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Results for “sentinel lymph node biopsy”

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PubMed2026

Use of indocyanine green fluorescence versus patent blue V dye for sentinel lymph node biopsy in early breast cancer, a randomized controlled trial.

BACKGROUND: Sentinel lymph node biopsy (SLNB) is standard for axillary staging in early breast cancer. While the combination of radioisotope and blue dye (e.g., patent blue V, PBV) remains the standard, it has limitations including logistics, variable identification rate (IR), and allergic potential. Indocyanine green (ICG) fluorescence is a promising alternative, but high-quality comparative evidence is needed. METHODS: This was a single-center, prospective, randomized controlled trial. Forty patients with early-stage, node-negative breast cancer were allocated to SLNB using either ICG (n = 20) or PBV (n = 20). All patients subsequently underwent completion level I-II axillary lymph node dissection (ALND) as the pathological reference standard for diagnostic performance assessment. Primary outcome was sentinel lymph node (SLN) IR. Secondary outcomes included detection time, number of SLNs retrieved, false-negative rate (FNR), and safety. RESULTS: Baseline characteristics were comparable between groups. The SLN IR was significantly higher with ICG (100% [20/20]) than with PBV (75% [15/20], p = 0.047). ICG was associated with a significantly shorter median detection time (14.5 vs. 24.0 min, p < 0.001) and retrieved more SLNs (mean: 3.6 vs. 2.4, p = 0.002). Most critically, ICG demonstrated 100% sensitivity, specificity, negative predictive value (NPV), and overall diagnostic accuracy, with a 0% FNR. In contrast, PBV achieved a sensitivity of 75%, an overall diagnostic accuracy of 90%, and an FNR of 25%. No ICG-related adverse events occurred. PBV caused skin discoloration in 75% of patients and one (5%) allergic reaction. CONCLUSION: ICG fluorescence achieved a higher SLN IR, shorter detection time, higher sensitivity, lower FNR, and fewer tracer-related adverse events than PBV as a single tracer for SLNB in patients with early-stage breast cancer. These findings suggest that ICG is a promising standalone tracer when radioisotope mapping is unavailable. Larger multicenter studies are required before widespread adoption can be recommended.

Humans↗

PubMed1992

Anatomy and biopsy of sentinel lymph nodes.

Lymphangiograms performed via the dorsal lymphatics of the penis demonstrate drainage into a specific lymph node center, the so-called sentinel lymph node, which is located close to the superficial epigastric vein between the latter and the superficial external pudendal vein. Anatomically, clinically, and pathologically, the sentinel lymph node is the first site of metastasis and often is the only lymph node involved. We recommend preliminary bilateral sentinel lymph node biopsy, with inguinofemoral dissection being performed only when this node is involved. If the biopsies are negative for metastases, no further surgical therapy is immediately indicated, and the patient needs to be observed closely with monthly examination for 1 year and examination every 2 months for 3 years. The clinical staging of cancer of the penis needs a new review for further evaluation of different modalities of treatment. Sentinel lymph node biopsy must not be used to determine whether node dissection is needed in patients with evident clinically positive nodes. Also, the concept of sentinel lymph node should not be applied in the management of patients who will not be available for frequent follow-up. If during physical examination, suspect lymph nodes are found other than the classic sentinel node, these lymph nodes must be removed for staging and subsequent treatment planned according to the histologic report.

Biopsy↗

PubMed1991

Penile cancer--the sentinel lymph node controversy.

The management of lymph nodes in penile cancer has always been a problem. Sentinel lymph node biopsy was supposed to solve this problem but has not been universally accepted due to conflicting results. We herein present a case of penile cancer with bilateral pathologically positive inguinal lymph nodes associated with concurrent negative sentinel lymph node biopsies. We discuss the possible reasons for this situation and suggest guidelines to study this issue.

Biopsy↗

PubMed1992

Anatomic considerations of the penis and its lymphatic drainage.

A few clinical caveats relevant to penile neurovascular and lymphatic anatomy deserve special emphasis. First, it is clear from the work of Breza and others that the neurovascular anatomy of the penis differs from patient to patient, especially with regard to the arterial supply. It seems prudent to identify an accessory pudendal artery during pelvic lymphadenectomy and nerve-sparing prostatectomy in order to prevent a neurologically intact penis being left with an inadequate corporal blood supply. From an anatomic perspective, it appears that the sentinel lymph node biopsy might be useful in the management of superficial carcinoma of the prepuce or skin of the penis, as these areas drain to the superomedial zone of the superficial inguinal nodes, to which the sentinel node belongs. However, most tumors of the penis involve the glans. Thus, the sentinel node biopsy will not reliably predict nodal involvement for all clinical stage I lesions, as the lymphatics from the glans may bypass the superficial nodes to invade the pelvic nodes directly. Finally, it remains to be determined what impact, if any, the improved understanding of penile anatomy will have for the patient with carcinoma of the penis. The extent of dissection, both in partial penectomy and in nodal dissection, deserves careful consideration. Armed with a clearer understanding of the anatomy of the penis, the urologist can choose a plan of surgical treatment wisely.

Erectile Dysfunction↗

PubMed2026

Selective Omission of Oncotype Dx Genomic Testing in Ultra-Low-Risk Luminal A Breast Cancer.

INTRODUCTION: Older women with early-stage luminal A breast cancer have an excellent prognosis with a 5-year relative survival >99%. Research on curtailing overtreatment has challenged historical standards of care by reducing radiotherapy dose and volume, and selectively omitting sentinel lymph node biopsy. This study assessed the utility of Oncotype Dx genomic testing in ultra-low-risk luminal A breast cancer. PATIENTS AND METHODS: A community hospital cancer registry was queried to identify consecutive breast cancer patients from 2014 to 2022. An ultra-low-risk population was defined as age ≥60 years, hormone-receptor positive, HER2-negative, pathologic stage T1b-T2N0 without lymphovascular invasion, and Ki-67 ≤13.25%. Analyses examined the distribution of Oncotype Dx scores categorized as low risk (0-18), intermediate risk (19-25), or high risk (26-100), as well as recurrence and overall survival. RESULTS: Of 1711 patients, 91 met ultra-low-risk eligibility criteria with available Oncotype Dx results. The median age was 70 years with a median follow-up of 5.1 years, and no patients received chemotherapy. Only 1 patient (1.1%) had a high-risk Oncotype Dx score of ≥26, while 12 (13.2%) had intermediate scores and 78 (85.7%) were low risk. Five-year local control and overall survival were 100% and 93%, respectively. Ten non-breast cancer deaths occurred, and no patients developed distant metastases. CONCLUSION: We describe a pragmatic method using common clinical and pathological features to define an ultra-low-risk cohort. Older luminal A patients with favorable pathology have a very low probability of receiving a high-risk Oncotype Dx score and demonstrate an excellent prognosis with standard adjuvant therapy.

Chemotherapy↗

PubMed2026

Tertiary lymphoid structure transcriptomic signatures show limited and cohort-dependent value for predicting axillary nodal involvement in oestrogen receptor-positive luminal breast cancer.

Tertiary lymphoid structures (TLS) are associated with prognosis in solid tumours. Their value for predicting axillary nodal involvement in oestrogen receptor-positive luminal breast cancer remains uncertain. Three published TLS signatures were scored by single-sample gene set enrichment analysis in oestrogen receptor-positive luminal tumours. The Cancer Genome Atlas Breast Invasive Carcinoma cohort (TCGA-BRCA) included 632 cases, of which 379 met strict consensus. METABRIC included 1086 cases, of which 663 met strict consensus. Logistic models adjusted for age and pathological tumour stage. Strict consensus, majority vote, and continuous scores were compared. Performance assessment included bootstrapped changes in area under the receiver-operating-characteristic curve, Brier scores, calibration, and decision-curve analysis. Survival was evaluated in METABRIC and explored in TCGA-BRCA. Strict-consensus TLS status was not associated with nodal positivity in TCGA-BRCA (adjusted odds ratio: 0.95, 95% confidence interval: 0.62-1.45, P = 0.822). METABRIC was similar (odds ratio: 0.76, 95% confidence interval: 0.55-1.06, P = 0.105). Full-cohort METABRIC analyses detected small majority-vote and continuous-score associations, absent in TCGA-BRCA. Across specifications, bootstrapped changes in area under the receiver-operating-characteristic curve ranged from 0.0002 to 0.0089, with minimal Brier-score improvement and no stable decision-curve benefit. In METABRIC, the univariable overall survival association attenuated after age adjustment (hazard ratio: 1.33-1.10). TCGA-BRCA survival analyses were nonsignificant. TLS transcriptomic signals showed small, cohort-dependent associations with nodal status but no reproducible or clinically meaningful incremental predictive value. These data do not support replacing sentinel lymph node biopsy with a TLS signature in oestrogen receptor-positive luminal breast cancer.

breast cancer↗

PubMed2026

Feasibility, reliability, and clinical value of genomic assay on pre-therapeutic biopsy for endocrine receptor-positive HER2-negative early breast cancer.

Endocrine receptor-positive (ER+) and HER2-negative breast cancer (BC) represents approximately 80% of all BCs. Most patients are treated with upfront surgery; however, 15%-30% will develop late recurrences. Genomic assay indication is usually based on postoperative pathological data including histology subtype, tumor size, lymph node status, SBR grade, and Ki67. Performing genomic testing on core needle biopsy specimens prior to surgery may offer several advantages. In this manuscript, we assess the feasibility, reliability, utility, and potential benefits of such genomic analyses performed on core needle biopsies. Several factors may lead to proposing genomic assay analysis on biopsy: (1) optimization of the patient pathway by reducing time to therapeutic decision-making, (2) predicting response to neoadjuvant chemotherapy (NAC) or neoadjuvant endocrine therapy (NET), and (3) refining prognostic assessment to guide adjuvant chemotherapy decisions in patients for whom axillary surgery is not planned. Given the feasibility and reliability of genomic assay on core needle biopsies, it can be suggested that this practice may become more common in the near future. Knowledge of the evolutive risk determined by the result of genomic assay, as well as clinicopathological characteristics, allows more precise personalization of the therapeutic strategy, including the choice between upfront surgery and neoadjuvant therapy, the selection of systemic treatments, and decision-making in the absence of axillary staging.

breast cancer↗

PubMed1992

Controversies in ilioinguinal lymphadenectomy for cancer of the penis.

One of the most important aspects in oncology is the definition of clinically relevant subgroups of patients whose disease wil have different behavior to enable decision making about therapeutic methods. The appropriate management of regional adenopathy in patients with penile cancer has generated a number of controversies. Generally, clinical determination of the extent of local disease is difficult. About 50% of patients with node enlargement have no tumor on histologic examination, and 20% of patients with clinically negative nodes have micrometastases. Lymph node biopsies, including sentinel node biopsy, are of limited staging value. Patients with lesions that do not invade the corpora and who have no palpable nodes should be followed carefully at 2- to 3-month intervals after excision of the primary tumor. Those with persistent adenopathy should undergo superficial lymph node dissection first, and if positive nodes are found, bilateral deep node dissection should be performed. Bilateral inguinal and pelvic lymphadenectomy is recommended for patients with lesions invading the corpora with clinically negative or positive nodes because of the high incidence of lymph node metastases in such cases (Table 1). When adenopathy persists after excision of the primary tumor, we advocate first a limited pelvic dissection. If the pelvic nodes are negative or not extensively involved, bilateral groin dissection should be performed, preferably in two stages. Percutaneous fine-needle aspiration of palpable or nonpalpable nodes can be helpful in preoperative staging in patients with penile cancer. Potential areas of study include identification of better risk factors and improvement of preoperative staging methods. This goal is hampered by the fact that penile cancer is a rare finding.(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy↗

PubMed2026

Adjuvant CDK4/6 inhibitors in early-stage breast cancer: Clinical evidence and considerations for risk stratification and treatment selection.

Hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer is the most common biologic subtype and carries a persistent risk of recurrence, particularly in patients with high-risk, early-stage disease. Cyclin-dependent kinase 4 and 6 inhibitors, initially established as a standard component of first-line therapy in the metastatic setting based on improvements in progression-free and overall survival, have since been evaluated in the adjuvant setting. While adjuvant palbociclib did not improve invasive disease-free survival, the monarchE and NATALEE trials demonstrated that abemaciclib and ribociclib, respectively, reduce recurrence risk in patients with high-risk, early-stage disease, with emerging overall survival data further supporting their use. However, the absolute magnitude of benefit varies substantially with baseline risk, and treatment-related toxicity and adherence challenges must be considered, as approximately 20% to 25% of patients discontinue therapy before completion. The integration of these agents into clinical practice also intersects with ongoing efforts to deescalate axillary surgery, as treatment eligibility has been largely defined by anatomic staging, particularly nodal status. Available data suggest that the incremental impact of axillary surgery on identifying candidates for cyclin-dependent kinase 4 and 6 inhibition is modest, especially among the favorable-risk populations now eligible for surgical deescalation. As the field evolves, advances in molecular risk stratification, genomic profiling, and dynamic biomarkers are poised to shift treatment selection from anatomic staging toward biologically driven approaches. Multidisciplinary decision-making that integrates tumor biology, anticipated absolute benefit, toxicity, patient preferences, and surgical considerations will be essential to ensure individualized care.

Humans↗

PubMed1987

Early versus delayed lymph-node dissection versus no lymph-node dissection in carcinoma of the penis.

Assessment of the inguinal lymph nodes for metastases in patients with penile cancer is inaccurate. About 50 per cent of patients with node enlargement have no tumor on histologic examination, and 20 per cent of patients with clinically negative nodes have micrometastases. Lymph-node biopsies, including sentinel-node biopsy, are of limited staging value. Patients with lesions that do not invade the corpora and who have no palpable nodes should be followed carefully after excision of the primary tumor at 2- to 3-month intervals. If compliance with such a follow-up is doubtful, bilateral superficial groin-node dissection seems appropriate. Those with persistent adenopathy should undergo superficial lymph-node dissection first, and if positive nodes are found, bilateral deep-node dissection should then be performed. Bilateral inguinal and pelvic lymphadenectomy is recommended for patients with lesions invading the corpora with clinically negative or positive nodes because of the high incidence of lymph-node metastases in such cases. Where adenopathy persists after excision of the primary tumor, we advocate first limited pelvic dissection. If the pelvic nodes are negative or are not extensively involved, bilateral groin dissection should be performed, preferably in two stages. Percutaneous fine-needle aspiration of palpable or nonpalpable nodes can improve preoperative staging in patients with penile cancer.

Humans↗

PubMedDate not supplied

Carcinoma of the penis.

Most premalignant penile lesions should be completely locally excised. Giant condyloma frequently cannot be distinguished from fungating carcinoma and usually requires limited penectomy. Cancers other than epidermoid carcinomas are very rare and, except for basal cell carcinoma, have a generally poor prognosis. Prognosis of squamous cell carcinoma, however, depends on the stage of disease as determined by both local invasion and by involvement of inguinal nodes. The three-year survival rates for 55 patients were: stage I, 95 percent; stage II, 67 percent; stage III, 29 percent; and stage IV, zero percent. Most primary lesions were treated by partial penectomy, and no patient developed local recurrence. There is a significant discrepancy between initial clinical and histologic staging, due to the difficulty of determining lymph node metastases. Current methods of radiation therapy indicate that it has a role for management of primary penile cancer, especially in young men with small lesions. The management of inguinal lymph nodes is still debated. Although the reliability of the sentinel node biopsy has not been established, it may be appropriate in patients with noninvasive primary lesions and no detectable inguinal metastases. The need for immediate or prophylactic lymph node dissection in patients with invasive primary tumors is controversial. Successful management depends on careful and frequent follow-up examinations, with early intervention for suspicious adenopathy. In view of the poor prognosis for advanced lymph node metastases, we prefer to use early lymph node dissection when the primary lesion is deeply invasive. Limited bilateral pelvic lymph node dissection is associated with minimal morbidity and seems to be an appropriate prelude to groin dissection. Extensive pelvic metastases are a sign of incurability and abrogate the need for groin dissection. We prefer to perform the inguinal dissection at the time of lymph node dissection through a separate curve groin incision.

Adult↗

PubMed1977

An approach for the treatment of penile carcinoma.

One hundred cases were studied in detail using lymphangiograms (LAG), anatomic dissections, and/or microscopic evaluation. LAG performed via the dorsal lymphatics of the penis demonstrate the existence of specific lymph node center, the so-called sentinel lymph node (SLN). This appears to be the primary site of metastases from penile carcinoma. The SLN is visualized radiographically, on the antero-posterior view, at the junction of the femoral head and the ascending ramus of the pubis. Anatomically, the SLN is part of the lymphatic system around the superficial epigastric vein. Forty-six SLN biopsies were performed with 15 positive for metastatic disease. In these 15 patients, an inguinofemoroiliac dissection was performed; in 12 cases there was no involvement of other lymph nodes. Lymphatic channels draining into the iliac lymph nodes without first draining into the sentinel lymph node were never demonstrated, nor were the inguinal-femoral lymph nodes involved in the absence of SLN involvement. On this bases, we recommend preliminary bilateral SLN biopsy to be followed by inguinofemoroiliac dissection when biopsy of the SLN biopsy to be followed by inguinofemoroiliac dissection when biopsy of the SLN is positive. When biopsy of the SLN is negative for metastatic disease, no further surgical therapy is immediately indicated. With negative SLN, 5-year survival was 90%. When SLN alone was involved, 5-year survival was 70%. Five-year survival was 50% with both SLN and other inguinal nodes involved. When iliac metastases were also present, 3-year survival was 20%.

Biopsy↗

PubMed1991

Inguinal pick in invasive penile carcinoma: can it stage node negative patients?

In node negative patients of invasive penile carcinoma, prophylactic lymphadenectomy is associated with considerable morbidity, while a "wait and watch" policy is associated with up to 20% cancer related mortality in many series. In between, selective node biopsies, including sentinel node biopsies, have been suggested to stage these patients. However, these procedures are unreliable and associated with high false negative rates. The inguinal pick procedure was devised by us to stage these patients more accurately. It is more elaborate that the previously described selective biopsies and includes biopsy of all identifiable nodes in the inguinal region, including the sentinel node area. In our experience of the procedure in 52 patients with invasive penile carcinoma, it was positive in 5 patients (9.6%). However, 7 of the 47 patients with negative result developed inguinal recurrences and 3 other patients developed distant metastases on follow up. The 5-year disease free survival of inguinal pick positive and negative patients was 100% and 82.9%, respectively. The sensitivity of the procedure in detecting regional spread in these patients was only 72%. Thus, the inguinal pick, though associated with no morbidity, can be meaningful only if it is positive and a negative result does not guarantee absence of regional metastases in node negative patients of invasive penile carcinoma.

Biopsy↗