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Sumiyoshi A, Fujii H, Okuma Y. Targeting microbiome, drug metabolism, and drug delivery in oncology. Adv Drug Deliv Rev 2023; 199:114902. [PMID: 37263544 DOI: 10.1016/j.addr.2023.114902] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 05/13/2023] [Accepted: 05/24/2023] [Indexed: 06/03/2023]
Abstract
Recent emerging scientific evidence shows a relationship between gut microbiota (GM) and immunomodulation. In the recently published "Hallmarks of Cancer", the microbiome has been reported to play a crucial role in cancer research, and perspectives for its clinical implementation to improve the effectiveness of pharmacotherapy were explored. Several studies have shown that GM can affect the outcomes of pharmacotherapy in cancer, suggesting that GM may affect anti-tumor immunity. Thus, studies on GM that analyze big data using computer-based analytical methods are required. In order to successfully deliver GM to an environment conducive to the proliferation of immune cells both within and outside the tumor microenvironment (TME), it is crucial to address a variety of challenges associated with distinct delivery methods, specifically those pertaining to oral, endoscopic, and intravenous delivery. Clinical trials are in progress to evaluate the effects of targeting GM and whether it can enhance immunity or act on the TME, thereby to improve the clinical outcomes for cancer patients.
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Affiliation(s)
- Ai Sumiyoshi
- Department of Pharmacy, National Cancer Center Hospital 5-1-1 Tsukiji Chuo, Tokyo 104-0045, Japan
| | - Hiroyuki Fujii
- Department of Thoracic Oncology, National Cancer Center Hospital 5-1-1 Tsukiji Chuo, Tokyo 104-0045, Japan; Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo, Kyoto 602-8566, Japan
| | - Yusuke Okuma
- Department of Thoracic Oncology, National Cancer Center Hospital 5-1-1 Tsukiji Chuo, Tokyo 104-0045, Japan.
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2
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Tateishi AT, Okuma Y. Onco-biome in pharmacotherapy for lung cancer: a narrative review. Transl Lung Cancer Res 2022; 11:2332-2345. [PMID: 36519027 PMCID: PMC9742621 DOI: 10.21037/tlcr-22-299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/11/2022] [Indexed: 08/30/2023]
Abstract
BACKGROUND AND OBJECTIVE The gut microbiota (GM) was recently recognized to play an important role in modulating systemic immune responses and is known to influence the effects or adverse events of immune checkpoint blockade (ICB) or carcinogenesis by crosstalk with regulators of cancer-related immunity, and this relationship is complex and multifactorial. Diversity in the gut microbiome and the abundance of specific bacterial species have been identified to be associated with better response and prognosis. Therefore, the purpose of the current interest in the gut microbiome is to enable modulation of the immune system in donor cancer patients by the administration of specific bacterial species and enabling their dominance. To understand this "terra incognita" is to uncover the role of the mechanisms underlying unknown organ functions, and this knowledge will lead to enhanced immunotherapy for lung cancer patients. METHODS In this article, we summarized the literature on the relationship between the microbiome and lung cancer and the potential of the microbiome as a therapeutic target. KEY CONTENT AND FINDINGS This article is organized into the following sections: introduction, methods, microbiota and cancer development, microbiota and lung cancer treatment, future directions, and conclusion. CONCLUSIONS The gut microbiome is currently becoming the hallmark of cancer research and has an established and critical role in regulating antitumor immunity and the response to ICB in patients with lung cancers.
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Winder AA, Spillane AJ, Sood S, McKessar M, Cohn D, Snook K. Radio-isotope occult lesion localization (ROLL) techniques to identify the clipped node for targeted axillary dissection (TAD) in breast cancer. ANZ J Surg 2022; 92:3017-3021. [PMID: 36262092 DOI: 10.1111/ans.18079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/24/2022] [Accepted: 09/15/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Breast cancer patients having neoadjuvant systemic therapy (NAST) who have a positive (clipped) lymph node (CN) at presentation must have that CN removed to assess pathologic response at later surgery. Multiple techniques for localizing the CN have been described. We describe a novel ROLL-based approach. METHODS Consecutive patients between 2018 and 2021, having NAST with biopsy proven positive lymph node(s), had a clip placed into the most abnormal node(s). At later surgery sentinel node and occult lesion localization (SNOLL) was performed with peritumoral radio-isotope (99m Tc-Nanoscan) injected under ultrasound guidance. Planar and single photon emission computed tomography (SPECT-CT) images were used to identify sentinel nodes (SN) and the CN. If the CN was not a SN, then additional 99m Tc-Nanoscan was injected directly into the CN using ultrasound (ROLL). TAD was performed using a gamma probe and intra-operative specimen radiographs to confirm excision of the CN. RESULTS Thirty-eight patients underwent TAD. 20/38 CNs were SNs on SPECT-CT. 17/38 CN were localized separately. 1/38 CN was not a SN and could not be identified on ultrasound. The remaining 37/38 (97.4%) of the CNs were removed intra-operatively. Pathological complete response in the axilla was identified in 18/38 cases. The CN was the only positive node in 10/20 cases. In 18/20 cases the CN contained the largest tumour deposit. CONCLUSION Combining SNOLL and ROLL techniques to identify the SNs and, if separate, the CN for TAD is very reliable and logistically robust, especially for units already performing peritumoral lymphoscintigraphy.
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Affiliation(s)
- Alec A Winder
- Breast and Endocrine Department, Mater Hospital, Wollstonecraft, New South Wales, Australia.,Breast and Surgical Oncology at the Poche Centre, Wollstonecraft, New South Wales, Australia
| | - Andrew J Spillane
- Breast and Endocrine Department, Mater Hospital, Wollstonecraft, New South Wales, Australia.,Breast and Surgical Oncology at the Poche Centre, Wollstonecraft, New South Wales, Australia.,Breast Surgery Department, North Shore Private Hospital, St Leonards, New South Wales, Australia.,Breast and Melanoma Surgery Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Samriti Sood
- Breast and Endocrine Department, Mater Hospital, Wollstonecraft, New South Wales, Australia.,Breast and Surgical Oncology at the Poche Centre, Wollstonecraft, New South Wales, Australia.,Breast and Melanoma Surgery Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,General Surgery Department, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.,General Surgery Department, Northern Beaches Hospital, Frenchs Forest, New South Wales, Australia
| | - Merran McKessar
- Department of Radiology and Department of Nuclear Medicine, Mater Hospital, Wollstonecraft, New South Wales, Australia
| | - Deborah Cohn
- Department of Radiology and Department of Nuclear Medicine, Mater Hospital, Wollstonecraft, New South Wales, Australia
| | - Kylie Snook
- Breast and Endocrine Department, Mater Hospital, Wollstonecraft, New South Wales, Australia.,Breast and Surgical Oncology at the Poche Centre, Wollstonecraft, New South Wales, Australia.,Breast Surgery Department, North Shore Private Hospital, St Leonards, New South Wales, Australia.,General Surgery Department, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
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Rietbergen DD, VAN Oosterom MN, Kleinjan GH, Brouwer OR, Valdes-Olmos RA, VAN Leeuwen FW, Buckle T. Interventional nuclear medicine: a focus on radioguided intervention and surgery. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2021; 65:4-19. [PMID: 33494584 DOI: 10.23736/s1824-4785.21.03286-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Within interventional nuclear medicine (iNM) a prominent role is allocated for the sub-discipline of radioguided surgery. Unique for this discipline is the fact that an increasing number of clinical indications (e.g. lymphatic mapping, local tumor demarcation and/or tumor receptor targeted applications) have been adopted into routine care. The clinical integration is further strengthened by technical innovations in chemistry and engineering that enhance the translational potential of radioguided procedures in iNM. Together, these features not only ensure ongoing expansion of iNM but also warrant a lasting clinical impact for the sub-discipline of radioguided surgery.
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Affiliation(s)
- Daphne D Rietbergen
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, the Netherlands
| | - Matthias N VAN Oosterom
- Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, the Netherlands.,Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Gijs H Kleinjan
- Department of Urology, Leiden University Medical Center, Leiden, the Netherlands
| | - Oscar R Brouwer
- Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, the Netherlands.,Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Renato A Valdes-Olmos
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Fijs W VAN Leeuwen
- Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, the Netherlands.,Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Tessa Buckle
- Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, the Netherlands - .,Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
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5
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Hubley S, Barton R, Snook KL, Spillane A. Sentinel node occult lesion localization technique for impalpable breast cancer. ANZ J Surg 2020; 90:2510-2515. [PMID: 33124171 DOI: 10.1111/ans.16402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mammographic screening has enabled earlier detection of breast cancer, with 25-35% of malignancies being non-palpable at diagnosis. Accurate removal and sentinel node biopsy for staging these lesions are crucial to successful management. Both these aspects are achieved by peritumoural localization with radioisotope and lymphoscintigraphy for sentinel lymph node (SN) mapping using the sentinel node and occult lesion localization (SNOLL) technique. This study reports SNOLL outcomes in a large cohort of women with non-palpable breast cancers to assess its performance and promote its logistic advantages. METHODS This retrospective cohort study used data from BreastSurgANZ Quality Audit supplemented with private case notes. Inclusion criteria were females >18 years, with invasive breast cancer that was asymptomatic and non-palpable at presentation, who underwent SNOLL (n = 450). Primary outcomes were proportion of successful lesion localization, proportion of patients requiring re-excision and volume of tissue excised. Secondary outcomes focused on lymphoscintigraphy success rate in detecting sentinel nodes and SN positivity rates. RESULTS Tumours were successfully removed with the initial SNOLL procedure in 449 cases (99.8%). The re-excision rate was 15.1% (n = 68). The mean total excision volume was 54.69 cm3 (95% CI 51.49-57.88 cm3 ; range 2.75-195.33 cm3 ), with a mean closest circumferential margin of 7.05 mm (95% CI 6.60-7.49 mm; range 0 to ≥10 mm). Lymphoscintigraphy was successful in 96.9% (n = 436) of cases. Sentinel nodes were successfully identified and removed in 99.6% (n = 448) of cases. SN positivity rate was 18.4%. CONCLUSION SNOLL is an efficient and effective technique for localizing non-palpable invasive breast lesions while simultaneously identifying sentinel nodes.
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Affiliation(s)
| | - Ryan Barton
- Bankstown Lidcombe Hospital, Sydney, New South Wales, Australia
| | - Kylie L Snook
- Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- Breast Surgery Unit, Mater Hospital North Sydney, Sydney, New South Wales, Australia
- Department of Breast and Melanoma Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Breast Surgery Unit, Hornsby Hospital, Sydney, New South Wales, Australia
| | - Andrew Spillane
- Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- Breast Surgery Unit, Mater Hospital North Sydney, Sydney, New South Wales, Australia
- Department of Breast and Melanoma Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
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6
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Cahoon AR, Smith BD, Yang WT. Internal Thoracic Lymphadenopathy in Breast Cancer. Radiographics 2017; 37:1024-1036. [PMID: 28696856 DOI: 10.1148/rg.2017160166] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The internal thoracic (IT) nodal basin is a first-echelon drainage pathway in the breast, accounting for up to a quarter of its lymphatic drainage, primarily from the deep structures of the breast. The presence of internal thoracic node (ITN) metastases upstages the breast cancer (BC) patient to a minimum of clinical stage III disease. Medial tumors, deep tumors, young age, axillary nodal metastases, tumors of a high nuclear grade, lymphovascular invasion, and triple-negative hormone receptor status are predisposing factors for ITN metastases from primary BC. It has been observed that medial tumors carry a worse prognosis than lateral tumors when all other factors are equal, indicating that understaging of ITN has a significant impact on patient outcomes. Despite the established prognostic significance of IT adenopathy in BC, this nodal basin is not routinely staged due to the difficulty in accessing it and due to the controversy regarding its management. Since the initial ITN studies in the 1960s, improvement in imaging techniques and the availability of minimally invasive biopsy techniques have fueled renewed interest in ITNs and their clinical significance in BC. Radiologists who image and diagnose BC can offer more accurate staging assessments by consistently evaluating the IT nodal chain in the BC patient. In this article, the authors discuss current knowledge of the ITNs in BC and review ITN anatomy. The imaging appearance of pathologic ITNs using various modalities, potential mimics of IT adenopathy, and image-guided sampling techniques are described. A succinct discussion of the clinical management of ITN-positive BC and its challenges is also included. © RSNA, 2017.
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Affiliation(s)
- Ashley R Cahoon
- From the Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas M.D. Anderson Cancer Center, 1400 Pressler St, Unit 1459, Houston, TX 77030
| | - Benjamin D Smith
- From the Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas M.D. Anderson Cancer Center, 1400 Pressler St, Unit 1459, Houston, TX 77030
| | - Wei T Yang
- From the Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas M.D. Anderson Cancer Center, 1400 Pressler St, Unit 1459, Houston, TX 77030
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7
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Zetterlund L, Gabrielson S, Axelsson R, de Boniface J, Frisell J, Olsson A, Celebioglu F. Impact of previous surgery on sentinel lymph node mapping: Hybrid SPECT/CT before and after a unilateral diagnostic breast excision. Breast 2016; 30:32-38. [DOI: 10.1016/j.breast.2016.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 07/31/2016] [Accepted: 08/17/2016] [Indexed: 10/21/2022] Open
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8
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Pouw JJ, Grootendorst MR, Bezooijen R, Klazen CAH, De Bruin WI, Klaase JM, Hall-Craggs MA, Douek M, Ten Haken B. Pre-operative sentinel lymph node localization in breast cancer with superparamagnetic iron oxide MRI: the SentiMAG Multicentre Trial imaging subprotocol. Br J Radiol 2015; 88:20150634. [PMID: 26492466 DOI: 10.1259/bjr.20150634] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Sentinel lymph node biopsy (SLNB) with a superparamagnetic iron oxide (SPIO) tracer was shown to be non-inferior to the standard combined technique in the SentiMAG Multicentre Trial. The MRI subprotocol of this trial aimed to develop a magnetic alternative for pre-operative lymphoscintigraphy (LS). We evaluated the feasibility of using MRI following the administration of magnetic tracer for pre-operative localization of sentinel lymph nodes (SLNs) and its potential for non-invasive identification of lymph node (LN) metastases. METHODS Patients with breast cancer scheduled to undergo SLNB were recruited for pre-operative LS, single photon emission CT (SPECT)-CT and SPIO MRI. T1 weighted turbo spin echo and T2 weighted gradient echo sequences were used before and after interstitial injection of magnetic tracer into the breast. SLNs on MRI were defined as LNs with signal drop and direct lymphatic drainage from the injection site. LNs showing inhomogeneous SPIO uptake were classified as metastatic. During surgery, a handheld magnetometer was used for SLNB. Blue or radioactive nodes were also excised. The number of SLNs and MR assessment of metastatic involvement were compared with surgical and histological outcomes. RESULTS 11 patients were recruited. SPIO MRI successfully identified SLNs in 10 of 11 patients vs 11 of 11 patients with LS/SPECT-CT. One patient had metastatic involvement of four LNs, and this was identified in one node on pre-operative MRI. CONCLUSION SPIO MRI is a feasible technique for pre-operative localization of SLNs and, in combination with intraoperative use of a handheld magnetometer, provides an entirely radioisotope-free technique for SLNB. Further research is needed for the evaluation of MRI characterization of LN involvement using subcutaneous injection of magnetic tracer. ADVANCES IN KNOWLEDGE This study is the first to demonstrate that an interstitially administered magnetic tracer can be used both for pre-operative imaging and intraoperative SLNB, with equal performance to imaging and localization with radioisotopes.
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Affiliation(s)
- Joost J Pouw
- 1 MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands
| | - Maarten R Grootendorst
- 2 Department of Surgery, Medisch Spectrum Twente, Enschede, Netherlands.,3 Research Oncology, Division of Cancer Studies, King's College London, London, UK
| | - Roland Bezooijen
- 4 Department of Radiology, Medisch Spectrum Twente, Enschede, Netherlands
| | | | - Wieger I De Bruin
- 5 Department of Nuclear Medicine, Medisch Spectrum Twente, Enschede, Netherlands
| | - Joost M Klaase
- 2 Department of Surgery, Medisch Spectrum Twente, Enschede, Netherlands
| | | | - Michael Douek
- 3 Research Oncology, Division of Cancer Studies, King's College London, London, UK
| | - Bennie Ten Haken
- 1 MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands
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9
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Chung DKV. Rolling out radioguided occult lesion localisation for breast tumours. J Med Radiat Sci 2015; 62:1-2. [PMID: 26229660 PMCID: PMC4364799 DOI: 10.1002/jmrs.94] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- David K V Chung
- Alfred Nuclear Medicine & Ultrasound S206 RPAH Medical Centre, Newtown, New South Wales, Australia ; Sydney Medical School, The University of Sydney Sydney, New South Wales, Australia
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10
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Wang H, Heck K, Pruitt SK, Wong TZ, Scheri RP, Georgiade GS, Ichite I, Hwang ES. Impact of delayed lymphoscintigraphy for sentinel lymphnode biopsy for breast cancer. J Surg Oncol 2015; 111:931-4. [DOI: 10.1002/jso.23915] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 02/12/2015] [Accepted: 03/09/2015] [Indexed: 12/12/2022]
Affiliation(s)
- Hanghang Wang
- Department of Surgery; Duke University Medical Center; Durham North Carolina
- Computational Biology and Bioinformatics; Duke University; Durham North Carolina
| | - Karissa Heck
- School of Medicine; Duke University; Durham North Carolina
| | - Scott K. Pruitt
- Department of Surgery; Duke University Medical Center; Durham North Carolina
| | - Terence Z. Wong
- Department of Radiology; North Carolina School of Medicine; Chapel Hill North Carolina
| | - Randall P. Scheri
- Department of Surgery; Duke University Medical Center; Durham North Carolina
| | | | - Ikwunze Ichite
- Department of Radiology; Duke University Medical Center; Durham North Carolina
| | - E. Shelley Hwang
- Department of Surgery; Duke University Medical Center; Durham North Carolina
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11
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Greene LR, Wilkinson D. The role of general nuclear medicine in breast cancer. J Med Radiat Sci 2015; 62:54-65. [PMID: 26229668 PMCID: PMC4364807 DOI: 10.1002/jmrs.97] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 01/08/2015] [Accepted: 01/14/2015] [Indexed: 12/12/2022] Open
Abstract
The rising incidence of breast cancer worldwide has prompted many improvements to current care. Routine nuclear medicine is a major contributor to a full gamut of clinical studies such as early lesion detection and stratification; guiding, monitoring, and predicting response to therapy; and monitoring progression, recurrence or metastases. Developments in instrumentation such as the high-resolution dedicated breast device coupled with the diagnostic versatility of conventional cameras have reinserted nuclear medicine as a valuable tool in the broader clinical setting. This review outlines the role of general nuclear medicine, concluding that targeted radiopharmaceuticals and versatile instrumentation position nuclear medicine as a powerful modality for patients with breast cancer.
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Affiliation(s)
- Lacey R Greene
- Faculty of Science, Charles Sturt University Wagga Wagga, New South Wales, Australia
| | - Deborah Wilkinson
- Faculty of Health, Wheeling Jesuit University Wheeling, West Virginia
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12
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Ahmed M, Purushotham AD, Horgan K, Klaase JM, Douek M. Meta-analysis of superficial versus deep injection of radioactive tracer and blue dye for lymphatic mapping and detection of sentinel lymph nodes in breast cancer. Br J Surg 2014; 102:169-81. [PMID: 25511661 DOI: 10.1002/bjs.9673] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 06/24/2014] [Accepted: 09/16/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) is the standard of care for axillary staging in early breast cancer. Currently, no consensus exists on the optimal site of injection of the radioactive tracer or blue dye. METHODS A systematic review and meta-analysis of studies comparing superficial and deep injections of radioactive tracer or blue dye for lymphatic mapping and SLNB was performed. The axillary and extra-axillary sentinel lymph node (SLN) identification rates obtained by lymphoscintigraphy and intraoperative SLNB were evaluated. Pooled odds ratios (ORs) and 95 per cent c.i. were estimated using fixed-effect analyses, or random-effects analyses if there was statistically significant heterogeneity (P < 0·050). RESULTS Thirteen studies were included in the meta-analysis. There was no significant difference between superficial and deep injections of radioactive tracer for axillary SLN identification on lymphoscintigraphy (OR 1·59, 95 per cent c.i. 0·79 to 3·17), during surgery (OR 1·27, 0·60 to 2·68) and for SLN identification using blue dye (OR 1·40, 0·83 to 2·35). The rate of extra-axillary SLN identification was significantly greater when deep rather than superficial injection was used (OR 3·00, 1·92 to 4·67). The discordance rate between superficial and deep injections ranged from 4 to 73 per cent for axillary and from 0 to 61 per cent for internal mammary node mapping. CONCLUSION Both superficial and deep injections of radioactive tracer and blue dye are effective for axillary SLN identification. Clinical consequences of discordance rates between the two injection techniques are unclear. Deep injections are associated with significantly greater extra-axillary SLN identification; however, this may not have a significant impact on clinical management.
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Affiliation(s)
- M Ahmed
- Research Oncology, Division of Cancer Studies, King's College London, London
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13
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Elmadahm AA, Gill PG, Bochner M, Gebski VJ, Zannino D, Wetzig N, Campbell I, Stockler M, Ung O, Simes J, Uren R. Identification of the sentinel lymph node in the SNAC-1 trial. ANZ J Surg 2014; 85:58-63. [PMID: 25626066 DOI: 10.1111/ans.12527] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND A combination of scintigraphy and a lymphotropic dye (patent blue dye (BD)) is the recommended technique to detect the sentinel lymph node (SLN) in early breast cancer. This study determined the effect of clinical factors on SLN identification in the sentinel node biopsy versus axillary clearance (SNAC) trial. METHODS A total of 1088 women were registered. Lymphatic mapping was performed using preoperative lymphoscintigraphy (LSG) and gamma probe (GP) combined with peritumoural injection of patent BD (971 patients) or BD alone (106 patients). RESULTS SLNs were identified in 1024 women (94%), localized with LSG in 779 (81.4%), and were identified by GP in 879 (91.8%). The BD identified SLNs in 890 of 1073 (82%) women. Three patients had allergic reactions. BD detected the SLNs in 141 of 178 women with negative LSG mapping and in 44 of 79 women with no hot SLNs detected intraoperatively. Age, body mass index (BMI) and tumour presentation (screen detected versus symptomatic) were significantly related to the identification of the SLN. For BD, the primary tumour location was significantly related to identification rate. The detection of blue SLN was significantly lower in women with inner quadrant tumours. CONCLUSION The combined technique resulted in a high identification rate. BD contributed to the identification of the SLNs in patients where LSG and GP failed to identify the sentinel node. Special attention to these techniques is needed in particular groups of patients such as those with high BMI, screen-detected primary tumours and tumour located in the inner quadrants.
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Affiliation(s)
- Amira A Elmadahm
- Department of Surgery, University of Adelaide, Adelaide, South Australia, Australia
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14
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Axillary concordance between superficial and deep sentinel node mapping material injections in breast cancer patients: systematic review and meta-analysis of the literature. Breast Cancer Res Treat 2014; 144:213-22. [DOI: 10.1007/s10549-014-2866-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 01/27/2014] [Indexed: 10/25/2022]
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15
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A prospective validation study of sentinel lymph node biopsy in multicentric breast cancer: SMMaC trial. Eur J Surg Oncol 2014; 40:1250-5. [PMID: 24685336 DOI: 10.1016/j.ejso.2013.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 09/17/2013] [Accepted: 11/04/2013] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Multicentric breast cancer is often considered a contra-indication for sentinel lymph node (SLN) biopsy due to concerns with sensitivity and false negative rate. To assess SLN feasibility and accuracy in multicentric breast cancer, the multi-institutional SMMaC trial was conducted. METHODS In this study 30 patients with multicentric breast cancer and a clinically negative axilla were prospectively included. Periareolar injection of radioisotope and blue dye was administered. In all patients SLN biopsy was validated by back-up completion axillary lymph node dissection. RESULTS the SLN was successfully identified in 30 of 30 patients (identification rate 100%). The incidence of axillary metastases was 66.7% (20/30). The false negative rate was 0% (0/20) and the sensitivity was 100% (20/20). The negative predictive value was 100% (10/10). CONCLUSION SLN biopsy in multicentric breast cancer seems feasible and accurate and should therefore be considered in patients with multicentric breast cancer and clinically negative axilla.
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