Sentinel Node Biopsy: An Evolution of the Science and Surgical Principles
Lymphatic vessels were rst referred to as vasa chylifera or the lacteals by Greek physicians Herophilus and Erasistratus in human and goat dissections, around 300 BC (Robinson, 1907). Hippocrates had referred to lymph as white blood (Rusznyak et al., 1960), and in 1622, Italian anatomist/surgeon Aselli was fascinated by milky vessels, describing lacteals at canine vivisection. The existence of lacteals was supported in humans by de Peiresc, who repeated Aselli’s experiment on a prisoner shortly pre-execution (Dunglison, 1841). Later, Joylife (1652) and Rudbeck (1651) independently described lymphatic drainage from all parts of the body, recognising the coalescence of individual lymphatic pathways into an organised system (Robinson, 1907; Skobe and Detmar, 2000). That same year, Pecquet (1651) would elucidate the lymph passage from the thoracic duct into the central venous system. It was Bartholin, a Danish anatomist also working on lymphatics around this period, who coined the term vasa lymphatic or lymph vessels (Robinson, 1907; Skobe and Detmar, 2000). The question of how lymph entered the lymphatic system, partly addressed by Hunter (1746) – who observed that the lymphatic capillaries were engaged in absorption (Skobe and Detmar, 2000) – was further claried by von Recklinghuasen, who established the concept of blind-ended lymphatic capillaries, in contrast to characteristic arteriovenous loops of blood vessel capillary beds (Skobe and Detmar, 2000). From the earliest origins of lymphatic research, injection studies were fundamental to our understanding of the lymphatic system, including Sappey’s pioneering use of mercury injections to map cadaveric collecting lymphatic’s (Sappey, 1874) – diagrams of which still form the basis of many current anatomical reference texts (Last, 1998). Unfortunately, Sappey’s work was never repeated due to the hazards of mercury use, and the limitations of this body of work have now begun to emerge, for example, regarding the centrifugal drainage pattern of the female breast, emanating radially from the nipple (Sappey, 1874; Uren et al., 1998b).