Presence Of Sentinel Lymph Node Research Articles

The Accuracy of the Preoperative Axillary Ultrasound Examination in Predicting the Status of the Sentinel Lymph Node Involvement in Patients with Infiltrating Breast Carcinoma.

Background: we aimed to determine the accuracy of preoperative axillary ultrasound (US) in predicting the presence of sentinel lymph node (SLN) metastasis in breast cancer patients. Methods and Results: out of 54 cases, visible nodes on US were identified in 35 cases of which, 15 had metastasis. In 19 cases no axillary lymph nodes were visible on US. Of these, only 3 had metastasis. Moreover, our results demonstrated that neither the maximum diameter (p=0.738 Fisher exact test) nor the ratio between the longitudinal and transverse axes (p=0.728 Fisher exact test) can predict the positivity of the SLN. Conclusion: US cannot predict the positivity of the SLN.

Lymphangioinvasion in routine H&E staining is strongly associated with poor clinical outcome in lymph node-negative cutaneous melanoma patients.

Lymphatic invasion (LYI) and lymphangiogenesis in the primary tumor are important processes related to the dissemination of neoplasms. The aim of the study was to examine the relationship of LYI status in cutaneous melanoma with patient survival and clinicopathological data. LYI status was assessed in 104 hematoxylin-eosin (H&E) stained melanoma primary tumor samples and analyzed in relation to patient survival and other clinicopathological and histopathological characteristics. LYI was found in 30 (28.8%) patients. It was observed more frequently in ulcerated, proliferating, and thicker tumors. It correlated with the presence of sentinel lymph node, regional and distant metastases. The presence of LYI significantly correlated with shorter overall survival, cancer specific overall survival and disease-free survival in Kaplan-Meier analysis (all P < 0.001). Positive LYI status was a factor of unfavorable prognosis also in patients without regional lymph node metastases. Our results support earlier observations that LYI is a powerful prognostic factor. We recommend an assessment of LYI status during routine review of cutaneous melanoma slides stained with H&E as a standard, potentially informative, yet economically beneficial procedure.

Invasive Micropapillary Carcinoma of the Breast: A Clinicopathologic Study of 103 Cases of an Unusual and Highly Aggressive Variant of Breast Carcinoma

Invasive micropapillary carcinoma (IMPC) of the breast is an uncommon, highly aggressive breast cancer that may occur in pure and mixed forms. Our aim in this study is to investigate the relationship between clinical, histopathologic, and immunohistochemical features of pure and mixed IMPC cases diagnosed and treated at our institution. One hundred and three IMPC cases diagnosed at our institution over a period of 19 years have been selected. Clinical, histopathologic features, as well as hormone status and c-erb-B2 overexpression of tumors were re-evaluated. Mann-Whitney U, chi-squared, Kaplan-Meier, and Fisher's exact tests were used for statistical analyses. Results were considered to be significant at p < 0.05. Twenty cases (19.4%) were pure, and 83 cases (80.6%) were mixed IMPC. The most common nonmicropapillary invasive carcinoma component in mixed cases was invasive ductal carcinoma (IDC; 78.3%). Progesterone receptor was significantly less positive in pure IMPC cases (p = 0.031). There was no statistically significant difference between the two groups, in terms of mean age of the patients (53.0 versus 52.8), mean tumor size (26.6 mm versus 27.7 mm), presence of high-grade tumor (p = 0.631), presence of sentinel lymph node (SN) metastasis (p = 1.000), axillary lymph node metastasis (p = 1.000), lymphatic invasion (p = 1.000) and blood vessel invasion (p = 0.475), c-erbB-2 overexpression of tumor cells (p = 0.616), distant metastasis (p = 0.549), or overall survival (p = 0.759). The local recurrence rate of the two groups was not statistically significant either (16.7% versus 4.3%). However, local recurrence was detected 12% more commonly (p = 0.100), and ~8 months earlier (p = 0.967) in pure IMPC cases, compared to mixed cases. In addition, presence of local recurrence was found to be statistically significantly associated with estrogen receptor (ER) status (p = 0.004), progesterone receptor (PR) status (p = 0.001), and c-erb-B2 overexpression (p = 0.016) in all patients. Overall survival rate was significantly associated with ER staining of the tumor (log-rank = 0.028). Our findings suggest that hormone receptor negativity may explain the more aggressive behavior of pure IMPC compared to mixed cases. Besides, longer survival period of patients with ER positivity, and the relationship of hormone status and c-erb-B2 overexpression and local recurrence further support favorable prognostic value of hormone receptors in invasive breast cancer.

Interstitial magnetic resonance lymphography is an effective diagnostic tool for the detection of lymph node metastases in patients with cervical cancer

BackgroundThe aim of the present study was to determine the feasibility of detecting sentinel lymph node (SLN) metastases using interstitial magnetic resonance (MR) lymphography in patients with cervical cancer. MR data were compared to pathological results from the lymph nodes excised during surgery.MethodsTwenty-eight patients with cervical cancer were enrolled and studied from January 2006 to December 2010. All patients underwent interstitial MR lymphography to determine the presence of sentinel lymph nodes and visualize lymphatic vessel drainage in the pelvis. Radical hysterectomy and excision of pelvic lymph nodes was performed according to their lesion grade. Gadodiamide was injected either intradermally into the bipedal toe web, into the labia majora or into the cervical tissue. MR results were compared with pathological reports.ResultsIn 28 patients, lymphatic vessel drainage and lymph node groups were clearly visualized. Of these, 5 were MR lymphography positive and 23 were MR lymphography negative. Six had pathologically proven metastasis, five had true positives and 1 had a false negative in the obturator lymph node.ConclusionsInterstitial MR lymphography can be used to determine the extent and shape of pelvic lymphatic vessel drainage and lymph node metastases in patients with cervical cancer.

P3-07-36: Predicting Sentinel Lymph Node Metastasis of a Chinese Breast Cancer Population: Assessment of an Existing Nomogram and a New Predictive Nomogram.

Abstract Background: The Memorial Sloan-Kettering Cancer Center (MSKCC) developed a nomogram to predict the presence of sentinel lymph node (SLN) metastasis in breast cancer patients. In our study, The MSKCC nomogram performance for prediction of SLN metastases was assessed in Chinese breast cancer population. A new model (Shanghai Cancer Center Nomogram, SCC nomogram ) was developed with clinically relevant variables and possible advantages. Methods: Data were collected from 771 patients with successful SLN biopsy who were treated during March 2005 to June 2010. Touch imprint cytology (TIC) and serial section with H&amp;E staining were performed routinely on each sentinel node. 580 SLN biopsy procedures from March 2005to November 2009were used as training group to validate the MSKCC nomogram and assessed with multivariable logistic regression to predict the presence of SLN metastasis in breast cancer. The predictive accuracy of MSKCC nomogram was assessed by calculating the area under the receiver-operating characteristic (ROC) curve (AUC). The SCC nomogram was created from the logistic regression model. The new model was subsequently applied to 191 sequential SLN biopsies from January 2010 to June 2010 as the validation group. Results: It was shown that age, tumor size, tumor type, histological grade, lymphovascular invasion and neural invasion was correlated with the probability of SLN metastasis by univariate analysis (P&amp;lt;0.05). By multivariate analysis, tumor size, histological grade and lymphovascular invasion were identified as independent predictors of SLN metastasis. The SCC nomogram was then developed with four variables associated with SLN metastasis: age, tumor size, histological grade and lymphovascular invasion. The new model was accurate and discriminating, with AUC of 0.773 when applied to the validation group, as compared to the MSKCC nomogram with AUC of 0.754 in the modeling group. The trend of actual probability in various decile groups was comparable to the predicted probability. For predicted probability cut-off points of 7% and 15%, the false-negative rates of SCC nomogram were 0% and 8.1%. Conclusion: As far as we know, this is the first study designed to evaluate the MSKCC nomogram and develop a new nomogram in Chinese early breast cancer population. Compared to the MSKCC nomogram, the SCC nomogram was developed with similar AUC but less variables and lower false-negative rates for low-probability subgroups. It could provide a more acceptable clinical accessory in the preoperative discussion with patients, especially in the very low risk of patients. For those patients, the SCC nomogram could be used to safely avoid a SLN procedure, thereby reducing postoperative morbidity, whereas the rate could be as high as 7% in the literature. Although the SCC nomogram that predicts metastasis of breast cancer in the sentinel lymph node performed well in Chinese breast cancer population, it is imperfect. The SCC nomogram was developed and validated in the single instite. The SCC model should be validated in different patient groups before it is demonstrated to be reproducible and would be applied widely. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-07-36.

Abstract P1-01-20: Validation of MSKCC Nomogram in Predicting Sentinel Lymph Node Metastasis of a Chinese Breast Cancer Population

Abstract Background: The Memorial Sloan-Kettering Cancer Center (MSKCC) developed a nomogram to predict the presence of sentinel lymph node (SLN) metastasis in breast cancer patients. Our study was designed to validate the clinical value of the MSKCC nomogram in Chinese early-stage breast cancer population. Methods: Data were collected from 524 patients with successful SLN biopsy who were treated during 2005 March to 2009 October. Positive SLN metastasis was found in 154 patients. Touch imprint cytology (TIC) and serial section with H&amp;E staining were performed routinely on each sentinel node. Univariate analysis and logistic regressions tested whether a characteristic was correlated with the SLN positivity. MSKCC nomogram was used to estimate probability of SLN involvement and compared with actual probability after grouping into deciles. A ROC curve was drawn and predictive accuracy was assessed by calculating the area under the receiver-operating characteristic (ROC) curve. Results: It was shown that age, tumor size, histological grade and lymphovascular invasion was correlated with the probability of SLN metastasis by univariate analysis (P&amp;lt;0.05). By multivariate analysis, tumor size and lymphovascular invasion were identified as independent predictors of SLN metastasis. The odds ratio (OR) of the lymphovascular invasion was 9.462(95% CI 5.551-16.130)while OR of tumor size was 1.429(95% CI 1.142-1.788). The trend of actual probability in various decile groups was comparable to the predicted probability. Patients in the group with the least probability of a positive SLN predicted by the nomogram (≥10 decile) were all diagnosed with a negative SLN by serial section by H&amp;E staining. Three patients in our collective with extremely high probability (≥90) were all diagnosed as positive SLN by pathology. The area under the ROC curve was 0.757 as compared to 0.754 in the original population. Conclusion: As far as we know, this is the first study designed to evaluated the MSKCC nomogram in Chinese early breast cancer population. The MSKCC nomogram that predicts metastasis of breast cancer in the sentinel lymph node performed good in a Chinese breast cancer population. Though the nomogram cannot be an alternative of SLN biopsy, it could provide a clinical accessory in the preoperative discussion with patients, especially in the very high or very low risk of patients. The nomogram could be used in very low risk patients to safely avoid a SLN procedure, thereby reducing postoperative morbidity, whereas the rate could be as high as 7% in the literature. While for patients with very high risk estimated by the nomogram, axillary lymph node dissection could be recommended directly. The shortcoming of the nomogram is that clinical and pathological parameters include detail histological diagnosis of the primary tumor before the final decision for surgical procedure. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-01-20.

Limited pelvic lymphadenectomy using the sentinel lymph node procedure in patients with localised prostate carcinoma: a pilot study

The purpose of this study was to determine the potential role of the sentinel lymph node (SLN) procedure in limited lymph node dissection in patients with apparently localised prostate carcinoma. In 27 patients with organ-confined prostate cancer, a single injection of 0.3 ml/30 MBq( 99m)Tc-rhenium sulphur colloid was injected transrectally into the peripheral zone of each lobe of the prostate (total 0.6 ml/60 MBq) under ultrasound guidance. Two hours after injection, scintigraphy was performed. The first step in surgery was the detection and dissection of lymph nodes identified as SLNs. Then, standard lymphadenectomy was performed, consisting in a limited dissection that included all lymph nodes from the obturator fossa and along the external iliac vein. Lymphatic tissue along the hypogastric artery was not systematically removed, except in the presence of SLNs. Mean patient age was 66 years (48-77); the mean serum prostate-specific antigen value was 10.6 ng/ml. In a high proportion of patients (21/27, 77.8%) an SLN was located along the initial centimetres of the hypogastric artery. The second most frequent site of SLNs was in the obturator fossa (11/27 patients, 40.7%), followed by the external iliac area (5/27 patients, 18.5%). Four patients had lymph node metastases, all in SLNs: two in the hypogastric area and two in the obturator fossa. The SLN procedure revealed the individual variability in the lymphatic drainage of the prostate. The main site of SLNs was the hypogastric area, and two of the four metastatic nodes were located at this site. A limited standard pelvic lymphadenectomy, excluding the hypogastric lymph nodes, would have missed half of the lymph node metastases in this study. A radionuclide SLN procedure could assist in the correct staging of patients with early prostate cancer, especially when performing limited lymphadenectomy.