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Zhang Y, Han X, Luo J, Zhang Q, He X. Viscoelasticity quantification of cancerous tongue using intraoral optical coherence elastography: a preliminary study. BIOMEDICAL OPTICS EXPRESS 2024; 15:3480-3491. [PMID: 38855658 PMCID: PMC11161336 DOI: 10.1364/boe.519078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 06/11/2024]
Abstract
Quantifying the biomechanical properties of the tongue is significant for early diagnosis of tongue carcinoma. Therefore, an intraoral optical coherence elastography system based on a miniature probe was proposed here to evaluate the viscoelasticity of in vivo tongue for the first time. Results of experiments with Sprague-Dawley rats indicate that considerable elasticity diversity occurred between cancerous and normal tongues, and the corresponding ratio of their Young's modulus was evaluated to be 3.74. It is also found that, viscosity in diseased tissue is smaller than that in normal tissue. Additionally, healthy, transitional and cancerous regions in the cancerous tongue can be distinguished easily by calculating viscoelasticity characteristics. Based on this preliminary attempt, our method with advantages of noninvasive, high-resolution, high-sensitivity and real-time detection and convenient operation may have good potential to become a useful tool for tongue carcinoma assessment after further optimization.
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Affiliation(s)
- Yubao Zhang
- Key Laboratory of Opto-Electronic Information Science and Technology of Jiangxi Province and Jiangxi Engineering Laboratory for Optoelectronics Testing Technology, Nanchang Hangkong University, Nanchang, P. R., China
| | - Xiao Han
- Key Laboratory of Opto-Electronic Information Science and Technology of Jiangxi Province and Jiangxi Engineering Laboratory for Optoelectronics Testing Technology, Nanchang Hangkong University, Nanchang, P. R., China
- School of Instrument Science and Opto-Electronics Engineering, Beihang University, Beijing, P. R., China
| | - Jiahui Luo
- Key Laboratory of Opto-Electronic Information Science and Technology of Jiangxi Province and Jiangxi Engineering Laboratory for Optoelectronics Testing Technology, Nanchang Hangkong University, Nanchang, P. R., China
| | - Qin Zhang
- Key Laboratory of Opto-Electronic Information Science and Technology of Jiangxi Province and Jiangxi Engineering Laboratory for Optoelectronics Testing Technology, Nanchang Hangkong University, Nanchang, P. R., China
| | - Xingdao He
- Key Laboratory of Opto-Electronic Information Science and Technology of Jiangxi Province and Jiangxi Engineering Laboratory for Optoelectronics Testing Technology, Nanchang Hangkong University, Nanchang, P. R., China
- School of Instrument Science and Opto-Electronics Engineering, Beihang University, Beijing, P. R., China
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Stolz M. The Revolution in Breast Cancer Diagnostics: From Visual Inspection of Histopathology Slides to Using Desktop Tissue Analysers for Automated Nanomechanical Profiling of Tumours. Bioengineering (Basel) 2024; 11:237. [PMID: 38534510 DOI: 10.3390/bioengineering11030237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/28/2024] Open
Abstract
We aim to develop new portable desktop tissue analysers (DTAs) to provide fast, low-cost, and precise test results for fast nanomechanical profiling of tumours. This paper will explain the reasoning for choosing indentation-type atomic force microscopy (IT-AFM) to reveal the functional details of cancer. Determining the subtype, cancer stage, and prognosis will be possible, which aids in choosing the best treatment. DTAs are based on fast IT-AFM at the size of a small box that can be made for a low budget compared to other clinical imaging tools. The DTAs can work in remote areas and all parts of the world. There are a number of direct benefits: First, it is no longer needed to wait a week for the pathology report as the test will only take 10 min. Second, it avoids the complicated steps of making histopathology slides and saves costs of labour. Third, computers and robots are more consistent, more reliable, and more economical than human workers which may result in fewer diagnostic errors. Fourth, the IT-AFM analysis is capable of distinguishing between various cancer subtypes. Fifth, the IT-AFM analysis could reveal new insights about why immunotherapy fails. Sixth, IT-AFM may provide new insights into the neoadjuvant treatment response. Seventh, the healthcare system saves money by reducing diagnostic backlogs. Eighth, the results are stored on a central server and can be accessed to develop strategies to prevent cancer. To bring the IT-AFM technology from the bench to the operation theatre, a fast IT-AFM sensor needs to be developed and integrated into the DTAs.
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Affiliation(s)
- Martin Stolz
- National Centre for Advanced Tribology at Southampton, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton SO17 1BJ, UK
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Pang W, Zhou F, Zhu Y, Jia Y, Nie F. The Value of Percutaneous Contrast-Enhanced Ultrasound in Sentinel Lymph Node Identification, Metastatic Status and Burden Diagnosis in Early Breast Cancer. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:293-303. [PMID: 37876335 DOI: 10.1002/jum.16359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/26/2023] [Accepted: 09/29/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the value of percutaneous contrast-enhanced ultrasound (PCEUS) in the identification and characterization of sentinel lymph node (SLN). METHODS A total of 102 breast cancer patients were collected and underwent preoperative PCEUS, which was used to identify SLN and lymphatic drainage. SLNs were classified into 4 enhancement patterns, including 6 subtypes: homogeneous (I), featured inhomogeneous (II) including inhomogeneous hypoenhancement (IIa) and annular or semi-annular enhancement (IIb), focal filling defect (III) including filling defect area < 50% (IIIa) and filling defect area ≥ 50% (IIIb), and no enhancement (IV). The enhancement patterns of SLNs were compared with the final pathological diagnosis. RESULTS The identification rate of SLNs using PCEUS was 100% (102/102); the rate of identification of LCs was 100% (102/102), and the coincidence rate was 98.0% (100/102). Four lymphatic drainage patterns (LDPs) including 5 subtypes were found: single LC/single SLN(74.5%), multiple LCs/ single SLN (13.7%) including 2 subtypes:2 LCs/1 SLN and 3 LCs/1 SLN, single LC/multiple SLNs (7.8%), and multiple LCs/multiple SLNs (3.9%). A total of 86.3% (44/51) of patients without axillary metastasis could be safely selected for types I, IIa, and IIb, while the axillary metastasis rates of types III and IV were 74.4% and 87.5%, respectively (P < .001). Compared with grayscale US, the PCEUS significant improvement in diagnosing metastatic SLNs (.794 versus .579, P < .001). For the SLN metastatic burden, Types I, IIa, IIb, and IIIa had ≤2 SLNs metastases, with a pathological coincidence rate of (64/67, 95.5%), and types IIIb and IV had >2 SLNs metastases, with a pathological coincidence rate of (25/35, 71.4%) (P < .001). The AUC of PCEUS for the diagnosis of SLN metastatic status and burden was .794 and .879, respectively (P < .001). CONCLUSION PCEUS has a high identification rate for SLN and has good potential for diagnosing SLN metastatic status and burden by enhancement patterns.
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Affiliation(s)
- Wenjing Pang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
- Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
| | - Fei Zhou
- Critical Care Medicine, Lanzhou University Second Hospital, Lanzhou, China
| | - Yangyang Zhu
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
- Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
| | - Yingying Jia
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
- Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
| | - Fang Nie
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
- Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
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Nguyen CL, Dayaratna N, Graham S, Azimi F, Mak C, Pulitano C, Warrier S. Evolution of Indocyanine Green Fluorescence in Breast and Axilla Surgery: An Australasian Experience. Life (Basel) 2024; 14:135. [PMID: 38255750 PMCID: PMC10821188 DOI: 10.3390/life14010135] [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: 11/20/2023] [Revised: 01/05/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
The evolution of indocyanine green (ICG) fluorescence in breast and axilla surgery from an Australasian perspective is discussed in this narrative review with a focus on breast cancer and reconstruction surgery. The authors have nearly a decade of experience with ICG in a high-volume institution, which has resulted in publications and ongoing future research evaluating its use for predicting mastectomy skin flap perfusion for reconstruction, lymphatic mapping for sentinel lymph node (SLN) biopsy, and axillary reverse mapping (ARM) for prevention of lymphoedema. In the authors' experience, routine use of ICG angiography during breast reconstruction postmastectomy was demonstrated to be cost-effective for the reduction of ischemic complications in the Australian setting. A novel tracer combination, ICG-technetium-99m offered a safe and effective substitute to the "gold standard" dual tracer for SLN biopsy, although greater costs were associated with ICG. An ongoing trial will evaluate ARM node identification using ICG fluorescence during axillary lymph node dissection and potential predictive factors of ARM node involvement. These data add to the growing literature on ICG and allow future research to build on this to improve understanding of the potential benefits of fluorescence-guided surgery in breast cancer and reconstruction surgery.
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Affiliation(s)
- Chu Luan Nguyen
- Department of Breast Surgery, Chris O’Brien Lifehouse, Camperdown, NSW 2050, Australia; (S.G.); (F.A.); (C.M.); (S.W.)
- Department of Surgery, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia;
- Department of Surgery, The University of Sydney, Camperdown, NSW 2050, Australia;
| | - Nirmal Dayaratna
- Department of Surgery, The University of Sydney, Camperdown, NSW 2050, Australia;
| | - Susannah Graham
- Department of Breast Surgery, Chris O’Brien Lifehouse, Camperdown, NSW 2050, Australia; (S.G.); (F.A.); (C.M.); (S.W.)
- Department of Surgery, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia;
- Department of Surgery, The University of Sydney, Camperdown, NSW 2050, Australia;
| | - Farhad Azimi
- Department of Breast Surgery, Chris O’Brien Lifehouse, Camperdown, NSW 2050, Australia; (S.G.); (F.A.); (C.M.); (S.W.)
- Department of Surgery, The University of Sydney, Camperdown, NSW 2050, Australia;
| | - Cindy Mak
- Department of Breast Surgery, Chris O’Brien Lifehouse, Camperdown, NSW 2050, Australia; (S.G.); (F.A.); (C.M.); (S.W.)
| | - Carlo Pulitano
- Department of Surgery, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia;
- Department of Surgery, The University of Sydney, Camperdown, NSW 2050, Australia;
| | - Sanjay Warrier
- Department of Breast Surgery, Chris O’Brien Lifehouse, Camperdown, NSW 2050, Australia; (S.G.); (F.A.); (C.M.); (S.W.)
- Department of Surgery, The University of Sydney, Camperdown, NSW 2050, Australia;
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Subramonian S, Chopra S, Vidya R. New Alternative Techniques for Sentinel Lymph Node Biopsy. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2077. [PMID: 38138180 PMCID: PMC10744367 DOI: 10.3390/medicina59122077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/18/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: This review paper highlights the key alternatives to the blue dye/radioisotope method of sentinel lymph node biopsy (SLNB). It analyses the research available on these alternative methods and their outcomes compared to the traditional techniques. Materials and Methods: This review focused on fifteen articles, of which five used indocyanine green (ICG) as a tracer, four used magnetic tracers, one used one-step nucleic acid amplification (OSNA) and Metasin (quantitative reverse transcriptase-polymerase chain reaction), one used the photosensitiser talaporfin sodium, one used sulphur hexafluoride gas microbubbles, one used CT-guided lymphography and two focused on general SLNB technique reviews. Results: Of the 15 papers analysed, the sentinel node detection rates were 69-100% for indocyanine green, 91.67-100% for magnetic tracers, 81% for talaporfin sodium, 9.3-55.2% for sulphur hexafluoride gas microbubbles, 90.5% for CTLG and 82.7-100% for one-step nucleic acid amplification. Conclusions: Indocyanine green fluorescence (ICG) and magnetic tracers have been proven non-inferior to traditional blue dye and isotope regarding SLNB localisation. Further studies are needed to investigate the use of these techniques in conjunction with each other and the possible use of language learning models. Dedicated studies are required to assess cost efficacy and longer-term outcomes.
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Affiliation(s)
| | - Sharat Chopra
- Aneurin Bevan University Health Board, The Royal Gwent Hospital, Newport NP20 2UB, UK;
| | - Raghavan Vidya
- The Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK
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Liu X, Wang M, Wang Q, Zhang H. Diagnostic value of contrast-enhanced ultrasound for sentinel lymph node metastasis in breast cancer: an updated meta-analysis. Breast Cancer Res Treat 2023; 202:221-231. [PMID: 37500963 DOI: 10.1007/s10549-023-07063-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/16/2023] [Indexed: 07/29/2023]
Abstract
PURPOSE The status of sentinel lymph nodes (SLN) is an important factor in determining the stage of breast cancer (BC) and the surgical procedure, and also a biomarker of the BC prognosis. This meta-analysis was performed to investigate the diagnostic value of contrast-enhanced ultrasound (CEUS) for SLN metastasis. METHODS A systematic search was conducted for relevant articles published in the PubMed, Embase, Web of Science, OVID databases, and Cochrane Library from inception to March 2023. We calculated the sensitivity, specificity, positive and negative likelihood ratio (PLR; NLR), diagnostic odds ratio (DOR), and summary receiver operator characteristic (SROC) curve to evaluate the diagnostic efficacy of CEUS in SLN metastasis. Subgroup analysis was also performed to investigate potential sources of heterogeneity. RESULTS A total of 12 studies with 1525 patients were included in this meta-analysis. The overall pooled sensitivity and specificity of CEUS in the diagnosis of SLN metastasis were 0.91 (95% CI: 0.84-0.95) and 0.86 (95% CI: 0.78-0.92). The PLR, NLR, and DOR were 6.51 (95% CI: 4.09-10.36), 0.11 (95% CI: 0.07-0.18), and 59.43 (95% CI: 33.27-106.17), respectively, and the area under the SROC curve was determined to be 0.95 (95%CI: 0.92-0.96), all showing excellent diagnostic value. In the subgroup analysis, percutaneous CEUS was more sensitive than intravenous CEUS in the diagnosis of SLN metastases (0.92 versus 0.82, p < 0.05). CONCLUSION CEUS, especially percutaneous CEUS, is a reliable imaging technique for diagnosing SLN metastasis and providing important information in the stage management of breast cancer.
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Affiliation(s)
- Xiao Liu
- Department of Ultrasound, Shandong Provincial Hospital affiliated to Shandong First Medical University, No. 324 Jing 5 Rd, Jinan, Shandong, 250021, People's Republic of China
| | - Meihuan Wang
- Department of Ultrasound, Shandong Provincial Hospital affiliated to Shandong First Medical University, No. 324 Jing 5 Rd, Jinan, Shandong, 250021, People's Republic of China
| | - Qian Wang
- Department of Ultrasound, Shandong Provincial Hospital affiliated to Shandong First Medical University, No. 324 Jing 5 Rd, Jinan, Shandong, 250021, People's Republic of China.
| | - Huawei Zhang
- Department of Ultrasound, Shandong Provincial Hospital affiliated to Shandong First Medical University, No. 324 Jing 5 Rd, Jinan, Shandong, 250021, People's Republic of China.
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Wang Y, Peng Q, Sun P, Li X, Dong Y. Comparison of Sentinel Lymph Node Biopsy by Blue Dye Conjunction With Indocyanine Green or Radioisotope in Early-Stage Breast Cancer: A Prospective Single-Center Observational Study. Clin Med Insights Oncol 2023; 17:11795549231201129. [PMID: 37928452 PMCID: PMC10624060 DOI: 10.1177/11795549231201129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/28/2023] [Indexed: 11/07/2023] Open
Abstract
Background Although radioisotope (RI) combined with blue dye (BD) is the standard technique for sentinel lymph node (SLN) biopsy in breast cancer, the use of RI is limited at some institutions due to the specific equipment needed. Indocyanine green (ICG) fluorescence detection has been developed as a potential substitute for RI method. However, reports on the sensitivity of ICG and RI techniques in detecting SLN are inconsistent; hence, the present study was designed to compare the clinical efficacy between the combined method of ICG + BD (ICG-B) and RI + BD (RI-B). Methods A prospective observational study was performed that identified 138 breast cancer patients who had undergone lymphatic mapping and SLN biopsy with ICG-B or RI-B. The SLN detection rate, positive SLN counts, and lymph node metastasis between the 2 groups were compared. Results A total of 71 patients were recruited in the ICG-B group, while 67 were recruited in the RI-B group. The SLN detection rate was 100% in both the ICG-B and RI-B groups. Lymph node metastasis was found in 13 patients using ICG-B and in 12 patients using the RI-B technique (18.31% vs 17.91%, respectively; P = .61). No significant differences were observed in the positive SLN counts (3.12 ± 2.01 vs 3.33 ± 2.24, P = .37) between the 2 groups. Conclusions Indocyanine green combined with BD has an equal efficacy compared with RI plus BD when performing an axillary SLN biopsy in breast cancer. The ICG plus BD procedure is a promising alternative to traditional standard mapping methods.
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Affiliation(s)
- Yanmei Wang
- Department of Breast Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| | - Qing Peng
- Department of Breast Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| | - Pengcheng Sun
- Department of Breast Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| | - Xuesha Li
- Department of Breast Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| | - Yilong Dong
- Department of Physiology, School of Medicine, Yunnan University, Kunming, People’s Republic of China
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Nguyen CL, Zhou M, Easwaralingam N, Seah JL, Azimi F, Mak C, Pulitano C, Warrier S. Novel Dual Tracer Indocyanine Green and Radioisotope Versus Gold Standard Sentinel Lymph Node Biopsy in Breast Cancer: The GREENORBLUE Trial. Ann Surg Oncol 2023; 30:6520-6527. [PMID: 37402976 PMCID: PMC10507001 DOI: 10.1245/s10434-023-13824-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/14/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND The methods for sentinel lymph node (SLN) biopsy in breast cancer have been variable in type and number of tracers. Some units have abandoned the use of blue dye (BD) due to adverse reactions. Fluorescence-guided biopsy with indocyanine green (ICG) is a relatively novel technique. This study compared the clinical efficacy and costs between novel dual tracer ICG and radioisotope (ICG-RI) with "gold standard" BD and radioisotope (BD-RI). METHODS Single-surgeon study of 150 prospective patients with early breast cancer undergoing SLN biopsy (2021-2022) using ICG-RI compared with a retrospective cohort of 150 consecutive previous patients using BD-RI. Number of SLNs identified, rate of failed mapping, identification of metastatic SLNs, and adverse reactions were compared between techniques. Cost-minimisation analysis performed by using Medicare item numbers and micro-costing analysis. RESULTS Total number of SLNs identified with ICG-RI and BD-RI was 351 and 315, respectively. Mean number of SLNs identified with ICG-RI and BD-RI was 2.3 (standard deviation [SD] 1.4) and 2.1 (SD 1.1), respectively (p = 0.156). There were no cases of failed mapping with either dual technique. Metastatic SLNs were identified in 38 (25.3%) ICG-RI patients compared with 30 (20%) BD-RI patients (p = 0.641). There were no adverse reactions to ICG, whereas four cases of skin tattooing and anaphylaxis were associated with BD (p = 0.131). ICG-RI cost an additional AU$197.38 per case in addition to the initial cost for the imaging system. CLINICAL TRIAL REGISTRATION ACTRN12621001033831. CONCLUSIONS Novel tracer combination, ICG-RI, provided an effective and safe alternative to "gold standard" dual tracer. The caveat was the significantly greater costs associated with ICG.
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Affiliation(s)
- Chu Luan Nguyen
- Department of Breast Surgery, Chris O'Brien Lifehouse, Camperdown, NSW, Australia.
- Department of Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
- Department of Surgery, The University of Sydney, Camperdown, NSW, Australia.
| | - Michael Zhou
- Department of Surgery, The University of Sydney, Camperdown, NSW, Australia
| | - Neshanth Easwaralingam
- Department of Breast Surgery, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
- Department of Surgery, The University of Sydney, Camperdown, NSW, Australia
| | - Jue Li Seah
- Department of Breast Surgery, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
- Department of Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Department of Surgery, The University of Sydney, Camperdown, NSW, Australia
| | - Farhad Azimi
- Department of Breast Surgery, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
- Department of Surgery, The University of Sydney, Camperdown, NSW, Australia
| | - Cindy Mak
- Department of Breast Surgery, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
- Department of Surgery, The University of Sydney, Camperdown, NSW, Australia
| | - Carlo Pulitano
- Department of Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Department of Surgery, The University of Sydney, Camperdown, NSW, Australia
| | - Sanjay Warrier
- Department of Breast Surgery, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
- Department of Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Department of Surgery, The University of Sydney, Camperdown, NSW, Australia
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Lazar AM, Mutuleanu MD, Spiridon PM, Bordea CI, Suta TL, Blidaru A, Gherghe M. Feasibility of Sentinel Lymph Node Biopsy in Breast Cancer Patients with Axillary Conversion after Neoadjuvant Chemotherapy-A Single-Tertiary Centre Experience and Review of the Literature. Diagnostics (Basel) 2023; 13:3000. [PMID: 37761367 PMCID: PMC10528843 DOI: 10.3390/diagnostics13183000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Introduction: Sentinel lymph node biopsy (SLNB) is widely used in breast cancer patients who undergo neoadjuvant chemotherapy (NAC), replacing axillary lymph node dissection. While commonly accepted for cN0 patients, its role in cN1/2 patients remains controversial. Our study aims to investigate the role of SLNB in BC patients who underwent prior NAC and compare our results to those of other studies presented in the literature. (2) Materials and methods: Our retrospective study included 102 breast cancer patients who received NAC before 99mTc-albumin Nanocolloid SLN mapping and SLNB was performed, completed or not with axillary dissection. A review based on the PRISMA statement was also carried out, encompassing 20 studies. (3) Results: The lymphoscintigraphy performed after the administration of NAC presented an identification rate (IR) of 93.13%. IR for SLNB was 94.11%, with a false-negative rate (FNR) of 7.4%. After a median follow-up of 31.3 months, we obtained a distant disease-free survival rate of 98%. The results obtained by other groups were similar to those of our study, presenting IR in the range 80.8-96.8%, with FNR varying from 0 to 22%. (4) Conclusions: on conclusion, SLNB can accurately determine the lymph node status, with an acceptable FNR and maintain its expected prognostic role with low recurrence rates, and our results are comparable to those obtained by other studies.
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Affiliation(s)
- Alexandra Maria Lazar
- Carcinogenesis and Molecular Biology Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Mario-Demian Mutuleanu
- Nuclear Medicine Department, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
- Nuclear Medicine Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Paula Monica Spiridon
- Nuclear Medicine Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Cristian Ioan Bordea
- Surgical Oncology Department, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
- Surgical Oncology Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Tatiana Lucia Suta
- Nuclear Medicine Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Alexandru Blidaru
- Surgical Oncology Department, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
- Surgical Oncology Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Mirela Gherghe
- Nuclear Medicine Department, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
- Nuclear Medicine Department, Institute of Oncology “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
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Cuccurullo V, Rapa M, Catalfamo B, Cascini GL. Role of Nuclear Sentinel Lymph Node Mapping Compared to New Alternative Imaging Methods. J Pers Med 2023; 13:1219. [PMID: 37623469 PMCID: PMC10455335 DOI: 10.3390/jpm13081219] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/22/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
With the emergence of sentinel node technology, many patients can be staged histopathologically using lymphatic mapping and selective lymphadenectomy. Structural imaging by using US, CT and MR permits precise measurement of lymph node volume, which is strongly associated with neoplastic involvement. Sentinel lymph node detection has been an ideal field of application for nuclear medicine because anatomical data fails to represent the close connections between the lymphatic system and regional lymph nodes, or, more specifically, to identify the first draining lymph node. Hybrid imaging has demonstrated higher accuracy than standard imaging in SLN visualization on images, but it did not change in terms of surgical detection. New alternatives without ionizing radiations are emerging now from "non-radiological" fields, such as ophthalmology and dermatology, where fluorescence or opto-acoustic imaging, for example, are widely used. In this paper, we will analyze the advantages and limits of the main innovative methods in sentinel lymph node detection, including innovations in lymphoscintigraphy techniques that persist as the gold standard to date.
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Affiliation(s)
- Vincenzo Cuccurullo
- Department of Precision Medicine, Università della Campania “Luigi Vanvitelli”, 80138 Napoli, Italy
| | - Marco Rapa
- Department of Precision Medicine, Università della Campania “Luigi Vanvitelli”, 80138 Napoli, Italy
| | - Barbara Catalfamo
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy (G.L.C.)
| | - Giuseppe Lucio Cascini
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy (G.L.C.)
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Spiekerman van Weezelenburg MA, van Haaren ERM, Aldenhoven L, Frotscher CNA, Körver-Steeman R, van Bastelaar J, Bouwman LH, Vissers YLJ, Janssen A. An adapted protocol for magnetic localisation of nonpalpable breast cancer lesions and sentinel lymph nodes using a magnetic seed and superparamagnetic iron oxide tracer. J Surg Oncol 2023; 127:776-781. [PMID: 36598179 DOI: 10.1002/jso.27197] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Localisation techniques for nonpalpable breast cancer lesions and sentinel lymph node biopsy (SLNB) are associated with several drawbacks. A complete magnetic technique using magnetic seeds and superparamagnetic iron oxide tracer could be an interesting alternative. This study describes a clear protocol and the results of a combined magnetic approach. METHODS From August 2021 to February 2022 40 patients undergoing breast conserving surgery with SLNB were eligible for inclusion. Localisation was performed under ultrasound or stereotactic guidance, 1 week before surgery. Subsequently, 1 ml of tracer was injected at least 4 cm away from the tumour. Technetium-99m (99m Tc) was injected 1 day before surgery as control procedure. Outcomes were SLNB time, a number of nodes detected with magnetic tracer including comparison with 99m Tc, a success rate of malignant lesion detection and pathological margin assessment. RESULTS In total, 40 procedures were performed on 39 patients. A median of one node was retrieved. Sentinel nodes were retrieved using MagTrace® with a 92.5% detection rate compared to 99m Tc. Wide local excision under magnetic guidance was successful in 35 cases. CONCLUSIONS This paper describes a combined magnetic approach for breast-conserving surgery and SLNB. An adapted protocol is described and could be used for implementation.
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Affiliation(s)
| | | | - Loeki Aldenhoven
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | | | | | - James van Bastelaar
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Lee H Bouwman
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands.,Department of Clinical Engineering, Faculty of Science and Engineering, Maastricht University, Maastricht, The Netherlands
| | - Yvonne L J Vissers
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Alfred Janssen
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
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12
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van Haaren ERM, Martens MH, Spiekerman van Weezelenburg MA, van Roozendaal LM, Frotscher CNA, Körver-Steeman RRM, Lobbes MBI, van Bastelaar J, Vissers YLJ, Janssen A. Combined use of magnetic seed and tracer in breast conserving surgery with sentinel lymph node biopsy for non-palpable breast lesions: A pilot study describing pitfalls and solutions. Surg Oncol 2023; 46:101905. [PMID: 36706578 DOI: 10.1016/j.suronc.2023.101905] [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: 07/20/2022] [Revised: 12/28/2022] [Accepted: 01/22/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUNDS Traditionally, breast conserving surgery for non-palpable breast cancer is guided by wire or radioactive seed and radioactive tracer for sentinel lymph node biopsy (SLNB). Alternatively, a stain-less magnetic seed and superparamagnetic iron oxide tracer (SPIO) can be combined as a radioactive-free technique. The aim of this study was to define the pitfalls we encountered during implementation of this combined technique and provide solutions resulting in an instruction manual for a radio-active free procedure. METHODS Between January and March 2021, seventeen consecutive patients with cN0 non-palpable breast cancer were included. The magnetic seed was placed to localize the lesion and SPIO was used to identify the sentinel lymph node (SLN). A lymphoscintigraphy with Technetium-99m nano colloid was performed concomitantly in all patients as a control procedure for SPIO. Surgical outcomes are reported, including problems with placing and retrieval of the seed and SPIO and corresponding solutions. RESULTS Surgical excision was successful with invasive tumor-free margins in all patients. SLN detection was successful in 82% patients when compared to Technetium-99m. The most challenging issue was an overlapping magnetic signal of the seed and SPIO. Solutions are provided in detail. CONCLUSIONS Combined use of magnetic seed and SPIO for wide local excision and SLNB patients with non-palpable breast lesions appeared challenging due to overlapping magnetic signals. After multiple adaptations, the protocol proved to be feasible with an added advantage of eliminating the use of radioisotopes. We described the pitfalls and solutions resulting in an instruction manual for a totally radioactive-free procedure.
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Affiliation(s)
| | - Milou H Martens
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands
| | | | | | - Caroline N A Frotscher
- Department of Radiology and Nuclear Medicine Zuyderland Medical Centre, Sittard-Geleen, the Netherlands
| | - Rachel R M Körver-Steeman
- Department of Radiology and Nuclear Medicine Zuyderland Medical Centre, Sittard-Geleen, the Netherlands
| | - Marc B I Lobbes
- Department of Radiology and Nuclear Medicine Zuyderland Medical Centre, Sittard-Geleen, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, the Netherlands; GROW School for Oncology and Reproduction, Maastricht University, the Netherlands
| | - James van Bastelaar
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands
| | - Yvonne L J Vissers
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands
| | - Alfred Janssen
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands
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13
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Chen D, Liu X, Hu C, Hao R, Wang O, Xiao Y. Radiomics-based signature of breast cancer on preoperative contrast-enhanced MRI to predict axillary metastasis. Future Oncol 2022:1-14. [PMID: 36475996 DOI: 10.2217/fon-2022-0333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/23/2022] [Indexed: 12/13/2022] Open
Abstract
Aim: This study aimed to predict axillary metastasis using radiology features in dynamic contrast-enhanced MRI. Methods: This study included 243 breast lesions confirmed as malignant based on axillary status. Most outcome-predictive features were selected using four machine-learning algorithms. Receiver operating characteristic analysis was used to reflect diagnostic performance. Results: Least absolute shrinkage and selection operator was used to dimensionally reduce 1137 radiomics features to three features. Three optimal radiomics features were used to model construction. The logistic regression model achieved an accuracy of 97% and 85% in the training and test groups. Clinical utility was evaluated using decision curve analysis. Conclusion: The novel combination of radiomics analysis and machine-learning algorithm could predict axillary metastasis and prevent invasive manipulation.
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Affiliation(s)
- Danxiang Chen
- Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Xia Liu
- Department of Anesthesia, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Chunlei Hu
- Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Rutian Hao
- Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Ouchen Wang
- Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Yanling Xiao
- Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
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One Step Nucleic Acid Amplification (OSNA) Lysate Samples Are Suitable to Establish a Transcriptional Metastatic Signature in Patients with Early Stage Hormone Receptors-Positive Breast Cancer. Cancers (Basel) 2022; 14:cancers14235855. [PMID: 36497336 PMCID: PMC9736102 DOI: 10.3390/cancers14235855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/17/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
The One Step Nucleic Acid Amplification (OSNA) is being adopted worldwide for sentinel lymph nodes (SLNs) staging in breast cancer (BC). As major disadvantage, OSNA precludes prognostic information based on structural evaluation of SLNs. Our aim is to identify biomarkers related to tumor-microenvironment interplay exploring gene expression data from the OSNA remaining lysate. This study included 32 patients with early stage hormone receptors-positive BC. Remaining OSNA lysates were prepared for targeted RNA-sequencing analysis. Identification of differentially expressed genes (DEGs) was performed by DESeq2 in R and data analysis in STATA. The results show that, in metastatic SLNs, several genes were upregulated: KRT7, VTCN1, CD44, GATA3, ALOX15B, RORC, NECTIN2, LRG1, CD276, FOXM1 and IGF1R. Hierarchical clustering analysis revealed three different clusters. The identified DEGs codify proteins mainly involved in cancer aggressiveness and with impact in immune response. The overexpression of the immune suppressive genes VTCN1 and CD276 may explain that no direct evidence of activation of immune response in metastatic SLNs was found. We show that OSNA results may be improved incorporating microenvironment-related biomarkers that may be useful in the future for prognosis stratification and immunotherapy selection. As OSNA assay is being implemented for SLNs staging in other cancers, this approach could also have a wider utility.
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Wang G, Li W, Shi G, Tian Y, Kong L, Ding N, Lei J, Jin Z, Tian J, Du Y. Sensitive and specific detection of breast cancer lymph node metastasis through dual-modality magnetic particle imaging and fluorescence molecular imaging: a preclinical evaluation. Eur J Nucl Med Mol Imaging 2022; 49:2723-2734. [PMID: 35590110 PMCID: PMC9206605 DOI: 10.1007/s00259-022-05834-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/01/2022] [Indexed: 12/21/2022]
Abstract
PURPOSE A sensitive and specific imaging method to detect metastatic cancer cells in lymph nodes to detect the early-stage breast cancer is still a challenge. The purpose of this study was to investigate a novel breast cancer-targeting and tumour microenvironment ATP-responsive superparamagnetic iron oxide nanoparticles (SPIOs) imaging probe (abbreviated as SPIOs@A-T) that was developed to detect lymph node metastasis through fluorescence molecular imaging (FMI) and magnetic particle imaging (MPI). METHODS The conjugation of the targeted peptide CREKA and SPIOs was via linker sulfo-SMCC, while the dsDNA-Cy5.5 was modified on SPIOs through the conjugation between maleimide group in sulfo-SMCC and sulfydryl group in dsDNA-Cy5.5. SPIOs@A-T was characterised for its imaging properties, targeting ability and toxicity in vitro. Mice with metastatic lymph node (MLN) of breast cancer were established to evaluate the FMI and MPI imaging strategy in vivo. Healthy mice with normal lymph node (NLN) were used as control group. Histological examination and biosafety evaluation were performed for further assessment. RESULTS After injection with SPIOs@A-T, the obvious high fluorescent intensity and MPI signal were observed in MLN group than those in NLN group. FMI can specifically light up MLN using an ATP-responsive fluorescence design. On the other hand, MPI could complement the limitation of imaging depth from FMI and could detect MLN more sensitively. Besides, the biosafety evaluation results showed SPIOs@A-T had no detectable biological toxicity. CONCLUSION SPIOs@A-T imaging probe in combination with FMI and MPI can provide a promising novel method for the precise detection of MLN in vivo.
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Affiliation(s)
- Guorong Wang
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, 100730, China
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
| | - Wenzhe Li
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
| | - Guangyuan Shi
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
- University of Science and Technology of China, Hefei, 230026, China
| | - Yu Tian
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
- Medical School of Chinese PLA, Beijing, 100853, China
| | - Lingyan Kong
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Ning Ding
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jing Lei
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China.
- University of Chinese Academy of Sciences, Beijing, 100080, China.
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine, Beihang University, Beijing, 100083, China.
| | - Yang Du
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China.
- University of Chinese Academy of Sciences, Beijing, 100080, China.
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Li FM, Xu DY, Xu Q, Yuan Y. Breast-conserving surgery and sentinel lymph node biopsy for breast cancer and their correlation with the expression of polyligand proteoglycan-1. World J Clin Cases 2022; 10:3113-3120. [PMID: 35647115 PMCID: PMC9082713 DOI: 10.12998/wjcc.v10.i10.3113] [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] [Received: 12/20/2021] [Revised: 02/06/2022] [Accepted: 02/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Breast cancer is a malignant tumor with an unclear etiology and is the most common malignant tumor in women. Surgery is the main clinical treatment for breast cancer. Although traditional total mastectomy combined with axillary lymph node dissection is effective, it can result in shoulder dysfunction, especially in middle-aged and elderly patients with breast cancer with weak constitution and other underlying diseases. Furthermore, the postoperative quality of life is poor.
AIM To assess breast-conserving surgery and sentinel lymph node biopsy for breast cancer treatment and their correlation with polyligand proteoglycan-1.
METHODS Overall, 80 patients with breast cancer treated in our hospital from January 2021 to July 2021 were retrospectively selected and divided into an observation group (n = 44) and control group (n = 36) according to the treatment plan. The observation group was treated with breast-conserving surgery and sentinel lymph node biopsy, and the control group was treated with total breast resection. Simultaneously, immunohistochemical staining was used to detect the expression of syndecan-1 (SDC-1) in the lesions, and its relationship with clinicopathological findings was analyzed.
RESULTS Intraoperative blood loss, operation time, and hospital stay in the observation group were 65.51 ± 9.94 mL, 65.59 ± 9.40 min, and 14.80 ± 3.03 d, respectively, which were significantly lower than those in the control group (P < 0.05). The incidence of postoperative complications in the observation group was 11.36%, which was significantly lower than that in the control group (P < 0.05). The positive expression rate of SDC-1 in the observation group was 25.00%, and there was no significant difference between the groups (P > 0.05). The positive expression rate of SDC-1 in patients with American Joint Committee on Cancer (AJCC) stage II was 14.29%, which was significantly lower than that in patients with AJCC stage I (P < 0.05). The positive expression of SDC-1 had no significant relationship with age, course of disease, site, tissue type, and treatment plan (P > 0.05).
CONCLUSION Breast preservation surgery and sentinel lymph node biopsy for breast cancer treatment have fewer complications and quicker recovery than those treated with total breast resection. Low SDC-1 expression in breast cancer lesions is related to AJCC staging.
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Affiliation(s)
- Fu-Ming Li
- Department of Breast Surgery, The Second Hospital of Jiaxing, Jiaxing 314000, Zhejiang Province, China
| | - Dan-Ying Xu
- Department of Breast Surgery, The Second Hospital of Jiaxing, Jiaxing 314000, Zhejiang Province, China
| | - Qi Xu
- Department of Breast Surgery, The Second Hospital of Jiaxing, Jiaxing 314000, Zhejiang Province, China
| | - Yan Yuan
- Department of Breast Surgery, The Second Hospital of Jiaxing, Jiaxing 314000, Zhejiang Province, China
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Performance evaluation of machine learning for breast cancer diagnosis: A case study. INFORMATICS IN MEDICINE UNLOCKED 2022. [DOI: 10.1016/j.imu.2022.101009] [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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Zhang XP, Ma JD, Mo YQ, Jing J, Zheng DH, Chen LF, Wu T, Chen CT, Zhang Q, Zou YY, Lin JZ, Xu YH, Zou YW, Yang ZH, Ling L, Miossec P, Dai L. Addition of Fibroblast-Stromal Cell Markers to Immune Synovium Pathotypes Better Predicts Radiographic Progression at 1 Year in Active Rheumatoid Arthritis. Front Immunol 2021; 12:778480. [PMID: 34887865 PMCID: PMC8650215 DOI: 10.3389/fimmu.2021.778480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives This study aims to investigate if addition of fibroblast-stromal cell markers to a classification of synovial pathotypes improves their predictive value on clinical outcomes in rheumatoid arthritis (RA). Methods Active RA patients with a knee needle synovial biopsy at baseline and finished 1-year follow-up were recruited from a real-world prospective cohort. Positive staining for CD20, CD38, CD3, CD68, CD31, and CD90 were scored semiquantitatively (0-4). The primary outcome was radiographic progression defined as a minimum increase of 0.5 units of the modified total Sharp score from baseline to 1 year. Results Among 150 recruited RA patients, 123 (82%) had qualified synovial tissue. Higher scores of CD20+ B cells, sublining CD68+ macrophages, CD31+ endothelial cells, and CD90+ fibroblasts were associated with less decrease in disease activity and greater increase in radiographic progression. A new fibroblast-based classification of synovial pathotypes giving more priority to myeloid and stromal cells classified samples as myeloid-stromal (57.7%, 71/123), lymphoid (31.7%, 39/123), and paucicellular pathotypes (10.6%, 13/123). RA patients with myeloid-stromal pathotype showed the highest rate of radiographic progression (43.7% vs. 23.1% vs. 7.7%, p = 0.011), together with the lowest rate of Boolean remission at 3, 6, and 12 months. Baseline synovial myeloid-stromal pathotype independently predicted radiographic progression at 1 year (adjusted OR: 3.199, 95% confidence interval (95% CI): 1.278, 8.010). Similar results were obtained in a subgroup analysis of treatment-naive RA. Conclusions This novel fibroblast-based myeloid-stromal pathotype could predict radiographic progression at 1 year in active RA patients which may contribute to the shift of therapeutic decision in RA.
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Affiliation(s)
- Xue-Pei Zhang
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jian-Da Ma
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ying-Qian Mo
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jun Jing
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Dong-Hui Zheng
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Le-Feng Chen
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Tao Wu
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Chu-Tao Chen
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Qian Zhang
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yao-Yao Zou
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jian-Zi Lin
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yan-Hui Xu
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yao-Wei Zou
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ze-Hong Yang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Li Ling
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Pierre Miossec
- Department of Clinical Immunology and Rheumatology, Immunogenomics and Inflammation Research Unit, University of Lyon and Hospices Civils de Lyon, Lyon, France
| | - Lie Dai
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
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Deng H, Lei J, Jin L, Shi H. Diagnostic efficacy of sentinel lymph node in breast cancer under percutaneous contrast-enhanced ultrasound: An updated meta-analysis. Thorac Cancer 2021; 12:2849-2856. [PMID: 34605207 PMCID: PMC8563157 DOI: 10.1111/1759-7714.14139] [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] [Received: 07/19/2021] [Accepted: 08/19/2021] [Indexed: 11/28/2022] Open
Abstract
Background To investigate the diagnostic efficacy of sentinel lymph nodes (SLN) in breast cancer by percutaneous contrast‐enhanced ultrasound (CEUS) through pooled analysis of relevant studies published before June 2021. Methods We conducted a systematic review and meta‐analysis of relevant studies by searching the electronic databases of PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang and VIP and the studies were screened according to their inclusion and exclusion criteria. Sensitivity (SEN), specificity (SPE), positive likelihood ratio (+LR), negative likelihood ratio (−LR) and diagnostic odds ratio (DOR) were calculated by Meta‐disc 1.4 software and the summary receiver operating characteristic (SROC) curve and area under the curve of ROC (AUC) were constructed. Results Twenty‐two publications evaluating the diagnostic efficacy of SLN in breast cancer under percutaneous CEUS were included in the meta‐analysis. The diagnostic sensitivity, specificity were 0.86 (95% CI: 0.83–0.88) and 0.89 (95% CI: 0.87–0.91) for SLN in breast cancer detected by percutaneous CEUS respectively using a random effect model. The +LR and –LR were combined in a random effect model due to significant statistical heterogeneity (p < 0.05). The pooled +LR, −LR were 7.06 (95% CI: 4.34–11.50), and 0.17 (95% CI: 0.12–0.24), respectively. The combined DOR was 53.32 (95% CI: 29.74–95.61) for SLN diagnosis in breast cancer by percutaneous CEUS under a random effect model. The AUC was 0.94 which indicated that CEUS had high diagnostic efficacy of SLN in patients with breast cancer. Conclusions CEUS is a noninvasive method for the detection SLN in patients of breast cancer with relative high prediction efficacy.
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Affiliation(s)
- Huadong Deng
- Department of Ultrasonography, Lishui People's Hospital, Lishui, China
| | - Jianming Lei
- Department of Ultrasonography, Lishui People's Hospital, Lishui, China
| | - Lixian Jin
- Department of Ultrasonography, Lishui People's Hospital, Lishui, China
| | - Hongwei Shi
- Department of Ultrasonography, Lishui People's Hospital, Lishui, China
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20
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Bove S, Fragomeni SM, Romito A, DI Giorgio D, Rinaldi P, Pagliara D, Verri D, Romito I, Paris I, Tagliaferri L, Marazzi F, Visconti G, Franceschini G, Masetti R, Garganese G. Techniques for sentinel node biopsy in breast cancer. Minerva Surg 2021; 76:550-563. [PMID: 34338468 DOI: 10.23736/s2724-5691.21.09002-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Sentinel node biopsy (SNB) is the standard of care in women with breast cancer (BC) and clinically non suspicious axillary lymph nodes (LNs), due to its high negative predictive value (NPV) in the assessment of nodal status. SNB has significantly reduced complications related to the axillary lymph node dissection, such as lymphedema and upper limb dysfunction. EVIDENCE ACQUISITION The gold standard technique for SNB is the blue dye (BD) and technetium labelled nanocolloid (Tc-99m) double technique. However, nuclear medicine is not available in all Institutions and several new tracers and devices have been proposed, such as indocyanine green (ICG) and superparamagnetic iron oxides (SPIO). All these techniques show an accuracy and detection rate not inferior to that of the standard technique, with different specific pros and cons. The choice of how to perform a SNB primarily depends on the surgeon's confidence with the procedure, the availability of nuclear medicine and the economic resources of the Institutions. In this setting, new tracers, hybrid tracers and imaging techniques are being evaluated in order to improve the detection rate of sentinel lymph nodes (SNs) and minimize the number of unnecessary axillary surgeries through an accurate preoperative assessment of nodal status and to guide new minimally invasive diagnostic procedures of SNs. In particular, the contrast-enhanced ultrasound (CEUS) is an active field of research but cannot be recommended for clinical use at this time. EVIDENCE SYNTHESIS The ICG fluorescence technique was superior in terms of DR, as well as having the lowest FNR. The DR descending order was SPIO, Tc, dual modality (Tc/BD), CEUS and BD. CONCLUSIONS This paper is a narrative review of the most common SNB techniques in BC with a focus on recent innovations.
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Affiliation(s)
- Sonia Bove
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - Simona M Fragomeni
- Unità di Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessia Romito
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy -
| | | | - Pierluigi Rinaldi
- Radiology and Interventional Radiology Unit, Mater Olbia Hospital, Olbia, Italy.,Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Domenico Pagliara
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - Debora Verri
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - Ilaria Romito
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - Ida Paris
- Unità di Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Tagliaferri
- Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia - Gemelli ART (Advanced Radiation Therapy), Interventional Oncology Center (IOC), Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Fabio Marazzi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe Visconti
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC Chirurgia Plastica, Università Cattolica del Sacro Cuore - Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - Gianluca Franceschini
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Multidisciplinary Breast Center, Università Cattolica del Sacro Cuore - Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - Riccardo Masetti
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Multidisciplinary Breast Center, Università Cattolica del Sacro Cuore - Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - Giorgia Garganese
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy.,Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
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Operable breast cancer: How not to worsen the prognosis, especially in triple negative and stage II tumors. Surg Oncol 2021; 38:101596. [PMID: 34015750 DOI: 10.1016/j.suronc.2021.101596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/13/2021] [Accepted: 04/26/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Oncological surgery must follow some fundamental principles to be truly curative, one of which is the resection of the tumor with surgical margins free of neoplasia. In breast cancer, surgery with positive margins should be expanded immediately. There are probably different intensities, between the stages and molecular subtypes of operable breast cancer, of worsening prognosis due to the surgical margin compromised by the neoplasia in women not submitted to the necessary enlargement of the positive surgical margin. MATERIALS AND. METHODS Seven hundred and forty-seven women with invasive ductal carcinoma of the breast, analyzing anatomical-pathological information, types of surgery, molecular subtypes, and the presence or absence of the surgical margin compromised by neoplasia. RESULTS Sixty-one (8.2%) patients had positive surgical margin, causing 2.85 times more risk of locoregional relapse compared to negative surgical margin by multivariate analysis. In subgroup analysis, among stages I, II and III, stage II was the most negatively impacted, with those patients presenting 2.42 times more risk of distant metastasis and 4.94 times more risk of locoregional relapses compared to negative surgical margin by multivariate analysis. Among the molecular subtypes, Triple Negative tumors with a positive surgical margin had 3.56 times more risk of death, 4.98 times more risk of distant metastasis and 5.55 times more risk of locoregional relapse compared to negative surgical margin by multivariate analysis. CONCLUSIONS The positive surgical margin, especially in Stage II and Triple-Negative breast cancer patients negatively impact the patient's evolution, increasing risk of distant metastasis and death.
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