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PubMed2001

Histologic detection and clinical implications of micrometastases in axillary sentinel lymph nodes for patients with breast carcinoma.

BACKGROUND: Sentinel lymph node (SLN) biopsy is used increasingly in patients with clinically lymph node negative, early-stage breast carcinoma, because it can spare axillary dissection when the sentinel lymph nodes are negative. The question arises, however, whether complete axillary lymph node dissection (ALND) also is necessary in patients with only micrometastases (< or = 2 mm in greatest dimension) in axillary SLNs. The authors carried out the current study to ascertain the risk of non-SLN axillary metastases in such patients and to assess the detection rate of SLN micrometastases in relation to the sectioning interval and the number of sections examined. METHODS: The authors examined 109 patients with micrometastatic SLNs from a series of 634 patients with carcinoma of the breast who underwent SLN biopsy and complete ALND as part of the surgical treatment for their disease. The SLNs were sectioned completely at 50-microm intervals, and the sections were examined intraoperatively. RESULTS: The overall frequency of metastases in axillary non-SLNs was 21.8%. The frequency was correlated significantly with the size of the SLN micrometastatic focus (P = 0.02): 36.4% of patients with foci > 1 mm had metastases in axillary lymph nodes--a percentage approaching 44.7% of patients with macrometastatic SLNs--whereas only 15.6% of patients with micrometastases < or = 1 mm had other involved axillary lymph nodes. CONCLUSIONS: Outside of clinical trials, patients with T1 and small T2 breast carcinoma and micrometastatic SLNs should undergo complete ALND for adequate staging. However, patients with SLN micrometastases up to 1 mm in greatest dimension have a significantly lower risk of additional axillary metastases, raising the question of whether ALND may be avoided in this subgroup of patients.

Adult↗

PubMed2005

[Intraoperative lymphatic mapping and sentinel lymph node dissection in cervical uterine cancer].

Regional lymph node involvement is the most important prognostic indicator in patients with solid tumors. Conventional lymph node dissection has not been shown to affect survical and is often associated with considerable morbidity. Intraoperative lymphatic mapping and sentinel lymph node dissection were therefore designed as a minimally invesive alternative to routine elective lymph node dissection in patients with primary cutaneous melanoma. This study examined whether intraoperative lympatic mapping and sentinel lymph node dissection were accurate in staging patients with cervical cancer.

Female↗

PubMed2000

Molecular genetic changes in metastatic primary Barrett's adenocarcinoma and related lymph node metastases: comparison with nonmetastatic Barrett's adenocarcinoma.

Lymph node metastasis is one of the strongest negative prognostic factors for patients with Barrett's adenocarcinoma (BCA). However, despite the importance of the metastatic process in BCA, the molecular basis of it remains poorly understood. To search for cytogenetic events associated with metastasis in regional or distant lymph nodes in BCA, we investigated 8 primary BCA and their lymph node metastases and compared them with 18 nonmetastatic BCA. In metastatic primary BCA, we observed significantly more DNA gains on 3q (P = .013), 17q (P = .019), and 22q (P = .021) compared with nonmetastatic primary BCA. No statistically significant correlation could be observed between DNA copy number changes and the histopathologic stage, grade, or survival (P > .05). The most frequent alteration observed only in lymph node metastases but not in the related primary tumor was loss of 2q (5 of 8). Coamplification of 7p and chromosome 17 was found in 6 of 8 lymph node metastases. A comparison of DNA copy number changes between primary tumors and their corresponding metastases indicated a high degree of genetic heterogeneity. Fluorescence in situ hybridization analysis demonstrated the involvement of the Her-2/neu gene in primary BCA and its related lymph node metastases. Each of the investigated primary tumors and related lymph node metastases also showed striking heterogeneity with respect to Her-2/neu, with several areas displaying different levels of amplification. In summary, our data indicate that DNA copy number changes on 2q, 3q, 7p, 17q, and 22q may be involved in the metastatic process in BCA. Furthermore, the striking genetic heterogeneity that we found between primary BCA and its lymph node metastases may underlie BCA's poor responsiveness to therapy and could help explain why prognostic biomarkers measured exclusively in primary tumors give an incomplete view of the biologic potential of BCA.

Adenocarcinoma↗

PubMed2003

Intra-mammary tumor location does not influence prognosis but influences the prevalence of axillary lymph-node metastases.

BACKGROUND: The number of axillary lymph-node metastases is not only a function of disease progression in primary breast cancer, but is also influenced by the intra-mammary location of the tumor. Nevertheless, the prognostic role of the tumor site is discussed controversially. The objective of this study was to analyze the impact of primary-tumor location on axillary lymph-node involvement, relapse, and mortality risk by univariate and multivariate analysis, in patients both with and without systemic and loco-regional treatment. METHOD: Retrospective analysis was conducted on 2,414 patients at the I. Frauenklinik, Ludwig-Maximilians University, Munich and Berlin-Charlottenburg, who underwent R(0) resection of the primary tumor and systematic axillary lymph-node dissection (at least five lymph nodes resected) for UICC I-III-stage breast cancer. Patients with unknown tumor site, multifocal tumor spread, central tumor location, or tumor location within 15 degrees of the border between outer and inner quadrants were excluded from the study. Median observation time was 6.7 years. RESULTS: The primary tumor site was within or between the medial quadrants of the breast in 33.6% of the patients ( n=810) and in the lateral hemisphere of the breast in 66.4% ( n=1,604). Tumor size, histopathological grading, and estrogen receptor status were balanced between patients with lateral and medial tumor location. Metastatic axillary lymph-node involvement was significantly associated with a lateral tumor location ( P<0.0001). The mean number of axillary lymph-node metastases was increased by 29% in cases with lateral tumor location (2.2 vs 1.7, P=0.003). In a multivariate logistic regression analysis allowing for tumor location, estrogen receptor status, grading and tumor size, tumor location was confirmed as a significant risk factor ( P=0.02) for axillary lymph-node involvement. Tumor location, however, did not correlate with either disease-free survival (DFS) or overall survival (OS), by univariate (DFS: P=0.41; OS: P=0.57) or by multivariate analysis (DFS: P=0.16; OS: P=0.98). CONCLUSION: We conclude that there is no sufficient evidence to support any independent prognostic significance of intra-mammary tumor location in early breast cancer. However, medial tumor location may lead to the underestimation of axillary lymph-node involvement.

Analysis of Variance↗

PubMed2000

[Induced hypertensive chemotherapy with angiotensin II found effective for mediastinal lymph node metastases of unknown origin].

A 62-year-old woman suffering from gallbladder stone had a remarkably high preoperative CEA level of 525 ng/ml. Computed tomography revealed swollen mediastinal lymph nodes. Lymph node biopsy during thoracotomy led to a diagnosis of metastasis from poorly differentiated adenocarcinoma. Although thorough examinations were performed, the origin of the adenocarcinoma could not be detected. In this case, induced hypertensive chemotherapy with angiotensin II was effective. The mediastinal lymph nodes diminished remarkably and the patient's CEA level decreased to 22 ng/ml. Induced hypertensive chemotherapy with angiotensin II might be a useful treatment for cancer metastases of unknown origin.

Adenocarcinoma↗

PubMed2004

Hospital-to-hospital variation in lymph node detection after colorectal resection.

BACKGROUND: Better recovery of lymph nodes from colorectal carcinoma resection specimens has been shown to be associated with higher survival rates for patients with TNM Stage II and Stage III tumors. It is possible that inadequate lymph node recovery and/or assessment could contribute to disparities in survival, with particular variation according to hospital volume. METHODS: Data from a population-based study that involved 33 counties in North Carolina and was conducted between April 1997 and April 2000 were available for the examination of variations in lymph node recovery and detection of positive lymph nodes according to self-reported demographic characteristics and hospital volume. The study comprised 324 patients with T2-T3N0-N1M0 colon adenocarcinoma. Logistic regression was used to determine odds ratios (ORs) associated with the recovery of fewer than seven lymph nodes and ORs associated with the detection of a positive lymph node according to hospital volume and patient characteristics. RESULTS: Low-volume hospitals were more likely to recover < 7 lymph nodes compared with high- and medium-volume hospitals (low-volume vs. high-volume: adjusted OR, 1.9; 95% confidence interval [CI], 0.8-4.6; low-volume vs. medium-volume: adjusted OR, 1.7; 95% CI, 0.7-4.5) and less likely to detect positive lymph nodes. After controlling for tumor characteristics, low-volume hospitals were less than one-half as likely to detect a positive lymph node (low-volume vs. high-volume: adjusted OR, 0.3; 95% CI, 0.1-0.8; low-volume vs. medium-volume: adjusted OR, 0.4; 95% CI, 0.1-1.2). CONCLUSIONS: The current study suggests that patients at low-volume hospitals may have their tumors pathologically understaged more frequently compared with patients at high- and medium-volume hospitals.

Adenocarcinoma↗

PubMed1975

[Analytical study of 510 cases of surgical lymph node biopsies].

510 cases of surgical lymph node biopsies during a five year period are reviewed with the following conclusions: The lymph node biopsy constitutes 5% of all the surgical biopsies. The cervical and axillary lymph nodes are the most commonly biopsied nodes due to their easy accessibility and due to the fact that they drain the lymph from many vital organs; the next most commonly biopsied nodes are the sub-clavicular, grains, mesentric and mediastinal nodes. Among all the lymph node affections the metastatic tumours occupy the first place (23%) followed by the primary tumours (malignant lymphomas 16%) and the specific inflammatory lesions (10%). Among the metastic nodes squamous cell carcinoma occupy the first place (8%) followed by digestive tract, lung, thyroid glands, breast, testicular, pancreatic, ovarian and gall bladder tumours.

Adolescent↗

PubMed2000

Internal mammary chain sentinel lymph node identification in breast cancer.

BACKGROUND AND OBJECTIVES: Sentinel lymph node (SLN) biopsy is not usually performed with respect to the internal mammary lymph node chain. However, the SLN may be located in the internal mammary chain, particularly with medial lesions. We carried out this study to investigate whether lymphatic mapping and SLN biopsy can detect internal mammary involvement in patients with breast cancer. METHODS: A dye- and gamma probe-guided SLN biopsy was performed in a consecutive series of 41 patients with tumor in situ or clinical stage I or II breast cancer. After the biopsy, these patients underwent either a modified radical mastectomy or breast-conserving surgery including axillary lymph node dissection. Biopsy of internal mammary lymph nodes was performed in 19 of these patients. RESULTS: No involvement of internal mammary lymph nodes was found histologically in 5 patients in whom lymphatic flow or a "hot nodule" in the internal mammary chain was found using lymphoscintigraphy. Nodal involvement was demonstrated histologically in only 1 of 5 cases where lymphatic vessels showed dye staining or faintly stained nodes. Internal mammary lymph node biopsy also was performed in 14 of 36 patients with neither stained lymphatic vessels or nodes, nor with lymphatic flow or a hot nodule by lymphoscintigraphy. Nodal involvement was found histologically in 1 of these patients. CONCLUSION: SLN biopsy guided by lymphatic mapping is unreliable for identifying metastases to internal mammary lymph nodes.

Adult↗

PubMed2001

[Experimental and clinical approaches to lymph node imaging].

Exact assessment of lymph nodes is crucial to tumor staging, choice of therapy and in predicting the outcome. Although imaging plays a central role in the evaluation of lymph nodes, current imaging methods have low sensitivity and specificity primarily because they rely on insensitive morphological criteria or because they have low special resolution. Because of this diagnostic dilemma invasive, expansive and uncomfortable diagnostic techniques and/or unnecessary aggressive therapies are still in use. This brief overview is intended to summarize current imaging strategies and to give an outlook on experimental and clinical strategies in lymph node imaging in cancer.

Animals↗

PubMed2001

Significance of plasma cytokine levels in melanoma patients with histologically negative sentinel lymph nodes.

INTRODUCTION: Although sentinel lymph node (SLN) status is the most powerful predictor of prognosis in patients with clinically localized melanoma, a proportion of melanoma patients with histologically negative SLNs will still recur. It is hypothesized that tumor response may be altered or mediated by specific cytokines. We therefore investigated whether levels of IL-4, IL-6, IL-10, TNF-alpha, or IFN-gamma would predict disease recurrence in melanoma patients with histologically negative SLNs. METHODS: This prospective cohort study involved 218 patients with clinically localized melanoma who underwent a histologically negative SLN biopsy. Preoperative plasma cytokine levels were determined by enzyme-linked immunosorbent assay on these patients, as well as on 90 healthy controls. Kaplan-Meier life tables were constructed, and Cox proportional hazards analyses were performed to assess predictors of disease-free survival (DFS). RESULTS: At a median follow-up of 43 months, 33 of 218 patients (15%) had suffered disease recurrence. Melanoma patients had significant elevations of IL-4, IL-6, and IL-10 compared to healthy controls; levels of IFN-gamma were less elevated in melanoma patients compared to controls. Despite this, melanoma patients with detectable IFN-gamma levels were at significantly higher risk for recurrence compared to patients with undetectable levels (5-year DFS 70% vs. 86%, P = .03). On multivariate analysis including standard melanoma prognostic factors, only tumor thickness (P = .004) and the presence of detectable IFN-gamma levels (P = .05) were significant independent prognostic factors for disease-free survival. CONCLUSIONS: Among melanoma patients with clinically localized disease who have undergone a histologically negative SLN biopsy, presence of a detectable plasma level of IFN-gamma is an independent predictor of disease recurrence. Elevated levels of IFN-gamma may identify a group of early-stage melanoma patients who are more likely to have recurrence of disease and who may benefit from adjuvant therapies, including immunotherapies.

Adolescent↗

PubMed2006

The impact of axillary lymph nodes removed in staging of node-positive breast carcinoma.

PURPOSE: Number of positive lymph nodes in the axilla and pathologic lymph node status (pN) have a great impact on staging according to the current American Joint Committee on Cancer staging system of breast carcinoma. Our aim was to define whether the total number of removed axillary lymph nodes influences the pN and thus the staging. METHODS AND MATERIALS: The records of 798 consecutive invasive breast cancer patients with T1-3 tumors and positive axillary lymph nodes who underwent modified radical mastectomy between 1999 and 2005 in our hospital were reviewed. The total number of removed nodes were grouped, and compared with the patient and tumor characteristics and the influence of the number of nodes removed on the staging was analyzed. RESULTS: The proportion of patients with > or =4 positive nodes (59%), and pN3 status (51%) were the highest in the group with 21-25 nodes removed. Compared with patients with 1-20 nodes removed, the proportion of patients with > or =4 positive nodes (52%), and pN3 status (46%) were significantly higher in those with more than 20 nodes removed. Although the proportion of Stage IIA and IIB decreased, the proportion of Stage IIIA and IIIC increased in patients with >20 nodes removed compared with those with 1-20 nodes removed. CONCLUSIONS: In patients with axillary node-positive breast carcinoma, staging is highly influenced by total number of removed nodes. Levels I-III axillary dissection with more than 20 axillary lymph nodes removed could lead to more effective adjuvant chemotherapy and increases substantially the proportion of patients to receive radiotherapy.

Adult↗

PubMed1996

[Lymph node excision in thyroid carcinoma].

The prognostic value of lymph node metastases in thyroid cancer has been a matter of controversy for many years. However, during the past decade most multivariate analyses have shown a prognostic influence of lymph node metastases in papillary as well as medullary thyroid carcinoma constituting the basis for a standardized concept of lymphadenectomy oriented to the lymph node classification of the UICC (1993). Due to the frequency of lymph node metastases in the ipsilateral cervicocentral compartment (42-86%), in the ipsilateral cervicolateral compartment (32-68%), in the contralateral cervicolateral compartment (12-24%), and in the mediastinal compartment (3-20%), these compartments can be defined as the lymph node regions of the first, second, third and fourth order, respectively. Cervicocentral systematic lymphadenectomy should be part of the en bloc resection of the thyroid gland and the first lymph node region in any thyroid cancer. Cervicolateral as well as mediastinal lymphadenectomy should be performed according to the extent of lymph node involvement, i.e. systematically when multiple lymph node metastases are present, otherwise selectively. One exception is in medullary thyroid carcinoma, where a four-compartment lymphadenectomy is recommended in any patient with positive lymph nodes. Performing a gentle technique using magnifying glasses and bipolar coagulation forceps, systematic lymphadenectomy does not increase the rate of complications, can decrease the recurrence rate and improve survival.

Adenocarcinoma↗

PubMed1990

[The incidence and clinical significance of paraaortic lymph node metastases in patients with uterine cervical cancer].

Paraaortic lymph node dissection was performed in the treatment of patients with carcinoma of the cervix who were subjected to radical hysterectomy between June, 1982 and March, 1988 at the Department of Obstetrics and Gynecology, Hokkaido University Hospital, Sapporo, Japan. Thirteen out of 246 (5.3%) patients had metastases in the paraaortic lymph node. Of the patients with stage I carcinoma of the cervix, 1.0 per cent had positive paraaortic lymph node. Of the patients with stage II carcinoma, 4.9 per cent had metastases in the paraaortic lymph nodes, and of the stage III patients, 16.7 per cent had positive paraaortic lymph nodes. The incidence of paraaortic node involvement increased along with the advance of the disease. Of the patients with squamous cell carcinoma of the cervix, 4.6 per cent had paraaortic lymph node metastases. Of the patients with adenocarcinoma of the cervix including mixed carcinoma, 6.8 per cent had positive paraaortic node. All the patients with positive paraaortic lymph nodes had metastatic diseases in the pelvic nodes. In addition, the number of groups of positive pelvic nodes in the patients with positive paraaortic lymph nodes was significantly larger than that in those with negative paraaortic nodes. At the time of reporting, seven out of 13 patients with positive paraaortic lymph node have died of the disease. The mean survival period of those seven patients was 14.9 +/- 12.2 (mean +/- SD) months. Of the remaining six surviving patients, three have been doing well for more than three years.(ABSTRACT TRUNCATED AT 250 WORDS)

Aorta↗

PubMed1983

Lymphocyte migration during the development of regional lymph node anergy in experimental tumor growth.

The development of lymph node anergy in Wistar rats to growing Walker carcinoma 256 was studied in vitro using the 51Cr-release cytotoxicity assay. Cell-mediated cytotoxicity to the tumor peaked in draining lymph nodes 11 days after tumor transplantation. By 14 days, the regional lymph node had become anergic to the tumor at a time when cell-mediated cytotoxicity was still increasing in the more distal contralateral lymph node. Lymphocyte migration into resting, cytotoxic, and anergic lymph nodes was analyzed to determine if altered cell migration into the regional lymph node was associated with the development of anergy. Lymphocyte migration was found to be enhanced in both cytotoxic and anergic regional lymph nodes of tumor-bearing animals. It is concluded that lymph node anergy in this experimental tumor system is not related to changes in lymphocyte migration patterns; rather, it is the result of alterations in the microenvironment of the lymph node which prevents the expression of cytotoxic effector cells.

Animals↗

PubMed1971

The distribution of group E streptococcus among lymph nodes of experimentally infected swine.

Lymph nodes, spleens, and tonsils from swine infected experimentally with Group E Streptococcus (GES, the causative agent of jowl abscess) were examined grossly and bacteriologically. Forty-two abscessed lymph nodes were seen among 14 infected swine. Pure cultures of GES were recovered from each abscess. Approximately half of 112 pools of grossly normal lymph nodes yielded GES as did half of 14 tonsils and 14 spleens. All GES recovered were morphologically and serologically identical to the strain used to create the experimental infection.

Abscess↗

PubMedDate not supplied

Histological evaluation of lymph node metastasis on serial sectioning in gastric cancer with radical lymphadenectomy.

BACKGROUND/AIMS: Lymph node metastasis is one of the most important prognostic factors in gastric cancer patients. To evaluate the real extent of lymph node metastasis from gastric cancer, histological examination by serial sectioning was performed. METHODOLOGY: Histological examination of serial sections of lymph nodes was performed in 111 gastric cancer patients who underwent radical gastrectomy, to evaluate methods of examining lymph node metastasis. A total of 58430 cross-sections of 3449 lymph nodes were examined. The extent of lymph node metastasis was evaluated by the routine one-section method, the 3-section method and the serial sectioning method for lymph node examination. RESULTS: The frequency of lymph node metastasis was 81.1% (90/111) and metastatic foci were detected in 23.0% of all lymph nodes by serial sectioning. Serial sectioning of distant lymph nodes showed metastasis in 23.8% by the 1 section method, and 8.4% by the 3-section method. Micrometastasis was detected in 10.5% of metastatic lymph nodes, and distant lymph nodes had a higher rate of micrometastasis. CONCLUSION: Serial sectioning resulted in more accurate evaluation of the extent of lymph node metastasis, and it was also shown that distant lymph nodes had a higher rate of micrometastasis.

Gastrectomy↗

PubMed1989

Small bowel intussusception: an unusual complication of retroperitoneal lymph node dissection.

Modified bilateral retroperitoneal lymph node dissection is used widely in the staging and treatment of patients with nonseminomatous germ cell testis tumors. Complications are uncommon and include vascular injury, infertility and small bowel obstruction from fibrous adhesions. Small bowel intussusception following retroperitoneal lymph node dissection has not been reported previously. We report 2 cases of small bowel intussusception after retroperitoneal lymph node dissection, and discuss the etiology and possible preventive measures.

Adult↗

PubMed1975

Prognostic evaluation of regional lymph node morphology colorectal cancer.

Histologic sections from 143 patients treated with surgery for infiltrating adenocarcinoma of the distal large bowel were studied with emphasis on the morphologic characteristics of the regional lymph nodes. Lymph nodes were classified into four groups designated lymphocyte predominance, germinal center predominance, lymphocyte depletion, and unstimulated. Results were correlated with the extent of disease and five year survival data. There was no significant association between the histologic pattern of the lymph nodes and the extent of the primary lesion. There was a higher survival rate in patients whose nodes showed germinal center predominance (71 per cent) compared with those whose nodes showed lymphocyte predominance or the unstimulated pattern (both 54 per cent), but these results were not statistically significant.

Adenocarcinoma↗