Identify Sentinel Lymph Nodes Research Articles

Sentinel Lymph Node Biopsy (SLNB) for Early-Stage Head and Neck Squamous-Cell Carcinoma of the Tongue: Twenty Years of Experience at I.N.T. "G.Pascale".

Oral tongue squamous-cell carcinoma (OTSCC) is the most prevalent malignancy in the head and neck region. Lymphatic spread, particularly to cervical lymph nodes, significantly impacts 5-year survival rates, emphasizing the criticality of precise staging. Metastatic cervical lymph nodes can decrease survival rates by 50%. Yet, elective neck dissection (END) in T1-2 cN0 patients proves to be an overtreatment in around 80% of cases. To address this, sentinel lymph node biopsy (SLNB) was introduced, aiming to minimize postoperative morbidity. This study, conducted at the ENT and Maxillofacial Surgery department of the Istituto Nazionale Tumori in Naples, explores SLNB's efficacy in early-stage oral tongue squamous-cell carcinoma (OTSCC). From January 2020 to January 2022, 122 T1/T2 cN0 HNSCC patients were enrolled. Radioactive tracers and lymphoscintigraphy identified sentinel lymph nodes, aided by a gamma probe during surgery. Results revealed 24.6% SLN biopsy positivity, with 169 SLNs resected and a 21.9% positivity ratio. The study suggests SLNB's reliability for T1-2 cN0 OTSCC patient staging and early micrometastasis detection.

Utility of Indocyanine Green for Sentinel Lymph Node Biopsy in Pediatric Sarcoma and Melanoma

BackgroundIndocyanine green (ICG) is a fluorescent dye with increasing use for adult sentinel lymph node biopsy (SLNB). The utility of ICG in pediatric oncology remains understudied. We aim to describe our experience using ICG for SLNB in pediatrics versus standard blue dye. MethodsA retrospective review of pediatric patients with melanoma or sarcoma who underwent SLNB with technetium plus ICG or blue dye from 2014 to 2023 at a large academic children's hospital was conducted. ResultsTwenty-four patients were included; 58.3% were male with median age 13 years (range 4–21 years). The majority had a melanocytic tumor (91.7%) and 8.3% had sarcoma. All patients received technetium with concomitant blue dye (62.5%) or ICG (37.5%). ICG more reliably identified radioactive SLNs, compared to blue dye (mean 100% vs 78.3 ± 8.3%, p = 0.03). There was no significant difference in median operative time (ICG 82 min [68–203] vs blue dye 93 min [78–105], p = 0.84). Seven patients had positive SLNs (29.2%), with recurrence in 2 patients (8.3%) and 1 death (4.2%). There were no adverse events. ConclusionICG-directed SLNB in children is a safe and effective alternative to blue dye. Use of ICG did not add to operative time, and more often identified sentinel nodes versus blue dye. Type of StudyOriginal Research Article, Retrospective Comparative Study. Level of EvidenceIII.

SENTINEL LYMPH NODE BIOPSY IN THE MANAGEMENT OF PATIENTS WITH MALIGNANT MELANOMA

Objectives: To evaluate the efficacy of sentinel lymph node biopsy in the treatment of malignant melanoma. Materials and Methods: Thirty-two melanoma patients without distant or clinical lymph node metastasis underwent preoperative lymphoscintigraphy using Tc99m and a handheld gamma probe to identify sentinel lymph nodes for biopsy. In cases with detected sentinel lymph node metastasis, the patient may require total complete lymph node dissection, combined with optional systemic therapy. Follow-up was performed to evaluate the efficacy of this procedure. Results: In 32 melanoma patients, the most common site of primary tumors was the extremity, accounting for 90.6%, with a mean Breslow index (thickness of the primary tumor) of 1.84 mm. The incidence of microscopic lymph node metastasis was 34.4%. For cases with no detected sentinel lymph node metastasis, 100% of patients had a stable condition, and no recurrence or metastasis was detected. In 11 cases with occult nodal metastasis: 2 deaths, 4 patients were treated with chemotherapy, and 5 cases without chemotherapy. The mean duration of hospitalization for the group with sentinel lymph node metastasis was greater than that of the group without sentinel lymph node metastasis, 25.1 ± 3.1 days and 13.5 ± 1.3 days, respectively. Conclusion: Our results suggest that sentinel lymph node biopsy is a less invasive technique for melanoma patients with no clinically detectable lymph node and distant metastases. This procedure has shown initial outcomes, but it is necessary to conduct a study with a larger sample size and a longer follow-up time, as well as comparing it with a control group for accurate evaluation. Received 23 June 2023Revised 22 September 2023Accepted 27 November 2023

Canine preclinical safety evaluation of a multimodal nanoparticle agent (Nanotrast-CF800) for image-guided cancer surgery.

Surgical oncology often requires the use of contrast-enhanced cross-sectional imaging preoperatively to characterize solitary tumours and identify sentinel lymph nodes. Intraoperative optical guidance can effectively aid tissue-sparing tumour excision and locate sentinel lymph nodes. Nanotrast-CF800 (CF800) is a novel dual-modality contrast agent, which co-encapsulates iohexol and indocyanine green (ICG) within a liposomal nanoparticle. It was developed for preoperative and intraoperative imaging of solitary tumours and sentinel lymph node mapping and its efficacy has been demonstrated in preclinical animal models (Zheng et al. 2015). The objective of this study is to evaluate the safety profile of CF800 following intravenous administration in healthy dogs. Six research dogs were randomized into two groups. Group 1 received a low dose (1 mL/kg) and group 2 received a high dose (5 mL/kg). Dogs were placed under general anesthesia and a continuous rate infusion of CF800 was administered based on group allocation. Physiologic parameters including heart rate, respiratory rate, direct arterial blood pressure, cardiac output, and temperature were measured at set time points. Plasma concentrations of iohexol, ICG, and histamine were measured at set time points. Dogs underwent whole body computed tomography scans pre-injection, 2-, and 7-days post-injection (p.i.). Contrast enhancement was measured in select organ systems and great vessels at each time point. There were no significant changes in physiologic parameters following IV infusion of CF800 in all dogs. Plasma iohexol and ICG concentrations peaked at 1 day p.i., while histamine concentrations peaked at 30 minutes p.i. Significant contrast enhancement was noted within the liver, heart, aorta, and caudal vena cava on day 2 p.i., which was significantly different compared to baseline. Prolonged contrast retention within the liver was identified. Intravenous administration of CF800 was safe to use in healthy dogs with no significant systemic adverse effects.

Indocyanine green fluorescence imaging: an effective method to find inguinal sentinel lymph node in a case of vulvar carcinoma.

The aim was to demonstrate that the technique of near infrared range/indocyanine green (NIR/ICG) could aid the detection of inguinal sentinel lymph nodes in patients with vulvar cancer, in addition to technetium-99m (Tc-99m) scanning. We present a case report of sentinel lymph node detection in a patient with vulvar cancer with two methods: Tc-99m scan and NIR/ICG. The video showed that bilateral inguinal lymph nodes were detected both by Tc gamma probe and NIR/ICG. NIR/ICG may be a safe and effective alternative method for identifying sentinel lymph nodes in cases of early-stage vulvar cancer, although more evidence is required.

Variability of Sentinel Lymph Node Location in Patients with Trunk Melanoma.

(1) Background: Melanoma is one of the most aggressive types of neoplasia, and the management of this pathology requires a correct staging, as well as a personalized modern oncological treatment. The main objective of the study is to determine the variability of the lymphatic drainage for patients with melanomas located on the trunk and, secondarily, to determine the features of individuals who underwent sentinel lymph node biopsy (SLNB) depending on the exact location on the trunk. (2) Methods: This retrospective, observational, single-center study included 62 cases of trunk melanoma operated between July 2019 and March 2023, in which SLNB was performed and a total of 84 lymph nodes were excised. (3) Results: Patients had a median age of 54.5 (33-78) years, with 58.1% being male; the melanomas had a median Breslow index of 2.3 (0.5-12.5) mm. Approximately 64.3% of the cohort had melanoma on the upper part of the trunk (54 cases) and 35.7% had it on the lower part (30 cases). The type of anesthesia chosen was general anesthesia in 53 cases and spinal anesthesia in 9 cases (85.5% vs. 14.5%, p < 0.001). The number of sentinel lymph nodes excised was 54 for melanomas located on the upper part of the trunk (8 cervical and 46 axillary) and 30 sentinel lymph nodes for melanomas of the lower part of the trunk (16 at the axillary level and 14 at the inguinal level). Out of the 54 LNs identified in patients with melanoma on the upper part of the trunk, 13 were positive, with a total of 12 positive lymph nodes (LNs) from the axillar basin, and only one from the cervical region. Additionally, the incidence of patients with a minimum of two identified sentinel lymph nodes was 32.2%, with a total of seven having LN involvement in two basins, and only one of these cases showed positivity for malignancy. (4) Conclusions: SLNBs were more frequent in the axillary region overall, and had more positive SLNs. Moreover, melanoma on the upper part of the trunk had a higher rate of positive SLNs compared to the lower part. Tumors located on the lower part of the truck had more positive SLNs in the axillary region than in the inguinal one.

Indocyanine green and near-infrared fluorescence imaging in minimally invasive gastric cancer surgery: a narrative review

Background: The popularity of minimally invasive surgery for gastric cancer has been on the rise due to its advantages in faster recovery and improved outcomes. However, the lack of tactile sensation poses challenges for tumor identification and anatomical recognition. Indocyanine green (ICG) with near-infrared (NIR) fluorescence imaging has emerged as a potential solution to address these challenges. This review summarizes the current status, limitations, and future prospects of ICG and NIR fluorescence imaging in minimally invasive surgery for gastric cancer. Search strategy: This narrative review searched the PubMed database for relevant articles related to ICG and NIR fluorescence imaging in minimally invasive gastric cancer surgery, published through 2023. The search criteria comprised “indocyanine green”, “ICG”, “near-infrared fluorescence imaging”, “gastric cancer”, “gastrectomy”, and “minimally invasive surgery”. Findings: ICG with NIR fluorescence imaging offers three main applications in gastric cancer surgery. Firstly, it aids in real-time intraoperative tumor identification when injected locally around the tumor, surpassing traditional tattooing techniques. Secondly, ICG facilitates lymph node mapping, particularly in identifying sentinel lymph nodes, which could reduce unnecessary lymphadenectomy. Thirdly, ICG angiography enables the assessment of blood perfusion during reconstructive surgery, evaluating anastomosis sites and potentially reducing anastomotic leakage risk. Conclusions: ICG and NIR fluorescence imaging have shown promising advancements in enhancing the precision and safety of minimally invasive gastric cancer surgery. However, standardized analysis methods and further prospective studies are needed to fully establish their clinical significance. Overall, ICG and NIR fluorescence imaging hold potential as valuable tools to improve patient outcomes in minimally invasive gastric cancer surgery.

Investigating a Technologist-Driven Injection Technique in Lymphoscintigraphy at a Single Rural Center: A Retrospective Audit.

Our aim was to investigate the effectiveness of the technologist-driven injection technique of lymphoscintigraphy used at a rural hospital in Australia to identify the correct lymph node for sentinel lymph node biopsy (SLNB) in early-stage breast cancer patients. Methods: A retrospective audit was conducted using imaging and medical record data from 145 eligible patients who underwent preoperative lymphoscintigraphy for SLNB at a single center throughout 2013 and 2014. The lymphoscintigraphy technique included a single periareolar injection with subsequent dynamic and static images as required. Descriptive statistics, sentinel node identification rates, and imaging-surgery concordance rates were generated from the data. Additionally, χ2 analysis was used to examine the relationships between age, previous surgical intervention, and injection site and time until a sentinel node is visualized. The technique and statistical results were directly compared against multiple similar studies in the literature. Results: The sentinel node identification rate was 99.3%, and the imaging-surgery concordance rate was 97.2%. The identification rate was significantly higher than those of similar studies in the literature, and concordance rates were similar across studies. The findings demonstrated that age (P = 0.508) and previous surgical intervention (P = 0.966) did not influence the time it takes to visualize a sentinel node. Injection site did appear to have a statistically significant effect (P = 0.001), with injections in the upper outer quadrant correlating with increased times between injection and visualization. Conclusion: The reported lymphoscintigraphy technique for identifying sentinel lymph nodes for SLNB in early-stage breast cancer patients can be justified as an accurate and effective method that is time-sensitive and has outcomes comparable to those of successful studies in the literature.

Determination of sentinel lymph nodes in gynecological cancer using the radiopharmaceutical Sentiscan. A case series

Background. Lymphadenectomy in patients with malignant female genital neoplasms is a necessary step of surgical treatment, the implementation of which allows assessing the the metastatic involvement of the removed lymph nodes and determining indications for postoperative treatment. Sentinel lymph node (SLN) biopsy with ultrastaging method appears to be a good alternative to standard regional lymph node removal with similar long-term oncologic outcomes and significantly lower rates of postoperative complications.&#x0D; Aim. To present the possibility of using a domestic radiopharmaceutical labeled with technetium-99m (Sentiscan) in patients with gynecological cancer.&#x0D; Materials and methods. A series of clinical cases of the use of Sentiscan during SLN biopsy in three patients suffering from cancer of the uterus and vulva is presented.&#x0D; Results. 1824 hours before the operation, 0.4 ml of the prepared solution of radiopharmaceutical 99mTc-Sentiscan with a total activity of 150 MBq was injected into the cervix of the uterus with tumors of the uterine body and into the vulva. After 2 hours, SPECT/CT was performed on the Discovery 670 DR (GE) of the abdomen and pelvis, followed by 3D reconstruction of images for better intraoperative navigation. Intraoperatively, a portable gamma detector Rad Pointer Gamma (Medikor Pharma Ural) was used to identify sentinel lymph nodes. Sentinel lymph nodes were removed in all patients, followed by a control assessment of the gamma radiation level, histological and immunohistochemical studies using panCK, CK18 markers.&#x0D; Conclusion. Presented clinical cases demonstrated high efficacy of sentinel lymph node mapping using radiopharmaceutical Sentiscan. Further studies are necessary for wide implementation of this technology in clinical practice.

Biomimetic Fe-Cu Dual-atomic-site catalysts enable efficient H2O2 activation for tumor lymphatic metastasis inhibition

Achieving efficient activation of H2O2 in the tumor microenvironment (TME) and further improving the therapeutic efficiency is a great challenge in chemodynamic therapy against cancer. Herein, inspired by natural enzymes, atomically dispersed catalysts with Fe-Cu hetero-binuclear active sites on hollow nitrogen-doped carbon nanospheres (FeCuNC) are synthesized as catalytic nanomedicines for cancer therapy. We found that Fe-Cu hetero-binuclear sites in FeCuNC can catalytically dissociate the O–O bonds in H2O2 molecules more easily than those of single-Fe sites. Besides, the intrinsic photothermal effect of FeCuNC not only further accelerates H2O2 decomposition to produce abundant reactive oxygen species but also achieves synergistically chemodynamic therapy and photothermal therapy to induce cancer cell apoptosis and restrain tumor growth. Moreover, FeCuNC can accurately identify sentinel lymph node metastasis and effectively suppress tumor metastasis and recurrence. This work will provide an advanced strategy for the design of advanced catalysts for H2O2 activation in TME, which holds great promise for practical clinical applications.

Safety and Efficacy of Mitoxantrone Hydrochloride Injection for Identification of Axillary Sentinel Lymph Nodes in Patients with Primary Breast Cancer.

The dual technique using blue dye in combination with a radioisotope is considered the gold standard for identifying sentinel lymph nodes (SLNs) in patients with breast cancer. Unfortunately, not all cancer centres have access to radioactive material, which jeopardizes the SLN identification rate and patient safety. We aimed to assess the safety and efficacy of mitoxantrone hydrochloride injection (MHI) for identifying axillary SLNs in patients with primary breast cancer. We have conducted a prospective non-randomized analysis of patients diagnosed with invasive breast cancer who agreed to participate in the study between December 2019 and December 2022. We have used the patient's medical records to collect the data. We have used the SLN intraoperative identification rate as a marker for the efficacy of the technique and both the immediate and delayed complication rates and routine blood tests as markers for the safety of the technique. Out of the 296 patients, 289 (97.6%) had their SLNs identified using MHI, while seven patients (2.3%) had four-node sampling carried out because the SLNs were not identified. Liver functions were not significantly affected by MHI, and there was no technique-related readmission or reported morbidity or mortality. We have found that the MHI technique is still inferior to the combined radioactive directed technique and patent blue V dye in SLN identification. Yet, it may serve as a safe and reliable alternative in cases where the radioactive technique is unavailable.

Intraoperative ICG-Fluorescence Imaging of Lymph Nodes in Robot-Assisted Radical Cystectomy in Patients with Bladder Cancer

Introduction. Bladder cancer dominates among global health problems. Radical cystectomy is the recognized standard of care for muscle-invasive bladder cancer with bilateral pelvic lymphadenectomy as a mandatory step in the surgical procedure. The concept of sentinel lymph nodes, acting as a barrier to the spread of malignant process, can be beneficial in terms of reducing the extent of pelvic lymphadenectomy. Intraoperative imaging using indocyanine green now appears to be a contemporary and relevant method for intraoperative imaging of sentinel lymph nodes. Materials and methods. A study involving 28 patients diagnosed with bladder cancer was carried out at the clinic of the Bashkir State Medical University. All patients underwent robot-assisted radical cystectomy with intracorporeal formation of a heterotopic neobladder using Bricker technique. At the stage of pelvic lymphadenectomy, the isolated lymph nodes were evaluated and intraoperative ICG-fluorescence was performed. All lymph nodes obtained were examined microscopically and the results were interpreted taking into account the intraoperative diagnosis. Results and discussion. Intraoperative ICG fluorescence identified sentinel lymph nodes in 7 of 9 patients (77.8%, p &lt; 0.05), with sensitivity equal to 77.8%, p &lt; 0.05 and specificity — 87.5%, p &lt; 0.05. Conclusion. The results proved a high reliability of the method of intraoperative lymph nodes imaging with indocyanine green in patients with muscle-invasive bladder cancer. Fluorescence navigation in cancer surgery opens up new opportunities for improving perioperative outcomes and reducing complications.

Abstract P5-01-09: Evaluation of the efficacy of using fluorescence-associated indocyanine green in sentinel lymph node biopsies from breast cancer patients

Abstract Introduction: Sentinel lymph node biopsy is the technique of choice for axillary staging in patients with breast cancer. Although it is already a widespread technique, its history is relatively recent. Three techniques are globally used to detect sentinel lymph nodes: the patent blue, described by Giuliano et al. (1994); the technetium-99 radiopharmaceutical with gamma probe, published by Krag et al. (1993); and the combination of these two techniques. Objective: This study aims to evaluate sentinel lymph node detection rate using the innovative fluorescence-associated indocyanine green technique in breast cancer patients, and to compare it with that of patent blue and with a combination of the two dyes. Method: A randomized trial was conducted on 99 patients who were equally divided into three arms, each one undergoing sentinel lymph node detection using either patent blue, indocyanine green, or a combination of the two dyes. The study was conducted at Hospital de Esperança, Presidente Prudente, SP, Brazil, in partnership with the Breast Department of Paulista School of Medicine, Federal University of São Paulo. Results: The accuracy rate in identifying sentinel lymph nodes was 78.8% with patent blue, 93.9% with indocyanine green, and 100% with patent blue + indocyanine green. Two sentinel nodes (48.5%) were mostly identified in the combined group; however, only one sentinel node was identified in the other groups. The mean time for sentinel lymph node identification was 20.6 minutes with the traditional dye, 8.6 minutes with indocyanine green, and 10 minutes with the combination of the two methods (p &amp;lt; 0.001). The mean surgical time was 69.4 minutes with patent blue, 55.1 minutes with indocyanine green, and 69.4 minutes with their combination (p &amp;lt; 0.001). Conclusion: Sentinel lymph node detection rate by fluorescence-associated indocyanine green was considered effective. The comparison of sentinel lymph node detection rates between patent blue, indocyanine green, and a combination of patent blue + indocyanine green revealed statistically significant differences (p = 0.030), with the combined method being the most effective. Keywords: breast neoplasm, sentinel lymph node biopsy, fluorescence, indocyanine green Citation Format: Rafael Sá, Afonso Nazário, Vanessa M. Sanvido, Roberto Giordano, Raquel Rodrigues, Luiz Bugalho, Suelen Silva. Evaluation of the efficacy of using fluorescence-associated indocyanine green in sentinel lymph node biopsies from breast cancer patients [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-01-09.

Sentinel Lymph Node Identification in Patients With Breast Cancer Using Lymphosonography.

The objective of the work described here was to evaluate the efficacy of lymphosonography in identifying sentinel lymph nodes (SLNs) in patients with breast cancer undergoing surgical excision. Of the 86 individuals enrolled, 79 completed this institutional review board-approved study. Participants received subcutaneous 1.0-mL injections of ultrasound contrast agent (UCA) around the tumor. An ultrasound scanner with contrast-enhanced ultrasound (CEUS) capabilities was used to identify SLNs. Participants were administered with blue dye and radioactive tracer to guide SLN excision as standard-of-care. Excised SLNs were classified as positive or negative for the presence of blue dye, radioactive tracer and UCA, and sent for pathology. Two hundred fifty-two SLNs were excised; 158 were positive for blue dye, 222 were positive for radioactive tracer and 223 were positive for UCA. Comparison with blue dye revealed accuracies of 96.2% for radioactive tracer and 99.4% for lymphosonography (p > 0.15). Relative to radioactive tracer, blue dye had an accuracy of 68.5%, and lymphosonography achieved 86.5% (p < 0.0001). Of 252 SLNs excised, 34 were determined to be malignant by pathology; 18 were positive for blue dye (detection rate=53%), 23 for radioactive tracer (detection rate=68%) and 34 for UCA (detection rate=100%) (p < 0.0001). Lymphosonography was similar in accuracy to radioactive tracer and higher in accuracy than blue dye in identifying SLNs. All 34 malignant SLNs were identified by lymphosonography.

Fluorescence-guided colorectal surgery: applications, clinical results, and protocols.

In recent years, the rise of minimally invasive surgery has driven the development of surgical devices. Indocyanine green (ICG) fluorescence imaging is receiving increased attention in colorectal surgery for improved intraoperative visualization and decision-making. ICG, approved by the U.S. Food and Drug Administration in 1959, rapidly binds to plasma proteins and is primarily intravascular. ICG absorption of near-infrared light (750-800 nm) and emission as fluorescence (830 nm) when bound to tissue proteins enhances deep tissue visualization. Applications include assessing anastomotic perfusion, identifying sentinel lymph nodes, and detecting colorectal cancer metastasis. However, standardized protocols and research on clinical outcomes remain limited. This study explores ICG's role, advantages, disadvantages, and potential clinical impact in colorectal surgery.

Anatomy Versus Physiology: Is Breast Lymphatic Drainage to the Internal Thoracic (Internal Mammary) Lymphatic System Clinically Relevant?

Approximately 15%-25% of breast lymphatic drainage passes through the internal thoracic (internal mammary) lymphatic system, draining the inner quadrants of the breast. This study aimed to use lymphosonography to identify sentinel lymph nodes (SLNs) in the axillary and internal thoracic lymphatic systems in patients with breast cancer. Seventy-nine patients received subcutaneous ultrasound contrast agent injections around the tumor. Lymphosonography was used to identify SLNs. In 14 of the 79 patients (17.7%), the tumor was located in the inner quadrant of the breast. Lymphosonography identified 217 SLNs in 79 patients, averaging 2.7 SLNs per patient. The 217 identified SLNs in the 79 patients were located in the axillary lymphatic system; none were located in the internal thoracic (internal mammary) lymphatic system, although it was expected in two to four patients (i.e., 4-11 SLNs). These results implied that SLNs associated with breast cancer are predominantly located in the axillary lymphatic system.

A novel nomogram for the preoperative prediction of sentinel lymph node metastasis in breast cancer.

A practical noninvasive method to identify sentinel lymph node (SLN) status in breast cancer patients, who had a suspicious axillary lymph node (ALN) at ultrasound (US), but a negative clinical physical examination is needed. To predict SLN metastasis using a nomogram based on US and biopsy-based pathological features, this retrospective study investigated associations between clinicopathological features and SLN status. Patients treated with SLN dissection at four centers were apportioned to training, internal, or external validation sets (n=472, 175, and 81). Lymph node ultrasound and pathological characteristics were compared using chi-squared and t-tests. A nomogram predicting SLN metastasis was constructed using multivariate logistic regression models. In the training set, statistically significant factors associated with SLN+ were as follows: histology type (p < 0.001); progesterone receptor (PR: p=0.003); Her-2 status (p=0.049); and ALN-US shape (p=0.034), corticomedullary demarcation (CMD: p < 0.001), and blood flow (p=0.001). With multivariate analysis, five independent variables (histological type, PR status, ALN-US shape, CMD, and blood flow) were integrated into the nomogram (C-statistic 0.714 [95% CI: 0.688-0.740]) and validated internally (0.816 [95% CI: 0.784-0.849]) and externally (0.942 [95% CI: 0.918-0.966]), with good predictive accuracy and clinical applicability. This nomogram could be a direct and reliable tool for individual preoperative evaluation of SLN status, and therefore aids decisions concerning ALN dissection and adjuvant treatment.

Can late lymphoscintigraphy be omitted in the sentinel node procedure in early-stage vulvar cancer?

In the Netherlands, the sentinel lymph node procedure protocol consists of preoperative lymphoscintigraphy combined with intraoperative blue dye for identifying sentinel lymph nodes in early vulvar squamous cell carcinoma. This study aimed at investigating the role of early and late lymphoscintigraphy. From January 2015 to January 2019, early and late lymphoscintigraphies of 52 women were retrospectively analyzed. Lymphoscintigraphy was performed 30 minutes (early) and 2.5-4hours (late) after vulvar injection of 99m Tc-labeled nanocolloid. We calculated the concordance correlation coefficient (CCC) between number of sentinel lymph nodes detected on both images using the Lins concordance coefficient and correlated with clinicopathological data. Thirty-four women had a midline tumor and 18 had a lateral tumor. Detection rates with early and late scintigraphy were 88.5% and 98.1%, respectively. Median number of detected nodes was 1.0 (0-7) and 2.0 (0-7). Good statistical correlation between number of sentinel lymph nodes detected on early and late imaging was found (CCC=0.76) in most patients. In 18 women (35%) a mismatch occurred: a higher number of nodes was detected on late imaging. In 11 of 18 women re-injection was performed because no sentinel lymph nodes were visualized on early images. Late imaging and intraoperative detection showed a good statistical correlation (CCC=0.61). One woman showed an isolated groin recurrence despite negative sentinel lymph nodes. This study showed good statistical correlations between early and late scintigraphy in most patients. However, in 35% of women late scintigraphy detected more nodes. In case of poor visualization after the first scintigraphy, re-injection should be considered. Late scintigraphy is probably helpful in confirming successful re-injection and in showing deviating lymph flow in women with failed mapping after the first injection and successful re-injection. Because missing metastatic sentinel lymph nodes often leads to a poor prognosis, we prefer optimal correlations between imaging and intraoperative identification. Hence, late scintigraphy cannot be safely omitted.

Radio-isotope occult lesion localization (ROLL) techniques to identify the clipped node for targeted axillary dissection (TAD) in breast cancer.

Breast cancer patients having neoadjuvant systemic therapy (NAST) who have a positive (clipped) lymph node (CN) at presentation must have that CN removed to assess pathologic response at later surgery. Multiple techniques for localizing the CN have been described. We describe a novel ROLL-based approach. Consecutive patients between 2018 and 2021, having NAST with biopsy proven positive lymph node(s), had a clip placed into the most abnormal node(s). At later surgery sentinel node and occult lesion localization (SNOLL) was performed with peritumoral radio-isotope (99m Tc-Nanoscan) injected under ultrasound guidance. Planar and single photon emission computed tomography (SPECT-CT) images were used to identify sentinel nodes (SN) and the CN. If the CN was not a SN, then additional 99m Tc-Nanoscan was injected directly into the CN using ultrasound (ROLL). TAD was performed using a gamma probe and intra-operative specimen radiographs to confirm excision of the CN. Thirty-eight patients underwent TAD. 20/38 CNs were SNs on SPECT-CT. 17/38 CN were localized separately. 1/38 CN was not a SN and could not be identified on ultrasound. The remaining 37/38 (97.4%) of the CNs were removed intra-operatively. Pathological complete response in the axilla was identified in 18/38 cases. The CN was the only positive node in 10/20 cases. In 18/20 cases the CN contained the largest tumour deposit. Combining SNOLL and ROLL techniques to identify the SNs and, if separate, the CN for TAD is very reliable and logistically robust, especially for units already performing peritumoral lymphoscintigraphy.

The Application of Magnetic Nanoparticles for Sentinel Lymph Node Detection in Clinically Node-Negative Breast Cancer Patients: A Systemic Review and Meta-Analysis.

Simple SummaryGenerally, the standard method of applying sentinel lymph node biopsy in breast cancer patients is via a technetium-labeled nanocolloid (radiolabeled tracer) with or without blue dye. However, the radioactive agents may cause challenges both to hospitals and patients. Alternatively, a safer candidate method, such as SPIO, has been often introduced and validated in comparison with standard methods. The aim of this study was to perform a systematic review and meta-analysis to evaluate the diagnostic accuracy of SPIO and its clinical impact on the management of breast cancer. Based on our study, SPIO could be considered as an alternative standard of care for sentinel lymph node detection. Compared with the standard method, SPIO exhibited equivalent or even superior detection capacities, while safety could be guaranteed. Lower SPIO doses would also not impair detection capacity compared with the standard method. The absence of radioactivity of SPIO is one of the most important advantages for clinical applications.Superparamagnetic iron oxide (SPIO), an alternative mapping agent, can be used to identify sentinel lymph nodes in patients with clinically node-negative breast cancer. However, its performance in comparison with the standard method, using a radioisotope (technetium-99 m, Tc) alone or in combination with blue dye, remains controversial. Hence, a systematic review and meta-analysis were conducted to evaluate the diagnostic accuracy of SPIO and its clinical impact in the management of breast cancer. The PubMed, Embase, and Cochrane databases were comprehensively searched from inception to 1 May 2022. Cohort studies regarding the comparison of SPIO with standard methods for sentinel lymph node identification were included. A total of 19 prospective cohort studies, which collectively included 2298 clinically node-negative breast cancer patients undergoing sentinel lymph node identification through both the standard method and SPIO, were identified. The detection rate for sentinel lymph nodes (RR, 1.06; 95% CI, 1.05–1.08; p < 0.001) was considerably higher in the SPIO cohorts than in the standard method cohorts, although this difference was not significant in detected patients, patients with positive sentinel lymph nodes, or positive sentinel lymph nodes. Compared with the standard method, the SPIO method could be considered as an alternative standard of care for sentinel lymph node detection in patients with clinically node-negative breast cancer.