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At least 1,549 records · Page 86Linked to original sources

PubMed2003

[Analysis of lymph node metastases of 217 cases of thoracic esophageal carcinoma and its impact on prognosis].

BACKGROUND & OBJECTIVE: At present, the range of lymph node dissection in treatment of thoracic esophageal cancer is still controversial. This study was designed to explore the status of lymph node metastases of thoracic esophageal carcinoma and its influence on the prognosis and to seek reasonable dissecting range of lymph nodes. METHODS: A retrospective study was performed on the clinical data of 217 patients who had underwent radical operation through three-field lymphadenectomy. Nine distinguishing clinicopathological factors possibly influencing survival rate were chosen. A multivariate analysis of these factors was performed by the computerized Cox proportional hazards model. RESULTS: The 1-, 3-, and 5-year survival rates of all patients were 82.6%, 59.8%, and 48.8%, respectively. The lymph node metastasis rate was 62.6% and the leaping metastasis rate of lymph nodes was 5.5%. In 3989 lymph nodes dissected, metastases were detected in 454 (11.38%). The lymph node metastasis rates present in neck, thoracic mediastinum, and abdominal cavity were 31.7%, 21.2%, and 12.1% in upper-thoracic esophageal carcinoma, 21.9%, 30.5%, and 15.6% in middle-thoracic carcinoma, 9.75%, 12.7%, and 34.5% in lower-thoracic carcinoma, respectively. Degree of tumor differentiation, depth of tumor invasion, and lymphatic vessels invasion were the factors influencing lymph nodes metastases, but the length of tumor was not. According to multivariate analysis, depth of tumor invasion, tumor differentiation, the number of lymph nodes metastatic field, and tumor location were of prognostic significance. With the increasing of the number of lymph nodes metastatic field, the survival rate of the patients dropped gradually(P = 0.0284). CONCLUSION: Lymph node metastasis especially the number of lymph node metastatic field is one of key factors affecting the prognosis of patients. Because of the upward, downward, and leaping spreading of esophageal carcinoma cells to the lymph nodes, the patients with thoracic esophageal carcinoma should be given radical operation through three-field lymphadenectomy to promote the 5-years survival rate.

Adult↗

PubMed1999

Comparison of clinical staging algorithms and 111indium-capromab pendetide immunoscintigraphy in the prediction of lymph node involvement in high risk prostate carcinoma patients.

BACKGROUND: The pretherapy prediction of occult lymph node involvement and the avoidance of otherwise futile and potentially morbid definitive local therapy is paramount in men with newly diagnosed prostate carcinoma. To identify patients with prostate carcinoma who likely have lymph node involvement and would benefit from staging lymphadenectomy prior to definitive local therapy, the authors compared the ability of several predictive staging algorithms and a radiolabeled monoclonal antibody scan to predict lymphatic metastases prior to treatment. METHODS: Between August 1991 and June 1994, 198 men with clinical T2 or T3 classified (TNM) prostate carcinoma (bone scan negative) who were at high risk of lymph node involvement underwent a 111In-capromab pendetide scan prior to staging lymphadenectomy. Several predictive models based on preoperative prostate specific antigen level, biopsy Gleason score, and clinical stage were selected to predict those men having a > or =20% probability of lymph node involvement. The ability to predict pathologic stage using several clinical algorithms and the monoclonal antibody scan was compared with pathologic examination of the lymph nodes. RESULTS: Overall, 39% of the pelvic lymph node specimens were positive for metastatic disease by pathologic analysis. Published algorithms predicting lymph node metastases had a positive predictive value (PPV) ranging from 40.5% to 46.6% and an area under the receiver operating characteristic curve (AUC) ranging from 0.52 to 0.61. The monoclonal antibody scan had a PPV of 66.7% and an AUC of 0.71. The differences between the PPV and the AUC for the individual clinical algorithms when compared with immunoscintigraphy were statistically significant. Combining the radiolabeled monoclonal antibody scan with clinical predictive models, a PPV of up to 72.1% could be obtained. CONCLUSIONS: These data suggest that the PPVs for the clinical predictive algorithms are similar and that the PPV of the radiolabeled monoclonal antibody scan alone or in combination with the algorithms has additional value in predicting lymph node involvement in prostate carcinoma patients at high risk of regional disease spread. These algorithms and the 111In-capromab pendetide scan may be used for the appropriate selection of candidates for definitive local therapy in men with clinically localized prostate carcinoma and significant risk of lymph node involvement.

Aged↗

PubMed1999

Development of a non-radioactive endpoint in a modified local lymph node assay.

A murine local lymph node assay (LLNA) has been developed as an alternative to guinea pig models for contact sensitization testing. Although the LLNA appears to be a little less sensitive than the most stringent of guinea pig assays, it provides a rapid, objective, quantitative and cost-effective method for screening strong contact sensitizers and has advantages with respect to animal welfare. However, a potential disadvantage is the need for the use of radioactive material. We have reported previously that an ex vivo assay based on similar principles to the original in vivo LLNA, but using a non-radioactive endopoint, was valid for the prediction of strong sensitizers. This ex vivo assay was not sensitive enough to allow prediction of moderately potent ones. In this study, we propose a new parameter, Corrected IL-2 Index (CII), for the prediction of moderate sensitizers. To obtain CII the IL-2 release in the supernatant of the cell culture is corrected for lymph node weight ratio and ratio of CD4-positive subset. We found that CII predicted the allergenicity of moderate sensitizers, including the ones recommended by the OECD in guideline 406, such as mercaptobenzothiazole and hexyl cinnamic aldehyde. The allergenicity of metal salts, such as potassium dichromate, ammonium tetrachloroplatinate and cobalt chloride, was also predicted by the CII. We conclude that the use of CII as an index significantly increases the sensitivity of the ex vivo method so that moderate sensitizers may also be detected.

Allergens↗

PubMed2000

Sentinel lymph node procedure is highly accurate in squamous cell carcinoma of the vulva.

PURPOSE: To determine the diagnostic accuracy of the sentinel lymph node procedure in patients with squamous cell carcinoma of the vulva and to investigate whether step sectioning and immunohistochemistry of sentinel lymph nodes increase the sensitivity for detection of metastases. PATIENTS AND METHODS: Between July 1996 and July 1999, 59 patients with primary vulvar cancer were entered onto a two-center prospective study. All patients underwent sentinel lymph node procedure with the combined technique (preoperative lymphoscintigraphy with technetium-99m-labeled nanocolloid and intraoperative blue dye). Radical excision of the primary tumor with uni- or bilateral inguinofemoral lymphadenectomy was performed subsequently. Sentinel lymph nodes and lymphadenectomy specimens were sent for histopathologic examination separately. Sentinel lymph nodes, negative at the time of routine pathologic examination, were re-examined with step sectioning and immunohistochemistry. RESULTS: In 59 patients, 107 inguinofemoral lymphadenectomies were performed (11 unilateral and 48 bilateral). All sentinel lymph nodes, as observed on preoperative lymphoscintigram, were identified successfully intraoperatively. Routine histopathologic examination showed lymph node metastases in 27 groins, all of which were detected by the sentinel lymph node procedure. The negative predictive value for a negative sentinel lymph node was 100% (97.5% confidence interval [CI], 95% to 100%). Step sectioning and immunohistochemistry showed four additional metastases in 102 sentinel lymph nodes (4%; 95% CI, 1% to 9%) that were negative at the time of routine histopathologic examination. CONCLUSION: Sentinel lymph node procedure with the combined technique is highly accurate in predicting the inguinofemoral lymph node status in patients with early-stage vulvar cancer. Future trials should focus on the safe clinical implementation of the sentinel lymph node procedure in these patients. Step sectioning and immunohistochemistry slightly increase the sensitivity of detecting metastases in sentinel lymph nodes and should be included in these trials.

Adult↗

PubMed1977

Natural cytotoxicity in man: activity of lymph node and tumor-infiltrating lymphocytes.

Lymphocytes from blood, lymph node and tumor have been tested for cytotoxicity against the K562 cell line which is known to be highly sensitive to lysis by spontaneously reactive cells. Cytotoxicity was found in all 13 samples from healthy donors and in 17/32 cancer patients. By contrast, activity was determined in only 1/18 lymph node and 1/14 preparations of tumor-infiltrating lymphocytes. Lymph node cells were similarly nonreactive against 3 other cell lines known to be sensitive to natural cytotoxicity. Studies of the composition of the effector populations revealed no absolute deficit of a particular cell type although there were differences between them resulting from the different isolation procedures used. Enrichment of the lymph node population for non-T, non-B lymphocyte was ineffective in inducing cytotoxicity in previously nonreactive samples although this procedure uniformly increased the cytotoxic potential of blood lymphocytes. Tests with blood taken during operation showed that the lack of reactivity in these preparations was unlikely to be a result of the effects of anesthesia or surgery. The reason for the low cytotoxicity in the lymph node and tumor-infiltrating lymphocytes is as yet undefined.

Anesthesia↗

PubMed2002

[T(1) carcinoma of the lung: characteristics of lymph node metastasis and its clinical significance].

OBJECTIVE: To investigate the frequency, distribution and features of lymph node metastasis in T(1) carcinoma of the lung, and to provide evidence for lymph node dissection. METHODS: Two hundred and fifteen patients with T(1) carcinoma of the lung underwent R2 surgery plus extended dissection of hilar, interlobular and mediastinal lymph nodes according to the mapping system developed by Naruke. RESULTS: 1 674 groups of lymph nodes were dissected. The metastatic rates of N(1) and N(2) were 11% and 6% respectively. Lymph node metastatic rates in carcinoma of the lung with maximum diameters less than 1.5 cm and between 1.6 cm approximately 3.0 cm were 5% and 8% respectively. N(1) and N(2) metastasis was not found in squamous cell carcinoma of the lung with a maximum diameter less than 1.5 cm. N(2) metastatic rates were 5% in squamous cell carcinoma 23% in adenocarcinoma and 3/9 in small cell carcinoma, the difference being significant (P < 0.01). 3/4 squamous cell carcinoma invaded only one group of N(2) nodes, but over 3 groups of lymph nodes were positive in 40% of adenocarcinoma. Saltatory metastasis accounted for 41% of N(2) metastasis. Fourteen percent of N(2)-positive tumors in upper lobes metastasized to the lower mediastinum, whereas 60% of N(2)-positive cancers in lower lobes invaded the upper mediastinum. CONCLUSIONS: The frequency of lymph node metastasis increases with the growth of tumors. Metastasis in adenocarcinoma occurs more frequently than in squamous cell carcinoma, but most common in small cell carcinoma. Tumors at any site can metastasize to the distant mediastinum. Except for squamous cell carcinoma with maximum diameter less than 1.5 cm which are likely to be cured without lymph node dissection, other types of T(1) carcinoma of the lung need extended lymph node dissection.

Adult↗

PubMed1998

Detection of micrometastases in histologically negative lymph nodes in esophageal cancer.

BACKGROUND: New molecular techniques may identify micrometastases in histologically negative lymph nodes and have an impact on the staging of esophageal cancer. We investigated the role of the reverse transcriptase-polymerase chain reaction (RT-PCR) assay to identify micrometastases in esophageal cancer. METHODS: The RT-PCR assay to detect carcinoembryonic antigen (CEA) messenger ribonucleic acid (mRNA) was performed on lymph nodes from patients with esophageal cancer and benign esophageal disorders. The presence of CEA mRNA in lymph nodes was considered evidence of metastases. RESULTS: Histopathologic study revealed metastases in 50 (41%) of 123 lymph nodes from 30 patients with esophageal cancer. All histologically positive lymph nodes contained CEA mRNA by RT-PCR. Of 73 histologically negative lymph nodes, 36 (49%) contained CEA mRNA, a significant increase compared with the histopathologic diagnosis (p < 0.001). Lymph nodes in patients with benign disease contained no CEA mRNA. In 10 patients, histologic stage was NO. Five of them were also negative by RT-PCR, and all are alive with only one recurrence. In the remaining 5 patients, RT-PCR was positive for occult lymph node metastases; 2 have died of disease, and 1 is alive with recurrent disease. CONCLUSIONS: In patients with esophageal cancer, RT-PCR detects more lymph node metastases than does histopathology. Initial follow-up suggests a positive RT-PCR with negative histologic findings may have poor prognostic implications. Further studies will be needed to confirm any clinical implications.

Carcinoembryonic Antigen↗

PubMed2005

Diagnostic performance of nanoparticle-enhanced magnetic resonance imaging in the diagnosis of lymph node metastases in patients with endometrial and cervical cancer.

PURPOSE: Lymph node metastases affect management and prognosis of patients with gynecologic malignancies. Preoperative nodal assessment with computed tomography or magnetic resonance imaging (MRI) is inaccurate. A new lymph node-specific contrast agent, ferumoxtran-10, composed of ultrasmall particles of iron oxide (USPIO), may enhance the detection of lymph node metastases independent of node size. Our aim was to compare the diagnostic performance of MRI with USPIO against standard size criteria. METHODS: Forty-four patients with endometrial (n = 15) or cervical (n = 29) cancer were included. MRI was performed before and after administration of USPIO. Two independent observers viewed the MR images before lymph node sampling. Lymph node metastases were predicted using size criteria and USPIO criteria. Lymph node sampling was performed in all patients. RESULTS: Lymph node sampling provided 768 pelvic or para-aortic nodes for pathology, of which 335 were correlated on MRI; 17 malignant nodes were found in 11 of 44 patients (25%). On a node-by-node basis, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) by size criteria were 29%*, 99%, 56%, and 96%, and by USPIO criteria (reader 1/reader 2) were 93%/82%* (*P = .008/.004), 97%/97%, 61%/59%, and 100%/99%, respectively (where [*] indicates the statistical difference of P = x/x between the two results marked by the asterisk). On a patient-by-patient basis, sensitivity, specificity, PPV, and NPV by size criteria were 27%*, 94%, 60%, and 79%, and by USPIO criteria (reader 1/reader 2) were 100%/91%* (*P = .031/.06), 94%/87%, 82%/71%, and 100%/96%, respectively. The kappa statistic was 0.93. CONCLUSION: Lymph node characterization with USPIO increases the sensitivity of MRI in the prediction of lymph node metastases, with no loss of specificity. This may greatly improve preoperative treatment planning.

Adult↗

PubMed1986

The arterial blood supply of human inguinal and mesenteric lymph nodes.

Injection of the arterial tree supplying human inguinal (superficial) and mesenteric (deep) lymph nodes was performed using a barium sulphate suspension. Radiography and histological examination showed two distinct types of arterial supply to lymph nodes. The superficial inguinal nodes are generally supplied by a single artery which penetrates the hilum and then radiates outwards to the lymph node pulp. The deep mesenteric lymph nodes, in contrast, are invariably supplied by several separate arteries which penetrate the nodal capsule, enter the trabeculae and run centripetally. These differences reflect the microanatomical differences in structure between deep and superficial lymph nodes. The two types of blood supply may be responsible for the different patterns of ischaemia found in deep and superficial lymph nodes. The findings re-emphasise the heterogeneous character of lymph nodes in man.

Angiography↗

PubMedDate not supplied

Sentinel lymph node drainage in multicentric breast cancers.

Axillary lymph node status is the most important prognostic marker in patients with breast cancer; the presence of axillary metastases impacts prognosis as well as subsequent systemic therapy. Axillary lymph node dissection (ALND) is associated with significant morbidity and psychological distress; the introduction of sentinel lymph node (SLN) biopsy with lymphatic mapping affords the ability to identify those patients most likely to benefit from ALND, sparing node-negative patients. The lymphatic drainage of the breast is poorly understood, and the situation is further complicated by the lack of standardization of the SLN biopsy technique among institutions. Multicentricity has generally been considered to be a contraindication to SLN biopsy due to concerns about potential inaccuracies. Here we report five cases of patients with multicentric breast cancers (two tumors in two distinct quadrants). In each case, injection of one site with technetium-labeled sulfur colloid and the second site with isosulfan blue dye resulted in successful identification of at least one node that was both hot and blue within the axilla. These observations suggest that the lymphatic drainage of the entire breast coincides with drainage of the tumor bed, regardless of the quadrant. However, further studies are needed to validate the accuracy of SLN biopsy in multicentric breast cancers.

Adult↗

PubMed2007

Immediate dynamic lymphoscintigraphy delivers no additional value to lymphoscintigraphy 3 hr after tracer injection in sentinel lymph node biopsy in breast cancer patients.

OBJECTIVE: Immediate dynamic imaging enables accurate definition of sentinel lymph nodes, whereas imaging 3 hr after tracer injection may lead to overestimation of the number of sentinel lymph nodes. A study was performed to define the value of lymphoscintigraphy immediately versus 3 hr after tracer injection in sentinel lymph node biopsy for breast cancer management. METHODS: In 165 sentinel lymph node biopsy procedures preoperative immediate and 3 hr post-injection lymphoscintigraphy was performed after intraparenchymal tracer administration. RESULTS: Lymph node visualization occurred in 63 immediate procedures (38%) versus in 163 procedures 3 hr post-injection (99%). In 17 procedures (10%) in which immediate lymphoscintigraphy had visualized sentinel lymph nodes, additional nodes had been seen on 3 hr post-injection lymphoscintigraphy. In eight of these procedures (5%) all nodes were detected in the same draining lymph node basin. Non-axillary sentinel lymph nodes were identified by preoperative lymphoscintigraphy in 28 procedures (17%) and improved staging in three patients (5%). CONCLUSION: The only impact of immediate lymphoscintigraphy was the possible omission of removal of 1-2 sec-echelon nodes per patient in 5% of patients. We consider this yield too low to continue immediate lymphoscintigraphy in breast cancer patients.

Adult↗

PubMedDate not supplied

Prognostic significance of total lymph node number in patients with T1-4N0M0 colorectal cancer.

BACKGROUND/AIMS: The presence of lymph node metastases is the main prognostic factor in patients with colorectal cancer. Controversy exits relating to the minimum number of lymph nodes to be harvested for accurate staging in patients classified as stage I and II. The purpose of this study was to define a cut-off value for the number of lymph nodes examined and determine if this minimum number could have any impact on prognosis of node negative patients. METHODOLOGY: A total of 301 T1-4N0M0 colorectal cancer patients were reviewed. The clinical and pathological factors considered in statistical analysis were age, gender, tumor location, depth of invasion, differentiation and the number of examined lymph nodes. RESULTS: The median number of harvested lymph nodes was 10 and the 5-year overall survival rate was 62%. Univariate analysis revealed that patients with well differentiated, right-sided, T1-2 tumors and those with more than 11 nodes examined had improved survival compared to their counterparts. In Cox regression analysis, the same variables except tumor location independently affected the prognosis, where the number of lymph nodes recovered showed the highest significance (p=0.0008; RR: 2.8; 95% CI: 1.6-5.2). CONCLUSIONS: Patients classified as T1-4N0M0 colorectal carcinoma with more than 11 lymph nodes examined may be considered as more accurately staged and have better prognosis than those with lower number of lymph nodes recovered.

Adolescent↗

PubMed1991

Increased number of dendritic cells in draining lymph nodes accompanies the generation of contact photosensitivity.

Draining lymph node cells isolated from mice 48 h after topical exposure to tetrachlorosalicylanilide (TCSA) + UVA radiation (TCSA + UVA) demonstrated a two-fivefold increase in the number of dendritic cells (DC) compared with control mice treated with vehicle + UVA. The increase in number of DC was both time and dose dependent, with the peak DC accumulation occurring at 48 h post application and at a TCSA dose of 1.0%. Photospecificity was evident in that mice irradiated prior to treatment with TCSA (UVA/TCSA) demonstrated no significant increase in DC accumulation. The accumulation of DC was followed by a significant increase in total lymph node cellularity. An in situ 3H-thymidine incorporation assay showed a significant increase in proliferative activity of cells isolated from the draining lymph nodes of mice treated with TCSA + UVA as compared to naive, vehicle, or UVA/TCSA-treated mice. Dendritic cells isolated from mice treated 24 h earlier with TCSA + UVA, but not those from naive mice or mice treated with UVA/TCSA, were capable of TCSA-specific antigen presentation. Responder lymphocytes from untreated mice or mice photosensitized with musk ambrette showed a much lower response to DC isolated from TCSA + UVA-treated mice, demonstrating the specificity of the reaction. DC-depleted lymph node cells were unable to stimulate this blastogenesis response. These results suggest that application and photoactivation of TCSA induces cellular and functional changes in the lymph node DC indicative of their involvement in the induction phase of a contact photoallergic reaction.

Allergens↗

PubMed1999

Factors associated with axillary lymph node metastasis from breast carcinoma: descriptive and predictive analyses.

BACKGROUND: Although axillary lymph node metastasis is one of the most important prognostic determinants of breast carcinoma prognoses, the reasons why tumors vary in their capability to produce for axillary metastases remain unclear. METHODS: The authors used data from the nationwide Patient Care Evaluation (PCE) survey of the American College of Surgeons to evaluate the correlations between patient/tumor characteristics and lymph node status, and to explore the use of these factors, which are all known prior to axillary dissection, in predicting lymph node status. The PCE data set contained 18,025 breast carcinoma cases diagnosed in 1990 after exclusion of women older than 79 years or with fewer than 6 lymph nodes examined. RESULTS: In a multivariate logistic regression model, larger tumor size, young age, African American or Hispanic race, outer half tumor location, poor or moderate differentiation, aneuploidy, and infiltrating ductal histology were independently associated with a higher likelihood of one or more positive lymph nodes. Contrary to expectation, cases negative for estrogen receptor (ER) and progesterone receptor (PR) had a lower risk of positive lymph nodes when adjusted for other factors (odds ratio = 0.82; 95% confidence interval: 0.74-0.91) compared with cases positive for both receptors. This model accurately predicted lymph node status in 2 validation data sets (a 50% random sample of 1990 PCE data and 1992 data from the National Cancer Data Base), but was less accurate in a third, older data set (1983 PCE data). However, the percentage of cases (1990 validation set) with predicted probabilities less than 0.05 or greater than 0.95 were only 4.6% and <0.1%, respectively. CONCLUSIONS: The authors concluded that 1) most variation in axillary lymph node metastatic status can be explained by routinely available data, 2) ER and PR status may be involved in the mechanism of this behavior, and 3) the difficulty of using prediction models to avert axillary dissection should not be underestimated.

Adult↗

PubMed2006

[Evaluation of the ultrasonographic features of axillary lymph node metastasis in breast cancer].

OBJECTIVE: To analyze the ultrasonographic features of axillary lymph node metastasis in breast cancer patients, and to evaluate the accuracy of these features by Receiver Operating Characteristic (ROC) curve. METHODS: Ultrasonography was carried out in 113 patients (mean age 56.5 yr, range 29 - 77 yr). The ultrasonographic features of the primary tumor and the axillary lymph node were observed. Univariate analysis was performed by Chi-squared test and Fisher exact test, and multivariate analysis to determine independent significant individual variables by multiple logistic regression analysis. ROC curve analysis was done to determine the sensitivity and specificity of individual and combined ultrasonographic features in distinguishing metastatic lymph node from the normal one. RESULTS: The primary tumor size, abundance of blood supply in the primary tumor, longitudinal-transverse diameter ratio, cortex-hilum thickness ratio (on the longitudinal section), abnormal cortex thickness, distribution of intra-nodal vascularity of axillary lymph nodes were found to be statistically significant factors by univariate analysis. The primary tumor size, longitudinal-transverse ratio and cortex-hilum thickness ratio of lymph node were proved to be significant independent predictors of axillary lymph node metastasis by logistic regression analysis. Through ROC analysis, the combination of these independent ultrasonographic feature predictors was found to contribute significantly in differentiating metastatic lymph node from the normal with a sensitivity of 88.6% and specificity of 84.5%. CONCLUSION: Axillary ultrasonography is helpful in staging the axillary lymph node in breast cancer patient. The primary tumor size, longitudinal-transverse diameter ratio and cortex-hilum thickness ratio of lymph node are the main features to determine whether metastatic involvement is present or not.

Adult↗

PubMed2004

[Multi-antibody combined determination of lymph node micrometastasis in patients with gastric cancer].

BACKGROUND & OBJECTIVE: Immunohistochemical staining is a simple method for determination of lymph node micrometastasis in gastric cancer; but the sensitivity is low. Whether this disadvantage can be improved using multi-antibody combined determination is still controversial. This study was designed to determine the lymph node micrometastasis in patients with gastric cancer by the antibodies of cytokeratin 20 (CK20), epithelial membrane antigen (EMA), and carcinoembryonic antigen 72-4 (CA72-4)for clarifying the value of multi-antibody combined determination of micrometastasis. METHODS: A total of 466 lymph nodes was collected with operation from 44 gastric cancer patients from April 1991 to April 1994. All these lymph nodes showed no lymph node metastasis by routine histological examination. Immunohistochemical staining was performed on all the samples by the mouse antibodies of anti-CK 20, mouse anti-EMA, and mouse anti CA72-4, respectively. Then, the micrometastases were identified under microscope according to the color of the cells. The results were analyzed according to clinical, pathological, and follow-up data. RESULTS: Fifty-one (10.9%) lymph nodes of 18 (40.9%) cases showed micrometastasis. The number of micrometastatic lymph nodes were detected by CK20, CA72-4, and EMA was 40 (8.6%), 27 (5.8%), and 21 (4.5%), respectively. There was no significant correlation between the lymph node micrometastasis and clinical data, such as gender, age, tumor site, histological differentiation, and stage (P >0.05). The 5-year survival rate of the patients with lymph node micrometastasis was lower than that of the patients without lymph node micrometastasis(61.11+/-11.49% vs. 92.31+/-5.23%, P=0.0113). The 5-year survival rate of the patients with 3 or more positive micrometastatic nodes was lower than that of the patients with less than 3 positive micrometastatic nodes (44.44+/-16.56% vs. 77.78+/-13.86%,P=0.0196). CONCLUSION: Immunohistochemical staining marked by different antibodies can be an useful method to seek more micrometastatic lymph nodes in gastric cancer patients.

Adenocarcinoma↗

PubMed1990

Surgical approach to the retrocrural lymph nodes.

Removal of retrocrural lymph nodes requires an approach other than the infradiaphragmatic retroperitoneal access generally used in the surgical management of testicular tumours. The transperitoneal route given access, at best, to the origin of the superior mesenteric artery, but advanced testicular tumours occasionally require retrocrural node dissection. We describe a useful surgical approach to these nodes and the underlying anatomy.

Humans↗

PubMed1999

Assessment of cervical lymph node metastasis in esophageal carcinoma using ultrasonography.

OBJECTIVE: To evaluate the efficacy of ultrasonography for the diagnosis of cervical lymph node metastasis in esophageal carcinoma. SUMMARY BACKGROUND DATA: Ultrasound (US) examination is useful for diagnosing lymph node metastasis. However, few reports have examined its role in the decision to perform cervical lymph node dissection in esophageal carcinoma. METHODS: Ultrasound examination was performed to evaluate cervical lymph node metastasis in 519 patients with esophageal carcinoma. The patients were divided into 5 groups according to treatment received: group 1, 153 patients who underwent curative resection of primary tumor by right thoracotomy and complete bilateral cervical lymphadenectomy; group 2, 112 patients who underwent curative resection of primary tumor by right thoracotomy but without cervical lymphadenectomy; group 3, 78 patients who underwent esophagectomy by left thoracotomy or blunt dissection with or without removal of cervical lymph nodes; group 4, 76 patients with palliative resection without cervical lymphadenectomy; and group 5, 100 patients without any surgical treatment. US diagnosis was compared with histologic findings or cervical lymph node recurrence. RESULTS: Lymph node metastasis was detected in 30.8% of patients (160/519). The sensitivity, specificity, and accuracy of US diagnosis in group 1 were 74.5%, 94.1%, and 87.6%, respectively. Cervical lymph node recurrence was seen in 7 patients (4.6%) in group 1, in 4 patients (3.6%) in group 2, and 3 patients (3.8%) in group 3. Although the incidence of cervical lymph node metastasis as determined by US examination was high in groups 4 and 5, almost none of the patients died of cervical lymph node metastasis. CONCLUSIONS: Ultrasound examination plays a useful role in the decision to perform cervical lymph node dissection in patients with esophageal carcinoma, particularly in those with potentially curative dissection.

Esophageal Neoplasms↗