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PubMed1994

Histopathology and viral antigen distribution in lymph nodes of cats naturally infected with feline immunodeficiency virus.

Lymph nodes from cats with natural feline immunodeficiency virus (FIV) infection were examined histopathologically for characterization of lesions in the symptomatic and terminal stages. The localization of viral antigen was also studied in the nodes by immunohistochemistry using a monoclonal antibody to FIV p24. In a node of persistent generalized lymphadenopathy stage, follicular hyperplasia was prominent and the viral antigen was demonstrated predominantly in the follicular lymphocytes and tingible body macrophages. In cats died at AIDS related complex stage, the lymph nodes showed either mixed follicular hyperplasia and involution, involution, or mixed involution and depletion. The lymph nodes in those died at AIDS stage showed considerable destruction of the nodal architecture with involution and depletion of lymphoid follicles. In this terminal stage, the viral antigen was seen prominently in histiocytes/macrophages of the sinus. These findings observed in the dead cats were similar to the lymph node changes seen in human AIDS associated with HIV infection. It was suggested that sequential histologic changes from follicular hyperplasia to depletion via involution took place in the FIV infected lymph node with persistence of FIV antigen.

Animals↗

PubMed2004

[Influence of the number of lymph node metastasis on survival and significance of postoperative radiotherapy for esophageal carcinoma].

OBJECTIVE: To analyze the influence of the number of lymph node metastasis on survival and prophylactic postoperative radiotherapy after radical resection of thoracic esophageal carcinoma. METHODS: Four hundred and ninety-five patients with thoracic esophageal squamous cell cancer who had undergone radical resection were randomly divided into surgery group alone (S, 275) and surgery plus radiotherapy group (S + R, 220). The patients were classified into three groups: Group A: 234 patients (47.2%) without lymph node involvement; Group B: 146 patients (29.5%) with 1 to 2 involved lymph nodes and Group C: 115 patients (23.2%) with >or= 3 involved lymph nodes. RESULTS: 1. The 5-year survival rate in Groups A, B and C for the same T stage (T3) was 52.6%, 28.8% and 10.9%, respectively (P = 0.0000); the 5-year survival rate in group C was 0% in S group and 19.3% in S + R group (P = 0.0336); 2. In the positive lymph node group, the metastatic rate of intra-thoracic and supraclavicular lymph node was 35.9% and 21.2% in S group and 19.7% and 4.4% in S+R group (P = 0.014 and P = 0.000). In the negative lymph node group, the metastatic rates of intra-thoracic lymph node was 27.8% in S group and 10.3% in S + R group (P = 0.003). The metastatic rate of intra-abdominal lymph node in Groups A, B and C was 3.9%, 9.4% and 17.5%, respectively (P = 0.0000). The occurrence of hematogenous metastasis was most frequent in group C (27.8%) with >or= 3 positive lymph nodes. CONCLUSION: 1. The number of metastatic lymph node is one of the important factors which affects the survival of thoracic esophageal carcinoma. 2. Chemotherapy might be given to the patients with three or more lymph nodes involved who have the possibility of developing hematogenous metastasis. Postoperative radiotherapy can reduce the occurrence of intra-thoracic and supraclavicular lymph node metastasis and improve the survival of patients with three or more lymph nodes involvement.

Adult↗

PubMed1986

[Interferon production in lymph nodes draining breast carcinoma and its augmentation by OK-432].

In breast cancer patients on whom modified radical mastectomy is performed, relatively more of the regional lymph nodes draining the breast carcinoma remain in comparison with standard radical mastectomy. Therefore, investigation of the functions of lymph nodes draining breast carcinoma has become important. Lymphocyte subsets of 33 axillary lymph nodes from 19 breast cancer patients were analysed using flow cytometry. In axillary lymph nodes, both OKT-3(+) cells and OKT-8(+) cells were decreased in comparison with those in peripheral blood. However, the OKT 4/8 ratio was increased in axillary lymph nodes. These findings suggest that axillary lymph nodes are immunologically more functional against cancer spread than peripheral blood. OK-M1(+) cells, Leu-7(+) cells and Leu-11a(+) cells were decreased in axillary lymph nodes in comparison with peripheral blood. The ability of IFN production in axillary lymph nodes and peripheral blood was analysed using the cytopathic effect of VSV-sindbis virus. After 72 hours incubation, IFN production of axillary lymph nodes showed maximum titer. When lymph nodes were co-cultured with OK-432, IFN production of axillary lymph nodes was strongly augmented. IFN production of axillary lymph nodes draining breast carcinoma were increased in comparison with peripheral blood. Axillary lymph nodes draining breast carcinoma would thus seem to be important as cytokine-producing organs. IFN has been found to be an activator of NK cells, cytotoxic T cells and IL-2 production. Axillary lymph nodes may therefore play an important role against the spread of breast cancer.

Axilla↗

PubMed2006

[Laparoscopic sentinel lymph nodes identification followed by trachelectomy in early stage cervical cancer].

The status of regional lymph nodes is the main prognostic factor in diagnosis and treatment of early stage of the cervical cancer. If the first node that drains a tumor site (sentinel node) is not metastatic, other lymph nodes should also be free of the disease. Detection using blue dye and laparoscopic removal of the sentinel lymph nodes let to avoid radical hysterectomy with pelvic limphadenectomy and it is especially useful in young women who want to preserve fertility. We describe a case of a 33- year old woman with invasive cervical cancer who underwent laparoscopic sentinel lymph nodes detection followed by trachelectomy. Thus histopatological examination confirmed no metastasis in removed sentinel lymph nodes, trachelectomy as a minimally invasive procedure was performed.

Adult↗

PubMed1982

When is lymph node biopsy indicated in children with enlarged peripheral nodes?

To better define the indications for diagnostic biopsy, 239 children who underwent peripheral lymph node biopsy were reviewed. The duration of the lymph-adenopathy by history, the consistency of the lymph nodes, and the presence of more than one site of palpable adenopathy were not specific in differentiating serious diseases involving lymph nodes from reactive hyperplasia. The differential diagnosis of specific causes for lymph node enlargement is approached based on the child's age, the location of the adenopathy, and the presence or absence of lymph node fixation and tenderness. Most children with supraclavicular adenopathy, children sick with fever of one week's duration or with weight loss for which a specific diagnosis is not readily made, and some children with fixation of the lymph node to the overlying skin should undergo early biopsy. Excluding the above findings, when a specific diagnosis is not apparent, serial measurements with a ruler over several weeks appears to be the most reasonable method, at the present time, of discriminating hyperplastic lymph nodes from nodes that are involved by a progressive disease process.

Adolescent↗

PubMed2005

Receptor-binding cancer antigen expressed on SiSo cells can be detected in metastatic lymph nodes from gastrointestinal cancers.

AIM: To investigate the expression of receptor-binding cancer antigen expressed on SiSo cells (RCAS1) in metastatic lymph nodes from gastrointestinal cancer. METHODS: Metastatic lymph nodes from gastrointestinal cancer were detected for RCAS1 by immunohistochemical staining and mRNA in situ hybridization. RESULTS: A total of 102 metastatic lymph nodes from bile duct, gastric, colon and pancreatic cancer were investigated for RCAS1 expression. The immunoreactivity of RCAS1 was identified in 100% of metastatic lymph nodes. Both local and distant metastatic lymph nodes showed RCAS1 expression. On the contrary, specimens of non-cancerous lymph nodes were negative for RCAS1. The result of mRNA in situ hybridization was also confirmed by the finding of immunohistochemical staining. RCAS1 mRNA was detected in all tumor cells that metastasized to lymph nodes. CONCLUSION: All metastatic lymph nodes express RCAS1 in tumor cells at both mRNA levels, and RCAS1 that should be used as a complementary factor for identification of metastatic lymph nodes from gastrointestinal cancers.

Antigens, Neoplasm↗

PubMed2004

Usefulness of inhibiting the lymph node metastasis in human gastric carcinoma by B7-1 gene transfection.

INTRODUCTION: Lymph node metastasis is one of the crucial prognostic factors in gastric cancer. We have reported that ICAM-1 gene transfection was effective against lymph node metastases of gastric cancer. B7-1, one of the co-stimulatory factors, was reported to induce cytotoxic T lymphocytes when using melanoma and bladder cancer cell lines, as well as ICAM-1. In this study, we investigated the inhibitory effect of B7-1 on lymph node metastasis by B7-1 gene transfection into gastric cancer cells. MATERIALS AND METHODS: We transfected B7-1 genes into a gastric cancer cell line (OCUM-2MLN) and analyzed the effect of B7-1 transduction on lymph node metastasis, the in vitro adhesiveness and cytotoxicity assay of mononuclear lymphocytes to cancer cells and lymph node metastatic ability after orthotopic implantation of gastric cancer cells in vivo. RESULTS: We revealed that mononuclear lymphocytes showed significantly stronger adherence and cytotoxicity to B7-1 transfected cells (2MLN/B7) than its parent OCUM-2MLN cells. The tumor growth rate of 2MLN/B7 xenograft was significantly slower than OCUM-2MLN xenograft in nude mice. In orthotopic implantation experiments for nude mice, 2MLN/B7 cells in stomach developed significantly less lymph node metastasis than OCUM-2MLN cells. Histologic findings showed that leukocytes were intensively infiltrated in both the 2MLN/B7 tumors and its metastatic lesions, however, were scarcely observed in the lesions associated with 2MLN cells. CONCLUSION: B7-1 may play an important role in inhibiting lymph node metastasis by the mechanism of enhanced immunogenicity, and that B7-1 gene transduction might be effective against lymph node metastases of gastric cancer.

Animals↗

PubMed1982

Subpopulations of human T-lymphocytes. XIX. T-cells and T-cells with receptors for IgMFc (T mu), IgGFc (T gamma), or IgAFc (T alpha) in the peripheral blood and regional lymph nodes of patients with untreated breast cancer.

Peripheral blood and regional lymph node mononuclear cells from 43 untreated patients with breast cancer were analyzed for the proportions of total T-cells and T-cells with receptors for the Fc portion of IgM (T mu), IgG (T gamma), or IgA (T alpha). Proportions of total T-cells and T mu cells both in peripheral blood and lymph nodes from breast cancer patients were comparable to those from health controls. The proportion of T gamma cells, however, was significantly (P less than 0.01) increased in the peripheral blood and lymph nodes from breast cancer patients as compared to that from controls. The proportion of T alpha in the peripheral blood was comparable; however, when compared to the number of T alpha cells in control lymph nodes, T alpha cells were increased (P less than 0.025) in the regional lymph nodes from patients with breast cancer. When data on the proportions of T-cells and T-cell subsets were analyzed according to the presence or absence of metastatic disease in the regional lymph nodes, the proportion of T gamma cells was significantly (P less than 0.025) higher in the peripheral blood from patients with metastatic disease than in patients with nonmetastatic disease. This study demonstrates an abnormality of T-cell subsets in the peripheral blood and the regional lymph nodes from patients with breast cancer. The significance of these observations is discussed.

Antigens, CD↗

PubMed2001

Prognostic importance of isolated peritumoral lymphangiosis carcinomatosa in lymph-node-negative colorectal carcinoma.

BACKGROUND: The prognostic value of microinvasion of lymph vessels and lymph nodes has become increasingly important; there is a wide range in prognosis of patients with nodal-negative tumor stages after curative resection for colorectal cancer. AIM: Detection of the prognostic importance of isolated lymph-vessel invasion as a possible precursor of lymph-node metastasis in patients with nodal-negative tumor stages. PATIENTS/METHODS: Retrospective analysis of 894 patients with R0-resected colorectal cancer, uni- and multivariate analysis of tumorbiologic prognostic factors, immunohistochemical proof of tumor cells in negative lymph nodes (pN0) using the epithelial marker HEA-125 (human epithelial antigen). RESULTS: The incidence of lymph-vessel invasion (L) was 37.7% in total. A pN0,L1 status was found in 144 patients (16.1% of all analyzed patients). Comparing patients with pN0,L1 status to those with pN+,L0 status showed that both groups have similar rates of overall survival and tumor relapse. Lymph-node status, lymph-vessel invasion, depth of tumor infiltration (pT) stage, and age were detected as independent prognostic factors by multivariate analysis. After reanalysis of 54 cases primarily classified as 18.5% pN0,L1, microinvasion in lymph nodes was detected by immunohistochemistry. We found a higher rate of tumor relapse (approximately 20%) for those patients. In regard to the overall survival rate, however, there was no difference when compared to patients without immunohistochemical proof of microinvasion. CONCLUSION: Isolated lymph-vessel invasion in nodal-negative tumor stages and a lymph-node-positive tumor status have equivalent prognostic importance in colorectal cancer.

Aged↗

PubMed1987

Variations in functional immunocompetence of individual tumor-draining lymph nodes in humans.

In studying the histology and immunohistology of tumor-draining lymph nodes, we observed that nodes close to tumor showed reduced paracortical activity relative to those further away. To assess whether this reduction was paralleled by alterations in the functional activity of nodes, we examined the immunocompetence of individually oriented tumor-draining lymph nodes. We assessed the unstimulated activity of lymph node lymphocytes and their responses to phytohemagglutinin, interleukin 2, and one-way alloantigenic stimulation (mixed lymphocyte reaction) in vitro. Regional nodes from patients with malignant melanoma or breast cancer were classified as proximal, intermediate, or distal relative to tumor. Node groups with and without tumor metastases in them were studied. Significant variations in [3H]thymidine uptake were noted with the unstimulated and stimulated lymphocytes of different lymph nodes from the same individual. Nodes near to tumor were less responsive than those located further away; some of the latter showed relative immunostimulation. Tumor-draining node groups thus demonstrated a nonrandom variation in the strength of reaction of individual nodes. There are zones of low and high lymph node reactivity, related to the position of each node relative to tumor. Tumor-derived immunosuppressive products and/or immunoregulation down-regulates lymph node functional activity, creating conditions that may permit the survival of tumor cells and the establishment of metastases. It is suggested that immunosuppression of nodes nearest to tumor may facilitate the early establishment of metastases.

Humans↗

PubMedDate not supplied

Detection of occult lymph node metastases in esophageal cancer by minimally invasive staging combined with molecular diagnostic techniques.

BACKGROUND AND OBJECTIVES: Lymph node metastases are the most important prognostic factor in patients with esophageal cancer. Histologic examination misses micrometastases in up to 20% of lymph nodes evaluated. In addition, non-invasive imaging modalities are not sensitive enough to detect small lymph nodes metastases. The objective of this study was to investigate the use of reverse transcriptase-polymerase chain reaction (RT-PCR) of messenger RNA (mRNA) for carcinoembryonic antigen (CEA) to increase the detection of micrometastases in lymph nodes from patients with esophageal cancer. METHODS: RT-PCR of CEA mRNA was performed in lymph nodes from patients with malignant and benign esophageal disease. Each specimen was examined histopathologically and by RT-PCR and the results were compared. RESULTS: Metastases were present in 29 of 60 (48%) lymph nodes sample by minimally invasive staging from 13 patients with esophageal cancer when examined histopathologically. RT-PCR identified nodal metastases in 46 of these 60 (77%) samples. RT-PCR detected CEA mRNA in all 29 histologically positive samples and in 17 histologically negative lymph nodes. All lymph nodes from patients with benign disease (n = 15) were negative both histopathologically and by RT-PCR. The stage of two patients was reclassified based on the RT-PCR results, which identified lymph node spread undetected histopathologically. Both of these patients developed recurrent disease after resection of the primary tumor. CONCLUSIONS: RT-PCR is more sensitive than histologic examination in the detection of lymph node metastases in esophageal cancer and can lead to diagnosis of a more advanced stage in some patients. The combination of minimally invasive surgical techniques in combination with new molecular diagnostic techniques may improve our ability to stage cancer patients.

Adenocarcinoma↗

PubMed2003

Imprint cytology of axillary lymph nodes as an intraoperative diagnostic tool.

AIMS: Frozen section histology of lymph nodes intraoperatively is associated with a false negative rate of twenty-five per cent. Imprint cytology is reported to have greater accuracy than frozen section. Accurate intraoperative examination of lymph nodes could help to prevent some patients from having a second axillary operation in breast cancer. This study assesses the sensitivity of imprint cytology to lymph node metastases using two different staining techniques. METHODS: Imprint cytology of 238 freshly excised axillary lymph nodes in 53 patients with stage T1-2, N0, M0 breast cancer was performed. Imprints were stained using toluidine blue dye and anti-pancytokeratin immunoglobulin to compare the two staining methods. A consultant histopathologist blinded to the routine histology results examined each set of imprints. A non-pathologist also examined each set of imprints to determine whether a technician could be used to screen slides in order to decrease the workload of the pathologist. RESULTS: Sensitivity was 82% with toluidine blue and 36.4% with anti-pancytokeratin immunoglobulin. Positive predictive values were 100% and 57% respectively for toluidine blue and anti-pancytokeratin. The false-negative rate was 18% for toluidine blue and 63.6% for anti-pancytokeratin antibody when examined by a consultant histopathologist. CONCLUSIONS: Imprint cytology using toluidine blue is as sensitive as frozen section in the detection of axillary lymph node metastases. A positive result may be acted upon with acceptable safety. Immunohistochemistry using antibody to pancytokeratin did not improve imprint sensitivity in this study. Imprint cytology could help to prevent a second operation in 80% of breast cancer patients with positive lymph nodes.

Adult↗

PubMed2000

In vivo identification of parasinus macrophages in the mesenteric lymph node.

Macrophages beneath the marginal sinus in the lymph nodes may play a role in defense against microorganism. The purpose of this study was to directly visualize the parasinus macrophages in the mesenteric lymph node. Fluorescent latex particles were injected into the appendix submucosa of rats. The mesenteric lymph node was epi-illuminated and observed with a fluorescent microscope. Fluorescent particles entered the marginal sinus of the mesenteric lymph node through the afferent lymphatic vessels, and distributed diffusely all over the marginal sinus. The particles became aggregated and interspersed 3 hr after injection, suggesting that particles were incorporated by phagocytes. The number of these particle-laden phagocytes increased up to 12 hr after injection, and then declined. Some phagocytes migrated rapidly within the marginal sinus. Morphology of these phagocytes in cell suspension was consistent with macrophages. In conclusion, we successfully visualized parasinus macrophages in vivo, which incorporated foreign bodies and migrated within the marginal sinus.

Animals↗

PubMed2004

MAdCAM-1 expressing sacral lymph node in the lymphotoxin beta-deficient mouse provides a site for immune generation following vaginal herpes simplex virus-2 infection.

The members of the lymphotoxin (LT) family of molecules play a critical role in lymphoid organogenesis. Whereas LT alpha-deficient mice lack all lymph nodes and Peyer's patches, mice deficient in LT beta retain mesenteric lymph nodes and cervical lymph nodes, suggesting that an LT beta-independent pathway exists for the generation of mucosal lymph nodes. In this study, we describe the presence of a lymph node in LT beta-deficient mice responsible for draining the genital mucosa. In the majority of LT beta-deficient mice, a lymph node was found near the iliac artery, slightly misplaced from the site of the sacral lymph node in wild-type mice. The sacral lymph node of the LT beta-deficient mice, as well as that of the wild-type mice, expressed the mucosal addressin cell adhesion molecule-1 similar to the mesenteric lymph node. Following intravaginal infection with HSV type 2, activated dendritic cells capable of stimulating a Th1 response were found in this sacral lymph node. Furthermore, normal HSV-2-specific IgG responses were generated in the LT beta-deficient mice following intravaginal HSV-2 infection even in the absence of the spleen. Therefore, an LT beta-independent pathway exists for the development of a lymph node associated with the genital mucosa, and such a lymph node serves to generate potent immune responses against viral challenge.

Animals↗

PubMedDate not supplied

[Lymph node metastases of papillary thyroid cancer in immunohistochemical and molecular examination--preliminary report].

BACKGROUND: Total thyroidectomy with lymphadenectomy is the most typical operation in a case of papillary thyroid cancer. Range of lymph node resection still remains a matter of controversy. In some publications treatment of lymph node metastases doesn't affect survival, so only selective lymph node resection is the extended enough operation. The others remark that, local relapse- the worst prognostic factor, appears the most often in the lymph nodes, so they suggest more aggressive treatment. To solve that problem we try to find more sensitive methods to examine lymph nodes. AIM: To compare the results of detection lymph node metastases of papillary thyroid cancer by immunohistochemistry with the results of RT- PCR for thyroglobulin (Tg) mRNA. MATERIAL AND METHODS: Each of one hundred eighty four cervical lymph nodes obtained from 24 patients, operated in our Department was divided into 2 halves: one was used for conventional histopathology and immunohistochemistry, the other part was investigated by RT- PCR for Tg mRNA. Immunohistochemical staining for Tg was performed on formalin-fixed, paraffin-embedded sections with anti-Tg antibodies. RESULTS: According to routine, histopathological examination 8 (33.5%) patients had involved lymph nodes. One hundred correspondence of the results of immunohistochemistry and histopathology was observed. We obtained different results of examination of the lymph nodes in 6 (25%) patients. In four patients (16.7%) RT-PCR was more sensitive in detection of positive lymph nodes, in two patients (8.3%) it revealed less metastasized lymph nodes than immunohistochemistry. The remaining 18 patients didn't have any differences, fourteen (58.3%) of them had the negative lymph nodes and four (16.7%) had positive, the same lymph nodes in all examinations. Finally, according to RT-PCR 10 (41.7%) of the patients had metastasized lymph nodes. CONCLUSION: Tg RT-PCR is a sensitive method of detection of papillary thyroid cancer cells and may help to detect the metastases of papillary thyroid cancer in regional lymph nodes.

Adenocarcinoma, Papillary↗

PubMed2005

Ectopic decidua of pelvic lymph nodes: a potential diagnostic pitfall.

Ectopic decidua is one of several benign lymph node inclusions that have been increasingly documented in the literature, most often in postmortem examinations of pregnant woman and recently in pregnant women with cervical squamous cell carcinoma. Although lacking clinical significance of its own, the major diagnostic implication would be misdiagnosis as metastatic carcinoma in the lymph node. Intraoperative frozen sections are often performed prior to radical hysterectomy, leading to a potential alteration of therapy if metastatic carcinoma is identified in the lymph nodes. We report such a case of a pregnant woman with cervical squamous cell carcinoma requiring lymphadenectomy and hysterectomy, in which the intraoperative frozen section of a pelvic lymph node with ectopic decidual change was mistakenly identified as metastatic carcinoma. Its histologic resemblance to carcinoma and location within subcapsular sinuses, compounded with the fact that ectopic lymph node decidua is not commonly seen in routine practice, can lead to this diagnostic pitfall. We review the literature regarding ectopic decidua, its presence in lymph nodes, and its pathogenesis, as well as review the literature on benign lymph node inclusions.

Adult↗

PubMed1989

[Retroperitoneal lymph node metastasis in patients with ovarian cancer].

From 1979 to 1987 retroperitoneal lymph node dissection was performed at the Tokyo University Hospital in 41 cases (pelvic lymph node biopsy was done in 4 cases, pelvic lymphadenectomy in 23 cases, pelvic and paraaortic lymphadenectomy up to the renal vessels in 14 cases) of Stage Ia to IV ovarian cancer following cytoreductive surgery. The incidence of retroperitoneal positive nodes was 11.1% (2/18) in Stage I, 50.0% (5/10) in Stage II, 50.0% (5/10) in Stage III and 0% (0/3) in Stage IV (FIGO criteria without considering the pathologic findings of retroperitoneal lymph nodes). The positive rate of lymph node involvement in Stage II and Stage III was significantly higher than that in Stage I. The tumors involving both ovaries were more likely to metastasize to retroperitoneal lymph nodes. Enlargement of tumors and increased ascites were not the risk factors of retroperitoneal lymph node metastasis. These data suggest that the occurrence of retroperitoneal lymphatic spread in ovarian cancer is comparable to that in uterine cancer and increased by involvement of both ovaries and extension to other pelvic tissues.

Adult↗

PubMed1999

Evaluation of metastatic celiac axis lymph nodes in patients with esophageal carcinoma: accuracy of EUS.

BACKGROUND: Endosonography (EUS) is the most accurate modality for assessing depth of tumor invasion and local lymph node metastasis. However, its accuracy in the identification of metastatic (celiac axis) lymph nodes is less well defined. Our objective in this study was to determine the accuracy of Eus in detecting celiac axis lymph node metastasis in patients with esophageal carcinoma. METHODS: Two hundred fourteen patients with esophageal carcinoma underwent preoperative EUS. Of these, 145 underwent attempted surgical resection and staging, and 4 underwent EUS-guided fine-needle aspiration of mediastinal and celiac lymph nodes. Local (mediastinal) and distant (celiac axis) lymph nodes were assessed for malignancy on the basis of four criteria (larger than 1 cm, round, homogeneous echo pattern, sharp borders). Accuracy of EUS was determined by means of correlating histopathologic findings for the resected lymph nodes or results of EUS-guided fine-needle aspiration cytologic examination. RESULTS: Surgical exploration (n = 145) and fine-needle aspiration cytologic examination (n = 4) revealed metastatic celiac axis lymph nodes in 23 and metastatic mediastinal (local) lymph nodes in 93 of 149 patients with esophageal carcinoma. According to defined criteria for malignant lymph nodes, there were 19 true-positive and 4 falsenegative results. Sensitivity for the diagnosis of celiac lymph node metastasis with EUS was 83% with a 98% specificity. For the diagnosis of mediastinal lymph node metastasis, sensitivity was 79% and specificity was 63%. All patients with malignant celiac axis lymph nodes had local T3 (tumor breaching adventitia) or T4 (tumor invading adjacent organs) disease. CONCLUSION: EUS is an excellent modality in the evaluation of metastatic celiac axis lymph nodes in patients with esophageal carcinoma. These findings should be used in selecting options for treatment. Sensitivity for detecting malignancy is consistent with that of prior studies, and local and regional lymph nodes and specificity is significantly higher.

Aged↗