Injection Of Patent Blue Dye Research Articles

Evaluation of Targetive Axillary Dissection in Node Positive Locally Advanced Breast Cancer Patients with Complete Pathological Response to Neoadjuvant Chemotherapy

Abstract Background This study aimed to evaluate targeted axillary dissection (TAD) in node locally advanced node positive breast cancer patients with complete pathological response to neoadjuvant chemotherapy. Methods This is a prospective cohort study including twenty-five females diagnosed with locally advanced breast cancer with proven lymph node involvement who had complete pathological response to the neoadjuvant chemotherapy regarding the clipped previously involved lymph node. Lymph node biopsy and frozen section of the clipped lymph node after wire localization and the sentinel lymph node after patent blue dye injection was done. This is followed by paraffin section examination of the lymph node biopsy and 6 months follow-up for the patients. Results Twenty-four patients out of twenty-five patients had successful localization of the clipped and sentinel lymph node with no macro-metastasis detected in frozen section. Twenty-two out of the twenty-four patients had no micro-metastasis in paraffin section. Two of the twenty-four patients had micro-metastasis on paraffin section and required axillary radiotherapy. One of the twenty-five patients failed localization of the clipped lymph node and received conventional axillary lymph node dissection. Two patients developed lymphoedema, one of them after axillary radiotherapy and the other one after axillary lymph node dissection. Conclusion The combination of TAD and SLNB can replace Axillary clearance in patients with node positive Locally advanced breast cancer with complete pathological response to neoadjuvant chemotherapy.

Evaluation of targeted axillary dissection in node positive locally advanced breast cancer patients with complete pathological response to neoadjuvant chemotherapy

BackgroundThis study aimed to evaluate targeted axillary dissection in node locally advanced node positive breast cancer patients with complete pathological response to neoadjuvant chemotherapy.Patients and methodsThis is a prospective cohort study including 25 females diagnosed with locally advanced breast cancer with proven lymph node involvement who had complete pathological response to the neoadjuvant chemotherapy regarding the clipped previously involved lymph node. Lymph node biopsy and frozen section of the clipped lymph node after wire localization and the sentinel lymph node after patent blue dye injection was done. This is followed by paraffin section examination of the lymph node biopsy and 6 months follow-up for the patients.ResultsTwenty-four patients out of 25 patients had successful localization of the clipped and sentinel lymph node with no macrometastasis detected in frozen section. Twenty-two out of the 24 patients had no micrometastasis in paraffin section. Two of the 24 patients had micrometastasis on paraffin section and required axillary radiotherapy. One of the 25 patients failed localization of the clipped lymph node and received conventional axillary lymph node dissection. Two patients developed lymphedema, one of them after axillary radiotherapy, and the other one after axillary lymph node dissection.ConclusionThe combination of targeted axillary dissection and sentinel lymph node biopsy can replace axillary clearance in patients with node positive locally advanced breast cancer with complete pathological response to neoadjuvant chemotherapy.

Successful localisation of recurrent thyroid cancer using preoperative patent blue dye injection

PurposeIn the follow-up of patients with thyroid cancer, recurrences are often detected, posing challenges in locating and removing these lesions in a reoperative setting. This study aimed to assess the effectiveness of preoperative ultrasound (US)-guided injection of patent blue (PB) dye into the recurrences to aid in their safe and efficient removal.MethodsIn this retrospective analysis, we reviewed the records of the patients in a tertiary care centre between February 2019 and March 2023 who underwent US-guided PB injection in the endocrinology outpatient clinic before reoperative neck surgery. The duration between the injection of PB and the initiation of surgery was recorded. The complications and effectiveness of the procedure were evaluated using ultrasonographic, laboratory, surgical, and pathologic records.ResultsWe reached 23 consecutive patients with 28 lesions. The recurrences averaged 8.8 mm (4.1–15.6) in size and were successfully stained in all cases. The median time between the PB injection and the incision was 90 (35–210) min. There were no complications related to the dye injection. The blue recurrences were conveniently identified and removed in all cases.ConclusionsA preoperative US-guided injection of PB is a safe, readily available and highly effective technique for localising recurrent tumours, even in small lesions within scarred reoperative neck surgeries.

Indocyanine Green Is a Safe and Effective Alternative to Radioisotope in Breast Cancer Sentinel Lymph Node Biopsy regardless of Patient Body Mass Index

Introduction: A recent meta-analysis [Lancet Oncol. 2010;11:908–909] has confirmed high sensitivity of indocyanine green (ICG) fluorescence mapping for sentinel node detection in early breast cancer. Concerns have previously been raised regarding the efficacy in patients with high body mass index (BMI). Materials and Methods: All consecutive patients undergoing sentinel lymph node biopsies (SLNBs) for early breast cancer in NHS Tayside were included in a prospective audit of surgical and pathology findings. All patients included in the study received dual injection of patent blue dye and ICG. Approval was obtained from the local Caldicott guardian for collection and use of personal data. Results: Of 239 cases, all were female patients of mean age 62 years (range 27–93). In 4.2% (10/239) of cases, neither blue dye nor ICG was present in the axilla. Of the remaining 229 SLNB cases in this series, surgeons documented retrieval of 451 nodes, with a mean surgical nodal count per case of 1.97 (range 1–5) and pathological nodal count of 2.15 (range 0–7). Eighty three cases were performed in patients with BMI 30–39.9 and 21 cases with BMI ≥40, with nodal detection rates of 96.4% (80/83) and 95.2% (20/21), respectively, in these groups of patients. Twenty percent (48/229) of cases had nodal metastases on histopathology. Conclusions: This is a large single-center study which demonstrates the safety and accuracy of the combined ICG and blue dye technique for SLNB in breast cancer. This is represented by nodal detection rates and node positivity rates which are comparable to previous multicenter studies of standard SLNB regardless of BMI.

A visualization system for erectile vascular dynamics.

Erection is an essential process which requires the male penis for copulation. This copulatory process depends on the vascular dynamic regulation of the penis. The corpus cavernosum (CC) in the upper (dorsal) part of the penis plays a major role in regulating blood flow inside the penis. When the CC is filled with blood, the sinusoids, including micro-vessels, dilate during erection. The CC is an androgen-dependent organ, and various genital abnormalities including erectile dysfunction (ED) are widely known. Previous studies have shown that androgen deprivation by castration results in significantly decreased smooth muscles of the CC. Experimental works in erectile biology have previously measured intracavernosal penile pressure and mechanical tension. Such reports analyze limited features without assessing the dynamic aspects of the erectile process. In the current study, we established a novel explant system enabling direct visual imaging of the sinusoidal lumen to evaluate the dynamic movement of the cavernous space. To analyze the alternation of sinusoidal spaces, micro-dissected CC explants by patent blue dye injection were incubated and examined for their structural alternations during relaxation/contraction. The dynamic process of relaxation/contraction was analyzed with various external factors administered to the CC. The system enabled the imaging of relaxation/contraction of the lumens of the sinusoids and the collagen-containing tissues. Histological analysis on the explant system also showed the relaxation/contraction. Thus, the system mimics the regulatory process of dynamic relaxation/contraction in the erectile response. The current system also enabled evaluating the erectile pathophysiology. In the current study, the lumen of sinusoids relaxed/contracted in castrated mice similarly with normal mice. These results suggested that the dynamic erectile relaxation/contraction process was similarly retained in castrated mice. However, the system also revealed decreased duration time of erection in castrated mice. The current study is expected to promote further understanding of the pathophysiology of ED, which will be useful for new treatments in the future. Hence, the current system provides unique information to investigate the novel regulations of erectile function, which can provide tools for analyzing the pathology of ED.

Assessment of Intraparenchymal Injection of 1% Patent Blue Dye in the Upper Outer Quadrant of the Breast to Identify Sentinel Lymph Node in Early Retro-Areolar Breast Cancer in Women: A Tertiary Centre Experience in Egypt.

Sentinel lymph node biopsy is the gold standard for axillary assessment of patients with clinically node negative breast cancer. The current internationally accepted methods comprise of the usage of either a radioactive tracer, vital stains or the combination of both. However, in developing countries radioactive tracer is not widely used due to its high cost and limited availability. In addition, the classic retro-areolar blue dye injection has a high failure rate. Our study aimed to assess the efficacy of patent blue dye injection in the upper outer quadrant of the breast after validation by concurrent usage of radioactive nanocolloid, in comparison with the classic retro-areolar injection in identifying the sentinel node. A randomized control study involving 279 patients randomly divided into two groups. In group A lateral injection of 1% patent blue dye (validated by radioactive nanocolloid) was used, while subdermal patent blue dye injection in the retro-areolar space was performed in group B. The new technique showed the promising results with lower failure rate (3.4%) in comparison with the classic retro-areolar patent blue injection (13.7%). The lateral injection technique can be result in comparable results to the combination technique with the added benefit of being widely available and a cheaper option especially in developing countries.

The Utility of Indocyanine Green Dye Fluorescence Lymphography and Angiography During Wide Excision of Cutaneous Melanoma.

Background and Objectives. Lymph node status is the most important prognostic factor in cutaneous melanoma patients. Recent studies showed that indocyanine green (ICG) fluorescence lymphography helps locating sentinel nodes better. Sometimes, flap reconstruction is needed after wide excision of tumor. Indocyanine green fluorescence also simplifies the intraoperative design of flaps. This study investigates the use of ICG fluorescence in patients with cutaneous melanoma during operation. Methods. We performed a single-center, retrospective study of subjects with cutaneous melanoma using ICG lymphograhy and/or angiography during wide excision of tumor between 2015 and 2019. Patients received a dermal injection of ICG and patent blue (PB) dye. The positive node was excised. Indocyanine green angiography was utilized to visualize better skin paddle during flap reconstruction if needed. Results. A total of 37 sentinel lymph nodes (SLNs) were removed in 12 patients. Indocyanine green successful localization was found in 10 of the 12 patients (83%). Three patients were found with 6 metastatic nodes on final pathology. 100% of these 6 nodes were identified by ICG, while 83% (5/6) were positive PB. Three of the 12 patients received flap reconstruction after operation, and no major complications occurred. Conclusions. ICG dye lymphangiography is a good alternative for locating SLNs in patients with melanoma. It could also visualize well perfusion skin paddle during reconstruction. We reported a reproducible and simple method to utilize ICG fluorescence in cutaneous melanoma patients.

Anaphylactic Shock after Patent Blue Dye Injection

Intraoperative anaphylactic shock is an unusual complication. About a case report a severe anaphylactic reaction to Patent Blue (PB) dye used in sentinel node biopsy for lymphatic mapping during breast cancer surgery to stage the axilla, the authors discuss the mechanisms, principles of treatments, and prevention measures of this complication.

RECURRENT INGUINAL LYMPHOCELE - A THERAPEUTIC CHALLENGE.

Recurrent lymphocele after repair of crural hernia without resolution after several aspirations and injections of sclerosing agents. Reintervention with lymphatic marking (injection of patent blue dye at the interdigital level, Figure 1 a) Lymphatic marking through injection of patent blue dye at the interdigital level. b) Surgical approach of the inguinal region. Figure 1), followed by en bloc removal of the ganglia of the saphenofemoral junction and the lymphocele capsule (Figure 2). No evidence of recurrence at 24 months of follow- up.

Kounis syndrome after patent blue dye injection for sentinel lymph node biopsy

Kounis syndrome (KS) has been described as an acute coronary syndrome (ACS) associated with an anaphylactic reaction. Several triggers have been identified and the diagnostic and treatment process can be challenging. A 58-year-old, female patient diagnosed with breast cancer and no history of allergies had subcutaneous injection of patent blue V dye for sentinel lymph node biopsy (SLNB). Intraoperatively, she developed anaphylactic shock and was transferred to the intensive care unit (ICU). A few hours later, electrocardiographic alterations and elevation of blood troponin were observed. Emergency coronary angiography revealed no occlusive lesions in coronary vessels. Further investigation in the allergy department set the diagnosis of KS. There are just ten cases of perioperative KS in the literature so far and here we present the first one triggered by patent blue V dye for sentinel node biopsy.

Comparison between sentinel lymph node hybrid scintigraphy and blue dye technique in breast cancer patients: An institutional experience.

To compare the detection efficacy of radionuclide lymphoscintigraphy (LS) versus patent blue dye (PBD) technique for hidden sentinel lymph node (SLN) in breast cancer patients and to determine which modality is better for SLN detection. One hundred and thirty-four early stage breast cancer female patients with clinically negative axilla who underwent post technetium-99m nanocolloid injection single photon emission computed tomography (SPECT-CT) for negative SLN on planar imaging were studied prospectively between 2015 and 2017. Following SPECT-CT, patients underwent peroperative gamma probe count detection GP-CD and PBD technique. Visually, blue stained ± hot nodes were surgically removed and subjected to histopathological analysis. The detection rate by individual method was calculated. Kappa statistics were applied to calculate overall agreement between radioisotope and PBD techniques for diagnostic value assessment. One hundred and thirty-four patients underwent SPECT-CT LS and PBD injection. Mean age: 47 ± 7.6 years (range: 26–82 years). Forty-nine (36.6%) had T1 and 85 (63.4%) T2. SPECT-CT LS detected SLN in 105/134 cases (success rate: 78.4%), later GP-CD localized “hot nodes” in additional 20 cases (success rate: 93.3%). The PBD successfully localized SLN in 131/134 (97.8%) cases. Three cases remained negative on both radioisotope and PBD localization, which on subsequent nodal dissection had metastatic disease. All SLNs detected on SPECT-CT showed blue dye uptake. In 112 cases, more than one SLN was surgically removed. Frozen section analysis of excised SLNs showed metastasis in 31%. Overall moderate agreement (k = 0.56) was calculated. No statistically significant difference was seen between isotope detection and PBD. Radionuclide sentinel mapping has good detection rate particularly combined with peroperative GP-CD. The PBD has added value to reduce false-negative rate of SLN mapping and can substitute radionuclide imaging with negative results.

A simple and efficient method to perform preoperative pulmonary nodule localization: CT-guided patent blue dye injection

ObjectiveTo assess the efficacy of computed tomography (CT)-guided localization with the injection of a low dose of patent blue dye (PBD) for the thoracoscopic resection of pulmonary nodules. Materials and methodsOverall, 125 consecutive patients underwent CT-guided localization with injection of a lower dose of PBD between June 2015 and June 2016. The total injection dose relative to the distance between nodules and the visceral pleura was recorded. The clinical and radiological characteristics, technical details, pathological results and procedure-related complications were reviewed. ResultsA total of 137 indeterminate pulmonary nodules were identified. The mean nodule size was 9.5 (3.0–22.0) mm. The mean injection dose of PBD relative to the distance between nodules and the visceral pleura was classified as follows: 0.07 ml: <1 cm, 0.1 ml: 1–2 cm and 0.18 ml: >2 cm. The mean time of CT-guided localization was 16.5 (10–50) min. The mean time interval from localization to surgery was 188 (24–1440) min. Pneumothorax developed in 50 patients (40%), and focal parenchymal hemorrhage occurred in 16 patients (12.8%) after localization. No patient required chest tube placement or emergent resuscitation. The success rate of dye marking was 98.5% (135/137). Malignancies, including 82 lung cancers, were diagnosed in 97 nodules (70.8%). ConclusionThe injection of a lower dose PBD based on the distance to the visceral pleura can be successful with nodular localization and may facilitate thoracoscopic surgery, even in cases with a long interval from localization to surgery.

Abstract No. 565 An efficient and precise technique of preoperative pulmonary nodule localization: computer tomography-guided patent blue dye injection

Resection of small pulmonary nodules via video assisted thoracic surgery (VATS) is usually challenging without preoperative localization. The aim of this study is to evaluate the efficacy of our experience in CT-guided preoperative localization with patent blue dye injection to facilitate thoracoscopic resection of pulmonary nodules. 125 consecutive patients underwent CT-guided localization with injection of patent blue dye between June 2015 to June 2016. The clinical and radiological characteristics, technical details, pathological results and procedure related complications were retrospectively reviewed. 125 consecutive patients (44 men and 81 women) with 137 indeterminate pulmonary nodules (46 pure ground-glass opacity nodules, 41 part-solid nodules and 50 solid nodules) were included in the study. The mean size of the nodules was 9.5 mm (3.0–22.0 mm). The mean distance between the nodule and pleural surface was 12.1 mm (2.0–42.1 mm). The mean procedure time of CT-guided localization was 16.5 min (10–50 min). The mean time interval from dye injection to operation was 188 min (range, 24–1440 min). Pneumothorax developed in forty patients (32%) and focal parenchymal hemorrhage was identified in 16 patients (12.8%) after localization. No patient required air drainage. Although non-visualization of dye marking occurred in 2 patients, focal hematoma and puncture hole can be identified on the pleural surface. Therefore, all nodules were successfully resected by VATS without conversion to open thoracotomy. 103 nodules (75.1%) were confirmed as malignancies including 87 primary lung cancer. CT-guided patent blue dye localization is an efficient technique which facilitates successful resection of small pulmonary nodules even if a long duration from localization to operation is needed.

Omitting Preoperative Lymphoscintigraphy Does Not Decrease Sentinel Lymph Node Detection Rate in Vulvar Cancer

Sentinel lymph nodes in vulvar cancer can be detected in a variety of ways. A method described in GOG-173 involves injection of technetium-99m and isosulfan blue intraoperatively. Lymphoscintigraphy, for which the technetium-99m is injected preoperatively, became required two years into the study due to unpublished evidence that lymphoscintigraphy improved intraoperative sentinel lymph node localization. Despite this amendment, the need for preoperative lymphoscintigraphy has been questioned. The primary objective of this study was to determine the detection rate of sentinel lymph nodes in vulvar cancer when preoperative lymphoscintigraphy is omitted. The secondary objective was to compare the sentinel lymph node detection rate when lymphoscintigraphy is omitted to the rate reported in GOG-173, in which preoperative lymphoscintigraphy was performed. The tertiary objective was to determine lymphoscintigraphy cost at one institution. Patients with vulvar cancer who underwent sentinel lymph node dissection at a single institution from 2008 to 2016 were identified. All but one patient had intraoperative peritumoral injection of both technetium-99m and patent blue dye. Patients were excluded if preoperative lymphoscintigraphy was performed. Information on demographics, pathology, and outcomes were collected. Descriptive statistics were used for patient demographics, tumor characteristics, and the detection rate. A 1-sample proportion test was used to compare our detection rate to data available from GOG-173. Percentages were rounded to the nearest whole number. Current procedural terminology codes were used to estimate lymphoscintigraphy cost. Fifty patients were identified and 32 patients were deemed eligible for the study. The sentinel lymph node detection rate was 97% per patient, which was not statistically different from the rate of 92% reported in GOG-173 (p = 0.347). It was determined that lymphoscintigraphy cost $5,288.22 per imaging study. In this study, omitting preoperative lymphoscintigraphy did not decrease sentinel lymph node detection rates when compared to GOG-173. Furthermore, there is a substantial cost associated with lymphoscintigraphy, although this cost may vary between institutions.

Usefulness of sentinel lymph node biopsy for the detection of metastasis in the early stage of extramammary Paget's disease.

Invasive cases of extramammary Paget's disease have a poor prognosis, owing to its rapid progression and resistance to irradiation and chemotherapy. Morton et al. introduced a technique to identify sentinel lymph nodes by local injection of vital dyes and reported its benefit for managing the progress of malignant melanoma. Since the rate of lymph node metastasis of extramammary Paget's disease is not uncommon (reported from 8.5% to 26%), this study tested the hypothesis that sentinel lymph node biopsy would be useful to detect lymph node metastasis in the clinically early stage of extramammary Paget's disease. Eighteen patients with primary extramammary Paget's disease were enrolled in the study. The precise location of sentinel lymph nodes was visualized using either intraoperative patent blue dye injection or indocyanine green dye injection in combination with a hand-held gamma-detecting probe after a 99mTc phytate injection. Of the 18 patients, sentinel lymph node metastasis was identified in 2 (Cases 2 and 15) of the 2 patients with deep invasion and in 1 (Case 12) of the 7 patients with minimal dermal invasion, however, it was absent in 9 patients who had been categorized into the intraepidermal group. This study demonstrates that extramammary Paget's disease possibly causes metastasis via regional lymphatic systems to which the lesion belongs, even in the early stages of no nodule or tumor formation, and that sentinel lymph node biopsy is useful to detect lymph node metastasis.

Accidental injection of patent blue dye during gynaecological surgery: Lack of knowledge constitutes a system error

The authors report a case in which an intravenous injection of Patent Blue V dye instead of Indigo Carmine was given during routine gynaecological surgery. The patient presented with temporary arterial (spurious) desaturation and skin discoloration over a 48-hour period. Pharmacological differences between these dyes are described. Root cause analysis based on the ALARM (Association of Litigation and Risk Management) model is presented. The authors emphasise that use of this model should not be limited solely to describing and correcting well known systems errors such as working conditions or teamwork and communication. Furthermore, they conclude that insufficient knowledge must also be recognised as a systems error and as such should be sought out and corrected using similar strategies to those used to discover other contributory factors, without allocation of blame to any individual.

Axillary reverse mapping in breast cancer: a Canadian experience.

The aim of this study was to evaluate the axillary reverse lymphatic mapping (ARM) procedure for reducing the risk of arm lymphedema after breast cancer surgery. The ARM procedure was carried out with a subareolar injection of technetium-99 sulfur colloid the morning of surgery, and a patent blue dye injection into the upper inner arm after anesthesia. Fifty-two women made up our study population. Thirty-seven patients underwent sentinel lymph node biopsy (SLNB) and 15 patients underwent an axillary lymph node dissection (ALND) for known nodal metastasis. The sentinel lymph node was identified in 36 of the 37 cases who underwent SLNB alone and in 12 of 15 patients who underwent on ALND. In 13 patients, both blue and radioactive lymph nodes or lymphatics were clearly identified (25%) and 5 patients had a clear crossover with nodes being both blue and hot. Only a single patient with crossover lymphatics had metastases present in their sentinel node. The ARM technique did not prevent identification of the SLN and we identified much greater crossover than reported. We had a single patient, who underwent a sentinel node biopsy, with mild arm lymphedema (1.9%) after 2 years of follow up.

Patent blue and air as an alternative for resection of nonpalpable breast lesions: a case series.

Use of mammography for breast cancer screening has resulted in a significantly increased number of patients with nonpalpable radiological findings that need histopathological study for better management. The present study evaluated an alternative to excision of nonpalpable breast lesions, using injection of patent blue (CAS 3536-49-0) dye and air. Cohort study of 64 consecutive patients at a private clinic in the city of Teresina (Piauí), between January 2009 and December 2010. The patients had received mammographic diagnoses of nonpalpable breast lesions classified as BI-RADS 3, 4 and 5, with indication of histopathological study. They underwent stereotaxy and/or ultrasound-guided injection of patent blue, for marking and subsequent excision of the lesion. The patients' mean age was 47.7 years. Nodes accounted for 53.1% of the breast abnormalities; microcalcifications, 37.5%; and complex cysts, 9.4%. In 89.1% of cases, the lesions were BI-RADS 4; 7.8% were BI-RADS 5 and 3.1% were BI-RADS 3. The histopathological findings were benign in 70.3% of the cases; atypical hyperplasia, 9.4%; and malignant, 20.3%. Among the malignant cases, 53.8% were carcinoma in situ and 46.2%, invasive carcinoma. The percentage of malignancy was 0% in BI-RADS 3 lesions; 14.3% in BI-RADS 4 and 100% in BI-RADS 5. In the cases of malignancy, the margins were clear in 92.3%. Reoperation to widen the margins was required in one patient. Excision of nonpalpable breast lesions marked with patent blue and air was possible in all cases.

Microsurgery for groin lymphocele and lymphedema after oncologic surgery

Groin lymphocele (GL) is a frequent complication of inguinal lymph node dissection, and conservative treatment is not always successful. Different surgical methods have been used to treat lymphoceles arising from lymphatics injured during groin surgery. However, they all involve the closure of lymphatics merging at the lymphocele, increasing the risk of postoperative lower limb lymphedema or of worsening lymphedema if already clinically evident. We assessed the efficacy of a diagnostic and therapeutic protocol to manage inguinal lymphoceles using lymphoscintigraphy (LS) and microsurgical procedures. Sixteen GL [seven associated with leg lymphedema (LL)] were studied by LS preoperatively and treated by complete excision of lymphocele and microsurgical lymphatic-venous anastomoses between afferent lymphatics and a collateral branch of great saphenous vein. Lower limb lymphatics were identified intraoperatively using Patent Blue dye injection. Nine patients without lymphedema had complete healing of lymphocele and no appearance of lower limb postoperative lymphedema. The other seven patients with associated secondary lymphedema had complete disappearance of lymphocele and a remarkable reduction of leg volume. Four of them completely recovered without the need of any compression garment, after the first year postoperative. Inguinal lymphocele nonresponsive to conservative treatment can be advantageously studied by LS and successfully treated by microsurgical reconstructive procedures, above all if associated to LL.

Ressecções gástricas menores com linfadenectomia modificada em câncer gástrico precoce com linfonodo sentinela negativo

To study the sentinel lymph node in early gastric cancer as a diagnostic method of unsuspected lymph node metastasis, which may allow the performance, in those with negative lymph nodes, of smaller gastric resections with limited lymphadenectomy. We studied seven patients with early gastric cancer treated at the Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, from September 2008 to May 2011, who underwent sentinel lymph node exams, performed by intraoperative peritumoral endoscopic injection of patent blue dye. We found an average of three sentinel nodes per patient. The frozen biopsy of lymph nodes was negative for metastases, which allowed the realization of atypical gastric resection in three cases and antrectomy with BI reconstruction in four. The performed lymphadenectomy was modified D1. There was no operative mortality. The duration of postoperative follow-up ranged from five to 37 months, without evidence of recurrence. One patient developed a second early tumor 13 months after the initial surgery and underwent total gastrectomy. The sentinel lymph node in early gastric cancer proved to be an effective method for the evaluation of nodal metastases in seven patients and allowed for smaller gastric resections and limited lymphadenectomies. These minor procedures reduce the risk of postoperative complications, maintaining, on the other hand, the oncological radicality that is required in the treatment of gastric cancer.