Sentinel lymph node biopsy in oral cavity cancer using indocyanine green: A systematic review and meta-analysis

This meta-analysis was conducted to evaluate the value of indocyanine green (ICG) in guiding sentinel lymph node biopsy (SLNB) for patients with oral cavity cancer. An electronic database search (PubMed, MEDLINE, Cochrane Library, Embase, and Web of Science) was performed from their inception to June 2020 to retrieve clinical studies of ICG applied to SLNB for oral cavity cancer. Data were extracted from 14 relevant articles (226 patients), and 9 studies (134 patients) were finally included in the meta-analysis according to the inclusion and exclusion criteria. The pooled sentinel lymph node (SLN) sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 88.0% (95% confidence interval [CI], 74.0-96.0), 64.0% (95% CI, 61.0-66.0), 2.45 (95% CI, 1.31-4.60), 0.40 (95% CI, 0.17-0.90), and 7.30 (95% CI, 1.74-30.68), respectively. The area under the summary receiver operating characteristic curve was 0.8805. In conclusion, ICG applied to SLNB can effectively predict the status of regional lymph nodes in oral cavity cancer.

Observaciones críticas en torno al ganglio centinela en el cáncer colorrectal / Critical observations about the sentinel lymph node in colorectal cancer

Introducción: La identificación del ganglio centinela durante el tratamiento quirúrgico del cáncer colorrectal puede ayudar a la correcta estadificación posoperatoria y trascender a la quimioterapia adyuvante en el seguimiento a fin de mejorar la supervivencia de estos enfermos. Objetivo: Identificar las técnicas utilizadas para detectar el ganglio centinela mediante acceso convencional o laparoscópico: tinción o radiotrazador, ex vivo o in vivo así como su influencia en la estadificación posoperatoria y en el tratamiento adyuvante correlacionado con la evolución del cáncer de colon. Material y Métodos: Revisión documental en formato electrónico e impreso de publicaciones actualizadas sobre el tema. Desarrollo: El estudio de los linfáticos supone el factor pronóstico más importante en el cáncer colorrectal sin metástasis. La detección del ganglio centinela es la técnica que mejor predice el estado ganglionar de un paciente y permite realizar estudios intensivos que mejoran la estadificación. Conclusiones: El estudio del ganglio centinela es una práctica reproducible sin aumento significativo del tiempo y costos. En el seguimiento de los enfermos clasificados N0 con ganglio centinela positivo parece haber tendencia a un porcentaje mayor de recidivas, lo que podría trascender a cambios en las pautas de tratamiento adyuvante en aras de mejorar la supervivencia(AU)

Introduction: The identification of the sentinel lymph node during surgical treatment of colorectal cancer can help the correct postoperative staging and go beyond adjuvant chemotherapy in the follow-up of patients with the aim to improve survival of these sick people. Objective: To identify the techniques used to detect the sentinel lymph node through either conventional or laparoscopic approach: staining or radiotracer ex vivo or in vivo, as well as its influence in postoperative staging and the adjuvant treatment correlated with the evolution of colon cancer. Material and Methods: Document review of up-to-date publications about the topic in both electronic and printed formats. Development:The study of lymphatics is considered the most important prognostic factor in the colorectal cancer without metastases. The detection of the sentinel node is the technique that best predicts the lymph node status in a patient, and allows to conduct intensive studies to improve staging. Conclusions:The study of the sentinel lymph node is a reproducible practice without a significant increase in time and costs. The follow-up of patients classified as NO with a positive sentinel lymph node seems to have a tendency to a higher percentage of relapses, which could go beyond changes in the adjuvant treatment guidelines aimed at improving survival(AU)

role of SPECT/CT in detection and localization of sentinel lymph node in breast cancer

Objectives: The purpose of this study was to compare SPECT/CT and planar lymphoscintigraphy in detecting hot nodes

Methods: In this retrospective study, planar and SPECT/CT lymphoscintigraphy were performed in 119 consecutive women with invasive breast cancer. Both images were assessed for the number of lymph nodes and their anatomical site. Hot nodes were categorized based on the classification used by surgeons as level I, II, III nodes. In addition, pathology reports were retrieved which provided additional information concerning the characteristics of the lesions missed or detected by either or both imaging modalities

Results: SPECT/CT detected hot nodes in 81 [68%] patients, while planar lymphoscintigraphy detected hot nodes in 70 [58.8%] patients. SPECT/ CT and planar imaging had 38 [32%] patients in common where they did not detect any hot nodes. According to histopathology, 15 [12.6%] out of 36 patients with negative lymphoscintigraphic sentinel node identification on both modalities had nodal metastasis. The higher lymph node detection rate by SPECT/CT was significant [p = 0.019]

Conclusion: When compared to planar lymphoscintigraphy, SPECT/CT refines preoperative lymph node detection and thus [N] staging. As such, we recommend that SPECT/CT ought to be performed in a particular set of patients, for it improves localization of the draining nodes, detects nodes missed on planar, and excludes false positives in cases of lymphatic/blood vessel radiotracer accumulation

Linfonodo centinela en cáncer de mama: correlación entre detección isotópica y quirúrgica / Pre and intraoperative scintigraphic detection of sentinel nodes in breast cancer

Background: Sentinel node detection localizes the first node that drains a malignant lesion aiming to detect tumor dissemination. Aim: To assess the yield of sentinel node detection in breast cancer, using pre or intraoperative scintigraphy. Material and Methods: Review of medical records of patients with breast cancer who had a scintigraphic detection of sentinel nodes. Lymph node scintigraphy and surgery were performed in the same day. Results: We studied 174 women aged 53 ± 13 years, operated with a diagnosis of breast cancer, including six highly suspicious lesions in the contralateral breast (totaling 180 studied breasts). Preoperative scintigraphy showed a sentinel node in 174 of 180 breasts (97%). Intraoperative gamma probe confirmed the presence of the sentinel node in the same 174 breasts and detected an additional one reaching a detection yield of 97%. Four patients in whom a sentinel node was not detected in the preoperative scintigraphy, had macrometastases. Frozen section biopsies were available in 177 of 180 breasts. Metastases were informed in 45 patients who underwent axillary lymph node dissection, plus one additional patient with a suspicious lesion. Conclusions: A high rate of sentinel node detection in the preoperative scintigraphy was observed. Most sentinel nodes not detected with nuclear medicine had macrometastases. In 71% of patients, the detection of sentinel node avoided axillary lymph node dissection.

Time-lapse imaging of sentinel lymph node using indocyanine green with near-infrared fluorescence imaging in early endometrial cancer / 부인종양

OBJECTIVE: Indocyanine green with near-infrared fluorescence imaging (NIR-ICG) is a new tracer modality in the limelight used for lymphatic mapping. The advantage of this method is to provide real-time image during surgery. To use ICG for image guided lymph node dissection, a surgeon needs to know initial appearing time and duration. METHODS: A 52-year-old woman undertook surgery diagnosed with endometrial cancer. She had no past medical history and her body mass index was 25.3 kg/m2. Preoperative magnetic resonance imaging examination revealed 2.7 cm sized cancerous mass in the endometrial cavity with superficial myometrial invasion without lymph node enlargement. Four mL (1.25 mg/mL) of ICG solution was prepared for injection. For each site, 1 mL of solution was injected superficially, 2-3 mm into the cervical submucosa and another 1 mL was injected deep, 1-2 cm into the stroma of the cervix. We recorded video with 30° 10 mm scope equipped with a specific lens and light source emitting both visible and NIR light (KARL STORZ GmbH & Co. KG, Tuttlingen, Germany). RESULTS: Pelvic lymph node was visualized from around 5 minutes. ICG was dispersed into organs after hysterectomy (53 minutes after ICG injection), yet we could clearly identify sentinel lymph node (SLN). Pathology revealed endometriod adenocarcinoma grade I, myometrial invasion with less than half of myometrium and no lymph node metastasis. CONCLUSION: Cervical injection of ICG provides good visualization of SLN from 5 minutes to over an hour. Our film gives an idea about time management to make a plan for surgery and not to miss SNLs.