• 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.

• 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.

• Archives of Plastic Surgery
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• 제36권4호
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• pp.485-488
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• 2009

Purpose: Malignant melanoma of the lower extremity is well known to metastasize to the lymph nodes of the groin. However, in rare cases, the initial site of the nodal disease can be the popliteal fossa. As of yet, there has not been any report on cases with popliteal lymph node metastasis in Koreans. In the following report, authors would like to present two cases of popliteal node metastasis. Methods: A 60 - year - old male patient presented with nodular mass at his left sole. He had popliteal node metastasis detected on preoperative positron emission tomography(PET). Another 67 - year - old man presented with pigmented lesion at his right heel. He also had popliteal node metastasis detected on the MRI. They underwent wide excision of the primary lesion with popliteal node dissection. Results: In the first case, $2.5{\times}2.5cm$ sized metastatic melanoma in popliteal node was pathologically confirmed. There were no postoperative complications, and to date(18 months after the surgery), the patient is alive with no evidence of disease. In the second case, multiple(4) metastatic melanoma in popliteal nodes was confirmed. The patient is alive, but has had interferon therapy for liver metastasis. Conclusion: By increasing the use of lymphoscintigraphy or PET as a preoperative diagnostic work - up for metastasis, even popliteal node metastasis undetectable in a physical exam becomes detectable. When metastatic lymph node is found, node dissection is the standard of care. Therefore, it is essential that we know the anatomy and surgical technique for popliteal lymph node dissection.

• Journal of Chest Surgery
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• 제46권4호
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• pp.241-248
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• 2013

Esophageal cancer has one of the highest malignant potentials of any type of tumor. The 3-field lymph node dissection is the standard procedure in Japan for surgically curable esophageal cancer in the middle or upper thoracic esophagus. Minimally invasive esophagectomy is being increasingly performed in many countries, and several studies report its feasibility and curability; further, the magnifying effect of the thoracoscope is another distinct advantage. However, few studies have reported that minimally invasive esophagectomy is more beneficial than open esophagectomy. A recent meta-analysis revealed that minimally invasive esophagectomy reduces blood loss, respiratory complications, the total morbidity rate, and hospitalization duration. A randomized study reported that the pulmonary infection rate, pain score, intraoperative blood loss, hospitalization duration, and postoperative 6-week quality of life were significantly better with the minimally invasive procedure than with other procedures. In the future, sentinel lymph node mapping might play a significant role by obtaining individualized information to customize the surgical procedure for individual patients' specific needs.

• Journal of Breast Cancer
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• 제21권4호
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• pp.433-4341
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• 2018

Purpose: This study aimed to evaluate the effects of sentinel lymph node biopsy (SLNB) on recurrence and survival after neoadjuvant chemotherapy (NAC) in breast cancer patients with cytology-proven axillary node metastasis. Methods: We selected patients who were diagnosed with invasive breast cancer and axillary lymph node metastasis and were treated with NAC followed by curative surgery between January 2007 and December 2014. We classified patients into three groups: group A, negative sentinel lymph node (SLN) status and no further dissection; group B, negative SLN status with backup axillary lymph node dissection (ALND); and group C, no residual axillary metastasis on pathology with standard ALND. Results: The median follow-up time was 51 months (range, 3-122 months) and the median number of retrieved SLNs was 5 (range, 2-9). The SLN identification rate was 98.3% (234/238 patients), and the false negative rate of SLNB after NAC was 7.5%. There was no significant difference in axillary recurrence-free survival (p=0.118), disease-free survival (DFS; p=0.578) or overall survival (OS; p=0.149) among groups A, B, and C. In the subgroup analysis of breast pathologic complete response (pCR) status, there was no significant difference in DFS (p=0.271, p=0.892) or OS (p=0.207, p=0.300) in the breast pCR and non-pCR patients. Conclusion: These results suggest that SLNB can be feasible and oncologically safe after NAC for cytology-determined axillary node metastasis patients and could help reduce arm morbidity and lymphedema by avoiding ALND in SLN-negative patients.

• Nuclear Medicine and Molecular Imaging
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• 제41권6호
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• pp.546-552
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• 2007

목적: 유방암 환자에게 불필요한 액와림프절 전절제술을 예방하기 위해서는 감시림프절을 절제하여 전이 여부를 평가하는 것이 중요하다. 감시림프절 매핑을 위한 방사성교질중 antimony trisulfide colloid (ASC), tin colloid (TC), human serum albumin (HSA) 이상의 3가지 교질에 $^{99m}Tc$을 표지하여 각각에서 림포신티그라피, 감시림프절 매핑의 성적을 비교하였다. 대상 및 방법: 2001년 10월부터 2006년 12월까지 임상적으로 액와림프절 전이가 없는 조기 유방암 환자 총 397명에게 시행한 림포신티그라피와 수술 중 감시림프절 절제 동결절편 검사, 및 수술 후 병리 소견을 후향적으로 평가하였다. 림포신티그라피 영상 소견을 분석하고, 감시림프절의 발견율(identification rate)과 위음성율(false negative rate), 그리고 음성예측도(negative predictive value)를 구하여 각 군의 자료에 대해 Fisher 직접확률법으로 비교하였다. 결과: 202명에게는 $^{99m}Tc$ ASC를, 120명에게는 $^{99m}Tc$-TC를, 75명에게는 $^{99m}Tc$-HSA를 사용하였으며 평균 연령, 병기, 원발 종양의 크기 등에서는 각 군별 환자들 사이에 유의한 차이가 없었다. ASE는 59명에게는 유륜부 피내 혹은 피하주사법을 사용했으며 136명에게는 종양주위 주사를, 그리고 7명의 환자에게는 두 가지를 병용하였다. TC와 HSA를 사용한 환자들에게는 모두 피내 혹은 피하주사하였다. 액와림프절 전이는 ASE사용 군에서 33.2%, TC 사용군에서 31.7%, HSA 사용 군에서 22.7%였으며 통계적으로 유의한 차이는 없었다. 감시 림프절 발견율(IR) 과 위음성율(FNR) 그리고 음성예측도(NPV) 는 사용한 교질 ASC/TC/HSA 각각에 대해 99.0%, 21.5%, 90.5% / 96.7%, 20.5%, 90.7% / 94.7%, 17.7%, 94.7%로 사용한 교질의 종류에 따라 통계적으로 유의한 차이가 없었다. 감시림프절 매핑 성적은 방사성교질의 주사방법에 따라서 유의한 차이를 보이지 않았다. 림포신티그라피의 영상에서 감시림프절이 명확히 구분된 경우는 ASC에서 79.6%, TC 에서 92.5%, HSA에서 88.6%였다. 림프관이 관찰된 비율은 ASC에서 43.6%, TC에서 0.8%, HSA 에서 96.8%이었다. 림포신티그라피에서 관찰된 감시림프절의 개수는 HSA가 가장 많았지만 통계적으로 유의한 차이는 없었다. 결론: ASC, TC 및 HSA등의 방사성교질을 이용한 감시림프절 매핑 성적은 서로 유의한 차이를 보이지 않았다.

• Asian Pacific Journal of Cancer Prevention
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• 제14권10호
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• pp.5731-5734
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• 2013

Background: The object of this study was to examine whether a new protocol including step-sectioning and immunohistochemistry (IHC) staining of axillary sentinel nodes (SN) would lead to detection of more metastases in patients with breast cancer. Materials and Methods: Sixty-nine tumor free sentinel lymph nodes were examined. Step frozen sectioning was performed on formalin fixed SN and stained both by hematoxylin and eosin (H and E) and cytokeratin markers using IHC. Any tumoral cell in IHC stained slides were considered as a positive result. Metastases up to 0.2 mm were considered as isolated tumor cells and 0.2 up to 2 mm as micrometastasis. Results: Mean age of the patients was $48.7{\pm}12.2$ years. Step sectioning of the SN revealed 11 involved by metastasis which was statistically significant (p<0.001). Furthermore, 15 (21.7%) of the patients revealed positive results in IHC staining for pan-CK marker and this was also statistically significant (p=0.001). Ten patients had tumoral involvement in lymph nodes harvested from axillary dissection and 4 out of 15 lymph nodes with positive result for CK marker were isolated tumor cells. However, 4 of 10 patients with tumor positive lymph nodes in axillary dissection were negative for CK marker and in contrast 6 of the pan-CK positive SN were in patients with tumor-free axillary lymph nodes. Conclusions: Both IHC and step sectioning improve the detection rate of metastases. Considering the similar power of these two methods, we recommend using either IHC staining or step sectioning for better evaluation of harvested SNs.

• Asian Pacific Journal of Cancer Prevention
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• 제13권11호
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• pp.5385-5389
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• 2012

Introduction: Sentinel lymph node biopsy (SLNB) is a precise procedure for lymphatic staging in early breast cancer. In a valid SLNB procedure, axillary lymph node dissection (ALND) can be omitted in nodenegative cases without compromising patient safety. In this study, detection rate, accuracy and false negative rate of SLNB for breast cancer was evaluated in a setting with simple modified conventional pathology facilities without any serial sectioning or immunohistochemistry. Material and Medthod: Patients with confirmed breast cancer were enrolled in the study. SLNB and ALND were performed in all cases. Lymph node metastasis was evaluated in SLN and in nodes removed by ALND to determine the false negative rate. Pathologic assessment was carried out only by modified conventional technique with only 3 sections. Detection rate was determined either by lymphoscintigraphy or during surgery. Results: 78 patients with 79 breast units were evaluated. SLN was detected in 75 of 79 cases (95%) in lymphoscintigraphy and 76 of 79 cases (96%) during surgery. SLN metastases was detected in 30 of 75 (40%) cases either in SLNB and ALND groups. Accuracy of SLNB method for detecting LN metastases was 92%. False negative rate was 3 of 30 of positive cases: 10%. In 7 of 10 cases with axillary lymphadenopathy, LN metastastates was detected. Conclusion: SLNB is recommended for patients with various tumor sizes without palpable lymph nodes. In modified conventional pathologic examination of SLNs, at least macrometastases and some micrometastases could be detected similar to ALND. Consequently, ALND could be omitted in node-negative cases with removal of all palpable LNs. We conclude that SLNB, as one of the most important developments in breast cancer surgery, could be expanded even in areas without sophisticated pathology facilities.

• Archives of Plastic Surgery
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• 제47권1호
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• pp.42-48
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• 2020

Background Methods for identifying local lymph node metastasis in malignant melanoma include sentinel lymph node biopsy (SLNB) and lymph node dissection (LND). In particular, SLNB has been widely used in recent years. This study aimed to retrospectively confirm the adequacy of the current indication criteria for SLNB by applying those criteria to a mixed group of patients who previously received SLNB and LND. Methods This study included 77 patients with malignant melanoma of the extremities and trunk who were monitored for >24 months. The patients were classified according to whether the current indication criteria for SLNB were applicable. The sentinel lymph nodes were evaluated for each group. Patients for whom the indication criteria for SLNB and LND were applicable were analyzed according to whether SLNB or LND was performed. Finally, the outpatient records of these patients were reviewed to evaluate recurrence, metastasis, and prognosis. Results Of the 77 patients, SLNB was indicated according to the current criteria in 60 cases. Among the 60 patients for whom SLNB was indicated, 35 survived the follow-up period disease-free, 21 died during the follow-up period, and four experienced metastasis. The 17 patients for whom SLNB was not indicated had no recurrence or metastasis. Conclusions Patients for whom SLNB was not indicated had no recurrence or metastasis. In cases where SLNB is indicated, the possibility of metastasis and recurrence may be high even if SLNB is negative or LND is performed, so more aggressive treatment and careful follow-up are crucial.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제45권5호
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• pp.267-275
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• 2019

Objectives: Metastasis in oral squamous cell carcinoma (OSCC) can occur in a variety of ways, and draining lymphatics and lymph nodes serve as a common route. Prior to metastasis, lymph nodes elicit an immune response to either wall off or create a favorable environment for homing of tumor cells. This immune response to tumor stimuli is visualized by recognizing various immunoreactive patterns exhibited by the lymph node. The present study aims to evaluate the role of immuno-morphologic patterns of the lymph node in neck dissection for cases of OSCC. Materials and Methods: Our retrospective study included 50 neck dissection cases of OSCC and a total of 1,078 lymph nodes. The grades of primary tumors with eight different immunoreactive patterns were compared. Vascularity and metastasis in lymph nodes were also evaluated. Results: The lymphocyte predominant pattern was the most common immunoreactive pattern found in 396 of 1,078 lymph nodes. Patterns of lymphocyte predominant (P=0.0005), sinus histiocytosis (P=0.0500), paracortical hyperplasia (P=0.0001), cortical hyperplasia (P=0.0001), and increased vascularity (P=0.0190) were significantly associated with tumor grade. Conclusion: The present study adds to the understanding of lymph node immunoreactivity patterns and their correlation with tumor grade. We recommend further study of lymph node patterns for all sentinel lymph node biopsies and routine neck dissections for OSCCs.