Sentinel node imaging in breast cancer using superficial injections: Technical details and observations

Somasundaram, Santosh K.; Chicken, Dennis W.; Waddington, W; Bomanji, Jamshed; Ell, Peter J.; Keshtgar, Mohammed

doi:10.1016/j.ejso.2009.05.006

Cited by 18 publications

(15 citation statements)

References 22 publications

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“…Sentinel nodes were detected using a standard protocol of localization using radiopharmaceutical and blue dye injection intraoperatively, as previously described 17. Briefly the technique includes subcutaneous administration of 20–40 MBq of Nanocoll into the periareolar region within 2 hours prior to surgery.…”

Section: Methodsmentioning

confidence: 99%

Imprint cytology versus frozen section analysis for intraoperative assessment of sentinel lymph node in breast cancer

Petropoulou¹,

Kapoula²,

Mastoraki³

et al. 2017

BCTT

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IntroductionSentinel lymph node (SLN) biopsy is the gold standard for surgical staging of the axilla in breast cancer (BC). Frozen section (FS) remains the most popular means of intraoperative SLN diagnosis. Imprint cytology (IC) has also been suggested as a less expensive and equally accurate alternative to FS. The aim of our study was to perform a direct comparison between IC and FS on the same SLNs of BC cases operated in a single center by the same surgical team.Materials and methodsInto this prospective study we enrolled 60 consecutive patients with histologically proven T1–T3 BC and clinically negative axilla. Sentinel nodes were detected using a standard protocol. The SLN(s) was always assessed by IC as well as FS analysis and immunohistochemistry. Nevertheless, all intraoperative decisions were based on FS analysis.ResultsDuring the study period 60 patients with invasive BC were registered, with 80 SLNs harvested. Mean number of SLN(s) identified for each patient was 1.33. The sensitivity and specificity were 90% and 100%, respectively, for IC, and 80% and 100% for FS. Relevant positive/negative predictive values were 100%/98% for IC and 100%/96.15%, respectively, for FS. Overall accuracy was 98% for IC and 97% for FS. Therefore, statistically significant difference between the two methods in the detection of positive nodes was not elucidated (p=1.000).ConclusionsIC appeared to be marginally more sensitive than FS in detecting SLN metastatic activity. Overall accuracy was 98.75%. With regard to the primary lesion characteristics, we conclude that initial lesion size and lymphovascular invasion play a pivotal role in metastatic involvement of the SLN with the dimensions of metastasis bearing no correlation with tumor size. Therefore, IC appears to be a sensitive and accurate method for the intraoperative assessment of SLN in BC patients, but further studies are required to confirm this interesting data.

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Section: Methodsmentioning

confidence: 99%

Imprint cytology versus frozen section analysis for intraoperative assessment of sentinel lymph node in breast cancer

Petropoulou¹,

Kapoula²,

Mastoraki³

et al. 2017

BCTT

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“…After a few minutes the axilla is minimally incised, and stained lymphatic vessels and stained lymph nodes are detected visually. The combination of radioactive lymphatic tracers and blue dye staining increases the success and accuracy of the SLN mapping [9], [10], [11], [12], [13].…”

Section: Introductionmentioning

confidence: 99%

In vivo biodistribution studies and ex vivo lymph node imaging using heavy metal-free quantum dots

et al. 2016

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Quantum dots (QDs) are attractive photoluminescence probes for biomedical imaging due to their unique photophysical properties. However, the potential toxicity of QDs has remained a major obstacle to their clinical use because they commonly incorporate the toxic heavy metal cadmium within the core of the QDs. In this work, we have evaluated a novel type of heavy metal-free/cadmium-free and biocompatible QD nanoparticles (bio CFQD® nanoparticles) with a good photoluminescence quantum yield. Sentinel lymph node mapping is an increasingly important treatment option in the management of breast cancer. We have demonstrated their potential for lymph node mapping by ex vivo imaging of regional lymph nodes after subcutaneous injection in the paw of rats. Using photoluminescence imaging and chemical extraction measurements based on elemental analysis by inductively coupled plasma mass spectroscopy, the quantum dots are shown to accumulate quickly and selectively in the axillary and thoracic regional lymph nodes. In addition, lifetime imaging microscopy of the QD photoluminescence indicates minimal perturbation to their photoluminescence properties in biological systems.

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“…In our experience, false negative rate of SLNB was 10% which showed a good result regarding few sections of specimen and modified conventional pathologic examination. Although, it has been stressed that FN rate to be less than 5% for omitting ALND in node-negative cases (Clarke et al, 2004;Lyman et al, 2005;Somasundaram et al, 2009) but most trials haven't achieved FN rate lower than 5% even in Milan trial with very experienced and expert pathologists and about 60 sections per node (Veronesi et al, 2003). So, threshold of 10% (Keshtgar et al, 2011) seems to be a suitable cut-off point for FN rate of SLNB.…”

Section: Resultsmentioning

confidence: 99%

“…Subsequently, it is advised to perform preoperative US-guided FNA or core biopsy to detect metastatic LNs (Hinson et al, 2008). In node-negative cases, SLNB could be performed with harvesting of all palpable LNs during surgery regardless of its activity to reduce FN rate (Krag et al, 2007;Somasundaram et al, 2009).…”

Section: Discussionmentioning

confidence: 99%

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Value of Sentinel Lymph Node Biopsy in Breast Cancer Surgery with Simple Pathology Facilities -An Iranian Local Experience with a Review of Potential Causes of False Negative Results

Amoui

Akbari²,

Tajeddini³

et al. 2012

Asian Pacific Journal of Cancer Prevention

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Introduction: Sentinel lymph node biopsy (SLNB) is a precise procedure for lymphatic staging in early breast cancer. In a valid SLNB procedure, axillary lymph node dissection (ALND) can be omitted in nodenegative cases without compromising patient safety. In this study, detection rate, accuracy and false negative rate of SLNB for breast cancer was evaluated in a setting with simple modified conventional pathology facilities without any serial sectioning or immunohistochemistry. Material and Method: Patients with confirmed breast cancer were enrolled in the study. SLNB and ALND were performed in all cases. Lymph node metastasis was evaluated in SLN and in nodes removed by ALND to determine the false negative rate. Pathologic assessment was carried out only by modified conventional technique with only 3 sections. Detection rate was determined either by lymphoscintigraphy or during surgery. Results: 78 patients with 79 breast units were evaluated. SLN was detected in 75 of 79 cases (95%) in lymphoscintigraphy and 76 of 79 cases (96%) during surgery. SLN metastases was detected in 30 of 75 (40%) cases either in SLNB and ALND groups. Accuracy of SLNB method for detecting LN metastases was 92%. False negative rate was 3 of 30 of positive cases: 10%. In 7 of 10 cases with axillary lymphadenopathy, LN metastastates was detected. Conclusion: SLNB is recommended for patients with various tumor sizes without palpable lymph nodes. In modified conventional pathologic examination of SLNs, at least macrometastases and some micrometastases could be detected similar to ALND. Consequently, ALND could be omitted in node-negative cases with removal of all palpable LNs. We conclude that SLNB, as one of the most important developments in breast cancer surgery, could be expanded even in areas without sophisticated pathology facilities.Keywords: Breast neoplasm -lymphatic metastasis -lymph node dissection -sentinel lymph node biopsy

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Sentinel node imaging in breast cancer using superficial injections: Technical details and observations

Abstract: Abstract:Introduction:

Cited by 18 publications

References 22 publications

Imprint cytology versus frozen section analysis for intraoperative assessment of sentinel lymph node in breast cancer

Imprint cytology versus frozen section analysis for intraoperative assessment of sentinel lymph node in breast cancer

In vivo biodistribution studies and ex vivo lymph node imaging using heavy metal-free quantum dots

Value of Sentinel Lymph Node Biopsy in Breast Cancer Surgery with Simple Pathology Facilities -An Iranian Local Experience with a Review of Potential Causes of False Negative Results

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