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PubMed2006

[Clinical application of sentinel lymph node detection to early stage cervical cancer].

BACKGROUND & OBJECTIVE: Sentinel lymph node (SLN) identification has been increasingly used in the treatment design of a variety of solid tumors, particularly breast cancer and melanoma. A negative SLN predicts the absence of tumor metastases in the regional lymph nodes with high accuracy. This study was to investigate the clinical value of combined isotope-dye technique for detecting SLN, and to evaluate the accuracy of SLN in predicting the pelvic lymph nodes status in patients with early stage cervical cancer. METHODS: A total of 27 patients with early stage cervical cancer,scheduled for radical hysterectomy and total pelvic lymphadenectomy, were eligible for the study. Lymphoscintigraphy was performed with injection of radioactivity isotope (99m)Tc-labeled dextran ((99m)Tc-DX) into the uterine cervix 16 h before surgery. Methylthioninium (4 ml) was injected into the same points as (99m)Tc-DX during surgery, and the patients underwent lymphatic mapping with a handheld gamma-detecting probe. After resection of SLNs, standard radical hysterectomy with pelvic lymph node dissection was performed. All removed lymph nodes, including the SLNs, were examined by routine histopathology. The histopathologic results of SLNs and non-SLNs were compared. RESULTS: The detection rates of SLN were 96.3% by blue dye method, and 100% by radiolabeled tracer or combined isotope-dye. Blue dye method identified 61 SLNs, radiolabeled tracer identified 69 SLNs, and combined isotope-dye identified 70 SLNs. Preoperative SPECT/CT fusion images detected 4 SLNs in the parametrium. Seven (25.9%) patients had lymph node metastasis. The sensitivity, accuracy, negative predictive value, and false negative rate of SLN detection were 85.7% (6/7), 96.3% (26/27), 95.2% (20/21), and 14.3% (1/7), respectively. CONCLUSIONS: SPECT/CT imaging not only is superior to planar imaging in detecting SLN but also enables precise localization of SLNs. The combined isotope-dye method can improve the accuracy of SLN detection. SLN detection can accurately predict the pelvic lymph nodes status in early stage cervical cancer.

Adult↗

PubMed1993

[Axillary recurrence after lymph node excision in malignant melanoma].

In a retrospective study 143 patients with 155 axillary lymphadenectomies were observed with a maximum of 8 years of follow-up (mean 51.9 +/- 25.8 months). At the time of their lymphadenectomies, 39 patients had histologically negative nodes (stage I), 85 patients lymph-node metastases (stage II), 19 patients axillary node involvement and distant metastases (stage III). The estimated 5-year survival rates were 77.5% in stage I and 28.6% in stage II. Axillary recurrence after dissection of tumor-free lymph nodes rarely happened, but in stage II the probability of recurrence was as high as 30.7%. All axillary recurrences occurred in the first 20 months after lymphadenectomy. In a multivariate analysis (Cox model), the only prognostic factor of probability of recurrence in stage II was the development of regional in-transit cutaneous metastases (p = 0.048). Factors that did not affect the appearance of recurrent metastases in the node dissection field were: epidermal ulceration, vascular invasion, tumor thickness, degree of lymph-node involvement, age, sex, and adjuvant chemotherapy. Median survival after axillary recurrence following therapeutic lymph-node excision (5 months) was comparable with survival after lymphadenectomy in stage III (7 months). There was a high incidence (> 30%) of regional in-transit cutaneous metastases in both groups. Regardless of the poor prognosis, we found 15% axillary recurrences after lymph-node clearance in stage III.

Combined Modality Therapy↗

PubMedDate not supplied

Magnetic resonance imaging features of presumed normal head and neck lymph nodes in dogs.

To document the magnetic resonance imaging appearance of presumed normal lymph nodes of the head and neck in the dog, 91 studies of dogs with no detectable disease in the head acquired on a low-field unit were reviewed. If lymph nodes were imaged, symmetry, signal intensity, homogeneity, and size as well as the relation to the surrounding fat were noted. To improve the description of lymph node topography, we used corresponding E12 plastinated embedded sections of a dog. Compared with surrounding fat, lymph nodes were hypointense in T1 images. In T1-weighted images after intravenous contrast medium lymph nodes were isointense. In T2-weighted images, lymph nodes were slightly hypointense to surrounding fat. In T1 and T2 images, a hypointense band, created by the chemical shift artifact, could be seen at the lymph node-fat boundary along the frequency encoding gradient. In some dogs the lymph node hilus was characterized by vessels indenting the capsule of the lymph node. The facial vein is a consistent landmark to identify mandibular lymph nodes, and the mandibular salivary gland is a useful landmark to localize the medial pharyngeal lymph nodes. The parotid salivary gland or the external acoustic meatus were useful markers to identify the parotid lymph nodes, which were not consistently seen. In some dogs, nodules within the lymphoreticular tissue of the soft palate were seen.

Animals↗

PubMed2005

[Genomic changes in primary lesion and lymph node metastases of esophageal squamous cell carcinoma].

BACKGROUND & OBJECTIVE: Local lymph node and blood metastasis could occur at early stage of esophageal squamous cell carcinoma (ESCC), which may be the key factors of its recurrence and poor prognosis. However, the mechanism of ESCC metastasis is unclear. This study was to analyze the genetic changes in primary lesion and lymph node metastases of ESCC, to screen for and locate ESCC metastasis-related genes. METHODS: Genomic alterations in 15 pairs of primary lesions and matched metastatic lymph nodes of ESCC were analyzed by comparative genomic hybridization (CGH). RESULTS: In the 15 pairs of tissues, the most common chromosomal alterations were the gains of 3q, 8q, 6p, 20p, 5p, 18p, 2p, 2q and 1q, and the losses of 10p, 10q, 17p, 18q, 4p and 13q. Of these changes, the most significant finding was the gain of 6p with a frequency of 47% in metastatic lymph nodes and 13% in primary lesions, and the gain of 20p with a frequency of 73% in metastatic lymph nodes and 33% in primary lesions. The second interesting finding was the loss of 10p with a frequency of 53% in metastatic lymph nodes and 13% in primary lesions, and the loss of 10q with a frequency of 47% in metastatic lymph nodes and 13% in primary lesions. CONCLUSION: The gains of 6p and 20p and the losses of 10p and 10q are common genomic alterations in primary lesion and lymph node metastases of ESCC, which may code ESCC metastasis-related genes.

Adult↗

PubMed2005

Usefulness of thyroglobulin measurement in fine-needle aspiration biopsy specimens for diagnosing cervical lymph node metastasis in patients with papillary thyroid cancer.

The diagnosis of lymph node metastasis in patients with papillary thyroid cancer is an important factor when deciding to perform neck dissection at the initial surgery, as well as for evaluating the lymph node swelling after surgery. Ultrasound (US)-guided fine-needle aspiration biopsy cytology (FNAB-C) is the most useful technique for diagnosing lymph node metastasis. Recently, however, measurement of thyroglobulin in the wash-out of the needle (FNAB-Tg) has been proposed for early detection of neck lymph node metastasis in patients with differentiated thyroid cancer. The purpose of this study was to evaluate the usefulness of FNAB-Tg in detecting lymph node metastasis prior to initial or reoperative thyroid surgery. US-guided FNAB-C was performed on 129 enlarged lymph nodes of 111 patients before surgery. All of them were later histologically confirmed to contain metastasis. Immediately after obtaining an FNAB-C specimen, the needle was rinsed with 0.5 ml of normal saline solution, and the wash-out was subjected to measurement of the Tg level (FNAB-Tg). If the FNAB-Tg level was higher than the serum Tg of the patient, we diagnosed the lymph node as positive (metastatic lymph node). FNAB-Tg sensitivity was 81.4%, and FNAB-C sensitivity was 78.0%. Altogether, 4 (36.4%) of 11 cases judged "benign" and 6 (37.5%) of 16 cases judged "inadequate" by FNAB-C were positive by the FNAB-Tg measurement. Thyroglobulin measurement in fine-needle aspiration biopsy wash-out is thus a useful technique for diagnosing lymph node metastasis of papillary thyroid cancer.

Biopsy, Fine-Needle↗

PubMed2005

High prevalence and possible de novo formation of BRAF mutation in metastasized papillary thyroid cancer in lymph nodes.

CONTEXT: The role of the T1799A BRAF mutation in lymph node metastasis of papillary thyroid cancer (PTC) is not clear. OBJECTIVE: Our objective was to explore the relationship between BRAF mutation and lymph node metastasis of PTC by examining the mutation in both the primary tumors and their paired lymph node metastases. DESIGN: We isolated genomic DNA from primary thyroid tumors and paired lymph node metastases and performed direct sequencing of exon 15 of the BRAF gene mutation that carries the T1799A mutation. RESULTS: In a series of 33 cases, 21 harbored the T1799A mutation in the primary tumors, and 17 (81%) of them harbored the same mutation also in the paired lymph node metastases. Twelve cases did not harbor the T1799A mutation in the primary tumors, among which nine cases also did not harbor BRAF mutation in the lymph node-metastasized tumors, whereas the other three did harbor the T1799A mutation in lymph node-metastasized tumor tissues. A novel tandem TG1799-1800AA mutation within one allele was found in a lymph node-metastasized tumor but not in the primary tumor. This mutation results in the change of codon 600 (GTG) of the gene to GAA with the consequent amino acid change (V600E) in the B-type Raf (BRAF) protein, same as that caused by the T1799A mutation alone. CONCLUSION: The high prevalence of BRAF mutation in lymph node-metastasized PTC tissues from BRAF mutation-positive primary tumors and the possible de novo formation of BRAF mutation in lymph node-metastasized PTC were consistent with a role of BRAF mutation in facilitating the metastasis and progression of PTC in lymph nodes.

Adenine↗

PubMed2000

[Benign epithelial inclusions in pelvic lymph nodes. 2 case reports].

A large number of lymph node inclusions excluding endometriosis have been described in a variety of anatomical sites; they are usually epithelial and only rarely non-epithelial. Their presence can give rise to an erroneous diagnosis of metastasis. Recently the staging laparotomy has become a frequent procedure in the management of neoplasms of the female genital tract, and involves abdominal lymphadenectomy, inspection of the peritoneal surface, multiple biopsies and the resection of suspicious lesions. During the surgery, and among the lesions excised, the occasional presence of lymph node inclusions can lead to a diagnostic error. In order to avoid this problem, it is necessary to be adequately informed about these inclusions, including their anatomic sites, their histologic characteristics and the knowledge that they can present in lymph nodes related to an inflammatory process or a tumour. This revision is to alert pathologist towards a group of lesions which can imitate metastatic carcinoma, and specially towards those inclusions which present together with malignant neoplasias of the female genital tract. Recently we received two cases of pelvic lymph nodes, initially diagnosed as metastatic carcinoma, and eventually found to correspond to mesothelial cell hyperplasia in one case, and to lymph node inclusions in the other.

Adult↗

PubMed1989

[Size relations of the spleen and lymph nodes in normal and pathologic processes].

63 spleens and 79 lymph node specimens, both normal and diseased, were measured in three planes. The ratio of length to width and to thickness was established to determine if characteristic changes in proportion - in connection with the expansion of the respective organs - are evident. The healthy spleens did not differ markedly from the diseased ones, whereas striking differences were obvious among the diseased lymph nodes. Lymph nodes involved in malignant disease appeared globular, whereas those involved in inflammatory disease showed a longish and flattened shape.

Adult↗

PubMed2004

Analysis of dendritic cells in tumor-free and tumor-containing sentinel lymph nodes from patients with breast cancer.

INTRODUCTION: Sentinel lymph node (SLN) biopsy allows identification of the first lymph node into which a primary tumor drains. In breast cancer, identification of tumor cells in the SLNs is a predictor of the tumor's metastatic potential. In the present article, we tested the hypotheses that a positive immune response can occur in tumor-free SLNs and that the activation state of dendritic cells (DCs), the major antigen presenting cells within SLNs, predicts the immune status and metastatic potential of the tumor. METHODS: Fifty paraffin-embedded SLN sections, 25 tumor-free and 25 tumor-containing, from patients with breast cancer were analyzed by immunohistochemistry to determine the immune maturation state of their DCs. In addition, 12 lymph nodes from noncancer-containing breasts were analyzed. Tissues were stained with antibodies against CD3, MHC class II, CD1a, CD83, IL-10, and IL-12. Mature DCs were defined by CD83 expression and immature DCs by CD1a expression. RESULTS: We found a trend toward higher numbers of mature CD83-positive DCs in tumor-free SLNs than in tumor-containing SLNs (P = 0.07). In addition, tumor-free SLNs were more likely to contain cells expressing IL-10 (P = 0.02) and, to a lesser extent, IL-12 (P = 0.12). In contrast, when all SLNs, both tumor-free and tumor-containing, were compared with uninvolved lymph nodes, the numbers of mature and immature DCs were similar. CONCLUSIONS: Our results suggest tumor-free SLNs are immunologically competent and potentially a site of tumor-specific T-cell activation, as evidenced by the presence of greater numbers of mature DCs and cytokine-producing cells in tumor-free SLNs.

Adult↗

PubMed2003

Fine-needle aspiration biopsy and intraoperative cytologic smear findings in a case of benign mesothelial-cell inclusions involving a lymph node: case report and review of the literature.

Although first described over a decade ago, the rare entity of mesothelial lymph node inclusions (nonneoplastic mesothelial cells involving lymph node sinuses) is not well-known among pathologists. Unlike most lymph node inclusions such as Müllerian inclusions or nevus cells, which usually occur in the capsule of the lymph node, mesothelial cells involve the lymph node sinus, mimicking metastatic carcinoma or metastatic mesothelioma. The spectrum of histologic findings ranges from a few mesothelial cells, perhaps only detectable by immunohistochemical stains, to a massive distention of the lymph node sinus with abundant mesothelial cells. Mesothelial-cell inclusions in lymph nodes are usually found in mediastinal lymph nodes of patients with pleural and/or pericardial effusions. It is hypothesized that the effusion, due to whatever cause, allows for mesothelial-cell migration into the submesothelial lymphatics and regional lymph nodes. To our knowledge, cytologic findings on aspiration biopsy and intraoperative smear preparations of a lymph node with mesothelial-cell inclusions have never been described. Familiarity with this entity is important in preventing misdiagnosis of malignancy.

Biopsy, Fine-Needle↗

PubMed2002

Intraoperative evaluation of sentinel lymph nodes for metastatic breast carcinoma by imprint cytology.

BACKGROUND: The increasing utilization of lymphatic mapping techniques for breast carcinoma has made intraoperative evaluation of sentinel lymph nodes attractive. Axillary lymph node dissection can be performed during the initial surgery if the sentinel lymph node is positive, potentially avoiding a second operative procedure. At present the optimal technique for rapid sentinel lymph node assessment has not been determined. Both frozen sectioning and intraoperative imprint cytology are used for rapid intraoperative sentinel lymph node evaluation at many institutions. The purpose of this study is to evaluate experience with imprint cytology for intraoperative evaluation of sentinel lymph nodes in patients with breast cancer. METHODS: A retrospective review of the intraoperative imprint cytology results of 678 sentinel lymph node mappings for breast carcinoma was performed. Sentinel nodes were evaluated intraoperatively by either bisecting or slicing the sentinel node into 4 mm sections. Imprints were made of each cut surface and stained with H&E and/or Diff-Quik. Permanent sections were evaluated with up to four H&E stained levels and cytokeratin immunohistochemistry. Intraoperative imprint cytology results were compared with final histologic results. RESULTS: The sensitivity of imprint cytology was 53%, specificity was 98%, positive predictive value was 94%, negative predictive value was 82% and accuracy was 84%. The sensitivity for detecting macrometastases (more than 2mm) was significantly better than for detecting micrometastases (<or=2 mm), 81 versus 21%, respectively (P < 00001). CONCLUSIONS: The sensitivity and specificity of imprint cytology are similar to that of intraoperative frozen section evaluation. Imprint cytology is therefore a viable alternative to frozen sectioning when intraoperative evaluation is required. If sentinel lymph node micrometastasis is used to determine the need for further lymphadenectomy, more sensitive intraoperative methods will be needed to avoid a second operation.

Breast Neoplasms↗

PubMed2002

Evaluation of an indicator for lymph node metastasis of esophageal squamous cell carcinoma invading the submucosal layer.

Lymph node metastasis is a major prognostic factor for esophageal squamous cell carcinoma (ESCC). In recent years, endoscopic mucosal resection (EMR) has been developed with excellent results for the treatment of the superficial ESCC. To make the EMR treatment successful, it is important to establish a good indicator to identify ESCC patients at a high risk of lymph node metastasis. In this study, we examined clinicopathological and immunohistochemical factors to investigate the factors involved in lymph node metastasis of ESCC invading to the submucosal layer (sm-ESCC). Surgical specimens from 84 sm-ESCC patients were examined. Among 84 sm-ESCC patients, 33 (39.3%) had lymph node metastases. Clinicopathologically, tumor depth, lymphatic invasion and blood vessel invasion showed significant correlations with lymph node metastasis by univariate analysis. Tumor depth and lymphatic invasion showed significant correlations by multivariate analysis of these factors. Immunohistochemically, P53 accumulation was observed in 45 cases (53.6%), cyclin D1 overexpression in 25 (29.8%), and pRB in 65 (77.4%). P53 accumulation, cyclin D1 overexpression and MIB-1 Labeling Index were significantly associated with lymph node metastasis by univariate analysis, and P53 accumulation showed a significant correlation with lymph node metastasis by multivariate analysis. Among tumor depth, lymphatic invasion and P53 accumulation, tumor depth and lymphatic invasion were significantly correlated with lymph node metastasis (P = 0.0023 and P = 0.0092, respectively) by multivariate analysis. These data suggest that tumor depth and lymphatic invasion can be considered as good indicators for lymph node metastasis among patients with sm-ESCC. In addition, P53 accumulation could be helpful to identify the patients who need additional treatment after EMR.

Adult↗

PubMed2005

Axillary disease recurrence after sentinel lymph node dissection for breast carcinoma.

BACKGROUND: Surgical recommendation for early-stage breast carcinoma includes removal of the primary breast tumor and evaluation of the axillary lymph nodes on the ipsilateral side. Sentinel lymph node dissection (SLND) is increasingly being used to evaluate axillary lymph nodes in clinically lymph node negative patients as an alternative to axillary lymph node dissection (ALND). Results from SLND are highly predictive of metastatic involvement in the axilla, and are associated with fewer side effects. However, the greatest concern with SLND alone is the potential for a higher rate of axillary lymph node recurrence. The purpose of the current study was to review data collected on 700 consecutive patients with early-stage breast carcinoma who underwent SLND without concomitant ALND. METHODS: A retrospective study was conducted using the oncology registry at Park Nicollet Health Services (Minneapolis, MN). Consecutive breast carcinoma cases with SLND only for axillary surgery, from January 28, 1999 to December 31, 2003, were included in the study. During this period, 700 patients with breast carcinoma were identified who had SLND alone. Fifty-two patients were excluded from the analysis because they had ductal carcinoma in situ. RESULTS: With a median follow-up of 33 months (range, 2-73 mos), axillary lymph node recurrence occurred in 4 of 647 (0.62%) patients overall. In these 4 patients, the axillary lymph node recurrences were isolated to the axillary lymph nodes and amenable to surgery. CONCLUSIONS: Data from the current study showed that axillary lymph node recurrence after SLND occurred very infrequently in early-stage breast carcinoma, and these results were comparable to other studies.

Axilla↗

PubMedDate not supplied

Antibody responses to thymic independent antigens in the peripheral and mesenteric lymph nodes of mice.

Differentiation of B lymphocytes from various peripheral lymph nodes (PLN) of mice was studied in the in vitro and in vivo conditions. Subcutaneous (SC) immunization in the foot pads with thymic independent (TI)-2 antigens such as polyvinyl pyrrolidone (PVP), R36A, and Trinitrophenyl (TNP)-Dextran failed to elicit plaque forming cell (PFC) responses from the draining popliteal and inguinal lymph nodes, whereas the splenic B cells of these animals exhibited good PFC response. Injection of unconjugated Brucella abortus (BA) along with TNP-Dextran was able to induce anti-TNP PFC formation from the draining lymph node B cells. However, PVP + BA or R36A + BA failed to stimulate such antigen specific B cell responses from the lymph nodes. Since TI antigens are metabolized slowly because of their long repeating subunits, we measured antibody responses up to 8 weeks after SC immunization with TNP-Ficoll and failed to observe any anti-TNP IgM PFC in the lymph nodes. TNP-Ficoll, in contrast to TI-1 antigen TNP-BA, did not induce IgG PFC response in the draining lymph node cells. In in vitro cultures, TNP-Ficoll induced the B cell differentiation from mesenteric lymph node (MLN) cells but not from the PLN cells. This activation of MLN B cells with TNP-Ficoll was limited to normal DBA/2J mice and was absent in the MLN cells of X-linked immune defective CBA/N mice. Finally, there was good antibody response from the inguinal and lumbar lymph node cells after an intraperitoneal immunization with TNP-BA but not with TNP-Ficoll.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2003

Prognostic significance of the size of cancer nests in metastatic lymph nodes in human esophageal cancers.

BACKGROUND: Postoperative survival of patients with esophageal cancers after curative surgery is strongly affected by the presence of lymph node metastasis. The number and location of lymph node metastases have been evaluated and graded, but the clinical significance of their size has not been well investigated. METHODS: Of 322 esophageal cancer patients who underwent curative operations with radical lymph node dissection, 170 (53%) had lymph node metastasis. A total of 784 metastatic lymph nodes were obtained, and the area of the cancer nests was measured microscopically in the cross section. The data from each patient included the area of the largest cancer nest in the positive nodes (Nmax), classified as Na (<4 mm2), Nb (4-25 mm2), Nc (25-100 mm2), or Nd (>100 mm2). RESULTS: The 170 patients were classified according to the Nmax value: Na, 31 (18.2%); Nb, 35 (20.5%); Nc, 49 (28.8%); and Nd, 55 (32.4%). The 5-year survival rate was 77.7% in patients without lymph node metastasis and 35.4% in those with lymph node metastasis. When classified by Nmax, the 5-year survival rate was 77.8% for Na, 63.9% for Nb, 18.8% for Nc, and 12.8% for Nd. There was no significant difference in the survival rate between Na patients and those without lymph node metastasis. Nmax showed significant correlation with the primary tumor size, depth of tumor invasion, and number and location of metastatic lymph nodes, but not with histologic type or primary tumor location. In multivariate analysis, the Nmax value, the number of lymph node metastases and depth of tumor invasion were independent prognostic factors, while the location of the lymph node metastases was not statistically significant. CONCLUSIONS: The area of the largest cancer nest in the lymph nodes was one of the most significant prognostic factors for esophageal cancers. This estimation is objective and reproducible and may be of great importance when deciding the therapeutic modality for patients with esophageal cancers.

Esophageal Neoplasms↗

PubMed1987

Ontogeny of ovine lymphocytes. III. An immunohistological study on the development of T lymphocytes in sheep fetal lymph nodes.

The development of T lymphocytes in ovine fetal lymph nodes was studied immunohistologically using a panel of monoclonal antibodies. T lymphocyte subsets appeared within the ovine fetal lymph node in a specific sequence. SBU-T1- and SBU-T8-positive lymphocytes were seen at Day 47 of gestation. LCA, sIg, MHC I, MHC II, SBU-T6 and 46.66 antigens were also seen within the lymph node at this time. The first SBU-T4-positive cells were seen within the fetal lymph node at Day 50 of gestation, along with the first 20.96-, 25.69- and 38.38-positive cells. SBU-T19 lymphocytes appeared later in gestation, being present in fetal lymph nodes from Day 69 of gestation. The appearance and distribution of T and B cells in the developing lymph nodes of the ovine fetus is described and compared with the ontogeny of lymphocytes in the fetal thymus and spleen.

Animals↗

PubMed2002

Prognostic effect of lymph node micrometastasis in patients with histologically node-negative gastric cancer.

BACKGROUND: There is no consensus as to the impact of lymph node micrometastasis on survival of patients with gastric cancer. The aim of this study was to clarify the prognostic significance of lymph node micrometastasis in patients with histologically node-negative gastric cancer. METHODS: Lymph nodes (n = 2039) from 64 patients with histologically node-negative gastric cancer (T2, T3) were evaluated for micrometastasis. Three serial 5- micro m sections of the resected lymph nodes were prepared for immunohistochemical staining with the anti-cytokeratin antibody CAM 5.2. RESULTS: Micrometastasis was found in 73 of 2039 nodes (4%) and 20 of 64 patients (32%). The 5-year survival rate was significantly lower for patients with lymph node micrometastasis than for those without lymph node micrometastasis (66% vs. 95%, P <.01). The 5-year survival rate was significantly lower when there were four or more positive micrometastatic nodes (94% vs. 29%, P <.01) and when there were extragastric micrometastatic nodes (89% vs. 53%, P <.01). CONCLUSIONS: Lymph node micrometastasis was associated with poor outcome in patients with histologically node-negative gastric cancer. The number and the level of lymph node micrometastases are useful prognostic markers for deciding treatment strategies for additional therapy and follow-up.

Adenocarcinoma↗

PubMed2005

[Magnetic resonance imaging diagnosis of cervical lymph node metastasis from lingual squamous cell carcinoma].

BACKGROUND & OBJECTIVE: The identification of cervical lymph node metastasis is very important for the treatment and prognosis prediction of lingual squamous cell carcinoma. Simple palpation is unsatisfactory for the accurate diagnosis of cervical lymph node metastasis. Magnetic resonance imaging (MRI) has been increasingly used to evaluate cervical lymph node status. This study was to explore MRI features of cervical lymph nodes metastasis from lingual squamous cell carcinoma, and to investigate the role of MRI in diagnosing this kind of metastasis. METHODS: The MR images of 448 nodal levels in 92 patients with lingual squamous cell carcinoma were analyzed, and compared with their pathologic diagnoses. RESULTS: Of the 488 nodal levels, 166 (37.1%) were proved pathologically as metastases, level II was the most commonly involved. False-positive and false-negative rates of MRI diagnoses were higher in levels I, and II than in levels III, IV, and V. There is no statistical difference in the incidence of cervical lymph nodes metastases of different nodal levels between squamous cell carcinoma of corpus linguae and that of radix linguae. Obvious central nodal necrosis was seen in 76 nodal levels at MR images,which were proved pathologically as metastatic nodes. Extracapsular nodal invasions in 34 nodal levels had irregular contour, and infiltration of adjacent fat tissues around lymph nodes, among which carotid artery walls were encased in 2 cases. With the diagnostic criteria of metastasis as the minimal nodal diameter of >/= 8 mm or central nodal necrosis, the diagnostic sensitivity, specificity, and accuracy of MRI were 79.5%, 90.4%, and 86.4%, respectively. CONCLUSIONS: The incidence of cervical lymph nodes metastasis from lingual squamous cell carcinoma is highest in level II. MRI diagnostic criteria of cervical lymph nodes metastasis are nodal size, central nodal necrosis, and irregular contour of lymph nodes. MRI may diagnose lymph node metastasis in levels III-V with high accuracy, While its diagnosis accuracy on levels I-II is affected by the sites, which weakens its clinical value.

Adult↗