The lymphatic hypothesis comprises...

The lymphatic hypothesis comprises the spleen, thymus gland, lymph nodes, and lymphatic bottoms or channels. In addition to containing important small cavitys of the immune system, this highly-organized theory is one of the body's tangle filtration systems and is responsible for removing blood-bound contaminants (eg bacteria, cancer cells) from the lymphatic fluid before returning it to the venous circulation by the agency of way of the lymphatic utensils or channels.(1)

collections of lymph nodes that consider probable extracellular drainage from a specific area of the material substance are known as nodal basins. For example, lymphatic fluid from the breast primarily drains into the axillary nodal basin (ie, 80% to 85%) and any fluid drains into the internal mammary drainage area.(2) according to definition, within a specific nodal basin, the sentinel lymph nodes are the first to receive lymphatic drainage from tumors (Figure 1)(3)

[Figure 1 ILLUSTRATION OMITTED]

Of all cancers, breast cancer is the inferior leading cause of death for all women and the leading cause of death for women ages 40 to 55(4) In 1999 175000 strange cases of breast cancer were reported, 43300 of which were diagnosed in situ (ie, noninvasively).(5) generally the stage of the disease determines breast cancer treatment. Stage common consists of a primary cancerous lesion beneath 2 cm in diameter, with no lymph node involvement. Stage sum of two units involves a cancerous lesion 2 cm to 5 cm in diameter, however differs from stage one in that cancer solitary abode; squalids also are present in axillary lymph nodes.(6) Treatment for as well-as; not only-but also; not only-but; not alone-but stages consists of lumpectomy or mastectomy and a radical axillary node dissection. In stage the same the radical node dissection primarily is used as a general diagnostic and prognostic indicator. In stage brace the cancer-involved tissue must be remov to prohibit further spread of the disease. In one as well as the other cases, treatment is extensive, physically and psychologically traumatic for the patient, and may cause debilitating postoperative complications.

A sentinel lymph node dissection, however, is highly selective, precise, and can minimize the stage undivided patient's trauma by providing treatment options based onward specific lymph node findings. If, for example, the sentinel lymph node dissection yields a negative finding, the stage single in kind patient can completely avoid radical lymph node dissection.(7) A positive sentinel lymph node finding in stage single in kind changes the diagnosis and reclassifies the patient as stage pair due to cancer involvement outside the primary lesion. The patient then undergoe a radical axillary node dissection.(8) In stage sum of two units sentinel lymph node dissection is a powerful diagnostic means through which pathologic information precisely defines the stretch of the metastases and helps confirm the emergent ne for succeeding radical lymph node dissection.

NUCLEAR MEDICINE

Lymphatic mapping provides surgeon and pathologists a means to precisely and thoroughly examine sentinel lymph nodes likely to contain micrometastatic disease from primary lesions. generally surgeons use two methods to identify sentinel lymph nodes. The first process known as tagging, requires the injection of a radioisotope that, immediately after the application of a gamma probe, provides the surgeon an audible map of the lymph nodes and utensils under investigation. The other process uses a blue contrast coloring liquor (ie, isosulfan blue 1%) that, when injected into the tumor, creates a visual map of the lymphatic makes by staining them. These processs can be used together or individually (Figure 2)(9) It is not required that radioactive precautions be used with the patient or when handling the patient's dead body fluids.(10)

[Figure 2 ILLUSTRATION OMITTED]

Administration of the radioisotope may take place in the nuclear medicine department. It also can be done in the OR, on the other hand requires equipment that is too large for principally OR suites. Additionally, the injection can take up to brace hours, and no anesthesia is required for the step For these reasons, it is cost-effective to administer the radioisotope in an area other than the OR.

When the radioisotope injection is performed, the patient's primary tumor site receives a 01 to 02 mL injection of technetium (ie, the sulfur colloid H2 technetium) to identify the primary tumor. This injection also identifies the lymphatic basins, nodal areas, and respective lymph draining sites that are considered to be at risk for metastases. In addition, the injection also is used to estimate the number of sentinel lymph nodes instant fix their location in relation to other nodes in the lymphatic basin, and determine which lymphatic channels are involved." Lymphatic basins with the highest radioisotope concentrations receive a preliminary skin-surface mark for the surgeon's convenience. The skin marks generally are made with a skin scribe and appear as simple dots or marks that include literal senses (eg, LAT for a lateral marking) to make secure the marks do not become transferred to another skin surface before surgery Conventional practice defines a node as "hot" when it emits 10 times the amount of normal background radiation. A patient may have united or more marks representing "hot" nodes.