Method For Sentinel Lymph Node Biopsy Research Articles

Three-dimensional visual technique based on CT lymphography data combined with methylene blue in endoscopic sentinel lymph node biopsy for breast cancer

BackgroundThe combined application of blue dye and radioisotopes is currently the primary mapping technique used for sentinel lymph node biopsy (SLNB) in breast cancer patients. However, radiocolloid techniques have not been widely adopted, especially in developing countries, given the strict restrictions on radioactive materials. Consequently, we carried out a retrospective study to evaluate the feasibility and accuracy of three-dimensional visualization technique (3DVT) based on computed tomography-lymphography (CT-LG) in endoscopic sentinel lymph node biopsy (ESLNB) for breast cancer.MethodsFrom September 2018 to June 2020, 389 patients who underwent surgical treatment of breast cancer in our department were included in this study. The CT-LG data of these patients were reconstructed into digital 3D models and imported into Smart Vision Works V1.0 to locate the sentinel lymph node (SLN) and for visual simulation surgery. ESLNB and endoscopic axillary lymph node dissection were carried out based on this new technique; the accuracy and clinical value of 3DVT in ESLNB were analyzed.ResultsThe reconstructed 3D models clearly displayed all the structures of breast and axilla, which favors the intraoperative detection of SLNs. The identification rate of biopsied SLNs was 100% (389/389). The accuracy, sensitivity, and false-negative rate were 93.83% (365/389), 93.43% (128/137), and 6.57% (9/137), respectively. Upper limb lymphedema occurred in one patient 3 months after surgery during the 12-month follow-up period.ConclusionsOur 3DVT based on CT-LG data combined with methylene blue in ESLNB ensures a high identification rate of SLNs with low false-negative rates. It, therefore, has the potential to serve as a new method for SLN biopsy in breast cancer cases.

Sentinel lymph node biopsy in medullary thyroid microcarcinomas.

The aim of this prospective study was to analyze accuracy of sentinel lymph node biopsy with methylene blue dye for intraoperative detection of lateral metastases in clinically N0M0 medullary microcarcinomas with calcitonin <1,000 pg/mL and selection of true-positive patients for one-time therapeutic lateral dissection. In addition to total thyroidectomy and central neck dissection, all patients had bilateral sentinel biopsy of jugulo-carotid regions after methylene blue injection to decide upon necessity for lateral dissection. If sentinels were benign on frozen section, additional non-sentinels were extirpated, with no further lateral dissection. If sentinels were malignant, one-time lateral dissection was performed. 20 patients were included in this study. Hereditary disease form was observed in 3/20 (15%) of patients with RET proto-oncogene mutation C634F; remaining 17/20 (85%) were negative for germline mutations. There were no allergic reactions to methylene blue and identification rate of sentinels was 100%. In total, 2/20 (10%) cN0 patients had lymphonodal metastases, thus were reclassified as pN1b. Remaining 18/20 (90%) were classified pN0 based on standard pathohistology. Frozen section findings on sentinels were 100% match with standard pathohistology, and there were no skip metastases in lateral compartments. Sensitivity, specificity and accuracy of sentinel biopsy method with methylene dye and frozen section were 100%. Dzodic's sentinel lymph node biopsy method can be used for intraoperative assessment of lateral compartments and optimization of initial surgery of medullary microcarcinomas with calcitonin <1,000 pg/mL. This way, cN0 patients with sentinel metastases can receive one-time lateral dissection, and those without benefit from less extensive surgery.

Sentinel lymph node biopsy using indocyanine green fluorescence navigation method after neoadjuvant chemotherapy for patients with clinically node-positive breast cancer.

e12108 Background: Sentinel lymph node biopsy (SNB) for initially clinically node-positive (cN1) after neoadjuvant chemotherapy (NAC) is controversial. Even if approximately 40% of node positive disease converts to node negative after NAC, SNB using blue dye (BD) and/or radioisotope (RI) agent showed the high false-negative rate (FNR) (SENTINA, ACOSOG Z1071). These trials showed the accuracy of SNB was closely related to the number of sentinel lymph nodes (SNs) removed. We presented the efficacy of indocyanine green (ICG) fluorescence navigation method for SNB in clinically node-negative (cN0) patients (ASCO2008). The ICG method can provide higher numbers of SNs and it helps to identify lymph nodes with the remained metastases. Methods: Of 1900 patients (Jan. 2010 - Dec. 2016), 242 women with cN0 or cN1 received NAC: Group 0 (cN0 before NAC, n=150), Group 1 (cN1 converted ycN0 after NAC, n=71) , Group 2 (cN1 remained ycN1 after NAC, n=21). Node status was evaluated by ultrasound. All patients underwent SNB using both ICG- and BD-method together. Fluorescence images were obtained by a CCD camera with a cut filter as a detector, light emitting diodes at 760nm as the light source. ALND was performed in Group1 and Group 2. Results: Pathological complete nodal response rate (pcNRR) was 48.4%. Table shows the number of SNs removed by ICG or BD. SNs detection rates (ICG, BD): Group 0 (98.7%, 84.7%), Group 1 (98.6%, 83.1%), Group 2 (85.7%, 47.6%). Resulting of a FNR (ICG, BD): Group 1 (5.7%, 15.3%), Group 2 (22.2%, 60.0%). Conclusions: The pcNRR and a FNR of BD in Group 1 were similar to those of SENTINA or ACOSOGZ 1071 trials. In patients who converted from cN1 to ycN0, the fluorescent ICG method showed a high detection rate of SNs and a low FNR. [Table: see text]

Retrospective analysis of melanocytic lesions in children at the National Cancer Institute-RJ.

Skin cancer is the most common neoplasm in Brazil. Melanoma accounts for 4% of these neoplasms. Although childhood melanoma is rare, there is evidence that its incidence is increasing, placing it among the most important public health problems for the future. This work sought to conduct a retrospective review of cases of suspected melanocytic skin lesions in children, their diagnosis and management, and evaluate the sentinel lymph node biopsy method in some cases of cutaneous melanoma.

Abstract P1-01-03: Comparison of sentinel lymph node biopsy guided by the multi-modal method of indocyanine green fluorescence, radioisotope and blue dye versus the radioisotope in breast cancer; A randomized phase II trial

Abstract Background: Sentinel lymph node (SLN) biopsy is a standard surgery for axillary staging of early breast cancer. This study aimed to evaluate the identification rate and surgery time of SLN biopsy with the multi-modal method using the mixture of indocyanine green (ICG) fluorescence, RI and blue dye as a new method, in comparison with the RI, in clinically node negative breast cancer patients. Materials and methods: In this phase-II randomized study, 86 patients with clinically node negative breast cancer were randomized to receive periareolar injection of the mixture including ICG fluorescence, RI and blue dye or the only RI for SLN biopsy. We compared the identification rate, the number of SLN, and detections time of SLN biopsy between these two groups. Results: The mean age of the multimodal group and the only RI group was 48.2 years and 51.0 years (p = 0.12), respectively. There were no differences of histopathologic factors including tumor size, node positivity, hormone receptor positivity and HER2 positivity between two groups. Sentinel lymph nodes were identified in all patients of both groups (100% in the multimodal group vs 100% in the RI group). The average number of SLN in the mixture group was more than that of the RI group (3.4 ±1.37 vs 2.3 ± 1.04; p &amp;lt; 0.001). The time to excise the first SLN was similar in each group (6.5 ± 5.16 min vs 8.0 ± 4.35 min; p = 0.13). In multimodal group, percutaneous lymphatic drainage was visualized by fluorescent imaging in 90.7% (39 of 43 patients) and all of the first SLN were detected by both ICG fluorescent and RI. After operation, there was no complication including skin staining or necrosis. Conclusions: This study is the first randomize trial which compared the multimodal method using the mixture of ICG fluorescence, RI and blue dye and the conventional RI method for SLN biopsy. The multimodal method is an available method for SLN biopsy, which allows percutaneous visualization of lymphatic vessels and intraoperative lymph node detection. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-01-03.

Will neoadjuvant chemotherapy affect the lymphatic routes to the sentinel lymph node? Investigation using indocyanine green fluorescence method.

164 Background: Neoadjuvant chemotherapy (NAC) is a standard therapy for breast cancer. However, the changes in the lymphatic route to the sentinel lymph node (SLN) before and after NAC are unclear. Indocyanine green (ICG) fluorescence method of SLN biopsy (ICG-SLNB) is useful because of its high identification rate of the SLN and ability to visualize lymphatic routes. Using ICG-SLNB, we compared the lymphatic routes to the SLN (sentinel lymphatic routes) before and after NAC and investigated whether chemotherapy affects the sentinel lymphatic routes. Methods: From October 2010 to April 2012 20 patients received NAC. In 13 cases of clinical node-negative cancer, we performed SLNB before NAC. We recorded the sentinel lymphatic routes before NAC and confirmed the routes at surgery after NAC by using the same method. In 7 cases of clinical node-positive cancer, we recorded the localization of SLN and lymphatic routes by using the ICG fluorescence method before NAC. After NAC, we performed SLNB with axillary dissection and recorded the sentinel lymphatic routes by photography and drawing. Results: Regardless of the presence or absence of lymph node metastasis, the SLN and sentinel lymphatic routes could be detected before and after NAC in all cases. All sentinel lymphatic routes reached the same location of the SLN before and after NAC. In 3 cases, the number of sentinel lymphatic routes had increased after NAC, but the location of the SLN was the same before and after NAC. Other cases showed no changes in the sentinel lymphatic routes. In clinical node-positive cases of pathological complete response, there was no metastasis to the SLN, but there were 2 metastases in the lymph nodes after back-up dissection. Conclusions: ICG fluorescence method provided visual confirmation that the sentinel lymphatic routes were not affected by NAC. This result suggests that SLNB after NAC can be used to safely and positively identify the SLN in clinical node-negative patients. Further investigation would be required to safely perform SLNB after NAC in clinical node-positive patients.

P3-07-10: Sentinel Lymph Node Navigation Surgery Using Combination of Indocyanine Green Fluorescence and Blue Dye for Breast Cancer Patients.

Abstract Background: Sentinel lymph node (SLN) biopsy is now widely accepted for staging the axilla in breast cancer patients. Several methods are presently used to detect SLNs. Combined use of blue dye and radiocolloid has previously been described as a superior method for detecting SLNs in breast cancer patients, but radiocolloid is not generally available in Japan. SLN detection guided by indocyanine green (ICG) fluorescence could emerge as a new and effective method for SLN biopsy. The aim of this study was to evaluate SLN biopsy using combination of ICG fluorescence and blue dye methods for breast cancer patients. Material and Methods: We enrolled 75 patients with clinically node-negative breast cancer. An isosulfan blue dye solution (5ml) was injected subcutaneously just above the tumor and in the periareolar area after the induction of anesthesia. The injection site was massaged for five minutes and ICG (2ml) was then injected subcutaneously just above the tumor and in the periareolar area before starting the surgical procedure. Subcutaneous lymphatic channels draining from the areola to the axilla were visualized with a fluorescence imaging system (Photodynamic Eye: PDE, Hamamatsu Photonics Corporation, Japan) under fluorescence within several minutes. SLNs were dissected under direct visualization supported by fluorescence and dye navigation and diagnosed by intraoperative frozen section with hematoxylin and eosin staining. Any patient with a positive SLN underwent immediate axillary lymph node dissection (ALND). Results: SLNs were detected in all 75 patients. The fluorescence imaging identified 2.6 SLNs in 74 (98.7%) of 75 patients. The blue dye identified 1.6 SLNs in 68 (90.1%) of 75 patients. Twelve of the 75 (16.0%) patients had metastatic SLNs and ALND was immediately performed. No metastasis revealed in any non-SLN in eight of these 12 patients. Metastatic SLNs were detected by the ICG fluorescence and not by blue dye in four of these 12 patients. Discussion: The combination of ICG fluorescence and blue dye method had two advantages: it could reveal lymph flow on the surface before we determined the skin incision line; and it had a high SLN detection rate. In hospitals where radioisotopes are unavailable, a combination of the two methods would be advantageous. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-07-10.

ICG fluorescence-guided sentinel node biopsy for axillary nodal staging in breast cancer

Sentinel lymph node (SLN) biopsy is a selective approach to axillary staging of breast cancer with reduced morbidity. Current detection methods including radioisotope and blue dye show good results but some drawbacks are remaining. Indocyanine green (ICG) fluorescence detection was evaluated as a new method for SLN biopsy in breast cancer allowing both transcutaneous visualization of lymphatic vessels and intraoperative identification of SLN. Forty-three women with clinically node negative breast cancer received subareolar injection of ICG for fluorescence detection of SLN. All patients underwent either planned axillary lymph node dissection (ALND) with SLN biopsy or selective SLN biopsy to determine need for ALND. Clinical feasibility, detection rate, sensitivity, and axillary recurrence after isolated SLN biopsy were analyzed. Overall ICG fluorescence imaging identified 2.0 SLN in average in 42 of 43 patients (detection rate: 97.7%). Metastatic involvement of the SLN was found in 17 of 18 nodal positive patients by conventional histopathology (sensitivity: 94.4%). Immunohistochemistry revealed isolated tumor cells in five further cases. There was only one false-negative case in 43 patients (5.6%). In 17 of 23 overall nodal positive patients, the SLN was the only positive lymph node. After a median follow-up of 4.7 years none of the patients presented with axillary recurrence. ICG fluorescence imaging is a new method for SLN biopsy in breast cancer with acceptable sensitivity and specificity comparable to conventional methods. One advantage of this technique is that it allows transcutaneous visualization of lymphatic vessels and intraoperative lymph node detection without radioisotope.