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

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

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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