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.

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 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 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 Sentinel Node Mapping for Breast Cancer: Current Situation

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Sergi Vidal-Sicart ◽  
Renato Valdés Olmos
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Sentinel Node ◽  
False Negative ◽  
False Negative Rate ◽  
Lymph Node Biopsy ◽  
Axillary Lymph ◽  
Node Dissection ◽  
Node Biopsy

Axillary node status is a major prognostic factor in early-stage disease. Traditional staging needs levels I and II axillary lymph node dissection. Axillary involvement is found in 10%–30% of patients with T1 (<2 cm) tumours. Sentinel lymph node biopsy is a minimal invasive method of checking the potential nodal involvement. It is based on the assumption of an orderly progression of lymph node invasion by metastatic cells from tumour site. Thus, when sentinel node is free of metastases the remaining nodes are free, too (with a false negative rate lesser than 5%). Moreover, Randomized trials demonstrated a marked reduction of complications associated with the sentinel lymph node biopsy when compared with axillary lymph node dissection. Currently, the sentinel node biopsy procedure is recognized as the standard treatment for stages I and II. In these stages, this approach has a positive node rate similar to those observed after lymphadenectomy, a significant decrease in morbidity and similar nodal relapse rates at 5 years. In this review, the indications and contraindications of the sentinel node biopsy are summarized and the methodological aspects discussed. Finally, the new technologic and histologic developments allow to develop a more accurate and refinate technique that can achieve virtually the identification of 100% of sentinel nodes and reduce the false negative rate.

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 State of the Art of Sentinel Lymph Node Biopsy in Vulvar Carcinoma

2009 ◽  
Vol 5 (5) ◽  
pp. 555-563 ◽  
Author(s):  
Jacob McGee ◽  
Allan Covens
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Early Stage ◽  
Frozen Section ◽  
Lymph Node Biopsy ◽  
Blue Dye ◽  
Vulvar Carcinoma ◽  
En Bloc ◽  
Node Biopsy

Treatment for early-stage vulvar carcinoma has evolved from radical en bloc dissection to wide local incision with lymphadenectomy through separate groin incisions, to sentinel lymph node biopsy (SLNB). The morbidity of SLNB is far less than traditional inguinofemoral lymphadenectomy, with less lymphedema and sensory deficit, shorter hospital stays and fewer infections. A multidisciplinary approach is required, with success of the SLNB technique maximized when radiolabeled colloid is used, with blue dye added when further identification is needed. Frozen-section analysis, followed by ultrastaging of the nodal sample, minimizes the need for reoperations and decreases the risk of false negatives. We believe that SLNB will become the standard of care for treatment of early-stage vulvar carcinoma.

scholarly journals Efficacy of sentinel lymph node biopsy with radioisotope alone and the prediction of sentinel node status using PET-CT in breast cancer

2021 ◽  
Vol 17 (1) ◽  
pp. 23-30
Author(s):  
Ran Song ◽  
Seong Uk Kwon ◽  
Dae Sung Yoon ◽  
In Eui Bae ◽  
In Seok Choi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Primary Tumor ◽  
False Negative ◽  
Lymph Node Biopsy ◽  
Blue Dye ◽  
Node Biopsy ◽  
Pet Ct

Purpose: Sentinel lymph node biopsy (SLNB) using both a radioactive isotope (RI) and blue dye is considered highly effective; however, there were limitations with the use of both agents in some hospitals, and blue dye has been shown to have some adverse effects. Additionally, preoperative prediction of sentinel lymph node (SLN) status using the maximum standardized uptake value (SUVmax) on positron emission tomography-computed tomography (PET-CT) can help avoid unnecessary axillary dissection or SLNB. Thus, we evaluated the efficacy and oncologic safety of SLNB using an RI alone in terms of long-term outcomes and determined the association between SLN metastasis and SUVmax of the primary tumor.Methods: This retrospective study was conducted at Konyang University Hospital between March 2011 and May 2018. Overall, 142 patients with breast cancer who underwent SLNB using an RI alone were enrolled. Data on identification and false-negative rates were collected. The SUVmax of primary tumors on PET-CT were analyzed for their association with SLN metastasis.Results: The identification and false-negative rates were 98.6% and 0%, respectively. There was no axillary local recurrence in patients with negative SLN findings. The correlation between the SUVmax of the primary tumor and SLN status was significant (r=0.249, P=0.005); the cutoff value for negative SLN metastasis was <2.15.Conclusion: The single agent method using an RI is not inferior to other methods and serves as a feasible option for SLNB. And the number of excised SLNs could be minimized when the SUVmax of primary tumor is extremely low.

Evaluation of mobile gamma camera imaging in sentinel lymph node biopsy for melanoma independent of pre-operative lymphscintigraphy.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19062-e19062
Author(s):  
Joshua Marshall Judge ◽  
Craig L. Slingluff ◽  
Lynn Thacher Dengel ◽  
Mark Williams ◽  
Kosta Popovic
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Sentinel Node ◽  
Gamma Camera ◽  
Gamma Probe ◽  
Lymph Node Biopsy ◽  
Node Localization ◽  
Node Biopsy ◽  
Imaging Results

e19062 Background: Sentinel lymph node biopsy (SLNB) is the standard method for staging cutaneous melanoma and involves identifying the first node(s) draining a tumor, by detecting an intradermally-injected radioactive colloid tracer. Intra-operatively the sentinel node(s) are identified with a hand-held gamma probe. Pre-operative lymphoscintigraphy is obtained to identify draining lymph node basins, but requires coordinating schedules between nuclear medicine and the operating room. A pilot study utilizing Mobile Gamma Camera (MGC) devices in conjunction with conventional lymphoscintigraphy for intraoperative sentinel node localization provided clinical benefit in 20% of patients. However, utilizing MGC devices to localize lymph node basins at the time of surgery independent of conventional lymphoscintigraphy with a fixed gamma camera (FGC) has not been adequately studied. Here, we present the results of a clinical trial utilizing MGC devices to localize lymph node basins in a manner blinded to the FGC images in order to compare the modalities directly. Methods: In 2011-12 18 patients underwent Tc99 sulfur colloid lymphoscintigraphy, and MGC survey immediately pre-operative by the study surgeon. The study surgeon established an operative plan using the MGC survey, while blinded to lymphoscintigraphy results. SLNB was then performed with use of a gamma probe and intra-operative MGC imaging. Results: 22 lymph node basins were detected in 18 imaged patients by lymphoscintigraphy. All of these basins were identified by the study surgeon using the MGC device in the pre-operative setting prior to un-blinding. In every case the operative plan established based on pre-operative MGC imaging was confirmed by the FGC images. In two cases, additional information from the MGC images aided surgical decision-making. 5 of 22 lymph node basins were positive for metastasis. All of these basins were identified by pre-operative MGC imaging, and all individual positive nodes were identified by intra-operative MGC imaging. Conclusions: Pre-operative MGC imaging in sentinel lymph node biopsy can provide comparable information for operative planning, compared to standard FGC imaging.

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