate: • 99mTc-antimony sulfide colloid (15-50 nm) • 99mTc-nanocoll(albumin colloid) (~80 nm) • 99mTc-Albumin microcolloid (200-1000 nm) • 99mTc-sulfur colloid • Filtered (50-200 nm) • Unfiltered (200-1000 nm) • 99mTc-phytate

  14. Radiopharmaceuticals The smaller the size of tracer, the more lymph nodes are detected

  15. Injection site • Melanoma • Intradermal • Breast cancer • Subdermal • Intra-tumoral • Peri-tumoral • Peri-areolar • Subdermal + peri-tumoral

  16. Injection site (cont.) • Subdermal injection is sub-optimal for internal mammary nodes • Subdermal + peri-tumoral is the preferred method of injection

  17. Imaging • Why imaging is necessary? • Helpful in incision planning • Smaller incision is performed • Surgical time is shortened • Not all hot lymph nodes should be excised

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