Comprehensive meta analysis chapter 19
The current standard technique for SLNB is as follows. 6With an overall estimated incidence of lymphedema of 6% for breast cancer, 4% for melanoma, and 9% for gynecologic cancers after SLNB, we estimate that 207,617 people will be diagnosed annually worldwide with lymphedema after SLNB, and many more are at a significant lifetime risk. 6Melanoma is one of only a handful of cancers with an increasing annual incidence worldwide an estimated 232,130 cases were diagnosed worldwide in 2012. 5īreast and cervical cancers are the first and fourth most commonly diagnosed cancers in women worldwide an estimated 1,676,633 new cases of breast cancer and 1,085,948 new cases of cervical cancer are diagnosed annually. Metastatic nodal disease was pathologically confirmed in almost half of the patients, each of whom had a positive SLN.
5In a prospective study of women undergoing routine lymphadenectomy, surgeons identified and excised the SLNs with preoperative lymphoscintigraphy and intraoperative blue dye and subsequently performed a completion inguinofemoral lymph node dissection (ILND). This procedure was initially piloted for the treatment of squamous cell carcinoma of the vulva. SLNB has also been applied to gynecologic cancers. This technique also gave pathologists the opportunity for an in-depth evaluation of fewer lymph nodes to more accurately identify micrometastatic disease. Albertini et al 4reported that this technique reduced surgical morbidity.
COMPREHENSIVE META ANALYSIS CHAPTER 19 TRIAL
4In this trial the SLN was identified in 92% of patients, and a positive SLN was identified before ALND in all patients with positive nodal disease. In 1996 a prospective trial of patients with invasive breast cancer who underwent SLNB before a completion axillary lymph node dissection (ALND) and segmental mastectomy or mastectomy within a single surgical procedure was reported. In the early 1990s, SLNB was adopted for the pathologic staging of regional lymph nodes in patients with breast cancer. C, The tumor and sentinel nodes are excised for pathologic assessment of the regional lymph nodes. Sentinel nodes are identified visually or with a gamma-detecting probe. B, The injected material migrates to draining lymph nodes. A, Radioactive isotope and/or blue dye is injected into the tissue surrounding the tumor.
19-1 SLN biopsy for the treatment of breast cancer. At about this time, Morton et al 3investigated the various techniques of SLN identification-first in a feline model and subsequently in patients-by the intraoperative injection of isosulfan blue dye adjacent to primary melanoma sites to identify SLNs in the regional nodal basin 3( Fig. The SLN was then excised for immediate evaluation on identification of tumor cells in the SLN, a total lymph node dissection was done. In 1977 Cabanas 2published an article on SLNB at the time of surgical resection for penile cancer in which lymphatic imaging was used to identify the SLN. After node removal and identification of metastatic tumor cells, a complete cervical lymph node dissection was performed. Gould et al 1first described the concept of SLNB in 1960 after an incidental finding of a lymph node at the junction of the anterior and posterior facial veins during a total parotidectomy. Finally, there is a discussion of the impact of SLNB on lymphedema and quality of life (QOL) outcomes related to the use of this technique. This chapter outlines the technique for performing a SLNB and highlights recent literature findings related to the efficacy of the procedure in different types of cancers. This minimally invasive procedure identifies and resects sentinel lymph nodes (SLNs) for the pathologic staging of lymph node basins in patients at risk for nodal metastases and can be used to avoid the morbidity associated with a complete lymphadenectomy in patients with pathologically confirmed negative SLNs.
The use of the sentinel lymph node biopsy (SLNB) has changed the landscape for the surgical treatment of many types of solid tumors, including melanomas and breast cancer.
Patient-reported quality of life is affected less by SLNB than by total lymphadenectomy. The incidence of lymphedema after SLNB ranges from 4% to 9% in the three tumor types (melanoma, breast cancer, and gynecologic cancer) discussed in this chapter. The incidence of lymphedema has been reduced but not eliminated by the use of the SLNB technique. Sentinel lymph node biopsy (SLNB) is an oncologically safe procedure to identify the primary lymph node to which a solid tumor, such as a melanoma, breast cancer, or gynecologic cancer, is likely to drain.Ĭompared with nodal observation alone, SLNB increases overall and disease-free survival in patients with intermediate-thickness tumors.