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Isis W. Gayed - One of the best experts on this subject based on the ideXlab platform.
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Sentinel Node mapping in vulvovaginal melanoma using SPECT/CT lymphoscintigraphy
Clinical Nuclear Medicine, 2009Co-Authors: Katsuhiro Kobayashi, Eric M. Rohren, Pedro Tomas Ramirez, Michael Frumovitz, Charles F Levenback, Isis W. GayedAbstract:We report 2 cases of vulvovaginal melanoma in which Sentinel Node mapping, performed using Tc-99m filtered sulfur colloid SPECT/CT lymphoscintigraphy, added important information to that provided by planar imaging and played a critical role in surgical planning and subsequent management. In the first case, lymphoscintigraphy planar imaging showed only foci of tracer uptake in the right groin and an equivocal focus in the left groin. SPECT/CT precisely localized these radioactive foci to the right and left inguinal Sentinel Nodes. The patient then underwent bilateral inguinal Sentinel Node sampling. In the second case, F-18 FDG PET/CT performed prior to lymphoscintigraphy demonstrated a moderately FDG-avid right inguinal lymph Node that was indeterminate in nature. SPECT/CT revealed this lymph Node to be a radioactive Sentinel lymph Node that was seen in the right groin on planar imaging. The patient then underwent right inguinal Sentinel Node sampling. Because pathologic study showed metastasis to the Sentinel Node, a planned pelvic exenteration was canceled, and the patient was referred for systemic treatment. Preoperative SPECT/CT lymphoscintigraphy is ideal for mapping the unpredicted lymphatic drainage pathways within the complex pelvic anatomy and this technique may also be used in the preoperative workup of other gynecologic malignancies.
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Sentinel Node mapping in vulvovaginal melanoma using spect ct lymphoscintigraphy
Clinical Nuclear Medicine, 2009Co-Authors: Katsuhiro Kobayashi, Eric M. Rohren, Pedro Tomas Ramirez, Michael Frumovitz, Charles F Levenback, E E Kim, Martha Mar, Isis W. GayedAbstract:We report 2 cases of vulvovaginal melanoma in which Sentinel Node mapping, performed using Tc-99m filtered sulfur colloid SPECT/CT lymphoscintigraphy, added important information to that provided by planar imaging and played a critical role in surgical planning and subsequent management. In the first case, lymphoscintigraphy planar imaging showed only foci of tracer uptake in the right groin and an equivocal focus in the left groin. SPECT/CT precisely localized these radioactive foci to the right and left inguinal Sentinel Nodes. The patient then underwent bilateral inguinal Sentinel Node sampling. In the second case, F-18 FDG PET/CT performed prior to lymphoscintigraphy demonstrated a moderately FDG-avid right inguinal lymph Node that was indeterminate in nature. SPECT/CT revealed this lymph Node to be a radioactive Sentinel lymph Node that was seen in the right groin on planar imaging. The patient then underwent right inguinal Sentinel Node sampling. Because pathologic study showed metastasis to the Sentinel Node, a planned pelvic exenteration was canceled, and the patient was referred for systemic treatment. Preoperative SPECT/CT lymphoscintigraphy is ideal for mapping the unpredicted lymphatic drainage pathways within the complex pelvic anatomy and this technique may also be used in the preoperative workup of other gynecologic malignancies.
Th Behr - One of the best experts on this subject based on the ideXlab platform.
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Sentinel Node detection in N0 cancer of the pharynx and larynx
British Journal of Cancer, 2002Co-Authors: J A Werner, A-a Dünne, A Ramaswamy, B J Folz, B M Lippert, R Moll, Th BehrAbstract:Neck lymph Node status is the most important factor for prognosis in head and neck squamous cell carcinoma. Sentinel Node detection reliably predicts the lymph Node status in melanoma and breast cancer patients. This study evaluates the predictive value of Sentinel Node detection in 50 patients suffering from pharyngeal and laryngeal carcinomas with a N0 neck as assessed by ultrasound imaging. Following 99m-Technetium nanocolloid injection in the perimeter of the tumour intraoperative Sentinel Node detection was performed during lymph Node dissection. Postoperatively the histological results of the Sentinel Nodes were compared with the excised neck dissection specimen. Identification of Sentinel Nodes was successful in all 50 patients with a sensitivity of 89%. In eight cases the Sentinel Node showed nodal disease (pN1). In 41 patients the Sentinel Node was tumour negative reflecting the correct neck lymph Node status (pN0). We observed one false-negative result. In this case the Sentinel Node was free of tumour, whereas a neighbouring lymph Node contained a lymph Node metastasis (pN1). Although we have shown, that skipping of nodal basins can occur, this technique still reliably identifies the Sentinel Nodes of patients with squamous cell carcinoma of the pharynx and larynx. Future studies must show, if Sentinel Node detection is suitable to limit the extent of lymph Node dissection in clinically N0 necks of patients suffering from pharyngeal and laryngeal squamous cell carcinoma.
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Sentinel Node detection in n0 cancer of the pharynx and larynx
British Journal of Cancer, 2002Co-Authors: J A Werner, A-a Dünne, A Ramaswamy, B J Folz, B M Lippert, R Moll, Th BehrAbstract:Neck lymph Node status is the most important factor for prognosis in head and neck squamous cell carcinoma. Sentinel Node detection reliably predicts the lymph Node status in melanoma and breast cancer patients. This study evaluates the predictive value of Sentinel Node detection in 50 patients suffering from pharyngeal and laryngeal carcinomas with a N0 neck as assessed by ultrasound imaging. Following 99m-Technetium nanocolloid injection in the perimeter of the tumour intraoperative Sentinel Node detection was performed during lymph Node dissection. Postoperatively the histological results of the Sentinel Nodes were compared with the excised neck dissection specimen. Identification of Sentinel Nodes was successful in all 50 patients with a sensitivity of 89%. In eight cases the Sentinel Node showed nodal disease (pN1). In 41 patients the Sentinel Node was tumour negative reflecting the correct neck lymph Node status (pN0). We observed one false-negative result. In this case the Sentinel Node was free of tumour, whereas a neighbouring lymph Node contained a lymph Node metastasis (pN1). Although we have shown, that skipping of nodal basins can occur, this technique still reliably identifies the Sentinel Nodes of patients with squamous cell carcinoma of the pharynx and larynx. Future studies must show, if Sentinel Node detection is suitable to limit the extent of lymph Node dissection in clinically N0 necks of patients suffering from pharyngeal and laryngeal squamous cell carcinoma. British Journal of Cancer (2002) 87, 711–715. doi:10.1038/sj.bjc.6600445 www.bjcancer.com © 2002 Cancer Research UK
Omgo E Nieweg - One of the best experts on this subject based on the ideXlab platform.
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What is a Sentinel Node and what is a false-negative Sentinel Node?
Annals of surgical oncology, 2004Co-Authors: Omgo E Nieweg, Susanne H EstourgieAbstract:Morton's original definition of a Sentinel Node as the first lymph Node to receive afferent lymphatic drainage from a primary tumor reflects the concept of stepwise spread of cancer through the lymphatic system. Several new definitions have been developed, based on surgical anatomy and on the technique that is used to find the Node. The various definitions of a Sentinel Node are critically analyzed. Breast cancer surgeons use three different definitions of a false-negative Sentinel Node biopsy. The best definition appears to be based on the assumption that the procedure is truly positive if either the Sentinel Node or a suspicious Node that is not radioactive or blue contains metastatic disease.
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feasibility of Sentinel Node lymphoscintigraphy in stage i testicular cancer
European Journal of Nuclear Medicine and Molecular Imaging, 2002Co-Authors: Pieter J. Tanis, Cornelis A. Hoefnagel, Renato Valdes A Olmos, Simon Horenblas, Omgo E NiewegAbstract:The aim of this study was to investigate the feasibility of lymphoscintigraphy for Sentinel Node identification in testicular cancer. Five patients with clinical stage I testicular cancer were prospectively included. A single dose of technetium-99m nanocolloid (mean dose 99 MBq, volume 0.2 ml) was injected into the funiculus in the first patient and into the testicular parenchyma in the following four patients. Dynamic lymphoscintigraphy was performed over 10 min, followed by early and late static images after 15 min and 2 to 24 h, respectively. Lymphoscintigraphy was followed by laparoscopic Sentinel Node biopsy on the same day in the last two patients using patent blue dye and an endoscopic gamma probe. The funicular administration route showed five hot spots in the right inguinal region after 2 h. Intratesticular administration resulted in Sentinel Node visualisation in three of the four patients. Dynamic images showed afferent lymphatic vessels to one Sentinel Node in the left para-aortic region in two patients and two Sentinel Nodes in the left para-aortic region in another patient. Sentinel Nodes were intraoperatively identified in one of two patients who underwent laparoscopic exploration. It is concluded that lymphoscintigraphy for Sentinel Node identification is feasible in stage I testicular cancer using intratesticular radiocolloid administration.
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The hidden Sentinel Node in breast cancer
European Journal of Nuclear Medicine and Molecular Imaging, 2002Co-Authors: Pieter J. Tanis, Omgo E Nieweg, J.w. Van Sandick, R.a. Valdés Olmos, E. J. T. Rutgers, Cornelis A. Hoefnagel, Bbr KroonAbstract:The purpose of this study was to analyse the occurrence of non-visualisation during preoperative lymphoscintigraphy for Sentinel Node identification in breast cancer. Preoperative lymphoscintigraphy was performed in 495 clinically Node-negative breast cancer patients (501 Sentinel Node procedures) after injection of technetium-99m nanocolloid. Anterior and prone lateral (hanging breast) planar images were obtained a few minutes and 4 h after injection. The Sentinel Node was intraoperatively identified with the aid of patent blue dye and a gamma-ray detection probe. A Sentinel Node was visualised on the 4-h images in 449 of 501 procedures (90%). This visualisation rate improved from 76% to 94% during the study period. Delayed imaging (5–23 h) in 19 patients whose Sentinel Nodes failed to show, resulted in visualisation in four of them. A repeat injection of radiocolloid in 11 patients revealed a Sentinel Node in six. In the end, the visualisation rate was 92%. The Sentinel Node was surgically retrieved in 24 of the remaining 42 patients with non-visualisation (57%). Sentinel Nodes that were visualised were tumour-positive in 38% and non-visualised Sentinel Nodes were involved in 50% (χ2, P=0.17). In a multivariate regression analysis, scintigraphic non-visualisation was independently associated with increased patient age (P
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the hidden Sentinel Node in breast cancer
European Journal of Nuclear Medicine and Molecular Imaging, 2002Co-Authors: Pieter J. Tanis, Omgo E Nieweg, J.w. Van Sandick, E. J. T. Rutgers, Cornelis A. Hoefnagel, R Valdes A Olmos, Bbr KroonAbstract:The purpose of this study was to analyse the occurrence of non-visualisation during preoperative lymphoscintigraphy for Sentinel Node identification in breast cancer. Preoperative lymphoscintigraphy was performed in 495 clinically Node-negative breast cancer patients (501 Sentinel Node procedures) after injection of technetium-99m nanocolloid. Anterior and prone lateral (hanging breast) planar images were obtained a few minutes and 4 h after injection. The Sentinel Node was intraoperatively identified with the aid of patent blue dye and a gamma-ray detection probe. A Sentinel Node was visualised on the 4-h images in 449 of 501 procedures (90%). This visualisation rate improved from 76% to 94% during the study period. Delayed imaging (5–23 h) in 19 patients whose Sentinel Nodes failed to show, resulted in visualisation in four of them. A repeat injection of radiocolloid in 11 patients revealed a Sentinel Node in six. In the end, the visualisation rate was 92%. The Sentinel Node was surgically retrieved in 24 of the remaining 42 patients with non-visualisation (57%). Sentinel Nodes that were visualised were tumour-positive in 38% and non-visualised Sentinel Nodes were involved in 50% (χ2, P=0.17). In a multivariate regression analysis, scintigraphic non-visualisation was independently associated with increased patient age (P<0.001), decreased tracer dose (P<0.001) and increased number of tumour-positive lymph Nodes (P=0.013). The use of a sufficient amount of radioactivity (at least 100 MBq) is recommended for lymphatic mapping in breast cancer, especially in elderly women. Delayed imaging and re-injection of the radioactive tracer increase the visualisation rate. The non-visualised Sentinel Node can be identified intraoperatively in more than half of the patients.
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history of Sentinel Node and validation of the technique
Breast Cancer Research, 2001Co-Authors: Pieter J. Tanis, Omgo E Nieweg, E. J. T. Rutgers, Renato Valdes A Olmos, Bbr KroonAbstract:Sentinel Node biopsy is a minimally invasive technique to select patients with occult lymph Node metastases who may benefit from further regional or systemic therapy. The Sentinel Node is the first lymph Node reached by metastasising cells from a primary tumour. Attempts to remove this Node with a procedure based on standard anatomical patterns did not become popular. The development of the dynamic technique of intraoperative lymphatic mapping in the 1990s resulted in general acceptance of the Sentinel Node concept. This hypothesis of sequential tumour dissemination seems to be valid according to numerous studies of Sentinel Node biopsy with confirmatory regional lymph Node dissection. This report describes the history and the validation of the technique, with particular reference to breast cancer.
Katsuhiro Kobayashi - One of the best experts on this subject based on the ideXlab platform.
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Sentinel Node mapping in vulvovaginal melanoma using SPECT/CT lymphoscintigraphy
Clinical Nuclear Medicine, 2009Co-Authors: Katsuhiro Kobayashi, Eric M. Rohren, Pedro Tomas Ramirez, Michael Frumovitz, Charles F Levenback, Isis W. GayedAbstract:We report 2 cases of vulvovaginal melanoma in which Sentinel Node mapping, performed using Tc-99m filtered sulfur colloid SPECT/CT lymphoscintigraphy, added important information to that provided by planar imaging and played a critical role in surgical planning and subsequent management. In the first case, lymphoscintigraphy planar imaging showed only foci of tracer uptake in the right groin and an equivocal focus in the left groin. SPECT/CT precisely localized these radioactive foci to the right and left inguinal Sentinel Nodes. The patient then underwent bilateral inguinal Sentinel Node sampling. In the second case, F-18 FDG PET/CT performed prior to lymphoscintigraphy demonstrated a moderately FDG-avid right inguinal lymph Node that was indeterminate in nature. SPECT/CT revealed this lymph Node to be a radioactive Sentinel lymph Node that was seen in the right groin on planar imaging. The patient then underwent right inguinal Sentinel Node sampling. Because pathologic study showed metastasis to the Sentinel Node, a planned pelvic exenteration was canceled, and the patient was referred for systemic treatment. Preoperative SPECT/CT lymphoscintigraphy is ideal for mapping the unpredicted lymphatic drainage pathways within the complex pelvic anatomy and this technique may also be used in the preoperative workup of other gynecologic malignancies.
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Sentinel Node mapping in vulvovaginal melanoma using spect ct lymphoscintigraphy
Clinical Nuclear Medicine, 2009Co-Authors: Katsuhiro Kobayashi, Eric M. Rohren, Pedro Tomas Ramirez, Michael Frumovitz, Charles F Levenback, E E Kim, Martha Mar, Isis W. GayedAbstract:We report 2 cases of vulvovaginal melanoma in which Sentinel Node mapping, performed using Tc-99m filtered sulfur colloid SPECT/CT lymphoscintigraphy, added important information to that provided by planar imaging and played a critical role in surgical planning and subsequent management. In the first case, lymphoscintigraphy planar imaging showed only foci of tracer uptake in the right groin and an equivocal focus in the left groin. SPECT/CT precisely localized these radioactive foci to the right and left inguinal Sentinel Nodes. The patient then underwent bilateral inguinal Sentinel Node sampling. In the second case, F-18 FDG PET/CT performed prior to lymphoscintigraphy demonstrated a moderately FDG-avid right inguinal lymph Node that was indeterminate in nature. SPECT/CT revealed this lymph Node to be a radioactive Sentinel lymph Node that was seen in the right groin on planar imaging. The patient then underwent right inguinal Sentinel Node sampling. Because pathologic study showed metastasis to the Sentinel Node, a planned pelvic exenteration was canceled, and the patient was referred for systemic treatment. Preoperative SPECT/CT lymphoscintigraphy is ideal for mapping the unpredicted lymphatic drainage pathways within the complex pelvic anatomy and this technique may also be used in the preoperative workup of other gynecologic malignancies.
Umberto Veronesi - One of the best experts on this subject based on the ideXlab platform.
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Sentinel Node biopsy in breast cancer early results in 953 patients with negative Sentinel Node biopsy and no axillary dissection
European Journal of Cancer, 2005Co-Authors: Umberto Veronesi, Giovanni Paganelli, Giuseppe Viale, Stefano Zurrida, Viviana Galimberti, Mattia Intra, Paolo Veronesi, Luigi Mariani, Giovanna Gatti, R. GennariAbstract:Sentinel Node biopsy in patients with breast carcinoma accurately predicts the axillary nodal status. However, in some 6% of patients with negative Sentinel Nodes the remaining axillary Nodes harbour metastases. Our purpose was to observe a large number of patients who did not undergo an axillary dissection after a negative Sentinel Node biopsy for the appearance of overt axillary metastases. 953 patients treated from 1996 to 2000, with negative Sentinel Nodes not submitted to axillary dissection, were followed-up to 7 years, with a median follow-up of 38 months. Fifty-five unfavourable events occurred among the 953 patients, 37 (4%) related to the primary breast carcinoma. Three cases of overt axillary metastases were found: they received total axillary dissection and are presently alive and well. The 5 year overall survival rate of the whole series was 98%. Patients with negative Sentinel Node biopsies not submitted to axillary dissection show during follow-up a rate of overt axillary metastases that is lower than that expected.
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Sentinel Node biopsy in elderly breast cancer patients.
Surgical Oncology, 2004Co-Authors: R. Gennari, Nicole Rotmensz, Elisa Perego, Gabriela Rosali Dos Santos, Umberto VeronesiAbstract:Abstract Introduction : Even if an increasing body of data suggests that Sentinel Node biopsy is a safe and accurate method of screening the axillary Nodes for metastasis, there is a tendency to perform less extensive or no axillary surgery in older breast cancer women. The aim of this study therefore was to assess the safety of the procedure as well as the rate of axillary recurrences after Sentinel Node biopsy in this older population. Methods : Between May 1997 and March 2003, 241 consecutive elderly patients (⩾70 years) with operable breast cancer up to 3cm and clinically negative axillary lymph Nodes were entered into this study. Sentinel Node was identified using 5–10MBq of 99m Tc-labeled colloidal particles and examined with immediate complete intraoperative frozen-section. Results : The Sentinel Node identification rate was 100%. Ninety-seven percent of the patients underwent breast-conserving surgery. In 90 out of 241 patients (37.3%) the Sentinel Node was positive for metastasis and complete axillary dissection was immediately performed. In 56.7% of these patients the Sentinel Node was the only lymph Node involved. Micrometastasis in the Sentinel Node was detected in 30 of the 90 (33.3%) patients. A total of 151 patients (62.7%) were Sentinel Node negative and no further surgical treatment was done. There were no axillary recurrences at a median followup of 29.7 months (range 3–87 months). The overall survival of this group of patients was 97.9%. Conclusions : Sentinel Node biopsy is a safe and accurate method of screening the axillary Nodes for elderly women with operable breast cancer less than 3cm. The absence of axillary recurrences after Sentinel Node biopsy without complete axillary dissection supports the hypothesis.
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a randomized comparison of Sentinel Node biopsy with routine axillary dissection in breast cancer
The New England Journal of Medicine, 2003Co-Authors: Umberto Veronesi, Giovanni Paganelli, Giuseppe Viale, Alberto Luini, Stefano Zurrida, Viviana Galimberti, Mattia Intra, Paolo Veronesi, Chris Robertson, Patrick MaisonneuveAbstract:Background Although numerous studies have shown that the status of the Sentinel Node is an accurate predictor of the status of the axillary Nodes in breast cancer, the efficacy and safety of Sentinel-Node biopsy require validation. Methods From March 1998 to December 1999, we randomly assigned 516 patients with primary breast cancer in whom the tumor was less than or equal to 2 cm in diameter either to Sentinel-Node biopsy and total axillary dissection (the axillary-dissection group) or to Sentinel-Node biopsy followed by axillary dissection only if the Sentinel Node contained metastases (the Sentinel-Node group). Results The number of Sentinel Nodes found was the same in the two groups. A Sentinel Node was positive in 83 of the 257 patients in the axillary-dissection group (32.3 percent), and in 92 of the 259 patients in the Sentinel-Node group (35.5 percent). In the axillary-dissection group, the overall accuracy of the Sentinel-Node status was 96.9 percent, the sensitivity 91.2 percent, and the specifi...
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Sentinel Node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph Nodes
The Lancet, 1997Co-Authors: Umberto Veronesi, Giovanni Paganelli, Giuseppe Viale, Stefano Zurrida, Viviana Galimberti, Marilia Bedoni, Alberto Costa, Concetta De Cicco, James Geraghty, Alberto LuiniAbstract:Summary Background Axillary lymph-Node dissection is an important staging procedure in the surgical treatment of breast cancer. However, early diagnosis has led to increasing numbers of dissections in which axillary Nodes are free of disease. This raises questions about the need for the procedure. We carried out a study to assess, first, whether a single axillary lymph Node (Sentinel Node) initially receives malignant cells from a breast carcinoma and, second, whether a clear Sentinel Node reliably forecasts a disease-free axilla. Methods In a consecutive series of 163 women with operable breast carcinoma, we injected microcolloidal particles of human serum albumin labelled with technetium-99m. This tracer was injected subdermally, close to the tumour site, on the day before surgery, and scintigraphic images of the axilla and breast were taken 10 min, 30 min, and 3 h later. A mark was placed on the skin over the site of the radioactive Node (Sentinel Node). During breast surgery, a hand-held γ-ray detector probe was used to locate the Sentinel Node, and make possible its separate removal via a small axillary incision. Complete axillary lymphadenectomy was then done. The Sentinel Node was tagged separately from other Nodes. Permanent sections of all removed Nodes were prepared for pathological examination. Findings From the Sentinel Node, we could accurately predict axillary lymph-Node status in 156 (97·5%) of the 160 patients in whom a Sentinel Node was identified, and in all cases (45 patients) with tumours less than 1·5 cm in diameter. In 32 (38%) of the 85 cases with metastatic axillary Nodes, the only positive Node was the Sentinel Node. Interpretation In the large majority of patients with breast cancer, lymphoscintigraphy and γ-probe-guided surgery can be used to locate the Sentinel Node in the axilla, and thereby provide important information about the status of axillary Nodes. Patients without clinical involvement of the axilla should undergo Sentinel-Node biopsy routinely, and may be spared complete axillary dissection when the Sentinel Node is disease-free.
