Sentinel Lymph Node Biopsy Technique Research Articles

Breast cancer staging: Sentinel node biopsy using a fluorescence navigation versus standard technique.

e12018 Background: Sentinel lymph node (SLN) biopsy with radioisotope has been used successfully for axillary staging in breast cancer. This study evaluated the feasibility of fluorescence detection of SLNs with indocyanine green (ICG) for lymphatic mapping and SLN biopsy. Study evaluated a fluorescence-guided technique for sentinel node biopsy (SLNB) against the standard (radioisotope). This technique requires two devices: A fluorescence tracer – ICG and the hand held near infrared camera. The standard technique for SLNB has drawbacks, including exposure to radiation, legislation on use of radiation and poor preoperative imaging. Therefore fluorescence guided with its advantages may by an alternative method for SLN visualization. Methods: Patients with T1 and T2 primary breast cancer treated between Sept. 2012 - Jan. 2013 without clinical and radiological lymph node involvement were included into this study. Standard SLN technique using blue dye and radioisotope was used. Additionally ICG as a fluorescence-emitting source was injected into the tumor area prior to the surgery. Sentinel node biopsy was undertaken using NIR camera initially and than with gammaprobe. The proportion of sentinel nodes detected (sentinel node identification rate) with either the standard or the fluorescence techniques was calculated. Results: Twenty-one SLNB procedures were undertaken in 20 patients. The proportion of successful identification rate with the ICG was 69%, whereas with standard technique 73%. One procedure was unsuccessful with standard technique and patient was found to have no metastases to SLN. Three patients who were unsuccessful with ICG had lymph node involvement. Of 32 lymph nodes removed 29 were true sentinel nodes identified by the radioisotope. Lymph node retrieval rate was 1.38 nodes per patient overall, 1.4 nodes per patient with the standard technique and 1.3 nodes per patient with the fluorescence-guided technique Conclusions: Moderate rate of SLN detection was achieved using both the ICG and radioisotope. The first SLN identified by fluorescence imaging provided an exact indication of the axillary status. Therefore, the ICG method provided sufficient information required to avoid unnecessary ALND.

A systematic review of novel techniques for the performance of sentinel lymph node biopsy in breast cancer

Background: The current standard for axillary lymph node staging in breast cancer patients with a clinically and radiologically normal axilla, is sentinel lymph node biopsy (SLNB) using radioisotope and blue dye (dual technique). The dependence upon radioisotopes has resulted in SLNB uptake being limited to only about 60 per cent of eligible patients in the developed world and negligible elsewhere. We performed a systematic review to assess the alternative techniques for SLNB, which are not radioisotope dependent or which refine the current technique.

Shoulder and arm morbidity in sentinel node-negative breast cancer patients: a systematic review

The purpose of this study was to assess which shoulder and arm impairments are common in sentinel node-negative breast cancer patients and to describe the incidence and time course of these impairments. A systematic literature search was performed using different electronic databases until October 2013. Inclusion criteria were (1) research studies that included breast cancer patients surgically treated using the sentinel lymph node biopsy (SLNB) technique, (2) sentinel node-negative patients, and (3) studies that investigated morbidities of shoulder and/or arm. The exclusion criteria were (1) reviews or case studies, (2) patients who have had a SLNB followed by an axillary lymph node dissection (ALND), (3) results of ALND patients and SLNB patients were not described separately, and (4) no follow-up described. Thirty articles were included, representing 5,448 patients. Shoulder and arm impairments among sentinel node-negative patients are loss of mobility, loss of strength, pain, axillary web syndrome, and sensory disorders. Within the first month after SLNB, the morbidities with the highest incidence are decreased abduction (range 40.8-100 %), forward flexion of the shoulder (range 37-100 %), pain (range 3.4-56.6 %), and numbness (range 2-64 %). Morbidities with the highest incidence after 2 years are pain (range 5.6-51.1 %), numbness (range 5.1-51.1 %), loss of strength (range 0-57.7 %), decreased internal rotation (44.4 %), and decreased abduction (range 0-41.4 %). In conclusion, although the shoulder and arm impairments are less common after SLNB alone compared to ALND, they cannot be neglected. A considerable amount of patients still suffer from those impairments more than 2 years after surgery.

Sentinel node biopsy in papillary thyroid cancer—what is the potential?

Sentinel node biopsy (SNB) may identify lymph node metastases in patients with papillary thyroid cancer (PTC), enabling selective application of central node dissection (CND). The aim of this study was to assess the feasibility of implementing SNB in patients undergoing thyroidectomy for a cytologically indeterminate/suspicious/malignant thyroid nodule and to determine the potential improvement in clinical outcomes and the costs associated with the SNB technique. The treatment strategies and clinical and pathological outcomes of two retrospective cohorts of patients who underwent preoperative thyroid FNA over a 5-year period in two different centres were studied. The potential for implementing the SNB technique and the benefits and costs associated with implementation were estimated. In centre 1, in 819 adult patients who had thyroid fine-needle aspiration cytology, the final cytology was indeterminate, suspicious and diagnostic of malignancy in 113, 29 and 28 patients, respectively. One hundred eight patients were 'suitable' for SNB. Twenty-three of these patients had PTC, six of whom underwent CND. Of these six patients, node metastasis was absent in five--the cohort in whom prophylactic CND may have been avoided consequent to a negative 'sentinel node' biopsy. Morbidity attributable to CND may have been avoided in up to four patients over a 5-year period. Costs associated with implementation of SNB outweighed any potential savings. Analysis of 491 patients in centre 2 confirmed that the benefit of SNB in PTC was similarly limited; morbidity attributable to CND may have been avoided in up to seven patients over a 5-year period. Even under ideal conditions (assuming 100 % node identification rate and 0 % false negative rate), the potential short- to medium-term benefit of sentinel node biopsy in patients with thyroid cancer in centres implementing a policy of selective or routine prophylactic CND is low.

The Application and Indications for Sentinel Lymph Node Biopsy in Pediatric Solid Tumors: Current Status and Future Directions

Oncologic staging of many solid organ malignancies involves an understanding of how cancers spread via the lymphatic system, and ultimately may involve evaluation of the primary nodal drainage basin by performing a sentinel lymph node biopsy. In the adult population, there are well established indications for sentinel lymph node biopsy in diseases like melanoma and breast cancer. However, its use and relevance in the pediatric population is less defined. This review details the history and development of sentinel lymph node biopsy technique, advanced lymph node mapping techniques currently under investigation, and the applications of sentinel node biopsy towards childhood cancers.

Abstract P1-01-27: SentiMAG multicentre trial*: Comparison of sentinel node biopsy identification rates using a magnetic tracer vs. standard technique. * UKCRN ID 12178 (UK); NTR 3283 (Netherlands)

Abstract Background: The SentiMAG Multicentre Trial, an international phase II paired equivalence trial, evaluated a new magnetic technique for sentinel node biopsy (SLNB) against the standard (radioisotope and patent blue dye; or radioisotope alone). The magnetic technique does not utilize radiation and provides both a colour change (brown dye) and a hand-held probe for node localization. The primary end-point of this trial was defined as the proportion of sentinel nodes detected with each technique (identification rate) and was found to be non-inferior with the magnetic when compared to the standard technique, in the primary analysis on 160 patients (95% vs 94%, 0.62% difference; 95% upper confidence limit 4.4%). The trial was extended to 350 patients in order to evaluate identification rates further with each technique and at each trial site. Methods: Women with breast cancer scheduled for SLNB, who were clinically and radiologically node negative, were recruited from 7 centres in the UK and the Netherlands. Sentinel node biopsy was undertaken after administration of both the magnetic and standard tracers (radioisotope +/- blue dye). To determine local identification rate with both techniques, a minimum of 30 cases were recruited at each site. Results: A total of 364 patients were recruited and 17 were excluded due to a breech of protocol (e.g: no radioisotope or magnetic dye given). SLNB procedures were undertaken on 347 patients. The overall identification rate was 96.3% (334/347) with the standard technique and 91.9% (319/347) with the magnetic technique (4.3% difference; 95% upper confidence limit 7.2%; 9.5% discordance). The identification rate was 93.4% (324/347) with the radioisotope alone (compared with magnetic technique 1.4% difference; 95% upper confidence limit 4.5%; 11.2% discordance). Identification rates with the standard technique at each site, ranged between 87% - 100% and with the magnetic technique between 84% - 100%. Of the 21% (72/347) of patients with lymph node involvement, 15% (51/347) had at least 1 macrometastasis and 6% (21/347), a micrometastasis only. Another 2% (8/347) had isolated tumour cells. Of 825 lymph nodes removed, 625 (76%) were true sentinel nodes identified with the standard technique. The lymph node retrieval rate was 2.38 nodes per patient overall, 1.80 nodes per patient with the standard technique and 1.83 nodes per patient with the magnetic technique. Conclusion: The magnetic technique is a feasible technique for SLNB, with an identification rate non-inferior to the radioisotope technique but inferior to the standard technique, within the non-inferiority margins setout for this trial. Variation exists in sentinel node identification rates between sites with both techniques. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-01-27.

Abstract P1-01-25: Predictive factors of micrometastases in the sentinel node of patients affected by invasive early breast cancer

Abstract Aim: nodal metastatic involvement is the most important prognostic indicator in breast cancer. Sentinel node biopsy led to an increase in the detection of micrometastases. The aim of our analysis was to identify predictive factors of micrometastases and macrometastases of sentinel node. Materials and Methods: between January 2000 and December 2006, 675 patients were treated with breast surgery and sentinel node evaluation at University of Florence (Florence, Italy). Estrogen receptor status, progesterone receptor status, and Ki-67 labeling index determined with the MIB1 monoclonal antibody were assessed. HER2 immunohistochemistry (IHC) expression was scored as follows: 0, no staining or faint membrane staining; 1+, faint membrane staining in >10% of tumor cells, incomplete membrane staining; 2+, weak to moderate membrane staining in >10% of tumor cells; and 3+, intense circumferential membrane staining in >10% of tumor cells. HER2 scores of 0 and 1+ were considered negative. HER2 IHC 3+ and fluorescent in situ hybridization (FISH) – amplified tumors were considered positive. All IHC 2+ tumors and indeterminate tumors were tested for gene amplification by FISH. The sentinel node was examined by hematoxylin and eosin. The patients were divided into three groups based on AJCC TNM staging: sentinel node negative (n = 601); micrometastases if tumor deposit more than 0.2 mm but <2 mm (n = 20), and macrometastases if tumor deposit more than 2 mm (n = 53). Results: at the logistic regression with polytomous analyses (outcome micrometastases or macrometastases), age (p = 0.048), menopausal state (p = 0.013), breast quadrant (p = 0.005), lymph vascular invasion (p = 0.0001), post-surgical T stage (p = 0.0001), histotypes (p = 0.023), HER2 status (p = 0.02), Ki-67 proliferative index (p = 0.001) and nuclear grade (p = 0.024) were significantly correlated with sentinel node macrometastases. Sentinel node biopsy technique (cytological aspiration versus histological biopsy) was not associated with micrometastases (p = 0.89) or macrometastases (p = 0.48) occurrence. The only feature significantly associated with micrometastases in sentinel node was the lymph vascular invasion (p = 0.0001). Conclusion: the presence of micrometastases remained fairly constant over time if compared to macrometastases. In our experience the only feature significantly associated with micrometastases in sentinel node is the lymph vascular invasion. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-01-25.

Sentinel Node Biopsy Using a Magnetic Tracer Versus Standard Technique: The SentiMAG Multicentre Trial

The SentiMAG Multicentre Trial evaluated a new magnetic technique for sentinel lymph node biopsy (SLNB) against the standard (radioisotope and blue dye or radioisotope alone). The magnetic technique does not use radiation and provides both a color change (brown dye) and a handheld probe for node localization. The primary end point of this trial was defined as the proportion of sentinel nodes detected with each technique (identification rate). A total of 160 women with breast cancer scheduled for SLNB, who were clinically and radiologically node negative, were recruited from seven centers in the United Kingdom and The Netherlands. SLNB was undertaken after administration of both the magnetic and standard tracers (radioisotope with or without blue dye). A total of 170 SLNB procedures were undertaken on 161 patients, and 1 patient was excluded, leaving 160 patients for further analysis. The identification rate was 95.0 % (152 of 160) with the standard technique and 94.4 % (151 of 160) with the magnetic technique (0.6 % difference; 95 % upper confidence limit 4.4 %; 6.9 % discordance). Of the 22 % (35 of 160) of patients with lymph node involvement, 16 % (25 of 160) had at least 1 macrometastasis, and 6 % (10 of 160) had at least a micrometastasis. Another 2.5 % (4 of 160) had isolated tumor cells. Of 404 lymph nodes removed, 297 (74 %) were true sentinel nodes. The lymph node retrieval rate was 2.5 nodes per patient overall, 1.9 nodes per patient with the standard technique, and 2.0 nodes per patient with the magnetic technique. The magnetic technique is a feasible technique for SLNB, with an identification rate that is not inferior to the standard technique.

Validation of the Sentinel Lymph Node Biopsy Technique in Head and Neck Cancers of the Oral Cavity

The purpose of this study was to present our experience and validate the use of sentinel lymph node (SLN) mapping in patients with head and neck cancers. A retrospective review of a prospectively collected database of patients with a diagnosis of squamous cell carcinomas of the head and neck from 2008 to 2011 was done. The group consisted of a total of 20 patients. The first node(s) highlighted with blue, or identified as radioactive by Tc99-sulfur radioactive colloid, was (were) identified as the SLNs. In the first seven patients, formal modified neck dissection was performed. In the remaining 13 patients, only a SLN biopsy procedure was done. At least one SLN was identified in all 20 patients (100%). Only one patient (5%) had positive nodes. In this case, the SLN was also positive. In the remaining 19 cases, all lymph nodes were negative. After an average of 24 months of follow-up, there have been three local recurrences (15%) but no evidence of distant metastatic disease. SLN mapping in head and neck cancers is a feasible technique with a high identification rate and a low false-negative rate. Although the detection rate of regional metastatic disease compares favorably with published data as well as the disease-free and overall survival, further studies are warranted before considering this technique to be the "gold standard" in patients with oral squamous cell carcinoma and a negative neck by clinical examination and imaging studies.

Minimally invasive surgery for esophageal cancer: a review on sentinel node concept

Lymphoadenectomy is a cornerstone of esophageal cancer treatment, and sentinel node (SN) biopsy (SNB) might provide surgeons with an extra tool to limit unnecessarily extended lymphadenectomy and to implement a minimally invasive approach. The aim of our study was to review all the available literature on the use of SNB in esophageal surgery for malignancy. The review was conducted according to the PRISMA guidelines. A systematic search was performed in PubMed, EMBASE, and the Cochrane database to identify all original articles on the role of SNB in esophageal cancer. Data on methodologies, tumor stage and localization, and results were summarized and used to address relevant clinical questions related to the application of the SNB technique in esophageal cancer. Twelve studies were included, with a total of 492 patients. Different methods for SN identification were used (radionuclide, blue dye, computed tomography [CT] lymphography). The pooled values estimated using the random-effects model were, respectively: technetium-99 m overall detection rate (DR) 0.970 (95 % CI 0.814-0.996), accuracy (ACC) 0.902 (95 % CI 0.736-0.968); blue-dye DR 0.971 (95 % CI 0.890-0.993), ACC 0.790 (95 % CI 0.681-0.870); and CT lymphoscintigraphy DR 0.970 (95 % CI 0.814-0.996), ACC 0.902 (95 % CI 0.736-0.968). Based on these results, the concept of SN in esophageal cancer is technically feasible with an acceptable DR and ACC, and it might be applicable in the event of early-stage adenocarcinoma of the gastroesophageal junction in patients with a high surgical risk or in a patient where an endoscopic resection is taken into consideration. Further studies focused on a single tumor type and localizations are needed in order to predict the correct utilization of this concept in minimally invasive treatment of esophageal cancer.

Feasibility Animal Study of Novel ICG Sentinel Node Detection Technique in Head and Neck Region

Objectives: Sentinel node biopsy (SNB) allows head and neck surgeons to avoid unnecessary neck dissection. The popular SNB method using radioisotope (RI) has some drawbacks, such as the strict legal regulations for RI use in Japan. Recently, the SNB technique using real time indocyanine green (ICG) fluorescence image has become prevalent in breast cancer testing. Some reports demonstrated improved detection sensitivity with this method. However, the major problem of ICG method is its quick migration through the lymphatic system, which results in a limited diagnostic time window and detection of downstream subsequent nodes. To overcome this problem, we modified the ICG detection method by making ICG-colloid and demonstrated the feasibility of this technique in a mouse model. Methods: ICG-colloid was formed by mixing ICG and phytate colloids, which are commercially available as a kit for 99mTc-radiocolloid. Twenty microliters of ICG or ICG-colloid was injected into the tongue of a nude mouse, and the fluorescent images were observed with time until 48Hrs after injection. The fluorescence intensity in detected SN was analyzed. Results: In ICG injected animals, SNs were detected soon after injection, and second echelon lymph nodes were detected after 30-60min. In ICG-colloid injected animals, SNs were also detected after 30-60 min, and no second echelon lymph node was detected. Peak fluorescence intensity was 6-12Hr in both animal groups. No SN was detected after 24Hr in ICG animals, whereas SNs were still detectable in ICG-colloid animals. Conclusions: SNB using ICG-colloid technique may have advantages of prolonged diagnostic time window and prevention of downstream subsequent node detection.

Long term results of sentinel lymph node biopsy in early oral squamous cell carcinoma

The objective of the study was to evaluate the long term results of the sentinel node (SN) biopsy technique in the management of the clinically negative (N0) neck in patients with early oral squamous cell carcinoma (T1–T2). Patients with positive SN underwent neck dissection. A sentinel lymph node (SLN) biopsy was performed on 31 consecutive patients. Six of the 31 patients were upstaged by the results of the SLN biopsy. The SLN biopsy allowed the identification of node metastasis in 100% of the cases with a sensitivity of 100%, specificity of 100%, and negative predictive value of 100%. There was a mean follow-up of 59 months. The neck control rate was 100% in the SLN negative group and two SLN positive patients developed subsequent neck disease (neck control rate of 88%). One SLN patient presented at the follow-up with a second primary tumor, 18 months later treated successfully by chemoradiotherapy. The overall survival rate was 100% in both groups. The promising reported short-term results have been sustained by long term follow-up. Patients with negative SLN achieved an excellent neck control rate. The neck control rate in SN negative patients was superior to that in SLN positive patients, but not statistically different.

Sentinel lymph node biopsy for melanoma: A critical update for dermatologists after two decades of experience

The technique of lymphatic mapping and sentinel node biopsy represents a minimally invasive approach to accurately stage the regional lymph node basin as a component of the initial management of selected patients with stage I and II cutaneous melanomas. In addition to its significant role in accurate regional nodal staging and prognosis, important goals of this procedure include improved regional disease control and possible survival benefit. After 20 years of experience, questions and some controversy persist. This review provides the dermatology community with a critical analysis of major publications that have defined the role of sentinel node biopsy, addresses several contemporary issues, and provides recommendations for appropriate patient referral.

Axillary Sentinel Lymph Node Biopsy for Breast Cancer and Melanoma Patients after Previous Axillary Surgery: A Systematic Review

Objective: Sentinel lymph node biopsy (SLNB) is a validated staging technique for breast carcinoma. Some women are exposed to have a second SLNB due to breast cancer recurrence or a second neoplasia (breast or other). Due to modified anatomy, it has been claimed that previous axillary surgery represents a contra-indication to SLNB. Our objective was to analyse the literature to assess if a second SLNB is to be recommended or not. Methods: For the present study, we performed a review of all published data during the last 10 years on patients with previous axilla surgery and second SLNB. Results: Our analysis shows that second SLNB is feasible in 70%. Extra-axillary SNs rate (31%) was higher after radical lymph node dissection (ALND) (60% - 84%) than after SLNB alone (14% - 65%). Follow-up and complementary ALND following negative and positive second SLNB shows that it is a reliable procedure. Conclusion: The review of literature confirms that SLNB is feasible after previous axillary dissection. Triple technique for SN mapping is the best examination to highlight modified lymphatic anatomy and shows definitively where SLNB must be performed. Surgery may be more demanding as patients may have more frequently extra-axillary SN only, like internal mammary nodes. ALND can be avoided when second SLNB harvests negative SNs. These conclusions should however be taken with caution because of the heterogeneity of publications regarding SLNB and surgical technique.

Ensuring Radiation Safety to Staff in Lymphatic Tracing and Sentinel Lymph Node Biopsy Surgery – Some Recommendations

Introduction: Lymphatic mapping and sentinel node biopsy (LM/ SNB) techniques for melanoma and breast cancer management potentially expose staff, including operating theatre personnel, radiologists, pathologists and others, to ionising radiation. Aims: To ascertain exposure levels in a practical setting and to establish safe work practices for staff involved in the LM/ SNB procedure pathway. Methods: Cumulative intra-procedural extremity (hands) and whole body radiation doses were recorded separately for surgeons, pathologists and couriers during standard sentinel lymph node biopsy procedures from 13 melanoma and included also radiologists in 11 breast cancer cases. Results: The measured extremity dose for melanoma procedures was zero for surgeons and pathologists. The extremity dose for breast cancer procedures was approximately 250 μSv for surgeons, and about 10 μSv for pathologists per breast procedure if done on the day of surgery, but is otherwise negligible; zero for the radiologist; and zero for the courier. No whole body dose was detectable for any staff member. Conclusions: Using the international limit for skin dose some 200 breast cancer procedures could be performed per annum per surgeon (at the general public radiation limit) – and 2000 breast surgical procedures (at the radiation worker limit) based on extremity doses. Radiologists, pathologists and couriers received minimal or zero radiation doses from handling breast specimens. Melanoma procedures showed no measurable dose. Some recommendations for effective safe work practices are given.

Frozen section analysis and sentinel lymph node biopsy in well differentiated thyroid cancer

BackgroundThe aim of this study is to prospectively review the role of sentinel lymph node (SLN) biopsy in the management of well differentiated thyroid carcinoma (WDTC), and to determine the efficacy of intraoperative frozen section analysis at detecting SLN metastasis and central compartment involvement.MethodsThe SLN biopsy protocol using 1% methylene blue was performed in 300 patients undergoing thyroidectomy for WDTC. A limited pretracheal central compartment neck dissection (CCND) was performed on all patients. Lymph nodes staining blue were considered as SLN’s. Both frozen and permanent section analyses were performed.ResultsSLN’s with metastasis were found in 14.3% (43/300) of cases. Of this, 11% (33/300) were positive on intraoperative frozen section analysis. Frozen section results failed in predicting central compartment involvement in 15 cases (5%) whereas central neck compartment involvement was missed in 5 cases (1.7%) when based on permanent section results. On frozen section analysis, the sensitivity, specificity, positive predictive value and negative predictive value (95% CI) of our SLN biopsy technique aiming to remove all disease from the central compartment was 68.8% (53.6-80.9), 100% (98.1-100), 100% (87.0-100) and 94.4% (90.7-96.7) respectively with P < 0.0001. On permanent section analysis, the values were 89.6% (76.6-96.1), 100% (98.1-100), 100% (89.8-100), and 98.1% (95.3-99.3) with P < 0.0001.ConclusionThis data series demonstrates that patients with WDTC have positive SLN’s in 14.3% of cases. Moreover, when the SLN’s are negative for metastasis on frozen section, the central compartment was disease-free in 94.4% of cases. Finally, this study shows that 23.3% of positive SLN’s were false negatives on intraoperative frozen section. According to this data, SLN involvement is an accurate predictor of central compartment metastasis, however surgeons should use caution when relying on intraoperative frozen section to determine whether to perform a CCND.

Axillary Staging Prior to Neoadjuvant Chemotherapy: The Roles of Sentinel Lymph Node Biopsy and Axillary Ultrasonography

Clinical evaluation of the axilla is an area of controversy in current breast cancer research and management. Evidence of axillary metastasis on biopsy affects all modalities of cancer therapeutics and is central to breast cancer staging. Neoadjuvant chemotherapy is standard therapy for patients with locally advanced breast cancer and considered for patients with early-stage breast cancer. This article discusses axillary ultrasonography for axillary staging relative to neoadjuvant chemotherapy, reviews advances in sentinel lymph node (SLN) biopsy techniques, and explores an integrated approach to axillary staging. Techniques for staging the axilla after a breast cancer diagnosis relative to the use of neoadjuvant chemotherapy are also discussed. There is increasing support in the literature for routine axillary ultrasonography and percutaneous biopsy in the evaluation of regional nodal metastasis for breast cancer. SLN biopsy and axillary node dissection continue to be the standards for definitive staging. Axillary ultrasonography (with or without biopsy) and SLN biopsy are safe and feasible options for breast cancer staging and may facilitate treatment decisions for surgery, chemotherapy, and radiation therapy. Multidisciplinary review may also significantly influence treatment and timing of staging and therapy. An integrated approach to diagnosis and treatment is beneficial for both patients and providers.

Study of the sentinel node in endometrial cancer at early stages: Preliminary results

AimTo investigate the applicability of the sentinel lymph node biopsy technique in early stages of endometrial cancer. Material and methodsA prospective study that included consecutive patients with a histological diagnosis of clinical state I endometrial carcinoma was performed. Two doses of 2mCi (74MBq) of 99mTc-albumin nanocolloid were injected in the uterine cervix, and planar and SPECT-CT images were obtained at 1h, and at 24h if no migration of the tracer was observed.Methylene blue dye was also injected into the cervix immediately prior to the surgery.A gamma probe was used during the surgical procedure for sentinel lymph node identification.In all cases, a hysterectomy, double adnexectomy and pelvic lymphadenectomy were performed, carrying out a histological analysis (hematoxylin–eosin) of the sentinel lymph nodes and the lymphadenectomy specimen. ResultsWe included 19 patients, with a final diagnoses of endometrioid carcinoma (18 cases) and endometrial stromal sarcoma (1 case). At least one sentinel lymph node was identified in 17 of them (89.5% detection rate).Twenty-nine sentinel lymph nodes were identified during surgery, all of them negative for neoplastic infiltration. No metastatic invasion was found in the pelvic lymphadenectomy specimens as well. ConclusionsThe sentinel lymph node biopsy technique seems to be a reliable tool in nodal staging of endometrial cancer at early stages, with an acceptable detection rate and high histological correlation.The low prevalence of lymphatic spread in this group of patients and the encouraging results obtained could make the sentinel lymph node an alternative to routine complete lymphadenectomy.

Magnetic resonance lymphography of sentinel lymph nodes in patients with breast cancer using superparamagnetic iron oxide: a feasibility study

The sentinel lymph node (SLN) biopsy technique using superparamagnetic iron oxide (SPIO) as a tracer instead of radioisotopes has been described. To further advance this technique, we evaluated preoperative SPIO-MR sentinel lymphography to facilitate the accurate identification of the lymphatic pathways and primary SLN. A prospective study was performed in ten patients with breast cancer and clinically negative axillary lymph nodes. None of the patients received preoperative chemotherapy. After 1.6 ml of SPIO (ferucarbotran) was injected in the subareolar breast tissue, sentinel axillary lymph nodes were detected by MRI in T2*-weighted gradient echo images and resected using the serial SPIO-SLN biopsy procedure with a handheld magnetometer. In one patient, gadolinium-enhanced MR imaging was performed at the same time as SPIO-MR lymphography, and this patient was excluded from further analysis. In all patients (9/9) SLNs were detected by SPIO-MR sentinel lymphography and successfully identified at surgery. The number of SLNs detected by lymphography (mean 2.7) significantly correlated with SLNs identified at surgery (mean 2.2). One patient had nodal metastases. In one patient, skin color changed to brown at the injection site and resolved spontaneously. There were no severe reactions to the procedure or complications in any patient. This is the first study to evaluate SPIO both as a contrast material in MR sentinel lymphography and as a tracer in SLN biopsy using an integrated method. The acquired three-dimensional imaging demonstrated excellent image quality and usefulness to identify SLN in conjunction with SLN biopsy.

Estudio del ganglio centinela en el cáncer de endometrio en estadios iniciales: resultados preliminares

AimTo investigate the applicability of the sentinel lymph node biopsy technique in early stages of endometrial cancer. Material and methodsA prospective study that included consecutive patients with a histological diagnosis of clinical state I endometrial carcinoma was performed. Two doses of 2 mCi (74 MBq) of 99mTc-albumin nanocolloid were injected in the uterine cervix, and planar and SPECT-CT images were obtained at one hour, and at 24hours if no migration of the tracer was observed.Methylene blue dye was also injected into the cervix immediately prior to the surgery.A gamma probe was used during the surgical procedure for sentinel lymph node identification.In all cases, a hysterectomy, double adnexectomy and pelvic lymphadenectomy were performed, carrying out a histological analysis (hematoxylin-eosin) of the sentinel lymph nodes and the lymphadenectomy specimen. ResultsWe included 19 patients, with a final diagnoses of endometrioid carcinoma (18 cases) and endometrial stromal sarcoma (1 case). At least one sentinel lymph node was identified in 17 of them (89.5% detection rate).Twenty-nine sentinel lymph nodes were identified during surgery, all of them negative for neoplastic infiltration. No metastatic invasion was found in the pelvic lymphadenectomy specimens as well. ConclusionsThe sentinel lymph node biopsy technique seems to be a reliable tool in nodal staging of endometrial cancer at early stages, with an acceptable detection rate and high histological correlation.The low prevalence of lymphatic spread in this group of patients and the encouraging results obtained could make the sentinel lymph node an alternative to routine complete lymphadenectomy.