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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 .
Donald Lee Morton (September 12, 1934 – January 10, 2014) was an American surgical oncologist who was best known for developing sentinel lymph node evaluation, a procedure that, by some estimates, saves the U.S. healthcare system nearly $4 billion annually in the treatment of melanoma and breast cancer. [1]
Neither sentinel lymph node biopsy nor other diagnostic tests should be performed to evaluate early, thin melanoma, including melanoma in situ, T1a melanoma or T1b melanoma ≤ 0.5mm. [114] People with these conditions are unlikely to have the cancer spread to their lymph nodes or anywhere else and have a 5-year survival rate of 97%. [ 114 ]
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]
Treatment is by excisional biopsy, wide local excision and possibly sentinel node biopsy. Localized melanoma, which has not spread beyond the skin, has a very good prognosis with low recurrence rates. Spread of disease to local lymph nodes or distant sites (typically brain, bone, skin and lung) marks a decidedly poor prognosis.
A large study validated the importance of tumor depth (but not Breslow's original description) as one of the three most important prognostic factors in melanoma (the others being T stage and ulceration). [4] Breslow's depth also accurately predicted the risk for lymph node metastasis, with deeper tumors being more likely to involve the nodes. [5]
A sentinel node biopsy can establish cancer staging of the axilla if there are positive lymph nodes present. [5] It is also less risky than performing a lymphadenectomy, having fewer side effects and a much lower chance of causing lymphedema. [5] If cancer is not present in the sentinel lymph nodes, then the axillary lymph node dissection ...
Five-year survival is greater than 90% for patients with stage I lesions but decreases to 20% when pelvic lymph nodes are involved. Lymph node involvement is the most important predictor of prognosis. [39] Prognosis depends on the stage of cancer, which refers the amount and spread of cancer in the body. [40] The stages are broken into four ...
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