Lymphoscintigraphy, lymphangiography, magnetic resonance imaging
Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki in Handbook of Venous and Lymphatic Disorders, 2017
The sentinel lymph node is the first lymph node that filters lymph draining from the tumor site. Lymphatic drainage varies greatly in each individual. Lymphoscintigraphy maps the drainage pattern in each patient. The Tc-fSC particles injected adjacent to the tumor site are trapped in the sentinel node. Pre-operative lymphoscintigraphy is valuable for identifying lymphatic drainage and sentinel node location. A hand-held γ-probe is then used intra-operatively to identify the lymph nodes where radioactivity has accumulated. Tracer injections in the dermis, subcutaneous tissue, and peri-tumor locations have all been used with reasonable results. Most reports have agreed that a combination of radioactive tracer with a visible dye (isosulfan blue) yields the best results. Investigators have reported the identification of a sentinel node in well over 90% of patients. The utility and long-term impact of sentinel node mapping and examination in the management of melanoma and breast cancer are well established, but are beyond the scope of this chapter.20–23
Premalignant and malignant disease of the lower genital tract
Helen Bickerstaff, Louise C Kenny in Gynaecology, 2017
Sentinel lymph node biopsy is an attempt to address this issue. The sentinel node is the first node in the lymph node basin to receive lymphatic drainage from a tumour. The theory states that if the sentinel lymph node is negative then the rest of the lymph node basin must be negative for metastatic disease too. Therefore, if the sentinel lymph node can be identified and carefully checked for metastatic disease, full groin lymphadenectomy can be reserved for those patients who really need it. Removing the sentinel lymph node is a far less morbid procedure than full groin lymphadenectomy. The sentinel lymph node principle has been established in tumours originating from other anatomical sites, including breast cancer and malignant melanoma. The data in vulval cancer look extremely promising and sentinel lymph node biopsy is likely to replace full groin lymphadenectomy as standard of care for carefully selected patients in the near future.
Principles of surgical oncology
Peter Hoskin, Peter Ostler in Clinical Oncology, 2020
A more conservative approach, sentinel lymph node mapping, is now the standard of care for breast cancer and melanoma. This entails the identification of the ‘sentinel’ lymph node. This is the node that is first to receive lymph from the tumour-bearing tissue. A vital blue dye and radiolabelled colloid microspheres are injected pre-operatively to allow perioperative identification of the lymph node(s) to be removed. If they are found to be involved by frozen section analysis or on definitive histological examination, a full lymph node dissection is mandatory. If this is negative, it is highly unlikely that other lymph nodes in that group will harbour cancer cells, and the patient may be spared the additional morbidity of the larger operation. The technique allows the identification of unusual patterns of lymphatic spread, e.g. to the internal mammary lymph nodes in breast cancer, or the axilla in truncal melanoma.
Does Wide Excisional Biopsy in Skin Cancer Prevent Finding The Real Sentinel Lymph Node?
Published in Journal of Investigative Surgery, 2020
Selami S Sirvan, Isil Akgun Demir, Fatih Irmak, Mesut Kafi, Kenan Budak, Semra Karsidag
Sentinel lymph node is defined as the first lymph node that drains tumor related lymphatic vessels. The SLN status is the most important determining factor of recurrence and malignant melanoma related deaths in malignant melanoma with intermediate thickness [4,6]. According to the incubator hypothesis, which is supported by clinical studies, early detection of local lymph node metastasis followed by regional lymph node dissection enhances survival by preventing dissemination of melanoma cells from the SLN [4,6,7]. SLNB is currently being used also for nonmelanoma skin cancers. Its use is prominent in plastic surgery especially for squamous cell skin cancers, although it is also used for atypical Spitz nevus, nevi with deep penetration, extra-mammarian Paget disease, and eccrine and apocrine sweat gland carcinomas [8,9].
Impact of Non-Steroidal Anti-Inflammatory Drugs on Recurrence and Survival after Melanoma Surgery: A Cohort Study
Published in Cancer Investigation, 2020
Bruno Luís de Castro Araujo, Jadivan Leite de Oliveira, José Francisco Neto Rezende, Washington Silva Noguera, Andréia Cristina de Melo, Luiz Claudio Santos Thuler
SLNB was performed as described elsewhere (21). This technique was employed to detect clinically occult nodal involvement. Before going to the operating room, technetium(99mTc) phytate radioisotope was injected around the primary melanoma or the scar of a previous resection, and subsequently, lymphoscintigraphy of the whole body and specific areas with planar or tomographic scans was performed for sentinel node mapping. After the administration of anesthesia, the patent blue dye was injected. During the procedure, the sentinel lymph nodes were located using both the gamma probe and visual lymphatic dye drainage. All blue-stained nodes and all nodes with greater than 10% of the hottest node’s radioactivity were resected. Melanoma wide margin resections were performed when appropriate, and simultaneously, complete regional lymphadenectomy was executed based on the results of the SLNB frozen section analysis.
Cutaneous adverse effects of methylene blue in an animal skin-flap model
Published in Acta Chirurgica Belgica, 2020
Sertaç Ata Güler, Sertaç Kırnaz, Turgay Şimşek, Can İlker Demir, Abdullah Güneş, Tonguç İşken, Nuh Zafer Cantürk, Nihat Zafer Utkan
Cancer is one of the leading causes of mortality in this century. Detecting the disease at an early stage is one of the most important factors for achieving a good prognosis in newly diagnosed cancer cases. SLNB plays a crucial role in diagnosing the early stage of the disease. The sentinel lymph node is defined as the first lymph node receiving direct lymphatic drainage from a primary tumor, therefore an SLN is the first possible lymph node to become involved when a metastasis occurs before the lymph flow from primary lesion goes to the other regional lymph nodes [1–3]. The sentinel lymph node biopsy is based on this principle and used for cancer staging by evaluating tumor status of SLN. The main benefit of SLNB is avoiding morbidity due to unnecessary radical lymph node dissections in patient management [4]. In 1992, it was reported that the SLNs were successfully detected in malignant melanoma patients by injecting isosulfan blue intradermally [5]. Later, the injection of radiocolloid material and detection of SLN by both preoperative imaging and intraoperative gamma probe in breast cancer patients was reported [6]. Nowadays, SLNB is performed as a standard procedure for breast cancer and melanoma patients [4]. The SLNB is a well-established, minimally invasive technique of axillary staging for breast cancer patients who are clinically node-negative. There are also other indications for SNLB including gastrointestinal malignancies (colorectal cancer, anal cancer, gastric cancer and esophageal cancer), head and neck tumors (thyroid, parathyroid and squamous cell cancer), non-small cell lung cancers.Figure 3
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