The first node reached by the lymphatic stream, assuming an orderly and sequential drainage from the tumour site, And should be predictive of the nodal stage

1. SENTINEL NODE
PREPARED BY-DR DHWANI RANVERIA

2. • The first node reached by the lymphatic stream,
assuming an orderly and sequential drainage
from the tumour site,
• And should be predictive of the nodal stage.
L. Calabrese Et Al. Sentinel Node In Oral Cancer Acta Otorhinolaryngol Ital 26, 345-
349, 2006

3. • If the Sentinel Node is free from cancer cells,
• Then distal node involvement is assumed to be rare.
• Alvarez et al.Diagnostic efficacy of sentinel node biopsy in oral squamous cell
carcinoma Med Oral Patol Oral Cir Bucal 2007; 12:E235–43.

4. Flowchart Depicting The Process Of Primary
Tumour Spread To A Sentinel Lymph Node.
Sharma et al., Sentinel Lymph Node Biopsy, Sultan Qaboos University Med J, February
2017, Vol. 17, Iss. 1, pp. e3–10

5. • Recently, the concept of a sentinel lymph node (SLN) was
introduced in head and neck squamous cell carcinomas
(HNSCCs)
• In order to more precisely detect and evaluate neck
metastasis and unpredictable lymphatic drainage patterns,
following its successful application in melanomas and
breast cancer. .
• Sharma et al., Sentinel Lymph Node Biopsy, Sultan Qaboos University Med J,
February 2017, Vol. 17, Iss. 1, pp. e3–10

6. The Techniques And Methodology For
SLN Identification
• Shoaib et al. suggested a protocol involving
1. preoperative lymphoscintigraphy,
2. intraoperative blue dye and
3. gamma probe localization.
Shoaib T, et al. The accuracy of head and neck carcinoma sentinel lymph node
biopsy in the clinically N0 neck. Cancer 2001

7. The Techniques And Methodology For
SLN Identification
1. Lymphoscintigraphy reveals SLNs associated with the
primary tumour,
2. To enhance the detection rate, blue dye is often used
in combination with radioisotopes.
3. During the surgery, a handheld gamma probe is used
for radionuclide detection to trace the SLN
perioperatively and a gamma camera is used for
dynamic monitoring of lymphatic drainage.

8. Sentinel Node Biopsy
• Diagnostic technique used to assess the presence of occult
metastatic disease in the N0 neck.
• In 1996, the first successful SLN Biopsy was performed by
Alex et al. on a patient with a laryngeal supraglottic
carcinoma.
• Rakheja M et al Sentinel lymph node biopsy in oral squamous cell carcinoma:
Ensuing from elective to selective. J Res Med Dent Sci 2014; 2:5–10.

9. Proposed treatment
protocol for a sentinel
lymph node biopsy.
Shoaib T, et al. The
accuracy of head and
neck carcinoma sentinel
lymph node biopsy in the
clinically N0 neck. Cancer
2001

10. Sentinel European Node Trial (SENT):
3-year Results Of
Sentinel Node Biopsy In Oral Cancer
C. Schilling et al. / European Journal of Cancer 51 (2015)

12. CONCLUSION
• Not a widely used diagnostic adjunct in N0 neck
• It does hold the potential to be used as single
diagnostic modality in determining the management of
early N0 lesions
• It is an accurate and oncologically safe procedure.
C. Schilling et al. / European Journal of Cancer 51 (2015)

13. THANKYOU