Lymph nodes mapping for detection of sentinel nodes in patients with papillary thyroid cancer

We examined the feasibility of sentinel lymph node biopsy for papillary thyroid cancer. In the dye injection method, 1% of isosulfan blue dye was injected around the tumor of 32 patients intra-operatively, and in the radioisotope (RI) colloid injection method, 99mTc-tin colloid was injected in 23 patients 1 day preoperatively. Lymph node mapping for detection of sentinel nodes was performed after thyroidectomy and central and modified lateral neck lymph node dissections. All dissected nodes were examined postoperatively by hematoxylineosin staining to determine whether or not metastasis was present. In the dye injection method, sentinel lymph nodes were identified in 30 (94%) of the 32 patients. Lymph node metastases were found in 14 patients, and some sentinel lymph nodes had papillary cancer metastasis in 13 patients. There was only 1 false-negative case. Sensitivity and accuracy of sentinel lymph node biopsy was 93% (13/14) and 97% (29/30). With the RI method, detection rate, sensitivity and accuracy of sentinel lymph node biopsy was 96% (22/23), 90% (9/10) and 95% (21/22), respectively. Our preliminary study indicated that sentinel lymph node biopsy was feasible in patients with thyroid cancer. It may be helpful in avoiding unnecessary lymph node dissection and improving quality of life in patients with thyroid cancer.     

Sentinel node biopsy in breast cancer: the experience of Brescia Civic Hospital

The accuracy of the sentinel node technique in the evaluation of axillary node involvement in breast cancer was evaluated in 83 consecutive patients with monofocal T1-2 carcinoma, who were clinically N0 and who underwent lymphoscintigraphy with 99mTc-colloid integrated with intraoperative sentinel node detection by a portable probe. Lymphoscintigraphy revealed at least one sentinel node in 75 patients (90.4%), always identified by the probe. In eight patients (9.6%) the sentinel node was detected neither by lymphoscintigraphy nor by the probe. All removed lymph nodes were analyzed by hematoxylin-eosin histology and the sentinel node by immunostaining. In 28/75 patients (37.3%) at least one metastatic axillary lymph node was detected; in 16 of the 28 N+ subjects (57%) only the sentinel node was positive. The false negative rate (sentinel node negative/other axillary lymph nodes positive) was 17.85% (5/28 patients). In 9/23 patients (39%) micrometastases were found in the sentinel node only. In conclusion, specific sentinel node positivity in 57% of cases supports the validity of the sentinel node concept. Moreover, nine patients would have been considered N0 by standard hematoxylin-eosin histology without sentinel node-aided immunostaining. A 17.8% false negative rate calls for caution in patients with negative sentinel nodes.     

Sentinel node identification by scintigraphic methods in cutaneous melanoma

In melanoma patients lymph node metastasis is an important prognostic factor that indicates the need for therapeutic lymph node dissection. Preoperative lymphoscintigraphy mapping associated with radioguided sentinel lymph node biopsy has become a well established procedure for cutaneous melanoma patients without clinically detectable lymph node metastases (stage I, II). This technique is a versatile way of characterizing the lymphatic basin at risk for metastases and identifying involved lymph nodes. The purpose of the present study was to examine the reproducibility of lymphoscintigraphy and sentinel lymph node biopsy in detecting micro metastases in cutaneous melanoma. The study was a single-institution prospective analysis of 74 melanoma patients, with primary tumors having Breslow thickness > 0.7 mm, who underwent lymphoscintigraphies between May 2002 and September 2003. Technetium-99m sulfur colloid was injected intradermally at the primary tumor site and dynamic images were obtained for 40 minutes. Two observers evaluated the images. One to two weeks after the first lymphoscintigraphy, radioguided lymph node biopsy was performed. For the biopsy, technetium-99m sulfer colloid was injected intradermally in the same manner as performed before. Lymph nodes were identified and removed with the aid of a gamma ray detecting probe (GDP), and were submitted to histopathological analysis. The histopathological analysis of the sentinel lymph nodes collected during surgery was performed in a sequential manner. First, frozen sections were analyzed during surgery. The lymph nodes considered negative by frozen section were analyzed by H&E staining. Subsequently, the slides considered negative with H&E were sent for immunohistochemical analysis. Lymphoscintigraphy identified at least one sentinel lymph node in all patients. Sentinel node biopsy detected metastases in 20 patients (27.2%). In all cases the lymph node basins identified during lymphoscintigraphy were found to have at least one sentinel lymph node during surgery. Frozen section analysis of the lymph node was only able to identify the disease in 35% of the patients eventually found to have micrometastases with H&E and immunohistochemistry. Two lymph nodes were negative with H&E and positive with immunohistochemical analysis. In conclusion, lymphoscintigraphy is a simple procedure that is well tolerated by patients. It is useful in locating sentinel lymph nodes in patients with melanoma and is an important tool in the clinical practice of oncology. We recommend performing H&E, and if necessary, immunohistochemical analysis of all sentinel lymph nodes because of the high rate of false negative results with frozen sections alone.     

Sentinel lymph node biopsy in breast cancer--the Aarhus experience

Eighty patients, with newly diagnosed unifocal breast cancer and with no axillary metastases verified by ultrasonography, underwent sentinel lymph node (SLN) and subsequent axillary lymph node dissection. To identify the SLN, we used a combination of Tc-99m labelled colloid (Albures) and blue dye (Patent Blue V) injected peritumorally. Lymphoscintigraphy was not performed. The SLN was successfully identified in 78 out of 80 patients (97.5%); 43 patients (54%) were found to have metastatic disease. In 33 patients (77%) the SLN was the only node involved. No false-negative nodes were found, defined as SLNs that tested negative but with higher nodes that tested positive. If SLN biopsy is accepted as a routine procedure and when the exact indications are defined, the method described probably could be offered to the majority of breast cancer patients.     

Sentinel lymph node biopsy is not accurate in predicting lymph node status for patients with cervical carcinoma

BACKGROUND: The authors evaluated the accuracy of sentinel lymph node biopsy in predicting lymph node status for patients with early cervical carcinoma. In particular, the authors set out to determine the false-negative rate associated with sentinel lymph node biopsy in this setting. METHODS: Twenty-nine consecutive patients with early cervical carcinoma who were treated with pelvic laparoscopic lymphadenectomy and radical surgery underwent sentinel lymph node biopsy following lymphatic mapping with patent blue dye. All sentinel and nonsentinel lymph nodes were evaluated for micrometastases via multilevel sectioning followed by immunohistochemical staining. RESULTS: At least one sentinel lymph node was identified for each patient. On routine pathologic evaluation, 3 patients (10%) were found to have positive lymph nodes. Among the remaining 26 patients, multilevel sectioning in conjunction with immunohistochemical analysis identified 5 patients (19%) who had micrometastases in the pelvic lymph nodes. Two of these five patients had micrometastases in a sentinel lymph node; however, the more notable finding was that the other three patients had micrometastases in nonsentinel pelvic lymph nodes despite having negative findings on sentinel lymph node biopsy. Thus, the negative predictive value of sentinel lymph node biopsy in the current study was 87.5%. CONCLUSIONS: Multilevel sectioning followed by cytokeratin immunohistochemistry may identify additional patients who have lymph node micrometastases; in the current study, this technique identified cases in which micrometastases were present in nonsentinel lymph nodes even when sentinel lymph nodes were found to be negative for disease on biopsy. This high false-negative rate associated with sentinel lymph node biopsy, raises questions regarding the validity of the sentinel lymph node concept in cervical carcinoma.     

Blue nodes left behind after vital blue dye-guided axillary sentinel node biopsy in breast cancer patients

BACKGROUND: Vital dye-guided sentinel node biopsy is affordable in most hospitals, but may be of limited accuracy in identifying all sentinel nodes. Leaving sentinel nodes in the axilla may result in a false nodal staging of breast carcinomas. METHODS: From a series of 112 successful sentinel lymph node biopsies with Patent Blue dye followed by axillary dissection, 10 cases were identified where 1-3 blue nodes were found in the axillary dissection specimens. These 10 cases were compared with those which had all blue nodes identified during surgery. Five of the 10 patients with missed blue nodes also underwent lymphoscintigraphy with 99m-Tc-labeled colloidal human albumin and all of their nodes were subjected to external gamma well counting postoperatively. RESULTS: There were six false-negative sentinel lymph node biopsies overall, but none in patients with missed blue nodes. Patients with primarily unidentified blue nodes had more sentinel nodes and a higher rate of multiple sentinel nodes than the others. CONCLUSION: Blue nodes missed during surgery may be either true sentinel nodes or second echelon nodes labeled by dye overflow. This type of error may occur in <8% of patients and may lead to false-negative sentinel node-based staging in an even smaller proportion of cases (none in this series).     

Sentinel lymph node concept in patients with esophageal cancer

It is not uncommon that first lymph node involvement appears at a distant lymph node not at a nearest node from the primary lesion in patients with esophageal cancer. Identification of the sentinel node, which permits the detection of the first draining node from a primary lesion, is expected to individualize the treatment of esophageal cancer. From our study in 23 patients with esophageal cancer using Tc-99 m tin colloids, the sentinel node concept seemed to be applicable to patients with esophageal cancer (-pT2). However, injection techniques and intraoperative probe searching for hot nodes are more difficult and uncertain in esophageal cancer compared to superficial cancers such as breast cancer and malignant melanoma. Further studies are necessary to reliably apply the sentinel node biopsy technique to patients with esophageal cancer.     

Accuracy of sentinel node biopsy in predicting nodal status in patients with breast carcinoma

BACKGROUND AND OBJECTIVES: While sentinel lymph node biopsy is considered by many to have replaced axillary node dissection in the management of breast cancer, concerns remain regarding false-negative results. METHODS: To investigate the accuracy of sentinel node biopsy, we reexamined all sentinel and nonsentinel nodes with multilevel sectioning and immunohistochemical staining in 42 consecutive cases of breast cancer in which sentinel node biopsy was performed and followed by axillary dissection. RESULTS: By routine hematoxylin and eosin (H&E) staining, 34% of patients were found to be node positive, with no cases of false-negative sentinel node biopsy. Reevaluation of 775 negative sentinel and nonsentinel nodes with an additional two levels and immunohistochemistry identified three "node-negative" patients who had micrometastases in the sentinel node, increasing detection in 8% of cases. More important, is the fact however, that there were no cases where additional sections and immunohistochemistry identified metastases in nonsentinel nodes that had bypassed the sentinel node. The accuracy of the sentinel node in predicting the nodal status was 100%. CONCLUSIONS: Cytokeratin immunohistochemistry will identify more patients with nodal micrometastases; however, it was unable to identify any cases where micrometastases were present in nonsentinel nodes when the sentinel node was negative. The status of the sentinel node accurately identifies the status of the axillary basin.     

Sentinel lymph-node biopsy in head and neck cancer

The aim of the study was to assess the diagnostic value of the sentinel node method in patients suffering from squamous cell carcinoma of the upper aerodigestive tract. In 50 patients with oral, pharyngeal or laryngeal carcinomas staged N0 up to 50 MBq technetium-99m colloid were injected peritumorally. Sentinel nodes were localised using a gamma-probe in the setting of an elective neck dissection. Pathological findings of sentinel nodes and corresponding neck specimens were compared. In 46 patients sentinel nodes were detected. Of these 34 patients were free of metastatic disease in the sentinel nodes and in the neck specimens. In 12 patients clinically occult metastases were found in the sentinel nodes. Three metastases were detected only after additional sectioning of the sentinel nodes. In four patients, a sentinel lymph node could not be localised. Our results support the sentinel node concept in head and neck cancer and a definition of the sentinel nodes as the three nodes with the highest activity. Careful clinical staging of the neck and thorough pathological evaluation of the sentinel nodes are necessary to avoid false-negative results.     

Influence of the new AJCC breast cancer staging system on sentinel lymph node positivity and false-negative rates

The sixth and newest edition of the American Joint Committee on Cancer (AJCC) staging system for breast cancer now defines axillary sentinel lymph nodes with micrometastatic deposits 0.2 mm in diameter or smaller as node-negative. The aim of this study was to determine how this new classification scheme would affect axillary sentinel lymph node positivity, false-negative rate, and overall accuracy of an inception cohort of 205 breast cancer patients undergoing definitive surgery that included sentinel lymph node biopsy plus level I/II axillary lymphadenectomy. Based on the previous AJCC system for staging breast cancer, in which all sentinel lymph node metastases were considered positive, the rate of nodal positivity in this cohort was 47%, the overall accuracy was 99%, and the false-negative rate was 2.1%. According to the new classification system, the rate of nodal positivity in this cohort was 39.5% and the overall accuracy was 98%. The false-negative rate rose to 4.9% because two patients with micrometastatic deposits 0.2 mm or smaller, which are considered node-negative in the new system, had macroscopically positive disease in non-sentinel lymph nodes found in the completion lymphadenectomy.     

Feasibility and morbidity of sentinel lymph node detection in patients with vulvar carcinoma

The aim of this study was to investigate the feasibility and the morbidity of sentinel lymph node detection in patients with vulvar carcinoma. In 15 patients with vulvar squamous cell carcinoma, the inguinal sentinel lymph nodes was detected using both peritumoral injection of technetium-99m sulfur colloid and isosuflan blue before the surgical time. The detection of the inguinal sentinel lymph node was never completed by an inguinal lymphadenectomy. In case of metastatic lymph node, patients were treated by complementary inguinal irradiation. A total of 19 inguinal node dissection were performed. The sentinel lymph node was identified in 18/19 (94.7%) groin dissections. A total of 38 sentinel lymph nodes were removed. 4 patients were found to have metastatic lymph node (26.7%) with a total of 6 metastatic lymph nodes. The postoperative morbidity was minimal, with only one patient presenting a permanent edema of the extremity (6.7%) after complementary inguinal irradiation. We confirm the results of previous studies that sentinel node dissection appears to be technically feasible in patients with vulvar carcinoma. This may reduce the morbidity of usual inguinal lymphadenectomy without under-evaluate the nodal status. This procedure could be implemented in future therapy concepts.     

Sentinel lymph node detection with Tc-99m tin colloids in patients with esophagogastric cancer

BACKGROUND: The aim of this study was to determine by radioisotope use whether the sentinel lymph node concept is applicable to esophagogastric cancers. In addition, we examined radioactivities of hot nodes and compared them with the sensitivity of a gamma probe. METHODS: The subjects were 44 patients, 23 with esophageal cancer and 21 with gastric cancer. The day before surgery, patients underwent endoscopic submucosal injection of 184 MBq of Tc-99m tin colloids into sites surrounding the tumor. Radioisotope activities of lymph nodes dissected at surgery were measured with a well-typed gamma detector and each lymph node was categorized as a hot or cold node. Histopathology of the lymph nodes was examined by hematoxylin and eosin staining. Radioisotope activities and histopathological results were compared to determine whether radioisotope flow reflects lymphatic flow to regional lymph nodes. The sensitivity of a gamma probe was measured in a laboratory study and the relation between the radioisotope activities of hot nodes and the detection sensitivity of the gamma probe was examined. RESULTS: Histopathological examination revealed lymph node metastasis in 18 of the 44 patients. In 15 of these 18 patients, metastatic foci were recognized in at least one hot node. Subsequent analysis was performed on the 36 patients in whom tumor invasion was confined to the muscle layer and in whom endoscopic clippings had not been applied. Lymph node metastases were observed in 12 of these 36 patients. In these 12 patients, at least one hot node was positive for metastasis. The laboratory study revealed that the gamma probe was able to detect radioisotope activities of >/=0.02 micro Ci. Thirty-two of 63 (51%) esophageal cancer hot nodes and 16 of 86 (19%) gastric cancer hot nodes showed radioisotope activities below the detection sensitivity of the gamma probe. CONCLUSION: The sentinel lymph node concept is applicable to patients with esophageal and gastric cancers; however, further studies are necessary to identify hot nodes accurately using gamma probes.     

核素淋巴显像识别前哨淋巴结在乳腺癌治疗中的应用

目的评价核素淋巴显像和γ探针定位在乳腺癌中确定前哨淋巴结(SLN)的应用价值,验证前哨淋巴结活检替代腋窝淋巴结清除术用于乳腺癌治疗的安全性与价值。方法选择1999年6月至2009年11月本院住院的女性乳腺癌患者206例(体检时腋窝均未扪及肿块),应用99Tcm-DX37～74 MBq或99Tcm-SC74 MBq经皮下注射,行核素淋巴显像后,术中注射专利兰1 ml和(或)术中用γ探针定位并行前哨淋巴结活检,与术中冰冻病理检查结果对照。若术中冰冻发现有前哨淋巴结转移,则行腋窝淋巴结清除术,若前哨淋巴结阴性,则不做腋窝淋巴结清除,术后定期随访。结果 206例乳腺癌术中成功活检SLN204例,成功率为99.0%(204/206)。本组有64例仅行SLN切除,术后病理检查证实64例SLN均阴性,故未行腋窝淋巴结清除,其中仅1例于术后1年时出现腋窝淋巴结转移,其余63例患者在随访期间均未发现腋窝淋巴结转移,也未出现同侧上肢水肿、感觉及活动异常;另140例行腋窝淋巴结清除,其中6例经病理证实SLN阳性但腋窝淋巴结为阴性,134例经病理证实SLN阳性35例,阴性99例,腋窝淋巴结阳性37例,阴性97例。核素淋巴显像和γ探针定位法的灵敏度为94.6%(35/37例),准确率为98.5%(138/140),假阴性为5.4%(2/37)。结论核素淋巴显像和γ探针定位应用于乳腺癌是切实可行和可能的,对预测腋窝淋巴结转移有很大的临床实用价值。如技术方法规范,早期乳腺癌前哨淋巴结活检则能取代常规的腋窝淋巴结清除术,乳腺癌手术上肢并发症的发生率可大大降低。     

Gamma probe guided biopsy of the sentinel node in malignant melanoma: a multicentre study

Sentinel lymph node biopsy was attempted in 336 patients with clinically node-negative cutaneous melanoma. All patients were injected with technetium-99m labelled radiocolloid, with 108 patients simultaneously receiving vital blue dye for sentinel node identification. Sentinel lymph nodes were identified in 329 patients, giving a technical success rate of 97.9%. Metastatic disease was identified in 39 (11.9%) of the patients in whom sentinel nodes were found. Patients with negative sentinel nodes were observed and patients with positive sentinel nodes underwent comprehensive lymph node dissection. The presence of metastatic disease in the sentinel nodes and primary tumour depth by Breslow or Clark levels were joint predictors of survival based on Cox proportional hazards modelling. Disease recurrences occurred in 26 (8.8%) patients with negative sentinel lymph nodes, with isolated regional recurrences as the first site in 10 (3.4%). No patients with Clark level II primary tumours were found to have positive sentinel nodes or disease recurrences. One patient with a thin (<0.75 mm) Clark level III primary had metastatic disease in a sentinel node. Patients with metastases confined to the sentinel nodes had similar survival rates regardless of the number of nodes involved.     

早期乳腺癌前哨淋巴结示踪和定位的临床研究

背景与目的:目前乳腺癌手术都常规行腋窝淋巴结清扫(axillarylymphnodedissection,ALND)。对早期乳腺癌行ALND能否提高患者的生存率尚有争论,但其带来的并发症却明确。对早期乳腺癌能否用前哨淋巴结活检(sentinellymphnodebiopsy,SLNB)来代替ALND是目前国际研究的热点。本研究旨在探讨用不同的方法示踪和定位行乳腺癌SLNB的可行性及其临床意义,并探索多层切片加免疫组化技术对判断前哨淋巴结(sentinellymphnode,SLN)微转移灶的意义。方法:对121例早期乳腺癌患者行SLN示踪活检,其中美蓝法38例,单纯用美蓝标记;联合法83例,用美蓝和99mTc-SC同时标记。术后将SLN和所有常规ALND的淋巴结作常规病理检查,对阴性的SLN作3层切片加免疫组化检查,以检测淋巴结的微转移灶。结果:美蓝组和联合组活检的成功率分别为81.6%和95.2%;对腋窝淋巴结状况预测的准确率分别为93.5%和97.5%。淋巴结闪烁成像(lymphoscintigraphy,LS)和手持式γ-探头术前定位SLN的成功率分别为23%和92%(P<0.05)。本组194枚常规病理检查阴性的SLN,后经3层切片加免疫组化检查,发现13例21枚(11%)SLN含微转移灶。再用联合法检查对腋窝淋巴结预测的准确率上升为98.7%;假阴性率下降为3.2%。结论:美蓝法和联合法行SLNB均能准确地反映腋窝淋巴结状况,但联合法相对较好。LS对SLNB的意义尚待进一步探讨。多层切片加免疫组化检查能提高SLN微转移灶的发现率。     

Intradermal radioisotope injection is superior to subdermal injection for the identification of the sentinel node in breast cancer patients

BACKGROUND AND OBJECTIVES: The purpose of the present study was to evaluate whether the intradermal injection of radiocolloids would improve the identification rate of sentinel nodes over the subdermal injection in breast cancer patients. METHODS: Sentinel node biopsy was performed in T2 breast cancer patients with clinically negative nodes, using subdermal or intradermal injection of radioisotopes with the peritumoral dye injection. We used Tc-99m tin colloid, with a larger particle size (0.4-5 microm), rather than sulfur colloid and colloidal albumin. RESULTS: The initial 55 patients underwent subdermal injection of radiocolloids; the next 61 patients underwent intradermal injection of radiocolloids for sentinel node biopsy. The detection rate of sentinel nodes was significantly (P = 0.048) higher in the intradermal injection group (61/61, 100%) than in the subdermal injection group (51/55, 92.7%). False-negative rates were comparable between the two groups. Lymphoscintigraphy visualized the sentinel nodes significantly (P < 0.0001) more often in the intradermal injection group (59/61, 96.7%) than in the subdermal injection group (20/54, 37.0%). CONCLUSIONS: A significantly higher identification rate of sentinel node biopsy and lymphoscintigraphy can be achieved by intradermal injection of Tc-99m tin colloid with a large particle size than by subdermal injection.     

Lymphatic mapping with intralesional tracer administration in breast carcinoma patients

BACKGROUND: The objectives of the study were to determine how often a sentinel lymph node is visualized by lymphoscintigraphy in breast carcinoma patients, how often the sentinel lymph node is identified during surgery, and the sensitivity of these procedures to identify the presence of axillary lymph node metastasis. METHODS: A total of 136 patients were enrolled in 2 hospitals. Preoperative dynamic and static lymphoscintigraphy were performed; in addition, both a vital dye and a gamma detection probe were used intraoperatively. The tracers were injected into the primary lesion. Sentinel lymph node biopsy was followed by completion axillary lymph node dissection. The sentinel lymph nodes and other axillary lymph nodes were examined routinely and by immunohistochemical staining. RESULTS: A sentinel lymph node was visualized by lymphoscintigraphy in 118 patients (87%). During the operation a sentinel lymph node was localized in 126 patients (93%). A total of 224 sentinel lymph nodes were harvested (average of 1.7 and range of 1-4 sentinel lymph nodes per patient). Of all the sentinel lymph nodes, 37 were blue (17%), 68 were radioactive (30%), and 119 were both blue and radioactive (53%). The sentinel lymph nodes contained metastatic disease in 56 patients (44%). Three sentinel lymph node biopsies were false-negative (sensitivity 95%). CONCLUSIONS: Sentinel lymph node biopsy with preoperative lymphoscintigraphy after intralesional tracer administration and intraoperative use of both a gamma detection probe and a vital dye is a reliable technique for staging the axilla of breast carcinoma patients.     

Sentinel lymph node procedure is highly accurate in squamous cell carcinoma of the vulva.

PURPOSE: To determine the diagnostic accuracy of the sentinel lymph node procedure in patients with squamous cell carcinoma of the vulva and to investigate whether step sectioning and immunohistochemistry of sentinel lymph nodes increase the sensitivity for detection of metastases. PATIENTS AND METHODS: Between July 1996 and July 1999, 59 patients with primary vulvar cancer were entered onto a two-center prospective study. All patients underwent sentinel lymph node procedure with the combined technique (preoperative lymphoscintigraphy with technetium-99m-labeled nanocolloid and intraoperative blue dye). Radical excision of the primary tumor with uni- or bilateral inguinofemoral lymphadenectomy was performed subsequently. Sentinel lymph nodes and lymphadenectomy specimens were sent for histopathologic examination separately. Sentinel lymph nodes, negative at the time of routine pathologic examination, were re-examined with step sectioning and immunohistochemistry. RESULTS: In 59 patients, 107 inguinofemoral lymphadenectomies were performed (11 unilateral and 48 bilateral). All sentinel lymph nodes, as observed on preoperative lymphoscintigram, were identified successfully intraoperatively. Routine histopathologic examination showed lymph node metastases in 27 groins, all of which were detected by the sentinel lymph node procedure. The negative predictive value for a negative sentinel lymph node was 100% (97.5% confidence interval [CI], 95% to 100%). Step sectioning and immunohistochemistry showed four additional metastases in 102 sentinel lymph nodes (4%; 95% CI, 1% to 9%) that were negative at the time of routine histopathologic examination. CONCLUSION: Sentinel lymph node procedure with the combined technique is highly accurate in predicting the inguinofemoral lymph node status in patients with early-stage vulvar cancer. Future trials should focus on the safe clinical implementation of the sentinel lymph node procedure in these patients. Step sectioning and immunohistochemistry slightly increase the sensitivity of detecting metastases in sentinel lymph nodes and should be included in these trials.     

CK19表达与子宫颈癌前哨淋巴结转移的关系

目的 观察CK19表达与子宫颈癌前哨淋巴结转移的关系.方法 回顾性分析行宫颈癌根治术治疗的46例宫颈癌患者的临床资料,采用mRNA和免疫组化检测CK19在子宫颈前哨淋巴结中的表达.结果 RT-PCR分析结果显示82个淋巴结中,11个淋巴结CK19高表达,71个淋巴结CK19低表达.免疫组化染色结果显示,11个CK19高表达淋巴结免疫组化染色阳性,71个CK19低表达淋巴结免疫组化染色阴性.多因素分析结果表明CK19高表达与前哨淋巴结转移呈正相关(P<0.05).结论 CK19表达与宫颈癌患者淋巴结转移呈正相关,CK19有可能称为宫颈癌转移的分子标记物.     

Sentinel lymph node biopsy using periareolar injection of radiocolloid for patients with neoadjuvant chemotherapy-treated breast carcinoma

BACKGROUND: The feasibility and accuracy of sentinel lymph node (SLN) biopsy after neoadjuvant chemotherapy (NAC) for patients with breast carcinoma have been investigated primarily for the situation in which the radiocolloid imaging agent is injected peritumorally. No such study has involved periareolar injection of radiocolloid, although the usefulness of this injection technique has been demonstrated in patients with early-stage breast carcinoma who have not been treated with NAC. The objective of the current study was to determine the feasibility and accuracy of SLN biopsy using periareolar injection of radiocolloid for patients with breast carcinoma who were treated with NAC. METHODS: Forty-seven patients with AJCC Stage II or III breast carcinoma who were treated with NAC were enrolled in the study. All patients underwent SLN biopsy, which involved a combination of periareolar injection of radiocolloid (technetium 99m tin colloid) and peritumoral injection of isosulfan blue dye, followed by backup axillary lymph node dissection. SLN metastases were examined by hematoxylin and eosin staining and immunohistochemical analysis using an anticytokeratin antibody. RESULTS: An SLN was identified successfully in 44 patients (94%). Twenty-nine patients (66%) had positive SLNs. Fifteen patients had negative SLNs, and 4 patients had positive non-SLNs. Thus, the false-negative rate was 12.1% (4 of 33 patients). The false-negative rate tended to be higher, although not statistically significantly so, among patients who had clinically positive axillary lymph nodes before and/or after NAC (15.8%; 3 of 19 patients) compared with patients who had clinically negative axillary lymph nodes both before and after NAC (7.1%; 1 of 14 patients). CONCLUSIONS: SLN biopsy using periareolar injection of radiocolloid is feasible after NAC. In patients with clinically negative axillary lymph nodes both before and after NAC, SLN biopsy was capable of predicting axillary lymph node status with an accuracy comparable to the accuracy associated with SLN biopsy for patients with early-stage carcinoma who have not been treated with NAC.