scholarly journals The potential risk of contralateral non-sentinel groin node metastasis in women with early primary vulvar cancer following unilateral sentinel node metastasis: a single center evaluation in University Hospital of Düsseldorf

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Andreas Suhartoyo Winarno ◽  
Anne Mondal ◽  
Franca Christina Martignoni ◽  
Tanja Natascha Fehm ◽  
Monika Hampl
Keyword(s):  
Lymph Nodes ◽  
Sentinel Node ◽  
Vulvar Cancer ◽  
High Volume ◽  
University Hospital ◽  
Morbidity Rate ◽  
Current Guideline ◽  
Single Center ◽  
Node Metastasis ◽  
Increased Risk

Abstract Background Since the introduction of sentinel node biopsy (SLNB) in unifocal vulvar cancer (diameter of < 4 cm) and unsuspicious groin lymph nodes, the morbidity rate of patients has significantly decreased globally. In contrast to SLNB, bilateral inguinofemoral lymphadenectomy (IFL) has been associated with increased risk of common morbidities. Current guidelines (NCCN, ESGO, RCOG, and German) recommend that in cases of unilaterally positive sentinel lymph node (SLN), bilateral IFL should be performed. However, two recent publications by Woelber et al. and Nica et al. contradict the current guideline, since a significant rate of positive non sentinel lymph nodes in IFL contralaterally was not observed [Woelber et al. 0% (p = 0/28) and Nica et al. 5.3% (p = 1/19)]. Methods A retrospective single-center analysis conducted in the University Hospital of Dusseldorf, evaluating vulvar cancer patients treated with SLNB from 2002 to 2018. Results 22.2% of women (n = 4/18) were found to have contralateral IFL groin metastasis after an initial diagnosis of unilateral SLN metastasis. The depth of tumor infiltrating cells correlated significantly and positively with the rate of incidence of groin metastasis (p = 0.0038). Conclusion Current guideline for bilateral IFL should remain as the standard management. Therefore, this depth may be taken into account as an indication for bilateral IFL. The management of VC and SLNB should be performed in a high volume center with an experienced team in marking SLN and performing the adequate surgical procedure. Well conducted counseling of the patients outlining advantages but also potential oncological risks of this technique especially concerning rate of groin recurrence is critical.

scholarly journals The potential risk of contralateral non-sentinel groin node metastasis in women with early primary vulvar cancer following unilateral sentinel node metastasis: a single center evaluation in University Hospital of Düsseldorf

2021 ◽  
Author(s):  
Andreas Suhartoyo Winarno ◽  
Anne Mondal ◽  
Franca Christina Martignoni ◽  
Tanja Natascha Fehm ◽  
Monika Hampl
Keyword(s):  
Lymph Nodes ◽  
Sentinel Node ◽  
Vulvar Cancer ◽  
High Volume ◽  
University Hospital ◽  
Morbidity Rate ◽  
Current Guideline ◽  
Single Center ◽  
Node Metastasis ◽  
Increased Risk

Abstract Background: Since the introduction of sentinel node biopsy (SLNB) in unifocal vulvar cancer (diameter of < 4cm) and unsuspicious groin lymph nodes, the morbidity rate of patients has significantly decreased globally. In contrast to SLNB, bilateral inguinofemoral lymphadenectomy (IFL) has been associated with increased risk of common morbidities. Current guidelines (NCCN, ESGO, RCOG, and German) recommend that in cases of unilaterally positive sentinel lymph node (SLN), bilateral IFL should be performed. However, two recent publications by Woelber et al. and Nica et al. contradict the current guideline, since a significant rate of positive non sentinel lymph nodes in IFL contralaterally was not observed (Woelber et al. 0% (p=0/28) and Nica et al. 5.3% (p=1/19)). Methods: A retrospective single-center analysis conducted in the University Hospital of Dusseldorf, evaluating vulvar cancer patients treated with SLNB from 2002 to 2018. Results: 22.2% of women (n=4/18) were found to have contralateral IFL groin metastasis after an initial diagnosis of unilateral SLN metastasis. The depth of tumor infiltrating cells correlated significantly and positively with the rate of incidence of groin metastasis (p=0.0038). Conclusion: Current guideline for bilateral IFL should remain as the standard management. Therefore, this depth may be taken into account as an indication for bilateral IFL. The management of VC and SLNB should be performed in a high volume center with an experienced team in marking SLN and performing the adequate surgical procedure. Well conducted counseling of the patients outlining advantages but also potential oncological risks of this technique especially concerning rate of groin recurrence is critical.

scholarly journals The potential of contralateral non-sentinel groin node metastasis in women with early primary vulvar cancer following unilateral sentinel node metastasis: a single center evaluation in University Hospital of Düsseldorf

2020 ◽  
Author(s):  
Andreas Suhartoyo Winarno ◽  
Anne Mondal ◽  
Franca Christina Martignoni ◽  
Tanja Natascha Fehm ◽  
Monika Hampl
Keyword(s):  
Lymph Nodes ◽  
Sentinel Node ◽  
Vulvar Cancer ◽  
Positive Sentinel Lymph Node ◽  
University Hospital ◽  
Morbidity Rate ◽  
Current Guideline ◽  
Single Center ◽  
Node Metastasis ◽  
Increased Risk

Abstract Background: Since the introduction of sentinel node biopsy (SLNB) in unifocal vulvar cancer (diameter of < 4cm) and unsuspicious groin lymph nodes, the morbidity rate of patients has significantly decreased globally. In contrast to SLNB, bilateral inguinofemoral lymphadenectomy (IFL) has been associated with increased risk of common morbidities. Current guidelines (NCCN, ESGO, RCOG, and German) recommend that in cases of unilaterally positive sentinel lymph node (SLN), bilateral IFL should be performed. However, two recent publications by Woelber et al. and Nica et al. contradict the current guideline, since a significant rate of positive non sentinel lymph nodes in IFL contralaterally was not observed (Woelber et al. 0% (p=0/28) and Nica et al. 5.3% (p=1/19)). Methods: A retrospective single-center analysis conducted in the University Hospital of Dusseldorf, evaluating vulvar cancer patients treated with SLNB from 2002 to 2018. Results, discussion and conclusion: Current guideline for bilateral IFL should remain as the standard management as 22.2% of women (n=4/18) were found to have contralateral IFL groin metastasis after an initial diagnosis of unilateral SLN metastasis. The depth of tumor infiltrating cells correlated significantly and positively with the rate of incidence of groin metastasis (p=0.0038). Therefore, this depth may be taken into account as an indication for bilateral IFL.

scholarly journals The Possibility of Contralateral Non-Sentinel Groin Node’s Metastasis in Early Primary Vulvar Cancer Women After Unilateral Sentinel Node’s Metastasis: A Single Center Evaluation in University Hospital of Düsseldorf

2020 ◽  
Author(s):  
Andreas Suhartoyo Winarno ◽  
Anne Mondal ◽  
Franca Christina Martignoni ◽  
Tanja Natascha Fehm ◽  
Monika Hampl
Keyword(s):  
Vulvar Cancer ◽  
University Hospital ◽  
Morbidity Rate ◽  
Current Guideline ◽  
Single Center ◽  
Standard Management ◽  
Increased Risk ◽  
Early Primary ◽  
The University ◽  
Current Guidelines

Abstract Background: Sentinel node biopsy (SLNB) technique in unifocal vulvar cancer (diameter of < 4cm) and unsuspicious groin lymph nodes, the morbidity rate of patients has significantly decreased all over the world. In contrast to SLNB, bilateral inguinofemoral lymphadenectomy (IFL) has been associated with increased risk of common morbidities. Current guidelines (NCCN, ESGO, RCOG, and German) suggest that in cases of metastasis of unilateral SLNB, groin node dissection with IFL, should be performed bilaterally. However, a publication by Woelber et al. 0% (p=0/28) and Nica et al. 5.3% (p=1/19) contradicted the current guideline. Methods: A single-center analysis conducted in the University Hospital of Dusseldorf, evaluating vulvar cancer patients treated with SLNB retrospectively from 2002 to 2018. Result, discussion and conclusion: Current guideline for bilateral IFL should remain as the standard management because 22.2% women (n=4/18) had contralateral IFL groin metastasis after unilateral SLNB metastasis initially. The depth of tumor infiltrating cells was correlated significantly and positively with the incidence rate of groin metastasis (p=0.0038). Therefore, it is an indication for bilateral IFL.

Validation of MSKCC nomogram for prediction of metastasis to nonsentinel lymph nodes in carcinoma breast in Indian patients.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e11510-e11510
Author(s):  
S. P. Somashekhar ◽  
Amit Rauthan
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Sentinel Node ◽  
Cancer Patients ◽  
Breast Cancer Patients ◽  
Sentinel Nodes ◽  
Sentinel Node Metastasis ◽  
Node Metastasis ◽  
Indian Patients ◽  
Mskcc Nomogram

e11510 Background: Sentinel node biopsy has emerged as the standard of care in clinically node negative breast cancer (cT1,T2 N0). In cases where sentinel node is negative, ALND can be avoided. In nearly 30-50% cases, the sentinel lymph nodes is the only site of metastases, demonstrated in Indian population too. In ASCOG ZOO11 trial, patients who had metastases in sentinel node did not undergo ALND. Patients in the trial received radiation as part of breast conservation surgery. In Indian patients, this is not applicable as most of the patients undergo mastectomy. It would be highly beneficial to identify the subset of patients, where the sentinel node is the only site of metastasis. Various nomograms have been used to predict the risk of metastasis in non sentinel nodes. MSKCC nomogram has been validated in many studies in the USA and Netherlands. Methods: The records of 240 breast cancer patients between 2007 and 2011 who underwent SLN and / or ALND were selected. Serial hemotoxylin and eosin (HE) analysis and immunohistochemistry were routinely performed on each sentinel node. Various factors like T size, histology and grade, lymphovascular invasion, number of +ve and –ve sentinel nodes, hormonal status, multifocality were recorded. Risk of non sentinel node metastasis were calculated by nomogram. Results: 63 out of 240 patients had sentinel node positivity and underwent ALND 20 out of 63(31%) had metastasis in non sentinel nodes also. Mean predictive risk as per nomogram for SLN was 53% and non SLN mets was 68%. None of our patients had low risk of non sentinel node metastasis as per MSKCC nomogram. Conclusions: MSKCC nomogram is not validated for Indian Breast Cancer patients, in our study population as it could not differentiate between patients having metastasis in sentinel node only from those having non sentinel node metastasis based on risk stratification. Because in India, the mean Tumour (T) size is big and Grade is usually high grade and one of the reason the present MSKCC nomogram is not applicable to Indian Breast cancer patients. In Indian populations, a different nomogram is required to correctly predict the non sentinel node metastasis.

scholarly journals The predictors of “hidden” central neck lymph node metastasis in patients with differentiated thyroid cancer

2018 ◽  
Vol 14 (1) ◽  
pp. 19-24
Author(s):  
Vladimir A. Solodkiy ◽  
Dmitry K. Fomin ◽  
Dmitry A. Galushko ◽  
Hayk G. Asmaryan
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Thyroid Gland ◽  
Lymph Nodes ◽  
Differentiated Thyroid Cancer ◽  
Central Neck ◽  
Neck Lymph Node ◽  
Node Metastasis ◽  
Increased Risk

Background. The regional lymph node metastasis in differentiated thyroid cancer (DTC) is still very high: 50–60%, especially in papillary form. Averagely, after central neck lymph node dissection (CNLD), in 30–40% cases “hidden” metastasis in lymph nodes of VI zone of neck were revealed. But they were not indicated by preoperative diagnostic procedures: ultrasound (US) and computer tomogpraphy (CT). Aims. To define the factors associated with the increased risk of lymph node metastasis for specification of indications to CNLD performance. Materials and methods. The study covers 105 patients with clinical stages of DTC T1-2N0M0, who received a thyroidectomy (TE) with preventive bilateral CNLD in RSCRR since 2012 till 2017. Patients older than 45 y.o. prevailed (66 patients (62.9%)). Data processing was carried out in a Microsoft Access database, a one-factor dispersion analysis was used for the analysis of the quantitative signs, and a c-square criterion was used for the qualitative ones. Results. The “hidden” metastasizes are founded by 32 (30.5%) patients. Multifocality is registered in 29 (27.6%) cases, lack of the tumor node capsule is registered in 65 (61.9%) and an invasion of the thyroid gland capsule is registered in 38 (36.2%) patients. Background diseases of the thyroid gland (TG) have 69 (65.7%) patients. According to the multifactorial analysis reliable independent predictors of the “hidden” metastasis of central neck lymph nodes were invasion of the anatomic capsule of TG (р = 0.003), age of patients ≤45 y.o. (р = 0.005), nonincapsulated form of tumor (р = 0.007). Conclusion. Use of TE in combination with CNLD allowed to restage at 46.7% of patients due to TG capsule invasion (28.6%) and “hidden” metastasis in VI group lymph nodes (30.5%) identification.

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