Current Status of Sentinel Lymph Node Mapping and Biopsy: Facts and Controversies

Learning Objectives After completing this course, the reader will be able to: Explain the current application of lymphatic mapping and sentinel lymph node biopsy. Discuss the ability of sentinel lymph node biopsy to allow a more focused pathologic evaluation and identify tumor cells not previously detected by standard techniques. Discuss the major controversies of lymphatic mapping and sentinel lymph node biopsy as they apply to melanoma, breast cancer, and colon cancer. Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com Lymphatic mapping and sentinel lymph node biopsy were first reported in 1977 by Cabanas for penile cancer. Since that time, the technique has become rapidly assimilated into clinical practice. Morton first described the application of lymphatic mapping for melanoma only a decade ago, and this technique is now accepted as the standard of care. The application for lymphatic mapping and sentinel lymph node biopsy in breast cancer remains approximately 5 years behind its utilization in melanoma. This technique has the potential to be utilized in all solid tumors. The rapid assent of this technique in clinical practice is the result of multiple factors, including accuracy, decreased morbidity, and supplying the pathologist with only a few nodes to allow a more focused and sensitive pathologic evaluation. Despite the success and acceptance of lymphatic mapping, many controversies remain. We have attempted to clearly highlight these controversies in this review.