• Archives of Plastic Surgery
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• 제32권5호
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• pp.635-640
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• 2005

Sentinel lymphnode biopsy is widely performed in the management of malignant melanoma and breast cancer. The sentinel lymphnode is the prime site of draining from the malignant lesion and of metastasis. The aim of this study was to evaluate a usefulness of lymphoscintigraphy in conjunction with a removal of sentinel lymphnodes of skin and soft tissue malignancy. We studied 11 patients selected between January, 2003 and November, 2004. Clinically sentinel lymphnodes free of metastasis were examined with lymphoscintigraphy, gamma detection probe and vital dye staining, and we reviewed histopathologic findings and inert status of the nodes and the results fo treatment. Nine cases were malignant melanoma, one was squamous cell carcinoma on the left hand and another one leiomyosarcoma. Sentinel lymphnodes were identified in all cases. Three cases of malignant melanoma had positive sentinel lymphnodes on histological examination. All patients with positive sentinel lymphnodes were treated with therapeutic regional lymphadectomy, chemotherapy and adjuvant regimen. Four patients underwent PET scanning and followed sentinel lymphnode biopsy. Two had no metastasis signs on PET scanning. Therapeutic lymphnode dissection was carried out upon the patients whose sentinel lymphnode was positive on PET scanning. We contend that lymphoscintigraphy and sentinel lymphnode biopsy are reliable to confirm regional lymphnode metastasis of the skin and soft tissue malignancy, and blind extensive lymphnode dissection can be spared.

• Radiation Oncology Journal
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• 제32권3호
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• pp.132-137
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• 2014

Purpose: To evaluate non-sentinel lymph node (LN) status after sentinel lymph node biopsy (SNB) in patients with breast cancer and to identify the predictive factors for disease failure. Materials and Methods: From January 2006 to December 2007, axillary lymph node (ALN) dissection after SNB was performed for patients with primary invasive breast cancer who had no clinical evidence of LN metastasis. A total of 320 patients were treated with breast-conserving surgery and radiotherapy. Results: The median age of patients was 48 years, and the median follow-up time was 72.8 months. Close resection margin (RM) was observed in 13 patients. The median number of dissected SNB was two, and that of total retrieved ALNs was 11. Sentinel node accuracy was 94.7%, and the overall false negative rate (FNR) was 5.3%. Eleven patients experienced treatment failure. Local recurrence, regional LN recurrence, and distant metastasis were identified in 0.9%, 1.9%, and 2.8% of these patients, respectively. Sentinel LN status were not associated with locoregional recurrence (p > 0.05). Close RM was the only significant factor for disease-free survival (DFS) in univariate and multivariate analysis. The 5-year overall survival, DFS, and locoregional DFS were 100%, 96.8%, and 98.1%, respectively. Conclusion: In this study, SNB was performed with high accuracy and low FNR and high locoregional control was achieved.

• Asian Pacific Journal of Cancer Prevention
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• 제15권17호
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• pp.7049-7054
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• 2014

Background: Almost half of the breast cancer patients with positive sentinel lymph nodes have no additional disease in the remaining axillary lymph nodes. This group of patients do not benefit from complete axillary lymph node dissection. This study was designed to assess the clinicopathologic factors that predict non-sentinel lymph node metastasis in Iranian breast cancer patients with positive sentinel lymph nodes. Materials and Methods: The records of patients who underwent sentinel lymph node biopsy, between 2003 and 2012, were reviewed. Patients with at least one positive sentinel lymph node who underwent completion axillary lymph node dissection were enrolled in the present study. Demographic and clinicopathologic characteristics including age, primary tumor size, histological and nuclear grade, lymphovascular invasion, perineural invasion, extracapsular invasion, and number of harvested lymph nodes, were evaluated. Results: The data of 167 patients were analyzed. A total of 92 (55.1%) had non-sentinel lymph node metastasis. Univariate analysis of data revealed that age, primary tumor size, histological grade, lymphovascular invasion, perineural invasion, extracapsular invasion, and the number of positive sentinel lymph nodes to the total number of harvested sentinel lymph nodes ratio, were associated with non-sentinel lymph node metastasis. After logistic regression analysis, age (OR=0.13; 95% CI, 0.02-0.8), primary tumor size (OR=7.7; 95% CI, 1.4-42.2), lymphovascular invasion (OR=19.4; 95% CI, 1.4-268.6), extracapsular invasion (OR=13.3; 95% CI, 2.3-76), and the number of positive sentinel lymph nodes to the total number of harvested sentinel lymph nodes ratio (OR=20.2; 95% CI, 3.4-121.9), were significantly associated with non-sentinel lymph node metastasis. Conclusions: According to this study, age, primary tumor size, lymphovascular invasion, extracapsular invasion, and the ratio of positive sentinel lymph nodes to the total number of harvested sentinel lymph nodes, were found to be independent predictors of non-sentinel lymph node metastasis.

• 대한의용생체공학회:의공학회지
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• 제31권2호
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• pp.114-122
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• 2010

This paper presents a method that registers a lymphoscintigraphy to the real image captured by a CMOS camera, which helps surgeons to easily and precisely detect sentinel lymph nodes for sentinel lymph node biopsy in breast cancer patients. The proposed method consists of two steps: pre-matching and image registration. In the first step, we localize fiducial markers in a lymphoscintigraphy and a real image of a four quadrant bar phantom by using image processing techniques, and then determines perspective transformation parameters by matching with the corresponding marker points. In the second step, we register a lymphoscintigraphy to a real images of patients by using the perspective transformation of pre-matching. To examine the accuracy of the proposed method, we conducted an experiment with a chest mock-up with radioactive markers. As a result, the euclidean distance between corresponding markers was less than 3mm. In conclusion, the present method can be used to accurately align lymphoscintigraphy and real images of patients without attached markers to patients, and then provide useful anatomical information on sentinel lymph node biopsy.

• 대한의사협회지
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• 제61권11호
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• pp.662-669
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• 2018

The cutaneous melanoma has been regarded as rare disease entity in Korea for long time but it shows a silent growth recently. Furthermore the management of cutaneous melanoma including staging system, surgical principle, sentinel lymph node biopsy and subsequent complete node dissection and, most importantly, immunotherapy and target therapy against cutaneous melanoma recently. The incidence of cutaneous melanoma is steadily increasing in Korea but its increase is rapid recent 2 decades to 4.3 times and should be greater soon according to the steeper increase of life expectancy. New staging system proposed by American Joint Committee on Cancer (2017) includes changes in individual TNM category and stage groups, particularly from a prognostic viewpoint. Dermoscopy has been successfully introduced in the differential diagnosis of pigmented skin lesion focusing on cutaneous melanoma by non-invasive simple diagnostic tool. Sentinel lymph node biopsy was a issue of long debate whether survival benefit is real or not. Temporary conclusion about this question is reached after two large scale studies and immediate complete node dissection should be performed in a certain situations. Most important change is drug therapy focusing on immunotherapy and target therapy. Braf- and MEK-inhibitor, immune checkpoint inhibitor and PD-1 blocker has been proved to be effective as a sole or combination regimen against advanced and/or high-risk adjuvant setting of cutaneous melanoma. In conclusion, these remarkable changes will be reviewed shortly here.

• Archives of Plastic Surgery
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• 제35권3호
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• pp.312-315
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• 2008

Purpose: Amelanotic melanoma represents a melanoma with an absence or a small number of melanin pigments and comprises 2% of all melanomas. These melanomas are frequently misdiagnosed, probably because of its nonspecific clinical features and difficulty in diagnosis, resulting in delayed diagnosis and treatment. We report a patient with amelanotic melanoma, who underwent surgical treatment with sentinel lymph node biopsy using gamma probe. Methods: A 32-year-old female was presented with a slowly growing ill-defined, hypopigmented nonerythematous lesion with nail defect on right index finger tip. Preoperative punch biopsy was performed, showing an amelanotic melanoma. Sentinel lymph node biopsy was done using gamma probe(Crystal probe system, CRYSTAL PHOTONICS GmbH, Germany) and confirmed no evidence of regional lymph node metastases. The patient underwent amputation at the proximal interphalangeal joint. Results: Histopathologic findings showed superficial spreading melanoma. There were no melanin pigments in Hematoxylin & Eosin stain but positive immunohistochemical stainings for S-100 protein and Hmb45, which were consistent with amelanotic melanoma. Patient's postoperative course was uneventful without any complication and had no evidence of recurrence of tumor in 6 months follow-up period. Conclusion: Amelanotic melanoma is extremely rare subtype of malignant melanoma with histopathologic findings of atypical melanocytes without melanin pigments. Early detection is crucial since survival is strongly related to tumor thickness and tissue invasion at the time of diagnosis. Wide excision is the treatment of choice and other conjunctive therapy has not been successful.

• 대한핵의학회지
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• 제34권6호
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• pp.478-486
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• 2000

목적: 조직 검사에서 유방암으로 확진된 환자 15명 (평균 연령 50.4세)을 대상으로 수술 전에 시행한 유방림프신티그라피(lymphoscintigraphy)와 수술 중 감마프로우브를 이용하여, 림프관 유입형태 및 전초림프절(sentinel lymph node)을 찾아, 전초 및 액와림프절을 각각 절제, 생검하여, 전초 림프절의 림프신티그라피 발현율, 전초림프절 전이와 액와림프절 전이의 상관 관계 등을 보고자 하였다. 대상 및 방법: 환자의 임상병기는 병기 I-II 이었고, 4례에서 액와림프절이 촉지되었다. 침습성 관암 13명, 수질암 및 포도당 풍부암이 각각 1명씩이었다. 유방림프신티그라피는 다음과 같이 시행하였다. 방사성의약품 Tc-99m antimony sulfide colloid $30{\sim}37MBq$을 총 0.4 ml 용량으로 만들어, 원발 종괴에서 $2{\sim}3mm$ 떨어진 위치의 12, 3, 6, 9시 방향에 각각 0.1 ml를 피내 주사하고 약 2분 동안 마사지하였다. 저에너지, 고해상도 평행 조준기를 이용하여 초기 동적 영상(10 sec/frame)을 10분간 시행하였으며, 이어서 5분 간격으로 $30{\sim}60$분에 걸쳐 초기 정적영상을 얻었고, 주사 후 2시간에 지연영상을 획득하였으며, 각각의 영상을 비교하여 전초림프절과 유입 림프관을 확인하였다. 유방림프신티그라피검사가 끝나면 즉시 수술실로 옮겨 전초림프절이라고 판독된 부위를 감마프로우브로 찾아 림프절의 계수와 배후 방사능을 측정하였고, 이 부위를 절개하여 조직을 떼어내 표지하고 생검하였으며, 그 외에 배후 방사능보다 높은 계수를 보인 부위가 있으면 따로 표지하여 조직 검사를 하였다. 모든 환자에서 원발 종양의 절제술과 액와림프절 절제술을 시행하였다. 결과: 전체 환자 15명 가운데 14명에서 유방림프신티그라피 및 수술 중 감마 프로우브로 전초림프절이 발견되었다(전초 림프절 검출율: 93.3%). 유방림프신티그라피로 발견된 평균 전초림프절수는 $2.47{\pm}2.00$개였으며, 감마프로우브를 이용하여 수술로 절제된 평균 전초림프절 수는 $2.36{\pm}1.96$개였다. 초기 동적 유방림프신티그라피에서 전초림프절로 유입되는 림프관이 총 15명 중 3명에서 관찰 할 수 있었으며(20%), 3명에서는 전초림프절이 2시간 지연 영상에서만 발견되었다(20%). 유방림프신티그라피에서 전초림프절이 나타난 시간은 평균 $33.4{\pm}48.4$분이었다. 전초림프절의 조직 생검 결과 14명 가운데 7명의 전초림프절에서 전이 소견이 관찰되었고(50%), 이 중 5명 환자의 액외림프절에서 전이가 보였다(예민도: 71.2%). 그러나 전초림프절에 전이가 있었던 7명 가운데 2명은 액와림프절에서 전이 소견은 관찰되지 않았다. 전초림프절에 전이가 없었던 7명 환자에서는 모두 액와림프절에서도 전이 소견을 관찰 할 수 없었다(특이도: 100%). 유방림프신티그라피 및 수술 중 감마프로우브로 전초림프절을 발견 할 수 없었던 1명에서 액와절제술 후 액와림프절 조직에서 림프절에 전이가 관찰되었다. 결론: 따라서 유방암 환자에서 유방림프신티그라피와 수술 중 감마프로우브를 이용한 전초림프절 생검은 액와림프절 전이 평가에 있어 높은 예민도와 특이도를 나타내므로 불필요한 액와림프절 절제술을 줄이는데 도움이 될 것이다.

• Journal of Breast Cancer
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• 제21권4호
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• pp.442-446
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• 2018

Purpose: The definition of nodal pathologic complete response (pCR) after a neoadjuvant chemotherapy (NAC) just included the evaluation of axillary lymph node (ALN) without internal mammary lymph node. This study aimed to evaluate the feasibility of internal mammary-sentinel lymph node biopsy (IM-SLNB) in patients with breast cancer who underwent NAC. Methods: From November 2011 to 2017, 179 patients with primary breast cancer who underwent operation after NAC were included in this study. All patients received radiotracer injection with modified injection technology. IM-SLNB would be performed on patients with internal mammary sentinel lymph node (IMSLN) visualization. Results: Among the 158 patients with cN+ disease, the rate of nodal pCR was 36.1% (57/158). Among the 179 patients, the visualization rate of IMSLN was 31.8% (57/179) and was 12.3% (7/57) and 87.7% (50/57) among those with $cN_0$ and cN+ disease, respectively. Furthermore, the detection rate of IMSLN was 31.3% (56/179). The success rate of IM-SLNB was 98.2% (56/57). The IMSLN metastasis rate was 7.1% (4/56), and all of them were accompanied by ALN metastasis. The number of positive ALNs in patients with IMSLN metastasis was 3, 6, 8, and 9. The pathology nodal stage had been changed from $pN_1/pN_2$ to $pN_{3b}$. The pathology stage had been changed from IIA/IIIA to IIIC. Conclusion: Patients with visualization of IMSLN should perform IM-SLNB after NAC, especially for patients with cN+ disease, in order to complete lymph nodal staging. IM-SLNB could further improve the definition of nodal pCR and guide the internal mammary node irradiation.

• 대한위암학회:학술대회논문집
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• 대한위암학회 2004년도 제17회 춘계학술대회
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• pp.14-17
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• 2004

• 대한위암학회:학술대회논문집
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• 대한위암학회 2004년도 제17회 춘계학술대회
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• pp.18-22
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• 2004