- Email: [email protected]
191 POSTER Ultrastaging of left colon cancer by sentinel lymph node. A prospective control trial. Preliminary results
S56
Poster session: Sentinel node biopsy
POSTER SESSION
Robotic surgery 188
POSTER
The use of a computer assisted navigation device in cranio facial oncologic surgery - preliminary results G. Dolivet 1 , F. Marchal 2 , P. Henrot 3 , J. Stines 3 , H. Mirghani 1 , F. Guillemin 2 , J. Verhaeghe 2 . 1 Centre Alexis Vautrin, Head And Neck Surgery, Vandoeuvre Les Nancy, France; 2 Centre Alexis Vautrin, Oncologic Surgery, Vandoeuvre Les Nancy, France; 3 Centre Alexis Vautrin, Radiology, Vandoeuvre Les Nancy, France Introduction: Cranio facial oncologic surgery have always had to face to the double difficulties of sparing vital structures and evaluating the quality of the resection in bony structures. The computer assisted navigation device could allow to avoid those problems. Goal of our study: the first five cases of our feasability study were use to evaluate the difficulties of instalation, the time increase in the surgical procedure, the real possibility of evaluating surgical virtual margin, the precision of the device in all cases, the detection of vital structures. Material and method: Five patient with tumor closed to the facial bone structure wer treated by surgery. We use a Praxim (Surgetic Station) system with infra red and stereo camera, pre op imaging were CT Scan or CT Scan/MRI fusion. patients had different desease as: 1) lacrymal tumor relapse in irradiated area, 2) SCC of the facial skin invading the infra orbital area, 3) latero fronto-facial SCC invading the pterygo-maxillar fossa, 4) atypical CT scan image in the 2 maxillar sinus with history of oral pharynx SCC and 5) relapse of a rhino pharyngeal indifferentied carcinoma. Result: All procedure were done without difficulty. The average increase of time were 15 minute of the surgical procedure. We were able to define surgical margin in 4 cases, the last were a sinusal exploration. The infra orbital nerve was finded and analysed in the case 2. If soft tissue may have modification and cannot be use as precise landmarks, hard tissue give a precision of 1 to 2 mm. Conclusion: The computer assisted device seems to be very promising in oncological craniofacial surgery and the principle could be extended to other as vertebral, pelvic and probably liver oncologic surgery either for virtual margin detection, vital structure management and minimal invasive surgery. 189
POSTER
Telemedicine in oncology L. Kronberger. Emergency and Out-Patient-Dept., Surgery, Graz, Austria Telemedicine means medicine at a distance and combines the use of telecommunications, computer technologies, and informatics – the applied science of collecting, storing, and retrieving data to support informed decisions making – to improve the effectiveness and efficiency of healthcare. Telemedicine is frequently used to describe care-related applications while Telehealth encompasses other functions such as education and training, health promotion, public health, health services management, technical information retrieval, etc. Cybermedicine refers to the intersection of health and bioengineering, implantable intelligent hardware, automation of processes, robotics, biosensor nanotechnology, etc. Telemedicine in this abstract is used in its broadest possible scope including functions and applications of both Telehealth and Cybermedicine. Telemedicine potentialities are most often misunderstood and confused by focus on implementation issues, regulatory problems, limited applications and utopian expectations. The general perception and most accounts of applications are used in a physician centered context or in a patient-doctor relationship without considering the broader context of providers and the multiplicity of other possible uses. Telemedicine also creates a total new range of possibilities by allowing providers and clients to interact using store and forward techniques, and thus liberating them from the need and constraint of synchronous encounters. The Internet offers the potential to allow convenient access to authoritative information at the point-of-care. However, the majority of the information on the Internet is poorly organized, growing rapidly and of questionable authority. The mission of an Oncology Department is to support, and to promote,
protect and maintain the health of all those entrusted to their care, anytime, anywhere. Telemedicine includes Teleconsultation, Teleradiology, TeleLab, as well as Telesurgery in the Future. The combination of several wireless communication techniques enables a variety of telemedicine applications. There are two possible scenarios described: the first scenario enabling remote examination, advising the patient and controlling the medical equipment the patient or the hospital uses. The second scenario envisioning high quality video communication between doctors at different locations with an high speed data channel for transferring medical data is introduced. In the Future even after continuous access to the Internet would be provided to all Medical Units, there may never be enough bandwidth available to the primary care providers. Their medical information needs are always secondary so bandwidth may be turned off. This simple fact leads to a requirement for continuous refinement and enhancement of the caching strategy under the assumption that patrons can only expected to have intermittent access to the Internet. Nevertheless personal care and communication is important in the future as it was in the past and the present. From “Future - The Aventis magazine” it should be cited In years gone by, I was often asked, “Will the computer replace the doctor?” My rejoinder, still apt today, is that any doctor who can be replaced by a computer deserves to be.
POSTER SESSION
Sentinel node biopsy 190
POSTER
Value of the sentinel lymph node procedure in patients with large size breast cancer G. Houvenaeghel 1 , L. Lelièvre 1 , M. Buttarelli 1 , I. Brenot-Rossi 2 , L. Huiart 3 , A. Tallet 4 , C. Tarpin 3 , J. Jacquemier 5 . 1 Institut Paoli Calmettes, Surgery, Marseille, France; 2 Institut Paoli Calmettes, Nuclear medecine, Marseille, France; 3 Institut Paoli Calmettes, Medical oncology, Marseille, France; 4 Institut Paoli Calmettes, Radiotherapy, Marseille, France; 5 Institut Paoli Calmettes, Pathology, Marseille, France Background: Widely used in routine for small breast cancers, the sentinel lymph node (SN) biopsy is still discussed in tumors ≥ 3 cm. Methods: From 2000 to 2005, 152 patients with invasive breast tumor pT ≥ 3 cm had a SN biopsy systematically followed by complete level I/II axillary dissection. Surgery was always the first stage of the treatment. Detection was done after injection of radioisotope followed by a lymphoscintigraphy and injection of Patent Blue. The SN procedure systematically included palpation of the axilla with removal of any enlarged node even if neither blue nor radioactive. The sentinel lymph node status was compared with the final axillary status. Results: Tumor size ranged from 30 to 200 mm. Lymphoscintigraphy was positive in 98% of the cases. At least one sentinel node was retrieved in 97.4% of the patients. The median number of SN cleared out was 2 (range 1-9). The false negative risk was 4% (4/99). The false negative risk was not related to the tumor size, and not related to the number of SN removed. Conclusions: This study shows that the SN procedure is feasible in patients with breast tumors ≥ 3 cm with an acceptable false negative risk < 5%, similar to false negatives reported for smaller tumors. 191
POSTER
Ultrastaging of left colon cancer by sentinel lymph node. A prospective control trial. Preliminary results R. Hernando Tavira 1 , X. Serra Aracil 1 , J. Bombardo Junca 1 , A. Casalots Casado 2 , J. Martin Miramon 3 , E. Mena Gonzalez 3 , F. Junquera Florez 4 , C. Pericay Pijaume 5 , S. Navarro Soto 1 . 1 Corporació Sanitària Parc Tauli, Cirugia General Y Del Aparato Digestivo, Sabadell, Spain; 2 Corporació Sanitària Parc Tauli., Patologia, Sabadell, Spain; 3 Corporació Sanitària Parc Tauli., Medicina Nuclear, Sabadell, Spain; 4 Corporació Sanitària Parc Tauli., Digestologia, Sabadell, Spain; 5 Corporació Sanitària Parc Tauli., Oncologia, Sabadell, Spain Background: The utility of the sentinel node lymph (SNL) in the colorectal
Poster session: Sentinel node biopsy cancer is a subject about which there has been some controversy. Purpose: To research the occult micrometastases in the SNL in order to improve accuracy of colon cancer staging. Patients and Methods: Prospective control trial of patients with left colon cancer stage II. Methylene Blue® or Nanocoll® has been used to identify the SNL. The standard pathologic examination with hematoxylin and eosin (H&E) has been compared with the study of SNL with H&E and Cytokeratine. Results: A total of 49 consecutive patients with the diagnosis of left colon cancer were studied. Detection of SNL: 100%, 2,73 SNL detected in each patient. Nodal disease (N+) was detected in 18 patients (36,7%), and 31 patients (63,3%) were classified as node-negative (N0). Overall 32,25% patients considered as N0 by conventional histopathology we found occult micrometastases in the SNL study. The false-negative rate was 38,9%(7 patients).Having applied both the SNL study and the standard pathologic examination the number of patients N+ has increased to 57,1% (28 patients), upstaging: 20,4% (p= 0,002). Conclusion: The combined nodal study (H&E + SNL) increased in 20,4% the staging in our group. 192
POSTER
Intraoperative assessment of regional lymph nodes with imprint biopsy of sentinel lymph node in early breast cancer T. Jastrzebski 1 , K. Drucis 1 , J. Jaskiewicz 2 , G. Gulida 3 , A. Kopacz 1 . 1 Medical University od Gdansk, Surgical Oncology, Gdansk, Poland; 2 Medical University od Gdansk, Plastic and Reconstructive Surgery, Gdansk, Poland; 3 Medical University od Gdansk, Pathology, Gdansk, Poland Aim of the study: Evaluation of cytology examination of sentinel node material collected with intraoperative imprint biopsy in patients with breast cancer. Material: The material of the study were 81 patients with breast cancer, without clinical signs of metastases into regional lymph nodes, in whom sentinel nodes were identified and evaluated with intraoperative imprint biopsy in the years 2002-2005. The average number of sentinel nodes identified per patient was 1.23 (ranging from 1 to 3). The average tumour size in clinical examination was 1.8 mm. Methods: Sentinel node was identified with two tracer techniques: dye and radiotracer, with lymphoscintigraphy applied in each case. Patient was qualified for intraoperative sentinel node evaluation only if the node was visualized with lymphoscintigraphy. The removed lymph nodes were bisected along the long axis across the entrance of the lymph vessel into the node. Imprint biopsy was performed by pressing the cut surfaces of each half of the sectioned node to the surface of a glass slide. Two imprints were made from each excised sentinel node. Imprints were fixed in 95% ethanol and stained with hematoxilin and eosin. Then both parts of sentinel node were fixed in 10% buffered formalin and subjected to standard pathologic examination as well as to standard immunohistochemical staining with use of cytokeratin. Results: On the basis of the obtained results sensitivity of imprint biopsy was determined to be 86.7%, and specificity – 100%. PPV index was 100%, NPV index – 97.1%, and accuracy index – 97.5%. Due to the fact that false negative results concerned micrometastases only, sensitivity and specificity were determined separately also for macrometastases, with both these parameters equal to 100%. A statistically significant difference was found (p<0.05, Chi-square test) for histopathological classification of the tumour type. In the subgroup of patients with SN micrometastases the lobular type of breast cancer was present in 3 out of 4 patients (75%), whereas in the subgroup of patients with macrometastases the ductal type prevailed, with lobular breast cancer diagnosed in just 1 patient (9%). Conclusions: Intraoperative evaluation of regional lymph nodes with the method of cytology examination of dye-stained sentinel node material collected with imprint biopsy is reliable, sure and secure for the patient, because of no false positive results observed.
193
S57 POSTER
Technical details of intraoperative lymphatic mapping for sentinel lymph node biopsy for N0 stage lip cancer H. Khalil 1 , A. Elaffandi 1 , Y. Alsayed 2 , H. Zayed 1 , K. Sallam 1 . 1 Cairo University Hospital, General and Plastic& Reconstructive Surgery, Cairo, Egypt; 2 Cairo University Hospital, Nuclear Medicine, Cairo, Egypt Background: One of the difficulties of Sentinel Lymph Node (SLN) biopsy in N0 stage lip cancer patients is the proximity of the primary tumour to the cervical lymphatic basin surveyed for SLN. This may lead to overlapping and scattering of the radioactivity from the injected Tc99m Human Serum Albumin (HSA) at the primary tumour, especially when primary tumour extirpation is done after SLN biopsy. The aim of this prospective study is to increase accuracy of SLN biopsy by increasing its resolution. Methods: Fifteen consecutive patients with N0 stage lip cancer (10 men and 5 women, median age: 57years, range 34-65years) treated between November 2002 and August 2005 were prospectively included. SLN biopsy was performed using the triple diagnostic technique (preoperative lymphoscintigraphy, intra-operative visual localization using patent blue and radio-localisation using T99m HSA). To increase the accuracy of SLN localization, the following measures were routinely performed: During scanning of the neck nodal basin the tip of hand held gamma probe used for intraoperative radiolocalisation was always directed away from the primary lesion. A collimator was used to cover the tip of the hand held gamma probe to increase the resolution of the SLN by avoiding scattering radiation from the nearby primary tumour. On the other hand, the primary lesion was covered with a lead shield to reduce scattering of the radiation thus giving better differentiation between the count coming from SLN and the primary lesion. After SLN biopsy, the neck nodal basin was scanned to confirm excision of the SLN. This was followed by excision of primary lesion. Results: Visual localization was successful in 14/15 while radiolocalization was successful in all patients confirmed by post-SLN biopsy neck scanning. By using the previously mentioned measures we could avoid interference of radioactivity from the primary tumour with radioactivity of the SLN. Micrometastases was detected in only one patient who underwent a second stage therapeutic neck dissection. Conclusion: These measures successfully increased the accuracy of SLN localisation using the triple diagnostic localization technique, which is a technically feasible and accurate approach for detection of CLN micrometastases in early stage lip cancer. 194
POSTER
A study on the influence of multifocality in the sentinel node concept in breast cancer patients J.L. Fougo, T. Dias, C. Araújo, F. Sousa, L. Giesteira, P. Reis, J.P. Silva, P. Antunes, H. Pereira, H. Silva. Portuguese Institute of Oncology-Porto Centre, Surgical Oncology, Porto, Portugal Introduction and aims: Traditionally, multifocality has been considered an exclusion criteria for the application of Sentinel Node (SN) concept to Breast Cancer (BC) patients. The aim of this study is to analyse the influence of multifocality on the SN concept outcomes and to present our experience in this field. Patients and methods: This is a retrospective analysis of a prospectively collected database of 676 consecutive cN0 BC patients. Sentinel node was identified using a combined, triple, technique, with peritumoural radioisotope injection (with lymphoscintigraphy), subareolar blue dye injection and perioperative hand-held gamma probe use. From June 1999 to May 2006 there were operated on 586 patients with unifocal and 90 with multifocal tumours, diagnosed either pre or post operatively. Chi-square, Student’s t and Mann-Whitney tests were done (SPSS 14.0, SPSS Inc.). Results: Median of age was 55 years (range:20-87); there were 5 black women and 2 men. Mean number of SNs identified by lymphoscintigraphy was 1.61 (±1.03) and mean number of removed SN was 1.84 (± 1.0). Global identification rate was 97.8%. There were 7 false-negative cases (among the first 272 patients). Multifocality was associated with more frequent lobular cancer type (p=0.005) and total mastectomy (p<0.001); we didn’t found any significant relationship between multifocality and the number of lymphoscintigraphy hot-spots, the number of removed SN, false-negativity, SN identification rate or pN status.
Poster session: Sentinel node biopsy
POSTER SESSION
Robotic surgery 188
POSTER
The use of a computer assisted navigation device in cranio facial oncologic surgery - preliminary results G. Dolivet 1 , F. Marchal 2 , P. Henrot 3 , J. Stines 3 , H. Mirghani 1 , F. Guillemin 2 , J. Verhaeghe 2 . 1 Centre Alexis Vautrin, Head And Neck Surgery, Vandoeuvre Les Nancy, France; 2 Centre Alexis Vautrin, Oncologic Surgery, Vandoeuvre Les Nancy, France; 3 Centre Alexis Vautrin, Radiology, Vandoeuvre Les Nancy, France Introduction: Cranio facial oncologic surgery have always had to face to the double difficulties of sparing vital structures and evaluating the quality of the resection in bony structures. The computer assisted navigation device could allow to avoid those problems. Goal of our study: the first five cases of our feasability study were use to evaluate the difficulties of instalation, the time increase in the surgical procedure, the real possibility of evaluating surgical virtual margin, the precision of the device in all cases, the detection of vital structures. Material and method: Five patient with tumor closed to the facial bone structure wer treated by surgery. We use a Praxim (Surgetic Station) system with infra red and stereo camera, pre op imaging were CT Scan or CT Scan/MRI fusion. patients had different desease as: 1) lacrymal tumor relapse in irradiated area, 2) SCC of the facial skin invading the infra orbital area, 3) latero fronto-facial SCC invading the pterygo-maxillar fossa, 4) atypical CT scan image in the 2 maxillar sinus with history of oral pharynx SCC and 5) relapse of a rhino pharyngeal indifferentied carcinoma. Result: All procedure were done without difficulty. The average increase of time were 15 minute of the surgical procedure. We were able to define surgical margin in 4 cases, the last were a sinusal exploration. The infra orbital nerve was finded and analysed in the case 2. If soft tissue may have modification and cannot be use as precise landmarks, hard tissue give a precision of 1 to 2 mm. Conclusion: The computer assisted device seems to be very promising in oncological craniofacial surgery and the principle could be extended to other as vertebral, pelvic and probably liver oncologic surgery either for virtual margin detection, vital structure management and minimal invasive surgery. 189
POSTER
Telemedicine in oncology L. Kronberger. Emergency and Out-Patient-Dept., Surgery, Graz, Austria Telemedicine means medicine at a distance and combines the use of telecommunications, computer technologies, and informatics – the applied science of collecting, storing, and retrieving data to support informed decisions making – to improve the effectiveness and efficiency of healthcare. Telemedicine is frequently used to describe care-related applications while Telehealth encompasses other functions such as education and training, health promotion, public health, health services management, technical information retrieval, etc. Cybermedicine refers to the intersection of health and bioengineering, implantable intelligent hardware, automation of processes, robotics, biosensor nanotechnology, etc. Telemedicine in this abstract is used in its broadest possible scope including functions and applications of both Telehealth and Cybermedicine. Telemedicine potentialities are most often misunderstood and confused by focus on implementation issues, regulatory problems, limited applications and utopian expectations. The general perception and most accounts of applications are used in a physician centered context or in a patient-doctor relationship without considering the broader context of providers and the multiplicity of other possible uses. Telemedicine also creates a total new range of possibilities by allowing providers and clients to interact using store and forward techniques, and thus liberating them from the need and constraint of synchronous encounters. The Internet offers the potential to allow convenient access to authoritative information at the point-of-care. However, the majority of the information on the Internet is poorly organized, growing rapidly and of questionable authority. The mission of an Oncology Department is to support, and to promote,
protect and maintain the health of all those entrusted to their care, anytime, anywhere. Telemedicine includes Teleconsultation, Teleradiology, TeleLab, as well as Telesurgery in the Future. The combination of several wireless communication techniques enables a variety of telemedicine applications. There are two possible scenarios described: the first scenario enabling remote examination, advising the patient and controlling the medical equipment the patient or the hospital uses. The second scenario envisioning high quality video communication between doctors at different locations with an high speed data channel for transferring medical data is introduced. In the Future even after continuous access to the Internet would be provided to all Medical Units, there may never be enough bandwidth available to the primary care providers. Their medical information needs are always secondary so bandwidth may be turned off. This simple fact leads to a requirement for continuous refinement and enhancement of the caching strategy under the assumption that patrons can only expected to have intermittent access to the Internet. Nevertheless personal care and communication is important in the future as it was in the past and the present. From “Future - The Aventis magazine” it should be cited In years gone by, I was often asked, “Will the computer replace the doctor?” My rejoinder, still apt today, is that any doctor who can be replaced by a computer deserves to be.
POSTER SESSION
Sentinel node biopsy 190
POSTER
Value of the sentinel lymph node procedure in patients with large size breast cancer G. Houvenaeghel 1 , L. Lelièvre 1 , M. Buttarelli 1 , I. Brenot-Rossi 2 , L. Huiart 3 , A. Tallet 4 , C. Tarpin 3 , J. Jacquemier 5 . 1 Institut Paoli Calmettes, Surgery, Marseille, France; 2 Institut Paoli Calmettes, Nuclear medecine, Marseille, France; 3 Institut Paoli Calmettes, Medical oncology, Marseille, France; 4 Institut Paoli Calmettes, Radiotherapy, Marseille, France; 5 Institut Paoli Calmettes, Pathology, Marseille, France Background: Widely used in routine for small breast cancers, the sentinel lymph node (SN) biopsy is still discussed in tumors ≥ 3 cm. Methods: From 2000 to 2005, 152 patients with invasive breast tumor pT ≥ 3 cm had a SN biopsy systematically followed by complete level I/II axillary dissection. Surgery was always the first stage of the treatment. Detection was done after injection of radioisotope followed by a lymphoscintigraphy and injection of Patent Blue. The SN procedure systematically included palpation of the axilla with removal of any enlarged node even if neither blue nor radioactive. The sentinel lymph node status was compared with the final axillary status. Results: Tumor size ranged from 30 to 200 mm. Lymphoscintigraphy was positive in 98% of the cases. At least one sentinel node was retrieved in 97.4% of the patients. The median number of SN cleared out was 2 (range 1-9). The false negative risk was 4% (4/99). The false negative risk was not related to the tumor size, and not related to the number of SN removed. Conclusions: This study shows that the SN procedure is feasible in patients with breast tumors ≥ 3 cm with an acceptable false negative risk < 5%, similar to false negatives reported for smaller tumors. 191
POSTER
Ultrastaging of left colon cancer by sentinel lymph node. A prospective control trial. Preliminary results R. Hernando Tavira 1 , X. Serra Aracil 1 , J. Bombardo Junca 1 , A. Casalots Casado 2 , J. Martin Miramon 3 , E. Mena Gonzalez 3 , F. Junquera Florez 4 , C. Pericay Pijaume 5 , S. Navarro Soto 1 . 1 Corporació Sanitària Parc Tauli, Cirugia General Y Del Aparato Digestivo, Sabadell, Spain; 2 Corporació Sanitària Parc Tauli., Patologia, Sabadell, Spain; 3 Corporació Sanitària Parc Tauli., Medicina Nuclear, Sabadell, Spain; 4 Corporació Sanitària Parc Tauli., Digestologia, Sabadell, Spain; 5 Corporació Sanitària Parc Tauli., Oncologia, Sabadell, Spain Background: The utility of the sentinel node lymph (SNL) in the colorectal
Poster session: Sentinel node biopsy cancer is a subject about which there has been some controversy. Purpose: To research the occult micrometastases in the SNL in order to improve accuracy of colon cancer staging. Patients and Methods: Prospective control trial of patients with left colon cancer stage II. Methylene Blue® or Nanocoll® has been used to identify the SNL. The standard pathologic examination with hematoxylin and eosin (H&E) has been compared with the study of SNL with H&E and Cytokeratine. Results: A total of 49 consecutive patients with the diagnosis of left colon cancer were studied. Detection of SNL: 100%, 2,73 SNL detected in each patient. Nodal disease (N+) was detected in 18 patients (36,7%), and 31 patients (63,3%) were classified as node-negative (N0). Overall 32,25% patients considered as N0 by conventional histopathology we found occult micrometastases in the SNL study. The false-negative rate was 38,9%(7 patients).Having applied both the SNL study and the standard pathologic examination the number of patients N+ has increased to 57,1% (28 patients), upstaging: 20,4% (p= 0,002). Conclusion: The combined nodal study (H&E + SNL) increased in 20,4% the staging in our group. 192
POSTER
Intraoperative assessment of regional lymph nodes with imprint biopsy of sentinel lymph node in early breast cancer T. Jastrzebski 1 , K. Drucis 1 , J. Jaskiewicz 2 , G. Gulida 3 , A. Kopacz 1 . 1 Medical University od Gdansk, Surgical Oncology, Gdansk, Poland; 2 Medical University od Gdansk, Plastic and Reconstructive Surgery, Gdansk, Poland; 3 Medical University od Gdansk, Pathology, Gdansk, Poland Aim of the study: Evaluation of cytology examination of sentinel node material collected with intraoperative imprint biopsy in patients with breast cancer. Material: The material of the study were 81 patients with breast cancer, without clinical signs of metastases into regional lymph nodes, in whom sentinel nodes were identified and evaluated with intraoperative imprint biopsy in the years 2002-2005. The average number of sentinel nodes identified per patient was 1.23 (ranging from 1 to 3). The average tumour size in clinical examination was 1.8 mm. Methods: Sentinel node was identified with two tracer techniques: dye and radiotracer, with lymphoscintigraphy applied in each case. Patient was qualified for intraoperative sentinel node evaluation only if the node was visualized with lymphoscintigraphy. The removed lymph nodes were bisected along the long axis across the entrance of the lymph vessel into the node. Imprint biopsy was performed by pressing the cut surfaces of each half of the sectioned node to the surface of a glass slide. Two imprints were made from each excised sentinel node. Imprints were fixed in 95% ethanol and stained with hematoxilin and eosin. Then both parts of sentinel node were fixed in 10% buffered formalin and subjected to standard pathologic examination as well as to standard immunohistochemical staining with use of cytokeratin. Results: On the basis of the obtained results sensitivity of imprint biopsy was determined to be 86.7%, and specificity – 100%. PPV index was 100%, NPV index – 97.1%, and accuracy index – 97.5%. Due to the fact that false negative results concerned micrometastases only, sensitivity and specificity were determined separately also for macrometastases, with both these parameters equal to 100%. A statistically significant difference was found (p<0.05, Chi-square test) for histopathological classification of the tumour type. In the subgroup of patients with SN micrometastases the lobular type of breast cancer was present in 3 out of 4 patients (75%), whereas in the subgroup of patients with macrometastases the ductal type prevailed, with lobular breast cancer diagnosed in just 1 patient (9%). Conclusions: Intraoperative evaluation of regional lymph nodes with the method of cytology examination of dye-stained sentinel node material collected with imprint biopsy is reliable, sure and secure for the patient, because of no false positive results observed.
193
S57 POSTER
Technical details of intraoperative lymphatic mapping for sentinel lymph node biopsy for N0 stage lip cancer H. Khalil 1 , A. Elaffandi 1 , Y. Alsayed 2 , H. Zayed 1 , K. Sallam 1 . 1 Cairo University Hospital, General and Plastic& Reconstructive Surgery, Cairo, Egypt; 2 Cairo University Hospital, Nuclear Medicine, Cairo, Egypt Background: One of the difficulties of Sentinel Lymph Node (SLN) biopsy in N0 stage lip cancer patients is the proximity of the primary tumour to the cervical lymphatic basin surveyed for SLN. This may lead to overlapping and scattering of the radioactivity from the injected Tc99m Human Serum Albumin (HSA) at the primary tumour, especially when primary tumour extirpation is done after SLN biopsy. The aim of this prospective study is to increase accuracy of SLN biopsy by increasing its resolution. Methods: Fifteen consecutive patients with N0 stage lip cancer (10 men and 5 women, median age: 57years, range 34-65years) treated between November 2002 and August 2005 were prospectively included. SLN biopsy was performed using the triple diagnostic technique (preoperative lymphoscintigraphy, intra-operative visual localization using patent blue and radio-localisation using T99m HSA). To increase the accuracy of SLN localization, the following measures were routinely performed: During scanning of the neck nodal basin the tip of hand held gamma probe used for intraoperative radiolocalisation was always directed away from the primary lesion. A collimator was used to cover the tip of the hand held gamma probe to increase the resolution of the SLN by avoiding scattering radiation from the nearby primary tumour. On the other hand, the primary lesion was covered with a lead shield to reduce scattering of the radiation thus giving better differentiation between the count coming from SLN and the primary lesion. After SLN biopsy, the neck nodal basin was scanned to confirm excision of the SLN. This was followed by excision of primary lesion. Results: Visual localization was successful in 14/15 while radiolocalization was successful in all patients confirmed by post-SLN biopsy neck scanning. By using the previously mentioned measures we could avoid interference of radioactivity from the primary tumour with radioactivity of the SLN. Micrometastases was detected in only one patient who underwent a second stage therapeutic neck dissection. Conclusion: These measures successfully increased the accuracy of SLN localisation using the triple diagnostic localization technique, which is a technically feasible and accurate approach for detection of CLN micrometastases in early stage lip cancer. 194
POSTER
A study on the influence of multifocality in the sentinel node concept in breast cancer patients J.L. Fougo, T. Dias, C. Araújo, F. Sousa, L. Giesteira, P. Reis, J.P. Silva, P. Antunes, H. Pereira, H. Silva. Portuguese Institute of Oncology-Porto Centre, Surgical Oncology, Porto, Portugal Introduction and aims: Traditionally, multifocality has been considered an exclusion criteria for the application of Sentinel Node (SN) concept to Breast Cancer (BC) patients. The aim of this study is to analyse the influence of multifocality on the SN concept outcomes and to present our experience in this field. Patients and methods: This is a retrospective analysis of a prospectively collected database of 676 consecutive cN0 BC patients. Sentinel node was identified using a combined, triple, technique, with peritumoural radioisotope injection (with lymphoscintigraphy), subareolar blue dye injection and perioperative hand-held gamma probe use. From June 1999 to May 2006 there were operated on 586 patients with unifocal and 90 with multifocal tumours, diagnosed either pre or post operatively. Chi-square, Student’s t and Mann-Whitney tests were done (SPSS 14.0, SPSS Inc.). Results: Median of age was 55 years (range:20-87); there were 5 black women and 2 men. Mean number of SNs identified by lymphoscintigraphy was 1.61 (±1.03) and mean number of removed SN was 1.84 (± 1.0). Global identification rate was 97.8%. There were 7 false-negative cases (among the first 272 patients). Multifocality was associated with more frequent lobular cancer type (p=0.005) and total mastectomy (p<0.001); we didn’t found any significant relationship between multifocality and the number of lymphoscintigraphy hot-spots, the number of removed SN, false-negativity, SN identification rate or pN status.