Sentinel Lymph Nodes In Patients Research Articles

A Study on the Detection Rates and Location of Sentinel Lymph Node in Patients with Gynecologic Cancers.

Sentinel lymph node mapping is emerging as an accurate technique to assess the lymph nodal status while reducing surgical and postoperative morbidity. Present study looks into the detection rates and location of sentinel nodes during Sentinel node mapping when Indocyanine green dye was used as a tracer. This is a single institutional study with details retrieved from a prospectively maintained database. All patients who underwent sentinel node mapping using ICG dye for atypical hyperplasia, endometrial and cervical cancers from February 2015 to April 2020 were included. Location of the sentinel node was taken from the graphical record maintained during surgery. The data obtained are expressed as number and percentage and/or mean and standard deviation for continuous variables. Chi-square test was performed to compare categorical variables. Two hundred and seventy-nine patients underwent sentinel node mapping with ICG dye during this period. Mapping was successful in 270 patients (96.8%) with 85% having successful bilateral mapping. Obturator was the most common location (52%) followed by external iliac (34%). There was no significant difference in detection among patients with BMI less than 30 or more than 30. The detection rate across various histologies of endometrial cancer was also similar. Sentinel node mapping using ICG dye has got excellent overall and bilateral detection rates making it a valuable tool. Obturator was found to be the most common location for the sentinel node. Mapping using ICG dye yield good detection rates in all histologies of endometrial cancer and in patients with high BMI.

Skin-sparing and nipple-sparing mastectomy with a positive sentinel node in patients with breast cancer

Introduction. A skin-sparing or nipple-sparing mastectomy is a surgical treatment that is increasingly used in the treatment of patients with breast cancer. More often women themselves decide or even ask to undergo this type of surgery. In our paper, we present the issue of combined treatment of 62 patients after nipple-sparing or skin-sparing mastectomy with a positive sentinel lymph node. Realisation of this type of surgery has further consequences in adjuvant treatment policies. Material and methods. The group of 62 previously untreated women with positive sentinel lymph nodes took part in this analysis. The individual plan of treatment was established for every patient by the multidisciplinary team according to the rules of the breast cancer unit. All patients were treated in the Holycross Cancer Centre in Kielce (in 2015–2018). Results. The early results show that proper qualification and realisation of oncological treatment is safe and effective. Severe complications appeared rarely. Conclusions. Skin-sparing or nipple-sparing mastectomy is a method of surgical treatment that is increasingly used in the treatment of patients with breast cancer. It should be remembered that the qualification for this type of procedure should be careful, and adjuvant treatment should be rationally planned. Our experience shows that it is an effective and safe method.

Comparative study of two contrast agents for intraoperative identification of sentinel lymph nodes in patients with early breast cancer.

The use of contrast-enhanced ultrasound (CEUS) to locate sentinel lymph nodes (SLNs) in breast cancer has been studied more and more in recent years. This prospective study aimed to compare periareolar injection of two different contrast agents, SonoVue® (SNV) and Sonazoid® (SNZ), followed by CEUS to identify SLNs in breast cancer patients with clinically negative nodes. A total of 205 patients with T1-2N0M0 breast cancer were divided into the SNV group and SNZ group. All were administered a periareolar injection of SNV or SNZ and underwent US to identify contrast-enhanced SLNs. Each contrast-enhanced SLN underwent a biopsy with blue dye and examined again by CEUS in vitro. In all cases, contrast-enhanced lymphatic vessels were clearly visualized using US soon after the periareolar injection of SNZ, and the SLNs were easily identified. The SLN identification rates were 75.27% (210/279) for SNV and 93.58% (102/109) for SNZ. Although the accuracy of detecting SLN metastasis was slightly different between the two groups, there was no statistically significant difference between those groups (P=0.615). Moreover, it was possible to identify SLNs in vitro in the SNZ group, and these could be compared with the lymph nodes (LNs) located using SNZ during the preoperative stage and with blue dye during the procedure. This helped in determining the resection requirements. When comparing the subdermal use of SNV and SNZ, no significant differences in the number of detected SLNs and the diagnosis of metastatic LNs were observed. Because SLNs can be detected for a longer time in living tissues with SNZ, this contrast agent may provide more intraoperative information for complete resection of all preoperative localization of SLN.

Contrast-Enhanced Ultrasound in Locating Axillary Sentinel Lymph Nodes in Patients with Breast Cancer: A Prospective Study

The objective was to explore the clinical value of contrast-enhanced ultrasound (CEUS) in locating the sentinel lymph node (SLN) in patients with early breast cancer. We screened 143 consecutive patients with breast cancer between July 2017 and August 2019. The number of SLNs identified by CEUS and dual labeling (blue dye and radiolabeled colloid) were recorded. The accuracy of CEUS plus fine-needle aspiration cytology (FNAC) was assessed. The rate of identification of SLNs with CEUS was 84.0% (121/144), and that of dual labeling was 97.92% (141/144). There was no significant association between non-enhancement (p = 0.060) or inhomogeneous enhancement (p = 0.468) and lymph node metastasis. The sensitivity and specificity of CEUS-SLNs plus FNAC was 78.38% and 100%, respectively. The technique of CEUS is a promising method for locating the axillary SLN. But it is hard to identify lymph node metastasis with CEUS alone. CEUS-SLNs plus FNAC is a sound technique for diagnosis of the metastasis of SLN.

La peur bleue de ne pas retrouver le bon bleu

In medicine, blue dyes are widely used for lymphatic mapping and biopsy of sentinel lymph nodes in patients with malignant tumors. Three dyes are used for this purpose, namely patent blue, isosulfan blue and methylene blue. They are also used to stain tissues for chromoendoscopy. Reports of anaphylactic reactions to blue dyes are increasing. The allergological work-up is based mainly on history. In the case of perioperative anaphylaxis, it relies on a thouroughly review of the perioperative record. The incorrect identification of the blue dye in the peroperative record will lead to an incorrect diagnosis which could cause serious consequences for patients in case of re-exposure. We describe here two cases of patients who presented peroperative anaphylactic shocks. Both of them had the wrong dye identified in their perioperative record.

Technologic (R)Evolution Leads to Detection of More Sentinel Nodes in Patients with Melanoma in the Head and Neck Region.

Sentinel lymph node (SN) biopsy (SNB) has proven to be a valuable tool for staging melanoma patients. Since its introduction in the early 1990s, this procedure has undergone several technologic refinements, including the introduction of SPECT/CT, as well as radioguidance and fluorescence guidance. The purpose of the current study was to evaluate the effect of this technologic evolution on SNB in the head and neck region. The primary endpoint was the false-negative (FN) rate. Secondary endpoints were number of harvested SNs, overall operation time, operation time per harvested SN, and postoperative complications. Methods: A retrospective database was queried for cutaneous head and neck melanoma patients who underwent SNB at The Netherlands Cancer Institute between 1993 and 2016. The implementation of new detection techniques was divided into 4 groups: 1993-2005, with preoperative lymphoscintigraphy and intraoperative use of both a γ-ray detection probe and patent blue (n = 30); 2006-2007, with addition of preoperative road maps based on SPECT/CT (n = 15); 2008-2009, with intraoperative use of a portable γ-camera (n = 40); and 2010-2016, with addition of near-infrared fluorescence guidance (n = 192). Results: In total, 277 patients were included. At least 1 SN was identified in all patients. A tumor-positive SN was found in 59 patients (21.3%): 10 in group 1 (33.3%), 3 in group 2 (20.0%), 6 in group 3 (15.0%), and 40 in group 4 (20.8%). Regional recurrences in patients with tumor-negative SNs resulted in an overall FN rate of 11.9% (group 1, 16.7%; group 2, 0%; group 3, 14.3%; group 4, 11.1%). The number of harvested nodes increased with advancing technologies (P = 0.003), whereas Breslow thickness and operation time per harvested SN decreased (P = 0.003 and P = 0.017, respectively). There was no significant difference in percentage of tumor-positive SNs, overall operation time, and complication rate between the different groups. Conclusion: The use of advanced detection technologies led to a higher number of identified SNs without an increase in overall operation time, possibly indicating an improved surgical efficiency. Operation time per harvested SN decreased; the average FN rate remained 11.9% and was unchanged over 23 y. There was no significant change in postoperative complication rate.

Sentinel Lymph-Node Biopsy in Early-Stage Cervical Cancer: The 4-Year Follow-Up Results of the Senticol 2 Trial.

IntroductionSenticol 2 is a randomized multicenter trial in the treatment of early-stage cervical cancer patients. The aim of the Senticol 2 study was to compare the effect of sentinel-lymph-node biopsy (SLNB) to that of SLNB + pelvic lymphadenectomy (PLND), and to determine the postoperative lymphatic morbidity in the two groups. Here, we report a secondary objective of this study: the follow up.Material and MethodsIn the Senticol 2 trial, patients underwent a laparoscopy with a sentinel-node-detection procedure and were randomized into two groups, namely: Group A, in which participants received SLNB, and Group B, in which participants received SLNB + PLND. Patients with an intra-operative macroscopically suspicious lymph node, were given a frozen-section evaluation and were randomized only if the results were negative. All of the patients received follow up with a clinical examination at 1, 3, and 6 months after surgery, and then every 3–4 months after that. The median follow up was 51 months (4 years and 3 months).ResultsDisease-free survival after 4 years for the SLNB group and the SLNB + PLND group were 89.51% and 93.1% (p = 0.53), respectively. The only statistical factor associated with recurrence in the univariate analysis was the adjuvant radiotherapy. No other factors, including the age of the patients, histological type, tumor size, lymph vascular space invasion (LVSI), and positive nodal status, were significant in the univariate or multivariate analyses. The overall survival rates after 4 years in the SLNB and SLNB + PLND groups were 95.2% and 96% (p = 0.97), with five and four deaths, respectively. The univariate and multivariate analyses did not find any prognostic factors.ConclusionsThis randomized study confirmed the results of the Senticol 1 study and supports the sentinel lymph node (SLN) technique as a safe technique for use in patients with early-stage cervical cancer treated with SLNB only. Disease-free survival after 4 years was similar in patients treated with SLN biopsy and patients who underwent a lymphadenectomy.

Evaluation of axillary lymph node status after axillary dissection in patients with SLN negative or single SLN positive T1 and T2 breast cancer

Aim: The most substantial factor determining prognosis in breast cancer is axillary lymph node involvement. Therefore, axillary lymph node status should be evaluated correctly in the staging of the disease and determining the prognosis. In this study, we aim to evaluate the detection rate of metastatic lymph nodes after axillary dissection in patients with negative or single positive sentinel lymph nodes in early-stage breast cancer.Materials and Methods: We have included patients with sentinel lymph node biopsy and/or axillary dissection diagnosed with early-stage (T1 and T2) breast cancer between 2018 and 2019 in the study. We have evaluated tumor prognostic factors from patient files and the total number of lymph nodes and tumor positive lymph nodes from pathology paraffin specimens.Results: The study included 29 female patients with an average age of 56 (34-83). Breast-conserving surgery (BCS)+SLNB was performed in 15 patients and BCS+ AD in 11 patients and modified radical mastectomy (MRM) was performed in 3 patients. In 3 patients with positive surgical margin after BCS + SLN, although one patient was positive and the other two patients were negative in SLN, multiple metasatic lymph nodes were detected after axillary dissection due to the patients' request for axillary dissection. Patients were followed-up for an average of 26 months without recurrence or metastasis. Conclusion: Considering that there may be lymph node metastasis other than the sentinel lymph node in patients with SLNB negatives or single positive sentinel lymph node, we recommend more than one lymph node excision in addition to the stained lymph node.

Prognostic Role of Non-Identification of Sentinel Lymph Node in Cutaneous Melanoma Patients: An Observational Retrospective Study.

Simple SummarySentinel lymph node status is the most important prognostic factor for patients with cutaneous melanoma, but occasionally it is not possible to identify the sentinel lymph node. Little is known in cutaneous melanoma literature about the phenomenon of non-identification of sentinel lymph node and its prognostic implications. In this study we observed that not identifying the sentinel lymph node involves a worse nodal disease-free survival, but not a worse melanoma-specific survival than a negative sentinel lymph node. Potentially, patients with non-identified SLN should receive a follow-up schedule like that of patients with positive SLN.Background: Sentinel lymph node (SLN) status is recognized as the most important prognostic factor for patients with cutaneous melanoma. However, sometimes it is not possible to identify SLN. The phenomenon of non-identification of SLN and its prognostic role have not been thoroughly evaluated in melanoma literature. The objective of this study was to identify which patient or tumor variables may be associated to non-identification of SLN and to evaluate the prognostic role of non-identification of SLN. Methods: Observational retrospective study of 834 cutaneous melanoma patients who underwent SLN biopsy at Instituto Valenciano de Oncología. Results: Forty-two patients (5%) presented non-identification of SLN. Patients with age at diagnosis of ≥ 64 years, obesity (BMI ≥ 30), and head and neck localization were at higher risk of non-identification of SLN. Non-identified SLN patients had worse nodal disease-free survival with respect to negative SLN patients, but not worse melanoma-specific survival. Conclusions: Our findings suggest a need to follow-up patients with non-identified SLN in the same way as patients with positive SLN.

Efficacy of Periareolar Versus Peritumoral Injection of TC99-Labelled Sulphur Colloid and Methylene Blue Dye for Detection of Sentinel Lymph Node in Patients with Early Breast Cancer: a Comparative Study.

Sentinel lymph node biopsy using dual methods of blue dye and radioactive isotope is what is practised as the standard of care at most of the centres. The combined use of radioactive colloid and blue dye injection is considered the gold standard for axillary sentinel lymph node biopsy in breast cancer with a 97% accuracy rate. The aim of this study is to determine the optimal injection site for methylene blue dye and Tc99-labelled sulphur colloid for sentinel lymph node biopsy in early breast cancer. In both periareolar and peritumoral groups of patients, overall rate of identifying sentinel lymph node (hot, blue and hot and blue nodes) with dual dye was comparable (100% and 96.36%) with p value = 0.475. Also in both groups of patients, overall rate of getting pathological positive sentinel lymph node on final histopathological report was comparable (52.73% and 45.28%) with p value = 0.561. Periareolar versus peritumoral injection of dual dye shows comparable success rates for axillary sentinel lymph node identification and can be considered rapid and reliable method. However, the periareolar route is technically simple and especially privileged in nonpalpable (T0) and upper outer quadrant lesions mainly for the prevention of the shine through phenomenon.

What is the Cost-Effective Treatment for Melanoma Patients with a Positive Sentinel Node?

Survival for positive sentinel lymph node (SLN) patients does not differ between completion lymph node dissection (CLND) and nodal observation (OBS). However, treating these patients with CLND and checkpoint inhibitors, such as pembrolizumab (PEM), improves outcomes. This study evaluated the cost-effectiveness of OBS, CLND, and CLND with PEM (CLND-PEM) treatments. A Markov model was designed to simulate treatment for a theoretical cohort of 1000 positive SLN patients per therapy with a 5-year follow-up period. An intervention was cost-effective if its incremental cost-effectiveness ratio among therapies was below the willingness-to-pay threshold of $100,000 per quality-adjusted life year (QALY). Compared with CLND or CLND-PEM, OBS resulted in fewer lymphedema cases but in more disease recurrences. Compared with OBS, CLND had higher costs and lower QALYs. Although CLND-PEM had a lower number of recurrences and deaths than OBS or CLND, it had higher costs and lower QALYs than OBS, and thus was not cost-effective. However, with the effects of CLND from CLND-PEM removed, allowing evaluation of PEM effects alone (PEM alone), the resulting QALYs were the highest, but PEM alone still was not cost-effective compared with OBS ($1.2 million per QALY). By reducing the drug cost to less than $14,404 per patient, PEM alone would become cost-effective. Compared with CLND, CLND-PEM, and PEM alone, OBS was cost-effective for managing positive SLN patients. Although CLND-PEM and PEM alone result in fewer recurrences and deaths, these therapies were not cost-effective due to the quality-of-life decrement of CLND and the current high drug cost of PEM.

Molecular analysis of sentinel lymph nodes in patients with breast cancer using one-step nucleic acid amplification (OSNA): Does not lead to overtreatment in the current era of de-escalating axillary management

PurposeOSNA is a molecular technique for sentinel lymph node (SN) analysis in breast cancer. Compared to histology, OSNA may yield more (micro)metastases and thereby result in more axillary lymph node dissections or radiotherapy. We investigated whether axillary treatments increase when using OSNA, applying current guidelines for de-escalating axillary management. MethodsAll patients treated for cT1-3N0 breast cancer in our hospital between December 2013 and February 2016 were included. In 148 prospectively included patients (January 2015–February 2016), SN's were examined with OSNA. In a retrospective cohort of 123 patients (December 2013–December 2014), SN's were examined with conventional histology. Outcomes were: number of macro and micrometastases, amount of patients receiving axillary dissection or irradiation, number of patients receiving adjuvant systemic therapy. Data were analyzed using Mann-Whitney and Pearson Chi-square test. P < 0.05 was considered statistically significant. Results230 SN's from 123 patients were examined with conventional histology. 229 SN's from 148 patients were evaluated with OSNA. Amount of macrometastases was equal between groups (histology 17.9% versus OSNA 16.2%, p = 0.715). We found significantly more micrometastases when using OSNA (histology 11.4% versus OSNA 25.0%, p = 0.004). Total number of axillary lymph node dissections was comparable in both groups (histology 12.2%, OSNA 12.2%, p = 0.993), as well as number of axillary radiations (histology 8.9%, OSNA 11.5%, p = 0.493). Also, the number of patients receiving adjuvant systemic therapy was similar between conventional histology and OSNA (histology 53.7% versus OSNA 58.1%, p = 0.462). ConclusionOSNA analysis for SN in breast cancer is a highly sensitive technique, detecting more micrometastases than standard histology. When applying current guidelines, OSNA analysis does not lead to overtreatment with more axillary dissections or irradiation.

SPECT-CT visualization and biopsy of sentinel lymph nodes in patients with stage IAB-IIA cervical cancer.

To evaluate the diagnostic accuracy of sentinel lymph node (SLN) biopsy and to determine clinical significance of preoperative single-photon emission computed tomography/computed tomography (SPECT-CT). We retrospectively evaluate data and images of 55 women with stage IAB-IIA cervical cancer that underwent sentinel lymph node biopsy and subsequent lymph node dissection. 99mTc-phytate (300MBq) was injected submucosally in 4 points and SPECT-CT started 2h after the injection. All lymph nodes (LN) that accumulated radiocolloids were regarded as sentinel. Next day after the mapping radical hysterectomy with complete pelvic and parametrial LN dissection and SLN biopsy were performed according to the institute protocol. SPECT-CT identified SLNs in 51 of 55 patients. All SLNs were successfully detected during the surgery. The SLN mapping efficacy was 92.7%. LN metastases were diagnosed in 6/51 (11.8%) cases, including 2 patients with positive SLNs. Sensitivity, negative predictive value (NPV) and false-negative rate for SLN biopsy were as follows: 33.4%, 91.8% and 66.6%. In patients with unilateral SPECT-CT localization of SLNs, LN metastases were identified in 4 (20%) of 20 patients but SLN biopsy was false negative in all cases. In 31 women, SPECT-CT detected SLNs on both sides of the pelvis. In this group, regional LN metastases were diagnosed in 2 patients, and in both cases metastases were detected only in SLNs. In women with SPECT-CT visualization of SLNs on both sides of the pelvis, SLN biopsy had high sensitivity and NPV. In patients with unilateral SLN localization, SLN biopsy cannot be used for the prediction of regional LN status.

Детекция сигнальных лимфатических узлов индоцианин зеленым (ICG) у больных раком эндометрия

Детекция сигнальных лимфатических узлов индоцианин зеленым (ICG) у больных раком эндометрия

Molecular Analysis of Sentinel Lymph Nodes in Patients With Breast Cancer Using One-Step Nucleic Acid Amplification (OSNA): Does Its High Sensitivity Lead to Axillary Overtreatment?

Background: OSNA is a molecular technique for sentinel lymph node (SN) analysis in breast cancer that can be performed intraoperatively, enabling a completion axillary lymph node dissection during the same operative procedure. Compared to standard histology, OSNA may yield more (micro)metastases and result in more axillary lymph node dissections or radiotherapy. We investigated whether axillary treatments increase when using OSNA, applying current Dutch guidelines, based on a multidisciplinary approach with axillary lymph node dissection only being performed in patients at high risk for N2-disease, when more than two macrometastases are present in the sentinel node.

Sentinel Lymph Node Biopsy in Breast Cancer Using Methylene Blue Dye: Experience at Sir Ganga Ram Hospital Lahore

Background: sentinel lymph node biopsy is used widely for the management of breast cancer. Axillary lymph node involvement is a very good prognostic indicator in breast cancer. It is the first node draining the primary tumor and is the first node to be involved by the cancer. Objectives: The purpose of this study was to find out the accuracy, sensitivity and specificity of sentinel lymph node biopsy by using methylene blue dye in our setting. Methods: It is a case series study. The study was conducted in the surgical unit 3 Sir Ganga Ram Hospital Lahore from February 2017 to July 2018. Patients with breast lump diagnosed as breast carcinoma on needle biopsy and clinically impalpable lymph nodes in axilla were subjected to sentinel lymph node biopsy using methylene blue dye. 42 patients were selected by purposive simple random technique planned for modified radical mastectomy. Sentinel lymph node biopsy was performed by injecting blue dye in sub areolar region. Mastectomy performed then axilla dissected out to find out blue stained sentinel lymph node. Stained node/nodes were taken out and placed in separate jar. Level II axillary clearance now done to complete the procedure. Both specimens were sent for histopathology. All patients are followed up till now. Results: out of 42 patients true positive results were in 39 cases i.e metastasis detected in 16 cases in sentinel node and so in the axillary nodes, in 33 patients no metastasis found in sentinel as well as in axillary nodes, only in 3 cases false negative results seen there were no false positive cases. Sensitivity was 92% and specificity 99%. Conclusion: Sentinel lymph node biopsy using Methylene blue dye is a safe and feasible procedure to identify the sentinel lymph node in patients of breast cancer with impalpable axillary nodes. In our study this technique is proved to be effective in staining the sentinel lymph node by which unnecessary axillary dissection can be avoided in breast cancer surgery

Detection of high‑risk human papillomavirus DNA in sentinel lymph nodes of patients with cervical cancer

The aim of the present study was to investigate the expression of human papillomavirus (HPV) DNA in sentinel lymph nodes (SLN) in patients with early-stage cervical cancer (CC). In addition, the present study compared the positive rate of SLNs metastasis detected by routine pathological examination, and investigated the value of HPV-DNA in the detection of early CC lymph node micrometastasis. Reverse transcription-quantitative PCR (RT-qPCR) was used in order to evaluate the HPV DNA detection in all CC samples [International Federation of Gynecology and Obstetrics (FIGO) stage IA2-IIA2]. The consistency of HPV-DNA was compared between primary lesions and SLNs. The positive rates of HPV-DNA were compared with pathological diagnosis of SLN metastasis, and the association between the positive expression of HPV-DNA in SLNs and the clinical and pathological parameters of patients with cervical cancer were analyzed. A total of 345 sentinel lymph nodes were detected in 100 patients with IA2-IIA2 CC. The positive rates of RT-qPCR and conventional histopathological detection of SLNs metastasis were 31.6% (109/345) and 12.8% (44/345), respectively (P<0.001). The positive expression of HPV-DNA in SLNs was associated with the clinical stage and tumor diameter (P<0.05), but not with patients' age, depth of cervical invasion, histological grade, lymphatic and vascular space invasion (LVSI), squamous cell carcinoma antigen (SCCAg) (P>0.05). The detection of HPV-DNA expression in pelvic lymph nodes of early CC may be used to improve the detection rate of micrometastasis, guide the postoperative adjuvant therapy more accurately and improve prognosis. Patients with positive HPV-DNA would require closer surveillance than those with negative HPV-DNA.

Identifying the Sentinel Lymph Node in Patients with Cutaneous Melanoma - Preliminary Report of a Private Clinic in Bucharest.

Background: The accuracy of the staging, along with the reproductibility of intraoperative lymph car-tography, and lymph node biopsy in patients with malignant melanoma was unanimously validated in the last decade. This technique allows the discovery of lymph node micrometastses with the help of immunohistochemical methods. The goal of the present study is to present the experience of our clinic in identification and biopsy protocol of the lymph node. Methods: A year-long retrospective analysis was running between March 2019 - December 2019 con-cerning 57 patients with cutaneous melanoma on which detection and excisional biopsy of the lymph node was performed. The procedure was performed by the double method using vital dye and a ra-dio-active tracer. Demographic information was filed, as well as data on location of primary tumors, tumor histology, and radioactivity level. Results: The mean Breslow thickness of primary skin melanomas was 2.7 mm. At least one lymph node was identified in 56 of the 57 patients included in the study. Among those, 15 (26%) had at least one metastatic node. The mean number of excised lymph nodes per patient was 1.6. Conclusions: The cartography and biopsy of lymph nodes need the involvement of a complex multi disciplinary team made of nuclear medicine, surgery, and anatomopathology specialists. This way one provides both a correct staging of the patient with melanoma and access to adjuvant innovative therapies, thus considerably improving the prognosis.

To Level or Not: Histological Examination of Sentinel Lymph Nodes in Patients with Breast Carcinoma

Abstract Management of the axilla in patients with breast carcinoma has changed rapidly in recent years due to development of an increasingly conservative approach to axillary staging. Sentinel node examination plays a pivotal role in subsequent decision for axillary lymph node dissection. There is still no consensus on how best to examine SLNs histologically. The examination of sentinel node should be thorough enough whilst not missing clinically significant information. The main goal of sentinel lymph node examination is to detect all macrometastasis. In this study we have reviewed an extensive histological protocol to identify whether it resulted in detection of clinically significant metastatic deposits. Our study identified that one hematoxylineosin–stained section along with immunostaining for pancytokeratin from each block results in the detection of clinically significant metastases and hence recommended as the preferred method of pathologic evaluation. Keywords Axillary node examination; Breast carcinoma; Sentinel node Abbreviations ALND: Axillary Lymph Node Dissection; MiM: Micrometastasis; SLN: Sentinel Lymph Node

Diagnostic accuracy of sentinel lymph node biopsy in determining the axillary lymph node metastasis.

Sentinel lymph node biopsy (SLNB) is accepted as the standard procedure to determine the axillary lymph node metastasis in breast cancer at early stage. However, in many cases with sentinel lymph node positivity, the axilla does not contain any tumor cells. As a result, the accuracy of SLNB to predict axillary lymph node metastasis must be evaluated. Thousand hundred and fourteen women operated for breast cancer were retrospectively examined. Breast cancer patients without axillary metastasis on clinical examination who had undergone SLNB were included in the study. Sentinel lymph node positivity and axillary lymph node positivity were compared. Among 1114 women operated for breast cancer, 230 were clinically node negative preoperatively and undergone SLNB. Eighty-three (36%) of the patients were SLNB positive and undergone axillary dissection. Forty-three (51.8%) of them had tumor positive axillary lymph nodes and 40 (48.2%) of them had tumor negative axillary lymph nodes. In 48.2% of the patients, positive sentinel lymph node does not demonstrate a positive axilla. This finding supports sparing axillary dissection in patients with favorable prognostic factors even if the sentinel lymph node is found to be positive. Axillary lymph node dissection(ALND) may be spared even if there are macrometastatic sentinel lymph nodes in patients with favorable tumor types who will undergo breast-conserving surgery.