Abstract
Background: Although sentinel lymph node (SLN) biopsy is a powerful staging tool for patients with melanoma and breast cancer, controversy remains regarding specific aspects of technique. We examined particle uptake by antigen-presenting cells (APCs) to determine if this mechanism is responsible for the differential retention of radioactivity in SLNs relative to nonsentinel lymph nodes (NSLNs).
Methods: Mapping was conducted in pigs injected with vital blue dye, fluoroscein isothiocyanate- labeled human serum albumin (FITC-HSA), and one of two99mtechnetium-labeled tracers, i.e., human serum albumin, a small macromolecule, or unfiltered sulfur colloid, a mixture of small and large particles. Macromolecule uptake by APCs was studied in vitro by using FITC-HSA and measured by fluorescence-activated cell sorting (FACS). SLNs and NSLNs were analyzed by fluorescence microscopy or FACS, with counterstaining for leukocyte cell surface markers.
Results: Both radiotracers were effective. Cultured APCs rapidly took up FITC-HSA. Microscopy showed FITC-HSA in the subcapsular sinus of SLNs shortly after injection and subsequent distribution to interfollicular areas. FACS revealed increasing amounts of FITC-HSA in SLNs over time. Cells responsible for uptake were APCs, expressing major histocompatibility (locus) class II.
Conclusions: This report establishes active macromolecule uptake as a mechanism that determines SLN status. This mechanism has important implications for performing SLN biopsy.
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Faries, M.B., Bedrosian, I., Reynolds, C. et al. Active Macromolecule Uptake by Lymph Node Antigen-Presenting Cells: A Novel Mechanism in Determining Sentinel Lymph Node Status. Ann Surg Oncol 7, 98–105 (2000). https://doi.org/10.1007/s10434-000-0098-6
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DOI: https://doi.org/10.1007/s10434-000-0098-6