Sentinel lymph node
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Overview
The sentinel lymph node is the hypothetical first lymph node or group of nodes reached by metastasizing cancer cells from a tumor.
Physiology
The spread of some forms of cancer usually follows an orderly progression, spreading first to regional lymph nodes, then the next echelon of lymph nodes, and so on, since the flow of lymph is unidirectional.
Uses
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.
There are various advantages to the sentinel node procedure. First and foremost, it decreases unnecessary lymph node dissections where this is not necessary, thereby reducing the risk of lymphedema, a common complication of this procedure. Increased attention on the node(s) identified to most likely contain metastasis is also more likely to detect micro-metastasis and result in staging and treatment changes. The main uses are in breast cancer and malignant melanoma surgery, although it has been used in other tumor types (colon cancer) with a degree of success (Tanis et al 2001a).
The sentinel node procedure in breast cancer was pioneered by surgical oncologist, Armando Giuliano, MD at the John Wayne Cancer Institute in the 1990s, and confirmative trials followed soon after (Tanis et al 2001b).
References
- Tanis PJ, Boom RP, Koops HS, Faneyte IF, Peterse JL, Nieweg OE, Rutgers EJ, Tiebosch AT, Kroon BB (2001a). Frozen section investigation of the sentinel node in malignant melanoma and breast cancer. Ann Surg Oncol 8:222-6. PMID 11314938.
- Tanis PJ, Nieweg OE, Valdes Olmos RA, Th Rutgers EJ, Kroon BB (2001b). History of sentinel node and validation of the technique. Breast Cancer Res 3:109-12. PMID 11250756.
Immune system: Lymphatic system (Lymph, Lymphocytes) | |
|---|---|
| Primary | Bone marrow – Thymus (Hassall's corpuscles) |
| Secondary: Spleen (process blood) | Hilum – Trabeculae
Red pulp (Cords of Billroth, Marginal zone) White pulp (Periarteriolar lymphoid sheaths, Germinal center) Trabecular arteries – Trabecular veins |
| Secondary: Lymph nodes (process extracellular fluid) | Afferent lymph vessels - Cortical sinuses - Medullary sinuses - Efferent lymph vessels
T cells: High endothelial venules B cells: Primary follicle/Germinal center - Mantle zone - Marginal zone Lymph node capsule - Subcapsular sinus - Cortex - Paracortex - Medulla (Medullary cord) - Hilus Lymph node trabeculae |
| Secondary: MALT (process mucosa) | GALT – Peyer's patches – Germinal center |
www.sentinelnode.net[2]
da:Skildvagtslymfekirtel de:Wächterlymphknoten nl:Schildwachtklier sk:Sentinelová uzlina
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
