Skip to main content
Erschienen in: World Journal of Surgery 9/2019

07.05.2019 | Original Scientific Report

Evaluation of Radiation Exposure During Sentinel Lymph Node Biopsy in Breast Cancer: A Retrospective Study

verfasst von: Rajaram Burrah, Karen James, Shabbir Poonawala

Erschienen in: World Journal of Surgery | Ausgabe 9/2019

Einloggen, um Zugang zu erhalten

Abstract

Introduction

Sentinel node biopsy (SNB) is the standard of care for nodal staging in breast cancer. Currently, radioisotope-guided SNB is the standard technique. We have undertaken this study to analyse radiation exposure during SNB for breast cancer over a significant period of time.

Methods

The study was conducted over a period of 41 months and included 183 patients. The radioisotope was usually administered the day preceding the surgery at a dose of 40 MBq (±10%), and a lower dose of 20 MBq (±10%) was given if injected on the day of surgery. The radiation exposure was measured by dosimeters worn by the surgeon and surgical assistant.

Results

The surgical procedures performed were mastectomy and SNB (56 patients), wide local excision and SNB (109 patients), and SNB alone (18 patients). The median time interval between the injection and surgery was 19.3 h, and median duration of surgery 93 min. The annual exposure for the surgeon was 0.125 mSv (range 0.01–0.03 mSv) and for the assistant was 0.265 (range 0.01–0.13 mSv).

Conclusion

Contrary to other studies, we found the radiation exposure in the assistant was higher than that in the surgeon and we think this is because the assistant is positioned closer to the injection site during the procedure. However, the cumulative levels of radiation with SNB were very low and significantly below the permissible limits. The timing of injection, type of breast surgery and duration of procedure did not affect the levels of radiation exposure.
Literatur
1.
Zurück zum Zitat Charalampoudis P, Markopoulos C, Kovacs T et al (2018) Controversies and recommendations regarding sentinel lymph node biopsy in primary breast cancer: a comprehensive review of current data. Eur J Surg Oncol 44(1):5–14CrossRefPubMed Charalampoudis P, Markopoulos C, Kovacs T et al (2018) Controversies and recommendations regarding sentinel lymph node biopsy in primary breast cancer: a comprehensive review of current data. Eur J Surg Oncol 44(1):5–14CrossRefPubMed
2.
Zurück zum Zitat Lyman GH, Somerfield MR, Bosserman LD et al (2017) Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 35(5):561–564CrossRefPubMed Lyman GH, Somerfield MR, Bosserman LD et al (2017) Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 35(5):561–564CrossRefPubMed
3.
Zurück zum Zitat Goyal A, Mansel RE (2008) Recent advances in sentinel lymph node biopsy for breast cancer. Curr Opin Oncol 20(6):621–626CrossRefPubMed Goyal A, Mansel RE (2008) Recent advances in sentinel lymph node biopsy for breast cancer. Curr Opin Oncol 20(6):621–626CrossRefPubMed
4.
Zurück zum Zitat Wong SL, Faries MB, Kennedy EB et al (2018) Sentinel lymph node biopsy and management of regional lymph nodes in melanoma: American Society of Clinical Oncology and Society of Surgical Oncology clinical practice guideline update. Ann Surg Oncol 25(2):356–377CrossRefPubMed Wong SL, Faries MB, Kennedy EB et al (2018) Sentinel lymph node biopsy and management of regional lymph nodes in melanoma: American Society of Clinical Oncology and Society of Surgical Oncology clinical practice guideline update. Ann Surg Oncol 25(2):356–377CrossRefPubMed
8.
Zurück zum Zitat Rosso KJ, Nathanson S (2015) Techniques that accurately identify the sentinel lymph node in cancer. World J Surg Proced 5(1):14–26CrossRef Rosso KJ, Nathanson S (2015) Techniques that accurately identify the sentinel lymph node in cancer. World J Surg Proced 5(1):14–26CrossRef
9.
Zurück zum Zitat Seim NB, Wright CL, Agrawal A (2016) Contemporary use of sentinel lymph node biopsy in the head and neck. World J Otorhinolaryngol Head Neck Surg 2(2):117–125CrossRefPubMedPubMedCentral Seim NB, Wright CL, Agrawal A (2016) Contemporary use of sentinel lymph node biopsy in the head and neck. World J Otorhinolaryngol Head Neck Surg 2(2):117–125CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Park JY, Kook MC, Eom BW et al (2016) Practical intraoperative pathologic evaluation of sentinel lymph nodes during sentinel node navigation surgery in gastric cancer patients—proposal of the pathologic protocol for the upcoming SENORITA trial. Surg Oncol 25(3):139–146CrossRefPubMed Park JY, Kook MC, Eom BW et al (2016) Practical intraoperative pathologic evaluation of sentinel lymph nodes during sentinel node navigation surgery in gastric cancer patients—proposal of the pathologic protocol for the upcoming SENORITA trial. Surg Oncol 25(3):139–146CrossRefPubMed
11.
12.
Zurück zum Zitat Zalewski K, Benke M, Mirocha B et al (2018) Technetium-99m-based radiopharmaceuticals in sentinel lymph node biopsy: gynecologic oncology perspective. Curr Pharm Des 24(15):1652–1675CrossRefPubMed Zalewski K, Benke M, Mirocha B et al (2018) Technetium-99m-based radiopharmaceuticals in sentinel lymph node biopsy: gynecologic oncology perspective. Curr Pharm Des 24(15):1652–1675CrossRefPubMed
13.
Zurück zum Zitat Kimura F, Yoshimura M, Koizumi K et al (2015) Radiation exposure during sentinel lymph node biopsy for breast cancer: effect on pregnant female physicians. Breast Cancer 22(5):469–474CrossRefPubMed Kimura F, Yoshimura M, Koizumi K et al (2015) Radiation exposure during sentinel lymph node biopsy for breast cancer: effect on pregnant female physicians. Breast Cancer 22(5):469–474CrossRefPubMed
14.
Zurück zum Zitat Klausen TL, Chakera AH, Friis E et al (2005) Radiation doses to staff involved in sentinel node operations for breast cancer. Clin Physiol Funct Imaging 25(4):196–202CrossRef Klausen TL, Chakera AH, Friis E et al (2005) Radiation doses to staff involved in sentinel node operations for breast cancer. Clin Physiol Funct Imaging 25(4):196–202CrossRef
15.
Zurück zum Zitat Pestan C, Larg MI, Barbus E et al (2018) Quantification of radiation exposure of non-dominant index for the surgeon performing sentinel lymph-node removal procedure. Curr Radiopharm 11:64–68CrossRef Pestan C, Larg MI, Barbus E et al (2018) Quantification of radiation exposure of non-dominant index for the surgeon performing sentinel lymph-node removal procedure. Curr Radiopharm 11:64–68CrossRef
17.
18.
Zurück zum Zitat Morton DL, Wen DR, Wong JH et al (1992) Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 127:394–399CrossRef Morton DL, Wen DR, Wong JH et al (1992) Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 127:394–399CrossRef
19.
Zurück zum Zitat Giuliano AE, Jones RC, Brennan M et al (1997) Sentinel lymphadenectomy in breast cancer. J Clin Oncol 15:2345–2350CrossRefPubMed Giuliano AE, Jones RC, Brennan M et al (1997) Sentinel lymphadenectomy in breast cancer. J Clin Oncol 15:2345–2350CrossRefPubMed
20.
Zurück zum Zitat Alex JC, Krag DN (1993) Gamma probe guided localization of lymph nodes. Surg Oncol 2:137–144CrossRefPubMed Alex JC, Krag DN (1993) Gamma probe guided localization of lymph nodes. Surg Oncol 2:137–144CrossRefPubMed
22.
Zurück zum Zitat International Commission on Radiological Protection, The 2007 recommendations of the international commission on radiological protection. ICRP publication 103, Ann. ICRP 37 (2007) 1-332 International Commission on Radiological Protection, The 2007 recommendations of the international commission on radiological protection. ICRP publication 103, Ann. ICRP 37 (2007) 1-332
23.
Zurück zum Zitat Goyal A (2018) New technologies for sentinel lymph node detection. Breast Care 13(5):349–353CrossRefPubMed Goyal A (2018) New technologies for sentinel lymph node detection. Breast Care 13(5):349–353CrossRefPubMed
24.
Zurück zum Zitat Ahmed M, Purushotham AD, Douek M (2014) Novel techniques for sentinel lymph node biopsy in breast cancer: a systematic review. Lancet Oncol 15(8):e351–e362CrossRefPubMed Ahmed M, Purushotham AD, Douek M (2014) Novel techniques for sentinel lymph node biopsy in breast cancer: a systematic review. Lancet Oncol 15(8):e351–e362CrossRefPubMed
25.
Zurück zum Zitat Douek M, Klaase J, Monypenny I et al (2014) Sentinel node biopsy using a magnetic tracer versus standard technique: the SentiMAG Multicentre Trial. Ann Surg Oncol 21(4):1237–1245CrossRefPubMed Douek M, Klaase J, Monypenny I et al (2014) Sentinel node biopsy using a magnetic tracer versus standard technique: the SentiMAG Multicentre Trial. Ann Surg Oncol 21(4):1237–1245CrossRefPubMed
Metadaten
Titel
Evaluation of Radiation Exposure During Sentinel Lymph Node Biopsy in Breast Cancer: A Retrospective Study
verfasst von
Rajaram Burrah
Karen James
Shabbir Poonawala
Publikationsdatum
07.05.2019
Verlag
Springer International Publishing
Erschienen in
World Journal of Surgery / Ausgabe 9/2019
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-019-05024-9

Weitere Artikel der Ausgabe 9/2019

World Journal of Surgery 9/2019 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.