吲哚菁绿荧光法在乳腺癌前哨淋巴结活检中的应用

目的评价吲哚菁绿荧光(ICG)法在乳腺癌患者前哨淋巴结活检(SLNB)中的应用价值。方法对2014年2月至2015年3月期间在我院住院且行SLNB的66例乳腺癌患者的临床资料进行回顾性分析,66例患者分别应用ICG法(ICG组,34例)和美蓝染色法(美蓝组,32例)来预测腋窝淋巴结转移情况,对此进行比较。结果所有66例患者中检出前哨淋巴结患者共59例,检出率为89.39%(59/66)。59例检出前哨淋巴结患者中共检出前哨淋巴结162枚,平均2.75枚/例。检出时间为(5.05±1.52)min。在ICG组前哨淋巴结检出率为97.06%(33/34),美蓝组前哨淋巴结检出率为81.25%(26/32),ICG组的前哨淋巴结检出率明显高于美蓝组(P0.05)。59例检出前哨淋巴结中有32例是前哨淋巴结阳性,其中ICG组20例,美蓝组12例。所有患者均行ALND,有35例发现腋窝淋巴结转移,其中ICG组21例,美蓝组14例。ICG组和美蓝组的灵敏度和假阴性率比较差异无统计学意义(95.2%比85.7%,P0.05;4.8%比14.3%,P0.05)。结论 ICG法在乳腺癌患者SLNB的应用中的检出率明显高于美蓝组,且具有操作简单、灵敏度高的特点。     

腹腔镜结直肠癌根治术中前哨淋巴结定位方法的探讨

目的：比较、评价纳米碳混悬液与亚甲蓝应用于腹腔镜结直肠癌根治术前哨淋巴结标记的差异、优劣及其临床应用价值。方法：将50例结直肠癌患者随机分为两组,分别于腹腔镜结直肠癌根治术中采用纳米碳、亚甲蓝进行前哨淋巴结定位活检,记录两种方法检出前哨淋巴结的数量及分布情况,比较两组检出总淋巴结数及前哨淋巴结检测的成功率、准确性、敏感性、特异性、假阴性率。结果：两组患者一般资料差异无统计学意义（P〉0.05）。纳米碳组平均检出淋巴结（16.1±1.02）枚,明显多于亚甲蓝组（12.7±1.10,P=0.025）。纳米碳组23例检出前哨淋巴结,共43枚,平均（1.87±0.18）枚;亚甲蓝组20例检出前哨淋巴结,共23枚,平均（1.15±0.11）枚,两组差异有统计学意义（P=0.002）。纳米碳组前哨淋巴结检出成功率、准确性、敏感性、特异性、假阴性率等均优于亚甲蓝组,但差异无统计学意义（P〉0.05）。结论：腹腔镜结直肠癌根治术中使用纳米碳混悬液进行前哨淋巴结活检效果明显优于亚甲蓝,且有助于淋巴结的清扫,并指导病理分期。     

吲哚菁绿与纳米炭淋巴结示踪技术在腹腔镜右半结肠癌根治术中的应用

目的对比吲哚菁绿(indocyanine green, ICG)与纳米炭在腹腔镜右半结肠癌根治术中淋巴结示踪效果的差异。方法纳入自2020年10月至2022年7月北京大学国际医院胃肠外科收治的52例择期接受腹腔镜右半结肠癌根治术患者, 随机分为ICG组和纳米炭组, 每组26例, 术中进行淋巴结示踪, 对常规病理检测阴性淋巴结进行微转移灶检测。结果 ICG组前哨淋巴结(SLN)的检出率为100%, 灵敏度为93%, 假阴性率为7%, 准确度为96%, 均优于纳米炭组(92%、57%、43%、77%)。ICG组比纳米炭组检出更多的SLN[(3.2±0.7)枚比(2.6±1.1)枚, t=4.424, P=0.020], 其中阳性淋巴结数差异有统计学意义[(1.2±1.2)枚比(0.5±0.8)枚, t=15.176, P=0.013]。ICG组中BMI≥24 kg/m2和肿瘤直径≥3 cm患者的SLN活检准确度明显优于纳米炭组(90%比44%, χ2=7.935, P=0.005;90%比57%, χ2=4.309, P=0.038), 差异有统计学意义。ICG组与纳米炭组的SLN中微转移...     

吲哚菁绿与纳米碳在乳腺癌前哨淋巴结活检中的对比研究

目的:比较吲哚菁绿(ICG)、纳米碳混悬注射液在乳腺癌前哨淋巴结(SLN)示踪中的应用效果。方法:选择2013年11月—2016年7月收治乳腺癌行前哨淋巴结活检(SLNB)的患者136例,其中以ICG为示踪剂者60例(ICG组),以纳米碳混悬注射液为示踪剂者76例(纳米碳组)。比较两组的相关指标。结果:两组基本临床资料差异无统计学意义(均P0.05);ICG组与纳米碳组SLN的检出率(96.67%vs.100%)、灵敏度(89.47%vs.95.83%)、假阴性率(10.53%vs.4.17%)、准确率(93.33%vs.98.68%),组间差异均无统计学意义(均P0.05);ICG组较纳米碳组SLN检出数目少(3.17枚vs.3.92枚,P=0.000),但检出时间短(25.72 min vs.49.29 min,P=0.000);年龄、体质量指数(BMI)并不影响两种方法的SLN检出率及SLNB准确率(均P0.05)。结论:ICG与纳米碳混悬注射液示踪乳腺癌SLN具有相似的效能,并且均操作简便,便于推广实施。     

吲哚氰绿荧光显影联合亚甲蓝与核素联合亚甲蓝在新辅助化疗后前哨淋巴结活检中的效果对比

目的探讨吲哚氰绿(ICG)联合亚甲蓝与核素联合亚甲蓝在新辅助化疗后前哨淋巴结活检(SLNB)中的效果差异。方法回顾性收集2017年6月到2019年2月期间于青岛大学附属医院乳腺病诊疗中心完成新辅助化疗后行SLNB并同时行腋窝淋巴结清扫(ALND)的乳腺癌患者77例,其中通过ICG+亚甲蓝示踪行SLNB的乳腺癌患者46例(ICG+亚甲蓝组),通过核素+亚甲蓝示踪行SLNB的乳腺癌患者31例(核素+亚甲蓝组)。比较2组患者的示踪效果。结果 77例患者中至少检出1枚前哨淋巴结(SLN)者73例,SLN检出率为94.80%,其中ICG+亚甲蓝组43例,核素+亚甲蓝组30例。ICG+亚甲蓝组患者的NAC后前哨淋巴结检出率为93.48%(43/46),平均检出SLN 2.32枚/例,灵敏度为82.61%(19/23),假阴性率为17.39%(4/23),准确率为90.70%(39/43)。核素+亚甲蓝组的SLN检出率为96.77%(30/31),平均检出SLN 2.6枚/例,灵敏度为83.33%(10/12),假阴性率为16.67%(2/12),准确率为93.33%(28/30)。2组的SLN检出率、检出数目、灵敏度、假阴性率及准确率比较差异均无统计学意义(P0.05)。结论 ICG联合亚甲蓝与核素联合亚甲蓝在新辅助化疗后的乳腺癌SLNB中具有相似的SLN检出率、SLN检出数目、灵敏度、准确率及假阴性率,可以推广实施。     

腔镜下乳腺癌前哨淋巴结活检临床应用及效果分析

目的探讨在腔镜下进行乳腺癌前哨淋巴结活检(SLNB)的可行性及手术效果。方法分析笔者所在医院2009年1月至2012年3月期间行乳腺癌SLNB病例,其中腔镜下活检107例,开放活检303例,采用放射性核素+亚甲蓝联合法与单用亚甲蓝法进行前哨淋巴结(SLN)探测。结果开放组SLN检出率联合法为94.56%(139/147),亚甲蓝法为88.46%(138/156);腔镜组联合法为94.25%(82/87),亚甲蓝法为85.00%(17/20)。检出前哨淋巴结数量,开放组联合法平均1.90枚/例,亚甲蓝法平均1.98枚/例;腔镜组则分别为1.91枚/例和1.82枚/例。SLN阳性率联合法及亚甲蓝法开放组分别为22.30%(31/139)和25.36%(35/138);腔镜组分别为19.51%(16/82)和23.53%(4/17)。上述各指标2组间的差异均无统计学意义(P>0.05)。术后并发症:腔镜组发生皮下积液的比例(5/107)高于开放组(0/303),P=0.001;其他并发症发生情况2组间比较差异均无统计学意义(P>0.05)。结论腔镜下SLNB与传统SLNB可达到相似的安全性与临床效果,但前者表现出较优越的美容效果,腔镜下SLNB可作为乳腺癌SLNB手术技术进行推广应用。     

纳米碳在腔镜甲状腺癌手术中的应用

目的:探讨纳米碳在腔镜甲状腺癌根治术中的作用。方法:将43例甲状腺微小乳头状癌患者随机分为实验组与对照组,实验组于甲状腺内注射纳米碳混悬液,20 min后施术。统计清扫组织中淋巴结数量、转移淋巴结数量及甲状旁腺数量。结果:实验组平均清扫淋巴结(9.67±5.26)枚,对照组平均(4.95±2.54)枚,两组差异有统计学意义(t检验,t=3.716,P=0.001)。实验组于2例标本中找到甲状旁腺,对照组10例找到甲状旁腺,两组差异有统计学意义(χ2检验,χ2=6.894,P=0.009)。实验组淋巴结转移率为15.43%,对照组为8.16%,两组差异无统计学意义(t=1.043,P=0.303)。结论:纳米碳在腔镜甲状腺癌根治术中可使中央区淋巴结得到很好的显影,同时不会染黑甲状旁腺,术中清扫黑染组织,保留未黑染组织,可达到既彻底清扫淋巴结同时又保护甲状旁腺的效果。     

乳腔镜前哨淋巴结活检术的临床应用

目的 探讨经乳腔镜前哨淋巴结活检的可行性及应用前景。方法 应用亚甲蓝染色法检测62例乳腺癌患者的前哨淋巴结(SLN)。在乳腔镜下切除SLN,随后行乳腔镜腋窝淋巴结清扫,SLN、腋窝淋巴结同时行HE染色,评价SLN检出率及假阴性率。结果 62例患者61例检出前哨淋巴结,成功率98．4％。无腋窝淋巴结转移者35例,转移27例,假阴性率0。结论 乳腔镜前哨淋巴结活检检出率高,美容效果好,并发症低,对于乳腺癌腋窝淋巴结转移有较高的敏感性,可以为绝大多数乳腺癌进行准确淋巴分期。     

乳腺癌腔镜前哨淋巴结活检83例临床分析

目的探讨染料法腔镜腋窝前哨淋巴结活检在乳腺癌中的可行性和临床意义。方法应用亚甲蓝染色法对83例Ⅰ、Ⅱ期乳腺癌行腔镜前哨淋巴结活检(ESLNB),然后行腔镜腋窝淋巴结清扫(EALND)。对获取的全部淋巴结行病理检查,评价前哨淋巴结检出率、准确率及假阴性率。结果83例中73例检出前哨淋巴结,检出率87.9%(73/83)。ESLNB准确率97.3%(71/73),灵敏性88.2%(15/17),特异性100.0%(56/56)。结论染料法腔镜腋窝前哨淋巴结活检临床可行,能够对早期乳腺癌进行准确分期,但体重指数高、肿瘤部位在内侧、术前肿瘤切除活检、腔镜技术欠熟练等是影响前哨淋巴结检出的主要因素。     

达芬奇机器人联合淋巴示踪在进展期远端胃癌根治术中的应用

目的探讨达芬奇机器人联合淋巴示踪技术在进展期远端胃癌根治术中的应用效果。方法回顾性分析2016年6月~2017年6月72例进展期远端胃癌患者临床资料,根据患者自身经济状况及自愿选择分为达芬奇+纳米碳组24例,开腹手术+纳米碳组20例,开腹手术组(无术中淋巴结示踪)28例。对3组淋巴结检出情况、术后资料进行比较。结果达芬奇+纳米碳组检出淋巴结(28.9±5.3)枚/例,明显高于开腹手术+纳米碳组(24.6±5.5)枚/例(P=0.006)及开腹手术组(20.2±4.5)枚/例(P=0.000);达芬奇+纳米碳组检出淋巴结黑染率75.9%(527/694),黑染淋巴结的肿瘤阳性率为27.1%(143/527),与开腹手术+纳米碳组(27.0%,103/382)无统计学差异(χ2=0.003,P=0.954)。达芬奇+纳米碳组出血量(162.5±84.0)ml,明显少于开腹手术+纳米碳组(227.0±53.9)ml(P=0.005)和开腹手术组(208.9±76.0)ml(P=0.026);3组手术时间、术后吻合口或残端漏、术后出血、淋巴漏发生率无统计学差异(P0.05)。达芬奇+纳米碳组术后排气时间(2.2±0.6)d,明显早于开腹手术+纳米碳组(3.7±1.3)d(P=0.000)和开腹手术组(4.0±1.2)d(P=0.000)。达芬奇+纳米碳组术后48 h疼痛评分(0.40±0.16)分,明显低于开腹手术+纳米碳组(1.33±0.18)分(P=0.000)和开腹手术组(1.36±0.20)分(P=0.000)。达芬奇+纳米碳组术后住院时间(9.5±3.5)d,明显短于开腹手术+纳米碳组(15.4±4.9)d(P=0.000)和开腹手术组(16.2±4.8)d(P=0.000)。开腹手术+纳米碳组术中严重副损伤发生率最高(P=0.015)。结论达芬奇联合纳米碳在进展期胃癌根治术淋巴结清扫中操作安全可行,创伤小,患者术后恢复快;在淋巴结清扫方面,纳米碳具有良好的淋巴结示踪效果,淋巴结检出数量明显提高。     

Lymphoscintigraphy in penile cancer: limited value of sentinel node biopsy in patients with clinically suspicious lymph nodes

The staging lymph node dissection in patients with penile carcinoma is accompanied with a high morbidity. As many patients are free of nodal metastases the lymphoscintigraphic sentinel node biopsy is supposed to minimize perioperative morbidity in these patients. In the current study the accuracy of the lymphoscintigraphic sentinel node biopsy was verified against the gold standard of radical inguinal dissection. In particular, patients with enlarged lymph nodes have also been included since one half of these patients is known to have histologically negative lymph nodes. Between 2000 and 2004 fifteen patients with penile carcinoma were elected to undergo bilateral groin dissection, thus 30 inguinal areas have been dissected. Nine patients have had clinically palpable nodes. All patients underwent lymphoscintigraphy after injection of Tc99-nanocolloid subcutaneously into the peritumoral area. Intraoperatively the sentinel nodes were identified with the aid of a gamma ray detection probe and excised. Afterwards a standard groin dissection was performed and the different lymph nodes were histopathologically assessed separately. In all patients lymph nodes with high radioactivity uptake were detected bilaterally. In 10 out of 30 inguinal areas histopathologically positive lymph nodes were present. In four of them the sentinel node was positive for tumor but in six dissection areas lymph node metastases were found despite a negative sentinel node. These patients had clinically palpable lymph nodes in their histologically positive inguinal regions. If no palpable nodes were present dynamic sentinel biopsy detected the positive nodes. The current study showed that dynamic sentinel node biopsy in patients with clinically suspicious lymph nodes is of low value for detection of lymphatic spread in penile cancer. Therefore the gold standard in these patients remains the radical groin dissection. However, dynamic sentinel node biospy is still a promising strategy to identify lymphatic spreading in clinically N0 patients and therefore to prevent unnecessary groin dissection.     

Detection of Sentinel Node in Gastric Cancer Surgery by Indocyanine Green Fluorescence Imaging: Comparison with Infrared Imaging

Background Secure methods for clinical detection of the sentinel node (SN) are in great demand to avoid unnecessary resection. This was a clinical exploration/feasibility study of a novel detection system for SN biopsy using indocyanine green (ICG) fluorescence imaging in gastric cancer surgery. Methods SN biopsy using ICG dye was performed in three patients who had gastric cancer. ICG fluorescence images were obtained using a detection system comprising a charge-coupled device (CCD) camera with a cut filter as the detector and light emitting diodes (LED) as the light source. The nodes were also examined simultaneously by an infrared (IR) imaging videoscope. Results Immediately after intraoperative ICG injection, the fluorescence imaging system allowed easy visualization of the lymphatic vessels draining from the primary gastric tumor toward the lymph nodes and tracing of the moving injected dye. Some lymph vessels and nodes were hardly recognized by ICG green color or IR imaging. The ICG fluorescence system also allowed visualization of the lymph node when ICG was injected the day before surgery, similar to the radio-guided method. Conclusions Detection of SNs in gastric cancer surgery using the ICG fluorescence imaging system is a promising novel technique and may perhaps prove useful for laparoscopic surgery.     

纳米碳与吲哚菁绿导航腹腔镜胃癌根治术淋巴结清扫的对比性研究

目的对比纳米碳与吲哚菁绿(ICG)在腹腔镜胃癌根治术淋巴结清扫方面的优劣性。方法回顾性分析2016年1月至2019年12月接受腹腔镜胃癌根治术的167例患者资料,根据所使用的示踪剂种类,分为纳米碳组130例、ICG组37例,应用GraphPad Prism 8.0统计软件进行分析,围术期指标及淋巴结清扫数目等计量资料以(±s)表示,采用独立t检验;术后并发症、二次手术率等计数指标比较采用χ²检验,P<0.05为差异有统计学意义。结果两种示踪剂对不同病理分期胃癌的淋巴结清扫效果差异无统计学意义。在各种胃癌根治术式中,淋巴结分拣均有助于提高淋巴结总检出数。纳米碳组较ICG组更有助于提高根治性全胃切除术第5站淋巴结的清扫数目(P=0.02)、根治性近端胃切除术第1站淋巴结的清扫数目(P=0.03)以及根治性远端胃淋巴结的总清扫数目(P=0.03)。在提高淋巴结检出率方面,两种示踪剂差异无统计学意义。结论纳米碳与吲哚菁绿在不同病理分期中的总体淋巴结清扫效果差异无统计学意义。无论使用何种示踪剂,均提倡淋巴结分拣。纳米碳较吲哚菁绿更有助于提高根治性全胃第5站淋巴结的清扫数、根治性近端胃第1站淋巴结的清扫数以及根治性远端胃淋巴结的总清扫数目。     

Indocyanine green fluorescence method for sentinel lymph node biopsy in breast cancer

Background/ObjectiveBreast biopsy and analysis of sentinel lymph nodes (SLNs) accurately predict tumor status in the affected basin and help in avoiding unnecessary axillary lymph node dissection, which is associated with remarkable morbidity risk. Blue dye and radioisotope are the most widely used mapping agents, but non-radioactive tracers of comparable accuracy warrant further investigation. This study aimed to investigate utilization of indocyanine green (ICG) fluorescence in sentinel node localization compared with blue dye and to assess the incremental value of ICG.MethodsA total of 39 consecutive patients underwent sentinel lymph node biopsy (SLNB) (40 cases: 38 unilateral and 1 bilateral) with combined blue dye and ICG for localization. The obtained fluorescence images of the lymphatic system were investigated.ResultsAll 84 lymph nodes removed in 40 procedures were identified by ICG, but only 37 were identified by blue dye. The ICG method identified an average of 2.1 SLNs in 39 of 40 cases with a detection rate of 97.5%, but only 0.93 SLN per case with blue dye. Subcutaneous lymphatic channel patterns were also detected by fluorescent imaging in 37 procedures, which all revealed lymphatic drainage toward the axilla except in one case with internal mammary pathway.ConclusionThis study demonstrated the accuracy and safety of ICG for SLNB and its superiority to blue dye method in SLN localization. Therefore, ICG fluorescence method is safe and effective addition in breast clinical settings, wherein blue dye alone is used.     

Infrared ray electronic endoscopy combined with indocyanine green injection for detection of sentinel nodes of patients with gastric cancer

BACKGROUND: To avoid unnecessary lymphadenectomy in patients with cancer accurate diagnosis of the sentinel lymph node (SLN) is important. METHODS: This report examined the initial clinical use of infrared ray electronic endoscopy (IREE) combined with indocyanine green (ICG) injection for SLN detection in 84 patients with gastric cancer not invading the subserosa (75 T1 N0 M0 and nine T2 N0 M0 tumours, according to tumour node metastasis classification). RESULTS: There were no adverse events after injection of ICG. At least one SLN was detected in all but one patient by both ICG injection alone and by IREE with ICG. Eleven of the 84 patients had lymph node metastasis. SLNs detected by ICG injection alone did not include metastases in four of 11 patients, whereas IREE with ICG detected SLNs containing lymph node metastases in all 11 patients. Moreover, SLNs illuminated by IREE with ICG included all metastases among the 105 regional lymph nodes in the 11 patients; no metastatic lymph nodes were identified among 154 non-SLNs. CONCLUSION: IREE combined with ICG injection may efficiently detect SLNs that contain metastases in patients with gastric cancer.     

Sentinel lymph node biopsy after neo-adjuvant chemotherapy in breast cancer

The timing of sentinel node biopsy in the setting of neo-adjuvant chemotherapy for breast cancer is controversial. Sentinel node biopsy performed after neo-adjuvant chemotherapy may save patients with a nodal response the morbidity of an axillary lymph node dissection. A retrospective review of prospectively collected data compared sentinel node biopsies performed after patients had received neo-adjuvant chemotherapy with patients who had not received neo-adjuvant chemotherapy. Demographic factors, tumor characteristics, and the results of the sentinel node biopsies and completion lymph node dissections (when applicable) were compared. A total of 231 axillary procedures (224 patients) were evaluated. The patients who received neo-adjuvant chemotherapy (NEO; N=52) were younger, had higher grade tumors, were more likely to have a mastectomy, and were more likely to have ER-negative and HER-2/neu positive tumors than the patients who did not receive neo-adjuvant chemotherapy (NON; N=179). The mean clinical tumor size in the neo-adjuvant group was 4.5cm (±1.8) prior to chemotherapy; the post-chemotherapy pathologic size was 1.4cm (±1.3). A sentinel node was identified in all cases. There were no significant differences between the groups in the mean number of sentinel nodes removed (NEO=3.3; NON=3.1; p=0.545), the percentage of positive axillae (NEO=24%; NON=21%; p=0.776) or the mean number of positive sentinel nodes (NEO=1.3; NON=1.5; p=0.627). There was no difference in the percentage of completion lymph node dissections with additional positive nodes (NEO=20%; NON=35%; p=0.462); there was a difference in the number of nodes removed in the completion lymph node dissections (mean NEO=12.0; NON=16.4; p=0.047). Sentinel node biopsy performed after neo-adjuvant chemotherapy appears to be an oncologically sound procedure and may save some patients the morbidity of a complete lymph node dissection.     

Sentinel Lymph Node Biopsy for Melanoma: How Many Radioactive Nodes Should be Removed?

Background: Sentinel lymph node (SLN) biopsy has become a standard method of staging patients with cutaneous melanoma. Sentinel lymph node biopsy usually is performed by intradermal injection of a vital blue dye (isosulfan blue) plus radioactive colloid (technetium sulfur colloid) around the site of the tumor. Intraoperative gamma probe detection has been shown to improve the rate of SLN identification compared to the use of blue dye alone. However, multiple sentinel nodes often are detected using the gamma probe. It is not clear whether these additional lymph nodes represent true sentinel nodes, or second-echelon lymph nodes that have received radiocolloid particles that have passed through the true sentinel node. This analysis was performed to determine the frequency with which these less radioactive lymph nodes contain metastatic disease when the most radioactive, or hottest, node does not.Materials and Methods: In the Sunbelt Melanoma Trial, 1184 patients with cutaneous melanoma of Breslow thickness 1.0 mm or more had sentinel lymph nodes identified. Sentinel lymph node biopsy was performed by injection of technetium sulfur colloid plus isosulfan blue dye in 99% of cases. Intraoperative determination of the degree of radioactivity of sentinel nodes (ex vivo) was measured, as well as the degree of blue dye staining.Results:Sentinel nodes were identified in 1373 nodal basins in 1184 patients. A total of 288 of 1184 patients (24.3%) were found to have sentinel node metastases detected by histology or immunohistochemistry. Nodal metastases were detected in 306 nodal basins in these 288 patients. There were 175 nodal basins from 170 patients in which at least one positive sentinel node was found and more than one sentinel node was harvested. Blue dye staining was found in 86.3% of the histologically positive sentinel nodes and 66.4% of the negative sentinel nodes. In 40 of 306 positive nodal basins (13.1%), the most radioactive sentinel node was negative for tumor when another, less radioactive, sentinel node was positive for tumor. In 20 of 40 cases inding a positive sentinel node other than the hottest node.Conclusions: If only the most radioactive sentinel node in each basin had been removed, 13.1% of the nodal basins with positive sentinel nodes would have been missed. It is recommended that all blue lymph nodes and all nodes that measure 10% or higher of the ex vivo radioactive count of the hottest sentinel node should be harvested for optimal detection of nodal metastases.Preliminary findings presented at the annual meeting of the Society of Surgical Oncology, Orlando, Florida, March 4–7, 1999.     

Dynamic sentinel node biopsy for penile cancer: reliability of a staging technique

PURPOSE: We determine the value of dynamic sentinel node biopsy for staging squamous cell carcinoma of the penis. MATERIALS AND METHODS: A total of 90 patients with clinically node negative penile cancer were prospectively entered in this study. Preoperative lymphoscintigraphy was performed after intradermal injection of 99mtechnetium nanocolloid around the primary tumor. The sentinel node was intraoperatively identified with the aid of intradermal administered patent blue dye and a gamma ray detection probe. Histopathological examination of sentinel nodes included serial sectioning and immunohistochemical staining. Regional lymph node dissection was performed only if metastasis was found in a sentinel node. Median followup was 36 months (range 5 to 95). RESULTS: Lymphoscintigraphy visualized 217 sentinel nodes in 159 inguinal regions of 88 patients. A total of 208 sentinel nodes were intraoperatively identified in 149 inguinal regions of 88 patients. Sentinel node metastasis was found in 19 inguinal regions of 18 patients. Four of 8 patients with unilateral clinical stage N1 disease had a tumor positive sentinel node on the opposite site. Regional recurrence after excision of a tumor negative sentinel node or after nonvisualization was seen in 5 patients, resulting in a false-negative rate of 22% (5 of 23). The 3-year disease specific survival was 98% and 71% for patients with a tumor negative or tumor positive sentinel node, respectively (p = 0.0018). CONCLUSIONS: Occult lymph node metastases in penile cancer can be detected with a sensitivity of about 80% by dynamic sentinel node biopsy, including preoperative lymphoscintigraphy, vital dye and a gamma ray detection probe.     

Sentinel Lymph Node Biopsy in Patients with Extramammary Paget''s Disease

BACKGROUND: Patients with invasive extramammary Paget's disease appear to have a risk of regional lymph node metastasis. Despite the poor prognosis for patients with lymph node metastasis, management of extramammary Paget's disease without clinical evidence of involved nodes is controversial. OBJECTIVE: To evaluate the usefulness of sentinel lymph node biopsy, patients with extramammary Paget's disease underwent sentinel lymph node biopsy using preoperative lymphoscintigraphy and intraoperative patent blue dye injection with a handheld gamma-detecting probe. METHODS: Thirteen patients with primary genital extramammary Paget's disease were included in the study. Sentinel nodes identified were excised and examined by hematoxylin and eosin staining. All sentinel lymph nodes were also subjected to immunohistochemical staining for carcinoembryonic antigen, MUC1, cytokeratin 7, and gross cystic disease fluid protein-15. RESULTS: A total of 23 nodes were removed successfully. Tumor cells were detected in 4 nodes from four patients by hematoxylin and eosin staining. No additional lymph nodes were positive by immunohistochemistry. Three of the four sentinel-node-positive patients developed distant metastases. All nine patients without node involvement were free from disease during the follow-up period. CONCLUSION: Sentinel lymph node biopsy was safe and feasible method and may have an important role in the management of extramammary Paget's disease with clinically N0 status. To establish the optimal management of inguinal lymph nodes in extramammary Paget's disease, additional studies in large number of patients are needed.