The sentinel node is defined as a lymph node on a direct lymphatic drainage pathway from the primary tumour. The sentinel node biopsy is an invasive and potentially complex diagnostic test that requires considerable skill and experience from nuclear medicine physicians, surgeons and pathologists involved in the process. The procedure provides important staging information. The tumour bearing status of a regional lymph node basin is the most important prognostic factor for patients with a clinically localised melanoma. The recently published final report of the first Multicenter Selective Lymphadenectomy Trial (MSLT-1) shows that sentinel node biopsy with subsequent regional node dissection improves the survival rate in patients with nodal metastases from an intermediate Breslow thickness melanoma (1.23.5 mm). The false negative rate is substantial but can be limited by experience, a meticulous technique and close cooperation of the specialists involved. The surgical procurement of the sentinel nodes is associated with minor morbidity. Sentinel node biopsy is now part of the standard work-up in patients with intermediate thickness melanoma and can be considered in patients with a thinner or thicker melanoma. New lymph node tracers and innovative imaging techniques are likely to improve the sensitivity of the procedure further. Now that the results of MSLT-1 are available, the next question is whether sentinel node-positive patients require further surgery. This issue is addressed by EORTCs Minitub study and the MSLT-2. Until these studies yield results, regional node dissection is recommended for patients with sentinel node metastases.

• MeSH
• biopsie sentinelové lymfatické uzliny metody   MeSH
• lidé MeSH
• lymfatické metastázy MeSH
• lymfatické uzliny patologie   MeSH
• melanom diagnóza   sekundární   MeSH
• nádory kůže patologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Indications for elective neck dissection (ELND) and its extent in N0-staged patients with parotid gland carcinoma are inconsistent. Therefore, a pilot study was performed to test the feasibility and efficacy of radioguided sentinel lymph node biopsy (SLNB) in these tumors. A total of 6 patients underwent lymphoscintigraphy, SLNB, and level II-IV ELND. In 2 patients, the latter was extended to level V because the scans had revealed an additional sentinel lymph node (SLN) in this atypical nodal region. In all cases, the SLNs were detected intraoperatively. The SLNB exactly reflected the positive and negative histopathologic status of the remaining lymphatic basin in patients 1 and 4, respectively. One case of false negativity of SLNB could be explained by distortion of the lymphatic outflow resulting from intraparotid localization of lymphatic metastasis. The authors believe that the SLNB could provide reliable information on the status of regional lymph nodes, making it possible to base the neck dissection on the actual presence of the micrometastases and to detect metastatic tumors at unusual nodal levels.

• MeSH
• biopsie sentinelové lymfatické uzliny metody   MeSH
• krční disekce MeSH
• lidé MeSH
• lymfatické metastázy diagnostické zobrazování   patologie   MeSH
• nádory příušní žlázy diagnostické zobrazování   patologie   MeSH
• pilotní projekty MeSH
• radiofarmaka MeSH
• radioisotopová scintigrafie MeSH
• technecium 99mTc-agregovaný albumin MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• radiofarmaka MeSH
• technecium 99mTc-agregovaný albumin MeSH
• technetium Tc 99m nanocolloid MeSH Prohlížeč

INTRODUCTION: No consensus exists as yet regarding the optimal extent of surgery on the lymph nodes in breast cancer patients after neoadjuvant treatment. In addition to axillary dissection and sentinel lymph node biopsy (SLNB), a new approach called Targeted Axillary Dissection (TAD) was introduced. It requires the marking of metastatic nodes before the neoadjuvant treatment. METHOD: A retrospective observational study on patients with breast cancer and neoadjuvant chemotherapy treated surgically at a single institution in 2017. RESULTS: The analysis included 121 cancers in 120 patients. Clinical regression of lymphadenopathy occurred in 29 out of 74 cases. Axillary dissection was performed 34x, SLNB 52x and TAD 35x. In TAD procedures, the marked lymph node was found 30x and was among the sentinel nodes in 19 cases. No case occurred in which the marked node was assessed as negative with a metastasis found in the other nodes. On the contrary, there were 3 cases with negative sentinel nodes whereas the marked node was positive. Out of 74 cases with initially pathologic nodes, 23 patients were spared axillary dissection. CONCLUSION: Clinical assessment of the lymph node status is rather inaccurate. In cases with initially pathologic nodes we recommend marking of the most explicit metastatic node to enable TAD. The marked node is likely to reflect the status of the lymph nodes after neoadjuvant treatment more accurately than common sentinel nodes. A considerable proportion of patients can be spared axillary dissection in this way. However, the long-term oncologic safety of TAD still needs to be verified. Key words: breast cancer - neoadjuvant treatment - axillary dissection - sentinel lymph node biopsy - targeted axillary dissection.

• Klíčová slova
• breast cancer - neoadjuvant treatment - axillary dissection - sentinel lymph node biopsy - targeted axillary dissection,
• MeSH
• axila MeSH
• biopsie sentinelové lymfatické uzliny * MeSH
• lidé MeSH
• lymfadenektomie * MeSH
• lymfatické metastázy MeSH
• lymfatické uzliny MeSH
• nádory prsu * farmakoterapie   chirurgie   MeSH
• neoadjuvantní terapie MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH

INTRODUCTION: The role of sentinel lymph node biopsy (SLNB) in patients with breast cancer after neoadjuvant chemotherapy (NAC) is currently under discussion. The aim of our study was to determine the false negativity rate (FNR) of SLNB, the accuracy of ultrasound examination in the evaluation of the status of lymph nodes and the accuracy of perioperative cryobiopsy of the sentinel lymph node (SLN). METHODS: Prospective multicentre study, which took place in years 20182020 at three centres in the Czech Republic. A total of 59 patients were evaluated. RESULTS: The FNR of SLNB in the group of patients with cN1 before NAC and ycN0 after NAC was 12.5%. The FNR of perioperative histological examination of the SLN was 38.5%. The FNR of ultrasound examination of axillary lymph nodes in patients after NAC was 35.5%, and the false positivity rate was 16.7%. The incidence of inflammatory complications in our cohort was 3.3%. CONCLUSION: The FNR of SLNB in the group of patients with cN1 before NAC and ycN0 after NAC exceeds the tolerable limit of 10%. The FNR of perioperative histological examination of the SLN is high; definitive histological examination of the SLN may change the original diagnostic-therapeutic plan. Ultrasound examination of the axillary lymph nodes in patients after NAC is a method with high false negativity and positivity and may not correspond with the perioperative finding. The incidence of inflammatory complications in our cohort in patients after NAC is comparable to literature data on the frequency of complications in patients without NAC.

• Klíčová slova
• breast cancer − sentinel lymph node biopsy − neoadjuvant chemotherapy − axillary dissection,
• MeSH
• axila MeSH
• biopsie sentinelové lymfatické uzliny * MeSH
• lidé MeSH
• lymfadenektomie MeSH
• lymfatické metastázy MeSH
• lymfatické uzliny MeSH
• nádory prsu * farmakoterapie   chirurgie   MeSH
• neoadjuvantní terapie MeSH
• prospektivní studie MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

PURPOSE OF REVIEW: To summarize current knowledge and recent advances in sentinel lymph node (SLN) concept in the three most frequent gynecological cancers. RECENT FINDINGS: In cervical cancer, SLN biopsy and ultrastaging has high sensitivity in lymph node staging in patients with bilaterally detected SLN. The presence of micrometastasis is associated with shortened survival. In endometrial cancer, SLN biopsy incorporating an institutional mapping algorithm and ultrastaging has been shown to significantly reduce false-negative rates and increase sensitivity and negative predictive value. SUMMARY: SLN biopsy and ultrastaging is useful in current management of patients with early-stage cervical cancer for multiple reasons, such as the reliable detection of key lymph nodes, identification of micrometastasis and intraoperative triage of patients. Although a complete or selective pelvic and paraaortic lymphadenectomy for adequate staging remains the standard treatment approach in patients with early-stage endometrial cancer, SLN biopsy has been shown to be safe and effective in detecting lymph node metastases. The application of the SLN procedure is safe in patients with early-stage unifocal squamous cell cancer of the vulva (<4 cm) and no suspicious enlarged lymph nodes at imaging.

• MeSH
• algoritmy MeSH
• barvicí látky MeSH
• biopsie sentinelové lymfatické uzliny metody   MeSH
• fluoroskopie * MeSH
• indokyanová zeleň MeSH
• lidé MeSH
• lymfadenektomie metody   MeSH
• lymfatické uzliny patologie   MeSH
• nádory děložního čípku patologie   MeSH
• nádory endometria patologie   MeSH
• nádory vulvy patologie   MeSH
• staging nádorů MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH
• Názvy látek
• barvicí látky MeSH
• indokyanová zeleň MeSH

OBJECTIVE: Comparison of systems to detect sentinel lymph node in endometrial carcinoma using indocyanine green. Robotic Firefly Da Vinci fluorescence imaging system (Intuitive Surgical Inc., Sunnyvale, CA, USA) vs. laparoscopic Novadaq Pinpoint near-infrared imaging system (Novadaq, Ontario, Canada). MATERIAL AND METHOD: Fifteen patients with stage I endometrial cancer underwent sentinel lymph node biopsy after intracervical application of indocyanine green. For all of them, the detection was performed sequentially using both evaluated devices. The detection rate, identification match and extent of imaging of the lymphatic system were evaluated. RESULTS: The detection rate of both systems verified on a set of patients was identical, the detected sentinel nodes were identical, and the lymphatic system was shown to the same extent. The quality of the display and overall user-friendliness is different due to the applied technologies. CONCLUSION: Both systems used in minimally invasive surgery provide excelent perioperative imaging of the lymphatic system.

• Klíčová slova
• Da Vinci Firefly, Novadaq Pinpoint, endometrial cancer, indocyanine green, sentinel lymph node,
• MeSH
• biopsie sentinelové lymfatické uzliny metody   MeSH
• indokyanová zeleň MeSH
• laparoskopie * metody   MeSH
• lidé MeSH
• lymfadenektomie metody   MeSH
• lymfatické uzliny patologie   MeSH
• nádory endometria * chirurgie   patologie   MeSH
• roboticky asistované výkony * metody   MeSH
• sentinelová uzlina * diagnostické zobrazování   patologie   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• indokyanová zeleň MeSH

BACKGROUND: Extent of lymphadenectomy in gastric cancer is one of the still unresolved and ongoing questions. Whether extensive procedures lead to better survival remains controversial. The detection of sentinel node could become a helpful method to define the desirable extent of lymph node dissection for each particular patient. MATERIAL AND METHODS: Prospective, single-centre, clinical trial. Sentinel node is identified using vital blue dye. After performance of D2 lymphadenectomy, the pathologist minutely investigates all lymphatic nodes by histological and immunohistochemistry techniques. RESULTS: During a period of 36 months, an attempt to localise the sentinel node for biopsy was made in 22 patients. The successful rate of sentinel node detection with a good relation between metastatic involvement of the sentinel node and other nodes was 56% (13 out of 22 patients). All these patients suffered from small tumours and early stage of the disease. In large tumours and advanced stages, blue dye stained the tissue around the tumour diffusely rendering the identification of true sentinel node impossible. Fresh frozen section of the sentinel node resulted in two patients in a false negative outcome because of micrometastatic involvement. CONCLUSIONS: Sentinel node biopsy in gastric cancer using vital staining is a feasible method. Reliable results were seen in early stage of the disease. Fresh frozen section of sentinel node has probably a low sensitivity for detection of micrometastases.

• MeSH
• biopsie sentinelové lymfatické uzliny * MeSH
• imunohistochemie MeSH
• lidé MeSH
• lymfatické metastázy diagnóza   MeSH
• nádory žaludku patologie   MeSH
• prospektivní studie MeSH
• studie proveditelnosti MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Sentinel lymph node biopsy (SLNB) has become the preferred method of surgical pathological nodal staging of early breast cancer by the end of the nineties. As the most likely sites of metastasis, the SLNs allow a more precise staging, and indeed gross sectioning, step sectioning, immunohistochemistry, and molecular staging methods have been used to disclose metastatic involvement of these lymph nodes. This review summarizes the backgrounds of SLNB, trends in related surgery and pathology. It also gives an insight into European National recommendations related to SLN and divergent daily practices in European pathology departments, on the basis of replies to questionnaires from 84 pathologists from 38 European countries. The questionnaires revealed the post-neoadjuvant setting as an area where a significant minority of pathologists report less confidence in classifying residual nodal involvement into TNM categories. The review also summarizes the neoadjuvant therapy-related aspects of SLNB.

• Klíčová slova
• Breast cancer, Lymph nodes, Neoadjuvant treatment, Questionnaire, Sentinel lymph nodes,
• MeSH
• axila patologie   MeSH
• biopsie sentinelové lymfatické uzliny MeSH
• lidé MeSH
• lymfadenektomie MeSH
• lymfatické metastázy diagnóza   patologie   MeSH
• lymfatické uzliny patologie   MeSH
• nádory prsu * patologie   MeSH
• neoadjuvantní terapie MeSH
• sentinelová uzlina * patologie   MeSH
• staging nádorů MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

OBJECTIVE: The purpose of this study was to establish a consensus on the surgical technique for sentinel lymph node (SLN) dissection in cervical cancer. METHODS: A 26 question survey was emailed to international expert gynecological oncology surgeons. A two-step modified Delphi method was used to establish consensus. After a first round of online survey, the questions were amended and a second round, along with semistructured interviews was performed. Consensus was defined using a 70% cut-off for agreement. RESULTS: Twenty-five of 38 (65.8%) experts responded to the first and second rounds of the online survey. Agreement ≥70% was reached for 13 (50.0%) questions in the first round and for 15 (57.7%) in the final round. Consensus agreement identified 15 recommended, three optional, and five not recommended steps. Experts agreed on the following recommended procedures: use of indocyanine green as a tracer; superficial (with or without deep) injection at 3 and 9 o'clock; injection at the margins of uninvolved mucosa avoiding vaginal fornices; grasping the cervix with forceps only in part of the cervix is free of tumor; use of a minimally invasive approach for SLN biopsy in the case of simple trachelectomy/conization; identification of the ureter, obliterated umbilical artery, and external iliac vessels before SLN excision; commencing the dissection at the level of the uterine artery and continuing laterally; and completing dissection in one hemi-pelvis before proceeding to the contralateral side. Consensus was also reached in recommending against injection at 6 and 12 o'clock, and injection directly into the tumor in cases of the tumor completely replacing the cervix; against removal of nodes through port without protective maneuvers; absence of an ultrastaging protocol; and against modifying tracer concentration at the time of re-injection after mapping failure. CONCLUSION: Recommended, optional, and not recommended steps of SLN dissection in cervical cancer have been identified based on consensus among international experts. These represent a surgical guide that may be used by surgeons in clinical trials and for quality assurance in routine practice.

• Klíčová slova
• Cervical Cancer, Laparoscopes, Sentinel Lymph Node,
• MeSH
• biopsie sentinelové lymfatické uzliny metody   MeSH
• indokyanová zeleň MeSH
• konsensus MeSH
• lidé MeSH
• lymfadenektomie metody   MeSH
• lymfatické metastázy patologie   MeSH
• lymfatické uzliny patologie   MeSH
• nádory děložního čípku * chirurgie   patologie   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• indokyanová zeleň MeSH

BACKGROUND: In the primary treatment of apparent uterine-confined endometrial carcinoma, pelvic ± para-aortic lymphadenectomy has been considered the standard of care. Although some retrospective data suggest that the sentinel lymph node algorithm without complete lymphadenectomy can be used without jeopardizing oncologic outcome, prospective data are lacking. PRIMARY OBJECTIVES: To assess the 36 month incidence of pelvic/non-vaginal recurrence in women with pathologically confirmed stage I intermediate-risk endometrioid endometrial carcinoma who have bilateral negative pelvic sentinel lymph nodes. STUDY HYPOTHESIS: We hypothesize that patients with stage I, intermediate-risk endometrioid endometrial carcinoma who have bilateral negative pelvic sentinel lymph nodes will demonstrate a pelvic/non-vaginal recurrence rate comparable to historical estimate of stage I, intermediate-risk endometrioid endometrial carcinoma patients (estimated 2.5%). TRIAL DESIGN: This prospective multicenter single-arm observational study will follow women with stage I, intermediate risk endometrioid endometrial adenocarcinoma who have undergone successful hysterectomy, bilateral salpingo-oophorectomy, and bilateral sentinel lymph node biopsies, for recurrence. All patients will undergo lymphatic mapping using indocynanine green and will either receive no adjuvant treatment or vaginal brachytherapy only. Patients will be followed for 36 months. MAJOR INCLUSION/EXCLUSION CRITERIA: Patients will be enrolled in the study cohort if all the following criteria are met: (i) at time of surgery: hysterectomy with bilateral adnexectomy, and successful bilateral pelvic sentinel lymph node mapping; (ii) on final pathology: pathologic stage I, intermediate-risk endometrioid endometrial carcinoma (grade 1 or grade 2 with ≥50% myometrial invasion, or grade 3 with <50% myometrial invasion), negative pelvic peritoneal cytology, and bilateral sentinel lymph nodes negative for malignancy; (iii) recommended adjuvant treatment: vaginal brachytherapy or no adjuvant treatment. PRIMARY ENDPOINT: Incidence of pelvic/non-vaginal recurrence at 36 months. SAMPLE SIZE: 182 patients for study cohort ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS: Accrual will be completed in 2023 with results reported in 2026. TRIAL REGISTRATION: NCT04291612.

• Klíčová slova
• endometrium, sentinel lymph node, surgical procedures, operative,
• MeSH
• adenokarcinom * patologie   MeSH
• biopsie sentinelové lymfatické uzliny * metody   MeSH
• lidé MeSH
• lokální recidiva nádoru diagnóza   MeSH
• lymfatické metastázy patologie   MeSH
• multicentrické studie jako téma MeSH
• nádory endometria * patologie   MeSH
• pozorovací studie jako téma MeSH
• prospektivní studie MeSH
• sentinelová uzlina * patologie   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• protokol klinické studie MeSH
• Research Support, N.I.H., Extramural MeSH