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PubMedDate not supplied

Accuracy of axillary staging using sentinel node biopsy or diagnostic axillary lymph node dissection--a case-control study.

We aimed to compare the accuracy of axillary staging in breast cancer between sentinel node biopsy (SNB) and axillary lymph node dissection (ALND). The prevalence of axillary metastases was studied in 166 breast cancer patients with SNB and pair-matched control patients with ALND. The matching factors included age of the patient and grade, histological type and histological size of the tumour. There were 37% of patients with axillary metastases in the SNB group and 31% in the ALND group. Altogether, 57 pairs were discordant in relation to axillary metastases. In 34 discordant pairs the SNB patient and in 23 the ALND patient had axillary metastases, p=ns. Among the 36 discordant pairs with invasive ductal carcinoma (IDC), axillary metastases were detected as often in the SNB and the ALND patients. In the 21 discordant pairs with other histological types, the SNB patient had axillary metastases in 16 pairs and the ALND patient in 5 pairs, p<0.03. SNB seems to be as accurate a method for axillary staging as ALND. However, SNB generated no upstaging effect in IDC, only in other histological tumour types.

Adult↗
PubMed1988

Study of AIDS-related lymphadenopathy in the intraparotid and perisubmaxillary gland lymph nodes.

Salivary gland lymph node involvement is rare in patients at risk for AIDS. Intraparotid and perisubmaxillary gland lymph node biopsies from 2 intravenous drug abusers serologically positive for human immunodeficiency virus (HIV) affected by persistent generalized lymphadenopathy (PGL) were also analyzed immunohistologically. We found hypervascular reactive lymphoid hyperplasia with prevalence of suppressor T-cells within follicular centers often lacking surface IgD-positive mantle zone cells and showing disruption of the network of dendritic reticulum cells revealed with DRC-1 and anti-S-100 protein antibodies. Within the nodes there were numerous cysts lined by metaplastic squamous epithelium/positive for epithelial membrane antigen and containing numerous lymphocytes positive for leukocyte common antigen, macrophages positive for alpha 1 -antichymotrypsin, and Langerhans cells positive for OKT6. Salivary gland lymph nodes are immunohistologically similar to those of other sites in PGL and their increased epithelial metaplastic component containing cells involved in the immune response might represent an exuberant reaction to HIV infection.

AIDS-Related Complex↗
PubMed1996

Endoscopic exploration and lymph node sampling of the axilla. Preliminary findings of a randomized pilot study comparing clinical and anatomo-pathologic results of endoscopic axillary lymph node sampling with traditional surgical treatment.

OBJECTIVE: To describe the technique of endoscopic exploration of the axilla. To compare this technique to open surgical treatment by comparing the following variables: operative time, peri-operative complications, duration of hospital stay, node's histology and morphologic aspects and esthetic results. MATERIALS: Standard instruments for traditional operative laparoscopy plus a lipo-aspirator (0.8 Bar). PATIENTS: Forty patients, 20 (group A) undergoing open surgery and 20 (group B) undergoing axilloscopy. All patients with early invasive breast cancer are eligible for conservative operative treatment. METHOD: Randomized study. The technique is described and preliminary results are presented. RESULTS: The operative time for axilloscopy is approximately double that for open surgery. A comparable number of lymph nodes is collected by axilloscopy and open surgery. The nodes collected by axilloscopy are more likely to be fractured. What is the clinical consequence? Two loco-regional relapses are observed in the endoscopic group. DISCUSSION: Axillary sampling by endoscopic procedure gives the same pathologic information than surgical axillary sampling. Anatomo-pathologic aspects of nodes and possibilities of relapses were two drawbacks of this procedure. CONCLUSION: Operative time is increased for axilloscopy compared with open surgery. The techniques yield comparable anatomo-pathologic results. It is still unknown whether this endoscopic technique is as effective as traditional surgery or if the frequency or severity of lymphedema is decreased by the endoscopic approach.

Adult↗
PubMed1999

Pathological investigation of sentinel lymph nodes.

The sentinel lymph-node procedure enables selective targeting of the first draining lymph node, where the initial metastases will form. A negative sentinel node (SN) predicts the absence of tumour metastases in the other regional lymph nodes with high accuracy. This means that in the case of a negative SN, regional lymph-node dissection is no longer necessary. Besides saving costs, this will prevent many side-effects as a result of lymph-node dissection. The task of the pathologist is to screen SNs for metastases. To this end, several techniques are available such as standard histo- and cytopathological techniques, immunohistochemistry, flow cytometry, and molecular biological techniques. These methods are explained and their sensitivity for detecting SN metastases is discussed. Some of these techniques also appear to be useful for intra-operative evaluation of SNs. The standard protocol for detection of SN metastases consists of extensive histopathological investigation including step H&E stained sections and immunohistochemistry. Intra-operative frozen-section analysis of SNs has been shown to be reliable for breast-cancer axillary lymph nodes. In the intra-operative setting, imprint cytology can also be used but its additional value to frozen section analysis is not yet clear. Further studies are necessary to establish the role of sophisticated molecular biological techniques such as reverse transcription polymerase chain reaction (RT-PCR) in detecting SN metastases. The sensitivity of flow cytometry is too low for this purpose.

Biopsy↗
PubMed1990

Atrophy of lymph node compartments lacking lymph-carried lymphocytes in athymic rats.

This paper reports on a form of atrophy of lymph node compartments occurring in mesenteric nodes of athymic nude rats whose perinodal tissue had become unusually rich in mast cells and fibrotic. The subcapsular sinus of an affected compartment was depleted of lymphocytes, while the medullary sinuses were loaded with macrophages. A progressive expansion of medullary sinuses into the medullary cords, the extrafollicular zone, the deep cortex unit and, finally, the folliculo-nodules of the compartment was accompanied by a gradual atrophy of the usual lymphoid cell populations of these nodal components. The occurrence of such a mode of atrophy of a compartment, associated with a lack of lymphocytes in the afferent lymph, agrees with our previous proposal that lymphocytes of the afferent lymph provide the stimuli for the development and maintenance of the structures of the node. The involvement of mast cells and fibrosis in the emergence of the present form of nodal atrophy, which further weakens the immune system of an immunodeficient animal, is considered.

Animals↗
PubMedDate not supplied

The effect of changing gamma count threshold on sentinel lymph node accuracy.

PURPOSE: Sentinel lymph node (SLN) biopsy has been increasingly accepted in many centers as an alternative to axillary lymph node dissection in the nodal staging of breast cancer. The goal of SLN biopsy is to accurately stage the axilla while minimizing postoperative morbidity. Theoretically, the continuing search for SLNs disrupts additional lymphatics and impacts on operative time. The gamma count threshold is a predefined threshold percentage of the ex vivo count of the "hottest" SLN, which when applied to each individually excised lymph node determines whether a given lymph node is the SLN or a non-SLN. The higher the threshold percentage, the less the number of lymph nodes will meet the criteria of being an SLN. This study examines the hypothesis that changing the gamma count threshold from 10% to 50% will not significantly affect accuracy or the false-negative rate. METHODS: We retrospectively reviewed the charts of patients who underwent SLN biopsy with or without completion axillary lymph node dissection from March 1995 to January 2001 at Walter Reed Army Medical Center. Data were collected on gamma counts for each SLN and histopathology of each SLN. For each SLN ex vivo gamma count, percentage of the ex vivo gamma count of the "hottest" SLN was calculated. RESULTS: The SLN identification success rate was 94% (163 out of 174 patients). On average, 2.07 SLNs were removed per patient and 58% of patients had more than 1 SLN removed (94 out of 163 patients). Only 10% had 4 or more SLNs removed (17 out of 163 patients). Sentinel lymph node metastasis was found in 21% of patients (35 of 163 patients). Of these 35 patients with positive SLNs, 8 patients had a negative "hottest" SLN when a less radioactive SLN was positive for metastasis. Changing the gamma count threshold from 10% to 50% lowers the extrapolated accuracy from 98% to 95% and increases the extrapolated false-negative rate from 8% to 21%. CONCLUSIONS: The accuracy and false-negative rate of SLN biopsy varies based on the lower limit gamma threshold. Maintaining our 10% gamma count threshold results in acceptable accuracy and false-negative rates comparable to reported literature.

Journal Article↗
PubMed2006

[Intraoperative labeling of sentinel lymph nodes with a combination of vital dye and radionuclide tracer--results in sentinel lymph node-positive patients].

BACKGROUND: Sentinel lymph node biopsy enhances the accuracy of tumor staging in patients with malignant melanoma and can help select candidates for regional lymphadenectomy. There are two techniques for identifying the sentinel lymph node: intradermal injection of a radionuclide tracer or of a blue dye. We evaluated both methods to determine how they can be best utilized to locate a sentinel lymph node. PATIENTS AND METHODS: In a retrospective study, 323 patients with melanoma (tumor thickness > or = 0.75 mm) who underwent sentinel lymph node biopsy after both radionuclide and blue dye injection were evaluated. The labeling of lymph nodes showing micrometastasis by histopathological examination was determined. RESULTS: 63 patients showed sentinel lymph nodes with micrometastasis. All of these nodes (100 %) were labeled with radionuclide tracer, but only 90 % with blue dye. In 5 patients, only radionuclide labeling identified the histopathologically-positive lymph node. In 36 patients, several sentinel lymph nodes were identified, with the histopathologically-positive nodes usually showing a higher radioactive signal intensity than the negative ones. CONCLUSION: Since in some patients histopathologically-positive lymph nodes are only labeled by radionuclide tracer, radionuclide labeling is indispensable for locating sentinel lymph nodes. In contrast, labeling with blue dye represents a supplementary method, which can simplify the recognition of the sentinel lymph node during surgery.

Female↗
PubMed2003

The clinical relevance of positive sentinel nodes only versus positive nonsentinel lymph nodes in breast cancer patients.

BACKGROUND: The purpose of this study was to determine the difference in clinical outcomes for patients with histologically positive sentinel lymph nodes (SLN+) compared with patients with histologically positive nonsentinel second echelon lymph nodes (NSLN+). METHODS: Eight hundred thirteen node positive patients from a prospectively accrued database of 3200 patients who underwent sentinel node mapping were evaluated. In all, 506 of the 813 patients (62%) were SLN+ only and 307 of the 813 patients (38%) were SLN+ plus at least one NSLN+. Patients' overall survival and disease-free survival were obtained and statistical analyses performed comparing the two groups. RESULTS: As the number of NSLN+ increased, there was a significant difference in disease-free survival (P = 0.001) and overall survival (P = 0.003) between those patients who had 0 to 4 NSLN+ and those who had 5 or more NSLN+. The SLN+ only patients did not show significant differences with respect to survival, based on the number of SLN+ (overall survival, disease-free survival; P = 0.742). CONCLUSIONS: The survival (overall survival, disease-free survival) for patients with 3 or more SLN+ was not statistically different than for patients with 1 or 2 SLN+ (P = 0.742). However, an alteration of biologic behavior was observed when multiple NSLN+ contain metastatic breast cancer. Involvement of 5 or more NSLN+ portends a significantly (P = 0.001) worse prognosis, regardless of the number of SLN+.

Breast Neoplasms↗
PubMed1998

Gamma-probe-guided resection of the sentinel lymph node in breast cancer.

Regional lymph node metastases in patients with breast cancer have fundamental staging, prognostic, and treatment implications. Classically, axillary lymph node sampling requires a dissection under general anesthesia. The concept that a primary, or sentinel, lymph node is the first node to receive drainage from a tumor has been established in patients with malignant melanomas using radiolabeled tracers and vital dyes. This study proposed two hypotheses: (1) radiolabeled sentinel lymph nodes can be identified in most patients with breast cancer, and (2) radiolabeled sentinel lymph node biopsy accurately predicts axillary lymph node metastases in those patients. Patients with operable breast cancer had Tc-99 sulphur colloid injected around their breast tumors 1-6 hours preoperatively. Patients underwent gamma probe identification of sentinel lymph nodes that were biopsied. All patients underwent axillary lymphadenectomy in conjunction with lumpectomy or mastectomy. Fifty female patients ages 26 to 90 years underwent lumpectomies with axillary dissections (40 patients) or modified radical mastectomies (10 patients). Sentinel lymph nodes were identified in 42 of 50 patients (84%). Eight patients (16%) had metastases to the axillary lymph nodes. In 7 patients, sentinel lymph nodes correctly predicted the status of the axillary nodes. There was one false negative result. A total of 550 lymph nodes were resected for an average of 11.2 nodes per patient. Sentinel lymph node scintigraphy and biopsy accurately predicted the axillary lymph node status in 41 of 42 patients (98%). Scintigraphy can identify sentinel lymph nodes in a large majority of patients. Sentinel lymph node biopsy is an accurate predictor of axillary lymphatic metastases.

Adult↗
PubMed1993

Gamma-probe guided localization of lymph nodes.

The initial draining lymph node (Sentinel node) of a tumour may reflect the status of the tumours spread to the remaining lymphatic bed. The sentinel node, which has been reported to predict metastatic melanoma, has recently been localized by a new invasive technique [1]. The goal of our pre-clinical trial was to test a non-invasive technique to localize the sentinel node. Gamma-probe guided localization was used to identify and then surgically remove the first draining lymph node(s) in 16 inguinal lymphatic basins of eight cats. This method was found to be comparable to an invasive method using a blue dye. Gamma-probe localization has several potential advantages in that it can: (a) precisely locate on the surface of the skin the position of an underlying lymph node, (b) intraoperatively guide the surgeon to the lymph node during dissection, (c) verify that the correct node has been biopsied, (d) determine the possible presence of residual lymph nodes, (e) allow lymph nodes to be harvested through a small incision as opposed to raising a skin flap, and (f) be rapidly and easily performed.

Animals↗
PubMed1992

[Recurrence of cervical lymph node involvement in surgically treated thyroid cancer. Uselessness of routine cervical lymph node excision (medullary carcinoma excluded)].

From 1966 throughout September 1990, 753 patients underwent surgery for thyroid carcinoma, in the same institution, covering all pathological types. Complete follow-up was achieved in 96% of them, being at least 7 years in 50% of cases. 599 (80%) are currently alive. Neck dissection was not routinely done, except for medullary thyroid carcinoma, but rather selectively, if nodes were palpable either pre or intraoperatively, and also (since oct. 1983 i.e. the last 400 cases) if, after routine sampling of mid jugular nodes, frozen sections assessed nodal invasion. On the grounds of this policy, 205 patients underwent unilateral or bilateral neck dissection; 17% of them died during follow-up whereas 5.9% (12 cases) exhibited a cervical nodal recurrence, 6 of them occurring less than two years post-operatively, including 3 medullary thyroid carcinomas. 548 had no neck dissection; 9% died during follow-up whereas 0.9% (5 cases) exhibited a cervical nodal recurrence, 3 of them occurring less than two years post-operatively. Routine neck dissection seems not to be justified in the surgery of non medullary differentiated thyroid carcinoma, in as much as late occurrence of cervical node metastases is uncommon and does not obviously impair life-expectancy.

Carcinoma, Papillary↗