**Northern Lincolnshire and Goole NHS Foundation Trust - Nuclear Medicine** 

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^  Authorised By  ^  Authorising Role  ^  Authorisation Signature \\  (only on master paper copy)  ^  Date Authorised  |
|  Prof G Avery  |  ARSAC Licence Holder  |    |  2025-01-16  |

====== REF005 - Sentinel Node Breast ======
See [[referral_criteria:ref000-how_to_refer_to_nlagnm|REF000 - Referring to Nuclear Medicine (NLAG)]] for details on how to refer. 

===== Description =====
Sentinel Lymph Node Biopsy is a minimally invasive surgical procedure which determines the status of the axillary lymph nodes in newly diagnosed breast cancer, without requiring formal clearance of axillary nodes. NICE guidelines[(Early and locally advanced breast cancer: diagnosis and management - NICE guideline [NG101]. Published: 18 July 2018 Last updated: 16 January 2024.)][(The EANM and SNMMI practice guideline for lymphoscintigraphy and sentinel node localization in breast cancer. Giammarile et al. Eur J Nucl Med Mol Imaging. 2013 Dec;40(12):1932-47.)] recommend the technique to be used routinely.

The procedure requires an intradermal injection of a <sup>99</sup>Tc<sup>m</sup> labelled radiopharmaceutical (colloid) into the breast which is cleared by the body through the lymphatic system and localises in axillary lymph nodes.  The injection is administered in the Pink Rose Suite by an appropriately trained Breast Care Nurse. Patients having surgery in the afternoon should be injected in the morning on the day of surgery. Patients having surgery in the morning should be injected the afternoon before surgery.

Imaging is not normally required but can be performed in Nuclear Medicine if deemed helpful to localisation.  Imaging can be performed between 15 minutes 3 hours after the time of injection for same day surgery or if surgery is the day after injection, imaging can be delayed until the morning of surgery.  

In Theatre, a gamma probe is used to localise the radioactivity in the breast.

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^Typical Radiation Dose (mSv)  | 0.02 - 0.08 | 

===== Staff Entitled to Refer =====
  * Any clinician holding a current valid medical qualification currently employed in Secondary care.

===== Supplementary Drugs =====
  * None

===== Contraindications =====
^Diagnostic Procedures | • Any other administration of <sup>99</sup>Tc<sup>m</sup> based radiopharmaceuticals within the previous two days \\ • If the patient has been administered with a diagnostic radiopharmaceutical other than <sup>99</sup>Tc<sup>m</sup> or and nuclear medicine therapy in the last 6 months, please contact the Nuclear Medicine department |

===== Patient Preparation =====
Patient preparation is undertaken by the Consultant Breast Surgeon and staff in the Pink Rose suite.

===== Clinical Indications =====
|Localisation of sentinel lymph nodes  |