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Sentinel Lymph Node Biopsy

Sentinel Lymph Node Biopsy is a topic covered in the Pediatric Surgery NaT.

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Steps of the Procedure

What are the steps of sentinel lymph node biopsy?


  • The tracer is injected four to six hours prior to the operative procedure.
  • EMLA cream is placed on the primary or biopsy site one hour prior to the injection by patient or family in older patients who will have the procedure performed under local anesthesia. Younger patients will have the procedure performed under general anesthesia.
  • 0.1 ml aliquots of 125 µCi of Tc99m sulfur microcolloid are injected in four locations in the intradermal layers around the lesion or biopsy site.
  • Images are then obtained with a large field-of-view camera with a high resolution collimator until the optimal nodal uptake is visualized. The images should then be localized using lymphoscintigraphy and co-localized using cross sectional imaging. The surgeons should review with the radiologist the location of the nodes in order to guide the incision site.


Computerized tomographic lymphoscintigraphy allows better anatomic localization than planar images alone.

Intraoperative Technique

  • After adequate general anesthesia, 3 mL of Lymphazurin 1% dye (isosulfan blue, Autosuture Norwalk Conn) is injected into the dermal layer in four quadrants at the tumor.
  • The patient is then prepped and draped for the surgical procedure.
  • A gamma probe is then used to identify the area of maximal signal intensity in order to guide the dissection.
  • After the first node is removed, it is moved away from the operative field and checked for a radioactive signal. The lymphatic basin should be rechecked and sentinel lymph nodes continue to be removed until the bed count is ten percent of the hottest lymph node (ex vivo count) consistent with background signal. All nodes should then be labeled appropriately and sent to pathology fresh for processing as sentinel lymph nodes.

sentinel lymph node

Pathologic Evaluation

Direct communication with pathology is essential and a standardized protocol should be developed.

  • Serial sections and analysis by hematoxylin and eosin and subsequent immunohistochemical staining.
  • Nodes sectioned into five slides with two sent for immunohistochemistry (500 µm sections of entire nodes for rhabdomyosarcoma).

see also Breast Procedures

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Last updated: May 6, 2016


Dasgupta, Roshni. "Sentinel Lymph Node Biopsy." Pediatric Surgery NaT, American Pediatric Surgical Association, 2016. APSA Webapp, www.pedsurglibrary.com/apsa/view/Pediatric-Surgery-NaT/829240/all/Sentinel_Lymph_Node_Biopsy.
Dasgupta R. Sentinel Lymph Node Biopsy. In: Waldhausen J, Powell D, Hirschl R, eds. Pediatric Surgery NaT. American Pediatric Surgical Association; 2016. https://www.pedsurglibrary.com/apsa/view/Pediatric-Surgery-NaT/829240/all/Sentinel_Lymph_Node_Biopsy. Accessed June 16, 2019.
Dasgupta, R. (2016). Sentinel Lymph Node Biopsy. In Waldhausen, J., Powell, D., & Hirschl, R. (Eds.), Pediatric Surgery NaT. Available from https://www.pedsurglibrary.com/apsa/view/Pediatric-Surgery-NaT/829240/all/Sentinel_Lymph_Node_Biopsy
Dasgupta R. Sentinel Lymph Node Biopsy [Internet]. In: Waldhausen J, Powell D, Hirschl R, editors. Pediatric Surgery NaT. American Pediatric Surgical Association; 2016. [cited 2019 June 16]. Available from: https://www.pedsurglibrary.com/apsa/view/Pediatric-Surgery-NaT/829240/all/Sentinel_Lymph_Node_Biopsy.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Sentinel Lymph Node Biopsy ID - 829240 A1 - Dasgupta,Roshni,MD MPH ED - Waldhausen,John, ED - Powell,David, ED - Hirschl,Ron, Y1 - 2016/05/06/ BT - Pediatric Surgery NaT UR - https://www.pedsurglibrary.com/apsa/view/Pediatric-Surgery-NaT/829240/all/Sentinel_Lymph_Node_Biopsy PB - American Pediatric Surgical Association DB - APSA Webapp DP - Unbound Medicine ER -