Sentinel Lymph Node Biopsy – A Legacy of Research at Saint John’s Cancer Institute
In the early 1990s, Dr. Donald Morton, described a technique to identify the first lymph nodes in the sequence of spread, revolutionizing the standard of care for surgical oncology globally. Previously, patients with intermediate-risk melanoma underwent complete removal of all regional lymph nodes, a procedure with moderate complication rates, such as lymphedema, nerve injuries, and wound complications.
The late Dr. Morton, who served as chief of the melanoma program and co-director of the surgical oncology fellowship program at the John Wayne Cancer Institute, now the Saint John’s Cancer Institute, revolutionized a field that too often was stumped by the complexity and tenacity of cancer. The Saint John’s Cancer Institute pioneered a procedure using dye and radiotracers to locate and remove only the key affected lymph nodes, termed Sentinel Lymph Node Biopsy (SLNB). These nodes are then examined under a microscope to determine if there has been any spread of the tumor outside the primary site, which has also been particulary helpful in breast cancer patients.
What are the Benefits to Patients?
- Minimizes the extent of surgery needed: SLNB allows for less invasive surgery compared to complete lymph node dissection.
- Decreases risk for long-term complications: Reduces the likelihood of complications like lymphedema and nerve injuries.
- Provides better staging and prognostic information: Helps guide treatment decisions with more accurate staging.
- Improves patient survival: Studies have shown that SLNB can enhance survival rates.
What is a Sentinel Lymph Node Biopsy Procedure?
The sentinel node biopsy procedure is minimally invasive and performed on an outpatient basis. While some patients may still require a larger operation, four out of five can be spared. The technique involves injecting a blue dye and radioisotope substance into the lymphatic system near the tumor. These tracers travel through the lymphatic channels to the first, at-risk lymph node. This is typically done the same day as the surgery in the radiology department, where the tracer is placed around the melanoma. The blue dye is injected in the operating room once the patient is under anesthesia.
Recent Advancements
Recent advancements in SLNB have further refined the procedure. For example, new guidelines from the American Society of Clinical Oncology (ASCO) emphasize optimizing SLNB use while minimizing invasive interventions. Additionally, studies have shown that SLNB can be safely omitted in certain low-risk cases, reducing complications and improving quality of life.
What to Expect Undergoing the Sentinel Node Biopsy
Prior to the operation, you will undergo a test called a lymphoscintigram to identify the sentinel lymph node basin. A small amount of fluid is injected into the skin around the melanoma, and blue dye is injected in the operating room. This test allows for the removal of only the first draining lymph nodes, whereas in the past, all lymph nodes in the draining basin would be removed.
Recovery and Side Effects
The incision for the sentinel lymph node is small and usually only requires over-the-counter pain medications. There is a small risk for lymphedema, infection, bleeding, or seroma formation after the procedure. However, the risks are low, and it is generally a safe procedure.
Patient Experience
Patients undergoing SLNB can expect a relatively quick and minimally invasive procedure. Some discomfort may be experienced during the injection of the radiotracer, but numbing agents can help minimize this. Most patients can leave the hospital on the same day and resume normal activities shortly after.
The Borstein Family Foundation Melanoma Program, a center of excellence at the Saint John’s Cancer Institute, is one of the most experienced melanoma research centers in the world. Together, with expert physicians of Saint John’s Health Center, we offer patient-specific treatment options including access to advanced clinal trails. Contact us today to schedule an appointment.
If you have questions regarding the evaluation or treatment for melanoma, please call today or click here to schedule an appointment or for an expert second opinion.
