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PubMed1987

[Comparative study on the macroscopic and histopathological diagnosis of lymph node metastases in cancer patients].

Macroscopic diagnosis for lymph node metastases was compared with histopathological diagnosis in 444 patients with carcinoma of the esophagus, stomach, colon, thyroid and breast. The former indicated lymph node metastases in 181 patients. In all of them, none or less than five node metastases were proven by routine histopathological diagnosis. Detailed histological study revealed lymph node metastases in 25 out of 263 patients with macroscopically negative nodes, the rate of false negative being 9.5 per cent. The study also demonstrated no lymph node metastases in 51 of 181 patients with macroscopically positive nodes. Three additional specimens were obtained from originally examined 693 lymph nodes and reexamined microscopically in these 51 patients. Involvement by cancer cells was detected in 9 nodes (1.3 per cent) in 8 patients. Metastases were found from additional specimens in 7 of 9 nodes, indicating that metastatic carcinoma had been overlooked in the remaining two nodes. Additional specimens or embedding-techniques were recommended in such cases as macroscopic metastases were strongly suspected or lymph vessel invasions were remarkable. In 24 patients with esophageal cancer, one to one correspondence was available in the analysis of macroscopic diagnosis. Seventy-eight out of 108 involved nodes were macroscopically judged as involved (sensitivity; 72.2 per cent), and 1166 out of 1260 nodes without macroscopical metastases were judged as cancer-free (specificity; 92.5 per cent). Overestimation of macroscopic diagnosis was due to thickened capsule, fibrosis, inflammation and enlargement in size more than 10 mm in diameter of the nodes. Underestimation was observed in case of nodes with metastatic area less than one-third and with smaller size less than 5mm in diameter.

Diagnosis, Differential↗

PubMed1991

[The adequate diagnostic criterion of mediastinal lymph node size for detection of metastasis in primary lung cancer].

The size of lymph node is one of the most important factor in evaluation of lymph node metastasis in lung cancer. The most appropriate size for detecting lung cancer lymph node metastasis was studied by 2403 dissected lymph nodes in 75 operated cases of lung cancer. From the result of Receiver Operating Characteristic (ROC) curve analysis, long-axis diameter of the lymph node showed higher accuracy of diagnosis of metastasis than short-axis diameter. Metastasis of squamous cell carcinoma was diagnosed more accurately than that of adenocarcinoma. The most adequate threshold for detection of metastasis in squamous cell carcinoma was 10 mm in long-axis diameter with sensitivity of 73.8% and specificity of 78%. On the other hand, that of adenocarcinoma was 7 mm in long-axis diameter with sensitivity of 65.7% and specificity of 55.9%. That threshold value of adenocarcinoma was approximate to the value of normal lymph node size in the mediastinum. It was suggested that the size for detection of lymph node metastasis was depended upon histological type, and detection of lymph node metastasis in adenocarcinoma was extremely difficult.

Adenocarcinoma↗

PubMedDate not supplied

Sentinel lymph node mapping for staging breast cancer: preliminary results of a prospective study.

Axillary lymph node dissection is the gold standard for staging breast cancer, but it is associated with significant morbidity and complications. Sentinel lymph node mapping technique has demonstrated a successful detection of the node or nodes more likely to have metastasis. Two techniques are being used to detect sentinel lymph node-intraoperative use of gamma detecting probe after injection of radio tracer preoperatively and the injection of blue dye and lymphatic mapping intraoperatively. We used both techniques. Twenty-four patients underwent sentinel lymph node mapping. Blue dye and gamma detecting probe identified sentinel lymph nodes in 78% and 77% of patients, respectively. Overall, 23 of 24 patients had a sentinel lymph node identified (96%). Ten patients had metastatic disease in the axilla. Out of these ten patients the only positive node/nodes were the sentinel lymph node in six patients. The other four patients had positive non-sentinel lymph node along with positive sentinel lymph node. All of the patients who had metastatic disease in the axilla were detected by the sentinel lymph node mapping technique. Therefore, no patient had positive non-sentinel lymph node if the sentinel lymph node was negative. This technique was 100% predictive of the axillary status. Sentinel lymph node mapping technique will change the management of breast cancer and will allow two-thirds of the patients with breast cancer to be managed without axillary lymph node dissection with a resulting reduction in morbidity and cost.

Axilla↗

PubMed1990

Endosonography of pararectal lymph nodes. In vitro and in vivo evaluation.

One hundred thirteen patients with carcinoma of the rectum were evaluated for lymph node metastases by endorectal ultrasound. With the use of 7.5 MHz and based on different echo patterns, two main groups of lymph nodes can be differentiated: hypoechoic and hyperechoic lymph nodes. Compared with pathologic findings, hypoechoic lymph nodes represent metastases, whereas hyperechoic lymph nodes are visualized due to unspecific inflammation. Lymph node metastases can be predicted with a sensitivity of 72 percent and inflammatory lymph nodes with a specificity of 83 percent. The physical basis of the differentiation of lymph nodes was assessed in vitro by the determination of ultrasound parameters (speed of sound, acoustic impedance, attenuation, and backscattered amplitude). The attenuation coefficient of benign lymph nodes [2.5 dB/(MHz x cm)] is significantly higher than the mean value of lymph node metastases [1.3 db/(MHz x cm)]. The results demonstrate that involved nodes can principally be differentiated from not involved nodes. Micrometastases, mixed lymph nodes, and changing echo patterns within inflammatory nodes explain the accuracy rate of 78 percent.

Acoustics↗

PubMed1999

Three-field lymphadenectomy and pattern of lymph node spread in T3 adenocarcinoma of the distal esophagus and the gastro-esophageal junction.

OBJECTIVE: Lymph node metastasis in carcinoma of the esophagus and the gastro-esophageal junction is often underestimated by clinical staging. It is the aim of this study to provide support to the fact that three-field lymphadenectomy leads to a better pathological staging also in adenocarcinoma. METHODS: The pattern of lymph node metastasis in adenocarcinoma of the gastro-esophageal junction (GEJ) and the distal esophagus was charted in a prospective way by using a database. An analysis was performed with regard to lymphatic spread in T3, N+ adenocarcinomas of the distal esophagus and the GEJ junction, which were treated with a radical resection including a three-field lymphadenectomy. Out of 324 patients with adenocarcinoma of the esophagus and GEJ, we selected a group of 37 patients with an adenocarcinoma T3, N+ of the distal (n = 17) or GEJ junction (n = 20), treated with a radical resection and three-field lymphadenectomy ( > 25 lymph nodes resected). RESULTS: In total, 2240 lymph nodes were removed, with a mean of 59.5 per patient. In the GEJ group the ratio of positive nodes was 15.9, in the distal 1/3 group this ratio was 12.7%. Abdominal lymph nodes were positive in all GEJ tumors and in 70% of the distal third carcinomas. Thoracic lymph nodes were positive in 40% of GEJ tumors, and 70.6% of the distal group. Cervical lymph nodes were positive in 20% of the GEJ tumors and in 35.3% of the distal tumors. In six patients only right-sided cervical nodes were affected. Three patients in the GEJ group had positive lymph nodes in the neck without any involvement of thoracic lymph nodes. CONCLUSIONS: (1) Three-field lymphadenectomy improves accuracy of staging. (2) Cervical nodes are frequently involved. (3) Especially in tumors of the GEJ there is an important skipping phenomenon, i.e. positive lymph nodes in the neck in the absence of involvement of thoracic nodes. (4) Clinical staging remains deficient in regard to lymph node metastasis, especially cervical nodes. (5) The frequent unforeseen involvement of cervical lymph nodes in adenocarcinoma of the distal esophagus and GEJ tumors makes the interpretation of results of induction chemoradiotherapy questionable. (6) For the same reason, cervical lymph nodes should be included in the radiation field in case of induction chemoradiotherapy. (7) The similar pattern of lymph node involvement suggests similar oncological behavior of adenocarcinoma of the distal esophagus and the GEJ, questioning the actual TNM classification of these tumors as gastric carcinomas.

Adenocarcinoma↗

PubMed1987

Immunohistochemical studies of lymph nodes from LAS and AIDS patients.

Lymph nodes from eight LAS and six AIDS patients were studied by routine histology, immunohistochemistry, and ultraimmunohistochemistry. LAS lymph nodes show a peculiar follicular hyperplasia with a characteristic increase of proliferating dendritic and interdigitating reticulum cells. In AIDS, these cells are reduced and the expression of proliferation-associated antigens is diminished. The immunohistochemical analysis of dendritic and interdigitating reticulum cells and of proliferation-associated antigens in lymph nodes thus allows a clear distinction between LAS and AIDS and may have important prognostic implications.

AIDS-Related Complex↗

PubMed1995

[Renal cell carcinoma with regional lymph node metastasis].

A follow up study of 20 cases of renal cell carcinoma with regional lymph node metastasis at the department of urology in Niigata Cancer Center Hospital from 1979 to 1993 is presented. During this period, we treated 249 patients with renal cell carcinoma with or without lymph node metastasis. Lymph node metastasis could be estimated in 188 out of 249 patients. Histologically, lymph node metastasis was classified as pN1 in 8 cases, pN2 in 7 cases, and pN3 in 5 cases. The 3- and 5-year survival rates of 20 patients with lymph node metastasis were 45.0% and 16.4%, respectively. Nine of the 20 cases had no distant metastasis and 11 cases had distant metastasis. Three of the 9 patients with distant metastasis had no recurrence. Two of these 3 patients are still alive after 10 years and 3 years and 1 patient died because of acute heart failure. These 3 patients had pN1 metastasis smaller than 1 cm lymph node. Four of the 11 patients with distant metastasis had more than a two-year survival. However, 3 patients died due to renal cell carcinoma although primary and metastatic regions were resected and IFN with chemotherapy were given. Only one patient is still alive without recurrence after 3 years. This case detected as right renal cell carcinoma with pN2 metastasis and bilateral pulmonary metastasis was treated with radical nephrectomy with regional lymph node dissection and administered Methotrexate, VP16 and CisPlatinum chemotherapy and IFN.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed2005

Implications of the sentinel lymph node procedure for local and systemic adjuvant treatment.

PURPOSE OF REVIEW: The objective of the sentinel lymph node procedure in breast cancer is to perform an accurate axillary staging and provide good local control, while sparing the patients the morbidity of an axillary lymph node dissection. Since its routine clinical use, questions were raised concerning the implications for local and systemic adjuvant treatment. This review provides an update of the recent literature. RECENT FINDINGS: As a result of a more detailed histopathologic work-up of the sentinel lymph node, higher rates of lymph node metastases are detected. This leads to an upstaging of a subset of node-negative patients and an increase in the overall percentage of node-positive patients. However, the clinical implications of micrometastases and isolated tumor cells remain unclear. Furthermore, sentinel lymph nodes may be found in the internal mammary lymph node chain but the treatment of these nodes is subject of debate. SUMMARY: Current guidelines recommend axillary lymph node dissection in patients with a positive sentinel node. The surgical removal of the internal mammary lymph node is only indicated in the context of a clinical trial. Radiation therapy of the axilla is an acceptable alternative for patients who refuse an axillary lymph node dissection (clinical trial). The value of radiotherapy to the internal mammary lymph node has never been established. Systemic treatment decisions in patients with a macrometastasis or micrometastasis in the sentinel lymph node follow the guidelines of node-positive patients, whereas in patients with isolated tumor cells only, guidelines for node-negative patients are followed. The results of ongoing clinical trials will be important for the development of further guidelines.

Breast Neoplasms↗

PubMed1999

Immunohistochemistry with pancytokeratins improves the sensitivity of sentinel lymph node biopsy in patients with breast carcinoma.

BACKGROUND: Sentinel lymph node (SLN) biopsy is being investigated as a staging procedure for breast carcinoma. The authors evaluated whether immunohistochemical (IHC) analysis improves the sensitivity of this procedure. METHODS: Forty-four women with breast carcinoma were recruited for SLN biopsy. Preoperative lymphoscintigraphy was followed by intraoperative localization using a handheld gamma probe and blue dye. After SLN identification, an immediate complete axillary lymph node dissection was performed in all patients. All lymph nodes were subjected to routine histology (hematoxylin and eosin [H&E]) and IHC using antibody to cytokeratins. RESULTS: The SLN was identified in 41 of 43 patients (95%). Successful SLN identification was independent of biopsy technique (open surgical [95%] vs. fine-needle aspiration/core needle biopsy [96%]). Twelve of 41 patients (29%) had evidence of lymph node metastasis in the SLN by routine histology. Of the twenty-nine patients with H&E negative SLN, 3 were found to have metastasis by IHC for a conversion rate of 10%. Fifteen of 41 patients (37%) had evidence of metastasis in SLN. All 26 patients with H&E and IHC negative SLN had negative nonsentinel lymph nodes by routine histology and IHC (100% negative predictive value). All patients with tumors < 2 cm and micrometastasis to the SLN had no additional lymph node disease, in contrast to patients with lesions > 2 cm or patients with macrometastasis to the SLN (P = 0.007). CONCLUSIONS: These results confirm that SLN biopsy is extremely accurate for patients with breast carcinoma, even after open surgical biopsy. IHC analysis or serial sectioning of SLN improves the sensitivity of this staging technique.

Adult↗

PubMed1994

[Value of computerized tomography in detection of lymph node metastases in bladder cancer].

The accuracy of computed tomography (CT) in staging of pelvic lymph nodes in bladder cancer was investigated in 50 patients. All patients underwent pelvic lymph node dissection and cystectomy. The results of preoperative CT findings were compared with the histopathological findings in the dissected lymph nodes. Normal lymph nodes free of tumour cells were found in 32 patients. In 6 patients, single lymph node involvement was detected, while in 12 patients two or more lymph nodes were found to be positive for tumour infiltration. CT results were confirmed in 38 patients (76%). Specificity of CT was 100%, but the sensitivity of this method was only 33%. Based on these results, it appears that CT evaluation of pelvic lymph nodes in bladder cancer patients should have only a limited impact on decision making in patient management.

Adenocarcinoma↗

PubMed1994

Treatment of lymph node recurrence in patients with hepatocellular carcinoma.

The clinicopathological features and results of lymph node dissection were investigated in four patients with hepatocellular carcinoma (HCC) who developed lymph node recurrence following hepatectomy. One patient was found to have metastasis in the periportal lymph nodes at the time of a second laparotomy, while the other three developed posterior pancreaticoduodenal lymph node metastasis. All four patients had concomitant cirrhosis of the liver and were negative for hepatitis B surface antigen. No relationship between the site of the primary lesion and the location of lymph node metastasis was found. Two of the four patients are alive and in good health 4 years and 3 months, and 7 years and 3 months after their first operation, respectively. Thus, we conclude that the posterior pancreaticoduodenal lymph nodes are the most common site of lymph node recurrence of HCC, and that dissection of the affected lymph nodes offers the best chance of long-term survival.

Carcinoma, Hepatocellular↗

PubMed1990

Management of inguinal lymph node metastases from adenocarcinoma of the rectum.

Forty patients with inguinal lymph node metastases from rectal adenocarcinoma were reviewed. Patients were divided into three groups based on the extent of their disease: (1) patients with unresectable primary tumors; (2) patients with recurrent disease after abdominoperineal resection; and (3) patients with isolated inguinal lymph node metastases after abdominoperineal resection. Patients in Groups 1 and 2 underwent biopsy of their nodal metastases. Patients in Group 3 were treated by inguinal node dissection. Survival data were examined for each group, and four clinical and pathologic features were analyzed to determine their impact on prognosis: depth of invasion of the primary tumor (T1-2 vs. T3-4), number of positive lymph nodes in the rectal specimen (0-2 vs. greater than 2), extent of the inguinal lymph node metastases (unilateral vs. bilateral), and timing of the inguinal lymph node metastases (less than 1 vs. greater than 1 year after abdominoperineal resection). There were no five-year survivors in any group. Median survival was highest in those with isolated lymph node metastases, with 2 patients remaining free of disease, and was lowest in those with unresectable primary disease (7 months). Median survival was increased when inguinal LNM were unilateral (17 vs. 6 months; P less than 0.01) and when they occurred more than 1 year after abdominoperineal resection (21 vs. 7 months; P = 0.02). Stage of the primary lesion (depth of invasion and number of positive lymph nodes) did not affect survival. Of the 32 patients who underwent biopsy alone, only 1 developed a tumor-related groin complication. For patients with isolated inguinal lymph node metastases, inguinal node dissection is recommended for the purposes of local control and possible cure. For patients with extranodal disease, prophylactic excision of inguinal lymph node metastases is not warranted.

Adenocarcinoma↗

PubMed1975

Control of the immune response. I. Depression of DNA synthesis by immune lymph node cells.

The DNA response in the regional lymph nodes draining the site of immunization with contact sensitizing agents was assessed by measuring the uptake of radioactive iododeoxyuridine. The DNA response in the regional lymph nodes reached a peak on day 3 after immunization and fell to pre-immunization levels by day 6. The hypothesis was tested that lymph node cells from mice immunized with picryl chloride might depress the DNA response to the same antigen. Immune lymph node cells were injected intravenously and the recipient mice were immunized with picryl chloride on the same day. The immune cells depressed the DNA response on day 4 by an average of about 60 per cent. Smaller but significant depression also occurred on day 3. The cells responsible for the depression appeared in the regional lymph nodes 3-4 days after immunization and disappeared by day 21. The transfer of small numbers of immune cells (less than 2-5 X 10(6)) increased the DNA response in recipients 4 days after immunization with picryl chloride. The depression of the DNA response was largely specific. Pooled data from ten experiments showed that cells immunized with 4-ethoxymethylene-phenyl oxazolone ('oxazolone') caused no depression of the DNA response to picryl chloride, although in two of these experiments significant depression of about 21 per cent was seen. Similar results were obtained when immune cells were injected into mice immunized with 'oxazolone'.

Animals↗

PubMed2002

Detection of micrometastasis in the sentinel lymph nodes in breast cancer.

BACKGROUND: The axillary lymph node (ALN) status is still the most important prognostic factor in the staging and treatment of breast cancer. Intraoperative lymphatic mapping and sentinel lymphadenectomy techniques were investigated in patients with early-stage breast cancer who did not have clinically palpable ALNs. METHODS: Forty-four patients with breast cancer underwent a sentinel lymph node biopsy (SLNB), followed by a complete axillary lymphadenectomy. Sentinel lymph nodes (SLNs) were detected by means of so-called 2-way mapping with coloring matter and an isotope. Our standard protocol for evaluating metastasis in SLNs included a frozen section at 1 level for reverse transcription polymerase chain reaction (RT-PCR), plus a paraffin section at 1 level for immunohistochemistry (IHC) of cytokeratin 19, while the rest were evaluated by hematoxylin-eosin (H&E) staining. RESULTS: SLNs were identified in 42 (95%) of 44 patients. Twenty-one patients had no metastasis in SLNs; however, ALN metastasis was found in 3 patients. Of these 3 patients, 2 had micrometastasis detected by means of either IHC or RT-PCR. Therefore the false-negative rate was decreased from 7% (3/44) to 2% (1/44). Furthermore, of the remaining 18 ALN-negative patients, micrometastasis was detected by means of either IHC or RT-PCR in 7 (39%) patients. CONCLUSION: We suggest that SLNB is recommended to detect micrometastasis by means of H&E staining, IHC, and RT-PCR. Omitting ALN dissection referred by SLNB should be avoided if SLNs were evaluated only by H&E staining, and/or IHC without RT-PCR.

Adult↗

PubMed2005

[Drug concentration in axillary lymph nodes of patients with breast cancer after lymphatic chemotherapy].

BACKGROUND & OBJECTIVE: Lymph node status is one of the decisive prognostic factors of breast cancer. Chemotherapy targeting regional lymphatic tissues has emerged as a promising therapy for malignancies with high tendency to disseminate lymphatically. This study was to detect drug concentration in axillary lymph nodes of patients with breast cancer after lymphatic chemotherapy (LC), and to investigate effect of LC on accumulation of antitumor drugs in regional lymph nodes through comparing with the effect of intravenous chemotherapy (VC). METHODS: Sixty patients with breast cancer, confirmed by preoperative puncture biopsy, were randomized into 2 groups, 30 (LC group) were subcutaneously injected with 4 ml of carboplatin-activated carbon suspension (containing 20 mg of carboplatin) around the primary tumor, the other 30 (VC group) were intravenously injected with an equal dose of aqueous carboplatin. Every 6 patients from each group received modified radical mastectomy 1, 12, 24, 36, or 48 h after injection. Axillary lymph nodes were removed for pathologic examination. The concentration of carboplatin in nodes was detected by Zeeman atomic absorption spectrometry. RESULTS: A total of 275 axillary lymph nodes were resected, with 154 in LC group and 121 in VC group. Of the 275 lymph nodes, 136(49.5%) were from 23 patients (38.3%) had pathologically detected metastases. The concentrations of carboplatin were significantly higher in LC group than in VC group 1, 12, 24, 36, and 48 h after injection [(11.82+/-3.50) microg/g vs. (0.06+/-0.02) microg/g, (23.58+/-7.34) microg/g vs. (0.11+/-0.05) microg/g, (18.22+/-4.93) microg/g vs. (0.10+/-0.02) microg/g, (16.70+/-5.15) microg/g vs. (0.05+/-0.02) microg/g, and (14.62+/-4.29) microg/g vs. 0, respectively, P < 0.001]. Lymph node metastasis had no correlation with drug concentration (P > 0.05). CONCLUSION: Compared with VC, LC can effectively and continuously improve drug concentration in axillary lymph nodes of patients with breast cancer.

Adult↗

PubMed1990

Scalene lymph node sampling in cervical carcinoma: a reappraisal.

Scalene lymph node sampling to detect occult metastases from cervical carcinoma has been reported to have varying degrees of clinical utility. During the past 7 years at the Los Angeles County University of Southern California Medical Center, 17 scalene lymph node samplings were performed in patients with clinical stage IB to IIIB cervical carcinoma who had metastases to the paraaortic lymph nodes, negative chest X ray, and no clinical evidence of scalene/supraclavicular node metastases. Four of the patients were demonstrated on microscopic examination to have scalene lymph node metastases (23.5%). There were no serious complications related to this surgery. Patients with cervical carcinoma whose only extra pelvic site of metastases is the paraaortic modes should be considered for scalene lymph node sampling as part of their pretreatment evaluation, especially if extended-field radiation is contemplated.

Adenocarcinoma↗

PubMed1993

[Clinical evaluation of cervical and superior mediastinal lymph node dissection for intrathoracic esophageal carcinoma].

From 1985 to 1989, 257 cases of carcinoma of the thoracic esophagus underwent esophagectomy and lymph node dissection with right thoracotomy based on preoperative staging. Bilateral cervical lymph node dissection was selected in cases in which preoperative examinations (CT, US, EUS, etc) revealed metastasis to cervical or superior mediastinal lymph nodes and cervical or superior mediastinal lymph nodes and in cases of tumors of the upper intrathoracic esophagus. All cases were classified into 3 groups according to region of lymph node dissection. In addition to dissection of the lymph node in the mediastinum and abdomen, group A (102 cases) underwent bilateral cervical and extensive superior mediastinal lymph node dissection (en bloc removal of tissue from the upper mediastinum), group B (61 cases) underwent extensive superior mediastinal lymph node dissection with or without left side cervical dissection and group C (94 cases) underwent standard dissection. Group A contained more advanced cases and cases with metastasis to the upper mediastinal lymph nodes compared to groups B and C. Postoperative complications were also more frequent in group A than groups B or C and were slightly more frequent in group C than group B. Recurrent nerve palsy was recognized in 21% of group A cases. Operative death (within 30 days) was highest in the group A (5.8%) particularly in the elderly group aged over 70 y or absolutely non-curatively resected cases, while in group C the operative mortality was 2.2%. Apart from absolutely non-curatively resected cases, there was no significant difference in the survival curves of the 3 groups, and there was no difference between group A and B cases with no cervical metastasis and group C cases. Also, this selection showed a favorable survival curve following esophagectomy in the period since 1985 compared to the earlier period (1980-1984), excluding absolutely non-curative cases and early stage cases (ep, mm cancer). The results suggest our evaluation methods and selection criteria were appropriate. All absolutely non-curatively resected cases had poor survival rates without significant difference among the 3 groups. In this category of cases, bilateral cervical lymph node dissection of absolutely non-curative cases was not effective. In cases with 1-3 metastatic lymph nodes of all, there was a significant difference in prognosis between group A and groups B and C, but there was no significant difference in cases with more than 4 metastatic lymph nodes. Those results suggest that when 1-3 lymph nodes are metastatic, it is necessary to dissect bilateral cervical lymph nodes.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

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↗