Breast Lymphoscintigraphy

 In treating breast cancer, it is very important to know if the cancer has spread beyond the breast. The cancer most commonly spreads first to the lymph nodes in the axilla (armpit). In the past, while removing the cancerous breast tissue, surgeons would also remove all or most of the lymph nodes in and around the affected breast to determine if the cancer had spread. Unfortunately, this radical removal could lead to marked swelling of that arm and other complications in recovery from surgery.

Now a test called breast lymphoscintigraphy helps define more accurately exactly what tissue needs to be removed. This test locates the sentinel lymph node or nodes, so called because they are the first ones reached by fluids from the cancerous lesion and thus typically the first nodes to be affected by cancer spread. This sentinel node or nodes can then be sampled at the same time as the breast surgery, possibly limiting the amount of surgery to be done. If tumor cells have not yet traveled to the sentinel node, complete lymph node dissection and additional therapy (chemotherapy/radiation therapy) may be avoided.

Procedure Description

On the day of surgery, the patient arrives in the Rex Hospital nuclear medicine department 2 hours before the scheduled surgery time. A local anesthetic, lidocaine, is injected beneath the nipple of the involved breast, which may cause some localized burning in the injection site, but this should only last for a few seconds. Following the lidocaine injection, a radioactive tracer is injected that will move through the lymph system over the next few hours.

The patient arrives in surgery 2 hours after injection of the radioactive tracer. After anesthesia is administered, the surgeon also injects 2 to 5 cc of 1% isosulfan blue dye around the tumor site as an additional method of locating sentinel nodes. A hand-held gamma probe called a Neoprobe will be moved over the body to identify “hot” or radioactive lymph nodes. These nodes may also be stained blue because of the blue dye. Lymph nodes with high radiation counts and/or stained blue are considered sentinel nodes and will be removed and studied by the pathology department.

If the sentinel node or nodes do not contain cancerous material, the patient may be spared axillary dissection, which decreases the potential for complications such as arm swelling and nerve irritation.


Neil A. Ramquist, MD

Diagnostic Radiologist

                          

  • BS, MD, University of California at Davis
  • Chief resident in radiology, Bowman Gray School of Medicine
  • Member, American College of Radiology
  • Member, Radiological Society of North America
  • Native of Wisconsin

Expertise in mammography, CT, and ultrasound
Joined Raleigh Radiology in 1981

Donald G. Detweiler, MD

Diagnostic Radiologist

  • President, Raleigh Radiology Associates
  • Medical Director, Raleigh Radiology Blue Ridge, Cary and Breast Center
  • Chairman, Rex Classic - 2000
  • President, Medical Staff Rex Hospital - 1995
  • BS, Duke University
  • MD, Emory University
  • Fellow and resident in diagnostic radiology, University of North Carolina Medical Center
  • Native of Illinois

Expertise in mammography, CT, and ultrasound
Joined Raleigh Radiology in 1982

W. Kent Davis, MD

Neuroradiologist

  • Medical Director, Raleigh Radiology Cedarhurst, Clayton, Wake Forest, and Brier Creek
  • BS, Duke University
  • MD, University of North Carolina at Chapel Hill
  • Internship in internal medicine, Union Memorial Hospital, Baltimore
  • Resident in radiology, Duke University Medical Center
  • Fellowship in neuroradiology, Duke University Medical Center
  • Certificate of Added Qualifications in Neuroradiology awarded by American Board of Radiology
  • Member, American Society of Neuroradiology
  • Native of North Carolina

Expertise in head, neck, and spine imaging; breast imaging and breast intervention
Joined Raleigh Radiology in 1990

Andrew B. Weber, MD

Vascular and Interventional Radiologist

  • BS, University of Pennsylvania
  • MD, Temple University Medical School
  • Internship in surgery, York Hospital
  • Chief resident, Duke University Medical Center
  • Former Chief, Rex Hospital Radiology
  • 2009 Chairman, Rex Hospital Open
  • Rex Corporate Counsel
  • Native of Pennsylvania

Expertise in vascular/interventional radiology and MR angiography
Joined Raleigh Radiology in 1992

Julia K. Taber, MD

Women’s Imaging Radiologist

  • Chief of Radiology at Rex Hospital
  • BS, Brown University
  • MD, Duke University Medical School
  • Internship in internal medicine, New York Hospital
  • Resident in diagnostic radiology, Duke University Medical Center
  • Fellowship in mammography and pediatric radiology, Duke University Medical Center
  • Member, Society of Breast Imaging
  • Member, American Institute of Ultrasound in Medicine
  • Women’s Imaging Radiologist

 Expertise in breast imaging, breast intervention, and pediatric radiology   

Joined Raleigh Radiology in 1993

Gregory C. Hinn, MD

Musculoskeletal Radiologist

  • Head of Musculoskeletal Imaging at Rex Hospital
  • BA, University of North Carolina at Chapel Hill
  • MD, Bowman Gray School of Medicine at Wake Forest University
  • Resident in radiology, University of Virginia Health Sciences Center
  • Fellowship in diagnostic and interventional musculoskeletal radiology, University of Virginia Health Sciences Center
  • Musculoskeletal radiologist for the North Carolina State University Athletic Department.
  • Raised in North Carolina

Expertise in musculoskeletal imaging with bone and joint intervention
Joined Raleigh Radiology in 1995

Gregory A. Bortoff, MD, PhD

Abdominal Imaging Radiologist

  • Head of Computed Tomography (CT) at Rex Hospital
  • BS, Cornell University
  • MD, PhD, State University of New York Health Science Center at Syracuse
  • Resident in radiology, Wake Forest University Baptist Medical Center
  • Fellowship in abdominal imaging, Wake Forest University Baptist Medical Center
  • Member, Radiological Society of North America
  • Member, American Roentgen Ray Society
  • Native of New York

Expertise in abdominal imaging, including MRI, MRA, ultrasound, oncologic imaging, and PET/CT
Joined Raleigh Radiology in 1999

Jerry L. Watson, MD

Abdominal Imaging Radiologist

  • BS with honors, Johns Hopkins University
  • MD, University of Texas, Southwestern Medical Center at Dallas
  • Resident in radiology, University of North Carolina at Chapel Hill
  • Fellowship in abdominal imaging, University of North Carolina at Chapel Hill
  • Chief of Radiology, 67th Combat Support Hospital, United States Army, Germany 1996–1998
  • Native of Georgia

Expertise in abdominal imaging, including MRI, MRA, ultrasound, breast intervention, oncologic imaging, and PET/CT
Joined Raleigh Radiology in 1999

Cynthia S. Payne, MD

Vascular and Interventional & Neuroradiologist

  • MD, Medical College of Ohio
  • Internship, Mount Auburn Hospital, Harvard Medical School
  • Resident, neurology and radiology, Duke University Medical Center
  • Fellowships in molecular neurogenetics, vascular/interventional radiology and neuroradiology, Duke University Medical Center
  • Certificate of Added Qualifications in Neuroradiology, Vascular and
  • Interventional Radiology awarded by American Board of Radiology
  • Director of neuro-interventional radiology, Greater Baltimore Medical Center
  • Native of North Carolina

Expertise in vascular and interventional radiology, diagnostic, and interventional neuroradiology
Joined Raleigh Radiology in 2001

Tracey E. O’Connell, MD

Musculoskeletal Radiologist

  • BA, University of Colorado at Boulder
  • MD, University of North Carolina at Chapel Hill
  • Resident in radiology, University of North Carolina at Chapel Hill
  • Fellowship in musculoskeletal radiology, Duke University Medical Center
  • Member, Radiological Society of North America
  • Native of California

Expertise in musculoskeletal imaging with bone and joint intervention and abdominal imaging including MRI, MRA, CT, and ultrasound
Joined Raleigh Radiology in 2001

Jennifer S. Van Vickle, MD

Abdominal Imaging Radiologist

  • Head of Ultrasound at Rex Hospital
  • BA, University of Chicago, M.Div and Th.M, Duke University
  • MD, Duke University Medical Center
  • Internship in internal medicine, Duke University Medical Center
  • Resident in diagnostic radiology, Duke University Medical Center
  • Fellowship in abdominal imaging and mammography, Duke University Medical Center
  • Native of Missouri

Expertise in breast imaging, breast intervention, abdominal and pelvic imaging, including CT, ultrasound, and MRI
Joined Raleigh Radiology in 2002

Gintaras E. Degesys, MD

Musculoskeletal Radiologist

  • BA with high honors, Kenyon College
  • MD, University of Cincinnati College of Medicine
  • Internship and chief resident, Northwestern University
  • Fellowship in interventional and abdominal imaging, Duke University Medical Center
  • Certificate of Added Qualifi cations in Vascular and Interventional Radiology awarded by  American Board of Radiology
  • Native of Ohio

Expertise in musculoskeletal imaging, breast intervention, and abdominal imaging and intervention
Joined Raleigh Radiology in 2002

Laura O. Thomas, MD

Abdominal Imaging Radiologist

  • Head of Rex Breast Care Center at Rex Hospital
  • Radiologist Recruiter
  • BA, Princeton University
  • MD, Duke University Medical School
  • Internship in internal medicine, UNC Hospitals
  • Chief resident, Duke University Medical Center
  • Fellowship in women’s and abdominal imaging, Duke University Medical Center
  • Native of Missouri

Expertise in breast imaging, breast intervention, abdominal imaging, oncologic imaging, and PET/CT
Joined Raleigh Radiology in 2003

John G. “Jay” Alley, Jr, MD

Neuroradiologist

  • Vice Chief of Radiology at Rex Hospital
  • BA, University of North Carolina at Chapel Hill
  • Post-Baccalaureate Premedical Program, Columbia University, New York
  • MD, University of North Carolina School of Medicine
  • Co-chief resident in diagnostic radiology, University of North Carolina Hospitals
  • Fellowship in neuroradiology, University of North Carolina Hospitals
  • Native of North Carolina

Expertise in neuroradiology
Joined Raleigh Radiology in 2004

Todd J. Roth, MD

Abdominal Imaging Radiologist

  • BS, University of Texas, Austin
  • MD, University of Texas Health Sciences Center, San Antonio
  • Residency, Baptist Medical Center, Wake Forest University, Winston-Salem
  • Fellowship in abdominal imaging, Baptist Medical Center, Wake Forest University
  • Native of Kansas

Expertise in abdominal and pelvic MRI, MRA, CT, and ultrasound
Joined Raleigh Radiology in 2004

Steven R. Carter, MD

Musculoskeletal Radiologist

  • BS, University of Virginia
  • MS, Medical College of Virginia
  • MD, Medical College of Virginia
  • Internship in internal medicine, MCV
  • Chief resident, diagnostic radiology, Emory University
  • Fellowship in musculoskeletal imaging, Emory University
  • Member, American Roentgen Ray Society, American College of Radiology, Radiological Society of North America
  • Musculoskeletal radiologist for the Carolina Hurricanes
  • Native of Richmond, Virginia

Expertise in musculoskeletal radiology
Joined Raleigh Radiology in 2005

Satish Mathan, MD

Vascular and Interventional Radiologist

  • Head of Interventional and Vascular Radiology at Rex Hospital
  • BS, University of California at Santa Barbara
  • MD, Medical College of Wisconsin
  • Internship, Santa Clara Valley Medical Center, San Jose, CA
  • Chief resident, University of North Carolina Hospitals, Chapel Hill, NC
  • Fellowship in vascular and interventional radiology, University of North Carolina Hospitals
  • Member, Society of Interventional Radiology, American College of Radiology
  • Native of Raleigh, North Carolina

Expertise in interventional radiology
Joined Raleigh Radiology in 2005

Andrew G. Moran, MD

Nuclear Medicine Radiologist

  • Head of Nuclear Medicine Radiology at Rex Hospital
  • BS, Idaho State University
  • MD, Utah School of Medicine
  • Residency, Duke University Medical Center
  • Fellowships in body imaging and nuclear radiology, Duke University Medical Center
  • Member, Society of Nuclear Medicine
  • Native of California

Expertise in abdominal imaging, oncologic imaging, nuclear medicine and PET/CT
Joined Raleigh Radiology in 2006

Joshua B. Mitchell, MD

Musculoskeletal Radiologist

  • BA, University of Virginia
  • MD, University of Tennessee College of Medicine
  • Internship, Medical University of South Carolina
  • Chief resident, Medical University of South Carolina
  • Fellowship in musculoskeletal radiology, University of Florida
  • Member, American College of Radiology, South Carolina
  • Radiological Society, Association of University Radiologists, Radiological Society of North America
  • Native of Chattanooga, Tennessee

Expertise in musculoskeletal imaging
Joined Raleigh Radiology in 2007

Jeffrey Browne, MD

Musculoskeletal Radiologist

  • BS, Boston College
  • MD, University of Connecticut School of Medicine
  • Internship, St. Raphael’s Hospital
  • Residency, Duke University Medical Center
  • Fellowship in musculoskeletal radiology, Duke University Medical Center
  • Member, American College of Radiology, Radiological Society of North America and American Roetgen Ray Society.
  • Native of Connecticut

Expertise in musculoskeletal imaging
Joined Raleigh Radiology in 2008

Michael C. Hollingshead, MD

Neuroradiologist

  • Head of Neuroradiology at Rex Hospital
  • BA, University of North Carolina at Chapel Hill
  • MD, University of North Carolina at Chapel Hill
  • Internship, University of North Carolina at Chapel Hill
  • Residency, University of North Carolina at Chapel Hill
  • Fellowship in neuroradiology, University of North Carolina at Chapel Hill
  • Certificate of added Qualifications in Neuroradiology awarded by American Board of Radiology
  • Member, American Society of Neuroradiology, American College of Radiology,Radiological Society of North America
  • Native of Massachusetts

Expertise in neuroradiology
Joined Raleigh Radiology in 2008

Jason R. Harris, MD

Vascular and Interventional Radiologist

  • BS, Brigham Young University
  • MD, Harvard Medical School
  • Internship, Newton-Wellesley Hospital, Newton, Massachusetts
  • Residency, Massachusetts General Hospital, Boston, Massachusetts
  • Fellowship in vascular and interventional radiology, Duke University Medical Center
  • Member, American College of Radiology, Society of Interventional Radiology
  • Native of California

Expertise in vascular and interventional and musculoskeletal radiology
Joined Raleigh Radiology in 2008

Mark H. Knelson, MD

Vascular and Interventional Radiologist

  • BS, MD, University of North Carolina at Chapel Hill
  • Rotating internship, Case Western Reserve University Hospitals of Cleveland
  • Chief resident, Case Western Reserve University Hospitals of Cleveland
  • Fellowship, vascular and interventional radiology, Duke University Medical Center
  • Certificate of Added Qualifications in Vascular and Interventional Radiology awarded 
  • American Board of Radiology Assistant professor of radiology, Duke University Medical Center
  • Member, Society of Interventional Radiology, American College of Radiology
  • Native of North Carolina

Expertise in diagnostic angiography and interventional radiology, nuclear cardiology, and spine intervention
Joined Raleigh Radiology in 1993

There is no prep for this procedure.

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