In this overview, I have discussed the application and indications of sentinel lymph node biopsy in surgical oncology including gynecological cancers, Urological cancers, breast cancer, melanoma, and gastrointestinal cancers. Several cases of our department were also included in the presentation to augment the message of the presentation. It is an evidence based overview.

1. Sentinel node biopsy in
oncology: beyond
breast cancer
RAMIN SADEGHI, MD

2. Melanoma

3. Melanoma
SLNB is a surgical procedure developed to accurately stage patients with cutaneous
melanoma through pathologic assessment of the regional nodal basin(s) and to provide
prognostic information for patients with clinical stage I/II melanoma (no clinical or
radiographic evidence of nodal disease).
In patients with clinical stage I/II melanoma, SLN status is the strongest predictor of
survival.

5. Melanoma
Injection of the radiotracer
◦ is done in a peri-tumoral fashion (intradermal or subcutaneous), and both same-day and 2-day protocols
worked well

6. Melanoma
Imaging
◦ Imaging using planar and SPECT/CT is mandatory in sentinel node mapping of melanoma as lymphatic
drainage of melanoma can be unpredictable and into multiple basins, especially in the trunk or head and
neck melanomas
◦ Imaging should cover all potentially relevant lymphatic basins: for example, for limbmelanomas, the entire
limb, including intercalary nodes, and for trunk melanoma, bilateral axillary and inguinal areas should be
imaged.
◦ Imaging can also show intercalary sentinel nodes such as epitrochlear in upper limb and popliteal in lower
limb melanomas. Without preoperative lymphoscintigraphy, the identification of intercalary nodes would be
almost impossible despite important prognostic and diagnostic implications

9. Melanoma
In the case of a lower-extremity melanoma with iliac nodes on the same lymphatic
channel as a more proximal superficial femoral SLN, excision of the second order nodes
may be omitted. However, if they are on a distinct lymphatic channel or there is
uncertainty as to their drainage pattern, these SLNs should be identified and excised.

10. Melanoma lower limb

11. Cloquet sentinel

12. External iliac

13. Intercalary node

14. Uterine Cervix Cancer

16. Uterine cervix cancer
Preoperative lymphoscintigraphy (especially with SPECT/CT) is of utmost importance in cervical
cancer patients. It can show technical failures such as inappropriate injections or unusual locations
of the sentinel nodes

18. A patient with uterine cervix cancer

19. Bilateral external iliac sentinel nodes

21. Endometrial cancer

23. Endometrial cancer
A cervical injection with dye has emerged as a useful and validated technique for
identification of lymph nodes that are at high risk for metastases.
◦ Superficial (1–3 mm) and optional deep (1–2 cm) cervical injection leads to dye delivery to the
main layers of lymphatic channel origins in the cervix and corpus, namely the superficial
subserosal, intermediate stromal, and deep submucosal lymphatic sites of origin.

25. Vulvar cancer

27. Vulvar cancer patient

28. Penile cancer

30. Unusual location of a mid-thigh sentinel
node in a penile cancer patient

31. Colorectal cancer

32. The injection techniques for colorectal cancers are very diverse: in vivo injections (submucosal or
subserosal, intraoperatively or preoperatively using endoscopy) and ex vivo technique (injections
following removal of the tumor) have both done well.
◦ In in vivo techniques, the mapping material is injected in the submucosal or subserosal areas around the
tumor. Lymphoscintigraphy can be done if available.
◦ In ex vivo technique, the mapping material is injected in a subserosal fashion around the resected tumor

34. Ex vivo sentinel node mapping in a colon
cancer

35. Head and neck cancers