Background The purpose of this study was to investigate the feasibility of avoiding axillary lymph node dissection （ALND） for patients with only one sentinel lymph node （SLN） metastasis. The characteristics and pr...Background The purpose of this study was to investigate the feasibility of avoiding axillary lymph node dissection （ALND） for patients with only one sentinel lymph node （SLN） metastasis. The characteristics and predictive factors for non-sentinel lymph node （NSLN） metastasis of patients with single positive SLN were also analyzed. Methods Patients with no and only one SLN metastasis （OIn and 1In group, n ≥2） were selected from 1228 cases of invasive breast carcinoma, who underwent axillary dissection in Shandong Cancer Hospital between November 1999 and December 2011, to compare the characteristics of NSLN metastasis between them. For the 1In group, the factors that influenced the NSLN metastasis were analyzed by univariate and multivariate analysis. Results Differences of the NSLN metastasis between the OIn and the 1In groups were significant （P 〈0.001）. There was no significant difference between the axillary lymph node metastasis on level III in 1In group and OIn group （P=0.570）. When the total SLN number was 〉4 and with one positive case, the NSLN metastasis was not significantly different from that in the OIn group （P=-0.118）. In the 1In group, clinical tumor size （P = 0.012）, over-expression of Her-2 （P=0.003）, tumor grade （P=0.018） and the total number of SLN （P=0.047） significantly correlated with non-SLN metastasis. Clinical tumor size （P=0.015） and the expression of Her-2 （P=0.01） were independent predictive factors for non-SLN metastasis by the Logistic regression model. Conclusion Under certain conditions, breast cancer patients with single SLN metastasis could avoid ALND.展开更多
Objective:This randomized study aimed to compare the clinical efficacy between the novel dual tracer composed of indocyanine green(ICG)and blue dye(BD)and the conventional dual tracer composed of radioisotope and BD f...Objective:This randomized study aimed to compare the clinical efficacy between the novel dual tracer composed of indocyanine green(ICG)and blue dye(BD)and the conventional dual tracer composed of radioisotope and BD for sentinel lymph node(SLN)mapping in patients with breast cancer.Methods:This study enrolled 471 clinically lymph node-negative patients with primary breast cancer.All patients underwent mastectomy,and those undergoing sentinel lymph node biopsy(SLNB)were randomized to receive blue dye plus radioisotope(RB group)or BD plus ICG(IB group).The detection performances on SLN identification rate,positive SLN counts,detection sensitivity,and false-negative rate were compared between the two groups.Results:In the IB group,97%(194/200)of the patients who underwent the ICG and BD dual tracer injection showed fluorescentpositive lymphatic vessels within 2–5 min.The identification rate of SLNs was comparable between the IB group(99.0%,198/200)and the RB group(99.6%,270/271)(P=0.79).No significant differences were observed in the identification rate of metastatic SLNs(22.5%vs.22.9%,P>0.05,RB group vs.IB group,the same below),positive SLN counts(3.72±2.28 vs.3.91±2.13,P>0.05),positive metastatic SLN counts(0.38±0.84 vs.0.34±0.78,P>0.05),SLNB detection sensitivity(94.4%vs.92.5%,P>0.05),or false-negative rate(5.6%vs.7.5%,P>0.05)between the two groups.Conclusions:ICG can be used as a promising alternative tracer for radioisotope in SLN mapping,and when it is combined with BD in lymphangiography,it offers comparable detection sensitivity compared to the conventional lymphatic mapping strategies that are widely used in clinical practice.展开更多
Lymph node metastasis informs prognosis and is a key factor in deciding further management, particularly adjuvant chemotherapy. It is core to all contemporary staging systems, including the widely used tumor node meta...Lymph node metastasis informs prognosis and is a key factor in deciding further management, particularly adjuvant chemotherapy. It is core to all contemporary staging systems, including the widely used tumor node metastasis staging system. Patients with nodenegative disease have 5-year survival rates of 70%-80%, implying a significant minority of patients with occult lymph node metastases will succumb to disease recurrence. Enhanced staging techniques may help to identify this subset of patients, who might benefit from further treatment. Obtaining adequate numbers of lymph nodes is essential for accurate staging. Lymph node yields are affected by numerous factors, many inherent to the patient and the tumour, but others related to surgical and histopathological practice. Good lymph node recovery relies on close collaboration between surgeon and pathologist. The optimal extent of surgical resection remains a subject of debate. Extended lymphadenectomy, extra-mesenteric lymph node dissection, high arterial ligation and complete mesocolic excision are amongst the surgical techniques with plausible oncological bases, but which are not supported by the highest levels of evidence. With further development and refinement, intra-operative lymphatic mapping and sentinel lymph node biopsy may provide a guide to the optimum extent of lymphadenectomy, but in its present form, it is beset by false negatives, skip lesions and failures to identify a sentinel node. Once resected, histopathological assessment of the surgical specimen can be improved by thorough dissection techniques, step-sectioning of tissue blocks and immunohistochemistry. More recently, molecular methods have been employed. In this review, we consider the numerous factors that affect lymph node yields, including the impact of the surgical and histopathological techniques. Potential future strategies, including the use of evolving technologies, are also discussed.展开更多
Fluorodeoxyglucose positron emission tomography/computed tomography(FDG PET/CT) is not indicated or recommended in the initial staging of early breast cancer. Although it is valuable for detecting distant metastasis, ...Fluorodeoxyglucose positron emission tomography/computed tomography(FDG PET/CT) is not indicated or recommended in the initial staging of early breast cancer. Although it is valuable for detecting distant metastasis, providing prognostic information, identifying recurrence and evaluating response to chemotherapy, the role of FDG PET/CT in evaluating locoregional nodal status for initial staging of breast cancer has not yet been well-defined in clinical practice. FDG PET/CT has high specificity but compromised sensitivity for identifying axillary nodal disease in breast cancer. Positive axillary FDG PET/CT is a good predictor of axillary disease and correlates well with sentinel lymph node biopsy(SLNB). FDG PET/CT may help to identify patients with high axillary lymph node burden who could then move directly to axillary lymph node dissection(ALND) and would not require the additional step of SLNB. However, FDG PET/CT cannot replace SLNB or ALND due to unsatisfactory sensitivity. The spatial resolution of PET instruments precludes the detection of small nodal metastases. Although there is still disagreement regarding the management of internal mammary node(IMN) disease in breast cancer, it is known that IMN involvement is of prognostic significance, and IMN metastasis has been associated with higher rates of distant metastasis and lower overall survival rates. Limited clinical observationssuggested that FDG PET/CT has advantages over conventional modalities in detecting and uncovering occult extra-axillary especially IMN lesions with upstaging the disease and an impact on the adjuvant management.展开更多
Development of sentinel node navigation surgery (SNNS) and advances in minimally invasive surgical techniques have greatly shaped the modern day approach to gastric cancer surgery.An extensive body of knowledge now ex...Development of sentinel node navigation surgery (SNNS) and advances in minimally invasive surgical techniques have greatly shaped the modern day approach to gastric cancer surgery.An extensive body of knowledge now exists on this type of clinical application but is principally composed of single institute studies.Certain dye tracers,such as isosulfan blue or patent blue violet,have been widely utilized with a notable amount of success;however,indocyanine green is gaining popularity.The double tracer method,a synchronized use of dye and radio-isotope tracers,appears to be superior to any of the dyes alone.In the meantime,the concepts of infrared ray electronic endoscopy,florescence imaging,nanoparticles and near-infrared technology are emerging as particularly promising alternative techniques.Hematoxylin and eosin staining remains the main method for the detection of sentinel lymph node (SLN) metastases.Several specialized centers have begun to employ immunohistochemical staining for this type of clinical analysis but the equipment costs involving the associated ultra-rapid processing systems is limiting its widespread application.Laparoscopic function-preserving resection of primary tumor from the stomach in conjunction with lymphatic basin dissection navigated by SLN identification represents the current paramount of SNNS for early gastric cancer.Patients with cT3 stage or higher still require standard D 2 dissection.展开更多
Background Sentinel lymph node （SLN） biopsy has become a common procedure for early breast cancer patients. The GeneSearchTM Breast Lymph Node （BLN） Assay is a real-time RT-PCR assay for the detecting nodal metast...Background Sentinel lymph node （SLN） biopsy has become a common procedure for early breast cancer patients. The GeneSearchTM Breast Lymph Node （BLN） Assay is a real-time RT-PCR assay for the detecting nodal metastases larger than 0.2 mm. China Breast Cancer Clinical Study Group （CBCSG）-001a is a prospective multi-center clinical trial that was conducted to validate the GeneSearchTM BLN Assay in China.展开更多
文摘Background The purpose of this study was to investigate the feasibility of avoiding axillary lymph node dissection （ALND） for patients with only one sentinel lymph node （SLN） metastasis. The characteristics and predictive factors for non-sentinel lymph node （NSLN） metastasis of patients with single positive SLN were also analyzed. Methods Patients with no and only one SLN metastasis （OIn and 1In group, n ≥2） were selected from 1228 cases of invasive breast carcinoma, who underwent axillary dissection in Shandong Cancer Hospital between November 1999 and December 2011, to compare the characteristics of NSLN metastasis between them. For the 1In group, the factors that influenced the NSLN metastasis were analyzed by univariate and multivariate analysis. Results Differences of the NSLN metastasis between the OIn and the 1In groups were significant （P 〈0.001）. There was no significant difference between the axillary lymph node metastasis on level III in 1In group and OIn group （P=0.570）. When the total SLN number was 〉4 and with one positive case, the NSLN metastasis was not significantly different from that in the OIn group （P=-0.118）. In the 1In group, clinical tumor size （P = 0.012）, over-expression of Her-2 （P=0.003）, tumor grade （P=0.018） and the total number of SLN （P=0.047） significantly correlated with non-SLN metastasis. Clinical tumor size （P=0.015） and the expression of Her-2 （P=0.01） were independent predictive factors for non-SLN metastasis by the Logistic regression model. Conclusion Under certain conditions, breast cancer patients with single SLN metastasis could avoid ALND.
基金supported by grants from the Clinical Research Founding of Southwest Hospital (Grant No. SWH2016BZGFKJ-30), Technological Innovation for Intelligent Medicine of Southwest Hospital (Grant No. SWH2016ZDCX4403) Talents Training Program of Third Military Medical University (Grant No. 2017MPRC18)
文摘Objective:This randomized study aimed to compare the clinical efficacy between the novel dual tracer composed of indocyanine green(ICG)and blue dye(BD)and the conventional dual tracer composed of radioisotope and BD for sentinel lymph node(SLN)mapping in patients with breast cancer.Methods:This study enrolled 471 clinically lymph node-negative patients with primary breast cancer.All patients underwent mastectomy,and those undergoing sentinel lymph node biopsy(SLNB)were randomized to receive blue dye plus radioisotope(RB group)or BD plus ICG(IB group).The detection performances on SLN identification rate,positive SLN counts,detection sensitivity,and false-negative rate were compared between the two groups.Results:In the IB group,97%(194/200)of the patients who underwent the ICG and BD dual tracer injection showed fluorescentpositive lymphatic vessels within 2–5 min.The identification rate of SLNs was comparable between the IB group(99.0%,198/200)and the RB group(99.6%,270/271)(P=0.79).No significant differences were observed in the identification rate of metastatic SLNs(22.5%vs.22.9%,P>0.05,RB group vs.IB group,the same below),positive SLN counts(3.72±2.28 vs.3.91±2.13,P>0.05),positive metastatic SLN counts(0.38±0.84 vs.0.34±0.78,P>0.05),SLNB detection sensitivity(94.4%vs.92.5%,P>0.05),or false-negative rate(5.6%vs.7.5%,P>0.05)between the two groups.Conclusions:ICG can be used as a promising alternative tracer for radioisotope in SLN mapping,and when it is combined with BD in lymphangiography,it offers comparable detection sensitivity compared to the conventional lymphatic mapping strategies that are widely used in clinical practice.
文摘Lymph node metastasis informs prognosis and is a key factor in deciding further management, particularly adjuvant chemotherapy. It is core to all contemporary staging systems, including the widely used tumor node metastasis staging system. Patients with nodenegative disease have 5-year survival rates of 70%-80%, implying a significant minority of patients with occult lymph node metastases will succumb to disease recurrence. Enhanced staging techniques may help to identify this subset of patients, who might benefit from further treatment. Obtaining adequate numbers of lymph nodes is essential for accurate staging. Lymph node yields are affected by numerous factors, many inherent to the patient and the tumour, but others related to surgical and histopathological practice. Good lymph node recovery relies on close collaboration between surgeon and pathologist. The optimal extent of surgical resection remains a subject of debate. Extended lymphadenectomy, extra-mesenteric lymph node dissection, high arterial ligation and complete mesocolic excision are amongst the surgical techniques with plausible oncological bases, but which are not supported by the highest levels of evidence. With further development and refinement, intra-operative lymphatic mapping and sentinel lymph node biopsy may provide a guide to the optimum extent of lymphadenectomy, but in its present form, it is beset by false negatives, skip lesions and failures to identify a sentinel node. Once resected, histopathological assessment of the surgical specimen can be improved by thorough dissection techniques, step-sectioning of tissue blocks and immunohistochemistry. More recently, molecular methods have been employed. In this review, we consider the numerous factors that affect lymph node yields, including the impact of the surgical and histopathological techniques. Potential future strategies, including the use of evolving technologies, are also discussed.
文摘Fluorodeoxyglucose positron emission tomography/computed tomography(FDG PET/CT) is not indicated or recommended in the initial staging of early breast cancer. Although it is valuable for detecting distant metastasis, providing prognostic information, identifying recurrence and evaluating response to chemotherapy, the role of FDG PET/CT in evaluating locoregional nodal status for initial staging of breast cancer has not yet been well-defined in clinical practice. FDG PET/CT has high specificity but compromised sensitivity for identifying axillary nodal disease in breast cancer. Positive axillary FDG PET/CT is a good predictor of axillary disease and correlates well with sentinel lymph node biopsy(SLNB). FDG PET/CT may help to identify patients with high axillary lymph node burden who could then move directly to axillary lymph node dissection(ALND) and would not require the additional step of SLNB. However, FDG PET/CT cannot replace SLNB or ALND due to unsatisfactory sensitivity. The spatial resolution of PET instruments precludes the detection of small nodal metastases. Although there is still disagreement regarding the management of internal mammary node(IMN) disease in breast cancer, it is known that IMN involvement is of prognostic significance, and IMN metastasis has been associated with higher rates of distant metastasis and lower overall survival rates. Limited clinical observationssuggested that FDG PET/CT has advantages over conventional modalities in detecting and uncovering occult extra-axillary especially IMN lesions with upstaging the disease and an impact on the adjuvant management.
文摘Development of sentinel node navigation surgery (SNNS) and advances in minimally invasive surgical techniques have greatly shaped the modern day approach to gastric cancer surgery.An extensive body of knowledge now exists on this type of clinical application but is principally composed of single institute studies.Certain dye tracers,such as isosulfan blue or patent blue violet,have been widely utilized with a notable amount of success;however,indocyanine green is gaining popularity.The double tracer method,a synchronized use of dye and radio-isotope tracers,appears to be superior to any of the dyes alone.In the meantime,the concepts of infrared ray electronic endoscopy,florescence imaging,nanoparticles and near-infrared technology are emerging as particularly promising alternative techniques.Hematoxylin and eosin staining remains the main method for the detection of sentinel lymph node (SLN) metastases.Several specialized centers have begun to employ immunohistochemical staining for this type of clinical analysis but the equipment costs involving the associated ultra-rapid processing systems is limiting its widespread application.Laparoscopic function-preserving resection of primary tumor from the stomach in conjunction with lymphatic basin dissection navigated by SLN identification represents the current paramount of SNNS for early gastric cancer.Patients with cT3 stage or higher still require standard D 2 dissection.
文摘Background Sentinel lymph node （SLN） biopsy has become a common procedure for early breast cancer patients. The GeneSearchTM Breast Lymph Node （BLN） Assay is a real-time RT-PCR assay for the detecting nodal metastases larger than 0.2 mm. China Breast Cancer Clinical Study Group （CBCSG）-001a is a prospective multi-center clinical trial that was conducted to validate the GeneSearchTM BLN Assay in China.
