scholarly journals Should laparoscopic lymph node biopsy be the preferred diagnostic modality for isolated abdominal lymphadenopathy?

2019 ◽  
Vol 26 (3) ◽  
Author(s):  
R. W.D. Gilbert ◽  
B. H. Bird ◽  
M. G. Murphy ◽  
C. J. O’Boyle
Keyword(s):  
Lymph Node ◽  
Diagnostic Accuracy ◽  
Percutaneous Biopsy ◽  
Lymph Node Biopsy ◽  
Complication Rates ◽  
Diagnostic Modality ◽  
Disease States ◽  
Node Biopsy ◽  
Laparoscopic Biopsy ◽  
Abdominal Lymphadenopathy

Background Isolated abdominal lymphadenopathy is frequently detected, but often challenging to diagnose. To obtain a tissue diagnosis, percutaneous biopsy (pb) or laparoscopic biopsy (lb) is often undertaken. The safety profiles and diagnostic accuracy of pb and lb within the abdomen are both poorly defined.Methods In this retrospective analysis, we identified all patients who underwent lb or pb for isolated abdominal lymphadenopathy at our institute during 2008–2016.Results Of 62 patients who underwent nodal biopsy for isolated abdominal lymphadenopathy, 33 underwent lb and 29 underwent pb. For the 33 patients who underwent lb, the procedure was diagnostic in 100% of cases; for the 29 who underwent pb, the procedure was diagnostic in 18 cases (62.1%). Both procedures were safe, with similar complication rates (6.0% for lb; 7.0% for pb).Conclusions Our results establish that lb and pb are both safe and reliable in the setting of isolated abdominal lymphadenopathy. We also demonstrate that each procedure has situational advantages. A pb should be considered to be the upfront diagnostic modality, particularly when anatomic or disease factors favour its success. In situations in which it is felt that pb cannot safely access the lymphadenopathy or in disease states in which the yield of a core biopsy will be insufficient, lb should be strongly considered. Examples include extra-retroperitoneal lymphadenopathy and cases of suspected lymphoma.

scholarly journals Controversial Indications for Sentinel Lymph Node Biopsy in Breast Cancer Patients

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Hazem Assi ◽  
Eman Sbaity ◽  
Mahmoud Abdelsalam ◽  
Ali Shamseddine
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Recurrent Breast Cancer ◽  
Lymph Node Biopsy ◽  
Axillary Lymph ◽  
Complication Rates ◽  
Breast Cancer Patients ◽  
Node Biopsy

Sentinel lymph node biopsy (SLNB) emerged in the 1990s as a new technique in the surgical management of the axilla for patients with early breast cancer, resulting in lower complication rates and better quality of life than axillary lymph node dissection (ALND). Today SLNB is firmly established in the armamentarium of clinicians treating breast cancer, but several questions remain. The goal of this paper is to review recent work addressing 4 questions that have been the subject of debate in the use of SLNB in the past few years: (a) What is the implication of finding micrometastases in the sentinel nodes? (b) Is ALND necessary in all patients who have a positive SLNB? (c) How accurate is SLNB after neoadjuvant therapy? (d) Can SLNB be used to stage the axilla in locally recurrent breast cancer following breast surgery with or without prior axillary surgery?

scholarly journals Pregnancy-associated breast cancer – Case report

Mastology ◽  
2020 ◽  
Vol 30 (Suppl 1) ◽  
Author(s):  
Vanessa Monteiro Sanvido ◽  
Mary Miyazawa Simomoto ◽  
Afonso Celso Pinto Nazário
Keyword(s):  
Breast Cancer ◽  
Case Report ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Histological Grade ◽  
Percutaneous Biopsy ◽  
Lymph Node Biopsy ◽  
Node Biopsy ◽  
Axillary Lymphadenectomy ◽  
The Right

Introduction: Mammographic screening is recommended yearly after the age of 40; however, many pregnant women are younger and should undergo the test. In these cases, anamnesis and clinical examination of the breasts are essential to detect any breast change. In case of clinical suspicion, it is recommended to undergo mammography with abdominal protection, and breast ultrasound is the examination of choice to assess the extension of the injury and guide the percutaneous biopsy. Breast surgery is safe, and can be performed in the three trimesters of pregnancy. It is important to emphasize the importance of the type of surgery according to gestational age. The reference axillary surgery during pregnancy is axillary lymphadenectomy. However, some articles present the safety of the sentinel lymph node biopsy. The use of technetium (Tc-99m) with lymphoscintigraphy is an acceptable technique, with fetal exposure to radiation inferior to the teratogenic limit of 50 mGv. Objective: To emphasize the importance of mammary propedeutics during pregnancy. Case report: 37 year-old patient, primiparous, of 34 weeks, referred a nodule in the right breast for 1 year. She denies having family history of carcinoma. At clinical examination, she presented with turgid breasts, absence of palpable nodules and negative axilla. Current mammography with presence of architectural distortion in the inferolateral quadrant of the right breast, and ultrasound with irregular and spiculated 2 cm nodule , both BIRADS category 5. Percutaneous biopsy showed invasive breast carcinoma of no special type, histological grade 2, and immunohistochemical with positive hormone receptors (estrogen and progesterone receptor with 90%), negative HER2 and Ki 67 of 20%> The conduct was conserving surgery (excision of the breast injury and radio-guided sentinel lymph node biopsy) on the 36th week of pregnancy. The intraoperative assessment of the sentinel lymph node showed presence of macrometastasis and, as a consequence of the exclusion of pregnancy in the ACOSOG Z0011 study, the patient was submitted to axillary lymphadenectomy. The definitive anatomopathological result was invasive breast carcinoma of no special type, histological grade 3, measuring 2.1 cm, and 1 lymph node compromised by macrometastasis of 15 dissected nodes (pT2 pN1a). The multidisciplinary team chose to wait for delivery, from 2 to 4 weeks, and a Cesarean section was performed after 40 weeks of pregnancy. The chemotherapy was scheduled to begin 4 weeks after delivery. The patient was referred to genetic counselling. Conclusions: The treatment of breast cancer during pregnancy is challenging for the multidisciplinary team, which must focus on maternal and fetal well-being. Therapy should be carried out similarly to non-pregnant patients, respecting the procedures that are allowed in each gestational trimester. It is important to mention how essential it is to not delay the treatment, in order to not compromise the patient’s prognosis.

scholarly journals New Developments in Imaging for Sentinel Lymph Node Biopsy in Early-Stage Oral Cavity Squamous Cell Carcinoma

Cancers ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 3055 ◽  
Author(s):  
Rutger Mahieu ◽  
Josanne S. de Maar ◽  
Eliane R. Nieuwenhuis ◽  
Roel Deckers ◽  
Chrit Moonen ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Diagnostic Accuracy ◽  
Injection Site ◽  
Early Stage ◽  
Lymph Node Biopsy ◽  
Tracer Injection ◽  
Node Biopsy

Sentinel lymph node biopsy (SLNB) is a diagnostic staging procedure that aims to identify the first draining lymph node(s) from the primary tumor, the sentinel lymph nodes (SLN), as their histopathological status reflects the histopathological status of the rest of the nodal basin. The routine SLNB procedure consists of peritumoral injections with a technetium-99m [99mTc]-labelled radiotracer followed by lymphoscintigraphy and SPECT-CT imaging. Based on these imaging results, the identified SLNs are marked for surgical extirpation and are subjected to histopathological assessment. The routine SLNB procedure has proven to reliably stage the clinically negative neck in early-stage oral squamous cell carcinoma (OSCC). However, an infamous limitation arises in situations where SLNs are located in close vicinity of the tracer injection site. In these cases, the hotspot of the injection site can hide adjacent SLNs and hamper the discrimination between tracer injection site and SLNs (shine-through phenomenon). Therefore, technical developments are needed to bring the diagnostic accuracy of SLNB for early-stage OSCC to a higher level. This review evaluates novel SLNB imaging techniques for early-stage OSCC: MR lymphography, CT lymphography, PET lymphoscintigraphy and contrast-enhanced lymphosonography. Furthermore, their reported diagnostic accuracy is described and their relative merits, disadvantages and potential applications are outlined.

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