ObjectiveTo explore the value of fluorescence tracer technique in sentinel lymph node (SLN) orientation of cN0 papillary thyroid cancer.
MethodsThe total clinical data of 40 cT1-3N0M0 thyroid cancer patients admitted from January 2015 to January 2016 in our hospital were collected, and the SLN with indocyanine green (ICG) as fluorescent trace agent were observed and detected, and the effect of ICG detecting SLN and the guide role of SLNB on the dissection of the central area of neck lymph nodes by intraoperative frozen biopsy pathology and postoperative paraffin pathology were analyzed.
ResultsA total of 40 thyroid cancer patients were treated by SLNB and then conducted by the dissection of the central area of neck lymph nodes, and 37 cases detected SLN, so the detection rate was 92.5% (37/40). And a total of 98 SLNs were detected, 1-5 for each case, average of 2.65/case. Intraoperative frozen pathological detected 28 cases of patients with metastases in SLN, and 9 patients without metastasis, including 1 case with postoperative pathology detecting micrometastasis in SLN and other 8 cases without metastasis in the central area of neck lymph nodes. Three cases who were not detected the SLN showed no metastases in final postoperative paraffin pathology. The SLNB of ICG fluorescent tracer was with a sensitivity of 96.6% (28/29), false-negative rate of 3.45% (1/29).
ConclusionThe fluorescent tracer technique can guide the dissection of the central of neck lymph node of cN0 thyroid cancer patients accurately with a high detection rate and advantages of high sensitivity in detecting the SLN of thyroid cancer.
ObjectiveTo review the recent studies about sentinel lymph node biopsy in breast cancer.MethodsThe literatures in recent years on the history, concept, technique and clinical application of sentinel lymph node biopsy were reviewed and summarized.ResultsThere was no unified method for sentinel lymph node biopsy. There was a wide range of detection rate and falsenegative rate.ConclusionProspective multicenter random clinical trials will help to evaluate the clinical application of sentinel lymph node biopsy.
ObjectiveTo evaluate the quality of life after sentinel lymph node biopsy (SLNB) in patients with breast cancer. MethodsFrom January 2004 to December 2006, 591 patients with breast cancer who were suitable for SLNB were divided into SLNB group (n=339) and axillary lymph node dissection (ALND) group (n=252). All patients didn’t have the upper extremity joints disease, the vascular nerve disease, and the cervical spondylosis previously. Results①In patients with SLNB, the circumferences of upper arm in one, two, and three weeks after operation were similar to those before operation (P=0.232, P=0.318, and P=0.415, respectively). While, in patients with ALND, the circumferences of upper arm in one or two weeks after operation were significantly bigger than those before operation (P=0.011, P=0.041, respectively), and the circumference in three weeks after operation was similar to that before operation (P=0.290). ②In patients with SLNB, the outreach angles of shoulder joint in one and two weeks after operation were significantly smaller than those before operation (P=0.031, P=0.043, respectively), and the angle in three weeks after operation was similar to that before operation (P=0.196). However, in patients with ALND, the angles in one, two or three weeks after operation were significantly smaller than those before operation (all Plt;0.001). ③The retention time of drainage tube in patients with ALND who received breast conserving surgery or mastectomy was significantly longer than that in patients with SLNB who received mastectomy (all Plt;0.001). ④The infection rate and the sensory disjunction rate in patients with ALND were significantly higher than those in patients with SLNB (P=0.002, Plt;0.001, respectively). ConclusionsFor patients with lymph node negative breast cancer, SLNB could decrease postoperative complications, and improve the quality of life. It could also save money by reducing hospital stay.
Objective To identify the feasibility of the lymphatic mapping and sentinel node biopsy (SLNB) in patients with breast cancer and to examine whether the characteristics of the sentinel lymph node (SLN) accurately predict the status of axillary lymph node.MethodsFrom March to October 2000, 32 patients with breast cancer were evaluated at the Sichuan Provincial People’s Hospital. Lymphatic mapping was performed using Methlene Blue. A SLN was defined as any blue node. Thirtytwo patients, with breast cancer underwent a complete axillary lymph node resection (ALNR) following SLN biopsy. Subsequently, all SLNs and ALNs were examined by both Hamp;E staining as well as immunohistochemical staining for cytokeratin. ResultsLymphatic mapping was successful in identifying the SLN in 26/32(81.25%) cases of nodes at level Ⅰ. Of the 26 patients mapped successfully, 10 had metastasis to the SLNs.In 3 cases that SLNs were positive, but other axillary lymph nodes were negative. In 2 cases that the SLNs were negative, but other axillary lymph nodes were positive. The sensitivity of SLNB using Methlene Blue in this study was 77.78%(7/9), accuracy 80.77%(21/26), specificity 82.35%(14/17), and false negative rate 22.22%(2/9). ConclusionSLN can predict the status of the axillary lymph nodes reliably. However, the efficacy of SLNB in the setting of randomized, prospective trials must be tested first before abandoning axillary lymph node resection as the standard of care.
Objective To explore the clinical application of combination of radiolabeled colloid （99Tcm-sulphur colloid） and blue dye in sentinel lymph node biopsy （SLNB） for early-stage breast cancer. Methods SLNB was performed with the guidance of blue dye, radiolabeled colloid, and the combination method in all patients enrolled, and clinical and pathological data were recorded respectively for analysis. Results Two hundred and one patients were enrolled in this study and the SLN were successfully detected in 200 cases. The identification rate of radiolabeled colloid method and combination method was 99.5% （200/201） and 99.5% （198/199） respectively, which significantly higher than blue dye method （85.4%, P＜0.001）. There were no differences of accuracy rate 〔95.3% （162/170） vs. 94.5% （189/200） vs. 98.0% （194/198）, P=0.185〕 and false negative rate 〔11.3% （8/71） vs. 13.9% （11/79） vs. 5.1% （4/79）, P=0.165） between blue dye method, radiolabeled colloid method, and combination method. The combination method could detect more SLN than radiolabeled colloid method or blue dye method only （P＜0.001）. Compared to combination method, there were 12 and 7 patients miss diagnosed in blue dye method and radiolabeled colloid method, and the miss diagnosed rate was 16.0% （12/75） and 9.3% （7/75）, respectively. Conclusions Compared to radiolabeled colloid and blue dye method, combination method has higher identification rate, and could identify more SLNs. It is recommended that the combination of radiolabeled colloid and blue dye should be adapted for procedure of SLNB in clinical practice.
Objective To explore the clinical value of only using blue dye as tracer in the sentinel lymph node biopsy (SLNB) of breast cancer. Methods SLNB was performed with the guidance of the combination of blue dye and isotope in all patients enrolled. SLNB data of blue dye only, and the combination method was recorded respectively for analyses. Results Three hundred and eight patients were enrolled in this prospective study. Significant differences were found in the identification rate (IDR, 93.5% vs. 99.4%, P=0.000), the false negative rate (FNR, 14.8% vs. 3.3%, P=0.007), the accuracy rate (AR, 89.6% vs. 97.8%, P=0.006), and the negative predictive value (NPV, 74.0% vs. 93.3%, P=0.012) between the blue dye alone and the combination method. The IDR and the FNR of the two methods were not significantly associated with the patient age, tumor size and location, histopathological type, type of biopsy and breast surgery, or ER, PR, and HER-2 status (all Pgt;0.05). The FNR of blue dye alone was significantly associated with clinically suspicious turgescence of axillary lymph nodes (P=0.042) and decreased followed by the increased number of sentinel lymph nodes obtained (P=0.000). Conclusions Compared with the combination method, SLNB guided with blue dye alone had significantly poorer IDR, AR, and NPV, and higher FNR. It is recommended that the combination of dye and isotope should be adopted for the guidance of SLNB in clinical practice rather than the use of blue dye alone.
ObjectiveTo summarize the research progress of sentinel lymph node biopsy (SLNB) in the surgery of thyroid carcinoma in recent years.
MethodsLiteratures about the recent studies on categories of SLNB and the neck lymph node dissection conducted by SLNB in the surgery of thyroid carcinoma were reviewed following the results searched from PubMed and CNKI data base.
ResultsSLNB has a high detection rate and it is of great significance to detect the occult metastatic lymph nodes and guide the neck lymph node dissection during operation.
ConclusionThe SLNB, with its high accuracy rate on the detection of occult metastatic lymph nodes, guides neck lymph node dissection during operation in order that it can maximize the benefits of patients.
ObjectiveTo evaluate clinical value of indocyanine green (ICG) fluorescence in sentinel lymph node (SLN) biopsy (SLNB) for breast cancer.
MethodThe SLNBs were performed in 66 patients with breast cancer,who were divided into ICG group (n=34) and methylene blue dye group (n=32) according to the tracing method.
ResultsThe SLNs were found in 59 patients,the detection rate was 89.39%(59/66).One hundred and sixty-two SLNs in 59 patients were detected,the average number of detected SLNs was 2.75.The SLNs detection rate was 97.06%(33/34) and 81.25%(26/32) in the ICG group and in the methylene blue dye group,respectively,which in the ICG group was significantly higher than that in the methylene blue dye group (P<0.05).The positive SLNs were found in 32 cases,within which was 20 cases in the ICG group,12 cases in the methylene blue dye group.The axillary lymph node metastases were found in 35 of 66 cases,within which was 21 cases in the ICG group,14 cases in the methylene blue dye group.The sensitivity and false negative rate had no significant differences between the ICG group and the methylene blue dye group (sensitivity:95.2% versus 85.7%,P>0.05;false negative rate:4.8% versus 14.3%,P>0.05).
ConclusionThe ICG fluorescence in SLNB for breast cancer has many advantages,including shorter time,simple operation,high sensitivity,and high detection rate as compared with methylene blue dye.
ObjectiveTo summarize the current situation and progress of sentinel lymph node biopsy (SLNB) in breast cancer.
MethodsDomestic and foreign documents related SLNB in breast cancer in recent years were collected to summaize some problems about the definition, indications, biopsy techniques, improvement methods of the detection rate, the pathological examinations of sentinel lymph node (SLN), the types of metastasis, clinical applications of SLNB technology in breast cancer, and so on.
ResultsThe indications of SLNB were expanding. The development of the tracer, imaging examination, and pathological detection technology contributed to the status assessment of SLN in breast cancer. The operation method of SLNB in breast cancer had no uniform standards yet. There were many arguments on whether SLNB can guide axillary lymph node dissection, and the detection rate and the false negative rate of it varied widely.
ConclusionsSLNB technology has became an important method in the surgical therapy of breast cancer, but the operation still needs to be further standardized. The clinical application of SLNB also needs a lot of prospective multicenter randomized experiments for further demonstration.
ObjectiveTo summarize the current status and advances of sentinel lymph node biopsy (SLNB) technique in breast cancer. MethodsThe pertinent domestic and overseas literatures were reviewed and the localization, harvest, status assessment, indications, and complications of SLNB were analyzed. ResultsSLNB could accurately locate and pick out sentinel lymph node (SLN) in breast cancer. The development on imaging examination and pathological techniques promoted the assessment of SLN, and the indications of SLNB were expanding. The complication rate of SLNB was low and the technique could accurately predict axillary lymph node staging and direct selective axillary lymph node dissection. ConclusionsSLNB has been an important method of surgical therapy in breast cancer, but the operation process needs to be further standardized to decrease the false negative rate. Continuative attentions shall be paid to the problems such as the false positive and controversial indications.
