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The Royal Marsden Healthcare experts

Q&A: Sentinel lymph nodes

Ms Marielle Nobbenhuis, Consultant Gynaecological Oncology Surgeon, discusses recent research that aims to better identify lymph nodes affected by cancer
20 September 2018

Marielle Nobbenhuis

In 95 per cent of women in the study, we were able to successfully identify the sentinel lymph nodes

What are sentinel lymph nodes?

Lymph nodes are an important part of the body’s immune system. These nodes, or glands, act by filtering abnormal cells from lymphatic fluid – a colourless fluid that forms in the body’s tissues. Cancer often spreads through the lymphatic system, and sentinel nodes are the first such areas to which cancer is likely to spread.

Why are you researching this?

In early cervical and endometrial cancer, a standard course of action is a radical lymphadenectomy – the removal of all lymph nodes to assess the spread of disease in a biopsy. However, most patients have negative nodes, and this total removal might expose them to the risk of lymphoedema, a major condition that can have a huge impact on a patient’s life.

What did the FRIENDS feasibility study involve?

My colleague Mr Thomas Ind and I injected a fluorescent green dye into the cervix, which spread through to the nodes. Using a black-and-white ‘filter’ on the viewfinder of the da Vinci Xi surgical robot, we could find the first sentinel lymph nodes draining fluid from the cancer, which ‘flare up’ green in response to the dye. We could then remove these and send them for testing.

What did you find?

The results were overwhelmingly positive. In 95 per cent of the 53 women who were part of the study, we were able to successfully identify the sentinel lymph nodes.

What does this mean for patients?

In addition to avoiding the risk of lymphoedema, the fact that the procedure is carried out robotically, as opposed to with keyhole or open surgery, has many benefits. It is minimally invasive – meaning better recovery and less pain and scarring – and the greater magnification means the surgeon can be much more precise.