Implementing Sentinel Lymph Node Biopsy Programs in Developing Countries: Challenges and Opportunities

Keshtgar, Mohammed; Zaknun, John J.; Sabih, Durre; Lago, Graciela; Cox, Charles E.; Leong, Stanley P. L.; Mariani, Giuliano

doi:10.1007/s00268-011-0956-3

Cited by 19 publications

(16 citation statements)

References 79 publications

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“…The development of intraoperative optical imaging (31) will enable wider dissemination of SLN mapping to hospitals without access to radiopharmaceuticals. This is especially true in developing countries, where only urban hospitals are equipped to handle radioactivity (32).…”

Section: Molecular Imaging: Sentinel Lymph Node Imagingmentioning

confidence: 99%

A Receptor-targeted Fluorescent Radiopharmaceutical for Multireporter Sentinel Lymph Node Imaging

Emerson¹,

Limmer²,

Hall³

et al. 2012

Radiology

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Purpose:To determine the imaging and receptor-binding properties of a multireporter probe designed for sentinel lymph node (SLN) mapping via nuclear and fluorescence detection. Materials and Methods:The animal experiments were approved by the institutional animal care and use committee. A multireporter probe was synthesized by covalently attaching cyanine 7 (Cy7), a near-infrared cyanine dye, to tilmanocept, a radiopharmaceutical that binds to a receptor specific to recticuloendothelial cells. In vitro binding assays of technetium 99m ( 99m Tc) -labeled Cy7 tilmanocept were conducted at 4°C by using receptor-bearing macrophages. Optical SLN imaging after foot pad administration was performed by using two molar doses of Cy7 tilmanocept. Six mice were injected with 0.11 nmol of 99m Tc-labeled Cy7 tilmanocept (low-dose group); an additional six mice were injected with 31 nmol of 99m Tc-labeled Cy7 tilmanocept (high-dose group) to saturate the receptor sites within the SLN. After 2.5 hours of imaging, the mice were euthanized, and the sentinel and distal lymph nodes were excised and assayed for radioactivity for calculation of SLN percentage of injected dose and extraction. Four mice were used as controls for autofluorescence. Standard optical imaging software was used to plot integrated fluorescence intensity against time for calculation of the SLN uptake rate constant and scaled peak intensity. Significance was calculated by using the Student t test. Results:In vitro binding assays showed subnanomolar affinity (mean dissociation constant, 0.25 nmol/L 6 0.10 [standard deviation]). Fluorescence imaging showed a detection sensitivity of 1.6 310 3 counts ⋅ sec 21 ⋅ mW 21 per picomole of Cy7. All four imaging metrics (percentage of injected dose, SLN extraction, SLN uptake rate constant, and expected peak fluorescence intensity) exhibited higher values (P = .005 to P = .042) in the low-dose group than in the high-dose group; this finding was consistent with receptor-mediated image formation. Conclusion:The multireporter probe

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Section: Molecular Imaging: Sentinel Lymph Node Imagingmentioning

confidence: 99%

A Receptor-targeted Fluorescent Radiopharmaceutical for Multireporter Sentinel Lymph Node Imaging

Emerson¹,

Limmer²,

Hall³

et al. 2012

Radiology

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“…Although, it has been stressed that FN rate to be less than 5% for omitting ALND in node-negative cases (Clarke et al, 2004;Lyman et al, 2005;Somasundaram et al, 2009) but most trials haven't achieved FN rate lower than 5% even in Milan trial with very experienced and expert pathologists and about 60 sections per node (Veronesi et al, 2003). So, threshold of 10% (Keshtgar et al, 2011) seems to be a suitable cut-off point for FN rate of SLNB.…”

Section: Resultsmentioning

confidence: 99%

Value of Sentinel Lymph Node Biopsy in Breast Cancer Surgery with Simple Pathology Facilities -An Iranian Local Experience with a Review of Potential Causes of False Negative Results

Amoui

Akbari²,

Tajeddini³

et al. 2012

Asian Pacific Journal of Cancer Prevention

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Introduction: Sentinel lymph node biopsy (SLNB) is a precise procedure for lymphatic staging in early breast cancer. In a valid SLNB procedure, axillary lymph node dissection (ALND) can be omitted in nodenegative cases without compromising patient safety. In this study, detection rate, accuracy and false negative rate of SLNB for breast cancer was evaluated in a setting with simple modified conventional pathology facilities without any serial sectioning or immunohistochemistry. Material and Method: Patients with confirmed breast cancer were enrolled in the study. SLNB and ALND were performed in all cases. Lymph node metastasis was evaluated in SLN and in nodes removed by ALND to determine the false negative rate. Pathologic assessment was carried out only by modified conventional technique with only 3 sections. Detection rate was determined either by lymphoscintigraphy or during surgery. Results: 78 patients with 79 breast units were evaluated. SLN was detected in 75 of 79 cases (95%) in lymphoscintigraphy and 76 of 79 cases (96%) during surgery. SLN metastases was detected in 30 of 75 (40%) cases either in SLNB and ALND groups. Accuracy of SLNB method for detecting LN metastases was 92%. False negative rate was 3 of 30 of positive cases: 10%. In 7 of 10 cases with axillary lymphadenopathy, LN metastastates was detected. Conclusion: SLNB is recommended for patients with various tumor sizes without palpable lymph nodes. In modified conventional pathologic examination of SLNs, at least macrometastases and some micrometastases could be detected similar to ALND. Consequently, ALND could be omitted in node-negative cases with removal of all palpable LNs. We conclude that SLNB, as one of the most important developments in breast cancer surgery, could be expanded even in areas without sophisticated pathology facilities.Keywords: Breast neoplasm -lymphatic metastasis -lymph node dissection -sentinel lymph node biopsy

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“…Similarly, in Patient 4, only focal involvement of the lymph node was found. In other tumors, such as breast cancer and cutaneous melanoma, it has been found that foci of cancer may be detected microscopically in small, nonpalpable sentinel nodes [7]. Excisional biopsy of a lymph node, even if small, is preferable to fine-needle aspiration in cases such as ours, where study of overall tissue architecture is usually essential for diagnosis.…”

Section: Patientmentioning

confidence: 93%

“…The protein C pathway is a modulator of the coagulation system, and PC itself plays an integral role in the host response to infection, immune system, and cancer cells [1,2]. The extent of PC deficiency assessed at the time of diagnosis has been found to correlate with increased morbidity and mortality [6,7].…”

Section: Methodsmentioning

confidence: 99%

“…Its management, still unsatisfactory due to the lack of an effective therapy, is mainly based on the treatment of the underlying condition along with the administration of fresh-frozen plasma (FFP) and replacement therapy (such as anti-thrombin [AT]) [3,4]. Recently, the correlation between sepsis and coagulation abnormalities has been intensively investigated [5][6][7]; in septic patients with DIC, substitution therapy with activated recombinant protein C (ar-PC) has been proven to be effective, but with an increase in bleeding [8,9]. The protein C pathway is a modulator of the coagulation system, and PC itself plays an integral role in the host response to infection, immune system, and cancer cells [1,2].…”

Section: Alessandra Malato Giorgia Saccullo Lucio Lo Coco Clementimentioning

confidence: 99%

See 1 more Smart Citation

The diagnostic value of biopsy of small peripheral lymph nodes in patients with suspected lymphoma

Baron¹,

Baron²

2011

American J Hematol

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In a patient with suspected lymphoma, it is considered desirable to confirm the diagnosis by excisional biopsy of enlarged lymph nodes. However, sometimes the ideal nodes are positioned internally, requiring a deep invasive procedure for access, or the patient may have underlying medical conditions that make it risky to perform such an invasive procedure. Under a protocol approved by our institution's review board (IRB), we reviewed five patients in whom superficial lymph nodes were biopsied which were smaller than usually considered optimal for diagnosis (=2 cm). In each of these cases, the biopsy yielded diagnostic information upon which treatment could be based, sparing the patient a deep invasive procedure. We suggest that in situations in which large internal lymph nodes are not easily accessible and/or the patient's clinical situation precludes more invasive procedures, including deep core needle biopsy of a large mass, it is worthwhile to consider the removal of smaller, superficial lymph nodes with minimal risk which may suffice for diagnosis. © 2011 Wiley Periodicals, Inc.

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Implementing Sentinel Lymph Node Biopsy Programs in Developing Countries: Challenges and Opportunities

Abstract: It is hoped that this article will be a useful resource for our colleagues planning to establish a SLNB program.

Cited by 19 publications

References 79 publications

A Receptor-targeted Fluorescent Radiopharmaceutical for Multireporter Sentinel Lymph Node Imaging

A Receptor-targeted Fluorescent Radiopharmaceutical for Multireporter Sentinel Lymph Node Imaging

Value of Sentinel Lymph Node Biopsy in Breast Cancer Surgery with Simple Pathology Facilities -An Iranian Local Experience with a Review of Potential Causes of False Negative Results

The diagnostic value of biopsy of small peripheral lymph nodes in patients with suspected lymphoma

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