Clinical Lymphatic Mapping of Gynecologic Cancer by Charles Levenback

By Charles Levenback

This absolutely illustrated textual content describes the idea that of sentinel lymph node detection and information some of the mapping strategies used and the research of the implications.

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The fragile individual vessels coalesce to form channels, which flow out from the mucosa within the plicae palmatae, generally perpendicular to the axis of the cervical canal. Interfacing with the stroma, the channels flatten and angle to run parallel with the endocervical canal, where they combine further to make larger channels. Ultimately, these vessels converge upon intermediate trunks located within the stromal vasculature. Within the cervical stroma, a dense and regular lattice of lymphatic vessels is found.

The authors found that faster lymphatic drainage was strongly associated with uptake to second-tier (or second-echelon) nodes. Antimony sulfide has a small particle size of 10–15 nm in diameter. Sulfur microcolloid, commonly used in North America, has a larger particle size and therefore somewhat slower uptake. From a gynecologic perspective, the primary tumor in patients with vulvar and cervix cancer is relatively close to the regional lymph node bed, and therefore radionuclide should be transferred relatively quickly to the sentinel node or nodes.

Molecular quantification and mapping of lymph-node micrometastases in cervical cancer. Lancet 2001; 357(9249):15–20. COLEMAN THE VULVA In certain respects, understanding the anatomy of the vulva, its targeted nodal basin, and its directed, physiologic lymphatic drainage should provide the clearest insight into why lymphatic mapping as a surgical procedure garners clinical relevance. Detailed study of this anatomy coupled with clinical correlates of patients with vulvar carcinoma has dictated surgical care, of which nodal resection in toto has become a standard procedure.

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