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Leong SP, Witte MH. Cancer metastasis through the lymphatic versus blood vessels. Clin Exp Metastasis 2024:10.1007/s10585-024-10288-0. [PMID: 38940900 DOI: 10.1007/s10585-024-10288-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/10/2024] [Indexed: 06/29/2024]
Abstract
Whether cancer cells metastasize from the primary site to the distant sites via the lymphatic vessels or the blood vessels directly into the circulation is still under intense study. In this review article, we follow the journey of cancer cells metastasizing to the sentinel lymph nodes and beyond to the distant sites. We emphasize cancer heterogeneity and microenvironment as major determinants of cancer metastasis. Multiple molecules have been found to be associated with the complicated process of metastasis. Based on the large sentinel lymph node data, it is reasonable to conclude that cancer cells may metastasize through the blood vessels in some cases but in most cases, they use the sentinel lymph nodes as the major gateway to enter the circulation to distant sites.
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Affiliation(s)
- Stanley P Leong
- California Pacific Medical Center and Research Institute, University of California School of Medicine, San Francisco, USA.
| | - Marlys H Witte
- Department of Surgery, Neurosurgery and Pediatrics, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
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2
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Chmiel P, Krotewicz M, Szumera-Ciećkiewicz A, Bartnik E, Czarnecka AM, Rutkowski P. Review on Lymph Node Metastases, Sentinel Lymph Node Biopsy, and Lymphadenectomy in Sarcoma. Curr Oncol 2024; 31:307-323. [PMID: 38248105 PMCID: PMC10814427 DOI: 10.3390/curroncol31010020] [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: 10/29/2023] [Revised: 12/17/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Soft tissue sarcomas (STS) originating from connective tissue rarely affect the lymph nodes. However, involvement of lymph nodes in STS is an important aspect of prognosis and treatment. Currently, there is no consensus on the diagnosis and management of lymph node metastases in STS. The key risk factor for nodal involvement is the histological subtype of sarcoma. Radiological and pathological evaluation seems to be the most effective method of assessing lymph nodes in these neoplasms. Thus, sentinel lymph node biopsy (SLNB), which has been shown to be valuable in the management of melanoma or breast cancer, may also be a beneficial diagnostic option in some high-risk STS subtypes. This review summarizes data on the risk factors and clinical characteristics of lymph node involvement in STS. Possible management and therapeutic options are also discussed.
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Affiliation(s)
- Paulina Chmiel
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.C.); (M.K.); (P.R.)
| | - Maria Krotewicz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.C.); (M.K.); (P.R.)
| | - Anna Szumera-Ciećkiewicz
- Department of Pathology, Maria Sklodowska Curie National Research Institute of Oncology, 02-781 Warsaw, Poland;
| | - Ewa Bartnik
- Institute of Genetics and Biotechnology, Faculty of Biology, University of Warsaw, 02-106 Warsaw, Poland;
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, 02-106 Warsaw, Poland
| | - Anna M. Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.C.); (M.K.); (P.R.)
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.C.); (M.K.); (P.R.)
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Sturgess V, Azubuike UF, Tanner K. Vascular regulation of disseminated tumor cells during metastatic spread. BIOPHYSICS REVIEWS 2023; 4:011310. [PMID: 38510161 PMCID: PMC10903479 DOI: 10.1063/5.0106675] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 02/17/2023] [Indexed: 03/22/2024]
Abstract
Cancer cells can travel to other organs via interconnected vascular systems to form new lesions in a process known as metastatic spread. Unfortunately, metastasis remains the leading cause of patient lethality. In recent years, it has been demonstrated that physical cues are just as important as chemical and genetic perturbations in driving changes in gene expression, cell motility, and survival. In this concise review, we focus on the physical cues that cancer cells experience as they migrate through the lymphatic and blood vascular networks. We also present an overview of steps that may facilitate organ specific metastasis.
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Affiliation(s)
- Victoria Sturgess
- Laboratory of Cell Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 37, Room 2132, Bethesda MD 20892, USA
| | - Udochi F. Azubuike
- Laboratory of Cell Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 37, Room 2132, Bethesda MD 20892, USA
| | - Kandice Tanner
- Laboratory of Cell Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 37, Room 2132, Bethesda MD 20892, USA
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Allard-Coutu A, Dobson V, Schmitz E, Shah H, Nessim C. The Evolution of the Sentinel Node Biopsy in Melanoma. Life (Basel) 2023; 13:life13020489. [PMID: 36836846 PMCID: PMC9966203 DOI: 10.3390/life13020489] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/11/2023] [Accepted: 02/02/2023] [Indexed: 02/12/2023] Open
Abstract
The growing repertoire of approved immune-checkpoint inhibitors and targeted therapy has revolutionized the adjuvant treatment of melanoma. While the treatment of primary cutaneous melanoma remains wide local excision (WLE), the management of regional lymph nodes continues to evolve in light of practice-changing clinical trials and dramatically improved adjuvant therapy. With large multicenter studies reporting no benefit in overall survival for completion lymph node dissection (CLND) after a positive sentinel node biopsy (SLNB), controversy remains regarding patient selection and clinical decision-making. This review explores the evolution of the SLNB in cutaneous melanoma in the context of a rapidly changing adjuvant treatment landscape, summarizing the key clinical trials which shaped current practice guidelines.
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Affiliation(s)
- Alexandra Allard-Coutu
- Department of General Surgery, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Correspondence:
| | | | - Erika Schmitz
- Department of General Surgery, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Hely Shah
- Department of Medical Oncology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Carolyn Nessim
- Department of General Surgery, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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Sentinel Lymph Node Biopsy in Cutaneous Melanoma, a Clinical Point of View. Medicina (B Aires) 2022; 58:medicina58111589. [DOI: 10.3390/medicina58111589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Sentinel lymph node biopsy (SLNB) is a surgical procedure that has been used in patients with cutaneous melanoma for nearly 30 years. It is used for both staging and regional disease control with minimum morbidity, as proven by numerous worldwide prospective studies. It has been incorporated in the recommendations of national and professional guidelines. In this article, we provide a summary of the general information on SLNB in the clinical guidelines for the management of cutaneous malignant melanoma (American Association of Dermatology, European Society of Medical Oncology, National Comprehensive Cancer Network, and Cancer Council Australia) and review the most relevant literature to provide an update on the existing recommendations for SLNB.
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Crystal JS, Thompson JF, Hyngstrom J, Caracò C, Zager JS, Jahkola T, Bowles TL, Pennacchioli E, Beitsch PD, Hoekstra HJ, Moncrieff M, Ingvar C, van Akkooi A, Sabel MS, Levine EA, Agnese D, Henderson M, Dummer R, Neves RI, Rossi CR, Kane JM, Trocha S, Wright F, Byrd DR, Matter M, Hsueh EC, MacKenzie-Ross A, Kelley M, Terheyden P, Huston TL, Wayne JD, Neuman H, Smithers BM, Ariyan CE, Desai D, Gershenwald JE, Schneebaum S, Gesierich A, Jacobs LK, Lewis JM, McMasters KM, O'Donoghue C, van der Westhuizen A, Sardi A, Barth R, Barone R, McKinnon JG, Slingluff CL, Farma JM, Schultz E, Scheri RP, Vidal-Sicart S, Molina M, Testori AAE, Foshag LJ, Van Kreuningen L, Wang HJ, Sim MS, Scolyer RA, Elashoff DE, Cochran AJ, Faries MB. Therapeutic Value of Sentinel Lymph Node Biopsy in Patients With Melanoma: A Randomized Clinical Trial. JAMA Surg 2022; 157:835-842. [PMID: 35921122 PMCID: PMC9475390 DOI: 10.1001/jamasurg.2022.2055] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/19/2022] [Indexed: 12/12/2022]
Abstract
Importance Sentinel lymph node (SLN) biopsy is a standard staging procedure for cutaneous melanoma. Regional disease control is a clinically important therapeutic goal of surgical intervention, including nodal surgery. Objective To determine how frequently SLN biopsy without completion lymph node dissection (CLND) results in long-term regional nodal disease control in patients with SLN metastases. Design, Setting, and Participants The second Multicenter Selective Lymphadenectomy Trial (MSLT-II), a prospective multicenter randomized clinical trial, randomized participants with SLN metastases to either CLND or nodal observation. The current analysis examines observation patients with regard to regional nodal recurrence. Trial patients were aged 18 to 75 years with melanoma metastatic to SLN(s). Data were collected from December 2004 to April 2019, and data were analyzed from July 2020 to January 2022. Interventions Nodal observation with ultrasonography rather than CLND. Main Outcomes and Measures In-basin nodal recurrence. Results Of 823 included patients, 479 (58.2%) were male, and the mean (SD) age was 52.8 (13.8) years. Among 855 observed basins, at 10 years, 80.2% (actuarial; 95% CI, 77-83) of basins were free of nodal recurrence. By univariable analysis, freedom from regional nodal recurrence was associated with age younger than 50 years (hazard ratio [HR], 0.49; 95% CI, 0.34-0.70; P < .001), nonulcerated melanoma (HR, 0.36; 95% CI, 0.36-0.49; P < .001), thinner primary melanoma (less than 1.5 mm; HR, 0.46; 95% CI, 0.27-0.78; P = .004), axillary basin (HR, 0.61; 95% CI, 0.44-0.86; P = .005), fewer positive SLNs (1 vs 3 or more; HR, 0.32; 95% CI, 0.14-0.75; P = .008), and SLN tumor burden (measured by diameter less than 1 mm [HR, 0.39; 95% CI, 0.26-0.60; P = .001] or less than 5% area [HR, 0.36; 95% CI, 0.24-0.54; P < .001]). By multivariable analysis, younger age (HR, 0.57; 95% CI, 0.39-0.84; P = .004), thinner primary melanoma (HR, 0.40; 95% CI, 0.22-0.70; P = .002), axillary basin (HR, 0.55; 95% CI, 0.31-0.96; P = .03), SLN metastasis diameter less than 1 mm (HR, 0.52; 95% CI, 0.33-0.81; P = .007), and area less than 5% (HR, 0.58; 95% CI, 0.38-0.88; P = .01) were associated with basin control. When looking at the identified risk factors of age (50 years or older), ulceration, Breslow thickness greater than 3.5 mm, nonaxillary basin, and tumor burden of maximum diameter of 1 mm or greater and/or metastasis area of 5% or greater and excluding missing value cases, basin disease-free rates at 5 years were 96% (95% CI, 88-100) for patients with 0 risk factors, 89% (95% CI, 82-96) for 1 risk factor, 86% (95% CI, 80-93) for 2 risk factors, 80% (95% CI, 71-89) for 3 risk factors, 61% (95% CI, 48-74) for 4 risk factors, and 54% (95% CI, 36-72) for 5 or 6 risk factors. Conclusions and Relevance This randomized clinical trial was the largest prospective evaluation of long-term regional basin control in patients with melanoma who had nodal observation after removal of a positive SLN. SLN biopsy without CLND cleared disease in the affected nodal basin in most patients, even those with multiple risk factors for in-basin recurrence. In addition to its well-validated value in staging, SLN biopsy may also be regarded as therapeutic in some patients. Trial Registration ClinicalTrials.gov Identifier: NCT00297895.
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Affiliation(s)
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - John Hyngstrom
- Department of Surgery, University of Utah, Salt Lake City
| | - Corrado Caracò
- Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale," Napoli, Italy
| | - Jonathan S Zager
- Departments of Cutaneous Oncology and Sarcoma, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Tiina Jahkola
- Department of Plastic and Reconstructive Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Tawnya L Bowles
- Department of Surgical Oncology, Intermountain Medical Center, Salt Lake City, Utah
| | - Elisabetta Pennacchioli
- Division of Melanoma, Soft Tissue Sarcomas and Rare Tumors, European Institute of Oncology, Milano, Italy
| | | | - Harald J Hoekstra
- Department of Surgery, University Hospital Groningen, Groningen, the Netherlands
| | - Marc Moncrieff
- Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | | | - Alexander van Akkooi
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Edward A Levine
- Department of Surgical Oncology, Wake Forest University, Winston-Salem, North Carolina
| | - Doreen Agnese
- Department of Surgery, Ohio State University, Columbus
| | - Michael Henderson
- Department of Surgery, University of Melbourne, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Rogerio I Neves
- Department of Surgery, Pennsylvania State University Milton S. Hershey Medical Center, Hershey
- Now at Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | | | - John M Kane
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York
| | - Steven Trocha
- Department of Surgical Oncology, Prisma Health, Columbia, South Carolina
| | - Frances Wright
- Department of Surgical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - David R Byrd
- Department of Surgery, University of Washington, Seattle
| | - Maurice Matter
- Department of Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Eddy C Hsueh
- Department of Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Alastair MacKenzie-Ross
- Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Mark Kelley
- Department of Surgery, Vanderbilt University, Nashville, Tennessee
| | | | - Tara L Huston
- Department of Surgery, Stony Brook University, Stony Brook, New York
| | - Jeffrey D Wayne
- Department of Surgery, Northwestern University, Chicago, Illinois
| | - Heather Neuman
- Department of Surgery, University of Wisconsin at Madison
| | - B Mark Smithers
- Department of Surgery, University of Queensland, Brisbane, Australia
| | - Charlotte E Ariyan
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Darius Desai
- Department of Surgery, Saint Luke's University Hospital, Bethlehem, Pennsylvania
| | | | - Shlomo Schneebaum
- Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Anja Gesierich
- Department of Dermatology, University Hospital Wurzburg, Wurzburg, Germany
| | - Lisa K Jacobs
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - James M Lewis
- Department of Surgery, University of Tennessee Medical Center, Knoxville
| | - Kelly M McMasters
- Department of Surgery, University of Louisville, Louisville, Tennessee
| | | | | | - Armando Sardi
- Department of Surgical Oncology, Mercy Medical Center, Baltimore, Maryland
| | - Richard Barth
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire
| | - Robert Barone
- Surgical Oncology, Sharp Hospital, San Diego, California
| | - J Greg McKinnon
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | | | - Jeffrey M Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Erwin Schultz
- Department of Dermatology, Nuremberg General Hospital, Paracelsus Medical Center, Nuremberg, Germany
| | | | - Sergi Vidal-Sicart
- Nuclear Medicine Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Manuel Molina
- Department of Surgery, Lakeland Regional Health, Lakeland, Florida
| | | | - Leland J Foshag
- Department of Surgical Oncology, John Wayne Cancer Institute, Santa Monica, California
| | - Lisa Van Kreuningen
- Manager of Research Operations, Saint John's Cancer Institute, Santa Monica, California
| | - He-Jing Wang
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Myung-Shin Sim
- Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Richard A Scolyer
- Melanoma Institute Australia, Department of Medicine, University of Sydney, Sydney, Australia
| | - David E Elashoff
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Alistair J Cochran
- Department of Anatomic Pathology, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Mark B Faries
- The Angeles Clinic and Research Institute, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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Molecular mechanisms of cancer metastasis via the lymphatic versus the blood vessels. Clin Exp Metastasis 2021; 39:159-179. [PMID: 34767139 PMCID: PMC8967809 DOI: 10.1007/s10585-021-10120-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/26/2021] [Indexed: 02/07/2023]
Abstract
Cancer metastasis is the process by which primary cancer cells invade through the lymphatic or blood vessels to distant sites. The molecular mechanisms by which cancer cells spread either through the lymphatic versus blood vessels or both are not well established. Two major developments have helped us to understand the process more clearly. First, the development of the sentinel lymph node (SLN) concept which is well established in melanoma and breast cancer. The SLN is the first lymph node in the draining nodal basin to receive cancer cells. Patients with a negative SLN biopsy show a significantly lower incidence of distant metastasis, suggesting that the SLN may be the major gateway for cancer metastasis in these cancer types. Second, the discovery and characterization of several biomarkers including VEGF-C, LYVE-1, Podoplanin and Prox-1 have opened new vistas in the understanding of the induction of lymphangiogenesis by cancer cells. Cancer cells must complete multiple steps to invade the lymphatic system, some of which may be enabled by the evolution of new traits during cancer progression. Thus, cancer cells may spread initially through the main gateway of the SLN, from which evolving cancer clones can invade the blood vessels to distant sites. Cancer cells may also enter the blood vessels directly, bypassing the SLN to establish distant metastases. Future studies need to pinpoint the molecules that are used by cancer cells at different stages of metastasis via different routes so that specific therapies can be targeted against these molecules, with the goal of stopping or preventing cancer metastasis.
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El-Omar O, Ragavan S, Yoon WY, Grant ME, Green AC, Oudit D. Is skipped nodal metastasis a phenomenon of cutaneous melanoma? Cancer Treat Res Commun 2021; 29:100485. [PMID: 34798594 DOI: 10.1016/j.ctarc.2021.100485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/31/2021] [Accepted: 11/04/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND METHODS Skipped nodal metastasis (SNM) is a recognized phenomenon of visceral cancers when metastases bypass the regional basin and skip to a distant nodal basin without evidence of distant metastases. Its occurrence is undocumented in cutaneous melanoma patients but of potential prognostic significance. We therefore assessed the frequency of SNM in a large series of patients with limb melanomas. PATIENTS AND METHODS We studied melanoma patients attending a tertiary oncology hospital in northwest England using two approaches. First, we systematically searched medical records of an unselected patient sample treated 2002-2015, and second, we studied lymphoscintigrams of all patients with limb melanoma who underwent sentinel node biopsy 2008-2019. RESULTS Of 672 melanoma patients whose clinical records were examined, 16 had regional nodal metastases without apparent visceral spread and one appeared to have SNM but further scans were uncovered that showed concurrent pulmonary metastases. Of 667 limb melanoma patients with lymphoscintigrams, 7 showed dual lymphatic drainage patterns to distal as well as regional nodal basins, but none had micro-metastases solely in the distant basin. CONCLUSION Occurrence of SNM in cutaneous melanoma is highly unlikely.
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Affiliation(s)
- Omar El-Omar
- The Christie NHS Foundation Trust, Wilmslow Rd, Manchester, United Kingdom
| | | | - Won Young Yoon
- The Christie NHS Foundation Trust, Wilmslow Rd, Manchester, United Kingdom
| | - Megan E Grant
- Molecular Oncology Group, CRUK Manchester Institute, University of Manchester, Manchester, United Kingdom.
| | - Adele C Green
- Molecular Oncology Group, CRUK Manchester Institute, University of Manchester, Manchester, United Kingdom; QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia; Division of Musculoskeletal and Dermatological Sciences, NIHR Manchester Biomedical Research Centre, United Kingdom
| | - Deemesh Oudit
- The Christie NHS Foundation Trust, Wilmslow Rd, Manchester, United Kingdom.
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Leong SP, Pissas A, Scarato M, Gallon F, Pissas MH, Amore M, Wu M, Faries MB, Lund AW. The lymphatic system and sentinel lymph nodes: conduit for cancer metastasis. Clin Exp Metastasis 2021; 39:139-157. [PMID: 34651243 PMCID: PMC8967769 DOI: 10.1007/s10585-021-10123-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/06/2021] [Indexed: 11/03/2022]
Abstract
The lymphatic system is a complicated system consisting of the lymphatic vessels and lymph nodes draining the extracellular fluid containing cellular debris, excess water and toxins to the circulatory system. The lymph nodes serve as a filter, thus, when the lymph fluid returns to the heart, it is completely sterile. In addition, the lymphatic system includes the mucosa-associated lymphoid tissue, such as tonsils, adenoids, Peyers patches in the small bowel and even the appendix. Taking advantage of the drainage system of the lymphatics, cancer cells enter the lymphatic vessels and then the lymph nodes. In general, the lymph nodes may serve as a gateway in the majority of cases in early cancer. Occasionally, the cancer cells may enter the blood vessels. This review article emphasizes the structural integrity of the lymphatic system through which cancer cells may spread. Using melanoma and breast cancer sentinel lymph node model systems, the spread of early cancer through the lymphatic system is progressive in a majority of cases. The lymphatic systems of the internal organs are much more complicated and difficult to study. Knowledge from melanoma and breast cancer spread to the sentinel lymph node may establish the basic principles of cancer metastasis. The goal of this review article is to emphasize the complexity of the lymphatic system. To date, the molecular mechanisms of cancer spread from the cancer microenvironment to the sentinel lymph node and distant sites are still poorly understood and their elucidation should take major priority in cancer metastasis research.
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Affiliation(s)
- Stanley P Leong
- California Pacific Medical Center and Research Institute, San Francisco, CA, USA. .,University of California, San Francisco, San Francisco, CA, USA.
| | - Alexander Pissas
- Department of Visceral Surgery General Hospital of Bagnols sur Cèze and of Anatomy Faculty of Medicine of Montpellier, Bagnols sur Ceze, Montpellier, France
| | - Muriel Scarato
- Department of Visceral Surgery General Hospital of Bagnols sur Cèze and of Anatomy Faculty of Medicine of Montpellier, Bagnols sur Ceze, Montpellier, France
| | - Francoise Gallon
- Department of Visceral Surgery General Hospital of Bagnols sur Cèze and of Anatomy Faculty of Medicine of Montpellier, Bagnols sur Ceze, Montpellier, France
| | - Marie Helene Pissas
- Department of Visceral Surgery General Hospital of Bagnols sur Cèze and of Anatomy Faculty of Medicine of Montpellier, Bagnols sur Ceze, Montpellier, France
| | - Miguel Amore
- Vascular Anatomy Lab. III Chair of Anatomy, Faculty of Medicine, Buenos Aires University, Buenos Aires, Argentina.,Phlebology and Lymphology Unit. Cardiovascular Surgery Division, Central Military Hospital, Buenos Aires, Argentina
| | - Max Wu
- California Pacific Medical Center, San Francisco, USA
| | - Mark B Faries
- The Angeles Clinic and Research Institute A Cedars-Sinai Affiliate, Los Angeles, CA, USA
| | - Amanda W Lund
- Ronald O. Perelman Department of Dermatology, Department of Pathology, and NYU Langone Laura and Isaac Perlmutter Cancer Center, NYU Grossman School of Medicine, New York, NY, 10016, USA
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Fan YF, Zhu SX, Hou FB, Zhao DF, Pan QS, Xiang YW, Qian XK, Ge GB, Wang P. Spectrophotometric Assays for Sensing Tyrosinase Activity and Their Applications. BIOSENSORS 2021; 11:290. [PMID: 34436092 PMCID: PMC8393227 DOI: 10.3390/bios11080290] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 12/13/2022]
Abstract
Tyrosinase (TYR, E.C. 1.14.18.1), a critical enzyme participating in melanogenesis, catalyzes the first two steps in melanin biosynthesis including the ortho-hydroxylation of L-tyrosine and the oxidation of L-DOPA. Previous pharmacological investigations have revealed that an abnormal level of TYR is tightly associated with various dermatoses, including albinism, age spots, and malignant melanoma. TYR inhibitors can partially block the formation of pigment, which are always used for improving skin tone and treating dermatoses. The practical and reliable assays for monitoring TYR activity levels are very useful for both disease diagnosis and drug discovery. This review comprehensively summarizes structural and enzymatic characteristics, catalytic mechanism and substrate preference of TYR, as well as the recent advances in biochemical assays for sensing TYR activity and their biomedical applications. The design strategies of various TYR substrates, alongside with several lists of all reported biochemical assays for sensing TYR including analytical conditions and kinetic parameters, are presented for the first time. Additionally, the biomedical applications and future perspectives of these optical assays are also highlighted. The information and knowledge presented in this review offer a group of practical and reliable assays and imaging tools for sensing TYR activities in complex biological systems, which strongly facilitates high-throughput screening TYR inhibitors and further investigations on the relevance of TYR to human diseases.
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Affiliation(s)
- Yu-Fan Fan
- Shanghai Frontiers Science Center for Chinese Medicine Chemical Biology, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; (Y.-F.F.); (F.-B.H.); (D.-F.Z.); (Q.-S.P.); (X.-K.Q.); (G.-B.G.)
| | - Si-Xing Zhu
- Institute of Science, Technology and Humanities, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China;
| | - Fan-Bin Hou
- Shanghai Frontiers Science Center for Chinese Medicine Chemical Biology, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; (Y.-F.F.); (F.-B.H.); (D.-F.Z.); (Q.-S.P.); (X.-K.Q.); (G.-B.G.)
| | - Dong-Fang Zhao
- Shanghai Frontiers Science Center for Chinese Medicine Chemical Biology, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; (Y.-F.F.); (F.-B.H.); (D.-F.Z.); (Q.-S.P.); (X.-K.Q.); (G.-B.G.)
| | - Qiu-Sha Pan
- Shanghai Frontiers Science Center for Chinese Medicine Chemical Biology, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; (Y.-F.F.); (F.-B.H.); (D.-F.Z.); (Q.-S.P.); (X.-K.Q.); (G.-B.G.)
| | - Yan-Wei Xiang
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China;
| | - Xing-Kai Qian
- Shanghai Frontiers Science Center for Chinese Medicine Chemical Biology, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; (Y.-F.F.); (F.-B.H.); (D.-F.Z.); (Q.-S.P.); (X.-K.Q.); (G.-B.G.)
| | - Guang-Bo Ge
- Shanghai Frontiers Science Center for Chinese Medicine Chemical Biology, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; (Y.-F.F.); (F.-B.H.); (D.-F.Z.); (Q.-S.P.); (X.-K.Q.); (G.-B.G.)
| | - Ping Wang
- Shanghai Frontiers Science Center for Chinese Medicine Chemical Biology, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; (Y.-F.F.); (F.-B.H.); (D.-F.Z.); (Q.-S.P.); (X.-K.Q.); (G.-B.G.)
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11
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Würnschimmel C, Wenzel M, Maurer T, Valdés Olmos RA, Vidal-Sicart S. Contemporary update of SPECT tracers and novelties in radioguided surgery: a perspective based on urology. 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; 65:215-228. [PMID: 33829716 DOI: 10.23736/s1824-4785.21.03345-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Recent technical advances and implementation of novel radiotracers have further increased the potential of radioguided surgery for a broad variety of malignancies. Indeed, the possibilities for future applications of novel radiotracers in diverse oncological strategies has become more promising than ever. This literature review aims to provide a contemporary update on a selected group of radiotracers and evaluates the usability of radioguided surgery and sentinel node procedures, focusing on most promising advances. For example, the impact of targeted radiotracers on prostate specific membrane antigen (PSMA), CD206 receptor-targeted agents (99mTc-tilmanocept), and hybrid tracers adding fluorescence to radioguidance (ICG-99mTc-nanocolloid) as well as targeting hypoxia-induced carbonic anhydrase IX (CAIX) will be covered. Furthermore, future outlooks on the implementation of gold nanoparticles (AuNP's), but also technical advances in improved radiotracer detection by hybrid gamma devices will be discussed.
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Affiliation(s)
- Christoph Würnschimmel
- Martini-Klinik Prostate Cancer Center, University Hospital of Hamburg-Eppendorf, Hamburg, Germany -
| | - Mike Wenzel
- Department of Urology, University Hospital of Frankfurt, Frankfurt, Germany
| | - Tobias Maurer
- Martini-Klinik Prostate Cancer Center, University Hospital of Hamburg-Eppendorf, Hamburg, Germany.,Department of Urology, University Hospital of Hamburg-Eppendorf, Hamburg, Germany
| | - Renato A Valdés Olmos
- Section of Nuclear Medicine, Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, the Netherlands
| | - Sergi Vidal-Sicart
- Department of Nuclear Medicine, Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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12
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Yüksel C, Çulcu S, Doğan L. The Effects of Modified Lymphoscintigraphy Techniques on Sentinel Lymph Node Biopsy Success During the COVID-19 Pandemic Period. J INVEST SURG 2020; 35:469-474. [PMID: 33322956 DOI: 10.1080/08941939.2020.1859022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Sampling of the sentinel lymph node (SLN) in breast cancer provides accurate information about the condition of the axilla in 95% of cases. Technically in detecting SLN; radioactive substance, dyers or both are used. During the COVID-19 (Coronavirus disease 2019) pandemic, delayed images were not taken in lymphoscintigraphy to reduce the risk of transmission by shortening the waiting time in our center. In this study, the effects of early and delayed lymphoscintigraphic images and only early images on our clinical practice were evaluated. METHODS We investigated the data of 147 patients in this study who underwent SLNB due to early-stage breast cancer at our institute during the COVID-19 pandemic period (PP) (March/April/May 2020) and within 3 months before the pandemic were evaluated. RESULTS Patients were divided into two groups, before pandemic (BP) and PP. BP consisted of patients whose early and delayed images were taken in lymphoscintigraphy whereas PP consisted of those with early images only. There were 74 patients in the BP group and 73 patients in the PP group. Early phase increased uptake was not observed in 23 patients, and increased uptake was obtained from 22 of these patients with delayed imaging in BP period. In PP, increased uptake was not observed in 12 patients. SLN was not detected in 2 patients in the BP group and 7 in the PP group. It was found that the sensitivity, NPV and accuracy of the SLNB procedure performed after taking delayed images was higher. CONCLUSIONS In the present study, we believe that if technically possible, delayed images taken during the lymphoscintigraphy can assist the surgeon in terms of SLN detection and the number of SLNs removed.
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Affiliation(s)
- Cemil Yüksel
- Department of Surgical Oncology, University of Health Science, Ankara Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Serdar Çulcu
- Department of Surgical Oncology, University of Health Science, Ankara Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Lütfi Doğan
- Department of Surgical Oncology, University of Health Science, Ankara Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
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13
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Ferwerda CC, Muller MGS, Meijer S. The Sentinel Node Concept in Melanoma and Breast Cancer : Relevancy and Therapeutic Consequences. Acta Chir Belg 2020. [DOI: 10.1080/00015458.2000.12098558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- C. C. Ferwerda
- University Hospital Vrije Universiteit, Department of Surgical Oncology, Amsterdam, The Netherlands
| | - M. G. Statius Muller
- University Hospital Vrije Universiteit, Department of Surgical Oncology, Amsterdam, The Netherlands
| | - S. Meijer
- University Hospital Vrije Universiteit, Department of Surgical Oncology, Amsterdam, The Netherlands
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14
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Harrison BM, Meniawy T, Saunders C. Synchronous cancers of the breast and upper limb: a unique anatomical perspective. ANZ J Surg 2020; 91:E405-E406. [PMID: 33180970 DOI: 10.1111/ans.16440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/09/2020] [Accepted: 10/26/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Ben M Harrison
- Department of General Surgery, St John of God Subiaco Hospital, Perth, Western Australia, Australia
| | - Tarek Meniawy
- Department of General Surgery, St John of God Subiaco Hospital, Perth, Western Australia, Australia.,UWA Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Christobel Saunders
- Department of General Surgery, St John of God Subiaco Hospital, Perth, Western Australia, Australia.,UWA Medical School, The University of Western Australia, Perth, Western Australia, Australia
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15
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David Nathanson S, Leonard-Murali S, Burmeister C, Susick L, Baker P. Clinicopathological Evaluation of the Potential Anatomic Pathways of Systemic Metastasis from Primary Breast Cancer Suggests an Orderly Spread Through the Regional Lymph Nodes. Ann Surg Oncol 2020; 27:4810-4818. [PMID: 32720039 PMCID: PMC7384564 DOI: 10.1245/s10434-020-08904-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/30/2020] [Indexed: 12/25/2022]
Abstract
Background Two conflicting hypotheses as to how breast cancer (BC) accesses the systemic circulation dominated the 20th century and affected surgical treatment. We hypothesized that tumor lymphovascular invasion (LVI) at the primary tumor site favors lymphatic and not blood vessel, capillaries, and systemic metastases (Smets) are dependent upon regional lymph node (RLN) mets. Methods Data from BC patients undergoing RLN biopsy was professionally abstracted and maintained in a prospective, precisely managed, single-institution database. Associations of RLN, LVI, and Smets were estimated by univariate and multivariate backward logistic regression models and patient-affiliated demographic, clinicopathologic, treatment type, and molecular marker data. Results Of 3329 patients, followed 1–22 years (mean 7.8), 463 of 3329 (13.9%) showed LVI, 742 of 3329 (22.3%) had RLN mets, and 262 of 3329 (7.9%) had Smets. Smets occurred in 52 of 252 (21% with LVI+/RLN+); 116 of 2301 (5% with LVI−/RLN−); 65 of 465 (14% with LVI−/RLN+); and 17 of 207 (8% with LVI+/RLN−), p = 0.021 for association between LVI and Smets for RLN+ patients but not for RLN− patients (p = 0.051). Positive RLN, larger tumor size, and higher grade (all p < 0.001) were predictive of Smets by the multivariable model, whereas positive LVI was not. Conclusions LVI predicts RLN mets in BC. RLN is critical to Smets from BC, whereas LVI on its own is not. Smets occur significantly more commonly when both LVI and RLN mets occur together. LVI is, thus, likely to be primarily lymphatic invasion, and rarely, blood vessel invasion, supporting the Halsted paradigm. LVI and RLN together predict clinical outcome better than either alone. Graphic Abstract ![]()
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Affiliation(s)
| | | | - Charlotte Burmeister
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Laura Susick
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Patricia Baker
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
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16
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Nuclear Medicine Imaging Techniques in Melanoma. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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17
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Jackett LA, Scolyer RA. A Review of Key Biological and Molecular Events Underpinning Transformation of Melanocytes to Primary and Metastatic Melanoma. Cancers (Basel) 2019; 11:cancers11122041. [PMID: 31861163 PMCID: PMC6966527 DOI: 10.3390/cancers11122041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/02/2019] [Accepted: 12/12/2019] [Indexed: 02/06/2023] Open
Abstract
Melanoma is a major public health concern that is responsible for significant morbidity and mortality, particularly in countries such as New Zealand and Australia where it is the commonest cause of cancer death in young adults. Until recently, there were no effective drug therapies for patients with advanced melanoma however significant advances in our understanding of the biological and molecular basis of melanoma in recent decades have led to the development of revolutionary treatments, including targeted molecular therapy and immunotherapy. This review summarizes our current understanding of the key events in the pathway of melanomagenesis and discusses the role of genomic analysis as a potential tool for improved diagnostic evaluation, prognostication and treatment strategies. Ultimately, it is hoped that a continued deeper understanding of the mechanisms of melanomagenesis will lead to the development of even more effective treatments that continue to provide better outcomes for patients with melanoma.
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Affiliation(s)
- Louise A. Jackett
- Melanoma Institute Australia, 2065 Sydney, Australia;
- Sydney Medical School, The University of Sydney, 2050 Sydney, Australia
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, 2050 Sydney, Australia
- Department of Anatomical Pathology, Austin Hospital, 3084 Melbourne, Australia
| | - Richard A. Scolyer
- Melanoma Institute Australia, 2065 Sydney, Australia;
- Sydney Medical School, The University of Sydney, 2050 Sydney, Australia
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, 2050 Sydney, Australia
- Correspondence: ; Tel.: +61-299117200; Fax: +61-299549290
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18
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Chang JWC, Huang YL, Chang YY, Lo YF, Ho TY, Huang YT, Chen HW, Wu CE. Sentinel Lymph Node Biopsy Was Associated With Favorable Survival Outcomes For Patients With Clinically Node-Negative Asian Melanoma. Cancer Manag Res 2019; 11:9655-9664. [PMID: 31814762 PMCID: PMC6861523 DOI: 10.2147/cmar.s227837] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 10/31/2019] [Indexed: 02/05/2023] Open
Abstract
Purpose Sentinel lymph node biopsy (SLNB) is the standard management for clinically node-negative cutaneous melanoma patients. This study aimed to evaluate the role of SLNB in Taiwanese melanoma patients and in particular, patients with acral lentiginous melanoma (ALM). Patients and methods We retrospectively analyzed the clinicopathological characteristics and survival outcomes of the patients who underwent primary surgery followed by either SLNB or nodal observation at the Linkou Chang Gung Memorial Hospital from January 2000 to December 2011. Results Among the total of 209 patients, 127 underwent SLNB and 51 underwent nodal observation only after primary surgery. There were no significant differences in clinicopathological features between the two groups except that patients who underwent SLNB were older and had a higher rate of ALM than those under nodal observation. The median follow-up time was 43.5 months until July 2013. The patients who underwent SLNB had significantly better disease-free survival (DFS) (57.1 vs 18.7 months, p < 0.01) and melanoma-specific survival (MSS) (112.4 vs 45.2 months, p < 0.01) than those under observation. Improvement in DFS (HR: 0.51, p < 0.01) and MSS (HR: 0.60, p = 0.03) was observed even after adjusting for age and disease pathology by multivariate analysis. This benefit of clinical outcomes persisted in patients with ALM, Breslow thickness ≤2 mm, or no ulceration, but not in patients with non-ALM, Breslow thickness >2 mm, or ulceration. Conclusion SLNB was associated with favorable outcomes in patients with clinically node-negative cutaneous melanoma, particularly in Taiwanese patients with ALM, Breslow thickness ≤2 mm, and nonulcerated melanoma.
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Affiliation(s)
- John Wen-Cheng Chang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yen-Lin Huang
- Department of Pathology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yao-Yu Chang
- Department of Dermatology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yung-Feng Lo
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tsung-Ying Ho
- Department of Nuclear Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yi-Ting Huang
- Department of Radiology Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Huan-Wu Chen
- Department of Medical Imaging & Intervention, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chiao-En Wu
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
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19
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[Sentinel node biopsy and lymph node dissection in the era of new systemic therapies for malignant melanoma]. Hautarzt 2019; 70:864-869. [PMID: 31605168 DOI: 10.1007/s00105-019-04491-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Recently, adjuvant therapies with checkpoint inhibitors and BRAF/MEK inhibitors have become available for patients with malignant melanoma and microscopic nodal disease. Meanwhile the number of complete nodal dissections for a melanoma-positive sentinel node (SN) have decreased significantly. OBJECTIVE The authors discuss the significance of sentinel node biopsy (SNB) and early lymph node dissection in the era of adjuvant systemic therapy for stage III melanoma. MATERIALS AND METHODS Current publications and recommendations were evaluated. RESULTS Complete nodal dissection for a positive SN significantly reduces the risk of regional nodal relapse. However, neither SNB nor complete nodal dissection following a positive SN are associated with a benefit in survival. With the availability of novel adjuvant systemic treatment strategies for stage III melanoma, SNB has become an even more important part of modern staging diagnostics. Thus, detection of early dissemination of melanoma cells into the SN as well as the quantification of the tumor load are decisive for further therapy planning. CONCLUSION Accurate assessment of the regional lymph node status by SNB is becoming even more important in the era of novel effective adjuvant therapies for microscopic nodal disease. Whether complete lymph node dissection is performed in patients with a positive SN needs to be assessed individually. In the case of "active nodal surveillance" instead of surgery, long-term close follow-up in specialized centers, including ultrasonographic controls, is required.
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20
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Maus RLG, Jakub JW, Hieken TJ, Nevala WK, Christensen TA, Sutor SL, Flotte TJ, Markovic SN. Identification of novel, immune-mediating extracellular vesicles in human lymphatic effluent draining primary cutaneous melanoma. Oncoimmunology 2019; 8:e1667742. [PMID: 31741769 PMCID: PMC6844317 DOI: 10.1080/2162402x.2019.1667742] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/19/2019] [Accepted: 09/09/2019] [Indexed: 12/11/2022] Open
Abstract
Epithelial tumors including melanoma often first metastasize to regional, sentinel lymph nodes (SLN). Thus, the presence of SLN metastases is a critical prognostic factor of survival. Prior to metastasis, accumulating evidence suggests the SLN is immunologically compromised; however, the process by which pre-metastatic niche formation occurs remains unknown. In this prospective study, freshly dissected, afferent lymphatic fluid was obtained during SLN biopsy in three patients with primary cutaneous melanoma. Lymphatic extracellular vesicles (L-EV) were visualized by transmission electron microscopy and proteomic cargo profiled by mass spectrometry. Flow cytometry assessed L-EV effects on autologous dendritic cell maturation in vitro. Immunogold electron microscopy and immunohistochemistry visualized expression of EV cargo within the primary tumor and SLN. Lymphatic extracellular vesicles from each afferent lymphatic channel demonstrated inhibition of autologous dendritic cell maturation. Proteomic profiling identified 81 peptides shared among the L-EV preparations including a signature of 18 immune-modulating proteins including previously established inhibitor of dendritic cell maturation, S100A9. Immunohistochemistry and immunogold electron microscopy confirmed S100A9 tracking along the lymphatic path, from keratinocytes in the primary tumor to sub-capsular macrophages in the SLN. Our findings suggest L-EV cargo may serve as early mediators of tumor-induced immune subversion in regional lymph nodes, by preceding malignant cells and trafficking within the lymphatic vasculature to harbor the first pre-metastatic niche.
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Affiliation(s)
| | - James W Jakub
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Tina J Hieken
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Trace A Christensen
- Department of Biochemistry and Molecular Biology, Microscopy and Cell Analysis Core Facility, Mayo Clinic, Rochester, MN, USA
| | - Shari L Sutor
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - Thomas J Flotte
- Department of Anatomic and Clinical Pathology, Mayo Clinic, Rochester, MN, USA
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21
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Güney İB, Küçüker KA. Cilt kanserlerinde lenfosintigrafi ve cerrahi gama prob ile sentinel lenf nodu biyopsisinin minimal invaziv cerrahi yaklaşımındaki rolü. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.411652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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22
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Sukhbaatar A, Mori S, Saiki Y, Takahashi T, Horii A, Kodama T. Lymph node resection induces the activation of tumor cells in the lungs. Cancer Sci 2019; 110:509-518. [PMID: 30499190 PMCID: PMC6361607 DOI: 10.1111/cas.13898] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/13/2018] [Accepted: 11/26/2018] [Indexed: 01/14/2023] Open
Abstract
Lymph node (LN) dissection is a crucial procedure for cancer staging, diagnosis and treatment, and for predicting patient survival. Activation of lung metastatic lesions after LN dissection has been described for head and neck cancer and breast cancer. Preclinical studies have reported that dissection of a tumor‐bearing LN is involved in the activation and rapid growth of latent tumor metastases in distant organs, but it is also important to understand how normal (non‐tumor‐bearing) LN resection influences secondary cancer formation. Here, we describe how the resection of tumor‐bearing and non‐tumor‐bearing LN affects distant metastases in MXH10/Mo‐lpr/lpr mice. Tumor cells were administered intravenously and/or intranodally into the right subiliac lymph node (SiLN) to create a mouse model of lung metastasis. Luciferase imaging revealed that tumor cells in the lung were activated after resection of the SiLN, irrespective of whether it contained tumor cells. No luciferase activity was detected in the lungs of mice that did not undergo LN resection (excluding the intravenous inoculation group). Our results indicate that resection of an LN can activate distant metastases regardless of whether the LN contains tumor cells. Hence, lung metastatic lesions are suppressed while metastatic LN are present but activated after LN resection. If this phenomenon occurs in patients with cancer, it is likely that lung metastatic lesions may be activated by elective LN dissection in clinical N0 cases. The development of minimally invasive cancer therapy without surgery would help to minimize the risk of activation of distant metastatic lesions by LN resection.
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Affiliation(s)
- Ariunbuyan Sukhbaatar
- Laboratory of Biomedical Engineering for Cancer, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan.,Biomedical Engineering Cancer Research Center, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan.,Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Tohoku University, Sendai, Japan
| | - Shiro Mori
- Laboratory of Biomedical Engineering for Cancer, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan.,Biomedical Engineering Cancer Research Center, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan.,Department of Oral and Maxillofacial Surgery, Tohoku University Hospital, Sendai, Japan
| | - Yuriko Saiki
- Department of Molecular Pathology, Tohoku University School of Medicine, Sendai, Japan
| | - Tetsu Takahashi
- Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Tohoku University, Sendai, Japan
| | - Akira Horii
- Department of Molecular Pathology, Tohoku University School of Medicine, Sendai, Japan
| | - Tetsuya Kodama
- Laboratory of Biomedical Engineering for Cancer, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan.,Biomedical Engineering Cancer Research Center, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
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23
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He M, Jiang Z, Wang C, Hao Z, An J, Shen J. Diagnostic value of near‐infrared or fluorescent indocyanine green guided sentinel lymph node mapping in gastric cancer: A systematic review and meta‐analysis. J Surg Oncol 2018; 118:1243-1256. [DOI: 10.1002/jso.25285] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 10/05/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Meifeng He
- Chengde Medical UniversityChengde Hebei China
| | - Zhanwu Jiang
- Baoding First Central HospitalBaoding Hebei China
| | | | - Zhiwei Hao
- Baoding First Central HospitalBaoding Hebei China
| | - Jie An
- Baoding First Central HospitalBaoding Hebei China
| | - Jiankai Shen
- Baoding First Central HospitalBaoding Hebei China
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24
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Masoud SJ, Perone JA, Farrow NE, Mosca PJ, Tyler DS, Beasley GM. Sentinel Lymph Node Biopsy and Completion Lymph Node Dissection for Melanoma. Curr Treat Options Oncol 2018; 19:55. [PMID: 30232648 PMCID: PMC6684152 DOI: 10.1007/s11864-018-0575-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OPINION STATEMENT This review critically evaluates recent trials which have challenged the practice of completion lymph node dissection (CLND) for melanoma patients diagnosed with regional metastasis by positive sentinel lymph node biopsy (SLNB). Two trials in the last 2 years, DeCOG-SLT and MSLT-II, found no significant differences in melanoma-specific survival between patients, whether they received immediate CLND or observation after positive SLNB, despite decreases in nodal recurrence achieved by dissection. These trials together disfavor routine CLND in most patients after positive SLNB. However, their conclusions are limited by study populations which overall harbored a lower burden of SLN disease. Special attention needs to be given to patients who do have higher risk disease, with SLN tumor burdens exceeding 1 mm in diameter, for whom CLND may remain both prognostic and therapeutic. Current guidelines thus recommend either CLND or careful observation after positive SLNB after appropriate risk stratification of patients. While a decline in CLND is inevitable, treatment of stage III melanoma is witnessing the concurrent rise of effective adjuvant therapies. PD-1 inhibitors such as nivolumab, or combination BRAF/MEK inhibitors for V600E or K mutant melanoma, which were previously available to only trial patients with completely resected stage III disease, are now approved for use in patients with positive SLNB alone. Providers are better equipped than ever to treat clinically occult, regional metastatic disease with SLNB followed by adjuvant therapy for most patients, but should take steps to avoid undertreatment of high-risk patients who may proceed to disease relapse or progression.
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Affiliation(s)
- Sabran J Masoud
- Department of Surgery, Duke University, Durham, NC, 27710, USA
| | - Jennifer A Perone
- Department of Surgery, University Texas Medical Branch, Galveston, TX, USA
| | - Norma E Farrow
- Department of Surgery, Duke University, Durham, NC, 27710, USA
| | - Paul J Mosca
- Department of Surgery, Duke University, Durham, NC, 27710, USA
| | - Douglas S Tyler
- Department of Surgery, University Texas Medical Branch, Galveston, TX, USA
| | - Georgia M Beasley
- Department of Surgery, Duke University, Durham, NC, 27710, USA.
- Duke University Medical Center, DUMC Box 3118, Durham, NC, 27710, USA.
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25
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Parikh PP, Tashiro J, Rubio GA, Sola JE, Neville HL, Hogan AR, Perez EA. Incidence and outcomes of pediatric extremity melanoma: A propensity score matched SEER study. J Pediatr Surg 2018; 53:1753-1760. [PMID: 29602554 DOI: 10.1016/j.jpedsurg.2018.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 02/19/2018] [Accepted: 03/04/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is a paucity of literature on treatment of melanoma in children with surgical management extrapolated from adult experience. The incidence and clinical outcomes of pediatric extremity melanoma were studied. METHODS SEER registry was analyzed between 1973 and 2010 for patients <20years old with extremity melanoma. Multivariate and propensity-score matched analyses were performed to identify independent predictors of survival. RESULTS Overall, 917 patients were identified with an age-adjusted incidence of 0.2/100,000 persons, annual percent change 0.96. Most had localized disease (77%), histology revealing melanoma-not otherwise specified (52%). Surgical procedures performed included wide local excision (50%), excisional biopsy (32%), lymphadenectomy (LA) (28%), and sentinel lymph node biopsy (SLNB) (15%). Overall, 30-year disease specific mortality was 7% with lower survival for extremity melanoma (90%), males (89%), nodular histology (69%), and distant disease (36%) (all P<0.05). Post-treatment multivariate analysis revealed localized disease (HR 9.76; P=0.006) as an independent prognosticator of survival; earlier diagnostic years 1988-1999 (HR 2.606; P=0.017) were a negative prognosticator of survival. Propensity-score matched analysis found no difference in survival between SLNB/LA vs no sampling for regional/distant disease. CONCLUSIONS Pediatric extremity melanoma in SEER demonstrate no survival advantage between children undergoing sampling procedures vs no sampling for regional/distant disease. TYPE OF STUDY Retrospective, prognostic study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Punam P Parikh
- DeWitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida.
| | - Jun Tashiro
- DeWitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Gustavo A Rubio
- DeWitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Juan E Sola
- DeWitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Holly L Neville
- DeWitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Anthony R Hogan
- DeWitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Eduardo A Perez
- DeWitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
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Leong SP, Zager JS. Future perspectives: cancer metastases. Clin Exp Metastasis 2018; 35:559-561. [PMID: 30039283 DOI: 10.1007/s10585-018-9920-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 07/02/2018] [Indexed: 12/13/2022]
Abstract
The sentinel lymph node (SLN) is the initial metastatic site for the majority of solid cancers. In some cases, cancer cells may bypass the SLNs and enter the vascular channels directly to spread to the systemic sites. Metastatic progression is an orderly process. During the process of metastasis, complex biochemical and molecular mechanisms are involved being subjected to the host influence, in particular, the immune system. With more detailed understanding of the genomic and molecular characteristics of cancer both from the primary site and its metastases, the pathways of cancer growth and spread within the cancer microenvironment may be further elucidated.
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Affiliation(s)
- Stanley P Leong
- California Pacific Medical Center and Research Institute, San Francisco, CA, USA.
| | - Jonathan S Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA
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Perissinotti A, Rietbergen DDD, Vidal-Sicart S, Riera AA, Olmos RA. Melanoma & nuclear medicine: new insights & advances. Melanoma Manag 2018; 5:MMT06. [PMID: 30190932 PMCID: PMC6122522 DOI: 10.2217/mmt-2017-0022] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 03/29/2018] [Indexed: 12/16/2022] Open
Abstract
The contribution of nuclear medicine to management of melanoma patients is increasing. In intermediate-thickness N0 melanomas, lymphoscintigraphy provides a roadmap for sentinel node biopsy. With the introduction of single-photon emission computed tomography images with integrated computed tomography (SPECT/CT), 3D anatomic environments for accurate surgical planning are now possible. Sentinel node identification in intricate anatomical areas (pelvic cavity, head/neck) has been improved using hybrid radioactive/fluorescent tracers, preoperative lymphoscintigraphy and SPECT/CT together with modern intraoperative portable imaging technologies for surgical navigation (free-hand SPECT, portable gamma cameras). Furthermore, PET/CT today provides 3D roadmaps to resect 18F-fluorodeoxyglucose-avid melanoma lesions. Simultaneously, in advanced-stage melanoma and recurrences, 18F-fluorodeoxyglucose-PET/CT is useful in clinical staging and treatment decision as well as in the evaluation of therapy response. In this article, we review new insights and recent nuclear medicine advances in the management of melanoma patients.
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Affiliation(s)
- Andrés Perissinotti
- Department of Nuclear Medicine, Hospital Clinic, C/Villarroel 170, 08036 Barcelona, Spain
| | - Daphne DD Rietbergen
- Nuclear Medicine Section & Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Sergi Vidal-Sicart
- Department of Nuclear Medicine, Hospital Clinic, C/Villarroel 170, 08036 Barcelona, Spain
| | - Ana A Riera
- Department of Nuclear Medicine, Hospital Universitario Nuestra Señora de la Candelaria, Carretera del Rosario 145, 08010 SC de Tenerife, Spain
| | - Renato A Valdés Olmos
- Nuclear Medicine Section & Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands
- Department of Nuclear Medicine, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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Buonomo O, Felici A, Granai AV, Piccirillo R, De Liguori Carino N, Guadagni F, Mariotti S, Orlandi A, Tipaldi G, Cipriani C, Chimenti S, Cervelli V, Casciani CU, Roselli M. Sentinel Lymphadenectomy in Cutaneous Melanoma. TUMORI JOURNAL 2018; 88:S49-51. [PMID: 12369552 DOI: 10.1177/030089160208800343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and Background In the last ten years validation of the sentinel lymph node (SLN) concept has led to modification of the surgical approach for patients with intermediate-risk cutaneous melanoma. Methods and Study Design Forty-eight patients affected by cutaneous melanoma with a Breslow thickness between 0.65 and 4 mm were enrolled in the study. Approximately 2 mCi of radiotracer and 1 mL of vital blue dye were injected in each patient around the site of the primary lesion. Lymphoscintigraphy was performed until the lymphatic basin and the respective SLN were localized. The whole surgical procedure consisted of enlargement of the surgical margins followed by localization and excision of the SLN(s) by using both radiotracer and vital dye. Whenever the SLN proved to be histologically positive for metastasis, complete regional lymphadenectomy was performed. Results Within 15 minutes of radiotracer administration the lymphatic basin was localized in all 48 patients by lymphoscintigraphy. Vital dye and radiotracer successfully allowed SLN localization and excision in 46 of 48 patients (97%); in one case the SLN was detected by radiotracer alone. The SLN proved to be metastatic in six (13%) of 46 evaluable patients; interestingly, in three of them the presence of metastatic cells was revealed only by immunohistochemistry. All patients with tumor-positive SLNs had primary lesions with a Breslow thickness = 2 mm. Conclusions Sentinel lymphadenectomy is able to identify lymph node involvement in patients with cutaneous melanoma with a Breslow thickness >1 mm, thus avoiding the risks associated with radical regional lymphadenectomy. Lymphoscintigraphy proved to be an important tool to obtain correct preoperative localization of the drainage basin, especially for melanomas located on the face and trunk.
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Affiliation(s)
- O Buonomo
- Department of Surgery, University of Rome Tor Vergata, Italy.
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Belli F, Lenisa L, Clemente C, Tragni G, Mascheroni L, Gallino G, Cascinelli N. Sentinel Node Biopsy and Selective Dissection for Melanoma Nodal Metastases. TUMORI JOURNAL 2018; 84:24-8. [PMID: 9619709 DOI: 10.1177/030089169808400105] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Early detection of nodal metastases still represents an important goal in the management of melanoma patients. A sentinel node is defined as the first colored node in the regional lymphatic basin following injection of blue dye in the site of the primary melanoma. Sentinel node biopsy may represent a feasible technique for early identification of occult disease. A therapeutic dissection is then performed only in patients with proven nodal disease, thus introducing the concept of selective dissection. Methods At the National Cancer Institute of Milan from February 1994 to October 1996, 74 patients with a melanoma of the trunk or limbs and without clinically detectable node metastases were submitted to sentinel node biopsy and eventual selective dissection. Results The sentinel node was identified in 67 patients (90%). Nodal metastases were detected in 11 patients (16%); 5 of these were identified by an intraoperative frozen section examination. In all but one case, only the sentinel node was affected at radical dissection. Incidence of positive sentinel nodes was correlated with depth of infiltration of the primary lesion. Mapped nodal basin failures were observed in 3 patients with negative sentinel node biopsy. All patients but one, presenting distant metastases, are alive at this writing and free of disease with a follow-up ranging from 2 to 34 months. Conclusions Our study adds to accumulating evidence supporting the efficacy of sentinel node biopsy in detecting occult localizations and the potential of the technique to better select the group of patients that may benefit from nodal dissection.
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Affiliation(s)
- F Belli
- Department of General Surgery B, National Cancer Institute, Milan, Italy
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Caggiati A, Potenza C, Gabrielli F, Passarelli F, Tartaglione G. Sentinel Node Biopsy for Malignant Melanoma: Analysis of a Four-Year Experience. TUMORI JOURNAL 2018; 86:332-5. [PMID: 11016720 DOI: 10.1177/030089160008600421] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background Sentinel node (SN) biopsy has been introduced to solve the controversy concerning the effectiveness of prophylactic lymphadenectomy in intermediate thickness melanoma. The aim of this study was to evaluate the rate of metastases, the technical details of the procedure, and the main reasons of failure. Methods 235 patients affected by intermediate thickness melanoma (tumor thickness >0.75 mm and <4 mm) without clinical signs of systemic spread (N0M0) were submitted to sentinel node biopsy between 1996 and 2000. Preoperative lymphoscintigraphy was routinely performed in the last 184 patients. Intraoperative mapping with gamma probe was combined with the use of vital dye for identification of sentinel nodes in the last 113 patients. Results The SN detection rate was 95.6%, with significant differences depending on the site of dissection and the use of a gamma probe. The overall rate of micrometastases was 14.7%, but relevant differences were recorded between different subgroups of patients (T2, 5.1%; T3a, 19.6%; T3b, 29%). Conclusions Sentinel node biopsy requires a multidisciplinary approach (surgery, pathology and nuclear medicine) for reliable results. The association of vital dye and intraoperative gamma probe for sentinel node harvesting has made the procedure more effective, less time-consuming and less invasive. Failures may be due not only to surgical mistakes, but also to improper nuclear medicine procedures or inaccurate histological evaluation of SNs. Methods for histological examination of the SN are still debated and not standardized but promising results have recently been obtained with molecular oncology techniques (RT-PCR).
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Affiliation(s)
- A Caggiati
- Department of Plastic Surgery, Istituto Dermopatico dell'Immacolata, IRCCS, Rome, Italy
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31
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Maffioli L, Sturm E, Roselli M, Fontanelli R, Pauwels E, Bombardieri E. State of the Art of Sentinel Node Biopsy in Oncology. TUMORI JOURNAL 2018; 86:263-72. [PMID: 11016701 DOI: 10.1177/030089160008600401] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Sentinel node biopsy has become a standard diagnostic procedure to assess lymph node status of various tumors. The combination of blue dye and a radioactive tracer offers the best chances of identifying the sentinel lymph node. Most progress in the technique of the sentinel node procedure has been made in melanoma and breast cancer. In melanoma, sentinel node biopsy has been introduced as a fundamental procedure for staging. Information on the lymphatic drainage from a melanoma can have a direct impact on the surgery. More recently, the technique has been successfully introduced in the management of breast cancer, in which a large number of unnecessary axillary dissections could be avoided. However, there are many other potential fields of application of the sentinel node biopsy (e.g. endometrial, vulvar, head and neck cancers) that are worthy of investigation. In any case, multicenter trials are required to standardize the procedures, taking into account several variables such as particle size and mode of delivery of the radiotracer, amount of radioactivity administered, number and location of injections, and choice of the hand-held probe. We briefly describe the technical and historical aspects of the sentinel node biopsy and summarize the main clinical trials proposed and/or performed in the field.
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Affiliation(s)
- L Maffioli
- Nuclear Medicine, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
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32
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Pellegrino D, Bellina CR, Manca G, Boni G, Grosso M, Volterrani D, Desideri I, Bianchi F, Bottoni A, Ciliberti V, Salimbeni G, Gandini D, Castagna M, Zucchi V, Romanini A, Bianchi R. Detection of Melanoma Cells in Peripheral Blood and Sentinel Lymph Nodes by RT-PCR Analysis: A Comparative Study with Immunohistochemistry. TUMORI JOURNAL 2018; 86:336-8. [PMID: 11016721 DOI: 10.1177/030089160008600422] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The presence of lymph node metastases is the best prognostic factor for predicting relapse or survival in melanoma patients. It has been demonstrated that melanoma metastases spread through the first lymph node(s) draining the tumor (sentinel lymph node, SN) to the lymphatic system and that detection of melanoma cells in peripheral blood directly correlates with prognosis in melanoma. To identify lymph node metastases and circulating melanocytes, we developed a single-step reverse transcriptase-polymerase chain reaction assay (RT-PCR) for detection of two melanoma-specific markers: the tyrosinase gene, which encodes an enzyme associated with melanin synthesis, and melanoma antigen-related T-cells, which are present in tumor infiltrating T-lymphocytes. This method detects two tumor cells in a background of 107 lymphocytes. Thirty patients with stage I–IV cutaneous melanoma entered the study. Blood samples were taken preoperatively, one month after excision of the primary melanoma lesion and the SN or total lymphadenectomy, and before the start of chemotherapy and every three months thereafter in metastatic patients. SNs were collected from 22 patients, bisected and analyzed by RT-PCR and routine pathological and immunohistochemical tests. The preliminary results indicate that RT-PCR for melanoma markers is a sensitive and valuable method for the detection of micrometastases and for early diagnosis and staging of melanoma.
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Affiliation(s)
- D Pellegrino
- Department of Medical Oncology, University of Pisa, Italy
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Pizzocaro C, Rossini PL, Magri GC, Manca G, Caglioni C, Manganoni MA, Giubbini R. Sentinel Node Biopsy in Melanoma: The Experience of Brescia Civic Hospital. TUMORI JOURNAL 2018; 86:349-50. [PMID: 11016726 DOI: 10.1177/030089160008600427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The accuracy of the sentinel node (SN) technique in the evaluation of lymph node involvement in melanoma was evaluated in 71 consecutive patients with localized disease and Breslow index >1 mm. Lymphoscintigraphy identified at least one SN in 70 of the 71 patients (98.5%). The following day 69 patients underwent selective SN excision. The SN was identified by portable probe. One hundred and twenty-two lymph nodes were removed, 14 (11.4%) of which were metastatic in 9 patients (13%). No metastases were found in 40 patients with Breslow <2 mm. Eight of the 9 patients with positive SNs underwent lymphadenectomy of the whole basin and in two patients new metastatic nodes were found. At 4–26 months’ follow-up 1 of the 60 patients with negative SN (scalp melanoma with Breslow 6.2 mm) developed bilateral cervical metastatic nodes. Two more patients with Breslow 3.7 and 5 mm, respectively, developed liver and lung metastases. The remaining 57 patients are still disease free. Among the 9 patients with tumor-positive SNs, 1 was lost to follow-up, 3 died and 5 are still alive. Our data confirm the clinical reliability of the SN technique in melanoma; we feel the technnique should be considered a standard tool in the evaluation of melanoma patients.
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Affiliation(s)
- C Pizzocaro
- Divisione di Medicina Nucleare, Spedali Civili, Brescia, Italy
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Villa G, Agnese G, Bianchi P, Buffoni F, Costa R, Carli F, Peressini A, Solari N, Cafiero F, Mariani G. Mapping the Sentinel Lymph Node in Malignant Melanoma by Blue Dye, Lymphoscintigraphy and Intraoperative Gamma Probe. TUMORI JOURNAL 2018; 86:343-5. [PMID: 11016724 DOI: 10.1177/030089160008600425] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Eighty-eight consecutive patients (48 men and 40 women; mean age, 58.9 years; range, 16–84 years) with clinically localized cutaneous melanoma involving the trunk, extremities or head and neck underwent lymphatic mapping at our institution. The primary melanoma had a mean thickness of 2.74 mm (range, 0.95 to 9 mm). Patients were divided into two groups: group A (39 patients) underwent only vital blue dye (VBD) mapping, while group B (49 patients) underwent lymphatic mapping with VBD and radio-guided surgery (RGS) combined. In all patients 1-1.5 mL of VBD was injected subdermally around the biopsy scar 10–20 min before surgery. In group B 37 MBq in 150 μL of 99mTc-HSA nanocolloid was additionally injected intradermally 18 h before surgery (3–6 aliquots injected perilesionally). In all lymphatic basins where drainage was noted the sentinel lymph nodes (SNs) were identified and marked with a cutaneous marker. Final identification of the SN was then performed externally by a hand-held gamma probe. After the induction of anesthesia 0.5–1-0 mL of patent blue V dye was injected intradermally with a 25-gauge needle around the site of the primary melanoma. SNs were examined by routine hematoxylin and eosin (H&E) staining and immunohistochemistry. Patients with histologically positive SN(s) underwent standard lymph node dissection (SLND) in the involved lymph node basin. The SN was identified in 37/39 patients (94.9%) of group A and in 48/49 patients (98.0%) of group B. Blue dye mapping failed to identify the SN in 5 of the 88 patients (5.8%), while the radioisotope method failed in only 1 of 49 patients (2.0%). Similar results were obtained with the combined use of the two probes. The average number of SNs harvested was 1.9 per basin sampled, which does not differ significantly from the numbers reported by other authors114. The SN was histologically positive in 18 patients (20.5%). None of the 12 patients with a Breslow thickness less than 1.5 mm had positive SNs, whereas 18 of the 77 patients (23.4%) with a Breslow index exceeding 1.5 mm showed metastatic SNs with H&E or immunohistochemistry. The latter all underwent SLND of the affected basin. In 10 patients (55.6%) the SN was the only site of tumor invasion; eight patients (44.4%) with positive SNs had one or more metastatic lymph nodes in the draining basin.
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Affiliation(s)
- G Villa
- Nuclear Medicine Service, DIMI, Genoa, Italy
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Mazzuca N, Bagnoni G, Solimeo C, Malvaldi F, Pratali R, Ceccarini M, Santini P, Morini V. Sentinel Node Biopsy in Clinical Stage 1 Melanoma: Rationale for Restaging and Follow-Up. TUMORI JOURNAL 2018; 86:351-3. [PMID: 11016727 DOI: 10.1177/030089160008600428] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Lymph node involvement appears to be the most significant prognostic factor in patients affected by melanoma and has been shown to reduce the five-year survival by 40%. We studied 31 patients (15 M; 16 F; age range, 28–83 years) with clinical stage 1 (CS1) intermediate thickness (0.75–4 mm) melanoma. Scintigraphic examination of the nodes was performed in all patients, 29 of whom underwent surgical biopsy of the SN after 24 hours. Early images were acquired 5, 15 and 79 min and late images 60–180 min following perilesional injection of 2–4 microdoses of 99mTc-nanocolloid (15–20 MBq). A cobalt marker was used to project the SN on the skin surface which was later stained with indelible ink. For intraoperative localization we used a portable probe and perilesional injection of patent blue violet dye, which proved positive in 24/29 patients (83%). After surgery histological examination of the sentinel lymph nodes (SNs) (hematoxylin-eosin and immunohistochemistry) found positivity for metastatic cells in 6 patients. They all underwent elective lymph node dissection (ELND); five are N0+ and are currently undergoing supportive therapy with interferon alpha with an 8–24-month follow-up, while one N+ patient died 14 months after surgery. Follow-up (3–26 months) of NO- patients has not evidenced any locoregional recurrence so far. Only one case showed hematogenic metastases. This procedure might radically change the therapeutic approach to CS1 melanoma because it is simple, scarcely invasive, and shows a favorable cost-benefit ratio.
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Affiliation(s)
- N Mazzuca
- Nuclear Medicine Unit, Livorno, Italy
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36
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Ulmer A, Dietz K, Werner-Klein M, Häfner HM, Schulz C, Renner P, Weber F, Breuninger H, Röcken M, Garbe C, Fierlbeck G, Klein CA. The sentinel lymph node spread determines quantitatively melanoma seeding to non-sentinel lymph nodes and survival. Eur J Cancer 2018; 91:1-10. [DOI: 10.1016/j.ejca.2017.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 12/03/2017] [Indexed: 10/18/2022]
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37
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Chang JM, Kosiorek HE, Dueck AC, Leong SPL, Vetto JT, White RL, Avisar E, Sondak VK, Messina JL, Zager JS, Garberoglio C, Kashani-Sabet M, Pockaj BA. Stratifying SLN incidence in intermediate thickness melanoma patients. Am J Surg 2017; 215:699-706. [PMID: 29502857 DOI: 10.1016/j.amjsurg.2017.12.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 11/08/2017] [Accepted: 12/11/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Guidelines for melanoma recommend sentinel lymph node biopsy (SLNB) in patients with melanomas ≥1 mm thickness. Recent single institution studies have found tumors <1.5 mm a low-risk group for positive SLNB. METHODS A retrospective review of the Sentinel Lymph Node Working Group multicenter database identified patients with intermediate thickness melanoma (1.01-4.00 mm) who had SLNB, and assessed predictors for positive SLNB. RESULTS 3460 patients were analyzed, 584 (17%) had a positive SLNB. Univariate factors associated with a positive SLNB included age <60 (p < .001), tumor on the trunk/lower extremity (p < .001), Breslow depth ≥2 mm (p < .001), ulceration (p < .001), mitotic rate ≥1/mm2 (p = .01), and microsatellitosis (p < .001). Multivariate analysis revealed age, location, and Breslow depth as significant predictors. Patients ≥75 with lesions 1.01-1.49 mm on the head/neck/upper extremity and 1.5-1.99 mm without high-risk features had <5% risk of SLN positivity. CONCLUSIONS Intermediate thickness melanoma has significant heterogeneity of SLNB positivity. Low-risk subgroups can be found among older patients in the absence of high-risk features.
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Affiliation(s)
- James M Chang
- Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | | | - Amylou C Dueck
- Section of Biostatistics, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Stanley P L Leong
- Center for Melanoma Research and Treatment, Department of Surgery, California Pacific Medical Center, San Francisco, CA, USA
| | - John T Vetto
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Richard L White
- Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC, USA
| | - Eli Avisar
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Vernon K Sondak
- Departments of Cutaneous Oncology and Sarcoma, Moffitt Cancer Center, Tampa, FL, USA
| | - Jane L Messina
- Departments of Cutaneous Oncology and Sarcoma, Moffitt Cancer Center, Tampa, FL, USA
| | - Jonathan S Zager
- Departments of Cutaneous Oncology and Sarcoma, Moffitt Cancer Center, Tampa, FL, USA
| | - Carlos Garberoglio
- Department of Surgery, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Mohammed Kashani-Sabet
- Center for Melanoma Research and Treatment, Department of Surgery, California Pacific Medical Center, San Francisco, CA, USA
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Abstract
The metastasis of neoplastic cells from their site of origin to distant anatomic locations continues to be the principal cause of death from malignant tumors, and that fact has been recognized by physicians for over a century. After the work done by Halsted in the treatment of breast cancer in the 1880s, accepted surgical canon held that metastasis occurred in a linear fashion, with centrifugal "growth in continuity" from the primary neoplasm that first involved regional lymph nodes. Those structures were considered to then be the sources of more distant, visceral metastases. With that premise in mind, radical and "ultra-radical" surgical procedures were devised to remove as many lymph nodes as possible in the treatment of carcinomas and melanomas. However, such interventions were ineffective in altering tumor-related mortality. This review considers the details of the historical material just mentioned. It also reviews currently-held concepts on biological mechanisms of metastasis, the "sentinel" lymph node biopsy technique, and the important topic of metastatic tumor "dormancy" as the cause of surgical treatment failure. Finally, predictive models of tumor behavior are discussed, which are based on gene signatures. These will likely be the key to identifying malignant lesions of low surgical stage that ultimately prove fatal through later manifestation of metastasis.
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Affiliation(s)
- Mark R Wick
- Division of Surgical Pathology & Cytopathology, Department of Pathology, University of Virginia Medical Center, Room 3020, 1215 Lee Street, Charlottesville, VA 22908-0214, United States.
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39
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Camacho I, Rajabi-Estarabadi A, Targhi SK, Tsatalis J, Hsu VM, Nouri K. Cells to Surgery Quiz: October 2017. J Invest Dermatol 2017; 137:e181. [PMID: 28941478 DOI: 10.1016/j.jid.2017.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Isabella Camacho
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ali Rajabi-Estarabadi
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sadra Khazaei Targhi
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - John Tsatalis
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Vincent M Hsu
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
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Nelson DW, Stern S, Elashoff DE, Elashoff R, Thompson JF, Mozzillo N, Nieweg OE, Hoekstra HJ, Cochran AJ, Faries MB. Impact of Time Between Diagnosis and SLNB on Outcomes in Cutaneous Melanoma. J Am Coll Surg 2017; 225:302-311. [PMID: 28668274 DOI: 10.1016/j.jamcollsurg.2017.05.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 05/07/2017] [Accepted: 05/09/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Hypothetically, delay between melanoma diagnosis and SLNB could affect outcomes, either adversely by allowing growth and dissemination of metastases, or beneficially by allowing development of an anti-melanoma immune response. Available data are conflicting about the effect of SLNB delay on patient survival. Our objective was to determine whether delay between initial diagnosis and SLNB affects outcomes in patients with cutaneous melanoma. STUDY DESIGN We performed query and analysis of a large prospectively maintained database of patients with primary cutaneous melanomas undergoing SLNB. An independent dataset from MSLT-1 (Multicenter Selective Lymphadenectomy Trial-1) was used for validation. Primary outcomes included disease-free survival and melanoma-specific survival. RESULTS Early and delayed SLNB were defined as less than 30 and 30 or more days from initial diagnosis, respectively. There were 2,483 patients that met inclusion criteria. Positive sentinel lymph nodes were identified in 17.4% (n = 432). Among all patients, 42% had SLNB 30 or more days after diagnosis and 37% of positive sentinel lymph nodes were at 30 or more days. No differences in sex, anatomic site, or histopathologic features were identified between the 2 groups. There was no difference in melanoma-specific survival or disease-free survival between those undergoing early or delayed SLNB. Examination of MSLT-1 trial data similarly demonstrated no difference in survival outcomes. CONCLUSIONS This, the largest study on this subject to date, found no adverse impact on long-term clinical outcomes of patients due to delay of SLNB beyond 30 days. The MSLT-1 data confirm this result. Patients can be reassured that if the operation is performed 30 or more days after diagnosis, it will not cause harm.
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Affiliation(s)
- Daniel W Nelson
- Division of Surgical Oncology, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA
| | - Stacey Stern
- Department of Biostatistics, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA
| | - David E Elashoff
- Department of Biostatistics, University of California Los Angeles, Los Angeles, CA
| | - Robert Elashoff
- Department of Biostatistics, University of California Los Angeles, Los Angeles, CA
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Omgo E Nieweg
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Harald J Hoekstra
- Division of Surgical Oncology, Groningen University, University Medical Center Groningen, Groningen, The Netherlands
| | - Alistair J Cochran
- Department of Pathology, University of California Los Angeles, Los Angeles, CA
| | - Mark B Faries
- Division of Surgical Oncology, The Angeles Clinic and Research Institute, Los Angeles, CA.
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Madu M, Wouters M, van Akkooi A. Sentinel node biopsy in melanoma: Current controversies addressed. Eur J Surg Oncol 2017; 43:517-533. [DOI: 10.1016/j.ejso.2016.08.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 08/11/2016] [Accepted: 08/12/2016] [Indexed: 12/17/2022] Open
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Tardelli E, Mazzarri S, Rubello D, Gennaro M, Fantechi L, Duce V, Romanini A, Chondrogiannis S, Volterrani D, Colletti PM, Manca G. Sentinel Lymph Node Biopsy in Cutaneous Melanoma: Standard and New Technical Procedures and Clinical Advances. A Systematic Review of the Literature. Clin Nucl Med 2016; 41:e498-e507. [PMID: 27749418 DOI: 10.1097/rlu.0000000000001370] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Melanoma is an important public health problem, and its incidence is increasing worldwide. The disease status of regional lymph nodes is the most important prognostic factor in early-stage melanoma patients. Sentinel lymph node biopsy (SLNB) was introduced in the early 1990s as a less invasive procedure than complete lymph node dissection to allow histopathologic evaluation of the "sentinel lymph node" (SLN), which is the first node along the lymphatic pathway from a primary tumor. Sentinel lymph node biopsy has minimal complication risks compared with standard complete lymph node dissection. Currently, SLNB is the accepted method for staging patients with clinically node-negative cutaneous melanoma and provides the most powerful prognostic information by evaluating the nodal basin status. The current practice of SLNB consists of the injection of Tc-labeled radiopharmaceutical, preoperative lymphoscintigraphy with the possibility of using the SPECT/CT hybrid imaging, and intraoperative SLN localization using a handheld gamma probe with or without the use of blue dye. Recently, the SLN localization and detection have been enhanced with the use of new tracers and new intraoperative devices, which have demonstrated to be particularly useful in melanomas of the head and neck region and in area of complex anatomy. Despite these important advances in the technology and the increasing experience in SLN mapping, major research centers have reported a false-negative rate higher than 15%. This relatively high false-negative rate, greater than those reported in the initial validation studies, points out the importance for the nuclear medicine community to continuously improve their knowledge on the biological behavior of melanoma and to improve the technical aspects that may allow more precise staging. For the SLNB procedure to be accurate, it is of critical importance that all "true" SLNs are identified and removed for examination. The aim of this article is to provide general information about the SLNB procedure in clinical practice highlighting the importance of standardization and accuracy of SLN identification in the light of the most recent technical innovations.
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Affiliation(s)
- Elisa Tardelli
- From the *Regional Center of Nuclear Medicine, University Hospital of Pisa, Pisa; †Department of Nuclear Medicine, Santa Maria della Misericordia Rovigo Hospital, Rovigo; ‡Nuclear Medicine Department, Sant'Andrea Hospital, La Spezia; §Department of Oncology, University Hospital of Pisa, Pisa, Italy; and ∥Department of Nuclear Medicine, University of Southern California, Los Angeles, CA
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43
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Ren L, Liu Z, Liang M, Wang L, Song X, Wang S. 10 % fluorescein sodium vs 1 % isosulfan blue in breast sentinel lymph node biopsy. World J Surg Oncol 2016; 14:280. [PMID: 27809854 PMCID: PMC5093998 DOI: 10.1186/s12957-016-1031-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 10/19/2016] [Indexed: 12/13/2022] Open
Abstract
Background Sentinel lymph node biopsy (SLNB) is well accepted to be a standard procedure in breast cancer surgery with clinically negative lymph nodes. Isosulfan blue is the first dye approved by the USA Food and Drug Administration for the localization of the lymphatic system. Few alternative tracers have been investigated. In this study, we aimed to compare the differences between 10 % fluorescein sodium and 1 % isosulfan blue in breast sentinel lymph node biopsy and to investigate the feasibility of using 10 % fluorescein sodium as a new dye for breast sentinel lymph node biopsy. Methods A total of 30 New Zealand rabbits were randomly divided into the fluorescein sodium group and the isosulfan blue group (15 rabbits per group). Fluorescein sodium or isosulfan blue was injected subcutaneously into the second pair of mammary areolas. Results The average fading time of the second lymph nodes in the isosulfan blue group was significantly shorter than that in the fluorescein sodium group. Moreover, the detection rates of SLNs were higher in the fluorescein sodium group than in the isosulfan blue group. No significant differences between the fluorescein sodium group and isosulfan blue group were observed regarding the distances between the detected sentinel lymph nodes and second pair of mammary areolas, the distances between the second lymph nodes and second pair of mammary areolas, the number of detected sentinel lymph nodes and second lymph nodes, the average dyeing time of the sentinel and the second lymph nodes, and the average fading time of the second lymph nodes. Conclusions In summary, we first reported that fluorescein sodium is a potential new tracer for breast sentinel lymph node biopsy.
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Affiliation(s)
- Lidong Ren
- Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.,Department of Breast Surgery, Inner Mongolia People's Hospital, Hohhot, China
| | - Zhao Liu
- Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.,Department of Thyroid and Breast Surgery, Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - Mengdi Liang
- Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Li Wang
- Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Xingli Song
- Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Shui Wang
- Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
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45
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Faut M, Wevers KP, van Ginkel RJ, Diercks GFH, Hoekstra HJ, Kruijff S, Been LB, van Leeuwen BL. Nodular Histologic Subtype and Ulceration are Tumor Factors Associated with High Risk of Recurrence in Sentinel Node-Negative Melanoma Patients. Ann Surg Oncol 2016; 24:142-149. [PMID: 27646020 PMCID: PMC5179586 DOI: 10.1245/s10434-016-5566-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Indexed: 12/16/2022]
Abstract
Background Since its introduction, the sentinel lymph node biopsy (SLNB) has become the standard staging procedure in clinical node-negative melanoma patients. A negative SLNB, however, does not guarantee a recurrence-free survival. Insight into metastatic patterns and risk factors for recurrence in SLNB negative melanoma patients can provide patient tailored guidelines. Methods Data concerning melanoma patients who underwent SLNB between 1996 and 2015 in a single center were prospectively collected. Cox regression analyses were used to determine variables associated with overall recurrence and distant first site of recurrence in SLNB-negative patients. Results In 668 patients, SLNBs were performed between 1996 and 2015. Of these patients, 50.4 % were male and 49.6 % female with a median age of 55.2 (range 5.7–88.8) years. Median Breslow thickness was 2.2 (range 0.3–20) mm. The SLNB was positive in 27.8 % of patients. Recurrence rates were 53.2 % in SLNB-positive and 17.9 % in SLNB-negative patients (p < 0.001). For SLNB-negative patients, the site of first recurrence was distant in 58.5 %. Melanoma located in the head and neck region (hazard ratio 4.88, p = 0.003) and increasing Breslow thickness (hazard ratio 1.15, p = 0.013) were predictive for distant first site of recurrence in SLNB-negative patients. SLNB-negative patients with a nodular melanoma and ulceration had a recurrence rate of 43.1 %; the site of recurrence was distant in 64 % of these patients. Conclusions The recurrence rates of SLNB-negative nodular ulcerative melanoma patients approach those of SLNB-positive patients. Stringent follow-up is recommended in this subset of patients.
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Affiliation(s)
- Marloes Faut
- Departments of Surgical Oncology and Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Kevin P Wevers
- Departments of Surgical Oncology and Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robert J van Ginkel
- Departments of Surgical Oncology and Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gilles F H Diercks
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Harald J Hoekstra
- Departments of Surgical Oncology and Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Schelto Kruijff
- Departments of Surgical Oncology and Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lukas B Been
- Departments of Surgical Oncology and Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Barbara L van Leeuwen
- Departments of Surgical Oncology and Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Sentinel Lymph Node Biopsy in Breast Cancer: Indications, Contraindications, and Controversies. Clin Nucl Med 2016; 41:126-33. [PMID: 26447368 DOI: 10.1097/rlu.0000000000000985] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Axillary lymph node status, a major prognostic factor in early-stage breast cancer, provides information important for individualized surgical treatment. Because imaging techniques have limited sensitivity to detect metastasis in axillary lymph nodes, the axilla must be explored surgically. The histology of all resected nodes at the time of axillary lymph node dissection (ALND) has traditionally been regarded as the most accurate method for assessing metastatic spread of disease to the locoregional lymph nodes. However, ALND may result in lymphedema, nerve injury, shoulder dysfunction, and other short-term and long-term complications limiting functionality and reducing quality of life. Sentinel lymph node biopsy (SLNB) is a less invasive method of assessing nodal involvement. The concept of SLNB is based on the notion that tumors drain in an orderly manner through the lymphatic system. Therefore, the SLN is the first to be affected by metastasis if the tumor has spread, and a tumor-free SLN makes it highly unlikely for other nodes to be affected. Sentinel lymph node biopsy has become the standard of care for primary treatment of early breast cancer and has replaced ALND to stage clinically node-negative patients, thus reducing ALND-associated morbidity. More than 20 years after its introduction, there are still aspects concerning SLNB and ALND that are currently debated. Moreover, SLNB remains an unstandardized procedure surrounded by many unresolved controversies concerning the technique itself. In this article, we review the main indications, contraindications, and controversies of SLNB in breast cancer in the light of the most recent publications.
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Abbassi-Ghadi N, Golf O, Kumar S, Antonowicz S, McKenzie JS, Huang J, Strittmatter N, Kudo H, Jones EA, Veselkov K, Goldin R, Takats Z, Hanna GB. Imaging of Esophageal Lymph Node Metastases by Desorption Electrospray Ionization Mass Spectrometry. Cancer Res 2016; 76:5647-5656. [DOI: 10.1158/0008-5472.can-16-0699] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 05/31/2016] [Indexed: 11/16/2022]
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Akcali C, Zincirkeser S, Erbagcý Z, Akcali A, Halac M, Durak G, Sager S, Sahin E. Detection of Metastases in Patients with Cutaneous Melanoma Using FDG-PET/CT. J Int Med Res 2016; 35:547-53. [PMID: 17697533 DOI: 10.1177/147323000703500415] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study aimed to detect metastases in patients with stage III or IV cutaneous melanoma by 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG-PET/CT). Thirty-nine patients with clinically evident stage III or IV melanoma underwent whole-body FDG-PET/CT scans for metastatic disease and these results were compared with those of biopsy. Scans for 38 of the patients were evaluated; one patient's scan could not be evaluated. There were 11 true-positive, two false-positive, 24 true-negative and one false-negative scans for the detection of melanoma metastases, with sensitivity 91%, specificity 92%, accuracy 92%, and positive and negative predictive values 84% and 96%, respectively. False-positive FDG-PET/CT scans were due to sarcoidosis in the lung and infected cyst in the liver. It is concluded that FDG-PET/CT scanning has high sensitivity and specificity for detecting stage III or IV metastatic melanoma.
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Affiliation(s)
- C Akcali
- Department of Dermatology, Medical School, Gaziantep University, Gaziantep, Turkey.
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Reintgen M, Kerivan L, Reintgen E, Swaninathan S, Reintgen D. Breast Lymphatic Mapping and Sentinel Lymph Node Biopsy: State of the Art: 2015. Clin Breast Cancer 2016; 16:155-65. [DOI: 10.1016/j.clbc.2016.02.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/03/2016] [Indexed: 12/14/2022]
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50
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Assessment of laparoscopic stomach preserving surgery with sentinel basin dissection versus standard gastrectomy with lymphadenectomy in early gastric cancer-A multicenter randomized phase III clinical trial (SENORITA trial) protocol. BMC Cancer 2016; 16:340. [PMID: 27246120 PMCID: PMC4886393 DOI: 10.1186/s12885-016-2336-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 05/04/2016] [Indexed: 02/08/2023] Open
Abstract
Background Along with the marked increase in early gastric cancer (EGC) in the Eastern countries, there has been an effort to adopt the sentinel node concept in EGC to preserve gastric function and reduce the occurrence of postoperative complications. Based on promising results from a previous quality control study, this prospective multicenter randomized controlled phase III clinical trial aims to elucidate the oncologic safety of laparoscopic stomach-preserving surgery with sentinel basin dissection (SBD) compared to a standard laparoscopic gastrectomy. Methods/Design This trial is an investigator-initiated, open-label, multicenter randomized controlled phase III trial with a non-inferiority design. Patients diagnosed with a single lesion of clinical stage T1N0M0 gastric adenocarcinoma, with a diameter of 3 cm or less are eligible for the present study. A total of 580 patients (290 per group) will be randomized to either laparoscopic stomach-preserving surgery with SBD or standard surgery. The primary end-point is 3-year disease-free survival (DFS) and the secondary endpoints include postoperative morbidity and mortality, quality of life, 5-year DFS, and overall survival. Qualified investigators who completed the prior quality control study are exclusively allowed to participate in this phase III clinical trial. Discussion The proposed trial is expected to verify whether laparoscopic stomach-preserving surgery with SBD achieves similar oncologic outcomes and improved quality of life compared to a standard gastrectomy in EGC patients. Trial registration This study was registered at the NIH ClinicalTrial.gov database (NCT01804998) on March 4th, 2013.
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