Sentinel node biopsy in breast cancer revisited

Surface charge of well-defined polymeric nano-stars regulates non-invasive fluorescence imaging of lymph node

Accurate identification of sentinel lymph node (SLN) is crucial for clinical SLN biopsy surgery. Herein, we developed an innovative nanoprobe based on well-defined core crosslinked star (CCS) polymers for non-invasive fluorescence imaging of SLN. A well-defined biodegradable CCS polymer comprising multiple polyethylene glycol (PEG) arms and carboxyl terminal groups (denoted as CCS-COOH) was synthesized successfully by reversible addition-fragmentation chain transfer polymerization with a disulfide-based crosslinker reagent. Besides, CCS-COOH was coupled by tert-butyl carbazate to produce the CCS derivative with neutral butoxycarbonyl (Boc) terminal groups (denoted as CCS-Boc). By the removal of Boc groups, another CCS derivative with positive primary amino terminal groups (denoted as CCS-NH₂) was also yielded. These CCS polymers had similar particle size but different surface charge. For SLN fluorescence imaging, the CCS polymers labeled by CY7, a near-infrared probe, exhibited superior in vitro photo-stability to CY7 alone. After intradermal injection of the CY7-labeled CCS polymers in a mouse model, they could efficiently accumulate in the lymph node of the mouse. CY7-labeled CCS-COOH having negatively-charged surface displayed longer duration time and higher fluorescence intensity in the lymph node as compared to its counterparts with neutral or positive charge surface. In vitro and in vivo toxicity tests supported low cytotoxicity of these CCS polymers against cell lines and low systemic toxicity. The results of this work highlight the potential of negatively-charged near-infrared-emitting CCS polymer as a new nanoprobe for safe and efficient SLN imaging.

Is it really useful the Harmonic scalpel in axillary dissection for locally advanced breast cancer? A case series

BACKGROUND

The seroma is one of the most common complications in the axillary lymph nodal dissection (different surgical approaches have been tried to reduce the seroma incidence). In our study we evaluate the outcome of patients using or not the ultrasonic scalpel (Harmonic scalpel) according to a standardized surgical technique.

PATIENTS AND METHODS

From January 2011 to December 2015 120 patients underwent axillary dissection for breast cancer. Patients were divided in two groups: patients belonging to the first group underwent Harmonic scalpel dissection and patients belonging to the second group underwent classical dissection. Each group consisted of 60 patients. Quadrantectomy (QUAD) was performed in 54 patients, 66 women underwent mastectomy. In all patients axillary dissection included the I, II and III level. We compared two groups in terms of: time of surgery, hematoma, drainage volume, days of sealing drainage, seroma formation, number of post-seroma aspirations, upper limb lymphedema, wound infections, post-operative pain.

RESULTS

Statistically significant results were obtained in terms of the total volume of the breast and axillary drainage in the two techniques. There were no significant differences in the two samples in terms of operative time incidence of seroma, post-operative hematoma, wound infection, and lymphedema of the upper limb.

CONCLUSION

The small number of cases did not allow us to reach definitive conclusions. The use of Harmonic scalpel seems to show smaller incidence of seroma and reduction of the amount of both breast and axillary drainages. Further studies are needed to define the real advantage in terms of cost benefit of using these devices in the axillary surgery.