link
Bookmarks
Sentinel Lymph Node Mapping
Christopher R. McAdams, MD; Paige Bennett, MD
To access 4,300 diagnoses written by the world's leading experts in radiology, please log in or subscribe.Log inSubscribe
0
0
0
0

KEY FACTS

  • Terminology

    • Top Differential Diagnoses

      TERMINOLOGY

      • Definitions

        • Sentinel lymph node (SLN)
          • 1st lymph node(s) visualized in lymphatic drainage basin of malignancy
          • Most likely to have tumor cells before other nodes within similar drainage pathways
        • Sentinel lymph node mapping
          • Tc-99m sulfur colloid injected at primary tumor site prior to surgery/therapy
            • Tc-99m sulfur colloid taken up by lymphatic system to lymph node basin
            • Lymphoscintigraphic imaging may be performed to locate drainage basins (e.g., in patients with melanoma)
            • Intraoperative gamma probe detects gamma rays from SLN at surgery
            • Isosulfan blue dye injected during surgery; stains SLN blue for visual colocalization with radioactive SLN
          • Mapping > 92% effective in locating SLN
            • Guides lymphadenectomy, radiation port planning, staging of malignancy
            • Truncal, head and neck tumors often require surgery at multiple lymphatic drainage basins
          • Used most commonly for melanoma and breast cancer
          • Reduces morbidity of locoregional radical lymphadenectomy (lymphedema, pain)

      IMAGING

      • Nuclear Medicine Findings

        • Imaging Recommendations

          DIFFERENTIAL DIAGNOSIS

            CLINICAL ISSUES

            • Presentation

              DIAGNOSTIC CHECKLIST

              • Consider

                Selected References

                1. Giammarile F et al: The EANM and SNMMI practice guideline for lymphoscintigraphy and sentinel node localization in breast cancer. Eur J Nucl Med Mol Imaging. 40(12):1932-47, 2013
                2. Intenzo CM et al: Lymphoscintigraphy in cutaneous melanoma: an updated total body atlas of sentinel node mapping. Radiographics. 29(4):1125-35, 2009
                3. Alazraki N et al: Procedure guideline for lymphoscintigraphy and the use of intraoperative gamma probe for sentinel lymph node localization in melanoma of intermediate thickness 1.0. J Nucl Med. 43(10):1414-8, 2002
                4. Kern KA: Breast lymphatic mapping using subareolar injections of blue dye and radiocolloid: illustrated technique. J Am Coll Surg. 192(4):545-50, 2001
                5. Yudd AP et al: Use of sentinel node lymphoscintigraphy in malignant melanoma. Radiographics. 19(2):343-53; discussion 354-6, 1999
                6. Sideri M et al: Detection of sentinel nodes by lymphoscintigraphy and gamma probe guided surgery in vulvar neoplasia. Tumori. 86(4):359-63, 2000
                7. Borgstein PJ et al: Sentinel lymph node biopsy in breast cancer: guidelines and pitfalls of lymphoscintigraphy and gamma probe detection. J Am Coll Surg. 186(3):275-83, 1998
                Related Anatomy
                Loading...
                Related Differential Diagnoses
                Loading...
                References
                Tables

                Tables

                KEY FACTS

                • Terminology

                  • Top Differential Diagnoses

                    TERMINOLOGY

                    • Definitions

                      • Sentinel lymph node (SLN)
                        • 1st lymph node(s) visualized in lymphatic drainage basin of malignancy
                        • Most likely to have tumor cells before other nodes within similar drainage pathways
                      • Sentinel lymph node mapping
                        • Tc-99m sulfur colloid injected at primary tumor site prior to surgery/therapy
                          • Tc-99m sulfur colloid taken up by lymphatic system to lymph node basin
                          • Lymphoscintigraphic imaging may be performed to locate drainage basins (e.g., in patients with melanoma)
                          • Intraoperative gamma probe detects gamma rays from SLN at surgery
                          • Isosulfan blue dye injected during surgery; stains SLN blue for visual colocalization with radioactive SLN
                        • Mapping > 92% effective in locating SLN
                          • Guides lymphadenectomy, radiation port planning, staging of malignancy
                          • Truncal, head and neck tumors often require surgery at multiple lymphatic drainage basins
                        • Used most commonly for melanoma and breast cancer
                        • Reduces morbidity of locoregional radical lymphadenectomy (lymphedema, pain)

                    IMAGING

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          CLINICAL ISSUES

                          • Presentation

                            DIAGNOSTIC CHECKLIST

                            • Consider

                              Selected References

                              1. Giammarile F et al: The EANM and SNMMI practice guideline for lymphoscintigraphy and sentinel node localization in breast cancer. Eur J Nucl Med Mol Imaging. 40(12):1932-47, 2013
                              2. Intenzo CM et al: Lymphoscintigraphy in cutaneous melanoma: an updated total body atlas of sentinel node mapping. Radiographics. 29(4):1125-35, 2009
                              3. Alazraki N et al: Procedure guideline for lymphoscintigraphy and the use of intraoperative gamma probe for sentinel lymph node localization in melanoma of intermediate thickness 1.0. J Nucl Med. 43(10):1414-8, 2002
                              4. Kern KA: Breast lymphatic mapping using subareolar injections of blue dye and radiocolloid: illustrated technique. J Am Coll Surg. 192(4):545-50, 2001
                              5. Yudd AP et al: Use of sentinel node lymphoscintigraphy in malignant melanoma. Radiographics. 19(2):343-53; discussion 354-6, 1999
                              6. Sideri M et al: Detection of sentinel nodes by lymphoscintigraphy and gamma probe guided surgery in vulvar neoplasia. Tumori. 86(4):359-63, 2000
                              7. Borgstein PJ et al: Sentinel lymph node biopsy in breast cancer: guidelines and pitfalls of lymphoscintigraphy and gamma probe detection. J Am Coll Surg. 186(3):275-83, 1998