REF005 - Sentinel Node Breast

The purpose of this document is to assist clinicians in deciding on the appropriateness of a Nuclear Medicine Sentinel Lymph Node Biopsy Procedure and to give guidance on the mechanism of referral.

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^[1][2] recommend the technique to be used routinely.

The procedure requires an intradermal injection of a Tc^99m 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. This guides the surgeon and determines the course of action required for optimum patient care.

• Any clinician holding a current valid medical qualification currently employed in Secondary care.

Referring clinicians are reminded of the requirement to avoid unnecessary exposure to ionising radiation. The investigation may already have been requested at this hospital or elsewhere and clinicians are asked to be particularly vigilant to ensure that their request is not a double request.

Requests will only be accepted if the diagnostic question fulfills one of the referral criteria below. Appropriate clinical information must be supplied to allow the investigation to be justified. It is not acceptable to simply request the investigation without appropriate clinical information.

Requests will be returned to the referrer if:

• The diagnostic question is unclear.
• The diagnostic question cannot be answered by the investigation.
• Insufficient clinical information is supplied to justify the investigation.

Requests should be submitted on the orange stripe NUCLEAR MEDICINE (ISOTOPE SCAN) request form. Patient details, Investigation required and Reason for Test/Diagnostic Question should be fully and appropriately completed and the form signed.

Referrals for pregnant women must be discussed with the ARSAC Licence holder.

Sufficient clinical information must be provided to justify the investigation proceeding. The clinical indications are detailed below.

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