Sentinel Lymph Node Biopsy And Disseminated Tumor Cells Detection In Bone Marrow Of Breast Cancer

Surgery has witnessed few procedures that have been so rapidly adopted into clinical practice as sentinel lymph node biopsy(SLNB) in patients with breast carcinoma. The following issues were still controversial: which techniques are better, radiation safety, special techniques to detect micrometastasis, et al.30% of breast cancer patients with axillary lymph node negative at primary surgery will relapse within 10 years, which may be caused by disseminated tumor cells derived from the primary tumor. The prognostic significance of isolated tumor cells in bone marrow from patients with breast carcinoma has been established not only in single-center studies, but also in a recent pooled analysis, which included 4199 patients from 8 European centers.In our previous study, SLNB was proved to accurately predict the axillary lymph node status in most of the breast cancer patients. We further pursue this study to address the widely debated issues, and get prepared for the clinical trial of replacing conventional axillary lymph node dissection (ALND) with SLNB. We also reported the phenotypic profiles of disseminated tumour cells and microenviromental characteristics in the bone marrow of breast cancer patients.The application of lymphoscintigraphy in sentinel lymph node biopsy of breastcancer[Abstract] Objective To evaluate the application of lymphoscintigraphy in sentinel lymph node biopsy of breast cancer. Method We performed lymphscitigraphy after peritumoral or subdermal injection of radioactive colloid, and underwent sentinel lymph node (SLN) biopsy with the guild of y detector probe. The factors correlated with identification detection rate were assessed. Result lymphatic drainage was present in preoperative lymphoscitigraphy for eighty-eight out of 95 patients(93%), in whom 39 patients(44.3%) had the lymphatic drainage other than in axillary, and 91 patients(95.8%) were identified for SLN in the intraoperative procedure. The status of lymphoscitigraphy was significantly correlated with identification detection rate in the intraoperative procedure (P=0.025 ). Conclusion we can detect SLN other than in axillary by lymphoscitigraphy. The combination of lymphoscitigraphy and y detector probe for sentinel lymph node biopsy of breast cancer is acceptable and promising.Prediction of non-sentinel lymph node metastases in breast cancer [Abstract] Purpose To identify a subset of breast cancer patients in whom metastatic disease is confined only to the sentinel lymph node(SLN) . Method A total of 95 breast cancer patients were administered with sentinel lymph node biopsy with 99mTc-SC, and non-SLN metastases were assessed in univariate and multivariate analysis .Result We successfully identified ninety-one out of 95 patients for SLN(95.8%). The accuracy of sentinel lymph node biopsy to predict the axillary lymph node status was 93.4%. Clinical tumor size (0.028), tumorgrade(0.040) and the expression of cyclinDl protein (0.017) were significantly correlated with the non-SLN metastases. Clinical tumor size and tumor grade were the independent predictive factors for non-SLN metastases by logistic regression model. Conclusion A subset of the patients who have a low risk of non-SLN metastases may not require axillary lymph node dissection.Detection for disseminated tumor cells in bone marrow and its microenviroment in breast cancer patientsI. Detection of minimal residual disease and immunologic microenviroment in bone marrow of breast cancer patients.[Abstract] Objective This study was designed to detect minimal residual disease and immunologic microenviromental characteristics in bone marrow of breast cancer. Methods We detected disseminated tumor cells with immunocytochemical staining of EMA and CK19 , analyzed the immunological changes through flow cytometry between different groups. Results With the immunocytochemical staining of EMA and CK19, We detected micrometastases in thirty out of 72 (41.67%) breast cancer patients. We found primary tumor size and P53 protein expression were significantly associated with the incidence of micrometastases. We also found the percentage of memory CD4+ T cell and the ratio of the memory helper T cell and memory suppressor T cell were significantly higher in micrometastases positive group than that in micrometastases negative...