Lymphatic Metastasis and Sentinel Lymphonodectomy

Metastases determine malignancy. The main attention so far has been focused upon organ metastases. The molecular mechanisms thereof, while far from being totally elucidated, are increasingly well understood. Modern diagnostic tools now enable detection and precise localization of small lesions. In contrast, our knowl­ edge and diagnostic capabilities regarding metastatic spread to the'lymphatic system are rather limited. However, there have re­ cently been a number of interesting advances. It is the aim of this volume to submit these developments to detailed analysis. The therapeutic relevance of enhanced sensitivity in detection of lymph node metastases has to be considered in the light of in­ creased morbidity versus eventual prognostic improvements by modification of therapy. An interesting concept which might im­ prove diagnostic accuracy while reducing operative morbidity is the "sentinel node" technique. Surgical standards are lacking, however, and many fundamental questions pertaining to precise lymphatic mapping remain unanswered. Whether the sentinel node concept is of general relevance or whether it is applicable in only a few organs remains to be determined. This book offers intensive discussion of the concept from methodological and tu­ mor biological viewpoints. World-renowned experts with long­ term involvement in related basic and clinical research provide the reader with a broad survey of actual knowledge together with a critical appraisal of recent and future developments. We sincerely hope this book succeeds in providing an outlook as a reference for all clinicians on future prospects and serving and researchers in this extremely important field.

Inhalt

I. Clinical Assessment of Lymph Node Metastases.- Efficacy of Immunoscintigraphy for Detection of Lymph Node Metastases.- Sensitivity and Specificity of Positron Emission Tomography (PET) for the Diagnosis of Lymph Node Metastases.- Diagnosis and Staging of Lymph Node Metastases.- Detection and Relevance of Immunohistochemically Identifiable Tumor Cells in Lymph Nodes.- II. Principles of Lymphatic Metastasis.- Cell Biology of Lymphatic Metastases: The Potential Role of c-erbB Oncogene Signalling.- The Lymph Node as a Bridgehead in the Metastatic Dissemination of Tumors.- Functional Anatomy of Lymphatic Vessels Under the Aspect of Tumor Invasion.- Molecular Diagnosis of Head and Neck Cancer.- III. Principles of Lymphatic Mapping and Sentinel Node Detection.- The Concept of the Sentinel Lymph Node.- Sentinel Node Localization by Lymphoscintigraphy: A Reliable Technique with Widespread Applications.- Vital Dye and Radiolabelled Colloids - Complement or Alternative.- IV. Sentinel Node Detection in Urogenital Cancer.- Application of the Sentinel Node Concept in Urogenital Cancer.- Intraoperative Lymphatic Mapping and Sentinel Node Identification: Gynecologic Applications.- V. Sentinel Node Detection in Malignant Melanoma.- Sentinel Node Detection in Malignant Melanoma.- Adjuvant Therapy of Malignant Melanoma and the Role of Sentinel Node Mapping.- VI. Sentinel Node Detection in Neck and Thyroid Cancer.- Selective Neck Dissection and Sentinel Node Biopsy in Head and Neck Squamous Cell Carcinomas.- Sentinel Lymph Node Dissection for Thyroid Malignancy.- Lymphoscintigraphy and Ultrasound Guided Fine Needle Aspiration Cytology of Sentinel Lymph Nodes in Head and Neck Cancer Patients.- VII. Sentinel Node Detection in Breast Cancer.- Present and Future of Sentinel Node Lymphadenectomy in Breast Cancer.- Specification of Potential Indications and Contraindications of Sentinel Lymph Node Biopsy in Breast Cancer.- Potential and Pitfalls of Sentinel Node Detection in Breast Cancer.- VIII. Sentinel Node Detection in Gastric Cancer.- Gastric Lymphography and Detection of Sentinel Nodes.- Potential and Futility of Sentinel Node Detection for Gastric Cancer.- IX. Sentinel Node Detection in Colorectal Cancer.- Probe Guided Surgery for Colorectal Cancer.- Identification of Lymph Node Metastases in Recurrent Colorectal Cancer.- Fluorescence as a Concept in Colorectal Lymph Node Diagnosis.