Sentinel Lymph Node Technique Research Articles

Intraoperative lymphatic mapping for non–small cell lung cancer: The sentinel node technique

Background:The purpose of the study was to determine the accuracy and role of the sentinel node technique in patients with non–small cell lung cancer. Methods: This study was carried out on 36 consecutive patients undergoing lung resection. Peritumoral tissue was infiltrated with isosulfan blue dye and the first lymph node to stain was identified as a sentinel node. Sensitivity and specificity of the sentinel node in predicting the status of other lymph node stations were determined. Results: Seventeen patients had sentinel lymph nodes. In 9 of these 17 cases neither the sentinel node nor any other lymph node contained metastatic carcinoma. In 5 cases the sentinel node was in the mediastinum and documented unexpected N2 disease. In 19 patients no sentinel node was found. Final lymph node statuses were N0 in 13 patients, N1 in 5, and N2 in 1. Conclusions: The use of isosulfan blue for intraoperative lymphatic mapping is feasible. The specificity in our experience was good; 9 of 9 patients with negative sentinel nodes were found to be N0 on the final pathology report. Unexpected N2 disease was found in 5 patients. The accumulation of further experience will determine the role of the sentinel node technique in patients with non–small cell lung cancer. (J Thorac Cardiovasc Surg 1999;117:220-4)

Sentinel node localization in breast cancer

The status of the axillary nodes is the strongest known prognostic variable in patients with early breast cancer, and is routinely used in planning postoperative therapy. Conventional axillary lymph node dissection is limited by sampling error and potential morbidity. Sentinel node techniques have revolutionized the management of axillary nodes. Accurate identification and focused histologic evaluation of the sentinel node allow accurate prediction of the tumor status of other axillary nodes, thereby avoiding the morbidity and expense of a complete axillary dissection in node-negative patients. Radiotracer techniques play an important role in the preoperative and intraoperative localization of the sentinel nodes. Optimal localization of the sentinel node requires the use of both preoperative lymphoscintigraphy and intraoperative radiosensitive probes. Lymphoscintigraphy also identifies patients with lymphatic drainage to sites other than the axilla, thereby allowing more appropriate treatment and follow-up in this subset of patients. Procedures for localizing sentinel nodes require an understanding of the kinetics of the radiopharmaceuticals or other tracers used and the detection devices employed in each institution. Both surgical and nuclear medicine personnel should understand these principles, and close cooperation between surgeons, nuclear medicine physicians, and pathologists is essential for the application of sentinel node techniques.

Sentinel Lymph Node Technique for Staging of Breast Cancer

Lymphatic mapping and sentinel lymphadenectomy is becoming an important surgical technique for assessing axillary status in breast cancer. In experienced hands, it can be successfully performed in >90% of cases. The morbidity of sentinel lymphadenectomy is minimal, considerably less than the 15%-20% rate of complications associated with axillary lymph node dissection. Moreover, excision of the sentinel node provides a specimen for focused histopathologic analysis and experimental studies using sensitive immunohistochemical techniques and even reverse transcriptase polymerase chain reaction, which may improve detection of axillary metastases. Intraoperative mapping of the lymphatic tract draining to the sentinel node may use vital blue dye and/or radioactive tracer. The rate of sentinel node detection exceeds 90% with either agent alone or in combination. Because definitive follow-up data are not yet available, intraoperative lymphatic mapping and sentinel lymphadenectomy should be considered an experimental staging adjunct rather than a therapeutic modality.

The axilla: to clear or not to clear? That is the question!

The prime objectives for axillary dissection are staging and treatment to cure. No physical examination, no imaging techniques, and no tumor markers can replace axillary dissection for staging. Further, axillary node status in potentially curable breast carcinomas is still considered the single best predictor of outcome and the primary determinant of the use of systemic therapy. Finally, locoregional tumor control seems to improve survival, emphasizing meticulous axillary dissection. Today, the question to be asked is not whether or not to clear the axilla; rather, the question should go: How do we distinguish node-negative patients from those who are node-positive without clearing the axilla unnecessarily? No surgeon would advocate dissecting the axilla in node-negative patients if nodal status could be ascertained by a different technique. Ongoing trials addressing the reliability of the sentinel node technique seem promising, and this technique may perhaps in the near future solve the problem of distinguishing node-negative patients from those with axillary spread. For the time being, the necessity of determining axillary status and to treat for cure can hardly be questioned. Therefore, once axillary spread has been demonstrated in one way or another, an adequate and meticulous axillary dissection should be performed.

Lymphatic Mapping and Sentinel Node Biopsy in Breast Cancer

To the Editor. —The study by Dr Albertini and colleagues 1 confirms our sentinel node hypothesis in breast cancer. Since our group began investigating the sentinel node technique for breast cancer 5 years ago, we have performed nearly 400 mapping procedures using isosulfan blue dye to identify the first axillary lymph node draining a primary breast cancer, 2,3 and have abandoned routine axillary lymph node dissection. As reported in a summary of our last 100 cases, dye-based mapping in our hands has reached an accuracy of 100%, with a 93% rate of sentinel node detection. 4 Thus, the authors' comment, Previous studies have used either the vital blue dye or the radiocolloid alone, with lower success rates reported, is not correct. In addition, the use of preoperative lymphoscintigraphy for inner-quadrant lesions has increased our detection rate even further. Although we have started to evaluate the combined use of blue dye