Sentinel Lymph Node Biopsy in Breast Cancer with 99mTc-Tilmanocept: A Multicenter Study on Real-Life Use of a Novel Tracer.

99mTc-tilmanocept is a novel radiopharmaceutical for sentinel lymph node (SLN) biopsy in breast cancer. Our aim was to describe results with 99mTc-tilmanocept in a heterogeneous group of breast cancer patients scheduled for SLN biopsy. Methods: Radiotracer preparation followed the manufacturer's indications. Local protocols for SLN detection within 9 participant centers were not changed for the entire duration of the study. In total, 344 patients with T1-T4, N0-N2 breast cancer (352 lesions) were included. Superficial (intradermal or periareolar) or deep (peritumoral or intratumoral) injections were performed. The doses were adjusted depending on the scheduled time for surgery. Results: Lymphoscintigraphy was able to depict at least 1 SLN in 339 of 352 breast lesions (96.3%), and the intraoperative SLN detection rate reached 97.2%. On univariable analysis, SLN detection rates did not differ by age, clinical T or N stage, tumor location, histologic subtype, or prior neoadjuvant therapy. Lymphoscintigraphy showed higher SLN detection in patients with a normal weight (body mass index < 25) than in those who were overweight or obese (body mass index ≥ 25), at 99.2% versus 94.6%, respectively (P = 0.031). The proportion of patients with preoperative lymphoscintigraphic detection or excised SLNs was higher with superficial than deep injections. Reinjected cases were significantly lower when superficial injection was chosen first (P < 0.001). Injection site and the tumor markers human epidermal growth factor receptor 2 and estrogen receptor had an impact on preoperative SLN visualization and intraoperative localization. In 80 cases, SLN biopsy resulted in a positive lymph node. During a mean follow-up of 19 mo, no axillary recurrences were observed. Conclusion: Whatever the protocol, 99mTc-tilmanocept showed good results in a heterogeneous breast cancer population, although the best results were achieved when a superficial injection was chosen.

Selective Neck Dissection Guided by a Radioactive I125 Seed for Papillary Thyroid Carcinoma Recurrence. / Disección cervical radioguiada con semillas de I125 como tratamiento de la recurrencia de cáncer papilar de tiroides.

Lymph nodes are the most common place of recurrence of papillary thyroid cancer, and surgery can be considered a therapeutic option. The risks of surgery increase with every intervention. We present 3 cases of cervical non palpable thyroid cancer recurrence managed with I125 seed radioguided cervical dissection from 2017 to 2019. Two of the cases had already a thyroidectomy and central compartment lymphadenectomy performed. The seed was placed guided by US on the lesion and its position was confirmed afterwards. The target was successfully localized in 100% of cases. There was no post surgery complications. There was no evidence of recurrence with a mean follow up of 15 months. Radioguided surgery using I125 seed it is a save technique and it offers a precise localization of the non palpable thyroid cancer recurrence.

Sentinel lymph node biopsy in selected cases of ductal carcinoma in situ.

INTRODUCTION: Axillary lymphadenectomy is nowadays not recommended to treat ductal carcinoma in situ (DCIS), but there is controversy surrounding the indication for sentinel lymph node biopsy (SLNB). MATERIALS AND METHODS: A prospective study of a selected group of patients diagnosed preoperatively with DCIS was performed between 2004 and 2009. Indications for SLNB were histologically determined high-grade tumours, tumour size >2 cm and patients scheduled to undergo a mastectomy. RESULTS: Sixty-five patients were analysed. Surgical technique was mastectomy in 39 patients (60%) and conservative breast surgery in 26 (40%). Definitive histological study of the resected breast tumour revealed 43 cases (66.2%) of DCIS, 15 (23.1%) of ductal invasive carcinoma and seven (10.7%) microinvasive tumours. In confirmed DCIS, only 6.9% of sentinel lymph nodes were positive, in microinvasive carcinoma 28.5% and in invasive carcinoma 40% were positive. Total number of patients with positive sentinel lymph nodes was 11 (16.9%). Of 39 mastectomies, 12 corresponded to microinvasive or invasive carcinoma and six (50%) showed a positive SLNB. CONCLUSIONS: Performing SLNB avoids an unnecessary second surgery to study axillary lymph nodes in invasive carcinoma diagnosed after definitive histological study. In patients undergoing a mastectomy, this study requires an axillary lymphadenectomy that is not useful in up to 50% of cases. We think that in a selected group of patients with DCIS, SLNB improves tumour staging, adapts the treatment and avoids second surgery in this group of patients.