Sentinel Lymph Node Biopsy Research Articles

Sentinel Node Biopsy in Laryngeal Cancer: A Systematic Review and Meta-Analysis

Background: Sentinel lymph node (SLN) biopsy offers a minimally invasive approach to staging lymph node involvement in laryngeal squamous cell carcinoma (SCC). Despite its adoption in other cancers, its accuracy in laryngeal SCC remains under investigation. This systematic review and meta-analysis evaluates the diagnostic performance of SLN mapping in laryngeal cancer. Methods: A systematic search of MEDLINE, Scopus, and Google Scholar was conducted using the keywords “(larynx OR laryngeal) AND sentinel”, with no date or language restrictions. Studies reporting SLN detection rates and/or sensitivity in laryngeal SCC were included. A random-effects model was applied for data pooling, and subgroup analyses were performed based on tumor location (supraglottic versus transglottic) and mapping material (radiotracer versus blue dye). Publication bias was assessed using funnel plots and statistical methods. Results: Nineteen studies, encompassing 366 patients, were analyzed. The overall pooled SLN detection rate was 90.8% (95% CI: 86–94.1), and sensitivity was 88% (95% CI: 81–94). Supraglottic tumors demonstrated superior outcomes (detection rate: 93.7%, sensitivity: 96%) compared to transglottic tumors (detection rate: 84.7%, sensitivity: 71%). Radiotracers significantly outperformed blue dye, with detection rates of 90.8% versus 81.5% and sensitivities of 88% versus 77%. Conclusions: SLN mapping is a reliable technique for staging laryngeal SCC, particularly for supraglottic tumors, where high detection rates and sensitivity were observed. Radiotracers offer superior performance compared to blue dye, underscoring their clinical value. These findings support the feasibility and accuracy of SLN biopsy in laryngeal cancer, while emphasizing the importance of tumor location and mapping material.

Long-term survival of node-positive breast cancer with complete nodal response to neoadjuvant chemotherapy treated with sentinel lymph node biopsy alone: A meta-analysis.

There exist concerns regarding the use of sentinel lymph node (SLN) biopsy alone in node-positive breast cancer patients who have a clinical/radiological complete response in the axilla and are negative on histopathology after neoadjuvant chemotherapy (NACT). We hereby conducted a meta-analysis examining 5-year overall survival (OS) and disease-free survival (DFS) of such patients. PubMed, the Cochrane CENTRAL library, Embase, Web of Science, and Scopus were searched up to 30th July 2024 for studies reporting survival data. OS and DFS were pooled in a meta-analysis. Subgroup analysis was conducted based on the location of the study, pre-NACT node assessment, and SLN mapping technique. Random-effects meta-regression was conducted for the following moderators: age, initial T3-4, initial N2-3, breast-conserving surgery, breast pathological complete response (pCR), number of SLN removed, adjuvant radiotherapy, endocrine therapy, and follow-up Results: 16 studies with 5249 patients were included. Meta-analysis showed that node-positive breast cancer patients showing nodal pCR after NACT and undergoing only SLN biopsy had a 5-year OS and DFS of 94% (95% CI: 92%, 96%) and 89% (95% CI: 87%, 92%) respectively. There was not much variation in the survival rate on sensitivity and subgroup analyses. Meta-regression showed that OS and DFS were higher in studies with a greater number of patients receiving endocrine therapy. Breast cancer patients with cN+ who achieve a complete clinical/radiological axillary response after NACT and subsequently become SLN biopsy negative may have high rates of DFS and OS after 5 years. Given the high degree of heterogeneity, results should be interpreted with caution. We do not recommend change in treatment plans given the high risk of bias and large heterogeneity in the patient population included in the studies. Only high-quality large multicentric randomised trials can provide better evidence.

An initial benchmark of the quality of the diagnosis and surgical treatment of breast cancer in South Africa

Background. Monitoring quality indicators to improve breast cancer care is well established in high-income countries. This is the first evaluation of diagnostic and surgical quality indicators for initial benchmarking of breast cancer care in South Africa (SA). Objective. To measure the adherence rates to quality indicators among women with breast cancer in SA. Methods. Ten quality indicators were evaluated for 3 545 breast cancer patients across four SA surgical breast units using a shared electronic patient record system. Data quality and adherence rates with differences between units were determined. The effect of HIV status on adherence was assessed by multivariate Poisson regression analyses. Results. Our electronic patient record reliably measured most quality indicators. Rates of positive margins (5.7%), overall axillary surgery (95.8%) and appropriate treatment sequencing in locally advanced breast cancer patients (98.4%) consistently reached minimum international standards. Rates of multidisciplinary team discussion (72.2%), radiotherapy (66.7%) and sentinel node biopsy (39.6%) showed wide cross-site variance. Histopathology reporting (62.0%), breast-conserving surgery (19.4%) and number of nodes excised with axillary dissection (47.3%) and sentinel node biopsy (82.7%) were consistently below minimum standards. Unit volumes were achieved consistently in Gauteng Province, but only for some years in KwaZulu-Natal Province; surgeon volumes were achieved across all units. HIV status did not affect adherence levels. Most quality indicators were well measurable, but data quality on reoperations and surgeon volumes was poor. Conclusion. We evaluated local quality indicators for an initial benchmark, and the most emergent gaps in care are the receipt of radiotherapy and underutilisation of sentinel node biopsy.

The challenge of calculating EUSOMA quality indicators with administrative data – A pilot study in Belgium

Introduction: The study aimed to assess the feasibility of calculating the European Society of Breast Cancer Specialists (EUSOMA) quality indicators (QIs) using Belgian cancer registry data coupled to administrative health data, and to provide national results. Methods: Women diagnosed with ductal carcinoma in situ (DCIS) or invasive breast cancer (IBC) in 2014-2018 were selected from the cancer registry. Fourteen EUSOMA QIs were chosen to assess the quality of care. Results: Overall, 46,035 patients with IBC and 3,973 patients with DCIS were included. Most QIs had to be rephrased so that they could be calculated with the available data. None of the selected QIs on systemic treatment could be calculated due to a lack of reliable receptor status information. For some QIs there is ample room for improvement in Belgian clinical practice: cTNM stage reporting, multidisciplinary team meetings, sentinel lymph-node biopsy only in IBC with clinically negative lymph nodes. The result was 1-5% lower than the target for mammography and breast ultrasound, pTNM reporting, start of treatment, single breast surgery in DCIS, and no axillary clearance in DCIS. For histological or cytological assessment, receptor status assessment, start of radiotherapy, and single breast surgery in IBC, the results were at or above the target. Conclusion: Several EUSOMA QIs can be calculated with routinely collected data, while for several important aspects of care additional data collection is indicated so that its quality can be assessed. The validity of the obtained results depends on the reporting accuracy.

Amelanotic Melanoma: Clinical Presentation, Diagnosis, and Management.

Amelanotic melanoma (AM) is a subtype of cutaneous melanoma with little or no pigment on visual or histopathologic examination and makes up approximately 2% of melanoma cases. This uncommon variant is often misdiagnosed or diagnosed in late stages due to its variable clinical presentation and lack of established criteria for clinical diagnosis. AM often presents nonspecifically as pink to red macule, papule, or dermal nodule, therefore, dermatoscopy and reflectance confocal microscopy (RCM) are extremely helpful tools in the diagnosis of AM. Histopathologically, there is an attenuation or complete absence of melanin granules, and immunohistochemistry for melanocytic markers, such as S100, Melan-A, HMB-45, may be necessary for accrate diagnosis. Like other types of melanomas, the Breslow depth, presence or absence of ulceration, and mitotic rate are necessary for diagnosis, staging, and management. The standard of treatment for AM includes surgical excision with margins based on staging with sentinel lymph node biopsy if indicated. We present the clinical and histopathological features, special techniques, differential diagnoses, and current management of amelanotic melanoma.

Recent advances of photodiagnosis and treatment for head and neck squamous cell carcinoma.

Head and neck squamous cell carcinoma (HNSCC) are the most common type of head and neck tumor that severely threatens human health due to its highly aggressive nature and susceptibility to distant metastasis. The diagnosis of HNSCC currently relies on biopsy and histopathological examination of suspicious lesions. However, the early mucosal changes are subtle and difficult to detect by conventional oral examination. As for treatment, surgery is still the primary treatment modality. Due to the complex anatomy and the lack of intraoperative modalities to accurately determine the incision margins, surgeons are in a dilemma between extensive tumor removal and improving the quality of patient survival. As more knowledge is gained about HNSCC, the increasing recognition of the value of optical imaging has been emphasized. Optical technology offers distinctive possibilities for early preoperative diagnosis, intraoperative real-time visualization of tumor margins, sentinel lymph node biopsies, phototherapy. Fluorescence imaging, narrow-band imaging, Raman spectroscopy, optical coherence tomography, hyperspectral imaging, and photoacoustic imaging have been reported for imaging HNSCC. This article provides a comprehensive overview of the fundamental principles and clinical applications of optical imaging in the diagnosis and treatment of HNSCC, focusing on identifying its strengths and limitations to facilitate advancements in this field.

Melanoma and Melanocytic Nevi in Pregnancy.

A changing melanocytic nevus during pregnancy should be biopsied promptly. For women with the dysplastic nevus syndrome, there may be more changes in nevi during pregnancy, requiring close monitoring. Melanoma is one of the most common malignancies that occurs during pregnancy. Those diagnosed with a localized melanoma before, during, or after pregnancy do not have an altered prognosis; however, a few studies have noted thicker melanomas and poorer prognosis when melanoma is diagnosed in the first year postpartum, possibly due to a delay in diagnosis. Although local excision of melanomas can be performed safely during pregnancy, sentinel lymph node biopsy during pregnancy is controversial for the timing and method. There are safe methods of imaging with some special precautions for staging in pregnant women. Systemic therapy requires an interdisciplinary team to assist in patient decision-making, because some of these agents are teratogenic. There is no reason to withhold combined estrogen-progestin oral contraceptives or menopausal hormone therapy in those with a prior diagnosis of melanoma, nor should future pregnancies be delayed in those diagnosed with localized melanoma. Only limited data are available concerning prognosis for women with a melanoma diagnosis after in vitro fertilization.

Clinical Utility of Sentinel Lymph Node Biopsy Using the Medical Imaging Projection System in Breast Cancer Patients, Including Those Following Neoadjuvant Chemotherapy.

The Medical Imaging Projection System (MIPS) is a real-time projection mapping system with a highly sensitive fluorescence sensing system. The aim of this study was to investigate the clinical utility of sentinel lymph node (SLN) biopsy using MIPS and radioisotopes (RI) in patients with breast cancer including those who had undergone neoadjuvant chemotherapy (NAC). This retrospective observational study included patients with breast cancer who underwent SLN biopsy using both MIPS and RI at Hyogo Medical University Hospital from August 2023 to August 2024. In all, 151 patients with breast cancer (157 axillary lesions, considering bilateral cancer as two lesions) were included in this study. MIPS identified significantly more SLNs than RI (median, 2 vs. 1, p<0.001). MIPS alone identified SLNs in 96.2% of lesions, and when combined with RI, identified SLNs in 99.4% of lesions, including in patients who had undergone NAC. Eleven of 157 lesions (7.0%) had positive SLNs, and the combination method identified positive nodes in 10 of these 11 lesions (90.9%). Importantly, all five lesions with metastases after NAC were observed in patients with cN1/ycN0 disease and the luminal subtype. MIPS combined with RI achieves a high identification rate of SLNs in patients with breast cancer, including those who had undergone NAC. Patients with cN1 disease prior to NAC should undergo axillary surgery tailored to their characteristics.

Robotic Surgery in Severely Obese Frail Patients for the Treatment of Atypical Endometrial Hyperplasia and Endometrial Cancer: A Propensity-Match Analysis at an ESGO-Accredited Center

Background and Objectives: Robotic-assisted laparoscopy (RS) has been widely adopted for the management of endometrial cancer (EC) due to favorable perioperative outcomes, especially in the context of obesity, which is an established risk factor for EC. This study retrospectively evaluated the perioperative outcomes of RS versus conventional laparoscopy (LS) in treating EC and atypical endometrial hyperplasia (AH). Methods: Between November 2021 and October 2023, 138 patients with AH or EC underwent surgery at the Clinic of Obstetric and Gynecological—Azienda Sanitaria Universitaria Friuli Centrale, Udine. All patients had total hysterectomy with bilateral salpingo-oophorectomy, with or without lymphadenectomy or sentinel lymph node biopsy. The study included 62 patients treated with LS and 62 with RS. Results: The median BMI was higher in the RS group (35.5 vs. 24 kg/m2, p = 0.001). There was no significant difference in operative time between the laparoscopic group and the robotic console time (median 130 vs. 130 min, p = 0.131). No significant differences were found in terms of blood loss, conversion to laparotomy, intraoperative complications, hospital stay, or early postoperative complications between the two groups. Conclusions: Our data confirm the feasibility of robotic surgery in obese patients, allowing surgical results comparable to those of laparoscopy in normal-weight patients.

Omitting elective neck dissection in cT1/2N0 oral squamous cell carcinoma with sentinel lymph node metastasis: A prospective study.

To examine the distribution of non-sentinel lymph nodes (SLNs) and to determine the feasibility of omitting elective neck dissection (END) in cases of cT1/2N0 oral cancer presenting with SLN metastasis. A prospective cohort of patients with cT1/2N0 oral cancer underwent SLN biopsy using a γ-probe alongside methylene blue staining, followed by subsequent END. The primary outcome variable was non-SLN metastasis, with its predictors evaluated through logistic regression analysis. A total of 200 patients with detectable SLNs were analyzed. Logistic regression revealed a significant odds ratio of 4.28 [95% confidence interval: 2.11-14.56] for predicting non-SLN metastasis when comparing a depth of invasion greater than 4.0mm to a DOI of 4.0mm or less. Among the six cases of non-SLN metastasis, three patients with negative SLN biopsy results exhibited metastasis; one was found in ipsilateral level V and two in contralateral level Ib. In contrast, all three patients with positive SLN biopsy results had a DOI surpassing 4.0mm, presenting with at least two positive SLNs. Non-SLN metastasis was detected in ipsilateral level III for one patient and at level IV for two others. END may be judiciously omitted in cases where only one positive SLN is identified in early-stage oral cancer with a depth of invasion of≤4.0mm.

Predictors of subclinical metastasis to non-sentinel lymph nodes for patients having clinically localized cutaneous melanoma

Introduction. The use of modern adjuvant drug therapy in cases of cutaneous melanoma with sentinel lymph node (LN) (SLN) metastases reduced frequency of performance of completing lymphadenectomy. However, until now, domestic and foreign clinical recommendations indicate possibility of using this procedure in patients with an unfavorable prognosis while criteria are not provided for assessing the risk of non-sentinel LN (NSLN) damage and the need to perform lymphadenectomy.Aim. To identify predictors of high risk of metastasis in NSLN in patients with cutaneous melanoma with subclinical metastases in SLN.Materials and methods. The study included 92 patients with clinically localized cutaneous melanoma (cT1–4N0M0), who showed subclinical lesions as a result of SLN biopsy, and therefore underwent a final lymphadenectomy.Results. In the examined group, 26 (28.3 %) patients, along with SLN lesions, showed metastases in NSLN. Recognition of several active LNs during radionuclide mapping of SLNs is associated with a significantly higher risk of NSLN damage – in 42.3 % vs 15.2 % in the group with radiopharmaceutical activity only in SLNs (p = 0.018). Tumors thickness of &gt;2 mm is also associated with a high frequency of NSLN metastasis (100 % of cases). No metastasis to other LNs was observed in tumor thickness of &lt;2 mm. In ulcerated melanomas, the incidence of NSLN lesions was 92.3 % (p = 0.02). Only subcapsular localization of SLN metastases is associated with a relatively low incidence of NSLN metastasis (13.3 % of cases) as compared with parenchymal, mixed localization, and multifocal lesion (42.9 % of cases) (p = 0.002). For SLN metastases &gt; 4 mm in size, a incidence of NSLN damage was higher than for metastases of &lt;4 mm in size (43.3% vs 19.3%; p &lt;0.05), as that for invasion of LN structures of &gt; 2 mm in size versus invasion of &lt;2 mm in size (44.4% vs 15.7 %; p = 0,003). The identified predictors of NSLN involvement in practice are often combined forming a pattern of predictors. The number of prognostic parameters in the pattern has a significant effect on the incidence of NSLN lesions (&lt;0.001). In particular, the presence of 2 or less predictors is associated with low risk of metastasis in NSLN (0–12.5 % of cases), 3-5 predictors - with a relatively high risk (37.5–44.4 % of cases), 6 predictors – with a very high risk (80 % of cases).Conclusion. Recognition of predictors of metastasis in NSLN and their number allows us to decide on the need to perform final lymphadenectomy in patients with cutaneous melanoma with subclinical metastases in SLN. Conducting the final lymphadenectomy in patients with a high risk of multiple lesions of regional LNs will provide better locoregional control over stage III cutaneous melanoma and will create optimal conditions for adjuvant drug therapy.

Single breast incision for breast conservation surgery and sentinel lymph node biopsy: a systematic review.

Breast conservation surgery and sentinel lymph node biopsy via a single incision allows excision of tumours from all quadrants of the breast, with access to both axillary and internal mammary nodal basins with no additional incisions. This systematic review aims to consolidate the current literature on the efficacy, safety, functional and cosmetic outcomes of single-incision breast conserving surgery and sentinel lymph node biopsy. A comprehensive search of Pubmed, EMBASE, Medline and GoogleScholar was conducted from inception to 7th July 2024 for all peer-reviewed articles assessing breast conserving surgery and sentinel lymph node biopsy via single incision using PRISMA guidelines. The literature search generated 426 articles. 400 were excluded by abstract review with the remaining 26 articles reviewed in full. An additional three articles were retrieved from review of full article reference lists. 13 articles were excluded, leaving 10 articles meeting the inclusion criteria. The technique demonstrated success across all quadrants of the breast. Eight studies documented successful axillary dissection completed via a single incision. Four studies compared the single-incision approach to the conventional two-incision technique. There was no difference in complication rates. The single-incision technique was associated with higher patient satisfaction and reduced post-operative axillary pain. Single-incision breast conservation surgery and sentinel lymph node biopsy is surgically safe and can be feasible for tumours in all quadrants of the breast and is associated with improvement in cosmesis, pain and patient satisfaction. Further studies are required to confirm its long-term oncological safety.

Discussion of Predictors of Sentinel Lymph Node Biopsy in Thin Melanoma: Understanding the Impact of the American Joint Commission on Cancer 8th Edition Staging System.

Discussion of Predictors of Sentinel Lymph Node Biopsy in Thin Melanoma: Understanding the Impact of the American Joint Commission on Cancer 8th Edition Staging System.

Performance of sentinel lymph node biopsy after neoadjuvant chemotherapy in clinically node positive breast cancer patients: systematic review and meta-analysis.

The reliability of sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NACT) in patients with initially node-positive breast cancer is still controversial. This meta-analysis is conducted to investigate the feasibility and accuracy of SLNB after NACT in patients with initially positive axillary nodes. We conducted a literature search using Medline, PubMed, Embase, Central, and SCOPUS up until April 2021 for studies on the performance of SLNB following NACT. We included prospective studies including breast cancer patients with positive lymph nodes at diagnosis and received NACT before undergoing SLNB irrespective of their molecular subtypes or stage. Our main outcomes of interest were the identification rate (IR) and the false negative rate (FNR) of SLNB. We included an aggregate of 33 studies in this meta-analysis enrolling 4,624 patients. The reported IR ranged from a minimum of 77.6% to a maximum of 100% and resulted in a pooled IR of 88% (95%CI: 86-90, I2:80.9%). The FNR reported in the studies ranged from a minimum of 5.1% to a maximum of 43% and showed a pooled FNR of 13% (95% CI: 11-15, I2: 72.31%). The subgroup analysis demonstrated that the usage of dual mapping technique could decrease the FNR and increase the IR. Moreover, the number of lymph nodes retrieved inversely correlated with FNR (p<0.01). Our findings support the feasibility and accuracy of SLNB after NACT in initially node-positive breast cancer patients, that converted to clinically node negative when performed in properly selected cases. SLNB offers a less invasive approach in selected patients sparing them the morbidity associated with ALND. This approach aligns with efforts to de-escalate surgical management in breast cancer and reinforces that SLNB post-NACT should be incorporated into clinical practice, provided that stringent patient selection and procedural standards are maintained.

Is the Pressure from Blue Dye Cervical Injection Associated with Sentinel Lymph Node Detection in Laparoscopic Surgery for Endometrial Cancer?

Abstract Introduction Sentinel lymph node biopsy (SLNB) has been proven to be a safe procedure in the treatment of endometrial cancer, and the instillment of a dye/marker in the cervix is the most used technique. Various studies have correlated the body mass index (BMI) impact as well as menopausal status and staging with the rate of lymph node detection, but few studies have evaluated if the high density of the cervix decreases detection. Objective To quantify the injection pressure of the marker in the uterine cervix and to correlate it with the sentinel lymph node detection rate in endometrial neoplasia. Materials and Methods Patients with endometrial cancer with programmed laparoscopic SLNB were selected to have the cervical injection pressure assessed. Immediately following the extraction of the uterus, saline solution was reapplied to measure injection pressure with a device attached to the syringe. We investigated the possible correlation of injection pressure with lymph node detection rate and the clinical data of the patients. Results A total of 18 women participated in the study; a correlation between injection pressure and lymph node detection rate was not identified, neither was greater injection pressure detected in smaller uteruses or cervices. The pressure of the deep injection is greater than that of the superficial one, but the more medial application, or more lateral in relation to the midpoint, does not alter the injection pressure. Conclusion The presence of greater resistance in the instillment of stain into the cervix was not associated with a lower lymph node detection rate.

Clinical impact of the Z0011 trial on axillary surgical management in Australia and New Zealand from the BreastSurgANZ Quality Audit.

The clinical management of the axilla in early breast cancer has changed since the Z0011 trial, which showed that axillary lymph node dissection (ALND) is not necessary in select patients with a positive sentinel lymph node biopsy (SLNB). Studies have shown a significant decrease in the rates of completion ALND (cALND) since Z0011. The aims of this study were to investigate the effect of the Z0011 trial on the management of positive axillary sentinel nodes and the trends in axillary surgical management since 2005 in Australia and New Zealand. This study utilized prospectively maintained data from the BreastSurgANZ Quality Audit (BQA). Patients with early breast cancer between 2005 and 2023 satisfying the Z0011 trial inclusion criteria undergoing SLNB or SLNB followed by cALND were identified. There were 91 196 patients who underwent breast-conserving surgery and SLNB of which 12 035 were node positive therefore satisfying the Z0011 trial inclusion criteria, of which 8194 (68.1%) received SLNB only with no cALND. There has been a 55.4% reduction in the rate of cALND after 2010 when the Z0011 trial was published (P < 0.001). There was a significant downward trend in the number of cALND performed per year (R2 = 0.890, P < 0.001). The Z0011 trial was a practice changing trial and since its publication in 2010 has been correlated with de-escalation in surgical management of the axilla and decline in the rates of cALND in Australia and New Zealand.

Evaluating Postoperative Morbidity and Outcomes of Robotic-Assisted Esophagectomy in Esophageal Cancer Treatment—A Comprehensive Review on Behalf of TROGSS (The Robotic Global Surgical Society) and EFISDS (European Federation International Society for Digestive Surgery) Joint Working Group

Background: Esophageal cancer, the seventh most common malignancy globally, requires esophagectomy for curative treatment. However, esophagectomy is associated with high postoperative morbidity and mortality, highlighting the need for minimally invasive approaches. Robotic-assisted surgery has emerged as a promising alternative to traditional open and minimally invasive esophagectomy (MIE), offering potential benefits in improving clinical and oncological outcomes. This review aims to assess the postoperative morbidity and outcomes of robotic surgery. Methods: A comprehensive review of the current literature was conducted, focusing on studies evaluating the role of robotic-assisted surgery in esophagectomy. Data were synthesized on the clinical outcomes, including postoperative complications, survival rates, and recovery time, as well as technological advancements in robotic surgery platforms. Studies comparing robotic-assisted esophagectomy with traditional approaches were analyzed to determine the potential advantages of robotic systems in improving surgical precision and patient outcomes. Results: Robotic-assisted esophagectomy (RAMIE) has shown significant improvements in clinical outcomes compared to open surgery and MIE, including reduced postoperative pain, less blood loss, and faster recovery. RAMIE offers enhanced thoracic access, with fewer complications than thoracotomy. The RACE technique has improved patient recovery and reduced morbidity. Fluorescence-guided technologies, including near-infrared fluorescence (NIRF), have proven valuable for sentinel node biopsy, lymphatic mapping, and angiography, helping identify critical structures and minimizing complications like anastomotic leakage and chylothorax. Despite these benefits, challenges such as the high cost of robotic systems and limited long-term data hinder broader adoption. Hybrid approaches, combining robotic and open techniques, remain common in clinical practice. Conclusions: Robotic-assisted esophagectomy offers promising advantages, including enhanced precision, reduced complications, and faster recovery, but challenges related to cost, accessibility, and evidence gaps must be addressed. The hybrid approach remains a valuable option in select clinical scenarios. Continued research, including large-scale randomized controlled trials, is necessary to further establish the role of robotic surgery as the standard treatment for resectable esophageal cancer.

Epidemio-Clinical Profile and Management of Carcinoma in Situ of the Breast in the Department of Obstetrics and Gynecology II of the CHU HASSAN II of Fès: 2000-2024

Breast cancer is the most common cancer in women and is, therefore, a major public health problem. Among the different types of breast cancer, breast carcinoma in situ occupies a special place because of its pre-invasive nature. Ductal carcinoma in situ (DCIS) accounts for 85% to 90% of in situ breast cancers. Their incidence is increasing as a result of widespread screening. Lobular carcinoma in situ remains a rare lesion and is considered to be a cancer risk factor. Diagnosis of this cancer is quite difficult, and treatment is team-dependent, ranging from conservative treatment to mastectomy. The aim of our study was to describe the epidemiological and clinical characteristics of patients with carcinoma in situ isolated within the gyneco-obstetrics II department in Fez, as well as the therapeutic modalities. 19 patients were included; the mean age of our patients was 56 years, with extremes ranging from 34 to 88 years. The average consultation time was seven months; the mode of discovery was dominated by the discovery of a nodule on a breast self-exam in 13 patients (72%), followed by a pathological nipple discharge in 5 and a combination of two in one patient. The average tumor size was 3 cm, with extremes ranging from 1 cm to 5 cm. Combined screening with mammography and breast ultrasound was carried out in all our patients (100%), supplemented by MRI in 4 patients (high breast density) with a view to conservative treatment. Histology was dominated by ductal carcinoma in 17 patients (92%). The surgical procedure was conservative in 5 patients (28%) and radical in 13 (72%). 3 out of the 5 patients who had undergone conservative surgery underwent revision surgery (mastectomy) due to positive surgical margins (60%). 11 (61%) patients benefited from an axillary procedure essentially by sentinel lymph node biopsy which was negative (100%).

Predictors of Sentinel Lymph Node Biopsy in Thin Melanoma: Understanding the Impact of the American Joint Commission on Cancer 8th Edition Staging System.

The definition of T1b cutaneous melanoma was changed in the 8th edition of the AJCC staging system based on survival differences but not risk of sentinel lymph node (SLN) metastases. We sought to evaluate changes in SLN biopsy (SLNB) use and rates of positive SLNB in response to updated staging criteria, and to evaluate the incidence of high-risk features in T1a melanoma in whom SLNB is now recommended. The 2021 National Cancer Database Melanoma PUF was used to obtain SLNB utilization and positivity rates in T1 (thin) melanoma (thickness ≤1.0mm) from 2012 to 2021. Rates were compared between AJCC 7th (2012-2017) and 8th editions (2018-2021). Factors associated with SLNB use in non-ulcerated T1 melanoma were evaluated. The presence of high-risk feature in T1a melanoma were identified and SLN positivity rates were reviewed. A total of 136,966 cases were included with 76,485 (55.8%) cases diagnosed under the AJCC 7th edition era (2021-2017). The overall proportion of patients with thin melanoma undergoing SLNB was relatively stable over the time periods, roughly 30%. In the AJCC 8th edition era, the overall SLNB positivity rate slightly increased from 4.5% to 6.6% (p < 0.001). There was increased SLNB use in melanoma with a thickness of 0.8 to 1.0mm (T1b: OR 2.53 [95% CI 2.31-2.78]) and decreased use when thickness was less than 0.8mm (T1a: OR 0.80 [0.76-0.85]). Rates of SLNB positivity increased in both thickness groups over time. After implementation of the AJCC 8th edition staging criteria, surgeons have become more selective in SLNB use with a resulting increase in SLNB positivity rate. Fewer SLNBs in T1a and more SLNBs in non-ulcerated T1b are being performed.

Photoacoustic Imaging with Attention-Guided Deep Learning for Predicting Axillary Lymph Node Status in Breast Cancer.

Preoperative assessment of axillary lymph node (ALN) status is essential for breast cancer management. This study explores the use of photoacoustic (PA) imaging combined with attention-guided deep learning (DL) for precise prediction of ALN status. This retrospective study included patients with histologically confirmed early-stage breast cancer from 2022 to 2024, randomly divided (8:2) into training and test cohorts. All patients underwent preoperative dual modal photoacoustic-ultrasound (PA-US) examination, were treated with surgery and sentinel lymph node biopsy or ALN dissection, and were pathologically examined to determine the ALN status. Attention-guided DL model was developed using PA-US images to predict ALN status. A clinical model, constructed via multivariate logistic regression, served as the baseline for comparison. Subsequently, a nomogram incorporating the DL model and independent clinical parameters was developed. The performance of the models was evaluated through discrimination, calibration, and clinical applicability. A total of 324 patients (mean age ± standard deviation, 51.0 ± 10.9 years) were included in the study and were divided into a development cohort (n = 259 [79.9%]) and a test cohort (n = 65 [20.1%]). The clinical model incorporating three independent clinical parameters yielded an area under the curve (AUC) of 0.775 (95% confidence interval [CI], 0.711-0.829) in the training cohort and 0.783 (95% CI, 0.654-0.897) in the test cohort for predicting ALN status. In comparison, the nomogram showed superior predictive performance, with an AUC of 0.906 (95% CI, 0.867-0.940) in the training cohort and 0.868 (95% CI, 0.769-0.954) in the test cohort. Decision curve analysis further confirmed the nomogram's clinical applicability, demonstrating a better net benefit across relevant threshold probabilities. This study highlights the effectiveness of attention-guided PA imaging in breast cancer patients, providing novel nomograms for individualized clinical decision-making in predicting ALN node status.