Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A sentinel node biopsy done at the time of initial tumor resection allows for a one-stage surgical procedure. In addition, sentinel node identification may be impaired when done after a previous tumor excision. This study evaluates the sentinel node biopsy in patients with nonpalpable breast cancer and assesses whether a sentinel node biopsy for mammographically suspect breast lesions is justified when preoperative needle biopsy is inconclusive for invasive malignancy. A sentinel node biopsy was done in 67 patients with nonpalpable breast lesions after injection of radioactive tracer (intraparenchymal in 35 and subdermal in 32) and blue dye (para-areolar). A preoperative core needle biopsy was positive for malignancy in 42 patients. Thirteen patients had positive cytology or ductal carcinoma in situ (DCIS). In 12 patients the needle biopsy was nondiagnostic, but the lesions remained highly suggestive of malignancy on mammography. Sentinel node biopsy was successful in 64 patients (96%). In these, the sentinel node was both radioactive and blue in 58 patients (91%). Only 4 of 13 patients with positive cytology or DCIS on preoperative needle biopsy and only 5 of 12 patients without a preoperative diagnosis had an invasive cancer after resection. Sentinel nodes were positive for nodal metastases in 9 of 49 patients (18%) with a successful sentinel node biopsy for invasive malignancy. None of the eight patients with DCIS had nodal metastases. The sentinel node procedure avoids the potential morbidity of an axillary dissection in more than 80% of patients with nonpalpable breast cancer. A sentinel node biopsy for mammographically detected suspect breast lesions is not justified without a preoperative histologic diagnosis of invasive breast cancer.
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PMID:Sentinel node biopsy for nonpalpable breast tumors requires a preoperative diagnosis of invasive breast cancer. 1512 62

The trend to implement sentinel node biopsy as standard of care in patients with clinically localized melanoma is encouraged by the following three factors: the technique of lymphatic mapping has matured to the point that consensus was reached on how the procedure should be carried out, surgeons showed that they can find the node in nearly 100% of patients, and tumor-status was shown to be the most powerful prognostic factor. However, recent studies revealed unfavorable new information that questions the wisdom of this trend. Three studies published in 2001 with a combined total of 1,851 patients show false-negative rates of 16-25%. Another unnerving finding is the 13-19% incidence of in-transit metastases in patients with a tumor-positive sentinel node, reported by three groups. The ultimate purpose of lymphatic mapping is to provide sentinel node positive patients with early therapeutic measures, such as regional node dissection and adjuvant systemic treatment. However, there is currently no evidence that this approach results in improved regional control and survival. Sentinel node biopsy can only become part of routine patient management if the tumor-status of the sentinel node carries clear implications of proven benefit for the manner in wich patients are managed and if regional control is not jeopardized.
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PMID:[Biopsy of sentinel lymph node in melanoma is not yet the standard treatment]. 1463 63

Sentinel node biopsy has become an integral part of the management of malignant melanoma. Here, the authors describe the technique that is used at the St George's Hospital Melanoma Unit. Results obtained over the past 5 years on a cohort of patients are presented. Three hundred and forty seven patients were entered in the study. Population demographics were analysed for both the primary melanoma and for sentinel node positive status. Histological features of the primary, particularly regression were noted and, in addition to metastatic disease, the presence of capsular naevus cells within the node also recorded. Complications associated with the procedure have been presented along with the specificity and sensitivity of the technique. The relative influence of both Breslow thickness and sentinel node positivity were analysed statistically and Kaplan-Meier survival curves produced for the cohort as a whole. This confirmed the accuracy of sentinel node biopsy and its role as a prognostic indicator.
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PMID:Five years of sentinel node biopsy for melanoma: the St George's Melanoma Unit experience. 1538 Jul 6

Sentinel node biopsy in breast cancer is a new rapidly advancing minimal invasive procedure which enables nodal staging of clinically node negative breast cancer patients without performing complete axillary dissection. There are still controversies over the added value of Blue Dye when lymphoscintigraphy and gamma probe are used. In our series, 91 consecutive patients with invasive breast carcinoma were operated by a single surgeon, using lymphoscintigraphy, gamma probe and Blue Dye. The sentinel nodes (SLN) were histologically examined by HE and immunohistochemistry. Lymphoscintigraphy was succesful in 81 patients (89%). After the injection of Blue Dye, SLN could be identified in all 91 patients. Metastases in the SLN were present in 35 patients. We retrieved 128 SLN, of these 93 were hot and blue, 19 only hot and 16 only blue. The distribution of metastatic and nonmetastatic SLN between these three labeling groups was not different (P = 0.9361). We could not show any difference in the metastatic involvement of SLN in patients in whom preoperative lymphoscintigraphy could visualise the SLN preoperatively compared to those in whom it could not (P = 0.7315). False negativity calculated in our initial series of 36 patients was 0%. Our study showed added value of Blue Dye in detection of metastatic and nonmetastatic SLN.
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PMID:Added value of blue dye in sentinel node biopsy for breast cancer. 1505 96

Sentinel node biopsy in patients with breast carcinoma accurately predicts the axillary nodal status. However, in some 6% of patients with negative sentinel nodes the remaining axillary nodes harbour metastases. Our purpose was to observe a large number of patients who did not undergo an axillary dissection after a negative sentinel node biopsy for the appearance of overt axillary metastases. 953 patients treated from 1996 to 2000, with negative sentinel nodes not submitted to axillary dissection, were followed-up to 7 years, with a median follow-up of 38 months. Fifty-five unfavourable events occurred among the 953 patients, 37 (4%) related to the primary breast carcinoma. Three cases of overt axillary metastases were found: they received total axillary dissection and are presently alive and well. The 5 year overall survival rate of the whole series was 98%. Patients with negative sentinel node biopsies not submitted to axillary dissection show during follow-up a rate of overt axillary metastases that is lower than that expected.
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PMID:Sentinel node biopsy in breast cancer: early results in 953 patients with negative sentinel node biopsy and no axillary dissection. 1566 42

Sentinel node biopsy (SNB) has proved to be a useful and accurate procedure for lymph node staging in breast cancer and melanoma and should be standard of care in the treatment of these tumors. In other malignancies (colon, rectum, stomach, esophagus, head and neck and thyroid, cervix uteri) it is still under investigation. SNB in breast cancer was accepted as a sole and reliable diagnostic method in breast cancer from the panel of distinguished experts at the 8th international conference of primary therapy of early breast cancer 2003 in St. Gallen. Combination of the current techniques with radiocolloids and blue dye, applicated superficially (intradermal, subdermal, peri- and subareolar) and deeply (peritumoral, intratumoral, subtumoral) enables high identification rates and negative predictive values. It should be performed by teams consisting of surgeons, pathologists and nuclear medicine specialists with appropriate training and experience. Accepted indications are uni- and multifocal tumors smaller than 3 cm without suspicious findings in the axilla, furthermore SNB is indicated in patients with large ductal carcinoma in situ (>2cm) and/or with assumed microinvasion. Albeit SNB could be shown to be safe after preoperative chemotherapy and in multicentric breast cancer, due to lack of sufficient data it is still under discussion in these cases. Expedience of this procedure in other lymph node basins, along the mammaria interna vessels or in the infra- and supraclavicular region is considered to be at an investigative stage as well. SNB allows the pathologist to focus on a small number of nodes most likely to contain metastases. Application of serial sectioning and immunhistochemistry results in a more accurate staging than routine examination. Detection of additional micrometastases that are found in 10-15% leads to an upgrading from N0 to N1. Broad application and refurbishment led to scientific discussion of prognostic importance of micrometastases and its relevance according axillary dissection and adjuvant systemic treatment. Although many unicentric and multicentric observational studies validated by complete axillary dissection could demonstrate that SNB is accurate and suitable for all operable clinically node-negative breast cancers, longterm results and especially the incidence of axillary recurrence and its sequelae are outstanding. Findings of ongoing large prospective randomized trials like NSABP 32, Z0010 and Z0011 of the American College of Surgeons (ACOSOG), the AMAROS-Trial of the European Organisation of Research and Treatment of Cancer (EORTC) and the ALMANAC-Trial of the British Association of Surgical Oncology (BASO) will give a conclusive answer. Significant improvement in morbidity and quality of life measurements could be revealed several times in unicentric and even in muticentric studies like ALMANAC. Sentinel node biopsy is a team approach, requirements are good cooperation and well-defined stuctures of quality indicators and documentation. Participation in national clinical studies is recommended.
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PMID:[Sentinel node biopsy in breast cancer: techniques and indications]. 1584 90

Sentinel node biopsy accurately predicts the nodal status of early-stage gastric carcinomas. Nevertheless, surgeons are concerned about missing a micrometastasis in applying the sentinel node-negative finding to surgery. Of 36 patients who underwent D2 dissection based on positive sentinel node biopsy, 15 patients had histologic metastasis in the sentinel nodes, 20 patients in both the sentinel and nonsentinel nodes in the lymphatic basin system, and 1 in the nodes not only in the basins but also in the nonbasin system. This means that metastases spread along the anatomic lymphatic flows in the early stage. Micrometastases of the sentinel nodes develop prior to histologic appearance, and the neighboring nonsentinel nodes are also possibly involved in the early stage. This suggests that, even in the case of cancer-free sentinel nodes, the basins should be dissected. Since 1995, we have performed lymphatic basin dissections and limited gastric resections on 159 sentinel node-negative patients. The crude survival curve was not different from that of the conventional group. The incidence of postoperative distress such as early satiety, unsatisfactory recovery of body weight dumping syndrome, duodenogastric reflux, and gallstone formation was significantly lower in the limited group than that in the conventional group.
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PMID:[Lymphatic basin dissection and function-preserving limited gastrectomy for early-stage gastric carcinoma]. 1585 38

In melanoma patients lymph node metastasis is an important prognostic factor that indicates the need for therapeutic lymph node dissection. Preoperative lymphoscintigraphy mapping associated with radioguided sentinel lymph node biopsy has become a well established procedure for cutaneous melanoma patients without clinically detectable lymph node metastases (stage I, II). This technique is a versatile way of characterizing the lymphatic basin at risk for metastases and identifying involved lymph nodes. The purpose of the present study was to examine the reproducibility of lymphoscintigraphy and sentinel lymph node biopsy in detecting micro metastases in cutaneous melanoma. The study was a single-institution prospective analysis of 74 melanoma patients, with primary tumors having Breslow thickness > 0.7 mm, who underwent lymphoscintigraphies between May 2002 and September 2003. Technetium-99m sulfur colloid was injected intradermally at the primary tumor site and dynamic images were obtained for 40 minutes. Two observers evaluated the images. One to two weeks after the first lymphoscintigraphy, radioguided lymph node biopsy was performed. For the biopsy, technetium-99m sulfer colloid was injected intradermally in the same manner as performed before. Lymph nodes were identified and removed with the aid of a gamma ray detecting probe (GDP), and were submitted to histopathological analysis. The histopathological analysis of the sentinel lymph nodes collected during surgery was performed in a sequential manner. First, frozen sections were analyzed during surgery. The lymph nodes considered negative by frozen section were analyzed by H&E staining. Subsequently, the slides considered negative with H&E were sent for immunohistochemical analysis. Lymphoscintigraphy identified at least one sentinel lymph node in all patients. Sentinel node biopsy detected metastases in 20 patients (27.2%). In all cases the lymph node basins identified during lymphoscintigraphy were found to have at least one sentinel lymph node during surgery. Frozen section analysis of the lymph node was only able to identify the disease in 35% of the patients eventually found to have micrometastases with H&E and immunohistochemistry. Two lymph nodes were negative with H&E and positive with immunohistochemical analysis. In conclusion, lymphoscintigraphy is a simple procedure that is well tolerated by patients. It is useful in locating sentinel lymph nodes in patients with melanoma and is an important tool in the clinical practice of oncology. We recommend performing H&E, and if necessary, immunohistochemical analysis of all sentinel lymph nodes because of the high rate of false negative results with frozen sections alone.
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PMID:Sentinel node identification by scintigraphic methods in cutaneous melanoma. 1611 Jul 49

Preoperative systemic treatment (PST) is a valid option not only for advanced breast cancer stages but also for operable breast cancer. We know that disease-free and overall survival after PST are equivalent to those after adjuvant therapy. Furthermore, PST is able to improve surgical treatment by increasing the rate of breast conservation surgery, which minimises psychological distress for patients fearing mastectomy. Response to PST is a predictor of long-term outcome and gives prognostic information after a short-term interval in contrast to adjuvant trials, which do not show their results until after a 5- to 10-year follow-up. More often, endocrine non-responsive tumours demonstrate a pathological complete response (pCR). Thus, PST can change the formerly bad prognostic marker into one that indicates a favourable prognosis if pCR is achieved by PST. If PST is performed outside clinical trials, anthracycline/taxane-based regimens should be used, especially in sequential prolonged schedules. The use of aromatase inhibitors in preoperative endocrine therapy in elderly postmenopausal patients with endocrine-responsive breast cancer yields a larger proportion of local response than tamoxifen. The duration of PST is not well established, but at least four cycles of chemotherapy should be administered and endocrine therapy needs a minimal time to show greatest benefit when given for at least 3-4 months . The concurrent use of chemotherapy and endocrine drugs did not show any benefit, even in endocrine-responsive tumours and should therefore be avoided. Sentinel node biopsy is a reasonable approach, but this technique should be reserved for experienced surgeons. PCR is the most important surrogate marker of PST, demonstrating an improved disease-free and overall survival. But even if pCR of the primary tumour is achieved, the detection of lymph node metastases is the most important prognostic factor, indicating a substantial risk of cancer recurrence. PST will lead to individualised (tailored) treatment in patients with primary breast cancer.
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PMID:Preoperative (neoadjuvant) systemic treatment of breast cancer. 1619 60

Axillary clearance provides important prognostic information but is associated with significant morbidity. Sentinel node biopsy can provide staging .141 patients with node negative early breast cancers-tumour size less than 1.5 cm measured clinically or by imaging had guided axillary sampling (sentinel lymph node biopsy in combination with axillary sampling). Four node axillary sampling improved the detection rate of axillary node metastases by 13.6% as compared to blue dye sentinel node biopsy alone. Positive sampled nodes strongly indicated the likelihood of further metastatic being revealed by axillary dissection (67%). Negative sampled nodes in combination with a positive sentinel node biopsy were associated with a much lower rate of further nodal involvement in the axillary clearance (8%).
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PMID:Sentinel node biopsy should be supplemented by axillary sampling in patients with small breast cancers. 1631 79


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