The Sentinel Node Concept

The term ''sentinel node'' to describe the lymph nodes receiving lymphatic drainage from a lesion site was first used by Cabanas in 1977 [22]. However, he used the term to describe a group of nodes that regularly drained the penis and did not use any intraoperative mapping technique to locate the relevant one or two nodes in individual patients. The current use of the term must be attributed to Morton, Cochran, and colleagues at the John Wayne Cancer Institute in Santa Monica, California. In 1992, they described a method of mapping the lymphatic drainage from a primary melanoma site using intradermal injections of blue dye [23]. The stained lymphatic was followed surgically until the blue channel was seen entering a blue-stained node in the draining node field. This node was called the ''sentinel node.'' It was found that if this node was free of metastatic disease, then the node field was almost invariably free of disease. The disadvantage of this approach was that the surgical technique was difficult to learn, requiring about 50 operations before a surgeon achieved reliable results. It was this study, however, which demonstrated that the metastatic melanoma status of a whole node field could be accurately determined by selectively removing and carefully examining one or two sentinel nodes. It is of interest that blue dye injection had long been used to identify lymphatics peripherally and had also been used as an aid to permit canulation for radiological lymphangiography (Fig. 4). However, the concept of tracing it to a specific lymph node or nodes had not previously been considered.

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