Sentinel Lymph Node Biopsy (SLNB), also referred to as Intraoperative Lymphatic Mapping (ILM), involves the localization of the lymph node that is first in the lymph node chain to receive lymphatic drainage from a primary tumor site. This first draining node is referred to as the “sentinel” lymph node. SLNB has been found to be a highly accurate indicator of the metastatic involvement of the entire lymph node basin in which it is situated. In short, if the sentinel node is cancer-free, then “downstream” lymph nodes are also negative for cancer.

This technique relieves the patient of the trauma and complications associated with a full axillary lymph node dissection (ALND), which typically involves the removal of all (10-25) lymph nodes in the lymphatic basin in the area of the tumor.

For further information, please see Introduction to Lymphatic Mapping.

The accuracy of sentinel lymph node biopsy in multicentric and multifocal invasive breast cancers
Tousimis E, Van Zee KJ, Fey JV, Hoque LW, Tan LK, Cody HS 3rd, Borgen PI and Montgomery LL (Oct. 2003)
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Radioguided Sentinel Lymph Node Biopsy in Breast Cancer Surgery
Giuliano Mariani, Luciano Moresco, Giuseppe Viale, Giuseppe Villa, Marcello Bagnasco, Giuseppe Canavese, John Buscombe, H William Strauss and Giovanni Paganelli (Aug. 2001)
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Anaphylactoid Reactions to Isosulfan Blue Dye During Breast Cancer Lymphatic Mapping in Patients Given Preoperative Prophylaxis
Chandrajit P Rault, M Denise Daley, Kelly K Hunt, Jeri Akins, Merrick I Ross, S Eva Singletary, Gailen D Marshall, Jr, Funda Meric-Berstam, Gildy Babiera, Barry W Feig, Frederick C Ames and Henry M Kuerer (Feb. 2004)
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Controversies in sentinel lymph node biopsy for breast cancer
Stefanie S Jeffrey, Sunita B Jones and Kenneth L Smith (2000)
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Sentinel Lymph Node Biopsy for Breast Cancer
Stephanie J Kellar (Aug. 2001)
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Sentinel node staging of primary melanoma by the “10% rule”: pathology and clinical outcomes
Jeffery S Stevens, Robert W Nance, Christopher L Coriess and John T Vetto (Nov. 2006)
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SLNB Probe types:

14mm Lymphatic Mapping Probes (Angled & Straight)
• This angled probe allows surgeon to maintain excellent visual contact with the tissue being interrogated. It also features internal collimation and high-energy tungsten shielding. Also available in straight configuration

12mm SMX Lymphatic Mapping Probe
• Featuring a small 12mm tip diameter and scintillation crystal detector, this probe is one of the most sensitive gamma detectors on the market. In challenging cases of low radioactivity due to tissue density, previous surgery, poor lymphatics, or extended wait time post-injection, this probe consistently yields superior counts.

Because all Dynasil lymphatic-mapping probes are isotope agnostic, they can be used in cases that require multiple isotopes simply by switching the isotope indicator on the control box. This feature is ideal in procedures involving the use of I-125 radioactive seed for breast tumor localization and Tc-99, for sentinel lymph node biopsy.

14mm Standard Lymphatic Mapping Probe (Part # SP-2A14-67)
*Also available in straight configuration (Part # SP-2S14-67)

12mm SMX Lymphatic Mapping Probe (Part # SP-3075-00)

1. Intradermal Injection:

This technique is designed to be used directly above the tumor in “sentinel node” cases. Four syringes containing 75 microcuries TC-99m each in 0.05 cc sulfur colloid. Each syringe is injected between the dermal layers at one of four quadrants (NSEW) taking care not to spill injectate on the skin.

2. Subdermal Injection:

This technique use injections below the dermal layers usually around the nipple “periareolar” in breast cases. When using this technique one should consider using larger doses of radioactivity and larger volumes of sulfur colloid. Five hundred microcuries in one or two cc’s of sulfur colloid should be sufficient. If the patient is heavy-set with fatty breasts, more volume may be needed to push the TC-99m through the lymphatics. An extra 2-10 cc’s can be injected, but should be done once the patient is sedated due to discomfort considerations.

3. Interparenchymal Injection:

This technique uses more radioactivity and volume of injectate than others. The usual split is four doses of 125 mics per syringe in two cc’s of sulfur colloid. (This means diluting the colloid with 8cc of saline.) The injections should be spaced into four quadrants around the tumor or biopsy site. If a biopsy has already been performed, inject into the cavity walls or as close as possible. Again make certain no injectate is “spilled” on the skin.