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1.
Rev. senol. patol. mamar. (Ed. impr.) ; 33(4): 130-136, oct.-dic. 2020. graf
Artigo em Espanhol | IBECS | ID: ibc-192959

RESUMO

OBJETIVO: Describir las medidas adoptadas dentro del plan de contingencia del COVID-19 respecto a la biopsia selectiva de ganglio centinela (BSGC) y analizar su impacto sobre la actividad asistencial. METODOLOGÍA: Estudio cualitativo, descriptivo y retrospectivo de BSGC realizadas durante el período del 14/03 al 11/05 de 2020. Análisis de las medidas tomadas para minimizar las probabilidades de contagio y resultados de PCR de pacientes y personal. Comparativa de casos con los realizados en el mismo período de 2019. Actividad diaria de linfogammagrafía y de cirugía radioguiada (CRG) por indicación médica. Cálculo numérico y porcentual de CRG por hospital y recursos humanos diarios de medicina nuclear requeridos. RESULTADOS: Se realizaron 42 intervenciones con BSGC, un 31,1% menos que en 2019. La indicación médica de cáncer de mama experimentó el mayor descenso de actividad (n=18, 41,9%). Del total de CRG, Hospital Clínic realizó el 45,2%, Hospital Maternitat el 31,0%, Hospital Plató el 16,7% y Hospital Sant Joan de Déu el 7,1% restante. En relación con los recursos humanos, la planificación inicial se cumplió en un 77% de los días. El total de los controles PCR a pacientes (n=42) y personal de CRG (n=9) dio resultado negativo. CONCLUSIONES: El COVID-19 influyó negativamente en la actividad asistencial de la BSGC del Hospital Clínic, pero fue compensado por una planificación acertada, basada en el análisis previo de los procesos del procedimiento, que permitió adaptar los recursos de material y personal a las circunstancias cambiantes, otorgándole una flexibilidad que posibilitó el cumplimiento de la programación establecida


OBJECTIVE: To describe the measures taken within the COVID-19 contingency plan concerning sentinel lymph node biopsy (SNB) procedures and to assess their impact on healthcare activity. METHODOLOGY: Qualitative, descriptive and retrospective study of SNB procedures conducted during the lockdown period of COVID-19 (14/03 to 11/05 2020). Analysis of measures taken to minimise the chances of contagion and PCR outcomes of patients and staff. Comparison with SNB procedures conducted in the same time interval in 2019. Daily activity of lymphoscintigraphy and radioguided surgery (RGS) by medical indication. Numerical and percentage calculation of RGS by hospital and daily requirements for human resources in nuclear medicine. RESULTS: Forty-two SNB were performed, representing 31.1% less than those conducted in the same period in 2019. The medical indication of breast cancer showed the greatest activity decrease (n=18, 41.9%). RGS was performed in 45.2% of patients in Hospital Clínic, 31.0% in Maternitat, 16.7% in Plató and 7.1% in Sant Joan de Déu Hospital. Concerning the human resources required, the initial planning was accomplished in 77% of the days (24/31). All the PCR samples from patients (n=42) and RGS staff (n=9) were negative for COVID-19. CONCLUSIONS: COVID-19 negatively influenced the healthcare activity of SNB in Hospital Clínic, but was compensated by adequate planning, based on prior analysis of the procedure's processes, which allowed adaptation of material and personnel resources to the changing circumstances. This allowed flexibility, which in turn enabled compliance with the established schedule


Assuntos
Humanos , Neoplasias da Mama/patologia , Biópsia de Linfonodo Sentinela/estatística & dados numéricos , Infecções por Coronavirus/prevenção & controle , Reação em Cadeia da Polimerase/estatística & dados numéricos , Cirurgia Assistida por Computador/estatística & dados numéricos , Linfocintigrafia/estatística & dados numéricos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Precauções Universais/métodos , Pandemias/estatística & dados numéricos , Biópsia de Linfonodo Sentinela/métodos , Estudos Retrospectivos , Serviço Hospitalar de Medicina Nuclear/estatística & dados numéricos , Gestão da Segurança/métodos
2.
BMC Womens Health ; 20(1): 143, 2020 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-32646416

RESUMO

BACKGROUND: The benefit of axillary lymph node dissection (ALND) in breast cancer patients with one or two positive sentinel lymph nodes (SLNs) remains inconclusive. The purpose of this study was to identify risk factors independently associated with axillary lymph node (ALN) metastasis. METHODS: We retrospectively analyzed data from 389 Chinese breast cancer patients with one or two positive SLNs who underwent ALND. Univariate and multivariate logistic regression analyses were performed to identify ALN metastasis-associated risk factors. RESULTS: Among the 389 patients, 174 (44.7%) had ALN metastasis, while 215 (55.3%) showed no evidence of ALN metastasis. Univariate analysis revealed significant differences in age (< 60 or ≥ 60 years), human epidermal growth factor receptor-2 (Her-2) status, and the ratio of positive to total SLNs between the ALN metastasis and non-metastasis groups (P < 0.05). The multivariate analysis indicated that age, the ratio of positive to total SLNs, and occupations were significantly different between the two groups. Lastly, younger age (< 60 years), a higher ratio of positive to total SLNs, and manual labor jobs were independently associated with ALN metastasis (P < 0.05). CONCLUSIONS: The risk of ALN metastasis in breast cancer patients with one or two positive SLNs can be further increased by younger age, manual labor jobs, and a high ratio of positive to total SLNs. Our findings may also aid in identifying which patients with one or two positive SLNs may not require ALND.


Assuntos
Axila/patologia , Neoplasias da Mama/patologia , Metástase Linfática/patologia , Biópsia de Linfonodo Sentinela/métodos , Linfonodo Sentinela/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/cirurgia , China , Feminino , Humanos , Hibridização in Situ Fluorescente , Excisão de Linfonodo , Linfonodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Linfonodo Sentinela/cirurgia
4.
Asian Pac J Cancer Prev ; 21(3): 647-651, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32212789

RESUMO

BACKGROUND: Improvements in the process of staging and surgical treatment of axillary lymph nodes in recent years, have led to the use of intra operative frozen section pathology to examine the sentinel lymph node biopsy in breast cancer patients. MATERIALS AND METHODS: we evaluated the results of the Sentinel biopsy in 102 patients with early stage breast cancer, which were negative clinical lymph nodes, and analyzing the true positive and false negative rate, diagnostic accuracy of frozen section lymph node biopsy. It also studied the factors affecting the sentinel and non-sentinel lymph nodes in patients treated by axillary lymph dissection. RESULTS: In this study, we investigated 102 patients' stage 1and 2 breast cancer with clinical negative axillary lymph node and candidates for sentinel lymph node biopsy, were placed under investigation. 15.7 % of the real positive results of sentinel and 62.7 % of the real negative and 2 % false positives and 20.9 % false negative results and% 78. 4 diagnostic accuracy, has been frozen section. Among the patients who were initially or delayed in the axillary dissection, 37% had more than two lymph nodes. While in general, 16.7% of patients had a need for axillary lymph node dissection based on z11 criteria. Lymph-vascular invasion was a major contributor to lentil involvement in Sentinel and non-Sentinel nodes. CONCLUSION: Frozen section pathology during the operation of sentinel lymph node biopsy has been initiated to prevent the need for a reoperation in early stage breast cancer patients. However, due to low tumor burden in patients who are candidates for this procedure, and the constraints in the initial sections and their false negative results, also the removal of frozen section will not have an effect on the rate of increasing reoperation and can be effective in reducing the time and cost of surgery.


Assuntos
Neoplasias da Mama/patologia , Biópsia de Linfonodo Sentinela/métodos , Adulto , Idoso , Secções Congeladas , Humanos , Cuidados Intraoperatórios , Pessoa de Meia-Idade , Adulto Jovem
5.
J Med Ultrason (2001) ; 47(2): 299-303, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32112307

RESUMO

PURPOSE: The American College of Surgeons Oncology Group (ACOSOG) Z1071 trial assessed the accuracy of sentinel lymph node biopsies in clinically node-positive patients who underwent neoadjuvant chemotherapy (NAC). Axillary ultrasound (US) images after NAC were reviewed, and the accuracy of classifying nodes into six types according to the ACOSOG Z1071 trial was determined. METHODS: This study included 69 patients who underwent NAC followed by curative surgery for breast cancer including axillary lymph node dissection between January 2010 and July 2019. All patients were pathologically confirmed as being initially node positive. Lymph nodes were retrospectively classified into one of six types based on the appearance of the nodal cortex and hilum. Types I and II were classified as having normal nodal morphology, whereas types III, IV, V, and VI were classified as having suspicious nodal morphology. These node types on US images after NAC were compared between patients with an axillary complete response (Ax-pCR) and those with residual metastatic lymph nodes (Ax-non-pCR) using Chi-square tests. RESULTS: Twenty-four (35%) of the 69 patients achieved Ax-pCR. Patients with nodes classified as type I or II were more likely to achieve Ax-pCR (83% vs. 36%, p = 0. 0002). CONCLUSION: The classification of six node types was associated with nodal status.


Assuntos
Neoplasias da Mama/tratamento farmacológico , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Terapia Neoadjuvante/métodos , Biópsia de Linfonodo Sentinela/métodos , Ultrassonografia/métodos , Adulto , Idoso , Axila/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos
6.
Anticancer Res ; 40(3): 1711-1717, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32132079

RESUMO

BACKGROUND/AIM: The aim of this study was to evaluate the current role of frozen section in identifying patients who could benefit from an immediate axillary lymph node dissection (ALND), following the criteria of the ASOCOG Z0011 and IBCSG 23-10 trials. PATIENTS AND METHODS: A retrospective review was performed involving 2,079 patients with early breast cancer who underwent conservative surgery or total mastectomy with sentinel lymph node biopsy. RESULTS: Sensitivity and diagnostic accuracy were 63.8% and 90.3%, respectively. Sensitivity was significantly higher (p<0.001) in finding macrometastases (81.8%) compared to micrometastases (11.9%). Frozen section was useful only in 7.7% of the patients who met the criteria of the IBCSG 23-01 and ACOSOG Z0011 trials. CONCLUSION: Frozen section continues to be very useful in the intraoperative assessment of the SLN, offering a high sensitivity and diagnostic accuracy. Omission of ALND in 24.4% of patients who met the ACOSOG Z0011 criteria would have resulted in their undertreatment.


Assuntos
Neoplasias da Mama/cirurgia , Secções Congeladas/métodos , Biópsia de Linfonodo Sentinela/métodos , Linfonodo Sentinela/cirurgia , Neoplasias da Mama/patologia , Feminino , Humanos , Estudos Retrospectivos , Linfonodo Sentinela/patologia
7.
G Chir ; 41(1): 94-98, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32038018

RESUMO

Although considered the gold standard in treatment of EBC, sentinel node biopsy still remains a debated issue. What to do in case of positive sentinel node and the need of intraoperative histological examination are the most topics under discussion. In this study we have retrospectively evaluate our case series of 359 sentinel node biopsy in the managing of breast cancer from January 2011 to December 2018, focusing on the TIC technique for performing intraoperative examination. It results in 12,8% "FALSE NEGATIVE" rate, in which only 4,2% in macrometastases, with an overall sensitivity of 68,4% (macrometastases: 86%; micrometastases: 11%), overall specificity of 98,7% and an overall accuracy of 89,7%. The intraoperative examination of SLN allows to reduce delayed surgery procedures and greater therapeutic safety in case of mastectomy. The TIC method can be considered valid, simple and rapid in identifying macrometastases, also allowing to avoid under-staging. The low sensitivity for micrometastases is not a limit, considering that recent evidence has drastically reduced the indications for ALND in these cases. Further ongoing trials and the possible validation of NOMOGRAMMS and SCORE are necessary to identify low risk cases in which to definitively omit the ALND and/or even the SLNB itself.


Assuntos
Neoplasias da Mama/patologia , Biópsia de Linfonodo Sentinela/métodos , Linfonodo Sentinela/patologia , Reações Falso-Negativas , Feminino , Hospitais com Baixo Volume de Atendimentos , Humanos , Cuidados Intraoperatórios/métodos , Metástase Linfática/patologia , Mastectomia , Micrometástase de Neoplasia/patologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Linfonodo Sentinela/citologia , Biópsia de Linfonodo Sentinela/estatística & dados numéricos
8.
Breast Cancer Res Treat ; 180(2): 423-428, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32034581

RESUMO

OBJECTIVE: The aim of the study is to evaluate the optimal timing of sentinel lymph node biopsy (SLNB) in patients with clinical negative axillary lymph nodes (ALNs) before neoadjuvant therapy (NAT) and the feasibility of SLNB substituting for ALN dissection in patients with positive ALNs who convert to node negative, for HER2-positive disease. METHODS: Patients receiving SLNB with dual tracer mapping in the PEONY trial were analyzed. RESULTS: For 80 patients with clinical negative ALNs, the node negative rate by pathology after NAT was 83.8%. SLNB was performed after NAT in 71 patients. The identification rate of sentinel lymph nodes (SLNs) was 100%. For patients with positive ALNs before NAT, the axillary pathologic complete response rate in the dual HER2 blockade arm was significantly higher than that in the single blockade arm (p = 0.002). SLNB was performed in 71 patients. The identification rate was 100% and the false-negative rate was 17.2%. The false-negative rates were 33.3%, 14.3%, and 0 when 1, 2, and more than 2 SLNs were detected. There was no false-negative case when more than 1 SLN and the clipped nodes were removed simultaneously. CONCLUSIONS: For clinical ALN negative patients, HER2-positive subtype is found to have high node negative rate by pathology and it is recommended to undergo SLNB after NAT. For patients with positive ALNs who convert to negative, the false-negative rate is high. Dual tracer mapping, more than 2 SLNs detected, more than 1 SLN identified plus the clips placed are the guarantees for lower false-negative rate.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Terapia Neoadjuvante/métodos , Receptor ErbB-2/metabolismo , Biópsia de Linfonodo Sentinela/métodos , Adulto , Idoso , Axila , Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Método Duplo-Cego , Feminino , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Resultado do Tratamento , Adulto Jovem
9.
Breast Cancer Res Treat ; 180(2): 429-436, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32043193

RESUMO

PURPOSE: A substantial proportion of patients enrolled on ACOSOG Z0011 received protocol-deviant radiation treatment. It is currently unknown whether these deviations involved the use of more extensive fields in patients at higher nomogram-predicted risk. METHODS: We used the M.D. Anderson (MDA) and Memorial Sloan-Kettering (MSK) nomograms to estimate risk of additional positive axillary nodes using surgical pathology information. In the control arm, we compared axillary dissection (AD) findings to nomogram-predicted estimates for validation. We used logistic regression to evaluate whether nomogram-estimated higher risk of nodal involvement was associated with high tangent (HT) or supraclavicular (SCV) radiation fields for patients with known radiation field design. RESULTS: 552/856 (64.5%) had complete details for the MDA nomogram. Mean MDA risk estimate in both treatment arms was 23.8%. Estimated risk for patients on the AD arm with positive nodes was 25.9%. Higher risk estimate was associated with additional positive nodes in the AD arm (OR 1.04, 95% CI 1.02-1.06, p < 0.0001). We observed significant association with higher MDA nomogram-estimated risk and SCV radiation (OR 1.07, 95% CI 1.04-1.10, p < 0.0001) but not HT (OR 0.99, 95% CI 0.96-1.02, p = 0.52) The MSK nomogram had similar associations. CONCLUSION: MDA and MSK nomogram risk estimates were associated with lymph node risk in ACOSOG Z0011. Radiation oncologists' use of differing radiation fields were associated with treating higher risk patients. ClinicalTrials.gov id: NCT00003854.


Assuntos
Neoplasias da Mama/patologia , Fidelidade a Diretrizes/estatística & dados numéricos , Excisão de Linfonodo/métodos , Nomogramas , Radioterapia/métodos , Biópsia de Linfonodo Sentinela/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Axila , Neoplasias da Mama/radioterapia , Feminino , Humanos , Modelos Logísticos , Metástase Linfática , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Adulto Jovem
10.
Am J Surg ; 220(4): 982-986, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32087988

RESUMO

BACKGROUND: Sentinel lymph node biopsy (SLNB) is widely used for Merkel cell carcinoma (MCC), however in SLNB positive MCC the role of completion lymph node dissection (CLND) with or without adjuvant radiation therapy is unclear. OBJECTIVE: Our goal was to determine the impact of CLND and adjuvant radiation therapy on survival in SLNB positive MCC. MATERIALS AND METHODS: We examined 447 patients with MCC with a positive SLNB in the National Cancer Data Base from 2012 to 2015. We compared patients who underwent CLND versus observation with or without adjuvant radiation. RESULTS: Compared with CLND and adjuvant radiation (reference) treatment with observation (HR 3.54, CI 1.36-9.18) or CLND alone (HR 2.54, CI 1.03-6.27) were associated with worse overall survival after adjusting for clinicopathologic differences. In contrast treatment with adjuvant radiation alone without CLND was not associated with worse overall survival (HR 1.70, CI 0.74-3.92) compared with CLND and adjuvant radiation (reference). CONCLUSIONS: In SLNB positive MCC, CLND alone is associated with worse survival compared with treatment with adjuvant radiation or both CLND and adjuvant radiation.


Assuntos
Carcinoma de Célula de Merkel/cirurgia , Excisão de Linfonodo/métodos , Neoplasias Cutâneas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Célula de Merkel/diagnóstico , Carcinoma de Célula de Merkel/secundário , Feminino , Humanos , Metástase Linfática , Masculino , Prognóstico , Estudos Retrospectivos , Biópsia de Linfonodo Sentinela/métodos , Neoplasias Cutâneas/patologia
11.
Int J Gynecol Cancer ; 30(3): 339-345, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32075897

RESUMO

OBJECTIVE: To achieve the full potential of sentinel lymph node (SLN) detection in endometrial cancer, both presumed low- and high-risk groups should be included. Perioperative resource use and complications should be minimized. Knowledge on distribution and common anatomical sites for metastatic SLNs may contribute to optimizing the concept while maintaining sensitivity. Proceeding from previous studies, simplified algorithms based on histology and lymphatic anatomy are proposed. METHODS: Data on mapping rates and locations of pelvic SLNs (metastatic and non-metastatic) from two previous prospective SLN studies in women with endometrial cancer were retrieved. Cervically injected indocyanine green was used as a tracer and an ipsilateral re-injection was performed in case of non-display of the upper and/or lower paracervical pathways. A systematic surgical algorithm was followed with clearly defined SLNs depicted on an anatomical chart. In high-risk endometrial cancer patients, removal of SLNs was followed by a pelvic and para-aortic lymphadenectomy. RESULTS: 423 study records were analyzed. The bilateral mapping rates of the upper and lower paracervical pathways were 88.9% and 39.7%, respectively. 72% of all SLNs were typically positioned along the upper paracervical pathway (interiliac and/or proximal obturator fossa) and 71 of 75 (94.6%) of pelvic node positive women had at least one metastatic SLN at either of these positions. Women with grade 1-2 endometroid cancers (n=275) had no isolated metastases along the lower paracervical pathway compared with two women with high-risk histologies (n=148). CONCLUSION: SLNs along the upper paracervical pathway should be identified in all endometrial cancer histological subtypes; removal of nodes at defined typical positions along the upper paracervical pathway may replace a site-specific lymphadenectomy in case of non-mapping despite tracer re-injection. Detection of SLNs along the lower paracervical pathway can be restricted to high-risk histologies and a full pre-sacral lymphadenectomy should be performed in case of non-display.


Assuntos
Algoritmos , Carcinoma Endometrioide/patologia , Neoplasias do Endométrio/patologia , Sistema Linfático/anatomia & histologia , Biópsia de Linfonodo Sentinela/métodos , Linfonodo Sentinela/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Endometrioide/cirurgia , Corantes , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Verde de Indocianina , Excisão de Linfonodo , Sistema Linfático/citologia , Sistema Linfático/patologia , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Linfonodo Sentinela/cirurgia
12.
Int J Gynecol Cancer ; 30(3): 394-401, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32079711

RESUMO

Efforts to reduce surgical morbidity related to en bloc lymph node removal associated with cancer surgery led to the development of targeted lymph node sampling to identify the lymph node(s) most likely to harbor a metastasis. Through identification of one or only a few lymph nodes at highest risk, the overall number of lymph nodes removed could be markedly reduced. Submission of fewer lymph nodes affords more detailed pathologic examination than would otherwise be practical with a standard lymph node dissection. Such enhanced pathologic examination techniques (ie, ultra-staging) have contributed to increased detection of lymph node metastases, primarily by detection of low volume metastatic disease. Based on the success of sentinel lymph node mapping and ultra-staging in breast cancer and melanoma, such techniques are increasingly used for other organ systems including the gynecologic tract. This review addresses the historical aspects of sentinel lymph node evaluation and reviews current ultra-staging protocols as well as the implications associated with increased detection of low volume metastases.


Assuntos
Neoplasias dos Genitais Femininos/patologia , Biópsia de Linfonodo Sentinela/métodos , Linfonodo Sentinela/patologia , Feminino , Humanos , Linfonodos/patologia , Metástase Linfática , Melanoma/patologia
13.
Int J Gynecol Cancer ; 30(3): 378-382, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32079712

RESUMO

OBJECTIVE: To evaluate the combination of positron emission tomography/computed tomography (PET/CT) and sentinel lymph node (SLN) biopsy in women with apparent early-stage endometrial carcinoma. The correlation between radiomics features extracted from PET images of the primary tumor and the presence of nodal metastases was also analyzed. METHODS: From November 2006 to March 2019, 167 patients with endometrial cancer were included. All women underwent PET/CT and surgical staging: 60/167 underwent systematic lymphadenectomy (Group 1) while, more recently, 107/167 underwent SLN biopsy (Group 2) with technetium-99m +blue dye or indocyanine green. Histology was used as standard reference. PET endometrial lesions were segmented (n=98); 167 radiomics features were computed inside tumor contours using standard Image Biomarker Standardization Initiative (IBSI) methods. Radiomics features associated with lymph node metastases were identified (Mann-Whitney test) in the training group (A); receiver operating characteristic (ROC) curves, area under the curve (AUC) values were computed and optimal cut-off (Youden index) were assessed in the test group (B). RESULTS: In Group 1, eight patients had nodal metastases (13%): seven correctly ridentified by PET/CT true-positive with one false-negative case. In Group 2, 27 patients (25%) had nodal metastases: 13 true-positive and 14 false-negative. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of PET/CT for pelvic nodal metastases were 87%, 94%, 93%, 70%, and 98% in Group 1 and 48%, 97%, 85%, 87%, and 85% in Group 2, respectively. On radiomics analysis a significant association was found between the presence of lymph node metastases and 64 features. Volume-density, a measurement of shape irregularity, was the most predictive feature (p=0001, AUC=0,77, cut-off 0.35). When testing cut-off in Group B to discriminate metastatic tumors, PET false-negative findings were reduced from 14 to 8 (-43%). CONCLUSIONS: PET/CT demonstrated high specificity in detecting nodal metastases. SLN and histologic ultrastaging increased false-negative PET/CT findings, reducing the sensitivity of the technique. PET radiomics features of the primary tumor seem promising for predicting the presence of nodal metastases not detected by visual analysis.


Assuntos
Neoplasias do Endométrio/diagnóstico por imagem , Neoplasias do Endométrio/patologia , Linfonodo Sentinela/diagnóstico por imagem , Linfonodo Sentinela/patologia , Neoplasias do Endométrio/cirurgia , Feminino , Fluordesoxiglucose F18 , Humanos , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos , Biópsia de Linfonodo Sentinela/métodos
14.
Arch Gynecol Obstet ; 301(3): 787-792, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32048031

RESUMO

PURPOSE: Lymph node metastasis is a significant predictive factor for disease recurrence and survival in cervical cancer patients and relevant for therapeutic strategies. We evaluated the clinical value of indocyanine green (ICG) by measuring the sensitivity and negative predictive value of sentinel lymph node mapping compared with the gold standard of complete lymphadenectomy in detecting lymph node metastases for cervical cancer. METHODS: We utilized the near-infrared imaging agent ICG to detect tumor-infested lymph nodes in the pelvis analogue to a classical sentinel lymph node procedure by analyzing data from 20 patients who had undergone surgery for cervical cancer at our institution. A laparoscopic lymph node mapping procedure by means of ICG, followed by a complete pelvic lymphadenectomy with or without paraaortic lymphadenectomy was done in all patients. RESULTS: Histological examination identified seven patients with tumor-positive pelvic nodes, whereas mapping with ICG identified only five of these patients. Detection rate of positive nodes by ICG mapping and false negative rate was 71.4% and 28.6%, respectively; bilateral detection rate was 83.3%. One of the two false negative patients additionally suffered from deep infiltrating endometriosis. CONCLUSIONS: Our results indicate that ICG can identify the relevant pelvic nodes independent of tumor size, provided bilateral detection is achieved and additional, related diseases are excluded. TRIAL REGISTRATION: This trial is registered within the German Clinical Trial Register (DRKS-ID: DRKS00014692).


Assuntos
Verde de Indocianina/uso terapêutico , Biópsia de Linfonodo Sentinela/métodos , Linfonodo Sentinela/diagnóstico por imagem , Neoplasias do Colo do Útero/cirurgia , Adulto , Idoso , Feminino , Humanos , Verde de Indocianina/farmacologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias do Colo do Útero/patologia
15.
Arch Gynecol Obstet ; 301(3): 729-736, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32055954

RESUMO

PURPOSE: Application of radioactive tracers for sentinel lymph node biopsy (SLNB) in vulvar cancer has been established, however, the use of radioisotopes is expensive and requires complex logistics. This exploratory study evaluated the feasibility of near-infrared fluorescence-based SLNB in comparison to the gold standard using radioactive guidance. METHODS: At Evangelische Kliniken Essen-Mitte (Essen, Germany) between 02/2015 and 04/2019, 33 patients with squamous cell vulvar cancer and unifocal tumors (32 midline, 1 lateral) smaller than 4 cm underwent SLNB as part of their routine primary surgical therapy. Radiolabeled nanocolloid technetium 99 (99mTc) was injected preoperatively and indocyanine green (ICG) intraoperatively. Demographic and clinical data were retrieved from patients' records, and descriptive statistics were applied. The detection rate of the ICG fluorescence technique was compared with the standard radioactive approach. RESULTS: In patients with midline tumors, bilateral SLNB was attempted. SLNB was feasible in 61/64 (95.3%) groins with 99mTc and in 56/64 (87.5%) with ICG. In total, 125 SLNs were excised; all SLNs were radioactive and 117 (93.6%) also fluorescent. In 8 patients with BMI > 30 kg/m2, SLNB was successful in 14/15 groins (93.3%) with 99mTc and 13/15 groins (86.7%) with ICG. Upon final histology, infiltrated nodes were present in 9/64 (14.1%) groins and 10/125 SLNs; one positive SLN was not detected with ICG. CONCLUSIONS: SLNB using ICG is a promising technique, however, the detection rate obtained was slightly lower than with 99mTc. The detection rate increased over time indicating that experience and training may play an important role besides further methodological refinements.


Assuntos
Carcinoma de Células Escamosas/diagnóstico por imagem , Linfocintigrafia/métodos , Traçadores Radioativos , Biópsia de Linfonodo Sentinela/métodos , Linfonodo Sentinela/diagnóstico por imagem , Neoplasias Vulvares/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Vulvares/patologia
16.
Otolaryngol Head Neck Surg ; 162(3): 410-413, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32043908

RESUMO

In this study, we sought to evaluate the clinical feasibility of indocyanine green (ICG)-guided sentinel lymph node (SLN) sampling during robotic retroauricular neck dissection (RAND) in patients with cN0 oral cancer. Nine adult patients diagnosed with T1 to T2 oral squamous cell carcinoma were consecutively recruited. All of them underwent transoral partial glossectomy and robotic RAND (levels I-III) simultaneously. Twelve hours prior to surgery, ICG was injected into the 4 quadrants around primary tongue tumors. During robotic RAND, intraoperative and ex vivo ICG-stained LNs were identified using the Firefly system and examined for the presence of fluorescence. ICG-stained LNs were identified in all patients. Thirty-one ICG-stained LNs were detected in 313 retrieved LNs (9.9%). Occult metastases were detected among the ICG-stained LNs in 2 patients (22.2%). There was no metastasis identified in the ICG-unstained LNs. Upstaging rates, sensitivity, specificity, and negative predictive value of ICG-guided SLN sampling were 22.2%, 100%, 91.5%, and 100%, respectively.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Verde de Indocianina/administração & dosagem , Neoplasias Bucais/cirurgia , Esvaziamento Cervical/métodos , Procedimentos Cirúrgicos Robóticos , Biópsia de Linfonodo Sentinela/métodos , Idoso , Carcinoma de Células Escamosas/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/patologia , Espectroscopia de Luz Próxima ao Infravermelho
17.
Int J Gynecol Cancer ; 30(3): 383-386, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32075896

RESUMO

OBJECTIVES: To characterize our institutional experience with sentinel lymph node (SLN) biopsy in patients with vulvar cancer. We describe the oncologic outcomes of these patients and the utilization of SLN detection techniques over time. METHODS: A retrospective analysis of all patients who underwent inguinofemoral SLN biopsy as part of their treatment for vulvar cancer at Memorial Sloan Kettering Cancer Center from January 1, 2000 to April 1, 2019. Patients were included in this analysis if they underwent inguinofemoral SLN biopsy for vulvar cancer, irrespective of presenting factors such as histology, tumor size or laterality. An "at-risk groin" was defined as either the right or left groin for which SLN biopsy of inguinofemoral lymph nodes was performed. RESULTS: A total of 160 patients were included in our analysis, representing 265 at-risk groins. 114 patients had squamous cell histology representing 195 at-risk groins. Of the 169 negative groins in patients with squamous cell carcinoma, the 2 year isolated groin recurrence rate was 1.2%. SLN detection rate, irrespective of modality, was 96.2%. Technetium-99 (TC-99) + blue dye detected SLNs in 91.8% of groins; TC-99 + indocyanine green detected SLNs in 100% of groins (p=0.157). Among the 110 groins that underwent mapping with TC-99 and blue dye, 4 patients had failed mapping with blue dye and mapped with TC-99 alone (3.6%). Among the 96 groins that underwent mapping with TC-99 and ICG, 14 patients failed to map with TC-99 and mapped with indocyanine green alone (14.6%). CONCLUSIONS: SLN mapping in vulvar cancer is reliable and oncologically effective. The utilization of indocyanine green for mapping has increased over the past decade and is associated with high rates of SLN detection.


Assuntos
Linfonodo Sentinela/patologia , Neoplasias Vulvares/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/patologia , Feminino , Humanos , Excisão de Linfonodo , Linfonodos/patologia , Linfonodos/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Linfonodo Sentinela/cirurgia , Biópsia de Linfonodo Sentinela/métodos , Neoplasias Vulvares/cirurgia , Adulto Jovem
18.
Int J Gynecol Cancer ; 30(3): 325-331, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32029429

RESUMO

OBJECTIVE: To evaluate the relationship between pelvic/para-aortic sentinel lymph node status and two different injection sites of 99m-technetium (99mTc)-labeled phytate in patients with endometrial cancer. METHODS: This was a randomized controlled trial involving 81 patients with endometrial cancer. In the cervical group (n=40), injections of 99mTc were performed at the 3 and 9 o'clock positions of the uterine cervix. In the endometrial group (n=41), 99mTc was injected into the fundal endometrium using a transcervical catheter. Sentinel lymph nodes were detected through pre-operative lymphoscintigraphy and intra-operatively using a handheld gamma probe. All patients underwent complete pelvic and para-aortic lymphadenectomy procedures. Pathologic ultra-staging was performed with immunostaining for cytokeratin in sentinel lymph nodes after routine hematoxylin and eosin histological examinations. The primary endpoint was the estimation of detection rates, sensitivity, false-negative rates, negative predictive value, and analysis of the distribution of pelvic and para-aortic sentinel lymph nodes. RESULTS: The rate of detection of at least one sentinel lymph node, sensitivity, and the negative predictive value was 80%, 66.6%, 96.6% for the cervical group and 85%, 66.6%, 96.9% for the endometrial group, respectively. False-negative sentinel lymph nodes were detected in one patient from each group . There was no significant difference between the groups in terms of total sentinel lymph node count, sentinel pelvic lymph node count, and pelvic bilaterality, but the para-aortic sentinel lymph node count was significantly higher in the endometrial group (p<0.001). Ultra-staging examination of the pelvic sentinel lymph nodes revealed isolated tumor cells in one patient from each group. CONCLUSION: Transcervical endometrial tracer injection in endometrial cancer revealed similar pelvic but significantly higher para-aortic sentinel lymph node detection.


Assuntos
Neoplasias do Endométrio/diagnóstico por imagem , Compostos de Organotecnécio/administração & dosagem , Ácido Fítico/administração & dosagem , Compostos Radiofarmacêuticos/administração & dosagem , Biópsia de Linfonodo Sentinela/métodos , Linfonodo Sentinela/diagnóstico por imagem , Idoso , Aorta , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Linfonodos/cirurgia , Linfocintigrafia/métodos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Pelve , Estudos Prospectivos , Linfonodo Sentinela/patologia , Linfonodo Sentinela/cirurgia
19.
Int J Gynecol Cancer ; 30(3): 358-363, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31911532

RESUMO

INTRODUCTION: Sentinel lymph node (SLN) detection has been shown to be accurate in detecting lymph node involvement in early-stage cervical cancer. The objective of this study was to evaluate the accuracy of frozen section examination in the assessment of SLN status, with the aim of adequately driving the intra-operative decision. METHODS: We designed a retrospective study including patients from two comprehensive cancer centers between January 2001 and December 2018 with early-stage cervical cancer (IA1-IB2 according to International Federation of Gynecology and Obstetrics (FIGO) 2018) undergoing SLN dissection. The SLN procedure was performed using a cervical injection with technetium-99m combined with blue dye or indocyanine green in most cases. RESULTS: A total of 176 patients fulfilled inclusion criteria. Bilateral mapping was detected in 153 (86.7%) of them. Nineteen of these patients (12.4%) had SLN involvement: 13 with macrometastases, three with micrometastases and three with isolated tumor cells (ITC). Macrometastatic disease was missed on frozen section in 3/13 FIGO 2018 stage IIIC patients. The three patients with ITC were also missed by frozen section examination.Considering only macrometastases as lymph node involvement, frozen section sensitivity was 76.9% (95% CI 49.7 to 91.8) and negative predictive value (NPV) was 97.9% (95% CI 94.0 to 99.3) in patients with bilateral detection. Including micrometastases, sensitivity was 81.2% (95% CI 57.0 to 93.4) and NPV remained at 97.9% (95% CI 93.9 to 99.3). CONCLUSIONS: With a prevalence of final-stage IIIC in patients with pre-operative early-stage cervical cancer of the order of 10% in this series, the NPV of frozen section examination of SLN is very high, with an inferior limit of the CI superior to 94%. Diagnostic accuracy remains acceptable even if micrometastases are considered. The impact of missed ITC has not been established. Frozen section examination can be incorporated in the intra-operative decision algorithm.


Assuntos
Secções Congeladas/métodos , Linfonodo Sentinela/patologia , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgia , Adulto , Algoritmos , Tomada de Decisões , Feminino , Humanos , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática , Estadiamento de Neoplasias , Estudos Retrospectivos , Linfonodo Sentinela/cirurgia , Biópsia de Linfonodo Sentinela/métodos
20.
Int J Gynecol Cancer ; 30(3): 346-351, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31911534

RESUMO

BACKGROUND: Sentinel lymph node (SLN) biopsy is increasingly used in endometrial cancer staging; however, success of the technique is variable, and the learning curve needs to be better understood. Success is defined as identification of a SLN specimen containing nodal tissue in bilateral hemi-pelvises. OBJECTIVE: To assess the learning curve of surgeons at an academic institution in performing successful SLN mapping and biopsy during robotic staging for endometrial cancer. METHODS: After institutional review board approval, patients who underwent staging with robotic SLN mapping using indocyanine green at a single academic program between July 2012 and December 2017 were identified. Demographic, pathologic, and surgical data were retrospectively collected from the medical records. Descriptive and comparative statistics were performed. Surgeon rates of successful bilateral SLN mapping and removal of lymphoid-containing SLN specimens were compared. A logistic model was used to analyze the probability of successful SLN mapping and removal of lymph node-containing tissue with increasing number of procedures performed. RESULTS: Three hundred and seventeen patients met the eligibility criteria. Most had early-stage, low-grade endometrial cancer. A total of 194 (61%) patients had successful bilateral mapping. Among seven surgeons, a plateau in rates of successful bilateral mapping was achieved after 40 cases. No linear correlation was seen between the number of surgeries performed and the rate of removal of lymph node-containing tissue among surgeons. Each additional 10 procedures performed was associated with a 5% and an 11% increase in the odds of successful SLN mapping and removal of lymph node-containing tissue, respectively. DISCUSSION: The successful removal of lymph node-containing specimens appears to be a surgeon-specific phenomenon. The plateau of the learning curve for successful bilateral mapping seems to be reached at around 40 cases. These first 40 cases offer a time for auditing of individual rates of SLN mapping and removal to identify surgeons who may benefit from procedure-specific remediation.


Assuntos
Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Curva de Aprendizado , Biópsia de Linfonodo Sentinela/educação , Oncologia Cirúrgica/educação , Centros Médicos Acadêmicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Ensaios Clínicos como Assunto , Corantes , Feminino , Humanos , Verde de Indocianina , Modelos Logísticos , Pessoa de Meia-Idade , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Linfonodo Sentinela/patologia , Linfonodo Sentinela/cirurgia , Biópsia de Linfonodo Sentinela/métodos , Cirurgiões/educação , Oncologia Cirúrgica/métodos
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