Sentinel Lymph Node Dissection Research Articles

Sentinel lymph node detection with indocyanine green and patent blue dye in cervical cancer: A single-centre feasibility study.

Sentinel lymph node (SLN) dissection has been established as standard of care in many tumours. Its use in early cervical cancer is an area of increasing interest and some studies suggest a high detection rate. To explore feasibility of SLN dissection and establish the patient detection rate in women with early cervical cancer. All patients with early cervical cancer, International Federation of Gynaecology and Obstetrics (FIGO) 2018 Stage 1, of any histology who underwent SLN dissection from January 2017 to March 2023 were included. Patients were eligible if they had pelvic confined disease; no suspicious lymph nodes on pre-operative imaging or intra-operatively; tumours <4 cm at the time of surgery and no contra-indications to surgery. Patients were excluded if there was a known allergy to dye or less than six months follow-up data. Sixty-two patients were included in the study and 53% had FIGO stage 1b1 disease. The overall bilateral SLN detection rate was 89%, and the side-specific rate was 94%. Where indocyanine green (ICG) was used alone, the bilateral detection rate was 87% and the side-specific rate was 93%. Where ICG was used with patent blue dye (PTB) the bilateral detection rate was 92% and the side-specific rate was 96%. Where PTB was used alone the bilateral detection rate was 85% and the side-specific rate was 92%. The node positive rate was 6% (7/124) which included isolated tumour cells in four patients. SLN dissection with ICG or PTB is feasible in early-stage cervical cancer.

The Role of Axillary Lymph Node Dissection versus Sentinel Lymph Node Dissection in Breast Cancer Patients with Clinical N2b-N3c Disease Who Receive Adjuvant Radiotherapy.

For breast cancer with advanced regional lymph node involvement, axillary lymph node dissection (ALND) remains the standard of care for staging and treating the axilla despite the presence of undissected lymph nodes. The benefit of ALND in this setting is unknown. We sought to describe national patterns of care of axillary surgery and its association with overall survival (OS) among women with cN2b-N3c breast cancer who receive adjuvant radiotherapy. We identified female patients with cN2b-N3c breast cancer from 2012 to 2017 from the National Cancer Database. Clinical and demographic information were analyzed using Wilcoxon rank sum and χ2 tests. Predictors of receipt of ALND and predictors of death were identified with multivariable logistic regression modeling. Inverse probability of treatment weighting was implemented to adjust for differences in treatment cohorts. The Kaplan-Meier method was used to evaluate OS. We identified 7167 patients. Of these, 922 (13%) received SLNB and 6254 (87%) received ALND; 7% were cN2b, 19% cN3a, 24% cN3b, 19% cN3c, and 31% cN3, not otherwise specified. Predictors of receipt of ALND were age 50-69 years [odds ratio (OR) 1.3, p < 0.01], cN3a (OR 7.6, p < 0.01), cN3b (OR 2.8, p < 0.01), and cN3c (OR 4.2, p < 0.01). Predictors of death included cN3c (OR 1.9, p < 0.01), age 70-90 years (OR 1.5, p = 0.01), and positive surgical margins (OR 1.5, p < 0.01). After cohort balancing, ALND was not associated with improved OS when compared with SLNB (HR 0.99, p = 0.91). ALND in patients with advanced nodal disease was not associated with improved survival compared with SLNB for women who receive adjuvant radiotherapy.

VNOTES retroperitoneal sentinel lymph node dissection for endometrial cancer staging: First multicenter, prospective case series.

The current standard treatment for endometrial cancer is a laparoscopic hysterectomy with adnexectomies and bilateral sentinel node resection. A retroperitoneal vNOTES sentinel node resection has several theoretical potential advantages. These include being less invasive, leaving no visible scars, operating without Trendelenburg, and therefore offering the anesthetic advantage of easier ventilation in obese patients and following the natural lymph node trajectory from caudally to cranially and therefore a lower risk of missing the sentinel node. The aim of this study is to determine the feasibility of a retroperitoneal vNOTES approach to sentinel lymph node dissection for staging of endometrial cancer. A prospective multicenter case series was performed in four hospitals. A total of 64 women with early-stage endometrial carcinoma suitable for surgical staging with sentinel lymph node removal were operated via a transvaginal retroperitoneal vNOTES approach. The paravesical space was entered through a vaginal incision after injecting the cervix with indocyanine green. A vNOTES port was placed into this space and insufflation of the retroperitoneum was performed. Sentinel lymph nodes were identified bilaterally using near-infrared light followed by endoscopic removal of these nodes. A total of 64 women with early-stage endometrial cancer underwent sentinel lymph node removal by retroperitoneal vNOTES technique. All patients also underwent subsequent vNOTES hysterectomy and bilateral salpingo-oophorectomy. The median age was 69.5 years, median total operative time was 126 min and the median estimated blood loss was 80 mL. In 97% of the cases bilateral sentinel nodes could be identified. A total of 60 patients had negative sentinel nodes, three had isolated tumor cells and one had macroscopically positive sentinel nodes. No complications with sequel occurred. This prospective multicenter case series demonstrates the feasibility of the vNOTES approach for identifying and removing sentinel lymph nodes in women with endometrial carcinoma successfully and safely. vNOTES allows sole transvaginal access with exposure of the entire retroperitoneal space, following the natural lymph trajectory caudally to cranially, and without the need for a Trendelenburg position.

Clinical axillary staging in breast cancer patients using ultrasound imaging

Introduction: The presence of axillary lymph node involvement is an important prognostic factor and has a major impact on treatment decisions in early breast cancer patients. This study aimed to determine the role of cortical thickness in axillary ultrasound (AUS) as an indicator of lymph node metastasis. Methods: 766 patients with primary breast cancer who received AUS during clinical work-up were selected for this retrospective study. Lymph nodes were defined as suspicious if they showed a cortical thickness of &gt; 3,0 mm at 11-15 MHz harmonic imaging ultrasound. Lymph node involvement was assessed by core needle biopsy (n=150), sentinel node dissection or axillary dissection. Extensive axillary spread (EAS) was diagnosed if more than two lymph nodes showed metastatic disease on histology. Results: AUS for detecting all lymph node metastases had a sensitivity of 62,27 %, a specificity of 93,15 % and a negative predictive value of 81,74 %. However, the resulting negative predictive value for transcapsular growth was 93,97 %, and for extensive axillary spread 97,52 %. Conclusion: Extensive axillary spread - in contrast to non-palpable involvement of 1 or 2 lymph nodes - contributes relevantly to the individualization of breast cancer treatment. In combination with SNB, axillary ultrasound using cortical thickness as the main distinctive parameter seems to be an easily available, robust tool of diagnosing extensive axillary metastases. If axillary ultrasound proves negative, it helps to reduce the number of classic axillary dissections.

VNOTES surgical staging for endometrial carcinoma in overweight patients: a case series.

The purpose of this study is to show the feasibility and surgical outcome of vNOTES retroperitoneal dissection and isolation of sentinel lymph nodes in overweight and obese patients with endometrial cancer. Four patients had undergone pelvic lymphadenectomy with a sentinel lymph node. Three patients were overweight, and one was obese with a BMI of 34.6kg/m2. By using NMR mode sentinel lymph node was visualized, excised and marked separately for pathohistological analysis from the rest of the visualized lymph nodes that were then consecutively excised. The mean number of overall excised lymph nodes was 12.5, and the mean number on the right side was 5.75 and 6.25 on the left side. There were no metastases verified in the pathohistological evaluation. vNOTES retroperitoneal isolation of sentinel lymph nodes is good alternative and has its benefits, especially in overweight and obese patients with satisfying low intra- and postoperative complications.

Postmastectomy radiation therapy in breast cancer patients with micrometastatic disease in sentinel node dissection: A cohort study and meta-analysis

AimThe potential role of postmastectomy radiation therapy (PMRT) on prognosis in patients with T1-2 breast cancer and micrometastatic disease in sentinel lymph node dissection (SLND) has not yet been established. The aim of this study was to investigate the impact of PMRT on prognosis in patients with T1-2 breast cancer and micrometastatic in SLND. MethodA register- and population-based cohort was utilized by identifying eligible patients on the research database BcBase 3.0. Multivariate Cox regression models were applied for survival outcomes. In addition, a systematic literature review and meta-analysis including all relevant studies on this topic was performed. ResultsIn total, 956 patients fulfilling the inclusion criteria were found through the BcBaSe 3.0 with 237 (25.0 %) receiving PMRT and 719 (75.0 %) not receiving PMRT. No statistically significant differences between the two patient groups in terms of neither breast cancer-specific (adjusted Hazard Ratio (HR): 0.49; 95 % Confidence Interval (CI): 0.14 – 1.73) nor overall survival (adjusted HR: 0.63; 95 % CI: 0.29 – 1.35) was found. In the pooled analyses after literature review, PMRT did not result in better breast cancer-specific (5 studies; pooled HR: 1.06; 95 % CI: 0.88–1.27; I2 = 1 %; low certainty of evidence) or overall survival (6 studies; pooled HR: 1.01; 95 % CI: 0.91–1.13; I2 = 10 %; low certainty of evidence). ConclusionPMRT does not seem to impact survival in patients with T1 or T2 breast cancer with micrometastatic disease in SLND. Considering the low level of evidence and the relatively short follow-up of included studies, caution in interpreting the results into clinical practice is suggested.

Use of Indocyanine Green Near-Infrared Imaging for Sentinel Lymph Node Biopsy in Early Oral Squamous Cell Carcinoma: A Pilot Study

PurposeThe current established technique for sentinel lymph node (SLN) biopsy is preoperative injection of 99mtechnetium-labeled nanosized colloids (99mTc) followed by single photon emission computed tomography and standard computed tomography (SPECT/CT) with subsequent intraoperative gamma probe-guided excision of the SLN. It is however time and resource consuming, causes radiation exposure and morbidity for the patient as the injection is done in the awake patient. Recently near-infrared imaging with indocyanine green (ICG) gained importance in SLN biopsy as a faster and more convenient technique. The objective of our study was to investigate the feasibility of SLN biopsy using ICG-imaging in early oral squamous cell carcinoma (OSCC).MethodsSingle-centre pilot study of five patients with early-stage OSCC. For all patients, both techniques (99mTc and ICG) were performed. We injected 99mTc preoperatively in the awake patient, followed by SPECT/CT imaging. Intraoperatively ICG was injected around the primary tumor. Then the neck incision was performed according to the SPECT/CT images and SLN were detected by using a gamma probe and near-infrared fluorescence imaging of the ICG-marked lymph nodes intraoperatively. The excised lymph nodes were sent to histopathological examination according to the SLN dissection protocol.ResultsIn all five patients sentinel lymph nodes were identified. A total of 7 SLN were identified after injection of 99mTc, imaging with SPECT/CT and intraoperative use of a gamma probe. All these SLN were fluorescent and visible with the ICG technique. In two patients, we could identify additional lymph nodes using the ICG technique. Pathological analysis demonstrated occult metastasis in two of the cases.ConclusionsOur study shows that ICG-guided SLN biopsy is a feasible technique, especially in combination with conventional radioisotope method and may help for intraoperative localization of SLN. Validation studies with bigger patient cohorts are needed to prove our results.

Consensus on surgical technique for sentinel lymph node dissection in cervical cancer

ObjectiveThe purpose of this study was to establish a consensus on the surgical technique for sentinel lymph node (SLN) dissection in cervical cancer.MethodsA 26 question survey was emailed to international...

Opioid prescribing practices in breast oncologic surgery-A retrospective cohort study.

In breast oncologic surgery, 75% of patients receive a postoperative opioid prescription at discharge, and 10%-20% will develop persistent opioid use. To inform future institutional guidelines, the objective of this study was to determine baseline opioid prescribing patterns in a single high-volume, referral-based breast center. We hypothesized that opioid prescribing practices varied between procedures and operating surgeons. A retrospective analysis of all women undergoing breast cancer surgery between January and December 2019. Opioid prescriptions at discharge were converted to morphine milligram equivalents (MME). The primary outcome of interest was MME prescribed at discharge. Multiple linear regression was used to identify factors independently associated with MME prescribed. 392 patients met inclusion criteria; 68.3% underwent partial mastectomy. Median age was 61 (interquartile range [IQR] 51-70). Median MME prescribed at discharge was 112.5 (IQR 75-150); 83.9% of patients were prescribed co-analgesia. The prescriber was a trainee in 37.7% of cases. 15 patients (3.8%) required opioid renewal. On multivariate analysis, axillary procedure was associated with increased MME (ß=17, 95% CI 5.5-28 and ß=32, 95% CI 17-47, for sentinel node and axillary dissection, respectively). However, the factor with the greatest impact on MME was operating surgeon (ß=72, 95% CI 58-87). Residents prescribed less MME compared to attending surgeons (ß=11, 95% CI -22; -0.06). In a tertiary care center, the operating surgeon had the greatest influence on opioid prescribing practices, and trainees tended to prescribe less MME. These findings support the need for a standardized approach to optimize prescribing and reduce opioid-related harms after oncologic breast surgery.

Sentinel Lymph Node Evaluation in Early-Stage Vulvar Cancer.

Sentinel lymph node mapping (SLNM) and dissection (SLND) should be used as an alternative to full inguinofemoral lymph node dissection (IFLND) in select patients with early-stage vulvar cancer. IFLND is associated with high postoperative complications such as wound breakdown, lymphedema, lymphocyst formation, and infection. SLND in select patients offers a safe, effective, and less morbid alternative. Candidates for SLND include patients with a unifocal vulvar tumor less than four centimeters, clinically negative lymph nodes, and no prior inguinofemoral surgeries. SLND should ideally be performed by a high-volume SLN surgeon. Most commonly, SLND is performed using both radiocolloid lymphoscintigraphy (e.g., Technetium-99) and a visual tracer such as blue dye; however, near infrared imaging with indocyanine green injection is becoming more widely adopted. Further prospective studies are needed to examine the safety and efficacy of various techniques for SLND. SLND has been demonstrated to be cost-effective, especially when including perioperative complications. Further studies are needed to demonstrate quality of life differences between IFLND and SLND.

A prospective audit to assess the feasibility of sentinel lymph node biopsy and/or low axillary sampling in clinicoradiologically node-negative axilla for early breast carcinoma

Background: Sentinel lymph node (SLN) dissection was designed to minimize side effects of lymph node surgery but still offer outcomes of axillary lymph node dissection. Aims and Objectives: Our study is designed to determine whether SLN resection achieves the same therapeutics outcome as complete axillary dissection but with fewer side effects for node-negative axilla in clinicoradiologically operable breast cancer patients. Materials and Methods: Duration-based prospective observational study was carried out at the General Surgery and Surgical Oncology Department at Government Medical College and Hospital, Aurangabad with a duration of 2 ½ years from July 2019 to January 2022. A total of 36 patients of breast cancers with stages T1-T2, N0 with clinically and radiologically negative axilla from July 2019 to January 2022 duration were included in our study. Results: When the histopathological status of axillary lymph nodes was compared to the histopathology of SLNs it was seen that out of 36 patients, the histopathology of sentinel node was positive in 10 patients (10/36) however the rest of the axilla was positive in 6 cases and negative in 4 cases and the histopathology sentinel node was negative in 26 patients out of 36 cases (26/36) however the rest of the axilla was also negative in 24 cases and positive in 2 cases. Conclusion: SLN biopsy using methylene blue dye alone is a highly reliable and predictable technique to stage the axilla in breast cancer patients as this study shown a low false-negative rate (7.69%). This technique may help to avoid complete axillary lymph node dissection in sentinel node-negative patients thereby minimizing the morbidity of axillary lymph node dissection. This study demonstrates that sentinel node localization is possible with methylene blue dye alone.

Detection and dissection of sentinel nodes in endometrial endometrioid cancer with indocyanine green using PinPoint laparoscopy: Analysis of the learning curve

ObjectiveEarly-stage endometrial endometrioid adenocarcinoma is managed through laparoscopic total hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy. Detection of positive nodes is rare, and lymphadenectomy may involve complications. Pelvic sentinel lymph node dissection can prevent complete dissection. Herein, we evaluated the learning curve of sentinel lymph node dissection using indocyanine green.Study design: All surgeries for endometrial endometrioid adenocarcinoma were performed laparoscopically with indocyanine green to detect sentinel nodes. The primary outcome was the ability to identify and resect sentinel lymph nodes on each side. The secondary outcome was correspondence between the frozen section histology of the nodes with the final histology. ResultsAmong 31 patients with endometrial endometrioid adenocarcinoma treated between October 2018 and August 2020, 29 who underwent laparoscopy using indocyanine green were enrolled. Complete lymphadenectomy was performed in 16 patients. Failure to recognize sentinel nodes on right and left sides occurred in 10.34% and 0% of cases, respectively. The median number of recognized and dissected sentinel nodes was 1 on both sides (range 0–5). One patient had a lymph node positive for malignancy on histology (3.45%) on both sides. There were 13 and 14 cases of negative frozen sections on the right and left sides, respectively, and 1 case of a positive frozen section with positive whole pelvic lymph nodes. ConclusionSentinel node dissection using indocyanine green in endometrial endometrioid adenocarcinoma has a distinct learning curve; however, it is practical and achievable for skilled surgeons.

A Fluorescent and Magnetic Hybrid Tracer for Improved Sentinel Lymphadenectomy in Prostate Cancer Patients.

In prostate cancer, sentinel lymph node dissection (sLND) offers a personalized procedure with staging ability which is at least equivalent to extended LND while inducing lower morbidity. A bimodal fluorescent-radioactive approach was introduced to improve sentinel LN (SLN) detection. We present the first in-human case series on exploring the use of a fluorescent-magnetic hybrid tracer in a radiation-free sLND procedure. Superparamagnetic iron oxide nanoparticles and indocyanine green were administered simultaneously in five prostate cancer patients scheduled for extended LND, sLND and radical prostatectomy. In situ and ex vivo fluorescence and magnetic signals were documented for each LN sample detected via a laparoscopic fluorescence imaging and magnetometer system. Fluorescence and magnetic activity could be detected in all patients. Overall, 19 lymph node spots could be detected in situ, 14 of which were fluorescently active and 18 of which were magnetically active. In two patients, no fluorescent LNs could be detected in situ. The separation of the LN samples resulted in a total number of 30 SLNs resected. Ex vivo measurements confirmed fluorescence in all but two magnetically active SLNs. One LN detected in situ with both modalities was subsequently shown to contain a metastasis. This study provides the first promising results of a bimodal, radiation-free sLND, combining the advantages of both the magnetic and fluorescence approaches.

The rational of Cloquet lymph node as a sentinel lymph node in iliac dissection in lower limb melanoma

Background and aims Intraoperative lymphatic mapping and sentinel lymphadenectomy (LM/SL) is a growingly popular operating procedure for staging regional lymph nodes in early-stage melanoma. The groin is a promising area for this method since superficial groin dissection and iliac dissection have a significant risk of morbidity. There is currently no consensus on how best to treat cases with tumor-positive sentinel lymph nodes (SNs) during surgery involving these basins. Methods A total of 182 cases were treated using the LM/SL method. There was consistent detection of sentinel lymph nodes. SN dissection was performed on patients who had tumor in their SN. A hematoxylin and eosin stain was used to analyze the sentinel lymph nodes. Patient selection for SN dissection was based only on the presence of tumor in that node. Computerized database containing log-rank tests and Cox regression models for statistical analysis. Results 61% of the 182 cases were female, with an average age of 50 (range, 15–89). Tumor-positive SNs were detected in 21% of cases. 67% of cases were identified to have sentinel full lymph node dissection and a single tumor-positive lymph node after LM/SL, whereas 27% had 2 tumor-positive lymph nodes and 6% had 3 or more tumor-positive lymph nodes. Recurrence in the dissected basin occurs in just 4% of individuals with tumor-negative SNs. Cases whose lymph nodes tested negative for tumors had a significantly greater 5-year overall survival (mean±SD, 94% 5%) compared with those whose lymph nodes tested positive for tumors (meanSD, 75% 4%; P 0.01). Primary tumor thickness (P = 0.03), Tumor-positive SN (P 0.001) and ulceration (P = 0.001) were revealed to be important indicators of survival in multivariate studies using a Cox regression model. Conclusions This surgical treatment ought to become common for cases with early-stage melanoma of the lower extremities and trunk because the accuracy of LM/SL as judged by the infrequent recurrences implies that it should. When a tumor-positive SN is found in the groin, it is important to take a sample from the Cloquet node so that one may decide whether or not an iliac dissection is necessary.

Patterns of Recurrence for Lymph Node Positive Cutaneous Melanoma in the Era of Immunotherapy

The management of patients with lymph node positive, nonmetastatic cutaneous melanoma has changed significantly with the adoption of anti-PD-1 immunotherapy. We compared clinical outcomes and patterns of recurrence of patients with lymph node positive, nonmetastatic cutaneous melanoma who received adjuvant immunotherapy with those who did not receive immunotherapy. Patients with lymph node or in-transit metastasis positive, nonmetastatic cutaneous melanoma diagnosed from 2013-2020 were identified from a prospectively-maintained, single-institution database. Baseline patient demographics and treatment details were recorded. Patients were stratified by receipt of adjuvant immunotherapy. Local and regional recurrence, distant metastasis, first site of recurrence, and overall survival (OS) were recorded, and rates of OS, progression-free survival (PFS), freedom from distant metastasis (ffDM), local recurrence (ffLR), and regional lymph node recurrence (ffRR) were estimated using the Kaplan-Meier method. Wilcoxon rank-sum test, Fisher's exact test, and chi-square test of independence were used to analyze variables between groups. Ninety-two patients were included with a median age of 67 years and a median follow-up of 2.9 years. Fifty-six (61%) patients received adjuvant immunotherapy for a median duration of 8.5 months. Fifty-three (58%) patients had a sentinel lymph node dissection alone while thirty-two (35%) had a complete regional lymph node dissection. A median of 3 lymph nodes were removed (range 0-83) with a median of 1 positive lymph node (range 1-15). Twenty-four (26%) patients had extranodal extension, thirty-nine (42%) had ulceration of the primary site, and twenty-eight (30%) had LVSI present. Median age of patients receiving immunotherapy versus those who did not was 63 years versus 72 years (p = 0.02). There were no differences in primary site, disease thickness, Clark stage, primary site ulceration, LVSI, extranodal extension, satellite metastasis, AJCC T- and N-stage, and completion lymph node dissection rates between the groups. Patients receiving immunotherapy had significantly improved OS (HR = 0.3, p = 0.001) with no difference in PFS (HR = 0.6, p = 0.08), ffDM (HR = 0.66, p = 0.28), ffLR (HR = 0.18, p = 0.1), and ffRR (HR = 2.5, p = 0.08). The initial site of recurrence was regional lymph nodes in thirteen (23%) patients receiving immunotherapy versus two (6%) patients who did not receive immunotherapy (p = 0.01). On UVA, male gender, number of positive lymph nodes, clinically positive lymph nodes, extranodal extension, in-transit metastasis, LVSI, and tumor thickness were significant predictors of regional lymph node recurrence. Patients with lymph node positive cutaneous melanoma receiving immunotherapy had a higher rate of initial disease progression in the regional lymph nodes compared with patients not receiving immunotherapy.

A Phase II Randomized Clinical Trial to Assess Toxicity and Quality of Life of Breast Cancer Patients with Hypofractionated vs. Conventional Fractionation Radiotherapy with Regional Nodal Irradiation

To compare acute toxicity between conventional fractionated radiation therapy (CFRT) and hypofractionated radiation therapy (HFRT) for patients undergoing breast-conserving surgery or mastectomy with breast or chest wall and regional nodal irradiation (RNI). The secondary endpoints were acute and subacute toxicity, cosmesis, quality of life, and lymphedema features. Unblinded randomized trial with a total of 86 patients treated with CFRT (n = 33; 50 Gy/25 fractions ± sequential boost [10 Gy/5 fractions]) versus HFRT (n = 53; 40 Gy/15 fractions ± concomitant boost [8 Gy/15 fractions]). Women included for enrollment were 18 years or older and diagnosed with breast carcinoma, staging T1-4, with at least one positive lymph node (American Joint Committee on Cancer - AJCC 8th). The surgery performed was mastectomy or breast-conservative surgery with the investigation of sentinel lymph node or axillary dissection. Toxic effects and cosmesis evaluation used the Common Terminology Criteria for Adverse Events version 4.03 (CTCAE) and the Harvard/NSABP/RTOG scale. Patients-reported QoL was determined using the European Organization for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30) and the breast cancer-specific supplementary questionnaire (QLQ-BR23). The comparative analysis of categorical variables between the control and experimental groups used the Chi-square test and Fisher's exact test, while numerical variables basing on the Mann-Whitney U test. The intergroup comparison of the EORTC QLQ-C30 used the Generalized Equations Estimating method. All analyses used 2-sided α = 0.05 with R software version 4.1.2. Lymphedema determination compared volume differences between the affected and contralateral arms using the Casley-Smith volume formula. Grade 2 and grade 3 skin rash dermatitis were lower with HFRT than with CF-RT (28% vs. 52%, 0% vs. 6%; p = 0.022, respectively). HFRT vs. CFRT had lower rate of grade 2 hyperpigmentation (23% vs. 55%; p = 0.005). Overall rates of any physician-assessed grade ≥ 2 and grade ≥ 3 acute toxicities were no different between HFRT vs. CFRT arms. There was no statistical difference between the CFRT and the HFRT regarding cosmesis, lymphedema rate (13% vs. 12% HFRT vs. CFRT; p = 1.000, respectively), and functional and symptom scales during irradiation and after six months of treatment. HF-RT showed lower rates of acute toxicity, with no changes in quality-of-life outcomes.

353 Targeted Axillary Dissection Does Benefit Patients with a Single Positive Node Prior to Neoadjuvant Chemotherapy

Abstract Aim Targeted Axillary Dissection (TAD) is a procedure where positive axillary nodes are clipped with a view to sentinel lymph node dissection plus removal of clipped nodes post-neoadjuvant therapies (NACT) rather than axillary lymph node clearance (ANC), reducing morbidity. This study aimed to assess whether patients with a single positive node undergoing NACT would benefit from TAD. Method Patients planned for TAD post-NACT were identified from the surgical diary from March 2020 – July 2022. Data were recorded for age, histopathology, MRI response and surgical procedure. Results Eighteen women were identified, mean age 46.7 (33- 63 years). 44% (8) had ER positive, HER2 negative invasive ductal carcinoma (IDC), 28% (5) had HER2 positive IDC, 22% (4) had triple negative IDC and 6% (1) had ER positive, HER2 negative lobular carcinoma. Treatment response on MRI was complete in 22% (4), near complete or very good in 11%(2), partial in 61% (11) with 6% (1) patient having stable disease. Four patients including the patient who had no response to chemotherapy opted for ANC post-NACT. Only 17% (1/6) patients with complete or good response had positive nodes post-NACT whereas 58% (7/12) of patients with partial or no response had positive nodes post-NACT. Conclusions Although the numbers in our study are small, TAD did benefit patients with a single positive node who have complete or good response to NACT. Larger multicentre studies are needed to confirm this and determine whether TAD is of benefit in patients who have partial or no response.

Progress of laparoscopy and endoscopy cooperative surgery for early colorectal tumors

Cooperative laparoscopic or robotic-endoscopic surgery has emerged as a promising approach for the treatment of early-stage colorectal cancers that are difficult to treat with endoscopic techniques alone. Cooperative surgery allows organ and function preservation by complementing the advantages of each modality, providing minimally invasive, precise and personalized treatment options. Laparoscopic-endoscopic cooperative surgery includes laparoscopic-assisted endoscopic resection, combined laparoscopic-endoscopic full-thickness resection, endoscopic-assisted laparoscopic wedge resection, endoscopic-assisted laparoscopic segmental resection, and laparoscopic-endoscopic cooperative surgery with sentinel lymph node dissection. Nearly three decades of clinical research and practice have demonstrated the safety and efficacy of laparoscopic and endoscopic cooperative surgery in the treatment of colorectal tumors. With the progress of the minimally invasive concept, the development of minimally invasive technology and the innovation of minimally invasive equipment, laparoscopy and endoscopy cooperative surgery is expected to have a proper place in the treatment of colorectal tumors.

Sentinel lymph node sampling versus full lymphadenectomy in endometrial cancer: a SEER database analysis

ObjectiveTo assess the long term outcomes and prognosis of sentinel lymph node sampling compared with full lymph node dissection in endometrial cancer patients.MethodsWe used the Surveillance, Epidemiology, and End Results...

A Multicentre Clinical Trial Evaluating a Drop-in Gamma Probe for Minimally Invasive Sentinel Lymph Node Dissection in Prostate Cancer

BackgroundThis study evaluated the safety and performance of a drop-in gamma probe for prostate cancer (PCa) sentinel lymph node biopsy (SeLNB) in a prospective, open-label, multicentre, single-arm clinical trial. ObjectiveThe main objective was to determine the sentinel lymph node (SeLN) detection rate with the drop-in gamma probe system. The secondary objectives were overall performance and safety. Design, setting, and participantsAt three European centres, patients received an ultrasound-guided systemic and tumour-targeted injection of [99mTc]Tc-nanocolloid followed by planar lymphoscintigraphy and/or single-photon emission computerised tomography. The next day, manual laparoscopic or robot-assisted radical prostatectomy was performed, including SeLN dissection (SeLND) and extended pelvic lymph node dissection (ePLND). Outcome measurements and statistical analysisSeLNs were detected with the drop-in probe and a rigid laparoscopic gamma probe (RLGP). The primary endpoint of the study was the SeLND rate defined as the percentage of patients with at least one SeLN detected in vivo by the drop-in probe. The secondary endpoints included diagnostic performance, ease of SeLN detection, number of SeLNs detected, and safety. The first two patients at each site (six in total) were used for familiarisation. Results and limitationsA total of 27 patients were included in the main analysis. SENSEI successfully detected at least one SeLN in all 27 patients, resulting in a detection rate of 100% (95% confidence interval 87.2–100%). The total number of SeLNs identified with SENSEI was 85 (median three SeLNs per patient, range 1–6); of these 85 SeLNs, 12 were located outside of the ePLND template. In the nine patients in whom the RLGP was used, SENSEI detected two SeLNs that could not be detected with the RLGP due to manoeuvrability restrictions. Ten of the 27 patients were pN1; four patients had a false-negative SeLNB. No adverse events or complications were related to the use of the drop-in probe. ConclusionsThe study demonstrated that the drop-in gamma probe meets the performance and safety requirements for SeLNB in PCa. The device provided improved manoeuvrability and SeLN detection compared with the conventional RLGP. Patient summaryA novel device was tested for detecting sentinel lymph nodes during minimally invasive surgery for prostate cancer. In this first evaluation, the performance and safety of the device were evaluated positively.