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Angeles MA, Migliorelli F, León Ramírez LF, Ros C, Perissinotti A, Tapias A, Casanueva-Eliceiry S, Pahisa J, Torné A, Vidal-Sicart S, Del Pino M, Paredes P. Predictive factors of preoperative sentinel lymph node detection in intermediate and high-risk endometrial cancer. 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... 2023; 67:37-45. [PMID: 32077670 DOI: 10.23736/s1824-4785.20.03246-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In endometrial cancer (EC), sentinel lymph node (SLN) mapping has emerged as an alternative to systematic lymphadenectomy. Little is known about factors that might influence SLN preoperative detection. The aim of our study was to evaluate the clinical and technical variables that may influence on the success of SLN detection in preoperative lymphatic mapping in patients with intermediate and high-risk EC when performing transvaginal ultrasound-guided myometrial injection of radiotracer (TUMIR). METHODS Between March 2006 and March 2017, we prospectively enrolled patients with histologically confirmed EC with intermediate or high-risk of lymphatic involvement. All women underwent SLN detection by using TUMIR approach. After radiotracer injection, pelvic and abdominal planar and SPECT/CT images were acquired to obtain a preoperative lymphoscintigraphic mapping. Pattern of drainage was registered and analyzed to identify the factors directly involved in drainage. Sonographer learning curves to perform TUMIR approach were created following Cumulative Sum and Wright methods. Univariate and multivariate analyses were performed using logistic regression. RESULTS During study period, 123 patients were included. SLN preoperative detection rate was 70.7%. Age under 75 years at diagnosis (P<0.01), radiotracer injection above 4 mL -high-volume- (P<0.01), and tumoral size below 2 cm (P=0.04) were associated with higher SLN preoperative detection rate. Twenty-five procedures were necessary to attain an adequate performance in TUMIR approach. CONCLUSIONS The higher SLN preoperative detection rate in women with intermediate and high-risk endometrial cancer after TUMIR approach was related with younger age, smaller tumors and high-volume injection of radiotracer. Sonographers are required to perform 25 procedures before acquiring an expertise in radiotracer injection.
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Affiliation(s)
- Martina A Angeles
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Clinical Hospital of Barcelona, Barcelona, Spain - .,Department of Surgical Oncology, Claudius Regaud Institute, Cancer University Institute of Toulouse - Oncopole, Toulouse, France -
| | - Federico Migliorelli
- Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal des Vallées de l'Ariège, St Jean de Verges, France
| | | | - Cristina Ros
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Clinical Hospital of Barcelona, Barcelona, Spain
| | - Andrés Perissinotti
- Department of Nuclear Medicine, Clinical Hospital of Barcelona, Barcelona, Spain.,Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain
| | - Andrés Tapias
- Department of Nuclear Medicine, Clinical Hospital of Barcelona, Barcelona, Spain
| | | | - Jaume Pahisa
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Clinical Hospital of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Aureli Torné
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Clinical Hospital of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Sergi Vidal-Sicart
- Department of Nuclear Medicine, Clinical Hospital of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Marta Del Pino
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Clinical Hospital of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Pilar Paredes
- Department of Nuclear Medicine, Clinical Hospital of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine, University of Barcelona, Barcelona, Spain
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Fu X, Fu S, Cai Z, Jin R, Xia C, Lui S, Song B, Gong Q, Ai H. Manganese porphyrin/ICG nanoparticles as magnetic resonance/fluorescent dual-mode probes for imaging of sentinel lymph node metastasis. J Mater Chem B 2022; 10:10065-10074. [PMID: 36454208 DOI: 10.1039/d2tb01885c] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Diagnosis of sentinel lymph node (SLN) metastasis and its status are key parameters for predicting overall disease prognosis. In this work, Pluronic F127 stabilized ICG/tetra(4-carboxyphenyl)porphyrin-Mn(III) (TCPP(Mn)) nanoparticles (F127-ICG/Mn NPs) as fluorescent/magnetic resonance (FL/MR) dual-modality probes were prepared. The application of F127-ICG/Mn NPs in SLN imaging was mainly evaluated from two perspectives: the difference between the normal LN and the metastatic SLN and the difference between micrometastasis and macrometastasis. Normal and metastatic SLNs and micro- and macro-SLN metastasis were successfully distinguished through fluorescence and MR imaging with the help of F127-ICG/Mn NPs. In contrast, for the ICG group, the micro- and macro-SLN metastasis status could not be differentiated by fluorescence imaging. Besides, the lymph nodes can be stained green by the F127-ICG/Mn NPs and clearly visualized by the naked eye. In general, F127-ICG/Mn NPs demonstrated the potential of the preoperative diagnosis of SLN metastasis and its status, as well as intraoperative navigation by green-stained SLN and NIR FL imaging. This work provides a reference for developing multimodal nanoparticles for SLN metastasis diagnosis.
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Affiliation(s)
- Xiaomin Fu
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, 610064, P. R. China
| | - Shengxiang Fu
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, 610064, P. R. China
| | - Zhongyuan Cai
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, 610064, P. R. China
| | - Rongrong Jin
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, 610064, P. R. China
| | - Chunchao Xia
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China
| | - Su Lui
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China
| | - Bing Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.,Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Sichuan University, Chengdu, China
| | - Hua Ai
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, 610064, P. R. China.,Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China
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Hybrid (2D/3D) Dosimetry of Radiolabeled Gold Nanoparticles for Sentinel Lymph Node Detection in Patients with Breast Cancer. CONTRAST MEDIA & MOLECULAR IMAGING 2020; 2020:2728134. [PMID: 32489332 PMCID: PMC7229544 DOI: 10.1155/2020/2728134] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/28/2019] [Indexed: 11/17/2022]
Abstract
Previously, we reported the preparation and preclinical studies of 99mTc-labeled gold nanoparticles-mannose (99mTc-AuNP-mannose) with potential for sentinel lymph node (SLN) detection by using nuclear medicine procedures. This study aimed to evaluate the biokinetics and hybrid (2D/3D) dosimetry of 99mTc-AuNP-mannose in five patients with breast cancer under a sentinel lymph node detection protocol. Anterior and posterior whole-body planar images (2D, at 0.5, 2, 6, and 24 h) and single-photon emission computed tomography (3D at 6.5 h)/computed tomography (SPECT/CT) images were acquired after 99mTc-AuNP-mannose administration (37 MBq). Through a hybrid quantification method, activity in tissues of interest at the different acquisition times was determined and integrated over time to obtain the total nuclear transformations (N), as well as the mean residence time, in each tissue. N values and the OLINDA code were used for estimating the internal radiation absorbed doses. Results demonstrated that 99mTc-AuNP-mannose successfully accumulates and remains up to 24 h in the sentinel lymph node without detectable migration to other lymph nodes and no side effects on patients. Negligible absorption of the radiolabeled nanoparticles into the circulatory system was observed, from which the radio-nanosystem is rapidly eliminated by kidneys. Hybrid (2D/3D) dosimetry evaluations showed equivalent doses to SLN, breast, and kidneys of 172.34, 5.32, and 0.08 mSv/37 MBq, respectively, with an effective dose of 2.05E - 03 mSv/MBq. The mean effective residence time in SLN was 0.92 h. This preliminary study indicates that the use of 99mTc-AuNP-mannose for successful SLN detection in patients is safe, producing an effective dose at the level recommended for diagnostic studies (<10 mSv).
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Munrós J, Vázquez M, Santiago P, Romay G, Acea B. Management of breast carcinoma in ectopic axillary breast tissue. Cir Esp 2016; 95:232-233. [PMID: 27641761 DOI: 10.1016/j.ciresp.2016.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 07/25/2016] [Accepted: 07/26/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Jordina Munrós
- Servicio de Ginecología, Hospital Clínic de Barcelona, Barcelona, España.
| | - Macarena Vázquez
- Servicio de Ginecología, Hospital Costa del Sol, Marbella, Málaga, España
| | - Paz Santiago
- Servicio de Anatomía Patológica, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - Gabriela Romay
- Servicio de Cirugía General, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - Benigno Acea
- Unidad de Patología Mamaria, Complejo Hospitalario Universitario A Coruña, A Coruña, España
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Gültekin SS, Hasdemir AO, Tokgöz S, Özgehan G, Güzel H, Yücesoy C, Öztürk E, Arıkök AT. Sentinel Lymph Node Detection by 3D Freehand Single-Photon Emission Computed Tomography in Early Stage Breast Cancer. Mol Imaging Radionucl Ther 2016; 25:97-101. [PMID: 27277327 PMCID: PMC5096627 DOI: 10.4274/mirt.81894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
We herein present our first experience obtained by 3D freehand single-photon emission computed tomography (SPECT) (F-SPECT) guidance for sentinel lymph node detection (SLND) in two patients with early stage breast cancer. F-SPECT guidance was carried out using one-day protocol in one case and by the two-day protocol in the other one. SLND was performed successfully in both patients. Histopathologic evaluation showed that the excised nodes were tumor negative. Thus, patients underwent breast-conserving surgery alone.
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Affiliation(s)
- Salih Sinan Gültekin
- Dışkapı Yıldırım Beyazıt Training and Research Hospital, Clinic of Nuclear Medicine, Ankara, Turkey, Phone: +90 533 761 49 91 E-mail:
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Esposito M, Busam B, Hennersperger C, Rackerseder J, Navab N, Frisch B. Multimodal US-gamma imaging using collaborative robotics for cancer staging biopsies. Int J Comput Assist Radiol Surg 2016; 11:1561-71. [PMID: 27507282 DOI: 10.1007/s11548-016-1464-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 07/25/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE The staging of female breast cancer requires detailed information about the level of cancer spread through the lymphatic system. Common practice to obtain this information for patients with early-stage cancer is sentinel lymph node (SLN) biopsy, where LNs are radioactively identified for surgical removal and subsequent histological analysis. Punch needle biopsy is a less invasive approach but suffers from the lack of combined anatomical and nuclear information. We present and evaluate a system that introduces live collaborative robotic 2D gamma imaging in addition to live 2D ultrasound to identify SLNs in the surrounding anatomy. METHODS The system consists of a robotic arm equipped with both a gamma camera and a stereoscopic tracking system that monitors the position of an ultrasound probe operated by the physician. The arm cooperatively places the gamma camera parallel to the ultrasound imaging plane to provide live multimodal visualization and guidance. We validate the system by evaluating the target registration errors between fused nuclear and US image data in a phantom consisting of two spheres, one of which is filled with radioactivity. Medical experts perform punch biopsies on agar-gelatine phantoms with complex configurations of hot and cold lesions to provide a qualitative and quantitative evaluation of the system. RESULTS The average point registration error for the overlay is [Formula: see text] mm. The time of the entire procedure was reduced by 36 %, with 80v of the biopsies being successful. The users' feedback was very positive, and the system was deemed to be very intuitive, with handling similar to classic US-guided needle biopsy. CONCLUSION We present and evaluate the first medical collaborative robotic imaging system. Feedback from potential users for SLN punch needle biopsy is encouraging. Ongoing work investigates the clinical feasibility with more complex and realistic phantoms.
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Affiliation(s)
- Marco Esposito
- Computer Aided Medical Procedures (CAMP), Technische Universität München, Munich, Germany.
| | - Benjamin Busam
- Computer Aided Medical Procedures (CAMP), Technische Universität München, Munich, Germany
- FRAMOS GmbH, Taufkirchen, Germany
| | | | - Julia Rackerseder
- Computer Aided Medical Procedures (CAMP), Technische Universität München, Munich, Germany
| | - Nassir Navab
- Computer Aided Medical Procedures (CAMP), Technische Universität München, Munich, Germany
- Computer Aided Medical Procedures, Johns Hopkins University, Baltimore, MD, US
| | - Benjamin Frisch
- Computer Aided Medical Procedures (CAMP), Technische Universität München, Munich, Germany
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Location of Sentinel Lymph Node in Cervical Carcinoma and Factors Associated With Unilateral Detection. Int J Gynecol Cancer 2016; 25:1663-8. [PMID: 26270124 DOI: 10.1097/igc.0000000000000539] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The aims of this study were to assess locality of the sentinel lymph node (SLN) in cervical carcinoma and examine factors affecting bilateral SLN detection. METHODS This was a retrospective review of SLN data (anatomical location, count and laterality) in patients with early-stage cervical cancer (International Federation of Gynecology and Obstetrics stage IA1 with lymphovascular space invasion to stage IIA) using intraoperative gamma probe and blue dye. The preoperative single-photon emission computed tomography with computed tomography was used to detect laterality, number of the SLNs, and rare locations. Patients were treated between January 2005 to January 2015 at the West Kent Gynaecological Oncology Centre, Maidstone Hospital, Maidstone, United Kingdom. RESULTS A total of 132 women were investigated. The most common SLN location was the external iliac (38.6%) followed by obturator (25.3%) and internal iliac (23.6%) regions. A small percentage was identified in presacral (1.4%) and para-aortic regions (0.7%). Older age (P = 0.01) and an elevated body mass index (P = 0.03) were associated with decreased SLN count by preoperative single-photon emission computed tomography with computed tomography, and only age affected SLN count by gamma probe (P = 0.01). Initial surgery, large loop excision of the transformation zone, or cone biopsy of the cervix had no effect on SLN count. There was no difference observed in bilateral detection with respect to surgical approach (open: n = 48/laparoscopic: n = 84). However, older age was independently associated with a decrease in bilateral SLN detection (P = 0.003). In these patients who underwent unilateral full pelvic lymphadenectomy, all the nonsentinel nodes were negative. CONCLUSIONS The majority of SLNs were located in the external iliac, obturator, and internal iliac regions. Both older age and an elevated body mass index were associated with a reduced SLN count. Unilateral detection of SLN was independently associated with older age, which may be due to sclerosis in the lymphatic vessels or reduced perfusion in the pelvis in these women. If no SLN is detected on one side, the consensus is to perform a full pelvic lymphadenectomy on that side of the pelvis.
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Misra M, Sagar P, Friedmann AM, Ryan DP, Sgroi DC. CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 12-2016. An 8-Year-Old Boy with an Enlarging Mass in the Right Breast. N Engl J Med 2016; 374:1565-74. [PMID: 27096583 DOI: 10.1056/nejmcpc1503831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Madhusmita Misra
- From the Departments of Pediatrics (M.M., A.M.F.), Radiology (P.S.), Pediatric Surgery (D.P.R.), and Pathology (D.C.S.), Massachusetts General Hospital, and the Departments of Pediatrics (M.M., A.M.F.), Radiology (P.S.), Pediatric Surgery (D.P.R.), and Pathology (D.C.S.), Harvard Medical School - both in Boston
| | - Pallavi Sagar
- From the Departments of Pediatrics (M.M., A.M.F.), Radiology (P.S.), Pediatric Surgery (D.P.R.), and Pathology (D.C.S.), Massachusetts General Hospital, and the Departments of Pediatrics (M.M., A.M.F.), Radiology (P.S.), Pediatric Surgery (D.P.R.), and Pathology (D.C.S.), Harvard Medical School - both in Boston
| | - Alison M Friedmann
- From the Departments of Pediatrics (M.M., A.M.F.), Radiology (P.S.), Pediatric Surgery (D.P.R.), and Pathology (D.C.S.), Massachusetts General Hospital, and the Departments of Pediatrics (M.M., A.M.F.), Radiology (P.S.), Pediatric Surgery (D.P.R.), and Pathology (D.C.S.), Harvard Medical School - both in Boston
| | - Daniel P Ryan
- From the Departments of Pediatrics (M.M., A.M.F.), Radiology (P.S.), Pediatric Surgery (D.P.R.), and Pathology (D.C.S.), Massachusetts General Hospital, and the Departments of Pediatrics (M.M., A.M.F.), Radiology (P.S.), Pediatric Surgery (D.P.R.), and Pathology (D.C.S.), Harvard Medical School - both in Boston
| | - Dennis C Sgroi
- From the Departments of Pediatrics (M.M., A.M.F.), Radiology (P.S.), Pediatric Surgery (D.P.R.), and Pathology (D.C.S.), Massachusetts General Hospital, and the Departments of Pediatrics (M.M., A.M.F.), Radiology (P.S.), Pediatric Surgery (D.P.R.), and Pathology (D.C.S.), Harvard Medical School - both in Boston
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Rocha RD, Girardi AR, Pinto RR, de Freitas VAR. Axillary ultrasound and fine-needle aspiration in preoperative staging of axillary lymph nodes in patients with invasive breast cancer. Radiol Bras 2016; 48:345-52. [PMID: 26811550 PMCID: PMC4725394 DOI: 10.1590/0100-3984.2014.0121] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To propose an algorithm to determine the necessity for ultrasonography-guided fine-needle aspiration (US-FNA) in preoperative axillary lymph node staging of patients with invasive breast cancer. MATERIALS AND METHODS Prospective study developed at National Cancer Institute. The study sample included 100 female patients with breast cancer referred for axillary staging by US-FNA. RESULTS The overall US-FNA sensitivity was set at 79.4%. The positive predictive value was calculated to be 100%, and the negative predictive value, 69.5%. The US-FNA sensitivity for lymph nodes with normal sonographic features was 0%, while for indeterminate lymph nodes it was 80% and, for suspicious lymph nodes, 90.5%. In the assessment of invasive breast tumors stages T1, T2 and T3, the sensitivity was respectively 69.6%, 83.7% and 100%. US-FNA could avoid sentinel node biopsy in 54% of cases. CONCLUSION Axillary ultrasonography should be included in the preoperative staging of all patients with invasive breast cancer. The addition of US-FNA in cases of lymph nodes suspicious for malignancy may prevent more than 50% of sentinel lymphadenectomies, significantly shortening the time interval to definitive therapy.
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Affiliation(s)
- Rafael Dahmer Rocha
- MD, Radiologist, Trainee in Interventional Radiology at Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - André Ricardo Girardi
- MD, Radiologist, Trainee in General Radiology at Med Imagem - Real e Benemérita Sociedade Portuguesa de Beneficência, São Paulo, SP, Brazil
| | - Renata Reis Pinto
- MD, Breast Specialist, Hospital do Câncer III - Instituto Nacional de Câncer - Ministério da Saúde (INCA-MS), Rio de Janeiro, RJ, Brazil
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Sharma N, Pinto A, Notghi A, Sintler M. Preoperative Scintigrams to Identify the Sentinel Lymph Node in Breast Cancer: a Waste of Time? Indian J Surg 2015; 77:1480-3. [PMID: 27011606 PMCID: PMC4775584 DOI: 10.1007/s12262-013-0994-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 10/10/2013] [Indexed: 10/26/2022] Open
Abstract
Sentinel lymph node biopsy (SLNB) remains the gold standard for assessing axillary node status in breast cancer. Preoperative scintigrams have been used to identify the sentinel lymph node (SLN); however, their use is controversial. Studies suggest they add little to successful SLN detection in theatre, immediately prior to node excision. They have been associated with high false negatives, time expense, patient dissatisfaction, and unnecessary costs. The aim of the present study was to evaluate the diagnostic accuracy of scintigrams in comparison to intraoperative SLN identification techniques. This study included all patients undergoing a SLNB for breast cancer from April 2010 to 2011. Scintigram reports, operation notes, and histology results were analyzed. Mann-Whitney U and chi-squared tests were used for statistical analysis of data. Two hundred nineteen female patients with a median age of 59.6 years (24.0-89.9 years) were included in this study. Scintigram was performed in 185 and not in 34 patients due to time constraints. Combined γ-probe and Isosulfan blue dye for SLN detection (intraoperative methods) have an identification rate of 98.2 % (p = 0.005), compared to 92.4 % (p = 0.088) from scintigrams alone. Scintigrams confer no additional advantage to the operating surgeon for successful SLN detection and excision in theatre. Intraoperative SLN identification is more accurate and reliable. Routine scintigram use is unjustified and should be withdrawn from current practice.
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Affiliation(s)
- N. Sharma
- />Royal Shrewsbury Hospital, Shrewsbury, UK
| | - A. Pinto
- />Royal Wolverhampton Hospital Trusts, Wolverhampton, UK
| | - A. Notghi
- />Sandwell and West Birmingham Hospital Trusts, Birmingham, UK
| | - M. Sintler
- />Sandwell and West Birmingham Hospital Trusts, Birmingham, UK
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The Value of Isosulfan Blue Dye in Addition to Isotope Scanning in the Identification of the Sentinel Lymph Node in Breast Cancer Patients With a Positive Lymphoscintigraphy. Ann Surg 2015; 262:243-8. [DOI: 10.1097/sla.0000000000001213] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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12
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Teixeira SC, Peeters MJTFDV, Stokkel MPM, Rutgers EJTH, Olmos RAV, Koolen BB. The role of PET/CT for nodal staging in primary stage II/III breast cancer patients. BREAST CANCER MANAGEMENT 2015. [DOI: 10.2217/bmt.15.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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13
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Vetter C, Lasser T, Okur A, Navab N. 1D-3D registration for intra-operative nuclear imaging in radio-guided surgery. IEEE TRANSACTIONS ON MEDICAL IMAGING 2015; 34:608-617. [PMID: 25343756 DOI: 10.1109/tmi.2014.2363551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
3D functional nuclear imaging modalities like SPECT or PET provide valuable information, as small structures can be marked with radioactive tracers to be localized before surgery. This positional information is valuable during surgery as well, for example when locating potentially cancerous lymph nodes in the case of breast cancer. However, the volumetric information provided by pre-operative SPECT scans loses validity quickly due to posture changes and manipulation of the soft tissue during surgery. During the intervention, the surgeon has to rely on the acoustic feedback provided by handheld gamma-detectors in order to localize the marked structures. In this paper, we present a method that allows updating the pre-operative image with a very limited number of tracked readings. A previously acquired 3D functional volume serves as prior knowledge and a limited number of new 1D detector readings is used in order to update the prior knowledge. This update is performed by a 1D-3D registration algorithm that registers the volume to the detector readings. This enables the rapid update of the visual guidance provided to the surgeon during a radio-guided surgery without slowing down the surgical workflow. We evaluate the performance of this approach using Monte-Carlo simulations, phantom experiments and patient data, resulting in a positional error of less than 8 mm which is acceptable for surgery. The 1D-3D registration is also compared to a volumetric reconstruction using the tracked detector measurements without taking prior information into account, and achieves a comparable accuracy with significantly less measurements.
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Arias Ortega M, Torres Sousa M, González García B, Pardo García R, González López A, Delgado Portela M. Preoperative lymphoscintigraphy and tumor histologic grade are associated with surgical detection of the sentinel lymph node. RADIOLOGIA 2014. [DOI: 10.1016/j.rxeng.2012.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Balalis GL, Thompson SK. Sentinel lymph node biopsy in esophageal cancer: an essential step towards individualized care. ANNALS OF SURGICAL INNOVATION AND RESEARCH 2014; 8:2. [PMID: 24829610 PMCID: PMC4019891 DOI: 10.1186/1750-1164-8-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 04/29/2014] [Indexed: 12/23/2022]
Abstract
Lymph node status is the most important prognostic factor in esophageal cancer. Through improved detection of lymph node metastases, using the sentinel lymph node concept, accurate staging and more tailored therapy may be achieved. This review article outlines two principle ways in which the sentinel lymph node concept could dramatically influence current standard of care for patients with esophageal cancer. We discuss three limitations to universal acceptance of the technique, and propose next steps for increasing enthusiasm amongst physicians and surgeons including the development of a universal tracer, and improved contrast agents with novel dual-modality 'visibility'.
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Affiliation(s)
- George L Balalis
- Department of Surgery, Level 5, Eleanor Harrald Building, Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia
| | - Sarah K Thompson
- Department of Surgery, Level 5, Eleanor Harrald Building, Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia
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Torresan C, Oliveira MMC, Pereira SRF, Ribeiro EMSF, Marian C, Gusev Y, Lima RS, Urban CA, Berg PE, Haddad BR, Cavalli IJ, Cavalli LR. Increased copy number of the DLX4 homeobox gene in breast axillary lymph node metastasis. Cancer Genet 2014; 207:177-87. [PMID: 24947980 DOI: 10.1016/j.cancergen.2014.04.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 04/08/2014] [Accepted: 04/20/2014] [Indexed: 10/25/2022]
Abstract
DLX4 is a homeobox gene strongly implicated in breast tumor progression and invasion. Our main objective was to determine the DLX4 copy number status in sentinel lymph node (SLN) metastasis to assess its involvement in the initial stages of the axillary metastatic process. A total of 37 paired samples of SLN metastasis and primary breast tumors (PBT) were evaluated by fluorescence in situ hybridization, quantitative polymerase chain reaction and array comparative genomic hybridization assays. DLX4 increased copy number was observed in 21.6% of the PBT and 24.3% of the SLN metastasis; regression analysis demonstrated that the DLX4 alterations observed in the SLN metastasis were dependent on the ones in the PBT, indicating that they occur in the primary tumor cell populations and are maintained in the early axillary metastatic site. In addition, regression analysis demonstrated that DLX4 alterations (and other DLX and HOXB family members) occurred independently of the ones in the HER2/NEU gene, the main amplification driver on the 17q region. Additional studies evaluating DLX4 copy number in non-SLN axillary lymph nodes and/or distant breast cancer metastasis are necessary to determine if these alterations are carried on and maintained during more advanced stages of tumor progression and if could be used as a predictive marker for axillary involvement.
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Affiliation(s)
- Clarissa Torresan
- Department of Genetics, Federal University of Paraná, Curitiba, PR, Brazil
| | | | - Silma R F Pereira
- Department of Biology, Federal University of Maranhão, São Luis, MA, Brazil
| | | | - Catalin Marian
- Department of Biochemistry, University of Medicine and Pharmacy, Timisoara, Romania
| | - Yuriy Gusev
- Innovation Center for Biomedical Informatics, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Rubens S Lima
- Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil
| | - Cicero A Urban
- Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil; Positivo University, Curitiba, PR, Brazil
| | - Patricia E Berg
- Department of Biochemistry and Molecular Medicine, George Washington University Medical Center, Washington, DC, USA
| | - Bassem R Haddad
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Iglenir J Cavalli
- Department of Genetics, Federal University of Paraná, Curitiba, PR, Brazil
| | - Luciane R Cavalli
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
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Abstract
Malignant tumors release growth factors such as VEGF-C to induce lymphatic vessel expansion (lymphangiogenesis) in primary tumors and in draining sentinel LNs, thereby promoting LN metastasis. Surprising recent evidence suggests that lymphatic vessels do not merely represent passive channels for tumor spread, but that they may actively promote tumor cell recruitment to LNs, cancer stem cell survival, and immune modulation. New imaging approaches allow the sensitive visualization of the earliest LN metastases and the quantitative, noninvasive measurement of the function of tumor-draining lymphatic vessels, with potential applications in the development of biomarkers for prognosis and measurement of therapeutic response.
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Vidal-Sicart S, Giammarile F, Mariani G, Valdés Olmos RA. Pre- and intra-operative imaging techniques for sentinel node localization in breast cancer. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/iim.13.31] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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van den Berg NS, Valdés-Olmos RA, van der Poel HG, van Leeuwen FW. Sentinel Lymph Node Biopsy for Prostate Cancer: A Hybrid Approach. J Nucl Med 2013; 54:493-6. [DOI: 10.2967/jnumed.112.113746] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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21
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Proulx ST, Detmar M. Molecular mechanisms and imaging of lymphatic metastasis. Exp Cell Res 2013; 319:1611-7. [PMID: 23499738 DOI: 10.1016/j.yexcr.2013.03.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 02/26/2013] [Accepted: 03/02/2013] [Indexed: 12/31/2022]
Abstract
In many types of cancer, tumors metastasize through the lymphatic system to draining lymph nodes. These sentinel lymph nodes have gained increased attention as a prognostic indicator for the severity of the disease, leading to the sentinel lymph node mapping and biopsy procedure to be accepted as standard-of-care for breast cancer and melanoma. However, many limitations exist with this procedure resulting in high false negative rates. In this review we highlight the new advances in the understanding of the molecular mechanisms of lymphangiogenesis and tumor metastasis that may lead to improved strategies in the detection of the sentinel lymph nodes and therapeutic interventions to prevent further tumor spread. In addition, advances in imaging technology are allowing new approaches for anatomical mapping of lymphatic drainage patterns and molecular imaging strategies that may improve detection of metastatic tumor cells within sentinel lymph nodes.
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Affiliation(s)
- Steven T Proulx
- Institute of Pharmaceutical Sciences, Swiss Federal Institute of Technology, ETH Zurich, Wolfgang-Pauli-Str. 10, CH-8093 Zurich, Switzerland
| | - Michael Detmar
- Institute of Pharmaceutical Sciences, Swiss Federal Institute of Technology, ETH Zurich, Wolfgang-Pauli-Str. 10, CH-8093 Zurich, Switzerland.
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22
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Tsushima H. [From diagnosis to therapy of breast cancer. 8. Sentinel lymph node biopsy]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2012; 68:1401-12. [PMID: 23089844 DOI: 10.6009/jjrt.2012_jsrt_68.10.1401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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