Elsevier

Current Problems in Surgery

Volume 35, Issue 11, November 1998, Pages 951, 953-1016
Current Problems in Surgery

Minimal access surgery for staging regional lymph nodes: The sentinel-node concept

https://doi.org/10.1016/S0011-3840(98)80008-7Get rights and content

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      Sentinel lymph node biopsy (SLNB) has been established as the gold standard for axillary staging and has supplanted axillary lymph node dissection (ALND) as a means of regional nodal staging in clinically and radiologically node-negative breast cancer [3–7]. SLNB provides adequate axillary nodal staging information to guide further regional and systemic treatment, whilst it spares the patient the increased risk of complications associated with ALND, most importantly lymphedema, motor deficit and dysesthesia of the operated arm [6,8–10]. However, the appropriateness of SLNB in specific patient subgroups, as well as the optimal further management of the positive sentinel lymph node (SLN) remain highly debatable.

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      In this study, we hypothesize that the accuracy of the hottest nodes for predicting metastasis might be related to the number of draining channels and the location of the hottest nodes, i.e., the lymphoscintigraphic patterns of hottest nodes. When the hottest nodes are the first nodes in cases with single draining channels, they are most likely the ones that harbor metastasis [2–4]. Conversely, when there are alternative draining routes or the hottest nodes are not first nodes, the likelihood of detecting metastasis with the hottest nodes is considerably lessened.

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      Although many individuals had recognised the importance of the sentinel-node idea, its relevance to clinical practice was not fully appreciated until the results of studies undertaken in patients with melanoma in the late 1980s and early 1990s were reported.4,27 Within a few years, the validity of the sentinel-node hypothesis had been confirmed in clinical studies of patients with melanoma treated at other centres, initially by tracing lymphatics after injection of vital blue dye at the primary melanoma sites28,29 (figure 1), and subsequently by identification of sentinel nodes as so-called hot nodes by use of a hand-held gamma probe during surgery after radiolabelled colloid had been injected intradermally at the primary melanoma site before surgery.30–33 The technique of selective sentinel-node biopsy was used subsequently in patients with breast cancer34–42 and other types of primary malignant disease, including thyroid, skin (squamous-cell carcinoma and Merkel-cell carcinoma), lung, stomach, colon, vulva, uterus, prostate, and penis.43–50

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