Sentinel Node Biopsy

Sentinel lymph node (SLN) biopsy is a technique that allows the early detection of metastasis within a clinically negative regional lymphatic drainage basin. The rationale behind SLN biopsy is to identify the patients who develop microscopic lymph node metastasis at the time of initial diagnosis and are most likely to benefit from lymph node dissection to avoid distant metastasis.43,44

The application of this technique to ocular and ad-nexal tumors was recently introduced by Esmaeli and coworkers.45-47 The technique of mapping sentinel lymph nodes begins with lymphoscintigraphy of 99mTc sulfur colloid and isosulfan blue dye (Figure 12.8). Identification of the positive lymph nodes is done with a handheld gamma probe during lym-phoscintigraphy, and the lymph nodes to be harvested for histopathologic examination are marked on the skin as soon as they have been identified. Skin incisions are made over the positive lymph nodes, and the lymph nodes that are stained with blue dye are identified and removed for histopathologic examination.

The harvested lymph nodes are submitted for routine formalaldehyde-fixed and paraffin-embedded sections; the entire node should be serially sectioned at 2 mm intervals for H&E staining. Depending on the

FIGURE 12.8. Sentinel lymph node biopsy: lymphoscintigraphy showing tumor-positive satellite lymph nodes in the region of a conjunctival/orbital melanoma. (Courtesy of Dr. Bita Esmaeli, Houston, TX.)

RT LAT TRANS

FIGURE 12.8. Sentinel lymph node biopsy: lymphoscintigraphy showing tumor-positive satellite lymph nodes in the region of a conjunctival/orbital melanoma. (Courtesy of Dr. Bita Esmaeli, Houston, TX.)

TABLE 12.2. Antibody Panels Commonly Used in Flow Cytometric Analyses of Hematologic Disorders.

Cluster designations

TABLE 12.2. Antibody Panels Commonly Used in Flow Cytometric Analyses of Hematologic Disorders.

Cluster designations

Diagnosis

CD5

CD10

CD19

CD20

CD23

CD79b

FMC-7

CD25

CD11c

CD103

SLL/CLL

+

-

+

+ (w)

+

-

-

-/ +

+/-

-

Mantle cell lymphoma

+

-

+

+

-

+

+

-

-

-

Follicle center lymphoma

-

+

+

+

-/+

+/-

+ /-

-

-

-

Marginal zone lymphoma

-

-

+

+

-

+/-

+ /-

-/ +

+

-

Hairy cell leukemia

-

-

+

+

-

+/-

+ /-

+/-

+

+

MALToma

-

-

+

-

SLL/CLL, small lymphocytic lymphoma/chronic lymphocytic leukemia; +, positive; —, negative; +/—, often positive; — /+, occasionally positive; w, weak expression; FMC, Flander's Medical Center; MALToma, B-cell lymphoma of mucosa-associated lymphoid tissue.

SLL/CLL, small lymphocytic lymphoma/chronic lymphocytic leukemia; +, positive; —, negative; +/—, often positive; — /+, occasionally positive; w, weak expression; FMC, Flander's Medical Center; MALToma, B-cell lymphoma of mucosa-associated lymphoid tissue.

tumor type, certain immunohistochemical stains can be used (e.g., S-100 and HMB-45 for melanoma, cy-tokeratin for squamous cell carcinoma).

Although with proper patient selection SNL biopsy is useful in the clinical management of early conjunctival and eyelid tumors, its application to orbital tumor management is limited and its significance in the staging of orbital tumors warrants further study.48-50

How To Prevent Skin Cancer

How To Prevent Skin Cancer

Complete Guide to Preventing Skin Cancer. We all know enough to fear the name, just as we do the words tumor and malignant. But apart from that, most of us know very little at all about cancer, especially skin cancer in itself. If I were to ask you to tell me about skin cancer right now, what would you say? Apart from the fact that its a cancer on the skin, that is.

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