Mapping the Sentinel Lymph Node in Malignant Melanoma by Blue Dye, Lymphoscintigraphy and Intraoperative Gamma Probe

2000 ◽  
Vol 86 (4) ◽  
pp. 343-345 ◽  
Author(s):  
Giuseppe Villa ◽  
Giuseppe Agnese ◽  
Pietro Bianchi ◽  
Ferdinando Buffoni ◽  
Rosario Costa ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Lymphatic Mapping ◽  
Gamma Probe ◽  
Primary Melanoma ◽  
Blue Dye ◽  
Radioisotope Method ◽  
Patent Blue ◽  
Group A ◽  
Group B

Eighty-eight consecutive patients (48 men and 40 women; mean age, 58.9 years; range, 16–84 years) with clinically localized cutaneous melanoma involving the trunk, extremities or head and neck underwent lymphatic mapping at our institution. The primary melanoma had a mean thickness of 2.74 mm (range, 0.95 to 9 mm). Patients were divided into two groups: group A (39 patients) underwent only vital blue dye (VBD) mapping, while group B (49 patients) underwent lymphatic mapping with VBD and radio-guided surgery (RGS) combined. In all patients 1-1.5 mL of VBD was injected subdermally around the biopsy scar 10–20 min before surgery. In group B 37 MBq in 150 μL of 99mTc-HSA nanocolloid was additionally injected intradermally 18 h before surgery (3–6 aliquots injected perilesionally). In all lymphatic basins where drainage was noted the sentinel lymph nodes (SNs) were identified and marked with a cutaneous marker. Final identification of the SN was then performed externally by a hand-held gamma probe. After the induction of anesthesia 0.5–1-0 mL of patent blue V dye was injected intradermally with a 25-gauge needle around the site of the primary melanoma. SNs were examined by routine hematoxylin and eosin (H&E) staining and immunohistochemistry. Patients with histologically positive SN(s) underwent standard lymph node dissection (SLND) in the involved lymph node basin. The SN was identified in 37/39 patients (94.9%) of group A and in 48/49 patients (98.0%) of group B. Blue dye mapping failed to identify the SN in 5 of the 88 patients (5.8%), while the radioisotope method failed in only 1 of 49 patients (2.0%). Similar results were obtained with the combined use of the two probes. The average number of SNs harvested was 1.9 per basin sampled, which does not differ significantly from the numbers reported by other authors114. The SN was histologically positive in 18 patients (20.5%). None of the 12 patients with a Breslow thickness less than 1.5 mm had positive SNs, whereas 18 of the 77 patients (23.4%) with a Breslow index exceeding 1.5 mm showed metastatic SNs with H&E or immunohistochemistry. The latter all underwent SLND of the affected basin. In 10 patients (55.6%) the SN was the only site of tumor invasion; eight patients (44.4%) with positive SNs had one or more metastatic lymph nodes in the draining basin.

Localization of the Sentinel Lymph Node in Breast Cancer by Combined Lymphoscintigraphy, Blue DYE and Intraoperative Gamma Probe

2000 ◽  
Vol 86 (4) ◽  
pp. 297-299 ◽  
Author(s):  
Giuseppe Villa ◽  
Marco Gipponi ◽  
Ferdinando Buffoni ◽  
Carlo Vecchio ◽  
Pietro Bianchi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Predictive Value ◽  
Gamma Probe ◽  
Axillary Lymph Nodes ◽  
Blue Dye ◽  
Axillary Lymph ◽  
Patent Blue ◽  
Metastatic Involvement

Axillary lymph node status represents the most important prognostic factor in patients with operable breast cancer. A severe limitation of this technique is the relatively high rate of false negative sentinel lymph nodes (>5%). We studied 284 patients suffering from breast cancer; 264 had T1 tumors (16 T1a, 37 T1b and 211 T1c), while 20 had T2 tumors. All patients underwent lymphoscintigraphy 18-h before surgery. At surgery, 0.5 mL of patent blue violet was injected subdermally, and the sentinel lymph node (SN) was searched by gamma probe and by the dye method. The surgically isolated SN was processed for intraoperative and delayed examinations. The SN was successfully identified by the combined radioisotopic procedure and patent blue dye technique in 278/284 cases (97.9%). Analysis of the predictive value of the SN in relation to the status of the axillary lymph nodes was limited to 191 patients undergoing standard axillary dissection irrespective of the SN status. Overall, 63/191 (33%) identified SNs were metastatic, the SN alone being involved in 37/63 (58.7%) patients; a positive axillary status with negative SN was found in 10/73 (13.7%) patients with metastatic involvement. In T1a-T1b patients the SN turned out to be metastatic in 9/53 patients (17.0%). In 7/9 patients the SN was the only site of metastasis, while in 2/9 patients other axillary lymph nodes were found to be metastatic in addition to the SN. None of the 44 patients in whom the SN proved to be non-metastatic showed any metastatic involvement of other axillary lymph nodes. Our results demonstrate a good predictive value of SN biopsy in patients with breast cancer; the predictive value was excellent in those subjects with nodules smaller than 1 cm.

CLO19-049: Central Lymph Node Dissection in the Clinically Node-Negative (cN0) Papillary Thyroid Carcinoma: Is it Necessary?

2019 ◽  
Vol 17 (3.5) ◽  
pp. CLO19-049
Author(s):  
Girish M. Suresh ◽  
C. Ramachandra ◽  
Ravi Arjunan ◽  
Rajshekar Halkud
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Postoperative Complication ◽  
Central Compartment ◽  
Central Neck ◽  
Papillary Thyroid ◽  
Node Dissection ◽  
Group A ◽  
Group B

Background: Surgery is the treatment of choice in papillary thyroid cancer (PTC), which is the most common thyroid malignancy and frequently has metastases in the central compartment lymph nodes (CLN). There is debate among surgeons whether removing normal-appearing lymph nodes in the central neck (prophylactic lymph node dissection) is better than removing only the abnormal-appearing lymph nodes. Herein, we review the potential utility of central compartment lymph nodal dissection (CLND) on surgical outcome and disease-free follow-up of PTC and 5-year survival of patients operated on at our center. Methods: A total of 246 patients from February 2009 to March 2012 who were treated for PTC in our Kidwai Cancer Institution was analyzed retrospectively. 135 patients who underwent total thyroidectomy and CLND were assigned to Group A, which was compared with 111 patients who received total thyroidectomy, without CLND, who were assigned to Group B by evaluation of postoperative complications (recurrent laryngeal nerve damage, hoarseness, hypocalcemia, and hemorrhage rates) and recurrence at the time of Iodine131 treatment and subsequently at 60 months follow-up. Results: In the present study, Mean DFS and OS did not differ in both groups. Male gender and age more than 45 years had statistically significant DFS but without any impact on OS. There was a significant postoperative complication in group A compared to group B (P≤.001), with a very minimal recurrence in the central neck. 4 patients (3.6%) had recurrences in CLN. Conclusion: Considering the significant postoperative complication, which outweighs benefit, we conclude that for cN0 PTC, routine CLND is not necessary.

Dye- and gamma probe-guided sentinel lymph node biopsy in breast cancer patients: using patent blue dye and technetium-99m-labeled human serum albumin

Breast Cancer ◽  
2000 ◽  
Vol 7 (1) ◽  
pp. 87-94 ◽  
Author(s):  
Koichiro Tsugawa ◽  
Masakuni Noguchi ◽  
Koichi Miwa ◽  
Etsuro Bando ◽  
Kunihiko Yokoyama ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Gamma Probe ◽  
Lymph Node Biopsy ◽  
Blue Dye ◽  
Breast Cancer Patients ◽  
Patent Blue ◽  
Node Biopsy ◽  
Patent Blue Dye

scholarly journals SENTINEL LYMPH NODE SCINTIGRAPHY IN BREAST CARCINOMA- COMPARISON OF TWO VERSUS FOUR INJECTION SITE TECHNIQUE

2017 ◽  
Vol 3 (1) ◽  
Author(s):  
Yasir Majeed ◽  
Saima Riaz ◽  
Muhammad Zulqarnain Chaudry ◽  
Muhammad Khalid Nawaz
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Primary Tumour ◽  
Gamma Probe ◽  
Tier 1 ◽  
Group A ◽  
The Mean ◽  
Second Tier ◽  
Group B

Purpose: Sentinel lymph node (SLN) is the first regional node that drains lymph from the primary tumour and receives seeding of metastatic cells. Axillary node dissection remains the most reliable predictor of disease outcome. Controversies still exist about several aspects of lymphatic mapping and SLN biopsy for breast cancer, including number of radioisotope injection. The purpose of this study is to evaluate the success rate of different number of injection sites in the detection of SLN in breast cancer.Materials and Methods: A total of 120 consecutive breast cancer patients were divided into two groups. Group A (60 patients) received four intradermal periareolar (ID-PA) injections. Group B (60 patients) received two ID-PA injections.Imaging was carried out at 45 min post-injection. A gamma probe was used to explore the SLNs during surgery.Results: In Group A, 60 females with the mean age of 50.77 years were included in the study. 34 (56%) patients had single SLN. 25 (41.7%) had SLN with the second tier. 1 (1.7%) was negative. Group B included 60 patients (59 females and 1 male) with the mean age of 51.9 years. In 30 (50%) patients, single SLN was detected. 29 (48.3%) had SLN with the second tier. 1 (1.7%) was negative.Conclusion: SLN mapping with two periareolar ID injections carries less radiation dose and less pain as compared to the four injections with equal sensitivity for the visualization of SLNs.Key words: Breast cancer, intradermal injection, sentinel lymph node, Tc99 human serum albumin

scholarly journals Relevance of Regional Lymph Node Invasion in Radical Hepatectomy and Lymphadenectomy for Alveolar Echinococcosis: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Xianwei Yang ◽  
Tao Wang ◽  
Shu Shen ◽  
Wentao Wang
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Alveolar Echinococcosis ◽  
Regional Lymph Node ◽  
Regional Lymph Nodes ◽  
Node Number ◽  
Lymph Node Enlargement ◽  
Group A ◽  
Group B ◽  
Node Diameter

Abstract Background Hepatic Alveolar echinococcosis (AE) is also known as worm cancer, parasitic cancer, and it often invades the regional lymph nodes of the liver. The present study was to investigate the clinical value of radical hepatectomy and lymphadenectomy in AE patients. Methods Our study enrolled consecutive AE patients who underwent radical hepatectomy with removal the regional lymph nodes between January 2009 and April 2019. Patients with inflammatory lymph node enlargement was included in group A, and patients with AE lymph node invasion were included in group B. The clinical characteristics, survival and recurrence rates were compared.Results A total of 103 patients were enrolled group A, and 24 in group B. Preoperative computed tomography showed that the lymph node positivity rate in group B was 70.8% while that in group A was 43.7% (p=0.017). The lymph node diameter was 1.8±0.9 cm in group A vs 2.5±1.1 cm in group B (p=0.004), and the lymph node number (p=0.035) and lymph node location (p=0.001). A total of 10 patients (7.9%) had recurrent lesions, and 6 patients (4.7%) died (P>0.05). Conclusions lymph node diameter, number, and distance from the liver were important characteristics for describing lymph node invasion. There was no difference in the long-term efficacy of lymphadenectomy between patients with lymph node enlargement and those with invasion.

Monitoring early response of lymph node metastases to radiotherapy in animal models: diffusion-weighted imaging vs. morphological MR imaging

2011 ◽  
Vol 52 (9) ◽  
pp. 989-994 ◽  
Author(s):  
Jie Chen ◽  
Jing Sheng ◽  
Wei Xing ◽  
Hussein Aoun ◽  
Ming Chen ◽  
...  
Keyword(s):  
Lymph Node ◽  
Animal Models ◽  
Mr Imaging ◽  
Lymph Nodes ◽  
Diffusion Weighted Imaging ◽  
Invasive Technique ◽  
Diffusion Weighted ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background Diffusion-weighted imaging (DWI) offers a non-invasive technique that can reveal microscopic details about the architecture of both normal and anomalous tissues. Some studies have confirmed DWI can detect the early changes of tumors that have originated from various organs, even after treatment. Purpose To compare the usefulness of apparent diffusion coefficient (ADC) and morphologic magnetic resonance (MR) imaging for monitoring the therapeutic response of metastatic disease in lymph nodes to radiotherapy. Material and Methods Twenty-six rabbits (metastatic, n = 17; non-metastatic, n = 9) were divided into group A (metastatic, n = 10), group B (metastatic, n = 7) and group C (non-metastatic, n = 9). Groups A and C underwent irradiation, whereas group B was set as a reference. Standard MR imaging and DWI were performed before and 1, 3, and 7 days after radiotherapy for all rabbits. The lymph node volumes and ADCs were measured and evaluated with repeated measures ANOVA. The difference between group A and B was analyzed using Student's t-test. Results In all rabbits, a total of 35 lymph nodes were found, including 16 nodes in group A, 10 in group B and nine in group C. In group A, 3 and 7 days after therapy ADCs were significantly higher than pre-treatment and 1 day after therapy ( P < 0.05). For groups A and B, a significant difference of ADCs was present 7 days after therapy. A significant difference of variation of ADCs among the three groups was also present ( P < 0.001). Conclusion DWI is superior to morphological MRI in monitoring early radiation response in animal models.

scholarly journals Hemosiderin: a new marker for sentinel lymph node identification

2009 ◽  
Vol 24 (6) ◽  
pp. 432-436 ◽  
Author(s):  
Luiz Gonzaga Porto Pinheiro ◽  
Renato Santos de Oliveira Filho ◽  
Paulo Henrique Diógenes Vasques ◽  
Pedro Henrique de Oliveira Filgueira ◽  
Douglas Henning Pinheiro Aragão ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
Breast Biopsy ◽  
Gamma Probe ◽  
Sentinel Lymph Nodes ◽  
Patent Blue ◽  
Sentinel Lymph Node Identification ◽  
Lymphatic Duct ◽  
The Right

PURPOSE: To evaluate and present our initial results of a new marker (hemosiderin) for mammary sentinel lymph node identification in an experimental model. METHODS: Skins mapped like a lymphatic duct draining to the axilla in patients submitted to breast biopsy, in our mastology service, stimulated us to try it in an animal model (female dogs). Our theory was that some blood derivate (hemosiderin) was captured by macrophages and accessed the lymphatic ducts in direction to the axilla. Six female dogs of no defined race were studied. We injected 0,2 ml of technetium on both superior mammary glands. After ten minutes, a 2,5 ml solution of hemolized blood (hemosiderin) from the own animal was injected in the subareolar lymphatic plexus on the left superior mammary gland and 2,5 ml of patent blue concomitantly and equally on the contralateral gland. Ten minutes after, incisions on both axilas were made to search, through the lymphatic mapping and a gamma probe, the sentinel lymph nodes. RESULTS: Seven brown sentinel lymph nodes were indentified and also radiomarked on the left axilla. Six blue sentinel lymph nodes were identified and also radiomarked on the right axilla. CONCLUSION: Preliminary studies of a potential new dye for sentinel lymph node identification are presented. It may be the change of the current use of the blue dyes and their severe side-effects on patients submitted to sentinel lymph node biopsies.

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.

scholarly journals National equipment of intraoperatory gamma detection in the identification of sentinel lymph node in animal model

2009 ◽  
Vol 24 (3) ◽  
pp. 195-199 ◽  
Author(s):  
Paula Cristina Fada dos Santos ◽  
Ivan Dunshee de Abranches Oliveira Santos ◽  
Fábio Xerfan Nahas ◽  
Renato Santos de Oliveira Filho ◽  
Lydia Masako Ferreira
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Ex Vivo ◽  
Random Sequence ◽  
Male Rats ◽  
Patent Blue ◽  
Group A ◽  
Patent Blue V ◽  
Group B ◽  
Gamma Detection

PURPOSE: To investigate a national equipment of intraoperatory gamma detection in the identification of sentinel lymph node. METHODS: Thirty young adult male rats were used. After anesthetized, animals were divided into two groups of 15 animals each. Animals from group A received dextram 500 - Tc99 radiopharmaceutical and patent blue V and those from group B received only patent blue V to map the lymphatic drainage. The presence of radiation in the background area, in the area of injection and of the ex vivo sentinel lymph node of group A were measured. After the exeresis, each lymph node in group A and in group B was mixed forming a new random sequence and the radioactive reading of each lymph node was carried out, using both pieces of equipment. RESULTS: The hottest sentinel lymph node was identified by the national equipment when radiation was measured in the area of limphatic drainage after the Dextran 500 was injected. Also, the ex vivo sentinel lymph node. The national equipment has also detected radiation in the lymph nodes that had not received radiopharmaceutical, leading to false positive, checked by the application of Mann-Whitney tests and Student's paired t-tests. The Cronbach alpha has shown high internal consistency of data 0,9416. CONCLUSIONS: The national equipment of intraoperatory gamma detection identifies the LS and showed false positives LS and needs improvement.

scholarly journals A prospective randomized trial comparing patent blue and methylene blue for the detection of the sentinel lymph node in breast cancer patients

2017 ◽  
Vol 63 (2) ◽  
pp. 118-123 ◽  
Author(s):  
Régis Resende Paulinelli ◽  
Ruffo Freitas-Junior ◽  
Rosemar Macedo de Souza Rahal ◽  
Luis Fernando de Pádua Oliveira ◽  
Maria Helena Tavares Vilela ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Methylene Blue ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Randomized Trial ◽  
Cancer Patients ◽  
Breast Cancer Patients ◽  
Patent Blue ◽  
Group A ◽  
Group B

Summary Introduction: Methylene blue is more widely available and less expensive than patent blue, with an apparently lower risk of anaphylaxis. Objective: The two dyes were compared regarding detection of the sentinel lymph node (SLN). Method: A prospective, randomized trial involved 142 patients with invasive breast carcinoma. Sixty-nine (49.3%) assigned to patent blue (group A) and 71 (50.70%) to methylene blue (group B). Thirty-five patients (25.0%) were clinical stage III or IV; 55 (38.7%) had axillary lymph nodes affected; and 69 (49.3%) underwent neoadjuvant chemotherapy. Two patients were excluded because the dye type was not recorded. Results: Patients and tumor characteristics were similar in both groups. SLNs were identified in 47 women (68.1%) in group A and 43 (60.6%) in group B (p=0.35). SLNs were affected in 22 cases (51.2%) in group A and 21 (48.8%) in group B (p=0.62). The SLN was the only node affected in 12 cases (54.5%) in group A and six (33.3%) in group B (p=0.18). The time and degree of difficulty involved in identifying the SLN were similar in both groups. There were no complications or allergies. Conclusion: Methylene blue performed as well as patent blue in identifying the SLN in breast cancer patients.

Sign in / Sign up

Export Citation Format

Share Document