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Deng X, Zhang Y, Li D, Zhang X, Guo H, Wang F, Sheng X. Abdominal radical trachelectomy guided by sentinel lymph node biopsy for stage IB1 cervical cancer with tumors >2 cm. Oncotarget 2018; 8:3422-3429. [PMID: 27926501 PMCID: PMC5356892 DOI: 10.18632/oncotarget.13788] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 11/21/2016] [Indexed: 02/06/2023] Open
Abstract
Accuracy of prediction of pelvic lymph node status using sentinel lymph node biopsy (SLNB), and outcomes of SLNB-guided abdominal radical trachelectomy (ART) were assessed. Patients with stage IB1 (Figure 2009) cervical cancer and with tumors >2 cm were enrolled. Prior to fertility-sparing surgery 99mTc-labeled phytate was administered. SLNs were intraoperatively identified, excised, and assessed using fast-frozen sections. Systematic bilateral pelvic lymphadenectomy with or without para-aortic lymphadenectomy was subsequently undertaken. The SLN detection rate was 91.8% (45/49 patients); 8.2% (4/49) had radical hysterectomies because of metastatic primary SLNs. All SLNs received routine immunopathological examination to detect micrometastasis. Sensitivity, accuracy, and false negative rates were 100%, 100%, and 0%, respectively. ART was successfully completed in 45 patients (median follow-up, 61 [range, 4-149] months). Three of the 45 (6.7%) were lost to follow-up; two relapsed and one died of tumor progression. Overall 3-year survival and progression-free survival rates were 97.6% and 95.2%, respectively. Of the 19 patients who attempted to conceive after surgery, five achieved pregnancy, and one had a live birth in the third trimester. We concluded that SLNB using 99mTc-labeled phytate can accurately assess pelvic node status. SLNB-guided ART is safe and feasible in patients selected for fertility-sparing procedures.
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Affiliation(s)
- Xiangyun Deng
- School of Medicine and Life Sciences, University of Jinan, Jinan 250022, Shandong, People's Republic of China.,Shandong Academy of Medical Sciences, Jinan 250000, Shandong, People's Republic of China.,Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, Shandong, People's Republic of China
| | - Ying Zhang
- School of Medicine and Life Sciences, University of Jinan, Jinan 250022, Shandong, People's Republic of China.,Shandong Academy of Medical Sciences, Jinan 250000, Shandong, People's Republic of China.,Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, Shandong, People's Republic of China
| | - Dapeng Li
- Shandong Academy of Medical Sciences, Jinan 250000, Shandong, People's Republic of China.,Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, Shandong, People's Republic of China
| | - Xiaoling Zhang
- Shandong Academy of Medical Sciences, Jinan 250000, Shandong, People's Republic of China.,Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, Shandong, People's Republic of China
| | - Hui Guo
- School of Medicine and Life Sciences, University of Jinan, Jinan 250022, Shandong, People's Republic of China.,Shandong Academy of Medical Sciences, Jinan 250000, Shandong, People's Republic of China.,Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, Shandong, People's Republic of China
| | - Fei Wang
- School of Medicine and Life Sciences, University of Jinan, Jinan 250022, Shandong, People's Republic of China.,Shandong Academy of Medical Sciences, Jinan 250000, Shandong, People's Republic of China.,Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, Shandong, People's Republic of China
| | - Xiugui Sheng
- Shandong Academy of Medical Sciences, Jinan 250000, Shandong, People's Republic of China.,Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, Shandong, People's Republic of China
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Utility of Laparoscopic Indocyanine Green-Guided Sentinel Node Biopsy in Open Cervical Cancer Surgery. Int J Gynecol Cancer 2018; 26:1288-9. [PMID: 27643651 DOI: 10.1097/igc.0000000000000752] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE Multiple tracers have been used to improve lymphatic mapping and to reduce the false-negative rate of the sentinel node detection in gynecologic cancers. Nowadays, 99mTc colloids combined with blue-dye technique is the most extended technique. New alternatives such as the fluorescent indocyanine green and near-infrared fluorescent imaging detection have been introduced in lymphatic mapping staging procedures because of its easier visualization compared with the previous tracers. METHODS We used the laparoscopic infrared camera for the indocyanine green-guided sentinel node biopsy in a laparotomic radical hysterectomy in a pregnant patient after a cesarean section, with the aim of improving the detection rate of sentinel node biopsy in open surgery. RESULTS The technique was used in the first patient with accurate detection of sentinel node and no complications during the procedure. CONCLUSIONS The use of laparoscopic indocyanine green in open surgery may be a useful tool for the detection of sentinel node biopsy.
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Abstract
Objective A comprehensive literature search for more recent studies pertaining to sentinel lymph node mapping in the surveillance of cervical cancer to assess if sentinel lymph node mapping has sensitivity and specificity for evaluation of the disease; assessment of posttreatment response and disease recurrence in cervical cancer. Materials and Methods The literature review has been constructed on a step wise study design that includes 5 major steps. This includes search for relevant publications in various available databases, application of inclusion and exclusion criteria for the selection of relevant publications, assessment of quality of the studies included, extraction of the relevant data and coherent synthesis of the data. Results The search yielded numerous studies pertaining to sentinel lymph node mapping, especially on the recent trends, comparison between various modalities and evaluation of the technique. Evaluation studies have appraised high sensitivity, high negative predictive values and low false-negative rate for metastasis detection using sentinel lymph node mapping. Comparative studies have established that of all the modalities for sentinel lymph node mapping, indocyanine green sentinel lymph node mapping has higher overall and bilateral detection rates. Corroboration of the deductions of these studies further establishes that the sentinel node detection rate and sensitivity are strongly correlated to the method or technique of mapping and the history of preoperative neoadjuvant chemotherapy. Conclusions The review takes us to the strong conclusion that sentinel lymph node mapping is an ideal technique for detection of sentinel lymph nodes in cervical cancer patients with excellent detection rates and high sensitivity. The review also takes us to the supposition that a routine clinical evaluation of sentinel lymph nodes is feasible and a real-time florescence mapping with indocyanine green dye gives better statistically significant overall and bilateral detection than methylene blue.
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Rundle S, Halvorsrud K, Bizzarri N, Ratnavelu NDG, Fisher AD, Ang C, Bryant A, Naik R, Kucukmetin A. Sentinel node biopsy for diagnosis of pelvic lymph node involvement in early stage cervical cancer. Hippokratia 2017. [DOI: 10.1002/14651858.cd007925.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Stuart Rundle
- Northern Gynaecological Oncology Centre; Gynaecological Oncology; Queen Elizabeth Hospital Sheriff Hill Gateshead UK NE9 6SX
| | - Kristoffer Halvorsrud
- Wolfson Institute of Preventive Medicine; Centre for Psychiatry; Barts and The London School of Medicine and Dentistry Queen Mary University of London London UK EC1M 6BQ
| | - Nicolo Bizzarri
- Northern Gynaecological Oncology Centre; Gynaecological Oncology; Queen Elizabeth Hospital Sheriff Hill Gateshead UK NE9 6SX
| | - Nithya DG Ratnavelu
- Northern Gynaecological Oncology Centre; Gynaecological Oncology; Queen Elizabeth Hospital Sheriff Hill Gateshead UK NE9 6SX
| | - Ann D Fisher
- Northern Gynaecological Oncology Centre; Gynaecological Oncology; Queen Elizabeth Hospital Sheriff Hill Gateshead UK NE9 6SX
| | - Christine Ang
- Northern Gynaecological Oncology Centre; Gynaecological Oncology; Queen Elizabeth Hospital Sheriff Hill Gateshead UK NE9 6SX
| | - Andrew Bryant
- Newcastle University; Institute of Health & Society; Medical School New Build Richardson Road Newcastle upon Tyne UK NE2 4AX
| | - Raj Naik
- Northern Gynaecological Oncology Centre; Gynaecological Oncology; Queen Elizabeth Hospital Sheriff Hill Gateshead UK NE9 6SX
| | - Ali Kucukmetin
- Northern Gynaecological Oncology Centre; Gynaecological Oncology; Queen Elizabeth Hospital Sheriff Hill Gateshead UK NE9 6SX
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Cusimano MC, Walker R, Bernardini MQ, Bouchard-Fortier G, Laframboise S, May T, Murphy J, Rosen B, Covens A, Clarke B, Shaw P, Rouzbahman M, Mohan R, Ferguson SE. Implementing a Cervical Sentinel Lymph Node Biopsy Program: Quality Improvement in Gynaecologic Oncology. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:659-667. [DOI: 10.1016/j.jogc.2017.02.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/14/2017] [Accepted: 02/15/2017] [Indexed: 10/19/2022]
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Ferrandina G, Pedone Anchora L, Gallotta V, Fagotti A, Vizza E, Chiantera V, De Iaco P, Ercoli A, Corrado G, Bottoni C, Fanfani F, Scambia G. Can We Define the Risk of Lymph Node Metastasis in Early-Stage Cervical Cancer Patients? A Large-Scale, Retrospective Study. Ann Surg Oncol 2017; 24:2311-2318. [PMID: 28608117 DOI: 10.1245/s10434-017-5917-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Sentinel lymph node (SLN) biopsy has emerged as one of the most appreciated techniques for reducing the rate of complete lymph node dissection (LND) performed in patients with early-stage cervical cancer (ECC). However, its performances are still a matter of debate and, to improve them, international guidelines recommend performing at least unilateral LND in case of SLN mapping. In a prior study, we identified a group of patients without evidence of lymph node metastasis (LNM). Our objective is to define a precise risk of LNM for each ECC patient in order to significantly tailor surgery for ECC. METHODS Clinical and pathological data of ECC patients were retrospectively collected by eight Italian institutions. Chi-square test or Fisher's exact test along with logistic regression analysis was used to determine the association of each variable between patients with or without LNM. Results of logistic regression have been used as a basis to calculate the probability to harboring LNM. RESULTS A total of 463 ECC patients were identified. No LNM was detected among the 161 (34.8%) patients who met the criteria and were defined as Very Low Risk. In the other 302 patients, the precise risk of LNM was calculated, and it was <1% in 31 (10.3%) patients. CONCLUSIONS Defining the precise risk of LNM could lead to proper selection of patients in whom any lymph nodal procedure, including SLN, could be avoided.
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Affiliation(s)
- Gabriella Ferrandina
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy. .,Institute of Obstetrics/Gynecology, Catholic University of Sacred Heart, Rome, Italy.
| | - Luigi Pedone Anchora
- Institute of Obstetrics/Gynecology, Catholic University of Sacred Heart, Rome, Italy
| | - Valerio Gallotta
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy
| | - Anna Fagotti
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy.,Institute of Obstetrics/Gynecology, Catholic University of Sacred Heart, Rome, Italy
| | - Enrico Vizza
- Gynecologic Oncology Unit, Department of Oncological Surgery, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Vito Chiantera
- Division of Gynecologic Oncology, Fondazione "Giovanni Paolo II", Campobasso, Italy
| | - Pierandrea De Iaco
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Alfredo Ercoli
- Department of Obstetrics and Gynecology, University of Eastern Piedmond, Novara, Italy
| | - Giacomo Corrado
- Gynecologic Oncology Unit, Department of Oncological Surgery, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Carolina Bottoni
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy
| | - Francesco Fanfani
- Department of Medicine and Aging Sciences, University "G. D'Annunzio", Chieti, Pescara, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy.,Institute of Obstetrics/Gynecology, Catholic University of Sacred Heart, Rome, Italy
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Di Martino G, Crivellaro C, De Ponti E, Bussi B, Papadia A, Zapardiel I, Vizza E, Elisei F, Diestro MD, Locatelli L, Gasparri ML, Di Lorenzo P, Mueller M, Buda A. Indocyanine Green versus Radiotracer with or without Blue Dye for Sentinel Lymph Node Mapping in Stage >IB1 Cervical Cancer (>2 cm). J Minim Invasive Gynecol 2017; 24:954-959. [PMID: 28571944 DOI: 10.1016/j.jmig.2017.05.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/09/2017] [Accepted: 05/10/2017] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE To compare sentinel lymph node (SLN) mapping in women with cervical cancer stage >IB1 (tumor size >2 cm) using indocyanine green (ICG) versus the standard technique using radioisotope technetium 99m radiocolloid (Tc99m) radiotracer with or without blue dye. DESIGN European multicenter, retrospective observational study (Canadian Task Force classification II-2). SETTING Four academic medical centers. PATIENTS Ninety-five women with stage IB1 cervical cancer (>2 cm) who underwent SLN mapping with Tc99m with or without blue dye or ICG and radical hysterectomy. INTERVENTION The detection rate and bilateral mapping rate were compared between ICG and standard Tc99m radiotracer with or without blue dye. Lymphadenectomy was performed, and the false-negative rate was assessed. MEASUREMENTS AND MAIN RESULTS Forty-seven patients underwent SLN mapping with Tc99m with or without blue dye, and 48 did so with ICG. All patients underwent radical hysterectomy with or without bilateral salpingo-oophorectomy between 2008 and 2016. The overall detection rate of SLN mapping was 91.5% for Tc99m with or without blue dye and 100% for ICG. A 91.7% rate of bilateral migration was achieved for ICG, significantly higher than the 66% obtained with Tc99m with or without blue dye (p = .025). Nine of the 23 SLN-positive patients (39.1%) were diagnosed exclusively as a result of the ultrastaging used to identify micrometastases or isolated tumor cells only. CONCLUSIONS In advanced cervical cancer (stage IB1 >2 cm), the detection rate and bilateral migration rate on real-time fluorescent SLN mapping were higher with ICG than with Tc99m radiotracer with or without blue dye. SLN mapping and ultrastaging can provide additional information for nodal staging in advanced cervical cancer. In this setting, ICG is a promising tool for mapping, appearing less affected by higher disease stage compared with traditional methods.
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Affiliation(s)
- Giampaolo Di Martino
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | | | - Elena De Ponti
- Department of Medical Physics, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Beatrice Bussi
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital-IdiPAZ, Madrid, Spain
| | - Enrico Vizza
- Department of Oncological Surgery, Gynecologic Oncologic Unit "Regina Elena", National Cancer Institute, Rome, Italy
| | - Federica Elisei
- Tecnomed Foundation, University of Milano-Bicocca, Monza, Italy
| | | | - Luca Locatelli
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | | | - Paolo Di Lorenzo
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Michael Mueller
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - Alessandro Buda
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
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Farzaneh F, Moridi A, Azizmohammadi Z, Ansari J M, Hosseini MS, Arab M, Ashrafganjoei T, Mazaheri M. Value of Sentinel Lymph Node (SLN) Mapping and Biopsy using Combined Intracervical Radiotracers and Blue Dye Injections for Endometrial Cancer. Asian Pac J Cancer Prev 2017; 18:431-435. [PMID: 28345826 PMCID: PMC5454739 DOI: 10.22034/apjcp.2017.18.2.431] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Lymphadenectomy, as part of the initial surgical staging of patients with endometrial carcinoma, remains a controversial topic in gynecologic oncology. Sentinel lymph node (SLN) mapping has become a well-accepted procedure for melanomas and breast cancer; a number of investigators have begun to explore the utility and accuracy of this technique with regard to endometrial cancer. Aim: This study was conducted to evaluate SLN mapping of early stage endometrial cancer with blue dye in conjunction with a radioactive tracer. Subjects and methods: In this prospective cross-sectional study, patients with stage I and II endometrial cancer who were candidates for systemic lymph node dissection during surgery were enrolled, some underwent lymph node mapping and SLN biopsy using combined intra cervical radiotracer and blue dye injections and some applying only an intra cervical radiotracer. SLNs and other lymph nodes were sent for pathological assessment. Sensitivity, specificity, the positive predictive value, and the negative predictive value were calculated as predictive values for the radiotracer and blue dye. Results: Pre-operative lymph node mapping showed SLN in 29 out of 30 patients. Intra operations in 29/30 patients, SLNs were harvested by gamma probe; in 13 out of 19 patients SLNs were detected by blue dye. The median number of SLNs per patient was 3 and the total number of SLNs detected was 81. Four patients had positive pelvic lymph nodes. All of the positive nodes were SLNs. Using this technique (radiotracer and blue dye) an overall detection rate of 96.7%, an NPV of 100%, a sensitivity of 100% and a specificity of 3.85% were achieved. Conclusion: Results of SLN research for endometrial cancer are promising and make feasible the possibility of avoiding unnecessary aggressive surgical procedures in near future by advances in SLN mapping.
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Affiliation(s)
- Farah Farzaneh
- Preventative Gynecology Research Center, Shahid Beheshti university of Medical Sciences, Tehran, Iran. moridi59@
gmail.com
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59
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Brar H, Hogen L, Covens A. Cost-effectiveness of sentinel node biopsy and pathological ultrastaging in patients with early-stage cervical cancer. Cancer 2017; 123:1751-1759. [DOI: 10.1002/cncr.30509] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 11/07/2016] [Accepted: 11/21/2016] [Indexed: 12/30/2022]
Affiliation(s)
- Harinder Brar
- Division of Gynecological Oncology; Department of Obstetrics and Gynecology, University of Toronto; Toronto Ontario Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto; Toronto Ontario Canada
- Division of Gynecological Oncology; Odette Cancer Center, Sunnybrook Hospital; Toronto Ontario Canada
| | - Liat Hogen
- Division of Gynecological Oncology; Department of Obstetrics and Gynecology, University of Toronto; Toronto Ontario Canada
- Division of Gynecological Oncology; Odette Cancer Center, Sunnybrook Hospital; Toronto Ontario Canada
| | - Al Covens
- Division of Gynecological Oncology; Department of Obstetrics and Gynecology, University of Toronto; Toronto Ontario Canada
- Division of Gynecological Oncology; Odette Cancer Center, Sunnybrook Hospital; Toronto Ontario Canada
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Lennox GK, Covens A. Can sentinel lymph node biopsy replace pelvic lymphadenectomy for early cervical cancer? Gynecol Oncol 2017; 144:16-20. [DOI: 10.1016/j.ygyno.2016.08.337] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 08/26/2016] [Accepted: 08/27/2016] [Indexed: 11/25/2022]
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Re: Radio-Guided Lymph Node Mapping in Bladder Cancer Using SPECT/CT and Intraoperative γ-Probe Methods. Clin Nucl Med 2016; 42:327. [PMID: 27997419 DOI: 10.1097/rlu.0000000000001485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tanaka T, Terai Y, Ashihara K, Tsunetoh S, Akagi H, Yamada T, Ohmichi M. The detection of sentinel lymph nodes in laparoscopic surgery for uterine cervical cancer using 99m-technetium-tin colloid, indocyanine green, and blue dye. J Gynecol Oncol 2016; 28:e13. [PMID: 27894166 PMCID: PMC5323283 DOI: 10.3802/jgo.2017.28.e13] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 09/28/2016] [Accepted: 10/21/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Our objective was to determine the feasibility and detection rates and clarify the most effective combination of injected tracer types for sentinel lymph node (SLN) mapping in uterine cervical cancer in patients who have undergone laparoscopic surgery or neoadjuvant chemotherapy (NAC). METHODS A total of 119 patients with cervical cancer underwent SLN biopsy at radical hysterectomy using three types of tracers. The various factors related to side-specific detection rate, sensitivity, and false negative (FN) rate were analyzed. RESULTS The SLN detection rates using 99m-technetium ((99m)Tc)-tin colloid, indigo carmine, and indocyanine green (ICG) were 85.8%, 20.2%, and 61.6%, respectively. The patients with ≥2-cm-diameter tumors and those who received NAC had lower detection rates than those with <2-cm-diameter tumors (75.7% vs. 91.5%, p<0.01) and those who did not receive NAC (67.9% vs. 86.3%, p<0.01), respectively. Laparoscopic procedures had a higher detection rate than laparotomy (100.0% vs. 77.1%, p<0.01). No factors significantly affected the sensitivity; however, the patients with ≥2-cm-diameter tumors (86.0% vs. 1.4%, p<0.01), NAC (19.4% vs. 2.2%, p<0.01), and those who underwent laparotomy (7.4% vs. 0%, p<0.01) had an unfavorable FN rate. CONCLUSION Among the examined tracers, (99m)Tc had the highest detection of SLN mapping in patients with uterine cervical cancer. Patients with local advanced cervical cancer with/without NAC treatment might be unsuited for SLN mapping. SLN mapping is feasible and results in an excellent detection rate in patients with <2-cm-diameter cervical cancer. Laparoscopic surgery is the best procedure for SLN detection in patients with early-stage disease.
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Affiliation(s)
- Tomohito Tanaka
- Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan
| | - Yoshito Terai
- Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan.
| | - Keisuke Ashihara
- Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan
| | - Satoshi Tsunetoh
- Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan
| | - Hiroyuki Akagi
- Department of Radiology, Osaka Medical College, Osaka, Japan
| | - Takashi Yamada
- Department of Pathology, Osaka Medical College, Osaka, Japan
| | - Masahide Ohmichi
- Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan
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Sato S, Itamochi H, Sugiyama T. Fertility-sparing surgery for uterine cervical cancer. Future Oncol 2016; 12:2345-55. [DOI: 10.2217/fon-2016-0260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The standard treatment for early cervical cancer of the uterus (CC) is radical hysterectomy with resection of the parametrium and pelvic lymphadenectomy. At least 40% of patients develop early-stage CC during child-bearing age, therefore preserving the uterus to maintain fertility has been an important consideration. Several surgical procedures including conization and vaginal or abdominal radical trachelectomy have been reported. These procedures are safe for removing lymph node negative CC tumors with <2 cm diameter. Recently, less radical surgical procedures that maintain fertility, such as conization, simple trachelectomy, minimally invasive surgery and neoadjuvant chemotherapy, have been indicated for tumors greater than 2 cm in diameter. In this review, we discuss the currently accepted surgical approaches for treating CC while maintaining fertility.
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Affiliation(s)
- Seiya Sato
- Department of Obstetrics & Gynecology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka-City 020-8505, Iwate, Japan
| | - Hiroaki Itamochi
- Department of Obstetrics & Gynecology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka-City 020-8505, Iwate, Japan
| | - Toru Sugiyama
- Department of Obstetrics & Gynecology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka-City 020-8505, Iwate, Japan
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Hassanzadeh M, Hosseini Farahabadi E, Yousefi Z, Kadkhodayan S, Zarifmahmoudi L, Sadeghi R. Lymphatic mapping and sentinel node biopsy in ovarian tumors: a study using intra-operative Tc-99m-Phytate and lymphoscintigraphy imaging. J Ovarian Res 2016; 9:55. [PMID: 27604260 PMCID: PMC5013627 DOI: 10.1186/s13048-016-0265-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 09/05/2016] [Indexed: 01/18/2023] Open
Abstract
Background Experience on sentinel node mapping in ovarian tumors is very limited. We evaluated the sentinel node concept in ovarian tumors using intra-operativeTc-99m-Phytate injection and lymphoscintigraphy imaging. Methods Thirty-five patients with a pelvic mass due to an ovarian pathology were included in the study. The radiotracer was injected just after laparotomy and before removal of the tumor either beneath the normal cortex (10 patients) or in the utero-ovarian and suspensory ligaments of the ovary just beneath the peritoneum two injections of the radiotracer (25 patients). For malignant masses, the sentinel nodes were identified using a hand held gamma probe. Then standard pelvic and para-aortic lymphadenectomy was performed. In case of benign pathologies or borderline ovarian tumors on frozen section, lymphadenectomy was not performed. The morning after surgery, all patients were sent for lymphoscintigraphy imaging of the abdomen and pelvis. Results Sentinel node was identified only in 4 patients of the cortical injection group. At least one sentinel node could be identified in 21 patients of the sub-peritoneal group. Sentinel nodes were identified only in the para-aortic area in 21, pelvic/para-aortic areas in 2, and pelvic only area in 2 patients. Three patients had lymph node involvement and all had involved sentinel nodes (no false negative case). Conclusion Sentinel node mapping using intra-operative injection of the radiotracer (in the utero-ovarian and suspensory ligaments of the ovary just beneath the peritoneum) is feasible in ovarian tumors. Technical aspects of this method should be explored in larger multicenter studies in the future.
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Affiliation(s)
- Malihe Hassanzadeh
- Women's Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Zohreh Yousefi
- Women's Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sima Kadkhodayan
- Women's Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Leili Zarifmahmoudi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ramin Sadeghi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Beavis AL, Salazar-Marioni S, Sinno AK, Stone RL, Fader AN, Santillan-Gomez A, Tanner EJ. Sentinel lymph node detection rates using indocyanine green in women with early-stage cervical cancer. Gynecol Oncol 2016; 143:302-306. [PMID: 27526991 DOI: 10.1016/j.ygyno.2016.08.236] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/31/2016] [Accepted: 08/08/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Our study objective was to determine feasibility and mapping rates using indocyanine green (ICG) for sentinel lymph node (SLN) mapping in early-stage cervical cancer. METHODS We performed a retrospective review of all women who underwent SLN mapping with ICG during primary surgical management of early-stage cervical cancer by robotic-assisted radical hysterectomy (RA-RH) or fertility-sparing surgery. Patients were treated at two high-volume centers from 10/2012 to 02/2016. Completion pelvic lymphadenectomy was performed after SLN biopsy; additionally, removal of clinically enlarged/suspicious nodes was part of the SLN treatment algorithm. RESULTS Thirty women with a median age of 42.5 and BMI of 26.5 were included. Most (90%) had stage IB disease, and 67% had squamous histology. RA-RH was performed in 86.7% of cases. One patient underwent fertility-sparing surgery. Median cervical tumor size was 2.0cm. At least one SLN was detected in all cases (100%), with bilateral mapping achieved in 87%. SLN detection was not impacted by tumor size and was most commonly identified in the hypogastric (40.3%), obturator (26.0%), and external iliac (20.8%) regions. Five cases of lymphatic metastasis were identified (16.7%): three in clinically enlarged SLNs, one in a clinically enlarged non-SLN, and one case with cytokeratin positive cells in an SLN. All metastatic disease would have been detected even if full lymphadenectomy had been omitted from our treatment algorithm, CONCLUSIONS: SLN mapping with ICG is feasible and results in high detection rates in women with early-stage cervical cancer. Prospective studies are needed to determine if SLN mapping can replace lymphadenectomy in this setting.
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Affiliation(s)
- Anna L Beavis
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Sergio Salazar-Marioni
- Texas Oncology, San Antonio, Texas, USA; University of Monterrey, San Pedro Garza Garcia, Mexico
| | - Abdulrahman K Sinno
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Rebecca L Stone
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Amanda N Fader
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Antonio Santillan-Gomez
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD, USA; Texas Oncology, San Antonio, Texas, USA
| | - Edward J Tanner
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD, USA.
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Sadalla JC, Andrade JMD, Genta MLND, Baracat EC. Cervical cancer: what's new? Rev Assoc Med Bras (1992) 2016; 61:536-42. [PMID: 26841164 DOI: 10.1590/1806-9282.61.06.536] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 10/23/2015] [Indexed: 12/17/2022] Open
Abstract
Cervical cancer is the most common gynecological cancer in Brazil. Among women, it is the second most frequent, second only to breast cancer. It is the fourth leading cause of cancer death in the country, with estimated 15,590 new cases (2014) and 5,430 deaths (2013). In order to update information to improve outcomes, reduce morbidity and optimize the treatment of this cancer, this article will address the advancement of knowledge on cervical cancer. The topics covered include the role of surgery in different stages, treatment of locally advanced carcinomas, fertility preservation, the role of the sentinel lymph node technique, indications and techniques of radiotherapy and chemotherapy, and some special situations.
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Affiliation(s)
- José Carlos Sadalla
- Mastology Sector, Division of Gynecology, Department of Obstetrics and Gynecology and the Institute of Cancer of the State of São Paulo, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Jurandyr Moreira de Andrade
- Department of Gynecology and Obstetrics, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Maria Luiza Nogueira Dias Genta
- Mastology Sector, Division of Gynecology, Department of Obstetrics and Gynecology and the Institute of Cancer of the State of São Paulo, FM, USP, São Paulo, SP, Brazil
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Köhler C, Le X, Dogan NU, Pfiffer T, Schneider A, Marnitz S, Bertolini J, Favero G. Molecular Diagnosis for Nodal Metastasis in Endoscopically Managed Cervical Cancer: The Accuracy of the APTIMA Test to Detect High-risk Human Papillomavirus Messenger RNA in Sentinel Lymph Nodes. J Minim Invasive Gynecol 2016; 23:748-52. [DOI: 10.1016/j.jmig.2016.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 03/02/2016] [Accepted: 03/03/2016] [Indexed: 11/26/2022]
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The sentinel node approach in gynaecological malignancies. Clin Transl Imaging 2016; 4:411-420. [PMID: 27738629 PMCID: PMC5037154 DOI: 10.1007/s40336-016-0187-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 05/23/2016] [Indexed: 12/11/2022]
Abstract
This review discusses the state-of-the-art of sentinel lymph node mapping in gynaecological malignancies, including cervical cancer, endometrial cancer, and vulvar cancer, with an emphasis on new technological advances. For this objective, PubMed/MEDLINE was searched for relevant studies about the sentinel lymph node procedure in gynaecology. In particular, the use of preoperative lymphatic mapping with lymphoscintigraphy and single photon emission tomography/computed tomography (SPECT/CT) was identified in 18 studies. Other recent advances as hybrid tracers (e.g. ICG-99mTc-nanocolloid) and intraoperative tools (portable γ-camera and 3D navigation devices) appear to also represent a useful guide for the surgeon during the operation. Concerning vulvar and cervical cancers, the sentinel lymph node procedure has been incorporated to the current guidelines in Europe and North America, whereas for endometrial cancer it is considered investigative.
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69
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Fagotti A, Pedone Anchora L, Conte C, Chiantera V, Vizza E, Tortorella L, Surico D, De Iaco P, Corrado G, Fanfani F, Gallotta V, Scambia G. Beyond sentinel node algorithm. Toward a more tailored surgery for cervical cancer patients. Cancer Med 2016; 5:1725-30. [PMID: 27230108 PMCID: PMC4971900 DOI: 10.1002/cam4.722] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 02/29/2016] [Accepted: 03/09/2016] [Indexed: 12/17/2022] Open
Abstract
Nowadays cervical cancer is frequently diagnosed at early stage. For these patients lymph node metastasis (LNM) is considered the most important prognostic factor. During the last decade many efforts have been made to reduce rate of complications associated with lymphadenectomy (LND). A great interest has arisen in sentinel lymph node (SLN) biopsy as a technique able to decrease number of LND performed and, at the same time, to assess lymph nodal status. High diagnostic performances have been reached thanks to SLN surgical algorithm. However, despite the efforts, about 25% of these patients undergo at least unilateral LND to meet NCCN recommendations. Data of women with International Federation of Gynecology and Obstetrics stage IA1‐IB1/IIA1 cervical carcinoma were retrospectively collected by six Italian institutions. All patients underwent complete preoperative staging workup and were primarily treated by radical hysterectomy and pelvic bilateral LND. A total of 368 patients with early‐stage cervical cancer were identified. Among them 333 (90.5%) showed no suspicious enlarged nodes at the preoperative magnetic resonance imaging (MRI). In this subset, tumor diameter ≥20 mm was the only independent predictor of LN status (P = 0.003). None of the 106 patients with negative MRI nodal assessment, with squamous and adenosquamous histotype and a tumor diameter less than 2 cm had LNM. Based on these results we propose a new modified SLN surgical algorithm that could safely reduce LND performed in patients with very low‐risk early‐stage cervical cancer.
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Affiliation(s)
- Anna Fagotti
- Division of Minimally Invasive Gynaecology, St. Maria Hospital, University of Perugia, Terni, Italy
| | - Luigi Pedone Anchora
- Gynecologic Oncology Unit, Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Carmine Conte
- Gynecologic Oncology Unit, Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Vito Chiantera
- Division of Gynecologic Oncology, Department of Oncology, Foundation John Paul II, Catholic University of the Sacred Heart, Campobasso, Italy
| | - Enrico Vizza
- Gynecology Oncology Unit, Department of Oncological Surgery, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Lucia Tortorella
- Gynecologic Oncology Unit, Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Daniela Surico
- Department of Obstetrics and Gynecology, University of Eastern Piedmont, Novara, Italy
| | - Pierandrea De Iaco
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Giacomo Corrado
- Gynecology Oncology Unit, Department of Oncological Surgery, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Francesco Fanfani
- Gynecologic Oncology Unit, Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Valerio Gallotta
- Gynecologic Oncology Unit, Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy
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Buda A, Papadia A, Zapardiel I, Vizza E, Ghezzi F, De Ponti E, Lissoni AA, Imboden S, Diestro MD, Verri D, Gasparri ML, Bussi B, Di Martino G, de la Noval BD, Mueller M, Crivellaro C. From Conventional Radiotracer Tc-99(m) with Blue Dye to Indocyanine Green Fluorescence: A Comparison of Methods Towards Optimization of Sentinel Lymph Node Mapping in Early Stage Cervical Cancer for a Laparoscopic Approach. Ann Surg Oncol 2016; 23:2959-65. [PMID: 27126631 DOI: 10.1245/s10434-016-5227-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND The credibility of sentinel lymph node (SLN) mapping is becoming increasingly more established in cervical cancer. We aimed to assess the sensitivity of SLN biopsy in terms of detection rate and bilateral mapping in women with cervical cancer by comparing technetium-99 radiocolloid (Tc-99(m)) and blue dye (BD) versus fluorescence mapping with indocyanine green (ICG). METHODS Data of patients with cervical cancer stage 1A2 to 1B1 from 5 European institutions were retrospectively reviewed. All centers used a laparoscopic approach with the same intracervical dye injection. Detection rate and bilateral mapping of ICG were compared, respectively, with results obtained by standard Tc-99(m) with BD. RESULTS Overall, 76 (53 %) of 144 of women underwent preoperative SLN mapping with radiotracer and intraoperative BD, whereas 68 of (47 %) 144 patients underwent mapping using intraoperative ICG. The detection rate of SLN mapping was 96 % and 100 % for Tc-99(m) with BD and ICG, respectively. Bilateral mapping was achieved in 98.5 % for ICG and 76.3 % for Tc-99(m) with BD; this difference was statistically significant (p < 0.0001). CONCLUSIONS The fluorescence SLN mapping with ICG achieved a significantly higher detection rate and bilateral mapping compared to standard radiocolloid and BD technique in women with early stage cervical cancer. Nodal staging with an intracervical injection of ICG is accurate, safe, and reproducible in patients with cervical cancer. Before replacing lymphadenectomy completely, the additional value of fluorescence SLN mapping on both perioperative morbidity and survival should be explored and confirmed by ongoing controlled trials.
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Affiliation(s)
- Alessandro Buda
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, University of Berne, Bern, Switzerland
| | - Ignacio Zapardiel
- Gynaecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain
| | - Enrico Vizza
- Department of Oncological Surgery, Gynecologic Oncologic Unit, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy
| | - Elena De Ponti
- Department of Medical Physics, San Gerardo Hospital, Monza, Italy
| | - Andrea Alberto Lissoni
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Sara Imboden
- Department of Obstetrics and Gynecology, University of Berne, Bern, Switzerland
| | | | - Debora Verri
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | | | - Beatrice Bussi
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Giampaolo Di Martino
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | | | - Michael Mueller
- Department of Obstetrics and Gynecology, University of Berne, Bern, Switzerland
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Emerson J, Robison K. Evaluation of sentinel lymph nodes in vulvar, endometrial and cervical cancers. World J Obstet Gynecol 2016; 5:78-86. [DOI: 10.5317/wjog.v5.i1.78] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 10/15/2015] [Accepted: 11/25/2015] [Indexed: 02/05/2023] Open
Abstract
Sentinel lymph node (SLN) biopsies are a sensitive tool in evaluating lymph nodes for multiple cancers, and in some diseases they decrease morbidity in both the short- and long-term. SLN detection in gynecologic malignancies has been studied extensively over the past decade. We review the current literature on SLN dissection in vulvar, endometrial and cervical cancers. Large, well-designed trials in each of the three types of cancer have demonstrated high sensitivity and low false-negative rates when SLN biopsy is performed in the correct patients and with an appropriate technical approach. In all of these cases the addition of ultra-staging to conventional pathology yields increased detection of micrometastatic disease. Biopsy of the sentinel nodes is feasible and safe in early vulvar malignancies, with multiple studies describing low recurrence rates in those women who have with negative SLNs. There does not appear to be a survival benefit to lymphadenectomy over SLN biopsy and quality of life is improved in women undergoing SLN biopsy. Optimal treatment strategies for women with positive nodal biopsies, particularly in cases with micrometastatic disease, remain unclear. Multiple large studies investigating the utility of SLN biopsy in endometrial malignancy have found that sentinel nodal status is a reliable predictor of metastases in women with low-risk disease. Prospective studies are ongoing and suggest sentinel nodal detection may soon become widely accepted as an alternative standard of care for select cases of endometrial cancer. In cervical cancer, SLN biopsy is accurate for diagnosing metastatic disease in early stage tumors (≤ 2 cm diameter or stage ≤ IB2) where the risk of metastasis is low. It is unknown if women who undergo SLN biopsy alone will have different survival outcomes than women who undergo complete lymphadenectomy in these cases. In a specific population of women with vulvar cancer, SLN dissection is an effective and safe alternative to complete dissection. It can be offered as an alternative management strategy in these women. In women who do undergo SLN biopsy, it is associated with improved quality of life. Promising evidence supporting the utility of SLN dissection in endometrial and cervical cancer continues to emerge, and it may soon become a reasonable option for select patients. However, continued research and refinement of appropriate patient selection and long-term follow-up are necessary.
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Re: Lymphatic Path of the Inguinal Lymph Node Metastases in Anorectal Cancer: The Springbok Pattern. Clin Nucl Med 2016; 41:747. [PMID: 26825199 DOI: 10.1097/rlu.0000000000001137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The sentinel node procedure in early stage cervical cancer, taking the next step; a diagnostic review. Gynecol Oncol 2015; 139:559-67. [DOI: 10.1016/j.ygyno.2015.09.076] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 09/23/2015] [Accepted: 09/24/2015] [Indexed: 12/31/2022]
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Tsuruga T, Fujimoto A, Kawana K, Mori M, Hasumi Y, Kino N, Tomio K, Miura S, Tanikawa M, Sone K, Miyamoto Y, Ikeda Y, Kojima S, Adachi K, Nagasaka K, Matsumoto Y, Arimoto T, Oda K, Nakagawa S, Horie K, Yasugi T, Yokota H, Osuga Y, Fujii T. Radical hysterectomy with or without para-aortic lymphadenectomy for patients with stage IB2, IIA2, and IIB cervical cancer: outcomes for a series of 308 patients. Int J Clin Oncol 2015; 21:359-366. [PMID: 26438230 DOI: 10.1007/s10147-015-0907-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 09/15/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although many studies have already shown that lymph node metastasis is one of the major prognostic factors for cervical cancer, the therapeutic significance of para-aortic lymphadenectomy for the surgical treatment of cervical cancer remains controversial. METHODS A total of 308 patients diagnosed with stage IB2, IIA2, or IIB cervical cancer and treated with radical hysterectomy were retrospectively investigated to assess the incidence of para-aortic lymph node metastasis and the clinicopathological factors linked to cervical cancer prognosis. RESULTS Para-aortic lymph node metastases were pathologically confirmed in 13 of the 136 patients (9.6 %) who underwent para-aortic lymphadenectomy. The incidence of para-aortic lymph node metastasis was significantly higher in the patients who had common iliac lymph node metastases (odds ratio 31.5, p < 0.001) according to logistic regression analysis. Common iliac lymph node metastasis was related to risk of recurrence (hazard ratio 2.43, p = 0.003) and death (hazard ratio 2.62, p = 0.007) in Cox regression analysis. Kaplan-Meier analysis and Cox regression analysis showed that para-aortic lymphadenectomy did not have a positive impact on survival in 308 patients or 140 pN1 patients, but para-aortic lymphadenectomy was related to better overall survival with a marginal trend toward significance (p = 0.053) in 30 patients with common iliac lymph node metastasis. CONCLUSIONS Indication for para-aortic lymphadenectomy in the surgical treatment of stage IB2, IIA2, or IIB cervical cancer needs to be individualized. Patients with common iliac lymph node metastasis are possible candidates, and a prospective study is needed to clarify this issue.
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Affiliation(s)
- Tetsushi Tsuruga
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Asaha Fujimoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kei Kawana
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Mayuyo Mori
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yoko Hasumi
- Department of Gynecology, Saitama Cancer Center, 780 Komuro, Ina-machi, Kita-adachi-Gun, Saitama, 362-0806, Japan
| | - Nao Kino
- Department of Gynecology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Kensuke Tomio
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shiho Miura
- Department of Gynecology, Saitama Cancer Center, 780 Komuro, Ina-machi, Kita-adachi-Gun, Saitama, 362-0806, Japan
| | - Michihiro Tanikawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kenbun Sone
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yuichiro Miyamoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yuji Ikeda
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Satoko Kojima
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Katsuyuki Adachi
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kazunori Nagasaka
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yoko Matsumoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takahide Arimoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Katsutoshi Oda
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shunsuke Nakagawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Koji Horie
- Department of Gynecology, Saitama Cancer Center, 780 Komuro, Ina-machi, Kita-adachi-Gun, Saitama, 362-0806, Japan
| | - Toshiharu Yasugi
- Department of Gynecology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Harushige Yokota
- Department of Gynecology, Saitama Cancer Center, 780 Komuro, Ina-machi, Kita-adachi-Gun, Saitama, 362-0806, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tomoyuki Fujii
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Symptomatic Lymphocele Formation After Sentinel Lymph Node Biopsy for Early Stage Cervical Cancer. J Minim Invasive Gynecol 2015; 23:442-5. [PMID: 26260297 DOI: 10.1016/j.jmig.2015.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 07/28/2015] [Accepted: 07/30/2015] [Indexed: 11/20/2022]
Abstract
In early stage cervical cancer, nodal status is the most important prognostic factor, and execution of retroperitoneal lymphadenectomy is currently an integral part of surgical therapy. Sentinel lymph node biopsy has been progressively incorporated with surgical therapy and could reduce morbidity. However, the current incidence of complications exclusively related to the procedure is unknown. We report on a 29-year-old woman affected by cervical cancer (Fédération Internationale de Gynécologie et d'Obstétrique Stage 1b1), who underwent sentinel lymph node biopsy in combination with radical vaginal trachelectomy, and who later developed a symptomatic pelvic lymphocele that required surgical therapy. Conservative procedures in the pelvic lymph nodes are not free of complications, especially with regard to the formation of symptomatic lymphoceles. This report brings to light an important discussion about the exact magnitude of the complications associated with the procedure.
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Acar C, Kleinjan GH, van den Berg NS, Wit EMK, van Leeuwen FWB, van der Poel HG. Advances in sentinel node dissection in prostate cancer from a technical perspective. Int J Urol 2015; 22:898-909. [DOI: 10.1111/iju.12863] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 06/07/2015] [Indexed: 01/23/2023]
Affiliation(s)
- Cenk Acar
- Department of Urology; Acibadem University School of Medicine; Istanbul Turkey
| | - Gijs H Kleinjan
- Interventional Molecular Imaging Laboratory; Department of Radiology; Leiden University Medical Centre; Leiden the Netherlands
- Department of Nuclear Medicine; The Netherlands Cancer Institute; Antoni van Leeuwenhoek Hospital; Amsterdam the Netherlands
| | - Nynke S van den Berg
- Interventional Molecular Imaging Laboratory; Department of Radiology; Leiden University Medical Centre; Leiden the Netherlands
- Department of Urology; The Netherlands Cancer Institute; Antoni van Leeuwenhoek Hospital; Amsterdam the Netherlands
| | - Esther MK Wit
- Department of Urology; The Netherlands Cancer Institute; Antoni van Leeuwenhoek Hospital; Amsterdam the Netherlands
| | - Fijs WB van Leeuwen
- Interventional Molecular Imaging Laboratory; Department of Radiology; Leiden University Medical Centre; Leiden the Netherlands
- Department of Urology; The Netherlands Cancer Institute; Antoni van Leeuwenhoek Hospital; Amsterdam the Netherlands
| | - Henk G van der Poel
- Department of Urology; The Netherlands Cancer Institute; Antoni van Leeuwenhoek Hospital; Amsterdam the Netherlands
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Liu H, Wu DC. Advances in research of fluorescence imaging for detection of gastrointestinal tumors. Shijie Huaren Xiaohua Zazhi 2015; 23:2193-2199. [DOI: 10.11569/wcjd.v23.i14.2193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Fluorescence imaging, which has a high sensitivity, produces images by capturing fluorescence signal from the inside of organisms. Over the past few years, notable development of fluorescence imaging technique has been made in the field of gastrointestinal cancer. Imaging instruments and fluorescent probes for fluorescence imaging are being improved and innovated, making it a promising technique for broad clinical applications in the near future. Future clinical applications of fluorescence imaging include aiding diagnosis and surgical treatment of gastrointestinal tumors, which are important development directions of this technique. However, increasing the safety and the accuracy for tumor detection is a challenge for fluorescence imaging. Besides, in order to acquire better diagnostic effects, the combination of fluorescence imaging and other imaging modalities which require novel imaging probes for tumor is also an important trend for fluorescence imaging development.
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Arimoto T, Kawana K, Adachi K, Ikeda Y, Nagasaka K, Tsuruga T, Yamashita A, Oda K, Ishikawa M, Kasamatsu T, Onda T, Konishi I, Yoshikawa H, Yaegashi N. Minimization of curative surgery for treatment of early cervical cancer: a review. Jpn J Clin Oncol 2015; 45:611-6. [DOI: 10.1093/jjco/hyv048] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/10/2015] [Indexed: 11/14/2022] Open
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