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Background: Presence of neck nodes in cases of head neck squamous cell cancers is an adverse prognostic factor. Elective neck dissection is traditionally recommended along with primary disease resection. Sentinel lymph node (SLN) is the first draining node. Sentinel lymph node biopsy (SNB) is a minimally invasive technique to identify occult nodal metastasis in early HNSCC. Methods: The objective of this study is to determine the identification rate of SNB using methylene blue dye (MBD) in N0 neck of Oral Squamous cell carcinoma (OSCC) and estimating specificity, sensitivity, negative predictive value and positive predictive value of SNB with frozen section (FS) analysis and in comparison to post-operative histopathological examination (HPE). It is a cross-sectional study conducted at a tertiary care centre, Lucknow, India. 21 patients of N0 OSCC from January 2019 to May 2020, were included. All patients underwent peritumoral injection with MBD. Sentinel nodes were harvested and sent for FS. Depending on FS findings, appropriate neck dissection was performed. Results: SLN was identified at level Ib and II in 19 patients (90.47%). The sensitivity, specificity, PPV and NPV in identifying SLN using MBD versus FS were 100.00%, 11.11%, 15.79% and 100.00% respectively. Whereas, SLN using MBD versus HPE specimens were 100.00%, 10.52%, 10.52% and 100.00% respectively. Conclusion: Despite having 100% sensitivity, MBD alone has poor specificity. With this poor discriminatory power, it is unlikely to be employed as a diagnostic test alone. It is recommended to rely on per-operative FS for taking decision as far as extent of neck dissection in N0 neck is concerned. [ABSTRACT FROM AUTHOR]

Background and aims Intraoperative lymphatic mapping and sentinel lymphadenectomy (LM/SL) is a growingly popular operating procedure for staging regional lymph nodes in earlystage melanoma. The groin is a promising area for this method since superficial groin dissection and iliac dissection have a significant risk of morbidity. There is currently no consensus on how best to treat cases with tumor-positive sentinel lymph nodes (SNs) during surgery involving these basins. Methods A total of 182 cases were treated using the LM/SL method. There was consistent detection of sentinel lymph nodes. SN dissection was performed on patients who had tumor in their SN. A hematoxylin and eosin stain was used to analyze the sentinel lymph nodes. Patient selection for SN dissection was based only on the presence of tumor in that node. Computerized database containing log-rank tests and Cox regression models for statistical analysis. Results 61% of the 182 cases were female, with an average age of 50 (range, 15-89). Tumor-positive SNs were detected in 21% of cases. 67% of cases were identified to have sentinel full lymph node dissection and a single tumor-positive lymph node after LM/SL, whereas 27% had 2 tumor-positive lymph nodes and 6% had 3 or more tumor-positive lymph nodes. Recurrence in the dissected basin occurs in just 4% of individuals with tumor-negative SNs. Cases whose lymph nodes tested negative for tumors had a significantly greater 5-year overall survival (mean±SD, 94% 5%) compared with those whose lymph nodes tested positive for tumors (meanSD, 75% 4%; P 0.01). Primary tumor thickness (P=0.03), Tumor-positive SN (P 0.001) and ulceration (P=0.001) were revealed to be important indicators of survival in multivariate studies using a Cox regression model. Conclusions This surgical treatment ought to become common for cases with early-stage melanoma of the lower extremities and trunk because the accuracy of LM/SL as judged by the infrequent recurrences implies that it should. When a tumor-positive SN is found in the groin, it is important to take a sample from the Cloquet node so that one may decide whether or not an iliac dissection is necessary. [ABSTRACT FROM AUTHOR]

Negative pressure pulmonary edema (NPPE) is a rare complication that occurs mainly after tracheal extubation. We report a case of postoperative NPPE associated with the use of the i-gel. A 28-year-old woman was scheduled for an emergency right axillary sentinel lymph node excision. During emergence, the patient experienced a sudden onset of airway obstruction, and spontaneous ventilation through the i-gel was impossible. Pink and frothy secretions were noted in the i-gel and the patient's oral cavity. Positive airway pressure with 100% oxygen was applied using a facemask, and the patient was subsequently treated with high-flow oxygen therapy. In this case, laryngospasm or displacement of the i-gel was believed to be the cause of airway obstruction. We recognized that NPPE is likely to occur regardless of the airway device, and the use of the i-gel cannot completely eliminate the possibility of NPPE occurrence. [ABSTRACT FROM AUTHOR]

Objective This study aimed to measure the efficacy of using carbon nanoparticles in the preoperative localization of early breast cancer (BC) cases as well as in the detection of sentinel lymph nodes in Egypt. In addition, the purpose of the study was to determine whether the efficacy of carbon nanoparticles outweighs their high price and additional shipping fees. Material and methods The current pilot study enrolled 16 early BC patients, particularly those eligible for breast-conserving surgery. All patients underwent standardized injection techniques. The operating surgeons provided comprehensive intraoperative findings and postoperative histopathological reports of the excised tissues. Results After neoadjuvant chemotherapy (NAC), downstaging of the study subjects was achieved until reaching the TNM stage of T1N1M0 and T1N0M0 in 2 cases (12.5%) and 14 cases (87.5%), respectively. Ultrasound-guided injection of carbon nanoparticles was done, followed by surgical excision on the same day or the day after injection. Eleven patients had positive mass lesions preoperatively, with a mean tumoral size of less than 1 cm in maximum dimension. Moreover, 6 out of the 11 patients showed positive black staining intraoperatively with an accuracy of 68.75%. Postoperative histopathological examination (the gold standard) of axillary specimens revealed that 3 out of 16 of the study population have positive tumor-infiltrated lymph nodes. However, only 2 of these cases demonstrated intra-operative black staining, with the black dye's positive and negative predictive values of staining being 100% and 92.2%, respectively. Conclusions Preoperative carbon nanoparticle suspension injection is a safe and effective method for adequate tumoral localization in BC patients. Nevertheless, this pilot study did not provide strong evidence for the adequacy of sentinel lymph node detection due to the small sample size, high cost, and extra shipping fees of the carbon nanoparticles. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to evaluate the role of 18F-2-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography-computed tomography (PET-CT) scan in the detection of axillary lymph node (ALN) involvement and comparison with sentinel lymph node biopsy (SLNB) in operable early-stage breast cancer (EBC). Settings and Design: It is a retrospective analysis of staging PET-CT scan of EBC. Methods: A total of 128 patients with histopathologically proven breast cancer (BC) were included in the study. Preoperative mammography supplemented with ultrasonography and staging 18F-FDG PET-CT scan was done for all patients. Surgery was done within 30 (mean ± standard deviation = 13.8 ± 10.5) days of staging. SLNB was performed in patients without PET-positive ALNs. All patients with positive sentinel nodes and PET-positive ALNs underwent axillary lymph node dissection (ALND). Statistical Analysis Used: The comparison between categorical variables was made by Chi-square/Fisher's exact test as applicable. For continuous variables comparisons, Student's t-test and one-way analysis of variance tests were used. Results: Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of PET-CT scan for detection of ALN involvement were 41.7%, 93.2%, 92.1%, and 45.6%, respectively. Sensitivity, specificity, PPV, and NPV of mammography were 84.5%, 54.5%, 78.0%, and 68.6%, respectively. Sixteen out of 46 (34.7%) patients with negative ALNs in PET-CT scan finally showed involvement in histopathology report after SLNB resulting in upstage of the disease. The size of tumor deposits in sentinel nodes was significantly smaller than PET-positive ALNs (P = 0.01). Our observations correlate with the results of earlier studies published in the literature. Conclusions: 18F-FDG PET-CT scan cannot substitute SLNB for ALN screening in EBC. The limitations are most marked in smaller and micrometastatic tumor deposits in ALNs and may be attributed to limitations of PET resolution. However, PET-positive nodes showed good specificity for disease involvement in our study. Therefore, ALND can safely be performed by omitting SLNB in such cases. [ABSTRACT FROM AUTHOR]

Low‑grade adenosquamous carcinoma of the breast is a rare variant of metaplastic mammary carcinoma. It shows indolent behavior contrary to the usual aggressive nature of metaplastic carcinomas and has a good prognosis despite being triple negative. Recurrence rates tend to be high and a consequence of incomplete excision. Although this variant has an infiltrative growth pattern, owing to its bland cytologic features, it is liable to be confused with benign sclerosing adenotic breast lesions. We present here a case of a 55‑year‑old postmenopausal female, who presented with a painless, mobile, hard, and nontender lump in the lower outer quadrant of the left breast, with normal overlying skin and nipple–areola complex. No associated axillary lymphadenopathy was seen. On mammography, a high‑density mass of architectural distortion, characterized as BIRADS category 4C, was found. Core‑needle biopsy showed haphazard glands lined by a double layer of epithelium and nests of squamoid cells arranged in an infiltrative fashion within a fibromyxoid stroma. On immunohistochemistry, tumor cells showed a lack of expression of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 receptor and were positive for CK 5/6 and CK7. There was counterintuitive, but characteristic positivity for myoepithelial markers calponin and CD 10 around the neoplastic nests and stromal cells expressed smooth muscle myosin. Subsequently, the patient underwent a wide local excision with free margins and sentinel lymph nodes were negative for tumor deposits. This patient remains well and free of recurrence well into follow‑up. [ABSTRACT FROM AUTHOR]

Purpose: Sentinel node mapping is the standard of care for evaluation of axilla for women with early node negative breast cancer. Validation of a new tracer for sentinel node biopsy requires full axillary lymph node dissection to establish its performance indicators. This exposes about 70% of women to unnecessary axillary dissection with its attendant morbidity. Aims and Objective: To investigate the predictive value of identification of sentinel lymph nodes by a tracer for knowing its sensitivity and false-negative rates (FNR). Methods: A linear regression on data from a network meta-analysis was carried out, and the correlation between identification and sensitivity and its predictive value were ascertained. Results: A strong linear relationship was observed between identification and sensitivity of sentinel node biopsy (correlation coefficient r = 0.97). The sensitivity and false negativity can be predicted by the identification rate. An identification rate of 93% corresponds to sensitivity = 90.51% and a FNR = 9.49%. The current literature on newer tracers has been succinctly reviewed. Conclusion: The linear regression demonstrated a very high predictive value of identification rate for ascertaining the sensitivity and FNRs of sentinel node biopsy. A new tracer for sentinel node biopsy can be introduced in clinical practice, if it achieves an identification rate of 93% or more. [ABSTRACT FROM AUTHOR]

Introduction Management in breast cancer is heading toward less invasive approaches with high survival and low recurrence rates. Axillary lymph node dissection (ALND) has a high morbidity on breast cancer patients; on the other hand, sentinel lymph node biopsy (SLNB) overcomes such morbidity with comparable survival and recurrence rates. In this study, the authors aim to assess diagnostic accuracy of carbon nanoparticles (CN) in SLNB in patients with early breast cancer. Patients and methods From November 2020 to March 2022, patients with early breast cancer and clinically and radiologically free axillary lymph nodes who had SLN detection using CNs followed by ALND were included. Patients who received neoadjuvant chemotherapy, are pregnant, or refused consent were excluded. Results In this study, 30 patients with clinically node-negative early breast cancer patients were investigated using CN for SLN mapping. Mean age of our participants was 49.2±5.8. CN technique had a sensitivity of 100% (95% confidence interval: 80.49–100), specificity of 92.3% (95% confidence interval: 63.9–99.8), positive predictive value of 94.4%, negative predictive value of 100%, and false-negative rate=0%. The summary receiver-operating characteristics of CN showed excellent diagnostic performance with area under the curve of 0.962 (P=0.0001). Conclusion SLN mapping using proper technique is vital to avoid recurrence and promote survival and decrease morbidity without need for ALND. CN had excellent sensitivity and specificity with low false-negative rate. [ABSTRACT FROM AUTHOR]

Background Axillary lymph nodes (LNs) are known to be the most important prognostic factor for recurrence and survival in the management of patients with early breast cancer. Blue dye and radioactive isotopes are the most widely used tracers in the mapping of axillary sentinel node (SN) biopsy. These tracers still have several drawbacks. Indocyanine green (ICG) has the potential for guiding SN biopsy. Patients and methods A total of 35 patients with early breast cancer, clinically and radiologically node negative, underwent SN biopsy with combined ICG and patent blue (PB) dye for localization of SNs. The obtained lymph nodes were histopathologically investigated. Outcomes This study aimed to assess the feasibility of using ICG for SN biopsy, to calculate the detection rate, and to assess the safety of ICG dye. Results The mean age of the patients was 51.94 years. The detection rate of SN depending on ICG was 100 and 91% depending on the PB dye visualization. Of 129 SNs dissected from the 35 recruited patients, a mean of 2.31±1.23 nodes/patient were seen in case of SN detection by the PB dye and a mean of 3.69±0.72 nodes/ patient in case of SN detection by ICG (P<0.001). No complications or adverse actions were recorded in all patients. Conclusion This study demonstrated that ICG is a feasible technique for SN biopsy with a high detection rate and can be used safely. [ABSTRACT FROM AUTHOR]

Radical surgery remains the primary treatment option for gall bladder cancer (GBC). Margin-negative liver resection is a critical component of radical cholecystectomy. Anatomical segment IVb and V resection is preferred in primary GBC with liver infiltration and incidental GBC patients with puckering of gall bladder (GB) bed. Despite the initial scepticism, minimally invasive radical cholecystectomy is recommended as a treatment option in selected GBC patients. However, anatomical Segment IVb and V resection using the minimally invasive approach is scarcely reported. The standardised technique of robotic (daVinci®XiTM) anatomical Segment IVb and V liver resection guided by indocyanine green fluorescence is described here. The systematic fluorescence-guided anatomical resection described in this report could facilitate minimally invasive Segment IVb and V resection with radical lymphadenectomy in selected patients with GBC. [ABSTRACT FROM AUTHOR]

Purpose: Evaluation of fluorescein along with blue dye as an affordable tracer for sentinel node biopsy in comparison with technetium + methylene blue. A randomized trial was conducted with the following objectives: (1) to demonstrate that the identification of sentinel lymph node by fluorescein + methylene blue is not inferior to the identification by Tc-99 m sulfur colloid + methylene blue and (2) to evaluate the cost-effectiveness of sentinel node biopsy by above two tracers. Subjects and Methods: One-thirty patients above age 18 years presenting with early breast cancer T1, T2, N0 breast carcinoma were randomized to undergo sentinel node biopsy by either fluorescein + methylene blue or Tc-99 m sulfur colloid + methylene blue. Results: The sentinel lymph nodes were identified in 89% in Fluorescein + methylene blue group and 90.9% with Tc-99 m sulfur colloid + methylene blue group. The trial demonstrated noninferiority of fluorescein + methylene blue as compared to isotope + methylene blue with effect size = 1; 95% confidence interval-9.54 to + 11.54. The fluorescein + methylene blue was more cost-effective than isotope guided sentinel node biopsy. Conclusion: Fluorescein-guided sentinel node biopsy is noninferior and more cost-effective than isotope-guided sentinel node biopsy. [ABSTRACT FROM AUTHOR]

Background Sentinel lymph node (SLN) biopsy has emerged as an alternative to routine axillary node dissection in early-stage node-negative breast cancer. However, there have been controversies in clinical application because of its various identification rates and false-negative rates. We analyzed endoscopic sentinel node biopsy as a feasible procedure for visualization of the axillary space and resection of the sentinel node using endoscopic technique. Objective To evaluate the implementation of the technique and to compare the feasibility, effectiveness, outcome, and complications of endoscopic axillary SLN biopsy versus open technique in early-stage breast cancer. Patients and methods Between October 2020 and May 2021, 48 patients with breast cancer with clinically node-negative results were injected methylene blue or patent blue dye. A total of 24 female patients underwent endoscopic sentinel node biopsy and 24 female patients underwent the traditional method at the breast unit of Department of Surgery at Cairo University Hospitals. The following were evaluated during the study period: feasibility of technique, seroma formation, shoulder mobility, numbness, and pain at the postoperative site. Results In 24 patients undergoing the endoscopic technique using insufflation and minimal instrument dissection, the SLN at level I was inspected at its anatomical site and individual lymph nodes were easily identified. One patient developed lateral chest wall infection in the form of cellulitis (4%). The same patient experienced postoperative seroma. Intercostobrachial nerve affection was seen in 29% in the endoscopic method; however, it was 75% in the open method owing to nerve manipulation, not owing to direct injury. Conclusion Using endoscopy, we found that this technique allows (a) a minimally invasive working space, (b) recognition of anatomic landmarks, and (c) instrument manipulation within the axilla to identify and extract lymph nodes and apply the sentinel node technique. In almost every case, an excellent anatomical orientation was achieved. The retrieval rate for the sentinel node in endoscopic technique was 100% as found in the open technique. [ABSTRACT FROM AUTHOR]

Background Surgical management of the axilla in breast cancer has evolved greatly in the past 20 years. Sentinel lymph node biopsy (SLNB), which was first investigated in the early 1990s, has replaced routine axillary lymph node dissection with its associated greater morbidity in early-stage node-negative patients. However, the role and timing of SLNB, management of the axilla, and technical aspects of the procedure in patients treated with neoadjuvant chemotherapy (NACT) are matters of controversy. Although data on SLNB and NACT are accumulating, the accuracy of SLNB to stage the axilla and the value of SLNB in relation to long-term outcomes remain to be seen. Objectives To evaluate the use of 1% methylene blue (MB) as a single agent tracer for the detection of sentinel lymph node after NACT for locally advanced breast cancer with the calculation of the identification rate and false-negative rates (FNRs). Patients and methods A total of 31 patients with cT3-4(a-c) cN1-3, M0 breast cancer after NACT who showed downstaging of their nodal status to N0 were injected with 1% MB, retroareolarly or peritumorally, followed by axillary lymph node dissection, and the results were studied to detect the identification rate and FNR. Results The median age of the patients was 48 years, with 83.8% of the patients above the age of 40 years. The identification rate was found to be 83%, and a FNR of 11.5% was detected. FNRs were found to be less when more than three sentinel lymph nodes were dissected, with no statistically significant difference relating FNRs to the initial nodal state of the disease. Conclusion The use of 1% MB after NACT showed a comparable identification rate and FNRs to other single tracer techniques, yet all single tracer techniques are lesser than ideal in this group of patients. [ABSTRACT FROM AUTHOR]

Context: Sentinel lymph node (SLN) biopsy is the standard of care for breast cancer (BC) patient staging. The axillary node status can be evaluated by frozen section (FS) or imprint cytology (IC). Despite the major disadvantages of tissue loss and freezing artifact in FS, many pathologists consider SLN IC a more difficult task requiring special expertise and prefer FS to IC. Aims: To conduct a large cohort study to evaluate the results of intraoperative SLN IC, compare them with those of FS and permanent section (PS), and determine the best method for general pathologists. Settings and Design: A very large cohort study with many pathologists engaged was designed and the diagnostic results were compared. Materials and Methods: With 12 pathologists engaged, we conducted the largest patient cohort study of SLN IC to date, including 4,327 consecutive BC patients undergoing SLN biopsy during the past 15 years. The touch imprints were stained using three different methods and evaluated. The PS was used as the gold standard for evaluation. Statistical Analysis: The false positivity, false negativity, accuracy, sensitivity, and specificity of the IC and FS for each pathologist were evaluated and compared. Results: Our results showed an overall sensitivity of 82.7%, specificity of 99.3%, and an accuracy rate of 95.9% for SLN IC, which were comparable to those of FS. The accuracy rate did not correlate with the length of working experience and the staining method. Conclusions: Intraoperative hematoxylin and eosin (H&E)-stained IC preparation was found to be the best SLN examination method for general pathologists. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to determine the advantages of preoperative sentinel lymph node mapping (SLNM) by single photon emission computed tomography/computed tomography (SPECT / CT) in patients with early-stage cutaneous head-and-neck malignancies. Materials and Methods: We conduct a 7-year and 6 months retrospective, cross-sectional study. Patients with early-stage malignant head-and-neck skin tumors and cutaneous adnexa who underwent SLNM by SPECT/CT from March 2012 and December 2019, were included in the study. Results: We retrospectively analyzed 28 patients: Melanoma was the most frequent tumor (64.2%), followed by squamous cell carcinoma (25%). The anterior cheek was the most common functional subsite (25%). Twenty-seven patients (96.4%) had a successful SLN detection with SPECT/CT. Neck lymph node dissection was performed in 23 patients (82.1%). According to the pathological specimen, lymph nodes were found in all of them; hence, the efficacy of the SPECT/CT for SLNM was 100%. At 7-year follow-up, systemic recurrence was found in one patient (3.6%), another had locoregional recurrence (3.6%), and the mortality rate was 3.6%. Conclusions: In early-stage malignant head-and-neck skin tumors, there is a high concordance between SLN found by SPECT/CT and the histopathological results. Preoperative SPECT/CT accurately detects the SLN, assesses unexpected lymph nodes and their drainage pathways, and facilitates their location by reliably showing the relationships between sentinel nodes and important anatomic structures. This allows to perform a clear preoperative evaluation, an accurate staging for all patients and to avoid excessive dissections that could result in cosmetic and functional deformities. [ABSTRACT FROM AUTHOR]

Background: Indocyanine green (ICG) fluorescence with high-definition, three-dimensional imaging systems is emerging as the latest strategy to reduce trauma and improve surgical outcomes during oncosurgery. Materials and Methods: This is a prospective study involving 100 patients with carcinoma endometrium who underwent robotic-assisted Type 1 pan-hysterectomy, with ICG-directed sentinel lymph node (SLN) biopsy from November 2017 to December 2019. The aim was to assess the feasibility and diagnostic accuracy of SLN algorithm and to evaluate the location and distribution of SLN in pelvic, para-aortic and unusual areas and the role of frozen section. Results: The overall SLN detection rate was 98%. Bilateral detection was possible in 92% of the cases. Right side was detected in 98% of the cases and left side was visualised in 92% of the cases. Complete node dissection was done where SLN mapping failed. The most common location for SLN in our series was obturator on the right hemipelvis and internal iliac on the left hemipelvis. SLN in the para-aortic area was detected in 14% of cases. In six cases, SLN was found in atypical locations, that is pre-sacral area. Eight patients had SLN positivity for metastasis and underwent complete retroperitoneal lymphadenectomy. Comparison of final histopathological report with frozen section reports showed no false negatives. Conclusions: SLN mapping holds a great promise as a modern staging strategy for endometrial cancer. In our experience, cervical injection was an optimal method of mapping the pelvis. ICG showed a high overall detection rate, and bilateral mapping appears to be a feasible alternative to the more traditional methods of SLN mapping in patients with endometrial cancer. The ICG fluorescence imaging system is simple and safe and may become a standard in oncosurgery in view of its staging and anatomical imaging capabilities. This approach can reduce the morbidity, operative times and costs associated with complete lymphadenectomy while maintaining prognostic and predictive information. [ABSTRACT FROM AUTHOR]

Context: The sentinel lymph nodes (SLNs), as most other regions, are prone to tumoral invasion. In colorectal cancers, they can help the higher levels of pathological examination techniques. Aims: We attempted to investigate the efficiency of the use of radioactive tracer in identifying SLNs in colorectal cancers using the same pathological technique. Settings and Design: This cross‑sectional, single‑center study was carried out from 2014 to august 2016 at Mashhad University of Medical Sciences. Subjects and Methods: The study population included 100 patients with colorectal cancers. We used a radioactive tracer to detect SLNs and to compare the number and involvement of SLNs and non‑SLNs generally and in terms of the tumor site. For pathological study, we used the same conventional method in both the groups. Statistical Analysis Used: Statistical analysis was performed using SPSS 22.0 software (IBM Corp., Armonk, NY, USA) with Chi‑square and Fisher’s exact test, Student’s t‑test, ANOVA test, Mann–Whitney U‑test, and Kruskal–Wallis test. Results: SLNs were detected in 89 of 100 patients. All the remaining 11 patients had T4 lower rectal cancer and the injection was performed ex vivo. We noted ten cases of upstaging due to SLN mapping and nine cases of false negative. Thus, the sensitivity was found to be 43.75%at and the accuracy was 78.65%. Conclusions: We used the same traditional method in both the groups, and our sensitivity, accuracy and upstaging rate were fewer than similar studies. Our recommendation for further studies is to use intensive SLN biopsy method in both groups of SLNs and non‑SLNs. [ABSTRACT FROM AUTHOR]

Context: The sentinel lymph nodes (SLNs), as most other regions, are prone to tumoral invasion. In colorectal cancers, they can help the higher levels of pathological examination techniques.Aims: We attempted to investigate the efficiency of the use of radioactive tracer in identifying SLNs in colorectal cancers using the same pathological technique.Settings and Design: This cross-sectional, single-center study was carried out from 2014 to august 2016 at Mashhad University of Medical Sciences.Subjects and Methods: The study population included 100 patients with colorectal cancers. We used a radioactive tracer to detect SLNs and to compare the number and involvement of SLNs and non-SLNs generally and in terms of the tumor site. For pathological study, we used the same conventional method in both the groups.Statistical Analysis Used: Statistical analysis was performed using SPSS 22.0 software (IBM Corp., Armonk, NY, USA) with Chi-square and Fisher's exact test, Student's t-test, ANOVA test, Mann-Whitney U-test, and Kruskal-Wallis test.Results: SLNs were detected in 89 of 100 patients. All the remaining 11 patients had T4 lower rectal cancer and the injection was performed ex vivo. We noted ten cases of upstaging due to SLN mapping and nine cases of false negative. Thus, the sensitivity was found to be 43.75%at and the accuracy was 78.65%.Conclusions: We used the same traditional method in both the groups, and our sensitivity, accuracy and upstaging rate were fewer than similar studies. Our recommendation for further studies is to use intensive SLN biopsy method in both groups of SLNs and non-SLNs. [ABSTRACT FROM AUTHOR]

Background: Sentinel lymph node biopsy (SLNB) is accepted as the standard procedure to determine the axillary lymph node metastasis in breast cancer at early stage. However, in many cases with sentinel lymph node positivity, the axilla does not contain any tumor cells. As a result, the accuracy of SLNB to predict axillary lymph node metastasis must be evaluated. Patients and Methods: Thousand hundred and fourteen women operated for breast cancer were retrospectively examined. Breast cancer patients without axillary metastasis on clinical examination who had undergone SLNB were included in the study. Sentinel lymph node positivity and axillary lymph node positivity were compared. Results: Among 1114 women operated for breast cancer, 230 were clinically node negative preoperatively and undergone SLNB. Eighty-three (36%) of the patients were SLNB positive and undergone axillary dissection. Forty-three (51.8%) of them had tumor positive axillary lymph nodes and 40 (48.2%) of them had tumor negative axillary lymph nodes. Interpretation: In 48.2% of the patients, positive sentinel lymph node does not demonstrate a positive axilla. This finding supports sparing axillary dissection in patients with favorable prognostic factors even if the sentinel lymph node is found to be positive. Conclusion: Axillary lymph node dissection(ALND) may be spared even if there are macrometastatic sentinel lymph nodes in patients with favorable tumor types who will undergo breast-conserving surgery. [ABSTRACT FROM AUTHOR]

Background: Sentinel lymph node biopsy (SLNB) is accepted as the standard procedure to determine the axillary lymph node metastasis in breast cancer at early stage. However, in many cases with sentinel lymph node positivity, the axilla does not contain any tumor cells. As a result, the accuracy of SLNB to predict axillary lymph node metastasis must be evaluated.Patients and Methods: Thousand hundred and fourteen women operated for breast cancer were retrospectively examined. Breast cancer patients without axillary metastasis on clinical examination who had undergone SLNB were included in the study. Sentinel lymph node positivity and axillary lymph node positivity were compared.Results: Among 1114 women operated for breast cancer, 230 were clinically node negative preoperatively and undergone SLNB. Eighty-three (36%) of the patients were SLNB positive and undergone axillary dissection. Forty-three (51.8%) of them had tumor positive axillary lymph nodes and 40 (48.2%) of them had tumor negative axillary lymph nodes.Interpretation: In 48.2% of the patients, positive sentinel lymph node does not demonstrate a positive axilla. This finding supports sparing axillary dissection in patients with favorable prognostic factors even if the sentinel lymph node is found to be positive.Conclusion: Axillary lymph node dissection(ALND) may be spared even if there are macrometastatic sentinel lymph nodes in patients with favorable tumor types who will undergo breast-conserving surgery. [ABSTRACT FROM AUTHOR]

A histopathology report offers important prognostic and predictive information that helps plan systemic therapy in breast cancer. However, in many cases a pathologist fails to provide relevant information chiefly due to the lack of awareness of the impact of these parameters in clinical decision-making. This review seeks to put forth common practice points in grossing and reporting of specimens harboring breast cancer with focus on latest revisions in the same. Just as it is important to document tumor size, tumor type, margins, estrogen receptor/progesterone receptor, and human epidermal growth factor (ER/PR/HER2) in breast cancer, we need to also focus on sentinel node grossing, nodal burden, size of nodal metastasis, and extranodal extension. In parallel, increasing number of patients are getting neoadjuvant chemotherapy in breast cancer and points in grossing and reporting of such specimens are also alluded to. This article will serve as reference guide to pathologists on what we do and why we do the same. [ABSTRACT FROM AUTHOR]

Melanoma in children is a rare entity with an estimated incidence of one/million/year. Only 1.3% of melanomas reported in the United States of America affect individuals under the age of 20 years, and this neoplasm accounts for only 0.9% of all malignancies in children under the age of 15 years. Melanoma is particularly rare in prepubertal children before the age of 10 years. We present a case of a 9-year-old girl with a melanoma of the right foot. Her sentinel node biopsy was positive for isolated melanoma cells, and none of 5 additional lymph nodes removed following inguinal dissection were found to contain malignant melanoma cells. To our knowledge, this is the youngest melanoma patient recorded in the Greek population. The histological diagnosis of melanoma in this age group can be extremely difficult, and physicians ought to be cautious. The rarity of the disease results in small series of cases from which reliable figures are difficult to obtain. Unfortunately, this also applies to currently available treatments whose effectiveness is unclear. [ABSTRACT FROM AUTHOR]

Background: There is growing evidence that intranodal pressure (INP) can predict metastatic sentinel lymph nodes (SLNs). The objective of this study was to measure and utilize INP to evaluate the metastatic involvement of axillary SLNs in breast cancer patients. Materials and Methods: INP was measured in 73 clinically node-negative (cN0) breast cancer patients who were candidate for SLN biopsy. Clinical evaluation of the lymph node, coupled with frozen section analysis of the same excised SLN, was conducted. The level of suspicion (LOS) was used to assess the likelihood of metastases in the SLNs by the surgeons. Then, the miniature catheter tip pressure transducer was used to measure INP in the operation room. Finally, excised SLN was sent for permanent pathologic analysis as a gold standard for the evaluation of SLNs metastatic.Results: We identified the statistically significant increase in INP in nodes containing tumor metastasis in comparison with tumor-free SLNs (19.17 ± 13.63 vs. 8.82 ± 4.23) (P = 0.003). We considered the cutoff value for INP at 16 mmHg, which resulted in sensitivity of 80% and specificity of 87%. When the combination of INP above 16 mmHg and the LOS were taken into account for determining the likelihood of metastatic involvement of the LNs, the sensitivity and specificity were 87.5% and 91.7%, respectively. Conclusion: Our data suggest that INP measurement has the potential to help surgeons differentiate metastatic and nonmetastatic SLNs in combination with LOS. Meanwhile, it can be used along with frozen analysis to decrease false-negative rate. [ABSTRACT FROM AUTHOR]

Aim To determine the validity of sentinel lymph node (SLN) biopsy after neoadjuvant chemotherapy (NAC) in case of complete pathological response of axillary lymph node. Patients and methods This is a prospective study that included female patients with cancer breast who became clinically and radiologically node negative (cN0) after receiving NAC during the period of March 2016 to October 2018 in Alexandria Medical Research Institute, Alexandria, Egypt. Dual technique was used to identify the SLN followed by standard axillary lymph node dissection (ALND). Analysis of the pathological reports was used to determine the false-negative rate (FNR) of SLN. Results Of the 86 patients who completed the NAC and showed cN0, SLN could be identified in 76 (88.4%) patients. ALND was completed for the 76 patients, and SLNs showed false-negative results in nine (11.8%) patients. Patients in whom three or more (10.3%) SLNs could be identified showed better FNR compared with patients with two SLNs or less (16.7%). Conclusions SLN biopsy after NAC for patients with cN0 seems to be a reliable technique to replace ALND if certain precautions are applied. The use of a dual technique for SLN identification and determination of at least three SLNs to be the minimum number accepted is an essential requirement to be applied in this selective approach to ensure FNR within accepted range. In addition, patients should be counseled regarding benefits of the SLN biopsy technique and the possibility of failure to identify the SLN or being false negative. [ABSTRACT FROM AUTHOR]

Background Axillary lymph node status is the single most important prognostic factor in breast cancer. Sentinel lymph node biopsy (SLNB) can give an idea about the axillary nodal status, with a high rate of identification. Because the upper outer quadrant is the most common site for breast cancer, most studies of SLNB of the breast have been performed in patients with breast cancer mostly located in this quadrant of the breast, whereas the medial quadrants have much been less studied. In this study, we evaluate the axillary SLNB in medially located breast cancer only, using methylene blue injection technique, regarding identification rate, accuracy rate, and false negativity rate (FNR). Patients and methods The study included 42 female patients with medially located breast cancer and negative axilla, scheduled for modified radical mastectomy or conservative breast surgery. Overall, 4 milliliters of methylene blue 1% was injected in the peritumoral tissue. Sentinel lymph node(s) (SLN) and other axillary nodes were individually sent for pathological assessment. Results Average time taken from methylene blue injection until SLN(s) identification and dissection reached 45 min. SLN identification rate was 92.9% of the patients. The number of SLN removed per patient ranged from 1 to 3 nodes. The number of axillary lymph node removed during axillary lymph node dissection ranged from 10 to 22 nodes. Accuracy rate was 88.1%, and SLN FNR was 4.8%. Conclusion Axillary SLNB is highly valid in medially located breast cancer, with high identification and accuracy rates and low FNR. [ABSTRACT FROM AUTHOR]

Background: The present study aims to explore the role of sentinel lymph node biopsy (SLNB) with intraoperative frozen section in the management of early-staged oral tongue cancers. Materials and Methods: Fifty-two patients with clinical stages cT1/2N0 oral tongue cancers were included in the present study. The curative surgery was preceded by the performance of an SLNB using a dual technique. Results: The identification rate of sentinel lymph node (SLN) in this study was 98.07%. The sensitivity, specificity, positive predictive value (PPV), and the negative predictive value (NPV) of SLNB were 88.2%, 100%, 100%, and 94.5%, respectively. Further, the sensitivity, specificity, PPV, and the NPV of intraoperative frozen section of the SLN were 70.5%, 100%, 100%, and 87.5%, respectively. Conclusions: The addition of intraoperative frozen section could identify 70.5% of patients with occult metastasis. An intraoperative frozen section assessment of sentinel node has the potential to change the overall management of patients with early-oral tongue cancers. [ABSTRACT FROM AUTHOR]

Introduction: The recommended technique of sentinel lymph node biopsy (SLNB) in breast cancer is a combination of blue dye and radiotracer. In the Indian scenario, SLNB is still not routinely practiced due to lack of nuclear medicine facilities and unavailability of isosulfan blue or patent blue violet (PBV). This study was conducted for optimizing SLN identification techniques by comparing the identification rate using PBV and methylene blue (MB) in combination with radiotracer.Materials and Methods: Single-blinded two-arm parallel design randomized control trial was conducted at an apex teaching and research medical institute in India. Patients with axillary LN-negative breast cancer were included. Blue dye and radio tracer were injected preoperatively, and SLNB was performed using a combination technique. Frozen section was performed. Demographic, clinical, radiological, operative, and histopathological data were recorded. Descriptive statistics were used to represent patient characteristics. Baseline characteristics for entire cohort and between groups were compared using Student's t-test for quantitative variables and Chi-square test for qualitative variables.Results: A total of 119 patients were randomized for mapping with MB and 118 patients with PBV between 2011 and 2015. SLN was identified in 116 patients with MB and 115 with PBV. SLN identification proportions were 97.4% (MB) and 96.6% (PBV). In patients undergoing axillary lymph node dissection, concordance with SLNB was 98.5% and 96.61% in MB and PBV, respectively. False-negative proportion for MB was 2.56% and 7.69% for PBV, respectively. The cost of MB is about INR 15 per ~10-mL vial. The cost of PBV is approximately ~$91 per ampoule (equivalent to approximately INR 8190).Conclusion: SLNB using MB can be recommended as the technique of choice in low-resource settings. [ABSTRACT FROM AUTHOR]

Preoperative endoscopic tattooing is not only an easy and practical method to increase lymph node yield in rectal carcinoma following NACR but also acts as a guide to the surgeon in identifying the tumor bed. I Literature is the most agreeable way of ignoring life. i - I Fernando Pessoa, The Book of Disquiet i The Portuguese poet and philosopher clearly did not account for the contents of this year's medical literature, which has been awash with COVID-19-related studies reflecting the impact the pandemic has had on our lives. Lymph node number, surface area and lymph node ratio are important prognostic indicators in neoadjuvant chemoradiotherapy treated rectal cancer. [Extracted from the article]

Introduction: Evidence supporting the use of Sentinel node biopsy (SNB) for nodal staging of early oral squamous cell carcinomas (OSCC) appears to be very promising. Pre-operative lymphatic mapping using planar lymphoscinitigraphy (PL) with or without SPECT/CT in the SNB procedure is useful in sentinel node localization and for planning appropriate surgery. Recently, a large prospective multi-centric study evaluating SNB in cutaneous melanoma, breast and pelvic malignancies, demonstrated that adding SPECT to PL leads to surgical adjustments in a considerable number of patients. Our aim of this study was to evaluate the incremental value of additional SPECT/CT over PL alone in SNB for OSCC. Materials and Methods: This was a retrospective analysis of 44 patients (40- tongue, 4- buccal mucosa) with T1-T2, clinically N0 oral cavity SCC who underwent sentinel node biopsy procedure. PL and SPECT lymphoscinitigraphy images were compared for pre-operative mapping of sentinel nodes. Results: Using a handheld gamma probe, a total of 179 sentinel nodes were harvested, with a mean of 4.06 per patient. PL revealed 75 hotspots with a mean of 1.70 per patient, and SPECT/CT revealed 92 hotspots with a mean of 2.09 per patient. Additional hotpots were identified in 14 patients on SPECT/CT, which included 4 patients, where PL did not detect any sentinel nodes. Conclusion: Pre-operative SPECT/CT in addition to planar lympho-scinitigraphy in sentinel node biopsies of oral cavity SCC detects more number of sentinel nodes compared to planar imaging alone. The higher sensitivity of SPECT combined with better anatomical localization using diagnostic CT may further improve the precision of SNB procedure. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this meta-analysis was to evaluate the predictive value of cervical lymph node metastasis through sentinel lymph node biopsy (SLNB) in patients with oral cancer.Materials and Methods: Two authors independently searched the databases of PubMed, Cochrane central register of controlled trials, EMBASE, and CNKI to find the potential suitable diagnostic study related to SLNB. The diagnostic sensitivity, specificity, positive likely hood ratio (+LR), negative likely hood ratio (-LR), diagnostic odds ratio (DOR) were pooled by Meta-DiSc1.4 software. The publication bias was assessed by funnel plot and line regression test.Results: After electronic searching the related databases, we finally included twenty diagnostic studies. The pooled sensitivity, specificity, +LR, and DOR were 0.91 (95% confidence interval [CI]: 0.88-0.94), 1.00 (95% CI: 0.99-1.00), 35.52 (95% CI: 19.19-65.75), and 323.50 (95% CI: 148.27-705.83), respectively, with fixed-effect model. Moreover, the pooled -LR was 0.13 (95% CI: 0.07-0.23) by random-effect model. The area under the summary receiver operating characteristic curve of SLNB for cervical lymph node metastasis was 0.99.Conclusion: SLNB had very high sensitivity and specificity for productizing cervical lymph node metastasis in oral cancer patients. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to examine the role of sentinel lymph node biopsy (SLNB) on long-term disease outcome in patients with intermediate-thickness primary cutaneous melanomas.Materials and Methods: Forty patients with intermediate-thickness melanomas, defined as 1.0-4.0 mm, underwent SLNB between 1998 and 2011. The disease-free survival (DFS), overall survival (OS) and prognostic factors were analyzed.Results: Median age was 53 years (range: 24-74 years). Median Breslow thickness was 2.8 mm (range: 1.0-4.0 mm) and 27.5% were ulcerated melanomas. Median follow-up time was 70 months (range: 23-168 months). The number of patients with sentinel lymph node (SLN)-positive was 9 (22.5%) and completion lymph node dissection was performed in all of these patients. Ten patients (25%) developed distant and locoregional recurrence; 4 in the SLN-positive group (4/9; 45%) and 6 in the SLN-negative group (6/31; 19%), P < 0.042. In the SLN-negative group, one patient developed regional node recurrence; false-negative rate was 10%. SLN positivity and ulceration were independent prognostic factors for DFS in multivariate analysis (hazard ratio [HR] of 4.6, and 10.5, respectively; P < 0.011). For OS SLN positivity, ulceration and Breslow thickness were found to be the significant prognostic factors (HR of 5.4, 8.5 and 5.0, respectively; P < 0.024). Ten-year DFS and OS for SLN-negative and SLN-positive patients were 71%, 47% (P < 0.003), and 80%, 55% (P < 0.005), respectively.Conclusion: This study shows that survival rates are worse in the SLN-positive patients according to the long-term follow-up data. Ulceration and Breslow thickness also have significant effects on long-term survival in patients with intermediate-thickness primary cutaneous melanomas. [ABSTRACT FROM AUTHOR]

Objective: In the surgery of breast cancer, axillary reverse mapping (ARM) is the identification and preservation of arm draining lymph node (ARM node) during an axillary dissection. The assumption is that the ARM node is different from node draining breast and is unlikely to be involved even in the patients with axillary nodal metastases. If we can identify and preserve ARM node using lymphoscintigraphy; morbidity of lymphedema, as seen with axillary dissection, may be avoided. Materials and Methods: Pathologically proven 50 breast cancer patients undergoing initial surgery (cTx-4, cN0-2, and Mx-0) were included in this study. Less than 37 MBq, 0.5 ml in equally divided doses of filtered 99mTc sulfur colloid was injected intradermally into the second and third web spaces. ARM nodes in the axilla were identified with the help of Gamma Probe intraoperatively; however, their location was noted with the reference to specific anatomical landmarks and sent for histopathological examination after excision. Results: The ARM node was successfully identified in 47/50 cases (sensitivity - 94%). In 40 out of 47 cases (85%), the location of the ARM node was found to lateral to the subscapular pedicle, above the second intercostobrachial nerve and just below the axillary vein. Of the 47 patients in whom ARM node/s were identified, metastasis was noted in 5 of them (10%). Four out of these 5 patients had the pN3 disease. Conclusion: ARM node exists, and it is feasible to identify ARM node using radio isotope technique with an excellent sensitivity. ARM node seems to have a fairly constant location in more than 80% cases. It is involved with metastasis (10% cases) only when there are multiple lymph nodal metastases in the axilla. [ABSTRACT FROM AUTHOR]

Sentinel lymph node is the first regional lymph node that drains the lymph from the primary tumor. It is potentially the first node to receive the seeding of lymph-borne metastatic cells. This study aimed to discuss lymphoscintigraphy procedural guidelines for detection of sentinel node using 99mTc-Phytate in Isfahan, Iran. Moreover, the preliminary results of the first year's clinical experience of lymphoscintigraphy in Isfahan, Iran are also presented. A total of 36 consecutive sentinel node procedures were performed following our protocol in March 2013 to March 2014. For all 36 patients, after intradermal injection of 0.5-1 mCi of 99mTc-Phytate, 5, 30 and 120 min with hands up lymphoscintigraphy was performed. All procedures were performed in a 1-day setting with 99mTc-Phytate injection in intradermal volume of about 0.1 cc. At 5, 30 and 120 min after injection, anterior and lateral images (4 min), were acquired using gamma-camera (energy 140 keV, window 15-20% and LEHR collimator). For all patients, at least one axillary sentinel lymph node was detected. For three patients, 2 SNs were seen. The images 5 min after injection showed at least one axillary sentinel node in 18 of 36 patients. However for the remaining patients, more delayed images (after 30 and 120 min) were needed. Although, no changes were seen in 120 min images compared to 30 min images. Considering the used protocol, from the evaluated data it can be concluded that lymphoscintigraphy after 30 min periareolar injection of about 0.5-1 mCi 99mTc-Phytate in an intradermal volume of about 0.1 cc yields an axillary sentinel node in all the patients. Imaging 120 min after injection is of no additional value and can be omitted. [ABSTRACT FROM AUTHOR]

Objective: This study aims to explore the application value of sentinel lymph node (SLN) biopsy in patients with Stage II advanced gastric cancer and its effects on prognosis.Materials and Methods: A total of 43 patients with Stage II gastric cancer (experimental group) admitted to our department from March 2011 to February 2013 underwent radical operation using SLN biopsy, and 51 patients with gastric cancer D2 (the control group) received conventional radical operation. The operation time, intraoperative blood loss, number of lymph nodes dissected, postoperative complications, and length of hospital stay between the two groups of patients were recorded. Their clinical data were retrospectively analyzed.Results: The operation times of the experimental group and that of the control group patients were, respectively, 199.6 ± 38.7 and 143.8 ± 33.6 min, with statistical difference (P < 0.05). The number of lymph nodes dissected in the experimental group (18.2 ± 0.8) was significantly greater than that of the control group (13.8 ± 0.7) (P < 0.05). No difference in statistical significance in the intraoperative blood loss (150.2 ± 33.6 vs. 143.8 ± 39.4 mL) or length of stay (12.3 ± 2.6 vs. 11.8 ± 3.1 days) was found between the two groups (P > 0.05). The 2-year survival rates of the experimental group after surgery and that of the control group were 83.7% and 72.5%, respectively, with statistical difference (P < 0.05).Conclusions: Compared with conventional radical gastrectomy, Stage II SLN biopsy on the premise that neither the intraoperative blood loss nor the length of hospital stay increases can improve the 2-year survival. [ABSTRACT FROM AUTHOR]

Purpose: Role of (18 [F] fluorine-18-labeled 2-fluoro-2-deoxy-D-glucose [FDG] positron emission tomography-computed tomography [PET-CT]) in the evaluation of axillary lymph node involvement in T1T2N0 breast cancer and compare results with sentinel lymph node biopsy (SLNB). Methods: A total of 37 patients of proven T1T2N0 breast cancer were included in the study. Patients with past history of breast surgery, T3T4 disease, uncontrolled diabetes mellitus and pregnant patients were excluded from the study. Pre-operative FDG PET-CT was performed followed by sentinel lymph node (SLN) biopsy with blue dye or combined technique. Results: SLN was identified in 32 of 37 patients with an identification rate of 86.48% (32/37). With combined technique SLN identification rate was 100% (6/6) while with blue dye alone; it was 83.8% (26/31). Among 37 patients, 16 had axillary metastases of which 12 had macrometastases and four had micrometastases detected by immunohistochemistry (IHC). Of 12 patients with axillary macrometastases, skip metastases were present in two patients in whom SLN was negative and in two patients SLN was not identified, but axillary dissection showed metastases. PET-CT had shown sensitivity, specificity, negative predictive value and positive predictive value of 56%, 90%, 73%, and 81.8%, respectively. IHC of SLN detected four patients with micrometastases upstaging the disease by 11% (4/37). Conclusion: Because FDG PET-CT has a high specificity in the evaluation of axillary lymph node involvement in T1T2N0 breast cancer patients according to the results of this study if FDG PET-CT is positive in axillary lymph nodes, axillary lymph node dissection may be considered instead of SLNB. [ABSTRACT FROM AUTHOR]

Abstract: Pigmented epithelioid melanocytoma (PEM), or animal-type melanoma, is an unusual variant of melanoma which has been reported to have indolent behavior and a relatively good prognosis. We report a 12-year-old girl with PEM on the third finger web of her right hand. Histopathologically, it was composed of heavily pigmented dermal epithelioid and spindled melanocytic tumor cells. A sentinel lymph node biopsy was negative, and no recurrence was noted 1 year later. We reviewed 173 previously published cases of PEM or so-called animal-type melanoma in the literature. Among the 173 cases and our case, extremities were the most common sites of occurrence (52/129, 40.3%), and most of the depth of invasions were Clark level IV and V [76/114 (66.7%) and 33/114 (28.9%), respectively]. Lymph nodes metastasis was noted in 39/89 (43.8%) of the cases being investigated. Only two cases died of the disease with visceral metastasis. Thus, a more advanced level of invasion and the presence of lymph node metastasis did not imply a definitely malignant clinical course, because spreading beyond lymph nodes was rare (5/174, 2.9%). However, long-term follow-up with more cases and further research are needed to fully delineate the true biological nature of this pigmented melanocytic tumor. [Copyright &y& Elsevier]

Sentinel lymph nodes (SLNs) are the nodes in direct communication with the primary tumor and are therefore the first group of nodes to be involved in lymphatic metastasis. Though the role of SLN biopsy is well established in cancers of the breast and melanoma, its role in gastrointestinal malignancies is still evolving and controversial. In this paper, the literature is reviewed with respect to the status of SLN biopsy in gastrointestinal malignancies. [ABSTRACT FROM AUTHOR]

Background/Aim: Precise evaluation of lymph node status is one of the most important factors in determining clinical outcome in treating gastro-intestinal (GI) cancer. Sentinel lymph node (SLN) mapping clearly has become highly feasible and accurate in staging GI cancer. This study aims to investigate the feasibility and accuracy of detection of SLN using methylene blue dye in patients with carcinoma of the esophagus and assess its potential role in determining the rational extent of lymphadenectomy in esophageal cancer surgery. Materials and Methods: Thirty-two patients of esophageal cancer diagnosed on endoscopic biopsy were enrolled in this prospective study. After laparotomy, patent methylene blue was injected into the subserosal layer adjacent to the tumor. SLNs were defined as blue stained nodes within a period of 5 min. Standard radical esophagogastrectomy with lymphadenectomy was performed in all the patients. All the resected nodes were examined postoperatively by routine hematoxylin and eosin stain for elucidating the presence of metastasis, and the negative SLNs were examined further with cytokeratin immunohistochemical staining. Results: SLNs were detected in 26 (81.25%) patients out of 32 patients who were studied. The number of SLNs ranged from 1 to 4 with a mean value of 1.7 per case. The SLNs of esophageal cancer were only found in N1 area in 21 (80.77%) cases, and in N2 or N3 area in only 19.33%. The overall accuracy of the procedure was 75% in predicting nodal metastasis. SLN had a sensitivity of 85.71% in mid esophageal tumors and 93.33% in lower esophageal tumors. The SLN biopsy had sensitivity of 87.5% in the case of squamous cell carcinoma and 92.86% in the cases of adenocarcinoma of the esophagus. The accuracy of the procedure for squamous cell carcinoma and adenocarcinoma was 60% and 76.47%, respectively. Conclusion: SLN mapping is an accurate diagnostic procedure for detecting lymph node metastasis in patients with esophageal cancer and may indicate rational extent of lymphadenectomy in these patients. SLN mapping provides "right nodes" to the pathologists for detailed analysis and appropriate staging, thereby helping in individualizing the multi-modal treatment for esophageal cancer. [ABSTRACT FROM AUTHOR]

Purpose: Penile carcinoma is a common disease in India. This paper shows the results of sentinel node biopsy using methylene blue and discusses the incidence of false-negative rates. Materials and Methods: From September 2005 to March 2008, 22 newly diagnosed penile carcinoma patients (T1, T2, N0) were included in this prospective study. Intraoperative lymphatic mapping was done using methylene blue dye and the sentinel node was identified and removed. Lymphadenectomy was performed for positive inguinal lymph node metastasis. Results: There were 22 patients (mean age 52.7). The tumors were mostly located in the glans (73%). Eighty six percent was T1 lesions and 14% was T2. Ninety one percent of the patients underwent partial penectomy, and 9% underwent total penectomy. Sentinel node was identified in 20 patients (90.9%). In total, 49 sentinel nodes were identified (2.45 nodes per person). Only one patient had a positive pathological lymph node metastasis at the time of the surgery. Additionally, two patients became inguinal lymph node positive at the follow-up. This data yielded a sensitivity rate of 33% and a false-negative rate of 66%. There were no complications due to methylene blue. Conclusion: Sentinel node biopsy using only methylene blue for penile carcinoma has a very low sensitivity and a high false-negative rate. However, methylene blue can be used as a substitute for lymphazurin. [ABSTRACT FROM AUTHOR]

Lymphatic drainage outside the ipsilateral axilla in breast cancer is discovered in as many as 25% of all sentinel lymph node procedures and it is evidenced by lymphoscintigraphy. Contralateral axillary drainage is a rare clinical situation, mostly if there is not prior breast surgery, but this situation is extremely exceptional if we also found internal mammary chain drainage. We have not found such a case published in literature. This atypical finding is source of doubts because it could have clinical implications in the management of patients. We present a woman just diagnosed of breast carcinoma with hot nodes in bilateral axillary and ipsilateral internal mammary chain lymph nodes, shown by preoperative lymphoscintigraphy. We review published cases with contralateral axillary drainage, which enhance the role of scintigraphic procedure in such cases and show induced controversies in selecting the most adequate managemet [ABSTRACT FROM AUTHOR]

Background: 70% cases of early breast cancer cases (cT1, T2 N0) harbor no axillary lymph node metastases. Axillary lymph node dissection is associated with complications like lymphedema in 15-25% cases, intercostobrachial numbness in 78% cases, shoulder dysmotility in 17% cases, paresthesia, prolonged lymphorrhea, seroma formation and prolonged hospital stay. Sentinel node biopsy is an acceptable modality for axillary lymph node staging in early breast cancers as an alternative to axillary lymph node dissection and also avoids the morbidity of axillary node dissection. Method: 214 patients of early breast cancer cases (cT1, T2 N0) underwent sentinel node biopsy between Jan 2007 and July 2017 using combined radioisotope and blue dye technique. 0.2ml (0.2 mCi) of 99Tc-Sulphur colloid is injected peri -tumorally/ intradermally (total of 1ml), two hours prior to surgery. Radioscintigraphy is performed to map the sentinel node location and patient is shifted to the operating room. 1ml Methylene Blue dye is injected peri- tumorally/ retroareolar (total of 4 ml), 20 mins prior to surgery. In case of breast conservation surgery, 2.5- 3.5 cm transverse axillary skin crease incision is made over the index radioactive node. If mastectomy is planned, axilla is exposed after raising the superior skin flap. Deep blue stained node identified peroperatively and its radioactivity checked using hand held gamma camera. The sentinel node must have a significant high radioactivity compared to the background (at least 10:1). Entinel node is harvested and sent for frozen section. Axilla is checked for any palpable suspicious nodes or residual radioactivity. Frozen section analysis and multiple serial sections (12 to 15) are taken on the sentinel nodes. If sentinel node is found to harbor metastases, complete axillary dissection is performed. If no metastases are found in the sentinel node, no further axillary surgery is performed. Results: 214 patients of early breast cancer cases (cT1, T2 N0) underwent sentinel node biopsy between Jan 2007 and July 2017 using combined radioisotope and blue dye technique. 17% cases had T1 tumors and 83% cases had T2 tumors. 135 cases had Right sided and 79 cases had left sided breast cancers. Sentinel lymph node was identified in all (100%) cases. On an average, 1-2 sentinel nodes identified, mean size of positive sentinel node was 7mm. Sentinel node was the only positive node in 54 cases (69%). Gamma probe and methylene blue combined identified the sentinel node in 87% cases, gamma probe alone in 8.7% cases and methylene blue alone in 4.3% cases. The sensitivity, specificity, positive predictive value, overall accuracy and false negative rate were 95.8%, 100%, 100%, 98.7% and 4% respectively Conclusion: SLNB allows better staging of axillary nodes in early stage breast cancers. It also avoids morbidity of axillary node dissection. It can detect micro metastases. [ABSTRACT FROM AUTHOR]

Background: Oral cavity squamous cell carcinoma is one of the most common cancers in south Asia. Sentinel lymph node biopsy has a good accuracy using combination of lymphoscintigraphy and blue dye technique in oral cancer; however, the limited availability of lymphoscintigraphy facilities in many developing countries requires exploration of alternative techniques. The need for the present study was to evaluate the feasibility and role of sentinel lymph node biopsy in identifying the occult lymph node metastasis using methylene blue dye alone. Material and methods: We conducted a prospective study in 94 patients with early oral cancer (cT1, T2 and cN0) in a high volume tertiary care cancer centre in North India from 2013 to 2016. Patients having negative neck nodes on clinical examination and ultrasound were included in study. Intra operatively, one ml of methylene blue dye was injected at the interface of tumor and palpable normal tissue in four quadrants. After 10-15 minutes incision in neck was given and any visualized blue nodes were dissected and sent for frozen section, routine histopathology and immunohistochemistry (IHC) for cytokeratin. Elective neck dissection was done in all patients as per institutional protocol. Results: A total of 94 patients (79.8% male and 20.2% female) with mean age of 46.23 years (range 20-77 years) were included in this study. Smokeless tobacco was the commonest risk factor. Tumor sub sites were tongue (45.7%), buccal mucosa (38.3%), and lip (16%). Identification rate of sentinel lymph node was 93.61% with mean blue node (1.83±1.03). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy for frozen section and histopathology were 84.6%, 100%, 100%, 93.9% and 95.5% respectively. IHC detected two micrometastases and one isolated tumor cells. Occult lymph node metastasis was seen in 27.6% cases. The lymph node distribution was as level IA (5.7%), IB (48.6%), IIA (37.1%), and III (8.6%). None of the patient had lymph metastasis to level IV or V. Majority of the patients (57.4%) had pathological T2 disease. We did not encountered anaphylactic or allergic reactions to methylene blue dye in our study. Surgical procedures performed were as wide local excision only (84%), WLE with or without marginal or segmental mandibulectomy (14.9%), SOND (42.6%), ESOND (45.7%), MND (11.7%), and bilateral neck dissection (7.4%), reconstruction with local flaps (34%). Pathological TNM stage was as T1 (46.8%), T2 (53.18%), N1 (23.4%) and N2 (5.31%). Conclusion: Thus we conclude that SLNB with blue dye alone in early oral cancer is feasible. It can be used successfully with good sensitivity and negative predictive value in limited resource countries like India. Immunohistochemistry contributes to SLNB increasing sensitivity and negative predictive value to improve diagnostic value. [ABSTRACT FROM AUTHOR]

BACKGROUND Lymph node involvement is the most important prognostic factor in the treatment of endometrial cancer.Comprehensive lymphadenectomy {pelvic and paraortic lymphadenectomy)(CND)} as a part of staging surgery is debatable.It may cause severe surgical complications affecting the quality of life while on the other hand;it allows for accurate disease staging and decides adjuvant therapy with debatable therapeutic benefit.The risk of pelvic nodal metastasis in early stage I cancer is only 3 to 6%. Sentinel lymph node biopsy (SLNB) might be a possible middle ground between CND versus no nodal evaluation for these patients.In this study, we intend to find out the feasibility of SLNB in early stage endometrial carcinoma. METHODS: This is a prospective observational study in proven endometrial carcinoma patients (n=32) diagnosed in our hospital. All patients received cervical injection of methylene blue (2ml) and radiotracer dye (Tc-99 nano colloidal albumin dye) (1ml) at 3 o' clock and 9 o'clock position in ectocervix along with subserosal injection of 1.5ml radiotracer and 2ml methylene blue in 3 locations in fundus. SLN were identified by direct visualisation and gamma probe and labelled. CND (upto origin of IMA) was done in patients. Dye related adverse events were monitored. RESULTS In 32 patients study, the median age was 58 years (25-72) and mean BMI was 27 kg/ m2.The median SLN count was 5 (0-12) and median lymph node count was 31 (10-56). Overall and bilateral detection rate was 96.8 % (31/32) and 78% (25/32) respectively. No SLN identified in one patient (3%). On pathology, 25 patients were node negative (78%) and 6 patients had node positive disease (19%).These 6 patients had atleast one positive sentinel node. Sensitivity and Negative Predictive Value were 100% and 100%. Para-aortic SLN were detected in 14 patients (44%), none of the patients had isolated positive paraaortic lymph nodes.There was no allergic reaction to the dyes used in our study. CONCLUSION SLNB appears to be a feasible tool to decide about CND in low risk endometrial carcinoma with a high overall detection rate (96.8%), sensitivity of 100% and false negative rate of zero. Use of dual dye method is associated with high detection rate rather than alone. CONFLICT OF INTEREST None of the authors has any financial and personal relationships with other people or organizations to disclose that could inappropriately influence their work. This includes employment relationships, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/ registrations, and grants or other funding. Ethical Clearance link https://drive.google.com/file/d/0Bx167xmRfdwxdHJkMjZYTzF6bXc/ view?usp=sharing. [ABSTRACT FROM AUTHOR]

Aims and Objectives: Currently the triple technique (including preoperative SLN imaging using SPECT CT after radioactive colloid injection; intraoperative injection of blue dye; and intraoperative usage of hand held gamma probe) has been demonstrated to be most accurate for the identification of Sentinel lymph node (SLN). However the availability of nuclear medicine department for SLN imaging is one of the major barriers in the diffusion of SLNB technology. The purpose of this study was to investigate whether the SLN detection rate using the intraoperative dual mapping (radioactive colloid + methylene blue dye) technique is comparable to the triple technique in a prospective trial. Methods: This prospective trial was started in the department of breast and gynecology oncology in collaboration with department of nuclear medicine at Amrita Institute of Medical Sciences, Kochi, Kerala in May 2017. Intraoperative dual SLN mapping technique consisted of subareolar injection of technetium 99m- labelled filtered sulphur colloid (15-37 MBq) and 3ml of 1% isosulphan blue dye just after anaesthetic induction followed by locating and dissecting the SLN using hand held gamma probe and blue dye. Triple technique consisted of subareolar injection of radioactive colloid followed by SPECT CT preoperatively; subareolar injection of blue dye intraoperatively; locating and dissection of SLN using gamma probe and blue dye. SLN biopsies (SLNBs) or complete axillary dissections were carried out, and SLNs identified during these procedures were classified as containing both blue dye and radioactivity ("blue-hot" nodes), radioactivity alone ("hot-only" nodes), or blue dye alone ("blue-only" nodes). Cases were categorized and tabulated based on the presence or absence of these three types of SLNs. Endpoint measured was the overall SLN detection rates and were compared between the two techniques. Results: Out of total 375 SLNBs done, 203 were done using triple technique and 41 using dual technique. SLN detection rates with intraoperative dual mapping technique was 100%, while that of triple technique of SLN identification was 97.6% (p = 0.216). We looked into the SLN detection rate of the individual procedures of the two techniques (triple versus dual technique): SLN detection rate of preoperative imaging using SPECT CT after radioactive dye injection was 100% in triple technique (procedure not performed in dual technique); SLN detection rate of intraoperative injection of blue dye ("blue" node) was 76% in both the techniques; SLN detection rate of "hot" nodes with the gamma probe was 94.5% in triple and 99% in dual technique; and the SLN detection rate of "hot and blue" nodes was 96.7% in triple and 100% in dual technique. Using either technique the SLN location was in axilla in 100% of cases. In 100% cases the surgical approach for SLN biopsy remained same. Conclusion: SLN detection rate of intraoperative dual technique was equivalent to the SLN detection rate of triple technique. Thereby in low resource settings where SPECT CT imaging is not possible in vicinity, the sentinel lymph node biopsy can still be performed by procuring the radioactive colloid (from outside centre) and blue dye and the hand held gamma probe. [ABSTRACT FROM AUTHOR]

Background: FDG PET/CT has high sensitivity but compromised specificity for identifying axillary nodal metastasis in breast cancer. FDG PET/CT may help to identify patients with high axillary lymph node burden who could then move directly to axillary lymph node dissection and would not require the additional step of SLNB. Methods: seventy five consecutive patients with operable Carcinoma breast were evaluated by FDG PET/CT for radioactive uptake in axillary lymph nodes. In all these patient's axillary nodes were not palpable clinically before surgery. Sentinel node biopsy procedure was done using methylene blue technique and sentinel node isolated. PETCT had a sensitivity of 83.3% (95% CI- 61.8 to 91.5%) and specificity of only 11.7% . This is because majority of the sentinel nodes were subcentimeter and hence specificity was too low.60% of PET CT negative on sentinel node were negative on histopathology, but 40% were positive on histopathology .69.2% positive on PETCT were negative on histopathology as these were subcentimetric nodes with only 30.8% positive on histopathology. Conclusion: Though FDG PET/CT is good for overall staging of the breast cancer, it cannot replace sentinel lymph node biopsy to rule out axillary lymph node involvement due to poor specificity. [ABSTRACT FROM AUTHOR]

Background: Sentinel node biopsy on frozen section helps reduce unnecessary axillary dissection. Frozen section specimens for validation of sentinel node positivity is important to make decisions intra-operatively on axillary dissection. Methods: One hundred and forty two consecutive patients with operable Carcinoma breast were evaluated for sentinel node biopsy using frozen section while undergoing primary surgery as a treatment. In all these patient's axillary nodes were not palpable clinically before surgery. Sentinel node biopsy procedure was done using methylene blue technique and sentinel node isolated. Frozen section had a sensitivity of 91.6% with histopathology (95% CI-76.4 to 97.8%) and specificity of 98% (95% CI- 92.6 to 99.8%). 97.2% negative on frozen was negative on histopathology and 94.3% positive on frozen section was positive on histopathology. Only 5.7% positive on frozen was negative on histopathology. This was significant with chi square = 115.2, p<0.001 Conclusion: Frozen section is a good technique with good sensitivity to detect sentinel node. [ABSTRACT FROM AUTHOR]

Lymphovascular space invasion is one of the important prognostic factors for endometrial cancer. Therefore, determination of lymph node status becomes very important in deciding the management and adjuvant therapy for endometrial cancer. Majority of endometrial cancers are type I and present at an early stage. Hence these women may not require a complete lymphadenectomy for the purpose of staging. Complete lymphadenectomy is also associated with increased operating time and postoperative morbidities. Sentinel node biopsy is considered to be a bridge between no lymph node assessment and a complete lymph node dissection. Hence the focus of research is now on assessing the most reliable and efficacious method of assessing sentinel lymph nodes in endometrial cancer. However, there is a complete dearth of research from India in this area. The need of the hour is to standardize the technique and protocols for SLN mapping in endometrial cancer. Hence, we decided to do this study on the feasibility of sentinel lymph node biopsy in endometrial cancer using cervical injection of Technetium 99m nanocolloid. OBJECTIVES: To study the feasibility of sentinel node biopsy in early stage endometrial cancer and to analyse the detection rate of sentinel lymph node (SLN) using preoperative cervical injection of Tc99m nanocolloid. METHODS: 20 patients with preoperative histological diagnosis of endometrial cancer without any extra-uterine involvement on imaging were included in the study from January 2016 to June 2017. Sentinel node mapping was done by cervical injection of Tc 99m nanocolloid on the evening before surgery. Scintigraphic images were taken using gamma camera. Intraoperatively, nodes showing radioactivity were detected using hand-held gamma probe, dissected out separately and labelled as sentinel lymph nodes. Detection rate was calculated and analysed with respect to various parameters. RESULTS: Sentinel lymph node biopsy is feasible in endometrial cancer using cervical injection of Tc99m nanocolloid. SLN detection was possible in 18(90%) out of 20 patients. Bilateral detection was feasible in 11 patients (61.1%) with detection in left and right hemipelvis being 83% and 77.7% respectively. Detection rate of SLN was 88.88% in endometrioid adenocarcinoma. Sentinel node was detected in both the patients with non-endometrioid histology. CONCLUSION: SLNB using cervical injection of Tc99m nanocolloid is feasible in endometrial cancer. It is a safe and easily reproducible technique with good detection rates and high sensitivity. Stage of the tumour, grade and myometrial invasion do not seem to have an influence on sentinel node detection. Cervical involvement, enlarged lymph nodes and obstructed lymphatics can affect sentinel node mapping adversely. [ABSTRACT FROM AUTHOR]

Sentinel lymph node biopsy (SLNB) in clinically node negative breast cancer patients is now a well established treatment modality. We are presenting our experience in SLNB from a tertiary cancer centre from north India. We performed SLNB in 90 clinically node negative breast cancer patients in last one year, using both Tc99 labelled radiocolloid and methylene blue technique. Our SLNB identification rate was 95.5% (86/90) by dual tracer technique. Sentinel lymph node was found to be positive in 22.1% by frozen section (FS) analysis (19/86). Accuracy of frozen section (FS) analysis was 95% (19/20) as after routine histopathological examination SLN were found to be positive in 20 cases. False negative rate of FS was 5%, as in 1 case where SLNB was negative but final histopathological examination showed nodal metastasis. Sensitivity and specificity of SLNB was 95.24% and 100% respectively. Our initial experience with the dual tracer SLNB is encouraging and consistent with the available literature. [ABSTRACT FROM AUTHOR]

Background- Intraoperative assessment of sentinel lymph nodes for patients undergoing surgery for early breast cancer has the potential to reduce the need for delayed axillary lymph node dissection(ALND), significantly reducing patient morbidity, expediting adjuvant therapy, reducing length of hospital stay and cost of hospitalisation. Our study aims to determine the sensitivity of intraoperative frozen section in identifying cancerous involvement of sentinel lymph nodes in early breast cancer. Materials and methods- the frozen section and final histopathology reports of 104 consecutive patients undergoing surgery for early breast cancer with sentinel lymph node biopsy between May 2016 and June 2017 were assessed and sensitivity and negative predictive value were analysed. Results- intraoperative frozen section has a sensitivity and specificity of 89.74%(75.78% to 97.13%, p?0.05) and 100% respectively with a negative predictive value of 94.12% (86.34% to 97.59, p?0.05) in identifying metastasis to sentinel node. The sensitivity of frozen section is lowered by its inability to accurately pick up micrometastasis. However, frozen section is highly accurate in picking up macrometastasis with a sensitivity of 100%. Conclusionintraoperative frozen section, when performed as per CAP guidelines, can identify macrometastasis to sentinel lymph nodes with a very high sensitivity in early breast cancer. Its routine use in early breast cancer can reduce the need for second procedure, in the form of delayed ALND. [ABSTRACT FROM AUTHOR]