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Sentinel Node Biopsy (sentinel + node_biopsy)
Selected AbstractsCURRENT STATUS OF SENTINEL NODE BIOPSY IN BREAST CANCERANZ JOURNAL OF SURGERY, Issue 2 2000PETER STANTON No abstract is available for this article. [source] REPEAT DYNAMIC SENTINEL NODE BIOPSY IN LOCALLY RECURRENT PENILE CARCINOMABJU INTERNATIONAL, Issue 12 2010Yao Zhu No abstract is available for this article. [source] Regarding Sentinel Node Biopsy in the Management of MelanomaDERMATOLOGIC SURGERY, Issue 1 2001Brett Coldiron MD No abstract is available for this article. [source] The Current Status of Sentinel Node Biopsy in the Management of MelanomaDERMATOLOGIC SURGERY, Issue 8 2000Julie R. Lange MD [source] Isolated Supraclavicular Lymph Node Recurrence After Breast-Conserving Surgery and Negative Axillary Sentinel Node BiopsyTHE BREAST JOURNAL, Issue 6 2003Doreen M. Agnese MD No abstract is available for this article. [source] Sentinel node biopsy in patients with cutaneous melanoma of the head and neck: Recurrence and survival studyHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2008Fernando Gomez-Rivera MD Abstract Background. Controversy remains regarding the benefits of sentinel lymph node (SLN) biopsy for predicting survival in cutaneous melanoma of the head and neck (CMHN). Methods. We analyzed the factors associated with the recurrence and survival of CMHN patients treated in our institution. Results. One hundred thirteen patients underwent SLN biopsy for CMHN in a 12-year period. SLN identification was successful in 96%, with a median of 3 SLNs per patient. Positive-SLNs were identified in 21%. With a median follow-up of 34 months, 28% recurred. Disease-free survival (DFS) and overall survival (OS) rates were 66% and 78% in patients with SLN-negative, and 39% and 62% in SLN-positive disease. In multivariate analysis, greater Breslow-thickness was associated with decreased DFS rate (HR 2.07, CI 1.04,4.09), and age >60 years (HR 3.53, CI 1.32,9.4) with lower 5-year OS rate. Conclusion. Primary tumor thickness and age were associated with decreased survival, whereas SLN status showed a trend for prognostic significance in CMHN. © 2008 Wiley Periodicals, Inc. Head Neck, 2008 [source] Sentinel node biopsy and head and neck tumors,Where do we stand today?HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 12 2006FCAP, Kenneth O. Devaney MD Abstract Background. Sentinel lymph node sampling may be studied profitably in series of patients with 1 tumor type, such as breast carcinoma, in 1 anatomic locale. The present work analyzes the efficacy of sentinel node sampling in a pathologically diverse group of lesions from an anatomically diverse region such as the head and neck; however, there are risks conflating the findings in different tumors with radically different behaviors, in the process producing muddled data. This report reviews the head and neck experience with sentinel sampling and concludes that certain tumor types that have a known propensity for aggressive behavior are the best candidates for trials employing sentinel node sampling; candidates include many cutaneous melanomas of the head and neck, oropharyngeal squamous carcinomas, and selected thyroid carcinomas. Despite the growing popularity of sentinel node sampling in a variety of regions of the body, however, at this juncture this technique remains an investigational procedure, pending demonstration of a tangible improvement in patient outcome through its use. It is recommended that studies of the efficacy of this technique strive, whenever possible, to segregate results of different tumor types in different head and neck locales from one another so as to produce more focused findings for discrete types of malignancies, and not group together tumor types that may in reality exhibit different biological behaviors. © 2006 Wiley Periodicals, Inc. Head Neck, 2006 [source] Sentinel node biopsy in squamous cell cancer of the oral cavity and oral pharynx: A diagnostic meta-analysis,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 9 2005Vinidh Paleri MS FRCS (ORL-HNS) Abstract Background. The sentinel node biopsy concept has been gaining support in the head and neck cancer literature during only the last few years, and several pilot studies have been published. This procedure aims to avoid unnecessary treatment to the clinically negative neck by identifying the patients with occult neck disease. Methods. We performed a systematic review and a diagnostic meta-analysis of all published literature regarding sentinel node biopsies in head and neck cancer until December 2003 using established guidelines. Using the pooled sensitivity rates obtained from the meta-analysis and treatment outcomes from published literature, we created a decision analysis model to identify the treatment arm with better payoffs. Results. A total of 301 patients with oral cavity primary tumors and 46 patients with oropharyngeal primary tumors from 19 articles were included for the meta-analysis. The pooled sensitivity result using the random effects model was 0.926 (95% confidence interval, 0.852,0.964). The cumulative payoff for the sentinel node biopsy arm was lower than that for the elective node dissection arm by about 1%. The payoffs were assigned for the recurrence and mortality rates only and did not take into account the morbidity caused by the procedures. Conclusions. The sentinel node biopsy procedure has shown high sensitivity rates in pilot studies for oral and oropharyngeal squamous cell cancer across the globe and is reliable and reproducible. This study provides a firm evidence base for forthcoming trials on the role of sentinel node biopsy in head and neck cancer. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] Sentinel node biopsy in oral cavity cancer: Correlation with PET scan and immunohistochemistryHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 1 2003Francisco J. Civantos MD Abstract Background. Lymphoscintigraphy and sentinel node biopsy (LS/SNB) is a minimally invasive technique that samples first-echelon lymph nodes to predict the need for more extensive neck dissection. Methods. We evaluated this technique in 18 oral cavity cancers, stages T1,T3, N0. Patients underwent CT and positron emission tomography (PET) of the neck, followed by LS/SNB, frozen section, immediate selective neck dissection, definitive histology, and immunoperoxidase staining for cytokeratin. Histopathology of the sentinel node was correlated with that of the neck specimen. Results. There were 10 true positives: 6 identified on frozen section; 2 on permanent histology; and 2 only on immunoperoxidase staining. In six, the sentinel node was the only positive node. There were seven true negatives and one false negative. Conclusions. Gross tumor replacement of lymph node architecture may obstruct and redirect lymphatic flow. Overall LS/SNB holds promise for oral cancer. © 2002 Wiley Periodicals, Inc. Head Neck 25: 000,000, 2003 [source] Sentinel node biopsy: who needs it?INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 11 2000Brett M. Coldiron MD First page of article [source] Sentinel node biopsy in melanoma: Technical considerations of the procedure as performed at the john wayne cancer instituteJOURNAL OF SURGICAL ONCOLOGY, Issue 8 2010Sanjay P. Bagaria MD Abstract Since its first description in 1990, sentinel node (SN) biopsy has become the standard for accurate staging of a melanoma-draining regional lymphatic basin. This minimally invasive, multidisciplinary technique can detect occult metastases by selective sampling and focused pathologic analysis of the first nodes on the afferent lymphatic pathway from a primary cutaneous melanoma. An understanding of preoperative lymphoscintigraphy, intraoperative lymphatic mapping, and the definition of SN are critical for surgical expertise with SN biopsy. J. Surg. Oncol. 2010; 101:669-676. © 2010 Wiley-Liss, Inc. [source] Intradermal radioisotope injection is superior to subdermal injection for the identification of the sentinel node in breast cancer patientsJOURNAL OF SURGICAL ONCOLOGY, Issue 2 2003Kazuyoshi Motomura MD Abstract 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 ,m), 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. J. Surg. Oncol. 2003;82:91,97. © 2003 Wiley-Liss, Inc. [source] ROLE OF AXILLARY SURGERY IN EARLY BREAST CANCER: REVIEW OF THE CURRENT EVIDENCEANZ JOURNAL OF SURGERY, Issue 7 2000Andrew J. Spillane Background: Controversy continues to surround the best practice for management of the axilla in patients with early breast cancer (EBC), particularly the clinically negative axilla. The balance between therapeutic and staging roles of axillary surgery (with the consequent morbidity of the procedures utilized) has altered. This is due to the increasing frequency of women presenting with early stage disease, the more widespread utilization of adjuvant chemoendocrine therapy and, more recently, the advent of alternative staging procedures, principally sentinel node biopsy (SNB). The aim of the present review is to critically analyse the current literature concerning the preferred management of the axilla in early breast cancer and make evidence-based recommendations on current management. Methods: A review was undertaken of the English language medical literature, using MEDLINE database software and cross-referencing major articles on the subject, focusing on the last 10 years. The following combinations of key words have been searched: breast neoplasms, axilla, axillary dissection, survival, prognosis, and sentinel node biopsy. Results: Despite the trend to more frequent earlier stage diagnosis, levels I and II axillary dissection remain the treatment of choice in the majority of women with EBC and a clinically negative axilla. Conclusions: Sentinel node biopsy has no proven superiority over axillary dissection because no randomized controlled trials have been completed to date. Despite this, SNB will become increasingly utilized due to encouraging results from major centres responsible for its development, and patient demand. Therefore if patients are not being enrolled in clinical trials strict quality controls need to be established at a local level before SNB is allowed to replace standard treatment of the axilla. Unless this is strictly adhered to there is a significant risk of an increase in the frequency of axillary relapse and possible increased understaging and resultant inadequate treatment of patients. [source] Multicentre validation study of sentinel node biopsy for staging in breast cancerBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 10 2005L. Bergkvist Background: The aim of this study was to validate sentinel node biopsy for axillary staging after the initial learning phase, and to analyse factors associated with false-negative biopsies. Methods: Some 675 patients, who had standard sentinel node biopsy followed by level I and II axillary clearance in one of 20 hospitals in Sweden and were operated on by 36 different surgeons, were recruited prospectively. Results: The overall detection rate was 94·5 per cent. It varied between surgeons but was not influenced by the number of operations per surgeon. Moreover, it was lower among older patients. The overall false-negative rate was 7·7 per cent. This rate was not affected by patient age, tumour histological type or Elston grade, but was increased in patients with multifocal tumours. Some 21 per cent of patients with a multifocal tumour diagnosed on postoperative histopathological analysis had a false-negative biopsy compared with 5·6 per cent of those with unifocal tumours (P = 0·004). Conclusion: Sentinel node biopsy was shown to be a reliable method for axillary staging of unifocal breast tumours. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Detection of micrometastases in lymph nodes from patients with breast cancerBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2002G. Branagan Background: Sentinel node biopsy affords the opportunity of focused examination of lymph nodes, including the use of the reverse transcriptase,polymerase chain reaction (RT-PCR). The mammaglobin gene is expressed by breast cancers but has not been detected in histologically normal lymph nodes. This study compared mammaglobin RT-PCR with routine histology in the sentinel and non-sentinel nodes of patients with breast cancer. Methods: Patients with breast cancer underwent tumour excision, sentinel node biopsy and axillary dissection. All nodes were bisected and half of each node was sent for routine histological examination. The other half underwent RNA extraction and mammaglobin RT-PCR. Results: Sentinel node biopsy was successful in 50 (96 per cent) of 52 patients. Mammaglobin expression was detected in nine (8 per cent) of 119 histologically negative sentinel nodes (Clopper,Pearson 95 per cent confidence interval (c.i.) 4 to 14 per cent) and in 13 (5 per cent) of 247 histologically negative non-sentinel nodes (95 per cent c.i. 3 to 9 per cent). Mammaglobin expression was detected in four (13 per cent) of 31 patients with histologically negative sentinel nodes (95 per cent c.i. 4 to 30 per cent) and in six (14 per cent) of 44 patients with histologically negative non-sentinel nodes (95 per cent c.i. 5 to 27 per cent). The false-negative rate for sentinel node biopsy was zero using histology results and 10 per cent using RT-PCR. Conclusion: RT-PCR screening of axillary nodes for mammaglobin expression increased the detection of breast cancer metastases compared with routine histology. © 2002 British Journal of Surgery Society Ltd [source] Multicentre study of detection and false-negative rates in sentinel node biopsy for breast cancerBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 12 2001Dr L. Bergkvist Background: Sentinel node biopsy has recently evolved as a means of staging the axilla in breast cancer with minimal surgical trauma. The aim of this prospective multicentre study was to identify factors that influencd the detection and false-negative rates during the learning phase. Methods: Data on all 498 sentinel node biopsies performed between August 1997 and December 1999 in Sweden were collected. Results: A sentinel node was found in 450 patients (90 per cent). Preoperative scintigraphy visualized 83 per cent of all sentinel nodes. The detection rate was higher with same-day injection of tracer than with injection the day before (96 versus 86 per cent; P < 0·01). Dye injected less than 5 min or more than 30 min before the start of the operation lowered the detection rate (less than 60 per cent versus more than 65 per cent; P = 0·02). The detection rate varied from 61 to 100 per cent between surgeons. The false-negative rate was 11 per cent. The presence of multiple tumour foci and a high S-phase fraction increased the risk of a false-negative sentinel node, whereas the number of operations performed by each surgeon was less important. Conclusion: Training of the individual surgeon influenced the detection rate, as did timing of tracer and dye injection. The false-negative rate seemed to be related to biological factors. © 2001 British Journal of Surgery Society Ltd [source] Sentinel node biopsy in squamous cell cancer of the oral cavity and oral pharynx: A diagnostic meta-analysis,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 9 2005Vinidh Paleri MS FRCS (ORL-HNS) Abstract Background. The sentinel node biopsy concept has been gaining support in the head and neck cancer literature during only the last few years, and several pilot studies have been published. This procedure aims to avoid unnecessary treatment to the clinically negative neck by identifying the patients with occult neck disease. Methods. We performed a systematic review and a diagnostic meta-analysis of all published literature regarding sentinel node biopsies in head and neck cancer until December 2003 using established guidelines. Using the pooled sensitivity rates obtained from the meta-analysis and treatment outcomes from published literature, we created a decision analysis model to identify the treatment arm with better payoffs. Results. A total of 301 patients with oral cavity primary tumors and 46 patients with oropharyngeal primary tumors from 19 articles were included for the meta-analysis. The pooled sensitivity result using the random effects model was 0.926 (95% confidence interval, 0.852,0.964). The cumulative payoff for the sentinel node biopsy arm was lower than that for the elective node dissection arm by about 1%. The payoffs were assigned for the recurrence and mortality rates only and did not take into account the morbidity caused by the procedures. Conclusions. The sentinel node biopsy procedure has shown high sensitivity rates in pilot studies for oral and oropharyngeal squamous cell cancer across the globe and is reliable and reproducible. This study provides a firm evidence base for forthcoming trials on the role of sentinel node biopsy in head and neck cancer. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] Multicentre study of detection and false-negative rates in sentinel node biopsy for breast cancerBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 12 2001Dr L. Bergkvist Background: Sentinel node biopsy has recently evolved as a means of staging the axilla in breast cancer with minimal surgical trauma. The aim of this prospective multicentre study was to identify factors that influencd the detection and false-negative rates during the learning phase. Methods: Data on all 498 sentinel node biopsies performed between August 1997 and December 1999 in Sweden were collected. Results: A sentinel node was found in 450 patients (90 per cent). Preoperative scintigraphy visualized 83 per cent of all sentinel nodes. The detection rate was higher with same-day injection of tracer than with injection the day before (96 versus 86 per cent; P < 0·01). Dye injected less than 5 min or more than 30 min before the start of the operation lowered the detection rate (less than 60 per cent versus more than 65 per cent; P = 0·02). The detection rate varied from 61 to 100 per cent between surgeons. The false-negative rate was 11 per cent. The presence of multiple tumour foci and a high S-phase fraction increased the risk of a false-negative sentinel node, whereas the number of operations performed by each surgeon was less important. Conclusion: Training of the individual surgeon influenced the detection rate, as did timing of tracer and dye injection. The false-negative rate seemed to be related to biological factors. © 2001 British Journal of Surgery Society Ltd [source] Cutaneous melanoma: practical usefulness of the American Joint Committee on Cancer staging systemDERMATOLOGIC THERAPY, Issue 6 2005Arthur J. Sober ABSTRACT:, The 2002 American Joint Committee on Cancer melanoma staging classification is the first to be based on natural history. Although primarily for hospital tumor registrars, knowledge of the classification is of value to dermatologists in prognosticating for their patients and in selecting candidates for sentinel node biopsy and possible subsequent therapies. [source] Sentinel node in head and neck cancer: Use of size criterion to upstage the no neck in head and neck squamous cell carcinoma,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 2 2007Lee W. T. Alkureishi MBChB Abstract Background. Anatomical imaging tools demonstrate poor sensitivity in head and neck squamous cell carcinoma (HNSCC) patients with clinically node-negative necks (cN0). This study evaluates nodal size as a staging criterion for detection of cervical metastases, utilizing sentinel node biopsy (SNB) and additional pathology (step-serial sectioning, SSS; and immunohistochemistry, IHC). Methods. Sixty-five patients with clinically N0 disease underwent SNB, with a mean of 2.4 nodes excised per patient. Nodes were fixed in formalin, bisected, and measured in 3 axes before hematoxylin-eosin staining. Negative nodes were subjected to SSS and IHC. SNB-positive patients underwent modified radical neck dissection. Results. Maximum diameter was larger in levels II and III (13.1 and 13.2 mm) when compared with level I (10.5 mm; p = .004, p = .018), while minimum diameter was constant. Positive nodes were larger than negative nodes (p = .007), but nodes found positive by SSS/IHC were not significantly larger than negative nodes for either measurement (p = .433). Sensitivity and specificity were poor for all measurements. Conclusions. Nodal size is an inaccurate predictor of nodal metastases and should not be regarded as an accurate means of staging the clinically N0 neck. © 2006 Wiley Periodicals, Inc. Head Neck, 2006 [source] Lymphoscintigraphy for sentinel node mapping using a hybrid single photon emission CT (SPECT)/CT system in oral cavity squamous cell carcinomaHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2006Avi Khafif MD Abstract Background. We assessed the added clinical value of fused single photon emission computed tomography (SPECT) and low-dose CT images compared with planar images for sentinel node (SN) mapping in patients with oral cavity squamous cell carcinoma (SCC). Methods. Twenty consecutive patients with newly diagnosed biopsy-proven SCC of the oral cavity were enrolled. Scintigraphy was performed using a hybrid gamma-camera/low-dose CT system. Planar images and fused SPECT/CT images were interpreted separately. All patients underwent a sentinel node biopsy (SNB) followed by a neck dissection. All SNs underwent meticulous pathologic examination and immunohistochemistry staining (cytokeratin complex) in addition to routine pathologic examinations of the neck dissection specimen. Results. The sensitivity for the detection of nodal metastases was 87.5%. SPECT/CT improved SN identification and/or localization compared with planar images in 6 patients (30%). Conclusions. SPECT/CT SN mapping provides additional preoperative data of clinical relevance to SNB in patients with oral cavity SCC. © 2006 Wiley Periodicals, Inc. Head Neck, 2006 [source] Sentinel node biopsy in squamous cell cancer of the oral cavity and oral pharynx: A diagnostic meta-analysis,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 9 2005Vinidh Paleri MS FRCS (ORL-HNS) Abstract Background. The sentinel node biopsy concept has been gaining support in the head and neck cancer literature during only the last few years, and several pilot studies have been published. This procedure aims to avoid unnecessary treatment to the clinically negative neck by identifying the patients with occult neck disease. Methods. We performed a systematic review and a diagnostic meta-analysis of all published literature regarding sentinel node biopsies in head and neck cancer until December 2003 using established guidelines. Using the pooled sensitivity rates obtained from the meta-analysis and treatment outcomes from published literature, we created a decision analysis model to identify the treatment arm with better payoffs. Results. A total of 301 patients with oral cavity primary tumors and 46 patients with oropharyngeal primary tumors from 19 articles were included for the meta-analysis. The pooled sensitivity result using the random effects model was 0.926 (95% confidence interval, 0.852,0.964). The cumulative payoff for the sentinel node biopsy arm was lower than that for the elective node dissection arm by about 1%. The payoffs were assigned for the recurrence and mortality rates only and did not take into account the morbidity caused by the procedures. Conclusions. The sentinel node biopsy procedure has shown high sensitivity rates in pilot studies for oral and oropharyngeal squamous cell cancer across the globe and is reliable and reproducible. This study provides a firm evidence base for forthcoming trials on the role of sentinel node biopsy in head and neck cancer. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] Sentinel node biopsy in oral cavity cancer: Correlation with PET scan and immunohistochemistryHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 1 2003Francisco J. Civantos MD Abstract Background. Lymphoscintigraphy and sentinel node biopsy (LS/SNB) is a minimally invasive technique that samples first-echelon lymph nodes to predict the need for more extensive neck dissection. Methods. We evaluated this technique in 18 oral cavity cancers, stages T1,T3, N0. Patients underwent CT and positron emission tomography (PET) of the neck, followed by LS/SNB, frozen section, immediate selective neck dissection, definitive histology, and immunoperoxidase staining for cytokeratin. Histopathology of the sentinel node was correlated with that of the neck specimen. Results. There were 10 true positives: 6 identified on frozen section; 2 on permanent histology; and 2 only on immunoperoxidase staining. In six, the sentinel node was the only positive node. There were seven true negatives and one false negative. Conclusions. Gross tumor replacement of lymph node architecture may obstruct and redirect lymphatic flow. Overall LS/SNB holds promise for oral cancer. © 2002 Wiley Periodicals, Inc. Head Neck 25: 000,000, 2003 [source] Positive sentinel node biopsy in a 30-month-old boy with atypical Spitz tumour (Spitzoid melanoma)HISTOPATHOLOGY, Issue 7 2006C Urso No abstract is available for this article. [source] The role of lymphatic mapping and sentinel node biopsy in the management of atypical and anomalous melanocytic lesionsJOURNAL OF CUTANEOUS PATHOLOGY, Issue 2010Alistair J. Cochran Atypical and anomalous melanocytic lesions are tumors that cannot be determined by microscopy to be certainly benign or fully malignant. The malignant potential of these borderline lesions is unknown and logical determination of best therapy is challenging, in particular whether lymphatic mapping and sentinel node biopsy have a place in their management. Lesions that fall into this category include atypical Spitzoid lesions, atypical cellular blue nevi, combined nevi, deep penetrating nevi, ancient nevi, desmoplastic nevi, balloon cell nevi and proliferation nodules of congenital nevi. We report our experience managing patients with these problematic tumors and discuss our approaches to determining the true location of lesional cells in sentinel nodes. Cochran AJ, Binder S, Morton DL. The role of lymphatic mapping and sentinel node biopsy in the management of atypical and anomalous melanocytic lesions. [source] Neoadjuvant therapy for breast cancerJOURNAL OF SURGICAL ONCOLOGY, Issue 4 2010Stephen V. Liu MD Abstract The past few decades have seen an increase in both the role and the complexity of neoadjuvant therapy for breast cancer. Neoadjuvant therapy was initially described as systemic chemotherapy for inflammatory or locally advanced breast cancer but now entails a combination of chemotherapy, endocrine therapy, and targeted therapy. Neoadjuvant systemic therapy is employed for inoperable inflammatory and locally advanced breast cancer, and also for patients with operable breast cancers who desire breast-conserving therapy (BCT) but are not candidates based on the initial size of the tumor in relation to the size of the breast. Neoadjuvant therapy in this subset of patients may impact the surgical options. This review will summarize the benefits of neoadjuvant systemic therapy and implications for BCT, the timing of sentinel node biopsy, and the utility of magnetic resonance imaging (MRI) to predict response to therapy. J. Surg. Oncol. 2010; 101:283,291. © 2010 Wiley-Liss, Inc. [source] Added value of ultrasound in screening the clinically negative axilla in breast cancerJOURNAL OF SURGICAL ONCOLOGY, Issue 5 2006I.M.J. Mathijssen MD Abstract Background For staging purposes in breast cancer it is current practice to perform a sentinel node biopsy in a clinically negative axilla, followed by an axillary lymph node dissection if metastases are found in the sentinel node. To limit the number of surgical procedures it is therefore of importance to try and identify as much patients as possible who have axillary metastases. Clinical staging of the axillary nodes in breast cancer is mainly based on palpation, but ultrasound has been shown to be of additional value in detecting pathological nodes. Methods In this paper, we report our results of screening 131 breast cancer patients without palpable axillary nodes through ultrasound. Results Out of the 53 patients with axillary node involvement, 18 were identified as such by our radiologist, resulting in a detection score of 34%. Discussion This high rate is probably reached because of the limited number of radiologists performing this procedure, thereby rapidly increasing their experience. J. Surg. Oncol. 2006;94:364,367. © 2006 Wiley-Liss, Inc. [source] Symmetrization reduction mammaplasty combined with sentinel node biopsy in patients operated for contralateral breast cancerJOURNAL OF SURGICAL ONCOLOGY, Issue 1 2006Peter Schrenk MD Abstract Background and Objectives: Occult invasive cancer found in reduction mammaplasty specimen in the contralateral breast in breast cancer patients requires axillary lymph node dissection (ALND) to assess the lymph node status. Routine Sentinel node (SN) biopsy in these patients may avoid secondary ALND when an occult cancer is found and the SN is negative in the permanent histological examination. Methods: One hundred sixty-nine breast cancer patients underwent contralateral reduction mammaplasty for symmetrization and with SN biopsy of the non-cancer breast. SN mapping was done using a vital blue dye alone (n,=,136) or in combination with a radiocolloid (n,=,33). Results: A mean number of 1.4 SNs (range 1,3 SNs) was identified in 158 of 169 patients (identification rate 93.5%). One of 158 patients revealed a positive SN but no tumor was found in the reduction mammaplasty/mastectomy specimen, whereas the SN was negative in 157 patients. Histological examination of the 169 reduction mammaplasty specimen revealed 5 occult invasive cancers and 4 patients with high grade DCIS but due to a negative SN biopsy the patients were spared a secondary ALND. Conclusion: The small number of patients with occult contralateral cancers may not warrant routine SN mapping in patients scheduled for contralateral reduction mammaplasty. J. Surg. Oncol. 2006;94:9,15. © 2006 Wiley-Liss, Inc. [source] Lymphoscintigraphic and intraoperative detection of the sentinel lymph node in breast cancer patients: The nuclear medicine perspectiveJOURNAL OF SURGICAL ONCOLOGY, Issue 3 2004Giuliano Mariani MD Abstract The concept of sentinel lymph node biopsy in breast cancer surgery relates to the fact that the tumor drains in a logical way via the lymphatic system, from the first to upper levels. Therefore, (1) the first lymph node met (the sentinel node) will most likely be the first one affected by metastasis, and (2) a negative sentinel node makes it highly unlikely that other nodes are affected. Sentinel lymph node biopsy would represent a significant advantage as a mini-invasive procedure, considering that, after operation, about 70% of patients are found to be free from metastatic disease, yet axillary node dissection can lead to significant morbidity. Although the pattern of lymphatic drainage from a breast cancer can be very variable, the mammary gland and the overlying skin can be considered as a biologic unit in which lymphatics tend to follow the vasculature. Considering that tumor lymphatics are disorganized and relatively ineffective, subdermal, and peritumoral injection of small aliquots of radiotracer is preferred to intratumoral administration. 99mTc-labeled colloids with most of the particles in the 100,200 nm size range would be ideal for radioguided sentinel node biopsy in breast cancer. Lymphoscintigraphy is an essential part of radioguided sentinel lymph node biopsy, as images are used to direct the surgeon to the site of the node. The sentinel lymph node should have a significantly higher count than background. After removal of the sentinel node, the axilla must be re-examined to ensure all radioactive sites are identified and removed for analysis. The success rate of radioguidance in localizing the sentinel lymph node in breast cancer surgery is about 94,97% in Institutions where a high number of procedures are performed, approaching 99% when combined with the vital blue dye technique. At present, there is no definite evidence that a negative sentinel lymph node biopsy is invariably correlated with a negative axillary status, except perhaps for T1a-b breast cancers, with size ,1 cm. Randomized clinical trials should elucidate the impact of avoiding axillary node dissection in patients with a negative sentinel lymph node on the long-term clinical outcome of patients. J. Surg. Oncol. 2004;85:112,122. © 2004 Wiley-Liss, Inc. [source] Intradermal radioisotope injection is superior to subdermal injection for the identification of the sentinel node in breast cancer patientsJOURNAL OF SURGICAL ONCOLOGY, Issue 2 2003Kazuyoshi Motomura MD Abstract 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 ,m), 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. J. Surg. Oncol. 2003;82:91,97. © 2003 Wiley-Liss, Inc. [source] |