BackgroudOvarian cancer is the most fatal of all gynecologic cancers. The need and role of pelvic and para-aortic lymphadenectomy in ovarian cancer patients with clinically normal nodes remains debated.ObjectiveTo assess the accuracy of sentinel lymph node (SLN) mapping in patients with ovarian carcinoma.MethodsThis is a single cohort quality improvement study conducted from May 1, 2020 to Dec. 31, 2022 at a single institution. Patients undergoing surgery for newly diagnosed ovarian carcinoma of all stages were eligible. All patients were injected with methylene blue into the bilateral ovarian cortex, uterine horns and infundibulopelvic ligaments by the same surgeon, SLN mapping was performed followed by an immediate back-up systematic pelvic and para-aortic lymphadenectomy. Ultrastaging was performed on all SLNs that were negative on original H&E slides. Descriptive statistics were used.ResultsTwenty-nine patients were enrolled. The overall detection rate of SLN in ovarian cancer was 100%, sensitivity was 85.7%, false negative rate was 14.3%, and negative predictive value was 95.7%. The median number of SLNs removed per patient was 8 (range, 1–20) and the median total of lymph nodes removed was 34 (range, 6–66). SLNs were identified in the supra-mesenteric para-aortic basin in 90 (34%) and in the infra-mesenteric para-aortic basin in 86 (32.5%).ConclusionIn this preliminary study with a small sample size of 29 patients, intraoperative SLN mapping using methylene blue injection demonstrated a high detection rate and promising feasibility and accuracy for identifying lymph node metastases in ovarian cancer.

Predicting the Probability of Residual Axillary Nodal Metastases in Patients With Breast Cancer Treated With Neoadjuvant Chemotherapy.

Comparison of robotic and natural orifice transluminal endoscopic surgical technique procedures in patients undergoing sentinel lymph node biopsy during endometrial cancer surgery.

Sentinel Lymph Node Sampling in Endometrial Cancers.

Sentinel node-positive POLE-mutated endometrial cancer.

Trends and disparities in locoregional treatment of programme-detected ductal carcinoma in situ in New Zealand women, 1999-2022.

385 Basophil infiltration in sentinel lymph nodes of early-stage melanoma: potential pro-metastatic role suggested by human and murine studies

Coping strategies and psychological distress in postoperative recovery: A repeated-measures study in women undergoing breast-conserving surgery.

Trends in axillary staging for breast cancer in the elderly: Outcomes of choosing wisely at a high-usage institution.

A single arm, prospective, open label, multicenter study assessing the safety and effectiveness of SPY AGENT GREEN and SPY fluorescence imaging systems in the visualization of lymphatic vessels and lymph nodes during lymphatic mapping and sentinel lymph node biopsy in subjects with breast cancer

It has been 131 years since Halsted reported radical mastectomy to treat breast cancer in 1894. The concept of "R0 resection" as the most important treatment strategy has significantly contributed to improving the survival rate of patients with breast cancer. With deep understanding of the mechanism of tumorigenesis and advancements in systematic treatment since the 20th century,modified radical mastectomy proposed by Patey and Auchincloss,aimed to improve quality of life,replaced radical mastectomy and became the mainstream surgery for breast cancer. Based on NSABP-B06 trial,the 2025 St. Gallen consensus persisted in the principle of preserving breast-conserving surgery whenever possible. Additionally,the guidelines recommend axillary lymph node dissection can be omitted in patients with negative sentinel lymph nodes,supported by high-level evidence. The AJCC Cancer Staging System (8th Edition) showed the evaluation of breast cancer burden has transcended TNM stage,leading to the level of detecting microscopic tumor burden. Pathological test is no longer limited to pathomorphology, instead,immunohistochemistry,molecular pathology testing,and next-generation sequencing technologies have laid a scientific foundation for categorized treatment of breast cancer. The evolution of breast cancer surgery is undergoing a shift from "maximal resection" to "minimal effective treatment" de-escalation. On this basis,promoting the standardization and homogenization of breast surgery suited to China's national conditions is the common goal of breast surgeons at this stage.

Prediction models for sentinel lymph node (SLN) status could potentially substitute surgical axillary staging in patients with early breast cancer. Several imaging modalities have been used with various feature extraction and selection approaches. This systematic review and meta-analysis aimed to evaluate prediction models for SLN status based on breast imaging in patients with early breast cancer to summarize the current evidence and to identify areas requiring additional research. The systematic literature search strategy was based on the Population, Intervention, Comparison, and Outcome (PICO) framework: P: female patients with clinically node-negative invasive breast cancer scheduled to undergo primary surgery; I: breast imaging; C: upfront sentinel lymph node biopsy; and O: prediction model performance regarding SLN status. The search was conducted in the PubMed, Embase, Web of Science, Cochrane, and Cumulative Index to Nursing and Allied Health Literature databases in March 2024. The screening of records, data collection, and bias assessments were performed independently by two reviewers. The risk of bias was assessed via the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool and the Prediction Model Study Risk of Bias Assessment Tool. A meta-analysis was performed using the random-effects model to assess performance and heterogeneity overall and in subgroups. The literature search resulted in the inclusion of 32 articles with 11,464 patients in total. Five imaging categories were included: ultrasound (n = 8), magnetic resonance imaging (MRI) (n = 17), mammography (n = 1), positron emission tomography computed tomography (n = 1), and multiple modalities (n = 5). Four studies, assessed as having a high risk of bias, were excluded from the meta-analysis. The meta-analysis revealed heterogeneity in overall performance, except for MRI-based studies, with a pooled area under the curve of 0.85 (95% confidence interval 0.82-0.87). Meta-regression indicated that MRI and model calibration assessment upon validation contributed to heterogeneity. This systematic review and meta-analysis revealed that prediction models using breast imaging-particularly MRI-could serve as a noninvasive alternative to surgical axillary staging in patients with early breast cancer. The results illustrate the heterogeneity between studies and the need for additional high-quality studies. PROSPERO CRD42022301852, available at https://www.crd.york.ac.uk/PROSPERO.

Abstract Synchronous primary malignancies are uncommon but increasingly identified due to advanced imaging techniques like positron emission tomography–computed tomography (PET-CT). The coexistence of breast and cervical cancers is particularly rare, given their distinct etiologies – hormonal and genetic factors in breast cancer versus persistent human papillomavirus infection in cervical cancer. We present the case of a 69-year-old postmenopausal woman who reported vaginal discharge. Clinical and radiological evaluation revealed a locally advanced cervical tumor, confirmed as nonkeratinizing squamous cell carcinoma. PET-CT performed for staging incidentally detected a fluorodeoxyglucose-avid lesion in the right breast. Subsequent biopsy confirmed a Grade II, estrogen and progesterone receptor-positive,Human Epidermal Growth Factor 2 Receptor (HER2)-negative infiltrating ductal carcinoma. There was no axillary nodal involvement. A multidisciplinary tumor board recommended a right mastectomy with sentinel lymph node biopsy to avoid radiation overlap, followed by concurrent chemoradiotherapy for the cervical cancer. Postoperatively, the patient received 45 Gy of external beam radiotherapy with weekly cisplatin, followed by brachytherapy. She was started on adjuvant endocrine therapy for breast cancer and remains under regular follow-up. This case underscores the importance of comprehensive imaging in cancer evaluation, particularly when clinical findings are atypical. The detection of synchronous tumors can significantly alter treatment planning and prognosis. A multidisciplinary, individualized approach is essential to optimize outcomes in such complex scenarios.

Background: De-escalation of axillary surgery has become an important focus in early-stage breast cancer management. While sentinel lymph node biopsy (SLNB) remains the standard for clinically node-negative patients, it provides no therapeutic benefit and carries potential complications. Axillary ultrasound has emerged as a less invasive modality for nodal assessment, although criteria for defining suspicious lymph nodes vary across studies. Objective: To evaluate the value of preoperative axillary ultrasound for detecting lymph node metastasis in early breast cancer. Materials and Methods: The present study was a prospective study enrolled 81 women with early-stage breast cancer and clinically negative axilla at Chao Phraya Abhaibhubej Hospital, Thailand between March 2022 and April 2024. Preoperative axillary ultrasound was performed one day prior to surgery, with cortical thickness greater than 3 mm or absence of fatty hilum defined as suspicious. All patients underwent breast surgery with SLNB, followed by frozen section and completion axillary lymph node dissection (ALND) if positive. Clinical, pathological, and imaging data were analyzed. Results: The mean age was 55.7 years, and the mean tumor size was 2.5 cm. Preoperative ultrasound identified suspicious nodes in 36 patients (44.4%). Pathology confirmed sentinel lymph node metastasis in 30 patients (37.0%). Axillary ultrasound demonstrated a sensitivity of 93.3% (95% CI 85.9 to 100.0), specificity of 84.3% (95% CI 74.6 to 94.0), positive predictive value (PPV) of 77.8%, and negative predictive value (NPV) of 95.6%. Subgroup analysis revealed that cortical thickening and loss of fatty hilum were significant predictors of nodal metastasis. Conclusion: Preoperative axillary ultrasound, when applying cortical thickness and fatty hilum criteria, achieved high sensitivity and NPV in detecting nodal metastasis in early breast cancer. These findings support its role as a practical and minimally invasive tool to guide surgical decision-making and potentially reduce the need for axillary surgery, particularly in resource-limited settings.

Background/Objectives: Acral melanoma (AM) is a rare and aggressive melanoma subtype that arises on sun-shielded, non-hair-bearing skin of the palms, soles, and nail beds. Although more common among individuals of non-European descent, AM remains underrecognized and understudied in the Middle East and North Africa (MENA). This study presents the first dedicated AM registry from Lebanon, aiming to characterize clinical, histopathological, and molecular features and evaluate diagnostic, referral, treatment approaches, and clinical outcomes over a 12-year period. Methods: This retrospective cohort study was conducted at the American University of Beirut Medical Center (AUBMC), a major tertiary referral center in the MENA region. All melanoma cases diagnosed between January 2012 and January 2024 were identified through electronic health records. From this cohort, all adult patients (≥18 years) with biopsy-confirmed AM or tumors located on the palms, soles, or under the nails were selected. Results: Our cohort consisted of 26 adult AM patients, identified from a total of 331 melanoma cases during the study period (8%). Median age at diagnosis was 58.5 years; 54% were female; and 96% of Middle Eastern origin. Most tumors were plantar (81%), and over half (53%) were diagnosed at early stages (Stage I–II). Surgery was performed in 92% of patients, yet 55% had positive margins. Sentinel lymph node biopsy was performed in 46%, and 35% received immunotherapy. Only 35% underwent molecular testing, identifying BRAF mutations in 11% of those tested; no patients received circulating tumor DNA analysis. At a median follow-up of 24.5 months, recurrence occurred in 27%, and metastasis developed in 23%. At the last follow-up, 92% were alive. Conclusions: Despite early-stage detection, high rates of positive margins and limited molecular testing reveal care gaps. This first national registry highlights the need to improve surgical management and expand access to precision oncology in the region.

A fundamental premise of statistical physics is that the particles in a physical system are interchangeable, and hence the state of each specific component is representative of the system as a whole. This assumption breaks down for complex networks, in which nodes may be extremely diverse, and no single component can truly represent the state of the entire system. It seems, therefore, that to observe the dynamics of social, biological or technological networks, one must extract the dynamic states of a large number of nodes—a task that is often practically prohibitive. Theoretical tools are also highly restrictive, given the analytically impenetrable combination of complex heterogeneous networks with nonlinear, often hidden, dynamics. To overcome this challenge, we use machine learning techniques to detect the network’s sentinel nodes, a set of network components whose combined states can help approximate the average dynamics of the entire network. The method allows us to assess the equilibrium state of a large complex system by tracking just a small number of carefully selected nodes. We find that the sentinels are mainly determined by the network structure such that they can be extracted even with little knowledge of the system’s specific interaction dynamics. Therefore, the network’s sentinels offer a natural probe by which to observe the system’s dynamic states. Intriguingly, sentinels tend to avoid the highly central nodes such as the hubs.

Sentinel lymph node biopsy improves surgical management of cervical cancer.

BackgroundPatients with early-stage node-negative oral cancer undergo a sentinel lymph node biopsy (SLNB) or elective neck dissection under general anesthesia. A noninvasive imaging alternative would be of great interest. Superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging (MRI) can visualize draining lymph nodes and potentially metastases. We investigated the optimal combination of SPIO injection and T2*-weighted MRI settings to identify the sentinel lymph nodes (SLNs), the lymphatic drainage pattern, and possibly to detect metastatic SLNs.Materials and methodsSPIO nanoparticles were injected submucosally around the primary tongue tumor in ten patients after routine SLNB imaging with indocyanine green-[99mTc]Tc-nanocolloid, and MRI was performed 1 h after injection. SPIO dose was adjusted for every two patients based on the imaging quality. Drainage patterns were compared between single-photon emission computed tomography (SPECT)/computed tomography (CT) and MRI. MRI appearance of SLNs was compared to histopathology of resected nodes.ResultsOne mg of iron was deemed a suitable dose after two dose alterations. All 25 SLNs observed on SPECT/CT in eight patients were also identified on MRI. Including higher echelons, 55 lymph nodes were seen on SPECT/CT, while 107 lymph nodes were seen on MRI. Eighteen lymph nodes showed a mixture of partial MRI signal attenuation and retention, which, when compared to histopathology, made discrimination between metastatic and nonmetastatic lymph nodes solely based on MRI impossible.ConclusionSPIO-enhanced T2*-weighted MRI is suitable for mapping SLNs and lymphatic drainage pattern, showing significantly more lymph nodes compared to SPECT/CT. Discriminating metastatic from nonmetastatic nodes does not seem feasible after SPIO injection.Trial registrationClinicaltrials.gov NCT04803331. Registered 4 March 2021; https://clinicaltrials.gov/study/NCT04803331.Relevance statementSPIO-enhanced MRI seems noninferior to the current method of SLN detection with technetium, with better anatomical detail than SPECT/CT: if proven comparable, SPIO-enhanced MRI could be considered a nonradioactive alternative with higher spatial resolution to define lymphatic drainage of tumors.Key PointsThe use of superparamagnetic iron oxide (SPIO)-enhanced MRI in head and neck cancer is underassessed.SPIO-enhanced MRI detects nodal drainage patterns comparably to SPECT/CT.SPIO-enhanced MRI does not discriminate lymph node metastases from false positives.Graphical

Background: Cutaneous melanoma is among the most prevalent malignancies in the United States. Traditional prognosis systems have limitations in providing individualized profiles. The 31-gene expression profiling (31-GEP) test has been validated as an independent predictor of metastatic recurrence and can accurately inform the decision to recommend sentinel lymph node biopsy. Despite published data, there remains a lack of clarity regarding how and when the test should be used in everyday clinical practice. The purpose of this expert consensus panel was to review published literature on the clinical efficacy, utility, and accuracy of the 31-GEP test in providing prognostic information for invasive melanoma. Methods: A comprehensive literature search was completed using a combination of keywords “31-gene expression profiling,” “melanoma,” “prognosis,” “clinical efficacy,” and “clinical utility”. A panel of 10 dermatologists with significant expertise in management of melanoma gathered to review the articles and create consensus statements. A modified Delphi process was used to approve each statement, which requires a supermajority approval for adoption of a recommendation through multiple rounds of real-time voting, and a strength of recommendation was assigned. Results: The literature search produced 150 articles. A screening of the studies resulted in 26 articles that met criteria. The panel unanimously voted to adopt nine consensus statements and recommendations regarding use of 31-GEP testing: eight with strength of “A”, and one with strength of “C”. Conclusion: Following a comprehensive review of existing literature, this expert panel agreed that there is strong support for the use of 31-GEP testing to provide prognostic information for invasive melanoma. The 31-GEP test has been shown to provide prognostic information when the thickness/other traditional factors are unknown, statistically improve prognosis assessment when added to AJCC8 staging, and patients who have received the test have improved melanoma specific mortality and overall survival. The expert panel believes that the robust existing literature strongly supports its use as a best practice for the appropriate melanoma patient.

Internal mammary lymph nodes in breast cancer: A comprehensive review of anatomy, imaging, biopsy considerations, clinical implications, and future directions.