cN0舌癌前哨淋巴结定位方法研究

背景与目的：由于没有任何临床检查方法或生化标志能准确的评价临床NO（clinically negative neck,cNO)舌癌颈部淋巴结转移的状况。因而,目前对cNO舌癌的颈部治疗存在一定的盲目性。前哨淋巴结（sentinel node,SN)活检的应用为指导cNO舌癌患者颈部的个体化治疗提供了依据。本研究旨在探讨SN活检能否准确评价cNO舌癌的颈部淋巴结转移状况,寻找舌癌前哨淋巴结定位的最佳方法。方法：使用术前核素扫描法和术中亚甲蓝示踪法对24例cNO舌癌患者进行SN示踪,研究SN活检在评价cNO舌癌颈部淋巴结转移状况中的作用。对比核素扫描法,亚甲蓝示踪法,两法结合示踪法的优缺点。结果：3种方法全组SN检出率均为100%,24例中有4例手术标本发现有颈淋巴结转移（即隐匿性颈淋巴结转移,cNOpN^ ),SN活检对全组病例颈部淋巴结转移状况评价的准确率为100%。无假阴性;平均检出SN数目;核素扫描法3.5枚/例,亚甲蓝示踪法2.7枚/例,两法结合示踪法2.2枚/例。结论：核素扫描法和亚甲蓝示踪法均能有效地对cNO舌癌进行SN定位并准确地评价颈部淋巴结转移状况,两法结合SN示踪法最为准确。并且具有可操作性和实用性。     

舌体鳞癌前哨淋巴结的放射性胶体定位

背景与目的:目前缺乏一种特异性的诊断手段能在术前准确地评价临床颈淋巴结阴性(clinically negetive neck,cN0)舌癌患者的颈部隐匿性转移状况,所以其颈部的手术处理还存在争议.而前哨淋巴结(sentinel lymph node,SLN)活检的应用可能为cN0舌癌患者颈部个体化治疗提供依据.本研究旨在探讨cN0舌体鳞癌前哨淋巴结放射性胶体定位的可行性,以及前哨淋巴结检测的临床价值.方法:选择21例cNO患者,其中初诊者20例,原发灶有手术史者1例.手术当天于舌肿瘤周围多点注射99mTc-SC,尽量包绕肿瘤,全部患者术前及术中用γ探测仪探测SLN,其中5例患者结合使用术前核素扫描示踪SLN,全部患者行肩胛舌骨肌上颈清扫,以颈清扫标本的常规病理结果为金标准,评价放射性胶体定位SLN的准确率.对常规病理检查阴性的SLN进一步行免疫组化检查.结果:21例患者定位到SLN(共41枚),SLN检出率为100%(21/21),其中20例患者SLN的病理检查结果与颈清扫的病理检查结果相符合,准确率95%(20/21).1例患者SLN病理阴性,而颈清扫标本出现阳性淋巴结,为假阴性.多层切片加免疫组化微转移检出率为7.3%(3/41).结论:舌癌SLN放射性胶体定位是可行的,SLN活检能较好地预测颈部淋巴结转移状况,但其临床应用价值还需进一步研究.     

cN0喉癌前哨淋巴结的检测及意义

目的 应用核素法、染料法以及二者联合法检测cN0喉癌患者前哨淋巴结(SLN),并评价SLN对颈部淋巴结转移状况的预测价值.方法 41例cN0喉癌患者采用核素法、染料法和联合法示踪SLN.核素法为手术前于喉镜引导下在肿瘤周围注射99TCm-硫胶体(SC)进行SLN显像,手术中用γ探针探测放射性"热点";染料法为手术中注射亚甲蓝,示踪蓝染的SIN;联合法为将核素法和染料法联合应用的方法.结果 核素法、染料法和联合法对SLN的检出率分别为87.8%、70.7%和92.7%(P<0.01);核素法与联合法、染料法与联合法检出SIN数目的 差异有统计学意义(P<0.05,P<0.01),核素法与染料法检出SLN数目的 差异无统计学意义(P>0.05).病理结果示,有9例患者淋巴结转移,占22.0%.联合法检测SLN的灵敏度、准确度和阴性预测值分别为88.9%、97.4%和96.7%.结论 联合应用核素法和染料法可提高SEN检出的准确性,SLN的病理结果可以准确预测cN0喉癌患者颈部淋巴结的病理状态.     

cN0喉癌前哨淋巴结的检测及意义

目的 应用核素法、染料法以及二者联合法检测cN0喉癌患者前哨淋巴结(SLN),并评价SLN对颈部淋巴结转移状况的预测价值.方法 41例cN0喉癌患者采用核素法、染料法和联合法示踪SLN.核素法为手术前于喉镜引导下在肿瘤周围注射99TCm-硫胶体(SC)进行SLN显像,手术中用γ探针探测放射性"热点";染料法为手术中注射亚甲蓝,示踪蓝染的SIN;联合法为将核素法和染料法联合应用的方法.结果 核素法、染料法和联合法对SLN的检出率分别为87.8%、70.7%和92.7%(P<0.01);核素法与联合法、染料法与联合法检出SIN数目的 差异有统计学意义(P<0.05,P<0.01),核素法与染料法检出SLN数目的 差异无统计学意义(P>0.05).病理结果示,有9例患者淋巴结转移,占22.0%.联合法检测SLN的灵敏度、准确度和阴性预测值分别为88.9%、97.4%和96.7%.结论 联合应用核素法和染料法可提高SEN检出的准确性,SLN的病理结果可以准确预测cN0喉癌患者颈部淋巴结的病理状态.     

cN0喉癌前哨淋巴结的检测及意义

目的 应用核素法、染料法以及二者联合法检测cN0喉癌患者前哨淋巴结(SLN),并评价SLN对颈部淋巴结转移状况的预测价值.方法 41例cN0喉癌患者采用核素法、染料法和联合法示踪SLN.核素法为手术前于喉镜引导下在肿瘤周围注射99TCm-硫胶体(SC)进行SLN显像,手术中用γ探针探测放射性"热点";染料法为手术中注射亚甲蓝,示踪蓝染的SIN;联合法为将核素法和染料法联合应用的方法.结果 核素法、染料法和联合法对SLN的检出率分别为87.8%、70.7%和92.7%(P<0.01);核素法与联合法、染料法与联合法检出SIN数目的 差异有统计学意义(P<0.05,P<0.01),核素法与染料法检出SLN数目的 差异无统计学意义(P>0.05).病理结果示,有9例患者淋巴结转移,占22.0%.联合法检测SLN的灵敏度、准确度和阴性预测值分别为88.9%、97.4%和96.7%.结论 联合应用核素法和染料法可提高SEN检出的准确性,SLN的病理结果可以准确预测cN0喉癌患者颈部淋巴结的病理状态.     

cN0喉癌前哨淋巴结的检测及意义

目的 应用核素法、染料法以及二者联合法检测cN0喉癌患者前哨淋巴结(SLN),并评价SLN对颈部淋巴结转移状况的预测价值.方法 41例cN0喉癌患者采用核素法、染料法和联合法示踪SLN.核素法为手术前于喉镜引导下在肿瘤周围注射99TCm-硫胶体(SC)进行SLN显像,手术中用γ探针探测放射性"热点";染料法为手术中注射亚甲蓝,示踪蓝染的SIN;联合法为将核素法和染料法联合应用的方法.结果 核素法、染料法和联合法对SLN的检出率分别为87.8%、70.7%和92.7%(P<0.01);核素法与联合法、染料法与联合法检出SIN数目的 差异有统计学意义(P<0.05,P<0.01),核素法与染料法检出SLN数目的 差异无统计学意义(P>0.05).病理结果示,有9例患者淋巴结转移,占22.0%.联合法检测SLN的灵敏度、准确度和阴性预测值分别为88.9%、97.4%和96.7%.结论 联合应用核素法和染料法可提高SEN检出的准确性,SLN的病理结果可以准确预测cN0喉癌患者颈部淋巴结的病理状态.     

cN0喉癌前哨淋巴结的检测及意义

目的 应用核素法、染料法以及二者联合法检测cN0喉癌患者前哨淋巴结(SLN),并评价SLN对颈部淋巴结转移状况的预测价值.方法 41例cN0喉癌患者采用核素法、染料法和联合法示踪SLN.核素法为手术前于喉镜引导下在肿瘤周围注射99TCm-硫胶体(SC)进行SLN显像,手术中用γ探针探测放射性"热点";染料法为手术中注射亚甲蓝,示踪蓝染的SIN;联合法为将核素法和染料法联合应用的方法.结果 核素法、染料法和联合法对SLN的检出率分别为87.8%、70.7%和92.7%(P<0.01);核素法与联合法、染料法与联合法检出SIN数目的 差异有统计学意义(P<0.05,P<0.01),核素法与染料法检出SLN数目的 差异无统计学意义(P>0.05).病理结果示,有9例患者淋巴结转移,占22.0%.联合法检测SLN的灵敏度、准确度和阴性预测值分别为88.9%、97.4%和96.7%.结论 联合应用核素法和染料法可提高SEN检出的准确性,SLN的病理结果可以准确预测cN0喉癌患者颈部淋巴结的病理状态.     

cN0喉癌前哨淋巴结的检测及意义

目的 应用核素法、染料法以及二者联合法检测cN0喉癌患者前哨淋巴结(SLN),并评价SLN对颈部淋巴结转移状况的预测价值.方法 41例cN0喉癌患者采用核素法、染料法和联合法示踪SLN.核素法为手术前于喉镜引导下在肿瘤周围注射99TCm-硫胶体(SC)进行SLN显像,手术中用γ探针探测放射性"热点";染料法为手术中注射亚甲蓝,示踪蓝染的SIN;联合法为将核素法和染料法联合应用的方法.结果 核素法、染料法和联合法对SLN的检出率分别为87.8%、70.7%和92.7%(P<0.01);核素法与联合法、染料法与联合法检出SIN数目的 差异有统计学意义(P<0.05,P<0.01),核素法与染料法检出SLN数目的 差异无统计学意义(P>0.05).病理结果示,有9例患者淋巴结转移,占22.0%.联合法检测SLN的灵敏度、准确度和阴性预测值分别为88.9%、97.4%和96.7%.结论 联合应用核素法和染料法可提高SEN检出的准确性,SLN的病理结果可以准确预测cN0喉癌患者颈部淋巴结的病理状态.     

cN0喉癌前哨淋巴结的检测及意义

目的 应用核素法、染料法以及二者联合法检测cN0喉癌患者前哨淋巴结(SLN),并评价SLN对颈部淋巴结转移状况的预测价值.方法 41例cN0喉癌患者采用核素法、染料法和联合法示踪SLN.核素法为手术前于喉镜引导下在肿瘤周围注射99TCm-硫胶体(SC)进行SLN显像,手术中用γ探针探测放射性"热点";染料法为手术中注射亚甲蓝,示踪蓝染的SIN;联合法为将核素法和染料法联合应用的方法.结果 核素法、染料法和联合法对SLN的检出率分别为87.8%、70.7%和92.7%(P<0.01);核素法与联合法、染料法与联合法检出SIN数目的 差异有统计学意义(P<0.05,P<0.01),核素法与染料法检出SLN数目的 差异无统计学意义(P>0.05).病理结果示,有9例患者淋巴结转移,占22.0%.联合法检测SLN的灵敏度、准确度和阴性预测值分别为88.9%、97.4%和96.7%.结论 联合应用核素法和染料法可提高SEN检出的准确性,SLN的病理结果可以准确预测cN0喉癌患者颈部淋巴结的病理状态.     

cN0喉癌前哨淋巴结的检测及意义

目的 应用核素法、染料法以及二者联合法检测cN0喉癌患者前哨淋巴结(SLN),并评价SLN对颈部淋巴结转移状况的预测价值.方法 41例cN0喉癌患者采用核素法、染料法和联合法示踪SLN.核素法为手术前于喉镜引导下在肿瘤周围注射99TCm-硫胶体(SC)进行SLN显像,手术中用γ探针探测放射性"热点";染料法为手术中注射亚甲蓝,示踪蓝染的SIN;联合法为将核素法和染料法联合应用的方法.结果 核素法、染料法和联合法对SLN的检出率分别为87.8%、70.7%和92.7%(P<0.01);核素法与联合法、染料法与联合法检出SIN数目的 差异有统计学意义(P<0.05,P<0.01),核素法与染料法检出SLN数目的 差异无统计学意义(P>0.05).病理结果示,有9例患者淋巴结转移,占22.0%.联合法检测SLN的灵敏度、准确度和阴性预测值分别为88.9%、97.4%和96.7%.结论 联合应用核素法和染料法可提高SEN检出的准确性,SLN的病理结果可以准确预测cN0喉癌患者颈部淋巴结的病理状态.     

Sentinel node localization in primary melanoma: learning curve and results

Ninety primary melanoma patients were studied to investigate the importance of adopting the simultaneous use of patent blue dye (PBD) and lymphoscintigraphy plus gamma detection probe to locate the sentinel node (SN). In total 135 SNs in 105 basins were visualized preoperatively under a gamma camera after lymphoscintigraphy. When a SN was identified intraoperatively, its radioactivity level and colour were verified and documented. Two of the SNs seen on lymphoscintigraphy were not found. Using PBD 78.52% of the SNs were identified; 95.5% were identified using the gamma detection probe. Using both methods together 98.5% of the SNs were detected. Twenty-two patients (24.4%) had pathologically positive SNs. The surgical learning curve was assessed for the two techniques. The learning curve associated with the methodology was important in finding the SN when using PBD associated with lymphoscintigraphy, but not when the gamma detection probe was used; we found a statistically significant reduction in the percentage of stained SNs found using PBD in the initial 14 SNs biopsied compared with the subsequent 121 nodes. This is important as not all institutions have access to a gamma probe. The time required to identify each SN was documented and analysed. The duration of the procedure was significantly shorter for stained SNs than for non-stained SNs, which support the use of both PBD and the gamma probe. In conclusion, SN biopsy should be performed by surgeons and nuclear medicine doctors in co-operation, both methods being adopted simultaneously to reduce the percentage of procedure failures.     

Sentinel node biopsy procedures with an analysis of recurrence patterns and prognosis in melanoma patients: technical advantages using computer-assisted gamma probe with adjustable collimation

The purpose of this study was to investigate whether a computer-assisted gamma probe with adjustable collimation could aid in the detection of sentinel nodes (SNs) and to analyse the patterns of recurrence and prognosis in SN-positive and SN-negative cases. We analysed 385 SN biopsies. The SN identification rate was 87.2% using preoperative lymphoscintigraphy and blue dye, 93.9% using preoperative lymphoscintigraphy, blue dye and different probes, and 100% using preoperative lymphoscintigraphy, blue dye and a computer-assisted probe with adjustable collimation. The computer-assisted probe was particularly advantageous in cases where the melanoma was located very close to the SN and in cases of deep-seated nodes or nodes with low uptake, due to the possibility of changing the collimation during the procedure. The SN-positive rate according to the thickness of the primary melanoma was 1.7% for melanomas < or = 1 mm in thickness and 27.5% for melanomas > or = 1 mm. In 4.9% of cases we identified nodes outside the regional nodal basin. In one case we found a micrometastasis in a blue and hot interval node of the lateral abdominal wall. Analysing the node counts registered by the computer-assisted probe, we verified that the blue-positive node for tumour metastases was not the most radioactive node in the field in six out of 52 positive cases (11.5%). Distant metastases were present in 2.0% of SN-negative patients, and in 24% of SN-positive patients (P < 0.001). Highly statistically significant differences were found between SN-negative and SN-positive patients in both the 3 year disease-free survival (86.3% versus 49.2%) and the 3 year disease-specific survival (92.3% versus 77.1%) (P < 0.001).     

甲状腺乳头状癌前哨淋巴结活检的临床意义

目的 探讨甲状腺乳头状癌颈部前哨淋巴结(SLN)活检的准确性及可行性.方法 前瞻性分析23例临床淋巴结阴性(cNO)的甲状腺乳头状癌患者,术前2～5 h在超声引导下瘤体内注入99Tcm-右旋糖酐(99Tcm-DX)74 MBq,术中在肿瘤周围注入亚甲蓝0.2～0.4 ml.采用核素法(淋巴结闪烁显像法+γ探针法)和染料法定位SLN,并行术中冰冻病理检查,与术后颈清扫标本常规病理进行对照.结果 23例甲状腺乳头状癌患者均检测出SLN,检出率达100%(23/23).其中染料法和核素法的检出率分别为87.0%和100%.23例患者中,SLN冰冻阳性12例.1例术中冰冻检测SLN未发现转移癌而术后常规病理发现转移;1例SLN冰冻及病理均未发现转移,但颈清扫标本中非SLN(Ⅵ区)有转移.有21例患者的SLN活检结果与术后颈部淋巴结常规病理结果相符,准确度为91.3%(21/23),阳性预测值为100%(12/12),阴性预测值为81.8%(9/11).结论 SLN活检对预测cNO甲状腺乳头状癌的颈部淋巴结转移和指导临床治疗有重要的意义.     

Detection of sentinel nodes by lymphoscintigraphy and gamma probe guided surgery in vulvar neoplasia

BACKGROUND: Pathologic lymph node status is the most important prognostic factor in vulvar cancer; however, complete inguinofemoral node dissection is associated with significant morbidity. Intraoperative lymphoscintigraphy associated with gamma detecting probe-guided surgery has proved to be reliable in the detection of sentinel node (SN) involvement in melanoma and breast cancer patients. The present study evaluates the feasibility of the surgical identification of inguinal sentinel nodes using lymphoscintigraphy and a gamma detecting probe in patients with early vulvar cancer. METHODS: Technetium-99-labeled colloid human albumin was administered perilesionally in 44 patients. Twenty patients had T1 and 23 had T2 invasive epidermoid vulvar cancer; one patient had a lower-third vaginal cancer. An intraoperative gamma detecting probe was used to identify SNs during surgery. Complete inguinofemoral node dissection was subsequently performed. SNs underwent separate pathologic evaluation. RESULTS: A total of 77 groins were dissected in 44 patients. SNs were identified in all the studied groins. Thirteen cases had positive nodes: the SN was positive in all of them; in 10 cases the SN was the only positive node. Thirty-one patients showed negative SNs: all of them were negative for lymph node metastasis. CONCLUSIONS: Lymphoscintigraphy and SN biopsy under gamma detecting probe guidance proved to be an easy and reliable method for detection of SNs in early vulvar cancer. If these preliminary data will be confirmed, the technique would represent a real progress towards less aggressive treatment in patients with vulvar cancer.     

Role of routine preoperative lymphoscintigraphy in sentinel node biopsy for breast cancer

Sentinel node biopsy (SNB) is rapidly emerging as the preferred technique for nodal staging in breast cancer. When radioactive colloid is used, a preoperative lymphoscintiscan is obtained to ease sentinel lymph node (SN) identification. This study evaluates whether preoperative lymphoscintigraphy adds diagnostic accuracy to offset the additional time and cost required. 823 breast cancer patients underwent SNB based on lymphoscintigraphy, intraoperative gamma probe detection, and blue dye mapping using 99 mTc-nanocolloid and Patent Blue V injected peritumourally. The SNB was followed by standard axillary treatment at the same operation. Preoperative lymphoscintigraphy was performed around 3 h after the radioisotope injection. Preoperative lymphoscintigraphy revealed SNs in 593 (72%) of the 823 patients imaged. SN visualisation on lymphoscintigraphy was less successful in large tumours and tumours involving the upper outer quadrant of the breast (P=0.046, P<0.001, respectively). Lymphoscintigraphy showed internal mammary sentinel nodes in 9% (62/707) patients. The SN was identified intraoperatively in 98% (581) patients who had SN visualised on preoperative lymphoscintigraphy, with a false-negative rate of 7%. In patients who did not have SN visualised on preoperative lymphoscintigraphy, the SN was identified at operation in 90% (204) patients, with a false-negative rate of 7%. The SN identification rate was significantly higher in patients with SN visualised on preoperative lymphoscintigraphy (P<0.001). SN identification rate intraoperatively using the gamma probe was significantly higher in the SN visualised group compared with the SN non-visualised group (95% vs. 68%; chi square (1 degrees of freedom (df)) P<0.001. There was no statistically significant difference in the false-negative rate and the operative time between the two groups. A mean of 2.3 (standard deviation (SD) 1.3) SNs per patient were removed in patients with SN visualised on preoperative lymphoscintigraphy compared with 1.8 (SD 1.2) in patients with no SN visualised on lymphoscintigraphy (P<0.001). Although SN visualisation on preoperative lymphoscintigraphy significantly improved the intraoperative SN localisation rate, SN was successfully identified in 90% of patients with no SN visualisation on lymphoscintigraphy. Given the time and cost required to perform routine preoperative lymphoscintigraphy, these data suggest that it may not be necessary in all cases. It may be valuable for surgeons in the learning phase to shorten the learning curve and in patients who have increased risk of intraoperative failed localisation (obese or old patients). A negative preoperative lymphoscintiscan predicts the inability to localise with the hand-held gamma probe. Therefore, if the SN is not visualised on lymphoscintigraphy then the addition of intraoperative blue dye is recommended to increase the likelihood of SN identification.     

Sentinel node biopsy in patients with cutaneous melanoma of the head and neck

Biopsy of head and neck sentinel nodes (SNs) can be technically problematic due to the unpredictable and variable drainage patterns of this anatomic region. The aim of the present study was to evaluate the feasibility of SN biopsy for cutaneous melanoma of the head and neck. We performed SN biopsy in 17 patients affected by stage I cutaneous melanoma of the head and neck on the basis of lymphoscintigraphy, blue dye and gamma probe. A total of 24 procedures were performed. Drainage to more than one lymphatic basin was observed in five patients (two basins in three cases and three basins in two cases) and in all cases SN biopsy was performed in all basins. The biopsy distribution by site was: six cervical nodes, five parotid nodes, four supraclavicular and submandibular nodes, three auricular and axillary nodes. The SN identification rate was 87.5% (21/24); metastases were discovered in four cases, with a positivity rate of 23.6%. At the time of writing, 1 patient is alive with local disease, 3 patients are dead and 13 are alive and free of disease with a follow-up ranging from 1 to 40 months (median, 21 months) following SN biopsy. In our opinion preoperative lymphoscintigraphy and the intraoperative use of a gamma probe are useful for the identification of lymphatic drainage of cutaneous melanoma of the head and neck.     

Sentinel node study in early breast cancer

Since October 1997 60 patients with early breast cancer (T <3 cm) were studied. All patients underwent lymphoscintigraphy with two types of colloid: the first (17 pts) with a particle size <1,000 nm; the second (43 pts) with a particle size <80 nm. The standard procedure consists of injection, on the day before surgery, of 70 MBq of the smaller nanocolloid in 0.4 cc saline divided over four sites, around the lesion or subdermally around the surgical scar. We utilize a low-energy, high-resolution LFOV camera for scintigraphy and a probe specific for the sentinel node during surgery. In 56/60 patients (93.3%) lymphoscintigraphy showed the sentinel node (SN). In two cases the SN was not detected presumably because of lymphatic interruption by an old surgical scar; in the other two cases the sites of injection were too close to the SN, thus masking it. In five cases (9%) the SN was not visualized with the surgical probe but in two of these drainage to the internal mammary chain was observed. The apparently lower sensitivity of intraoperative localization was due to the extra-axillary lymphatic drainage or to the vicinity of the SN to the primary lesion. The SN proved to be metastatic in 12 cases. No false-negative SNs were found. In five cases (10%) the radiolabeled lymph node was the only node containing tumor cells (micrometastases): this result depends on the combined use of hematoxylin-eosin and rapid cytokeratin staining. The application of blue dye was useful for easier identification of the SN but did not allow detection of more SNs. Our preliminary results are extremely encouraging. Considering that at the early stages of breast cancer the likelihood of lymph node metastases is low (20% in our series) and no false negative were reported in this study, we conclude that with SN biopsy axillary lymph node dissection can be avoided, making surgery less aggressive but maintaining accuracy.     

Omitting axillary lymph node dissection in sentinel node negative breast cancer patients is safe: a long term follow-up analysis

PURPOSE: To evaluate the rate of axillary recurrences in sentinel node (SN) negative breast cancer patients without further axillary lymph node dissection (ALND). PATIENTS AND METHODS: Between October 1994 and November 1999, all SN negative breast cancer patients who did not underwent complete ALND were enrolled in this prospective study. SN biopsy was performed by using the triple technique which combines preoperative lymphoscintigraphy, intraoperative use of blue dye, and a handheld gamma probe to visualize and localize the SN. SNs were examined by standard hematoxylin and eosin (H&E) staining and immunohistochemistry (IHC). During the first year after surgery all patients underwent clinical examination at 3 monthly intervals. This follow-up interval was prolonged to 6 month after the first year. RESULTS: From the 104 patients, 93 (89%) underwent breast-conserving therapy; all remaining patients were treated by modified radical mastectomy. In 91 cases a ductal carcinoma and in 13 cases a lobular carcinoma was diagnosed. One SN was removed in 80, two SNs in 18, and three SNs in 2 patients. Twenty patients received systemic therapy based on age and primary tumor characteristics. After a median follow-up of 57 month only one axillary recurrence was observed. During follow-up three patients developed distant metastases. One of these patient with metastases to the bone is alive with evidence of disease. The remaining two patients died 9 and 19 month after surgery. CONCLUSIONS: Our long term follow-up results indicate that survival is excellent (98%) and local axillary control is adequate (99%) after omitting ALND in a group of 104 SN negative breast cancer patients.     

Sentinel node biopsy in cutaneous melanoma patients: technical and clinical aspects

The role of the patent blue dye (PBD) technique and intraoperative probe-guided lymphoscintigraphy (LS) in detecting the sentinel node (SN) was investigated in a group of 130 consecutive stage I cutaneous melanoma patients. The preoperative workup included high-resolution US scanning and LS performed 15-18 hours before surgery. On the basis of preoperative LS, in the group of examined patients a total of 143 lymphatic drainage basins were identified and surgically explored: 41.6% in the axilla, 52.8% in the groin, and 5.6% in the head/neck. A total of 228 SNs were intraoperatively detected and removed; 110 lymphatic basins contained histologically negative SNs, while 33 basins had metastatic SNs. The sensitivity for SN detection using PBD alone was 93%, while it was 100% when PBD was combined with intraoperative LS. Preoperative and intraoperative LS appears to be a highly sensitive technique for SN detection in cutaneous melanoma patients. Furthermore, in view of the limited skin incision when radioguided surgery is performed, SN biopsy could be feasible under local anesthesia.