The sentinel lymph node is the first lymph node that receives lymphatic drainage from a tumour. It is the first lymph node that may be metastasized, therefore it is of utmost importance to monitor it to assess the extent of a primary tumour.
The lymph nodes and the cells inside of them are meant to protect our body against external contaminations (like viruses, bacteria …), or internal ones such as when cancer cells develop. They are genuine sentinels located at the outposts of the immune system and are responsible for detecting intruders or enemies, and participating in their elimination.
When cancer develops, tumorous cells can escape into the lymphatic circulation, and develop in a ganglion. This is a lymph node metastasis that mandates to remove all affected nodes.
Prior to the development of lymph node identification techniques, lymph node resection was systematic, leading to frequent side effects like lymphedema.
In 1994, a first publication described the sentinel lymph node localisation technique and postulated that if no cancer cells were detected in first ganglion, then the ganglion cain downstream would not be affected neither, making the curettage of the chain unwarranted.
The affected sentinel node has therefore to be identified for resection and analysed via extemporary examination by a pathologist to characterise the presence of cancer cells.
If the ganglion is negative upon histopathological examination, further complementary analyses, including immunohistochemical ones, will be conducted to confirm whether metastases are present or not, and guide any complementary treatment necessary.
Conversely, if the sentinel lymph node proved positive for metastatic cells, the surgeon will perform an axillary dissection during surgery to eliminate all potentially affected lymph nodes.
The concept of the sentinel lymph node quickly expanded the clinical applications of radio-guided surgery. Fields of Application cover following areas:
Senology: Detection of sentinel lymph nodes / Detection of subclinical lesions. (ROLL, SNOLL
Gynaecology: Laparoscopic detection of sentinel lymph nodes in cervical and endometrial cancers / Detection of sentinel lymph nodes in vulvar cancer
ENT: Oral cavity, Head and stroke
Dermatology: Melanoma / Osteoid osteoma
Endocrinology: Thyroid / ParaThyroid
Nuclear Medicine: Percutaneous Detection / Activity Search
Urology: Prostate Cancer / Penis Cancer
EuroMedical Instruments is offering since 2014 a major innovation in sentinel lymph node detection with bi-modal Gamma and Fluorescence detection of SNLs.
During a Sentinel Ganglion search, both radio-isotopic and colorimetric detections are recommended as standard of care, as it maximises the detection rate. The patented blue is the most commonly used colorimetric marker, but is laden with many disadvantages, not least allergic risks resulting in an unacceptably high level of anaphylactic shocks.
Eurorad has developed a new highly sensitive colorimetric technique based on indocyanine green (ICG) fluorescence detection, which advantageously replaces any other colorimetric tracer.
The first description of the technique is relatively old since it dates from 2005 and the data of the literature are abundant.
According to a press briefing entitled “Indocyanine green sentinel lymph node detection methods”, conducted by Professor Emmanuel Barranger of the Antoine Lacassagne Centre in Nice, the fluorescence GS identification rate varies between 93% and 100% and the average number of GS taken out 1.5 to 5.4.
This method of detection by the ICG has been adopted by many surgical teams around the world and is currently recommended by the European Society of Medical Oncology[1]
[1] Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. E. Senkus, S. Kyriakides, S. Ohno, F. Penault-Llorca, P. Poortmans, E. Rutgers, S. Zackrisson, F. Cardoso on behalf of the ESMO Guidelines Committee.Annals of Oncology, Volume 26, Issue suppl_5, 1 September 2015, Pages v8–v30.Published: 25 August 2015
The Europrobe is the only device in the world that offers this dual Gamma/Fluorescence detection.
The identification is accurate and can be done in normal light environment.
The detection method is simple and identical to the normal practice. Only a very short training is required to master technique.
Fluorescence is offered as an add-on option to the Gamma module.
Transitioning from one detection mode to the other is fast and can be achieved as often as needed via a foot switch.