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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 .
Advances in SLN mapping over the past decade have increased the accuracy of detecting Sentinel Lymph Node from 80% using blue dye alone to between 92% and 98% using combined modalities. [10] SLN biopsy is indicated for patients with T1 and T2 lesions (<5 cm) and carries a number of recommendations for use on patient subgroups. [ 10 ]
The first draining lymph node, the "sentinel", represents an existing or non-existing tumour of an entire lymph node region. The method has been validated using radionuclides and/or blue dye for breast cancer, malignant melanoma and also gastrointestinal tumours and gives a good detection rate and sensitivity.
For clinical stages I and II breast cancer, axillary lymph node dissection should only be performed after first attempting sentinel node biopsy. [4] If cancer cells are found in the nodes, it increases the risk of metastatic breast cancer. Another method of determining breast cancer spread is to perform an endoscopic axillary sentinel node biopsy.
The general location of the sentinel node is determined with the use of a handheld scanner with a gamma-sensor probe that detects the technetium-99m–labeled tracer that was previously injected around the biopsy site. An injection of Methylene blue or isosulfan blue is done at the same time to dye any draining nodes visibly blue. An incision ...
The sentinel node market experienced high growth in the early and mid-1990s, starting with melanoma sentinel node surgical search and breast cancer sentinel node staging; both are currently considered standards of care. [4] The use of a radioactive tracer, rather than a coloured dye, was proposed in 1984. [5] [6]
The cystic lymph node is situated at the neck of the gallbladder. [2] [4] It is invariably situated lateral to the biliary tree. [9] The node receives lymphatic drainage from the gallbladder, cystic duct, hepatic duct, and the superior portion of the common bile duct. [10] It in turn drains lymph into the hepatic lymph nodes. [2] [4]
The list starts out with a single node, the sentinel node which has the next and previous pointers point to itself. This condition determines if the list is empty. In a non-empty list, the sentinel node's next pointer gives the head of the list, and the previous pointer gives the tail of the list.