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Tanaka T, Nishie R, Murakami H, Tsuchihashi H, Toji A, Ueda S, Morita N, Hashida S, Terada S, Maruoka H, Taniguchi K, Komura K, Ohmichi M. Oncologic Outcomes of Patients with Early-Stage Cervical Cancer after Minimally Invasive Radical Hysterectomy and Sentinel Lymph Node Biopsy. J Clin Med 2024; 13:3981. [PMID: 38999545 PMCID: PMC11242828 DOI: 10.3390/jcm13133981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/28/2024] [Accepted: 07/05/2024] [Indexed: 07/14/2024] Open
Abstract
Background: The sentinel lymph node is the first node that cancer cells reach when migrating from the primary site. However, oncological outcomes after sentinel lymph node biopsy (SNB) have not been reported for cervical cancer. In this study, oncological outcomes were compared between patients receiving SNB and pelvic lymphadenectomy (PLD) for early-stage cervical cancer. Methods: One hundred and four patients with clinical stage 1A2, 1B1, and 2A1 cervical cancer were included in this study. All patients underwent laparoscopic or robot-assisted radical hysterectomy with SNB or PLD. Fifty-two patients with tumors ≤2 cm underwent SNB. Disease-free survival (DFS) and overall survival (OS) were compared between the groups. Results: The median (interquartile range) tumor size was 12 (7-20) mm in the SNB group and 20 (13-25) mm in the PLD group. Lymph node metastasis occurred in one patient in the SNB group and in nine patients in the PLD group. The median follow-up periods were 42 (24-60) and 82 (19-101) months in the SNB group and PLD group, respectively. The 3-year DFS rates were 100% in SNB and 91.5% in PLD. The 3-year OS was 100% in both groups. Conclusions: SNB was sufficient in cervical cancer patients with tumors ≤2 cm, suggesting that PLD might not be necessary for these patients.
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Affiliation(s)
- Tomohito Tanaka
- Department of Obstetrics and Gynecology, Educational Foundation of Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki 569-8686, Osaka, Japan; (R.N.); (H.M.); (H.T.); (A.T.); (S.U.); (N.M.); (S.H.); (S.T.); (H.M.); (M.O.)
- Center for Medical Research & Development, Division of Translational Research, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki 569-8686, Osaka, Japan; (K.T.); (K.K.)
| | - Ruri Nishie
- Department of Obstetrics and Gynecology, Educational Foundation of Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki 569-8686, Osaka, Japan; (R.N.); (H.M.); (H.T.); (A.T.); (S.U.); (N.M.); (S.H.); (S.T.); (H.M.); (M.O.)
| | - Hikaru Murakami
- Department of Obstetrics and Gynecology, Educational Foundation of Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki 569-8686, Osaka, Japan; (R.N.); (H.M.); (H.T.); (A.T.); (S.U.); (N.M.); (S.H.); (S.T.); (H.M.); (M.O.)
| | - Hiromitsu Tsuchihashi
- Department of Obstetrics and Gynecology, Educational Foundation of Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki 569-8686, Osaka, Japan; (R.N.); (H.M.); (H.T.); (A.T.); (S.U.); (N.M.); (S.H.); (S.T.); (H.M.); (M.O.)
| | - Akihiko Toji
- Department of Obstetrics and Gynecology, Educational Foundation of Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki 569-8686, Osaka, Japan; (R.N.); (H.M.); (H.T.); (A.T.); (S.U.); (N.M.); (S.H.); (S.T.); (H.M.); (M.O.)
| | - Shoko Ueda
- Department of Obstetrics and Gynecology, Educational Foundation of Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki 569-8686, Osaka, Japan; (R.N.); (H.M.); (H.T.); (A.T.); (S.U.); (N.M.); (S.H.); (S.T.); (H.M.); (M.O.)
| | - Natsuko Morita
- Department of Obstetrics and Gynecology, Educational Foundation of Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki 569-8686, Osaka, Japan; (R.N.); (H.M.); (H.T.); (A.T.); (S.U.); (N.M.); (S.H.); (S.T.); (H.M.); (M.O.)
| | - Sousuke Hashida
- Department of Obstetrics and Gynecology, Educational Foundation of Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki 569-8686, Osaka, Japan; (R.N.); (H.M.); (H.T.); (A.T.); (S.U.); (N.M.); (S.H.); (S.T.); (H.M.); (M.O.)
| | - Shinichi Terada
- Department of Obstetrics and Gynecology, Educational Foundation of Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki 569-8686, Osaka, Japan; (R.N.); (H.M.); (H.T.); (A.T.); (S.U.); (N.M.); (S.H.); (S.T.); (H.M.); (M.O.)
| | - Hiroshi Maruoka
- Department of Obstetrics and Gynecology, Educational Foundation of Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki 569-8686, Osaka, Japan; (R.N.); (H.M.); (H.T.); (A.T.); (S.U.); (N.M.); (S.H.); (S.T.); (H.M.); (M.O.)
| | - Kohei Taniguchi
- Center for Medical Research & Development, Division of Translational Research, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki 569-8686, Osaka, Japan; (K.T.); (K.K.)
| | - Kazumasa Komura
- Center for Medical Research & Development, Division of Translational Research, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki 569-8686, Osaka, Japan; (K.T.); (K.K.)
| | - Masahide Ohmichi
- Department of Obstetrics and Gynecology, Educational Foundation of Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki 569-8686, Osaka, Japan; (R.N.); (H.M.); (H.T.); (A.T.); (S.U.); (N.M.); (S.H.); (S.T.); (H.M.); (M.O.)
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Bercow A, Del Carmen MG, Rauh-Hain JA, Melamed A. Role of Minimally Invasive Techniques in the Management of Early-Stage Carcinoma of the Uterine Cervix. J Clin Oncol 2024:JCO2400656. [PMID: 38917386 DOI: 10.1200/jco.24.00656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/10/2024] [Accepted: 05/03/2024] [Indexed: 06/27/2024] Open
Abstract
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.
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Affiliation(s)
- Alexandra Bercow
- Vincent Department of Obstetrics and Gynecology, Meigs Division of Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Marcela G Del Carmen
- Vincent Department of Obstetrics and Gynecology, Meigs Division of Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Alexander Melamed
- Vincent Department of Obstetrics and Gynecology, Meigs Division of Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Bizzarri N, Obermair A, Hsu HC, Chacon E, Collins A, Tsibulak I, Mutombo A, Abu-Rustum NR, Balaya V, Buda A, Cibula D, Covens A, Fanfani F, Ferron G, Frumovitz M, Guani B, Kocian R, Kohler C, Leblanc E, Lecuru F, Leitao MM, Mathevet P, Mueller MD, Papadia A, Pareja R, Plante M, Querleu D, Scambia G, Tanner E, Zapardiel I, Garcia JR, Ramirez PT. Consensus on surgical technique for sentinel lymph node dissection in cervical cancer. Int J Gynecol Cancer 2024; 34:504-509. [PMID: 38378695 DOI: 10.1136/ijgc-2023-005151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
OBJECTIVE The purpose of this study was to establish a consensus on the surgical technique for sentinel lymph node (SLN) dissection in cervical cancer. METHODS A 26 question survey was emailed to international expert gynecological oncology surgeons. A two-step modified Delphi method was used to establish consensus. After a first round of online survey, the questions were amended and a second round, along with semistructured interviews was performed. Consensus was defined using a 70% cut-off for agreement. RESULTS Twenty-five of 38 (65.8%) experts responded to the first and second rounds of the online survey. Agreement ≥70% was reached for 13 (50.0%) questions in the first round and for 15 (57.7%) in the final round. Consensus agreement identified 15 recommended, three optional, and five not recommended steps. Experts agreed on the following recommended procedures: use of indocyanine green as a tracer; superficial (with or without deep) injection at 3 and 9 o'clock; injection at the margins of uninvolved mucosa avoiding vaginal fornices; grasping the cervix with forceps only in part of the cervix is free of tumor; use of a minimally invasive approach for SLN biopsy in the case of simple trachelectomy/conization; identification of the ureter, obliterated umbilical artery, and external iliac vessels before SLN excision; commencing the dissection at the level of the uterine artery and continuing laterally; and completing dissection in one hemi-pelvis before proceeding to the contralateral side. Consensus was also reached in recommending against injection at 6 and 12 o'clock, and injection directly into the tumor in cases of the tumor completely replacing the cervix; against removal of nodes through port without protective maneuvers; absence of an ultrastaging protocol; and against modifying tracer concentration at the time of re-injection after mapping failure. CONCLUSION Recommended, optional, and not recommended steps of SLN dissection in cervical cancer have been identified based on consensus among international experts. These represent a surgical guide that may be used by surgeons in clinical trials and for quality assurance in routine practice.
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Affiliation(s)
- Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Andreas Obermair
- Queensland Centre for Gynaecological Cancer Research, Faculty of Medicine, Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Heng-Cheng Hsu
- Obstetrics and Gynaecology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Enrique Chacon
- Gynaecologic Oncology, Universidad de Navarra, Pamplona, Spain
| | - Anna Collins
- Obstetrics and Gynaecology, Derby Hospitals NHS Foundation Trust, Derby, UK
| | - Irina Tsibulak
- Department of Obstetrics and Gynaecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alex Mutombo
- Gynaecology and Obstetrics, University of Kinshasa, Kinshasa, Congo (Democratic Republic of the)
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Vincent Balaya
- Department of Obstetrics and Gynaecology, Felix Guyon Hospital, CHU Nord Réunion, France
| | - Alessandro Buda
- Gynaecologic Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Italy
| | - David Cibula
- Department of Obstetrics and Gynecology, Charles University, First Faculty of Medicine, Prague, Czech Republic
| | - Allan Covens
- Gynecologic Oncology, Toronto Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada
| | - Francesco Fanfani
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gwenaël Ferron
- Department of Surgical Oncology, Institut Claudius Regaud Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Michael Frumovitz
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Benedetta Guani
- Department of Obstetrics and Gynaecology, Fribourg Hospitals, Fribourg, Switzerland
| | - Roman Kocian
- Department of Obstetrics and Gynecology, Charles University, First Faculty of Medicine, Prague, Czech Republic
| | - Christhardt Kohler
- Department of Gynaecology, University of Cologne, Koln, Germany
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg-Altona, Asklepios Hospital Group, Hamburg, Germany
| | - Eric Leblanc
- Department of Surgical Oncology, Centre Oscar Lambret, Lille, France
| | - Fabrice Lecuru
- Breast, Gynaecology, and Reconstructive Surgery Unit, Institute Curie, Paris, France
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Patrice Mathevet
- Centre Hospitalier Universitaire Vaudois Departement de gynecologie-obstetrique et genetique medicale, Lausanne, Switzerland
| | - Michael D Mueller
- Gynaecology and Gynaecological Oncology, Inselspital University Hospital Berne Department of Gynaecology, Bern, Switzerland
| | - Andrea Papadia
- Department of Gynaecology and Obstetrics, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Università della Svizzera italiana, Lugano, Switzerland
| | - Rene Pareja
- Department of Gynaecology, Gynaecologic Oncology, Clinica Astorga, Medellin, Colombia
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | | | - Denis Querleu
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Edward Tanner
- Department of Obstetrics and Gynecology, Northwestern University, Evanston, Illinois, USA
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
| | - Jaime R Garcia
- Department of Academic Analytics and Technology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Pedro T Ramirez
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas, USA
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Monthatip K, Boonnag C, Muangmool T, Charoenkwan K. A machine learning-based prediction model of pelvic lymph node metastasis in women with early-stage cervical cancer. J Gynecol Oncol 2024; 35:e17. [PMID: 37921601 PMCID: PMC10948976 DOI: 10.3802/jgo.2024.35.e17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/03/2023] [Accepted: 10/03/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVE To develop a novel machine learning-based preoperative prediction model for pelvic lymph node metastasis (PLNM) in early-stage cervical cancer by combining the clinical findings and preoperative computerized tomography (CT) of the whole abdomen and pelvis. METHODS Patients diagnosed with International Federation of Gynecology and Obstetrics stage IA2-IIA1 squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma of the cervix who had primary radical surgery with bilateral pelvic lymphadenectomy from January 1, 2003 to December 31, 2020, were included. Seven supervised machine learning algorithms, including logistic regression, random forest, support vector machine, adaptive boosting, gradient boosting, extreme gradient boosting, and category boosting, were used to evaluate the risk of PLNM. RESULTS PLNM was found in 199 (23.9%) of 832 patients included. Younger age, larger tumor size, higher stage, no prior conization, tumor appearance, adenosquamous histology, and vaginal metastasis as well as the CT findings of larger tumor size, parametrial metastasis, pelvic lymph node enlargement, and vaginal metastasis, were significantly associated with PLNM. The models' predictive performance, including accuracy (89.1%-90.6%), area under the receiver operating characteristics curve (86.9%-91.0%), sensitivity (77.4%-82.4%), specificity (92.1%-94.3%), positive predictive value (77.0%-81.7%), and negative predictive value (93.0%-94.4%), appeared satisfactory and comparable among all the algorithms. After optimizing the model's decision threshold to enhance the sensitivity to at least 95%, the 'highly sensitive' model was obtained with a 2.5%-4.4% false-negative rate of PLNM prediction. CONCLUSION We developed prediction models for PLNM in early-stage cervical cancer with promising prediction performance in our setting. Further external validation in other populations is needed with potential clinical applications.
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Affiliation(s)
- Kamonrat Monthatip
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chiraphat Boonnag
- Biomedical Informatics Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tanarat Muangmool
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kittipat Charoenkwan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Pantelis AG, Machairiotis N, Stavros S, Disu S, Drakakis P. Current applications of indocyanine green (ICG) in abdominal, gynecologic and urologic surgery: a meta-review and quality analysis with use of the AMSTAR 2 instrument. Surg Endosc 2024; 38:511-528. [PMID: 37957300 DOI: 10.1007/s00464-023-10546-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/13/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Indocyanine green (ICG) is an injectable fluorochrome that has recently gained popularity as a means of assisting intraoperative visualization during laparoscopic and robotic surgery. Many systematic reviews and meta-analyses have been published. We conducted a meta-review to synthesize the findings of these studies. METHODS PubMed and Embase were searched to identify systematic reviews and meta-analyses coping with the uses of ICG in abdominal operations, including Metabolic Bariatric Surgery, Cholecystectomy, Colorectal, Esophageal, Gastric, Hepato-Pancreato-Biliary, Obstetrics and Gynecology (OG), Pediatric Surgery, Surgical Oncology, Urology, (abdominal) Vascular Surgery, Adrenal and Splenic Surgery, and Interdisciplinary tasks, until September 2023. We submitted the retrieved meta-analyses to qualitative analysis based on the AMSTAR 2 instrument. RESULTS We identified 116 studies, 41 systematic reviews (SRs) and 75 meta-analyses (MAs), spanning 2013-2023. The most thoroughly investigated (sub)specialties were Colorectal (6 SRs, 25 MAs), OG (9 SRs, 15 MAs), and HPB (4 SRs, 12 MAs). Interestingly, there was high heterogeneity regarding the administered ICG doses, routes, and timing. The use of ICG offered a clear benefit regarding anastomotic leak prevention, particularly after colorectal and esophageal surgery. There was no clear benefit regarding sentinel node detection after OG. According to the AMSTAR 2 tool, most meta-analyses ranked as "critically low" (34.7%) or "low" (58.7%) quality. There were only five meta-analyses (6.7%) that qualified as "moderate" quality, whereas there were no "high" quality reviews. CONCLUSIONS Regardless of the abundance of pertinent literature and reviews, surgeons should be cautious when interpreting their results on ICG use in abdominal surgery. Future reviews should focus on ensuring methodological vigor; establishing clear protocols of ICG dose, route of administration, and timing; and improving reporting quality. Other sources of data (e.g., registries) and novel methods of data analysis (e.g., machine learning) might also contribute to an enhanced role of ICG as a decision-making tool in surgery.
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Affiliation(s)
- Athanasios G Pantelis
- Mohak Bariatric and Robotic Surgery Center, Sri Aurobindo Medical College Campus, Indore-Ujjain Highway Near MR-10 Crossing, Indore, Madhya Pradesh, 453555, India.
| | - Nikolaos Machairiotis
- Assisted Reproduction Unit, 3rd Department of Obstetrics and Gynecology, School of Medicine, Attikon University Hospital, University of Athens, Athens, Greece
- Endometriosis Centre, London North West University Healthcare NHS Trust, Harrow, UK
| | - Sofoklis Stavros
- Assisted Reproduction Unit, 3rd Department of Obstetrics and Gynecology, School of Medicine, Attikon University Hospital, University of Athens, Athens, Greece
| | - Stewart Disu
- Endometriosis Centre, London North West University Healthcare NHS Trust, Harrow, UK
| | - Petros Drakakis
- Assisted Reproduction Unit, 3rd Department of Obstetrics and Gynecology, School of Medicine, Attikon University Hospital, University of Athens, Athens, Greece
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Kodama K, Tateishi C, Oda T, Cui L, Kuramoto K, Yahata H, Okugawa K, Maenohara S, Yagi H, Yasunaga M, Onoyama I, Asanoma K, Mori T, Katayama Y, Kato K. Development of novel tracers for sentinel node identification in cervical cancer. Cancer Sci 2023; 114:4216-4224. [PMID: 37648257 PMCID: PMC10637086 DOI: 10.1111/cas.15927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/24/2023] [Accepted: 07/29/2023] [Indexed: 09/01/2023] Open
Abstract
Indocyanine green (ICG) with near-infrared (NIR) fluorescence imaging is used for lymphatic mapping. However, binding of ICG to blood proteins like serum albumin can shorten its retention time in sentinel lymph nodes (SLNs). Here, we investigated the efficacy and safety of a new fluorescence tracer comprising phytate and liposome (LP)-encapsulated ICG. Coadministration of phytate with LP containing phosphatidic acid promotes chelation mediated by Ca2+ in bodily fluids to enhance SLN retention. Uniformly sized LPs (100 nm) encapsulating ICG under conditions that minimized fluorescence self-quenching during storage were produced. We analyzed the behavior of the new tracer (ICG-phytate-LP) and control tracers (ICG and ICG-LP) in the lymphatic flow of mice in terms of lymph node retention time. We also tested lymphatic flow and safety in pigs that have a more human-like lymphatic system. LPs encapsulating stabilized ICG were successfully prepared. Mixing LP with phytate in the presence of Ca2+ increased both the particle size and negative surface charge. In mice, ICG-phytate-LP had the best lymph node retention, with a fluorescence intensity ratio that increased over 6 h and then decreased slowly over the next 24 h. In pigs, administration of ICG and ICG-phytate-LP resulted in no death or weight loss. There were no obvious differences between blood test results for the ICG and ICG-phytate-LP groups, and the overall safety was good. ICG-phytate-LP may be a useful new tracer for gynecological cancers that require time for lymph node identification due to a retroperitoneal approach.
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Affiliation(s)
- Keisuke Kodama
- Department of Obstetrics and GynecologyGraduate School of Medical Sciences, Kyushu UniversityFukuokaJapan
| | - Chuya Tateishi
- Department of Chemistry and BiochemistryGraduate School of Systems Life Sciences, Graduate School of Engineering, Kyushu UniversityFukuokaJapan
| | - Tsuyoshi Oda
- Department of Chemistry and BiochemistryGraduate School of Systems Life Sciences, Graduate School of Engineering, Kyushu UniversityFukuokaJapan
| | - Lin Cui
- Department of Obstetrics and GynecologyGraduate School of Medical Sciences, Kyushu UniversityFukuokaJapan
| | - Kazutaka Kuramoto
- Department of Obstetrics and GynecologyGraduate School of Medical Sciences, Kyushu UniversityFukuokaJapan
| | - Hideaki Yahata
- Department of Obstetrics and GynecologyGraduate School of Medical Sciences, Kyushu UniversityFukuokaJapan
| | - Kaoru Okugawa
- Department of Obstetrics and GynecologyGraduate School of Medical Sciences, Kyushu UniversityFukuokaJapan
| | - Shoji Maenohara
- Department of Obstetrics and GynecologyGraduate School of Medical Sciences, Kyushu UniversityFukuokaJapan
| | - Hiroshi Yagi
- Department of Obstetrics and GynecologyGraduate School of Medical Sciences, Kyushu UniversityFukuokaJapan
| | - Masafumi Yasunaga
- Department of Obstetrics and GynecologyGraduate School of Medical Sciences, Kyushu UniversityFukuokaJapan
| | - Ichiro Onoyama
- Department of Obstetrics and GynecologyGraduate School of Medical Sciences, Kyushu UniversityFukuokaJapan
| | - Kazuo Asanoma
- Department of Obstetrics and GynecologyGraduate School of Medical Sciences, Kyushu UniversityFukuokaJapan
| | - Takeshi Mori
- Department of Chemistry and BiochemistryGraduate School of Systems Life Sciences, Graduate School of Engineering, Kyushu UniversityFukuokaJapan
| | - Yoshiki Katayama
- Department of Chemistry and BiochemistryGraduate School of Systems Life Sciences, Graduate School of Engineering, Kyushu UniversityFukuokaJapan
- Department of Biomedical EngineeringChung Yuan Christian UniversityTaoyuan CityTaiwan
| | - Kiyoko Kato
- Department of Obstetrics and GynecologyGraduate School of Medical Sciences, Kyushu UniversityFukuokaJapan
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Berasaluce Gómez A, Martín-Calvo N, Boria F, Manzour N, Chacón E, Bizzarri N, Chiva L. SUCCOR Nodes: May Sentinel Node Biopsy Determine the Need for Adjuvant Treatment? Ann Surg Oncol 2023; 30:4975-4985. [PMID: 37208571 PMCID: PMC10319697 DOI: 10.1245/s10434-023-13529-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 04/03/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND The SUCCOR cohort was developed to analyse the overall and disease-free survival at 5 years in women with FIGO 2009 stage IB1 cervical cancer. The aim of this study was to compare the use of adjuvant therapy in these women, depending on the method used to diagnose lymphatic node metastasis. PATIENTS AND METHODS We used data from the SUCCOR cohort, which collected information from 1049 women with FIGO 2009 stage IB1 cervical cancer who were operated on between January 2013 and December 2014 in Europe. We calculated the adjusted proportion of women who received adjuvant therapy depending on the lymph node diagnosis method and compared disease free and overall survival using Cox proportional-hazards regression models. Inverse probability weighting was used to adjust for baseline potential confounders. RESULTS The adjusted proportion of women who received adjuvant therapy was 33.8% in the sentinel node biopsy + lymphadenectomy (SNB+LA) group and 44.7% in the LA group (p = 0.02), although the proportion of positive nodal status was similar (p = 0.30). That difference was greater in women with negative nodal status and positive Sedlis criteria (difference 31.2%, p = 0.01). Here, those who underwent a SNB+LA had an increased risk of relapse [hazard ratio (HR) 2.49, 95% confidence interval (CI) 0.98-6.33, p = 0.056] and risk of death (HR 3.49, 95% CI 1.04-11.7, p = 0.042) compared with those who underwent LA. CONCLUSIONS Women in this study were less likely to receive adjuvant therapy if their nodal invasion was determined using SNB+LA compared with LA. These results suggest a lack of therapeutic measures available when a negative result is obtained by SNB+LA, which may have an impact on the risk of recurrence and survival.
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Affiliation(s)
- Arantxa Berasaluce Gómez
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain
| | - Nerea Martín-Calvo
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
- CIBER de Fisiopatología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Félix Boria
- Department of Obstetrics and Gynecology, Universidad de Navarra Clinic, Madrid, Spain
| | - Nabil Manzour
- Department of Obstetrics and Gynecology, Universidad de Navarra Clinic, Pamplona, Spain
| | - Enrique Chacón
- Department of Obstetrics and Gynecology, Universidad de Navarra Clinic, Pamplona, Spain
| | - Nicolò Bizzarri
- Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Rome, Italy
| | - Luis Chiva
- Department of Obstetrics and Gynecology, Universidad de Navarra Clinic, Madrid, Spain.
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Huang Q, Li S, Chen X, Liu X, Zhou G, Huang L, Li X, Lin K, Zheng X. A preoperative prediction of lymph node metastasis in early cervical squamous cell cancer with hematologica - based model. J Cancer 2023; 14:1763-1772. [PMID: 37476184 PMCID: PMC10355196 DOI: 10.7150/jca.85301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/04/2023] [Indexed: 07/22/2023] Open
Abstract
Background: This study aimed to construct a preoperative model predicting lymph node metastasis (LNM) in IB1-IIA2 stage cervical squamous cell cancer (CSCC) based on hematological indexes. Merhods: Between February 2011 and February 2022, 463 patients with IB1-IIA2 stage CSCC underwent radical resection. Patients were allocated to either a model-development cohort (n=337) or a validation cohort (n=126). The final model was determined by comparing different methods of variable selection, and then its discrimination and calibration metrics were evaluated. A predicted probability of LNM < 5% was defined as low risk. ROC curves were used to define high risk. Results: Age, lactate dehydrogenase level, FIGO stage, squamous cell carcinoma antigen, cancer antigen 125, and cancer antigen 199 were identified as critical factors for the construction of the model. The model demonstrated good discrimination and calibration (concordance index, 0.761; 95% confidence interval, 0.666-0.884). In the validation cohort the discrimination accuracy was 0.821 (95% confidence interval, 0.714 - 0.927). In the model-development cohort, 11.9% were classified as low risk with a negative predictive value of 95.0%, and 24.9% were classified as high risk with a positive predictive value of 39.3%. Conclusion: A predictive model was developed and validated for LNM in IB1-IIA2 stage CSCC. The model will assist physicians in appraising the risk of LNM in preoperative patients and could aid in patient counseling and individualized clinical decision-making.
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Affiliation(s)
- Qiuyuan Huang
- Department of Radiation Oncology, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Suyu Li
- Department of Gynecology, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xiaoying Chen
- Department of Gynecology, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xiaohong Liu
- Department of Radiation Oncology, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Guangrun Zhou
- Department of Radiation Oncology, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Liyuan Huang
- Department of Radiation Oncology, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xiaoyan Li
- Department of Radiation Oncology, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Kaiwu Lin
- Department of Radiology, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xiangqin Zheng
- Department of Gynecology, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
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[Carbon nanoparticle tracing of sentinel lymph nodes in diagnosis and treatment of cervical cancer and clinical value of lymph node ultrastaging detection]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2022; 42:1896-1901. [PMID: 36651260 PMCID: PMC9878409 DOI: 10.12122/j.issn.1673-4254.2022.12.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate the clinical value of sentinel lymph node (SLN) detection using carbon nanoparticles in the diagnosis and treatment of cervical cancer and the value of lymph node pathological ultrastaging detection. METHODS A total of 79 patients with cervical cancer in IA2, IB1, IB2, IIA1 and IIICp1 stages admitted to the Department of Gynecology and Obstetrics, Nanfang Hospital between June, 2018 and January, 2021 were included in this study. During the operation, the patients were injected with a total of 0.25 mL carbon nanoparticles at 3 and 9 o'clock of the normal cervix after general anesthesia. The first black-dyed lymph nodes were identified as SLNs and removed one by one. All the patients underwent pelvic lymph node dissection and radical hysterectomy with or without para-aortic lymphadenectomy. The black-dyed SLNs were removed for routine pathological examination. Thirty patients with negative SLNs were randomly selected for pathological ultrastaging. RESULTS In 67 of the 79 patients, a total of 417 SLNs were detected with a detection rate of 84.8%; in each patient, at least 1 SLN was detected with a mean SLN number of 5.28. After the operation, 5 patients were found to have positive SLNs; 1 patient was negative for SLN but positive for non-SLN. The sensitivity of SLN biopsy was 83.3% with a specificity of 100%, false negative rate of 16.7%, an accuracy of 98.5% and a negative predictive value of 98.4%. SLN was distributed mainly in the obturator region, the external iliac region, the internal iliac region and the total iliac region (15.11%). Univariate and multivariate analyses suggested that preoperative cervical coning (P=0.045 and 0.009) and tumor size (P=0.033 and 0.008) significantly affected the overall detection rate of SLN. Kappa test showed a high consistency between SLN and pelvic lymph node metastasis status (Kappa value=0.901, P < 0.001). In 30 patients with negative pathological results of SLN, pathological ultrastaging detection identified no micrometastases or isolated tumor cells. CONCLUSION Carbon nanoparticle tracing of the SLNs is safe and feasible in the diagnosis and treatment of cervical cancer, and SLN detection is safe in patients with primary lesion size below 2 cm or without cervical conization. SLN combined with pathological ultrastaging detection does not improve the detection rate of isolated tumor cells or micrometastases.
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Abstract
PURPOSE OF REVIEW This article discusses recent developments towards less radical surgical treatment for early-stage cervical cancer. RECENT FINDINGS Surgery is the standard treatment for early-stage cervical cancer. In the last decades, new treatment strategies have been developed aiming to reduce morbidity, without hampering oncological safety. We provide an update of the latest knowledge on safety and morbidity following less radical surgical procedures in early-stage cervical cancer. In cervical cancer with a tumour size of 2 cm or less, radical surgery (simple hysterectomy or fertility-sparing conisation) may be a well tolerated option. For patients with larger lesions (>2 cm) and wishing to preserve fertility, administration of neoadjuvant chemotherapy followed by less extensive surgery appears to be a feasible and well tolerated alternative to abdominal trachelectomy. With regard to lymph node assessment, increasing evidence shows the feasibility of the sentinel lymph node procedure instead of full pelvic lymphadenectomy. Prospective trials reporting on oncological safety are awaited.It is important to exercise caution when new surgical strategies are introduced. Despite promising retrospective data, prospective randomized studies may present unexpected results, for instance, minimally invasive radical hysterectomy showed inferior results compared to laparotomy. SUMMARY There is a shift towards less radical treatment for early-stage cervical cancer. This review explores whether and when less is really more.
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Lin Y, Huang J, Chen Y, Wen Z, Cao Y, Zhang L, Cai T, Yu C, He X. Evaluation of perfluoropropane (C 3F 8)-filled chitosan polyacrylic acid nanobubbles for ultrasound imaging of sentinel lymph nodes and tumors. Biomater Sci 2022; 10:6447-6459. [PMID: 36018299 DOI: 10.1039/d2bm01140a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Accurate sentinel lymph node (SLN) identification is an important prerequisite for sentinel lymph node biopsy (SLNB). However, existing SLN mapping techniques, mainly imaging-guided methods, are severely restricted by the high cost of the instruments, harmful radiation or unsatisfactory imaging depths. Herein, we prepared a new ultrasound contrast agent by filling perfluoropropane (C3F8) into chitosan polyacrylic acid nanobubbles for precise SLN identification. The obtained ultrasound contrast agent, coined C3F8-CS-PAA nanobubbles, presents a nanometer size with a diameter of approximately 120 nm. The C3F8-CS-PAA nanobubbles of desirable size are able to enter lymphatic vessels and accumulate in the sentinel lymph node to enhance ultrasound imaging. As a result, the injection of C3F8-CS-PAA nanobubbles can remarkably enhance the ultrasound imaging lymph system, providing image guidance for sentinel lymph node biopsy. Furthermore, it was shown that such C3F8-CS-PAA nanobubbles can effectively permeate into the tumor region via the tumor-enhanced permeability and retention (EPR) effect to enhance tumor ultrasound imaging for monitoring tumorigenesis. This work highlights a novel nanoscale ultrasound contrast agent for the lymphatic system and tumor imaging, with great promise for subsequent studies and clinical applications.
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Affiliation(s)
- Yi Lin
- Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China.
| | - Ju Huang
- Chongqing Key Laboratory of Ultrasound Molecular Imaging, Institute of Ultrasound Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Yinyin Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering & Chongqing Key Laboratory of Biomedical Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing 400010, China
| | - Ziwei Wen
- Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China.
| | - Yang Cao
- Chongqing Key Laboratory of Ultrasound Molecular Imaging, Institute of Ultrasound Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Liang Zhang
- Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China.
| | - Tao Cai
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Chaoqun Yu
- College of Pharmacy, Chongqing Medical University, Chongqing 400010, China.
| | - Xuemei He
- Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China.
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12
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Use of Nomogram to Predict the Risk of Lymph Node Metastasis among Patients with Cervical Adenocarcinoma. J Immunol Res 2022; 2022:6816456. [PMID: 36052281 PMCID: PMC9427274 DOI: 10.1155/2022/6816456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background The objective of this study was to develop a nomogram that can predict lymph node metastasis (LNM) in patients with cervical adenocarcinoma (cervical AC). Methods A total of 219 patients with cervical AC who had undergone radical hysterectomy and lymphadenopathy between 2005 and 2021 were selected for this study. Both univariate and multivariate logistic regression analyses were performed to analyze the selected key clinicopathologic features and develop a nomogram and underwent internal validation to predict the probability of LNM. Results Lymphovascular invasion (LVI), tumor size ≥ 4 cm, and depth of cervical stromal infiltration were independent predictors of LNM in cervical AC. However, the Silva pattern was not found to be a significant predictor in the multivariate model. The Silva pattern was still included in the model based on the improved predictive performance of the model observed in the previous studies. The concordance index (C-index) of the model increased from 0.786 to 0.794 after the inclusion of the Silva pattern. The Silva pattern was found to be the strongest predictor of LNM among all the pathological factors investigated, with an OR of 4.37 in the nomogram model. The nomogram developed by incorporation of these four predictors performed well in terms of discrimination and calibration capabilities (C − index = 0.794; 95% confidence interval (CI), 0.727–0.862; Brier score = 0.127). Decision curve analysis demonstrated that the nomogram was clinically effective in the prediction of LNM. Conclusion In this study, a nomogram was developed based on the pathologic features, which helped to screen individuals with a higher risk of occult LNM. As a result, this tool may be specifically useful in the management of individuals with cervical AC and help gynecologists to guide clinical individualized treatment plan.
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Gómez-Hidalgo NR, Acosta Ú, Rodríguez TG, Mico S, Verges R, Conesa VB, Bradbury M, Pérez-Hoyos S, Pérez-Benavente A, Gil-Moreno A. Adjuvant therapy in early-stage cervical cancer after radical hysterectomy: are we overtreating our patients? A meta-analysis. Clin Transl Oncol 2022; 24:1605-1614. [PMID: 35441353 DOI: 10.1007/s12094-022-02808-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/09/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE There is a gap in knowledge regarding the ideal management of patients with early-stage cervical cancer and intermediate-risk features. Here, we present a meta-analysis of the published literature on oncological outcomes in these patients and determine trends in postoperative management. METHODS MEDLINE and PubMed were used for literature searches. The inclusion criteria were: English language articles including ≥ 10 patients, patients who underwent radical hysterectomy, nodes negative, studies reporting oncological outcomes and complications treatment-related and compare a surgery-only cohort with a radiotherapy cohort. The PRISMA guidelines were followed. Combined relative risk was calculated using DerSimonian-Laird random-effects model and a forest plot was drawn. RESULTS We collected 183 manuscripts on early-stage cervical cancer treated with radical hysterectomy alone or with adjuvant radiotherapy after surgery. A total of eight studies met the inclusion criteria. Regarding oncological outcomes, survival was reported in five studies. The relative risk of recurrence and the relative risk of mortality was similar in both groups independently whether receive or not adjuvant therapy. Most of the studies did not report significant differences regarding morbidity treatment related between the groups, except for a higher rate of lymphedema after radiotherapy. CONCLUSION We found that the relative risk of recurrence and mortality was similar in both groups not depending on adjuvant therapy. Therefore, whether radiotherapy adjuvant treatment is indicated remains a topic of debate.
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Affiliation(s)
- Natalia R Gómez-Hidalgo
- Unit of Gynecologic Oncology, Service of Gynecology, Vall d'Hebron Barcelona Hospital Campus, Autonoma University of Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Úrsula Acosta
- Unit of Gynecologic Oncology, Service of Gynecology, Vall d'Hebron Barcelona Hospital Campus, Autonoma University of Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | | | - Soraya Mico
- Radiotherapy Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ramona Verges
- Radiotherapy Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Vicente Bebia Conesa
- Unit of Gynecologic Oncology, Service of Gynecology, Vall d'Hebron Barcelona Hospital Campus, Autonoma University of Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Melissa Bradbury
- Unit of Gynecologic Oncology, Service of Gynecology, Vall d'Hebron Barcelona Hospital Campus, Autonoma University of Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Santiago Pérez-Hoyos
- Statistics Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Asunción Pérez-Benavente
- Unit of Gynecologic Oncology, Service of Gynecology, Vall d'Hebron Barcelona Hospital Campus, Autonoma University of Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Antonio Gil-Moreno
- Unit of Gynecologic Oncology, Service of Gynecology, Vall d'Hebron Barcelona Hospital Campus, Autonoma University of Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer, CIBERONC, Madrid, Spain
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Yahata H, Kodama K, Okugawa K, Hachisuga K, Yasutake N, Maenohara S, Yagi H, Yasunaga M, Ohgami T, Onoyama I, Asanoma K, Kobayashi H, Sonoda K, Baba S, Ishigami K, Ohishi Y, Oda Y, Kato K. Long-term follow up after sentinel node biopsy alone for early-stage cervical cancer. Gynecol Oncol 2022; 165:149-154. [DOI: 10.1016/j.ygyno.2022.01.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/10/2022] [Accepted: 01/27/2022] [Indexed: 02/06/2023]
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15
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Leong SP, Pissas A, Scarato M, Gallon F, Pissas MH, Amore M, Wu M, Faries MB, Lund AW. The lymphatic system and sentinel lymph nodes: conduit for cancer metastasis. Clin Exp Metastasis 2021; 39:139-157. [PMID: 34651243 PMCID: PMC8967769 DOI: 10.1007/s10585-021-10123-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/06/2021] [Indexed: 11/03/2022]
Abstract
The lymphatic system is a complicated system consisting of the lymphatic vessels and lymph nodes draining the extracellular fluid containing cellular debris, excess water and toxins to the circulatory system. The lymph nodes serve as a filter, thus, when the lymph fluid returns to the heart, it is completely sterile. In addition, the lymphatic system includes the mucosa-associated lymphoid tissue, such as tonsils, adenoids, Peyers patches in the small bowel and even the appendix. Taking advantage of the drainage system of the lymphatics, cancer cells enter the lymphatic vessels and then the lymph nodes. In general, the lymph nodes may serve as a gateway in the majority of cases in early cancer. Occasionally, the cancer cells may enter the blood vessels. This review article emphasizes the structural integrity of the lymphatic system through which cancer cells may spread. Using melanoma and breast cancer sentinel lymph node model systems, the spread of early cancer through the lymphatic system is progressive in a majority of cases. The lymphatic systems of the internal organs are much more complicated and difficult to study. Knowledge from melanoma and breast cancer spread to the sentinel lymph node may establish the basic principles of cancer metastasis. The goal of this review article is to emphasize the complexity of the lymphatic system. To date, the molecular mechanisms of cancer spread from the cancer microenvironment to the sentinel lymph node and distant sites are still poorly understood and their elucidation should take major priority in cancer metastasis research.
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Affiliation(s)
- Stanley P Leong
- California Pacific Medical Center and Research Institute, San Francisco, CA, USA. .,University of California, San Francisco, San Francisco, CA, USA.
| | - Alexander Pissas
- Department of Visceral Surgery General Hospital of Bagnols sur Cèze and of Anatomy Faculty of Medicine of Montpellier, Bagnols sur Ceze, Montpellier, France
| | - Muriel Scarato
- Department of Visceral Surgery General Hospital of Bagnols sur Cèze and of Anatomy Faculty of Medicine of Montpellier, Bagnols sur Ceze, Montpellier, France
| | - Francoise Gallon
- Department of Visceral Surgery General Hospital of Bagnols sur Cèze and of Anatomy Faculty of Medicine of Montpellier, Bagnols sur Ceze, Montpellier, France
| | - Marie Helene Pissas
- Department of Visceral Surgery General Hospital of Bagnols sur Cèze and of Anatomy Faculty of Medicine of Montpellier, Bagnols sur Ceze, Montpellier, France
| | - Miguel Amore
- Vascular Anatomy Lab. III Chair of Anatomy, Faculty of Medicine, Buenos Aires University, Buenos Aires, Argentina.,Phlebology and Lymphology Unit. Cardiovascular Surgery Division, Central Military Hospital, Buenos Aires, Argentina
| | - Max Wu
- California Pacific Medical Center, San Francisco, USA
| | - Mark B Faries
- The Angeles Clinic and Research Institute A Cedars-Sinai Affiliate, Los Angeles, CA, USA
| | - Amanda W Lund
- Ronald O. Perelman Department of Dermatology, Department of Pathology, and NYU Langone Laura and Isaac Perlmutter Cancer Center, NYU Grossman School of Medicine, New York, NY, 10016, USA
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Wang L, Liu S, Xu T, Yuan L, Yang X. Sentinel lymph node mapping in early-stage cervical cancer: Meta-analysis. Medicine (Baltimore) 2021; 100:e27035. [PMID: 34449483 PMCID: PMC8389869 DOI: 10.1097/md.0000000000027035] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 08/09/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The value of sentinel lymph node (SLN) mapping for early-stage cervical cancer remains controversial. Therefore, we collected data to investigate the feasibility and diagnostic accuracy of SLN in patients with early-stage (IA-IIA) cervical cancer. METHODS We searched Embase, PubMed, and the Cochrane Library databases issued before June 1, 2020. The sample size of the selected study was at least 10 patients with early-stage (IA-IIA) cervical cancer, the pooled detection rates and the separate detection rate (overall detection rate, bilateral detection rate) using blue dye with Tc, technetium 99 (Tc) and indocyanine green (ICG) technique of early-stage cervical cancer was reported. R-3.6.1 software was used to evaluate pooled detection rate and sensitivity. RESULTS Two thousand one hundred sixty-four patients included for analysis in 28 studies ranging from 12 to 405 patients. The combined overall detection rate of SLN mapping was 95% with a 72% pooled bilateral detection rate. The sensitivity of the combined overall detection rate of SLN mapping was 94.99% as well as a sensitivity of 72.43% bilateral detection rate. The overall detection rate of SLN was 96% for blue dye with Tc, 95% for Tc, 98% for ICG technique. The bilateral detection rate of SLN was 76% for blue dye with Tc, 63% for Tc, 85% for ICG technique. The sensitivity of the overall detection rate of SLN mapping was 97.76% as well as a sensitivity of 84.96% bilateral detection rate of ICG technique. CONCLUSION In early-stage cervical cancer, overall detection rate of SLN mapping is elevated while bilateral detection rate is lower. The overall detection rate (98%) as well as bilateral rate (85%) of ICG seems to be a better SLN mapping technique among the method of SLN mapping (using blue dye with Tc, Tc or ICG). We believe SLN mapping may be considered contemporary technique which could provide additional benefits over traditional pelvic lymphadenectomy. While promising results in SLN mapping has been found, larger patient samples, including randomized studies, are required at the same time.
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Affiliation(s)
- Lijun Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Shanshan Liu
- Department of Clinical Laboratory, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Ting Xu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Linnan Yuan
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Xinyuan Yang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
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Yang E, Huang S, Ran X, Huang Y, Li Z. The 5-year overall survival of cervical cancer in stage IIIC-r was little different to stage I and II: a retrospective analysis from a single center. BMC Cancer 2021; 21:203. [PMID: 33639874 PMCID: PMC7912513 DOI: 10.1186/s12885-021-07890-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/21/2021] [Indexed: 12/24/2022] Open
Abstract
Background The 2018 International Federation of Gynecology and Obstetrics (FIGO) staging guideline for cervical cancer includes stage IIIC recognized by preoperative radiology (IIIC-r) to state there are lymph nodes metastases (LNM) identified by imaging tools. We aim to explore the reasonability and limitations of stage IIIC-r and try to explore the potential reasons. Methods Electronic medical records were used to identify patients with cervical cancer. According to the new staging guidelines, patients were reclassified and assigned into five cohorts: stage I, stage II, stage IIIC-r, LNM confirmed by pathology (IIIC-p) and LNM detected by radiology and confirmed by pathology (IIIC r + p). Five-year overall survivals were estimated for each cohort. The diagnosis accuracy of computed tomography (CT), magnetic resonance imaging (MRI) and diameter of detected lymph nodes were also evaluated. Results A total of 619 patients were identified. The mean follow-up months were 65 months (95% CI 64.43–65.77) for all patients. By comparison, the 5-year overall survival rates were not statistically different (p = 0.21) among stage IIIC-r, stage I and stage II. While, the rates were both statistical different (p<0.001) among stage IIIC-p, IIIC r + p and stage I and stage II. The sensitivities of CT and MRI in detecting LNM preoperatively were 51.2 and 48.8%. The mean maximum diameter of pelvic lymph nodes detected by CT cohort was 1.2 cm in IIIC-r cohort, and was 1.3 cm in IIIC r + p cohort. While, the mean maximum diameter of pelvic lymph nodes detected by MRI was 1.2 cm in IIIC-r cohort, and was 1.48 cm in IIIC r + p cohort. When the diagnosis efficacy of the diameter of pelvic lymph nodes in detecting LNM were evaluated, the area under the receiver operating characteristic curve (ROC curve) was 0.58 (p = 0.05). Conclusions It seems that the FIGO 2018 staging guideline for cervical cancer is likely to has certain limitations for the classification of those with LNM. CT or MRI, however, has limitations on detecting LNM. It would be better to use more accurate imaging tools to identify LNM in the clinical practices.
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Affiliation(s)
- E Yang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Shuying Huang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Xuting Ran
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yue Huang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Zhengyu Li
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, People's Republic of China.
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