Actualización en cirugía radioguiada: del consenso internacional en ganglio centinela de cabeza y cuello a los avances en tumores ginecológicos y localización de lesiones no palpables

Vidal-Sicart, Sergi; Cabero, S. Fuertes; Lainez, M. Danús; Olmos, R.A. Valdés; Paredes, Pilar; Madrid, J.I. Rayo; Martín, María Eugenia; Expósito, R. Díaz; Gironés, E. Goñi

doi:10.1016/j.remn.2018.10.007

Cited by 3 publications

(5 citation statements)

References 38 publications

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“…3,7 Shielding the PI with lead may be useful to detect the sentinel nodes very close to the PI in melanoma and urological and gynecological tumors. 3,6,7,13 Concave lead shields are designed to partially introduce the breast inside its interior and provide the highest scatter reduction possible. We have compared CLS with FLS in a few melanoma patients, and the preliminary results showed scatter reduction, although not as evident as in breast cancer.…”

Section: Discussionmentioning

confidence: 99%

“…This problem may be solved using images with and without lead shields as has been proposed by some authors. 6 Some authors do not describe the shape of the shielding, 3,13,15 whereas others relate small shield, 5 metal plate, 12,18 small metal plate, 7 and malleable lead shielding. 4 Three authors report more precisely the shape of the lead shield.…”

Section: Discussionmentioning

confidence: 99%

“…16 Regarding the state of the art of lymphoscintigraphy in sentinel node biopsy, several authors advise against using lead shields in breast cancer, 14,15 whereas others indicate that it improves sentinel node detection, 5,6,13,14 and others even recommend including images with and without the lead shield to adequately image the area and prevent from covering lymph nodes very close to the PI. 6 Perhaps, in the future, the reduction of the scatter radiation and the reduction of the acquisition time will be demonstrated with studies, and this will be the basis for the modification of the current recom-mendations, such as occurs with the current European Association of Nuclear Medicine guideline for sentinel node biopsy and melanoma, in which lead shields are recommended when the primary tumor is very close to the sentinel node. 3,7 Shielding the PI with lead may be useful to detect the sentinel nodes very close to the PI in melanoma and urological and gynecological tumors.…”

Section: Discussionmentioning

confidence: 99%

“…The sentinel node biopsy technique provides an accurate lymphatic staging and reduces unnecessary morbidity associated with lymphadenectomies. [1][2][3][4][5][6][7][8][9][10][11] The first step includes the injection of the radiotracer in the tumor or in the nearby tissue. The radiotracer migrates through the lymphatic vessels until it reaches the sentinel nodes.…”

mentioning

confidence: 99%

“…To reduce the scatter, a flat lead shield (FLS) is used to cover the PI (emitter) and the detector (receptor). [3][4][5][6][7]12,13 This shield is generally designed in radiation oncology departments using a mold cutter, obtaining a circular shaped FLS.…”

mentioning

confidence: 99%

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Sentinel Node Biopsy Imaging in Breast Cancer

et al. 2022

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Background Point of injection scatter (SPI) confounds breast cancer sentinel lymph node detection. Round flat lead shields (FLSs) incompletely reduce SPI, requiring repositioning. We designed lead shields that reduce SPI and acquisition time. Methods Two concave lead shields, a semioval lead shield (OLS) and a semispherical lead alloy shield (SLS), were created with a SICNOVA JCR 1000 3D printer to cover the point of injection (patent no. ES1219895U). Twenty breast cancer patients had anterior and anterior oblique imaging, 5 minutes and 2 hours after a single 111 MBq nanocolloid in 0.2 mL intratumoral or periareolar injection. Each acquisition was 2 minutes. Absolute and normalized background corrected scatter counts (CSCs) and scatter reduction percentage (%SR) related to the FLS were calculated. Repositionings were recorded. Differences between means of %SR ( t test) and between means of CSC (analysis of variance) with Holm multiple comparison tests were determined. Results Mean %SR was 91.8% with OLS and 92% using SLS in early images ( P = 0.91) and 87.2%SR in OLS and 88.5% in late images ( P = 0.66). There were significant differences between CSC using FLS and OLS ( P < 0.001) and between FLS and SLS ( P < 0.001), but not between OLS and SLS ( P = 0.17) in early images, with the same results observed in delayed studies ( P < 0.001 in relation to FLS and P = 0.1 between both curved lead shields). Repositioning was required 14/20 times with FLS, 4/20 times with OLS, and 2/20 times with SLS. Conclusions We designed 2 concave lead shields that significantly reduce the SPI and repositioning with sentinel lymph node lymphoscintigraphy.

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