Lymph dissection

Local therapy of early-stage breast cancer consists of modified radical mastectomy or lumpectomy plus external-beam radiation therapy. The surgical approach to the ipsilateral axilla may consist of a full level I/II axillary lymph node dissection or a lymph node mapping procedure with sentinel lymph node biopsy. 

Intermediate Less than 10 years EM, RT or RP with or without pelvic lymph node dissection... 

Axillary lymph nodes should be sampled for staging and prognostic information. Lymphatic mapping with sentinel lymph node biopsy is a new, less invasive alternative to axillary dissection however, the procedure is controversial because of the lack of long-term data. 

Bonenkamp J J, et al. Extended lymph-node dissection for gastric cancer. Dutch Gastric Cancer Group. N Engl J Med 1999 340(12) 908-914. 

F = fluorouracil, HU = hydroxyurea, LAG = lymphangiogram, PAN = paraaortic node, LND = lymph node dissection, NED = no evidence of disease, P = cisplatin. 

Depending on the research question, other organs such as spleen and lymph nodes can be removed from the mice for (immunological) analysis, fixed in 4% formalin, and subsequently in 70% ethanol before paraffin embedding. Alternatively, the tissue, placed in aluminum cryotubes, can be snap frozen immediately in liquid nitrogen after dissection. This procedure should be performed if RNA, DNA, or protein needs to be isolated from the tissue. 

At the end of the study period following lymph node dissection (see below), surgically remove primary tumors from the animals, isolate from surrounding tissues, and weigh (Figs. 14.IB and 14.3B). 

Baniel J, Foster RS, Rowland RG, Bihrle R, Donohue JP. Complications of post-chemotherapy retroperitoneal lymph node dissection. J Urol 1995 153(3 Pt 2) 976-80. 

Hsueh EC, Hansen N, GiuUano A. Intraoperative lymphatic mapping and sentinel lymph node dissection in breast cancer. CA Cancer J CUn 2000 50 279-291. 

Historically, complete axillary lymph node dissections had been performed with lumpectomy or mastectomy primarily for staging purposes, providing information that was used to determine adjuvant chemotherapy. The complete axillary lymph node dissection (CALND) may not change the course of the disease, although with removal of involved axillary nodes, the control of local recurrence in the axilla is easier. The morbidity associated with this procedure is substantial in terms of limitation of arm motion, arm pain, and chronic lymphedema. 

Kamath VJ, Giuliano R, Dauway EL, et al. Gharacteristics of the sentinel lymph node in breast cancer predict further involvement of higher-echelon nodes in the axilla A study to evaluate the need for complete axillary lymph node dissection. Arch Surg. 2001 136 688-692. 

Mignotte H, Treilleux I, Faure C, et al. Axillary lymph-node dissection for positive sentinel nodes in breast cancer patients. Eur J Surg Oncol. 2002 28 623-626. 

Doss LL, Padilla RS and Hiadik WB (1986) Technetium antimony sulfur colloid scintiscan in selective lymph node dissection for malignant melanoma. 

Lymph nodes dissected from patients of melanoma... 

Dissect the tissue sample selected for the biorepository as rapidly as possible. Place in 10 vol of fixative at room temperature. After 1 h, inspect the sample. If the fixative is cloudy, replace it with fresh fixative. If the sample is thick, remove sample, place on a cutting board, cut 1- to 2-mm slices to expose all surfaces and return to 10 vol of fixative. (Note a short period of fixation will firm up hard-to-slice tissues such as lymph nodes, spleen. 

---