Method Of Sentinel Lymph Node Detection Research Articles

Novel color fluorescence imaging for sentinel lymph node detection in oral and oropharyngeal cancer.

Fluorescence imaging (FI) using indocyanine green (ICG) is a noteworthy alternative technique for sentinel lymph node (SLN) detection without radiation exposure in oral cavity and oropharynx cancer. However, conventional FI is monochrome, so the visibility is limited. This study assessed whether color FI using the HyperEye Medical System (HEMS) is feasible as an alternative for SLN detection. Patients with previously untreated cT1-2N0 oral or oropharyngeal cancer who were to undergo primary tumor resection and elective neck dissection (END) in our hospital were enrolled from November 2012 to March 2016. The patients underwent SLN detection for biopsy via the HEMS following the injection of ICG solution around the primary lesion before neck dissection. The visibility and the diagnostic accuracy of the imaging were evaluated. SLNs were visualized in all eight cases; however, transcutaneous fluorescence detection was not observed in all cases. Utilizing color mode imaging simplified harvest by clearly discriminating SLNs from surrounding structures, while the monochrome mode proved to be more sensitive for detection. Two cases showed occult metastases on both sentinel and regional nodes. The identification and false negative rates were 100% and 0%, respectively. There were no complications incurred due to this method. Our results suggest that color FI with the HEMS allows for the accurate and safe harvest of SLNs with a preparatory skin incision. Although there is room for improvement of sensitivity, this easy-to-handle procedure might provide the potential to expand the role of the ICG method for SLN detection in head and neck cancer.

Near Infrared (NIR) Fluorescence is Not a Substitute for Lymphoscintigraphy and Gamma Probe for Melanoma Sentinel Node Detection: Results from a Prospective Trial.

Sentinel lymph node (SLN) biopsy is the standard care for early detection and staging of lymph node metastasis in melanomas. Radiocolloids (RC) and blue dyes are used for SLN detection. Recently, near infrared (NIR) fluorescence tracing using indocyanine green has been developed as an alternative method for SLN detection. The relatively high tissue penetration depth of several millimeters and the ability to detect low concentrations of tracer both suggest that NIR may have significant advantages over RC and the blue dye methods. The objective of this study was to prospectively compare the performance of all three SLN detection techniques using them sequentially to evaluate the same group of patients. One hundred twenty-one primary cutaneous melanoma patients with an indication for SLN biopsy were assigned to the procedure following NIR, blue dye, and RC detection techniques. No adverse event was reported. SLN was not detected in only 4.1% of cases. In 90.9%, an SLN was identified with NIR, but without any auxiliary technique in only 70.2% of cases. RC detected the SLN in 92.6% of cases. Patent blue was found in the sentinel node in 76.9%. The combination of all three techniques detected an SLN in 95.9% of cases. Metastases were present in 26.7%. The false-negative rate was 8.8%, with a negative predictive value of 91.2%. RC was the only technique with high SLN detection. Both the blue dye and NIR methods added sensitivity to the detection rate but should not be a substitute for RC.

Ultrasonography-guided wire-localization and nano-carbon staining for detection of sentinel lymph node in breast cancer

Objective To evaluate the usage of ultrasound guided wire-localization, nano-carbon staining and the combination of the above two methods in detecting sentinel lymph node (SLN) in breast cancer. Methods A total of 159 cases of breast cancer from May 2015 to December 2017 in Shanxi Provincial Cancer Hospital were selected, and they were treated with ultrasound guided wire-localization, nano-carbon staining and combination of the two methods separately to detect SLN before the operation. After the operation, SLN and axillary lymph node in each group were marked and made pathological diagnosis. Results There were 69 cases with pathological diagnosis of SLN metastasis and 90 cases without abnormal representation. With the patient as the unit, the sensitivity of ultrasound guided wire-localization was 100.0% (69/69), the sensitivity of nano-carbon staining was 98.6% (68/69), and the sensitivity of combination of the two methods was 97.1% (67/69). The specificity of ultrasound guided wire-localization was 3.3% (3/90), the specificity of nano-carbon staining was 2.2% (2/90), and the specificity of combination of the two methods was 5.6% (5/90). With the count of SLN as the unit, the combination of the two methods had the highest diagnostic efficiency in detecting SLN, and the difference was statistical significant (χ2 = 34.31, P < 0.001). Conclusions Ultrasound guided wire-localization and nano-carbon staining are safe and accessible methods for detecting SLN. It provides a precise treatment for early breast cancer, and it can protect medical staff from radiation, which is expected to be the best method for detection of SLN in breast cancer. Key words: Breast neoplasms; Sentinel lymph node; Ultrasound guided wire-localization; Nano-carbon staining

Use of a Magnetic Tracer for Sentinel Lymph Node Detection in Early-Stage Breast Cancer Patients: A Meta-analysis.

Sentinel lymph node (SLN) dissection involves lymphatic mapping and selective removal of clinically negative lymph nodes at highest risk for harboring metastases. Lymphatic mapping is most often performed using radioisotope with or without blue dye (standard tracers). Sienna+(®), a superparamagnetic iron oxide that can be detected using the Sentimag(®) magnetometer, is an alternative mapping agent to identify SLNs that has been investigated in five clinical trials. This meta-analysis was performed to determine if Sienna+(®) is non-inferior for SLN detection when compared to standard tracers. Five clinical trials comparing Sienna+(®) to a standard technique were identified, and data from these studies were used to determine the agreement by Kappa statistic between Sienna+(®) and standard tracers in identifying SLNs and malignant SLNs. The trials included 1683 SLNs identified in 804 patients. Data from the studies were imbalanced, therefore additional agreement indices were utilized to compare techniques. The estimated difference between the techniques was analyzed and a margin of ≤5% was used to determine non-inferiority. Agreement between the Sienna+(®) and standard tracers was strong for SLN detection by patient [prevalence-adjusted bias-adjusted kappa (PABAK) 0.94, 95% confidence interval (CI) 0.89-0.98], moderate to substantial for SLN detection by node (PABAK 0.68, 95% CI 0.54-0.82), and strong for the detection of malignant SLNs by patient (PABAK 0.89, 95% CI 0.84-0.95). Sienna+(®) demonstrated non-inferiority compared with standard tracers. The Sienna+(®) mapping agent is non-inferior to the standard method for SLN detection in patients with clinically node-negative breast cancer.

Sentinel lymph node biopsy in gastric cancer.

Clinical application of sentinel lymph node (SLN) mapping in patients with early-stage gastric cancer has been a controversial issue for years. However, a recent meta-analysis and a prospective multicenter trial of SLN mapping for early-stage gastric cancer have shown acceptable SLN detection rates and accuracy of determination of lymph node status. A dual-tracer method that uses radioactive colloids and blue dyes is currently considered the most reliable method for the stable detection of SLNs in patients with early-stage gastric cancer. However, the new technologies such as indocyanine green infrared or fluorescence imaging might revolutionize the SLN mapping procedures in gastric cancer. For early-stage gastric cancer, the establishment of individualized, minimally invasive treatments based on SLN concept may retain the patients' quality of life.

子宮頸癌手術におけるインドシアニングリーンを用いた蛍光色素による腹腔鏡下センチネルリンパ節同定法

Objective: Radical hysterectomy with pelvic lymphadenectomy is standard therapy for cervical cancer. The standard surgical lymph node assessment is a systematic lymphadenectomy, but the procedure is associated with lymphedema and lymphocysts. A sentinel lymph node (SLN) is the first node draining the lymphatic flow from a primary tumor. If the SLN is negative for metastasis, nodes after the SLN are also considered to be negative. We report our experience using a new laparoscopic fluorescence imaging system with indocyanine green (ICG) for SLN detection with cervical cancer.Methods: Participants included 12 patients treated from April 2014 to April 2015. Median age was 41.8 years (range, 27-56years) and median body mass index was 20.2 kg/m2 (range, 15-31 years). Patients underwent SLN mapping by intracervical injection of ICG at 3 and 9 o'clock positions. Following SLN mapping, radical hysterectomy and pelvic lymphadenectomy was performed. Result: Median SLN count was 2.8 (range, 1-7). The overall and bilateral detection rate was 100% (12/12) and 83% (10/12), respectively. Positive SLNs were identified in 2 of 12 patients (16%). SLNs were identifided in the external iliac, internal iliac, obturator and common iliac regions and sensitivity, specificity and NPV were all 100%. Conclusions: Fluorescence imaging using ICG is a feasible and safe method for SLN detection. In the future, this technique may represent a useful treatment for patients with early cervical cancer.

Sentinel lymph node in endometrial cancer: A systematic review on laparoscopic detection

Endometrial cancer (EC) is the most frequent gynecological malignancy in developed countries, and accounts for 6–9% of female malignancies. The prevalence is growing in overweight individuals and those with medical comorbidities such as diabetes and hypertension. Nodal status is a key determinant of the outcome and there is a strong rationale incorporating sentinel lymph node (SLN) biopsy in the management of EC. We performed a systemic review concerning studies investigating the role of laparoscopic detection of SLN in early-stage EC. The detection rate and sensitivity of the laparoscopic approach in SLN ranged from 69.6% to 100% and 58.6% to 100%, respectively. The combination of dye and radiocolloid detection substances is the best method for SLN detection in EC. The use of pericervical injection and the laparoscopic approach increase the detection rate of SLNs, especially in the iliac lymph node groups. The hysteroscopy injection technique highlights the presence of isolated para-aortic lymph node metastasis. However, the precise method of SLN biopsy in EC needs to be determined further.