Application value of indocyanine green fluorescence imaging in guiding sentinel lymph node biopsy diagnosis of gastric cancer: Meta-analysis

BACKGROUND Gastric cancer is a common malignant tumor of the digestive system worldwide,and its early diagnosis is crucial to improve the survival rate of patients.Indocyanine green fluorescence imaging(ICG-FI),as a new imaging technology,has shown potential application prospects in oncology surgery.The meta-analysis to study the application value of ICG-FI in the diagnosis of gastric cancer sentinel lymph node biopsy is helpful to comprehensively evaluate the clinical effect of this technology and provide more reliable guidance for clinical practice.AIM To assess the diagnostic efficacy of optical imaging in conjunction with indocya-nine green(ICG)-guided sentinel lymph node(SLN)biopsy for gastric cancer.METHODS Electronic databases such as PubMed,Embase,Medline,Web of Science,and the Cochrane Library were searched for prospective diagnostic tests of optical imaging combined with ICG-guided SLN biopsy.Stata 12.0 software was used for analysis by combining the"bivariable mixed effect model"with the"midas"command.The true positive value,false positive value,false negative value,true negative value,and other information from the included literature were extracted.A literature quality assessment map was drawn to describe the overall quality of the included literature.A forest plot was used for heterogeneity analysis,and P<0.01 was considered to indicate statistical significance.A funnel plot was used to assess publication bias,and P<0.1 was considered to indicate statistical significance.The summary receiver operating characteristic(SROC)curve was used to calculate the area under the curve(AUC)to determine the diagnostic accuracy.If there was interstudy heterogeneity(I2>50%),meta-regression analysis and subgroup analysis were performed.analysis were performed.RESULTS Optical imaging involves two methods:Near-infrared(NIR)imaging and fluorescence imaging.A combination of optical imaging and ICG-guided SLN biopsy was useful for diagnosis.The positive likelihood ratio was 30.39(95%CI:0.92-1.00),the sensitivity was 0.95(95%CI:0.82-0.99),and the specificity was 1.00(95%CI:0.92-1.00).The negative likelihood ratio was 0.05(95%CI:0.01-0.20),the diagnostic odds ratio was 225.54(95%CI:88.81-572.77),and the SROC AUC was 1.00(95%CI:The crucial values were sensitivity=0.95(95%CI:0.82-0.99)and specificity=1.00(95%CI:0.92-1.00).The Deeks method revealed that the"diagnostic odds ratio"funnel plot of SLN biopsy for gastric cancer was significantly asymmetrical(P=0.01),suggesting significant publication bias.Further meta-subgroup analysis revealed that,compared with fluorescence imaging,NIR imaging had greater sensitivity(0.98 vs 0.73).Compared with optical imaging immediately after ICG injection,optical imaging after 20 minutes obtained greater sensitivity(0.98 vs 0.70).Compared with that of patients with an average SLN detection number<4,the sensitivity of patients with a SLN detection number≥4 was greater(0.96 vs 0.68).Compared with hematoxylin-eosin(HE)staining,immunohistochemical(+HE)staining showed greater sensitivity(0.99 vs 0.84).Compared with subserous injection of ICG,submucosal injection achieved greater sensitivity(0.98 vs 0.40).Compared with 5 g/L ICG,0.5 and 0.05 g/L ICG had greater sensitivity(0.98 vs 0.83),and cT1 stage had greater sensitivity(0.96 vs 0.72)than cT2 to cT3 clinical stage.Compared with that of patients≤26,the sensitivity of patients>26 was greater(0.96 vs 0.65).Compared with the literature published before 2010,the sensitivity of the literature published after 2010 was greater(0.97 vs 0.81),and the differences were statistically significant(all P<0.05).CONCLUSION For the diagnosis of stomach cancer,optical imaging in conjunction with ICG-guided SLN biopsy is a therapeut-ically viable approach,especially for early gastric cancer.The concentration of ICG used in the SLN biopsy of gastric cancer may be too high.Moreover,NIR imaging is better than fluorescence imaging and may obtain higher sensitivity.

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.

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.

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.

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.

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.

Application of sentinel lymph node (SLN) biopsy in breast cancer patients

Objective： To discuss if the sentinel lymph node （SLN） biopsy is able to reflect the status of the axillary lymph node and the application of this technic in clinic. Methods： Using^ 99mTc-signed dextran, SLN-biopsy （SLNB） was carried out in 182 cases with breast cancer during May 1999 to September 2006. During the operation, y-detector was used for orientation. After the SLNB, a modified radical mastectomy or breast conserving surgery were carried out to the patients, then a particular separate pathological examination of the SLN was made. Results： 178 cases of SLNB were carried out successfully, and the success rate was 97.8%, the out-checked SLN of each case ranged from 1 to 4, with an average of 2.5. All SLN was located at the first level of axilla, sensitivity of the SLN B was 93.4%, specificity was 100%, false negative rate was 6.6%, false positive rate was 0, accuracy was 97.8%, positive predictive value was 100.0%, negative predictive value was 96.7%, and Youden＇s index was 0.934. Immunohistochemical examination was carried out in 59 cases of SLN, and 14 cases showed the existences of micro-metastasis, however, metastasis had not been found in non-SLN of these cases. Conclusion： SLN is able to reflect the metastasis of the axillary lymph node, and this can suggest the necessity of the axillary dissection in clinic. The SLNB using the isotope-tracer technic is simple and accurate.

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 clinical significance of axillary sentinel lymph node biopsy in different clinical stages breast cancer patients after neoadjuvant chemotherapy

Objective： We aimed to study the success and false negative rate of sentinel lymph node biopsy （SLNB） in dif- ferent clinical stages breast cancer patients being carried out with neoadjuvant chemotherapy （NAC）, and the clinical signifi- cance of SLNB, we conducting this trial. Methods： One hunderd and thirty-seven cases were enrolled in this clinical research from March 2003 to March 2007. All of the patients＇ sentinel lymph nodes were detected with 99mTc-Dx and methylene blue. There were 61 patients with stage TI_2NoMo carried SLNB without NAC （group A）, 76 cases were carried out NAC 3-4 cycles before SLNB, including 39 T2_4N0_IMo cases （group B） and 27 T2-4N2_3M0 cases （group C）. The success and false negative rate of SLNB were analysed with chi-square test. Results： In group A, the successful and false negative rate of SLNB were 92.31% （36/39）, 8.57% （3/35）, and in group B and C were 92.31% （36/39）, 8.57% （3/35） and 74.07 % （20/27）, 18.52 % （5/27）, respectively. The successful rate of group C decreased and false negative rate increased significantly compared with group A and B （P 〈 0.05）, but group A and B had no significant difference （P 〉 0.05）. Conclusion： The SLNB can accurately predict lymph node status of axillary lymph node in N0-1 stage patients with NAC, but in N2-3 stage patients the success rate decreased and false rate increased negative significantly.

Signif icance of Sentinel Lymph Node Biopsy and Immunohistochemistry in Diagnosis and Staging of Stage-cN0 Oral Squamous Cell Carcinoma

OBJECTIVE To assess the significance of sentinel lymph node biopsy （SLNB）, serial section and cytokeratin immunohistochemical staining in the diagnosis and staging of Stage-cNO oral squamous cell carcinoma （OSCC）, METHODS A blue stain, 99mTc-dextran SPECT lymphoscintigrapgy and intraoperative y-ray probes were used to examine the sentinel nodes in 31 cases with Stage-oNO oral cancer, The H＆E staining and a cytokeratin AE1/ AE3 immunohistochemistry （IHC） assessment, with serial sections, were conducted to provide results obtained from a routine pathological examination of lymph nodes, The value of the routine pathological examination of the sentinel lymph node （SLN）, serial sections and IHC determination for cervical lymph node metastasis of Stage-cN0 OSCC was appraised, RESULTS A total of 45, 55 and 51 SLNs were examined in 25 （80%）, 31 （100%） and 30 （96,5%） of the cases, by using the blue stain, y-ray probes, and SPECT lymphoscintigraphy, respectively, The average SLNs found in each case of the groups was 1,4 （1 to 3） and there were 1,302 non-NSLNs, Six positive SLN metastases were detected by routine pathological examination, among which 1 case was found to be an accompanied positive metastasis of non-SLN, One positive SLN metastasis was found after examination of serial sections plus routine H＆E staining and 2 were detected using serial sections plus AE3 immunohistochemical staining methods, No positive NSLNs were found in the study, CONCLUSION In order to make more progress in accurate SLNB diagnosis, serial sections and IHC （AE1/AE3） methods can be used for examination of the micrometastases which are difficult to identify by routine pathological sections and H＆E staining.

Sentinel lymph node biopsy for gastric cancer:Where do we stand?

Development of sentinel node navigation surgery (SNNS) and advances in minimally invasive surgical techniques have greatly shaped the modern day approach to gastric cancer surgery.An extensive body of knowledge now exists on this type of clinical application but is principally composed of single institute studies.Certain dye tracers,such as isosulfan blue or patent blue violet,have been widely utilized with a notable amount of success;however,indocyanine green is gaining popularity.The double tracer method,a synchronized use of dye and radio-isotope tracers,appears to be superior to any of the dyes alone.In the meantime,the concepts of infrared ray electronic endoscopy,florescence imaging,nanoparticles and near-infrared technology are emerging as particularly promising alternative techniques.Hematoxylin and eosin staining remains the main method for the detection of sentinel lymph node (SLN) metastases.Several specialized centers have begun to employ immunohistochemical staining for this type of clinical analysis but the equipment costs involving the associated ultra-rapid processing systems is limiting its widespread application.Laparoscopic function-preserving resection of primary tumor from the stomach in conjunction with lymphatic basin dissection navigated by SLN identification represents the current paramount of SNNS for early gastric cancer.Patients with cT3 stage or higher still require standard D 2 dissection.

Sentinel lymph node biopsy in clinically detected ductal carcinoma in situ

AIM:To study the indications for sentinel lymph node biopsy(SLNB) in clinically-detected ductal carcinoma in situ(CD-DCIS).METHODS:A retrospective analysis of 20 patients with an initial diagnosis of pure DCIS by an image-guided core needle biopsy(CNB) between June 2006 and June 2012 was conducted at King Faisal Specialist Hospital.The accuracy of performing SLNB in CD-DCIS,the rate of sentinel and non-sentinel nodal metastasis,and the histologic underestimation rate of invasive cancer at initial diagnosis were analyzed.The inclusion criteria were a preoperative diagnosis of pure DCIS with no evidence of invasion.We excluded any patient with evidence of microinvasion or invasion.There were two cases of mammographically detected DCIS and 18 cases of CDDCIS.All our patients were diagnosed by an imageguided CNB except two patients who were diagnosed by fine needle aspiration(FNA).All patients underwent breast surgery,SLNB,and axillary lymph node dissection(ALND) if the SLN was positive.RESULTS:Twenty patients with an initial diagnosis of pure DCIS underwent SLNB,2 of whom had an ALND.The mean age of the patients was 49.7 years(range,35-70).Twelve patients(60%) were premenopausal and 8(40%) were postmenopausal.CNB was the diagnostic procedure for 18 patients,and 2 who were diagnosed by FNA were excluded from the calculation of the underestimation rate.Two out of 20 had a positive SLNB and underwent an ALND and neither had additional non sentinel lymph node metastasis.Both the sentinel visualization rate and the intraoperative sentinel identification rate were 100%.The false negative rate was 0%.Only 2 patients had a positive SLNB(10%) and neither had additional metastasis following an ALND.After definitive surgery,3 patients were upstaged to invasive ductal carcinoma(3/18 = 16.6%) and 3 other patients were upstaged to DCIS with microinvasion(3/18 = 16.6%).Therefore the histologic underestimation rate of invasive disease was 33%.CONCLUSION:SLNB in CD-DCIS is technically feasible and highly accurate.We recommend limiting SLNB to patients undergoing a mastectomy.

The Initial Implementation of the Sentinel Lymph Node Biopsy (SLNB) for Breast Cancer Management in Malta

Over the past two decades, the sentinel lymph node biopsy (SLNB) based on sentinel node (SN) being the first lymph node that harbors metastases, revolutionized breast cancer management. SLNB presents much less morbidity when compared to radical axillary lymph node dissection (ALND) where all nodes are dissected irrespective of their metastatic involvement. The purpose of this study was to evaluate the effectiveness of SLNB by investigating whether the histological characteristics of the SNs identified using scintigraphy are predictive of the histological characteristics of the ALN basin. Methods: Fifty-five female breast cancer patients underwent lymphoscintigraphy and SLNB followed by ALND. The histological status of the SN/s was correlated to the histological status of the ALNs to determine whether the SN accurately stages the ALNs in breast cancer. Results: During surgery, SNs were successfully isolated in 52 out of 55 cases (94.5%) (range, 0 to 9). No SNs were identified in 3 cases (5.5%). Results demonstrate a significant association (p = 0.05) between the metastatic status of SNs and the corresponding ALNs in 42 out of 52 patients (80.8%), but with a high false-negative rate (FNR) of 37.5%. Conclusion: The findings of this study show that the sentinel node concept provides the benefits of SLNB in the majority of instances. However, further work is required in reducing the FNR. Once the effectiveness of SLNB as a staging technique is locally established, the need of ALND in SN-negative patients would be limited, thus improving the quality of life of Maltese breast cancer patients.

Clinical Study of Double Contrast-Enhanced Ultrasound Combined with Dye Method and Marker Placement to Identify and Locate Sentinel Lymph Nodes in Patients with Breast Cancer

Objective: To explore the value of percutaneous ultrasonography combined with transvenous ultrasonography for accurate localization of sentinel lymph nodes and diagnosis of metastatic lymph nodes in patients with breast cancer. Methods: 18 cases of patients with breast cancer attending the Hainan General Hospital from May 2022 to June 2024 who were proposed to undergo axillary lymph node dissection were selected, and the ultrasonographic agent was injected subcutaneously through the areola on the 1st day before the operation, and the marker localization of the manifestation of the Sentinel lymph nodes and draw the lymphatic vessel alignment for drainage on the body surface, and record the manifestation of SLN by conventional ultrasound and dual ultrasonography. At the time of surgery, intraoperative melphalan localization was used to identify the SLN, the difference between the number of ultrasound and melphalan localization was observed, and resection was performed for pathological examination to determine whether they were metastatic or not. Results: There were 8 metastatic lymph nodes and 18 non-metastatic lymph nodes among 31 SLN. A total of 62 SLN were localized by intraoperative melphalan, of which 31 were consistent with ultrasound localization and 31 were not identified by ultrasound. The diagnostic sensitivity of SLN metastasis diagnosed by transcutaneous ultrasonography was 62.50%, specificity was 91.30%, positive predictive value was 71.43%, negative predictive value 87.50%, accuracy was 83.87%, and the AUC was 0.769;the diagnostic sensitivityof transvenous ultrasonography diagnosed was 75.00%, specificity was 75.00%, and the accuracy was 83.87%, 75.00%, specificity 91.30%, positive predictive value 75.00%, negative predictive value 91.30%, accuracy 87.10%, AUC 0.832;dual ultrasonography diagnostic sensitivity 87.50%, specificity 91.30%, positive predictive value 77.78%, negative predictive value 95.45%, accuracy 90.32%. The AUC was 0.894. Conclusion: Transcutaneous ultrasonography combined with transvenous ultrasonography can accurately localize sentinel lymph nodes and improve the sensitivity and accuracy of the diagnosis of metastatic SLN.