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1
Nikitenko, R., V. Kosovan, K. Vorotyntseva, and E. Koichev. "The role of sentinel lymph nodes in breast cancer." Journal of Education, Health and Sport 12, no. 6 (June 30, 2022): 365–76. http://dx.doi.org/10.12775/jehs.2022.12.06.037.
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Introduction. The problem of improving early diagnosis and prognosis of breast cancer remains one of the most actual for current oncological practice. Taking into account a close correlation between the general prevalence of breast neoplasms and mortality from breast cancer, this problem is not only of professional interest, but also has medical-social and socio-economic significance.
The purpose of the study is to improve the quality of the sentinel lymph node detection in patients with breast cancer using ICG.
Material and methods. At the period 2009–2016, 400 patients with T1-T3N0M0 breast cancer were operated on. All the patients were divided into two groups using two dyes – Patent Blue and ICG. The patients after mastectomy with a sentinel lymph node biopsy had a clinical diagnosis of T2-T3N0M0 breast cancer more often.
In group I, 100 patients had the sentinel lymph node biopsy. Lymph node staining was performed using Patent Blue dye.
In group II, sentinel lymph nodes biopsy was conducted with the Patent Blue dye and another fluorescent dye — ICG, which was also injected on the affected side of the breast. After ICG dye introduction, in 15 minutes the stained green lymph nodes were detected using special equipment.
Criteria for inclusion of patients in the clinical trial:
1) breast cancer patients of any age with T1-3N0M0, I-II AB disease stage;
2) patients with clinically unaffected lymph nodes N0 after examination.
Criteria for exclusion of patients from the clinical trial:
The exceptions were T3-T4 tumors > 5 cm in diameter, or the skin and chest wall invasion, as well as palpable axillary lymph nodes, 3 or more affected lymph nodes with sentinel lymph node biopsy;
3) patients after radiation therapy.
Results. The tumor histology was performed after the node trephine biopsy. The main aims of sentinel nodes detection were staging and improving the breast cancer patients’ life quality after surgical treatment. The post-mastectomy syndrome, the main manifestation of which is swelling of the upper extremity is a big problem for patients because it affects their life quality and disturbs their usual lifestyle. The sentinel lymph node detection, in contrast to axillary lymph node dissection of I-II level, significantly minimizes all the risks of postmastectomy syndrome, in particular, impaired lymphatic drainage in the form of lymphatic edema of the upper extremity, impaired venous outflow in the form of stenoses or the axillary and/or subclavian veins occlusion, rough scars which limit the function of the extremity in the shoulder joint, and brachioplexitis.
Conclusions. The study of sentinel lymph nodes significantly improves the results of surgical treatment of breast cancer patients. Based on the clinical-laboratory and histological examinations, new data were obtained concerning the sentinel lymph node detection using two dyes, the choice of the surgical intervention volume and reduction of complications rate at the postoperative period. We found that fluorescent lymphography is highly effective, which allows to recommend it for implementation into the clinical practice. The frequency of sentinel lymph node detection in breast cancer patients is 98% in the control group, 100% – in the main group.
On the basis of the obtained results, the sentinel lymph node detection algorithm and the surgical management of patients with breast cancer was developed and implemented into practice, which allowed to reduce the number of complications with using two dyes for the sentinel lymph node detection from 19% to 2% (χ2 =15.37, p<0.001). Recurrence of breast cancer fell from 13% to 8%.
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Lee, S., J. Yang, S. Nam, J. Lee, W. Kim, J. Choi, G. Kim, and G. Kim. "Triple detection method for sentinel lymph node detection." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e11605-e11605. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e11605.
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e11605 Background: Sentinel lymph node biopsy is widely accepted method to determine nodal stage of breast cancer. There are several reported method for detecting sentinel lymph node. The aim of this study was to show the new detection method of sentinel lymph node and show the effectiveness of this method. Methods: We did prospective study and enrolled 25 patients who underwent partial mastectomy and sentinel lymph node biopsy. We injected indigocyanine green (green dye) at peritumoral lesion, indigocarmine dye (blue dye) in subareolar area and radioisotope (Tc-99m) injection. Sentinel lymph nodes are identified by color change or radioisotope uptake, and classified by each color (blue or green) and radioisotope uptake. We compared the detection rate from our study with that from the previous studies. Results: Sentinel lymph nodes were detected in all patients (25/25). Green color stained sentinel lymph nodes were identified in 18 patients (18/25), blue color stained sentinel lymph nodes were identified in 15 patients (15/25) and radioactive lymph nodes were identified in 19 patients (19/25). Conclusions: The triple mapping method showed higher detection rate than the previous studies and this method is recommendable to detect sentinel lymph node. No significant financial relationships to disclose.
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Coibion, Michel, Fabrice Olivier, Audrey Courtois, Nathalie Maes, Véronique Jossa, and Guy Jerusalem. "A Randomized Prospective Non-Inferiority Trial of Sentinel Lymph Node Biopsy in Early Breast Cancer: Blue Dye Compared with Indocyanine Green Fluorescence Tracer." Cancers 14, no. 4 (February 10, 2022): 888. http://dx.doi.org/10.3390/cancers14040888.
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Background: Indocyanine green (ICG) is a promising tracer for sentinel lymph node biopsy in early breast cancer. This randomized study was conducted to evaluate sentinel lymph node biopsy with ICG compared with blue dye as a tracer in woman with early breast cancer without any sign of lymph node invasion. Methods: Between January 2019 and November 2020, 240 consecutive women with early breast cancer were enrolled and randomized to sentinel lymph node biopsy using ICG or blue dye. The primary endpoint was the sentinel lymph node detection rate in both arms. Results: ICG was used in 121 patients and detected sentinel lymph nodes in all patients (detection rate, 100%; 95% CI: 96.9–100.0) while blue dye was used in 119 patients and detected sentinel lymph nodes in 116 patients (detection rate: 97.5%, 95% CI: 92.9–99.1). This analysis indicated the non-inferiority of ICG vs. blue dye tracer (90%CI: −1.9–6.9; p = 0.0009). Conclusion: ICG represents a new promising tracer to detect sentinel lymph nodes in early breast cancer with a detection rate similar to other conventional tracers, and is associated with easy learning and low cost. Our result suggest that this technique is a good alternative to avoid radioactive isotope manipulation.
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Portnoy, Sergey, A. Kuznetsov, N. Shakirova, Nikolay Kozlov, A. Maslyaev, A. Karpov, Yelena Kampova-polevaya, et al. "SENTINEL LYMPH NODE BIOPSY USING FLUORESCENT LYMPHOGRAPHY IN CT1-4N0M0 BREAST CANCER PATIENTS: HIGH DIAGNOSTIC CAPABILITIES." Problems in oncology 65, no. 2 (February 1, 2019): 243–49. http://dx.doi.org/10.37469/0507-3758-2019-65-2-243-249.
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Breast cancer cT1-4N0M0 patients usually require a sentinel lymph node biopsy. Sentinel lymph node biopsy with indocyanine green fluorescence detection is a modern technique with a high lymph node detection rate. However, the false-negative rate was not evaluated adequately. Our objective was to determine node detection rate and the false-negative rate. 99 patients with 100 cases of breast cancer cT1-4N0M0 were operated on. The axillary part of an operation consisted of indocyanine green fluorescence-guided SLN biopsy and an axillary lymphadenectomy of levels I-II or I-П-Ш. A signal lymph node was detected in 98 cases (98 %). In 28 (28.6%) cases out of 98, metastases in signal lymph nodes were found. Other than sentinel lymph node had metastatic lesion only in 35.7% in SLN N+ cases. False negative result occurred in 1 case of 28 (3.6%). The application of indocyanine green fluorescence-guided sentinel lymph node biopsy in cN0 breast cancer patients allows for a high signal lymph node detection rate and a low false negative rate.
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Song, B., J. Bae, J. Kim, H. Jeon, and S. Jung. "Comparing study of positron emission tomography and ultrasonography in the detection of axillary lymph node metastasis in patients with early stage breast cancer." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 616. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.616.
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616 Background: The current status of axillary lymph node is the most important prognostic factor in breast cancer. Axillary lymph node dissection (ALND) is currently the standard option for assessment of axillary lymph nodes. Positron emission tomography - computerized tomography (PET-CT) imaging and breast sonography are a noninvasive imaging modality that can detect malignant lymph node. The purpose of this study was to evaluate the clinical usefulness of axillary lymph node staging by means of PET-CT imaging compare with breast sonography in breast cancer. Methods: This study involves 129 breast cancer patients and clinically negative axillary node. All patients had whole body PET-CT imaging and breast sonography before SLN biopsy. After SLN biopsy, all patients underwent complete ALND. Axillary lymph nodes were evaluated by standard hematoxylin and eosin staining techniques, while sentinel nodes were further examined for micrometastatic disease. The findings of PET-CT imaging and breast sonography of 129 patients were compared with pathologic findings after operation. Diagnostic accuracy was evaluated applying ROC curve areas. Results: The sensitivity of PET-CT imaging was 60.0%; specificity and accuracy were 83.6% and 73.4%, respectively. The sensitivity, specificity and accuracy of breast sonography were 61.8%, 89.0%, and 77.3% respectively. The SUVs of axillary lymph node ranged from 0.0 to 7.01. Analysis using ROC curves revealed the area under each curve which indicated a diagnostic accuracy. For involvement of axillary lymph node, PET-CT imaging had the area under the curve of 0.735, breast sonography one of 0.769. Conclusions: Axillary lymph node staging using PET-CT imaging is inferior to the breast sonography in early stage of breast cancer patients. Our study reveals the value of PET-CT imaging is not good compare to the breast sonography in the detection of axillary lymph nodes metastasis in patients with early breast cancer. No significant financial relationships to disclose.
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Mátrai, Zoltán, László Tóth, Toshiaki Saeki, István Sinkovics, Mária Gődény, Hideki Takeuchi, Mária Bidlek, et al. "The potential role of SPECT/CT in the preoperative detection of sentinel lymph nodes in breast cancer." Orvosi Hetilap 152, no. 17 (April 2011): 678–88. http://dx.doi.org/10.1556/oh.2011.29077.
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Regional lymph node status is the most important prognostic factor in breast cancer. Sentinel lymph node biopsy is the standard method of axillary staging in early breast cancer patients with clinically negative nodes. Preoperative lymphoscintigraphy might support refining biopsy findings by determining the number and location of sentinel lymph nodes. In aged or overweight patients, in the presence of atypical or extra-axillary lymphatic drainage, non-visualized lymph nodes, or sentinel lymph nodes close to the isotope injection site, detection could be aided by a new, hybrid imaging tool: the single-photon emission computed tomography combined with computed tomography (3D SPECT/CT). For the first time in Hungarian language, authors overview the literature: all 14 English-language articles on the implementation of 3D SPECT/CT in sentinel lymph node detection in breast cancer are included. It is concluded that 3D SPECT/CT increases the success rate and quality of preoperative sentinel node identification, and is capable of providing a more accurate staging of breast cancer patients in routine clinical practice. Orv. Hetil., 2011, 152, 678–688.
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Huang, Yihong, Shuo Zheng, and Baoyong Lai. "Analysis of the Mechanism of Breast Metastasis Based on Image Recognition and Ultrasound Diagnosis." Journal of Healthcare Engineering 2021 (October 11, 2021): 1–11. http://dx.doi.org/10.1155/2021/4452500.
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Breast cancer is one of the cancers with the highest incidence among women. In the late stage, cancer cells may metastasize to a distance, causing multiple organ diseases, threatening the lives of patients. The detection of lymph node metastasis based on pathological images is a key indicator for the diagnosis and staging of breast cancer, and correct staging decisions are the prerequisite and basis for targeted treatment. At present, the detection of lymph node metastasis mainly relies on manual screening by pathologists, which is time-consuming and labor-intensive, and the diagnosis results are variable and subjective. The automatic staging method based on the panoramic image calculation of the sentinel lymph node of the breast proposed in this paper can provide a set of standardized, high-accuracy, and repeatable objective diagnosis results. However, it is very difficult to automatically detect and locate cancer metastasis areas in highly complex panoramic images of lymph nodes. This paper proposes a novel deep network training strategy based on the sliding window to train an automatic localization model of cancer metastasis area. The training strategy first trains the initial convolutional network in a small amount of data, extracts false-positive and false-negative image blocks, and uses manual screening combined with automatic network screening to reclassify the false-positive blocks to improve the class of negative categories. Using mammography, ultrasound, MRI, and 18F-FDG PET-CT examinations, the detection rate and diagnostic accuracy of primary cancers in the breast of patients with axillary lymph node metastasis as the first diagnosis were obtained. The detection rate and diagnostic accuracy of breast MRI for primary cancers in the breast are much higher than those of X-ray, ultrasound, and 18F-FDG PET-CT (all P values <0.001). Mammography, ultrasound, and PET-CT examinations showed no difference in the detection rate and diagnostic accuracy of primary cancers in the breast of patients with axillary lymph node metastasis as the first diagnosis. Breast MRI should be used as a routine examination for patients with axillary lymph node metastasis as the first diagnosis. The primary breast cancer in the first diagnosed patients with axillary lymph node metastasis is often presented as localized asymmetric compactness or calcification on X-ray; it often appears as small focal mass lesions and ductal lesions without three-dimensional space-occupying effect on ultrasound.
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Liu, Pengcheng, Jie Tan, Yuting Song, Kai Huang, Qingyi Zhang, and Huiqi Xie. "The Application of Magnetic Nanoparticles for Sentinel Lymph Node Detection in Clinically Node-Negative Breast Cancer Patients: A Systemic Review and Meta-Analysis." Cancers 14, no. 20 (October 14, 2022): 5034. http://dx.doi.org/10.3390/cancers14205034.
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Superparamagnetic iron oxide (SPIO), an alternative mapping agent, can be used to identify sentinel lymph nodes in patients with clinically node-negative breast cancer. However, its performance in comparison with the standard method, using a radioisotope (technetium-99 m, Tc) alone or in combination with blue dye, remains controversial. Hence, a systematic review and meta-analysis were conducted to evaluate the diagnostic accuracy of SPIO and its clinical impact in the management of breast cancer. The PubMed, Embase, and Cochrane databases were comprehensively searched from inception to 1 May 2022. Cohort studies regarding the comparison of SPIO with standard methods for sentinel lymph node identification were included. A total of 19 prospective cohort studies, which collectively included 2298 clinically node-negative breast cancer patients undergoing sentinel lymph node identification through both the standard method and SPIO, were identified. The detection rate for sentinel lymph nodes (RR, 1.06; 95% CI, 1.05–1.08; p < 0.001) was considerably higher in the SPIO cohorts than in the standard method cohorts, although this difference was not significant in detected patients, patients with positive sentinel lymph nodes, or positive sentinel lymph nodes. Compared with the standard method, the SPIO method could be considered as an alternative standard of care for sentinel lymph node detection in patients with clinically node-negative breast cancer.
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Euscher, Elizabeth. "Pathology of sentinel lymph nodes: historical perspective and current applications in gynecologic cancer." International Journal of Gynecologic Cancer 30, no. 3 (February 19, 2020): 394–401. http://dx.doi.org/10.1136/ijgc-2019-001022.
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Efforts to reduce surgical morbidity related to en bloc lymph node removal associated with cancer surgery led to the development of targeted lymph node sampling to identify the lymph node(s) most likely to harbor a metastasis. Through identification of one or only a few lymph nodes at highest risk, the overall number of lymph nodes removed could be markedly reduced. Submission of fewer lymph nodes affords more detailed pathologic examination than would otherwise be practical with a standard lymph node dissection. Such enhanced pathologic examination techniques (ie, ultra-staging) have contributed to increased detection of lymph node metastases, primarily by detection of low volume metastatic disease. Based on the success of sentinel lymph node mapping and ultra-staging in breast cancer and melanoma, such techniques are increasingly used for other organ systems including the gynecologic tract. This review addresses the historical aspects of sentinel lymph node evaluation and reviews current ultra-staging protocols as well as the implications associated with increased detection of low volume metastases.
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Pelosi, E., V. Arena, B. Baudino, M. Bellò, R. Giani, D. Lauro, A. Ala, R. Bussone, and G. Bisi. "Sentinel Node Detection in Breast Carcinoma." Tumori Journal 88, no. 3 (May 2002): S10—S11. http://dx.doi.org/10.1177/030089160208800323.
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Aims and Background The standard procedure for the evaluation of axillary nodal involvement in patients with breast cancer is still complete lymph node dissection. However, about 70% of patients are found to be free of metastatic disease while axillary node dissection may cause significant morbidity. Lymphatic mapping and sentinel lymph node (SLN) biopsy are changing this situation. Methods and Study Design In a period of 18 months we studied 201 patients with breast cancer, excluding patients with palpable axillary nodes, tumors >2.5 cm in diameter, multifocal or multicentric cancer, pregnant patients and patients over 80 years of age. Before surgery 99mTc-labeled colloid and vital blue dye were injected into the breast to identify the SLN. In lymph nodes dissected during surgery the metastatic status was examined by sections at reduced intervals. Only patients with SLNs that were histologically positive for metastases underwent axillary dissection. Results We localized one or more SLNs in 194 of 201 (96.5%) patients; when both techniques were utilized the success rate was 100%. Histologically, 21% of patients showed SLN metastases (7.8% micrometastases) and 68% of these had metastases also in other axillary nodes. None of the patients with negative SLNs developed metastases during follow-up. Conclusions At present there is no definite evidence that negative SLN biopsy is invariably correlated with negative axillary status; however, our study and those of others demonstrate that SLN biopsy is an accurate method of axillary staging.
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Vatankha, S. S., and F. Yu Aliev. "First experience of lymphoscintigraphy use in early stages of breast cancer." Kazan medical journal 98, no. 2 (April 15, 2017): 293–95. http://dx.doi.org/10.17750/kmj2017-293.
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Aim. To evaluate efficacy of radioisotopic methods in detection of metastatic involvement of sentinel lymph nodes for choosing further theurapeutic tactics.
Methods. The study group included 23 females with confirmed breast cancer. Sentinel lymph nodes were detected by isotope 99mTc Nanocolloid and blue dye in General Electric gamma camera (USA).
Results. In all cases patients’ age was 45 to 60 years. In 16 (69.5%) cases the tumor size was below 5 cm which corresponded to clinical stage 2, in other 7 (30.5%) patients the tumor size was below 2 cm. Positive results with the use of lymphoscintigraphy were revealed in 6 (26%) cases, all results were morphologically confirmed straight after lymph node removal. In 5 (83%) cases metastatic involvement of the node was observed in stage 2 cancer. Such patients were immediately referred to radical mastectomy with radical lymph node dissection. In other cases pathological accumulation of a radiopharmaceutical was not observed. Only in one case after removal of such node its metastatic involvement was confirmed histologically. So the frequency of false negative results was 4.3%. Respectively, status of sentinel lymph nodes in breast cancer reflects the status of lymphatic collector with 95.7% accuracy.
Conclusion. The biopsy results demonstrated high diagnostic value of lymphoscintigraphy for detection of breast cancer metastases to sentinel lymph nodes (sensitivity 86%, specificity 100%): the method can be successfully used in early stages of breast cancer and also in case of negative results of conventional diagnostic methods (ultrasound, roentgen mammography).
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Scharl, Anton J., and Andreas Düran. "Where to look for sentinel node in breast cancer?" Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): 2560. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.2560.
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2560 Background: It has been observed, that the caudal Axilla on the border to pectoralis muscle is predicive for the sentinel node. The sono-morphology of lymph nodes has been the subject of multiple publications, usually dealing with malignant melanoma. In the context of sentinel lymph node biopsy (SLNB) in breast cancer patients, the following study examines the feasibility of the sonographic differentiation of the Sentinel lymph node (SLN) from neighboring non-SLNs and whether sentinel-ultrasound-needle localization (SUN) is a useful addition or alternative to current methods of “lymphatic mapping”. Methods: During a prospective study performed from 1/2003 to 9/2005 including 404 breast cancer patients (Tis-T4), the SLNB was performed using patent blue+/- 99Tc-Nanocoll. In addition to and independent of this method, the axilla was sonographically examined for “reactive” lymph nodes n=180 pt. (Siemens Elegra 7.5 MHz). The “reactivity” of the nodes was quantified using an index , which allowed the comparison of adjacent nodes. The most “reactive” lymph node in the caudal axilla was identified as the “Ultrasound-Sentinel-Node”(US-SLN) and has been marked with a wire. Results: In 180 patients the SLN was localized using the standard methods as well as (SUN). The was no difference in detection rates of US-SLN and the standard methods in tumor-free nodes(SLN-). However, for patients with axillary metastases (SLN+) SUN provided superior detection rate (99,1%). The false-negative-rate was reduced from 10,7 % to 1,3%. This was attributed to the embolization of lymph vessels afferent to the metastasized (SLN+) node causing a bypass of the “lymphatic mapping” and inhibiting detection. Conclusions: The SUN–Method is comparable to “lymphatic mapping” in tumor free nodes (SLN -). If SLN is metastasized (SLN+) - SUN is superior to the standard methods in sensitivity and specificity (80%) and the false-negative-rate can be reduced. Systematic axilla sonography is an effective method for the SLN-Localisation, and offers an excellent method for quality control during SLNB.
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Vogt, H., R. Bares, W. Brenner, F. Grünwald, J. Kopp, C. Reiners, O. Schober, et al. "Verfahrensanweisung für die nuklear medizinische Wächter-Lymphknoten-Diagnostik." Nuklearmedizin 49, no. 04 (2010): 167–72. http://dx.doi.org/10.3413/nukmed-321.
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SummaryThe authors present a procedure guideline for scintigraphic detection of sentinel lymph nodes in malignant melanoma and other skin tumours, in breast cancer, in head and neck cancer, and in prostate and penile carcinoma. Important goals of sentinel lymph node scintigraphy comprise reduction of the extent of surgery, lower postoperative morbidity and optimization of histopathological examination focussing on relevant lymph nodes. Sentinel lymph node scintigraphy itself does not diagnose tumorous lymph node involvement and is not indicated when lymph node metastases have been definitely diagnosed before sentinel lymph node scintigraphy. Procedures are compiled with the aim to reliably localise sentinel lymph nodes with a high detection rate typically in early tumour stages. Radiation exposure is low so that pregnancy is not a contraindication for sentinel lymph node scintigraphy. Even with high volumes of scintigraphic sentinel lymph node procedures surgeons, theatre staff and pathologists receive a radiation exposure < 1 mSv/year so that they do not require occupational radiation surveillance.
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Gerber, Bernd, Annette Krause, Heiner Müller, Dagmar Richter, Toralf Reimer, Josef Makovitzky, Christina Herrnring, Udo Jeschke, Günther Kundt, and Klaus Friese. "Simultaneous Immunohistochemical Detection of Tumor Cells in Lymph Nodes and Bone Marrow Aspirates in Breast Cancer and Its Correlation With Other Prognostic Factors." Journal of Clinical Oncology 19, no. 4 (February 15, 2001): 960–71. http://dx.doi.org/10.1200/jco.2001.19.4.960.
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PURPOSE: We studied the prognostic and predictive value of immunohistochemically detected occult tumor cells (OTCs) in lymph nodes and bone marrow aspirates obtained from node-negative breast cancer patients. All were classified as distant metastases-free using conventional staging methods. PATIENTS AND METHODS: A total of 484 patients with pT1-2N0M0 breast cancer and 70 with pT1-2N1M0 breast cancer and a single affected lymph node participated in our trial. Ipsilateral axillary lymph nodes and intraoperatively aspirated bone marrow were examined. All samples were examined for OTCs using monoclonal antibodies to cytokeratins 8, 18, 19. Immunohistological findings were correlated with other prognostic factors. The mean follow-up was 54 ± 24 months. RESULTS: OTCs were detected in 180 (37.2%) of 484 pT1-2N0M0 patients: in the bone marrow of 126 patients (26.0%), in the lymph nodes of 31 patients (6.4%), and in bone marrow and lymph nodes of 23 (4.8%) patients. Of the 70 patients with pT1-2N1MO breast cancer and a single involved lymph node, OTCs were identified in the bone marrow of 26 (37.1%). The ability to detect tumor cells increased with the following tumor features: larger size, poor differentiation, and higher proliferation. Tumors of patients with OTCs more frequently demonstrated lymph node invasion, blood vessel invasion, higher urokinase-type plasminogen activator levels, and increased PAI-1 concentrations. Patients with detected OTCs showed reduced disease-free survival (DFS) and overall survival (OAS) rates that were comparable to those observed in patients who had one positive lymph node. Multivariate analysis of prognostic factors revealed that OTCs, histological grading, and tumor size are significant predictors of DFS; OTCs and grading of OAS. CONCLUSION: OTCs detected by simultaneous immunohistochemical analysis of axillary lymph nodes and bone marrow demonstrate independent metastatic pathways. Although OTCs were significantly more frequent in patients with other unfavorable prognostic factors, they were confirmed as an independent prognostic factor for pT1-2N0M0, R0 breast cancer patients.
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Jean Pierre, M., J. Extra, J. Jacquemier, M. Buttarelli, E. Lambaudie, M. Bannier, I. Brenot Rossi, and G. Houvenaeghel. "Sentinel lymphadenectomy for the staging of clinical axillary node-negative breast cancer before neoadjuvant chemotherapy." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e11575-e11575. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e11575.
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e11575 Background: Several authors reported sentinel lymph node biopsy after neoadjuvant chemotherapy. Nevertheless, the ideal time of sentinel lymph node biopsy is still a matter of debate. Methods: We evaluated the feasibility and the accuracy of sentinel lymph node biopsy before neoadjuvant chemotherapy using a combined procedure (blue dye and radio-labelled detection) in a homogeneous cohort study with clinically axillary node-negative breast cancer. Study candidates were patients referred to the Institut Paoli-Calmettes Cancer Center (Marseille, France) for the treatment of invasive breast cancer. Patients were included in the study if they had tumor more than 3 cm in diameter without palpable axillary lymph node for which a neoadjuvant chemotherapy was indicated in order to enhance the likelihood of breast conservation. An axillary lymph node dissection was performed after completion of neoadjuvant chemotherapy. Results: From September 2005 to September 2007, thirty-one women with T2 or T3 invasive breast cancer without palpable axillary lymph node underwent sentinel lymph node biopsy before neoadjuvant chemotherapy and an axillary lymph node dissection after neoadjuvant chemotherapy. Among the 20 women who had metastatic sentinel lymph node biopsy (65%), 4 (20%) had additional metastatic node on axillary lymph node dissection. By contrast, all the 11 women who had no metastatic sentinel lymph node biopsy had no involved nodes in the axillary lymph node dissection. The sentinel lymph node biopsy identification rate before neoadjuvant chemotherapy was 100% with any false negative. Conclusions: Sentinel lymph node biopsy before neoadjuvant chemotherapy is a feasible and an accurate diagnostic tool to predict the pre-therapeutic axilla status. These findings suggest that axillary lymph node dissection may be avoided in patients with a negative sentinel lymph node biopsy performed before neoadjuvant chemotherapy. No significant financial relationships to disclose.
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Menard, J., J. Extra, J. Jacquemier, M. Buttarelli, E. Lambaudie, M. Bannier, I. Brenot Rossi, and G. Houvenaeghel. "Sentinel lymphadenectomy for the staging of clinical axillary node-negative breast cancer before neoadjuvant chemotherapy." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e11604-e11604. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e11604.
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e11604 Background: Several authors reported sentinel lymph node biopsy after neoadjuvant chemotherapy. Nevertheless, the ideal time of sentinel lymph node biopsy is still a matter of debate. Methods: We evaluated the feasibility and the accuracy of sentinel lymph node biopsy before neoadjuvant chemotherapy using a combined procedure (blue dye and radio-labelled detection) in a homogeneous cohort study with clinically axillary node-negative breast cancer. Study candidates were patients referred to the Institut Paoli-Calmettes Cancer Center (Marseille, France) for the treatment of invasive breast cancer. Patients were included in the study if they had tumor more than 3 cm in diameter without palpable axillary lymph node for which a neoadjuvant chemotherapy was indicated in order to enhance the likelihood of breast conservation. An axillary lymph node dissection was performed after completion of neoadjuvant chemotherapy. Results: From September 2005 to September 2007, thirty-one women with T2 or T3 invasive breast cancer without palpable axillary lymph node underwent sentinel lymph node biopsy before neoadjuvant chemotherapy and an axillary lymph node dissection after neoadjuvant chemotherapy. Among the 20 women who had metastatic sentinel lymph node biopsy (65%), 4 (20%) had additional metastatic node on axillary lymph node dissection. By contrast, all the 11 women who had no metastatic sentinel lymph node biopsy had no involved nodes in the axillary lymph node dissection. The sentinel lymph node biopsy identification rate before neoadjuvant chemotherapy was 100% with any false negative. Conclusions: Sentinel lymph node biopsy before neoadjuvant chemotherapy is a feasible and an accurate diagnostic tool to predict the pre-therapeutic axilla status. These findings suggest that axillary lymph node dissection may be avoided in patients with a negative sentinel lymph node biopsy performed before neoadjuvant chemotherapy. No significant financial relationships to disclose.
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Bozhok, A. A., O. N. Tsarev, S. A. Maysuradze, and A. I. Gil. "Questions of axillary region surgery in breast cancer patients after systemic neoadjuvant therapy." Tumors of female reproductive system 17, no. 4 (January 20, 2022): 56–65. http://dx.doi.org/10.17650/1994-4098-2021-17-4-56-65.
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As a consequence of the advances in systemic neoadjuvant therapy of breast cancer is the de-escalation of surgical treatment. The study of a limited number of axillary lymph nodes after neoadjuvant therapy and refusal of lymphadenectomy in the absence of metastatic lesions is becoming more common. The published studies have proven the informativeness and safety of standard techniques of sentinel lymph node biopsy after neoadjuvant treatment for cN0 patients. For group cN1 and regression of metastases after neoadjuvant treatment, standard sentinel lymph node biopsy techniques have failed. The use of combined methods of double detection and an increase in the number of examined lymph nodes to 3 and more increased the detection rate of sentinel node biopsy after neoadjuvant therapy and reduced false-negative rate. Long-term results, questions of methodology lymph nodes evaluation, radiation therapy in this group of patients require further investigation.
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Pargaonkar, Anjali S., Robert S. Beissner, Samuel Snyder, and V. O. Speights. "Evaluation of Immunohistochemistry and Multiple-Level Sectioning in Sentinel Lymph Nodes From Patients With Breast Cancer." Archives of Pathology & Laboratory Medicine 127, no. 6 (June 1, 2003): 701–5. http://dx.doi.org/10.5858/2003-127-701-eoiams.
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Abstract Context.—Previous investigations on sentinel lymph node biopsies have demonstrated their importance in nodal staging of patients with breast cancer. However, sentinel node biopsy in breast cancer is currently a controversial procedure and continues to provoke debate. Objectives.—We designed our study to determine the usefulness of a standard protocol for evaluating sentinel lymph node metastases and to assess the value of sentinel node biopsy as the only procedure in nodal staging in breast cancer patients. Materials and Methods.—A retrospective analysis of 84 breast cancer patients with sentinel node biopsies, who also underwent axillary dissection, was conducted using a standard protocol (3 levels of immunohistochemical stains for keratin and 2 levels of hematoxylin-eosin (HE) stains on the first 3 negative lymph nodes). Results.—Hematoxylin-eosin staining identified 20 patients (23.8%) with sentinel node metastases. The remaining 64 negative patients (76.1%) were tumor free on sentinel lymph nodes at level 1 HE. Additional immunohistochemical stains for keratin and HE stains on specimens from these 64 patients showed an additional 5 patients (7.8%) to be positive for lymph node micrometastases (<2 mm). The total percentage of cases with sentinel lymph node metastases detected by HE staining and immunohistochemistry was 29.7%. Of the remaining 59 cases that were negative on HE and immunohistochemistry, axillary dissection revealed 3 cases that had metastases in the axillary lymph nodes. The false-negative rate was 10.7%. The concordance rate between sentinel lymph nodes and axillary lymph nodes was 96.4%. The sensitivity was 89% and specificity was 100%. Conclusion.—Immunohistochemistry and multiple-level sectioning increased detection of metastases by 7.8% in sentinel lymph nodes. Caution should be used in accepting sentinel node biopsy alone as the only procedure for staging due to a high false-negative rate (10.7%). A predictive value of 96.4% confirms that sentinel lymph node biopsy is most likely to contain metastatic carcinoma. Sentinel lymph node examination with the protocol we describe, combined with axillary dissection, increased the yield of metastatic disease by identifying 8 additional cases of nodal metastatic disease (an increase of 28%), as compared to standard axillary nodal dissection and single-section sentinel lymph node examination alone.
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Sakorafas, George H., and Adelais G. Tsiotou. "Sentinel Lymph Node Biopsy in Breast Cancer." American Surgeon 66, no. 7 (July 2000): 667–74. http://dx.doi.org/10.1177/000313480006600713.
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One of the most important prognostic indicators in patients with breast cancer is axillary lymph node status. Sentinel lymph node (SLN) biopsy has emerged as a potential alternative to routine axillary dissection in clinically node-negative early breast cancer. This procedure requires a specialized but multidisciplinary approach utilizing the surgeon, nuclear radiologist and pathologist. SLN biopsy allows adequate assessment of the axillary nodal status in patients with early breast cancer, with minimal—if any—morbidity. Blue dye and lymphoscintigraphy are complementary techniques, and the success rate is maximized when the two methods are used together. Focused histopathologic examination on one or two lymph nodes most likely to contain metastases [SLN(s)], using serial sectioning and immunohistochemical techniques, allows an improved staging to be performed. Detection of metastases on SLN(s) is not only a prognostic indicator, but it also dictates whether the patient should receive further surgery and adjuvant chemotherapy. Until data regarding the long-term results of the SLN biopsy are available, this method should be considered investigational and be performed by surgeons experienced in this technique to achieve a failure rate of less than 2 per cent.
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Schem, C., N. Maass, D. O. Bauerschlag, F. Hilpert, C. Roder, T. Löning, M. Carstensen, W. Jonat, and K. Tiemann. "One Step Nucleic Acid Amplification (OSNA) for intra-operative detection of lymph node metastases in breast cancer patients." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 21053. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.21053.
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21053 Background: Sentinel lymph node metastasis in breast cancer patients has conventionally been determined by intra- operative histopathological examination of frozen sections followed by definitive post-operative examination of permanent sections. The purpose of this study is to evaluate a more efficient method for intra-operative detection of lymph node metastasis in a clinical setting. Therefore, a new rapid method of detection of CK19 mRNA by One Step Nucleic Acid Amplification (OSNA) and Reverse Transcription Loop Mediated Isothermal Amplification (RT-LAMP) was tested against standard histological techniques. Methods: The clinical study was conducted at two facilities using 188 lymph nodes (46 patients). Lymph nodes from axillary dissected patients with breast cancer were divided into four slices. Alternate slices were used for the new method of CK19 mRNA detection (OSNA) and histopathological examination by hematoxylin & eosin and cytokeratin staining. For the analysis of concordance between both methods, the slices for histopathology were cut in 4 μm sections. For the OSNA method the other 2 slices were homogenised in a short sample preparation step. Afterwards CK19 mRNA was directly amplified from the tissue lysate within 16 minutes. Results: In the clinical study, an overall concordance rate between the OSNA assay and histopathology was 92%. Several discordant results are explainable with the expected uneven distribution of metastases within the lymph nodes. Conclusions: The study indicates that OSNA is a reliable and fast diagnostic tool for the detection of lymph node metastases in breast cancer patients. This method could be beneficial to avoid diagnostic delay for the patient or second surgery based on a post-operatively diagnosed positive lymph node. No significant financial relationships to disclose.
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Bembenek, Reuhl, Markwardt, Schneider, and Schlag. "Sentinel Lymph Node Dissection in Breast Cancer." Swiss Surgery 5, no. 5 (October 1, 1999): 217–21. http://dx.doi.org/10.1024/1023-9332.5.5.217.
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During the last years, the efficacy and reliability of the sentinel lymph node biopsy (snb) as a minimal invasive diagnostic procedure for the nodal status has been intensively evaluated. After the widespread clinical use in the staging of melanoma patients the snb is currently introduced in the clinical management of breast cancer patients. We present our experience with this method during 3,5 years and discuss its potential and pitfalls. From 11/95 to 3/99 we performed sentinel node detection in 146 patients with breast cancer stage I to III, consisting of 127 patients with pT1/2-tumors and 19 patients with pT3/4-tumors. We used the radionuclid method including preoperative lymphoscintigraphy and intraoperative gamma-probe detection. The detection rate varied with the tumor size between 94% for tumors with a diameter < 1cm, 85% (1-3cm), 70% (3-5cm) and 63% (> 5cm). The accuracy of the snb in the prediction of the nodal status changed also with the tumor diameter between 100% for very small tumors (< 1cm), 97% (1-3cm), 88% (3-5cm) and 67% (> 5cm). In the subgroup of patients restricted to T1-2-tumors (n = 106), 57 patients (53%) showed true negative snb. 38 patients (36%) revealed tumor cells in the H&E-staining and an additional 7 patients (7%) solely in the immunohistochemical staining. 4 (4%) of these patients, all of them from the first half of the study period, underwent false-negative snb, 3 of them showing lymphangiosis carcinomatosa. The presented results show, that snb using the radionuclid method is a reliable method for the evaluation of the nodal status in early breast cancer patients with a tumor size up to ca. 3cm. Therefore the sn procedure should be restricted to small tumors with clinically uninvolved axillary nodes or patients with a ductal carcinoma in situ (DCIS) to rule out invasiveness.
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Sharma, Sunita, and C. S. Mohanty. "Detection of Micrometasteses In Lymph Nodes in Cases of Carcinoma Breast by Immunohistochemistry." Annals of Pathology and Laboratory Medicine 7, no. 8 (September 1, 2020): A400–408. http://dx.doi.org/10.21276/apalm.2745.
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Background – We evaluated archived lymph nodes of breast carcinoma for micrometastases detection by serial multiple sections (SMS) and immunohistochemistry (IHC) and found increased positive lymph nodes yield which led to change in staging in few cases, treatment and prognosis.
Method – Metastatic free, early breast cancer cases of 36 patients with lymph node status pN0 or pN1 were evaluated. These were the cases had been treated with modified radicle mastectomy and axillary lymph node dissection. All the lymph node was cut at 50µm interval to get 5µm thick serial sections. These serial sections (SMS) were stained with Hematoxyline and Eosin (H&E). Out of these 2 sections were subjected to Immunohistochemistry (IHC). Monoclonal antibodies chosen for IHC were panCK (Cytokeratin) and EMA (Epithelial membrane antigen) to detect micrometasteses.
Results – Total 463 lymph nodes from 36 cases of carcinoma breast were studied. New serial sections (SMS) cut from 435 lymph nodes of breast revealed 16(3.67%) additional positive lymph nodes from 12 cases. Out of 16 positive lymph nodes 4 were macrometasteses and 12 were micrometastases. Immunostaining with CK antibody revealed micrometasteses in 40 of 435 (9.19%) lymph nodes and by EMA antibody 33 of 435 (7.59%). Out of 40 micrometasteses 8 were positive for isolated tumor cells (ITC). We calculated the Z value and corresponding p value between the two methods as H&E versus SMS, H&E versus IHC and SMS versus IHC for carcinoma breasts. The tests revealed that SMS and IHC are definitely the superior methods in detection of a greater number of positive lymph nodes in cases of carcinoma breast.
P value for detection of micrometasteses H&E versus SMS is <0.05 (S), H&E versus IHC <0.01(S) and SMS versus IHC (<0.02). Out of 36 cases 06 cases showed change in staging and 03 out of 06 cases were upstaged from early to advanced stage carcinoma.
Conclusion – Significant number of metasteses are missed by routine processing of lymph nodes on H&E staining. SMS and IHC increase the yield of metasteses in lymph nodes. CK is superior marker than EMA.
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Bara, Tivadar, Tivadar Bara, Radu Neagoe, Daniela Sala, Simona Gurzu, Ioan Jung, and Cristian Borz. "Sentinel Lymph Node Mapping In Gastric Cancer Surgery: Current Status." Acta Medica Marisiensis 62, no. 4 (December 1, 2016): 403–7. http://dx.doi.org/10.1515/amma-2016-0047.
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AbstractLymphonodular metastases remain an important predictive and prognostic factor in gastric cancer development. The precise determination of the lymphonodular invasion stage can be made only by extended intraoperative lymphadenectomy and histopathological examination. But the main controversy is the usefulness of extended lymph dissection in early gastric cancer. This increases the duration of the surgery and the complications rate, and it is unnecessary without lymphonodular invasion. The identification of the sentinel lymph nodes has been successfully applied for some time in the precise detection of lymph nodes status in breast cancer, malignant melanoma and the use for gastric cancer patients has been a controversial issue. The good prognosis in early gastric cancer had been a surgery challenge, which led to the establishment of minimally invasive individualized treatment and acceptance of sentinel lymph node mapping. The dual-tracer method, submucosally administered endoscopically is also recommended in sentinel lymph node biopsy by laparoscopic approach. There are new sophisticated technologies for detecting sentinel lymph node such as: infrared ray endoscopy, florescence imaging and near-infrared technology, carbon nanoparticles, which will open new perspectives in sentinel lymph nodes mapping.
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Hartmann, Steffi, Angrit Stachs, Thorsten Kühn, Jana de Boniface, Maggie Banys-Paluchowski, and Toralf Reimer. "Targeted Removal of Axillary Lymph Nodes After Carbon Marking in Patients with Breast Cancer Treated with Primary Chemotherapy." Geburtshilfe und Frauenheilkunde 81, no. 10 (October 2021): 1121–27. http://dx.doi.org/10.1055/a-1471-4234.
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AbstractIn breast cancer patients who have received primary chemotherapy and then no longer have any suspicious lymph nodes clinically and/or on imaging, marking of initially suspicious axillary lymph nodes with targeted removal has recently been discussed and practised both in Germany and internationally as an alternative to complete axillary lymph node dissection. Tattooing of the suspicious lymph nodes with a highly purified carbon suspension is currently being investigated in clinical studies. Compared with other techniques, the advantages of this method are the high rate of intraoperative lymph node detection, avoidance of an immediately preoperative localisation procedure and the low costs. The practical aspects of lymph node tattooing and the current data regarding this method will be described.
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Yang, Benlong, Dechuang Jiao, Jiajian Chen, Chunjian Wang, Lidan Jin, Wenhe Zhao, Xueqiang Gao, et al. "Abstract P1-01-10: A phase 3, multicenter, self-controlled, non-inferiority trial comparing mitoxantrone hydrochloride injection for tracing versus technetium-99m in the detection of axillary sentinel nodes in patients with early-stage breast cancer." Cancer Research 82, no. 4_Supplement (February 15, 2022): P1–01–10—P1–01–10. http://dx.doi.org/10.1158/1538-7445.sabcs21-p1-01-10.
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Abstract Aim:Mitoxantrone is an antineoplastic antibiotic used in the treatment of acute leukemia, lymphoma, prostate and breast cancer. Mitoxantrone Hydrochloride Injection for tracing has a high degree of lymph node tropism by changing the dosage form, which penetrates into lymphatic capillaries through the interstitial space and enriches regional lymph nodes through the gland to stain the lymph nodes blue to achieve lymph node tracing effect. This study is aim to evaluate the efficacy and safety of Mitoxantrone Hydrochloride injection(MHI) for tracing sentinel lymph nodes in patients with early-stage breast cancer.Materials & methods: This study was a phase 3, multicenter, self-controlled, non-inferiority trial designed to assess the efficacy and safety of sentinel lymph node tracing with the investigational drug in patients with early-stage breast cancer. All subjects received MHI combined with Technetium-99m(99mTc-Sc), prior to SLNB. The sentinel node identification rate was compared between MHI and 99mTc-Sc to evaluate non-inferiority and concordance. Results: Data were collected from 381 patients in 6 centers all across China. The SLN detection rate was 96.9% (369/381) when using MHI and 97.4% (371/381) when using the standard technique(Table 1). There was no significant difference in the success rate of SLN detection between the two groups(P > 0.05). Since the lower limit of 95% confidence interval was greater than or equal to -5%, the success rate of SLN detection of MHI was non-inferior to that of 99mTc-Sc. In the combination group, 380 cases (99.5%) were successfully detected with SLN. 202 nodes (13.1%) were detected by the MHI but not by the 99mTc-Sc, and 222 nodes (14.4%) were detected by the 99mTc-Sc but not by the MHI(Table 2). All adverse events recovered within one month after intervention.Conclusion: This prospective, multicenter study has shown the Mitoxantrone Hydrochloride injection for tracing to be non-inferior to the standard technique (99mTc-Sc) for breast SLNB. The Mitoxantrone Hydrochloride injection for tracing can be used alone or combined with radioactive material.Key words:Mitoxantrone Hydrochloride injection(MHI), Tracing, Technetium-99m(99mTc-Sc), sentinel lymph node (SLN), Early-Stage Breast Cancer. Attachments: Table 1.SLN detection rate - comparing the Mitoxantrone Hydrochloride Injection and 99mTc-Sc for TracingSLN detection rates [n (%)]Mitoxantrone Hydrochloride Injection for TracingTotalAt least one node detectedNo nodes detected99mTc-ScPositive361 (94.8%)10 (2.6%)371 (97.4%)Negative8 (2.1%)2 (0.5%)10 (2.6%)Total369 (96.9%)12 (3.1%)381(100%) Table 2.Detected nodes-comparing the Mitoxantrone Hydrochloride Injection and 99mTc-Sc for TracingPer node detection rates [n (%)]Mitoxantrone Hydrochloride Injection for TracingTotalPositiveNegative99mTc-ScPositive869 (56.3%)222 (14.4%)1091 (70.7%)Negative202 (13.1%)251 (16.3%)453 (29.3%)Total1071 (69.4%)473 (30.6%)1544 (100%) Citation Format: Benlong Yang, Dechuang Jiao, Jiajian Chen, Chunjian Wang, Lidan Jin, Wenhe Zhao, Xueqiang Gao, Haibo Wang, Jun Li, Haidong Zhao, Di Wu, Zhiming Fan, Shujun Wang, Zhenzhen Liu, Yongsheng Wang, Jiong Wu. A phase 3, multicenter, self-controlled, non-inferiority trial comparing mitoxantrone hydrochloride injection for tracing versus technetium-99m in the detection of axillary sentinel nodes in patients with early-stage breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-01-10.
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Masood, S. "Micrometastasis in lymph node." Breast Cancer Online 9, no. 5 (March 29, 2006): 1–3. http://dx.doi.org/10.1017/s1470903105003342.
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Determining whether cancer has spread to the lymph nodes is important in predicting survival from breast cancer and determining what treatment a patient requires. The traditional method of detecting such metastases, complete axillary node dissection, can result in lymphedema and other quality-of-life damaging side effects. The new technique of sentinel lymph node biopsy (SLNB) offers a way to test for lymph node metastases without causing the side effects of traditional axillary node dissection. Intraoperative analysis of SLNB is becoming an effective tool in assessment of the presence or absence of metastatic tumor, and therefore influences the treatment offered to the patient. Because of this central diagnostic use, as it is a new procedure, further studies need to be conducted to fully assess its role in breast cancer treatment.
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Singh, Rohit, Bhavinder Kumar Arora, Vijay Pal, Gourav Mittal, and Monika Shekhawat. "Role of magnetic resonance imaging in detection of metastatic axillary lymph nodes in breast cancer patients." International Surgery Journal 9, no. 5 (April 26, 2022): 1046. http://dx.doi.org/10.18203/2349-2902.isj20221153.
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Background: Magnetic resonance imaging has been evolved as a very important tool in diagnosing the axillary lymph nodes pre-operatively. In recent studies, in women with various risk profiles, the sensitivity ranges between 81% and 100%, which is approximately twice as high as the sensitivity of mammography. Methods: This prospective study was performed at PGIMS, Haryana from December 2018 to March 2020. Total 30 patients (n=30) were included in the study. All the patients presenting with clinically palpable breast lump, underwent triple assessment test. All the patient underwent modified radical mastectomy and the final histopathological report of the specimen was then compared with the preoperative clinical and MRI assessment of the metastatic axillary lymph nodes. Results: This study aimed at detection of axillary lymph node metastasis in breast malignancies by breast MRI. The sensitivity of this MRI came to be about 80.00%, specificity of about 80%, positive predictive value of about 95.24%, negative predictive value of about 44.44% and accuracy of about 80.0% with 95% confidence interval.Conclusions: Magnetic resonance imaging is a very important investigation in detection of breast malignancies, their depth, muscles and skin involvement as well as axillary lymph node detection. Axillary lymph nodes can although be detected by clinical examination, but problem lies in their sensitivity and specificity as axillary lymph nodes of small size cannot be detected by clinical examination.
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Singh, Rohit, Bhavinder Kumar Arora, Vijay Pal, Gourav Mittal, and Monika Shekhawat. "Role of magnetic resonance imaging in detection of metastatic axillary lymph nodes in breast cancer patients." International Surgery Journal 9, no. 5 (April 26, 2022): 1046. http://dx.doi.org/10.18203/2349-2902.isj20221153.
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Background: Magnetic resonance imaging has been evolved as a very important tool in diagnosing the axillary lymph nodes pre-operatively. In recent studies, in women with various risk profiles, the sensitivity ranges between 81% and 100%, which is approximately twice as high as the sensitivity of mammography. Methods: This prospective study was performed at PGIMS, Haryana from December 2018 to March 2020. Total 30 patients (n=30) were included in the study. All the patients presenting with clinically palpable breast lump, underwent triple assessment test. All the patient underwent modified radical mastectomy and the final histopathological report of the specimen was then compared with the preoperative clinical and MRI assessment of the metastatic axillary lymph nodes. Results: This study aimed at detection of axillary lymph node metastasis in breast malignancies by breast MRI. The sensitivity of this MRI came to be about 80.00%, specificity of about 80%, positive predictive value of about 95.24%, negative predictive value of about 44.44% and accuracy of about 80.0% with 95% confidence interval.Conclusions: Magnetic resonance imaging is a very important investigation in detection of breast malignancies, their depth, muscles and skin involvement as well as axillary lymph node detection. Axillary lymph nodes can although be detected by clinical examination, but problem lies in their sensitivity and specificity as axillary lymph nodes of small size cannot be detected by clinical examination.
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Abreu, Benedita Andrade Leal de, Adriana de Morais Santos, Lívia de Almeida Soares, Antônio Ricardo dos Santos, Idna de Carvalho Barros, Everardo Leal de Abreu, Alexandre Jorge Gomes da Cruz Filho, João Batista de Abreu, and Sabas Carlos Vieira. "Sentinel lymph node detection through radioguided surgery in patients with breast cancer." Brazilian Archives of Biology and Technology 51, spe (December 2008): 57–61. http://dx.doi.org/10.1590/s1516-89132008000700010.
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Biopsy of the sentinel lymphnode (SLNB), the first lymphnode to receive lymphatic drainage from the primary tumor, accurately predicts the axillary lymph node status and, when negative, obviates the need for axillary lymphadenectomy (AL). The aim of this study was, to verify the SLN localization in breast cancer through preoperative lymphoscintigraphy and intraoperative gamma-probe, as well as to demonstrate the benefits of such techniques in preventing complications of AL. Medical records of 228 patients with breast carcinoma, who were underwent SLN localization and, radioguided surgery, from March 2005 to December 2007 were analyzed retrospectively. Data regarding age, tumor characteristic, breast involved, type of surgery, radiopharmaceutical drainage pattern, axillary assessment (SLNB or AL) and number of lymph nodes dissected were collected. It was ascertained that radioguided surgery is a selective method of axillary assessment in breast cancer, which makes this technique a safe alternative to radical assessment of total dissection of axillary lymph nodes and its subsequent complications.
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Pizzocaro, Claudio, Pier Luigi Rossini, Arturo Terzi, Roberto Farfaglia, Laura Lazzari, Edda Simoncini, and Raffaele Giubbini. "Sentinel Node Biopsy in Breast Cancer: The Experience of Brescia Civic Hospital." Tumori Journal 86, no. 4 (July 2000): 309–11. http://dx.doi.org/10.1177/030089160008600412.
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The accuracy of the sentinel node technique in the evaluation of axillary node involvement in breast cancer was evaluated in 83 consecutive patients with monofocal T1–2 carcinoma, who were clinically N0 and who underwent lymphoscintigraphy with 99mTc-colloid integrated with intraoperative sentinel node detection by a portable probe. Lymphoscintigraphy revealed at least one sentinel node in 75 patients (90.4%), always identified by the probe. In eight patients (9.6%) the sentinel node was detected neither by lymphoscintigraphy nor by the probe. All removed lymph nodes were analyzed by hematoxylin-eosin histology and the sentinel node by immunostaining. In 28/75 patients (37.3%) at least one metastatic axillary lymph node was detected; in 16 of the 28 N+ subjects (57%) only the sentinel node was positive. The false negative rate (sentinel node negative/other axillary lymph nodes positive) was 17.85% (5/28 patients). In 9/23 patients (39%) micrometastases were found in the sentinel node only. In conclusion, specific sentinel node positivity in 57% of cases supports the validity of the sentinel node concept. Moreover, nine patients would have been considered No by standard hematoxylin-eosin histology without sentinel node-aided immunostaining. A 17.8% false negative rate calls for caution in patients with negative sentinel nodes.
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Milulescu, Amelia, Cristian Gabriel Viisoreanu, Nicolae Bacalbasa, Irina Balescu, Tiberiu-Augustin Georgescu, Corina Grigoriu, Costin Berceanu, and Roxana Elena Bohiltea. "Management of the axilla: Conventional tracers vs ICG-fluorescence in sentinel lymph node biopsy." Romanian Medical Journal 68, S6 (December 30, 2021): 126–28. http://dx.doi.org/10.37897/rmj.2021.s6.21.
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The evaluation of regional lymph nodes is part of breast cancer staging. Biopsy of the sentinel lymph node was established, in order to evaluate the condition of the axillary lymph nodes without having to complete an axillary dissection. The concept of sentinel lymph node (SLN) is based on the theory of sequential dissemination of tumor cells through the lymph. When lymphatic dissemination occurs, the invasion initially occurs in the first lymph node that drains lymph from the tumor. This lymph node has been named GS and depending on its negative or positive status, the presence or absence of metastases in the remaining regional lymph nodes can be established. Blue dye (BD) and radioactive isotopes (RI) are routinely used markers for identification of the sentinel lymph nodes during sentinel lymph node biopsy (SLNB) in early stage breast cancer. Unlike the blue dye technique, using radioactive isotopes has lower false-negative rates. Nonetheless, the need of lymphoscintigraphy, the time needed for preoperative injection, and undetected sentinel lymph nodes in some cases cause surgeons to rely only on the combination of blue dye and radioisotopes. At present, indocyanine green (ICG) fluorescence method (ICG-SLNB) is starting to gain more and more field as an alternative to conventional mapping methods. The purpose of this review is to compare ICG with the conventional methods (blue dye and radioactive isotopes) and their role in detection of SLN.
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Sahin, Aysegul A., Merih Guray, and Kelly K. Hunt. "Identification and Biologic Significance of Micrometastases in Axillary Lymph Nodes in Patients With Invasive Breast Cancer." Archives of Pathology & Laboratory Medicine 133, no. 6 (June 1, 2009): 869–78. http://dx.doi.org/10.5858/133.6.869.
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Abstract Context.—The presence or absence of metastases in axillary lymph nodes is one of the most important prognostic factors for patients with breast cancer. During the past decade sentinel lymph node (SLN) biopsy has been increasingly adopted as a minimally invasive staging alternative to complete axillary node dissection. Objective.—Sentinel lymph nodes are more likely to contain metastases than non-SLNs. In routine clinical practice SLNs are assessed by diverse methodologies including multiple sectioning, immunohistochemical staining, and molecular diagnostic tests. Despite the lack of standard histopathologic protocols during the years detailed evaluation of SLNs has resulted in an increased detection of small (micro) metastases. Data Sources.—Breast cancer with micrometastases constitutes a heterogenous group of tumors with variable clinical outcome regarding the risk of additional metastases in the remaining axillary lymph nodes and to patients' survival. Conclusion.—The clinical significance of micrometastases has been subject to great controversy in patients with breast cancer. In this review we highlight controversies regarding micrometastases especially in relation to SLNs.
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Leong, Stanley P. "Detection of melanoma, breast cancer and head and neck squamous cell cancer sentinel lymph nodes by Tc-99m Tilmanocept (Lymphoseek®)." Clinical & Experimental Metastasis 39, no. 1 (December 28, 2021): 39–50. http://dx.doi.org/10.1007/s10585-021-10137-4.
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AbstractTechnetium-99m-labeled Tilmanocept or Lymphoseek® (Cardinal Health, Dublin, Ohio) is a soluble, synthetic molecule with a small diameter (7 nm), which is comprised of technetium-99m chelated to a dextran backbone containing multiple units of mannose ligands with a high affinity for CD206, a receptor located on the surface of macrophages and dendritic cells that are found in high concentration in lymph nodes. It enables quick transit from the injection site and rapid lymph node accumulation. The binding of mannose ligand and CD206 results in the internalization of the ligand and receptor into the cell. Once the Technetium-99m-labeled Tilmanocept (Lymphoseek®) reaches the lymph node, it is readily internalized by the macrophages and dendritic cells within the draining lymph nodes. Technetium-99m-labeled Tilmanocept (Lymphoseek®) has been extensively studied as a radioisotope for detection of sentinel lymph nodes in melanoma, breast cancer and head and neck squamous cell carcinoma in clinical trials. Based on its safety and ability to detect sentinel lymph nodes satisfactorily, it has been approved by the FDA to use as a radioisotope for preoperative lymphoscintigraphy for identification of sentinel lymph nodes in these types of cancer. Further, the FDA has expanded approval of Technetium-99m-labeled for sentinel lymph node mapping of all solid tumors as well as in pediatric patients.
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Hou, Qiaoyun, Shuohua Chen, Qi An, Boya Li, Yan Fu, and Yongzhang Luo. "Extracellular Hsp90α Promotes Tumor Lymphangiogenesis and Lymph Node Metastasis in Breast Cancer." International Journal of Molecular Sciences 22, no. 14 (July 20, 2021): 7747. http://dx.doi.org/10.3390/ijms22147747.
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Early detection and discovery of new therapeutic targets are urgently needed to improve the breast cancer treatment outcome. Here we conducted an official clinical trial with cross-validation to corroborate human plasma Hsp90α as a novel breast cancer biomarker. Importantly, similar results were noticed in detecting early-stage breast cancer patients. Additionally, levels of plasma Hsp90α in breast cancer patients were gradually elevated as their clinical stages of regional lymph nodes advanced. In orthotopic breast cancer mouse models, administrating with recombinant Hsp90α protein increased both the primary tumor lymphatic vessel density and sentinel lymph node metastasis by 2 and 10 times, respectively. What is more, Hsp90α neutralizing antibody treatment approximately reduced 70% of lymphatic vessel density and 90% of sentinel lymph node metastasis. In the in vitro study, we demonstrated the role of extracellular Hsp90α (eHsp90α) as a pro-lymphangiogenic factor, which significantly enhanced migration and tube formation abilities of lymphatic endothelial cells (LECs). Mechanistically, eHsp90α signaled to the AKT pathway through low-density lipoprotein receptor-related protein 1 (LRP1) to upregulate the expression and secretion of CXCL8 in the lymphangiogenic process. Collectively, this study proves that plasma Hsp90α serves as an auxiliary diagnosis biomarker and eHsp90α as a molecular mediator promoting lymphangiogenesis in breast cancer.
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Hopkins, L., S. H. Chang, L. J. Kirstein, T. Fulop, S. C. Malamud, M. Chadha, and S. K. Boolbol. "Does mammography affect the nodal status at presentation in 40- to 49-year-old breast cancer patients?" Journal of Clinical Oncology 29, no. 27_suppl (September 20, 2011): 55. http://dx.doi.org/10.1200/jco.2011.29.27_suppl.55.
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55 Background: It has previously been demonstrated that mammographically-detected breast cancers present as earlier stage disease than those detected as a palpable finding. In addition, it is well known that the single most important prognostic indicator in breast cancer is lymph node status. The benefit of screening mammography in women age 40-49 has been questioned recently, and has led to a change in the recommendations by the United States Preventative Services Task Force (USPSTF) to begin screening mammography in the average risk woman at age 50, rather than 40. In this study, we sought to determine whether detection of breast cancer in 40-49 year old women by screening mammography is associated with negative nodal status at presentation. Methods: A prospectively collected database was reviewed to identify 460 women ages 40-49 diagnosed with invasive breast cancer from 2003-2008. The method of detection of the breast cancer was noted, and the lymph node status at presentation was identified. Results: There were 460 eligible patients with invasive breast cancer for whom information regarding nodal status was available. Of these, 205 patients were diagnosed with a mammographic finding, and 255 patients presented with a palpable abnormality. In the group whose cancers were detected on mammography, 18% presented with lymph node metastases. This is significantly lower than the 41% who presented with a palpable finding (p<0.0001). For 40-49 year old women with invasive breast cancer, the likelihood of having a positive lymph node at presentation is 3.2 times higher if her cancer is detected as a palpable abnormality rather than on mammography (odds ratio) (CI: 2.1-5.0) (Table). Conclusions: Our analysis demonstrates that a patient diagnosed with invasive breast cancer in her 40s is more likely to present with lymph node metastases if her cancer is detected as a palpable mass, compared to those detected on mammography. This has certain prognostic importance, and provides an additional rationale for performing screening mammography in women of this age group. [Table: see text]
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Abe, Makoto, Tetsuya Yamada, and Akinobu Nakano. "Prospective Comparison of Intraoperative Touch Imprint Cytology and Frozen Section Histology on Axillary Sentinel Lymph Nodes in Early Breast Cancer Patients." Acta Cytologica 64, no. 5 (2020): 492–97. http://dx.doi.org/10.1159/000508016.
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Introduction: Since the late 1970s, sentinel lymph node biopsy (SLNB) has been used for several solid malignancies to identify lymph node metastases. This procedure is associated with less surgical morbidity than complete lymphadenectomy. Recent evidence suggests that axillary lymphadenectomy is not required for breast sentinel nodes with micrometastases (≤2 mm). Current clinical management of sentinel nodes indicates that only macrometastases (>2 mm) should be detected intraoperatively. In Japan, an intraoperative histopathological frozen section (FS) method is used to identify lymph node metastases, but this method takes more than 30 min and requires complex techniques and expensive equipment. Touch imprint cytology (TIC) is an easier, less expensive, and faster method, but its sensitivity has been shown to be low. Objective: The purpose of this study was to determine if TIC is more useful than FS in identifying macrometastases in sentinel lymph nodes in preoperative node-negative breast cancer operations. Methods: A prospective review of 49 consecutive patients with node-negative breast cancer treated with SLNB and intraoperative TIC and FS between November 2017 and June 2019 was performed. TIC samples were stained using Papanicolaou and Diff-Quick stains. Results were compared with routine postoperative paraffin sections. Results: With TIC, the Papanicolaou stain took a mean of 12 min, and the Diff-Quick stain took a mean of 10 min. Results of both TIC stain methods were the same. In contrast, the FS method took a mean of 80 min (including the transfer of specimens to a different hospital with the necessary equipment). TIC confirmed macrometastases in 5 cases. All macrometastases were diagnosed equally by the 2 techniques. Both the sensitivity and specificity of TIC were 100% for detection of macrometastases. Conclusion: TIC of SLNB for breast cancer is an easy and useful method for the detection of macrometastases of breast sentinel nodes.
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Somasundaram, S. K., D. W. Chicken, and M. R. S. Keshtgar. "Detection of the sentinel lymph node in breast cancer." British Medical Bulletin 84, no. 1 (September 3, 2007): 117–31. http://dx.doi.org/10.1093/bmb/ldm032.
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Rasouli, Z., N. Riyahi-Alam, M. Khoobi, S. Haghgoo, E. Gholibegloo, A. Ebrahimpour, Ashouri H, and H. Hashemi. "Lymph Node Metastases Detection Using Gd2O3@PCD as Novel Multifunctional Contrast Imaging Agent in Metabolic Magnetic Resonance Molecular Imaging." Contrast Media & Molecular Imaging 2022 (October 12, 2022): 1–11. http://dx.doi.org/10.1155/2022/5425851.
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Axillary lymph node detection is crucial to staging and prognosis of the lymph node metastatic spread in breast cancer. Currently, lymphoscintigraphy and blue dye, as the conventional methods to localize sentinel lymph nodes (SLNs), are invasive and can only be performed during surgery. This study has had a novel hybrid gadolinium oxide nanoparticle coating with Cyclodextrin-based polyester as a high-relaxivity T1 magnetic resonance molecular imaging (MRMI) contrast agent (CA). Twelve female BALB/c mice were randomly divided into three groups of four mice; each group was injected with 4T1 cells to obtain metastasis lymph nodes and diagnosed by using the 3D T1W (VIBE) MRI (Siemens 3T, Prisma). The synthesized Gd2O3@PCD nanoparticles with a suitable particle size range of 20–40 nm have had much higher longitudinal relaxivity (r1) for Gd2O3@PCD and Gd-DOTA (Dotarem) with the values of 3.98 mM−1·s−1 ± 0.003 and 2.71 mM−1·s−1 ± 0.005, respectively. Identical MR images in coronal views were subsequently obtained to create time-intensity curves of the right axillary lymph nodes and to measure the contrast ratio (CR). The peak CR and qualitative assessment of axillary lymph nodes at five-time points were evaluated. After subcutaneous injection, the contrast ratio of axillary lymph node and tumor in mice exhibited CR peak of Gd2O3@PCD and Dotarem with the values of 2.21 ± 0.06 and 0.40 ± 0.004 for lymph node and 2.54 ± 0.04 and 1.21 ± 0.007 for the tumor, respectively. Furthermore, the lumbar-aortic lymph node is weakly visible in the original coronal image. In conclusion, the use of Gd2O3@PCD nanoparticles as novel MRMI CAs enables high resolution for the detection of lymph node metastasis in mice with the potential capability for breast cancer diagnostic imaging.
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Zehentner, Barbara K., Davin C. Dillon, Yuqiu Jiang, Jiangchun Xu, Angela Bennington, David A. Molesh, XinQun Zhang, Steven G. Reed, David Persing, and Raymond L. Houghton. "Application of a Multigene Reverse Transcription-PCR Assay for Detection of Mammaglobin and Complementary Transcribed Genes in Breast Cancer Lymph Nodes." Clinical Chemistry 48, no. 8 (August 1, 2002): 1225–31. http://dx.doi.org/10.1093/clinchem/48.8.1225.
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Abstract Background: Mammaglobin mRNA expression is found in 70–80% of primary and metastatic breast tumor biopsies. The potential breast tumor markers B305D, B726P, and γ-aminobutyrate type A receptor π subunit (GABAπ) complement the expression of mammaglobin. Collectively the expression profile of these four genes could be used as a diagnostic and prognostic indicator for breast cancer. Methods: A multigene reverse transcription-PCR (RT-PCR) assay was established to detect the expression of mammaglobin, GABAπ, B305D, and B726P simultaneously. Specific primers and TaqMan® probes were used to analyze combined mRNA expression profiles in primary breast tumors and metastatic lymph node specimens. Results: The multigene RT-PCR assay detected substantial expression signals in 27 of 27 primary tumor and 50 of 50 metastatic breast lymph node samples. Specificity studies demonstrated no significant expression signal in 27 non-breast cancer lymph nodes, in 22 various healthy tissue samples, or in 14 colon tumor samples. Conclusion: The novel RT-PCR-based assay described here provides a sensitive detection system for disseminated breast tumor cells in lymph nodes. In addition, this multigene assay could also be used to test peripheral blood and bone marrow samples.
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Sideri, Mario, Concetta De Cicco, Angelo Maggioni, Nicoletta Colombo, Luca Bocciolone, Giuseppe Trifirò, Maria De Nuzzo, Costantino Mangioni, and Giovanni Paganelli. "Detection of Sentinel Nodes by Lymphoscintigraphy and Gamma Probe Guided Surgery in Vulvar Neoplasia." Tumori Journal 86, no. 4 (July 2000): 359–63. http://dx.doi.org/10.1177/030089160008600431.
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Background Pathologic lymph node status is the most important prognostic factor in vulvar cancer; however, complete inguinofemoral node dissection is associated with significant morbidity. Intraoperative lymphoscintigraphy associated with gamma detecting probe-guided surgery has proved to be reliable in the detection of sentinel node (SN) involvement in melanoma and breast cancer patients. The present study evaluates the feasibility of the surgical identification of inguinal sentinel nodes using lymphoscintigraphy and a gamma detecting probe in patients with early vulvar cancer. Methods Technetium-99-labeled colloid human albumin was administered perilesionally in 44 patients. Twenty patients had T1 and 23 had T2 invasive epidermoid vulvar cancer; one patient had a lower-third vaginal cancer. An intraoperative gamma detecting probe was used to identify SNs during surgery. Complete inguinofemoral node dissection was subsequently performed. SNs underwent separate pathologic evaluation. Results A total of 77 groins were dissected in 44 patients. SNs were identified in all the studied groins. Thirteen cases had positive nodes: the SN was positive in all of them; in 10 cases the SN was the only positive node. Thirty-one patients showed negative SNs: all of them were negative for lymph node metastasis. Conclusions Lymphoscintigraphy and SN biopsy under gamma detecting probe guidance proved to be an easy and reliable method for detection of SNs in early vulvar cancer. If these preliminary data will be confirmed, the technique would represent a real progress towards less aggressive treatment in patients with vulvar cancer.
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Ameri, Bita, Riti Kanesa-Thasan, Maysa M. Abu-Khalaf, Adam C. Berger, Tara Eisenberg, Melissa A. Lazar, Alexander Sevrukov, et al. "Negative predictive value of ipsilateral axillary ultrasound in the pre-operative assessment of invasive breast cancer." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): e12080-e12080. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e12080.
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e12080 Objective: To determine if a negative preoperative axillary ultrasound predicts a negative sentinel lymph node biopsy at surgery. Background: Axillary lymph node involvement is an important prognostic indicator in patients with breast cancer. Sentinel lymph node biopsy (SLNB) is currently the gold standard for determining the presence or absence of axillary metastases. Pre-operative axillary ultrasound is often used to evaluate axillary lymph node status prior to surgery and SLNB. Although there are no established guidelines on when preoperative axillary ultrasound is performed, at our institution we evaluate the axilla when invasive breast cancer is suspected. This study evaluated the negative predictive value (NPV) of axillary ultrasound compared to the pathology results of SLNB. Methods: In this single-center IRB-approved retrospective study, 3 years of breast imaging data (2014-2016) were reviewed. 137 patients had pathology verified invasive breast cancer with negative preoperative axillary ultrasound and subsequent SLNB. All patients had clinically negative axillae. Based upon the pathology results of SLNB, the negative predictive value of preoperative axillary ultrasound was calculated. Negative axillary ultrasound is defined as the absence of morphologically abnormal lymph nodes on imaging. A lymph node is considered morphologically normal when there is preserved fatty hilum and a uniform cortex measuring 3 mm or less. Results: Out of 137 patients with invasive breast cancer who had negative preoperative axillary ultrasound, 122 had negative SLNB results and 15 had positive SLNB results. Preoperative axillary ultrasound demonstrated a NPV of 89.1% for the detection of axillary metastatic disease at the time of SLNB. Conclusions: Negative axillary ultrasound excluded axillary metastatic disease in 89.1% of patients. This data suggests that negative axillary ultrasound may have a role in the setting of failed SLNB (no lymph nodes found at the time of surgery) in deciding whether to pursue axillary dissection.
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Vaz, Teresa, Susy Costa, and Bárbara Peleteiro. "Biópsia do Gânglio Sentinela Guiada por Fluorescência no Cancro da Mama: Taxa de Deteção e Performance Diagnóstica." Acta Médica Portuguesa 31, no. 12 (December 28, 2018): 706. http://dx.doi.org/10.20344/amp.10395.
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Introduction: Sentinel lymph node biopsy is currently the standard surgical procedure for lymph node staging in patients with early stage breast cancer. It is performed using different techniques, such as the injection of vital dyes and / or radioisotopes and, more recently, guided by fluorescence using Indocyanine green. The aim of this study is to assess the detection rate of sentinel lymph node using Indocyanine green in breast cancer patients according to factors related to the patient and the tumor.Material and Methods: Retrospective study of a random sample of patients with breast cancer, treated and followed at Centro Hospitalar São João, in Porto, between 2012 and 2016.Results: Indocyanine green detection rate was over 90% and its diagnostic accuracy was similar to other methods described in the presence of metastatic involvement of lymph nodes.Discussion: There was no statistically significant difference between the three methods in the detection rates in subgroups of older women, with normal weight and in those who underwent previous surgery in breast or axilla or neo-adjuvant chemotherapy.Conclusion: Indocyanine green is a potential alternative method to other sentinel lymph node screening techniques, appearing as a future option for breast cancer centers with no nuclear medicine department. However, it is essential to carry out further research in order to define the ideal patients’ profile that maximizes the method’s effectiveness.
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Choudhury, Monisha, Sapna Agrawal, Mukta Pujani, Shaji Thomas, and Meenu Pujani. "Immunohistochemical detection of axillary lymph node micrometastases in node negative breast cancer patients using cytokeratin and epithelial membrane antigen." South Asian Journal of Cancer 04, no. 01 (January 2015): 028–31. http://dx.doi.org/10.4103/2278-330x.149946.
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Abstract Background and Objective: The study was conducted to detect occult metastases in lymph node negative breast cancer patients using cytokeratin (CK) and epithelial membrane antigen (EMA) immunohistochemistry (IHC) and correlate this with primary tumor size and grade. Materials and Methods: A total of 32 cases including 12 prospective and 20 retrospective cases of axillary lymph node negative breast cancer were studied. CK and EMA IHC were performed to detect micrometastases. Results: Axillary lymph node metastases were detected in 18.75% of previously node negative cases using CK and EMA IHC. CK was found to be more sensitive for detection of metastases compared to EMA. A highly significant correlation was observed between tumor grade and axillary lymph node metastases detected by CK and EMA. However, no significant correlation was found between tumor size and axillary lymph node metastases detected by IHC. Conclusion: In the present study, there was an increase of 18.75% in the occult metastases detection rate using CK and EMA. To conclude, IHC detection of occult metastases should be done using CK in all axillary node negative cases, especially in T1 and T2 stage tumors.
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Liu, Lucy H., Kalliopi P. Siziopikou, Sheryl Gabram, and Kenneth D. McClatchey. "Evaluation of Axillary Sentinel Lymph Node Biopsy by Immunohistochemistry and Multilevel Sectioning in Patients With Breast Carcinoma." Archives of Pathology & Laboratory Medicine 124, no. 11 (November 1, 2000): 1670–73. http://dx.doi.org/10.5858/2000-124-1670-eoasln.
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Abstract Background.—Axillary lymph node dissection for evaluation of the presence or absence of metastatic disease is the single most important prognostic factor for patients with newly diagnosed primary breast cancer. Recently, sentinel lymph node (SLN) biopsy is being investigated as an alternative to the evaluation of the entire axilla. We evaluated whether the application of multilevel sectioning and immunohistochemistry in SLNs will increase the accuracy of detection of metastatic deposits. Methods.—Between October 1998 and July 1999, 38 patients with breast carcinoma (25 ductal, 5 lobular, 4 tubular, and 4 mixed ductal and lobular) underwent successful SLN biopsy followed by complete axillary node dissection. Sentinel lymph nodes were localized with a combination of isosulfan blue dye and radionuclide colloid injection. Frozen sections and permanent sections of SLNs were examined. All negative SLNs were examined for micrometastases by 3 additional hematoxylin-eosin (H&E)-stained sections and immunohistochemistry with the cytokeratins AE1/AE3. Results.—Sentinel lymph nodes were successfully identified surgically in 38 (93%) of 41 patients. There was a 97% correlation between the results of the frozen sections and the permanent H&E-stained sections. Twelve (32%) of 38 patients showed evidence of metastatic disease in their SLN by routine H&E staining. In 7 (58%) of 12 patients with positive nodes, the sentinel node was the only positive node. The 26 patients with negative SLN examination by H&E were further analyzed for micrometastases; 5 (19%) were found to have metastatic deposits by immunohistochemistry. Of these patients, 2 were also converted to node positive by detection of micrometastatic disease by examination of the additional H&E levels. Conclusions.—Sentinel lymph nodes can be accurately identified in the axilla of breast cancer patients. Evaluation of SLNs provides reliable information representative of the status of the axilla in these patients. Immunohistochemistry and, to a lesser degree, detailed multilevel sectioning are able to further improve our ability to detect micrometastatic disease in SLNs of breast cancer patients.
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Luan, Ting, Yongqing Li, Qingwei Wu, Yan Wang, Zongwei Huo, Xiaohui Wang, Ligang Xing, and Xiaorong Sun. "Value of Quantitative SPECT/CT Lymphoscintigraphy in Improving Sentinel Lymph Node Biopsy in Breast Cancer." Breast Journal 2022 (March 28, 2022): 1–9. http://dx.doi.org/10.1155/2022/6483318.
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Background and Objectives. Sentinel lymph node biopsy has been widely accepted as the standard procedure to assess the axillary lymph node status in breast cancer. However, more than 70% of excised sentinel lymph nodes have been found to be healthy. It may lead to unnecessary excisions and increase the incidence of postoperative complications. The aim of this study was to investigate the value of quantitative Tc-99 m sulfur colloid SPECT/CT in avoiding excessive removal of unnecessary sentinel lymph nodes in breast cancer patients. Methods. We retrospectively enrolled breast cancer patients who underwent SPECT/CT prior to sentinel lymph node biopsy. Quantification of radiotracer uptake from SPECT/CT data was performed. A radioactivity count threshold (RSPECT) using SPECT/CT was calculated for detecting metastatic sentinel lymph nodes. To localize sentinel lymph nodes exactly, we compared the positions of sentinel lymph nodes localized using SPECT/CT with positions localized surgically using an intraoperative γ-probe. Results. 491 patients were included, with a median of 3 sentinel lymph nodes/patient detected by the γ-probe and 2 sentinel lymph nodes/patient detected by SPECT/CT. As the number of sentinel lymph nodes visualized on SPECT/CT images, the metastasis incidence of lymph nodes in the ≤2 SLNs group was significantly higher than that in the >2 SLNs group (35% vs. 15%, P < 0.001 ). No metastasis was found in lymph nodes with RSPECT ≤ 30% in the >2 SLNs group, and thus, 30% (157/526) of SPECT/CT-identified nodes would avoid unnecessary removal. The positions of sentinel lymph nodes localized by SPECT/CT and γ-probe were identical in 42% (39/93) of patients. Conclusions. Quantitative Tc-99 m SC SPECT/CT imaging has the potential to preoperatively locate sentinel lymph nodes and intraoperatively avoid unnecessary sentinel lymph node biopsy.
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Chen, Jie, Jiqiao Yang, Tao He, Yunhao Wu, Xian Jiang, Zhoukai Fu, Qing Lv, et al. "Adding carbon nanoparticles to dual-tracers for the sentinel node evaluation after neoadjuvant chemotherapy in patients with pretreatment node-positive breast cancers: The TT-SLNB trial." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): 566. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.566.
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566 Background: This study measures the feasibility and accuracy of sentinel lymph node biopsy (SLNB) with triple-tracers (TT-SLNB) which combines carbon nanoparticles (CNS) with dual tracers of radioisotope and blue dye, hoping to achieve an optimized method of SLNB after neoadjuvant chemotherapy (NAC) in ycN0 breast cancer patients with pretreatment positive axillary lymph nodes. Methods: Clinically node-negative invasive breast cancer patients with pre-NAC positive axillary lymph nodes who received surgeries from November 2020 to January 2021 were included. CNS was injected at the peritumoral site the day before surgery. Standard dual-tracer (SD)-SLNs were defined as blue-colored and/or hot nodes, and TT-SLNs were defined as lymph nodes detected by any of hot, blue-stained, black-stained, and/or palpated SLNs. All patients received subsequent axillary lymph node dissection. Detection rate (DR), false-negative rate (FNR), negative predictive value (NPV) and accuracy of SLNB were calculated. Results: Seventy-six of 121 (62.8%) breast cancer patients converted to cN0 after NAC and received TT-SLNB. After NAC, 28.95% (22/76) achieved overall (breast and axilla) pCR. The DR was 94.74% (72/76), 88.16% (67/76) and 96.05% (73/76) for SLNB with single-tracer of CNS (CNS-SLNB), SD-SLNB, and TT-SLNB, respectively. The FNR was 22.86% (8/35) for CNS-SLNB and 10% (3/30) for SD-SLNB. The FNR of TT-SLNB was 5.71% (2/35), which was significantly lower than those of CNS-SLNB and SD-SLNB. The NPV and accuracy was 95.0% and 97.3% for TT-SLNB, respectively. Moreover, a significant relation was seen between the pretreatment clinical T classification and the DR of TT-SLNB (Fisher’s exact test, p= 0.010). Conclusions: TT-SLNB revealed ideal performance in post-NAC ycN0 patients with pretreatment node-positive breast cancers. The application of TT-SLNB reached a better balance between more accurate axillary evaluation and less intervention. Clinical trial information: ChiCTR2000039814. [Table: see text]
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Kanngurn, Samornmas, Siripong Chewatanakornkul, Teerapon Premprapha, and Paramee Thongsuksai. "Comparability of Different Pathologic Protocols in Sentinel Lymph Node Evaluation: An Analysis of Two Step-Sectioning Methods for the Same Patients With Breast Cancer." Archives of Pathology & Laboratory Medicine 133, no. 9 (September 1, 2009): 1437–40. http://dx.doi.org/10.5858/133.9.1437.
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Abstract Context.—The pathologic protocol for sentinel lymph node evaluation has yet to be standardized. Results from previous studies are troublesome to compare because they have been conducted on different sets of subjects with cancer. Objective.—To compare the detection of sentinel lymph node metastases by using step-sectioning methods at 20-μm and 150-μm intervals for the same patient with primary breast cancer. Design.—A total of 186, initially tumor-negative sentinel lymph nodes from a group of 80 patients with breast cancer were included. For all nodes, each paraffin block was cut serially to produce a total of 10 levels: 5 consecutive levels of sections for each of the 20-μm and 150-μm intervals. The nodal findings obtained at these intervals on hematoxylin-eosin and cytokeratin slides were compared by using the McNemar test. Results.—The overall detection rate for sentinel lymph node metastasis at intervals of 20 μm and 150 μm was 27.5% (22/80) and 20% (16/80), respectively. The overall agreement between the 20-μm and 150-μm sections was 82.5%. No macrometastasis was missed by either method. At the 20-μm interval, 2 cases of micrometastasis were missed, while 10 cases of isolated tumor cells were missed at the 150-μm interval. However, no statistical difference was observed for the final sentinel lymph node results with either method. (McNemar test, P = .18 for case-based results and P = .052 for nodal-based results). Conclusions.—The 20-μm and 150-μm interval step-sectioning methods produce comparable results for detection of metastatic deposits in sentinel lymph nodes.
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Braun, Stephan, B. Semeni Cevatli, Cyamak Assemi, Wolfgang Janni, Christina R. M. Kentenich, Christian Schindlbeck, Dorothea Rjosk, and Florian Hepp. "Comparative Analysis of Micrometastasis to the Bone Marrow and Lymph Nodes of Node-Negative Breast Cancer Patients Receiving No Adjuvant Therapy." Journal of Clinical Oncology 19, no. 5 (March 1, 2001): 1468–75. http://dx.doi.org/10.1200/jco.2001.19.5.1468.
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PURPOSE: In node-negative patients, of whom up to 30% will recur within 5 years after diagnosis, markers are still needed that identify patients at high enough risk to warrant further adjuvant treatment. In the present study we analyzed whether a correlation exists between microscopic tumor cell spread to bone marrow and to lymph nodes and attempted to determine which route is clinically more important. PATIENTS AND METHODS: According to a prospective design, bone marrow aspirates and axillary lymph nodes of level I (n = 1,590) from 150 node-negative patients with stage I or II breast cancer were analyzed immunocytochemically with monoclonal anticytokeratin (CK) antibodies. We investigated associations with prognostic factors and the effect of micrometastasis on patients’ prognosis. RESULTS: CK-positive cells in bone marrow aspirates were present in 44 (29%) of 150 breast cancer patients, whereas only 13 patients (9%) had such positive findings in lymph nodes; simultaneous microdissemination to bone marrow and lymph nodes was seen in merely two patients. No correlation of bone marrow micrometastases with other risk factors was assessed. Reduced 4-year distant disease-free and overall survival were each associated with a positive bone marrow finding (P = .032 and P = .014, respectively) but not with lymph node micrometastasis. Multivariate analysis revealed an independent prognostic effect of bone marrow micrometastasis on survival, with a hazards ratio of 6.1 (95% confidence interval, 1.2 to 31.3) for cancer-related death (P = .031) in our series. CONCLUSION: Immunocytochemical detection of micrometastatic cells in bone marrow but not in lymph nodes is an independent prognostic risk factor in node-negative breast cancer that may have implications for surgery and stratification into adjuvant therapy trials.
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Taffurelli, Mario. "Sentinel lymph node biopsy in breast cancer surgery." Reviews in Health Care 2, no. 2 (April 26, 2011): 101–12. http://dx.doi.org/10.7175/rhc.v2i2.26.
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Axillary lymph node status is one of the most reliable prognostic factors of long-term survival in breast cancer surgery. Metastatic involvement of the axillary lymph nodes is also crucial in the decision making of potentially useful adjuvant treatment. Until the last decade, Axillary Lymph Nodes Dissection (ALND) was performed in order to obtain the regional lymphatic system staging. In case of non-metastatic spread, that kind of surgery was limited only to this purpose; no further oncological benefits were obtained and the patients were exposed to several comorbidities affecting this type of surgery. Complications after ALND are reported in 15-30% of cases. They are well known and range from early bleeding, infection, symptomatic nerve damage, and longstanding limb lymph-edema with an incredible impairment of the quality of life.The Sentinel Lymph Node (SLN) theory holds that the SLNs are the first nodes draining lymph from an anatomic region (i.e. the breast) where metastatic disease will most likely to be found. If that node is found to be cancer free, the entire lymphatic system is likely to be cancer free; if it is metastatic, there is an elevated chance of finding more metastatic nodes. Thanks to the application of this hypothesis, several patients over the last 10-15 years have avoided unnecessary major demolitive surgery. To obtain accurate evaluation of the SLN a multidisciplinary dedicated team is necessary. This procedure has been internationally validated and the false negative rate is nowadays less than 5% when performed by expert hands. Dedicated breast surgeons working in a high-volume centres are necessary to reach satisfactory confidence in performing this very specialised procedure in order to obtain an accurate staging. The number of women presenting to the breast oncology units is continuously increasing and the implementation of screening programs has been crucial in detecting numerous patients (more than 75%) with early disease and non-metastatic axillary lymph nodes. The practice of the SLN is clearly able to offer those patients an accurate staging with low comorbidities, preserving their quality of life.
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Parasuraman, Madhivardhanam, Bhanumati Giridharan, and Vijaylakshmi. "Use of methylene blue for the detection of sentinel lymph node in breast cancer: a systematic review and meta-analysis." International Surgery Journal 5, no. 1 (December 26, 2017): 1. http://dx.doi.org/10.18203/2349-2902.isj20175879.
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Sentinel lymph node biopsy is the widely acceptable method for the examination of the breast cancer in the patients. This biopsy is considered as the best method for identifying the axillary involvement. Various dyes are used in this biopsy to find the sentinel lymph node. However, methylene blue dye (MBD) is considered to have a low risk of anaphylaxis, be cost effective and widely available.A systematic review and meta-analysis is performed on the utilisation of the methylene blue dye in the sentinel lymph node biopsy in the examination of breast cancer.Eight studies were appropriate for the inclusion criteria that were analysed systematically wherein meta- analysis is performed on studies which had ample data that comparatively analysed the efficiency of methylene blue. However, only two studies were selected for meta- analysis based on the availability of data.Systematic review reveals that methylene blue dye can be used as the best alternative when compared to other dyes in the detection of sentinel lymph node in the patients with breast cancer. However, the meta-analysis of two studies revealed no statistical significance defining the efficacy of methylene blue for sentinel lymph node detection.