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PubMed2004

Sentinel lymph node biopsy in breast cancer patients: the medical oncology perspective.

Recent data indicates that the sentinel lymph node biopsy (SLNB) is a possible alternative to axillary lymph node dissection (ALND) in early breast cancer patients, with minimal risk of complications. From the medical oncologist's point of view, the impact of SLNB on the management of patients should consider if SLNB is useful to choose adjuvant treatment, if it is adequate to provide local control, and what is the significance of lymph node micrometastases on treatment and staging. Lymph node involvement has always been recognised as the most important prognostic factor in early-stage breast cancer, even if many other parameters have been evaluated in recent years. However, the lack of knowledge of nodal status in patients with false-negative SLNB seems to result in an undertreatment in a very low percentage of patients. Adjuvant chemotherapy and hormonal therapy with tamoxifen are associated with an absolute reduction of the risk of recurrence and death both in node-positive and in node-negative patients, then if patients are treated with modern adjuvant systemic therapy, any effect associated with false negative SLN should be minimised. The impact of axillary treatment on survival is still controversial, but in recent times axillary lymph node positivity is considered as an indicator for high risk of systemic diffusion of the disease rather than a possible origin of systemic metastases. The significance of occult sentinel lymph node metastases detected by immunohistochemistry (IHC) or molecular biology on prognosis is still uncertain. The new version of the staging system of breast cancer has recognised the need for a standard diagnostic approach and of a nomenclature system which also takes SLNB into account.

Axilla↗

PubMed2002

[Sentinel lymph node biopsy in breast cancer: feasibility study and initial experiments].

OBJECTIVE: To evaluate and accredit the sentinel lymph node biopsy in the surgical treatment of breast cancer in our institute. PATIENTS AND METHODS: From February to September 2001 at Tenon Hospital, 64 patients with breast cancer and clinically negative node underwent sentinel lymph node biopsy followed immediately by standard axillary dissection. Both blue dye and radioisotope were used in the majority of patients (70.4%) to identify the sentinel node. These sentinel nodes were evaluated by hematoxylin and eosin, immunohistochemistry and multiple sections. RESULTS: The mean tumor diameter was 17.2 mm (range, 7 to 40 mm). The sentinel node was identified in 97% of the cases (62/64). Of the 62 patients, 24 were histologically positive (38.7%). The sentinel node was falsely negative in one patient (4%). In patients with tumors less than 20 mm, the identification and false negative rates were 97.8% and 0%, respectively. CONCLUSIONS: Our study confirms the validity of the sentinel lymph node. This procedure identifies in a reliable way the sentinel node in most cases. The histological characteristics of the sentinel node reflect those of the rest of the axillary lymph nodes. This procedure appears more accurate for patients with tumors less than 20 mm. This procedure will become the method of choice for axillary staging in small-sized breast cancer. This minimally invasive procedure represents a major step in the field of breast cancer treatment.

Adult↗

PubMed2003

Implication of micrometastases of lymph nodes in patients with extended operation for pancreatic cancer.

INTRODUCTION: Accurate evaluation of lymph node metastases is very important in planning treatment for pancreatic cancer. AIM: To detect micrometastases in lymph nodes dissected from patients with pancreatic cancer. METHODOLOGY: We used cytokeratin staining of negative lymph nodes in routine hematoxylin-eosin (HE) staining. We examined by cytokeratin staining 239 HE-negative nodes from 7 patients with no pathologic evidence of lymph node metastasis (n0 cases) and 718 HE-negative group 2 nodes from 23 patients with metastasis in group 1 lymph nodes (n1 cases) who underwent extended operation combined with intraoperative radiation therapy (IORT). RESULTS: Cytokeratin staining identified 15 positive nodes among the 239 HE-negative nodes from the 7 n0 cases and 8 positive nodes among the 718 HE-negative nodes from the 23 n1 cases. Among the 7 n0 cases, 5 (71.4%) had positive n1 nodes and 2 (28.3%) also had positive n2 nodes. Among the 23 n1 cases, 4 (17.4%) had positive n2 nodes. Patients with micrometastases in n2 nodes died within 25 months. CONCLUSION: Cytokeratin staining is very useful to evaluate the involvement of lymph nodes in pancreatic cancer. Prognosis of pancreatic cancer should be determined in conjunction with evaluation of nodal status by cytokeratin staining. Extended operation was not useful for pancreatic cancer patients with micrometastases of group 2 nodes.

Adult↗

PubMed1997

Predicting pelvic lymph node involvement in patients with localized prostate cancer.

Pelvic lymph node dissection is a routine staging procedure in localized prostate cancer. It provides prognostic information, it influences the design of the subsequent therapeutic strategy and it provides information necessary to compare the results of various therapeutic strategies. It is not considered a curative procedure. Thanks to improved diagnostic means, the unexpected finding of positive lymph nodes has decreased from 30% 15 years ago to below 10%. Hence, today the procedure is unnecessary in over 90% of the cases. Improvements in staging by imaging techniques, including CT scan, MRI, ultrasound, and ileopelvic scintigraphy, have so far been unsuccessful because of low specificity and sensitivity. Using a combination of tumor grade and stage plus serum prostate-specific antigen (PSA) levels, a good indication of the likelihood of positive pelvic nodes can be obtained. A review of the literature indicates that for clinically localized tumors, i.e. stages T1a to T2b, lymph node dissection can be omitted provided serum PSA levels are < 10 ng/ml and the tumor is well to moderately well differentiated (Gleason grade < 7). Using these cutoff values, approximately 25% of our patients can be saved a pelvic lymph node dissection at the price of approximately 3% missed cases.

Biomarkers, Tumor↗

PubMed1995

[Long-term survival of a patient with lung cancer with skip metastasis to supraclavicular lymph nodes].

A case of lung cancer with skip metastasis to supraclavicular lymph nodes is described. The patient had undergone radical resection for gastric cancer about nine years ago. For about one year, chemotherapy had been done by Tegafur (600 mg/day) after operation. Radical resection for lung cancer (p/d squamous cell carcinoma) was performed about seven years ago. Pathologically, mediastinal lymph node metastasis could not be detected. The needle aspiration biopsy of supraclavicular lymph node revealed metastasis. Then, radical neck lymph nodes dissection involving supraclavicular lymph nodes and radiation therapy were added. There has been no sign of recurrence so far.

Aged↗

PubMedDate not supplied

Ultrasonographic detection of regional lymph node metastases in patients with intermediate or thick malignant melanoma.

Careful monitoring of regional lymph nodes and early detection of metastases in malignant melanoma patients has an impact on their survival, since it may permit beneficial surgical therapy. Palpation is routinely used in clinical practice. The value of ultrasonography for routine follow-up of melanoma patients, still, is not generally accepted. The aim of our study was to assess the sensitivity and specificity of ultrasound and clinical examination respectively, in the detection of melanoma regional node metastases. Additionally, we evaluated whether early detection of metastases improved overall survival. One hundred and forty-eight melanoma patients with an intermediate or thick primary lesion were followed between January 1997 and May 2001. Clinical examination and concomitant regional lymph node ultrasonography were performed, every 3-4 months. If suspicious findings were identified, regional lymph node dissection was undertaken. Forty-four from the initial 148 patients relapsed with regional lymph nodal metastases. In 11 patients (25%) palpation failed to reveal the disease and metastases were depicted only by ultrasonography. In only 1 patient ultrasonography was false-negative. The sensitivity and specificity of palpation were 72.7 and 97% respectively, while those of ultrasonography were 97.7 (p<0.001) and 98% respectively. Ultrasonography was more sensitive in detecting lymph node metastases in the axilla (100%) and the groin (93.3%). When overall survival of patients presenting with local-regional recurrence was calculated--depending on the number of involved lymph nodes--a survival benefit (p<0.05) was found for patients with only one lymph node metastasis. In conclusion, ultrasonography is superior to clinical examination in the early detection of regional lymph node metastases from an intermediate or thick malignant melanoma and should be a part of those patients' surveillance.

Adult↗

PubMed2005

Prognostic implication of isolated tumor cells and micrometastases in regional lymph nodes of gastric cancer.

AIM: To determine the prognostic significance of isolated tumor cells (ITCs) and lymph node micrometastases in gastric cancer. METHODS: Hematoxylin and eosin-stained slides of lymph node dissections of 632 consecutive gastric cancers were reviewed. Cytokeratin immunostaining was performed in 280 node-negative cases and 5 cases indefinite for lymph node metastases. Lymph node metastases were divided into ITCs, micrometastases, or macrometastases, according to the sizes of tumor deposits in largest dimension. ITCs were further classified into four groups according to metastasis pattern. RESULTS: Lymph node metastases were identified by immunostaining in 58 of 280 node-negative cases (20.7%) and were not significantly associated with patient survival (P = 0.3460). After cytokeratin immunostaining, 196 cases were classified as pN1, which consisted of 20 cases with micrometastases detected by immunostaining (pN1mi(i+)), 34 cases with only micrometastases (pN1mi), and 142 cases with pN1 with one or more macrometastases (pN1). Cases with pN1mi and pN1mi(i+) had a significantly better prognosis than the cases with pN1 (P = 0.0037). ITCs were found in 38 of these 58 cases, and could be divided into four groups: 12 cases with only a single cell pattern, 7 cases with multiple individual cells, 5 cases with single small cluster, and 14 cases with multiple small clusters. Among these four groups, cases with ITCs of multiple individual cell pattern showed the worst survival (median survival: 28 mo, P<0.0001). CONCLUSION: Both size and pattern of lymph node metastases can give prognostic information on the survival of gastric cancer patients.

Humans↗

PubMed1981

Wiskott-Aldrich syndrome: histopathologic findings in the lymph nodes and spleens of 15 patients.

Seventeen lymph nodes and 13 spleens from 15 patients with the Wiskott-Aldrich syndrome were examined histologically. The material included both biopsy and autopsy specimens. Consistent findings included depletion of small lymphocytes from T cell areas (all cases), prominence of the reticulum cell stroma (all cases), the presence of atypical plasma cells with and without plasmacytosis (16 lymph nodes and 11 spleens), and extramedullary hematopoiesis (13 lymph nodes and 9 spleens). Less frequent features noted were tissue eosinophilia, hemophagocytosis, focal fibrosis, and progressive depletion of germinal centers. One case with a unique abundance of transformed lymphocytes is described.

Child↗

PubMedDate not supplied

Intraoperative cytologic examination of breast sentinel lymph nodes: test utility and patient impact.

The sentinel lymph node (SLN) procedure is a method for ascertaining the axillary lymph node status in patients with breast cancer. Intraoperative examination of the SLN may be important, because a positive result directs surgery to a complete axillary lymph node dissection. Intraoperative cytologic examination (IOCE) is a method of intraoperative evaluation, although little data are available regarding the sensitivity of the method with respect to tumor size and the size of the SLN metastasis. All SLN cases for the years 1997-2002 at Magee-Womens Hospital were tabulated for primary breast carcinoma size, IOCE result, final histologic result, and size of the SLN metastasis. All SLNs had IOCE with touch imprints. Scrape SLN preparations and frozen sections were strongly discouraged. There were 748 SLN cases comprising 1576 SLNs that had IOCE, and there were 247 true positive SLN cases comprising 522 SLNs. Of the 247 true positive SLN cases, 111 had a positive IOCE (111/247; 45% sensitivity overall) and there were 136 false negatives. Of the 247 cases, 164 were SLN micrometastases < or =2.0 mm in size, and 44 (27%) of these were detected by IOCE, while the remaining 120 cases were false negative. Of the 83 SLN macrometastases (>2.0 mm), 66 (80%) were detected by IOCE, with 17 false negatives. In this series, 15 cases (2%) were given the IOCE diagnosis of atypical/defer, and all of these permanent sections were histologically positive. There were five IOCE-positive cases that were histologically negative. Of the 164 SLNs with micrometastases < or =2.0 mm, 17.6% (29/164) were < or =0.5 mm (6/29 [21.4%] were IOCE positive), 5.5% (9/164) were 0.51-1.0 mm (3/9 [33%] were IOCE positive), and 3.6% (6/164) were 1.1-2.0 mm (2/6 [33%] were IOCE positive). There were 83 SLNs with macrometastases larger than 2.0 mm, and 66/83 (80%) were detected by IOCE. In this group, 22% (18/83) were 2.1-5.0 mm (8/18 [44.4%] were IOCE positive) and 57.8% (48/83) were larger than 5.0 mm (41/48 [85%] were IOCE positive). The mean primary breast tumor size was 15.4 mm, with a mean SLN tumor size of 1.4 mm. There was a significant correlation with tumor size and the presence of SLN metastasis, and a significant correlation with tumor size and size of the SLN metastasis. There was a significant t correlation of primary tumor size and positive IOCE, with the group of negative IOCE cases having a mean tumor size of 14 mm and the positive IOCE group having a mean tumor size of 22 mm. The overall sensitivity of the method was 45%, specificity 99%, positive predictive value 0.99, and negative predictive value 0.80. Sensitivity of the IOCE procedure based on SLN tumor size is as follows: < or =0.5 mm, 21.4%; 0.51-1.0 mm, 33%; 1.1-2.0 mm, 33%; 2.1-5.0 mm, 44.4%; and >5.0 mm, 85%. Primary tumor size correlates with a positive SLN status and size of the SLN metastasis. Most false-negative IOCEs are due to micrometastases. Positive IOCE cases had a significantly larger SLN metastasis size (mean 8.0 mm) than the false-negative IOCE group (mean 1.4 mm). The IOCE of SLNs has a high negative predictive value, but this is a poor test for the detection of micrometastases, as this group accounts for the majority of false-negative IOCEs of breast SLNs.

Axilla↗

PubMed2005

Tumor lymphangiogenesis predicts melanoma metastasis to sentinel lymph nodes.

Cutaneous melanoma is a common melanocytic neoplasm that can quickly metastasize to regional lymph nodes. Currently, prognosis is determined by measuring tumor thickness but more reliable markers for metastatic spread are urgently needed. We investigated whether the extent of tumor lymphangiogenesis can predict melanoma metastasis to sentinel lymph nodes. We quantified the extent of tumor lymphangiogenesis, as well as other factors, in excised primary tumors and in sentinel lymph node biopsy samples from 45 patients with primary cutaneous melanoma. The results were correlated with histological and clinical outcome. Primary melanomas from patients whose tumors had metastasized to the sentinel lymph nodes contained prominent 'hot spots' of increased lymphatic vessel density, compared to nonmetastatic tumors. Multivariate risk analysis revealed that the lymphatic vascular area of primary melanomas, an index of tumor lymphangiogenesis, was the most sensitive prognostic marker for sentinel lymph node metastasis, and was even able to more accurately predict which tumors were metastatic to sentinel lymph nodes than the currently used method of measuring tumor thickness. Highly lymphangiogenic melanomas maintained their lymphangiogenic activity after metastasis to the sentinel lymph node. The extent of tumor lymphangiogenesis is a highly sensitive (83%) and specific (89%) prognostic marker of lymph node metastasis. Assessment of lymphangiogenesis in primary melanomas may be a more effective approach than the currently used technique of measuring tumor thickness in selecting patients with early metastatic disease for aggressive therapy.

Adult↗

PubMed1990

Bilateral cervical lymph node metastases in well-differentiated thyroid cancer.

We analyzed the regional lymph node metastases of 98 patients with thyroid cancer who underwent bilateral modified neck dissection. Bilateral jugular lymph node metastases were frequent in patients with papillary carcinoma of the thyroid, especially in those patients with obvious carcinoma in both lobes of the gland, cancer arising in the isthmus, clinically detectable bilateral lymphadenopathy, and recurrent thyroid cancer. In patients whose cancer was clinically confined to one lobe, and where there were no obviously enlarged contralateral lymph nodes, the occurrence of contralateral jugular lymph node metastasis was significantly correlated with the contralateral paratracheal lymph node metastasis. The bilateral lymphadenectomy appears to be appropriate in these instances.

Adenocarcinoma↗

PubMed2002

Comparison of peritumoral and subareolar injection of Tc99m sulphur colloid and blue-dye for detection of the sentinel lymph node in breast cancer.

BACKGROUND: The new trend in diagnosis of the lymph node is sentinel node biopsy. This method has become increasingly accepted as a minimally invasive alternative to routine axillary dissection. Although the results of numerous studies have shown that sentinel node biopsy can accurately determine the axillary nodal status, the identification rates and false-negative rates have been variable. The sentinel lymph node is defined as the first node in the lymphatic basin that receives the primary lymphatic flow. MATERIAL AND METHODS: Between September 1998 and August 2002 123 patients with primary operative breast cancer without clinical palpable axillary lymph nodes were enrolled in the study. There were two groups of patients according to sentinel node identification technique: 51 patients (Group I) received parenchymal, peritumoral injection of 1.0 ml of 16 MBq Tc(99m)-radiolabelled sulphur colloid and single intradermal injection of blue-dye over the tumour. The next 72 patients (Group II) received intradermal, periareolar one-site injection of 0.5 ml of 16 MBq Tc(99m)-radiolabelled sulphur colloid and blue-dye. RESULTS: Sentinel lymph node was found in 41 (80.4%) cases in Group I and in 67 (93.0%) cases in Group II (p = 0.028). The localisation of the axillary lymph node as a "hot spot" visualised by lymphoscintigraphy was successful in 39/51 (76.5%) cases in Group I and 67/72 (93.0%) in Group II, p = 0.004). In both groups the success of sentinel node identification in the axillary region by lymphoscintigraphy was connected with sentinel lymph node finding during surgery (Group I: p < 0.001, Group II: p < 0.001). CONCLUSIONS: This study shows that intradermal, periareolar one-site injection of Tc(99m)-radiolabelled sulphur colloid and blue-dye is superior to peritumoral 4-sites injections Tc(99m)-radiolabelled sulphur colloid and single intradermal injection of blue-dye over the tumour in sentinel lymph node identification.

Journal Article↗

PubMed2002

Lymph node micrometastasis and lymphatic mapping determined by reverse transcriptase-polymerase chain reaction in pN0 gastric carcinoma.

BACKGROUND: The purposes of this study were to examine lymph node micrometastasis (LMM) by reverse transcriptase-polymerase chain reaction (RT-PCR) method, and clarify the initial nodes involved by metastatic disease according to tumor location. METHODS: We examined 312 lymph nodes obtained from 50 patients with node-negative gastric carcinoma. RT-PCR and immunohistochemistry were performed. The clinical characteristics of LMM were investigated, and the map of LMM was made according to tumor location. RESULTS: The number of patients and LMM detected by RT-PCR was 14 and 17 and by immunohistochemistry was 7 and 8, respectively. RT-PCR was a more sensitive method than immunohistochemistry. LMM by RT-PCR correlated with depth of tumor invasion and lymphatic invasion. Regarding pT1 tumor, 9 patients with LMM had tumors that were of the macroscopically depressed type and 2 cm or more in diameter. According to the lymphatic map, right pericardial lymph nodes and lymph nodes along the lesser curvature were the initial nodes involved in the upper third of the stomach. Right pericardial lymph nodes, lymph nodes along the lesser curvature, and infrapyloric nodes were more important initial metastatic sites in the middle third of the stomach, and lymph nodes along the lesser curvature and infrapyloric nodes in the lower third. CONCLUSIONS: We demonstrated the relationship between LMM and clinicopathologic factors, especially in pT1 tumor. The mapping of LMM may prove useful for selecting the optimal treatment.

Aged↗

PubMed2004

A population-based atlas and clinical target volume for the head-and-neck lymph nodes.

PURPOSE: To develop a population-based three-dimensional lymph node target volume of the head and neck. METHODS AND MATERIALS: The T2 weighted axial magnetic resonance imaging (MRI) images of 35 patients with known head and neck cancer were reviewed. An experienced head and neck radiologist marked each lymph node (LN) electronically. The images were distributed to one of 12 axial levels of the head and neck with each level representing a distinct portion of the neck based on external contours and the presence of anatomic structures. The LNs were marked with five different symbols to distinguish the superior/inferior extent of each LN within each level. With the categorization of each image into a different superior/inferior level of the neck, the registration of the images was limited to two dimensions. Nonlinear transformation accounted for inter-patient differences although no local warping was used. The co-registration used recognizable anatomic landmarks (vertebral body, mandible, maxilla, clivus as well as the sternocleidomastoid muscle, external skin contour, spinal cord) to match the patient anatomy. RESULTS: In total, 503 images were co-registered with the baseline images. The majority of the co-registrations were of good quality; 361, 122, and 20 image co-registrations scored as global, limited, and poor co-registrations respectively. One thousand and fifty seven LNs were marked, with 122 LNs marked as submandibular and submental LN. Among the levels A, B, C, D, E, F, G, H, 22, 44, 206, 199, 196, 175, 63, 35 LN were marked respectively. Noteworthy anatomic variation was observed among the different nodal groups that are summarized in the representative baseline images. CONCLUSIONS: Image registration of a series of head and neck images generates a valuable population-based lymph node map that can be used to guide the three-dimensional delineation of the elective lymph node target volume. Significant variation in the lymph node location was seen in all LN groups. The medial border of the internal jugular vein can be used as an important landmark structure in delineating the jugular LN clinical target volume and, for that reason, intravenous contrast is recommended to improve visualization. The location of the submandibular LN appear to be limited to the space anterior and lateral to the submandibular gland and are found mostly along the inferior edge of the mandible. The location of the retropharyngeal LN does vary but their location does not appear to vary with any other recognizable axial structure. The lymph node map provides another collaborating piece of evidence in defining the head and neck LN clinical target volume.

Adolescent↗

PubMed1988

The role of elective lymph node dissection in melanoma: rationale, results, and controversies.

Elective lymph node dissection (ELND) for patients with clinically occult metastatic melanoma in regional lymph nodes has the goal of curing metastases with a surgical treatment. This is in contrast to the low probability for surgical cure in patients with clinically detectable lymph node metastases. The rationale for elective node dissection is based on a hypothesis that melanoma metastasizes sequentially via lymph nodes and then to distant sites. A subgroup of melanoma patients with high risk for regional node micrometastases but low risk for distant micrometastases has been identified from prognostic factors analysis of large patient series, as well as surgical results of nonrandomized clinical trials. However, two nonrandomized surgical trials have failed to show a survival benefit for ELND. These studies were largely performed in female patients with extremity melanomas and there were limitations that preclude a definitive conclusion. No randomized trials have been conducted involving melanomas of the trunk or head and neck. Two prospective randomized surgical trials are now being conducted in North America and in Europe. Until the results of these trials are available, physicians are encouraged to enter patients into these ongoing clinical trials or consider ELND in selected patients where the benefit-risk ratio justifies it. Factors to be considered in this decision include intermediate tumor thickness (ie, 1 to 4 mm thickness), anatomic site, histology (ulceration and growth pattern), and the risk of the operation in individual patient settings.

Clinical Trials as Topic↗

PubMed1980

Non-Hodgkin malignant lymphomas of B-cell lineage with special reference to their lymph node involvement pattern.

A total number of 137 lymph nodes from 33 patients with a malignant non-Hodgkin lymphoma of B-cell lineage was assessed histologically and immunohistochemically with special reference to the presence or absence of the neoplastic B-cells in the B- and T-cell areas of the lymph nodes as well as inside the post-capillary venules (PCV) of the paracortical areas. The B-cell origin of the lymphomas was confirmed by staining the tissues with an indirect immunoperoxidase technique for the cell surface immunoglobulins. The B-cell areas (cortex and medulla) of the lymph nodes were involved by the lymphoma cells in all studied cases. The T-cell areas (paracortex) were involved in 93.4% of the nodes. Lymphoma cells were encountered inside th PCV in 83.2% of the nodes. Furthermore, fifteen nodes were found where the T-cell area was only partially involved despite the totally involved B-cell areas. The results lend some support to the view that the lymph node involvement by the B-cell neoplasias starts from the B-cell areas. This involvement pattern may be used as an aid in the diagnosis of these lymphomas, and utilized in the study of the circulatory properties of the B-lymphocytes in general.

B-Lymphocytes↗

PubMed1995

[Laparoscopic pelvic lymph node dissection valuable in the staging of clinically localized prostate carcinoma].

OBJECTIVE: To assess the value of laparoscopic lymph node dissection of the obturator fossa in patients with prostate carcinoma with high risk of lymph node metastases. DESIGN: Prospective descriptive study. SETTING: Department of Urology, University Hospital Nijmegen, the Netherlands. METHOD: Prior to curative therapy for prostate carcinoma a bilateral laparoscopic pelvic lymph node dissection was performed in 25 patients, with a high risk of lymph node metastases on the basis of tumour size, tumour grade or serum prostate specific antigen. RESULTS: In 52% (13/25) of the patients lymph node metastases were found. Once a laparotomy was performed for an arterial bleeding. A mean of 11.6 lymph nodes were removed during bilateral dissection of the obturator fossa. Three quarter of the patients were discharged one day postoperatively. CONCLUSION: A laparoscopic lymph node dissection is a valuable tool for the evaluation of pelvic lymph nodes in patients with a clinically localised prostate carcinoma and a high risk of lymph node metastases.

Aged↗

PubMed1982

Quantitation of changes in lymph protein concentration during lymph node transit.

Many investigators assume the protein concentration and colloid osmotic pressure of interstitial fluid and lymph to be identical even after the lymph has passed through a lymph node. We quantitated the degree of modification of lymph by the dog popliteal lymph node by perfusing isolated lymph nodes in situ at physiological flow rates with homologous plasma or plasma diluted to low protein concentration. This enabled us to compare directly prenodal and postnodal lymph flows and protein concentrations. When undiluted plasma was infused into the node, fluid filtered from the blood into the lymph, diluting the lymph. When diluted plasma was infused, fluid was absorbed from the lymph, concentrating the lymph. Nearly all (98%) of the change in lymph protein concentration could be explained by transfer of protein-free fluid either into or out of the lymph. However, when the nodes were perfused with lymph having a colloid osmotic pressure that exactly balanced the hydrostatic and osmotic forces acting across the lymph node blood-lymph barrier, the lymph was not modified during nodal transit. This "equilibrium colloid osmotic pressure" averaged 60% of that of plasma. The concentrating-diluting mechanism became more significant as the perfusion rate decreased and/or as the colloid osmotic pressure of the afferent lymph was made progressively greater than or less than the equilibrium colloid osmotic pressure. We conclude that lymph nodes modify lymph protein concentration and colloid osmotic pressure except when these are already at equilibrium values for given lymph node conditions. Therefore, the assumption that postnodal lymph is representative of interstitial fluid, especially at low but still physiological lymph flows, is likely to be incorrect.

Animals↗