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Sentinel node procedures (SNP) are performed with the use of tracer-agents, mainly radio-colloid and/or blue dye. Fluorescent agents have emerged as a new tracer-agent to identify the SLN intra-operatively with near-infrared imaging. Our aim is to compare the detection rate of fluorescent agents to current "golden standards" (blue dye and/or radio-colloid) for the SNP by means of a systematic review and meta-analysis without any restrictions based on tumor type. A systematic search in PubMed, Embase and The Cochrane Library was performed. Articles that compared the detection rates of fluorescent agents with radio-colloid and/or blue dye were included. Meta-analyses were performed for breast, gynecological and dermatological cancer using a random effects model. In total 6195 articles were screened which resulted in a final inclusion of 55 articles. All studies used indocyanine green (ICG) as fluorescent agent. Meta-analyses comparing ICG with blue dye showed a significant and clinically relevant difference in detection rate in favor of ICG, for both breast, dermatological and gynecological cancer. Meta-analyses comparing ICG with radio-colloid did not show any significant differences, with the exception of ICG versus radio-colloid + blue dye for the bilateral SLN detection in gynecological cancer. Near-infrared fluorescence imaging using ICG provides a higher detection rate compared to blue dye for the SNP in a range of different tumor types. SLN detection rates of ICG are comparable to radio-colloid. Due to their complementary characteristics in terms of spatial resolution and transdermal sensitivity, we suggest to use a combination of both ICG and a radio-colloid. • This meta-analysis concerns breast, gynecological and dermatological SNP studies • Indocyanine green (ICG) provides a higher SLN detection rate compared to blue dye • SLN detection rates of ICG are comparable to radio-colloids • ICG and radio-colloids have complementary characteristics • We suggest to use a combination of both ICG and a radio-colloid for the SNP [ABSTRACT FROM AUTHOR]

The sentinel node (SN) procedure is adopted in selected patients with early-stage vulva cancer (VC) in Denmark. Due to the low incidence of VC, large population-based studies on the safety of SN outside multicenter clinical trials are lacking. The current study evaluated the risk of recurrence and survival in SN- negative VC patients. Nationwide data was collected and registered prospectively in the Danish Gynecologic Cancer Database from January 2011 to July 2017. Patients with clinically stage IB-II unifocal vulva squamous cell carcinoma, tumor <4 cm and no clinically suspicious groin nodes or distant metastases, who underwent SN-procedure, were included. The SN-procedure was performed in 286 patients, of these 190 (66.4%) patients were SN-negative. Twenty-three of the 190 SN-negative patients (12.1%) had one or more recurrences during a median follow-up of 30 months (range 1–83). Four patients (2.1%) had an isolated groin recurrence identified from 5 to 17 months after primary surgery. Fourteen patients (7.4%) experienced a local recurrence in vulva, 1 patient (0.5%) had a recurrence in the vulva and the groin and 4 patients (2.1%) had distant recurrences. The 3-year overall (OS) and disease-specific survival (DSS) for SN-negative patients was 84% and 93%, respectively. The 3-year OS for patients with recurrent disease was 58%. This is the largest prospective nationwide study on SN-procedure in vulva cancer. The study confirms the safety of the SN-procedure in selected early-stage VC patients with a low isolated groin recurrence rate and a good DSS. • The sentinel node procedure is a safe treatment option in a selected group of patients with early-stage vulva cancer. • The three year overall and disease-specific survival is 84% and 93% respectively in sentinel node negative patients. • The rate of isolated groin recurrences is 2.1% in sentinel node negative patients. [ABSTRACT FROM AUTHOR]

Objective Standard treatment of primary T1 squamous cell carcinoma (SCC) of the vulva < 4 cm consists of wide local excision (WLE) and sentinel lymph node (SLN) procedure of the groin(s). In case of a local recurrence WLE and inguino femoral lymphadenectomy (IFL) is generally recommended. In this study we assessed the feasibility of repeat SLN procedure in patients with recurrent vulvar SCC who were not able or willing to undergo IFL. Methods A retrospective study was performed in consecutive patients with recurrent vulvar SCC who underwent a repeat SLN procedure between 2006 and 2014. We present the clinical and pathological outcomes. The study conforms to the STROBE guidelines. Results A total number of 27 patients aged 35–87 years at first diagnosis of SCC of the vulva were identified. Median follow-up after 2nd surgery was 27.4 (range 2–96) months. In 78% of patients and in 84% of the groins the repeat SLN procedure was successful. No structured questionnaires were used to describe details on the repeat SLN procedures but in general the gynecologic oncologists experienced repeat SLN procedures more challenging compared to primary procedures. There were no groin recurrences documented. Conclusions Our findings suggest that it is feasible to perform a repeat SLN procedure in recurrent vulvar SCC, but the procedure appears technically more challenging compared to primary setting, resulting in a lower SLN identification rate. [ABSTRACT FROM AUTHOR]

Purpose In the present study we describe patients with non-palpable breast lesions, in which an Iodine-125 ( 125 I)-marker (or “seed”) for excision of the primary tumour and Technetium-99m nanocolloid ( 99m Tc-nanocolloid) for sentinel node biopsy (SNB) are used simultaneously. The purpose was to investigate any interference between 125 I-seeds and 99m Tc-nanocolloid by an in vitro and in vivo analysis. Methods Contrast/interference-ratios between 125 I and 99m Tc count-rates were determined in vitro using a realistic simulation model. Measurements were performed with 3 gamma-probes with different crystal materials. In 25 consecutive patients 99m Tc-nanocolloid was intratumourally administered at the site of a previously implanted 125 I-seed. Respectively, the 125 I-setting and 99m Tc-setting of the gamma-probe guided the wide local excision and SNB and maximum counts-per-second (cps) were measured. Results In vitro the different probes varied in 125 I- and 99m Tc-sensitivity. The contrast-ratio between 125 I and 99m Tc in the 125 I-channel was 4.6 for a 3-month-old 125 I-seed using the most appropriate gamma-probe. In vivo the gamma-probe in the 125 I-setting measured a median of 16,300 cps at the tumour site compared to 4820 cps using the 99m Tc-setting. The 125 I-seed could be well distinguished from the 99m Tc-nanocolloid in 92% of the patients and 96% required a single operation. The SNB was successful in all patients. Conclusions Simultaneous use of 125 I-seeds and 99m Tc-nanocolloid is possible under well-standardised conditions. Non-palpable breast lesions can be safely excised using the 125 I-seed in combination with a SN procedure. Use of 125 I-seeds is a next step within fine-tuning breast-conserving surgery that should lead to further investigation to confirm its value. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To compare preoperative sentinel node (SN) mapping with planar lymphoscintigraphy (LSG) to single photon emission computed tomography with computed tomography (SPECT–CT) for differences in intraoperative SN retrieval time in surgically treated cervical cancer patients. Methods: In cervical cancer patients planned for radical surgery, one day preoperatively, 220–290MBq technetium-99m-nanocolloid was injected intracervically in four quadrants. Subsequent SN mapping was performed by either LSG (09.2009–03.2011) or SPECT–CT (03.2011–10.2012). The SN resection, by four armed robot assisted laparoscopy, was based on blue dye and technetium-99m and followed by pelvic lymph node dissection. Timing of perioperative care, including SN procedure times, was prospectively registered. Results: Out of the 62 subjects included, 33 (53.2%) underwent LSG and 29 (46.8%) SPECT–CT. No significant differences in baseline characteristics were observed. Bi- and unilateral SN visualization rates were 75.8% and 15.2% for LSG versus 86.2% and 6.9% for SPECT–CT (p=0.299 and p=0.305, respectively). Intraoperative bi/unilateral SN detection occurred in 84.8% and 9.1% of LSG subjects versus 89.7% and 3.4% for SPECT–CT (p=0.573 and p=0.616). Correlation in SN location between mapping and surgery was low for LSG (Spearman ρ =0.098; p=0.449) but high for SPECT–CT (ρ =0.798; p<0.001). Bilateral intraoperative SN retrieval times for LSG and SPECT–CT were 75.4±33.5 and 50.1±15.6min, resulting in an average difference of 25.4min (p=0.003). Conclusion: SPECT–CT significantly reduces intraoperative SN retrieval with a clinically relevant time compared to LSG. The trend towards better bilateral visualization rates and significantly higher anatomical concordance may partly explain the observed difference in SN retrieval time. [Copyright &y& Elsevier]

Abstract: Introduction: Sentinel lymph node biopsy (SLNB) is accepted as a standard surgical staging procedure for determining the tumour status of the regional lymph nodes. Until September 2000 we performed SLNB in general anaesthesia. Since 1999, after validation of the SLNB concept, axillary dissection was omitted in SLN-negative patients. This study presents our data after SLNB under local anaesthesia after a follow-up of at least 5 years. Materials and methods: Between September 2000 and May 2003, 356 SLNBs were performed under local anaesthesia without sedation in patients with proven breast cancer (T4-tumours and small in situ carcinomas excluded) and without clinically or ultrasound guided cytological evidence of axillary node involvement. Lymphatic mapping and SLN identification were performed through the combination of blue dye and 99m Tc-nanocolloid. All positive SLNs were followed by an axillary dissection up to level three. SLN-negative patients were followed without axillary clearance. Results: In 353/356 SLNBs at least one sentinel node was found. 254/353 SLNs were tumour free. After a median follow-up of 73 months loco-regional and distant events were encountered in 10/353 SLNBs. Four patients (SLN-negative) showed tumour localization in the residual breast or chest wall (1.1%). Three patients (SLN-negative) presented with supraclavicular metastases (0.8%). In three patients (one SLN-negative and two SLN-positive followed by ALND) an axillary recurrence was encountered (0.8%). Conclusion: This survey confirms the safety of the SLNB under local anaesthesia in selecting patients for axillary lymph node dissection in breast cancer. [Copyright &y& Elsevier]

Abstract: Objective: The required radicality of hysterectomy for women with early-stage cervical cancer is controversial owing to the risk of severe complications. The aim of this study was to determine the contribution of the sentinel node (SN) procedure to tailoring the radicality of hysterectomy in women with cervical cancer. Methods: Between April 2001 and December 2005, 54 patients with early-stage or locally advanced cervical cancer underwent laparoscopic sentinel node (SN) biopsy based on combined patent blue and radiocolloid detection. Thirty-nine patients with early-stage cervical cancer underwent a laparoscopic SN procedure with complete pelvic lymphadenectomy and radical hysterectomy. Moreover, 15 women with locally advanced cervical cancer underwent an SN procedure with pelvic and para-aortic lymphadenectomy before concurrent neoadjuvant chemoradiotherapy. Results: The SN detection rate was 83.3%. The detection rate was higher in women with early-stage disease (90%) than in women with more advanced disease (66.6%) (p =0.03). At final histology, 14 metastatic SN were found in 11 (21.3%) of the 54 patients. They comprised macrometastases in 6 SN, micrometastases in 5 SN, and isolated tumour cells in 3 SN. Parametrial involvement with negative sentinel nodes was found in 15.1% of cases. The overall sensitivity, specificity, positive and negative predictive values and accuracy of intraoperative imprint cytology were 20%, 100%, 100%, 79.5% and 80.5%, respectively. Among the 39 women with early cervical cancer, five (12.8%) had parametrial involvement. In univariate analysis, parametrial involvement was significantly associated with large tumour size, advanced-stage disease, positive pelvic lymph nodes and lymphovascular space involvement. Parametrial involvement tended to be associated with positive sentinel nodes. Conclusion: These results underline the contribution of the SN procedure to evaluating lymph node status. However, intraoperative imprint cytology appeared poorly accurate, and further histological or biological tools are needed to evaluate SN status and, hence, to tailor the radicality of hysterectomy. [Copyright &y& Elsevier]

Background: The sentinel node (SN) concept assumes that early lymphatic metastases, if present, always are found first in the SN. The aim of this study was to determine the reliability ofthis procedure by establishing the success rate and number of failed procedures during a follow-up period of at least 2 years. Methods: From August 1993 to November 1996, 204 consecutive patients with stage I and II cutaneous melanoma underwent SN biopsy by a triple technique. Preoperatively, all patients underwent (dynamic) lymphoscintigraphy. A gamma probe and blue dye helped localize the SN(s) during surgery, and these nodes subsequently were excised. These lymph nodes were step-sectioned and examined by routine and immunohistochemical staining. If the SN contained tumor cells, a lymphadenectomy was performed at a later date. Results: The median follow-up time was 42 months. The success rate was 99%. Three patients developed a recurrence in the negative SN basin during follow-up, without simultaneous appearance of (locoregional) metastases. Conclusions: With a 99% success rate and a 1.5% rate of failed SN procedures (7% falsenegative rate) after a median follow-up of 3.5 years, we concluded that the combined triple technique approach of detecting the SN was a reliable method to accurately identify and retrieve the SN. [ABSTRACT FROM AUTHOR]

Background: Primary aim of our study was to assess the impact of timing of sentinel node procedure, pre- versus post-neoadjuvant chemotherapy, on final pathologic node-negative rate (pN0) in patients with clinically node-negative (cN0) breast cancer. Secondary endpoint was the usability of the sentinel node procedure in patients with clinically node-positive disease that converted to cN0 after neoadjuvant chemotherapy., Patients and Methods: Patients were enrolled in two sequentially conducted Dutch phase III trials, studying the impact of two neoadjuvant chemotherapy schedules and use of zoledronic acid on complete pathologic response rate. For the present analyses, patients were excluded if they had not undergone surgical axillary staging., Results: In total 439 patients were included, of whom 230 (52%) had pre-treatment cN0. In this group, pN0 status was seen in 58% (N = 23) of patients with a sentinel node biopsy post-neoadjuvant chemotherapy compared to 51% (N = 83) pre-neoadjuvant chemotherapy, including the axillary lymph node dissection whenever performed. In multivariable analysis, timing of sentinel node procedure (pre- versus post- neoadjuvant chemotherapy) was, however, not significantly associated with final pN0/pN0(i+) status, with an odds ratio of 1.18 (95% CI 0.64 - 2.18) after correction for age, clinical tumor status, histology, grade, hormone- and HER2 receptor. Of patients with clinically node-positive disease only 15% had a final pN0 status, with a false-negative rate of the sentinel node of 30%., Conclusion: In breast cancer patients with cN0 disease, sentinel node procedure performed post-neoadjuvant chemotherapy led to nodal down staging, although not statistically significant after multivariate correction for patient and tumor characteristics.

In 2008, the first Groningen International Study on Sentinel nodes in Vulvar cancer (GROINSS-V) showed that omission of inguinofemoral lymphadenectomy is safe in patients with early-stage vulvar cancer and a negative sentinel node and it simultaneously decreases treatment-related morbidity. An important part of the sentinel node procedure is pathologic ultrastaging of the removed sentinel nodes. Subsequently, since the introduction of this procedure in the standard care of patients with early-stage vulvar cancer, more and smaller inguinofemoral lymph node metastases have been diagnosed. The clinical consequences of these micrometastases are not clear yet. With increasing size of the sentinel node metastasis, chances of non-sentinel node metastases increase and those of survival decrease. The size of lymph node metastases is included in the latest staging system for vulvar cancer, however at this moment without clinical implications. Furthermore, a separate category for micrometastases is not incorporated yet. More research is needed to determine the clinical consequences of the size of (sentinel) lymph node metastases., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

A. Schiettecatte, C. Bourgain, C. Breucq, N. Buls, V. De Wilde and J. de Mey To evaluate the preoperative detection of axillary metastasis combining ultrasound (US)-guided fine needle aspiration cytology (FNAC) and liquid-based cytology (Surepath) to reduce sentinel node procedures. In total, 148 patients with clinically negative lymph nodes and no preoperative therapy were included. All patients underwent preoperative ultrasound of the axilla with FNAC if suspicious lymph nodes were found. Complete axillary lymph node dissection was performed at primary surgery when FNAC was positive. All other patients underwent a sentinel node procedure. US-guided FNAC of the axilla revealed metastasis in 34 (23.0%) of the 148 patients. These 34 patients were 53.1% of all patients ( n = 64) with proven axillary lymph node involvement. In 66 patients (44.6%), both ultrasound and histopathology were negative. Overall sensitivity of US-guided FNAC was 50.0%, specificity 100%, positive predictive value 100% and negative predictive value 70.2%. In T1 tumours, all patients referred for sentinel node procedure were node-negative. The correlation between malignant FNAC and histopathology was 100%. US-guided liquid-based FNAC in patients with no clinically positive lymph nodes reduced the necessity for a sentinel node procedure by 23.0%. We advocate that US-guided fine needle aspiration (FNA) combined with liquid-based cytology of axillary lymph nodes should be included in the preoperative staging of breast cancer. [ABSTRACT FROM AUTHOR]