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In recent years, research about sentinel lymph node mapping in endometrial cancer surgery has developed quickly. Several clinical studies indicate that sentinel lymph node mapping in early endometrial cancer can improve detectable rate and decrease the false-negative rate. However, the technology is still controversial. Therefore, further study is needed to assess the role of sentinel lymph node mapping in endometrial cancer. This review mainly focused on the current clinical practice of sentinel node mapping technique in endometrial cancer, and the existing problems and controversies.
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Objective: To explore the value of nanoparticles (CN) in lateral cervical lymph node mapping in papillary thyroid carcinoma using carbon. Methods: Thyroid cancer patients with suspicious lymph node metastasis but without typical signs of metastatic disease from March 2016 to November 2017 in Fudan University Shanghai Cancer Center were prospectively included in the cohort. Neck dissection was performed in all patients (compartmentsⅡ-Ⅴ). Suspicious lateral lymph node metastasis was identified using pre-operative ultrasound or computed tomography. CN were used for lymph node mapping during surgery. Results: A total of 70 surgeries were performed in 67 patients, among which 57 were found to have lateral lymph node metastasis (81.4%). The median number of CN-dyed lateral lymph nodes was 6. Compartment IV had the highest number of CN-dyed positive lymph nodes as well as the highest rate of metastasis, followed by compartmentⅢ. In compartmentsⅢandⅣ, the incidence of lymph node metastasis was significantly higher in the CN-dyed group than in the CN-undyed group (P<0.001). When the final pathology of neck dissection was set as the gold standard, lateral CN-dyed lymph node biopsy was found to have a sensitivity of 86.0%; its negative predictive value was 61.9% and its overall accuracy was 88.6%. Conclusions:Injection of CN during surgery was a potential method of mapping lateral lymph nodes in papillary thyroid carcinoma. CompartmentⅢ-ⅣCN-dyed lymph node biopsy had a satisfactory sensitivity and thus, served as a reasonable range for lymph node biopsy.
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The study aimed to examine the applicability of carbon nanoparticles as a tracer for lymph node mapping and the related factors of lymph node and No.8p subgroup metastasis in patients with gastric cancer. Clinical data of 50 patients with gastric cancer, who had not received treatment preoperatively and underwent gastrectomy in Department of Gastrointestinal Surgery, Wuhan Union Hospital, between October 2014 and August 2015, were retrospectively analyzed. These patients were found to have no distant metastasis preoperatively. Thirty-five out of 50 patients were subjected to lymphatic mapping technique using carbon nanoparticles as the tracer, and the rest 15 cases did not experience the lymphatic mapping and served as controls. The sensitivity, specificity, false positive rate and false negative rate were calculated according to the number of lymph nodes, and the staining and metastasis condition of lymph nodes. The diagnostic value of carbon nanoparticles on metastatic lymph nodes was evaluated. The relationship between the metastasis of lymph nodes or subgroup No.8p lymph nodes and clinicopathologic features was analyzed by χ-test or Fisher's exact test. All patients underwent D2 surgery (lymph node dissection including all the group 1 and group 2 nodes) plus the dissection of the subgroup No.8p lymph nodes. It was found that the average number of harvested lymph nodes in lymphatic mapping technique group (45.7±14.5) was greater than that in control group (39.2±11.7), but the difference was not significantly different (P=0.138>0.05). The success rate, the accuracy, sensitivity, specificity and false negative rate was 97%, 57%, 28%, 62% and 72% respectively. The metastasis of lymph nodes was correlated to the depth of cancer invasion (T stage) (P=0.004<0.05), and the metastasis of No.8p lymph nodes was correlated to the extent of lymph node involvement (N stage) (P=0.007<0.05). Six cases had lymph node metastasis in subgroup No.8p, and their TNM stages and clinical stages were as follows: T1N2M0 IIA, T3N3M0 IIIB, T4aN3M0 IIIC, T4aN3M0 IIIC, T4aN3M0 IIIC, and T4bN3M0 IIIC. In conclusion, our study indicated that carbon nanoparticles failed to show good selectivity for metastatic lymph nodes; the result of lymphatic mapping does not achieve a satisfactory performance; the incidence of lymph node metastasis may increase, accompanying with the increase of the depth of cancer invasion; No.8p lymph node metastasis tends to occur for gastric carcinoma patients with the extent of lymph node metastasis over N2 stage.
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Carbon , Carcinoma , Diagnostic Imaging , Pathology , General Surgery , Lymph Nodes , Diagnostic Imaging , Pathology , Lymphatic Metastasis , Nanoparticles , Chemistry , Sensitivity and Specificity , Stomach Neoplasms , Diagnostic Imaging , Pathology , General SurgeryABSTRACT
Lymph node mapping, a hotspot in oncology and surgery in recent years, has been successful-ly used in the discovery and resection of the metastatic lymph nodes in patients with melanoma and breast cancer. For the complex of lymphatic drainage and the defect of tracers, lymph nodes mapping is still under investigation. As a new type of nano-materials, the quantum dots are used widely, the tumor lymph node mapping.
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Nodal status is an important prognosticating factor in patients with melanoma. Metastasis to the lymph nodes would affect surgical treatment plan. Sentinel node mapping, otherwise known as lymphoscintigraphy, has become an integral part in the management of melanoma. This is a case report of the use of scintigraphic lymph node mapping in a patient with a very rare case of vulvar melanoma. The protocols and principles utilized in routine lymph node mapping have been applied in this case. The patient's lymphoscintigraphy revealed unilateral nodal drainage to the left, probably, corresponding to the obturator or internal and external iliac chains. This guided the attending physician to perform unilateral, left-sided nodal dissection only, as opposed to the usual bilateral nodal dissection. Thus, the possibility for post-operative morbidity was greatly minimized in this patient.
Subject(s)
Humans , Female , Adult , Drainage , Lymph Nodes , Lymphoscintigraphy , Melanoma , Radionuclide Imaging , Skin NeoplasmsABSTRACT
Objective To understand the current research status of sentinel lymph node (SLN) biopsy in colorectal cancer. Methods Literatures about the application of SLN biopsy in the field of colorectal surgery were collected and reviewed.Results The results of SLNs biopsy accurately reflected the status of the nodal basin. Focused examination of the SLNs could identify micrometastases that might otherwise had been missed by standard histopathological analysis, thus upstaged this group of patients.Conclusion SLN biopsy represents a new and effective technique to predict the tumor status of regional lymph nodes, which offers a potential alternative to improve the accuracy of tumor staging in colorectal cancer.