A Prospective Single-Center Study of Sentinel Lymph Node Detection in Cervical Carcinoma: Is There a Place in Clinical Practice?

2012 ◽  
Vol 22 (6) ◽  
pp. 1044-1049 ◽  
Author(s):  
Omer Devaja ◽  
Gautam Mehra ◽  
Michael Coutts ◽  
Stephen Attard Montalto ◽  
John Donaldson ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Cervical Carcinoma ◽  
Pelvic Lymph Node Dissection ◽  
Blue Dye ◽  
Node Dissection ◽  
Combined Method ◽  
Sentinel Lymph Node Detection

ObjectiveTo establish the accuracy of sentinel lymph node (SLN) detection in early cervical cancer.Materials and MethodsSentinel lymph node detection was performed prospectively over a 6-year period in 86 women undergoing surgery for cervical carcinoma by the combined method (Tc-99m and methylene blue dye). Further ultrastaging was performed on a subgroup of 26 patients who had benign SLNs on initial routine histological examination.ResultsThe SLN was detected in 84 (97.7%) of 86 women by the combined method. Blue dye uptake was not seen in 8 women (90.7%). Sentinel lymph nodes were detected bilaterally in 63 women (73.3%), and the external iliac region was the most common anatomic location (48.8%). The median SLN count was 3 nodes (range, 1–7). Of the 84 women with sentinel node detection, 65 also underwent bilateral pelvic lymph node dissection, and in none of these cases was a benign SLN associated with a malignant non-SLN (100% negative predictive value). The median non-SLN count for all patients was 19 nodes (range, 8–35). Eighteen patients underwent removal of the SLN without bilateral pelvic lymph node dissection. Nine women (10.5%) had positive lymph nodes on final histology. One patient had bulky pelvic nodes on preoperative imaging and underwent removal of the negative bulky malignant lymph nodes and a benign SLN on the contralateral side. This latter case confirms the unreliability of the SLN method with bulky nodes. The remaining 8 patients had positive SLNs with negative nonsentinel lymph nodes. Fifty-nine SLNs from 26 patients, which were benign on initial routine histology, underwent ultrastaging, but no further disease was identified. Four patients (5%) relapsed after a median follow-up of 28 months (range, 8–80 months).ConclusionSentinel lymph node detection is an accurate and safe method in the assessment of nodal status in early cervical carcinoma.

Morbidity and Outcome after Sentinel Lymph Node Dissection in Patients with Early-Stage Malignant Cutaneous Melanoma

Swiss Surgery ◽  
2002 ◽  
Vol 8 (5) ◽  
pp. 209-214 ◽  
Author(s):  
Blumenthal ◽  
Banic ◽  
Brand ◽  
Ris ◽  
Lardinois
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Early Stage ◽  
Blue Dye ◽  
Consecutive Series ◽  
Node Dissection ◽  
Immunohistochemical Examination

Objective: Prospective analysis of the morbidity and outcome of the sentinel lymph node (SLN) technique in a consecutive series of patients with early-stage melanoma. Methods: Between 1997 and 1998, 60 patients with stage IB-II malignant melanoma underwent SLN dissection. Preoperative dynamic lymphoscintigraphy with mapping of the lymph vessels and lymph nodes and location of the sentinel node was performed the day before SLN dissection. SLN was identified by use of the blue dye technique. SLN was assessed for histopathological and immunohistochemical examination. Postoperative morbidity and mortality were recorded. Follow-up consisted of repetitive clinical examination with lymph nodes status, laboratory and radiologic findings. Results: Tumor-positive SLN was observed in 18% of the patients and stage II disease was found in 91% of the patients with positive SLN. Breslow thickness was the only significant factor predicting involvement of a SLN (p = 0.02). In 36% of the positive SLN, metastases could be assessed only by immunohistochemical examination. Postoperative complications after SLN dissection were observed in 5% in comparison with 36% after elective lymph node dissection. After a mean follow-up of 32 months, recurrence was observed in 3% with a mean disease-free survival of 8 months. Overall survival was 82% and 90% in patients with positive and negative SLN, respectively. Overall mortality was 15%, due to distant metastases in 78% of the cases. Conclusions: Staging of early-stage melanoma with the SLN dissection by use of the blue dye technique combined to lymphoscintigraphy and immunohistochemistry is reliable and safe, with less morbidity than elective lymphadenectomy. Long-term follow-up is mandatory to establish the exact reliability of SLN dissection.

scholarly journals ROBOT-ASSISTED PELVIC LYMPH NODE DISSECTION USING ICG TESTING IN PATIENTS WITH PROSTATE CANCER

2018 ◽  
Vol 14 (3) ◽  
pp. 51-57
Author(s):  
I. A. Aboyan ◽  
D. I. Pakus ◽  
S. M. Pakus ◽  
S. V. Grachev ◽  
K. V. Berezin
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
Indocyanine Green ◽  
Lymph Node Dissection ◽  
Sentinel Lymph Nodes ◽  
Pelvic Lymph Node Dissection ◽  
Node Dissection ◽  
Robot Assisted

The objective is to investigate the possibility of using fluorescent testing in robot-assisted radical prostatectomy using indocyanine green (ICG testing) during pelvic lymph node dissection (PLND) in patients with localized prostate cancer.Materials and methods. Fifteen minutes prior to robot-assisted PLND, intraprostatic transperineal administration of 0.4 ml of indocyanine green (ICG) per lobe under transrectal ultrasound control was performed. Fluorescence map was used. After activation of the FireFly mode, fluorescence of the lymph nodes was evaluated. If a sentinel lymph node was present, lymph node dissection was performed using the FireFly mode. If fluorescence was diffuse, PLND using this option wasn’t performed.Results. In total, 35 patients with localized prostate cancer underwent surgery. Mean age was 62.0 ± 6.5 years (41–68 years), mean prostatespecific antigen level prior to surgery was 15.6 ± 11.3 ng/ml (1.5–27.0 ng/ml).  Postoperative examination revealed micrometastases in the lymph nodes in 7 (20 %) cases. Sentinel lymph nodes were detected in 29 patients. Intraoperative examination revealed sentinel lymph nodes metastases in 6 (17 %) cases, in other cases (83 %) metastases were absent. Morphological examination showed that in 5 (83 %) of 6 patients with lesions in the sentinel lymph node, micrometastases in other lymph nodes were present. In patients without lesions in the sentinel lymph node, no micrometastases in other lymph nodes were observed. PLND complications included lymphocele in 3 (8 %) patients, prolonged drain indwelling time in 5 (14 %) patients.Conclusion. Initial experience of our clinic shows reproducibility and low complications profile of fluorescence monitoring in the near-infrared region using ICG testing during robot-assisted PNLD. In conditions of continuous increase in the number of performed robot-assisted radical prostatectomies, ICG testing is a promising minimally invasive method for evaluation of regional metastases allowing to detect the sentinel lymph node. This approach allows to decrease the number of complications associated with PLND.

scholarly journals Microinvasive carcinoma of the cervix

2004 ◽  
Vol 12 (3) ◽  
pp. 142-144 ◽  
Author(s):  
Milica Zivaljevic ◽  
Tamara Vujkov ◽  
Dejan Nincic ◽  
Aljosa Mandic ◽  
Dragan Zikic ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Lymph Node Dissection ◽  
Cervical Carcinoma ◽  
Radical Hysterectomy ◽  
Pelvic Lymph Node Dissection ◽  
Pelvic Lymph Node ◽  
Class Iii ◽  
Node Dissection

BACKGROUND: Superficially invasive neoplasias of the uterine cervix are a matter of controversy in terms of their definition, prognostic factors and selection of treatment to minimize the risk of recurrences. METHODS: Forty-three women with invasive cervical carcinoma, operated from 1993 to 2003, were postoperatively staged as IA cervical carcinoma. There were 28 patients who were submitted to class III radical hysterectomy, 9 patients to class II hysterectomy, 2 patients to class I hysterectomy, and 2 patients to abdominal trachelectomy and pelvic lymph node dissection. Mean age of patients was 44 years (range, 27-64 years). RESULTS: Twenty-three patients (56.1%) were stage with IA1 and 18 (43.9%) with stage IA2 disease according to the 1995 FIGO classification. Tumor histology revealed squamous cell carcinoma in 38 (92.6%) cases, adenocarcinoma in 2 (4.8%) cases and glassy cell carcinoma in 1 (2.4%). The average number of examined lymph nodes was 17.4 (2-53). Lymphovascular space invasion was identified in 3 patients. None of the 41 patients had metastasis to the pelvic lymph nodes or developed recurrence of disease. CONCLUSION: The results suggest that patients with cervical cancer stage IA1 have an extremely low risk of pelvic lymph node metastasis and an excellent prognosis, so nonradical management that excludes pelvic lymph node dissection could be as effective as radical surgery in these patients. Stage IA2 invasive squamous carcinoma of the cervix should be treated with radical hysterectomy with lymph node dissection considering the presence of risk factors. The treatment should be individualized and based on an exhaustive pathological evaluation of an adequate cone biopsy specimen.

DISTRIBUTION OF PELVIC LYMPH NODES IS NOT SYMMETRIC. RESULTS FROM AN EXTENDED PELVIC LYMPH NODE DISSECTION SERIES

2009 ◽  
Vol 181 (4S) ◽  
pp. 100-101 ◽  
Author(s):  
Firas Abdollah ◽  
Alberto Briganti ◽  
Andrea Gallina ◽  
Nazareno Suardi ◽  
Umberto Capitanio ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Pelvic Lymph Node Dissection ◽  
Pelvic Lymph Node ◽  
Node Dissection ◽  
Pelvic Lymph Nodes

Selective Sentinel Lymph Node Dissection for Melanoma: Importance of Harvesting Nodes with Lower Radioactive Counts without the Need for Blue Dye

2011 ◽  
Vol 18 (10) ◽  
pp. 2919-2924 ◽  
Author(s):  
Liang-Chih Liu ◽  
Brian M. Parrett ◽  
Tyler Jenkins ◽  
Wayne Lee ◽  
Eugene Morita ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Node Dissection ◽  
Sentinel Lymph Node Dissection ◽  
Blue Dye ◽  
Node Dissection

Outcome analysis for melanoma patients undergoing deep pelvic lymph node dissection

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 8514-8514
Author(s):  
B. Badgwell ◽  
Y. Xing ◽  
J. Gershenwald ◽  
J. Lee ◽  
P. Mansfield ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Metastatic Disease ◽  
Pelvic Lymph Node Dissection ◽  
Pelvic Lymph Node ◽  
Survival Outcomes ◽  
Node Dissection ◽  
Factors Associated ◽  
Melanoma Patients

8514 Background: The benefits of deep pelvic lymph node dissection (DLND) for node-positive melanoma patients continue to be debated. The objective of our analysis was to assess factors associated with metastatic disease to deep pelvic nodes and examine survival outcomes following DLND. Methods: We retrospectively reviewed the records of 804 patients undergoing lymph node dissection (1990-2001). 97 patients underwent a superficial inguinofemoral lymph node dissection along with a DLND for indications which included: suspicious radiologic imaging (n= 31), documented superficial disease and concern for deep involvement (n = 57), and in-transit disease undergoing limb perfusion (n=9). Logistic regression was performed to identify factors associated with the metastatic tumor spread to deep nodes. Associations between clinicopathologic factors and disease-specific survival (DSS) were estimated using the Cox proportional hazards model. Results: Fifty-four patients (56%) had metastatic disease (median 2 positive lymph nodes, range 1–12) within their deep pelvis. With a median follow-up of 7.5 years, the 5-year DSS was 42% for patients with positive deep pelvic nodes and 52% for those with negative deep pelvic nodes (p = 0.07). When the number of metastatic deep nodes was stratified, the 5-year DSS for patients with 1 positive node, 2–3 positive nodes, and >3 positive nodes was 49%, 48%, and 27%, respectively (p = 0.04). Age ≥ 50 years (odds ratio [OR] = 3.5, p = 0.03), increasing number of positive superficial nodes (OR = 2.1, p < 0.001), and suspicious findings on pelvic CT images (OR = 11.9, p < 0.001) were associated with metastatic deep nodes. In the multivariate analysis, the number of positive deep nodes (hazard ratio [HR] = 1.1, p = 0.03), male gender (HR = 1.9, p = 0.03), and extra-capsular nodal extension of tumor (HR = 2.7, p < 0.001) were identified as adverse prognostic factors for DSS. Conclusions: Survival outcomes in patients with melanoma metastatic to ≤ 3 deep pelvic lymph nodes are comparable to those in patients without deep nodal involvement. These favorable outcomes support an aggressive surgical approach (i.e., DLND) in patients ≥ 50 years, with multiple positive superficial nodes, and suspicious CT findings. No significant financial relationships to disclose.

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