Gamma-probe-guided lymph node localization in malignant melanoma

Alex, James C.; Weaver, Donald L.; Fairbank, Jonathan T.; Rankin, B.S.; Krag, David N.

doi:10.1016/s0960-7404(06)80006-x

Cited by 322 publications

(127 citation statements)

References 27 publications

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“…The gamma-probe is resistant, portable, not too expensive and easy to use, presenting a high sensitivity and specificity, as demonstrated by the GPAS performed to remove a wide variety of tumors [3][4][5]9,10,[20][21][22][23][24][25] and sentinel-nodes [13][14][15][16][17][18][19] . In fact, its sensitivity se- ems to be greater than that of CT (Bell et al 3 : 11 of 13 patients harboring ovarian cancer underwent preoperative CT-scan, which was normal in all of them), MRI (Martinez et al 23 : one out of three patients with parathyroid disease underwent preoperative MRI and CT, being both normal) and external scintigraphy (Martin et al 4 : this procedure was normal in 11 out of 23 patients with colorectal tumor).…”

Section: Discussionmentioning

confidence: 99%

“…This technique, named by others as radioguided surgery (RGS) and by the present authors as gamma probe-assisted surgery (GPAS), was introduced into clinical practice in 1985 by Martin et al 3,4 , allowing them to promptly recognize the lesion in 28 patients harboring colorectal tumors. Using a variety of radiolabeled substances [1][2][3][4][5][6][7][8][9][10] , many authors have performed GPAS to map sentinelnodes of melanomas 13 , of breast 14 , vulvar 15 , cervical 16 , prostate 17 , penile 18 and thyroid 19 cancer, and to identify breast (the radiolabeled substance may be injected intravenously 20 and within 21 or around 22 the tumor), ovarian 3 , colorectal 4,5 , gastroenteropancreatic 10 , parathyroid 23 and thyroid 24,25 tumors and neuroblastomas 9 , with a significant successful rate.…”

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Gamma probe-assisted brain tumor microsurgical resection: a new technique

Filho

Filho²

2002

Arq. Neuro-Psiquiatr.

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-Objectives: The pioneering performance of gamma probe-assisted surgery (GPAS) for brain tumors, aiming not only an improvement of tumor detection, but mainly assurance of its complete removal and the study of the usual distribution of the 99m Tc-MIBI in the brain SPECT of normal individuals. Method: Patient's informed consent and demonstration of the tumor by the preoperative MIBI SPECT were the inclusion criteria adopted for GPAS, which was performed in one patient with a right parietal lobe metastatic tumor. The radiotracer ( 99m Tc-MIBI) was injected in a peripheral vein 5 hours before the operation. A tumor to-normal tissue count ratio equal to or greater than 2/1 was considered indicative of tumor. MIBI SPECT was performed in five normal individuals in a pilot study. Results: The gamma probe greatly facilitated intraoperative tumor detection (tumor to-normal brain count ratio was 5/1) and indicated a small piece of residual tumor after what was thought to be a complete tumor removal, allowing its resection, which, otherwise, would have been left behind. Postoperative CT confirmed complete tumor resection. The MIBI SPECT in normal individuals showed an increased uptake by the hypophisis, choroid plexus, skull, scalp and salivary glands and absence of uptake by the normal brain tissue. There were no complications. Conclusion: GPAS proved to be, in this single case, a safe and reliable technique to improve brain tumor detection and to confirm the presence or absence of residual tumor.KEY WORDS: radioguided surgery, gamma probe, gamma probe-assisted surgery, 99m Tc-MIBI, SPECT, brain tumor, brain neoplasm.Ressecção microcirúrgica de tumor cerebral assistida por detector gama: uma nova técnica RESUMO -Objetivos: A realização pioneira de cirurgia assistida por detector gama (CADG) para tumores cerebrais, objetivando-se não apenas a identificação do tumor, mas, sobretudo, assegurar-se quanto à sua completa ressecção e estudar a distribuição usual do 99m Tc-MIBI no SPECT cerebral de indivíduos normais. Método: O consentimento informado do paciente e a demonstração do tumor pelo SPECT pré-operatório com MIBI foram os critérios de inclusão adotados para a CADG, a qual foi realizada em um paciente com metástase para lobo parietal direito. O radiotraçador ( 99m Tc-MIBI) foi injetado em uma veia periférica 5 horas antes da cirurgia. Uma relação ≥ 2/1 entre a radiação gama emitida pelo tumor e pelo tecido normal foi considerada como indicativa de presença tumoral. Em um estudo piloto, SPECT cerebral com MIBI foi realizado em cinco pacientes normais. Resultados: O detector gama em muito facilitou a detecção per-operatória do tumor e demonstrou a presença de um pequeno resíduo tumoral após o que se pensou tratar-se de uma completa ressecção; tal resíduo, de outro modo, não teria sido percebido, o que teria impossibilitado sua exérese. Tomografia computorizada pós-operatória confirmou a completa ressecção do tumor. O SPECT com MIBI de indivíduos normais mostrou sua captação pela hipófise, plexo coróide, crânio, co...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Gamma probe-assisted brain tumor microsurgical resection: a new technique

Filho

Filho²

2002

Arq. Neuro-Psiquiatr.

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“…Nos anos seguintes alguns autores publicaram trabalhos demonstrando resultados efetivos com o uso de substância radioativa (Tecnécio) e sua captação com o aparelho Gama Probe na identificação do LS em câncer de mama e melanomas na fase inicial 2,3,26 .…”

Section: Linfonodo Sentinela -Histórico E Manuseiounclassified

Linfonodo sentinela: importância na cirurgia do câncer gástrico e perspectiva da aplicação de um modelo experimental em caninos

Melo

Pinheiro

2010

ABCD, arq. bras. cir. dig.

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DESCRITORES -Câncer gástrico. Metástase linfática. Biópsia de linfonodo sentinela.RESUMO -Introdução -A única perspectiva de cura do câncer gástrico ainda é o tratamento cirúrgico -gastrectomia associada com linfadenectomia ampliada -, embora tal procedimento possa levar a alto índice de morbidade ou mortalidade. Atualmente, a pesquisa do linfonodo sentinela para o câncer gástrico inicial (EC T1/ T2) apresenta argumentos que podem está modificando esta conduta. Objetivo -Realizar revisão bibliográfica atualizada da importância do linfonodo sentinela na cirurgia do câncer gástrico e apresentar modelo experimental, em caninos, que poderia se prestar como treinamento de cirurgiões para o método da pesquisa de linfonodo sentinela em estômago. Método -Revisão da literatura baseaa no Pubmed/Medline, Scielo e Lilacs cruzando os unitermos câncer gástrico, metástase linfática e biópsia de linfonodo sentinela e apresentação de método experimental para localização de nódulo sentinela. Conclusões -As evidências demonstram que há muito para se comprovar, entretanto a definição do tratamento do CaG nos tumores T1 parece ser o maior foco e abre bastante espaço para pesquisa. O modelo experimental em caninos para a pesquisa do LS no estômago, poderia se prestar como treinamento para cirurgiões na aplicação do método.ABSTRACT -Introduction -The only possibility to cure gastric cancer is still through a surgical treatment -gastrectomy associated with extended lymphadenectomy -, although this procedure may lead to high rates of morbidity or mortality. Currently, sentinel lymph node biopsy for early gastric cancer (T1/T2 EC) presents arguments that can change this behavior. Aim -To review updated bibliography of the importance of sentinel lymph nodes in gastric cancer surgery and present experimental model in dogs, which could provide training for surgeons as to the method of sentinel lymph node in the stomach. Method -Review of literature basing on Pubmed / Medline, Lilacs and Scielo crossing the key-words gastric cancer, lymph node metastasis and sentinel lymph node biopsy and presenting an experimental method for localization of sentinel node. Conclusions -The evidence shows that there is much to prove, however, the definition of the treatment of gastric cancer in T1 tumors appears to be the major focus and opens up plenty of space for research. The experimental model in dogs for the study of LS in the stomach, could provide training for surgeons in the method. ABCDDV/727INTRODUÇÃO O câncer gástrico (CaG) é atualmente a quarta neoplasia maligna mais frequente e a segunda causa de morte entre todos os tipos de câncer no mundo. Sua maior incidência é no Japão, onde se encontram 780 casos por 100.000 habitantes. No Brasil, por 100.000 habitantes, existem de 10 a 20 casos na população masculina e de cinco a 10 casos na população feminina 21 .A gastrectomia (total ou parcial) associada com linfadenectomia é a principal alternativa terapêutica e representa, atualmente, a única perspectiva de cura da doença. Disseminações por contigui...

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“…[5][6][7] In 1993, Alex et al 8 injected technetium and introduced the technique of gamma probe-guided surgery to identify the sentinel node. In the same year, Krag et al 9 published a study on sentinel node using Technetium-99 (Tc99) associated with the use of probes for detection of gamma rays in breast cancer.…”

Section: Introductionmentioning

confidence: 99%

Experimental canine model for sentinel lymph node biopsy in the vulva using technetium and patent blue dye

Aquino¹,

Pinheiro²,

Vasques³

et al. 2012

Acta Cir. Bras.

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PURPOSE: This paper aims to study and define the experimental model of sentinel lymph node biopsy of the vulva in bitches. METHODS: 0.2 ml of 99mTc phytate was injected intradermally, using a fine gauge insulin needle in the anterior commissure of the vulva. Thirty minutes after 99mTc injection, the inguinal mapping was performed using a gamma probe. After this, 0.5 ml of blue dye (bleu patenté V Guerbet 2.5%) was injected in the same place. After 15 minutes, a 3 cm long inguinal incision was made at point maximum uptake followed by careful dissection, guided by visualization of a bluish afferent lymphatic system that points to the sentinel lymph node (SLN). RESULTS: It was observed that 88% of SLN were identified. It wasn´t found a significant difference among the presence or not of sentinel lymph node in the sides, which is an indication of a good consistency. It was observed a high (88%) and significant (χ2=12.89 and p=0.0003) intercession between both methods (blue dye and radiation). CONCLUSION: The experimental model adopted is feasible, becoming advantageous in applying the association of Patent blue and 99mTc.

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Gamma-probe-guided lymph node localization in malignant melanoma

Cited by 322 publications

References 27 publications

Gamma probe-assisted brain tumor microsurgical resection: a new technique

Gamma probe-assisted brain tumor microsurgical resection: a new technique

Linfonodo sentinela: importância na cirurgia do câncer gástrico e perspectiva da aplicação de um modelo experimental em caninos

Experimental canine model for sentinel lymph node biopsy in the vulva using technetium and patent blue dye

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