Статті в журналах: "Non-sentinel lymph node"

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Picciotto, Franco, Gianluca Avallone, Federico Castellengo, Martina Merli, Virginia Caliendo, Rebecca Senetta, Adriana Lesca, et al. "Non-Sentinel Lymph Node Detection during Sentinel Lymph Node Biopsy in Not-Complete-Lymph-Node-Dissection Era: A New Technique for Better Staging and Treating Melanoma Patients." Journal of Clinical Medicine 10, no. 19 (September 23, 2021): 4319. http://dx.doi.org/10.3390/jcm10194319.

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Sentinel lymph node biopsy has been demonstrated to be an effective staging procedure since its introduction in 1992. The new American Joint Committee on Cancer (AJCC) classification did not consider the lack of information that would result from the less usage of the complete lymph node dissection as for a diagnostic purpose. Thus, this makes it difficult the correct staging and would leave about 20% of the further positive non-sentinel lymph nodes in the lymph node basin. In this paper, we aim to describe a new surgical technique that, combined with single-photon emission computed tomography-computed tomography (SPECT-CT), allows for better staging of melanoma patients. This is a prospective study that includes 104 patients with cutaneous melanoma. Sentinel lymph node biopsy was offered according to the AJCC guideline. Planar lymphoscintigraphy was performed in association with SPECT-CT, identifying and removing all non-biologically “excluded” lymph nodes, guiding the surgeon’s hand in detection and removal of lymph nodes. Even if identification and removal of non-sentinel lymph nodes is unable to increase overall survival, it definitely gives better disease control in the basin. With a “classic” setting, the risk of leaving further lymph nodes out of the sentinel lymph node procedure is around 20%, thus, basically, the surgical sentinel lymph node of first and second lymph nodes would have therapeutic value and complete lymph node dissection classically performed.

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Oliveira, Andrea Fernandes de, Ivan Dunshee de Abranches Oliveira Santos, Thaís Cardoso de Mello Tucunduva, Luciana Garbelini Sanches, Renato Santos Oliveira Filho, Mílvia Maria Simões e. Silva Enokihara, and Lydia Masako Ferreira. "Sentinel lymph node biopsy in cutaneous melanoma." Acta Cirurgica Brasileira 22, no. 5 (October 2007): 332–36. http://dx.doi.org/10.1590/s0102-86502007000500002.

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PURPOSE: To assess the importance of sentinel lymph node biopsy in patients with cutaneous melanoma. METHODS: Ninety consecutive non-randomized patients with stages I and II melanoma who underwent sentinel lymph node biopsy were followed up prospectively for six years. RESULTS: Patients were followed up for a mean period of 30 months. Their mean age was 53.3 years, ranging from 12 to 83 years. Thirty patients were male (37.5%) and 50, female (62.5%). Sentinel lymph node was positive in 32.5% and negative in 67.5%. It was found that the thicker the tumor, the greater the incidence of positive sentinel lymph nodes. In the group of patients with positive sentinel lymph nodes, recurrence occurred in 43.5%, but in those with negative sentinel lymph nodes, in only 7%, what points out to the association of tumor recurrence and positive sentinel lymph nodes. There were no major postoperative complications. CONCLUSION: Sentinel lymph node biopsy was demonstrated to be a safe method for selecting patients who need therapeutic lymphadenectomy.

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Santoro, Angela, Giuseppe Angelico, Frediano Inzani, Damiano Arciuolo, Saveria Spadola, Michele Valente, Nicoletta D’Alessandris, et al. "Standard ultrastaging compared to one-step nucleic acid amplification (OSNA) for the detection of sentinel lymph node metastases in early stage cervical cancer." International Journal of Gynecologic Cancer 30, no. 12 (October 30, 2020): 1871–77. http://dx.doi.org/10.1136/ijgc-2020-001710.

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ObjectiveWe compared ultrastaging and one-step nucleic acid amplification (OSNA) examination of sentinel lymph nodes in two homogeneous patient populations diagnosed with early stage cervical cancer. The primary aim of our study was to evaluate the rate and type of sentinel lymph node metastases detected by ultrastaging and OSNA assay. Secondary aims were to define the sensitivity and the negative predictive value of sentinel lymph node biopsy assessed with OSNA and ultrastaging and to define the role of sentinel lymph node assessment in predicting non-sentinel lymph node status.MethodsConsecutive patients who underwent surgery (radical hysterectomy or trachelectomy or cervical conization) at our institution, between January 2018 and March 2020, were enrolled. All patients had a preoperative diagnosis of early-stage cervical carcinoma (International Federation of Gynecology and Obstetrics (FIGO) 2018 stages IA–IIB) and underwent sentinel lymph node assessment with ultrastaging or OSNA. Patients with advanced FIGO stages and special histology subtypes (other than squamous cell carcinoma, adenocarcinoma or adenosquamous carcinoma) or patients with sentinel lymph nodes analyzed only with hematoxylin and eosin were excluded. Clinical data were compared using the χ2 test and Fisher’s exact test. A κ coefficient was determined with respect to lymph node assessment. A p value <0.05 was considered statistically significant.ResultsA total of 116 patients were included in this retrospective analysis (53 ultrastaging, 63 OSNA). Overall, 531 and 605 lymph nodes were removed in the ultrastaging and OSNA groups, respectively, and 140 and 129 sentinel lymph nodes were analyzed in the ultrastaging and OSNA groups, respectively. 22 patients had metastatic sentinel lymph nodes: 6 (11.3%) of 53 patients in the ultrastaging group and 16 (25.4%) of 63 patients in the OSNA group. The total amount of positive SLNs was 7 (5%) of 140 in the ultrastaging group and 21 (16.3%) of 129 in the OSNA group, respectively (p=0.0047). Pelvic lymphadenectomy was performed in 26 (49.1%) of 53 patients in the ultrastaging group and in 34 (54%) of 63 patients in the OSNA group due to comorbidities. Metastatic non-sentinel lymph nodes were found in 4 patients: 2 (7.7%) of 26 patients in the ultrastaging group and 2 (5.9%) of 34 patients in the OSNA group, respectively. The total amount of positive pelvic lymph nodes was 3 (0.6%) of 531 in the ultrastaging group and 4 (0.7%) of 605 in the OSNA group (p=0.61). In the OSNA group, only 2 patients with negative sentinel lymph nodes had metastatic disease in the pelvic lymph nodes. By contrast, no patients with OSNA-positive sentinel lymph nodes had metastases in the pelvic lymph nodes. In the ultrastaging group, all patients with negative sentinel lymph nodes did not have metastatic disease in other pelvic lymph nodes.ConclusionsOSNA assessment of sentinel lymph nodes was associated with a negative predictive value of 91% but poor reliability in detecting node metastases in non-sentinel pelvic lymph nodes. Of note, the ultrastaging protocol revealed higher sensitivity and more reliability in predicting pelvic non-sentinel lymph node status.

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Wong, Willard, Illana Rubenchik, Sharon Nofech-Mozes, Elzbieta Slodkowska, Carlos Parra-Herran, Wedad M. Hanna, and Fang-I. Lu. "Intraoperative Assessment of Sentinel Lymph Nodes in Breast Cancer Patients Post-Neoadjuvant Therapy." Technology in Cancer Research & Treatment 18 (January 1, 2019): 153303381882110. http://dx.doi.org/10.1177/1533033818821104.

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Background: Shift toward minimizing axillary lymph node dissection in patients with breast cancer post neoadjuvant therapy has led to the assessment of sentinel lymph nodes by frozen section intraoperatively to determine the need for axillary lymph node dissection. However, few studies have examined the accuracy of sentinel lymph node frozen section after neoadjuvant therapy. Our objective is to compare the accuracy of sentinel lymph node frozen section in patients with breast cancer with and without neoadjuvant therapy and to identify features that may influence accuracy. Design: We identified 161 sentinel lymph node frozen section from 77 neoadjuvant therapy patients and 255 sentinel lymph node frozen section from 88 non-neoadjuvant therapy patients diagnosed between 2010 and 2016 in 2 institutions. The frozen section diagnoses were compared to the final diagnoses, and clinicopathologic data were analyzed. Results: The sensitivity, specificity, and accuracy of frozen section analysis were comparable between neoadjuvant therapy patients and non-neoadjuvant therapy patients (71.9% vs 50%, 100% vs 100%, and 88.3% vs 81.8%). Nine (11.7%) of 77 neoadjuvant therapy patients had discordant results, most often due to undersampling (tumor absent on frozen section slide). Four of these patients subsequently underwent axillary lymph node dissection. Discordant results (all false negatives) were significantly more likely in neoadjuvant therapy patients with Estrogen Receptor-positive/HER2-negative status, and in sentinel lymph node with pN1mic and pN0i+ deposits; age, preneoadjuvant therapy lymph node status, histotype, nuclear grade, tumor size, and response to neoadjuvant therapy showed no significant differences. For non-neoadjuvant therapy cases, large tumor size, lobular histotype, and sentinel lymph node with pN1mic and pN0i+ were associated with false-negative frozen section assessment. Conclusion: Sentinel lymph node frozen section diagnosis post-neoadjuvant therapy has comparable sensitivity, specificity, and accuracy to the sentinel lymph node frozen section diagnosis in the non-neoadjuvant therapy setting.

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Maguire, Aoife, and Edi Brogi. "Sentinel Lymph Nodes for Breast Carcinoma: A Paradigm Shift." Archives of Pathology & Laboratory Medicine 140, no. 8 (August 1, 2016): 791–98. http://dx.doi.org/10.5858/arpa.2015-0140-ra.

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Context.—Sentinel lymph node biopsy has been established as the new standard of care for axillary staging in most patients with invasive breast carcinoma. Historically, all patients with a positive sentinel lymph node biopsy result underwent axillary lymph node dissection. Recent trials show that axillary lymph node dissection can be safely omitted in women with clinically node negative, T1 or T2 invasive breast cancer treated with breast-conserving surgery and whole-breast radiotherapy. This change in practice also has implications on the pathologic examination and reporting of sentinel lymph nodes.Objective.—To review recent clinical and pathologic studies of sentinel lymph nodes and explore how these findings influence the pathologic evaluation of sentinel lymph nodes.Data Sources.—Sources were published articles from peer-reviewed journals in PubMed (US National Library of Medicine) and published guidelines from the American Joint Committee on Cancer, the Union for International Cancer Control, the American Society of Clinical Oncology, and the National Comprehensive Cancer Network.Conclusions.—The main goal of sentinel lymph node examination should be to detect all macrometastases (>2 mm). Grossly sectioning sentinel lymph nodes at 2-mm intervals and evaluation of one hematoxylin-eosin–stained section from each block is the preferred method of pathologic evaluation. Axillary lymph node dissection can be safely omitted in clinically node-negative patients with negative sentinel lymph nodes, as well as in a selected group of patients with limited sentinel lymph node involvement. The pathologic features of the primary carcinoma and its sentinel lymph node metastases contribute to estimate the extent of non–sentinel lymph node involvement. This information is important to decide on further axillary treatment.

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Cecchi, Roberto, Cataldo De Gaudio, Lauro Buralli, and Stefania Innocenti. "Lymphatic Mapping and Sentinel Lymph Node Biopsy in the Management of Primary Cutaneous Melanoma: Report of a Single-centre Experience." Tumori Journal 92, no. 2 (March 2006): 113–17. http://dx.doi.org/10.1177/030089160609200205.

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Aims and Background Lymphatic mapping and sentinel lymph node biopsy provide important prognostic data in patients with early stage melanoma and are crucial in guiding the management of the tumor. We report our experience with lymphatic mapping and sentinel lymph node biopsy in a group of patients with primary cutaneous melanoma and discuss recent concepts and controversies on its use. Patients and Methods A total of 111 patients with stage I-II AJCC primary cutaneous melanoma underwent lymphatic mapping and sentinel lymph node biopsy from December 1999 through December 2004 using a standardized technique of preoperative lymphoscintigraphy and biopsy guided by blue dye injection in addition to a hand-held gamma probe. After removal, sentinel lymph nodes were submitted to serial sectioning and permanent preparations for histological and immunohistochemical examination. Complete lymph node dissection was performed only in patients with tumor-positive sentinel lymph nodes. Results Sentinel lymph nodes were identified and removed in all patients (detection rate of 100%), and metastases were found in 17 cases (15.3%). The incidence of metastasis in sentinel lymph nodes was 2.1%, 15.9%, 35.2%, and 41.6% for melanomas < or 1.0, 1.01-2.0, 2.01-4.0, and > 4.0 mm in thickness, respectively. Complete lymph node dissection was performed in 15 of 17 patients with positive sentinel lymph nodes, and metastases in non-sentinel lymph nodes were detected in only 2 cases (11.7%). Recurrences were more frequently observed in patients with a positive than in those with negative sentinel lymph node (41.1% vs 5.3% at a median follow-up of 31.5 months, P<0.001). The false-negative rate was 2.1%. Conclusions Our study confirms that lymphatic mapping and sentinel lymph node biopsy allow accurate staging and yield relevant prognostic information in patients with early stage melanoma.

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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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Choi, Hee Jun, Jai Min Ryu, Byung Joo Chae, Seok Jin Nam, Jonghan Yu, Se Kyung Lee, Jeong Eon Lee, and Seok Won Kim. "Is Sentinel Lymph Node Biopsy for Breast Cancer with Cytology-Proven Axillary Metastasis Safe? A Prospective Single-Arm Study." Journal of Clinical Medicine 10, no. 20 (October 16, 2021): 4754. http://dx.doi.org/10.3390/jcm10204754.

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The purpose of this study was to evaluate pathologic lymph node metastasis in breast cancer with cytology-proven axillary metastasis. This study was designed prospectively. We performed axillary lymph node dissections (ALND) after lymphatic mapping by near-infrared (NIR) fluorescence imaging with Indocyanine Green (ICG). We evaluated 72 breast cancer patients with cytology-proven axillary metastasis by curative surgery at the Samsung Medical Center between May of 2016 and December of 2017. Among the 72 patients with cytology-proven axillary metastasis, 14 of 39 patients (35.9%) with one or two sentinel lymph nodes containing metastases were metastasized to post-sentinel lymph node. Thirteen of fourteen patients had additional non-sentinel lymph node metastases, seven of thirteen patients also had additional level II lymph node metastases, and one patient had only one additional level II lymph node metastasis. Of T1 or T2 stage patients, 10 of 33 patients (30.3%) with one or two sentinel lymph nodes containing metastases were metastasized to post-sentinel lymph node. Even in patients without SLN metastasis, 50% of the patients had at least three LN metastases, and 40% in the T1 or T2 stage patients. Sentinel lymph node biopsy without ALND might be not safe for patients with cytology-proven axillary metastasis.

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Tominaga, Shusei. "Prediction of the non-sentinel node metastasis in patients without clinically axillary lymph node metastasis, with implication of breast cancer subtypes." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): e13060-e13060. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e13060.

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e13060 Background: The accuracy of the nomogram about non-sentinel lymph node metastasis (NSLNM ) in breast cancer patients is still controversial to avoid axillary dissection particularly sentinel lymph node biopsy was positive. The aim of this study was to evaluate the necessity of adding breast cancer subtypes to the NSLNM nomgram variables. Methods: Between 2009 and 2011, consecutive breast cancer patients without clinically axillary lymph node metastasis (n=140) who received sentinel lymph node biopsy at Higashiosaka General Hospital were studied retrospectively. Twenty-two patients were turned out that breast cancer already spread to the sentinel nodes and all of 22 patients received complete axillary lymph node dissection. Results: Twelve patients had only sentinel lymph node metastases(Group S), 10 patients had non-SLN metastases (Group A). Patient characteristics and average probability of spread to additional lymph node developed by Memorial Sloan-Kettering Cancer Center (MSKCC) Nomogram were almost the same results in both groups. However, subtypes of Group S consisted of 8 HER2 positive , 2 triple negative, and 2 luminal A cases, subtypes of Group A consisted of 4 luminal A and 6 luminal B cases. Conclusions: Our data suggested that luminal type breast cancer tends to spread to non-sentinel lymph node metastasis and adding HER2, Ki-67, and intrinsic biological subtypes may improve predictivity of MSKCC nomogram.

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Wang, Xuefei, Guochao Zhang, Zhichao Zuo, Qingli Zhu, Shafei Wu, Yidong Zhou, Feng Mao, et al. "Sentinel Lymph Node Positive Rate Predicts Non-Sentinel Lymph Node Metastasis in Breast Cancer." Journal of Surgical Research 271 (March 2022): 59–66. http://dx.doi.org/10.1016/j.jss.2021.09.039.

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Cserni, Gábor, Rita Bori, István Sejben, Gábor Boross, Róbert Maráz, Mihály Svébis, Mária Rajtár, Eliza Tekle Wolde, and Éva Ambrózay. "Analysis of predictive tools for further axillary involvement in patients with sentinel lymph node positive small (≤15 mm) invasive breast cancer." Orvosi Hetilap 150, no. 48 (November 2009): 2182–88. http://dx.doi.org/10.1556/oh.2009.28699.

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Small breast cancers often require different treatment than larger ones. The frequency and predictability of further nodal involvement was evaluated in patients with positive sentinel lymph nodes and breast cancers ≤15 mm by means of 8 different predictive tools. Of 506 patients with such small tumors 138 with positive sentinel nodes underwent axillary dissection and 39 of these had non-sentinel node involvement too. The Stanford nomogram and the micrometastatic nomogram were the predictive tools identifying a small group of patients with low probability of further axillary involvement that might not require completion axillary lymph node dissection. Our data also suggest that the Tenon score can separate subsets of patients with a low and a higher risk of non-sentinel node metastasis. Predictive tools based on multivariate models can help in omitting completion axillary dissection in patients with low risk of non-sentinel lymph node metastasis based on their small tumor size.

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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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GRUBER, INES, MAJA HENZEL, BIRGITT SCHÖNFISCH, ANNETTE STÄBLER, FLORIN-ANDREI TARAN, MARKUS HAHN, CARMEN RÖHM, et al. "Prediction of Non-sentinel Lymph Node Metastases After Positive Sentinel Lymph Nodes Using Nomograms." Anticancer Research 38, no. 7 (July 2018): 4047–56. http://dx.doi.org/10.21873/anticanres.12694.

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Ellsworth, D. L., R. E. Ellsworth, T. E. Becker, B. Deyarmin, H. L. Patney, J. A. Hooke, and C. D. Shriver. "Genomic heritage of sentinel lymph node metastases: Implications for clinical management of breast cancer patients." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 571. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.571.

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571 Background: Sentinel lymph node (SLN) biopsy status is a key prognostic factor for breast cancer patients. Sentinel nodes are believed to receive early disseminating cells from the primary tumor, but little is known about the origin of metastases colonizing the sentinel nodes. We used allelic imbalance (AI) to examine genomic relationships among metastases in the sentinel and non-sentinel axillary lymph nodes from complete axillary dissections in 15 patients with lymph node positive breast cancer. Methods: Sentinel nodes were localized by standard scintigraphic and gamma probe techniques using 1.0 mCi technetium-99m sulfur colloid. Pathologically positive nodes were identified by H&E histology and immunohistochemistry. Primary breast tumors and metastases in sentinel and axillary nodes were isolated by laser microdissection. AI was assessed at 26 chromosomal regions and used to examine the timing and molecular mechanisms of metastatic spread to the sentinel and axillary nodes. Results: Overall AI frequencies were significantly higher (p<0.05) in primary breast tumors compared to lymph node metastases. A high level of discordance was observed in patterns and frequencies of AI events between metastases in the sentinel and non-sentinel axillary nodes. Phylogenetic analyses showed that 1) multiple genetically-divergent lineages of metastatic cells independently colonize the lymph nodes; 2) some lymph node metastases appeared to acquire metastatic potential early in tumorigenesis, while other metastases evolved later; and 3) importantly, lineages colonizing the sentinel nodes appeared to originate at different times and to progress by different molecular mechanisms. Conclusions: Genomic diversity and timing of metastatic nodal spread may be important factors in determining outcomes of breast cancer patients. Metastases colonizing the sentinel nodes appear to arise at different times during disease progression and may not be descendants of progenitor cells that colonize the lymph nodes early in tumorigenesis. Metastatic growth in the sentinel nodes thus may be a consequence of stimulating factors from the primary tumor that affect proliferation of previously disseminated cells rather than the timing of metastatic spread. No significant financial relationships to disclose.

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Gutierrez, Jessica, Daniel Dunn, Margit Bretzke, Eric Johnson, John O'Leary, Diane Stoller, Sally Fraki, Leslie Diaz, and Tamera Lillemoe. "Pathologic Evaluation of Axillary Dissection Specimens Following Unexpected Identification of Tumor Within Sentinel Lymph Nodes." Archives of Pathology & Laboratory Medicine 135, no. 1 (January 1, 2011): 131–34. http://dx.doi.org/10.5858/2009-0694-oar.1.

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Abstract Context—Axillary lymph node dissection has been the standard of care after identification of a positive sentinel lymph node for breast cancer patients. Objective—To determine the likelihood of non–sentinel lymph node involvement for patients with negative sentinel node by frozen section, who are subsequently found to have tumor cells in the sentinel node by permanent section levels and/or cytokeratin immunohistochemistry. Design—One hundred three patients with invasive breast cancer exhibiting negative frozen section evaluation of their sentinel node, but later found to have isolated tumor cells (n = 46), micrometastasis (n = 46), or metastases (n = 11) in their sentinel node by permanent sections or immunohistochemistry, were enrolled in this prospective cohort study and underwent completion axillary dissection. Results—Six of 46 patients (13%) with isolated tumor cells in their sentinel node, 15 of 46 patients (33%) with micrometastasis in their sentinel node, and 2 of 11 patients (18%) with metastasis in their sentinel node had additional findings in the nonsentinel nodes. These findings resulted in a pathologic stage change in 2 patients. Predictors of positive nonsentinel nodes were 2 or more positive sentinel nodes (P = .002), sentinel nodes with micrometastasis versus isolated tumor cells (P = .03), and those with angiolymphatic invasion (P = .04). Conclusions—Our findings lend support to axillary node dissection for patients with micrometastasis or metastasis in their sentinel nodes. However, studies with clinical follow-up are needed to determine whether axillary node dissection is necessary for patients with isolated tumor cells in sentinel nodes.

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Somashekhar, S. P., and Amit Rauthan. "Validation of MSKCC nomogram for prediction of metastasis to nonsentinel lymph nodes in carcinoma breast in Indian patients." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): e11510-e11510. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.e11510.

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e11510 Background: Sentinel node biopsy has emerged as the standard of care in clinically node negative breast cancer (cT1,T2 N0). In cases where sentinel node is negative, ALND can be avoided. In nearly 30-50% cases, the sentinel lymph nodes is the only site of metastases, demonstrated in Indian population too. In ASCOG ZOO11 trial, patients who had metastases in sentinel node did not undergo ALND. Patients in the trial received radiation as part of breast conservation surgery. In Indian patients, this is not applicable as most of the patients undergo mastectomy. It would be highly beneficial to identify the subset of patients, where the sentinel node is the only site of metastasis. Various nomograms have been used to predict the risk of metastasis in non sentinel nodes. MSKCC nomogram has been validated in many studies in the USA and Netherlands. Methods: The records of 240 breast cancer patients between 2007 and 2011 who underwent SLN and / or ALND were selected. Serial hemotoxylin and eosin (HE) analysis and immunohistochemistry were routinely performed on each sentinel node. Various factors like T size, histology and grade, lymphovascular invasion, number of +ve and –ve sentinel nodes, hormonal status, multifocality were recorded. Risk of non sentinel node metastasis were calculated by nomogram. Results: 63 out of 240 patients had sentinel node positivity and underwent ALND 20 out of 63(31%) had metastasis in non sentinel nodes also. Mean predictive risk as per nomogram for SLN was 53% and non SLN mets was 68%. None of our patients had low risk of non sentinel node metastasis as per MSKCC nomogram. Conclusions: MSKCC nomogram is not validated for Indian Breast Cancer patients, in our study population as it could not differentiate between patients having metastasis in sentinel node only from those having non sentinel node metastasis based on risk stratification. Because in India, the mean Tumour (T) size is big and Grade is usually high grade and one of the reason the present MSKCC nomogram is not applicable to Indian Breast cancer patients. In Indian populations, a different nomogram is required to correctly predict the non sentinel node metastasis.

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Kim, W., W. G. Kim, and J. Lee. "Metastasis in non-sentinel lymph node correlates with ALDH-1 expression in sentinel lymph node." Breast 32 (March 2017): S41. http://dx.doi.org/10.1016/s0960-9776(17)30155-8.

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Touil, Leila L., and Richard K. Johnson. "Predicting non-sentinel lymph node metastases following positive sentinel lymph node biopsy in our unit." European Journal of Surgical Oncology (EJSO) 38, no. 5 (May 2012): 450. http://dx.doi.org/10.1016/j.ejso.2012.02.149.

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Uemoto, Yasuaki, Naoto Kondo, Yumi Wanifuchi-Endo, Tomoko Asano, Tomoka Hisada, Sayaka Nishikawa, Yusuke Katagiri, et al. "Sentinel lymph node biopsy may be unnecessary for ductal carcinoma in situ of the breast that is small and diagnosed by preoperative biopsy." Japanese Journal of Clinical Oncology 50, no. 12 (August 28, 2020): 1364–69. http://dx.doi.org/10.1093/jjco/hyaa151.

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Abstract Background Current guidelines do not recommend that sentinel lymph node biopsy is routinely performed for ductal carcinoma in situ; thus, indications for sentinel lymph node biopsy in patients with ductal carcinoma in situ remain controversial. In this study, we investigated whether sentinel lymph node biopsy can be safely omitted when ductal carcinoma in situ has been diagnosed by preoperative biopsy. Methods We retrospectively analysed sentinel lymph node metastasis rates and upstaging to invasive cancer in surgical specimens, performed receiver operating characteristic analysis for ductal carcinoma in situ lesion size and assessed correlations with preoperative clinicopathological factors of 277 patients with ductal carcinoma in situ diagnosed by preoperative biopsy at our institution. Results Among 277 patients with sentinel lymph node biopsy, six (2.2%) had sentinel lymph node metastasis. All six were upstaged to invasive cancer by pathological examination of surgical specimens. In total, 69 patients (24.9%) were upstaged to invasive cancer. The mean size of ductal carcinoma in situ lesions on preoperative imaging was significantly larger for the 69 upstaged patients (50.0 mm) than for the non-upstaged patients (34.4 mm; P < 0.0001). Of the 277 patients with sentinel lymph node biopsy, 117 (42.2%) had preoperative ductal carcinoma in situ lesions <31.8 mm, which was identified as the optimal cut-off size by receiver operating characteristic analysis. Of these 117 patients, 96 (82.1%, 95% confidence interval: 73.9–88.5%) could be safely omitted from sentinel lymph node biopsy because all of them remained as ductal carcinoma in situ and had negative sentinel lymph nodes at surgery. Conclusions Size of ductal carcinoma in situ lesions on preoperative diagnostic imaging is a predictor of diagnosis of invasive cancer on pathological examination of surgical specimens. Sentinel lymph node biopsy may be unnecessary in ductal carcinoma in situ diagnosed by preoperative biopsy in patients with small lesions.

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Guo, Ruby, Case E. Brabham, Kelly Fahrner-Scott, Mary Kathryn Abel, Jasmine Wong, Michael Alvarado, Laura Esserman, Cheryl Ann Ewing, and Rita A. Mukhtar. "Accuracy of sentinel lymph node biopsy in invasive lobular carcinoma of the breast." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e12604-e12604. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e12604.

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e12604 Background: The safety of the sentinel lymph node biopsy procedure (SLNB) in the surgical management of breast cancer relies upon a false negative rate (FNR) being less than 10%. The accuracy of SLNB in invasive lobular carcinoma (ILC), the second most common type of breast cancer, has not been evaluated. Because of high rates of false negative imaging and the diffuse growth pattern in ILC, less accurate pre-operative staging and a potentially unreliable lymphatic drainage pattern may impact the accuracy of SLNB in this tumor type. We therefore sought to characterize the accuracy of SLNB in a cohort of patients with ILC. Methods: We queried an institutional database of 707 patients with ILC and identified 196 patients who underwent SLN mapping with excision of both sentinel and non-sentinel nodes. A false negative was defined as having negative sentinel lymph nodes and a positive non-sentinel node. We calculated the FNR and sensitivity of SLNB and evaluated clinicopathologic variables. Results: Of 196 cases, 183 were clinically node-negative, 9 were clinically node-positive, and 4 had unknown clinical node status. Of the 183 clinically node-negative patients, 69 (37.7%) patients had node-positive disease at surgery. Overall, 7 of 196 cases had false negative SLNB, yielding an FNR of 8.97%. The sensitivity of SLNB was 91%. Patients with a false negative SLNB were significantly older than patients without (mean age 63 versus 54.7 years, p = 0.041). Significantly fewer sentinel and non-sentinel nodes were removed in women aged 50 years or older compared to those under 50 (1.9 vs. 2.5 sentinel nodes, p = 0.0158; 4.7 vs. 7.9 non-sentinel nodes, p = 0.0077). There were no differences in tumor receptor subtype, grade, stage, presence of lymphovascular invasion, or receipt of neoadjuvant therapy in those with a false negative SLNB compared to those without. Conclusions: The high rate of nodal positivity in clinically node negative patients highlights the challenges of clinical nodal assessment in ILC. Despite this, the SLNB procedure had a FNR that fell within the acceptable range, supporting its use in ILC. The relationship between number of sentinel nodes removed and FNR deserves further study, particularly in older women where extent of nodal surgery continues to decline.

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Sanders, Melissa M., Shamaela Waheed, Sanjay Joshi, Caroline Pogson, and Stephen R. Ebbs. "The importance of pre-operative axillary ultrasound and intra-operative sentinel lymph node frozen section analysis in patients with early breast cancer – a 3-year study." Annals of The Royal College of Surgeons of England 93, no. 2 (March 2011): 103–5. http://dx.doi.org/10.1308/003588411x12851639108196.

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INTRODUCTION To ensure appropriate axillary surgery is performed at a single operation, we have sought to identify patients with involved nodes who might progress directly to axillary dissection. PATIENTS AND METHODS We evaluated pre-operative ultrasound of the axilla and intra-operative frozen section of sentinel lymph nodes over a 3-year period. Patients with clinical early breast cancer underwent axillary ultrasound. Abnormal nodes were defined as a cortex > 2.5 mm, loss of high echogenic medulla, and morphological changes. Any axilla containing a lymph node considered abnormal had ultrasound-directed fine needle aspiration (FNA) performed. Patients with positive cytology proceeded directly to axillary dissection. Patients with negative cytology and those with normal ultrasound proceeded to sentinel four-node biopsy using Patent Blue dye alone. A single sentinel node was evaluated by intra-operative frozen section. RESULTS A total of 311 patients underwent pre-operative ultrasound successfully, identifying 115 (77%) patients of the total 150 who were found to have positive lymph nodes. Overall, 196 patients underwent sentinel lymph node biopsy analysis intra-operatively. Of the 11 false negative cases in which the lymph node was found to be positive postoperatively, eight cases showed the single tested sentinel node contained cancer that was recognised on postoperative staining but not frozen section. In six, the deposit in the sentinel node was a micrometastasis. Three cases were found to contain cancer in the ‘non-sentinel' node; in all, this was micrometastatic disease. CONCLUSIONS This study confirms the value of pre-operative ultrasound and intra-operative frozen section examination of axillary nodes. Only 3.5% of patients required two operations.

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DE AGUIAR, PAULO HENRIQUE WALTER, RANNIERE GURGEL FURTADO DE AQUINO, MAYARA MAIA ALVES, JULIO MARCUS SOUSA CORREIA, AYANE LAYNE DE SOUSA OLIVEIRA, ANTÔNIO BRAZIL VIANA JÚNIOR, and LUIZ GONZAGA PORTO PINHEIRO. "Identification of the sentinel lymph node using hemosiderin in locally advanced breast cancer." Revista do Colégio Brasileiro de Cirurgiões 44, no. 6 (December 2017): 612–18. http://dx.doi.org/10.1590/0100-69912017006013.

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ABSTRACT Objective: to verify the agreement rate in the identification of sentinel lymph node using an autologous marker rich in hemosiderin and 99 Technetium (Tc99) in patients with locally advanced breast cancer. Methods: clinical trial phase 1, prospective, non-randomized, of 18 patients with breast cancer and clinically negative axilla stages T2=4cm, T3 and T4. Patients were submitted to sub-areolar injection of hemosiderin 48 hours prior to sentinel biopsy surgery, and the identification rate was compared at intraoperative period to the gold standard marker Tc99. Agreement between methods was determined by Kappa index. Results: identification rate of sentinel lymph node was 88.9%, with a medium of two sentinel lymph nodes per patients. The study identified sentinel lymph nodes stained by hemosiderin in 83.3% patients (n=15), and, compared to Tc99 identification, the agreement rate was 94.4%. Conclusion: autologous marker rich in hemosiderin was effective to identify sentinel lymph nodes in locally advanced breast cancer patients.

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Georgescu, Rareş, Orsolya Bauer, Marius Coroş, Rareş Barbat, Daniela Podeanu, Adela Oprea, Andreea Păscutoi, Adrian Naznean, and Simona Stolnicu. "Study on the Efficacy of Sentinel Lymph Node Identification by Radionuclide Method (Tc 99) Versus Combined Method (Radionuclide and Vital Stain) in the Staging of Breast Carcinoma." Journal of Interdisciplinary Medicine 1, no. 2 (September 1, 2016): 168–72. http://dx.doi.org/10.1515/jim-2016-0035.

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Abstract Introduction: Sentinel node biopsy is the gold standard for axillary assessment of patients with breast cancer without axillary metastases on clinical and radiological examination. Internationally accepted biopsy methods currently use a radioactive tracer (Te) or different variations of vital stain, or the combination of the two. Due to the high cost of technical and organizational difficulty related to the radioactive material, as well as the disadvantages of using the vital stain method, great effort is being made to find alternative solutions. The aim of this study was to determine the effectiveness of the exclusive use of vital stain versus the radioactive isotope, and the need to use the combined method. A second goal was the comparative analysis of the radioactive method and intraoperative assessment of suspicious (non-sentinel) lymph nodes. Materials and methods: This article is based on a prospective nonrandomized study conducted on 69 patients with early breast cancer in whom the combined method was used (injection of radionuclide and methylene blue vital stain). The comparatively monitored parameters were the following: the total and mean number of excised sentinel lymph nodes, the number of metastatic ganglia revealed by the 2 methods, and the risk of understaging in case only one technique was used. Results: We excised 153 sentinel nodes identified by the radioisotope method. Of these only 56 were stained with methylene blue (p <0.0001). We could also identify a significantly higher number of metastatic nodes with the aid of the radioactive method (p = 0.0049). Most importantly, a significant number of patients (57.14%) who would have been declared node-negative using vital staining could only be properly staged using the radionuclide or the combined method. On microscopic examination of 35 non-sentinel lymph nodes, we found 3 lymph nodes with metastases, and in 1 case the metastases were found only in the non-sentinel lymph node. Conclusions: Given the risk of understaging, exclusive use of the vital stain method is not recommended, especially under the ASGO Z 00011 Protocol, since the more accurate determination of the number of metastatic sentinel lymph nodes in a patient influences the decision whether to perform lymphadenectomy or not. Using the combined method confers benefits only during the learning curve, in our database we found no stained nodes which were not radioactive. It is very important that the intraoperative stage uses the radioactive method and the intraoperative assessment of suspicious lymph nodes, because 35 non-sentinel lymph nodes were identified in our study, 3 of which had metastases, while in 1 case the metastases were in the non-sentinel lymph node.

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Kim, Hye Jung, Jin Hyang Jung, Ho Yong Park, and Ji-young Park. "Concordance of preoperative US-guided tattooing of axillary lymph nodes to sentinel lymph nodes and comparison of their pathologic results according to imaging modalities in breast cancer patients." Journal of Clinical Oncology 33, no. 28_suppl (October 1, 2015): 28. http://dx.doi.org/10.1200/jco.2015.33.28_suppl.28.

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28 Background: We wanted to know the concordance of preoperative ultrasound (US)-guided tattooing of axillary lymph nodes (ALNs) to sentinel lymph node and to correlate MR and PET-CT findings with the final histologic results. Methods: Axillary US examination was performed for all breast cancer patients before sentinel lymph node biopsy. The detected lymph nodes in US were classified as negative (group I, enlarged but image-benign) or positive (group II, image-suspicious) finding for metastases based on US, MRI and PET-CT findings. US-guided tattooing for ALNs was performed preoperatively by injection of 3cc of activated charcoal into the cortex of lymph node and the adjacent soft tissue. We evaluated their concordance to sentinel lymph node and correlated the histologic results of US tattooed LN according to each imaging modality. Results: Forty ALNs were tattooed and sentinel nodes corresponded to tattooed nodes in all except one patient with a tattooed non-sentinel node. Ten in group I and 30 in group II on US, 18 in group I and 22 in group II on MR, and 19 in group I and 21 in group II on PET-CT. Eight cases had evidence of metastases in final histology, 2 (20.0%) in group I and 6 (20.0%) in group II on US, 4 (22.2%) in group I and 4 (18.1%) in group II on MR, and 6 (31.6%) in group I and 2 ( 9.5%) in group II on PET-CT. Conclusions: US-guided tattooing is a feasible method for marking ALNs. In addition, tattooed lymph nodes correlate well with sentinel nodes, which may obviate the need for additional localization for axillary staging.

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Cornwell, Laura B., Kelly M. Mcmasters, and Anees B. Chagpar. "The Impact of Lymphovascular Invasion on Lymph Node Status in Patients with Breast Cancer." American Surgeon 77, no. 7 (July 2011): 874–77. http://dx.doi.org/10.1177/000313481107700722.

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Lymphovascular invasion (LVI) is not uniformly found or reported in breast cancer tumor reports. We sought to determine the impact of the finding of LVI on various parameters of lymph node status in patients with breast cancer. A chart review was performed of 400 node-positive patients from a cohort of patients in a prospective multicenter national sentinel node registry. The finding of LVI was then correlated to number of positive sentinel nodes, the number of positive non-sentinel nodes, the lymph node ratio, and the size of the largest metastatic deposit. Of the 400 patients, data regarding LVI were missing in 98 (24.5%) cases. Although all of these patients were node-positive, LVI was noted to be present in 155 patients (38.8%) and absent in 147 (36.8%). LVI was found to correlate with more positive sentinel nodes (mean, 1.72 vs 1.35; P < 0.001), more positive nonsentinel nodes (mean, 2.16 vs 0.54; P < 0.001), and a higher lymph node ratio (0.29 vs 0.16; P < 0.001). LVI also correlated with size of largest metastatic deposit ( P = 0.002). Although LVI is known to be associated with lymph node status, it is not frequently noted on pathology reports. Given its prognostic value, LVI should be carefully evaluated and reported.

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Postacı, Hakan, Baha Zengel, Ulkem Yararbas, Adam Uslu, Nukhet Eliyatkin, Goksever Akpinar, Fevzi Cengiz, and Raika Durusoy. "Sentinel Lymph Node Biopsy in Breast Cancer: Predictors of Axillary and Non-Sentinel Lymph Node Involvement." Balkan Medical Journal 30, no. 4 (December 30, 2013): 415–21. http://dx.doi.org/10.5152/balkanmedj.2013.9591.

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Jinno, H., T. Onishi, M. Takahashi, M. Sakata, Y. Kitagawa, N. Kitamura, T. Nakahara, and M. Mukai. "Non-sentinel lymph node status and prognosis of the breast cancer patients with micrometastatic sentinel lymph nodes." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e11504-e11504. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e11504.

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e11504 Background: Sentinel lymph node biopsy (SLNB) has become a standard therapy for clinically node-negative breast cancer patients and improvements of histopathological and molecular analysis of sentinel lymph node (SLN) have increased the rate of micrometastases identified. However it remains controversial whether to perform axillary lymph node dissection (ALND) for patients with micrometastases in SLNs and their prognostic significance is also a matter of debate. The purpose of this study is to determine the non- sentinel lymph node (NSLN) status and prognosis of the patients with micrometastatic SLNs. Methods: A prospective database of 666 breast cancer patients with the tumor size less than 3cm and clinical negative node, who underwent SLNB from January 2002 to July 2007 at Keio University Hospital was analyzed. SLNs were detected using a combined method of isosulfun blue dye and small-sized technetium-99m-labeled tin colloid. SLNs were diagnosed with standard hematoxylin and eosin (HE) staining and immunohistochemical (IHC) analysis. Results: Micrometastases in SLNs were found in 50 (7.5%) of 666 patients. Twenty nine (58.0%) of 50 patients with micrometastatic SLNs underwent ALND and revealed no NSLN metastasis. Among 21 (42.0%) patients with micrometastatic SLNs who skipped ALND, no axillary lymph node recurrence has been observed in the median follow-up time of 43 months, although 20 patients (95.2%) in 21 patients received adjuvant systemic therapy. There is no significant difference in recurrence free survival between the patients with micrometastatic and negative SLNs (98.0% vs. 95.7%, respectively). Conclusions: These date suggested that it may not be necessary to perform ALND for the patients with micrometastases in SLNs and the presence of micrometastases in SLNs may not be associated with prognosis. No significant financial relationships to disclose.

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Mir, Maria Carmen, Olivia Herdiman, Damien M. Bolton, and Nathan Lawrentschuk. "The Role of Lymph Node Fine-Needle Aspiration in Penile Cancer in the Sentinel Node Era." Advances in Urology 2011 (2011): 1–3. http://dx.doi.org/10.1155/2011/383571.

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Penile squamous cell carcinoma (SCC) is an uncommon condition in Western countries. Inguinal lymph nodes dissection can be curative in 20%–60% of node positive patients. However, there is a high complication rates from the dissection, thus accurate diagnosis of inguinal lymph nodes metastasis is required. Current non invasive methods to detect lymph nodes metastasis are unreliable. Dynamic Sentinel Node Biopsy (DNSB), ultrasonography (US), and fine needle aspiration (FNA) cytology were proposed to in an attempt to detect sentinel lymph node (SLN). Despite the initial high rate of false negative results, recent DSNB showed improved survival compared to wait and see policy as well as reduced mortality compared to prophylactic inguinal lymphadenectomy. In addition, the US guided FNA shown 100% of specificity in detecting clinically occult lymph nodes metastasis. We proposed an algorithm for management of lymph nodes in penile cancer and suggest that FNA with US guidance should be performed in all high risk patients and that therapeutic dissection should be performed if findings are positive.

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Monterossi, Giorgia, Danilo Buca, Giorgia Dinoi, Eleonora La Fera, Gian Franco Zannoni, Saveria Spadola, Giovanni Scambia, and Francesco Fanfani. "Intra-operative assessment of sentinel lymph node status by one-step nucleic acid amplification assay (OSNA) in early endometrial cancer: a prospective study." International Journal of Gynecologic Cancer 29, no. 6 (June 6, 2019): 1016–20. http://dx.doi.org/10.1136/ijgc-2018-000113.

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BackgroundSentinel node mapping has been proposed to reduce surgical side effects, maintaining the accuracy in nodal status assessment for endometrial cancer.ObjectiveTo investigate the role of one-step nucleic acid amplification assay (OSNA) analysis, in the intra-operative tailoring of full nodal dissection, and to analyze the correlation between the type of sentinel node metastasis and the risk of non-sentinel node metastasis.MethodsSurgical and pathological data were collected from 141 consecutive, clinical stage I patients with endometrial cancer undergoing surgical staging. Patients were excluded if they had previous pelvic or abdominal radiotherapy, chemotherapy, abdominal cancer, pelvic or abdominal lymphadenectomy, or contraindications to indocyanine green. All sentinel nodes were analyzed by OSNA, and full lymphadenectomy was performed in positive cases. Statistical analysis was performed using Χ2 and Fisher's exact test to determine whether any of these characteristics could accurately predict the non-sentinel nodes status in positive sentinel node patients.ResultsA total of 141 patients were included in the analysis. Bilateral sentinel nodes were identified in 104 (73.8%) patients, with a median number of 2 (range 2–6) sentinel nodes per patient. In the remaining 37 patients (26.2%), a unilateral sentinel node was obtained, with a median of 1 (range 1–3) sentinel node per patient. Thirty-three (12.0%) positive nodes were found in 24 (17.0%) patients: micro-metastases and macro-metastases were detected in 22 and 2 patients, respectively. At final pathology, all patients with positive non-sentinel nodes had macro-metastases in the sentinel node, whereas in micro-metastatic sentinel nodes no other positive nodes were found at full lymphadenectomy (p<0.001).ConclusionsOur results showed a correlation between the type of metastasis in the sentinel lymph node (SLN) and the incidence of positive non-SLNs. These data suggest a potential role of OSNA analysis in the surgical tailoring of patients with early endometrial cancer, with the goal of definitive risk stratification and a better individualization of adjuvant therapy.

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Takahashi, M., H. Jinno, T. Hayashida, S. Hirose, M. Mukai, and Y. Kitagawa. "Prognosis and non-sentinel lymph node status of the breast cancer patients with micrometastatic sentinel lymph nodes." Journal of Clinical Oncology 29, no. 27_suppl (September 20, 2011): 140. http://dx.doi.org/10.1200/jco.2011.29.27_suppl.140.

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140 Background: Sentinel lymph node biopsy (SLNB) is a more sensitive and accurate nodal staging procedure than axillary lymph node dissection (ALND). Because of detailed pathologic evaluation in SLNs, more nodal micrometastases have been identified. However, it remains controversial whether to perform ALND for patients with micrometastases in SLNs and their prognostic significance is also a matter of debate. The purpose of this study is to determine the non-sentinel lymph node (NSLN) status and prognosis of the patients with micrometastatic SLNs. Methods: A prospective database of 1,012 clinically node-negative, T1-T2 breast cancer patients, who underwent SLNB from January 2002 to Dec 2010 at Keio University Hospital was analyzed. SLNs were detected using a combined method of isosulfun blue dye and small-sized technetium-99m-labeled tin colloid. Intraoperative frozen examination was performed with hematoxylin and eosin (HE) staining. SLNs, fixed and embedded in paraffin, were additionally diagnosed with HE staining and immunohistochemical (IHC) analysis. Results: Micrometastases in SLNs were found in 69 (6.8%) of 1,012 patients. Thirty eight (55.1%) of 69 patients with micrometastatic SLNs underwent immediate or delayed ALND and revealed no NSLN metastasis. Among 31 (44.9%) patients with micrometastatic SLNs who omitted ALND and axillary radiation therapy, no axillary lymph node recurrence has been observed after a median follow-up of 50 months, although 29 patients (93.5%) in these 31 patients received adjuvant systemic therapy. There is no significant difference in recurrence free survival between the patients with micrometastatic and negative SLNs (98.0% vs. 95.7%, respectively). Conclusions: These date suggested that it may not be necessary to perform ALND for the patients with micrometastatic SLNs and the presence of micrometastases in SLNs may not worsen prognosis with proper systemic therapy.

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Murata, Takeshi, Maiko Takahashi, Tetsu Hayashida, Shigemichi Hirose, Hiromitsu Jinno, Makio Mukai, and Yuko Kitagawa. "Extent of lymph node involvement in breast cancer patients with sentinel lymph node metastasis." Journal of Clinical Oncology 30, no. 27_suppl (September 20, 2012): 199. http://dx.doi.org/10.1200/jco.2012.30.27_suppl.199.

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199 Background: Axillary lymph node dissection (ALND) is a standard procedure in patients with positive sentinel lymph node (SLN). However, the appropriate level of ALND remains to be elucidated. The aim of this study is to determine the extent of lymph node involvement and predictors to assess non-SLN status in patients with metastatic SLNs. Methods: A prospective database of 235 breast cancer patients with metastases in SLNs who underwent ALND at Keio University Hospital from January 2001 to December 2011 was reviewed. Results: The median age of the patients was 54 years (range 28-86 years) and the mean tumor size was 2.08±0.74 cm. The mean total number of sentinel, level I, and level II lymph nodes removed was 2.72, 18.2, and 2.47, respectively. Other tumor factors include 66.5 % lymphatic invasion positive, 23.7% being nuclear grade 3, 89.4% estrogen receptor positive, and 83.2% progesterone receptor positive. Among 235 patients with SLN involvement, non-SLN metastases were identified in 72 (30.7%) patients and 13 (5.5%) patients had metastases at level II nodes.A univariate analysis showed a significant correlation between non-SLN involvement and number of tumor-involved SLNs. The mean number of tumor-involved SLNs in patients with positive non-SLNs was 1.86 compared with 1.33 in patients with negative non-SLNs (p=0.001). Patients with 2 or more positive SLNs showed a significantly higher rate of non-SLN metastases compared with patients with 1 positive SLNs (47.4% (37/78) vs. 22.3% (35/157), p<0.001).The mean number of tumor-involved SLNs in patients with positive lymph nodes in level II was 2.08 compared with 1.46 in patients with negative lymph nodes in level II (p=0.016). Patients with 2 or more positive SLNs showed a significantly higher rate of metastases at level II nodes compared with patients with 1 positive SLNs (10.3% (8/78) vs. 3.2% (5/157), p=0.0026). Conclusions: Among 235 patients with SLN involvement, the positive rate of non-SLN metastases was 30.7%, whereas that of level II lymph nodes was 5.5%. The number of tumor-involved SLNs was a significant predictor of non-SLN involvement and level II lymph node metastases.

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Devaja, Omer, Gautam Mehra, Michael Coutts, Stephen Attard Montalto, John Donaldson, Mallikarjun Kodampur, and Andreas John Papadopoulos. "A Prospective Single-Center Study of Sentinel Lymph Node Detection in Cervical Carcinoma: Is There a Place in Clinical Practice?" International Journal of Gynecologic Cancer 22, no. 6 (July 2012): 1044–49. http://dx.doi.org/10.1097/igc.0b013e318253a9c9.

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ObjectiveTo establish the accuracy of sentinel lymph node (SLN) detection in early cervical cancer.Materials and MethodsSentinel lymph node detection was performed prospectively over a 6-year period in 86 women undergoing surgery for cervical carcinoma by the combined method (Tc-99m and methylene blue dye). Further ultrastaging was performed on a subgroup of 26 patients who had benign SLNs on initial routine histological examination.ResultsThe SLN was detected in 84 (97.7%) of 86 women by the combined method. Blue dye uptake was not seen in 8 women (90.7%). Sentinel lymph nodes were detected bilaterally in 63 women (73.3%), and the external iliac region was the most common anatomic location (48.8%). The median SLN count was 3 nodes (range, 1–7). Of the 84 women with sentinel node detection, 65 also underwent bilateral pelvic lymph node dissection, and in none of these cases was a benign SLN associated with a malignant non-SLN (100% negative predictive value). The median non-SLN count for all patients was 19 nodes (range, 8–35). Eighteen patients underwent removal of the SLN without bilateral pelvic lymph node dissection. Nine women (10.5%) had positive lymph nodes on final histology. One patient had bulky pelvic nodes on preoperative imaging and underwent removal of the negative bulky malignant lymph nodes and a benign SLN on the contralateral side. This latter case confirms the unreliability of the SLN method with bulky nodes. The remaining 8 patients had positive SLNs with negative nonsentinel lymph nodes. Fifty-nine SLNs from 26 patients, which were benign on initial routine histology, underwent ultrastaging, but no further disease was identified. Four patients (5%) relapsed after a median follow-up of 28 months (range, 8–80 months).ConclusionSentinel lymph node detection is an accurate and safe method in the assessment of nodal status in early cervical carcinoma.

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Onishi, T., H. Jinno, M. Takahashi, T. Hayashida, M. Sakata, T. Nakahara, N. Shigematsu, M. Mukai, and Y. Kitagawa. "Non-Sentinel Lymph Node Status and Prognosis of Breast Cancer Patients with Micrometastatic Sentinel Lymph Nodes." European Surgical Research 45, no. 3-4 (2010): 344–49. http://dx.doi.org/10.1159/000321709.

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Zheng, Jianwei, Shuyan Cai, Huimin Song, Yunlei Wang, Xiaofeng Han, Haoliang Wu, Zhigang Gao, and Fanrong Qiu. "Positive non-sentinel axillary lymph nodes in breast cancer with 1-2 sentinel lymph node metastases." Medicine 97, no. 44 (November 2018): e13015. http://dx.doi.org/10.1097/md.0000000000013015.

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Guzijan, A., Z. Gojković, B. Babić, I. Rakita, B. Jakovljević, and B. Jovanić. "P339 Predictive values for non sentinel lymph nodes in breast cancer with metastatic sentinel lymph node." Breast 24 (March 2015): S143. http://dx.doi.org/10.1016/s0960-9776(15)70369-3.

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Piechocki, J., W. R. Olszewski, A. Szumera-Cieckiewicz, E. Towpik, and W. T. Olszewski. "Predictors of positive non-sentinel lymph nodes in breast carcinoma cases with sentinel lymph node biopsy." European Journal of Cancer Supplements 6, no. 7 (April 2008): 157. http://dx.doi.org/10.1016/s1359-6349(08)70684-0.

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Ulmer, Anja, Klaus Dietz, Melanie Werner-Klein, Hans-Martin Häfner, Claudia Schulz, Philipp Renner, Florian Weber, et al. "The sentinel lymph node spread determines quantitatively melanoma seeding to non-sentinel lymph nodes and survival." European Journal of Cancer 91 (March 2018): 1–10. http://dx.doi.org/10.1016/j.ejca.2017.12.002.

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Den Toom, Inne J., Elisabeth Bloemena, Stijn van Weert, K. Hakki Karagozoglu, Otto S. Hoekstra, and Remco de Bree. "Additional non-sentinel lymph node metastases in early oral cancer patients with positive sentinel lymph nodes." European Archives of Oto-Rhino-Laryngology 274, no. 2 (August 25, 2016): 961–68. http://dx.doi.org/10.1007/s00405-016-4280-2.

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Durak, Merih Guray, Bulent Akansu, Mehmet Mustafa Akin, Ali Ibrahim Sevinc, Mehmet Ali Kocdor, Serdar Saydam, Omer Harmancioglu, Hulya Ellidokuz, Recep Bekis, and Tulay Canda. "Factors predicting non-sentinel lymph node involvement in sentinel node positive breast carcinoma." Turkish Journal of Pathology 27, no. 3 (2011): 189. http://dx.doi.org/10.5146/tjpath.2011.01074.

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Hung, Wai-Ka, Miranda Chi-Mui Chan, Kong-Ling Mak, Sui-Fan Chong, Yvonne Lau, Chiu-Ming Ho, and Andrew Wai-Chun Yip. "Non-sentinel lymph node metastases in breast cancer patients with metastatic sentinel nodes." ANZ Journal of Surgery 75, no. 1-2 (January 2005): 27–31. http://dx.doi.org/10.1111/j.1445-2197.2005.03283.x.

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Peyroteo, Mariana, Rita Canotilho, Ana Margarida Correia, Catarina Baía, Cátia Ribeiro, Paulo Reis, and Abreu de Sousa. "Predictive factors of non-sentinel lymph node disease in breast cancer patients with positive sentinel lymph node." Cirugía Española (English Edition) 100, no. 2 (February 2022): 81–87. http://dx.doi.org/10.1016/j.cireng.2022.01.003.

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Jinno, Hiromitsu, Michio Sakata, Sota Asaga, Masahiro Wada, Toshiyuki Shimada, Yuko Kitagawa, Takayuki Suzuki, et al. "Predictors to Assess Non-Sentinel Lymph Node Status in Breast Cancer Patients with Sentinel Lymph Node Metastasis." Breast Journal 14, no. 6 (November 2008): 551–55. http://dx.doi.org/10.1111/j.1524-4741.2008.00646.x.

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Barron, Alison U., Tanya L. Hoskin, and Judy C. Boughey. "Predicting Non-sentinel Lymph Node Metastases in Patients with a Positive Sentinel Lymph Node After Neoadjuvant Chemotherapy." Annals of Surgical Oncology 25, no. 10 (June 28, 2018): 2867–74. http://dx.doi.org/10.1245/s10434-018-6578-3.

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Hwang, R. F. "Predictors to Assess Non-Sentinel Lymph Node Status in Breast Cancer Patients with Sentinel Lymph Node Metastasis." Breast Diseases: A Year Book Quarterly 20, no. 4 (January 2009): 417–18. http://dx.doi.org/10.1016/s1043-321x(09)79435-4.

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Boler, D. E., C. Uras, U. Ince, and N. Cabioglu. "Factors predicting the non-sentinel lymph node involvement in breast cancer patients with sentinel lymph node metastases." Breast 21, no. 4 (August 2012): 518–23. http://dx.doi.org/10.1016/j.breast.2012.02.012.

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Reynders, Anneleen, Olivier Brouckaert, Ann Smeets, Annouschka Laenen, Emi Yoshihara, Frederik Persyn, Giuseppe Floris, et al. "Prediction of non-sentinel lymph node involvement in breast cancer patients with a positive sentinel lymph node." Breast 23, no. 4 (August 2014): 453–59. http://dx.doi.org/10.1016/j.breast.2014.03.009.

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Pal, A., E. Provenzano, S. W. Duffy, S. E. Pinder, and A. D. Purushotham. "A model for predicting non-sentinel lymph node metastatic disease when the sentinel lymph node is positive." British Journal of Surgery 95, no. 3 (2008): 302–9. http://dx.doi.org/10.1002/bjs.5943.

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Dewar, D., A. Topping, B. Newell, M. Green, B. Powell, and M. Cook. "Pattern of metastasis within sentinel nodes predicts non-sentinel lymph node involvement – do all patients with a positive sentinel node biopsy need a lymph node clearance?" Melanoma Research 14, no. 2 (April 2004): S33—S34. http://dx.doi.org/10.1097/00008390-200404000-00052.

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Ershov, Vladimir A., Ada V. Anisimova, Sergei M. Vashkurov, Svetlana P. Vorob’eva, Natalia D. Shchelkova, Maksim V. Zinkevich, and Georgii M. Manikhas. "FEATURES OF DEFEATS OF SENTINEL LYMPH NODES AT PRIMARY MELANOMA OF SKIN." Scientific Notes of the Pavlov University 26, no. 1 (August 23, 2019): 54–60. http://dx.doi.org/10.24884/1607-4181-2019-26-1-54-60.

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Introduction. Each tenth tumor of skin is melanoma. Presence of tumor cells in sentinel lymph node influenced the medical tactics.The objective of the research was to study the metastasis of skin melanoma into the clinically negative regional lymph nodes.Material and methods. Histological, immunohistochemical, cytological and immunocytochemical methods were used to study biopsies of regional lymph nodes in 60 patients with skin melanoma.Results. 5 % of patients were diagnosed with melanoma in situ, 15 % – Т1, 28.3 % – Т2, 23.3 % – Т3, 28.3 % – Т4. At outflow of the lymph through 1 collector, the metastases in sentinel lymph node (SLN) was defined in 51 %, through 2 collectors – in 81.8 % of cases. Tumor cells damaged single lymph node in 35.3 % of cases, two and more lymph nodes in 64.7 % of cases. Metastases in SLN with formation of secondary tumor at the T1 melanoma were observed at 11.1 %, T2 – 5.9 %, T3 – 21.4 %, T4 – 47.1 % of studies. Clusters of cells or isolated cells of melanoma in SLN at Т1 were noted in 22.2 %, at Т2 – in 41.2 %, at Т3 – in 42.9 %, at Т4 – in 35.3 % of cases. At outflow of lymph through 1 collector, metastasises of melanoma in non-sentinel lymph nodes (NSLN) were revealed in 24 %, through 2 collectors – in 44.4 % of cases. Secondary changes of NSLN were noted in 16.7 % of cases of defeat of single SLN, in 31.8 % of cases of defeat of two and more SLN. Metastases of melanoma were revealed in 69.2 % of cases of formation of secondary tumor and in 4.8 % of cases of presence of clusters in SLN in removed NSLN.Conclusion. At increase of Тmelanoma of the skin, the quantity of sentinel lymph nodes with reactive changes decreased, and their number with metastases increased. Metastatic defeat of sentinel lymph nodes at outflow of lymph through 2 lymph collectors in two and more SLN and NSLN exceeded the defeat of SLN at outflow of lymph through 1 lymph collector in single lymph nodes. The use of immunocytochemical method of research allowed to expand pathomorphological verification of metastatic defeat of sentinel lymph nodes by 66.7%.

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Zaal, Afra, Ronald P. Zweemer, Michal Zikán, Ladislav Dusek, Denis Querleu, Fabrice Lécuru, Anne-Sophie Bats, et al. "Pelvic Lymphadenectomy Improves Survival in Patients With Cervical Cancer With Low-Volume Disease in the Sentinel Node: A Retrospective Multicenter Cohort Study." International Journal of Gynecologic Cancer 24, no. 2 (February 2014): 303–11. http://dx.doi.org/10.1097/igc.0000000000000043.

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ObjectiveIn this study, we aimed to describe the value of pelvic lymph node dissection (LND) after sentinel lymph node (SN) biopsy in early-stage cervical cancer.MethodsWe performed a retrospective multicenter cohort study in 8 gynecological oncology departments. In total, 645 women with International Federation of Gynecology and Obstetrics stage IA to IIB cervical cancer of squamous, adeno, or adenosquamous histologic type who underwent SN biopsy followed by pelvic LND were enrolled in this study. Radioisotope tracers and blue dye were used to localize the sentinel node, and pathologic ultrastaging was performed.ResultsAmong the patients with low-volume disease (micrometastases and isolated tumor cells) in the sentinel node, the overall survival was significantly better (P = 0.046) if more than 16 non-SNs were removed. No such significant difference in survival was detected in patients with negative or macrometastatic sentinel nodes.ConclusionsOur findings indicate that in patients with negative or macrometastatic disease in the sentinel nodes, an additional LND did not alter survival. Conversely, our data suggest that the survival of patients with low-volume disease is improved when more than 16 additional lymph nodes are removed. If in a prospective trial our data are confirmed, we would suggest a 2-stage operation.

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