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Sentinel lymph node detection in breast cancer patients using blue dye, radio-colloid tracers and hybrid fluorescent tracers with Single Photon Emission Computed Tomography - Computed Tomography technique
Macedonia (MMSA) - St. Cyril and Methodius, Skopje
Institute of Pathophysiology and Nuclear Medicine `` Isak Tadzer ``, Medical Faculty, University `` St. Cyril and Metodius `` Streeet: Mother Theresa 32, 1000 Skopje, North Macedonia
PhD MD Daniela Pop Gjorceva
Type of Research Project
- Clinical Project with Laboratory work
What is the background of the project?
Breast cancer accounts for 22.9% of all cancers in women and 13.7% of cancer deaths. Upon early detection and precise diagnosis, the disease outcome, overall survival rate and disease specific survival rate is in favor of the patient. However, with distant metastasis detection, the outcome worsens significantly and the survival rate drops to 25-35% of the patients. Positive loco regional axillary lymph nodes (ALN) or internal mammary lymph nodes predict the future development of distant metastases. The status of the sentinel lymph nodes (SLN) is essential for the exact staging of patients and appropriate postoperative treatment protocol selection. The sentinel lymph node is the first lymph node in which tumor cells spread through the lymphatic system drainage pathway. Precise detection and consecutive histopathology evaluation dictates the exact staging, restaging and following oncologic course of action and treatment. It also determines the minimally invasive surgical approach, radio guided surgery technique application and extensity of the intervention – selective or radical lymph node dissection, quadrant breast resection or radical mastectomy. The end beneficial result for the patient is precise disease staging, low rate of postoperative surgical complications, appropriate oncology treatment regimen selection and improved 5 years survival rate and disease free period.
What is the aim of the project?
The aim of the project is to compare the sensitivity, specificity, accuracy and detection rate of blue dye, radio colloid tracers and fluorescent tracers for sentinel lymph node mapping in breast cancer patients.
What techniques and methods are used?
Blue dye preparation and injection for lymphatic drainage pathway visualization and intra operative SLN visual localization ( dilution of the methyl blue dye concentrate with 20 ml of sterile saline solution; quality control before application; 15 minutes before surgery – injection of the diluted blue dye to the patient ); Indo-cyanine green fluorescent dye preparation and injection for lymphatic drainage pathway fluorescent intra operative visualization and intra operative SLN fluorescent visual localization with infra red and near infra red multispectral camera ( dilution of the indo cyanine green dye concentrate with 10 ml of sterile saline solution; quality control before application; 30 minutes before surgery – injection of the diluted fluorescent dye to the patient ); Tc99m (Technetium 99m) labelling of colloid particles: Elution of 99mTc from the 99Tc / 99Mo ( technetium / molybdenum) generator and labeling of the SENTI-SCINT colloid particles in the ``hot`` radio pharmaceutical laboratory; quality control before application; patient injection ( 4 separate periareolar injections - 4 mCi (150 MBq) – each injection being 1mCi / 37 MBq ) for SLN preoperative detection; 2D ( two dimensional ) planar scintigraphy: dynamic phase scintigraphy – duration 30 minutes ( 30 frames; each frame duration 60 seconds ) and static planar images acquisition at 30 minutes, 60 minutes and 120 minutes post injection on MEDISO dual head Nucline spirit gamma camera; for body conture delineation and planar SLN localisation - Featherlite Co 57 flood source MED 3709 is used; 3D ( three dimensional ) hybrid SPECT/CT technique: Using Optima NM/CT 640 camera, 3D hybrid functional and morphological imaging is performed for precise anatomical SLN localization, spatial resolution and minimally invasive surgical preoperative approach planning; Radio-guided surgery: peoperative and intra opeative usage of gamma detection probe - EUROPROBE I SYSTEM CE 0459 for SLN intra operative precise localization and postoperative basin exploration and lymph node counts evaluation; Intra operative ex tempore and postoperative histopathology: frozen section, haematoxiline and eosine ( H & E ) staining and immunohistochemisty ( using monoclonal antibody ) on the SLN for metastasis detection; The results will be processed using adequate methods of descriptive and analytical statistics. Data will be analysed using the Student’s ‘t’ test, one way ANOVA test for proportions and X2 test. To compare the data betwean two groups Mann-Whitney U–test will be used and significance will be assessed by ‘p’ value, labelled as significant if the value is p < 0.05
What is the role of the student?
- The student will observe the practical experiments but will be highly involved in the analysis of the results
- The tasks will be done under supervision
What are the tasks expected to be accomplished by the student?
The student is expected to learn the methods of blue dye preparation, Tc99m labelling of colloid particles, familiarise himself with 2D planar and 3D spect scintigraphy, 3D hybrid spect/CT technique and attend radioguided surgery. The student is expected to collect data from the cases. After the data is collected, the student is supposed to analyze the data, and afterwards to form a conclusion and evaluation based upon statistical analysis.
Will there be any theoretical teaching provided (preliminary readings, lectures, courses, seminars etc)
Yes, the tutor will provide both theoretical and practical knowledge.
What is expected from the student at the end of the research exchange? What will be the general outcome of the student?
- The student will prepare a scientific report - The student’s name will be mentioned in a future publication
What skills are required of the student? Is there any special knowledge or a certain level of studies needed?
Devotion and commitment to research medicine Subjects passed: Anatomy, Nuclear Medicine
Are there any legal limitations in the student’s involvement
Type of students accepted
This project accepts: - Medical students - Graduated students (less than 6 months)
- Sinisa Stojanoski; Nevena Ristevska; Daniela Pop Gjorceva; Borce Antevski; Gordana Petrusevska - SENTINEL LYMPH NODE DETECTION IN BREAST CANCER – FIRST EXPERIENCE. Contributions. 2015; 36(1): 145-151.
- Stojanoski S; Ristevska N; Pop-Gjorcheva D; Antevski B; Petrushevska G. Internal Mammary Sentinel Lymph Nodes in Breast Cancer - Effects on Disease Prognosis and Therapeutic Protocols - A Case Report. Mac J Med Sci. 2015; 3(1): 139-142.
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