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Title: The sentinel node in surgical oncology
Author: Safaei-Keshtgar, Mohammad Reza
Awarding Body: University of London
Current Institution: University College London (University of London)
Date of Award: 2001
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This thesis is composed of nine chapters. Chapter-1 reviews the milestones in surgical management of breast cancer over the last century with special emphasis on axillary management. The role of axillary lymph node dissection (ALND) in staging, loco-regional control and survival of breast cancer patients is discussed. Limitations of imaging modalities in diagnosing the histological status of the axillary lymph node are also presented. Chapter-2 deals with the sentinel lymph node (SLN) concept and its importance as a staging procedure in surgical oncology. A historical review of the advances in this field is presented. The structure and function of lymph node is also outlined in this section. Technical issues including the radiopharmaceutical and particle size, the injection dose and volume, the injection technique, imaging technique, types of gamma detection probes, design of gamma camera, detection techniques of sentinel node during surgery are presented in this section. Chapter-3 describes the patients and methods used including inclusion and exclusion criteria, injection and imaging protocols, image processing and display and surgical detection technique and histological analysis of the sentinel node. The results of sentinel node biopsy in 101 breast cancer patients are presented and discussed. Data on dynamic and static imaging, detection rate, sensitivity and specificity of the technique as well as positive and negative predictive values are presented. Pitfalls related to the technique of SLN detection and localization and lessons learnt from these are described in detail in this section of the thesis. Chapter-4 deals with the importance of a reliable intraoperative tool to determine the histological status of the sentinel node. The study of the role of intra-operative touch imprint cytology and optical biopsy in determining the histological status of the SLN is presented. Chapter-5 describes a new injection technique used for the delivery of radiopharmaceutical for sentinel node biopsy. This technique involves the use of a needle-free and pain free injection system. Chapter-6 deals with the experience gained in sentinel node biopsy in other areas of surgical oncology. It includes malignant melanoma, penile carcinoma, anal carcinoma, squamous carcinoma of head and neck and colo-rectal carcinoma. Chapter-7 presents the results and experience gained on the radiation safety aspects of sentinel node biopsy. We analyse the radiation dose to the patient, staff and report on the radiation waste generated as a result of SLNB procedure and present some guidelines with regards to safe use of radioactivity. Chapter-8 presents the cost issues in sentinel node biopsy and preliminary data are presented. Chapter-9 presents the concluding remarks and future directions. It is concluded that the concept of sentinel node biopsy is valid in the management of patients with early breast carcinoma and malignant melanoma. Whether SLNB is ready to replace conventional ALND in breast cancer remains unclear. Although SLN biopsy is now a reliable staging investigation the data on regional control and long term survival is lacking.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available