Video of Procedure
Friday, April 28, 2017
Image Gallery

Return to: Sentinel Lymph Node Biopsy (contains information not only about false negatives, but also controversy regarding the use of the technique)

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Video

 

Clinical Images

Lymphoscintigram with CT co-registration. Note the post-auricular/anterior occipital node identified within the cross-hairs on the three CT images
Gamma probe identifying activity from the Tc99 injection performed 3 hours previously for lymphoscintigram.
1 cm margins about T1b melanoma oriented with suture at 12:00. Note region (at 9:00) of 0.5 cc of dermal injection of methylene blue.
Lymphoscintigram with CT co-registration. Note the post-auricular/anterior occipital node identified within the cross-hairs on the three CT images.Gamma probe identifying activity from the Tc99 injection performed 3 hours previously for lymphoscintigram.1 cm margins about T1b melanoma oriented with suture at 12:00. Note region (at 9:00) of 0.5 cc of dermal injection of methylene blue.
Resection of primary site is done first - with planning for incision for SLN bx directed by gamma probe and consideration for potential need for subsequent surgery if node positive (postero-lateral neck dissection)
Superficial suboccipital node is identified with gamma probe with blue color (from methylene blue injection) further helping identification
"In vivo" 10 second count with gamma probe is recorded as 40,447 on grid (see last photo). "In vivo" refers to evaluation with the node exposed through the incision.
Resection of primary site is done first - with planning for incision for SLN bx directed by gamma probe and consideration for potential need for subsequent surgery if node positive (postero-lateral neck dissection)Superficial suboccipital node is identified with gamma probe with blue color (from methylene blue injection) further helping identification."In vivo" 10 second count with gamma probe is recorded as 40,447 on grid (see last photo). "In vivo" refers to evaluation with the node exposed through the incision.
"Ex vivo" analysis with the node removed is recorded as 39,065.
Appearance of resected blue node. Note that grasping soft tissue adjacent the node (and not the node itself) facilitates traction during removal
"Site after removal" is recorded as 7,720 - still too high to confirm removal of SLN (7,720/40,447 x 100 = 19.1%) - a drop to 10% activity is required
"Ex vivo" analysis with the node removed is recorded as 39,065.Appearance of resected blue node. Note that grasping soft tissue adjacent the node (and not the node itself) facilitates traction during removal."Site after removal" is recorded as 7,720 - still too high to confirm removal of SLN (7,720/40,447 x 100 = 19.1%) - a drop to 10% activity is required.
Further dissection directed by the gamma probe activity reveals an adjacent, deeper blue node removed and tested.
Activity in the second node ("ex vivo") is 10,297
Final analysis of "site after removal" activity of 676 identifies a decrease from 40,447 (676/40,447 x 100 =1.7% activity) - confirming removal of sentinel nodes.
Further dissection directed by the gamma probe activity reveals an adjacent, deeper blue node removed and tested.Activity in the second node ("ex vivo") is 10,297.Final analysis of "site after removal" activity of 676 identifies a decrease from 40,447 (676/40,447 x 100 =1.7% activity) - confirming removal of sentinel nodes.
040 fu one week.jpg
041 fu one week.jpg
051 fu two weeks.jpg
followup one week postopfollowup one week postopfollowup two weeks postop
052 fu two weeks_0.jpg
061 fu 3 months.jpg
062 fu 3 months.jpg
followup two weeks postopfollowup 3 months postopfollowup 3 months postop
063 fu 3 months.jpg
064 fu 3 months.jpg
 
followup 3 months postopfollowup 3 months postop 
Gallery
Lymphoscintigram with CT co-registration. Note the post-auricular/anterior occipital node identified within the cross-hairs on the three CT images
Gamma probe identifying activity from the Tc99 injection performed 3 hours previously for lymphoscintigram.
1 cm margins about T1b melanoma oriented with suture at 12:00. Note region (at 9:00) of 0.5 cc of dermal injection of methylene blue.
Resection of primary site is done first - with planning for incision for SLN bx directed by gamma probe and consideration for potential need for subsequent surgery if node positive (postero-lateral neck dissection)
Superficial suboccipital node is identified with gamma probe with blue color (from methylene blue injection) further helping identification
"In vivo" 10 second count with gamma probe is recorded as 40,447 on grid (see last photo). "In vivo" refers to evaluation with the node exposed through the incision.
"Ex vivo" analysis with the node removed is recorded as 39,065.
Appearance of resected blue node. Note that grasping soft tissue adjacent the node (and not the node itself) facilitates traction during removal
"Site after removal" is recorded as 7,720 - still too high to confirm removal of SLN (7,720/40,447 x 100 = 19.1%) - a drop to 10% activity is required
Further dissection directed by the gamma probe activity reveals an adjacent, deeper blue node removed and tested.
Activity in the second node ("ex vivo") is 10,297
Final analysis of "site after removal" activity of 676 identifies a decrease from 40,447 (676/40,447 x 100 =1.7% activity) - confirming removal of sentinel nodes.
040 fu one week.jpg
041 fu one week.jpg
051 fu two weeks.jpg
052 fu two weeks.jpg
052 fu two weeks_0.jpg
061 fu 3 months.jpg
062 fu 3 months.jpg
063 fu 3 months.jpg
064 fu 3 months.jpg