Axillary lymph node dissection vs sentinel biopsy only among women with early-stage breast cancer and sentinel node metastasis: A systematic review and meta-analysis

Axillary lymph node dissection (ALND) in early-stage breast cancer with limited sentinel node metastasis may not be superior to sentinel lymph node dissection (SLND). We performed a meta-analysis comparing SLND/Radiotherapy (RT) with ALND. All data were analyzed using Review Manager Software 5.3. Five randomized controlled trials (RCTs) were included. Overall survival, death, and disease-free survival were estimated higher in the SLND group compared to the ALND group. Statistically significant differences in axillary recurrence were observed in favor of ALND. Omission of ALND in patients with <3 positive SLNs is indicated.     

前哨淋巴结活检在食管癌手术中的应用

前哨淋巴结（SLN）是原发肿瘤发生淋巴结转移时首先累及到的淋巴结,SLN导航手术在黑色素瘤和乳腺癌中的应用得到了广泛证实.近年来,在胃肠道肿瘤手术中的应用也得到越来越高的重视.然而,与其他肿瘤相比,由于食管癌特殊的解剖学部位和淋巴引流途径,SLN在食管癌手术中应用的有效性和可行性存在较大争议.淋巴结微转移是影响无淋巴结转移食管癌患者预后的重要因素,SLN微转移的检测对食管癌治疗方案的制定具有重要意义.本文简要论述近年来SLN活检在食管癌手术中的应用,并阐述其临床意义.     

Clear cell sarcoma and sentinel lymph node biopsy. Case report and literature review

The procedure of sentinel node biopsy has been used previously in clear cell sarcoma. There are few studies reported. Due to the similar biological features with melanoma, this procedure can be effective. Sentinel biopsy is an option to detect nodal subclinical metastases. A 19-year-old man presented with ulcerated lesion in the fifth finger of the left hand. The biopsy reported clear cell sarcoma. Immunohistochemistry was positive for Vimentin and S-100. There was no evidence of regional disease. The sentinel lymph node biopsy, using patent blue and Tc-99 rhenium, was positive for metastases. Axillar dissection was carried out. The final report confirmed three metastasic nodes and the patient received adjuvant chemotherapy.     

Morbidity of dynamic sentinel node biopsy in penile carcinoma

PURPOSE: We report on the morbidity of dynamic sentinel lymph node biopsy (DSNB) in penile squamous cell carcinoma (SCC). MATERIALS AND METHODS: Between 1994 and 2003 DSNB was performed in 129 patients with T2 or T3 penile SCC who had 243 clinically node negative groins. Patients with groins with a tumor positive sentinel node underwent additional standard inguinal lymphadenectomy. RESULTS: A total of 285 sentinel nodes were harvested in 223 explored groins. The sentinel nodes were tumor-free in 189 groins. A total of 34 standard inguinal lymphadenectomies were performed because of a tumor positive sentinel node. There were 6 regional relapses during a median followup of 50 months (range 5 to 124) resulting in a false-negative rate of 15% (6 of 40 groins). This rate was 17% when calculated per patient (6 of 35 patients). Early and/or late complications following DSNB only occurred in 7% (14 of 189) of the groins. After DSNB followed by a standard inguinal lymphadenectomy, the rate was 68% (23 of 34). All complications of DSNB were minor and easily managed. CONCLUSIONS: Morbidity of DSNB in penile SCC is low. However, an in field recurrence after a negative DSNB is perhaps the greatest complication of the procedure.     

Anaphylactic reaction to isosulfan blue used for sentinel node biopsy: case report and literature review

Isosulfan blue is a commonly used agent in the detection of sentinel lymph nodes during cancer surgery. Similar to any drug, it is possible to have an allergic reaction to this increasingly popular chemical during breast cancer operations. We present one case of anaphylactic shock in response to injection of isosulfan blue for the purpose of localizing the sentinel node and review the medical literature. A thorough knowledge of possible isosulfan blue side effects, including their presentation and subsequent therapy, is essential for the modern breast surgeon.     

Prognostic value of node skip metastasis on esophageal cancer: A systematic review and meta-analysis

The association between NSM and prognosis of esophageal cancer remains controversial, though several studies have been conducted drawing their own conclusion. Therefore, we firstly carried out this meta-analysis aiming to explore the association. We performed a comprehensive literature search online, including PubMed, Embase and Web of Science. We selected deaths at 5 years and hazard ratio (HR) with 95% (CI) to perform the meta-analysis with Review Manager 5.3, predicting value of clinic-pathological features in NSM also been analyzed. A total of 7 studies were finally enrolled in this study. NSM, defined by either JSED criterion or anatomical compartment criterion, neither showed significant prognostic value on OS of esophageal cancer (P = 0.64), (P = 0.24). Subgroup analysis of JSED criterion, NSM was not a prognostic factor in solitary node metastasis patients (P = 0.39), whereas NSM demonstrated a poor prognostic factor (P = 0.01) for ESCC. Subgroup analysis according to anatomical criterion, NSM was a favorable factor for OS in middle thoracic ESCC (P = 0.003). Pathological N1 status was found to be a risk factor for NSM (P < 0.00001) according to JSED criterion and middle thoracic ESCC was identified as a predictor for NSM (P = 0.0003) according to anatomical compartment criterion. According to JSED criterion, NSM demonstrated poor prognosis on ESCC and N1 status was a risk factor for NSM. Concerning the anatomical compartment criterion, a favorable prognosis of NSM was found in middle thoracic ESCC and NSM was prone to occur in middle thoracic ESCC. CRD42021219333.     

Microinvasive breast cancer and the role of sentinel node biopsy: an institutional experience and review of the literature

Abstract:  Ductal carcinoma in situ with microinvasion (DCISM) is a distinct clinicopathologic entity. Its true metastatic potential has been unclear, due in part to historical differences in the definition of microinvasion. The role of routine axillary staging for DCISM is controversial, given the reportedly low incidence of axillary metastases. We describe our institutional experience with DCISM, and define the role of axillary staging. A retrospective analysis was made of patients with DCISM. Forty-four patients underwent axillary staging (24 axillary lymph node dissection [ALND], 22 sentinel node biopsy [SNB]). Macrometastatic disease was present in three patients (7%), and two patients had isolated tumor cells (itc) in the sentinel node. Patients with axillary metastases tended to be younger. Comedonecrosis, nuclear grade, multifocal microinvasion or presentation as a clinical mass was not associated with a higher rate of axillary metastases. In this series, 7% of patients had macrometastatic disease, and two patients (5%) had itc only. Axillary staging is indicated, and SNB is appropriate for the identification of axillary metastatic disease.     

Meta分析HLA-DRB1等位基因多态性对于食管癌发生的影响

目的 采用系统评价的方法探究HLA-DRB1等位基因多态性与食管癌发生的相关性.方法 计算机检索Medline、EMbase、Cochrane Library、Web of Science、CBM、CNKI、VIP、万方等数据库查找相关文献.中文检索关键词:食管癌、HLA-DRB1;英文关键词:esophageal neoplasm、HLA-DRB1.按照纳入和排除标准筛选后提取数据,采用Stata12.0软件进行Meta分析.结果 最终纳入5篇文献,共包含1630例患者.Meta分析结果显示,食管癌组HLA-DRB1*0901基因易感率明显高于正常人,两组基因易感率差异有统计学意义[OR=1.70,95％ CI(1.31,2.20),P＜0.001];食管癌患者HLA-DRB1* 1501基因易感率明显高于正常人,两组基因易感率差异有统计学意义[OR=3.02,95％ CI(1.65,5.51),P＜0.001];食管癌组HLA-DRB1* 0301基因易感率明显高于正常人,两组基因易感率差异有统计学意义[OR =2.84,95％ CI(0.43,18.96),P＜0.001].结论 食管癌的发生与HLA-DRB1* 0901、HLA-DRB1* 1501与HLA-DRB1* 0301基因有关,但由于目前有关食管癌的发生与HLA-DRB1* 1501和HLA-DRB1* 0301基因之间的关系所研究文献较少,且纳入文献之间存在明显统计学异质性,因此食管癌的发生与它们之间的关系仍有待论证.     

乳腺癌前哨淋巴结活检的临床应用

探讨前哨淋巴结活检 (SLNB)在乳腺癌临床中的应用价值。使用放射性99mTc -亚锡大分子右旋糖酐对 2 1例女性乳腺癌患者的前哨淋巴结 (SLN )进行定位及活检。检出SLN 18例 ( 85 .7% )。SLN检出成功率与肿瘤所在部位、病理类型、病理分期无关 (P >0 .0 5 )。共取出 3 3个SLN ,其中 1个者 9例 ( 5 0 .0 % ) ,2个者 5例 ( 2 7.8% ) ,3个者 2例 ( 11.1% ) ,4个者 2例 ( 11.1% )。 11例SLN阳性者 ,10例腋淋巴结 (ALN )呈阳性 ,1例ALN呈阴性。 7例SLN阴性者 ,1例ALN呈阳性 ,6例ALN阴性。灵敏度 91.7% ,特异度 10 0 % ,准确性 88.9% ,假阴性率 8.3 %。提示99mTc -亚锡大分子右旋糖酐皮下注射、放射性核素淋巴显像定位行SLNB可反映腋淋巴结转移情况。     

Accuracy of sentinel lymph node in papillary thyroid carcinoma.

BACKGROUND: The sentinel lymph node has been used in several tumors. The aim of this study was to analyze the accuracy of the sentinel node in papillary thyroid carcinoma. METHODS: A series of 22 patients with papillary thyroid carcinoma were included. Approximately 0.5 cc of isosulfan blue dye was injected at operation to trace the sentinel node. Lymph node dissection of the ipsilateral central compartment and extensive sampling of the jugular compartment were performed in addition to sentinel node resection. Surgical specimens were stained with hematoxylin-eosin, and negative sentinel nodes were subsequently stained with immunohistochemistry for cytokeratin-7. RESULTS: Mean age was 37 +/- 14 years. Twenty patients were women, and 2 were men. Mean tumor size was 2.5 +/- 1 cm. A sentinel lymph node was found in 20 patients. With use of hematoxylin-eosin, metastases were identified in 12/20 sentinel nodes (60%). Eleven patients with positive sentinel nodes presented additional lymph node metastases: 9 in the central compartment, 1 in the jugular compartment, and 1 in both compartments. Two patients with negative sentinel nodes had lymph node metastases elsewhere. When sentinel nodes were processed by immunohistochemistry, accuracy increased to 100%. CONCLUSIONS: Sentinel node is highly accurate for diagnosing metastases in papillary thyroid carcinoma.     

Repeat dynamic sentinel node biopsy in locally recurrent penile carcinoma

Study Type – Diagnosis (case series)
Level of Evidence 4

OBJECTIVE

To explore the role of repeat dynamic sentinel‐node biopsy (SNB) in clinically node‐negative patients with locally recurrent penile carcinoma after previous penile surgery and SNB.

PATIENTS AND METHODS

Between 1994 and 2008, 12 patients (4% of the 304 in our prospectively maintained dynamic sentinel node database) with clinically node‐negative groins had a repeat SNB for locally recurrent penile carcinoma after previous penile surgery and SNB. Five of these patients had previously had a unilateral inguinal node dissection for groin metastases. The median disease‐free interval was 18 months. The protocol and technique of primary dynamic SNB and the repeat procedure were similar, including preoperative lymphoscintigraphy and blue‐dye injection. Completion inguinal node dissection was only done if there was an involved sentinel node.

RESULTS

No sentinel nodes were seen on preoperative lymphoscintigraphy in the five groins that had previously been dissected. A sentinel node was visualized on lymphoscintigraphy in the remaining 19 undissected groins. In 15 of these groins (79%) the sentinel node was identified during surgery. Histopathological analysis showed involved sentinel nodes in four groins of three patients. Additional metastatic nodes were found in one completion inguinal lymph node dissection specimen. During a median follow‐up of 32 months after the repeat SNB, one patient developed a groin recurrence 14 months after a tumour‐negative sentinel node procedure.

CONCLUSIONS

Repeat dynamic SNB is feasible in clinically node‐negative patients with locally recurrent penile carcinoma despite previous SNB.     

Minimally invasive surgery for esophageal cancer: a review on sentinel node concept

Background

Lymphoadenectomy is a cornerstone of esophageal cancer treatment, and sentinel node (SN) biopsy (SNB) might provide surgeons with an extra tool to limit unnecessarily extended lymphadenectomy and to implement a minimally invasive approach. The aim of our study was to review all the available literature on the use of SNB in esophageal surgery for malignancy.

Methods

The review was conducted according to the PRISMA guidelines. A systematic search was performed in PubMed, EMBASE, and the Cochrane database to identify all original articles on the role of SNB in esophageal cancer. Data on methodologies, tumor stage and localization, and results were summarized and used to address relevant clinical questions related to the application of the SNB technique in esophageal cancer.

Results

Twelve studies were included, with a total of 492 patients. Different methods for SN identification were used (radionuclide, blue dye, computed tomography [CT] lymphography). The pooled values estimated using the random-effects model were, respectively: technetium-99 m overall detection rate (DR) 0.970 (95 % CI 0.814–0.996), accuracy (ACC) 0.902 (95 % CI 0.736–0.968); blue-dye DR 0.971 (95 % CI 0.890–0.993), ACC 0.790 (95 % CI 0.681–0.870); and CT lymphoscintigraphy DR 0.970 (95 % CI 0.814–0.996), ACC 0.902 (95 % CI 0.736–0.968).

Conclusion

Based on these results, the concept of SN in esophageal cancer is technically feasible with an acceptable DR and ACC, and it might be applicable in the event of early-stage adenocarcinoma of the gastroesophageal junction in patients with a high surgical risk or in a patient where an endoscopic resection is taken into consideration. Further studies focused on a single tumor type and localizations are needed in order to predict the correct utilization of this concept in minimally invasive treatment of esophageal cancer.     

Accuracy of axillary sentinel lymph node biopsy following neoadjuvant (induction) chemotherapy for carcinoma of the breast

Sentinel lymph node biopsy (SLNB) is widely employed to detect axillary lymph node metastases in breast cancer patients with clinically negative (N0) axillae. One of the few reported contraindications to SLNB is prior treatment with systemic chemotherapy (neoadjuvant/induction chemotherapy). Previous investigators reported difficulty identifying the sentinel node and an unacceptable false-negative rate in this patient cohort. We present one experienced surgeon's experience with SLNB following induction chemotherapy (n = 21). Following treatment with Adriamycin and Cytoxan (AC)-based cyclic chemotherapy, patients underwent SLNB, followed by levels I and II axillary lymph node dissection (ALND). At least one sentinel node was identified in all patients (100%). With respect to metastatic disease, the status of the sentinel node(s) accurately reflected the status of the axilla in 20 of 21 patients (95%). Eleven patients (52%) had axillary metastases identified by ALND. Of this group, SLNB failed to identify metastatic disease in one patient (9%). Previous treatment with induction chemotherapy should not be considered an absolute contraindication to SLNB. An experienced surgeon may utilize the technique in these patients, sparing them the added morbidity of axillary dissection.