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Zang J, Liu Q, Sui H, Guo H, Peng L, Li F, Lang L, Jacobson O, Zhu Z, Mao F, Chen X. Combined 68Ga-NOTA-Evans Blue Lymphoscintigraphy and 68Ga-NOTA-RM26 PET/CT Evaluation of Sentinel Lymph Node Metastasis in Breast Cancer Patients. Bioconjug Chem 2020; 31:396-403. [PMID: 31880916 DOI: 10.1021/acs.bioconjchem.9b00789] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In this study, we applied a new strategy to identify sentinel lymph node (SLN) metastasis by combining 68Ga-NOTA-Evans Blue (68Ga-NEB) for SLN mapping and 68Ga-NOTA-RM26 for LN metastasis detection in breast cancer patients. A total of 24 female patients with breast cancer diagnosed by core biopsy or suspected by mammography or ultrasonography were recruited and provided informed consent. All patients underwent 68Ga-NEB and 68Ga-NOTA-RM26 PET/CT imaging. Visual analysis of 68Ga-NEB PET/CT images was used to determine SLNs, and then compared with the 68Ga-NOTA-RM26 results and histopathological findings. SLNs were visualized in 24 of 24 patients (100.0%) within 4.0-10.0 (5.6 ± 1.4) min. All patients were pathologically diagnosed with breast cancer, and 12 patients had ipsilateral lymph node metastasis. By combining 68Ga-NEB and 68Ga-NOTA-RM26 images, 7/12 (58.3%) patients showed mild to intense uptake of 68Ga-NOTA-RM26 in SLNs, 1/12 patient (8.3%) had moderate uptake of 68Ga-NOTA-RM26 in the non-SLNs rather than SLN, indicating possible bypass lymphatic drainage, partially accounting for the false negatives in SLN biopsy during surgery. No false positives were found. The SUVmax of 68Ga-NOTA-RM26 activity in metastatic SLNs was significantly higher than that in non-metastatic SLNs (2.2 ± 2.3 vs 0.7 ± 0.1, P = 0.047). This study manifests the value of combination of 68Ga-NEB and 68Ga-NOTA-RM26 dual tracer PET/CT in preoperative evaluation of SLN metastasis in breast cancer patients, especially in those patients with lymphatic obstruction and bypass drainage. In general, positive 68Ga-NOTA-RM26 uptake in either SLN or other lymph nodes can apply lymph node dissection rather than intraoperative SLN biopsy.
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Affiliation(s)
- Jie Zang
- Department of Nuclear Medicine, Peking Union Medical College Hospital , Chinese Academy of Medical Science and Peking Union Medical College , Beijing 100730 , China.,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine , Beijing 100730 , China
| | - Qingxing Liu
- Department of Nuclear Medicine, Peking Union Medical College Hospital , Chinese Academy of Medical Science and Peking Union Medical College , Beijing 100730 , China.,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine , Beijing 100730 , China
| | - Huimin Sui
- Department of Nuclear Medicine, Peking Union Medical College Hospital , Chinese Academy of Medical Science and Peking Union Medical College , Beijing 100730 , China.,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine , Beijing 100730 , China
| | - Hua Guo
- Department of Nuclear Medicine, Peking Union Medical College Hospital , Chinese Academy of Medical Science and Peking Union Medical College , Beijing 100730 , China.,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine , Beijing 100730 , China
| | - Li Peng
- Department of Breast Surgery, Peking Union Medical College Hospital , Chinese Academy of Medical Science and Peking Union Medical College , Beijing 100730 , China
| | - Fang Li
- Department of Nuclear Medicine, Peking Union Medical College Hospital , Chinese Academy of Medical Science and Peking Union Medical College , Beijing 100730 , China.,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine , Beijing 100730 , China
| | - Lixin Lang
- Laboratory of Molecular Imaging and Nanomedicine (LOMIN), National Institute of Biomedical Imaging and Bioengineering (NIBIB) , National Institutes of Health (NIH) , Bethesda , Maryland 20892 , United States
| | - Orit Jacobson
- Laboratory of Molecular Imaging and Nanomedicine (LOMIN), National Institute of Biomedical Imaging and Bioengineering (NIBIB) , National Institutes of Health (NIH) , Bethesda , Maryland 20892 , United States
| | - Zhaohui Zhu
- Department of Nuclear Medicine, Peking Union Medical College Hospital , Chinese Academy of Medical Science and Peking Union Medical College , Beijing 100730 , China.,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine , Beijing 100730 , China
| | - Feng Mao
- Department of Breast Surgery, Peking Union Medical College Hospital , Chinese Academy of Medical Science and Peking Union Medical College , Beijing 100730 , China
| | - Xiaoyuan Chen
- Laboratory of Molecular Imaging and Nanomedicine (LOMIN), National Institute of Biomedical Imaging and Bioengineering (NIBIB) , National Institutes of Health (NIH) , Bethesda , Maryland 20892 , United States
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Li H, Jun Z, Zhi-Cheng G, Xiang Q. Factors that affect the false negative rate of sentinel lymph node mapping with methylene blue dye alone in breast cancer. J Int Med Res 2019; 47:4841-4853. [PMID: 31507208 PMCID: PMC6833398 DOI: 10.1177/0300060519827413] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
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.
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Affiliation(s)
- Huang Li
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Department of Breast Surgery Ward No. 3, The Affiliated Tumor Hospital of Shanxi Medical University, Shanxi Tumor Hospital, Taiyuan, Shanxi, China
| | - Zhang Jun
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ge Zhi-Cheng
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qu Xiang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Man V, Wong TT, Co M, Suen D, Kwong A. Sentinel Lymph Node Biopsy in Early Breast Cancer: Magnetic Tracer as the Only Localizing Agent. World J Surg 2019; 43:1991-1996. [PMID: 30888473 DOI: 10.1007/s00268-019-04977-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The combined use of radioisotope and blue dye is the gold standard in sentinel lymph node (SLN) localization in early breast cancer. Superparamagnetic iron oxide (SPIO) has recently emerged as a non-inferior new tracer in sentinel lymph node mapping with fewer disadvantages. This study represents the first and the largest cohort of superparamagnetic iron oxide application in Asian population. METHODS Retrospective analysis of a prospectively maintained database was performed from August 2016 to December 2017. All patients with SLN localization by SPIO were included in this study. RESULTS A total of 328 breast cancer patients with 333 SLNB procedures were included in this study. Median age was 54 years (range 32-86). Median tumor size was 1.9 cm (range 0.1-12 cm).There were 138 breast-conserving surgeries and 195 mastectomies. All patients received injection of SPIO 1 day prior to operation. A total of 329 successful sentinel lymph node biopsy (SLNB) procedures were undertaken with 1514 sentinel lymph nodes (SLNs) identified. One hundred and fifty-three (10.1%) of the SLNs were positive for malignancy. There were 54 patients with macrometastases, 26 with micrometastases and 24 with isolated tumor cells. Sixty-seven patients underwent subsequent axillary dissection. Four patients failed sentinel lymph node identification with SPIO. The success rate of SPIO in sentinel lymph node localization was 98.8%. CONCLUSION SPIO represents a feasible alternative in sentinel lymph node mapping with comparably high nodal detection rate.
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Affiliation(s)
- Vivian Man
- Division of Breast Surgery, Department of Surgery, The University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, K1401, Hong Kong, Hong Kong SAR
| | - Ting Ting Wong
- Private Practice Breast Surgeon, The Breast Surgery, Suite 1203, 12/F East Point Center, 555 Hennessy Road, Causeway Bay, Hong Kong, Hong Kong SAR
| | - Michael Co
- Division of Breast Surgery, Department of Surgery, The University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, K1401, Hong Kong, Hong Kong SAR
| | - Dacita Suen
- Division of Breast Surgery, Department of Surgery, The University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, K1401, Hong Kong, Hong Kong SAR
| | - Ava Kwong
- Division of Breast Surgery, Department of Surgery, The University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, K1401, Hong Kong, Hong Kong SAR.
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Kuemmel S, Holtschmidt J, Gerber B, Von der Assen A, Heil J, Thill M, Krug D, Schem C, Denkert C, Lubitz J, Blohmer JU, Reinisch M, Hötzeldt M, Seither F, Nekljudova V, Schwidde I, Uhrhan K, Von Minckwitz G, Rezai M, Mulowski J, Loibl S, Kuehn T. Prospective, Multicenter, Randomized Phase III Trial Evaluating the Impact of Lymphoscintigraphy as Part of Sentinel Node Biopsy in Early Breast Cancer: SenSzi (GBG80) Trial. J Clin Oncol 2019; 37:1490-1498. [DOI: 10.1200/jco.18.02092] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The aim of the current work was to clarify whether a preoperative lymphoscintigraphy (LSG) enhances staging accuracy of sentinel lymph node biopsy (SLNB). PATIENTS AND METHODS In a prospective, multicenter, randomized phase III trial, patients with cN0 early breast cancer or extensive/high-grade ductal carcinoma in situ planned for standard radioactive-labeled colloid LSG with subsequent SLNB were randomly assigned 1:1 to receive SLNB either with knowledge of the LSG findings or without. As the false-negative rate of SLNB correlates with the number of resected sentinel lymph nodes (SLNs), our primary end point was the mean number of histologically detected SLNs per patient. One thousand one hundred two evaluable patients were necessary to demonstrate noninferiority of SLNB without LSG. Stratified one-sided 95% CI for the difference (without LSG − with LSG) in the mean number of histologically detected SLNs had to be greater than −0.27 (10% noninferiority margin). Stratification was performed according to tumor focality and trial site. Additional predefined secondary end points (rates of node-positive patients and of completion axillary lymph node dissection) were analyzed to rule out differences in the reliable detection of nodal metastases. RESULTS Between May 2014 and October 2015, 1,198 patients were randomly assigned in 23 German and Swiss breast centers. Modified intention-to-treat analysis (n = 1,163) showed a mean number of histologically detected SLNs of 2.21 with LSG and 2.26 without LSG (difference 0.05; stratified 95% CI, −0.18 to infinity), thus establishing noninferiority of omitting preoperative LSG. Secondary end points displayed no statistically significant differences. CONCLUSION We show that SLNB is equally effective irrespective of the surgeon’s knowledge of preoperative LSG results. SLNB without LSG will speed up the preoperative workflow and reduce cost.
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Affiliation(s)
| | | | | | | | - Joerg Heil
- University Hospital Heidelberg, Heidelberg, Germany
| | - Marc Thill
- Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | - David Krug
- University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Schem
- University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
- Mammazentrum Hamburg, Hamburg, Germany
| | | | | | | | - Mattea Reinisch
- Kliniken Essen-Mitte, Essen, Germany
- German Breast Group, Neu-Isenburg, Germany
| | | | | | | | - Ilka Schwidde
- Die Frauenärztinnen Mülheim an der Ruhr, Mülheim, Germany
| | - Klara Uhrhan
- Zentrum für Nuklearmedizin und Molekulare Bildgebung Essen, Essen, Germany
| | | | - Mahdi Rezai
- Luisenkrankenhaus Düsseldorf, Düsseldorf, Germany
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Zhao YX, Liu YR, Xie S, Jiang YZ, Shao ZM. A Nomogram Predicting Lymph Node Metastasis in T1 Breast Cancer based on the Surveillance, Epidemiology, and End Results Program. J Cancer 2019; 10:2443-2449. [PMID: 31258749 PMCID: PMC6584352 DOI: 10.7150/jca.30386] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 04/22/2019] [Indexed: 01/21/2023] Open
Abstract
Background: Patients with early stage breast cancer with lymph nodes metastasis were proven to have more aggressive biologically phenotypes. This study aimed to build a nomogram to predict lymph node metastasis in patients with T1 breast cancer. Methods: We identified female patients with T1 breast cancer diagnosed between 2010 and 2014 in the Surveillance, Epidemiology and End Results database. The patients were randomized into training and validation sets. Univariate and multivariate logistic regressions were carried out to assess the relationships between lymph node metastasis and clinicopathological characteristics. A nomogram was developed and validated by a calibration curve and receptor operating characteristic curve analysis. Result: Age, race, tumour size, tumour primary site, pathological grade, oestrogen receptor (ER) status, progesterone receptor (PR) status and human epidermal growth factor receptor 2 (HER2) status were independent predictive factors of positive lymph node metastasis in T1 breast cancer. Increasing age, tumour size and pathological grade were positively correlated with the risk of lymph node metastasis. We developed a nomogram to predict lymph node metastasis and further validated it in a validation set, with areas under the receiver operating characteristic curves of 0.733 and 0.741 in the training and validation sets, respectively. Conclusions: A better understanding of the clinicopathological characteristics of T1 breast cancer patients might important for assessing their lymph node status. The nomogram developed here, if further validated in other large cohorts, might provide additional information regarding lymph node metastasis. Together with sentinel lymph node biopsy, this nomogram can help comprehensively predict lymph node metastasis.
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Affiliation(s)
- Ya-Xin Zhao
- Department of Breast Surgery, Fudan University Shanghai Cancer Center; Cancer Institute, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, P. R. China
| | - Yi-Rong Liu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center; Cancer Institute, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, P. R. China
| | - Shao Xie
- Department of Oncology, Shanghai Medical College, Fudan University, P. R. China
| | - Yi-Zhou Jiang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center; Cancer Institute, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, P. R. China
| | - Zhi-Ming Shao
- Department of Breast Surgery, Fudan University Shanghai Cancer Center; Cancer Institute, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, P. R. China.,Institutes of Biomedical Sciences, Fudan University, Shanghai, P. R. China
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Predictive risk factors for sentinel lymph node nonvisualization on planar lymphoscintigraphy using an intratumoral injection in patients with primary breast cancer. Nucl Med Commun 2019; 40:317-324. [PMID: 30601244 DOI: 10.1097/mnm.0000000000000971] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Lymphoscintigraphy is considered a useful tool to optimize sentinel lymph node (SLN) identification. Nonvisualization of the SLN is associated with a lower SLN identification rate. The aim of this study was to identify preoperative factors associated with SLN nonvisualization on lymphoscintigraphy. PATIENTS AND METHODS A total of 2050 consecutive SLN procedures were evaluated from clinically node-negative breast cancer patients. Planar lymphoscintigraphy was performed at 3 h after an intratumoral injection of technetium-99m-nanocolloid. This technique was used for extra-axillary SLN identification. Patient, tumor, and treatment characteristics were analyzed for association with SLN nonvisualization. Factors with a P-value less than 0.1 in univariate analysis were included in a multivariate logistic regression model. RESULTS The SLN visualization rate was 86.7%. In multivariate logistic regression, age of at least 70 years [odds ratio (OR): 3.24; 95% confidence interval (CI): 2.14-4.91)], BMI of at least 30 (OR: 1.93; 95% CI: 1.39-2.69), T3/T4-tumors (OR: 2.70; 95% CI: 1.37-5.32), medially/centrally located tumors (OR: 1.52; 95% CI: 1.17-1.99), previous mantle field radiation (OR: 4.04; 95% CI: 1.74-9.35), nonpalpable tumors (OR: 1.88; 95% CI: 1.36-2.60), and presence of iodine seeds (OR: 1.35; 95% CI: 1.02-1.78) were associated significantly with nonvisualization on lymphoscintigraphy. Nonvisualization was the strongest independent predictor of unsuccessful intraoperative SLN identification (P<0.001). Overall, the SLN identification rate was 97.7% because of the use of additional imaging and blue dye. CONCLUSION This study reports new tumor and treatment-related risk factors for nonvisualization on lymphoscintigraphy by using an intratumoral injection in primary breast cancer. We recommend a periareolar subcutaneous injection to improve SLN visualization in patients with limited prognostic and therapeutic relevance of internal mammary chain SLN identification.
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Relationship between Upper Extremity Lymphatic Drainage and Sentinel Lymph Nodes in Patients with Breast Cancer. JOURNAL OF ONCOLOGY 2019; 2019:8637895. [PMID: 31057616 PMCID: PMC6463564 DOI: 10.1155/2019/8637895] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 01/10/2019] [Accepted: 02/11/2019] [Indexed: 12/02/2022]
Abstract
Purpose The purpose of this study was to identify the relationship between upper extremity lymphatics and sentinel lymph nodes (SLNs) in breast cancer patients. Methods Forty-four patients who underwent axillary reverse mapping (ARM) during axillary lymph node dissection (ALND) with SNL biopsy (SLNB) between February 2017 and October 2017 were investigated. ARM was performed using indocyanine green (ICG) to locate the upper extremity lymphatics; methylene blue dye was injected intradermally for SLN mapping. Results ARM nodes were found in the ALND fields of all examined patients. The rate of identification of upper extremity lymphatics within the SLNB field was 65.9% (29 of 44). The ARM nodes were involved in metastases arising from primary breast tumors in 7 of the patients (15.9%), while no metastases were detected in pathologic axillary lymph node-negative patients. Lymphatics from the upper extremity drained into the SLNs in 5 of the 44 patients (11.4%); their ARM-detected nodes were found to be in close proximity to the SLNs. Conclusions The ARM nodes and SLNs are closely related and share lymphatic drainage routes. The ARM procedure using fluorescence imaging is both feasible and, in patients who are SLN negative, oncologically safe. ARM using ICG is therefore effective for identifying and preserving upper extremity lymphatics, and SLNB combined with ARM appears to be a promising surgical refinement for preventing upper extremity lymphoedema. Clinical Trial Registration This trial is registered with ClinicalTrial.gov: NCT02651142.
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Korbi A, Khaskhoussy A, Cherif O, Hajji A, Gaddab I, Chaabene A, Gara M, Jbeli F, Grati L, Rhim MS, Faleha R. Anaphylactic shock due to patent blue: case report and review of literature. Pan Afr Med J 2019; 31:7. [PMID: 30918536 PMCID: PMC6430938 DOI: 10.11604/pamj.2018.31.7.15576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 08/03/2018] [Indexed: 11/11/2022] Open
Abstract
Intraoperative search for the sentinal node using patent blue is considered a non risk procedure. We emphasize the highly exceptional nature of this adverse effect previously observed in other disciplines using this coloring agent. We present a case of allergic reaction to patent blue in a patient who underwent left mastectomy with sentinel lymph node. About 25 min after the dye injection, the patient developed increased heart frequency and allergic skin reaction. The patient was treated successfully with decreased inspired fraction of inhaled anesthetic and fluid replacement. The patient recovered uneventfully and was discharged from the PACU 3h after the end of surgery without skin changes and was discharged from hospital on the morning after surgery. Allergic reactions with the use of patent blue are far superior to the hypersensitivity reactions seen with anesthetic and adjuvant drugs. Therefore, the anesthesiologist must be aware of cardiovascular instability associated with skin changes during the use of patent blue, for early diagnosis and appropriate treatment of this hypersensitivity reaction to this dye. Skin tests done later confirmed allergy to patent blue dye; the tests induced a small syndrome reaction. Surgical personnel who use patent blue dye should be made aware of the risk of allergic reactions, sometimes severe, to this dye.
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Affiliation(s)
- Asma Korbi
- Service de Gynéco-Obstétrique Monastir CMNM 5000 Monastir, Tunisia
| | - Amel Khaskhoussy
- Service de Gynéco-Obstétrique Monastir CMNM 5000 Monastir, Tunisia
| | - Ons Cherif
- Service de Gynéco-Obstétrique Monastir CMNM 5000 Monastir, Tunisia
| | - Ahmed Hajji
- Service de Gynéco-Obstétrique Monastir CMNM 5000 Monastir, Tunisia
| | - Imen Gaddab
- Service de Gynéco-Obstétrique Monastir CMNM 5000 Monastir, Tunisia
| | - Amel Chaabene
- Service de Pharmacologie Clinique, CHU Fattouma Bourguiba Monastir, 5000 Monastir, Tunisia
| | - Mouna Gara
- Département d'Anesthésie Réanimation Monastir CMNM 5000 Monastir, Tunisia
| | - Fathi Jbeli
- Département d'Anesthésie Réanimation Monastir CMNM 5000 Monastir, Tunisia
| | - Lotfi Grati
- Département d'Anesthésie Réanimation Monastir CMNM 5000 Monastir, Tunisia
| | - Med Salah Rhim
- Service de Gynéco-Obstétrique Monastir CMNM 5000 Monastir, Tunisia
| | - Raja Faleha
- Service de Gynéco-Obstétrique Monastir CMNM 5000 Monastir, Tunisia
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Indocyanine Green (ICG) Fluorescence Imaging in Sentinel Lymph Node Biopsy (SLNB) for Early Breast Cancer: First Indian Experience. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2019. [DOI: 10.1007/s40944-019-0275-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Sentinel Lymph Node Evaluation: What the Radiologist Needs to Know. Diagnostics (Basel) 2019; 9:diagnostics9010012. [PMID: 30658417 PMCID: PMC6468633 DOI: 10.3390/diagnostics9010012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/05/2019] [Accepted: 01/05/2019] [Indexed: 02/06/2023] Open
Abstract
Axillary lymph node status is the single most important prognostic indicator in patients with breast cancer. Axillary lymph node dissection, the traditional method of staging breast cancer, is associated with significant morbidity. Sentinel lymph node biopsy has become standard in patients being treated for breast cancer with clinically negative lymph nodes. There is considerable variation in the medical literature regarding technical approaches to sentinel lymph node biopsy in patients with breast cancer. The purpose of this article is to describe our preferred approaches to sentinel lymph node biopsy with a review of the literature.
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Dejust S. L’exploration axillaire : un standard du bilan préthérapeutique. ONCOLOGIE 2019. [DOI: 10.3166/onco-2019-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
L’exploration préthérapeutique axillaire est une étape majeure du bilan initial du cancer du sein. L’échographie associée à un prélèvement est actuellement recommandée en première intention. L’IRM et la TEP/TDM au 18FDG sont utiles dans l’évaluation ganglionnaire axillaire. Les sensibilités et spécificités des examens d’imagerie sont globalement identiques, et leur combinaison permet d’obtenir les meilleures performances. Actuellement, la technique du ganglion sentinelle est indispensable en cas de tumeurs mammaires T1-T2 N0 et en cas d’adénopathie suspecte échographiquement avec cytoponction ou microbiopsie négative.
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Hellingman D, de Wit-van der Veen BJ, Wan OY, van der Ploeg IM, Rutgers EJT, Stokkel MPM. Sentinel lymph node nonvisualization after intratumoral radioisotope tracer injection in breast cancer is not associated with a higher nodal metastasis rate or worse outcomes. J Surg Oncol 2018; 119:421-429. [DOI: 10.1002/jso.25339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/13/2018] [Accepted: 11/28/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Daan Hellingman
- Department of Nuclear Medicine; Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital; Amsterdam The Netherlands
| | - Berlinda J de Wit-van der Veen
- Department of Nuclear Medicine; Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital; Amsterdam The Netherlands
| | - Oi Yan Wan
- Department of Nuclear Medicine; Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital; Amsterdam The Netherlands
| | - Iris M van der Ploeg
- Department of Surgical Oncology; Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital; Amsterdam The Netherlands
| | - Emiel J. Th. Rutgers
- Department of Surgical Oncology; Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital; Amsterdam The Netherlands
| | - Marcel P. M. Stokkel
- Department of Nuclear Medicine; Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital; Amsterdam The Netherlands
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Combination Technique Is Superior to Dye Alone in Identification of the Sentinel Lymph Node in Male Breast Cancer. Am Surg 2018. [DOI: 10.1177/000313481808401244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sentinel lymph node (SLN) biopsy is the main method in staging the axilla. There are insufficient data available regarding the accuracy of an SLN biopsy in male breast cancer. The aim of this study is to evaluate whether the combination of dye and radiotracer would improve the detection rate of SLNs versus dye alone in male breast cancer patients. From February 2009 to January 2012, our SLN biopsy database was retrospectively reviewed to identify male breast cancer cases. Of the 890 SLN procedures contained in the database, 10 male breast cancer patients were identified. Patient age, body mass index, SLN biopsy technique, SLN identification, number of SLN excised, and pathology reports were reviewed. Mean age was 57.2 (34–85) years with a mean tumor size was 2.2 (1.0–4.0) cm. SLN detection ratios were two in four with blue dye and six in six with the combination technique. Overall, SLNs were identified in 8 of the 10 patients. SLN biopsy is applicable in male breast cancer cases. The addition of a radiotracer to the dye in SLN biopsy increases the detection rate of sentinel nodes in male breast cancer patients.
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Favril S, Stock E, Hernot S, Hesta M, Polis I, Vanderperren K, de Rooster H. Sentinel lymph node mapping by near-infrared fluorescence imaging and contrast-enhanced ultrasound in healthy dogs. Vet Comp Oncol 2018; 17:89-98. [PMID: 30311430 DOI: 10.1111/vco.12449] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 09/04/2018] [Accepted: 09/24/2018] [Indexed: 02/06/2023]
Abstract
Sentinel lymph node (SLN) mapping is a valuable and crucial diagnostic procedure in staging malignancies. We compared two non-invasive techniques, near-infrared (NIR) fluorescence imaging and contrast-enhanced ultrasound (CEUS), to identify the SLNs in three superficial anatomical regions in an animal model. Six healthy laboratory dogs were included in a proof-of-concept trial. A NIR fluorescent dye (Indocyanine Green) and microbubbles (Sonovue) were consecutively injected subdermally in the Inguinal, axillary and popliteal region to map the SLNs. Transcutaneous NIR fluorescence imaging identified SLNs in 17 out of a total of 18 occasions. CEUS identified SLNs in all regions (18/18). Whereas NIR fluorescence imaging performed better in the visualization of the afferent lymphatic tract, CEUS demonstrated different filling patterns of the SLNs, a feature potentially critical for the concept of SLN mapping in cancer patients. Both NIR fluorescence imaging and CEUS are safe, non-invasive, practical and accurate methods to perform real-time transcutaneous SLN mapping with potential in a clinical setting.
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Affiliation(s)
- Sophie Favril
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.,Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Emmelie Stock
- Department of Medical Imaging of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Sophie Hernot
- Laboratory in vivo Cellular and Molecular Imaging (ICMI-BEFY/MIMA), Vrije Universiteit Brussel, Brussels, Belgium
| | - Myriam Hesta
- Laboratory of Animal Nutrition, Department of Nutrition, Genetics and Ethology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Ingeborgh Polis
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Katrien Vanderperren
- Department of Medical Imaging of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Hilde de Rooster
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.,Cancer Research Institute Ghent (CRIG), Ghent, Belgium
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66
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Gasparri ML, Caserta D, Benedetti Panici P, Papadia A, Mueller MD. Surgical staging in endometrial cancer. J Cancer Res Clin Oncol 2018; 145:213-221. [PMID: 30460411 DOI: 10.1007/s00432-018-2792-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 11/12/2018] [Indexed: 01/17/2023]
Abstract
In several malignancies, it has been demonstrated that the lymph nodal status is the most important pathologic factor affecting prognosis and giving the indication to further adjuvant treatment. The surgical assessment of the lymph nodal status in endometrial cancer is debated since 30 years. Recently, the sentinel lymph node mapping is rapidly gaining clinical acceptance in endometrial cancer. The adoption of Indocyanine Green as a safe and user friendly tracer for sentinel lymph node mapping increased the speed to which this procedure is getting applied in clinical practice. As a consequence of this rapid growth, several fundamental questions have been raised and are still debatable. In this manuscript, we discuss the importance of a known pathological lymph nodal status, the technique of the sentinel lymph node mapping with the reported false negative rates and detection rates according to the different tracers adopted, and the clinical scenarios in which a sentinel lymph node mapping could be employed.
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Affiliation(s)
- Maria Luisa Gasparri
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland.
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Rome, Italy.
- Department of Gynecological-Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, Rome, Italy.
| | - Donatella Caserta
- Surgical and Medical Department of Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Gynecological-Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
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67
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Bouquet de Jolinière J, Major A, Khomsi F, Ben Ali N, Guillou L, Feki A. The Sentinel Lymph Node in Breast Cancer: Problems Posed by Examination During Surgery. A Review of Current Literature and Management. Front Surg 2018; 5:56. [PMID: 30488035 PMCID: PMC6247078 DOI: 10.3389/fsurg.2018.00056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 08/16/2018] [Indexed: 11/24/2022] Open
Abstract
The presence of tumor cells can be identified in the lymph node when metastasis has occurred from the primary cancer site into the lymph node (1) If the sentinel lymph node ganglion is negative for the presence of tumor cells at the time of histological examination, the other lymph nodes are also negative in 99% of cases. If no tumor cells are identified in the sentinel lymph node ganglion by histological examination, the other lymph nodes are also negative for the presence of tumor cells in 99% of cases. The sentinel lymph node advantageously replaces axillary dissection as a staging method in breast cancer T1 and T2 (2). Approximately 40% of breast cancers metastasize to axillary lymph nodes and metastatic extension depends on disease stage. Sentinel lymph nodes are affected in the following stages: T1a (4.3%), T1b (19.5%), T1c (23.8%), T2 (48.9%), T3 (66.7%).
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Affiliation(s)
| | - A. Major
- Department of Gynecology Obstetrics, Cantonal Hospital, HFR, Fribourg, Switzerland
| | - F. Khomsi
- Department of Gynecology Obstetrics, Cantonal Hospital, HFR, Fribourg, Switzerland
| | - N. Ben Ali
- Department of Gynecology Obstetrics, Cantonal Hospital, HFR, Fribourg, Switzerland
| | - L. Guillou
- Argotlab and Synlab Laboratories, Department of Pathology, Lausanne, Switzerland
| | - A. Feki
- Department of Gynecology Obstetrics, Cantonal Hospital, HFR, Fribourg, Switzerland
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68
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Surgeon-associated variation in breast cancer staging with sentinel node biopsy. Surgery 2018; 164:680-686. [DOI: 10.1016/j.surg.2018.06.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/25/2018] [Accepted: 06/12/2018] [Indexed: 11/23/2022]
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Takemoto N, Koyanagi A, Yasuda M, Yamamoto H. Comparison of the indocyanine green dye method versus the combined method of indigo carmine blue dye with indocyanine green fluorescence imaging for sentinel lymph node biopsy in breast conservative therapy for stage ≤IIA breast cancer. BMC WOMENS HEALTH 2018; 18:151. [PMID: 30227837 PMCID: PMC6145193 DOI: 10.1186/s12905-018-0646-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 09/12/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Fluorescence imaging (FI) is one of the methods to identify sentinel lymph nodes (SLNs). However, the procedure is technically complicated and requires procedural skills, as SLN biopsy must be conducted in dim light conditions. As an improved version of this method, we introduced a combined method (Combined mixed dye and fluorescence; CMF) consisting of indigo carmine blue dye and FI. The direct visualization of SLNs under shadowless surgical light conditions is facilitated by the addition of the blue dye. We compared the SLN detection rates of CMF with that of the indocyanine green (ICG) dye method (ICG-D). METHODS A total of 202 patients with stage ≤IIA breast cancer who underwent breast conservative therapy with separate incision from January 2004 to February 2017 were reviewed. Details of the two methods are as follows: (1) ICG-D: 10 mg of ICG was used and the green-stained SLNs were resected via a 3-4 cm axillary incision; (2) CMF: A combination of 5 mg of ICG and 4-8 mg of indigo carmine was used. After a 1.5-2 cm incision was made near the point of disappearance of the fluorescence using Photodynamic Eye (PDE), the blue-stained SLNs were resected under shadowless surgical light conditions. RESULTS There were 92 ICG-D and 110 CMF cases. CMF resulted in a significantly higher SLN detection rate than ICG-D (96.4% vs. 83.7%; p = 0.003). This difference was particularly notable in those aged ≥60 years (98.3% vs. 74.3%) and individuals with body mass index (BMI) ≥25 kg/m2 (90.3% vs. 58.3%). CONCLUSION CMF is an effective method to identify SLNs which is safe and efficient. CMF achieves a high SLN identification rate and most of this procedure is feasible under shadowless surgical light conditions. CMF can reliably perform SLN biopsy even in those aged ≥60 years and individuals with BMI ≥ 25 kg/m2.
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Affiliation(s)
- Nobuyuki Takemoto
- Department of Breast & Endocrine Surgery, Japan Medical Alliance East Saitama General Hospital, 5-517, Yoshino, Satte, Saitama, 0153-340, Japan.
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
| | - Masanori Yasuda
- Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Hiroshi Yamamoto
- Geriatric Health Service Facility (COSMOS), Japan Medical Alliance Yokohama Stroke and Brain Center, Yokohama city, Japan
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Soran A, Menekse E, Kanbour-Shakir A, Tane K, Diego E, Bonaventura M, Johnson R. The importance of tattoo pigment in sentinel lymph nodes. Breast Dis 2018; 37:73-76. [PMID: 28697552 DOI: 10.3233/bd-170282] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The presence of pigment in axillary lymph nodes (LN) secondary to migration of tattoo ink can imitate the appearance of a blue sentinel lymph node (SLN) on visual inspection, causing the operator to either miss the true SLN or excise more than is needed. OBJECTIVE We present patients with tattoos ipsilateral to an early stage breast cancer who underwent a SLN biopsy. METHODS Patients were retrospectively reviewed from medical records and clinicopathologic data was collected. A total of 52 LNs were retrieved from 15 patients for sentinel mapping and 29 of them had tattoo pigmentation on pathologic evaluation. RESULTS Of those 29 SLNs, 2 of them (6.9%) were pigmented, but did not contain either blue dye or Tc-99m (pseudopigmented SLN). Two (3.8%) SLNs were positive for metastasis; both of these had either blue dye or Tc99m uptake, and 1 demonstrated tattoo pigment in the node. CONCLUSIONS In this cohort of patients with ipsilateral tattoos, removed more LNs lead to unnecessary excision which may important for increasing the risk of arm morbidity from SLN biopsy. However, the presence of tattoo pigment did not interfere with understaging for axillary mapping and it did not effect of pathological identification of SLNs positivity.
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Affiliation(s)
- Atilla Soran
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA
| | - Ebru Menekse
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA
| | - Amal Kanbour-Shakir
- University of Pittsburgh, Department of Pathology - Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA
| | - Kaori Tane
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA
| | - Emilia Diego
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA
| | - Marguerite Bonaventura
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA
| | - Ronald Johnson
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA
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Surgical Standards for Management of the Axilla in Breast Cancer Clinical Trials with Pathological Complete Response Endpoint. NPJ Breast Cancer 2018; 4:26. [PMID: 30131975 PMCID: PMC6098077 DOI: 10.1038/s41523-018-0074-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 06/26/2018] [Accepted: 06/29/2018] [Indexed: 12/17/2022] Open
Abstract
Advances in the surgical management of the axilla in patients treated with neoadjuvant chemotherapy, especially those with node positive disease at diagnosis, have led to changes in practice and more judicious use of axillary lymph node dissection that may minimize morbidity from surgery. However, there is still significant confusion about how to optimally manage the axilla, resulting in variation among practices. From the viewpoint of drug development, assessment of response to neoadjuvant chemotherapy remains paramount and appropriate assessment of residual disease—the primary endpoint of many drug therapy trials in the neoadjuvant setting—is critical. Therefore decreasing the variability, especially in a multicenter clinical trial setting, and establishing a minimum standard to ensure consistency in clinical trial data, without mandating axillary lymph node dissection, for all patients is necessary. The key elements which include proper staging and identification of nodal involvement at diagnosis, and appropriately targeted management of the axilla at the time of surgical resection are presented. The following protocols have been adopted as standard procedure by the I-SPY2 trial for management of axilla in patients with node positive disease, and present a framework for prospective clinical trials and practice.
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72
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Zhang L, Huang Y, Yang C, Zhu T, Lin Y, Gao H, Yang M, Cheng M, Wang K. Application of a carbon nanoparticle suspension for sentinel lymph node mapping in patients with early breast cancer: a retrospective cohort study. World J Surg Oncol 2018; 16:112. [PMID: 29914538 PMCID: PMC6006710 DOI: 10.1186/s12957-018-1414-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 06/07/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To stage axillary lymph nodes in women with early-stage breast cancer, sentinel lymph node biopsy (SLNB), rather than axillary lymph node dissection (ALND), has been employed. Moreover, different tracer methods have various advantages and disadvantages. In recent years, carbon nanoparticle suspensions (CNSs) have been used as lymph node tracers during surgeries for thyroid cancer, gastric cancer, and colorectal cancer. The study retrospectively analyzed the feasibility and accuracy of CNS for sentinel lymph node (SLN) mapping in patients with early breast cancer. METHODS This single-center, retrospective study included breast cancer patients who underwent SLNB from January 1, 2016, to December 31, 2017, in the Department of Breast Cancer, Guangdong General Hospital. All patients received standard SLNB surgery using a CNS tracer. RESULTS A total of 332 cases were included in this study. The SLN identification rate was 99.1% (329/332), and the mean number of SLNs was 2.6 (range, 1-6). SLN metastasis was found in 62 (18.8%) cases, of which 90.3% were found to be macrometastases. The sensitivity of SLNB was 95.9% (47/49), with a specificity of 100% (42/42), a positive predictive value of 100% (47/47), a negative predictive value of 95.5% (42/44), and a false-negative rate of 4.1% (2/49). CONCLUSION The identification and predictive values of a CNS tracer for SLNB were satisfactory.
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Affiliation(s)
- Liulu Zhang
- Department of Breast Cancer, Cancer Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Yijie Huang
- Department of General Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.,Department of Breast Cancer, Cancer Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Ciqiu Yang
- Department of Breast Cancer, Cancer Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Teng Zhu
- Department of Breast Cancer, Cancer Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Yufeng Lin
- Department of Breast Cancer, Cancer Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Hongfei Gao
- Department of Breast Cancer, Cancer Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Mei Yang
- Department of Breast Cancer, Cancer Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Minyi Cheng
- Department of Breast Cancer, Cancer Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Kun Wang
- Department of Breast Cancer, Cancer Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
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Takada M, Takeuchi M, Suzuki E, Sato F, Matsumoto Y, Torii M, Kawaguchi-Sakita N, Nishino H, Seo S, Hatano E, Toi M. Real-time navigation system for sentinel lymph node biopsy in breast cancer patients using projection mapping with indocyanine green fluorescence. Breast Cancer 2018; 25:650-655. [PMID: 29744670 DOI: 10.1007/s12282-018-0868-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/02/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Inability to visualize indocyanine green fluorescence images in the surgical field limits the application of current near-infrared fluorescence imaging (NIR) systems for real-time navigation during sentinel lymph node (SLN) biopsy in breast cancer patients. The aim of this study was to evaluate the usefulness of the Medical Imaging Projection System (MIPS), which uses active projection mapping, for SLN biopsy. METHODS A total of 56 patients (59 procedures) underwent SLN biopsy using the MIPS between March 2016 and November 2017. After SLN biopsy using the MIPS, residual SLNs were removed using a conventional NIR camera and/or radioisotope method. The primary endpoint of this study was identification rate of SLNs using the MIPS. RESULTS In all procedures, at least one SLN was detected by the MIPS, giving an SLN identification rate of 100% [95% confidence interval (CI) 94-100%]. SLN biopsy was successfully performed without operating lights in all procedures. In total, 3 positive SLNs were excised using MIPS, but were not included in the additional SLNs excised by other methods. The median number of SLNs excised using the MIPS was 3 (range 1-7). Of procedures performed after preoperative systemic therapy, the median number of SLNs excised using the MIPS was 3 (range 2-6). CONCLUSIONS The MIPS is effective in detecting SLNs in patients with breast cancer, providing continuous and accurate projection of fluorescence signals in the surgical field, without need for operating lights, and could be useful in real-time navigation surgery for SLN biopsy.
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Affiliation(s)
- Masahiro Takada
- Department of Surgery (Breast Surgery), Kyoto University Hospital, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Megumi Takeuchi
- Department of Breast Surgery, Mitsubishi Kyoto Hospital, 1, Katsura Goshocho, Nishikyo-ku, Kyoto, 615-8087, Japan
| | - Eiji Suzuki
- Department of Surgery (Breast Surgery), Kyoto University Hospital, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Fumiaki Sato
- Department of Surgery (Breast Surgery), Kyoto University Hospital, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshiaki Matsumoto
- Department of Surgery (Breast Surgery), Kyoto University Hospital, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Masae Torii
- Department of Surgery (Breast Surgery), Kyoto University Hospital, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Nobuko Kawaguchi-Sakita
- Department of Surgery (Breast Surgery), Kyoto University Hospital, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hiroto Nishino
- Department of Surgery (Hepato-Biliary-Pancreatic Surgery and Transplantation), Kyoto University Hospital, 54, Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Satoru Seo
- Department of Surgery (Hepato-Biliary-Pancreatic Surgery and Transplantation), Kyoto University Hospital, 54, Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Etsuro Hatano
- Department of Surgery (Hepato-Biliary-Pancreatic Surgery and Transplantation), Kyoto University Hospital, 54, Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
- Department of Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, 663-8501, Japan
| | - Masakazu Toi
- Department of Surgery (Breast Surgery), Kyoto University Hospital, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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Qiu SQ, Zhang GJ, Jansen L, de Vries J, Schröder CP, de Vries EGE, van Dam GM. Evolution in sentinel lymph node biopsy in breast cancer. Crit Rev Oncol Hematol 2018; 123:83-94. [PMID: 29482783 DOI: 10.1016/j.critrevonc.2017.09.010] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/12/2017] [Accepted: 09/19/2017] [Indexed: 02/05/2023] Open
Abstract
Sentinel lymph node biopsy (SLNB) is the standard of care for axillary staging in clinically node-negative (cN0) breast cancer patients without neoadjuvant chemotherapy (NAC). The application of SLNB in patients receiving NAC has also been explored. Evidence supports its use after NAC in pretreatment cN0 patients. Nonetheless, its routine use in all the pretreatment node-positive patients who become cN0 after NAC is unjustified due to the unacceptably high false-negative rate, which can be improved in a subset of patients. Axillary surgery omission in selected patients with a low risk of ALN metastasis has gained more and more research interest because the SLNs are tumor-free in more than 70% of all patients. To avoid drawbacks of conventional mapping methods, novel techniques for SLN detection have been developed and shown to be highly accurate in patients with early breast cancer. This article reviews the progress in SLNB in patients with breast cancer.
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Affiliation(s)
- Si-Qi Qiu
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands; Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands; The Breast Center, Cancer Hospital of Shantou University Medical College, Guangdong, China
| | - Guo-Jun Zhang
- The Breast Center, Cancer Hospital of Shantou University Medical College, Guangdong, China; Changjiang Scholar's Laboratory of Shantou University Medical College, Guangdong, China
| | - Liesbeth Jansen
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Jakob de Vries
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Carolien P Schröder
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - Gooitzen M van Dam
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands; Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands.
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Ramzi S, Hyett EL, Wheal AS, Cant PJ. The case for the omission of axillary staging in invasive breast carcinoma that exhibits a predominant tubular growth pattern on preoperative biopsy. Breast J 2018; 24:493-500. [DOI: 10.1111/tbj.13000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/20/2017] [Accepted: 07/21/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Saed Ramzi
- Primrose Beast Care Centre; Derriford Hospital; Plymouth UK
| | | | - Abigail S. Wheal
- Department of Cellular & Anatomical Pathology; Derriford Hospital; Plymouth UK
| | - Peter J. Cant
- Primrose Beast Care Centre; Derriford Hospital; Plymouth UK
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Yuan L, Qi X, Zhang Y, Yang X, Zhang F, Fan L, Chen L, Zhang K, Zhong L, Li Y, Gan S, Fu W, Jiang J. Comparison of sentinel lymph node detection performances using blue dye in conjunction with indocyanine green or radioisotope in breast cancer patients: a prospective single-center randomized study. Cancer Biol Med 2018; 15:452-460. [PMID: 30766755 PMCID: PMC6372915 DOI: 10.20892/j.issn.2095-3941.2018.0270] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective: This randomized study aimed to compare the clinical efficacy between the novel dual tracer composed of indocyanine green (ICG) and blue dye (BD) and the conventional dual tracer composed of radioisotope and BD for sentinel lymph node (SLN) mapping in patients with breast cancer. Methods: This study enrolled 471 clinically lymph node-negative patients with primary breast cancer. All patients underwent mastectomy, and those undergoing sentinel lymph node biopsy (SLNB) were randomized to receive blue dye plus radioisotope (RB group) or BD plus ICG (IB group). The detection performances on SLN identification rate, positive SLN counts, detection sensitivity, and false-negative rate were compared between the two groups. Results: In the IB group, 97% (194/200) of the patients who underwent the ICG and BD dual tracer injection showed fluorescent-positive lymphatic vessels within 2–5 min. The identification rate of SLNs was comparable between the IB group (99.0%, 198/200) and the RB group (99.6%, 270/271) (P = 0.79). No significant differences were observed in the identification rate of metastatic SLNs (22.5% vs. 22.9%, P > 0.05, RB group vs. IB group, the same below), positive SLN counts (3.72 ± 2.28 vs. 3.91 ± 2.13, P > 0.05), positive metastatic SLN counts (0.38 ± 0.84 vs. 0.34 ± 0.78, P > 0.05), SLNB detection sensitivity (94.4% vs. 92.5%, P > 0.05), or false-negative rate (5.6% vs. 7.5%, P > 0.05) between the two groups.
Conclusions: ICG can be used as a promising alternative tracer for radioisotope in SLN mapping, and when it is combined with BD in lymphangiography, it offers comparable detection sensitivity compared to the conventional lymphatic mapping strategies that are widely used in clinical practice.
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Affiliation(s)
- Long Yuan
- Department of Breast Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Xiaowei Qi
- Department of Breast Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Yi Zhang
- Department of Breast Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Xinhua Yang
- Department of Breast Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Fan Zhang
- Department of Breast Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Linjun Fan
- Department of Breast Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Li Chen
- Department of Breast Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Kongyong Zhang
- Department of Breast Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Ling Zhong
- Department of Breast Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Yanling Li
- Department of Breast Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Sijie Gan
- Department of Breast Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Wenying Fu
- Department of Breast Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Jun Jiang
- Department of Breast Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
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77
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Chang JM, Kosiorek HE, Wasif N, Gray RJ, Stucky CCH, Northfelt DW, Anderson KS, McCullough AE, Ocal IT, Pockaj BA. The success of sentinel lymph node biopsy after neoadjuvant therapy: A single institution review. Am J Surg 2017; 214:1096-1101. [DOI: 10.1016/j.amjsurg.2017.08.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 08/04/2017] [Accepted: 08/21/2017] [Indexed: 10/18/2022]
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78
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Nielsen Moody A, Bull J, Culpan AM, Munyombwe T, Sharma N, Whitaker M, Wolstenhulme S. Preoperative sentinel lymph node identification, biopsy and localisation using contrast enhanced ultrasound (CEUS) in patients with breast cancer: a systematic review and meta-analysis. Clin Radiol 2017; 72:959-971. [DOI: 10.1016/j.crad.2017.06.121] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/11/2017] [Accepted: 06/26/2017] [Indexed: 01/08/2023]
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79
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Fung V, Kohlhardt S, Vergani P, Zardin GJ, Williams NR. Intraoperative prediction of the two axillary lymph node macrometastases threshold in patients with breast cancer using a one-step nucleic acid cytokeratin-19 amplification assay. Mol Clin Oncol 2017; 7:755-762. [PMID: 29142748 PMCID: PMC5666659 DOI: 10.3892/mco.2017.1404] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 07/11/2017] [Indexed: 01/17/2023] Open
Abstract
The aim of the present study was to assess the sensitivity, specificity and practicality of using a one-step nucleic acid amplification (OSNA) assay during breast cancer staging surgery to predict and discriminate between at least 2 involved nodes and more than 2 involved nodes and facilitate the decision to provide axillary conservation in the presence of a low total axillary node tumour burden. A total of 700 consecutive patients, not treated with neo-adjuvant chemotherapy, received intraoperative sentinel lymph node (SLN) analysis using OSNA for cT1-T3 cN0 invasive breast cancer. Patients with at least one macrometastasis on whole-node SLN analysis underwent axillary lymph node dissection (ALND). The total tumour load (TTL) of the macrometastatic SLN sample was compared with the non-sentinel lymph node (NSLN) status of the ALND specimen using routine histological assessment. In total, 122/683 patients (17.9%) were found to have an OSNA TTL indicative of macrometastasis. In addition, 45/122 (37%) patients had NSLN metastases on ALND with a total positive lymph node burden exceeding the American College of Surgeons Oncology Group Z0011 trial threshold of two macrometastatic nodes. The TTL negative predictive value was 0.975 [95% confidence interval (CI), 0.962-0.988]. The area under the curve for the receiver operating characteristic curve was 0.86 (95% CI, 0.81-0.91), indicating that SLN TTL was associated with the prediction (and partitioning) of total axillary disease burden. OSNA identifies a TTL threshold value where, in the presence of involved SLNs, ALND may be avoided. This technique offers objective confidence in adopting conservative management of the axilla in patients with SLN macrometastases.
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Affiliation(s)
- Victoria Fung
- Department of Breast and Plastic Surgery, Sheffield Breast Center, Royal Hallamshire Hospital, S10 2JF Sheffield, UK
| | - Stan Kohlhardt
- Department of Breast and Plastic Surgery, Sheffield Breast Center, Royal Hallamshire Hospital, S10 2JF Sheffield, UK
| | - Patricia Vergani
- Department of Histopathology, Royal Hallamshire Hospital, S10 2JF Sheffield, UK
| | - Gregory J. Zardin
- Department of Histopathology, Royal Hallamshire Hospital, S10 2JF Sheffield, UK
| | - Norman R. Williams
- Division of Surgery and Interventional Science, University College London, WC1E 6AU London, UK
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80
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Non-visualized sentinel nodes in breast cancer patients; prevalence, risk factors, and prognosis. Breast Cancer Res Treat 2017; 167:147-156. [PMID: 28861665 DOI: 10.1007/s10549-017-4483-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 08/23/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Evidence and consensus is lacking in international guidelines regarding axillary treatment recommendations for patients in whom a sentinel lymph node (SLN) cannot be visualized (non-vSLN) during the sentinel node procedure. In this study we aimed to determine the prevalence of non-vSLNs in a Dutch population of breast cancer patients and to examine predictors and survival rate for non-vSLN. METHODS A nationwide, retrospective, population-based study was performed including 116,920 patients with invasive breast cancer who underwent a SLN procedure in the Netherlands between January 2005 and December 2013. RESULTS Of the 76,472 clinically negative patients who underwent a SLN procedure, 1924 patients (2.5%) had a non-vSLN, of whom 1552 (80.7%) underwent an ALND. Multivariate analysis showed predictive factors for non-vSLN: older age (p < 0.001), diagnosis in the period 2005-2009 (p < 0.001), larger tumor size (p = 0.003), and extensive nodal involvement (p < 0.001). Multivariate survival analysis showed a significantly worse survival (HR 1.18, 95% CI 1.03-1.34, p = 0.015) for non-vSLNs patients. However, in the non-vSLN group, an ALND was not statistically significantly associated with a better survival (HR 0.96, 95% CI 0.53-1.75, p = 0.891). CONCLUSION Patients with non-vSLNs had less favorable disease characteristics and a worse survival compared to patients with a visualized SLN. Performing an ALND was not associated with a significantly better survival in patients with non-vSLNs. However, further research on the necessity of axillary treatment in this specific patient group is required.
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81
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Ding J, Jiang L, Wu W. Predictive Value of Clinicopathological Characteristics for Sentinel Lymph Node Metastasis in Early Breast Cancer. Med Sci Monit 2017; 23:4102-4108. [PMID: 28839123 PMCID: PMC5584843 DOI: 10.12659/msm.902795] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) is one of the preferred treatments for breast cancer including clinically negative lymph node breast cancer. However, for 60-70% of patients this invasive axilla surgery is unnecessary. Our study aimed to identify the predictors for sentinel lymph node (SLN) metastasis in early breast cancer patients and provide evidence for rational decision-making in specified clinical situations. MATERIAL AND METHODS Medical records of 417 breast cancer patients who were treated with a breast surgical procedure and SLNB in Ningbo Medical Center Lihuili Eastern Hospital were retrospectively reviewed. Univariate analysis and multivariate logistic regression analysis were used to analyze the correlation between SLN metastasis and clinicopathological characteristics, including patient age, menstrual status, body mass index (BMI), family history, tumor size, laterality of tumor, histological grade, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor-2 (HER2), Ki67 index, and molecular subtypes of the tumor. RESULTS In the cohort of 417 cases, the ratio of SLNM was 23.0%. Univariate analysis found that age, tumor size, histological grade, and Ki67 index were associated with SLN metastasis. However, age, tumor size, and histological grade were the only three independent predictors for SLN metastasis by multivariate logistic regression analysis. When these three factors were considered together, three different levels of SLN metastasis groups could be classified: low-risk group with the ratio of 14.3%, moderate-risk group with the ratio of 31.4%, and high-risk group with the ratio of 66.7%. CONCLUSIONS Our study demonstrated that age, tumor size, and histological grade were three independent predictive factors for SLN metastasis in early breast cancer patients. This finding may help surgeons in the decision-making process for early breast cancer patients before considering axilla surgical procedure.
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Affiliation(s)
- Jinhua Ding
- Department of Breast and Thyroid Surgery, Ningbo Medical Center Lihuili Eastern Hospital, Ningbo, Zhejiang, China (mainland)
| | - Li Jiang
- Department of Emergency, Ningbo Medical Center Lihuili Eastern Hospital, Ningbo, Zhejiang, China (mainland)
| | - Weizhu Wu
- Department of Breast and Thyroid Surgery, Ningbo Medical Center Lihuili Eastern Hospital, Ningbo, Zhejiang, China (mainland)
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82
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Agrawal SK, Shenoy SS, Nalawade N, Datta SS, Roy S, Chatterjee S, Arun I, Ahmed R. Quality Indicators for Sentinel Lymph Node Biopsy in Breast Cancer: Applicability and Clinical Relevance in a Non-screened Population. Indian J Surg Oncol 2017; 9:312-317. [PMID: 30287989 DOI: 10.1007/s13193-017-0695-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 08/14/2017] [Indexed: 11/25/2022] Open
Abstract
Quality Indicators for Sentinel Lymph Node Biopsy in Breast Cancer: Applicability and Clinical Relevance in a Non-screened Population: sentinel lymph node biopsy (SLNB) has replaced axillary lymph node dissection (ALND) as standard of care for management of early breast cancer. This study assessed our SLNB program against 11 published quality indicators (QIs). All breast cancer patients who underwent SLNB in our centre from June 2013-Dec 2015 were included. Clinical, pathological and follow-up data were extracted from the institutional REDCap data system. Analysis was done with SPSS 23. Following validation, 234 patients had SLNB, always performed along with primary surgery. Identification rate was 95.3% and > 1 SLN was identified in 72% of patients. SLNB positivity was 33%, of these, 100% underwent ALND. Overall 91% of QI eligible patients underwent SLNB. No ineligible patients (T4) underwent SLNB. For the patients who had radio colloid, injection criteria were met for 100%. Pathological evaluation and reporting criteria were met for 100% of patients. There were no axillary recurrences in a median follow-up of 2 years. 7.6% patients had SLN negative on frozen section but positive on final histology. 7.2% of patients with clinical negative nodes had pN2 disease in final histopathology report after surgery. Sixty percent of patients who had completion ALND had only positive SLN. This study supports the applicability of published QI of SLNB in a non-screened cohort of early breast cancer patients. Although QI were useful, modification based on patient characteristics and resource availability may be needed. These indicators can be used as audit tools to improve the overall accuracy of the procedure.
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Affiliation(s)
| | | | - Nikhil Nalawade
- 1Department of Breast Oncosurgery, Tata Medical Center, Kolkata, India
| | | | - Soumendranath Roy
- 3Department of Nuclear Medicine, Tata Medical Center, Kolkata, India
| | - Sanjoy Chatterjee
- 4Department of Clinical Oncology, Tata Medical Center, Kolkata, India
| | - Indu Arun
- 5Department of Pathology, Tata Medical Center, Kolkata, India
| | - Rosina Ahmed
- 1Department of Breast Oncosurgery, Tata Medical Center, Kolkata, India
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83
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Lee SA, Lee HM, Lee HW, Yang BS, Park JT, Ahn SG, Jeong J, Kim SI. Risk Factors for a False-Negative Result of Sentinel Node Biopsy in Patients with Clinically Node-Negative Breast Cancer. Cancer Res Treat 2017; 50:625-633. [PMID: 28759990 PMCID: PMC6056988 DOI: 10.4143/crt.2017.089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 06/20/2017] [Indexed: 11/21/2022] Open
Abstract
Purpose Although sentinel lymph node biopsy (SLNB) can accurately represent the axillary lymph node (ALN) status, the false-negative rate (FNR) of SLNB is the main concern in the patients who receive SLNB alone instead of ALN dissection (ALND). Materials and Methods We analyzed 1,886 patientswho underwent ALND after negative results of SLNB,retrospectively. A logistic regression analysis was used to identify risk factors associated with a falsenegative (FN) result. Cox regression model was used to estimate the hazard ratio of factors affecting disease-free survival (DFS). Results Tumor located in the upper outer portion of the breast, lymphovascular invasion, suspicious node in imaging assessment and less than three sentinel lymph nodes (SLNs) were significant independent risk factors for FN in SLNB conferring an adjusted odds ratio of 2.10 (95% confidence interval [CI], 1.30 to 3.39), 2.69 (95% CI, 1.47 to 4.91), 2.59 (95% CI, 1.62 to 4.14), and 2.39 (95% CI, 1.45 to 3.95), respectively. The prognostic factors affecting DFS were tumor size larger than 2 cm (hazard ratio [HR], 1.86; 95% CI, 1.17 to 2.96) and FN of SLNB (HR, 2.51; 95% CI, 1.42 to 4.42) in SLN-negative group (FN and true-negative), but in ALN-positive group (FN and true-positive), FN of SLNB (HR, 0.64; 95% CI, 0.33 to 1.25) did not affect DFS. Conclusion In patients with risk factors for a FN such as suspicious node in imaging assessment, upper outer breast cancer, less than three harvested nodes, we need attention to find another metastatic focus in non-SLNs during the operation. It may contribute to provide an exact prognosis and optimizing adjuvant treatments.
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Affiliation(s)
- Seung Ah Lee
- Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea.,Department of Medicine, Graduate School, Yonsei University, Seoul, Korea
| | - Hak Min Lee
- Department of Surgery, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Gangneung, Korea
| | - Hak Woo Lee
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ban Seok Yang
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Tae Park
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Gwe Ahn
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Jeong
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Il Kim
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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84
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Nakamura R, Yamamoto N, Miyaki T, Itami M, Shina N, Ohtsuka M. Impact of sentinel lymph node biopsy by ultrasound-guided core needle biopsy for patients with suspicious node positive breast cancer. Breast Cancer 2017; 25:86-93. [PMID: 28735457 DOI: 10.1007/s12282-017-0795-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 07/16/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study was to investigate the accuracy of preoperative diagnostic tools for axillary lymph nodes (LNs) staging of breast cancer. MATERIALS AND METHODS A total of 2464 consecutive patients with operable breast cancer were prospectively identified at our institution between April 2012 and March 2017. Patients with suspicious axillary LN of breast cancer were assessed using preoperative ultrasound(US) or computed tomography (CT), underwent fine-needle aspiration cytology (FNA) or core needle biopsy (CNB). The inclusion criteria for both FNA and CNB were a cortical thickness >3 mm or abnormal morphological characteristics. Patients with biopsy-proven metastasis underwent axillary lymph node dissection (ALND), and those with a negative FNA or CNB underwent sentinel lymph node biopsy (SNB). If the SNB was positive, ALND was performed. Diagnostic accuracy for SNB was calculated for both FNA and CNB. In addition, the patients in this study were divided into two groups as follows: the cN0-FNA group (suspicious LN but negative FNA) and cN0-CNB group (suspicious LN but negative CNB). RESULTS A number of patients with negative US/CT findings of LNs were 1406, with 744 undergoing FNA and 272 undergoing CNB for suspicious LNs. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 65, 99, 99, 80, and 85% in FNA, and 87, 100, 100, 93 and 95% in CNB, respectively. SNB was performed in 172 (cN0-CNB group) of 272 CNB and 487 (cN0-FNA group) of 744 FNA patients. One hundred and seventy-two patients from the cN0-CNB group (Tis 6, T1 97, T2 66, T3 3 patients) treated with SNB were compared to 487 from the cN0-FNA group (Tis 21, T1 225, T2 233, T3 8 patients) in terms of number of LN metastasis. A number of patients with more than 3 positive SNB and positive LNs were 9 (5%) and 0 (0%) in cN0-CNB group, and 78 (16%) and 24 (5%) in cN0-FNA group, respectively. A number of patients who had complications such as haematoma and pain at the time of 7 to 14 days after CNB and FNA were 1 (0.5%) and 1 (0.5%) in cN0-CNB group, and were 0% and 0.2% in cN0-FNA group (p = 0.44), respectively. CONCLUSIONS The preoperative diagnosis of axillary LNs was influenced by the diagnostic tool used. CNB is a reliable method for the preoperative diagnosis of LN metastasis.
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Affiliation(s)
- Rikiya Nakamura
- Division of Breast Surgery, Chiba Cancer Center, 666-2 Nitona-Cho, Chuo-Ku, Chiba, 260-8717, Japan.
| | - Naohito Yamamoto
- Division of Breast Surgery, Chiba Cancer Center, 666-2 Nitona-Cho, Chuo-Ku, Chiba, 260-8717, Japan
| | - Toshiko Miyaki
- Division of Breast Surgery, Chiba Cancer Center, 666-2 Nitona-Cho, Chuo-Ku, Chiba, 260-8717, Japan
| | - Makiko Itami
- Division of Diagnostic Pathology, Chiba Cancer Center, 666-2 Nitona-Cho, Chuo-Ku, Chiba, 260-8717, Japan
| | - Nobumitsu Shina
- Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba, 260-8670, Japan
| | - Masayuki Ohtsuka
- Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba, 260-8670, Japan
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85
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Li X, Chen S, Jiang L, Kong X, Ma T, Xu H, Yang Q. Precise intraoperative sentinel lymph node biopsies guided by lymphatic drainage in breast cancer. Oncotarget 2017; 8:63064-63072. [PMID: 28968971 PMCID: PMC5609903 DOI: 10.18632/oncotarget.18624] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 05/29/2017] [Indexed: 02/05/2023] Open
Abstract
The purpose of this study was to present a novel surgical method for intraoperative precise sentinel lymph node biopsy (SLNB) and to determine its clinical efficacy and sensitivity in breast cancer patients. The sentinel lymph nodes (SLNs) were preoperatively evaluated by axillary ultrasound. The intraoperative detection of SLNs was guided by lymphatic drainage pathway. The lymphatic vessels and SLNs were visualized. During operation, we searched for all the true SLNs (trSLNs), para-SLNs (paSLNs) and post-SLNs (poSLNs) followed lymphatic drainage ducts. After precisely locating the lymphatic channels and lymph node, all the lymph nodes that firstly receive lymphatic drainage are designated as trSLNs. We precisely distinguished the trSLNs, paSLNs and poSLNs. We found the average number of trSLNs ranged from1 to 6. In addition, we assessed the novel technique in a total of 125 breast cancer patients. trSLNs were successfully identified in all patients (detection rate: 100 %). The accuracy of trSLNs is 99.2%. Data from our study strongly suggest that our method is a feasible and effective for the detection of precise trSLNs in breast cancer with real-time observations. (ClinicalTrials.gov number, NCT02651142).
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Affiliation(s)
- Xiaoyan Li
- Department of Breast Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Sisi Chen
- Department of Breast Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Liyu Jiang
- Department of Breast Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Xiaoli Kong
- Department of Breast Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Tingting Ma
- Department of Breast Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Hong Xu
- Department of Breast Surgery, General Hospital of Chinese Armed Police Force, Beijing 100039, P.R. China
| | - Qifeng Yang
- Department of Breast Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China.,Department of Pathology Tissue Bank, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
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86
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Desirable Properties of Radiopharmaceuticals for Sentinel Node Mapping in Patients With Breast Cancer Given the Paradigm Shift in Patient Management. Clin Nucl Med 2017; 42:275-279. [PMID: 28166148 DOI: 10.1097/rlu.0000000000001565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Over the past 2 decades, lymphoscintigraphy and sentinel node biopsy have become widely accepted and are used by surgeons to stage many solid cancers, especially breast cancer. However, despite growing experience, there are a number of unresolved issues. In addition, the impact of a new radiopharmaceutical remains to be determined. The present article addresses some of these issues (either unresolved, recurrent, or newly emerged), with a focus on the properties of radiopharmaceuticals used for sentinel node mapping in breast cancer.
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87
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Marrazzo A, Damiano G, Taormina P, Buscemi S, Lo Monte AI, Marrazzo E. Does Conservative Surgery for Breast Carcinoma Still Require Axillary Lymph Node Evaluation? A Retrospective Analysis of 1156 Consecutive Women With Early Breast Cancer. Clin Breast Cancer 2017; 17:e53-e57. [DOI: 10.1016/j.clbc.2016.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/06/2016] [Accepted: 10/12/2016] [Indexed: 02/05/2023]
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88
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Phase-Transition Nanodroplets for Real-Time Photoacoustic/Ultrasound Dual-Modality Imaging and Photothermal Therapy of Sentinel Lymph Node in Breast Cancer. Sci Rep 2017; 7:45213. [PMID: 28338071 PMCID: PMC5364557 DOI: 10.1038/srep45213] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 02/21/2017] [Indexed: 02/05/2023] Open
Abstract
Pathological status of lymph nodes (LNs) plays a critical role in staging and treatment for the patients with breast cancer. Sentinel lymph node biopsy has become the standard method in determining pathological status of axillary LNs. Therefore, the determination of sentinel lymph nodes (SLNs) and therapy of metastatic LNs are highly desirable in clinic. Herein, an unprecedented carbon nanoparticles (CNs)-incorporated liquid-gas phase-transition nanodroplets (CNPs) with strong near-infrared (NIR) absorption, good biocompatibility, excellent photoacoustic (PA) and ultrasound (US) contrast, and high photothermal-conversion efficiency are reported in this study. Upon laser irradiation, liquid-gas phase transition of the CNPs has been demonstrated to provide excellent contrasts for PA/US dual-modality imaging both in vitro and in vivo. Additionally, the CNPs are capable of staining lymph nodes, which can contribute significantly to the identification of LNs with naked eyes. With increased laser energy, the CNPs exhibit the high performance in killing the breast cancer cells both in vitro and in vivo, due to the photothermal effect induced from the CNs within CNPs. These results suggest that the developed multifunctional phase-transition nanodroplets have high potential to act as the theranostic agents in both SLNs detection and therapy of metastatic LNs.
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89
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Verheuvel NC, Voogd AC, Tjan-Heijnen VCG, Roumen RMH. What to Do with Non-visualized Sentinel Nodes? A Dutch Nationwide Survey Study. Ann Surg Oncol 2017; 24:2155-2160. [PMID: 28258414 PMCID: PMC5491635 DOI: 10.1245/s10434-017-5824-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Indexed: 01/02/2023]
Abstract
Introduction International guidelines differ regarding their recommendations on axillary treatment of patients with non-visualized sentinel lymph nodes (non-vSLN). Therefore, we distributed a survey among Dutch oncological surgeons to determine their routine practice and opinion regarding axillary treatment in case of a non-vSLN, with the emphasis on whether these practices and opinions have changed since publication of the Z0011 trial. Methods A Dutch nationwide survey containing 10 questions regarding clinical routine during the sentinel node procedure and axillary treatment of non-vSLN patients was distributed among 510 oncological surgeons. Results The survey was completed by 122 (24%) oncological surgeons, of whom 116 (95%) were registered as specialized breast surgeons. These surgeons had, on average, 13 years of experience. The majority of respondents used both lymphoscintigraphy and Patent Blue during the sentinel node procedure, and 39% estimated the prevalence of a non-vSLN to be 1–2%. Most surgeons are currently more reserved when considering whether to perform an axillary lymph node dissection (ALND) than prior to publication of the Z0011 trial (15 vs. 80%, respectively). Sixty percent base their decision on various clinicopathological characteristics. Twenty-three respondents (20%) opted for an alternative axillary treatment. Conclusion This study shows that, in daily practice, most specialized breast surgeons think that a non-vSLN is rare. If so, most currently opt not to perform an ALND, whereas a small proportion consider an alternative axillary treatment. These decisions differ than in the period prior to the Z0011 trial. More research is needed to provide optimal treatment recommendations in case of a non-vSLN. Electronic supplementary material The online version of this article (doi:10.1245/s10434-017-5824-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nicole C Verheuvel
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands.
| | - Adri C Voogd
- Department of Medical Oncology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Epidemiology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- Department of Medical Oncology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rudi M H Roumen
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands.,Department of Medical Oncology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
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90
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Mondal SB, Gao S, Zhu N, Habimana-Griffin L, Akers WJ, Liang R, Gruev V, Margenthaler J, Achilefu S. Optical See-Through Cancer Vision Goggles Enable Direct Patient Visualization and Real-Time Fluorescence-Guided Oncologic Surgery. Ann Surg Oncol 2017; 24:1897-1903. [PMID: 28213790 DOI: 10.1245/s10434-017-5804-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND The inability to visualize the patient and surgical site directly, limits the use of current near infrared fluorescence-guided surgery systems for real-time sentinel lymph node biopsy and tumor margin assessment. METHODS We evaluated an optical see-through goggle augmented imaging and navigation system (GAINS) for near-infrared, fluorescence-guided surgery. Tumor-bearing mice injected with a near infrared cancer-targeting agent underwent fluorescence-guided, tumor resection. Female Yorkshire pigs received hind leg intradermal indocyanine green injection and underwent fluorescence-guided, popliteal lymph node resection. Four breast cancer patients received 99mTc-sulfur colloid and indocyanine green retroareolarly before undergoing sentinel lymph node biopsy using radioactive tracking and fluorescence imaging. Three other breast cancer patients received indocyanine green retroareolarly before undergoing standard-of-care partial mastectomy, followed by fluorescence imaging of resected tumor and tumor cavity for margin assessment. RESULTS Using near-infrared fluorescence from the dyes, the optical see-through GAINS accurately identified all mouse tumors, pig lymphatics, and four pig popliteal lymph nodes with high signal-to-background ratio. In 4 human breast cancer patients, 11 sentinel lymph nodes were identified with a detection sensitivity of 86.67 ± 0.27% for radioactive tracking and 100% for GAINS. Tumor margin status was accurately predicted by GAINS in all three patients, including clear margins in patients 1 and 2 and positive margins in patient 3 as confirmed by paraffin-embedded section histopathology. CONCLUSIONS The optical see-through GAINS prototype enhances near infrared fluorescence-guided surgery for sentinel lymph node biopsy and tumor margin assessment in breast cancer patients without disrupting the surgical workflow in the operating room.
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Affiliation(s)
- Suman B Mondal
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA.,Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Shengkui Gao
- Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Nan Zhu
- College of Optical Science, The University of Arizona, Tucson, AZ, USA
| | - LeMoyne Habimana-Griffin
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA.,Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Walter J Akers
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Rongguang Liang
- College of Optical Science, The University of Arizona, Tucson, AZ, USA
| | - Viktor Gruev
- Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Julie Margenthaler
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Samuel Achilefu
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA. .,Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA. .,Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO, USA. .,Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
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91
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Brahma B, Putri RI, Karsono R, Andinata B, Gautama W, Sari L, Haryono SJ. The predictive value of methylene blue dye as a single technique in breast cancer sentinel node biopsy: a study from Dharmais Cancer Hospital. World J Surg Oncol 2017; 15:41. [PMID: 28173818 PMCID: PMC5297091 DOI: 10.1186/s12957-017-1113-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 02/01/2017] [Indexed: 01/25/2023] Open
Abstract
Background Axillary lymph node dissection (ALND) has been the standard treatment of breast cancer axillary staging in Indonesia. The limited facilities of radioisotope tracer and isosulfan or patent blue dye (PBD) have been the major obstacles to perform sentinel node biopsy (SNB) in our country. We studied the application of 1% methylene blue dye (MBD) alone for SNB to overcome the problem. Methods This prospective study enrolled 108 patients with suspicious malignant lesions or breast cancer stages I–III. SNB was performed using 2–5 cc of 1% MBD and proceeded with ALND. The histopathology results of sentinel nodes (SNs) were compared with axillary lymph nodes (ALNs) for diagnostic value assessments. Results There were 96 patients with invasive carcinoma from July 2012 to September 2014 who were included in the final analysis. The median age was 50 (25–69) years, and the median pathological tumor size was 3 cm (1–10). Identification rate of SNs was 91.7%, and the median number of the identified SNs was 2 (1–8). Sentinel node metastasis was found in 53.4% cases and 89.4% of them were macrometastases. The negative predictive value (NPV) of SNs to predict axillary metastasis was 90% (95% CI, 81–99%). There were no anaphylactic reactions, but we found 2 cases with skin necrosis. Conclusions The application of 1% MBD as a single technique in breast cancer SNB has favorable identification rates and predictive values. It can be used for axillary staging, but nevertheless the technique should be applied with attention to the tumor size and grade to avoid false negative results.
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Affiliation(s)
- Bayu Brahma
- Department of Surgical Oncology, Dharmais Cancer Hospital, Jalan. Let. Jend. S. Parman Kav. 84-86, Jakarta, 11420, Indonesia. .,Department of Surgical Oncology, Bogor City General Hospital, Jalan DR. Semeru No. 120, West Bogor, West Java, 16112, Indonesia.
| | - Rizky Ifandriani Putri
- Department of Anatomical Pathology, Dharmais Cancer Hospital, Jalan. Let. Jend. S. Parman Kav. 84-86, Jakarta, 11420, Indonesia
| | - Ramadhan Karsono
- Department of Surgical Oncology, Dharmais Cancer Hospital, Jalan. Let. Jend. S. Parman Kav. 84-86, Jakarta, 11420, Indonesia.,Departement of Surgical Oncology, Mochtar Riady Comprehensive Cancer Center (MRCCC) Siloam Hospital, Jalan Garnisun Dalam No. 2-3, Semanggi, Central Jakarta, 12930, Indonesia
| | - Bob Andinata
- Department of Surgical Oncology, Dharmais Cancer Hospital, Jalan. Let. Jend. S. Parman Kav. 84-86, Jakarta, 11420, Indonesia
| | - Walta Gautama
- Department of Surgical Oncology, Dharmais Cancer Hospital, Jalan. Let. Jend. S. Parman Kav. 84-86, Jakarta, 11420, Indonesia
| | - Lenny Sari
- Department of Anatomical Pathology, Dharmais Cancer Hospital, Jalan. Let. Jend. S. Parman Kav. 84-86, Jakarta, 11420, Indonesia
| | - Samuel J Haryono
- Department of Surgical Oncology, Dharmais Cancer Hospital, Jalan. Let. Jend. S. Parman Kav. 84-86, Jakarta, 11420, Indonesia.,Departement of Surgical Oncology, Mochtar Riady Comprehensive Cancer Center (MRCCC) Siloam Hospital, Jalan Garnisun Dalam No. 2-3, Semanggi, Central Jakarta, 12930, Indonesia
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92
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Breast-Conserving Surgery After Neoadjuvant Therapy. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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93
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Liu J, Huang L, Wang N, Chen P. Indocyanine green detects sentinel lymph nodes in early breast cancer. J Int Med Res 2017; 45:514-524. [PMID: 28415938 PMCID: PMC5536661 DOI: 10.1177/0300060516687149] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To explore the clinical value of indocyanine green (ICG) for the fluorescence-guided detection of sentinel lymph nodes (SLNs) during sentinel lymph node biopsy (SLNB) in patients with early breast cancer. Methods This retrospective study included female patients with breast cancer. Patients were administered methylene blue and ICG using standard techniques. All SLNs that were collected during surgery were submitted for pathological examination. SLNs were defined as those that were either fluorescent, blue, fluorescent and blue or palpably suspicious. Surgical complications, axillary recurrence, distant metastasis and overall survival rates were observed postoperatively. Results A total of 60 patients were enrolled in the study. The fluorescence detection rate of SLNs was 100% (n = 177), with a mean of 2.95 SLNs per patient. The methylene blue staining rate was 88.3% (n = 106), with a mean of 1.77 SLNs per patient. Pathological assessment of intraoperative frozen specimens revealed SLN metastases in 10 patients, who immediately underwent axillary lymph node dissection. No patient had axillary recurrence or distant metastases, with a survival rate of 100%. Patients who underwent SLNB showed good appearance in the axillary wound, with no limited shoulder joint abduction and upper limb oedema. Conclusion Fluorescence-guided SLNB has several advantages and is suitable for clinical application.
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Affiliation(s)
- Jun Liu
- Breast Cancer Centre, China-Japan Friendship Hospital, Beijing, China
| | - Linping Huang
- Breast Cancer Centre, China-Japan Friendship Hospital, Beijing, China
| | - Ning Wang
- Breast Cancer Centre, China-Japan Friendship Hospital, Beijing, China
| | - Ping Chen
- Breast Cancer Centre, China-Japan Friendship Hospital, Beijing, China
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94
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Dominici LS, Morrow M, Mittendorf E, Bellon J, King TA. Trends and controversies in multidisciplinary care of the patient with breast cancer. Curr Probl Surg 2016; 53:559-595. [PMID: 28160790 PMCID: PMC5298793 DOI: 10.1067/j.cpsurg.2016.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Laura S Dominici
- Surgical Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Monica Morrow
- Department of Surgery, Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Jennifer Bellon
- Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Tari A King
- Surgical Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
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95
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Echalier C, Pluvy I, Pauchot J. Angiographie au vert d’indocyanine en chirurgie reconstructrice : revue de la littérature. ANN CHIR PLAST ESTH 2016; 61:858-867. [DOI: 10.1016/j.anplas.2016.07.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 07/27/2016] [Indexed: 02/05/2023]
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96
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Thangarajah F, Malter W, Hamacher S, Schmidt M, Krämer S, Mallmann P, Kirn V. Predictors of sentinel lymph node metastases in breast cancer-radioactivity and Ki-67. Breast 2016; 30:87-91. [DOI: 10.1016/j.breast.2016.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 07/29/2016] [Accepted: 09/08/2016] [Indexed: 10/21/2022] Open
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97
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Rekaya R, Smith S, Hay EH, Farhat N, Aggrey SE. Analysis of binary responses with outcome-specific misclassification probability in genome-wide association studies. Appl Clin Genet 2016; 9:169-177. [PMID: 27942229 PMCID: PMC5138056 DOI: 10.2147/tacg.s122250] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Errors in the binary status of some response traits are frequent in human, animal, and plant applications. These error rates tend to differ between cases and controls because diagnostic and screening tests have different sensitivity and specificity. This increases the inaccuracies of classifying individuals into correct groups, giving rise to both false-positive and false-negative cases. The analysis of these noisy binary responses due to misclassification will undoubtedly reduce the statistical power of genome-wide association studies (GWAS). A threshold model that accommodates varying diagnostic errors between cases and controls was investigated. A simulation study was carried out where several binary data sets (case-control) were generated with varying effects for the most influential single nucleotide polymorphisms (SNPs) and different diagnostic error rate for cases and controls. Each simulated data set consisted of 2000 individuals. Ignoring misclassification resulted in biased estimates of true influential SNP effects and inflated estimates for true noninfluential markers. A substantial reduction in bias and increase in accuracy ranging from 12% to 32% was observed when the misclassification procedure was invoked. In fact, the majority of influential SNPs that were not identified using the noisy data were captured using the proposed method. Additionally, truly misclassified binary records were identified with high probability using the proposed method. The superiority of the proposed method was maintained across different simulation parameters (misclassification rates and odds ratios) attesting to its robustness.
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Affiliation(s)
- Romdhane Rekaya
- Department of Animal and Dairy Science, College of Agricultural and Environmental Sciences
- Department of Statistics, Franklin College of Arts and Sciences
- Institute of Bioinformatics, The University of Georgia, Athens, GA
| | | | - El Hamidi Hay
- United States Department of Agriculture, Agricultural Research Service, Beltsville, MD
| | | | - Samuel E Aggrey
- Institute of Bioinformatics, The University of Georgia, Athens, GA
- Department of Poultry Science, College of Agricultural and Environmental Sciences, University of Georgia, Athens, GA, USA
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98
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Yaghini E, Turner HD, Le Marois AM, Suhling K, Naasani I, MacRobert AJ. In vivo biodistribution studies and ex vivo lymph node imaging using heavy metal-free quantum dots. Biomaterials 2016; 104:182-91. [PMID: 27454064 PMCID: PMC4993815 DOI: 10.1016/j.biomaterials.2016.07.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 06/08/2016] [Accepted: 07/10/2016] [Indexed: 12/13/2022]
Abstract
Quantum dots (QDs) are attractive photoluminescence probes for biomedical imaging due to their unique photophysical properties. However, the potential toxicity of QDs has remained a major obstacle to their clinical use because they commonly incorporate the toxic heavy metal cadmium within the core of the QDs. In this work, we have evaluated a novel type of heavy metal-free/cadmium-free and biocompatible QD nanoparticles (bio CFQD(®) nanoparticles) with a good photoluminescence quantum yield. Sentinel lymph node mapping is an increasingly important treatment option in the management of breast cancer. We have demonstrated their potential for lymph node mapping by ex vivo imaging of regional lymph nodes after subcutaneous injection in the paw of rats. Using photoluminescence imaging and chemical extraction measurements based on elemental analysis by inductively coupled plasma mass spectroscopy, the quantum dots are shown to accumulate quickly and selectively in the axillary and thoracic regional lymph nodes. In addition, lifetime imaging microscopy of the QD photoluminescence indicates minimal perturbation to their photoluminescence properties in biological systems.
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Affiliation(s)
- Elnaz Yaghini
- Division of Surgery and Interventional Science and Institute of Healthcare Engineering, University College London, London, UK.
| | - Helen D Turner
- Nanoco Technologies Ltd., 46 Grafton Street, Manchester, UK
| | | | - Klaus Suhling
- Department of Physics, King's College London, London, UK
| | - Imad Naasani
- Nanoco Technologies Ltd., 46 Grafton Street, Manchester, UK
| | - Alexander J MacRobert
- Division of Surgery and Interventional Science and Institute of Healthcare Engineering, University College London, London, UK
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99
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Peek MC, Kovacs T, Baker R, Hamed H, Kothari A, Douek M. Is blue dye still required during sentinel lymph node biopsy for breast cancer? Ecancermedicalscience 2016; 10:674. [PMID: 27729939 PMCID: PMC5045297 DOI: 10.3332/ecancer.2016.674] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Indexed: 12/12/2022] Open
Abstract
Background In early breast cancer, the optimal technique for sentinel lymph node biopsy (SLNB) is the combined technique (radioisotope and Patent Blue V) which achieves high identification rates. Despite this, many centres have decided to stop using blue dye due to blue-dye-related complications (tattoo, anaphylaxis). We evaluated the SLNB identification rate using the combined technique with and without Patent Blue V and the blue-dye-related complication rates. Methods Clinical and histological data were analysed on patients undergoing SLNB between March 2014 and April 2015. SLNB was performed following standard hospital protocols using the combined technique. Results A total of 208 patients underwent SLNB and 160 patients (342 nodes) with complete operation notes were available for final analysis. The identification rate with the combined technique was 98.8% (n = 158/160), with blue dye alone 92.5% (n = 148/160) and with radioisotope alone 97.5% (n = 156/160). A total of 76.9% (263/342) of nodes were radioactive and blue, 15.5% (53/342) only radioactive and 2.3% (8/342) only blue, 5.3% (18/342) were neither radioactive nor blue. No anaphylactic reactions were reported and blue skin staining was reported in six (3.8%) patients. Conclusion The combined technique should continue be the preferred technique for SLNB and should be standardised. Radioisotope alone (but not blue dye alone) has comparable sentinel node identification rates in experienced hands. National guidelines are required to optimise operative documentation.
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Affiliation(s)
- Mirjam Cl Peek
- Division of Cancer Studies, King's College London, Guy's Hospital Campus, Great Maze Pond, London SE1 9RT, UK; Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Tibor Kovacs
- Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Rose Baker
- School of Business, 612, Maxwell Bldg, University of Salford, Salford M5 4WT, UK
| | - Hisham Hamed
- Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Ash Kothari
- Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Michael Douek
- Division of Cancer Studies, King's College London, Guy's Hospital Campus, Great Maze Pond, London SE1 9RT, UK; Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
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Sentinel Lymph Node Biopsy in Breast Cancer: Indications, Contraindications, and Controversies. Clin Nucl Med 2016; 41:126-33. [PMID: 26447368 DOI: 10.1097/rlu.0000000000000985] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Axillary lymph node status, a major prognostic factor in early-stage breast cancer, provides information important for individualized surgical treatment. Because imaging techniques have limited sensitivity to detect metastasis in axillary lymph nodes, the axilla must be explored surgically. The histology of all resected nodes at the time of axillary lymph node dissection (ALND) has traditionally been regarded as the most accurate method for assessing metastatic spread of disease to the locoregional lymph nodes. However, ALND may result in lymphedema, nerve injury, shoulder dysfunction, and other short-term and long-term complications limiting functionality and reducing quality of life. Sentinel lymph node biopsy (SLNB) is a less invasive method of assessing nodal involvement. The concept of SLNB is based on the notion that tumors drain in an orderly manner through the lymphatic system. Therefore, the SLN is the first to be affected by metastasis if the tumor has spread, and a tumor-free SLN makes it highly unlikely for other nodes to be affected. Sentinel lymph node biopsy has become the standard of care for primary treatment of early breast cancer and has replaced ALND to stage clinically node-negative patients, thus reducing ALND-associated morbidity. More than 20 years after its introduction, there are still aspects concerning SLNB and ALND that are currently debated. Moreover, SLNB remains an unstandardized procedure surrounded by many unresolved controversies concerning the technique itself. In this article, we review the main indications, contraindications, and controversies of SLNB in breast cancer in the light of the most recent publications.
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