Sentinel lymph node in endometrial cancer

2007 ◽  
Vol 17 (5) ◽  
pp. 1113-1117 ◽  
Author(s):  
L.A.F Lopes ◽  
S. M Nicolau ◽  
F. F Baracat ◽  
E. C Baracat ◽  
W. J Gonçalves ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
Sentinel Node ◽  
Endometrial Carcinoma ◽  
Frozen Section ◽  
False Negative ◽  
Pelvic Lymphadenectomy ◽  
Clinical Staging ◽  
Blue Dye

The aim of this study was to evaluate the possibility of identifying the sentinel lymph node and involvement of neoplastic cells in patients with endometrial carcinoma limited to the uterus, and also its correlation with the conditions of other pelvic and para-aortic lymph nodes. Forty patients with endometrial carcinoma, clinical staging I and II, were submitted to complete surgical staging through laparotomy, as recommended by FIGO in 1988. The sentinel node was investigated using patent blue dye in the myometrial subserosa. The sentinel node was excised and submitted to frozen section examination of specimen, stained with hematoxylin and eosin (H&E). Afterward, selective bilateral para-aortic and pelvic lymphadenectomy, total hysterectomy with bilateral salpingo-oophorectomy were performed. The lymph nodes excised were examined by means of paraffin-embedded slices stained with H&E and of imunohistochemistry with antikeratin antibody AE1/AE3. The sentinel lymph node was identified in 77.5% of patients (31/40), and 16.1% (5/31) presented neoplastic involvement in the node. In 25 cases of negative sentinel node, 96% (24/25) had no neoplastic involvement, and 4% (1/25) had other lymph node affected (false negative). In nine cases with no sentinel node identified, 55.5% (5/9) had lymph node involvement. The results of this study allow us to conclude that it is possible to identify the sentinel node using the methods described, and the pathologic examination significantly represents the same conditions of other pelvic and para-aortic lymph nodes.

scholarly journals Failure of Radiotracer Migration: Salvaging Sentinel Lymph Node Biopsy in Melanoma Care With Indocyanine Green

2021 ◽  
Vol 7 ◽  
pp. 2513826X2110222
Author(s):  
Christine Nicholas ◽  
Carmen Webb ◽  
Claire Temple-Oberle
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Indocyanine Green ◽  
Sentinel Node ◽  
Head And Neck ◽  
Near Infrared ◽  
False Negative ◽  
Lymph Node Biopsy ◽  
Blue Dye ◽  
Traditional Methods

Reducing false negative rates for sentinel lymph node biopsies (SLNB) in melanoma is important to accurately prognosticate and to guide treatment. Traditionally, SLNB has been performed with the adjunct of radiotracers and blue dye. Although sentinel node mapping is highly successful in axillary and inguinal node basins, identification of nodes in the head and neck is not as accurate with traditional methods. One reason for this may be failure of radiotracer migration. To augment standard technique using a radiocolloid, indocyanine green (ICG) combined with near infrared spectroscopy (NIRS), has shown promising results. We demonstrate a case of an individual undergoing SLNB in the head and neck region with failure of radiotracer migration. Identification of a sentinel node was accomplished with the use of ICG and NIRS. This technology offers an opportunity to salvage the SLNB when traditional methods fail.

scholarly journals Factors that affect the false negative rate of sentinel lymph node mapping with methylene blue dye alone in breast cancer

2019 ◽  
Vol 47 (10) ◽  
pp. 4841-4853 ◽  
Author(s):  
Huang Li ◽  
Zhang Jun ◽  
Ge Zhi-Cheng ◽  
Qu Xiang
Keyword(s):  
Breast Cancer ◽  
Methylene Blue ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
False Negative ◽  
False Negative Rate ◽  
Blue Dye ◽  
Methylene Blue Dye ◽  
Clinicopathological Factors

Objective This study aimed to investigate the clinicopathological factors of the false negative rate (FNR) and accuracy of sentinel lymph node biopsy (SLNB) mapping with 1% methylene blue dye (MBD) alone, and to examine how to reduce the FNR in patients with breast cancer. Methods A total of 365 patients with invasive breast carcinoma who received axillary lymph node dissection after SLNB were retrospectively analyzed. SLNB was performed with 2 to 5 mL of 1% MBD. We studied the clinicopathological factors that could affect the FNR of SLNB. Results The identification rate of sentinel lymph nodes (SLNs) was 98.3% (359/365) and the FNR of SLNB was 10.4% (16/154). Multivariate analysis showed that the number of dissected SLNs and metastatic lymph nodes were independent predictive factors for the FNR of SLNB. The FNR in patients with 1, 2, 3, and ≥4 SLNs was 23.53%, 15.79%, 3.85%, and 1.79%, respectively. Conclusions SLNB mapping with MBD alone in patients with breast cancer can produce favorable identification rates. The FNR of SLNB decreases as the number of SLNs rises. Because of side effects of searching for additional SLNs and the FNR, removal of three or four SLNs may be appropriate.

scholarly journals Sentinel lymph node identification in early stage ovarian cancer: is it still possible after prior tumor resection?

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Pim Laven ◽  
Roy Kruitwagen ◽  
Petra Zusterzeel ◽  
Brigitte Slangen ◽  
Toon van Gorp ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Node ◽  
Early Stage ◽  
Frozen Section ◽  
Gamma Probe ◽  
Tumor Resection ◽  
Blue Dye ◽  
Sentinel Nodes

Abstract Objective Sentinel lymph node (SLN) detection in ovarian cancer is feasible when tracers are injected before the pathological ovary is resected. This study aims to investigate whether the SLN identification is also feasible in patients whose ovarian tumor has already been resected with injection of the tracer into the ovarian ligaments stumps, i.e. in the event that a frozen section confirms malignancy. Methods Patients who underwent laparotomy with frozen section confirming an ovarian malignancy, and those who underwent a second staging laparotomy after prior resection of a malignant ovarian mass, were included. Blue dye and a radioactive isotope were injected in the stumps of the ligamentum ovarium proprium and the ligamentum infundibulo-pelvicum. After an interval of at least 15-min, the sentinel node(s) were identified using either the gamma-probe and / or blue dye. Results A total of 11 patients were included in the study, the sentinel node (SLN) procedure was completed in all 11 patients. At least one SLN was identified in 3 patients, resulting in a rather low detection rate of 27,3%. Conclusion In this study we showed that SLN procedure after (previous) resection of the tumor seems inferior to detect sentinel nodes when compared to injection of the tracer in the ovarian ligaments before tumor resection. Trial registration NCT02540551

scholarly journals The importance of pre-operative axillary ultrasound and intra-operative sentinel lymph node frozen section analysis in patients with early breast cancer – a 3-year study

2011 ◽  
Vol 93 (2) ◽  
pp. 103-105 ◽  
Author(s):  
Melissa M Sanders ◽  
Shamaela Waheed ◽  
Sanjay Joshi ◽  
Caroline Pogson ◽  
Stephen R Ebbs
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
Sentinel Node ◽  
Axillary Dissection ◽  
Frozen Section ◽  
Axillary Ultrasound ◽  
Node Biopsy ◽  
Operative Ultrasound

INTRODUCTION To ensure appropriate axillary surgery is performed at a single operation, we have sought to identify patients with involved nodes who might progress directly to axillary dissection. PATIENTS AND METHODS We evaluated pre-operative ultrasound of the axilla and intra-operative frozen section of sentinel lymph nodes over a 3-year period. Patients with clinical early breast cancer underwent axillary ultrasound. Abnormal nodes were defined as a cortex > 2.5 mm, loss of high echogenic medulla, and morphological changes. Any axilla containing a lymph node considered abnormal had ultrasound-directed fine needle aspiration (FNA) performed. Patients with positive cytology proceeded directly to axillary dissection. Patients with negative cytology and those with normal ultrasound proceeded to sentinel four-node biopsy using Patent Blue dye alone. A single sentinel node was evaluated by intra-operative frozen section. RESULTS A total of 311 patients underwent pre-operative ultrasound successfully, identifying 115 (77%) patients of the total 150 who were found to have positive lymph nodes. Overall, 196 patients underwent sentinel lymph node biopsy analysis intra-operatively. Of the 11 false negative cases in which the lymph node was found to be positive postoperatively, eight cases showed the single tested sentinel node contained cancer that was recognised on postoperative staining but not frozen section. In six, the deposit in the sentinel node was a micrometastasis. Three cases were found to contain cancer in the ‘non-sentinel' node; in all, this was micrometastatic disease. CONCLUSIONS This study confirms the value of pre-operative ultrasound and intra-operative frozen section examination of axillary nodes. Only 3.5% of patients required two operations.

scholarly journals Sentinel lymph node identification in early stage ovarian cancer: is it still possible after prior tumor resection?

2020 ◽  
Author(s):  
Pim Laven ◽  
Roy Kruitwagen ◽  
Petra Zusterzeel ◽  
Brigitte Slangen ◽  
Toon van Gorp ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Node ◽  
Early Stage ◽  
Frozen Section ◽  
Gamma Probe ◽  
Tumor Resection ◽  
Blue Dye ◽  
Sentinel Nodes

Abstract Objective: Sentinel lymph node (SLN) detection in ovarian cancer is feasible when tracers are injected before the pathological ovary is resected. This study aims to investigate whether the SLN identification is also feasible in patients whose ovarian tumor has already been resected with injection of the tracer into the ovarian ligaments stumps, i.e. in the event that a frozen section confirms malignancy. Methods: Patients who underwent laparotomy with frozen section confirming an ovarian malignancy, and those who underwent a second staging laparotomy after prior resection of a malignant ovarian mass, were included. Blue dye and a radioactive isotope were injected in the stumps of the ligamentum ovarium proprium and the ligamentum infundibulo-pelvicum. After an interval of at least 15-minutes, the sentinel node(s) were identified using either the gamma-probe and / or blue dye.Results: A total of 11 patients were included in the study, the sentinel node (SLN) procedure was completed in all 11 patients. At least one SLN was identified in 3 patients, resulting in a rather low detection rate of 27,3%. Conclusion: In this study we showed that SLN procedure after (previous) resection of the tumor seems inferior to detect sentinel nodes when compared to injection of the tracer in the ovarian ligaments before tumor resection.Trial registration on clinical trials: NCT02540551 https://clinicaltrials.gov/ct2/show/NCT02540551

First experiences with a new radiopharmaceutical for sentinel lymph node detection in malignant melanoma

2004 ◽  
Vol 43 (01) ◽  
pp. 10-15 ◽  
Author(s):  
R. A. Schmid ◽  
C. Kunte ◽  
B. Konz ◽  
K. Hahn ◽  
M. Weiss
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Malignant Melanoma ◽  
Sentinel Node ◽  
Gamma Probe ◽  
Blue Dye ◽  
Sentinel Nodes ◽  
Technetium 99M ◽  
Positive Rate ◽  
Metastatic Involvement

Summary Aim of this study was to localize the sentinel lymph node by lymphoscintigraphy using technetium-99m colloidal rhenium sulphide (Nanocis®), a new commercially available radiopharmaceutical. Due to the manufacturers’ instructions it is licensed for lymphoscintigraphy. Patients, methods: 35 consecutive patients with histologically proved malignant melanoma, but without clinical evidence of metastases, were preoperatively examined by injecting 20-40 MBq Nanocis® with (mean particle size: 100 nm; range: 50-200 nm) intradermally around the lesion. Additionally blue dye was injected intaoperatively. A hand-held gamma probe guided sentinel node biopsy. Results: During surgery, the preoperatively scintigraphically detected sentinel lymph nodes were identified in 34/35 (97%) patients. The number of sentinel nodes per patient ranged from one to four (mean: n = 1.8). Histologically, metastatic involvement of the sentinel lymph node was found in 12/35 (34%) patients; the sentinel lymph node positive-rate (14/63 SLN) was 22%. Thus, it is comparable to the findings of SLN-mapping using other technetium-99m-labeled nanocolloides. Conclusion: 99mTc-bound colloidal rhenium sulphide is also suitable for sentinel node mapping.

scholarly journals Sentinel Lymph Node Biopsy in Early Breast Cancer Using the Indocyanine Green Fluorescence Technique: A Validation Study

2021 ◽  
Vol 20 (3) ◽  
Author(s):  
Loh Soon Khang ◽  
Suraya Baharudin ◽  
Juliana Abdul Latiff ◽  
Siti Aishah Mahamad Dom ◽  
Shahrun Niza Suhaimi
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Early Breast Cancer ◽  
Detection Rate ◽  
False Negative ◽  
False Negative Rate ◽  
Lymph Node Biopsy ◽  
Blue Dye ◽  
Node Biopsy

INTRODUCTION: Introduction: Sentinel lymph node biopsy (SLNB) is now recognized as the standard of care for early breast cancer patients with negative axillary lymph nodes. Various approaches for Sentinel Lymph Node (SLN) identification using either the blue dye method or scintigraphy alone or their combination have been proposed. However, this method is costly and may not be applicable in certain developing countries. SLNB involving the use of indocyanine green (ICG) offers several advantages, and it is valid and safe when in direct comparison with the blue dye method and scintigraphy. Hence, we performed SLNB using this method in early breast cancer as the first center that involves the use of ICG in Malaysia. We performed validation study on this method with the aims to determine its sensitivity and safety profile. MATERIALS AND METHODS: This is a validation and non-randomised prospective observational study involving 20 patients underwent SLNB wherein ICG is used for localisation. The patients were recruited according to the recommendations stipulated in the Malaysia Clinical Practice Guideline. RESULT: The average number of SLNs removed per patient was 4.0 (range, 3–6) with sentinel lymph nodes detection rate at 98.75% (79/80). The false negative rate is at 5%. No adverse events were observed in all cases. CONCLUSION: The ICG fluorescence method is simple, reliable and safe. Moreover, it demonstrates a high SLN detection rate with a low false-negative rate, and it does not require a special instrument for radioisotope use.

Radioisotopic Lymphatic Mapping of the Sentinel Node in Melanoma: Importance of Immunohistochemistry

2000 ◽  
Vol 86 (4) ◽  
pp. 346-348 ◽  
Author(s):  
Luca Vaggelli ◽  
Antonio Castagnoli ◽  
Lorenzo Borgognoni ◽  
Carmelo Urso ◽  
Maria Matteini ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Node ◽  
Primary Tumor ◽  
Frozen Section ◽  
Gamma Probe ◽  
Lymph Node Biopsy ◽  
Pathological Examination ◽  
Blue Dye ◽  
Node Dissection ◽  
Hematoxylin Eosin

Background Elective lymph node dissection (ELND) for patients with malignant melanoma is still controversial. A possible alternative could be biopsy of the first tumor draining lymph node, the sentinel node (SN), which can be identified by means of radionuclide techniques. Aim Our study was undertaken to assess the accuracy of lymph node biopsy and to stress the importance of immunohistochemistry (IHC) in the pathological assessment of the SN for improved staging of the primary tumor. Methods We performed lymphoscintigraphy (LS) in 183 melanoma patients (89 with melanoma of the legs, 11 of the arms and 83 of the trunk). Our protocol consisted of preoperative peritumoral i.d. injection of 99mTc-labeled microcolloid to define the regional lymphatic basin and identify the sentinel node by means of planar scintigraphy. In 147 of the 183 cases a gamma probe (GP) was used during surgery to trace the SN. Vital blue dye was used during surgery in all cases. The SNs were excised for pathological examination. The pathological status of the SN was defined by means of examination of frozen sections, hematoxylin-eosin staining and immunohistochemistry for S-100 and HMB-45 MAb. Results At least one separate focus of activity was identified by LS in 182 out of 183 patients; in all 147 cases where a GP was used, it was successful in tracing the SN. LS with cutaneous mapping of the SN successfully guided the surgical excision in 177 of the 183 cases; in the 7 remaining cases, i.e. 7 out of 83 cases with SNs in the axillary basin, GP was not used and no elective node dissection was performed. Metastases were found in 39 of these 177 cases. In all 39 cases the SNs were the only positive nodes in the basin. Of the 39 metastases 18 were identified by means of frozen section, 12 by means of hematoxylin-eosin, and 9 by means of immunohistochemistry. We therefore emphasize the importance of immunohistochemistry in the pathology of LS for improved staging of the primary tumor.

A Multidisciplinary Approach to Locoregional Management of the Axilla for Primary Operable Breast Cancer

1997 ◽  
Vol 4 (6) ◽  
pp. 491-499 ◽  
Author(s):  
Benjamin O. Anderson ◽  
Mary M. Austin-Seymour ◽  
Julie R. Gralow ◽  
Roger E. Moe ◽  
David R. Byrd
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Node ◽  
Axillary Dissection ◽  
False Negative ◽  
Cancer Prognosis ◽  
Blue Dye ◽  
Prognostic Information ◽  
Cancer Management ◽  
Axillary Lymphadenectomy

Background Lymph node metastasis is the single most important factor in assessing breast cancer prognosis and planning systemic therapy. However, lymph node dissection portends significant morbidity, with little or no therapeutic benefit if the nodes prove to be negative for cancer. Methods The authors review indications for avoiding axillary dissection, and they analyze the results from lower-level axillary lymphadenectomy together with the morbidity from full axillary dissection. Results Limited level I dissection depends on surgical technique and limits prognostic information. Three approaches have evolved to identify the sentinel node in breast cancer: perilesional breast injection of radiocolloid alone, blue dye alone, or a combination of radiocolloid and blue dye. These techniques provide high diagnostic accuracy, few false-negative results, and less morbidity. Conclusions Knowledge of axillary status is critical to current breast cancer management and cannot be foregone in the preponderance of patients with advanced breast cancer. Results from lymphatic mapping and sentinel node biopsy are highly encouraging.

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