Sentinel Lymph Nodes In Patients Research Articles

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.

Oncologic impact of micrometastases or isolated tumor cells in sentinel lymph nodes of patients with endometrial cancer: a meta-analysis

There is a gap in knowledge regarding the impact of micrometastases (MIC) and isolated tumor cells (ITCs) found in the sentinel lymph nodes of patients with endometrial cancer. Here, we present a meta-analysis of the published literature on the rate of MIC and ITCs after lymphatic mapping and determine trends in postoperative management. Literature search of Medline and PubMed was done using the terms: micrometastases, isolated tumor cells, endometrial cancer, and sentinel lymph node. Inclusion criteria were: English-language manuscripts, retrospectives, or prospective studies published between January 1999 and June 2019. We removed manuscripts on sentinel node mapping that did not specify information on micrometastases or isolated tumor cells, non-English-language articles, no data about oncologic outcomes, and articles limited to ten cases or less. A total of 45 manuscripts were reviewed, and 8 studies met inclusion criteria. We found that the total number of patients with MIC/ITCs was 286 (187 and 99, respectively). The 72% of patients detected with MIC/ITCs in sentinel nodes received adjuvant therapies. The MIC/ITCs group has a higher relative risk of recurrence of 1.34 (1.07, 1.67) than the negative group, even if the adjuvant therapy was given. We noted that there is an increased relative risk of recurrence in patients with low-volume metastases, even after receiving adjuvant therapy. Whether adjuvant therapy is indicated remains a topic of debate because there are other uterine factors implicated in the prognosis. Multi-institutional tumor registries may help shed light on this important question.

The clinical study of character types of sentinel lymph nodes in patients with breast cancer in lymphatic contrast enhanced ultrasound

Objective To evaluate the diagnostic efficiency in differential diagnosis for breast sentinel lymph nodes, and to analyze the imaging characteristics of involved breast sentinel lymph node in lymphatic contrast enhanced ultrasound. Methods Sixty-one patients suspected with breast cancer from May 2017 to March 2019 in Shanghai General Hospital, Shanghai Jiao Tong University were included in the study. Ultrasound contrast agent was injected subcutaneously, and axillary lymph nodes were displayed under contrast enhanced ultrasound mode. The longitudinal diameter (anteroposterior diameter), transverse diameter, longitudinal/transverse ratio and the distance from skin surface were measured. Five types were concluded according to the imaging characteristics in lymphatic contrast enhanced ultrasound: typeⅠ, uniform enhancement; type Ⅱ, ring-shape enhancement; type Ⅲ, ununiform enhancement; type Ⅳ, regional filling defect; type Ⅴ, total filling defect. Sentinel lymph nodes were guided by wire guides and verified in pathology after excision in the operation. Results The detection rate of sentinel lymph nodes was 95.08% (58/61). Seventy-seven lymph nodes, including 21 involved nodes and 56 uninvolved nodes were detected by lymphatic contrast enhanced ultrasound in 58 patients. The longitudinal diameters and transverse diameters of involved lymph nodes were larger than those of uninvolved ones (P=0.001, 0.003). When type Ⅳ(regional filling defect) and type Ⅴ(total filling defect) were classified as involved, the sensitivity, specificity, positive-predictive value, negative-predictive value, accuracy and the area under ROC curve of predicting sentinel lymph node metastases were 85.71%, 96.43%, 90.00%, 94.70%, 93.51% and 0.911, respectively. Conclusions Lymphatic contrast enhanced ultrasound reaches a high diagnostic efficiency in qualitative analysis of breast sentinel lymph nodes. Regional filling defect and total filling defect are the imaging characteristics of involved sentinel lymph nodes in lymphatic contrast enhanced ultrasound. Key words: Contrast-enhanced ultrasound; Breast cancer; Sentinel lymph node; Differential diagnose; Diagnostic efficiency

Fewer tumour draining sentinel nodes in patients with progressing muscle invasive bladder cancer, after neoadjuvant chemotherapy and radical cystectomy

PurposeTo examine the relationship between the number of tumour draining sentinel nodes (SNs) and pathoanatomical outcomes, in muscle-invasive bladder cancer (MIBC), in patients undergoing neoadjuvant chemotherapy (NAC) and radical cystectomy (RC).Materials and MethodsIn an ongoing prospective multicenter study, we included 230 patients with suspected urothelial MIBC from ten Swedish urological centers. All underwent TURb and clinical staging. From the cohort, 116 patients with urothelial MIBC; cT2-cT4aN0M0, underwent radical cystectomy (RC) and lymphadenectomy with SN-detection (SNd). 83 patients received cisplatin-based NAC and 33 were NAC-naïve. The number and locations of detected SNs and non-SNs were recorded for each patient. The NAC treated patients were categorized by pathoanatomical outcomes post-RC into three groups: complete responders (CR), stable disease (SD) and progressive disease (PD). Selected covariates with possible impact on SN-yield were tested in uni -and multivariate analyses for NAC-treated patients only.ResultsIn NAC treated patients, the mean number of SNs was significantly higher in CR patients (3.3) and SD patients (3.6) compared with PD patients (1.4) (p = 0.034). In a linear multivariate regression model, the number of harvested nodes was the only independent variable that affected the number of SNs (p = 0.0004).ConclusionsThe number of tumor-draining SNs in NAC-treated patients was significantly lower in patients with progressive disease.

Sentinel Lymph Node Biopsy Using Preoperative Computed Tomographic Lymphography and Intraoperative Indocyanine Green Fluorescence Imaging in Patients With Localized Tongue Cancer

The indocyanine green method alone is unsuitable for sentinel lymph node biopsy in patients with oral cancer because of poor transcutaneous identification of the fluorescent signal through the platysma and sternocleidomastoid muscles. To assess the utility of a novel sentinel lymph node biopsy technique using preoperative computed tomographic (CT) lymphography followed by the intraoperative indocyanine green fluorescence method. In this prospective study performed at Akita University Hospital, Akita, Japan, participants comprised 18 patients with previously untreated cN0 tongue cancer (squamous cell carcinoma) were enrolled from November 2012 to November 2016. Median observer period was 38 (range, 14-62) months. Analysis was completed between January 10 and March 10, 2018. For preoperative sentinel lymph node mapping, CT lymphography was performed the day before sentinel lymph node biopsy. For sentinel lymph node biopsy, a minimum skin incision was made according to the predetermined location of sentinel lymph nodes. Sentinel lymph nodes were excised under indocyanine green fluorescence guidance. Identification rate of preoperative sentinel lymph node mapping by CT lymphography and the number of sentinel lymph node successfully identified by the intraoperative indocyanine green fluorescence method. Among 18 patients (8 men, 10 women; median age, 65.5 [range, 40-83] years), sentinel lymph nodes could be mapped by preoperative CT lymphography in 16 patients (89%). At least 1 sentinel lymph node was successfully identified and excised in each of these 16 patients using intraoperative indocyanine green fluorescence. Among the 16 patients in whom sentinel lymph nodes were excised, metastases to sentinel lymph nodes were found in 5 patients (31%). The novel sentinel lymph node biopsy technique of preoperative CT lymphography mapping with intraoperative indocyanine green fluorescence has a high potential for identifying sentinel lymph nodes in patients with cN0 tongue cancer. Because the intraoperative indocyanine green method alone cannot identify sentinel lymph nodes in the neck region, this combined method has clinical potential as a sentinel lymph node biopsy technique that does not require radioisotopes.

Is there a role of frozen section of sentinel lymph node in patients with early breast cancer for the management of axilla in India: a prospective study

Background: Evaluation of axilla using sentinel lymph node biopsy (SLNB) is the standard of care in node negative early breast cancer. Intra operative assessment of SLNB with frozen section (FS) often guides the surgeon regarding decision for level of axillary dissection. The aim of this study was to evaluate accuracy of FS of SLNB in these patients with histopathology examination (HPE) as the gold standard.Methods: This study was performed between July 2017 and November 2018. After gross evaluation of SLNB, nodes were cut in half and frozen; the other half was preserved for HPE. For FS, nodes were sectioned to 4 mm width and examined.Results: A total of 61 patients underwent SLNB, 55 patients undergoing intra-operative FS. The mean age was 53 years (range 30-84, ± 15.09 SD), primary tumor was clinically T1 in 23.6%, T2 in 76.4% patients. A median of four sentinel nodes were identified, mean size 13.84 mm. On FS SLNB was positive for metastasis in 14 (25.5%), on HPE in 16 (29.1%) patients. There were 13 true positive, 38 true negative, 3 false negative and 1 false positive result for FS. The sensitivity, specificity, positive and negative predictive value, false negative and false positive rates were 81.25%, 97.44%, 92.86%, 92.73%, 18.75% and 2.56% respectively in this study. The overall accuracy of FS of SLNB in early carcinoma breast was found to be 92.73%.Conclusions: An intra-operative FS of the SLN in node negative early breast cancer is a highly sensitive tool in axilla management.

Robotic sentinel node mapping in clinical stage 1 endometrial cancer using methylene blue dyes using the robotic platform

Endometrial cancer is a surgically staged cancer. We examined our preliminary experience with sentinel lymph node (SLN) mapping in early stage endometrial cancer using methylene blue dyes. Retrospective review of all clinically stage 1 endometrial cancer staged surgically using the robotic platform. Logistic regression models were built to predict nodal metastasis taking into account age, grade, histology, depth of myometrial invasion, cervical involvement, and use of SLN mapping. Four hundred sixty-nine patients were reviewed. Sixty patients had SLN mapping (13%). Four hundred nine patients underwent standard lymphadenectomy with five documented nodal metastasis (1.2%). Five nodal metastasis (8.3%) were seen in the SLN patients. In the logistic model, the application of SLN mapping was significantly associated with diagnosed nodal metastasis (OR 7.74; 95% CI, 2.04-29.3; P=.003) together with nonendometroid histology (OR 5.05; 95% CI, 1.27-20.12; P=.022). SLN mapping protocol using methylene blue significantly identifies more nodal metastasis than standard lymphadenectomy.

P004. Intraoperative assessment of sentinel nodes in mastectomy patients

Introduction: Intraoperative sentinel node assessment was routinely offered to patients undergoing curative breast surgery with negative preoperative nodal status. Our previous audit showed 34% patients undergoing mastectomy had positive OSNA results. Axillary radiotherapy is now increasingly being offered to node positive patients with one or two positive sentinel nodes. The aim of this audit was to assess the rate of positive sentinel nodes in patients undergoing mastectomy.

Relationship between Upper Extremity Lymphatic Drainage and Sentinel Lymph Nodes in Patients with Breast Cancer

Purpose The purpose of this study was to identify the relationship between upper extremity lymphatics and sentinel lymph nodes (SLNs) in breast cancer patients. Methods Forty-four patients who underwent axillary reverse mapping (ARM) during axillary lymph node dissection (ALND) with SNL biopsy (SLNB) between February 2017 and October 2017 were investigated. ARM was performed using indocyanine green (ICG) to locate the upper extremity lymphatics; methylene blue dye was injected intradermally for SLN mapping. Results ARM nodes were found in the ALND fields of all examined patients. The rate of identification of upper extremity lymphatics within the SLNB field was 65.9% (29 of 44). The ARM nodes were involved in metastases arising from primary breast tumors in 7 of the patients (15.9%), while no metastases were detected in pathologic axillary lymph node-negative patients. Lymphatics from the upper extremity drained into the SLNs in 5 of the 44 patients (11.4%); their ARM-detected nodes were found to be in close proximity to the SLNs. Conclusions The ARM nodes and SLNs are closely related and share lymphatic drainage routes. The ARM procedure using fluorescence imaging is both feasible and, in patients who are SLN negative, oncologically safe. ARM using ICG is therefore effective for identifying and preserving upper extremity lymphatics, and SLNB combined with ARM appears to be a promising surgical refinement for preventing upper extremity lymphoedema. Clinical Trial Registration This trial is registered with ClinicalTrial.gov: NCT02651142.

Completion lymphadenectomy for a positive sentinel node biopsy in melanoma patients is not associated with a survival benefit.

Completion lymph node dissection (CLND) for sentinel lymph node (SLN) disease in melanoma patients is debated. We evaluated the impact of CLND on survival and assessed for predictors of nonsentinel node metastasis (positive CLND). Positive SLN melanoma patients were retrospectively identified in the Sentinel Lymph Node Working Group database. Clinicopathological factors were correlated with CLND status, overall survival (OS), and melanoma-specific survival (MSS). There were 953 positive SLN patients of whom 831 (87%) had CLND. Positive CLND was seen in 141 (17%) cases and was associated with worse OS and MSS (both P < 0.001). CLND was not performed (No-CLND) in 122 of 953 positive SLN cases (13%), of whom 100 had follow-up and 18 (18%) developed a nodal recurrence (NR). No significant differences in OS and MSS were seen comparing CLND with No-CLND (P = 0.084, P = 0.161, respectively) and comparing positive CLND with No-CLND NR patients (P = 0.565, P = 0.998, respectively). Gender, primary site, ulceration, and number of positive SLNs were correlated with nonsentinel node metastasis. Performance of CLND provides prognostic information but is not associated with a survival benefit. Clinical variables can predict a positive CLND in patients who may be at high risk of recurrence.

The prognostic value of sentinel lymph nodes on distant metastasis–free survival in patients with high-risk squamous cell carcinoma

BackgroundCutaneous squamous cell carcinoma (cSCC) is the second most common cutaneous cancer worldwide. Several tumour characteristics are considered to pose an elevated risk for systemic spread of carcinoma cells (‘high-risk’ features). Early detection of subclinical metastases could permit early treatment and improve overall survival. To detect occult metastases and evaluate risk of future distant metastases, diagnostic extirpation of the sentinel lymph node (SLNE) is routinely performed in cutaneous melanoma and can be offered in high-risk cutaneous squamous cell carcinoma (hrcSCC). However, the clinical utility of SLNE in patients with hrcSCC remains unknown. Material and methodsAn ambidirectional cohort study with prospective patient recruitment was performed. Between July 2008 and April 2017, of 139 eligible patients, SLNE was performed in 114 cases (25 patients refused). Median follow-up was 23.7 months. ResultsWe analysed the characteristics of 114 patients with hrcSCC who underwent SLNE. Eighty-nine patients (78.1%) were men, and 25 patients (21.9%) were women (median age 72.2 years). In multivariable analyses, histopathological detection of ulceration (hazard ratio, HR 2.9 [95% confidence interval, CI 0.7–12.2]), perineural growth (HR 3.0 [95% CI 0.6–14.6]) and clinically occult SLN metastases (HR 10.7 [95% CI 1.9–60.6]) were strongly associated with future occurrence of distant metastases. A positive predictive value of 50% was noted for patients where SLN metastasis was detected to develop distant metastases. However, distant metastases also occurred in seven patients when histopathological SLN evaluation had shown no evidence of metastases. ConclusionsOur data suggest SLNE is not a reliable diagnostic approach to evaluate the risk of future systemic carcinoma spread and development of distant metastases in patients with hrcSCC.

494 - The SentiPen trial from eUROGEN & The NCRI (UK): Concordance of Sienna+/Sentimag with Standard 99mTc labeled nanocolliod technique for the detection of inguinal sentinel lymph nodes in patients with cN0 penile cancer

494 - The SentiPen trial from eUROGEN & The NCRI (UK): Concordance of Sienna+/Sentimag with Standard 99mTc labeled nanocolliod technique for the detection of inguinal sentinel lymph nodes in patients with cN0 penile cancer

Abstract P6-16-08: Using continuing professional development (CPD) as an investigative tool to improve clinical practice and interdisciplinary team treatment

Abstract Background: Continued and rapid evolution of diagnosis and staging methods along with the development of new treatments has changed the decision-making process for cancer patients into a more complex task. In breast cancer, quality measures related to sentinel lymph node biopsy (SLNB), axillary dissection (AD), HER2 testing and use of HER2-targeted therapy, provide parameters for assessing care quality. We assessed the influence of quality improvement education (QIE) on alignment with BC quality indicators. Methods: 39 members of the interprofessional team at Inova (an integrated care network of 5 hospitals) participated in the QIE components. For a baseline Inova provided deidentified electronic medical records (EMR) data that included a total of 67 breast cancer patients treated between 12/1/16 – 2/28/17. The patients diagnosed with HER2+ breast cancer records were retrospectively reviewed for adherence to quality measures pertaining to HER2 testing, SLNB, AD, and treatment. Follow-up reviews were completed 6 months after the launch of the online component, which included 142 patients. Results: Patient and disease characteristics were generally similar across the 2 cohorts. At baseline, treatment selection for patients with advanced stage cancer was consistent. The original goal of the activity was to assess adherence to quality measures in breast cancer treatment, in our assessment stage the team discovered potential undersampling of sentinel lymph nodes in patients who underwent neoadjuvant chemotherapy for clinically node-positive, with 3 of 8 patients (37.5%) having only 1 or 2 lymph nodes sampled. The educational programming improved recognition of the risk of false negative rates of sampling under 2 lymph nodes in this setting. In addition, the Inova team recommended that the triage protocol be changed to include the medical oncologist earlier in the treatment decision making process in tandem with the surgeon. In the post-program patient data, 26 patients with clinically N1/N2 disease had neoadjuvant therapy and a SLN biopsy. Of these, 3 (11.5%) had only 1 lymph node sampled, suggesting an increased adherence to recommended sampling. The educational program also improved participant knowledge of the phase III APHINITY trial efficacy findings, which was consistent with an increase in the use of pertuzumab-containing adjuvant therapy for early breast cancer (use of TCHP, 0% vs 46% in the pre-program and post-program charts, respectively). In addition, participants in the educational programming increased awareness of the need for reflex testing in the event of an equivocal HER2 IHC result. In the post-program follow-up, no cases of equivocal HER2 IHC staining lacked reflex testing with FISH. Taken together, these findings are consistent with practice change following interventional medical education for incorporating best practices and emerging clinical data in the management of HER2-positive breast cancer. Citation Format: Harnden K, Hester D. Using continuing professional development (CPD) as an investigative tool to improve clinical practice and interdisciplinary team treatment [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-16-08.

SPECT-CT VISUALIZATION OF SENTINEL LYMPH NODES AND LYMPH FLOW FROM TONGUE CANCER

The main purpose of the study was to determine distribution of sentinel lymph nodes in patients with tongue cancer. SPECT-CT visualization of sentinel lymph nodes was performed in 19 primary patients with clinically T1-2N0M0 tongue cancer. SPECT-CT acquisition started 60-120 min after peritumoral injections of 99mTc-nannocolloids (100-150MBq in 0.3-0.4ml). Finally we analyzed lymph flow patterns and localization of lymph nodes with radiocolloids uptake. Bilateral lymph flow from the tongue cancer was detected in 9 (47%) of 19 patients. In 6 cases bilateral pattern was associated with tumors less than 5mm from medial sulcus of the tongue. On the contrary, in 9 of 10 patients with lesions more than 4mm from medial sulcus we detected monolateral lymph-flow. In 4 (21%) of 19 patients SPECT-CT visualized sentinel lymph nodes only in groups Ib-IIa. Modeling of radiotherapy with with standard and lymph-flow guided radiation fields was performed on Eclips treatment planning station. It demonstrated that with lymph-flow guided strategy irradiated volumes can be reduced from 1224 cm3 to 367 cm3, dose to spinal cord can be reduced from 24,7Gy to 14.3Gy, medial dose to contralateral parotid gland - from 24,6Gy to 12,4 Gy. SPECT-CT with radiocolloids can be successfully used for visualization of lymph flow from the primary tumour and subsequent radiotherapy planning.

A unique gene expression signature is significantly differentially expressed in tumor-positive or tumor-negative sentinel lymph nodes in patients with melanoma: Erratum.

A unique gene expression signature is significantly differentially expressed in tumor-positive or tumor-negative sentinel lymph nodes in patients with melanoma: Erratum.

Surgical Management of the Axilla in Breast Cancer Patients with Negative Sentinel Lymph Node: A Method to Reduce False-Negative Rate.

False-negative rate (FNR) of sentinel lymph node dissection (SLND) has not been eliminated. The study was conducted to optimize the surgical resection of axilla in patients with negative sentinel lymph node (SLN) for the purpose of eradicating false-negative (FN) events of SLND. A total of 312 clinically node-negative patients without neoadjuvant therapy underwent SLND with indocyanine green (ICG), methylene blue and the combination of ICG and methylene blue. Axillary dissection was performed subsequently regardless of the status of SLN. Lymph nodes were sent for pathological examination separately by serial resection every 0.5cm away from marginally visualized SLNs. SLND was successfully conducted in 98.1% (306/312) of patients using methylene blue, ICG, and its combination. Further examination revealed 97 true-positive, 189 true-negative, and 13 FN results. The overall FNR was 11.8% (13/110). A horizontal line 1.5cm away from the superior vSLN and a vertical line 1.5cm away from the medial vSLN formed a zone of lower outer quadrant (LOQ) in axilla. Surgical resection of LOQ 'en bloc' showed a FNR of zero. The surgical management of axilla may benefit negative SLN patients with potential nodal involvement, reducing the FNR of SLND to zero. This study was registered with the Chinese Clinical Trial Registry (ChiCTR1800014247).

Clinical Significance of Molecular Micrometastasis in the Sentinel Lymph Node of Early-stage Non-Small Cell Lung Cancer Patients.

Metastatic affectation of lymph node is the main prognostic factor in localized lung cancer. A pathologic study of the obtained samples, even after adequate lymphadenectomy, showed tumor relapses for 20% of stage I patients after oncological curative surgery. We evaluated the prognostic value of molecular micrometastasis in the sentinel lymph node of patients with early-stage lung cancer. The sentinel node was marked immediately after performing thoracotomy by peritumorally injecting 0.25 mCi of nanocoloid of albumin (Nanocol1) labeled with Tc-99m in 0.3 mL. Guided by a Navigator1 gammagraphic sensor, we proceeded to its resection. The RNA of the tissue was extracted, and the presence of genes CEACAM5, BPIFA1, and CK7 in mRNA was studied. The significant association between the presence of micrometastasis, clinicopathologic characteristics, and patients' outcome was assessed. Eighty-nine stage I-II non-small cell lung cancer patients were included in the study. Of the 89 analyzed sentinel lymph nodes, 44 (49.4%) were positive for CK7, 24 (26.9%) for CEACAM5, and 17 (19.1%) for BPIFA1, whereas 10 (11.2%) were positive for the 3 analyzed genes. A survival analysis showed no significant relation between the presence of molecular micrometastasis in the sentinel node and patients' progression. The molecular analysis of the sentinel node in patients with early-stage lung cancer shows node affectation in cases staged as stage I/II by hematoxylin-eosin or an immunohistochemical analysis. However, this nodal affectation was not apparently related to patients' outcome.

Comparing Frozen and Paraffin Section in the Detection of Metastases in Sentinel Lymph Node in Breast Cancer in Aminu Kano Teaching Hospital, Kano, North-Western, Nigeria

Background: Sentinel lymph node biopsy is an effective diagnostic procedure to determine the need to treat the axilla or otherwise in patients with early breast cancer to avoid its inherent complication and further morbidity. Frozen section is one of the acceptable methods of scrutinizing sentinel lymph nodes to enable decision be made intraoperatively. This study is aimed to determine the sensitivity of frozen section biopsy in the diagnosis of positive sentinel lymph nodes in patients with early breast cancer. Materials and Methods: The study was conducted in the Surgery and Pathology Departments of Aminu Kano Teaching Hospital, Kano, from September 2015 to March 2017. Consecutive patients diagnosed with early breast cancer, who met the inclusion criteria, were recruited into the study after obtaining informed consent. Early breast cancer in this study was defined as stage I (T1, N0, M0) or stage IIA (T2, N0, M0). Additional information included age, sex, menopausal status, surgical procedures, duration of surgery, and the histopathological types. Statistical and comparative analysis was made. Result: A total of 117 patients with breast cancer were seen at the General Surgery Outpatient Department during the study period. Out of these patients, 40 met the inclusion criteria and were recruited for the study. The age range of 28 to 70 years and mean age of 47.4 ± 11.6 years were recorded. Twenty-two (55%) patients were premenopausal. Eighty-two sentinel lymph nodes were harvested and analyzed. Twenty-eight (34.1%) sentinel nodes were found to be positive by frozen section, whereas 54 (65.9%) were negative. The paraffin section analysis showed that 44 (53.7%) out of 82 sentinel nodes were positive for malignancy, whereas 38 (46.3%) were negative. The sensitivity, specificity, and accuracy of frozen section were 70.8%, 100%, and 82.5%, respectively. The false-negative rate was 29.2% (P = 0.292, confidence interval = 90%). Conclusion: Frozen section biopsy of sentinel lymph node is not as effective as routine staining technique in detecting malignant cells in patients with early breast cancer.

Infrared fluorescence lymphography in experimental and clinical practice

Introduction. Near infrared (NIR) fluorescent diagnostics is promising due to a deeper penetration into biological tissues. Material and methods. In experiments on rabbits and in clinical studies evaluation the lymphatic system with the use of the instrument complex FLUM-808 was analysed. Results. For visualization of the lymphatic vessels of the skin, the intradermal administration of ICG, dissolved in 20 % albumin in the order of 0.02 mg/ml, is optimal. Peritumoral injection of ICG allows visualizing sentinel lymph nodes in patients with lung cancer. Conclusions. The developed NIR fluorescence diagnostic system FLUM-808 allows to real time visualization of lymphatic vessels and lymph nodes.