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Sentinel node biopsy: visiting my colleagues at the Memorial Sloan Kettering Cancer Center in New York

This week I visited New York to spend a few days with my colleagues at the Memorial Sloan Kettering Cancer Center (MSKCC). I have been in close contact with my colleagues from MSKCC for many years. We catch up at conferences, sit on boards together and develop health policy. MSKCC is at the forefront of sentinel node biopsy for some years. The technology is emerging in the United States and is building up in Australia. I am fortunate enough to be able to use it in my practice in Brisbane.

Sentinel node biopsy limits the number of lymph nodes removed during surgery for uterine and cervical cancer and therefore limits the morbidity of surgery, including lymphoedema.

For the past few days, I have watched my colleagues in the operating theatres in New York, stealing with my eyes and bringing home tips and tricks on how we can improve sentinel node biopsy techniques for Queensland patients.

What is Sentinel node dissection?

Sentinel lymph node biopsy allows the doctors to determine whether the cancer has spread from the uterus to nearby lymph nodes. This procedure is completed at the same time as the main surgery to remove the primary tumour.                                                                                             

Before the actual surgical procedure, a green dye is injected into the cervix. We then perform a laparoscopy using special equipment to detect a particular wavelength of light that is emitted from the sentinel nodes. The lymph nodes that are stained are identified as sentinel lymph nodes. If this node is tumour free, all remaining nodes are also tumour free. 

This node is then examined under a microscope and tested for cancer cells. If the sentinel node is negative for cancer, it is inferred that all other nodes are also cancer-free. This procedure helps inform a treatment plan and avoids removing healthy lymph nodes.

This procedure is slowly beginning to replace a radical lymphadenectomy, where most or all of the lymph nodes are removed. Previously extensive pelvic and para-aortic lymphadenectomy was required to stage cervical or endometrial cancer. The para-aortic lymph nodes are around the lower part of the aorta (the large artery that carries blood away from the heart).

Why change to sentinel node biopsy?

In nine of ten patients, all lymph nodes that are removed and examined will be cancer free. However, removing more than four lymph nodes is associated with a substantial risk of lymphoedema of the lower limbs, causing great difficulties to the daily lives of patients. Sparing healthy lymph nodes will help prevent lymphoedema and improve the chances of a healthy life after treatment for gynaecological cancer.

Pictured below: Tiny lymph nodes that were normally invisible until now (top picture) can be seen bright green with this technique (bottom picture).

without dye

 

green dye

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