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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
- Tc-99m sulfur colloid injected at primary tumor site prior to surgery/therapy
- Sentinel lymph node (SLN)
IMAGING
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
CLINICAL ISSUES
Presentation
DIAGNOSTIC CHECKLIST
Consider
Selected References
- 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
- Qiu SQ et al: Evolution in sentinel lymph node biopsy in breast cancer. Crit Rev Oncol Hematol. 123:83-94, 2018
- Collarino A et al: The sentinel node approach in gynaecological malignancies. Clin Transl Imaging. 4(5):411-20, 2016
- 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
- Paño B et al: Pathways of lymphatic spread in gynecologic malignancies. Radiographics. 35(3):916-45, 2015
- 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
- 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
- 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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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
- Tc-99m sulfur colloid injected at primary tumor site prior to surgery/therapy
- Sentinel lymph node (SLN)
IMAGING
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
CLINICAL ISSUES
Presentation
DIAGNOSTIC CHECKLIST
Consider
Selected References
- 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
- Qiu SQ et al: Evolution in sentinel lymph node biopsy in breast cancer. Crit Rev Oncol Hematol. 123:83-94, 2018
- Collarino A et al: The sentinel node approach in gynaecological malignancies. Clin Transl Imaging. 4(5):411-20, 2016
- 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
- Paño B et al: Pathways of lymphatic spread in gynecologic malignancies. Radiographics. 35(3):916-45, 2015
- 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
- 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
- Intenzo CM et al: Lymphoscintigraphy in cutaneous melanoma: an updated total body atlas of sentinel node mapping. Radiographics. 29(4):1125-35, 2009
