Sentinel Lymph Nodes In Patients Research Articles

Evaluation of Ex Vivo Shear Wave Elastography of Axillary Sentinel Lymph Nodes in Patients with Early Breast Cancer.

Background: The pretherapeutic assessment of axillary lymph node status is crucial in staging early breast cancer patients, significantly influencing their further treatment and prognosis. According to current guidelines, patients with clinically unsuspicious axillary status regularly undergo a biopsy of sentinel lymph nodes (SLNs), whereby metastasis is detected in up to 20% of cases. In recent years, the use of shear wave elastography (SWE) has been studied as an additional ultrasound tool for the non-invasive assessment of tumors in the breast parenchyma and axillary lymph nodes. Previous studies (examining the axilla in patients) have shown that metastases have significantly higher SWE values than benign nodes. Methods: This study aims to evaluate whether SWE can differentiate between tumor-free and metastatic-affected SLN ex vivo, i.e., by examining the pathological specimen. SWE was performed ex vivo on SLN specimens and compared with final histopathological results. Results: A total of 168 SLNs from 105 patients were measured using ex vivo SWE and subjected to standard histopathological processing. In this group, 17 metastases in 17 patients (16.19%) were detected. Tumor-free SLNs had a mean velocity of 1.33 ± 0.23 m/s, while metastatic nodes showed a mean velocity of 1.35 ± 0.29 m/s (p = 0.724). There was no significant difference in ex vivo SWE between benign and malignant SLNs in this population. Conclusions: Contrary to previous studies, this study did not find SWE effective in differentiating lymph node metastases. Further research is needed to clarify SWE's potential role in axillary staging.

PRAME immunohistochemistry distinguishes nodal nevi from metastatic melanoma

BackgroundPreferentially expressed antigen in melanoma (PRAME) is a promising immunohistochemical marker for distinguishing benign from malignant melanocytic lesions in lymph node deposits.ObjectiveTo evaluate PRAME expression in metastatic melanomas and nevi found in the sentinel lymph nodes of patients with primary melanoma.MethodsThirty patients, comprising 15 nodal nevi and 15 metastatic melanomas, were immunohistochemically analyzed for PRAME expression. Nuclear expression was scored as 0–25%, > 25–50%, > 50–75% or > 75% in tumor cells. The sensitivity, specificity, and positive and negative predictive values were calculated considering nuclear expression of PRAME > 75% as positive cases.ResultsCases previously diagnosed as nodal nevi were uniformly negative for PRAME. Conversely, all cases diagnosed as melanoma showed PRAME expression in more than 50% of the cells. Twelve cases showed expression above 75% of cells and were considered positive for calculations, resulting in sensitivity and specificity rates of 80% and 100%, respectively, with corresponding positive and negative predictive values of 100% and 83%.ConclusionsA high level of PRAME immunoreactivity was identified in metastatic melanoma, suggesting that PRAME is a useful analytical tool for confirming the diagnosis of melanoma in a melanocytic nodal deposit.

Frozen Section Analysis of Sentinel Nodes in Patients With Oral Squamous Cell Carcinoma

Frozen section (FS) analysis of sentinel nodes offers potential on-table diagnosis and treatment for occult metastasis in oral squamous cell cancer. Systematic analysis of FS during sentinel node biopsy has not been illuminated in the literature. To systematically review pooled data from studies using FS analysis in evaluating sentinel nodes in patients with cT1-T2 N0 oral squamous cell cancer. An academic librarian led the search of CENTRAL, CINAHL, Cochrane Database of Systematic Reviews, Embase, and MEDLINE for studies published in English between January 2000 and January 2023. Two authors independently screened cohort studies, case series, and randomized clinical trials, in which FS analysis was used to evaluate sentinel nodes in patients with cT1-T2 N0 oral squamous cell cancer. Data were extracted by 2 reviewers. Reporting quality was estimated using the Diagnostic Precision Study Quality Assessment Tool. Data analysis was performed between April and July 2023, and the meta-analysis was completed using the bivariate random-effects model. The primary outcome was the pooled sensitivity of FS sentinel node analysis. Secondary outcomes included evaluation of the FS technique, rate of occult metastasis, false-negative rate, and survival. Seventeen articles with 878 patients met the eligibility criteria. Although protocols varied, confirmatory serial step sectioning was performed in all studies. Occult metastasis was found in 263 of 878 patients (30%), and FS analysis identified 173 cases (65.8%). Following serial sectioning, an additional 90 positive results were identified, leading to 47 patients undergoing staged completion neck dissection. The pooled sensitivity of FS was 0.71 (95% CI, 0.60-0.80), the diagnostic odds ratio was 110, and the false-negative rate was 34.2%. The Cochrane Q value was 15.62 (df = 16; P = .48) and τ2 = 0.36. In this systematic review and meta-analysis, evaluated studies showed various techniques, in which pooled sensitivity reached 0.71, providing a benchmark for comparison to other 1-stop approaches. Due to the high false-negative rate of approximately one-third of patients, intraoperative FS must always be supplemented by serial sectioning. On-table diagnosis remains a key objective for sentinel node biopsy, and FS detection may be improved by standardizing protocols.

Using express cytological method for diagnosis of sentinel lymph nodes in breast cancer patients

Objective: to assess the informativity of the use of the rapid cytological method in the study of sentinel lymph nodes in patients with breast cancer. Material and methods. The study involved 46 patients from 30 to 85 years old with verified breast cancer. On the eve of the operation, about 150-200 MBq of the 99 mTc-Nanotope radiopharma-ceutical was peritumorally injected into the parenchyma of the affected mammary gland. After 1.5-2 hours, lymphos-cintigraphy was performed, followed by SPECT/CT, in which sentinel lymph nodes are zualized. The next day after the administration of the radiopharmaceutical, during surgery, sentinel lymph nodes were found using a g-detector. Further, the surgeon removed the node (or nodes) and sent them for express cytological examination. To check the informativity of this method, a comparison was made with the "gold standard" of morphological diagnostics — with histological examination of postoperative material. Results. An express cytological study revealed the presence of metastases in the sentinel lymph nodes in 12 patients, which significantly influenced the further tactics. It was found that the cytological method of the study is not inferior to the histological one, the sensitivity and specificity of the method is 100%. When comparing the results of rapid cytological and planned histological studies, there were no discrepancies in diagnoses by the state of the lymph nodes. Conclusion. Rapid cytological examination of sentinel limphatic nodes informative method for sentinel lymph node detection in breast cancer patients.

Intraoperative evaluation of sentinel lymph nodes in patients with breast cancer treated with systemic neoadjuvant therapy

AimsTouch preparation (TP) and frozen section (FS) are the two methods routinely used in the intraoperative evaluation (IOE) of sentinel lymph nodes (SLNs) to detect metastases in patients with breast...

A lactate-SREBP2 signaling axis drives tolerogenic dendritic cell maturation and promotes cancer progression.

Conventional dendritic cells (DCs) are essential mediators of antitumor immunity. As a result, cancers have developed poorly understood mechanisms to render DCs dysfunctional within the tumor microenvironment (TME). After identification of CD63 as a specific surface marker, we demonstrate that mature regulatory DCs (mregDCs) migrate to tumor-draining lymph node tissues and suppress DC antigen cross-presentation in trans while promoting T helper 2 and regulatory T cell differentiation. Transcriptional and metabolic studies showed that mregDC functionality is dependent on the mevalonate biosynthetic pathway and its master transcription factor, SREBP2. We found that melanoma-derived lactate activates SREBP2 in tumor DCs and drives conventional DC transformation into mregDCs via homeostatic or tolerogenic maturation. DC-specific genetic silencing and pharmacologic inhibition of SREBP2 promoted antitumor CD8+ T cell activation and suppressed melanoma progression. CD63+ mregDCs were found to reside within the lymph nodes of several preclinical tumor models and in the sentinel lymph nodes of patients with melanoma. Collectively, this work suggests that a tumor lactate-stimulated SREBP2-dependent program promotes CD63+ mregDC development and function while serving as a promising therapeutic target for overcoming immune tolerance in the TME.

Abstract ED05-01: Demystifying the Axilla: Challenging scenarios in the upfront surgery setting and after NAC

Abstract Management of the axilla has evolved significantly over time, with a trend toward less extensive axillary surgery. While historically, all patients underwent axillary lymph node dissection (ALND) due to the Halstedian belief that ALND was essential for the cure of breast cancer, advances in systemic therapy, radiotherapy, and understanding of tumor biology have resulted in the abandonment of ALND for a large proportion of patients having upfront surgery with limited nodal disease, and in those with no residual nodal disease after neoadjuvant systemic therapy. Over time, axillary management has become increasingly complicated, with significant variability in real-world management for different clinical scenarios. In this talk, we will address challenging scenarios in axillary management, both in the upfront surgery setting and after neoadjuvant chemotherapy (NAC). In the upfront surgery setting, we will address management of a positive sentinel node in patients treated with mastectomy, management of ≥ 3 positive sentinel nodes after lumpectomy or mastectomy, and the use of sentinel lymph node biopsy for patients with clinically node-positive hormone receptor (HR) positive/human epidermal growth factor receptor 2 (HER2) negative breast cancer. In the setting of patients receiving NAC, we will discuss the optimal approach to the axilla in patients with residual disease after NAC, and in those with locally advanced breast cancer. As we move away from ALND in low-risk scenarios where data from randomized and prospective trials have demonstrated oncologic safety, we await results from ongoing clinical trials to provide us with high-level evidence regarding the safety of omission of ALND in high-risk patients with more extensive nodal disease. Citation Format: A. Barrio. Demystifying the Axilla: Challenging scenarios in the upfront surgery setting and after NAC [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr ED05-01.

Multimodal ultrasound imaging: a method to improve the accuracy of sentinel lymph node diagnosis in breast cancer.

This study assessed the utility of multimodal ultrasound in enhancing the accuracy of breast cancer sentinel lymph node (SLN) assessment and compared it with single-modality ultrasound. Preoperative examinations, including two-dimensional ultrasound (2D US), intradermal contrast-enhanced ultrasound (CEUS), intravenous CEUS, shear-wave elastography (SWE), and surface localization, were conducted on 86 SLNs from breast cancer patients. The diagnostic performance of single and multimodal approaches for detecting metastatic SLNs was compared to postoperative pathological results. Among the 86 SLNs, 29 were pathologically diagnosed as metastatic, and 57 as non-metastatic. Single-modality ultrasounds had AUC values of 0.826 (intradermal CEUS), 0.705 (intravenous CEUS), 0.678 (2D US), and 0.677 (SWE), respectively. Intradermal CEUS significantly outperformed the other methods (p<0.05), while the remaining three methods had no statistically significant differences (p>0.05). Multimodal ultrasound, combining intradermal CEUS, intravenous CEUS, 2D US, and SWE, achieved an AUC of 0.893, with 86.21% sensitivity and 84.21% specificity. The DeLong test confirmed that multimodal ultrasound was significantly better than the four single-modal ultrasound methods (p<0.05). Decision curve analysis and clinical impact curves demonstrated the superior performance of multimodal ultrasound in identifying high-risk SLN patients. Multimodal ultrasound improves breast cancer SLN identification and diagnostic accuracy.

Carbon nanoparticles versus patent blue dye for detection of sentinel lymph node in patients with early breast cancer

Background Sentinel lymph nodes biopsy (SLNB) has replaced axillary lymph node dissection (ALND) in a considerable percentage of patients with early-stage breast cancer which was a great advance in preventing many surgical complications and enhancing their health welfare. Although there are different sentinel lymph nodes (SLNs) tracers with different identification rates, there is no agreement about the idealistic method. Aim The study was designed to compare carbon nanoparticles and patent blue v dye regarding SLNs detection rate, number of SLNs, time of detection, metastatic SLNs, cost, and safety in patients with early breast cancer and clinically node-negative axilla. Patients and methods A total of 40 patients with axillary lymph node-negative early-stage breast cancer patients were divided into two groups and subjected to carbon nanoparticles and patent blue V dye in group A and group B, respectively. Patients who were pregnant or lactating had node-positive axilla (N1-3) or metastatic breast cancer (M1) or had neoadjuvant chemotherapy were excluded. Results The mean age was 48.3±9.5 and 47 ±8.9, while the mean BMI of 33.3±4.8 and 32.834±4.862, the SLN detection rates were 95% and 90% in groups A and B, respectively. A total of 128 sentinel lymph nodes (SLNs) were removed from patients in the two groups (65 with Carbon Nanoparticles and 63 with patent blue dye). The mean number of SLNs was 3.4±0.7 (range, 2–5) and 3.5±1.2 (range, 2–7), mean time of SLNs detection was 13.5±4.5 (range, 7–22) and 12.7± 3.6 (range, 7–18 min) between group A and B, respectively. Conclusion There is no significant difference between carbon nanoparticles and patent blue dye regarding axillary SLNs in early breast cancer regarding identification rate, number of SLNs, time of detection, metastatic SLNs, cost, and safety with slight preference to carbon nanoparticles regarding postoperative skin staining and Egyptian market availability.

Assessment of sentinel Lymph node mapping with different volumes of Indocyanine green in early-stage ENdometrial cancer: the ALIEN study

ObjectiveTo evaluate the impact of different volumes of indocyanine green (ICG) on the detection rate and bilateral mapping of sentinel lymph nodes in patients with apparent uterine-confined endometrial cancer.MethodsAll patients...

СОБСТВЕННЫЙ ОПЫТ ПРИМЕНЕНИЯ РАДИОФАРМАЦЕВТИЧЕСКОГО ПРЕПАРАТА 99mТс-СЕНТИСКАН ПРИ ВИЗУАЛИЗАЦИИ СТОРОЖЕВЫХ ЛИМФАТИЧЕСКИХ УЗЛОВ У БОЛЬНЫХ РАКОМ МОЛОЧНОЙ ЖЕЛЕЗЫ

Purpose: To study the capabilities of the new radiopharmaceutical 99mTc-sentiscan in the visualization of sentinel lymph nodes in patients with breast cancer. Material and methods: A survey of 178 people diagnosed with breast cancer. Patients were divided into two groups depending on the route of administration of the radiopharmaceutical. The day before surgical treatment, all subjects were injected with a radiopharmaceutical using a syringe with an activity of no more than 120 MBq, in a volume of 0.3‒0.4 ml. The visualized sentinel lymph nodes were marked on the skin using a patented device – «Device for external marking of sentinel lymph nodes during radionuclide visualization». Intraoperative search for sentinel lymph nodes was carried out using gamma detectors Gamma-Finder II or Radical, followed by urgent histological examination. Results: Radioisotope visualization of sentinel lymph nodes using the domestic radiopharmaceutical 99mTc-sentiscan: in the first group (the drug was administered peritumorally) was 100 %, the average number of visualized lymph nodes in this group was 2.2; in the second group (the drug was administered subareolarly) ‒ 99.1 %, the average number of visualized lymph nodes ‒ 2.6. In the first group of patients, metastatic lesions of sentinel lymph nodes were detected in 8 cases (13.1 %), and in the second group ‒ in 14 (11.9 %). All lymph nodes were mapped in the axillary region on the side of the tumor process. Conclusion: The possibility of the radiopharmaceutical 99mTc-sentiscan for the identification and biopsy of sentinel lymph nodes in patients with breast cancer was assessed. The use of the domestic 99mTc-sentiscan makes it possible to visualize sentinel lymph nodes in patients with breast cancer and detect their location in 99.1‒100 % of cases. Taking into account the results obtained, the expanded indications for the use of the radiopharmaceutical and the cost of the kits, 99mTc-sentiscan is more preferable for use in clinical practice.

Assessing the sentimag system for guiding sentinel node biopsies in patients with breast cancer

ABSTRACT Introduction Sentinel lymph node biopsy for breast cancer is a method to localize and excise the first draining lymph node from an invasive cancer of the breast. The histopathologic evaluation of the sentinel lymph node is used for predicting recurrence and survival and thus, guiding oncologists for treatment-decision making to administer adjuvant therapies. The ability to identify the sentinel node depends on methods to map lymphatic drainage from the breast to the sentinel node and accurately discriminate that node from other non-sentinel lymph nodes of the axilla. Areas Covered This review covers the clinical demand for technologies to assist the surgeon in intraoperative lymphatic mapping to specifically identify the sentinel lymph node in patients with breast cancer. Performance characteristics are reviewed for superparamagnetic iron oxide tracers used in lymphatic mapping compared to other current available technologies for lymphatic mapping. Expert opinion The Magtrace (superparamagnetic iron oxide tracer) Sentimag (handheld magnetic probe) system is an FDA-approved technology for intraoperative lymphatic mapping to facilitate sentinel lymph node biopsy in breast cancer with technologic performance characteristics that are equivalent to 99Technetium-sulfur colloid. Barriers to broader utilization primarily center around the need for nonmetallic devices to be used for the conduct of surgery which would interfere with the paramagnetic method for tracer localization.

Evaluation of the diagnostic value of Sentinel Lymph Node in patients with gastric adenocarcinoma.

Sentinel lymph node biopsy (SLNB) has been proven as a safe and efficient procedure in some cancers like breast cancer and melanoma with a reduction of complications and side effects of unnecessary lymphadenectomy in many patients. However, the diagnostic value of SLNB in gastric cancer is a point of debate. This study evaluated the diagnostic value of SLNB using radiotracer and isosulphan blue dye injection in patients with Gastric Adenocarcinomas (GA). This descriptive study was performed at Imam-Reza HOSPITAL on 39 patients diagnosed with GA with no lymphatic metastasis using two methods: the combination of radionuclide with isosulphan together (R&I) method compared with the isosulphan alone method. Lymphatic dissection was performed in all patients. The pathological results were compared between the sentinel lymph nodes (SLN) and other lymph nodes and their accordance rate was calculated. In the T1 group, the sentinel lymph node biopsy detection rate was 100% for the combination of the R&I method and 60% for the isosulphan method and the false negative rate was zero. These values respectively were 88.8% and 88.8% in the T2 group with a false negative rate of 75%. In the T3 group, the values were 100% for the combination of the R&I method and 93.7% for the isosulphan method with a false negative rate of 40%. In the combination of the R&I method, the sensitivity, specificity, and positive and negative predictive values were 57.9, 100, 100, and 69.2 percent respectively. Based on the false negative rate (47.4%), SLNB by injection of isosulphan blue dye alone is not a diagnostic enough value for predicting lymph node metastasis in GA. Although, SLNB by combination of the R&I had better accuracy compared to the isosulphan alone, more studies with larger samples are needed to prove this result.

Clinical Study of Double Contrast-Enhanced Ultrasound Combined with Dye Method and Marker Placement to Identify and Locate Sentinel Lymph Nodes in Patients with Breast Cancer

Clinical Study of Double Contrast-Enhanced Ultrasound Combined with Dye Method and Marker Placement to Identify and Locate Sentinel Lymph Nodes in Patients with Breast Cancer

Indocyanine green fluorescence imaging: an effective method to find inguinal sentinel lymph node in a case of vulvar carcinoma.

The aim was to demonstrate that the technique of near infrared range/indocyanine green (NIR/ICG) could aid the detection of inguinal sentinel lymph nodes in patients with vulvar cancer, in addition to technetium-99m (Tc-99m) scanning. We present a case report of sentinel lymph node detection in a patient with vulvar cancer with two methods: Tc-99m scan and NIR/ICG. The video showed that bilateral inguinal lymph nodes were detected both by Tc gamma probe and NIR/ICG. NIR/ICG may be a safe and effective alternative method for identifying sentinel lymph nodes in cases of early-stage vulvar cancer, although more evidence is required.

Risk factors for sentinel lymph node metastasis in Korean acral and non-acral melanoma patients.

Breslow thickness, ulceration, and mitotic rate are well-known prognostic factors for sentinel lymph node (SLN) metastasis in cutaneous melanoma. We investigated risk factors, including especially the degree of pigmentation, for SLN metastasis in Korean melanoma patients. We enrolled 158, composed of Korean 107 acral and 51 non-acral melanoma patients who underwent SLN biopsy. Clinicopathologic features such as Breslow thickness, ulceration, mitotic rate, and the degree of pigmentation were evaluated. The recurrence-free survival (RFS) rate and date of recurrence were determined. Fifty-four patients (34.2%) had a positive SLN biopsy result. In a multivariate analysis, Breslow thickness (odds ratio [OR] 1.93; 95% confidence interval [CI], 1.12-3.47; p = .022) and heavy pigmentation (OR 13.14; 95% CI, 2.96-95.20, p = .002) were associated with SLN metastasis. Positive SLN patients had a higher rate of loco-regional and/or distant recurrence (hazard ratio 6.32; 95% CI, 3.39-11.79; p < .001). Heavy pigmentation was associated with poor RFS. Heavy pigmentation is an independent predictor of SLN metastasis in both acral and non-acral melanoma. Our results suggest the need for in-depth SLN evaluation of cutaneous melanoma patients with heavy pigmentation and provide clinicians with important information for determining patient prognosis.

Radioactive nanosized colloids and indocyanine green identify the same sentinel lymph nodes in oral squamous cell carcinoma

PurposeNear-infrared fluorescence imaging using indocyanine green (ICG) combined with radioactive markers has the potential to improve sentinel lymph-node (SLN) mapping in oral squamous cell carcinoma (OSCC). This study aimed to evaluate the ability of 99mTc and ICG in identifying the sentinel lymph nodes in patients with early stage OSCC.MethodsData were collected prospectively, and a retrospective analysis of 15 patients with early stage OSCC and a cN0 neck was performed. All patients received peritumoral injection of 99mTc the day before surgery and ICG was administered intraoperatively. Intentionally, the application of the two different tracers were done by two different physicians with varying degrees of experience. The number of identified lymph nodes positive for 99mTc and ICG, the overlap or possible discrepancies of both methods, and the time until fluorescence signals of ICG were detected were noted.ResultsIn all patients, a 100% agreement in sentinel lymph-node identification was achieved, regardless of both the exact location of the peritumoral injection and the experience of the injecting surgeon. Time until ICG accumulation in the sentinel lymph node was consistently found to be between 1 and 3 min.ConclusionICG constitutes a viable and useful addition to 99mTc for intraoperative sentinel lymph-node detection in this study.

A new method for the establishment of inguinal working space in the resection of inguinal sentinel lymph nodes in patients with early stage vulvar cancer.

A new method for the establishment of inguinal working space in the resection of inguinal sentinel lymph nodes in patients with early stage vulvar cancer.

318P Evaluation of novel diagnostic kits using the semi-dry dot-blot method combined for detecting metastases in sentinel lymph nodes of patients with breast cancer: A multi-center prospective study

318P Evaluation of novel diagnostic kits using the semi-dry dot-blot method combined for detecting metastases in sentinel lymph nodes of patients with breast cancer: A multi-center prospective study

Diamond positioning and balloon dilation method: a new method for the establishment of inguinal working space in the resection of inguinal sentinel lymph nodes in patients with early stage vulvar cancer

Diamond positioning and balloon dilation method: a new method for the establishment of inguinal working space in the resection of inguinal sentinel lymph nodes in patients with early stage vulvar cancer