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British Journal of Radiology (2009) 82, 41-48
© 2009 British Institute of Radiology
doi: 10.1259/bjr/99732265
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Sentinel lymph node biopsy using dynamic lymphoscintigraphy combined with ultrasound-guided fine needle aspiration in penile carcinoma

J W CRAWSHAW, FRCR 1 P HADWAY, MSc, MRCS 2 D HOFFLAND, DCR 1 S BASSINGHAM, DCR, DRI 1 C M CORBISHLEY, FRCPath 3 Y SMITH, MRCS 2 J PILCHER, FRCR 1 R ALLAN, FRCR 1 N A WATKIN (Urol), MA, FRCS 2 and S D HEENAN, FRCP, FRCR 1

Departments of 1 Radiology, 2 Urology and 3 Cellular Pathology, St George's Hospital, Blackshaw Road, London, UK


Figure 1
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  		Figure 1. Anterior planar dynamic scan(summed 1 min image) of the groins, demonstrating bilateral drainage to three lymph nodes on the right and one on the left (arrows).

 

Figure 2
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  		Figure 2. Anterior and lateral planar static images of the groin of a different patient, with an additional anterior transmission scan showing lymphatic drainage to bilateral sentinel lymph nodes. Labels A1–3 represent the right sentinel lymph nodes; label B1 indicates a left sentinel lymph node.

 

Figure 3
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  		Figure 3. Anterior and lateral planar static images of the groin, demonstrating unilateral drainage to a cluster of lymph nodes in the left groin. Labels A1–3 represent three left sentinel lymph nodes.

 

Figure 4
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  		Figure 4. (a) High-resolution ultrasound image showing a normal lymph node in the right groin. It has a normal echogenic fatty hilum, with peripheral hypoechogenicity. (b) High-resolution ultrasound image showing an abnormal lymph node in the right groin. The node is hypoechoeic, irregularly shaped and has lost the central fatty hilum. The node demonstrated abnormal vascularity (not shown). Fine needle aspiration cytology was performed, which confirmed metastatic disease.

 

Figure 5
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  		Figure 5. Intra-operative image locating a sentinel lymph node in the left groin using a hand-held gamma probe.

 

Figure 6
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  		Figure 6. Immunohistochemistry with a LP34 stained section, which stains high molecular weight keratins, indicating metastatic squamous cell carcinoma(arrow).

 




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