SENTINEL NODE BIOPSY BY TWO KINDS OF BLUE DYES IN PATIENTS WITH BREAST CANCER

Objective To evaluate the identification successful rate of sentinel lymph node with breast cancer and the accuracy to predict axillary lymph node status in different vital blue dyes.Methods 94 patients with breast cancer were recruited for the study between Oct. 1999 and Apr. 2001, of whom 32 and 62, respectively, were injected 0.028mmol·L -1 Methylene blue and 0.018mmol·L -1 Patent blue violet in breast parenchyma surrounding the primary tumor to identify SLN.All 94 patients underwent the axillary lymph node dissection.Results For Methylene blue group and Patent blue violet group, SLN identification successful rates were 65.6% and 88.7% and accuracy rate to predict axillary lymph node status were 90.5% and 98.2% , respectively.Conclusion In identifying SLN,Patent blue violet is more ideal vital blue dye than Methylene blue, whereas the accuracy rate to predict axillary lymph node status had no significant difference.

Experimental Study of Chinese Ink as a New Type of Dye Tracer in Sentinel Lymph Node Biopsy~*

Objective： To investigate the potential clinical value of Chinese ink as a tracer in dye-directed sentinel lymph node biopsy. Methods： Forty-two female rabbits were randomly divided into 7 groups. The breast drainage lymphatic vessels and nodes in axilla were exposed by surgery. Under the papillae of the second pair of breast, 0.1 mL Chinese ink dilution at concentrations of 0.1%, 1%, 10%, 50% and 100% and isosulfan blue （IB, 1.0%） were injected. The movement of ink in lymphatic chain was investigated, and the number of stained nodes and their staining and washout time ware recorded. The first stained lymph node that was followed through lymphatic drainage was identified as the sentinel lymph node （SLN）. The SLNs were dissected and prepared for histological observation 5 rain, 1 h and 2 weeks after stained. Blood samples were harvested and tested before and 2 weeks after injection. The hearts, lungs, livers and kidneys were dissected after a period of post-operation observation and sent for pathologic examination. Results： No obvious differences were observed among the staining time of SLNs and the second lymph node using ink at different concentrations （P〉0.05）. But they were obviously longer than that of IB （P〈0.05）. The mean number of nodes obtained was nearly the same （P〉0.05）. It was too light for gross visual inspection when nodes were stained by ink at the concentration of 0.1%. Nodes stained by IB faded 33.9 rain after stained. And carbon staining seemed permanent without any visible decline after 2 weeks. Carbon particles were found to be in the sinus of lymph nodes that were obtained 5 rain after stained, and then was phagocytosed by macrophages （MФ） 1 h later. The density of carbon obscured the microscopic observation of lymph nodes when they were stained using Chinese ink at concentration of higher than 20.0%. No obvious changes were investigated in blood test and vital organ pathologic examination. Conclusion： Chinese ink is potentially a novel type of dye tracer in SLN biopsy.

LYMPHATIC MAPPING AND SENTINEL LYMPH NODE BIOPSY IN THE PATIENTS WITH BREAST CANCER

Objective: To identify the feasibility of the lymphatic mapping and sentinel node biopsy (SNB) in patients with breast cancer and to examine whether the characteristics of the sentinel lymph node (SLN) accurately predict the status of axillary node. Methods: 33 patients with breast cancer intraoperatively and postoperatively underwent a lymphatic mapping and the SNB using Patent Blue. Results: The SLNs were found in 30 of 33 patients (90.9%), the SLN accurately predicted the status of the axillary in 29 (96.7%). In one case the SLN was negative, but other axillary nodes were tumor positive. Conclusion: This study confirmed that the procedure of lymphatic mapping and SNB in the patients with breast cancer is feasibility, and that the histological characteristics of the SLN accurately predict the status of the axillary node. We believe that this technique might replace axillary lymph node dissection for breast cancer patients with negative axillae in the future.

The role of sentinel node biopsy in oral squamous cell carcinoma

Aim:The purpose of this study was to conduct a systematic review of the published literature to assess the state of the art of this procedure.Sentinel node biopsy(SNB)in oral squamous cell cancer(OSCC)is a novel and proven useful technique alternative to the neck dissection(ND)in the management of OSCC.Methods:The authors searched PubMed for literature in English published for the last five years,addressing this topic.Prospective studies articles were selected with at least thirty patients studied.Results:Of 235 studies found,14 studies met the exclusion and inclusion criteria for this review.The studies selected focused on the role of the SNB in the OSCC,advantages compared to ND and its limitations,testing different solutions and innovations that could implement the conventional procedure.Meta-analysis studies and review articles were also selected in order to perform the introduction and support the discussion.Based upon these findings authors have tried to establish the state of the art of the SNB and authors have highlighted recent advances that improve the sentinel lymphatic node biopsy technique in the future.Conclusion:SNB is an excellent staging method in OSCC and an interesting alternative to ND.The authors show the most appropriate procedures recommended in the bibliography revised in a trend to depict the actual state of the art.

Prospective study found that peripheral lymph node sampling reduced the false-negative rate of sentinel lymph node biopsy for breast cancer

Background:Although sentinel lymph node biopsy(SLNB) can accurately predict the status of axillary lymph node(ALN) metastasis,the high false?negative rate(FNR) of SLNB is still the main obstacle for the treatment of patients who receive SLNB instead of ALN dissection(ALND).The purpose of this study was to evaluate the clinical significance of SLNB combined with peripheral lymph node(PLN) sampling for reducing the FNR for breast cancer and to discuss the effect of "skip metastasis" on the FNR of SLNB.Methods:At Shandong Cancer Hospital Affiliated to Shandong University between March 1,2012 and June 30,2015,the sentinel lymph nodes(SLNs) of 596 patients with breast cancer were examined using radiocolloids with blue dye tracer.First,the SLNs were removed;then,the area surrounding the original SLNs was selected,and the visible lymph nodes in a field of 3–5 cm in diameter around the center(i.e.,PLNs) were removed,avoiding damage to the structure of the breast.Finally,ALND was performed.The SLNs,PLNs,and remaining ALNs underwent pathologic examination,and the relationship between them was analyzed.Results:The identification rate of SLNs in the 596 patients was 95.1%(567/596);the metastasis rate of ALNs was 33.7%(191/567);the FNR of pure SLNB was 9.9%(19/191);and after the SLNs and PLNs were eliminated,the FNR was 4.2%(8/191),which was significantly decreased compared with the FNR before removal of PLNs(P Aected number(N) of SLNs,the patients were divided into four groups of N = 0.028).ccording to the det= 1,2,3,and ≥4;the FNR in these groups was 19.6,9.8,7.3,and 2.3%,respectively.For the patients with removal of PLNs was significantly decreased compared with that before remo≤2 or val of P≤3 detected SLNs,the FNR afterLNs(N 3:12.2% vs.4.7%,P ≤ 2:14.0% vs.4.7%,P = 0.019;N ≤ nt(P = 0.021),whereas for patients with ≥4 detected SLNs,the decrease in FNR was not statistically significa= 1.000).In the entire cohorts,the "skip metastasis" rate was 2.5%(15/596);the FNR caused by "skip metastasis" was 2.1%(4/191).Conclusions:The FNR of SLNB was associated with the number of SLNs.For patients with mpling can reduce the FNR of SLNB to an acceptable level of less than 5%.Because of the≤3 detected SLNs,PLN sa existence of the "skip metastasis" and distinct metastasis patterns,the FNR of SLNB cannot be completely eliminated.

Is sentinel lymph node biopsy necessary for the patients diagnosed with breast ductal carcinoma in situ using core needle biopsy or vacuum-assisted biopsy as the initial diagnostic method？

Axillary lymph node status is one of the most important prognostic indicator of survival for breast cancer, especially in ductal carcinoma in situ （DCIS）. The purpose of this study was to investigate whether sentinel lymph node biopsy （SLNB） should be performed in patients with an initial diagnosis of DCIS. Methods： A retrospective study was performed of 124 patients with an initial diagnosis of DCIS between March 2000 and June 2014. The patients were treated with either SLNB or axillary node dissection during the surgery, and we compared the clinicopathologic characteristics, image features, and immunohistochemical results. Results： Eighty-two patients （66.1%） had pure DCIS and 25 （20.2%） had DCIS with microinvasion （DCISM）, 17 （13.7%） updated to invasive breast cancer （IBC）. 115 patients （92.7%） underwent SLNB, among them, 70 patients （56.5%） underwent axillary node dissection. 3 of 115 patients （2.6%） had a positive sentinel lymph node, only 1 （1.4%） of 70 patients had axillary lymph node metastasis, in 84 patients （66.7%） who were diagnosed DCIS by core needle biopsy （CNB） and vacuum-assisted biopsy （VAB）. 26 patients （31.0%） were upstaged into IBC or DCISM in the final histological diagnosis. The statistically significant factors predictive of underestimation were large tumor size, microcalcifications, comedo necrosis, positive Her-2 status, negative estrogen receptor status. Conclusion： The metastasis of sentinel lymph nodes in pure DCIS is very low, but the underestimation of invasive carcinoma in patients with an initial diagnosis of DCIS is an usual incident, especially in the cases when DCIS is diagnosed by CNB or VAB. Our findings suggest patients presenting with a preoperative diagnosis of DCIS associated with large tumor sizes, microcalcifications, comedo necrosis, positive Her-2 status, negative ER status are more likely to be DCISM and IBC in final diagnosis. SLNB should be performed in this part of patients.

Feasibility of sentinel lymph node biopsy omission after integration of ^(18)F-FDG dedicated lymph node PET in early breast cancer: a prospective phase II trial

Objective:Sentinel lymph node biopsy(SLNB)is currently the standard of care in clinically node negative(cN0)breast cancer.The present study aimed to evaluate the negative predictive value(NPV)of 18F-FDG dedicated lymph node positron emission tomography(LymphPET)in cN0 patients.Methods:This was a prospective phase II trial divided into 2 stages(NCT04072653).In the first stage,cN0 patients underwent axillary LymphPET followed by SLNB.In the second stage,SLNB was omitted in patients with a negative preoperative axillary assessment after integration of LymphPET.Here,we report the results of the first stage.The primary outcome was the NPV of LymphPET to detect macrometastasis of lymph nodes(LN-macro).Results:A total of 189 patients with invasive breast cancer underwent LymphPET followed by surgery with definitive pathological reports.Forty patients had LN-macro,and 16 patients had only lymph node micrometastasis.Of the 131 patients with a negative LymphPET result,16 patients had LN-macro,and the NPV was 87.8%.After combined axillary imaging evaluation with ultrasound and LymphPET,100 patients were found to be both LymphPET and ultrasound negative,9 patients had LN-macro,and the NPV was 91%.Conclusions:LymphPET can be used to screen patients to potentially avoid SLNB,with an NPV>90%.The second stage of the SOAPET trial is ongoing to confirm the safety of omission of SLNB according to preoperational axillary evaluation integrating LymphPET.

Breast-conserving surgery and sentinel lymph node biopsy for breast cancer and their correlation with the expression of polyligand proteoglycan-1

BACKGROUND Breast cancer is a malignant tumor with an unclear etiology and is the most common malignant tumor in women.Surgery is the main clinical treatment for breast cancer.Although traditional total mastectomy combined with axillary lymph node dissection is effective,it can result in shoulder dysfunction,especially in middle-aged and elderly patients with breast cancer with weak constitution and other underlying diseases.Furthermore,the postoperative quality of life is poor.AIM To assess breast-conserving surgery and sentinel lymph node biopsy for breast cancer treatment and their correlation with polyligand proteoglycan-1.METHODS Overall,80 patients with breast cancer treated in our hospital from January 2021 to July 2021 were retrospectively selected and divided into an observation group(n=44)and control group(n=36)according to the treatment plan.The observation group was treated with breast-conserving surgery and sentinel lymph node biopsy,and the control group was treated with total breast resection.Simultaneously,immunohistochemical staining was used to detect the expression of syndecan-1(SDC-1)in the lesions,and its relationship with clinicopathological findings was analyzed.RESULTS Intraoperative blood loss,operation time,and hospital stay in the observation group were 65.51±9.94 m L,65.59±9.40 min,and 14.80±3.03 d,respectively,which were significantly lower than those in the control group(P<0.05).The incidence of postoperative complications in the observation group was 11.36%,which was significantly lower than that in the control group(P<0.05).The positive expression rate of SDC-1 in the observation group was 25.00%,and there was no significant difference between the groups(P>0.05).The positive expression rate of SDC-1 in patients with American Joint Committee on Cancer(AJCC)stageⅡwas 14.29%,which was significantly lower than that in patients with AJCC stageⅠ(P<0.05).The positive expression of SDC-1 had no significant relationship with age,course of disease,site,tissue type,and treatment plan(P>0.05).CONCLUSION Breast preservation surgery and sentinel lymph node biopsy for breast cancer treatment have fewer complications and quicker recovery than those treated with total breast resection.Low SDC-1 expression in breast cancer lesions is related to AJCC staging.

Recent Advances in the Tracer Technology Used for Sentinel Lymph Node Biopsy in Breast Cancer

The high incidence of breast cancer poses one of the greatest risks to female health worldwide. Sentinel lymph node biopsy (SLNB) is the standard of treatment for patients with axillary lymph node-negative early-stage breast cancer. Herein, the precise use of tracers is the key to ensuring the success of SLNB. However, owing to select-few limitations of traditional tracers, their clinical application is limited. New tracer techniques, such as the near-infrared fluorescent dye method (using indocyanine green), contrast-enhanced ultrasound, and superparamagnetic iron oxide nanoparticles are being applied in clinical practice. In this paper, we review the recent progress in SLNB tracer technology.

Diagnostic biopsy of cutaneous melanoma, sentinel lymph node biopsy and indications for lymphadenectomy

The incidence of cutaneous melanoma appears to be increasing worldwide and this is attributed to solar radiation exposure.Early diagnosis is a challenging task.Any clinically suspected lesion must be assessed by complete diagnostic excision biopsy(margins 1-2 mm);however,there are other biopsy techniques that are less commonly used.Melanomas are characterized by Breslow thickness as thin(<1 mm),intermediate(1-4 mm)and thick(>4 mm).This thickness determines their biological behavior,therapy,prognosis and survival.If the biopsy is positive,a wide local excision(margins 1-2 cm)is finally performed.However,metastasis to regional lymph nodes is the most accurate prognostic determinant.Therefore,sentinel lymph node biopsy(SLNB)for diagnosed melanoma plays a pivotal role in the management strategy.Complete lymph node clearance has undoubted advantages and is recommended in all cases of positive SLN biopsy.A PET-CT(positron emission tomography-computed tomography)scan is necessary for staging and follow-up after treatment.Novel targeted therapies and immunotherapies have shown improved outcomes in advanced cases.

Applied study of sentinel lymph node biopsy in colorectal cancer

Objective： The aim of this study was to investigate the feasibility of sentinel lymph node biopsy （SLNB） in colorectal cancer. Methods： Twenty patients of colorectal cancer were enrolled in this study. Endoscopic injection submucosally of ^99m Tc-DX was performed around the primary tumor 3 h before operation. Immediately after laparotomy, methylene blue was injected into subserosal layer adjacent to the tumor. Sentinel lymph nodes （SLNs） were defined as blue stained nodes or （and） those containing 10 times more radioactivity than surrounding tissue with a y probe, all resected nodes were examined postoperatively by routine rapid frozen examination and HE stain. The diagnostic nodes metastasis states and false-negative rate of regional lymph node status on the basis of SLNs were calculated respectively. Results： SLNs were detected in 16 of 20 patients with a successful detection rate of 80%, the number of SLNs ranged from 1 to 3, with a mean value of 2.4 per case, metastasis rate of SLNs were 37.5% （18/48）, the diagnostic sensitivity was 80% （16/20）, the diagnostic accuracy was 83.3% （15/18）, the false-negative rate was 20% （4/20）. Conclusion： The SLN concept is validated in colorectal cancer. Com- bined-agent SLN mapping is an accurate diagnostic procedure for detecting lymph node metastasis in patients with colorectal cancer and may indicate rational extent of lymphadenectomy for colorectal cancer.

Sentinel lymph node biopsy in renal malignancy: The past, present and future

Sentinel lymph node biopsy （SLNB） is now an establishedtechnique in penile and pelvic cancers, resulting in alower mortality and morbidity when compared withthe traditional lymph node dissection. In renal cancer however, despite some early successes for the SLNB technique, paucity of data remains a problem, thus lymph node dissection and extended lymph node dissection remain the management of choice in clinically node positive patients, with surveillance of lymph nodes in those who are clinically node negative. SLNB is a rapidly evolving technique and the introduction of new techniques such as near infra-red fuorescence optical imaging agents and positron emission tomography/computed tomography scans, may improve sensitivity. Evidence in support of this has already been recorded in bladder and prostate cancer.Although the lack of large multi-centre studies and issues around false negativity currently prevent its widespread use, with evolving techniques improving accuracy and the support of large-scale studies, SLNB does have the potential to become an integral part of staging in renal malignancy.

Effect of Breast Conserving Sentinel Lymph Node Biopsy(SLNB)and Modified Radical Mastectomy on Patients with Early Breast Cancer

Objective:To study the clinical effect of breast conserving combined with sentinel lymph node biopsy and modified radical mastectomy in patients with early breast cancer.Methods:Female patients with early breast cancer in clinical stage I and II were selected as the main objects of this study,the study period started from July 2017 to July 2020.In the breast conserving and sentinel lymph node biopsy patients,50 cases were randomly selected as the experimental group;50 cases in the modified radical mastectomy patients were randomly selected as the control group.The clinical intervention effect of the two groups was analyzed.Results:the perioperative indexes of the experimental group were shorter than those of the control group,the patients recovered faster,the incidence of complications in the experimental group was lower,and the quality of life scores of the experimental group were significantly higher than those of the control group,and the difference was statistically significant,the intervention effect of the experimental group was also better.Conclusion:The application of breast conserving and sentinel lymph node biopsy in the treatment of early breast cancer can promote the recovery of patients,shorten the operation time and reduce the rate of complications,which has significant clinical significance.

Assessing the Clinical Efficacy and Effectiveness of Sentinel Lymph Node Biopsy Combined with Breast-Conserving Surgery for Early-Stage Breast Cancer

Objective:To analyze the impact of sentinel lymph node biopsy(SLNB)combined with breast-conserving surgery in the clinical treatment of early-stage breast cancer.Methods:80 patients with early-stage breast cancer admitted to the Second Department of Breast Surgery at Dezhou Second People’s Hospital from September 2020 to September 2022 were selected and randomly divided into a control group and an observation group using the random number table method,with 40 cases in each group.The control group underwent a modified radical mastectomy,while the observation group underwent SLNB combined with breast-conserving surgery.The surgical efficacy and prognosis between the two groups were compared.Results:The observation group exhibited shorter operation,hospitalization,and extubation times,as well as less intraoperative blood loss and drainage volume,all of which were significantly better than those in the control group(P<0.05).Additionally,the observation group demonstrated a higher rate of excellent breast cosmetology and quality of life,with lower complication incidence,significantly outperforming the control group(P<0.05).There was no statistical difference in the metastasis rate and recurrence rate between the two groups(P>0.05).Conclusion:The combination of SLNB and breast-conserving surgery proves highly effective for patients with early-stage breast cancer,presenting fewer complications and enhancing both breast cosmetic outcomes and quality of life.

Life prognosis of sentinel node navigation surgery for early-stage gastric cancer:Outcome of lymphatic basin dissection

BACKGROUND Lymphatic basin dissection is a sentinel node biopsy method that is specific for gastric cancer.In this method,the dyed lymphatic system is dissected en bloc,and sentinel nodes are identified at the back table(ex vivo).Even with lymphatic basin dissection,blood flow to the residual stomach can be preserved,and functionpreserving curative gastrectomy can be performed.The oncological safety of function-preserving curative gastrectomy combined with lymphatic basin dissection has not yet been fully investigated.We hypothesized that the oncological safety of sentinel node navigation surgery(SNNS)is not inferior to that of the guidelines.AIM To investigate the life prognosis of SNNS for gastric cancer in comparison with guidelines surgery.METHODS This was a retrospective cohort study.Patients were selected from gastric cancer patients who underwent sentinel node biopsy from April 1999 to March 2016.Patients from April 1999 to August 2008 were from the Department of Surgery II,Kanazawa University Hospital,and patients from August 2009 to March 2016 were from the Department of Surgical Oncology,Kanazawa Medical University Hospital.Patients who were diagnosed with gastric cancer,which was preoperatively diagnosed as superficial type(type 0),5 cm or less in length,clinical T1-2 and node negative,and underwent various gastrectomies guided by sentinel node navigation were retrospectively collected.The overall survival(OS)and relapsefree survival(RFS)of these patients(SNNS group)were investigated.Patients with gastric cancer of the same stage and who underwent guidelines gastrectomy with standard nodal dissection were also selected as the control group.RESULTS A total of 239 patients in the SNNS group and 423 patients in the control group were included.Pathological nodal metastasis was observed in 10.5%and 10.4%of the SNNS and control groups,respectively.The diagnostic abilities of sentinel node biopsy were 84%and 98.6%for sensitivity and accuracy,respectively.In the SNNS group,81.6%of patients underwent modified gastrectomy or functionpreserving curative gastrectomy with lymphatic basin dissection,in which the extent of nodal dissection was further reduced compared to the guidelines.The OS rate in the SNNS group was 96.8%at 5 years and was significantly better than 91.3%in the control group(P=0.0014).The RFS rates were equal in both groups.After propensity score matching,there were 231 patients in both groups,and the cumulative recurrence rate was 0.43%at 5 years in the SNNS group and 1.30%in the control group,which was not statistically different.CONCLUSION The oncological safety of patients who undergo gastrectomy guided by sentinel node navigation is not inferior to that of the guidelines surgery.

Sentinel node biopsy in early oral squamous cell carcinoma - a safe diagnostic and therapeutic procedure

Sentinel node biopsy(SNB)is considered the standard surgical procedure for detecting occult neck node metastasis in oral squamous cell carcinoma(OSCC)in many centers around the world.Due to the fact that this method removes and evaluates the first lymph node(s)reached by the lymphatic flow from the tumor area,this has raised the question of whether SNB could also be considered a therapeutic procedure by targeted lymphadenectomy instead of elective neck dissection(END).Compared to END,its safety and low morbidity have been established.However,the surgical management of the clinical node-negative(cN0)neck in T1/T2 oral carcinoma has been under ongoing debate due to the lack of randomized studies comparing SNB to END in terms of overall survival(OS),disease-free survival(DFS)and neck recurrence rates(NRRs).In the last years,two prospective randomized studies have proven with high-level evidence the noninferiority of SNB compared to END in terms of oncologic outcome while reducing costs and morbidity.In our opinion,SNB should be offered as the new standard therapeutic procedure in early OSCC.

A mini-review on factors and countermeasures associated with false-negative sentinel lymph node biopsies in breast cancer

Sentinel lymph node biopsy （SLNB） is a new surgical technique for local axillary lymph nodes （ALNs） of breast cancer. Large-scale clinical trials have confirmed that undergoing SLNB and ALN dissection （ALND） showed no significant difference for sentinel lymph node （SLN）-negative patients in terms of disease-free survival, overall survival and recurrence-free survival. However, false-negative results are still the main concern of physicians as well as patients who undergo SLNB instead of ALND. The American Society of Breast Surgeons established a task force to suggest acceptable standards for SLNB. In 2000, the task force recommended that the identification rate for SLNB be 85% or higher and the false-negative rate be 5% or lower. This review focuses on clinical factors （tumor volume, multifocal/multi-center cancers, neoadjuvant chemotherapy and skip metastasis）, tracer techniques and pathological factors affecting SLNB and explores methods for reducing the false-negative rate.

PREDICTION OF NON-SENTINEL LYMPH NODE METASTASES IN BREAST CANCER

Objective.To identify a subset of breast cancer patients in whom metastatic disease is confined on-ly to the sentinel lymph node(SLN).Methods.Sentinel lymph node biopsy is performed with the injecetion of Tc99m-SC,and a gamma probe.Sentinel node biopsy was compared with standard axillary dissection for its ability to reflect the fi-nal pathological status of the axillary nodes.The factors associated with non-SLN metastases were as-sessed in the univariate and multivariate analysis.Result.We successfully identified91out of95patients for SLN(95.8%).The accuracy of sentinel lymph node to predict the axillary lymph node status was93.4%.Clinical tumor size and tumor grade were proved to be the independent predictive factors for non-SLN metastases by logistic regression model.Conclusion.In most cases,the gamma probe guided method is technically feasible for detecting sentinel nodes,accurately predicting the axillary lymph node status.A subset of the patients identified who have a low risk of non-SLN metastases may not require axillary lymph node dissection.

Macrometastasis at selective lymph node biopsy:A practical goingfor-the-one clinical scoring system to personalize decision making

BACKGROUND Axillary sentinel lymph node biopsy(SLNB)is standard treatment for patients with clinically and pathological negative lymph nodes.However,the role of completion axillary lymph node dissection(cALND)following positive sentinel lymph node biopsy(SLNB)is debated.AIM To identify a subgroup of women with high axillary tumor burden undergoing SLNB in whom cALND can be safely omitted in order to reduce the risk of longterm complications and create a Preoperative Clinical Risk Index(PCRI)that helps us in our clinical practice to optimize the selection of these patients.METHODS Patients with positive SLNB who underwent a cALND were included in this study.Univariate and multivariate analysis of prognostic and predictive factors were used to create a PCRI for safely omitting cALND.RESULTS From May 2007 to April 2014,we performed 1140 SLN biopsies,of which 125 were positive for tumor and justified to practice a posterior cALND.Pathologic findings at SLNB were micrometastases(mic)in 29 cases(23.4%)and macrometastasis(MAC)in 95 cases(76.6%).On univariate analysis of the 95 patients with MAC,statistically significant factors included:age,grade,phenotype,histology,lymphovascular invasion,lymph-node tumor size,and number of positive SLN.On multivariate analysis,only lymph-node tumor size(≤20 mm)and number of positive SLN(>1)retained significance.A numerical tool was created giving each of the parameters a value to predict preoperatively which patients would not benefit from cALND.Patients with a PCRI≤15 has low probability(<10%)of having additional lymph node involvement,a PRCI between 15-17.6 has a probability of 43%,and the probability increases to 69%in patients with a PCRI>17.6.CONCLUSION The PCRI seems to be a useful tool to prospectively estimate the risk of nodal involvement after positive SLN and to identify those patients who could omit cALND.Further prospective studies are necessary to validate PCRI clinical generalization.

Sentinel Lymph Node Identification in Endometrial Cancer

OBJECTIVE To evaluate the feasibility of intra-operativedetection of sentinel lymph nodes (SLN) in the patient withendometrial cancer (EC).METHODS Thirty-one patients with Stage Ⅰ and Ⅱ endometrialcancer, who underwent a hysterectomy and a lymphadenectomy,were enrolled in the study. At laparotomy, methylene blue dyetracer was injected into the subserosal myometrium of corpusuteri at multiple sites, and dye uptake into the lymphatic channelswas observed. The blue nodes which were identified as SLNs weretraced and excised. The other nodes were then removed. All of theexcised nodes were submitted for pathological hematoxylin andeosin (H&E) staining examination.RESULTS Failure of dye uptake occurred in 4 of the 31 cases(12.9%) because of spillage, and no lymphatic coloration wasobserved there. Lymphatic staining was clearly observable as bluedye diffused to the lymphatic channels of the uterine surface andthe infundibulopelvic ligaments in 27 (87.1%) cases. Concurrentcoloration in the pelvic lymphatic vessels was also observed in 22of the 27 patients. The SLNs were identified in 23 of the 27 (85.2%)cases with a lymphatic staining, with a total number of 90 SLNs,and a mean of 3.9 in each case (range, 1-10). Besides one SLN (1.1%)in the para-aortic area, the other 89 (98.9%) were in the nodes ofthe pelvis. The most dense locations of SLNs included obturator in38 (42.2%) and interiliac in 19 (21.1%) cases. In our group, pelviclymphadenectomy was conducted in 27 (87.1%) patients andpelvic nodal sampling in 4 (12.9%). Of the 31 cases, a concurrentabdominal para-aortic lymph node sampling was conducted in7. A total of 926 nodes were harvested, with an average of 39.8 ineach case (range, 14-55). Nodal metastases occurred in 3 patients(9.7%), 2 of them with SLN involvement and the other withoutSLN involvement. Adverse reactions or injury related to the studywas not found.CONCLUSION Application of methylene blue dye is feasible inan intra-operative SLN identification of endometrial cancer. Thetechnology is convenient, safe, and worth further investigation.