Medical Radiology and Radiation Safety. 2023. Vol. 68. № 5


E.K. Azimova1, 2, Sh.Sh. Abdulloeva1, F.N. Usov1,
A.D. Zikiryakhodzhaev1, 3 ,4, E.I. Egina1

Variants of Sentinel Lymph Node Research Protocols in Breast Cancer

1 P.A. Herzen Moscow Research Oncology Institute, Moscow, Russia

2Tashkent State Dental Istitute, Tashkent, Uzbekistan

3Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia

4I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia

Contact person: E.K. Azimova, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.


Purpose: To study the advantages of the technique of administering a radiopharmaceutical according to the “two-day protocol” for determining the sentinel lymph node in breast cancer. Compare the methods of introducing radiopharmaccutical according to the “two-day protocol” and the “one-day protocol”. To identify the advantages of using the “two-day protocol” method over the “one-day protocol” method.

Material and methods: In order to improve the diagnosis and treatment of breast cancer by means of a sentinel lymph node biopsy (SLNB) using the technique of introducing a radiopharmaceutical a day before surgical treatment, we analyzed 76 patients with various molecular biological types and stage of breast cancer disease who underwent examination and treatment in the conditions of the P.A. Herzen Moscow State Medical Institute. This cohort of patients was divided into 2 comparable groups: 1 group of patients who underwent SLNB according to a two-day protocol (n=38), the 2nd group of patients who underwent SLNB according to a one-day protocol (n=38). The ambient equivalent dose rate of photon radiation was measured using the MKS-08P dosimeter on the day of RP administration and on the day of surgery.

Results: On average, the dose rate of photon radiation 0.5 m from the injection point on the day of radiopharmaccutical administration (according to the “one-day protocol”) and on the day of surgery (according to the “two-day protocol”) was 46.9±23.1(11.0‒85.4) and 2.2±1.1(1.0‒6.4) μSv/h, respectively. The average value of thedose rate directly in the colloid injection zone two hours after administration is equal to 185.1±25.7 (138.9‒258.0) μSv/h, a day later ‒ 9.8±3.8 (6.5‒27) μSv/h. In the first group, when using the “two-day protocol”, when scanning the SPECT/CT in 34/38 (89.5 %) patients revealed 83 lymph nodes, in the second in 30/38 (78.9 %) patients – 72; the total number of removed lymph nodes ‒ 147 and 156, respectively. With an urgent cytological examination, adenogenic metastases were detected in 8 cases in the first group, in 11 cases in the second. In 11/38 (29.0 %) patients, according to the “two-day protocol”, the number of detected and removed lymph nodes is equal, “according to the one-day protocol” ‒ in 5/38 (13.2 %). The scan did not reveal any SLN in the first group – 5/38 (13.2 %), in the second – 7/38 (18.4 %).

Conclusions: The advantage of using the “two-day protocol” was revealed, consisting in an 18-fold decrease in background radiation. And also, a faster and more accurate determination of the sentinel lymph node in the surgical field using a gamma detector, associated with a minimum number of cases of scattered radiation in the area of regional lymph outflow, in contrast to the weak accumulation of “sentinel” lymph nodes and strong background radiation outside the nodes when a radioisotope is injected on the day of surgery. The “two-day protocol” greatly facilitates the work of the oncologist surgeon, contributes to a more accurate determination and biopsy of the sentinel lymph node, reduces the radiation load on medical staff during surgery.

Keywords: breast cancer, sentinal lymph node, SPECT/CT, gamma-probe, biopsy, one-day protocol, two-day protocol, radiation

For citation: Azimova EK, Abdulloeva ShSh, Usov FN, Zikiryakhodzhaev AD, Egina EI.Variants of Sentinel Lymph Node Research Protocols in Breast Cancer. Medical Radiology and Radiation Safety. 2023;68(5):82–87. (In Russian). DOI:10.33266/1024-6177-2023-68-5-82-87



1. Lyman G.H., Somerfield M.R., Bosserman L.D., et al. Sentinel Lymph Node Biopsy for Patients with Early-Stage Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. J. Clin. Oncol. 2017;35;5:561–564.

2. Veronesi U., Cascinelli N., Mariani L., et al. Twenty-Year Follow-up of a Randomized Study Comparing Breast-Conserving Surgery with Radical Mastectomy for Early Breast Cancer. N. Engl. J. Med. 2002;347:1227–11232.

3. Audretsch W., Kolotas Ch., Rezai M., et al. Conservative Treatment for Breast Cancer. Complications Requiring for Breast Cancer. Materials of IOPBS 3rd International Oncoplastic Breast Surgery Symposium (Tokyo). 2010;1:391-392.

4. Cabanas R.M. An Approach for the Treatment of Penile Carcinoma. Cancer. 1977;39;2:456–466.

5. Allard-Coutu A., Dobson V., Schmitz E., Shah H., Nessim C. The Evolution of the Sentinel Node Biopsy in Melanoma. Life. 2023;13:489.

6. Cochran A.J., Roberts A., Wen D.-R., Huang R.-R., Itakura E., Luo F., Binder S. W. Optimized Assessment of Sentinel Lymph Nodes for Metastatic Melanoma: Implications for Regional Surgery and Overall Treatment Planning. Annals of Surgical Oncology. 2004;11:156S-161.

7. Jakobsen J.K. Sentinel Node Methods in Penile Cancer – a Historical Perspective on Development of Modern Concepts. Seminars in Nuclear Medicine. 2022;52:486-497.

8. Imyanitov E.N., Khanson K.P. Advances in Fundamental Oncology: the Year 2020 Update. Prakticheskaya Onkologiya = Practical Oncology. 2005;6;1:1-5 (In Russ.).

9. Dick A., Perri T., Kogan L., Brandt B., Meyer R., Levin G. Sentinel Lymph Node Mapping in Endometrial Cancer: A Comparison of Main National and International Guidelines. International Journal of Gynecology & Obstetrics. 2022.

10. Krag D.N., Weaver D.L., Alex J.C., Fairbank J.T. Surgical Resection and Radiolocalization of the Sentinel Lymph Node in Breast Cancer Using a Gamma Probe. Surg. Oncol. 1993;2;6:335–339.

11. Ermakov A.V., Zikiryakhodzhayev A.D., Saribekyan E.K., Ablitsova N. V., Usov F.N. The Biological Conceptualization of the Sentinel Lymph Node (Literature Review). Zlokachestvennyye Opuholi = Malignant Tumoursis. 2016;4:5-13 (In Russ.).

12. Ismagilov A.Kh., Asnina N.G., Azarov G.A. Sentinel Lymph Node Biopsy: History and Current Concepts. Opukholi Zhenskoy Reproduktivnoy Sistemy = Tumors of Female Reproductive System. 2018;14;1:38-46 (In Russ.).

13. Semiglazov V.F., Krivorotko P.V., Zhiltsova E.K., et al. Twenty-Year Experience of Examining Biopsies of Signal Lymph Nodes in Breast Cancer. Opukholi Zhenskoy Reproduktivnoy Sistemy = Tumors of Female Reproductive System. 2020;16;1:2-20 (In Russ.).

14. Nazera Dodia, Deena El‑Sharief, Cliona C. Kirwan. The Use of Isotope Injections in Sentinel Node Biopsy for Breast Cancer: Are the 1- and 2-Day Protocols Equally Effective? SpringerPlus. 2015;4:495.

15. Stoffels I., Dissemond J., Pöppel T., Schadendorf D., Klode J. Intraoperative Fluorescence Imaging for Sentinel Lymph Node Detection: Prospective Clinical Trial to Compare the Usefulness of Indocyanine Green vs Technetium Tc 99m for Identification of Sentinel Lymph Nodes. JAMA Surg. 2015;150;7:617-623.

16. Waqar M., Afridi T.A., Soomror Q., Khatoon J., Dahri J. Determination of Annual Effective Doses from Background Ionizing Radiation to Nuclear Medicine Professionals in Medical Centre. Journal of Radiation and Nuclear Applications. 2022;7;3:15-20.



 PDF (RUS) Full-text article (in Russian)


Conflict of interest. The authors declare no conflict of interest.

Financing. The study had no sponsorship.

Contribution. A.D. Zikiryakhodjaev: concept and design of the study;
E.K. Azimova, Sh.Sh. Abdulloeva, E.I. Egina: collection and processing of the material; E.K. Azimova: writing the text; F.N. Usov: editing.

Article received: 20.04.2023. Accepted for publication: 27.05.2023.