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.

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.

Interest of SPECT/CT in Detection of Sentinel Lymph Node in Breast Cancer

Aim: Assess the role of hybrid modality SPECT/CT versus planar scintigraphy in sentinel lymph node (SLN) identification in patients with breast cancer. Methods: Planar scintigraphy and hybrid modality SPECT/CT were performed in 23 women with breast cancer (mean age 59.5 years with range 25 - 82 years) with invasive breast cancer (T0, T1 and T2), without clinical evidence of axillary lymph node metastases (N0) and no remote metastases (M0), radiocolloid was injected in four subareolar sites. Planar and SPECT/CT images were separately interpreted. Results: SLNs were detected on lymphoscintigraphy in all patients (100%), taking into consideration both techniques (planar and SPECT-CT images). Planar images identified 45 SLNs in 23 women, with a mean of 1.95 per patient, whereas 56 SLNs were detected on SPECT/CT, increasing this mean to 2.43 per patient. Drainage to internal mammary lymph nodes was seen in 4 patients (17.39%). However, two foci of uptake were identified on planar image as hot SLN in two patients (8.69%);while they have been found as a false positive non-nodal site of uptake on SPECT/CT. Conclusion: SPECT/CT is more focused than planar scintigraphy in the detection of SLN in patients with breast cancer. It detects some lymph nodes not visible on planar images, excludes false positive uptake and exactly locates axillary and non-axillary SLNs.

Robotic-assisted retroperitoneal lymph node dissection for stage II testicular cancer

Objective:To evaluate the perioperative as well as early oncological outcomes of patients undergoing robotic retroperitoneal lymph node dissection for treatment of testicular cancer.Methods:We conducted a prospective consecutive case series of patients undergoing robotic assisted retroperitoneal lymph node dissection for metastatic testicular cancer between May 2018 and July 2021 at our institution.Data were collected on patient and tumour characteristics,intraoperative and postoperative parameters,and functional and oncological outcomes.Descriptive statistics are presented.Results:Nineteen patients were identified;18(94.7%)completed the procedure robotically and one was converted to open surgery;78.9%of patients had stage≥IIB and 12(63.2%)patients had undergone prior chemotherapy.The median operative time was 300(interquartile range[IQR]240-315)min.Median blood loss was 100(IQR 50-175)mL.Median length of stay was 2(range 1-11)days.All robotically completed patients commenced diet and passed flatus on Day 1 and were discharged by Day 3.The median lymph node yield was 40.5(IQR 38-51)nodes.All patients undergoing nerve-sparing procedures recovered antegrade ejaculatory function.One patient had a Clavien-Dindo III complication(chylous ascites requiring drainage).At a median follow-up of 22.3(IQR 16.3-24.9)months,one patient developed retroperitoneal recurrence,which was successfully treated with second-line chemotherapy;no other patients have had recurrences.Conclusion:Robotic retroperitoneal lymph node dissection is a safe and feasible alternative to open surgery in appropriately selected patients,offering low morbidity.Early oncological outcomes are promising.Larger cohorts and longer follow-ups are required to validate our institution's findings.

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.

Primary Treatment for Clinically Early Cervical Cancer with Lymph Node Metastasis:Radical Surgery or Radiation?

Objective To compare survival outcomes between primary radical surgery and primary radiation in early cervical cancer.Methods Patient information was extracted from the Surveillance,Epidemiology,and Results database.Patients diagnosed with early cervical cancer of stage T1a,T1b,and T2a(American Joint Committee on Cancer,7th edition)from 1998 to 2015 were included in this study after propensity score matching.Overall survival(OS)was analyzed using the Kaplan-Meier method.Results Among the 4964 patients included in the study,1080 patients were identified as having positive lymph nodes(N1),and 3884 patients were identified as having negative lymph nodes(N0).Patients with primary surgery had significantly longer 5-year OS than those with primary radiotherapy in both the N1 group(P<0.001)and N0 group(P<0.001).In the subgroup analysis,similar results were found in patients with positive lymph nodes of stage T1a(100.0%vs.61.1%),T1b(84.1%vs.64.3%),and T2a(74.4%vs.63.8%).In patients with T1b1 and T2a1,primary surgery resulted in longer OS than primary radiation,but not in patients with T1b2 and T2a2.In multivariate analysis,the primary treatment was identified as an independent prognostic factor in both N1 and N0 patients(HR_(N1)=2.522,95%CI=1.919–3.054,PN1<0.001;HR_(N0)=1.895,95%CI=1.689–2.126,PN0<0.001).Conclusion In early cervical cancer stage T1a,T1b1,and T2a1,primary surgery may result in longer OS than primary radiation for patients with and without lymph node metastasis.

ScRNA-seq reveals the correlation between M2 phenotype of tumorassociated macrophages and lymph node metastasis of breast cancer

The process of lymphatic metastasis was proved to be associated with podoplanin-expressing macrophages in breast cancer(BC).This study aimed to investigate the role of the M2 phenotype of tumor-associated macrophages and mine the key M2 macrophages-related genes for lymph node metastasis in BC.We downloaded the GSE158399 dataset from the Gene Expression Omnibus(GEO)database,which includes transcriptomic profiles of individual cells from primary tumors,negative lymph nodes(NLNs),and positive lymph nodes(PLNs)of breast cancer patients.The cell subsets were identified by clustering analysis after quality control of the scRNA-seq using Seurat.The activation and migration capability of M2 macrophages were evaluated with R package“GSVA”.The key M2 macrophages-related genes were screened from the differential expressed genes(DEGs)and M2 macrophages activation and migration gene sets collected from MSigDB database.Our analysis identified three main cell types in primary tumors,NLNs,and PLNs:basal cells,luminal cells,and immune cell subsets.The further cell type classification of immune cell subsets indicated M2 macrophages accumulation in NLs and PLs.The GSVA enrichment scores for activation and migration capability were increased significantly in M2 macrophages from primary tumors than NLNs and PLNs(pvalue<0.001).Seven M2 macrophages activation-related and 15 M2 macrophages migration-related genes were significantly up-regulated in primary tumors than NLNs and PLNs.The proportion and GSVA enrichment scores for activation and migration of M2 macrophages may be potential markers for lymph node metastasis in breast cancer.Our study demonstrated that twenty-two up-regulated mRNA may be possible therapeutic targets for lymph node metastasis in breast cancer.

Axillary Sentinel Lymph Node Biopsy for Breast Cancer and Melanoma Patients after Previous Axillary Surgery: A Systematic Review

Objective: Sentinel lymph node biopsy (SLNB) is a validated staging technique for breast carcinoma. Some women are exposed to have a second SLNB due to breast cancer recurrence or a second neoplasia (breast or other). Due to modified anatomy, it has been claimed that previous axillary surgery represents a contra-indication to SLNB. Our objective was to analyse the literature to assess if a second SLNB is to be recommended or not. Methods: For the present study, we performed a review of all published data during the last 10 years on patients with previous axilla surgery and second SLNB. Results: Our analysis shows that second SLNB is feasible in 70%. Extra-axillary SNs rate (31%) was higher after radical lymph node dissection (ALND) (60% - 84%) than after SLNB alone (14% - 65%). Follow-up and complementary ALND following negative and positive second SLNB shows that it is a reliable procedure. Conclusion: The review of literature confirms that SLNB is feasible after previous axillary dissection. Triple technique for SN mapping is the best examination to highlight modified lymphatic anatomy and shows definitively where SLNB must be performed. Surgery may be more demanding as patients may have more frequently extra-axillary SN only, like internal mammary nodes. ALND can be avoided when second SLNB harvests negative SNs. These conclusions should however be taken with caution because of the heterogeneity of publications regarding SLNB and surgical technique.

Prediction of lymph node metastasis and sentinel node navigation surgery for patients with early-stage gastric cancer

Accurate prediction of lymph node(LN) status is crucially important for appropriate treatment planning in patients with early gastric cancer(EGC). However,consensus on patient and tumor characteristics associated with LN metastasis are yet to be reached. Through systematic search,we identified several independent variables associated with LN metastasis in EGC,which should be included in future research to assess which of these variables remain as significant predictors of LN metastasis. On the other hand,even if we use these promising parameters,we should realize the limitation and the difficulty of predicting LN metastasis accurately. The sentinel LN(SLN) is defined as first possible site to receive cancer cells along the route of lymphatic drainage from the primary tumor. The absence of metastasis in SLN is believed to correlate with the absence of metastasis in downstream LNs. In this review,we have attempted to focus on several independent parameters which have close relationship between tumor and LN metastasis in EGC. In addition,we evaluated the history of sentinel node navigation surgery and the usefulness for EGC.

Comparison of sentinel lymph node detection performances using blue dye in conjunction with indocyanine green or radioisotope in breast cancer patients: a prospective singlecenter randomized study

Objective:This randomized study aimed to compare the clinical efficacy between the novel dual tracer composed of indocyanine green(ICG)and blue dye(BD)and the conventional dual tracer composed of radioisotope and BD for sentinel lymph node(SLN)mapping in patients with breast cancer.Methods:This study enrolled 471 clinically lymph node-negative patients with primary breast cancer.All patients underwent mastectomy,and those undergoing sentinel lymph node biopsy(SLNB)were randomized to receive blue dye plus radioisotope(RB group)or BD plus ICG(IB group).The detection performances on SLN identification rate,positive SLN counts,detection sensitivity,and false-negative rate were compared between the two groups.Results:In the IB group,97%(194/200)of the patients who underwent the ICG and BD dual tracer injection showed fluorescentpositive lymphatic vessels within 2–5 min.The identification rate of SLNs was comparable between the IB group(99.0%,198/200)and the RB group(99.6%,270/271)(P=0.79).No significant differences were observed in the identification rate of metastatic SLNs(22.5%vs.22.9%,P>0.05,RB group vs.IB group,the same below),positive SLN counts(3.72±2.28 vs.3.91±2.13,P>0.05),positive metastatic SLN counts(0.38±0.84 vs.0.34±0.78,P>0.05),SLNB detection sensitivity(94.4%vs.92.5%,P>0.05),or false-negative rate(5.6%vs.7.5%,P>0.05)between the two groups.Conclusions:ICG can be used as a promising alternative tracer for radioisotope in SLN mapping,and when it is combined with BD in lymphangiography,it offers comparable detection sensitivity compared to the conventional lymphatic mapping strategies that are widely used in clinical practice.

Sentinel lymph node navigation surgery for early stage gastric cancer

We attempted to evaluate the history of sentinel node navigation surgery (SNNS), technical aspects, tracers, and clinical applications of SNNS using Infrared Ray Electronic Endoscopes (IREE) combined with Indocyanine Green (ICG). The sentinel lymph node (SLN) is defined as a first lymph node (LN) which receives cancer cells from a primary tumor. Reports on clinical application of SNNS for gastric cancers started to appear since early 2000s. Two prospective multicenter trials of SNNS for gastric cancer have also been accomplished in Japan. Kitagawa et al reported that the endoscopic dual (dye and radioisotope) tracer method for SN biopsy was confirmed acceptable and effective when applied to the early-stage gastric cancer (EGC). We have previously reported the usefulness of SNNS in gastrointestinal cancer using ICG as a tracer, combined with IREE (Olympus Optical, Tokyo, Japan) to detect SLN. LN metastasis rate of EGC is low. Hence, clinical application of SNNS for EGC might lead us to avoid unnecessary LN dissection, which could preserve the patient&#x02019;s quality of life after operation. The most ideal method of SNNS should allow secure and accurate detection of SLN, and real time observation of lymphatic flow during operation.

Analysis of factors related to non-sentinel lymph node metastasis in 296 sentinel lymph node-positive Chinese breast cancer patients

Objective: Axillary lymph node dissection(ALND) may be unnecessary in 20%–60% of breast cancer patients with sentinel lymph node(NSLN) metastasis. The aim of the present study was to review the medical records of Chinese patients with early-stage breast cancer and positive NSLN metastasis to identify clinicopathological characteristics as risk factors for non-NSLN metastasis.Methods: The medical records of 2008 early-stage breast cancer patients who received intraoperative sentinel lymph node biopsy(SLNB) between 2006 and 2016 were retrospectively reviewed. These patients were clinically and radiologically lymph nodenegative and had no prior history of receiving neoadjuvant chemotherapy or endocrinotherapy. The clinicopathological characteristics of patients with positive NSLN metastasis who underwent ALND were investigated.Results: In the present study, 296 patients with positive NSLN metastases underwent ALND. Positive non-NSLN metastases were confirmed in 95 patients(32.1%). On univariate analysis, ≥ 3 positive NSLN metastases(P <0.01), NSLN macrometastases(P =0.023), and lymphovascular invasion(P = 0.04) were associated with non-NSLN metastasis(P <0.05). In multivariate analysis, the number of positive SLNs was the most significant predictor of non-SLN metastasis. For patients with 0, 1, 2, or 3 associated risk factors, the non-SLN metastatic rates were 11.5%, 22.5%, 35.2%, and 73.1%, respectively.Conclusions: The number of positive NSLNs, NSLN macrometastases, and lymphovascular invasion were correlated with nonSLN metastasis. The number of positive SLNs was an independent predictor for non-NSLN metastasis. When 2 or 3 risk factors were present in one patient, the probability of non-NSLN was higher than that in the American College of Surgeons Oncology Group Z0011 trial(27.3%); thus, avoiding ALND should be considered carefully.

Sentinel lymph node navigation surgery for gastric cancer: Does it really benefit the patient?

Sentinel lymph node (SLN) navigation surgery is accepted as a standard treatment procedure for malignant melanoma and breast cancer. However, the benefit of reduced lymphadenectomy based on SLN examination remains unclear in cases of gastric cancer. Here, we review previous studies to determine whether SLN navigation surgery is beneficial for gastric cancer patients. Recently, a large-scale prospective study from the Japanese Society of Sentinel Node Navigation Surgery reported that the endoscopic dual tracer method, using a dye and radioisotope for SLN biopsy, was safe and effective when applied to cases of superficial and relatively small gastric cancers. SLN mapping with SLN basin dissection was preferred for early gastric cancer since it is minimally invasive. However, previous studies reported that limited gastrectomy and lymphadenectomy may not improve the patient&#x02019;s postoperative quality of life (QOL). As a result, the benefit of SLN navigation surgery for gastric cancer patients, in terms of their QOL, is limited. Thus, endoscopic and laparoscopic limited gastrectomy combined with SLN navigation surgery has the potential to become the standard minimally invasive surgery in early gastric cancer.

Axillary lymph node management in breast cancer with positive sentinel lymph node biopsy

The surgical treatment of localized breast cancer has become progressively less aggressive over the years.The management of the axillary lymph nodes has been modified by the introduction of sentinel lymph node biopsy. Axillary dissection can be avoided in patients with sentinel lymph node negative biopsies. Based on randomized trials data, it has been proposed that no lymph node dissection should be carried out even in certain patients with sentinel lymph node positive biopsies. This commentary discusses the basis of such recommendations and cautions against a general omission of lymph node dissection in breast cancer patients with positive sentinel lymph node biopsies. Instead, an individualized approach based on axillary tumor burden and biology of the cancer should be considered.

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.

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.

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.

Sentinel lymph node metastasis after neoadjuvant treatment in breast cancer:Any size matters?

One of the advantages of neoadjuvant chemotherapy(NAC) treatments is its ability to convert patients who need a mastectomy in breast conservative surgery. NAC has also increased the conversion of node positive patients into node negative in around 40% allowing the use of sentinel node biopsy(SLN) in this setting. Timing of SLN biopsy after NAC has been a subject of debate. In patients with clinically node negative before NAC,rates of success and false negative rates of SLN after NAC are similar to those in the adjuvant setting,so SLN after NAC in previous negative axilla has been incorporated in the staging of the axilla. More controversial is its use in patients with positive axillary nodes before NAC who convert to node negative after NAC. Several randomized studies have reported the identification rates and the false negative rates of the SLN after NAC,concordant in the importance of surgical technique. As there is an agreement in the abandon of the immunohistochemistry(IHC) for SLN in the adjuvant setting as SLN IHC detected metastasis appear to have no impact on overall survival,in patients with SLN after NAC the inclusion of isolated tumor cell(ITC) as positive nodes lowers the false negative rates of the technique,suggesting the importance of assessing the SLN by IHC after NAC and considering it as residual disease. Longer follow up is needed to determine the prognostic implications of ITC in the SLN after NAC.

Usefulness of Breast MRI for Safe Omission of Axillary Lymph Nodes Dissection in Sentinel Node-Positive Breast Cancer Patients

Background: Preoperative identification of patients with extensive lymph node metastasis (LNM) is important for safe omission of axillary lymph node dissection (ALND) in sentinel node (SN)-positive (SN+) breast cancer patients. Methods: We evaluated retrospectively the collected data of 758 breast cancer patients who underwent axillary surgery between 2008 and 2017, excluding those who received neoadjuvant chemotherapy. Results: Of the 758 patients, 607 were not suspicious to have LNM by axillary ultrasound (AUS-), but 38 suspicious cases were found by breast magnetic resonance imaging (MRI). Of 15 patients undergoing axillary fine needle biopsy (AFNA) due to second-look axillary ultrasound (AUS), 9 underwent ALND because of a positive AFNA (AFNA+). Among 81 (10.9%) patients undergoing ALND due to SN+ findings, 6 (7.4%) had extensive LNM (LNM ≥ 4). If MRI was not performed, among the 90 of 673 patients undergoing ALND who had SN+ findings, 12 (13.3%) had LNM ≥ 4. Conclusions: The proportion of cases with LNM ≥ 4 was reduced from 13.3% to 7.4% among patients undergoing SN biopsies combined with breast MRI. ALND might be omitted safely in SN+ cases according to detailed preoperative evaluations using additional breast MRI to ultrasound.

Locoregional treatment of early breast cancer with isolated tumor cells or micrometastases on sentinel lymph node biopsy

The advent of sentinel lymph-node technique has led to a shift in lymph-node staging,due to the emergence of new entities namely micrometastases(p N1mi) and isolated tumor cells [p N0(i+)].The prognostic significance of this low positivity in axillary lymph nodes is currently debated,as is,therefore its management.This article provides updates evidence-based medicine data to take into account for treatment decision-making in this setting,discussing the locoregional treatment in p N0(i+) and p N1 mi patients(completion axillary dissection,axillary irradiation with or without regional nodes irradiation,or observation),according to systemic treatment,with the goal to help physicians in their daily practice.