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1.
Plast Reconstr Surg ; 145(2): 459-467, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985641

RESUMO

BACKGROUND: Injuries to the upper extremity lymphatic system from cancer may require measures to prevent secondary lymphedema. Guidelines were established relating to the use of tourniquet and elective hand and upper extremity surgery. However, reports in the setting of hand surgery have indicated that prior guidelines may not be protective to the patient. METHODS: The study systematically reviewed the current literature evaluating elective hand surgery in breast cancer patients. The authors evaluated the risk of complications, including new or worsening lymphedema and infection. RESULTS: One hundred ninety-eight abstracts were identified, and a bibliographic review was performed. Nine studies pertained to our subject, and four were included for final review. All studies included patients with prior breast cancer treatment involving breast surgery and axillary lymph node dissection. Pneumatic tourniquets were used during nearly all operations. Patients without presurgery ipsilateral lymphedema had a 2.7 percent incidence of developing new lymphedema and a 0.7 percent rate of postoperative infection. Patients with presurgery lymphedema had a 11.1 percent incidence of worsening lymphedema and a 16.7 percent rate of infection. However, all cases of new or exacerbated lymphedema resolved within 3 months. Tourniquet use was not found to increase rates of lymphedema. CONCLUSIONS: Based on the available evidence, there is no increased risk of complications for elective hand surgery in patients with prior breast cancer treatment. Breast cancer patients with preexisting ipsilateral lymphedema carry slightly increased risk of postoperative infection and worsening lymphedema. It is the authors' opinion and recommendation that elective hand surgery with a tourniquet is not a contradiction in patients who have received previous breast cancer treatments.


Assuntos
Neoplasias da Mama/cirurgia , Mãos/cirurgia , Linfedema/cirurgia , Neoplasias da Mama/complicações , Neoplasias da Mama/radioterapia , Síndrome do Túnel Carpal/etiologia , Síndrome do Túnel Carpal/cirurgia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Humanos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Linfedema/complicações , Mastectomia/efeitos adversos , Mastectomia/métodos , Segurança do Paciente , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Cirurgia de Second-Look/estatística & dados numéricos , Biópsia de Linfonodo Sentinela/efeitos adversos , Biópsia de Linfonodo Sentinela/métodos , Infecção da Ferida Cirúrgica/etiologia , Torniquetes , Resultado do Tratamento
2.
Surg Clin North Am ; 100(1): 71-90, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31753117

RESUMO

This article provides a comprehensive evaluation of surgical management of the lymph node basin in melanoma, with historical, anatomic, and evidence-based recommendations for practice.


Assuntos
Excisão de Linfonodo/métodos , Linfonodos/cirurgia , Melanoma/patologia , Neoplasias Cutâneas/patologia , Humanos , Linfonodos/patologia , Metástase Linfática , Prognóstico , Biópsia de Linfonodo Sentinela/métodos
3.
Zhonghua Zhong Liu Za Zhi ; 41(12): 896-899, 2019 Dec 23.
Artigo em Chinês | MEDLINE | ID: mdl-31874545

RESUMO

Indocyanine green (ICG) has been used as a novel tracer for mapping lymph nodes in navigation surgeries for many malignant tumors. Recently, ICG is mainly applied in sentinel lymph node biopsy for early gastric cancer, while its application in advanced gastric cancer is less reported. It was reported that application of ICG in locating perigastric lymph nodes could elevate the efficiency of lymphadenectomy for advanced gastric cancer. Besides, recognizing small lymph nodes and dissecting certain lymph node stations are its unique advantages. However, some problems remain unsolved, as few relevant research has been done. Based on conceptions of minimal invasive and precision medicine, ICG may play an important role in improving the accuracy of laparoscopic surgery for advanced gastric cancer in the future.


Assuntos
Corantes/administração & dosagem , Verde de Indocianina/administração & dosagem , Laparoscopia , Biópsia de Linfonodo Sentinela/métodos , Linfonodo Sentinela , Neoplasias Gástricas/cirurgia , Humanos , Excisão de Linfonodo , Linfonodos , Neoplasias Gástricas/patologia
4.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(12): 1196-1204, 2019 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-31874538

RESUMO

Objective: To systematically evaluate the diagnostic value of optical imaging combined with indocyanine green (ICG)-guided sentinel lymph node (SLN) biopsy in gastric cancer, and to identify potential factors that would influence diagnostic accuracy. Methods: Study was carried out by searching the electronic database of PubMed, Embase, Medline, Web of Science, and the Cochrane Library with keywords as "gastric/stomach" and "cancer/carcinoma/tumor/tumour/adenocarcinoma/neoplasm" and "sentinel lymph node" and "near-infrared/NIR or fluorescent imaging" and "indocyanine green/ICG" . Literature inclusion criteria: (1) gastric cancer clinical stage was cT0-3; (2) clinical stage determined by at least 2 kinds of imaging modalities; (3) optical imaging (near-infrared or fluorescence imaging) combined with ICG-guided SLN biopsy; (4) prospective study to predict lymph node metastasis; (5) intraoperative or postoperative pathology for all lymph nodes removed; (6) patients number in the literature >10 cases. Exclusion criteria: (1) patients with a history of ICG allergy or chemoradiotherapy; (2) previous history of endoscopic mucosal resection or endoscopic submucosal dissection; (3) patients with a variety of gastrointestinal tumor; (4) case reports, conference abstracts, clinical guidelines, editorials, reviews, meta-analysis and correspondence letters; (5) in vitro or animal experiments; (6) insufficient diagnostic efficacy data. The meta-analysis was performed in the Stata12.0 software using the "bivariate mixed-effects model" combined with the "midas" command to pool the data. Information such as true positive value, false positive value, false negative value, and true negative value of each included articles were extracted. The literature quality assessment map was drawn to describe the overall quality of the articles; the heterogeneity analysis was performed with the forest map, with P<0.01 considered as statistical significance; the funnel plot was used to describe publication bias, with P<0.1 considered as statistically significant. Area under curve (AUC) of summary receiver operator characteristic (SROC) was used to describe the diagnostic accuracy and the AUC closer to 1 indicated higher diagnostic accuracy. If there was heterogeneity (I(2)>50%) among studies, regression analysis and subgroup analysis were performed. P<0.05 was considered as statistically significant. Results: A total of 15 studies (1020 patients) were included. The optical imaging contained near-infrared (NIR) and fluorescent imaging (FI). The diagnostic value of optical imaging combined with ICG-guided SLN biopsy in gastric cancer was as follows: the pooled sensitivity (Sen) was 0.95 (95% CI: 0.82 to 0.99), specificity (Spe) was 1.00 (95% CI: 0.92 to 1.00), positive likelihood ratio (PLR) was 30.39 (95% CI: 9.14 to 101.06), negative likelihood ratio (NLR) was 0.05 (95% CI:0.01 to 0.20), diagnostic odds ratio (DOR) was 225.54 (95% CI: 88.81 to 572.77), AUC was 1.00 (95% CI: 0.99 to 1.00), threshold value was sensitivity=0.95 (95% CI: 0.82 to 0.99) and specificity=1.00 (95% CI: 0.92 to 1.00). Deeks method revealed DOR funnel plot of SLN biopsy was not asymmetrical obviously with significant difference (P=0.01), which indicated remarkable publishing bias. Meta-subgroup analysis showed that compared to FI, NIR imaging had higher sensitivity (0.98 vs. 0.73); compared to 0 minutes, optical imaging performed 20 minutes after ICG injection had higher sensitivity (0.98 vs. 0.70); compared to mean detected number of SLN of 4, mean detected number≥4 had higher sensitivity (0.96 vs. 0.68); compared to HE stain, immunohistochemistry + HE had higher sensitivity (0.99 vs. 0.84); compared to subserous injection of ICG, submucosa injection of ICG had higher sensitivity (0.98 vs. 0.40); compared to injection of 5 g/L ICG, 0.5 g/L and 0.05 g/L had higher sensitivity (0.98 vs. 0.83); compared to cT2-3 tumor, early stage (cT1) tumor had higher sensitivity (0.96 vs. 0.72); compared to ≤ enrolled 26 cases in the study, > 26 cases had higher sensitivity (0.96 vs. 0.65); compared to papers before 2010, papers after 2010 had higher sensitivity (0.97 vs. 0.81); whose differences were all significant. Sensitivity differences between mean tumor diameter of ≤30 cm and >30 cm, open surgery and laparoscopic surgery, lymph node regional dissection and retrieved dissection were not significant (all P>0.05). Conclusions: Optical imaging combined with ICG-guided SLN biopsy is clinically feasible, and especially suitable for early gastric cancer. However, the ICG being used in current studies may be overdosed. Higher sensitivity may be achieved from NIR imaging when compared with FI method.


Assuntos
Imagem Óptica/métodos , Biópsia de Linfonodo Sentinela/métodos , Linfonodo Sentinela/diagnóstico por imagem , Neoplasias Gástricas/patologia , Corantes , Humanos , Verde de Indocianina , Linfonodos/diagnóstico por imagem , Estudos Prospectivos
6.
J Surg Oncol ; 120(8): 1391-1396, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31667855

RESUMO

BACKGROUND: Sentinel lymph node biopsy is a standard staging procedure for early axillary lymph node-negative breast cancer. As an alternative to the currently used radioactive tracers for sentinel lymph node (SLN) detection during the surgical procedure, a number of studies have shown promising results using superparamagnetic iron oxide (SPIO) nanoparticles. Here, we developed a new handheld, cordless, and lightweight magnetic probe for SPIO detection. METHODS: Resovist (SPIO nanoparticles) were detected by the newly developed handheld probe, and the SLN detection rate was compared to that of the standard radioisotope (RI) method using radioactive colloids (99m Tc) and a blue dye (indigo carmine). This was a multicenter prospective clinical trial that included 220 patients with breast cancer scheduled for sentinel node biopsy after a clinical diagnosis of negative axillary lymph node from three facilities in Japan. RESULTS: Of the 210 patients analyzed, SLN was detected in 94.8% (199/210 cases, 90% confidence interval [CI]) with our magnetic method and in 98.1% (206/210 cases, 90% CI) with the RI method. The magnetic method exceeded the threshold identification rate of 90%. CONCLUSION: This was the first clinical study to use a novel handheld magnetometer to detect SLN, which we demonstrate to be not inferior to the RI method.


Assuntos
Compostos Férricos , Nanopartículas de Magnetita , Magnetometria/instrumentação , Biópsia de Linfonodo Sentinela/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/patologia , Corantes , Meios de Contraste , Dextranos , Feminino , Humanos , Índigo Carmim , Pessoa de Meia-Idade , Estudos Prospectivos , Compostos Radiofarmacêuticos , Linfonodo Sentinela/patologia
7.
Hautarzt ; 70(11): 864-869, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31605168

RESUMO

BACKGROUND: Recently, adjuvant therapies with checkpoint inhibitors and BRAF/MEK inhibitors have become available for patients with malignant melanoma and microscopic nodal disease. Meanwhile the number of complete nodal dissections for a melanoma-positive sentinel node (SN) have decreased significantly. OBJECTIVE: The authors discuss the significance of sentinel node biopsy (SNB) and early lymph node dissection in the era of adjuvant systemic therapy for stage III melanoma. MATERIALS AND METHODS: Current publications and recommendations were evaluated. RESULTS: Complete nodal dissection for a positive SN significantly reduces the risk of regional nodal relapse. However, neither SNB nor complete nodal dissection following a positive SN are associated with a benefit in survival. With the availability of novel adjuvant systemic treatment strategies for stage III melanoma, SNB has become an even more important part of modern staging diagnostics. Thus, detection of early dissemination of melanoma cells into the SN as well as the quantification of the tumor load are decisive for further therapy planning. CONCLUSION: Accurate assessment of the regional lymph node status by SNB is becoming even more important in the era of novel effective adjuvant therapies for microscopic nodal disease. Whether complete lymph node dissection is performed in patients with a positive SN needs to be assessed individually. In the case of "active nodal surveillance" instead of surgery, long-term close follow-up in specialized centers, including ultrasonographic controls, is required.


Assuntos
Excisão de Linfonodo/métodos , Linfonodos/patologia , Melanoma/patologia , Biópsia de Linfonodo Sentinela/métodos , Neoplasias Cutâneas/patologia , Humanos , Estadiamento de Neoplasias
8.
BMC Cancer ; 19(1): 859, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31470821

RESUMO

BACKGROUND: We report on our experience of ultrasound (US)-guided dual-localization for axillary nodes before and after neoadjuvant chemotherapy (NAC) with clip and activated charcoal to guide axillary surgery in breast cancer patients. METHODS: Between November 2017 and May 2018, a dual-localization procedure was performed under US guidance for the most suspicious axillary nodes noted at initial staging (before NAC, with clip) and restaging (after NAC, with activated charcoal) in 28 cytologically proven node-positive breast cancer patients. Patients underwent axillary sampling or dissection, which involved removing not only the sentinel nodes (SNs), but also clipped nodes (CNs) and tattooed nodes (TNs). Success (or failure) rates of biopsies of SNs, CNs, and TNs and inter-nodal concordance rates were determined. Sensitivities for the individual and combined biopsies were calculated. RESULTS: SN biopsy failed in four patients (14%), whereas the CN biopsy failed in one patient (4%). All TNs were identified in the surgical field. Concordance rates were 79% for CNs-TNs, 63% for CNs-SNs, and 58% for TNs-SNs. Sensitivity for SN, CN, and TN biopsy was 73%, 67%, and 67%, respectively. Sensitivity was 80% for any combination of biopsies (SN plus CN, SN plus TN, SN plus CN plus TN). CONCLUSIONS: US-guided dual-localization of axillary nodes before and after NAC with clip and activated charcoal was a feasible approach that might facilitate more reliable nodal staging with less-invasive strategies in node-positive breast cancer patients.


Assuntos
Neoplasias da Mama/tratamento farmacológico , Carvão Vegetal/administração & dosagem , Metástase Linfática/diagnóstico por imagem , Biópsia de Linfonodo Sentinela/métodos , Adulto , Idoso , Axila , Neoplasias da Mama/diagnóstico por imagem , Carvão Vegetal/uso terapêutico , Tratamento Farmacológico , Estudos de Viabilidade , Feminino , Humanos , Pessoa de Meia-Idade , Terapia Neoadjuvante , Sensibilidade e Especificidade , Ultrassonografia de Intervenção
9.
Gynecol Oncol ; 155(1): 34-38, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31402166

RESUMO

OBJECTIVE: To identify predictors of unsuccessful sentinel lymph node (SLN) mapping in patients with apparent early-stage endometrial cancer (EC) undergoing surgical staging with cervical injection of indocyanine green and SLN biopsy. METHODS: We retrospectively identified consecutive patients with EC with attempted SLN biopsy between June 2014 and June 2016 at our institution. Patients were grouped according to whether they had a successful procedure, defined as the bilateral identification of SLNs, or an unsuccessful procedure, defined as unilateral or no SLN mapping. Logistic regression was used to evaluate predictors of an unsuccessful procedure. RESULTS: Among 327 patients included in the analysis, 256 (78.3%) had a successful procedure and 71 (21.7%) had an unsuccessful procedure (15.0% unilateral SLN mapping, 6.7% no mapping). The rate of successful procedure increased from 57.7% to 83.3% between the first and last quarters of the 2-year study period, which represented the learning curve for the technique. The mean (SD) operative time decreased from 164 (55) to 137 (37) minutes. By multivariable analysis, lysis of adhesions at the beginning of surgery (odds ratio, 3.07; 95% CI, 1.56-6.07) and the presence of enlarged lymph nodes (odds ratio, 4.69; 95% CI, 1.82-12.11) were independently associated with an unsuccessful procedure. CONCLUSIONS: Lysis of adhesions at the beginning of surgery and the presence of enlarged lymph nodes independently affect the bilateral detection of SLNs.


Assuntos
Neoplasias do Endométrio/patologia , Verde de Indocianina/administração & dosagem , Biópsia de Linfonodo Sentinela/métodos , Idoso , Corantes/administração & dosagem , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Histerectomia , Excisão de Linfonodo , Metástase Linfática , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Salpingo-Ooforectomia , Linfonodo Sentinela/patologia
10.
Gynecol Oncol ; 155(1): 83-87, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31451293

RESUMO

BACKGROUND: Lymph node metastasis is the most important prognostic factor in patients with vulvar squamous cell carcinoma (SCC). Previous excision of the vulvar tumor may disrupt lymphatic channels and alter the accuracy of the sentinel lymph node (SLN) biopsy. The purpose of this study was to measure outcomes after SLN biopsy in patients with and without previous excision of the vulvar tumor. METHODS: Retrospective study of patients at a single institution with primary vulvar cancer, clinically negative nodes, and vulvar tumors < 4 cm treated with surgical excision who had SLN biopsy (2008-2015). RESULTS: There were 106 cases of concomitant wide local excision (WLE) and SLN biopsy and 24 additional cases of patients who had previous vulvar surgery and no visible tumor; these patients underwent scar re-excision and SLN biopsy. Median follow-up was 31 months. Patients who had previous tumor excision were more likely to be of younger age (p = 0.0001), have a smaller tumor (p = 0.002), and less depth of invasion (p = 0.02). In the wide local excision of the scar specimen, 11 patients (46%) had no residual disease left, 8 patients (33%) had only vulvar intraepithelial neoplasia (VINIII), 4 patients (17%) had carcinoma in situ with focal invasion and 1 patient (4%) had invasive carcinoma within the second specimen, resected with clear margins. There were no groin recurrences in patients who underwent scar re-excision and who had a negative SLN biopsy. CONCLUSION: SLN biopsy is feasible and safe in patients who have had previous excision of the vulvar tumor and present with a scar. When a SLN is detected by injecting the remaining scar, this accurately reflects the nodal status and does not negatively impact oncologic outcomes.


Assuntos
Carcinoma de Células Escamosas/patologia , Linfonodo Sentinela/patologia , Neoplasias Vulvares/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/cirurgia , Cicatriz/patologia , Estudos de Coortes , Coloides , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Prognóstico , Compostos Radiofarmacêuticos , Estudos Retrospectivos , Linfonodo Sentinela/diagnóstico por imagem , Biópsia de Linfonodo Sentinela/métodos , Neoplasias Vulvares/diagnóstico por imagem , Neoplasias Vulvares/cirurgia
11.
Actas dermo-sifiliogr. (Ed. impr.) ; 110(6): 482-489, jul.-ago. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185276

RESUMO

Antecedentes y objetivo: La biopsia selectiva de ganglio centinela (BSGC) no tiene utilidad terapéutica y solo se utiliza por su valor pronóstico. Su beneficio ha sido menor del esperado, por lo que los riesgos cobran más valor y no están claramente definidos. Nos hemos propuesto describir las complicaciones y secuelas sufridas por pacientes con melanoma expuestos a la técnica de BSGC en la práctica clínica habitual. Pacientes y métodos: En este estudio de cohortes retrospectivo unicéntrico hemos recogido los datos de todos los pacientes diagnosticados de melanoma y sometidos a la BSGC en nuestro centro (Vigo) entre enero de 2011 y julio de 2017, revisando sus historias clínicas. Resultados: Se realizaron 124 BSGC. El tiempo de seguimiento medio fue de 52,7 meses (rango 10,8-88,7 meses). El 37,9% de los pacientes presentaron complicaciones. Excluyendo a aquellos en los que se realizó linfadenectomía, el porcentaje de complicaciones fue del 30,9%. De las complicaciones totales, 14 (11,3%) fueron alteraciones en la cicatrización, 13 (10,5%) infecciones de la herida quirúrgica, 12 (9,7%) linfedemas, 11 (8,9%) seromas, 4 (3,2%) hematomas, 4 (3,2%) heridas dehiscentes, 2 (1,6%) linforragias, 2 (1,6%) alteraciones sensitivas y una (0,8%) infección del tracto urinario. El 15,3% de los pacientes presentaron secuelas, siendo el linfedema la más frecuente. Entre los pacientes sin linfadenectomía completa presentaron secuelas el 7,5%. El tabaquismo se asoció con un aumento en el porcentaje de complicaciones de un 33 a un 73%. La principal limitación de este estudio es que pueda haber un sesgo de información que infravalore los resultados por un seguimiento incompleto de los pacientes. Conclusiones: La BSGC es una técnica de estadificación del melanoma no exenta de complicaciones y secuelas. La recomendación de su uso rutinario en las guías de práctica clínica debería revisarse, sopesando los riesgos y los beneficios en cada caso. En especial tienen un alto riesgo de presentar complicaciones los pacientes fumadores. El desarrollo de otras herramientas de estadificación menos invasivas puede ser de gran utilidad para los pacientes con melanoma


Background and objective: Sentinel lymph node (SLN) biopsy is a staging, not a therapeutic, procedure. The benefits of SLN biopsy have been more modest than expected and could be outweighed by the risks, which remain unclear. The aim of this study was to describe complications and sequelae observed in patients with melanoma who underwent routine SLN biopsy at our hospital. Patients and methods: In this retrospective cohort study, we performed a chart review of all patients with melanoma who underwent SLN biopsy at our hospital in Vigo, Spain, between January 2011 and July 2017. Results: In the period analyzed, 124 SLN biopsies were performed. Over a mean follow-up of 52.7 months (range 10.8-88.7 months). A percentage of 37.9 of the patients experienced complications. The complication rate after excluding patients who underwent lymph node dissection was 30.9%. In the full chort group, there were 14 scar-related complications (11.3%), 13 surgical wound infections (10.5%), 12 lymphedemas (9.7%), 11 seromas (8.9%), 4 hematomas (3.2%), 4 wound dehiscences (3.2%), 2 cases of lymphorrhagia (1.6%), 2 cases of sensitivity alteration (1.6%), and one urinary tract infection (0.8%). The most common sequela was lymphedema. Sequelae were on record for 15.3% of patients in the full cohort (7.5% of the patients who did not undergo lymphadenectomy). Smoking was associated with a 33 to 73% increased risk of complications. The main limitation of this study is the risk of information bias due to incomplete follow-up. Conclusions: SLN biopsy is a melanoma staging procedure that causes complications and sequelae. Recommendations for its use in clinical practice guidelines should be revised and the risks and benefits carefully evaluated in each case. Smokers in particular seem to have a high risk of complications. Patients with melanoma could benefit greatly from the development of less invasive staging tools


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Metástase Linfática/patologia , Melanoma/secundário , Biópsia de Linfonodo Sentinela/efeitos adversos , Cicatriz/epidemiologia , Linfedema/etiologia , Hemorragia/epidemiologia , Cicatriz/etiologia , Seguimentos , Hemorragia/etiologia , Excisão de Linfonodo , Linfedema/epidemiologia , Melanoma/patologia , Estadiamento de Neoplasias , Estudos Retrospectivos , Biópsia de Linfonodo Sentinela/métodos , Deiscência da Ferida Operatória
12.
Expert Opin Drug Saf ; 18(9): 817-827, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31305174

RESUMO

Introduction: Preoperative systemic therapy (PST) including neoadjuvant chemotherapy (NAC) in breast cancer (BC) is used nowadays on a large scale especially in aggressive BC subtypes. The use of NAC in BC may be associated with some safety issues and hazards including possible increased rate of locoregional recurrence, inadequate staging with subsequent over or under-treatment, and surgical complications. Areas covered: This review article aims to discuss these concerns and to clarify the adequate steps and procedures needed to increase safety and alleviate the possible drawbacks of NAC. The author will discuss the adequate and meticulous technical procedures needed to stage and localize the breast tumor, detect any affected axillary lymph node, improve the accuracy and safety of doing sentinel lymph node biopsy (SLNB) after NAC, estimate the tumor response to NAC to determine the extent of surgery, and enhance the precise documentation of pCR. Expert opinion: The use of breast MRI, image-detectable clips in the tumor bed, dual technique during SLNB, and target axillary dissection are among the required steps to maintain safety. In the future, ongoing prospective trials will allow us to select patients who can safely avoid breast and/or axillary surgery after systemic therapy.


Assuntos
Antineoplásicos/administração & dosagem , Neoplasias da Mama/tratamento farmacológico , Terapia Neoadjuvante/métodos , Antineoplásicos/efeitos adversos , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Terapia Neoadjuvante/efeitos adversos , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Seleção de Pacientes , Biópsia de Linfonodo Sentinela/métodos
13.
BMJ Case Rep ; 12(7)2019 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-31315840

RESUMO

Paraneoplastic syndromes (PS) are a rare presentation of cancer, most commonly associated with small cell lung cancer (SCLC), breast cancer and haematologic malignancies. The diagnosis of PS is challenging because it could affect multiple organ systems and it may present before the tumour is visible by imaging. We report a malignant tumour diagnosed in a male patient who referred long-term paraesthesia and proximal muscle strength loss. After ruling out common causes of polyneuropathy, the anti-SOX1 antibody gave light to the diagnosis. A pulmonary opacity in the upper right lobe was observed in the chest X-ray and a pulmonary tumour was later confirmed by CT scan. The biopsy of the cervical lymphadenopathy determined an SCLC, which caused a PS called Lambert-Eaton myasthenic syndrome (LEMS). Our case raises awareness of a rare PS presentation, which can be diagnosed by specific antibodies, allowing early diagnosis and treatment of lung cancer.


Assuntos
Síndrome Miastênica de Lambert-Eaton/sangue , Síndromes Paraneoplásicas/diagnóstico , Parestesia/etiologia , Fatores de Transcrição SOXB1/antagonistas & inibidores , Carcinoma de Pequenas Células do Pulmão/patologia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Autoanticorpos/sangue , Diagnóstico Diferencial , Eletromiografia/métodos , Humanos , Síndrome Miastênica de Lambert-Eaton/complicações , Síndrome Miastênica de Lambert-Eaton/diagnóstico , Masculino , Síndromes Paraneoplásicas/fisiopatologia , Fatores de Transcrição SOXB1/sangue , Biópsia de Linfonodo Sentinela/métodos , Carcinoma de Pequenas Células do Pulmão/complicações , Carcinoma de Pequenas Células do Pulmão/diagnóstico por imagem , Carcinoma de Pequenas Células do Pulmão/tratamento farmacológico , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
14.
J Clin Ultrasound ; 47(8): 445-452, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31359458

RESUMO

OBJECTIVE: To evaluate perinodal fibrosis after 14-gauge staging core-needle biopsy (CNB) of the axillary sentinel lymph node (SLN) identified using contrast-enhanced ultrasonography (CEUS) and its interference with subsequent surgical SLN dissection in breast cancer patients. METHODS: Frequencies or means of main clinical, sonographic, pathological, and surgical characteristics were calculated. We also compared patient groups with and without perinodal pathological fibrosis. RESULTS: Forty-eight patients who underwent CEUS + CNB and axillary surgery were eligible for this cross-sectional study. Axillary surgical specimens showed perinodal fibrosis in 9/48 (18.7%) patients. Interference with SLN dissection was reported in 4/48 (8.3%) patients (two hematomas, three abnormal palpation findings, and four difficult dissections). The overall surgical detection rate of SLN was 43/48 (89.6%). In the majority of cases, perinodal fibrosis was described as moderate (4/9 [44.4%]) or severe (4/9 [44.4%]). The mean time elapsed between CEUS + CNB and axillary dissection was shorter in patients with perinodal fibrosis (P = .04). Interference with SLN dissection was only reported in patients with perinodal fibrosis (P < .001). Surgical SLN detection was successful in all nine cases in which perinodal pathological fibrosis or interference with SLN dissection was reported. CONCLUSION: Perinodal fibrosis may impair the surgical SLN dissection in early stage breast cancer patients who were staged using CEUS + CNB using a14-gauge needle.


Assuntos
Meios de Contraste/farmacologia , Excisão de Linfonodo/métodos , Biópsia de Linfonodo Sentinela/métodos , Linfonodo Sentinela/diagnóstico por imagem , Ultrassonografia Mamária/métodos , Adulto , Idoso , Axila , Biópsia com Agulha de Grande Calibre , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Neoplasias da Mama/secundário , Estudos Transversais , Feminino , Fibrose , Humanos , Linfonodos/diagnóstico por imagem , Metástase Linfática , Pessoa de Meia-Idade , Estadiamento de Neoplasias
15.
Zhonghua Zhong Liu Za Zhi ; 41(7): 481-485, 2019 Jul 23.
Artigo em Chinês | MEDLINE | ID: mdl-31357833

RESUMO

Melanoma is a malignant tumor derived from the skin and mucous membrane, the epidemiological data showed that the incidence of melanoma elevated rapidly in the last decade. Early lymph node metastasis is a distinguishing characteristic of melanoma. The assessment of regional lymph nodes is a vital factor for melanoma staging and comprehensive therapeutic strategies. The sentinel lymph node biopsy (SLNB) plays an important role in this comprehensive diagnosis and treatment system. Completion lymph node dissection (CLND) with positive sentinel lymph node was accepted by traditional theories. But it has recently been questioned via the latest global clinical trial. CLND limited the benefit for melanoma specific survival. However, SLNB is the reliable procedure for staging and prognostic evaluation of melanoma patients with positive sentinel lymph node, and CLND can significantly improve the local control and decrease the regional recurrence according to the evidence-based medicine. The authors summary the recently correlational research of SLNB and CLND in melanoma in this review.


Assuntos
Excisão de Linfonodo/métodos , Melanoma/patologia , Melanoma/cirurgia , Biópsia de Linfonodo Sentinela/métodos , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Humanos , Metástase Linfática , Recidiva Local de Neoplasia , Biópsia de Linfonodo Sentinela/tendências
17.
Vet Clin North Am Small Anim Pract ; 49(5): 793-807, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31147188

RESUMO

Clinical staging is important for determining the extent of disease in animals with malignant cancers. The status of the lymph node will help determine whether adjuvant treatment is indicated. Historically, the regional anatomic lymph node has been sampled to determine the presence or absence of metastatic disease, but there is increasing evidence that the regional anatomic lymph node is often different to the sentinel lymph node. As a result, several sentinel lymph node mapping techniques have been described for more accurate clinical staging of oncologic patients.


Assuntos
Doenças do Cão/diagnóstico , Biópsia de Linfonodo Sentinela/veterinária , Linfonodo Sentinela/diagnóstico por imagem , Animais , Meios de Contraste , Cães , Humanos , Excisão de Linfonodo/métodos , Excisão de Linfonodo/veterinária , Linfografia/métodos , Linfografia/veterinária , Biópsia de Linfonodo Sentinela/métodos , Ultrassonografia/métodos , Ultrassonografia/veterinária
18.
Breast Cancer Res Treat ; 177(2): 469-475, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31236811

RESUMO

PURPOSE: Increasing evidence suggests that completion axillary lymph node dissection (ALND) may be omitted in breast cancer patients with limited axillary nodal metastases. However, the representativeness of trial participants for the original clinical practice population, and thus, the generalizability of published trials have been questioned. We propose the use of background data from national registers as a means to assess whether trial participants mirror their target population and to strengthen the generalizability and implementation of trial outcomes. METHODS: The Swedish prospective SENOMIC trial, omitting a completion ALND in breast cancer patients with sentinel lymph node micrometastases, reached full target accrual in 2017. To assess the generalizability of trial results for the target population, a comparative analysis of trial participants versus cases reported to the Swedish National Breast Cancer Register (NKBC) was performed. RESULTS: Comparing 548 trial participants and 1070 NKBC cases, there were no significant differences in age, tumor characteristics, breast surgery, or adjuvant treatment. Only the mean number of sentinel lymph nodes with micrometastasis per individual was lower in trial participants than in register cases (1.06 vs. 1.09, p = 0.037). CONCLUSIONS: Patients included in the SENOMIC trial are acceptably representative of the Swedish breast cancer target population. There were some minor divergences between trial participants and the NKBC population, but taking these into consideration, upcoming trial outcomes should be generalizable to breast cancer patients with micrometastases in their sentinel lymph node biopsy.


Assuntos
Neoplasias da Mama/epidemiologia , Ensaios Clínicos como Assunto/normas , Auditoria Médica , Adulto , Idoso , Idoso de 80 Anos ou mais , Axila/patologia , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Terapia Combinada , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Excisão de Linfonodo , Metástase Linfática , Auditoria Médica/métodos , Pessoa de Meia-Idade , Micrometástase de Neoplasia , Sistema de Registros , Linfonodo Sentinela/patologia , Biópsia de Linfonodo Sentinela/métodos , Suécia/epidemiologia , Resultado do Tratamento
19.
Adv Anat Pathol ; 26(4): 221-234, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31149907

RESUMO

Breast and axillary lymph node specimens from breast cancer patients treated with neoadjuvant systemic therapy are being encountered by pathologists with increasing frequency. Evaluation of these specimens presents challenges that differ from those encountered during the examination of other types of breast specimens. This article reviews the key issues regarding the gross and microscopic evaluation of post-neoadjuvant systemic therapy breast and lymph node specimens, and emphasizes the importance of accurate specimen evaluation in assessing treatment response.


Assuntos
Neoplasias da Mama/terapia , Linfonodos/patologia , Terapia Neoadjuvante , Axila/patologia , Neoplasias da Mama/patologia , Humanos , Metástase Linfática/terapia , Biópsia de Linfonodo Sentinela/métodos
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