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1、LymphaticMappingandSentinelNodeAnalysisStevenL.Chen,MD,MBA,DouglasM.Iddings,DO,RandallP.Scheri,MDandAntonJ.Bilchik,MD,PhD,FACSDr.ChenisFello;DirectorofGastrointestinalSurgicalOncology,Johnonica,CA.ABSTRACTSincetheintroductionofsentinelnodebiopsyin1990asaminimallyinva
2、sivesurgicaltechniqueforthediagnosisofmelanomalymphaticmetastases,thenumberofapplicationshasexpanded.orton,etal.2in1992.TheirseminalreportusedisosulfanbluedyetointraoperativelymapthepathaprimarycutaneousmelanomatooneormoreSLNsintheregionallymphaticbasin.Biopsyandanal
3、ysisofSLNsaccuratelyreflectedthetumorstatusoftheentirelymphaticbasin.Afterthatinitialreport,thetechniquehasbeenrefined,anditsindicationshaveexpanded.Giuliano,etal.3popularizedtheuseofsentinelnodemappinginbreastcancerin1994.Sincethen,thesentinelnodeconcepthasbeenteste
4、dinanumberoftumorsentofsentinelnodemappinganddiscussesitscurrentapplicationsacrossavarietyoftumorsinountofevidencehasbeenaccumulated.GENERALIZEDRATIONALEFORSENTINELNODEMAPPINGBecausethesentinelnodeconceptimpliestheorderlyprogressionofmetastasisfromaprimarytumortoasin
5、gledrainingnodeintherelevantlymphnodebasin,ithaslittlerelevanceintumorsthatareprimarilyspreadthroughhematogenousroutes.Inlymphaticallyspreadtumors,hoor-bearingnodesearyreasonsforsentinelnodebiopsy:(1)tominimizethemorbidityoflymphnodeassessment,(2)toalterthesurgicalpr
6、ocedureperformed,and/or(3)toimprovetheaccuracyofthenodalassessment.Sentinellymphnodebiopsy(SLNB)inimallyinvasivesurgicalalternativetoroutine(elective)pletelymphadenectomy.Untilthedevelopmentofthistechnique,significantcontroversyexistedastotheselectionofpatientsphnode
7、dissectionsinthesettingofclinicallynegativenodes.Theincidenceofplications,mostprominentlylymphedema,hadtobebalancedagainsttheadditionalstaginginformationthatorbidity,asshotheAmericanCollegeofSurgeons(ACoS)OncologyGroup(ACOSOG)Z0010trial,4itcontinuestobefarlessthantha
8、tassociatedphnodedissections.5,6Thedevelopmentofthesentinelnodetechniqueusingthegammacounteralloe.Forexample,nonextremitymelanomasn
