![]() The blue-dye technique involves injection of isosulfan blue dye into the tumor or the dermal lymphatics overlying the tumor bed approximately 3 to 10 minutes before surgery. ![]() Two strategies are used to identify sentinel lymph nodes: injection of blue dye and injection of a radioactive colloid. Correspondingly, if these lymph nodes do not contain disease, the probability of disease in any other axillary lymph node should be very small. The strategy is based on the assumption that the lymphatic drainage of a primary breast tumor progresses first through one or a small number of lymph nodes. Strom, in Radiation Oncology (Ninth Edition), 2010 Sentinel Lymph Node SurgeryĪ second strategy for minimizing the morbidity of axillary treatment is sentinel lymph node surgery, which attempts to remove only the first-echelon lymph nodes to which the primary tumor drains-the sentinel nodes. Sentinel lymph nodes are examined under closer detail called micro-staging and this may allow for the identification of tiny cancer cells that may have otherwise gone undetected. In addition, sentinel lymph nodes are processed differently by the pathologist than a routine lymph node sampling. The benefit of sentinel lymph node staging is to minimize the number and amount of lymph nodes removed to obtain accurate surgical staging. The surgeon will then visualize the lymph nodes that turn the color of the dye, which allows for identification of the sentinel lymph node. 15 The injection of these dyes is performed intraoperatively directly into the cervix. 14 Multiple sentinel lymph node mapping techniques include the use of dyes such as methylene blue, isosulfan blue, patent blue, and indocyanine green. With the widespread adoption of minimally invasive robotic surgery in endometrial cancer, sentinel lymph node staging has become a new standard of care. Sentinel lymph nodes are defined as the first lymph nodes in lymphatic drainage from a particular organ. Lambrou MD, Angel Amadeo BS, in Breast Cancer and Gynecologic Cancer Rehabilitation, 2021 Sentinel Lymph Node Staging
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