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Sentinel Lymph Node Concept

This document discusses the sentinel lymph node (SLN) concept and technique for identification in breast cancer patients. It addresses technical issues in SLN detection such as the appropriate tracer, injection site, and volume. The optimal detection method is with a combination of probe detection and blue dye. Identification of the SLN allows for staging of breast cancer while avoiding unnecessary axillary lymph node dissection in many early stage patients. Training programs need further development to establish SLN biopsy as standard practice.

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Karthikeyan Radhakrishnan
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383 views27 pages

Sentinel Lymph Node Concept

This document discusses the sentinel lymph node (SLN) concept and technique for identification in breast cancer patients. It addresses technical issues in SLN detection such as the appropriate tracer, injection site, and volume. The optimal detection method is with a combination of probe detection and blue dye. Identification of the SLN allows for staging of breast cancer while avoiding unnecessary axillary lymph node dissection in many early stage patients. Training programs need further development to establish SLN biopsy as standard practice.

Uploaded by

Karthikeyan Radhakrishnan
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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Sentinel Lymph Node Concept; and Technique

of SLN Identification in Breast Cancer Patients

Dr S.Gambhir
Department of Nuclear Medicine
S.G.P.G.I.M.S
Lucknow

These PowerPoint presentations are free to download only for academic


purposes, with due acknowledgements to authors and this website.
Axillary Lymph Node Dissection (ALND) in
Carcinoma Breast

 Axillary clearance for local disease control

 Prognosis
Early Carcinoma Breast

 Histopathological positivity of axilla on ALND 30% ~40%

 60-70% patients of primary carcinoma breast patients are


undergoing unnecessary ALND

 ALND associated morbidity

 ? Adjuvant chemotherapy
Technical Issues in SLN Detection and
Imaging
 What tracer ?

 What injection site ?

 Large or small volume.

 How many MBq’s ?


Technical Issues in SLN Detection and
Imaging

What is most appropriate site of injection

 Subareolar
 Peritumoral
 Intratumoral
 Subdermal
 Subcutaneous
Concept of Single Injection

 Lymphatic drainage of breast consists of dermal and


parenchymal lymphatics which meet at Subareolar
lymphatics which meet at subareolar plexus of Sappey.
 This further drain through one or two major lymphatic
trunk to axilla.
 Position of this lymphatic plexus gives the opportunity of
single uniformally consistent subareolar injection of
injection of radiopharmaceutical/blue dye into breast
lymphatics.
 Adjuvant Systemic therapy
Radioactive but non blue lymph node
Invitro demonstration of radioactive but non blue lymph node
Results
 Imaging + ve 84.8%

 Probe +ve 97.3%

 Blue dye +ve 91.4%

 Concordance between
probe and blue dye 94.4%

 SLN histopathology 97.2 % (accuracy)


(H.E. matched with axilla nodes)
Technical Issues in SLN Detection and
Imaging

Which mode of detection is preferable ?

 Probe detection and imaging

 Probe detection only

 Blue dye alone or in combination with probe detection


Best Method of SNB Mapping?
Positive Non-Sentinel Axillary Nodes in
Patients with Positive Sentinel Nodes
Tumor Size +NSN

T1a 14%

T1b 22%

T1c 30%

T2 45%

T3 57%
Technical Issues in SLN Detection and
Imaging

What pathological evidence is required?

 Fine-needle aspiration cytology

 Imprint cytology

 H.E. Staining alone

 Cytokeratin immunohistochemistry
Conclusion

 Currently detection of SLN is highly accurate in context of


carcinoma breast.

 There is rapidly increasing database population.

 Training programmers relevant to multidisciplinary teams


need to be developed for this methodology.

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