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Should sentinel lymph-node biopsy be used routinely for staging melanoma and breast cancers?

Nature Clinical Practice Oncology volume 2, pages 448–455 (2005)Cite this article

Abstract

The sentinel lymph node (SLN) is the lymph node that represents the 'gate-keeper' of the lymphatic basin; it is the first node to receive lymphatic drainage from the site of the primary tumor. SLN biopsy is a staging procedure and should be considered as such; it is not meant to be a therapeutic operation. The SLN can be mapped and biopsied using tracer agents (e.g. radiolabelled colloid and/or vital blue dye), which are injected around the primary tumor site. Pathologic analysis of the SLN using a combination of serial sectioning of the node, standard hematoxylin and eosin staining, and immunohistochemistry decreases the false-negative rate compared with traditional nodal processing. SLN biopsy is associated with lower morbidity than full lymphadenectomy. The SLN technique accurately reflects the metastatic status of the regional lymph-node basin; recurrent nodal disease in the mapped basin is rare following a tumor-free SLN biopsy result. The objectives of this review are to provide a current and concise overview of the current literature on SLN biopsy and describe its role in clinical oncology.

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Figure 1: Preoperative lymphoscintigram on a midline truncal melanoma demonstrating bilateral axillary nodal drainage.
Figure 2: Pathologic analysis of a sentinel lymph node containing metastatic melanoma.
Figure 3: Sentinel lymphatic mapping in a patient with invasive breast cancer demonstrating a blue stained lymphatic channel leading to a blue stained sentinel node.
Figure 4: Intraoperative lymphatic mapping and sentinel lymph node biopsy in a patient with invasive breast cancer.

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Acknowledgements

We would like to thank the University of Louisville and the Center for Advanced Surgical Technologies of Norton Hospital for their support.

Author information

Authors and Affiliations

  1. Assistant Professors of Surgical Oncology,

    Charles R Scoggins, Anees B Chagpar, Robert CG Martin & Kelly M McMasters

  2. James Graham Brown Cancer Center Multidisciplinary Breast Program and Director of the Norton Breast Health Program,

    Charles R Scoggins, Anees B Chagpar, Robert CG Martin & Kelly M McMasters

  3. Sam and Lolita Weakley Professor and Chairman of the Department of Surgery, all at the University of Louisville, Louisville, KY, USA

    Charles R Scoggins, Anees B Chagpar, Robert CG Martin & Kelly M McMasters

Authors
  1. Charles R Scoggins
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  2. Anees B Chagpar
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Corresponding author

Correspondence to Kelly M McMasters.

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Competing interests

K McMasters has been on the Speaker's bureau for Schering Oncology Biotech and Ethicon, and has served as a consultant to National Genetics Corporation, Veridex, and Ethicon. The other authors declared they have no competing interests.

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Scoggins, C., Chagpar, A., Martin, R. et al. Should sentinel lymph-node biopsy be used routinely for staging melanoma and breast cancers?. Nat Rev Clin Oncol 2, 448–455 (2005). https://doi.org/10.1038/ncponc0293

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