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PubMed2003

Blue liposomes for identification of the sentinel lymph nodes in pigs.

Effective preoperative staining of regional lymph nodes improves their intraoperative identification and thus the selectivity of "sentinel node" lymphadenectomy. Unfortunately, aqueous Patent Blue V (PBV) often fails to provide the requisite intensity and duration of contrast (1,2). A comparative study of staining characteristics of PBV in aqueous solution with those of liposomally encapsulated PBV was carried out on 7 female pigs with an average weight of 40 kg. The liposomes, consisting of lecithin and cholesterol in a molar ratio of 3:1, were produced by an extrusion technique using membranes with thicknesses of 5 microm, 1.2 microm, 0.4 microm and 0.2 microm. In each instance, a 0.5-ml depot containing 25 +/- 0.4 mg of PBV/ml was injected into each of the four upper and lower mammary glands in aqueous solution on the left side and in a liposomal preparation on the right side. Stained lymph nodes of the groin, pelvis and neck were identified after 3, 6, 12 or 24 hours, then excised and photographed. Their PBV concentrations were measured by spectrophotometry. In all cases, the liposome preparations provided greater intensity and a longer duration than the aqueous solution. Liposomal PBV compared with aqueous PBV can therefore be recommended for better preoperative lymph node staining and identification of "sentinel" lymph nodes.

Animals↗

PubMed1985

Lymphocyte subsets in lymph nodes of homosexual men with generalized unexplained lymphadenopathy. Correlation with morphology and blood changes.

Frozen sections of lymph nodes from 20 homosexual men with chronic generalized lymphadenopathy and of lymph nodes showing follicular hyperplasia from 14 patients without known risk factors of the acquired immunodeficiency syndrome were studied with monoclonal antibodies to T-cell subsets and to the HLA-DR antigen. In T-cell areas of the lymph nodes, excluding tertiary paracortical nodules, the mean T-helper-to-T-suppressor ratio (Th/Ts) +/- 1 SEM was significantly lower in the homosexual group (1.07 +/- 0.06) when compared with the control group (2.49 +/- 0.23), P less than .0001. In seven homosexual men, cell suspensions from the same lymph nodes were analyzed using a fluorescence-activated cell sorter. Results obtained by this method and by immunohistochemistry were comparable except in a homosexual man whose lymph node contained large tertiary paracortical nodules. Although the Th/Ts ratios of the blood and lymph nodes of the same patients were both low, there was not good correlation between the two sets of values (r = .2). Furthermore, there was not good correlation between blood lymphocyte count and lymph node Th/Ts ratios (r = .45). The lymph node Th/Ts ratios of the homosexual patients show less variations compared with the control group. The patient who subsequently developed multiple opportunistic infections had the lowest value. Whether the lymph node Th/Ts ratio has prognostic significance in patients with the lymphadenopathy syndrome warrants further investigation.

Adolescent↗

PubMedDate not supplied

Effectiveness of paraaortic lymph node dissection for advanced gastric cancer.

BACKGROUND/AIMS: To evaluate the effectiveness of paraaortic lymph node dissection (D4) for gastric cancer from the viewpoint of long-term results. METHODOLOGY: Among 879 patients who underwent gastrectomy for advanced gastric cancer, 130 patients who underwent D4 lymphadenectomy were evaluated in relation to clinicopathological findings and long-term results. RESULTS: The frequency of histological paraaortic lymph node metastasis (n4) was 23.1% (30/130). The cumulative 5-year survival rate of 30 n4 patients with D4 lymphadenectomy was 16.7%, which was higher than that (4.2%) of n4 patients without D4 (sampling of paraaortic lymph nodes). Among n4 patients with D4 lymphadenectomy, the cumulative survival rate in 8 patients with 1-2 paraaortic lymph nodes involved (5-year survival rate: 50%) was significantly higher than that in 21 patients with 3 or more paraaortic lymph nodes involved (5-year survival rate: 4.6%). According to the intra-operative macroscopic extent of lymph node metastasis, the cumulative survival rate of patients who were judged as N2 was higher than that of patients judged as N4. CONCLUSIONS: Paraaortic lymph node dissection for advanced gastric cancer was effective, especially when it was done prophylactically and when the number of paraaortic lymph node metastases were 2 or less.

Aorta↗

PubMed2006

Immunohistochemically demonstrated lymph node micrometastasis and prognosis in patients with gallbladder carcinoma.

OBJECTIVE: To investigate whether immunohistochemically demonstrated lymph node micrometastasis has a survival impact in patients with advanced gallbladder carcinoma (pT2-4 tumors). SUMMARY BACKGROUND DATA: The clinical significance of immunohistochemically detected lymph node micrometastasis recently has been evaluated in various tumors. However, few reports have addressed this issue with regard to gallbladder carcinoma. METHODS: A total of 1476 lymph nodes from 67 patients with gallbladder carcinoma (pN0, n = 40; pN1, n = 27) who underwent curative resection were immunostained with monoclonal antibody against cytokeratins 8 and 18. The results were correlated with clinical and pathologic features and with patient survival. RESULTS: Lymph node micrometastases were detected immunohistochemically in 23 (34.3%) of the 67 patients and in 37 (2.5%) of the 1476 nodes examined. Of the 37 nodal micrometastases, 21 (56.8%) were single-cell events, and the remaining 16 were clusters. Five micrometastases were detected in the paraaortic nodes. Clinicopathologic features showed no significant associations with the presence of lymph node micrometastases. Survival was worse in the 27 patients with pN1 disease than in the 40 with pN0 disease (5-year survival; 22.2% vs. 52.6%, P = 0.0038). Similarly, survival was worse in the 23 patients with micrometastasis than in the 44 without micrometastasis (5-year survival; 17.4% vs. 52.7%, P = 0.0027). Twenty-eight patients without any lymph node involvement had the best prognosis, whereas survival for the 11 patients with both types of metastasis was dismal. The grade of micrometastasis (single-cell or cluster) had no effect on survival. The Cox proportional hazard model identified perineural invasion, lymph node micrometastasis, and microscopic venous invasion as significant independent prognostic factors. CONCLUSIONS: Lymph node micrometastasis has a significant survival impact in patients with pN0 or pN1 gallbladder carcinoma who underwent macroscopically curative resection. Extensive lymph node sectioning with keratin immunostaining is recommended for accurate prognostic evaluation for patients with gallbladder carcinoma.

Adult↗

PubMed1978

A morphometrical analysis of lymph node responses to tumors of different immunogenicity.

An immunogenic tumor and a nonimmunogenic tumor were used in C57BL/Ka and CBA/Rij mice, respectively, in a study in which lymph node morphology was quantitatively measured. Lymph nodes were cut in semiseries, and a morphometrical analysis was done on the paracortical and cortical areas as major parts of the active lymph nodes. These parameters could be expressed with confidence in both absolute and relative numbers, since a strong correlation existed between the weight of lymph nodes and the summated surface areas. To determine whether the regional lymph node plays a major role in this response, we performed similar analyses of two nonregional lymph nodes. It was observed that immunogenicity, defined as the ability to evoke an immune response that significantly influences tumor cell take and tumor cell growth, was not relevant in evoking a morphologically evident response. In absolute numbers, the response evoked was strongest in the regional lymph nodes in both systems. However, the percentages of paracortical and cortical areas in the lymph nodes reacting were not essentially different from one node to another during the growth of both tumors. This observation was confirmed by an analysis of variance. These findings suggest that great caution must be exercised when one is interpreting morphological lymph node changes as evidence of an influence of immunological reactions on tumor cell growth.

Adenocarcinoma↗

PubMed1996

Ultrasonographic detection of lymph-node metastases in superficial carcinoma of the esophagus.

BACKGROUND AND STUDY AIMS: The presence or absence of lymph-node metastasis is the single most important factor in determining the strategy for treating superficial carcinoma of the esophagus. In this study, ultrasound (US) and endoscopic ultrasonography (EUS) were used in the diagnosis of lymph-node metastases, and the accuracy and limitations of these methods were assessed. PATIENTS AND METHODS: Prospectively, 37 patients with superficial esophageal cancer were studied by US and EUS before surgery, and the results were compared with the histological findings. Twelve of the patients had histologically confirmed lymph-node metastases. Ultrasonographic images of the lymph nodes were classified into three types, based on their boundaries and internal echoes. RESULTS: The sensitivity, specificity, and accuracy of predicting mediastinal lymph-node metastasis by EUS diagnosis were 80.0%, 87.5%, and 86.5%, respectively. The sensitivity, specificity, and accuracy of US in the assessment of cervical and abdominal lymph-node metastasis were 71.4%, 86.7%, and 83.3%, respectively. In cases in which there was a solitary metastatic lymph node, the detection rate was higher than in cases with two or more positive nodes. Most metastatic lymph nodes correctly diagnosed by US and EUS were larger than 6 mm and had tumor involving more than one-third of their cross-sectional area. CONCLUSIONS: In patients with superficial esophageal carcinomas, US is accurate in staging cervical and abdominal lymph nodes. EUS is accurate in staging mediastinal lymph nodes.

Carcinoma, Squamous Cell↗

PubMed2001

Axillary lymph node status of T1 primary breast cancer in a diverse population.

The utility of level I and II axillary lymph node dissection in women with primary tumors less than 1 cm in diameter has recently received extensive evaluation. Numerous patients undergo axillary lymph node dissection ultimately to discover no pathological involvement. This study investigates the lymph node status in T1 primary breast adenocarcinoma in our diverse patient population. A retrospective evaluation of patients treated at the Medical Center of Louisiana at New Orleans and the Tulane University Medical Center with breast adenocarcinoma less than or equal to 2 cm was performed. Demographic data and pathological reports were reviewed to obtain breast lesion size and lymph node status. One hundred sixteen patients were found to have T1 lesions. Ethnic distribution was African American 66 per cent; Caucasians 30 per cent; Hispanic 2 per cent; and Asian 3 per cent. Whereas no patients with T1a lesions had positive lymph nodes, 11 per cent of patients with T1b lesions and 36 per cent of patients with T1c lesions had positive lymph nodes. However, in our patient population no patients with tumors less than 1.0 cm. in diameter had positive lymph nodes. Although this may be due to our relatively small sample size axillary lymph node dissection may be unnecessary in this select patient population. For patients with lesions 1.0 cm and greater an axillary lymph node dissection seems to add necessary information for correct treatment in a small percentage of patients. The use of lymphatic mapping with sentinel axillary lymph node biopsy may reduce the number of unnecessary axillary dissections in early breast cancer.

Adenocarcinoma↗

PubMed1996

Distribution of antigen specific memory T cells in lymph nodes after immunization at peripheral or mucosal sites.

The distribution of antigen-specific memory T cells in different lymph nodes of sheep was determined using an antigen-specific in vitro proliferation assay. Lymph nodes were collected from sheep immunized simultaneously with avidin or ovalbumin in a peripheral tissue site (hind leg muscle) and keyhole limpet haemocyanin (KLH) in an intestinal tissue site (gut wall or colonic mucosa). The results showed a consistently high proliferative response in typical peripheral lymph nodes (popliteal and prescapular) and a low or negative response in gastrointestinal lymph nodes (abomasal and jejunal) while the response in other nodes was variable. The low proliferative response in the gastrointestinal lymph nodes was not due to the presence of suppressor CD8- lymphocytes and the proliferative response could not be raised to peripheral lymph nodes levels with the addition to cultures of IL-2 or mitomycin-C treated peripheral lymph node cells. The high proliferative response in the peripheral lymph nodes was not suppressed by the addition of mitomycin-C-treated gastric lymph node cells but was dramatically reduced by the addition of mAb against the IL-2-receptor or by depletion of CD4- T cells. The results suggest that antigen-specific proliferative memory T cells, which may be Th1-like memory cells, preferentially migrate to peripheral lymph nodes independent of their site of induction.

Administration, Rectal↗

PubMedDate not supplied

Size, CD4 and CD8 marker profiles and functions of lymphocyte subpopulations in mucosal-associated lymph nodes.

We analyzed phenotypic and functional characteristics of T cell populations in mucosal-associated supramammary and mesenteric lymph nodes in goats. Here we demonstrate, by flow cytometry, quantitative differences in CD4 and CD8 T cell subsets among large and small mucosal-associated lymphocyte populations and their differential regulatory activities on resident lymph node B cells stimulated with Staphylococcus aureus Cowan I or pokeweed mitogen. The CD4/CD8 T cell ratio was lower in mesenteric lymph nodes (1.46) when compared to that of supramammary lymph nodes (2.18). Analysis of large and small lymphocyte subpopulations from lymph nodes showed nearly 62% of the lymphocytes from mesenteric lymph nodes being of large cell phenotype with CD4/CD8 ratios of 1.34. In contrast, large cell subpopulations in supramammary lymph nodes showed a significantly lower number (50%) with a higher CD4/CD8 ratio of 2.05. Functionally, mesenteric lymph node T cells, isolated by nylon wool, showed heightened suppressive activity in mitogen-driven B cell proliferation responses, whereas T cells from supramammary lymph nodes were stimulatory. These findings clearly demonstrate distinctive functional properties between resident T cell populations of supramammary and mesenteric lymph nodes, suggesting that different proportions of T cell subsets in these nodes are activated and thus regulate regional immune responses via different pathways.

Animals↗

PubMed1994

Occult lymph node metastasis in gastric cancer with submucosal invasion.

To evaluate more precisely the incidence of lymph node metastasis in patients with submucosally invaded (sm) gastric cancer, three additional sections were made from the remaining half of 1,794 lymph nodes taken from 57 patients, for a detailed reexamination. Lymph node metastasis was demonstrated in 19 nodes from 11 patients by the initial routine examination; however, the detailed reexamination showed cancer involvement in a further nine lymph nodes from eight patients. Of these eight patients, metastasis had not been detected in any lymph nodes by routine examination in six. Macroscopically, the lesion was of the depressed or mixed type in six of the eight patients. From the intranodal location and growth pattern of the cancer foci, lymph nodes with occult metastasis were divided into the marginal sinus type, the medullary sinus type, and the mixed type, with the marginal type being found most frequently. The overall incidence of lymph node metastasis in patients with sm gastric cancer was as high as 29.8% (17/57) in this series. Moreover, a follow-up study revealed that two patients with occult metastasis died of cancer recurrence postoperatively. Accordingly, systematic regional lymph node dissection should be carried out at the time of surgery for sm gastric cancer.

Adenocarcinoma↗

PubMed1992

[A case of unknown origin cancer of the mediastinal lymph node].

We encountered an unusual case with a sole cancer focus at the mediastinal lymph node. The patient was a 44-year-old man who visited our department with a chief complaint of chest pain. Subsequent chest X-ray and CT revealed an enlargement of a mediastinal lymph node. The excised lymph node measured 6.8 x 5.5 x 4.0 cm and weighed 51 g. It showed metastasis of poorly differentiated adenocarcinoma. In spite of a thorough systemic examination, no primary foci were detected. Lymph node tumors of the mediastinum or hilar region with unknown primary foci are extremely rare (there have been only 2 reported cases of lesions found at the hilar lymph node with unknown primary focus). There have been no reports on cancerous foci limited to the mediastinal lymph nodes. The patient has been under chemotherapy and radiotherapy during the past 3 years following surgery. He shows no signs of recurrence. It is a very unusual case. A possible classification of T0N2M0 has been considered.

Adenocarcinoma↗

PubMed1976

Age-related changes in localization of injected radiolabelled lymphocytes in the lymph nodes of antigen-stimulated mice.

The localization of i.v. injected syngeneic lymph node cells, radiolabelled with 51Cr or 75Se-L-selenomethionine, was studied in male CBA/H mice aged between 3 and 30 months. The following results were obtained. (1) Localization of cells from young adult donors was greater in the s.c. lymph nodes of old than of young recipients, the main increase being between 15 and 17 months of age. Increases in lymph node weight and DNA-synthesis were also seen at this time; but the rise in cell localization was significant even when calculated per unit of tissue weight. Splenic localization either declined slightly with age or, like the liver, showed no significant change. (2) Local antigenic stimulation by a single injection of sheep erythrocytes into one front footpad, 24 hr before lymph node cell injection, resulted in increased localization in the regional lymph nodes of 3-17 month old, but rarely of 24-30 month old mice. (3) No consistent differences in localization were observed between lymph node cells from 4-month and 25-month old donors. Both age-related and antigen-related increases in cell localization were at least partly attributable to an enhanced rate of entry of lymphocytes from the blood to the lymph nodes. Although the changes underlying the decline in antigen-related localization of cells in old recipients have still to be clarified, it is probable that the defective immune responses of old mice result partly from this decline.

Aging↗

PubMed2005

Redefining ultrasound appearance criteria of positive axillary lymph nodes.

OBJECTIVE: To determine objective criteria for ultrasonography (US) appearance in the diagnosis of abnormal axillary lymph nodes (ALNs) and to assess retrospectively their accuracy in preoperative staging of patients with Breast Imaging Reporting and Data System (BI-RADS) Category 5 breast lesion. METHODS: US-guided axillary fine-needle aspiration biopsy (FNAB) was performed for preoperative staging of BI-RADS Category 5 lesions in breast cancer patients seen at the Ottawa Regional Women's Breast Health Centre. Retrospectively, ALN morphology was classified into 3 categories based on US appearance: mass-like appearance, focal nodular cortical thickening (FNCT), and diffuse cortical thickening (DCT), the latter 2 with fatty hilum preservation and cortical thickening greater than 2 mm. Cytologic results from the FNAB were compared with axillary lymph node dissection (ALND) or sentinel lymph node procedure (SLNP), when available. Retrospective image-based classification was performed blind to pathology results and analyzed with Pearson's correlation coefficient, receiver operating characteristic (ROC) curves, and chi-square and Hosmer-Lemeshow tests against the cytologic ground truth. RESULTS: Eighty-six ALNs in 84 patients were sampled with an 18-gauge needle under US guidance. The number of passes per sample was related to adequate sampling of positive ALNs having mass-like morphology but not DCT or FNCT (p < 0.001). The most frequent morphologic presentation of the 86 ALNs was mass-like appearance of lymph nodes (45%), followed by DCT (35%) and FNCT (20%). Metastatic involvement was found in 34 (87%) of 39 ALNs that were mass-like, in 9 (53%) of 17 ALNs with FNCT, and in 9 (30%) of 30 ALNs with DCT. The kappa agreement between FNAB and ALND or SLNP was 0.64 for mass-like lymph nodes, 0.7 for lymph nodes with DCT, and 1.0 for FNCT. Overall sensitivity and specificity were 94% and 89%, respectively, with a positive predictive value of 97% and negative predictive value of 80%. CONCLUSIONS: Using a 2-mm threshold, FNCT and DCT warrant US-guided FNAB by an experienced radiologist as much as do mass-like lymph nodes. When biopsy is positive, axillary dissection can be performed and the sentinel node technique avoided.

Axilla↗

PubMed2006

Evaluation of the relevance of lymph node density in a contemporary series of patients undergoing radical cystectomy.

PURPOSE: Lymph node density, that is the ratio of positive nodes to the total number of nodes excised, has been suggested to better stratify patients with bladder cancer who have nodal metastasis. We evaluated its relevance in a contemporary series of patients treated with radical cystectomy and in the context of adjuvant chemotherapy. MATERIALS AND METHODS: From 1993 to 2003, 150 patients had pN+M0 disease at cystectomy, of whom 108 who did not receive neoadjuvant chemotherapy form the basis of this report. Statistical analyses were performed using standard methodology. RESULTS: Five-year overall, disease specific and recurrence-free survival rates were 30.9%, 45.5% and 29.7%, respectively. The median number of lymph nodes removed was 12 and the median number of positive nodes was 2. Of the patients 70% received adjuvant chemotherapy. Patients with a lymph node density of 25% or less had 5-year overall and recurrence-free survival rates of 37.3% and 38.1% compared with 18.7% and 10.6%, respectively in those with a lymph node density of greater than 25% (p = 0.02). In the context of adjuvant chemotherapy, which was associated with prolonged overall, disease specific and recurrence-free survival (p < or =0.01), lymph node density still remained prognostic for recurrence-free survival (HR 1.69, p = 0.047). The total number of nodes removed and the number of positive nodes were not prognostic. CONCLUSIONS: Our results support the relevance of lymph node density in a contemporary series of patients with bladder cancer treated with radical cystectomy. Lymph node density remains a significant prognostic factor for recurrence-free survival even when adjuvant chemotherapy is used.

Aged↗

PubMed2005

Does the extent of lymph node dissection influence outcome in patients with stage I non-small-cell lung cancer?

OBJECTIVE: To assess the therapeutic effect of the extent of lymph node dissection performed in patients with a stage pI non-small-cell lung cancer (NSCLC). METHODS: We analysed data on 465 patients with stage I NSCLC who were treated with surgical resection and some form of lymph node sampling. The median number of lymph node sampled was 10 and the median number of ipsilateral mediastinal lymph node stations sampled was two. We chose to define a procedure that harvested 10 or more lymph nodes and sampled two or more ipsilateral mediastinal stations as a lymphadenectomy, by contrast with sampling when one or both criteria were not satisfied. The effect of the surgical techniques: lymph node sampling (LS; n=207) vs. lymphadenectomy (LA; n=258) on 30-day mortality and overall survival were investigated. RESULTS: A total of 6244 lymph nodes was examined, including 4306 mediastinal lymph nodes. The mean (+/-SD) numbers of removed lymph nodes were 7+/-6.1 per patient following LS vs.18.6+/-9.3 following LA (P=0.001). An average mean of 1+/-0.90 mediastinal lymph node station per patient was sampled following LS vs. 2.7+/-0.8 following LA (P<10(-6)). Overall 30-day mortality rates were 2.4 and 3.1%, respectively. LA was disclosed as a favourable prognosticator at multivariate analysis (Hazard Risk: 1.43; 95% Confidence Interval: 1.00-2.04; P=0.048), together with younger patient age, absence of blood vessels invasion, and smaller tumour size. CONCLUSIONS: Importance of lymph node dissection affects patients outcome, while it does not enhance the operative mortality. A minimum of 10 lymph nodes assessed, and two mediastinal stations sampled are suggested as possible pragmatic markers of the quality of lymphadenectomy.

Adult↗

PubMed2005

Prognostic factors after cervical lymph node dissection for cutaneous melanoma metastases.

Cervical lymph node dissection (CLND) is the surgical therapy used for the local control of regionally metastasized cutaneous head and neck melanoma. This study evaluated the outcome of patients undergoing CLND at our institution in order to determine the prognostic factors for recurrence-free survival and overall survival after this procedure. The hospital records of 66 patients with histologically proven lymph node metastases who underwent curative or palliative CLND between 1982 and 2004 were analysed. The characteristics of the patients, the primary tumour and the surgical procedure were recorded. During follow-up, the incidence of local or distant recurrences was recorded and the survival was determined. Of the 66 patients, a (modified) radical neck dissection was performed in 20 and a selective procedure in 46. The 5-year actuarial overall survival was 26% and the recurrence-free survival was 22%. Neither the primary tumour characteristics nor the extent of surgery was of prognostic value; the number of positive nodes affected both the overall survival (P=0.046) and overall recurrence-free survival (P<0.001). Selective CLND is the recommended procedure for patients with cervical metastases of cutaneous melanoma. The number of positive lymph nodes significantly affects the outcome of the patients.

Adult↗

PubMed1983

Lymph node removal for advanced gastric cancer with special reference to peritoneal metastasis.

The 5-year survival rate of gastric cancer patients was evaluated in relation to cancer infiltration to the gastric serosa, lymph node metastasis and lymph node removal, the pattern of cancer recurrence, and the presence of free cancer cells in the peritoneal cavity. The 5-year survival of patients with cancer infiltration to the gastric serosa was not improved even by more extensive lymph node removal (R3 removal) than secondary lymph node removal (R2 removal). In these patients, viable free cancer cells were detected in the peritoneal cavity. In patients with cancer recurrence, peritoneal metastasis was often present within 2 years of curative surgery. Based on our present results, we suggest that in advanced gastric cancer with marked serosal invasion, selective removal of more distant lymph nodes than secondary lymph nodes according to the location of the primary cancer lesion should be carried out in addition to R2 removal and that this selective removal is superior to uniform R3 removal.

Humans↗

PubMed1995

Sentinel lymph node dissection for penile carcinoma: the M. D. Anderson Cancer Center experience.

PURPOSE: We determined whether an extended sentinel lymph node dissection is effective for staging penile squamous carcinoma associated with clinically negative inguinal lymph nodes. MATERIALS AND METHODS: A retrospective review was done of 20 consecutive patients who underwent extended sentinel lymph node dissection between 1985 and 1994. RESULTS: Of the patients 14 underwent bilateral extended sentinel lymph node dissection, and 6 underwent ipsilateral extended sentinel lymph node dissection plus contralateral inguinal or ilioinguinal lymphadenectomy. All lymph nodes included in the extended sentinel node dissection were negative for metastases. Five patients had inguinal metastases at a median of 10 months (range 3 to 21) after negative extended sentinel lymph node dissection. CONCLUSIONS: Although it is a more extensive procedure than sentinel lymph node biopsy, extended sentinel lymph node dissection is still associated with a significant false-negative rate (25%). Thus, its routine use can no longer be recommended.

Adult↗