Objective: Axillary lymph node dissection(ALND) may be unnecessary in 20%–60% of breast cancer patients with sentinel lymph node(NSLN) metastasis. The aim of the present study was to review the medical records of Chi...Objective: Axillary lymph node dissection(ALND) may be unnecessary in 20%–60% of breast cancer patients with sentinel lymph node(NSLN) metastasis. The aim of the present study was to review the medical records of Chinese patients with early-stage breast cancer and positive NSLN metastasis to identify clinicopathological characteristics as risk factors for non-NSLN metastasis.Methods: The medical records of 2008 early-stage breast cancer patients who received intraoperative sentinel lymph node biopsy(SLNB) between 2006 and 2016 were retrospectively reviewed. These patients were clinically and radiologically lymph nodenegative and had no prior history of receiving neoadjuvant chemotherapy or endocrinotherapy. The clinicopathological characteristics of patients with positive NSLN metastasis who underwent ALND were investigated.Results: In the present study, 296 patients with positive NSLN metastases underwent ALND. Positive non-NSLN metastases were confirmed in 95 patients(32.1%). On univariate analysis, ≥ 3 positive NSLN metastases(P <0.01), NSLN macrometastases(P =0.023), and lymphovascular invasion(P = 0.04) were associated with non-NSLN metastasis(P <0.05). In multivariate analysis, the number of positive SLNs was the most significant predictor of non-SLN metastasis. For patients with 0, 1, 2, or 3 associated risk factors, the non-SLN metastatic rates were 11.5%, 22.5%, 35.2%, and 73.1%, respectively.Conclusions: The number of positive NSLNs, NSLN macrometastases, and lymphovascular invasion were correlated with nonSLN metastasis. The number of positive SLNs was an independent predictor for non-NSLN metastasis. When 2 or 3 risk factors were present in one patient, the probability of non-NSLN was higher than that in the American College of Surgeons Oncology Group Z0011 trial(27.3%); thus, avoiding ALND should be considered carefully.展开更多
Despite declining incidence,gastric cancer remains one of the most common cancers worldwide.Early detection in population-based screening programs has increased the number of cases of early gastric cancer,representing...Despite declining incidence,gastric cancer remains one of the most common cancers worldwide.Early detection in population-based screening programs has increased the number of cases of early gastric cancer,representing approximately 50%of newly detected gastric cancer cases in Asian countries.Endoscopic mucosal resection and endoscopic submucosal dissection have become the preferred therapeutic techniques in Japan and Korea for the treatment of early gastric cancer patients with a very low risk of lymph node metastasis.Laparoscopic and robotic resections for early gastric cancer,including function-preserving resections,have propagated through advances in technology and surgeon experience.The aim of this paper is to discuss the recent advances in minimally invasive approaches in the treatment of early gastric cancer.展开更多
AIM： To investigate the distribution pathway of metastatic lymph nodes in gastric carcinoma as a foundation for rational lymphadenectomy. METHODS： We investigated 173 cases with solitary or single station metastatic...AIM： To investigate the distribution pathway of metastatic lymph nodes in gastric carcinoma as a foundation for rational lymphadenectomy. METHODS： We investigated 173 cases with solitary or single station metastatic lymph nodes （LN） from among 2476 gastric carcinoma patients. The location of metastatic LN, histological type and growth patterns were analyzed retrospectively. RESULTS： Of 88 solitary node metastases cases, 65 were limited to perigastric nodes （N1）, while 23 showed skipping metastasis. Among 8 tumors in the upper third stomach, 3 involved right paracardial LN （station number： No.1）, and one in the greater curvature was found in No.1. In the 28 middle third stomach tumors, 10 were found in LN of the lesser curvature （No.3） and 6 in LN of the left gastric artery （No.7）; 5 of the 20 cases on the lesser curvature spread to No.7, while 2 of the 8 on the greater curvature metastasized to LN of the spleen hilum （No.10）. Of 52 lower third stomach tumors, 13 involved in No.3 and 19 were detected in inferior pyloric LN （No.6）; 9 of the 29 cases along the lesser curvature were involved in No.6. CONCLUSION： Transversal and skipping metastases of sentinel lymph nodes （SLN） are notable, and rational lymphadenectomy should, therefore, be performed.展开更多
AIM: To investigate feasibility and accuracy of near-infrared fluorescence imaging using indocyanine green: nanocolloid for sentinel lymph node (SLN) detection in gastric cancer.METHODS: A prospective, single-institut...AIM: To investigate feasibility and accuracy of near-infrared fluorescence imaging using indocyanine green: nanocolloid for sentinel lymph node (SLN) detection in gastric cancer.METHODS: A prospective, single-institution, phase I feasibility trial was conducted. Patients suffering from gastric cancer and planned for gastrectomy were included. During surgery, a subserosal injection of 1.6 mL ICG:Nanocoll was administered around the tumor. NIR fluorescence imaging of the abdominal cavity was performed using the Mini-FLARE™ NIR fluorescence imaging system. Lymphatic pathways and SLNs were visualized. Of every detected SLN, the corresponding lymph node station, signal-to-background ratio and histopathological diagnosis was determined. Patients underwent standard-of-care gastrectomy. Detected SLNs outside the standard dissection planes were also resected and evaluated.RESULTS: Twenty-six patients were enrolled. Four patients were excluded because distant metastases were found during surgery or due to technical failure of the injection. In 21 of the remaining 22 patients, at least 1 SLN was detected by NIR Fluorescence imaging (mean 3.1 SLNs; range 1-6). In 8 of the 21 patients, tumor-positive LNs were found. Overall accuracy of the technique was 90% (70%-99%; 95%CI), which decreased by higher pT-stage (100%, 100%, 100%, 90%, 0% for respectively Tx, T1, T2, T3, T4 tumors). All NIR-negative SLNs were completely effaced by tumor. Mean fluorescence signal-to-background ratio of SLNs was 4.4 (range 1.4-19.8). In 8 of the 21 patients, SLNs outside the standard resection plane were identified, that contained malignant cells in 2 patients.CONCLUSION: This study shows successful use of ICG:Nanocoll as lymphatic tracer for SLN detection in gastric cancer. Moreover, tumor-containing LNs outside the standard dissection planes were identified.展开更多
Advances in molecular diagnostic tools have allowed the identification of lymph node micrometastasis(LNM),including isolated tumor cells,in cancer patients. While immunohistochemistry and reverse transcription-polymer...Advances in molecular diagnostic tools have allowed the identification of lymph node micrometastasis(LNM),including isolated tumor cells,in cancer patients. While immunohistochemistry and reverse transcription-polymerase chain reaction have been used to identify LNM in patients with gastric cancer,the clinical significance of this finding remains unclear. Recently,minimally invasive treatments,such as endoscopic submucosal dissection and laparoscopic surgery,are widely performed to help improve postsurgical quality of life(QOL). However,it is important to maintain the balance between QOL and curability when making treatments decision for patients with gastric cancer. If minimally invasive surgery based on accurate intraoperative LNM diagnosis was established,it could be performed safely. Therefore,we reviewed the clinical significance of LNM detected by molecular techniques as an important target for treatment decision making with gastric cancer patients.展开更多
BACKGROUND Recent evidence showed that combining endoscopic submucosal dissection(ESD)and laparoscopic sentinel lymph node dissection may avoid unnecessary gastrectomy in treating early mucinous gastric cancer(EMGC)pa...BACKGROUND Recent evidence showed that combining endoscopic submucosal dissection(ESD)and laparoscopic sentinel lymph node dissection may avoid unnecessary gastrectomy in treating early mucinous gastric cancer(EMGC)patients with risks of positive lymph node metastasis(pLNM).AIM To explore the predictive factors for pLNM in EMGC,and to optimize the clinical application of combing ESD and sentinel lymph node dissection in a proper subgroup of patients with EMGC.METHODS Thirty-one patients with EMGC who had undergone gastrectomy with lymph node dissection were consecutively enrolled from January 1988 to December 2016.Univariate and multivariate logistic regression analyses were used to estimate the association between the rates of pLNM and clinicopathological factors,providing odds ratio(OR)with 95%confidence interval.And the association between the number of predictors and the pLNM rate was also investigated.RESULTS Depth of invasion(OR=7.342,1.127-33.256,P=0.039),tumor diameter(OR=9.158,1.348-29.133,P=0.044),and lymphatic vessel involvement(OR=27.749,1.821-33.143,P=0.019)turned out to be significant and might be the independent risk factors for predicating pLNM in the multivariate analysis.For patients with 1,2,and 3 risk factors,the pLNM rates were 9.1%,33.3%,and 75.0%,respectively.pLNM was not detected in seven patients without any of these risk factors.CONCLUSION ESD might serve as a safe and sufficient treatment for intramucosal EMGC if tumor size≤2 cm,and when lymphatic vessel involvement is absent by postoperative histological examination.Combining ESD and sentinel lymph node dissection could be recommended as a safe and effective treatment for EMGC patients with a potential risk of pLNM.展开更多
AIM:To compare the difference between tumorinduced lymph node enlargement and inflammation-induced lymph node enlargement by contrast-enhanced ultrasonography and pathological findings. METHODS:A model of tumor-induce...AIM:To compare the difference between tumorinduced lymph node enlargement and inflammation-induced lymph node enlargement by contrast-enhanced ultrasonography and pathological findings. METHODS:A model of tumor-induced lymph node metastasis was prepared by embedding a VX2 tumor into the hind paws of white rabbits.A model of inflammation-induced enlargement was prepared by injecting a suspension of Escherichia coli into separate hind paws of white rabbits.Then,a solution of SonazoidTM(GE Healthcare,Oslo,Norway)was injected subcutaneously in the proximity of the lesion followed by contrast-enhanced ultrasonography of the enlarged popliteal lymph nodes. RESULTS:In the contrast-enhanced ultrasonography of the tumor-induced metastasis model,the sentinel lymph node was imaged.An area of filling defect was observed in that enlarged lymph node.In the histology examination,the area of filling defect corresponded to the metastatic lesion of the tumor.Contrast-enhanced ultrasonography of the model on inflammation-induced lymph node enlargement,and that of the acute inflam-mation model performed 3-7 d later,revealed dense staining that was comparatively uniform.The pathological findings showed acute lymphadenitis mainly due to infiltration of inflammatory cells.Contrast-enhanced ultrasonography that was performed 28 d post-infection in the acute inflammation model showed speckled staining.Inflammation-induced cell infiltration and fiberization,which are findings of chronic lymphadenitis, were seen in the pathological findings. CONCLUSION:Sentinel lymph node imaging was made possible by subcutaneous injection of SonazoidTM.Contrast-enhanced ultrasonography was suggested to be useful in differentiating tumor-induced enlargement and inflammation-induced enlargement of lymph nodes.展开更多
Background:Although sentinel lymph node biopsy(SLNB) can accurately predict the status of axillary lymph node(ALN) metastasis,the high false?negative rate(FNR) of SLNB is still the main obstacle for the treatment of p...Background:Although sentinel lymph node biopsy(SLNB) can accurately predict the status of axillary lymph node(ALN) metastasis,the high false?negative rate(FNR) of SLNB is still the main obstacle for the treatment of patients who receive SLNB instead of ALN dissection(ALND).The purpose of this study was to evaluate the clinical significance of SLNB combined with peripheral lymph node(PLN) sampling for reducing the FNR for breast cancer and to discuss the effect of "skip metastasis" on the FNR of SLNB.Methods:At Shandong Cancer Hospital Affiliated to Shandong University between March 1,2012 and June 30,2015,the sentinel lymph nodes(SLNs) of 596 patients with breast cancer were examined using radiocolloids with blue dye tracer.First,the SLNs were removed;then,the area surrounding the original SLNs was selected,and the visible lymph nodes in a field of 3–5 cm in diameter around the center(i.e.,PLNs) were removed,avoiding damage to the structure of the breast.Finally,ALND was performed.The SLNs,PLNs,and remaining ALNs underwent pathologic examination,and the relationship between them was analyzed.Results:The identification rate of SLNs in the 596 patients was 95.1%(567/596);the metastasis rate of ALNs was 33.7%(191/567);the FNR of pure SLNB was 9.9%(19/191);and after the SLNs and PLNs were eliminated,the FNR was 4.2%(8/191),which was significantly decreased compared with the FNR before removal of PLNs(P Aected number(N) of SLNs,the patients were divided into four groups of N = 0.028).ccording to the det= 1,2,3,and ≥4;the FNR in these groups was 19.6,9.8,7.3,and 2.3%,respectively.For the patients with removal of PLNs was significantly decreased compared with that before remo≤2 or val of P≤3 detected SLNs,the FNR afterLNs(N 3:12.2% vs.4.7%,P ≤ 2:14.0% vs.4.7%,P = 0.019;N ≤ nt(P = 0.021),whereas for patients with ≥4 detected SLNs,the decrease in FNR was not statistically significa= 1.000).In the entire cohorts,the "skip metastasis" rate was 2.5%(15/596);the FNR caused by "skip metastasis" was 2.1%(4/191).Co展开更多
Background:Sentinel lymph node(SLN)biopsy is gradually accepted as the standard of care in breast cancer patients with down-staged axillary disease after neoadjuvant chemotherapy(NAC).However,it is still difficult to ...Background:Sentinel lymph node(SLN)biopsy is gradually accepted as the standard of care in breast cancer patients with down-staged axillary disease after neoadjuvant chemotherapy(NAC).However,it is still difficult to precisely define pre-NAC clinical node-positive(cN1)and post-NAC clinical node-negative(ycN0).This prospective single-center trial was designed to evaluate the feasibility and accuracy of standard targeted axillary dissection(TAD)after NAC in highly selective pre-NAC cN1 patients(not considering ultrasound-based axillary ycN staging).Methods:This prospective trial included patients with initial pre-NAC cT1-3N1M0 invasive breast cancer but with a rigorous definition of cN1 from the Affiliated Cancer Hospital of Zhengzhou University.When NAC was effective(including complete and partial responses)and preoperative axillary palpation was negative,preoperative ultrasound-based axillary staging was not considered,and all patients underwent TAD followed by axillary lymph node(LN)dissection.The detection rate(DR)and false-negative rate(FNR)of TAD were calculated.Results:A total of 82 patients were included,and 77 of them were eligible for data analysis.The DR for TAD was 94.8%(73/77).There were 26 patients with one abnormal LN at the time of diagnosis based on ultrasound,45 patients with two,and 2 patients with three.One patient had one TAD LN,four patients had two TAD LNs,and 68 patients had three or more TAD LNs.Preoperative axillary palpation yielded negative results for all 73 patients who successfully underwent TAD.Preoperative ultrasound-based ycN0 and ycN+conditions were detected for 52 and 21 cases,respectively.The FNR was 7.4%(2/27)for standard TAD(≥3 SLNs),which was lower than that of all successful TAD(≥1 SLN;10.0%,3/30).Conclusions:In rigorously defined pre-NAC cN1 breast cancer patients,standard TAD is feasible for those with negative axillary palpation after NAC,and FNR is also less than 10%.Registration:chictr.org.cn,ChiCTR2100049093.展开更多
With the continuous improvement of systemic treatment, reasonable local regional control of early-stage breast cancer can be translated into survival benefits. The optimization of regional nodal management in patients...With the continuous improvement of systemic treatment, reasonable local regional control of early-stage breast cancer can be translated into survival benefits. The optimization of regional nodal management in patients with limited sentinel lymph node(SLN) metastasis needs to be weighed by surgical complications, regional recurrence risk, and lymph node status, as well as other escalating treatment(systemic/radiotherapy) that may result from deescalating surgery. With the effective support and supplementation of systemic therapy and radiotherapy, the management of axillary surgery is developing in a de-escalating trend. The widespread application of neoadjuvant therapy has contributed to optimizing the management of patients with clinically node-negative/imaging nodepositive disease. In clinical practice, it is necessary to consider the residual tumor burden of regional lymph nodes when formulating the optimal irradiation fields in patients with limited positive SLN without axillary lymph node dissection. The combined application of genomic tests and American College of Surgeons Oncology Group Z0011/AMAROS criteria could provide patients with a better strategy of dual de-escalation treatment, which includes the de-escalation of both axillary surgery and systemic treatment. In the era of sentinel lymph node biopsy(SLNB), the regional nodal management of breast cancer should adhere to the concept of “updating ideas, making bold assumptions, and carefully seeking proof”, make full use of the benefits of systemic therapy and radiotherapy to reduce the scope of surgery and complications, and expand the “net benefit” of efficacy and quality of life. This review discusses the optimization of regional nodal management in the era of SLNB, in order to provide reference information for clinicians.展开更多
文摘Objective: Axillary lymph node dissection(ALND) may be unnecessary in 20%–60% of breast cancer patients with sentinel lymph node(NSLN) metastasis. The aim of the present study was to review the medical records of Chinese patients with early-stage breast cancer and positive NSLN metastasis to identify clinicopathological characteristics as risk factors for non-NSLN metastasis.Methods: The medical records of 2008 early-stage breast cancer patients who received intraoperative sentinel lymph node biopsy(SLNB) between 2006 and 2016 were retrospectively reviewed. These patients were clinically and radiologically lymph nodenegative and had no prior history of receiving neoadjuvant chemotherapy or endocrinotherapy. The clinicopathological characteristics of patients with positive NSLN metastasis who underwent ALND were investigated.Results: In the present study, 296 patients with positive NSLN metastases underwent ALND. Positive non-NSLN metastases were confirmed in 95 patients(32.1%). On univariate analysis, ≥ 3 positive NSLN metastases(P <0.01), NSLN macrometastases(P =0.023), and lymphovascular invasion(P = 0.04) were associated with non-NSLN metastasis(P <0.05). In multivariate analysis, the number of positive SLNs was the most significant predictor of non-SLN metastasis. For patients with 0, 1, 2, or 3 associated risk factors, the non-SLN metastatic rates were 11.5%, 22.5%, 35.2%, and 73.1%, respectively.Conclusions: The number of positive NSLNs, NSLN macrometastases, and lymphovascular invasion were correlated with nonSLN metastasis. The number of positive SLNs was an independent predictor for non-NSLN metastasis. When 2 or 3 risk factors were present in one patient, the probability of non-NSLN was higher than that in the American College of Surgeons Oncology Group Z0011 trial(27.3%); thus, avoiding ALND should be considered carefully.
文摘Despite declining incidence,gastric cancer remains one of the most common cancers worldwide.Early detection in population-based screening programs has increased the number of cases of early gastric cancer,representing approximately 50%of newly detected gastric cancer cases in Asian countries.Endoscopic mucosal resection and endoscopic submucosal dissection have become the preferred therapeutic techniques in Japan and Korea for the treatment of early gastric cancer patients with a very low risk of lymph node metastasis.Laparoscopic and robotic resections for early gastric cancer,including function-preserving resections,have propagated through advances in technology and surgeon experience.The aim of this paper is to discuss the recent advances in minimally invasive approaches in the treatment of early gastric cancer.
基金Supported in part by the Gastric Cancer Laboratory of Chinese Medical University
文摘AIM： To investigate the distribution pathway of metastatic lymph nodes in gastric carcinoma as a foundation for rational lymphadenectomy. METHODS： We investigated 173 cases with solitary or single station metastatic lymph nodes （LN） from among 2476 gastric carcinoma patients. The location of metastatic LN, histological type and growth patterns were analyzed retrospectively. RESULTS： Of 88 solitary node metastases cases, 65 were limited to perigastric nodes （N1）, while 23 showed skipping metastasis. Among 8 tumors in the upper third stomach, 3 involved right paracardial LN （station number： No.1）, and one in the greater curvature was found in No.1. In the 28 middle third stomach tumors, 10 were found in LN of the lesser curvature （No.3） and 6 in LN of the left gastric artery （No.7）; 5 of the 20 cases on the lesser curvature spread to No.7, while 2 of the 8 on the greater curvature metastasized to LN of the spleen hilum （No.10）. Of 52 lower third stomach tumors, 13 involved in No.3 and 19 were detected in inferior pyloric LN （No.6）; 9 of the 29 cases along the lesser curvature were involved in No.6. CONCLUSION： Transversal and skipping metastases of sentinel lymph nodes （SLN） are notable, and rational lymphadenectomy should, therefore, be performed.
文摘AIM: To investigate feasibility and accuracy of near-infrared fluorescence imaging using indocyanine green: nanocolloid for sentinel lymph node (SLN) detection in gastric cancer.METHODS: A prospective, single-institution, phase I feasibility trial was conducted. Patients suffering from gastric cancer and planned for gastrectomy were included. During surgery, a subserosal injection of 1.6 mL ICG:Nanocoll was administered around the tumor. NIR fluorescence imaging of the abdominal cavity was performed using the Mini-FLARE™ NIR fluorescence imaging system. Lymphatic pathways and SLNs were visualized. Of every detected SLN, the corresponding lymph node station, signal-to-background ratio and histopathological diagnosis was determined. Patients underwent standard-of-care gastrectomy. Detected SLNs outside the standard dissection planes were also resected and evaluated.RESULTS: Twenty-six patients were enrolled. Four patients were excluded because distant metastases were found during surgery or due to technical failure of the injection. In 21 of the remaining 22 patients, at least 1 SLN was detected by NIR Fluorescence imaging (mean 3.1 SLNs; range 1-6). In 8 of the 21 patients, tumor-positive LNs were found. Overall accuracy of the technique was 90% (70%-99%; 95%CI), which decreased by higher pT-stage (100%, 100%, 100%, 90%, 0% for respectively Tx, T1, T2, T3, T4 tumors). All NIR-negative SLNs were completely effaced by tumor. Mean fluorescence signal-to-background ratio of SLNs was 4.4 (range 1.4-19.8). In 8 of the 21 patients, SLNs outside the standard resection plane were identified, that contained malignant cells in 2 patients.CONCLUSION: This study shows successful use of ICG:Nanocoll as lymphatic tracer for SLN detection in gastric cancer. Moreover, tumor-containing LNs outside the standard dissection planes were identified.
文摘Advances in molecular diagnostic tools have allowed the identification of lymph node micrometastasis(LNM),including isolated tumor cells,in cancer patients. While immunohistochemistry and reverse transcription-polymerase chain reaction have been used to identify LNM in patients with gastric cancer,the clinical significance of this finding remains unclear. Recently,minimally invasive treatments,such as endoscopic submucosal dissection and laparoscopic surgery,are widely performed to help improve postsurgical quality of life(QOL). However,it is important to maintain the balance between QOL and curability when making treatments decision for patients with gastric cancer. If minimally invasive surgery based on accurate intraoperative LNM diagnosis was established,it could be performed safely. Therefore,we reviewed the clinical significance of LNM detected by molecular techniques as an important target for treatment decision making with gastric cancer patients.
文摘BACKGROUND Recent evidence showed that combining endoscopic submucosal dissection(ESD)and laparoscopic sentinel lymph node dissection may avoid unnecessary gastrectomy in treating early mucinous gastric cancer(EMGC)patients with risks of positive lymph node metastasis(pLNM).AIM To explore the predictive factors for pLNM in EMGC,and to optimize the clinical application of combing ESD and sentinel lymph node dissection in a proper subgroup of patients with EMGC.METHODS Thirty-one patients with EMGC who had undergone gastrectomy with lymph node dissection were consecutively enrolled from January 1988 to December 2016.Univariate and multivariate logistic regression analyses were used to estimate the association between the rates of pLNM and clinicopathological factors,providing odds ratio(OR)with 95%confidence interval.And the association between the number of predictors and the pLNM rate was also investigated.RESULTS Depth of invasion(OR=7.342,1.127-33.256,P=0.039),tumor diameter(OR=9.158,1.348-29.133,P=0.044),and lymphatic vessel involvement(OR=27.749,1.821-33.143,P=0.019)turned out to be significant and might be the independent risk factors for predicating pLNM in the multivariate analysis.For patients with 1,2,and 3 risk factors,the pLNM rates were 9.1%,33.3%,and 75.0%,respectively.pLNM was not detected in seven patients without any of these risk factors.CONCLUSION ESD might serve as a safe and sufficient treatment for intramucosal EMGC if tumor size≤2 cm,and when lymphatic vessel involvement is absent by postoperative histological examination.Combining ESD and sentinel lymph node dissection could be recommended as a safe and effective treatment for EMGC patients with a potential risk of pLNM.
文摘AIM:To compare the difference between tumorinduced lymph node enlargement and inflammation-induced lymph node enlargement by contrast-enhanced ultrasonography and pathological findings. METHODS:A model of tumor-induced lymph node metastasis was prepared by embedding a VX2 tumor into the hind paws of white rabbits.A model of inflammation-induced enlargement was prepared by injecting a suspension of Escherichia coli into separate hind paws of white rabbits.Then,a solution of SonazoidTM(GE Healthcare,Oslo,Norway)was injected subcutaneously in the proximity of the lesion followed by contrast-enhanced ultrasonography of the enlarged popliteal lymph nodes. RESULTS:In the contrast-enhanced ultrasonography of the tumor-induced metastasis model,the sentinel lymph node was imaged.An area of filling defect was observed in that enlarged lymph node.In the histology examination,the area of filling defect corresponded to the metastatic lesion of the tumor.Contrast-enhanced ultrasonography of the model on inflammation-induced lymph node enlargement,and that of the acute inflam-mation model performed 3-7 d later,revealed dense staining that was comparatively uniform.The pathological findings showed acute lymphadenitis mainly due to infiltration of inflammatory cells.Contrast-enhanced ultrasonography that was performed 28 d post-infection in the acute inflammation model showed speckled staining.Inflammation-induced cell infiltration and fiberization,which are findings of chronic lymphadenitis, were seen in the pathological findings. CONCLUSION:Sentinel lymph node imaging was made possible by subcutaneous injection of SonazoidTM.Contrast-enhanced ultrasonography was suggested to be useful in differentiating tumor-induced enlargement and inflammation-induced enlargement of lymph nodes.
文摘Background:Although sentinel lymph node biopsy(SLNB) can accurately predict the status of axillary lymph node(ALN) metastasis,the high false?negative rate(FNR) of SLNB is still the main obstacle for the treatment of patients who receive SLNB instead of ALN dissection(ALND).The purpose of this study was to evaluate the clinical significance of SLNB combined with peripheral lymph node(PLN) sampling for reducing the FNR for breast cancer and to discuss the effect of "skip metastasis" on the FNR of SLNB.Methods:At Shandong Cancer Hospital Affiliated to Shandong University between March 1,2012 and June 30,2015,the sentinel lymph nodes(SLNs) of 596 patients with breast cancer were examined using radiocolloids with blue dye tracer.First,the SLNs were removed;then,the area surrounding the original SLNs was selected,and the visible lymph nodes in a field of 3–5 cm in diameter around the center(i.e.,PLNs) were removed,avoiding damage to the structure of the breast.Finally,ALND was performed.The SLNs,PLNs,and remaining ALNs underwent pathologic examination,and the relationship between them was analyzed.Results:The identification rate of SLNs in the 596 patients was 95.1%(567/596);the metastasis rate of ALNs was 33.7%(191/567);the FNR of pure SLNB was 9.9%(19/191);and after the SLNs and PLNs were eliminated,the FNR was 4.2%(8/191),which was significantly decreased compared with the FNR before removal of PLNs(P Aected number(N) of SLNs,the patients were divided into four groups of N = 0.028).ccording to the det= 1,2,3,and ≥4;the FNR in these groups was 19.6,9.8,7.3,and 2.3%,respectively.For the patients with removal of PLNs was significantly decreased compared with that before remo≤2 or val of P≤3 detected SLNs,the FNR afterLNs(N 3:12.2% vs.4.7%,P ≤ 2:14.0% vs.4.7%,P = 0.019;N ≤ nt(P = 0.021),whereas for patients with ≥4 detected SLNs,the decrease in FNR was not statistically significa= 1.000).In the entire cohorts,the "skip metastasis" rate was 2.5%(15/596);the FNR caused by "skip metastasis" was 2.1%(4/191).Co
基金supported by a grant from the Science and Technology development plan of Henan(No.202102310428)
文摘Background:Sentinel lymph node(SLN)biopsy is gradually accepted as the standard of care in breast cancer patients with down-staged axillary disease after neoadjuvant chemotherapy(NAC).However,it is still difficult to precisely define pre-NAC clinical node-positive(cN1)and post-NAC clinical node-negative(ycN0).This prospective single-center trial was designed to evaluate the feasibility and accuracy of standard targeted axillary dissection(TAD)after NAC in highly selective pre-NAC cN1 patients(not considering ultrasound-based axillary ycN staging).Methods:This prospective trial included patients with initial pre-NAC cT1-3N1M0 invasive breast cancer but with a rigorous definition of cN1 from the Affiliated Cancer Hospital of Zhengzhou University.When NAC was effective(including complete and partial responses)and preoperative axillary palpation was negative,preoperative ultrasound-based axillary staging was not considered,and all patients underwent TAD followed by axillary lymph node(LN)dissection.The detection rate(DR)and false-negative rate(FNR)of TAD were calculated.Results:A total of 82 patients were included,and 77 of them were eligible for data analysis.The DR for TAD was 94.8%(73/77).There were 26 patients with one abnormal LN at the time of diagnosis based on ultrasound,45 patients with two,and 2 patients with three.One patient had one TAD LN,four patients had two TAD LNs,and 68 patients had three or more TAD LNs.Preoperative axillary palpation yielded negative results for all 73 patients who successfully underwent TAD.Preoperative ultrasound-based ycN0 and ycN+conditions were detected for 52 and 21 cases,respectively.The FNR was 7.4%(2/27)for standard TAD(≥3 SLNs),which was lower than that of all successful TAD(≥1 SLN;10.0%,3/30).Conclusions:In rigorously defined pre-NAC cN1 breast cancer patients,standard TAD is feasible for those with negative axillary palpation after NAC,and FNR is also less than 10%.Registration:chictr.org.cn,ChiCTR2100049093.
基金supported by grants from China Postdoctoral Science Foundation (No. 2022M721987)。
文摘With the continuous improvement of systemic treatment, reasonable local regional control of early-stage breast cancer can be translated into survival benefits. The optimization of regional nodal management in patients with limited sentinel lymph node(SLN) metastasis needs to be weighed by surgical complications, regional recurrence risk, and lymph node status, as well as other escalating treatment(systemic/radiotherapy) that may result from deescalating surgery. With the effective support and supplementation of systemic therapy and radiotherapy, the management of axillary surgery is developing in a de-escalating trend. The widespread application of neoadjuvant therapy has contributed to optimizing the management of patients with clinically node-negative/imaging nodepositive disease. In clinical practice, it is necessary to consider the residual tumor burden of regional lymph nodes when formulating the optimal irradiation fields in patients with limited positive SLN without axillary lymph node dissection. The combined application of genomic tests and American College of Surgeons Oncology Group Z0011/AMAROS criteria could provide patients with a better strategy of dual de-escalation treatment, which includes the de-escalation of both axillary surgery and systemic treatment. In the era of sentinel lymph node biopsy(SLNB), the regional nodal management of breast cancer should adhere to the concept of “updating ideas, making bold assumptions, and carefully seeking proof”, make full use of the benefits of systemic therapy and radiotherapy to reduce the scope of surgery and complications, and expand the “net benefit” of efficacy and quality of life. This review discusses the optimization of regional nodal management in the era of SLNB, in order to provide reference information for clinicians.
