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Sentinel Node Biopsy

Involvement of the local and regional nodes is the most important prognostic factor in early-stage tumors like melanoma and breast cancer.  In Most cases, tumor spread to regional nodes takes place in an orderly fashion.  Sentinel node is the first and central node that tumor cells drain into and first to become involved with the cancerous process.   One can think of this node as the first and main highway that the tumor cells take to spread out. Therefore, Sentinel node sampling and biopsy may identify the first-draining lymph node in melanoma and breast cancer and possibly in other cancers.  Sampling of this node is felt to be indicative of the spread of tumor to regional nodes.  If this node does not harbor any cancer cells, the odds are that the cancer has not spread to other nodes.

The procedure to biopsy this node is performed in operating room, is rather cumbersome and needs special training that not every surgeon has.  This procedure is best performed by an oncology surgeon who had experience in performing this procedure. The tumor site is injected with a special dye (dark blue color), which may or may not contain radioactive markers.  The surgeon then opens the suspected region that contains the lymph nodes and searches for the one node, sentinel node that has picked up the dye.

The pathological study of this node, like any other tissue, and the accuracy of the results depends on the method used to detect cancer cells.  Normal pathological study involves sectioning of the node and removing a very small amount of tissue for study.  The more sections studied the higher the accuracy of the results.  Also the study methods used, such as simple viewing of the tissue under microscope as opposed to searching the sample with genetic markers can result in different levels of accuracy.

The result of this test depends on many variables, from the experience of the surgeon to the experience of the pathologist and the methods used to study the tissue.

Current data indicates that identification of the sentinel node and accurate determination of its tumor status can have a significant impact on the prognosis of the underlying cancer. The low rate of nodal recurrence and the significantly longer survival for patients with tumor-negative sentinel nodes validate the use of this technique to achieve more accurate diagnostic and prognostic staging of primary melanomas and early stage breast cancers.