Lymphoscintigraphy and Sentinel Nodes

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Mammography: 1.00
Procedures: 1.00
Mammographic Positioning, Special Needs, and Imaging Procedures: 1.00

Nuclear Medicine Technology: 1.50
Procedures: 1.50
Endocrine and Oncology Procedures: 1.50

Registered Radiologist Assistant: 1.00
Procedures: 1.00
Thoracic Section: 1.00

Outline

1. Introduction
2. Lymphoscintigraphy in SLN Procedures
   1. Procedure for SLN Lymphoscintigraphy
   2. Radiopharmaceuticals and Injection Parameters
   3. Imaging
3. Cancer Indications
   1. Breast Cancer
   2. Melanoma
   3. Head and Neck Malignancies
4. Radiation Risks
5. Summary

Objectives

Upon completion of this course, students will:

1. be familiar with the validation of SLNB for breast cancer
2. be familiar with the growth and development of lymphoscintigraphy
3. be able to identify who is credited with the introduction of SLNB based on radiotracer techniques
4. be familiar with techniques used to minimize pain during lymphoscintigraphy
5. be able to identify the radiopharmaceuticals used to perform lymphoscintigraphy
6. be familiar with the injection technique for performing lymphoscintigraphy in patients with melanoma
7. be familiar with the injection techniques for performing lymphoscintigraphy in patients with breast cancer
8. be familiar with the different imaging techniques employed in lymphoscintigraphy
9. be familiar with the imaging procedure used to perform lymphoscintigraphy on patients with melanoma
10. be familiar with the planar projections acquired when performing lymphoscintigraphy on patients with breast cancer
11. be familiar with the technique for skin markings once SLNs are visualized on lymphoscintigraphy
12. compare the patient outcomes between SLNB and ALND
13. be familiar with the aims of SLNB in regards to false-negative rates
14. identify the clinical circumstances in which SLNB is utilized
15. be familiar with the criteria for performing SLN procedures for multicentric breast cancer
16. be familiar with the use of neoadjuvant chemotherapy
17. be familiar with the benefits of SLNB as compared to ALND
18. identify the clinical trial with the lowest false-negative rate in Table 1
19. identify the false-negative rates of the various clinical trials
20. be familiar with the lesion characteristics used to stage the invasiveness of melanoma
21. be familiar with the criteria for performing SLNB in patients with melanoma
22. identify the ability of elective complete lymph node dissection to reveal metastases in melanoma patients
23. identify the percent of risk associated with melanoma thickness of greater than 4mm
24. be familiar with the primary goal of the Multicenter Selective Lymphadenectomy Trial 1
25. be familiar with the design question of the Multicenter Selective Lymphadenectomy Trial 2
26. be familiar with criteria for using SLNB in patients with oral squamous cell cancer
27. be familiar with the advantages of using SPECT/CT when performing head and neck lymphoscintigraphy
28. be familiar with a method to reduce potential contamination when performing head and neck lymphoscintigraphy
29. identify the radiopharmaceutical that has been FDA-approved for use in the management of oral squamous cell carcinoma
30. be familiar with the use of SLNB for lymph node staging in breast cancer and melanoma