Intra Radiotracer for Mapping in a Uterine Cervix Cancer...
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* Corresponding author: Ramin Sadeghi, Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Tel: +985118012202; Fax: +985118933186; Email: [email protected]; [email protected] © 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
136
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Earlylymphoscit’shue in the loearrows).Nosen
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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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epartment ofplanned tod bilatera
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al views werection, usingmacamera(ECed (7).Theglow‐energy hges were taerphotopeakt)(1image/5phy imagof radiotraceroactivity waslso, no sentincintigraphyim
esofthepatient.minimalactivitydbevisualizedi
ymphoscintigrapvisible.Arrows
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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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DiscussionThe impor
entinel nodey many resehindbluedegative ratencrease theentinelnodesHowever, a
with somenaphylacticome authorsse of bluedyn an importahatthemargireast cancexperience of
Lymphoscin
Oceania J Nucl M
nintheupperroandextensiono
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
ntigraphy in Cerv
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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
hnique inonstratedrationalease false‐ping andction of
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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