DOI: https://doi.org/10.22141/oncology.1.1.2018.155378

Sentinel lymph node biopsy: state of art, evidence base and recommendations (literature review)

O.V. Postupalenko

Abstract


Background. Sentinel lymph node (SLN) concept is the area of active research due to its perspectives for oncosurgery, which allows individualizing treatment approaches to the cancer patients. The purpose of the study was the review of the European Society for Medical Oncology (ESMO) and the National Comprehensive Cancer Network (NCCN) guidelines, publications in the Cochrane Library on the oncological efficacy of SLN and traditional lymph node dissection in the treatment of primary solid cancers. Materials and methods. Current ESMO and NCCN guidelines, publications in the Cochrane Library are given, in which the concept of SLN and its place beside the traditional approach of lymph node dissection are considered in the aspect of surgical treatment. Results. Three Cochrane reviews, 7 ESMO and NCCN recommendations were found. Combined methods (dye + radiocolloid) were the most informative for SLN identification in the cervical, axillary or inguinal­femoral area, fluorescents — in the pelvic cavity and abdomen. Investigation of frozen sections in skin melanoma is not recommended, and is indicated in cervical cancer. Immunohistochemistry of SLN is mandatory for penile cancer and melanoma, but not relevant in breast cancer. A common point of view regar­ding cancer patients is the need for a biopsy (fine needle aspiration, core needle or excisional biopsy) in case of suspected metastatic lesion of lymph nodes and for lymphadenopathy. The absence of enhanced SLN is an indication for the application of traditional approaches to lymph node dissection in relevant oncological pathology. Conclusions. The discrepancies in the conclusions and recommendations of the analyzed literature are explained by the use of the results of various studies as output data. The NCCN guidelines, with their constant dynamic updates, contain the most up­to­date information. Taking into account the active development of SLN concept, the results of trails accumulated over several years allow changing the views on its place in the treatment of oncological di­seases. The ESMO guidelines and the Cochrane Library reviews on SLN are already more of historical significance and in most cases, their application requires a critical approach based on the results of research and meta­analyzes that were published later.


Keywords


sentinel lymph node; biopsy; surgical treatment; re­commendations; review

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