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Sentinel Lymph Node Mapping
Christopher R. McAdams, MD; Paige Bennett, MD
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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
        • SLN 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 (planar and SPECT/CT) may be performed to locate drainage basins
            • Intraoperative γ-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 & neck tumors often require SLN excision at multiple lymphatic drainage basins
          • Used most commonly for melanoma and breast cancer
          • Reduces morbidity (lymphedema, pain) of radical lymphadenectomy

      IMAGING

      • Nuclear Medicine Findings

        • Imaging Recommendations

          DIFFERENTIAL DIAGNOSIS

            CLINICAL ISSUES

            • Presentation

              DIAGNOSTIC CHECKLIST

              • Consider

                Selected References

                1. Nijhuis AAG et al: Clinical importance and surgical management of sentinel lymph nodes in the popliteal fossa of melanoma patients. Eur J Surg Oncol. 45(9):1706-11, 2019
                2. Qiu SQ et al: Evolution in sentinel lymph node biopsy in breast cancer. Crit Rev Oncol Hematol. 123:83-94, 2018
                3. Collarino A et al: The sentinel node approach in gynaecological malignancies. Clin Transl Imaging. 4(5):411-20, 2016
                4. Tardelli E et al: Sentinel lymph node biopsy in cutaneous melanoma: standard and new technical procedures and clinical advances. A systematic review of the literature. Clin Nucl Med. 41(12):e498-507, 2016
                5. Paño B et al: Pathways of lymphatic spread in gynecologic malignancies. Radiographics. 35(3):916-45, 2015
                6. Vercellino L et al: Role of SPECT/CT in sentinel lymph node detection in patients with breast cancer. Clin Nucl Med. 39(5):431-6, 2014
                7. 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
                8. Intenzo CM et al: Lymphoscintigraphy in cutaneous melanoma: an updated total body atlas of sentinel node mapping. Radiographics. 29(4):1125-35, 2009
                Related Anatomy
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                Related Differential Diagnoses
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                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
                      • SLN 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 (planar and SPECT/CT) may be performed to locate drainage basins
                          • Intraoperative γ-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 & neck tumors often require SLN excision at multiple lymphatic drainage basins
                        • Used most commonly for melanoma and breast cancer
                        • Reduces morbidity (lymphedema, pain) of radical lymphadenectomy

                    IMAGING

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          CLINICAL ISSUES

                          • Presentation

                            DIAGNOSTIC CHECKLIST

                            • Consider

                              Selected References

                              1. Nijhuis AAG et al: Clinical importance and surgical management of sentinel lymph nodes in the popliteal fossa of melanoma patients. Eur J Surg Oncol. 45(9):1706-11, 2019
                              2. Qiu SQ et al: Evolution in sentinel lymph node biopsy in breast cancer. Crit Rev Oncol Hematol. 123:83-94, 2018
                              3. Collarino A et al: The sentinel node approach in gynaecological malignancies. Clin Transl Imaging. 4(5):411-20, 2016
                              4. Tardelli E et al: Sentinel lymph node biopsy in cutaneous melanoma: standard and new technical procedures and clinical advances. A systematic review of the literature. Clin Nucl Med. 41(12):e498-507, 2016
                              5. Paño B et al: Pathways of lymphatic spread in gynecologic malignancies. Radiographics. 35(3):916-45, 2015
                              6. Vercellino L et al: Role of SPECT/CT in sentinel lymph node detection in patients with breast cancer. Clin Nucl Med. 39(5):431-6, 2014
                              7. 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
                              8. Intenzo CM et al: Lymphoscintigraphy in cutaneous melanoma: an updated total body atlas of sentinel node mapping. Radiographics. 29(4):1125-35, 2009