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2005, Number 2

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Acta Med 2005; 3 (2)

What is the sentinel node? Concept and practical applications in oncology

Gallegos HJF

Language: Spanish
References: 41
Page: 91-98
PDF size: 93.73 Kb.


ABSTRACT

Most neoplasias have three ways of spreading: local (adjoining tissues invasion), systemic (blood) and lymphatic. The three of them may be independent from one another. The treatment must be addressed to each of them; regarding the lymphatic, it may be the manifestation of an advanced disease or the starting point of systemic spreading. According to their lymphatic histological status, patients with certain types of cancer may have clinic nodular metastasis at the time of diagnosis (cN+), they may not have them (cN0) or may have them sub-clinical, not palpable (cN0, pN+). The treatment objective is to eliminate the existing metastasis, to prevent unnecessary treatment in cN0 patients and to attack hidden metastasis starting from here to a distance or that are clinically evident. The best way to achieve this is with nodular dissection of the problem area; nevertheless, the use of this procedure in cN+ patients is beneficial, without question, but its use is questionable in the other two groups of patients because we identify cN0 patients after they have undergone surgery; therefore, they are exposed to the possibility of a complication without necessarily being benefited with the treatment. Since 12 years ago, a technique has been described that is based on a sequential nodular spreading theory, which allows pre-treatment identification in cN0 and cN0, pN+ patients; it identifies the signal node or sentinel node which receives the lymph from the tumor before any other, from there the neoplastic cells derive to the others; its value lies in the fact that it is a reliable marker of the nodular status. The object herein is to inform, based on our own experience and on the evidence in existing literature, the state of the art of this technique called lymphatic mapping and sentinel node biopsy.


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