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Jan H Wong - One of the best experts on this subject based on the ideXlab platform.
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periareolar or peritumoral injection of Isosulfan Blue and the effect on the number of sentinel lymph nodes examined
American Surgeon, 2017Co-Authors: Joseph J Weber, Jan H WongAbstract:The conduct of sentinel node biopsy (SLNBx) for breast cancer (BC) has evolved substantially since its original description. No national standards for the performance of SLNBx exist, therefore, we sought to determine the effect of Isosulfan Blue (ISB) injection technique on nodal harvesting and staging accuracy during SLNBx. Our main outcome measures included the number of SLNs examined and the number of positive axillae in patients undergoing SLNBx after injection of filtered sulfur colloid intradermally and either small volume ISB injected in the periareolar dermis (PA,∼0.75 cc) or large volume peritumoral (PT, 5 cc). Between January 1, 2009, and September 30, 2013, 1357 patients at an academic/community practice setting underwent SLNBx of which 966 (71.2%) were node negative. These patients ranged in age from 27 to 97 years (mean 60.1 years). The majority of patients (76%) underwent PT injection of ISB. There was no significant difference in the mean age of these two groups (61.2 PT vs 59.7 PA years). All were female. The majority of patients (72.7%) had T1 primaries. Nearly 73 per cent of patients were Luminal A/B, 10.8 per cent HER, and 16.4 per cent were triple negative. There was no significant difference in the distribution of T stage (P = 0.56) or breast cancer subtypes between the techniques (P = 0.59). The mean number of nodes examined was 3.1 (range, 1-18). PT patients had a mean of 3.5 (range, 1-18) nodes, whereas PA patients had a mean of 2.4 nodes (range, 1-10) (P < 0.001). The technical aspects of injecting ISB affect the number of nodes harvested during SLNBx but not staging accuracy.
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outcomes for patients with t1 squamous cell cancer of the vulva undergoing sentinel node biopsy
Gynecologic Oncology, 2006Co-Authors: Keith Terada, Jan H Wong, David Shimizu, Caroline S JiangAbstract:Abstract Objective. This retrospective review was undertaken to evaluate survival in patients with T1 squamous cell carcinoma of the vulva treated with radical local excision and sentinel node dissection. Methods. Patients with T1 cancers underwent pre-operative lymphoscintigraphy and sentinel lymph node dissection using technetium sulfur colloid and Isosulfan Blue dye. The primary tumor was removed with radical local excision. Patients with negative sentinel nodes did not receive any additional treatment. Survival was calculated using life table analysis. Results. There were 21 patients who underwent 27 sentinel node dissections. Three patients were found to have positive sentinel nodes. At a median follow-up of 4.6 years, two patients have died of cancer, and three patients have died of intercurrent illness. None of the patients with negative sentinel nodes has died of cancer. There were no groin or distant recurrences in patients with negative sentinel nodes. Three-year disease-free survival for all patients and for patients with negative sentinel nodes were 90% and 100% respectively. Conclusion. The survival for patients with early vulvar cancer treated with sentinel node dissection and radical local excision appears excellent.
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sentinel node dissection and ultrastaging in squamous cell cancer of the vulva
Gynecologic Oncology, 2000Co-Authors: Keith Y Terada, David Shimizu, Jan H WongAbstract:Abstract Objective. The aim of this study was to evaluate the findings when pathologic ultrastaging techniques are applied in conjunction with sentinel node dissection in patients with vulvar cancer. Methods. Patients with squamous cell cancer of the vulva underwent intraoperative lymphoscintigraphy following intradermal injection of 99mTc-labeled sulfur colloid at the site of the primary tumor. Isosulfan Blue dye was also injected at the tumor site to facilitate identification of the sentinel node in the groin. Following removal, the sentinel node was then bisected and examined in the standard manner using hematoxylin and eosin staining. Negative nodes were subjected to additional ultrastaging evaluation with serial sectioning and immunohistochemical staining. Results. Nine patients with 10 primary tumors underwent radical local excision of the primary tumor and sentinel node dissection of the groin. Sentinel nodes were identified and removed in all patients. One node was positive by conventional staining; the remainder were all negative. Of these negative nodes, 2 were found to be positive for micrometastases on serial sectioning and immunohistochemical staining. Therefore 2 of 3 positive nodes were not detected using conventional histologic techniques. Conclusion. Sentinel node dissection appears to be technically feasible in patients with vulvar cancer. Pathologic ultrastaging combined with sentinel node dissection appears to be highly sensitive for detecting subclinical micrometastases in the regional lymphatics. This technique potentially provides a more accurate assessment with less surgical morbidity than conventional inguinalfemoral lymphadenectomy.
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combined use of intraoperative lymphatic mapping and lymphoscintigraphy in the management of squamous cell cancer of the vulva
Gynecologic Oncology, 1998Co-Authors: Keith Terada, Marc N Coel, Jan H WongAbstract:Abstract Background. The standard care of the patient with squamous cell cancer of the vulva is radical vulvectomy along with inguinal–femoral node dissection. We explored the feasibility of sentinel lymphadenectomy in patients with squamous cell cancer of the vulva. Methods. Patients with biopsy proven squamous cell cancer of the vulva were studied with preoperative lymphoscintigraphy, intraoperative lymphatic mapping with Isosulfan Blue combined with intraoperative lymphoscintigraphy utilizing a hand-held gamma counter. Results. Five patients with invasive squamous cell cancer were studied. Sentinel nodes were identified in six lymphatic basins. One lymphatic basins had two sentinel nodes. Six of seven sentinel nodes were Blue and all retained radioactivity at a ratio of at least 3:1 above the background levels in the regional node basin. One patient was found to have metastatic tumor which was confined to a sentinel lymph node. There was minimal morbidity associated with the procedure. Conclusions. Lymphatic mapping is feasible in patients with squamous cell cancer of the vulva. These initial results suggests further study is warranted.
Eugene N Myers - One of the best experts on this subject based on the ideXlab platform.
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sentinel lymph node biopsy in head and neck squamous cell carcinoma
Laryngoscope, 2002Co-Authors: Karen T Pitman, Jonas T Johnson, Manuel L Brown, Eugene N MyersAbstract:Objectives/Hypothesis Sentinel lymph node biopsy is a minimally invasive method to stage the regional lymphatics that has revolutionized the management of patients with intermediate-thickness cutaneous melanoma. Head and neck surgeons have been encouraged by the accuracy of sentinel lymph node biopsy in cutaneous melanoma and have applied the technique to patients with head and neck squamous cell carcinoma (HNSCC). The objectives of the study were 1) to study the feasibility and accuracy of sentinel lymph node biopsy as a method to stage the regional lymphatics in HNSCC and 2) to determine whether there are qualitative differences between the cutaneous and mucosal lymphatics that would affect the technique used in HNSCC. Study Design Two methods of investigation were employed: a prospective laboratory study using a feline model for sentinel lymph node biopsy and a retrospective review of patients who received lymphoscintigraphy before neck dissection and intraoperative identification of the sentinel lymph node. Methods Lymphoscintigraphy and a gamma probe were used in four felines to study the kinetics of technetium-labeled sulfa colloid (Tc-SC) in the mucosal lymphatics. In the second part of the feline study, eight subjects were studied intraoperatively. Tc-SC and Isosulfan Blue dye were used to study the injection technique for the mucosal lymphatics and to determine the time course of the dye and Tc-SC to the sentinel lymph node. In Part II of the present study, a retrospective review of 33 patients with HNSCC was conducted. Twenty patients (stage N0) whose treatment included elective neck dissection were studied with preoperative lymphoscintigraphy and underwent intraoperative identification of the sentinel lymph node to determine the accuracy and feasibility of sentinel lymph node biopsy. Eight patients with palpable neck disease and five patients with recurrent or second primary disease whose previous treatment included neck dissection were also studied with lymphoscintigraphy before neck dissection. Results In the feline study, both Tc-SC and Isosulfan Blue dye traversed the lymphatics rapidly, appearing in the sentinel lymph node in less than 5 minutes. Modification of the injection technique used for cutaneous melanoma was required to depict the sentinel lymph node of the base of tongue. In the human study, the sentinel lymph node was accurately identified in 19 of 20 (95%) N0 patients. On average, 2.9 sentinel lymph nodes (range, 1–5) were identified in 2.2 (range, 1–4) levels of the neck. Sentinel lymph nodes were bilateral in 4 of 19 patients. When the sentinel lymph node was identified, it accurately predicted the pathological nodal status of the regional lymphatics. Three of 20 patients had cervical metastases, and the sentinel lymph node was identified in 2 of 3 patients with pathologic nodes (pN+). Focal areas of radiotracer uptake were identified in seven of eight patients with palpable disease. These areas corresponded to the level with palpable disease in four patients. The lymphatics delineated by lymphoscintigraphy in the five patients with previous neck dissection were outside the levels that had been dissected. Lymphoscintigraphy depicted collateral patterns of lymphatic drainage. Conclusions Sentinel lymph node biopsy is technically feasible and is a promising, minimally invasive method for staging the regional lymphatics in patients with stage N0 HNSCC. Lymphoscintigraphy alone may determine the levels that require treatment in patients with disrupted or previously operated cervical lymphatics.
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lymphatic mapping with Isosulfan Blue dye in squamous cell carcinoma of the head and neck
Archives of Otolaryngology-head & Neck Surgery, 1998Co-Authors: Karen T Pitman, Jonas T Johnson, Howard Edington, Leon E Barnes, Roger Day, Robin L Wagner, Eugene N MyersAbstract:Objective To determine whether intraoperative lymphatic mapping with Isosulfan Blue dye and sentinel lymph node biopsy accurately demonstrates the pathway of regional metastases from mucosal sites in squamous cell carcinoma of the head and neck. Design A prospective clinical study of intraoperative lymphatic mapping. Setting An academic tertiary referral center. Patients Patients with previously untreated squamous cell carcinoma of the head and neck whose surgical treatment included neck dissection. Intervention Injection of Isosulfan Blue dye into the mucosa surrounding squamous cell carcinomas of the upper aerodigestive tract during cervical lymphadenectomy. Outcome Measures Correlation of the pathologic findings in the Blue sentinel lymph node with those in the remaining cervical lymphatics. Results No Blue-stained cervical lymphatics were identified after injection of the mucosa surrounding the primary squamous cell carcinoma with Isosulfan dye. Conclusion The technique of intraoperative lymphatic mapping with Isosulfan Blue dye requires further study before it can be used for the detection of occult cervical metastases in squamous cell carcinoma of the head and neck.
Keith Terada - One of the best experts on this subject based on the ideXlab platform.
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outcomes for patients with t1 squamous cell cancer of the vulva undergoing sentinel node biopsy
Gynecologic Oncology, 2006Co-Authors: Keith Terada, Jan H Wong, David Shimizu, Caroline S JiangAbstract:Abstract Objective. This retrospective review was undertaken to evaluate survival in patients with T1 squamous cell carcinoma of the vulva treated with radical local excision and sentinel node dissection. Methods. Patients with T1 cancers underwent pre-operative lymphoscintigraphy and sentinel lymph node dissection using technetium sulfur colloid and Isosulfan Blue dye. The primary tumor was removed with radical local excision. Patients with negative sentinel nodes did not receive any additional treatment. Survival was calculated using life table analysis. Results. There were 21 patients who underwent 27 sentinel node dissections. Three patients were found to have positive sentinel nodes. At a median follow-up of 4.6 years, two patients have died of cancer, and three patients have died of intercurrent illness. None of the patients with negative sentinel nodes has died of cancer. There were no groin or distant recurrences in patients with negative sentinel nodes. Three-year disease-free survival for all patients and for patients with negative sentinel nodes were 90% and 100% respectively. Conclusion. The survival for patients with early vulvar cancer treated with sentinel node dissection and radical local excision appears excellent.
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combined use of intraoperative lymphatic mapping and lymphoscintigraphy in the management of squamous cell cancer of the vulva
Gynecologic Oncology, 1998Co-Authors: Keith Terada, Marc N Coel, Jan H WongAbstract:Abstract Background. The standard care of the patient with squamous cell cancer of the vulva is radical vulvectomy along with inguinal–femoral node dissection. We explored the feasibility of sentinel lymphadenectomy in patients with squamous cell cancer of the vulva. Methods. Patients with biopsy proven squamous cell cancer of the vulva were studied with preoperative lymphoscintigraphy, intraoperative lymphatic mapping with Isosulfan Blue combined with intraoperative lymphoscintigraphy utilizing a hand-held gamma counter. Results. Five patients with invasive squamous cell cancer were studied. Sentinel nodes were identified in six lymphatic basins. One lymphatic basins had two sentinel nodes. Six of seven sentinel nodes were Blue and all retained radioactivity at a ratio of at least 3:1 above the background levels in the regional node basin. One patient was found to have metastatic tumor which was confined to a sentinel lymph node. There was minimal morbidity associated with the procedure. Conclusions. Lymphatic mapping is feasible in patients with squamous cell cancer of the vulva. These initial results suggests further study is warranted.
Tomoaki Ueda - One of the best experts on this subject based on the ideXlab platform.
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a novel method for sentinel lymph node mapping using magnetite in patients with non small cell lung cancer
The Journal of Thoracic and Cardiovascular Surgery, 2003Co-Authors: Taku Nakagawa, Yoshihiro Minamiya, Yoshihisa Katayose, Hajime Saito, Kousei Taguchi, Hiroshi Imano, Hitoshi Watanabe, Katsuhiko Enomoto, Masato Sageshima, Tomoaki UedaAbstract:Abstract Objective The detection rate of sentinel lymph nodes in patients with non–small cell lung cancer using Isosulfan Blue dye is too low for clinical use. Although exposure to radioactivity is reportedly minimal, special procedures are nonetheless required when a radioactive isotope is used as a tracer. Therefore, to eliminate the need for a radioactive tracer and to obtain a better detection rate than is obtained with Isosulfan Blue dye, we have developed a novel method that employs magnetite as the tracer. The aim of the present study was to test the feasibility of this technique. Methods The tracer employed was ferumoxides, a colloidal superparamagnetic iron oxide of nonstoichiometric magnetite. Thirty-eight non–small cell lung cancer patients participated in the study; each received 5 mL of ferumoxides, injected around the tumor intraoperatively. Fifteen minutes after injection, lung resection and lymph node dissection were carried out. The magnetic force within the lymph nodes was measured using a highly sensitive handheld magnetometer ex vivo. All lymph nodes were also subjected to conventional histological analysis. Results The rate of detection of sentinel lymph nodes was 81.6% (31/38). The accuracy, sensitivity, and false-negative rates were 96.8% (30/31), 85.7% (6/7), and 14.3% (1/7), respectively. Conclusion Intraoperative sentinel lymph node mapping using ferumoxides and a highly sensitive magnetometer is a safe, accurate, and sensitive way to detect sentinel lymph nodes in non–small cell lung cancer patients.
Karen T Pitman - One of the best experts on this subject based on the ideXlab platform.
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sentinel lymph node biopsy in head and neck squamous cell carcinoma
Laryngoscope, 2002Co-Authors: Karen T Pitman, Jonas T Johnson, Manuel L Brown, Eugene N MyersAbstract:Objectives/Hypothesis Sentinel lymph node biopsy is a minimally invasive method to stage the regional lymphatics that has revolutionized the management of patients with intermediate-thickness cutaneous melanoma. Head and neck surgeons have been encouraged by the accuracy of sentinel lymph node biopsy in cutaneous melanoma and have applied the technique to patients with head and neck squamous cell carcinoma (HNSCC). The objectives of the study were 1) to study the feasibility and accuracy of sentinel lymph node biopsy as a method to stage the regional lymphatics in HNSCC and 2) to determine whether there are qualitative differences between the cutaneous and mucosal lymphatics that would affect the technique used in HNSCC. Study Design Two methods of investigation were employed: a prospective laboratory study using a feline model for sentinel lymph node biopsy and a retrospective review of patients who received lymphoscintigraphy before neck dissection and intraoperative identification of the sentinel lymph node. Methods Lymphoscintigraphy and a gamma probe were used in four felines to study the kinetics of technetium-labeled sulfa colloid (Tc-SC) in the mucosal lymphatics. In the second part of the feline study, eight subjects were studied intraoperatively. Tc-SC and Isosulfan Blue dye were used to study the injection technique for the mucosal lymphatics and to determine the time course of the dye and Tc-SC to the sentinel lymph node. In Part II of the present study, a retrospective review of 33 patients with HNSCC was conducted. Twenty patients (stage N0) whose treatment included elective neck dissection were studied with preoperative lymphoscintigraphy and underwent intraoperative identification of the sentinel lymph node to determine the accuracy and feasibility of sentinel lymph node biopsy. Eight patients with palpable neck disease and five patients with recurrent or second primary disease whose previous treatment included neck dissection were also studied with lymphoscintigraphy before neck dissection. Results In the feline study, both Tc-SC and Isosulfan Blue dye traversed the lymphatics rapidly, appearing in the sentinel lymph node in less than 5 minutes. Modification of the injection technique used for cutaneous melanoma was required to depict the sentinel lymph node of the base of tongue. In the human study, the sentinel lymph node was accurately identified in 19 of 20 (95%) N0 patients. On average, 2.9 sentinel lymph nodes (range, 1–5) were identified in 2.2 (range, 1–4) levels of the neck. Sentinel lymph nodes were bilateral in 4 of 19 patients. When the sentinel lymph node was identified, it accurately predicted the pathological nodal status of the regional lymphatics. Three of 20 patients had cervical metastases, and the sentinel lymph node was identified in 2 of 3 patients with pathologic nodes (pN+). Focal areas of radiotracer uptake were identified in seven of eight patients with palpable disease. These areas corresponded to the level with palpable disease in four patients. The lymphatics delineated by lymphoscintigraphy in the five patients with previous neck dissection were outside the levels that had been dissected. Lymphoscintigraphy depicted collateral patterns of lymphatic drainage. Conclusions Sentinel lymph node biopsy is technically feasible and is a promising, minimally invasive method for staging the regional lymphatics in patients with stage N0 HNSCC. Lymphoscintigraphy alone may determine the levels that require treatment in patients with disrupted or previously operated cervical lymphatics.
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lymphatic mapping with Isosulfan Blue dye in squamous cell carcinoma of the head and neck
Archives of Otolaryngology-head & Neck Surgery, 1998Co-Authors: Karen T Pitman, Jonas T Johnson, Howard Edington, Leon E Barnes, Roger Day, Robin L Wagner, Eugene N MyersAbstract:Objective To determine whether intraoperative lymphatic mapping with Isosulfan Blue dye and sentinel lymph node biopsy accurately demonstrates the pathway of regional metastases from mucosal sites in squamous cell carcinoma of the head and neck. Design A prospective clinical study of intraoperative lymphatic mapping. Setting An academic tertiary referral center. Patients Patients with previously untreated squamous cell carcinoma of the head and neck whose surgical treatment included neck dissection. Intervention Injection of Isosulfan Blue dye into the mucosa surrounding squamous cell carcinomas of the upper aerodigestive tract during cervical lymphadenectomy. Outcome Measures Correlation of the pathologic findings in the Blue sentinel lymph node with those in the remaining cervical lymphatics. Results No Blue-stained cervical lymphatics were identified after injection of the mucosa surrounding the primary squamous cell carcinoma with Isosulfan dye. Conclusion The technique of intraoperative lymphatic mapping with Isosulfan Blue dye requires further study before it can be used for the detection of occult cervical metastases in squamous cell carcinoma of the head and neck.