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Giovanni Paganelli - One of the best experts on this subject based on the ideXlab platform.
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Radioguided Sentinel Lymph Node Biopsy in Malignant Cutaneous Melanoma
The Journal of Nuclear Medicine, 2002Co-Authors: Giuliano Mariani, L Moresco, G Villa, Marco Gipponi, Mirco Bartolomei, Giovanni Mazzarol, Maria Claudia Bagnara, Antonella Romanini, Ferdinando Cafiero, Giovanni PaganelliAbstract:: The procedure of sentinel Lymph Node Biopsy in patients with malignant cutaneous melanoma has evolved from the notion that the tumor drains in a logical way through the Lymphatic system, from the first to subsequent levels. As a consequence, the first Lymph Node encountered (the sentinel Node) will most likely be the first affected by metastasis; therefore, a negative sentinel Node makes it highly unlikely that other Nodes in the same Lymphatic basin are affected. Although the long-term therapeutic benefit of the sentinel Lymph Node Biopsy per se has not yet been ascertained, this procedure distinguishes patients without nodal metastases, who can avoid nodal basin dissection with its associated risk of Lymphedema, from those with metastatic involvement, who may benefit from additional therapy. Sentinel Lymph Node Biopsy would represent a significant advantage as a minimally invasive procedure, considering that an average of only 20% of melanoma patients with a Breslow thickness between 1.5 and 4 mm harbor metastasis in their sentinel Node and are therefore candidates for elective Lymph Node dissection. Furthermore, histologic sampling errors (amounting to approximately 12% of Lymph Nodes in the conventional routine) can be reduced if one assesses a single (sentinel) Node extensively rather than assessing the standard few histologic sections in a high number of Lymph Nodes per patient. The cells from which cutaneous melanomas originate are located between the dermis and the epidermis, a zone that drains to the inner Lymphatic network in the reticular dermis and, in turn, to larger collecting Lymphatics in the subcutis. Therefore, the optimal route for interstitial administration of radiocolloids for Lymphoscintigraphy and subsequent radioguided sentinel Lymph Node Biopsy is intradermal or subdermal injection. (99m)Tc-Labeled colloids in various size ranges are equally adequate for radioguided sentinel Lymph Node Biopsy in patients with cutaneous melanoma, depending on local experience and availability. For melanomas along the midline of the head, neck, and trunk, particular consideration should be given to ambiguous Lymphatic drainage, which frequently requires interstitial administration virtually all around the tumor or surgical scar from prior excision of the melanoma. Lymphoscintigraphy is an essential part of radioguided sentinel Lymph Node Biopsy because images are used to direct the surgeon to the sites of the Nodes. The sentinel Lymph Node should have a significantly higher count than that of the background (at least 10:1 intraoperatively). After removal of the sentinel Node, the surgical bed must be reexamined to ensure that all radioactive sites are identified and removed for analysis. Virtually the entire sentinel Lymph Node should be processed for histopathology, including both conventional hematoxylin-eosin staining and immune staining with antibodies to the S-100 and HMB-45 antigens. The success rate of radioguidance in localizing the sentinel Lymph Node in melanoma patients is approximately 98% in institutions that perform a high number of procedures and approaches 99% when combined with the vital blue-dye technique. Growing evidence of the high correlation between a sentinel Lymph Node Biopsy negative for cancer and a negative status for the Lymphatic basin-evidence, therefore, of the high prognostic value of sentinel Node Biopsy-has led to the procedure's being included in the most recent version of the TNM staging system and starting to become the standard of care for patients with cutaneous melanoma.
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radioguided sentinel Lymph Node Biopsy in breast cancer surgery
The Journal of Nuclear Medicine, 2001Co-Authors: Giuliano Mariani, L Moresco, Giuseppe Viale, G Villa, Marcello Bagnasco, Giancarlo Canavese, John R Buscombe, H W Strauss, Giovanni PaganelliAbstract:: The concept of sentinel Lymph Node Biopsy in breast cancer surgery relates to the fact that the tumor drains in a logical way through the Lymphatic system, from the first to upper levels. Therefore, the first Lymph Node met (the sentinel Node) will most likely be the first to be affected by metastasis, and a negative sentinel Node makes it highly unlikely that other Nodes are affected. Because axillary Node dissection does not improve prognosis of patients with breast cancer (being important only to stage the axilla), sentinel Lymph Node Biopsy might replace complete axillary dissection to stage the axilla in clinically N0 patients. Sentinel Lymph Node Biopsy would represent a significant advantage as a minimally invasive procedure, considering that, after surgery, about 70% of patients are found to be free from metastatic disease, yet axillary Node dissection can lead to significant morbidity. Furthermore, histologic sampling errors can be reduced if a single (sentinel) Node is assessed extensively rather than few histologic sections in a high number of Lymph Nodes per patient. Although the pattern of Lymph drainage from breast cancer can be variable, the mammary gland and the overlying skin can be considered as a biologic unit in which Lymphatics tend to follow the vasculature. Therefore, considering that tumor Lymphatics are disorganized and relatively ineffective, subdermal and peritumoral injection of small aliquots of radiotracer is preferred to intratumoral administration. (99m)Tc-labeled colloids with most of the particles in the 100- to 200-nm size range would be ideal for radioguided sentinel Node Biopsy in breast cancer. Lymphoscintigraphy is an essential part of radioguided sentinel Lymph Node Biopsy because images are used to direct the surgeon to the site of the Node. The sentinel Lymph Node should have a significantly higher count than that of background (at least 10:1 intraoperatively). After removal of the sentinel Node, the axilla must be reexamined to ensure that all radioactive sites are identified and removed for analysis. The sentinel Lymph Node should be processed for intraoperative frozen section examination in its entirety, based on conventional histopathology and, when needed, immune staining with anticytokeratin antibody. The success rate of radioguidance in localizing the sentinel Lymph Node in breast cancer surgery is about 94%--97% in institutions where a high number of procedures are performed and approaches 99% when combined with the vital blue dye technique. At present, there is no definite evidence that negative sentinel Lymph Node Biopsy is invariably correlated with negative axillary status, except perhaps for T1a-b breast cancers, with a size of < or =1 cm. Randomized clinical trials should elucidate the impact of avoiding axillary Node dissection on patients with a negative sentinel Lymph Node on the long-term clinical outcome of patients.
Michael Douek - One of the best experts on this subject based on the ideXlab platform.
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novel techniques for sentinel Lymph Node Biopsy in breast cancer a systematic review
Lancet Oncology, 2014Co-Authors: Muneer Ahmed, Arnie Purushotham, Michael DouekAbstract:Summary The existing standard for axillary Lymph Node staging in breast cancer patients with a clinically and radiologically normal axilla is sentinel Lymph Node Biopsy with a radioisotope and blue dye (dual technique). The dependence on radioisotopes means that uptake of the procedure is limited to only about 60% of eligible patients in developed countries and is negligible elsewhere. We did a systematic review to assess three techniques for sentinel Lymph Node Biopsy that are not radioisotope dependent or that refine the existing method: indocyanine green fluorescence, contrast-enhanced ultrasound using microbubbles, and superparamagnetic iron oxide nanoparticles. Our systematic review suggested that these new methods for sentinel Lymph Node Biopsy have clinical potential but give high levels of false-negative results. We could not identify any technique that challenged the existing standard procedure. Further assessment of these techniques against the standard dual technique in randomised trials is needed.
Giuliano Mariani - One of the best experts on this subject based on the ideXlab platform.
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Sentinel Lymph Node Biopsy in Cutaneous Melanoma
Radioguided Surgery, 2020Co-Authors: Jeffrey E. Gershenwald, Roger F. Uren, Giuliano Mariani, John F. ThompsonAbstract:In a landmark paper published in 1992, Morton et al. (1) described the technique of Lymphatic mapping and sentinel Lymph Node Biopsy in melanoma and set in motion a series of changes that has led to a paradigm shift in the identification of nodal metastases in this disease. Using this approach, the specific Lymph Node or Nodes in a regional nodal basin that are the first to receive the afferent Lymphatic drainage from a primary cutaneous melanoma—the sentinel Nodes—are identified and removed. Since this approach limits the size of the surgical specimen submitted for evaluation (i.e., fewer Nodes), the sentinel Lymph Node(s) can be subjected to a more thorough pathological analysis to assess the presence of disease. The likelihood of identifying patients who harbor microscopic metastases, and thus may be offered early therapeutic Lymph Node dissection and adjuvant therapy, is improved. Since its introduction, the technique of Lymphatic mapping and sentinel Lymph Node Biopsy has been refined (2)–(4) and validated (1)–(8). Methods to more intensely assess the histologic status of the sentinel Lymph Node, including serial sectioning and immunohistochemistry (9)–(13) have been developed and refined to enhance identification of occult nodal disease.
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Radioguided Sentinel Lymph Node Biopsy in Malignant Cutaneous Melanoma
The Journal of Nuclear Medicine, 2002Co-Authors: Giuliano Mariani, L Moresco, G Villa, Marco Gipponi, Mirco Bartolomei, Giovanni Mazzarol, Maria Claudia Bagnara, Antonella Romanini, Ferdinando Cafiero, Giovanni PaganelliAbstract:: The procedure of sentinel Lymph Node Biopsy in patients with malignant cutaneous melanoma has evolved from the notion that the tumor drains in a logical way through the Lymphatic system, from the first to subsequent levels. As a consequence, the first Lymph Node encountered (the sentinel Node) will most likely be the first affected by metastasis; therefore, a negative sentinel Node makes it highly unlikely that other Nodes in the same Lymphatic basin are affected. Although the long-term therapeutic benefit of the sentinel Lymph Node Biopsy per se has not yet been ascertained, this procedure distinguishes patients without nodal metastases, who can avoid nodal basin dissection with its associated risk of Lymphedema, from those with metastatic involvement, who may benefit from additional therapy. Sentinel Lymph Node Biopsy would represent a significant advantage as a minimally invasive procedure, considering that an average of only 20% of melanoma patients with a Breslow thickness between 1.5 and 4 mm harbor metastasis in their sentinel Node and are therefore candidates for elective Lymph Node dissection. Furthermore, histologic sampling errors (amounting to approximately 12% of Lymph Nodes in the conventional routine) can be reduced if one assesses a single (sentinel) Node extensively rather than assessing the standard few histologic sections in a high number of Lymph Nodes per patient. The cells from which cutaneous melanomas originate are located between the dermis and the epidermis, a zone that drains to the inner Lymphatic network in the reticular dermis and, in turn, to larger collecting Lymphatics in the subcutis. Therefore, the optimal route for interstitial administration of radiocolloids for Lymphoscintigraphy and subsequent radioguided sentinel Lymph Node Biopsy is intradermal or subdermal injection. (99m)Tc-Labeled colloids in various size ranges are equally adequate for radioguided sentinel Lymph Node Biopsy in patients with cutaneous melanoma, depending on local experience and availability. For melanomas along the midline of the head, neck, and trunk, particular consideration should be given to ambiguous Lymphatic drainage, which frequently requires interstitial administration virtually all around the tumor or surgical scar from prior excision of the melanoma. Lymphoscintigraphy is an essential part of radioguided sentinel Lymph Node Biopsy because images are used to direct the surgeon to the sites of the Nodes. The sentinel Lymph Node should have a significantly higher count than that of the background (at least 10:1 intraoperatively). After removal of the sentinel Node, the surgical bed must be reexamined to ensure that all radioactive sites are identified and removed for analysis. Virtually the entire sentinel Lymph Node should be processed for histopathology, including both conventional hematoxylin-eosin staining and immune staining with antibodies to the S-100 and HMB-45 antigens. The success rate of radioguidance in localizing the sentinel Lymph Node in melanoma patients is approximately 98% in institutions that perform a high number of procedures and approaches 99% when combined with the vital blue-dye technique. Growing evidence of the high correlation between a sentinel Lymph Node Biopsy negative for cancer and a negative status for the Lymphatic basin-evidence, therefore, of the high prognostic value of sentinel Node Biopsy-has led to the procedure's being included in the most recent version of the TNM staging system and starting to become the standard of care for patients with cutaneous melanoma.
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radioguided sentinel Lymph Node Biopsy in breast cancer surgery
The Journal of Nuclear Medicine, 2001Co-Authors: Giuliano Mariani, L Moresco, Giuseppe Viale, G Villa, Marcello Bagnasco, Giancarlo Canavese, John R Buscombe, H W Strauss, Giovanni PaganelliAbstract:: The concept of sentinel Lymph Node Biopsy in breast cancer surgery relates to the fact that the tumor drains in a logical way through the Lymphatic system, from the first to upper levels. Therefore, the first Lymph Node met (the sentinel Node) will most likely be the first to be affected by metastasis, and a negative sentinel Node makes it highly unlikely that other Nodes are affected. Because axillary Node dissection does not improve prognosis of patients with breast cancer (being important only to stage the axilla), sentinel Lymph Node Biopsy might replace complete axillary dissection to stage the axilla in clinically N0 patients. Sentinel Lymph Node Biopsy would represent a significant advantage as a minimally invasive procedure, considering that, after surgery, about 70% of patients are found to be free from metastatic disease, yet axillary Node dissection can lead to significant morbidity. Furthermore, histologic sampling errors can be reduced if a single (sentinel) Node is assessed extensively rather than few histologic sections in a high number of Lymph Nodes per patient. Although the pattern of Lymph drainage from breast cancer can be variable, the mammary gland and the overlying skin can be considered as a biologic unit in which Lymphatics tend to follow the vasculature. Therefore, considering that tumor Lymphatics are disorganized and relatively ineffective, subdermal and peritumoral injection of small aliquots of radiotracer is preferred to intratumoral administration. (99m)Tc-labeled colloids with most of the particles in the 100- to 200-nm size range would be ideal for radioguided sentinel Node Biopsy in breast cancer. Lymphoscintigraphy is an essential part of radioguided sentinel Lymph Node Biopsy because images are used to direct the surgeon to the site of the Node. The sentinel Lymph Node should have a significantly higher count than that of background (at least 10:1 intraoperatively). After removal of the sentinel Node, the axilla must be reexamined to ensure that all radioactive sites are identified and removed for analysis. The sentinel Lymph Node should be processed for intraoperative frozen section examination in its entirety, based on conventional histopathology and, when needed, immune staining with anticytokeratin antibody. The success rate of radioguidance in localizing the sentinel Lymph Node in breast cancer surgery is about 94%--97% in institutions where a high number of procedures are performed and approaches 99% when combined with the vital blue dye technique. At present, there is no definite evidence that negative sentinel Lymph Node Biopsy is invariably correlated with negative axillary status, except perhaps for T1a-b breast cancers, with a size of < or =1 cm. Randomized clinical trials should elucidate the impact of avoiding axillary Node dissection on patients with a negative sentinel Lymph Node on the long-term clinical outcome of patients.
Muneer Ahmed - One of the best experts on this subject based on the ideXlab platform.
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novel techniques for sentinel Lymph Node Biopsy in breast cancer a systematic review
Lancet Oncology, 2014Co-Authors: Muneer Ahmed, Arnie Purushotham, Michael DouekAbstract:Summary The existing standard for axillary Lymph Node staging in breast cancer patients with a clinically and radiologically normal axilla is sentinel Lymph Node Biopsy with a radioisotope and blue dye (dual technique). The dependence on radioisotopes means that uptake of the procedure is limited to only about 60% of eligible patients in developed countries and is negligible elsewhere. We did a systematic review to assess three techniques for sentinel Lymph Node Biopsy that are not radioisotope dependent or that refine the existing method: indocyanine green fluorescence, contrast-enhanced ultrasound using microbubbles, and superparamagnetic iron oxide nanoparticles. Our systematic review suggested that these new methods for sentinel Lymph Node Biopsy have clinical potential but give high levels of false-negative results. We could not identify any technique that challenged the existing standard procedure. Further assessment of these techniques against the standard dual technique in randomised trials is needed.
Valentina Nekljudova - One of the best experts on this subject based on the ideXlab platform.
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sentinel Lymph Node Biopsy in patients with breast cancer before and after neoadjuvant chemotherapy sentina a prospective multicentre cohort study
Lancet Oncology, 2013Co-Authors: Thorsten Kuehn, I Bauerfeind, Tanja Fehm, Barbara Fleige, Maik Hausschild, Gisela Helms, Aurore Lebeau, Cornelia Liedtke, Gunter Von Minckwitz, Valentina NekljudovaAbstract:Summary Background The optimum timing of sentinel-Lymph-Node Biopsy for breast cancer patients treated with neoadjuvant chemotherapy is uncertain. The SENTINA (SENTinel NeoAdjuvant) study was designed to evaluate a specific algorithm for timing of a standardised sentinel-Lymph-Node Biopsy procedure in patients who undergo neoadjuvant chemotherapy. Methods SENTINA is a four-arm, prospective, multicentre cohort study undertaken at 103 institutions in Germany and Austria. Women with breast cancer who were scheduled for neoadjuvant chemotherapy were enrolled into the study. Patients with clinically Node-negative disease (cN0) underwent sentinel-Lymph-Node Biopsy before neoadjuvant chemotherapy (arm A). If the sentinel Node was positive (pN1), a second sentinel-Lymph-Node Biopsy procedure was done after neoadjuvant chemotherapy (arm B). Women with clinically Node-positive disease (cN+) received neoadjuvant chemotherapy. Those who converted to clinically Node-negative disease after chemotherapy (ycN0; arm C) were treated with sentinel-Lymph-Node Biopsy and axillary dissection. Only patients whose clinical nodal status remained positive (ycN1) underwent axillary dissection without sentinel-Lymph-Node Biopsy (arm D). The primary endpoint was accuracy (false-negative rate) of sentinel-Lymph-Node Biopsy after neoadjuvant chemotherapy for patients who converted from cN1 to ycN0 disease during neoadjuvant chemotherapy (arm C). Secondary endpoints included comparison of the detection rate of sentinel-Lymph-Node Biopsy before and after neoadjuvant chemotherapy, and also the false-negative rate and detection rate of sentinel-Lymph-Node Biopsy after removal of the sentinel Lymph Node. Analyses were done according to treatment received (per protocol). Findings Of 1737 patients who received treatment, 1022 women underwent sentinel-Lymph-Node Biopsy before neoadjuvant chemotherapy (arms A and B), with a detection rate of 99·1% (95% CI 98·3–99·6; 1013 of 1022). In patients who converted after neoadjuvant chemotherapy from cN+ to ycN0 (arm C), the detection rate was 80·1% (95% CI 76·6–83·2; 474 of 592) and false-negative rate was 14·2% (95% CI 9·9–19·4; 32 of 226). The false-negative rate was 24·3% (17 of 70) for women who had one Node removed and 18·5% (10 of 54) for those who had two sentinel Nodes removed (arm C). In patients who had a second sentinel-Lymph-Node Biopsy procedure after neoadjuvant chemotherapy (arm B), the detection rate was 60·8% (95% CI 55·6–65·9; 219 of 360) and the false-negative rate was 51·6% (95% CI 38·7–64·2; 33 of 64). Interpretation Sentinel-Lymph-Node Biopsy is a reliable diagnostic method before neoadjuvant chemotherapy. After systemic treatment or early sentinel-Lymph-Node Biopsy, the procedure has a lower detection rate and a higher false-negative rate compared with sentinel-Lymph-Node Biopsy done before neoadjuvant chemotherapy. These limitations should be considered if Biopsy is planned after neoadjuvant chemotherapy. Funding Brustkrebs Deutschland, German Society for Senology, German Breast Group.
