The Sentinel Lymph Node Concept

Sentinel lymph-node biopsy in head and neck cancer
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If cancer is found, the surgeon may remove additional lymph nodes, either during the same biopsy procedure or during a follow-up surgical procedure. SLNB may be done on an outpatient basis or may require a short stay in the hospital. SLNB is usually done at the same time the primary tumor is removed. In some cases the procedure can also be done before or even after depending on how much the lymphatic vessels have been disrupted removal of the tumor.

SNLB helps doctors stage cancers and estimate the risk that tumor cells have developed the ability to spread to other parts of the body. If the sentinel node is negative for cancer, a patient may be able to avoid more extensive lymph node surgery, reducing the potential complications associated with having many lymph nodes removed. All surgery to remove lymph nodes, including SLNB, can have harmful side effects , although removal of fewer lymph nodes is usually associated with fewer side effects, particularly serious ones such as lymphedema.

The potential side effects include:. SLNB is most commonly used to help stage breast cancer and melanoma. Breast cancer cells are most likely to spread first to lymph nodes located in the axilla , or armpit area, next to the affected breast. However, in breast cancers close to the center of the chest near the breastbone , cancer cells may spread first to lymph nodes inside the chest under the breastbone, called internal mammary nodes before they can be detected in the axilla. The number of lymph nodes in the axilla varies from person to person; the usual range is between 20 and Historically, all of these axillary lymph nodes were removed in an operation called axillary lymph node dissection , or ALND in women diagnosed with breast cancer.

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This was done for two reasons: to help stage the breast cancer and to help prevent a regional recurrence of the disease. Regional recurrence of breast cancer occurs when breast cancer cells that have migrated to nearby lymph nodes give rise to a new tumor. Sentinel lymph node biopsy of the breast. The sentinel node s the first lymph node s to take up the material is are removed and checked for cancer cells last panel.

However, because removing multiple lymph nodes at the same time increases the risk of harmful side effects , clinical trials were launched to investigate whether just the sentinel lymph nodes could be removed. Those women in the two groups whose sentinel lymph node s were negative for cancer a total of 3, women were then followed for an average of 8 years. The researchers found no differences in overall survival or disease-free survival between the two groups of women.

The other trial included women with tumors up to 5 cm in the breast and one or two positive sentinel lymph nodes. All of the women were treated with lumpectomy , and most also received adjuvant systemic therapy and external-beam radiation therapy to the affected breast. After extended follow-up, the two groups of women had similar year overall survival, disease-free survival, and regional recurrence rates 7. Research indicates that patients with melanoma who have undergone SLNB and whose sentinel lymph node is found to be negative for cancer and who have no clinical signs that cancer has spread to other lymph nodes can be spared more extensive lymph node surgery at the time of primary tumor removal.

Sentinel lymph node biopsy in a patient with melanoma. Sentinel lymph node biopsy can be done before or after the tumor is removed. This large randomized phase 3 clinical trial , which included more than 1, patients, compared the potential therapeutic benefit of SLNB plus the immediate removal of the remaining regional lymph nodes called completion lymph node dissection, or CLND with SNLB plus active surveillance , which included regular ultrasound examination of the remaining regional lymph nodes and treatment with CLND if signs of additional lymph node metastasis were detected.

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Sentinel Lymph Node Biopsy

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SLN, sentinel lymph node; NA, not available. Therefore, data were pooled using a random effects model. The pooled detection rate of SLN was Forest plot showing the detection rate of sentinel lymph node biopsy in the 17 studies.

The Sentinel Lymph Node Concept

Forest plot showing A the sensitivity and B the negative predictive value of sentinel lymph node biopsy in the 17 studies. The results of the subgroup analyses are presented in Table III. When considering the route of surgery, the pooled SLN detection rate in the laparoscopy subgroup 4 studies was The sensitivity and negative predictive values of the two subgroups were When considering the detection method, the pooled SLN detection rate in dye subgroup 2 studies , the isotope subgroup 4 studies and the combination of the two subgroup 11 studies was The pooled negative predictive value of the combination subgroup was higher compared to that of the dye and isotope subgroups.

In the present meta-analysis we pooled the detection rate, sensitivity and negative predictive values with data extracted from 17 studies. The overall SLN detection rate was Subgroup analyses were performed for the three factors mentioned above. First, in the subgroup analysis according to the route of surgery, we observed that the detection rate of laparoscopy was superior to that of laparotomy Furthermore, laparoscopy exhibited a higher sensitivity compared to laparotomy Therefore, the technologically improved laparoscopic equipment is recommended for the surgical treatment of cervical cancer.

Second, the SLN detection rate in cervical cancer with the combination of dye and isotope In addition, the pooled negative predictive value exhibited the same trend. Van de Lande et al 29 also reported that the combination of a radionuclide with a blue dye was the optimal method of SLN detection in a systematic review that mainly compared the three methods. IHC may accurately determine the lymph node status, since it is able to detect micrometastases, compared to HE alone In this meta-analysis, the predetermined search strategy described above was used for the selection of studies from the available literature.

Several studies on SLNB in cervical cancer were identified; however, the data used by each study to describe the performance characteristics were inconsistent, due to the different objectives of the studies. Several studies reported data that were not sufficient to calculate sensitivity or negative predictive values, leading to the exclusion of those studies. Furthermore, in view of the limited time and capacity, newly published literature was not included in our study.

In conclusion, we analyzed the performance characteristics of SLNB in cervical cancer using data from 17 studies, including a total of 1, patients.

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Although SLNB appears to exhibit a satisfactory diagnostic performance in the meta-analysis, further studies are required to determine the true performance of the clinical application of SLNB in cervical cancer. Cabanas RM: An approach for the treatment of penile carcinoma. Arch Surg. J Clin Oncol. Gynecol Oncol. Eur J Surg Oncol.

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