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Soltanmohammadi F, Gharehbaba AM, Zangi AR, Adibkia K, Javadzadeh Y. Current knowledge of hybrid nanoplatforms composed of exosomes and organic/inorganic nanoparticles for disease treatment and cell/tissue imaging. Biomed Pharmacother 2024; 178:117248. [PMID: 39098179 DOI: 10.1016/j.biopha.2024.117248] [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: 05/18/2024] [Revised: 07/30/2024] [Accepted: 07/30/2024] [Indexed: 08/06/2024] Open
Abstract
Exosome-nanoparticle hybrid nanoplatforms, can be prepared by combining exosomes with different types of nanoparticles. The main purpose of combining exosomes with nanoparticles is to overcome the limitations of using each of them as drug delivery systems. Using nanoparticles for drug delivery has some limitations, such as high immunogenicity, poor cellular uptake, low biocompatibility, cytotoxicity, low stability, and rapid clearance by immune cells. However, using exosomes as drug delivery systems also has its own drawbacks, such as poor encapsulation efficiency, low production yield, and the inability to load large molecules. These limitations can be addressed by utilizing hybrid nanoplatforms. Additionally, the use of exosomes allows for targeted delivery within the hybrid system. Exosome-inorganic/organic hybrid nanoparticles may be used for both therapy and diagnosis in the future. This may lead to the development of personalized medicine using hybrid nanoparticles. However, there are a few challenges associated with this. Surface modifications, adding functional groups, surface charge adjustments, and preparing nanoparticles with the desired size are crucial to the possibility of preparing exosome-nanoparticle hybrids. Additional challenges for the successful implementation of hybrid platforms in medical treatments and diagnostics include scaling up the manufacturing process and ensuring consistent quality and reproducibility across various batches. This review focuses on various types of exosome-nanoparticle hybrid systems and also discusses the preparation and loading methods for these hybrid nanoplatforms. Furthermore, the potential applications of these hybrid nanocarriers in drug/gene delivery, disease treatment and diagnosis, and cell/tissue imaging are explained.
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Affiliation(s)
- Fatemeh Soltanmohammadi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Pharmaceutics, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Adel Mahmoudi Gharehbaba
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Pharmaceutics, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Rajabi Zangi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Pharmaceutics, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Khosro Adibkia
- Department of Pharmaceutics, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yousef Javadzadeh
- Department of Pharmaceutics, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran; Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Hu M, Yingyu Z, Zhang M, Wang Q, Cheng W, Hou L, Yuan J, Yu Z, Li L, Zhang X, Zhang W. Functionalizing tetrahedral framework nucleic acids-based nanostructures for tumor in situ imaging and treatment. Colloids Surf B Biointerfaces 2024; 240:113982. [PMID: 38788473 DOI: 10.1016/j.colsurfb.2024.113982] [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: 03/18/2024] [Revised: 05/13/2024] [Accepted: 05/20/2024] [Indexed: 05/26/2024]
Abstract
Timely in situ imaging and effective treatment are efficient strategies in improving the therapeutic effect and survival rate of tumor patients. In recent years, there has been rapid progress in the development of DNA nanomaterials for tumor in situ imaging and treatment, due to their unsurpassed structural stability, excellent material editability, excellent biocompatibility and individual endocytic pathway. Tetrahedral framework nucleic acids (tFNAs), are a typical example of DNA nanostructures demonstrating superior stability, biocompatibility, cell-entry performance, and flexible drug-loading ability. tFNAs have been shown to be effective in achieving timely tumor in situ imaging and precise treatment. Therefore, the progress in the fabrication, characterization, modification and cellular internalization pathway of tFNAs-based functional systems and their potential in tumor in situ imaging and treatment applications were systematically reviewed in this article. In addition, challenges and future prospects of tFNAs in tumor in situ imaging and treatment as well as potential clinical applications were discussed.
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Affiliation(s)
- Minghui Hu
- Health Commission of Henan Province Key Laboratory for Precision Diagnosis and Treatment of Pediatric Tumor, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, China
| | - Zhang Yingyu
- Henan Key Laboratory of Rare Diseases, Endocrinology and Metabolism Center, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, China
| | - Mengxin Zhang
- Health Commission of Henan Province Key Laboratory for Precision Diagnosis and Treatment of Pediatric Tumor, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, China
| | - Qionglin Wang
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, China
| | - Weyland Cheng
- Henan International Joint Laboratory for Prevention and Treatment of Pediatric Disease, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, China
| | - Ligong Hou
- Henan International Joint Laboratory for Prevention and Treatment of Pediatric Disease, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, China
| | - Jingya Yuan
- Henan Key Laboratory of Rare Diseases, Endocrinology and Metabolism Center, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, China
| | - Zhidan Yu
- Henan International Joint Laboratory for Prevention and Treatment of Pediatric Disease, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, China
| | - Lifeng Li
- Henan International Joint Laboratory for Prevention and Treatment of Pediatric Disease, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, China
| | - Xianwei Zhang
- Health Commission of Henan Province Key Laboratory for Precision Diagnosis and Treatment of Pediatric Tumor, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, China.
| | - Wancun Zhang
- Health Commission of Henan Province Key Laboratory for Precision Diagnosis and Treatment of Pediatric Tumor, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, China; Henan International Joint Laboratory for Prevention and Treatment of Pediatric Disease, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, China; Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, China.
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He X, Deng T, Li J, Guo R, Wang Y, Li T, Zang S, Li J, Zhang L, Li M, He Q. A core-satellite micellar system against primary tumors and their lymphatic metastasis through modulation of fatty acid metabolism blockade and tumor-associated macrophages. NANOSCALE 2023; 15:8320-8336. [PMID: 37083874 DOI: 10.1039/d2nr04693h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Lymph nodes (LNs) are the initial sanctuary of various metastatic tumor cells, and thus a precise lymphatic drug delivery strategy is necessary for the effective inhibition of metastasis. However, the complex biological barriers have restrained the drug delivery to tumor-draining lymph nodes (TDLNs). Metastatic tumor cells would undergo metabolic adaptation towards fatty acid oxidation (FAO) upon reaching the lipid-rich LNs. Herein, to inhibit primary tumors and their lymphatic metastasis, a core-satellite matrix metalloproteinase 2 (MMP-2) responsive micellar system was developed for sequential delivery of paclitaxel (PTX) and the metabolism-regulating drug etomoxir (ET) to tumors and TDLNs, respectively. Upon arrival at the tumor microenvironment (TME), the small satellite micelle encapsulating ET was detached from the core micelle in response to MMP-2, which not only drained to TDLNs via tumor-draining lymphatic vessels and inhibited the FAO of metastatic tumor cells, but also blocked M2-like macrophage polarization in the TME. Meanwhile, the core micelle containing PTX could largely accumulate in the TME and kill tumor cells. In an orthotopic 4T1 breast cancer model, the tumor and TDLN dual-targeted core-satellite micellar system effectively inhibited the growth of the primary tumor and alleviated immune suppression by blocking macrophage polarization. More importantly, tumor lymphatic metastasis was suppressed through FAO metabolic regulation. This strategy provides a promising approach for TDLN targeted therapy against breast cancer and its lymphatic metastasis.
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Affiliation(s)
- Xuan He
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Med-X Center for Materials, Sichuan University, China.
| | - Tao Deng
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Med-X Center for Materials, Sichuan University, China.
| | - Jiaxin Li
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Med-X Center for Materials, Sichuan University, China.
| | - Rong Guo
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Med-X Center for Materials, Sichuan University, China.
| | - Yashi Wang
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Med-X Center for Materials, Sichuan University, China.
| | - Ting Li
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Med-X Center for Materials, Sichuan University, China.
| | - Shuya Zang
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Med-X Center for Materials, Sichuan University, China.
| | - Jiaxin Li
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Med-X Center for Materials, Sichuan University, China.
| | - Ling Zhang
- College of Polymer Science and Engineering, Sichuan University, China
| | - Man Li
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Med-X Center for Materials, Sichuan University, China.
| | - Qin He
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Med-X Center for Materials, Sichuan University, China.
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Booka E, Takeuchi H. Recent Advances in Sentinel Node Navigation Surgery for Early Gastric Cancer. J Gastric Cancer 2023; 23:159-170. [PMID: 36750996 PMCID: PMC9911613 DOI: 10.5230/jgc.2023.23.e4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 01/18/2023] Open
Abstract
Maintaining the postoperative quality of life (QOL) while ensuring curability without overtreatment is important in the treatment of early gastric cancer. Postoperative QOL is anticipated to be maintained through minimally invasive function-preserving gastrectomy in early gastric cancer. The concept of the sentinel lymph node (SN) basin is essential to maintain the curability of early gastric cancer using minimally invasive function-preserving gastrectomy. However, additional resection after surgery is difficult to perform in gastric cancer. Thus, the SN basin theory is important. Recently, a multicenter randomized phase III trial in South Korea (SENORITA trial) proved that laparoscopic sentinel node navigation surgery (LSNNS) for stomach preservation results in better postoperative QOL compared with standard gastrectomy in patients with early gastric cancer. LSNNS contributes to patients' QOL based on the concept that curability is not impaired. A multicenter nonrandomized phase III trial is ongoing in Japan, and oncologic safety is expected to be demonstrated. LSNNS has been established as a treatment option for selected patients with early gastric cancer, and its application will become widespread in the future.
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Affiliation(s)
- Eisuke Booka
- Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan.
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Alsumai TS, Alhazzaa N, Alshamrani A, Assiri S, Alhefdhi A. Factors Predicting Positive Sentinel Lymph Node Biopsy in Clinically Node-Negative Breast Cancer. BREAST CANCER (DOVE MEDICAL PRESS) 2022; 14:323-334. [PMID: 36237483 PMCID: PMC9553108 DOI: 10.2147/bctt.s373005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022]
Abstract
Purpose Sentinel lymph node (SLN) biopsy (SLNB) is the standard tool to stage the axilla of breast cancer patients. This study aimed to identify the predictors of positive SLNB in patients with clinically node-negative breast cancer. Patients and Methods A retrospective, single-institution cohort of patients with early-stage breast cancer without clinically identifiable axillary lymphadenopathy was chosen from January 2010 to December 2018. Logistic regression was used to identify possible predictors of positive SLNB. Results Four hundred and seventy patients were identified; their mean age was 50±11 years. Most patients had the following characteristics: invasive ductal carcinoma (n=382, 81.3%), unilateral tumor (n=461, 98.1%), unifocal disease (n=351, 74.7%), intermediate grade (n=276, 59.0%), and estrogen and progesterone receptor positivity with human epidermal growth factor receptor 2 negativity (n=305, 64.9%). The mean size of the breast mass was 2.3±1.5 cm. SLNB was positive in 128 (27.2%) cases. The mean number of SLNs was 2±1.2. Axillary lymph node dissection was performed in 109 patients. The mean number of lymph nodes removed was 15±6. In 66 (60.6%) of the 109 patients with metastatic axillary nodes, only the SLNs were found to be positive. The number of SLNs, tumor size, tumor grade, receptor status, prominent axillary lymph nodes, and lymphovascular invasion predicted positive SLNB (P = 0.01, 0.03, 0.03, and 0.04 and <0.001 and <0.001, respectively). Conclusion Our results suggest that a number of histopathological and radiological characteristics of breast cancer can predict SLNB positivity in clinically node-negative breast cancer patients.
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Affiliation(s)
- Thuraya S Alsumai
- Department of Surgery, Section of Breast & Endocrine Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia,Correspondence: Thuraya S Alsumai, Department of Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia, Tel +966 565433996, Email
| | - Norah Alhazzaa
- Department of Surgery, Section of Breast & Endocrine Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | | | - Sarah Assiri
- Department of Surgery, Section of Breast & Endocrine Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Amal Alhefdhi
- Department of Surgery, Section of Breast & Endocrine Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia,Faculty of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Pathania S, Khan MI, Bandyopadhyay S, Singh SS, Rani K, Parashar TR, Jayaram J, Mishra PR, Srivastava A, Mathur S, Hari S, Vanamail P, Hariprasad G. iTRAQ proteomics of sentinel lymph nodes for identification of extracellular matrix proteins to flag metastasis in early breast cancer. Sci Rep 2022; 12:8625. [PMID: 35599267 PMCID: PMC9124668 DOI: 10.1038/s41598-022-12352-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 05/03/2022] [Indexed: 12/24/2022] Open
Abstract
Patients with early breast cancer are affected by metastasis to axillary lymph nodes. Metastasis to these nodes is crucial for staging and quality of surgery. Sentinel Lymph Node Biopsy that is currently used to assess lymph node metastasis is not effective. This necessitates identification of biomarkers that can flag metastasis. Early stage breast cancer patients were recruited. Surgical resection of breast was followed by identification of sentinel lymph nodes. Fresh frozen section biopsy was used to assign metastatic and non-metastatic sentinel lymph nodes. Discovery phase included iTRAQ proteomics coupled with mass spectrometric analysis to identify differentially expressed proteins. Data is available via ProteomeXchange with identifier PXD027668. Validation was done by bioinformatic analysis and ELISA. There were 2398 unique protein groups and 109 differentially expressed proteins comparing metastatic and non-metastatic lymph nodes. Forty nine proteins were up-regulated, and sixty proteins that were down regulated in metastatic group. Bioinformatic analysis showed ECM-receptor interaction pathways to be implicated in lymph node metastasis. ELISA confirmed up-regulation of ECM proteins in metastatic lymph nodes. ECM proteins have requisite parameters to be developed as a diagnostic tool to assess status of sentinel lymph nodes to guide surgical intervention in early breast cancer.
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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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Qi S, Wang X, Chang K, Shen W, Yu G, Du J. The bright future of nanotechnology in lymphatic system imaging and imaging-guided surgery. J Nanobiotechnology 2022; 20:24. [PMID: 34991595 PMCID: PMC8740484 DOI: 10.1186/s12951-021-01232-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/28/2021] [Indexed: 12/23/2022] Open
Abstract
Lymphatic system is identified the second vascular system after the blood circulation in mammalian species, however the research on lymphatic system has long been hampered by the lack of comprehensive imaging modality. Nanomaterials have shown the potential to enhance the quality of lymphatic imaging due to the unparalleled advantages such as the specific passive targeting and efficient co-delivery of cocktail to peripheral lymphatic system, ease molecular engineering for precise active targeting and prolonged retention in the lymphatic system of interest. Multimodal lymphatic imaging based on nanotechnology provides a complementary means to understand the kinetics of lymphoid tissues and quantify its function. In this review, we introduce the established approaches of lymphatic imaging used in clinic and summarize their strengths and weaknesses, and list the critical influence factors on lymphatic imaging. Meanwhile, the recent developments in the field of pre-clinical lymphatic imaging are discussed to shed new lights on the design of new imaging agents, the improvement of delivery methods and imaging-guided surgery strategies.
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Affiliation(s)
- Shaolong Qi
- Key Laboratory & Engineering Laboratory of Lymphatic Surgery Jilin Province, China-Japan Union Hospital of Jilin University, Changchun, 130031, People's Republic of China.,Key Laboratory of Bioorganic Phosphorus Chemistry & Chemical Biology, Department of Chemistry, Tsinghua University, Beijing, 100084, People's Republic of China
| | - Xinyu Wang
- Key Laboratory & Engineering Laboratory of Lymphatic Surgery Jilin Province, China-Japan Union Hospital of Jilin University, Changchun, 130031, People's Republic of China
| | - Kun Chang
- Department of Lymphology, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People's Republic of China
| | - Wenbin Shen
- Department of Lymphology, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People's Republic of China
| | - Guocan Yu
- Key Laboratory of Bioorganic Phosphorus Chemistry & Chemical Biology, Department of Chemistry, Tsinghua University, Beijing, 100084, People's Republic of China.
| | - Jianshi Du
- Key Laboratory & Engineering Laboratory of Lymphatic Surgery Jilin Province, China-Japan Union Hospital of Jilin University, Changchun, 130031, People's Republic of China.
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Gao X, Ma T, Cui J, Zhang Y, Wang L, Li H, Ye Z. A CT-based Radiomics Model for Prediction of Lymph Node Metastasis in Early Stage Gastric Cancer. Acad Radiol 2021; 28:e155-e164. [PMID: 32507613 DOI: 10.1016/j.acra.2020.03.045] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/28/2020] [Accepted: 03/29/2020] [Indexed: 02/03/2023]
Abstract
RATIONALE AND OBJECTIVES To develop and validate a CT-based radiomics model for preoperative prediction of lymph node metastasis (LNM) in early stage gastric cancer (EGC). MATERIALS AND METHODS Four hundred and sixty-three consecutive EGC patients were enrolled in this retrospective study. Radiomics features were extracted from portal venous phase CT scans. A radiomics signature was built based on highly reproducible features using the least absolute shrinkage and selection operator method. The predictive performance of radiomics signature was tested in the training and testing cohorts. Multivariate logistic regression analysis was conducted to build a radiomics-based model combined radiomics signature and lymph node status according to CT. Performance of the model was determined by its discrimination, calibration, and clinical usefulness. RESULTS The radiomics signature comprised six robust features showed significant association with LNM in both cohorts. A radiomics model that incorporated radiomics signature and CT-reported lymph node status showed good calibration and discrimination in the training cohort (AUC = 0.91) and testing cohort (AUC = 0.89). Decision curve analysis confirmed the clinical utility of this model. CONCLUSION The CT-based radiomics model showed favorable accuracy for prediction of LNM in EGC and may help to improve clinical decision-making.
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Affiliation(s)
- Xujie Gao
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Hexi District, Tianjin 300060, China; National Clinical Research Center for Cancer, Tianjin, China; Tianjin's Clinical Research Center for Cancer, Tianjin, China; The Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Tingting Ma
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Hexi District, Tianjin 300060, China; National Clinical Research Center for Cancer, Tianjin, China; Tianjin's Clinical Research Center for Cancer, Tianjin, China; The Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Jingli Cui
- Department of General Surgery, Weifang People's Hospital, Weifang City, Shandong Province, China
| | - Yuwei Zhang
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Hexi District, Tianjin 300060, China; National Clinical Research Center for Cancer, Tianjin, China; Tianjin's Clinical Research Center for Cancer, Tianjin, China; The Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Lingwei Wang
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Hexi District, Tianjin 300060, China; National Clinical Research Center for Cancer, Tianjin, China; Tianjin's Clinical Research Center for Cancer, Tianjin, China; The Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Hui Li
- National Clinical Research Center for Cancer, Tianjin, China; Department of Gastrointestinal Cancer Biology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China; Key Laboratory of Cancer Immunology and Biotherapy, Tianjin, China
| | - Zhaoxiang Ye
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Hexi District, Tianjin 300060, China; National Clinical Research Center for Cancer, Tianjin, China; Tianjin's Clinical Research Center for Cancer, Tianjin, China; The Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.
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Kim SG, Eom BW, Yoon HM, Kim CG, Kook MC, Kim YW, Ryu KW. Recent updates and current issues of sentinel node navigation surgery for early gastric cancer. Chin J Cancer Res 2021; 33:142-149. [PMID: 34158734 PMCID: PMC8181869 DOI: 10.21147/j.issn.1000-9604.2021.02.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
With the increase in the incidence of early gastric cancer (EGC), several endoscopic and laparoscopic approaches, such as endoscopic submucosal dissection and function-preserving gastrectomy, have been accepted as standard treatments. Sentinel node navigation surgery (SNNS) is an ideal surgical option for preservation of most parts of the stomach and consequent maintenance of normal gastric function to improve quality of life in patients with EGC. Although many previous studies and clinical trials have demonstrated the safety and feasibility of the sentinel node concept in gastric cancer, the clinical application of SNNS is debatable. Several issues regarding technical standardization and oncological safety need to be resolved. Recently several studies to resolve these problems are being actively performed, and SNNS might be an important surgical option in the treatment of gastric cancer in the future.
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Affiliation(s)
- Sung Gon Kim
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang-si 410-769, Republic of Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang-si 410-769, Republic of Korea
| | - Hong Man Yoon
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang-si 410-769, Republic of Korea
| | - Chan Gyoo Kim
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang-si 410-769, Republic of Korea
| | - Myeong-Cherl Kook
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang-si 410-769, Republic of Korea
| | - Young-Woo Kim
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang-si 410-769, Republic of Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang-si 410-769, Republic of Korea
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Jung SM, Woo J, Ryu JM, Lee SK, Chae BJ, Yu J, Kim SW, Nam SJ, Kim EJ, Lee JE. Is the intraoperative frozen section analysis of sentinel lymph nodes necessary in clinically negative node breast cancer? Ann Surg Treat Res 2020; 99:251-258. [PMID: 33163454 PMCID: PMC7606132 DOI: 10.4174/astr.2020.99.5.251] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/01/2020] [Accepted: 07/29/2020] [Indexed: 02/06/2023] Open
Abstract
Purpose Although metastasis occurs in 1 or 2 sentinel lymph nodes (SLNs), axillary lymph node dissection (ALND) has been widely not performed. For axillary staging and management, the necessity of intraoperative frozen section analysis of SLN has been controversial. The aim of this study is to evaluate the validity and benefit of SLN analysis by permanent section alone in clinically negative lymph node breast cancer patients. Methods We conducted a retrospective study of 283 cases with negative node clinical findings between July 2018 and August 2019 in Samsung Medical Center. Clinical nodal stage was evaluated by physical examination, breast ultrasonography, breast magnetic resonance imaging, and chest computerized tomography. The cases were divided into 2 groups; the permanent group had 151 cases (53.4%) and the frozen group had 132 cases (46.6%). We retrospectively analyzed the differences in the number of metastatic lymph nodes and rates of performed ALND between the 2 groups. Results Baseline and clinicopathologic characteristics between the 2 groups were well balanced. Three cases in the permanent group and 6 cases in the frozen group underwent additional or immediate ALND. The rates of ALND between the 2 groups were not significantly different (P = 0.312). The cased of 78.9% and 89.5% with metastatic lymph nodes in permanent and frozen groups were in the pathologic N1 stage, respectively. Conclusion SLNs analysis by permanent section alone may be performed in clinically negative axillary node breast cancer patients. Our findings can help to avoid unnecessary intraoperative frozen section analysis.
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Affiliation(s)
- Sung Mi Jung
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinsun Woo
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jai Min Ryu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Kyung Lee
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung Joo Chae
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jonghan Yu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Won Kim
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Jin Nam
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Ji Kim
- Breast Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Eon Lee
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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12
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Hlusko KC, Cole R, Tillson DM, Boothe HW, Almond G, Coggeshall WS, Matz BM. Sentinel lymph node detection differs when comparing lymphoscintigraphy to lymphography using water soluble iodinated contrast medium and digital radiography in dogs. Vet Radiol Ultrasound 2020; 61:659-666. [PMID: 32929849 DOI: 10.1111/vru.12908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/23/2020] [Accepted: 06/29/2020] [Indexed: 01/24/2023] Open
Abstract
Sentinel lymph node (SLN) mapping by various means has become standard of care in certain types of human cancers and is receiving more attention in veterinary oncology. Current SLN mapping techniques can be costly and often require advanced imaging equipment. The objective of this prospective, method comparison study was to compare an SLN mapping protocol of lymphoscintigraphy to lymphography using water soluble iodinated contrast medium (WIC) and digital radiography for identification of an SLN. Lymphoscintigraphy and lymphography were performed on eight healthy purpose-bred dogs using technetium-99m sulfur colloid and WIC injected into the subcutaneous tissues in a four-quadrant technique around a predefined area of skin on the brachium. Images were obtained using a gamma camera and digital radiography at different time points post-injection. Image sequences were evaluated by one of two American College of Veterinary Radiology board-certified veterinary radiologists. Data obtained were compared between methods using descriptive statistics. An SLN was identified in all dogs with lymphoscintigraphy and seven of eight dogs with lymphography. Agreement between results of the lymphoscintigraphy and lymphography studies was a complete match in three dogs, a partial match in four dogs, and no match in one dog. The SLN detected differed based on the imaging modality used.
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Affiliation(s)
- Katelyn C Hlusko
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA
| | - Robert Cole
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA
| | - David Michael Tillson
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA
| | - Harry W Boothe
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA
| | - Greg Almond
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA
| | | | - Brad M Matz
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA
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13
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Hlusko KC, Cole R, Tillson DM, Boothe HW, Almond GT, Coggeshall WS, Matz BM. The effect of surgery on lymphoscintigraphy drainage patterns from the canine brachium in a simulated tumor model. Vet Surg 2020; 49:1118-1124. [PMID: 32584435 DOI: 10.1111/vsu.13473] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/08/2020] [Accepted: 05/14/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine the effect of surgery on lymphoscintigraphy drainage patterns from the canine brachium. STUDY DESIGN Experimental study. ANIMALS Eight healthy research beagles. METHODS A predefined area of skin measuring 2 × 1.5 cm in dimension was designated on either the right or left brachium. Preoperative lymphoscintigraphy was performed with technetium sulfur colloid injected into the subcutaneous tissues around the predefined anatomic location in a four-quadrant technique. Dogs underwent surgery for excision of the predefined area of skin, subcutis, and fascia of the lateral head of the triceps muscle with 1-cm margins. Eighteen days after surgery, lymphoscintigraphy was again performed with technetium sulfur colloid injected into the subcutaneous tissues around the surgical scar in a four-quadrant technique. RESULTS Sentinel lymph nodes were identified in eight of eight dogs preoperatively and in eight of eight dogs postoperatively. Agreement between the results of the preoperative and postoperative lymphoscintigraphy studies was identified as complete in four of eight dogs and partial in four of eight dogs. Sentinel lymph node identification occurred immediately in three of eight dogs preoperatively and in eight of eight dogs postoperatively. CONCLUSION Sentinel lymph node identification occurred faster postoperatively. Agreement or partial agreement between the results of the preoperative and postoperative lymphoscintigraphy studies was observed in eight of eight dogs. CLINICAL SIGNIFICANCE Surgery appears to have an effect on lymphoscintigraphy drainage patterns. Additional studies are required to compare preoperative and postoperative sentinel lymph node mapping patterns in tumor-bearing dogs. However, this study provides preliminary information regarding the effect of surgery on sentinel lymph node identification.
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Affiliation(s)
- Katelyn C Hlusko
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, Alabama
| | - Robert Cole
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, Alabama
| | - David Michael Tillson
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, Alabama
| | - Harry W Boothe
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, Alabama
| | - Greg T Almond
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, Alabama
| | | | - Brad M Matz
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, Alabama
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14
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Morigi C, Peradze N, Galimberti V, Leonardi MC, Radice D, Santomauro GI, Bagnardi V, Intra M, Firpo E, Veronesi P. Feasibility and surgical impact of Z0011 trial criteria in a single-Institution practice. Breast J 2020; 26:1330-1336. [PMID: 32506628 DOI: 10.1111/tbj.13851] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 04/08/2020] [Accepted: 04/08/2020] [Indexed: 01/06/2023]
Abstract
The purpose of this study is the evaluation of clinical and surgical impact of the Z0011 trial criteria on the management of breast cancer (BC) patients undergoing breast conservative surgery (BCS) at the European Institute of Oncology (IEO). We studied 1386 patients who underwent BCS and sentinel lymph node biopsy (SLNB) from July 2016 to July 2018. Clinical evaluation, breast ultrasound, mammogram, and cyto/histological examination were performed for all patients at the time of diagnosis. Frozen sections of the sentinel lymph node (SLN) were not performed for any patient. Patients who underwent neo-adjuvant therapy were excluded. To evaluate the results before and after the introduction of Z0011 criteria, a group of 1425 patients with the same characteristics who underwent BCS and SLNB from July 2013 to July 2015 were analyzed. We studied the characteristics of the patients by nodal status, and we observed that T stage, tumor grade, and lymphovascular invasion were statistically related with the highest rate of positive SLN. Of the 1386 patients who underwent surgery after the introduction of the Z011 trial, 1156 patients (83.4%) had negative SLN, 230 patients (16.6%) had positive SLN. Subsequent axillary lymph node dissection (ALND) was performed in only 7 cases (3.0%). Of the 1425 patients operated before the introduction of the Z0011 trial, 216 patients had subsequent ALND (15%). The reduction in the number of ALND performed after the introduction of Z0011 is statistically significant, and this could result in a remarkable reduction of the comorbidities of our patients.
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Affiliation(s)
- Consuelo Morigi
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Nickolas Peradze
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Viviana Galimberti
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Davide Radice
- Division of Epidemiology and Biostatistics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Mattia Intra
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Emma Firpo
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paolo Veronesi
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Faculty of Medicine, University of Milan, Milan, Italy
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15
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A radiomics-based model for prediction of lymph node metastasis in gastric cancer. Eur J Radiol 2020; 129:109069. [PMID: 32464581 DOI: 10.1016/j.ejrad.2020.109069] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/27/2020] [Accepted: 05/10/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To develop and validate a radiomics-based model for preoperative prediction of lymph node metastasis (LNM) in gastric cancer (GC). METHOD A total of 768 GC patients were enrolled in this retrospective study. Radiomics features were extracted from portal venous phase computed tomography (CT) scans. A radiomics signature was built with highly reproducible features using the least absolute shrinkage and selection operator (LASSO) method in the training cohort (n = 486). The signature was further validated in internal validation (n = 240) and external testing cohorts (n = 42). Multivariate logistic regression analysis was conducted to build a model that combined radiomics signature, serum biomarkers, and lymph node status according to CT. Performance of the model was determined by its discrimination, calibration, and clinical usefulness. The predictive value of the model was also evaluated in early stage GC (EGC) subgroup. RESULTS The radiomics signature comprised 7 robust features showed favorable prediction efficacy in all cohorts. A radiomics-based model that incorporated radiomics signature, serum CA72-4, and CT-reported lymph node status had good calibration and discrimination in training cohort [AUC, 0.92; 95% confidence interval (CI), 0.89-0.95] and validation cohort (AUC 0.86; 95% CI, 0.81-0.91). The model also showed a favorable predictive performance for EGC patients with an AUC of 0.85 (95% CI, 0.76-0.94). Decision curve analysis confirmed the clinical utility of this model. CONCLUSIONS The radiomics-based model showed favorable accuracy for prediction of LNM in GC. The model may also serve as a noninvasive tool for preoperative evaluation of LNM in EGC.
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16
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Hu DY, Wu JW, Li P, Zhang ST. Sentinel node navigation to treat early gastric cancer after non-curative endoscopic submucosal dissection: A case series. Chronic Dis Transl Med 2020; 7:65-68. [PMID: 34013181 PMCID: PMC8110865 DOI: 10.1016/j.cdtm.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/28/2020] [Accepted: 03/08/2020] [Indexed: 10/28/2022] Open
Affiliation(s)
- Dong-Ya Hu
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing 100050, China
| | - Jing-Wei Wu
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing 100050, China
| | - Peng Li
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing 100050, China
| | - Shu-Tian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing 100050, China
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17
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Zang J, Liu Q, Sui H, Guo H, Peng L, Li F, Lang L, Jacobson O, Zhu Z, Mao F, Chen X. Combined 68Ga-NOTA-Evans Blue Lymphoscintigraphy and 68Ga-NOTA-RM26 PET/CT Evaluation of Sentinel Lymph Node Metastasis in Breast Cancer Patients. Bioconjug Chem 2020; 31:396-403. [PMID: 31880916 DOI: 10.1021/acs.bioconjchem.9b00789] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In this study, we applied a new strategy to identify sentinel lymph node (SLN) metastasis by combining 68Ga-NOTA-Evans Blue (68Ga-NEB) for SLN mapping and 68Ga-NOTA-RM26 for LN metastasis detection in breast cancer patients. A total of 24 female patients with breast cancer diagnosed by core biopsy or suspected by mammography or ultrasonography were recruited and provided informed consent. All patients underwent 68Ga-NEB and 68Ga-NOTA-RM26 PET/CT imaging. Visual analysis of 68Ga-NEB PET/CT images was used to determine SLNs, and then compared with the 68Ga-NOTA-RM26 results and histopathological findings. SLNs were visualized in 24 of 24 patients (100.0%) within 4.0-10.0 (5.6 ± 1.4) min. All patients were pathologically diagnosed with breast cancer, and 12 patients had ipsilateral lymph node metastasis. By combining 68Ga-NEB and 68Ga-NOTA-RM26 images, 7/12 (58.3%) patients showed mild to intense uptake of 68Ga-NOTA-RM26 in SLNs, 1/12 patient (8.3%) had moderate uptake of 68Ga-NOTA-RM26 in the non-SLNs rather than SLN, indicating possible bypass lymphatic drainage, partially accounting for the false negatives in SLN biopsy during surgery. No false positives were found. The SUVmax of 68Ga-NOTA-RM26 activity in metastatic SLNs was significantly higher than that in non-metastatic SLNs (2.2 ± 2.3 vs 0.7 ± 0.1, P = 0.047). This study manifests the value of combination of 68Ga-NEB and 68Ga-NOTA-RM26 dual tracer PET/CT in preoperative evaluation of SLN metastasis in breast cancer patients, especially in those patients with lymphatic obstruction and bypass drainage. In general, positive 68Ga-NOTA-RM26 uptake in either SLN or other lymph nodes can apply lymph node dissection rather than intraoperative SLN biopsy.
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Affiliation(s)
- Jie Zang
- Department of Nuclear Medicine, Peking Union Medical College Hospital , Chinese Academy of Medical Science and Peking Union Medical College , Beijing 100730 , China.,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine , Beijing 100730 , China
| | - Qingxing Liu
- Department of Nuclear Medicine, Peking Union Medical College Hospital , Chinese Academy of Medical Science and Peking Union Medical College , Beijing 100730 , China.,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine , Beijing 100730 , China
| | - Huimin Sui
- Department of Nuclear Medicine, Peking Union Medical College Hospital , Chinese Academy of Medical Science and Peking Union Medical College , Beijing 100730 , China.,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine , Beijing 100730 , China
| | - Hua Guo
- Department of Nuclear Medicine, Peking Union Medical College Hospital , Chinese Academy of Medical Science and Peking Union Medical College , Beijing 100730 , China.,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine , Beijing 100730 , China
| | - Li Peng
- Department of Breast Surgery, Peking Union Medical College Hospital , Chinese Academy of Medical Science and Peking Union Medical College , Beijing 100730 , China
| | - Fang Li
- Department of Nuclear Medicine, Peking Union Medical College Hospital , Chinese Academy of Medical Science and Peking Union Medical College , Beijing 100730 , China.,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine , Beijing 100730 , China
| | - Lixin Lang
- Laboratory of Molecular Imaging and Nanomedicine (LOMIN), National Institute of Biomedical Imaging and Bioengineering (NIBIB) , National Institutes of Health (NIH) , Bethesda , Maryland 20892 , United States
| | - Orit Jacobson
- Laboratory of Molecular Imaging and Nanomedicine (LOMIN), National Institute of Biomedical Imaging and Bioengineering (NIBIB) , National Institutes of Health (NIH) , Bethesda , Maryland 20892 , United States
| | - Zhaohui Zhu
- Department of Nuclear Medicine, Peking Union Medical College Hospital , Chinese Academy of Medical Science and Peking Union Medical College , Beijing 100730 , China.,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine , Beijing 100730 , China
| | - Feng Mao
- Department of Breast Surgery, Peking Union Medical College Hospital , Chinese Academy of Medical Science and Peking Union Medical College , Beijing 100730 , China
| | - Xiaoyuan Chen
- Laboratory of Molecular Imaging and Nanomedicine (LOMIN), National Institute of Biomedical Imaging and Bioengineering (NIBIB) , National Institutes of Health (NIH) , Bethesda , Maryland 20892 , United States
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18
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Zhang X, Shen YP, Li JG, Chen G. Clinical feasibility of imaging with indocyanine green combined with carbon nanoparticles for sentinel lymph node identification in papillary thyroid microcarcinoma. Medicine (Baltimore) 2019; 98:e16935. [PMID: 31490376 PMCID: PMC6738994 DOI: 10.1097/md.0000000000016935] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although several previous studies demonstrated the feasibility and efficacy of indocyanine green (ICG) for thyroid cancer surgery, ICG was administered through venous injection and focused on parathyroid gland protection. We thus aimed to study the feasibility of imaging using ICG combined with carbon nanoparticles (CNs) in the identification of sentinel lymph nodes (SLNs) in patients diagnosed with papillary thyroid microcarcinoma (PTMC). METHODS Two approaches were applied to detect lymph nodes in PTMC surgery. Patients were randomized into 2 groups. ICG and CNs were injected into the thyroid in Group A. In Group B, only CNs was injected. Black-stained or fluorescent nodes observed using near-infrared fluorescence imaging systems were defined as SLNs. SLN and central lymph node (CLN) dissection was completed in both groups. The pathological and postoperative outcomes were compared between 2 groups. RESULTS There were 40 patients in Group A and 60 in Group B. A total of 138 SLNs were identified; 72 and 66 SLNs were detected and dissected in Groups A and B, respectively. The number of SLNs identified (per patient) in Group A was higher than that in Group B (P = .027). The number of harvested CLNs was 161 and 192 in Groups A and B, respectively, out of which 45 and 48 lymph nodes with metastasis were confirmed by permanent pathology. The CLN metastatic rate in Group A was higher than that in Group B (P = .048). CONCLUSION Imaging using ICG combined CNs is feasible and safe for SLN identification in PTMC patients. Compared with using only CNs, more SLNs can be removed and more metastatic lymph nodes can be confirmed when using the combined method. Although the combined method appears to accurately stage tumors, further research is needed.
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Affiliation(s)
- Xing Zhang
- Department of Thyroid and Breast Surgery
| | | | - Jia-Gen Li
- Department of Thyroid and Breast Surgery
| | - Gun Chen
- Department of Pathology, Yinzhou Hospital of Ningbo University Medical College, Ningbo, Zhejiang, China
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19
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Novel Hybrid Dextran-Gadolinium Nanoparticles as High-relaxivity T1 Magnetic Resonance Imaging Contrast Agent for Mapping the Sentinel Lymph Node. J Comput Assist Tomogr 2019; 43:350-357. [PMID: 30875338 DOI: 10.1097/rct.0000000000000842] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To assess the applicability of a novel hybrid dextran-gadolinium nanoparticles (NPs) as high-relaxivity T1 magnetic resonance imaging (MRI) contrast agent for mapping the sentinel lymph node (SLN). METHODS Dextran-bis-acrylamide-polyacrylic acid (Dex-MBA-PAA) NPs were synthesized through a self-assembly assisted approach and complexed with multiple chelated gadolinium (Gd) (III) ions. After their characterization was validated, they were used to mapping SLNs by MRI in Wistar rats, and their biosafety was evaluated. RESULTS Dextran-MBA-polyacrylic acid-Gd NPs have suitable particle size and much higher longitudinal relaxivity (r1) than that of commonly used clinical MRI contrast agents (eg, gadopentetic acid dimeglumine salt injection). The in vivo T1-weighted MRI results revealed their effectiveness at mapping SLNs. And their biological safety was also verified. CONCLUSIONS Dextran-MBA-polyacrylic acid-Gd NPs were synthesized and validated by in vitro and in vivo experiments for their ability to visualize SLNs by MRI with accurate positioning and excellent biosafety, and they have great potential for clinical SLN mapping.
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20
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Valente SA, Al-Hilli Z, Radford DM, Yanda C, Tu C, Grobmyer SR. Near Infrared Fluorescent Lymph Node Mapping with Indocyanine Green in Breast Cancer Patients: A Prospective Trial. J Am Coll Surg 2018; 228:672-678. [PMID: 30582975 DOI: 10.1016/j.jamcollsurg.2018.12.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 12/10/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Near infrared (NIR) fluorescence imaging is an emerging modality that can enable real-time image-guided procedures. Indocyanine green (ICG) is an FDA-approved, inexpensive, and widely available NIR dye. We hypothesized that axillary lymphatic mapping with ICG is equivalent to lymphatic mapping with technetium 99m (99mTc) in breast cancer patients. STUDY DESIGN Breast cancer patients (cT1-2, N0) were prospectively enrolled. Patients underwent lymphatic mapping with 99mTc preoperatively and ICG mapping intraoperatively (0.8 mL). Sentinel lymph node (SLN) biopsy was guided by NIR camera and gamma probe. Rate of failed mapping, number of SLNs identified, and rate of identifying pathologically positive SLNs were compared between the 2 techniques (p < 0.05 was considered statistically significant). RESULTS Ninety-two female patients were enrolled (median age 59 years). Mean transit time from ICG injection in the breast to localization in the axilla was 5 minutes (range 2 to 29 minutes). No adverse reactions to ICG were noted. Mean number of SLNs identified with ICG and 99mTc was 2.4 (SD 1.42) and 2.2 (SD 1.23), respectively (p = 0.34). Pathologically positive SLNs were identified in 18 (19.8%) patients. A total of 24 pathologically positive SLNs in 18 patients were identified by ICG in 24 of 24 (100%) patients and by 99mTc in 23 of 24 (96%) patients (p = 0.99). CONCLUSIONS Indocyanine green with NIR fluorescence imaging can be safely and efficiently used for real-time intraoperative lymphatic mapping in breast cancer patients. Indocyanine green performs similarly to 99mTc with regard to the number of SLNs identified, rate of failed mapping, and identification of pathologically positive SLNs.
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Affiliation(s)
- Stephanie A Valente
- Division of Breast Surgery, Department of General Surgery, Cleveland Clinic, Cleveland, OH
| | - Zahraa Al-Hilli
- Division of Breast Surgery, Department of General Surgery, Cleveland Clinic, Cleveland, OH
| | - Diane M Radford
- Division of Breast Surgery, Department of General Surgery, Cleveland Clinic, Cleveland, OH
| | - Courtney Yanda
- Division of Breast Surgery, Department of General Surgery, Cleveland Clinic, Cleveland, OH
| | - Chao Tu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Stephen R Grobmyer
- Division of Breast Surgery, Department of General Surgery, Cleveland Clinic, Cleveland, OH.
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Zheng J, Cai S, Song H, Wang Y, Han X, Wu H, Gao Z, Qiu F. Positive non-sentinel axillary lymph nodes in breast cancer with 1-2 sentinel lymph node metastases. Medicine (Baltimore) 2018; 97:e13015. [PMID: 30383658 PMCID: PMC6221619 DOI: 10.1097/md.0000000000013015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Recent clinical trials have shown that sentinel lymph node biopsy (SLNB) alone without axillary lymph node dissection (ALND) can offer excellent regional control if there is sentinel lymph nodes (SLN) metastases to 1-2 nodes. This study aimed to explore the predictive factors for non-sentinel lymph node (NSLN) metastasis in breast cancer patients with 1-2 positive SLNs.Patients with breast cancer and 1-2 positive SLN admitted between March 2009 and March 2017 and who underwent ALND after SLN biopsy (SLNB) at Beijing Chaoyang Hospital were analyzed retrospectively. Factors influencing the status of NSLN were studied by univariate and multivariate analysis.Of 1125 patients, 147 patients had SLN metastasis (13.1%) and 119 patients (81.0%) had 1-2 positive SLNs. Among them, 42 patients (35.3%) had NSLN metastasis. The invasive tumor size (P <.001), histological grade (P =.011), lymphovascular invasion (LVI) (P =.006), and over-expression of HER2 (P =.025) significantly correlated with non-SLN metastasis by univariate analysis. LVI (LVI) (P =.007; OR: 4.130; 95% confidence interval [CI]: 1.465-11.641), invasive tumor size (P <.001; OR: 7.176; 95% CI: 2.710-19.002), and HER2 over-expression (P =.006; OR: 5.489; 95% CI: 1.635-18.428) were independently associated with NSLN metastasis by the Logistic regression model. The ROC analysis identified a cut-off point of 26 mm of tumor size (area under the receiver operating characteristic [ROC] curve [AUC] 0.712, CI: 0.614-0.811) was useful for dividing patients with positive SLN (1-2 nodes) into non-SLN-positive and non-SLN-negative groups.For 1-2 positive SLNs of breast cancer, LVI, large invasive tumor size, and HER2 over-expression are independent factors affecting NSLN metastases.
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22
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Sandoughdaran S, Malekzadeh M, Mohammad Esmaeil ME. Frequency and Predictors of Axillary Lymph Node Metastases in Iranian Women with Early Breast Cancer. Asian Pac J Cancer Prev 2018; 19:1617-1620. [PMID: 29936787 PMCID: PMC6103571 DOI: 10.22034/apjcp.2018.19.6.1617] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Axillary lymph node metastasis is the most important predictive factor for recurrence risk and survival in patients with invasive breast carcinoma. The aim of this study was to determine factors associated with metastatic involvement of axillary lymph nodes in Iranian women with early breast cancer. Methods: This article reports a retrospective study of 774 patients with T1-T2 breast cancer who underwent resection of the primary tumor and axillary staging by SLNB and/or ALND between 2005 and 2015 at our institution. Results: Of the 774 patients included in this study, 35.5% (275 cases) had axillary lymph node involvement at the time of diagnosis. Factors associated with nodal involvement in univariate analyses were tumor size, lymphovascular invasion (LVI), tumor grade, ER/PR status and HER2 expression. All factors identified with univariate analyses were entered into a multivariate logistic regression model and tumor size (OR= 3.01, CI 2.01–4.49, P <0.001), ER/PR positivity (OR = 1.74, CI 1.1.16–2.62, P = 0.007) and presence of LVI (OR = 3.3.8, CI 2.31–4.95, P <0.001) remained as independent predictors of axillary lymph node involvement. Conclusions: In conclusion, the results of this study suggests that positive hormonal receptor status, LVI and tumor size are predictive factors for ALNM in Iranian women with early breast cancer.
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Affiliation(s)
- Saleh Sandoughdaran
- Department of Radiation Oncology, Shohada-e-Tajrish Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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23
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Cigna E, Gradilone A, Ribuffo D, Gazzaniga P, Fino P, Sorvillo V, Scuderi N. Morbidity of Selective Lymph Node Biopsy for Melanoma: Meta-Analysis of Complications. TUMORI JOURNAL 2018; 98:94-8. [DOI: 10.1177/030089161209800113] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background and Aim Intraoperative lymphatic mapping and selective lymph node biopsy is accepted worldwide as the standard procedure for staging regional lymph nodes of 1–4 mm thick melanomas, as well as for other neoplasms. Although it is often stated that selective lymph node biopsy is a minimally invasive procedure associated with few complications, few data exist concerning the morbidity associated with the procedure. The present analysis was performed to evaluate the morbidity associated with selective lymph node biopsy in a long-term follow-up. Materials and Methods The study provides a review of 437 selective lymph node biopsies on 269 patients, operated on between the 1994 and the 2009, for the lymph node biopsy of head and neck, groin, axilla, upper and lower limbs and nodal basins. Patients’ history and follow-up were reviewed for 2 weeks after surgery, every 3 months for the first 2 years, every 4 months during the third year, and every 6 months subsequently, and postoperative morbidity was evaluated. Results After sentinel node biopsy, 14 patients developed one of the following complications: hematoma, 1 case (0.30%); lymphedema, 1 case (0.30%); seroma, 2 cases (0.61%); wound infection, 6 cases (1.83%); keloid scar, 2 cases (0.61%); and postoperative pain, 2 cases (0.61%). The total complication rate was 4.26%. Conclusions Selective lymph node biopsy for melanoma, as for other tumors, in respect to radical lymphadenectomy, is not a complications-free procedure but is usually not severe.
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Affiliation(s)
- Emanuele Cigna
- Department of Plastic and Reconstructive Surgery, Sapienza University of Rome
| | - Angela Gradilone
- Department of Experimental Medicine, Sapienza University of Rome
| | - Diego Ribuffo
- Unit of Plastic Surgery, Cagliari University Hospital, Monserrato, Italy
| | - Paola Gazzaniga
- Department of Experimental Medicine, Sapienza University of Rome
| | - Pasquale Fino
- Department of Plastic and Reconstructive Surgery, Sapienza University of Rome
| | - Valentina Sorvillo
- Department of Plastic and Reconstructive Surgery, Sapienza University of Rome
| | - Nicolò Scuderi
- Department of Plastic and Reconstructive Surgery, Sapienza University of Rome
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Kim WH, Kim HJ, Jung JH, Park HY, Lee J, Kim WW, Park JY, Cheon H, Lee SM, Cho SH, Shin KM, Kim GC. Ultrasound-Guided Fine-Needle Aspiration of Non-palpable and Suspicious Axillary Lymph Nodes with Subsequent Removal after Tattooing: False-Negative Results and Concordance with Sentinel Lymph Nodes. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2576-2581. [PMID: 28830644 DOI: 10.1016/j.ultrasmedbio.2017.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/21/2017] [Accepted: 07/14/2017] [Indexed: 06/07/2023]
Abstract
Ultrasonography-guided fine-needle aspiration (US-guided FNA) for axillary lymph nodes (ALNs) is currently used with various techniques for the initial staging of breast cancer and tagging of ALNs. With the implementation of the tattooing of biopsied ALNs, the rate of false-negative results of US-guided FNA for non-palpable and suspicious ALNs and concordance with sentinel lymph nodes were determined by node-to node analyses. A total of 61 patients with breast cancer had negative results for metastasis on US-guided FNA of their non-palpable and suspicious ALNs. The biopsied ALNs were tattooed with an injection of 1-3 mL Charcotrace (Phebra, Lane Cove West, Australia) ink and removed during sentinel lymph node biopsy or axillary dissection. We determined the rate of false-negative results and concordance with the sentinel lymph nodes by a retrospective review of surgical and pathologic findings. The association of false-negative results with clinical and imaging factors was evaluated using logistic regression. Of the 61 ALNs with negative results for US-guided FNA, 13 (21%) had metastases on final pathology. In 56 of 61 ALNs (92%), tattooed ALNs corresponded to the sentinel lymph nodes. Among the 5 patients (8%) without correspondence, 1 patient (2%) had 2 metastatic ALNs of 1 tattooed node and 1 sentinel lymph node. In multivariate analysis, atypical cells on FNA results (odds ratio = 20.7, p = 0.040) was independently associated with false-negative FNA results. False-negative ALNs after US-guided FNA occur at a rate of 21% and most of the tattooed ALNs showed concordance with sentinel lymph nodes.
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Affiliation(s)
- Won Hwa Kim
- Department of Radiology, Kyungpook National University Medical Center, Daegu, Korea
| | - Hye Jung Kim
- Department of Radiology, Kyungpook National University Medical Center, Daegu, Korea.
| | - Jin Hyang Jung
- Department of Surgery, Kyungpook National University Medical Center, Daegu, Korea
| | - Ho Yong Park
- Department of Surgery, Kyungpook National University Medical Center, Daegu, Korea
| | - Jeeyeon Lee
- Department of Surgery, Kyungpook National University Medical Center, Daegu, Korea
| | - Wan Wook Kim
- Department of Surgery, Kyungpook National University Medical Center, Daegu, Korea
| | - Ji Young Park
- Department of Pathology, Kyungpook National University Medical Center, Daegu, Korea
| | - Hyejin Cheon
- Department of Radiology, Kyungpook National University Medical Center, Daegu, Korea
| | - So Mi Lee
- Department of Radiology, Kyungpook National University Medical Center, Daegu, Korea
| | - Seung Hyun Cho
- Department of Radiology, Kyungpook National University Medical Center, Daegu, Korea
| | - Kyung Min Shin
- Department of Radiology, Kyungpook National University Medical Center, Daegu, Korea
| | - Gab Chul Kim
- Department of Radiology, Kyungpook National University Medical Center, Daegu, Korea
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Chemotherapy port related lymphedema after axillary lymph node dissection. Breast 2016; 28:145-7. [PMID: 27318169 DOI: 10.1016/j.breast.2016.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/15/2016] [Accepted: 05/21/2016] [Indexed: 11/23/2022] Open
Abstract
UNLABELLED The Mascagni lymphatic pathway comprises superficial channels along the clavicle that drain upper extremity lymph. A 65 year-old woman with recurrent left breast cancer presented with a non-functioning chemotherapy port in the right deltopectoral groove. She had undergone right mastectomy with axillary lymph node dissection (ALND). After port removal and wound closure she developed right upper extremity lymphedema. Patients who have undergone ALND may depend solely on this pathway for upper extremity lymphatic drainage. LEVEL OF EVIDENCE level V.
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Beserra HEO, Grandi F, Dufloth RM, Pinheiro LGP, Miot HA, Vexenat SCOR, Rocha NS. Metastasis of Mammary Carcinoma in Bitches: Evaluation of the Sentinel Lymph Node Technique. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/abcr.2016.52006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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27
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Xie F, Zhang D, Cheng L, Yu L, Yang L, Tong F, Liu H, Wang S, Wang S. Intradermal microbubbles and contrast-enhanced ultrasound (CEUS) is a feasible approach for sentinel lymph node identification in early-stage breast cancer. World J Surg Oncol 2015; 13:319. [PMID: 26585236 PMCID: PMC4653941 DOI: 10.1186/s12957-015-0736-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 11/12/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Microbubbles and contrast-enhanced ultrasound (CEUS) is a new technique for locating sentinel lymph node (SLN). The aim of this study is to explore the feasibility of SLNs tracing by CEUS using microbubbles in breast cancer patients and the value of enhancing patterns in diagnosing lymph nodes metastases. METHODS A clinical trial was registered (trial registration: ChiCTR-DDT-13003778). One hundred and one consecutive consenting patients with breast cancer undergoing SLN biopsy were enrolled. Before the surgery, microbubble was injected periareolarly. Lymphatic drainage pathway was detected by CEUS, and guidewire was deployed to locate the SLN before the operation. Blue dye was also used to help in tracing sentinel lymph node during the operation. The identification rate and the accuracy rate were recorded. Enhancing patterns of lymph nodes were recorded and compared with the pathological diagnosis. RESULTS Of the 101 cases, SLNs in 99 cases were successfully identified by at least one tracer, including 98 cases identified by CEUS and 97 cases by blue dye. There was no significant difference between the two methods (P = 0.705). Guidewires were deployed successfully in all 98 cases, and the localized SLNs were all isolated successfully in the following operations. The status of SLNs isolated by CEUS was completely identical to that of the whole axillary lymph node while 7.1 % cases were misdiagnosed as negative by blue dye method. The sensitivity of predicting SLNs metastases by CEUS enhancing pattern was 81.8 %, the specificity was 86.2 %, and the positive and negative predictive values were 75.0 and 90.3 %, respectively. CONCLUSIONS Microbubbles and CEUS are feasible approaches for SLN identification. The enhancing patterns on CEUS may be helpful to recognize the metastasizing SLNs. This novel method may be a promising technique for the clinical application.
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Affiliation(s)
- Fei Xie
- Department of Breast Disease, Peking University People's Hospital, Beijing, China.
| | - Dongjie Zhang
- Department of Breast Disease, Peking University People's Hospital, Beijing, China.
| | - Lin Cheng
- Department of Breast Disease, Peking University People's Hospital, Beijing, China.
| | - Lei Yu
- Department of Ultrasound Diagnosis, Peking University People's Hospital, Beijing, China.
| | - Li Yang
- Department of Ultrasound Diagnosis, Peking University People's Hospital, Beijing, China.
| | - Fuzhong Tong
- Department of Breast Disease, Peking University People's Hospital, Beijing, China.
| | - Hongjun Liu
- Department of Breast Disease, Peking University People's Hospital, Beijing, China.
| | - Shu Wang
- Department of Ultrasound Diagnosis, Peking University People's Hospital, Beijing, China.
| | - Shan Wang
- Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing, China.
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Kato S, Mori S, Kodama T. A Novel Treatment Method for Lymph Node Metastasis Using a Lymphatic Drug Delivery System with Nano/Microbubbles and Ultrasound. J Cancer 2015; 6:1282-94. [PMID: 26640589 PMCID: PMC4643085 DOI: 10.7150/jca.13028] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 08/31/2015] [Indexed: 12/24/2022] Open
Abstract
Chemotherapy based on hematogenous administration of drugs to lymph nodes (LNs) located outside the surgically resected area shows limited tissue selectivity and inadequate response rates, resulting in poor prognosis. Here, we demonstrate proof of concept for a lymphatic drug delivery system using nano/microbubbles (NMBs) and ultrasound (US) to achieve sonoporation in LNs located outside the dissection area. First, we demonstrated the in vitro effectiveness of doxorubicin (Dox) delivered into three different tumor cell lines by sonoporation. Sonoporation increased the Dox autofluorescence signal and resulted in a subsequent decrease in cell viability. Next, we verified the antitumor effects of Dox in vivo using MXH10/Mo-lpr/lpr mice that exhibit systemic lymphadenopathy, with some peripheral LNs reaching 10 mm in diameter. We defined the subiliac LN (SiLN) as the upstream LN within the dissection area, and the proper axillary LN (PALN) as the downstream LN outside the dissection area. Dox and NMBs were injected into the SiLN and delivered to the PALN via lymphatic vessels; the PALN was then exposed to US when it had filled with solution. We found that sonoporation enhanced the intracellular uptake of Dox leading to high cytotoxicity. We also found that sonoporation induced extravasation of Dox from lymphatic endothelia and penetration of Dox into tumor tissues within the PALN. Furthermore, our method inhibited tumor growth and diminished blood vessels in the PALN while avoiding systemic toxic effects of Dox. Our findings indicate that a lymphatic drug delivery system with sonoporation represents a promising method for treating metastatic LNs located outside the dissection area.
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Affiliation(s)
- Shigeki Kato
- 1. Laboratory of Biomedical Engineering for Cancer, Graduate School of Biomedical Engineering, Tohoku University, 4-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
| | - Shiro Mori
- 2. Department of Oral Medicine and Surgery, Tohoku University Hospital, 1-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
| | - Tetsuya Kodama
- 1. Laboratory of Biomedical Engineering for Cancer, Graduate School of Biomedical Engineering, Tohoku University, 4-1 Seiryo, Aoba, Sendai, Miyagi 980-8575, Japan
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29
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Liu Z, Rong P, Yu L, Zhang X, Yang C, Guo F, Zhao Y, Zhou K, Wang W, Zeng W. Dual-Modality Noninvasive Mapping of Sentinel Lymph Node by Photoacoustic and Near-Infrared Fluorescent Imaging Using Dye-Loaded Mesoporous Silica Nanoparticles. Mol Pharm 2015; 12:3119-28. [PMID: 26132789 DOI: 10.1021/mp500698b] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Zhiguo Liu
- School
of Pharmaceutical Sciences, Central South University, Changsha, 410013, P. R. China
| | - Pengfei Rong
- Department
of Radiology, the Third Xiangya Hospital, Central South University, Changsha, 410013, P. R. China
| | - Lun Yu
- School
of Pharmaceutical Sciences, Central South University, Changsha, 410013, P. R. China
| | - Xintong Zhang
- School
of Pharmaceutical Sciences, Central South University, Changsha, 410013, P. R. China
| | - Cejun Yang
- Department
of Radiology, the Third Xiangya Hospital, Central South University, Changsha, 410013, P. R. China
| | - Fei Guo
- Department
of Radiology, the Third Xiangya Hospital, Central South University, Changsha, 410013, P. R. China
| | - Yanzhong Zhao
- Department
of Radiology, the Third Xiangya Hospital, Central South University, Changsha, 410013, P. R. China
| | - Kechao Zhou
- State
Key Lab Powder Met, Central South University, Changsha, 410083, P. R. China
| | - Wei Wang
- Department
of Radiology, the Third Xiangya Hospital, Central South University, Changsha, 410013, P. R. China
| | - Wenbin Zeng
- School
of Pharmaceutical Sciences, Central South University, Changsha, 410013, P. R. China
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30
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Liu H, Wu DC. Advances in research of fluorescence imaging for detection of gastrointestinal tumors. Shijie Huaren Xiaohua Zazhi 2015; 23:2193-2199. [DOI: 10.11569/wcjd.v23.i14.2193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Fluorescence imaging, which has a high sensitivity, produces images by capturing fluorescence signal from the inside of organisms. Over the past few years, notable development of fluorescence imaging technique has been made in the field of gastrointestinal cancer. Imaging instruments and fluorescent probes for fluorescence imaging are being improved and innovated, making it a promising technique for broad clinical applications in the near future. Future clinical applications of fluorescence imaging include aiding diagnosis and surgical treatment of gastrointestinal tumors, which are important development directions of this technique. However, increasing the safety and the accuracy for tumor detection is a challenge for fluorescence imaging. Besides, in order to acquire better diagnostic effects, the combination of fluorescence imaging and other imaging modalities which require novel imaging probes for tumor is also an important trend for fluorescence imaging development.
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31
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Rizwan A, Bulte C, Kalaichelvan A, Cheng M, Krishnamachary B, Bhujwalla ZM, Jiang L, Glunde K. Metastatic breast cancer cells in lymph nodes increase nodal collagen density. Sci Rep 2015; 5:10002. [PMID: 25950608 PMCID: PMC4423440 DOI: 10.1038/srep10002] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 03/26/2015] [Indexed: 02/07/2023] Open
Abstract
The most life-threatening aspect of breast cancer is the occurrence of metastatic disease. The tumor draining lymph nodes typically are the first sites of metastasis in breast cancer. Collagen I fibers and the extracellular matrix have been implicated in breast cancer to form avenues for metastasis. In this study, we have investigated extracellular matrix molecules such as collagen I fibers in the lymph nodes of mice bearing orthotopic human breast cancer xenografts. The lymph nodes in mice with metastatic MDA-MB-231 and SUM159 tumor xenografts and tumor xenografts grown from circulating tumor cell lines displayed an increased collagen I density compared to mice with no tumor and mice with non-metastatic T-47D and MCF-7 tumor xenografts. These results suggest that cancer cells that have metastasized to the lymph nodes can modify the extracellular matrix components of these lymph nodes. Clinically, collagen density in the lymph nodes may be a good marker for identifying lymph nodes that have been invaded by breast cancer cells.
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Affiliation(s)
- Asif Rizwan
- The Johns Hopkins University In Vivo Cellular and Molecular Imaging Center, Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Camille Bulte
- 1] The Johns Hopkins University In Vivo Cellular and Molecular Imaging Center, Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland [2] Department of Neuroscience, College of Literature, Science, and the Arts Honors Program, University of Michigan - Ann Arbor, Michigan
| | - Anusha Kalaichelvan
- 1] The Johns Hopkins University In Vivo Cellular and Molecular Imaging Center, Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland [2] Department of Health Sciences, Western University, London, Ontario, Canada
| | - Menglin Cheng
- The Johns Hopkins University In Vivo Cellular and Molecular Imaging Center, Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Balaji Krishnamachary
- The Johns Hopkins University In Vivo Cellular and Molecular Imaging Center, Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Zaver M Bhujwalla
- 1] The Johns Hopkins University In Vivo Cellular and Molecular Imaging Center, Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland [2] The Johns Hopkins University School of Medicine, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Lu Jiang
- The Johns Hopkins University In Vivo Cellular and Molecular Imaging Center, Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kristine Glunde
- 1] The Johns Hopkins University In Vivo Cellular and Molecular Imaging Center, Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland [2] The Johns Hopkins University School of Medicine, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
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Sentinel lymph node localization with contrast-enhanced ultrasound and an I-125 seed: An ideal prospective development study. Int J Surg 2015; 14:1-6. [DOI: 10.1016/j.ijsu.2014.12.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 12/17/2014] [Indexed: 11/21/2022]
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Ashitate Y, Hyun H, Kim SH, Lee JH, Henary M, Frangioni JV, Choi HS. Simultaneous mapping of pan and sentinel lymph nodes for real-time image-guided surgery. Am J Cancer Res 2014; 4:693-700. [PMID: 24883119 PMCID: PMC4038751 DOI: 10.7150/thno.8721] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 03/24/2014] [Indexed: 12/27/2022] Open
Abstract
The resection of regional lymph nodes in the basin of a primary tumor is of paramount importance in surgical oncology. Although sentinel lymph node mapping is now the standard of care in breast cancer and melanoma, over 20% of patients require a completion lymphadenectomy. Yet, there is currently no technology available that can image all lymph nodes in the body in real time, or assess both the sentinel node and all nodes simultaneously. In this study, we report an optical fluorescence technology that is capable of simultaneous mapping of pan lymph nodes (PLNs) and sentinel lymph nodes (SLNs) in the same subject. We developed near-infrared fluorophores, which have fluorescence emission maxima either at 700 nm or at 800 nm. One was injected intravenously for identification of all regional lymph nodes in a basin, and the other was injected locally for identification of the SLN. Using the dual-channel FLARE intraoperative imaging system, we could identify and resect all PLNs and SLNs simultaneously. The technology we describe enables simultaneous, real-time visualization of both PLNs and SLNs in the same subject.
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Arrington AK, Kruper L, Vito C, Yim J, Kim J, Chen SL. Rural and urban disparities in the evolution of sentinel lymph node utilization in breast cancer. Am J Surg 2013; 206:674-81. [DOI: 10.1016/j.amjsurg.2013.07.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 07/15/2013] [Accepted: 07/16/2013] [Indexed: 11/25/2022]
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Pavlista D, Eliska O. Relationship Between the Lymphatic Drainage of the Breast and the Upper Extremity: A Postmortem Study. Ann Surg Oncol 2012; 19:3410-5. [DOI: 10.1245/s10434-012-2363-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Indexed: 11/18/2022]
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Carpenter S, Fong Y. Real-time fluorescence imaging of abdominal, pleural, and lymphatic metastases. Methods Mol Biol 2012; 872:141-157. [PMID: 22700409 DOI: 10.1007/978-1-61779-797-2_10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Virally-directed fluorescence imaging has the potential to revolutionize intra-operative oncologic staging and tumor resection. Many viruses genetically engineered to specifically infect tumor cells as cancer therapy can be further modified to have a visible marker gene for cancer staging. In this chapter, we describe such a herpes simplex virus (HSV) modified to be detected by fluorescence. Other viruses so designed can be similarly used in cancer detection and staging. Replication-competent, tumor-specific HSV NV1066 expresses green fluorescent protein (GFP) in infected cancer cells. One single dose of NV1066 administered via intratumor, intracavitary, or systemic injection can spread within and across body cavities to target tumor cells while sparing normal tissue cells from infection. Tumors otherwise invisible by conventional laparoscopy appear green with the use of an endoscope equipped with a fluorescent filter. Furthermore, with GFP expression easily visualized by stereomicroscopy, microscopic, and pathologic analysis is significantly enhanced. This chapter addresses NV1066-directed visualization of peritoneal, pleural, and lymphatic metastases. This chapter also provides protocols for the production of tumor models in various body cavities in rodents.
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Affiliation(s)
- Susanne Carpenter
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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37
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Ban EJ, Lee JS, Koo JS, Park S, Kim SI, Park BW. How many sentinel lymph nodes are enough for accurate axillary staging in t1-2 breast cancer? J Breast Cancer 2011; 14:296-300. [PMID: 22323916 PMCID: PMC3268926 DOI: 10.4048/jbc.2011.14.4.296] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 10/06/2011] [Indexed: 11/30/2022] Open
Abstract
Purpose During a sentinel lymph node biopsy (SLNB) for breast cancer, the appropriate number of sentinel lymph nodes (SLNs) to be removed for accurate axillary staging is still controversial. We hypothesized that there might be an optimal threshold number of SLNs. We investigated how many SLNs should be removed to achieve an acceptable accuracy and ensure minimal morbidity. Methods We reviewed data of 328 patients with invasive breast cancer who underwent SLNB followed by complete level I and II axillary dissection between January 2004 and December 2005. The false negative rate (FNR) and accuracy of SLNB according to the number of removed SLNs were evaluated. Results The mean number of SLNs removed was 3.0 (range, 1-14), and that of total retrieved axillary lymph nodes was 17.5 (range, 10-40). In total, 111 (33.8%) patients had positive nodes on the permanent pathological report. Among them, 12 patients had negative SLNs; thus, the overall FNR of SLNB was 10.8% (12/111) and the accuracy was 96.3% (316/328). The FNR was 26.6% for a single SLN, 8.0% for two, and 11.1% for three. In cases where four or more SLNs were removed, the FNR decreased to 0% and accuracy reached 100%. Conclusion Our data suggest that a SLNB should not only remove one or two of the hottest node(s) when other hot nodes exist. We also suggest that four might be an optimal threshold number of SLNs to be removed and that removal of more than four SLNs does not improve axillary staging accuracy.
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Affiliation(s)
- Eun Jeong Ban
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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Early Dynamic Versus Late Static Lymphoscintigraphy for the Identification of Sentinel Lymph Nodes in Breast Cancer. Clin Nucl Med 2011; 36:1098-101. [DOI: 10.1097/rlu.0b013e31821a2aaf] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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39
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Cheng H, Liang H, Qin Y, Liu Y. Nuclear beta-catenin overexpression in metastatic sentinel lymph node is associated with synchronous liver metastasis in colorectal cancer. Diagn Pathol 2011; 6:109. [PMID: 22053859 PMCID: PMC3222611 DOI: 10.1186/1746-1596-6-109] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 11/04/2011] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Beta-catenin, a component of the Wingless/Wnt signaling pathway, can activate target genes linking with the adenomatous polyposis coli (APC) gene in colorectal cancer. The purpose of this study is to investigate whether nuclear beta-catenin overexpression in metastatic sentinel lymph node(s) [SLN(s)] is associated with synchronous liver metastasis. METHODS Clinicopathological data from 355 patients (93 cases with liver metastasis and 262 cases without liver metastasis) were reviewed. Beta-catenin expression in metastatic SLN(s) and liver metastatic lesions was examined by immunohistochemistry. The association of nuclear beta-catenin expression in metastatic SLN(s) and liver metastatic lesions was evaluated, and the relationship between nuclear beta-catenin expression and clinicopathological characteristics was analyzed. Finally, univariate and logistic multivariate regression analyses were adopted to discriminate the risk factors of liver metastasis. RESULTS Nuclear beta-catenin overexpression in metastatic SLN(s) was observed in 70 patients with liver metastasis and 31 patients without liver metastasis (75.3% vs. 11.8%; P < 0.001). Nuclear beta-catenin expression was noted in all the metastatic lesions. Spearman rank correlation analysis demonstrated that nuclear beta-catenin expression in metastatic SLN(s) had a positive correlation with that in metastatic lesions (r = 0.425, P < 0.001). Univariate and multivariate analyses indicated that nuclear beta-catenin overexpression in metastatic SLN(s) correlated with liver metastasis. CONCLUSIONS Nuclear beta-catenin overexpression in metastatic SLN(s) is strongly associated with liver metastasis and may contribute to predict liver metastasis.
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Affiliation(s)
- Hongxia Cheng
- Department of Pathology, Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong, People's Republic of China
| | - Hui Liang
- Department of otolaryngology, Qianfoshan Hospital Affiliated to Shandong University, Jinan 250014, Shandong, People's Republic of China
| | - Yejun Qin
- Department of Pathology, Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong, People's Republic of China
| | - Ying Liu
- Department of Pathology, Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong, People's Republic of China
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Pimiento JM, Lee MC, Esposito NN, Kiluk JV, Khakpour N, Carter WB, Han G, Laronga C. Role of axillary staging in women diagnosed with ductal carcinoma in situ with microinvasion. J Oncol Pract 2011; 7:309-13. [PMID: 22211128 DOI: 10.1200/jop.2010.000096] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2011] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Axillary staging via sentinel node biopsy (SLNB) in patients with ductal carcinoma in situ with microinvasion (DCISM) is routinely performed but remains controversial with regard to the risk-benefit ratio. METHODS Retrospective single-institution review of patients with diagnosis of DCISM (invasive tumor ≤ 0.1 cm). Age, clinicopathologic data, and follow-up were recorded. RESULTS Of 90 patients, 33% were diagnosed by core needle biopsy (CNB), 37% by excisional biopsy, and 29% were upstaged from DCIS on CNB to DCISM at final operation. Three (10%) of 30 patients with DCISM on CNB were upstaged to invasive cancer on final pathology. Median age at diagnosis was 58.9 years (range: 30-89). Lumpectomy was performed in 45% of patients and mastectomy in 55%. Mean number of sentinel nodes was 2.59 (SE 0.17). Six (6.9%) of 87 patients with DCISM as final diagnosis had a positive SLNB (four lumpectomies, two mastectomies). There was no correlation with any clinicopathologic features, including palpable DCIS, DCIS grade/necrosis, or age at diagnosis. All six SLNB-positive patients had a complete axillary dissection; two had additional disease. Median follow-up time was 74.2 months (range: 2-169). In-breast recurrence was seen in three patients (5%), regardless of SLN status, DCIS grade, or necrosis. Two patients developed distant metastasis. Overall survival was 94.19% at 5 years for DCISM and 100% for DCISM with nodal disease. CONCLUSION DCISM comprises 0.6% of breast cancer diagnoses at our institution. There is a low likelihood of nodal spread; however, a lack of identifiable clinicopathologic features associated with a positive SLNB limits selective SLNB use.
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Affiliation(s)
- Jose M Pimiento
- Don and Erika Wallace Comprehensive Breast Program, Department of Women's Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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Van Eetvelde E, Vanhoeij M, Verfaillie G, Bourgain C, Lamote J. Role of intra-operative touch imprint cytology in the treatment of breast cancer. Acta Chir Belg 2011; 111:130-5. [PMID: 21780518 DOI: 10.1080/00015458.2011.11680723] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES A prospective study was carried out to evaluate the role of intra-operative touch imprint cytology (TIC) in the assessment of sentinel lymph node (SLN) involvement for staging and treatment of early-stage, clinically node-negative breast carcinoma. METHODS Forty-five patients with early-stage, clinically node-negative breast cancer underwent a SLN biopsy with intra-operative TIC. The SLN was bisected if its width was less than 4 mm or sliced every 2 mm if it was more than 4 mm. The imprint specimens were stained with haematoxylin and eosin (H&E). Rapid immunochemistry (IH) was performed in case of equivocal cytological result. Permanent sections were evaluated with H&E and IH staining. The results of TIC were compared to histopathological results. RESULTS The sensitivity, specificity and overall accuracy of TIC on a node basis were 65.5%, 96.3%, 85.5%, respectively. When calculated according to the size of SLN metastasis, the sensitivity of TIC for overt metastasis was 84.6%, while it was 62.5% for micrometastasis and 37.5% for sub-micrometastasis. The mean size of nodal metastasis was 5.08 mm and 1.25 mm for true positive and false negative results, respectively (P = 0.0236). Because of intra-operative TIC, 76.5% of the patients who needed further axillary lymph node dissection (ALND) could undergo this during the same operating time. CONCLUSIONS TIC is a rapid and reliable method for the intra-operative assessment of metastatic sentinel node involvement in patients with early-stage, clinically node-negative breast carcinoma. Despite a low sensitivity comparable to frozen section (FS) in detecting micro- and sub-micrometastases, the technique offers the advantage of full tissue preservation for subsequent histological analysis.
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Affiliation(s)
| | - M. Vanhoeij
- Departments of Oncological Surgery, Brussels, Belgium
| | - G. Verfaillie
- Departments of Oncological Surgery, Brussels, Belgium
| | - C. Bourgain
- Departments of Pathology, UZ Brussel, Brussels, Belgium
| | - J. Lamote
- Departments of Oncological Surgery, Brussels, Belgium
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Abstract
INTRODUCTION Breast cancer screening increased the ratio of small tumours. These tumours have a low lymph node metastatic potential. Sentinel node detection allows detecting axillary lymph node invasion without the morbidity of complete axillary lymph node dissection. OBJECTIVES In this study we report the results of the learning curve of sentinel node detection in the Institut Salah-Azaïz of Tunis. MATERIALS AND METHODS It is a prospective study between January 2004 and December 2005 in which 115 patients were included with breast cancer less than 3 cm without antecedents of breast surgery. All these women had sentinel node dissection by a colorimetric method and 30% had a combined method (colorimetric and isotopic). RESULTS The rate of detection was 97.3% (n = 112). An extemporaneous examination was performed in 91 patients. The rate of negative forgery of the extemporaneous examination was 4.3% and the sensitivity of 95.7%. There are no false positive with the extemporaneous exam. The sentinel lymph node was the only node invaded in 15 patients (44%). In 3 patients, the sentinel node was healthy whereas the axillary dissection was positive, so the false negative rate is about 2.6%. CONCLUSION Sentinel node dissection is a reliable and feasible technique. It however requires a training of the surgeon, the pathologist and the nuclear doctor. It allows to reduce the morbidity of the treatment of the breast cancer by avoiding "useless" axillary dissection out in patients without node invasion. The increase in the number of the small cancers discovered during screening makes it possible to increase the number of patients who can profit from this technique.
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Wang YZ, Joseph S, Lindholm E, Lyons J, Boudreaux JP, Woltering EA. Lymphatic mapping helps to define resection margins for midgut carcinoids. Surgery 2009; 146:993-7. [DOI: 10.1016/j.surg.2009.09.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Accepted: 09/17/2009] [Indexed: 11/25/2022]
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Biopsia del ganglio centinela como factor pronóstico en el melanoma cutáneo. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s0001-7310(09)71595-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Nguyen BD, Roarke MC, Karstaedt PJ, Ingui CJ, Ram PC. Practical applications of nuclear medicine in imaging breast cancer. Curr Probl Diagn Radiol 2009; 38:68-83. [PMID: 19179194 DOI: 10.1067/j.cpradiol.2007.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The rise in incidence, morbidity, and mortality of breast cancer has triggered multiple imaging efforts to detect this malignancy early, stage it accurately, and monitor it with precision in the posttherapeutic course. Among different imaging modalities, nuclear medicine provides an important contribution to the clinical management of breast cancer. This article discusses four practical applications based on the use of radionuclides in the evaluation of breast malignancy, focusing on scintimammography, preoperative tumor localization procedure using radioactive seeds, sentinel nodal scintigraphy, and F-18 fluorodeoxyglucose positron emission tomography/computed tomography.
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Affiliation(s)
- Ba D Nguyen
- Department of Radiology, Mayo Clinic, Scottsdale, AZ 85259, USA.
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Quantitative RT-PCR detection of tumor cells in sentinel lymph nodes isolated from colon cancer patients with an ex vivo approach. Ann Surg 2009; 249:602-7. [PMID: 19300229 DOI: 10.1097/sla.0b013e31819ec923] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To investigate quantitative RT-PCR-based detection of tumor cells in lymph nodes (LNs) isolated from colon cancer patients by ex vivo sentinel lymph node (SLN) mapping. SUMMARY BACKGROUND DATA Although lymph node status is among the strongest prognostic factors in colon cancer patients, 20% to 30% of node negative patients experience disease recurrence. These patients may have LN metastases that are not detected by routine examination. METHODS Ex vivo SLN mapping was applied to 131 prospectively recruited patients undergoing curative surgery for primary colon cancer. The SLNs were analyzed for the presence of tumor cells by routine histology and real-time RT-PCR quantitation of cytokeratin 20 (CK20) and mucin 2(MUC2) mRNA. RESULTS SLNs were identified in 125 (95%) of the 131 patients included.Routine histologic analysis of SLNs and other regional lymph nodes revealed LN metastases in 42 patients (N+), of which 29 (69%) had metastases detected in 1 or more SLNs (sensitivity, 69%; false negative rate, 31%).When analyzing the SLNs by quantitative RT-PCR, the sensitivity, compared with routine LN examination, was 37/42 (88%) for both the CK20 and the MUC2 mRNA markers. In addition, 46% and 27% of the patients' node negative by routine LN examination (N0) were positive for the CK20 and MUC2 mRNA markers, respectively, possibly reflecting the presence of occult tumor cells in their SLNs. CONCLUSIONS Quantitative RT-PCR analysis of SLNs identified N+ patients with high sensitivity and revealed a subgroup of N0 patients with potential occult LN disease.
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Taras AR, Hendrickson NA, Pugliese MS, Lowe KA, Atwood M, Beatty JD. Intraoperative evaluation of sentinel lymph nodes in invasive lobular carcinoma of the breast. Am J Surg 2009; 197:643-6; discussion 646-7. [DOI: 10.1016/j.amjsurg.2008.12.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2008] [Revised: 12/23/2008] [Accepted: 12/29/2008] [Indexed: 10/20/2022]
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Erratum. Ann R Coll Surg Engl 2009. [DOI: 10.1308/rcsann.2009.91.4.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Jahromi AH, Narayanan S, MacNeill F, Osin P, Nerurkar A, Gui G. Testing the Feasibility of Intra-Operative Sentinel Lymph Node Touch Imprint Cytology. Ann R Coll Surg Engl 2009; 91:336-339. [DOI: 10.1308/rcsann.2009.91.4.336] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
INTRODUCTION Sentinel lymph node biopsy is emerging as the new standard for axillary staging in breast cancer. Intra-operative assessment of the sentinel lymph nodes allows immediate completion of axillary dissection during the same anaesthetic. This project was a quality assurance practice to establish feasibility, time-to-report, as well as accuracy of performing intra-operative assessment of sentinel lymph nodes using touch imprint cytology in our centre. PATIENTS AND METHODS This prospective audit included 146 sentinel lymph nodes from 74 consecutive patients with invasive breast cancer. All patients underwent axillary sentinel lymph node biopsy using combined blue dye and radiocolloid technique. Results of intra-operative touch imprint cytology using haematoxylin and eosin staining were compared with the definitive histopathology results. RESULTS Mean time to report touch imprint cytology was 25.7 ± 6.4 min (range, 15–40 min). Histopathology demonstrated metastasis in 25 sentinel nodes from 17 (23%) patients. Intra-operative touch imprint cytology detected 15 nodes in 11 patients, giving a sensitivity of 60% (nodes) and 66.7% (patients) and specificity of 99.2% (nodes) and 98.2% (patients) based on the number of nodes and patients involved, respectively. Touch imprint cytology failed to show metastatic involvement in 10 nodes from 6 patients; of these, five nodes had micrometastasis (< 2 mm) and the other five had macrometastasis. One touch imprint cytology positive node contained isolated tumour cells only. Using intra-operative touch imprint cytology made a change in treatment of 11(14.9%) patients, and spared second axillary procedure in 7 (9.4%) patients. CONCLUSIONS Intra-operative sentinel lymph node assessment using touch imprint cytology is feasible within a busy NHS practice. We now offer touch imprint cytology to patients following appropriate counselling.
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Affiliation(s)
| | - Sankaran Narayanan
- Departments of Breast Surgery, The Royal Marsden NHS Foundation Trust London, UK
| | - Fiona MacNeill
- Departments of Breast Surgery, The Royal Marsden NHS Foundation Trust London, UK
| | - Peter Osin
- Departments of Histopathology, The Royal Marsden NHS Foundation Trust London, UK
| | - Ashutash Nerurkar
- Departments of Histopathology, The Royal Marsden NHS Foundation Trust London, UK
| | - Gerald Gui
- Departments of Breast Surgery, The Royal Marsden NHS Foundation Trust London, UK
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