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The concept of the sentinel lymph node is important because of the advent of the sentinel lymph node biopsy technique, also known as a sentinel node procedure. This technique is used in the staging of certain types of cancer to see if they have spread to any lymph nodes, since lymph node metastasis is one of the most important prognostic signs .
The sentinel lymph node biopsy (SLNB) is the standard of care for detecting nodal metastases in cutaneous melanoma patients and has been the most informative prognostic factor to guide subsequent treatment. However, ~85% of patients undergoing this procedure have no evidence of nodal metastasis.
The sentinel lymph node is the first lymph node in the drainage area of the tumor lymph. If this is not affected, the more distant lymph nodes are very likely tumor-free and do not have to be removed. The need to remove lymph node metastases is a controversial topic. [6]
The detection of micrometastases in the sentinel lymph nodes (SLN) is the primary indicator of its spread to the regional lymph nodes, bone marrow, peripheral blood and ultimately to distant metastatic sites, since they are the first of the nodes that cancer would travel to. [3]
N1: regional lymph node metastasis present; at some sites, tumor spread to closest or small number of regional lymph nodes; N2: tumor spread to an extent between N1 and N3 (N2 is not used at all sites) N3: tumor spread to more distant or numerous regional lymph nodes (N3 is not used at all sites) M: presence of distant metastasis
The sentinel lymph node is the first node that drains the tumor, and subsequent SLN mapping can save 65–70% of patients with breast cancer from having a complete lymph node dissection for what could turn out to be a negative nodal basin.
This lymph node is then called a sentinel lymph node. Lymphatic spread is the most common route of initial metastasis for carcinomas . [ 8 ] In contrast, it is uncommon for a sarcoma to metastasize via this route.
The left supraclavicular nodes are the classical Virchow's node because they receive lymphatic drainage of most of the body (from the thoracic duct) and enters the venous circulation via the left subclavian vein. The metastasis may block the thoracic duct leading to regurgitation into the surrounding Virchow's nodes.