Sentinel Lymphadenectomy in Cutaneous Melanoma

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.

The use of an equine collagen fleece (Gentafleece®) in T1 breast cancer surgery: preliminary results

Abstract #4147

Introduction: A prospective multicentric randomized study is being conduced by Breast Cancer Surgical Group of Rome in order to evaluate the benefits of the use of equine collagen (Gentafleece®) on surgical and aesthetic outcome in T1 breast cancer patients.
 Materials and Methods: One hundred and sixty T1 breast cancer patients have been randomized in two groups by four Roman Institutions in order to evaluate the potential clinical benefits of the use of equine collagen and gentamicine fleece (Gentafleece®). The parameters we studied and compared into the Gentafleece® and control group were: patients'satisfaction, seroma, hematoma, infections, fibrosis and aesthetic result. Both the groups underwent clinical and Ultrasound evaluations after One, Two, and Six months.
 Results: Belonging to Gentafleece® group, seroma was detected in 7 (5,6%) pts, hematoma in 4 (3,2%) cases, fibrosis and surgical suture aesthetic distortions in 14 (11,2%) pts. On the other hand, in control group were found: 20 (16%) cases of hematoma; 32 (25,6%) cases of seroma; 22 (17,6%) cases were represented by parenchimal fibrosis associated to surgical suture distortions. One case (0,8%) of so defined “reactive megalomasty” occurred in a patient previously treated by neo adjuvant chemotherapy (Gentafleece® group). One case (0,8%) of dermatitis occurred in the same group. In many cases the complete healing of surgical suture was anticipated into first Group. Infection or suture dehiscences occurred in two cases (1,6%) treated by Gentafleece® beside 13 cases (10,4%) of the control group.
 Discussion: This preliminary study seems to demonstrate that Gentafleece®, equine collagen and gentamicine fleece, is able to reduce the impact of seromas, ematomas, parenchimal fibrosis and surgical sutures and parenchimal aesthetic distortions in according to collagenic properties of cicatrization and hemostatic response. Furthermore Gentafleece® affords a significative antiinfective protection against surgical infection or suture dehiscence.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4147.

[Intraoperative radiolocalization of intraductal breast carcinoma: sentinel lymph node evaluation]

Sentinel lymph node biopsy and intraoperatory radiolocalization (RLI) are fast becoming the standard surgical treatment for invasive breast cancer. Actually, it seems, they have the same rule in "high risk" DCIS of the breast.

Radioguided-surgery of early breast lesions

BACKGROUND

Radioguided-surgery has been recently proposed in patients with clinically occult breast lesions. This study aimed to evaluate the feasibility of correctly locating and eradicating, by a single intralesional injection of a radiotracer, any breast lesion and, in the case of malignancy, to perform simultaneous sentinel lymph node (SLN) biopsy procedure.

PATIENTS AND METHODS

Sixty-three women with early breast lesions were enrolled: 42 were invasive carcinomas, 16 in situ ductal carcinomas (DCIS) and 5 fibroadenomas.

RESULTS

Scintigraphic images clearly identified the lesions in all patients while SLN/s were evident in 88% of them. At surgery all the breast lesions were easily radiolocalized and eradicated with minimum surgical trauma and, for those patients with invasive carcinomas, the SLN technique was performed in 86% of them. No skip metastases were found.

CONCLUSION

A single intralesional administration of radiotracer is an easy and reliable procedure to simultaneously locate and remove both the non-palpable breast lesion and the SLN when primary malignancy was intraoperatively confirmed.

Medical and industrial hygiene characterization of the cotton waste utilization industry

We studied 260 workers in the cotton waste utilization industry and 310 "blue-collar" control workers from nondusty industries in the same geographic area of the United States by respiratory symptom questionnaire and by pre- and postshift spirometry. We excluded 75 cotton workers and 75 control workers from statistical analysis because of prior hazardous occupational exposures. Plant-wide, 8-hour time-weighted average exposures ranged from 0.28 mg/m3 to 7.80 mg/m3. The overall prevalence of symptoms compatible with byssinosis was 5.9% in cotton workers and 4.7% in the controls. Cotton workers with less than 2 years of employment had a significantly greater prevalence of bronchitis than their control counterparts. The cotton workers with 2 years or more of employment had significantly greater prevalences of bronchitis, shift decrement in forced expiratory volume in 1 second (FEV1) of greater than or equal to 10%, and FEV1/FEV1-predicted less than 80%, than their control counterparts. Regression analysis showed that for matched cotton and control workers, the percentage decrement in FEV1 over the shift was significantly greater for cotton workers; and that in all cotton workers, longevity in industry had a negative effect on the before-shift forced vital capacity (FVC). This study suggests that there are both acute and chronic effects of cotton exposure in the cotton waste utilization industry.