Basic training in sentinel node lymphoscintigraphy is sufficient to produce successful results

Abstract

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Objectives: Lymphatic mapping with sentinel node biopsy is currently being used at most institutions for staging patients with cutaneous melanoma and breast cancer without the morbidity associated with elective lymph node dissection. Identification and subsequent surgical removal of occult metastases before the development of clinical disease may improve survival in these patients. Success in finding the sentinel node relies on the successful injection technique of the radiotracer. We evaluated whether a physician’s case experience with the sentinel node lymphoscintigraphy injection technique might affect the successful identification of the sentinel node(s) and the time it takes for the visualization.

Methods: To achieve the required level of training for successful performance of sentinel lymph node scintigraphy, physicians who were not familiar with the test underwent systematic training for the injection technique used in sentinel node scintigraphy. They must demonstrate technical competence in its performance. The training protocol included reading an instruction manual and performance of two patient studies. A consecutive cohort of 68 patients during a 10-month period who had undergone sentinel lymph node localization and biopsy for cutaneous melanoma (n: 55) and breast cancer (n: 13) was retrospectively analyzed. Two areas were studied: success in finding the sentinel node(s) and the duration of the imaging in minutes needed for a successful localization. These parameters were compared for Group-1, the studies performed by an experienced nuclear medicine resident, and Group-2, rotating radiology residents. The statistical significance levels were determined.

Results: Six radiology residents injected 35, and the 2 NM resident injected 20 patients with melanoma. The radiology residents injected 4/13 patients with breast cancer. The sentinel node(s) were successfully identified in 93% of the patients (63/68) studied. Of the 5 patients with non-visualized SLNs, 3 had melanoma and 2 had breast cancer. The radiology residents injected 3 of these 5 and the NMresidenst injected 2 of them. The mean ± SD SLNs visualization time in minutes was 23 ± 33 for the radiology residents, and 26 ± 31 minutes for the NM residents. The non-visualization rates and SLNs visualization time were not different between two groups, with p values of 0.66 and 0.61 respectively.

Conclusions: Sentinel node lymphoscintigraphy has a high localization rate, which can be achieved with basic training of the physicians performing the tests. The number of patients previously studied does not affect the physician’s ability to visualize the sentinel node or the time that it takes for the SLN localization.