Sentinel node lymphoscintigraphy for cervical and vulvar carcinomas - technical and patient consideration

Full text: Sentinel Node Lymphoscintigraphy (SNL) is a technique that while still investigative, is widely used in many clinical centers in melanoma and breast carcinoma SNL also has the potential to assist management of patients with cervical and vulvar carcinomas. The SNL procedure for gynaecological cancers requires some modifications with respect to technical preparation and patient care At the Mercy and Freemason's Private Hospitals 22 SNLs have been performed for gynaecological malignancies - 10 for cervical carcinoma, 11 for vulvar carcinoma and 1 for carcinoma of the vagina. Emla cream was applied for vulval lesions 1 hour prior to the procedure. A speculum was required to enable direct paracervical or paratumoural injection for cervical and vaginal cancers 2-4 x 0.1ml injections of 10MBq 99mTc-Antimony Colloid were injected around the lesion Dynamic images of 15sec/frame were acquired for a minimum of 1 hour to identify the sentinel node Patent blue dye V and a hand held gamma probe were used in surgery to localise sentinel nodes. Sentinel nodes were identified on imaging in 18/22 patients Follow-up of surgery results was available in 13 patients. Nodes were identified in surgery in all of those patients. One of the nodes was positive for metastases, and in no cases were non sentinel nodes positive where the sentinel node was negative. The procedure was generally well tolerated. SNL is a promising technique in lower genital tract gynaecological malignancies, requiring some modifications in technical preparation and patient care. The studies have afforded an insight into patterns of drainage and it is likely that this procedure will provide valuable assistance in managing this group of patients. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc