Selective Sentinel Lymphadenectomy for Human Solid Cancer

Abstract

The Development of Lymphatic Mapping and Selective Lymphadenectomy -- Role of Lymphoscintigraphy for Selective Sentinel Lymphadenectomy -- Selective Sentinel Lymphadenectomy for Malignant Melanoma, Merkel Cell Carcinoma, and Squamous Cell Carcinoma -- Selective Sentinel Lymphadenectomy for Breast Cancer -- Sentinel Lymph Node Mapping in Colon and Rectal Cancer -- Sentinel Lymph Node Mapping in Esophageal and Gastric Cancer -- Sentinel Lymph Node Mapping in Lung Cancer -- Lymphatic Mapping and Sentinel Lymphadenectomy in Urology -- Selective Sentinel Lymphadenectomy for Gynecologic Cancer -- Selective Sentinel Lymphadenectomy for Head and Neck Squamous Cell Carcinoma -- Accurate Evaluation of Nodal Tissues for the Presence of Tumor is Central to the Sentinel Node Approach -- Molecular Diagnosis of Micrometastasis in the Sentinel Lymph Node -- Credentialing of Nuclear Medicine Physicians, Surgeons, and Pathologists as a Multidisciplinary Team for Selective Sentinel Lymphadenectomy -- Selective Sentinel Lymphadenectomy: Progress to Date and Prospects for the Future.Lymph node (LN) status is the most important prognostic indicator for the clinical outcome of patients in human solid cancer. Recent developments in sentinel lymph node (SLN) concept and technology have resulted in the application of this revolutionary approach to determine if cancer has metastasized. The underlying thesis in solid cancer biology is that metastasis generally starts in an orderly progression, often spreading through the lymphatic channels to the SLN. Thus, the logical approach is to harvest that specific SLN for thorough analysis. The most exciting possibility of selective sentinel lymphadenectomy (SSL) is that it will lead to early diagnosis of micrometastasis in regional LNs. Early diagnosis makes it useful as a clinical staging procedure, and opens up new opportunities to study micrometastasis and its evolution within the SLNs. New molecular and genetic tools may be used to dissect the mechanisms of lymphatic and hemotogenous routes of metastasis. If such mechanisms can be understood, new therapeutic advances may be developed to prevent the process of micrometastasis. *********************************************************************************** Minimally invasive surgery associated with reduced morbidity has transformed the management of cancer patients. Sentinel lymphadenectomy for staging and treatment of solid tumors is now standard of care in many settings. In this text, distinguished investigators review the technical aspects and clinical considerations related to this procedure. Steven T. Rosen, M.D. Series Editor.