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The Sentinel Node Story

         

A sentinel node is the first lymph node to receive drainage of lymphatic fluid and cells from a tumor or malignant growth. By injecting a blue dye & radioactive sulfur colloid around the tumor site, these materials can then be found in the early draining, i.e., "sentinel" node, thereby identifying this node(s) (oftentimes more than 1 node). If this sentinel node is identified, and sampled or removed, malignant cells, which could have spread from the tumor, can be detected in that node. Currently, we perform sentinel node biopsy in conjunction with our surgery for patients who have either malignant melanoma or breast cancer (see below).

Malignant Melanoma
Identification of this node has become a standard technique for determining whether or not melanoma cells may have spread to a lymph gland from the site of the original melanoma. Because nodal staging for melanoma with sentinel node biopsy is accurate and associated with minimal morbidity generally speaking, it has become in some people's opinions the preferred staging technique.

Breast Cancer
There is a growing body of data, which suggest strongly that for patients with breast cancer, that the status of the sentinel node can predict whether the other nodes in the axilla may harbor breast cancer deposits. Sentinel node biopsy for patients with breast cancer offers the theoretical advantage of identifying patients who really have nodal metastases, while sparing other patients the necessity for axillary dissection or radiation therapy. An added advantage for patients who have a sentinel node identified as part of their breast cancer surgery is the ability to perform immunohistochemistry, a special staining technique, on the sentinel node tissue. Currently, this sentinel node procedure is being done for our patients with breast cancer in conjunction with a more comprehensive axillary assessment.

Some additional reading for those interested in these topics: The Sentinel Node in Breast Cancer. New England Journal of Medicine, vol. 339, pages 941-946, 1998.

Sentinel-Lymph-Node Biopsy for Breast Cancer-Not Yet the Standard of Care. New England Journal of Medicine, vol. 339, pages 990-998, 1998.

The Treatment of Breast Cancer. New England Journal of Medicine, vol. 339, pages 974-984, 1998.

Questions can be directed to Dr. Baskies at (856) 291-8920, fax (856) 291-8922 or click here to request additional information


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