Technological innovation in the sentinel node procedure: towards 3-D intraoperative imaging

Excerpt

The concept of the sentinel node procedure is based on the existence of an orderly and predictable pattern of lymphatic drainage to a regional lymph node basin, and on the functioning of lymph nodes on a direct drainage pathway as effective filters for tumour cells. When Dr. Donald Morton described the modern concept of lymphatic mapping in melanoma in 1992, he also introduced the technique of intraoperative visualization of the sentinel node using blue dye [1]. With the addition of radioactive colloids and gamma probe detection in 1993 the acoustic signals, corresponding with the detection of radioactivity, were incorporated into the sentinel node search in the operating room [2]. In the last two decades, this combination of visual and auditory signals has been a fundament of the intraoperative identification of sentinel nodes in patients with melanoma or breast cancer. The combination of “hot” and “blue” in the operating room has been successful to localize the sentinel node in the expected lymph drainage basin. The blue dye is less effective in areas of aberrant drainage that may be indicated preoperatively by lymphoscintigraphy. Blue dye has also a limited value in deep nodal basins. …