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O gânglio sentinela : passado, presente e futuro : artigo de revisão
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Historicamente, a descoberta da biópsia do gânglio sentinela (GS) é atribuída a Morton e Cochran. No entanto, sabe-se que o percurso desta técnica começou muito antes, com inúmeros contributos que permitiram que o desenvolvimento da biópsia do GS seja considerado actualmente como um dos mais importantes feitos em Medicina. O procedimento baseia-se no facto de existir um primeiro gânglio linfático filtrador de células tumorais, cuja remoção permite actuar directamente na história natural do cancro, evitando a formação de metástases, melhorando assim o prognóstico dos doentes. Vários estudos ao longo dos anos puseram em evidência o papel da biópsia do GS no que concerne ao estadiamento, tratamento e prognóstico da doença oncológica, dos quais importa destacar o estudo ACSOG-Z0011, revolucionário ao demonstrar que biópsias positivas nem sempre implicavam a necessidade de realização esvaziamento axilar, com benefícios claros na morbilidade e sem prejuízo da sobrevivência a longo prazo. Não só a biópsia do GS tornou obsoleta a realização de esvaziamento ganglionar em alguns pacientes oncológicos, como permitiu estadiar de forma mais precisa, o que tornou a abordagem mais individualizada a cada doente. Nesta revisão refere-se a evolução histórica da biópsia do GS, quais as considerações actuais sobre a técnica e faz-se algumas reflexões sobre qual será o futuro da técnica, tendo em conta algumas alternativas que começam hoje a surgir.
Historically, the discovery of the sentinel node biopsy (SNB) is atributed to Morton and Cochran. However, it is known that this technique’s path began many years before. Several past contributions allowed the development of the SNB to be considered nowadays as one of the most important breakthroughs in modern medicine. The procedure is based on the existence of one first lymph node that filtrates the tumour cells. If one removes this node, one prevents the formation of metastasis. This way it is possible to act directly on the natural history of the disease, improving patient’s prognosis. Numerous studies throughout the years showed the importance of the SNB concerning cancer staging, treatment and prognosis. Of these, it is important to mention the ACSOG-Z0011, a revolutionary study that revealed that not every positive biopsy meant that an axillary lymphatic node dissection was needed. This has clear benefits in morbidity, without prejudice in terms of long-term survival. Not only the SNB turned the axillary lymphatic node dissection in some patients obsolete, but also allowed a more precise disease staging, which made each patient’s approach more individualised. In this review it is referred the historical evolution of the SNB, the current considerations of the technique and some reflections are made about what the future holds for SNB, considering some new approaches to the technique that are arising
Historically, the discovery of the sentinel node biopsy (SNB) is atributed to Morton and Cochran. However, it is known that this technique’s path began many years before. Several past contributions allowed the development of the SNB to be considered nowadays as one of the most important breakthroughs in modern medicine. The procedure is based on the existence of one first lymph node that filtrates the tumour cells. If one removes this node, one prevents the formation of metastasis. This way it is possible to act directly on the natural history of the disease, improving patient’s prognosis. Numerous studies throughout the years showed the importance of the SNB concerning cancer staging, treatment and prognosis. Of these, it is important to mention the ACSOG-Z0011, a revolutionary study that revealed that not every positive biopsy meant that an axillary lymphatic node dissection was needed. This has clear benefits in morbidity, without prejudice in terms of long-term survival. Not only the SNB turned the axillary lymphatic node dissection in some patients obsolete, but also allowed a more precise disease staging, which made each patient’s approach more individualised. In this review it is referred the historical evolution of the SNB, the current considerations of the technique and some reflections are made about what the future holds for SNB, considering some new approaches to the technique that are arising
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2018
Palavras-chave
Biópsia do gânglio sentinela Esvaziamento ganglionar Doença oncológica