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2.
Indian J Cancer ; 56(3): 269-270, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31389393

RESUMO

Sentinel lymph node biopsy (SLNB) was introduced in the 1990s, as a minimally invasive procedure for staging the axilla with less morbidity to the traditional axillary lymph node dissection and is now standard management of the axilla in the early breast cancer. SLNB using the combined technique of blue dye and radioisotope is currently the recommended method for lymphatic mapping, and studies have shown high identification rates (IR) (>95%) and low false-negative rates (FNR) 5-10%. However, there are several reports raising awareness regarding patent blue V dye-induced peri-operative anaphylaxis. The main aim of this article is to highlight the emergence of patent blue dye as a new allergen and present evidence regarding the utility of alternative safer methods of evaluation of early breast cancer without compromising IR.


Assuntos
Neoplasias da Mama/diagnóstico , Reações Falso-Negativas , Corantes de Rosanilina/normas , Biópsia de Linfonodo Sentinela/normas , Linfonodo Sentinela/patologia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Corantes/normas , Feminino , Humanos , Prognóstico , Linfonodo Sentinela/cirurgia
3.
J Surg Oncol ; 120(4): 587-592, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31309573

RESUMO

BACKGROUND: We implemented selective use of frozen section (FS) to optimize accuracy and cost control in the intraoperative diagnosis of sentinel lymph node (SLN) in patients with breast cancer, guided by the Memorial Sloan Kettering Cancer Center (MSKCC) nodal metastasis risk prediction nomogram. METHODS: Surgical pathology records were reviewed, examining 2582 consecutive biopsies from 2552 patients with breast cancer to compare intraoperative FS diagnoses with postoperative final reports. We calculated sensitivity, specificity, and false-negative rates (FNRs) for various MSKCC risk levels, also analyzing axillary reoperation rates, with and without FS, and the number needed to treat (NNT) to avoid separate axillary lymph node dissection. RESULTS: The sensitivity, specificity, and FNR of FS were 84.7%, 99.9%, and 15.3%, respectively. FNR and MSKCC risk level negatively correlated (r = -0.86; P = .002). Axillary reoperation rate significantly declined if FS was done (FS: 4.0%; no FS: 36.4%; P = .002). In grouping patients by quartile of MSKCC risk, axillary reoperation rates were 16.7%, 25.1%, 38.7%, and 58.7% without FS, compared with 4.3%, 3.2%, 5.6%, 3.3% with FS and NNT correspondingly fell from 8.1 to 4.6, 3.0, and 1.8. CONCLUSIONS: A stratified decision-making algorithm based on the MSKCC risk prediction model improved the effectiveness of FS during SLN biopsy to avoid axillary reoperation.


Assuntos
Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/secundário , Carcinoma Lobular/secundário , Secções Congeladas/normas , Linfonodos/patologia , Nomogramas , Biópsia de Linfonodo Sentinela/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/cirurgia , Carcinoma Lobular/cirurgia , Feminino , Seguimentos , Humanos , Cuidados Intraoperatórios , Excisão de Linfonodo , Linfonodos/cirurgia , Metástase Linfática , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Adulto Jovem
4.
Breast Cancer Res Treat ; 177(1): 1-4, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31152326

RESUMO

PURPOSE: The steady move towards axillary conservatism in breast cancer is based on studies demonstrating that axillary node clearance affords no survival benefit in a subset of patients with a positive pre-operative axillary ultrasound (AUS). However, less attention has been paid to AUS-negative patients who receive sentinel node biopsy as standard. METHODS: Previously assembled systematic review data was reassessed to evaluate nodal burden amongst patients with breast cancer and a clinically and radiologically negative axilla. RESULTS: Pooled data from four cohort studies reporting pre-operative axillary ultrasound in 5139 patients with breast cancer show it has a negative predictive rate of 0.951 (95% confidence interval 0.941-0.960). CONCLUSIONS: Reconsidering the use of ultrasound in patients with early breast cancer and non-palpable axillae reveals that sentinel node biopsy itself may represent surgical over-treatment in patients with a negative axillary ultrasound. The implications of this on the future of surgical management of the axilla are discussed.


Assuntos
Neoplasias da Mama/diagnóstico , Radiografia , Biópsia de Linfonodo Sentinela , Axila/diagnóstico por imagem , Axila/patologia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Gerenciamento Clínico , Feminino , Humanos , Linfonodos/patologia , Metástase Linfática , Valor Preditivo dos Testes , Cuidados Pré-Operatórios , Radiografia/métodos , Radiografia/normas , Biópsia de Linfonodo Sentinela/normas , Ultrassonografia
5.
Ann Surg Oncol ; 26(9): 2738-2746, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31147995

RESUMO

BACKGROUND: Among patients with a core biopsy diagnosis of ductal carcinoma in situ (DCIS), approximately 10% have microinvasion (DCISM), which, like DCIS, is subject to upstaging by surgical excision, but for which the rates of T and N upstaging are unknown, as is the role of sentinel lymph node biopsy (SLNB), since current studies of SLNB for DCISM are based on the final pathologic report, not the core needle biopsy. In this study, we identified the rates of T and N upstaging following surgical excision in patients with a suspected versus definite core needle biopsy diagnosis of DCISM. METHODS: Overall, 369 consecutive patients (2007-2017) with a core biopsy diagnosis of suspected versus definite DCISM and surgical excision were stratified by extent of DCISM on core biopsy: suspicious focus, single focus, multiple foci/single biopsy, and multiple foci/multiple biopsies. Within strata, we identified clinicopathologic features associated with T and N upstaging. RESULTS: Across core biopsy strata, there were no clear differences in imaging characteristics or median invasive tumor size (0.2 cm). Among 105 patients with a core biopsy suspicious for DCISM versus 264 with definite DCISM, 28% and 37%, respectively, were upstaged to at least pT1a, but only 1% and 6%, respectively, to pN1. CONCLUSIONS: Although 28% of patients with suspected DCISM on core biopsy were surgically upstaged to invasive cancer, the frequency of pN1 SLN metastasis (1%) was comparable with that of DCIS, and was insufficient to recommend SLNB at initial surgery. SLNB remains reasonable for patients with definite DCISM on core biopsy.


Assuntos
Neoplasias da Mama/diagnóstico , Carcinoma Intraductal não Infiltrante/diagnóstico , Biópsia de Linfonodo Sentinela/estatística & dados numéricos , Biópsia de Linfonodo Sentinela/normas , Adenocarcinoma/diagnóstico , Adenocarcinoma/cirurgia , Idoso , Biópsia com Agulha de Grande Calibre , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Ductal de Mama/cirurgia , Carcinoma Intraductal não Infiltrante/cirurgia , Carcinoma Papilar/diagnóstico , Carcinoma Papilar/cirurgia , Feminino , Seguimentos , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Invasividade Neoplásica , Prognóstico , Estudos Retrospectivos , Fatores de Risco
7.
Eur J Cancer Care (Engl) ; 28(4): e13043, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30993764

RESUMO

Population-based cancer registry data from three Spanish areas were used to assess the patterns of care and adherence to guidelines for cutaneous malignant melanoma. We included 934 cases diagnosed in 2009-2013. Completeness of the pathology reports, imaging for detecting distant metastasis and the use of sentinel lymph node biopsy (SLNB) were analysed. The proportion of pathology reports that mentioned the essential pathological features required for T staging was 93%, ranging across geographic areas from 81% to 98% (p < 0.001). The percentage of low-risk patients who underwent no imaging studies, as proposed by guidelines, or only chest imaging ranged among areas from 0.6% to 84% (p < 0.001). Of the patients with clinically node-negative melanoma >1 mm thick and no distant metastases, 68% underwent SLNB, varying by area from 61% to 78% (p = 0.017). This study revealed wide geographic variation in different aspects of melanoma care. The use of a standardised structured pathology report could strengthen the completeness of reporting. Improvement strategies should also include efforts to reduce overuse of imaging in low-risk patients and to increase the adherence to guidelines recommendations on the use of SLNB.


Assuntos
Disparidades em Assistência à Saúde , Melanoma/cirurgia , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Diagnóstico por Imagem/normas , Diagnóstico por Imagem/estatística & dados numéricos , Feminino , Fidelidade a Diretrizes , Humanos , Excisão de Linfonodo/normas , Excisão de Linfonodo/estatística & dados numéricos , Metástase Linfática , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto/normas , Estudos Retrospectivos , Biópsia de Linfonodo Sentinela/normas , Biópsia de Linfonodo Sentinela/estatística & dados numéricos , Neoplasias Cutâneas/patologia , Espanha
8.
Gynecol Oncol ; 153(2): 292-296, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30814024

RESUMO

OBJECTIVES: To report the interim findings of an audit of the outcomes of sentinel node (SN) biopsy performed as a replacement for groin node dissection in women with early stage vulvar cancer in routine clinical practice in Australia and New Zealand. METHODS: A prospective multi-center study in 8 participating centers. Eligible patients had squamous cell carcinomas clinically restricted to the vulva <4 cm in diameter. SN procedures and pathological assessment were to be performed in accordance with the methods published by the GROINSS-V collaboration [1]. RESULTS: 130 women with apparent early stage vulvar cancer were enrolled. Seventeen women subsequently did not meet the eligibility criteria and were excluded. SNs were identified in 111/113 of the remaining women. Twenty-two women had positive nodes. Sixteen of these women had at least 12 months follow up and 7 (44%) had recurrent disease. Eighty-nine women had only negative nodes. Seventy-four of these women had at least 12 months follow up and 6 (8%) had recurrent disease (including 2 [2.7%] with recurrence in the groin). On subsequent review of the two women with negative SNs who had groin recurrences, it was found that the recommended pathology protocol had not been followed. In both cases, SN metastases were identified following serial sectioning of the nodes. CONCLUSIONS: SN biopsy is feasible in routine clinical practice. However, undetected metastases in a removed SN may be associated with groin recurrence. To ensure patient safety, strict adherence to the pathology protocol is an essential component in the utilization of the sentinel lymph node technique in vulvar cancer.


Assuntos
Metástase Linfática/patologia , Recidiva Local de Neoplasia/prevenção & controle , Biópsia de Linfonodo Sentinela/normas , Neoplasias Vulvares/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália , Estudos de Viabilidade , Feminino , Virilha , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Excisão de Linfonodo/estatística & dados numéricos , Auditoria Médica/estatística & dados numéricos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Nova Zelândia , Patologia/normas , Segurança do Paciente/normas , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Linfonodo Sentinela/patologia
9.
Breast Dis ; 38(1): 1-5, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30829609

RESUMO

BACKGROUND: The mainstream treatment of breast cancer is radical mastectomy accompanied with Axillary Lymph Node Dissection (ALND). Lately, more conservative methods accompanied by adjuvant radiotherapy have been gradually replacing radical modalities. The Sentinel Lymph Node Biopsy (SLNB) has been considered such a valuable alternative to surgery conservative approach. OBJECTIVE: To assess the agreement between SLNB in breast cancer patients and pathology results following ALND and to provide correlation between the sentinel lymph nodes (SLN) anatomical topography and biopsy positivity according to SLNBs. METHODS: Two hundred female breast cancer patients (31 to 83 years of age) underwent partial or simple mastectomy with or without subsequent ALND. All patients were randomized against selection criteria and underwent SLNB. RESULTS: In a set of 200 patients, 96.3% presented identical results between SLNB and pathology. 36% of them were confirmed with positive SLN through both approaches. Regarding the SLN topographic anatomical position, 67.3% of samples were located in the front axillary position, 24.5% in the front thoracic position, whereas 6.1% was located in the central axillary position. CONCLUSIONS: The correlation between the SLN topographic anatomical position and the pathology results, revealed that the majority of the SLN accumulates in the front axillary region. A larger patient population will statistically support this association.


Assuntos
Neoplasias da Mama/patologia , Biópsia de Linfonodo Sentinela/normas , Linfonodo Sentinela/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/patologia , Carcinoma Ductal de Mama/cirurgia , Feminino , Humanos , Excisão de Linfonodo , Mastectomia , Pessoa de Meia-Idade , Linfonodo Sentinela/cirurgia , Biópsia de Linfonodo Sentinela/métodos
10.
World J Surg Oncol ; 17(1): 37, 2019 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-30786903

RESUMO

BACKGROUND: Breast cancer patients with suspicious axillary lymph node (ALN) at ultrasound and positive fine-needle aspiration (FNA) results were required to receive ALN dissection (ALND), which was not certain in the post-ACOSOG Z0011 era. We aim to evaluate the ALN metastasis burden in these patients, thus to illustrate whether they can follow the ACOSOG Z0011 trial procedure. METHODS: Clinically, T1-2 N0 breast cancer patients with positive preoperative ALN biopsy (FNA group) or 1-2 positive sentinel nodes (SLNB group) were retrospectively analyzed. ALN metastasis burden was compared between the two groups, which were further analyzed in certain subtypes. An association between clinicopathological factors and ≥ 3 ALN metastasis was also analyzed. RESULTS: A total of 388 patients were included: 202 in the FNA group and 186 in the SLNB group. The FNA group had a significantly higher number of positive ALN (5.18 vs. 1.77, P <  0.001) and a larger proportion of patients with ≥ 3 ALN metastasis (58.42% vs. 11.83%, P <  0.001) than the SLNB group, which was not influenced by different tumor size stage and molecular subtypes. ALN metastasis identified by FNA was independently associated with a high rate of ≥ 3 ALN metastasis (OR = 6.98, 95% CI 1.95-25.02, P = 0.003). CONCLUSIONS: Patients with positive preoperative ALN biopsy had a higher ALN metastasis burden than patients with 1-2 positive SLNs, which was also the strongest factor associated with ≥ 3 ALN metastasis, indicating that these patients are not appropriate to receive SLNB in the post-ACOSOG Z0011 trial era.


Assuntos
Neoplasias da Mama/patologia , Metástase Linfática/patologia , Biópsia de Linfonodo Sentinela/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Axila , Biópsia por Agulha Fina , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Feminino , Humanos , Excisão de Linfonodo/normas , Pessoa de Meia-Idade , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos , Linfonodo Sentinela/diagnóstico por imagem , Linfonodo Sentinela/patologia , Biópsia de Linfonodo Sentinela/métodos , Ultrassonografia
11.
Oral Oncol ; 87: 64-69, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30527245

RESUMO

Oral cancer is a global disease. Despite a well elucidated tumour progression model, these cancers present late. Attempts at early detection by way of adjunctive diagnostic technologies and screening have not lived up to expectations in spite initial promise. Surgery is the mainstay of treatment. Treatment intensification by way of adjuvant radiation/chemo radiation is warranted for those with high risk features. Recent studies have explored intensification in those with intermediate risk factors in an attempt to improve outcomes. There has been generation of recent robust evidence that has influenced the need and extent of neck dissection. Neoadjuvant chemotherapy (NACT) may have a potential role in organ preservation and borderline resectable oral cancers. Recurrent tumours should be offered surgery whenever feasible while the addition of biological agents to chemotherapy gives best results in the palliative settings.


Assuntos
Medicina Baseada em Evidências/métodos , Neoplasias Bucais/terapia , Recidiva Local de Neoplasia/terapia , Tratamentos com Preservação do Órgão/métodos , Antineoplásicos Imunológicos/uso terapêutico , Quimiorradioterapia Adjuvante/métodos , Quimiorradioterapia Adjuvante/normas , Intervalo Livre de Doença , Medicina Baseada em Evidências/normas , Humanos , Metástase Linfática/diagnóstico , Metástase Linfática/patologia , Neoplasias Bucais/mortalidade , Neoplasias Bucais/patologia , Esvaziamento Cervical/métodos , Esvaziamento Cervical/normas , Terapia Neoadjuvante/métodos , Terapia Neoadjuvante/normas , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Tratamentos com Preservação do Órgão/normas , Cuidados Paliativos/métodos , Cuidados Paliativos/normas , Guias de Prática Clínica como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Biópsia de Linfonodo Sentinela/métodos , Biópsia de Linfonodo Sentinela/normas
12.
Rev Esp Med Nucl Imagen Mol ; 37(6): 373-379, 2018.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30409688

RESUMO

Sentinel lymph node (SLN) biopsy is now the standard of care for regional staging in several solid tumors. The interstitial administration of a radiotracer around the primary tumor provide the possibility to sequentially obtain images with a gamma camera and visualize lymphatic mapping and the SLN. There is, however, a large geographical variability in those radiotracers and nanocolloids ranging from 15-100nm which are most widely employed in Europe, while filtered and unfiltered 99mTc-sulfur colloid (range 20-1000nm) is usually used in the USA with different drawbacks in its use. The new radiotracer 99mTc-Tilmanocept, designed specifically for the identification of SLNs and recently becoming commercially available in USA and Europe, appears to have the potency to overcome the shortcomings described for the conventional radiotracers used until now for SLN biopsy and at the same time to transform current imaging paradigms. After delineating the challenges for the next generation of radiotracers, this paper discusses the properties of 99mTc-Tilmanocept, its validation process for SLN biopsy and its emerging clinical applications in various malignancies.


Assuntos
Dextranos , Mananas , Neoplasias/diagnóstico por imagem , Neoplasias/patologia , Cintilografia , Biópsia de Linfonodo Sentinela/normas , Pentetato de Tecnécio Tc 99m/análogos & derivados , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/patologia , Humanos , Melanoma/diagnóstico por imagem , Melanoma/patologia , Neoplasias Bucais/diagnóstico por imagem , Neoplasias Bucais/patologia
13.
Br J Surg ; 105(12): 1541-1552, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30311642

RESUMO

BACKGROUND: Neoadjuvant chemotherapy for breast cancer has the potential to achieve a pathological complete response in up to 40 per cent of patients, converting disease that was initially node-positive to node-negative. This has raised the question of whether sentinel lymph node biopsy could be an alternative to axillary lymph node dissection in these patients. The aim was to undertake a systematic review and meta-analysis of the accuracy and reliability of sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with initial biopsy-proven node-positive breast cancer. METHODS: A literature search was conducted using PubMed, Ovid MEDLINE, Embase and Web of Science databases up to 30 April 2017. Inclusion criteria for studies were pathological confirmation of initial node-positive disease, and sentinel lymph node biopsy performed after neoadjuvant chemotherapy followed by axillary lymph node dissection. RESULTS: A total of 13 studies met the inclusion criteria and were included in the analysis (1921 patients in total). The pooled estimate of identification rate was 90 (95 per cent c.i. 87 to 93) per cent and the false-negative rate was 14 (11 to 17) per cent. In subgroup analysis, the false-negative rate with use of dual mapping was 11 (6 to 15) per cent, compared with 19 (11 to 27) per cent with single mapping. The false-negative rate was 20 (13 to 27) per cent when one node was removed, 12 (5 to 19) per cent with two nodes removed and 4 (0 to 9) per cent with removal of three or more nodes. CONCLUSION: Sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with biopsy-proven node-positive breast cancer is accurate and reliable, but requires careful patient selection and optimal surgical techniques.


Assuntos
Neoplasias da Mama/patologia , Linfonodos/patologia , Neoplasias da Mama/tratamento farmacológico , Quimioterapia Adjuvante , Métodos Epidemiológicos , Feminino , Humanos , Metástase Linfática , Terapia Neoadjuvante , Estadiamento de Neoplasias , Seleção de Pacientes , Biópsia de Linfonodo Sentinela/normas
14.
Diagn Cytopathol ; 46(11): 919-926, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30353679

RESUMO

BACKGROUND: Sentinel lymph node biopsy (SLNB) has become the standard in breast cancer staging, but it is costly and time-consuming. Fine-needle aspiration cytology (FNAC) under ultrasonographic guidance identifies patients who need axillary lymph-node dissection (ALND), thus reducing costs. As an alternative to frozen sections (FS), intraoperative scrape cytology (ISC) for SLNB is an inexpensive, rapid, accurate and safe technique. We evaluated the synergy of FNAC and SLNB in determining the axillary burden and the performance of the ISC method. METHODS: Over a nine-year period, 894 breast cancer patients were analyzed. Of these, 439 patients with echographic suspicious nodes underwent preoperative FNAC; negative axillary ultrasounds or FNACs resulted in 606 intraoperative SLNB, performed using the ISC technique. The results were compared with histological diagnosis, and sensitivity, specificity, predictive values and accuracy were calculated. RESULTS: Of the 439 FNACs, 121 were positive and underwent immediate ALND, and 242 negative patients underwent intraoperative SLNB (69% sensitivity, 99% specificity). Positive cases often had multiple nodal involvement (55% pN2-3). Of the 606 SLNB-ISC smears, 510 were true negative; 65 true positives allowed for one-step ALND (71% sensitivity, 99% specificity). CONCLUSION: Preoperative positive axillary FNAC predicts a higher disease burden and determines the avoidance of SLNB for patients eligible for immediate ALND. ISC instead of FS is a safe and sensitive technique to identify metastases, indicating completion of ALND. PARTIALLY PRESENTED AT: Joint International Oncology (sentinel node & cancer metastasis) Congress, May 27-29, 2013, San Francisco, California, USA 18 ° International Congress of Cytology (ICC 2013-1161), May 26-30, 2013, Paris, France Convegno Nazionale GISMa - Finalborgo (Savona), Italy,19-20 maggio 2016.


Assuntos
Neoplasias da Mama/patologia , Linfonodo Sentinela/patologia , Biópsia por Agulha Fina/métodos , Biópsia por Agulha Fina/normas , Neoplasias da Mama/cirurgia , Feminino , Humanos , Período Intraoperatório , Estadiamento de Neoplasias/métodos , Estadiamento de Neoplasias/normas , Valor Preditivo dos Testes , Linfonodo Sentinela/cirurgia , Biópsia de Linfonodo Sentinela/métodos , Biópsia de Linfonodo Sentinela/normas
17.
Am Surg ; 84(5): 672-679, 2018 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-29966567

RESUMO

Thin melanoma is the most common form of melanoma in the United States. The National Comprehensive Cancer Network (NCCN) has guidelines for sentinel lymph node biopsy (SLNB) which recommend "discuss and consider" SLNB for invasion >0.75 mm and "discuss and offer" SLNB for invasion >0.75 mm with suspicious features. This study looked at compliance with NCCN guidelines and factors that are predictive of a positive SLNB. This is a retrospective study of patients diagnosed with thin melanoma 2012-2013 using the National Cancer Database. A total of 26,456 patients met study qualifications. Univariate analysis showed that 76 per cent of patients meeting criteria underwent SLNB. Patients recommended to "discuss and consider" received SLNB 53 per cent of the time and those not recommended for SLNB received SLNB 20 per cent of the time. On multivariate analysis, depth was not predictive for positive SLNB whereas mitoses and ulceration were. Other factors predictive of positive SLNB were nodular cell type, lymphovascular invasion, and Clark's level greater than or equal to IV. Patients with thin melanoma that meet NCCN guidelines for SLNB undergo this procedure in good compliance but those who do not meet criteria continue to receive SLNB. Positive predictive factors for positive SLNB include mitoses, ulceration, Clark's level, and primary site.


Assuntos
Fidelidade a Diretrizes/estatística & dados numéricos , Melanoma/patologia , Padrões de Prática Médica/estatística & dados numéricos , Biópsia de Linfonodo Sentinela/estatística & dados numéricos , Neoplasias Cutâneas/patologia , Adulto , Idoso , Bases de Dados Factuais , Feminino , Humanos , Masculino , Melanoma/cirurgia , Pessoa de Meia-Idade , Análise Multivariada , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Biópsia de Linfonodo Sentinela/normas , Neoplasias Cutâneas/cirurgia , Estados Unidos
19.
J Cancer Res Clin Oncol ; 144(7): 1385-1393, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29691646

RESUMO

PURPOSE: To evaluate the sensitivity, negative predictive value (NPV) and false-negative (FN) rate of the near infrared (NIR) indocyanine green (ICG) sentinel lymph node (SLN) mapping in patients with poorly differentiated endometrial cancer who have undergone a full pelvic and para-aortic lymphadenectomy after SLN mapping. METHODS: We performed a retrospective analysis of patients with endometrial cancer undergoing a laparoscopic NIR-ICG SLN mapping followed by a systematic pelvic and para-aortic lymphadenectomy. Inclusion criteria were a grade 3 endometrial cancer or a high-risk histology (papillary serous, clear cell carcinoma, carcinosarcoma, and neuroendocrine carcinoma) and a completion pelvic and para-aortic lymphadenectomy to the renal vessels after SLN mapping. Overall and bilateral detection rates, sensitivity, NPV, and FN rates were calculated. RESULTS: From December 2012 until January 2017, 42 patients fulfilled inclusion criteria. Overall and bilateral detection rates were 100 and 90.5%, respectively. Overall, 23.8% of the patients had lymph node metastases. In one patient, despite negative bilateral pelvic SLNs, a metastatic non-SLN-isolated para-aortic metastasis was detected. This NSLN was clinically suspicious and sent to frozen section analysis during the surgery. FN rate, sensitivity, and NPV were 10, 90, and 97.1%, respectively. For the SLN mapping algorithm, FN rate, sensitivity, and NPV were 0, 100, and 100%, respectively. CONCLUSIONS: Laparoscopic NIR-ICG SLN mapping in high-risk endometrial cancer patients has acceptable sensitivity, FN rate, and NPV.


Assuntos
Neoplasias do Endométrio/patologia , Biópsia de Linfonodo Sentinela/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Endométrio/diagnóstico , Feminino , Humanos , Verde de Indocianina , Laparoscopia/métodos , Laparoscopia/normas , Excisão de Linfonodo , Metástase Linfática , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Reprodutibilidade dos Testes , Estudos Retrospectivos , Linfonodo Sentinela/patologia , Linfonodo Sentinela/cirurgia , Biópsia de Linfonodo Sentinela/normas
20.
J Obstet Gynaecol Res ; 44(6): 1150-1157, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29673015

RESUMO

AIM: This study aims to explore the accuracy, specificity and laws of axillary lymph node metastasis predicted by sentinel lymph node biopsy (SLNB) by comparing axillary lymph node status via SLNB and axillary lymph node dissection (ALND) with nanocarbon as the tracer. METHODS: Forty six patients were retrospectively analyzed. These patients underwent SLNB with nanocarbon as the tracer from March 2013 to April 2014. RESULTS: Two hundred and forty six patients of sentinel lymph node (SLN) were successfully detected. Among these patients, 8 patients had 1 SLN (3.25%), 33 patients had 2 SLN (13.41%), 46 patients had 3 SLN (18.70%), 51 patients had 4 SLN (20.73%), 40 patients had 5 SLN (16.26%), 24 patients had 6 SLN (9.76%) and 24 patients had 7 or more SLN (9.76%). The SLNB success rate of nanocarbon staining in the 246 cases was 99.59%, accuracy rate was 97.06% and sensitivity was 93.22%. Furthermore, false negatives were found in four patients, and the false-negative rate was 6.78%. The number of lymph node metastasis in the SLNB and ALND of early-stage breast cancer was analyzed. When the number of SLN dissection was 1, 2, 3, 4, 5, 6 or 7, the coincidence rate of lymph node metastasis for SLNB and ALND was 80.00, 84.36, 78.57, 88.89, 90.48, 80.00, 73.68 and 78.36, respectively. CONCLUSION: Sentinel lymph node biopsy performed using the nanocarbon staining method is simple, easy and reliable, and it can be used to predict the axillary status of breast cancer in the early stage.


Assuntos
Neoplasias da Mama/diagnóstico , Carbono , Linfonodos/patologia , Nanopartículas , Biópsia de Linfonodo Sentinela/estatística & dados numéricos , Biópsia de Linfonodo Sentinela/normas , Adulto , Idoso , Axila/patologia , Neoplasias da Mama/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade
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