SLN Group Research Articles

Comparing Surgical and Oncological Outcomes between Indocyanine Green (ICG) Sentinel Lymph Node Mapping with Routine Lymphadenectomy in the Surgical Staging of Early-Stage Endometrioid Endometrial Cancer.

A retrospective single-centre cohort study of patients with early-stage endometrioid endometrial cancer undergoing staging surgery (total hysterectomy, bilateral salpingo-oophorectomy with/without pelvic lymph node, and/or para-aortic lymph node dissection (PLND)) with either SLN mapping or routine lymphadenectomy between July 2017 and December 2018. 203 cases with clinical and radiological International Federation of Gynaecology and Obstetrics (FIGO) stage I endometrioid endometrial cancer were included, out of which 109 cases underwent SLN mapping and 94 cases complete lymphadenectomy. Compared to the PLND group, the SLN group had shorter operative time (129 vs. 162 minutes), less blood loss (100 vs. 300 ml), and decreased length of postoperative hospital stay (3 vs. 4 days) (p < 0.001). The lymph node metastases detection rate was 4.6% and 7.4% for the SLN and PLND groups, respectively (p = 0.389). With a median follow-up of 14 months for the SLN and 15 months for the PLND group, the disease-free (DFS) and overall survival (OS) were comparable for both at 13 months (p = 0.538 and p = 0.333, respectively). SLN mapping has been shown to be an acceptable alternative to routine lymphadenectomy in the surgical staging of early-stage endometrial cancer in our centre, with a comparable lymph node metastases detection rate, DFS and OS, and reduction in operative morbidity. Our results with SLN mapping reproduce comparable outcomes to those reported in the literature.

Pentoxifylline reduces inflammation and prevents myocardial perfusion derangements in experimental chronic Chagas' cardiomyopathy.

Myocardial perfusion defect (MPD) is common in chronic Chagas cardiomyopathy (CCC) and is associated with inflammation and development of left ventricular systolic dysfunction. We tested the hypothesis that pentoxifylline (PTX) could reduce inflammation and prevent the development of MPD in a model of CCC in hamsters. We investigated with echocardiogram and rest myocardial perfusion scintigraphy at baseline (6-months after T. cruzi infection/saline) and post-treatment (after additional 2-months of PTX/saline administration), female Syrian hamsters assigned to 3 groups: T. cruzi-infected animals treated with PTX (CH + PTX) or saline (CH + SLN); and uninfected control animals (CO). At the baseline, all groups showed similar left ventricular ejection fraction (LVEF) and MPD areas. At post-treatment evaluation, there was a significant increase of MPD in CH + SLN group (0.8 ± 1.6 to 9.4 ± 9.7%), but not in CH + PTX (1.9 ± 3.0% to 2.7 ± 2.7%) that exhibited MPD area similar to CO (0.0 ± 0.0% to 0.0 ± 0.0%). The LVEF decreased in both infected groups. Histological analysis showed a reduced inflammatory infiltrate in CH + PTX group (395.7 ± 88.3 cell/mm2), as compared to CH + SLN (515.1 ± 133.0 cell/mm2), but larger than CO (193.0 ± 25.7 cell/mm2). The fibrosis and TNF-α expression was higher in both infected groups. The prolonged use of PTX is associated with positive effects, including prevention of MPD development and reduction of inflammation in the chronic hamster model of CCC.

Adipose-Derived Stem Cells and Tacrolimus Improve Nerve Regeneration in a Rat Sciatic Nerve Defect Model.

This study compared the effect of undifferentiated adipose-derived stem cells (ADSCs) vs tacrolimus (FK506) in peripheral nerve regeneration in a rat sciatic nerve complete transection model. Forty Wistar rats were equally distributed in four groups. In the SHAM surgery group, the sciatic nerve was exposed and no further intervention was done. In the conduit-alone group (the SLN group), a 10-mm nerve gap was created and bridged with a fibrin conduit filled in with normal saline. In the FK506 group, the fibrin conduit was injected with soluble FK506. In the ADSC group, the conduit was impregnated with undifferentiated ADSCs. Nerve regeneration was assessed by means of walking track analysis, electromyography, and neurohistomorphometry. Clinically and microscopically, nerve regeneration was achieved in all groups at 12 weeks. Walking track analysis confirmed functional recovery in the FK506 and ADSC groups, but there was no difference between them. Recovery in function was also achieved in the SLN group, but it was inferior (P<.05). Electromyography demonstrated superior nerve regeneration in the FK506 and ADSC groups compared with the SLN group (P<.05), with no difference between the FK506 and ADSC groups. Similarly, histology showed no difference between the FK506 and ADSC groups, although both outperformed the SLN group (P<.05). No complications were observed. Successful peripheral nerve regeneration can be accomplished after a 10-mm nerve defect treated with nerve conduits. Superior nerve regeneration may be expected when the conduits are loaded with undifferentiated ADSCs or FK506, with similar outcomes for ADSCs and FK506. [Orthopedics. 2023;46(6):e353-e361.].

Outcome of Patients with High-Risk Endometrial Cancer Undergoing Sentinel Lymph Node Assessment versus Full Lymphadenectomy (070)

Objectives: Sentinel lymph node mapping and dissection (SLN) is endorsed by the National Comprehensive Cancer Network as a recommended surgical staging approach in patients diagnosed with apparent uterine-confined endometrial cancer (EC) of all histologies. While SLN has been validated for use in patients with high-risk histologies, data regarding the oncologic safety of SLN in the management of high-risk EC is limited and inconclusive. The objective of this study was to determine the 3-year progression-free survival (PFS) and overall survival (OS) in patients with high-risk EC who underwent SLN compared to patients who underwent pelvic ± para-aortic lymphadenectomy (LND). Methods: All patients in our healthcare system diagnosed with EC with no radiologic evidence of extra-uterine disease who underwent surgical management between January 1, 2014, and September 1, 2020, were identified, and follow-up data were recorded. SLN was performed in accordance with evidence-based practice, and an SLN algorithm was used. High-risk EC was classified based on hysterectomy specimen pathology demonstrating non-endometrioid histology or FIGO grade 3 endometrioid histology. Patients were excluded if they had more than one primary cancer at the time of diagnosis or if no follow-up records were available. Patients were categorized based on intention to treat. All statistical analyses were performed using SAS version 9.4. Conclusions: Patients with high-risk EC who underwent SLN had no difference in 3-year survival relative to LND; however, the SLN group experienced shorter unadjusted OS. When adjusting for age, adjuvant therapy, and surgical approach, the two methods were found to be similar, with a trend towards worse OS for those who underwent SLN. A randomized control trial comparing SLN versus LND with long-term follow-up for patients with EC of high-risk histologies is necessary. Objectives: Sentinel lymph node mapping and dissection (SLN) is endorsed by the National Comprehensive Cancer Network as a recommended surgical staging approach in patients diagnosed with apparent uterine-confined endometrial cancer (EC) of all histologies. While SLN has been validated for use in patients with high-risk histologies, data regarding the oncologic safety of SLN in the management of high-risk EC is limited and inconclusive. The objective of this study was to determine the 3-year progression-free survival (PFS) and overall survival (OS) in patients with high-risk EC who underwent SLN compared to patients who underwent pelvic ± para-aortic lymphadenectomy (LND). Methods: All patients in our healthcare system diagnosed with EC with no radiologic evidence of extra-uterine disease who underwent surgical management between January 1, 2014, and September 1, 2020, were identified, and follow-up data were recorded. SLN was performed in accordance with evidence-based practice, and an SLN algorithm was used. High-risk EC was classified based on hysterectomy specimen pathology demonstrating non-endometrioid histology or FIGO grade 3 endometrioid histology. Patients were excluded if they had more than one primary cancer at the time of diagnosis or if no follow-up records were available. Patients were categorized based on intention to treat. All statistical analyses were performed using SAS version 9.4. Conclusions: Patients with high-risk EC who underwent SLN had no difference in 3-year survival relative to LND; however, the SLN group experienced shorter unadjusted OS. When adjusting for age, adjuvant therapy, and surgical approach, the two methods were found to be similar, with a trend towards worse OS for those who underwent SLN. A randomized control trial comparing SLN versus LND with long-term follow-up for patients with EC of high-risk histologies is necessary.

Clinical relevance of a degree of extracapsular extension in a sentinel lymph node in breast cancer patients: a single-centre study

In some breast cancer (BC) patients, an examination of lymph nodes dissected during sentinel lymph node biopsy (SLNB) demonstrates a presence of metastatic lesions and extracapsular extension (ECE) in a SLN. This study aimed to evaluate clinical relevance of ECE in BC patients. This is a retrospective analysis of 891 patients with cancer metastases to SLN, referred to supplementary axillary lymph node dissection (ALND), hospitalized between Jan 2007 and Dec 2017. Clinical and epidemiological data was evaluated. Long-term treatment outcomes were analysed. In 433 (48.6%) patients, cancer metastases were limited to the SLN (group I), in 61 (6.8%) patients the SLN capsule was exceeded focally (≤ 1 mm—group II). In 397 (44.6%) patients, a more extensive ECE was found (> 1 mm—group III). Metastases to non-sentinel lymph nodes (nSLNs) were diagnosed in 27.0% patients from group I, 44.3% patients from group II and in 49.6% patients from group III. No statistically significant differences were observed in long-term treatment outcomes for compared groups. The presence of ECE is accompanied by a higher stage of metastatic lesions in the lymphatic system. The differences in this respect were statistically significant, when compared to the group of ECE(−) patients. ECE, regardless of its extent, did not impact the long-term treatment results. ECE remains an indication for supplementary ALND and for other equivalent cancer treatment procedures, regardless of ECE size.

Effects of multiple breath hold reproducibility on treatment localization and dosimetric accuracy in radiotherapy of left-sided breast cancer with voluntary deep inspiration breath hold technique

The purpose of this study was to investigate the effects of breath hold reproducibility on positional and dosimetric errors in radiotherapy of patients with left-sided breast cancer (LSBC) treated with voluntary deep inspiration breath hold (vDIBH) technique. Clinical data from 2 groups of patients with LSBC were retrospectively investigated: (1) those irradiated for the whole breast only (WB group, n = 20) using typically from 3 to 5 breath holds per treatment session and (2) those irradiated simultaneously also for supraclavicular lymph nodes (WB + SLN group, n = 27) using from 7 to 9 breath holds per fraction. Setup and field images (n = 1365) from tangential breast fields, and anterior and posterior lymph node fields were analyzed to obtain total, inter-, and intrafractional residual positional errors of the chest wall and clavicle. The dosimetric effect of intrafractional positional errors was investigated at the abutment level of breast and lymph node fields. The total systematic setup error in the longitudinal (superior-inferior [SI]) direction was 1.4 and 1.9 mm (1 standard deviation, p = 0.049) for the WB and WB + SLN groups, respectively, whereas in the anterior/lateral direction, the error was 1.2 mm for both groups. In the SI direction, the systematic intrafractional error was also larger in the WB + SLN group (1.9 vs 1.1 mm, p = 0.003). The latter positional errors correlated moderately (ρ = 0.51) with the number of breath holds. Mean intrafractional errors of at least 2 mm were observed for 38% of the patients in the WB + SLN group. These errors resulted in a dosimetric error from 8.3% to 10.1% (1 cc). The total localization errors and needed setup margins were wider for the WB + SLN group, due to increased amount of breath holds in treatment session. Mean intrafraction movements ≥ 2 mm were shown to occur with this patient group in the SI direction, requiring intrafractional positional monitoring and corrective actions in daily practice.

Application of artificial neural networks for predicting presence of non-sentinel lymph node metastases in breast cancer patients with positive sentinel lymph node biopsies.

IntroductionThe aim of this study was to present a new predictive tool for non-sentinel lymph node (nSLN) metastases.Material and methodsOne thousand five hundred eighty-three patients with early-stage breast cancer were subjected to sentinel lymph node biopsy (SLNB) between 2004 and 2012. Metastatic SLNs were found in 348 patients – the retrospective group. Selective axillary lymph node dissection (ALND) was performed in 94% of cases. Involvement of the nSLNs was identified in 32.1% of patients following ALND. The correlation between nSLN involvement and selected epidemiological data, primary tumor features and details of the diagnostic and therapeutic management was examined in metastatic SLN group. Multivariate analysis was performed using an artificial neural network to create a new nomogram. The new test was validated using the overall study population consisting of the prospective group (365 patients – SLNB between 01–07.2013).ResultsAccuracy of the new test was calculated using area under the receiver operating characteristics curve (AUC). We obtained AUC coefficient equal to 0.87 (95% confidence interval: 0.81–0.92). Sensitivity amounted to 69%, specificity to 86%, accuracy – 80% (retrospective group) and 77%, 46%, 66% (validation group), respectively. The Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram the calculated AUC value was 0.71, for Stanford – 0.68, for Tenon – 0.67.ConclusionsIn the analyzed group only the MSKCC nomogram and the new model showed AUC values exceeding the expected level of 0.70. Our nomogram performs well in prospective validation on patient series. The overall assessment of clinical usefulness of this test will be possible after testing it on different patient populations.

P341 Use of fibrin glue in the prevention of seroma formation after axillary lymphadenectomy

Goals: The ACOSOG Z0011 trial showed that an axillary lymph node dissection (ALND) may be safely omitted in selected patients with a positive sentinel lymph node biopsy (SNB). One of these eligible criteria has non palpable lymphadenopathy. However, the eligibility for patients with a suspicious Ultrasonography (US) is controversial. The purpose of this study was to evaluate the validity of the SNB for patients with suspicious lymph node (sN+) compared to clinical node negative patients (cN0). Methods: Patients with suspicious axillary lymph node positive breast cancer by preoperative assessed US or CT were performed fine needle aspiration (FNA) cytology between 2004 and 2014. Patients with a negative axillary US (cN0 group) or negative FNAC (sN+ group) result underwent SNB. All SNB positive patients underwent completion ALND. The number of positive nodes after ALND was compared cN0 group with sLN group. Results: 530/2683 patients (19.7%) had positive SNB. Ultrasoundaxilla was 49% sensitive and 84% specific in predicting SNB metastases. The positive (PPV) and negative predictive value (NPV) was 53% and 81% respectively. For suspicious group, this was 68.4% sensitive and 99.7% specific in detecting SNB metastases. PPV and NPV were 99.6% and 74.2% respectively. The number of metastasis lymph nodes is 1 (48%), 2 (19%), 3 (9%), more than 4 (54%) and N1mic (17%) in the cN0 group, and 1 (37%), 2 (14%), 3 (7%), more than 4 (10%) and N1mic (28%) in the cN1 suspicious group. Conclusion: These results suggest that patients with suspicious axillary metastases on ultrasound-guided biopsy have less involved nodes than SNB-positive patients with clinical negative node. Therefore, we conclude that SNB can be safely performed in patients with clinically suspicious lymph node on ultrasonography. Disclosure of Interest: No significant relationships.

Localization of sentinel lymph node in breast cancer. A prospective study

IntroductionSentinel Lymph Node Biopsy (SLNB) is the standard of care for staging axillary lymph nodes in women with breast cancer and clinically negative nodes. It is associated with reduced arm morbidity, moderated or severe lymphoedema, and a better quality of life in comparison with standard axillary treatment. Unfortunately, skip metastases makes all minimally invasive approaches, such as axillary sampling, unreliable. The aim of the present clinical prospective study is to evaluate the position of SLN in an important number of cases and establish the real incidence of skip metastases in clinically node-negative patients. Patients and methodsA cohort of 898 female patients with breast carcinoma was considered, from 2001 to 2008. Once SLN was localized, by means of radio-colloid or blue dye staining, and isolated, a biopsy was performed. Only those positive for metastases were submitted to axillary dissection. ResultsOnly in nine cases a SLN was not isolated. We had 819 cases of first level SLN (group A) and 69 cases of second level SLN (group B). Considering all of 889 cases, SLN was localized in the second level in 69 patients (7.8%); but if we consider metastatic SLN alone (340 cases), it was in the second level in 23 subjects (6.8%). In total, we had a positive second level SLN in 2.3% of cases (23/889). ConclusionSecond level SLN could be considered only an anomalous lymphatic axillary drainage and it does not linked to particular histological variants of the primitive tumour. In our study, skip metastases were recognized in only 2.6% of cases, therefore, whenever a SLN is not isolated for any reason, the first level sampling represent a viable operative choice.

Efficacy of lidocaine solid lipid nanoparticles for sciatic nerve blockade in rats

Objective To evaluate the efficacy of lidocaine solid lipid nanoparticles (L-SLNs) for sciatic nerve blockade in rats.Methods Lidocaine-loaded SLNs were prepared using high pressure homogenization.Ninety SPF male Wistar rats,weighing 220-280 g,were randomized into 6 groups (n =15 each) using a random number table:control group (group C),1％ L-SLN group (group L1-SLN),1％ lidocaine group (group L1),2％ L-SLN group (group L2-SLN),2％ lidocaine group (group L2),and blank SLN group (group SLN).In C,L1-SLN,L1,L2-SLN,L2 and SLN groups,normal saline,1％ lidocaine SLN,1％ lidocaine,2％ lidocaine SLN,2％ lidocaine and blank SLN (200 μl) were injected,respectively,around the sciatic nerve.Before sciatic nerve blockade (baseline) and at 10,20,30,60,120,180,240,300,360,420,480,540 and 600 min after blockade,the paw withdraw latency to a thermal stimulus was measured,and maximum possible effect (MPE) was calculated to reflect the degree of sensory block.Before sciatic nerve blockade and at 10,20,30,60,120 and 150 min after blockade,extensor postural thrust (EPT) of the hind limbs was detected to reflect the degree of motor block.The sciatic nerve at the injection site and the tissues around the site were obtained for observation of the pathological changes at 2 days and 1 and 4 weeks after blockade.Results Compared with the baseline value before blockade and group C,the MPE was significantly increased in at 10-30 min after blockade group L1,at 10-60 min after blockade in group L2,at 10-360 min after blockade in group L1-SLN,and at 10-540 min after blockade in group L2-SLN,and the EPT was decreased at 10-30 min after blockade in group L1,at 10-60 min after blockade in group L2 and group L1-SLN,and at 10-90 min after blockade in group L2-SLN.Compared with group L1,the MPE was significantly decreased at 10 min after blockade,no significant change was found at 20-30 min after blockade,and the MPE was increased at 60-360 min after blockade,and the EPT was increased at 10-30 min after blockade,and no significant change was found at the other time points in group L1-SLN.Compared with group L2,no significant change was found in the MPE at 10-30 min after blockade,the MPE was significantly increased at 60-540 minafter blockade,and the EPT was increased at 10-60 min after blockade,and no significant change was found at the other time points in L2-SLN group.In SLN,L1-SLN and L2-SLN groups,no pathological changes were found in the sciatic nerve at the injection site and the tissues around the site,and only mild inflammatory responses were observed.Conclusion L-SLNs can prolong the duration of block when applied for sciatic nerve blockade in rats and biocompatibility is good. Key words: Nanocapsules; Lidocaine; Nerve block; Sciatic nerve

Sentinel Node Dissection Delays Recurrence and Prolongs Melanoma-Related Survival: An Analysis of 673 Patients from a Single Center with Long-Term Follow-Up

The status of the sentinel lymph node is an important predictor for survival in melanoma patients, but it is still unclear if early removal of micrometastases by sentinel lymph node dissection (SLND) alters survival. A large series of melanoma patients from a single center with long-term follow-up was analyzed with regard to a possible effect of SLND on the prognosis. A total of 673 consecutive melanoma patients were assessed treated in our center either without SLND (377 patients, pre-SLN group, between January 1995 and March 2000) or with SLND (296 patients, SLN group, between April 2000 and March 2003). The median follow-up was 64.0 months in the pre-SLN and 72.5 months in the SLN group. The pre-SLN group and SLN group did not differ significantly with regard to characteristics of the primary melanoma thickness and ulceration, sex, and age. Kaplan-Meier analyses showed a significantly better recurrence-free survival (P < .001), distant metastases free survival (P = .006), and overall survival (P = .049) for patients of the SLN group; the 5-year melanoma-specific survival rates were 80.3% in pre-SLN patients and 84.8% in SLN patients. Initial metastases in the in-transit region and distant locations were of similar frequency in the pre-SLN and SLN groups (P = .191 and P = .959, respectively), but initial regional lymph node metastases were significantly more frequent in the pre-SLN group (P < .001). Our data point toward a subgroup of melanoma patients who might have a prognostic benefit from SLN.

Sentinel lymph node biopsy (SLNB) prior to primary chemotherapy (PC) in breast cancer patients.

Abstract Abstract #5111 Background: Lymph node status is the single most important determinant of prognosis and is used for planning adjuvant therapy. Patient selection and timing of SLNB for PC continue to evolve; SLNB prior to PC may allow more accurate initial staging and prognostication and guide decisions about adjuvant treatment.&amp;#x2028; Methods: 78 patients (pts) who were treated in the Cambridge Breast Unit as part of Neo-tAnGo (a multicentre PC trial). 57 were identified as potentially suitable for SLNB pre-PC (clinically node negative, non-inflammatory tumours 2–5cm in size). 38 had axillary ultrasound, and of these, 18 had sonographically suspicious nodes. 12/18 had confirmed nodal metastasis on core biopsy (CB) and had direct ALND post-PC. The remaining 20 patients had innocent nodes or were CB negative, of whom 19 underwent SLNB. A total of 19 patients in this subgroup did not undergo axillary ultrasound; 16 of these proceeded to ALND post-PC and 3 to SLN biopsy pre-PC according to unit policy at the time. A total of 22 (19 + 3) pts were available for analysis of SLN biopsy pre-PC in terms of time to treatment compared to the remainder of the centre's cohort in the Neo-tAnGo study. 42, (22 SLNB + 20 node positive on CB), were analysed as having axillary pathological staging before PC and compared to the other patient cohort on study.&amp;#x2028; Results: The SLN was successfully identified in all 22 pts using dual localisation techniques with a mean SLN harvest of 2.8 nodes per patient (range 1–10). 6/22 pts (27%) were node positive, and 5 had single SLN involvement (4 macro-; 1 micro-) and one had a macro- and a micrometastasis in 2 different nodes. The mean time from diagnosis to start of PC in the SLN group was 23 days (range 8–43) compared 18 days (range 7–36) for the comparator cohort on study (p=0.02). When all 42 pts with pathological axillary assessment were analysed (including clinically node positive pts with tumours &amp;gt;5cm), there was no significant difference in time from diagnosis to start of PC for pts undergoing CB and/or SLNB (21 days) compared with no axillary assessment (17 days) (wilcoxon test p=0.10). The mean number of nodes removed on completion ALND was 9 (range 4–16). There was no evidence of any viable tumour or fibrosis in any of the non-SLN's (NSLN) examined. Amongst the group of 18 ultrasound/CB positive pts who underwent ALND without SLNB, nodal disease was found in 9 (50%) with evidence of pathological downstaging in 4 (22%).&amp;#x2028; Conclusion: There is potential loss of staging information when SLNB is performed after PC and the clinical significance of a negative SLNB result in this setting is uncertain. A combination of axillary ultrasound (with CB) and SLNB can more accurately stage the axilla without significant overall delays in commencement of PC for clinically node positive and negative pts. Downstaging of disease in NLSN may occur in response to PC with a lower NSLN rate (0%) when compared to primary surgical treatment in smaller tumours (15–25%). Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5111.

Sentinel-lymph-node biopsy as a staging procedure in breast cancer: update of a randomised controlled study

In women with breast cancer, sentinel-lymph-node biopsy (SLNB) provides information that allows surgeons to avoid axillary-lymph-node dissection (ALND) if the SLN does not have metastasis, and has a favourable effect on quality of life. Results of our previous trial showed that SLNB accurately screens the ALN for metastasis in breast cancers of diameter 2 mm or less. We aimed to update this trial with results from longer follow-up. Women with breast tumours of diameter 2 cm or less were randomly assigned after breast-conserving surgery either to SLNB and total ALND (ALND group), or to SLNB followed by ALND only if the SLN was involved (SLN group). Analysis was restricted to patients whose tumour characteristics met eligibility criteria after treatment. The main endpoints were the number of axillary metastases in women in the SLN group with negative SLNs, staging power of SLNB, and disease-free and overall survival. Of the 257 patients in the ALND group, 83 (32%) had a positive SLN and 174 (68%) had a negative SLN; eight of those with negative SLNs were found to have false-negative SLNs. Of the 259 patients in the SLN group, 92 (36%) had a positive SLN, and 167 (65%) had a negative SLN. One case of overt clinical axillary metastasis was seen in the follow-up of the 167 women in the SLN group who did not receive ALND (ie, one false-negative). After a median follow-up of 79 months (range 15-97), 34 events associated with breast cancer occurred: 18 in the ALND group, and 16 in the SLN group (log-rank p=0.6). The overall 5-year survival of all patients was 96.4% (95% CI 94.1-98.7) in the ALND group and 98.4% (96.9-100) in the SLN group (log-rank p=0.1). SLNB can allow total ALND to be avoided in patients with negative SLNs, while reducing postoperative morbidity and the costs of hospital stay. The finding that only one overt axillary metastasis occurred during follow-up of patients who did not receive ALND (whereas eight cases were expected) could be explained by various hypotheses, including those from cancer-stem-cell research.

Comparison of recurrence after vulvectomy and lymphadenectomy with and without sentinel node biopsy in early stage vulvar cancer

Objectives. To determine the usefulness of sentinel lymph node biopsy in early stage vulvar cancer and to assess recurrences after surgical treatment with sentinel node identification or surgical treatment without sentinel node identification. Methods. We reviewed the records of 55 patients with early stage vulvar cancer operated on between 1995 and 2005. A prospective series of 28 patients who underwent vulvectomy and lymphadenectomy with intraoperative sentinel lymph node identification between 2000 and 2005 (SLN group) was compared with a retrospective series of 27 patients who underwent vulvectomy and lymphadenectomy without sentinel node procedure between 1995 and 2000 (non-SLN group). Patients in the sentinel node identification group underwent preoperative lymphoscintigraphy (technetium-99 colloid albumin injection around the tumor) and intraoperative mapping with isosulfan blue dye. Results. In the SLN group, 9 tumors were T 1 and 19 were T 2, with a total of 40 groins dissected and 9 positive nodes in 7 patients. Sixty-two sentinel lymph nodes were detected with a mean of 2.2 sentinel nodes per patient (range 0–4). A false negative case was found. In the non-SLN group, 7 tumors were T 1 and 20 were T 2, with a total of 49 groins dissected and 9 positive nodes in 6 patients. Recurrence occurred in 8 patients (28.6%) in the SLN group and in 6 (26.9%) in the non-SLN group ( P = 0.8). Conclusions. Sentinel lymph node identification in early stage vulvar cancer is a feasible. Analysis of recurrence may allow considering this procedure as a possible alternative to inguino-femoral lymphadenectomy.

Hormonal changes in normal and polycythemic high-altitude natives

Acute and chronic exposure to high-altitude (HA) hypoxia inhibits the renin-angiotensin-aldosterone system and may modify the release of atrial natriuretic peptide (ANP) in sea-level (SL) natives. In HA natives, the release of these hormones could be influenced by changes in blood volume or pulmonary arterial pressure. Twenty-four men residing in La Paz, Bolivia, at 3,600 m were separated into two groups: one normocythemic (HAN; with hematocrit < 57%; n = 13) and the other polycythemic (HAP; with hematocrit > 57%; n = 11). A control group of 9 SL residents was studied in normoxia (SLN) as well as after 4 days spent at 4,350 m (SLH). The groups were tested for plasma active renin (PAR), plasma aldosterone concentration, ANP, and potassium and norepineprine concentrations at rest and after a maximal exercise. Pulmonary arterial systolic pressure was assessed by a Doppler technique. It was observed that PAR and plasma aldosterone concentration at rest and after exercise were lower in the SLH than in the SLN group. PAR and norepineprine concentration were higher among highlanders than in the SLN group. Renin response to exercise was normal among the HAN group and slightly decreased among the HAP group, and an exercise-induced increase in aldosterone was attenuated in both HA groups. Aldosterone response to renin was maintained among the SLH group but was attenuated in the HA groups, possibly owing to a protective mechanism against salt and water retention. Resting and exercise ANP was lower in the HA groups than in the SLN group.(ABSTRACT TRUNCATED AT 250 WORDS)