ATLAS OF SELECTIVE SENTINEL LYMPHADENECTOMY FOR MELANOMA, BREAST CANCER AND COLON CANCER |
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| Written by news one man | |
| Thursday, 06 March 2008 | |
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Page 4 of 69 PREFACEThe underlying thesis in solid cancer biology is that metastasis in general starts inan orderly progression with lymphatic spread first to the sentinel lymph node (SLN) in the nearest lymph node basin. Therefore, the logical approach is to harvest that specific SLN for thorough analysis. Because a tumor-free SLN is usually associated with a negative residual lymph node basin, a negative SLN is an excellent indication that micrometastasis has not occurred in the regional lymph nodes. When the SLN is involved it is not known whether or not metastasis is limited only to the SLN or if the disease has spread to the remainder of the nodal basin. For this reason, if a SLN is positive, a complete lymph node dissection is indicated. Thus, a selective sentinel lymphadenectomy should be considered as a staging procedure so that patients with negative SLNs (about 80%) may be spared an extended lymph node dissection. Malignant melanoma has been proven to be the most ideal tumor model to study the role of SLN. Subsequently, selective sentinel lymphadenectomy has been applied to breast cancer, colon cancer and other types of solid cancer. The multidisciplinary approach encompassing the surgeon, nuclear medicine physician, and pathologist is the key to such a successful procedure. Beyond the technical aspects of harvesting the SLN, the implication of micrometastasis remains to be defined. Follow-up of patients after selective sentinel lymphadenectomy is crucial. Since selective sentinel lymphadenectomy is a recently developed technique, most surgeons who are actively practicing surgery have not learned this procedure during their formal training years. Therefore, it is important for the surgeons to learn this technique through well designed lymphatic mapping courses and observe actual operative procedures of selective sentinel lymphadenectomy to achieve proficiency. It is imperative that the surgeon should learn this technique properly so that the most accurate SLN may be harvested. Thus, it is timely to have a book entirely dedicated to the theory and practice of selective sentinel lymphadenectomy combining preoperative and interoperative lymphatic mapping approaches. Further, evaluation of the SLN requires meticulous assessment of the SLN with multiple sections and immunohistochemistry. This atlas is tailored to bring the practical aspects of selective sentinel lymphadenectomy for melanoma, breast and colon cancer into focus so that practitioners can use it as a reference manual. It is important to emphasize the multidisciplinary approach of harvesting SLN(s) incorporating the experiences of a nuclear medicine physician, a surgeon, and a pathologist. Such a team can be formed readily with appropriate training. Stanley P. L. Leong, MD Department of Surgery UCSF Comprehensive Cancer Center 1600 Divisadero Street San Francisco, California 94115 |
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