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Newer Modalities for the Detection and Assessment of the Sentinel Lymph Node

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Sentinel Node Biopsy in Breast Cancer

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Abstract

The combination of radioactive colloid (RI, Tc99) with a blue dye (BD) for visual reference has traditionally been regarded as the gold standard for the mapping and identification of sentinel lymph nodes (SLNs), following the first landmark trials validating the outcomes of SLN biopsy (SLNB) [1–4]. The isotope is usually injected in the sub-areolar region or within the parenchyma around the tumour, a few hours before the operation. The BD is injected intra-operatively under anaesthesia, and the breast is massaged to facilitate tracer migration towards the axilla. The tracers reach the SLN via the lymphatic system. The SLN is then detected using a hand-held gamma probe or by following a blue lymphatic to a blue SLN. The procedure is conventionally considered complete when the residual gamma probe signal in the axilla is less than 10% of the maximum signal of the lymph node retrieved [4]. This technique results in detection rates as high as 99% with a false-negative rate of less than 5% and axillary recurrence rates lower than 2% [5–7]. The procedure is reasonably intuitive, is easy to standardise and has therefore gained wide acceptance. This combined technique over time has become the benchmark or the reference for SLNB procedures.

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Authors and Affiliations

  1. Department of Surgical Sciences, Uppsala University, Uppsala, Sweden

    Andreas Karakatsanis

  2. Section for Breast Surgery, Department of Surgery, Uppsala University Hospital, Uppsala, Sweden

    Andreas Karakatsanis

  3. Department of Breast Surgery, Guy’s & St Thomas’ NHS Foundation Trust, London, UK

    Ashutosh Kothari

  4. King’s College, London, UK

    Ashutosh Kothari

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  1. Andreas Karakatsanis
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  1. Vardhman Mahavir Medical College Safdarjang Hospital, New Delhi, India

    Chintamani

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Karakatsanis, A., Kothari, A. (2023). Newer Modalities for the Detection and Assessment of the Sentinel Lymph Node. In: Chintamani (eds) Sentinel Node Biopsy in Breast Cancer. Springer, New Delhi. https://doi.org/10.1007/978-81-322-3994-9_8

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  • DOI: https://doi.org/10.1007/978-81-322-3994-9_8

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