Evaluation of the efficacy of using indocyanine green associated with fluorescence in sentinel lymph node biopsy.

INTRODUCTION: Sentinel lymph node biopsy is the technique recommended for the axillary staging of patients with breast cancer in the initial stages without clinical axillary involvement. Three techniques are widely used globally to detect sentinel lymph nodes: patent blue, the radiopharmaceutical technetium 99 with gamma probe, and the combination of these two. OBJECTIVES: To evaluate the sentinel lymph node detection rate with an innovative technique: indocyanine green (ICG) associated with fluorescence in breast cancer patients, and compare it with patent blue and a combination of patent blue and indocyanine green. METHODS: 99 patients were sequentially (not randomly) allocated into 3 arms with 33 patients submitted to sentinel lymph node techniques. One arm underwent patent blue dying, the other indocyanine green, and the third received a combination of both. The detection rates between arms were compared. RESULTS: The detection rate in identifying the sentinel lymph node was 78.8% with patent blue, 93.9% with indocyanine green, and 100% with the combination. Indocyanine green identified two sentinel nodes in 48.5% of patients; the other groups more commonly had only one node identified. The mean time to sentinel lymph node identification was 20.6 ± 10.7 SD (standard deviation) minutes among patients submitted to the patent blue dye, 8.6 ± 6.6 minutes in the indocyanine green arm, and 10 ± 8.9 minutes in the combined group (P<0.001; Student's test). The mean surgery time was 69.4 ± 16.9; 55.1 ± 13.9; and 69.4 ± 19.3 minutes respectively (P<0.001; Student's test). CONCLUSIONS: The sentinel lymph node detection rate by fluorescence using indocyanine green was 93.9%, considered adequate. The rates using patent blue, indocyanine green, and patent blue plus indocyanine green (combined) were significantly different, and the indocyanine green alone is also acceptable, since it has a good performance in sentinel lymph node identification and it can avoid tattooing, with a 100% sentinel lymph node detection rate when combined with patent blue.

[Gastrointestinal stromal tumor: a report of eight cases]. / Tumor estromal gastrointestinal: estudo de oito casos.

INTRODUCTION: Diagnosis and treatment of Gastrointestinal Stromal Tumor have changed because of recent genetic and molecular biological studies which have a direct impact on longer survival. METHODS: A retrospective research was carried out from November 1998 to July 2004 at the university and in the private clinics of the authors who identified GIST cases based upon positive tests to c-kit (CD117). RESULTS: The eight patients that were evaluated had an average age of 53.2 and 75% were females. The most common clinical feature was abdominal mass (62.5%). The more frequent tumor site was the stomach (62.5%) followed by the small bowel (37.5%). Mean tumor size was 10.6 cm. Resection with negative microscopic margins was possible in all patients. Tumor recurrence occurred in four cases which were treated with imatinib mesilate (STI-571) with partial response in three cases and complete response in the other. Seven patients (87.5%) are alive with a mean follow-up of 33.4 months (9 to 60 months). Due to the limited number of patients it was not possible to correlate biological behavior of the tumor with its size and mitotic count. CONCLUSIONS: There was prevalence in the female gender. Most common tumor site was the stomach. Histological examinations did not disclose any correlation between tumor size and number of mitosis. At an average follow-up of 33.4 months, the mean survival was 87.5%.

Tumor estromal gastrointestinal: estudo de oito casos / Gastrointestinal stromal tumor: a report of eight cases

OBJETIVO: O diagnóstico e tratamento dos tumores estromais gastrointestinais (TEGI) têm evoluído a partir de estudos recentes de genética e biologia molecular. Tais avanços têm refletido em melhor sobrevivência dos doentes. MÉTODOS: Foi realizado estudo retrospectivo no período de novembro/1998 a julho/2004, em instituição universitária e em clínica privada dos autores, que identificou portadores de TEGI a partir de positividade para c-kit (CD 117), ao exame imunoistoquímico. RESULTADOS: Dos oito pacientes estudados, seis eram do sexo feminino (75 por cento), a idade média foi de 53,2 anos. A presença de massa abdominal palpável foi a apresentação mais comum (62,5 por cento). O estômago foi o órgão mais acometido (62,5 por cento) seguido pelo intestino delgado (37,5 por cento). O tamanho médio do tumor foi de 10,6 cm. Em todos, foi possível a ressecção com margens livres. Em quatro doentes houve recidiva local ou à distância, todos esses foram tratados com mesilato de imatinib, com resposta parcial em três e completa em um deles. Sete pacientes (87,5 por cento) estão vivos em um período de seguimento médio de 33,4 meses. Não foi possível avaliar o comportamento biológico do tumor a partir das variáveis estudadas em virtude da pequena casuística. CONCLUSÕES: Com base nos dados obtidos de oito pacientes com TEGI do presente estudo, observamos: prevalência dos TEGI em doentes do sexo feminino o estômago como órgão preferencialmente acometido, ausência de correlação entre tamanho do tumor e número de mitoses à análise histológica e taxa de sobrevivência de 87,5 por cento com um seguimento médio de 33,4 meses.