Sentinel node biopsy in oncology a breif overview
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Sentinel lymph node biopsy (SLNB) is crucial for accurately staging melanoma patients and predicting survival, particularly in clinical stage I/II cases. The procedure involves injecting a radiotracer to facilitate imaging of the lymphatic drainage, which can be unpredictable, especially in head and neck melanomas. Additionally, SLNB techniques vary for different cancers, with significant importance placed on preoperative lymphoscintigraphy for cancers like cervical and colorectal cancer to ensure accurate identification of sentinel nodes.
Sentinel node biopsy in oncology a breif overview
- 1. Sentinel node biopsy in oncology: beyond breast cancer RAMIN SADEGHI, MD
- 2. Melanoma
- 3. Melanoma SLNB is a surgical procedure developed to accurately stage patients with cutaneous melanoma through pathologic assessment of the regional nodal basin(s) and to provide prognostic information for patients with clinical stage I/II melanoma (no clinical or radiographic evidence of nodal disease). In patients with clinical stage I/II melanoma, SLN status is the strongest predictor of survival.
- 5. Melanoma Injection of the radiotracer ◦ is done in a peri-tumoral fashion (intradermal or subcutaneous), and both same-day and 2-day protocols worked well
- 6. Melanoma Imaging ◦ Imaging using planar and SPECT/CT is mandatory in sentinel node mapping of melanoma as lymphatic drainage of melanoma can be unpredictable and into multiple basins, especially in the trunk or head and neck melanomas ◦ Imaging should cover all potentially relevant lymphatic basins: for example, for limbmelanomas, the entire limb, including intercalary nodes, and for trunk melanoma, bilateral axillary and inguinal areas should be imaged. ◦ Imaging can also show intercalary sentinel nodes such as epitrochlear in upper limb and popliteal in lower limb melanomas. Without preoperative lymphoscintigraphy, the identification of intercalary nodes would be almost impossible despite important prognostic and diagnostic implications
- 9. Melanoma In the case of a lower-extremity melanoma with iliac nodes on the same lymphatic channel as a more proximal superficial femoral SLN, excision of the second order nodes may be omitted. However, if they are on a distinct lymphatic channel or there is uncertainty as to their drainage pattern, these SLNs should be identified and excised.
- 11. Cloquet sentinel
- 12. External iliac
- 13. Intercalary node
- 16. Uterine cervix cancer Preoperative lymphoscintigraphy (especially with SPECT/CT) is of utmost importance in cervical cancer patients. It can show technical failures such as inappropriate injections or unusual locations of the sentinel nodes
- 18. A patient with uterine cervix cancer
- 19. Bilateral external iliac sentinel nodes
- 23. Endometrial cancer A cervical injection with dye has emerged as a useful and validated technique for identification of lymph nodes that are at high risk for metastases. ◦ Superficial (1–3 mm) and optional deep (1–2 cm) cervical injection leads to dye delivery to the main layers of lymphatic channel origins in the cervix and corpus, namely the superficial subserosal, intermediate stromal, and deep submucosal lymphatic sites of origin.
- 25. Vulvar cancer
- 28. Penile cancer
- 30. Unusual location of a mid-thigh sentinel node in a penile cancer patient
- 32. The injection techniques for colorectal cancers are very diverse: in vivo injections (submucosal or subserosal, intraoperatively or preoperatively using endoscopy) and ex vivo technique (injections following removal of the tumor) have both done well. ◦ In in vivo techniques, the mapping material is injected in the submucosal or subserosal areas around the tumor. Lymphoscintigraphy can be done if available. ◦ In ex vivo technique, the mapping material is injected in a subserosal fashion around the resected tumor
- 34. Ex vivo sentinel node mapping in a colon cancer
- 35. Head and neck cancers