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Fairhurst K, McIntosh SA, Cutress RI, Potter S. Current axillary management of patients with early breast cancer and low-volume nodal disease undergoing primary surgery: results of a United Kingdom national practice survey. Breast Cancer Res Treat 2024; 206:465-471. [PMID: 38724821 DOI: 10.1007/s10549-024-07328-4] [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: 10/21/2023] [Accepted: 03/28/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE UK NICE guidelines recommend axillary node clearance (ANC) should be performed in all patients with biopsy-proven node-positive breast cancer having primary surgery. There is, however, increasing evidence such extensive surgery may not always be necessary. Targeted axillary dissection (TAD) may be an effective alternative in patients with low-volume nodal disease who are clinically node negative (cN0) but have abnormal nodes detected radiologically. This survey aimed to explore current management of this group to inform feasibility of a future trial. METHODS An online survey was developed to explore current UK management of patients with low-volume axillary disease and attitudes to a future trial. The survey was distributed via breast surgery professional associations and social media from September to November 2022. One survey was completed per unit and simple descriptive statistics used to summarise the results. RESULTS 51 UK breast units completed the survey of whom 78.5% (n = 40) reported performing ANC for all patients with biopsy-proven axillary nodal disease having primary surgery. Only 15.7% of units currently performed TAD either routinely (n = 6, 11.8%) or selectively (n = 2, 3.9%). There was significant uncertainty (83.7%, n = 36/43) about the optimal surgical management of these patients. Two-thirds (n = 27/42) of units felt an RCT comparing TAD and ANC would be feasible. CONCLUSIONS ANC remains standard of care for patients with low-volume node-positive breast cancer having primary surgery in the UK, but considerable uncertainty exists regarding optimal management of this group. This survey suggests an RCT comparing the outcomes of TAD and ANC may be feasible.
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Affiliation(s)
- K Fairhurst
- Centre for Surgical Research, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - S A McIntosh
- Patrick G Johnston Centre for Cancer Research, Queens University Belfast, 97 Lisburn Road, Belfast, BT9 7AE, Northern Ireland
| | - R I Cutress
- Somers Cancer Research Building, University of Southampton and University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - S Potter
- Centre for Surgical Research, Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Yadav SK, Bharath S, Sharma D, Srivastava A, Jha CK, Agarwal G, Khadka S, Singh M, Shekhar S, Goyal A. A systematic review and meta-analysis of diagnostic performance of fluorescein-guided sentinel lymph node biopsy in early breast cancer. Breast Cancer Res Treat 2024; 206:19-30. [PMID: 38668856 DOI: 10.1007/s10549-024-07310-0] [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: 01/16/2024] [Accepted: 03/22/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Evaluation of axillary lymph nodes status in cN0 axilla is performed by sentinel lymph node biopsy (SLNB) utilizing a combination of radioactive isotope and blue dye or alternative to isotope like Indocyanine green (ICG). Both are very resource-intensive; which has prompted development of low-cost technique of Fluorescein Sodium (FS)-guided SLNB. This systematic review and meta-analysis evaluate the diagnostic performance of FS-guided SLNB in early breast cancer. OBJECTIVES The objective was to evaluate the diagnostic performance of FS for sentinel lymph node biopsy. METHODS Eligibility criteria: Studies where SLNB was performed using FS. INFORMATION SOURCES PubMed, EMBASE, Cochrane library and online clinical trial registers. Risk of bias: Articles were assessed for risk of bias using the QUADAS-2 tool. SYNTHESIS OF RESULTS The main summary measures were pooled Sentinel Lymph Node Identification Rate (SLN-IR) and pooled False Negative Rate (FNR) using random-effects model. RESULTS A total of 45 articles were retrieved by the initial systematic search. 7 out of the 45 studies comprising a total of 332 patients were included in the meta-analysis. The pooled SLN-IR was 93.2% (95% confidence interval [CI], 0.87-0.97; 87% to 97%). Five validation studies were included for pooling the false negative rate and included a total of 211 patients. The pooled FNR was 5.6% (95% confidence interval [CI], 2.9-9.07). CONCLUSION Fluorescein-guided SLNB is a viable option for detection of lymph node metastases in clinically node negative patients with early breast cancer. It achieves a high pooled Sentinel Lymph Node Identification Rate (SLN-IR) of 93% with a false negative rate of 5.6% for the detection of axillary lymph node metastasis.
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Affiliation(s)
| | - S Bharath
- Department of Surgery, NSCB Medical College, Jabalpur, India
| | | | - Anurag Srivastava
- Subharti Institute of Cancer Management & Research, Swami Vivekanand Subharti University Meerut, Meerut, India
| | | | - Gaurav Agarwal
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute Lucknow, Lucknow, India
| | - Sarada Khadka
- Assistant Professor of Surgery, BP Koirala Institute of Health Sciences Dharan, Dharan, Nepal
| | - Manju Singh
- Department of Surgery, Jawahar Lal Nehru Medical College Raipur, Raipur, India
| | - Saket Shekhar
- Department of Biostatistics, Rama Medical College, Kanpur, India
| | - Amit Goyal
- Consultant Oncoplastic Breast Surgeon, Royal Derby Hospital, Derby, UK
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Sayal NR, Schafer J, Jayne C, Wali A, Lindau R, Sayles H, Marr A, Aurit S, Lydiatt W, Holcomb A, Militsakh O, Coughlin A, Osmolak A, Panwar A. 99mTc-Tilmanocept vs. Sulfur Colloid for Sentinel Node Biopsy for Melanoma in the Head and Neck. Indian J Surg Oncol 2024; 15:82-87. [PMID: 38511039 PMCID: PMC10948650 DOI: 10.1007/s13193-023-01841-6] [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: 08/04/2023] [Accepted: 10/11/2023] [Indexed: 03/22/2024] Open
Abstract
The objective of the study is to compare sentinel lymph node (SLN) identification rates and performance characteristics of lymphoscintigraphy using 99mTc-sulfur colloid (SC) and 99mTc-tilmanocept (TL) for head and neck cutaneous melanoma. This study is a retrospective study, conducted at a single, tertiary care cancer center. Patients underwent sentinel lymph node biopsy (SLNB) for head and neck cutaneous melanoma, using SC or TL, between October 2014 and February 2019. Differences in SLN identification rates and performance characteristics between the groups were examined using the Mann-Whitney, or Fisher's exact test. Sixty patients underwent SLNB, of which 19 employed TL. There were no significant differences between SC vs. TL in operative duration (116 vs. 127 min, P = 0.97), radiation dose (530 vs. 547 μCi, P = 0.27), median number of SLNs removed (3 vs. 2, P = 0.32), or median follow-up (46.3 vs. 38.4 months, P = 0.11). The rates of positive SLNs (17% vs. 37%, P = 0.11), intraoperative non-localization (12% vs. 16%, P = 0.70), and false-negative SLNB (5% each, P = 1.00) were not significantly different between groups. In patients with head and neck melanoma undergoing SLNB, 99mTc-tilmanocept may not differ from 99mTc-sulfur colloid in identifying SLNs or other performance characteristics. The added expense related to 99mTc-tilmanocept and lack of favorable performance data should urge caution in its adoption and promote further examination of its value in similar patient cohorts.
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Affiliation(s)
- Navdeep R. Sayal
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Nebraska Methodist Hospital, 8303 Dodge Street, Suite 304, Omaha, NE 68114 USA
| | - Jeffrey Schafer
- Department of Otolaryngology, Naval Medical Center Portsmouth, Portsmouth, VA USA
| | | | - Ansar Wali
- Creighton University School of Medicine, Omaha, NE USA
| | - Robert Lindau
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Nebraska Methodist Hospital, 8303 Dodge Street, Suite 304, Omaha, NE 68114 USA
- Department of Surgery, Creighton University School of Medicine, Omaha, NE USA
| | - Harlan Sayles
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE USA
| | - Alissa Marr
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE USA
| | - Sarah Aurit
- Division of Clinical Research and Evaluative Sciences, Creighton University School of Medicine, Omaha, NE USA
| | - William Lydiatt
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Nebraska Methodist Hospital, 8303 Dodge Street, Suite 304, Omaha, NE 68114 USA
- Department of Surgery, Creighton University School of Medicine, Omaha, NE USA
| | - Andrew Holcomb
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Nebraska Methodist Hospital, 8303 Dodge Street, Suite 304, Omaha, NE 68114 USA
- Department of Surgery, Creighton University School of Medicine, Omaha, NE USA
| | - Oleg Militsakh
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Nebraska Methodist Hospital, 8303 Dodge Street, Suite 304, Omaha, NE 68114 USA
- Department of Surgery, Creighton University School of Medicine, Omaha, NE USA
| | - Andrew Coughlin
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Nebraska Methodist Hospital, 8303 Dodge Street, Suite 304, Omaha, NE 68114 USA
- Department of Surgery, Creighton University School of Medicine, Omaha, NE USA
| | - Angela Osmolak
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Nebraska Methodist Hospital, 8303 Dodge Street, Suite 304, Omaha, NE 68114 USA
- Department of Surgery, Creighton University School of Medicine, Omaha, NE USA
| | - Aru Panwar
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Nebraska Methodist Hospital, 8303 Dodge Street, Suite 304, Omaha, NE 68114 USA
- Department of Surgery, Creighton University School of Medicine, Omaha, NE USA
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Abidi H, Bold RJ. Assessing the Sentimag system for guiding sentinel node biopsies in patients with breast cancer. Expert Rev Med Devices 2024; 21:1-9. [PMID: 37992402 DOI: 10.1080/17434440.2023.2284790] [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: 06/15/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023]
Abstract
INTRODUCTION Sentinel lymph node biopsy for breast cancer is a method to localize and excise the first draining lymph node from an invasive cancer of the breast. The histopathologic evaluation of the sentinel lymph node is used for predicting recurrence and survival and thus, guiding oncologists for treatment-decision making to administer adjuvant therapies. The ability to identify the sentinel node depends on methods to map lymphatic drainage from the breast to the sentinel node and accurately discriminate that node from other non-sentinel lymph nodes of the axilla. AREAS COVERED This review covers the clinical demand for technologies to assist the surgeon in intraoperative lymphatic mapping to specifically identify the sentinel lymph node in patients with breast cancer. Performance characteristics are reviewed for superparamagnetic iron oxide tracers used in lymphatic mapping compared to other current available technologies for lymphatic mapping. EXPERT OPINION The Magtrace (superparamagnetic iron oxide tracer) Sentimag (handheld magnetic probe) system is an FDA-approved technology for intraoperative lymphatic mapping to facilitate sentinel lymph node biopsy in breast cancer with technologic performance characteristics that are equivalent to 99Technetium-sulfur colloid. Barriers to broader utilization primarily center around the need for nonmetallic devices to be used for the conduct of surgery, which would interfere with the paramagnetic method for tracer localization.
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Affiliation(s)
- Hira Abidi
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, CA, USA
| | - Richard J Bold
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, CA, USA
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Zhou M, Liu P, Yin X, Deng C, Xiao Y, Lei M, Hu S, An F, Zhao M. A SPECT/NIR Fluorescence Dual-Modality Imaging Agent Composed of Drugs and Hospital Available Isotope for Preoperative Sentinel Lymph Node Mapping and Intraoperative Biopsy. Int J Nanomedicine 2023; 18:7637-7646. [PMID: 38106445 PMCID: PMC10725784 DOI: 10.2147/ijn.s430502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023] Open
Abstract
Background Sentinel lymph node (SLN) mapping-guided biopsy is crucial for cancer staging and treatment. Optical/nuclide dual-modality imaging agents for mapping SLN are ideal for preoperative planning and intraoperative biopsy, which are enabled by penetration-depth unlimited nuclide imaging and dynamic real-time optical imaging, respectively. However, commonly reported dual-modality imaging agents are composed of novel but safety-unproven materials, making their quick clinical translation challenging. Herein, we report a novel nanoparticle composed of facile hospital-available drugs and isotope for single-photon emission computed tomography (SPECT)/near-infrared (NIR) fluorescence imaging to detect SLNs. Methods Indocyanine green-human serum albumin (ICG-HSA) nanoparticles (NPs) were synthesized by ICG-induced HSA self-assembly and further 99mTc-labeling via a one-step, facile hospital-available method. After injecting 99mTc-ICG-HSA into the rats' forepaw pads, the rats' draining axillary lymph nodes were visualized by preoperative mapping with SPECT/CT and intraoperative biopsy with NIR fluorescence. The axillary lymph nodes of rats were identified by pathology and fluorescent staining after execution. Additionally, its toxicity testing and comparison with 99mTc-sulfur colloid imaging were also explored. Results The study reported a self-assembled 99mTc-ICG-HSA with a high radiochemical yield (85.6 ± 3.8%). Compared with conventional 99mTc-sulfur colloid, 99mTc-ICG-HSA NPs showed faster SLN identification, higher renal clearance, and lower hepatic retention. Furthermore, NIRF imaging allowed for the accurate visualization of the SLN and guided SLN biopsy intraoperatively. Notably, the 99mTc-ICG-HSA NPs were composed of hospital-available drugs and isotope, which are safe for acute toxicity evaluation by a certified institute. Conclusion The proposed 99mTc-ICG-HSA NPs are safe and capable of noninvasive SLN identification and biopsy guidance with multi-modal imaging strategies and could be a promising tool for clinically assisted SLN biopsy.
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Affiliation(s)
- Ming Zhou
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- Key Laboratory of Biological, Nanotechnology of National Health Commission, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Peng Liu
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- Key Laboratory of Biological, Nanotechnology of National Health Commission, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Xiaoqin Yin
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Caiting Deng
- School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, People’s Republic of China
- Institute of Medical Engineering, Department of Biophysics, School of Basic Medical Science, Health Science Center, Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Yi Xiao
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Meng Lei
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Shuo Hu
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Feifei An
- School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Min Zhao
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- Department of Nuclear Medicine, Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
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6
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Liang X, Wang Y, Fu G, Fan P, Ma K, Cao XC, Lin GX, Zheng WP, Lyu PF. Top 100 cited classical articles in sentinel lymph nodes biopsy for breast cancer. Front Oncol 2023; 13:1170464. [PMID: 37901325 PMCID: PMC10600391 DOI: 10.3389/fonc.2023.1170464] [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: 02/20/2023] [Accepted: 08/03/2023] [Indexed: 10/31/2023] Open
Abstract
Background The sentinel lymph node biopsy (SLNB) takes on a critical significance in breast cancer surgery since it is the gold standard for assessing axillary lymph node (ALN) metastasis and determining whether to perform axillary lymph node dissection (ALND). A bibliometric analysis is beneficial to visualize characteristics and hotspots in the field of sentinel lymph nodes (SLNs), and it is conducive to summarizing the important themes in the field to provide more insights into SLNs and facilitate the management of SLNs. Materials and methods Search terms relating to SLNs were aggregated and searched in the Web of Science core collection database to identify the top 100 most cited articles. Bibliometric tools were employed to identify and analyze publications for annual article volume, authors, countries, institutions, keywords, as well as hotspot topics. Results The period was from 1998 to 2018. The total number of citations ranged from 160 to 1925. LANCET ONCOLOGY and JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION were the top two journals in which the above articles were published. Giuliano, AE was the author with the highest number of articles in this field with 15. EUROPEAN INST ONCOL is the institution with the highest number of publications, with 35 articles. Hotspots include the following 4 topics, false-negative SLNs after neoadjuvant chemotherapy; prediction of metastatic SLNs; quality of life and postoperative complications; and lymphography of SLNs. Conclusion This study applies bibliometric tools to analyze the most influential literature, the top 100 cited articles in the field of SLNB, to provide researchers and physicians with research priorities and hotspots.
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Affiliation(s)
- Xinrui Liang
- Breast Cancer Center, Chongqing Cancer Institute, Chongqing University Cancer Hospital, Chongqing, China
| | - Yu Wang
- Department of Breast Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Guanghua Fu
- The First Department of Breast Cancer, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Key Laboratory of Breast Cancer Prevention and Therapy, Ministry of Education, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, China
| | - Pingmig Fan
- Department of Breast Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Ke Ma
- Department of Thyroid and Breast Surgery, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Xu-Chen Cao
- Department of Thyroid and Breast Surgery, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Guang-Xun Lin
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Wu-ping Zheng
- The First Department of Breast Cancer, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Key Laboratory of Breast Cancer Prevention and Therapy, Ministry of Education, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, China
| | - Peng-fei Lyu
- Department of Breast Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, China
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Cui Q, Dai L, Li J, Shen Y, Tao H, Zhou X, Xue J. Contrast-enhanced ultrasound-guided sentinel lymph node biopsy in early-stage breast cancer: a prospective cohort study. World J Surg Oncol 2023; 21:143. [PMID: 37158920 PMCID: PMC10165809 DOI: 10.1186/s12957-023-03024-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/27/2023] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVE This study evaluated the identification efficiency of contrast-enhanced ultrasound (CEUS) for sentinel lymph nodes (SLN) to accurately represent the axillary node status in early-stage breast cancer. METHOD In total, 109 consecutive consenting patients with clinically node-negative and T1-2 breast cancer were included in this study. All patients received CEUS to identify SLN before surgery, and a guidewire was deployed to locate SLN in those who were successfully explored by CEUS. The patients underwent sentinel lymph node biopsy (SLNB), and the blue dye was used to trace SLN during the surgery. The decision to perform axillary lymph node dissection (ALND) depended on the intraoperative pathological identification of SLN by CEUS (CE-SLN). The concordance rate of pathological status between CE-SLN and dyed SLN was calculated. RESULT The CEUS detection rate was 96.3%; CE-SLN failed in 4 patients. Among the remaining 105 successful identifications, 18 were CE-SLN positive by intraoperative frozen section, and one with CE-SLN micrometastasis was diagnosed by paraffin section. No additional lymph node metastases were found in CE-SLN-negative patients. The concordance rate of pathological status between CE-SLN and dyed SLN was 100%. CONCLUSION CEUS can accurately represent the status of axillary lymph nodes in patients with clinically node-negative and small tumor burden breast cancer.
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Affiliation(s)
- Qiuxia Cui
- Department of Thyroid and Breast Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, No. 6, Huanghe Road, Changshu, 215500, Jiangsu, China
| | - Li Dai
- Department of Thyroid and Breast Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, No. 6, Huanghe Road, Changshu, 215500, Jiangsu, China
| | - Jialu Li
- Department of Thyroid and Breast Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, No. 6, Huanghe Road, Changshu, 215500, Jiangsu, China
| | - Yang Shen
- Department of Ultrasonic Medicine, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, China
| | - Huijiang Tao
- Department of Ultrasonic Medicine, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, China
| | - Xiaofeng Zhou
- Department of Ultrasonic Medicine, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, China
| | - Jialei Xue
- Department of Thyroid and Breast Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, No. 6, Huanghe Road, Changshu, 215500, Jiangsu, China.
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Di Paola V, Mazzotta G, Conti M, Palma S, Orsini F, Mola L, Ferrara F, Longo V, Bufi E, D'Angelo A, Panico C, Clauser P, Belli P, Manfredi R. Image-Guided Localization Techniques for Metastatic Axillary Lymph Nodes in Breast Cancer; What Radiologists Should Know. Cancers (Basel) 2023; 15:cancers15072130. [PMID: 37046791 PMCID: PMC10093304 DOI: 10.3390/cancers15072130] [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: 02/28/2023] [Revised: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 04/14/2023] Open
Abstract
Targeted axillary dissection (TAD) is an axillary staging technique after NACT that involves the removal of biopsy-proven metastatic lymph nodes in addition to sentinel lymph node biopsy (SLNB). This technique avoids the morbidity of traditional axillary lymph node dissection and has shown a lower false-negative rate than SLNB alone. Therefore, marking positive axillary lymph nodes before NACT is critical in order to locate and remove them in the subsequent surgery. Current localization methods include clip placement with intraoperative ultrasound, carbon-suspension liquids, localization wires, radioactive tracer-based localizers, magnetic seeds, radar reflectors, and radiofrequency identification devices. The aim of this paper is to illustrate the management of axillary lymph nodes based on current guidelines and explain the features of axillary lymph node markers, with relative advantages and disadvantages.
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Affiliation(s)
- Valerio Di Paola
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiodiagnostica Presidio Columbus, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Giorgio Mazzotta
- Institute of Radiology, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Marco Conti
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiologia Toracica e Cardiovascolare, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Simone Palma
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiodiagnostica Presidio Columbus, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Federico Orsini
- Institute of Radiology, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Laura Mola
- Institute of Radiology, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Francesca Ferrara
- Institute of Radiology, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Valentina Longo
- Institute of Radiology, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Enida Bufi
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiologia Toracica e Cardiovascolare, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Anna D'Angelo
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiologia Toracica e Cardiovascolare, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Camilla Panico
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiologia Toracica e Cardiovascolare, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Paola Clauser
- Department of Biomedical Imaging and Image-Guided Radiotherapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Paolo Belli
- Institute of Radiology, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiologia Toracica e Cardiovascolare, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Riccardo Manfredi
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiodiagnostica Presidio Columbus, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, 00168 Rome, Italy
- Institute of Radiology, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
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Rella R, Conti M, Bufi E, Trombadori CML, Di Leone A, Terribile D, Masetti R, Zagaria L, Mulè A, Morciano F, Franceschini G, Belli P. Selective Axillary Dissection after Neoadjuvant Chemotherapy in Patients with Lymph-Node-Positive Breast Cancer (CLYP Study): The Radio-Guided Occult Lesion Localization Technique for Biopsy-Proven Metastatic Lymph Nodes. Cancers (Basel) 2023; 15:cancers15072046. [PMID: 37046707 PMCID: PMC10093210 DOI: 10.3390/cancers15072046] [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: 02/26/2023] [Revised: 03/26/2023] [Accepted: 03/28/2023] [Indexed: 04/14/2023] Open
Abstract
(1) Background: To help to refine the accuracy of sentinel lymph node biopsy (SLNB) in breast cancer (BC) patients with biopsy-proven nodal disease prior to neoadjuvant chemotherapy (NACT), a method of marking the biopsy-proven positive LN at diagnosis to enable its removal during surgery was proposed. The aim of this study was to evaluate the accuracy of the Radio-Guided Occult Lesion Localization (ROLL) technique of biopsy-proven metastatic LN in nodal staging after NACT among node-positive BC patients. (2) Methods: Patients with invasive BC and biopsy-proven axillary metastases receiving NACT were enrolled. A clip marker was placed on the sampled LN (clipped lymph node, CLN) before NACT. Before surgery, the ROLL procedure (radioactive tracer injection into CLN under ultrasound guidance) was performed, and the CLN was surgically resected. The correspondence between the CLNs and SLNs was evaluated. The pathologic findings of the CLNs and SLN(s) were compared with remaining axillary nodes at ALND to determine false negative rates (FNRs). (3) Results: Seventy-two patients were analyzed. Surgery successfully identified the CLN in 70/72 procedures (97.2%). For 60/72 patients who underwent ALND, the FNRs dropped from 19.35% for SLNB to 3.13% for CLN biopsy. (4) Conclusions: The ROLL procedure got CLNs is accurate in axillary nodal staging after NACT in node-positive BC patients at diagnosis.
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Affiliation(s)
- Rossella Rella
- UOC di Radiologia Toracica e Cardiovascolare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Marco Conti
- UOC di Radiologia Toracica e Cardiovascolare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Enida Bufi
- UOC di Radiologia Toracica e Cardiovascolare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Charlotte Marguerite Lucille Trombadori
- UOC di Radiologia Toracica e Cardiovascolare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Alba Di Leone
- Centro Integrato di Senologia, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Daniela Terribile
- Centro Integrato di Senologia, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Riccardo Masetti
- Centro Integrato di Senologia, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Luca Zagaria
- UOC di Medicina Nucleare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Antonino Mulè
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Unità di Gineco-Patologia e Patologia Mammaria, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Francesca Morciano
- Facoltà di Medicina e Chirurgia, Università Cattolica Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| | - Gianluca Franceschini
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Unità di Gineco-Patologia e Patologia Mammaria, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Paolo Belli
- UOC di Radiologia Toracica e Cardiovascolare, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Facoltà di Medicina e Chirurgia, Università Cattolica Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
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Heidinger M, Knauer M, Tausch C, Weber WP. Tailored axillary surgery - A novel concept for clinically node positive breast cancer. Breast 2023; 69:281-289. [PMID: 36922305 PMCID: PMC10034500 DOI: 10.1016/j.breast.2023.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/25/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023] Open
Abstract
Axillary surgery in patients with breast cancer has been a history of de-escalation; however, surgery for clinically node-positive breast cancer remained at the dogmatic level of axillary lymph node dissection (ALND). In these patients, currently the only way to avoid ALND is neoadjuvant systemic treatment (NST) with nodal pathologic complete response (pCR) as diagnosed by selective lymph node removal. However, pCR rates are highly dependent on tumor biology, with luminal tumors being most present yet showing the lowest pCR rates. Therefore, the TAXIS trial is investigating whether in clinically node-positive patients, either with residual disease after NST or in the upfront surgical setting, ALND can be safely omitted. All patients undergo tailored axillary surgery (TAS), which includes removal of the biopsied and clipped node, the sentinel lymph nodes as well as all palpably suspicious nodes, turning a clinically positive axilla into a clinically negative. Feasibility of TAS was recently confirmed in the first pre-specified TAXIS substudy. TAS is followed by axillary radiotherapy to treat any remaining nodal disease. Disease-free survival is the primary endpoint of this non-inferiority trial, and morbidity as well as quality of life are the main secondary endpoints, with ALND being known for having a relevant negative impact on both. Currently, 663 of 1500 patients were randomized; accrual completion is projected for 2025. The TAXIS trial stands out in including clinically node-positive patients in both the neoadjuvant and upfront surgery setting, thereby investigating surgical de-escalation at the far-end of the risk spectrum of patients with breast cancer.
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Affiliation(s)
- Martin Heidinger
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Michael Knauer
- Breast Center Eastern Switzerland, St. Gallen, Switzerland
| | | | - Walter P Weber
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland.
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11
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Man V, Suen D, Kwong A. Use of Superparamagnetic Iron Oxide (SPIO) Versus Conventional Technique in Sentinel Lymph Node Detection for Breast Cancer: A Randomised Controlled Trial. Ann Surg Oncol 2023; 30:3237-3244. [PMID: 36849573 DOI: 10.1245/s10434-023-13252-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/01/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND The objective of this study is to compare the efficacy of the superparamagnetic iron oxide (SPIO)-guided and standard techniques for sentinel lymph node (SLN) detection in early breast cancer. Multiple inferiority trials have concluded the non-inferiority of SPIO to the conventional radioisotope technique, with or without blue dye, in detecting SLNs. PATIENTS AND METHODS From July 2018 to August 2022, patients clinically diagnosed with node-negative invasive breast cancer were randomised into the study group (SPIO) and control group (radioisotope and blue dye). Patient data and disease characteristics were prospectively collected. SLN detection rates were compared between the two groups. RESULTS A total of 282 patients undergoing 288 sentinel lymph node biopsy (SLNB) procedures were recruited, and 144 SLNB procedures were randomised into each group. The baseline patient and disease characteristics were comparable. SLN localisation failed in one patient in each group; the success rate of SLNB was 99.3%. The SPIO group demonstrated a higher mean number of SLNs harvested (3.3 versus 2.8, p = 0.039) and longer mean procedure duration (33.1 min versus 22.3 min, p = 0.01) than the control group did. In the study group, the concordance rates per patient and node were 99.3% and 94.6%, respectively. Sixty-seven positive SLNs were detected in 37 patients. The concordance rates per malignant SLNB procedure and positive SLN were 97.3% and 96.8%, respectively. CONCLUSION Single-tracer SPIO-guided SLNB was non-inferior to the dual technique (radioisotope and blue dye) and could safely replace the gold standard for SLN mapping in early breast cancer.
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Affiliation(s)
- Vivian Man
- Division of Breast Surgery, Department of Surgery, Faculty of Medicine, Queen Mary Hospital, The University of Hong Kong Li Ka Shing, Hong Kong, Hong Kong SAR, China
| | - Dacita Suen
- Division of Breast Surgery, Department of Surgery, Faculty of Medicine, Queen Mary Hospital, The University of Hong Kong Li Ka Shing, Hong Kong, Hong Kong SAR, China
| | - Ava Kwong
- Division of Breast Surgery, Department of Surgery, Faculty of Medicine, Queen Mary Hospital, The University of Hong Kong Li Ka Shing, Hong Kong, Hong Kong SAR, China.
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12
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Surgical Planning after Neoadjuvant Treatment in Breast Cancer: A Multimodality Imaging-Based Approach Focused on MRI. Cancers (Basel) 2023; 15:cancers15051439. [PMID: 36900231 PMCID: PMC10001061 DOI: 10.3390/cancers15051439] [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: 01/10/2023] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 03/12/2023] Open
Abstract
Neoadjuvant chemotherapy (NACT) today represents a cornerstone in the treatment of locally advanced breast cancer and highly chemo-sensitive tumors at early stages, increasing the possibilities of performing more conservative treatments and improving long term outcomes. Imaging has a fundamental role in the staging and prediction of the response to NACT, thus aiding surgical planning and avoiding overtreatment. In this review, we first examine and compare the role of conventional and advanced imaging techniques in preoperative T Staging after NACT and in the evaluation of lymph node involvement. In the second part, we analyze the different surgical approaches, discussing the role of axillary surgery, as well as the possibility of non-operative management after-NACT, which has been the subject of recent trials. Finally, we focus on emerging techniques that will change the diagnostic assessment of breast cancer in the near future.
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13
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Braue K, Baker C, Lippey J. Internal mammary node involvement in patients with axilla-negative early breast cancer: a narrative review. ANZ J Surg 2023; 93:59-64. [PMID: 35997283 DOI: 10.1111/ans.17982] [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: 03/19/2022] [Revised: 07/26/2022] [Accepted: 08/02/2022] [Indexed: 11/26/2022]
Abstract
Early breast cancer staging involves radiological and pathological evaluation of the tumour and regional lymph nodes. The internal mammary nodes (IMN) are an important site of possible metastasis and influence disease stage and prognosis. However, the recommendation for routine IMN assessment remains unclear. Internal mammary sentinel lymph node biopsy (SLNB) is associated with increased morbidity and an unknown survival benefit. Furthermore, the IMN are traditionally thought to be involved only synchronous with, or following, axillary node (AXN) metastasis. The aim of this review is to determine the prevalence of IMN metastasis in patients with axilla-negative early breast cancer. A narrative review of studies assessing IMN metastasis was performed. The literature search was completed using the database Medline (Ovid). Twenty-two retrospective studies were identified. The studies included data from SLNB, US, MRI, PET/CT and opportunistic biopsy during free-flap reconstruction (FFR). The prevalence of isolated IMN metastasis ranged from 1.2% to 17.9%.
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Affiliation(s)
- Kaela Braue
- St Vincent's Hospital Clinical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Caroline Baker
- Breast Surgery Unit, St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jocelyn Lippey
- Breast Surgery Unit, St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
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14
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Wang B, Ou C, Yu J, Ye J, Luo Y, Wang Y, Zhang P. Three-dimensional visual technique based on CT lymphography data combined with methylene blue in endoscopic sentinel lymph node biopsy for breast cancer. Eur J Med Res 2022; 27:274. [PMID: 36464689 PMCID: PMC9719621 DOI: 10.1186/s40001-022-00909-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 11/21/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND The combined application of blue dye and radioisotopes is currently the primary mapping technique used for sentinel lymph node biopsy (SLNB) in breast cancer patients. However, radiocolloid techniques have not been widely adopted, especially in developing countries, given the strict restrictions on radioactive materials. Consequently, we carried out a retrospective study to evaluate the feasibility and accuracy of three-dimensional visualization technique (3DVT) based on computed tomography-lymphography (CT-LG) in endoscopic sentinel lymph node biopsy (ESLNB) for breast cancer. METHODS From September 2018 to June 2020, 389 patients who underwent surgical treatment of breast cancer in our department were included in this study. The CT-LG data of these patients were reconstructed into digital 3D models and imported into Smart Vision Works V1.0 to locate the sentinel lymph node (SLN) and for visual simulation surgery. ESLNB and endoscopic axillary lymph node dissection were carried out based on this new technique; the accuracy and clinical value of 3DVT in ESLNB were analyzed. RESULTS The reconstructed 3D models clearly displayed all the structures of breast and axilla, which favors the intraoperative detection of SLNs. The identification rate of biopsied SLNs was 100% (389/389). The accuracy, sensitivity, and false-negative rate were 93.83% (365/389), 93.43% (128/137), and 6.57% (9/137), respectively. Upper limb lymphedema occurred in one patient 3 months after surgery during the 12-month follow-up period. CONCLUSIONS Our 3DVT based on CT-LG data combined with methylene blue in ESLNB ensures a high identification rate of SLNs with low false-negative rates. It, therefore, has the potential to serve as a new method for SLN biopsy in breast cancer cases.
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Affiliation(s)
- Baiye Wang
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong China
| | - Caifeng Ou
- Present Address: Department of Breast Care Surgery, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong 510080 China
- Department of Breast Surgery, Zhujiang Hospital, Southern Medical University, 253, Gongye Dadao Zhong, Haizhu District, Guangzhou, 510282 Guangdong China
| | - Jingang Yu
- School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong China
| | - Jianping Ye
- Shenzhen Smart Vision Co. LTD., Shenzhen, Guangdong China
| | - Yunfeng Luo
- Department of Breast Surgery, Zhujiang Hospital, Southern Medical University, 253, Gongye Dadao Zhong, Haizhu District, Guangzhou, 510282 Guangdong China
| | - Yu Wang
- Department of Pathology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong China
| | - Pusheng Zhang
- Department of Breast Surgery, Zhujiang Hospital, Southern Medical University, 253, Gongye Dadao Zhong, Haizhu District, Guangzhou, 510282 Guangdong China
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15
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Zhu T, Lin X, Zhang T, Li W, Gao H, Yang C, Ji F, Zhang Y, Zhang J, Pan W, Zhuang X, Shen B, Chen Y, Wang K. A Model Incorporating Axillary Tail Position on Mammography for Preoperative Prediction of Non-sentinel Lymph Node Metastasis in Patients with Initial cN+ Breast Cancer after Neoadjuvant Chemotherapy. Acad Radiol 2022; 29:e271-e278. [PMID: 35504810 DOI: 10.1016/j.acra.2022.03.012] [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: 12/23/2021] [Revised: 03/01/2022] [Accepted: 03/12/2022] [Indexed: 02/05/2023]
Abstract
RATIONALE AND OBJECTIVES This study aimed to develop a model incorporating axillary tail position on mammography (AT) for the prediction of non-sentinel Lymph Node (NSLN) metastasis in patients with initial clinical node positivity (cN+). METHODS AND MATERIALS The study reviewed a total of 257 patients with cN+ breast cancer who underwent both sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) following neoadjuvant chemotherapy (NAC). A logistic regression model was developed based on these factors and the results of post-NAC AT and axillary ultrasound (AUS). RESULTS Four clinical factors with p<0.1 in the univariate analysis, including ycT0(odds ratio [OR]: 4.84, 95% confidence interval [CI]: 2.13-11.91, p<0.001), clinical stage before NAC (OR: 2.68, 95%CI: 1.15-6.58, p=0.025), estrogen receptor (ER) expression (OR: 3.29, 95%CI: 1.39-8.39, p=0.009), and HER2 status (OR: 0.21, 95%CI: 0.08-0.50, p=0.001), were independent predictors of NSLN metastases. The clinical model based on the above four factors resulted in the area under the curve (AUC) of 0.82(95%CI: 0.76-0.88) in the training set and 0.83(95% CI: 0.74-0.92) in the validation set. The results of post-NAC AUS and AT were added to the clinical model to construct a clinical imaging model for the prediction of NSLN metastasis with AUC of 0.87(95%CI: 0.81-0.93) in the training set and 0.89(95%CI: 0.82-0.96) in the validation set. CONCLUSIONS The study incorporated the results of post-NAC AT and AUS with other clinal factors to develop a model to predict NSLN metastasis in patients with initial cN+ before surgery. This model performed excellently, allowing physicians to select patients for whom unnecessary ALND could be avoided after NAC.
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Affiliation(s)
- Teng Zhu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China; Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 123 Huifu West Road, Guangzhou, 510080, China
| | - Xiaocheng Lin
- Department of Ultrasound, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Tingfeng Zhang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China; Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 123 Huifu West Road, Guangzhou, 510080, China
| | - Weiping Li
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China; Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 123 Huifu West Road, Guangzhou, 510080, China
| | - Hongfei Gao
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 123 Huifu West Road, Guangzhou, 510080, China
| | - Ciqiu Yang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 123 Huifu West Road, Guangzhou, 510080, China
| | - Fei Ji
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 123 Huifu West Road, Guangzhou, 510080, China
| | - Yi Zhang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China; Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 123 Huifu West Road, Guangzhou, 510080, China
| | - Junsheng Zhang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 123 Huifu West Road, Guangzhou, 510080, China; Diagnosis & Treatment Center of Breast Diseases ,Shantou University Medical College, Shantou, Guangdong, China
| | - Weijun Pan
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China; The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiaosheng Zhuang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 123 Huifu West Road, Guangzhou, 510080, China; Diagnosis & Treatment Center of Breast Diseases ,Shantou University Medical College, Shantou, Guangdong, China
| | - Bo Shen
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 123 Huifu West Road, Guangzhou, 510080, China; Diagnosis & Treatment Center of Breast Diseases ,Shantou University Medical College, Shantou, Guangdong, China
| | - Yuanqi Chen
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China; Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 123 Huifu West Road, Guangzhou, 510080, China
| | - Kun Wang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 123 Huifu West Road, Guangzhou, 510080, China
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16
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Zhang L, Cheng M, Lin Y, Zhang J, Shen B, Chen Y, Yang C, Yang M, Zhu T, Gao H, Ji F, Li J, Wang K. Ultrasound-assisted carbon nanoparticle suspension mapping versus dual tracer-guided sentinel lymph node biopsy in patients with early breast cancer (ultraCars): phase III randomized clinical trial. Br J Surg 2022; 109:1232-1238. [PMID: 36074703 PMCID: PMC10364740 DOI: 10.1093/bjs/znac311] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/22/2022] [Accepted: 08/14/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Appropriate tracing methods for sentinel lymph node biopsy (SLNB) play a key role in accurate axillary staging. This prospective, non-inferiority, phase III RCT compared the feasibility and diagnostic performance of ultrasound-assisted carbon nanoparticle suspension (CNS) mapping with dual tracer-guided SLNB in patients with early breast cancer. METHODS Eligible patients had primary breast cancer without nodal involvement (cN0), or had clinically positive lymph nodes (cN1) that were downstaged to cN0 after neoadjuvant chemotherapy. Patients were randomly assigned (1 : 1) to undergo either ultrasound-assisted CNS sentinel lymph node (SLN) mapping (UC group) or dual tracer-guided mapping with CNS plus indocyanine green (ICG) (GC group). The primary endpoint was the SLN identification rate. RESULTS Between 1 December 2019 and 30 April 2021, 330 patients were assigned randomly to the UC (163 patients) or GC (167 patients) group. The SLN identification rate was 94.5 (95 per cent c.i. 90.9 to 98.0) per cent in the UC group and 95.8 (92.7 to 98.9) per cent in the GC group. The observed difference of -1.3 (-5.9 to 3.3) per cent was lower than the prespecified non-inferiority margin of 6 per cent (Pnon-inferiority = 0.024). No significant difference was observed in metastatic node rate (30.5 versus 24.4 per cent; P = 0.222), median number of SLNs harvested (3 (range 1-7) versus 3 (1-8); P = 0.181), or duration of surgery (mean(s.d.) 7.53(2.77) versus 7.63(3.27) min; P = 0.316) between the groups. Among the subgroup of patients who had undergone neoadjuvant treatment, the SLN identification rate was 91.7 (82.2 to 100) per cent in the UC group and 90.7 (81.7 to 99.7) per cent in the GC group. CONCLUSION The diagnostic performance of ultrasound-assisted CNS mapping was non-inferior to that of dual tracer-guided SLN mapping with CNS plus ICG in patients with early breast cancer. REGISTRATION NUMBER NCT04951245 (http://www.clinicaltrials.gov).
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Affiliation(s)
- Liulu Zhang
- Department of Breast Cancer, Cancer Centre, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Minyi Cheng
- Department of Breast Cancer, Cancer Centre, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yingyi Lin
- Department of Breast Cancer, Cancer Centre, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, Guangdong, China
| | - Junsheng Zhang
- Department of Breast Cancer, Cancer Centre, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, Guangdong, China
| | - Bo Shen
- Department of Breast Cancer, Cancer Centre, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, Guangdong, China
| | - Yuanqi Chen
- Department of Breast Cancer, Cancer Centre, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Ciqiu Yang
- Department of Breast Cancer, Cancer Centre, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Mei Yang
- Department of Breast Cancer, Cancer Centre, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Teng Zhu
- Department of Breast Cancer, Cancer Centre, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hongfei Gao
- Department of Breast Cancer, Cancer Centre, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Fei Ji
- Department of Breast Cancer, Cancer Centre, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jieqing Li
- Department of Breast Cancer, Cancer Centre, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Kun Wang
- Department of Breast Cancer, Cancer Centre, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
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17
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Qu L, Chen Q, Luo N, Zhao P, Zou Q, Mei X, Liu Z, Yi W. 3D reconstruction based novel methods are more effective than traditional clinical assessment in breast cancer axillary lymph node metastasis prediction. Sci Rep 2022; 12:12425. [PMID: 35858979 PMCID: PMC9300607 DOI: 10.1038/s41598-022-16380-3] [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: 12/30/2021] [Accepted: 07/08/2022] [Indexed: 11/09/2022] Open
Abstract
The status of axillary lymph node metastases determines the treatment and overall survival of breast cancer (BC) patients. Three-dimensional (3D) assessment methods have advantages for spatial localization and are more responsive to morphological changes in lymph nodes than two-dimensional (2D) assessment methods, and we speculate that methods developed using 3D reconstruction systems have high diagnostic efficacy. This exploratory study included 43 patients with histologically confirmed BC diagnosed at Second Xiangya Hospital of Central South University between July 2017 and August 2020, all of whom underwent preoperative CT scans. Patients were divided into a training cohort to train the model and a validation cohort to validate the model. A 3D axillary lymph node atlas was constructed on a 3D reconstruction system to create various methods of assessing lymph node metastases for a comparison of diagnostic efficacy. Receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic values of these methods. A total of 43 patients (mean [SD] age, 47 [10] years) met the eligibility criteria and completed 3D reconstruction. An axillary lymph node atlas was established, and a correlation between lymph node sphericity and lymph node metastasis was revealed. By continuously fitting the size and characteristics of axillary lymph nodes on the 3D reconstruction system, formulas and models were established to determine the presence or absence of lymph node metastasis, and the 3D method had better sensitivity for axillary lymph node assessment than the 2D method, with a statistically significant difference in the correct classification rate. The combined diagnostic method was superior to a single diagnostic method, with a 92.3% correct classification rate for the 3D method combined with ultrasound. In addition, in patients who received neoadjuvant chemotherapy (NAC), the correct classification rate of the 3D method (72.7%) was significantly higher than that of ultrasound (45.5%) and CT (54.5%). By establishing an axillary lymph node atlas, the sphericity formula and model developed with the 3D reconstruction system achieve a high correct classification rate when combined with ultrasound or CT and can also be applied to patients receiving NAC.
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Affiliation(s)
- Limeng Qu
- Department of General Surgery, The Second Xiangya Hospital Of Central South University, No. 139, Renmin Central Road, Changsha, 410011, People's Republic of China
| | - Qitong Chen
- Department of General Surgery, The Second Xiangya Hospital Of Central South University, No. 139, Renmin Central Road, Changsha, 410011, People's Republic of China
| | - Na Luo
- Department of General Surgery, The Second Xiangya Hospital Of Central South University, No. 139, Renmin Central Road, Changsha, 410011, People's Republic of China.,Department of General Surgery, The First People's Hospital of Changde City, Changde, China
| | - Piao Zhao
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiongyan Zou
- Department of General Surgery, The Second Xiangya Hospital Of Central South University, No. 139, Renmin Central Road, Changsha, 410011, People's Republic of China
| | - Xilong Mei
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ziru Liu
- Department of General Surgery, The Second Xiangya Hospital Of Central South University, No. 139, Renmin Central Road, Changsha, 410011, People's Republic of China.
| | - Wenjun Yi
- Department of General Surgery, The Second Xiangya Hospital Of Central South University, No. 139, Renmin Central Road, Changsha, 410011, People's Republic of China.
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Beer P, Rohrer-Bley C, Nolff MC. Near-infrared fluorescent image-guided lymph node dissection compared with locoregional lymphadenectomies in dogs with mast cell tumours. J Small Anim Pract 2022; 63:670-678. [PMID: 35815663 PMCID: PMC9542114 DOI: 10.1111/jsap.13529] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 03/03/2022] [Accepted: 05/25/2022] [Indexed: 12/21/2022]
Abstract
Objectives Near‐infrared fluorescent imaging has been described for intraoperative mapping of the draining lymph nodes in human cancer and canine oral tumours. The aim of this study was to retrospectively describe the results of lymphadenectomies in dogs with mast cell tumours treated either by standard unguided locoregional lymph node dissection or near‐infrared fluorescent image‐guided lymph node dissection. Methods Medical records between 2012 and 2020 were reviewed for dogs that were presented for surgical resection of mast cell tumours with concurrent lymphadenectomy either with (near‐infrared fluorescent image‐guided lymph node dissection) or without near‐infrared fluorescence image guidance (lymph node dissection). The number and location of lymph nodes planned for surgical dissection and actually dissected nodes, presence of metastases and perioperative complications were recorded. Results Thirty‐five patients underwent near‐infrared fluorescent image‐guided lymph node dissection, and 43 lymph node dissections. The number of nodes preoperatively planned for resection were 70 and 68, respectively. Fifty‐eight of those (83%) were identified during near‐infrared fluorescent image‐guided lymph node dissection procedures, compared with 50 (74%) during lymph node dissection. near‐infrared fluorescent image‐guided lymph node dissection resulted in resection of additional fluorescent nodes not corresponding to locoregional nodes in 15 of 35 dogs. Using near‐infrared fluorescent image‐guided lymph node dissection, we identified at least one metastatic node in 68% of dogs (24 of 35) compared with 33% (14 of 43) when lymph node dissection was used without imaging. No complications related to near‐infrared fluorescent imaging were reported. Clinical Significance The present study suggests that near‐infrared imaging is a promising technique for intraoperative detection of the draining lymph nodes in dogs with mast cell tumours. Further validation of the technique is required to assess if near‐infrared fluorescent imaging can detect the true sentinel lymph node.
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Affiliation(s)
- P Beer
- Vetsuisse Faculty, Clinic for Small Animal Surgery, University of Zurich, Zurich, 8057, Switzerland
| | - C Rohrer-Bley
- Division of Radiation Oncology, Vetsuisse Faculty, University of Zurich, Zurich, 8057, Switzerland
| | - M C Nolff
- Vetsuisse Faculty, Clinic for Small Animal Surgery, University of Zurich, Zurich, 8057, Switzerland
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Jiang Y, Li J, Chen B, Bao Y, Luo C, Luo Y, Li T, Lv J, Cheng X. Sentinel Lymph Node Biopsy Mapped With Carbon Nanoparticle Suspensions in Patients With Breast Cancer: A Systematic Review and Meta-Analysis. Front Oncol 2022; 12:818812. [PMID: 35419285 PMCID: PMC8995566 DOI: 10.3389/fonc.2022.818812] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 02/21/2022] [Indexed: 01/15/2023] Open
Abstract
Background The mapping method represents a crucial factor affecting the rate of sentinel lymph node detection in breast cancer. We carried out this meta-analysis to assess the clinical utility of carbon nanoparticle suspensions (CNSs) in guiding sentinel lymph node biopsy (SLNB) for breast cancer patients. Methods Electronic databases, which comprised the China National Knowledge Infrastructure, the Wanfang electronic database, the Cochrane Library, EMBASE, and PubMed, were explored to identify relevant studies from database inception to July 2021 that studied the detection rate of CNSs-guided SLNB. A meta-analysis was performed to generate pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), a summary receiver operator characteristic curve (SROC), and a diagnostic odds ratio (DOR). Results A total of 33 publications that enrolled 2,171 patients were analyzed. The pooled sensitivity, specificity, PLR, and NLR were 0.93 (95% CI: 0.91–0.95, I2 = 0.0%), 0.99 (95% CI: 0.98–0.99, I2 = 56.5%), 42.85 (95% CI: 29.73–61.77, I2 = 47.0%), and 0.09 (95% CI: 0.07–0.11, I2 = 0.0%), respectively. The area under the curve (AUC) of the SROC curve was 0.98. There were no significant differences when analyzed based on the dose and site of CNS injection. There was significant publication bias among the included publications based on Deeks’ funnel plot [Slope (Bias) = −7.35, P = 0.00]. Nonetheless, the sensitivity analysis identified the results to be reliable and stable. Conclusion This meta-analysis highlights the accuracy and feasibility of using CNSs for SLNB in patients with breast cancer. Clinically, the identification and predictive values of CNSs as an optimal tracer for SLNB remains undisputed.
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Affiliation(s)
- Yan Jiang
- Breast and Thyroid Surgery, Department of General Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Jiayang Li
- Drug Clinical Trial Institution, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Baolin Chen
- Breast and Thyroid Surgery, Department of General Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yuxiang Bao
- Breast and Thyroid Surgery, Department of General Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Chengmin Luo
- Breast and Thyroid Surgery, Department of General Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yi Luo
- Breast and Thyroid Surgery, Department of General Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Taolang Li
- Breast and Thyroid Surgery, Department of General Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Junyuan Lv
- Breast and Thyroid Surgery, Department of General Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xiaoming Cheng
- Breast and Thyroid Surgery, Department of General Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
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Chavda J, Mishra A, Silodia A, Yadav SK, Sharma DB, Sharma D, Khandare M. Validation sentinel lymph node biopsy study in cN0 axilla using low-cost dual dye technique: potential solution for resource poor settings. Breast Cancer Res Treat 2022; 193:105-110. [PMID: 35246773 DOI: 10.1007/s10549-022-06556-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/22/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) using radio-pharmaceutical and a blue dye is gold standard for axillary staging in clinically node-negative breast cancer. High costs and limited availability of radio-pharmaceutical and/or gamma probe are major deterrents in performing SLNB in developing countries. In this study, we evaluated feasibility of SLN identification (SLN-IR) of fluorescein-guided (FG) SLNB in combination with methylene blue dye (MBD). METHODS This was a prospective cross-sectional non-randomized validation study in patients with clinically node-negative axilla. Patients underwent validation SLNB using fluorescein (and blue LED light) and MBD. Axillary dissection was performed irrespective of SLNB histology. SLIN-IR and False Negative Rate (FNR) were assessed for both groups. RESULTS The SLNs were identified in 29 (96.6%) pre-chemotherapy patients and 23 (82%) post Neoadjuvant Chemotherapy (NACT) patients. The median number of sentinel lymph nodes identified was 3 (range of 1-5) in pre-chemotherapy patients and 1 (range of 1-3) in post NACT patients. The SLN-IR using MBD was 90%, FD was 86.7% and combined MBD FD was 96.7% in pre-chemotherapy patients. The SLN-IR using MBD was 82%, FD was 71% and combined MBD FD was 82% in in post NACT patients. The false negative rate (FNR) in pre-chemotherapy group was 8.0% (MBD), 8.3% (FD) and 7.4% (MBD + FD). The FNR in post NACT group was 8.7% (MBD), 10% (FD) and 8.7% (MBD + FD). CONCLUSION This prospective validation study showed adequate SLN-IR and FNR using low-cost dual dyes in early breast cancer patients and can be used in low resource settings. However, SLNB in post NACT axilla though viable along with a satisfactory FNR, is associated with low identification rate and needs further evaluation.
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Affiliation(s)
- Jayesh Chavda
- Department of Surgery, Netaji Subhash Chandra Bose (NSCB) Medical College, Jabalpur, India
| | - Arpan Mishra
- Department of Surgery, Netaji Subhash Chandra Bose (NSCB) Medical College, Jabalpur, India
| | - Ashutosh Silodia
- Department of Surgery, Netaji Subhash Chandra Bose (NSCB) Medical College, Jabalpur, India
| | - Sanjay Kumar Yadav
- Department of Surgery, Netaji Subhash Chandra Bose (NSCB) Medical College, Jabalpur, India.
| | - Deepti Bala Sharma
- Department of Surgery, Netaji Subhash Chandra Bose (NSCB) Medical College, Jabalpur, India
| | - Dhananjaya Sharma
- Department of Surgery, Netaji Subhash Chandra Bose (NSCB) Medical College, Jabalpur, India
| | - Muktesh Khandare
- Department of Pathology, Netaji Subhash Chandra Bose (NSCB) Medical College, Jabalpur, India
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Axillary lymph node dissection vs. sentinel node biopsy for early-stage clinically node-negative breast cancer: a systematic review and meta-analysis. Arch Gynecol Obstet 2022; 306:1221-1234. [DOI: 10.1007/s00404-022-06458-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/09/2022] [Indexed: 02/06/2023]
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22
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Isotope-only localisation for sentinel lymph node biopsy - medium-term oncological outcomes. Clin Breast Cancer 2022; 22:e636-e640. [DOI: 10.1016/j.clbc.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 11/17/2022]
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Jin Y, Yuan L, Zhang Y, Tang P, Yang Y, Fan L, Chen L, Qi X, Jiang J. A Prospective Self-Controlled Study of Indocyanine Green, Radioisotope, and Methylene Blue for Combined Imaging of Axillary Sentinel Lymph Nodes in Breast Cancer. Front Oncol 2022; 12:803804. [PMID: 35223482 PMCID: PMC8863935 DOI: 10.3389/fonc.2022.803804] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/10/2022] [Indexed: 12/25/2022] Open
Abstract
Purpose This self-controlled study aimed to clarify whether indocyanine green (ICG) could be an alternative tracer in the absence of radioisotope (RI) for combined imaging of axillary sentinel lymph node (SLN) in breast cancer. Methods Primary breast cancer, clinically axillary node-negative patients (n = 182) were prospectively enrolled from March 2015 to November 2020. ICG, methylene blue (MB), and RI were used to perform axillary sentinel lymph node biopsy (SLNB). The main observation index was the positivity of ICG + MB vs. RI + MB in axillary SLNB; the secondary observation indicators were the axillary SLN detection rate, mean number of axillary SLNs detected, mean number of metastatic axillary SLNs detected, and safety. Results All 182 patients had axillary SLNs; a total of 925 axillary SLNs were detected. Pathological examination confirmed metastatic axillary SLN in 42 patients (total of 79 metastatic SLNs). Positivity, detection rate of SLNs, detection rate of metastatic SLNs, and the number of metastatic SLNs detected were comparable with RI+MB and ICG+MB (p > 0.05). The mean number of axillary SLNs detected was significantly higher with ICG+MB than with RI+MB (4.99 ± 2.42 vs. 4.02 ± 2.33, p < 0.001). No tracer-related adverse events occurred. Conclusions ICG appears to be a safe and effective axillary SLN tracer, and a feasible alternative to RI in combined imaging for axillary SLN of breast cancer.
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Affiliation(s)
- Yuting Jin
- Department of Breast Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Long Yuan
- Department of Breast Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yi Zhang
- Department of Breast Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Peng Tang
- Department of Breast Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ying Yang
- Department of Breast Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Linjun Fan
- Department of Breast Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Li Chen
- Department of Breast Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiaowei Qi
- Department of Breast Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jun Jiang
- Department of Breast Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Arz R, Seehusen F, Meier VS, Nolff MC. Indocyanine-based near-infrared lymphography for real-time detection of lymphatics in a cat with multiple mast cell tumours. JFMS Open Rep 2022; 8:20551169221074961. [PMID: 35251677 PMCID: PMC8891856 DOI: 10.1177/20551169221074961] [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] [Indexed: 11/23/2022] Open
Abstract
Case summary An 11-year-old female domestic shorthair cat was presented with cutaneous mast cell tumours (MCTs) localised at the right temporal region, the left buccal region and on the third digit of the right thoracic limb. Staging was negative and locoregional lymph nodes appeared normal, based on clinical findings. During surgery, real-time indocyanine green (ICG)-based lymphography was performed to detect the cutaneous draining pattern of all the primary MCTs. ICG was injected intracutaneously in four quadrants around each tumour, and a clear lymphogram was visible shortly after injection. Using near-infrared lymphography (NIR-L) for guidance, all lymphadenectomies were performed in 12 mins or less, with a maximal incision length of 3.5 cm. The smallest resected node was 0.9 cm in diameter. All MCTs were classified as low-grade cutaneous MCT. All four ICG-positive lymph nodes were considered premetastatic or metastatic. The only ICG-negative resected node was also negative for tumour cells. No complications related to NIR-L were recorded. Relevance and novel information This is the first description of NIR-L in a cat with MCT. Application was straightforward and ICG enrichment only occurred in the metastatic nodes, suggesting correct identification of lymphatic draining patterns. Of note, as previously described in dogs, we did detect nodal metastasis, despite low-grade primary tumours. The clinical relevance should be evaluated in future studies.
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Affiliation(s)
- Raphael Arz
- Clinic for Small Animal Surgery, Department for Small Animals, Vetsuisse Faculty, University of Zurich, Switzerland
| | - Frauke Seehusen
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Switzerland
| | - Valeria S Meier
- Clinic for Oncology and Radiation Oncology, Department for Small Animals, Vetsuisse Faculty, University of Zurich, Switzerland
- Department of Physics, University of Zurich, Switzerland
| | - Mirja C Nolff
- Clinic for Small Animal Surgery, Department for Small Animals, Vetsuisse Faculty, University of Zurich, Switzerland
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Ladak F, Chua N, Lesniak D, Ghosh S, Wiebe E, Yakimetz W, Rajaee N, Olson D, Peiris L. Predictors of axillary node response in node-positive patients undergoing neoadjuvant chemotherapy for breast cancer. Can J Surg 2022; 65:E89-E96. [PMID: 35135785 PMCID: PMC8834246 DOI: 10.1503/cjs.012920] [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] [Accepted: 03/03/2021] [Indexed: 12/05/2022] Open
Abstract
Background: The ability to accurately predict which patients will achieve a pathologic complete response (pCR) after neoadjuvant chemotherapy could help identify those who could safely be spared the potential morbidity of axillary lymph node dissection. We performed a retrospective analysis of a cohort of clinically node-positive patients managed with neoadjuvant chemotherapy with the goal of identifying predictors of axillary pCR. Methods: Eligible patients were aged 18 years or older, had clinical T1–T4, N1–N3, M0 breast cancer and received neoadjuvant chemotherapy followed by surgical axillary lymph node staging between 2001 and 2017 at Misericordia Hospital, Edmonton, Alberta. Patient data, including tumour characteristics, details of neoadjuvant chemotherapy, imaging results before and after neoadjuvant chemotherapy, and final pathologic analysis, were collected from the appropriate provincial electronic data repositories. We summarized the data using descriptive statistics. We characterized associations between clinical/tumour characteristics and pCR using univariate and multivariate regression analysis. Results: Of the 323 patients included in the study, 130 (40.2%) achieved axillary pCR. Absence of residual disease in the breast was associated with axillary pCR (odds ratio 6.74, 95% confidence interval 2.89–15.67). HER2-positive, triple-negative and ER-positive/PR-negative/HER2-negative tumours were significantly associated with a pCR on univariate analysis; the association trended toward significance on multivariate analysis. Conclusion: Our findings support the routine use of neoadjuvant chemotherapy and sentinel lymph node biopsy in patients with an absence of residual disease in the breast, and potentially in those with HER2-positive or triple-negative subtypes, and highlight the ER-positive/PR-negative biomarker subtype as a potential predictor of nodal response.
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Affiliation(s)
- Farah Ladak
- From the Division of General Surgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Ladak, Chua, Lesniak, Yakimetz, Rajaee, Olson, Peiris); the Alberta Health Services-Cross Cancer Control Institute, Department of Medical Oncology, University of Alberta, Edmonton, Alta. (Ghosh); the Department of Mathematical and Statistical Sciences, University of Alberta, Alta. (Ghosh); and the Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alta. (Wiebe, Ghosh)
| | - Natalie Chua
- From the Division of General Surgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Ladak, Chua, Lesniak, Yakimetz, Rajaee, Olson, Peiris); the Alberta Health Services-Cross Cancer Control Institute, Department of Medical Oncology, University of Alberta, Edmonton, Alta. (Ghosh); the Department of Mathematical and Statistical Sciences, University of Alberta, Alta. (Ghosh); and the Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alta. (Wiebe, Ghosh)
| | - David Lesniak
- From the Division of General Surgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Ladak, Chua, Lesniak, Yakimetz, Rajaee, Olson, Peiris); the Alberta Health Services-Cross Cancer Control Institute, Department of Medical Oncology, University of Alberta, Edmonton, Alta. (Ghosh); the Department of Mathematical and Statistical Sciences, University of Alberta, Alta. (Ghosh); and the Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alta. (Wiebe, Ghosh)
| | - Sunita Ghosh
- From the Division of General Surgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Ladak, Chua, Lesniak, Yakimetz, Rajaee, Olson, Peiris); the Alberta Health Services-Cross Cancer Control Institute, Department of Medical Oncology, University of Alberta, Edmonton, Alta. (Ghosh); the Department of Mathematical and Statistical Sciences, University of Alberta, Alta. (Ghosh); and the Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alta. (Wiebe, Ghosh)
| | - Ericka Wiebe
- From the Division of General Surgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Ladak, Chua, Lesniak, Yakimetz, Rajaee, Olson, Peiris); the Alberta Health Services-Cross Cancer Control Institute, Department of Medical Oncology, University of Alberta, Edmonton, Alta. (Ghosh); the Department of Mathematical and Statistical Sciences, University of Alberta, Alta. (Ghosh); and the Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alta. (Wiebe, Ghosh)
| | - Walter Yakimetz
- From the Division of General Surgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Ladak, Chua, Lesniak, Yakimetz, Rajaee, Olson, Peiris); the Alberta Health Services-Cross Cancer Control Institute, Department of Medical Oncology, University of Alberta, Edmonton, Alta. (Ghosh); the Department of Mathematical and Statistical Sciences, University of Alberta, Alta. (Ghosh); and the Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alta. (Wiebe, Ghosh)
| | - Nikoo Rajaee
- From the Division of General Surgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Ladak, Chua, Lesniak, Yakimetz, Rajaee, Olson, Peiris); the Alberta Health Services-Cross Cancer Control Institute, Department of Medical Oncology, University of Alberta, Edmonton, Alta. (Ghosh); the Department of Mathematical and Statistical Sciences, University of Alberta, Alta. (Ghosh); and the Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alta. (Wiebe, Ghosh)
| | - David Olson
- From the Division of General Surgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Ladak, Chua, Lesniak, Yakimetz, Rajaee, Olson, Peiris); the Alberta Health Services-Cross Cancer Control Institute, Department of Medical Oncology, University of Alberta, Edmonton, Alta. (Ghosh); the Department of Mathematical and Statistical Sciences, University of Alberta, Alta. (Ghosh); and the Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alta. (Wiebe, Ghosh)
| | - Lashan Peiris
- From the Division of General Surgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Ladak, Chua, Lesniak, Yakimetz, Rajaee, Olson, Peiris); the Alberta Health Services-Cross Cancer Control Institute, Department of Medical Oncology, University of Alberta, Edmonton, Alta. (Ghosh); the Department of Mathematical and Statistical Sciences, University of Alberta, Alta. (Ghosh); and the Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alta. (Wiebe, Ghosh)
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Dumitru D, Ghanakumar S, Provenzano E, Benson JR. A Prospective Study Evaluating the Accuracy of Indocyanine Green (ICG) Fluorescence Compared with Radioisotope for Sentinel Lymph Node (SLN) Detection in Early Breast Cancer. Ann Surg Oncol 2022; 29:3014-3020. [DOI: 10.1245/s10434-021-11255-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/08/2021] [Indexed: 02/05/2023]
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Kurochkin MA, German SV, Abalymov A, Vorontsov DА, Gorin DA, Novoselova MV. Sentinel lymph node detection by combining nonradioactive techniques with contrast agents: State of the art and prospects. JOURNAL OF BIOPHOTONICS 2022; 15:e202100149. [PMID: 34514735 DOI: 10.1002/jbio.202100149] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/21/2021] [Accepted: 09/09/2021] [Indexed: 06/13/2023]
Abstract
The status of sentinel lymph nodes (SLNs) has a substantial prognostic value because these nodes are the first place where cancer cells accumulate along their spreading route. Routine SLN biopsy ("gold standard") involves peritumoral injections of radiopharmaceuticals, such as technetium-99m, which has obvious disadvantages. This review examines the methods used as "gold standard" analogs to diagnose SLNs. Nonradioactive preoperative and intraoperative methods of SLN detection are analyzed. Promising photonic tools for SLNs detection are reviewed, including NIR-I/NIR-II fluorescence imaging, photoswitching dyes for SLN detection, in vivo photoacoustic detection, imaging and biopsy of SLNs. Also are discussed methods of SLN detection by magnetic resonance imaging, ultrasonic imaging systems including as combined with photoacoustic imaging, and methods based on the magnetometer-aided detection of superparamagnetic nanoparticles. The advantages and disadvantages of nonradioactive SLN-detection methods are shown. The review concludes with prospects for the use of conservative diagnostic methods in combination with photonic tools.
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Affiliation(s)
| | - Sergey V German
- Skolkovo Institute of Science and Technology, Moscow, Russia
- Institute of Spectroscopy of the Russian Academy of Sciences, Moscow, Russia
| | | | - Dmitry А Vorontsov
- State Budgetary Institution of Health Care of Nizhny Novgorod "Nizhny Novgorod Regional Clinical Oncological Dispensary", Nizhny Novgorod, Russia
| | - Dmitry A Gorin
- Skolkovo Institute of Science and Technology, Moscow, Russia
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Shi XQ, Zhang H, Liu X, Dong Y, Yang P, Qian L. Feasibility and efficiency of contrast enhanced ultrasound real time guided fine needle aspiration for sentinel lymph node of breast cancer. Clin Hemorheol Microcirc 2022; 80:267-279. [PMID: 34719485 DOI: 10.3233/ch-211226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM To assess the feasibility and efficiency of contrast-enhanced ultrasound (CEUS) real-time guided fine needle aspiration (FNA) for sentinel lymph node (SLN) of breast cancer. MATERIALS AND METHODS This retrospective study reviewed 21 breast cancer patients who scheduled for surgical resection performed CEUS real-time guided SLN-FNA and intraoperative SLN biopsy (SLNB). The success rate of CEUS real-time guided SLN-FNA was analyzed. The FNA diagnostic efficiency of SLN metastasis was analyzed compared to SLNB. RESULTS Twenty-six SLNs were detected by intradermal CEUS whereas 130 SLNs were detected by SLNB. The median SLNs detected by intradermal CEUS (n = 1) and by SLNB (n = 5) was significantly difference (p < 0.001). All 26 CE-SLNs of 21 patients were successfully performed intradermal CEUS dual image real-time guided SLN-FNA including 5 SLNs of 4 patients which were difficult to distinguish in conventional ultrasound. Compared to SLNB, FNA found 2 of 5 cases of SLN metastasis, the diagnosis sensitivity, specificity, positive predictive value, negative predictive value, false negative rate, false positive rate and Yoden index were 40%, 100%, 100%, 84.2%, 60%, 0%and 40%, respectively. CONCLUSION SLN-FNA real-time guided by dual CEUS image mode was technically feasible. Patients with a positive SLN-FNA should be advised to ALND without intraoperative SLNB according to Chinese surgeon and patients' conservatism attitude. But a negative SLN-FNA did not obviate the need of conventional SLNB because of the high false negative rate.
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Affiliation(s)
- Xian-Quan Shi
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Huiming Zhang
- Department of Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xi Liu
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yunyun Dong
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Peipei Yang
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Linxue Qian
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Magnoni F, Corso G, Gilardi L, Pagan E, Massari G, Girardi A, Ghidinelli F, Bagnardi V, Galimberti V, Grana CM, Veronesi P. Does failed mapping predict sentinel lymph node metastasis in cN0 breast cancer? Future Oncol 2021; 18:193-204. [PMID: 34882010 DOI: 10.2217/fon-2021-0470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Aims: The clinical significance of nonvisualized sentinel lymph nodes (non-vSLNs) is unknown. The authors sought to determine the incidence of non-vSLNs on lymphoscintigraphy, the identification rate during surgery, factors associated with non-vSLNs and related axillary management. Patients & methods: A total of 30,508 consecutive SLN procedures performed at a single institution from 2000 to 2017 were retrospectively studied. Associations between clinicopathological factors and the identification of SLNs during surgery were assessed. Results: Non-vSLN occurred in 525 of the procedures (1.7%). In 73.3%, at least one SLN was identified intraoperatively. Nodal involvement was only significantly associated with SLN nonidentification (p < 0.001). Conclusion: Patients with non-vSLN had an increased risk for SLN metastasis. The detection rate during surgery was consistent, reducing the amount of unnecessary axillary dissection.
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Affiliation(s)
- Francesca Magnoni
- Breast Cancer Surgery Division, European Institute of Oncology, IRCCS, Milan, 20141, Italy
| | - Giovanni Corso
- Breast Cancer Surgery Division, European Institute of Oncology, IRCCS, Milan, 20141, Italy.,Departmentof Oncology & Hemato-Oncology, University of Milan, Milan, 20122, Italy
| | - Laura Gilardi
- Division of Nuclear Medicine, European Institute of Oncology, IRCCS, Milano, 20141, Italy
| | - Eleonora Pagan
- Department of Statistics & Quantitative Methods, University of Milan-Bicocca, Milan, 20126, Italy
| | - Giulia Massari
- Breast Cancer Surgery Division, European Institute of Oncology, IRCCS, Milan, 20141, Italy
| | - Antonia Girardi
- Breast Cancer Surgery Division, European Institute of Oncology, IRCCS, Milan, 20141, Italy
| | | | - Vincenzo Bagnardi
- Department of Statistics & Quantitative Methods, University of Milan-Bicocca, Milan, 20126, Italy
| | - Viviana Galimberti
- Breast Cancer Surgery Division, European Institute of Oncology, IRCCS, Milan, 20141, Italy
| | - Chiara Maria Grana
- Division of Nuclear Medicine, European Institute of Oncology, IRCCS, Milano, 20141, Italy
| | - Paolo Veronesi
- Breast Cancer Surgery Division, European Institute of Oncology, IRCCS, Milan, 20141, Italy.,Departmentof Oncology & Hemato-Oncology, University of Milan, Milan, 20122, Italy
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Quak E, Braux G, Weyts K, Lasnon C. More fat, less migration: breast density as a predictor of sentinel lymph node non-visualization in breast cancer. EJNMMI Res 2021; 11:112. [PMID: 34716507 PMCID: PMC8556450 DOI: 10.1186/s13550-021-00848-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Elske Quak
- Nuclear Medicine Department, Comprehensive Cancer Centre François Baclesse, UNICANCER, Avenue Général Harris, 14076, Caen Cedex 5, France
| | - Grégoire Braux
- Radiology Department, Caen University Hospital, 14000, Caen, France
| | - Kathleen Weyts
- Nuclear Medicine Department, Comprehensive Cancer Centre François Baclesse, UNICANCER, Avenue Général Harris, 14076, Caen Cedex 5, France
| | - Charline Lasnon
- Nuclear Medicine Department, Comprehensive Cancer Centre François Baclesse, UNICANCER, Avenue Général Harris, 14076, Caen Cedex 5, France. .,UNICAEN, INSERM 1086 ANTICIPE, Normandy University, 14000, Caen, France.
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31
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Bove S, Fragomeni SM, Romito A, DI Giorgio D, Rinaldi P, Pagliara D, Verri D, Romito I, Paris I, Tagliaferri L, Marazzi F, Visconti G, Franceschini G, Masetti R, Garganese G. Techniques for sentinel node biopsy in breast cancer. Minerva Surg 2021; 76:550-563. [PMID: 34338468 DOI: 10.23736/s2724-5691.21.09002-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Sentinel node biopsy (SNB) is the standard of care in women with breast cancer (BC) and clinically non suspicious axillary lymph nodes (LNs), due to its high negative predictive value (NPV) in the assessment of nodal status. SNB has significantly reduced complications related to the axillary lymph node dissection, such as lymphedema and upper limb dysfunction. EVIDENCE ACQUISITION The gold standard technique for SNB is the blue dye (BD) and technetium labelled nanocolloid (Tc-99m) double technique. However, nuclear medicine is not available in all Institutions and several new tracers and devices have been proposed, such as indocyanine green (ICG) and superparamagnetic iron oxides (SPIO). All these techniques show an accuracy and detection rate not inferior to that of the standard technique, with different specific pros and cons. The choice of how to perform a SNB primarily depends on the surgeon's confidence with the procedure, the availability of nuclear medicine and the economic resources of the Institutions. In this setting, new tracers, hybrid tracers and imaging techniques are being evaluated in order to improve the detection rate of sentinel lymph nodes (SNs) and minimize the number of unnecessary axillary surgeries through an accurate preoperative assessment of nodal status and to guide new minimally invasive diagnostic procedures of SNs. In particular, the contrast-enhanced ultrasound (CEUS) is an active field of research but cannot be recommended for clinical use at this time. EVIDENCE SYNTHESIS The ICG fluorescence technique was superior in terms of DR, as well as having the lowest FNR. The DR descending order was SPIO, Tc, dual modality (Tc/BD), CEUS and BD. CONCLUSIONS This paper is a narrative review of the most common SNB techniques in BC with a focus on recent innovations.
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Affiliation(s)
- Sonia Bove
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - Simona M Fragomeni
- Unità di Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessia Romito
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy -
| | | | - Pierluigi Rinaldi
- Radiology and Interventional Radiology Unit, Mater Olbia Hospital, Olbia, Italy.,Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Domenico Pagliara
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - Debora Verri
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - Ilaria Romito
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - Ida Paris
- Unità di Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Tagliaferri
- Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia - Gemelli ART (Advanced Radiation Therapy), Interventional Oncology Center (IOC), Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Fabio Marazzi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe Visconti
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC Chirurgia Plastica, Università Cattolica del Sacro Cuore - Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - Gianluca Franceschini
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Multidisciplinary Breast Center, Università Cattolica del Sacro Cuore - Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - Riccardo Masetti
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Multidisciplinary Breast Center, Università Cattolica del Sacro Cuore - Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - Giorgia Garganese
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy.,Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
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Sreedhar S, Maloney J, Hudson S. Introducing SentiMag in a rural setting: A 5-year experience. ANZ J Surg 2021; 91:2404-2410. [PMID: 34309147 DOI: 10.1111/ans.17093] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 06/27/2021] [Accepted: 07/11/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND The Sentimag device is a probe that contains a sensitive magnetometer which detects either an implantable magnetic marker (MagSeed) or an infectable superparamagnetic ironoxide nanoparticle tracer (MagTrace). MagSeed is used to localise impalpable breast lesions; MagTrace is used to identify sentinel lymph nodes. In Australasia, Sentinel lymph node (SLN) biopsy, using radioactive colloid injection, is a mainstay of prognostication in breast surgery in patients with a clinically negative axilla. In addition, radioactive seeds or hookwires have been used to detect impalpable breast lesions. Gisborne Hospital has been using the SentiMag device since June 2016 to both identify sentinel lymph nodes (Magtrace) and impalpable tumours (Magseed). This study gives perspective over more than 5 years on how this new technology can benefit patients and clinicians in the rural setting. METHODS Patient data had been collected by the operative surgeon prospectively and corroborated with the coding department. Consecutive cases performed by a single surgeon were included in this study. Inclusion criteria were: (1) any patient who needed localisation of an impalpable breast lesion; (2) any patient who needed a sentinel lymph node biopsy; (3) cases were collected from January 2013 with the large majority of cases were collected between January 2015 and Jan 2020. Comparisons were made between patients with different localisation methods. Basic demographics were collected at the time of the surgery and outcomes then recorded. Staging, lymph node status, lymph node detection rates and complications were collected. Mode of tumour and sentinel node location was recorded. Financial data was collected from administrative staff via receipts and invoices of purchases to the hospital. RESULTS Of the 125 patients included in this study: 23 underwent magnetic seed insertion; 15 underwent a hookwire insertion; 45 cases used MagTrace injection; 71 cases used radioactive colloid injection. There was a significantly higher detection rate of two or more sentinel nodes in the SentiMag group. (91% vs. 71.8%, p = 0.01). Neither complication rates, nor cancer detection rates were significantly different. Eighty-four (67.2%) cases did not require tumour location. CONCLUSION SentiMag is safe to use in a rural setting. Using the SentiMag system can simplify care for patients and surgeons and was shown to be cost effective in our hospital.
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Affiliation(s)
| | - Jay Maloney
- General Surgical Department, Gisborne Hospital, Gisborne, New Zealand
| | - Steven Hudson
- General Surgical Department, Gisborne Hospital, Gisborne, New Zealand
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33
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Superparamagnetic Iron Oxide for Identifying Sentinel Lymph Node in Breast Cancer after Neoadjuvant Chemotherapy: Feasibility Study. J Clin Med 2021; 10:jcm10143149. [PMID: 34300315 PMCID: PMC8305632 DOI: 10.3390/jcm10143149] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/02/2021] [Accepted: 07/15/2021] [Indexed: 12/23/2022] Open
Abstract
Sentinel lymph node biopsy (SLNB) is a well-established procedure for staging clinically node-negative early breast cancer (BC). Superparamagnetic iron oxide (SPIO) demonstrated efficacy for nodal identification using a magnetic probe after local retroaeroal interstitial injection. Its benefits lie in its flexibility, which is an essential property in the global setting, where access to the isotope is difficult. To the best of our knowledge, this is the first study to evaluate the feasibility and safety of the SPIO for SLNB in BC patients treated with neoadjuvant chemotherapy (NAC). Seventy-four female patients were included. The median time of lymph node retrieval was 20 min. The median number of resected sentinel nodes (SNs) was 4. SN was detected in all patients. No serious adverse event was observed. SPIO in identifying SN in BC patients after NAC is feasible and oncologically safe.
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34
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Kurylcio A, Pelc Z, Skórzewska M, Rawicz-Pruszyński K, Mlak R, Gęca K, Sędłak K, Kurylcio P, Małecka-Massalska T, Polkowski W. Superparamagnetic Iron Oxide for Identifying Sentinel Lymph Node in Breast Cancer after Neoadjuvant Chemotherapy: Feasibility Study. J Clin Med 2021. [PMID: 34300315 DOI: 10.3390/jcm10143149.pmid:34300315;pmcid:pmc8305632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Sentinel lymph node biopsy (SLNB) is a well-established procedure for staging clinically node-negative early breast cancer (BC). Superparamagnetic iron oxide (SPIO) demonstrated efficacy for nodal identification using a magnetic probe after local retroaeroal interstitial injection. Its benefits lie in its flexibility, which is an essential property in the global setting, where access to the isotope is difficult. To the best of our knowledge, this is the first study to evaluate the feasibility and safety of the SPIO for SLNB in BC patients treated with neoadjuvant chemotherapy (NAC). Seventy-four female patients were included. The median time of lymph node retrieval was 20 min. The median number of resected sentinel nodes (SNs) was 4. SN was detected in all patients. No serious adverse event was observed. SPIO in identifying SN in BC patients after NAC is feasible and oncologically safe.
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Affiliation(s)
- Andrzej Kurylcio
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland
| | - Zuzanna Pelc
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland
| | - Magdalena Skórzewska
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland
| | - Karol Rawicz-Pruszyński
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland
| | - Radosław Mlak
- Department of Human Physiology, Medical University of Lublin, Radziwiłłowska 11 St., 20-080 Lublin, Poland
| | - Katarzyna Gęca
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland
| | - Katarzyna Sędłak
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland
| | - Piotr Kurylcio
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland
| | - Teresa Małecka-Massalska
- Department of Human Physiology, Medical University of Lublin, Radziwiłłowska 11 St., 20-080 Lublin, Poland
| | - Wojciech Polkowski
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080 Lublin, Poland
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35
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Nakamura Y, Takada M, Imamura M, Higami A, Jiaxi H, Fujino M, Nakagawa R, Inagaki Y, Matsumoto Y, Kawaguchi K, Kawashima M, Suzuki E, Toi M. Usefulness and Prospects of Sentinel Lymph Node Biopsy for Patients With Breast Cancer Using the Medical Imaging Projection System. Front Oncol 2021; 11:674419. [PMID: 34123842 PMCID: PMC8187896 DOI: 10.3389/fonc.2021.674419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/11/2021] [Indexed: 02/06/2023] Open
Abstract
Background The Medical Imaging Projection System (MIPS) projects indocyanine green (ICG) fluorescence images directly on the surgical field using a projection mapping technique. We conducted an observational study of sentinel lymph node (SLN) biopsy using the prototype MIPS; we found a high identification rate. However, the number of SLN-positive cases was small, and the sensitivity could not be evaluated. The aim of this study was to investigate the clinical usefulness of the MIPS assisted ICG fluorescence method using commercially available equipment. Methods This was a retrospective observational study. Patients with primary breast cancer who underwent SLN biopsy using the MIPS at Kyoto University Hospital from April to December 2020 were included in the study. The primary endpoints were the identification rate of SLNs and detection of positive SLNs by the MIPS. The secondary endpoint was the number of SLNs excised using the MIPS per patient. We also conducted a questionnaire survey focused on the utility of the MIPS; it involved doctors with an experience in using the MIPS. Results Seventy-nine patients (84 procedures) were included in the study. In 60 (71%) procedures, both the radioisotope (RI) method and MIPS were used. At least one SLN could be detected by the MIPS in all the procedures, with an identification rate of 100% (95% confidence interval 95.6–100%). A total of 19 (7%) positive SLNs were removed, which were identifiable by the MIPS. Among 57 patients in whom the MIPS and RI methods were used, there was no positive SLN only identified by the RI method. The results of the questionnaire survey showed that the MIPS enabled the operator and assistant to share the ICG fluorescence image in the surgical field and to communicate with each other easily. Conclusion The current study demonstrated that the identification rate of SLNs using the MIPS was high, and the MIPS can be used for detecting positive SLNs. It was suggested that the MIPS will be useful in learning SLN biopsy procedures.
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Affiliation(s)
- Yuki Nakamura
- Department of Surgery (Breast Surgery), Kyoto University Hospital, Kyoto, Japan
| | - Masahiro Takada
- Department of Surgery (Breast Surgery), Kyoto University Hospital, Kyoto, Japan
| | - Michiko Imamura
- Department of Breast and Endocrine Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Akane Higami
- Department of Surgery (Breast Surgery), Kyoto University Hospital, Kyoto, Japan
| | - He Jiaxi
- Department of Surgery (Breast Surgery), Kyoto University Hospital, Kyoto, Japan
| | - Makoto Fujino
- Department of Surgery (Breast Surgery), Kyoto University Hospital, Kyoto, Japan
| | - Rie Nakagawa
- Department of Surgery (Breast Surgery), Kyoto University Hospital, Kyoto, Japan
| | - Yukiko Inagaki
- Department of Surgery (Breast Surgery), Kyoto University Hospital, Kyoto, Japan
| | - Yoshiaki Matsumoto
- Department of Surgery (Breast Surgery), Kyoto University Hospital, Kyoto, Japan
| | - Kosuke Kawaguchi
- Department of Surgery (Breast Surgery), Kyoto University Hospital, Kyoto, Japan
| | - Masahiro Kawashima
- Department of Surgery (Breast Surgery), Kyoto University Hospital, Kyoto, Japan
| | - Eiji Suzuki
- Department of Surgery (Breast Surgery), Kyoto University Hospital, Kyoto, Japan
| | - Masakazu Toi
- Department of Surgery (Breast Surgery), Kyoto University Hospital, Kyoto, Japan
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Adjuvant chemotherapy for breast cancer patients with axillary lymph node micrometastases. Breast Cancer Res Treat 2021; 187:715-727. [PMID: 33721148 DOI: 10.1007/s10549-021-06162-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/23/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND The axillary lymph node status is one of the most important prognostic factors in patients with early breast cancer. However, the impact of axillary lymph node micrometastases on survival remains unclear. There are no consistent recommendations for adjuvant chemotherapy (CHT). In this context, we aimed to investigate the impact of micrometastases on the clinical outcome of breast cancer patients according to the adjuvant CHT performed. PATIENTS AND METHODS We conducted a retrospective population-based registry study of 26,465 patients aged between 24 and 97 years with primary breast cancer diagnosed between 2003 and 2017. Of these patients, 8856 with early breast cancer were eligible for analysis: 8316 (93.9%) were node negative and 540 (6.1%) had lymph node micrometastases. RESULTS The median follow-up was 7.2 years, with a confidence interval (CI) of 7.1-7.3 years. Patients with lymph node micrometastases (pN1mi) without adjuvant CHT have reduced 10-year overall survival (OS) and recurrence-free survival (RFS) compared to patients who had axillary lymph node micrometastases and received an adjuvant CHT. However, this effect disappeared after adjustment for age, tumor size and tumor grading. Furthermore, in the group of patients with lymph node micrometastases, the administration of adjuvant CHT did not improve OS or RFS, compared to patients with lymph node micrometastases without adjuvant CHT: hazard ratio for treated patients was 1.51 (95% CI 0.80-2.85, p = 0.208) for OS and 1.12 (95% CI 0.63-1.97, p = 0.705) for RFS. CONCLUSION Patients with axillary lymph node micrometastases showed a comparable outcome to node negative patients and their outcome was not significantly improved with CHT. Thus, axillary lymph node micrometastases should not be considered in the treatment decision.
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Yang B, Zheng S, Huang X, Chen J, Liu Z, Liu G, Wang S, Shao Z, Wu J. A single-center, self-controlled, phase I clinical trial of mitoxantrone hydrochloride injection for lymph tracing for sentinel lymph node identification of breast cancer. Gland Surg 2021; 10:992-1001. [PMID: 33842243 DOI: 10.21037/gs-20-694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Mitoxantrone hydrochloride injection for lymph tracing (MHI) is a novel lymphatic tracer for sentinel lymph node (SLN) in patients with early breast cancer but exhibited remarkable liver, kidney, and hematologic toxicities in previous studies. Here, the pharmacokinetics and pharmacodynamics profiles of MHI were evaluated to surmise safety and tolerability. Methods Phase 1 open-label, single center, and dose escalation study was performed. Ten patients with invasive breast cancer received 0.5, 1.0, or 2.0 mL of MHI into the breast tissues surrounding the tumor for lymphatic mapping. All of these patients were injected with 2 mCi nuclide-labeled sulfur colloid as a self-control 24 to 48 hours before surgery. Safety was assessed by the incidence of adverse events graded by the National Cancer Institute Common Terminology Criteria, version 4.0.3 (CTCAE4.0.3). Blood samples for pharmacokinetic analyses were collected before and after administration at 15, 30, 60, 120, and 240 min of the injection of MHI. Results Up to the cutoff date of the study (Aug 8, 2018), no dose-limiting toxic effects or obvious allergic reactions were observed. Only one case of an adverse event was certainly related to MHI, where it caused blue discoloration of the local skin over the injection site after the operation, but this stain gradually went away. The peak level of MHI was achieved after 15-30 min post injection and completely eliminated from the plasma after 60 min. There were no significant differences in the number of lymph nodes detected by MHI and radioactive colloid. Only one patient with lymph node macrometastases had no SLN detected by either the radioactive colloid or the MHI. Conclusions At a dose of up to 2.0 mL, MHI was well tolerated and safe for conducting SLN biopsies in patients with breast cancer. Although there was a case with blue discoloration of the local skin over the injection site after the operation, and remained for a short period of time, but the overall safety was acceptable. Here, we approached a novel SLN tracing slant; however, more investigations of MHI should be performed for further evaluations. (Chinadrugtrials.org.cn number: CXHL1301201, Date of registration: October 12, 2015.).
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Affiliation(s)
- Benlong Yang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Fudan University, Shanghai Medical College, Shanghai, China.,Collaborative Innovation Center for Cancer Medicine, Shanghai, China
| | - Shuyue Zheng
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Fudan University, Shanghai Medical College, Shanghai, China.,Collaborative Innovation Center for Cancer Medicine, Shanghai, China
| | - Xiaoyan Huang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Fudan University, Shanghai Medical College, Shanghai, China.,Collaborative Innovation Center for Cancer Medicine, Shanghai, China
| | - Jiajian Chen
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Fudan University, Shanghai Medical College, Shanghai, China.,Collaborative Innovation Center for Cancer Medicine, Shanghai, China
| | - Zhebin Liu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Fudan University, Shanghai Medical College, Shanghai, China.,Collaborative Innovation Center for Cancer Medicine, Shanghai, China
| | - Guangyu Liu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Fudan University, Shanghai Medical College, Shanghai, China.,Collaborative Innovation Center for Cancer Medicine, Shanghai, China
| | - Shujun Wang
- Department of Pharmacy, Shenyang Pharmaceutical University, Shenyang, China
| | - Zhimin Shao
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Fudan University, Shanghai Medical College, Shanghai, China.,Collaborative Innovation Center for Cancer Medicine, Shanghai, China
| | - Jiong Wu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Fudan University, Shanghai Medical College, Shanghai, China.,Collaborative Innovation Center for Cancer Medicine, Shanghai, China
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Li H, Tang L, Chen Y, Mao L, Xie H, Wang S, Guan X. Development and validation of a nomogram for prediction of lymph node metastasis in early-stage breast cancer. Gland Surg 2021; 10:901-913. [PMID: 33842235 DOI: 10.21037/gs-20-782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Lymph node status is an important factor in determining the prognosis of early-stage breast cancer. We endeavored to build and validate a simple nomogram to predict lymph node metastasis (LNM) in patients with early-stage breast cancer. Methods Patients with T1-2 and non-metastasis (M0) breast cancer registered in the Surveillance, Epidemiology, and End Results (SEER) database were enrolled. All patients were divided into primary cohort and validation cohort in a 2:1 ratio. In order to assess risk factors for LNM, we performed univariate and multivariate binary logistic regression, and based on results of multivariable analysis, we built the predictive nomogram model. The C-index, receiver operating characteristic (ROC) and calibration plots were applied to assess LNM model performance. Moreover, the nomogram efficiency was further validated through the validation cohort, part of which was from the First Affiliated Hospital of Nanjing Medical University database. Results Totally, 184,531 female breast cancer with T1-2 tumor size from SEER database and 1,222 patients from the Chinese institutional data were included. There were 123,019 patients in the primary cohort and 62,734 patients in validation cohort. The LNM nomogram was composed of seven features including age at diagnosis, race, primary site, histologic type, grade, tumor size and subtype. The model showed good discrimination, with a C-index of 0.720 [95% confidence interval (CI): 0.717-0.723] and good calibration. Similar C-index was 0.718 (95% CI: 0.713-0.723) in validation cohort. Consistently, ROC curves presented good discrimination in the primary cohort [area under the curve (AUC) =0.720] and the validation set (AUC =0.718) for the LNM nomogram. Calibration curve of the nomogram demonstrated good agreement. Conclusions With the prediction of novel validated nomogram for women with early-stage breast cancer, doctors may distinguish patients with high possibility of LNM and devise individualize treatments.
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Affiliation(s)
- Huan Li
- Department of Respiratory Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Lin Tang
- Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yajuan Chen
- Department of Respiratory Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ling Mao
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Xie
- Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shui Wang
- Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoxiang Guan
- Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.,Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Valiveru RC, Agarwal G, Agrawal V, Gambhir S, Mayilvaganan S, Chand G, Mishra A, Agarwal A, Mishra SK. Low-cost Fluorescein as an Alternative to Radio-colloid for Sentinel Lymph Node Biopsy-a Prospective Validation Study in Early Breast Cancer. World J Surg 2021; 44:3417-3422. [PMID: 32504276 DOI: 10.1007/s00268-020-05631-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) using radio-pharmaceutical (RP) and a blue dye is gold standard for axillary staging in clinically node-negative early breast cancer. High costs and limited availability of RP and/or gamma probe are major deterrents in performing SLNB in developing countries. Fluorescence-guided SLNB can obviate the need for RP and gamma probe. Fluorescein is an inexpensive fluorescent lymphatic tracer. In this study, we compared SLN identification rate (SLN-IR) and false negative rates (FNR) of fluorescein-guided SLNB and radio-guided SLNB using 99mTc-Sulfur-colloid, in isolation, or in combination with methylene blue dye (MBD). METHODS Sixty-five cN0 early and large operable breast cancer patients underwent validation SLNB using fluorescein (and blue LED light), 99mTc-Sulfur-colloid (and gamma probe) and MBD. Inj Fluorescein 4% was injected, 1 ml each peri-tumoral and sub-areolar five minutes before axillary incision. Axillary dissection was performed irrespective of SLNB histology. The SLN-IR and FNR with various tracers and their combinations were compared. RESULTS The mean number of SLNs identified was 3.5 ± 1.8 (range 1-6). The SLN-IR using RP alone was 94%, fluorescein alone was 92%, and MBD alone was 82%. The SLN-IR using fluorescein plus MBD combination was 95.4%, compared to 97% using MBD plus RP combination. FNR was 6.3% using fluorescein plus MBD, as well as RP plus MBD combinations. CONCLUSIONS SLN-IR of > 90% and SLN-FNR of < 10% using fluorescein plus MBD combination are in acceptable range, and are comparable to that of RP plus MBD combination. Fluorescein can replace RP for performing SLNB, in combination with MBD.
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Affiliation(s)
- Ramya C Valiveru
- Department of Endocrine & Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Raebareli Road, Lucknow, Uttar Pradesh, 226014, India
| | - Gaurav Agarwal
- Department of Endocrine & Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Raebareli Road, Lucknow, Uttar Pradesh, 226014, India.
| | - Vinita Agrawal
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Sanjay Gambhir
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Sabaretnam Mayilvaganan
- Department of Endocrine & Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Raebareli Road, Lucknow, Uttar Pradesh, 226014, India
| | - Gyan Chand
- Department of Endocrine & Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Raebareli Road, Lucknow, Uttar Pradesh, 226014, India
| | - Anjali Mishra
- Department of Endocrine & Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Raebareli Road, Lucknow, Uttar Pradesh, 226014, India
| | - Amit Agarwal
- Department of Endocrine & Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Raebareli Road, Lucknow, Uttar Pradesh, 226014, India
| | - Saroj K Mishra
- Department of Endocrine & Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Raebareli Road, Lucknow, Uttar Pradesh, 226014, India
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Inua B, Fung V, Al-Shurbasi N, Howells S, Hatsiopoulou O, Somarajan P, Zardin GJ, Williams NR, Kohlhardt S. Sentinel lymph node biopsy with one-step nucleic acid assay relegates the need for preoperative ultrasound-guided biopsy staging of the axilla in patients with early stage breast cancer. Mol Clin Oncol 2021; 14:51. [PMID: 33604041 PMCID: PMC7849070 DOI: 10.3892/mco.2021.2213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 08/21/2020] [Indexed: 11/26/2022] Open
Abstract
Avoiding axillary node clearance in patients with early stage breast cancer and low-burden node-positive axillary disease is an emerging practice. Informing the decision to adopt axillary conservation is examined by comparing routine preoperative axillary staging using ultrasound (AUS) ± AUS biopsy (AUSB) with intraoperative staging using sentinel lymph node biopsy (SLNB) and a one-step nucleic acid cytokeratin-19 amplification assay (OSNA). A single-centre, retrospective cohort study of 1,315 consecutive new diagnoses of breast cancer in 1,306 patients was undertaken in the present study. An AUS ± AUSB was performed on all patients as part of their initial assessment. Patients who had a normal ultrasound (AUS-) or negative biopsy (AUSB-) followed by SLNB with OSNA ± axillary lymph node dissection (ALND), and those with a positive AUSB (AUSB+), were assessed. Tests for association were determined using a χ2 and Fisher's Exact test. A total of 266 (20.4%) patients with cT1-3 cN0 staging received 271 AUSBs. Of these, 205 biopsies were positive and 66 were negative. The 684 patients with an AUS-/AUSB-assessment proceeded to SLNB with OSNA. AUS sensitivity and negative predictive value (NPV) were 0.53 [0.44-0.62; 95% confidence interval (CI)] and 0.58 (0.53-0.64, 95% CI), respectively. Using a total tumour load cut-off of 15,000 copies/µl to predict ≥2 macro-metastases, the sensitivity and NPV for OSNA were 0.82 (0.71-0.92, 95% CI) and 0.98 (0.97-0.99, 95% CI) (OSNA vs. AUS P<0.0001). Of the AUSB+ patients, 51% had ≤2 positive nodes following ALND and were potentially over-treated. Where available, SLNB with OSNA should replace AUSB for axillary assessment in cT1-2 cN0 patients with ≤2 indeterminate nodes seen on AUS.
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Affiliation(s)
- Bello Inua
- Department of Breast, Plastic and Reconstructive Surgery, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - Victoria Fung
- Department of Breast, Plastic and Reconstructive Surgery, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - Nour Al-Shurbasi
- Department of Breast, Plastic and Reconstructive Surgery, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - Sarah Howells
- Department of Breast Screening and Breast Imaging, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - Olga Hatsiopoulou
- Department of Breast Screening and Breast Imaging, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - Praveen Somarajan
- Department of Breast Screening and Breast Imaging, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - Gregory J Zardin
- Department of Histopathology, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - Norman R Williams
- Surgical and Interventional Trials Unit, Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London W1W 7JN, UK
| | - Stan Kohlhardt
- Department of Breast, Plastic and Reconstructive Surgery, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
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Song BI. A machine learning-based radiomics model for the prediction of axillary lymph-node metastasis in breast cancer. Breast Cancer 2021; 28:664-671. [PMID: 33454875 DOI: 10.1007/s12282-020-01202-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/02/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The aim of this study was to develop and validate machine learning-based radiomics model for predicting axillary lymph-node (ALN) metastasis in invasive ductal breast cancer (IDC) using F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). METHODS A total of 100 consecutive IDC patients who underwent surgical resection of primary tumor with sentinel lymph-node biopsy and/or ALN dissection without any neoadjuvant treatment were analyzed. Volume of interests (VOIs) were drawn more than 2.5 of standardized uptake value in the primary tumor on the PET scan using 3D slicer. Pyradiomics package was used for the extraction of texture features in python. The radiomics prediction model for ALN metastasis was developed in 75 patients of the training cohort and validated in 25 patients of the test cohort. XGBoost algorithm was utilized to select features and build radiomics model. The sensitivity, specificity, and accuracy of the predictive model were calculated. RESULTS ALN metastasis was found in 43 patients (43%). The sensitivity, specificity, and accuracy of F-18 FDG PET/CT for the diagnosis of ALN metastasis in the entire patients were 55.8%, 93%, and 77%, respectively. The radiomics model for the prediction of ALN metastasis was successfully developed. The sensitivity, specificity, and accuracy of the radiomics model for the prediction of ALN metastasis in the test cohorts were 90.9%, 71.4%, and 80%, respectively. CONCLUSION The machine learning-based radiomics model showed good sensitivity for the prediction of ALN metastasis and could assist the preoperative individualized prediction of ALN status in patients with IDC.
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Affiliation(s)
- Bong-Il Song
- Department of Nuclear Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, 1095 Dalgubeol-daero, Dalseo-gu, Daegu, 42601, Republic of Korea.
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Wu J, Wang Z, Zeng H, He L, Zhang Y, Huang G, Zhang F, Wei X, Huang W, Zhang G. Comparison of indocyanine green and methylene blue use for axillary reverse mapping during axillary lymph node dissection. MedComm (Beijing) 2020; 1:211-218. [PMID: 34766119 PMCID: PMC8491232 DOI: 10.1002/mco2.31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 02/05/2023] Open
Abstract
Axillary reverse mapping (ARM) is a technique to identify arm lymphatic drainage during axillary lymph node dissection (ALND). This study compared the feasibility of ARM using indocyanine green (ICG) or methylene blue (MB), and accessed the oncologic safety of the procedure. Overall, 158 patients qualified for ALND were enrolled. The characteristics of ARM-identified nodes were recorded with ICG (n = 78) or MB (n = 80) visualization. Fine-needle aspiration cytology (FNAC) of the nodes were performed and validated by histologic analysis. The nodal identification rate in the ICG group significantly surpassed that of the MB group (87.2% vs 52.5%, P < .05) with fewer complications. Note that 10.9% of the patients had metastatic involvement of the ARM-identified nodes. Also 80% of the positive nodes were found in areas B and D, while the ARM-identified nodes mainly located in area A. All the 51 nodes diagnosed as negative of malignancy by FNAC were free of metastasis. Nodal metastasis was significantly correlated with extensive nodel involvement, advanced disease, and the characteristics of identified nodes. In conclusion, ICG appears superior to MB for ARM nodes identification. FNAC, together with the features of primary tumors and ARM nodes, can delineate which nodes could be preserved during ALND.
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Affiliation(s)
- Jun‐Dong Wu
- The Breast CenterCancer Hospital of Shantou University Medical CollegeShantouGuangdongChina
- Guangdong Provincial Key Laboratory for Breast Cancer Diagnosis and TreatmentCancer Hospital of Shantou University Medical CollegeShantouChina
| | - Zun Wang
- ChangJiang Scholar's LaboratoryShantou University Medical College (SUMC)ShantouChina
| | - Huan‐Cheng Zeng
- The Breast CenterCancer Hospital of Shantou University Medical CollegeShantouGuangdongChina
| | - Li‐Fang He
- The Breast CenterCancer Hospital of Shantou University Medical CollegeShantouGuangdongChina
| | - Yong‐Qu Zhang
- The Breast CenterCancer Hospital of Shantou University Medical CollegeShantouGuangdongChina
| | - Guang‐Sheng Huang
- The Breast CenterCancer Hospital of Shantou University Medical CollegeShantouGuangdongChina
| | - Fan Zhang
- The Central LaboratoryCancer Hospital of Shantou University Medical CollegeShantouChina
| | - Xiao‐Long Wei
- Department of PathologyCancer Hospital of Shantou University Medical CollegeShantouChina
| | - Wen‐He Huang
- Cancer Center & Department of Breast and Thyroid SurgeryXiang'an HospitalSchool of MedicineXiamen UniversityXiamenChina
| | - Guo‐Jun Zhang
- ChangJiang Scholar's LaboratoryShantou University Medical College (SUMC)ShantouChina
- Cancer Center & Department of Breast and Thyroid SurgeryXiang'an HospitalSchool of MedicineXiamen UniversityXiamenChina
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Newton A, Predina J, Mison M, Runge J, Bradley C, Stefanovski D, Singhal S, Holt D. Intraoperative near-infrared imaging can identify canine mammary tumors, a spontaneously occurring, large animal model of human breast cancer. PLoS One 2020; 15:e0234791. [PMID: 32555698 PMCID: PMC7299356 DOI: 10.1371/journal.pone.0234791] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/02/2020] [Indexed: 01/05/2023] Open
Abstract
Introduction Current methods of intraoperative margin assessment in breast conserving surgery are impractical, unreliable, or time consuming. We hypothesized that intraoperative near-infrared (NIR) imaging with an FDA-approved NIR optical contrast agent could identify canine mammary tumors, a spontaneous large animal model of human breast cancer, during surgery. Methods Dogs with mammary tumors underwent a standard of care lumpectomy or mastectomy with wide surgical margins 20 hours after indocyanine green administration (3 mg/kg IV). During surgery, NIR imaging was performed on tumors and wound margins in situ and tumors and lymph nodes ex vivo. Following resection, the wound bed was examined for residual fluorescence. Fluorescence intensity was determined by signal-to-background ratio (SBR). All tumors, areas of residual fluorescence, and lymph nodes underwent histopathologic analysis. Results There were 41 mammary tumors in 16 female dogs. Twenty tumors were malignant and 21 were benign. Twenty-eight tumors were fluorescent (mean SBR 1.5±0.2). Sensitivity of fluorescence for all malignant tumors was 80% (16/20) and 93.3% (14/15) for malignant tumors > 2 cm. Specificity for malignancy was low (< 2cm = 55%; > 2cm = 30%). Tumors > 2 cm were more likely to be fluorescent (OR 6.05, 95% CI 1.50–24.44, P = 0.011) but not more likely to be malignant (OR 3.09, 95% CI 0.86–11.14, P = 0.085) than tumors ≤ 2 cm. Four out of seven inguinal lymph nodes excised in the mastectomy specimen fluoresced. All four drained malignant tumors; however only 2/4 contained metastatic disease. Conclusion Systemic ICG accumulates reliably in malignant canine mammary tumors > 2 cm. Although no tumor margins fluoresced, a wider margin of normal tissue is removed in canine mastectomy, making direct comparisons with breast conserving surgery difficult. Targeted NIR imaging agents are likely required to improve detection of smaller tumors and improve the specificity of NIR imaging for residual disease and metastatic lymph node detection.
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Affiliation(s)
- Andrew Newton
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Jarrod Predina
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Michael Mison
- Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, United States of America
| | - Jeffrey Runge
- Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, United States of America
| | - Charles Bradley
- Department of Pathobiology, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, United States of America
| | - Darko Stefanovski
- Department of Clinical Studies New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, Pennsylvania, United States of America
| | - Sunil Singhal
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - David Holt
- Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, United States of America
- * E-mail:
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Cui Q, Dai L, Li J, Xue J. Accuracy of CEUS-guided sentinel lymph node biopsy in early-stage breast cancer: a study review and meta-analysis. World J Surg Oncol 2020; 18:112. [PMID: 32471428 PMCID: PMC7260746 DOI: 10.1186/s12957-020-01890-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 05/19/2020] [Indexed: 12/24/2022] Open
Abstract
Objective To investigate whether preoperative localization of sentinel lymph node (SLN) by contrast-enhanced ultrasound (CEUS) can further improve the accuracy of sentinel lymph node biopsy (SLNB). Method Collect published literatures or conference reports by searching electronic databases. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) evaluation method is used to evaluate the quality of the screened literatures. The pooled risk ratio of cancer metastasis of SLN identified by CEUS (CE-SLN) compared with SLN not identified by CEUS (nonCE-SLN) is calculated, and the pooled diagnostic accuracy of CE-SLN for pathological status of all SLNs is also evaluated. Result Through search and screening, a total of 16 studies were included, of which five and seven studies, respectively, entered the meta-analysis of metastatic risk ratio and diagnostic accuracy. The localization rate of preoperative CEUS for sentinel lymph nodes was 70 to 100%. The meta-analysis shows that the risk of metastasis of SLN identified by CEUS is significantly higher than that not identified by CEUS, 26.0% vs 4.6%, and risk ratio (RR) is 6.08 (95% CI 4.17–8.85). In early-stage breast cancer, the pathological status of CE-SLN is a good representative of all SLNs, with a pooled sensitivity of 98% (95% CI 0.94–1.00), pooled specificity of 100% (95% CI 0.99–1.00), diagnostic odds ratio (DOR) of 2153.18 (95% CI 476.53–9729.06), and area under the subject receiver operating characteristic (SROC) curve of 0.9968. Conclusion In early-stage breast cancer, preoperative localization of SLN by CEUS is expected to further improve the accuracy of sentinel lymph node biopsy (SLNB).
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Affiliation(s)
- Qiuxia Cui
- Department of Thyroid and Breast Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Li Dai
- Department of Thyroid and Breast Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Jialu Li
- Department of Thyroid and Breast Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Jialei Xue
- Department of Thyroid and Breast Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China.
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Yang J, Xu L, Liu P, Du Z, Chen J, Liang F, Long Q, Zhang D, Zeng H, Lv Q. Accuracy of Sentinel Lymph Node Biopsy in Breast Cancer: Pitfalls in the Application of Single Tracers. Cancer Manag Res 2020; 12:3045-3051. [PMID: 32431547 PMCID: PMC7200249 DOI: 10.2147/cmar.s244806] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 04/13/2020] [Indexed: 02/05/2023] Open
Abstract
Background Radioisotopes and blue dyes are used as dual tracers in the current gold standard procedure of sentinel lymph node (SLN) biopsy (SLNB) performed for breast cancer. However, the blue dye or the radioisotope as a single tracer is also being applied in some institutes. We aimed to explore the risk factors for the miss-detection of SLNs with the radioisotope and the blue dye and to describe the distribution of SLNs missed by each tracer. Patients and Methods Patients undergoing SLNB with radioisotope and blue dye as dual mapping agents were enrolled between August 2010 and August 2018. Radioactivity count, blue dye staining status, and size and location of each SLN were prospectively documented. Results In total, 2382 SLNs from 1010 patients were included for statistical analyses. The sentinel node identification rate was 100% for dual tracers, 99.4% for radioisotope, and 89.1% for blue dye. SLN identification using the blue dye was more likely to fail in patients undergoing breast-conserving surgery (p < 0.001) and mastectomy with reconstruction (p = 0.005). Furthermore, miss-detection was significantly more frequent in smaller and uninvolved nodes. Among all SLNs, 8.2% were located in level II and one was in level III. Notably, single tracer of blue dye tended to fail in the detection of lymph nodes in higher levels (p < 0.001). Conclusion This study explored the association between features and the incidence of the failure to detect SLNs using radioisotope and blue dye. The locations of the miss-detected SLNs are demonstrated to provide a reference for SLNBs conducted using blue dye or radioisotope as a single tracer.
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Affiliation(s)
- Jiqiao Yang
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China.,Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Li Xu
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Pengcheng Liu
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Zhenggui Du
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jie Chen
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Faqing Liang
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Quanyi Long
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Di Zhang
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China.,Cancer Research Institute, Kanazawa University, Kanazawa, Japan
| | - Helin Zeng
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Qing Lv
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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Somashekhar SP, Kumar CR, Ashwin KR, Zaveri SS, Jampani A, Ramya Y, Parameswaran R, Rakshit S. Can Low-cost Indo Cyanine Green Florescence Technique for Sentinel Lymph Node Biopsy Replace Dual Dye (Radio-colloid and Blue Dye) Technique in Early Breast Cancer: A Prospective Two-arm Comparative Study. Clin Breast Cancer 2020; 20:e576-e583. [PMID: 32389561 DOI: 10.1016/j.clbc.2020.03.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/26/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The objective of this study was to assess the detection and accuracy of sentinel lymph node (SLN) biopsy (SLNB) using the low-cost indocyanine green (ICG) fluorescence method and to compare this method with the gold standard dual-dye method (radio-colloid + methylene blue dye [MB]). MATERIALS AND METHODS One hundred patients with node-negative early breast cancer assessed clinically and by ultrasound axilla underwent an SLNB procedure using technetium-99m radio-colloid, MB, and ICG. The detection rate of SLNs and positive SLNs and the number of SLNs were compared. The injection safety of ICG and MB was evaluated. RESULTS One hundred female patients with a median age of 52.3 years participated in the study. Sixty-eight percent had a body mass index < 25, 85% presented with a palpable lump, of which 59% were in the outer quadrant. SLNs were identified in all 100 cases. A total of 290 SLNs were removed (mean, 2.9; range, 1-6). The identification rate with dual dye was 94%, whereas with ICG alone, it was 96%. The SLNB sensitivity rate and false negative rate were 97.6% versus 93.2% and 3.1% versus 6.2% in the ICG and dual-dye combination, respectively. None of the patients had any local or systemic reaction with ICG; 3 patients with blue dye had tattooing and staining of skin. CONCLUSION ICG fluorescence imaging permits real time visualization of lymphatics and provides an additional dimension to SLN biopsy that is safe and effective. These results confirm high sensitivity for fluorescence localization with comparable performance to the gold standard. ICG can reliably replace dual dye and be employed as a sole tracer for SLNB in early breast cancer.
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Affiliation(s)
- S P Somashekhar
- Department of Surgical Oncology, Manipal Comprehensive Cancer Centre, Manipal Hospital, Bangalore, India.
| | - C Rohit Kumar
- Department of Surgical Oncology, Manipal Comprehensive Cancer Centre, Manipal Hospital, Bangalore, India
| | - K R Ashwin
- Department of Surgical Oncology, Manipal Comprehensive Cancer Centre, Manipal Hospital, Bangalore, India
| | - Shabber S Zaveri
- Department of Surgical Oncology, Manipal Comprehensive Cancer Centre, Manipal Hospital, Bangalore, India
| | - Anil Jampani
- Department of Surgical Oncology, Manipal Comprehensive Cancer Centre, Manipal Hospital, Bangalore, India
| | - Y Ramya
- Department of Surgical Oncology, Manipal Comprehensive Cancer Centre, Manipal Hospital, Bangalore, India
| | - Rameshwaran Parameswaran
- Department of Nuclear Medicine, Manipal Comprehensive Cancer Centre, Manipal Hospital, Bangalore, India
| | - Sushmita Rakshit
- Department of Pathology, Manipal Comprehensive Cancer Centre, Manipal Hospital, Bangalore, India
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Yap RV, De La Serna FM. Outcomes of Sentinel Lymph Node Biopsy Using Blue Dye Method for Early Breast Cancer - A Single-Institution Experience in the Philippines. BREAST CANCER-TARGETS AND THERAPY 2020; 12:37-44. [PMID: 32210610 PMCID: PMC7073425 DOI: 10.2147/bctt.s242115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/26/2020] [Indexed: 01/13/2023]
Abstract
Purpose This study aimed to share our experience with SLNB in the Filipino population with early breast cancer. Patients and Methods A retrospective review was done on all patients with confirmed invasive breast carcinoma, tumor size of 5 cm or less (T1/T2), who preoperatively had no clinical signs of axillary metastasis and subsequently underwent SLNB with blue dye method from January 01, 2008 to December 31, 2017. Clinicopathologic profiles were recorded. Outcomes of patients who had SLNB only were assessed. Results One hundred twenty-nine patients matched the inclusion criteria with a mean age of 54.3 years. The majority (88.4%) had a total mastectomy. Invasive ductal carcinoma (65.1%) was the most common tumor. Estrogen and progesterone receptors were positive in 69% and 61.2% respectively while only 28.7% were HER2 positive. SLNB was successfully carried out in 126 (97.7%) patients with a range of 2-4 SLNs harvested. Thirty-four (26.4%) patients had completion ALND. With a median of 25 months follow-up, 75 out of 95 patients who underwent SLNB alone had follow-up data. Forty-six (61.3%) patients had seroma formation. One (1.3%) patient developed arm paresthesia, 2 (2.7%) local (chest wall) and 2 (2.7%) axillary recurrences after a negative SLNB. None of the patients developed lymphedema. Conclusion The blue dye method alone is acceptable and can be readily employed in institutions with limited resources. Even with the limited population, the morbidity and oncologic outcomes of patients who underwent SLNB alone were low and comparable to similar international published data. SLNB should be the preferred method for staging the axilla.
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Affiliation(s)
- Ralph Victor Yap
- Department of Surgery, Cebu Doctors' University Hospital, Cebu City, Cebu, Philippines
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Akita S, Yamaji Y, Takeuchi N, Wakai K, Azuma K, Nakagawa A, Fujimoto H, Sangai T, Nagashima T, Mitsukawa N, Ikehara Y. Detection of Nonpalpable Tiny Axillary Lymph Nodes Surrounded by Adipose Tissue Using a Near-Infrared Camera. Lymphat Res Biol 2020; 18:455-463. [PMID: 32048903 DOI: 10.1089/lrb.2019.0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: It is not always possible to detect nonpalpable small lymph nodes (LNs) surrounded by adipose tissue under the wavelength of visible light. A newly developed near-infrared camera with InGaAs element was able to capture photographs using light at >1000-nm wavelength, at which the difference in absorbance between water and lipids is large. This study investigated the ability to detect nonvisible small LNs using light at 1300-nm wavelength. Methods and Results: Following retrieval of LNs through axillary LN dissection from 20 patients with breast cancer, residual specimens were simultaneously photographed using light at 970-, 1070-, 1200-, 1300-, 1450-, and 1600-nm wavelengths. A total of 45 specimens were observed pathologically at the selected portions in which the 1300-nm light was absorbed (high absorbance group [HA group], n = 25) and those in which the 970-nm light was absorbed instead (low absorbance group [LA group], n = 20). All specimens categorized in the HA group detected the LNs, whereas none of those categorized in the LA group detected an LN. The sensitivity and specificity in the identification of an LN were 1.0. The LNs detected using this camera were significantly smaller than those detected by surgeons (3.00 ± 2.93 mm vs. 5.90 ± 3.91 mm, p < 0.01). Discussion: The light at 1300-nm wavelength was absorbed by axillary LNs. This camera detected LNs that were undetectable by surgeons. This novel technology may be applied to lymphatic microsurgery and contribute to the development of a minimally invasive LN dissection method.
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Affiliation(s)
- Shinsuke Akita
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Yoshihisa Yamaji
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Nobuyoshi Takeuchi
- Department of Pathology, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Ken Wakai
- Department of Pathology, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Kazuhiko Azuma
- Department of Pathology, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Ayako Nakagawa
- Department of Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Hiroshi Fujimoto
- Department of Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Takafumi Sangai
- Department of Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Takeshi Nagashima
- Department of Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Nobuyuki Mitsukawa
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Yuzuru Ikehara
- Department of Pathology, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan.,Biotechnology Research Institute for Drug Discovery, National Institute of Advanced Industrial Science and Technology, Tsukuba, Japan
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Goonawardena J, Yong C, Law M. Use of indocyanine green fluorescence compared to radioisotope for sentinel lymph node biopsy in early-stage breast cancer: systematic review and meta-analysis. Am J Surg 2020; 220:665-676. [PMID: 32115177 DOI: 10.1016/j.amjsurg.2020.02.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/12/2020] [Accepted: 02/03/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND In early-stage breast cancer, indocyanine green (ICG)-fluorescence based sentinel lymph node (SLN) detection is being considered. This is a meta-analysis of SLN detection rates and sensitivity of ICG-fluorescence compared to radioisotope (RI), to evaluate its clinical applicability. DATA SOURCES Systematic review of full-text articles from PubMed and Scopus, of women with early breast cancer who underwent SLN mapping using ICG and RI concurrently was performed. The meta-analysis was performed using the Mantel-Haenszel method. RESULTS 2301 patients from 19 studies were included. No significant difference was observed between ICG and RI for SLN detection (OR0.90,95%CI0.66-1.24) or sensitivity (OR1.23,95%CI0.73-2.05) with heterogeneity between studies (I2 = 58%,P = 0.003). Sensitivity of dual mapping (ICG + RI) was significantly better compared to single mapping with RI (OR3.69,95%CI1.79-7.62) or ICG (OR3.32,95%CI1.52-7.24) alone with no heterogeneity between studies (I2 = 0%,P = 0.004). CONCLUSION ICG-fluorescence could complement RI method or provide alternative in centers with poor accessibility to RI lymphoscintigraphy.
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Affiliation(s)
- Janindu Goonawardena
- Breast and Endocrine Surgery, Eastern Health, Box Hill, Victoria, 3128, Australia.
| | - Charles Yong
- Breast and Endocrine Surgery, Eastern Health, Box Hill, Victoria, 3128, Australia
| | - Michael Law
- Breast and Endocrine Surgery, Eastern Health, Box Hill, Victoria, 3128, Australia
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Nowikiewicz T, Głowacka‐Mrotek I, Tarkowska M, Nowikiewicz M, Zegarski W. Failure of sentinel lymph node mapping in breast cancer patients qualified for treatment sparing axillary lymph nodes—Clinical importance and management strategy—One‐center analysis. Breast J 2020; 26:873-881. [DOI: 10.1111/tbj.13769] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Tomasz Nowikiewicz
- Head and Department of Surgical Oncology Ludwik Rydygier's Collegium Medicum UMK Bydgoszcz Poland
- Department of Clinical Breast Cancer and Reconstructive Surgery Oncology Centre Bydgoszcz Poland
| | - Iwona Głowacka‐Mrotek
- Department of Rehabilitation Ludwik Rydygier's Collegium Medicum UMK Bydgoszcz Poland
| | - Magdalena Tarkowska
- Department of Physiotherapy Ludwik Rydygier's Collegium Medicum UMK Bydgoszcz Poland
| | - Magdalena Nowikiewicz
- Student Scientific Society – Head and Department of Surgical Oncology Ludwik Rydygier's Collegium Medicum UMK Bydgoszcz Poland
| | - Wojciech Zegarski
- Head and Department of Surgical Oncology Ludwik Rydygier's Collegium Medicum UMK Bydgoszcz Poland
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