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Clinical Cases

Sentinel Lymph Node Biopsy in Melanoma

Where are the sentinel lymph nodes expected?

The sentinel lymph node biopsy using radioisotope guidance is also standard in the work up for malignant melanoma. The injection and uptake of the sentinel lymph node is confirmed in the standard routine with a preoperative scintigraphy image, sometimes even with a SPECT/CT image. The drainage pattern is often unpredictable and can include multiple regions of the body. Similar to a breast cancer sentinel lymph node biopsy, the resection is intra-operatively guided by a handheld radiation detector. Using the declipse®SPECT the sentinel lymph node mapping can be performed intra-operatively for precise localization of the structures. Furthermore, the 3D nature of the solution and the anatomical correlation provides intuitive and direct access to the sentinel lymph node(s) regardless of the drainage pattern. This has the potential to speed up the procedure by knowing the exact location and depth and increasing the safety - as confirmed in various case reports [Naji2011, Rieger2011]. Moreover, a control 3D image while the patient is still in the operation room can confirm the complete removal of all radioactive lymph nodes or propose immediate action for re-excision of any additional radioactive lymph node(s).

3-D Sentinel LYMPH NODE IMAGING IN MELANOMA PATIENTS BEFORE INTERVENTION:

  • Full 3-D image acquisition ensures precise identification and localization even for sentinel nodes close to the injection site, as well as in remote areas (e.g. axilla, groin, abdominal wall, neck)
  • Direct correlation with anatomy enables orientation, referencing, and planning of minimally invasive interventions
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Figure: In this case two sentinel node conglomerates are clearly visible in its anatomical context in 3-D, augmented on the real-time video image of the patient.

Navigation to the sentinel nodes during intervention:

  • Orientation, localization and identification in 3-D ensures safety during procedure
  • Depth measurement provides direct and minimally invasive access
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Figure: Minimally invasive dissection of sentinel lymph nodes using the video overlay and navigation view.

CONTROL OF COMPLETE RESECTION OF ALL SENTINEL NODES:

  • 3-D scan enables confirmation of complete removal of radioactive sentinel nodes
  • Documentation provides transparent and reliable follow up treatments
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Figure: A 3-D image after the resection of the sentinel lymph nodes documents that there are no remaining sentinel lymph nodes with radioactivity in the axilla.
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