Podcasts about Lymph node

We’ve spiraled into chaos today, from debating if our boss is "hot" to Dan reliving a "stiffy webby" trauma involving Speedos and Roman Jandals. Plus, Clint’s 9-year-old is juggling three crushes, and we’re trying to figure out if being "honest and plain" is actually a compliment. 00:00 – Hot Chocolate Energy and the "Hot Boss" debate. 02:08 – The Cute, Funny, Sexy, Smart game (and why Dan is "Plain"). 04:36 – Clint’s 9-year-old son is a total player. 06:50 – Dan’s Speedos and the "Stiffy Webby" core memory. 08:15 – The Roman Jandal escape and "Lymph Node" flirting.

This mini-series on Behind the Knife delves into the technical aspects of the Operative Standards for Cancer Surgery, developed through the American College of Surgeons Cancer Research Program and Cancer Surgery Standards Program. This episode highlights sentinel lymph node biopsy for breast cancer.Hosts:- Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a Surgical Oncology fellow at MD Anderson Cancer Center.- Lauren Postlewait, MD, FACS, is an Associate Professor of Surgery at Emory University School of Medicine and is the Medical Director of the Breast Center at Grady Memorial Hospital in Atlanta, GA.- Chantal Reyna, MD, FACS (@kprgrl3) is a Breast surgical oncologist at Loyola University Medical Center in Chicago, IL and serves as the oncology clinical lead for the breast service line.Guest:- Susan E. Pories, MD, FACS (@SusanPoriesMD) is a professor of surgery, vice chair for quality and safety, and director of the Rutger's Breast Center at the University hospital. Learning Objectives: -       Understand the definition and identification of axillary sentinel lymph node. -       Understand the technique for injecting tracer or dye to perform sentinel lymph node biopsy. -       Understand the importance of preincision drainage evaluation and transcutaneous localization.-       Understand techniques to minimize seroma formation.Links to Papers Referenced in this EpisodeOperative Standards for Cancer Surgery, Volume 1: Breast, Lung, Pancreas, Colonhttps://www.facs.org/quality-programs/cancer-programs/cancer-surgery-standards-program/operative-standards-for-cancer-surgery/purchase/Kindle edition:https://www.amazon.com/Operative-Standards-Cancer-Surgery-Section-ebook/dp/B07MWSNFSBSentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial Lancet Oncol. 2010 Oct;11(10):927-33.https://pubmed.ncbi.nlm.nih.gov/20863759/Improved Axillary Evaluation Following Neoadjuvant Therapy for Patients With Node-Positive Breast Cancer Using Selective Evaluation of Clipped Nodes: Implementation of Targeted Axillary Dissection J Clin Oncol. 2016 Apr 1;34(10):1072-8.https://pubmed.ncbi.nlm.nih.gov/26811528/The false-negative rate of sentinel node biopsy in patients with breast cancer: a meta-analysis World J Surg. 2012 Sep;36(9):2239-51. https://pubmed.ncbi.nlm.nih.gov/22569745/Effect of lymphoscintigraphy drainage patterns on sentinel lymph node biopsy in patients with breast cancer Am J Surg. 2005 Oct;190(4):557-62.https://pubmed.ncbi.nlm.nih.gov/16164919/Sentinel Lymph Node Biopsy vs No Axillary Surgery in Patients With Small Breast Cancer and Negative Results on Ultrasonography of Axillary Lymph Nodes: The SOUND Randomized Clinical Trial JAMA Oncol. 2023 Nov 1;9(11):1557-1564.https://pubmed.ncbi.nlm.nih.gov/37733364/Choosing Wisely GuidelinesSociety of Surgical Oncology. Released 2016 July 12; last updated 2020 November 13. Choosing Wisely: Five Things Physicians and Patients Should Question.https://surgonc.org/wp-content/uploads/2020/11/SSO-5things-List_2020-Updates-11-2020.pdfPlease visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewOral Board Simulator: https://app.behindtheknife.org/oral-board-simulatorTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Send us Fan MailPaper Discussed in this Episode: High-Sensitivity Pan-Cancer AI Assessment of Lymph Node Metastasis via Uncertainty Quantification. Wang X, Chen Y, Liu X, et al. npj Digit. Med. (2026).Episode Summary: In this episode, we explore a groundbreaking 2026 study that tackles the "black box" problem of medical AI. We dive into UPATHLN, a pan-cancer AI platform for detecting lymph node metastases that doesn't just try to be right—it explicitly knows when it might be wrong. By using an innovative "uncertainty" fail-safe, this system achieved an unprecedented 100% sensitivity while drastically cutting down pathologist workload.In This Episode, We Cover:• The Needle in the Haystack Problem: Why finding cancer in lymph nodes is crucial for patient survival and therapeutic decision-making, and why the sheer volume of rising cancer cases is overwhelming human pathologists.• The Danger of "Overconfident Errors": How standard deep learning models stumble on rare, "long-tail" tumor variants. Standard AI is prone to making incorrect predictions with high certainty on data it hasn't seen before, leading to dangerous missed diagnoses.• Meet UPATHLN - The Unified AI: Moving away from fragmented, organ-specific AI to a single, foundation-model-powered platform trained and validated on a massive dataset of 26,229 lymph nodes across 14 distinct primary organs.• The "Fail-Safe" Mechanism (Uncertainty Estimation): How the researchers built a decoupled module that acts as a clinical safety net. Instead of forcing a guess, the AI flags "High Uncertainty" (HU) regions—like atypical cells or distracting elements like anthracotic pigment—and routes them directly for mandatory human review.• The Results - 100% Rescue Rate: In independent testing, relying on the AI's diagnostic probability alone would have missed 60 metastases. However, the uncertainty module successfully intercepted all 60 of these initially missed cases, achieving a 100% conditional sensitivity, even on 7 rare cancer types the AI had never seen before during training.• The Future of the Lab: How UPATHLN safely eliminated 73.2% of negative lymph nodes from manual review. By liberating pathologists from routine triage, the system frees up time for advanced, multi-dimensional precision oncology that goes beyond simple staging.Key Takeaway: The key to safe clinical AI isn't just raw accuracy—it's failure awareness. By teaching AI to explicitly model its own uncertainty, the system intercepted all missed diagnoses, handled rare biological variants safely, and established a trustworthy, workload-efficient partnership between human experts and artificial intelligenceSupport the showGet the "Digital Pathology 101" FREE E-book and join us!

In this new episode of Speaking of SurgOnc, Dr. Rick Greene & Dr. Jamie Rand discuss the article: Omission of Axillary Lymph Node Dissection in Patients with pT0-2 ER+/HER2− Breast Cancer with 3–5 Positive Lymph Nodes Undergoing Adjuvant Systemic Therapy and Radiation Does Not Impact Overall Survival: A Cancer Database Analysis, from the February 2026 issue of the Annals of Surgical Oncology.

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Send us Fan MailPaper Discussed in this AI Journal Club:Region-Based Segmentation of Lymph Node Metastases in Whole-Slide Images of Colorectal Cancer: A Pilot Clinical Study. Fayzullin A, Savelov N, Balkivskiy A, et al. Cancer Medicine 2026.Episode Summary: In this deep dive, we strip away the marketing gloss of AI as a mere time-saving tool and look at its true value in the lab: saving lives through relentless vigilance. We examine a 2026 study on colorectal cancer that deploys a two-stage AI pipeline to hunt down microscopic lymph node metastases. By highlighting "Specimen 8"—a speck of cancer hidden within a busy, benign background—we explore why the real return on investment for AI in digital pathology isn't about speeding up the human, but acting as an automated safety net that catches what the human eye naturally misses.In This Episode, We Cover:• The 12-Node Burden: The grueling clinical reality of staging colorectal cancer, where pathologists must manually scan at least 12 regional lymph nodes for microscopic tumor cells—a perfect storm for change blindness and visual fatigue.• The Mimics of Pathology: Why finding metastases isn't just looking for a "needle in a haystack," but fighting visual mimics like sinus histiocytosis that effortlessly camouflage tiny, poorly differentiated cancer cells.• The Two-Stage AI Pipeline ("The Scout" and "The Artist"): ◦ The Scout (GoogLeNet): A lightweight classification model that acts as a binary filter, achieving a staggering 100% recall by scanning image tiles and successfully filtering out confusing artifacts like tissue folds. ◦ The Artist (DeepLabV3+): A heavy-duty semantic segmentation model that draws precise boundaries around viable tumor cells while intelligently ignoring necrosis and lakes of mucin.• The Hardware Validation Test: How the researchers proved their AI's robustness by testing it across different hardware (Hamamatsu and Leica scanners) to avoid the "silent killer" of AI projects: domain shift from scanner variability.• The "Specimen 8" Revelation: A breakdown of the crucial moment the AI caught a 0.14 mm by 0.06 mm metastasis hiding in a benign pattern. The AI didn't save the pathologists time here—it actually slowed them down to verify—but it prevented a catastrophic misdiagnosis.• The Return on Investment (ROI) Myth: Why hospital administrators need to stop looking at AI strictly for turnaround time speed. The study proved overall time savings were essentially negligible (1-3 seconds per case), but the quality assurance and patient safety derived from catching missed cancers were priceless.Key Takeaway: The true value of AI in pathology isn't in racing the clock; it's in absolute vigilance. By successfully highlighting microscopic metastatic mimics that cause human false-negatives, AI proves its worth not as a turbo-button for the lab, but as a tireless quality assurance partner that ensures accurate cancer staging and optimal patient outcomes.Support the showGet the "Digital Pathology 101" FREE E-book and join us!

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Picture this: a patient with early-stage breast cancer is sitting in front of you in the clinic. You are about to offer your expert management plan. The age-old question arises—should you really perform a sentinel lymph node biopsy, or could omission actually help this patient more? Today, we're tackling one of the hottest debates in modern breast cancer care.Should we rethink sentinel lymph node biopsy for select patients, and can skipping it actually improve quality of life without sacrificing cancer control? The stakes couldn't be higher—balancing accurate cancer staging and minimizing harm is the name of the game. Together, we're breaking down the latest evidence from the SOUND and INSEMA trials. What do these landmark studies mean for your patients, your practice, and the future of axillary management? Ready for a journal review that might just change your next consult? Hosts:- Rashmi Kumar, MD, PhDResident, University of Michigan General Surgery Residency ProgramTwitter/X: @RashmiJKumar- Melissa Pilewskie, MDAttending Breast Surgical Oncologist, Co-Director of the Weiser Family Center for Breast Cancer, Michigan Medicine Twitter/X: @MPilewskie- Stephanie Downs-Canner, MDAttending Breast Surgical Oncologist & Physician-Scientist, Memorial Sloan Kettering Cancer Center, Program Director of the Breast Surgical Oncology Fellowship Training Program Twitter/X: @SDownsCannerLearning Objectives:- Understand when and for whom it is safe and beneficial to omit sentinel lymph node biopsy (SLNB) in early-stage breast cancer patients.- Identify the risks associated with foregoing SLNB, including loss of nodal staging, and analyze how this impacts treatment selection and prognosis.- Review key findings from the SOUND and INSEMA trials and their influence on axillary management.- Discuss implications for adjuvant therapy, genomic profiling, and multidisciplinary clinical practice.- Recognize which patient populations should still receive SLNB, and the importance of individualized, multidisciplinary decision-making.References:- Gentilini OD, Botteri E, Sangalli C, et al. Sentinel Lymph Node Biopsy vs No Axillary Surgery in Patients With Small Breast Cancer and Negative Results on Ultrasonography of Axillary Lymph Nodes: The SOUND Randomized Clinical Trial. JAMA Oncol. 2023;9(11):1557–1564. doi:10.1001/jamaoncol.2023.3759 https://pubmed.ncbi.nlm.nih.gov/37733364/- Reimer T, Stachs A, Veselinovic K, et al. Axillary surgery in breast cancer – primary results of the INSEMA trial. N Eng J Med. 2024. doi:10.1056/NEJMoa2412063.https://pubmed.ncbi.nlm.nih.gov/39665649/- Sparano JA, Gray RJ, Makower DF, Albain KS, Saphner TJ, Badve SS, Wagner LI, Kaklamani VG, Keane MM, Gomez HL, Reddy PS, Goggins TF, Mayer IA, Toppmeyer DL, Brufsky AM, Goetz MP, Berenberg JL, Mahalcioiu C, Desbiens C, Hayes DF, Dees EC, Geyer CE Jr, Olson JA Jr, Wood WC, Lively T, Paik S, Ellis MJ, Abrams J, Sledge GW Jr. Clinical Outcomes in Early Breast Cancer With a High 21-Gene Recurrence Score of 26 to 100 Assigned to Adjuvant Chemotherapy Plus Endocrine Therapy: A Secondary Analysis of the TAILORx Randomized Clinical Trial. JAMA Oncol. 2020 Mar 1;6(3):367-374. doi: 10.1001/jamaoncol.2019.4794. PMID: 31566680; PMCID: PMC6777230. https://pubmed.ncbi.nlm.nih.gov/31566680/- Slamon DJ, Fasching PA, Hurvitz S, Chia S, Crown J, Martín M, Barrios CH, Bardia A, Im SA, Yardley DA, Untch M, Huang CS, Stroyakovskiy D, Xu B, Moroose RL, Loi S, Visco F, Bee-Munteanu V, Afenjar K, Fresco R, Taran T, Chakravartty A, Zarate JP, Lteif A, Hortobagyi GN. Rationale and trial design of NATALEE: a Phase III trial of adjuvant ribociclib + endocrine therapy versus endocrine therapy alone in patients with HR+/HER2- early breast cancer. Ther Adv Med Oncol. 2023 May 29;15:17588359231178125. doi: 10.1177/17588359231178125. Erratum in: Ther Adv Med Oncol. 2023 Sep 29;15:17588359231201818. doi: 10.1177/17588359231201818. PMID: 37275963; PMCID: PMC10233570. https://pubmed.ncbi.nlm.nih.gov/37275963/Sponsor Disclosure: Visit goremedical.com/btkpod to learn more about GORE® SYNECOR Biomaterial, including supporting references and disclaimers for the presented content. 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Rx only Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

In this episode of SurgOnc Today, we discuss the recently updated ASCO guidelines for axillary staging with sentinel lymph node biopsy in breast cancer, as well as considerations for their application in a multidisciplinary setting. This episode is moderated by Dr. Ashley Woodfin from the University of Wisconsin, who is joined by Dr. Clara Park from Brigham and Women's Hospital and Dr. Andrea Abbott from Medical University of South Carolina for a in-depth discussion regarding the guidelines implementation and important considerations.

Brittinie presents with difficulty pushing up from a chair, weakness with shoulder extension and adduction, and no significant sensory deficits. She recently underwent axillary lymph node dissection following surgery for breast cancer. Which of the following peripheral nerves is MOST likely injured?A) Axillary nerveB) Thoracodorsal nerveC) Long thoracic nerveD) Radial nerveJoin the FREE Facebook Group: www.nptegroup.com

In this JCO Article Insights episode, Dr. Joseph Matthew interviews authors Dr. Yang Zhang and Dr. Haiquan Chen about their recently published JCO article, "Phase III Study of Mediastinal Lymph Node Dissection for Ground Glass Opacity–Dominant Lung Adenocarcinoma" TRANSCRIPT Joseph Mathew: Welcome to the Journal of Clinical Oncology Article Insights episode for the August issue of the JCO. This is Joseph Mathew, editorial fellow for JCO, and today, it is my pleasure to have with us Dr. Haiquan Chen and Dr. Yang Zhang, authors of the recently published manuscript, "Phase 3 Study of Mediastinal Lymph Node Dissection for Ground-Glass Opacity-Dominant Lung Adenocarcinoma," which we will be discussing today. Dr. Chen is the Director of the Institute of Thoracic Oncology at Fudan University and the Chief of Thoracic Surgery at Fudan University Shanghai Cancer Center, where he is also the Head of Thoracic Oncology MDT and the Director of the Lung Cancer Center. Dr. Chen is a surgeon-scientist and a pioneer in developing individualized surgical strategies for early-stage non-small cell lung cancer. Dr. Zhang is a surgical oncologist and a member of the team which Dr. Chen leads at the Fudan University Shanghai Cancer Center. Welcome Dr. Chen and Dr. Zhang. Thank you very much for accepting our invitation and joining us today as part of this podcast episode. To summarize the salient points, this study presented the interim analysis of a multi-center, open-label, non-inferiority, randomized controlled trial investigating the necessity of systematic mediastinal lymph node dissection at the time of segmentectomy or lobectomy in patients with clinical stage T1N0M0 ground-glass opacity-dominant invasive lung adenocarcinoma, as defined by a consolidation-to-tumor ratio of 0.5 or less on thin-section computed tomography and a maximum tumor diameter of 3 cm or less. Eligible participants with intraoperatively confirmed invasive adenocarcinoma on frozen section analysis were randomized to either the systematic mediastinal lymph node dissection arm or to no mediastinal lymph node dissection. In the latter experimental group, mediastinal lymph nodes comprising the N2 nodal stations were not dissected, and the hilar nodes were variably addressed at the discretion of the operating surgeon. The primary endpoint of the trial was disease-free survival at 3 years. Secondary endpoints included perioperative outcomes, the status of lymph node metastasis in the systemic lymph node dissection arm, and 3-year overall survival. Before the trial reached its accrual target, a pre-planned interim safety analysis set for the time point when enrollment reached 300 patients was performed. It was noted that while none of the patients in either arm had nodal metastasis on postoperative pathological evaluation, lymph node dissection-related intraoperative and postoperative complications were more commonly observed in the systematic lymph node dissection arm, including one life-threatening episode of massive bleeding. Since this met the predefined criteria for trial termination, and in accordance with the principle of non-maleficence, further recruitment was stopped and the trial terminated. Although the 3-year disease-free survival and the overall survival for the enrolled patients were comparable, operative outcomes, including the duration of surgery, blood loss, chest tube duration, length of postoperative stay, and the rate of clinically significant complications, were significantly lower in the experimental arm compared with the systematic lymph node dissection group. The authors concluded that for well-selected patients, mediastinal nodal dissection could be omitted without adversely affecting oncological outcomes, representing a significant shift in current surgical practice, given that guidelines the world over recommend systematic lymph node dissection or sampling for all invasive lung cancers. In summary, this study addressed a clinically relevant question with regard to the extent of nodal dissection, especially in the light of recent evidence recommending less extensive parenchymal dissections for early-stage non-small cell lung cancer, with the findings suggesting that invasive lung adenocarcinoma associated with ground-glass opacities of consolidation-to-tumor ratio up to 0.5 was an excellent predictor of tumor biology, and in clinical T1N0M0 lesions, a reliable predictor of negative mediastinal lymph node involvement. So Dr. Chen and Dr. Zhang, could you tell us some more about what led you to do this research and the challenges which you faced while recruiting patients for this trial? Dr. Yang Zhang: Dr. Mathew, thank you for your summary. The current clinical guidelines recommend systematic lymph node dissection or sampling for every patient with early-stage lung cancer, regardless of their lymph node status. And in our clinical practice, we observe that this procedure causes a lot of surgical complications including chylothorax and recurrent laryngeal nerve injury. Furthermore, dissecting the tumor-draining lymph nodes actually may potentially damage the body's anti-tumor immunity. So, Dr. Chen proposed the concept of selective lymph node dissection, which we aimed to dissect the metastatic lymph nodes, while at the same time we try to preserve as many uninvolved lymph nodes as possible. So previously, we have conducted a series of retrospective studies to identify reliable predictors of nodal negative status in certain mediastinal zones, and we have performed a prospective observational phase 2 clinical trial to validate that the six criteria we proposed are 100% in predicting node-negative status. And this forms the basis for our phase 3 clinical trial. Dr. Haiquan Chen: This trial is only one of the series of trials. The meaning of this trial you already said. And for a long time, from the surgeon's point of view, we considered minimally invasive surgery. It minimizes the size of the incision and minimizes the number of the holes we made. So, the true and the high-impact of minimally invasive, we make a concept of minimal dissection, that means organ-level minimally invasive. So we proposed the concept of minimally invasive 3.0, that means minimal incision, minimal dissection (that means organ-level minimal), and systemic minimally invasive. So at first, we judged from the point of minimally invasive surgery. As long as immunotherapy is widely used in the clinical practice, we know immunotherapy, that means you use drugs to stimulate and activate the lymph node site. If we dissect all the metastatic lymph nodes, cut them out, how can we restimulate that lymph node site? So, from minimally invasive trauma and second, from the functional aspect, to try to save as many uninvolved lymph nodes as possible. Joseph Mathew: Thank you, Dr. Chen. That's a very interesting concept that you alluded to even in the discussion of this paper, as to the potential role of the non-metastatic lymph nodes as immune reservoirs. So, coming back to this paper, were there any challenges which you faced while recruiting patients for this trial? Dr. Haiquan Chen: The criteria is very clear. That means invasive adenocarcinoma, that means most of the centimeter is 3.0 centimeter and also CTR ratio less than 0.5. And we can see that, you know, we did study about that. Even the invasive component of the subsolid nodule, it's bigger than the solid part. That means even the pure GGO, we can find out that there's still some invasive component. From this point of view, pure GGO and subsolid GGO, from this part of invasive carcinoma, that means it's a special clinical subtype that we, from retrospective study and also prospective study, we find out this group of patients, there are no mediastinal lymph node metastasis. So I think it's very important for this kind of group that we can avoid doing the mediastinal lymph node dissection. And we can do organ-level minimally invasive surgery. And also, we try to keep the patient's immune function as normal as possible. Dr. Yang Zhang: Well, Dr. Mathew, we believe that the biggest challenge when we are enrolling these patients is that there needs to be a paradigm shift in the mind because systematic lymph node dissection has long been the standard of care. And some patients may misunderstand. Before the enrollment, we have to give them informed consent, but if the patient hears that they may be enrolled in the no-lymph-node-dissection group, they may feel that they do not receive radical, curative-intent surgery. So we believe, as Dr. Chen has said, after the release of our results, the no-lymph-node dissection may be incorporated in the future guideline for those patients without lymph node involvement, we can just omit the lymph node dissection. Joseph Mathew: The study described two pre-planned interim points during the course of subject enrollment when the data was analyzed. So Dr. Chen and Dr. Zhang, could you please explain a little more about these two interim points of analysis that were planned and the rationale behind it? Dr. Yang Zhang: When conducting this trial, we have two concerns. One is if there is any lymph node metastasis, there may be omission of metastatic lymph nodes not dissected in the no-lymph-node-dissection group. And there is another concern is that if all these lymph nodes are uninvolved, then dissecting these lymph nodes may cause life-threatening complications. So, we set the 150 interim analysis to ensure that there is no lymph node involvement in this group. And the other early termination criteria is set because if there is no lymph node involvement found in both groups, then a severe complication which is life-threatening is unacceptable because it threatens the patient's safety. Joseph Mathew: So, although you did briefly allude to in the paper, what was the basis for selecting DFS as the primary endpoint when the objective of this trial was to assess nodal involvement in this subset of tumors? Dr. Yang Zhang: Well, previously, we have done a series of retrospective studies and one prospective phase 2 trial. And in these studies, we have identified that GGO-dominant lung adenocarcinoma, even if it's invasive, it has no lymph node involvement. So this phase 3 trial was primarily designed to compare the survival outcomes. But as the trial went on, as Dr. Chen has concerns that if the patients have no lymph node metastasis at all, it may be unfair to dissect the lymph nodes for patients enrolled in the systematic lymph node dissection group. So there is one life-threatening complication that happens due to dissecting the lymph nodes and injury to the superior vena cava, which leads to massive bleeding. It is at this point that we decided to terminate this trial for patient safety concerns. Joseph Mathew: Yeah, that's a very fair point. So you made sure that the ethical considerations were kept intact. So another point was, there was a mention in the study of the historical data from your institution suggesting a 3-year disease-free survival of 96.6% for patients with clinical T1N0M0 ground-glass opacity-dominant invasive lung adenocarcinoma. So could you please elaborate on the patterns of recurrence which you noted for this group of patients who had developed a recurrence? Dr. Haiquan Chen: Yeah, I think over 90% 3-year DFS, that's the least. From our retrospective data for this kind of group of patients, their DFS is so good. To the best of my knowledge, almost 100%. So this is very conservative, 94, 90% is very conservative. I think the trial eventually would have been positive. It's a special clinical subtype, even for invasive adenocarcinoma, their prognosis is much better than the other type of invasive adenocarcinoma. Joseph Mathew: So this question may be slightly outside the purview of this study, but in your clinical practice, would you advocate either segmentectomy or lobectomy for all patients meeting the trial criteria, that is, lesions measuring 3 cm or less with a CTR of up to 0.5? Or is there a subgroup of patients you would recommend a wedge dissection for? Dr. Haiquan Chen: I think CTR ratio is one parameter and also the location is another very important parameter. So we put it together to make a decision, the patient should do a lobectomy or segmentectomy. Even for an ongoing trial, for even the patient, invasive adenocarcinoma, we can do in the right location, even wedge, it can achieve enough negative margin in the ongoing trial to verify the comparable result for the patient, we can do the wedge dissection. So not just the CTR ratio, that's not the only parameter to make a decision on what kind of procedure we'll do. Joseph Mathew: Yeah, great point, Dr. Chen. So from my perspective, this study was a well-designed, randomized control trial based on a relevant and clinically valid research question. So what, in your opinion, are the main strong points of this study? Dr. Yang Zhang: We believe that this study represents the first randomized clinical trial published, yet, regarding the topic of selective lymph node dissection. It basically offers the highest level of evidence. We believe our results should be incorporated in the future clinical guideline. Joseph Mathew: Given the increasing incidence of these lesions, I think it was- a randomized control trial in this arena was much awaited. And the other point is that GGO-dominant lung adenocarcinomas, the specific clinical guidelines are not very clear. So I think your study brought out that lymph node dissection for these tumors which satisfy the eligibility criteria could be omitted safely. Important consideration here is that the conclusions of the trial were based on an interim analysis, and this analysis was not planned for an early assessment of the primary endpoint. In other words, the study was not adequately powered to detect a significant difference in DFS at 3 years. So Dr. Chen and Dr. Zhang, what do you perceive are the most important limitations of this study which you feel should be addressed in future research? Dr. Haiquan Chen: So the surgery now is more individualized. I think the surgery from the last two decades, from the maximum tolerable intervention to minimum effective treatment, there's a big shift. So I think that the consensus, we can preserve normal lung parenchyma as much as possible. For the lymph nodes, I think that the big shift, we should shift it to keep as many as uninvolved lymph nodes as possible. So that's very important, not just to reduce the intraoperative trauma, but also to keep the immune environment as normal as possible. Joseph Mathew: Another point was the limited long-term follow-up data to determine the actual impact of omitting lymph node dissection on local-regional disease control. So is any future follow-up planned to assess the long-term survival outcomes for the 302 patients which were enrolled in this trial? Dr. Haiquan Chen: Yeah, I think that's very important for us. This trial we terminated just because if we keep the trial going, it's unfair for the mediastinal lymph node dissection group. We tried to just stop here, and we shifted to the single-arm trial. So, 2 or 3 years, this trial and another trial, they will give our final result to demonstrate more if selective mediastinal lymph nodes have a better result than ever before. And we will support the mediastinal lymph node dissection. That's one way. And the American College just asked me, how can we put this policy into clinical practice in the United States? Because most of the patients they meet have solid tumors. So we have another trial, try to figure out how we can make sure before and intraoperative the lymph node status is negative or positive, and then we can solve that problem and put this policy into clinical practice in the Western society. Joseph Mathew: Great. So that would be something we should all be looking forward to. So, this brings me to the final point of discussion on future research in this field. Dr. Chen, you commented in the paper that future studies should focus on improving the reproducibility of CTR evaluation. What are your thoughts on this subject? Dr. Haiquan Chen: The CTR ratio, the concept from the JCOG 0201, just a concept from that prospective study, the phase 2 study, only subgroup analysis they give the concept of CTR ratio and the diameter. How can we reproduce? In our group and also I believe in Japan and in China, in Korea, and in our daily practice, I think CTR ratio is not a big issue. There are two very important things. One, you make sure the CTR ratio, not in a common CAT scan, but in a high-resolution CAT scan. So the imaging, that's the first thing. And the second, not from the single section and a two or three section, you make sure that your calculation is accurate. That's not just the single section, you make sure that you got the conclusion, the CTR ratio is the same number. We make sure that totally we, from the top to the bottom of the whole lesion, we make sure that the CTR ratio is accurate. Joseph Mathew: Thank you, Dr. Chen. I think that would involve training our radiologists also to be aware of the CTR ratio and how it should be interpreted. So another very interesting concept which you had alluded to in the discussion was the potential role of non-metastatic lymph nodes as immune reservoirs. So how do you think we could preserve these nodes and do you think sentinel node biopsies would play a role in future? Dr. Yang Zhang: Actually, Dr. Chen has also led some basic research on this topic. We are investigating the immunological role of the tumor-draining lymph nodes. And our preliminary results have already shown that the tumor-draining lymph nodes of lung cancer, especially those uninvolved lymph nodes, have a vital role in the anti-tumor immunity and also effective response to the current anti-PD-1 immunotherapy. In the future, we believe that by incorporating our clinical evidence and those findings from our basic research, we will be able to provide very strong rationale to support selective lymph node dissection. Joseph Mathew: So lastly, what are the questions that still remain to be answered and what do you perceive as the next step in this field? Dr. Haiquan Chen: I think for the lung cancer surgery, especially for the cT1N0M0, they are more individualized. We can, based on the patient, the location, the CTR ratio, we can do wedge dissection, or segmentectomy, or lobectomy. For the lymph node dissection, we can do no mediastinal lymph node dissection or selective, only to dissect the positive one, or we have to do the systemic mediastinal lymph node dissection. So we can see there are too many combinations. So in the near future, for the surgery perspective, we have it more individualized. In the future, we just try to make sure we do not cut as many as possible. We just make sure that we can avoid over-diagnosis or overtreatment or over-dissected. I think that in the near future, that goal will come true. Joseph Mathew: That's a great point, Dr. Chen. So that would be something also for the thoracic oncology community to work towards. This wraps up today's episode of JCO Article Insights. Dr. Chen and Dr. Zhang, thank you very much for taking the time to join us today in what has been a very insightful session. Dr. Haiquan Chen: Thank you. Dr. Yang Zhang: Thanks. Joseph Mathew: To our audience, thank you for listening. Please stay tuned for more interviews and articles, summaries, and be sure to leave us your comments and ratings. For more podcasts and episodes from ASCO, please visit asco.org/podcasts. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

Ever wondered why you still have inflammation and pain when you are working your lymphatic system? I mean it's supposed to help you feel better right? Well that all depends on how you are working your lymphatic system because not lymph reset programs are the same. You have to dive deep and look at the biggest blocks in the central lymphatics. If you miss the Central lyphatics you are still going to struggle. You cannot reach those by dry brushing alone. Take a listen. Learn. Share. Enjoy. Change your life. And don't forget to watch the video version on our YouTube channel. Stop Chasing Pain on YOUTUBE. 

Vincent and Cindy discuss differences between MPox-specific T cell responses following infection and vaccination, and lymph node macrophage control of memory B cell localization and trafficking that might be important for choosing which arm to get a vaccine. Hosts: Vincent Racaniello and Cindy Leifer Subscribe (free): Apple Podcasts, RSS, email Become a patron of Immune! Links for this episode MicrobeTV Discord Server Different T memory response to MPox infection or vaccination (Nat Comm 2025) Macrophages direct B cell recall responses after vaccination (Cell 2025) Time stamps by Jolene Ramsey. Thanks! Music by Tatami. Immune logo image by Blausen Medical Send your immunology questions and comments to immune@microbe.tv Information on this podcast should not be construed as medical advice.

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Dr. Ko Un “Clara” Park and Dr. Mylin Torres present the latest evidence-based changes to the SLNB in early-stage breast cancer guideline. They discuss the practice-changing trials that led to the updated recommendations and topics such as when SLNB can be omitted, when ALND is indicated, radiation and systemic treatment decisions after SLNB omission, and the role of SLNB in special circumstances. We discuss the importance of shared decision-making and other ongoing and future de-escalation trials that will expand knowledge in this space. Read the full guideline update, “Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer: ASCO Guideline Update” at www.asco.org/breast-cancer-guidelines. TRANSCRIPT This guideline, clinical tools, and resources are available at http://www.asco.org/breast-cancer-guidelines. Read the full text of the guideline and review authors' disclosures of potential conflicts of interest in the Journal of Clinical Oncology, https://ascopubs.org/doi/10.1200/JCO-25-00099       Brittany Harvey: Hello and welcome to the ASCO Guidelines podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges and advances in oncology. You can find all the shows, including this one at asco.org/podcasts. My name is Brittany Harvey and today I'm interviewing Dr. Ko Un "Clara" Park from Brigham and Women's Hospital, Dana-Farber Cancer Institute, and Dr. Mylin Torres from Glenn Family Breast Center at Winship Cancer Institute of Emory University, co-chairs on “Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer: ASCO Guideline Update.” Thank you for being here today, Dr. Park and Dr. Torres. Dr. Mylin Torres: Thank you, it's a pleasure to be here. Brittany Harvey: And before we discuss this guideline, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO Conflict of Interest Policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including Dr. Torres and Dr. Park, who have joined us here today, are available online with the publication of the guideline in the Journal of Clinical Oncology, which is linked in the show notes. To start us off, Dr. Torres, what is the scope and purpose of this guideline update on the use of sentinel lymph node biopsy in early-stage breast cancer? Dr. Mylin Torres: The update includes recommendations incorporating findings from trials released since our last published guideline in 2017. It includes data from nine randomized trials comparing sentinel lymph node biopsy alone versus sentinel lymph node biopsy with a completion axillary lymph node dissection. And notably, and probably the primary reason for motivating this update, are two trials comparing sentinel lymph node biopsy with no axillary surgery, all of which were published from 2016 to 2024. We believe these latter two trials are practice changing and are important for our community to know about so that it can be implemented and essentially represent a change in treatment paradigms. Brittany Harvey: It's great to hear about these practice changing trials and how that will impact these recommendation updates. So Dr. Park, I'd like to start by reviewing the key recommendations across all of these six overarching clinical questions that the guideline addressed. So first, are there patients where sentinel lymph node biopsy can be omitted? Dr. Ko Un "Clara" Park: Yes. The key change in the current management of early-stage breast cancer is the inclusion of omission of sentinel lymph node biopsy in patients with small, less than 2 cm breast cancer and a negative finding on preoperative axillary ultrasound. The patients who are eligible for omission of sentinel lymph node biopsy according to the SOUND and INSEMA trial are patients with invasive ductal carcinoma that is size smaller than 2 cm, Nottingham grades 1 and 2, hormone receptor-positive, HER2-negative in patients intending to receive adjuvant endocrine therapy, and no suspicious lymph nodes on axillary ultrasound or if they have only one suspicious lymph node, then the biopsy of that lymph node is benign and concordant according to the axillary ultrasound findings. The patients who are eligible for sentinel lymph node biopsy omission according to the SOUND and INSEMA trials were patients who are undergoing lumpectomy followed by whole breast radiation, especially in patients who are younger than 65 years of age. For patients who are 65 years or older, they also qualify for omission of sentinel lymph node biopsy in addition to consideration for radiation therapy omission according to the PRIME II and CALGB 9343 clinical trials. And so in those patients, a more shared decision-making approach with the radiation oncologist is encouraged. Brittany Harvey: Understood. I appreciate you outlining that criteria for when sentinel lymph node biopsy can be omitted and when shared decision making is appropriate as well. So then, Dr. Torres, in those patients where sentinel lymph node biopsy is omitted, how are radiation and systemic treatment decisions impacted? Dr. Mylin Torres: Thank you for that question. I think there will be a lot of consternation brought up as far as sentinel lymph node biopsy and the value it could provide in terms of knowing whether that lymph node is involved or not. But as stated, sentinel lymph node biopsy actually can be safely omitted in patients with low risk disease and therefore the reason we state this is that in both SOUND and INSEMA trial, 85% of patients who had a preoperative axillary ultrasound that did not show any signs of a suspicious lymph node also had no lymph nodes involved at the time of sentinel node biopsy. So 85% of the time the preoperative ultrasound is correct. So given the number of patients where preoperative ultrasound predicts for no sentinel node involvement, we have stated within the guideline that radiation and systemic treatment decisions should not be altered in the select patients with low risk disease where sentinel lymph node biopsy can be omitted. Those are the patients who are postmenopausal and age 50 or older who have negative findings on preoperative ultrasound with grade 1 or 2 disease, small tumors less than or equal to 2 cm, hormone receptor-positive, HER2-negative breast cancer who undergo breast conserving therapy. Now, it's important to note in both the INSEMA and SOUND trials, the vast majority of patients received whole breast radiation. In fact, within the INSEMA trial, partial breast irradiation was not allowed. The SOUND trial did allow partial breast irradiation, but in that study, 80% of patients still received whole breast treatment. Therefore, the preponderance of data does support whole breast irradiation when you go strictly by the way the SOUND and INSEMA trials were conducted. Notably, however, most of the patients in these studies had node-negative disease and had low risk features to their primary tumors and would have been eligible for partial breast irradiation by the ASTRO Guidelines for partial breast treatment. So, given the fact that 85% of patients will have node-negative disease after a preoperative ultrasound, essentially what we're saying is that partial breast irradiation may be offered in these patients where omission of sentinel node biopsy is felt to be safe, which is in these low risk patients. Additionally, regional nodal irradiation is something that is not indicated in the vast majority of patients where omission of sentinel lymph node biopsy is prescribed and recommended, and that is because very few of these patients will actually end up having pathologic N2 disease, which is four or more positive lymph nodes. If you look at the numbers from both the INSEMA and the SOUND trial, the number of patients with pathologic N2 disease who did have their axilla surgically staged, it was less than 1% in both trials. So, in these patients, regional nodal irradiation, there would be no clear indication for that more aggressive and more extensive radiation treatment. The same principles apply to systemic therapy. As the vast majority of these patients are going to have node-negative disease with a low risk primary tumor, we know that postmenopausal women, even if they're found to have one to three positive lymph nodes, a lot of the systemic cytotoxic chemotherapy decisions are driven by genomic assay score which is taken from the primary tumor. And therefore nodal information in patients who have N1 disease may not be gained in patients where omission of sentinel lymph node biopsy is indicated in these low risk patients. 14% of patients have 1 to 3 positive lymph nodes in the SOUND trial and that number is about 15% in the INSEMA trial. Really only the clinically actionable information to be gained is if a patient has four or more lymph nodes or N2 disease in this low risk patient population. So, essentially when that occurs it's less than 1% of the time in these patients with very favorable primary tumors. And therefore we thought it was acceptable to stand by a recommendation of not altering systemic therapy or radiation recommendations based on omission of sentinel nodes because the likelihood of having four more lymph nodes is so low. Dr. Ko Un "Clara" Park: I think one thing to add is the use of CDK4/6 inhibitors to that and when we look at the NATALEE criteria for ribociclib in particular, where node-negative patients were included, the bulk majority of the patients who were actually represented in the NATALEE study were stage III disease. And for stage I disease to upstage into anatomic stage III, that patient would need to have pathologic N2 disease. And as Dr. Torres stated, the rate of having pathologic N2 disease in both SOUND and INSEMA studies were less than 1%. And therefore it would be highly unlikely that these patients would be eligible just based on tumor size and characteristics for ribociclib. So we think that it is still safe to omit sentinel lymph node biopsy and they would not miss out, if you will, on the opportunity for CDK4/6 inhibitors. Brittany Harvey: Absolutely. I appreciate you describing those recommendations and then also the nuances of the evidence that's underpinning those recommendations, I think that's important for listeners. So Dr. Park, the next clinical question addresses patients with clinically node negative early stage breast cancer who have 1 or 2 sentinel lymph node metastases and who will receive breast conserving surgery with whole breast radiation therapy. For these patients, is axillary lymph node dissection needed? Dr. Ko Un "Clara" Park: No. And this is confirmed based on the ACOSOG Z0011 study that demonstrated in patients with 1 to 3 positive sentinel lymph node biopsy when the study compared completion axillary lymph node dissection to no completion axillary lymph node dissection, there was no difference. And actually, the 10-year overall survival as reported out in 2017 and at a median follow up of 9.3 years, the overall survival again for patients treated with sentinel lymph node biopsy alone versus those who were treated with axillary lymph node dissection was no different. It was 86.3% in sentinel lymph node biopsy versus 83.6% and the p-value was non-inferior at 0.02. And so we believe that it is safe for the select patients who are early stage with 1 to 2 positive lymph nodes on sentinel lymph node biopsy, undergoing whole breast radiation therapy to omit completion of axillary lymph node dissection. Brittany Harvey: Great, I appreciate you detailing what's recommended there as well. So then, to continue our discussion of axillary lymph node dissection, Dr. Torres, for patients with nodal metastases who will undergo mastectomy, is axillary lymph node dissection indicated? Dr. Mylin Torres: It's actually not and this is confirmed by two trials, the AMAROS study as well as the SENOMAC trial. And in both studies, they compared a full lymph node dissection versus sentinel lymph node biopsy alone in patients who are found to have 1 to 2 positive lymph nodes and confirmed that there was no difference in axillary recurrence rates, overall survival or disease-free survival. What was shown is that with more aggressive surgery completion axillary lymph node dissection, there were higher rates of morbidity including lymphedema, shoulder pain and paresthesias and arm numbness, decreased functioning of the arm and so there was only downside to doing a full lymph node dissection. Importantly, in both trials, if a full lymph node dissection was not done in the arm that where sentinel lymph node biopsy was done alone, all patients were prescribed post mastectomy radiation and regional nodal treatment and therefore both studies currently support the use of post mastectomy radiation and regional nodal treatment when a full lymph node dissection is not performed in these patients who are found to have N1 disease after a sentinel node biopsy. Brittany Harvey: Thank you. And then Dr. Park, for patients with early-stage breast cancer who do not have nodal metastases, can completion axillary lymph node dissection be omitted? Dr. Ko Un "Clara" Park: Yes, and this is an unchanged recommendation from the earlier ASCO Guidelines from 2017 as well as the 2021 joint guideline with Ontario Health, wherein patients with clinically node-negative early stage breast cancer, the staging of the axilla can be performed through sentinel lymph nodal biopsy and not completion axillary lymph node dissection. Brittany Harvey: Understood. So then, to wrap us up on the clinical questions here, Dr. Park, what is recommended regarding sentinel lymph node biopsy in special circumstances in populations? Dr. Ko Un "Clara" Park: One key highlight of the special populations is the use of sentinel lymph node biopsy for evaluation of the axilla in clinically node negative multicentric tumors. While there are no randomized clinical trials evaluating specifically the role of sentinel lymph nodal biopsy in multicentric tumors, in the guideline, we highlight this as one of the safe options for staging of the axilla and also for pregnant patients, these special circumstances, it is safe to perform sentinel lymph node biopsy in pregnant patients with the use of technetium - blue dye should be avoided in this population. In particular, I want to highlight where sentinel lymph node biopsy should not be used for staging of the axilla and that is in the population with inflammatory breast cancer. There are currently no studies demonstrating that sentinel lymph node biopsy is oncologically safe or accurate in patients with inflammatory breast cancer. And so, unfortunately, in this population, even after neoadjuvant systemic therapy, if they have a great response, the current guideline recommends mastectomy with axillary lymph node dissection. Brittany Harvey: Absolutely. I appreciate your viewing both where sentinel lymph node can be offered in these special circumstances in populations and where it really should not be used. So then, Dr. Torres, you talked at the beginning about how there's been these new practice changing trials that really impacted these recommendations. So in your view, what is the importance of this guideline update and how does it impact both clinicians and patients? Dr. Mylin Torres: Thank you for that question. This update and these trials that inform the update represent a significant shift in the treatment paradigm and standard of care for breast cancer patients with early-stage breast cancer. When you think about it, it seems almost counterintuitive that physicians and patients would not want to know if a lymph node is involved with cancer or not through sentinel lymph node biopsy procedure. But what these studies show is that preoperative axillary ultrasound, 85% of the time when it's negative, will correctly predict whether a sentinel lymph node is involved with cancer or not and will also be negative. So if you have imaging that's negative, your surgery is likely going to be negative. Some people might ask, what's the harm in doing a sentinel lymph node biopsy? It's important to recognize that upwards of 10% of patients, even after sentinel lymph node biopsy will develop lymphedema, chronic arm pain, shoulder immobility and arm immobility. And these can have a profound impact on quality of life. And if there is not a significant benefit to assessing lymph nodes, particularly in someone who has a preoperative axillary ultrasound that's negative, then why put a patient at risk for these morbidities that can impact them lifelong? Ideally, the adoption of omission of sentinel lymph node biopsy will lead to more multidisciplinary discussion and collaboration in the preoperative setting especially with our diagnostic physicians, radiology to assure that these patients are getting an axillary ultrasound and determine how omission of sentinel lymph node biopsy may impact the downstream treatments after surgery, particularly radiation and systemic therapy decisions, and will be adopted in real world patients, and how clinically we can develop a workflow where together we can make the best decisions for our patients in collaboration with them through shared decision making. Brittany Harvey: Absolutely. It's great to have these evidence-based updates for clinicians and patients to review and refer back to. So then finally, Dr. Park, looking to the future, what are the outstanding questions and ongoing trials regarding sentinel lymph node biopsy in early-stage breast cancer? Dr. Ko Un "Clara" Park: I think to toggle on Dr. Torres's comment about shared decision making, the emphasis on that I think will become even more evident in the future as we incorporate different types of de-escalation clinical studies. In particular, because as you saw in the SOUND and INSEMA studies, when we de-escalate one modality of the multimodality therapy, i.e., surgery, the other modalities such as radiation therapy and systemic therapy were “controlled” where we were not de-escalating multiple different modalities. However, as the audience may be familiar with, there are other types of de-escalation studies in particular radiation therapy, partial breast irradiation or omission of radiation therapy, and in those studies, the surgery is now controlled where oftentimes the patients are undergoing surgical axillary staging. And conversely when we're looking at endocrine therapy versus radiation therapy clinical trials, in those studies also the majority of the patients are undergoing surgical axillary staging. And so now as those studies demonstrate the oncologic safety of omission of a particular therapy, we will be in a position of more balancing of the data of trying to select which patients are the safe patients for omission of certain types of modality, and how do we balance whether it's surgery, radiation therapy, systemic therapy, endocrine therapy. And that's where as Dr. Torres stated, the shared decision making will become critically important. I'm a surgeon and so as a surgeon, I get to see the patients oftentimes first, especially when they have early-stage breast cancer. And so I could I guess be “selfish” and just do whatever I think is correct. But whatever the surgeon does, the decision does have consequences in the downstream decision making. And so the field really needs to, as Dr. Torres stated earlier, rethink the workflow of how early-stage breast cancer patients are brought forth and managed as a multidisciplinary team. I also think in future studies the expansion of the data to larger tumors, T3, in particular,reater than 5 cm and also how do we incorporate omission in that population will become more evident as we learn more about the oncologic safety of omitting sentinel lymph node biopsy. Dr. Mylin Torres: In addition, there are other outstanding ongoing clinical trials that are accruing patients right now. They include the BOOG 2013-08 study, SOAPET, NAUTILUS and the VENUS trials, all looking at patients with clinical T1, T2N0 disease and whether omission of sentinel lymph node biopsy is safe with various endpoints including regional recurrence, invasive disease-free survival and distant disease-free survival. I expect in addition to these studies there will be more studies ongoing even looking at the omission of sentinel lymph node biopsy in the post-neoadjuvant chemotherapy setting. And as our imaging improves in the future, there will be more studies improving other imaging modalities, probably in addition to axillary ultrasound in an attempt to accurately characterize whether lymph nodes within axilla contain cancer or not, and in that context whether omission of sentinel lymph node biopsy even in patients with larger tumors post-neoadjuvant chemotherapy may be done safely and could eventually become another shift in our treatment paradigm. Brittany Harvey: Yes. The shared decision making is key as we think about these updates to improve quality of life and we'll await data from these ongoing trials to inform future updates to this guideline. So I want to thank you both so much for your extensive work to update this guideline and thank you for your time today. Dr. Park and Dr. Torres. Dr. Mylin Torres: Thank you. Dr. Ko Un "Clara" Park: Thank you. Brittany Harvey: And thank you to all of our listeners for tuning in to the ASCO Guidelines podcast. To read the full guideline, go to www.asco.org/breast-cancer-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app available in the Apple App Store or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.  

In this episode Dr. Perry talks about the Cisterna Chyli the largest lymph node of the body located in the center of the abdomen. When that lymph node is stagnated you can get swelling inflammation discomfort or pain anywhere in the body. Come join us I learn how to help yourself heal. BIG 6 RESET LINK: https://www.stopchasingpain.com/the-big-6-tm/

In this episode of Own Your Health, Katie Brindle answers your questions, including unique listener questions on how to safely perform facial Gua Sha after a double mastectomy and lymph node removal. Katie shares her expert advice on supporting lymphatic health and explains why brushing, tapping, and gentle Gua Sha techniques can make a huge difference in boosting energy and reducing sluggishness. Let us know if any of the techniques seen in this video have helped you. Don't forget to comment or write in and your questions can be featured in one of Katie's episodes! This episode is sponsored by Liminal, a brand transforming how we approach menopause. Founded by Rebekah Brown, Liminal empowers women with naturopathic, whole-food-led supplements designed to support your unique needs. Beyond products, they offer a supportive community, masterclasses, and real-time social groups to help women connect and thrive. Use KATIE20 for a 20% discount on single purchases within the Liminal range - https://liveliminal.com In addition, we are teaming up with The Naked Pharmacy, a registered pharmacy offering science-backed supplements and free health consultations with expert pharmacists. Whether you need support with menopause, gut health, weight management, or boosting energy and mood, they've got you covered! Don't miss out on 20% off with the code KATIE20 at thenakedpharmacy.com Watch the full episode on YouTube: https://www.youtube.com/@KatieBrindleOfficial/videos To contact Katie, email: ownyourhealth@katiebrindle.com Sign up to Katie's newsletter: https://www.katiebrindle.com/ Disclaimer: Techniques highlighted in this episode are designed to support your overall wellbeing and should not be used as a substitute for any medical treatment you may be undergoing. You should not use the information in this podcast for diagnosing or treating a health problem or disease. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Lymph nodes are little bean shaped structures filled with the cells of the immune system and dotted around the body. Pathogens from skin injuries or that enter the body in other ways are passed to a lymph node and the cells here can respond. They are major parts of the immune system but metastatic cancer cells may also pass here, get stuck and continue to proliferate. This is important anatomy then, so let's quickly talk about it in around 5 minutes of podcast world time.

August 23, 2024 Mark, Scott, and Ray talk about two questions that came into the PRS Communities:I have Optum requesting records on all of our clot evac cases where something in the bladder was fulgurated during the same session and after record review we fail the audit.Now compliance is very quick to say refund it, stop billing it, its bundled, etc.But we know a modifier is allowed so when is it allowed????Everything I find online like AAPC says to bill both 52214 and 52001-59 but there is nothing recent and nothing concrete about what is considered distinct. I mean using a clot evacuator is different than using a loop electrode. Below are the Optum rationales.So the urologist does a cysto on hematuria work up, and they wind up using an evacuator to remove huge amounts of clot burden. Then use a loop electrode to fulgurate some areas that look suspicious.Why is that service not considered distinct? Compliance says its incidental but they can't tell me when it wouldn't be incidental and I don't want to let optum take back money without an argument.Hi, I would like to ask a coding question please. Thank you so much!For Robot-assisted left partial nephrectomy and Resection of a left renal hilar lymph node, Do we code any additional CPT to capture renal hilar lymph node, in addition to partial nephrectomy 50543?Pathology report had a separate report for Renal hilar lymph node dissection, which was negative for carcinoma. And for partial nephrectomy, path showed Renal cell carcinoma. PRS Billing and Other Services - Book a Call with Mark Painter or Marianne DescioseClick Here to Get More Information and Request a QuoteUrology Advanced Coding and Reimbursement Seminars - In-Person SeminarsRegister Now for the Urology Advanced Coding and Reimbursement SeminarSpecial Early Bird code: 25UACRS732 Click Here for Information and RegistrationEvent DetailsLocation:Las Vegas: December 6-7, 2024, at HorseshoeNew Orleans: January 31-February 1, 2025, at Harrah'sTime: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pmIncludes: Breakfast and Lunch on both days, plus 14 AAPC CEUs   The Thriving Urology Practice Facebook group.The Thriving Urology Practice Facebook Group link to join:https://www.facebook.com/groups/ThrivingPractice/    Join the discussion:Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.Click Here to Start Your Free Trial of AUACodingToday.com

Data analyst John Beaudoin returns with what he calls the “BIGGEST story” that everyone is missing about the pandemic, paradoxes in the graphing data, and evidence of an increase in lymph node cancer. Dr. Kelly Victory is filling in as host, joined by Beaudoin and CHD's Karl Jablonowski Ph.D. John Beaudoin, Sr. is an engineer and data analyst with a background in high-tech and military sales. He is the author of “The Real CdC: COVID Facts For Regular People” and “The CDC Memorandum”. Follow him at https://x.com/JohnBeaudoinSr and read more at https://TheRealCdC.com Karl Jablonowski Ph.D. is a specialist in Biomedical and Health Informatics. He has expertise in managing terabyte-sized databases, including biological and electronic medical record systems. Dr. Jablonowski's research contributions include over 14 peer-reviewed journal articles focused on data mining and analysis for scientific investigation. His work centers on leveraging large-scale data for advancements in health and biomedical sciences. 「 SUPPORT OUR SPONSORS 」 Find out more about the brands that make this show possible and get special discounts on Dr. Drew's favorite products at https://drdrew.com/sponsors  • FATTY15 – The future of essential fatty acids is here! Strengthen your cells against age-related breakdown with Fatty15. Get 15% off a 90-day Starter Kit Subscription at https://drdrew.com/fatty15 • CAPSADYN - Get pain relief with the power of capsaicin from chili peppers – without the burning! Capsadyn's proprietary formulation for joint & muscle pain contains no NSAIDs, opioids, anesthetics, or steroids. Try it for 15% off at https://drdrew.com/capsadyn • PALEOVALLEY - "Paleovalley has a wide variety of extraordinary products that are both healthful and delicious,” says Dr. Drew. "I am a huge fan of this brand and know you'll love it too!” Get 15% off your first order at https://drdrew.com/paleovalley • TRU NIAGEN - For almost a decade, Dr. Drew has been taking a healthy-aging supplement called Tru Niagen, which uses a patented form of Nicotinamide Riboside to boost NAD levels. Use code DREW for 20% off at https://drdrew.com/truniagen • THE WELLNESS COMPANY - Counteract harmful spike proteins with TWC's Signature Series Spike Support Formula containing nattokinase and selenium. Learn more about TWC's supplements at https://twc.health/drew 「 MEDICAL NOTE 」 Portions of this program may examine countervailing views on important medical issues. Always consult your physician before making any decisions about your health. 「 ABOUT THE SHOW 」 Ask Dr. Drew is produced by Kaleb Nation (https://kalebnation.com) and Susan Pinsky (https://twitter.com/firstladyoflove). This show is for entertainment and/or informational purposes only, and is not a substitute for medical advice, diagnosis, or treatment. Learn more about your ad choices. Visit megaphone.fm/adchoices

A TEAM OF SCIENTISTS HAVE LAUNCHED THE FIRST HUMAN TRIAL IN AN ATTEMPT TO GROW A NEW LIVER INSIDE OF A HUMAN USING LYMPH NODES, WHICH COULD TRANSFORM ORGAN DONATION IF SUCCESSFUL. WE SPEAK WITH DR. MICHAEL HUFFORD, CEO OF LYGENESIS, A PITTSBURGH-BASED BIOTECH COMPANY BEHIND THE RESEARCH.

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In this episode of the PRS Global Open Keynotes podcast, Dr. Marcello Molle discusses different techniques for identifying the sentinel lymph node for patients with melanoma. This episode discusses the following PRS Global Open article: Comparison of Different Techniques for the Assessment of Sentinel Lymph Node Biopsy in Melanoma: A Systematic Review by Sara Izzo, Marcello Molle, Francesco Paolo Gesuete, Claudia De Intinis, Paolo Izzo, Luciano Izzo and Giovanni Francesco Nicoletti. Read the article for free on PRSGlobalOpen.com: https://bit.ly/LymphMelanoma Dr. Marcello Molle is a senior resident at the Universita degli studi della campania Luigi Vanvitelli in Naples, Italy. Your host, Dr. Damian Marucci, is a board-certified plastic surgeon and Associate Professor of Surgery at the University of Sydney in Australia. #PRSGlobalOpen #KeynotesPodcast #PlasticSurgery

A perennial topic on GU Cast!! But today we welcome a couple of very useful papers in European Urology Oncology which help us understand how PSMA PET/CT can help patient selection for pelvic lymph node dissection in prostate cancer. We are joined by Dr Giorgio Gandaglia from San Raffaele Hospital in Milano to discuss these two papers (links below). We also hear about Declan's recent trip to San Raffaele as Visiting Professor, and he sits down for a wide-ranging chat with professor Francesco Monitorsi, Director & Professor of Urology at San Raffaele. Even better on our YouTube channelLinks:Can PSMA reduce PLND? A systematic reviewOptimal use of PSMA to select patients for PLND. Updated validation of the Briganti and MSKCC nomograms

Ang Cui joins Immune to discuss her career and her work on establishing the Immune Dictionary, a compendium of single-cell transcriptomic profiles of more than 17 immune cell types in response to each of 86 cytokines (>1,400 cytokine-cell type combinations) in mouse lymph nodes in vivo. Hosts: Vincent Racaniello, Cynthia Leifer, and Brianne Barker Guest: Ang Cui Subscribe (free): Apple Podcasts, Google Podcasts. RSS, email Become a patron of Immune! Links for this episode MicrobeTV Discord Server Publishing is broken (Solving for Science) Immune Dictionary (Nature) Time stamps by Jolene. Thanks! Music by Steve Neal. Immune logo image by Blausen Medical Send your immunology questions and comments to immune@microbe.tv

Dr Ashish Kamat (MD Anderson Cancer Centre, Houston),  joins Declan and Renu to discuss a very nice paper recently published in European Urology Oncology overviewsing the role of lymph node dissection (LND) in GU oncology. Really nice piece of work led by Dr Amanda Myers along with a bunch of well known names in urologic oncology. A very succinct summary of LND in bladder, upper tract urothelial, renal, prostate, penile and testicular cancer. Check out the link below to find the full paperEven better on our YouTube channelLinksMyers et al paper 

Carla Nowosad joins Immune to discuss her career and her work on germinal centers, the structure in secondary lymphoid tissues where B cells proliferate, differentiate, and diversify their immunoglobulin genes by somatic hypermutation. Hosts: Stephanie Langel, Cynthia Leifer, and Brianne Barker Guest: Carla R. Nowosad Subscribe (free): Apple Podcasts, Google Podcasts. RSS, email Become a patron of Immune! Links for this episode MicrobeTV Discord Server B cells and the intestinal microbiome (Sem Immunol) B cell selection in gut germinal centres (Nature) B cell antigen internalization (Methods Mol Biol) Immune synapse architecture (Nat Immunol) Time stamps by Jolene. Thanks! Music by Steve Neal. Immune logo image by Blausen Medical Send your immunology questions and comments to immune@microbe.tv

Breast cancers that are lymph node-positive are usually treated with chemotherapy before surgery (neoadjuvant chemotherapy). If those cancers become lymph node-negative after neoadjuvant chemotherapy, there's been a debate about whether to treat the nodes or not. A new study has practicing-changing results: Nodal radiation isn't need. Dr. Marisa Weiss, Breastcancer.org chief medical officer and founder, and radiation oncologist, explains the findings. Listen to the podcast to hear Dr. Weiss explain: why there has been debate about how to treat this type of breast cancer the study results what the results mean for patients

SABR supremos Piet Ost and Shankar Siva join us to discuss the management of lymph node-only recurrence following primary treatment of prostate cancer. And of course our resident PSMA PET/CT guru Michael Hofman also turned up as himself and Piet love debating the merits of PSMA!How and when shoudl we image for biochemical recurrence? What are the limits of SABR? WHat about systemic therapy? It's all in this episode with great leaders in the field.Recorded on site at Peter Mac on the fringe of the 2023 SABR Symposium. With your usual hosts Renu Eapen and Declan MurphyEven better on our YouTube channel 

Keep that lymph fluid flowing at Gentle Wellness Center! More details at https://www.mygentlewellness.com/ Gentle Wellness Center City: Fairfax Address: 12011 Lee Jackson Memorial Highway, STE 420 Website http://www.mygentlewellness.com Phone +1-703-996-3999 Email info@mygentlewellness.com

Immune reveals the total mass (1.2kg), number (1.8 trillion), and distribution of immune cells in the human body, with macrophages contributing nearly 50% of the total cellular mass. Hosts: Vincent Racaniello, Cynthia Leifer, and Brianne Barker Subscribe (free): Apple Podcasts, Google Podcasts. RSS, email Become a patron of Immune! Links for this episode MicrobeTV Discord Server Immune cells in the human body (PNAS) Letters read on Immune 73 Time stamps by Jolene. Thanks! Music by Steve Neal. Immune logo image by Blausen Medical Send your immunology questions and comments to immune@microbe.tv

Full article: https://ajronline.org/doi/10.2214/AJR.23.29984  Robbie Hill, MD discusses an article in which the authors derive an optimal size threshold for determining retropharyngeal lymph node involvement in nasopharyngeal carcinoma (NPC) based on outcome predictions. The authors show that the optimally derived threshold of 6mm provides better outcome predictions and may lead to improved treatment decision-making for patients with NPC.

Interview with Oreste Davide Gentilini, MD, author of Sentinel Lymph Node Biopsy vs No Axillary Surgery in Patients With Small Breast Cancer and Negative Results on Ultrasonography of Axillary Lymph Nodes: The SOUND Randomized Clinical Trial. Hosted by Jack West, MD. Related Content: Sentinel Lymph Node Biopsy vs No Axillary Surgery in Patients With Small Breast Cancer and Negative Results on Ultrasonography of Axillary Lymph Nodes

Interview with Oreste Davide Gentilini, MD, author of Sentinel Lymph Node Biopsy vs No Axillary Surgery in Patients With Small Breast Cancer and Negative Results on Ultrasonography of Axillary Lymph Nodes: The SOUND Randomized Clinical Trial. Hosted by Jack West, MD. Related Content: Sentinel Lymph Node Biopsy vs No Axillary Surgery in Patients With Small Breast Cancer and Negative Results on Ultrasonography of Axillary Lymph Nodes

Breast cancer is the most commonly diagnosed cancer worldwide, affecting over 2 million women each year. The most important predictor of both recurrence and survival in patients with breast cancer is if cancer has spread to the axillary lymph nodes.Dr. Alyssa Cubbison at The Ohio State University Wexner Medical Center specialises in breast imaging.  She puts forward an algorithm she helped create that uses preoperative ultrasound imaging of the axilla when facing suspected breast cancer.  Read the original research: 10.1016/j.clinimag.2022.04.011Dr. Cubbison can be contacted via Twitter or email

BEST OF HMS PODCASTS - THURSDAY - July 6, 2023 Learn more about your ad choices. Visit megaphone.fm/adchoices

BEST OF HMS PODCASTS - THURSDAY - July 6, 2023 Learn more about your ad choices. Visit megaphone.fm/adchoices

Kottie may just be the biggest worrywart OR she is a genius who discovered the next new strain of covid before any doctors. You can be the judge of that. 

Hosted by: Gregg Nelson, MD, PhD, Social Media Editor of Gynecologic Oncology Featuring: Jennifer Mueller MD, Memorial Sloan Kettering Cancer Center Emad Matanes MD, Rambam Medical Center Emma Rossi MD, Duke University Medical Center Editor's Choice Papers: Sentinel lymph node mapping in patients with endometrial hyperplasia: A practice to preserve or abandon? Is sentinel lymph node assessment useful in patients with a preoperative diagnosis of endometrial intraepithelial neoplasia? Editorial: Routine SLN biopsy for endometrial intraepithelial neoplasia: A pragmatic approach or over-treatment?

Editor's Choice Papers:  Sentinel lymph node mapping in patients with endometrial hyperplasia: A practice to preserve or abandon? Is sentinel lymph node assessment useful in patients with a preoperative diagnosis of endometrial intraepithelial neoplasia? Editorial: Routine SLN biopsy for endometrial intraepithelial neoplasia: A pragmatic approach or over-treatment? Hosted by:Gregg Nelson, MD, PhD, Social Media Editor of Gynecologic Oncology Featuring: Jennifer Mueller MD, Memorial Sloan Kettering Cancer CenterEmad Matanes MD, Rambam Medical CenterEmma Rossi MD, Duke University Medical Center    

Cindy, Steph, Brianne, and Vincent review some of their favorite immunology papers of 2022. Hosts: Vincent Racaniello, Cynthia Leifer, Steph Langel, and Brianne Barker Subscribe (free): Apple Podcasts, Google Podcasts. RSS, email Become a patron of Immune! Links for this episode CAR T for SLE (Nat MEd) Maternal gut microbiome induced IgG (Sci Immunol) Long-primed germinal centers (Nature) Fc mediated protection against SARS-CoV-2 VOC (bioRxiv) Dark side of macrophages (Nat Med) Pregnancy and antibody protection against infection (Nature) Regulators of inflammatory response to mRNA vaccines (Nature Immunol) Antibody effector function and protection against RSV (Cell) Color coded antibodies (bioRxiv) Endogenous retroviruses and inflammation (Cell) CD8 T cells and vaccine protection against SARS-CoV-2 (Sci Immunol) Time stamps by Jolene. Thanks! Music by Steve Neal. Immune logo image by Blausen Medical Send your immunology questions and comments to immune@microbe.tv

Here's something interesting you should know about lymph nodes and your immune system. Dr. Berg's Keto and IF Lab: https://www.facebook.com/groups/drbergslab/ How to Bulletproof your Immune System FREE Course: https://bit.ly/39Ry3s2 FREE MINI-COURSE ➜ ➜ Take Dr. Berg's Free Keto Mini-Course! ADD YOUR SUCCESS STORY HERE: https://bit.ly/3z9TviS Find Your Body Type: https://www.drberg.com/body-type-quiz Talk to a Product Advisor to find the best product for you! Call 1-540-299-1557 with your questions about Dr. Berg's products. Product Advisors are available Monday through Friday 8 am - 6 pm and Saturday 9 am - 5 pm EST. At this time, we no longer offer Keto Consulting and our Product Advisors will only be advising on which product is best for you and advise on how to take them. Dr. Eric Berg DC Bio: Dr. Berg, 51 years of age is a chiropractor who specializes in weight loss through nutritional & natural methods. His private practice is located in Alexandria, Virginia. His clients include senior officials in the U.S. government & the Justice Department, ambassadors, medical doctors, high-level executives of prominent corporations, scientists, engineers, professors, and other clients from all walks of life. He is the author of The 7 Principles of Fat Burning. Dr. Berg's Website: http://bit.ly/37AV0fk Dr. Berg's Recipe Ideas: http://bit.ly/37FF6QR Dr. Berg's Reviews: http://bit.ly/3hkIvbb Dr. Berg's Shop: http://bit.ly/3mJcLxg Dr. Berg's Bio: http://bit.ly/3as2cfE Dr. Berg's Health Coach Training: http://bit.ly/3as2p2q Facebook: https://www.facebook.com/drericberg Messenger: https://www.messenger.com/t/drericberg Instagram: https://www.instagram.com/drericberg/ YouTube: http://bit.ly/37DXt8C Pinterest: https://www.pinterest.com/drericberg/

In this episode, Dr. Art Mollen walks through topics such as what to do about heel and hamstring pain, how to train for a marathon, what you can do to mitigate migraines, how love can positively affect your health, and more!     Head on over to SpeakPipe.com/AskDrArtMollen to record a voicemail to be featured on the show, or email AskDrArtMollen@gmail.com to have your question read aloud and answered!

Christopher Weight, MD, Center Director of Urologic Oncology at Cleveland Clinic joins the Cancer Advances podcast to discuss robot assisted retroperitoneal lymph node dissection (RPLND) for the treatment of testicular cancer. Listen as Dr. Weight explains how this robotic surgery allows shorter hospital stays, quicker recovery time, and a lower rate of chylous ascites.

Hosted by: S. Diane Yamada, MD, Deputy Editor of Gynecologic Oncology Featuring: Maaike Oonk, MD, University Medical Center Groningen, University of Groningen, The Netherlands Akila Viswanathan, MD, MPH, Johns Hopkins Medicine Editor's Choice Paper: Unilateral inguinofemoral lymphadenectomy in patients with early-stage vulvar squamous cell carcinoma and a unilateral metastatic sentinel lymph node is safe Editorial:When is it safe to omit contralateral groin management in unilateral sentinel node-positive early stage vulvar cancer?

In this episode of SurgOnc Today®,  Judy Boughey, MD, from the Mayo Clinic in Rochester, MN, and Vice Chair of the SSO Breast Disease Site Work Group, discusses with her colleagues how they manage a missing clipped axillary lymph node. She is joined by Puneet Singh, MD, from MD Anderson Cancer Center and Firas Eladoumikdachi, MD, from Rutgers Cancer Institute of New Jersey. Their discussion is focused on patients with node positive breast cancer who were treated with neoadjuvant chemotherapy.

Holmberg's Morning Sickness - Opening Break - Tuesday June 28, 2022

Holmberg's Morning Sickness - Opening Break - Tuesday June 28, 2022 Learn more about your ad choices. Visit megaphone.fm/adchoices

Meet long-time STRONG Girl and Toronto-based radio host Sandra Crofford, who takes us through her experience with thyroid cancer and how becoming a STRONG Girl enhanced and changed her life and wellness journey. In this episode, Jenny and Sandra talk about what symptoms to pay attention to, how the thyroid affects our whole body, and the importance of being an advocate for your own health when it comes to investigating those (or any other) unexplained symptoms. Sandra shares her incredible story and reminds us how crucial it is to be mindful, accountable and dedicated to being the best version of yourself. Follow Sandra on IG  JOIN The YOUR BEST BODY PRIVATE COMMUNITY and for the Password say "Jenny invited me"JOIN The YOUR BEST BODY PROGRAM   If you enjoyed this episode, make sure and give us a five star rating  and leave us a review on iTunes, Podcast Addict, Podchaser and Castbox. STRONG Fitness Magazine Subscription Use discount code STRONGGIRLResourcesSTRONG Fitness MagazineSTRONG Fitness Magazine on IGTeam Strong GirlsCoach JVBFollow Jenny on social mediaInstagramFacebookYouTube   

Thank you for joining us for our 2nd Cabral HouseCall of the weekend! I'm looking forward to sharing with you some of our community's questions that have come in over the past few weeks… Kayla: Hi, I am working with an integrative practitioner right now. I have had a sharp pain in my lower left stomach, which she said it was a swollen lymph node. My candida antibodies came back extremely high, so I am currently taking antifungal herbs, as well as a probiotic and it my pain and symptoms seem to be getting worse. Do you think there are other underlying problems contributing to this pain? Or why do you think there is such a sharp pain in the lower left abdomen? Thank you so much!   Jenny: Hi Dr. Cabral - I am a long-time, dedicated podcast listener and am so appreciative of the information and insights you share. I am excited to now be a Ayubowan Member and look forward to receiving on going lab tests and coaching calls along with it. I follow the foundational protocol level 2 daily and also take your immune support products. My question has to do with the new longevity line of products that I am also excited to try. Because some of them include some of the supplements I'm already taking daily, how can I determine whether I should continue with my current supplements in addition to the longevity products? I have been reluctant to order the ones I'm most interested in trying because I am unsure. Much thanks to you and your amazing team!   Hans: how to rid the body of a fatty liver   Mally: Hi Dr. Cabral! Thank you so much for all you do, your podcasts and Equilife products have been SUCH a blessing for me and my family! I have ran a stool & organic acids test test through my local functional doctor, and have completed a 6 month bacteria overgrowth protocol through him. I recently tested for incredibly high levels of Ochratoxin A and started on your mold protocol. (His protocol called from some intense binders, so I did not feel comfortable taking those while my body is already herxing.) I appreciate how your mold protocol has less side effects. My question is, is your protocol able to address mold that has colonized in the sinuses and/or organs? My chronic sinusitis started when I was a kid and I am wondering what the proper expectation should be are far as recovery time. I have seen decent amounts of biofilm in my stool for about 6 months now. Also, is there any bloodwork I should be monitoring while I am detoxing so heavily?   Crystal: Hi Dr. Cabral! Because of my PCOS, I now have chronic dry eye syndrome. I have listened to all of your podcasts on dry eye that I could find and nothing seems to help. The only thing that has seemed to help the constant burning are Restasis eye drops that my eye doctor prescribed me. The dry eye suddenly started in Feb. 2020 out of nowhere and ever since, my eyes are really red and a large, visible, red vein has formed in my right eye. My eye doctor told me it will never go away, but I just don't want to believe that. My eyes have always been my best feature and I hate having red eyes all of the time and this giant red vein. What can I do to stop my dry eye and can I ever get rid of the red vein? Sorry my question is so long, but I so appreciate you taking your time out to answer my question and I value your work and advice so much. Thank you Dr. Cabral, you are my biggest inspiration!   Michael: Hi Dr Cabral what would cause someone to burp omega 3 capsules? I've tried many functional medicine brands but I keep burping them. I have low stomach acid, tested positive for h pylori and I probably have sibo as well. Thank you for tuning into this weekend's Cabral HouseCalls and be sure to check back tomorrow for our Mindset & Motivation Monday show to get your week started off right! - - - Show Notes & Resources:  http://StephenCabral.com/2270 - - - Dr. Cabral's New Book, The Rain Barrel Effect https://amzn.to/2H0W7Ge - - - Join the Community & Get Your Questions Answered: http://CabralSupportGroup.com - - -  Dr. Cabral's Most Popular At-Home Lab Tests: > Complete Minerals & Metals Test (Test for mineral imbalances & heavy metal toxicity) - - - > Complete Candida, Metabolic & Vitamins Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Complete Stress, Mood & Metabolism Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Complete Stress, Sleep & Hormones Test (Run your adrenal & hormone levels) - - - > Complete Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Complete Omega-3 & Inflammation Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels)