Sensitivity Of Sentinel Node Biopsy Research Articles

Implementation of sentinel node biopsy in high-risk endometrial cancer.

Endometrial cancer is the most common gynecologic malignancy and sentinel lymphnode biopsy is accepted as a valid alternative to lymphadenectomy for staging purposes. Recently, sentinel node biopsy has been also extended to high-risk disease where risk of nodal involvement is higher. Our review focuses on the definition of high-risk disease and how there are different concepts of high-risk in the scientific community. While the sensitivity of sentinel node biopsy has been established and accepted in lower risk endometrial cancers, only in recent years retrospective and prospective evidence has been published. Ultrastaging allows to identify more nodal disease that would normally be overlooked by traditional staging, allowing proper adjuvant therapy to be administered. The longstanding question of whether lymphadenectomy in high-risk settings is a therapeutic or a staging procedure remains open. Retrospective data, however, show that oncologic outcomes are not compromised by sentinel node biopsy. Sentinel node biopsy is a valid alternative to traditional, more extensive nodal staging: with the addition of ultrastaging, it has more sensitivity than lymphadenectomy with less surgical morbidity. Ongoing trials will definitively establish if oncological outcomes are affected by sentinel node biopsy, but retrospective data are encouraging.

The diagnostic accuracy of fluorodeoxyglucose-positron emission tomography/computed tomography and sentinel node biopsy in the prediction of pelvic lymph node metastasis in patients with endometrial cancer: A retrospective observational study.

According to the sentinel node biopsy (SNB), systematic pelvic lymph node dissection (PLND) may not be needed for patients with early-stage endometrial cancer. On the other hand, imaging technology including fluorodeoxyglucose-positron emission tomography/computed tomography (FDG PET/CT) has been developing worldwide. The aim of this study was to evaluate the combined diagnostic accuracy of FDG PET/CT and SNB in the prediction of pelvic lymph node metastasis in endometrial cancer patients.One hundred twenty-one patients with endometrial cancer underwent FDG PET/CT before hysterectomy and received SNB followed by systematic PLND. Univariate and multivariate analyses were performed to compare the diagnostic accuracy of FDG PET/CT and SNB in the prediction of pelvic node metastasis to the ultimate histologic status.FDG PET/CT had lower sensitivity (36.8% versus 57.9%, P = .1) and a higher specificity (96.4% versus 84.8%, P < .01) than SNB. The kappa statistics of FDG PET/CT and SNB were 0.37 (95% CI, 0.15–0.59) and 0.72 (95% CI, 0.53–0.90), respectively. The sensitivity of SNB was significantly higher than that of FDG PET/CT in all hemi-pelvises (HPs) in which the short axis of the largest metastatic lymph node was <5 mm in diameter (72.7% versus 18.2%, P = .01). In contrast, the sensitivity of FDG PET/CT was higher than that of SNB in all HPs in which the short axis of the largest metastatic lymph node was ≥5 mm in diameter (62.5% versus 37.5%, P = .2); however, the difference was not statistically significant. When the combined diagnosis of FDG PET/CT and SNB was made, the sensitivity and specificity were 84.2% and 82.1%, respectively.SNB was more useful for detecting lymph node metastasis than FDG PET/CT, especially in patients with small metastatic lymph nodes. The combined diagnosis of FDG PET/CT and SNB improves the sensitivity; PET-positive nodes should be dissected regardless of SNB status and HPs in which SNB was not detected should be dissected systematically regardless of FDG PET/CT status.

Sentinel node biopsy and lymphatic mapping in penile and prostate cancer.

Nodal metastases are linked to poor outcome in men with penile or prostate cancer. Early detection and resection are important for staging and for the prognosis. However, lymphadenectomy is associated with morbidity and may miss metastases when performed solely on the basis of anatomical templates. In this article we describe the technique and benefits of sentinel node biopsy (SNB) and provide a review of the literature. Dynamic sentinel node techniques using both radioactive and optical (hybrid) tracers have been proven effective in penile cancer. For prostate cancer, SNB added to extended nodal dissection may further tailor dissection to the highly variable lymphatic drainage patterns in the pelvis. The sensitivity of SNB was found to be superior to conventional imaging methods; however, false-negative SNB procedures can occur and acomplementary extensive lymphadenectomy is required to remove additional positive nodes that were not detected in the SNB template. SNB is astandard method for early detection of nodal metastases in penile cancer and provides superior diagnostic accuracy to conventional imaging modalities in prostate cancer.

Sentinel European Node Trial (SENT): 3-year results of sentinel node biopsy in oral cancer

PurposeOptimum management of the N0 neck is unresolved in oral cancer. Sentinel node biopsy (SNB) can reliably detect microscopic lymph node metastasis. The object of this study was to establish whether the technique was both reliable in staging the N0 neck and a safe oncological procedure in patients with early-stage oral squamous cell carcinoma. MethodsAn European Organisation for Research and Treatment of Cancer-approved prospective, observational study commenced in 2005. Fourteen European centres recruited 415 patients with radiologically staged T1–T2N0 squamous cell carcinoma. SNB was undertaken with an average of 3.2 nodes removed per patient. Patients were excluded if the sentinel node (SN) could not be identified. A positive SN led to a neck dissection within 3 weeks. Analysis was performed at 3-year follow-up. ResultsAn SN was found in 99.5% of cases. Positive SNs were found in 23% (94 in 415). A false-negative result occurred in 14% (15 in 109) of patients, of whom eight were subsequently rescued by salvage therapy. Recurrence after a positive SNB and subsequent neck dissection occurred in 22 patients, of which 16 (73%) were in the neck and just six patients were rescued. Only minor complications (3%) were reported following SNB. Disease-specific survival was 94%. The sensitivity of SNB was 86% and the negative predictive value 95%. ConclusionThese data show that SNB is a reliable and safe oncological technique for staging the clinically N0 neck in patients with T1 and T2 oral cancer.EORTC Protocol 24021: Sentinel Node Biopsy in the Management of Oral and Oropharyngeal Squamous Cell Carcinoma.

Head and neck cancer: towards a new paradigm with sentinel node localization

In an attempt to improve the detection of occult lymph node metastasis and avoid the morbidity, burden and costs of unnecessary elective neck dissection, sentinel node biopsy has been introduced successfully in early oral cancer: a sensitivity of 93 % and negative predictive values of 80–100 % have been reported. In comparison with elective neck dissection (in all patients), sentinel node biopsy (with neck dissection only in if sentinel node is positive) is associated with less complications, less shoulder morbidity and lower costs. In case of a positive sentinel node, neck dissections can potentially be tailored to the individual patient. Results in other non-cutaneous head and neck sites are promising, but need further research before entering routine clinical practice. New developments in tracers and instruments may increase the sensitivity of sentinel node biopsy further and facilitate harvesting of sentinel nodes.

Sentinel node biopsy for early‐stage oral cavity cancer: the VU University Medical Center experience

Sentinel node biopsy (SNB) in head and neck cancer is recently introduced as the staging technique of oral squamous cell carcinoma. We report the results of SNB in patients diagnosed with a T1-T2 oral squamous cell carcinoma and clinically negative (N0) neck in a single center. A retrospective analysis of 90 previously untreated patients who underwent SNB between 2007 and 2012 was performed. The SNB procedure consisted of preoperatively performed lymphoscintigraphy, intraoperative detection using blue dye, and gamma probe guidance and histopathologic examination including step-serial sectioning (SSS) and immunohistochemical (IHC) staining. A positive SNB was followed by neck dissection, whereas regular follow-up with ultrasound-guided fine-needle aspiration cytology (FNAC) was done in case of a negative SNB. The lymphoscintigraphic identification rate was 98% (88 of 90 patients) and the surgical detection rate was 99% (87 of 88 patients). The upstaging rate was 30%. Sensitivity of SNB was 93% and the negative predictive value was 97%. The median follow-up was 18 months (range, 2-62 months). Overall survival (OS) and disease-free survival (DFS) for SNB negative were 100% and 84% and for SNB positive patients 73% and 88%, respectively. SNB is a reliable diagnostic staging technique for the clinically negative neck in patients with early-stage (T1-T2, cN0) oral squamous cell carcinoma.

Sentinel Node Biopsy in Head and Neck Squamous Cell Cancer: 5-Year Follow-Up of a European Multicenter Trial

Sentinel node biopsy (SNB) may represent an alternative to elective neck dissection for the staging of patients with early head and neck squamous cell carcinoma (HNSCC). To date, the technique has been successfully described in a number of small single-institution studies. This report describes the long-term follow-up of a large European multicenter trial evaluating the accuracy of the technique. A total of 227 SNB procedures were carried out across 6 centers, of which 134 were performed in clinically T1/2 N0 patients. All patients underwent SNB with preoperative lymphoscintigraphy, intraoperative blue dye, and handheld gamma probe. Sentinel nodes were evaluated with hematoxylin and eosin (H&E) staining, step-serial sectioning (SSS), and immunohistochemistry (IHC). There were 79 patients who underwent SNB as the sole staging tool, while 55 patients underwent SNB-assisted elective neck dissection. Sentinel nodes were successfully identified in 125 of 134 patients (93%), with a lower success rate observed for floor-of-mouth tumors (FoM; 88% vs. 96%, P = 0.138). Also, 42 patients were upstaged (34%); of these, 10 patients harbored only micrometastatic disease. At a minimum follow-up of 5 years, the overall sensitivity of SNB was 91%. The sensitivity and negative predictive values (NPV) were lower for patients with FoM tumors compared with other sites (80% vs. 97% and 88% vs. 98%, respectively, P = 0.034). Sentinel node biopsy is a reliable and reproducible means of staging the clinically N0 neck for patients with cT1/T2 HNSCC. It can be used as the sole staging tool for the majority of these patients, but cannot currently be recommended for patients with tumors in the floor of the mouth.

Breast 04

Background: To discover the true accuracy of sentinel node biopsy (SNB) by eliminating the bias that results from the more intensive histological assessment of the SNs than non-SNs. Methods: Three hundred unselected consecutive patients with primary breast cancer (T1-3, N0–1) had sentinel biopsy followed by level III axillary clearance. SN localization was by isotope and dye in 112 patients and dye only in 188 patients. All sentinel and nonsentinel nodes were treated identically by serial sectioning, followed by H&E and immunohistochemistry for cytokeratin (CAM 5.2). Results: SN was identified in 250 (83.3 per cent), 91.9 per cent for isotope and dye compared to dye alone, 78.2 per cent (P = 0.005). A mean of 1.4 SNs and 21.8 non-SNs were retrieved. The SN predicted the status of the rest of the axilla with an accuracy of 91.2 per cent and a sensitivity of 82.3 per cent. There was no difference in the sensitivity of SNB between the methods of localization used (isotope and dye: 84.6 per cent; dye alone: 81.1 per cent). Multivariate analysis of 10 patients and methodological variants demonstrated that needle localization of the tumour and high node positivity (≥4 positive nodes) were the only factors associated with reduced SN identification. None of the same 10 factors affected SNB accuracy. Conclusions: In this prospective study when patients are not selected and all of the axillary nodes are cleared and treated by similar histological techniques, the accuracy and sensitivity of SNB is not as accurate as generally quoted. Different methodological techniques affect the rate of identification of the SN but not its accuracy.