Patients Undergoing Sentinel Lymph Node Research Articles

Contrast-enhanced ultrasound-guided sentinel lymph node biopsy in early-stage breast cancer: a prospective cohort study

ObjectiveThis study evaluated the identification efficiency of contrast-enhanced ultrasound (CEUS) for sentinel lymph nodes (SLN) to accurately represent the axillary node status in early-stage breast cancer.MethodIn total, 109 consecutive consenting patients with clinically node-negative and T1-2 breast cancer were included in this study. All patients received CEUS to identify SLN before surgery, and a guidewire was deployed to locate SLN in those who were successfully explored by CEUS. The patients underwent sentinel lymph node biopsy (SLNB), and the blue dye was used to trace SLN during the surgery. The decision to perform axillary lymph node dissection (ALND) depended on the intraoperative pathological identification of SLN by CEUS (CE-SLN). The concordance rate of pathological status between CE-SLN and dyed SLN was calculated.ResultThe CEUS detection rate was 96.3%; CE-SLN failed in 4 patients. Among the remaining 105 successful identifications, 18 were CE-SLN positive by intraoperative frozen section, and one with CE-SLN micrometastasis was diagnosed by paraffin section. No additional lymph node metastases were found in CE-SLN-negative patients. The concordance rate of pathological status between CE-SLN and dyed SLN was 100%.ConclusionCEUS can accurately represent the status of axillary lymph nodes in patients with clinically node-negative and small tumor burden breast cancer.Graphical

Long-term survival outcomes in high-risk endometrial cancer patients undergoing sentinel lymph node biopsy alone versus lymphadenectomy

ObjectiveEndometrial cancer is the most common gynecologic neoplasm. To date, international guidelines recommend sentinel lymph node biopsy for low-risk neoplasms, while systematic lymphadenectomy is still considered for high-risk cases. This...

SPECT/CT Lymphoscintigraphy Accurately Localizes Clipped and Sentinel Nodes After Neoadjuvant Chemotherapy in Node-Positive Breast cancer.

The aim of this study was to evaluate the impact of SPECT/CT lymphoscintigraphy on targeted axillary dissection (TAD) in node-positive breast cancer (BC) patients who had undergone neoadjuvant chemotherapy (NAC). Sixty-two female BC patients with biopsy-confirmed axillary nodal metastases underwent NAC, followed by breast surgery with TAD. A metallic clip was placed in the sampled LN before NAC. On the day of surgery, a periareolar intradermal 99mTc-nanocolloid injection was administered, followed by SPECT/CT lymphoscintigraphy. The clipped nodes were localized on CT images, assessed for 99mTc uptake before surgery, and confirmed during the procedure. T1-4, N1-2 patients were enrolled in the study. All patients underwent sentinel lymph node (SLN) biopsy. The clipped node was the SLN in 54 (88.5%) patients. In 3 patients (4.9%), a clip was found in a nonsentinel lymph node. In 4 patients, the clips were not visible on SPECT/CT images, and lymph nodes were not found during the procedure. SPECT/CT correctly localized the clipped lymph node in all patients. The overall false-negative rate for TAD was 3.33%. The mean follow-up duration was 29 months, and there were no axillary recurrences. SPECT/CT lymphoscintigraphy can accurately localize clipped nodes and SLNs after NAC in patients with node-positive BC.

Effect of lymph node sampling type on oncologic outcomes in endometrial cancers: comprehensive pelvic and paraaortic lymphadenectomy vs. sentinel lymph node mapping with indocyanine green.

Sentinel lymph node biopsy refers to an innovative and minimalist surgical approach that has been introduced to reduce both complications and morbidity. A definitive answer to the question of whether lymphadenectomy is performed for staging or curative purposes in endometrial cancer has not yet been found. The aim of this study is to compare patients who underwent sentinel lymph node biopsy with indocyanine green and those who underwent laparoscopic complete surgical staging in terms of survival. A total of 182 patients was included in the study. The patients were divided into two groups according to the lymph node sample type. The two groups were compared in terms of oncological outcomes. 92 patients underwent sentinel lymph node mapping (SLNM cohort) and 90 patients underwent extensive pelvic and paraaortic lymphadenectomy (SCL cohort). Considering only patients with negative lymph nodes, the Sentinel cohort was associated with a reduced DFS and OS (p=0.008 and p=0.005, respectively). This difference may be due to the longer follow-up times of patients with comprehensive lymph node sampling. On the other hand, There was no difference in survival in lymph node positive cases. Sentinel lymph node dissection has no negative effect on survival in lymph node positive patients.

Surgical Treatments for Ductal Carcinoma In Situ (DCIS) in Elderly Patients.

Despite an aging population, there is no consensus regarding ductal carcinoma in situ (DCIS) treatment for elderly women. Breast surgery can be well tolerated even in elderly patients. The aim of this study is to evaluate the surgical management of DCIS in elderly patients. We retrospectively analyzed patients with DCIS from 2016 to 2022 at our Breast Unit and divided our population according to age. Out of 231 patients with DCIS, 45 (19.5%) were elderly. The Charlson comorbidity index and American Society of Anesthesiology (ASA) score was significantly higher in the elderly (p<0.001 for both). Among the elderly, 10 (22.2%) patients received upstaging diagnoses, versus 18 (9.7%) in the control (p=0.048). Twelve (26.7%) of the elderly patients underwent sentinel lymph node biopsy, versus 93 (50%) in the control group (p=0.005). No difference was reported between groups in terms of breast conserving surgeries performed. A higher incidence of surgeries performed using local anesthesia was reported in the elderly group (p=0.041). Thirty-day surgical complications, according to Clavien-Dindo, did not show significant differences. Despite higher comorbidity and ASA score, breast surgery is safe and feasible in elderly patients. Due to the higher risk of upstaging to invasive ductal carcinoma, surgery should be performed but sentinel lymph node biopsy should be omitted, owing to the low risk of lymph node metastasis and lower use of adjuvant treatments.

The Role of Hemogram Parameters in Predicting Sentinel Lymph Node Metastasis in Breast Cancer

Abstract: Background: Breast cancer remains the second most common cancer in the world after lung cancer. Breast cancer rate in Turkey was 40-50 / 100.000 in the west, and was 20 / 100.000 in the east. Objective: In our study, we aimed to investigate the prediction of hemogram parameters in showing sentinel lymph node metastasis. Materials &amp; Methods: Patients undergoing sentinel lymph node biopsy (SLNB) with the diagnosis of breast cancer between January 2015 and August 2019 in General Surgery Department of Abant Izzet Baysal University were retrospectively analyzed in present descriptive study. The patients were divided into two groups, SLNB positive and negative. The measured hemogram parameters were compared between these two groups. Analysis of the data was held with a statistical software (SPSS 18.0 for Windows, IBM Inc., Chicago, IL, USA). Results: A total of 93 patients were included in the study. The average age of SLNB positive and negative patients were 55 (30-81) years 59 (35-88) years respectively. In detecting SLNB positivity, sensitivities and specificities of Tumor diameter&gt; 0.9 cm were 72% sensitivity, 56% specificity, of CRP&gt; 0.65 mg/dL were 76% sensitivity, 51% specificity, of RMR&gt; 1.85 were 72% sensitivity, 46% specificity, of RDW&gt; 15.45% were 75% sensitivity,% 42 specificity, of PLR&gt; 106.5 were 72% sensitivity, 56% specificity. Conclusion: Since auxiliary metastasis is one of the most important points for the prognosis of breast cancer, we suggest PLR, RDW, RMR could serve as prognostic factors in determining lymph node metastasis along with CRP and tumor size in breast cancer.

Does Stage Migration Occur as a Consequence of Omitting Completion Lymph Node Dissection for Melanoma?

Completion lymph node dissection (CLND) is no longer recommended routinely in the treatment of melanoma. CLND omission may understage patients for whom the distinction between stage IIIA and IIIB-C could alter adjuvant therapy recommendations. The aim of this study is to determine if stage migration has occurred with the declining use of CLND. Patients with clinically node-negative ≥T1b cutaneous melanoma were identified from the National Cancer Database (NCDB) from 2012 to 2018. CLND utilization and changes in AJCC staging were analyzed. Patients undergoing sentinel lymph node biopsy (SLNB) alone were compared with those undergoing SLNB + CLND. Overall, 68,933 patients met inclusion criteria and 60,536 underwent SLNB, of which 9031 (14.9%) were tumor positive. CLND was performed in 3776 (41.8%). Patients undergoing CLND were younger (58 versus 62 years, p < 0.0001) and more likely male (61.5% versus 57.9%, p = 0.0005). Patients were more likely to have an N classification >N1a if they received SLNB + CLND (36.8%) versus SLNB alone (19.3%), p < 0.0001. This translated to a small difference in stage IIIA patients between groups (SLNB alone 34.0%, SLNB + CLND 31.8%, p < 0.0001). Of the patients with T1b/T2a tumors who would be upstaged from IIIA to IIIC with identification of additional positive nodes, IIIC incidence was only slightly higher after SLNB + CLND compared with SLNB alone (4.4% versus 1.1%, p < 0.0001). CLND utilization dramatically decreased from 59% in 2012 to 12.6% in 2018, p < 0.0001. However, the incidence of stage IIIA disease for all patients remained stable over the 7-year study period. While the utilization of CLND after positive SLNB has declined dramatically in the last 7 years, stage migration that may affect adjuvant therapy decisions has not occurred to a clinically meaningful degree.

Predictive factors of sentinel lymph node failed mapping in endometrial carcinoma patients: a systematic review and meta-analysis

ObjectiveIn endometrial carcinoma patients, sentinel lymph node bilateral mapping fails in 20–25% of cases, with several factors affecting the likelihood of detection. However, pooled data about predictive factors of failure...

Abstract P2-14-10: Axillary Reverse Mapping Aids in Reducing the Rates of BCRL in Underserved Ethnically Diverse Population

Abstract Background: Breast Cancer Related Lymphedema (BCRL), is a long-term side effect affecting the patient’s quality of life after lymph node surgery. Historically BCRL is seen in 5-7% and 15-40% of patients undergoing sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) respectively; with the risk increasing two-fold in low-income and ethnic minority groups. Axillary Reverse Mapping (ARM) is a novel technique to distinguish drainage pathways of the arm and breast, and prior studies have reported significantly lower rates of BCRL with ARM. Lymphatic re-approximation can prevent and/or reduce lymphedema rates in cases where crossover nodes are encountered. Furthermore, blue nodes can be preserved during ALND; however, if resected during ALND, lymphatic venous (LYMPHA) procedure can help to restore lymphatic flow. However, there is a paucity of literature looking at the utility of ARM in ethnically minority groups. Therefore, we aimed to evaluate the prevalence of lymphedema in our patient population with breast cancer undergoing SLNB and ALND using ARM and in turn compare these findings to historical controls. Materials &amp; Methods: A retrospective study was carried out on patients who underwent axillary surgery with ARM from January 2019 to July 2021. Patient demographics such as age, BMI, gender, and ethnicity were recorded. Patients undergoing mastectomy vs breast conservation with SLNB ± ALND associated with ARM were monitored for lymphedema for a year at 3-month intervals using SOZO® scores, and then for another 2 years clinically. At each follow-up, SOZO® scores were computed using bioimpedance spectroscopy and compared to preoperative baseline scores. Results: A total of 142 patients’ data was evaluated, of which 83.8% belonged to the minority group (African American = 46, Hispanic = 63, Asian = 10). Mean BMI accounted for 29.1+5.31. Breast conservation surgery and mastectomy were performed in 71.8% (n=102) and 28.1% (n=40) of patients respectively. SLNB was performed on 88.7% (n=126) of the patients and ALND was carried out on 11.3% (n=16). Furthermore, 73.9% (n=105) of the patients underwent radiation therapy. Positive lymph nodes were identified in 24.6% (n=35) of patients. Blue nodes and blue lymphatics were encountered in 17.6% (n=25) and 32.4% (n=46) of patients respectively. Out of the blue nodes identified (n=25), 44% (n=11) were excised and 32% (n=8) were diagnosed as crossover nodes. All the crossover nodes were resected but none of them contributed to the development of lymphedema. Moreover, 90.9% of the patients with blue lymphatics underwent lymphatic re-approximation after excision of the blue nodes. Of the 142 patients, 59 had a three-month follow-up of which 2 patients (3.4%) developed clinical lymphedema diagnosed via SOZO® who had undergone SLNB which resolved by 6-month follow-up. Additionally, compared to the historical incidence of BCRL which accounts for up to 40.4% in ethnic minorities, we found a significantly lower incidence of lymphedema (p&amp;lt; 0.001) in our patient population. Moreover, in our study, ALND and radiation therapy did not contribute to lymphedema rates. Conclusion: ARM procedure can significantly lower BCRL even in ethnically minority groups. 3.4% of patients undergoing SLNB developed BCRL, which was significantly lower than historically reported data. Furthermore, in our study, no patients who underwent ALND developed lymphedema. Also, crossover nodes or radiation therapy did not contribute to the development of lymphedema after surgery demonstrating the effectiveness of ARM technique. Further studies with larger sample size and longer follow-up duration are necessary to better understand the utility of ARM technique in this population. Table 1 Baseline characteristics and follow-up data of the patients undergoing Axillary Reverse Mapping with SLNB ± ALND Citation Format: Fardeen Bhimani, Maureen McEvoy, Kelly Johnson, Sheldon Feldman. Axillary Reverse Mapping Aids in Reducing the Rates of BCRL in Underserved Ethnically Diverse Population [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 P2-14-10.

Phase II activity trial of high-dose radiation and chemosensitization in patients with macrometastatic lymph node spread after sentinel node biopsy in vulvar cancer: GROningen INternational Study on Sentinel nodes in Vulvar cancer III (GROINSS-V III/NRG-GY024)

BackgroundStandard treatment of early-stage vulvar cancer is a radical, wide, local excision of the primary tumor and a sentinel lymph node (SLN) procedure for the groins. An inguinofemoral lymphadenectomy is...

The effect of positron emission tomography/computed tomography in axillary surgery approach after neoadjuvant treatment in breast cancer

The aim of this study was to determine the role of positron emission tomography/computed tomography in the decision to perform axillary surgery by comparing positron emission tomography/computed tomography findings with pathology consistency after neoadjuvant chemotherapy. Patients who were diagnosed for T1-4, cN1/2 breast cancer receiving neoadjuvant chemotherapy in our clinic between January 2016 and February 2021 were evaluated. Clinical and radiological responses, axillary surgery, and histopathological results after neoadjuvant chemotherapy were evaluated. Axillary involvement was not detected in positron emission tomography/computed tomography after neoadjuvant chemotherapy in 140 (60.6%) of 231 node-positive patients. In total, 88 (62.8%) of these patients underwent sentinel lymph node biopsy, and axillary lymph node dissection was performed in 29 (33%) of these patients upon detection of 1 or 2 positive lymph nodes. The other 52 (37.1%) patients underwent direct axillary lymph node dissection, and no metastatic lymph nodes were detected in 33 (63.4%) patients. No metastatic lymph node was found pathologically in a total of 92 patients without involvement in positron emission tomography/computed tomography, and the negative predictive value was calculated as 65.7%. Axillary lymph node dissection was performed in 91 (39.4%) patients with axillary involvement in positron emission tomography/computed tomography after neoadjuvant chemotherapy. Metastatic lymph nodes were found pathologically in 83 of these patients, and the positive predictive value was calculated as 91.2%. Positron emission tomography/computed tomography was found to be useful in the evaluation of clinical response, but it was not sufficient enough to predict a complete pathological response. When planning axillary surgery, axillary lymph node dissection should not be decided only with a positive positron emission tomography/computed tomography. Other radiological images should also be evaluated, and a positive sentinel lymph node biopsy should be the determinant of axillary lymph node dissection.

Indocyanine green in diagnostics and reconstructive surgery for breast cancer

To analyze the efficacy of sentinel lymph node detection using indocyanine green (ICG) in breast cancer. The study included 153 breast cancer patients (stage 0-I-II-III, cN0 or cN1-ycN0) between October 2022 and April 2023. All patients underwent sentinel lymph node biopsy using ICG. Sentinel lymph node was successfully detected in 150 cases out of 153 ICG injections. Optimal period between ICG injection and its accumulation in regional lymph nodes was 10-12 min. Sensitivity of sentinel lymph node detection was 98.0% that exceeds the approximate value of radioisotope method adopted as a standard (96.9-97.2%), as well as sensitivity of proprietary blue dye (90.6-95.0%). Specificity of this method was 100%. The authors' experience regarding application of indocyanine green is consistent with numerous world statistics and proves the possibility of its effective use for sentinel lymph node biopsy. It is necessary to introduce this diagnostic method as a leading or alternative method for analysis of sentinel lymph node in national clinical guidelines.

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.

Sentinel lymph node biopsy in women over 70: Evaluation of rates of axillary staging and impact on adjuvant therapy in elderly women

BackgroundThe 2016 Society of Surgical Oncology Choosing Wisely guidelines recommended against routine sentinel lymph node biopsy in women ≥70 years old with favorable, early-stage breast cancer, as sentinel lymph node biopsy does not decrease recurrence or mortality in these patients. This study’s objective was to evaluate the use of sentinel lymph node biopsy and its effect on management in elderly patients. MethodsA retrospective analysis of female patients ≥70 years old with stage I–II, clinically node-negative, hormone-receptor positive, HER2-negative disease undergoing upfront breast cancer surgery between 2017 and 2019. Primary outcome was rate of sentinel lymph node biopsy. Secondary outcome was effect of sentinel lymph node biopsy on adjuvant therapy. ResultsIn total, 142 patients were included. Median age was 76 (interquartile range 73–81), and 71.8% underwent lumpectomy. On final pathology, 57.7% had invasive ductal carcinoma, and median tumor size was 15 mm (interquartile range 10–24.3). A total of 118 patients (83.1%) underwent sentinel lymph node biopsy; of these, 27 (22.9%) were positive for N1mi (7 patients) or N1a disease (20 patients). On multivariate regression analysis, patients undergoing sentinel lymph node biopsy were more likely to be younger (odds ratio 0.87, 95% confidence interval 0.78–0.95). The major risk factor for sentinel lymph node biopsy positivity was lymphovascular invasion (odds ratio 13.4, 95% confidence interval 4.57–40.1). Patients with sentinel lymph node biopsy positivity were more likely to receive local adjuvant radiation therapy (odds ratio 4.66, 95% confidence interval 1.49–16.8) and tended to receive more adjuvant regional radiation therapy (75.0% if sentinel lymph node biopsy positive compared with 15.3% if sentinel lymph node biopsy negative, P < .001). ConclusionDespite the 2016 Choosing Wisely guidelines, more than 80% of patients ≥70 years old underwent sentinel lymph node biopsy at our institution. If sentinel lymph node biopsy was positive, this is associated with over 4-fold higher rates of adjuvant radiation therapy.

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.

34151 Association of type II diabetes mellitus with characteristics and outcomes for patients undergoing sentinel lymph node biopsy for cutaneous melanoma

Background: Limited data exist describing patients with type II diabetes mellitus (T2DM) who are diagnosed with clinically localized primary cutaneous melanoma and require sentinel lymph node (SLN) biopsy. Methods: Consecutive patients diagnosed with AJCC clinical Stage I-II melanoma who underwent wide excision and SLN biopsy at a single institution (2007-2016) were identified, and patients with and without T2DM at the time of melanoma diagnosis were compared using logistic regression analysis. Patients were further stratified by whether their T2DM was non-insulin dependent (NID-T2DM) or insulin dependent (ID-T2DM). Associations between factors and outcomes were analyzed using Cox proportional hazards regression analysis. Results: Of the 1128 patients evaluated, 111 (9.8%) had T2DM (n = 94 [84.7%] NID-T2DM; n = 17 [15.3%] ID-T2DM). On multivariable analysis controlling for patient and tumor factors, T2DM patients were more likely to be older (odds ratio [OR] 1.04, p 1.0 mm thick (OR 1.91, P = .019), and have microsatellitosis (OR 2.27, P = .029). Ten-year cumulative incidence of melanoma recurrence was significantly greater for those with ID-T2DM (64.4% ID-T2DM vs. 34.4% NID-T2DM vs. 21.8% no T2DM, P < .001). On multivariable analysis, ID-T2DM was independently associated with melanoma recurrence (hazard ratio [HR] 2.58, P = .015); this association was not seen with NID-T2DM (HR 0.82, P = .421). Conclusion: Patients with insulin-dependent type II diabetes mellitus appear to present with more advanced melanoma and are at increased risk for melanoma recurrence. Further study as to whether this reflects differences in tumor biology or host differences in immune response is warranted.

Short-term and long-term outcomes of indocyanine green for sentinel lymph node biopsy in early-stage breast cancer

BackgroundIndocyanine green (ICG) is becoming a frequently used sentinel lymph node (SLN) tracer of breast cancer in China. However, there is still a lack of data on its safety. We reported the clinical outcome of ICG as a tracer of SLN over a median 67-month follow-up period to evaluate its feasibility in clinically node-negative patients with breast cancer.MethodsA total of 194 consecutive patients underwent sentinel lymph node biopsy (SLNB) with ICG, radioisotopes (RI) and methylene blue (MB), or with ICG and MB. The SLN mapping data by each tracer was recorded, and safety outcomes were analyzed through follow-up.ResultsWith the triad mapping (N = 44), the identification rate of SLN by ICG was 95.5%, slightly higher than that of MB (86.4%) and comparable with RI (95.5%) and combined methods (95.5%, 100%) (p = 0.068). Analysis of all candidates (N = 194) demonstrated that the identification rate of SLN by ICG or by ICG and MB was 99%, significantly higher than that by MB (92.8%) (p < 0.0001). No tracer-related allergic reaction and permanent skin staining of ICG were observed. Local disease progression was reported in 2 of the 194 patients at the ipsilateral axilla. After remedial axillary lymph node dissection, no disease progression was detected at follow-up.ConclusionsICG as an SLN tracer is more accurate than MB and comparable to the combined methods and has good clinical safety. ICG can be considered a useful supplement or suitable alternative to traditional tracers.

Feasibility of targeted axillary dissection for de-escalation of surgical treatment after neoadjuvant chemotherapy in breast cancer

BackgroundTargeted axillary dissection, which combines sentinel lymph node biopsy with removal of the proven involved node noted during the staging process, has been shown to improve axillary staging and decrease false negative rates after neoadjuvant chemotherapy in patients with breast cancer. Objective(s)The main goal of this study was to assess the ability to identify and remove the clipped node and the false negative rate of targeted axillary dissection. MethodsWe performed a prospective study among patients with biopsy-confirmed nodal metastases who received neoadjuvant chemotherapy. A clip was placed on the sample node prior systemic therapy. After neoadjuvant chemotherapy, all patients underwent sentinel lymph node biopsy (dual tracer), localization and excision of the clipped node and axillary lymph node dissection. The clipped node was preoperatively localized in all cases placing an iodine-125 seed guided by ultrasound. The pathology of the sentinel nodes and clipped node was compared with other nodes. ResultsA total of 455 patients with invasive breast cancer were studied. Of the 148 patients with NAC, 32 met the eligibility criteria and were enrolled in the study. Mean age at diagnosis was 52.3 years. Systematic lymphadenectomy was performed in all patients, with an average of 14.3 lymph nodes removed. Detection rate of the clipped node alone was 96.9%, and 100% for targeted axillary dissection. Ability of clipped node alone to predict nodal status showed a FNR of 10,5% while SLNB alone performed by dual tracer and targeted axillary dissection, showed FNRs of 5.3% and 5.0%, respectively. Sentinel lymph nodes matched clipped node in 23 patients (74.2%). Conclusion (s)In node positive breast cancer patients, targeted axillary dissection is a reliably approach for axillary staging after neoadjuvant chemotherapy. The preoperative location of the clipped node is mandatory to increase the detection rate and optimize the results of the technique.

Association of type II diabetes mellitus with characteristics and outcomes for patients undergoing sentinel lymph node biopsy for cutaneous melanoma.

Type II diabetes mellitus (T2DM) can lead to an immunosuppressed state, but whether T2DM is associated with worse outcomes for patients with melanoma has not been well studied. Consecutive patients diagnosed with clinical stage I-II cutaneous melanoma who underwent sentinel lymph node biopsy at a single institution (2007-2016) were identified. Melanoma characteristics and recurrence/survival outcomes were compared between patients with and without T2DM at the time of melanoma diagnosis. Of 1128 patients evaluated, 111 (9.8%) had T2DM (n = 94 [84.7%] non-insulin dependent [NID-T2DM]; n = 17 [15.3%] insulin dependent [ID-T2DM]). T2DM patients were more likely to be older (odds ratio [OR] 1.04, p < 0.001), male (OR 2.15, p = 0.003), have tumors >1.0 mm (OR 1.88, p = 0.023), and have microsatellitosis (OR 2.29, p = 0.030). Five-year cumulative incidence of melanoma recurrence was significantly higher for patients with ID-T2DM (46.7% ID-T2DM vs. 25.7% NID-T2DM vs. 17.1% no T2DM, p < 0.001), and on multivariable analysis, ID-T2DM was independently associated with melanoma recurrence (hazard ratio 2.57, p = 0.015). No difference in 5-year disease-specific survival was observed between groups. ID-T2DM appears to be associated with more advanced melanoma and increased risk for melanoma recurrence. Further study as to whether this reflects differences in tumor biology or host factors is warranted.

MAP3K8 and ALK alterations in pediatric patients with atypical Spitz tumors and Spitz melanoma.

e21569 Background: Pediatric atypical Spitz tumors and Spitz melanoma (AST/SM) are characterized by structural variants (rearrangements/truncations) of various kinase genes more commonly involving MAP3K8 and ALK. The clinical features associated with these genomic abnormalities have not been well characterized. Methods: We reviewed the clinical characteristics and outcomes of children and adolescents with AST/SM who were enrolled on our institutional comprehensive registry for melanocytic lesions MACMEL (Cancer 127:3825, 2021) and abstracted clinical and outcome data for patients with MAP3K8, ALK, and other less common genomic aberrations. Results: Table shows the characteristics and outcomes of patients with AST/SM who had MAP3K8, ALK, and other genomic aberrations. There were 49 patients of whom 21 had MAP3K8 rearrangements/ truncations (n = 11;22%) or ALK rearrangements (n = 10;20%). The remaining 28 patients had fusions involving ARAF (1), ROS1 (2), NTRK1 (3), ERBB2 (1) or rare mutations (ATM = 1) or copy number changes (n = 14) or no identifiable genomic abnormality (n = 6). Female sex was more common in all three groups (32 female and 17 male). The median age for the entire cohort was 7.5 years. Most lesions arose in the extremities (n = 32; 65%). About half had stage III disease. 40 patients underwent sentinel node biopsy (SLNB), 25 had at least one positive node (7/9 MAP3K8, 5/8 ALK, 13/23 other), Forty-four patients had FISH analysis for CDKN2A and homozygous loss was seen in 9/11 MAP3K8-rearranged, 2/6 ALK-rearranged, and 11/27 other tumors. No TERT promoter mutation was detected in any of the 45 tumors that were analyzed. Two patients experienced local recurrence, one with a MAP3K8-STX fusion and one with a FLOT2-ARAF fusion and activating RAC1 mutation. All patients are alive and currently disease free (median follow up of 2.33 years). There were no statistically significant associations between gene mutations and tumor site, gender, or stage. Conclusions: Approximately 40% of patients with AST/SM harbored ALK or MAP3K8 alterations in our pediatric melanoma registry. We found no significant association between the individual genes and any specific clinical features in this limited cohort.[Table: see text]