Gamma-probe guided localization of lymph nodes

Alex, James C.; Krag, David N.

doi:10.1016/0960-7404(93)90001-f

Cited by 353 publications

(138 citation statements)

References 22 publications

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“…1,2 The introduction of sentinel lymph node biopsy (SLNB) into the armamentarium of breast cancer management denotes progression in the understanding of this disease and has permitted a less extensive and less morbid surgical option for many patients. [3][4][5][6][7] Furthermore, the SLNB technique allows for a more precise pathologic evaluation of nodal disease to more accurately stage the axilla. 8 At many medical centers, a preliminary intraoperative pathologic analysis is performed on SLNs through frozen section or touch imprint cytology (TIC).…”

Section: Conclusion Tic Is Cost Effective For Assessing Sln Metastamentioning

confidence: 99%

Is intraoperative touch imprint cytology of sentinel lymph nodes in patients with breast cancer cost effective?

Jeruss¹,

Hunt²,

Xing³

et al. 2006

Cancer

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BACKGROUND.Sentinel lymph nodes (SLNs) are generally evaluated postoperatively, requiring 5–7 days for assessment. SLNs can also be evaluated intraoperatively by using touch imprint cytology (TIC), thus providing the surgeon immediate feedback and allowing for concurrent completion node dissection (CND) for positive SLNs. The authors hypothesized that TIC, when compared with standard postoperative SLN assessment alone, would permit a cost‐effective evaluation of SLNs in patients with clinically node‐negative breast cancer.METHODS.A decision‐analysis model was created to compare TIC with standard postoperative SLN assessment alone. Sensitivity and specificity of TIC were determined prospectively from 342 patients who underwent SLN biopsy assessed by both techniques. Short‐term health states associated with surgical staging were defined, and utilities were estimated using EuroQol‐5D. Base‐case analysis was performed to estimate quality‐adjusted life years and the incremental cost‐effectiveness ratio. Sensitivity analyses were performed to examine stability of model parameters.RESULTS.For each tumor stage, TIC was cost effective, and for patients with larger tumors (T3 and T4), TIC was the dominant strategy. The analysis was robust to changes in sensitivity and specificity of TIC, prevalence of metastasis, probability of complications, and cost. However, when utility associated with standard SLN assessment was 0.9 or greater, this became the preferred strategy.CONCLUSIONS.TIC is cost effective for assessing SLN metastasis intraoperatively. For patients with larger tumors, it is not only more effective, but also less costly than standard SLN assessment alone. TIC may be particularly useful for patients who experience significant anxiety while awaiting results of standard SLN assessment. Cancer 2006. © 2006 American Cancer Society.

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Section: Conclusion Tic Is Cost Effective For Assessing Sln Metastamentioning

confidence: 99%

Is intraoperative touch imprint cytology of sentinel lymph nodes in patients with breast cancer cost effective?

Jeruss¹,

Hunt²,

Xing³

et al. 2006

Cancer

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“…9,10 An additional technique, intraoperative use of the gamma probe, permits surgeons to evaluate intervening regions between the primary tumor and the standard lymph node basin and to identify SLNs in unusual locations. 3,5,[11][12][13][14] The significance of SLNs located in these unusual locations, however, has not been established completely. If these SLNs harbor metastatic disease, failure to evaluate them would lead to understaging the patient, alter treatment recommendations (i.e., the patient may not be offered indicated adjuvant therapy), and may result in an increased risk of regional or distant recurrence.…”

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confidence: 99%

Implications of lymphatic drainage to unusual sentinel lymph node sites in patients with primary cutaneous melanoma

Sumner

Ross

Mansfield

et al. 2002

Cancer

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BACKGROUNDSentinel lymphadenectomy reliably identifies the first site(s) of regional lymphatic drainage and, therefore, the most likely lymph nodes to contain occult metastasis in patients with primary cutaneous melanoma. Although in most patients lymphatic drainage from the primary melanoma first reaches a standard lymph node basin, a sentinel lymph node (SLN) may be identified in an unusual location. The objective of this study was to determine the frequency and significance of unusual sentinel lymph node drainage patterns in a large cohort of patients with primary melanoma.METHODSThe records of 1145 consecutive primary melanoma patients who underwent SLN biopsy were reviewed. Preoperative lymphoscintigraphy was performed in all patients with truncal melanoma and in many patients with distal extremity lesions. Unusual lymph node sites were defined as epitrochlear, popliteal, or ectopic/interval (in‐transit or any other nonstandard lymph node‐bearing area).RESULTSAt least one SLN was harvested in 1117 patients (98%). SLN biopsy of an unusual lymph node site was attempted in 59 patients (5%). Successful intraoperative localization and biopsy was performed in 54 (92%) of 59 patients for a total of 56 unusual sites. Of these, 7 (13%) were popliteal, 8 (14%) were epitrochlear, and 41 (73%) were ectopic/interval. Preoperative lymphoscintigraphy was performed in 41 of these 54 patients and correctly identified unusual SLN locations in 12 (29%); the majority of unusual SLNs were identified only with the assistance of the intraoperative gamma probe. In four patients (7%), the unusual lymph node site was the only site from which SLNs were harvested. In the remaining 50 patients (93%), biopsies were performed on SLNs from both unusual sites and from a standard lymph node basin. Among the 54 patients who underwent a SLN biopsy of an unusual nodal site, 7 (13%) had lymph node metastases in that location. In four of the seven patients, the only positive SLN was from the unusual site.CONCLUSIONSSentinel lymphatic drainage patterns include lymph node‐bearing areas that may be outside established standard lymph node basins and may represent the only site of regional lymph node metastases. Although preoperative lymphoscintigraphy may assist in the identification of unusual SLN drainage patterns, intraoperative use of the gamma probe is recommended to identify accurately and completely all sites of regional lymph node drainage. Cancer 2002;95:354–60. © 2002 American Cancer Society.DOI 10.1002/cncr.10664

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“…Nos anos seguintes alguns autores publicaram trabalhos demonstrando resultados efetivos com o uso de substância radioativa (Tecnécio) e sua captação com o aparelho Gama Probe na identificação do LS em câncer de mama e melanomas na fase inicial 2,3,26 .…”

Section: Linfonodo Sentinela -Histórico E Manuseiounclassified

Linfonodo sentinela: importância na cirurgia do câncer gástrico e perspectiva da aplicação de um modelo experimental em caninos

Melo

Pinheiro

2010

ABCD, arq. bras. cir. dig.

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DESCRITORES -Câncer gástrico. Metástase linfática. Biópsia de linfonodo sentinela.RESUMO -Introdução -A única perspectiva de cura do câncer gástrico ainda é o tratamento cirúrgico -gastrectomia associada com linfadenectomia ampliada -, embora tal procedimento possa levar a alto índice de morbidade ou mortalidade. Atualmente, a pesquisa do linfonodo sentinela para o câncer gástrico inicial (EC T1/ T2) apresenta argumentos que podem está modificando esta conduta. Objetivo -Realizar revisão bibliográfica atualizada da importância do linfonodo sentinela na cirurgia do câncer gástrico e apresentar modelo experimental, em caninos, que poderia se prestar como treinamento de cirurgiões para o método da pesquisa de linfonodo sentinela em estômago. Método -Revisão da literatura baseaa no Pubmed/Medline, Scielo e Lilacs cruzando os unitermos câncer gástrico, metástase linfática e biópsia de linfonodo sentinela e apresentação de método experimental para localização de nódulo sentinela. Conclusões -As evidências demonstram que há muito para se comprovar, entretanto a definição do tratamento do CaG nos tumores T1 parece ser o maior foco e abre bastante espaço para pesquisa. O modelo experimental em caninos para a pesquisa do LS no estômago, poderia se prestar como treinamento para cirurgiões na aplicação do método.ABSTRACT -Introduction -The only possibility to cure gastric cancer is still through a surgical treatment -gastrectomy associated with extended lymphadenectomy -, although this procedure may lead to high rates of morbidity or mortality. Currently, sentinel lymph node biopsy for early gastric cancer (T1/T2 EC) presents arguments that can change this behavior. Aim -To review updated bibliography of the importance of sentinel lymph nodes in gastric cancer surgery and present experimental model in dogs, which could provide training for surgeons as to the method of sentinel lymph node in the stomach. Method -Review of literature basing on Pubmed / Medline, Lilacs and Scielo crossing the key-words gastric cancer, lymph node metastasis and sentinel lymph node biopsy and presenting an experimental method for localization of sentinel node. Conclusions -The evidence shows that there is much to prove, however, the definition of the treatment of gastric cancer in T1 tumors appears to be the major focus and opens up plenty of space for research. The experimental model in dogs for the study of LS in the stomach, could provide training for surgeons in the method. ABCDDV/727INTRODUÇÃO O câncer gástrico (CaG) é atualmente a quarta neoplasia maligna mais frequente e a segunda causa de morte entre todos os tipos de câncer no mundo. Sua maior incidência é no Japão, onde se encontram 780 casos por 100.000 habitantes. No Brasil, por 100.000 habitantes, existem de 10 a 20 casos na população masculina e de cinco a 10 casos na população feminina 21 .A gastrectomia (total ou parcial) associada com linfadenectomia é a principal alternativa terapêutica e representa, atualmente, a única perspectiva de cura da doença. Disseminações por contigui...

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Gamma-probe guided localization of lymph nodes

Cited by 353 publications

References 22 publications

Is intraoperative touch imprint cytology of sentinel lymph nodes in patients with breast cancer cost effective?

Is intraoperative touch imprint cytology of sentinel lymph nodes in patients with breast cancer cost effective?

Implications of lymphatic drainage to unusual sentinel lymph node sites in patients with primary cutaneous melanoma

Linfonodo sentinela: importância na cirurgia do câncer gástrico e perspectiva da aplicação de um modelo experimental em caninos

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