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SPECT-CT-Guided Thoracoscopic Biopsy of Sentinel Lymph Nodes in the Internal Mammary Chain in Patients With Breast Cancer: A Pilot Study. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016; 11:94-8. [PMID: 27100165 DOI: 10.1097/imi.0000000000000257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to determine the impact of the use of single-photon emission computed tomography fused with computed tomography (SPECT-CT) on thoracoscopic biopsy of sentinel lymph nodes (SLNs) in the internal mammary chain in patients with breast cancer by evaluating resultant changes in staging and their clinical implications. METHODS Between September 2010 and January 2014, we performed lymphoscintigraphy-assisted thoracoscopic biopsy of the internal mammary chain SLN in 20 patients with breast cancer. Single-photon emission computed tomography fused with computed tomography was also used in 13 of these patients. The sentinel nodes were surgically identified with the aid of a gamma probe. RESULTS Sentinel lymph nodes were identified surgically in 19 of 20 patients. In the 13 patients in whom SPECT-CT was used, it readily identified SLNs, especially when they were located over an intercostal space. Change of staging occurred in three patients (15%), two of whom accordingly received adjuvant radiotherapy to the internal thoracic chain. CONCLUSIONS Compared with lymphoscintigraphy alone, the use of SPECT-CT improves localization of the SLN in the internal mammary chain, allowing more accurate planning of each individual's treatment.
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Piato JRM, Filassi JR, Vega AJMD, Coura-Filho GB, Aguiar FN, Porciuncula LMTP, Dória MT, Soares JM, Baracat EC. SPECT-CT-Guided Thoracoscopic Biopsy of Sentinel Lymph Nodes in the Internal Mammary Chain in Patients with Breast Cancer: A Pilot Study. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- José; Roberto Morales Piato
- Disciplina de Ginecologia do Departamento de Obstetricia e Ginecologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
| | - José; Roberto Filassi
- Disciplina de Ginecologia do Departamento de Obstetricia e Ginecologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
| | | | | | - Fernando Nalesso Aguiar
- Departamento de Patologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Maíra Teixeira Dória
- Disciplina de Ginecologia do Departamento de Obstetricia e Ginecologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
| | - José Maria Soares
- Disciplina de Ginecologia do Departamento de Obstetricia e Ginecologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
| | - Edmund Chada Baracat
- Disciplina de Ginecologia do Departamento de Obstetricia e Ginecologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
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Li Z, Gu X, Tong J, Liu B, Sun L, Gao X, Jiang X. A meta-analysis of internal mammary lymph node metastasis in breast cancer patients. ACTA ACUST UNITED AC 2013; 36:747-52. [PMID: 24356566 DOI: 10.1159/000356867] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Knowing the status of the internal mammary lymph (IML) nodes is important for accurate staging and appropriate selection of subsequent treatment in breast cancer. We conducted a meta-analysis to clarify the rate of IML node metastasis in breast cancer patients and discussed the importance of this finding. METHODS We retrieved articles from the literature that reported positive rates of IML node metastasis in breast cancer patients. The quality of the selected articles was assessed using the 'Methodological Index for Non-Randomized Studies'. The heterogeneity was tested, and publication bias was assessed using a funnel plot. Finally, the positive rate of IML node metastasis in breast cancer patients was calculated using the random-effects model. RESULTS 15 articles met the inclusion criteria and a total of 4,248 patients were included in the analysis. Heterogeneity across the studies was statistically significant (p = 0.014); thus, the random-effects model was used and the calculated positive rate of IML node metastasis was 23% (95% confidence interval (CI), 0.21-0.25). CONCLUSIONS Approximately 23% of the breast cancer patients had IML node metastases, for which the prognosis is generally poor. Accurate staging and integrated treatment are necessary to improve the survival of these patients.
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Affiliation(s)
- Zongtao Li
- Tangshan Gongren Hospital, Lunan District, Tangshan, China
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Thoracoscopic approach of the internal thoracic lymphatic chain. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013; 8:215-8. [PMID: 23989816 DOI: 10.1097/imi.0b013e3182a06c98] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Few studies to date have evaluated the videothoracoscopic approach of the internal thoracic lymphatic chain. However, the histological evaluation of lymph nodes is essential for patients with breast cancer who show lymph node uptake at scintigraphy in the preoperative period and also for patients with lymphoma who have exclusive uptake in these lymph nodes at positron emission tomography for recurrence assessment. Our goal was to evaluate the safety and the change in oncologic approach through this minimally invasive technique. METHODS This is a review of the prospectively collected data in a group of patients undergoing thoracoscopic biopsy of the thoracic lymphatic chain in patients with breast cancer and lymphoma carried out in our institution between September 2010 and June 2012. The analyzed variables include age, histological type, operated hemithorax, number of resected lymph nodes, neoplastic involvement of the resected lymph nodes, duration of chest tube drainage, length of hospital stay, and perioperative mortality. Complications such as subcutaneous emphysema and necessity for blood transfusion were also evaluated. RESULTS Thoracoscopic biopsy was successfully performed in 16 patients, of whom 14 had breast cancer and 2 had lymphoma. The surgical biopsy results changed the treatment in the two patients with lymphoma and avoided radiotherapy in the eight patients with breast cancer who did not have metastases. CONCLUSIONS The use of the thoracoscopic assessment of the internal thoracic lymphatic chain seems safe and resulted in therapy modification in more than half of our patients, suggesting that it is an effective technique for staging in selected breast cancer and lymphoma cases.
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AbraTo FC, Tamagno MFL, Abreu IRLB, Alfinito FS, Piato JR, Silva LMTP, Terra RM, Fernandez A, Jatene FB. Thoracoscopic Approach of the Internal Thoracic Lymphatic Chain. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013. [DOI: 10.1177/155698451300800308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Fernando Conrado AbraTo
- Department of Thoracic Surgery, Hospital Santa Marcelina and Hospital Beneficiência, Portuguesa, Brazil
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | - Jose Roberto Piato
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Angelo Fernandez
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Fabio Biscegli Jatene
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
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Yu JT, Provenzano E, Forouhi P, Malata CM. An evaluation of incidental metastases to internal mammary lymph nodes detected during microvascular abdominal free flap breast reconstruction. J Plast Reconstr Aesthet Surg 2011; 64:716-21. [DOI: 10.1016/j.bjps.2010.10.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2010] [Revised: 10/03/2010] [Accepted: 10/05/2010] [Indexed: 01/24/2023]
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Stage migration and therapy modification after thoracoscopic internal mammary lymph node dissection in breast cancer patients. Breast 2011; 20:129-33. [DOI: 10.1016/j.breast.2010.10.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 06/05/2010] [Accepted: 10/11/2010] [Indexed: 11/23/2022] Open
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Conrado-Abrão F, Das-Neves-Pereira JC, Fernandes A, Jatene FB. Thoracoscopic approach in the treatment of breast cancer relapse in the internal mammary lymph node. Interact Cardiovasc Thorac Surg 2010; 11:328-30. [PMID: 20576656 DOI: 10.1510/icvts.2010.240606] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Regional recurrence of breast cancer may involve the surgical site of mastectomy, axillary lymph nodes and the internal mammary lymphatic chain. Treatment of regional recurrent mammary cancer rarely requires thoracic surgery intervention, except in some selected cases of recurrence in the chest wall. Concerning lymphatic recurrence in breast cancer, the therapeutic choice rarely includes surgical lymph node excision. Exclusive videothoracoscopic (VTS) resection of recurrence in internal mammary lymph nodes has not as yet been reported in the literature. Due to the rare surgical exploration of this lymphatic chain, the thoracoscopic approach is described only in three published studies involving humans, furthermore, in these three descriptions, the operation was performed only for mere staging but not for the whole resection of the recurrent lymphatic structure. We present a case of recurrence of breast cancer in lymph nodes of the internal mammary chain that was treated with complete resection by pure VTS surgery.
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Affiliation(s)
- Fernando Conrado-Abrão
- Department of Thoracic Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
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Hennequin C, Romestaing P, Maylin C. Irradiation des aires ganglionnaires dans le cancer du sein. Cancer Radiother 2008; 12:559-64. [DOI: 10.1016/j.canrad.2008.07.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2008] [Accepted: 07/21/2008] [Indexed: 10/21/2022]
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Chengyu L, Jian Z, Xiaoxin J, Hua L, Qi Y, Chen G. Experience of a large series of mastoscopic axillary lymph node dissection. J Surg Oncol 2008; 98:89-93. [PMID: 18484080 DOI: 10.1002/jso.21080] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Minimally invasive and functional therapy represents an inevitable trend in breast surgery. Improved visualization during mastoscopic axillary lymph node dissection (MALND) realizes a clear exposure of axillary anatomy, but it differs from a general laparoscopic operation. There are some challenges in technique itself which need to be noted. Detailed understanding of the elaborate operative technique, familiarity with the axillary anatomy and accurate adherence to procedure are main elements for successful MALND. Based on our experience of MALND, we have identified several points that are essential in ensuring successful MALND. MATERIALS AND METHODS Five hundred twenty-two patients underwent MALND. The special instruments, axillary anatomic landmarks and operative steps were illuminated. RESULTS Mean operative time was 39.2 min (range 20-156 min). Operative bleeding was minimal. A mean of 13.4 (range 4-38) lymph nodes were harvested. No intra or post-operation-related complication occurred. No axillary tumor relapse or trocar tumor implantation was identified during follow-up. CONCLUSIONS MALND can be performed with great convenience and safety with adherence to suitable procedures.
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Affiliation(s)
- Luo Chengyu
- Beijing Fuxing Hospital, Capital University of Medical Science, Beijing, China.
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Krynyckyi BR, Shafir MK, Kim SC, Kim DW, Travis A, Moadel RM, Kim CK. Lymphoscintigraphy and triangulated body marking for morbidity reduction during sentinel node biopsy in breast cancer. INTERNATIONAL SEMINARS IN SURGICAL ONCOLOGY 2005; 2:25. [PMID: 16277655 PMCID: PMC1308847 DOI: 10.1186/1477-7800-2-25] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Accepted: 11/08/2005] [Indexed: 12/28/2022]
Abstract
Current trends in patient care include the desire for minimizing invasiveness of procedures and interventions. This aim is reflected in the increasing utilization of sentinel lymph node biopsy, which results in a lower level of morbidity in breast cancer staging, in comparison to extensive conventional axillary dissection. Optimized lymphoscintigraphy with triangulated body marking is a clinical option that can further reduce morbidity, more than when a hand held gamma probe alone is utilized. Unfortunately it is often either overlooked or not fully understood, and thus not utilized. This results in the unnecessary loss of an opportunity to further reduce morbidity. Optimized lymphoscintigraphy and triangulated body marking provides a detailed 3 dimensional map of the number and location of the sentinel nodes, available before the first incision is made. The number, location, relevance based on time/sequence of appearance of the nodes, all can influence 1) where the incision is made, 2) how extensive the dissection is, and 3) how many nodes are removed. In addition, complex patterns can arise from injections. These include prominent lymphatic channels, pseudo-sentinel nodes, echelon and reverse echelon nodes and even contamination, which are much more difficult to access with the probe only. With the detailed information provided by optimized lymphoscintigraphy and triangulated body marking, the surgeon can approach the axilla in a more enlightened fashion, in contrast to when the less informed probe only method is used. This allows for better planning, resulting in the best cosmetic effect and less trauma to the tissues, further reducing morbidity while maintaining adequate sampling of the sentinel node(s).
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Affiliation(s)
- Borys R Krynyckyi
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Michail K Shafir
- Department of Surgery, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Suk Chul Kim
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Dong Wook Kim
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Arlene Travis
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
| | - Renee M Moadel
- Department of Nuclear Medicine, Albert Einstein College of Medicine of Yeshiva University, and the Montefiore Medical Center, Bronx, New York, USA
| | - Chun K Kim
- Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, The Mount Sinai Hospital, New York, New York, USA
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Pulte D, Li E, Crawford BK, Newman E, Alexander A, Mustalish DC, Jacobson DR. Sentinel lymph node mapping and molecular staging in nonsmall cell lung carcinoma. Cancer 2005; 104:1453-61. [PMID: 16130135 DOI: 10.1002/cncr.21325] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Lymph node (LN) involvement predicts recurrence in patients who have undergone resection of apparently localized nonsmall cell lung carcinoma (NSCLC). Standard detection methods for LN disease have a low sensitivity, and many patients with apparent N0 disease status develop recurrent disease. Molecular techniques can improve the detection of micrometastases, whereas sentinel lymph node (SLN) mapping can indicate which LN may contain micrometastases. These methods, although potentially complementary, have not, to the authors' knowledge, been used together previously. METHODS The authors used SLN mapping and molecular staging to improve the detection of LN micrometastases in patients with NSCLC. Reverse transcriptase-polymerase chain reaction (RT-PCR) analysis for cytokeratin-7 (CK7), expressed both in normal lung and in malignant lung, was used to identify tumor-derived material in LN. RESULTS SLN mapping was performed in 13 patients, with 1-3 SLNs identified in each patient, and sufficient RNA for RT-PCR was obtained in 12 of these 13 patients. Eleven of 12 tumors expressed CK7. Overall, 32 LNs were positive for CK7, including 13 of 21 SLNs. Ten of 11 patients with evaluable SLNs had at least 1 CK7-positive SLN. Routine pathology showed Stage I disease in eight patients, T3N0 disease in one patient, and LN-positive disease in two patients. Of the nine patients with N0 disease according to routine pathology that was evaluable by RT-PCR, eight patients were upstaged by this technique. All patients with positive LN status by routine pathology who were evaluable by RT-PCR analysis had positive RT-PCR results. CONCLUSIONS LN micrometastases were common in resected NSCLC, including patients with N0 disease according to routine pathology. SLN mapping was useful for identifying disease-containing LNs. This approach may be useful for stratifying histologically N0 patients into higher risk and lower risk groups.
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Affiliation(s)
- Dianne Pulte
- Hematology/Oncology Research Service, Veterans Administration New York Harbor Healthcare System, New York, New York, USA
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Chengyu L, Yongqiao Z, Hua L, Xiaoxin J, Chen G, Jing L, Jian Z. A standardized surgical technique for mastoscopic axillary lymph node dissection. Surg Laparosc Endosc Percutan Tech 2005; 15:153-9. [PMID: 15956900 DOI: 10.1097/01.sle.0000166965.72145.79] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To standardize the surgical technique for mastoscopic axillary lymph node dissection (MALND). Mastoscopic lymph node dissection was performed consistently by a group of surgeons in 316 cases of breast cancer. The mean operation time was 46.7 minutes with minimal bleeding, and the median number of lymph nodes dissected at each operation was 17.0. There were no operative complications in any case, nor did trocar implantation or tumor diffusion occurring during the mean follow-up time of 15.1 months. MALND is distinctive and practicable in operative anatomy as well as safe and convenient. The location of critical anatomy such as the intercostobrachial nerve, lateral thoracic artery, medial thoracic nerve, and thoracoepigastric vein should be clearly identified to avoid damage to them, so that is the great advantage of MALND.
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Affiliation(s)
- Luo Chengyu
- Beijing Fuxing Hospital, Capital University of Medical Science, Beijing, PR China.
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Shahar KH, Buchholz TA, Delpassand E, Sahin AA, Ross MI, Ames FC, Kuerer HM, Feig BW, Meric-Bernstam F, Babiera GV, Singletary SE, Akins JS, Mirza NQ, Hunt KK. Lower and central tumor location correlates with lymphoscintigraphy drainage to the internal mammary lymph nodes in breast carcinoma. Cancer 2005; 103:1323-9. [PMID: 15726547 DOI: 10.1002/cncr.20914] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Radiation to the internal mammary chain (IMC) may be indicated for breast carcinoma patients with positive axillary sentinel lymph nodes (SLNs) and lymphoscintigraphic evidence of drainage to the IMC. The purpose of this study was to identify predictors of IMC drainage in patients with positive axillary SLNs. METHODS The records of 297 breast carcinoma patients with positive axillary SLNs and preoperative lymphoscintigraphy were reviewed between 1995 and 2002. Radiolabeled colloid was injected peritumorally with lymphoscintigraphy performed 30-60 minutes later. Drainage to the regional nodes of 279 patients was seen on lymphoscintigraphy. Associations among patient and tumor-related factors and drainage to the IMC were examined. RESULTS Drainage to the IMC on lymphoscintigraphy was seen in 63 patients (21%). IMC drainage only occurred in 4 patients, and 59 patients had both axillary and IMC drainage. The only variable that correlated with IMC drainage was tumor location (P = 0.017). Rates of drainage to the IMC were 14.1% for upper outer quadrant (n = 128), 16.7% for upper inner quadrant (n = 30), 31.6% for lower outer quadrant (n = 19), 42.9% for lower inner quadrant (n = 14), and 28.4% for central tumors (n = 88). IMC drainage rates differed significantly between upper and lower tumors (lower 36.4% vs. central 28.4% vs. upper 14.6%, P = 0.003) but not between medial and lateral tumors (medial 25.0% vs. central 28.4% vs. lateral 16.3%, P = 0.077). CONCLUSIONS Patients with tumors in the lower or central breast and positive axillary SLNs have increased incidence of drainage to the IMC. Preoperative lymphoscintigraphy can help to define the nodal basins at risk for harboring disease.
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Affiliation(s)
- Karen H Shahar
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA
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Park C, Seid P, Morita E, Iwanaga K, Weinberg V, Quivey J, Hwang ES, Esserman LJ, Leong SPL. Internal Mammary Sentinel Lymph Node Mapping for Invasive Breast Cancer: Implications for Staging and Treatment. Breast J 2005; 11:29-33. [PMID: 15647075 DOI: 10.1111/j.1075-122x.2005.21527.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The optimal staging and treatment of the internal mammary nodes (IMNs) among patients with invasive breast cancer (IBC) is controversial. Although medial tumors have been reported to more commonly drain to IMNs, other variables predictive for IMN drainage may help identify those patients who may benefit from further IMN assessment. Factors associated with IMN drainage were analyzed among 141 patients who underwent lymphatic mapping and selective sentinel lymphadenectomy using intradermal injection (ID) or peritumoral (PT) injection. Fourteen of 83 patients (17%) receiving PT injections had IMN drainage, compared to none among the 58 patients who underwent ID injection alone (p = 0.0004). There were no differences in patient or tumor variables detected between the two groups. Among patients receiving PT injections, no factors examined were significantly associated with IMN drainage on univariate analysis. Using the multivariate logistic regression model, palpable disease was the most important factor associated with IMN drainage (risk ratio [RR] = 6.02; 95% confidence interval [CI] 0.64-56.34; p = 0.05). In addition, lymphatic/vascular invasion (LVI) and age less than 50 years were associated with IMN drainage (RR = 6.17; 95% CI 1.02-37.50; p = 0.09 and RR = 2.94; 95% CI 0.82-10.49; p = 0.09, respectively). IMN drainage occurred in a significant proportion of patients after PT injection, but not ID injection. In the final model, palpable disease was the most important factor associated with IMN drainage; LVI and age less than 50 years were of borderline significance. These factors may aid in the selection of patients who might benefit from further staging or treatment of the IMNs.
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Affiliation(s)
- Catherine Park
- Department of Radiation Oncology, University of California, Mount Zion Medical Center, the UCSF Comprehensive Cancer Center, San Francisco, California, USA
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Schulze T, Bembenek A, Schlag PM. Sentinel lymph node biopsy progress in surgical treatment of cancer. Langenbecks Arch Surg 2004; 389:532-50. [PMID: 15197548 DOI: 10.1007/s00423-004-0484-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2004] [Accepted: 03/04/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Forty-three years after the first description of the sentinel lymph node technique in malignant tumours of the parotid by Gould, sentinel lymph node biopsy (SNLB) has become a precious tool in the treatment of solid tumours. METHODS In the following review we give a synopsis of the fundamentals of the sentinel lymph node concept and then proceed to an overview of recent advances of SNLB in gastrointestinal cancers. RESULTS In some tumour entities, SNLB has been shown to reflect reliably the lymph node status of the tumour-draining lymph node basin. In melanoma and breast cancer, it became a widely accepted element of the routine surgical management of these malignant diseases. In gastrointestinal tumours, the technique is currently under intense investigation. First reports on its application in other solid tumours, such as non-small cell lung cancer, thyroid carcinoma, oropharyngeal carcinoma, vulvar carcinoma, and Merckel cell carcinoma of the skin, were published more recently. CONCLUSION SNLB has become an important component of diagnosis and treatment of solid tumours. A growing number of publications on SNLB in gastrointestinal cancer documents the interest of many investigators in the application of this technique in this tumour entity. As long as imaging techniques like 18FDG PET or other molecular imaging techniques are limited by their spatial resolution, SNLB remains the technique of choice for lympho-nodal staging.
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Affiliation(s)
- T Schulze
- Klinik für Chirurgie und Klinische Onkologie, Charité, Campus Buch, Robert-Rössle-Klinik im HELIOS Klinikum Berlin, Lindenberger Weg 80, 13125, Berlin, Germany
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