Sentinel lymphnode
- 2. What is a sentinel lymph node? • A sentinel lymph node is defined as the first lymph node to which cancer cells are most likely to spread from a primary tumor. • Sometimes, there can be more than one sentinel lymph node.
- 3. What is a sentinel lymph node biopsy? • It is a procedure in which the sentinel lymph node is identified, removed, and examined to determine whether cancer cells are present. • A positive SLNB result indicates that cancer may be present in other nearby regional lymph nodes and, possibly, other organs.
- 4. • This information can help a doctor determine the stage of the cancer (extent of the disease within the body) and develop an appropriate treatment plan. • Also, reduces the potential adverse effects of lymph node surgery like Lymphedema, numbness, tingling, or pain at the site of the surgery
- 5. Uses • Breast • Melanoma • Others: colorectal cancer, gastric cancer, esophageal cancer, head and neck cancer, thyroid cancer, and non-small cell lung cancer
- 7. Breast • SNB for smaller tumors (T1 and T2) • multicentric tumors • DCIS, when mastectomy or immediate reconstruction is planned • for older or obese patients • in male breast cancer
- 8. Intra operative assessment a) A positive imprint/smear is of immediate practical assistance, but negative findings are not definitive evidence that a node is tumor free. b) The quality of frozen tissue preparations is seldom as good as those prepared from well- fixed tissue, and incomplete sections may exclude the critical subcapsular sinus. Prior freezing may compromise the quality of paraffin section histology.
- 9. Sampling of SLN • Limited step sections from the block (top level plus one or two sections cut at 200- to 500- μm intervals into the block) enhance detection of micrometastases by allowing evaluation of more of the subcapsular sinus, the location in which micrometastases are most often found. • Superficial serial sections limit sampling to the upper levels of the block.
- 10. • Help to detect, macrometastases (> 2.0 mm) and most micrometastases (> 0.2 mm to 2.0 mm pN1mi) will be detected on limited H&E- stained step sections. • In some patients, isolated tumor cells and clusters (≤ 0.2 mm or <200 confluent cellpN0i+) will also be detected with use of this sectioning technique, particularly if immunohistochemical analysis (IHC) is utilized.
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