Effects of Previous Surgery on the Detection of Sentinel Nodes in Women With Vulvar Cancer

2011 ◽  
Vol 21 (9) ◽  
pp. 1679-1683 ◽  
Author(s):  
Tessa A. Ennik ◽  
David G. Allen ◽  
Ruud L.M. Bekkers ◽  
Simon E. Hyde ◽  
Peter T. Grant
Keyword(s):  
Vulvar Cancer ◽  
False Negative ◽  
False Negative Rate ◽  
Blue Dye ◽  
Previous Surgery ◽  
Detection Rates ◽  
Reliable Technique ◽  
Appearance Time ◽  
Negative Rate ◽  
Significant Difference

BackgroundThere is a growing interest to apply the sentinel node (SN) procedure in the treatment of vulvar cancer. Previous vulvar surgery might disrupt lymphatic patterns and thereby decrease SN detection rates, lengthen scintigraphic appearance time (SAT), and increase SN false-negative rate. The aims of this study were to evaluate the SN detection rates at the Mercy Hospital for Women in Melbourne and to investigate whether previous vulvar surgery affects SN detection rates, SAT, and SN false-negative rate.MethodsData on all patients with vulvar cancer who underwent an SN procedure (blue dye, technetium, or combined technique) from November 2000 to July 2010 were retrospectively collected.ResultsSixty-five SN procedures were performed. Overall detection rate was 94% per person and 80% per groin. Detection rates in the group of patients who underwent previous excision of the primary tumor were not lower compared with the group without previous surgery or with just an incisional biopsy. There was no statistical significant difference in SAT between the previous excision group and the other patients. None of the patients with a false-negative SN had undergone previous excision.ConclusionsResults indicate that previous excision of a primary vulvar malignancy does not decrease SN detection rates or increase SN false-negative rate. Therefore, the SN procedure appears to be a reliable technique in patients who have previously undergone vulvar surgery. Previous excision did not significantly lengthen SAT, but the sample size in this subgroup analysis was small.

scholarly journals Three-dimensional camera anthropometry to assess risk of cephalopelvic disproportion-related obstructed labour in Ethiopia

2019 ◽  
Vol 9 (5) ◽  
pp. 20190036 ◽  
Author(s):  
Lorenzo Tolentino ◽  
Mahlet Yigeremu ◽  
Sisay Teklu ◽  
Shehab Attia ◽  
Michael Weiler ◽  
...  
Keyword(s):  
False Negative ◽  
Three Dimensional ◽  
False Negative Rate ◽  
Detection Rates ◽  
Cephalopelvic Disproportion ◽  
Obstructed Labour ◽  
Tape Measure ◽  
Negative Rate ◽  
Positive Rate ◽  
Tape Measurement

Cephalopelvic disproportion (CPD)-related obstructed labour requires delivery via Caesarean section (C/S); however, in low-resource settings around the world, facilities with C/S capabilities are often far away. This paper reports three low-cost tools to assess the risk of CPD, well before labour, to provide adequate time for referral and planning for delivery. We performed tape measurement- and three-dimensional (3D) camera-based anthropometry, using two 3D cameras (Kinect and Structure) on primigravida, gestational age ≥ 36 weeks, from Addis Ababa, Ethiopia. Novel risk scores were developed and tested to identify models with the highest predicted area under the receiver-operator characteristic curve (AUC), detection rate (true positive rate at a 5% false-positive rate, FPR) and triage rate (true negative rate at a 0% false-negative rate). For tape measure, Kinect and Structure, the detection rates were 53%, 61% and 64% (at 5% FPR), the triage rates were 30%, 56% and 63%, and the AUCs were 0.871, 0.908 and 0.918, respectively. Detection rates were 77%, 80% and 84% at the maximum J -statistic, which corresponded to FPRs of 10%, 15% and 11%, respectively, for tape measure, Kinect and Structure. Thus, tape measurement anthropometry was a very good predictor and Kinect and Structure anthropometry were excellent predictors of CPD risk.

scholarly journals Sentinel node biopsy in vulvar cancer: A critical appraisal

2017 ◽  
Vol 03 (01) ◽  
pp. 005-011
Author(s):  
Neville Hacker ◽  
Ellen Barlow
Keyword(s):  
Sentinel Node ◽  
Sentinel Node Biopsy ◽  
Vulvar Cancer ◽  
False Negative ◽  
False Negative Rate ◽  
Groin Dissection ◽  
Loss Of Life ◽  
Risks And Benefits ◽  
Node Biopsy ◽  
Negative Rate

AbstractSince the incorporation of inguinal-femoral lymphadenectomy into the management of patients with vulvar cancer in the mid-20th century, there have been attempts to modify or eliminate the groin dissection to decrease the risk of lower limb lymphedema. Early attempts were significantly flawed and resulted in much unnecessary loss of life because recurrence in an undissected groin is usually fatal. The best compromise yet to decrease the risk of lymphedema is sentinel node biopsy, but accumulated evidence now suggests that the false-negative rate for this procedure, if used for lesions up to 4 cm in diameter, is between 5% and 10%. Most women, properly informed of risks and benefits, are not prepared to take a 1% risk of dying from recurrent vulvar cancer to avoid lymphedema. This is the risk involved, assuming a false-negative rate of 5% and an incidence of positive nodes of 20%. For this reason, sentinel node biopsy should not be considered to be standard practice for patients with early vulvar cancer.

Further data on sentinel lymph node mapping in vulvar cancer by blue dye and radiocolloid Tc99

2007 ◽  
Vol 17 (1) ◽  
pp. 147-153 ◽  
Author(s):  
Lukas Rob ◽  
Helena Robova ◽  
Marek Pluta ◽  
Pavel Strnad ◽  
Josef Kacirek ◽  
...  
Keyword(s):  
Vulvar Cancer ◽  
Gamma Probe ◽  
False Negative ◽  
False Negative Rate ◽  
Sentinel Lymph Node Mapping ◽  
Patient Specific ◽  
Blue Dye ◽  
Lymph Node Mapping ◽  
Group A ◽  
Group B

We studied the distribution of sentinel lymph nodes (SLNs) in vulvar cancer using blue dye and 99mTc radiocolloid and evaluated the techniques used, including the optimum timing of preoperative scintigraphy scans and its contribution to 99mTc SLN detection over that of the intraoperative handheld gamma probe. Fifty-nine women with squamous cell cancers <4 cm treated at our institution between December 2001 and December 2005 were included in this study. Blue dye alone was used in the first 16 women (group A) and the combination of 99mTc and blue dye was used on 43 women (group B). Of the 118 SLN detected in 82 groins, 83.9% (99) were sited in the superficial medial and intermediate inguinal chain, none were in superficial lateral groin, 16.1% (19) were deep femoral. The patient-specific SLN detection and false-negative rate in group B was 100% and 0%, compared to 68.8% (11/16 cases) and 6.3% (1/16) in group A. The optimum timing for preoperative lymphoscintigraphy scans was 45 min postinjection, but intraoperative use of the handheld gamma probe yielded 15% more “hot” nodes and allowed tailored placement of the lymphadenectomy incision. Eighty-four percent of SLNs were in the medial and intermediate region of the superficial inguinal chain, 16.1% were deep femoral. The combined use of 99mTc radiocolloid and blue dye was significantly superior at SLN detection than blue dye alone. 99mTc SLN detection using the intraoperative handheld probes was not enhanced by preoperative scintigraphy scans.

Sentinel Lymph Node Biopsy in Endometrial Cancer—Comparison of 2 Detection Methods

2015 ◽  
Vol 25 (6) ◽  
pp. 1044-1050 ◽  
Author(s):  
Sambor Sawicki ◽  
Piotr Lass ◽  
Dariusz Wydra
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
False Negative ◽  
Lymph Node Biopsy ◽  
Blue Dye ◽  
Detection Rates ◽  
Node Biopsy ◽  
Significant Difference ◽  
Group 1

ObjectivesSentinel lymph node biopsy (SLNB) can identify patients with nodal metastases who are eligible for tailored treatment. The aim of study was to compare the SLN detection rates using cervical and subserosal administration of 2 tracers.ResultsIn group 1 (82 patients), SLNB was performed using radiocolloid injected to the cervix and blue dye administered to the fundus. In group 2, blue dye was injected to cervix and fundus (106 patients). Only SLNB was performed in 128 (68.1%) women. In the remaining 60 (31.9%) patients, pelvic/para-aortic lymphadenectomy together with SLNB was performed. Groups 1 and 2 did not differ with regard to the frequencies of SLNB and lymphadenectomy. The detection rate for both groups was 90.9%. Bilateral detection was achieved in 72.5%. Para-aortic SLNs were found in 9.6%. Detection rates in groups 1 and 2 were 95.1% and 87.7% (P= 0.065). In comparison of cervical administration of radioisotope and subserosal injection of blue dye in group 1, we found a significant difference for total SLN detection (91.5% vs 74.4%,P< 0.05) and no significant difference for bilateral detection (73.3% vs 59.1%,P= 0.776). We did not find differences in the para-aortic SLN detection rates achieved after administration of a radiotracer and injection of a blue dye (4.9% vs 9.8%,P= 0.184). Eighteen patients (9.6%) presented with nodal disease, including 15 women with SLN involvement. The false-negative rate, calculated for patients subjected to lymphadenectomy, was 12.5% (1/8); using the SLNB surgical algorithm, it was 10% (1/10).ConclusionsCervical administration of a tracer, especially radioisotope, results in high SLN detection rates. In turn, the subserosal injection can be used only as an adjuvant method for SLNB. Low para-aortic SLN detection rates observed after cervical administration of a tracer do not seem to be a serious limitation of this technique.

The final results of the United Kingdom sentinel node training program: New Start

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 629-629
Author(s):  
R. E. Mansel ◽  
F. McNeill
Keyword(s):  
Quality Assurance ◽  
Learning Curve ◽  
Sentinel Node ◽  
Training Program ◽  
False Negative ◽  
False Negative Rate ◽  
Blue Dye ◽  
Practical Training ◽  
Negative Rate ◽  
Formal Program

629 Background: Formal introduction of new surgicaltechniques is rare, but the rate of technological advances in cancer surgery mandates that surgeons in current practice will need to learn new techniques in an enviroment less rigorous than residency programs. The rapid introduction of sentinel node biopsy in breast cancer is a classic exemplar of the problematic issues around quality assurance and patient safety in new technology. In the UK this technique was introduced in a unique formal program –The New Start training program –which utilised educational methods with a mandatory quality assurance system for each individual surgical team prior to routine introduction of the technique in practice. Methods: Every hospital had to submit the breast team to a formal program consisting of a theory training day followed by in house supervised training for the first 5 cases in the operating room in their instituition.Surgical teams performed 5 directly supervised procedures followed by 25 further audited cases with data being submitted centrally. All sentinel procedures were combination isotope/blue dye, (Nanocoll 99 Tm and a blue dye (Patent Blue V- laboratoires Guerbert Paris, France). In order to be approved each team had to achieve a localisation rate of at least 90% and a false negative rate of less than 10%. Results: The program has now trained 242 surgeons performing a total of 6341 audited sentinel node validation procedures. The localisation rate was 99% and the false negative rate was <8%. The median number of sentinel nodes was 2 and in 54% of the node positive patients, the sentinel node was the only positive node. Preoperative scintigraphy showed hotspots in 83% of patients. Blue dye reactions in this large dataset were lower than quoted in the literature, (<1% of patients), suggesting over-reporting in smaller trials. There was short learning curve for false negativity falling to <4% after 40 audited cases. Failure to find a sentinel node correlated strongly with a higher rate of histological node positivity. Conclusions: This major national training program with in house practical training has shown a high localisation rate and a shortened learning curve for false negative cases, and has demonstrated the value of a formal training program, which can form the template for the introduction of new surgical techniques. No significant financial relationships to disclose.

scholarly journals Indications for Repeat Diagnostic Medial Branch Nerve Blocks Following a Failed First Medial Branch Nerve Block

2013 ◽  
Vol 5;16 (5;9) ◽  
pp. 479-488
Author(s):  
Richard Derby
Keyword(s):  
Pain Relief ◽  
False Negative ◽  
False Negative Rate ◽  
Medial Branch ◽  
Negative Rate ◽  
Significant Difference ◽  
Medial Branch Block ◽  
Group 2 ◽  
Delayed Relief ◽  
Group 1

No studies have directly measured the false negative rate of medial branch block (MBB) with correlation to medial branch neurotomy (MBN) outcome. We investigated the potential false negative MBB rate and the subsequent MBN outcome on a consecutive audit of all patients undergoing a double MBB protocol. We prospectively collected audit data and retrospectively collected data by phone on 229 consecutive patients undergoing diagnostic MBB. One-hundred-twenty-two patients reporting greater than 50% of subjective pain relief subsequently underwent either MBN or a confirmatory block followed by MBN. A total of 55 patients underwent a second confirmatory MBB and within that group 27.3% (15/55) reported less than 50% relief post initial MBB and 30.9% (17/55) between 50% and 69% relief. We performed an in-depth analysis of these 2 subgroups focusing on the reason a second MBB was performed despite a “negative” or “indeterminant” first MBB. We divided the “negative” responders to the first MBB into those reporting < 50% relief (Group 1) and those reporting between 50% and 69% relief (Group 2). We calculated a potential 46.7% false negative rate in Group 1 and 47.1% false negative in Group 2; however, the false negative results in Group 1 were predominately in those patients reporting delayed relief of pain and those re-blocked greater than 2 years after the first MBB. The success rate in all patients undergoing MBN was 87% compared to the 75% relief in the false negative groups with no statistically significant difference. In summary, the false negative rate for patients reporting less than 50% relief post MBB is probably less than 20% although there is a high “apparent negative” responds in patients reporting delayed relief or in those who had a second block 2 or more years post initial MBB. Patients reporting between 50 and 69% pain relief have a false negative response rate of 47.1% and should be considered for a confirmatory block. Key words: Facet rhizotomy, zygapophyseal joint, low back pain, chronic pain, facet joint, radiofrequency neurotomy, medial branch block, medial branch neurotomy

Combining Radioisotopic and Blue-Dye Technique Does Not Improve the False-Negative Rate in Sentinel Lymph Node Mapping for Colorectal Cancer

2007 ◽  
Vol 50 (7) ◽  
pp. 962-970 ◽  
Author(s):  
Olivier Tiffet ◽  
David Kaczmarek ◽  
Marie Laure Chambonnière ◽  
Thomas Guillan ◽  
Sylviane Baccot ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
False Negative ◽  
False Negative Rate ◽  
Sentinel Lymph Node Mapping ◽  
Blue Dye ◽  
Lymph Node Mapping ◽  
Negative Rate

Evaluation of the Sentinel Lymph Node Algorithm With Blue Dye Labeling for Early-Stage Endometrial Cancer in a Multicentric Setting

2013 ◽  
Vol 23 (7) ◽  
pp. 1237-1243 ◽  
Author(s):  
Fabien Vidal ◽  
Pierre Leguevaque ◽  
Stephanie Motton ◽  
Jerome Delotte ◽  
Gwenael Ferron ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Early Stage ◽  
Clinical Stage ◽  
False Negative ◽  
False Negative Rate ◽  
Blue Dye ◽  
Negative Rate ◽  
Early Stage Endometrial Cancer

ObjectivesSentinel lymph node (SLN) removal may be a midterm between no and full pelvic dissection in early endometrial cancer. Whereas the use of blue dye alone in SLN detection has a poor accuracy, its integration in an SLN algorithm may yield better results and overcome hurdles such as the requirement of nuclear medicine facility.MethodsSixty-six patients with clinical stage I endometrial cancer were prospectively enrolled in a multicentre study between May 2003 and June 2009. Patent blue was injected intraoperatively into the cervix. We retrospectively assessed the accuracy of a previously described SLN algorithm consisting of the following sequence: (1) pelvic node area is inspected for removal of all mapped SLN and (2) excision of every suspicious non-SLN, (3) in the absence of mapping in a hemipelvis, a standard ipsilateral lymphadenectomy is then performed.ResultsSentinel nodes were identified in 41 patients (62.1%), mostly in interiliac and obturator areas. None was detected in the para-aortic area. Detection was bilateral in 23 cases (56.1%). Seven patients (10.6%) had positive nodes. The false-negative rate was 40% using SLN detection alone. When the algorithm was applied, the false-negative rate was 14.3%. The use of a SLN algorithm would have avoided 53% of lymphadenectomiesConclusionOur multicentric evaluation validates the use of a SLN algorithm based on blue-only sentinel node mapping in early-stage endometrial cancer. The application of such SLN algorithm should be evaluated in a prospective context and might lead to decrease unnecessary lymphadenectomies.

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