38792 Injection procedure; radioactive tracer for identification of sentinel node

Name of the Procedure:

Injection of Radioactive Tracer for Sentinel Node Identification (a.k.a. Lymphoscintigraphy, Sentinel Lymph Node Biopsy)

Summary

This procedure involves the injection of a small amount of radioactive tracer near a tumor site to identify the sentinel lymph nodes, which are the first nodes to receive draining from a cancer tumor. This helps in determining the spread of cancer.

Purpose

This procedure helps in the staging of certain types of cancers, such as breast cancer and melanoma. By identifying sentinel nodes, doctors can determine whether cancer has spread to the lymphatic system and formulate an appropriate treatment plan.

Indications

• Patients diagnosed with certain types of cancer (e.g., breast cancer, melanoma).
• Presence of a tumor where lymphatic spread assessment is crucial.
• Patients who require precise staging of their cancer for treatment decisions.

Preparation

• Patients may need to fast for a few hours before the procedure.
• Inform your physician about any medications, including blood thinners.
• Pre-procedure imaging tests like a mammogram or ultrasound might be required.

Procedure Description

1. Injection: A small amount of radioactive tracer is injected near the tumor site.
2. Visualization: Using a special camera, healthcare providers track the tracer's movement to identify the sentinel lymph nodes.
3. Marking: The identified sentinel nodes are marked for biopsy.
4. Biopsy: A small tissue sample from the sentinel nodes is removed for further examination.

Tools/Equipment:

• Radioactive tracer
• Gamma camera or similar imaging device
• Biopsy instruments

Anesthesia/Sedation:

• Local anesthesia may be applied during the biopsy phase to minimize discomfort.

Duration

The entire procedure typically takes about 1 to 3 hours.

Setting

Performed in a hospital, outpatient clinic, or surgical center.

Personnel

• Nuclear medicine physician
• Radiologist
• Surgical oncologist
• Nurses and technologists

Risks and Complications

• Minor discomfort or pain at the injection site
• Low risk of infection or bleeding at the biopsy site
• Rare allergic reactions to the tracer
• Seroma (fluid buildup) at the biopsy site

Benefits

• Accurate staging of cancer for optimal treatment planning
• Minimizes the need for extensive lymph node removal
• Reduced risk of complications compared to traditional lymph node dissection

Recovery

• Pain and swelling at the biopsy site can be managed with mild pain relievers.
• Most patients can resume normal activities within a day or two.
• Follow-up appointments for biopsy results and further treatment planning.

Alternatives

• Traditional lymph node dissection, which involves the removal of multiple lymph nodes.
  • Pros: More thorough removal.
  • Cons: Increased risk of lymphedema, longer recovery.
• Imaging tests like MRI or CT scans.
  • Pros: Non-invasive.
  • Cons: Less precise for lymphatic spread assessment.

Patient Experience

During the procedure, patients may feel a slight pinprick at the injection site and some pressure or mild discomfort during the biopsy. Post-procedure, mild soreness and swelling are common, but these can be managed with over-the-counter pain medications. Most patients recover quickly with minimal interruption to their daily activities.

Pain management includes local anesthesia during the biopsy phase and mild analgesics post-procedure to ensure comfort.