Background
In this review, the position of behavioural ecotoxicology within the available means to assess the status of marine environments is described as filling the gap for the needed “early warning” signals. A few examples of studies performed since the 1960s are discussed to highlight the sensitivity of these approaches in investigating the effects of chemicals, including priority pollutants and emerging contaminants, relative to conventional toxicity tests measuring survival.

/pdf/behavioural-ecotoxicology-an-early-warning-signal-to-assess-4yp1e2nwem.pdf

Behavioural ecotoxicology, an “early warning” signal to assess environmental quality

The concept of radioguided surgery, which was first developed some 60 years ago, involves the use of a radiation detection probe system for the intraoperative detection of radionuclides. The use of gamma detection probe technology in radioguided surgery has tremendously expanded and has evolved into what is now considered an established discipline within the practice of surgery, revolutionizing the surgical management of many malignancies, including breast cancer, melanoma, and colorectal cancer, as well as the surgical management of parathyroid disease. The impact of radioguided surgery on the surgical management of cancer patients includes providing vital and real-time information to the surgeon regarding the location and extent of disease, as well as regarding the assessment of surgical resection margins. Additionally, it has allowed the surgeon to minimize the surgical invasiveness of many diagnostic and therapeutic procedures, while still maintaining maximum benefit to the cancer patient. In the current review, we have attempted to comprehensively evaluate the history, technical aspects, and clinical applications of radioguided surgery using gamma detection probe technology.

/pdf/a-comprehensive-overview-of-radioguided-surgery-using-gamma-46u7urctug.pdf

A comprehensive overview of radioguided surgery using gamma detection probe technology

The accurate diagnosis of a sentinel node in melanoma includes a sequence of procedures from different medical specialities (nuclear medicine, surgery, oncology, and pathology). The items covered are presented in 11 sections and a reference list: (1) definition of a sentinel node, (2) clinical indications, (3) radiopharmaceuticals and activity injected, (4) dosimetry, (5) injection technique, (6) image acquisition and interpretation, (7) report and display, (8) use of dye, (9) gamma probe detection, (10) surgical techniques in sentinel node biopsy, and (11) pathological evaluation of melanoma-draining sentinel lymph nodes. If specific recommendations given cannot be based on evidence from original, scientific studies, referral is given to "general consensus" and similar expressions. The recommendations are designed to assist in the practice of referral to, performance, interpretation and reporting of all steps of the sentinel node procedure in the hope of setting state-of-the-art standards for good-quality evaluation of possible spread to the lymphatic system in intermediate-to-high risk melanoma without clinical signs of dissemination.

EANM-EORTC general recommendations for sentinel node diagnostics in melanoma.

BACKGROUND: Atypical Spitz tumors (AST) are rare spitzoid melanocytic proliferations with an uncertain malignant potential. ASTs have overlapping features of both Spitz nevi and spitzoid melanoma, and consequently generate controversy with diagnosis and management. Sentinel lymph node biopsy (SLNB) has been proposed as a possible means to gain additional insight into the true biologic potential of these tumors; however, previous reports on the use of SLNB in ASTs have been limited by small numbers of patients and short durations of follow-up. METHODS: The authors extracted data from their institution’s prospective melanoma database, collected between 1994 and 2007, for all patients with ASTs of uncertain biologic potential. They reviewed the clinical features of these patients, including the sentinel lymph node status, and the histological features of the tumors. RESULTS: A total of 67 patients with ASTs were identified, with a median age of 23.7 years. The mean depth was 2.4 mm. Of these, 57 had a SLNB performed, with 27 (47%) having a positive sentinel lymph node. SLNB-positive cases had a significantly lower mean age than SLNB-negative cases (17.9 vs 28.7 years; P ¼ .013); however, no other significant differences were observed. All 27 patients with a positive SLNB were alive and disease free with median follow-up of 43.8 months. One patient who did not receive a SLNB developed recurrent disease with regional and distant metastases. CONCLUSIONS: ASTs do not appear to behave like conventional melanoma. There is a high incidence of microscopic lymph node deposits in SLNBs, but despite this finding, patients have a favorable prognosis. Our findings raise several questions regarding the malignant potential of ASTs, and the role of SLNB in their management. Cancer 2009;115:631–41. V C 2009 American Cancer Society.

/pdf/the-atypical-spitz-tumor-of-uncertain-biologic-potential-a-2jwf8jogu3.pdf

The atypical Spitz tumor of uncertain biologic potential: a series of 67 patients from a single institution.

Sentinel lymph node biopsy has been proposed as a diagnostic method for estimation of the malignant potential of atypical Spitz tumours. However, although cell deposits are commonly detected in the sentinel lymph nodes of patients with atypical Spitz tumours, their prognosis is substantially better than that of patients with melanoma and positive sentinel lymph node biopsies. We did a systematic review of published reports to assess the role of sentinel lymph node biopsy as a prognostic method in the management of atypical Spitz tumours. The results of our analysis did not show any prognostic benefit of sentinel lymph node biopsy; having a positive sentinel lymph node does not seem to predict a poorer outcome for patients with atypical Spitz tumours. These findings indicate that, especially in the paediatric population, it might be prudent initially to use complete excision with clear margins and careful clinical follow-up in patients with atypical Spitz tumours.

https://www.thelancet.com/pdfs/journals/lanonc/PIIS1470-2045(13)70608-9.pdf

Atypical Spitz tumours and sentinel lymph node biopsy: a systematic review

BACKGROUND

Desmoplastic and neurotropic melanoma (DNMM) occasionally metastasizes to regional lymph nodes and extranodal sites. The value of sentinel lymph node biopsy (SLNB) has not been demonstrated clearly for patients with DNMM. The authors report on the utility of SLNB in the management of patients with DNMM.



METHODS

The authors identified 33 patients with DNMM who were seen during a 5-year period in their institution who underwent lymphatic mapping and SLNB. Clinical and histopathologic data were reviewed.



RESULTS

Thirty-three patients with DNMM underwent SLNB (mean Breslow depth, 4.0 mm; median, 2.8 mm). There were 25 male patients and 8 female patients with a median age of 61 years (range, 31–86 years). Fifty-two percent of tumors presented in the head and neck region, and 24% were associated with lentigo maligna. Four of 33 patients (12%) without clinical evidence of metastatic disease who underwent SLNB had at least 1 positive sentinel lymph node. No additional positive lymph nodes were found in subsequent therapeutic regional lymphadenectomy in any of these four patients.



CONCLUSIONS

SLNB detected subclinical metastases of DNMM to regional lymph nodes. SLNB at the time of resection can provide useful information to guide early treatment and, coupled with lymphadenectomy in positive patients, may limit tumor spread and prevent recurrence at the draining lymph node basin. Cancer 2004. © 2003 American Cancer Society.

/pdf/desmoplastic-and-neurotropic-melanoma-4adeg7tzd9.pdf

Desmoplastic and neurotropic melanoma

BACKGROUND

Spindle and/or epithelioid melanocytic proliferations that display overlapping histopathologic features of Spitz nevus and Spitz-like melanoma are diagnostically difficult and controversial melanocytic tumors. There are reports of such lesions metastasizing to regional lymph nodes, with a few widely disseminating, resulting in death.



METHODS

The authors reviewed clinical and histopathologic data on all patients with atypical or borderline spitzoid melanocytic proliferations who underwent sentinel lymph node biopsy (SLNB). They examined how frequently histologically problematic or borderline spitzoid melanocytic lesions metastasized to sentinel lymph nodes (SLNs) and which clinical or histologic features, if any, predisposed patients to a higher risk lesion.



RESULTS

Six male patients and 12 female patients, ages 5–32 years (mean, 16 years), had tumors ranging in size from 1.2 mm to 7.9 mm (mean, 3.5 mm) in thickness. Atypical histologic features that were present most frequently included incomplete maturation (18 of 18 patients), deep dermal mitoses (16 of 18 patients), nuclear pleomorphism (10 of 18 patients), and focal sheet-like growth (10 of 18 patients). Eight of 18 patients (44%) had SLN metastasis and were offered adjuvant treatment. One of eight patients with SLN positive results who underwent regional lymphadenectomy had one additional involved lymph node. All 18 patients were alive and well with no evidence of recurrent or metastatic disease after a follow-up of 3–42 months (mean, 12 months).



CONCLUSIONS

Histologically atypical or borderline spitzoid, melanocytic tumors are diagnostically challenging and controversial melanocytic lesions, some of which represent unrecognized melanomas. SLNB aids in confirming a diagnosis of melanoma and identifies patients who may benefit from early therapeutic lymph node dissection and/or adjuvant therapy. Cancer 2003;97:499–507. © 2003 American Cancer Society.



DOI 10.1002/cncr.11074

/pdf/sentinel-lymph-node-biopsy-for-patients-with-problematic-35ffgwzjn7.pdf

Sentinel lymph node biopsy for patients with problematic spitzoid melanocytic lesions: A report on 18 patients

BACKGROUND

Several subtypes of sweat gland carcinoma have been found to demonstrate a propensity to metastasize systemically and to regional lymph nodes. The predictive value and benefit of sentinel lymph node (SLN) biopsy have been established in numerous other malignancies, but to the authors' knowledge there is little literature published to date regarding the use of SLN biopsy in patients with sweat gland carcinoma. In the current study, the authors demonstrated the utility of SLN biopsy in detecting subclinical metastases of sweat gland carcinoma, which may result in early treatment.



METHODS

The authors identified five patients with malignant eccrine tumors in whom SLN biopsy was performed at the study institution. Clinical and histopathologic data were reviewed.



RESULTS

The five study cases included two cases of aggressive digital papillary adenocarcinoma (both occurring on upper extremity digits), two cases of hidradenocarcinoma (occurring on the knee and foot, respectively), and an eccrine carcinoma (occurring on the scalp). In each biopsy-established case, there was no clinical evidence of metastatic disease, and a wide local excision or amputation was performed with concurrent SLN biopsy. Four of 18 SLNs in 3 of the 5 patients (60%) were found to be positive for metastatic carcinoma, as identified in hematoxylin and eosin stains and/or cytokeratin immunohistochemical stains. All three lymph node-positive patients subsequently underwent regional lymphadenectomy and were found to have no evidence of additional metastases.



CONCLUSIONS

The results of the current study demonstrate that SLN biopsy detects subclinical metastases from sweat gland carcinomas to regional lymph nodes. SLN mapping and biopsy at the time of resection can provide useful information with which to guide early treatment. Further studies are necessary to determine whether this procedure results in a survival benefit in patients with sweat gland carcinomas. Cancer 2003;97:2285–9. © 2003 American Cancer Society.



DOI 10.1002/cncr.11328

/pdf/lymphatic-mapping-and-sentinel-lymph-node-biopsy-in-the-266564qmqr.pdf

Lymphatic mapping and sentinel lymph node biopsy in the detection of early metastasis from sweat gland carcinoma

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Desmoplastic and neurotropic melanoma

Sentinel lymph node biopsy for patients with problematic spitzoid melanocytic lesions: A report on 18 patients

Lymphatic mapping and sentinel lymph node biopsy in the detection of early metastasis from sweat gland carcinoma