Sentinel lymph node biopsy in melanoma patients: an experience with Tc-99m antimony sulfide colloid

Sentinel lymph node biopsy is the standard procedure for lymph node staging in intermediate thickness melanoma. In Iran, this procedure has not been addressed sufficiently. In this study, we report our experience in this area. Ten consecutive patients with intermediate thickness melanoma where included in our study. 1.5 mCi of Tc-99m antimony sulfide colloid in two divided dose was injected around the tumor. All patients underwent surgery 2-4 hours after injection of the tracer. Patent blue V dye was also used for 8 patients. Using a hand-held gamma probe, the sentinel nodes were harvested and sent to the pathologist for frozen section and H and E review. For patients with positive sentinel nodes, lymph node dissection was performed. At least one sentinel node could be harvested in all patients. The mean number of sentinel nodes was 1.66. Detection rate with radiotracer and blue dye was 100% and 75% respectively. 30% of the patients had positive sentinel nodes. One patient in the pediatric age range and one head and neck melanoma were included in our study with successful sentinel node mapping. Sentinel lymph node biopsy using Tc-99m antimony sulfide colloid is a reliable and safe method in melanoma patients which can help in treatment planning and patient's ultimate prognosis

Minimally invasive radio-guided surgery for hyperparathyroidism: an experience with Tc-99m sestamibi

Radio-guided parathyroid surgery along with other minimally invasive surgeries constitutes the main surgical treatment procedures for different kinds of hyperparathyroidism. In this article we have reported our experience of radio-guided parathyroid surgery using Tc-99m sestamibi. Ten patients with hyperparathyroidism included in our study. Twenty mCi of Tc-99m sestamibi was injected intravenously to the patients in the day of surgery. All patients underwent surgery 4 hours after injection of the tracer. Abnormal parathyroid glands were localized by surgical gamma probe during surgery and were removed. Eight out of 10 patients had single adenoma. One patient had parathyroid hyperplasia secondary to chronic renal failure. The one remaining patient had persistent hyperparathyroidism with previous unsuccessful parathyroid surgeries. Except for the patient with parathyroid hyperplasia, parathyroid hormone [PTH] level of all other patients decreased after surgery including the patient with persistent hyperparathyroidism. Minimally invasive radio-guided parathyroid surgery is an easy and safe method for surgical treatment of hyperparathyroidism. With the increasing availability of surgical gamma probes and nuclear medicine facilities in Iran considering this kind of approach for surgical treatment of hyperparathyroidism seems rational

need for skin pen marking for sentinel lymph node biopsy: a comparative study

There is a consensus in the literature that sentinel lymph node biopsy is the standard procedure for axillary staging in early stage [I and II] breast cancer patients. Usually during lymphoscintigraphy, the location of the sentinel lymph node is marked on the skin by an indelible ink. In this study we evaluated this issue in our patients. 40 patients with the clinical diagnosis of early stage breast cancer [stage I or II] were included into the study. All patients received periareolar intradermal injections of 18.5 MBq Tc-99m antimony sulfide colloid 2-4 hours before the surgery and 2 ml patent blue V dye in a subdermal and periareolar fashion during surgery. The patients were divided randomly into two groups [20 patients in each group]. In group I, the anterior and lateral locations of the sentinel lymph node were marked on the skin with an indelible ink. In group II, no skin marking was used. A sentinel node was defined as any blue node or any node with an ex vivo radioisotope count of twofold or greater than the axillary background. All patients underwent standard axillary lymph node dissection after sentinel node biopsy. Mean age and tumor size were not significantly different between groups. SLN detection rate and number of detected SLNs were not significantly different either [P > 0.05]. Number of detected lymph nodes was 1.24 +/- 0.43 and 1.28 +/- 0.61 in group I and II of the patients, respectively. False negative rate [negative SLN and positive axillary nodes] for both groups were 0%. Although marking the location of the sentinel lymph node on the skin with an indelible ink can guide the surgeon during surgery, it can not increase the sentinel lymph node detection rate or improve the results of sentinel lymph node biopsy