Development of sentinel node localization and ROLL

Authors: Giovanni Paganelli Alberto Luini Maddalena Sansovini Paola Caroli Federica Matteucci

Publish Date: 2015/03/03

Volume: 3, Issue: 3, Pages: 171-178

PDF Link

Abstract

The concept of a precise region in which to find the lymph nodes that drain the lymph directly from the primary tumor site can be traced back to a century ago to the observations of Jamieson and Dobson who described how cancer cells spread from cancer of the stomach in a single lymph node which they called the “primary gland” However Cabanas was the first in 1977 to realize the importance of this concept in clinical studies following lymphography performed in patients with penile cancer Thanks to Morton’s studies on melanoma in 1992 we began to understand the potential impact of the sentinel lymph node SN on the surgical treatment of this type of cancer The use of a vital dye blue dye administered subdermally in the region surrounding the melanoma lesion led to the identification of the sentinel node and the vital dye technique was subsequently applied to other types of solid tumors eg breast vulva However difficulties in using this technique in anatomical regions with deep lymphatic vessels eg axilla led to the development of lymphoscintigraphy started by Alex and Krag in 1993 on melanoma and breast cancer and optimized by our group at European Institute of Oncology IEO in Milan in 1996 Today lymphoscintigraphy is still considered as the most reliable method for the detection of the SN In 1996 a new method for the localization of nonpalpable breast lesion called radioguided occult lesion localization ROLL was also developed at IEO Retrospective and prospective studies have since shown that the ROLL procedure permits the easy and accurate surgical removal of nonpalpable breast lesions overcoming the limitations of previous techniques such as the wireguided localization The purpose of this paper is to describe the evolution of SN biopsy and radioguided surgery in the management of breast cancer We also include a review of the literature on the clinical scenarios in which SN biopsy in breast cancer is currently used with particular reference to controversies and future prospects

Keywords: