Sentinel lymph node in endometrial cancer

The aim of this study was to evaluate the possibility of identifying the sentinel lymph node and involvement of neoplastic cells in patients with endometrial carcinoma limited to the uterus, and also its correlation with the conditions of other pelvic and para-aortic lymph nodes. Forty patients with endometrial carcinoma, clinical staging I and II, were submitted to complete surgical staging through laparotomy, as recommended by FIGO in 1988. The sentinel node was investigated using patent blue dye in the myometrial subserosa. The sentinel node was excised and submitted to frozen section examination of specimen, stained with hematoxylin and eosin (H&E). Afterward, selective bilateral para-aortic and pelvic lymphadenectomy, total hysterectomy with bilateral salpingo-oophorectomy were performed. The lymph nodes excised were examined by means of paraffin-embedded slices stained with H&E and of imunohistochemistry with antikeratin antibody AE1/AE3. The sentinel lymph node was identified in 77.5% of patients (31/40), and 16.1% (5/31) presented neoplastic involvement in the node. In 25 cases of negative sentinel node, 96% (24/25) had no neoplastic involvement, and 4% (1/25) had other lymph node affected (false negative). In nine cases with no sentinel node identified, 55.5% (5/9) had lymph node involvement. The results of this study allow us to conclude that it is possible to identify the sentinel node using the methods described, and the pathologic examination significantly represents the same conditions of other pelvic and para-aortic lymph nodes.     

Sentinel lymph node detection in patients with endometrial cancer

OBJECTIVE: The purpose of this study was to examine the feasibility of sentinel lymph node (SLN) detection in patients with endometrial cancer using preoperative lymphoscintigraphy and an intraoperative gamma probe. PATIENTS AND METHODS: Between June 2001 and January 2003, 28 consecutive patients with endometrial cancer who were scheduled for total abdominal hysterectomy, bilateral salpingo-oophorectomy, total pelvic lymphadenectomy, and paraaortic lymphadenectomy at Tohoku University School of Medicine underwent sentinel lymph node detection. On the day before surgery, preoperative lymphoscintigraphy was performed by injection of 99m-Technetium ((99m)Tc)-labeled phytate into the endometrium during hysteroscopy. At the time of surgery, a gamma-detecting probe was used to locate radioactive lymph nodes. RESULTS: At least one sentinel node was detected in each of 23 of the 28 patients (82%). The mean number of sentinel nodes detected was 3.1 (range, 1-9). Sentinel nodes could be identified in 21 of 22 patients (95%) whose tumor did not invade more than halfway into the myometrium. Eighteen patients had radioactive nodes in the paraaortic area. Most patients had a sentinel node in one of the following three sites: paraaortic, external iliac, and obturator. The sensitivity and specificity for detecting lymph node metastases were both 100%. CONCLUSION: The combination of preoperative lymphoscintigraphy with intraoperative gamma probe detection may be useful in identifying sentinel nodes in early-stage endometrial cancer.     

Sentinel lymph node biopsy in endometrial cancer: meta-analysis of 26 studies

Objective

The validity of the sentinel lymph node (SLN) procedure for the assessment of nodal status in patients with endometrial cancer is unclear. We aimed to assess the diagnostic performance of this procedure.

Methods

We searched the PubMed and Embase databases for studies published before June 1, 2011. Eligible studies had a sample size of at least 10 patients, and reported the detection rate and/or sensitivity of the SLN biopsy.

Results

We identified 26 eligible studies, which included 1101 SLN procedures. The overall weighted-mean number of harvested SLNs was 2.6. The detection rate and the sensitivity were 78% (95% confidence interval [CI] = 73%-84%) and 93% (95% CI = 87%-100%), respectively. Significant between-study heterogeneity was observed in the analysis of the detection rate (I-squared statistic, 80%). The use of pericervical injection was correlated with the increase of the detection rate (P = 0.031). The hysteroscopic injection technique was associated with the decrease of the detection rate (P = 0.045) and the subserosal injection technique was associated with the decrease of the sensitivity (P = 0.049), if they were not combined with other injection techniques. For the detection rate, significant small-study effects were noted (P < 0.001).

Conclusions

Although SLN biopsy has shown good diagnostic performance in endometrial cancer, such performance should be interpreted with caution because of significant small study effects. Current evidence is not yet sufficient to establish the true performance of SLN biopsy in endometrial cancer.     

Sentinel lymph node in breast cancer

PURPOSE OF REVIEW: Sentinel lymph node biopsy has become an accepted standard in staging axillary lymph nodes for breast cancer, but there are still unresolved questions regarding the application of the sentinel node procedure. The purpose of this review is to highlight recent developments in sentinel lymph node biopsy for breast cancer. RECENT FINDINGS: Recent evidence has demonstrated that subareolar injection immediately before surgery is an acceptable and accurate alternative to peritumoral injection, and that lymphoscintigraphy is not always necessary. The use of sentinel lymph node biopsy with neoadjuvant chemotherapy and ductal carcinoma in situ continues to undergo investigation. Recently completed clinical trials will answer questions relating to the value of identifying isolated tumor cells in the sentinel node by immunohistochemistry, and the need for axillary node dissection when the sentinel node is positive. SUMMARY: Sentinel lymph node biopsy is an accepted standard for stage I and II breast cancer, and is investigational with stage III cancer or with neoadjuvant therapy, as well as with ductal carcinoma in situ. Patients should be made aware of relevant issues as part of providing informed consent for surgery and subsequent therapy.     

Sentinel node procedures in gynecologic cancers: an overview

The aim of this study was to assess the value of sentinel lymph node procedures in gynecologic cancers. A systematic literature overview, using the PubMed database, was performed. In early stage vulvar, endometrial and cervical cancer, lymph node status is the most important prognostic factor. Lymphadenectomy, performed for adequate staging, is associated with high morbidity rates. Sentinel node procedures hold the promise of adequate staging with less treatment-related morbidity. Sentinel lymph node procedures in patients with early-stage vulvar cancer are associated with low recurrence rates, excellent survival, lower morbidity and shorter hospital stay compared to classical inguinal dissection. Therefore, these procedures should be the standard of care in early-stage unilateral vulvar cancer. Reports on sentinel lymph node procedures in endometrial and cervical cancer are ambiguous. The procedures in these cancers are reported in small studies only. Detection rates vary depending on the used injection sites and the used tracers. Bilateral detection rates are low and are not mentioned by default. Large controlled multi-institutional studies are necessary to evaluate the validity and the prognostic significance of the sentinel lymph node procedures in endometrial and cervical cancer.     

Sentinel lymph node mapping for endometrial cancer improves the detection of metastatic disease to regional lymph nodes

Objective

To compare the incidence of metastatic cancer cells in sentinel lymph nodes (SLN) vs. non-sentinel nodes in patients who had lymphatic mapping for endometrial cancer and to determine the contribution of metastases detected on ultrastaging to the overall nodal metastasis rate.

Methods

All patients who underwent lymphatic mapping for endometrial cancer were reviewed. Cervical injection of blue dye was used in all cases. Sentinel nodes were examined by routine hematoxylin and eosin (H&E), and if negative, by standardized institutional pathology protocol that included additional sections and immunohistochemistry (IHC).

Results

Between 09/2005 and 03/2010, 266 patients with endometrial cancer underwent lymphatic mapping. Sentinel node identification was successful in 223 (84%) cases. Positive nodes were diagnosed in 32/266 (12%) patients. Of those, 8/266 patients (3%) had the metastasis detected only by additional section or IHC as part of SLN ultrastaging. Excluding the 8 cases with positive SLN on ultrastaging only, 24/801 (2.99%) SLN and 30/2698 (1.11%) non-SLN were positive for metastatic disease (p = 0.0003).

Conclusion

Using a cervical injection for mapping, metastatic cells from endometrial cancer are three times as likely to be detected in SLN than in the non-sentinel nodes. This finding strongly supports the concept of lymphatic mapping in endometrial cancer to fine tune the nodal dissection topography. By adding SLN mapping to our current surgical staging procedures we may increase the likelihood of detecting metastatic cancer cells in regional lymph nodes. An additional benefit of incorporating pathologic ultrastaging of SLN is the detection of micrometastasis, which may be the only evidence of extrauterine spread.     

Sentinel lymph node detection in patients with cervical cancer

PURPOSE: We investigated the validity of sentinel lymph node (SLN) detection after radioactive isotope and/or blue dye injection in patients with cervical cancer. PATIENTS AND METHODS: Between December 1998 and May 2000, 50 patients (mean age 44 years) with cervical cancer FIGO stage I (n = 32), stage II (n = 16), or stage IV (n = 2) underwent SLN detection during primary operation (radical laparoscopic-vaginal or abdominal hysterectomy, exenteration). The day before surgery 1 ml of Albu-Res labeled with 50 MBq Technetium 99m was applied into the cervix at 3(00), 6(00), 9(00), and 12(00). Blue dye injection (Patentblue) occurred intraoperatively into the cervix at the same locations. RESULTS: The detection rate of SLN was 78%. Ten patients (20.0%) were diagnosed with lymph node metastases. No SLN was detected in 10 patients, of which 4 patients had positive lymph nodes. Sensitivity and negative predictive value were 83.3 and 97.1%, respectively. The false-negative rate was 16.6% (1 of 6 patients). After the combined injection, the detection rate, sensitivity, and negative predictive values were 100%. A mean of 2.7 pelvic and 2.6 para-aortic SLNs were detected. Para-aortic SLNs were located in the paracaval region in 66.6%, whereas pelvic SLNs were detected in 25.7% at the origin of the uterine artery and in 24.7% at the division of the common iliac artery. CONCLUSION: A combination of radioactively labeled albumin with blue dye allows successful detection of SLN in patients with cervical cancer. The clinical validity of this technique must be evaluated prospectively.     

Sentinel lymph node biopsy in breast cancer: state of the art

Axillary lymph node excision of level I and II with at least 10 lymph nodes is the operative gold standard for invasive breast cancer. Axillary lymph node excision is a diagnostic procedure for histopathologic tumor classification, for assessment of prognosis, local tumor control and adjuvant therapy decision. The sentinel node biopsy is a minimal-invasive procedure to determine the axillary lymph node status by excision of one or more sentinel nodes. This procedure is being increasingly implemented in breast cancer surgery. The classical axillary lymph node excision can be replaced by sentinel node biopsy if sentinel nodes are free of invasion in the intraoperative as well as in the final histopathological report. Sentinel node biopsy can become an operative routine procedure only in a quality-controlled environment.     

Sentinel lymph node biopsy improves staging in early cervical cancer

OBJECTIVES: The main study objective was to describe the distribution of sentinel lymph nodes (SLNs) and the prevalence of SLN micrometastases in patients with early cervical cancer. The secondary objective was to confirm the SLN detection rate and negative predictive value found in our preliminary study. PATIENTS AND METHODS: We prospectively included 25 patients with early cervical cancer, each of whom received an injection of 120 MBq of technetium-99m for preoperative lymphoscintigraphy and intraoperative node detection using an endoscopic gamma probe. Patent blue dye was injected intraoperatively. SLNs were sought in the pelvic and para-aortic drainage areas. Radical iliac dissection was performed routinely at the end of the procedure. SLNs were examined after hematoxylin-eosin-saffron staining; negative specimens were assessed using immunohistochemistry. RESULTS: Most (85%) of the SLNs were in the inter-iliac territory. Para-aortic or parametrial SLNs were found respectively in 2 patients and common iliac SLNs in 5 patients. Thus 9/25 patients had additional information due to SLN detection. One metastasis and one micrometastasis were detected in SLNs. No patients had positive non-sentinel nodes with negative SLNs. CONCLUSION: SLN detection ensures the identification of SLNs in unusual locations in 36% of patients. SLN disease was found in 8% of our patients. Thus, SLN biopsy improves staging in patients with early cervical cancer. Studies in larger patient populations are needed to evaluate the clinical impact of SLN biopsy.     

Sentinel lymph node biopsy in breast cancer patients--results and experience after 500 sentinel lymph node biopsies

INTRODUCTION: Sentinel lymph node biopsy (SLNB) is a widely used technique for axillary staging in breast cancer patients. The principle to evaluate the axillary status of a breast cancer patient with a less invasive surgery than axillary lymph node dissection (ALND) meets the new minimally invasive concept in breast cancer surgery. Some breast cancer centers proceed to SLNB without ALND in SLN-negative patients. PATIENTS AND METHODS: Between March 1998 and March 2002, 500 SLNBs were performed. After a learning period with SLNB and ALND in 75 patients with a sensitivity of 96.2% and a false-negative rate of 3.8%, SLNB alone without further ALND was performed in a group of patients. In addition, the feasibility of SLNBin patients with locally advanced breast cancer, in patients after neoadjuvant chemotherapy and in patients with multicentricity was evaluated. The combined method with blue dye and technetium-99m-labeled human albumin for identification of SLNs was applied. RESULTS: 500 SLNBs were performed. The identification rate was 86.2%. After exclusion of patients with neoadjuvant chemotherapy and patients with multicentricity, the identification rate was 94.5%. SLNs were positive in 41.3% of patients and negative in 58.7% of patients. DISCUSSION: SLNB is an excellent method for axillary stag-ing and an alternative for ALND in a certain group of breast cancer patients.     

子宫内膜癌淋巴结切除意义及指征

子宫内膜癌采用手术病理分期,然而是否对所有子宫内膜癌患者都行全面分期手术(全子宫切除术+双附件切除术+双侧盆腔淋巴结及腹主动脉旁淋巴结切除)争议广泛,尤其是对于早期子宫内膜癌患者淋巴结切除的价值值得探讨。文章回顾子宫内膜癌淋巴结切除的最新研究进展,进一步讨论淋巴结切除的意义及指征。     

Value of sentinel lymph node procedure in endometrial cancer

In cancer research, regional lymph node status is a major prognostic factor and a decision criterion for adjuvant therapy. The sentinel node procedure, which has emerged to reduce morbidity of extensive lymphadenectomy, remains a major step in the surgical management of various cancers. Sentinel node procedure has become a standard technique for the determination of the nodal stage of the disease in patients with melanoma, vulvar cancer and in breast cancer. In endometrial cancer, the sentinel node biopsy is still at the stage of feasibility. In this article, we review the technical aspects, results, clinical implications and limitations of sentinel node procedure in endometrial cancers.     

Sentinel lymph node biopsy in breast cancer: feasibility study and initial experiments

OBJECTIVE: To evaluate and accredit the sentinel lymph node biopsy in the surgical treatment of breast cancer in our institute. PATIENTS AND METHODS: From February to September 2001 at Tenon Hospital, 64 patients with breast cancer and clinically negative node underwent sentinel lymph node biopsy followed immediately by standard axillary dissection. Both blue dye and radioisotope were used in the majority of patients (70.4%) to identify the sentinel node. These sentinel nodes were evaluated by hematoxylin and eosin, immunohistochemistry and multiple sections. RESULTS: The mean tumor diameter was 17.2 mm (range, 7 to 40 mm). The sentinel node was identified in 97% of the cases (62/64). Of the 62 patients, 24 were histologically positive (38.7%). The sentinel node was falsely negative in one patient (4%). In patients with tumors less than 20 mm, the identification and false negative rates were 97.8% and 0%, respectively. CONCLUSIONS: Our study confirms the validity of the sentinel lymph node. This procedure identifies in a reliable way the sentinel node in most cases. The histological characteristics of the sentinel node reflect those of the rest of the axillary lymph nodes. This procedure appears more accurate for patients with tumors less than 20 mm. This procedure will become the method of choice for axillary staging in small-sized breast cancer. This minimally invasive procedure represents a major step in the field of breast cancer treatment.     

Sentinel lymph node biopsy: benefits and limitations

Multiple studies have demonstrated that a sentinel node can be identified in most women with breast cancer, and that it reliably predicts the status of the remaining axillary nodes. Contraindications to the procedure are decreasing with experience but further long term follow up is needed.     

Meta-analysis of laparoscopy sentinel lymph node mapping in endometrial cancer

Objective

Sentinel lymph node (SLN) mapping for endometrial cancer (EC) is a contemporary technique that could provide benefits over traditional lymphadenectomy. Comprehensive published literature on sentinel lymph node mapping for laparoscopy surgery in EC, data extraction, evidence-based medicine-based methods, and meta-analysis are carried out to further explore sentinel lymph node mapping in laparoscopy surgery in EC. The application value provides basis for prevention and treatment of EC.

Materials and methods

We searched Medline, Embase, and the Cochrane Central for studies published before February 1, 2018 which had a sample size of at least ten patients, and reported the detection rate and/or sensitivity of the laparoscopy SLN biopsy. Statistical analysis was conducted using R-2.15.2 software.

Results

The overall detection rate of sentinel lymph node mapping was included in 389 patients of 8 studies, ranging from 25 to 71 patients, which was 96% (95% confidence interval 95–98). 366 patients were included in bilateral sentinel node detection rate, ranging from 30 to 71 patients; it was 73% (95% confidence interval, 69–77). The sensitivity of the overall detection rate of sentinel lymph node mapping was 96.3% with a sensitivity of 73.1% bilateral sentinel node detection rate.

Conclusions

Laparoscopy sentinel lymph node localization is feasible and accurately predicts lymph node status in patients with EC. For patients with early stage clinical disease, it is very important to screen patients with no lymph node metastasis, reduce the range of surgical resection, reduce the incidence of the corresponding complications, and improve the quality of patients.