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Journal articles on the topic 'Sentinel lymph node concept'

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Published: 10 December 2022

Last updated: 28 January 2023

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1

Hertel, Hermann. "Cervical Cancer and the Role of Lymph Node Staging Cons Sentinel Concept." International Journal of Gynecologic Cancer 20, Suppl 2 (September 2010): S37—S38. http://dx.doi.org/10.1111/igc.0b013e3181f7f52b.

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Objective:To determine whether the current standard of cervical cancer staging is sentinel lymph node biopsy.Method:Review of the literature focusing on the significance of the sentinel node concept in patients with cervical cancer. Because of the data on the significance of the intraoperative histopathological assessment of sentinel lymph nodes, the role of micrometastasis in lymph nodes, and the standards of procedure, the sentinel procedure were analyzed.Result:Sentinel lymph node biopsy alone is currently not a routine procedure for cervical cancer staging. This procedure should be performed only by specialized centers in a study setting. More data on its oncological safety are needed.

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Karachun, Aleksey, Aleksey Belyaev, Yuriy Pelipas, D. Asadchaya, Oleg Tkachenko, Marina Grinkevich, Aleksandra Sidorova, and Yuriy Petrik. "A LOOK AT THE NAVIGATION SURGERY OF THE GASTRIC CANCER: THE PRESENT STATE OF THE PROBLEM AND OWN EXPERIENCE." Problems in oncology 65, no. 6 (June 1, 2019): 838–49. http://dx.doi.org/10.37469/0507-3758-2019-65-6-838-849.

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Introduction: Concept of sentinel lymph node biopsy has been discussed during several last decades, because this idea seems perspective in terms of modern minimally invasive and organ-preserving era. However, this method has several limitations including complicated anatomy of gastric lymph nodes distribution and presence of skip-metastases. Materials and methods: 66 Patients with early gastric cancer, intermediate risk of lymph node metastases and technical possibility of ESD were included into our investigation. Patients were assigned to either ESD with sentinel lymph node biopsy (54 patients), or underwent distal gastrectomy or total gastrectomy with D1+/D2 lymphadenectomy (12 patients) by chance. Results: 56 (84,6%) Patients had at least one sentinel lymph node. 11 (16,7%) Patients with T1a-T1b had metastases in regional lymph nodes, 9 of them in sentinel lymph nodes (2 false-negative result). So, we calculated sensitivity of 84,6%. In one case, the metastasis was located outside the sentinel lymphatic basin, and in the other case, metastasis was detected in a patient with unlit lymph nodes. Conclusion: Today sentinel lymph node biopsy thechnique is considered as a well investigated and widly used method. The concept itself is promising for organ-preserving gastric cancer surgery.

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Pizzocaro, Claudio, Pier Luigi Rossini, Arturo Terzi, Roberto Farfaglia, Laura Lazzari, Edda Simoncini, and Raffaele Giubbini. "Sentinel Node Biopsy in Breast Cancer: The Experience of Brescia Civic Hospital." Tumori Journal 86, no. 4 (July 2000): 309–11. http://dx.doi.org/10.1177/030089160008600412.

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The accuracy of the sentinel node technique in the evaluation of axillary node involvement in breast cancer was evaluated in 83 consecutive patients with monofocal T1–2 carcinoma, who were clinically N0 and who underwent lymphoscintigraphy with 99mTc-colloid integrated with intraoperative sentinel node detection by a portable probe. Lymphoscintigraphy revealed at least one sentinel node in 75 patients (90.4%), always identified by the probe. In eight patients (9.6%) the sentinel node was detected neither by lymphoscintigraphy nor by the probe. All removed lymph nodes were analyzed by hematoxylin-eosin histology and the sentinel node by immunostaining. In 28/75 patients (37.3%) at least one metastatic axillary lymph node was detected; in 16 of the 28 N+ subjects (57%) only the sentinel node was positive. The false negative rate (sentinel node negative/other axillary lymph nodes positive) was 17.85% (5/28 patients). In 9/23 patients (39%) micrometastases were found in the sentinel node only. In conclusion, specific sentinel node positivity in 57% of cases supports the validity of the sentinel node concept. Moreover, nine patients would have been considered No by standard hematoxylin-eosin histology without sentinel node-aided immunostaining. A 17.8% false negative rate calls for caution in patients with negative sentinel nodes.

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Liberale, Gabriel, Sophie Vankerckhove, Fikri Bouazza, Maria Gomez Galdon, Denis Larsimont, Michel Moreau, Pierre Bourgeois, and Vincent Donckier. "Systemic Sentinel Lymph Node Detection Using Fluorescence Imaging After Indocyanine Green Intravenous Injection in Colorectal Cancer: Protocol for a Feasibility Study." JMIR Research Protocols 9, no. 8 (August 14, 2020): e17976. http://dx.doi.org/10.2196/17976.

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Background Nodal staging is a major concern in colorectal cancer as it is an important prognostic factor. Several techniques that could potentially improve patient treatment and prognosis have been developed to increase the accuracy of nodal staging. Sentinel lymph node detection has been shown to accurately reflect nodal status in various tumors and has become the standard procedure in nodal staging of breast cancer and melanoma. However, in colorectal cancer, sentinel lymph node detection techniques are still controversial as the sensitivity reported in the literature varies from one study to another. Recently, indocyanine green fluorescence–guided surgery has been reported to be a useful technique for detection of macroscopic and microscopic metastatic deposits in lymph nodes after intravenous administration of indocyanine green dye. However, no studies have focused on the potential role of sentinel lymph node detection after systemic administration of indocyanine green dye, so-called systemic sentinel lymph nodes, or on the correspondence between the identification of the sentinel lymph node by standard local injection techniques and the detection of fluorescent lymph nodes with this new approach. Objective The aim of this protocol is to validate the concept of sentinel lymph nodes identified by fluorescence imaging after intravenous injection of indocyanine green dye and to compare the sentinel lymph nodes identified by fluorescence imaging with sentinel lymph nodes detected by the standard blue dye technique. Methods This study (SeLyNoFI; Sentinel Lymph Nodes Fluorescence Imaging) is a diagnostic, single-arm, open-label feasibility study, including patients with colorectal adenocarcinoma with or without metastatic disease who are admitted for elective colorectal resection of the primary tumor. This study evaluates the feasibility of a new approach for improving the accuracy of nodal staging using fluorescence imaging after intravenous administration of indocyanine green dye. Sensitivity, positive predictive value, and accuracy of the classical blue dye technique and of the investigatory fluorescence imaging technique will be calculated. Translational research will be proposed, if applicable. Results As of June 2020, this study has been registered. Submission for ethical review is planned for September 2020. Conclusions The potential correlation between the two different approaches to detect sentinel lymph nodes offers new strategies for improving the accuracy of nodal staging in colorectal cancer. This new concept of the systemic sentinel lymph node and a greater understanding of the interactions between systemic sentinel lymph nodes and standard sentinel lymph nodes may provide important information regarding the underlying mechanism of primary tumor lymphatic drainage. The enhanced permeability and retention effect can also play a role in the fluorescence of systemic sentinel lymph nodes, especially if these lymph nodes are inflamed. In this case, we can even imagine that this new technique will highlight more instances of lymph node–positive colorectal cancer. International Registered Report Identifier (IRRID) PRR1-10.2196/17976

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5

Milulescu, Amelia, Cristian Gabriel Viisoreanu, Nicolae Bacalbasa, Irina Balescu, Tiberiu-Augustin Georgescu, Corina Grigoriu, Costin Berceanu, and Roxana Elena Bohiltea. "Management of the axilla: Conventional tracers vs ICG-fluorescence in sentinel lymph node biopsy." Romanian Medical Journal 68, S6 (December 30, 2021): 126–28. http://dx.doi.org/10.37897/rmj.2021.s6.21.

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The evaluation of regional lymph nodes is part of breast cancer staging. Biopsy of the sentinel lymph node was established, in order to evaluate the condition of the axillary lymph nodes without having to complete an axillary dissection. The concept of sentinel lymph node (SLN) is based on the theory of sequential dissemination of tumor cells through the lymph. When lymphatic dissemination occurs, the invasion initially occurs in the first lymph node that drains lymph from the tumor. This lymph node has been named GS and depending on its negative or positive status, the presence or absence of metastases in the remaining regional lymph nodes can be established. Blue dye (BD) and radioactive isotopes (RI) are routinely used markers for identification of the sentinel lymph nodes during sentinel lymph node biopsy (SLNB) in early stage breast cancer. Unlike the blue dye technique, using radioactive isotopes has lower false-negative rates. Nonetheless, the need of lymphoscintigraphy, the time needed for preoperative injection, and undetected sentinel lymph nodes in some cases cause surgeons to rely only on the combination of blue dye and radioisotopes. At present, indocyanine green (ICG) fluorescence method (ICG-SLNB) is starting to gain more and more field as an alternative to conventional mapping methods. The purpose of this review is to compare ICG with the conventional methods (blue dye and radioactive isotopes) and their role in detection of SLN.

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HASEGAWA, Shogo, Ken OMURA, Hiroyuki HARADA, Hiroaki SHIMAMOTO, Yoshihiko YOSHIDA, Masaru UEKUSA, and Takashi TOGAWA. "SENTINEL LYMPH NODE CONCEPT IN ORAL CANCER." Toukeibu Gan 31, no. 4 (2005): 517–22. http://dx.doi.org/10.5981/jjhnc.31.517.

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Karachun, Aleksey, Yuriy Pelipas, Oleg Tkachenko, and D. Asadchaya. "BIOPSY OF THE SIGNALING LYMPH NODES IN GASTRIC CANCER - CURRENT STATUS OF THE PROBLEM AND PROSPECTS." Problems in oncology 64, no. 3 (March 1, 2018): 335–44. http://dx.doi.org/10.37469/0507-3758-2018-64-3-335-344.

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The concept of biopsy of sentinel lymph node as the first lymph node in the pathway of lymphogenous tumor spread has been actively discussed over the past decades and has already taken its rightful place in breast and melanoma surgery. The goal of this method is to exclude vain lymphadenectomy in patients without solid tumor metastases in regional lymph nodes. In the era of minimally invasive and organ-saving operations interventions it seems obvious an idea to introduce a biopsy of sentinel lymph node in surgery of early gastric cancer. Meanwhile the complexity of lymphatic system of the stomach and the presence of so-called skip metastases are factors limiting the introduction of a biopsy of sentinel lymph node in stomach cancer. This article presents a systematic analysis of biopsy technology of signaling lymph node as well as its safety and oncological adequacy. Based on literature data it seems to us that the special value of biopsy of sentinel lymph nodes in the future will be in the selection of personalized surgical tactics for stomach cancer.

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Cheng, Li-Yang. "Sentinel lymph node concept in gastric cancer with solitary lymph node metastasis." World Journal of Gastroenterology 10, no. 20 (2004): 3053. http://dx.doi.org/10.3748/wjg.v10.i20.3053.

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Miki, J., T. Yanagisawa, K. Obayashi, K. Sakanaka, T. Matsuura, M. Tanaka, K. Miyajima, et al. "Sentinel lymph node concept in bladder cancer with solitary lymph node metastasis." European Urology Open Science 19 (July 2020): e1519. http://dx.doi.org/10.1016/s2666-1683(20)33609-0.

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10

Cecchi, Roberto, Cataldo De Gaudio, Lauro Buralli, and Stefania Innocenti. "Lymphatic Mapping and Sentinel Lymph Node Biopsy in the Management of Primary Cutaneous Melanoma: Report of a Single-centre Experience." Tumori Journal 92, no. 2 (March 2006): 113–17. http://dx.doi.org/10.1177/030089160609200205.

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Aims and Background Lymphatic mapping and sentinel lymph node biopsy provide important prognostic data in patients with early stage melanoma and are crucial in guiding the management of the tumor. We report our experience with lymphatic mapping and sentinel lymph node biopsy in a group of patients with primary cutaneous melanoma and discuss recent concepts and controversies on its use. Patients and Methods A total of 111 patients with stage I-II AJCC primary cutaneous melanoma underwent lymphatic mapping and sentinel lymph node biopsy from December 1999 through December 2004 using a standardized technique of preoperative lymphoscintigraphy and biopsy guided by blue dye injection in addition to a hand-held gamma probe. After removal, sentinel lymph nodes were submitted to serial sectioning and permanent preparations for histological and immunohistochemical examination. Complete lymph node dissection was performed only in patients with tumor-positive sentinel lymph nodes. Results Sentinel lymph nodes were identified and removed in all patients (detection rate of 100%), and metastases were found in 17 cases (15.3%). The incidence of metastasis in sentinel lymph nodes was 2.1%, 15.9%, 35.2%, and 41.6% for melanomas < or 1.0, 1.01-2.0, 2.01-4.0, and > 4.0 mm in thickness, respectively. Complete lymph node dissection was performed in 15 of 17 patients with positive sentinel lymph nodes, and metastases in non-sentinel lymph nodes were detected in only 2 cases (11.7%). Recurrences were more frequently observed in patients with a positive than in those with negative sentinel lymph node (41.1% vs 5.3% at a median follow-up of 31.5 months, P<0.001). The false-negative rate was 2.1%. Conclusions Our study confirms that lymphatic mapping and sentinel lymph node biopsy allow accurate staging and yield relevant prognostic information in patients with early stage melanoma.

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11

Markovic, Ivan, and Radan Dzodic. "Sentinel lymph node concept in differentiated thyroid cancer." SANAMED 9, no. 3 (2014): 239–45. http://dx.doi.org/10.5937/sanamed1403239m.

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12

Rudoni, M., GM Sacchetti, L. Leva, E. Inglese, G. Monesi, D. Minocci, and B. Frea. "Recent Applications of the Sentinel Lymph Node Concept: Preliminary Experience in Prostate Cancer." Tumori Journal 88, no. 3 (May 2002): S16—S17. http://dx.doi.org/10.1177/030089160208800326.

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Aims and Background Following the widespread use of radioguided surgery (RGS) in melanoma and breast cancer, we applied this new surgical strategy to prostate cancer (PC). The aims of this study were 1) to evaluate the accuracy of RGS in the detection of prostatic sentinel lymph nodes (SLN), and 2) to verify if pelvic lymphadenectomy (LAD) is an accurate means to detect solitary micrometastases. Study design We investigated 48 patients with PC confirmed by transrectal biopsy who underwent radical prostatectomy and bilateral LAD. A dose of 99mTc-labeled nanocolloid particles was injected into the prostate after needle positioning by ultrasonography. Serial imaging was obtained with a gamma camera, identifying 1) the first radioactive lymph node (sentinel lymph node, SLN); 2) other radioactive lymph nodes, and 3) non-active lymph nodes. Results Forty-three SLNs were identified in 48 patients. Twenty SLNs were located at unusual sites with respect to the extent of conventional LAD. Five SLNs were positive for micrometastases and two of these were located outside the usual LAD area. No micrometastases were found in any of the remaining lymph nodes (active and non-active). Conclusions These preliminary results are in agreement with the few previous scientific contributions available on this topic and indicate that it is possible to reduce the extent and duration of surgery and necessary to reevaluate the conventional sites of lymphatic drainage.

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Frolova, I. G., E. L. Choinzonov, V. E. Goldberg, S. Yu Chizhevskaya, V. I. Chernov, A. V. Goldberg, and Yu V. Belevich. "IMAGING TECHNIQUES FOR THE DETECTION OF LYMPH NODE METASTASIS IN PATIENTS WITH LARYNGEAL ANF HYPOPHARYNGEAL CANCER." Siberian journal of oncology 17, no. 3 (July 4, 2018): 101–8. http://dx.doi.org/10.21294/1814-4861-2018-17-3-101-108.

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The purposeof the study was a systematic literature review of imaging assessment of lymph node metastasis in patients with laryngeal and hypopharyngeal cancer.Material and methods.In order to review the most relevant scientific literature available, we searched Elibrary, Medline databases (from January 2005 to December 2017). Of 735 identified studies, 32 were assessed.Results. The role of ultrasonography, spiral computer tomography, magnetic resonance tomography, positron emission tomography in the assessment of regional metastatic spread in patients with laryngeal and hypopharyngeal cancer was analyzed. All these imaging techniques failed to reliably identify clinically occult lymph node metastases. However, the choice of treatment options for laryngeal and hypopharyngeal cancer depends considerably on the diagnostic accuracy. In this context, the concept of sentinel lymph nodes deserves special attention.Conclusion.Further studies of the sentinel lymph node concept using various radiopharmaceutical drugs in the detection of preclinical regional metastasis in patients with laryngeal and hypopharyngeal cancer are required.

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Bit-Sava, Elena M., M. G. Anchabadze, M. A. Monogarova, and V. M. Moiseenko. "BIOPSY OF SIGNAL LYMPHATIC NODULES IN PATIENTS WITH BREAST CANCER AFTER NEOAVARIANT CHEMOTHERAPY." Russian Journal of Oncology 23, no. 3-6 (December 15, 2018): 116–19. http://dx.doi.org/10.18821/1028-9984-2018-23-3-4-116-119.

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One of the advantages of systemic cytotoxic therapy is the «transformation» of positive axillary nodes into negative nodes (cN+ → cN-); a similar concept is used in randomized clinical trials with «post-neoadjuvant» sentinel lymph node - pNsn. In studies of ACOSOG Z1071, SENTINA, SN FNAC, was evaluated the frequency of a false-negative result with a biopsy of the sentinel lymph node (BSLU) after neodjuvant chemotherapy. It was proved that there was no need for immunohistochemical examination of lymph nodes using the BSLU technique followed by adjuvant therapy, since the detected micrometastases did not worsen overall survival. As for patients with biopsy of signaling lymph nodes after neodjuvant chemotherapy, nowadays particular interest of prognostic in significance for micrometastases and individual tumor cells in the lymph nodes, as well as an estimate of the frequency of false-negative result.

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Tubaro, Andrea. "The sentinel lymph node concept in prostate cancer: first results of gamma probe-guided sentinel lymph node identification." Current Opinion in Urology 10, no. 3 (May 2000): 263. http://dx.doi.org/10.1097/00042307-200005000-00028.

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Altgassen, Christopher, Hermann Hertel, Antje Brandstädt, Christhardt Köhler, Matthias Dürst, and Achim Schneider. "Multicenter Validation Study of the Sentinel Lymph Node Concept in Cervical Cancer: AGO Study Group." Journal of Clinical Oncology 26, no. 18 (June 20, 2008): 2943–51. http://dx.doi.org/10.1200/jco.2007.13.8933.

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Purpose Single-institution case series have demonstrated the feasibility of the sentinel concept in cervical cancer. However, the diagnostic accuracy remains to be validated. We evaluated detection rate and diagnostic accuracy to predict the histopathologic pelvic nodal status in patients with cervical cancer of all stages. Patients and Methods In a hypothesis-based, prospective, multicenter cohort study, patients underwent lymph node detection after labeling with technetium, patent blue, or both. After systematic pelvic and, if indicated, para-aortic node dissection, all lymph nodes were histopathologically examined. Detection rate, sensitivity, and negative predictive value (NPV) were calculated. Results According to the protocol, 590 patients were eligible. Detection rate of pelvic sentinel nodes was 88.6% (95% CI, 85.8% to 91.1%) and was significantly higher for the combination of technetium and patent blue (93.5%; 95% CI, 90.3% to 96.0%). Of 106 patients with pelvic lymph node metastases, 82 had pelvic sentinel node metastases. The overall sensitivity was 77.4% (95% CI, 68.2% to 85.0%), which was lower than 90%, the predefined noninferiority margin (P < .001). Sensitivity in women with tumors ≤ 20 mm (90.9%), with bilateral detection (87.2%), or with both substances applied (80.3%) was higher compared with the total population. The overall NPV was 94.3% (95% CI, 91.6% to 96.4%) and was higher in patients with tumors ≤ 20 mm (99.1%; 95% CI, 96.6% to 100%) compared with patients with tumors more than 20 mm (88.5%; 95% CI, 82.9% to 92.8%; P < .001). Conclusion In our cohort (all stages), sensitivity of the sentinel concept was low. However, patients with tumor diameter ≤ 20 mm may profit from this concept.

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Rodier, Janser, Routiot, and David. "Sentinel Lymph Node Procedure - A Valid Selection Criterion?" Swiss Surgery 5, no. 5 (October 1, 1999): 214–16. http://dx.doi.org/10.1024/1023-9332.5.5.214.

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Sentinel node biopsy is currently considered to be an outstanding advance in surgical oncology and represents significant evolution toward minimally invasive breast cancer surgery. Detected by blue dye, radiopharmaceutical or combined techniques, the sentinel lymph node can be selectively used for the detection of micrometastasis through extensive histopathologic analysis. Nevertheless, before considering the sentinel lymph node concept as a new standard of care, the standardization of both detection methods and histopathological protocols is of critical importance. The future of this attractive technique is strictly dependent on the quality of teaching, training and evaluation in prospective controlled multicentric studies.

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Wawroschek, Friedhelm, Harry Vogt, Dorothea Weckermann, Theodor Wagner, and Rolf Harzmann. "The Sentinel Lymph Node Concept in Prostate Cancer – First Results of Gamma Probe-Guided Sentinel Lymph Node Identification." European Urology 36, no. 6 (1999): 595–600. http://dx.doi.org/10.1159/000020054.

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Taran, Florin Andrei, Lisa Jung, Julia Waldschmidt, Sarah Isabelle Huwer, and Ingolf Juhasz-Böss. "Status of Sentinel Lymph Node Biopsy in Endometrial Cancer." Geburtshilfe und Frauenheilkunde 81, no. 05 (May 2021): 562–73. http://dx.doi.org/10.1055/a-1228-6189.

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AbstractThe role of lymphadenectomy in surgical staging remains one of the biggest controversies in the management of endometrial cancer. The concept of sentinel lymph node biopsy in endometrial cancer has been evaluated for a number of years, with promising sensitivity rates and negative predictive values. The possibility of adequate staging while avoiding systematic lymphadenectomy leads to a significant reduction in the rate of peri- and postoperative morbidity. Nevertheless, the status of sentinel lymph node biopsy in endometrial cancer has not yet been fully elucidated and is variously assessed internationally. According to current European guidelines and recommendations, sentinel lymph node biopsy in endometrial cancer should be performed only in the context of clinical studies. In this review article, the developments of the past decade are explored concisely. In addition, current data regarding the technical aspects, accuracy and prognostic relevance of sentinel lymph node biopsy are explained and evaluated critically.

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Takeuchi, H., Y. Kitagawa, Y. Saikawa, A. Suto, M. Mukai, T. Nakahara, A. Kubo, and M. Kitajima. "Sentinel node mapping for esophageal cancer." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 4552. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.4552.

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4552 Background: Extended radical esophagectomy with three-field lymph node dissection has been recognized as a standard procedure for esophageal cancer in Japan, even for clinically node negative cases. However, a significant increase of morbidity and mortality after the invasive procedure was reported in randomized trials. To eliminate the uniform application of highly invasive surgery, we hypothesized that sentinel node (SN) mapping plays a key role to obtain individual information and allows modification of the surgical procedure for early esophageal cancer. Methods: We have established radio-guided method to detect SNs in patient with early esophageal cancer using endoscopic injection of technetium-99m tin colloid. Preoperative lymphoscintigraphy and intra-operative use of hand held gamma probe were reliable to locate the radioactive SNs. Intra-operative gamma probing was also feasible in thoracoscopic or laparoscopic surgery using a special gamma detector which is introducible from trocar ports. Results: SN mapping has been performed for 105 patients with clinically N0 early esophageal cancer in our institute since 1999. Detection rate of hot node using our procedure was 93% (98/105). The mean number of sentinel nodes per case was 5.1. Thirty-three of 37 cases with lymph node metastasis showed positive sentinel nodes. The sensitivity to detect metastasis based on SN status was therefore 89% in our experience. Accuracy of metastatic status based on SN was 96% (94/98). SNs widely spread from cervical to abdominal areas. In more than 80% of the cases, at least one SN was located in the 2nd or 3rd compartment of regional lymph nodes. Conclusions: Our results suggest that SN concept for clinically N0 early esophageal cancer could be validated, and individualized selective and modified lymphadenectomy targeted on sentinel node basins for clinically N0 early esophageal cancer should become feasible and clinically useful as less invasive surgical procedures. No significant financial relationships to disclose.

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Kågedal, Åsa, Gregori Margolin, Cornelia Held, Pedro F. N. da Silva, Krzysztof Piersiala, Eva Munck-Wikland, Hans Jacobsson, Valtteri Häyry, and Lars O. Cardell. "A Novel Sentinel Lymph Node Approach in Oral Squamous Cell Carcinoma." Current Pharmaceutical Design 26, no. 31 (September 17, 2020): 3834–39. http://dx.doi.org/10.2174/1381612826666200213100750.

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Background: Occult metastases are common in patients with oral squamous cell carcinoma (OSCC) which is why elective neck dissection, adjuvant radiotherapy or watchful waiting have been treatment options after surgical removal of the primary tumour. Sentinel lymph node biopsy (SLNB) has lately emerged as a novel possibility in treatment planning. Objectives: To establish a reliable and clinically useful protocol for SLNB in staging/elective neck dissection in oral cancer. Methods: Fourteen consecutive patients with T1-T2 N0 oral cancer were enrolled when scheduled for elective neck dissection. Results: This study outlines various techniques for improving SLNB in head and neck cancer. After evaluation, a combination of techniques was found to constitute a reliable, clinically adaptable work concept. The suggested procedure starts with the pre-surgical injection of radioactive technetium 99Tcm carried on tilmanocept (Lymphoseek ®) at the tumour site. The radioactivity in the lymph node is then visualized preoperatively with Single Photon Emission Computed Tomography (SPECT/CT). Intraoperatively, indocyanine green (ICG) is injected and a sentinel node is visualized with near-infrared light. To support the sentinel node detection, the surgeon uses a hand-held gamma detection probe. This approach results in a reproducible and reliable detection of sentinel nodes. Conclusion: This paper presents a novel protocol for the identification of the sentinel node in the head and neck region. The protocol additionally enables the use of flow cytometry analysis of resected lymph nodes.

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Saidi, Reza F., Paul S. Dudrick, Stephen G. Remine, and Vijay K. Mittal. "Nonsentinel Lymph Node Status after Positive Sentinel Lymph Node Biopsy in Early Breast Cancer." American Surgeon 70, no. 2 (February 2004): 101–5. http://dx.doi.org/10.1177/000313480407000202.

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Axillary dissection is the current standard of care for patients with breast cancer who are diagnosed with metastasis to axillary sentinel lymph nodes (SLNs). Recently, that concept has come under increasing scrutiny because not all women with a positive SLN will need further dissection. The purpose of this study was to look at nonsentinel lymph node status in patients with breast cancer and axillary SLN metastasis in an effort to determine tumor variables that can guide further treatment if there are additional axillary nodes involved. A retrospective chart review was performed on patients with breast cancer who underwent SLN biopsy between July 1998 and April 2003. χ2 analysis, Student t test, and multivariate analysis were used to determine the significance of tumor size, grade, location, estrogen receptor (ER) and progestrone receptor (PR) receptor status, angiolymphatic invasion, stage, and number and size of SLNs in predicting the status of nonsentinel lymph nodes. During the study interval, 116 patients were identified who underwent SLN biopsy and 34 (29.3%) had positive SLNs. All of these patients underwent complete axillary node dissection and 11 patients (32.3%) had non-SLN metastasis. The presence of palpable breast mass ( P = 0.03), tumor size ( P = 0.04), angiolymphatic invasion ( P = 0.03), and extracapsular extension of SLN metastasis ( P = 0.001) were the variables that predicted non-SLN involvement. Micrometastasis was inversely related to non-SLN involvement. In patients with breast cancer and SLN metastasis, the presence of a palpable breast mass, tumor size, angiolymphatic invasion, and extracapsular node extension increase the likelihood of identifying additional node metastasis on subsequent axillary dissection.

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Krag, David N. "Minimal access surgery for staging regional lymph nodes: The sentinel-node concept." Current Problems in Surgery 35, no. 11 (November 1998): 951–1016. http://dx.doi.org/10.1016/s0011-3840(98)80008-7.

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Takeuchi, Masashi, Hiroya Takeuchi, Hirofumi Kawakubo, Ayako Shimada, Tadaki Nakahara, Shuhei Mayanagi, Masahiro Niihara, et al. "Risk factors for lymph node metastasis in non-sentinel node basins in early gastric cancer: sentinel node concept." Gastric Cancer 22, no. 1 (May 24, 2018): 223–30. http://dx.doi.org/10.1007/s10120-018-0840-z.

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Nyberg, Reita H., Pasi Korkola, and Johanna U. Mäenpää. "Sentinel Node and Ovarian Tumors: A Series of 20 Patients." International Journal of Gynecologic Cancer 27, no. 4 (May 2017): 684–89. http://dx.doi.org/10.1097/igc.0000000000000948.

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ObjectiveIntraoperative detection of ovarian sentinel nodes has been shown to be feasible. We examined the detection rate and locations of sentinel nodes in patients with ovarian tumors. We also aimed to assess the reliability of sentinel node method in predicting regional lymph node metastasis.MethodsTwenty patients scheduled for laparotomy because of a pelvic mass were recruited to the study. In the beginning of the laparotomy, radioisotope and blue dye were injected under the serosa next to the junction of the ovarian tumor and suspensory ligament. The number and locations of the hot and/or blue nodes/spots were recorded during the operation. If the tumor was malignant according to the frozen section, systematic lymphadenectomies were performed, the sentinel nodes sampled separately, and their status compared with other regional lymph nodes.ResultsEleven patients had a right-sided ovarian tumor, 7 patients a left-sided tumor, and 2 patients had bilateral tumors. A median of 2 sentinel nodes/locations per patient (range, 1–3) were found. Sixty percent of all sentinel nodes were located in the para-aortic region only, compared with 30% in both para-aortic and pelvic areas and 10% in pelvic area only. Both unilateral and bilateral locations were found. In 83% of the cases with more than 1 sentinel node location, they were located in separate anatomical regions. In 3 patients, systematic lymphadenectomies were performed. One of them had nodal metastases in 2 regions and also a metastasis in 1 of her 2 sentinel nodes in 1 of those regions.ConclusionsIn patients with ovarian tumor(s), the detection of sentinel nodes is feasible. They are located in different anatomic areas both ipsilaterally and contralaterally, although most of them are found in the para-aortic region. The reliability of the sentinel node concept should be evaluated in the framework of a multicenter trial.

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Ochirov, M. O., A. Yu Kishkina, L. A. Kolomiets, and V. I. Chernov. "Sentinel lymph nodes biopsy in the surgical treatment of endometrial cancer: history and present." Tumors of female reproductive system 14, no. 4 (February 21, 2019): 65–71. http://dx.doi.org/10.17650/1994-4098-2018-14-4-65-71.

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This article reviews the concept of sentinel lymph node biopsy in patients with endometrial cancer. This technique is becoming increasingly appreciated and was included into the latest standards of surgical treatment for gynecological cancers. Sentinel lymph node mapping is a reliable and highly specific (100 %) method, which can be used for determining the indications for adjuvant therapy in addition to a detailed pathomorphological examination that should include immunohistochemical testing and ultrastaging.

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Markovic, Ivan, Radan Dzodic, Momcilo Inic, Neven Jokic, Srdjan Nikolic, Stevan Jokic, Aleksandar Celebic, and Zorka Milovanovic. "The sentinel lymph node concept in thyroid carcinoma: Preliminary results." Archive of Oncology 10, no. 3 (2002): 197–98. http://dx.doi.org/10.2298/aoo0203197m.

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Takeuchi, Hiroya, Hirofumi Kawakubo, Yoshiro Saikawa, Tadaki Nakahara, Tai Omori, Makio Mukai, and Yuko Kitagawa. "Sentinel lymph node mapping for T1 esophageal cancer." Journal of Clinical Oncology 30, no. 4_suppl (February 1, 2012): 7. http://dx.doi.org/10.1200/jco.2012.30.4_suppl.7.

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7 Background: Extended radical esophagectomy with three-field lymph node dissection has been recognized as the standard procedure for thoracic esophageal cancer in Japan, even for clinically T1N0 cases. However, to eliminate the uniform application of the highly invasive surgery, we hypothesized that sentinel lymph node (SLN) mapping would play a key role to obtain individual information and allows modification of the surgical procedure for early esophageal cancer. Methods: We have established radio-guided method to detect SLNs in patient with early esophageal cancer using endoscopic injection of technetium-99m tin colloid. Preoperative lymphoscintigraphy and intra-operative use of hand held gamma probe were reliable to locate the radioactive SLNs. Intra-operative gamma probing was also feasible in thoracoscopic or laparoscopic surgery using a special gamma detector which is introducible from trocar ports. Results: SLN mapping has been performed for 70 patients with clinically N0 and early (pT1) esophageal cancer in our institute since 1999. Detection rate of hot node using our procedure was 94% (66/70). The mean number of sentinel nodes per case was 4.6. Twenty-one of 23 cases (91%) with lymph node metastasis showed positive SLNs. Accuracy of metastatic status based on SLN was 97% (64/66). SLNs widely spread from cervical to abdominal areas. In more than 80% of the cases, at least one SLN was located in the 2nd or 3rd compartment of regional lymph nodes. However, 56 (85%) of 66 patients had no lymph node metastasis or metastasis (+) only in SLNs. Conclusions: Our results suggest that SLN concept for clinically N0 and T1 esophageal cancer could be validated. Theoretically more than 80% of patients with pT1b esophageal cancer may be controlled by local treatments such as surgery and chemoradiotherapy targeting primary tumors plus their SLNs. Individualized selective and modified lymphadenectomy targeted on SLN basins for clinically N0 early esophageal cancer should become feasible and clinically useful as less invasive surgical procedures.

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Bogdanov-Berezovsky, Alexander, Vasileios A. Pagkalos, Eldad Silberstein, Yaron Shoham, Arsinoi A. Xanthinaki, and Yuval Krieger. "Increasing the Efficacy of SLNB in Cases of Malignant Melanoma Located in Close Proximity to the Lymphatic Basin." ISRN Dermatology 2014 (February 10, 2014): 1–4. http://dx.doi.org/10.1155/2014/920349.

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Background. Being predictive of the entire nodal bed, sentinel lymph node biopsy (SLNB) is invaluable in the surgical management of melanoma. Although the concept is simple, sentinel lymph node (SLN) identification and removal can be technically challenging. Methods. A total of 102 consecutive patients have undergone SLNB in the Division of Plastic and Reconstructive Surgery of Soroka University Medical Center from 2009 to 2012. Patients have undergone SLNB using a radioactive tracer and blue stain in order to identify the SLN. Although SLNB usually precedes the wide excision of melanoma, primary lesions in close proximity (<10 cm) to the lymph basin require wide excision before beginning the SLN quest. Results. All pathology reports confirmed the excision of lymph nodes. Conclusions. When treating MM in close proximity to the lymph basin, changing the sequence of the SLNB procedure seems to increase the efficacy of the method.

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Touijer, Karim A., and James A. Eastham. "The Sentinel Lymph Node Concept and Novel Approaches in Detecting Lymph Node Metastasis in Prostate Cancer." European Urology 70, no. 5 (November 2016): 738–39. http://dx.doi.org/10.1016/j.eururo.2016.02.047.

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Kitagawa, Y., H. Takeuchi, Y. Takagi, S. Natsugoe, M. Terashima, N. Murakami, T. Fujimura, J. Sakamoto, T. Aikou, and M. Kitajima. "Prospective multicenter trial of sentinel node mapping for gastric cancer." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): 4518. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.4518.

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4518 Background: The sentinel node (SN) concept has revolutionized the approach to the surgical staging of both melanoma and breast cancer, and these techniques can yield patient benefit by avoiding various complications due to unnecessary prophylactic regional lymph node dissection in cases with negative SN for cancer metastasis. Clinical application of SN mapping for early gastric cancer had been controversial for years. However, single institutional results of SN mapping for early gastric cancer are almost acceptable results in terms of detection rate and accuracy to determine lymph node status. We hypothesized that SN mapping plays a key role to obtain individual information and allows modification of the surgical procedure for early gastric cancer. Methods: The Japan Society of Sentinel Node Navigation Surgery (JSNNS) has conducted a prospective multicenter trial of SN mapping by a dual tracer method with radioactive colloid and blue dye. Between September 2004 and March 2008, 433 patients with early gastric cancer were accrued at 12 comprehensive hospitals. Patients were enrolled under JSNNS and each institutional review board-approved protocols. Eligibility criteria were that patients had clinically T1N0M0 or T2N0M0 single tumor with diameter of primary lesion less than 4cm without any previous treatments. Technetium-99m tin colloid and isosulfan blue were utilized as dual tracers for SN mapping. Results: SN mapping has been performed for 397 patients with early gastric cancer. Detection rate of hot and/or blue node using our procedure was 97.5% (387/397). The mean number of sentinel nodes per case was 5.6. Fifty-three of 57 cases with lymph node metastasis showed positive sentinel nodes. The sensitivity to detect metastasis based on SN status was therefore 93% in our experience. Accuracy of metastatic status based on SN was 99% (383/387). In two of the four SN false-negative cases, the tumor involved to pT2, and only one case showed the metastatic lymph node beyond the SN basin. Conclusions: Our results suggest that SN concept for clinically N0 early gastric cancer could be validated, and minimized gastrectomy with individualized selective and modified lymphadenectomy for early gastric cancer with negative SN should become feasible and clinically useful as less invasive surgical procedures. No significant financial relationships to disclose.

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Hagihara, Takahiko, Yoshikazu Uenosono, Takaaki Arigami, Tsutomu Kozono, Hideo Arima, Shigehiro Yanagita, Munetsugu Hirata, et al. "Assessment of Sentinel Node Concept in Esophageal Cancer Based on Lymph Node Micrometastasis." Annals of Surgical Oncology 20, no. 9 (April 13, 2013): 3031–37. http://dx.doi.org/10.1245/s10434-013-2973-y.

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Zervos, Emmanuel E., and William E. Burak. "Lymphatic Mapping in Solid Neoplasms: State of the Art." Cancer Control 9, no. 3 (May 2002): 189–202. http://dx.doi.org/10.1177/107327480200900302.

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Background Lymphatic mapping and sentinel lymph node biopsy is an established technique for the staging and treatment of melanoma. The success of lymphatic mapping in this realm has broadened its application to other solid neoplasms. This update reviews the status of sentinel lymph node biopsy in its most widely cited applications. Methods Seminal manuscripts on lymphatic mapping in melanoma, breast, colon, vulvar, cervical, lung, gastric, and head and neck cancers are reviewed. Results Studies suggest that the application of lymphatic mapping as a staging tool in breast cancer and melanoma is justified when applied by trained surgeons. Additional validation is necessary before sentinel node biopsy is advocated in gynecologic, colon, lung, and head and neck cancer. Conclusions As in breast cancer and melanoma, validation of the sentinel node concept in other solid tumors must occur in institutions other than those in which the technique is being developed before it is generally applied to other neoplasms.

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SUDO, Hideo, Yu TAKAGI, Shigeru TSURUI, Soh KATAYANAGI, Kazushige ITO, Tatsuya AOKI, and Yasuhisa KOYANAGI. "Establishment of the Sentinel Lymph Node Concept in Early Gastric Cancer." Nihon Gekakei Rengo Gakkaishi (Journal of Japanese College of Surgeons) 28, no. 2 (2003): 200–206. http://dx.doi.org/10.4030/jjcs1979.28.2_200.

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TAKASHIMA, HIROSHI, MASAYUKI EGAWA, TETSUYA IMAO, MAMORU FUKUDA, KUNIHIKO YOKOYAMA, and MIKIO NAMIKI. "VALIDITY OF SENTINEL LYMPH NODE CONCEPT FOR PATIENTS WITH PROSTATE CANCER." Journal of Urology 171, no. 6 Part 1 (June 2004): 2268–71. http://dx.doi.org/10.1097/01.ju.0000127735.09469.c4.

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Novák, Ondřej, Pavel Bartoš, and Robert Bučko. "Indocyanine green as a new trend in sentinel lymphatic node detection in oncogynecology." Česká gynekologie 87, no. 1 (February 22, 2022): 54–61. http://dx.doi.org/10.48095/cccg202254.

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Summary: In oncological surgery the importance of the sentinel node concept is increasing, as we are capable of reducing the surgical burden of patients and its associated morbidity and preserving adequate oncological safety at the same time. Recently, there has been development of lymph node mapping techniques, where the most promising method appears to be the immunofluorescent one using indocyanine green dye. This technique provides high sensitivity in sentinel node detection in comparison with other existing methods using a dye in combination with a radionuclide. The indocyanine green technique has several advantages, and at the same time, we can use this method in non-oncological indications in gynecological surgery. Key words: indocyanine green – sentinel lymphatic node – oncogynecology

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Ismagilov, A. Kh, N. G. Asnina, and G. A. Azarov. "SENTINEL LYMPH NODE BIOPSY: HISTORY AND CURRENT CONCEPTS." Tumors of female reproductive system 14, no. 1 (April 12, 2018): 38–46. http://dx.doi.org/10.17650/1994-4098-2018-14-1-38-46.

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Kidd, Sabrina A., Jessica L. Keto, Huynh Tran, and Timothy L. Fitzgerald. "First Three Sentinel Lymph Nodes Accurately Stage the Axilla in Breast Cancer." American Surgeon 75, no. 3 (March 2009): 253–56. http://dx.doi.org/10.1177/000313480907500313.

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Sentinel lymph node (SLN) biopsy is the preferred method of assessing lymph nodes in breast cancer. Recent literature suggests increasing morbidity with increased number of SLN removed. However, controversy exists regarding the number of SLN that should be removed. A retrospective review of patients undergoing SLN biopsy for breast cancer from 2003 to 2005 was performed. Data analyzed included the number of SLNs, nodes per specimen, and pathology. The order of SLN removal was documented and the first positive lymph node noted. Three hundred fifty-three patients underwent successful SLN biopsy. On average, only one surgical SLN was identified. However, the average number of pathologically identified SLN was 1.3. Nodal disease was identified in 79 patients (22.4%). The first SLN was positive in 70 of those patients (88.6%). Six additional patients were diagnosed by the second SLN (76 of 79 [96.2%]), and all 79 patients were identified within the first three nodes. All patients with nodal disease were identified within three SLNs. These data support the concept that surgeons do not need to remove all identifiable sentinel nodes. Moreover, surgeons could consider limiting the number of excised SLNs to three.

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Peparini, Nadia, and Piero Chirletti. "Lymph node ratio, number of excised nodes and sentinel-node concepts in breast cancer." Breast Cancer Research and Treatment 126, no. 3 (December 29, 2010): 829–33. http://dx.doi.org/10.1007/s10549-010-1296-y.

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Schurr, Paulus G., Sophia Behnke, Jussuf T. Kaifi, Dean Bogoevski, Bjoern Link, Oliver Mann, Tim Strate, Klaus Pantel, Jakob R. Izbicki, and Emre Yekebas. "Central Mesenteric Lymph Node BER-Ep4+ Cells in Colorectal Cancer: Challenge to Sentinel Node Concept?" Digestive Surgery 24, no. 1 (2007): 19–27. http://dx.doi.org/10.1159/000100914.

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Schilling, David, Ulf Boekeler, Georgios Gakis, Christian Schwentner, Stefan Corvin, Karl Sotlar, Arndt-Christian Müller, Roland Bares, and Arnulf Stenzl. "Modified concept for radioisotope-guided sentinel lymph node dissection in prostate cancer." World Journal of Urology 28, no. 6 (March 27, 2010): 715–20. http://dx.doi.org/10.1007/s00345-010-0533-7.

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Grubnik, V. V., V. V. Ilyashenko, Yu V. Grubnik, R. P. Nykytenko, and K. I. Shapovalova. "Sentinel lymph nodes concept in early gasctric cancer." Surgery of Ukraine, no. 2 (July 2, 2018): 98–101. http://dx.doi.org/10.30978/su2018298.

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Berishvili, A. I., T. M. Kochoyan, N. V. Levkina, and O. V. Li. "THE SENTINEL LYMPH NODE CONCEPT IN IA2–IIA2 STAGES CERVICAL CANCER: CLINICAL PERSPECTIVES." Tumors of female reproductive system 14, no. 2 (August 15, 2018): 90–95. http://dx.doi.org/10.17650/1994-4098-2018-14-2-90-95.

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Cervical cancer is currently the second most common form of neoplasia worldwide and third in the female population. The standard surgical treatment, for stages IA2-IIA, is radical hysterectomy with pelvic lymphadenectomy. The risk of intraoperative (vessel or nerve damage) or postoperative complications (lymphedema) is high. The sentinel node concept can reduce risk of such complications but currently is not included in the standard treatment.

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Yasukawa, Koya, Akira Shimizu, Hiroaki Motoyama, Koji Kubota, Tsuyoshi Notake, Shinsuke Sugenoya, Kiyotaka Hosoda, Hikaru Hayashi, Ryoichiro Kobayashi, and Yuji Soejima. "Applicability of sentinel lymph node oriented treatment strategy for gallbladder cancer." PLOS ONE 16, no. 2 (February 12, 2021): e0247079. http://dx.doi.org/10.1371/journal.pone.0247079.

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Background Utility of the sentinel lymph node (SLN) biopsy in some malignancies has been reported, however, research on that of gallbladder cancer (GBC) is rare. The aim of this study is to investigate whether the concept of SLN is applicable to T2/3 GBC. Methods A total of 80 patients who underwent resection for gallbladder cancer were enrolled in this study. Patients with GBC were stratified into two groups based on the location of tumor, peritoneal-side (T2p or 3p) and hepatic-side (T2h or 3h) groups. We evaluated the relationship between cystic duct node (CDN) and downstream lymph node (LN) status. CDN was defined as a SLN in this study. Results Thirty-eight patients were classified into T2, including T2p (n = 18) and T2h (n = 20), and 42 patients into T3, including T3p (n = 22) andT3h (n = 20). The incidence of LN metastasis was significantly higher in hepatic-side than peritoneal-side in both T2 and T3 (P = 0.036 and 0.009, respectively). In T2, 14 T2p had negative CDN and downstream LN, however, three T2h had negative CDN and positive downstream LNs (defined as a skipped LN metastasis) (P = 0.043). In T3, patients with skipped LN metastasis were significantly higher in T3h (n = 11) than those in T3p (n = 2) (P<0.001). There was no recurrence of the local lymph node. Disease-free survival in the T2p and T3p were significantly better than those in the T2h and T3h (P = 0.005 and 0.025, respectively). Conclusion The concept of SLN can be applicable to T2p GBC, where the downstream LNs dissection can be omitted.

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Stein, Roland G., Roland Fricker, Thomas Rink, Hartmut Fitz, Sebastian Blasius, Joachim Diessner, Sebastian F. M. Häusler, et al. "Evaluation of Sentinel Lymph Node Biopsy and Axillary Lymph Node Dissection for Breast Cancer Treatment Concepts - a Retrospective Study of 1,214 Breast Cancer Patients." Breast Care 12, no. 5 (2017): 324–28. http://dx.doi.org/10.1159/000477610.

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Background: Most breast cancer patients require lumpectomy with axillary sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND). The ACOSOG Z0011-trial failed to detect significant effects of ALND on disease-free and overall survival among patients with limited sentinel lymph node (SLN) metastases. Intense dose-dense chemotherapy and supraclavicular fossa radiation (SFR) are indicated for patients with extensive axillary metastases. In this multicentered study, we investigated the relevance of ALND after positive SLNB to determine adequate adjuvant therapy. Methods: We retrospectively analyzed data from 1,214 patients with clinically nodal negative T1-T2 invasive breast cancer undergoing surgery at Hanau City Hospital Breast cancer center. Results: 681 patients underwent ALND after SLNB. 20 patients (8.5%) from the group with 1 or 2 SLN metastases (n = 236) showed more than 3 lymph node metastases after ALND. 13 patients (31.7%) from the group with more than 2 SLN metastases (n = 41) were diagnosed with a minimum of 4 axillary lymph node metastases after ALND. Conclusions: In 8.5% of the patients with 1 or 2 SLN metastases, ALND detected more than 3 macrometastases, setting the indication for intense dose-dense chemotherapy and SFR. More than 2 SLN metastases, T stage and grading predict lymph node metastases.

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Jagric, Tomaz, Katarina Mis, Maksimilijan Gorenjak, Ales Goropevsek, Rajko Kavalar, and Tomaz Mars. "Can flow cytometry reinvent the sentinel lymph node concept in gastric cancer patients?" Journal of Surgical Research 223 (March 2018): 46–57. http://dx.doi.org/10.1016/j.jss.2017.10.018.

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Vidal-Sicart, Sergi, Lluís María Puig-Tintoré, José Antonio Lejárcegui, Pilar Paredes, María Luisa Ortega, Antonio Muñoz, Jaume Ordi, et al. "Validation and application of the sentinel lymph node concept in malignant vulvar tumours." European Journal of Nuclear Medicine and Molecular Imaging 34, no. 3 (September 28, 2006): 384–91. http://dx.doi.org/10.1007/s00259-006-0237-9.

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Cibula, David, and W. Glenn McCluggage. "Sentinel lymph node (SLN) concept in cervical cancer: Current limitations and unanswered questions." Gynecologic Oncology 152, no. 1 (January 2019): 202–7. http://dx.doi.org/10.1016/j.ygyno.2018.10.007.

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Staib, Ludger. "A.J. Schauer, W. Becker, M. Reiser, K. Possinger: The sentinel lymph node concept." Langenbeck's Archives of Surgery 390, no. 3 (March 23, 2005): 274–75. http://dx.doi.org/10.1007/s00423-005-0546-7.

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Brucker, Sara Y., F. A. Taran, and D. Wallwiener. "Sentinel lymph node mapping in endometrial cancer: a concept ready for clinical routine?" Archives of Gynecology and Obstetrics 290, no. 1 (March 30, 2014): 9–11. http://dx.doi.org/10.1007/s00404-014-3224-6.

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