Validación de técnica de ganglio centinela en cáncer de endometrio en el Hospital de Talca / Validation of sentinel lymph node technique in endometrial cancer at the Hospital de Talca

Objetivo: Validar la técnica de ganglio centinela utilizando verde de indocianina en la estadificación del cáncer de endometrio. Método: Realizamos un estudio prospectivo entre enero y diciembre de 2021. Se incluyeron todas las pacientes portadoras de cáncer de endometrio clínicamente en etapa 1, de todos los grados de diferenciación e histologías. Todas las pacientes fueron sometidas a una estadificación laparoscópica. Se inició el procedimiento con identificación de ganglio centinela utilizando verde de indocianina. Posteriormente, se completó la cirugía de estadiaje estándar en todas las pacientes. Los ganglios centinelas fueron procesados con técnica de ultraestadiaje. Resultados: Se incluyeron 33 pacientes. El 81% presentaron histología endometrioide. El 100% fueron sometida además a una linfadenectomía pelviana estándar y el 20% a una linfadenectomía paraaórtica simultáneamente. Se detectó al menos un ganglio centinela en el 100% de los casos. La detección bilateral ocurrió en el 90,9%. La localización más frecuente fue la fosa obturatriz y la arteria hipogástrica. Obtuvimos una sensibilidad del 90% para detectar enfermedad ganglionar y un valor predictivo negativo del 95,8%. Conclusiones: La técnica de ganglio centinela utilizando verde de indocianina es replicable. Los resultados de nuestra serie nos permiten realizar procedimientos menos agresivos al estadificar el cáncer de endometrio.

Objective: To validate sentinel node mapping using indocyanine green in endometrial cancer staging. Method: A prospective study was conducted between January and December 2021. All patients with clinically stage 1 endometrial cancer, of all grades and histologies were included. All patients underwent laparoscopic staging. The procedure began with identification of the sentinel node using indocyanine green. Subsequently, standard staging surgery was completed in all patients. Sentinel nodes were processed using ultrastaging technique. Results: Thirty-three patients were enrolled. 81% of cases had endometrioid histology. All patients also underwent a standard pelvic lymphadenectomy and in 20% of cases a para-aortic lymphadenectomy. At least one sentinel node was detected in 100% of the cases. Bilateral detection occurred in 90.9%. The most frequent location was obturator fossa and hypogastric artery. Sensitivity to detect lymph node disease was 90% and negative predictive value 95.8%. Conclusions: Sentinel lymph node mapping using indocyanine green is a replicable technique. Our results allows us to perform less aggressive procedures in endometrial cancer staging.

Application value of indocyanine green fluorescence in sentinel lymph node biopsy for early-stage tongue cancer and oropharyngeal cancer / 中南大学学报(医学版)

OBJECTIVES@#Occult cervical lymph node metastasis is the most important reason for recurrence of early-stage tongue cancer and oropharyngeal cancer. Cervical sentinel lymph node (SLN) biopsy may help to identify them. Pigment dyes and radionuclide were used to label SLN. Both of them had shortage. This study aims to investigate the application and clinical value of indocyanine green fluorescence imaging in cervical SLN biopsy for patients with early-stage tongue cancer and oropharyngeal cancer.@*METHODS@#Retrospective analysis was conducted on 23 patients with early tongue cancer and oropharyngeal cancer, who received surgical treatment and used indocyanine green as a tracer to find SLN in Hunan Cancer Hospital from April to October 2021. The detection rate of SLN was calculated and the distribution of SLN in different regions of the neck was analyzed.@*RESULTS@#SLN was successfully identified in 22 of 23 patients, with a detection rate of 95.65%. Among these 22 patients, 3 patients were found to have cancer metastasis, and the rate of occult lymph node metastasis was 13.63%. No pathologically positive lymph nodes were detected in SLN-negative patients, and thus the positive predictive rate was 100%. For patients with primary lesions located in the anterior 2/3 of the tongue, the constituent ratios of SLN in neck area I, II, III, and IV were 15.15%, 71.72%, 13.13%, and 0, respectively. For patients with primary lesions located in base of the tongue, the constituent ratios of SLN in neck area I, II, III, and IV were 0, 44.44%, 44.44%, and 11.12%, respectively.@*CONCLUSIONS@#Indocyanine green fluorescence imaging has a high detection rate with accurate positive prediction in the anterior cervical SLN biopsy in patients with early-stage tongue cancer and oropharyngeal cancer. Meanwhile, it can also reflect the lymphatic drainage of tumors located at different primary sites, which has high clinical value.

Risk assessment of internal mammary lymph node metastasis and choice of irradiation of internal mammary lymphatic drainage area in breast cancer patients with negative internal breast lymph nodes on imaging / 中华肿瘤杂志

Objective: To explore the independent risk factors of internal mammary lymph nodes (IMN) metastasis and the risk assessment method of IMN metastasis preoperatively in breast cancer patients with negative IMN in imaging examination, and guide the radiotherapy of IMN in patients with different risk stratification of IMN metastasis. Methods: The clinical and pathological data of 301 breast cancer patients who underwent internal mammary sentinel node biopsy(IM-SLNB) and/or IMN dissection in Shandong Cancer Hospital with negative IMN on CT and/or MRI from January 2010 to October 2019 were analyzed retrospectively. The independent risk factors were analyzed by univariate and multivariate logistic regression, and the independent risk factors of IMN metastasis were used to risk stratification. Results: Among the 301 patients, 43 patients had IMN metastasis, and the rate of IMN metastasis was 14.3%. Univariate analysis showed that vascular tumor thrombus, progesterone receptor (PR) expression, T stage and N stage were associated with IMN metastasis. Multivariate logistic regression analysis showed that tumor located in medial quadrant, positive PR and axillary lymph node metastasis were independent risk factors for IMN metastasis. The risk of IMN metastasis was assessed according to the independent risk factors of the patients: low-risk group is including 0 risk factor, medium-risk group is including 1 risk factor, and high-risk group is including 2-3 risk factors. According to this evaluation criteria, 301 patients with breast cancer were divided into low-risk group (with 0 risk factors), medium-risk group (with 1 risk factor) and high-risk group (with 2-3 risk factors). The IMN metastasis rates were 0 (0/34), 4.3% (6/140) and 29.1% (37/127), respectively. Conclusions: The risk stratification of IMN metastasis according to three independent risk factors of IMN metastasis including tumor located in medial quadrant, positive PR and axillary lymph node metastasis in breast cancer patients can guide the radiotherapy of IMN in newly diagnosed breast cancer patients. For N1 patients, radiotherapy of IMN is strongly recommended when the primary tumor is located in the medial quadrant and/or PR positive.

Research progress of sentinel lymph node biopsy technique in cervical cancer / 中华肿瘤杂志

Cervical cancer is the most common gynecological malignant carcinoma in Chinese women, which seriously threatens women's health. Lymph node metastasis is the most important factor affecting the prognosis and adjuvant treatment of patients with early cervical cancer. Conventional systematic lymphadenectomy has always been a reliable method to detect lymph node metastasis. However, this procedure may affect the quality of life of patients because of high risks of complications. Recently, sentinel lymph node biopsy (SLNB) has been researched aiming to assess the status of pelvic lymph node metastasis intraoperatively, avoid unnecessary lymphadenectomy and achieve the goal of individualized diagnosis and treatment. Exploring efficient tracing methods and pathological ultra-staging is the key to the clinical application of SLNB for cervical cancer, and understanding the latest relevant clinical research progress will help SLNB to be applied in the clinic as soon as possible to benefit patients with cervical cancer.

Application value and difficulty analysis of fluorescence laparoscopy in lymphadenectomy of gastric cancer / 中华胃肠外科杂志

Gastric cancer is one of the most common gastrointestinal malignancies, and the incidence and mortality of gastric cancer remain high in China. In recent years, with the rapid popularization of laparoscopic technology, fluorescent laparoscopic technology is increasingly getting mature, providing a new method for accurate clinical tracing of lymph nodes and prediction of tumor metastasis lymph nodes. A large number of scientific research experiments and clinical trials have shown that, laparoscopic lymph node diagnosis technology based on the fluorescent indocyanine green (ICG) can significantly improve the efficiency of lymphadenectomy and prediction accuracy of lymph node metastasis, and can reveal a more accurate scope of lymphadenectomy in gastric cancer for surgeons, so as to avoid excessive adenectomy as well as iatrogenic injuries on patients. Although the status of the technology in gastric cancer surgery mentioned above continues improving, the overall operation process details of ICG fluorescence imaging, standardized fluorescence detecting equipment, and postoperative pathological examination process still need to be further optimized.

Ganglio centinela en el melanoma cutáneo / Sentinel node in cutaneous melanoma

La biopsia selectiva del ganglio centinela (BSGC) se ha desarrollado de tal manera que reemplazó a la linfadenectomía electiva en el tratamiento del melanoma cutáneo (MC). Numerosos estudios demostraron que el estado del ganglio centinela es un factor pronóstico independiente en relación con la supervivencia global y la supervivencia libre de enfermedad de los pacientes con melanoma. El objetivo del presente trabajo fue realizar una revisión bibliográfica para comprender la utilidad y las indicaciones de la BSGC en pacientes con MC a partir de la evidencia actual publicada.

Sentinel lymph biopsy (SLNB) has been developed in such a way that is has replaced elective lymphadenectomy in the treatment of cutaneous melanoma (CM). Numerous studies have shwn that sentinel node status is an independent prognostic factor in relation to overall survival and disease-free survival of patients with CM. The purpose of this article is to carry out a literature review to understand the usefulness and indications of SLNB in patients with CM based on the current evidence.

Patent blue V dye anaphylaxis: a case report and literature review / Anafilaxia por corante azul patente V: relato de caso e revisão da literatura

Abstract Background: Anaphylaxis is a constant perioperative concern due to the exposure to several agents capable of inducing hypersensitivity reactions. Patent blue V (PBV), also known as Sulfan Blue, a synthetic dye used in sentinel node research in breast surgery, is responsible for 0.6% of reported anaphylactic conditions. We present a case of a 49-year-old female patient who underwent left breast tumorectomy with sentinel lymph node staging using PBV and experienced an anaphylactic reaction. Methods: We conducted a literature search through PubMed for case reports, case series, review and systematic reviews since 2005 with the keywords "anaphylaxis" and "patent blue". We then included articles found in these publications' reference sections. Results: We found 12 relevant publications regarding this topic. The main findings are summarized, with information regarding the clinical presentation, management, and investigation protocol. Hypotension is the most common clinical manifestation. The presentation is usually delayed when compared with anaphylaxis from other agents and cutaneous manifestations are occasionally absent. Patients may have had previous exposure to the dye, used also as a food, clothes and drug colorant. Conclusion: The diagnosis of anaphylaxis in patients under sedation or general anesthesia may be difficult due to particularities of the perioperative context. According to the published literature, the presentation of the reaction is similar in most cases and a heightened clinical sense is key to address the situation appropriately. Finding the agent responsible for the allergic reaction is of paramount importance to prevent future episodes.

Resumo Introdução: A anafilaxia pode ocorrer durante o período perioperatório devido à exposição a diversos agentes capazes de induzir reações de hipersensibilidade. O corante sintético Azul Patente V (APV), também conhecido como Sulfan Blue, é usado na pesquisa de linfonodo sentinela em cirurgia de mama, e é responsável por 0,6% dos eventos anafiláticos relatados. Descrevemos o caso de uma paciente de 49 anos de idade submetida à tumorectomia de mama esquerda com estadiamento de linfonodo sentinela, em que se empregou o APV e que apresentou reação anafilática. Método: Por meio do PubMed, pesquisamos publicações que documentavam relatos de casos, séries de casos, revisões e revisões sistemáticas desde 2005, usando as palavras-chave "anaphylaxis" e "patent blue". Em seguida, incluímos artigos encontrados na lista de referências dessas publicações. Resultados: Encontramos 12 publicações relevantes sobre o tópico. Os principais achados estão resumidos, com informações do quadro clínico, tratamento e protocolo de investigação. A hipotensão foi a manifestação clínica mais frequente. De forma geral, o quadro clínico tem início tardio quando comparado à anafilaxia por outros agentes e, ocasionalmente, as manifestações cutâneas estão ausentes. Os pacientes podem ter tido exposição prévia ao APV, que também é usado como corante de alimentos, roupas e medicamentos. Conclusão: O diagnóstico de anafilaxia em pacientes sob sedação ou anestesia geral pode ser difícil devido às peculiaridades do contexto perioperatório. Segundo a literatura publicada, a apresentação da reação é semelhante na maioria dos casos e um discernimento clínico aguçado é fundamental para enfrentar o evento adequadamente. Encontrar o agente responsável pela reação alérgica é essencial para a prevenção de futuros episódios.

Association between tumor-infiltrating lymphocytes and sentinel lymph node positivity in thin melanoma

Abstract: Background: Sentinel lymph node biopsy in thin invasive primary cutaneous melanoma (up to 1mm thick) is a controversial subject. The presence of tumor-infiltrating lymphocytes could be a factor to be considered in the decision to perform this procedure. Objective: To evaluate the association between the presence of tumor-infiltrating lymphocytes and lymph node metastases caused by thin primary cutaneous melanoma. Methods: Cross-sectional study with 137 records of thin invasive primary cutaneous melanoma submitted to sentinel lymph node biopsy from 2003 to 2015. The clinical variables considered were age, sex and topography of the lesion. The histopathological variables assessed were: tumor-infiltrating lymphocytes, melanoma subtype, Breslow thickness, Clark levels, number of mitoses per mm2, ulceration, regression and satellitosis. Univariate analyzes and logistic regression tests were performed as well the odds ratio and statistical relevance was considered when p <0.05. Results: Among the 137 cases of thin primary cutaneous melanoma submitted to sentinel lymph node biopsy, 10 (7.3%) had metastatic involvement. Ulceration on histopathology was positively associated with the presence of metastatic lymph node, with odds ratio =12.8 (2.77-59.4 95% CI, p=0.001). The presence of moderate/marked tumor-infiltrating lymphocytes was shown to be a protective factor for the presence of metastatic lymph node, with OR=0.20 (0.05-0.72 95% CI, p=0.014). The other variables - clinical and histopathological - were not associated with the outcome. Study limitations: The relatively small number of positive sentinel lymph node biopsy may explain such an expressive association of ulceration with metastatization. Conclusions: In patients with thin invasive primary cutaneous melanoma, few or absent tumor-infiltrating lymphocytes, as well as ulceration, represent independent risk factors for lymph node metastasis.

Accuracy of sentinel lymph node mapping in detecting occult neck metastasis in papillary thyroid carcinoma

ABSTRACT Objectives: The objectives of this study were to evaluate the following: 1) the accuracy of sentinel lymph node mapping (SLNM) in detecting metastasis in papillary thyroid carcinoma (PTC), and 2) if SLNM could modify the American Joint Committee on Cancer (AJCC) staging of previous cN0 PTC patients. Subjects and methods: Forty SLNM were performed prospectively in 38 consecutive cN0 PTC patients, with total thyroidectomy and elective compartment neck dissection (CND). The results of SLNM were compared with CND pathological findings to verify the accuracy of sentinel SLNM. Results: The mean patients' follow-up was 36 months. A total of 133 SLN were found at levels VI, II, III and IV. The SLN was identified in 95% of the patients with one false negative, 95% sensitivity, a 94% negative predictive value and 97% accuracy. The SLNM upstaging from cN0 to pN+ was 49%, and to stages III and IVa, it was 21%. Conclusions: For this series of cN0 PTC patients: 1) SLNM accuracy was 97%, and 2) SLNM upstaging from cN0 to pN+ was 49%, whereas to stages III and IVa, it was 21%.

Intraoperative imprint cytology versus histological diagnosis for the detection of sentinel lymph nodes in breast cancer treated with neoadjuvant chemotherapy

OBJECTIVES: To compare imprint cytology and paraffin section histology for sentinel lymph node detection in women with breast cancer treated with neoadjuvant chemotherapy. METHOD: A cross-sectional study and report of the sentinel lymph node statuses of 64 patients with breast cancer who underwent intraoperative imprint cytology and neoadjuvant chemotherapy in a referral cancer institute in Rio de Janeiro, Brazil, between 2014 and 2016. RESULTS: The mean age was 51 years. The most common histological type was invasive ductal carcinoma (93.75%), and the most common differentiation grade was 2 (62.5%). Overall, 153 lymph nodes were identified, with a mean of 2.39/case. Thirty-four lymph nodes tested positive for malignancy by imprint cytology, and 55 tested positive by histology. Of the 55 positive lymph nodes, 41 (74.5%) involved macrometastases, and 14 (25.5%) involved micrometastases. There were 21 false negatives with imprint cytology, namely, 7 for macrometastases and 14 for micrometastases, resulting in a rate of 17.6%. The sensitivity of imprint cytology was 61.8%, with a specificity and positive predictive value of 100%, a negative predictive value of 82.4% and an accuracy of 86.3%. The method presented null sensitivity for the identification of micrometastases. CONCLUSIONS: The false-negative rate with imprint cytology was associated with the number of sentinel lymph nodes obtained. The rate found for complete response to neoadjuvant chemotherapy was comparable to the rates reported in the literature. The accuracy of imprint cytology was good, and its specificity was excellent for sentinel lymph node detection; however, the method was unable to detect lymph node micrometastases.

Single-Site Robotic Radical Hysterectomy and Sentinel Lymphnode Biopsy in Cervical Cancer: A Case Report / Histerectomia radical robótica de portal único e biópsia de linfonodo sentinela: relato de caso

ABSTRACT Robotic surgeries for cervical cancer have several advantages compared with lapa-rotomic or laparoscopic surgeries. Robotic single-site surgery has many advantages compared with the multiport approach, but its safety and feasibility are not established in radical oncologic surgeries. We report a case of a Federation of Gynecology and Obstetrics (FIGO) stage IB1 cervical carcinoma whose radical hysterectomy, sentinel lymph node mapping, and lymph node dissection were entirely performed by robotic single-site approach. The patient recovered very well, and was discharged from the hospital within 24 hours.

RESUMO A cirurgia robótica para carcinoma do colo do útero apresenta vantagens quando comparada com cirurgias laparotômicas ou laparoscópicas. A cirurgia robótica de portal único tem muitas vantagens quando comparada com cirurgias de múltiplos acessos, porém a segurança e a viabilidade deste procedimento ainda não estão estabelecidas para cirurgias oncológicas radicais. Apresentamos um caso de carcinoma de colo do útero, tratado por histerectomia radical, identificação e biópsia de linfonodo sentinela e linfadenectomia pélvica realizada totalmente por cirurgia robótica de acesso único. A paciente recuperou-se bem e recebeu alta no primeiro dia pós-operatório.

Sentinel node biopsy using blue dye and technetium99 in advanced gastric cancer: anatomical drainage and clinical application

Lymph node metastases are an independent prognosis factor in gastric carcinoma (GC) patients. Radical lymphadenectomy can improve survival but it can also increase surgical morbidity. As a principle, sentinel node (SN) navigation surgery can avoid unnecessary lymphadenectomy without compromising prognosis. In this pilot study, 24 patients with untreated GC were initially screened for SN navigation surgery, of which 12 were eligible. Five patients had T2 tumors, 5 had T3 tumors and 2 had T1 tumors. In 33% of cases, tumor diameter was greater than 5.0 cm. Three hundred and eighty-seven lymph nodes were excised with a median of 32.3 per patient. The SN navigation surgery was feasible in all patients, with a median of 4.5 SNs per patient. The detection success rate was 100%. All the SNs were located in N1 and N2 nodal level. In 70.9% of cases, the SNs were located at lymphatic chains 6 and 7. The SN sensitivity for nodal staging was 91.6%, with 8.3% of false negative. In 4 patients who were initially staged as N0, the SNs were submitted to multisection analyses and immunohistochemistry, confirming the N0 stage, without micrometastases. In one case initially staged as negative for nodal metastases based on SN analyses, metastases in lymph nodes other than SN were found, resulting in a 20% skip metastases incidence. This surgery is a reproducible procedure with 100% detection rate of SN. Tumor size, GC location and obesity were factors that imposed some limitations regarding SN identification. Results from nodal multisection histology and immunohistochemistry analysis did not change initial nodal staging.

Groin lymph node detection and sentinel lymph node biopsy in vulvar cancer / 부인종양

OBJECTIVE: To identify suitable diagnostic tools and evaluate the efficacy of sentinel lymph node (SLN) biopsy for inguinal lymph node metastasis in vulvar cancer. METHODS: Data from 41 patients with vulvar cancer were evaluated retrospectively, including magnetic resonance imaging (MRI) measurements, SLN biopsy status, groin lymph node metastasis, and prognosis. RESULTS: SLN biopsy was conducted in 12 patients who had stage I to III disease. Groin lymphadenectomy was omitted in five of the nine patients with negative SLNs. All SLN-negative patients who did not undergo groin lymphadenectomy showed no evidence of disease after treatment. On MRI, the long and short diameters of the inguinal node were significantly longer in metastasis-positive cases, compared with negative cases, in 25 patients whose nodes were evaluated pathologically (long diameter, 12.8 mm vs. 8.8 mm, p=0.025; short diameter, 9.2 mm vs. 6.7 mm, p=0.041). The threshold of >10.0 mm for the long axis gave a sensitivity, specificity, positive predictive value, and negative predictive value of 87.5%, 70.6%, 58.3%, and 92.3%, respectively, using a binary classification test. Decision tree analysis revealed a sensitivity, specificity, and accuracy of 87.5%, 70.6%, and 76.0%, respectively, with the threshold of >10.0 mm for the long axis on MRI. The criteria of >10.0 mm for the long axis on MRI predicted an advanced stage and poorer prognosis using a validation set of 15 cases (p=0.028). CONCLUSION: Minimally invasive surgery after preoperative evaluation on MRI and SLN biopsy is a feasible strategy for patients with vulvar cancer.

Comparison between hemosiderin and Technetium-99 in sentinel lymph node biopsy in human breast cancer

PURPOSE: To assess the safety and potential equivalence of the use of hemosiderin compared to the Technetium-99 in sentinel lymph node biopsy in human breast cancer. METHODS: Non-random sample of 14 volunteer women diagnosed with breast cancer with primary tumors (T1/T2) and clinically tumor-free axilla were submitted to the identification of sentinel lymph node using hemosiderin obtained from autologous blood injected in the periareolar region 24h before surgery on an outpatient basis. Patients received preoperative subareolar intradermal injection of Technetium-99 in the immediate preoperative period. Patients were submitted to sentinel lymph node biopsy, with incision in the axillary fold guided by Gamma-Probe, dissection by planes until the identification of the point of maximum uptake of Technetium-99, identifying the marked nodes and their colors. All surgical specimens were sent for pathological and immunohistochemical study. RESULTS: The results showed no evidence of side effects and/or allergic and non-allergic reactions in patients submitted to SLNB with hemosiderin. The SLN identification rate per patient was 100%. SLNB identification rate per patient with hemosiderin was the same as that of Technetium, with a concordance rate of 100% between the methods. CONCLUSION: Hemosiderin is a safe dye that is equivalent to Technetium in breast sentinel lymph node biopsy.

A critical assessment on the role of sentinel node mapping in endometrial cancer / 부인종양

Endometrial cancer is the most common gynecologic malignancy in the developed countries. Although the high incidence of this occurrence no consensus, about the role of retroperitoneal staging, still exists. Growing evidence support the safety and efficacy of sentinel lymph node mapping. This technique is emerging as a new standard for endometrial cancer staging procedures. In the present paper, we discuss the role of sentinel lymph node mapping in endometrial cancer, highlighting the most controversies features.

Punção aspirativa de linfonodo axilar guiada pela ultrassonografia é eficaz como método de predição de acometimento linfonodal em pacientes com câncer de mama? / Axillary lymph node aspiration guided by ultrasound is effective as a method of predicting lymph node involvement in patients with breast cancer?

OBJETIVO: Avaliar a viabilidade e acurácia diagnóstica da ultrassonografia pré-operatória combinada com biopsia por agulha fina (US-PAAF) e do exame clínico da axila em pacientes com câncer de mama. MÉTODOS: Neste estudo prospectivo 171 axilas de pacientes com câncer de mama foram avaliadas pelo exame clínico e ultrassonografia (US) com e sem biopsia por agulha fina (PAAF). Os linfonodos com espessura cortical maior que 2,3 mm na ultrassonografia foram considerados suspeitos e submetidos a US-PAAF. RESULTADOS: A análise de regressão logística não mostrou correlação estatisticamente significativa entre exame clínico e axilas positivas no exame patológico. Em relação à avaliação axilar com US, o risco de achados anatomopatológicos positivos aumentou 12,6 vezes, valor Kappa de Cohen foi de 0,12 para exame clínico, 0,48 para US e 0,80 para US-PAAF. A acurácia foi de 61,4% para o exame clínico, 73,1% para os US e 90,1% para US-PAAF. Análise Receiver Operating Chracteristics (ROC) mostrou que uma espessura de 2,75 mm cortical correspondeu à mais elevada sensibilidade e especificidade na predição metástase axilar (82,7 e 82,2%, respectivamente). CONCLUSÕES: A US combinada com aspiração por agulha fina é mais precisa que o exame clínico na avaliação do status axilar no pré-operatório em mulheres com câncer de mama. Aquelas que são US-PAAF positivo podem ser direcionadas para esvaziamento linfonodal axilar imediatamente, e somente aqueles que são US-PAAF negativos devem ser considerados para biópsia de linfonodo sentinela. .

PURPOSE: To assess the feasibility and diagnostic accuracy of preoperative ultrasound combined with ultrasound-guided fine-needle aspiration (US-FNA) cytology and clinical examination of axillary lymph node in patients with breast cancer. METHODS: In this prospective study, 171 axillae of patients with breast cancer were evaluated by clinical examination and ultrasonography (US) with and without fine needle aspiration (FNA). Lymph nodes with maximum ultrasonographic cortical thickness > 2.3 mm were considered suspicious and submitted to US-FNA. RESULTS: Logistic regression analysis showed no statistically significant correlation between clinical examination and pathologically positive axillae. However, in axillae considered suspicious by ultrasonography, the risk of positive anatomopathological findings increased 12.6-fold. Cohen's Kappa value was 0.12 for clinical examination, 0.48 for US, and 0.80 for US-FNA. Accuracy was 61.4% for clinical examination, 73.1% for US and 90.1% for US-FA. Receiver Operating Characteristics (ROC) analysis demonstrated that a cortical thickness of 2.75 mm corresponded to the highest sensitivity and specificity in predicting axillary metastasis (82.7 and 82.2%, respectively). CONCLUSIONS: Ultrasonography combined with fine-needle aspiration is more accurate than clinical examination in assessing preoperative axillary status in women with breast cancer. Those who are US-FNA positive can be directed towards axillary lymph node dissection straight away, and only those who are US-FNA negative should be considered for sentinel lymph node biopsy. .

Prevalencia del estudio de ganglio centinela ppositivo en pacientes con melanoma en el Hospital Privado de Córdoba en 10 años / Prevalence study of positive sentinel lymph node in melanoma patients in Hospital Privado de Córdoba in 10 years

Antecedentes: El melanoma (MM) afecta principalmente a personas de raza blanca,con predominio del sexo masculino; la edad promedio de diagnóstico es de 53 años. El factor pronóstico más importante es el índice de Breslow, ya que existe una fuerte correlación entre el grado de invasión tumoral y la sobrevida del paciente. La biopsia de ganglio centinela (GC) persigue la identificación de metástasis ganglionares subclínicas yestá demostrado que existe una mayor positividad en pacientes con nivel de Breslow superior a 1 mm Objetivos: Identificar la prevalencia de ganglio centinela positivo en pacientes conmelanoma en nuestra Institución. Determinar si existe correlación entre el nivel de Breslow y el subtipo histológico, con ganglio centinela positivo. Determinar factores epidemiológicos y clínicos (edad, sexo, subtipo histológico). Material y métodos: Estudio observacional, retrospectivo, descriptivo y transversal.Resultados: En 10 años, se diagnosticaron 264 casos nuevos de melanoma, de los cuáles a 73 se les realizó estudio de ganglio centinela con resultado positivo. En 12 casos. De éstos, 1 paciente correspondió a un Breslow menor a 1 mm, 9 pacientes entre 1 - 4 mm,y 2 pacientes tuvieron Breslow mayor a 4 mm. Del subtipo histológico y la positividad del ganglio centinela, 7 casos (58%) correspondieron a melanomas nodulares (MN) y 5(42%) fueron melanomas extensivos superficiales (MES). Conclusión: La prevalencia de ganglio centinela positivo en nuestro trabajo, fue menoren comparación con los otros estudios. La correlación entre el ganglio centinela positivo y el espesor de Breslow mostró ser significativo y los subtipos histológicos nodulares tienenmayor positividad de ganglio centinela, con respecto a otros...

Sentinel lymph node biopsy in rats. Comparison between paraffin and frozen section analysis

PURPOSE: To simulate a lymph node metastasis in an animal model using activated carbon, assess their identification in frozen section analysis and compare with histopathological examination in paraffin. METHODS: Thirty two adult female rats were used. They received the carbon injection on its hind legs. Half of the rats was sacrificed on day one, and the other half after 21 days. Thus, 64 lymph nodes were dissected and split longitudinally. One half of the lymph node was sent immediately to frozen section analysis. The other half was fixed in 10% formaldehyde to be cut in paraffin. Slides were divided into quadrants and classified by the presence of carbon in these four quadrants_ They were also classified by the carbon staining intensity. RESULTS: Comparing the slides obtained in the first day and 21 days, there was a tendency of carbon to spread over time, but without statistical significance. The intensity did not alter over time. CONCLUSION: There was no concordance between the two methods of pathological analysis, however the actived carbon was seen in all lymph nodes. .