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In melanoma treatment, complete lymph node dissection (CLND) has been considered the therapeutic gold standard in patients with positive sentinel lymph node biopsy (SLNB). This long-held approach was revised in 2017, with recent evidence questioning the therapeutic benefit of CLND in malignant melanoma (MM) therapy. In this study, we aimed to fill this knowledge gap by retrospectively analyzing the impact of CLND on MM patients' survival. Methods: We retrospectively analyzed the multi-center population-based Clinical Cancer Registry at the Tumor Center Regensburg (TUDOK) database (2004–2020) to identify patients who had been diagnosed with SLN-positive MM and underwent (non)invasive management thereof. Patient cohorts were subdivided according to the treatment received (CLND and waiving CLND). Primary outcomes included overall survival (OS), recurrence-free survival (RFS), and cumulative recurrence rate. Results: We identified 1143 MM patients, of whom 126 (11.0%) had positive SLN status. CLND was waived in the majority of SLN-positive MM cases (n = 71; 56.3%), with 55 (43.7%) patients undergoing CLND. Univariable and multivariable Cox regression revealed no significant advantage for CLND patients compared to non-CLND patients in OS (HR=0.970, p = 0.915 and HR=1.295, p = 0.479, respectively), RFS (HR=1.050, p = 0.849 and HR=1.220, p = 0.544, respectively), and cumulative recurrence rate (HR=1.234, p = 0.441 and HR=1.220, p = 0.544), respectively). Conclusion: We found that CLND had no significant impact on patient survival and MM recurrence rate, thus corroborating the validity of current clinical guidelines. [ABSTRACT FROM AUTHOR]

Desde sus inicios, la medicina nuclear se ha enfrentado a cambios tecnológicos que la han obligado a modificar sus modos operativos y a adecuar sus protocolos. En el campo de la cirugía radioguiada (CRG), la incorporación de la imagen gammagráfica preoperatoria y la detección intraoperatoria con la sonda gamma proporcionó un impulso definitivo a la biopsia del ganglio centinela (GC) para convertirse en el procedimiento estándar de aplicación en el melanoma y el cáncer de mama. Las diversas innovaciones tecnológicas y la adaptación consiguiente de protocolos confluyen en lo disruptivo y lo gradual. Como ejemplos evidentes tenemos la introducción de la tomografía por emisión de fotón único/tomografía computarizada (SPECT/TC) en el campo preoperatorio y las sondas Drop-in (Lightpoint Medical Ltd; Crystal photonics, Eurorad) en el intraoperatorio. Otros aspectos innovadores con posible aplicación en la CRG se basan en la utilización de la inteligencia artificial (IA), navegación y teleasistencia. Since its origins, nuclear medicine has faced technological changes that led to modifying operating modes and adapting protocols. In the field of radioguided surgery, the incorporation of preoperative scintigraphic imaging and intraoperative detection with the gamma probe provided a definitive boost to sentinel lymph node biopsy to become a standard procedure for melanoma and breast cancer. The various technological innovations and consequent adaptation of protocols come together in the coexistence of the disruptive and the gradual. As obvious examples we have the introduction of SPECT/CT in the preoperative field and Drop-in probes in the intraoperative field. Other innovative aspects with possible application in radio-guided surgery are based on the application of artificial intelligence, navigation and telecare. [ABSTRACT FROM AUTHOR]

To improve patient selection for sentinel node (SN) biopsy, the Melanoma Institute of Australia (MIA) created a predictive model based on readily available clinicopathologic factors. Validation of the MIA nomogram using the National Cancer Database (NCDB), a nationwide oncology outcomes database for >1500 Commission-accredited cancer programs in the United States. A total of 60,165 patients were included in the validation. The probability of SN positivity was calculated for each patient. Using calculated probabilities, a receiver operating characteristic curve was generated to assess the model's discrimination ability. At baseline, the NCDB cohort had different clinicopathologic characteristics compared with the original MIA data set. Despite these differences, the MIA nomogram retained high-predictive accuracy within the NCDB dataset (C-statistic, 0.733 [95% CI, 0.726-0.739]), although calibration weakened for the highest risk decile. The NCDB collects data from hospital registries accredited by the Commission on Cancer. In conclusion, this study validated the use of the MIA nomogram in a nationwide oncology outcomes database collected from >1500 Commission-accredited cancer programs in the United States, demonstrating the potential for this nomogram to predict SN positivity and reduce the number of negative SN biopsies. [ABSTRACT FROM AUTHOR]

The melanoma sentinel lymph node (SLN) is the first tumor-draining LN exposed to tumor-secretory factors that contribute to enabling cancer cell evasion of immunosurveillance. Melanoma-derived secreted factors can serve as immunosuppressants and lymphangiogenic factors, facilitating melanoma cells to locate and invade LNs. Extracellular vesicles secreted by tumor cells sequester oncogenic molecules from the tumor that are transported to SLNs which can mediate molecular dysregulation to suppress antitumor immunity and remodel the lymphatic system. Immunomodulators and blockers of melanoma-secreted mediators are under clinical investigation for the prevention of nodal metastasis through the interruption of premetastatic niche establishment. Melanoma-cell-derived mediators contribute to immunological tumor escape via immune paralysis of tumor-draining lymph nodes (LNs) by creating a premetastatic niche (PMN). This allows melanoma cells to survive in the tolerant immune environment of LNs, leading to significantly worsened clinical outcomes. Understanding the mechanisms of PMN formation offers an opportunity for developing early therapeutic intervention approaches and interrupting melanoma metastases, ideally impacting on clinical outcomes in high-risk melanoma. The natural history of advanced malignant melanoma demonstrates that, in most cases, widespread tumor dissemination is preceded by regional metastases involving tumor-draining lymph nodes [sentinel lymph nodes (SLNs)]. Under physiological conditions, LNs play a central role in immunosurveillance to non-self-antigens to which they are exposed via afferent lymph. The dysfunctional immunity in SLNs is mediated by tumor secretory factors that allow the survival of metastatic melanoma cells within the LN by creating a premetastatic niche (PMN). Recent studies outline the altered microenvironment of LNs shaped by melanoma mediators. Here, we discuss tumor secretory factors involved in subverting tumor immunity and remodeling LNs and highlight emerging therapeutic strategies to reinvigorate antitumoral immunity in SLNs. [ABSTRACT FROM AUTHOR]

Sentinel lymph node biopsy is a crucial step in the management of patients affected by melanoma. The decision whether to perform it or not is based on different histological parameters, but the mitotic rate is no longer considered a prognostic variable after the release of the 8th edition of the American Joint Committee on Cancer (AJCC) guidelines. Our objective was to investigate the risk factors that increase the chance for sentinel lymph node positivity in melanomas with a Breslow thickness of less than 2.00 mm, including the mitotic count. A retrospective single-center study was performed on a homogenous cohort of 408 patients treated for cutaneous melanoma. Histological and clinical features were gathered and correlated with the increased risk for sentinel lymph node positivity by means of univariate and multivariate analyses. A statistically significant correlation between a high mitotic index and a positive sentinel lymph node was found in pT1 and pT2 patients, suggesting that in the case of pT1a melanoma with a high number of mitoses, a discussion about whether a sentinel lymph node biopsy is required should be done. [ABSTRACT FROM AUTHOR]

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The objective of the work described here was to evaluate the efficacy of lymphosonography in identifying sentinel lymph nodes (SLNs) in patients with breast cancer undergoing surgical excision. Of the 86 individuals enrolled, 79 completed this institutional review board-approved study. Participants received subcutaneous 1.0-mL injections of ultrasound contrast agent (UCA) around the tumor. An ultrasound scanner with contrast-enhanced ultrasound (CEUS) capabilities was used to identify SLNs. Participants were administered with blue dye and radioactive tracer to guide SLN excision as standard-of-care. Excised SLNs were classified as positive or negative for the presence of blue dye, radioactive tracer and UCA, and sent for pathology. Two hundred fifty-two SLNs were excised; 158 were positive for blue dye, 222 were positive for radioactive tracer and 223 were positive for UCA. Comparison with blue dye revealed accuracies of 96.2% for radioactive tracer and 99.4% for lymphosonography (p > 0.15). Relative to radioactive tracer, blue dye had an accuracy of 68.5%, and lymphosonography achieved 86.5% (p < 0.0001). Of 252 SLNs excised, 34 were determined to be malignant by pathology; 18 were positive for blue dye (detection rate = 53%), 23 for radioactive tracer (detection rate = 68%) and 34 for UCA (detection rate = 100%) (p < 0.0001). Lymphosonography was similar in accuracy to radioactive tracer and higher in accuracy than blue dye in identifying SLNs. All 34 malignant SLNs were identified by lymphosonography. [ABSTRACT FROM AUTHOR]

Risk stratification, including nodal assessment, allows for selective de-intensification of adjuvant radiotherapy in stage II endometrial cancer. Patterns of treatment and clinical outcomes, including the use of reduced volume 'mini-pelvis' radiotherapy fields, were evaluated in a population-based study. All patients diagnosed with pathological stage II endometrial cancer between 2000 and 2014, and received adjuvant radiotherapy in a regional healthcare jurisdiction were reviewed. Registry data were supplemented by a comprehensive review of patient demographics, disease characteristics and treatment details. The Charlson Comorbidity Score was calculated. Survival and recurrence data were analysed. In total, 264 patients met the inclusion criteria. Most patients had endometrioid histology (83%); 41% of patients had International Federation of Gynecologists and Obstetricians grade 1 disease. Half (49%) had surgical nodal evaluation; 11% received chemotherapy. Most patients (59%) were treated with full pelvic radiotherapy fields ± brachytherapy. Seventeen per cent of patients received mini-pelvis radiotherapy ± brachytherapy, whereas 24% received brachytherapy alone. Five-year recurrence-free survival was 87% for the entire cohort, with no significant difference by adjuvant radiotherapy approach. Only one patient receiving mini-pelvis radiotherapy ± brachytherapy recurred in the pelvis but outside of the mini-pelvis field. Recorded late toxicity rates were highest for full pelvis radiotherapy + brachytherapy. Risk stratification in a real-world setting allowed for selective de-intensification of adjuvant radiation with equivalent outcomes for stage II endometrial cancer. Mini-pelvis radiotherapy combined with brachytherapy is effective in highly selected patients, with the potential to decrease toxicity without compromising local control. Brachytherapy should be considered in low-risk stage II patients. • Population outcomes for adjuvant radiotherapy in stage II endometrial cancer. • Risk stratification in a real-world setting allows for selective de-intensification with equivalent outcomes. • Mini-pelvis radiotherapy + brachytherapy boost, and brachytherapy alone, are effective adjuvant radiation options for selected Stage II endometrial cancer. [ABSTRACT FROM AUTHOR]

Axillary lymph node dissection (ALND) in patients with breast cancer has potential side effects, including upper-limb lymphedema. Axillary reverse mapping (ARM) is a technique that enables discrimination of the lymphatic drainage of the upper limb in the axillary lymph node basin from that of the breast. We aimed to evaluate ARM node identification by near-infrared (NIR) fluorescence imaging during total mastectomy with ALND and then to analyze potential predictive factors of ARM node involvement. The study enrolled 119 patients diagnosed with invasive breast cancer with an indication for ALND. NIR imaging using indocyanine green dye was performed in 109 patients during standard ALND to identify ARM nodes and their corresponding lymphatic ducts. 94.5% of patients had ARM nodes identified (95%CI = [88.4–98.0]). The ARM nodes were localized in zone D in 63.4% of cases. Metastatic axillary lymph nodes were found in 55% in the whole cohort, and 19.4% also had metastasis in ARM nodes. Two patients had metastatic ARM nodes but not in the remaining axillary lymph nodes. No serious adverse events were observed. Only the amount of mitosis was significantly associated with ARM node metastasis. ARM by NIR fluorescence imaging could be a reliable technique to identify ARM nodes in real-time when ALND is performed. The clinical data compared with ARM node histological diagnosis showed only the amount of mitosis in the diagnostic biopsy is a potential predictive factor of ARM node involvement. NCT02994225. [ABSTRACT FROM AUTHOR]

Desmoplastic melanoma (DM) is a less common form of cutaneous melanoma that has been described for decades; however, controversy remains regarding the management and use of sentinel lymph node biopsy (SLNB). The purpose of this study is to identify whether SLNB is indicated in all cases of DM, including the pure subtype. A systematic review was conducted using PubMed (with access to MEDLINE) along with the Cochrane Central Register of Controlled Trials from 2001 to 2019. Case series and case-control studies were included. Eighteen studies were included for a total population of 3,914 patients. SLNB was performed in 2229 patients. The percentage of positive SLNB results was 8.5%. However, patients with pure DM (>90% desmoplastic component) were found to have a significantly lower rate of occult metastatic node positivity when compared with that of mixed DM (4.9% and 14.8%, respectively). Our findings underscore the importance of the pathologist reporting percentage of desmoplastic component in melanoma. SLNB should be strongly considered for patients with mixed DM. However, the low rate of occult metastatic node positivity in pure DM is beneath the threshold for using SLNB as a staging procedure. Previous studies have suggested that desmoplastic melanoma is less likely to metastasize to regional lymph nodes when compared with conventional melanoma. This review suggests that it is imperative to distinguish the histologic subtype of desmoplastic melanoma to determine if staging procedure is indicated. [ABSTRACT FROM AUTHOR]

Presence of micrometastases in the sentinel lymph node (SLN) is currently used to assess prognosis of melanoma patients. The immunoactivity within the SLN is known to be influenced by the primary tumor (PT), which may in turn impact the SLNs' metastatic state. We characterize the temporal dependence and underlying mechanisms of the immunological effects of the PT on the SLN. The prognostic value of SLN state as a function of PT removal time was evaluated. To put the results into a functional context, selected PTs and corresponding SLNs were analyzed for gene and protein expression patterns. In a cohort of 202 patients with known distant metastasis and similar PT prognostic characteristics, SLNs removed before or within one week after the PT (IM-SLN) had a higher incidence of micrometastases than those removed at least one week after the PT (DEL-SLN). The immunoactivity in IM-SLN was found to be lower than in DEL-SLN. Specifically, in IM-SLNs, T helper 17 / regulatory T-cells were predominant, whereas in DEL-SLNs, cytotoxic γδT-cells were more frequent. The higher immune activity in DEL-SLNs was probably facilitated by CD209+ antigen-presenting cells. Indeed, in PT with high TGFβ expression CD209+ cells appear to be trapped and no increased immunoactivity was observed in DEL-SLN. Presence of micrometastases in DEL-SLNs have a higher negative prognostic value as in IM-SLNs since they indicate not only a melanoma's propensity to metastasize, but possibly also its capacity to escape immune responses. [Display omitted] • Immune activity of SLNs correlates with primary melanoma characteristics. • The delay of SLN excision after PT removal influences intranodal immune activity. • Immune reconstitution in DEL SLNs is mediated via melanoma derived CD209+ cells. • TGFβhigh PTs trap CD209+ DCs curbing SLN's immune reconstitution after PT removal. • Metastases in DEL SLNs have a higher negative prognostic value than in IM SLNs. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess whether the use of sentinel lymph node (SLN) in addition to lymphadenectomy was associated with survival benefit in patients with early-stage cervical cancer. International, multicenter, retrospective study. Inclusion criteria: cervical cancer treated between 01/2007 and 12/2016 by surgery only; squamous cell carcinoma, adenocarcinoma, adenosquamous carcinoma, FIGO 2009 stage IB1-IIA2, negative surgical margins, and laparotomy approach. Patients undergoing neo-adjuvant and/or adjuvant treatment and/or with positive para-aortic lymph nodes, were excluded. Women with positive pelvic nodes who refused adjuvant treatment, were included. Lymph node assessment was performed by SLN (with ultrastaging protocol) plus pelvic lymphadenectomy ('SLN' group) or pelvic lymphadenectomy alone ('non-SLN' group). 1083 patients were included: 300 (27.7 %) in SLN and 783 (72.3 %) in non-SLN group. 77 (7.1 %) patients had recurrence (N = 11, 3.7 % SLN versus N = 66, 8.4 % non-SLN, p = 0.005) and 34 (3.1 %) (N = 4, 1.3 % SLN versus N = 30, 3.8 % non-SLN, p = 0.033) died. SLN group had better 5-year disease-free survival (DFS) (96.0 %,95 %CI:93.5–98.5 versus 92.0 %,95 %CI:90.0–94.0; p = 0.024). No 5-year overall survival (OS) difference was shown (98.4 %,95 %CI:96.8–99.9 versus 96.8 %,95 %CI:95.4–98.2; p = 0.160). SLN biopsy and lower stage were independent factors associated with improved DFS (HR:0.505,95 %CI:0.266–0.959, p = 0.037 and HR:2.703,95 %CI:1.389–5.261, p = 0.003, respectively). Incidence of pelvic central recurrences was higher in the non-SLN group (1.7 % versus 4.5 %, p = 0.039). Adding SLN biopsy to pelvic lymphadenectomy was associated with lower recurrence and death rate and improved 5-year DFS. This might be explained by the lower rate of missed nodal metastasis thanks to the use of SLN ultrastaging. SLN biopsy should be recommended in patients with early-stage cervical cancer. • Survival benefit of SLN in addition to lymphadenectomy in cervix cancer is unclear. • Adding SLN biopsy to lymphadenectomy was associated with better survival outcomes. • SLN biopsy should be recommended in patients with early-stage cervical cancer. [ABSTRACT FROM AUTHOR]

• Integrated oral cancer diagnosis and treatment via efficient exosome enrichment. • Laser-responsive targeted drug carriers for quicker site-specific release of DDP. • A marked enhancement in the fluorescence intensity of the drug delivery system. • Enhanced imaging and photothermal ablation capabilities in oral SLN models. • Method's notable advantages: safe, efficient, rapid, clinical potential. The highly invasive and infiltrative nature of oral cancer blurs the boundary between tumor and normal tissue. The study aimed to develop a targeted nanodrug delivery system utilizing natural biomaterial functionalities to improve the accuracy of oral cancer diagnosis and treatment. In this study, we synthesized RGD-modified exosomes (RGD-EXO) as a targeted nanodrug delivery system to load a coordination compound of indocyanine green and cisplatin (ICG-DDP), collectively known as ID@RGD-EXO, aiming to achieve multimodal imaging and synergistic chemophototherapy for oral cancer. The fluorescence intensity of ID@RGD-EXO is significantly increased compared to ICG. ID@RGD-EXO demonstrated promising potential for noninvasive fluorescence, photoacoustic, and infrared thermal imaging, enabling the comprehensive visualization of oral cancer's structural and molecular characteristics for precise diagnosis. Laser irradiation-mediated temperature assists in breaking the ICG-DDP coordination bond and destabilizing the exosome membrane, enabling faster site-specific release of DDP to mitigate systemic toxicity of chemotherapy. ICG-mediated phototherapy and low-dose DDP-mediated chemotherapy demonstrated a strong synergistic antitumor effect, significantly improving the therapeutic outcomes for oral cancer. Furthermore, we utilized ID@RGD-EXO to effectively trace metastatic sentinel lymph nodes (SLN), showcasing its strong aggregation, excellent optical properties, enhanced photothermal effect, outstanding biocompatibility, and minimal toxicity. An advanced, low-toxicity nanomedical drug delivery system has been engineered to transport FDA-approved photoreactive and chemical drugs for precise diagnosis, synergistic chemophototherapy, as well as for tracing and ablating metastatic lymph nodes in oral cancer. This groundbreaking research holds great promise for clinical implementation. [ABSTRACT FROM AUTHOR]

To assess the association of prevalence and size of pelvic sentinel node (SLN) metastases with risk factors in endometrial cancer (EC). Between June 2014 and January 2024 consecutive women with a uterine confined EC undergoing robotic surgery including detection of pelvic SLNs at a University Hospital were included. An anatomically based algorithm utilizing Indocyanine green (ICG) as tracer was adhered to. Ultrastaging and immunohistochemistry (IHC) was applied on all SLNs. The prevalence and size of SLN metastases was assessed with regards to pre- and postoperative histologic types and myometrial invasion estimates. Of 1101 included women 72.6 % (759/1045) had low-grade, 7.6 % (79/1045) high-grade endometroid cancer and 19.8 % (207/1045) non-endometroid cancer. SLN-metastases were present in 174/1045 (16.6 %) women; 9.8 % of preoperatively presumed low-grade endometroid uterine stage 1A (6.4 % of low-grade stage 1A at final histology) and in 58.3 % and 47.8 % respectively in women with high-grade endometroid and non-endometroid uterine stage 1B cancer. In low-grade EC 45/95 (47.4 %) had only isolated tumor cells (ITC) in SLNs compared with 15/78 (19.2 %) in high-grade or non-endometroid cancer (p <.0001) This large population-based study, applying a consequent SLN-algorithm over time, provides important detailed information on the risk for, and size of, SLN metastases within risk groups of EC. The 9.8 % risk for metastases in women with presumed low grade uterine stage 1A endometrioid EC motivates detection of SLNs within this subgroup. The proportion of ITCs in SLNs was significantly lower in higher risk histologies. • 12.7 % women with preoperatively presumed low grade EC had metastatic SLNs. • The proportion of small volume SLN metastases is related EC histologic risk profile. • Detection of SLNs should be performed in all women with EC. [ABSTRACT FROM AUTHOR]

• Intentional irradiation does not exceed incidental irradiation in more than 5.7% in terms of DFS. • In our study, incidental irradiation is not inferior to intentional irradiation in LRR. • Intentional irradiation did not produce relevant higher chronic toxicity compared to incidental. In breast cancer (BC) patients, the involvement of four or more lymph nodes (LN) is an indication of regional irradiation. The optimal treatment strategy remains unclear when fewer nodes are involved and lymphadenectomy is not performed. We designed a clinical trial to show the non-inferiority of Incidental (INC) compared to intentional (INT) irradiation of axillary nodes in patients with early-stage BC and low burden LN involvement. BC patients, cN0 (n = 487) undergoing breast conservation surgery and sentinel node biopsy, with total tumor load assessed by OSNA (One-Step Nucleic Acid Amplification) of 250–15,000 copies mRNA CK19/µL in sentinel LN were randomized to receive INC or INT nodal irradiation. The primary endpoint was 5-year disease-free survival (DFS). Secondary endpoints were locoregional recurrence (LRR), distant recurrence (DR), and acute and chronic toxicity (CT). Five-years DFS were 93.7% (INC) and 93.8% (INT) (difference 0.1% [one-sided 95% CI < 5.7%]; non-inferiority p = 0.075). Cumulative Incidences of LRR were 3.5% (INC) and 3.4% (INT) (difference of 0.1% [<4.8%]; p = 0.021), and 5% (INC) and 3.5% (INT) (difference 1.4% [<6.0%]; non-inferiority p = 0.101) for DR. CT was more Incident with INT (26.9%) than with INC (19.2%), though the difference was not statistically significant (HR 1.39 [95% CI: 0.92, 2.10]; p = 0.11). Intentional does not outperform incidental irradiation by more than 5.7% in terms of 5-year DFS, 4.8% for LRR, and 6% for DR. Registration Number: ClinicalTrials.gov Identifier: NCT02335957. [ABSTRACT FROM AUTHOR]

Durante los últimos 15 años se han sucedido múltiples cambios en el tratamiento del cáncer de mama (CM) y, en especial, en las indicaciones de la biopsia del ganglio centinela (BGC) y las actitudes ante su resultado. Valorando estos avances, nuestro objetivo es comparar los resultados de las BGC realizadas en nuestro centro en 2012, año a partir del cual se dejó de practicar linfadenectomía axilar (LA) ante el hallazgo de micrometástasis en la BGC, con aquellas llevadas a cabo en 2018, cuando empezaron a aplicarse los criterios Z0011. Hemos desarrollado un estudio retrospectivo observacional comparativo entre la población de pacientes con CM cN0 a las que se les hizo una BGC en el año 2012 y aquellas a las que se les practicó este procedimiento en 2018. Al analizar los 2 grupos, 174 pacientes de 2012 y 165 de 2018, se hallaron algunas diferencias significativas: en 2018 hubo mayor tasa de BGC, menor número de cánceres lobulillares (14/28; p < 0,05), el tamaño medio anatomopatológico fue menor (p < 0,001), la representación de tumores Her2 y triple negativos fue mayor (28/49; p < 0,01), así como la proporción de tratamiento neoadyuvante (6,6 vs. 42,5%; p < 0,001). Al valorar los resultados del estudio axilar, en 2018 hubo un descenso tanto en la positividad de la BGC, que descendió a casi la mitad que en 2012 (42,4 vs. 24,1%; p < 0,0001), como en el porcentaje de LA (21,2 vs. 12,6%; p < 0,05), así como el de LA con resultado negativo (74,3 vs. 59,1%; p = ns). En el grupo de estudio de 2018 se halló una mayor tasa de BGC, con menor tasa de resultado positivo y de LA en blanco, pese a tratarse de una población con tumores más agresivos. Este hecho podría justificarse con la mejora en el filtro radiológico mediante ecografía al diagnóstico, así como con el aumento en el uso de la terapia neoadyuvante. Over the last 15 years, breast cancer (BC) treatment has undergone numerous changes, which have also affected the indications for sentinel lymph node biopsy (SLNB) as well as the procedures depending on its outcome. The aim of this study is to compare the results of the SLNB carried out at our center during 2012, when we stopped performing an axillary lymph node dissection (ALND) after the finding of a micrometastasis, with those conducted in 2018, when we started applying Z011 criteria. We have performed a comparative retrospective observational study, including cN0 BC patients that underwent a SLNB in 2012 versus those that underwent this procedure in 2018. A total of 174 patients from 2012 and 165 from 2018 were studied. We found significant differences between the 2 groups: in 2018 there were fewer lobular invasive cancers (14 vs. 28) (P < 0.05), a smaller mean pathological size(P < 0.001), a higher proportion of HER2 and triple negative tumors (28 vs. 49; P < 0.01) and, finally, an increase in use of neoadjuvant treatments (42.0 vs. 6.7%). Regarding axillary involvement, we observed a decrease in both the presence of a positive sentinel node (24.1% in 2018 vs. 42.4% in 2012; P < 0.0001) as well as in the proportion of ALND performed (12.6% in 2018 vs. 21.2% in 2012) and the presence of positive non sentinel nodes after a ALND (59.1% vs. 74.3%; P = ns). Although the 2018 cohort that underwent SLNB had more aggressive tumors, there were fewer positive SN and ALND performed. This is probably due to a more accurate radiological diagnosis with ultrasound, that enables to detect cN1 cases before surgery, and to the increasing use of neoadjuvant treatments that may downstage the axilla. [ABSTRACT FROM AUTHOR]

En la última década se ha introducido la biopsia selectiva del ganglio centinela en cáncer de endometrio de bajo riesgo, siendo opcional en el de riesgo intermedio y alto. Sin embargo, hasta hace un año no se existía consenso respecto al grupo de población indicado, el trazador de elección o el lugar de administración del trazador. En este trabajo, presentamos de forma multidisciplinar los aspectos más controvertidos sobre la técnica de detección del ganglio centinela en cáncer de endometrio, con mayor énfasis en las ventajas y desventajas de los tipos de trazadores disponibles: radiotrazadores, trazadores híbridos y verde de indocianina. In the last decade, the procedure of sentinel lymph node biopsy has been introduced in low-risk endometrial cancer, being optional in intermediate- and high-risk cancer. However, until the last year, there was no consensus regarding the group of patients to whom to apply it, the best tracer to use or the site of injection. In this paper, we present in a multidisciplinary view the most controversial issues about the sentinel lymph node procedure in endometrial cancer, emphasizing the pros and cons of the different tracers available: radiotracers, hybrid tracers and indocyanine green. [ABSTRACT FROM AUTHOR]

Although the sentinel lymph node Biopsy (SLNB) is well stablished in solid tumors among adults but the experience on SLNB in pediatrics is still limited. In this article we report our experience of sentinel lymph node detection that is applied on pediatric solid renal tumors. Twenty 1–16 year old children with non-metastatic primary Wilms tumor regarding the radiological studies were enrolled. Radio tracer injection was carried out after renal vein, artery and ureter ligation, at the time of radical nephrectomy. Sentinel node detection and sampling was performed in every location with radiotracer count of 3 times more than background. Finally lymph node sampling was completed following the standard current discipline in Wilms tumor surgery. A single SLN was detected in 16 patients. 4 patients had more than one SLN. The most common site of SLN was inter aortocaval space. Histopathologic studies revealed tumor involvement in 3 sentinel nodes (15%). All other lymph node samples were also studied histologically and LN involvement was not detected in any of the cases with tumor free sentinel lymph node (no false negative case). Multiple LN involvement was reported in two patients with positive SLN in which, other involved lymph nodes were removed with the tumor during radical nephrectomy. Intraoperative SLNB is a safe and feasible tool to improve the accuracy of staging in pediatric Wilms' tumor. We suggest to ligate renal artery and vein prior to radiotracer injection to diminish the background confounding effect. Level II (development of diagnostic criteria in a consecutive series of patients and a universally applied "gold standard") Study of Diagnostic Test. [ABSTRACT FROM AUTHOR]

Sentinel lymph node (SLN) biopsy algorithm has been routinely applied in all endometrial endometrioid tumors, however, no studies analyzed the feasibility of SLN mapping in endometrioid variants (EV), which included villoglandular, secretory, ciliated cell, mucinous, and squamous differentiation. This study aimed to demonstrate the feasibility of SLN biopsy in EV of EC. All patients undergoing minimally invasive surgical treatment for early-stage EC were included in the study. Patients were divided into 2 study groups: Group 1 which included patients with EV, and Group 2 which included patients with typical endometrioid histology. A propensity match analysis was performed according to age (≥65 years vs. no), BMI (≥30 kg/m2 vs. no), and LVSI (present vs. absent). After a 1:5 propensity-matched analysis, a total of 458 patients were identified (Group 1 n = 77, Group 2 n = 381). Overall detection rate was not statistically significant between the EV and the typical endometrioid group (94.8% vs. 92.4%, p = 0.319). Furthermore, neither bilateral nor unilateral detection rate was different between the two groups (70.1% vs. 74.8%, p = 0.267, and 23.4% vs. 17.8%, p = 0.120). BMI ≥30 kg/m2 was the only factor influencing SLN failure (p = 0.013). SLN technique showed excellent sensitivity in both the EV (100% sensitivity, p < 0.001) and the typical endometrioid unit (93.8% sensitivity, p < 0.001). SLN research/detection for EV of endometrial cancer is a feasible and highly sensitive technique. Obesity was confirmed to be a risk factor for SLN failure. •SLN research for EV is a feasible and highly sensitive technique. •Obesity was a risk factor for SLN failure even in EV cases. •Empty packets were more frequently associated with EV compared to typical endometrioid subtypes. [ABSTRACT FROM AUTHOR]

• Lymphatic mapping may guide neck management in the setting of second primary or recurrent oral cancers with prior neck treatment. • Anomalous drainage including contralateral, retropharyngeal or level IV drainage occurred in 38% of patients. • 20% of patients with prior neck radiation did not demonstrate drainage Lymphatic mapping is an established technique to map drainage patterns in oral cancer. Its utility in patients who have undergone prior radiation or neck dissection is not well studied. Patients presenting to a single tertiary cancer center between 2021–2023 for a recurrent/second oral cancer that underwent lymphatic mapping were considered. All patients had a history of a head and neck cancer treated with either radiation or neck dissection. We further conducted a scoping review in MEDLINE, Embase, and Web of Science of lymphatic mapping in oral cancer patients with previous neck treatment. In our single center review, a total of 11 patients were included. 73 % received prior radiotherapy and 55 % underwent prior neck dissections for a head and neck cancer. Lymphoscintigraphy-directed neck dissections identified sentinel nodes in 9/11 patients, with only one patient who had positive sentinel node disease. There were no reports of regional recurrence at a median of 10 months follow-up. Our scoping review of 980 studies identified 151 additional patients who underwent sentinel node biopsy for a second oral cancer after previous neck treatment. Overall, the negative predictive value of lymphatic mapping in all studies was 96.7 %. Lymphatic mapping is feasible in secondary or recurrent oral cavity cancers even in patients with prior radiation or surgical management of the neck. The literature to date demonstrates a negative predictive value of ∼ 97 % for sentinel node mapping and warrants further consideration in the management of salvage oral cancer. [ABSTRACT FROM AUTHOR]

• Data on Mi and ITC in the lymph nodes of patients with OOSCC are scarce. • Mi seems to negatively affect the prognosis of patients with OOSCC. • Too few patients with ITC have been studied to draw even definitive conclusions. • The appropriate thresholds to differentiate Mi from ITC in OOSCC are not supported from solid data. An estimated 20% of patients with oral and oropharyngeal squamous cell carcinoma (OOSCC) have micrometastases (Mi) or isolated tumor cells (ITC) in the cervical lymph nodes that evade detection by standard histological evaluation of lymph node sections. Lymph node Mi and ITC could be one reason for regional recurrence after neck dissection. The aim of this study was to review the existing data regarding the impact of Mi on the survival of patients with OOSCC. PubMed and the Cochrane Library were searched for articles reporting the impact of Mi and ITC on patient survival. Two authors independently assessed the methodological quality of retrieved studies using the Downs and Black index. Data were also extracted on study type, number of included patients, mode of histological analysis, statistical analysis, and prognostic impact. Sixteen articles with a total of 2064 patients were included in the review. Among the 16 included studies, eight revealed a statistically significant impact of Mi on at least one endpoint in the Kaplan-Meier and/or multivariate analysis. Three studies regarded Mi as Ma, while five studies found no impact of Mi on survival. Only one study demonstrated an impact of ITC on patient's prognosis in the univariate but not in the multivariate analysis. The majority of cases included in the review were patients with oral cancer. The findings provide low-certainty evidence that Mi negatively impacts survival. Data on ITC were scarcer, so no conclusions can be drawn about their effect on survival. The lower threshold to discriminate between Mi and ITC should be defined for OOSCC since the existing thresholds are based on data from different tumors. The histological, immunohistological, and anatomical characteristics of Mi and ITC in OOSCC as well as the effect of radiotherapy on Mi should be further investigated separately for oral and oropharyngeal carcinomas. [ABSTRACT FROM AUTHOR]

Identifying metastatic melanoma in the sentinel lymph node (SLN) is important because 80% of SLN biopsies are negative and 11% of patients develop complications. The neutrophil-to-lymphocyte ratio (NLR), a biomarker of micrometastatic disease, could improve prediction models for SLN status. We externally validated existing models and developed 'MelRisk' prognostic score to better predict SLN metastasis. The models were externally validated using data from a multicenter cohort study of 1,251 adults. Additionally, we developed and internally validated a new prognostic score 'MelRisk', using candidate predictors derived from the extant literature. The Karakousis model had a C-statistic of 0.58 (95% CI, 0.54–0.62). The Sondak model had a C-statistic of 0.57 (95% CI 0.53–0.61). The MIA model had a C-statistic of 0.60 (95% CI. 0.56–0.64). Our 'MelRisk' model (which used Breslow thickness, ulceration, age, anatomical site, and the NLR) showed an adjusted C-statistic of 0.63 (95% CI, 0.56–0.64). Our prediction tool is freely available in the Google Play Store and Apple App Store, and we invite colleagues to externally validate its performance. [ABSTRACT FROM AUTHOR]

Background: The neutrophil-to-lymphocyte ratio (NLR) is a known prognostic biomarker for survival and is predictive of sentinel lymph node (SLN) positivity in some cancers. However, its usefulness as a prognostic biomarker for cutaneous squamous cell carcinoma (cSCC) has not been fully investigated.Objective: Our objective was to investigate the relationship between the NLR and the disease-specific survival and SLN positivity in patients with cSCC.Methods: In this single-center retrospective case series, we analyzed patients with cSCC who underwent blood tests prior to the initiation of treatment at our oncology hospital. The relationship between the patients' clinical characteristics (including the NLR) and the disease-specific survival and SLN positivity was evaluated using univariate and multivariate analyses.Results: An elevated NLR was an independent prognostic factor for poor disease-specific survival and a predictive factor for SLN positivity.Limitations: Limitations include the small number of participants and selection bias due to the large proportion of high-risk cases in our patient population.Conclusion: NLR is a useful biomarker in cSCC because it is simple to measure and can predict prognosis. [ABSTRACT FROM AUTHOR]

In patients with melanoma, sentinel lymph node (SLN) status is pivotal for treatment decisions. Current routine for SLN detection combines Technetium99m (Tc99) lymphoscintigraphy and blue dye (BD). The primary aim of this study was to examine the feasibility of using a low dose of superparamagnetic iron oxide (SPIO) injected intracutaneously to detect and identify the SLN, and the secondary aim was to investigate if a low dose of SPIO would enable a preoperative MRI-evaluation of SLN status. Patients with melanoma of the extremities were eligible. Before surgery, a baseline MRI of the nodal basin was followed by an injection of a low dose (0.02–0.5 mL) of SPIO and then a second MRI (SPIO-MRI). Tc99 and BD was used in parallel and all nodes with a superparamagnetic and/or radioactive signal were harvested and analyzed. Fifteen patients were included and the SLNB procedure was successful in all patients (27 SLNs removed). All superparamagnetic SLNs were visualized by MRI corresponding to the same nodes on scintigraphy. Micrometastatic deposits were identified in four SLNs taken from three patients, and SPIO-MRI correctly predicted two of the metastases. There was an association between MRI artefacts in the lymph node and the dose SPIO given. It is feasible to detect SLN in patients with melanoma using a low dose of SPIO injected intracutaneously compared with the standard dual technique. A low dose of SPIO reduces the lymph node MRI artefacts, opening up for a non-invasive assessment of SLN status in patients with cancer. [ABSTRACT FROM AUTHOR]

In many patients with cutaneous melanoma that affects the trunk area, there is lymphatic drainage to multiple basins (MLBD). This study aimed to examine whether MLBD is associated with disease outcomes. Lymphatic mapping and sentinel lymph node (SLN) biopsy were performed in 161 patients with truncal melanoma. The number and location of draining nodal basins were established during the preoperative lymphoscintigraphy using technetium-99 m rhenium sulphide nanocolloid. MLBD was present in 59 (37%) patients, and single lymphatic basin drainage (SLBD) in 102 (63%) patients. Patients with MLBD showed no increased risk for SLN metastasis compared to patients with SLBD (27% versus 29%, respectively). There was no significant difference in disease-free survival (DFS) between patients with MLBD and those with SLBD. Five-year DFS was 64% for patients with MLBD and SLBD. Multivariate analysis showed that the presence of ulceration (p = 0.01) was an independent predictor of SLN metastasis, while melanoma thickness (p = 0.01) and SLN metastasis (p = 0.01) were independent predictors of DFS. In patients with a negative SLN, five-year DFS was 74% for patients with MLBD and 73% for those with SLBD. Multivariate analysis showed that melanoma thickness (p = 0.00) was an independent predictor of DFS. MLBD does not negatively impact the disease outcome in patients with truncal melanoma. [ABSTRACT FROM AUTHOR]

Many cancer guidelines include sentinel lymph node (SLN) staging to identify microscopic metastatic disease. Current SLN analysis of melanoma patients is effective but has the substantial drawback that only a small representative portion of the node is sampled, whereas most of the tissue is discarded. This might explain the high clinical false-negative rate of current SLN diagnosis in melanoma. Furthermore, the quantitative assessment of metastatic load and microanatomical localisation might yield prognosis with higher precision. Thus, methods to analyse entire SLNs with cellular resolution apart from tedious sequential physical sectioning are required. Eleven melanoma patients eligible to undergo SLN biopsy were included in this prospective study. SLNs were fixed, optically cleared, whole-mount stained and imaged using light sheet fluorescence microscopy (LSFM). Subsequently, compatible and unbiased gold standard histopathological assessment allowed regular patient staging. This enabled intrasample comparison of LSFM and histological findings. In addition, the development of an algorithm, RAYhance, enabled easy-to-handle display of LSFM data in a browsable histologic slide-like fashion. We comprehensively quantify total tumour volume while simultaneously visualising cellular and anatomical hallmarks of the associated SLN architecture. In a first-in-human study of 21 SLN of melanoma patients, LSFM not only confirmed all metastases identified by routine histopathological assessment but also additionally revealed metastases not detected by routine histology alone. This already led to additional therapeutic options for one patient. Our three-dimensional digital pathology approach can increase sensitivity and accuracy of SLN metastasis detection and potentially alleviate the need for conventional histopathological assessment in the future. (DRKS00015737). • Three-dimensional light sheet fluorescence analysis of entire sentinel lymph nodes. • Identification of melanoma metastases undetected by the current European Organisation for Research and Treatment of Cancer (EORTC) protocol. • Clinical potential of light sheet microscopy for the exact staging of melanoma patients. • Light sheet microscopy may increase the sensitivity of lymph node metastasis detection. • New approach suitable for the implementation in clinical routine. [ABSTRACT FROM AUTHOR]

Axillary strategy decisions have become more complex and controversial in considering minimally traumatic therapy instead of sentinel lymph node biopsy, axillary lymph node dissection or regional nodal irradiation for people with breast cancer. The purpose of this study was to noninvasively predict sentinel lymph node (SLN) and non-sentinel lymph node (NSLN) status based on pre-operative sonographic and clinicopathologic features to determine optimal decisions regarding axillary therapy. In total, 701 patients with breast cancer from two independent centers were retrospectively analyzed. The SLN model (SLNM) for predicting SLN status and the NSLN model (NSLNM) for predicting NSLN status were trained based on a training set using the random-forest algorithm, and their performance was validated using an independent external test set. A receiver operating characteristic curve was drawn to obtain the area under the curve, which was used to assess performance. The area under the curve for the SLNM in the training and test, respectively, was 94.2% and 83.0%, and for the NSLNM, 99.5% and 92.7%. The SLNM and NSLNM accurately predicted that 61.46% (319/519) and 17.53% (91/519), respectively, of our participants were non-metastatic. The overall benefit of the three models was 78.99% in our participants. The two models for predicting SLN and NSLN status showed excellent application potential in optimizing axillary strategies. [ABSTRACT FROM AUTHOR]

This study investigated the usefulness of conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) in distinguishing metastasis of pelvic sentinel lymph nodes (SLNs) in patients with gynecological cancer. We examined 74 SLNs of patients with endometrial cancer (n = 26) and cervical cancer (n = 11). Patients underwent US and CEUS followed by SLN biopsy; US and CEUS results were evaluated visually and quantitatively and compared between pathological metastasis-negative and -positive groups. To support CEUS results, the microvessel density of SLNs was evaluated immunohistochemically. Seventeen positive and 40 negative SLNs were evaluable. Margin and enhancement patterns by visual assessment revealed significant differences (p = 0.046 and 0.022, respectively). In quantitative time-intensity curve analyses, the weakest peak intensities (PImin), PI ratio and PI difference indicated significant differences (p = 0.045, p < 0.001 and p < 0.001, respectively). The areas under the receiver operating characteristic curves (AUCs) were 0.64, 0.82 and 0.83, respectively. The most effective PI ratio from the AUC was 1.3 (sensitivity = 82%, specificity = 70%), and the PI difference from the AUC was 20 (sensitivity = 88%, specificity = 70%). Microvessel density was significantly lower in metastatic lesions than in other areas. The quantitative analysis of CEUS seemed to be a reasonable method for distinguishing lymph node metastasis in patients with gynecological cancer. [ABSTRACT FROM AUTHOR]

Whether the extent of residual disease in the sentinel lymph node (SLN) after neoadjuvant chemotherapy (NAC) influences the prognosis in clinically node-positive breast cancer (BC) patients remains to be ascertained. One hundred and thirty-four consecutive cN+/BC-patients received NAC followed by SLN biopsy and axillary lymph node dissection. Cumulative incidence of overall (OS) and disease-free (DFS) survival, BC-related recurrences and death from BC were assessed using the Kaplan-Meier method both in the whole patient population and according to the SLN status. The log rank test was used for comparisons between groups. The SLN was identified in 123/134 (91.8%) patients and was positive in 98/123 (79.7%) patients. Sixty-five of them (66.3%) had other axillary nodes involved. SLN sensitivity and false-negative rate were 88.0% and 2.0%, Median follow-up was 10.2 years. Ten-year cumulative incidence of axillary, breast and distant recurrences, and death from BC were 6.5%, 11.9%, 33.4% and 31.3%, respectively. Ten-year OS and DFS were 67.3% and 55.9%. When stratified by SLN status, 10-year cumulative incidence of BC-related and loco-regional events, and death from BC were similar between disease-free SLN and micrometastatic SLN subgroups (28.9% vs 30.2%, p = 0.954; 21.6% vs 13.4%, p = 0.840; 12.9 vs 24.5%, p=0.494). Likewise, 10-year OS and DFS were comparable (80.0% vs 75.5%, p=0.975 and 68.0% vs 69.8, p=0.836). Both OS and DFS were lower in patients presenting a macrometastatic SLN (60.2% and 47.5%). Outcome of patients with micrometastatic SLN was similar to that of patients with disease-free SLN, which was more favorable as compared to that of patients with macrometastatic SLN. • Study purpose: SLN biopsy and outcome assessment in NAC-treated cN+-BC patients • Result1: SLN biopsy and status accurately staged the axilla • Result2: Ten-year cumulative incidence of locoregional recurrence was 16.4% • Result3: Absence of disease and micrometastatic residue in the SLN led to similar outcome [ABSTRACT FROM AUTHOR]

Endometrial cancer (EC) is the most common gynecological cancer. Sentinel lymph node (SLN) technique has been adopted worldwide and showed lower morbidity and superimposable survival outcomes than the systematic lymphadenectomy (LND). Although these encouraging results, no meta-analyzes were performed on surgical complications during SLN research among patients undergoing laparoscopic (L) versus robotic surgery (R). The present review aims to report surgical complications during laparoscopic versus robotic SLN technique. The Preferred Reporting Items for Systematic reviews and Meta-Analyzes (PRISMA) and the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines have been followed for the present meta-analysis. Six studies, including 769 participants, were included. L-LND resulted in a significantly higher risk of operative complications relative to L-SLN (RR 2.10 [95% CI 1.37 to 3.21]). The risk of complications was comparable between R-SLN and L-SLN (RR 2.32 [95% CI 0.04–121.02]) and between R-LND and L-LND (RR 2.17 [95% CI 0.04–126.69]). According to the SUCRA analysis, L-SLN and R-SLN had the highest chances of being ranked first among proposed surgical procedures (SUCRA 48.9% and 28.4% respectively). Our study reported a lower surgical complications rate in patients undergoing L-SLN technique compared to L-LND. A lower rate of surgical complications was also reported for the R-SLN technique compared to the R-LND. Both laparoscopic and robotic SLN surgical techniques were found to be safe surgical procedures. [ABSTRACT FROM AUTHOR]

The objective was to explore the clinical value of contrast-enhanced ultrasound (CEUS) in locating the sentinel lymph node (SLN) in patients with early breast cancer. We screened 143 consecutive patients with breast cancer between July 2017 and August 2019. The number of SLNs identified by CEUS and dual labeling (blue dye and radiolabeled colloid) were recorded. The accuracy of CEUS plus fine-needle aspiration cytology (FNAC) was assessed. The rate of identification of SLNs with CEUS was 84.0% (121/144), and that of dual labeling was 97.92% (141/144). There was no significant association between non-enhancement (p = 0.060) or inhomogeneous enhancement (p = 0.468) and lymph node metastasis. The sensitivity and specificity of CEUS-SLNs plus FNAC was 78.38% and 100%, respectively. The technique of CEUS is a promising method for locating the axillary SLN. But it is hard to identify lymph node metastasis with CEUS alone. CEUS-SLNs plus FNAC is a sound technique for diagnosis of the metastasis of SLN. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated diagnostic accuracy of intraoperative sentinel lymph node (SLN) frozen section examination and scrape cytology as a possible solution for management of SLN positive patients.Study Design: Clinically early-stage endometrial cancer patients who underwent SLN algorithm and intraoperative SLN examination were analyzed. Findings were compared with final pathology results and diagnostic accuracy of frozen section and scrape cytology were evaluated.Results: Of the 208 eligible patients, 100 patients (48 %) had frozen section examination and 108 (52 %) had scrape cytology of the SLN. Intraoperative examination and final pathology were negative for metastasis in 187/208 (90 %) cases. The rest 21 cases had metastatic SLNs according to final pathology. 12 of 21 (57 %) metastases were classified as macrometastasis. Intraoperative examination of SLNs correctly identified 13 cases (true positive) and missed 8 cases (false negative). Five of 8 false negative cases had micrometastasis or isolated tumor cells. Considering identification of macrometastasis, sensitivity and negative predictive value were 85.71 % and 98.94 %, respectively, for the frozen section and 60.00 % and 98.15 %, respectively, for the scrape cytology.Conclusion: Frozen section examination of SLN has higher sensitivity in detecting macrometastasis compared to scrape cytology and it could help the surgeon in decision for further lymphadenectomy intraoperatively. [ABSTRACT FROM AUTHOR]

Background: There is a trend towards de-escalation in early breast cancer axillary surgery. In the American College of Surgeons Oncology Group (ACOSOG) Z-0011 trial, observation was shown to be non-inferior in terms of overall survival to complementary axillary lymph node dissection (cALND) in patients with up to two sentinel lymph node (SLN) metastases. The study included patients with T1-T2 invasive breast cancer, clinically node negative, undergoing breast-conserving surgery with SLN biopsy, followed by systemic therapy and radiotherapy. The aim of our study was to evaluate the impact of applying these ACOSOG Z-0011 inclusion criteria in routine practice.Patients and Methods: This retrospective observational study was conducted in a French comprehensive cancer center where patients treated for breast cancer with primary surgery were prospectively included between 2010 and 2016. Patients meeting ACOSOG Z-0011 inclusion criteria were analyzed.Results: Among the 1900 included patients, 1497 (79 %) met the ACOSOG Z-0011 criteria before surgery. Of these, 390 (20 %) had one or two metastatic SLN and could have avoided cALND. Out of these patients, 319 (81 %) presented cT1 tumors. During the study period, cALND was performed in 320 (82 %) patients and was free of metastases in 80 % of cases, having an impact on eligibility for adjuvant chemotherapy in only 3 (0.8 %) patients.Conclusions: In situations of primary breast cancer surgery, use of ACOSOG Z-0011 criteria could reduce the rate of cALND by 20 %. Further studies are needed to help select patients for whom abstention from any axillary surgery would be reasonable. [ABSTRACT FROM AUTHOR]

Study Objective: To explore the technique and clinical value of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) in hysterectomy and sentinel lymph node (SLN) mapping for endometrial cancer by comparing its perioperative outcomes with those of laparoscopic staging.Design: Retrospective cohort study.Setting: Department of gynecology at a tertiary medical center.Patients: All women diagnosed with endometrial cancer who underwent minimally invasive surgery at our center between August 2017 and May 2020.Interventions: Both vNOTES and laparoscopic approaches were used for hysterectomy and SLN mapping. The success of SLN detection as well as perioperative outcomes were subsequently analyzed.Measurements and Main Results: This study included 74 patients; 23 patients underwent vNOTES surgery, whereas 51 underwent standard laparoscopic surgery. The total successful SLN detection was 95.7% in the vNOTES group and 92.2% in the laparoscopy group (p >.05), whereas the bilateral success rates were 87.0% and 90.2%, respectively. No difference in SLN detection was observed between the 2 groups in terms of the side-specific mapping efficacy quotient (91.3% vs 91.2%, p = .47). The number of harvested SLNs, operative time, estimated blood loss, and intraoperative complications in the 2 groups were similar. One (4.3%) postoperative complication occurred in the vNOTES group vs 4 (7.9%) in the laparoscopy group (p = .029), and the median postoperative hospital stay was 3 days vs 4 days (p = .003).Conclusion: This study suggests that the vNOTES procedure is feasible, with a potentially decreased postoperative hospital stay, faster recovery, and better cosmetic results. However, prospective research is needed to validate its broader clinical application. [ABSTRACT FROM AUTHOR]

We found a need for balancing the application of clinical guidelines and tailored approaches to follow-up of cervical cancer (CC) patients in the lymph node micrometastatic (MICs) setting. This review aimed to determine the current knowledge of management of MIC-positive CC cases. We addressed prognostic and risk of recurrence monitoring impacts associated with MIC+ cases. The electronic databases for literature and relevant articles were analysed. Fifteen studies, (4882 patients), were included in our systematic review. While the results show that MICs significantly worsen prognosis in early CC. A tertiary prevention algorithm for low volume lymph node disease may stratify follow-up according to the burden of nodal disease and provide data that helps improve follow-up performance. MICs worsen prognosis and should be managed as suggested by the algorithm. However, this algorithm must be externally validated. The clinical impact of isolated tumor cells (ITC) remains unclear. [Display omitted] • Algorithmic follow-up of MIC-positive CC cases requires balancing general clinical guidelines and personalised approaches. • SLNB-only versus SLNB+LND follow-up showed no differences, and neither differentiated postoperative monitoring methods. • MICs worsen prognosis and should be managed by the suggested algorithm though it requires external validation. • Clinical impact of ITCs remains unclear, and no strategy could yet be defined as larger cohort studies are required. [ABSTRACT FROM AUTHOR]

Sentinel lymph node (SLN) biopsy is part of surgical treatment of apparent early-stage cervical cancer. SLN is routinely analyzed by ultrastaging and immunohistochemistry. The aim of this study was to assess the survival of patients undergoing SLN analyzed by one-step nucleic acid amplification (OSNA) compared with ultrastaging. Single-center, retrospective, cohort study. Patients undergoing primary surgery and SLN mapping (±pelvic lymphadenectomy) for apparent early-stage cervical cancer between May 2017 and January 2021 were included. SLN was analyzed exclusively with OSNA or with ultrastaging. Patients with bilateral SLN mapping failure, with SLN analyzed alternatively/serially with OSNA and ultrastaging, and undergoing neo-adjuvant therapy were excluded. Baseline clinic-pathological differences between the two groups were balanced with propensity-match analysis. One-hundred and fifty-seven patients were included, 50 (31.8%) in the OSNA group and 107 (68.2%) in the ultrastaging group. Median follow up time was 41 months (95%CI:37.9–42.2). 5-year DFS in patients undergoing OSNA versus ultrastaging was 87.0% versus 91.0% (p = 0.809) and 5-year overall survival was 97.9% versus 98.6% (p = 0.631), respectively. No difference in the incidence of lymph node recurrence between the two groups was noted (OSNA 20.0% versus ultrastaging 18.2%, p = 0.931). In the group of negative SLN, no 5-year DFS difference was noted between the two groups (p = 0.692). No 5-year DFS and OS difference was noted after propensity-match analysis (87.6% versus 87.0%, p = 0.726 and 97.4% versus 97.9%, p = 0.998, respectively). The use of OSNA as method to exclusively process SLN in cervical cancer was not associated with worse DFS compared to ultrastaging. Incidence of lymph node recurrence in the two groups was not different. [ABSTRACT FROM AUTHOR]

Vulvar cancer is an uncommon gynecologic tumor and one of several human papillomavirus-associated malignancies. Squamous cell carcinoma is the most prevalent histologic subtype of vulvar cancer, accounting for the majority of cases. Imaging plays an important role in managing vulvar cancer. At initial diagnosis, imaging is useful to assess the size and extent of primary tumor and to evaluate the status of inguinofemoral lymph nodes. If recurrent disease is suspected, imaging is essential to demonstrate local extent of tumor and to identify lymph node and distant metastases. In this publication, we summarize the recent literature and describe the panel's recommendations about the appropriate use of imaging for various phases of patient management including initial staging, surveillance, and restaging of vulvar cancer. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. [ABSTRACT FROM AUTHOR]

Despite the use of blue dye and radioisotopes, sentinel lymph node biopsy (SLNB) is still associated with a high false-negative rate (FNR). The off-label use of indocyanine green (ICG) and near-infrared fluorescence (NIRF) imaging has been introduced with the objective of assisting SLNB and thereby improving regional control in melanoma. The objective of this study was to review and summarize the general experience, protocols and outcomes of the use of ICG and NIRF to assist SLNB in melanoma. A systematic literature review was performed in December 2019 as per the PRISMA guidelines. Inclusion criteria were articles written in English describing the applications of ICG in patients with melanoma. Systematic reviews, animal studies, case reports and letters to editors were excluded. Of the 585 studies retrieved, 13 articles met the inclusion criteria. The reported sentinel lymph node (SLN) detection rate using ICG was between 86 and 100% of nodes identified by lymphoscintigraphy. The average number of nodes per patient detected using ICG was 2. ICG fluorescence imaging contributed to the identification of 2.0% of the total number of SLNs harvested. ICG fluorescence may be a useful adjunct to lymphoscintigraphy, although high-level comparative data is lacking. It was found to be superior to blue dye at detecting sentinel lymph nodes. [ABSTRACT FROM AUTHOR]

Objective: Improved preoperative evaluation of lymph node status could potentially replace lymphadenectomy in women with endometrial cancer. PET/CT was routinely implemented in the preoperative workup of endometrial cancer at St Olav's University Hospital in 2016. Experience with PET/CT is limited, and there is no consensus about the use of PET/CT in the diagnostic workup of endometrial cancer. The aim of the study was to evaluate the diagnostic accuracy of PET/CT compared to standard CT/MRI in identifying lymph node metastases in endometrial cancer with histologically confirmed lymph node metastases as the standard of reference. We especially wanted to look at PET/CT as a supplement to the sentinel lymph node algorithm in the detection of paraaortic lymph nodes.Study Design: A retrospective study included all women undergoing surgery for endometrial cancer from January 2016 through July 2019 at St Olav's University Hospital. Clinical data, results of CT, MRI, and PET/CT, and histopathological results were analyzed.Results: Among 185 patients included, 27 patients (15 %) had lymph node metastases. 17 (63 %) had pelvic lymph node metastases, one (4 %) had isolated paraaortic lymph node metastases, and 9 (33 %) had lymph node metastases in both the pelvis and the paraaortic region. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of PET/CT for the detection of lymph node metastases were 63 %, 98 %, 85 %, 94 %, and 93 %, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CT/MRI were 41 %, 98 %, 73 %, 91 %, and 90 %, respectively (p = 0.07). For the 26 pelvic lymph node metastases, PET/CT had a sensitivity of 58 %, compared to 42 % for CT/MRI (p = 0.22). PET/CT detected all 10 paraaortic lymph node metastases, for a sensitivity of 100 %, compared to 50 % for CT/MRI (p = 0.06).Conclusions: PET is superior to CT/MRI for detection of lymph node metastases in endometrial cancer, particularly in detecting paraaortic lymph node metastases. The ability of preoperative PET to exclude paraaortic lymph node metastases may strengthen the credibility of the sentinel lymph node algorithm. [ABSTRACT FROM AUTHOR]

Describir las técnicas «radioguided occult lesion localization» (ROLL) y «sentinel node occult lesion localization» (SNOLL) guiadas por resonancia magnética (RM) para el marcaje de restos tumorales en pacientes con cáncer infiltrante de mama que han recibido quimioterapia neoadyuvante y presentar los resultados quirúrgicos y la supervivencia libre de enfermedad. Estudio observacional prospectivo de 132 pacientes correspondientes a 136 tumores, tratadas con quimioterapia neoadyuvante en nuestro hospital entre los años 2011 a 2017 y marcadas preoperatoriamente con ROLL/SNOLL guiado con RM. Se describieron los aspectos técnicos de localización del lecho tumoral residual y se registraron variables correspondientes a los procedimientos quirúrgicos y eventos ocurridos durante el seguimiento. La mediana de tamaño tumoral fue 20,5 mm (rango intercuartílico [RIC]:14 a 28). El 96,3% eran carcinomas ductales infiltrantes. La tasa de detección del ganglio centinela fue 98,9% y se obtuvo respuesta completa patológica (RCP) en el 58,1%. La tasa de bordes afectos en los 89 casos operados mediante cirugía conservadora fue del 2,2%. Con una mediana de seguimiento de 50 meses (RIC: 37 a 61) se observó un 7,4% de recaídas, siete locorregionales y tres a distancia. La media estimada de supervivencia libre de enfermedad fue de 83,2 meses (Intervalo de Confianza [IC] 95%: 79,6 a 86,6). La técnica ROLL/SNOLL guiada con RM es útil en el marcaje de los restos tumorales tras neoadyuvancia, proporcionando unos resultados quirúrgicos adecuados y un buen control locorregional. To describe the results of MRI (magnetic resonance image) guided ROLL (radioguided occult lesion localization) and SNOLL (sentinel node occult lesion localization) in the localization of residual disease after neoadjuvant chemotherapy for breast cancer, as well as assessing the surgical results obtained and disease free survival. Prospective observational analysis of 132 patients with 136 tumors, treated with neoadjuvant chemotherapy at our hospital between 2011-2017. Residual disease was located presurgically with MRI guided ROLL/SNOLL technique. We analyzed technical aspects of localization, and variables corresponding to surgical procedures and events occurred during follow-up. The median tumor size was of 20.5mm (interquartilic range [IQR]: 14-28). The majority (96.3%) were invasive ductal carcinomas. Sentinel lymph node detection rate was 98.9%. Complete pathological response (CPR) in the breast was achieved in 58.1% of cases. The rate of affected margins in 89 cases operated by conservative surgery was 2.2%. With a median follow-up of 50 months (IQR: 37-61) we found a 7.4% rate of relapses. Of these, seven were loco-regional and three at distant sites. The estimated mean of disease-free survival time was 83.2 months (Confidence Interval [CI] 95%: 79.6-86.6). MRI guided ROLL/SNOLL is a great tool for breast cancer residual disease localization following neoadjuvant chemotherapy. In addition, this technique attains good loco-regional control of the diseases and has excellent surgical results. [ABSTRACT FROM AUTHOR]

Axillary staging in breast cancer is performed with physical exam and axillary imaging. Suspicious lymph nodes are biopsied and clipped prior to surgery to identify the previously biopsied node during surgery. Conventional mapping techniques of blue dye and radioisotope do not always accurately identify the clipped lymph node and therefore many techniques have been described to improve the identification of the clipped lymph node. Most of these techniques rely on axillary ultrasound to identify the previously biopsied lymph node or previously placed clip. A marker such as a fiducial reflector is then placed percutaneously. In this case report we describe a novel technique of Computed tomography (CT) identification of a previously clipped lymph node with CT guided placement of a fiducial reflector (SAVI SCOUT). The SAVI SCOUT was then identified and successfully excised with the previously biopsied lymph node. CT guided placement of SAVI SCOUT is a novel technique for the identification and retrieval of a previously biopsied axillary lymph node in breast cancer patients. • The technique of placing a fiducial reflector into a previously biopsied lymph node using CT guidance is novel approach. • When US is unsuccessful at identifying a previously biopsied lymph node, CT guidance can be utilized to locate the clip. • Fiducial reflectors placed using ultrasound or CT guidance can be identified and successfully excised during surgery. [ABSTRACT FROM AUTHOR]

Fluorescence-guided surgery (FGS) is an increasingly available and popular method of visual field augmentation. The basic premise of FGS entails injection of fluorescent indocyanine green (ICG) and subsequent detection with a near-infrared (NIR) camera. For pediatric surgical oncologists, FGS remains experimental but is a promising modality for identifying tumor margins, locating metastases, performing sentinel lymph node biopsies, protecting peritumoral structures of interest, and facilitating reconstruction. Familiarity with basic ICG pharmacokinetics and NIR detection optics is critical for surgeons wishing to judiciously use FGS, as its success is firmly grounded in a thorough understanding of its capabilities and limitations. In this practical guide, we outline several well-described and innovative FGS applications by disease type, including their methods of administration, modes of detection, and typical ICG dosing paradigms. V [ABSTRACT FROM AUTHOR]

The DROP-IN gamma probe was introduced to overcome the restricted manoeuvrability of traditional laparoscopic gamma probes. Through enhanced manoeuvrability and surgical autonomy, the DROP-IN promotes the implementation of radioguided surgery in the robotic setting. To confirm the utility and safety profile of the DROP-IN gamma probe and to perform a comparison with the traditional laparoscopic gamma probe and fluorescence guidance. Twenty-five prostate cancer patients were scheduled for a robot-assisted sentinel lymph node (SN) procedure, extended pelvic lymph node dissection, and prostatectomy at a single European centre. After intraprostatic injection of indocyanine green (ICG)-99mTc-nanocolloid (n = 12) or 99mTc-nanocolloid + ICG (n = 13), SN locations were defined using preoperative imaging. Surgical excision of SNs was performed under image guidance using the DROP-IN gamma probe, the traditional laparoscopic gamma probe, and fluorescence imaging. Intraoperative SN detection was assessed for the different modalities and related to anatomical locations. Patient follow-up was included (a median of 18 mo). Overall, 47 SNs were pursued in vivo by the DROP-IN gamma probe, of which 100% were identified. No adverse events related to its use were observed. In vivo fluorescence imaging identified 91% of these SNs. The laparoscopic gamma probe identified only 76% of these SNs, where the detection inaccuracies appeared to be related to specific anatomical regions. Owing to improved manoeuvrability, the DROP-IN probe yielded improved SN detection rates compared with the traditional gamma probe and fluorescence imaging. These findings underline that the DROP-IN technology provides a valuable tool for radioguided surgery in the robotic setting. Radioguided robot-assisted surgery with the novel DROP-IN gamma probe is feasible and safe. It enables more efficient intraoperative identification of sentinel lymph nodes than can be achieved with a traditional laparoscopic gamma probe. The use of the DROP-IN probe in combination with fluorescence imaging allows for a complementary optical confirmation of node localisations. The DROP-IN gamma probe integrates radioguided surgery within the robotic surgical setting. It appears that the DROP-IN gamma probe provides a higher detection rate of sentinel nodes in prostate cancer than the traditional laparoscopic gamma probe or fluorescence imaging. [ABSTRACT FROM AUTHOR]

To determine the efficacy and safety of sentinel lymph node biopsy (SLNB) in the management of eyelid and conjunctival malignancy. A literature search was performed in August 2019 and January 2020 for articles published in English in the PubMed and Cochrane Library databases. This search yielded 151 articles that were reviewed for relevancy, of which 27 were deemed to have met the inclusion criteria for this assessment. The data from these articles were abstracted and the articles were rated for strength of evidence by the panel methodologist. All 27 studies were rated level III, and a total of 197 SLNBs were reported. Diagnoses included conjunctival and eyelid cutaneous melanoma (85 and 42 patients, respectively), sebaceous gland carcinoma (35 patients), squamous cell carcinoma (26 patients), Merkel cell carcinoma (6 patients), pigmented epithelioid melanocytoid tumor (1 patient), mucoepidermoid carcinoma (1 patient), and signet ring carcinoma (1 patient). Tracer was found in regional lymph nodes in 100% of patients in 21 of 27 articles and in 191 of 197 patients overall. The number of lymph nodes removed ranged from 1 to 16, with most ranging from 1 to 5. Tumor-positive lymph nodes were found in 33 of 197 patients (16.8%), prompting recommendations for adjuvant treatments. Survival data were reported for 16 of these patients, with follow-up periods ranging from 3 to 36 months (average, 12.7 months). Fourteen of 16 patients received adjuvant treatments. Nine were alive and well, 1 was alive with metastases, and 6 had died of metastatic disease (including 2 patients who declined additional treatment). False-negative SLNB results were reported in 5 articles involving 9 of 197 procedures (4.6%). Complications were documented in 7 of 27 articles and included transient facial nerve weakness, persistent blue dye staining of the conjunctiva, neck hematoma, and suture abscess. Sentinel lymph node biopsy is a promising procedure in patients with eyelid and conjunctival malignancy, and it is useful in identifying sentinel lymph nodes. However, at present, insufficient evidence exists showing that SLNB improves patient outcomes and survival. Recognition of microscopic metastatic disease may prove beneficial in staging and guiding adjuvant therapy. [ABSTRACT FROM AUTHOR]

To develop a nomogram for predicting the possibility of four or more positive nodes in breast cancer patients with 1–3 positive sentinel lymph nodes (SLN). Retrospective analysis of data of patients from two institutions was conducted. The inclusion criteria were: invasive breast cancer; clinically node negative; received lumpectomy or mastectomy plus SLN biopsy followed by axillary lymph node dissection (ALND); and pathologically confirmed T1-2 tumor, with 1–3 positive SLNs. Patients from one institution formed the training group and patients from the other the validation group. Univariate and multivariate analyses were performed to identify the predictors of four or more positive nodes. These predictors were used to build the nomogram. The area under the receiver operating characteristic curve (AUC) was calculated to assess the accuracy of the model. Of the 1480 patients (966 patients in the training group, 514 in the validation group), 306 (20.7%) had four or more positive nodes. Multivariate stepwise logistic regression showed number of positive (p <.001) and negative SLN (p <.001), extracapsular extension (p <.001), pT stage (p =.016), and tumor location in outer upper quadrant (p =.031) to be independent predictors of four or more positive nodes. The nomogram was built using these five factors. The AUC was 0.845 in the training group and 0.804 in the validation group. The proposed nomogram appears to accurately estimate the likelihood of four or more positive nodes and could help radiation oncologists to decide on use of regional nodal irradiation (RNI) for breast cancer patients with 1–3 positive nodes but no ALND. • Five predictors of four or more positive nodes in breast cancer patients were identified. • A nomogram was built using these five factors. • The nomogram was validated on an external cohort. • The proposed nomogram predicts four or more positive nodes with high accuracy. • The nomogram can help in decision making on use of regional nodal irradiation. [ABSTRACT FROM AUTHOR]

Sentinel lymph node (SLN) biopsy remains crucial for melanoma staging. The European Organisation for Research and Treatment of Cancer Melanoma Group recommends performing immunohistochemical stainings for reproducible identification of melanoma metastases. S100 protein (pS100) is a commonly used melanocytic antigen because of its high sensitivity in spite of relatively low specificity. SRY-related HMG-box 10 protein (SOX10) is a transcription factor characterising neural crest-derived cells. It is uniformly expressed mostly in the nuclei of melanocytes, neural, and myoepithelial cells. Pathologists sometimes prefer SOX10 as a melanoma marker, but it has not yet been investigated on a large-scale to confirm that it is reliable and recommendable for routine SLN evaluation. Four hundred one treatment-naïve lymph node (LN) metastatic melanomas were included in high-density tissue microarrays and were assessed for the presence of SOX10 and pS100 by immunohistochemistry. The slides were digitalised, shared and evaluated by a panel of experienced melanoma pathologists. The vast majority of melanomas were double-positive for pS100 and SOX10 (93.2%); a small percentage of the cases (3.9%) were double-negative melanomas. Discordance between the two markers was observed: 1.9% pS100(−)/SOX10(+) and 0.75% pS100(+)/SOX10(−). SOX10 was not expressed by immune cell types in the LN, resulting in a less controversial interpretation of the staining. SOX10 is as equally specific as pS100 for the detection of melanoma metastases in LNs. The interpretation of SOX10 staining is highly reproducible among different centres and different pathologists because of the absence of staining of immune cells. • SOX10 is a highly specific marker for melanoma metastasis in lymph nodes (LNs), comparable with pS100. • SOX10 is highly reproducible and easily interpretable if a ready-to-use antibody is used. • SOX10 has the same level of recommendation as pS100 for the detection of melanoma metastasis in SLN protocols. [ABSTRACT FROM AUTHOR]

Sentinel lymph node biopsy (SNB) still remains a key procedure to appropriately stage melanoma patients and to select those who are candidate to novel treatments with immunotherapy and targeted therapy in the adjuvant setting. The impact of timing of SNB on disease-free survival (DFS) and overall survival (OS) is still unclear. The study was conducted at 6 Italian Melanoma Intergroup (IMI) centres and included 8953 consecutive clinical stage I-II melanoma patients who were diagnosed, treated, and followed up between November 1997 and March 2018. All patients were prospectively included in dedicated IMI database. Multivariable Cox regression analyses were performed to investigate how baseline characteristics and time interval until SNB are related to DFS and OS. Considering the whole population, at multivariable analysis, after adjusting for age, gender, Breslow thickness, site, ulceration, and the SNB status, a delay in the timing of SNB was associated with a better DFS (adjusted hazard ratio [aHR, delayed versus early SNB] 0.98, 95% confidence interval [CI] 0.97–0.99, p < 0.001) and OS (aHR 0.98, 95% CI 0.97–0.99, p = 0.001). Specifically, in patients with a negative SNB status, a beneficial impact of delayed SNB (i.e. at least 32 days after primary excision) was confirmed for DFS (aHR 0.70, 95%CI 0.63–0.79, p < 0.001) and OS (aHR 0.69, 95%CI 0.61–0.78, p < 0.001), whereas in those with a positive SNB status, DFS (aHR 0.96, 95%CI 0.84–1.09, p = 0.534) and OS (aHR 0.94 95%CI 0.81–1.08, p = 0.374) were not significantly different in patients with early or delayed SNB. Our study does not support a strict time interval for SNB. These results may be useful for national guidelines, for counselling patients and reducing the number of high urgency referrals. • Sentinel lymph node biopsy (SNB) is a key procedure to stage melanoma patients (MPs). • In our series, the time interval of SNB is irrelevant in MPs with positive sentinel lymph node. • A delayed SNB biopsy is not detrimental in clinically stage I-II MPs. [ABSTRACT FROM AUTHOR]