Sentinel Node Studies

[Betty Schwab <bschwab@Gems.VCU.EDU>]

Our hospital has recently started lymph node mapping for melanomas
using Tc-99 sulfur colloid. They will soon start lymph node mapping for
breast tumors.  The dose for the melanoma study is 500 microcuries, and
1 millicurie for the breast study. The Tc-99m sulfur colloid is injected
adjacent to the tumor site. There is a delay of about 2 to 4 hours from
the time of the dose until the patient goes for surgery. The surgeon
locates the sentinel node with a "gamma probe".  Sometimes the breast
tumor (site of dose) will be removed and sent to pathology along with
the lymph nodes.
	My questions to radsafers are:  Who do you train and how extensively? 
Are the tissue samples labeled to alert pathology?  What precautions do
you advise for the tissue handlers in pathology?  Do you advise them to
wait 24 hours or longer before processing the samples?  After
processing, the tissue specimens are stored for several weeks - do you
require locking and labeling the freezer where the tissue is stored? Is
the removed tissue considered patient excreta or radioactive waste? 
	I have trouble stating that "there is no significant hazard associated
with handling these specimens", then giving extensive instructions on
how to lower handlers' dose(as in the radiation safety training from the
protocol of one multi-center study).  I've found that this type of
instruction causes confusion and sounds like double-talk.
	Please respond directly to me unless you think this is of general
interest for radsafe.  Thanks!
 
Betty Schwab 
bschwab@gems.vcu.edu
Virginia Commonwealth University/Medical College of Virginia Hospitals