Topic: Intraoperative Sentinel Node Imaging in Breast Cancer: is this the way forward? Speaker: Mo Keshtgar

1. Intraoperative sentinel node imaging in
breast cancer
Is this the way forward?
Presented by D.B.Ghosh MS,FRCS(Edin),FRCS(G.Surg)
FEBS(Breast & Surgical Oncology)
Consultant Breast & Oncoplastic Surgeon

2. ∗ This study was performed independently and none of
the authors received any fees or reimbursement from
the manufacturers of Sentinella
∗ None of the authors or their family have any financial
interest in the company that manufactures Sentinella.
Disclosure of Conflict of Interest

3. SLN
“Any node receiving direct
lymphatic drainage from
the primary tumour”
Donald Morton
Sentinel Node biopsy Is an established as standard of care in
management of early breast cancer

4. A Portable Gamma Camera
with a hand held probe
Sentinella®

5. Pioneering study from UK to compare Sentinella®
with the conventional gamma camera (cGC) in terms
of:
∗ accuracy and speed
∗ sensitivity and resolution
∗ evaluate it as an intraoperative imaging modality
for SLN detection that can reliably replace the cGC
Aims

6. ∗ Sentinella® was compared with the conventional
gamma camera (cGC) in laboratory settings
∗ Sentinella was used intraoperatively and its accuracy
and sensitivity was compared with
Lymphoscintograms and Hand held gamma probe
Methods

7. Evaluation of Sentinella in the Lab
∗ A simulator containing
seeds10 kBq, 100kBq,
500kBq of radiocolloid Tc,
mimicking SLN, were
used
∗ Seeds were placed at
several depths in the
axilla, at 3 cm, 5cm and 8
cm from the skin

8. • Images were obtained with Sentinella and Gamma
Camera
• The cGC was placed 20 cm away from the radioactive
seeds

9. ∗ Spatial resolution was measured by calculating the
full width half maximum (FWHM) of a line profile
measured perpendicular to the image of a capillary
tube filled with high activity concentration
technetium-99m pertechnetate.

10. ∗ For the Sentinella gamma camera spatial resolution
was measured at the centre and at the edge of the
field of view

11. The three images above are of 10 MBq seed(low radioactivity) at 3 ,
5 & 8 cms depth at 1minute.The decreasing counts picked up with
increasing distance can be seen

12. ∗ 68 Sentinella® images and 34 cGC images obtained
from the simulated axilla
∗ Sentinella® resolution is comparable with the cGC for
objects close to the camera i.e. ~ 5 cm, but reduces
rapidly as it’s moved away from the camera
∗ For distances up to about 7 cm the Sentinella® with the
blue collimator is more sensitive than the cGC
Results

13. ∗ Sentinella detects high radioactivity (500 kBq)
faster than cGC (1 vs 2.5min)
∗ In cases of low radioactivity (10kBq) Sentinella®
was equally accurate and faster than cGC, when
placed close to the skin
∗ Identification of different number of beads with
varying radioactivity was similar in Sentinella and
cGC
Results

14. ∗ All patients undergoing SLNB underwent standard
imaging with cGC
∗ This was followed by intraoperative mapping using
Sentinella
∗ Sentinella was also compared with a standard hand
held probe and images recorded when the hand held
probe was silent to activity
Clinical Evaluation

17. ∗ Number of patients studied = 150
∗ Sentinella correlated 100% with images
∗ Sentinella scans detected more nodes as
compared to cGC (1.25 vs 2.2) p<0.01
Results

18. ∗ Sentinella picked up extra nodes in 5/150 cases
due to visual residual activity when the hand held
probe was silent
∗ 2 /150 cases picked up histologically positive
nodes not detected by cGC and resulted in axillary
clearance & change in management

19. ∗ Sentinella is accurate and fast in detecting
radioactivity in the axilla
∗ The anatomical shape of its collimator allows the
operator to place it adjacent to the axilla, thus
increasing its sensitivity in cases of low
radioactivity
∗ Our independent tests and initial patient data
confirms the excellent sensitivity and specificity of
the machine in localisation of radioactive nodes
Conclusion

20. ∗ This potentially increases the identification of the
SLN and reduces false negative SLNB
∗ Reduces time of patient and personnel for the use
of Conventional Lymphoscintigrams
∗ It can resolve the problem of centres that do not
have on site nuclear medicine department in the
UK setting.
Conclusion

21. ∗ Vania Stafyla
∗ David McCool
∗ Fred Wickham
∗ Andrew O’Brien
Acknowledgements

22. Thank You
Your Questions