Der Chirurg

, Volume 75, Issue 8, pp 751–755 | Cite as

Zur Methodik des Sentinel Lymph Node Mapping

Leitthema

Zusammenfassung

Das Sentinel-Lymphknoten-Mapping (sentinel: der Wächter) ist ein diagnostisches Verfahren, mit dessen Hilfe eine recht genaue Aussage über den Nodalstatus eines Tumorpatienten zu treffen ist und dies ohne die Morbidität der radikalen Lymphadenektomie. Es basiert auf der Annahme, dass es für jeden Tumor einen oder mehrere Lymphknoten gibt, die als erste von Metastasen befallen werden. Nach histopathologischer Untersuchung dieser Sentinel-Lymphknoten kann der Lymphknotenstatus des tumorabhängigen Lymphabflusses zuverlässig vorhergesagt werden. Es hat sich in diesem Zusammenhang bei bisher allen untersuchten Entitäten gezeigt, dass auch die Lymphknotenmetastasierung per continuitatem erfolgt und nicht „de principe“ in allen Kompartimenten besteht. So wurde beim Mamma- und beim Magenkarzinom bewiesen, das es sog. Skip-Metastasen (das Überspringen von Kompartimenten) kaum gibt.

Die Hauptziele des Sentinel Lymph Node Mapping sind also die Verbesserung des Stagings durch Detektion der Lymphknoten, die mit höchster Wahrscheinlichkeit als erste Lymphknotenmetastasen entwickeln und zudem die Reduktion der Morbidität durch Individualisierung der Indikation zur radikalen Lymphadenektomie.

Schlüsselwörter

Sentinel-Lymphknoten Lymphadenektomie Karzinome des Gastrointestinaltrakts 

Methods of sentinel lymph node mapping

Abstract

Sentinel lymph node mapping is used as a diagnostic method in order to increase staging accuracy without the well-known morbidities of radical lymphadenectomy. The sentinel node is defined as the first node to receive lymphatic drainage from a primary tumor. The sentinel node concept postulates that if the first draining node is negative for metastasis, the remaining lymph nodes in the nodal basin can be spared. Thus one can predict the status of the nodal basin with high accuracy. It also shows that lymphatic spread seems to follow certain rules that do not concern the whole lymphatic basin. Skip metastases were proven to be rare in breast and gastric cancer. The main issue in sentinel lymph node mapping remains the improvement of staging accuracy for detection of lymph nodes most likely to develop metastasis as well as reducing morbidity by planning lymphadenectomies individually for each tumor and each patient.

Keywords

Sentinel lymph node Lymphadenectomy Gastrointestinal cancer 
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Notes

Interessenkonflikt:

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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  1. 1.Department of SurgeryKeio University School of MedicineTokyo
  2. 2.Chirurgische Klinik und PoliklinikKlinikum rechts der Isar, Technische Universität München
  3. 3.Chirurgische Klinik und PoliklinikKlinikum Rechts der IsarMünchen

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