{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T03:22:59Z","timestamp":1784604179407,"version":"3.55.0"},"reference-count":54,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nuklearmedizin"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:p>Die Autoren ver\u00f6ffentlichen eine Verfahrensanweisung zur szintigrafischen Lokalisation von W\u00e4chterlymphknoten beim malignen Melanom, beim Mammakarzinom, beim Penis- und Vulvakarzinom sowie bei Kopf-Hals-Tumoren und beim Prostatakarzinom. Wesentliche Ziele der szintigrafischen W\u00e4chterlymphknotendiagnostik bestehen in der Minimierung des Operationsausma\u00dfes und der postoperativen Morbidit\u00e4t sowie der Optimierung der histopathologischen Aufarbeitung durch Fokussierung auf die relevanten Lymphknoten. Die W\u00e4chterlymphknotenszintigrafie trifft selbst keine Aussage zu einem evtl. tumor\u00f6sen Befall und ist nicht indiziert, wenn bereits eine lymphogene (Ausnahme Prostata-Ca) oder Fernmetastasierung diagnostiziert ist. Es werden Vorgehensweisen zur Durchf\u00fchrung zusammengestellt, die zum Ziel haben, den oder die W\u00e4chterlymphknoten zuverl\u00e4ssig und mit hoher Nachweisrate typischerweise in einem fr\u00fchen Stadium einer Tumorerkrankung zu detektieren. Neue Aspekte in dieser \u00fcberarbeiteten Leitlinie sind neue Radiopharmaka wie Tilmanocept und Tc-99m-PSMA sowie die SPECT\/CT, die besonders bei Genitaltumoren und im Kopf-Hals-Bereich die anatomische Orientierung erleichtert. Abgewertet wird die Bedeutung der initialen dynamischen Lymphszintigrafie beim\u00a0Mammakarzinom. Die Strahlenexposition des Patienten\/der Patientin ist so niedrig, dass Schwangerschaft keine grunds\u00e4tzliche Kontraindikation darstellt. Bei Schwangerschaft wird bevorzugt ein 1-Tages-Protokoll eingesetzt.\u00a0Aufgrund der sehr geringen Strahlenexposition von &lt;\u200a1\u200amSv\/Jahr m\u00fcssen auch Operateur, OP-Personal und Pathologe selbst bei h\u00e4ufiger Durchf\u00fchrung der Sentinel-Lymphonodektomie (SLNE) nicht als beruflich strahlenexponierte Personen gef\u00fchrt werden. Aspekte der Qualit\u00e4tssicherung wurden neu aufgenommen (Szintigramm, \u00dcberpr\u00fcfung der Messsonde, 6\u200ah SLN-Kurs f\u00fcr Operateure, zertifizierte Brustzentren, \u00dcberpr\u00fcfung durch die \u00c4rztlichen Stellen).<\/jats:p>","DOI":"10.1055\/a-2319-8306","type":"journal-article","created":{"date-parts":[[2024,5,24]],"date-time":"2024-05-24T23:06:18Z","timestamp":1716591978000},"page":"233-246","source":"Crossref","is-referenced-by-count":1,"title":["DGN-Handlungsempfehlung (S1-Leitlinie) \u2013 Version 3"],"prefix":"10.1055","volume":"63","author":[{"given":"M.","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Klinik und Poliklinik f\u00fcr Nuklearmedizin, Universit\u00e4tsklinikum K\u00f6ln"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Hohberg","sequence":"additional","affiliation":[{"name":"Klinik und Poliklinik f\u00fcr Nuklearmedizin, Universit\u00e4tsklinikum K\u00f6ln"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Felcht","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Dermatologie, Venerologie und Allergologie, Universit\u00e4tsmedizin Mannheim (Vertreter der DDG)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"K\u00fchn","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Frauenheilkunde und Geburtshilfe, Klinikum Esslingen (Vertreter der DGGG \u2013 Mamma-Ca)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Eichbaum","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Gyn\u00e4kologie und gyn\u00e4kologische Onkologie, Helios Dr.-Horst-Schmidt-Kliniken Wiesbaden (Vertreter der DGGG \u2013 Genitaltumoren)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. J.","family":"Krause","sequence":"additional","affiliation":[{"name":"Klinik und Poliklinik f\u00fcr Nuklearmedizin, Universit\u00e4tsklinikum Rostock"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. K.","family":"Z\u00f6phel","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Nuklearmedizin, Klinikum Chemnitz"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Kotzerke","sequence":"additional","affiliation":[{"name":"Klinik und Poliklinik f\u00fcr Nuklearmedizin, Universit\u00e4tsklinikum Dresden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Deutsche Dermatologische Gesellschaft (DDG), vertreten durch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Prof. Dr. M. Felcht (Klinik f\u00fcr Dermatologie, Venerologie und Allergologie, Universit\u00e4tsmedizin Mannheim)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Deutsche Gesellschaft f\u00fcr\u00a0Gyn\u00e4kologie und Geburtshilfe (DGGG), vertreten durch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Prof. Dr. T. K\u00fchn (Klinik f\u00fcr Frauenheilkunde und Geburtshilfe, Klinikum Esslingen) und","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Prof. Dr. M. Eichbaum (Klinik f\u00fcr Gyn\u00e4kologie und gyn\u00e4kologische Onkologie, Helios\u00a0Dr.-Horst-Schmidt-Kliniken Wiesbaden)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2024,5,24]]},"reference":[{"key":"ref1","first-page":"1414","article-title":"Procedure guideline for lymphoscintigraphy and the use of intraoperative gamma probe for sentinel lymph node localization in melanoma of intermediate thickness 1.0","volume":"43","author":"N Alazraki","year":"2002","journal-title":"J Nucl Med"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"1915","DOI":"10.1007\/s00259-009-1248-0","article-title":"Joint practice guidelines for radionuclide lymphoscintigraphy for sentinel node localization in oral \/ oropharyngeal squamous cell carcinoma","volume":"36","author":"L WT Alkureishi","year":"2009","journal-title":"Eur J Nucl Med Mol Imaging"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"3708","DOI":"10.1245\/s10434-015-4382-x","article-title":"[(99m)Tc]Tilmanocept Accurately Detects Sentinel Lymph Nodes and Predicts Node Pathology Status in Patients with Oral Squamous Cell Carcinoma of the Head and Neck: Results of a Phase III Multi-institutional Trial","volume":"22","author":"A Agrawal","year":"2015","journal-title":"Ann Surg Oncol"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"1750","DOI":"10.1007\/s00259-015-3135-1","article-title":"EANM practice guidelines for lymphoscintigraphy and sentinel lymph node biopsy in melanoma","volume":"42","author":"C Bl\u00fcmel","year":"2015","journal-title":"Eur J Nucl Med Mol Imaging"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1055\/s-2006-921423","article-title":"Strahlenexposition des Personals bei der Sentinel-Lymph-Node-Diagnostik","volume":"29","author":"W Brenner","year":"2006","journal-title":"Der Nuklearmediziner"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1016\/S0140-6736(97)08260-3","article-title":"Immediate or delayed dissection of regional nodes in patients with melanoma of the trunk: a randomised trial. 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