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
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
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
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
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
STATdx includes over 200,000 searchable images, including x-ray, CT, MR, and ultrasound images. To access all images, please log in or subscribe.