Intraoperative Use of a Gamma Probe

Studies appeared describing the use of an intraoperative gamma probe to locate sentinel lymph nodes during surgery [36-38]. Most now accept that the best method of locating the sentinel nodes at surgery is to use a combination of preop-erative lymphoscintigraphy, blue dye injection just before anesthesia, and intraoperative use of a gamma probe to assist in locating the blue node or nodes and show that the node field returns to background levels of activity after the sentinel nodes are removed [39,40]. The delay between the injection of tracer and surgery will vary with different protocols; however, there is enough radioactivity remaining in the sentinel nodes to allow the gamma probe to be used up to 24 h after injection of the tracer. In fact, there are some advantages in this next-day surgical approach. There is less radiation safety concern for operating theater staff and no requirement for radiation licensing of the surgeon. Further, the node-to-background ratio rises with time, which facilitates the location of ''hot'' nodes using the gamma detection probe intraoperatively [39].

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