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Sentinel Lymph Node Dissection

 

Health care professionals at the King Hussein Cancer Center (KHCC) work tirelessly not only to treat cancer, but to treat the patient with cancer. Doctors are trained in the latest available techniques and findings; employ the most recent proven methods of diagnosis, procedures and treatment; and utilize state-of-the-art medical equipment. KHCC care is patient centric, focusing on the best interests of the patient-aggressively attacking cancer while working to minimize side effects for the patient. Sentinel Lymph Node Dissection (SLND) is one example of the many highly-advanced techniques offered to KHCC patients.

 

SLND is an effective surgical procedure for multiple types of cancer. According to Dr. Mahmoud Al Masari, Department Chairman of Surgery at KHCC, “SLND has been the standard of patient care at the Center in determining the spread of disease for breast cancer since 2003.” Doctors began using this procedure because of its extreme benefits to patients, offering a much less invasive alternative, quick recovery and fewer post-operative complications than the traditional staging method of Auxiliary Lymph Node Dissection (ALND).

 

Lymph nodes are small organs grouped in the neck, underarms, chest, abdomen and groin that help the body fight infection, clean and filter foreign cells. Although not all cancers spread in an orderly progression, the flow of fluid from a breast tumor is predictable; it will first drain into lymph nodes under the arm. If cells from a malignant breast tumor begin to spread, they are found trapped in an underarm lymph node closest to the tumor before potentially spreading to other areas of the body. Doctors refer to the sentinel lymph node as being the first lymph node fed directly from the tumor.

 

Years ago, breast cancer patients would undergo conventional ALND where surgeons remove most (approximately 10-30) nodes in the armpit area to determine if cancer has spread. This intrusive procedure has post-operative risks such as lymphedema (permanent, life-long swelling of the arm). In contrast, SLND involves the removal of only 3-4 nodes, those suspected to be the sentinel lymph node. If the nodes are found to be cancer-free after careful analysis, doctors determine that cancer from the breast tumor has been contained and not spread to create any secondary tumors.

 

A middle-aged woman, Rania, detected her breast cancer through screening from a Jordan Breast Cancer Program (JBCP)-sponsored campaign. Upon being diagnosed, she immediately sought treatment at KHCC, where she underwent a concurrent lumpectomy and SLND procedure. Like countless other KHCC patients, she is grateful that Dr. Al Masari used this method which not only assured that all cancer had been removed, but allowed “excellent mobility” within days of the operation. She quickly resumed daily activities with her three active children, relieved to have not endured the possible nerve damage or potential lymphedema commonly associated with ALND. Rania credits the excellent medical care she received at KHCC - accuracy in diagnosis, advanced procedures, cutting edge technology, and highly-skilled doctors- for being “a cancer-free survivor” today.

 

Procedure

When a patient is diagnosed in the early stages of breast cancer and presents only a small malignant mass, doctors determine in pre-operative exams if the patient is a likely candidate for SLND. If a patient meets required prerequisites for SLND, surgeons perform the SLND procedure before beginning the patient's lumpectomy or mastectomy to access if cancer has spread beyond the breast.

 

For KHCC surgeons to accurately locate the specific sentinel lymph node(s) requiring removal, patients are injected near the tumor site with two tracers- blue dye for visual identification and a low-level radioactive material detected via a Gamma Probe machine. With the help of the dual tracers, a specially-trained surgeon identifies the sentinel lymph nodes. Only dye-stained nodes, nodes detected with any radioactive activity, and any other suspicious nodes are removed for comprehensive analysis.

 

KHCC pathologists analyze the excised sentinel lymph nodes while surgeons concurrently perform their patient’s lumpectomy or mastectomy. The KHCC pathology lab tests nodes by varied methods in order to provide the most accurate results. Initially, a portion of the nodes are immediately examined during surgery to give doctors a preliminary indication if cancer is detected. If cancer is found, an ALND is performed to determine the extent of the cancer's spread. However, if preliminary pathology results show that cancer is not present, it is likely that cancer has not metastasized. Pathologists perform additional laboratory tests for verification which provide more reliable accuracy in detection but take longer to analyze. For this reason, there is a possibility that cancer could be detected days after SLND from one of the other methods of analysis. If cancer is identified, patients return to undergo the ALND procedure for deeper analysis.

 

 

At KHCC

The Center's overall SLND success rate is an amazing 98%, exceeding the international average. A relentless commitment to the success of SNLD is evident in rigorous training and unparalleled, uncompromising quality at KHCC.

 

Training Standard learning protocol requires SLND surgeons to perform at least 20-30 procedures where sentinel nodes have been correctly identified in over 90% of cases. All KHCC surgeons, residents and fellows are thoroughly trained under the watchful eye of Dr. Al Masari, an expert in the procedure, who helped pioneer this technique in Jordan as one of the first surgeons in the region to employ SLND. Since SLND is regularly performed at the Center, KHCC provides a learning platform for doctors in Jordan (and the region), to gain invaluable experience by receiving significant hands-on observational training from KHCC experienced surgeons.

 

Quality KHCC has always provided quality cancer care, utilizing only the latest and greatest tools and techniques for its patients. The Center's commitment to quality has been recognized nationally and internationally. Among the honors, the Center received accreditation from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) as both a general hospital in 2006 (renewed in 2009) and a disease-specific cancer center in 2007. Additionally, in 2009, the Department of Pathology and Laboratory Medicine of KHCC was awarded an accreditation from the College of American Pathologists (CAP), testifying to the exceptional high quality of KHCC’s pathology and laboratory services. KHCC's lab is the first and only lab in Jordan to achieve the high criterion set by CAP.

 

 

Statistics since 2005 indicate 335 procedures of SLND performed at KHCC. A staggering 90 of these 335 procedures were performed between 1/1/2010 to 8/2010. Dr. Al Masri credits increased public awareness and advocacy of regular breast examinations through the JBCP, with more incidences of breast cancer being detected at early stages. At these early stages of detection, SLND is most likely to be performed to detect any potential spread of cancer, thereby reducing mortality.

 

References

 

Dr. Mahmoud Al-Masri, KHCC Department Chairman of Surgery

Mrs. Rania Odeh, KHCC patient

www.breastcancer.org/treatment/surgery/lymph_node_removal/sentinel_dissection

www.cancer.gov/cancertopics/factsheet/therapy/sentinel-node-biopsy

www.cancernews.com/data/Article/202.asp

www.emedicinehealth.com/sentinel_node_biopsy/article_em.htm

www.gammaprobe.com/clinical/lymphnodes

www.imaginis.com/breast-health/sentinel-lymph-node-biopsy-2

www.wikipedia.org/wiki/Sentinel_lymph_node

 
  

 

  
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