Performing sentinel lymph node biopsy without a hand-held gamma probe - overcoming hurdles through team work: an analysis of our learning curve over five years

Sep 23, 2026

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Sentinel lymph node biopsy is standard for node-negative axilla in breast cancer, and for node-negative melanomas and penile cancers, yet adoption is limited by lack of a hand-held gamma probe. This study evaluates safety and feasibility using methylene blue with SPECT CT lymphoscintigraphy. A retrospective review covers patients undergoing surgery from Dec 2019 to Nov 2024, analyzing demographics, operative details, pathology, and follow-up.

LanguageEnglish

CategoryHealthcare

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Pages8

Reading Time20 min

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Abstract

Introduction

Patients and methods

Results

Conclusion

Ratnagiri etal. World Journal of Surgical Oncology (2025) 23:285 [https://doi.org/10.1186/s12957-025-03938-4](https://doi.org/10.1186/s12957-025-03938-4) World Journal of Surgical Oncology RESEARCH Open Access Performing sentinel lymph node biopsy without a hand-held gamma probe – overcoming hurdles through team work: an analysis of our learning curve over five years Ranganath Ratnagiri 1*, Madhur Kumar Srivastava2, Megha S. Uppin3, Monalisa Hui3, C. Rachana4, Monica I. Mall ik5 and Rajashekhar Shantappa 1 Abstract Background Sentinel lymph node biopsy is the standard of care in the management of node negative axilla in breast cancer and in node negative melanomas and penile cancers. The wide spread adoption of this procedure is however, hampered by the availability of the hand-held gamma probe. Aim To demonstrate the safety and feasibility of sentinel node biopsy using methylene blue and SPECT CT lymphoscintigraphy. Patients and methods A retrospective review of the case records of all patients of breast cancer, penile cancer and melanomas who underwent surgery at our Institute between December 2019 and November 2024 was analysed. Demographic data, operative data, pathological reports and follow up data were analysed. Results Out of a total of 628 patients operated for the above cancers, 70 patients underwent a sentinel lymph node biopsy along with surgery for the primary. Localization was possible in all the patients (100%) . The time taken to localize the node decreased from 33 min to 16 min over the course of the learning curve (percentage change of-50%) . The median number of nodes isolated increased by 200% and the seroma in the nodal basin decreased by 26% . Recurrences in the nodal basin were commonest in penile cancer (16 . 6%), while those in the axilla (6 . 5%) could be salvaged surgically. Conclusion Sentinel node biopsy can be safely performed even without a hand-held gamma probe, provided strict inclusion criteria, a double dye technique and a dedicated follow up regimen are adhered to. Keywords Sentinel node biopsy, Breast cancer, Axilla, Penile cancer, Melanoma, Lymphoscintigraphy, Methylene blue *Correspondence: Ranganath Ratnagiri [pranganam@gmail.com](pranganam@gmail.com) 1Department of Surgical Oncology, Nizam’s Institute of Medical Sciences (NIMS), Hyderabad, India 2Department of Nuclear Medicine, NIMS, Hyderabad, India 3Department of Pathology, NIMS, Hyderabad, India 4Department of Medical Oncology, NIMS, Hyderabad, India 5Department of Radiation Oncology, NIMS, Hyderabad, India © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/l](vecommons.org/l)icenses/by-nc-nd/4.0/. Ratnagiri et al. World Journal of Surgical Oncology (2025) 23:285 Introduction Sentinel lymph nodes as proposed by Cabanas in 1977 represent the first node/ echelon of nodes which drain an organ [1]. The idea underlying a sentinel lymph node biopsy (SLNB) for melanoma, penile cancer or breast cancer, is the hypothesis that canc

FAQs

What was the study’s aim regarding sentinel lymph node biopsy?

To demonstrate safety and feasibility of sentinel node biopsy using methylene blue and SPECT CT lymphoscintigraphy.

Which patients and time period were included in the retrospective review?

Patients with breast cancer, penile cancer, and melanomas of the extremities who were clinically and radiologically node negative, treated between December 2019 and November 2024.

What key improvements were observed over the learning curve?

Localization time decreased from 33 minutes to 16 minutes, the median number of nodes isolated increased by 200%, and seroma in the nodal basin decreased by 26%.

Sep 23, 2026

Uploaded by Terk