ObjectiveTo evaluate the diagnostic value of contrast enhanced ultrasound (CEUS) to the sentinel lymph node (SLN) of breast cancer. MethodsSeventy-two operable breast cancer patients with clinically negative axillary lymph node were enrolled.Sulphur hexafluoride microbubbles for injection (SonoVue) was used alone as the tracer agent for the sentinel lymph node biopsy (SLNB), and axillary dissection was performed after the methylene blue location.All SLNs were examined pathologically with HE staining.The SLN diagnosis result of contrast enhanced ultrasound and postoperative pathological examination result were comparative analyzed. ResultsAfter the injection of SonoVue can obtain a clear image of the lymphatic vessels and SLN.The success rate of CEUS imaging was 84.72% (61/72) in this group of 72 patients, and the false negative rate was 12.12% (4/33).The sensitivity and specificity of diagnosis by CEUS was 92.50% (37/40) and 92.59% (50/54), respectively, the diagnostic odds ratio (DOR) was 154.17.By the pathology results as the gold standard, the internal consistency of these two methods was good (Kappa value=0.848, P < 0.01). ConclusionCEUS may be a useful orientation and determination method for SLNs.
Objective To summarize and analyze the different views on the extent of lymphadenectomy in gastric cancer, and ways or methods to dissolve the disagreements. Methods The reports and advances on lymphadenectomy in gastric carcinomas were collected and reviewed.Results Eastern and western scholars presented different view on lymph nodes dissection in gastric cancers because of the difference in nationalty,studying method and operating technique.Conclusion Although extended lymph node dissection for gastric cancers are supported by more and more reports, it is difficult to evaluate the role exactly. Searchers over the world should learn from each other and explore further in order to develop guiding principles in the end.
ObjectiveTo summarize the current situation and progress of sentinel lymph node biopsy (SLNB) in breast cancer. MethodsDomestic and foreign documents related SLNB in breast cancer in recent years were collected to summaize some problems about the definition, indications, biopsy techniques, improvement methods of the detection rate, the pathological examinations of sentinel lymph node (SLN), the types of metastasis, clinical applications of SLNB technology in breast cancer, and so on. ResultsThe indications of SLNB were expanding. The development of the tracer, imaging examination, and pathological detection technology contributed to the status assessment of SLN in breast cancer. The operation method of SLNB in breast cancer had no uniform standards yet. There were many arguments on whether SLNB can guide axillary lymph node dissection, and the detection rate and the false negative rate of it varied widely. ConclusionsSLNB technology has became an important method in the surgical therapy of breast cancer, but the operation still needs to be further standardized. The clinical application of SLNB also needs a lot of prospective multicenter randomized experiments for further demonstration.
ObjectiveTo evaluate clinical value of indocyanine green (ICG) fluorescence in sentinel lymph node (SLN) biopsy (SLNB) for breast cancer. MethodThe SLNBs were performed in 66 patients with breast cancer,who were divided into ICG group (n=34) and methylene blue dye group (n=32) according to the tracing method. ResultsThe SLNs were found in 59 patients,the detection rate was 89.39%(59/66).One hundred and sixty-two SLNs in 59 patients were detected,the average number of detected SLNs was 2.75.The SLNs detection rate was 97.06%(33/34) and 81.25%(26/32) in the ICG group and in the methylene blue dye group,respectively,which in the ICG group was significantly higher than that in the methylene blue dye group (P<0.05).The positive SLNs were found in 32 cases,within which was 20 cases in the ICG group,12 cases in the methylene blue dye group.The axillary lymph node metastases were found in 35 of 66 cases,within which was 21 cases in the ICG group,14 cases in the methylene blue dye group.The sensitivity and false negative rate had no significant differences between the ICG group and the methylene blue dye group (sensitivity:95.2% versus 85.7%,P>0.05;false negative rate:4.8% versus 14.3%,P>0.05). ConclusionThe ICG fluorescence in SLNB for breast cancer has many advantages,including shorter time,simple operation,high sensitivity,and high detection rate as compared with methylene blue dye.
ObjectiveTo evaluate the effects of sentinel lymph node biopsy following total mastectomy on immunologic function and prognosis for patients with early breast cancer. MethodsTwo hundred and eleven patients with early breast cancer were entered in this study. In all these cases, the results of sentinel lymph node biopsy were negative. These patients were randomly divided into control group and research group. In 86 cases of control group, the sentinel lymph node biopsy and axillary lymph node dissection following total mastectomy was performed. In 125 cases of research group, the sentinel lymph node biopsy following total mastectomy was performed. The injury of shoulder joint function was analyzed in one year after surgery. The changes of T cell subsets and IL-2 level were detected in the patients respectively on the first day before operation, the second week after operation, and the fourth week after operation. Postoperative fatality rate and postoperative recurrence rate were also observed in two groups. Results①The points of shoulder joint function in the control group and the research group were 72.7±6.5 and 93.5±8.2 respectively, there was an obvious difference (P < 0.05).②The injury degree of shoulder joint function in the research group was significantly lower than that in the control group (P < 0.01).③Compared with the control group, the changes of T cell subsets and the IL-2 level had no significant differences in the research group on day 1 before operation and on week 2 after operation (P > 0.05). On the fourth week after surgery, the CD4+, CD4+/CD8+, and IL-2 level in the research group were obviously higher than those in the control group (P < 0.05). However, the percentage of CD8+ T cell in the research group was significantly lower than that in the control group (P < 0.05).④There were no significant differences for postoperative fatality rate and postoperative recurrence rate between two groups (P > 0.05). ConclusionsSentinel lymph node biopsy for patients with early breast cancer is safe and reliable. With respect to conventional axillary lymph node dissection, it could improve immune function and quality of life after surgery in patients with early breast cancer.
Objective To identify the feasibility of the lymphatic mapping and sentinel node biopsy (SLNB) in patients with breast cancer and to examine whether the characteristics of the sentinel lymph node (SLN) accurately predict the status of axillary lymph node.MethodsFrom March to October 2000, 32 patients with breast cancer were evaluated at the Sichuan Provincial People’s Hospital. Lymphatic mapping was performed using Methlene Blue. A SLN was defined as any blue node. Thirtytwo patients, with breast cancer underwent a complete axillary lymph node resection (ALNR) following SLN biopsy. Subsequently, all SLNs and ALNs were examined by both Hamp;E staining as well as immunohistochemical staining for cytokeratin. ResultsLymphatic mapping was successful in identifying the SLN in 26/32(81.25%) cases of nodes at level Ⅰ. Of the 26 patients mapped successfully, 10 had metastasis to the SLNs.In 3 cases that SLNs were positive, but other axillary lymph nodes were negative. In 2 cases that the SLNs were negative, but other axillary lymph nodes were positive. The sensitivity of SLNB using Methlene Blue in this study was 77.78%(7/9), accuracy 80.77%(21/26), specificity 82.35%(14/17), and false negative rate 22.22%(2/9). ConclusionSLN can predict the status of the axillary lymph nodes reliably. However, the efficacy of SLNB in the setting of randomized, prospective trials must be tested first before abandoning axillary lymph node resection as the standard of care.
ObjectiveTo explore the value of fluorescence tracer technique in sentinel lymph node (SLN) orientation of cN0 papillary thyroid cancer. MethodsThe total clinical data of 40 cT1-3N0M0 thyroid cancer patients admitted from January 2015 to January 2016 in our hospital were collected, and the SLN with indocyanine green (ICG) as fluorescent trace agent were observed and detected, and the effect of ICG detecting SLN and the guide role of SLNB on the dissection of the central area of neck lymph nodes by intraoperative frozen biopsy pathology and postoperative paraffin pathology were analyzed. ResultsA total of 40 thyroid cancer patients were treated by SLNB and then conducted by the dissection of the central area of neck lymph nodes, and 37 cases detected SLN, so the detection rate was 92.5% (37/40). And a total of 98 SLNs were detected, 1-5 for each case, average of 2.65/case. Intraoperative frozen pathological detected 28 cases of patients with metastases in SLN, and 9 patients without metastasis, including 1 case with postoperative pathology detecting micrometastasis in SLN and other 8 cases without metastasis in the central area of neck lymph nodes. Three cases who were not detected the SLN showed no metastases in final postoperative paraffin pathology. The SLNB of ICG fluorescent tracer was with a sensitivity of 96.6% (28/29), false-negative rate of 3.45% (1/29). ConclusionThe fluorescent tracer technique can guide the dissection of the central of neck lymph node of cN0 thyroid cancer patients accurately with a high detection rate and advantages of high sensitivity in detecting the SLN of thyroid cancer.
ObjectiveTo summarize the research progress of sentinel lymph node biopsy (SLNB) in the surgery of thyroid carcinoma in recent years. MethodsLiteratures about the recent studies on categories of SLNB and the neck lymph node dissection conducted by SLNB in the surgery of thyroid carcinoma were reviewed following the results searched from PubMed and CNKI data base. ResultsSLNB has a high detection rate and it is of great significance to detect the occult metastatic lymph nodes and guide the neck lymph node dissection during operation. ConclusionThe SLNB, with its high accuracy rate on the detection of occult metastatic lymph nodes, guides neck lymph node dissection during operation in order that it can maximize the benefits of patients.
Objective To understand the current research status of sentinel lymph node (SLN) biopsy in colorectal cancer. Methods Literatures about the application of SLN biopsy in the field of colorectal surgery were collected and reviewed. Results The results of SLNs biopsy accurately reflected the status of the nodal basin. Focused examination of the SLNs could identify micrometastases that might otherwise had been missed by standard histopathological analysis, thus upstaged this group of patients. Conclusion SLN biopsy represents a new and effective technique to predict the tumor status of regional lymph nodes, which offers a potential alternative to improve the accuracy of tumor staging in colorectal cancer.
ObjectiveTo review the recent studies about sentinel lymph node biopsy in breast cancer.MethodsThe literatures in recent years on the history, concept, technique and clinical application of sentinel lymph node biopsy were reviewed and summarized.ResultsThere was no unified method for sentinel lymph node biopsy. There was a wide range of detection rate and falsenegative rate.ConclusionProspective multicenter random clinical trials will help to evaluate the clinical application of sentinel lymph node biopsy.