Sentinel Lymph Node Research Articles

Bioinspired Synthesis of Intrinsically Radiolabeled Dy2O3 Nanoparticles as an In Vivo Generator of 166Dy/166Ho: A Smart Choice for Theranostics Engineering.

Functionalized inorganic nanoparticles (NPs) intrinsically radiolabeled with theranostic radiometals hold the potential to revolutionize cancer management. The appropriate choice of the radiometal used in the nanoplatform would not only aid in the diagnosis and staging of the disease but also facilitate them becoming an integral part of the therapeutic regimen, either as an independent treatment or in combination with other conventional modalities. Furthermore, due to the inherent characteristics of the NPs, such systems can demonstrate potential in multimodality imaging to offer improved diagnostic and therapeutic monitoring abilities for personalized treatment. In this study, intrinsically radiolabeled dysprosium oxide NPs were synthesized in a bioinspired manner for use as an efficient 166Dy/166Ho in vivo generator. The synthesized NPs (average size of 12.5 ± 2.4 nm) were extensively characterized by various instrumental techniques, including DLS, HRTEM, XRD, XPS, XANES, EXAFS, Raman spectroscopy, TGA, etc. Besides single-photon emission computed tomography (SPECT) imaging due to the nuclear decay characteristics of 166Dy/166Ho, the synthesized NPs demonstrated potential for use as contrast agents for magnetic resonance imaging (MRI) and computed tomography (CT) imaging, thereby combining three different imaging modalities in the same nanoplatform. In silico studies predicted the radiochemical stability and suitability of the intrinsically radiolabeled NPs for use as in vivo generator, which was further corroborated by SPECT imaging and biodistribution studies. Additionally, footpad administration of the intrinsically radiolabeled NPs led to clear visualization of the popliteal lymph node, highlighting their suitability for noninvasive sentinel lymph node mapping and for potential radiotherapy-based ablation of metastatic lymph nodes. Overall, this unique nanoplatform demonstrates promise for simultaneous diagnosis and therapy monitoring by multimodality (SPECT/MRI/CT) imaging along with precise cancer treatment.

Omission of Routine Frozen Section for Clinically Node-Negative Patients Undergoing Upfront Mastectomy Avoids Unnecessary Axillary Treatment.

Randomized trials established the safety of postmastectomy radiation/regional nodal irradiation (PMRT) as an alternative to axillary lymph node dissection (ALND) for cN0 patients undergoing upfront mastectomy with one or two positive sentinel lymph nodes (+SLNs). In January 2022, the authors adopted a policy omitting routine frozen section for cT1-3N0 patients undergoing upfront mastectomy, and this study sought to examine the impact of this policy on axillary treatment. Consecutive patients with cT1-3N0 breast cancer who underwent upfront mastectomy from January 2022 to July 2023 were identified. For patients with three or more +SLNs and those with one or two +SLNs not meeting institutional PMRT criteria, ALND was indicated. This study evaluated ALND/PMRT rates after adoption of this policy. In this study, 623 patients with cT1-3N0 breast cancer had upfront mastectomy with sentinel lymph node biopsy. Overall, 4.7% (n = 29) of the patients had completion ALND (cALND). These patients had larger tumors, and more often had lobular histology and LVI. Of 98 patients with one or two +SLNs, 86 (88%) underwent PMRT and no further surgery, and 8 (8%) had ALND due to no initial PMRT indication, of whom 2 then met PMRT criteria based on additional positive nodes, and 4 had neither. Among those with three or more +SLNs (n = 29), 21 (72%) underwent both ALND and PMRT, and 8 (28%) had PMRT alone or neither treatment. Overall, return to the operating room for ALND was indicated for 39 (6.2%) of the 623 patients with three or more +SLNs and for those who had one or two +SLNs without PMRT indication. In this study, only 6% of the cN0 patients who had SLN frozen section omitted at upfront mastectomy exhibited an indication for cALND. Receipt of ALND+PMRT for the patients with involvement of one or two nodes was rare, occurring for just 2% of the patients. Axillary management was optimized by routine omission of frozen section for cT1-3N0 patients undergoing upfront mastectomy.

Indocyanine green fluorescence in pelvic lymph node dissection during laparoscopic radical prostatectomy: a randomized controlled trial.

To evaluate the feasibility and diagnostic accuracy of indocyanine green (ICG)-guided pelvic lymph node dissection (PLND) during laparoscopic radical prostatectomy, and compare the lymph node detection rate and 3-year biochemical recurrence (BCR) rate between PLND and ICG-guided PLND. Sixty-eight patients were randomly divided into intervention and control groups (1:1). The intervention group underwent standard pelvic lymph node dissection (sPLND) and fluorescent visible sentinel lymph node dissection (SLND) after an ultrasound-guided injection of ICG (25mg), while the control group received sPLND without ICG injection. Kaplan-Meier survival curves were used to compare the two groups of patients for BCR at a point three years post-surgery. In the intervention group, 284 lymph nodes were removed, and 58 lymph nodes were visualized by ICG, including 4 positive lymph nodes. In the control group, 205 lymph nodes were removed. There were three cases of ICG leakage and six cases of lymphocele in the intervention group and one case of lymphocele in the control group. The sensitivity and specificity of ICG-guided lymph node dissection was 80.00% and 82.29%, respectively, while the area under the curve (AUC) of the receiver operating characteristic (ROC) curve was 0.727. The patients in the intervention group had longer biochemical recurrence-free survival (BRFS) rates compared to those in the control group. ICG-mediated fluorescence imaging technology is safe and reliable, although the sensitivity and specificity of identifying metastatic lymph nodes was not sufficient. This technique can be used as an auxiliary method to optimize BRFS, increase diagnostic accuracy during lymph node dissection, and reduce misdiagnosis.

Performing sentinel lymph node biopsy without a hand-held gamma probe - overcoming hurdles through team work: an analysis of our learning curve over five years.

Sentinel lymph node biopsy is the standard of care in the management of node negative axilla in breast cancer and in node negative melanomas and penile cancers. The wide spread adoption of this procedure is however, hampered by the availability of the hand-held gamma probe. To demonstrate the safety and feasibility of sentinel node biopsy using methylene blue and SPECT CT lymphoscintigraphy. A retrospective review of the case records of all patients of breast cancer, penile cancer and melanomas who underwent surgery at our Institute between December 2019 and November 2024 was analysed. Demographic data, operative data, pathological reports and follow up data were analysed. Out of a total of 628 patients operated for the above cancers, 70 patients underwent a sentinel lymph node biopsy along with surgery for the primary. Localization was possible in all the patients (100%). The time taken to localize the node decreased from 33min to 16min over the course of the learning curve (percentage change of -50%). The median number of nodes isolated increased by 200% and the seroma in the nodal basin decreased by 26%. Recurrences in the nodal basin were commonest in penile cancer (16.6%), while those in the axilla (6.5%) could be salvaged surgically. Sentinel node biopsy can be safely performed even without a hand-held gamma probe, provided strict inclusion criteria, a double dye technique and a dedicated follow up regimen are adhered to.

Sentinel lymph node staging in urological cancer surgery: advances in imaging, intra-operative detection and translational research.

To review the clinical utility, outcome and possible future applications of sentinel lymph node biopsy (SLNB) in penile cancer (PeC), bladder cancer (BCa), prostate cancer (PCa), testicular cancer (TCa) and renal cell carcinoma (RCC), focusing in particular on current SLNB standards and exploring advancements in imaging agents, intra-operative detection, surgical navigation, and the potential application of SLNB in translational and clinical research. A literature search was conducted in PubMed and EMBASE for studies published between 2000 and 2024, providing a narrative review of SLNB in oncological urology. In PeC, SLNB offers a lower adverse event rate compared to inguinal lymph node (LN) dissection, while maintaining high detection rates and acceptable sensitivity (92%-96%) for identifying inguinal LN metastases. Similarly, in PCa, SLNB achieves a sensitivity of 95%, potentially reinforcing its role in nodal staging and guiding personalised treatment strategies. For RCC, BCa and TCa, SLNB is currently under investigation in trials. In RCC, detection rates seem acceptable; however, in BCa and TCa, detection rates and false-negative rates vary, limiting its clinical usefulness. Contemporary approaches utilise various radiotracers, (fluorescent) dyes, and hybrid tracers for SLNB. Ongoing research refines tumour-targeted LN detection, including prostate-specific membrane antigen targeting in PCa, potential c-MET targeting in PeC, and 89Zr-girentuximab in RCC. The use of SLNB has transformed nodal staging in PeC, influencing treatment decisions and reducing morbidity in patients undergoing surgery. In other urological malignancies, it has not yet established itself as a standard tool for nodal staging. Its impact on survival, quality of life, and translational research remains to be determined.

Is axillary surgery still justified in DCIS diagnosed via vacuum-assisted biopsy?

BackgroundThe role of axillary surgery in ductal carcinoma in situ (DCIS) remains controversial, particularly for cases diagnosed via vacuum-assisted biopsy (VAB), which may reduce “upstage” to invasive disease. This study evaluates the incidence of axillary metastasis and pathologic upstaging in DCIS to identify subgroups where axillary staging can be safely omitted.MethodsA retrospective cohort of 494 patients with pure DCIS diagnosed by VAB (2011–2019) was analyzed. Patients were stratified by age, nuclear grade, comedonecrosis, and surgical approach (breast-conserving surgery [BCS] vs. mastectomy). Axillary management included sentinel node biopsy (SNB), axillary dissection (AD), or omission. Multivariate logistic regression identified predictors of axillary surgery and upstaging to invasive carcinoma.ResultsMost patients underwent BCS (72.7%), with axillary evaluation performed in 35.1% of BCS cases versus 91.9% of mastectomies (p < 0.001). Only 3.8% (19/494) were upstaged to invasive carcinoma, and nodal involvement occurred in 1.2% (3/250) of axillary procedures—all in patients with invasive foci on final pathology. No pure DCIS cases had nodal metastasis. Younger age (< 40 years, p = 0.039), high nuclear grade (grade 3, p = 0.006), and mastectomy (p < 0.001) independently predicted axillary surgery. Comedonecrosis and palpable lesions were associated with higher SNB rates but not nodal positivity.ConclusionsRoutine axillary surgery is unnecessary in VAB-diagnosed DCIS. Omission of SNB appears safe for patients undergoing BCS without high-risk features (palpability, high grade). Axillary staging may be reserved for mastectomy candidates or those with suspicions imaging of invasive disease.

Deep learning on routine full-breast mammograms enhances lymph node metastasis prediction in early breast cancer

With the shift toward de-escalating surgery in breast cancer, prediction models incorporating imaging can reassess the need for surgical axillary staging. This study employed advancements in deep learning to comprehensively evaluate routine mammograms for preoperative lymph node metastasis prediction. Mammograms and clinicopathological data from 1265 cN0 T1–T2 breast cancer patients (primary surgery, no neoadjuvant therapy) were retrospectively collected from three Swedish institutions. Compared to models using only clinical variables, incorporating full-breast mammograms with preoperative clinical variables improved the ROC AUC from 0.690 to 0.774 (improvement: 0.001–0.154) in the independent test set. The combined model showed good calibration and, at sensitivity ≥90%, achieved a significantly better net benefit, and a sentinel lymph node biopsy reduction rate of 41.7% (13.0–62.6%). Our findings suggest that routine mammograms, particularly full-breast images, can enhance preoperative nodal status prediction. They may substitute key predictors such as pathological tumor size and multifocality, aiding patient stratification before surgery.

Indocyanine green fluorescence imaging in the identification of sentinel lymph node in melanoma.

Sentinel lymph node biopsy is imperative in the management of melanoma and allows for accurate histological assessment of nodal basins in stage 1B disease, or greater. Indocyanine green (ICG) represents a somewhat novel localisation modality that may confer a decreased risk of anaphylaxis and reduced risk of skin discolouration. A middle childhood (6-11 years) boy with a 3-month history of a new, pigmented, right cheek lesion was referred for evaluation. Excisional biopsy revealed a pigmented epithelioid melanocytoma.After the MDM discussion, a WLE and sentinel lymph node biopsy were recommended. The sentinel node was successfully identified using intraoperative ICG fluorescence imaging. There were no adverse outcomes such as skin staining or lack of dye uptake.Although initially positive for nodal micrometastases, management consisted of clinical follow-up with 3 monthly ultrasound scans of the neck. To date, there is no evidence of recurrence.

Factors Associated With Metastasis of Eccrine Porocarcinoma: A Retrospective Cohort Analysis of National Cancer Databases

BACKGROUND Eccrine porocarcinoma is a rare cutaneous adnexal malignancy. Factors associated with metastasis of porocarcinoma and evidence for the utility of sentinel lymph node biopsy are incomplete within the literature. OBJECTIVE Determine prognostic factors that may guide the decision to pursue sentinel lymph node biopsy in patients with porocarcinoma. MATERIALS AND METHODS Retrospective analysis of the National Cancer Database and the Survival, Epidemiology, and End Results databases for cases of porocarcinoma. Multivariable logistic regression was performed examining tumor size and lymphovascular invasion for association with metastasis of porocarcinoma. The cumulative probability of sentinel node metastasis was calculated as a function of tumor size. RESULTS A total of 1,351 patients were identified; 75 (5.6%) had a positive lymph node on pathology and 15 (1.1%) had distant metastatic disease. Patients with tumors greater than 17 mm in size had a 6.8% risk of occult lymph node metastasis identified by sentinel lymph node biopsy. In the subset of tumors analyzed for lymphovascular invasion, 40% (14 of 47) had metastasized at diagnosis. CONCLUSION Tumor size and lymphovascular invasion affect metastasis of porocarcinoma. Tumors greater than 17 mm in size or with lymphovascular invasion warrant consideration of sentinel lymph node biopsy.

Current Updates on Surgical Management of Patients with Early-Stage Cervical Cancer.

The recommended treatment for early-stage cervical cancer (FIGO 2018 stages IA-IB2 and selected IIA1) is surgery, followed by either observation or adjuvant therapy, based on individual risk factors. Surgical management has evolved from extensive radical procedures to more conservative strategies, allowing for fertility-preserving options in appropriately selected patients. In 2018, a landmark study (LACC trial) evaluated the surgical approach to radical hysterectomy, comparing open vs. minimally invasive surgery. The results demonstrated that minimally invasive surgery was associated with worse disease-free and overall survival, leading to guidelines changes that recommend the open radical hysterectomy as the new standard of care. More recently, results from the prospective randomized SHAPE trial demonstrated that in well-selected patients with low-risk early-stage cervical cancer, recurrence rates are comparable between simple hysterectomy and radical hysterectomy. An ongoing study, the CONTESSA trial, is evaluating the role of neoadjuvant chemotherapy in the setting of fertility preservation for lesions measuring 2-4 cm. In addition, ongoing studies are evaluating different surgical approaches for both simple hysterectomy (LASH trial) and radical hysterectomy (ROCC/GOG-3043 and RACC trials), with a focus on comparing oncologic outcomes. Attention has also turned to refining lymph node assessment. Sentinel lymph node biopsy has become a standard staging strategy with reduced morbidity. The SENTICOL I-II and SENTIX/ENGOT-Cx2 trials support its safety and diagnostic accuracy in early-stage disease. This article offers a comprehensive overview of recently published prospective trials that have shaped clinical practice in the management of early-stage cervical cancer. It focuses on surgical approaches and radicality, the role of sentinel lymph node mapping, and fertility-sparing treatments. The review further draws attention to ongoing investigations and novel studies that may influence future directions in the field.

Validation of a Clinicopathologic and Gene Expression Model for Predicting Sentinel Node Metastasis in Melanoma: A Multicenter Danish Cohort Study.

Sentinel lymph node biopsy (SLNB) is crucial for staging and managing melanoma, but selecting patients for SLNB is challenging, with around 80% of procedures yielding negative results. The clinicopathological and gene expression profile model (CP-GEP) was developed to identify low-risk melanoma patients who may forgo SLNB. CP-GEP combines Breslow thickness, patient age, and a gene expression analysis to classify patients as high- or low-risk for nodal metastasis. This study aimed to validate the performance of CP-GEP in a multicenter Danish cohort. Primary melanoma tissue from 536 T1-T3 patients who had undergone SLNB was retrospectively analyzed using CP-GEP. Results were compared with SLNB status and the Melanoma Institute Australia nomogram (MIA). T1, T2, and T3 melanomas comprised 32.8%, 46.8%, and 20.3% of cases, respectively. The SLNB positivity rate was 18.1%. Overall, 40.9% was classified as CP-GEP low-risk (NPV 91.3%). Among T1 and T2 subgroups, 72.7% and 35.5% were low-risk, with NPVs of 94.5% and 87.6%, respectively. For 507 patients with MIA scores, CP-GEP identified 42.4% as low-risk (NPV 91.2%) versus 8.1% by MIA (NPV 95.1%). CP-GEP is a promising tool for supporting deselection of SLNB in melanoma patients, with a potential reduction rate of over 40%.

Axillary Management for Patients Undergoing Total Mastectomy and a Positive Sentinel Lymph Node: Is Axillary Dissection Necessary?

We sought to evaluate whether patients with breast cancer who undergo a total mastectomy (TM) can safely forgo a completion axillary lymph node dissection (cALND) in the presence of one to three positive sentinel lymph nodes (SLN+). A multicenter retrospective cohort study (2012-2022) was conducted in patients with cT1-3cN0 who underwent TM with 1-3 SLN+ compared by cALND versus. no further surgery. We compared overall survival (OS) and locoregional recurrence rates (LRR) and investigated whether the omission of cALND altered adjuvant treatment. In total, the study included 139 patients with SLN+TM, with a mean tumor size of 19.44mm (SD:10.64); 76% (n=105) of these patients underwent SLNB-alone. Patients treated by cALND had a younger mean age than those treated by SLNB-alone (49.5 vs. 56years and p=0.016). Patients undergoing cALND were more likely to have macrometastatic disease (97% vs. 65% and p<0.001) and extranodal extension (47% vs. 29% and p=0.046). cALND was associated with higher rates of adjuvant chemotherapy (88% vs. 62% and p=0.004). Postmastectomy radiotherapy (PMRT) was similar between groups (79% vs. 82% and p=0.68). At a mean follow-up of 5.2years, there was one chest-wall LRR in the SLNB group, with no axillary recurrences. LRR did not significantly differ with or without cALND (2.9% vs. 1.0% and p=0.4). Five-year overall survival rates were similar between groups (100% vs. 94% and p=0.2). We found high OS and low LRR among patients undergoing upfront TM with 1-3 SLN+without cALND. Completion ALND did not decrease receipt of PMRT but was associated with higher rates of adjuvant chemotherapy. Our findings support the omission of cALND after TM for patients with 1-3 SLN+.

To explore the targeting of toluidine blue: low molecular dextran-40 to the lymphatic system and its effect assessment

To investigate the targeting effect of toluidine blue-dextran-40 (TB-Dex-40) on the head and neck lymphatic system. Thirty healthy adult New Zealand white rabbits were randomly divided into two groups: the experimental group (TB-Dex-40 group, n = 15) and the control group (TB group, n = 15). In the experimental group, 1.0% TB-Dex-40 (0.14 mOsm/L) was submucosally injected at the lingual margin (1 cm from the tip of the tongue), while in the control group, 1.0% toluidine blue (32.60 mOsm/L) was administered under the same conditions. The time required for the dye to reach and stain the sentinel lymph node (SLN) was recorded, and the diffusion range of the dyes in the tongue was measured. SLN samples were collected at 30 min and 2 h post-injection for histopathological examination. SLN staining persistence was observed at 1 day, 2 days, and 4 weeks post-injection. Routine blood and biochemical tests were conducted before and 2 weeks after the experiment to evaluate systemic safety. Additionally, in two separate rabbits, the two dyes were injected into the common carotid artery to observe their effects on cervical lymph nodes, submandibular glands, and tongue tissue. A sucrose preference test was performed during animal rearing to assess potential neurotoxicity induced by the dyes. In the experimental group, it took (21.67 ± 0.19) seconds for the dye to reach the SLN and stain lymphatic vessels, which was significantly longer than that in the control group [(3.22 ± 0.34) seconds] (P < 0.01). The SLN stained in the experimental group remained clearly visible even after 4 weeks, whereas the SLN stained in the control group had completely faded by 2 days. The diffusion range of the dye in the tongue was significantly smaller in the experimental group [(10.53 ± 1.09) mm] compared with the control group [(20.04 ± 1.06) mm] (P < 0.01). No abnormalities were detected in the blood parameters of the experimental animals. Neither group exhibited neurological abnormalities. After injection via the common carotid artery, significant staining was observed in the lymph nodes of the TB group but not in the TB-Dex-40 group. TB-Dex-40 demonstrates superior targeting capabilities within the lymphatic system and holds substantial potential for clinical translation.Clinical relevance: TB-Dex-40 exhibits specificity for lymphatic vessels and serves as an effective tracer with significant clinical potential. Its molecular structure provides a robust theoretical foundation for the development of future imaging agents.

Sentinel lymph node biopsy without systematic pelvic lymphadenectomy in females with early-stage cervical cancer: final outcome of the SENTIX prospective, single-arm, noninferiority, international trial.

Sentinel lymph node (SLN) biopsy with ultrastaging is standard in endometrial and vulvar cancers, whereas systematic pelvic lymphadenectomy (PLND) remains recommended in cervical cancer. The SENTIX trial prospectively evaluated the safety of SLN biopsy without PLND in early-stage cervical cancer. Female patients, International Federation of Gynaecology and Obstetrics 2018 stage IA1/LVSI+ to IB2 disease, were enrolled between 2016 and 2020 across 47 sites in 18 countries. All underwent SLN biopsy followed by hysterectomy/trachelectomy. Patients with undetected, unilateral or intraoperatively metastatic SLNs were excluded from the intention-to-treat cohort. SLNs were assessed by pathological ultrastaging. Of 731 patients enrolled, 594 formed the intention-to-treat cohort. SLN metastases were identified in 82 patients (12%), 56.1% intraoperatively and 43.9% by ultrastaging. At 2 years, the recurrence rate was 6.1% (one-sided 95% CI 7.9%), confirming noninferiority to the 7% reference rate. Two-year disease-free and overall survival rates were 93.3% (95% CI 94.9-91.6) and 97.9% (95% CI 98.9-97.0), respectively. Here we show that SLN biopsy without systematic PLND did not increase the risk of recurrence in patients with early-stage cervical cancer. Pathological ultrastaging of SLNs detected about 44% of N1 cases, which would be missed by a standard lymph node assessment. Trial registration: ClinicalTrials.gov ( NCT02494063 ).

Intraoperative Evaluation of Whole Sentinel Lymph Nodes Using a One-Step Nucleic Acid Amplification Assay in Endometrial Cancer: A Prospective Study

Background and Objectives: The aim of this prospective study was to evaluate the diagnostic accuracy of the one-step nucleic acid amplification (OSNA) assay for the intraoperative assessment of sentinel lymph node (SN) metastases, including micrometastases in patients with stage IA low-grade endometrial cancer. Materials and Methods: A prospective analysis was conducted on 204 patients with low-risk endometrial cancer who underwent hysterectomy, bilateral salpingo-oophorectomy, and sentinel node navigation surgery. SNs were analyzed intraoperatively using the OSNA assay, and positive patients underwent systematic pelvic lymphadenectomy. Results: Among the 204 patients included, SN metastases were identified in 12 patients (6%), including 10 patients with micrometastases and 2 patients with macrometastases. No metastases were detected in non-SNs in any of the 12 patients. Recurrence occurred in two patients (1%), involving the vaginal stump and pelvic cavity dissemination, but no lymph node recurrence was observed. The OSNA assay identified a proportion of micrometastases in low-risk endometrial cancer. While a direct comparison with conventional pathological ultra-staging was not performed in this study, the detection rate of micrometastases appears higher than that reported in historical controls. Conclusions: This is the first prospective study to evaluate the intraoperative use of the OSNA assay for whole SNs in endometrial cancer. The results suggest that the OSNA assay enhances the detection of micrometastases, enabling a more accurate assessment of SN metastases. In low-risk endometrial cancer, systematic pelvic lymphadenectomy may be safely omitted in patients with SN-positive micrometastases. Further prospective studies are necessary to validate these findings and support the adoption of this approach in clinical practice.

Prospects of morphological ultra-staging in gynecological oncology

The condition of the lymph nodes is a mandatory prognostic sign and criterion for adjuvant therapy for malignant neoplasms (MN). While micrometastases have been found to correlate with prognosis in a number of cancers using ultrastaging techniques and are part of the standard treatment for patients with hematologic malignancies, controversy remains in the case of cervical cancer and endometrium cancer. The purpose of this review is the novelty of sentinel lymph node (SLN) ultrastaging in guiding treatment decisions and reducing the risk of regional recurrence.

Repair of Vesicovaginal Fistula in 12 Steps Using the da Vinci Surgical System.

Repair of Vesicovaginal Fistula in 12 Steps Using the da Vinci Surgical System.

The Role of Axillary Lymph Node Dissection Width and Radiotherapy in Axillary Vein Pathologies and Psychophysical Outcomes in Breast Cancer

Background and Objectives: Lymphedema is one of the most important morbid complications of modified radical mastectomy (MRM) surgery. It can cause limb movement restriction and psychosocial deformities in some patients. This study aimed to determine and compare the physiological and pathological changes that develop in the axillary venous structures in patients who underwent axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB). Materials and Methods: Patients diagnosed with breast cancer who underwent MRM and breast-conserving surgery (BCS) plus SLNB between 2017 and 2022 were retrospectively examined. The patients’ operation side and contralateral axillary vein diameter and the difference between them, axillary vein flow rate and the difference between them, axillary vein wall thickness and the difference between them, severity of lymphedema, extremity joint restriction examination, and the Nottingham Health Profile (NHP) data were recorded. The relationship of these parameters with the lymph node dissection width and radiotherapy was analyzed. Results: Fifty-eight patients in total were included in the study. In the distribution of lymphedema and lymphedema severity according to ALND groups, there is a statistically significant difference (p &lt; 0.001). A statistically significant difference was determined in the distribution of the difference in the axillary vein blood flow rate and axillary vein diameter difference between the two arms according to the lymph node dissection groups. In the distribution of physical therapy and rehabilitation scales according to the lymph node dissection groups, a significant difference was found in the disabilities of the arm, shoulder, and hand (DASH), shoulder flexion restriction variables, and NHP sleep variables (all p &lt; 0.001). Conclusions: This study demonstrated that ALND leads to more pronounced physiological and pathological changes in axillary venous structures—including increased vein wall thickness, altered flow rates, and diameter differences—compared to SLNB combined with breast-conserving surgery. These changes may be attributed to lymphovenous disruption and postoperative edema. Furthermore, radiotherapy appears to contribute to these changes, though to a lesser extent than ALND. Therefore, SLNB followed by radiotherapy may be preferable in eligible patients to reduce postoperative complications such as lymphedema, joint restriction, and sleep disturbances.

Digital Papillary Adenocarcinoma: An Updated Review of Epidemiology, Pathogenesis, and Management.

Digital papillary adenocarcinoma (DPAc) is an uncommon sweat gland malignancy. To review recent updates in epidemiology, pathogenesis, and treatment of DPAc. A PubMed/MEDLINE search of DPAc, with an emphasis on articles published after 2010. DPAc has an incidence of approximately one in 10 million person-years. Males are more commonly affected than women, and the tumor is commonly diagnosed in the fifth and sixth decades of life. Recent studies have detected human papillomavirus 42 DNA in DPAc, leading to a paradigm shift in the authors' understanding of DPAc oncogenesis. Additional studies also suggest BRAF V600E polymorphisms and fibroblast growth factor receptor dysregulation to be potential drivers of DPAc pathogenesis. Regarding treatment, wide local excision or amputation both appear to afford similar rates of recurrence-free survival; Mohs micrographic surgery is an emerging but understudied modality for DPAc. At present, there are insufficient data to strongly recommend the utilization of sentinel lymph node biopsy. Recent molecular advances in DPAc have paved the way for enhanced diagnosis and treatment. Further research on the utility of Mohs micrographic surgery and sentinel lymph node biopsy would be helpful in clarifying the optimal treatment approach for DPAc.

What Is the Role of Sentinel Lymph Node Biopsy in Recurrent Head and Neck Melanoma?

What Is the Role of Sentinel Lymph Node Biopsy in Recurrent Head and Neck Melanoma?