Description
Sentinel lymph node biopsy (SLNB) has become a cornerstone in the staging and management of various solid organ tumors, enabling accurate assessment while minimizing surgical morbidity. This webinar will explore the principles, indications, and techniques of SLNB across different malignancies. The session will highlight its role in guiding treatment decisions, improving outcomes, and reducing unnecessary extensive lymph node dissections. Practical surgical insights, along with recent advances and challenges, will be discussed to enhance clinical practice.
Summary Listen
- Sentinel lymph node biopsy (SLNB) is a minimally invasive surgical technique that identifies the first draining lymph node(s) from a tumor, allowing for pathological staging, prognosis prediction, and adjuvant therapy planning in solid organ cancers. This approach aims to reduce the morbidity associated with complete lymph node dissection.
- The technique involves injecting a tracer agent (blue dye, radioisotope, fluorescent agent, or magnetic tracer) near the tumor, which is then taken up by the lymphatic system and travels to the sentinel lymph node. Localization methods, such as visual identification of blue-stained lymphatics, lymphoscintigraphy, intraoperative gamma probe, or magnetometer, are used to identify and excise the sentinel node(s).
- Histopathological assessment of the sentinel lymph node determines the presence and extent of metastasis (macrometastasis, micrometastasis, or isolated tumor cells). This information guides further management decisions, including the need for additional lymph node dissection or adjuvant therapies.
- SLNB has limitations, including altered lymphatic drainage due to previous surgery, tumor blockage, technical difficulties, and pathological assessment challenges, which can lead to false negative results. It is also less reliable after neoadjuvant treatment, although techniques like dual tracer sampling and clipping positive nodes can improve accuracy.
- In breast cancer, SLNB has become a standard of care for clinically node-negative patients, replacing routine axillary lymph node dissection. Recent trials have explored further de-escalation, identifying patient subgroups who can avoid SLNB altogether.
- Radioisotopes are generally considered to be superior and more sensitive in identifying sentinel lymph nodes compared to blue dyes. But there are also newer options like Indocyanine Green (ICG) and Superparamagnetic Iron Oxide (SPIO) nanoparticles that allow for a unit to continue care of dual tracers.
- For melanoma, SLNB is indicated for tumors thicker than T1 or those with high-risk features, even in the absence of suspicious lymph nodes. In vulvar cancer and penile cancer, SLNB is also considered and dynamic sentinel lymph node biopsy is indicated for node negative patients.
Sample Certificate
About the Speakers
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Dr. Theekshana Pathirana
Consultant Surgical Oncologist, Sri Lanka
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