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Ferraris EI, Olimpo M, Giacobino D, Manassero L, Iussich S, Lardone E, Camerino M, Buracco P, Morello EM. Sentinel lymph node mapping with computed tomography lymphography for mast cell tumours and a comparison between regional and sentinel lymph node histological status: Sixty-two cases. Vet Comp Oncol 2023; 21:208-220. [PMID: 36635868 DOI: 10.1111/vco.12878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 01/04/2023] [Accepted: 01/07/2023] [Indexed: 01/14/2023]
Abstract
It is known that the regional lymph node (RLN) may not correspond to the sentinel lymph node (SLN) (the first lymph node draining the tumour), and many diagnostic techniques have recently been aimed at its detection. Although lymphoscintigraphy is the gold standard in both human and veterinary medicine for SLN mapping, it is relatively unavailable in veterinary medicine due to costs and difficult management of the radiotracer. This prospective study evaluated, as a first aim, the feasibility and sensitivity of the computed tomography lymphography (CTL) in detecting the SLN in 62 mast cell tumours (MCTs). The second aim was to evaluate the accuracy of the CTL in identifying the most representative lymph node of the patient's lymphatic status; the histological status of the SNL was compared with that of the RLN, to see in how many cases the patient's stage would have changed according to the RLN. When the RLN turned out to be also the SLN it was decided to excise, as a control LN, the one localised in the neighbourhood of the MCT (neighbouring lymph node; NLN). The detection rate was 90%, with failure of SLN identification in six cases. In 18 (32%) of 56 MCTs with a diagnostic CTL, the SLN did not correspond to the RLN. Forty-five MCTs were surgically removed, together with their corresponding SLN and RLN/NLN. Since the clinical stage of the patient would have changed in only 7% of cases, CTL is a reliable method of detecting the SLN and, for staging purposes, there is no need to remove other LNs.
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Affiliation(s)
| | - Matteo Olimpo
- Department of Veterinary Sciences, University of Torino, Turin, Italy
| | - Davide Giacobino
- Department of Veterinary Sciences, University of Torino, Turin, Italy
| | - Luca Manassero
- Department of Veterinary Sciences, University of Torino, Turin, Italy
| | - Selina Iussich
- Department of Veterinary Sciences, University of Torino, Turin, Italy
| | - Elena Lardone
- Department of Veterinary Sciences, University of Torino, Turin, Italy
| | | | - Paolo Buracco
- Department of Veterinary Sciences, University of Torino, Turin, Italy
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Manfredi M, De Zani D, Chiti LE, Ferrari R, Stefanello D, Giudice C, Pettinato V, Longo M, Di Giancamillo M, Zani DD. Preoperative planar lymphoscintigraphy allows for sentinel lymph node detection in 51 dogs improving staging accuracy: Feasibility and pitfalls. Vet Radiol Ultrasound 2021; 62:602-609. [PMID: 34131982 PMCID: PMC8518895 DOI: 10.1111/vru.12995] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/24/2021] [Accepted: 03/31/2021] [Indexed: 01/01/2023] Open
Abstract
Sentinel lymph node (SLN) mapping is the current gold standard for the oncological staging of solid malignancies in humans. This prospective observational study describes the feasibility and the limits of preoperative lymphoscintigraphy for SLN detection in dogs with spontaneous malignancies and the improvements in staging accuracy. Client‐owned dogs with confirmed malignant neoplasia and absence of distant metastasis were prospectively enrolled. Lymphoscintigraphy was performed after the peritumoral injection of Technetium‐99m labeled nanocolloids. Regional dynamic and static images were acquired, with and without masking of the injection site with a lead shield. The dogs were then subjected to surgery for tumor excision and SLN extirpation. Intraoperative SLN detection was performed by combining methylene blue dye and a dedicated gamma probe. Overall, 51 dogs with a total of 60 solid malignant tumors were enrolled. Lymphoscintigraphy identified at least one SLN in 57 of 60 cases (95%). The SLN did not always correspond to the regional lymph node (35/57, 61.4%). The use of a lead shield, masking the injection site, markedly improved the SLN visibility. The median time of SLN appearance was 11.4 ± 9.3 min. No side effects were observed. Preoperative lymphoscintigraphy allows for SLN detection in dogs and can improve staging accuracy by either identifying the SLN in a different lymphosome than clinically expected or discriminating the draining node in uncertain cases. The combined use of preoperative and intraoperative techniques is recommended to increase the SLN detection rate.
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Affiliation(s)
- Martina Manfredi
- Department of Veterinary Medicine, Università degli Studi di Milano, Lodi, Italy
| | - Donatella De Zani
- Centro Clinico-Veterinario e Zootecnico-Sperimentale, Università degli Studi di Milano, Lodi, Italy
| | - Lavinia Elena Chiti
- Department of Veterinary Medicine, Università degli Studi di Milano, Lodi, Italy
| | - Roberta Ferrari
- Department of Veterinary Medicine, Università degli Studi di Milano, Lodi, Italy
| | - Damiano Stefanello
- Department of Veterinary Medicine, Università degli Studi di Milano, Lodi, Italy
| | - Chiara Giudice
- Department of Veterinary Medicine, Università degli Studi di Milano, Lodi, Italy
| | - Vincenzina Pettinato
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy
| | - Maurizio Longo
- Department of Veterinary Medicine, Università degli Studi di Milano, Lodi, Italy
| | - Mauro Di Giancamillo
- Department of Veterinary Medicine, Università degli Studi di Milano, Lodi, Italy
| | - Davide Danilo Zani
- Department of Veterinary Medicine, Università degli Studi di Milano, Lodi, Italy
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Ferrari R, Chiti LE, Manfredi M, Ravasio G, De Zani D, Zani DD, Giudice C, Gambini M, Stefanello D. Biopsy of sentinel lymph nodes after injection of methylene blue and lymphoscintigraphic guidance in 30 dogs with mast cell tumors. Vet Surg 2020. [DOI: 10.1111/vsu.13483] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Roberta Ferrari
- Department of Veterinary MedicineUniversità degli Studi di Milano Lodi Italy
- Veterinary Teaching Hospital, Università degli Studi di Milano Lodi Italy
| | - Lavinia E. Chiti
- Department of Veterinary MedicineUniversità degli Studi di Milano Lodi Italy
- Veterinary Teaching Hospital, Università degli Studi di Milano Lodi Italy
| | - Martina Manfredi
- Department of Veterinary MedicineUniversità degli Studi di Milano Lodi Italy
- Veterinary Teaching Hospital, Università degli Studi di Milano Lodi Italy
| | - Giuliano Ravasio
- Department of Veterinary MedicineUniversità degli Studi di Milano Lodi Italy
- Veterinary Teaching Hospital, Università degli Studi di Milano Lodi Italy
| | - Donatella De Zani
- Department of Veterinary MedicineUniversità degli Studi di Milano Lodi Italy
- Veterinary Teaching Hospital, Università degli Studi di Milano Lodi Italy
| | - Davide D. Zani
- Department of Veterinary MedicineUniversità degli Studi di Milano Lodi Italy
- Veterinary Teaching Hospital, Università degli Studi di Milano Lodi Italy
| | - Chiara Giudice
- Department of Veterinary MedicineUniversità degli Studi di Milano Lodi Italy
- Veterinary Teaching Hospital, Università degli Studi di Milano Lodi Italy
| | - Matteo Gambini
- Department of Veterinary MedicineUniversità degli Studi di Milano Lodi Italy
- Veterinary Teaching Hospital, Università degli Studi di Milano Lodi Italy
| | - Damiano Stefanello
- Department of Veterinary MedicineUniversità degli Studi di Milano Lodi Italy
- Veterinary Teaching Hospital, Università degli Studi di Milano Lodi Italy
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Sentinel lymph node biopsy following previous axillary surgery in recurrent breast cancer. Eur J Surg Oncol 2019; 45:1835-1838. [DOI: 10.1016/j.ejso.2019.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 05/08/2019] [Accepted: 05/15/2019] [Indexed: 11/20/2022] Open
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Poodt IGM, Vugts G, Schipper RJ, Nieuwenhuijzen GAP. Repeat Sentinel Lymph Node Biopsy for Ipsilateral Breast Tumor Recurrence: A Systematic Review of the Results and Impact on Prognosis. Ann Surg Oncol 2018; 25:1329-1339. [DOI: 10.1245/s10434-018-6358-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Indexed: 11/18/2022]
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Brissot HN, Edery EG. Use of indirect lymphography to identify sentinel lymph node in dogs: a pilot study in 30 tumours. Vet Comp Oncol 2016; 15:740-753. [DOI: 10.1111/vco.12214] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 12/20/2015] [Accepted: 12/20/2015] [Indexed: 12/24/2022]
Affiliation(s)
- H. N. Brissot
- Department of small animal surgery (Brissot) and internal medicine (Edery); Pride Veterinary Centre; Derby UK
| | - E. G. Edery
- Department of small animal surgery (Brissot) and internal medicine (Edery); Pride Veterinary Centre; Derby UK
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Ikeda T. Re-sentinel node biopsy after previous breast and axillary surgery. Surg Today 2013; 44:2015-21. [DOI: 10.1007/s00595-013-0783-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 10/11/2013] [Indexed: 10/26/2022]
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Lizarraga IM, Scott-Conner CEH, Muzahir S, Weigel RJ, Graham MM, Sugg SL. Management of Contralateral Axillary Sentinel Lymph Nodes Detected on Lymphoscintigraphy for Breast Cancer. Ann Surg Oncol 2013; 20:3317-22. [DOI: 10.1245/s10434-013-3151-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Indexed: 02/06/2023]
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Repeat sentinel node biopsy in patients with locally recurrent breast cancer: a systematic review and meta-analysis of the literature. Breast Cancer Res Treat 2013; 138:13-20. [PMID: 23340861 DOI: 10.1007/s10549-013-2409-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 01/07/2013] [Indexed: 01/08/2023]
Abstract
Axillary staging in patients with locally recurrent breast cancer is important for obtaining locoregional control and predicting prognosis. The aim of the present study is to determine technical feasibility, validity, aberrant drainage patterns and clinical consequences of performing repeat sentinel node biopsy (SNB) in these patients. We performed a systematic review and meta-analysis of the literature and included all studies on repeat SNB in locally recurrent breast cancer. A total of 692 patients were described, 301 after a previous SNB, 361 after a previous axillary lymph node dissection (ALND), and 30 with no previous axillary surgery. Sentinel node identification was successful in 452 of the 692 patients (65.3 %), which was significantly higher in patients who had undergone previous SNB compared to previous ALND (81.0 vs. 52.2 %) (P < 0.0001). In 175 of 405 patients with successful lymphatic mapping aberrant drainage pathways were visualized (43.2 %), which were seen more frequently after previous ALND than after previous SNB (69.2 vs. 17.4 %) (P < 0.0001). In 19.2 % of the patients the sentinel node was tumor positive and 27.5 % of these metastases were found in aberrant lymph drainage basins. Overall, 213 patients could be spared an ALND and in 17.9 % of the patients the information derived from the repeat SNB led to a change in adjuvant radiotherapy or systemic treatment plans. The procedure had a false-negative rate of 0.2 %. Repeat SNB is technically feasible and accurate. Next to sparing patients an unnecessary ALND, the information can lead to a change in adjuvant treatment strategy.
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Hattori M, Nishimura S, Tada K, Koyama M, Akiyama F, Ito Y, Iwase T. Reoperative sentinel lymph node biopsy for ipsilateral breast tumor recurrence after previous axillary lymph node dissection: Report of a case. Surg Today 2011; 41:247-50. [DOI: 10.1007/s00595-009-4241-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Accepted: 10/05/2009] [Indexed: 10/18/2022]
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[Detection of contralateral axillary sentinel lymph node by lymphoscintigraphy in breast cancer: prognostic implications]. ACTA ACUST UNITED AC 2010; 29:135-7. [PMID: 20398968 DOI: 10.1016/j.remn.2009.12.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 12/01/2009] [Indexed: 12/16/2022]
Abstract
The role of nuclear medicine in the detection of sentinel lymph nodes (SLNs) in primary breast cancer is very useful to determine regional lymphatic drainage from the affected breast, mainly its anatomical and/or tumoral individual variability and to determine the initial tumor stage. We present the case of an infiltrating ductal carcinoma of the breast (T2) in the junction of the inner quadrants of the right breast studied by lymphoscintigraphy and gamma probe detection. Three non-metastatic sentinel lymph nodes were found with the selective lymphadenectomy: two in the ipsilateral axilla and one in the contralateral axilla. The lymphoscintigraphic finding of the axillary sentinel lymph node contralateral to the affected breast demonstrates the individual anatomical variability in mammary drainage. It emphasizes the importance of nuclear medicine imaging techniques in its detection and generates new prognostic approaches with impact on therapeutic measures and patient follow-up.
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Tada K, Ogiya A, Kimura K, Morizono H, Iijima K, Miyagi Y, Nishimura S, Makita M, Horii R, Akiyama F, Iwase T. Ductal carcinoma in situ and sentinel lymph node metastasis in breast cancer. World J Surg Oncol 2010; 8:6. [PMID: 20105298 PMCID: PMC2837658 DOI: 10.1186/1477-7819-8-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 01/27/2010] [Indexed: 02/07/2023] Open
Abstract
Background The impact of sentinel lymph node biopsy on breast cancer mimicking ductal carcinoma in situ (DCIS) is a matter of debate. Methods We studied the rate of occurrence of sentinel lymph node metastasis in 255 breast cancer patients with pure DCIS showing no invasive components on routine pathological examination. We compared this to the rate of occurrence in 177 patients with predominant intraductal-component (IDC) breast cancers containing invasive foci equal to or less than 0.5 cm in size. Results Most of the clinical and pathological baseline characteristics were the same between the two groups. However, peritumoral lymphatic permeation occurred less often in the pure DCIS group than in the IDC-predominant invasive-lesion group (1.2% vs. 6.8%, p = 0.002). One patient (0.39%) with pure DCIS had two sentinel lymph nodes positive for metastasis. This rate was significantly lower than that in patients with IDC-predominant invasive lesions (6.2%; p < 0.001). Conclusions Because the rate of sentinel lymph node metastasis in pure DCIS is very low, sentinel lymph node biopsy can safely be omitted.
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Affiliation(s)
- Keiichiro Tada
- Department of Breast Surgery, Cancer Institute Hospital, Tokyo, Japan.
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Koizumi M, Koyama M, Tada K, Nishimura S, Miyagi Y, Makita M, Yoshimoto M, Iwase T, Horii R, Akiyama F, Saga T. The feasibility of sentinel node biopsy in the previously treated breast. Eur J Surg Oncol 2008; 34:365-8. [PMID: 17532172 DOI: 10.1016/j.ejso.2007.04.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Accepted: 04/18/2007] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Sentinel lymph node biopsy (SNB) has been a standard technique in early breast cancer. However, it is not clear that the SNB procedure can be applied to second breast cancer or recurrence occurring in the previously treated breast. The purpose of this study was to clarify the feasibility of the SNB procedure in breast cancer occurring in the previously treated breast, and to investigate the factors related to altered lymphatic flow. PATIENTS AND METHODS Between April 2004 and December 2006, 1490 patients underwent the breast SNB procedure. Among them, 31 patients had a history of previous treatments in the same breast. Recent excision biopsy cases were not included in this group. All patients had previous breast-conserving surgery in the same breast. Sixteen patients had axillary dissection, 3 had SNB, and 12 had no axillary treatment. Ten patients had received radiation therapy to the breast and axilla. Visualization of axillary nodes, internal mammary nodes and contralateral axillary nodes was evaluated and compared with pathological results. RESULTS Axillary nodes were visualized in 23 patients, internal mammary nodes in 7 patients, and contralateral axillary nodes in 7 patients. The patients with previous axillary dissection exhibited altered lymph node distribution, but did not show involvement of contralateral axillary nodes. Visualization of contralateral axillary nodes occurred in 7 of the 10 patients with previous irradiation to breast irrespective of axillary dissection. Twenty-eight patients underwent SNB, 4 of whom showed cancer-positive nodes. Three patients were cancer-positive in non-ipsilateral axillary nodes (one patient showed positive opposite axillary node and two patients showed positive internal mammary nodes). CONCLUSION Previous axillary dissection or irradiation to the breast greatly influences lymphatic flow. Irradiation to the breast may be a strong factor for the visualization of contralateral axillary nodes. Despite the frequent alteration of lymphatic flow, SNB seems to be feasible in secondary or recurrent breast cancer patients.
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Affiliation(s)
- M Koizumi
- Diagnostic Imaging Group, Institute for Molecular Imaging, National Institutes of Radiological Sciences, Chiba, Japan.
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