Discussion

It is not true that the node closest to the primary tumor is by definition the (only) sentinel node. It is also not so that the hottest node is by definition the (only) sentinel node. The radioactivity content of a node is determined by parameters such as its size and the lymph flow rate. A large second-tier node occasionally accumulates more radioactivity than a small first-echelon node. For these reasons, it is questionable to use the radioactivity content or the sentinel node-to-background ratio to determine whether a node is a sentinel node.

How hot a node appears on the images is not only determined by its radioactivity content. One must also reckon with the inverse square law of physics. A superficial node lies closer to the gamma camera and is depicted brighter than an equally radioactive node that is situated deeper and, as a result, lies further away from the gamma camera.

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