Guidelines for the safe use of radioactive materials during localization and resection of the sentinel lymph node.
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 0.002 microCi/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.


CONCLUSIONS
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.
General Surgery Service, Walter Reed Army Medical Center, Washington, DC 20307, USA.
T J
TJ
Miner
C D
CD
Shriver
P R
PR
Flicek
F C
FC
Miner
D P
DP
Jaques
M E
ME
Maniscalco-Theberge
D N
DN
Krag
D001706:Biopsy; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis; D008545:Melanoma / Q000000981:diagnostic imaging / Q000473:pathology; D017410:Practice Guidelines as Topic; D011829:Radiation Dosage; D011835:Radiation Protection / Q000592:standards; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000009:adverse effects; D012449:Safety; D012878:Skin Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D013671:Technetium Tc 99m Sulfur Colloid / Q000009:adverse effects
D019275:Radiopharmaceuticals; D013671:Technetium Tc 99m Sulfur Colloid