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Intraoperative Imaging with a Portable Gamma Camera May Reduce the False-Negative Rate for Melanoma Sentinel Lymph Node Surgery.

ABSTRACT: BACKGROUND:Preoperative imaging and intraoperative gamma probe (GP) localization is standard for identifying sentinel lymph nodes (SLNs) in melanoma patients. The aim of this prospective Institutional Review Board-approved study was to investigate whether an intraoperative portable gamma camera (PGC) improves SLN detection over the GP. METHODS:Lymphoscintigraphy and single photon emission computed tomography/computed tomography were performed after injection of 99mTc-Tilmanocept in melanoma patients (??18 years, Breslow thickness???1.0 mm). A GP was used to localize the SLNs in each basin, which was explored by the GP to ensure that the operative field was?

SUBMITTER: Leong SP

PROVIDER: S-EPMC6437127 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Intraoperative Imaging with a Portable Gamma Camera May Reduce the False-Negative Rate for Melanoma Sentinel Lymph Node Surgery.

Leong Stanley P SP Wu Max M Lu Ying Y Torre Donald M DM von Bakonyi Anna A Ospina Arianna M AM Newsom James D JD Luckett William S WS Soon Christopher W CW Kim Kevin B KB Kashani-Sabet Mohammed M

Annals of surgical oncology 20180813 11

<h4>Background</h4>Preoperative imaging and intraoperative gamma probe (GP) localization is standard for identifying sentinel lymph nodes (SLNs) in melanoma patients. The aim of this prospective Institutional Review Board-approved study was to investigate whether an intraoperative portable gamma camera (PGC) improves SLN detection over the GP.<h4>Methods</h4>Lymphoscintigraphy and single photon emission computed tomography/computed tomography were performed after injection of 99mTc-Tilmanocept i ...[more]

PMID: 30105436

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First experience with a new technique: Portable gamma camera usage for sentinel lymph node identification in a patient with breast cancer.

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Optimization of sentinel lymph node biopsy in breast cancer using an operative gamma camera.

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Malignant melanoma (non-metastatic): sentinel lymph node biopsy.

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Optimization of an immunostaining protocol for the rapid intraoperative evaluation of melanoma sentinel lymph node imprint smears with the 'MCW melanoma cocktail'

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Coaxial projective imaging for sentinel lymph node mapping in melanoma.

Project description: Not available

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Precise intraoperative sentinel lymph node biopsies guided by lymphatic drainage in breast cancer.

Project description:The purpose of this study was to present a novel surgical method for intraoperative precise sentinel lymph node biopsy (SLNB) and to determine its clinical efficacy and sensitivity in breast cancer patients. The sentinel lymph nodes (SLNs) were preoperatively evaluated by axillary ultrasound. The intraoperative detection of SLNs was guided by lymphatic drainage pathway. The lymphatic vessels and SLNs were visualized. During operation, we searched for all the true SLNs (trSLNs), para-SLNs (paSLNs) and post-SLNs (poSLNs) followed lymphatic drainage ducts. After precisely locating the lymphatic channels and lymph node, all the lymph nodes that firstly receive lymphatic drainage are designated as trSLNs. We precisely distinguished the trSLNs, paSLNs and poSLNs. We found the average number of trSLNs ranged from1 to 6. In addition, we assessed the novel technique in a total of 125 breast cancer patients. trSLNs were successfully identified in all patients (detection rate: 100 %). The accuracy of trSLNs is 99.2%. Data from our study strongly suggest that our method is a feasible and effective for the detection of precise trSLNs in breast cancer with real-time observations. (ClinicalTrials.gov number, NCT02651142).

| S-EPMC5609903 | biostudies-literature

Debating Sentinel Lymph Node Biopsy for Melanoma in the Modern Adjuvant Era.

Project description: Not available

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Sentinel Lymph Node Biopsy for T1b Melanoma: Balancing Prognostic Value and Cost.

Project description:BackgroundThe purpose of this study is to report the additional prognostic information and cost associated with sentinel lymph node biopsy (SLNB) for patients with T1b melanoma.Patients and methodsAn institutional database was queried for patients with T1b melanoma (0.8-1.0 mm or < 0.8 mm with ulceration) with at least 5 years of follow-up. Results of SLNB, completion lymphadenectomy (CLND), recurrence, and melanoma-specific survival (MSS) were assessed. Institutional costs of melanoma care were converted to Medicare proportional dollars. A Markov model was created to estimate long-term costs.ResultsAmong the total 392 patients, 238 underwent SLNB. Median follow-up was 10.5 years. SLNB was positive in 19 patients (8.0%). Patients who underwent SLNB had higher 10-year nodal recurrence-free survival (98.6% vs. 91.2%, p < 0.001) but not MSS (94.4% vs. 93.2%, p = 0.55). Ulceration (HR 4.7, p = 0.022) and positive sentinel node (HR 11.5, p < 0.001) were associated with worse MSS. Estimates for 5-year costs reflect a fourfold increase in total costs of care associated with SLNB. However, a treatment plan that forgoes adjuvant therapy for resected stage IIIA melanoma but offers systemic therapy for a node-basin recurrence would nullify the additional cost of SLNB.ConclusionsSLNB is prognostic for T1b melanoma. Its impact on the overall cost of melanoma care is intimately tied to systemic therapy in the adjuvant and recurrent settings.

| S-EPMC8366311 | biostudies-literature

Avoiding unnecessary intraoperative sentinel lymph node frozen section biopsy of patients with early breast cancer.

Project description:PurposeAfter the publication of the ACOSOG (American College of Surgeons Oncology Group) Z0011 trial, the rate of axillary lymph node dissection has reduced. Thus, the need for intraoperative frozen section biopsy of sentinel lymph nodes (SLNs) has become controversial. We identified patients for whom intraoperative SLN frozen section biopsy could be omitted and found that frozen section biopsy rate can be reduced.MethodsWe reviewed the records of patients with tumors ≤5 cm in diameter who underwent breast-conserving surgery between January 2013 and December 2019 at Seoul St. Mary's Hospital. Clinicopathological and imaging characteristics were compared according to number of positive SLNs (0-2 SLNs positive vs. ≥3 SLNs positive).ResultsA total of 1,983 patients were included in this study. Thirty-two patients (1.6%) had at least 3 positive SLNs. Patients with ≥3 positive SLNs had significantly larger tumors and were more frequently high-grade tumors (P < 0.001 and P = 0.002, respectively). Identification of suspicious lymph nodes on imaging studies was also associated with the presence of ≥3 positive SLNs (hazard ratio, 11.54; 95% confidence interval, 4.42-30.10). All patients with none or only 1 suspicious lymph node on any imaging modality (n = 647, 32.6%) had 0-2 positive SLNs. Also, among patients with clinical T1-stage tumors and at least 2 suspicious lymph nodes on only 1 imaging modality (n = 514, 25.9%), only 2 cases had ≥3 positive SLNs.ConclusionWe found that intraoperative SLN frozen biopsy could be omitted in patients using tumor size and axillary lymph node status on imaging modality.

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