sentinel lymph node biopsy

WordNet

1. used to express refusal or denial or disagreement etc or especially to emphasize a negative statement; "no, you are wrong"
2. a negative; "his no was loud and clear"
3. referring to the degree to which a certain quality is present; "he was no heavier than a child" (同)no more
4. not in any degree or manner; not at all; "he is no better today"
5. quantifier; used with either mass nouns or plural count nouns for indicating a complete or almost complete lack or zero quantity of; "we have no bananas"; "no eggs left and no money to buy any"; "have you no decency?"; "did it with no help"; "Ill get you there in no time"
6. sway gently back and forth, as in a nodding motion; "the flowers were nodding in the breeze"
7. be almost asleep; "The old man sat nodding by the fireplace"
8. let the head fall forward through drowsiness; "The old man was nodding in his chair"
9. the act of nodding the head
10. a sign of assent or salutation or command
11. express or signify by nodding; "He nodded his approval"
12. lower and raise the head, as to indicate assent or agreement or confirmation; "The teacher nodded when the student gave the right answer"
13. any thickened enlargement (同)knob, thickening
14. (botany) the small swelling that is the part of a plant stem from which one or more leaves emerge (同)leaf node
15. a connecting point at which several lines come together
16. (computer science) any computer that is hooked up to a computer network (同)client, guest
17. (astronomy) a point where an orbit crosses a plane
18. (physics) the point of minimum displacement in a periodic system
19. any bulge or swelling of an anatomical structure or part
20. a thin coagulable fluid (similar to plasma but) containing white blood cells (lymphocytes) and chyle; is conveyed to the blood stream by lymphatic vessels
21. examination of tissues or liquids from the living body to determine the existence or cause of a disease

PrepTutorEJDIC

1. 《名詞の前に置いて》『一つも』(『一人も,少しも』)・・・『ない』 / 《補語につけて》『決して・・・でない』 / 《省略文で》・・・なし;・・・お断り / 《話》少ししか(あまり)・・・ない / (肯定の問いに対して)『いいえ』;(否定の問いに対して)はい,ええ / 《not, norの前に挿入して》『いや』,否 / 《形容詞の前に置その形容詞を否定して》…どころではない / 《比較級の前に置いて》ちっとも…でない,…と全く同じ / 《… or no の形で》…であってもなくても / 《驚き・困惑・不信などを表して》とんでもない / 《単数形で》『拒否』,「『いいえ』」という返事 / 《複数形で》反対[投]票
2. (承諾・あいさつ・合図などで)『うなずく』,会釈する / (眠くて)『こっくりする』,(油断して)うとうとする《+off》 / 〈草木・穂などが〉揺れる / (承諾・あいさつなどで)〈頭〉‘を'『うなずかせる』 / …‘を'うなずいて示す / 《副詞[句]を伴って》〈人〉‘に'うなずいて示す / 《同意・承諾・あいさつ・命令など,また時には拒絶を表して》(…に対する)『うなずき』,『会釈』《+『to』+『名』》;(眠気による)こっくり
3. (茎・幹の)節(ふし) / (体組織にできた)結節,こぶ(リンパ瘤(りゅう)など) / (天体の軌道の)交点 / (物事の)中心点
4. リンパ[液]

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/05/08 07:38:54」(JST)

wiki en

[Wiki en表示]

The sentinel lymph node is the hypothetical first lymph node or group of nodes draining a cancer. In case of established cancerous dissemination it is postulated that the sentinel lymph node/s is/are the target organs primarily reached by metastasizing cancer cells from the tumor. Thus, sentinel lymph nodes can be totally void of cancer, due to the fact that they were detected prior to dissemination.

Physiology

The spread of some forms of cancer usually follows an orderly progression, spreading first to regional lymph nodes, then the next echelon of lymph nodes, and so on, since the flow of lymph is directional. In layperson language, some cancers spread in a predictable fashion from where the cancer started. In these cases, if the cancer spreads it will spread first to lymph nodes (lymph glands) close to the tumor before it spreads to other parts of the body. The concept of sentinel lymph node surgery is to determine if the cancer has spread to the very first draining lymph node (called the "sentinel lymph node") or not. If the sentinel lymph node does not contain cancer, then there is a high likelihood that the cancer has not spread to any other area of the body.

Uses

The concept of the sentinel lymph node is important because of the advent of the sentinel lymph node biopsy technique, also known as a sentinel node procedure. This technique is used in the staging of certain types of cancer to see if they have spread to any lymph nodes, since lymph node metastasis is one of the most important prognostic signs. It can also guide the surgeon to the appropriate therapy.

A blue stained sentinel lymph node in the axilla.

A micrograph showing an adenocarcinoma of the breast (dark pink) in a lymph node (purple) and extending into the surrounding fat (white, chicken-wire appearance). H&E stain.

There are various procedures entailing the sentinel node detection:

• Preoperative planar lymphoscintigraphy
• Preoperative planar lymphoscintigraphy in conjunction with SPECT/CT [single photonemission CT (SPECT) with a low-dose CT]
• Intraoperative visual blue dye detection
• Intraoperative fluorescence detection (fluorescence image-guided surgery)
• Intraoperative gamma probe/Geiger meter-detection
• Postoperative scintigraphy of main specimen with planar acquisition

In everyday clinical activity, entailing sentinel node detection and sentinel lymph node biopsy, it is not requested to include all different techniques listed above. In skilled hands and in a center with sound routines, one, two or three of listed methods can be considered being sufficient.

To perform a sentinel lymph node biopsy, the physician performs a lymphoscintigraphy, wherein a low-activity radioactive substance is injected near the tumor. The injected substance, filtered sulfur colloid, is tagged with the radionuclide technetium-99m. The injection protocols differ by doctor but the most common is a 500 μCi dose divided among 5 tuberculin syringes with 1/2 inch, 24 gauge needles. The sulphur colloid is slightly acidic and causes minor stinging. A gentle massage of the injection sites spreads the sulphur colloid, relieving the pain and speeding up the lymph uptake. Scintigraphic imaging is usually started within 5 minutes of injection and the node appears from 5 min to 1 hour. This is usually done several hours before the actual biopsy. About 15 minutes before the biopsy the physician injects a blue dye in the same manner. Then, during the biopsy, the physician visually inspects the lymph nodes for staining and uses a gamma probe or a Geiger counter to assess which lymph nodes have taken up the radionuclide. One or several nodes may take up the dye and radioactive tracer, and these nodes are designated the sentinel lymph nodes. The surgeon then removes these lymph nodes and sends them to a pathologist for rapid examination under a microscope to look for the presence of cancer.

A frozen section procedure is commonly employed (which takes less than 20 minutes), so if neoplasia is detected in the lymph node a further lymph node dissection may be performed. With malignant melanoma, many pathologists eschew frozen sections for more accurate "permanent" specimen preparation due to the increased instances of false-negative with melanocytic staining.

Clinical advantages

There are various advantages to the sentinel node procedure. First and foremost, it decreases lymph node dissections where unnecessary, thereby reducing the risk of lymphedema, a common complication of this procedure. Increased attention on the node(s) identified to most likely contain metastasis is also more likely to detect micro-metastasis and result in staging and treatment changes. The main uses are in breast cancer and malignant melanoma surgery, although it has been used in other tumor types (colon cancer) with a degree of success. Other cancers which have been investigated with this technique are penile cancer, urinary bladder cancer, prostate cancer, testicular cancer and renal cell cancer.

Research advantages

As a bridge to translational medicine, various aspects of cancer dissemination can be studied using sentinel node detection and ensuing sentinel node biopsy. Tumor biology pertaining to metastatic capacity, mechanisms of dissemination, the EMT-MET-process (epithelial–mesenchymal transition) and cancer immunology are some subjects which can be more distinctly investigated.

Disadvantages

However, the technique is not without drawbacks, particularly when used for melanoma patients. This technique only has therapeutic value in patients with positive nodes. Failure to detect cancer cells in the sentinel node can lead to a false negative result - there may still be cancerous cells in the lymph node basin. In addition, there is no compelling evidence that patients who have a full lymph node dissection as a result of a positive sentinel lymph node result have improved survival compared to those who do not have a full dissection until later in their disease, when the lymph nodes can be felt by a physician. Such patients may be having an unnecessary full dissection, with the attendant risk of lymphedema.

History

The concept of a sentinel node was first described by Gould et al. 1960 in a patient with cancer of the parotid gland and was implemented clinically on a broad scale by Cabanas in penile cancer. The technique of sentinel node radiolocalization was co-founded by James C. Alex, MD, FACS and David N. Krag MD (University of Vermont Medical Center) and they were the first ones to pioneer this technique for the use of cutaneous melanoma, breast cancer, head and neck cancer and Merkel cell carcinoma. Confirmative trials followed soon after. Studies were also conducted at the Moffitt Cancer Center with Charles Cox, MD, Douglas Reintgen, MD and James Norman, MD.

References

6. Alex JC, Krag DN. Gamma-Probe-Guided Localizaton of Lymph Nodes, Surg Onc 1993, 2: 137-44.

7. Alex JC, Weaver DL, Fairbanks JT, Rankin BS, Krag DN. Gamma-Probe-Guided Lymph Node Localization in Malignant Melanoma, Surg Onc 1993; 2: 303-308.

8, Krag DN, Weaver DL, Alex JC, Fairbanks JT. Surgical Resection and Radio-localization of the Sentinel Node in Breast Cancer Using a Gamma Probe. Surg Onc 1993; 2: 335-340.

9. Krag DN, Meijer SJ, Weaver DL, Loggie BW, Harlow SP, Tanabe KK, Laughlin EH, Alex JC. Minimal Access Surgery for Staging Malignant Melanoma. Arch Surg 1995; 130: 654-658.

10. Alex JC and Krag DN. Gamma Probe Guided Resection of Radiolabeled Lymph Nodes. Surg Onc Clin N Am 1996; 5 (1): 33-41.

11. Alex JC, Krag DN, Meijer S, Weaver DL, Loggie. Sentinel Node Radio-Localization in Head and Neck Melanoma. Arch Otolaryngol Head Neck Surg 1998; 124: 135-140.

12. Alex JC. The Application of Sentinel Node Radiolocalization to Solid Tumors of the Head and Neck – a Ten Year Experience. Laryngoscope, 2004; 114: 2-19.

External links

• Sentinel node biopsy using radiocolloid blue dye
• Cancer Management Handbook: Sentinel node biopsy
• Sentinel Lymph Node - Know Your Body
• http://www.isns.info/main.php - International Sentinel Node Society (ISNS)

UpToDate Contents

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• 1. 乳癌におけるセンチネルリンパ節生検：手技 sentinel lymph node biopsy in breast cancer techniques
• 2. 乳癌のセンチネルリンパ節郭清：適応および転帰 sentinel lymph node dissection for breast cancer indications and outcomes
• 3. 黒色腫（メラノーマ）における所属リンパ節の評価および治療 evaluation and treatment of regional lymph nodes in melanoma
• 4. 乳癌における所属リンパ節のマネージメント management of the regional lymph nodes in breast cancer
• 5. メルケル細胞癌の病期分類および治療 staging and treatment of merkel cell carcinoma

English Journal

• Management of head and neck melanoma: results of a national survey.

• Sawh-Martinez R1, Douglas S, Pavri S, Ariyan S, Narayan D.
• Annals of plastic surgery.Ann Plast Surg.2014 Dec;73 Suppl 2:S175-7. doi: 10.1097/SAP.0000000000000182.
• We recently reported on the safety of minimally invasive parotid region sentinel node biopsy and level I-sparing radical neck dissection for head and neck melanoma. We therefore wished to assess the state of practice in the United States through a survey of specialists in head and neck surgery. We h
• PMID 24667883

• The Optimum Excision Margin and Regional Node Management for Primary Cutaneous T3 Melanomas (2-4 mm in Thickness): A Retrospective Study of 1587 Patients Treated at a Single Center.

• Lamboo LG1, Haydu LE, Scolyer RA, Quinn MJ, Saw RP, Shannon KF, Spillane AJ, Stretch JR, Bonenkamp JJ, Thompson JF.
• Annals of surgery.Ann Surg.2014 Dec;260(6):1095-102. doi: 10.1097/SLA.0000000000000792.
• OBJECTIVE: To determine the optimum excision margin and nodal management for patients with primary cutaneous melanomas 2.01- to 4.00-mm thick (T3 melanomas).BACKGROUND: Currently available evidence does not reliably define the minimum safe excision margin and best nodal management for patients with
• PMID 25072430

• A novel method for intraoperative sentinel lymph node detection in prostate cancer patients using superparamagnetic iron oxide nanoparticles and a handheld magnetometer: the initial clinical experience.

• Winter A1, Woenkhaus J, Wawroschek F.
• Annals of surgical oncology.Ann Surg Oncol.2014 Dec;21(13):4390-6. doi: 10.1245/s10434-014-4024-8. Epub 2014 Sep 5.
• BACKGROUND: A sentinel lymph node (SLN) biopsy using superparamagnetic iron oxide nanoparticles (SPIOs) as a tracer instead of radioisotopes was first applied successfully in breast cancer. This study determined the feasibility of this new technique using SPIOs and a handheld magnetometer to detect
• PMID 25190119

Japanese Journal

• 当院における原発乳癌の手術療法の現状 (第20巻記念号)

• 安藝 史典,伊藤 末喜
• 高知県医師会医学雑誌 = Journal of Kochi Medical Association 20(1), 115-120, 2015
• NAID 40020427994

• 趾尖部悪性黒色腫の1例

• 飯野 志郎,丸田 直樹,高嶋 渉,長谷川 稔,峯岸 芳樹,中井 國博,清原 隆宏
• Skin Cancer 29(3), 313-317, 2015
• 62歳，男性。左母趾尖端部に爪甲色素線条と連続した赤黒色腫瘤があった。腫瘤は徐々に増大し出血を伴ってきた。爪甲の破壊はなかった。腫瘤部の切除生検により悪性黒色腫と診断した。CT，PETで遠隔転移はなく，爪母を含めた拡大切除およびセンチネルリンパ節生検を施行した。鼠径リンパ節に被膜外浸潤を伴う転移を確認し，鼠径および骨盤内郭清を施行した。術後DTIC単独投与，IFNβ局注を3クール施行した。郭清から …
• NAID 130005067556

• 10年前に切除され，その後局所再発した手掌の悪性黒色腫の1例

• 土井 直孝,三木田 直哉,古川 福実,山本 有紀
• Skin Cancer 29(3), 309-312, 2015
• 2001年ごろから右手掌に黒色斑が出現していた。2004年10月に精査のため当院を受診した。3 mm大の辺縁不整な黒色斑であり，精査のため4 mmパンチで切除生検され，病理組織診でbasal pigmentationの診断で治療終了となっていた。切除部は肉眼的には病変は消失し瘢痕となっていた。しかし，5年後に瘢痕から色素性病変が出現し当科受診となった。2013年11月に生検施行し，悪性黒色腫と診断 …
• NAID 130005067555

Related Links

• Sentinel Lymph Node Biopsy - YouTube

For more information, visit CancerQuest at http://www.cancerquest.org/sentinel-l.... A video-animation presentation about sentinel lymph node biopsies for breast cancer diagnosis. 3D graphics are used to explain the process. Topics include the lymphatic system and the methods used. This video is part of ...

• Sentinel Lymph Node Biopsy - National Cancer Institute

A fact sheet that describes the sentinel lymph node biopsy procedure and details two clinical trials evaluating the effectiveness of this procedure. ... Lymph originates from a fluid, known as interstitial fluid, that has diffused, or ...

Related Pictures

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★リンクテーブル★

リンク元	「lymph node biopsy」「センチネルリンパ節生検」
関連記事	「node」「sentinel」「nod」

「lymph node biopsy」

　　[★]

関

sentinel lymph node biopsy

「センチネルリンパ節生検」

　　[★]

英

sentinel lymph node biopsy

「node」

　　[★]

• n.

• 結節、リンパ節、節、ノード

関

clause、ganglia、ganglion、ganglionic、knot、lymph node、nodal、nodose、nodulate、section、tubercle、tubercular、tuberosity

　 　 　 　 　 　 　 　

「sentinel」

　　[★]

• 番人、歩哨、センチネル

　

「nod」

　　[★]