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Results for “lymph node metastasis”

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PubMedDate not supplied

[Evaluation of occult lymph node metastasis in lower lip cancers and approach to N(0) neck metastasis].

OBJECTIVES: In this study, we evaluated the incidence of occult lymph node metastasis and the approach to N0 necks in carcinoma of the lower lip. PATIENTS AND METHODS: Sixty-eight patients who underwent surgery for squamous cell carcinoma of the lower lip were monitored for a minimum period of three years. All the patients were males (mean age 54 years; range 36 to 69 years). Preoperatively, 15 and 53 patients had N+ and N0 necks, respectively. Depending on the tumor localization, unilateral or bilateral suprahyoid neck dissections were performed. Nine patients underwent radical neck dissection following detection of metastasis on histopathologic examination. RESULTS: Histopathologic examination revealed metastasis in four patients (4/15; 26%) with N+ necks and in five patients (5/53; 9.4%) with N0 necks. Four patients (6.7%) developed late cervical lymph node metastasis at level 3. No evidence of neck disease was encountered in 93% of patients. CONCLUSION: Suprahyoid neck dissection appears to be effective in detecting occult lymph node metastasis. With improved surgical and histopathologic techniques and consideration of skip metastasis, more aggressive treatment approaches may be employed and better survival rates may be obtained.

Adult↗

PubMed1999

Submucosal gastric cancer with lymph node metastasis--a clinicopathological study.

We have reviewed the clinicopathological features of submucosal gastric cancer with lymph node metastasis. The degree of vertical submucosal infiltration was classified into three stages as sm1, sm2 or sm3. The number of cases with lymph node metastasis of sm3 was significantly more than that of sm1 or sm2. We found no correlation between the tumor size and the rate of lymph node metastasis from submucosal invasive cancer. Accordingly, we concluded that the vertical submucosal infiltration was a more important factor for lymph node metastasis than horizontal infiltration. Minimal invasive surgery was recommended for a tumor measuring 1 cm or less in size with vertical submucosal invasion of sm1 or sm2.

Gastric Mucosa↗

PubMed1981

Response of lymph node metastasis to sequential estrogen and radiation therapy in prostate carcinoma.

Increasingly sophisticated diagnostic studies have shown a high incidence of tumor spread to the regional lymph nodes. The status of the lymph nodes has been evaluated by noninvasive diagnostic procedures such as lymphangiography and computerized axial tomography. The applicability of these procedures has been enhanced by the use of stringent criteria. Gross lymph node metastasis can be diagnosed with considerable confidence. Serial observations of lymphangiograms and computerized axial tomograms before and two months after the administration of estrogens provide an added dimension to the interpretation of lymph node metastasis. The nature and range of the response of lymph node metastasis were observed. Survival of patients with gross lymph node metastasis treated by sequential estrogen and radiation therapy was evaluated. A total of 11/18 (61 per cent) of patients remained free of symptoms, 8/11 (74 per cent) with a favorable lymph node metastasis responsive to estrogen therapy, and 3/7 (42 per cent) with lymph node metastasis refractory to estrogen therapy. Follow-up computerized axial tomograms of the lymph nodes done at one and two years after irradiation showed a persistent favorable response. Five patients are alive with disease, and 2 patients died of the disease.

Aged↗

PubMed2004

Predictive factors for lymph node metastasis of differentiated submucosally invasive gastric cancer.

BACKGROUND: For early gastric cancer, submucosal invasion may be unrecognized until histopathologic examination of the specimen obtained by EMR. Gastrectomy with lymphadenectomy is the standard treatment for such submucosal cancers. However, approximately 80% of submucosal cancers do not have lymph node metastasis. Unnecessary surgery could be avoided if a subgroup of patients with submucosal cancer with negligible risk of lymph node metastasis can be defined. This study was conducted to define such a subgroup. METHODS: Data from 104 patients surgically treated for differentiated submucosal cancers were retrospectively collected. A multivariate analysis of clinicopathologic factors was performed to identify predictive factors for lymph node metastasis. RESULTS: Three independent risk factors, namely, female gender (p=0.0174), deep invasion (> or =500 microm) into the submucosal layer (p=0.001), and presence of lymphatic involvement (p < 0.0001) were associated with lymph node metastasis. Lymph node metastasis was not observed in any patient who had limited submucosal invasion and absence of lymphatic involvement. The rate of lymph node metastasis was calculated to be 80% in patients who had both deep submucosal invasion and lymphatic involvement. CONCLUSIONS: If endoscopic resection specimens exhibit no deep penetration (<500 microm) into the submucosal layer and lymphatic involvement is absent, EMR may be sufficient treatment for submucosal well-differentiated early gastric cancers. A long-term follow-up study of patients with such lesions treated by EMR alone is required.

Adolescent↗

PubMed1996

[Preoperative diagnosis and surgical treatment for lymph node metastasis in gastric cancer].

In order to clarify the preoperative diagnostic ability for lymph node metastasis, images from magnetic resonance imaging (MRI), computed axial tomography (CT) and ultrasonography (US) were evaluated in 200 gastric cancer patients. The long-term results of 2,000 gastric cancer patients who had undergone gastrectomy were also studied to evaluate the effectiveness of lymphadenectomy. 1) Preoperative diagnosis of lymph node metastasis: The detection rate of lymph nodes around the stomach was 34.1% in MRI, 18.7% in CT and 5.0% in US. The incidence of metastasis was over 80% when the size of lymph node imaged was 1.5 cm and over, against 25% for lymph nodes less than 1.0 cm in size. The detection rate of metastatic lymph node according to the mode of metastasis was 88% for macro-nodular type, 66% for micro-nodular type, 57% for diffuse type in MRI, 70, 41 and 15% in CT, and 38, 3, 0% in US, respectively. Therefore, MRI was most useful for detecting metastatic lymph node preoperatively. 2) Long-term results of gastric cancer with lymph node metastasis: The cumulative 5-year survival rate was 84.2% in n0, 56.1% in n1, 33.7% in n2, 16.5% in n3, and 5.1% in n4 patients. Satisfactory long-term results were obtained for n2 or less patients without serosal invasion. Moreover, by paraaortic lymph node dissection, the cumulative 5-year survival rate in n4 patients was 16.4% (27.8% for cases with radical resection). These results showed the effectiveness of lymph node dissection for gastric cancer.

Follow-Up Studies↗

PubMed1995

Is CIS of the ureter responsible for skipped lymph node metastasis? A case report.

A case of skipped lesion of lymph node metastasis of left ureteral tumour with concurrent carcinoma in situ in the affected ureter is presented. Postoperatively, lymph node metastasis was de novo detected in the left retrocrural and renal hilar regions on CT scan, although only the obturator lymph node was histologically metastatic among the regional lymph nodes completely dissected. The possible explanations of this rare metastatic mode are discussed.

Carcinoma in Situ↗

PubMed1998

Tumor angiogenesis related to growth pattern and lymph node metastasis in early gastric cancer.

OBJECTIVE: To investigate the correlation between angiogenesis and tumor growth pattern as well as the lymph node metastasis to reveal the significance of vascularity in the early stage of gastric cancer. METHODS: 97 specimens from patients with early gastric cancer were studied by immunohistochemical method using anti-factor VIII related antigen antibody. RESULTS: Microvessel count was related to tumor growth pattern. The mean vessel count was higher in superficially spreading and penetrating types of tumors. Lymph node metastasis was correlated to microvessel count. Tumors with lymph node metastasis had higher microvessel counts than those without lymph node metastasis. CONCLUSIONS: In the early stage of gastric carcinoma, angiogenesis is correlated with tumor growth pattern and lymph node metastasis. Identification of tumors with high density of vascularization is beneficial for closer follow-up and adjuvant therapy.

Adult↗

PubMed2004

Criteria for predicting the recurrence and metastasis of stage I and II gastric cancer without lymph node metastasis.

This study examined whether detection of occult neoplastic cells (ONCs) in lymph nodes or the high-risk criteria for recurrence/metastasis of colorectal cancer were useful for predicting the recurrence of primary gastric cancer. The subjects were 122 patients with node-negative stage I or stage II primary gastric cancer. Prediction of recurrence using ONCs showed a sensitivity of 25.0% (2/8), specificity of 97.1% (100/103), and accuracy of 61.1% in stage I patients, while the respective values were 75.0% (3/4), 100.0% (7/7), and 87.5% in stage II patients. Prediction of recurrence in patients who fulfilled 2 or more of the high-risk criteria showed a sensitivity of 37.5% (3/8), specificity of 94.2% (97/103), and accuracy of 65.9% for stage I patients, while the respective values were 100.0% (4/4), 85.7% (6/7), and 92.9% for stage II patients. These results suggest that the prediction of recurrence based on the high-risk criteria shows a high sensitivity, specificity, and accuracy in patients of stage II gastric cancer without lymph node metastasis.

Humans↗

PubMed2003

The predictors of pelvic lymph node metastasis at radical retropubic prostatectomy.

PURPOSE: We studied preoperative variables in a contemporary series of patients who underwent radical retropubic prostatectomy (RRP) to determine which variables were associated with lymph node metastasis. MATERIALS AND METHODS: Between January 1995 and November 1999, 1,091 men underwent RRP, 695 of whom underwent bilateral pelvic lymph node dissection without any prior therapy. We evaluated biopsy Gleason score, maximum tumor length and maximum percentage of tumor in the positive core(s), location and number of positive cores, and total prostate specific antigen before surgery in 295 of these patients. We also developed a classification and regression tree analysis algorithm to segregate the risk of positive lymph node metastasis. Stepwise logistic regression analyses were used to determine independent predictors of lymph node metastasis. RESULTS: Of the 695 patients 19 (2.7%) had lymph node metastasis. Clinical stage, Gleason score, positive basal core, greatest percentage of tumor on positive cores and maximum tumor length in positive core were significant predictors of lymph node metastasis in the Mann-Whitney U test and chi-square test. Classification and regression trees analysis revealed that 4 or more positive cores with any Gleason grade 4 or 5, serum prostate specific antigen 15.0 ng/ml or greater, or the presence of dominant Gleason 4 or 5 were independent predictors of lymph node metastasis. Our algorithm had a significantly higher diagnostic performance than the Hamburg algorithm (p = 0.002). CONCLUSIONS: Our algorithm may be a valid tool for the prediction of lymph node metastasis and may help to select men who do not need to undergo bilateral pelvic lymph node dissection with RRP.

Adult↗

PubMedDate not supplied

Surgical outcome of curative resection in patients with Borrmann type IV gastric carcinoma with particular reference to the extent of lymph node metastasis.

BACKGROUND/AIMS: The prognosis after curative resection for Borrmann type IV carcinoma, according to the extent of lymph node metastasis, is poorly understood. METHODOLOGY: The surgical outcome of curative resection was examined in 78 patients with T2-T3 Borrmann type IV gastric carcinomas, with particular reference to the extent of lymph node metastasis. RESULTS: The 5-year survival rate was 35.7% for the n0 patients, 27.8% for the n1 patients, 18.2% for the n2 patients and 0% for the n3 or n4 patients. The survival curve for the n3 or n4 patients differed significantly from those of the n0 (P < 0.0001), n1 (P = 0.0009) and n2 (P = 0.0203) patients. However, no other statistically significant differences between the curves were found. CONCLUSIONS: The results of the present study indicate that patients with Borrmann type IV carcinoma of the stomach may indeed be cured by curative surgery, and that the surgical outcome of this disease does not depend on the extent of lymph node metastasis under curative resection if lymph node metastasis is restricted to the n2 lymph nodes.

Female↗

PubMedDate not supplied

Probability of lymph node metastasis in small gastric cancer tumor: is it an indication for limited surgery?

The purpose of this study was to determine the factors that are predictive of lymph node metastasis in a small gastric cancer tumor <2 cm in diameter. The clinicopathological features of 17 patients with node-positive small gastric cancer were reviewed from the database of gastric cancer at the Department of Surgery, Sendai National Hospital, Sendai, Japan, and they were compared with those of 131 patients with node-negative cancer. The independent risk factors influencing the lymph node metastasis were determined by multiple logistic regression analysis. Depth of invasion, macroscopic appearance, cancer-stromal relationship, and lymphatic microinvasion were found to be associated with lymph node metastasis. The variables found to be significant risk factors for lymph node metastasis were depth of invasion (P = 0.0250) and lymphatic microinvasion (P = 0.0028). It is possible for even a small gastric cancer tumor to have lymph node metastasis. A surgeon treating a small gastric cancer tumor must consider that although the cure rate is high, >10% of these tumors have lymph node metastases. Because of the possibility of lymph node metastasis, even with accurate knowledge of the depth of cancer invasion, selective performance of local resection or limited surgery with incomplete lymph node dissection is not justified. Accurate preoperative diagnosis and the appropriate decision for surgical indication are important. Large-scale randomized, controlled trials should be performed to show the advantage of limited surgery for gastric cancer.

Adenocarcinoma↗

PubMed1996

General pattern of lymph node metastasis in early gastric carcinoma.

A reliable method for recognizing lymph node metastasis is indispensable for the attending physician to recommend less extensive treatment for early gastric carcinoma. Here we review 1137 consecutive patients with a single primary lesion, and the incidence and distribution of nodal involvement were investigated for correlations with pathologic findings. The overall incidence of metastasis was 9.5%: 2.6% for mucosal and 16.5% for submucosal carcinomas, a significant difference. The occurrence of metastasis was highest for lesions of the macroscopically mixed type, microscopically diffuse type, and large size. The involved nodes were most frequently found in the perigastric nodes along the lesser and greater curvatures, and it was well correlated with the tumor location, macroscopically depressed/mixed type, cancer depth, and histology. The diffuse-type carcinomas were most likely to metastasize to distant nodes. The distribution of involved nodes for early gastric carcinoma was similar to that for advanced carcinoma, as previously been reported. The submucosal carcinomas in this series had no indications for less extensive treatment, such as endoscopic or laparoscopic limited surgery. These carcinomas should be subject to standard surgery with gastrectomy and combined dissection of lymph nodes, especially node stations 1 and 3 to 8. The mucosal carcinomas sometimes involved the perigastric nodes, and such cases underwent gastrectomy and lymphadenectomy of node stations 1 and 3 to 7. Mucosal carcinomas 10 mm or less in size were negative for lymph node metastasis and were considered appropriate for less extensive treatment.

Carcinoma↗

PubMed2001

The risks of lymph node metastasis and the prognostic factors in carcinoma of the penis: analysis of 50 patients treated with bilateral ilioinguinal lymphadenectomy.

OBJECTIVE: To determine the risks of inguinal and pelvic lymph node metastasis as well as the prognostic factors in carcinoma of the penis. METHOD: Fifty patients with squamous cell carcinoma of the penis who consecutively underwent immediate bilateral ilioinguinal lymphadenectomy after treatment of the primary tumor. Clinical features were evaluated to determine the risk of inguinal and pelvic lymph node metastasis as well as prognostic factors. RESULTS: Patients with palpable inguinal lymph node had a high risk of inguinal lymph node metastasis compared with patients with a non palpable inguinal lymph node (p = 0.002). Patients with poor differentiated tumors had a high risk of pelvic lymph node metastasis compared with patients with well or moderately differentiated tumors (p = 0.021). Prognostic factors significantly related to survival were the clinical status of the inguinal lymph node, histological grade and the status of lymph node metastasis (N stage). None of the patients with stage N0 and N1 died with the longest follow-up at 85 and 67 months, respectively. Cumulative survivals were 0.6 at follow-up at 36 months for the patients with stage N2 and 0.5 at follow-up at 18 months for patients with stage N3. CONCLUSION: The clinical status of inguinal lymph node was related to the risk of inguinal lymph node metastasis. Histological grade was related to the risk of pelvic lymph node metastasis. The clinical status of the inguinal lymph node, histological grade and pathological N stage were the important factors affecting the prognosis.

Adult↗

PubMed2002

VEGF-C induced lymphangiogenesis is associated with lymph node metastasis in orthotopic MCF-7 tumors.

The spread of cancer cells to regional lymph nodes through the lymphatic system is the first step in the dissemination of breast cancer. In several human cancers including those of the breast and prostate, the expression of vascular endothelial growth factor C (VEGF-C) is associated with lymph node metastasis. Our study was undertaken to evaluate the effect of VEGF-C on metastasis of poorly invasive, estrogen dependent human MCF-7 breast cancer cells. MCF-7 breast cancer cells transfected with VEGF-C (MCF-7-VEGF-C) were grown as tumors in the mammary fat pads of nude mice implanted with subcutaneous estrogen pellets. Tumor lymphangiogenesis and lymph node metastasis were studied immunohistochemically using antibodies against lymphatic vessel hyaluronan receptor -1 (LYVE-1), VEGF receptor-3 (VEGFR-3), PECAM-1, pan-cytokeratin and estrogen dependent pS2 protein. Overexpression of VEGF-C in transfected MCF-7 cells stimulated in vivo tumor growth in xenotransplanted mice without affecting estrogen responsiveness. The resulting tumors metastasized to the regional lymph nodes in 75% (in 6 mice out of 8, Experiment I) and in 62% (in 5 mice out of 8, Experiment II) of mice bearing orthotopic tumors formed by MCF-7-VEGF-C cells whereas no metastases were observed in mice bearing tumors of control vector-transfected MCF-7 cells (MCF-7-Mock). The density of intratumoral and peritumoral lymphatic vessels was increased in tumors derived from MCF-7-VEGF-C cells but not MCF-7-Mock cells. Taken together, our results show that VEGF-C overexpression stimulates tumor lymphangiogenesis and induces normally poorly metastatic estrogen-dependent MCF-7 tumors to disseminate to local lymph nodes. These data suggest that VEGF-C has an important role in lymph node metastasis of breast cancer even at its hormone-dependent early stage.

Animals↗

PubMed1995

Number of argyrophilic nucleolar organizer regions is a good indicator of lymph node metastasis in patients with esophageal carcinoma.

The number of argyrophilic nucleolar organizer regions (AgNORs) was evaluated as a predictor of lymph node metastasis in 45 patients who had undergone resection of advanced squamous cell carcinoma of the esophagus. The mean AgNOR score of carcinomas was 5.0 +/- 1.8, and it was greater than that of normal esophageal epithelium adjacent to a carcinoma (2.3 +/- 0.5, P < 0.001). The AgNOR score of tumors from 26 patients with lymph node metastasis was 6.1 +/- 1.6, and it was greater than that of tumors from 19 patients without lymph node metastasis (3.7 +/- 1.0, P < 0.001). The AgNOR scores of metastatic lymph nodes (4.9 +/- 1.5) from 26 patients with lymph node metastasis were closely related to the number of metastatic lymph nodes of individual patients (r = 0.582, P < 0.0001). The 3-year survival rate in patients with low AgNOR scores (AgNOR score < 5, n = 22) was 56.2%. By contrast, that in patients with high AgNOR scores (AgNOR score > or = 5, n = 20) was only 13.1%. There was a statistically significant difference between the two survival curves (P < 0.05). These results indicate that the AgNOR score is a good indicator of lymph node metastasis and suggest that it might also be a useful prognostic marker in patients with esophageal cancer.

Aged↗

PubMed1995

[Gastric cancer with P53 overexpression and nm23 low-expression has high potential for lymph node metastasis].

By using SP immunohistochemical methods, the correlation of the expression of P53 and nm23 with the biologic behavior and lymph node metastasis in gastric carcinomas was studied. Abnormalities of P53 expression were found in 49% of the 88 primary gastric carcinomas. A significant correlation was found between P53 overexpression and the depth of invasion and the proliferative activities (Pearson Contingency Coefficient P = 0.32 and 0.35, P < 0.05, respectively). The metastatic rate of tumours stained positively for P53 (93%) were higher than in those with negative P53 staining (60%, P < 0.05). Meanwhile, a significant correlation of low expression of nm23 with the depth of cancer invasion was found (Pearson Contingency Coefficient P = 0.28, P < 0.05). nm23 low-expressive tumours were associated with a higher incidence of metastasis to lymph nodes (93%) than were nm23-normal expressive (49%, P < 0.05). The contributions of P53 overexpression and nm23 low-expression to the lymph nodal metastasis were the independent joint action. It is suggested that P53 overexpression and nm23 low-expression might play significant role in lymph node metastasis and invasion and proliferation in the primary gastric carcinomas.

Adenocarcinoma↗

PubMed2006

Histopathological risk factors for lymph node metastasis in submucosal invasive colorectal carcinoma of pedunculated or semipedunculated type.

AIMS: To evaluate the histopathological risk factors for lymph node metastasis in cases of pedunculated or semipedunculated submucosal invasive colorectal carcinoma (SICC). METHODS: A total of 48 patients with non-sessile SICC who underwent systematic lymph node dissection were included. Tumour size, histological grade, angiolymphatic invasion, tumour budding, dedifferentiation, objective submucosal invasion depth from the identified muscularis mucosa, relative invasion depth of the submucosal layer, and depth of stalk invasion were investigated histopathologically. RESULTS: Lymph node metastasis was observed in seven cases (14.6%). Univariate analysis showed angiolymphatic invasion and tumour budding to be significantly associated with lymph node metastasis. Multivariate analysis showed that tumour budding was the only independent factor associated with lymph node metastasis in cases of non-sessile SICC. CONCLUSIONS: Results indicate that tumour budding is a useful risk factor for predicting lymph node metastasis in cases of pedunculated or semipedunculated SICC.

Adenocarcinoma↗

PubMed2000

Computer simulations of lymph node metastasis for optimizing the pathologic examination of sentinel lymph nodes in patients with breast carcinoma.

BACKGROUND: Many empiric protocols are used to detect metastases in sentinel lymph nodes (SLNs), but comparison of the efficacy of these methods is impractical because tissue is lost in processing, making reassessment with another policy difficult. Consequently, performance indicators of this test are largely unknown. DESIGN: The authors retrospectively examined 112 SLNs removed from 89 patients with breast carcinoma treated at the authors' institution and used the histologic data to devise a mathematic model of a SLN with Matlab modeling software. The authors simulated examination of this computer-generated (virtual) lymph node according to several macroscopic and histologic sampling protocols and for each protocol assessed the probability of detecting micrometastases of specified sizes. The authors used published costing figures to estimate the cost of the policies. RESULTS: Direct comparison of 6 sectioning strategies currently in use by pathology laboratories showed the chances of detecting a 500-microm metastasis ranged from 20% to 75%. Four of the 6 protocols had a less than 30% chance of detecting metastases of this size. The detection rate of smaller metastases was poorer. Cost was not a good discriminator because some policies were more efficient than others. CONCLUSIONS: The detection of metastases is highly dependent on the methods used to look for them. The authors' simulations suggest that commonly used methods of examining lymph nodes have high false-negative rates, particularly for small metastases. There is an urgent need for pathologists and clinicians to agree on the minimum size of SLN metastases that will be sought by histology and set standard methods for examining these lymph nodes.

Breast Neoplasms↗