Detection of the sentinel lymph node in breast cancer

Abstract

The concept of SLN has been well validated and is the standard of care in early breast cancer. A multidisciplinary approach and structured training is the key to the successful introduction of the technique.

Sentinel lymph node biopsy in early breast cancer surgery – Working with the risks of vital blue dye to reap the benefits

“…The uptake kinetics of each mapping agent are different, but the function of both is to localise the sentinel node. It is thought that nanocolloids become entrapped within the sentinel lymph nodes either through a function of their particulate size 13,14 (the larger hydrodynamic diameter of 50-100nm for colloid requires a transit time of usually more than 1 hour 15 ) or because of phagocytosis by leukocytes which migrate to and are retained within the draining lymph nodes 16 . These entrapment processes are unlikely to be mutually exclusive, and other mechanisms may also exist, but the end result is localisation of the nanocolloid within the sentinel nodes rather than its diffuse spread to secondary nodes.…”

Preoperative Scintigrams to Identify the Sentinel Lymph Node in Breast Cancer: a Waste of Time?

“…There is a well-known fact that accurate SLN detection with the combined method requires the surgeon to go through the learning curve [17].…”

“…Nonvisualization of SLN on preoperative scintigrams have been documented and been attributed to technical errors involving improper or inadequate injection of radioactive colloid, inappropriate timing of scintigram, or true lymphatic blocking from cancer cells [17].…”

“…Anatomical changes in breast with fatty tissue deposition, reduced tissue turgor in elderly patients, and those with high BMI are contributing factors to scintigram failure rates [17,18]. Obesity can make scintigram use more difficult; increased adipose tissue may act as a barrier to successful intradermal injection of isotope, causes scattered radiation and soft tissue attenuation, leading to poor signal-to-noise ratio [21].…”

Lymphoscintigraphy and clinic

“…The fundamental innovation of the use of a radionuclide as a tracer is due to Alex and Krag 1993, which described the intradermal injection of sulfour-colloid labeled with 99mTc, followed by the lymphoscintigraphic study and surgical radiolocalization [37]. The concept of the sentinel lymph node since then has been studied extensively, validated by numerous studies and is today universally considered to be pro-procedure standard for melanoma and for cancers of the breast [38][39][40][41].…”