Lack of Standards for the Detection of Melanoma in Sentinel Lymph Nodes: A Survey and Recommendations

2013 ◽  
Vol 137 (11) ◽  
pp. 1603-1609 ◽  
Author(s):  
John Dekker ◽  
Lyn M. Duncan
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Clinical Care ◽  
Sentinel Lymph Node Mapping ◽  
Sentinel Lymph Nodes ◽  
Lymph Node Mapping ◽  
S 100 ◽  
Histologic Evaluation ◽  
Melanoma Patients ◽  
Immunohistochemical Stains

Context.—Detection of microscopic melanoma metastases in sentinel lymph nodes drives clinical care; patients without metastases are observed, and patients with metastases are offered completion lymphadenectomy and adjuvant therapy. Objective.—We sought to determine common elements in currently used analytic platforms for sentinel lymph nodes in melanoma patients. Design.—An electronic survey was distributed to 83 cancer centers in North America. Results.—Seventeen responses (20%) were received. The number of sentinel lymph node mapping procedures for melanoma ranged from less than 11 to more than 100 patients per year, with 72% of institutions mapping more than 50 melanoma patients a year. Uniform practices included (1) processing all of the lymph node tissue rather than submitting representative sections and (2) use of immunohistochemical stains if no tumor was identified on the hematoxylin-eosin–stained sections. Significant variability existed regarding the method of sectioning lymph nodes at grossing and in the histology laboratory; most bisected nodes longitudinally (94%) and performed deeper levels into the block (67%), but these were not uniform practices. S-100 was the most commonly used immunohistochemical stain (78%), followed by Melan-A (56%), MART-1 (50%), HMB-45 (44%), tyrosinase (33%), MiTF (11%), and pan-melanoma (6%). Conclusions.—There is a need for a standardized platform for detecting melanoma in sentinel lymph nodes. Current practices by a majority of laboratories and findings in the reported literature support the following: histologic evaluation of all lymph node tissue, use of immunohistochemical stains, bisecting lymph nodes longitudinally, and performing deeper levels into the tissue block.

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

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...

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

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.

scholarly journals Sentinel Lymph Nodes Mapping in Cervical Cancer a Comprehensive Review

2016 ◽  
Vol 27 (1) ◽  
pp. 154-158 ◽  
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.

scholarly journals Sentinel Lymph Node Mapping In Gastric Cancer Surgery: Current Status

2016 ◽  
Vol 62 (4) ◽  
pp. 403-407 ◽  
Author(s):  
Tivadar Bara ◽  
Tivadar Bara ◽  
Radu Neagoe ◽  
Daniela Sala ◽  
Simona Gurzu ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Early Gastric Cancer ◽  
Lymph Nodes ◽  
Sentinel Lymph Node Mapping ◽  
Sentinel Lymph Nodes ◽  
Current Status ◽  
Lymph Node Mapping ◽  
Invasion Stage

AbstractLymphonodular metastases remain an important predictive and prognostic factor in gastric cancer development. The precise determination of the lymphonodular invasion stage can be made only by extended intraoperative lymphadenectomy and histopathological examination. But the main controversy is the usefulness of extended lymph dissection in early gastric cancer. This increases the duration of the surgery and the complications rate, and it is unnecessary without lymphonodular invasion. The identification of the sentinel lymph nodes has been successfully applied for some time in the precise detection of lymph nodes status in breast cancer, malignant melanoma and the use for gastric cancer patients has been a controversial issue. The good prognosis in early gastric cancer had been a surgery challenge, which led to the establishment of minimally invasive individualized treatment and acceptance of sentinel lymph node mapping. The dual-tracer method, submucosally administered endoscopically is also recommended in sentinel lymph node biopsy by laparoscopic approach. There are new sophisticated technologies for detecting sentinel lymph node such as: infrared ray endoscopy, florescence imaging and near-infrared technology, carbon nanoparticles, which will open new perspectives in sentinel lymph nodes mapping.

scholarly journals CT lymphography for sentinel lymph node mapping of clinically N0 early oral cancer

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Satomi Sugiyama ◽  
Toshinori Iwai ◽  
Toshiharu Izumi ◽  
Keita Ishiguro ◽  
Junichi Baba ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Oral Cancer ◽  
Lymph Nodes ◽  
Contrast Medium ◽  
Sentinel Lymph Node Mapping ◽  
Ct Scanning ◽  
Optimal Timing ◽  
Ct Scanner ◽  
Lymph Node Mapping

Abstract Background The objectives of this retrospective study were to evaluate the usefulness of computed tomography lymphography (CTL) and to clarify the optimal timing of CTL in sentinel lymph node (SLN) mapping of clinically N0 early oral cancer. Methods Twenty patients with clinically N0 early oral cancer underwent CTL with a 128 multi-detector row CT scanner to detect SLN the day before resection of primary tumor and SLN biopsy with indocyanine green (ICG) fluorescence guidance. CT scanning was performed in the first 10 patients at 2, 5, and 10 min after submucosal injection of iopamidol and in the remaining 10 patients at 2, 3.5, 5, and 10 min after the injection of contrast medium. We evaluated the SLN detection rate at each scan timing and the number and location of SLNs. We evaluated whether CTL-enhanced SLNs could be identified intraoperatively as ICG fluorescent lymph nodes. Results SLNs were detected by CTL in 19 of the 20 patients (95.0%), and the mean number of SLNs was 2 (range, 1–4). All SLNs were located on the ipsilateral side; 35 of 37 SLNs were located at level I and II, and 2 SLNs were lingual lymph nodes. All SLNs could be detected 2 min and 3.5–5 min after contrast medium injection, and CTL-enhanced SLNs could be identified intraoperatively as fluorescent lymph nodes. Conclusions CTL could facilitate the detection of SLNs in early oral cancer, and the optimal timing of CT scanning was at 2 and 5 min after injection of contrast medium.

scholarly journals Cutting a sentinel lymph node into slices is the optimal first step for examination of sentinel lymph nodes in melanoma patients

2009 ◽  
Vol 22 (12) ◽  
pp. 1622-1627 ◽  
Author(s):  
Christina Mitteldorf ◽  
Hans P Bertsch ◽  
Antonia Zapf ◽  
Christine Neumann ◽  
Lutz Kretschmer
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
Sentinel Lymph Nodes ◽  
Melanoma Patients

Comparative analysis of survival in colon cancer undergoing sentinel lymph node mapping versus conventional surgery based on number of positive lymph nodes.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 734-734
Author(s):  
Sabarina Ramanathan ◽  
Sukamal Saha ◽  
Suresh Mukkamala ◽  
Michael Hicks ◽  
Patrick Knight ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
Success Rate ◽  
Sentinel Lymph Node Mapping ◽  
Multicenter Trial ◽  
Blue Dye ◽  
Lymph Node Mapping ◽  
Regional Lymphadenectomy

734 Background: Unlike in breast cancer or melanoma, resection during sentinel lymph node mapping (SLNM) in colon cancer (CCa) includes regional lymphadenectomy including SLNs and non SLNs. However, SLNM often identifies micrometastases which can be missed by conventional (Conv) surgery and pathologic examination. It is unknown whether this impacts survival or recurrence. Hence, a retrospective analysis was undertaken to study overall (OS) and disease -specific (DSS) survival between patients (pts) undergoing SLNM vs Conv surgery based on the number of +veLNs. Methods: SLNM was done by subserosal injection with blue dye followed by segmental resection including regional lymphadenectomy. All SLNs were ultrastaged and other nodes were examined by conv. methods with H&E. Results: There are 309 pts in SLNM (GpA) vs 499 pts in Conv surgery (GpB); with average no. of lymph nodes (LNs) and +ve LNs 17.3/1.6 vs 14.4/2.49 respectively. For GpA, success rate was 99.6% and the average no of SLN was 3. Of the pts in GpA vs GpB, 1+ve LN were found in 38% vs 27%, 2+ve LNs in 10% vs 16%, and > 2 LNs in 53% vs 57%, respectively. Comparing 5 years OS between GpA vs GpB, for 1+ve LN was 62.8% vs 52.38%, for 2 +ve LNs 72.7% vs 48.65% and for > 2 +ve LNs 35% vs 33.33%, respectively. Similarly, DSS for 1 +veLN was 54.4% vs 47.6%, 2+ve LNs 40% vs 40.54% and > 2+ve LNs, 30.4% vs 25.76%, respectively(Table1.). Conclusions: Compared to Conv surgery, SLNM identified higher no. of LNs per pt with high success rate. Five-year OS and DSS also are better in SLNM vs Conv surgery for all +ve LN gps. Hence, SLNM in CCa may have prognostic value. A larger multicenter trial needs to be done to validate such data. [Table: see text]

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

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.

scholarly journals Ultrastaging methods of sentinel lymph nodes in endometrial cancer – a systematic review

2020 ◽  
pp. ijgc-2020-001964
Author(s):  
Lara C Burg ◽  
Ellen M Hengeveld ◽  
Joanna in 't Hout ◽  
Johan Bulten ◽  
Peter Bult ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Detection Rate ◽  
Sentinel Lymph Node Mapping ◽  
Sentinel Lymph Nodes ◽  
Lymph Node Mapping ◽  
Node Metastases ◽  
Hematoxylin And Eosin ◽  
Hematoxylin And Eosin Staining

ObjectiveSentinel lymph node mapping has emerged as an alternative to lymphadenectomy in evaluating the lymph node status in endometrial cancer. Several pathological methods to examine the sentinel lymph node are applied internationally. The aim of this study was to determine the value of ultrastaging and to assess the ultrastaging method with the highest detection rate of metastases.MethodsA systematic review was conducted. Inclusion criteria were: pathologically-confirmed endometrial cancer with sentinel lymph node mapping, report of the histological outcomes, metastases found by hematoxylin and eosin staining and metastases found by ultrastaging were separately mentioned, and description of the ultrastaging method. The primary outcome was the detection of metastases found by ultrastaging that were not detected by routine hematoxylin and eosin staining. The secondary outcome was the difference in detection rate of metastases between several ultrastaging methods. Random effects meta-analyses were conducted.ResultsFifteen studies were selected, including 2259 patients. Sentinel lymph nodes were examined by routine hematoxylin and eosin staining. Subsequently, multiple ultrastaging methods were used, with differences in macroscopic slicing (bread-loaf/longitudinal), number of microscopic slides, and distance between slides, but all used immunohistochemistry. A positive sentinel lymph node was found in 14% of patients. In 37% of these, this was detected only by ultrastaging. Using more ultrastaging slides did not result in a higher detection rate. Bread-loaf slicing led to a higher detection rate compared with longitudinal slicing (mean detection rates 53% and 33%, respectively).ConclusionPathological ultrastaging after routine hematoxylin and eosin staining in endometrial cancer patients has led to an increased detection rate of sentinel lymph node metastases. Different ultrastaging methods are used, with a preference for bread-loaf slicing. However, due to the large heterogeneity of the studies, assessing which ultrastaging method has the highest detection rate of sentinel lymph node metastases was not possible.

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