Type of test Nuclear scan
Normal findings
Uptake is noted in one or more lymph nodes. No tumor in the sentinel node.
Test explanation and related physiology
Lymphoscintigraphy is used to identify the sentinel lymph node, which is the first lymph node in line to catch metastasis from a nearby primary tumor. It is primarily used in breast cancer and melanoma. With this procedure, the sentinel node is identified and biopsied. This test is an important part of the standard treatment for breast and melanoma cancer surgery.
Contraindications
• Patients who have a large cancer in which lymph node metastasis is very likely
• Patients in early pregnancy unless the benefit outweighs the risk of damage to the fetus Potential complications
• Anaphylaxis with injection of isosulfan blue dye
Procedure and patient care
Before
* Explain the procedure to the patient. See p. xviii for radiation exposure and risks.
• Because this is an operative procedure, routine preoperative nursing processes should be carried out, including obtaining operative consent, keeping the patient NPO (nothing by mouth), and surgical site preparation as ordered.
During
• Note the following procedural steps:
1. After the injection of technetium, the lymph node drain age basin is then scanned immediately and 1 to 24 hours later.
2. In the operating room, a handheld gamma detector locates hot areas of radionuclide uptake in the lymph node–bearing area. The most proximal hot node is excised as the sentinel node.
3. When using isosulfan blue, 4 to 5 mL of dye is injected around the tumor. Several minutes later, the lymphatics are stained blue and can be identified for biopsy.
After
* Inform the patient that no precautions are required if technetium is used because the radionuclide dose is minimal.
* If isosulfan blue dye is used, the patient’s skin may develop a transient blue hue (looking almost like severe cyanosis). This will dissipate over the next 6 hours.
* Warn the patient that the urine will have a blue tinge as a result of the isosulfan blue dye injection.
• Observe the patient for signs of allergy (rare) caused by the blue dye injection.
Abnormal findings
- Metastatic tumor to lymph node
