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Purpose: Access to nuclear medicine department for sentinel node imaging remains an issue in number of hospitals in the UK and many parts of the world. Sentinella ® is a portable imaging camera used intra-operatively to produce real time visual localisation of sentinel lymph nodes., Methods: Sentinella ® was tested in a controlled laboratory environment at our centre and we report our experience on the first use of this technology from UK. Moreover, preoperative scintigrams of the axilla were obtained in 144 patients undergoing sentinel node biopsy using conventional gamma camera. Sentinella ® scans were done intra-operatively to correlate with the pre-operative scintigram and to determine presence of any residual hot node after the axilla was deemed to be clear based on the silence of the hand held gamma probe., Results: Sentinella ® detected significantly more nodes compared with CGC (p < 0.0001). Sentinella ® picked up extra nodes in 5/144 cases after the axilla was found silent using hand held gamma probe. In 2/144 cases, extra nodes detected by Sentinella ® confirmed presence of tumour cells that led to a complete axillary clearance., Conclusions: Sentinella ® is a reliable technique for intra-operative localisation of radioactive nodes. It provides increased nodal visualisation rates compared to static scintigram imaging and proves to be an important tool for harvesting all hot sentinel nodes. This portable gamma camera can definitely replace the use of conventional lymphoscintigrams saving time and money both for patients and the health system., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

One step nucleic acid (OSNA) is a molecular diagnostic assay for intra-operative detection of sentinel node metastases. This study compared OSNA with standard histopathology in 283 nodes from 170 patients to evaluate sensitivity, specificity and concordance of the two methods. Additional analysis was done to investigate how cytokeratin 19 mRNA copy number affects prediction of non-sentinel node positivity. OSNA sensitivity was 93.2% and specificity 95.8%. Concordance between OSNA and histology was 95.6%. In the patients who had axillary clearance, the OSNA mRNA copy number on the sentinel node had 100% negative predictive value for histologically proven metastasis. mRNA copy numbers <1400 were not associated with histologically proven metastasis in subsequent nodes at axillary clearance. OSNA is a reliable method for the intra-operative evaluation of axillary lymph node metastasis even when half of the lymph node is used. Identification of mRNA copy number threshold predicting the positivity of non-sentinel axillary nodes seems to be feasible and would be clinically important., (Copyright © 2014. Published by Elsevier Ltd.)

Langer's axillary arch is a relatively rare anatomical variation of latissimus dorsi muscle insertion. The clinical importance of this condition in axillary lymph node dissection (ALND) and lymphoedema as well as latissimus dorsi flap reconstruction has been described previously. Axillary vein obstruction in association with this condition has also been reported. We report two cases of Langer's axillary arch encountered during sentinel lymph node (SLN) biopsy which had some bearing on the procedure.