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Guidelines for the Safe Use of Radioactive Materials During Localization and Resection of the Sentinel Lymph Node

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Abstract

Background: Several reports have demonstrated accurate prediction of nodal metastasis with radiolocalization and selective resection of the radiolocalized sentinel lymph node (SLN) in patients with breast cancer and melanoma. As reliance on this technique grows, its use by those without experience in radiation safety will increase.

Methods: Tissue obtained during radioguided SLN biopsies was examined for residual radioactivity. Specimens with a specific activity greater than the radiologic control level (RCL) of 0.002μCi/g were considered radioactive. Radiation exposure to the surgical team was measured.

Results: A total of 24 primary tissue specimens and 318 lymph nodes were obtained during 57 operations (37 for breast cancer, 20 for melanoma). All 24 (100%) of the specimens injected with radiopharmaceutical and 89 of 98 (91%) of the localized nodes were radioactive after surgery. Activity fell below the RCL 71 ± 3.6 hours in primary tissue specimens, 46 ± 1.7 hours in nodes from melanoma patients, and 33 ± 3.5 hours in nodes from breast cancer patients (P = .037). The hands of the surgical team (n = 22 cases) were exposed to 9.4 ± 3.6 mrem/case.

Conclusion: Although low levels of radiation exposure are associated with radiolocalization and resection of the SLN, the presented guidelines ensure conformity to existing regulations and allow timely pathologic analysis.

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Authors and Affiliations

  1. General Surgery Service and the Health Physics Department, Walter Reed Army Medical Center, Washington, DC, 20307

    Thomas J. Miner MD, Craig D. Shriver MD, Paul R. Flicek BS, David P. Jaques MD & Mary E. Maniscalco-Theberge MD

  2. Ryley, Carlock, and Applewhite, Attorneysat-Law, Phoenix, Arizona

    Frederick C. Miner JD

  3. The Vermont Cancer Center, Burlington, Vermont

    David N. Krag MD

Authors
  1. Thomas J. Miner MD
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  2. Craig D. Shriver MD
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  3. Paul R. Flicek BS
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The opinions and assertions herein are those of the authors and are not to be construed as official policy or reflecting the views of the Department of Defense.

Support for this work provided by the National Cancer Institute, Grant U01 CA65121-02.

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Miner, T.J., Shriver, C.D., Flicek, P.R. et al. Guidelines for the Safe Use of Radioactive Materials During Localization and Resection of the Sentinel Lymph Node. Ann Surg Oncol 6, 75–82 (1999). https://doi.org/10.1007/s10434-999-0075-7

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  • DOI: https://doi.org/10.1007/s10434-999-0075-7

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