Node Biopsy Research Articles

Significance of sentinel lymph node biopsy in low- and intermediate- risk endometrial cancer: a study at tertiary care centre, India.

To evaluate the incidence of sentinel lymph node (SLN) metastasis observed in patients with presumed low- and intermediate-risk endometrial cancer (EC) and change in stage and adjuvant therapy resulting from SLN analysis. Secondary objectives include assessing the rates of detection of SLN using indocyanine green (ICG) dye and complication rates. Between March 2017 and December 2023, 210 patients were included in the study. A total of 412 SLNs were detected in 210 patients using intracervical ICG dye injections. The pathologically confirmed detection rate was >95%. A total of 25 (11.9%) patients exhibited positive sentinel metastasis detected through pathological and immunohistochemical analysis, with isolated tumor cell in 5 (2.4%), micro-metastasis in 6 (2.9%), and macro-metastasis in 14 (6.7%) patients. SLN metastasis with micro- and macro-metastases changed to stage III; therefore, adjuvant therapy was administered in the form of chemotherapy and radiation therapy. Of the 210 patients, 186 (88.5%) remained at low and intermediate risk after the final histopathological analysis. The other 24 patients exhibited SLN metastasis, high-grade EC, higher-stage detection, or high risk on molecular profiling. A change in stage was observed in 11.9% of patients, and adjuvant therapy was administered to 20 patients, of whom 16 received adjuvant therapy based solely on SLN involvement (in the form of micro- and macro-metastasis), thus preventing undertreatment. Overtreatment was reduced in six patients who were classified as high-grade and non-endometrioid types with SLN metastases.

Angioimmunoblastic T-cell lymphoma harboring a t(8;14)(q24;q11.2)/TCR::MYC translocation that presented with intestinal infiltration.

Although rearrangement of the MYC oncogene (MYC-R) is frequently observed in aggressive B-cell lymphomas, it is extremely rare in T-cell malignancies. A 64-year-old man who had been under observation for several years because of asymptomatic pulmonary extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALToma) was admitted to our hospital because of poor general condition and hypotension. Blood tests revealed thrombocytopenia and elevated serum lactate dehydrogenase levels, whereas computed tomography revealed systemic lymphadenopathy and splenomegaly. An inguinal lymph node biopsy precipitated a diagnosis of angioimmunoblastic T-cell lymphoma (AITL). Shortly after admission, the patient experienced spontaneous intestinal perforation and hemorrhage caused by multiple intestinal infiltrations of the AITL. Although chemotherapy was administered, the patient died several weeks after admission. A 46,XY,t(8;14)(q24;q11.2) karyotype was identified, and fluorescence in situ hybridization analyses showed split signals for the MYC and T-cell receptor (TCR) alpha genes, by which a TCR::MYC translocation was confirmed. Pathological autopsy analysis revealed systemic infiltration of the AITL and no MALToma lesions. Only a few cases of mature T-cell lymphoma harboring MYC-R have been reported in the literature thus far. To the best of our knowledge, this is the first reported case of AITL with TCR::MYC rearrangement. This condition could be associated with refractoriness to chemotherapy and aggressive clinical course with systemic infiltration that included the intestine.

A patient with concurrent EBV-negative diffuse large B-cell lymphoma and angioimmunoblastic T-cell lymphoma: a case report

IntroductionDiffuse large B-cell lymphoma (DLBCL) is an aggressive form of non-Hodgkin lymphoma that accounts for approximately a quarter of all lymphomas in the United States. It is rare to have co-occurring T cell lymphoma with DLBCL as they often develop following treatment of DLBCL rather than concomitantly.Case presentationWe report a 71-year-old male patient diagnosed with Epstein–Barr virus (EBV) -negative DLBCL with concurrent angioimmunoblastic T-cell lymphoma (AITL). A right inguinal lymph node biopsy demonstrated aggressive B-cell lymphoma consistent with DLBCL with the non-germinal center immunophenotype that was EBV-negative. Furthermore, abnormal T-cells with irregular nuclear contours were found in T cell receptor sequencing with monoclonal gamma and beta T cells. A bone marrow biopsy demonstrated occasional large atypical CD3+PD1+ T cells with corresponding identical T-cell receptor clones in the lymph node biopsy. Next-generation sequencing from the lymph node biopsy demonstrated dual inactivating TET2 mutations.ConclusionComposite DLBCL and AITL is a rare occurrence and the absence of EBV is even more so. Given the rare nature of having these two hematologic malignancies simultaneously, no standard of care exists. However, R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) is a regimen commonly used in both malignancies individually, and therefore this patient was treated using this approach achieving a partial remission after four cycles of therapy. Unfortunately, he developed refractory disease 1 month after completion of six cycles of R-CHOP.

Cat scratch disease in children with nocturnal fever: A case report

BACKGROUND Cat scratch disease (CSD) is the most common human infection caused by Bartonella henselae (B. henselae ). The main manifestation is self-limited lymphadenopathy that primarily affects adolescents, and typically resolves without treatment within 2-4 months. However, individuals with compromised immune systems or immunodeficiency require specific antibacterial therapy following diagnosis. Due to its low incidence, nonspecific clinical manifestations, and diagnostic limitations, this condition often poses challenges for clinicians in terms of missed diagnoses and misdiagnoses. CASE SUMMARY The child was ultimately diagnosed with CSD. The primary manifestations included nocturnal fever, enlargement of lymph nodes in the neck, axilla and groin, and suspected brucellosis; however, both brucellosis tests conducted during the course of the illness yielded negative results. Bone marrow cytology indicated stimulated proliferation. Lymph node biopsy indicated hyperplasia of lymphoid tissue in the cervical lymph nodes (right), with combined immunohistochemical findings indicating reactive hyperplasia. Immunohistochemical analysis revealed CD20 B (+), CD3 T (+), BCL-6 (+), and BCL-2 (). CD21 FDC networks were present and Ki67 expression in the germinal center was ~80%. Blood next-generation sequencing indicated B. henselae sequence number was 3. Serological test results demonstrated positive antibody response to B. henselae IgG (+), B. henselae IgM (+), Bartonella quintana (B. quintana ) IgG () and B. quintana IgM (), and the final diagnosis was CSD. CONCLUSION In patients presenting with fever at night and swollen lymph nodes of unknown origin, CSD should be considered.

Spatiotemporal Mapping of Lymphatic Metastases in Gastric Cancer Using Tumor-Trackable and Enzyme-Activatable Near-Infrared Fluorescent Nanoprobes.

Sentinel lymph node biopsy holds significant importance in cancer management, yet the challenge persists in early detection and precise resection of metastasis lymph nodes (LNs) due to the absence of specific and sensitive optical probes. This study reports metastatic LN reporters (MLRs) with an activatable optical output for accurate spatiotemporal mapping of lymphatic metastases in gastric cancer. MLRs are self-assembled entities incorporating mixed amphiphiles with a lipophilic tail and a tumor-targeting ligand or a fluorescent moiety that is caged with a switch cleavable by tumor-specific β-galactosidase (β-Gal). After draining into LNs, MLRs selectively activate their near-infrared fluorescence in the presence of spreading tumor cells. In orthotopic gastric cancer mouse models, the representative reporter MLR1 distinguishes macro/micrometastatic LNs from benign LNs and enables early detection of skip LNs metastasis patterns in a spatial-dependent manner. Such an active sensing mechanism provides a high level of sensitivity and specificity comparable to those of flow cytometry analysis. In surgically resected patient specimens, MLR1 differentiates cancerous tissues and metastatic LNs from normal tissues and benign LNs within 1 h. This study thus presents NIRF nanoprobes that permit facile detection of LN metastases in GC patient samples and highlights a generic translatable nanoprobe design for understanding metastatic progression.

Validation of ACR TI-RADS performance in transition age: results from a multicenter retrospective study by the TALENT study group.

Although thyroid nodules are less common in the pediatric population, the risk of malignancy is higher than in adult patients. The aim of this study was to evaluate the ultrasonographic predictive factors of malignancy in thyroid nodules and to validate American College of Radiologists (ACR) TI-RADS performance in transition age patients. One hundred forty-two patients aged between 14 and 21 years referred to the participating centers for FNA biopsy of a thyroid nodule between 2007 and 2022 were included and ultrasound reports and sonographic images were retrospectively analyzed. Nodule features were defined according to the ACR-TIRADS lexicon. Two reference standards were applied: FNA cytology and surgical histology. The diagnostic performance of single sonographic features was estimated. Significant predictors were then included in a multivariate regression model. Nodules included in ACR-TIRADS categories TR4 or TR5 had 10-fold increased risk of indeterminate or suspicious/malignant cytology [p < 0.001]. In univariate analysis, solid composition [p = 0.016] and presence of hyperechoic foci [p = 0.040] significantly increased the likelihood of malignant histology. In multivariate regression analysis, irregular margins [p = 0.011] and hyperechoic foci [p = 0.019] were independent predictors of indeterminate or suspicious/malignant cytology. Nodules included in ACR-TIRADS categories TR4 or TR5 had 10-fold increased risk of indeterminate or suspicious/malignant cytology in transition age. ACR-TIRADS was not able to rule-out malignancy compared to FNAB alone, suggesting the need to reconsider recommendations in the transition age group.

The role of PET/CT SCAN in addressing autoinflammatory diseases; A case report of a young man presenting with fever, splenomegaly and exanthem.

Adult-onset Still's disease (AOSD) is an uncommon autoinflammatory syndrome characterized by quotidian fever, arthritis, evanescent exanthem and splenomegaly. Lymphadenopathy is present in about a half of patients; it is usually symmetrical with the cervical area being most commonly involved. When constitutional symptoms are present, an extensive work-up should be performed in order to exclude hematological malignancies, such as lymphoma. A 38-year-old male is presented due to fatigue and high-grade fever that first appeared a month ago. He did also refer night sweats, arthralgias and an evanescent erythema on the trunk and anterior thigh area. Serology testing for bacteria and viruses as well as autoimmune rheumatic diseases was requested. Whole body computed tomography (CT) scan was ordered and displayed a marginal lymph node in the right hilum and smaller ones in the axillary region. Positron emission tomography/CT (PET/CT) with fluorine-18-fluoro-deoxy-glucose (18F-FDG) showed hypermetabolic lymph nodes, with the right upper internal jugular lymph node being the most dominant, as well as diffusely increased 18F-FDG uptake by bone marrow and spleen, posing in the differential diagnosis a neoplastic disease of the hematopoietic tissues. Further laboratory testing showed high ferritin levels. It was decided to procced with biopsy of the aforementioned hypermetabolic internal jugular lymph node and bone marrow. Histopathological examination did show hyperreactivity and no malignant cells neither in the lymph node nor in the bone marrow. Adult-onset Still's disease is a rare disorder and it is a diagnosis of exclusion. High-grade fever along with arthralgias, splenomegaly, high serum ferritin levels and the presence of exanthem should pose high in the differential the AOSD. In this case, PET/CT guided the anatomical location for lymph node biopsy in order to differentiate AOSD from lymphoma. The dissociated increased 18F-FDG uptake from the cervical and axillary lymph nodes is characteristic of AOSD.

ASO Author Reflections: Nodal Recurrence Is Rare in Patients with cN+/ycN0 Breast Cancer after Neoadjuvant Chemotherapy Regardless of the Extent of Axillary Surgery or Nodal Pathology in the NEOSENTITURK-Trials MF18-02/18-03 Provided Regional Nodal Irradiation Is Administered.

The combined analysis of the retrospective multicentre and prospective multicenter cohort registry trial NEOSENTITURK MF18-02/18-03 (NCT04250129) investigated the outcomes and factors associated with recurrence in patients with cT1-4N1-3M0 who underwent a succesful sentinel lymph node biopsy or targeted axillary dissection (n = 1470), with or without axillary lymph node dissection (n = 937) after neoadjuvant chemotherapy. The present large registry data suggest that axillary recurrences (AR) can be detected at exceedingly low rates (< 0.5%) within 3 years after surgery. This is regardless of the extent of axillary surgery or nodal pathology, provided that regional nodal irradiation is administered. Factors associated with increased risk for AR included age under 45 years, nonpathologic complete response (non-pCR) in the breast, and nonluminal pathology. Similarly, having cT3-4, a non-pCR in the breast or axilla, and nonluminal pathology were identified as poor prognostic factors.

Perifollicular concentric granulomas: A clue to IgG4-related lymphadenopathy.

A 69-year-old with well-controlled HIV was evaluated for persistentcough, in the context of years of fatigue and influenza A infection 6months prior. Chest CT and PET scans were notable for adenopathyconcerning for a lymphoproliferative disorder. Radiologic studies alsoshowed diffuse FDG uptake in the prostate, consistent with prostatitis.Axillary lymph node biopsy showed follicular and paracorticalhyperplasia, and few germinal centers showed perifollicular non-necrotizing granulomas. Immunohistochemical staining demonstrated apredominance of IgG4 positive plasma cells. Serum proteinelectrophoresis (SPEP) and immunosubtraction showed a board-domedpeak pattern suggestive of possible monoclonality. Serum IgG4 levelswere elevated, and the patient was diagnosed with IgG4-relateddisease (IgG4-RD). This case highlights morphologic and SPEP patternsthat can aid in supporting a diagnosis of IgG4-RD.

Sentinel lymph node mapping with Indocyanine green fluorescence (ICG) for pediatric and adolescent tumors: a prospective observational study

Sentinel lymph node biopsy (SLNB) is an important technique in the staging of pediatric melanomas, sarcomas, and potentially useful for other solid tumors. Precise visual localization of the sentinel lymph node (SLN) during the operation is a key challenge of this procedure. Presently, the gold standard method employing Technetium 99 (99mTc) for localization carries a notable false-negative rate. In this context, we propose evaluating the use of Indocyanine Green near-infrared (ICG-NIR) as a supplementary tool to enhance the identification of SLN. A prospective observational study focused on pediatric and adolescent patients undergoing SLNB using ICG-NIR at a single institution from 2019 to 2022. Lymphoscintigraphy with 99mTc was performed before surgery and 99mTc was detected intraoperatively using a handheld gamma probe. ICG was administered intraoperatively and assessed using transcutaneous NIR. The study collected demographic data, intra-operative findings (Technetium 99 m, ICG fluorescence), and histopathological data. Eight patients with a median age of 16 years (range: 8–19 years) underwent fluorescence-guided sentinel lymph node harvesting with 100% sensitivity. Sentinel lymph node fluorescence was verified with a positive radiosignal in all patients. No adverse events were recorded. Fluorescence-guided assessment of the lymphatic system is both feasible and effective for sentinel lymph node identification. Nevertheless, larger-scale studies are essential to establish indocyanine green as a viable alternative rather than a complementary technique alongside the gold-standard radioisotope-guided method for sentinel lymph node assessment in children.

Computed tomography-guided core needle biopsy for pulmonary nodules: impact of the coaxial technique

Computed tomography-guided core needle biopsy for pulmonary nodules: impact of the coaxial technique

Breast Cancer Recurrence in Initially Clinically Node-Positive Patients Undergoing Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy in the NEOSENTITURK-Trials MF18-02/18-03.

This study aims to identify factors predicting recurrence and unfavorable prognosis in cN+ patients who have undergone sentinel lymph node biopsy (SLNB) following neoadjuvant chemotherapy (NAC). The retrospective multi-centre "MF18-02" and the prospective multi-centre cohort registry trial "MF18-03" (NCT04250129) included patients with cT1-4N1-3M0 with SLNB+/- axillary lymph node dissection (ALND) post-NAC. A total of 2407 cN+ patients, who later achieved cN0 status after NAC and subsequently underwent SLNB, were studied. The majority had cT1-2 (79.1%) and N1 (80.7%). After a median follow-up time of 41 months, the rates of locoregional recurrence and axillary recurrence (AR) were 1.83% and 0.37%, respectively. No significant difference in locoregional recurrence or AR rates was observed between the SLNB/targeted axillary dissection-only (n = 1470) and ALND (n = 937) groups. Factors significantly linked with AR included age younger than 45 years, nonpathological complete response (non-pCR) in the breast, and nonluminal pathology. Locoregional recurrences were associated with nonluminal or HER2(+) pathology, non-pCR in the breast, and ALND. Poor prognostic factors for disease-free survival (DFS) included having cT3-T4, no breast pCR (non-pCR), ypN(+), and nonluminal pathology. No significant difference was found in DFS or disease-specific survival (DSS) rates among ypN0, ypN-isolated tumour cells, ypNmic, and ypN1. However, significant decreases in DFS and DSS rates were observed when comparing ypN2 or ypN3 disease with ypN0. The present large registry data indicate that younger patients (<45), those with nonluminal pathology, and those who only partially respond in the breast are more susceptible to axillary and locoregional recurrences.

A case of silicosis with Mycobacterium avium infection relapsed with lymphadenitis 1 year after the completion of initial treatment.

A 71-year-old man with silicosis was treated for Mycobacterium avium infection. Antimycobacterial treatment for M. avium was terminated 1 year after a negative test result for the bacteria on sputum examination. One year following the treatment, the patient developed pneumonitis. In the sputum culture, growth of M. avium was not detected. Pneumonitis did not improve despite sufficient antibacterial therapy. Chest computed tomography scan revealed aggravated shadows of pneumonitis and swelling of supraclavicular lymph nodes. A lymph node biopsy was performed, and polymerase chain reaction testing revealed M. avium infection. We diagnosed the patient with pneumonitis and lymphadenitis due to recurrent M. avium infection. Antimycobacterial treatment with rifampicin, ethambutol, clarithromycin, and amikacin was initiated. Pneumonitis and the general status of the patient improved following the treatment. Lymphadenitis is rare in adults in the absence of any immunodeficiency condition. We speculate that silicosis is a risk factor for mycobacterial infection recurrence.

Sentinel lymph node biopsy in the treatment of breast cancer – is it a standard procedure in Bulgaria?

Sentinel lymph node biopsy in the treatment of breast cancer – is it a standard procedure in Bulgaria?

Sentinel Lymph Node Biopsy in Early Breast Cancer: Experience and Quality Indicators in a Philippine University Hospital

Sentinel Lymph Node Biopsy in Early Breast Cancer: Experience and Quality Indicators in a Philippine University Hospital

The feasibility of sentinel lymph node biopsy after previous mastectomy using Indocyanine Green (ICG): a case report

The feasibility of sentinel lymph node biopsy after previous mastectomy using Indocyanine Green (ICG): a case report

The magnetic technique of sentinel lymph node biopsy in breast cancer

The magnetic technique of sentinel lymph node biopsy in breast cancer

Axillary clearance and chemotherapy rates in ER+HER2− breast cancer: secondary analysis of the SENOMAC trial

Randomized trials have shown that axillary clearance (AC) can safely be omitted in patients with sentinel lymph node-positive breast cancer. At the same time, de-escalation of chemotherapy in postmenopausal patients with ER+HER2- breast cancer may depend on detailed axillary nodal stage. The aim of this pre-specified secondary analysis of the SENOMAC trial was to investigate whether the choice of axillary staging affected the proportion of patients receiving adjuvant chemotherapy, and recurrence-free survival(RFS). Proportion receiving adjuvant chemotherapy was calculated according to AC or sentinel lymph node biopsy (SLNB) only, menopausal status, and region of inclusion, for 2168 patients with clinically node-negative ER+HER2- breast cancer and 1-2 sentinel lymph node macrometastases included in the SENOMAC trial. In premenopausal patients, 514 out of 615 patients (83.6%) received adjuvant chemotherapy with no significant difference between randomization arms. In postmenopausal patients, the proportion receiving chemotherapy varied considerably by region and country (36.0-82.4%). In Denmark, where 194 out of 539 postmenopausal patients (36.0%) received adjuvant chemotherapy, rates differed significantly between the AC and the SLNB only arm (41.3% vs 31.4%, p=0.019). After a median follow-up of 44.88 months for Danish postmenopausal patients, no significant difference was seen in 5-year RFS, which was 91% (85.6%-96.6%) for the SLNB only and 90.9% (86.3%-95.6%) for the AC arm (p=0.42). When omitting axillary clearance, and thus reducing the risk of long-term arm morbidity, potential under-treatment of postmenopausal patients with ER+HER2- breast cancer may require the development of new predictive and imaging tools. Swedish Research Council, Swedish Cancer Society, Nordic Cancer Union, Swedish Breast Cancer Association.

Switching to a Super Paramagnetic Iron Oxide, non-radioactive tracer for sentinel lymph node biopsy: the Nottingham Breast Institute experience

Switching to a Super Paramagnetic Iron Oxide, non-radioactive tracer for sentinel lymph node biopsy: the Nottingham Breast Institute experience

ASO Author Reflections: Investigating the Role of Sentinel Lymph Node Biopsy in Older Patients with Triple-Negative Breast Cancer.

ASO Author Reflections: Investigating the Role of Sentinel Lymph Node Biopsy in Older Patients with Triple-Negative Breast Cancer.