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Liu JB, Machado P, Eisenbrey JR, Gummadi S, Forsberg F, Wessner CE, Kumar AR, Chiang A, Infantolino A, Schlachterman A, Kowalski T, Coben R, Loren D. Identification of sentinel lymph nodes in esophageal cancer patients using contrast-enhanced EUS with peritumoral injections. Endosc Ultrasound 2023; 12:362-368. [PMID: 37795347 PMCID: PMC10547247 DOI: 10.1097/eus.0000000000000001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 04/12/2023] [Indexed: 10/06/2023] Open
Abstract
Objectives The objective of this pilot study was to compare the performance of contrast-enhanced EUS (CE-EUS)-guided fine-needle aspiration (FNA) with EUS-FNA for lymph node (LN) staging in esophageal cancer. Methods Thirty-seven subjects with esophageal cancer undergoing EUS staging were enrolled, and 30 completed this institutional review board-approved study. A Prosound F75 US system (Hitachi Medical Systems, Tokyo, Japan) with harmonic contrast imaging software and GF-UCT180 curvilinear endoscope (Olympus, Tokyo, Japan) was utilized. All LNs identified by standard EUS were first noted. Sonazoid (dose: 1 mL; GE Healthcare, Oslo, Norway) was administered peritumorally, and all enhanced LNs were recorded. Fine-needle aspiration was performed on LNs considered suspicious by EUS alone, as well as LNs enhanced on CE-EUS. Performance of each modality was compared using FNA cytology as reference standard. Results A total of 132 LNs were detected with EUS, of which 59 showed enhancement on CE-EUS. Fifty-three LNs underwent FNA, and 22 LNs were determined to be malignant. Among the latter, 10 were considered suspicious by EUS, whereas the other 12 LNs underwent FNA only because of CE-EUS enhancement. Contrast-enhanced EUS showed enhancement in 19 of the 22 malignant LNs. The rate of metastatic node identification from EUS was 45% (10/22), and it was 86% (19/22; P = 0.008) for CE-EUS. Eight subjects (8/30 [27% of study total]) had nodal status upgraded by the addition of CE-EUS, which influenced LN staging and clinical management. Conclusions Fine-needle aspiration of LNs identified by CE-EUS may increase metastasis positive rate by ruling out LNs not associated with the tumor drainage pattern. In addition, CE-EUS seems to identify more metastatic LNs that would not be biopsied under the standard EUS criteria.
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Affiliation(s)
- Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA USA
| | - Priscilla Machado
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA USA
| | - John R. Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA USA
| | | | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA USA
| | - Corinne E. Wessner
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA USA
| | - Anand Raman Kumar
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Austin Chiang
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | - Thomas Kowalski
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Robert Coben
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - David Loren
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
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Singhal S, Roy S. cT2N0 esophageal adenocarcinoma: predictors of lymph nodal involvement and clinical significance. J Thorac Dis 2019; 11:S453-S456. [PMID: 30997246 DOI: 10.21037/jtd.2018.11.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Saurabh Singhal
- Department of GI Surgery and Liver Transplantation, Indraprastha Apollo Hospital, New Delhi, India
| | - Soumen Roy
- Department of GI Surgery and Liver Transplantation, Indraprastha Apollo Hospital, New Delhi, India
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Moncayo VM, Alazraki AL, Alazraki NP, Aarsvold JN. Sentinel Lymph Node Biopsy Procedures. Semin Nucl Med 2017; 47:595-617. [DOI: 10.1053/j.semnuclmed.2017.06.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Niu C, Wang L, Wang Z, Xu Y, Hu Y, Peng Q. Laser irradiated fluorescent perfluorocarbon microparticles in 2-D and 3-D breast cancer cell models. Sci Rep 2017; 7:43408. [PMID: 28262671 PMCID: PMC5338257 DOI: 10.1038/srep43408] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 01/24/2017] [Indexed: 12/20/2022] Open
Abstract
Perfluorocarbon (PFC) droplets were studied as new generation ultrasound contrast agents via acoustic or optical droplet vaporization (ADV or ODV). Little is known about the ODV irradiated vaporization mechanisms of PFC-microparticle complexs and the stability of the new bubbles produced. In this study, fluorescent perfluorohexane (PFH) poly(lactic-co-glycolic acid) (PLGA) particles were used as a model to study the process of particle vaporization and bubble stability following excitation in two-dimensional (2-D) and three-dimensional (3-D) cell models. We observed localization of the fluorescent agent on the microparticle coating material initially and after vaporization under fluorescence microscopy. Furthermore, the stability and growth dynamics of the newly created bubbles were observed for 11 min following vaporization. The particles were co-cultured with 2-D cells to form 3-D spheroids and could be vaporized even when encapsulated within the spheroids via laser irradiation, which provides an effective basis for further work.
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Affiliation(s)
- Chengcheng Niu
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Long Wang
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Zhigang Wang
- Second Affiliated Hospital, Institute of Ultrasound Imaging, Chongqing Medical University, Chongqing, 400010, China
| | - Yan Xu
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Yihe Hu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Qinghai Peng
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
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Goense L, van Rossum PSN, Kandioler D, Ruurda JP, Goh KL, Luyer MD, Krasna MJ, van Hillegersberg R. Stage-directed individualized therapy in esophageal cancer. Ann N Y Acad Sci 2016; 1381:50-65. [PMID: 27384385 DOI: 10.1111/nyas.13113] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 05/05/2016] [Indexed: 12/16/2022]
Abstract
Esophageal cancer is the eighth most common cancer worldwide, and the incidence of esophageal carcinoma is rapidly increasing. With the advent of new staging and treatment techniques, esophageal cancer can now be managed through various strategies. A good understanding of the advances and limitations of new staging techniques and how these can guide in individualizing treatment is important to improve outcomes for esophageal cancer patients. This paper outlines the recent progress in staging and treatment of esophageal cancer, with particularly attention to endoscopic techniques for early-stage esophageal cancer, multimodality treatment for locally advanced esophageal cancer, assessment of response to neoadjuvant treatment, and the role of cervical lymph node dissection. Furthermore, advances in robot-assisted surgical techniques and postoperative recovery protocols that may further improve outcomes after esophagectomy are discussed.
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Affiliation(s)
- Lucas Goense
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter S N van Rossum
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Daniela Kandioler
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Khean-Lee Goh
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Misha D Luyer
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Mark J Krasna
- Meridian Cancer Care, Jersey Shore University Medical Center, Neptune, New Jersey
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Wang L, Hu Y, Peng Q, Zhou J, Zhou Q, An S, Niu C. Indocyanine-green-loaded microbubbles for localization of sentinel lymph node using near-infrared fluorescence/ultrasound imaging: a feasibility study. RSC Adv 2016. [DOI: 10.1039/c5ra26814a] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Current strategies for sentinel lymph node (SLN) biopsy to detect cancer metastasis have some limitations such as the associated radiation exposure and high false-negative rates due to dye particles through the true SLNs to contiguous LNs.
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Affiliation(s)
- Long Wang
- Department of Orthopedics
- Xiangya Hospital
- Central South University
- Changsha
- P. R. China
| | - Yihe Hu
- Department of Orthopedics
- Xiangya Hospital
- Central South University
- Changsha
- P. R. China
| | - Qinghai Peng
- Department of Ultrasound
- The Second Xiangya Hospital
- Central South University
- Changsha
- P. R. China
| | - Jiawei Zhou
- Department of Ultrasound
- The Second Xiangya Hospital
- Central South University
- Changsha
- P. R. China
| | - Qichang Zhou
- Department of Ultrasound
- The Second Xiangya Hospital
- Central South University
- Changsha
- P. R. China
| | - Senbo An
- Department of Orthopedics
- Xiangya Hospital
- Central South University
- Changsha
- P. R. China
| | - Chengcheng Niu
- Department of Ultrasound
- The Second Xiangya Hospital
- Central South University
- Changsha
- P. R. China
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Rosso KJ, Nathanson SD. Techniques that accurately identify the sentinel lymph node in cancer. World J Surg Proced 2015; 5:14-26. [DOI: 10.5412/wjsp.v5.i1.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/30/2014] [Accepted: 02/09/2015] [Indexed: 02/06/2023] Open
Abstract
Sentinel lymph node (SLN) biopsy has become the gold standard for patients with melanoma and breast cancer but it’s clinical application in other solid tumor types such as cancers of the esophagus, stomach, colon and rectum, head and neck, penis, uterine cervix and endometrium has been somewhat limited. Commonly used mapping techniques utilizing the combination of radiocolloid and blue dye may result in reduced SLN detection and increased false negative rates when applied to cancers with more complex lymphatic drainage patterns. Novel localization techniques including near infrared fluorescence, high resolution imaging and molecular targeted agents have been developed to address the limitations of conventional SLN detection practices in many solid tumor types. This article reviews the indications, techniques and detection rates for SLN biopsy in several different solid tumor types as well as the promising novel techniques created to address the contemporary limitations of this procedure.
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He J, Zeng ZC, Shi SM, Yang P. Clinical features, outcomes and treatment-related pneumonitis in elderly patients with esophageal carcinoma. World J Gastroenterol 2014; 20:13185-13190. [PMID: 25278715 PMCID: PMC4177500 DOI: 10.3748/wjg.v20.i36.13185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 07/03/2014] [Accepted: 07/25/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the clinical features and prognoses of elderly patients with esophageal carcinoma and to compare the effects of radiotherapy and rates of treatment-related pneumonitis (TRP) between elderly and non-elderly patients.
METHODS: A total of 236 patients with esophageal carcinoma who received radiotherapy between 2002 and 2012 were enrolled. The patients were divided into two groups: an elderly group (age ≥ 65 years) and a non-elderly group (age < 65 years). The tumor position and stage, lymph node and distant metastases, and incidence and severity of TRP were compared. Multivariate analysis was applied to identify independent prognostic factors.
RESULTS: The median overall survival times after radiotherapy in the elderly and non-elderly groups were 18.5 and 20.5 mo, respectively. Cox regression analysis showed that TRP grade and tumor-node-metastasis (TNM) stage were independent prognostic factors in the elderly group. High-dose radiotherapy (> 60 Gy) was associated with a high incidence of TRP. Tumor TNM staging was significantly different between the two groups in which TRP occurred. Multivariate analysis showed that TNM stage was an independent prognostic factor. Esophageal carcinoma in elderly patients was relatively less malignant compared with that in non-elderly patients.
CONCLUSION: An appropriate dose should be used to decrease the incidence of TRP in radiotherapy, and intensity modulated radiation therapy should be selected if possible.
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