Pathologic Ultrastaging Improves Micrometastasis Detection in Sentinel Lymph Nodes During Endometrial Cancer Staging

ObjectiveTo describe the incidence of low-volume ultrastage-detected metastases in sentinel lymph nodes (SLNs) identified at surgical staging for endometrial carcinoma and to correlate it with depth of myoinvasion and tumor grade.MethodsWe reviewed all patients who underwent primary surgery for endometrial carcinoma with successful mapping of at least one SLN at our institution from September 2005 to December 2011. All patients underwent a cervical injection for mapping. The SLN ultrastaging protocol involved cutting an additional 2 adjacent 5-μm sections at each of 2 levels, 50-μm apart, from each paraffin block lacking metastatic carcinoma on routine hematoxylin and eosin (H&E) staining. At each level, one slide was stained with H&E and with immunohistochemistry (IHC) using anticytokeratin AE1:AE3.Micrometastases (tumor deposits >0.2 mm and ≤2 mm) and isolated tumor cells (≤0.2 mm) were classified as low-volume ultrastage-detected metastases if pathologic ultrastaging was the only method allowing detection of such nodal disease.ResultsOf 508 patients with successful mapping, 413 patients (81.3%) had endometrioid carcinoma. Sixty-four (12.6%) of the 508 patients had positive nodes: routine H&E detected 35 patients (6.9%), ultrastaging detected an additional 23 patients (4.5%) who would have otherwise been missed (4 micrometastases and 19 isolated tumor cells), and 6 patients (1.2%) had metastatic disease in their non-SLNs. The incidence rates of low-volume ultrastage-detected nodal metastases in patients with grades 1, 2, and 3 tumors were 3.8%, 3.4%, and 6.9%, respectively. The frequency rates of low-volume ultrastage-detected metastases in patients with a depth of myoinvasion of 0, less than 50%, and 50% or more were 0.8%, 8.0%, and 7.4%, respectively. Lymphovascular invasion was present in 20 (87%) of the cases containing low-volume ultrastage-detected metastases in the lymph nodes.ConclusionsSentinel lymph node mapping with pathologic ultrastaging in endometrial carcinoma detects additional low-volume metastases (4.5%) that would otherwise go undetected with routine evaluations. Our data support the incorporation of pathologic ultrastaging of SLNs in endometrial carcinoma with any degree of myoinvasion. The oncologic significance of low-volume nodal metastases requires long-term follow-up.

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Low-Volume Lymph Node Metastases in Endometrial Carcinoma

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000001016 ◽

2017 ◽

Vol 27 (6) ◽

pp. 1165-1170 ◽

Cited By ~ 10

Author(s):

Lani K. Clinton ◽

Jordan Kondo ◽

Michael E. Carney ◽

Pamela Tauchi-Nishi ◽

Keith Terada ◽

...

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Endometrial Carcinoma ◽

Tumor Cells ◽

Detection Rate ◽

Myometrial Invasion ◽

Isolated Tumor Cells ◽

Metastatic Deposit ◽

Node Metastases ◽

Low Volume

ObjectiveThe aim of this study was to determine the histopathologic characteristics of patients with endometrial carcinoma with low-volume metastases (micrometastases and isolated tumor cells) compared with macrometastases.MethodsWe performed a retrospective review of patients with endometrial carcinoma.ResultsAmong 350 robotic-assisted hysterectomies for endometrial cancer, 187 (53%) underwent attempted sentinel lymph node (SLN) biopsy. At least 1 SLN was detected in 185, a 99% overall detection rate; 108 (58%) also had non-SLNs removed. Among 91 patients with SLNs and non-SLNs from the ipsilateral hemipelvis, both were negative in 74 (81%) and positive in 7 (8%), and 10 (11%) had a positive SLN with negative non-SLNs. Among 17 patients with SLNs and non-SLNs from the contralateral hemipelvis, both were negative in 12 (71%), both were positive in 3 (18%), and 2 patients (12%) had negative SLNs with contralateral positive non-SLNs. Among 79 patients with only a SLN dissection, 4 (5%) were positive; among 69 patients with only a non-SLN dissection, 14 (20%) had positive lymph nodes. Among 24 patients with metastatic SLNs, 9 (38%) had isolated tumor cells, 3 (13%) had micrometastases, and 12 (50%) had macrometastases. Among the 40 total patients with metastatic lymph nodes, low-volume metastases represented the largest metastatic deposit in one third of patients, all of which had SLN dissection. All 12 with low-volume metastases had endometrioid histology compared with less than half (46%) of those with macrometastases (P < 0.01). Grade 1 carcinoma was present in 7 (58%) of the patients with low-volume metastases compared with 4 (14%) of those with macrometastases (P < 0.01) Furthermore, significantly more patients with low-volume metastases versus macrometastases had less than 50% myometrial invasion (67% vs 4%, P < 0.001).ConclusionsLow-volume disease was present in one third of patients with nodal metastases, the largest metastatic deposit only in patients who had SLN dissection; these patients were significantly more likely to have grade 1 endometrioid carcinoma with less than 50% myometrial invasion, traditional “low-risk” features.

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Novel quinoline-based near-infrared fluorescent bioimaging probe, KSNP117, for sentinel lymph node mapping

Journal of Materials Chemistry B ◽

10.1039/d1tb00568e ◽

2021 ◽

Author(s):

Ahmed A. Elbatrawy ◽

Da Sol Lee ◽

Sang Bong Lee ◽

Hui-Jeon Jeon ◽

Sijoon Lee ◽

...

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Lymph Nodes ◽

Near Infrared ◽

High Sensitivity ◽

Sentinel Lymph Node Mapping ◽

Sentinel Lymph Nodes ◽

Fluorescent Imaging ◽

Imaging Agents ◽

Lymph Node Mapping

Near-infrared (NIR) fluorescent imaging agents with biocompatibility and high sensitivity are urgently required for the accurate detection of sentinel lymph nodes (SLNs). Herein, we report the design of a novel...

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Isolated Tumor Cells in Sentinel Lymph Nodes of Primary Invasive Breast Carcinoma: A Cohort Analysis

Clinical Breast Cancer ◽

10.1016/j.clbc.2019.03.002 ◽

2019 ◽

Vol 19 (4) ◽

pp. 286-291

Author(s):

Gillian C. Bethune ◽

Manolhas A. Karkada ◽

Ryan DeCoste ◽

Penny J. Barnes ◽

Daniel Rayson

Keyword(s):

Breast Carcinoma ◽

Lymph Nodes ◽

Tumor Cells ◽

Cohort Analysis ◽

Sentinel Lymph Nodes ◽

Invasive Breast Carcinoma ◽

Isolated Tumor Cells

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Adipose-only sentinel lymph nodes: a finding during the adaptation of a sentinel lymph node mapping algorithm with indocyanine green in women with endometrial cancer

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2018-000008 ◽

2019 ◽

Vol 29 (1) ◽

pp. 53-59

Author(s):

J A Harold ◽

D Uyar ◽

J S Rader ◽

E Bishop ◽

M Nugent ◽

...

Keyword(s):

Endometrial Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Lymph Nodes ◽

Indocyanine Green ◽

Sentinel Lymph Node Mapping ◽

Sentinel Lymph Nodes ◽

Lymph Node Mapping ◽

Sentinel Lymph Node Identification ◽

Surgeon Experience

ObjectiveTo identify factors that affect successful adaptation of sentinel lymph node mapping and those that lead to unintended adipose-only sentinel lymph node identification.MethodsSurgical and pathological data were prospectively collected on patients with endometrial cancer who underwent sentinel lymph node mapping with indocyanine green with or without pelvic and/or para-aortic lymph node dissection between November 2013 and April 2017. All mapping cases were performed with the robotic system. Adipose-only specimens were defined as a sentinel lymph node without a pathologically identified lymph node after ultrastaging.ResultsA total of 202 patients were included: 83% had endometrioid pathology, 12% serous, 3% carcinosarcoma, and 2% clear cell, with mixed pathology noted in 2%. The bilateral sentinel lymph node detection rate was 66%, and the rate of mapping at least a unilateral sentinel lymph node was 86%. Neither the bilateral nor the unilateral sentinel lymph node mapping rate changed with increased surgeon experience. The rate of adipose-only sentinel lymph node identification was more frequent when comparing the first 10 cases (37%), cases 11 – 30 (28%), and > 30 cases (9%) (P = 0.006). Body mass index > 30 kg/m2, uterine fibroids, The International Federation of Gynecology and Obstetrics (FIGO) grade, and histology were not found to have a statistically significant impact on either sentinel lymph node identification or adipose-only sentinel lymph node identification. Adipose-only sentinel lymph nodes were more likely with increased time from cervical injection to identification of the sentinel lymph node in the right hemipelvis. The median range was 28 min (14–73) for true sentinel lymph node identification vs 33 min (23–74) for adipose-only sentinel lymph node identification (P = 0.02).ConclusionPatient and surgeon factors did not impact the identification of sentinel lymph nodes over time. Adipose-only sentinel lymph nodes were more frequently identified in the initial cases and represent a potential complication to adapting sentinel lymph node biopsy without lymphadenectomy. The increase in adipose-only sentinel lymph node identification that was associated with time from cervical injection may represent delayed or disrupted uptake of indocyanine green.

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Sentinel Lymph Nodes Mapping in Cervical Cancer a Comprehensive Review

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000853 ◽

2016 ◽

Vol 27 (1) ◽

pp. 154-158 ◽

Cited By ~ 18

Author(s):

Yasser Diab

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Lymph Nodes ◽

Indocyanine Green ◽

High Sensitivity ◽

Sentinel Lymph Node Mapping ◽

Sentinel Lymph Nodes ◽

Detection Rates ◽

Lymph Node Mapping

ObjectiveA comprehensive literature search for more recent studies pertaining to sentinel lymph node mapping in the surveillance of cervical cancer to assess if sentinel lymph node mapping has sensitivity and specificity for evaluation of the disease; assessment of posttreatment response and disease recurrence in cervical cancer.Materials and MethodsThe literature review has been constructed on a step wise study design that includes 5 major steps. This includes search for relevant publications in various available databases, application of inclusion and exclusion criteria for the selection of relevant publications, assessment of quality of the studies included, extraction of the relevant data and coherent synthesis of the data.ResultsThe search yielded numerous studies pertaining to sentinel lymph node mapping, especially on the recent trends, comparison between various modalities and evaluation of the technique. Evaluation studies have appraised high sensitivity, high negative predictive values and low false-negative rate for metastasis detection using sentinel lymph node mapping. Comparative studies have established that of all the modalities for sentinel lymph node mapping, indocyanine green sentinel lymph node mapping has higher overall and bilateral detection rates. Corroboration of the deductions of these studies further establishes that the sentinel node detection rate and sensitivity are strongly correlated to the method or technique of mapping and the history of preoperative neoadjuvant chemotherapy.ConclusionsThe review takes us to the strong conclusion that sentinel lymph node mapping is an ideal technique for detection of sentinel lymph nodes in cervical cancer patients with excellent detection rates and high sensitivity. The review also takes us to the supposition that a routine clinical evaluation of sentinel lymph nodes is feasible and a real-time florescence mapping with indocyanine green dye gives better statistically significant overall and bilateral detection than methylene blue.

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Response to Letter to the Editor: Isolated Tumor Cells in Sentinel Lymph Nodes and Clinical Implications for Early Breast Cancer

Annals of Surgical Oncology ◽

10.1245/s10434-009-0456-y ◽

2009 ◽

Vol 16 (9) ◽

pp. 2661-2661

Author(s):

Elizabeth A. Mittendorf ◽

Kelly K. Hunt

Keyword(s):

Breast Cancer ◽

Lymph Nodes ◽

Tumor Cells ◽

Early Breast Cancer ◽

Sentinel Lymph Nodes ◽

Clinical Implications ◽

Isolated Tumor Cells ◽

Letter To The Editor

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Evaluation of the Radiation Dose of an Embryo/Fetus during Lymphoscintigraphy (Sentinel Lymph Node Mapping) in Pregnant Patients with Breast Cancer

Journal of oncology: diagnostic radiology and radiotherapy ◽

10.37174/2587-7593-2021-4-4-78-87 ◽

2021 ◽

Vol 4 (4) ◽

pp. 78-87

Author(s):

A. S. Krylov ◽

B. Ya. Narkevich ◽

A. D. Ryzhkov ◽

M. E. Bilik ◽

S. M. Kaspshik ◽

...

Keyword(s):

Breast Cancer ◽

Radiation Dose ◽

Lymph Nodes ◽

Pregnant Women ◽

Sentinel Lymph Node Mapping ◽

Sentinel Lymph Nodes ◽

Radiation Doses ◽

Lymph Node Mapping ◽

Radionuclide Study ◽

Radiation Induced

Purpose: To develop a method for evaluation of the radiation dose of an embryo/fetus during lymphoscintigraphy (sentinel lymph node mapping) in pregnant patients with breast cancer.Material and methods: Two pregnant women (aged 43 and 30) with breast cancer stage IIA (T2N0M0), during the second trimester of pregnancy. We used a lymphotropic colloidal radiopharmaceutical labeled with 99mTc. To evaluate the radiation dose of an embryo, each patient had 6 individual dosimeters, which were placed around the abdomen using an elastic bandage at equal distances around the abdomen. Additionally, we placed the 7th dosimeter, it was placed near the injection site (under the mammary gland). After installing individual dosimeters, radiocolloid was injected into the affected mammary gland at four points (periareolar). The administered activity of radiopharmaceutical was 32.5 MBq, and 51.5 MBq. Lymphoscintigraphy was performed 1 hour after injection. First patient underwent sector resection of the left breast with SLN biopsy. The second patient underwent right mastectomy with SLN biopsy and breast reconstruction surgery using a tissue expander.Results: Based on the results of the study, the dose rate was calculated, on the basis of which the fetal radiation doses were calculated in both patients. Comparison of the mathematical data of both patients shows that, the calculated and experimental values of radiation exposure to the fetus during the radionuclide study of sentinel lymph nodes practically coincide. The obtained data shows that during pregnancy (280 days) the embryo/fetus will accumulate a natural radiation background dose of 1960 μSv, which is 2 times higher than the dose from the radionuclide study of sentinel lymph nodes. Thus these results verify the safety of SLN biopsy technology in pregnancy.Conclusion: 1. Radionuclide diagnostic studies of pregnant women determine radiation doses to the embryo/fetus that do not cause any radiation-induced effects in the prenatal period, and the probability of the occurrence of stochastic radiation-induced effects is several times lower than the incidence of endogenous cancers. 2. Radionuclide examination of sentinel lymph nodes appears to be safe for the fetus when conducted in pregnant women diagnosed with breast cancer. 3. In Russian Federation this method is used for the first time in pregnant women with diagnosed breast cancer. This technology has not been previously described in Russian literature.

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