Sentinel Node Concept Research Articles

Difference between sentinel and non-sentinel lymph nodes in the distribution of dendritic cells and macrophages: An immunohistochemical and morphometric study using gastric regional nodes obtained in sentinel node navigation surgery for early gastric cancer.

The sentinel lymph node (SN) concept has a significant impact on cancer surgery. We aimed to examine which morphology of dendritic cells (DCs) and macrophages corresponds to "preconditioning" of the SN against cancer. Although macrophages are generally able to tolerate cancer metastasis, the CD169-positive subtype is believed to be a limited exception. Immunohistochemical and morphometric analyses were performed to examine DC-SIGN-, CD68-, and CD169-positive cells in SNs and non-SNs of 23 patients with gastric cancer with or without nodal metastasis. All patients survived for >5 years without recurrence. DCs were present in the subcapsular, paracortical, and medullary sinuses, the endothelia of which expressed DC-SIGN and smooth muscle actin (SMA). In the non-SNs of patients without metastasis, subcapsular DCs occupied a larger area than SNs, and this difference was statistically significant. Conversely, subcapsular DCs were likely to have migrated to the paracortical area of the SNs. DC clusters often overlapped with macrophage clusters; however, histiocytosis-like clusters of CD169-negative macrophages showed a smaller overlap. We found a significantly larger overlap between DC-SIGN and CD169-positive clusters in SNs than in non-SNs; the larger overlap seemed to correspond to a higher cross-presentation of cancer antigens between these cell populations. DC-SIGN-CD169-double positive cells might exist within this overlap. SNs in gastric cancers are usually preconditioned as a frontier of cancer immunity, but they may sometimes be suppressed earlier than non-SNs. DC-SIGN- and CD169-positive cells appeared to decrease owing to a long lag time from the primary lesion occurrence and a short distance from the metastasis.

Can we apply the concept of sentinel lymph node in rectal cancer surgery?

Introduction Colorectal cancer remains one of the most common causes of cancer-related mortality worldwide, and lymph node staging is crucial in the diagnostic and therapeutic process. Sentinel lymph nodes are the first involved in this process, but their validity in colorectal surgery has not yet been established. Following the emergence of new imaging instrumentation, some authors have attempted to propose different techniques for lymph node identification. However, a clear pattern of mesorectal lymph node distribution relative to the primary lesion site has yet to be defined. Material and methods Our analysis retrospectively reviewed suspicious mesorectal pathological lymph nodes on pre-operative magnetic resonance imaging (MRI) of rectal cancer patients, in order to assess the distribution patterns of possible tumour-related rectal lymph nodes. Mesorectal space was subdivided into quadrants and levels, and morphological features and distances from the lymph node to the primary rectal tumour were recorded. Results Two hundred and fifty-five mesorectal lymph nodes distributed among 60 patients were collected. Results show that in 92.1% of cases, nodes were distributed in the same mesorectal quadrant as the rectal primary tumour, and in 88.5% of cases, they were found at the same level as the rectal primary tumour. Conclusions Although a clear node distribution pattern was not established, these results may suggest at least a lymphatic drainage preference lane, worthy of further investigation.

Sentinel lymph node mapping in patients with uterine cancer: current state of the problem. Literature review

Uterine cancer is one of the most common malignant diseases among female population. Surgical treatment is the main part of therapy but the question of lymph node dissection volume in patients with intermediate risk of uterine cancer metastasis remains open.The article considers the concept of sentinel lymph node, anatomical characteristics of uterine lymphatic system. Description of various techniques for identification of sentinel lymph nodes, as well as clinical trial data evaluating their diagnostic effectiveness and sensitivity, are presented. Comparative analysis of the techniques and their combinations, drug administration routes is performed.

Preclinical evaluation of sentinel node localization in the stomach via mannose-labelled magnetic nanoparticles and indocyanine green

BackgroundGastrectomy with extended (D2) lymphadenectomy is considered standard of care for gastric cancer to provide the best possible outcomes and pathologic staging. However, D2 gastrectomy is a technically demanding operation and reported to be associated with increased complications and mortality. Application of sentinel lymph node (SLN) concept in gastric cancer has the potential to reduce patient morbidity; however, SLN techniques are not established for gastrectomy, in part due to lack of practical tracers. An effective and convenient tracer with enhanced SLN accumulation is critically needed.MethodsMannose-labelled magnetic tracer ‘FerroTrace’ and fluorescent dye indocyanine green (ICG) were injected laparoscopically into the stomach submucosa of 8 healthy swine under general anaesthesia. Intraoperative fluorescence imaging was used to highlight draining lymphatic pathways containing ICG, while preoperative T2-weighted MRI and ex vivo magnetometer probe measurements were used to identify nodes containing FerroTrace. Lymphadenectomy was performed either robotically (n = 2) or via laparotomy (n = 6).ResultsMixing ICG and FerroTrace ensured concurrence of fluorescent and magnetic signals in SLNs. An initial trial with robotic dissection removed all magnetic LNs (n = 4). In the subsequent laparotomy study that targeted all ICG-LNs based on intraoperative fluorescence imaging, dissection removed an average of 4.7 ± 1.2 fluorescent, and 2.0 ± 1.3 magnetic LNs per animal. Both MRI and magnetometer detected 100% of SLNs (n = 7). FerroTrace demonstrated high specificity to SLNs, which contained 76 ± 30% of total lymphotropic iron, and 88 ± 20 % of the overall magnetometer signal.ConclusionsThrough utilisation of this dual tracer approach, SLNs were identified via preoperative MRI, visualised intraoperatively with fluorescence imaging, and confirmed with a magnetometer. This combination pairs the sensitivity of ICG with SLN-specific FerroTrace and can be used for reliable SLN detection in gastric cancer, with potential applications in neoadjuvant therapy.Graphical abstract

An Extraordinary Location of Sentinel Lymph Nodes in a Patient with Endometrial Cancer

To show dissection of sentinel lymph nodes. A step-by-step demonstration of the technique with narration. Endometrial cancer (EC) is the most common gynecologic malignancy worldwide. Sentinel lymph node biopsy with indocyanine green (ICG) has become more widely used and has been featured in recently published guidelines for EC [1]. Minimally invasive approaches with the sentinel lymph node concept (conventional laparoscopy, laparoscopic-assisted vaginal surgeries or robotic) to EC staging have resulted in lower rates of peri- and postoperative complications than conventional staging procedures [2]. No video article has been published in the literature about high pelvic, para-aortic sentinel lymph node dissection. An informed consent form was obtained from the patient. An institutional review board approval was not required. A 45-year-old female with gravidity 0, parity 0, and body mass index of 23.4 kg/m2 presented with complaints of abnormal uterine bleeding (spotting). Increased endometrial thickness was detected on transvaginal ultrasound (10 mm) in the postmenstrual period. Endometrioid-type endometrial adenocancer with focal squamous differentiation International Federation of Gynecology and Obstetrics grade I was detected on endometrial biopsy. The patient had hepatitis B virus positivity and no other chronic disease. A laparotomic myomectomy had been performed in 2016. Laparoscopic high pelvic, low para-aortic sentinel lymph node dissection with ICG and hysterectomy (without uterine manipulator)+bilateral salpingo-oophorectomy were performed (Supplemental Video 1). The operation time for the procedure was 110 minutes and the estimated blood loss was <20 mL. No major complications occurred during or after the surgery. The patient stayed in the hospital for 1 day. The final pathology result showed an International Federation of Gynecology and Obstetrics grade I, endometrioid-type endometrial adenocancer with focal squamous differentiation, as a 1.5×1 cm tumorous mass invading less than one-half of the myometrium. Neither lymphovascular invasion nor sentinel lymph node metastasis was detected. A multicenter, prospective study showed that sentinel lymph node dissection with ICG in clinical stage 1 EC is feasible and has a high degree of diagnostic accuracy in detecting EC metastases. In that study, isolated para-aortic sentinel lymph node was detected in 3 of 340 patients (<1%) [2]. Another study reported the detection rate of isolated para-aortic sentinel lymph node to be 1.1% in patients with intermediate- and high-risk EC [3]. There are in some cases 2 distinct channels emanating from one side, and it is important to follow each and to acknowledge there may be more than one sentinel, one of which is lower in a typical location and one higher as in this case. This video article is the first video demonstration of bilateral isolated high pelvic, para-aortic sentinel lymph node dissection in EC.

Mapping the Lymphatic Drainage Pattern of Esophageal Cancer with Near-Infrared Fluorescent Imaging during Robotic Assisted Minimally Invasive Ivor Lewis Esophagectomy (RAMIE)—First Results of the Prospective ESOMAP Feasibility Trial

While the sentinel lymph node concept is routinely applied in other surgical fields, no established and valid modality for lymph node mapping for esophageal cancer surgery currently exists. Near-infrared light fluorescence (NIR) using indocyanine green (ICG) has been recently proven to be a safe technology for peritumoral injection and consecutive lymph node mapping in small surgical cohorts, mostly without the usage of robotic technology. The aim of this study was to identify the lymphatic drainage pattern of esophageal cancer during highly standardized RAMIE and to correlate the intraoperative images with the histopathological dissemination of lymphatic metastases. Patients with clinically advanced stage squamous cell carcinoma or adenocarcinoma of the esophagus undergoing a RAMIE at our Center of Excellence for Surgery of the Upper Gastrointestinal Tract were prospectively included in this study. Patients were admitted on the day prior to surgery, and an additional EGD with endoscopic injection of the ICG solution around the tumor was performed. Intraoperative imaging procedures were performed using the Stryker 1688 or the FIREFLY fluorescence imaging system, and resected lymph nodes were sent to pathology. A total of 20 patients were included in the study, and feasibility and safety for the application of NIR using ICG during RAMIE were shown. NIR imaging to detect lymph node metastases can be safely performed during RAMIE. Further analyses in our center will focus on pathological analyses of ICG-positive tissue and quantification using artificial intelligence tools with a correlation of long-term follow-up data.

Intraoperative ICG-Fluorescence Imaging of Lymph Nodes in Robot-Assisted Radical Cystectomy in Patients with Bladder Cancer

Introduction. Bladder cancer dominates among global health problems. Radical cystectomy is the recognized standard of care for muscle-invasive bladder cancer with bilateral pelvic lymphadenectomy as a mandatory step in the surgical procedure. The concept of sentinel lymph nodes, acting as a barrier to the spread of malignant process, can be beneficial in terms of reducing the extent of pelvic lymphadenectomy. Intraoperative imaging using indocyanine green now appears to be a contemporary and relevant method for intraoperative imaging of sentinel lymph nodes. Materials and methods. A study involving 28 patients diagnosed with bladder cancer was carried out at the clinic of the Bashkir State Medical University. All patients underwent robot-assisted radical cystectomy with intracorporeal formation of a heterotopic neobladder using Bricker technique. At the stage of pelvic lymphadenectomy, the isolated lymph nodes were evaluated and intraoperative ICG-fluorescence was performed. All lymph nodes obtained were examined microscopically and the results were interpreted taking into account the intraoperative diagnosis. Results and discussion. Intraoperative ICG fluorescence identified sentinel lymph nodes in 7 of 9 patients (77.8%, p &lt; 0.05), with sensitivity equal to 77.8%, p &lt; 0.05 and specificity — 87.5%, p &lt; 0.05. Conclusion. The results proved a high reliability of the method of intraoperative lymph nodes imaging with indocyanine green in patients with muscle-invasive bladder cancer. Fluorescence navigation in cancer surgery opens up new opportunities for improving perioperative outcomes and reducing complications.

HF01-16 HISTORY OF THE SENTINEL NODE TECHNIQUE IN UROLOGICAL TUMORS, 100 YEARS SINCE ITS INCEPTION

You have accessJournal of UrologyCME1 Apr 2023HF01-16 HISTORY OF THE SENTINEL NODE TECHNIQUE IN UROLOGICAL TUMORS, 100 YEARS SINCE ITS INCEPTION Javier Perez-Ardavin, Manuel Martinez-Sarmiento, Juan José Monserrat-Monfort, Jaime Bolon, Francisco Quereda-Flores, César David Vera Donoso, and Alberto Budia Javier Perez-ArdavinJavier Perez-Ardavin More articles by this author , Manuel Martinez-SarmientoManuel Martinez-Sarmiento More articles by this author , Juan José Monserrat-MonfortJuan José Monserrat-Monfort More articles by this author , Jaime BolonJaime Bolon More articles by this author , Francisco Quereda-FloresFrancisco Quereda-Flores More articles by this author , César David Vera DonosoCésar David Vera Donoso More articles by this author , and Alberto BudiaAlberto Budia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003243.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The lymphatic pathway and its involvement in cancer treatment has been studied for centuries. The objective of this study was to historically assess the application of of the sentinel node (SN) technique in the assessment of lymphatic spread in urologic malignancy. METHODS: We conducted a comprehensive literature review of studies evaluating lymphatic spread in urologic malignancy. Medline, Embase, Scopus, and AGORA were queried from time of database inception until 1900/2022 We evaluated temporal trends in publication by genitourinary malignancy type. RESULTS: The first reference of lymphatic dissemination was by Bartholin in 1653, with discovery of a system that conducted liquid through the body, in parallel to the blood. In 1923, Braithwaite et al. first published the concept of the "sentinel gland." In 1953, Sherman and Ter-Pogossian managed to establish the SN technique using radioisotopes. With this advance, Rudolf Virchow's hypothesis was confirmed: "the lymphatic system runs in one direction and in an orderly manner". In 1966 Sayegh et al. described for the first time the lymphatic drainage of a urological organ, such as the testicles. However, it was not until 1977, when Cabanas defined the concept of SN as we know it today in penile cancer with its clinical application. A few years later, in 1999 Wawroschek et al. developed the technique in open surgery using the injection of nanocolloids labeled with Tc99m which is still used for experimental use. Nevertheless, as we can see in the image, the trend of publications on prostate cancer is on the rise, surpassing those on penile cancer. Finally, the use of SN technique extended to kidney, muscle-invasive bladder cancer and testicle with discouraging results according to data first published in the 00´s. CONCLUSIONS: Since its inception in 1923, several authors have studied the concept of the SN in urologic malignancy, with an increase in the number of studies performed over time. While the use of SN technique is well established, its application in prostate cancer remains an experimental for trial purposes. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e261 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Javier Perez-Ardavin More articles by this author Manuel Martinez-Sarmiento More articles by this author Juan José Monserrat-Monfort More articles by this author Jaime Bolon More articles by this author Francisco Quereda-Flores More articles by this author César David Vera Donoso More articles by this author Alberto Budia More articles by this author Expand All Advertisement PDF downloadLoading ...

Frontiers in Esophageal disease: lymph node metastatic patterns in esophageal cancer-first article in our new invited review series.

In the current issue of Diseases of the Esophagus, we have the pleasure of publishing the first new series of premium-invited review articles. The series, which we have named Frontiers in Esophageal Disease, is intended to give our readership comprehensive reviews of the current most important areas of development or controversy in the esophageal world, written by the most important international opinion leaders. Our goal is that these articles will guide and inform our readership in the diverse and rapidly evolving field of esophagology. This first article in the series, ‘Lymph node metastatic patterns and the development of multidisciplinary treatment for esophageal cancer’,1 is written by Professor Yuko Kitagawa and his colleagues at Keio University, Tokyo, Japan. Professor Kitagawa’s group have pioneered research on lymph node metastatic patterns in esophageal cancer, first by exploring the sentinel node concept in gastric and esophageal cancer, and then by performing prospective studies mapping the patterns of lymph node metastasis in esophageal cancer of both histological subtypes.

ICG fluorescence imaging for the evaluation of lymph nodes in bladder cancer

Radical cystectomy is the gold standard treatment for aggressive bladder cancer. Pelvic lymphadenectomy is an important step. This procedure is crucial for the cancer staging, determination of further treatment strategy, and optimization of surgical outcomes. Currently, the sentinel lymph node concept is being actively developed, which allows to reduce the required extent of pelvic lymph node dissection. Decrease in number of removed pelvic lymph node improves surgical safety of the patient. Indocyanine green near-infrared fluorescence is the main approach to the intraoperative visualization of sentinel lymph nodes. The prospects of this diagnostic technique application in radical cystectomy performed for bladder cancer determine the vector of future scientific research in this area.

Update of sentinel lymph node mapping assessment in endometrial cancer

Endometrial cancer is the most common gynecologic malignancy in developed countries. Pathologic confirmation of lymph node metastasis is important for risk stratification and the administration of adjuvant treatments. Therefore, comprehensive,...

Similar distribution of pelvic sentinel lymph nodes and nodal metastases in cervical and endometrial cancer. A prospective study based on lymphatic anatomy

ObjectiveComparing the anatomical distribution of metastatic and non-metastatic pelvic sentinel lymph nodes (SLN) in cervical and endometrial cancer. MethodsDetailed SLN mapping results were prospectively retrieved in cervical (n = 145) or high-risk endometrial cancer (n = 201) patients undergoing a robotic staging procedure. Cervically injected Indocyanine Green (ICG), allowing for reinjection in case of inadequate mapping, was used as tracer. An anatomically based definition of SLNs was adhered to evaluating the upper (UPP) and lower (LPP) paracervical lymphatic pathways. The positions of SLNs were intraoperatively depicted on an anatomical chart. A completory pelvic lymphadenectomy was performed. Mapping rates and anatomical distribution of SLNs and the location of pelvic nodal metastases were compared between groups. ResultsThe bilateral mapping rate was 97.9% and 95.0% for cervical and endometrial cancer respectively (p = .16). The proportion of typically positioned (interiliac and proximal obturator fossa) SLNs along the UPP was similar between groups (78.1% vs 82.1%, p = .09), and the rate of metastatic SLNs in the obturator fossa was 54.1% and 48.6% respectively (p = .45). All pelvic node positive women (cervical cancer n = 19, endometrial cancer n = 37) had at least one metastatic SLN. Anatomically typical positions could not be defined along the LPP. ConclusionThe anatomical location of SLNs and SLN metastases are similar in cervical and endometrial cancer suggesting that sensitivity results for an SLN concept in endometrial cancer and cervical cancer can be accumulated.

Indocyanine green as a new trend in sentinel lymphatic node detection in oncogynecology.

In oncological surgery the importance of the sentinel node concept is increasing, as we are capable of reducing the surgical burden of patients and its associated morbidity and preserving adequate oncological safety at the same time. Recently, there has been development of lymph node mapping techniques, where the most promising method appears to be the immunofluorescent one using indocyanine green dye. This technique provides high sensitivity in sentinel node detection in comparison with other existing methods using a dye in combination with a radionuclide. The indocyanine green technique has several advantages, and at the same time, we can use this method in non-oncological indications in gynecological surgery.

Methods for sentinel lymph node mapping in oral cancer: a literature review

Abstract Oral cancers, excluding non-melanoma skin cancer, are the most common cancers of the head and neck. Of these, 90% are squamous cell carcinomas (SCC). Surgery, which consists of dissection of the primary tumor and lymphadenectomy, is considered a radical method of treatment. There are several ranges of cervical lymphadenectomy: selective neck dissection (SND), modified radical neck dissection (MRND), and radical neck dissection (RND). The extension of surgery depends on the stage of clinical advancement, which can be determined by TNM classification, among other methods. The greatest controversy is related to SND in patients with cN0 (no evidence of regional lymph node metastasis), which is currently standard procedure. This approach is dictated by the possibility of hidden or subclinical metastases. The use of the sentinel lymph node (SLN) concept in patients with early stage of oral cancer and appropriate methods of its mapping may lead to a reduction in the extent of the lymphadenectomy procedure, thus reducing postoperative mortality and maintaining the patient’s function and quality of life, with correct oncological results. So far, available methods for SLN mapping are based on use of markers: methylene blue dye (MBD), metastable radioactive isotope Technetium (99mTc), or the fluorescent substance indocyanine green (ICG).

Management of the axilla: Conventional tracers vs ICG-fluorescence in sentinel lymph node biopsy

The evaluation of regional lymph nodes is part of breast cancer staging. Biopsy of the sentinel lymph node was established, in order to evaluate the condition of the axillary lymph nodes without having to complete an axillary dissection. The concept of sentinel lymph node (SLN) is based on the theory of sequential dissemination of tumor cells through the lymph. When lymphatic dissemination occurs, the invasion initially occurs in the first lymph node that drains lymph from the tumor. This lymph node has been named GS and depending on its negative or positive status, the presence or absence of metastases in the remaining regional lymph nodes can be established. Blue dye (BD) and radioactive isotopes (RI) are routinely used markers for identification of the sentinel lymph nodes during sentinel lymph node biopsy (SLNB) in early stage breast cancer. Unlike the blue dye technique, using radioactive isotopes has lower false-negative rates. Nonetheless, the need of lymphoscintigraphy, the time needed for preoperative injection, and undetected sentinel lymph nodes in some cases cause surgeons to rely only on the combination of blue dye and radioisotopes. At present, indocyanine green (ICG) fluorescence method (ICG-SLNB) is starting to gain more and more field as an alternative to conventional mapping methods. The purpose of this review is to compare ICG with the conventional methods (blue dye and radioactive isotopes) and their role in detection of SLN.

Function-Preserving Gastrectomy for Early Gastric Cancer.

Simple SummaryFor patients with early gastric cancer (EGC), a good prognosis is achieved by conventional standard gastrectomy with radical lymphadenectomy. However, postgastrectomy syndrome is often inevitable and results in decreased quality of life (QOL). To improve patients’ QOL, proximal gastrectomy instead of total gastrectomy and pylorus-preserving gastrectomy instead of distal gastrectomy have been widely accepted as function-preserving gastrectomies. Recently, personalized, minimized gastrectomy with sentinel node navigation surgery has been developed and is expected to be an ideal treatment option for patients with EGC. Herein, we review the indications, surgical techniques, and postoperative outcomes of function-preserving gastrectomy.Recently, minimally invasive (endoscopic or laparoscopic) treatment for early gastric cancer (EGC) has been widely accepted. However, a standard gastrectomy with radical lymphadenectomy is generally performed in patients with EGC who have no indications for endoscopic resection, and postgastrectomy dysfunction is one of the problems of standard gastrectomy. Function-preserving gastrectomy, such as proximal gastrectomy and pylorus-preserving gastrectomy, can be considered when attempting to preserve the patient’s quality of life (QOL) postoperatively. In addition, sentinel node navigation surgery for EGC has been applied in clinical practice in several prospective studies on function-preserving personalized minimized gastrectomy. In the near future, the sentinel lymph node concept is expected to form the basis for establishing an ideal, personalized, minimally invasive function-preserving treatment for patients with EGC, which will improve their postoperative QOL without compromising their long-term survival. In this review article, we summarize the current status, surgical techniques, and postoperative outcomes of function-preserving gastrectomy for EGC.

Exploratory analysis of lateral pelvic sentinel lymph node status for optimal management of laparoscopic lateral lymph node dissection in advanced lower rectal cancer without suspected lateral lymph node metastasis

BackgroundTotal mesorectal excision (TME) and lateral lymph node dissection (LLND) without radiotherapy (RT) are standard treatment for lower cT3/4 rectal cancers in Eastern countries. In comparative studies, both TME + LLND and RT + TME yield good local control. Although Japanese guidelines recommend LLND for locally advanced rectal cancers below the peritoneal reflection, LLND dissection of clinically negative lateral pelvic lymph nodes (LPLN) is controversial, and laparoscopic TME + LLND is technically challenging and time-consuming. New optical instruments for laparoscopy allow easy perioperative sentinel lymph node (SLN) identification using ICG. The SLN concept may facilitate accurate diagnosis of LPLN involvement, and thus reduce LLND in laparoscopic rectal cancer surgery. Here we investigated lateral pelvic SLN navigation surgery for SLN detection during laparoscopic rectal cancer surgery.MethodsThis study included 21 patients with clinical StageII/III lower rectal cancer without LPLN enlargement, who underwent curative laparoscopic surgery. All patients underwent TME, followed by lateral SLN identification and biopsy using ICG, and then laparoscopic LLND. ICG fluorescence imaging was conducted using the laparoscopic near-infrared camera system.ResultsLateral SLNs were successfully identified in 16 (76.2%) of the 21 patients. Among the 15 patients without SLN tumor metastasis, the dissected lateral non-SLNs were all negative.ConclusionsA lack of metastasis in the lateral pelvic SLN seems to reflect a lack of metastases to all lateral LNs. Our present results suggest that this laparoscopic ICG-guided SLN strategy may be a low-risk and time-saving method to prevent laparoscopic LLND in cases with negative lateral pelvic lymph nodes.

The Results of Sentinel Node Mapping for Patients with Clinically Early Staged Gastric Cancer Diagnosed with pT2/deeper Tumors.

Sentinel node (SN) mapping based on the SN concept has been applied to early gastric cancer. However, it is still controversial whether or not the oncological safety is ensured in case pathological stage was advanced in these patients. The aim of this study was to investigate the validity of SN mapping in patients with clinically early staged gastric cancer diagnosed with pT2/deeper tumors. We retrospectively analyzed 40 patients with a diagnosis of cT1N0 or cT2N0 single-lesion gastric cancer who were shown to have pT2 or deeper tumors after gastrectomy with SN mapping. We adopted a dual-tracer method using a radioactive colloid and blue dye to detect SNs. The diagnostic accuracy and distribution of SNs at each tumor site were analyzed. Of the 40 patients, 24 (60%) were postoperatively diagnosed as pT2, and 16 (40%) as pT3 or T4. SNs were detected in all patients. The false negative rate was 9% (1/11), and in that patient, the non-SN metastasis was observed within the SN basin. Diagnostic accuracy was 98% (39/40). Overall distribution of SNs was similar to that for patients with early gastric cancer. No significant differences in overall and recurrence-free survival were observed between the patients who underwent standard gastrectomy and those who underwent function-preserving gastrectomy, based on the results of SN mapping. Our results confirmed validity of SN mapping for patients with clinically early staged gastric cancer diagnosed with pT2/deeper tumors after gastrectomy. Closed surveillance without additional surgical treatment is an option for these patients.

O69: THE SENTINEL LYMPH NODE TECHNIQUE IN THE ENDOMETRIAL CANCER

Abstract Introduction The sentinel lymph node (SLN) concept represents advancement in the management of the endometrial cancer (EC). We aim to assess the performance of the SLN procedure; its positive predictive value (PPV) and negative predictive value (NPV); in stage I of EC (FIGO2009). Method A prospective study is conducted in our institution. We perform a double detection of the SLN (radiolabel Tc 99 microsulfur colloid and a color method using patent blue) followed by pelvic lymphadenectomy with or without paraaortic lymphadenectomy. A pelvic MRI is performed to determine myometrial invasion and nodal status. The injection of Tc 99m colloid occurs the day prior to surgery. The injection into the stroma of the cervix at the 3 and 9 o'clock positions was performed by an oncologist surgeon with the assistance of a nuclear medicine physician. Preoperative lymphoscintigraphy was obtained after 90-120 minutes. We inject into the cervical stroma 2cc of patent blue similar to the Tc99 injection. A gamma detecting probe is used to locate radioactive lymph nodes. The SLNs identified then are labelled as radioactive and/or blue. No frozen-section analysis was performed. Results For the pathological analysis of the SLN, Haematoxylin Eosin is used. If there is no metastasis detected, an ultra staging protocol using different anti-cytokeratines is conducted. Studies have shown that this approach is possible having satisfactory results when conducted by dedicated surgical, radiology and pathology team. We look forward to our outcomes to illustrate those results. Take-home message Sentinel lymph node is a good alternative for gynecological cancer

Sentinel lymph node in vulvar cancer.

Lymph node removal as a part of surgical management is a standard of care in vulvar cancer patients. Due to patient morbidities and difficulties in treatment of inguinal healing after lymph nodes removal, lymphatic mapping has emerged as an increasingly popular option over the past few years. At this time several different techniques have been described and variety of different dyes were used. In addition, an important aspect of the use of the sentinel lymph node (SLN) technique is the removal of a limited number of lymph nodes, which allows more detailed pathological examination. Moreover, the interpretation of pathological ultra-staging of SLNs, which can identify low-volume metastases for which the clinical significance and the ideal management, remain uncertain. Despite differences in techniques and dyes used, this minimally invasive procedure is currently recommended as an alternative to full inguinofemoral lymph node dissection in selected cases by all major international societies. As for now SLN concept became a standard of care in vulvar cancer. This technique, though simple as a concept, requires a learning curve and should only be used in expert centers. This article provides a review on literature on SLN technique in vulvar cancer, current recommendations and future lines of investigation.