Proven Lymph Node 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.

What alters prognosis in patients who were operated for lung cancer with lymph node metastasis?

In this study, we investigated the clinical outcomes of patients who underwent surgery with proven lymph node metastasis. Patients who were operated for lung cancer with pN1 or pN2 were examined in the study. The clinicopathological features and survival of the subjects were evaluated according to pN1-pN2 status, presence of neoadjuvant treatment, Positron emission tomography and computed tomography (PET/CT) avidity on mediastinal lymph nodes and specific lymph node stations. The study examines 100 patients operated from January 2016 to December 2021. Number of cases with pN1 and pN2 disease were 45 (45%) and 55 (55%) respectively. Thirty (30%) patients received neoadjuvant treatment. The 5-year overall survival (OS) and disease-free survival (DFS) of the patients were computed as 42.5% and 42.4% correspondingly. The 5-year cancer-related survival was 55.3%. In pN2 cohort, 5-year DFS was 67.9% in the neoadjuvant group and 15.9% in the non-neoadjuvant group (P = 0.042). In non-neoadjuvant group, 5-year DFS was 19.9% in cases with mediastinal PET/CT avidity and 56.3% in patients without mediastinal PET/CT avidity (P = 0.018). In pN2 disease, the presence of subcarinal or paratracheal lymph node metastasis did not create a significant difference in 5-year OS or DFS, but pulmonary ligament lymph node metastasis was found to be linked with worse survival in both 5-year OS (P = 0.005) and DFS (P = 0.017). The main elements related with poor prognosis were absence of neoadjuvant treatment and pulmonary ligament lymph node metastasis in pN2 disease, detecting PET/CT avid mediastinal lymph nodes in non-neoadjuvant group.

68Ga]Ga-FAPI-46 PET/CT for penile cancer - a feasibility study.

Penile cancer is a rare entity and has a good prognosis in localized stage. Delayed surgical treatment of lymphatic disease is associated with poor overall survival but conventional imaging cannot detect occult lymph node metastasis sufficiently. Imaging cancer related fibroblasts has shown promising results as non-invasive staging tool in various tumor entities but has not yet been evaluated in penile cancer. In this single-center pilot study, patients planned for surgical treatment for penile cancer underwent preoperatively [68Ga]Ga-FAPI-46 PET/CT. Post-operative histopathology was compared to [68Ga]Ga-FAPI-46 PET/CT results. From January 2022 to June 2022, a total number 11 patients with histopathologically proven penile cancer underwent surgery and received [68Ga]Ga-FAPI-46 PET/CT prior therapy. 8 primary tumor sites and 4 lymph node regions were analyzed. FAPI uptake was increased on primary tumor site (SUVmax 16.2 (9.1 - 25.8)). Histopathological proven lymph node regions showed highly increased FAPI uptakes (SUVmax 17.9 (16.4 - 23.5) on [68Ga]Ga-FAPI-46 PET/CT. In this first pilot cohort, there were no false-positive FAPI uptake which might allow the detection of occult lymph node metastasis by [68Ga]Ga-FAPI-46 PET/CT and might consequently lead to omitting lymph node regions during surgery that had no increased FAPI uptake pre-operatively.

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.

Prognostic Heterogeneity Between Oral Tongue and Gingivobuccal Tumours Based on Lymph Node Ratio and Number of Positive Nodes: A Survival Analysis.

Lymph node ratio (LNR) and number of pathologicalpositive nodes (pN) have shown better prognostic prediction compared to laterality, size and number of nodes (single or multiple). This study evaluates the prognostic significance of LNR and the number of pathologicalpositive nodes in predicting the outcomes of node positive oral squamous cell carcinoma(OSCC). It attempts to assess the prognostic heterogeneity between oral tongue and gingivobuccal complex tumours based on the lymph node ratio and the number of pathologicalpositive nodes. A retrospective chart review of 498 previously untreated OSCCpatients from January 2014 to December 2017 at our tertiary cancer institute was done. Our analysis included 133 oral tongue and 79 gingivobuccal tumours with histopathologically proven lymph node metastasis. The impact of LNR and number of positive nodes on overall survival and disease free survival was studied. Overall survival rate was found to vary significantly based on LNR (> 0.06) and number of positive nodes (> 2). Overall survivalreduced significantly in GBC tumours when LNR was more than 0.06(63.37 vs 32.1, p 0.005) but the same trend was not seen with tongue cancers (55.61 vs 41.9, p 0.98). Both the groups shown no difference in DFS based on LNR. Overall survival reduced significantlyin both the groups when >2o pathologically positive nodes werepresent but disease free survival did not vary significantlyin both the groups. Lymph node ratio (> 0.06) and number of pathological positivenodes (> 2) provide a better prognostic stratification in node positive oral squamous cell carcinoma. Oral tongue and GBC tumours were found to have a differential impact on overall survival rate on the stratification based on LNR.

Low axillary sampling to stage post neoadjuvant axilla in breast cancer patients - A practical approach in developing world

BackgroundPost-neoadjuvant sentinel lymph node biopsy or targeted axillary dissection in carcinoma breast patients need costly infrastructure, making it out of reach for resource constrained developing countries. This study assesses the diagnostic accuracy of low axillary node sampling to predict the nodal status of the post-chemotherapy node-negative axilla. Materials and methodsThis is a prospective study which included cytology proven node positive carcinoma breast patients who had node negative axilla after chemotherapy and underwent low axillary sampling with complete axillary lymph node dissection. Nodes below second intercostobrachial nerve were sent as low axillary sample. Results211 patients with carcinoma breast underwent FNAC of the axillary node prior to neoadjuvant systemic therapy (NAST). Low axillary sampling was performed on 77 patients who had clinically and radiologically node negative axilla after NAST. Out of 77, 24 (31%) had early breast cancer and 32 (41.5%) had T4 disease prior to NAST. In this cohort, 36 patients (47%) had a good biology tumour, 57 (74%) had Grade 3 tumour and 20 (26%) had lymphovascular invasion (LVI). Pathological complete response of breast and axilla was seen in 24 patients (31%). Low axillary sampling had a range of 1–12 nodes with median lymph nodal yield of 6. The false negative rate (FNR) of low axillary sampling was 8.3%. Good tumour biology, post NAST residual breast tumour and lymphovascular invasion were the independent predictors of positive low axillary nodes. ConclusionsLow axillary sampling is an economical and feasible option to de-escalate axillary surgery with acceptable false negative rate in carcinoma breast patients who had node negative axilla post neoadjuvant systemic therapy.

MP50-03 [ 68 Ga]Ga-FAPI-46 PET/CT PRIOR TO SURGERY IN SQUAMOUS PENILE CANCER – PRELIMINARY CLINICAL RESULTS

You have accessJournal of UrologyCME1 Apr 2023MP50-03 [68Ga]Ga-FAPI-46 PET/CT PRIOR TO SURGERY IN SQUAMOUS PENILE CANCER – PRELIMINARY CLINICAL RESULTS Lennert Eismann, Johannes Toms, Adrien Holzgreve, Elena Berg, Maximilian Schleifele, Severin Rodler, Franz-Josef Gildehaus, Matthias Brendel, Nathalie Albert, Clemens Cyran, Philipp Kazmierczak, Wolfgang Kunz, Stephan Ledderose, Christian Stief, Peter Bartenstein, Marcus Unterrainer, Boris Schlenker, and Lena Unterrainer Lennert EismannLennert Eismann More articles by this author , Johannes TomsJohannes Toms More articles by this author , Adrien HolzgreveAdrien Holzgreve More articles by this author , Elena BergElena Berg More articles by this author , Maximilian SchleifeleMaximilian Schleifele More articles by this author , Severin RodlerSeverin Rodler More articles by this author , Franz-Josef GildehausFranz-Josef Gildehaus More articles by this author , Matthias BrendelMatthias Brendel More articles by this author , Nathalie AlbertNathalie Albert More articles by this author , Clemens CyranClemens Cyran More articles by this author , Philipp KazmierczakPhilipp Kazmierczak More articles by this author , Wolfgang KunzWolfgang Kunz More articles by this author , Stephan LedderoseStephan Ledderose More articles by this author , Christian StiefChristian Stief More articles by this author , Peter BartensteinPeter Bartenstein More articles by this author , Marcus UnterrainerMarcus Unterrainer More articles by this author , Boris SchlenkerBoris Schlenker More articles by this author , and Lena UnterrainerLena Unterrainer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003298.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: [68Ga]Ga-FAPI-46 PET/CT is an innovative imaging modality for imaging the tumor-associated fibroblasts. The detection of tumor spread in patients with squamous penile cancer, a rare tumor entity, is crucial for therapy planning. Hence, we assessed the clinical feasibility of [68Ga]Ga-FAPI-46 PET/CT in this rare tumor entity. METHODS: Patients with suspected or recurrent penile cancer underwent [68Ga]Ga-FAPI-46 PET/CT imaging for evaluation of the primary tumor site and locoregional lymph node status prior to partial/total penectomy or inguinal/pelvic lymphadenectomy (LAE). Uptake intensities were assessed at the primary sites and at lymph nodes and then compared to histopathological results in a second step. RESULTS: 11 patients with penile cancer (mean 70.1 years) were included and underwent [68Ga]Ga-FAPI-46 PET/CT prior surgical treatment. 7/11 (63.6%) patients received local surgical therapy (partial/total penectomy), 3/11 (27.3%) patients were planned for inguinal/pelvic LAE and 1/11 patients received combined surgery. In 4/8 patients undergoing penectomy, the primary tumor showed increased FAPI uptake (SUVmax 16.2 (9.1 – 25.8)) while in the other 4 patients, the evaluation of primary tumoral site was hampered due to increased urinary activity. 4/11 patients underwent inguinal/pelvic LAE: 3/4 had at least one histopathologically proven pelvic and/or inguinal LN metastasis; all lymph node metastases showed an increased FAPI uptake (SUVmax 17.9 (16.4 – 23.5)) and an enlarged short-axis diameter (1.8 (1.2 – 2.5) cm). Furthermore, in 2/7 patients receiving penectomy only, [68Ga]Ga-FAPI-46 PET/CT revealed enlarged inguinal/pelvic lymph nodes with an distinctly increased FAPI uptake (SUVmax 16.5 (11.4 – 21.6) that could not be addressed during surgery and were subsequently treated by chemotherapy. CONCLUSIONS: In these first experiences in penile cancer, [68Ga]Ga-FAPI-46 PET shows promising clinical performance. [68Ga]Ga-FAPI-46 PET identified all histologically proven lymph node metastases, which might avoid unnecessary LAE and might lead to a reduced morbidity. Improved imaging protocols (e.g. omission of furosemide and urination prior to the scan) might improve evaluation of local tumor burden. Source of Funding: No funding © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e685 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lennert Eismann More articles by this author Johannes Toms More articles by this author Adrien Holzgreve More articles by this author Elena Berg More articles by this author Maximilian Schleifele More articles by this author Severin Rodler More articles by this author Franz-Josef Gildehaus More articles by this author Matthias Brendel More articles by this author Nathalie Albert More articles by this author Clemens Cyran More articles by this author Philipp Kazmierczak More articles by this author Wolfgang Kunz More articles by this author Stephan Ledderose More articles by this author Christian Stief More articles by this author Peter Bartenstein More articles by this author Marcus Unterrainer More articles by this author Boris Schlenker More articles by this author Lena Unterrainer More articles by this author Expand All Advertisement PDF downloadLoading ...

The prognostic impact of lymph node dissection for clinically node-negative upper urinary tract urothelial carcinoma in patients who are treated with radical nephroureterectomy.

To evaluate the prognostic impact of lymph node dissection (LND) in patients who underwent radical nephroureterectomy (RNU) with bladder cuff excision (BCE) for clinically node-negative (cN0) upper urinary tract urothelial carcinoma (UTUC). We retrospectively enrolled 520 patients with cN0 UTUC in a single tertiary referral center from 2000 to 2015. The patients were divided into three groups: patients with and without pathologically proved lymph node metastasis (pN1-3 and pN0, respectively) and patients without LND (pNx). We analyzed associations between overall survival (OS)/ disease-free survival (DFS)/ cancer-specific survival (CSS) and clinical characteristics. The patients were divided into three groups (pN1-3, pN0 and pNx with 20, 303, and 197 patients, respectively). OS/DFS/CSS in the pN1-3 group were significantly worse (all p<0.001) compared with the pN0 group. However, there were no significant differences between the pNx and pN0 groups. In the multivariate analyses, CSS was only affected by age [(hazard ratio (HR) = 1.03, p = 0.008]), positive surgical margin (HR = 3.38, p<0.001) and pathological T3-4 stages (HR = 4.07, p<0.001). In the subgroup analyses for patients with LND, locally advanced disease (pT3 and pT4) had significantly more metastases [T3-4: 13.91% (16/115) vs. T0-2: 1.92% (4/208), p<0.001]. In the pN0 group, LND for cN0 UTUC did not show therapeutic benefits in terms of DFS, CSS, and OS. However, LND with RNU allowed optimal tumor staging, through patients still had a poor prognosis. Clinically occult LN metastases were found in 6.2% of our patients.

Zufallsbefund NEN Appendix

With an incidence of 80%, neuroendocrine neoplasia (NEN) is the most common neoplasia of the appendix. In most cases, these tumours are diagnosed as an incidental finding after appendectomy with suspected appendicitis. They are usually highly differentiated neuroendocrine tumours. Due to their frequent location on the apex of the appendix, the NENs of the appendix are usually not the cause of the symptoms typical for appendicitis.Most patients (80-90%) receive adequate oncological treatment by laparoscopic or open appendectomy that has already been performed. However, if there are risk factors such as tumour size >2cm, location close to the base, angioinvasion, perforation or infiltration of neighbouring organs, proliferation index of >2% or infiltration of the mesoappendix by more than 3mm in the final histopathological finding, subsequent resection as an oncological right sided hemicolectomy is recommended .Due to their mostly early tumour stage at diagnosis without proven lymph node metastasis, patients with NEN of the appendix have an excellent 5-year survival rate of 70-85% across all tumour stages.

Prospective Clinical Trial of the Oncologic Outcomes and Safety of Extraperitoneal Laparoscopic Extended Retroperitoneal Lymph Node Dissection at Time of Nephroureterectomy for Upper Tract Urothelial Carcinoma.

PurposeTo determine the safety and feasibility of extraperitoneal laparoscopic extended lymph node dissection (LND) at the time of extraperitoneal laparoscopic radical nephroureterectomy (RNU).Materials and MethodsBetween May 2018 and March 2019, 39 patients with upper tract urothelial carcinoma (UTUC) received extraperitoneal laparoscopic RNU and concomitant extraperitoneal laparoscopic extended LND. All patients were followed for at least 90 days. Perioperative and pathological data including nodal status and perioperative complications were collected.ResultsAmong all 39 patients, 12 patients had pT1, 6 had pT2, 20 had pT3 disease, and 1 had T4 disease. The median (range) lymph node count was 10 (5–22), with 8 patients having pathologically proven lymph node metastasis. The median (range) operating time was 225 (165–430) min, and the median estimated blood loss was 200 (60–800) ml. The median postoperative hemoglobin loss was 1.6 (0–4.2) g/dl. The median (range) postoperative hospital stays were 6 (3–26) days. Overall, 7 patients experienced minor (Clavien Grade I–II) postoperative complications with five patients having Clavien Grade I complications and two patients having Clavien Grade II complications. No major complication (Clavien grade III–IV) occurred. With a median follow-up of 38 months, a total of 8 patients (20.5%) developed local or distant recurrence and no regional LNs where extended LND were performed had recurrence.ConclusionsThe present prospective study demonstrated that extraperitoneal laparoscopic extended LND during extraperitoneal laparoscopic RNU for UTUC is a feasible and safe procedure which provides minimal invasion, rapid recovery, and potentially lower risk of regional LN recurrence. Larger prospective clinical trials with survival endpoints are needed to further determine its potential therapeutic benefits.Trial RegistrationClinicalTrials.gov identifier NCT 03544437 www.clinicaltrials.gov

Risk Factors for Lymph Node Metastasis and Oncologic Outcomes in Small Rectal Neuroendocrine Tumors with Lymphovascular Invasion

Background/AimsSmall rectal neuroendocrine tumors (NETs) are often managed with local resection (endoscopic or transanal excision) owing to their low risk of metastasis and recurrence. However, the clinical significance of lymphovascular invasion in resected specimens remains controversial. In this study, we aimed to analyze the frequency of and risk factors for lymph node metastasis proven by histopathologic examination after radical resection.MethodsWe retrospectively reviewed the records of 750 patients diagnosed with a rectal NET at four academic medical centers in South Korea between 2001 and 2019. The frequency of histopathologically proven lymph node metastasis and the associated risk factors were analyzed for small tumors (≤1.5 cm) with lymphovascular invasion.ResultsAmong 750 patients, 75 had a small tumor (≤1.5 cm) with lymphovascular invasion, of whom 31 patients underwent endoscopic resection only and 44 patients underwent additional radical surgery. Among the 41 patients who underwent surgery and had available data, the rate of regional lymph node metastasis was 48.8% (20/41). In multivariate analysis, the Ki-67 index (odds ratio, 6.279; 95% confidence interval, 1.212 to 32.528; p=0.029) was an independent risk factor for lymph node metastasis. During the mean follow-up period of 37.7 months, only one case of recurrence was detected in the surgery group. The overall survival was not significantly different between radical resection and local resection (p=0.332).ConclusionsRectal NETs with lymphovascular invasion showed a significantly high rate of regional lymph node metastasis despite their small size (≤1.5 cm).

Lymph node ratio is a strong prognostic factor after minimally invasive surgery radical hysterectomy of early-stage cervical cancer

<h3>Objectives:</h3> To determine whether prognostic impact of lymph node ratio (LNR), defined as the ratio between the number of positive lymph nodes and removed lymph nodes, is different by the surgical approach of radical hysterectomy (RH) in node-positive, early-stage cervical cancer. <h3>Methods:</h3> We retrospectively identified 2009 FIGO stage IB1-IIA2 patients who underwent primary Type C RH between 2010 and 2018 at two tertiary hospitals. Among them, only those with pathologically proven lymph node metastases and received adjuvant radiation therapy were included. Each patient's LNR was calculated, and its prognostic significance was investigated according to the two surgical approaches, open surgery, and minimally invasive surgery (MIS). <h3>Results:</h3> In total, 55 patients were included in this analysis. All patients received concurrent chemoradiation therapy after surgery, and the median LNR (%) was 9.524 (range, 2.083-62.500). Based on receiver operating characteristic-curve analysis, the cut-off value for LNR (%) was determined as 8.831. Overall, patients with high LNR (≥8.831%; n=29) showed worse disease-free survival (DFS) than those with low LNR (<8.831%, n=26) (P=0.027), whereas no difference in overall survival was observed. Multivariate analyses adjusting clinicopathologic factors revealed that DFS was adversely affected by both MIS (HR, 8.132; P=0.038) and high LNR (HR, 10.837; P=0.045). In a subgroup of open RH, LNR was not associated with disease recurrence. However, in a subgroup of MIS, high LNR was identified as an independent poor prognostic factor for DFS (adjusted HR, 14.578; P=0.034). <h3>Conclusions:</h3> In patients with node-positive, early-stage cervical cancer, high LNR was associated with a significantly higher disease recurrence rate. This relationship was further consolidated among patients who received MIS RH.

Recurrence pattern and prognostic factors for survival in cervical cancer with lymph node metastasis.

The aim of this study is to evaluate the recurrence pattern and oncological outcomes in cervical cancer (CC) patients with lymph node metastasis. This study included 224 International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB1-IIIB CC patients with pathologically proven lymph node metastasis. Surgical intervention was grouped as hysterectomy performed/not performed. Adjuvant therapy decision was made by the tumor board. Radiotherapy was applied to all patients with lymph node metastasis. Only paraaortic lymph node metastasis was determined as an independent prognostic factor for recurrence. Presence of paraaortic lymph node metastasis increased the risk of recurrence more than two times (odds ratio: 2.129; 95% confidence interval: 1.011-4.485; p=0.047). An independent prognostic factor for death because of disease was age only. Risk of death was nearly doubled with younger age (odds ratio: 2.693; 95% confidence interval: 1.064-6.184; p=0.037). The most of recurrences were located at distant sites and multiple regions. Paraaortic lymph node metastasis was the only independent prognostic factor for recurrence, in spite of that age was an independent predictor for risk of death in patients with early stage or locally advanced CC and also with surgically proven metastatic lymph nodes. Furthermore, the presence of the paraaortic lymph node metastasis was significantly associated with distant recurrence. Therefore, more appropriate and individualized therapy strategy focusing on intenser systemic chemotherapy options in addition to radiotherapy should be taken into consideration according to paraaortic lymph node metastasis and age.

Abstract PS1-43: Axillary surgery after neoadjuvant chemotherapy in patients treated for an operable breast cancer with a proven initially positive axillary node: Preliminary results of identification and removal of the initially positive axillary node

Abstract BackgroundAlmost half of the patient with initially metastatic axillary node, treated with neoadjuvantchemotherapy (NAC) for a large operable breast cancer, has no axillary lymph node involvementat the time of surgery after NAC. Sentinel lymph node detection (SLND), performed after NAC,has a high false negative rate (FNR) when compared to FNR after primary surgery. GANEA 3 isa French prospective multi institutional ongoing trial, aimed at assessing the impact of targeting,before NAC, the initially positive node and removing it after NAC. The main objective of GANEA3 trial is the accuracy of this initially positive node to predict pathological status of the otheraxillary nodes after NAC. A total of 385 patients are required.ObjectiveThe current abstract assessed preliminary results of the detection rate of the clipped node and thedifferent methods to find it during axillary surgery based on the first 41 patients.Patients and MethodThis study is part of GANEA 3 Trial validated by scientific national board (clinicialtrials.gov:NCT03630913).Inclusion criteria: TNM stage T1-T3 N1 infiltrating breast carcinoma, indication of NAC, andsigned consent form,Exclusion criteria: more than 5 suspicious axillary nodes, inflammatory cancer, local relapse,mental disorder, pregnancy or no contraceptive method, contra-indication to NAC, NACinterrupted due to progressive disease.Design: Patients treated for an early breast cancer with NAC, axillary sonography with fine needlecytology before NAC to select patients with a proven lymph node involvement. Initially positive node identification warranted, for example with a clip. After NAC patients underwent the removalof the clipped node, a SLN detection with the combined method (patent blue and technetium) andan axillary lymph node dissection (ALND). In order to find the clipped node, during surgery thesurgeon attempted to find it with palpation and sonography. Each surgical specimen was then x-rayed before pathological examination.Studied parameters were clipped node and SLND detection rate, and the methods used to find theclipped node.ResultsFrom January 2019, to November 2019, 41 patients were enrolled, from 13 institutions, withinitially positive axillary node clipped, NAC courses and surgery after NAC.Median age was 53 (31-75), pathological subtype infiltrative ductal carcinoma (n=40) andinfiltrative lobular carcinoma (n=1), a median of 7 courses of NAC (1-16).SLN detection rate was 90% (37/41). A median number of 2 sentinel nodes were removed (1-7).The clipped node was removed in 100% of cases. The clipped node was identified by thesurgeon palpation (n=11), an axillary wire (n=13), per operative axillary sonography (n=4),surgical specimen radiography (n=11), the pathologist (n=2).The clipped node was part of SLN in 29 cases (70%). It was part of axillary lymphadenectomyspecimen in 6 cases (14.5%) and was find alone as an isolated node in 6 cases (14.5%).ConclusionThe clipped node was always found after NAC. It was mostly always part of SLN or ALNDspecimens. Further studies are needed in order to help the surgeon to remove only the clippednode. Citation Format: Celine Renaudeau, Roman Rouzier, Pierre Gimbergues, Marian Gutowski, Eva Jouve, Philippe Rauch, Charles Coutant, Christelle Faure, Catherine Uzan, Pierre-François Dupré, Vivien Ceccato, Charlotte N'go, Augustin Reynard, Isabelle Doutriaux, Loic Campion, Jean-Marc Classe. Axillary surgery after neoadjuvant chemotherapy in patients treated for an operable breast cancer with a proven initially positive axillary node: Preliminary results of identification and removal of the initially positive axillary node [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-43.

Lymph Node Ratio Is a Strong Prognostic Factor in Patients with Early-Stage Cervical Cancer Undergoing Minimally Invasive Radical Hysterectomy.

PurposeTo determine whether the prognostic impact of lymph node ratio (LNR), defined as the ratio between the number of positive lymph nodes and removed lymph nodes, differs between open and minimally invasive surgical approaches for radical hysterectomy (RH) in node-positive, early-stage cervical cancer.Materials and MethodsWe retrospectively identified 2009 International Federation of Gynecology and Obstetrics stage IB1-IIA2 patients who underwent primary type C RH between 2010 and 2018. Among them, only those with pathologically proven lymph node metastases who received adjuvant radiation therapy were included. The prognostic significance of LNR was investigated according to open surgery and minimally invasive surgery (MIS).ResultsIn total, 55 patients were included. The median LNR (%) was 9.524 (range, 2.083–62.500). Based on receiver operating characteristic curve analysis, the cut-off value for LNR (%) was determined as 8.831. Overall, patients with high LNR (≥8.831%; n=29) showed worse disease-free survival (DFS) than those with low LNR (<8.831%, n=26) (p=0.027), whereas no difference in overall survival was observed. Multivariate analyses adjusting for clinicopathologic factors revealed that DFS was adversely affected by both MIS [adjusted hazard ratio (HR), 8.132; p=0.038] and high LNR (adjusted HR, 10.837; p=0.045). In a subgroup of open surgery cases, LNR was not associated with disease recurrence. However, in a subgroup of MIS cases, high LNR was identified as an independent poor prognostic factor for DFS (adjusted HR, 14.578; p=0.034).ConclusionIn patients with node-positive, early-stage cervical cancer, high LNR was associated with a significantly higher disease recurrence rate. This relationship was further consolidated among patients who received MIS RH.

253 Poster - Does Neo-adjuvant chemotherapy response in the primary breast tumour correlate with axillary response in proven node positive ER positive HER2 negative disease?

253 Poster - Does Neo-adjuvant chemotherapy response in the primary breast tumour correlate with axillary response in proven node positive ER positive HER2 negative disease?

Surgery of adrenal diseases

Incidentally discovered adrenal alterations should be separated into those without any clinical importance and adrenal diseases that have to be surgically or conservatively treated. Before operative treatment, in addition to the possible different functional activity of tumors, a differentiation must be made between sporadically arising singular or multiple adrenal tumors or nodular adrenal hyperplasia, adrenal tumors as part of afamilial syndrome and metastases of other primary malignant tumors into the adrenal glands. Benign hormonally active adrenal tumors as well as questionable malignant tumors of the adrenal cortex are resected by minimally invasive techniques. For large malignant tumors infiltrating into surrounding tissues and tumors with proven lymph node metastases, the primarily open approach is indicated. Patients with adrenal diseases should always undergo an interdisciplinary assessment and in cases with clear indications for surgery, sometimes transferred to a center with experience in surgery and postoperative management of these patients.

Automated synthesis and quality control of [99mTc]Tc-PSMA for radioguided surgery (in a [68Ga]Ga-PSMA workflow)

BackgroundLymph node dissection is a therapeutic option for prostate cancer patients with a high risk of- or proven lymph node metastases. Radioguided surgery after intravenous injection of [99mTc]Tc-PSMA could improve the selectivity of lymph node dissection. The aim of this project was to develop an automated synthesis method for [99mTc]Tc-PSMA, using the disposables and chemicals used at our institute for [68Ga]Ga-PSMA labeling. Furthermore, quality control procedures and validation results of the automated production of [99mTc]Tc-PSMA conform cGMP and cGRPP are presented.Methods[99mTc]Tc-PSMA is produced fully automatic with a Scintomics synthesis module. Quality control procedures are described and performed for: activity, labeling yield, visual inspection, pH measurement, sterility and endotoxin determination, radionuclide purity, radiochemical purity (99mTc-colloids, unbound [99mTc]pertechnetate, and other impurities), and HEPES content. Three batches of [99mTc]Tc-PSMA were prepared on three separate days for validation and stability testing at 0, 4, 6, and 24 h.Results[99mTc]Tc-PSMA can be successfully manufactured automatically within a [68Ga]Ga-PSMA workflow with the addition of only [99mTc]pertechnetate and stannous chloride. The radiochemical purity after production was highly reproducible (96.3%, 97.6%, and 98.2%) and remained > 90% (required for patient administration) up to 6 h later.ConclusionA fully automated labeling procedure with corresponding quality control methods for production of [99mTc]Tc-PSMA is presented, which is validated according to cGMP and cGRPP guidelines and can be implemented in a GMP environment. The produced [99mTc]Tc-PSMA is stable for up to 6 h. The presented procedure is almost identical to the automated production of [68Ga]Ga-PSMA and can therefore be implemented expediently if a workflow for [68Ga]Ga-PSMA is already in place.

Implementation of a Standardized Approach to Borderline Resectable Pancreatic Cancer in a Multisite Community Oncology Program

Background: Treatment paradigms for borderline resectable pancreatic cancer (BRPC) are evolving with increasing use of neoadjuvant chemotherapy (NAC) and neoadjuvant chemoradiation (NACR). Variations in the definition of BRPCand neoadjuvant approaches have made standardizing care for BRPC difficult. We report an effort to standardize management of BRPC throughout Sanford Health, a large community oncology network. Methods: Starting in October 2013, cases of PC without known metastatic disease were categorized as BRPC if they met ≥1of the following criteria: 1) abutment of superior mesenteric, common hepatic or celiac arteries with <180° involvement, 2) venous involvement deemed potentially suitable for reconstruction, and/or 3) biopsy proven lymph node involvement. Patients with BRPC were treated with NAC followed by reimaging and surgery if venous involvement had improved; if disease remained borderline resectable, patients underwent NACR and surgical exploration as long as reimaging did not reveal evidence of progressive disease. Results: Forty-three patients from 10/2013-4/2017 were diagnosed with BRPC. Twelve of 42 (29%) patients proceeded to surgical exploration directly after NAC; 23 (55%) received NACR. Overall, 28/43 (65%) underwent exploration with 19 (44%) able to undergo resection. Of those, 14/19 (74%) attained R0 resection and 11/19 (58%) were pathologic N0. No pretreatment or treatment variables were associated with resection rates; resection was the only variable associated with survival. Conclusions: This report demonstrates the feasibility of implementing a standardized approach to BRPC across multiple sites over a wide geographic area. Adherance to protocol therapies was good and surgical outcomes are similar to many reported series.

Conversion Surgery for Pancreatic Cancer-The Impact of Neoadjuvant Treatment.

Pancreatic ductal adenocarcinoma (PDAC) has still a dismal prognosis, mainly because only 15–20% of all patients present with resectable tumor stages at the time of diagnosis. Due to locally extended tumor growth or distant metastases upfront resection is not reasonable in the majority of patients. Considerably, PDAC will be the 2nd most frequent cause of cancer-related deaths within the next 10 years for both men and women. While there is currently no convincing evidence for the use of neoadjuvant therapy in resectable PDAC, there are controversial results from studies investigating neoadjuvant treatment concepts in borderline resectable PDAC (BR-PDAC). However, the definition of BR-PDAC is a topic of debate. While BR-PDAC has originally been defined on merely anatomical criteria, the International Association of Pancreatology (IAP) has recently suggested a broader definition based on a combination of anatomical (A) findings, biological (B) criteria (which reflect tumor aggressiveness), and conditional (C) aspects (which respect host-related condition). In case of BR-PDAC with venous invasion alone, upfront resection is generally recommended whenever technically possible in patients fit for surgery and without evidence for lymph node metastases. In contrast, in case of arterial invasion neoadjuvant therapy is regarded as the treatment of choice. The same accounts for high CA 19-9 levels, suspected or proven lymph node involvement and poor performance status. In locally advanced PDAC (LA-PDAC), neoadjuvant treatment represents the standard of care resulting in proportionally high rates of secondary resection. This “conversion” surgery offers the chance for improved survival times in an otherwise palliative situation. Herein, we summarize the current evidence of different treatment strategies for pancreatic cancer with a focus on conversion surgery and the impact of neoadjuvant treatment in this setting.