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PubMedDate not supplied

Nonpalpable lymph nodes of the neck: assessment with US and US-guided fine-needle aspiration biopsy.

Ultrasound (US) and US-guided fine-needle aspiration biopsy (FNA) were performed in 91 nonpalpable neck nodes of 70 patients, 98% of which had known malignancy. Various sonographic findings were evaluated for predicting malignancy. The accuracy of US-guided FNA for detecting malignancy was 88%, with 96% sensitivity and 94% specificity. The ratio of minimal to maximal axial diameters of a node was most valid for predicting malignancy with US. A ratio of more than 0.55 yielded the highest accuracy (80%) (92% sensitivity, 63% specificity). Addition of any other factors to this criterion did not improve its accuracy. US and US-guided FNA are accurate for the assessment of nonpalpable neck nodes. Lymph nodes with a round configuration should be biopsied in patients with known malignancy.

Adolescent↗
PubMed1966

Antibody formation by single cells from lymph nodes and efferent lymph of sheep.

The antibody-forming cells which appear in the popliteal lymph node and efferent lymph of the sheep following immunization with boiled Salmonella have been studied by light and electron microscopy. Cells were incubated in monolayers with target erythrocytes sensitized with bacterial lipopolysaccharide. Three types of interaction between a proportion of the lymph cells and the erythrocytes surrounding them have been shown to indicate antibody formation: plaque-formation, immuno-cyto-adherence, and localized agglutination. At the peak of the response, 4 days after antigenic stimulation approximately 1 cell in every 200 from lymph node suspensions produces detectable specific antibody, while up to 1 cell in 20 in the lymph is active. For light microscope examination, individual antibody-forming cells were smeared in serum and stained with Leishman's stain. For electron microscopy, a number of active cells were clumped with antiserum to form a specimen of convenient size, then sectioned. Most of the active cells from efferent lymph are large and basophilic, while a small proportion are blastlike. These cells contain abundant free ribosomes and very little endoplasmic reticulum. In the node only, an additional class of antibody-forming plasma cells is found which have considerable amounts of endoplasmic reticulum in their cytoplasm.

Animals↗
PubMed2006

Surgical management of the groin lymph nodes in melanoma in the era of sentinel lymph node dissection.

HYPOTHESIS: Intraoperative lymphatic mapping and sentinel lymphadenectomy (LM/SL) has become an increasingly popular surgical technique for staging the regional lymph nodes in early-stage melanoma. The technique of LM/SL has potentially great advantage for the groin, where the morbidity of superficial groin dissection or iliac dissection can be high. The surgical management of these basins is unknown for patients with tumor-positive sentinel lymph nodes (SNs). DESIGN: Cohort of successive patients undergoing LM/SL over 18 years. Those patients found to have tumor-positive SNs underwent sentinel complete lymph node dissection. Postoperatively, patients were followed up on a routine basis with serial examinations and chest radiography. The median follow-up was 50 months. SETTING: Tertiary cancer center. PATIENTS: The technique of LM/SL was performed for 431 consecutive patients. Sentinal lymph nodes were identified in each case. Patients with tumor-positive SNs underwent sentinel complete lymph node dissection. INTERVENTION: Cutaneous lymphoscintigraphy and blue dye with or without use of the gamma probe-directed LM/SL. Sentinel lymph nodes were examined by hematoxylin-eosin staining and immunohistochemistry staining with HMB-45 and S100 protein. Only patients with tumor-positive SNs had sentinel complete lymph node dissection. Main Outcome Measure Computer-assisted database with statistical analyses using log-rank tests and Cox regression models. RESULTS: Of the 431 patients, 264 (61%) were women and the median age was 50 years (age range, 15-89 years). A majority (86%) of the primary tumors were on the lower extremities, 54% were of Clark level IV or V, and there was a mean +/- SD thickness of 1.89 +/- 1.59 mm (range, 0.30-14.00 mm). Ninety-three patients (21%) were found to have tumor-positive SNs. After LM/SL and sentinel complete lymph node dissection, 62 patients (67%) were found to have a single tumor-positive lymph node, 25 (27%) had 2 tumor-positive lymph nodes, and 6 (6%) had 3 or more tumor-positive lymph nodes. Only 12 patients (4%) with tumor-negative SNs have had recurrence in the dissected basin. The 5-year overall survival was significantly better for patients with tumor-negative lymph nodes (mean +/- SD 5-year overall survival, 94% +/- 5%) than for patients with tumor-positive lymph nodes (mean +/- SD 5-year overall survival, 75% +/- 4%) (P < .01). The tumor status of the Cloquet lymph node was predictive of the tumor status of the iliac lymph nodes. Multivariate analyses with a Cox regression model identified tumor-positive SN (P = .001), primary tumor thickness (P = .03), and ulceration (P = .001) as being predictive of survival. Sex, age, Clark level, and primary site were not significant (P > .05). CONCLUSIONS: Our results demonstrate the prognostic significance of LM/SL for early-stage melanoma draining to the groin basin. The accuracy of LM/SL measured by the rare recurrences suggests that this surgical procedure should become standard for patients with early-stage melanoma of the lower extremities and trunk. Sampling of the Cloquet node should be used to determine the need for iliac dissection when a tumor-positive SN is identified in the groin.

Adolescent↗
PubMed2004

Endometrial cancer metastatic to infrarenal aortic lymph nodes unrecognized during laparoscopic inframesenteric aortic lymph node dissection.

BACKGROUND: The incidence of isolated aortic nodal metastasis in clinical stages I and II endometrial cancer is generally low. Nevertheless, para-aortic nodes are still assessed during staging procedures, which include hysterectomy, bilateral salpingo-oophorectomy (BSO), and pelvic and para-aortic lymph node sampling up to the level of the inferior mesenteric artery (IMA). The procedure can be performed either abdominally or laparoscopically. It is unclear, however, as to whether infrarenal aortic nodal sampling above the IMA should be routinely performed. CASE: We describe a case of endometrial cancer metastatic to the infrarenal para-aortic lymph nodes above the IMA, missed during laparoscopic inframesenteric lymph node dissection, and found on subsequent laparotomy performed to resect matted pelvic nodes. CONCLUSIONS: The infrarenal para-aortic region above the IMA may be at risk for nodal metastasis in women with endometrial cancer. Consideration should be given to evaluate this area during staging laparotomy or laparoscopy. The role of routine bilateral infrarenal aortic nodal dissection needs further evaluation.

Endometrial Neoplasms↗
PubMed1975

[Contrast retention in retroperitoneal lymph nodes after lymphography; the effect of lymph node abnormalities, radiotherapy and contrast quantity].

The rate of contrast loss from retroperitoneal lymph nodes after lymphography was studied radiologically over a prolonged period in 302 patients. It varied remarkably, even in normal persons who were not receiving any treatment. Lymph nodes empty more quickly if only a small quantity of contrast has been used. Irradiation accelerates contrast transport, not only in the irradiated, but also in the neighbouring, group of nodes. This effect is dose dependent. There is evidence that pathological lymph nodes empty more quickly than normal ones.

Adult↗
PubMed2004

The size of metastatic foci and lymph nodes yielding false-negative and false-positive lymph node staging with positron emission tomography in patients with lung cancer.

BACKGROUND: We examined the sizes of lymph nodes and metastatic foci within the lymph nodes that affect false-positive and false-negative lymph node staging by positron emission tomography in lung cancer. METHODS: Preoperative positron emission tomography and computed tomography scans were performed for 564 lymph node stations in 80 patients with peripheral-type lung cancer. The sizes of both the lymph nodes and the metastatic foci within the lymph nodes were measured, and these measurements were compared with those obtained with positron emission tomography scanning. To establish general sizes of metastatic foci within the lymph nodes, 277 metastatic lymph nodes in operative specimens previously resected from another 111 patients with lung cancer were examined as a control. RESULTS: The sensitivity was significantly higher for positron emission tomography than for computed tomographic scanning (P =.026). The sizes of metastatic foci within lymph nodes that showed false-negative (n = 8) and true-positive (n = 28) with positron emission tomography ranged from 0.5 to 9 mm (3 +/- 1 mm) and from 4 to 18 mm (10 +/- 3 mm), respectively (P <.001). None of the metastatic foci smaller than 4 mm could be detected with positron emission tomography scanning. The review of the 277 previously resected metastatic lymph nodes showed that 89 (32%) had metastatic foci smaller than 4 mm. The sizes of true-positive (n = 28) and false-positive (n = 10) lymph nodes ranged from 6 to 15 mm (10 +/- 2 mm) and from 9 to 16 mm (12 +/- 2 mm), respectively (P <.01). None of the false-positive lymph nodes was smaller than 9 mm. CONCLUSIONS: Although positron emission tomography was superior to computed tomography scanning in lymph node staging in lung cancer, positron emission tomography was unable to distinguish metastatic foci smaller than 4 mm, which were not unusual sizes for lymph node metastases in lung cancer. Positive lymph nodes with positron emission tomography smaller than 9 mm are likely to be true-positive rather than false-positive.

Adenocarcinoma↗
PubMed1999

Sentinel-node guided lymph-node dissection for merkel cell carcinoma.

Merkel cell carcinoma is an aggressive neuroendocrine skin tumour. Treatment is still debatable. Merkel cell carcinoma resembles malignant melanoma in its cutaneous presentation and its embryonic origin; both have unpredictable biological behaviour, early regional lymph node involvement, early distant metastases and a high recurrence rate. In light of these common features, we used pre-operative lymphoscintigraphy, intraoperative lymph-node mapping and sentinel-node biopsy-a well-described technique for the treatment of melanoma-in a 60-year-old man with Merkel cell carcinoma in the right buttock. Following frozen section identification of a metastatic first-order sentinel node, radical right groin dissection was performed. All the other lymph nodes in this basin proved to be disease-free, including the second-order sentinel node and Cloquet node. The patient is now being treated with adjuvant chemotherapy and radiotherapy. This case shows that sentinel-node guided dissection is applicable to Merkel cell carcinoma.

Carcinoma, Merkel Cell↗
PubMed2003

[Fine needle aspiration cytology as diagnostic bed-side method for differential diagnostics of enlarged peripheral lymph nodes].

Enlarged lymph nodes are a common diagnosis in clinical practice. The causes are varied and both benign or malignant processes might be responsible. Clearly it is important to quickly discern whether the origin is malignant or benign. The aim of this study was to evaluate the reliability and efficacy of aspiration cytology of enlarged lymph nodes. 398 patients with peripheral enlarged lymph nodes, who, in the course of a five-year period, were subjected to at least one immediate cytologic analysis (bed-side-analysis), were included in the study. For comparison the gold standard was defined as either the histological result of a corresponding biopsy or the clinical outcome within an observation period of one year. Cytology analysis reached a sensitivity of 97.6% and a specificity of 96.0% of all lymph nodes analysed. For metastatic lymph nodes of solid neoplasmas (mainly bronchial carcinoma) sensitivity was even 98.7% (90.6% for malignant lymphomas). In conclusion, fine needle lymph node aspiration cytology is a quick, reliable, technically simple method for further assessment of enlarged lymph nodes in order to distinguish between benign and malignant causes. Further differentiation of the underlying type of malignant origin can be achieved with high efficacy. Thus, in the hands of a qualified investigator, fine needle lymph node aspiration cytology is a suitable method for use on a bed-side basis.

Biopsy↗
PubMed2001

Cytokeratin immunostaining patterns of benign, reactive lymph nodes: applications for the evaluation of sentinel lymph node specimen.

The use and interpretation of cytokeratin (CK) immunostains of sentinel lymph node specimens for breast carcinoma remain controversial. Variable immunoreactivity with anti-CK antibodies and CK-positive interstitial reticulum cells may complicate interpretation. The authors examined a series of reactive lymph nodes selected from patients without a history of malignancy. To demonstrate potential diagnostic pitfalls, three different CK antibody combinations were studied to characterize the immunostaining patterns. Formalin-fixed sections of lymph nodes were immunostained with a labeled streptavidin-biotin method using a DAKO autostainer. The anti-CK antibody preparations evaluated were AE1/AE3, CAM 5.2, and an in-house-prepared CK cocktail composed of 7 antibodies. The authors observed that up to 10% of cells in benign, reactive lymph nodes may be immunoreactive with anti-CK antibodies. AE1/AE3 stained 2 of 20 cases with rare immunoreactive reticulum cells, whereas CAM 5.2 and the CK cocktail immunostained cells in 85% of cases with reticulum cells in sinuses and the paracortex. Rare positive to 2+ cells were present in a similar distribution with these two antibodies. Careful interpretation of CK immunostaining of sentinel lymph node biopsies is essential, as is awareness of the presence of CK-positive native reticulum cells, to avoid confusion with single cells of metastatic carcinoma.

Adolescent↗
PubMed1997

Selective disruption of lymphotoxin ligands reveals a novel set of mucosal lymph nodes and unique effects on lymph node cellular organization.

Lymphotoxin (LT) provides a critical signal for the genesis of lymph nodes (LN) in mice. Here we show that mice treated in utero with LT beta-R-Ig, which binds to the membrane LT alpha 1 beta 2 heterotrimer, lacked most LN, yet retained a set of mucosal surface draining LN. Since mice genetically deficient in LT alpha lack all LN, including the mucosal set, we hypothesize that a novel LT alpha-dependent pathway controls their genesis. This novel set of mucosal LN cannot be discriminated on the basis of addressin expression. The discovery of LN in mice treated with LT beta-R-Ig fusion protein in utero allowed us to compare the roles of membrane LT alpha beta or soluble LT alpha/tumor necrosis factor (TNF) in the development of cellular organization in LN and spleen. Our results indicate that both membrane LT alpha beta and soluble LT alpha/TNF mediate T-B cell segregation and the organization of B cell follicles in spleen and LN. Interestingly, while antagonism of membrane LT alpha beta or soluble LT alpha/TNF prevented germinal center (GC) formation in spleen, antagonism of soluble LT alpha/TNF had no effect on LN formation. The data suggest that multiple LT/TNF ligands control B cell follicle organization in the spleen and LN of adult mice, and that the requirements for LT/TNF ligands in GC formation are distinct in the different lymphoid organs.

Animals↗
PubMed1993

[Ultrasound diagnosis of cervical lymph node tuberculosis].

Lymph node tuberculosis is the most frequent tuberculous manifestation in the otorhinolaryngological area. In 13 patients with histologically verified tuberculous lymphadenitis cervical sonographic examinations revealed characteristic findings. The sonographic features typical for this disease were multiple, enlarged, conglomerating roundish and oval lymph nodes. These lymph nodes were hypoechoic, exhibited dorsal sound amplification and had sharp margins. With caseation, however, there were blurred borders. In cold abscesses an inhomogeneous texture with inhomogeneous shadows was found. Differential diagnosis included non-specific abscess-forming lymphadenitis, lymph node metastases and malignant lymphoma. A tentative diagnosis of cervical lymph node tuberculosis may be made due to the polymorphous sonographic pattern if history and clinical findings are taken into account. A proper histological and microbiological work-up is still essential for confirmation of the sonographic diagnosis.

Adult↗
PubMed1990

[Correlation of lymph node size and metastatic involvement of lymph nodes in bronchial cancer].

For preoperative staging in lung cancer mediastinoscopy is in competition with X-ray, tomography, and computer-tomography (CT). Many authors certify a high sensitivity and specificity to CT in staging lung cancer preoperatively by measuring the diameter of the hilar and mediastinal lymph nodes. In this study we measured the diameter of 162 lymph nodes from 83 patients postoperatively. In view of staging we found no sufficient correlation between the diameter of the lymph nodes and their infiltration by cancer cells. Even 35.7% of the nodes with a diameter of more than 2 cm were not infiltrated. The data support the opinion that CT alone is not sufficient for preoperative staging in lung cancer.

Adenocarcinoma↗
PubMedDate not supplied

Lymph node revealing solution: a new method for lymph node sampling: results in gastric adenocarcinoma.

Staging of gastric carcinoma depends on exact lymph node status. However, very small nodes are not easily found as they are obscured by the surrounding adipose tissue. The purpose of the present study was to demonstrate the usefulness of a Olymph node revealing solutionO (LNRS) in gastric cancer. The perigastric adipose tissue of ten OproblematicO cases of gastric carcinoma, in which <10 lymph nodes were found using the traditional method, was immersed in LNRS for 6-12 h. Subsequently, the lymph nodes stood out as white chalky nodules. They were excised and processed routinely. The traditional method yielded a total of 30 lymph nodes with a mean size of 6.69 +/- 3.43 mm. The LNRS revealed 89 additional nodes with a mean size of 3.03 +/- 3.43 mm, which was significantly smaller. The Node (N) stage was changed in four cases from Nx to N0, in one case from N1 to N2, and in one case from N0 to N2. LNRS seems to be the technique of choice for staging of patients with gastric adenocarcinoma in whom <10 lymph nodes were found with the traditional method and accurate staging was not possible.

Adenocarcinoma↗
PubMed1999

Lymph node revealing solution: is it effective on detecting minute lymph nodes?

AIMS: The aim of this prospective study is to detect the efficiency of a previously described lymph node revealing solution (LNRS) in comparing with conventional lymph node dissection and re-dissection in colon, breast and urinary bladder carcinomas. METHODS: Total 30 cases in which less than 10 lymph nodes were found by conventional method, were immersed for 6-8 hours in LNRS, dissected and processed. Control group, 12 cases, was first dissected then a second conventional dissection was performed. At the end, specimens were again immersed in LNRS for 6-8 hours and last dissections were done. MAIN RESULTS: In the first group, a total of 150 lymph nodes, 46 of them with metastasis were detected. After using LNRS, 26 additional lymph nodes among which 10 were positive were detected. When compared with the results of conventional dissection, the increase in number of total and metastatic lymph nodes with LNRS was significant (p<0.01). The mean size of the lymph nodes detected by the conventional and LNRS methods was 6.8 and 4.2 mm, respectively. The pathologic lymph node stage was changed in three bladder carcinoma cases, and one breast carcinoma. In the control group, 75 lymph nodes (11 with metastases), 19 lymph nodes (3 with metastases), 14 lymph nodes (one with metastases) were detected after first and second conventional dissection and LNRS methods, respectively. CONCLUSION: LNRS enhanced the number of total and metastatic lymph nodes and is effective in detecting small lymph nodes. This method is useful for accurate staging where the number of detected lymph nodes is too small by the conventional method.

Adenocarcinoma↗
PubMed1988

[Lymph node metastasis of early gastric cancer and lymph node dissection].

Five hundred and four cases of early gastric cancer and their status of lymph node metastases were analyzed. The patients were classified into 4 groups by age; Group A: Younger than 50 years, Group B: 50-59, Group C: 60-69 and Group D: Over 70 years. The tumors were divided into 2 histologic groups, differentiated type and undifferentiated type. The results are as follows. 1. The incidence of lymph node metastasis was 2.4% in mucosal cancer and 17.1% in submucosal cancer. 2. The incidence of lymph node metastasis in Group D was remarkably lower compared to that in other younger groups. 3. No lymph node metastasis was found in mucosal cancer of differentiated type. 4. Positive node was usually found in the regional nodes near the tumor and in the nodes adjacent to the left gastric artery. 5. Extended lymph node dissection is not necessary for the patient over 70 years and for mucosal cancer of differentiated type.

Aged↗
PubMedDate not supplied

Indications for paraaortic lymph node dissection in gastric cancer patients with paraaortic lymph node involvement.

BACKGROUND/AIMS: The surgical results for stage IVb gastric cancer remain very poor. The purpose of the current study is to reveal indications for paraaortic lymph node dissection in stage IVb gastric cancer patients with paraaortic lymph node involvement by analyzing prognostic factors for 3-year survival of stage IVb gastric cancer patients followed by curative B resection. METHODOLOGY: The 3-year survival in clinicopathologic variables were compared by univariate analysis. Using Cox proportional hazards regression model, independent prognostic factors were identified from 11 variables. RESULTS: Overall 5-year survival in stage IVb was 26.5%; mean survival was 19 months. Using univariate analysis, p53 expression significantly influenced 3-year survival. Using Cox proportional hazards regression model, the number of total positive lymph nodes, the number of positive paraaortic lymph nodes, and p53 expression were independent prognostic factors. CONCLUSIONS: In stage IVb, paraaortic lymph node dissection should be indicated in patients with < or = 10 total positive lymph nodes, and < or = 3 positive paraaortic lymph nodes or p53 expression < or = 50%. This indication can be applied according to the preoperative imaging, the staining of p53 by endoscopic biopsy specimens and the intraoperative microscopic evaluation of dissected lymph nodes.

Adult↗
PubMed2005

Allelic imbalance in primary breast carcinomas and metastatic tumors of the axillary lymph nodes.

Axillary lymph node status is the most important prognostic factor in predicting disease outcome in women with breast cancer. A number of chromosomal aberrations in primary breast tumors have been correlated with lymph node status and clinical outcome, but chromosomal changes particular to metastatic lymph node tumors have not been well studied. DNA samples isolated from laser-microdissected primary breast and metastatic axillary lymph node tumors from 25 women with invasive breast cancer were amplified using 52 microsatellite markers defining 26 chromosomal regions commonly deleted in breast cancer. Levels and patterns of allelic imbalance (AI) within and between breast and lymph node tumors were assessed to identify chromosomal alterations unique to primary or metastatic tumors and to examine the timing of metastatic potential. The overall frequency of AI in primary breast tumors (0.24) was significantly greater (P < 0.001) than that in lymph node tumors (0.10), and congruent AI events were observed for < 20% of informative markers. AI at chromosomes 11q23.3 and 17p13.3 occurred significantly more frequently (P < 0.05) in primary breast tumors alone; no chromosomal regions showed a significantly higher AI frequency in lymph nodes. Higher rates of AI in primary versus metastatic lymph node tumors suggest that acquisition of metastatic potential may be an early event in carcinogenesis, occurring before significant levels of AI accumulate in the primary tumor. In addition, patterns of AI were highly discordant between tumor types, suggesting that additional genetic alterations accumulated independently in the two cell populations.

Allelic Imbalance↗