Strahlenexposition des Personals bei der Sentinel-Lymph-Node-Diagnostik

Zusammenfassung

Bei der Sentinel-Lymph-Node-Diagnostik mit Technetium-99m-markierten Tracern kommt es nicht nur zu einer Strahlenexposition der beteiligten Personen in der Nuklearmedizin, die generell einer gesetzlich geregelten Strahlenüberwachung unterliegen, sondern auch des normalerweise nicht überwachten Personals des Operationsteams sowie in der Pathologie. Die Strahlenexposition aller außerhalb der Nuklearmedizin beteiligten Personen soll für gängige Indikationen wie malignes Melanom und Mammakarzinom dargestellt und daraus erforderliche Strahlenschutzmassnahmen im Rahmen geltender Strahlenschutzvorschriften abgeleitet werden. Außerdem soll anhand des noch experimentellen Ansatzes bei Kopf-Hals-Tumoren aufgezeigt werden, wie durch veränderte Grundbedingungen im Prozedere die Strahlenexposition beeinflusst wird.

Abstract

Due to radioguided sentinel lymph node detection with technetium-99m labeled radiotracers not only persons working in the nuclear medicine department who are monitored for radiation exposure as required by national law but also personnel in the operating room and in the pathology laboratories are exposed to radiation. The radiation exposure for these workers will be presented for standard diagnostic procedures in patients with breast cancer and melanoma and respective radiation protection measures according to national law will be discussed. Based on experimental settings in patients with head and neck cancers, we will also demonstrate how the radiation exposure to the personnel is affected by varying procedure conditions.

Wächterlymphknoten - Sentinel-Lymph-Node - Strahlenexposition - Technetium-99m

sentinel lymph node - radiation exposure - technetium-99m

Literatur

• 1 Giuliano A E. Sentinel lymphadenectomy in primary breast carcinoma: an alternative to routine axillary dissection.  J Surg Oncol. 1996;  62 75-77
• 2 Veronesi U, Paganelli G, Galimberti V. et al . Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes.  Lancet. 1997;  349 1864-1867
• 3 Krag D, Weaver D, Ashikaga T. et al . The sentinel node in breast cancer - a multicenter validation study.  N Engl J Med. 1998;  339 941-946
• 4 Hill A D, Tran K N, Akhurst T. et al . Lessons learned from 500 cases of lymphatic mapping for breast cancer.  Ann Surg. 1999;  229 528-535
• 5 Nieweg O E, Jansen L, Valdes Olmos R A. et al . Lymphatic mapping and sentinel lymph node biopsy in breast cancer.  Eur J Nucl Med. 1999;  26 11-16
• 6 Maza S, Valencia R, Geworski L. et al . Peritumoural versus subareolar administration of technetium-99m nanocolloid for sentinel lymph node detection in breast cancer: preliminary results of a prospective intra-individual comparative study.  Eur J Nucl Med Mol Imaging. 2003;  30 651-656
• 7 Aarsvold J N, Alazraki N P. Update on detection of sentinel lymph nodes in patients with breast cancer.  Semin Nucl Med. 2005;  35 116-128
• 8 Cochran A J, Wen D R, Morton D L. Management of the regional lymph nodes in patients with cutaneous malignant melanoma.  World J Surg. 1992;  16 214-221
• 9 Pijpers R, Collet G J, Meijer S, Hoekstra O S. The impact of dynamic lymphoscintigraphy and gamma probe guidance on sentinel node biopsy in melanoma.  Eur J Nucl Med. 1995;  22 1238-1241
• 10 Vogt H, Bachter D, Buchels H K. et al . [Sentinel lymph node detection by preoperative lymphoscintigraphy and intraoperative gamma probe guidance in malignant melanoma].  Nuklearmedizin. 1999;  38 95-100
• 11 Maza S, Valencia R, Geworski L. et al . Influence of fast lymphatic drainage on metastatic spread in cutaneous malignant melanoma: a prospective feasibility study.  Eur J Nucl Med Mol Imaging. 2003;  30 538-544
• 12 Munz D L. Does increased lymphatic density contribute to fast drainage and metastatic spread to sentinel lymph nodes in melanoma?.  Br J Cancer. 2004;  91 193
• 13 Koch W M, Choti M A, Civelek A C, Eisele D W, Saunders J R. Gamma probe-directed biopsy of the sentinel node in oral squamous cell carcinoma.  Arch Otolaryngol Head Neck Surg. 1998;  124 455-459
• 14 Alex J C, Sasaki C T, Krag D N, Wenig B, Pyle P B. Sentinel lymph node radiolocalization in head and neck squamous cell carcinoma.  Laryngoscope. 2000;  110 198-203
• 15 Mozzillo N, Chiesa F, Botti G. et al . Sentinel node biopsy in head and neck cancer.  Ann Surg Oncol. 2001;  8 103S-105S
• 16 Shoaib T, Soutar D S, MacDonald D G. et al . The accuracy of head and neck carcinoma sentinel lymph node biopsy in the clinically N0 neck.  Cancer. 2001;  91 2077-2083
• 17 Barzan L, Sulfaro S, Alberti F. et al . Gamma probe accuracy in detecting the sentinel lymph node in clinically N0 squamous cell carcinoma of the head and neck.  Ann Otol Rhinol Laryngol. 2002;  111 794-798
• 18 Hoft S, Muhle C, Brenner W, Sprenger E, Maune S. Fine-needle aspiration cytology of the sentinel lymph node in head and neck cancer.  J Nucl Med. 2002;  43 1585-1590
• 19 Nieuwenhuis E J, Castelijns J A, Pijpers R. et al . Wait-and-see policy for the N0 neck in early-stage oral and oropharyngeal squamous cell carcinoma using ultrasonography-guided cytology: is there a role for identification of the sentinel node?.  Head Neck. 2002;  24 282-289
• 20 Werner J A, Dunne A A, Ramaswamy A. et al . Sentinel node detection in N0 cancer of the pharynx and larynx.  Br J Cancer. 2002;  87 711-715
• 21 Hoft S, Maune S, Muhle C. et al . Sentinel lymph-node biopsy in head and neck cancer.  Br J Cancer. 2004;  91 124-128
• 22 Muhle C, Brenner W, Sudmeyer M. et al . CT-guided lymphoscintigraphy in patients with squamous cell carcinoma of the head and neck: a feasibility study.  Eur J Nucl Med Mol Imaging. 2004;  31 940-944
• 23 de Hullu J A, Doting E, Piers D A. et al . Sentinel lymph node identification with technetium-99m-labeled nanocolloid in squamous cell cancer of the vulva.  J Nucl Med. 1998;  39 1381-1385
• 24 Wawroschek F, Vogt H, Weckermann D, Wagner T, Harzmann R. The sentinel lymph node concept in prostate cancer - first results of gamma probe-guided sentinel lymph node identification.  Eur Urol. 1999;  36 595-600
• 25 Sherif A, De La Torre M, Malmstrom P U, Thorn M. Lymphatic mapping and detection of sentinel nodes in patients with bladder cancer.  J Urol. 2001;  166 812-815
• 26 Levenback C, Coleman R L, Burke T W. et al . Lymphatic mapping and sentinel node identification in patients with cervix cancer undergoing radical hysterectomy and pelvic lymphadenectomy.  J Clin Oncol. 2002;  20 688-693
• 27 Kroon B K, Horenblas S, Estourgie S H. et al . How to avoid false-negative dynamic sentinel node procedures in penile carcinoma.  J Urol. 2004;  171 2191-2194
• 28 Jeschke S, Nambirajan T, Leeb K. et al . Detection of early lymph node metastases in prostate cancer by laparoscopic radioisotope guided sentinel lymph node dissection.  J Urol. 2005;  173 1943-1946
• 29 Selman T J, Luesley D M, Acheson N, Khan K S, Mann C H. A systematic review of the accuracy of diagnostic tests for inguinal lymph node status in vulvar cancer.  Gynecol Oncol. 2005;  99 206-214
• 30 Roca I, Caresia A P, Gil-Moreno A. et al . Usefulness of sentinel lymph node detection in early stages of cervical cancer.  Eur J Nucl Med Mol Imaging. 2005;  32 1210-1216
• 31 Cremonesi M, Ferrari M, Sacco E. et al . Radiation protection in radioguided surgery of breast cancer.  Nucl Med Commun. 1999;  20 919-924
• 32 Miner T J, Shriver C D, Flicek P R. et al . Guidelines for the safe use of radioactive materials during localization and resection of the sentinel lymph node.  Ann Surg Oncol. 1999;  6 75-82
• 33 Stratmann S L, McCarty T M, Kuhn J A. Radiation safety with breast sentinel node biopsy.  Am J Surg. 1999;  178 454-457
• 34 Brenner W, Ostertag H, Peppert E. et al . Radiation exposure to the personnel in the operating room and in the pathology due to SLN detection with ^99mTc-nanocolloid in breast cancer patients.  Nuklearmedizin. 2000;  39 142-145
• 35 Waddington W A, Keshtgar M R, Taylor I. et al . Radiation safety of the sentinel lymph node technique in breast cancer.  Eur J Nucl Med. 2000;  27 377-391
• 36 de Kanter A Y, Arends P P, Eggermont A M, Wiggers T. Radiation protection for the sentinel node procedure in breast cancer.  Eur J Surg Oncol. 2003;  29 396-399
• 37 Morton R, Horton P W, Peet D J, Kissin M W. Quantitative assessment of the radiation hazards and risks in sentinel node procedures.  Br J Radiol. 2003;  76 117-122
• 38 Gallowitsch H J. Lymphoscintigraphy and dosimetry. In: Munz DL (ed). The sentinel lymph node concept in oncology. Zuckschwerdt, München 2001; 57-66
• 39 Heidenreich P, Bares R, Brenner W. et al . Verfahrensanweisung für die nuklearmedizinische Wächter-Lymphknoten (sentinel lymph node)-Diagnostik.  Nuklearmedizin. 2001;  40 98-101
• 40 .Strahlenschutzverordnung in der Fassung der Bekanntmachung vom 26. Juli 2001. (BGBl. I S. 1714). 2001
• 41 .Richtlinie 96/29/Euratom des Rates vom 13. Mai 1996 zur Festlegung der grundlegenden Sicherheitsnormen für den Schutz der Gesundheit der Arbeitskräfte und der Bevölkerung gegen die Gefahren durch ionisierende Strahlungen. Amtsblatt der Europäischen Gemeinschaften 39, L159. 1996
• 42 Sera T, Mohos G, Papos M. et al . Sentinel node detection in malignant melanoma patients: radiation safety considerations.  Dermatol Surg. 2003;  29 141-145
• 43 Ammenwerth H. Strahlenexposition des Personals bei der SLN-Diagnostik mit Technetium-99m-Nanokolloid beim Malignen Melanom und bei Kopf-Hals-Tumoren. (Dissertation; Christian-Albrechts-Universität zu Kiel). Kiel 2005