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Introduction: Gastrointestinal metastases from breast cancer are rare. One large series reported a rate of 0.7% of gastrointestinal metastatic manifestations from breast cancer, but its true incidence could be underestimated. Here we report a case of bowel obstruction caused by sigmoid metastases from breast cancer and describe its relevance to histological origin and clinical practice., Methods: The clinical course and histopathology of the case are reviewed and compared with reports of similar cases in the literature., Results: An 80-year-old woman presented with bowel obstruction. Her medical history included infiltrating lobular breast cancer treated with left radical mastectomy 25 years before the current presentation; 13 years later bone metastases developed and were treated with hormone therapy. In 2003 the patient came to our emergency department because of symptoms of bowel obstruction. A computed tomography (CT) scan revealed a mass in the distal sigmoid causing the obstruction. A colostomy was performed, followed by a second operation completed with Hartmann's procedure. Histological examination revealed metastases from invasive lobular carcinoma. The patient was discharged 45 days postoperatively and died 9 months later because of disease progression., Conclusions: Although gastrointestinal metastases from breast cancer are rare, patients with diagnosed breast cancer, particularly invasive lobular carcinoma, should be regularly followed up with endoscopy, CT, endosonography and PET-CT when abdominal symptoms are present. This could permit early diagnosis of gastrointestinal metastases and improve treatment planning.

In colorectal cancer the sentinel node dissection may help to identify any unusual mesenteric lymphatic drainage pattern from the primary tumor site (ex/skip metastases); assuming that accurate pathological staging is critical for therapeutic decisions we are conducing a study to evaluate the feasibility of the sentinel node technique in colorectal neoplasms and its overall accuracy in predicting regional lymph nodes metastases for appropriate staging. From February 2001 to September 2004 we included in this study 30 patients with rectal lesions or degenerate colonic polyps not radically excised by endoscopy. Lymphatic mapping was performed with low molecular weight albumin colloid labelled with 500Mci of 99mTc in a 2 ml volume and injected submucosally by an endoscopic route at the four cardinal points around the tumor, the afternoon before the surgical procedure, both in case of colonic or rectal lesions. Scintigraphic images were obtained with a gamma camera fitted with a general purpose collimator. The day of the intervention, a hand held gamma detecting probe (Scintiprobe m100, Pol-Hi-Tech, Italy) was employed to detect the "hot" nodes, in vivo and ex vivo. These lymph nodes were tagged with a stitch in vivo; the specimen was removed by a standard resection and SLN were dissected ex vivo and sent separately for pathological examination. In case of rectal lesions, the sentinel nodes were searched ex vivo into mesorectal fat in case. All lymph nodes, including blue or hot ones, were embedded separately for preparation of paraffin sections and haematoxylin and eosin staining. Sentinel lymph node were submitted to multi-seriate sections in order to look for micrometastases. Using the radioactive tracer, sentinel lymph nodes were successfully identified in 27 out of 30 patients. Concordance between SLNs and nodal status was observed in 23 out of 27 cases (85%); two patients (7.4%) were upstaged, as SLN was the only site of metastases. In another two cases we observed no concordance between negative sentinel node and non sentinel nodes (false negative rate, 7.4%). Starting from this experience we are proposing a multicentric trial concerning the value of sentinel node technique in rectal cancer and in early colorectal cancers detected by screening programs.

Sentinel node biopsy has been widely adopted in the treatment of cutaneous melanoma and breast cancer. The ongoing controversy concerning the extension of lymphatic dissection in gastric cancer demonstrate that the optimal extent of lymphadenectomy has yet to be established, and underlines that the research in this area is needed to refine our knowledge and consequently our treatment of gastric tumors. In this paper the authors describe a multicentric protocol concerning the sentinel node research in early and advanced T1-T2 gastric cancer employing the blue dye method and lymphoscintigraphy by means of the endoscopic injection of Tc99m labeled nanocolloids. The aim of this protocol is to assess the clinical relevance of the sentinel node biopsy in selecting N+ patients in early gastric cancer, and the role of the same technique in detecting N2 positive patients in case of advanced gastric cancer. Assuming a confidence interval of +/- 5%, a sample of 100 recruited cases over three years is previewed.

Aims and Background: Sentinel lymph node (SLN) biopsy is currently used and investigated in melanoma and in breast cancer. Its utility in gastrointestinal malignancies is still under debate. The prognosis of colorectal cancer patients is strongly related to the lymphatic involvement. The aim of this study was to evaluate the feasibility of SLN mapping in colorectal cancer and to assess its impact on pathological staging and treatment., Methods and Study Design: We injected blue dye in 11 colorectal cancer patients during surgery. After resection the tumor specimen was examined to identify blue-stained lymph nodes and these lymph nodes were sent separately to the pathologist. Routine hematoxylin-eosin examination was performed on all nodes (including blue ones). No other techniques (eg immunohistochemistry or PCR) were performed., Results: Sentinel lymph nodes were successfully identified in 10 of the 11 patients. We observed only one false negative result (10%) and the agreement between SLN and other lymph node status was 80% (8/10). One patient was upstaged: SLN was positive for metastases while the other lymph nodes were negative., Conclusions: Lymphatic mapping using patent blue dye is feasible in colorectal cancer. The identification of lymph nodal metastases by this technique led to upstaging of one patient, who may benefit from adjuvant therapy. These initial results prompt further investigation of this procedure as an accurate, minimally invasive staging approach in early colorectal cancer. We proceed with our study to evaluate the role of SLN mapping in colorectal cancer management.

Aim of the Study: Validation of the sentinel node (SN) technique in breast cancer by means of lymphoscintigraphy., Materials and Methods: From December 1996 to January 1999 102 T1-T2 breast carcinoma cases were recruited in Turin. 99mTc-human serum albumin colloids were injected subdermally the day before surgery (mean activity, 5.2 +/- 2.5 MBq). Scintigraphic imaging was performed after injection. After identification of the SN during surgery by a hand-held gamma probe, the SN was excised and sent for histologic examination. SN histology was compared with that of other axillary nodes., Results: The SN detection rate was 86.3%; among 88 cases with an identified SN, 37 (42%) had axillary metastases; the SN was metastatic in 35 cases (sensitivity, 94.6%); in 51.3% of pN+ cases (19/37) the SN was the only metastatic site. In two of the 53 negative SNs, SN histology did not match with that of the remaining axilla (negative predictive value, 96.2%; staging accuracy, 97.7%)., Conclusions: Our results agree with those reported in the literature; however, except in clinical trials and experienced structures axillary lymph node dissection should not be abandoned when mandatory for prognostic purposes, considering that at present SN biopsy alone is not completely accurate for axillary staging, especially in the absence of an adequate learning period.

The status of axillary nodes is the most important prognostic factor in breast cancer to select patient subgroups for adjuvant chemotherapy; the current standard of care for surgical management of invasive breast cancer is complete removal of the tumor by either mastectomy or lumpectomy followed by axillary lymph node dissection (ALND). The recent introduction of intraoperative lymphatic mapping and sentinel lymph node biopsy (SLND) represents a major new opportunity for appropriate and less invasive surgical management of many tumors. There is an almost uniformly enthusiasm concerning the potential of this technique in breast carcinoma management, shown by published data. A peculiar attention to the so-called "sentinel node debate" in breast cancer surgery is a constant in the last years issues of the major medical journals. Even patients have become more aware about medical enthusiasm and their request of concise information on the topic and the possibilities of this approach is an increasing reality in medical practice. The aim of this paper is to review recent literature to offer an overview about the main controversial methodological aspects and a wide analysis of reported results. The most significative international literature papers from Medline were retrieved from 1993 to September 1999, and 4782 procedures were analysed. This extensive review of the literature has confirmed accuracy, feasibility and reliability of the SN detecting technique in axillary mapping. Provided a good proficiency in SN localisation and pathological evaluation, human resources and efforts should be mainly focused on its clinical validation as an alternative to ALND instead of on further phase I-lI clinical studies.