There have been conflicting data with regards to the use of indocyanine green fluorescence, contrast-enhanced ultrasound using microbubbles and MRI with superparamagnetic iron oxide nanoparticles in SLNB. Some of the factors that were associated with failed localization included obesity, tumor location and non-visualization of the SLN on preoperative lymphoscintigraphy. ![]() Ī study by Goyal et al showed that the sensitivity of SLNB was 93.3% and the accuracy was 97.6% when using both blue dye and radioactive material. The accuracy of the sentinel node biopsy was 97% (392 of 405), the specificity was 100%, the sensitivity was 89% (101 of 114), the positive predictive value was 100%, the negative predictive value was 96% (291 of 304) and the sensitivity was 89% (101 of 114). In a multicenter validation study, the overall rate of identification of the SLN was 93% (in 413 of 443 patients). Several studies have validated the SLN concept in patients with breast cancer. Intraoperative photograph following injection of isosulfan blue shows blue lymphatic channels leading to a blue SLN. The SLNB only group did not show inferior survival rates compared to the axillary lymph node dissection group. The other group was randomized to SLNB followed by completion axillary dissection. One group was randomized to SLNB without axillary dissection. The patients were treated with lumpectomy and opposing tangential field radiation therapy and adjuvant systemic therapy at the discretion of the treating physician. The American College of Surgeons Oncology Group (ACOSOG) Z011 trial compared two groups of clinical T1–2 N0 M0 breast cancer patients with a positive SLN. Originally proposed in the management of penile cancer by Cabanas in 1977, the SLN concept has been applied in patients with malignant melanoma with considerable success. The SLNs can be located by injecting blue dye and/or radioactive material at the tumor site and subsequently, identifying a blue ( Figure 3) and/or a radioactive lymph node in the axilla. Sentinel lymph nodes (SLNs) are defined as the first group of lymph nodes draining the tumor bed. The sentinel lymph node (SLN) concept ( Figure 2), which states that the histologic status of the SLN is predictive of the status of the regional lymph nodes, is based on the orderly spread of tumor from the tumor bed to the regional lymph nodes. Sentinel lymph node biopsy (SLNB) has become standard in patients being treated for breast cancer with clinically negative lymph nodes. Lymphedema following axillary lymph node dissection.
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