Clinicopathologic Features Predicting Involvement of Nonsentinel Axillary Lymph Nodes in Iranian Women with Breast Cancer

Moosavi, Seyed Alireza,Abdirad, Afshin,Omranipour, Ramesh,Hadji, Maryam,Razavi, Amirnader Emami,Najafi, Massoome Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.17

Background: Almost half of the breast cancer patients with positive sentinel lymph nodes have no additional disease in the remaining axillary lymph nodes. This group of patients do not benefit from complete axillary lymph node dissection. This study was designed to assess the clinicopathologic factors that predict non-sentinel lymph node metastasis in Iranian breast cancer patients with positive sentinel lymph nodes. Materials and Methods: The records of patients who underwent sentinel lymph node biopsy, between 2003 and 2012, were reviewed. Patients with at least one positive sentinel lymph node who underwent completion axillary lymph node dissection were enrolled in the present study. Demographic and clinicopathologic characteristics including age, primary tumor size, histological and nuclear grade, lymphovascular invasion, perineural invasion, extracapsular invasion, and number of harvested lymph nodes, were evaluated. Results: The data of 167 patients were analyzed. A total of 92 (55.1%) had non-sentinel lymph node metastasis. Univariate analysis of data revealed that age, primary tumor size, histological grade, lymphovascular invasion, perineural invasion, extracapsular invasion, and the number of positive sentinel lymph nodes to the total number of harvested sentinel lymph nodes ratio, were associated with non-sentinel lymph node metastasis. After logistic regression analysis, age (OR=0.13; 95% CI, 0.02-0.8), primary tumor size (OR=7.7; 95% CI, 1.4-42.2), lymphovascular invasion (OR=19.4; 95% CI, 1.4-268.6), extracapsular invasion (OR=13.3; 95% CI, 2.3-76), and the number of positive sentinel lymph nodes to the total number of harvested sentinel lymph nodes ratio (OR=20.2; 95% CI, 3.4-121.9), were significantly associated with non-sentinel lymph node metastasis. Conclusions: According to this study, age, primary tumor size, lymphovascular invasion, extracapsular invasion, and the ratio of positive sentinel lymph nodes to the total number of harvested sentinel lymph nodes, were found to be independent predictors of non-sentinel lymph node metastasis.

Lymphoscintigraphy와 Gamma-probe를 이용한 악성흑색종의 전초 림프절 생검 및 병기결정

김홍석 ( Kim Hong Seok ),송기훈 ( Song Ki Hoon ),심승주 ( Sim Seung Joo ),강도영 ( Kang Do Yeong ),김기호 ( Kim Ki Ho ) 대한피부과학회 2003 대한피부과학회지 Vol.41 No.12

N/A Background: In malignant melanoma, the regional nodal status is acknowledged as the most powerful indicator of prognosis. Sentinel lymph node status was formally adopted in 2002 AJCC melanoma staging system. However, there has been no clinical study on sentinel lymph node evaluation, especially using lymphoscintigraphy and gamma probe in melanoma patients in Korea. Objective: Our purpose was to assess the usefulness of lymphoscintigraphy and intraoperative gamma probe for the detection of sentinel lymph node in melanoma patients. Methods: In eight malignant melanoma patients (7 stage Ⅰ/Ⅱ, 1 stage 3), a lymphoscintigraphy with ^99m Tc-radiocolloids were injected peritumoral area and the identified first lymph node was considered to be a sentinel node. Once the sentinel lymph node was identified using a hand-held gamma probe for intraoperative mapping, it was excised. And the sentinel node was examined by routine hematoxylin-eosin and immunohistochemical stain (HMB45, S-100). Results: Sentinel nodes were identified in 8 patients all using lymphoscintigraphy and intraope-rative gamma probe. Nine sentinel nodes were found in 8 patients, and sentinel lymph node biopsies showed micrometases in 5(55.5%). The location of sentinel nodes was that 3(33.3%) were located in axilla, and 6(66.6%) in grion. The case that had melanoma on back revealed dual lymphatic pathway with 2 sentinel nodes on axilla and inguinal area. Conclusions: We conclude that preoperative lymphoscintigraphy and intraoperative gamma-probe guided sentinel lymph node biopsy is useful for acute staging and prediction of prognosis for melanoma patients. (Korean J Dermatol 2003;41(12):1575~1582)

암 수술시 Sentinel Lymph Node 의 임상적 유용성

임채춘(Chae Chun Rhim),황성진(Seong Jin Hwang),박종섭(Jong Sup Park),남궁성은(Sung Eun Namkoong) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.6

Objective : The purpose of this study is to evaluate the validity of sentinel lymph node detection and the possibility of clinical application in treatment of vulvar cancer patients. Patients and Methods : From March 2001 to January 2002, four patients with vulvar cancer were eligible for this study. All the patients were preoperative technetium-99 m colloid albumin and intraoperative isosulfan blue dye injection intradermally at the junction of tumor mass and normal skin. Superficial lymphatic channels and groin lymph node dissections were made to detect sentinel lymph node and then complete inguinofemoral lymph nodes dissection was performed. All the sentinel lymph nodes were sent to pathologic department for frozen biopsy. Results : Ten sentinel lymph nodes were identified in one-hundred and ten groin lymph nodes. All the ten sentinel lymph nodes showed benign. There was no case that non-sentinel lymph nodes were positive in the presence of negative sentinel lymph nodes by frozen biopsy (negative predictive value was 100%). Conclusion : Sentinel lymph nodes detection by combination use of technetium-99 m colloid albumin and isosulfan blue dye injection was simple and accurate in our preliminary study. To reduce postoperative morbidity, lymphedema and to minimize extensive inguinofemoral lymph nodes dissection, sentinel lymph node frozen biopsy may be a reasonable alternatives and a suitable method for limited control of vulvar cancer. This preliminary study showed the possibility of clinical application of sentinel lymph node detection in vulvar cancer surgery.

Sentinel Node Mapping of VX2 Carcinoma in Rabbit Thigh with CT Lymphography Using Ethiodized Oil

이윤진,김영훈,이경호,박지훈,이혜승,정승채,주승문 대한영상의학회 2014 Korean Journal of Radiology Vol.15 No.1

Objective: To assess the feasibility of computed tomography (CT) lymphography using ethiodized oil for sentinel node mapping in experimentally induced VX2 carcinoma in the rabbit thigh. Materials and Methods: This experiment received approval from the institutional animal use and care administrative advisory committee. Twenty-three rabbits with VX2 carcinoma in the thigh underwent CT before and after (1 hour, 2 hour) peritumoral injection of 2 mL ethiodized oil. After the CT examination, sentinel nodes were identified by peritumoral injection of methylene blue and subsequently removed. The retrieved sentinel and non-sentinel lymph nodes were investigated with radiographic and pathologic examinations. Based on the comparison of CT findings with those of radiographic and pathologic examinations, the diagnostic performance of CT for sentinel node identification was assessed. Results: All 23 rabbits showed 53 ethiodized oil retention nodes on post-injection CT and specimen radiography, and 52 methylene blue-stained nodes at the right femoroiliac area. Of the 52 blue-stained sentinel nodes, 50 nodes demonstrated ethiodized oil retention. Thus, the sentinel node detection rate of CT was 96% (50 of 52). On pathologic examination, 28 sentinel nodes in 17 rabbits (nodes/rabbit, mean ± standard deviation, 1.7 ± 0.6) harbored metastasis. Twenty seven of the 28 metastatic sentinel nodes were found to have ethiodized oil retention. Conclusion: Computed tomography lymphography using ethiodized oil may be feasible for sentinel node mapping in experimentally induced VX2 carcinoma in the rabbit thigh.

결장직장암에서 체외 감시림프절의 의의

김형진,이인규,이윤석,강원경,안창혁,오승택 대한대장항문학회 2008 Annals of Coloproctolgy Vol.24 No.1

The presence of lymph-node metastases is one of the most important prognostic factors for patients with a colorectal carcinoma. The sentinel lymph node is the first lymph node that receives afferent lymphatic drainage from a primary tumor, and thus has the highest risk of harboring metastatic disease. Methods: Twenty- eight patients with an adenocarcinoma of the colon or the rectum were investigated. After resection of the specimen in standard oncologic fashion, the specimen was dissected longitudinally along the antimesenteric border, and methylene blue was injected around the tumor submucosally. After 5 minutes, the mesentery was meticulously examined, and blue-stained lymphatics and lymph nodes were carefully dissected and harvested. Results: Sentinel lymph nodes were identified in all cases. The average number of sentinel nodes identified was 3 (range, 1∼6), and the average number of lymph nodes retrieved was 20.8 (range, 6∼42). Of the fifteen patients (53.6%) identified to be positive for lymph-node metastasis 10 showed nonsentinel nodal metastasis without sentinel nodal involvement. No additional isolated tumor cells were found by immunohistochemical staining in 13 patients who had no lymph-node metastasis on conventional pathologic examination. Conclusions: In colorectal cancer, the sentinel-lymph-node sampling method is easy and can be performed for the purpose of finding lymph nodes easily. However, applying the sentinel-lymph-node sampling method for the purpose of minimizing lymph node dissection, as in breast cancer, is not recommended because of the high probability of missing metastasis.

수술 전 항암화학요법 후 임상적으로 림프절 음성인 환자에서 감시림프절 생검

한세환 한국유방암학회 2007 Journal of breast cancer Vol.10 No.4

Purpose: We wanted to evaluate the accuracy of sentinel lymph node biopsy (SLNB) in patients with clinically negative lymph node after neoadjuvant chemotherapy. Methods: Fifty-nine women underwent 4 cycles of neoadjuvant chemotherapy with epirubicin (75mg/m2) plus docetaxel (75mg/m2), or with doxorubicin (50mg/m2), cyclophosphamide (600mg/m2)and 5-fluorouracil (500mg/m2) for their primary breast cancer. Their median age was 41 years (range: 29-62) and all the tumors were larger than 3 cm in maximum diameter. SLNB was performed 3 min after periareolar injection of 1% isosulfan blue dye. All the patients underwent lymph node dissection at the level 1 and 2 axillary areas irrespective of their nodal status. Results: A clinical response after neoadjuvant chemotherapy was observed in 46 patients (88%) and 11 (18.7%) patients had a complete pathologic response. Thirty-five patients (62.7%) underwent breast conserving surgery. The sentinel lymph node was identified in 96.6% and the median number of sentinel nodes was 3 (range: 1-6). The median number of dissected nodes was 14 (range: 11-47). Metastasis to the lymph node was observed in 56% of the patients. The sentinel lymph node was the only metastatic node in 12 patients. Three patients with a negative sentinel lymph node were confirmed to have metastasis to non-sentinel nodes after the final histologic examination (false negative rate: 9.1%). The overall accuracy of SLNB was 94.7%. Conclusion: SLNB after neoadjuvant chemotherapy was a safe method in patients with clinically negative lymph node.

Tc-99m Diphosphonate as a Potential Radiotracer to Detect Sentinel Lymph Nodes in Patients with Breast Cancer

Yang, You-Jung,Lim, Sung-Jig,Song, Jeong-Yoon The Korea Society of Nuclear Medicine 2010 핵의학 분자영상 Vol.44 No.1

Purpose To evaluate the potential of Tc-99m diphosphonate as a tracer for sentinel lymph node biopsy in breast cancer. Methods Lymphoscintigraphs of 35 patients ($50.9{\pm}10.2$ years) with breast cancer were acquired after administering a subareolar intradermal injection of Tc-99m diphosphonate 18 h before surgery. Static images were taken within 15 min (early phase) and 15 h after injection (delayed phase). The lymphoscintigraphic identification rate was defined as the percentage of subjects studied with visible foci at axillae. Sentinel lymph node biopsies were performed using a gamma probe and by blue dye injection. Any node that was radioactive or stained with blue dye was labeled as a sentinel lymph node. Lymph nodes without radioactivity or blue dye staining were defined as nonsentinel lymph nodes. The intraoperative identification rate was defined as the percentage of patients with a radioactive sentinel lymph node. Percentages of lymphoid cells expressing S-100, CD83, and CD1a were compared. Results The lymphoscintigraphic identification rate was 94.3% (33/35) during the early phase and 96.9% (31/32) during the delayed phase, whereas the intraoperative identification rate was 94.3% (33/35). The mean percentages of lymphoid cells that stained positively for S-100 or CD83 were lower in sentinel lymph nodes than in nonsentinel lymph nodes (1.5% vs. 9.0% for S-100, and 4.5% vs. 9.3% for CD83, respectively, p=0.0286). The mean percentages of lymphoid cells in sentinel lymph nodes and non- sentinel lymph nodes expressing CD1a were 3.3% and 7.0%, respectively (p=ns). Conclusions Tc-99m diphosphonate can reliably detect regional lymph nodes in breast cancer.

Sentinel node detection in early stage cervical cancer

( Chae Chun Rhim ),( Sung Joo Kim ),( Young Han Park ),( Jung Bae Kang ),( Pong Rheem Jang ) 대한산부인과학회 2011 Journal of Womens Medicine Vol.4 No.2

Objective: To investigate the feasibility of sentinel node frozen biopsy to minimize the extensive pelvic lymph nodes dissection in early stage cervical cancer patients on the basis that the risk of skip metastasis to the paraaortic area is negligible. Methods: The 45 patients with early stage cervical cancer were enrolled in this study. Technetium-99 m colloid albumin was injected intradermally around the tumor for allowing preoperative lymphoscintigraphy and intraoperative hand-held gamma probe detection of seninel lymph nodes. For visual detection, isosulfan blue dye was injected into the peritumoral sites before peritoneal opening. Postoperative morbidity and negative predictive value were the endpoints of this study. Results: The 45 patients, ranging in age from 32 to 71 year, underwent intraoperative sentinel nodes mapping. There were 33 benign and 12 malignant cases on frozen biopsy. On permanent histopathological specimen, there were 31 benign and 14 malignant cases. In 31 out of 33 cases determined to be benign on the sentinel node frozen biopsy, there were no pelvic lymph node metastasis on the permanent pathology. In only 2 cases found to be benign on the sentinel node frozen biopsy, there were pelvic lymph node metastasis on the permanent histopathology. These results are statistically significant(P<0.0001).Conclusion: This new technique of sentinel node mapping is safe and simple to perform. Further clinical trials using the combination of Technetium-99 m and isosulfan blue dye are warranted and this technique will make a true advance for lessaggressive management of patients with early stage cervical cancer.

Feasibility of Charcoal Tattooing of Cytology-Proven Metastatic Axillary Lymph Node at Diagnosis and Sentinel Lymph Node Biopsy after Neoadjuvant Chemotherapy in Breast Cancer Patients

Park, Seho,Koo, Ja Seung,Kim, Gun Min,Sohn, Joohyuk,Kim, Seung Il,Cho, Young Up,Park, Byeong-Woo,Park, Vivian Youngjean,Yoon, Jung Hyun,Moon, Hee Jung,Kim, Min Jung,Kim, Eun-Kyung Korean Cancer Association 2018 Cancer Research and Treatment Vol.50 No.3

<P><B>Purpose</B></P><P>Sentinel lymph node biopsy (SLNB) can be performed when node-positive disease is converted to node-negative status after neoadjuvant chemotherapy (NCT). Tattooing nodes might improve accuracy but supportive data are limited. This study aimed to investigate the feasibility of charcoal tattooing metastatic axillary lymph node (ALN) at presentation followed by SLNB after NCT in breast cancers.</P><P><B>Materials and Methods</B></P><P>Twenty patientswith cytology-proven node metastases prospectively underwent charcoal tattooing at diagnosis. SLNB using dual tracers and axillary surgery after NCT were then performed. The detection rate of tattooed node and diagnostic performance of SLNB were analyzed.</P><P><B>Results</B></P><P>All patients underwent charcoal tattooingwithout significant morbidity. Sentinel and tattooed nodes could be detected during surgery after NCT. Nodal pathologic complete response was achieved in 10 patients. Overall sensitivity, false-negative rate (FNR), negative predictive value, and accuracy of hot/blue SLNB were 80.0%, 20.0%, 83.3%, and 90.0%, respectively. Retrieving more nodes and favorable nodal response were associated with improved performance. The best accuracy was observed when excised tattooed node was calculated together (FNR, 0.0%). Cold/non-blue tattooed nodes of five patients were removed during non-sentinel axillary surgery but clinicopathological parameters did not differ compared to patients with hot/blue tattooed node detected during SLNB, suggesting the importance of the tattooing procedure itself to improve performance.</P><P><B>Conclusion</B></P><P>Charcoal tattooing of cytology-confirmed metastatic ALN at presentation is technically feasible and does not limit SLNB after NCT. The tattooing procedure without additional preoperative localization is advantageous for improving the diagnostic performance of SLNB in this setting.</P>

유방암 수술에서 내시경을 이용한 감시림프절 생검: 방사선동위원소 및 생체염료 동시 이용방법의 유용성과 정확성

이민혁,우희두,한선욱,손두민,김성용,임철완 한국유방암학회 2010 Journal of breast cancer Vol.13 No.1

Purpose: Since its introduction in the mid-1990s, sentinel lymph node biopsy has been rapidly and widely adopted for the axillary staging of clinically node-negative breast cancer patients. However, there is some controversy in the clinical application because of its various identification rates and its false negative rates. The objective of this study was to assess the usefulness of endoscopic sentinel lymph node biopsy (ESNB) and to compare the value of two methods for identification of ESNB using blue dye only or a combination of blue dye and radioisotope. Methods: This study was carried out in 137 breast cancer patients (bilateral breast cancer, 3 cases) who underwent ESBN, at the Department of Surgery in Soonchunhyang University from May of 2007 to August of 2008. The technique involved the injection of 5 mL of 0.5% indigocarmine or Tc-99m tin colloid into subareolar plexus. The Visiport docked with a telescope was inserted through a low transverse axillary incison (1.0 cm in size) lateral to the pectoralis major. During the dissection, we identified sentinel nodes by following blue-stained lymphatic duct directly into blue-stained lymph nodes. We compared the value of two methods for identification of ESNB using blue dye only or a combination of blue dye and radioactive tracer. Results: The mean number of sentinel nodes was 1.27 (range, 1-4). The identification rate and false negative rate of the sentinel node were 94.3% (132/140) and 6.9% (3/43), respectively. We compared ESNB with using blue dye only (n=77) vs. a combination of blue dye and radioactive tracer (n=63). Sentinel lymph node identification rate were 90.9% (70/77) vs. 98.4% (62/63) (p=0.043). Conclusion: The endoscopic technique of sentinel node biopsy can keep better operative visual fields and is less invasive. The combination of blue dye and radioactive tracer was superior to blue dye only for identification rates.