Results Of Lymph Node Biopsy Research Articles

Correction Notice: Preliminary results of sentinel lymph node biopsy using blue dye for early breast cancer staging: A single-center experience in Addis Ababa, Ethiopia

Correction Notice: Preliminary results of sentinel lymph node biopsy using blue dye for early breast cancer staging: A single-center experience in Addis Ababa, Ethiopia

Preliminary results of sentinel lymph node biopsy using blue dye for early breast cancer staging: A single-centre experience in Addis Ababa, Ethiopia

Preliminary results of sentinel lymph node biopsy using blue dye for early breast cancer staging: A single-centre experience in Addis Ababa, Ethiopia

Tailoring postoperative management through sentinel lymph node biopsy in low- and intermediate-risk endometrial cancer - the SENTRY clinical trial.

While total hysterectomy and bilateral salpingo-oophorectomy without lymph node staging are standard for low- and intermediate-risk endometrial cancer, certain histopathologic factors revealed after surgery can necessitate additional interventions. Our study assessed the influence of sentinel lymph node biopsy on postoperative decision-making. In the SENTRY trial (July 2021 - February 2023), we enrolled patients with International Federation of Gynaecology and Obstetrics (FIGO) stage IA-IB low-grade endometrioid endometrial cancer. Laparoscopic sentinel lymph node mapping using indocyanine green was performed alongside total hysterectomy with bilateral salpingo-oophorectomy. Subsequent management changes based on sentinel lymph node biopsy results were evaluated. The trial was registered at ClinicalTrials.gov (NCT04972682). Of the 100 enrolled participants, a bilateral detection rate of 91% was observed with a median detection time of 10 min (interquartile range 8-13 min). Sentinel lymph node metastases were found in 8% (N = 8) of participants. Postoperative FIGO staging increased in 15% (N = 15) and decreased in 5% (N = 5) of patients. Sentinel lymph node biopsy results altered the adjuvant treatment plan for 20% (N = 20): external beam radiotherapy was omitted in 12% (N = 12) while 6% (N = 6) had external beam radiotherapy +/- systemic chemotherapy added due to sentinel lymph node metastases. In 2% (N = 2), the external beam radiotherapy field was expanded with the paraaortic region. No intraoperative complications were reported and no 30-day major morbidity and mortality occurred. Throughout a median follow-up of 14 (95% CI 12-15 months, neither patient-reported lymphedema nor pelvic recurrence surfaced in the cohort. Sentinel lymph node biopsy using indocyanine green is a safe procedure and allows tailoring adjuvant therapy in presumed low- and intermediate-risk endometrial cancer. It assists in avoiding external beam radiotherapy overtreatment and introducing additional modalities when necessary.

Rate of occult metastasis in lip squamous cell carcinoma: A systematic review and meta-analysis.

The rate of occult metastasis in lip cancer is poorly studied. Management of the regional nodal basin in lip cancer is thus controversial. This study sought to understand the true rate of micrometastasis in lip cancer. Systematic review and meta-analysis was conducted of English language studies reporting lip cancer sentinel node biopsy results. Studies were obtained from the PubMed database between the years 2000 and 2023 using the search terms "sentinel node biopsy" and "squamous cell carcinoma." Random effect and fixed effect meta-analyses were performed. Thirteen studies met inclusion criteria. Low heterogeneity was noted among the studies, as indicated by the I2 inconsistency test (I2 = 0%). The rate of occult metastasis ranged between 0 and 33% (mean 9%). A total of 189 lip sentinel node biopsies had been performed. Of these, 21 revealed occult nodal metastasis (11.1%, 95% CI 7.36%-16.44%). One step, generalized linear mixed modeling revealed the true rate of occult nodal metastasis to be 10% (95% CI (0.0504, 0.1746), p < 0.0001). The rate of occult metastasis in lip cancer approaches the threshold for elective management of the regional nodal basin. Sentinel node biopsy is optimally suited for management of high-risk early T stage lip cancer.

SURGICAL TREATMENT OF ADVANCED PALMOPLANTAR MELANOMA

Aim:&#x0D; Palmoplantar melanoma is a rare and aggressive subtype of malignant melanoma. Not like other subtypes, sunlight is not the primary etiologic factor. We aim to expand the knowledge on this rare and neglected malignant melanoma subtype and add our findings to the literature. &#x0D; Materials and Methods:&#x0D; Malignant Melanoma patients admitted to our hospital between 2008 and 2020 were retrospectively analyzed. Twenty-seven patients with plantar and one with palmar melanoma were identified and included in our study. Data about gender, age at the diagnosis, histopathological features, sentinel lymph node localization, performed surgeries, sentinel lymph node biopsy (SLNB) and regional lymph node dissection results, recurrence, survival time, primary tumor localization, and systemic metastases were collected. &#x0D; Results:&#x0D; 26 plantar and one palmar melanoma patients were operated on in this period. Six patients died during follow-up. Twenty-three patients were treated with wide excisions, and four were treated with amputations. The defect was reconstructed with a skin graft in all cases with excisions. In 6 patients with suspicious lymph nodes in the preoperative imaging, lymph node dissection was added to the treatment. Other patients had sentinel lymph node biopsies and continued with dissection if a metastatic node was encountered. &#x0D; Conclusion:&#x0D; Our findings are congruent with the current literature. Skin grafting may enhance the success of palmoplantar melanoma follow-up and demands attention.

Personalized neck irradiation guided by sentinel lymph node biopsy in patients with squamous cell carcinoma of the oropharynx, larynx or hypopharynx with a clinically negative neck: (Chemo)radiotherapy to the PRIMary tumor only. Protocol of the PRIMO study

BackgroundElective neck irradiation (ENI) is performed in head and neck cancer patients treated with definitive (chemo)radiotherapy. The aim is to eradicate nodal metastases that are not detectable by pretreatment imaging techniques. It is conceivable that personalized neck irradiation can be performed guided by the results of sentinel lymph node biopsy (SLNB). It is expected that ENI can be omitted to one or both sides of the neck in 9 out of 10 patients, resulting in less radiation side effects with better quality of life. Methods/designThis is a multicenter randomized controlled trial aiming to compare safety and efficacy of treatment with SLNB guided neck irradiation versus standard bilateral ENI in 242 patients with cN0 squamous cell carcinoma of the oropharynx, larynx or hypopharynx for whom bilateral ENI is indicated. Patients randomized to the experimental-arm will undergo SLNB. Based on the histopathologic status of the SLNs, patients will receive no ENI (if all SLNs are negative), unilateral neck irradiation only (if a SLN is positive at one side of the neck) or bilateral neck irradiation (if SLNs are positive at both sides of the neck). Patients randomized to the control arm will not undergo SLNB but will receive standard bilateral ENI. The primary safety endpoint is the number of patients with recurrence in regional lymph nodes within 2 years after treatment. The primary efficacy endpoint is patient reported xerostomia-related quality of life at 6 months after treatment. DiscussionIf this trial demonstrates that the experimental treatment is non-inferior to the standard treatment in terms of regional recurrence and is superior in terms of xerostomia-related quality of life, this will become the new standard of care.

Surgical options in melanoma metastasis in regional lymph nodes

This review presents an analysis of treatment outcomes for patients with metastases of cutaneous melanoma into the regional lymph nodes. Types of surgical interventions currently used in oncological surgery for this pathology are considered, as well as the trends of their future practical application. The results of sentinel lymph node biopsy and regional lymph node dissection in patients with primary tumors with varying thickness and the effect of surgical interventions on treatment effectiveness are presented.

P59 Results of sentinel lymph node biopsies in thin melanomas (Breslow thickness 0.8–1.0 mm) and correlation with histopathological features

Abstract In July 2022, the National Institute for Health and Care Excellence (NICE) melanoma guidelines were updated to include recommendation for a sentinel lymph node (SLN) biopsy for those with a Breslow thickness of 0.8–1 mm and at least one of the following: ulceration, lymphovascular invasion and/or a mitotic index of ≥ 2 mm². SLN biopsy is a staging procedure and therefore has an impact on prognosis. However, SLN biopsy is an invasive procedure with associated morbidity. A 5-year retrospective review of melanoma data in the south east of Ireland was undertaken to establish the correlation between positive sentinel lymph node biopsies in 0.8–1.0-mm-thick melanomas and the risk factors outlined above. Melanoma outcomes, histopathology reports and outpatient clinic letters were assessed and data were extracted from 1 January 2018 to 31 December 2022 inclusive. A total of 52 patients were identified with a melanoma of Breslow thickness of 0.8–1 mm from the predetermined timeframe. Eight per cent (n = 4) of lesions were ulcerated. Thirteen per cent (n = 7) had a mitotic index of ≥ 2 mm². One lesion was both ulcerated and had a mitotic index of ≥ 2 mm². No lesions demonstrated lymphovascular invasion. Nineteen (36%) patients underwent SLN biopsy. All patients who underwent SLN biopsy were negative. One patient with an ulcerated melanoma did not undergo SLN biopsy and five with a mitotic index of ≥ 2 did not undergo SLN biopsy. There was no evidence of disease recurrence within the follow-up period (2 months–5 years). This population showed a 0% positivity rate on SLN biopsy. No correlation with mitotic index or ulceration and SLN biopsy was identified. No patients have developed local recurrence or metastatic disease within the follow-up period. This study supports the updated NICE guidance recommending SLN biopsies for thicker melanomas (i.e. Breslow thickness &amp;gt; 1.0 mm) and SLN biopsy in thinner melanomas (Breslow thickness 0.8–1 mm) only if concerning features are present on histology (i.e. ulceration, lymphovascular invasion and/or a mitotic index of ≥ 2).

Multiple Lymph Node and Bone Metastases From An Occult Breast Cancer: A Case Report

Cancer of unknown primary is defined as cancer with an unknown primary origin. Occult breast cancer (OBC) is a rare diagnosis in which physical examination, imaging methods, and even surgical procedures are insufficient to put on a primary tumoral site in the breasts. This definition leads to only 0.3-1% of all breast cancer cases. The diagnosis of OBC is usually obtained with an axillary lymph node biopsy. A 52-year-old female presented with right arm weakness and a neck lump. On the physical examination, multiple masses were palpated at the right axillary, right supraclavicular, and anterior cervical areas. Mammography, breast ultrasonography, breast magnetic resonance imaging, and 18-fluorodeoxyglucose positron emission tomography (18-FDG PET) scan could not show a suspicious tumoral area as the primary origin. 18-FDG PET scan put on the massive tumoral burden at multiple bones and lymph nodes, but there were no lesions to suspect as the tumoral origin. Finally, the supraclavicular lymph node biopsy result has revealed the diagnosis; hormone receptor-positive and C-erbB2 positive occult breast cancer. Cervical lymph node metastasis is also a scarce condition for breast cancer. The lymphatic drainage pathway is not clear in explaining the breast cancer involvement of the cervical.

Prognostic role of microsatellites in melanoma and implications in the American Joint Committee on Cancer classification system: A cohort study

There is limited information on microsatellite survival outcomes in patients with melanoma. To evaluate survival outcomes in patients with microsatellites, assess their role within stage III stratification of the American Joint Committee on Cancer classification, and assess the results of sentinel lymph node biopsies in patients with microsatellites. A retrospective bicenter cohort study from 1998 to 2019 included patients with a diagnosis of invasive cutaneous melanoma. Of a total of 5216 patients, 108 (2.1%) had microsatellites at initial staging. Survival analysis showed that microsatellites were an independent risk factor with decreased overall survival (OS), melanoma-specific survival (MSS), and disease-free survival, with hazard ratios of 1.57, 1.76, and 1.76, respectively. Stratified analysis in patients with stage III melanoma showed a 5-year OS of 35% (95% CI, 17.3%-73.4%) and a MSS of 45% (95% CI, 23.1-87.5) for patients with stage IIIB melanoma with microsatellites. Retrospective design of the study. Microsatellites were associated with other adverse melanoma prognostic factors. A multivariate Cox regression analysis showed that they are an independent risk factor for worse OS, MSS, and disease-free survival. Patients with stage IIIB melanoma with microsatellites had worse OS and MSS, whereas patients with stage IIIC melanoma had worse OS but not MSS.

P13 A case of Kikuchi-Fujimoto disease triggered by an episode of bacterial cellulitis, associated with features of SLE

P13 A case of Kikuchi-Fujimoto disease triggered by an episode of bacterial cellulitis, associated with features of SLE

ASO Visual Abstract: How Often Do Sentinel Lymph Node Biopsy Results Affect Adjuvant Therapy Decisions Among Postmenopausal Women with Early-Stage HR+/HER2- Breast Cancer in the Post-RxPONDER Era?

ASO Visual Abstract: How Often Do Sentinel Lymph Node Biopsy Results Affect Adjuvant Therapy Decisions Among Postmenopausal Women with Early-Stage HR+/HER2- Breast Cancer in the Post-RxPONDER Era?

How Often Do Sentinel Lymph Node Biopsy Results Affect Adjuvant Therapy Decisions Among Postmenopausal Women with Early-Stage HR+/HER2- Breast Cancer in the Post-RxPONDER Era?

The RxPONDER trial reported no benefit to chemotherapy among postmenopausal patients with HR+/HER2- tumors, one to three positive nodes, and low recurrence scores, questioning the role of axillary staging in this population. Here, we evaluate the impact of sentinel lymph node biopsy (SLNB) results on adjuvant therapy decisions in postmenopausal women with HR+/HER2- breast cancer. Postmenopausal women with cT1-2N0, HR+/HER2- breast cancer treated with lumpectomy and SLNB from 2012 to 2018 were identified. Receipt of nodal irradiation, indication for axillary lymph node dissection (ALND) and chemotherapy, and partial breast irradiation (PBI) eligibility were reviewed with pre- and post-SLNB results. A total of 1786 women were identified: median age 62 years, 84% with pT1 tumors, and 16% with pT2-3 tumors. Of those, 85% (n = 1525) remained pN0, 14% (n = 244) were pN1, and 1% (n = 17) were pN2-3. A total of 20 (1%) patients had > 2 positive SLNs, necessitating ALND. Pre-SLNB, 1478 women were considered PBI eligible; post-SLNB, 227 (13%) converted to PBI ineligible. In total, 58 patients with positive nodes received nodal irradiation, representing 3% of the entire cohort and 22% of pN+ patients. Overall, 1401 patients had an Oncotype DX recurrence score available, including 1273 patients with pN0 stage and 128 with pN1, with 173 (14%) and 16 (13%), respectively, having a recurrence score > 25, warranting chemotherapy. While few cN0 postmenopausal women with HR+/HER2- tumors had nodal pathology that warranted ALND, receipt of nodal irradiation, or indicated need for chemotherapy, in 13%, SLNB would have an impact on consideration for PBI. Among patients eligible for PBI, findings from SLNB may help refine selection among postmenopausal women with this tumor profile.

Development of the prediction model based on clinical-imaging omics: molecular typing and sentinel lymph node metastasis of breast cancer.

BackgroundImageology uses high-throughput and automatic computing methods to transform medical image data into quantitative data with feature space, and then makes accurate quantitative analysis, extracts features and builds models, which can intuitively observe the overall features of lesions and the surrounding tissues, and provide rich invisible information. At present, the research on the imaging features of dynamic contrast-enhanced (DCE) and diffusion-weighted imaging (DWI) to predict the molecular typing value has achieved results, but the imaging model based on DWI and DCE-magnetic resonance imaging (MRI) is not enough to predict the molecular subtypes, and the prediction value of the prediction model based on the three-dimensional volume of interest of the lesion to the four molecular subtypes of breast cancer has not been fully studied.MethodsThe clinical data of 202 breast cancer patients at our hospital from October 2020 to November 2021 were collected. All patients were examined with multimodal MRI before surgery. Base on immunohistochemical recombinant Ki-67 protein (Ki-67), estrogen receptor (ER), human epidermal growth factor receptor-2 (HER-2) and progesterone receptor (PR) results, the tumors were divided into four types According to the results of the sentinel lymph node (SLN) biopsies, the patients were divided into SLN (+) and SLN (−) groups. 3-dimensional (3D) Slicer software was used to outline the region of interest (ROI), and AMni-Kinetics software was used for feature extraction. The imaging characteristics were screened using least absolute shrinkage and selection operator (LASSO)-Logistic regression model using R statistical software, and the receiver operating characteristic (ROC) curve was drawn using “pROC” software package to evaluate the prediction efficiency of the model.ResultsThe most efficacious model at predicting SLN (+) in breast cancer patients with different molecular subtypes and SLN metastasis was the model based on the imageological characteristics of fat inhibition, and T2-weighted imaging (T2WI), T1-weighted imaging + C (T1WI-C), and DWI combined sequences at the tumor + 2 mm periphery. AUC (sensitivity, specificity) of the validation group were 0.831 (0.856, 0.891), 0.832 (0.660, 0.877), 0.801 (0.772, 0.765), 0.904 (0.769, 0.873), and 0.819 (0.810, 0.500) respectively when the tumor was 2 mm around the tumor.ConclusionsThe imaging features extracted from multi-parameter DWI, T1WI+C, and T2WI in breast cancer have certain value at predicting different molecular types and SLNs of breast cancer.

Sentinel lymph node biopsy for early squamous cell carcinoma of the lip and oral cavity: Real-world experience in Brazil.

This study aimed to evaluate the accuracy and oncological results of sentinel lymph node biopsy in patients with early lip and oral cavity squamous cell carcinoma (SCC) in a real-world scenario. Retrospective study including seven Brazilian centers. Four-hundred and seven cN0 patients were accrued for 20 years. The rate of occult metastasis was 23.1% and 22 patients (5.4%) had regional failure. We found, for 5 years of follow-up, 85.3% of regional recurrence-free survival; 77.1% of disease-free survival; 73.7% of overall survival; and 86.7% of disease-specific survival. The rate of false-negative cases was 5.4%. In a real-world scenario, sentinel lymph node biopsy for patients with SCC of the lip and oral cavity proved feasible in different settings and to be oncologically safe, with similar rates of occult lymph node metastasis and false-negative cases, when compared to elective neck dissection, and with similar long-term survival to that reported historically.

Risk Factor Assessment of Lymph Node Metastasis in Patients With FIGO Stage IB1 Cervical Cancer.

ObjectivesTo assess the risk factors of lymph node metastasis (LNM) in patients with FIGO stage (2009) IB1 cervical cancer (CC).MethodsPatients with FIGO stage IB1 CC who underwent radical resection between 2012 and 2018 were recruited. The risk factors for LNM were analysed. A recursive partitioning analysis (RPA) was used to divide the patients into risk groups and assess their risk of LNM.ResultsThe 5-year overall survival rate was 91.72%, while 80.0% and 93.5% for patients with or without LNM (P<0.05). Multivariable logistic regression analysis showed that lymphovascular invasion (LVI), depth of invasion (DI), tumour size (TS), squamous cell carcinoma (SCC) antigen level were independent risk factors (all P<0.05). Patients were divided into low-risk (no LVI, DI <1/2, TS <2 cm), intermediate-risk (no LVI, DI <1/2, TS ≥2 cm; no LVI, DI ≥1/2, normal SCC level; LVI, DI <1/2, TS <2 cm), and high-risk (no LVI, DI ≥1/2, SCC level ≥1.5 ng/ml; LVI, TS <2 cm, DI ≥1/2; LVI, TS ≥2 cm) groups by RPA according to these four factors. The incidence of LNM among the three groups was 0.00%, 4.40%, and 24.10%, respectively (all P<0.001). The 5-year overall survival rates differed among the groups (98.2%, 92.7%, 83.0%, respectively, P=0.001).ConclusionsLNM affects the prognosis of patients with FIGO stage IB1 CC. Lymphadenectomy may be avoided for patients in the low-risk group and recommended for those in the high-risk group. Whether dissection is performed in the intermediate-risk group depends on the lymph node biopsy results.

Indications and results of sentinel lymph node biopsy in breast cancer: Changes observed in 2018 compared to 2012

Background and objectiveOver the last 15 years, breast cancer (BC) treatment has undergone numerous changes, which have also affected the indications for Sentinel Lymph Node Biopsy (SLNB) as well as the procedures depending on its outcome. The aim of this study is to compare the results of the SLNB carried out at our Center during 2012, when we stopped performing an axillary lymph node dissection (ALND) after the finding of a micrometastasis, with those conducted in 2018, when we started applying Z011 criteria. Materials and methodsWe have performed a comparative retrospective observational study, including cN0 BC patients that underwent a SLNB in 2012 versus those that underwent this procedure in 2018. Results174 patients from 2012 and 165 from 2018 were studied. We found significant differences between the two groups: in 2018 there were fewer lobular invasive cancers (14 vs 28) (P < .05), a smaller mean pathological size (P < .001), a higher proportion of HER2 and triple negative tumors (28 vs 49) (P < .01) and, finally, an increase in use of neoadjuvant treatments (42.0% vs 6.7%). Regarding axillary involvement, we observed a decrease in both the presence of a positive sentinel node (24.1% in 2018 vs 42.4% in 2012) (P < .0001) as well as in the proportion of ALND performed (12.6% in 2018 vs 21.2% in 2012) and the presence of positive non sentinel nodes after a ALND (59.1% vs74.3%) (ns) ConclusionAlthough the 2018 cohort that underwent SLNB had more aggressive tumors, there were fewer positive SN and ALND performed. This is probably due to a more accurate radiological diagnosis with ultrasound, that enables to detect cN1 cases before surgery, and to the increasing use of neoadjuvant treatments that may downstage the axilla

Results of Sentinel lymph node biopsy post Neoadjuvant chemotherapy in clinically node-negative breast cancer patients: A retrospective, observational study

Background: Axillary surgery for breast cancer serves as a staging procedure. Improved systemic therapies have helped in the de-escalation of breast and axillary surgery for breast cancer patients in the last two decades.

Dermal invasion matters in breast cancer sentinel lymph node biopsy results

The aim of this study was to evaluate whether cancer invasion of the dermis could hamper drainage of the radiotracer in breast cancer patients who were undergoing a Sentinel Lymph Node Biopsy (SLNB) procedure. Ten patients who presented with T1-T2 breast cancer with dermal invasion alone as confirmed by a punch biopsy of skin were evaluated. For the SLNB procedure, a lymphoscintigraphy was performed 2 hours after intratumoral administration of 2 mCi (74 MBq) of 99mTc nanocolloid. The sentinel lymph nodes (SLN) were evaluated for the presence of tumor cells by hematoxylin-eosin staining and, when negative, by immunocytochemistry using anti-cytokeratin antibody (CAM 5.2). No migration of radiotracer was found in three patients, and one patient had a false negative SLN, so altogether the technique failed in four patients (40%). Axillary nodes proved to be positive in seven patients (70%).The high rate of failure in the lymphatic mapping and the high proportion of axillary positivity suggest a causal relationship with the invasion of the dermis, with possible implications for the validity of the SLNB procedure.

Preoperative ultrasound accurately characterizes surgically confirmed extracranial spinal accessory nerve injuries.

To determine the accuracy of preoperative ultrasound and MRI in surgically confirmed spinal accessory nerve injuries and present the benefits of a multimodality image review. A retrospective review of 38 consecutive patients referred to a peripheral nerve surgical practice at an academic teaching hospital with surgically confirmed spinal accessory nerve injuries. All cases were reviewed for patient demographics, date and cause of injury, preoperative EMG, and surgical diagnosis and management. Additionally, prospective interpretation of preoperative ultrasound and MRI reports were reviewed for concordance or discordance with the surgical diagnosis. Iatrogenic injury was present in 37 (97%) cases and most commonly a result of an excisional lymph node biopsy (68%). Surgically confirmed spinal accessory nerve injury diagnoses consisted of 25 (66%) stump neuromas and 13 (34%) incomplete nerve injuries. Nine months was the average time from injury to surgery. Twenty-nine patients underwent preoperative ultrasound and/or MRI evaluation: 12 ultrasound only, 10 MRI only, and seven with both ultrasound and MRI. Eighteen (95%) preoperative ultrasound reports compared to four (24%) preoperative MRI reports were concordant with the surgical diagnosis. In the seven cases with both preoperative ultrasound and MRI, six had discordant ultrasound and MRI imaging diagnoses for which the ultrasound was concordant with the surgical diagnoses in all cases. Preoperative ultrasound more accurately characterizes spinal accessory nerve injuries compared to MRI and should serve as the modality of choice when a spinal accessory nerve injury is suspected.