| Gamma probe | |
|---|---|
 A gamma probe | |
| Purpose | locate sentinel lymph nodes |
A gamma probe is a handheld device containing a scintillation counter, for intraoperative use following injection of a radionuclide, to locate sentinel lymph nodes by their radioactivity. [1] It is used primarily for sentinel lymph node mapping and parathyroid surgery. Gamma probes are also used for RSL (radioactive seed localization), to locate small and non-palpable breast lesions. [2] [3] : 243
The sentinel node market experienced high growth in the early and mid 1990s starting with melanoma sentinel node surgical search and breast cancer sentinel node staging; both are currently considered standards of care. [4] The use of a radioactive tracer, rather than a coloured dye, was proposed in 1984. [5] [6]
To locate the draining lymph nodes or sentinel lymph node from a breast cancer tumour a Technetium-99m based radiopharmaceutical is common. This may be a nanocolloid or sestamibi. [7] Although imaging with a gamma camera may also take place, the idea of a small gamma probe is that it can be used to identify lymph nodes (or other sites) with uptake at a much higher resolution, during an operation. The probe may be collimated to further restrict the field of detection. [8] [9]
Melanoma, also redundantly known as malignant melanoma, is a type of skin cancer that develops from the pigment-producing cells known as melanocytes. Melanomas typically occur in the skin, but may rarely occur in the mouth, intestines, or eye. In women, they most commonly occur on the legs, while in men, they most commonly occur on the back. About 25% of melanomas develop from moles. Changes in a mole that can indicate melanoma include an increase in size, irregular edges, change in color, itchiness, or skin breakdown.
Cancer staging is the process of determining the extent to which a cancer has developed by growing and spreading. Contemporary practice is to assign a number from I to IV to a cancer, with I being an isolated cancer and IV being a cancer that has spread to the limit of what the assessment measures. The stage generally takes into account the size of a tumor, whether it has invaded adjacent organs, how many regional (nearby) lymph nodes it has spread to, and whether it has appeared in more distant locations (metastasized).
This is a list of terms related to oncology. The original source for this list was the US National Cancer Institute's public domain Dictionary of Cancer Terms.
Lymphadenectomy, or lymph node dissection, is the surgical removal of one or more groups of lymph nodes. It is almost always performed as part of the surgical management of cancer. In a regional lymph node dissection, some of the lymph nodes in the tumor area are removed; in a radical lymph node dissection, most or all of the lymph nodes in the tumor area are removed.
Lumpectomy is a surgical removal of a discrete portion or "lump" of breast tissue, usually in the treatment of a malignant tumor or breast cancer. It is considered a viable breast conservation therapy, as the amount of tissue removed is limited compared to a full-breast mastectomy, and thus may have physical and emotional advantages over more disfiguring treatment. Sometimes a lumpectomy may be used to either confirm or rule out that cancer has actually been detected. A lumpectomy is usually recommended to patients whose cancer has been detected early and who do not have enlarged tumors. Although a lumpectomy is used to allow for most of the breast to remain intact, the procedure may result in adverse affects that can include sensitivity and result in scar tissue, pain, and possible disfiguration of the breast if the lump taken out is significant. According to National Comprehensive Cancer Network guidelines, lumpectomy may be performed for ductal carcinoma in situ (DCIS), invasive ductal carcinoma, or other conditions.
The sentinel lymph node is the hypothetical first lymph node or group of nodes draining a cancer. In case of established cancerous dissemination it is postulated that the sentinel lymph nodes are the target organs primarily reached by metastasizing cancer cells from the tumor.
Ductal carcinoma in situ (DCIS), also known as intraductal carcinoma, is a pre-cancerous or non-invasive cancerous lesion of the breast. DCIS is classified as Stage 0. It rarely produces symptoms or a breast lump one can feel, typically being detected through screening mammography. It has been diagnosed in a significant percentage of men.
Vulvar cancer is a cancer of the vulva, the outer portion of the female genitals. It most commonly affects the labia majora. Less often, the labia minora, clitoris, or vaginal glands are affected. Symptoms include a lump, itchiness, changes in the skin, or bleeding from the vulva.
The axillary lymph nodes or armpit lymph nodes are lymph nodes in the human armpit. Between 20 and 49 in number, they drain lymph vessels from the lateral quadrants of the breast, the superficial lymph vessels from thin walls of the chest and the abdomen above the level of the navel, and the vessels from the upper limb. They are divided in several groups according to their location in the armpit. These lymph nodes are clinically significant in breast cancer, and metastases from the breast to the axillary lymph nodes are considered in the staging of the disease.
Technetium-99m (99mTc) is a metastable nuclear isomer of technetium-99, symbolized as 99mTc, that is used in tens of millions of medical diagnostic procedures annually, making it the most commonly used medical radioisotope in the world.
Breast cancer management takes different approaches depending on physical and biological characteristics of the disease, as well as the age, over-all health and personal preferences of the patient. Treatment types can be classified into local therapy and systemic treatment. Local therapy is most efficacious in early stage breast cancer, while systemic therapy is generally justified in advanced and metastatic disease, or in diseases with specific phenotypes.
Breast-conserving surgery (BCS) refers to an operation that aims to remove breast cancer while avoiding a mastectomy. Different forms of this operation include: lumpectomy (tylectomy), wide local excision, segmental resection, and quadrantectomy. BCS has been increasingly accepted as an alternative to mastectomy in specific patients, as it provides tumor removal while maintaining an acceptable cosmetic outcome. This page reviews the history of this operation, important considerations in decision making and patient selection, and the emerging field of oncoplastic breast conservation surgery.
Lymphography is a medical imaging technique in which a radiocontrast agent is injected, and then an X-ray picture is taken to visualise structures of the lymphatic system, including lymph nodes, lymph ducts, lymphatic tissues, lymph capillaries and lymph vessels. Lymphangiography is the same procedure, used only to visualize the lymph vessels. The x-ray film or image of the lymphatic vessels and lymph nodes is called a lymphogram or a lymphangiogram.
Nuclear medicine physicians, also called nuclear radiologists or simply nucleologists, are medical specialists that use tracers, usually radiopharmaceuticals, for diagnosis and therapy. Nuclear medicine procedures are the major clinical applications of molecular imaging and molecular therapy. In the United States, nuclear medicine physicians are certified by the American Board of Nuclear Medicine and the American Osteopathic Board of Nuclear Medicine.
Technetium (99mTc) tilmanocept, trade name Lymphoseek, is a radiopharmaceutical diagnostic imaging agent used to locate lymph nodes which may be draining from tumors, and assist doctors in locating lymph nodes for removal during surgery.
In medicine, breast imaging is a sub-speciality of diagnostic radiology that involves imaging of the breasts for screening or diagnostic purposes. There are various methods of breast imaging using a variety of technologies as described in detail below. Traditional screening and diagnostic mammography uses x-ray technology and has been the mainstay of breast imaging for many decades. Breast tomosynthesis is a relatively new digital x-ray mammography technique that produces multiple image slices of the breast similar to, but distinct from, computed tomography (CT). Xeromammography and galactography are somewhat outdated technologies that also use x-ray technology and are now used infrequently in the detection of breast cancer. Breast ultrasound is another technology employed in diagnosis and screening that can help differentiate between fluid filled and solid lesions, an important factor to determine if a lesion may be cancerous. Breast MRI is a technology typically reserved for high-risk patients and patients recently diagnosed with breast cancer. Lastly, scintimammography is used in a subgroup of patients who have abnormal mammograms or whose screening is not reliable on the basis of using traditional mammography or ultrasound.
Endomag is a medical device manufacturer, headquartered in Cambridge, UK, with a US office in Austin, Texas. Originally incorporated as Endomagnetics Ltd, the company was founded in 2007 and produces surgical guidance products which assist surgeons in locating and removing cancerous tumors, predominantly for breast cancer surgery. The company's products are distributed by Leica Biosystems in North America and Sysmex Corporation across Europe.
Anne Louise Rosenberg is an American surgical oncologist retired from practice in Cherry Hill, New Jersey.
Emilia Dauway MD, FACS, FRACS is an American trained surgeon who is practicing general, breast and oncologic surgery in Australia. Dauway was co-inventor of the use of radioactive seeds in the breast to localise non-palpable breast cancers and the first in Australia to use magnetic seeds instead of radioactive seeds. This technique replaces hookwire or needle localisation improving patient safety, outcomes and satisfaction. The method was patented by the University of South Florida while Dauway was a fellow of surgical oncology. The method has been used since 1999 and has improved with the development of modern equipment. Dauway is also a Yoga Instructor, a Keynote speaker and is founder/director of Restore More, a non-profit initiative which provides education and funding to women in regional and geographically disadvantaged areas for breast cancer treatment and reconstruction.
Armando Elario Giuliano is a surgical oncologist, surgeon scientist and medical professor in Los Angeles, California, United States of America. He is the Linda and Jim Lippman Chair in Surgical Oncology and co-director of Saul and Joyce Brandman Breast Center at Cedars-Sinai Medical Center, Los Angeles.
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