The Sentinel Node in Surgical Oncology

Mohammed R. S. Keshtgar, Wendy A. Waddington, Sunil R. Lakhani, Peter J. Ell

Heidelberg, Germany: Springer-Verlag, 1999, 193 pages

This book, a comprehensive review on sentinel node detection, is geared toward nuclear medicine physicians, pathologists, surgeons, technologists, and health care providers interested in the growing field of tumor detection and removal. The foreword explains how sentinel node detection can alter our perception of cancer treatment and potentially influence treatment algorithms significantly, and the preface explains the importance of a multidisciplinary team approach to this method of treatment.

Well-presented, well-illustrated chapters are included on probe selection, radiopharmaceuticals, pathology, imaging techniques, dosimetry, radiation protection, and cost-effectiveness. Three chapters were previously published in the European Journal of Nuclear Medicine, and these are particularly well illustrated and have many tables. The main focus is on breast cancer and malignant melanoma, but penile carcinoma and colon cancer are also mentioned. A brief discussion on the use of blue dye in sentinel node localization contributes to the broad appeal and uniqueness of the book. Techniques, surgical imaging, and pathology are discussed well, and a useful chapter is included on dosimetry and radiation protection for health care providers. Inclusion of this chapter is interesting because many health care providers, especially those not used to dealing with radiation, are concerned about exposure. The issue is adequately addressed, including details on radiation protection. A final strong point is that the book is replete with peer-reviewed references.

Among the shortcomings of the book is its repetitiveness. For example, probe selection is discussed in chapter 1 and again in chapter 4. With 4 authors, and with 2 chapters edited by other contributors, the book is a compilation of efforts and reads as such. Other deficiencies are the superficial discussion of patient preparation and the lack of information on pain management. In addition, the subject index is incomplete and often does not direct one to all pertinent pages.

Another shortcoming is that the book was written mainly for Europeans. The authors describe the European practice in sentinel node detection and lymphoscintigraphy and include a chapter on malignant melanoma detection in Europe. They use many terms familiar to European physicians, such as the term “theater” for operating room. In the chapter on clinical cases, the radiopharmaceuticals discussed are used mainly in Europe, and for U.S. readers a more detailed discussion on radiopharmaceuticals available in the United States and on the size of colloid particle doses would have been useful. Besides this shortcoming, other weak points in the chapter include the similarity among the cases, the simplism of the teaching points, and the inadequacy of the information on radiopharmaceuticals, doses, patient preparation, and other complementary studies. Some discussion on pearls and pitfalls should also have been included.

Overall, I consider this text a primer for beginners in the field of sentinel node detection. It is useful for a multidisciplinary approach to this method of treatment and is written in a manner that all can understand. The clarity of the text and the high-quality figures and tables provide newcomers with fundamentals on the technique and information on the usefulness of sentinel node detection.

Charleston, South Carolina