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PubMed2001

Clinicopathologic factors correlated with number of metastatic lymph nodes in oesophageal cancer.

BACKGROUND: The number of metastatic lymph nodes is applied to the staging system of gastric cancer and colorectal cancer. However, it has not been evaluated in oesophageal cancer. PATIENTS AND METHODS: Of 258 patients with primary squamous cell carcinoma of the thoracic oesophagus between February 1981 and December 1999, 160 underwent three-field oesophagectomy with a curative intent. Clinicopathologic characteristics of those 160 patients were retrospectively investigated according to the number of metastatic lymph nodes. RESULTS: Seventy-eight patients had no lymph node metastases and 82 (51.3%) had lymph node metastases; 51 [31.9%)] had between 1 and 4 positive lymph nodes, and 31 (19.4%) had > or =5. The number of metastatic lymph nodes was significantly correlated with tumour size, macroscopic classification, histological differentiation, pT, pN, and vessel invasions. Multivariate analysis showed that lymph vessel invasion (relative risk 12.6), histological differentiation (relative risk 4.2), and tumour size (relative risk 3.8) were independent factors correlated with number of metastatic lymph nodes. The number of metastatic lymph nodes was also well correlated with the Japanese nodal level and TNM stage, respectively (p<0.001). The 5-year disease-specific survival rate according to the number of positive lymph nodes was 90% for patients without lymph node metastases, 52.2% with 1-4, and 28.9% with > or =5, respectively, p<0. 0001; 0 vs 1-4, p<0.05; 1-4 vs > or =5). CONCLUSION: The number of positive lymph nodes is well correlated with tumour progression and provides a useful prognostic indicator after oesophagectomy for oesophageal cancer.

Aged↗
PubMed1994

Differential function of dendritic cells isolated from blood and lymph nodes.

Dendritic cells (DC) isolated from the lymph nodes or spleens of mice and pulsed with contact sensitizers or protein antigens stimulate primary proliferative responses by syngeneic T cells and responses to alloantigens in the mixed leucocyte reaction (MLR). Using enriched human peripheral blood DC, we attempted to stimulate primary immune responses to contact sensitizers by autologous lymphocytes in vitro. No significant proliferation above background levels or CD69 expression (an early activation antigen on lymphocytes) was detected despite using a wide range of donors, chemicals, antigens and cell concentrations. Culture of DC for up to 5 days in vitro in the presence of phytohaemagglutinin (PHA)-conditioned culture supernatants, or recombinant granulocyte-macrophage colony-stimulating factor (GM-CSF) also failed to induce primary proliferative responses to contact sensitizers. Comparisons were made between blood and lymph node DC from mice to explore whether the lack of stimulation was the result of differences between mouse and human DC or between DC isolated from different tissues. DC from lymph nodes stimulated primary responses to contact sensitizers in both blood and lymph node lymphocytes whereas blood DC did not stimulate responses. Both lymph node and blood DC stimulated an allogeneic MLR, although blood DC were less efficient than those from lymph node. The data show that DC from different tissues exhibit variable functional activity. DC from blood and lymph nodes were examined to determine whether surface antigen expression is related to functional activity. Murine blood DC expressed similar levels of LFA-1, LECAM-1 and CD44 compared with lymph node DC but lower levels of MHC class II, B7 and ICAM-1. These results may therefore have important implications for antigen processing and presentation in cells from different tissue compartments.

Allergens↗
PubMed2002

Extended pelvic lymphadenectomy in patients undergoing radical prostatectomy: high incidence of lymph node metastasis.

PURPOSE: Lymphadenectomy for prostate cancer is limited to obturator and external iliac lymph nodes, although the internal lymph nodes represent the primary landing zone of lymphatic drainage. We performed anatomically adequate extended pelvic lymphadenectomy to assess the incidence of lymph node metastasis in cases of clinically localized prostate cancer. MATERIALS AND METHODS: A total of 103 consecutive patients underwent extended pelvic lymphadenectomy at radical retropubic prostatectomy comprising 9 selective fields, namely the external iliac, internal iliac, obturator and common iliac lymph nodes bilaterally, and the presacral lymph nodes. Histopathological findings were compared with serum prostate specific antigen (PSA), histopathological stage, preoperative biopsy and postoperative prostatectomy Gleason score. Extended pelvic lymphadenectomy was compared with radical retropubic prostatectomy and standard lymphadenectomy in 100 consecutive patients in terms of complications, the number of lymph nodes dissected and operative time. RESULTS: There were no significant differences in age, preoperative PSA or mean biopsy Gleason score in patients who underwent extended pelvic and standard lymphadenectomy. Metastases were diagnosed in 27 of the 103 patients (26.2%) who underwent the extended procedure. A mean of 28 lymph nodes (range 21 to 42) were dissected. Metastases were identified in the internal iliac and presacral regions despite negative obturator lymph nodes. Of the 27 patients 1 to 3 lymph nodes involved with metastasis were detected in 15, 9 and 1, respectively. In 26 of the 27 patients (95.8%) with lymph node metastasis PSA was greater than 10.5 ng./ml. and preoperative biopsy Gleason sum was 7 or greater. A low risk of 2% for lymph node disease was noted in patients with serum PSA less than 10.5 ng./ml. and biopsy Gleason sum less than 7. There were no significant differences in regard to intraoperative and postoperative complications, lymphocele formation or blood loss in the 2 groups. CONCLUSIONS: Extended pelvic lymphadenectomy is associated with a high rate of lymph node metastasis outside of the fields of standard lymphadenectomy in cases of clinically localized prostate cancer. Lymphadenectomy including the internal iliac lymph nodes should be performed in all patients with prostate cancer who are at high risk for lymph node involvement, as indicated by PSA greater than 10.5 ng./ml. and biopsy Gleason sum 7 or greater. In the low risk group pelvic lymphadenectomy can be omitted.

Aged↗
PubMed1998

[Clinical investigation of lymph node metastasis in carcinoma of the hypopharynx].

Carcinoma of the hypopharynx has a great tendency to metastasize to the neck. In addition it often metastasizes to the upper retropharyngeal lymph nodes (Rouviere's lymph nodes) and to the paratracheal lymph nodes. In this study, in order to determine the pattern of lymph node metastasis, 112 patients with carcinoma of the hypopharynx who had undergone bilateral radical neck dissection, bilateral paratracheal dissection, bilateral dissection of retropharyngeal nodes as an initial treatment between January 1982 and June 1997 in the Kurume University Hospital, were retrospectively reviewed in detail. Special attention was paid to retropharyngeal nodes and paratracheal lymph nodes. In N0 cases neck metastases were seen in more than one-quarter of the patients. Metastasis to retropharyngeal lymph nodes and to the paratracheal lymph nodes was seen in 5.4% and 12.5% of the patients, respectively. The frequency of metastasis to paratracheal lymph nodes had a significantly close relationship with that to the upper and lower jugular lymph nodes. The frequency of metastasis to retropharyngeal lymph nodes also had significantly close relationship with that to paratracheal lymph nodes, while having no relationship with that to other neck lymph nodes. These results suggest the following: 1) In patients with T1 or T2 PS type carcinoma of the hypopharynx, in which the lesion is confined unilaterally and is presumed to have been successfully treated by laser surgery prior to radiotherapy, unilateral neck dissection alone will be sufficient. In all the other patients with carcinoma of the hypopharynx bilateral neck dissection must be performed. 2) In all patients retropharyngeal lymph nodes and paratracheal lymph nodes should be dissected as much as possible and postoperative irradiation to both areas will be necessary.

Female↗
PubMedDate not supplied

Distribution of lymph node metastasis in gastric carcinoma.

BACKGROUND/AIMS: In gastric cancer, appropriate lymph node dissection increases survival, and hence it is of value to determine lymph node metastasis distribution in the early phase of progression. METHODOLOGY: This study involved a series of 274 consecutive patients with 1-6 lymph node metastases occurring after resection. The pattern of lymph node metastases was analyzed retrospectively. RESULTS: Of 102 patients with single lymph node metastasis, over 60% of metastases occurred in specific lymph nodes for each tumor. However, the remainder was scattered in an unpredictable manner including the para-aortic lymph nodes. Despite variations in invasiveness of tumors in patients with a single lymph node, the distribution remained unchanged. Nor was there any change in patients with an increased number of metastatic lymph nodes. However, in the latter group a higher proportion of metastases were widespread. About 85-90% of node was located within paragastric lymph nodes. CONCLUSIONS: Over 60% of metastatic lymph nodes would be eliminated by the dissection of specific areas determined by the site of the tumor. If the concept of sentinel lymph nodes in gastric cancer is valid, navigation surgery will be necessary for patients with early gastric cancer to locate such unpredictable metastasis.

Female↗
PubMed2003

Clinical impact of micrometastasis of the lymph node in gastric cancer.

Micrometastasis in regional lymph nodes has been observed immunohistochemically, but the biological and clinical roles of minute nodal invasion of carcinoma in gastric cancer remain unclear. We used the anti-cytokeratin (AE1/AE3) antibody to immunohistochemically detect nodal micrometastatic lesions that could not be identified by routine pathological examination. A total of 4203 lymph nodes were examined in 180 gastric cancer patients. Lymph node metastasis was found in 36 of the 180 patients by routine pathological evaluation. Immunohistochemically micrometastasis was detected in the lymph nodes of 19 node-negative patients. Micrometastasis was not detected in any of the mucosal gastric cancer patients who underwent lymph node dissection. Gastric cancer patients with more than six metastatic lymph nodes all had nodal micrometastasis. Patients with micrometastasis had a significantly poorer survival rate than those without micrometastasis (P < 0.05). Based on the present results the presence of lymph node micrometastasis may provide a more accurate indication for surgical outcome in gastric cancer patients at the same clinical stage.

Adult↗
PubMed2002

Lymph node staging of esophageal squamous cell carcinoma in patients with and without neoadjuvant radiochemotherapy: histomorphologic analysis.

In patients with squamous cell carcinoma of the esophagus, the preoperative clinical staging of the N category is primarily based on the lymph node size. Lymph nodes > 10 mm are considered to be tumor-infiltrated. This histopathologic study investigated the correlation of lymph node size and metastatic infiltration in esophageal carcinoma of patients with and without neoadjuvant radiochemotherapy. The specimens of 40 patients with squamous cell carcinoma of the esophagus were included in a prospective morphometric study. Half of these patients (n = 20) received preoperative radiochemotherapy. The number of resected lymph nodes were counted, and the largest diameter of each node was measured. Metastatic involvement of each node was analyzed by histologic examination. The frequency of lymph node metastases was calculated and correlated to the lymph node size. A total of 1196 lymph nodes with an average of 29.9 nodes per patient were resected and analyzed; 129 lymph nodes (10.8%) showed metastatic infiltration. The average size of 1067 tumor-free lymph nodes was 5.1 +/- 3.8 mm in maximum diameter, whereas the average size of 129 metastatic lymph nodes was 6.7 +/- 4.2 mm (p = 0.00006). Of all resected lymph nodes, 761 (63.6%) were < or = 5 mm in maximum diameter. Only 9.3% (n = 111) of all resected lymph nodes were > 10 mm in maximum diameter. There was no significant correlation between lymph node size and the frequency of nodal metastases. No difference in size could be demonstrated between patients with and without neoadjuvant radiochemotherapy. Diagnostic imaging techniques using size as the criterion of nodal infiltration cannot exactly assess the nodal status of patients with esophageal carcinoma. This is also true for patients after neoadjuvant radiochemotherapy. Therefore, evaluation of the nodal status in patients with squamous cell carcinoma of the esophagus is entirely based on pathohistologic analysis after a well defined lymphadenectomy.

Adult↗
PubMed1995

Axillary lymph node metastases of bronchogenic carcinoma.

BACKGROUND: Metastasis of bronchogenic carcinoma to axillary lymph nodes is rare. The pathways and possible significance of axillary lymph node metastasis from bronchogenic carcinoma were investigated. METHODS: Seventeen patients with probable axillary lymph node metastases from bronchogenic carcinoma were identified by computed tomography. There were 15 nonsmall cell lung cancers and 2 small cell lung cancers. Axillary lymph node metastasis was proven by biopsy in six cases. Metastases were presumed because of an increase in the size of axillary lymph nodes compared with prior studies in six patients and enlarged axillary lymph nodes associated with biopsy-proven ipsilateral supraclavicular lymph node metastasis in five patients. RESULTS: Four of 10 right-sided lung cancers had ipsilateral and six had contralateral axillary lymph node metastases. Six of seven left-sided cancers had ipsilateral and one had contralateral axillary lymph node metastases. Patients with ipsilateral lymph node disease had chest wall involvement and/or supraclavicular and mediastinal lymph node metastases. All seven patients with contralateral axillary lymph node metastases had supraclavicular and/or mediastinal lymph node metastases. CONCLUSION: Bronchogenic carcinoma may involve ipsilateral axillary lymph nodes via either chest wall invasion or retrograde spread from supraclavicular lymph nodes. Contralateral axillary lymph node involvement requires involvement of contralateral mediastinal and supraclavicular lymph nodes with retrograde spread to the axillary lymph nodes.

Axilla↗
PubMed2001

Vascular transformation of lymph node sinuses.

Vascular transformation of lymph node sinuses is an uncommon condition and only isolated cases have been reported. It is characterized by conversion of nodal sinuses into capillary-like channels, often accompanied by fibrosis. Venous or lymphatic obstruction is thought to be the underlying mechanism, and in most cases factors that may contribute to lymphovascular obstruction can be identified such as tumour in the vicinity, vascular thrombosis, heart failure, previous surgery or radiotherapy. Most cases involve abdominal lymph nodes, and head and neck involvement is rare. We present two cases of vascular transformation of lymph node sinuses presenting only as cervical lymphadenopathy, without an obvious cause of lymphovascular obstruction.

Adult↗
PubMed1993

Chemocoagulation of metastatic lymph nodes using a suspension of mitomycin C-adsorbing activated carbon particles in 80% ethanol.

Chemocoagulation therapy was evaluated in an experimental model of metastasis of murine lymph nodes following injection of a suspension of mitomycin C--containing activated carbon particles in 80% ethanol (MMC-CH-ET) into the popliteal lymph node. Lymph node metastasis was induced in the left popliteal and the lumbar lymph nodes 8 days after injection of mouse leukemia P388 cells into the footpad of the left hindleg of BDF1 mice. When MMC-CH-ET was injected into the left popliteal lymph node, it immediately left this site and entered the lumbar lymph node via lymphatic vessels. When compared with tissue concentrations of mitomycin C following injection of an aqueous solution of this drug, the mitomycin C concentration of MMC-CH-ET was maintained at significantly higher levels for 2 hr following injection both at the site of injection and at secondary lymph nodes. Furthermore, coagulative necrosis was identified histologically throughout the injected lymph node and the secondary lymph node, including the metastatic site. The mortality of mice treated with MMC-CH-ET injection was significantly reduced and lymph node metastasis was controlled with MMC-CH-ET when compared with the results for mice treated with an aqueous solution of mitomycin C or treated by surgical lymph node dissection. In this report, we suggest that the use of MMC-CH-ET as a therapeutic agent may be useful in targeting lymph node metastasis.

Animals↗
PubMedDate not supplied

Prophylactic lymph node dissection for early gastric cancer invading submucosa.

BACKGROUND/AIMS: Prophylactic lymph node dissection for gastric cancer patients was considered to prolong survival time and D2 lymph node dissection was a standard treatment for early gastric cancer invading submucosa without lymph node metastasis. We investigated the possibility of minimizing the extent of prophylactic lymph node dissection for early gastric cancer invading submucosa if there was no evidence of lymph node metastasis. METHODOLOGY: We analyzed data on 404 patients with early gastric cancer invading the submucosa who underwent gastrectomy from 1979 to 1998 in the National Kyushu Medical Center, Fukuoka, Japan. The postoperative survival rate of patients with standard D2 dissection was compared with cases of those with limited D2 dissection which was defined as confined as D2 dissection dissections No.7 (lymph nodes were those along the left gastric artery), No.8 (lymph nodes along the anterosuperior common hepatic artery) and No.9 (lymph nodes along the celiac artery). RESULTS: Of the 404 patients, 52 and 17 had lymph node metastasis in group 1 and group 2 nodes, respectively. Of 17 patients with lymph node metastasis in group 2, 14 (82.4%) had metastasis confined to No.7, 8 and 9 of group 2 nodes. The 5-year survival rate of patients with submucosal cancer without lymph node metastasis was 94.4% after limited D2 dissection and 97.3% after standard D2 dissection, respectively. CONCLUSIONS: The appropriate prophylactic lymph node dissection for early gastric cancer invading the submucosa without lymph node metastasis was considered to be minimized to limited D2 dissection.

Feasibility Studies↗
PubMed2002

[Significance of aggressive lymph node dissection in advanced gallbladder carcinoma].

Although aggressive lymph node dissection has been performed in gallbladder carcinoma as well as in other carcinomas of the alimentary tract, there is no definitive evidence of the efficacy of extended lymph node dissection. However, extensive lymph node metastasis is well known in advanced carcinoma of the gallbladder. From the viewpoint of the balance between radicality and safety in surgery, wider lymph node dissection consisting of the lymph nodes in the hepatoduodenal ligamentum and parapancreatic area is recommended in selected patients who hare no involvement of the paraaortic lymph nodes. Complete dissection of the superior mesenteric lymph nodes with pancreaticoduodenectomy is unlikely to result in cure.

Gallbladder Neoplasms↗
PubMedDate not supplied

Comparison of 99mTc-MIBI scintigraphy and sentinel node biopsy in the detection of occult lymph node metastases from cutaneous melanoma.

99mTc-MIBI scintigraphy has been proposed as a technique that can diagnose clinically undetectable melanoma metastases. The aim of the study was to compare the sensitivity of 99mTc-MIBI with that of sentinel node biopsy (SNB) in the detection of nodal disease. Twenty-eight patients with melanoma >1.0 mm thick were enrolled. Patients underwent 99mTc-MIBI scintigraphy and a preoperative lymphoscintigraphy followed by SNB. Sentinel nodes were identified in 27/28 patients. Twelve patients had an involved sentinel node (SN), being 99mTc-MIBI positive in 10. No patient with negative SNB developed regional recurrence during the study. 99mTc-MIBI had a sensitivity of 83% and a specificity of 93%. We conclude that SNB remains the procedure of choice for detecting subclinical lymph node involvement from melanoma. 99mTc-MIBI could have an alternative role in lymph node staging of patients who are not good candidates of SNB, that needs to be tested in appropriate trials.

Adult↗
PubMed1995

A simple classification of lymph node level in gastric carcinoma.

BACKGROUND: Because insufficient lymph node examination can cause erroneous listing of earlier-nodal-stage gastric carcinoma (stage migration phenomenon), surgical results must be evaluated based on a highly accurate examination of the dissected lymph nodes. To establish a simple and useful classification of lymph node level, we analyzed the frequency and distribution of lymph node metastasis by using curatively treated node-positive gastric carcinoma. PATIENTS AND METHODS: Various clinicopathologic data were analyzed with reference to the degree of lymph node metastasis by using 240 patients with curatively resected node-positive gastric carcinoma. The cases were divided into the following three groups: 142 with positive level I (perigastric) nodes, 71 with positive level II (intermediate) nodes, and 27 with positive level III (distant) nodes, irrespective of the location of tumors. RESULTS: The level of lymph node metastasis clearly correlated with the survival of patients, with the 5-year survival rates for level I, II, and III cases being 67%, 35%, and 26%, respectively (P < 0.01). The degree of lymph node metastasis was determined by the number of positive nodes (P < 0.01), the depth of invasion (P < 0.01), the size of tumors (P < 0.01), and the location of tumors (P < 0.05). CONCLUSION: This simple classification of lymph node level (level I, II, and III) is useful for the evaluation and prediction of surgical results in gastric carcinoma.

Arteries↗
PubMed2001

Radioisotope guided pelvic lymph node dissection for prostate cancer.

PURPOSE: The localization of lymph node metastases in prostate cancer varies enormously. Due to high morbidity complete pelvic lymphadenectomy is often decreased to modified staging lymphadenectomy, resulting in loss of sensitivity for detecting micrometastases. Based on the promising results of intraoperative gamma probe application for identifying sentinel lymph nodes in malignant melanoma, breast and penis cancer, we identified sentinel lymph nodes in prostate cancer using a comparable technique. MATERIALS AND METHODS: In 117 patients 99mtechnetium nanocolloid was transrectally injected directly into the prostate under ultrasound guidance 1 day before pelvic lymphadenectomy. Thereafter dynamic lymphoscintigraphy was done. Initially lymph nodes identified as sentinel lymph nodes by the gamma probe were removed and subsequently modified pelvic lymphadenectomy was performed. RESULTS: Lymphatic metastasis was detected in 28 cases. An average of 4 sentinel lymph nodes were identified per patient in 25 of 27 patients with micrometastasis, of which those in 24 contained micrometastasis for 96% sensitivity. In contrast, sensitivity of modified pelvic lymphadenectomy was 81.5%. In 16 patients only sentinel lymph nodes were positive. An average of 21.8 lymph nodes (range 10 to 51) was dissected per patient at pelvic lymphadenectomy. Lymph node metastasis was noted in 6 of the 46 patients with a prostate specific antigen between 4 and 10 ng./ml. and in 8 of the 64 with a stage pT2 tumor. CONCLUSIONS: Our study shows individual variability of lymphatic drainage of the prostate and limited sensitivity for detecting positive lymph nodes when the pelvic dissection area is limited. Furthermore, our experience implies that the identification of sentinel lymph nodes is feasible, not only in breast cancer and malignant melanoma, but also in prostate cancer using a comparable technique.

Aged↗
PubMed2004

[Sentinel lymph node biopsy in colorectal carcinoma].

Lymph node status as an important prognostic factor in colon and rectal cancer is affected by the selection and number of lymph nodes examined and by the quality of histopathological assessment. The multitude of influences is accompanied by an elevated risk of quality alterations. Sentinel lymph node biopsy (SLNB) is currently under investigation for its value in improving determination of the nodal status. Worldwide, the data of 800 to 1000 patients from about 20 relatively small studies are available that focus rather on colon than rectal cancer patients. SLNB may be of clinical value for the collective of patients that are initially node-negative after H&E staining but reveal small micrometastases or isolated tumor cells in the SLN after intensified histopathological workup. If further studies confirm that these patients benefit from adjuvant therapy, the method may have an important effect on the therapy and prognosis of colon cancer patients as well. Another potential application could be the determination of the nodal status after endoscopic excision of early cancer to avoid bowel resection and lymphonodectomy.

Colonic Neoplasms↗
PubMed2002

Molecular lymphatic mapping of the sentinel lymph node.

Intraoperative lymphatic mapping to identify the sentinel lymph node (SLN) has significantly changed the management of regional lymph node basin of patients with various types of solid tumors such as melanoma and breast cancer. The procedure has improved the diagnosis of micrometastasis in the regional tumor-draining lymph nodes by providing a focused histopathological assessment of select lymph nodes most likely to harbor occult disease. Blue dye and/or radioisotopes are efficient mapping agents but the lack of accurate methods to quantify their presence and the potential for dissolution and decay, respectively, throughout time limit their role as reliable markers for identifying a sentinel node from additional secondary lymph nodes that may be either blue and/or radioactive to some degree. A consistently durable marker is needed that can be introduced during surgery and successfully quantitated among tumor-draining lymph nodes to permit a more accurate assessment of hierarchical organization. This may be of particular importance in retrospective analysis of archival tissues as there are no inherent markers to denote the SLN from successive echelon nodes. A procedure of molecular lymphatic mapping (MLM) was developed in a rat model to label the SLN preoperatively with rice gene DNA containing plasmid or linear rice DNA fragment (rDNA). The MLM efficiency was demonstrated by polymerase chain reaction (PCR) detection of the molecular marker in both frozen and paraffin-embedded SLN; 1.25 micro g of rDNA injected with blue dye could be reproducibly detected by PCR. The MLM procedure was validated in a rat breast tumor model with lymph node metastasis. The procedure was successful in permanently labeling and identifying by PCR both frozen and paraffin-embedded SLN. MLM in conjunction with a conventional mapping agent can be used as a valuable asset for molecular assessment of the SLN and retrospective analysis of paraffin-embedded specimens.

Adenocarcinoma↗