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Ramin Sadeghi - One of the best experts on this subject based on the ideXlab platform.
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Sentinel node Mapping in vulvar cancers: report of two cases and literature review
iranian journal of nuclear medicine, 2020Co-Authors: Ramin Sadeghi, Zahra Shiravani, Malihe Hasanzadeh, Zohreh Yousefi, Sima Kadkhodayan, Noorieh Sharifi, Keyvan Sadri, Seyed Rasoul ZakaviAbstract:Vulvar cancer is a rare gynecological malignancy with mainly lymphatic spread. Sentinel node Mapping plays an important role in the management of this gynecological malignancy. In the current study, we reported our experience in sentinel node Mapping of vulvar cancer and review the literature accordingly. Since the introduction of sentinel node Mapping to the surgical oncology community of our university in 2004, we had two operable vulvar cancer patients who were candidate for sentinel node Mapping for inguinal lymph node staging. In the current study, we reported these two cases in details and a brief review of literature on sentinel node Mapping in vulvar cancer was done. We specifically discussed the overall accuracy, importance of blue dye injection, learning curve effect, frozen section, excisional biopsy and location of the tumors. Overall sentinel node Mapping is a safe and effective method for inguinal lymph node staging in vulvar cancers. In order to perform sentinel node Mapping efficiently, paying attention to the details is of utmost importance.
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Concordance between peri-areolar blue dye and peri-incisional radiotracer injections for sentinel node Mapping in patients with a history of primary breast cancer excisonal biopsy.
Acta Chirurgica Belgica, 2020Co-Authors: Mehrabibahar M, Ramin Sadeghi, Azizi S, Jangjoo A, Elena Saremi, Kakhki Vr, Chicken Dw, Mohammed KeshtgarAbstract:We evaluated the concordance between peri-areolar blue dye and peri-incisional radiotracer injections for axillary sentinel node Mapping of patients with the history of previous breast lesion excisional biopsy. 80 patients with the history of previous excisional biopsy of the breast lesions were included. All patients received two injections of 99mTc-antimony sulfide colloid in both ends of incision line in an intradermal fashion. 2 mL patient blue V dye was injection to all patients in the peri-areolar area of the index quadrant after induction of anesthesia. All blue or hot nodes were harvested as sentinel lymph nodes. At least one sentinel node could be detected during surgery in 79 patients. In total 94 sentinel nodes were detected. All detected sentinel nodes were hot. In three patients sentinel nodes were detected by gamma probe but not blue dye. The tumor location in all of these patients was in the upper lateral quadrant and the incision line was extended into the axillary tail of the breast in all of them. 91 out of 94 sentinel nodes were stained blue, which amounts to 95.8% concordance between blue dye and radiotracer on a per node analysis. Single peri-areolar injection in the index quadrant would suffice for sentinel node Mapping of patients with history of excisional biopsy. Care should be taken in patients with large excisional biopsy in the extreme proximity to axilla.
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The efficacy of Tc-99m sestamibi for sentinel node Mapping in breast carcinomas: comparison with Tc-99m antimony sulphide colloid
Nuclear Medicine Review, 2020Co-Authors: Ramin Sadeghi, Seyed Rasoul Zakavi, Fatemeh Homaee Shandiz, Vahid Reza Dabbagh Kakhki, Mohammad Naser Forghani, Kamran Aryana, Narjes Ayati, Mohammad Reza Ghavamnasiri, Mohammed KeshtgarAbstract:BACKGROUND : To study the value of periareolar intra-dermal injection of Tc-99m sestamibi (MIBI) for sentinel node Mapping in breast carcinoma. MATERIAL AND METHODS : Fifty patients with early-stage breast cancer were included in our study. 17.5 MBq Tc-99m-MIBI was injected intradermally to 25 patients and the remainders were injected with the same dose of Tc-99m-antimony sulphide colloid. Anterior and lateral static images were taken at 2 minutes. If sentinel lymph node was not detected, delayed imaging by up to 180 minutes was carried out. The patients were operated on 2–4 hours post-injection. Sentinel lymph node biopsy was performed by the aid of gamma probe and blue dye during surgery. RESULTS : In the Tc-99m-MIBI group, 23 patients had lymph nodes on scintigraphy images, and sentinel nodes were detected during surgery in all 23 patients. In the Tc-99m-antimony sulphide colloid group, 24 patients had lymph nodes on scintigraphy images, and sentinel nodes were identified during surgery in 24 patients. CONCLUSIONS : We concluded that 99mTc-MIBI is a suitable radiopharmaceutical for sentinel node detection. Nuclear Med Rev 2010; 13, 1: 1–4
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Sentinel Node Mapping in Non-small Cell Lung Cancer Using an Intraoperative Radiotracer Technique
Asia Oceania journal of nuclear medicine & biology, 2019Co-Authors: Susan Shafiei, Ramin Sadeghi, Vahid Reza Dabbagh Kakhki, Reza Bagheri, Amir Hossein Jafarian, Reza Afghani, Davood Attaran, Reza Basiri, Shahrzad M. LariAbstract:Objective(s): Lymph node metastases are the most significant prognostic factor in localized non-small cell lung cancer (NSCLC). Identification of the first nodal drainage site (sentinel node) may improve detection of metastatic nodes. Extended surgeries, such as lobectomy or pneumonectomy with lymph node dissection, are among the therapeutic options of higher acceptability. Sentinel node biopsy can be an alternative approach to less invasive surgeries. The current study was conducted to evaluate the accuracy of sentinel node Mapping in patients with NSCLC using an intraoperative radiotracer techniques. Methods: This prospective study was conducted on 21 patients with biopsy-proven NSCLC who were candidates for sentinel node Mapping during 2012-2014. All patients underwent thoracoabdominal computed tomography, based on which they had no lymph node involvement. Immediately after thoracotomy and before mobilizing the tumor, peritumoral injection of 2mCi/0.4 mL Tc-99m- phytate was performed in 4 corners of tumor. After mobilization of the tumoral tissues, the sentinel nodes were searched for in the hillar and mediastinal areas using hand-held gamma probe . Any lymph node with in vivo count twice the background was considered as sentinel node and removed and sent for frozen section evaluation. All dissected nodes were evaluated by step sectioning and hematoxylin and eosin staining (H&E).The recorded data included age, gender, kind of pathology, site of lesion, number of dissected sentinel nodes, number of sentinel nodes, and site of sentinel nodes. Data analysis was performed in SPSS software (version 22). Results: The mean age of the patients was 58.52±11.46 years with a male to female ratio of 15/6. The left lower lobe was the most commonly affected site (30.09). Squamous cell carcinoma and adenocarcinoma were detected in 11 and 10 subjects, respectively. A total of 120 lymph nodes were harvested with the mean number of 5.71±2.9 lymph nodes per patient. At least one sentinel node was identified in each patient, resulting in a detection rate of 95.2. The mean number of sentinel nodes per patient was 3.61±2. Frozen section results showed 100 concordance with the results of hematoxylin and eosin staining. Conclusion: Based on the findings, sentinel node Mapping can be considered feasible and accurate for lymph node staging and NSCLC treatment.
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is sentinel node Mapping possible in surgically removed ectopic axillary breast cancer a case report
Nuclear Medicine Review, 2016Co-Authors: Royasadat Alavifard, Sima Kadkhodayan, Fatemeh Homaee Shandiz, Vahid Reza Dabbagh, Ramin SadeghiAbstract:We reported a 24-year-old female patient with the history of ectopic axillary breast cancer which was removed surgically. Sentinel node Mapping was performed for lymphatic axillary staging of this patient with two injections of the 99m-Tc-phytate in both ends of the surgical scar. Lymphoscintigraphy showed an axillary sentinel node which was harvested during surgery and was not pathologically involved. Our case showed that sentinel node Mapping is possible for ectopic axillary breast cancer patients even after excisional biopsy of the index lesion.
Seyed Rasoul Zakavi - One of the best experts on this subject based on the ideXlab platform.
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Sentinel node Mapping in vulvar cancers: report of two cases and literature review
iranian journal of nuclear medicine, 2020Co-Authors: Ramin Sadeghi, Zahra Shiravani, Malihe Hasanzadeh, Zohreh Yousefi, Sima Kadkhodayan, Noorieh Sharifi, Keyvan Sadri, Seyed Rasoul ZakaviAbstract:Vulvar cancer is a rare gynecological malignancy with mainly lymphatic spread. Sentinel node Mapping plays an important role in the management of this gynecological malignancy. In the current study, we reported our experience in sentinel node Mapping of vulvar cancer and review the literature accordingly. Since the introduction of sentinel node Mapping to the surgical oncology community of our university in 2004, we had two operable vulvar cancer patients who were candidate for sentinel node Mapping for inguinal lymph node staging. In the current study, we reported these two cases in details and a brief review of literature on sentinel node Mapping in vulvar cancer was done. We specifically discussed the overall accuracy, importance of blue dye injection, learning curve effect, frozen section, excisional biopsy and location of the tumors. Overall sentinel node Mapping is a safe and effective method for inguinal lymph node staging in vulvar cancers. In order to perform sentinel node Mapping efficiently, paying attention to the details is of utmost importance.
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The efficacy of Tc-99m sestamibi for sentinel node Mapping in breast carcinomas: comparison with Tc-99m antimony sulphide colloid
Nuclear Medicine Review, 2020Co-Authors: Ramin Sadeghi, Seyed Rasoul Zakavi, Fatemeh Homaee Shandiz, Vahid Reza Dabbagh Kakhki, Mohammad Naser Forghani, Kamran Aryana, Narjes Ayati, Mohammad Reza Ghavamnasiri, Mohammed KeshtgarAbstract:BACKGROUND : To study the value of periareolar intra-dermal injection of Tc-99m sestamibi (MIBI) for sentinel node Mapping in breast carcinoma. MATERIAL AND METHODS : Fifty patients with early-stage breast cancer were included in our study. 17.5 MBq Tc-99m-MIBI was injected intradermally to 25 patients and the remainders were injected with the same dose of Tc-99m-antimony sulphide colloid. Anterior and lateral static images were taken at 2 minutes. If sentinel lymph node was not detected, delayed imaging by up to 180 minutes was carried out. The patients were operated on 2–4 hours post-injection. Sentinel lymph node biopsy was performed by the aid of gamma probe and blue dye during surgery. RESULTS : In the Tc-99m-MIBI group, 23 patients had lymph nodes on scintigraphy images, and sentinel nodes were detected during surgery in all 23 patients. In the Tc-99m-antimony sulphide colloid group, 24 patients had lymph nodes on scintigraphy images, and sentinel nodes were identified during surgery in 24 patients. CONCLUSIONS : We concluded that 99mTc-MIBI is a suitable radiopharmaceutical for sentinel node detection. Nuclear Med Rev 2010; 13, 1: 1–4
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Sentinel node Mapping in papillary thyroid carcinoma using combined radiotracer and blue dye methods
Endokrynologia Polska, 2014Co-Authors: Assadi, Seyed Rasoul Zakavi, Ali Jangjoo, Mostafa Mehrabibahar, Bahram Memar, Mohammad Yarani, Giorgio Treglia, Mohsen Aliakbarian, Ramin SadeghiAbstract:Introduction: In the current study, we evaluated the accuracy of sentinel node Mapping in thyroid cancer patients using both radiotracer and blue dye. Material and methods: 30 patients with a diagnosis of papillary thyroid carcinoma (PTC) were included in the study; 2–3 hours before surgery, 0.5 mCi 99m-Tc-Antimony Sulfide Colloid was injected intra-tumourally. 15 minutes post-injection, lymphoscintigraphy images of the neck were obtained. Immediately after anaesthesia induction, 0.5 mL patent blue V was also injected in the same fashion. Sentinel lymph nodes were detected intraoperatively using gamma probe and blue dye. Total thyroidectomy was performed for all patients with dissection of central neck lymph nodes as well as sampling of the lateral neck lymph nodes. Results: At least one sentinel node could be identified during surgery in 19 patients (63.3%). The median number of sentinel nodes per patient was 1. Sentinel nodes in 12 patients were pathologically involved. No false negative case was noted. Upstaging occurred in six patients (20%). Conclusions: Sentinel node Mapping in papillary thyroid carcinoma is a feasible technique with high accuracy for the detection of lymph node involvement. This technique can guide surgeons to perform central lymph node dissection only in patients with pathologically involved sentinel nodes. Although SLN detection in the lateral neck lymph nodes increases the extension of lymphadenectomy, SLN Mapping can result in upstaging in older patients (> 45 years of age) or treatment plan change in younger patients (< 45 years of age) by the detection of lateral lymph node involvement. (Endokrynol Pol 2014; 65 (4): 281–286)
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Determining axillary concordance rate for different injection locations in sentinel node Mapping of breast cancer: how ambitious can we get?
Breast Cancer Research and Treatment, 2014Co-Authors: Ramin Sadeghi, Seyed Rasoul Zakavi, Asieh Sadat Fattahi, Giorgio Treglia, Mehdi Asadi, David N. KragAbstract:First of all, we would like to thank Muneer Ahmed for the interest in our systematic review published in Breast Cancer Research and Treatment [1]. In his comment on our systematic review, Ahmed mentioned that determination of intraoperative axillary concordance rate (for deep and superficial injection techniques) using two different Mapping materials (radiotracer and blue dyes) can limit the conclusion that we could make as the same technique is not used for both injection sites. We totally agree with Muneer Ahmed that for determination of concordance rate, the best method is to compare ‘‘like with like.’’ Actually, using two different Mapping materials for deep and superficial injections can be considered as a major limitation for concordance determination in sentinel node Mapping studies. However, in order to evaluate axillary concordance rate, we only have two options to choose:
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Axillary concordance between superficial and deep sentinel node Mapping material injections in breast cancer patients: systematic review and meta-analysis of the literature
Breast Cancer Research and Treatment, 2014Co-Authors: Ramin Sadeghi, Seyed Rasoul Zakavi, Asieh Sadat Fattahi, Giorgio Treglia, Mehdi Asadi, David N. KragAbstract:It is still unclear whether the deep and superficial lymphatics of the breast always drain into the same nodes and which route best simulates the spread of breast cancer. In the current study, we systematically searched the available literature to find the studies evaluated the sentinel node locations of deep and superficial injections in the same patients simultaneously or serially. We searched SCOPUS, and PUBMED for relevant studies. Patient basis concordance rate was defined as the ratio of patients with at least one identified axillary sentinel node by both deep and superficial injections to all patients with identified axillary sentinel nodes using either methods. Sentinel node basis concordance was defined as the ratio of the number of axillary sentinel nodes identified by both deep and superficial injections to the sum of all identified axillary sentinel nodes using either methods. Pooled sentinel node detection rates were 94 % [92.1–95.5], 91.2 % [87.1–94.1], and 97.2 % [96–98] for superficial, deep, and combined (superficial and deep) injections. Pooled patient basis and sentinel node basis concordance rates were 90 % [86.7–92.4] and 73 % [63.3–80.9]. Pooled false negative rates were 9.1 % [5.9–14], 8.6 % [3.7–18.8], and 6.5 % [3.4–11.9] for superficial, deep, and combined (superficial and deep) injections, respectively. Axillary lymphatic drainage concordance between superficial and deep sentinel node Mapping material in breast cancer patients is fairly high and clinically acceptable. However, both injection techniques can complement each other and the combined superficial/deep injection technique seems to be more successful clinically and can decrease the overall false negative rate.
Vahid Reza Dabbagh Kakhki - One of the best experts on this subject based on the ideXlab platform.
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The efficacy of Tc-99m sestamibi for sentinel node Mapping in breast carcinomas: comparison with Tc-99m antimony sulphide colloid
Nuclear Medicine Review, 2020Co-Authors: Ramin Sadeghi, Seyed Rasoul Zakavi, Fatemeh Homaee Shandiz, Vahid Reza Dabbagh Kakhki, Mohammad Naser Forghani, Kamran Aryana, Narjes Ayati, Mohammad Reza Ghavamnasiri, Mohammed KeshtgarAbstract:BACKGROUND : To study the value of periareolar intra-dermal injection of Tc-99m sestamibi (MIBI) for sentinel node Mapping in breast carcinoma. MATERIAL AND METHODS : Fifty patients with early-stage breast cancer were included in our study. 17.5 MBq Tc-99m-MIBI was injected intradermally to 25 patients and the remainders were injected with the same dose of Tc-99m-antimony sulphide colloid. Anterior and lateral static images were taken at 2 minutes. If sentinel lymph node was not detected, delayed imaging by up to 180 minutes was carried out. The patients were operated on 2–4 hours post-injection. Sentinel lymph node biopsy was performed by the aid of gamma probe and blue dye during surgery. RESULTS : In the Tc-99m-MIBI group, 23 patients had lymph nodes on scintigraphy images, and sentinel nodes were detected during surgery in all 23 patients. In the Tc-99m-antimony sulphide colloid group, 24 patients had lymph nodes on scintigraphy images, and sentinel nodes were identified during surgery in 24 patients. CONCLUSIONS : We concluded that 99mTc-MIBI is a suitable radiopharmaceutical for sentinel node detection. Nuclear Med Rev 2010; 13, 1: 1–4
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Sentinel Node Mapping in Non-small Cell Lung Cancer Using an Intraoperative Radiotracer Technique
Asia Oceania journal of nuclear medicine & biology, 2019Co-Authors: Susan Shafiei, Ramin Sadeghi, Vahid Reza Dabbagh Kakhki, Reza Bagheri, Amir Hossein Jafarian, Reza Afghani, Davood Attaran, Reza Basiri, Shahrzad M. LariAbstract:Objective(s): Lymph node metastases are the most significant prognostic factor in localized non-small cell lung cancer (NSCLC). Identification of the first nodal drainage site (sentinel node) may improve detection of metastatic nodes. Extended surgeries, such as lobectomy or pneumonectomy with lymph node dissection, are among the therapeutic options of higher acceptability. Sentinel node biopsy can be an alternative approach to less invasive surgeries. The current study was conducted to evaluate the accuracy of sentinel node Mapping in patients with NSCLC using an intraoperative radiotracer techniques. Methods: This prospective study was conducted on 21 patients with biopsy-proven NSCLC who were candidates for sentinel node Mapping during 2012-2014. All patients underwent thoracoabdominal computed tomography, based on which they had no lymph node involvement. Immediately after thoracotomy and before mobilizing the tumor, peritumoral injection of 2mCi/0.4 mL Tc-99m- phytate was performed in 4 corners of tumor. After mobilization of the tumoral tissues, the sentinel nodes were searched for in the hillar and mediastinal areas using hand-held gamma probe . Any lymph node with in vivo count twice the background was considered as sentinel node and removed and sent for frozen section evaluation. All dissected nodes were evaluated by step sectioning and hematoxylin and eosin staining (H&E).The recorded data included age, gender, kind of pathology, site of lesion, number of dissected sentinel nodes, number of sentinel nodes, and site of sentinel nodes. Data analysis was performed in SPSS software (version 22). Results: The mean age of the patients was 58.52±11.46 years with a male to female ratio of 15/6. The left lower lobe was the most commonly affected site (30.09). Squamous cell carcinoma and adenocarcinoma were detected in 11 and 10 subjects, respectively. A total of 120 lymph nodes were harvested with the mean number of 5.71±2.9 lymph nodes per patient. At least one sentinel node was identified in each patient, resulting in a detection rate of 95.2. The mean number of sentinel nodes per patient was 3.61±2. Frozen section results showed 100 concordance with the results of hematoxylin and eosin staining. Conclusion: Based on the findings, sentinel node Mapping can be considered feasible and accurate for lymph node staging and NSCLC treatment.
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Intra-Operative Lymphatic Mapping and Sentinel Node Biopsy in Laryngeal Carcinoma: Preliminary Results.
Iranian Journal of Otorhinolaryngology, 2015Co-Authors: Ehsan Khadivi, Vahid Reza Dabbagh Kakhki, Leili Zarifmahmoudi, Maryam Daghighi, Kamran Khazani, Ramin SadeghiAbstract:Introduction: Sentinel node Mapping has been used for laryngeal carcinoma in several studies, with excellent results thus far. In the current study, we report our preliminary results on sentinel node Mapping in laryngeal carcinoma using intra-operative peri-tumoral injection of a radiotracer. Materials and Methods: Patients with biopsy-proven squamous cell carcinoma of the larynx were included in the study. Two mCi/0.4 cc Tc-99m-phytate in four aliquots was injected on the day of surgery, after induction of anesthesia, in the sub-mucosal peri-tumoral location using a suspension laryngoscopy. After waiting for 10 minutes, a portable gamma probe was used to search for sentinel nodes. All patients underwent laryngectomy and modified radical bilateral neck dissection. All sentinel nodes and removed non-sentinel nodes were examined by hematoxylin and eosin (H&E) staining. Results: Ten patients with laryngeal carcinoma were included. At least one sentinel node could be detected in five patients (bilateral nodes in four patients). One patient had pathologically involved sentinel and non-sentinel nodes (no false-negative cases). Conclusion: Sentinel node Mapping in laryngeal carcinoma is technically feasible using an intra-operative radiotracer injection. In order to evaluate the relationship of T-stage and the laterality of the tumor with accuracy, larger studies are needed.
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Sentinel node Mapping in esophageal squamous cell carcinoma using intra-operative combined blue dye and radiotracer techniques
Esophagus, 2013Co-Authors: Reza Bagheri, Seyed Rasoul Zakavi, Vahid Reza Dabbagh Kakhki, Amir Hossein Jafarian, Fatemeh Naghavi, Asieh Sadat Fattahi, Seyed Ziaollah Haghi, Ramin SadeghiAbstract:Background Extended surgeries such as two- or three-field lymph node dissections are gaining more acceptance for treatment of esophageal cancer. Sentinel node biopsy is an alternative approach in this regard. In the current study we evaluated the accuracy of sentinel node Mapping of the squamous cell carcinoma of the esophagus using intra-operative combined blue dye and radiotracer techniques.
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Sentinel node Mapping for early breast cancer patients using 99mTc-phytate: Single center experience on 165 patients
iranian journal of nuclear medicine, 2012Co-Authors: Vahid Reza Dabbagh Kakhki, Keyvan Sadri, Ali Jangjoo, Alireza Tavassoli, Asadi, Asiehsadat Fatahi Masoom, Mostafa Mehrabibahar, Bahram Memar, Mojtaba Ansari, Ramin SadeghiAbstract:Introduction: Several radiotracers are being used for sentinel node Mapping in patients with breast cancer. In the current study, we reported our experience with 99m-Tc Phytate for sentinel node Mapping in Mashhad University of Medical Sciences. Methods: All breast cancer patients who underwent sentinel node Mapping using 99m-Tc Phytate were included. All patients received intradermal peri-areolar injection of 0.5 mCi/0.1cc 99m-Tc Phytate. Lymphoscintiraphy was performed for 145 patients 5-10 minutes post-injection. The sentinel nodes were found during surgery using a hand-held gamma probe as well as blue dye technique. Results: In total 165 patients were evaluated. Lymphoscintigraphy showed axillary sentinel nodes in 135 out of 145 patients (93%) following imaging. At least one sentinel node could be detected in all these 135 patients during surgery. In the remaining 10 patients with sentinel node non-visualization, 5 had sentinel node harvesting failure during surgery. Median number of sentinel nodes on the lymphoscintigraphy images was 1. Sentinel node detection rate was 95% (157/165). In the 8 patients with sentinel node harvesting failure, 7 had pathologically involved axilla. Median number of harvested sentinel nodes was 1. Mean sentinel node to background count ratio was 10±2. Conclusions: 99m-Tc Phytate is an effective and highly successful radiotracer for sentinel node Mapping. Sentinel node can be visualized in a short time after 99m-Tc Phytate injection on the lymphoscintigraphy images. The sentinel to background count during surgery is high which results in more convenient sentinel node harvesting and high detection rate.
George M. Fuhrman - One of the best experts on this subject based on the ideXlab platform.
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5-year follow-up after sentinel node Mapping for breast cancer demonstrates better than expected treatment outcomes
American Surgeon, 2020Co-Authors: George M. Fuhrman, John S. Bolton, Jamie Gambino, Gist H. Farr, Xiaozhang JiangAbstract:We conducted this study to provide one of the initial assessments of treatment outcomes for breast cancer patients evaluated with sentinel node Mapping. All patients diagnosed with breast carcinoma, evaluated with sentinel node Mapping, and followed for 5 years were divided into three groups depending on sentinel node(s) status. Group I (node negative) included 91 patients, 77 with invasive cancer, and 7 lost to follow-up. Of the remaining 70 patients, 3 (4.3%) suffered a distant recurrence and died, 1 developed an in-breast recurrence, and 9 (12.9%) developed a contralateral cancer during the study. Group II (IHC positive) included 28 patients. One (3.6%) developed a distant recurrence and died of breast cancer, and one developed a contralateral cancer during follow. Group III (H&E positive) included 36 patients with 1 lost to follow-up. Five patients (14.3%) died of breast cancer and two (5.7%) developed contralateral carcinomas during follow-up. The most striking observation was a lower than expected rate of distant recurrences in these patients followed for 5 years after a diagnosis of breast cancer and staging with sentinel node Mapping. The ability to identify subtle nodal metastasis and design appropriate systemic therapeutic strategies may explain this finding.
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Lessons learned from the initial 100 patient experience with sentinel lymph node Mapping in the evaluation of breast cancer.
The Ochsner journal, 2020Co-Authors: George M. Fuhrman, Gist H. Farr, Ernest G. Burch, Tari A. King, E. A. Farkas, John S. BoltonAbstract:The initial reports of sentinel lymph node Mapping for breast cancer currently appearing in the surgical literature are demonstrating the practicality and accuracy of the technique to evaluate patients for axillary nodal disease. We reviewed our initial 100 patient experience with sentinel node Mapping to evaluate our ability to employ this technique in breast cancer patients. We combined a peritumoral injection of a radioactive substance and blue dye. Each sentinel node was evaluated with frozen section analysis, hematoxylin and eosin staining, and, if still negative, five re-cuts were taken from deeper levels of the node and evaluated for immunohistochemical evidence of cytokeratin staining. Sentinel node(s) were identified in all but two patients with 51% demonstrating metastasis. We have demonstrated the ability to accurately perform sentinel node Mapping in the evaluation of our breast cancer patients. This exciting advance should become a standard part of breast cancer surgery.
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An argument against routine sentinel node Mapping for DCIS
American Surgeon, 2020Co-Authors: E. A. Farkas, Alan J. Stolier, John S. Bolton, S. C. Teng, George M. FuhrmanAbstract:Indications for sentinel lymph node Mapping (SLNM) for patients with ductal carcinoma in situ (DCIS) of the breast are controversial. We reviewed our institutional experience with SLNM for DCIS to determine the node positive rate and clarify indications for nodal staging in patients with DCIS. Since 1998 we have used SLNM to stage breast cancer patients using both blue dye and radiocolloid. In DCIS patients, SLNM has been reserved for patients considered at high risk for harboring coexistent invasive carcinoma or treated by mastectomy. All sentinel nodes were evaluated with serial sectioning, hematoxylin and eosin staining, and immunohistochemical evaluation for cytokeratins. We identified 44 patients with 46 cases of DCIS (two patients with bilateral disease). SLNM identified at least one sentinel node in all cases. In all cases, the sentinel node(s) were negative for axillary metastasis. We calculated the binomial probability of observing 0 of 46 cases as negative when the expected incidence according to published reports in the surgical literature was 13 per cent and found a P value of
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Pro: SLNB in DCIS
Annals of Surgical Oncology, 2006Co-Authors: George M. FuhrmanAbstract:The role of sentinel node Mapping and biopsy in the management of ductal carcinoma in situ (DCIS) remains controversial. A debate about the use of a staging technique for the evaluation of a malignancy without metastatic potential seems absurd. However, this debate is fueled by two factors. First, some patients diagnosed with DCIS will ultimately prove to have invasive carcinoma. Second, the status of the sentinel node is the most powerful predictor of prognosis and surgeons want to ensure that those patients with invasive carcinoma have sentinel node Mapping for staging and treatment planning. In order to understand this debate an appreciation of the evolution of breast cancer management over the past decade is essential. The two most important historical events in this evolution have been the appreciation of the relationship of prior lumpectomy and its impact on lymphatic drainage from the breast to the sentinel node, and the increasing use of image guided core needle breast biopsies to sample mammographic abnormalities that may underestimate the extent of breast pathology. When Morton et al. 1 initially described the use of sentinel node Mapping for melanoma, a minimally or undisturbed primary tumor site was considered essential for accurate identification of the sentinel node. In fact, a wide excision of a primary melanoma prior to referral for sentinel node Mapping was considered a contraindication and these patients were denied sentinel node staging. When sentinel node Mapping was initially described for breast carcinoma, a precise injection of colloid and/or dye around an intact primary tumor were considered important technical aspects in order to identify the correct sentinel node in the axilla. 2 Like melanoma patients, if the primary breast tumor was removed prior to referral for sentinel node Mapping, the potential inaccuracy of the technique was used as a criterion to exclude patients from Mapping. Mapping was done routinely at the time of DCIS management to avoid losing the opportunity to stage the axilla after excision when invasive carcinoma was subsequently identified. Subsequent experience in melanoma and breast sentinel node Mapping has demonstrated that the technique is still accurate after wide excision of the primary tumor. 3,4 The evidence that Mapping
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Sentinel lymph node Mapping and biopsy for ductal carcinoma in situ and other controversial indications.
American Surgeon, 2004Co-Authors: George M. FuhrmanAbstract:This review discusses the currently available literature regarding three controversial indications for sentinel node Mapping for breast cancer patients. For women with ductal carcinoma in situ (DCIS), the use of sentinel lymph node Mapping (SLNM) should be limited to women having a mastectomy. For patients with multifocal breast carcinoma, SLNM is accurate when a retroareolar injection technique is employed in the procedure. When treatment plans for node-negative patients call for neoadjuvant chemotherapy, accurate sentinel node Mapping can be performed prior to the administration of chemotherapy. The resolution of these and other controversies should result in the expansion of the number of patients evaluated with SLNM in the future.
Francesco Raspagliesi - One of the best experts on this subject based on the ideXlab platform.
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Sentinel node Mapping in endometrial cancer
Translational cancer research, 2019Co-Authors: Giorgio Bogani, Antonino Ditto, Valentina Chiappa, Francesco RaspagliesiAbstract:Sentinel node Mapping in endometrial cancer staging has gained popularity among gynecologic oncology community. Although endometrial cancer represents the most common gynecological malignancy in developed countries several features of its management are still objects of debates. In particular the role of lymphadenectomy is still unclear (1). Accumulating data underlined that sentinel node Mapping is not inferior to conventional lymphadenectomy (2,3). However, sentinel node Mapping seems to be superior to conventional lymphadenectomy.
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Sentinel node Mapping vs. lymphadenectomy in endometrial cancer: A systematic review and meta-analysis
Gynecologic Oncology, 2019Co-Authors: Giorgio Bogani, Antonino Ditto, Ferdinando Murgia, Francesco RaspagliesiAbstract:Abstract Sentinel node Mapping is increasingly being utilized for endometrial cancer staging. However, only limited evidence supporting the adoption of sentinel node Mapping instead of conventional lymphadenectomy is still available. Here, we aimed to review the current evidence comparing sentinel node Mapping and lymphadenectomy in endometrial cancer staging. This systematic review was registered in the International Prospective Register of Systematic Reviews. Six comparative studies were included. Overall, 3536 patients were included: 1249 (35.3%) and 2287 (64.7%), undergoing sentinel node Mapping and lymphadenectomy, respectively. Pooled data suggested that positive pelvic nodes were detected in 184 out of 1249 (14.7%) patients having sentinel node Mapping and 228 out of 2287 (9.9%) patients having lymphadenectomy (OR: 2.03; (95%CI: 1.30 to 3.18); p = 0.002). No difference in detection of positive nodes located in the paraaortic was observed (OR: 93 (95%CI: 0.39 to 2.18); p = 0.86). Overall recurrence rate was 4.3% and 7.3% after sentinel node Mapping and lymphadenectomy, respectively (OR: 0.90 (95%CI: 0.58 to 1.38); p = 0.63). Similarly, nodal recurrences were statistically similar between groups (1.2% vs. 1.7%; OR: 1.51 (95%CI: 0.70 to 3.29); p = 0.29). In conclusion, our meta-analysis underlines that sentinel node Mapping is non-inferior to standard lymphadenectomy in term of detection of paraaortic nodal involvement and recurrence rates (any site and nodal recurrence); while, focusing on the ability to detect positive pelvic nodes, sentinel node Mapping could be consider superior to lymphadenectomy. Further randomized studies are needed to asses long term effectiveness of sentinel node Mapping.
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Low-volume disease in endometrial cancer: The role of micrometastasis and isolated tumor cells
Gynecologic Oncology, 2019Co-Authors: Giorgio Bogani, Antonino Ditto, Andrea Mariani, Biagio Paolini, Francesco RaspagliesiAbstract:Abstract Nodal assessment represents an integral part of staging procedure for endometrial cancer. The widespread diffusion of sentinel node Mapping determinates a phenomenon of migration from stage I to stage III disease, especially for low-risk endometrial cancer patients. The adoption of sentinel node Mapping and pathological ultrastaging increase the detection of low volume disease (i.e., micrometastasis and isolated tumor cells), being low volume disease detected in >30% of patients with positive nodes. The prognostic role of low volume disease is discussed as well as the possible adjuvant strategies for patients diagnosed with micrometastasis and isolated tumor cells. The role of further prospective treatments in endometrial cancer, including molecular and genetic profiling, is critically reviewed.
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Current landscape and future perspective of sentinel node Mapping in endometrial cancer
Journal of Gynecologic Oncology, 2018Co-Authors: Giorgio Bogani, Francesco Raspagliesi, Umberto Leone Roberti Maggiore, Andrea MarianiAbstract:Endometrial cancer (EC) represents the most common gynecological neoplasm in developed countries. Surgery is the mainstay of treatment for EC. Although EC is characterized by a high prevalence several features regarding its management are still unclear. In particular the execution of lymphadenectomy is controversial. The recent introduction of sentinel node Mapping represents the mid-way between the execution and omission of node dissection in EC patients. In the present review we discuss the emerging role of sentinel node Mapping in EC. In addition, we discussed how type of tracers utilized and site of injection impacted on sentinel node detection rates. Future perspective regarding EC management are also discussed.
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Sentinel Node Mapping Using Hysteroscopic Injection of Indocyanine Green and Laparoscopic Near-Infrared Fluorescence Imaging in Endometrial Cancer Staging
Journal of Minimally Invasive Gynecology, 2014Co-Authors: Antonino Ditto, Giorgio Bogani, Fabio Martinelli, Andrea Papadia, Domenica Lorusso, Francesco RaspagliesiAbstract:Herein is presented a technique for minimally invasive sentinel node Mapping. The patient had apparently early stage endometrial cancer. Sentinel node Mapping was performed using a hysteroscopic injection of indocyanine green followed by laparoscopic sentinel node detection via near-infrared fluorescence. This technique ensures delineation of lymphatic drainage from the tumor area, thus achieving accurate detection of sentinel nodes.
