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1

Axillary Lymph Nodes and Breast Cancer  

MedlinePLUS

... to 10 PM EST. FACTS FOR LIFE Axillary Lymph Nodes Lymphatic system and axillary nodes Lymph vessels, like ... They carry lymph fluid, cells and other material. Lymph nodes are small clumps of immune cells that act ...

2

Axillary lymph node management in breast cancer with positive sentinel lymph node biopsy  

PubMed Central

The surgical treatment of localized breast cancer has become progressively less aggressive over the years. The management of the axillary lymph nodes has been modified by the introduction of sentinel lymph node biopsy. Axillary dissection can be avoided in patients with sentinel lymph node negative biopsies. Based on randomized trials data, it has been proposed that no lymph node dissection should be carried out even in certain patients with sentinel lymph node positive biopsies. This commentary discusses the basis of such recommendations and cautions against a general omission of lymph node dissection in breast cancer patients with positive sentinel lymph node biopsies. Instead, an individualized approach based on axillary tumor burden and biology of the cancer should be considered. PMID:25667909

Voutsadakis, Ioannis A; Spadafora, Silvana

2015-01-01

3

Women with Breast Cancer Micrometastases in Their Sentinel Lymph Nodes May Not Need Axillary Dissection  

Cancer.gov

Results from a randomized clinical trial showed that women with breast cancer and only micrometastases in their sentinel lymph nodes who received axillary lymph node dissection had more side effects but no improvement in disease-free survival compared with women who had no further lymph node surgery.

4

Axillary sparganosis which was misunderstood lymph node metastasis during neoadjuvant chemotheraphy in a breast cancer patient  

PubMed Central

Sparganosis of the breast is an uncommon disease, but should be considered in the differential diagnosis of unusual and suspicious breast masses. A history of ingesting contaminated water and direct ingestion of snakes and frogs may help in differential diagnosis of the mass. Complete surgical removal is the treatment of choice and provides a definite diagnosis. We report a case of multiple axillary lymph node sparganosis. It was first considered as an axillary metastasis of breast cancer because a newly axillary mass appeared in follow-up radiologic study after neoadjuvant chemotherapy. We performed curative breast cancer surgery and sparganosis was confirmed by extracting the worm during axillary dissection. PMID:25485243

Lee, Eun Kyoung

2014-01-01

5

Patients with Breast Cancer and Negative Sentinel Lymph Node Biopsy without Additional Axillary Lymph Node Dissection: A Follow-Up Study of up to 5 Years  

Microsoft Academic Search

Objective: To analyze the rate of axillary recurrences and survival in patients operated on for breast cancer who had not undergone an axillary lymph node dissection (ALND) because of a negative sentinel node biopsy. Methods: The study includes 97 patients operated on for breast cancer and selective node biopsy from June 2000 to December 2001 who had a negative sentinel

Anna Domènech; Ana Benitez; María Teresa Bajén; María Jesús Pla; Miguel Gil; Josep Martín-Comín

2007-01-01

6

High field MRI of axillary lymph nodes and breast cancer  

Microsoft Academic Search

In this thesis nodal characteristics have been assessed with high field Magnetic Resonance Imaging (MRI) using a clinical scanner in order to discriminate non-metastatic from metastatic nodes of breast cancer patients. The final goal is to non-invasively determine nodal and tumor stage of breast cancer patients during one MR exam, thereby identifying which patients have non-metastatic nodes in order to

M. A. Korteweg

2011-01-01

7

Unnecessary axillary node dissections in the sentinel lymph node era  

Microsoft Academic Search

In the sentinel lymph node era, axillary lymph node dissection (ALND) for uninvolved axillary lymph nodes should be considered unnecessary and inappropriate. Between January 2000 and August 2005, 3487 out of 10,031 invasive breast cancer patients consecutively operated at the European Institute of Oncology were considered not suitable for sentinel lymph node biopsy (SNB) and were directly submitted to ALND

Mattia Intra; Nicole Rotmensz; Denise Mattar; Oreste D. Gentilini; Annarita Vento; Paolo Veronesi; Marco Colleoni; Concetta De Cicco; Enrico Cassano; Alberto Luini; Umberto Veronesi

2007-01-01

8

Immunohistochemical detection of axillary lymph node micrometastases in node negative breast cancer patients using cytokeratin and epithelial membrane antigen  

PubMed Central

Background and Objective: The study was conducted to detect occult metastases in lymph node negative breast cancer patients using cytokeratin (CK) and epithelial membrane antigen (EMA) immunohistochemistry (IHC) and correlate this with primary tumor size and grade. Materials and Methods: A total of 32 cases including 12 prospective and 20 retrospective cases of axillary lymph node negative breast cancer were studied. CK and EMA IHC were performed to detect micrometastases. Results: Axillary lymph node metastases were detected in 18.75% of previously node negative cases using CK and EMA IHC. CK was found to be more sensitive for detection of metastases compared to EMA. A highly significant correlation was observed between tumor grade and axillary lymph node metastases detected by CK and EMA. However, no significant correlation was found between tumor size and axillary lymph node metastases detected by IHC. Conclusion: In the present study, there was an increase of 18.75% in the occult metastases detection rate using CK and EMA. To conclude, IHC detection of occult metastases should be done using CK in all axillary node negative cases, especially in T1 and T2 stage tumors.

Choudhury, Monisha; Agrawal, Sapna; Pujani, Mukta; Thomas, Shaji; Pujani, Meenu

2015-01-01

9

Prediction of the axillary lymph node status in mammary cancer on the basis of clinicopathological data and flow cytometry.  

PubMed

Axillary lymph node status is a major prognostic factor in mammary carcinoma. It is clinically desirable to predict the axillary lymph node status from data from the mammary cancer specimen. In the study, the axillary lymph node status, routine histological parameters and flow-cytometric data were retrospectively obtained from 1139 specimens of invasive mammary cancer. The ten variables: age, tumour type, tumour grade, tumour size, skin infiltration, lymphangiosis carcinomatosa, pT4 category, percentage of tumour cells in G2/M- and S-phases of the cell cycle, and ploidy index were considered as predictor variables, and the single variable lymph node metastasis pN (0 for pN0, or 1 for pN1 or pN2) was used as an output variable. A stepwise logistic regression analysis, with the axillary lymph node as a dependent variable, was used for feature selection. Only lymphangiosis carcinomatosa and tumour size proved to be significant as independent predictor variables; the other variables were non-contributory. Three paradigms with supervised learning rules (multilayer perceptron, learning vector quantisation and support vector machines) were used for the purpose of prediction. If any of these paradigms was used with the information from all ten input variables, 73% of cases could be correctly predicted, with specificity ranging from 82 to 84% and sensitivity ranging from 60 to 63%. If only the two significant input variables were used, lymphangiosis carcinomatosa and tumour diameter, the prediction accuracy was no worse. Nearly identical results were obtained by two different techniques of cross-validation (leave-one-out against ten-fold cross validation). It was concluded that: artificial neural networks can be used for risk stratification on the basis of routine data in individual cases of mammary cancer; and lymphangiosis carcinomatosa and tumour size are independent predictors of axillary lymph node metastasis in mammary cancer. PMID:15587463

Mattfeldt, T; Kestler, H A; Sinn, H P

2004-11-01

10

Anatomical information for intercostobrachial nerve preservation in axillary lymph node dissection for breast cancer.  

PubMed

This study aimed to provide additional anatomical information for axillary lymph node dissection (ALND) through in vivo anatomy studies of intercostobrachial nerve (ICBN) preservation in order to provide theoretical and practical experience for clinicians. A total of 156 patients with breast cancer underwent ALND at the Department of Gynecology of Baotou Tumor Hospital between June 2009 and March 2010. The origin, destination, main source, length, branch type, and direction of ICBN in axilla were observed, as well as its relationship with adjacent major blood vessels and nerves within the axilla. There were 120 cases of single trunk, 23 cases of double trunks, 9 cases of multiple trunks, and 4 cases without trunks in 156 patients with ICBN preservation. The transverse diameter at the origin of the ICBN was 1.89 ± 0.44 mm with a length of 94.45 ± 12.08 mm; the distances were 77.19 ± 21.04 mm, 29.34 ± 6.73 mm, 90.04 ± 13.13 mm, and 28.63 ± 13.01 mm from origin to the inferior margin at the midpoint of the clavicle, inferior margin of the axillary vein, the bottom of axilla, and branch point, respectively. The identification, dissection, and preservation of ICBN was simple and easy in a modified radical mastectomy for breast cancer and breast-conserving surgery, which only took 10-20 min, but effectively reduced the incidence of post-mastectomy pain syndrome and significantly improved the quality of life for patients after surgery. PMID:24615083

Zhu, J J; Liu, X F; Zhang, P L; Yang, J Z; Wang, J; Qin, Y; Zhang, G L; Ren, D Q; Cui, C L; Guo, X G

2014-01-01

11

Spontaneous regression of breast cancer with axillary lymph node metastasis: a case report and review of literature  

PubMed Central

Spontaneous regression (SR) of cancer is a rare but well-documented biological phenomenon. However, the mechanism remains to be elucidated. We herein report a case of the SR of breast cancer at both the primary site and metastatic axillary lymph node with spontaneously-induced T cell-mediated immunological responses. A 52-year-old female with a lump in the left axilla was diagnosed to have a small breast carcinoma with a distinct axillary lymph node metastasis. During the preoperative systemic examination, she was diagnosed to have severe type 2 diabetes mellitus, was treated with insulin, and the hyperglycemia was normalized after one month. Surgery for left breast cancer was then performed. The postoperative histopathological examination revealed the SR of breast cancer at both the primary site and metastatic axillary lymph node. Immunohistochemical studies revealed that estrogen receptor positive, AE1/AE3-positive ductal carcinoma completely underwent necrosis associated with extensive infiltration of CD3-positive T cells in the tumor nodule in the lymph node. In addition, primary ductal carcinoma cells also underwent single cell necrosis with infiltration of T cells with lymph follicle-like organization of B cells in the mammary gland. The features were suggestive that the tumor eradication in the metastatic lymph node and regression of the primary ductal carcinoma could be due to host T cell response to the ductal carcinoma. As far as we know it is the first report that shows the spontaneous regression of breast cancer, probably due to the spontaneously-induced T cell response. PMID:25120822

Tokunaga, Eriko; Okano, Shinji; Nakashima, Yuichiro; Yamashita, Nami; Tanaka, Kimihiro; Akiyoshi, Sauri; Taketani, Kenji; Shirouzu, Mitsunori; Yamamoto, Hidetaka; Morita, Masaru; Maehara, Yoshihiko

2014-01-01

12

Morbidity after conventional dissection of axillary lymph nodes in breast cancer patients  

PubMed Central

Background Conventional axillary lymph node dissection (ALND) has recently become less radical. The treatment morbidity effects of reduced ALND aggressiveness are unknown. This article investigates the prevalence of the main complications of ALND: lymphedema, range-of-motion restriction, and arm paresthesia and pain. Methods This cross-sectional study included 200 women with invasive breast cancer who underwent breast-conserving surgery (82.5%, n?=?165) or mastectomy (17.5%, n?=?35) with ALND from 2007 to 2011. Arm perimetry was used to assess lymphedema, defined as a difference >2 cm in the upper arm circumference between the nonsurgical and surgical arms. Range-of-motion restriction was assessed by evaluating the degree of arm abduction. Paresthesia was measured in the inner and proximal arm regions. Arm pain was assessed by directly questioning the patients and defined as either present or absent. Results The average (±SD) time between ALND and morbidity evaluation was 35?±?18 months (range, 7-60 months). The average dissected lymph node number per patient was 14?±?4 (range, 6-30 lymph nodes). Only 3.5% (n?=?7) of the patients presented with lymphedema. Single-incision approaches to breast tumor and ALND (P?=?0.04) and the presence of a postoperative seroma (P?=?0.02) were associated with lymphedema in univariate analysis. Paresthesia was the most frequent side effect observed (53% of patients, n?=?106). This complication was associated with increased age (P?lymph node number (P?=?0.01) in univariate and multivariate analysis. Additionally, 24% (n?=?48) of patients had noticeable limited arm abduction. Among the patients, 27.5% (n?=?55) experienced sporadic arm pain corresponding to the surgically treated armpit. In multivariate analysis, the pain risk was 1.9-fold higher in patients who underwent ALND corresponding to their dominant arm (95% CI, 1.0-3.7, P?=?0.04). Conclusion Conventional ALND in breast cancer patients can result in unwanted complications. However, the current lymphedema prevalence is lower than that of the other analyzed side effects. PMID:24670000

2014-01-01

13

Cytologically Proven Axillary Lymph Node Metastases Are Eradicated in Patients Receiving Preoperative Chemotherapy With Concurrent Trastuzumab for HER2-Positive Breast Cancer  

PubMed Central

BACKGROUND The axillary pathologic complete response rate (pCR) and the effect of axillary pCR on disease-free survival (DFS) was determined in patients with HER2-positive breast cancer and biopsy-proven axillary lymph node metastases who were receiving concurrent trastuzumab and neoadjuvant chemotherapy. The use of neoadjuvant chemotherapy is reported to result in pCR in the breast and axilla in up to 25% of patients. Patients achieving a pCR have improved DFS and overall survival. To the authors’ knowledge, the rate of eradication of biopsy-proven axillary lymph node metastases with trastuzumab-containing neoadjuvant chemotherapy regimens has not been previously reported. METHODS Records were reviewed of 109 consecutive patients with HER2-positive breast cancer and axillary metastases confirmed by ultrasound-guided fine-needle aspiration biopsy who received trastuzumab-containing neoadjuvant chemotherapy followed by breast surgery with complete axillary lymph node dissection. Survival was evaluated by the Kaplan-Meier method. Clinicopathologic factors and DFS were compared between patients with and without axillary pCR. RESULTS Eighty-one patients (74%) achieved a pCR in the axilla. Axillary pCR was not associated with age, estrogen receptor status, grade, tumor size, initial N classification, or median number of lymph nodes removed. More patients with an axillary pCR also achieved a pCR in the breast (78% vs 25%; P < .001). At a median follow-up of 29.1 months, DFS was significantly greater in the axillary pCR group (P = .02). CONCLUSIONS Trastuzumab-containing neoadjuvant chemotherapy appears to be effective in eradicating axillary lymph node metastases in the majority of patients treated. Patients who achieve an axillary pCR are reported to have improved DFS. The success of pCR with concurrent trastuzumab and chemotherapy in eradicating lymph node metastases has impli cations for surgical management of the axilla in these patients. PMID:20564395

Dominici, Laura S.; Gonzalez, Viviana M. Negron; Buzdar, Aman U.; Lucci, Anthony; Mittendorf, Elizabeth A.; Le-Petross, Huong T.; Babiera, Gildy V.; Meric-Bernstam, Funda; Hunt, Kelly K.; Kuerer, Henry M.

2015-01-01

14

A study of the assessment of axillary lymph nodes before surgery for breast cancer using multidetector-row computed tomography  

Microsoft Academic Search

Purpose  Sentinel lymph node biopsy (SLNB) is widely used in the detection of breast cancer metastasis, and a retrospective study was\\u000a conducted to determine whether the preoperative assessment of axillary lymph node metastasis using multidetector-row computed\\u000a tomography (MDCT) images would contribute to the selection of patients who require SLNB.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Seventy of the 164 patients who underwent surgery of the breast during

Yuya Nasu; Hiroyuki Shikishima; Yuji Miyasaka; Yoshihiro Nakakubo; Kazuomi Ichinokawa; Toshifumi Kaneko

2010-01-01

15

Optical characterization of ex-vivo axillary lymph nodes of breast-cancer patients using a custom-built spectrophotometer  

NASA Astrophysics Data System (ADS)

Quantitative photoacoustics is emerging as a new hybrid modality to investigate diseases and cells in human pathology and cytology studies. Optical absorption of light is the predominant mechanism behind the photoacoustic effect. Therefore, a need exits to characterize the optical properties of specimens and to identify the relevant operating wavelengths for photoacoustic imaging. We have developed a custom low-cost spectrophotometer to measure the optical properties of human axillary lymph nodes dissected for breast-cancer staging. Optical extinction curves of positive and negative nodes were determined in the spectral range of 400 to 1000 nm. We have developed a model to estimate tissue optical properties, taking into account the role of fat and saline. Our results enabled us to select the optimal optical wavelengths for maximizing the imaging contrast between metastatic and noncancerous tissue in axillary lymph nodes.

Sampathkumar, Ashwin; Saegusa-Beecroft, Emi; Mamou, Jonathan; Chitnis, Parag V.; Machi, Junji; Feleppa, Ernest J.

2014-03-01

16

Intraoperative gamma imaging of axillary sentinel lymph nodes in breast cancer patients.  

PubMed

Sentinel lymph node (SLN) biopsy is now standard practice in the management of many breast cancer patients. Localization protocols vary in complexity and rates of success. The least complex involve only intraoperative gamma counting of radiotracer uptake or intraoperative visualization of blue-dye uptake; the most complex involve preoperative gamma imaging, intraoperative counting and intraoperative dye visualization. Intraoperative gamma imaging may improve some protocols. This study was conducted to obtain preliminary experience and information regarding intraoperative imaging. Sixteen patients were enrolled: 8 in a protocol that included intraoperative counting and dye visualization (probe/dye), 8 in a protocol that involved intraoperative imaging, counting and dye visualization (camera/probe/dye). Preoperative imaging of all 16 patients was performed using a GE 500 gamma camera with a LEAP collimator (300 cpm/muCi). The results of this imaging were not, however, given to the surgeon until the surgeon had completed the procedures required for the study. A Care Wise C-Trak probe was used for intraoperative counting. A Gamma Medica Inc. GammaCAM/OR (12.5 x 12.5 cm FOV) with a LEHR collimator (135 cpm/muCi) was used for intraoperative imaging. Times from start of surgery to external detection of a radioactive focus and to completion of excision of SLNs were recorded. Foci were detected preoperatively via imaging in 16/16 patients. Intraoperative external detection using the probe was accomplished in less than 4 min (mean = 1.5 min) in 15/16 patients, and via intraoperative imaging in 6/8 patients. The average time for completion of excision of nodes was 19 min for probe/dye and 28 min for camera/probe/dye. In one probe/dye case, review of the preoperative images prompted the surgeon to resume axillary dissection and remove one additional SLN. PMID:17646000

Aarsvod, John N; Greene, Carmen M; Mintzer, Robert A; Grant, Sandra F; Styblo, Toncred M; Alazraki, Naomi P; Patt, Bradley E; Caravaglia, Gina M; Li, Joshua; Iwanczyk, Jan S

2006-01-01

17

Axillary Lymph Node Status, But Not Tumor Size, Predicts Locoregional Recurrence and Overall Survival After Mastectomy for Breast Cancer  

PubMed Central

Objective To assess the significance of axillary lymph node status and tumor size for predicting locoregional recurrence (LRR) and overall survival after mastectomy for breast cancer and to discuss the utility of postmastectomy radiation therapy. Summary Background Data Patients with locally advanced breast cancer require multimodality treatment combining chemotherapy (and/or hormonal therapy), surgery, and radiation. Randomized trials have demonstrated that postmastectomy radiation reduces LRR, but no overall survival benefit has been established. Methods Criteria for accrual to the Alabama Breast Cancer Project (1975–1978) were female gender and T2–3 breast cancer with M0 status. Patients underwent a radical or a modified radical mastectomy. Node-positive patients received adjuvant cyclophosphamide, methotrexate, and fluorouracil chemotherapy or adjuvant melphalan. Patients were evaluated for LRR and overall survival based on the number of positive axillary lymph nodes and (in N0 patients) pathologic tumor size. Significance was determined using chi-square analysis. Survival curves were generated using the Kaplan-Meier method and were compared by log-rank analysis. Results After median follow-up of 15 years, neither type of surgery nor chemotherapy was shown to affect locoregional disease-free or overall survival. LRR rates were higher and overall survival rates were lower in patients with nodal involvement, while tumor size was not shown to significantly affect these rates. Conclusions Patients with axillary lymph node metastases may benefit from postmastectomy radiation, but the use of postmastectomy radiation in N0 patients is not supported when it is based on tumor size alone. PMID:12724640

Beenken, Samuel W.; Urist, Marshall M.; Zhang, Yuting; Desmond, Renee; Krontiras, Helen; Medina, Heriberto; Bland, Kirby I.

2003-01-01

18

Technetium99m--Sestamibi Prone Scintimammographyto Detect PrimaryBreast Cancer and Axillary Lymph Node Involvement  

Microsoft Academic Search

Thepurposeof this studywasto evaluate prOSpeCth\\/e@y the sensitivityand specificityof scintimammography in the detec tion of both pilmary breast cancer and axillary lymph node involvement.Methods: Sixty-fiveconsecutivewomen referred for a suspiciousbreastlesionon clinicalexaminationand\\/orwith abnormal mammographiessugges@ve of malignancieswere studied with scintimammographyusing planar prone imaging (witha chestpositioningdevicewith semicircularlateralaperture on the imagingtable)performed15 mmpostinjectionof 25-30 mCi °@1c-sestamibi. Threeplanar @ews, right and left lateral proneand anteriorsupinethoracicviews,wereobtained(8-10 minMew).The entire breastand

Raymond Taitlefer; Raymond Lambert; Sophie Turpin

1995-01-01

19

Quantitative Molecular Analysis of Sentinel Lymph Node May Be Predictive of Axillary Node Status in Breast Cancer Classified by Molecular Subtypes  

PubMed Central

To determine the performance of intraoperative one-step nucleic acid amplification (OSNA) assay in detecting sentinel lymph node metastases compared to postoperative histology taking into account breast cancer molecular classification and to evaluate whether the level of cytokeratin 19 mRNA copy number may be useful in predicting the likelihood of a positive axillary lymph node dissection. OSNA assay was performed in a prospective series of 903 consecutive sentinel lymph nodes from 709 breast cancer patients using 2 alternate slices of each sentinel lymph node. The remaining 2 slices were investigated by histology. Cytokeratin 19 mRNA copy number, which distinguishes negative cases (<250 copies), micrometastases (+, ?250?5000 copies) and macrometastases (++, >5000 copies), was compared to axillary lymph node dissection status and to the biological tumor profile. Concordance between OSNA and histopathology was 95%, specificity 95% and sensitivity 93%. Multiple Corresponce Analysis and logistic regression evidenced that positive axillary lymph node dissection was significantly associated with a higher cytokeratin 19 mRNA copy number (>5000; p<0.0001), HER2 subtype (p?=?0.007) and lymphovascular invasion (p<0.0001). Conversely, breast cancer patients with cytokeratin 19 mRNA copy number <2000 mostly presented a luminal subtype and a negative axillary lymph node dissection. We confirmed that OSNA assay can provide standardized and reproducible results and that it represents a fast and quantitative tool for intraoperative evaluation of sentinel lymph node. Omission of axillary lymph node dissection could be proposed in patients presenting a sentinel lymph node with a cytokeratin 19 mRNA copy number <2000 and a Luminal tumor phenotype. PMID:23533593

Buglioni, Simonetta; Di Filippo, Franco; Terrenato, Irene; Casini, Beatrice; Gallo, Enzo; Marandino, Ferdinando; Maini, Carlo L.; Pasqualoni, Rossella; Botti, Claudio; Di Filippo, Simona; Pescarmona, Edoardo; Mottolese, Marcella

2013-01-01

20

Intraoperative gamma imaging of axillary sentinel lymph nodes in breast cancer patients  

Microsoft Academic Search

Sentinel lymph node (SLN) biopsy is now standard practice in the management of many breast cancer patients. Localization protocols vary in complexity and rates of success. The least complex involve only intraoperative gamma counting of radiotracer uptake or intraoperative visualization of blue-dye uptake; the most complex involve preoperative gamma imaging, intraoperative counting and intraoperative dye visualization. Intraoperative gamma imaging may

John N. Aarsvod; Carmen M. Greene; Robert A. Mintzer; Sandra F. Grant; Toncred M. Styblo; Naomi P. Alazraki; Bradley E. Patt; Gina M. Caravaglia; Joshua Li; Jan S. Iwanczyk

2006-01-01

21

Can internal mammary chain treatment decrease the risk of death for patients with medial breast cancers and positive axillary lymph nodes  

Microsoft Academic Search

The effect of internal mammary chain treatment on each type of malignant death-related event was analyzed in 1195 patients with operable breast cancer and histologically involved axillary lymph nodes. A group of 135 patients who had no internal mammary chain treatment was compared with a control group of 1060 patients who were treated by surgery and\\/or postoperative radiation therapy. In

M. G. Le; Rodrigo Arriagada; Florent De Vathaire; John Dewar; Françoise Fontaine; Jean Lacour; Geneviève Contesso; Maurice Tubiana

1990-01-01

22

Gray scale and power Doppler US in the preoperative evaluation of axillary metastases in breast cancer patients with no palpable lymph nodes  

Microsoft Academic Search

The purpose of this study is to evaluate the accuracy of gray scale and Doppler US findings in the detection of axillary metastases in breast cancer patients with no palpable lymph nodes. One-hundred and ninety-eight lymph nodes detected in 83 women were evaluated. The size and longitudinal\\/transverse axis ratios of each node were documented. Absence of echogenic hilum, asymmetrical cortical

Gul Esen; Bengi Gurses; Mehmet Halit Yilmaz; Sennur Ilvan; S?la Ulus; Varol Celik; Mehmet Farahmand; Ozden Oz Calay

2005-01-01

23

A histomorphologic predictive model for axillary lymph node metastasis in preoperative breast cancer core needle biopsy according to intrinsic subtypes.  

PubMed

The aim of this study is construction of a pathologic nomogram that can predict axillary lymph node metastasis (LNM) for each intrinsic subtype of breast cancer with regard to histologic characteristics in breast core needle biopsy (CNB) for use in routine practice. A total of 534 CNBs with invasive ductal carcinoma classified into 5 intrinsic subtypes were enrolled. Eighteen clinicopathological characteristics and 8 molecular markers used in CNB were evaluated for construction of the best predictive model of LNM. In addition to conventional parameters including tumor multiplicity (P < .001), tumor size (P < .001), high histologic grade (P = .035), and lymphatic invasion (P = .017), micropapillary structure (P < .001), the presence of small cell-like crush artifact (P = .001), and overexpression of HER2 (P = .090) and p53 (P = .087) were proven to be independent predictive factors for LNM. A combination of 8 statistically independent parameters yielded the strongest predictive performance with an area under the curve of 0.760 for LNM. A combination of 6 independent variables, including tumor number, tumor size, histologic grade, lymphatic invasion, micropapillary structure, and small cell-like crush artifact produced the best predictive performance for LNM in luminal A intrinsic subtype (area under the curve, 0.791). Thus, adding these combinations of clinical and morphologic parameters in preoperative CNB is expected to enhance the accuracy of prediction of LNM in breast cancer, which might serve as another valuable tool in determining optimal surgical strategies for breast cancer patients. PMID:25496835

Yoo, Su Hyun; Park, In Ae; Chung, Yul Ri; Kim, Hyojin; Lee, Keehwan; Noh, Dong-Young; Im, Seock-Ah; Han, Wonshik; Moon, Hyeong-Gon; Lee, Kyung-Hun; Ryu, Han Suk

2015-02-01

24

The prognostic relevance of the mitotic activity index in axillary lymph node-negative breast cancer.  

PubMed

The aim of the present study is to look at the mitotic activity index (MAI) as a prognostic factor in a prospective population-based cohort of lymph node-negative invasive breast cancer patients. Analyses were based on 2,048 breast-conserving therapies in 1,971 patients, node-negative, and without any form of adjuvant systemic therapy with long-term follow-up. The 15-year distant metastases-free survival (DMFS) for women ?55 years was 88.3 % for low MAI values (?12) versus 73.4 % for high MAI values (>12); (HR 2.8; 95 % CI 1.8-4.4; p < 0.001). Multivariate analyses for DMFS showed significance for MAI. For MAI and Bloom-Richardson grading, by performing a likelihood ratio test, we showed the statistical significance for both. For women >55-years, the MAI was not an independent significant factor. We also confirmed the above findings for disease-specific survival. When multi-gene assays are not available, the MAI remains a robust prognostic marker in women younger than 55 years of age with early node-negative breast cancer. PMID:25526926

Jobsen, Jan J; van der Palen, Job; Brinkhuis, Mariël; Nortier, Johan W R; Struikmans, Henk

2015-01-01

25

HER2 Expression in Fine Needle Aspirates of Lymph Nodes Detected by Preoperative Axillary Ultrasound in Breast Cancer Patients  

PubMed Central

The purpose of this study was to assess the usefulness of HER2 levels in ultrasonographically guided fine-needle aspiration biopsy (US-FNA) aspirates of axillary lymph nodes (ALNs) in the determination of lymph node metastasis or the characterization of primary breast cancer, and to correlate the HER2 levels in US-FNA aspirates (FNA-HER2s) of metastatic ALNs with the HER2 statuses of corresponding primary breast cancers. An institutional review board approved the study. Between January and October 2010, 164 patients with 167 ALNs examined by US-FNA were included. FNA-HER2s of ALNs were measured by chemiluminescence immunoassay, and they were correlated with cytologic/final diagnoses. Receiver operating characteristics (ROC) curve analysis was performed to evaluate the diagnostic ability to differentiate benign and metastatic ALNs. Additionally, FNA-HER2s of metastatic ALNs were correlated with HER2 status and other clinicopathologic variables of the primary breast cancers. Among the 167 ALNs, 138 were metastatic and 29 were benign. The mean FNA-HER2 (6.3 ng/ml) of metastatic ALNs was higher than that of benign ALNs. All 29 benign ALNs showed no measurable value of FNA-HER2 (0.0 ng/ml). The area under the ROC curves of FNA-HER2 of ALNs was 0.679 for the diagnosis of ALN metastasis. The FNA-HER2 statuses of 108 metastatic ALNs (79.4%) were concordant with the HER2 statuses of the corresponding primary breast cancers. In a subgroup analysis of HER2-positive cancers with ALN metastasis, distant metastasis was significantly associated with FNA-HER2-negativity of metastatic ALNs (P?=?0.04). Although FNA-HER2 of ALNs did not improve the diagnostic performance of FNA cytology in preoperative diagnosis of ALN metastasis of overall patients, FNA-HER2-positive metastatic ALNs were significantly associated with HER2-positivity of primary breast cancers. Additionally, FNA-HER2 analysis of ALN may help to develop more personalized treatment protocol for breast cancer patients by determining the concordance or discordance of HER2 status between primary cancers and metastatic ALNs. PMID:25393693

Choi, Ji Soo; Kim, Hyun Ok; Kim, Eun-Kyung; Suh, Young Joo; Yoon, Jung Hyun; Moon, Hee Jung; Kim, Min Jung

2014-01-01

26

Quality of Life After Sentinel Lymph Node Biopsy or Axillary Lymph Node Dissection in Stage I/II Breast Cancer Patients: A Prospective Longitudinal Study  

PubMed Central

Background Breast cancer patients’ quality of life (QoL) after surgery has been reported to improve significantly over time. Little is known about QoL recovery after sentinel lymph node biopsy (SLNB) in comparison to axillary lymph node dissection (ALND). Methods 175 of 195 stage I/II breast cancer patients completed the EORTC QLQ-C30: one day before surgery (T0) and after 6 (T1), 26 (T2), 52 (T3) and 104 (T4) weeks. Of these, 54 patients underwent SLNB, 56 SLNB+ALND and 65 ALND. General linear models and paired T-tests between T0–T4 and T1–T4 were computed. Complications, radiotherapy and systemic therapy were added to the model. Results Significant time effects were found on physical, role and emotional functioning. Physical and role functioning decreased between T0 and T1. At T4, SLNB patients’ functioning had increased to their T0 level; ALND (+/– SLNB) patients’ functioning had increased, but had not improved to T0 level. Emotional functioning increased linearly between T0 and T4. At T4, emotional functioning was significantly higher in all groups as compared with T0. No significant group or interaction (time × group) effects were found. Complications and chemotherapy had a significant negative effect on role, emotional and cognitive functioning. Complications had a significant effect on social functioning also. Effect sizes varied between 0.00 and 0.06. Conclusion Two years post surgery, breast cancer patients’ QoL is comparable to that shortly before surgery. Women rated their emotional functioning as even better. SLNB is not associated with a better QoL than ALND. However, undergoing systemic therapy and/or experiencing complications affects QoL negatively. PMID:18597146

Kootstra, Jan; Hoekstra-Weebers, Josette E. H. M.; Rietman, Hans; de Vries, Jaap; Baas, Peter; Geertzen, Jan H. B.

2008-01-01

27

Detection of sentinel lymph node in breast cancer recurrence may change adjuvant treatment decision in patients with breast cancer recurrence and previous axillary surgery.  

PubMed

Use of sentinel lymph node dissection in patients with ipsilateral breast cancer recurrence is still controversial. The objective of this study is to evaluate the feasibility of the sentinel lymph node in breast cancer recurrence (SLNBR) and whether the positivity had impact in the adjuvant treatment. Between 2008 and 2012 we performed SLNBR in patients with ipsilateral breast tumor recurrence. We included 53 patients in a prospective study. Forty-three patients (81%) had a previous axillary lymph node dissection (ALND) and ten (19%) had a previous sentinel lymph node biopsy (SLNB). Identification rate after SLNB was 50% and after ALND was 60.5% (p = 0.4). Nine patients (26%) had a positive SLNBR. Adjuvant systemic treatment was given to all the patients with a positive SLNBR and to 23 (85%) with a negative SLNBR (p = 0.29). Six patients (66%) with positive SLNBR and 4 patients (14%) with negative SLNBR underwent radiation therapy (p < 0.01). As conclusions of our study we conclude that sentinel lymph node biopsy in breast tumor recurrence is feasible and significant differences were found in the use of radiation therapy in patients with a positive SLNBR. PMID:24726837

Cordoba, Octavi; Perez-Ceresuela, Francesc; Espinosa-Bravo, Martin; Cortadellas, Tomas; Esgueva, Antonio; Rodriguez-Revuelto, Robert; Peg, Vicente; Reyes, Victoria; Xercavins, Jordi; Rubio, Isabel T

2014-08-01

28

Postoperative radiation for women with cancer of the breast and positive axillary lymph nodes  

SciTech Connect

The author states his belief that further studies of routine radiation therapy of women with Stage II breast cancer are not waranted and further use of this treatment is not justified. He has not been able to find any systematic discussion within the medical community about what criteria will be used to reach some conclusion about the efficacy of radiation therapy in the large group of women with Stage II disease. (DAD)

Lipsett, M.B.

1981-01-08

29

Survival Outcomes of Different Treatment Methods for the Ipsilateral Breast of Occult Breast Cancer Patients with Axillary Lymph Node Metastasis: A Single Center Experience  

PubMed Central

Purpose This study compared the survival outcomes of different treatment methods for the ipsilateral breast of occult breast cancer (OBC) patients with axillary lymph node metastasis. Methods A retrospective study was conducted in which forty OBC patients with axillary lymph node metastasis were identified out of 15,029 patients who had been diagnosed with a primary breast cancer at between 1992 and 2010. The patients were categorized into three treatment groups based on ipsilateral breast management: breast-conserving surgery (BCS) (n=17), mastectomy (n=12), and nonsurgical intervention with or without radiation therapy (No surgery with or without radiation therapy [No Op±RT]) (n=11). All patients underwent axillary lymph node dissection. Cases were evaluated based on treatment and potential prognostic factors with respect to overall survival (OS) and disease-free survival (DFS). Results During the follow-up period (median follow-up of 71.5 months), the overall OS and DFS were 76.9% and 74.9%, respectively. The 5-year treatment-specific OS was 72.0% for the BCS group, 74.0% for the mastectomy group, and 87.5% for the No Op±RT group (log-rank p=0.49). The 5-year DFS was 70.6% for the BCS group, 66.7% for the mastectomy group, and 90.9% for the No Op±RT group (log-rank p=0.36). Recurrence rates for the BCS and No Op±RT groups were 5.9% and 18.2%, respectively. Histologic grade and lymph node status were inversely correlated with DFS (log-rank p=0.04 and p<0.01, respectively). Conclusion There was no difference in survival outcomes between the three treatment methods for the ipsilateral breast (mastectomy, BCS, and No Op±RT) of OBC patients with axillary lymph node metastasis. A large-scale multicenter study is needed to validate the results from this small retrospective study. PMID:24454463

Woo, Sang Min; Lee, Jong Won; Kim, Hee Jeong; Yu, Jong Han; Ko, Beom Seok; Sohn, Guiyun; Lee, Yu Ra; Kim, Hanna; Ahn, Sei Hyun; Baek, Seung Hee

2013-01-01

30

Breast Cancer Patients With 10 or More Involved Axillary Lymph Nodes Treated by Multimodality Therapy: Influence of Clinical Presentation on Outcome  

SciTech Connect

Purpose: To analyze tumor control and survival for breast cancer patients with 10 or more positive lymph nodes without systemic disease, treated by adjuvant radiation alone or combined-modality therapy. Methods and Materials: We reviewed the records of 309 consecutive patients with these characteristics who received locoregional radiotherapy (RT) at our institution. The majority of patients had clinical Stage II or IIIA-B disease (43% and 48%, respectively). The median number of positive axillary lymph nodes was 15 (range, 10-78). Adjuvant therapy consisted of RT alone, with or without chemotherapy, tamoxifen, and/or ovarian castration. Results: The overall 5-year and 10-year disease-free survival (DFS) rates were 20% and 7%, respectively. Median DFS was higher for patients with Stage I-II compared with those with Stage IIIABC (28 vs. 19 months; p = 0.006). Median DFS for patients aged {<=}35 years was lower than that of older patients (12 vs. 24 months; p < 0.0001). Patients treated with a combination therapy had a higher 5-year DFS rate compared with those treated by RT alone (26% vs. 11%; p 0.03). In multivariate analysis, clinical stage (III vs. I, II; relative risk = 1.8, p = 0.002) and age ({<=}35 vs. others; relative risk = 2.6, p <0.001) were found to be independent variables for DFS. Conclusion: This retrospective data analysis identified young age and advanced clinical stage as pertinent and independent clinical prognostic factors for breast cancer patients with advanced axillary disease (10 or more involved nodes). These factors can be used for further prognostic classification.

Geara, Fady B. [Department of Radiation Oncology, American University of Beirut Medical Center, Beirut (Lebanon)]. E-mail: fg00@aub.edu.lb; Nasr, Elie [Department of Radiation Oncology, American University of Beirut Medical Center, Beirut (Lebanon); Tucker, Susan L. [Department of Biomathematics, University of Texas, M. D. Anderson Cancer Center, Houston, TX (United States); Charafeddine, Maya [Department of Epidemiology and Biostatistics, American University of Beirut Medical Center, Beirut (Lebanon); Dabaja, Bouthaina [Department of Radiation Oncology, American University of Beirut Medical Center, Beirut (Lebanon); Eid, Toufic [Department of Radiation Oncology, American University of Beirut Medical Center, Beirut (Lebanon); Abbas, Jaber [Department of General Surgery, American University of Beirut Medical Center, Beirut (Lebanon); Salem, Ziad [Department of Medical Oncology, American University of Beirut Medical Center, Beirut (Lebanon); Shamseddine, Ali [Department of Medical Oncology, American University of Beirut Medical Center, Beirut (Lebanon); Issa, Philip [Department of Radiation Oncology, American University of Beirut Medical Center, Beirut (Lebanon); El Saghir, Nagi [Department of Medical Oncology, American University of Beirut Medical Center, Beirut (Lebanon)

2007-06-01

31

Intradermal administration of fluorescent contrast agents for delivery to axillary lymph nodes  

NASA Astrophysics Data System (ADS)

In this proof-of-concept study we seek to demonstrate the delivery of fluorescent contrast agent to the tumor-draining lymph node basin following intraparenchymal breast injections and intradermal arm injection of micrograms of indocyanine green in 20 breast cancer patients undergoing complete axillary lymph node dissection. Individual lymph nodes were assessed ex vivo for presence of fluorescent signal. In all, 88% of tumor-negative lymph nodes and 81% of tumor-positive lymph nodes were fluorescent. These results indicate that future studies utilizing targeted fluorescent contrast agents may demonstrate improved surgical and therapeutic intervention.

Rasmussen, John C.; Meric-Berstam, Funda; Krishnamurthy, Savitri; Tan, I.-Chih; Zhu, Banghe; Wagner, Jamie L.; Babiera, Gildy V.; Mittendorf, Elizabeth A.; Sevick-Muraca, Eva M.

2014-05-01

32

Detection of breast cancer micrometastases in axillary lymph nodes by means of reverse transcriptase-polymerase chain reaction. Comparison between MUC1 mRNA and keratin 19 mRNA amplification.  

PubMed Central

Usefulness of MUC1 mRNA and keratin 19 mRNA as a target of reverse-transcriptase polymerase chain reaction (RT-PCR) was compared in the detection of breast cancer micrometastases in axillary lymph nodes. RT-PCR amplification of MUC1 mRNA and keratin 19 mRNA was conducted using total RNA samples. RT-PCR products were stained with ethidium bromide and analyzed by agarose gel electrophoresis. Expression of both MUC1 mRNA and keratin 19 mRNA was detected by RT-PCR in a breast cancer cell line (MRK) and in all the 23 primary breast cancers but not in the control lymph nodes obtained from patients with benign diseases. A serial dilution study of MRK cells against normal lymph node cells has shown that detection sensitivity of MUC1 RT-PCR and keratin 19 RT-PCR were 1/10(5) and 1/10(6) (cancer/lymph node cells), respectively. Sixty-three axillary lymph nodes were obtained from 23 patients with primary breast cancer, and metastases in each lymph node were investigated by histological examination (hematoxylin and eosin sections) and RT-PCR method. In all 10 lymph nodes, which were histologically metastasis-positive, both MUC1 mRNA and keratin mRNA were detected by RT-PCR. Of the 53 histologically negative lymph nodes, 3 (6%) and 5 (9%) lymph nodes were found to express MUC1 mRNA and keratin 19 mRNA, respectively, indicating the presence of micrometastases which could be detected by RT-PCR but not by histological examination. These results demonstrate the usefulness of both MUC1 RT-PCR and keratin 19 RT-PCR in the detection of breast cancer micrometastases in lymph nodes, and also indicate the superiority of keratin 19 RT-PCR over MUC1 RT-PCR because of its higher detection sensitivity. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 PMID:8579127

Noguchi, S.; Aihara, T.; Motomura, K.; Inaji, H.; Imaoka, S.; Koyama, H.

1996-01-01

33

Axillary staging of breast cancer and the sentinel node  

PubMed Central

Pathological aspects of axillary nodal staging of breast cancer and in particular sentinel lymph node (SLN) biopsy are reviewed. SLN biopsy seems an almost ideal staging procedure because it has both high accuracy and a low false negative rate. It may also allow a cost effective use of more sensitive methods of metastasis detection. However, the biological relevance of metastases detected only by modern tools remains to be elucidated. This review focuses on standard axillary staging and the histopathological investigation of SLNs, with emphasis on the intraoperative setting. Future trends including ancillary studies, quality control issues, prediction of non-SLN involvement, and suggestions concerning the minimum requirements for the histology of axillary SLNs are also discussed. Key Words: axillary staging • breast cancer • sentinel lymph node PMID:11064665

Cserni, G

2000-01-01

34

Frequency distribution of plasma cells in the medullary cords of tumour-draining axillary and paracolic lymph nodes  

Microsoft Academic Search

Five hundred and ninety-seven axillary lymph nodes draining 104 invasive ductal breast cancers, and 94 paracolic lymph nodes draining 30 invasive adenocarcinomas of the large bowel were investigated immunohistologically to determine the frequency distribution of plasma cells (PC) in the medullary cords (MC). The degree of plasmacytic infiltration was calculated semiquantitatively using the 3-grade scale (0\\/+, ++, +++) of Cottier

Heinz-August Horst; Hans-Peter Horny

1987-01-01

35

Pitt study finds breast cancer patients with positive ultrasound guided axillary node biopsy need dissection  

Cancer.gov

Contrary to a trend in treatment, breast cancer patients with suspicious lymph nodes should have an ultrasound-guided axillary node biopsy, and if that biopsy is positive these patients should undergo an axillary dissection, a new study shows. The study, conducted at the University of Pittsburgh Medical Center, compared 199 patients with a positive ultrasound-guided axillary node biopsy to 434 patients with a positive sentinel lymph node biopsy.

36

Cost comparison of axillary sentinel lymph node detection and axillary lymphadenectomy in early breast cancer. A national study based on a prospective multi-institutional series of 985 patients ‘on behalf of the Group of Surgeons from the French Unicancer Federation’  

PubMed Central

Background: Our objective was to assess the global cost of the sentinel lymph node detection [axillary sentinel lymph node detection (ASLND)] compared with standard axillary lymphadenectomy [axillary lymph node dissection (ALND)] for early breast cancer patients. Patients and methods: We conducted a prospective, multi-institutional, observational, cost comparative analysis. Cost calculations were realized with the micro-costing method from the diagnosis until 1 month after the last surgery. Results: Eight hundred and thirty nine patients were included in the ASLND group and 146 in the ALND group. The cost generated for a patient with an ASLND, with one preoperative scintigraphy, a combined method for sentinel node detection, an intraoperative pathological analysis without lymphadenectomy, was lower than the cost generated for a patient with lymphadenectomy [€2947 (? = 580) versus €3331 (? = 902); P = 0.0001]. Conclusion: ASLND, involving expensive techniques, was finally less expensive than ALND. The length of hospital stay was the cost driver of these procedures. The current observational study points the heterogeneous practices for this validated and largely diffused technique. Several technical choices have an impact on the cost of ASLND, as intraoperative analysis allowing to reduce rehospitalization rate for secondary lymphadenectomy or preoperative scintigraphy, suggesting possible savings on hospital resources. PMID:21896543

Classe, J. M.; Baffert, S.; Sigal-Zafrani, B.; Fall, M.; Rousseau, C.; Alran, S.; Rouanet, P.; Belichard, C.; Mignotte, H.; Ferron, G.; Marchal, F.; Giard, S.; Tunon de Lara, C.; Le Bouedec, G.; Cuisenier, J.; Werner, R.; Raoust, I.; Rodier, J.-F.; Laki, F.; Colombo, P.-E.; Lasry, S.; Faure, C.; Charitansky, H.; Olivier, J.-B.; Chauvet, M.-P.; Bussières, E.; Gimbergues, P.; Flipo, B.; Houvenaeghel, G.; Dravet, F.; Livartowski, A.

2012-01-01

37

Virtual lymph node analysis to evaluate axillary lymph node coverage provided by tangential breast irradiation  

PubMed Central

Purpose To investigate the coverage of axillary lymph node with tangential breast irradiation fields by using virtual lymph node (LN) analysis. Materials and Methods Forty-eight women who were treated with whole breast irradiation after breast-conserving surgery were analyzed. The axillary and breast volumes were delineated according to the Radiation Therapy Oncology Group (RTOG) contouring atlas. To generate virtual LN contours, preoperative fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scans with identifiable LN were fused with the CT scans, and the virtual LN contour were delineated on the CT. Results The median level I and II axillary volume coverage percentages at the VD95% line were 33.5% (range, 5.3% to 90.4%) and 0.6% (range, 0.0% to 14.6%), respectively. Thirty-one LNs in 18 patients were delineated (26 in level I and 5 in level II). In the level I axilla, 84.6% of virtual LNs were encompassed by the 95% isodose line. In the level II axilla, by contrast, none of the virtual LNs were encompassed by the 95% isodose volumes. There was a substantial discrepancy between the RTOG contouring atlas-based axillary volume analysis and the virtual LN analysis, especially for the level I axillary coverage. The axillary volume coverage was associated with the body mass index (BMI) and breast volume. Conclusion The tangential breast irradiation did not deliver adequate therapeutic doses to the axillary region, particularly those in the level II axilla. Patients with small breast volumes or lower BMI showed reduced axillary coverage from the tangential breast fields. For axillary LN irradiation, individualized anatomy-based radiation fields for patients would be necessary.

Park, Shin-Hyung; Lee, Jeong Eun; Park, In-Kyu

2015-01-01

38

Predicting axillary lymph node metastasis from kinetic statistics of DCE-MRI breast images  

NASA Astrophysics Data System (ADS)

The presence of axillary lymph node metastases is the most important prognostic factor in breast cancer and can influence the selection of adjuvant therapy, both chemotherapy and radiotherapy. In this work we present a set of kinetic statistics derived from DCE-MRI for predicting axillary node status. Breast DCE-MRI images from 69 women with known nodal status were analyzed retrospectively under HIPAA and IRB approval. Axillary lymph nodes were positive in 12 patients while 57 patients had no axillary lymph node involvement. Kinetic curves for each pixel were computed and a pixel-wise map of time-to-peak (TTP) was obtained. Pixels were first partitioned according to the similarity of their kinetic behavior, based on TTP values. For every kinetic curve, the following pixel-wise features were computed: peak enhancement (PE), wash-in-slope (WIS), wash-out-slope (WOS). Partition-wise statistics for every feature map were calculated, resulting in a total of 21 kinetic statistic features. ANOVA analysis was done to select features that differ significantly between node positive and node negative women. Using the computed kinetic statistic features a leave-one-out SVM classifier was learned that performs with AUC=0.77 under the ROC curve, outperforming the conventional kinetic measures, including maximum peak enhancement (MPE) and signal enhancement ratio (SER), (AUCs of 0.61 and 0.57 respectively). These findings suggest that our DCE-MRI kinetic statistic features can be used to improve the prediction of axillary node status in breast cancer patients. Such features could ultimately be used as imaging biomarkers to guide personalized treatment choices for women diagnosed with breast cancer.

Ashraf, Ahmed B.; Lin, Lilie; Gavenonis, Sara C.; Mies, Carolyn; Xanthopoulos, Eric; Kontos, Despina

2012-03-01

39

Pathology Case Study: Enlarged Right Axillary Lymph Node  

NSDL National Science Digital Library

This is a case study presented by the University of Pittsburgh Department of Pathology in which a 40-year-old man was found to have an enlarged right axillary lymph node. Visitors are given the patient history, including images, and are given the opportunity to diagnose the patient. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student learning in pathology and clinical immunology.

Fung, Mark

40

Rare case of axillary lymph node metastasis in papillary thyroid carcinoma detected using Iodine-131 whole-body scintigraphy and single-photon emission computed tomography/computed tomography  

PubMed Central

Differentiated thyroid cancer is, usually, associated with an excellent prognosis and indolent course. Distant metastases are rare events at the onset of thyroid cancer. Among these presentations, metastasis to the axillary lymph nodes is even more unusual. Only few cases of papillary carcinoma with axillary nodal metastasis were previously reported in the literature. We present a 38-year-old female who underwent Iodine-131 whole-body scintigraphy, after total thyroidectomy and bilateral neck lymph node dissection for papillary carcinoma of thyroid, showed intense uptake in the remnant thyroid, lung metastasis, left cervical and left axillary lymph nodes. Excision of left axillary lymph nodes confirmed metastatic papillary carcinoma.

Kamaleshwaran, Koramadai Karuppusamy; Rajan, Firoz; Mohanan, Vyshak; Shinto, Ajit Sugunan

2015-01-01

41

A Phase I Study to Assess the Feasibility and Oncologic Safety of Axillary Reverse Mapping in Breast Cancer Patients  

PubMed Central

BACKGROUND Axillary reverse mapping (ARM) is a novel technique to preserve upper extremity lymphatics that may reduce the incidence of lymphedema after axillary lymph node dissection. Early reports have suggested that ARM lymph nodes do not contain metastatic disease from breast cancer; however, these studies were conducted in early stage patients with low likelihood of lymph node metastasis. This study reported a phase 1 trial conducted in patients with cytologically documented axillary metastasis undergoing axillary lymph node dissection to determine the feasibility and oncologic safety of ARM. METHODS Thirty patients, 23 (77%) of whom received preoperative therapy (chemotherapy in 22 patients and hormonal therapy in 1 patient), were enrolled. Blue dye was injected in the upper inner ipsilateral arm. The presence of blue lymphatics was noted, and blue lymph nodes were sent separately for pathologic evaluation. RESULTS The average time between blue dye injection and axillary exposure was 35 minutes (range, 15–60 minutes). Blue lymphatics were identified in 21 patients (70%) and blue lymph nodes in 15 patients (50%). The median number of ARM lymph nodes was 1 (range, 0–3 lymph nodes) and the median number of axillary lymph nodes was 26 (range, 6–47 lymph nodes). Axillary metastases were noted in 60% (18 of 30) of patients. Of 11 patients who had axillary metastasis and at least 1 ARM lymph node identified, 2 (18%) had metastasis to the ARM lymph node. CONCLUSIONS ARM appears to be a feasible technique with which to identify upper arm lymphatics during axillary surgery. However, the high prevalence of disease involving ARM lymph nodes in this small cohort suggested that preservation of these lymphatics is not oncologically safe in women with documented axillary lymph node metastasis from breast cancer. PMID:20336790

Bedrosian, Isabelle; Babiera, Gildy V.; Mittendorf, Elizabeth A.; Kuerer, Henry M.; Pantoja, Laura; Hunt, Kelly K.; Krishnamurthy, Savitri; Meric-Bernstam, Funda

2015-01-01

42

Sentinel Lymph Node Technique for Staging of Breast Cancer  

Microsoft Academic Search

Lymphatic mapping and sentinel lymphadenectomy is becoming an important surgical technique for assessing axillary status in breast cancer. In experienced hands, it can be successfully performed in >90% of cases. The mor- bidity of sentinel lymphadenectomy is minimal, consider- ably less than the 15%-20% rate of complications associated with axillary lymph node dissection. Moreover, excision of the sentinel node provides

EDDY C. HSUEH; ARMANDO E. GIULIANO

43

Sentinel Lymph Node Biopsy in Male Patients with Early Breast Cancer  

Microsoft Academic Search

Mastectomy with axillary dissection is still the most commonly recommended procedure for male breast cancer. The aim of this study was to retrospectively evaluate our experience in 32 male patients with early breast cancer who underwent sentinel lymph node bi- opsy (SLNB) and axillary dissection only in cases of me- tastases in the sentinel lymph node (SLN). The median age

ORESTE GENTILINI; EDUARDO CHAGAS; CONCETTA DE CICCO; GIUSEPPE RENNE; ENRICO CASSANO

44

Toward nodal staging of axillary lymph node basins through intradermal administration of fluorescent imaging agents  

PubMed Central

As part of a proof-of-concept study for future delivery of targeted near-infrared fluorescent (NIRF) tracers, we sought to assess the delivery of micrograms of indocyanine green to all the axillary lymph nodes following intraparenchymal breast injections and intradermal arm injections in 20 subjects with advanced breast carcinoma and undergoing complete axillary lymph node dissection. Lymphatic vessels and nodes were assessed in vivo. Ex vivo images demonstrated that 87% of excised lymph nodes, including 81% of tumor-positive lymph nodes, were fluorescent. Future clinical studies using microdose amounts of tumor-targeting NIRF contrast agents may demonstrate improved surgical intervention with reduced morbidity. PMID:24466486

Meric-Bernstam, Funda; Rasmussen, John C.; Krishnamurthy, Savitri; Tan, I-Chih; Zhu, Banghe; Wagner, Jamie L.; Babiera, Gildy V.; Mittendorf, Elizabeth A.; Sevick-Muraca, Eva M.

2013-01-01

45

Hand Related Disorders Following Axillary Dissection for Breast Cancer  

Microsoft Academic Search

Lymphedema is the most common complication of an axillary dissection with lymph node examination. A retrospective chart review and a detailed questionnaire were used to evaluate the prevalence of hand disorders in patients following breast surgery with an axillary dissection. The questionnaire was sent to 250 patients who had undergone an axillary dissection for breast can- cer. 143 patients returned

DAVID J. BOZENTKA; PEDRO K. BEREDJIKLIAN; PETER S. H. CHAN; STEVEN SCHMIDT; GORDON P. BUZBY; FIONA BORA

2001-01-01

46

Axillary lymph node dose with tangential whole breast radiation in the prone versus supine position: a dosimetric study  

PubMed Central

Background Prone breast positioning reduces skin reaction and heart and lung dose, but may also reduce radiation dose to axillary lymph nodes (ALNs). Methods Women with early stage breast cancer treated with whole breast irradiation (WBI) in the prone position were identified. Patients treated in the supine position were matched for treating physician, laterality, and fractionation. Ipsilateral breast, tumor bed, and Level I, II, and III ALNs were contoured according to the RTOG breast atlas. Clips marking surgically removed sentinel lymph nodes (SLN)s were contoured. Treatment plans developed for each patient were retrospectively analyzed. V90% and V95% was calculated for each axillary level. When present, dose to axillary surgical clips was calculated. Results Treatment plans for 46 women (23 prone and 23 supine) were reviewed. The mean V90% and V95% of ALN Level I was significantly lower for patients treated in the prone position (21% and 14%, respectively) than in the supine position (50% and 37%, respectively) (p?axillary Level I. The mean V95% of SLN clips was 47% for patients treated in the supine position and 0% for patients treated in the prone position (p?axillary coverage is indicated such as those with positive sentinel lymph node biopsy who do not undergo completion axillary dissection, treatment in the prone position may be inappropriate. PMID:22607612

2012-01-01

47

An optimized posterior axillary boost technique in radiation therapy to supraclavicular and axillary lymph nodes: A comparative study  

SciTech Connect

To assess the advantages of an optimized posterior axillary (AX) boost technique for the irradiation of supraclavicular (SC) and AX lymph nodes. Five techniques for the treatment of SC and levels I, II, and III AX lymph nodes were evaluated for 10 patients selected at random: a direct anterior field (AP); an anterior to posterior parallel pair (AP-PA); an anterior field with a posterior axillary boost (PAB); an anterior field with an anterior axillary boost (AAB); and an optimized PAB technique (OptPAB). The target coverage, hot spots, irradiated volume, and dose to organs at risk were evaluated and a statistical analysis comparison was performed. The AP technique delivered insufficient dose to the deeper AX nodes. The AP-PA technique produced larger irradiated volumes and higher mean lung doses than the other techniques. The PAB and AAB techniques originated excessive hot spots in most of the cases. The OptPAB technique produced moderate hot spots while maintaining a similar planning target volume (PTV) coverage, irradiated volume, and dose to organs at risk. This optimized technique combines the advantages of the PAB and AP-PA techniques, with moderate hot spots, sufficient target coverage, and adequate sparing of normal tissues. The presented technique is simple, fast, and easy to implement in routine clinical practice and is superior to the techniques historically used for the treatment of SC and AX lymph nodes.

Hernandez, Victor, E-mail: vhernandezmasgrau@gmail.com [Department of Medical Physics, Hospital Sant Joan de Reus, IISPV, Tarragona (Spain); Arenas, Meritxell [Department of Radiation therapy, Hospital Sant Joan de Reus, IISPV, Tarragona (Spain); Müller, Katrin [Department of Medical Physics, Hospital Sant Joan de Reus, IISPV, Tarragona (Spain); Gomez, David; Bonet, Marta [Department of Radiation therapy, Hospital Sant Joan de Reus, IISPV, Tarragona (Spain)

2013-01-01

48

Sentinel lymph node biopsy for breast cancer using methylene blue dye manifests a short learning curve among experienced surgeons: a prospective tabular cumulative sum (CUSUM) analysis  

Microsoft Academic Search

BACKGROUND: The benefits of sentinel lymph node biopsy (SLNB) for breast cancer patients with histologically negative axillary nodes, in whom axillary lymph node dissection (ALND) is thereby avoided, are now established. Low false negative rate, certainly with blue dye technique, mostly reflects the established high inherent accuracy of SLNB and low axillary nodal metastatic load (subject to patient selection). SLN

Jeffrey M East; Christopher SP Valentine; Emil Kanchev; Garfield O Blake

2009-01-01

49

Histiocytic necrotising lymphadenitis (Kikuchi-Fujimoto disease) of axillary lymph nodes.  

PubMed

Kikuchi-Fujimoto disease (KFD) or histiocytic necrotising lymphadenitis is a rare entity, occurring most commonly in young Asian adults. KFD is characterised by fever with tender lymph node enlargement. The cervical group of lymph nodes is most commonly involved, and the diagnosis is conclusively made by lymph node biopsy and histopathology. KFD is a self-limiting condition, which usually resolves over 1-4?months. Symptomatic treatment with antipyretics and/or non-steroidal anti-inflammatory drugs is recommended. Here we describe an uncommon presentation of KFD in a young woman in which only the axillary lymph nodes were enlarged. PMID:25564582

Nagaraju, Santosh; Vaishnav, Sakshi; Burke, Leandra H; Norman, Earl M

2015-01-01

50

Sentinel Lymph Node Biopsy Alone after Neoadjuvant Chemotherapy in Patients with Initial Cytology-Proven Axillary Node Metastasis  

PubMed Central

Purpose Neoadjuvant chemotherapy (NAC) has been recently used to downstage breast cancer. However, in patients with initial axillary lymph node (ALN) metastasis, ALN dissection regardless of the NAC response remains the standard treatment. The purpose of this study was to identify the feasibility and accuracy of sentinel lymph node biopsy (SLNB) after NAC in patients with ALN metastasis at diagnosis. Methods From January 2007 to August 2013, data of patients who were diagnosed with invasive breast cancer and ALN metastasis and treated with NAC followed by definitive surgery in two centers were collected retrospectively. A total of 386 patients were enrolled and classified into five groups according to surgical procedure for the ALNs and pathologic results. Results At SLNB after NAC, sentinel lymph nodes (SLNs) that stained blue or were hot, including suspicious nodes, were identified; the SLN identification and false-negative rates was 96% and 10%, respectively. There was no difference in the overall survival among the groups. For patients who revealed a pathologic complete node response, there was a significant difference in the disease-free survival rate between the SLNB only and complete ALN dissection groups (p=0.031). However, the rate of axillary recurrence demonstrated no significant differences among the groups (p>0.050). Conclusion SLNB after NAC in breast cancer patients with initial ALN metastasis may help identify downstaging to negative nodal status and thereby reduce the surgical morbidity by avoiding standard ALN dissection. PMID:25834607

Kim, Ji Young; Kim, Min Kuk; Lee, Jeong Eon; Bae, Soo Youn; Lee, Se Kyung; Kil, Won Ho; Kim, Seok Won; Kim, Ku Sang; Nam, Seok Jin; Han, Sehwan

2015-01-01

51

Radionuclide Sentinel Lymph Node Scan and Biopsy in Breast Cancer: The Experience in a Cancer Center  

Microsoft Academic Search

Backgrounds: In the past, axillary lymph node dissec- tion (ALND) was a routine procedure used in the surgery of invasive breast cancer. But procedure relat- ed morbidity was not uncommon. Sentinel lymph node (SLN) biopsy is a newly developed method to avoid unnecessary ALND. The purpose of this study was to evaluate the detection rate of radionuclide SLN scan and

Yu-Yi Huang; Dong-Ling You; Ben-Long Yu; Mei-Hua Tsou

2004-01-01

52

Patients with early breast cancer benefit from effective axillary treatment  

Microsoft Academic Search

Summary We have reviewed the available clinical data on the benefit of axillary treatment in patients with early breast cancer. The results of these studies suggest that perhaps 5–10% of patients are cured by effective axillary treatment. We conclude that effective axillary treatment should still be considered an essential aspect of primary treatment.

Jay R. Harris; Robert T. Osteen

1985-01-01

53

A Subset of Nondescript Axillary Lymph Node Inclusions Have the Immunophenotype of Endosalpingiosis  

PubMed Central

We report 2 cases of bland, otherwise nondescript axillary lymph node inclusions that have the immunophenotype of endosalpingiosis in patients with concurrent invasive breast carcinomas. Neither inclusion demonstrated the classic morphology of endosalpingiosis with admixed ciliated and secretory cells. Rather, both cases were composed of nondescript cuboidal to columnar bland epithelial cells situated within the lymph node capsule. Whereas both inclusions labeled diffusely for estrogen receptor and lacked evidence of a myoepithelial component, both labeled diffusely for PAX8 and WT-1, which distinguished them from their corresponding concurrent primary mammary carcinomas. These findings suggest that a subset of otherwise nondescript axillary lymph node inclusions represent endosalpingiosis and highlight the utility of PAX8 and WT-1 immunohistochemistry in distinguishing these from metastatic well-differentiated ductal carcinoma. PMID:24921637

Carney, Erin; Cimino-Mathews, Ashley; Argani, Cynthia; Kronz, Joseph; Vang, Russell; Argani, Pedram

2015-01-01

54

A subset of nondescript axillary lymph node inclusions have the immunophenotype of endosalpingiosis.  

PubMed

We report 2 cases of bland, otherwise nondescript axillary lymph node inclusions that have the immunophenotype of endosalpingiosis in patients with concurrent invasive breast carcinomas. Neither inclusion demonstrated the classic morphology of endosalpingiosis with admixed ciliated and secretory cells. Rather, both cases were composed of nondescript cuboidal to columnar bland epithelial cells situated within the lymph node capsule. Whereas both inclusions labeled diffusely for estrogen receptor and lacked evidence of a myoepithelial component, both labeled diffusely for PAX8 and WT-1, which distinguished them from their corresponding concurrent primary mammary carcinomas. These findings suggest that a subset of otherwise nondescript axillary lymph node inclusions represent endosalpingiosis and highlight the utility of PAX8 and WT-1 immunohistochemistry in distinguishing these from metastatic well-differentiated ductal carcinoma. PMID:24921637

Carney, Erin; Cimino-Mathews, Ashley; Argani, Cynthia; Kronz, Joseph; Vang, Russell; Argani, Pedram

2014-12-01

55

Can the Addition of RegionalRadiotherapy Counterbalance Important Risk Factors in BreastCancer Patients with Extracapsular Invasion of Axillary LymphNode Metastases?  

Microsoft Academic Search

Purpose: To evaluate if locoregional radiotherapy (RT) versus local irradiation only can alter the pattern of failure in breast cancer patients with extranodal invasion. Patients and Methods: From 08\\/1988 to 06\\/1998, 81 patients with extranodal invasion were treated with adjuvant RT (median total dose: 50.4 Gy), 46\\/81 only locally, 35\\/81 locoregionally due to presumed adverse parameters. The mean number of

Günther Gruber; Gilles Berclaz; Hans-Jörg Altermatt; Richard H. Greiner

2003-01-01

56

Less-Invasive Lymph Node Surgery Safe for Women with Breast Cancer  

Cancer.gov

Breast cancer patients who had sentinel lymph node biopsy followed by axillary lymph node dissection (ALND) only if cancer cells were detected in the sentinel nodes had the same overall survival as those  who underwent ALND regardless of sentinel node status, according to a randomized trial published online September 20, 2010, in Lancet Oncology.

57

Observation of the Primo Vessel Approaching the Axillary Lymph Node with the Fluorescent Dye, DiI  

PubMed Central

The primo vascular system (PVS) floating in lymph fluid has mostly been observed in large caliber ducts around the caudal vena cava and the thoracic duct of rabbits, rats, and mice. But the PVS has not been traced up to the lymph nodes. It has not been established whether the PVS leaves the lymph vessel through the lymph vessel wall or it enters the lymph nodes. Therefore, observing the PVS entering a lymph node, for example, the axillary node, is desirable. In the current work, we traced the PVS approaching up to the surface of axillary node of a rat. The method used for this study was based upon a method that was recently developed to detect the PVS in the lymph duct from the inguinal to the axillary nodes in the skin of a rat by injecting Alcian blue into the inguinal node. However, the Alcian blue blurred near the lymph nodes and tracing the PVS up to the lymph nodes has not been possible. The current method clearly showed the PVS approaching the axillary node. PMID:25477989

Park, Su Youn; Chang, Byung-Soo; Lee, Seung Hwan; Yoon, Ju Hwan; Kim, Sungchul

2014-01-01

58

Identification of 241Am in the axillary lymph nodes with an intrinsic germanium detector.  

PubMed

A routine measurement with two 200 mm-diameter phoswich detectors, placed one each side of the sternum, yielded an apparent lung content of 17 nCi 241Am for a subject. subject. Inspection of the data revealed that there were many more counts from the left side than from the right and that there was a greater number of Np L X rays observed, relative to the L gamma ray, than would be expected for a uniform lung distribution of 241Am. These observations suggested a shallow localised deposit in the left side of the chest. The subject's working history could not rule out an inhalation exposure, but he was known to have had a wound contaminated with Pu/Am in his left hand 16 yr previously. The wound had contained approx. 0.02-0.03 mu Ci 241Am initially, most of which was excised from the wound site after 50 days. Prompted by this knowledge we used a 50mm-diameter intrinsic Ge detector to examine the wound and relevant lymph node sites. The results demonstrated a localised deposit of 241Am in the axillary lymph nodes with approx. 1 nCi 241Am at the wound site. Subsequent measurements made with the phoswich detectors suggested that there was approx. 7 nCi 241Am in the lymph nodes with approx. 1 nCi 241Am in the liver, thereby accounting for most of the detectable 241Am contamination in the thorax. PMID:6862911

Graham, S G; Kirkham, S J

1983-01-01

59

The Axillary Nodal Harvest in Breast Cancer Surgery Is Unchanged by Sentinel Node Biopsy or the Timing of Surgery  

PubMed Central

Introduction. Patients with a positive sentinel lymph node biopsy may undergo delayed completion axillary dissection. Where intraoperative analysis is available, immediate completion axillary dissection can be performed. Alternatively, patients may undergo primary axillary dissection for breast cancer, historically or when preoperative assessment suggests axillary metastases. This study aims to determine if there is a difference in the total number of lymph nodes or the number of metastatic nodes harvested between the 3 possible approaches. Methods. Three consecutive comparable groups of 50 consecutive patients who underwent axillary dissection in each of the above contexts were identified from the Portsmouth Breast Unit Database. Patient demographics, clinicopathological variables, and surgical treatment were recorded. The total pathological nodal count and the number of metastatic nodes were compared between the groups. Results. There were no differences in clinico-pathological features between the three groups for all features studied with the exception of breast surgical procedure (P < 0.001). There were no differences in total nodal harvest (P = 0.822) or in the number of positive nodes harvested (P = 0.157) between the three groups. Conclusion. The three approaches to axillary clearance yield equivalent nodal harvests, suggesting oncological equivalence and robustness of surgical technique. PMID:22693673

Byrne, B. E.; Cutress, R. I.; Gill, J.; Wise, M. H.; Yiangou, C.; Agrawal, A.

2012-01-01

60

Volume-Based Parameters of {sup 18}F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Improve Disease Recurrence Prediction in Postmastectomy Breast Cancer Patients With 1 to 3 Positive Axillary Lymph Nodes  

SciTech Connect

Purpose: To determine whether volume-based parameters on pretreatment {sup 18}F-fluorodeoxyglucose positron emission tomography/computed tomography in breast cancer patients treated with mastectomy without adjuvant radiation therapy are predictive of recurrence. Methods and Materials: We retrospectively analyzed 93 patients with 1 to 3 positive axillary nodes after surgery, who were studied with {sup 18}F-fluorodeoxyglucose positron emission tomography/computed tomography for initial staging. We evaluated the relationship between positron emission tomography parameters, including the maximum standardized uptake value, metabolic tumor volume (MTV), and total lesion glycolysis (TLG), and clinical outcomes. Results: The median follow-up duration was 45 months. Recurrence was observed in 11 patients. Metabolic tumor volume and TLG were significantly related to tumor size, number of involved nodes, nodal ratio, nuclear grade, estrogen receptor (ER) status, and triple negativity (TN) (all P values were <.05). In receiver operating characteristic curve analysis, MTV and TLG showed better predictive performance than tumor size, ER status, or TN (area under the curve: 0.85, 0.86, 0.79, 0.74, and 0.74, respectively). On multivariate analysis, MTV was an independent prognostic factor of locoregional recurrence-free survival (hazard ratio 34.42, 95% confidence interval 3.94-882.71, P=.0008) and disease-free survival (DFS) (hazard ratio 13.92, 95% confidence interval 2.65-103.78, P=.0018). The 3-year DFS rate was 93.8% for the lower MTV group (<53.1; n=85) and 25.0% for the higher MTV group (?53.1; n=8; P<.0001, log–rank test). The 3-year DFS rate for patients with both ER-positive status and MTV <53.1 was 98.2%; and for those with ER-negative status and MTV ?53.1 it was 25.0% (P<.0001). Conclusions: Volume-based parameters improve recurrence prediction in postmastectomy breast cancer patients with 1 to 3 positive nodes. The addition of MTV to ER status or TN has potential benefits to identify a subgroup at higher risk for recurrence.

Nakajima, Naomi, E-mail: haruhi0321@gmail.com [Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Ehime (Japan); Department of Radiology, Ehime University, Ehime (Japan); Kataoka, Masaaki [Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Ehime (Japan); Sugawara, Yoshifumi [Department of Diagnostic Radiology, National Hospital Organization Shikoku Cancer Center, Ehime (Japan); Ochi, Takashi [Department of Radiology, Ehime University, Ehime (Japan); Kiyoto, Sachiko; Ohsumi, Shozo [Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, Ehime (Japan); Mochizuki, Teruhito [Department of Radiology, Ehime University, Ehime (Japan)

2013-11-15

61

Sentinel Lymph Node Biopsy in Breast Cancer: Guidelines and Pitfalls of Lymphoscintigraphy and Gamma Probe Detection  

Microsoft Academic Search

Background: Sentinel node (SN) biopsy appears to offer an alternative to routine axillary lymph node dissection (ALND) for staging patients with breast cancer. Various techniques have been studied for identifying the SN, using vital blue dye or radioactive colloid, and initial reports are promising. The inherent limitations and pitfalls must be clearly understood before SN biopsy can be implemented in

Paul J Borgstein; Rik Pijpers; Emile F Comans; Paul J van Diest; Rob P Boom; Sybren Meijer

1998-01-01

62

Optimization of sentinel lymph node biopsy in breast cancer using an operative gamma camera  

Microsoft Academic Search

BACKGROUND: Sentinel lymph node (SLN) procedure is now a widely accepted method of LN staging in selected invasive breast cancers (unifocal, size ? 2 cm, clinically N0, without previous treatment). Complete axillary clearance is no longer needed if the SLN is negative. However, the oncological safety of this procedure remains to be addressed in randomized clinical trials. One main pitfall

Carole Mathelin; Samuel Salvador; Sabrina Croce; Norosoa Andriamisandratsoa; Daniel Huss; Jean-Louis Guyonnet

2007-01-01

63

Clinical relevance of sentinel lymph nodes in the internal mammary chain in breast cancer patients  

Microsoft Academic Search

Purpose: Despite the widespread use of sentinel lymph node (SLN) biopsy in breast cancer patients, some controversy exists about the correct management of ex- tra-axillary nodes, especially those located in the internal mammary chain. The aim of this study was to evaluate the incidence of SLNs in this region, calculate the lympho- scintigraphic and surgical detection rates and evaluate the

Pilar Paredes; Sergi Vidal-Sicart; Gabriel Zanón; Jaume Pahisa; Pedro Luís Fernández; Martín Velasco; Gorane Santamaría; Jaime Ortín; Joan Duch; Francesca Pons

2005-01-01

64

Multidisciplinary approach to selective sentinel lymph node mapping in breast cancer  

Microsoft Academic Search

Although the role of axillary lymph node dissection is controversial with respect to survival benefits, its role as a staging\\u000a procedure has been well established since nodal involvement is the most reliable prognostic indicator for patients with breast\\u000a cancer. Selective sentinel lymph node (SLN) dissection is gaining acceptance as a useful staging procedure because it is minimally\\u000a invasive and spares

Stanley P. L. Leong; Engene T. Morita; Patrick A. Treseler; Jan H. Wong

2000-01-01

65

Sentinel Node Biopsy Alone versus Completion Axillary Node Dissection in Node Positive Breast Cancer: Systematic Review and Meta-Analysis  

PubMed Central

Introduction. There has been recent interest in validity of completion axillary node dissection after a positive sentinel node. This systematic review aims to ascertain if sentinel lymph node dissection alone was noninferior to axillary lymph node dissection for breast cancer patients who have a positive sentinel node. Method. A systematic review of the electronic databases Embase, MEDLINE, and Cochrane Register of Controlled Trials was carried out. Only randomised trials that had patients with positive sentinel node as the study sample were included in the meta-analysis using the reported hazard ratios with a fixed effect model. Results. Three randomised controlled trials and five retrospective studies were identified. The pooled effect for overall survival was HR 0.94, 95% CI [0.79, 1.19], and for disease free survival was HR 0.83, 95% CI [0.60, 1.14]. The reported rates for locoregional recurrence were similar in both groups. The surgical morbidity was found to be significantly more in patients who had underwent axillary dissection. Conclusion. Amongst patients with micrometastasis in the sentinel node, no further axillary dissection is necessary. For patients with macrometastasis in the sentinel node, it is reasonable to consider omitting axillary dissection to avoid the morbidity of the procedure. PMID:25383226

Singh, Jasprit; McCaig, Eddie

2014-01-01

66

Lymph node staging in prostate cancer.  

PubMed

Nodal staging is important in prostate cancer treatment. While surgical lymph node dissection is the classic method of determining whether lymph nodes harbor malignancy, this is a very invasive technique. Current noninvasive approaches to identifying malignant lymph nodes are limited. Conventional imaging methods rely on size and morphology of lymph nodes and have notoriously low sensitivity for detecting malignant nodes. New imaging techniques such as targeted positron emission tomography (PET) imaging and magnetic resonance lymphography (MRL) with iron oxide particles are promising for nodal staging of prostate cancer. In this review, the strengths and limitations of imaging techniques for lymph node staging of prostate cancer are discussed. PMID:25773350

Sankineni, Sandeep; Brown, Anna M; Fascelli, Michele; Law, Yan Mee; Pinto, Peter A; Choyke, Peter L; Turkbey, Baris

2015-05-01

67

Unusual Lymph Node Metastases of Prostate Cancer Detected by 18F-Fluorocholine PET/CT.  

PubMed

A 65-year-old patient with prostate adenocarcinoma was explored by F-fluorocholine (FCH) PET/CT for pretreatment staging because of a high risk of prostate cancer. Images showed multiple foci with increased uptake of F-FCH within some pelvic and retroperitoneal lymph nodes, osseous foci (iliac bones and sacrum), and much more unusual, increased uptake foci within some left supraclavicular and left axillary lymph nodes. Owing to the rarity of spread to supraclavicular lymph nodes, surgical removal was performed and revealed prostate cancer metastases. PMID:25674860

Pinaquy, Jb; Allard, Jb; Cornelis, F; Pasticier, G; De Clermont, H

2015-04-01

68

Immunolymphoscintigraphy for the detection of lymph node metastases from breast cancer  

SciTech Connect

The presence of metastases in the regional lymph nodes is the major prognostic factor in breast cancer in the absence of overt distant metastases and is also an important indicator of the need for adjuvant therapy in ''early'' breast cancer. Currently, the accurate assessment of axillary lymph node status requires axillary dissection which has an associated morbidity. An alternative method of identifying patients who are ''node positive'' has been developed by means of immunolymphoscintigraphy with s.c. administered radioiodinated monoclonal antibody. The /sup 131/I-labeled anti-breast cancer antibody (RCC-1; 400 micrograms) and cold iodine-labeled blocking antibody (Ly-2.1; 2 mg which is nonreactive with breast cancer) were injected s.c. into both arms and scintigraphy images were obtained 16-18 h after the injection, using the axilla contralateral to the side of the breast cancer as the control. Studies were reported as positive if the amount of background-subtracted radioactive count in the axilla of interest exceeded the normal side by a radio equal to or greater than 1.5:1.0 as assessed by computer analysis. In 38 of 40 patients the findings on scintigraphy were correlated with operative and histopathological findings on the axillary dissection specimen or cytological findings of fine needle aspiration of axillary lymph nodes. In a prospective study of 26 patients, the method is more sensitive (86%) and specific (92%) than preoperative clinical assessment (57% sensitivity, 58% specificity) in the detection of axillary lymph node metastases; and by combining both modalities of assessment, there was an improvement in the sensitivity (100%) but a deterioration in the specificity (50%).

Tjandra, J.J.; Russell, I.S.; Collins, J.P.; Andrews, J.T.; Lichtenstein, M.; Binns, D.; McKenzie, I.F.

1989-03-15

69

Changing the intraoperative nodal status of a breast cancer patient using freehand SPECT for sentinel lymph node biopsy.  

PubMed

Radio-guided sentinel lymph node biopsy in early-stage breast cancer is standard of care. Freehand SPECT is a system for intraoperative visualization of radioactivity in the body. It generates a 3-dimensional image of the radioactivity distribution complementing the acoustic information of the gamma probe by providing depth and radioactive uptake information. In the reported case, freehand SPECT was used in a breast cancer patient as a control method after conventional sentinel lymph node biopsy. Freehand SPECT identified an additional lymph node, changing the original stage from pN1(mic) (micrometastasis) to pN1a (nodal positive), resulting in an axillary lymph node dissection. PMID:24152664

Bluemel, Christina; Schnelzer, Andreas; Ehlerding, Alexandra; Scheidhauer, Klemens; Kiechle, Marion

2014-05-01

70

Hazard of recurrence and adjuvant treatment effects over time in lymph node-negative breast cancer  

Microsoft Academic Search

Background For patients with axillary lymph node-negative breast cancer, benefits from adjuvant therapy are smaller than in node-positive\\u000a disease and thus more selective use is warranted, prompting development of risk profiling to identify those most likely to\\u000a benefit. Examination of the magnitude and changes in the hazard of failure over time in node-negative breast cancer may also\\u000a be informative in

James J. Dignam; Vanja Dukic; Stewart J. Anderson; Eleftherios P. Mamounas; D. Lawrence Wickerham; Norman Wolmark

2009-01-01

71

Evaluation of a Single-Isocenter Technique for Axillary Radiotherapy in Breast Cancer  

SciTech Connect

The aim of this study was to develop a technique for axillary radiotherapy that minimizes the risk of radiation-induced damage to the surrounding normal tissue (i.e., arm, shoulder, lung, esophagus, and spinal cord) while keeping the risk of a nodal recurrence to a minimum. A planning study was performed in 20 breast cancer patients. The target volume of the axillary treatment encompassed the periclavicular and axillary lymph node areas. The 3-dimensional (3D) computed tomography (CT) information in this study was used to outline the lymph node areas and the organs at risk (i.e., the esophagus, spinal cord, brachial plexus, and lung). A conventional AP-PA technique (with a transmission plate placed in the AP beam) was evaluated. In addition, a new single-isocenter technique consisting of AP/PA fields using a gantry rotation of {+-}20 deg. and a medial AP segment was developed. Both techniques were compared by evaluation of the calculated dose distributions and the dose-volume histograms of the target volume and surrounding organs at risk. The field borders and humeral shielding were redefined based on the 3D anatomical references. Adapting the humeral shielding reduced the irradiated volume by 19% and might contribute to a reduction of the incidence of arm edema and impairment of shoulder function. The maximum radiation dose in the esophagus and spinal cord was reduced by more than 50% using the single-isocenter technique. The difference between both techniques with respect to the mean doses in the target volume and lung, and the maximum dose in brachial plexus, was not statistically significant. Moreover, the single-isocenter technique allowed a fast and easy treatment preparation and reduced the execution time considerably (with approximately 10 minutes per fraction)

Beek, Suzanne van [Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Department of Radiation Oncology, Amsterdam (Netherlands)], E-mail: s.v.beek@nki.nl; Jaeger, Katrien de [Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Department of Radiation Oncology, Amsterdam (Netherlands); Mijnheer, Ben [Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Department of Radiation Oncology, Amsterdam (Netherlands)]|[INHOLLAND University of Professional Training, Haarlem (Netherlands); Vliet-Vroegindeweij, Corine van [Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Department of Radiation Oncology, Amsterdam (Netherlands)

2008-10-01

72

Controversial Indications for Sentinel Lymph Node Biopsy in Breast Cancer Patients  

PubMed Central

Sentinel lymph node biopsy (SLNB) emerged in the 1990s as a new technique in the surgical management of the axilla for patients with early breast cancer, resulting in lower complication rates and better quality of life than axillary lymph node dissection (ALND). Today SLNB is firmly established in the armamentarium of clinicians treating breast cancer, but several questions remain. The goal of this paper is to review recent work addressing 4 questions that have been the subject of debate in the use of SLNB in the past few years: (a) What is the implication of finding micrometastases in the sentinel nodes? (b) Is ALND necessary in all patients who have a positive SLNB? (c) How accurate is SLNB after neoadjuvant therapy? (d) Can SLNB be used to stage the axilla in locally recurrent breast cancer following breast surgery with or without prior axillary surgery?

Assi, Hazem; Sbaity, Eman; Abdelsalam, Mahmoud

2015-01-01

73

Sentinel Lymph Node Biopsy in Prostatic Cancer  

Microsoft Academic Search

\\u000a The identification of lymph drainage has significant clinical importance for tumor spread in prostatic cancer. Pelvic lymph\\u000a node metastases indicate a poor prognosis for patients with clinically localized prostate cancer. The prognosis depends on\\u000a nodal cancer volume (1), extracapsular extension (2), and the number of prostatic nodes affected (3). It is not clear whether the more valuable prognostic factor is

Alexander Winter; Harry Vogt; Dorothea Weckermann; Rolf Harzmann; Friedhelm Wawroschek

74

Sentinel lymph node mapping of a breast cancer of the vulva: Case report and literature review  

PubMed Central

Ectopic breast tissue is rare and typically presents as an axillary mass. Previous reports have identified ectopic breast tissue in the vulva, but malignancy is exceedingly uncommon. We present a 62 years old with locally advanced breast carcinoma arising in the vulva demonstrates the utilization of sentinel lymph node mapping to identify metastatic lymph nodes previously unable to be identified via traditional surgical exploration. Our case supports the principles of adjuvant therapy for breast cancer to be applied to ectopic breast cancer arising in the vulva. A literature review highlights common key points in similar cases to guide management. PMID:25866706

Cripe, James; Eskander, Ramez; Tewari, Krishnansu

2015-01-01

75

Optimization of a gamma imaging probe for axillary sentinel lymph mapping  

NASA Astrophysics Data System (ADS)

Sentinel lymph node (SLN) mapping is a technique for assessing whether early-stage invasive breast cancer has metastasized, thus determining prognosis and treatment options. SLN identification is achieved using the blue-dye and radioactive colloids techniques, which are sometimes combined with lymphoscintigraphy. Furthermore, intra-operative gamma acoustic probes, as well as gamma imaging probes are used during surgery. The purpose of this study is the construction of a gamma probe for sentinel lymph node imaging and its optimization in terms of sensitivity with respect to spatial resolution. The reference probe has small field of view (2.5 × 2.5 cm2) and is based on a position sensitive photomultiplier tube (PSPMT) coupled to a pixellated CsI(Tl) scintillator. Following experimental validation, we simulated the system using the GATE Monte Carlo toolkit (GATE v6.1) and modeled various collimator geometries, in order to evaluate their performance and propose the optimal configuration. The constraints of the proposed gamma imaging probe are i) sensitivity close to 2 cps/kBq and ii) spatial resolution equal to 6 mm at 2 cm source-to-collimator distance and ~ 10 mm at 5 cm. An integrated structure that achieves those requirements is a tungsten collimator with 2 × 2 mm2square holes, 16 mm thickness, 0.15 mm septa, where each CsI(Tl) 2 × 2 × 5 mm3 crystal pixel is placed inside the collimator.

Georgiou, M.; Loudos, G.; Stratos, D.; Papadimitroulas, P.; Liakou, P.; Georgoulias, P.

2012-09-01

76

Familial Blood and Lymph Node Cancers Study  

Cancer.gov

A study of a group of familial blood and lymph node cancers (also called "lymphoproliferative disorders"), including: chronic lymphocytic leukemia, Hodgkin lymphoma, non-Hodgkin lymphoma, Waldenström's macroglobulinemia, and multiple myeloma

77

Intraoperative frozen section assessment of sentinel lymph nodes in the operative management of women with symptomatic breast cancer  

Microsoft Academic Search

BACKGROUND: Maximisation of the potential of sentinel lymph node biopsy as a minimally invasive method of axillary staging requires sensitive intraoperative pathological analysis so that rates of re-operation for lymphatic metastases are minimised. The aim of this study was to describe the test parameters of the frozen section evaluation of sentinel node biopsy for breast cancer compared to the gold

Rohanna Ali; Ann M Hanly; Peter Naughton; Constantino F Castineira; Rob Landers; Ronan A Cahill; R Gordon Watson

2008-01-01

78

Detection efficiency for measuring 241Am in axillary lymph nodes using different types and sizes of detectors.  

PubMed

The detection efficiency and interference susceptibility of four different types of low energy photon detectors, each with a unique geometric arrangement, were compared for direct measurement of Am deposited in the axillary lymph nodes. Although the most efficient detector was a single large 23,226 mm square phoswich detector, it was also the most susceptible to confounding depositions from activity deposited in adjacent organs. The array of two 2,800 mm high purity germanium detectors exhibited the highest efficiency per unit detector area with some resistance to confounding from activity deposited in the lungs. The array of two 4,560 mm NaI(Tl) detectors was the least susceptible to confounding and nearly as efficient per square millimeter as the high purity germanium detector array. Thus, selection of a detector system for in vivo measurement of activity deposited in the axillary lymph nodes should consider whether there is a likelihood for activity deposited in other organs, such as the lungs, skeleton, or liver, to create an interference that will confound the measurement result. PMID:22850233

Lobaugh, Megan L; Spitz, Henry B; Glover, Samuel E

2012-09-01

79

Systematic review of breast cancer related lymphoedema: making a balanced decision to perform an axillary clearance  

PubMed Central

Aim: Breast cancer-related lymphoedema (BCRL) is a disabling complication developing after breast cancer treatment in a proportion of patients. Its impact on quality of life becomes more substantial as survival after breast cancer diagnosis increases. The incidence of BCRL following breast cancer treatment varies due to a lack of uniform definition and measurement criteria. This review aims to determine the prevalence of BCRL following axillary lymph node dissection (ALND) as a benchmark to be used in a risk-benefit medical decision whether to proceed with ALND or not. The risk of leaving unresected non-sentinel metastatic lymph nodes with a presumed inherent risk of local recurrence will be balanced against the risk of BCRL following a potentially unnecessary ALND. Methods: Pubmed and Embase databases were searched for all publications on BCRL in order to estimate its incidence and to decide on the most appropriate measurement method to use in clinical practice. Results: 51 articles were identified on BCRL incidence and measurement technique. Most studies measured BCRL based on differences in arm circumference (n?=?18) or by self-reported symptoms (n?=?18). The weighted average of BCRL incidence following ALND measured by self-report and circumference method was 28% and 16%, respectively. Conclusion: The importance of ALND and irradiation as part of the treatment of operable breast carcinoma is well established, but its morbidity is less well documented. We argue self-report as the most appropriate method to establish a diagnosis of BCRL. Therefore a 28% risk of finding non-sentinel lymph node metastases in a completion ALND will be regarded as the cut-off in a medical decision to proceed with ALND. PMID:24753936

Göker, M.; Devoogdt, N.; Van de Putte, G.; Schobbens, J.C.; Vlasselaer, J.; Van den Broecke, R.; de Jonge, E.T.M.

2013-01-01

80

Sentinel lymph node biopsy for gastrointestinal cancers.  

PubMed

Sentinel lymph node biopsy (SLNB) in gastrointestinal-(GI)-tract cancer is not yet of clinical relevance. Nevertheless, the results in the upper GI-tract promise to be helpful to individualize the indication for surgical therapy. SLNB in colon cancer still fails to show high validity to predict the nodal status, but may be helpful to clarify the prognostic role of micrometastases/isolated tumor cells. In anal cancer SLNB is able to guide the indication for groin irradiation. PMID:17726666

Bembenek, A; Gretschel, S; Schlag, P M

2007-09-15

81

Combined Axillary Reverse Mapping (ARM) Technique for Breast Cancer Patients Requiring Axillary Dissection  

Microsoft Academic Search

Background  The objective of axillary reverse mapping (ARM) is to preserve the main lymphatic chain—with both the nodes and the ducts—in\\u000a relation to lymphatic arm drainage (LAD) during an axillary dissection (AD).\\u000a \\u000a \\u000a \\u000a Methods  From July 2006 to March 2008, 23 patients with stage II or III breast carcinoma requiring an AD underwent an ARM procedure.\\u000a Identification of the ARM nodes relied on

Claude Nos; Gabriel Kaufmann; Krishna B. Clough; Marie-Anne Collignon; Eric Zerbib; Pino Cusumano; Fabrice Lecuru

2008-01-01

82

Axillary lymph node groups--the center in lymphatic drainage from the truncal skin in man. Clinical significance for management of malignant melanoma.  

PubMed

In order to identify regional lymph node drainage groups of primary malignant melanomas resp. suspicious pigmented tumors on truncal skin, lymphoscintigraphy using 99mTc-Sb2S3 colloid was performed in 50 patients of either sex prior to operative treatment. The lymphatic drainage pattern proved to be practically unpredictable by conventional anatomic guidelines based on the thesis of "lymphatic watersheds". In 96 per cent of the patients examined radiocolloid uptake was to be found in one or both of the axillary lymph node groups, either solely or combined with inguinal, supraclavicular, posterior cervical or parasternal node-bearing areas. In conclusion, axillary lymph node drainage groups are the center in lymphatic drainage from the truncal skin in man. PMID:7162208

Munz, D L; Altmeyer, P; Sessler, M J; Hör, G

1982-12-01

83

Sentinel lymph node biopsy in male patients with early breast cancer.  

PubMed

Mastectomy with axillary dissection is still the most commonly recommended procedure for male breast cancer. The aim of this study was to retrospectively evaluate our experience in 32 male patients with early breast cancer who underwent sentinel lymph node biopsy (SLNB) and axillary dissection only in cases of metastases in the sentinel lymph node (SLN). The median age was 58 years (range, 33-80). Lymphoscintigraphy was successful in all patients, with a mean number of visualized SLNs per patient of 1.3 (range, 1-2). At surgery, the identification rate of the SLN was 100%, with a mean number of removed SLNs per patient of 1.5 (range, 1-3). Twenty-six patients had negative SLNs, six patients had positive SLNs. Two patients with metastatic SLNs had additional positive nodes. After a median follow-up of 30 months (range, 1-63) no axillary reappearance of the disease occurred. As with women, we recommend SLNB in male patients with breast cancer and clinically negative axilla. PMID:17522237

Gentilini, Oreste; Chagas, Eduardo; Zurrida, Stefano; Intra, Mattia; De Cicco, Concetta; Gatti, Giovanna; Silva, Luzemira; Renne, Giuseppe; Cassano, Enrico; Veronesi, Umberto

2007-05-01

84

PRECLINICAL STUDY Prediction of lymph node involvement in breast cancer  

E-print Network

PRECLINICAL STUDY Prediction of lymph node involvement in breast cancer from primary tumor tissue- ther lymph node involvement in breast cancer is influenced by gene or miRNA expression of the primary tissue from a group of 96 breast cancer patients balanced for lymph node involvement using Affymetrix

85

[Lymph nodes of esophagus cancer: radiological approach].  

PubMed

The cervico-thoracic-abdominal-pelvic CT-scan is a key examination of the staging of esophagus cancers. Anatomical and pathophysiological knowledge of the lymph nodes is an essential tool to establish a precise mapping. Imaging tests (such endoscopic ultrasound and PET scanning) will be very useful to determine clinical options and clinical target volume delineation for the radiotherapy of esophagus cancers. PMID:25205427

Aubert, E; Servois, V

2014-10-01

86

Risk Factors for Regional Nodal Relapse in Breast Cancer Patients With One to Three Positive Axillary Nodes  

SciTech Connect

Purpose: In many centers, supraclavicular fossa radiotherapy (SCF RT) is not routinely offered to breast cancer patients with one to three positive lymph nodes. We aimed to identify a subgroup of these patients who are at high risk of supra or infraclavicular fossa relapse (SCFR) such that they can be offered SCFRT at the time of diagnosis to improve long term locoregional control. Methods and Materials: We performed a retrospective analysis of the pathological features of 1,065 cases of invasive breast cancer with one to three positive axillary lymph nodes. Patients underwent radical breast conserving surgery or mastectomy. A total of 45% of patients received adjuvant chest wall/breast RT. No patients received adjuvant SCFRT. The primary outcome was SCFR. Secondary outcomes were chest wall/breast recurrence, distant metastasis, all death, and breast-cancer specific death. Kaplan-Meier estimates were used to calculate actuarial event rates and survival functions compared using log-rank tests. Multivariate analyses (MVA) of factors associated with outcome were conducted using Cox proportional hazards models. Results: Median follow-up was 9.7 years. SCFR rate was 9.2%. Median time from primary diagnosis to SCFR was 3.4 years (range, 0.7-14.4 years). SCFR was associated with significantly lower 10-year survival (18% vs. 65%; p < 0.001). Higher grade and number of positive lymph nodes were the most significant predictors of SCFR on MVA (p < 0.001). 10 year SCFR rates were less than 1% in all patients with Grade 1 cancers compared with 30% in those having Grade 3 cancers with three positive lymph nodes. Additional factors associated with SCFR on univariate analysis but not on MVA included larger nodal deposits (p = 0.002) and proportion of positive nodes (p = 0.003). Conclusions: Breast cancer patients with one to three positive lymph nodes have a heterogenous risk of SCFR. Patients with two to three positive axillary nodes and/or high-grade disease may warrant consideration of SCFRT.

Yates, Lucy, E-mail: lucy.yates@gstt.nhs.uk [Guy's, King's, St Thomas' Cancer Centre, Guy's Hospital, London (United Kingdom); Kirby, Anna [Guy's, King's, St Thomas' Cancer Centre, Guy's Hospital, London (United Kingdom); Department of Clinical Oncology, Royal Marsden Hospital, Sutton (United Kingdom); Crichton, Siobhan [Department of Statistics, Kings College London (United Kingdom); Gillett, Cheryl [Breast Pathology, Kings College London (United Kingdom); Cane, Paul [Department of Histopathology, Guy's and St Thomas' Foundation Trust, London (United Kingdom); Fentiman, Ian; Sawyer, Elinor [Guy's, King's, St Thomas' Cancer Centre, Guy's Hospital, London (United Kingdom)

2012-04-01

87

Validation of the Memorial Sloan Kettering Cancer Center nomogram for predicting non-sentinel lymph node metastasis in sentinel lymph node-positive breast-cancer patients  

PubMed Central

Background The main purpose of the study reported here was to validate the clinical value of the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram that predicts non-sentinel lymph node (SLN) metastasis in SLN-positive patients with breast cancer. Methods Data on 1,576 patients who received sentinel lymph node biopsy (SLNB) at the Shandong Cancer Hospital from December 2001 to March 2014 were collected in this study, and data on 509 patients with positive SLN were analyzed to evaluate the risk factors for non-SLN metastasis. The MSKCC nomogram was used to estimate the probability of non-SLN metastasis and was compared with actual probability after grouping into deciles. A receiver-operating characteristic (ROC) curve was drawn and predictive accuracy was assessed by calculating the area under the ROC curve. Results Tumor size, histological grade, lymphovascular invasion, multifocality, number of positive SLNs, and number of negative SLNs were correlated with non-SLN metastasis (P<0.05) by univariate analysis. However, multivariate analysis showed that tumor size (P=0.039), histological grade (P=0.043), lymphovascular invasion (P=0.001), number of positive SLNs (P=0.001), and number of negative SLNs (P=0.000) were identified as independent predictors for non-SLN metastasis. The trend of actual probability in various decile groups was comparable to the predicted probability. The area under the ROC curve was 0.722. Patients with predictive values lower than 10% (97/492, 19.7%) had a frequency of non-SLN metastasis of 17.5% (17/97). Conclusion The MSKCC nomogram can provide an accurate prediction of the probability of non-SLN metastasis, and offers a reference basis about axillary lymph node dissection. Axillary lymph node dissection could be avoided in patients with predictive values lower than 10%.

Bi, Xiang; Wang, Yongsheng; Li, Minmin; Chen, Peng; Zhou, Zhengbo; Liu, Yanbing; Zhao, Tong; Zhang, Zhaopeng; Wang, Chunjian; Sun, Xiao; Qiu, Pengfei

2015-01-01

88

The correlation between the spread of metastases by level in the axillary nodes and disease-free survival in breast cancer. A multifactorial analysis.  

PubMed

Axillary lymph nodes were separated from 492 radical or modified radical mastectomies for primary breast cancer and examined according to their anatomical level corresponding to their position along the theoretical pathway of lymph drainage from the breast. The patterns of metastasis and the relationship between metastatized levels and disease-free survival were investigated to see whether complete axillary dissection is necessary for the staging and the planning of adjuvant therapy in breast cancer. Progressive involvement from level I (proximal) to level III (distal) was found in 206 specimens (80.8% of tumors with axillary metastases), while discontinuous or "skip" metastases were present in 49 (19.2%), including 38 (14.9%) with positive nodes at level II or III but not at level I. "Skip" metastasis was more frequent when fewer than four nodes were positive, and not related to either the size of the primary tumor or its location. The effect of age, menopausal status, tumor size, node status, number of positive nodes, anatomic level of axillary node involvement, estrogen and progesterone receptors, and adjuvant therapies on disease-free survival was evaluated using a multivariate proportional hazard model and life table analysis. This showed that disease-free survival was strongly related to the number of positive nodes (P less than 0.001), tumor size (P = 0.001) and level of node involvement (P = 0.01) as independent prognostic factors. Moreover, the subset of patients with four or more positive nodes and involvements of level III had a higher risk of recurrence (25% recurrence-free patients 5 years after mastectomy). The high frequency of "skip" metastases and the prognostic value of both the level of involvement and the number of metastatic nodes suggest that a complete axillary dissection is needed in the surgical management of breast cancer to obtain all the data useful in the planning of adjuvant therapy. PMID:3653201

Gaglia, P; Bussone, R; Caldarola, B; Lai, M; Jayme, A; Caldarola, L

1987-06-01

89

Protein predictive signatures for lymph node metastasis of gastric cancer.  

PubMed

Lymph node status remains one of most crucial indicators of gastric cancer prognosis and treatment planning. Current imaging methods have limited accuracy in predicting lymph node metastasis. We sought to identify protein markers in primary gastric cancer and to define a risk model to predict lymph node metastasis. The Protein Pathway Array (PPA) (initial selection) and Western blot (confirmation) were used to assess the protein expression in a total of 190 freshly frozen gastric cancer samples. The protein expression levels were compared between samples with lymph node metastasis (n = 73) and those without lymph node metastasis (n = 57) using PPA. There were 27 proteins differentially expressed between lymph node positive samples and lymph node negative samples. Five proteins (Factor XIII B, TFIIH p89, ADAM8, COX-2 and CUL-1) were identified as independent predictors of lymph node metastasis. Together with vascular/lymphatic invasion status, a risk score model was established to determine the risk of lymph node metastasis for each individual gastric cancer patient. The ability of this model to predict lymph node metastasis was further confirmed in a second cohort of gastric cancer patients (33 with and 27 without lymph node metastasis) using Western blot. This study indicated that some proteins differentially expressed in gastric cancer can be selected as clinically useful biomarkers. The risk score model is useful for determining patients' risk of lymph node metastasis and prognosis. PMID:23011604

Li, Wei; Ye, Fei; Wang, Daguang; Sun, Xuan; Tong, Weihua; Lian, Guodong; Jiang, Jing; Suo, Jian; Zhang, David Y

2013-04-15

90

Breast cancer and sentinel lymph node micrometastases: indications for lymphadenectomy and literature review  

PubMed Central

An increasingly early diagnosis for discovering breast cancer, an improvement of surgical procedures with refining techniques for research and study of sentinel node, currently allow a more conservative surgical approach. Association with suitable chemo-radiotherapy allows a good control of breast disease. Our study, although modest, was carried out on 63 patients suffering from breast cancer, who underwent surgical treatment with assessment of sentinel lymph node. Aim of study was to establish the most correct strategy in the presence of isolated tumor cells (ITC) and/or micro-metastases of sentinel lymph node. Many studies have been carried out to find which was the most appropriate treatment, nevertheless, in the absence of univocal guidelines, we prefer to proceed to axillary dissection, though the topic is very debated and controversial. Following this strategy we obtained quite satisfactory results. PMID:25644726

ZANGHÌ, G.; DI STEFANO, G.; CAPONNETTO, A.; VECCHIO, R.; LANAIA, A.; LA TERRA, A.; LEANZA, V.; BASILE, F.

2014-01-01

91

Surgeon specialization and use of sentinel lymph node biopsy for breast cancer  

PubMed Central

IMPORTANCE Sentinel lymph node biopsy (SLNB) is the standard of care for axillary staging in clinically node-negative breast cancer patients. It is not known whether SLNB rates differ by surgeon expertise. If surgeons with less breast cancer expertise are less likely to offer SLNB to clinically node-negative patients, this practice pattern could lead to unnecessary axillary lymph node dissections (ALND) and lymphedema. OBJECTIVE To explore potential measures of surgical expertise (including a novel objective specialization measure – percentage of a surgeon’s operations devoted to breast cancer determined from claims) on the use of SLNB for invasive breast cancer. DESIGN Population-based prospective cohort study. Patient, tumor, treatment and surgeon characteristics were examined. SETTING California, Florida, Illinois PARTICIPANTS Elderly (65+ years) women identified from Medicare claims as having had incident invasive breast cancer surgery in 2003. MAIN OUTCOME MEASURES Type of axillary surgery performed. RESULTS Of the 1,703 women treated by 863 different surgeons, 56% underwent an initial SLNB, 37% initial ALND and 6% no axillary surgery. The median annual surgeon Medicare volume of breast cancer cases was 6 (range: 1.5–57); the median surgeon percentage of breast cancer cases was 4.6% (range: 0.7%–100%). After multivariable adjustment of patient and surgeon factors, women operated on by surgeons with higher volumes and percentages of breast cancer cases had a higher likelihood of undergoing SLNB. Specifically, women were most likely to undergo SLNB if operated on by high volume surgeons (regardless of percentage) or by lower volume surgeons with a high percentage of cases devoted to breast cancer. In addition, membership in the American Society of Breast Surgeons (OR 1.98, CI 1.51–2.60) and Society of Surgical Oncology (OR 1.59, CI 1.09–2.30) were independent predictors of women undergoing an initial SLNB. CONCLUSIONS AND RELEVANCE Patients treated by surgeons with more experience and focus in breast cancer were significantly more likely to undergo SLNB, highlighting the importance of receiving initial treatment by specialized providers. Factors relating to specialization in a particular area, including our novel surgeon percentage measure, require further investigation as potential indicators of quality of care. PMID:24369337

Yen, Tina W.F.; Laud, Purushuttom W.; Sparapani, Rodney A.; Nattinger, Ann B.

2014-01-01

92

Surgery for Breast Cancer  

MedlinePLUS

... as swelling of the arm and chest ( lymphedema ). Lymph node surgery To find out if the breast cancer ... nodes are checked in 2 major ways. Axillary lymph node dissection: In this operation, about 10 to 40 ( ...

93

A Randomized Comparison of Sentinel-Node Biopsy with Routine Axillary Dissection in Breast Cancer  

Microsoft Academic Search

background Although numerous studies have shown that the status of the sentinel node is an accu- rate predictor of the status of the axillary nodes in breast cancer, the efficacy and safety of sentinel-node biopsy require validation. methods From March 1998 to December 1999, we randomly assigned 516 patients with primary breast cancer in whom the tumor was less than

Umberto Veronesi; Giovanni Paganelli; Giuseppe Viale; Alberto Luini; Stefano Zurrida; Viviana Galimberti; Mattia Intra; Paolo Veronesi; Chris Robertson; Patrick Maisonneuve; Giuseppe Renne; Concetta De Cicco; Francesca De Lucia; Roberto Gennari

2010-01-01

94

Some Women May Not Need More Extensive Lymph Node Surgery for Breast Cancer  

Cancer.gov

Results from a randomized clinical trial published February 9, 2011, in the Journal of the American Medical Association demonstrate that axillary lymph node dissection provided no additional survival benefit when compared with sentinel lymph node biopsy in women with small breast tumors and minimal lymph node metastasis who were treated with lumpectomy, whole-breast radiotherapy, and adjuvant systemic therapy.

95

Cosmetic outcome of breast conserving therapy after sentinel node biopsy versus axillary lymph node dissection  

Microsoft Academic Search

Summary Introduction. Next to locoregional control, good cosmetic outcome is one of the main goals of breast conserving treatment (BCT) for breast cancer surgery. Factors affecting cosmetic outcome are well known. The sentinel node (SN) procedure avoids lymphedema in the breast, which might influence cosmetic outcome. The aim of this study was to evaluate the cosmetic outcome of BCT after

H. F. J. Fabry; B. M. Zonderhuis; S. Meijer; J. Berkhof; P. A. M. Van Leeuwen; J. R. M. Van der Sijp

2005-01-01

96

Comparison of Treatment Outcome Between Breast-Conservation Surgery With Radiation and Total Mastectomy Without Radiation in Patients With One to Three Positive Axillary Lymph Nodes  

SciTech Connect

Purpose: To test the difference in treatment outcome between breast-conservation surgery with radiation and total mastectomy without radiation, to evaluate the benefits of adjuvant radiotherapy in patients with one to three positive axillary lymph nodes. Methods and Materials: Using the Severance Hospital Breast Cancer Registry, we divided the study population of T1, T2 and one to three axillary node-positive patients into two groups: breast-conservation surgery with radiation (BCS/RT) and total mastectomy without radiation (TM/no-RT). Data related to locoregional recurrence, distant recurrence, and death were collected, and survival rates were calculated. Results: The study population consisted of 125 patients treated with BCS/RT and 365 patients treated with TM/no-RT. With a median follow-up of 68.4 months, the 10-year locoregional recurrence-free survival rate with BCS/RT and TM/no-RT was 90.5% and 79.2%, respectively (p = 0.056). The 10-year distant recurrence-free survival rate was 78.8% for patients treated with BCS/RT vs. 68.0% for those treated with TM/no-RT (p = 0.012). The 10-years overall survival rate for patients treated with BCT/RT and TM/no-RT was 87.5% and 73.9%, respectively (p = 0.035). After multivariate analysis, patients treated with BCT/RT had better distant recurrence-free survival (hazard ratio [HR], 0.527; 95% confidence interval [CI], 0.297-0.934; p = 0.028), with improving locoregional recurrence-free survival (HR, 0.491; 95% CI, 0.231-1.041; p = 0.064) and overall survival trend (HR, 0.544; 95% CI, 0.277-1.067; p = 0.076). Conclusions: This study provides additional evidence that adjuvant radiation substantially reduces local recurrence, distant recurrence, and mortality for patients with one to three involved nodes.

Kim, Seung Il; Park, Seho; Park, Hyung Seok [Department of Surgery, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Yong Bae; Suh, Chang Ok [Department of Radiation Oncology, Yonsei University College of Medicine, Seoul (Korea, Republic of); Park, Byeong-Woo, E-mail: bwpark@yuhs.ac [Department of Surgery, Yonsei University College of Medicine, Seoul (Korea, Republic of); Brain Korea 21 Project, Yonsei University College of Medicine, Seoul (Korea, Republic of)

2011-08-01

97

[Lymph node micrometastases in gastric cancer].  

PubMed

Lymph node micrometastases in gastric cancer are based on the definition in the 6th version of the TNM classification of malignant tumours edited by the International Union Against Cancer, which is also quoted in the 14th version of the Japanese Classification of Gastric Carcinoma. Histopathologic examination such as immunohistochemistry and molecular biological techniques including RT-PCR and one-step nucleic acid amplification are used for the detection of micrometastases. Because the time required for such detection is shortened to 30 to 40 min, intraoperative detection is feasible. Many papers have reported the correlation between micrometastases and prognosis in gastric cancer, although whether micrometastases are correlated with poor prognosis even when completely resected remains unknown. Intraoperative detection of micrometastases is important to decide the operative procedure in sentinel node navigation surgery. PMID:23457939

Fujimura, Takashi; Tsukada, Tomoya; Kinoshita, Jun; Oyama, Katsunobu; Fushida, Sachio; Ohta, Tetsuo

2013-01-01

98

Tangential Radiotherapy Without Axillary Surgery in Early-Stage Breast Cancer: Results of a Prospective Trial  

SciTech Connect

Purpose: To determine the risk of regional-nodal recurrence in patients with early-stage, invasive breast cancer, with clinically negative axillary nodes, who were treated with breast-conserving surgery, 'high tangential' breast radiotherapy, and hormonal therapy, without axillary surgery or the use of a separate nodal radiation field. Methods and Materials: Between September 1998 and November 2003, 74 patients who were {>=}55 years of age with Stage I-II clinically node-negative, hormone-receptor-positive breast cancer underwent tumor excision to negative margins without axillary surgery as a part of a multi-institutional prospective study. Postoperatively, all underwent high-tangential, whole-breast radiotherapy with a boost to the tumor bed, followed by 5 years of hormonal therapy. Results: For the 74 patients enrolled, the median age was 74.5 years, and the median pathologic tumor size was 1.2 cm. Lymphatic vessel invasion was present in 5 patients (7%). At a median follow-up of 52 months, no regional-nodal failures or ipsilateral breast recurrences had been identified (95% confidence interval, 0-4%). Eight patients died, one of metastatic disease and seven of other causes. Conclusion: In this select group of mainly older patients with early-stage hormone-responsive breast cancer and clinically negative axillary nodes, treatment with high-tangential breast radiotherapy and hormonal therapy, without axillary surgery, yielded a low regional recurrence rate. Such patients might be spared more extensive axillary treatment (axillary surgery, including sentinel node biopsy, or a separate nodal radiation field), with its associated time, expense, and morbidity.

Wong, Julia S. [Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA (United States)], E-mail: jwong@lroc.harvard.edu; Taghian, Alphonse G. [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Bellon, Jennifer R. [Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA (United States); Keshaviah, Aparna [Department of Biostatistics and Computational Biology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA (United States); Smith, Barbara L. [Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Winer, Eric P. [Department of Medical Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA (United States); Silver, Barbara; Harris, Jay R. [Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA (United States)

2008-11-01

99

Mediastinal lymph node size in lung cancer  

SciTech Connect

Using a size criterion of 1 cm or greater as evidence for abnormality, the size of mediastinal lymph nodes identified by computed tomography (CT) was a poor predictor of mediastinal lymph node metastases in a series of 86 patients who had surgery for bronchogenic carcinoma. The surgery included full nodal sampling in all patients. Of the 86 patients, 36 had nodes greater than or equal to 1 cm identified by CT. Of the 21 patients with mediastinal metastases proven at surgery, 14 had nodes greater than or equal to 1 cm (sensitivity = 67%). Of the 65 patients without mediastinal metastases, 22 had nodes greater than or equal to 1 cm. Obstructive pneumonia and/or pulmonary collapse distal to the cancer was present in 39 patients (45%). Obstructive pneumonia and/or pulmonary collapse is a common occurrence in bronchogenic carcinoma, but mediastinal nodes greater than or equal to 1 cm in this circumstance cannot be presumed to represent metastatic disease. Metastatic mediastinal lymph node involvement was related to nodal size also in patients with evidence of prior granulomatous disease and in patients with no putative benign cause for nodes greater than or equal to 1 cm.

Libshitz, H.I.; McKenna, R.J. Jr.

1984-10-01

100

Micrometastatic Breast Cancer Cells in Bone Marrow at Primary Surgery: Prognostic Value in Comparison With Nodal Status  

Microsoft Academic Search

Background: Approximately 30% of the patients with primary breast cancer who have no axillary lymph node in- volvement (i.e., lymph node negative) at the time of surgery will relapse within 10 years; 10% -20% of the patients with distant metastases will be lymph node negative at surgery. Axillary lymph node dissection, as a surgical procedure, is associated with frequent complications.

Ingo J. Diel; Manfred Kaufmann; Serban D. Costa; Erich F. Solomayer; Sepp Kaul; Gunther Bastert

101

A prospective comparative study to assess the contribution of radioisotope tracer method to dye-only method in the detection of sentinel lymph node in breast cancer  

PubMed Central

Background Metastasis in the axillary lymph nodes is the most important known prognostic factor for breast cancer. We aimed to investigate the contribution of the radioisotope tracer method to the dye-only method by performing sentinel lymph node biopsy on the same patient group during a single surgical session. Methods Forty-two patients who underwent operations in our clinic from February 2010 to October 2011 and with masses of <5 cm and clinically and radiologicallly negative axilla (T1-2 N0) were prospectively included in this study. After paraffin examination results were obtained, the numbers and metastatic states of the lymph nodes that were unidentifiable during surgery (although they were stained) but were detected by a gamma probe, lymph nodes that were only stained, lymph nodes that were only radioactive (hot), and lymph nodes that were both stained and radioactive (stained-hot) were determined in all patients. In patients who underwent axillary lymph node dissection, the total numbers of lymph nodes removed and their metastatic states were determined separately. Results At least one blue-stained sentinel lymph node was identified in all patients during the blue-stained lymph node detection stage. The average number of sentinel nodes removed at this stage was 2.1?±?1.1. In the second surgical stage (the stage in which nodes with axillary counts were investigated with the gamma probe) in these 41 patients, at least one additional hot node was removed, or at least one of the nodes that was removed because it was blue was also hot. In addition to the lymph nodes removed in the dye stage, 34 hot lymph nodes were excised from 21 patients. Overall, the average number of hot lymph nodes removed was 2.9?±?1.5. In all patients, subsequent frozen sections and histopathological examinations were 100% concordant with the sentinel lymph nodes that were removed; the stained sentinel lymph nodes that were removed first did not affect the decision to perform axillary dissection. Conclusion The results of our study indicate that performing sentinel lymph node biopsy with dye only is sufficient and as effective as the combined method. PMID:23617459

2013-01-01

102

Clinicopathologic subtypes and compromise of lymph nodes in patients with breast cancer  

PubMed Central

Breast cancer (BC) is currently a heterogeneous disease with variations in clinical behaviour. Classification according to subtypes has allowed progress in the individualisation of treatment. The objective of this study is to evaluate the risk of axillary node compromise in patients with BC, according to clinicopathologic subtypes. Materials and methods are a retrospective, descriptive-analytical study. All patients that had undergone surgery for invasive BC were included, with the study of sentinel lymph nodes (SLNs) at Hospital Clínico de la Pontificia Universidad Católica, between May 1999 and December 2012. The results showed 632 patients fulfilled the inclusion criteria, with the median age being 55 years (range: 28–95), and 559 (88.4%) patients presented with estrogen receptor and/or progesterone receptor positive tumours. Luminal A: 246 patients (38.9%), luminal B: 243 (38.4%), luminal not otherwise specified: 70 (11.1%) triple negative (TN): 60 (9.5%) and over expression of epidermal growth factor type 2 receptor (HER2 positive): 13 (2.1%). Luminal tumours displayed a greater risk of metastasis in the SLNs, but this difference was not statistically significant (p = 0.67). TN and HER2 positive tumours presented the greatest proportion of metastatic compromise in non-sentinel lymph nodes (non-SLNs) (57.1% and 50%, respectively). The presence of macrometastasis (MAM) in the SLN was associated with a greater risk of compromise of the non-SLN. Conclusions: Luminal tumours are the most frequent and present a greater proportion of axillary lymph node compromise, without being statistically significant. TN and HER2 positive tumours tend to have a higher axillary compromise; however, this was not statistically significant in either. Only the presence of MAM in SLNs displayed a statistically significantly association in the compromise of non-SLNs. PMID:25114720

Jaime Jans, B; Nicolás Escudero, M; Dahiana Pulgar, B; Francisco Acevedo, C; César Sánchez, R; Camus, A Mauricio

2014-01-01

103

Accuracy of intraoperative touch imprint cytologic analysis of sentinel lymph nodes in breast cancer  

Microsoft Academic Search

BackgroundEliminating full axillary dissection (AD) in the face of negative sentinel lymph nodes (SLN) has become increasingly popular. We sought to evaluate the accuracy of intraoperative touch imprint cytology in detecting clinically significant metastatic involvement of the SLN.

Tara Karamlou; Nathalie M Johnson; Benjamin Chan; Daisy Franzini; Diana Mahin

2003-01-01

104

99mTc-dextran lymphoscintigraphy can detect sentinel lymph node in breast cancer patients  

PubMed Central

The aim of this study was to retrospectively determine the accuracy and feasibility of using 99mTc-dextran (DX) lymphoscintigraphy for the localization of sentinel lymph nodes (SLNs) in breast cancer patients. The relevant factors affecting lymphoscintigraphy were also investigated. In this study, 235 breast cancer patients underwent 99mTc-DX lymphoscintigraphic imaging and examination by a ?-probe method in combination with blue dye staining to detect SLNs. The detection results were considered in combination with rapid frozen pathology results to determine whether SLN metastasis was positive or negative. SLNs were identified in 191 patients by ?-probe detection among the 202 patients that tested positive by lymphoscintigraphic imaging, a coincidence rate of 94.6%. This suggested that lymph node metastasis had occurred and could be detected using lymphoscintigraphy. The axillary status of the breast cancer patients was also predicted using lymphoscintigraphy and the false-negative rate, sensitivity, specificity and positive predictive value were 13.3% (4/30), 90.7% (39/43), 23.4% (45/192) and 13.5% (21/155), respectively. The age of the patient, menstrual status, tumor location, tumor size, pathological type, preoperative biopsy and neoadjuvant chemotherapy were unrelated to the success of lymphoscintigraphy (P>0.05). 99mTc-DX lymphoscintigraphy is able to exactly determine the location of SLN in breast cancer patients, and can be used for guiding ?-probe methods and sentinel lymph node biopsy. PMID:25452784

WEI, LINLIN; CHEN, FANGNI; ZHANG, XUEHUI; LI, DANGSHENG; YAO, ZHONGQIANG; DENG, LIYAN; XIAO, GUOYOU

2015-01-01

105

Race and age disparities in receipt of sentinel lymph node biopsy for early-stage breast cancer  

PubMed Central

To evaluate differences in use of sentinel lymph node biopsy (SLNB) by age and race in Medicare recipients with early-stage breast cancer, we examined Surveillance, Epidemiology and End Results—Medicare linked data for women undergoing breast conserving surgery for stage I or II breast cancer, including axillary staging, between January 2000 and December 2002. Multivariable generalized linear modeling with generalized estimating equations was used to identify predictors of receiving SLNB versus standard axillary lymph node dissection as the primary axillary staging modality. Women were significantly less likely to receive SLNB as their primary staging procedure if they were African American (OR 0.65), greater than 80 years of age (OR 0.71 vs. age <70), or dually eligible for Medicare and Medicaid (OR 0.61). Tumor characteristics, including well-differentiated histology and stage I disease, were associated with increased likelihood of SLNB, but estrogen receptor status was not a significant predictor. Women treated at an institution affiliated with an NCI cooperative research group had significantly greater likelihood of receiving SLNB (OR 2.31). Likelihood of receiving SLNB increased for women diagnosed in 2001 and 2002 compared with 2000. Significant disparities exist in receipt of SLNB in the Medicare population, with African Americans, the elderly, and economically disadvantaged patients being less likely to receive this innovative and morbidity-sparing procedure. These findings continue a previously observed pattern of reduced access to state of the art breast cancer care among underserved populations. PMID:21340480

Reeder-Hayes, Katherine E.; Bainbridge, John; Meyer, Anne Marie; Amos, Keith D.; Weiner, Bryan J.; Godley, Paul A.; Carpenter, William R.

2011-01-01

106

A Mammaglobin-A Targeting Agent for Non-invasive Detection of Breast Cancer Metastasis in Lymph Nodes  

PubMed Central

Pathologic axillary lymph node (ALN) status is an important prognostic factor for staging breast cancer. Currently, status is determined by histopathology following surgical excision of sentinel lymph node(s), which is an invasive, time consuming, costly and potentially morbid procedure. This work describes an imaging platform for the non-invasive assessment of ALN status, eliminating the need for operation in patients without nodal involvement. A targeted imaging probe (MamAb-680) was developed by conjugation of a mammaglobin-A specific monoclonal antibody to a near-infrared fluorescent dye. Using DNA and tissue microarray, mammaglobin-A was validated as a cell-surface target that is expressed in axillary lymph node positive patient samples but is not expressed in normal lymph nodes. In vivo selectivity was determined by intravenous injection of MamAb-680 into mice with mammaglobin-A positive and negative mammary fat pad (MFP) tumors; and by peritumoral MFP injection of the targeted imaging probe in mice with spontaneous ALN metastases. Fluorescence imaging showed that probe was only retained in positive tumors and metastases. As few as 1000 cells that endogenously express mammaglobin-A were detected in ALN indicating high sensitivity of this method. Hence, this approach has potential for translation into clinical use for the non-invasive staging of breast cancer. PMID:21169406

Tafreshi, NK; Enkemann, SA; Bui, MM; Lloyd, MC; Abrahams, D; Huynh, AS; Kim, J; Grobmyer, SR; Carter, WB; Vagner, J; Gillies, RJ; Morse, DL

2014-01-01

107

Surgery for Breast Cancer in Men  

MedlinePLUS

... seroma (buildup of clear fluid in the wound). Lymph node surgery To determine if the breast cancer has ... bloodstream to other parts of the body. Axillary lymph node dissection (ALND) In this procedure, anywhere from about ...

108

Increased Lymph Node Yield in Colorectal Cancer Is Not Necessarily Associated with a Greater Number of Lymph Node Positive Cancers  

PubMed Central

The presence of lymph node metastasis is a key prognostic factor in colorectal cancer and lymph node yield is an important parameter in assessing the quality of histopathology reporting of colorectal cancer excision specimens. This study assesses the trend in lymph node evaluation over time in a single institution and the relationship with the identification of lymph node positive tumours. It compares the lymph node yield of a contemporary dataset compiled from the histopathology reports of 2178 patients who underwent surgery for primary colorectal cancer between 2005 and 2012 with that of a historic dataset compiled from the histopathology reports of 1038 patients who underwent surgery for colorectal cancer at 5 yearly intervals from 1975 to 2000. The mean lymph node yield was 14.91 in 2005 rising to 21.38 in 2012. In 2012 92.9% of all cases had at least 12 lymph nodes examined. Comparison of the mean lymph node yield and proportion of Dukes C cases shows a significant increase (Pearson correlation?=?0.927, p?=?0.001) in lymph node yield while there is no corresponding significant trend in the proportion of Dukes C cases (Pearson correlation?=??0.138, p?=?0.745). This study shows that there is increasing yield of lymph nodes from colorectal cancer excision specimens. However, this is not necessarily associated with an increase number of lymph node positive cancers. Further risk stratifying of colorectal cancer requires consideration of other pathological parameters especially the presence of extramural venous invasion and relevant biomarkers. PMID:25118594

O'Shea, Aisling; Aly, Omar; Parnaby, Craig N.; Loudon, Malcolm A.; Samuel, Leslie M.; Murray, Graeme I.

2014-01-01

109

Prostate Cancer Metastatic to the Cervical Lymph Nodes  

PubMed Central

Prostate cancer is the most common cancer in men, often presenting with regional lymph node or bone metastasis and rarely with supradiaphragmatic lymph node involvement. Most metastatic cancers involving the cervical lymph nodes are from cancers of the upper aerodigestive tract. In this report, we describe two cases with cervical lymph node enlargement due to metastatic prostate cancer as the initial clinical presentation: a 43-year-old male, initially misdiagnosed with a tumor of the upper aerodigestive tract and an 87-year-old male with right lobe pneumonia and cervical lymph node enlargement, initially attributed to be an acute inflammatory lymph node reaction. To the best of our knowledge, there are less than 50 cases reported in the literature of adenocarcinoma of prostate metastatic to the cervical lymph nodes and only one case presenting in men younger than 45 years. The authors intend to highlight the importance of digital rectal exam and PSA test in case of persistent left cervical lymph node enlargement, including men younger than 45 years of age.

Sepúlveda, Luis; Gorgal, Tiago; Pires, Vanessa; Rodrigues, Filipe

2015-01-01

110

Anthracycline-based induction chemotherapy followed by concurrent cyclophosphamide, methotrexate and 5-fluorouracil and radiation therapy in surgically resected axillary node-positive breast cancer.  

PubMed

The present study aimed to determine the toxicity and efficacy of 4 courses of anthracyclines-taxane (AT) chemotherapy followed by radiation therapy (XRT) concurrent with cyclophosphamide, methotrexate and 5-fluorouracil (CMF) in surgically resected axillary node-positive (N+) breast cancer. A total of 200 women with N+ breast cancer were treated with adriamycin and docetaxel followed by XRT concurrent with six courses of CMF. Two courses of dose-dense chemotherapy with ifosfamide, carboplatin and etoposide, supported by pegfilgrastim, were administered to patients with >5 histologically confirmed axillary lymph node metastases and patients with triple-negative disease. Additional treatments included 1 year of trastuzumab in human epidermal growth factor receptor 2-positive patients, 5 years of a luteinizing hormone-releasing hormone analogue in premenopausal women and 5 years of an aromatase inhibitor (AI) in estrogen receptor-positive (ER+) patients. The mean number of positive axillary lymph nodes was 4.4 (range, 2-37), 52% of the patients were premenopausal, 74% were ER+ and 26% had triple-negative disease. After a median follow-up of 73 months, grade 2 and 3 hematological toxicity was observed in 20% of the patients. The 10-year disease-free survival (DFS) and overall survival (OS) rates were 73 and 77%, respectively. There was no significant difference in DFS between ER+ and estrogen receptor-negative (ER-) patients (P>0.05), whereas the OS was better in ER+ vs. ER- patients (P<0.05) and in premenopausal vs. postmenopausal patients (P<0.005). In conclusion, induction AT concurrent CMF and XRT and dose-dense chemotherapy followed by AI in N+ high-risk breast cancer was associated with a low level of systemic and late cardiac toxicity and excellent local control, DFS and OS. PMID:24772320

Recchia, Francesco; Candeloro, Giampiero; Cesta, Alisia; DI Staso, Mario; Bonfili, Pierluigi; Gravina, Giovanni Luca; DI Cesare, Ernesto; Necozione, Stefano; Rea, Silvio

2014-05-01

111

Anthracycline-based induction chemotherapy followed by concurrent cyclophosphamide, methotrexate and 5-fluorouracil and radiation therapy in surgically resected axillary node-positive breast cancer  

PubMed Central

The present study aimed to determine the toxicity and efficacy of 4 courses of anthracyclines-taxane (AT) chemotherapy followed by radiation therapy (XRT) concurrent with cyclophosphamide, methotrexate and 5-fluorouracil (CMF) in surgically resected axillary node-positive (N+) breast cancer. A total of 200 women with N+ breast cancer were treated with adriamycin and docetaxel followed by XRT concurrent with six courses of CMF. Two courses of dose-dense chemotherapy with ifosfamide, carboplatin and etoposide, supported by pegfilgrastim, were administered to patients with >5 histologically confirmed axillary lymph node metastases and patients with triple-negative disease. Additional treatments included 1 year of trastuzumab in human epidermal growth factor receptor 2-positive patients, 5 years of a luteinizing hormone-releasing hormone analogue in premenopausal women and 5 years of an aromatase inhibitor (AI) in estrogen receptor-positive (ER+) patients. The mean number of positive axillary lymph nodes was 4.4 (range, 2–37), 52% of the patients were premenopausal, 74% were ER+ and 26% had triple-negative disease. After a median follow-up of 73 months, grade 2 and 3 hematological toxicity was observed in 20% of the patients. The 10-year disease-free survival (DFS) and overall survival (OS) rates were 73 and 77%, respectively. There was no significant difference in DFS between ER+ and estrogen receptor-negative (ER?) patients (P>0.05), whereas the OS was better in ER+ vs. ER? patients (P<0.05) and in premenopausal vs. postmenopausal patients (P<0.005). In conclusion, induction AT concurrent CMF and XRT and dose-dense chemotherapy followed by AI in N+ high-risk breast cancer was associated with a low level of systemic and late cardiac toxicity and excellent local control, DFS and OS. PMID:24772320

RECCHIA, FRANCESCO; CANDELORO, GIAMPIERO; CESTA, ALISIA; DI STASO, MARIO; BONFILI, PIERLUIGI; GRAVINA, GIOVANNI LUCA; DI CESARE, ERNESTO; NECOZIONE, STEFANO; REA, SILVIO

2014-01-01

112

Genetic diagnosis of lymph-node metastasis in colorectal cancer  

Microsoft Academic Search

If a regional lymph node taken during surgery for colorectal cancer is found to be free of tumour on histological examination this is taken to be a good sign. However, conventional staining may not be sensitive enough. Mutant-allele-specific amplification (MASA) is a technique that can detect, at the level of an individual cell, micrometastases to lymph nodes that are histologically

N. Hayashi; I. Ito; Y. Nakamura; A. Yanagisawa; Y. Kato; S. Nakamori; S. Imaoka; H. Watanabe; M. Ogawa

1995-01-01

113

Intraoperative lymph scintigraphy during radical surgery for cervical cancer  

Microsoft Academic Search

Intraoperative lymph scintigraphy during radical surgery for cervical cancer was developed in the course of a program covering three periods. During the last period technetium-99m antimony sulfide has been used to visualize pelvic lymph nodes. Surgery is done with a modified gamma camera serving as an operating table. This ensures intraoperative monitoring and greater thoroughness of lymphadenectomy. The introduction of

E. Gitsch; K. Philipp; N. Pateisky

1984-01-01

114

Whole Genome Sequence Analysis Suggests Intratumoral Heterogeneity in Dissemination of Breast Cancer to Lymph Nodes  

PubMed Central

Background Intratumoral heterogeneity may help drive resistance to targeted therapies in cancer. In breast cancer, the presence of nodal metastases is a key indicator of poorer overall survival. The aim of this study was to identify somatic genetic alterations in early dissemination of breast cancer by whole genome next generation sequencing (NGS) of a primary breast tumor, a matched locally-involved axillary lymph node and healthy normal DNA from blood. Methods Whole genome NGS was performed on 12 µg (range 11.1–13.3 µg) of DNA isolated from fresh-frozen primary breast tumor, axillary lymph node and peripheral blood following the DNA nanoball sequencing protocol. Single nucleotide variants, insertions, deletions, and substitutions were identified through a bioinformatic pipeline and compared to CIN25, a key set of genes associated with tumor metastasis. Results Whole genome sequencing revealed overlapping variants between the tumor and node, but also variants that were unique to each. Novel mutations unique to the node included those found in two CIN25 targets, TGIF2 and CCNB2, which are related to transcription cyclin activity and chromosomal stability, respectively, and a unique frameshift in PDS5B, which is required for accurate sister chromatid segregation during cell division. We also identified dominant clonal variants that progressed from tumor to node, including SNVs in TP53 and ARAP3, which mediates rearrangements to the cytoskeleton and cell shape, and an insertion in TOP2A, the expression of which is significantly associated with tumor proliferation and can segregate breast cancers by outcome. Conclusion This case study provides preliminary evidence that primary tumor and early nodal metastasis have largely overlapping somatic genetic alterations. There were very few mutations unique to the involved node. However, significant conclusions regarding early dissemination needs analysis of a larger number of patient samples. PMID:25546409

Blighe, Kevin; Kenny, Laura; Patel, Naina; Guttery, David S.; Page, Karen; Gronau, Julian H.; Golshani, Cyrus; Stebbing, Justin; Coombes, R. Charles; Shaw, Jacqueline A.

2014-01-01

115

The optimal number of lymph nodes removed in maximizing the survival of breast cancer patients  

NASA Astrophysics Data System (ADS)

The number of lymph nodes removed is one of the important predictors for survival in breast cancer study. Our aim is to determine the optimal number of lymph nodes to be removed for maximizing the survival of breast cancer patients. The study population consists of 873 patients with at least one of axillary nodes involved among 1890 patients from the University of Malaya Medical Center (UMMC) breast cancer registry. For this study, the Chi-square test of independence is performed to determine the significant association between prognostic factors and survival status, while Wilcoxon test is used to compare the estimates of the hazard functions of the two or more groups at each observed event time. Logistic regression analysis is then conducted to identify important predictors of survival. In particular, Akaike's Information Criterion (AIC) are calculated from the logistic regression model for all thresholds of node involved, as an alternative measure for the Wald statistic (?2), in order to determine the optimal number of nodes that need to be removed to obtain the maximum differential in survival. The results from both measurements are compared. It is recommended that, for this particular group, the minimum of 10 nodes should be removed to maximize survival of breast cancer patients.

Peng, Lim Fong; Taib, Nur Aishah; Mohamed, Ibrahim; Daud, Noorizam

2014-07-01

116

Axillary Arch May Affect Axillary Lymphadenectomy  

PubMed Central

Summary Background The aim of this study was to identify the axillopectoral muscle anomaly commonly known as Langer's axillary arch, and to understand its importance in surgical procedures of the axilla. Patients and Methods Between 2009 and 2011, 758 patients underwent sentinel lymph node biopsy, axillary dissection, or both. Patients with Langer's axillary arch were identified and assessed retrospectively. The decision to cut or preserve the axillary arch was made based on clinical judgment, and patients were followed-up accordingly to monitor for adverse outcomes. Results Of the 758 patients who underwent axillary procedures, 9 (1.2%) were found to have a Langer's axillary arch. In 2 patients the arch was cut, and in 7 patients it was preserved. No adverse outcomes were identified in any of the patients upon follow-up. Conclusion Langer's axillary arch is a unique anatomic anomaly of the axillary region that may be problematic due to the potential risks of lymphedema and vascular or nerve compression. It is important for surgeons and radiologists alike to be aware of this anatomic variation in order to properly identify it and respond appropriately based on clinical judgment, and to complete close follow-up of the patient due to the potentially increased risk of adverse outcomes. PMID:24550750

Karanlik, Hasan; Fathalizadeh, Alisan; Ilhan, Burak; Serin, Kursat; Kurul, Sidika

2013-01-01

117

External compression dressing versus standard dressing after axillary lymphadenectomy  

Microsoft Academic Search

Background: Closed-catheter drainage after axillary lymph node dissection (ALND) for breast cancer may constitute a significant inconvenience to the recovering patient, and may also serve as portals of entry for bacteria. Any intervention that could reduce the volume and duration of postoperative drainage would be beneficial. The purpose of this study was to determine whether an external compression dressing after

Brian J O’Hea; May Nah Ho; Jeanne A Petrek

1999-01-01

118

An operative gamma camera for sentinel lymph node procedure in case of breast cancer  

NASA Astrophysics Data System (ADS)

Large field of view gamma cameras are widely used to perform lymphoscintigraphy in the sentinel lymph nodes (SLN) procedure in case of breast cancer. However, they are not specified for this application and their sizes do not enable their use in the operative room to control the excision of the all SLN. We present the results obtained with a prototype of a new mini gamma camera developed especially for the operative lymphoscintigraphy of the axillary area in case of breast cancer. This prototype is composed of 10 mm thick parallel lead collimator, a 2 mm thick GSO:Ce inorganic scintillating crystal from Hitachi and a Hamamatsu H8500 flat panel multianode (64 channels) photomultiplier tube (MAPMT) equipped with a dedicated electronics. Its actual field of view is 50 × 50mm2. The gamma interaction position in the GSO scintillating plate is obtained by calculating the center of gravity of the fired MAPMT channels. The measurements performed with this prototype demonstrate the usefulness of this mini gamma camera for the pre, per and post-operative identification of SLN's and how its complementary role with an intraoperative handheld gamma probe enables to improve the efficiency of this practice. A 100 × 100mm2 field of view camera designated to cover the entire axillary area is under investigation.

Salvador, S.; Bekaert, V.; Mathelin, C.; Guyonnet, J. L.; Huss, D.

2007-07-01

119

Reactivity of axillary lymph-nodes draining invasive breast carcinomas - immunohistochemical evidence of tumor-associated reactions of B-region and T-region.  

PubMed

The B and T regions in 495 axillary lymph nodes (TU-LN) draining 104 invasive breast carcinomas and 34 non-tumor-draining axillary/cervical lymph nodes (R-LN) were investigated immunohistochernically in frozen sections. The extents of the B regions and T regions were evaluated by staining with TO15 (CD22) and Leu-1 (CD5), respectively. Staining with Ki-M4, which specifically recognizes follicular dendritic cells, enabled determination of the number of lymphatic follicles. The germinal-center index (GCI), the numerical ratio of primary to secondary follicles, was determined to quantify the reactivity of the B regions. The number of Ki-67+ proliferating lymphoid cells per 0.5 mm(2) T region (PCT) was assessed as an index of the reactivity of the T regions. (i) In the TU-LN, the median GCI and PCT (0.1 and 18, respectively) were significantly lower than in the R-LN (0.6 and 26, respectively; both p<0.01). (ii) Greater TU-LN volumes were found to be associated with predominance of the T regions, high GCIs, and high PCTs. (iii) Higher GCIs and PCTs were associated with predominance of the T regions in TU-LN in general, but TU-LN partially destroyed by tumor metastases exhibited higher GCIs and PCTs when there was predominance of the B regions. The findings of the study show that LN draining breast carcinomas and reactive LN with signs of chronic nonspecific lymphadenitis exhibit significant immunohistochemical differences but it remains open to speculation whether the malignant tumor exerts suppressive effects on the lymphoreticular tissue or whether its antigenicity is low, particularly when compared with common, mostly infectious stimuli leading to chronic lymphadenitis. PMID:21607369

Horny, H; Horst, H

1994-03-01

120

How Many Sentinel Lymph Nodes Are Enough During Sentinel Lymph Node Dissection for Breast Cancer?  

PubMed Central

BACKGROUND It remains unclear how many sentinel lymph nodes (SLNs) must be removed to accurately predict lymph node status during SLN dissection in breast cancer. The objective of this study was to determine how many SLNs need to be removed for accurate lymph node staging and which patient and tumor characteristics influence this number. METHODS The authors reviewed data for all patients in their prospective database with clinical tumor, lymph node, metastasis (TNM) T1 through T3, N0, M0 breast cancer who underwent lymphatic mapping at their institution during the years 1994 through 2006. There were 777 patients who had at least 1 SLN that was positive for cancer. Simple and multiple quantile regression analyses were used to determine which patient and tumor characteristics were associated with the number of positive SLNs. The baseline number of SLNs that needed to be dissected for detection of 99% of positive SLNs in the total group of patients also was determined. RESULTS The mean number of SLNs removed in the 777 lymph node-positive patients was 2.9 (range, 1-13 SLNs). Greater than 99% of positive SLNs were identified in the first 5 lymph nodes removed. On univariate analysis, tumor histology, patient race, tumor location, and tumor size significantly affected the number of SLNs that needed to be removed to identify 99% of all positive SLNs. On multivariate analysis, mixed ductal and lobular histology, Caucasian race, inner quadrant tumor location, and T1 tumor classification significantly increased the number of SLNs that needed to be removed to achieve 99% recovery of all positive SLNs. CONCLUSIONS In general, the removal of a maximum of 5 SLNs at surgery allowed for the recovery of >99% of positive SLNs in patients with breast cancer. The current findings indicated that tumor histology, patient race, and tumor size and location may influence this number. PMID:18457326

Yi, Min; Meric-Bernstam, Funda; Ross, Merrick I.; Akins, Jeri S.; Hwang, Rosa F.; Lucci, Anthony; Kuerer, Henry M.; Babiera, Gildy V.; Gilcrease, Michael Z.; Hunt, Kelly K.

2015-01-01

121

Extracapsular tumor spread and the risk of local, axillary and supraclavicular recurrence in node-positive, premenopausal patients with breast cancer  

PubMed Central

Background: Extracapsular tumor spread (ECS) has been identified as a possible risk factor for breast cancer recurrence, but controversy exists regarding its role in decision making for regional radiotherapy. This study evaluates ECS as a predictor of local, axillary, and supraclavicular recurrence. Patients and methods: International Breast Cancer Study Group Trial VI accrued 1475 eligible pre- and perimenopausal women with node-positive breast cancer who were randomly assigned to receive three to nine courses of classical combination chemotherapy with cyclophosphamide, methotrexate, and fluorouracil. ECS status was determined retrospectively in 933 patients based on review of pathology reports. Cumulative incidence and hazard ratios (HRs) were estimated using methods for competing risks analysis. Adjustment factors included treatment group and baseline patient and tumor characteristics. The median follow-up was 14 years. Results: In univariable analysis, ECS was significantly associated with supraclavicular recurrence (HR?=?1.96; 95% confidence interval 1.23–3.13; P = 0.005). HRs for local and axillary recurrence were 1.38 (P = 0.06) and 1.81 (P = 0.11), respectively. Following adjustment for number of lymph node metastases and other baseline prognostic factors, ECS was not significantly associated with any of the three recurrence types studied. Conclusions: Our results indicate that the decision for additional regional radiotherapy should not be based solely on the presence of ECS. PMID:18385202

Gruber, G.; Cole, B. F.; Castiglione-Gertsch, M.; Holmberg, S. B.; Lindtner, J.; Golouh, R.; Collins, J.; Crivellari, D.; Thürlimann, B.; Simoncini, E.; Fey, M. F.; Gelber, R. D.; Coates, A. S.; Price, K. N.; Goldhirsch, A.; Viale, G.; Gusterson, B. A.

2008-01-01

122

Breast Cancer Surgery Now Often Involves Fewer Lymph Nodes  

MedlinePLUS

... sharing features on this page, please enable JavaScript. Breast Cancer Surgery Now Often Involves Fewer Lymph Nodes 2010 ... Preidt Friday, April 3, 2015 Related MedlinePlus Pages Breast Cancer Mastectomy FRIDAY, April 3, 2015 (HealthDay News) -- Compared ...

123

An improved axillary staging system using the OSNA assay does not modify the therapeutic management of breast cancer patients  

PubMed Central

The one-step nucleic acid amplification (OSNA) assay is a molecular procedure that can identify deposits of breast cancer (BC) cells in the sentinel lymph node (SLN). We examined the consistency of the OSNA assay with a classic hematoxylin-eosin (H&E)-based immunohistochemistry (IHC) study and evaluated how OSNA-based axillary staging might impact the therapeutic management of BC patients. SLN biopsy results were considered to be positive in 60 patients (40%) in the OSNA group (N = 148) and in 43 (28%) patients in the IHC cohort (N = 153, p = 0.023). There was no difference in the macrometastasis (22% for OSNA, 15% for H&E, p = 0.139) or micrometastasis (19% for OSNA, 13% for H&E, p = 0.166) rates, but we found statistically significant differences in the number of isolated tumor cells (1% for OSNA, 11% for H&E, p < 0.001). There were no differences in the administration rate of adjuvant systemic therapy between the OSNA (66% in the SLN+ patients) and the H&E (74% in the SLN+ patients) groups (p = 0.159). The OSNA assay allows for the detection of SLN metastases more precisely than conventional pathologic methods but does not alter the therapeutic management of SLN+ BC patients. PMID:25034150

Ruano, Miguel Alonso; Lopez-Bonet, Eugeni; Buxó, Maria; Tuca-Rodríguez, Francesc; Vila-Camps, Ester; Alvarez, Elena; Martin-Castillo, Begoña; Menendez, Javier A.

2014-01-01

124

Axillary dissection for breast carcinoma. The myth of skip metastasis.  

PubMed

The question of what constitutes an adequate axillary dissection for breast cancer remains open for debate. Central to this controversy is whether axillary nodal metastasis occurs in a stepwise fashion or spreads sporadically, creating skip metastases. The therapeutic aim of axillary dissection also must be considered. To resolve this controversy, a prospective study involving 129 patients who underwent complete axillary dissection for breast carcinoma was performed. The tissue from the axillary dissections was divided intraoperatively and sent to the pathologist as two specimens. The first specimen contained all nodes lateral to the pectoralis minor muscle (Level I), whereas the second contained all nodes beneath and medial to the pectoralis minor (Levels II and III). The tissue was analyzed to determine the frequency of skip metastasis. Only two patients, 1.6 per cent of the total group or 3.2 per cent of the positive node group, were found to have a positive node in Level II-III with no metastasis in Level I. A thorough dissection of Level I alone is sufficient to detect more than 98 per cent of all axillary lymph node metastases from breast cancer. Thus, proper staging of the disease can be obtained. When Level I contained positive nodes, the probability of metastatic disease to higher levels was significant (45%), indicating further treatment is necessary in incomplete axillary dissections. PMID:2729776

Lloyd, L R; Waits, R K; Schroder, D; Hawasli, A; Rizzo, P; Rizzo, J

1989-06-01

125

Number of Negative Lymph Nodes Can Predict Survival after Postmastectomy Radiotherapy According to Different Breast Cancer Subtypes  

PubMed Central

Purpose: To assess the prognostic value of the number of negative lymph nodes (NLNs) in breast cancer patients with positive axillary lymph nodes after mastectomy and its predictive value for radiotherapy efficacy of different breast cancer subtypes (BCS). Methods: The records of 1,260 breast cancer patients with positive axillary lymph nodes who received mastectomy between January 1998 and December 2007 were reviewed. The prognostic impact and predictive value of the number of NLNs with respect to locoregional recurrence-free survival (LRFS), disease-free survival (DFS), and overall survival (OS) were analyzed. Results: The median follow-up time was 58 months, and 444 patients (35.2%) received postmastectomy radiotherapy (PMRT). Univariate and multivariate Cox survival analysis indicated the number of NLNs was an independent prognostic factor of LRFS, DFS, and OS. Patients with a higher number of NLNs had better survival. PMRT improved the LRFS of patients with ? 8 NLNs ( p < 0.001), while failing to improve the LRFS of patients with > 8 NLNs (p = 0.075). In patients with luminal A subtype, PMRT improved the LRFS, DFS, and OS of patients with ? 8 NLNs, but in patients with > 8 NLNs only the LRFS was improved. For patients with luminal B subtype, PMRT only improved the LRFS of patients with ? 8 NLNs. The number of NLNs had no predictive value for the efficacy with PMRT in Her2+ and triple-negative subtypes. Conclusions: The number of NLNs is a prognostic indicator in patients with node-positive breast cancer, and it can predict the efficacy of PMRT according to different BCS. PMID:25663944

Wu, San-Gang; Peng, Fang; Zhou, Juan; Sun, Jia-Yuan; Li, Feng-Yan; Lin, Qin; Lin, Huan-Xin; Bao, Yong; He, Zhen-Yu

2015-01-01

126

Long-term outcomes in breast cancer patients with ten or more positive axillary nodes treated with combined-modality therapy: The importance of radiation field selection  

SciTech Connect

Purpose: To determine the long-term outcome of a consistent treatment approach with electron beam postmastectomy radiation therapy (PMRT) in breast cancer patients with {>=}10 positive nodes treated with combined-modality therapy. Methods and Materials: TSixty-three breast cancer patients with {>=}10 positive lymph nodes were treated with combined-modality therapy using an electron beam en face technique for PMRT at University of Florida. Patterns of recurrence were studied for correlation with radiation fields. Potential clinical and treatment variables were tested for possible association with local-regional control (LRC), disease-free survival (DFS), and overall survival (OS). Results: TAt 5, 10, and 15 years, OS rates were 57%, 36%, and 27%, respectively; DFS rates were 46%, 37%, and 34%; and LRC rates were 87%, 87%, and 87%. No clinical or treatment variables were associated with OS or DFS. The use of supplemental axillary radiation (SART) (p = 0.012) and pathologic N stage (p = 0.053) were associated with improved LRC. Patients who received SART had a higher rate of LRC than those who did not. Moderate to severe arm edema developed in 17% of patients receiving SART compared with 7% in patients not treated with SART (p = 0.28). Conclusions: TA substantial percentage of patients with {>=}10 positive lymph nodes survive breast cancer. The 10-year overall survival in these patients was 36%. The addition of SART was associated with better LRC.

Chang, Daniel T. [Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL (United States); Feigenberg, Steven J. [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States); Indelicato, Daniel J. [Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL (United States); Morris, Christopher G. [Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL (United States); Lightsey, Judith [Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL (United States); Grobmyer, Stephen R. [Department of Surgery, University of Florida College of Medicine, Gainesville, FL (United States); Copeland, Edward M. [Department of Surgery, University of Florida College of Medicine, Gainesville, FL (United States); Mendenhall, Nancy P. [Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL (United States)]. E-mail: mendenan@shands.ufl.edu

2007-03-15

127

Sentinel lymphnode biopsy in early breast cancer using methylene blue dye and radioactive sulphur colloid — a single institution Indian experience  

Microsoft Academic Search

Background  Axillary lymph node dissection is an established procedure in breast cancer staging. However, it is associated with unpleasant\\u000a side effects. A promising alternative to assess axillary lymph node status in early breast cancer patients is Sentinel Lymph\\u000a Node Biopsy (SLNB). Isosulfan blue has traditionally been the dye used to identify the Sentinel Lymph Node (SLN). This article\\u000a is a validation

S. P. Somashekhar; S. Zaveri Shabber; K. Udupa Venkatesh; K. Venkatachala; Parameshwaran; M. M. Vasan Thirumalai

2008-01-01

128

[Clinical application of biopsy of the sentinel lymph node in breast carcinoma].  

PubMed

Sentinel lymph node (SN) biopsy in primary breast cancer seems to be an alternative to complete axillary lymph node dissection for evaluation of the axillary lymph node status in selected patients. Following evaluation of the technique of SN biopsy, we applied SN biopsy clinically to 23 selected patients. A lymphoscintigraphy was performed preoperatively to evaluate lymphatic drainage. The SN was identified in the operating room by use of a hand-held gamma camera and a blue vital dye. The SN was found in all 23 patients. In 17/23 the SN was tumor free and no axillary dissection was performed; 6/23 showed a positive SN and complete axillary dissection was done. Intraoperative lymphatic mapping and SN biopsy may be the treatment of choice for evaluation of axillary node status in selected patients, for it combines accurate nodal staging and low morbidity. PMID:9833188

Schrenk, P; Hatzl, M; Rieger, R; Shamiyeh, A; Wayand, W; Maschek, W

1998-10-01

129

Subtype Is a Predictive Factor of Nonsentinel Lymph Node Involvement in Sentinel Node-Positive Breast Cancer Patients  

PubMed Central

Purpose This study aimed to identify the effect of breast cancer subtype on nonsentinel lymph node (NSLN) metastasis in patients with a positive sentinel lymph node (SLN). Methods The records of 104 early breast cancer patients with a positive SLN between April 2009 and September 2013 were retrospectively evaluated. All patients underwent axillary lymph node dissection. The effects of the tumor subtype (luminal A, luminal/HER2+, human epidermal growth factor receptor 2 [HER2] overexpression, and triple-negative) and other clinicopathological factors on NSLN metastasis were examined by univariate and multivariate statistical analyses. Results Fifty of 104 patients (48%) exhibited NSLN metastasis. Univariate and multivariate analyses revealed that tumor size and the ratio of positive SLNs were significant risk factors of NSLN metastasis in patients with a positive SLN. The rate of NSLN metastasis was higher in patients with luminal/HER2+ and HER2 overexpression subtypes than that in patients with other subtypes in the univariate analysis (p<0.001). In the multivariate analysis, both patients with luminal/HER2+ (p<0.006) and patients with HER2 overexpression (p<0.031) subtypes had a higher risk of NSLN metastasis than patients with the luminal A subtype. Conclusion Subtype classification should be considered as an independent factor when evaluating the risk of NSLN metastasis in patients with a positive SLN. This result supports the development of new nomograms including breast cancer subtype to increase predictive accuracy. PMID:25548586

Berbero?lu, U?ur; Aydo?an, Ogün; K?na?, Volkan

2014-01-01

130

The 70-gene prognosis-signature predicts disease outcome in breast cancer patients with 1–3 positive lymph nodes in an independent validation study  

Microsoft Academic Search

Purpose The 70-gene prognosis-signature has shown to be a valid prognostic tool in node-negative breast cancer. Although axillary\\u000a lymph node status is considered to be one of the most important prognostic factors, still 25–30% of node-positive breast cancer\\u000a patients will remain free of distant metastases, even without adjuvant systemic therapy. We therefore investigated whether\\u000a the 70-gene prognosis-signature can accurately identify

Stella Mook; Marjanka K. Schmidt; Giuseppe Viale; Giancarlo Pruneri; Inge Eekhout; Arno Floore; Annuska M. Glas; Jan Bogaerts; Fatima Cardoso; Martine J. Piccart-Gebhart; Emiel T. Rutgers; Laura J. van’t Veer

2009-01-01

131

A Long-Term Study of Radiation Therapy in T1-2 Node-Negative Breast Cancer Patients in Relation to the Number of Axillary Nodes Examined  

SciTech Connect

Purpose: The optimal number of axillary nodes to be resected is controversial. This large series investigated the effect of surgery with or without adjuvant radiotherapy among node-negative breast cancer patients in relation to the number of nodes examined. Methods and Materials: Node-negative patients from the Saskatchewan registry of 1981-1995 were studied. Because nodal status may be more reliable with more number of nodes examined, we analyzed T1-2 age < 90 patients with < 10 nodes examined treated with surgery alone (Group A{sub S}, n = 509) vs. surgery and adjuvant radiotherapy (Group A{sub S}+R, n = 342); and T1-2 age < 90 patients with {>=} 10 nodes examined treated with surgery alone (Group B{sub S}, n = 902) vs. surgery and adjuvant radiotherapy (Group B{sub S}+R, n = 596). Results: For the two radiotherapy groups, patients with < 10 nodes (Group A{sub S}+R) vs. {>=} 10 nodes (Group B{sub S}+R), there was no difference in overall survival (p = 0.14). In the two nonradiotherapy groups (A{sub S} and B{sub S}), there is a statistically significant decrease in overall survival for patients with < 10 nodes removed (p < 0.001, log-rank test). The optimal number of axillary nodes examined could be 8 nodes with adjuvant radiotherapy (p = 0.05, logrank test) and 12 nodes without adjuvant radiotherapy (p = 0.02, log-rank test). Conclusions: The poorer prognosis of a lesser number of nodes resected was overcome partly by the use of radiotherapy, raising the possibility of micrometastases in lymph nodes not removed. The optimal number of axillary nodes examined could be 8 nodes with adjuvant radiotherapy and 12 nodes without adjuvant radiotherapy.

Tai, Patricia [Department of Oncology, Allan Blair Cancer Center, University of Saskatchewan (Canada)], E-mail: ptai2@yahoo.com; Yu, Edward [Radiation Oncology Division, Department of Oncology, University of Western Ontario (Canada); Sadikov, Evgeny [Department of Oncology, Allan Blair Cancer Center, University of Saskatchewan (Canada); Joseph, Kurian [Department of Radiation Oncology, Cross Cancer Institute, University of Alberta (Canada)

2009-06-01

132

Intraoperative lymph scintigraphy during radical surgery for cervical cancer  

SciTech Connect

Intraoperative lymph scintigraphy during radical surgery for cervical cancer was developed in the course of a program covering three periods. During the last period technetium-99m antimony sulfide has been used to visualize pelvic lymph nodes. Surgery is done with a modified gamma camera serving as an operating table. This ensures intraoperative monitoring and greater thoroughness of lymphadenectomy. The introduction of the technique has improved the rate of total lymphadenectomies and has increased both the yields of involved nodes and the 3-yr survival rates.

Gitsch, E.; Philipp, K.; Pateisky, N.

1984-04-01

133

Seven synchronous early gastric cancer with 28 lymph nodes metastasis  

PubMed Central

An 85 year male patient complaining epigastric discomfort was admitted. From the esophagogastroduodenoscopy, three early gastric cancer (EGCa) lesions had been identified and these were diagnosed as adenocarcinoma with poorly differentiated cell type. The patient underwent operation. From the post-operative mapping, however, additional 4 EGCa lesions were found, and the patient was diagnosed with 7 synchronous EGCa. Out of the 7 EGCa lesions, 6 had shown invasion only to the mucosal layer and one had shown invasion into the 1/3 layer of submucosa. In spite of such superficial invasions, 28 of 48 lymph nodes had been identified as metastases. The multiple lesions of EGCa do not increase the risk of lymph node metastasis, but if their differentiations are poor or if they have lympho-vascular invasion, multiple lymph node metastases could incur even if the depth of invasion is limited to the mucosal layer or the upper portion of the submucosal layer. PMID:24307810

Seong, Hyeonjin; Kim, Jin Il; Lee, Hyun Jeong; Kim, Hyun Jin; Cho, Hyung Joon; Kim, Hye Kang; Cheung, Dae Young; Kim, Dong Jin; Kim, Wook; Kim, Tae-Jung

2013-01-01

134

Mapping sentinel lymph node in breast cancer by combined lymphoscintigraphy, blue-dye, and intraoperative gamma-probe.  

PubMed

The purpose of the present work was two-fold: 1) to evaluate the predictive value of the sentinel lymph node (sLN) versus the axillary-node status in patients with T1-T2 breast cancer, and 2) to form an experimental basis for a randomized trial in which one group of patients with non-metastatic sLN will not have axillary dissection. Of a group of 284 patients considered for this analysis, 264 had a T1 cancer (16 T1a, 37 T1b and 211 T1c), while 20 had a T2 cancer; 243 patients were in clinical stage N0 and 41 were N1. All patients underwent lymphoscintigraphy 18 hr before surgery: 10 MBq in 0.15 mL of 99mTc-human albumin nanocolloids (particle size between 50-80 nm) was injected subdermally at the cutaneous projection of the tumor. Static gamma-camera images were acquired every 10-15 minutes until scintigraphic identification of the sLN. At surgery, 1-2 mL of Patent-Blue Violet was injected subdermally, and the sLN was searched by gamma-probe and by the dye method. The surgically isolated sLN was processed for intraoperative Hematoxylin & Eosin (H&E) histology, then for delayed histological and immunohistochemical examinations. The sLN was successfully identified by the combined radioisotopic procedure and Patent-Blue dye technique in 278/284 cases (97.9%). The Patent-Blue dye technique alone identified fewer sLNs than the radioisotopic procedure alone (56.3% versus 97.2%). Analysis of the predictive value of the sLN as to the status of axillary lymph nodes was limited to 197 patients undergoing standard axillary dissection irrespective of the sLN status. Overall, 63/191 (33%) identified sLNs were metastatic, the sLN alone being involved in 37/63 (58.7%) patients; a positive axilla status with negative sLN was found in 10/73 patients with metastatic involvement (13.7% false-negative rate). In conclusion, subdermal lymphoscintigraphy was confirmed to be an effective technique for sLN mapping; the addition of Patent-Blue dye minimally improved intra-surgical identification of the sLN. There was a high, but not absolute, correlation between a negative sLN and a negative axilla. PMID:10941531

Mariani, G; Villa, G; Gipponi, M; Bianchi, P; Buffoni, F; Agnese, G; Vecchio, C; Tomei, D; Carli, F; Nicolò, G; Canavese, G

2000-06-01

135

[Gastric cancer--Japanese Classification, sentinel lymph nodes and lymph dissection].  

PubMed

The aim of Japanese Classification is to provide a common language for the clinical and pathological description of gastric cancer and thereby contribute to continued research and improvements in treatment and diagnosis. Lymph-node dissection has been regarded as an effective surgical treatment for gastric cancer in Japan. It reduces local recurrences and improves survival rate. Japanese-style systematic D2 lymphadenectomy is now being introduced in western countries for treatment of gastric cancer. This surgical procedure, however, is not simple and shoul be performed by experienced surgeons. And it is too early to apply sentinel node biopsy for reducing extent of lymphadenectomy because of so complicated lymphatic streams from the stomach and frequent skip- and micrometastases. PMID:20509523

Jarumov, N; Angelov, K; Toshev, S; Sokolov, M

2009-01-01

136

Pathology evaluation of sentinel lymph nodes in breast cancer: protocol recommendations and rationale.  

PubMed

Sentinel lymph nodes (SLN) are more likely to contain metastatic breast carcinoma than non-SLNs. The limited number of SLNs compared with an axillary dissection has prompted more comprehensive lymph node analysis increasing detection of micrometastases. National data show that many women previously classified node negative are now classified minimally node positive. As a result, our nodal classification and cancer staging have evolved to recognize the continuum of nodal tumor burden rather than a simplistic dichotomous stratification. It is quite clear that the more sections we evaluate from SLNs the more metastases we identify; however, it is impractical to expect the practicing pathologist to mount, stain, and microscopically examine every section through the SLN paraffin blocks. Despite recommendations from the College of American Pathologists and the American Society of Clinical Oncology, heterogeneity in the approach to SLN evaluation exists. What is needed is adherence to a standardized evaluation protocol. The most important aspect of the sentinel node examination is careful attention to slicing the SLN no thicker than 2.0 mm and correct embedding of the slices to assure we identify all macrometastases larger than 2.0 mm. A single section from blocks prepared in this manner will identify all macrometastases present but smaller metastases will be missed. The prognostic significance of these missed micrometastases is still being evaluated as we await SLN outcome studies. In the context of the new molecular classification of breast cancer, subgroups may be identified where detection of micrometastases has clinical significance. It is critical that both clinicians and pathologists understand there is a random component to micrometastasis distribution within the three-dimensional paraffin tissue blocks. If we ultimately adopt more comprehensive microscopic evaluation of SLNs, the candidate sampling strategies need to be carefully considered in the context of statistically valid sampling strategies. PMID:20436499

Weaver, Donald L

2010-05-01

137

Dye and gamma probe-guided sentinel lymph node biopsy in breast cancer patients: using patent blue dye and technetium-99m-labeled human serum albumin  

Microsoft Academic Search

Background  Sentinel lymph node (SLN) biopsy is a promising method for the diagnosis of the axillary nodal status. We examined the availability\\u000a of the SLN biopsy using two mapping procedures: the dye- and gamma probe-guided method, and preoperative lymphoscintigraphy\\u000a by gamma camera imaging.\\u000a \\u000a \\u000a \\u000a Methods  We enrolled 48 patients with breast cancer. Technetium-99m-labeled human serum albumin was injected into the subdermal tissue\\u000a above

Koichiro Tsugawa; Masakuni Noguchi; Koichi Miwa; Etsuro Bando; Kunihiko Yokoyama; Ken-ichi Nakajima; Takatoshi Michigishi; Norihisa Tonami; Hiroshi Minato; Akitaka Nonomura

2000-01-01

138

Curative use of forequarter amputation for recurrent breast cancer over an axillary area: a case report and literature review.  

PubMed

Axillary recurrence of breast cancer that involves the brachial neurovascular bundle is uncommon. However, for many patients with such recurrence, forequarter amputation can play a palliative role in relieving excruciating pain and paralysis of the upper limb. Further, for those patients who do not have distant metastasis or other local-regional recurrence, forequarter amputation provides a chance for a cure. Only a few case reports of curative amputations for recurrent breast cancer are present in the literature. Here, we report a case of forequarter amputation for curative treatment of axillary recurrent breast cancer, together with a literature review. To date, we have followed the patient for three years after amputation, during which there has been no evidence of recurrence or metastasis. Although radical resection is feasible, it can be accompanied by surgical wound complications and psychosocial stress. Therefore, an organized multidisciplinary approach is needed to ensure the success of radical resection. PMID:25407045

Tsai, Chun-Hao; Tzeng, Huey-En; Juang, Wei-Kae; Chu, Pei-Guo; Fann, Patricia; Fong, Yi-Chin; Hsu, Horng-Chaung; Yen, Yun

2014-01-01

139

Clinical significance of lymph node micrometastasis in gastric cancer.  

PubMed

Recently, the existence of lymph node micrometastasis (LNM), including isolated tumor cells, has been focused on during the development of molecular diagnostic tools for lymph node metastasis in various malignant neoplasms. In particular, immunohistochemistry and reverse transcription-polymerase chain reaction have been reported to be available for the detection of LNM in gastric cancer. However, at present, the clinical significance of LNM remains unclear in patients with gastric cancer. Therefore, we cannot strategically make light of this issue in clinical management. Currently, minimally invasive treatments, such as endoscopic submucosal dissection and laparoscopic surgery with personalized lymphadenectomy, are widely performed in consideration of postsurgical quality of life (QOL). However, it is important to maintain the balance between QOL and curability when selecting surgical treatments for patients with gastric cancer. If minimally invasive surgery based on LNM status was established for patients with early gastric cancer, it could be performed safely. We reviewed the clinical significance of LNM as an important strategic target in patients with gastric cancer. PMID:22546997

Arigami, Takaaki; Uenosono, Yoshikazu; Yanagita, Shigehiro; Nakajo, Akihiro; Ishigami, Sumiya; Okumura, Hiroshi; Kijima, Yuko; Ueno, Shinichi; Natsugoe, Shoji

2013-02-01

140

Sentinel lymph node navigation surgery for early stage gastric cancer  

PubMed Central

We attempted to evaluate the history of sentinel node navigation surgery (SNNS), technical aspects, tracers, and clinical applications of SNNS using Infrared Ray Electronic Endoscopes (IREE) combined with Indocyanine Green (ICG). The sentinel lymph node (SLN) is defined as a first lymph node (LN) which receives cancer cells from a primary tumor. Reports on clinical application of SNNS for gastric cancers started to appear since early 2000s. Two prospective multicenter trials of SNNS for gastric cancer have also been accomplished in Japan. Kitagawa et al reported that the endoscopic dual (dye and radioisotope) tracer method for SN biopsy was confirmed acceptable and effective when applied to the early-stage gastric cancer (EGC). We have previously reported the usefulness of SNNS in gastrointestinal cancer using ICG as a tracer, combined with IREE (Olympus Optical, Tokyo, Japan) to detect SLN. LN metastasis rate of EGC is low. Hence, clinical application of SNNS for EGC might lead us to avoid unnecessary LN dissection, which could preserve the patient’s quality of life after operation. The most ideal method of SNNS should allow secure and accurate detection of SLN, and real time observation of lymphatic flow during operation. PMID:24914329

Mitsumori, Norio; Nimura, Hiroshi; Takahashi, Naoto; Kawamura, Masahiko; Aoki, Hiroaki; Shida, Atsuo; Omura, Nobuo; Yanaga, Katsuhiko

2014-01-01

141

Predictors of recurrence in breast cancer subtypes with negative lymph node in a Chinese population  

PubMed Central

To establish a series of objective parameters to predict the risk of relapse from axillary lymph node-negative (ANN) breast cancer, and evaluate the patterns of recurrence according to molecular subtypes, we collected information on 2126 consecutive breast cancer patients operated between 2002 and 2006. In this case-control study, 212 patients experiencing recurrence or breast cancer related death were defined as ‘poor group’. Another 212 patients were selected from the remaining cases with stratified sampling method to comprise the ‘good group’. Significant differences were found in vascular invasion, grade and molecular subtype between the two groups. Expression of ER and PR in the ‘poor group’ was lower (P < 0.05). However, positive rates of Ki67, p53 and VEGF in the ‘poor group’ were higher (P < 0.05). Multivariate analysis revealed that molecular subtype, expression of VEGF, tumor grade, and vascular invasion were closely correlated with bad outcome. Analysis of the ‘poor group’ demonstrated that ‘HER2 positive’ and ‘triple negative’ subtypes more commonly suffered from distant metastases and death. No metastasis was found in patients with pure invasive papillary carcinoma, invasive cribriform carcinoma or adenoid cystic carcinoma, whereas the diagnoses of invasive micropapillary carcinoma, invasive apocrine carcinoma, invasive papillary carcinoma mixed with invasive ductal carcinoma, or metaplastic carcinoma were correlated with distant metastasis and death. In conclusion, molecular subtype and expression of VEGF are useful markers for predicting prognosis of ANN breast cancer patients. ‘Luminal A-like’ subtype has better outcome than others. Moreover, molecular subtypes have different recurrence patterns. PMID:25031741

Liu, Xia; Guan, Yong; Zhang, Wei; Liu, Shan; Liu, Junjun; Wang, Li; Niu, Yun

2014-01-01

142

Effect of local bleomycin sulfate application on seroma formation in a rat mastectomy and axillary lymph node dissection model.  

PubMed

Seroma formation is one of the most common complications following breast cancer surgery. It may lead to delay of adjuvant therapies and increasement of therapy costs. Bleomycin sulfate is a sclerosing antibiotic with antineoplastic efficacy. It is locally used in the treatment of pleural effusion. The present study aimed to investigate seroma-reducing effect of local bleomycin application after mastectomy. Sixteen female Wistar Albino rats were used in this study. The rats were divided into two equal groups. Under general anesthesia all rats underwent unilateral mastectomy as definition by Harada. Serum physiologic was applied to animals in Group 1 (control group) and bleomycin to Group 2. Mastectomized localization was explored on the 10th day postoperatively. Seroma and tissue samples were obtained from axilla and thoracic wall for histopathological examination. The amount of seroma was significantly lower in the bleomycin group as compared to the control group (P=0.002). Fibrosis, PNL infiltration and the number of fibroblasts were significantly higher in the bleomycin group. No difference was identified between the groups in terms of angiogenesis, edema, congestion, and monocyte, lymphocyte and macrophage infiltration. Local bleomycin sulfate application might be a therapeutic option in patients with seroma formation, as well as in the patients with malignant pleural effusion. Nonetheless, further studies that compare the efficacy and adverse effects (benefit-to-harm ratio) of bleomycin sulfate are needed. PMID:24231620

Eser, Mehmet; Gökçeimam, Mehmet; Eyvaz, Kemal; Tutal, F?rat; Geçer, Melin Özgün; Gökta?, Selçuk; Uzun, Hüseyin; Kaptanoglu, Levent; Kurt, N

2014-01-15

143

Predicting Likelihood of Having Four or More Positive Nodes in Patient With Sentinel Lymph Node-Positive Breast Cancer: A Nomogram Validation Study  

SciTech Connect

Purpose: Katz suggested a nomogram for predicting having four or more positive nodes in sentinel lymph node (SLN)-positive breast cancer patients. The findings from this formula might influence adjuvant radiotherapy decisions. Our goal was to validate the accuracy of the Katz nomogram. Methods and Materials: We reviewed the records of 309 patients with breast cancer who had undergone completion axillary lymph node dissection. The factors associated with the likelihood of having four or more positive axillary nodes were evaluated in patients with one to three positive SLNs. The nomogram developed by Katz was applied to our data set. The area under the curve of the corresponding receiver operating characteristics curve was calculated for the nomogram. Results: Of the 309 patients, 80 (25.9%) had four or more positive axillary lymph nodes. On multivariate analysis, the number of positive SLNs (p < .0001), overall metastasis size (p = .019), primary tumor size (p = .0001), and extracapsular extension (p = .01) were significant factors predicting for four or more positive nodes. For patients with <5% probability, 90.3% had fewer than four positive nodes and 9.7% had four or more positive nodes. The negative predictive value was 91.7%, and sensitivity was 80%. The nomogram was accurate and discriminating (area under the curve, .801). Conclusion: The probability of four or more involved nodes is significantly greater in patients who have an increased number of positive SLNs, increased overall metastasis size, increased tumor size, and extracapsular extension. The Katz nomogram was validated in our patients. This nomogram will be helpful to clinicians making adjuvant treatment recommendations to their patients.

Unal, Bulent; Gur, Akif Serhat [Department of Surgical Oncology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA (United States); Beriwal, Sushil [Department of Radiation Oncology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA (United States); Tang Gong [Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA (United States); Johnson, Ronald; Ahrendt, Gretchen; Bonaventura, Marguerite [Department of Surgical Oncology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA (United States); Soran, Atilla, E-mail: asoran@magee.ed [Department of Surgical Oncology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA (United States)

2009-11-15

144

Mayo Clinic study finds less invasive surgery detects residual breast cancer in lymph nodes after chemotherapy  

Cancer.gov

Most patients whose breast cancer has spread to their lymph nodes have most of the lymph nodes in their armpit area removed after chemotherapy to see if any cancer remains. A study conducted through the American College of Surgeons Oncology Group and led by the Mayo Clinic shows that a less invasive procedure known as sentinel lymph node surgery successfully identified whether cancer remained in lymph nodes in 91 percent of patients with node-positive breast cancer who received chemotherapy before their surgery. In sentinel lymph node surgery, only a few lymph nodes, the ones most likely to contain cancer, are removed. The findings are being presented at the 2012 CTRC-AACR San Antonio Breast Cancer Symposium.

145

Lymph node harvest in colon and rectal cancer: Current considerations  

PubMed Central

The prognostic significance of identifying lymph node (LN) metastases following surgical resection for colon and rectal cancer is well recognized and is reflected in accurate staging of the disease. An established body of evidence exists, demonstrating an association between a higher total LN count and improved survival, particularly for node negative colon cancer. In node positive disease, however, the lymph node ratios may represent a better prognostic indicator, although the impact of this on clinical treatment has yet to be universally established. By extension, strategies to increase surgical node harvest and/or laboratory methods to increase LN yield seem logical and might improve cancer staging. However, debate prevails as to whether or not these extrapolations are clinically relevant, particularly when very high LN counts are sought. Current guidelines recommend a minimum of 12 nodes harvested as the standard of care, yet the evidence for such is questionable as it is unclear whether an increasing the LN count results in improved survival. Findings from modern treatments, including down-staging in rectal cancer using pre-operative chemoradiotherapy, paradoxically suggest that lower LN count, or indeed complete absence of LNs, are associated with improved survival; implying that using a specific number of LNs harvested as a measure of surgical quality is not always appropriate. The pursuit of a sufficient LN harvest represents good clinical practice; however, recent evidence shows that the exhaustive searching for very high LN yields may be unnecessary and has little influence on modern approaches to treatment. PMID:22347537

McDonald, James R; Renehan, Andrew G; O’Dwyer, Sarah T; Haboubi, Najib Y

2012-01-01

146

Can methylene blue dye be used as an alternative to patent blue dye to find the sentinel lymph node in breast cancer surgery?  

PubMed Central

Background: Sentinel lymph node biopsy (SLNB) is standard care to evaluate axillary involvement in early breast cancer. It has fewer complications than complete lymph node dissection; however, using blue dye in SLNB is controversial. We have evaluated the detection rate and local complications associated with methylene blue dye (MBD) used in SLNB in early breast cancer patients and compared these results to patent blue dye (PBD). Materials and Methods: In a cohort prospective study, 312 patients with early breast cancer without axillary lymph node involvement were divided into two groups according to dye type. All of the patients received radiotracer and one type of blue dye. We filled out a checklist for the patients that contained demographic data, size of tumor, stage, detection of sentinel lymph node, and complications and then analyzed the data. Results: Demographic and histopathologic characteristics were not significantly different in both groups. Mean (standard deviation [SD]) tumor size in all patients was 2.4 (0.8) cm. Detection rate in the MBD group was 77.5% with dye alone and 94.2% with dye and radioisotope; and in the PBD group it was 80.1% and 92.9% respectively (P > 0.05). We had blue discoloration of the skin in 23.7% in the PBD and 14.1% in the MBD group (P < 0.05) local inflammation was detected in one patient in the PBD and five in the MBD group (P < 0.05). Skin necrosis and systemic complications were not observed. Conclusion: Methylene blue has an acceptable detection rate, which may be a good alternative in SLNB. Complication such as blue discoloration of the skin was also lower with MBD. PMID:25538772

Fattahi, Asieh Sadat; Tavassoli, Alireza; Rohbakhshfar, Omid; Sadeghi, Ramin; Abdollahi, Abbas; Forghani, Mohammad Naser

2014-01-01

147

Current Status and Scope of Lymph Node Micrometastasis in Gastric Cancer  

PubMed Central

Recently, lymph node micrometastasis has been evaluated for its prognostic value in gastric cancer. Lymph node micrometastasis cannot be detected via a usual pathologic examination, but it can be detected by using some other techniques including immunohistochemistry and reverse transcription-polymerase chain reaction assay. With the development of such diagnostic techniques, the detection rate of lymph node micrometastasis is constantly increasing. Although the prognostic value of lymph node micrometastasis remains debatable, its clinical impact is apparently remarkable in both early and advanced gastric cancer. At present, studies on the prognostic value of lymph node micrometastasis are evolving to overcome its current limitations and extend the scope of its application. PMID:25861517

Lee, Chang Min; Park, Sung-Soo

2015-01-01

148

Risk Factors of Lymph Edema in Breast Cancer Patients  

PubMed Central

Background. Lymphedema secondary to breast cancer treatment is a common and serious problem for disease survivors. The objective of the current study was to identify the risk factors of secondary lymphedema after breast carcinoma treatment. Materials & Methods. The breast cancer patients who were followed up in three centers in Tehran and Mashhad in 2010 were recruited in the study. The circumference measurement was used for defining lymphedema. Results. Among 410 breast cancer patients, 123 cases (30%) developed lymphedema. Variables such as low educational level, body mass index (BMI), higher stage of disease, number of involved lymph nodes, comorbid diseases, trauma, infection, and the time after surgery showed significant correlation with the development of lymphedema. In logistic regression analysis, increase of 1?kg/m2 in BMI (OR?=?1.09; 95%??CI 1.05–1.15), each number increase in lymph node involvement (OR?=?1.15; 95%??CI 1.08–1.21) and the increase of every 1 month after surgery (OR?=?1.01; 95%??CI 1.01–1.02) significantly increased the risk of lymphedema. Conclusion. The results of this study demonstrated that preserving a fitted BMI, emphasis on self-care, and educating preventive activities may have important roles in decreasing the lymphedema incidence and improving the patients' quality of life. PMID:23862068

Shahpar, Haghighat; Atieh, Akbari; Maryam, Ansari; Fatemeh, Homaei Shandiz; Massoome, Najafi; Mandana, Ebrahimi; Masud, Yunesian; Hamid Reza, Mirzaei; Mohammad Esmaeil, Akbari

2013-01-01

149

Preoperative LymphNode Staging in Gastrointestinal Cancer – Correlation between Size and Tumor Stage  

Microsoft Academic Search

Summary Conclusions Our data suggest that lymph-node size is not a reliable indicator for lymph-node metastasis in gastric, esophageal, and colon cancer. Despite a significant difference in diameter of metastatic and non-metastatic nodes, the accurate evaluation of lymph-node metastasis in gastro-intestinal carcinoma cannot be determined by nodal size, because the majority of counted lymph nodes is ?5 mm and the

S. P. Mönig; W. Schröder; S. E. Baldus; A. H. Hölscher

2002-01-01

150

Characterization of lymph node metastasis and its clinical significance in the surgical treatment of gastric cancer  

PubMed Central

This study aimed to characterize lymph node metastasis and determine its clinical significance in the surgical treatment of gastric cancer. The medical charts of 920 gastric cancer patients who underwent radical surgical resection between March, 2010 and March, 2013, were retrospectively reviewed and statistically analyzed. Lymphatic metastasis was observed in 69.6% of the patients (640/920). The frequency of lymph node metastasis in patients with early-stage gastric cancer was 21.4% (18/84). Lymph node metastasis was observed in all the patients with stage IIIC-IV gastric cancer. The incidence of lymph node metastasis was higher among patients with tumors >7 cm in size. The most frequently affected lymph nodes in patients with proximal, central and distal gastric cancer were station no. 1 (34.2%), no. 3 (33.8%) and no. 6 (34.3%) lymph nodes, respectively. The frequency of lymph node metastasis in patients with Borrmann type IV cancer was significantly higher compared to that in patients with other Borrmann type cancers. Our study further demonstrated that lymphatic metastasis is closely correlated with TNM stage, location, depth of invasion and size of gastric tumors. Therefore, we recommend that a sufficient number of lymph nodes be examined from each patient to determine the extent of lymph node dissection based on Borrmann type, location, size, depth of invasion and histology of the cancer. PMID:25054052

ZUO, CHAO-HUI; XIE, HAILONG; LIU, JINGSHI; QIU, XIAO-XIN; LIN, JIN-GUAN; HUA, XIAO; QIN, ANG

2014-01-01

151

Is Axillary Lymph Node Dissection Indicated for Early Stage Breast Cancer---A Decision Analysis  

E-print Network

no benefit results in ER negative women, almost all of whom would receive adjuvant chemotherapy. Adjusting because the results may not change adjuvant systemic therapy and/or the survival benefit of a change in adjuvant therapy would be small. We constructed a decision model to quantify the survival benefits of ALND

West, Mike

152

INTRODUCTION Assessment of axillary lymph node status is important in breast cancer staging. UK guidance  

E-print Network

studies of dynamic gadolinium-enhanced MRI,7,8 one study of (non-dynamic) gadolinium-enhanced MRI,9 higher sensitivity and specificity than gadolinium-enhanced MRI (Table 3). The diagnostic accuracy data, gadolinium- enhanced MRI showed lower sensitivity a

Oakley, Jeremy

153

Exploring molecular links between lymph node invasion and cancer prognosis in human breast cancer  

PubMed Central

Background Lymph node invasion is one of the most powerful clinical factors in cancer prognosis. However, molecular level signatures of their correlation are remaining poorly understood. Here, we propose a new approach, monotonically expressed gene analysis (MEGA), to correlate transcriptional patterns of lymph node invasion related genes with clinical outcome of breast cancer patients. Results Using MEGA, we scored all genes with their transcriptional patterns over progression levels of lymph node invasion from 278 non-metastatic breast cancer samples. Applied on 65 independent test data, our gene sets of top 20 scores (positive and negative correlations) showed significant associations with prognostic measures such as cancer metastasis, relapse and survival. Our method showed better accuracy than conventional two class comparison methods. We could also find that expression patterns of some genes are strongly associated with stage transition of pathological T and N at specific time. Additionally, some pathways including T-cell immune response and wound healing serum response are expected to be related with cancer progression from pathway enrichment and common motif binding site analyses of the inferred gene sets. Conclusions By applying MEGA, we can find possible molecular links between lymph node invasion and cancer prognosis in human breast cancer, supported by evidences of feasible gene expression patterns and significant results of meta-analysis tests. PMID:22784575

2011-01-01

154

Axillary sampling in the definitive treatment of breast cancer by radiation therapy and lumpectomy  

SciTech Connect

Between January, 1967 and July, 1980, 176 women who were referred to the Joint Center for Radiation Therapy (JCRT) for definitive breast irradiation underwent low axillary dissection. A typical operative technique is described. The dissection stops short of the axillary vein although the vein is usually visualized. One hundred thirty-two axillae were thought to be N/sub 0/ or N/sub 1a/. Forty-six axillae were felt to be N/sub 1b/. Seventeen percent of the T/sub 1/ N/sub 0/ patients had pathologically positive nodes. Twenty-seven percent of the T/sub 2/ N/sub 0/ patients had positive nodes. When 5 or less nodes were removed at axillary sampling the incidence of nodal involvement was very low. There were no differences in nodal positivity when comparing under quadrant to lower or central lesions. Ninety-four percent of axillae with N/sub 1b/ lesions were pathologically confirmed. The complication rate for this procedure was low. There was 5 transient non-surgical complications and 1 cellulitis resulting in a frozen shoulder, which required corrective surgery. There were no cases of moderate or severe arm edema. Axillary sampling is compared to axillary dissection as a diagnostic procedure. Axillary sampling may underestimate the true pathologic positive rate, but diagnostic accuracy appears excellent if level 1 and 2 nodes are sampled.

Rose, C.M.; Botnick, L.E.; Weinstein, M.; Harris, J.R.; Koufman, C.; Silen, W.; Hellman, S.

1983-03-01

155

Long-term follow-up of elderly patients with operable breast cancer treated with surgery without axillary dissection plus adjuvant tamoxifen.  

PubMed Central

Between 1982 and 1990, 321 elderly patients (range 70-92 years, median age 77) with operable breast cancer (T1 in 219, T2 in 77, T3 in one and T4b in 24 patients) and clinically uninvolved axillary nodes underwent surgery without axillary dissection and received adjuvant tamoxifen. All patients had surgery performed under local anaesthesia. Tamoxifen was given after surgery at the dose of 20 mg daily, indefinitely. With a median follow-up of 67 months (range 42-141), 17 patients developed local relapse, 14 ipsilateral axillary recurrence, five ipsilateral breast cancer, five contralateral breast cancer, 13 second primary and 23 developed distant metastases. The cumulative probability of developing a local, axillary and distant recurrence at 72 months was estimated to be 5.4%, 4.3% and 6.2%, respectively. Out of 244 patients who did not develop any relapse, 83 (25.8%) died from intercurrent disease. The 72 month relapse-free survival rate was 76%. This experience suggests that elderly patients with small tumours without clinical axillary involvement may be satisfactorily treated with conservative surgery and tamoxifen. The importance of axillary dissection is controversial owing to a high response rate to hormonal therapy and an increased death rate due to concomitant diseases. PMID:7577477

Martelli, G.; DePalo, G.; Rossi, N.; Coradini, D.; Boracchi, P.; Galante, E.; Vetrella, G.

1995-01-01

156

Prone-position thoracoscopic resection of posterior mediastinal lymph node metastasis from rectal cancer.  

PubMed

Mediastinal lymph node metastasis from colorectal cancer is rare, and barely any reports have described resection of this pathology. We report herein a successful thoracoscopic resection of mediastinal lymph node metastasis in a prone position. A 65-year-old man presented with posterior mediastinal lymph node metastasis after resection of the primary rectal cancer and metachronous hepatic metastasis. Metastatic lymph nodes were resected completely using thoracoscopic surgery in the prone position, which provided advantages of minimal invasiveness, good surgical field, and reduced ergonomic burden on the surgeon. Thoracoscopic resection in the prone position was thought to have the potential to become the standard procedure of posterior mediastinal tumors. PMID:25778039

Shirakawa, Yasuhiro; Noma, Kazuhiro; Koujima, Takeshi; Maeda, Naoaki; Tanabe, Shunsuke; Ohara, Toshiaki; Fujiwara, Toshiyoshi

2015-12-01

157

Lymph node staging in colorectal cancer: old controversies and recent advances.  

PubMed

Outcome prediction based on tumor stage reflected by the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) tumor node metastasis (TNM) system is currently regarded as the strongest prognostic parameter for patients with colorectal cancer. For affected patients, the indication for adjuvant therapy is mainly guided by the presence of regional lymph node metastasis. In addition to the extent of surgical lymph node removal and the thoroughness of the pathologist in dissecting the resection specimen, several parameters that are related to the pathological work-up of the dissected nodes may affect the clinical significance of lymph node staging. These include changing definitions of lymph nodes, involved lymph nodes, and tumor deposits in different editions of the AJCC/UICC TNM system as well as the minimum number of nodes to be dissected. Methods to increase the lymph node yield in the fatty tissue include methylene blue injection and acetone compression. Outcome prediction based on the lymph node ratio, defined as the number of positive lymph nodes divided by the total number of retrieved nodes, may be superior to the absolute numbers of involved nodes. Extracapsular invasion has been identified as additional prognostic factor. Adding step sectioning and immunohistochemistry to the pathological work-up may result in higher accuracy of histological diagnosis. The clinical value of more recent technical advances, such as sentinel lymph node biopsy and molecular analysis of lymph nodes tissue still remains to be defined. PMID:24379568

Resch, Annika; Langner, Cord

2013-12-14

158

Sentinel Lymph Node Surgery after Neoadjuvant Chemotherapy in Patients With Node-Positive Breast Cancer: The American College of Surgeons Oncology Group (ACOSOG) Z1071 Clinical Trial  

PubMed Central

Importance Sentinel lymph node (SLN) surgery provides reliable nodal staging information with less morbidity than axillary lymph node dissection (ALND) for clinically node-negative (cN0) breast cancer patients. The application of SLN surgery for staging the axilla following chemotherapy for women who initially had node-positive breast cancer (cN1) is unclear because of high false negative results reported in previous studies. Objective To determine the false negative rate (FNR) for SLN surgery following chemotherapy in patients initially presenting with biopsy-proven node-positive breast cancer. Design, Setting, and Patients The ACOSOG Z1071 trial enrolled women with clinical T0–4 N1–2, M0 breast cancer who received neoadjuvant chemotherapy. Following chemotherapy, patients underwent both SLN surgery and ALND. SLN surgery using both blue dye and a radiolabeled colloid mapping agent was encouraged. Main Outcome Measure The primary endpoint was the FNR of SLN surgery after chemotherapy in women who presented with cN1 disease. We examined the likelihood that the FNR in those with 2 or more SLNs examined was greater than 10%, the rate expected for women undergoing SLN surgery who present with clinically node-negative disease. Results Seven hundred fifty-six patients were enrolled from 136 institutions. Of 663 evaluable patients with cN1 disease, 649 underwent chemotherapy followed by both SLN surgery and ALND. A SLN could not be identified in 46 patients (7.1%). Only one SLN was excised in 78 patients (12.0%). Of the remaining 525 patients with 2 or more SLNs removed, no cancer was identified in the axillary lymph nodes of 215 patients yielding a pathological complete nodal response of 41.0% (95% CI: 36.7%–45.3%). In 39 patients, cancer was not identified in the SLNs but was found in lymph nodes obtained with ALND resulting in a FNR of 12.6% (90% Bayesian Credible Interval, 9.85%–16.05%). Conclusions and Relevance Among women with cN1 breast cancer receiving neoadjuvant chemotherapy who had 2 or more SLNs examined, the FNR was not found to be 10% or less. Given this FNR threshold, changes in approach and patient selection that result in greater sensitivity would be necessary to support the use of SLN surgery as an alternative to ALND. Trial Registration clinicaltrials.gov; trial identifier NCT00881361. PMID:24101169

Boughey, Judy C.; Suman, Vera J.; Mittendorf, Elizabeth A.; Ahrendt, Gretchen M.; Wilke, Lee G.; Taback, Bret; Leitch, A. Marilyn; Kuerer, Henry M.; Bowling, Monet; Flippo-Morton, Teresa S.; Byrd, David R.; Ollila, David W.; Julian, Thomas B.; McLaughlin, Sarah A.; McCall, Linda; Symmans, W. Fraser; Le-Petross, Huong T.; Haffty, Bruce G.; Buchholz, Thomas A.; Nelson, Heidi; Hunt, Kelly K.

2014-01-01

159

New models and online calculator for predicting non-sentinel lymph node status in sentinel lymph node positive breast cancer patients  

PubMed Central

Background Current practice is to perform a completion axillary lymph node dissection (ALND) for breast cancer patients with tumor-involved sentinel lymph nodes (SLNs), although fewer than half will have non-sentinel node (NSLN) metastasis. Our goal was to develop new models to quantify the risk of NSLN metastasis in SLN-positive patients and to compare predictive capabilities to another widely used model. Methods We constructed three models to predict NSLN status: recursive partitioning with receiver operating characteristic curves (RP-ROC), boosted Classification and Regression Trees (CART), and multivariate logistic regression (MLR) informed by CART. Data were compiled from a multicenter Northern California and Oregon database of 784 patients who prospectively underwent SLN biopsy and completion ALND. We compared the predictive abilities of our best model and the Memorial Sloan-Kettering Breast Cancer Nomogram (Nomogram) in our dataset and an independent dataset from Northwestern University. Results 285 patients had positive SLNs, of which 213 had known angiolymphatic invasion status and 171 had complete pathologic data including hormone receptor status. 264 (93%) patients had limited SLN disease (micrometastasis, 70%, or isolated tumor cells, 23%). 101 (35%) of all SLN-positive patients had tumor-involved NSLNs. Three variables (tumor size, angiolymphatic invasion, and SLN metastasis size) predicted risk in all our models. RP-ROC and boosted CART stratified patients into four risk levels. MLR informed by CART was most accurate. Using two composite predictors calculated from three variables, MLR informed by CART was more accurate than the Nomogram computed using eight predictors. In our dataset, area under ROC curve (AUC) was 0.83/0.85 for MLR (n = 213/n = 171) and 0.77 for Nomogram (n = 171). When applied to an independent dataset (n = 77), AUC was 0.74 for our model and 0.62 for Nomogram. The composite predictors in our model were the product of angiolymphatic invasion and size of SLN metastasis, and the product of tumor size and square of SLN metastasis size. Conclusion We present a new model developed from a community-based SLN database that uses only three rather than eight variables to achieve higher accuracy than the Nomogram for predicting NSLN status in two different datasets. PMID:18315887

Kohrt, Holbrook E; Olshen, Richard A; Bermas, Honnie R; Goodson, William H; Wood, Douglas J; Henry, Solomon; Rouse, Robert V; Bailey, Lisa; Philben, Vicki J; Dirbas, Frederick M; Dunn, Jocelyn J; Johnson, Denise L; Wapnir, Irene L; Carlson, Robert W; Stockdale, Frank E; Hansen, Nora M; Jeffrey, Stefanie S

2008-01-01

160

Lymph node count and prognosis in colorectal cancer: the influence of examination quality.  

PubMed

Colorectal cancer guidelines recommend adjuvant chemotherapy in stage II disease when less than 12 lymph nodes are assessed. The recommendation bases on previous studies showing an association of a low lymph node count and adverse outcome. Compared to current standards, however, the quality of lymph node examination in the studies was low. We, therefore, investigated the prognostic role of <12 lymph nodes in cancers diagnosed adherent to current quality measures. Stage I-IV colorectal cancers from 1,899 patients enrolled into a population-based cohort study were investigated for the prognostic impact of a lymph node count <12. The stage specific share of patients diagnosed with ?12 nodes (stage I-IV: 62, 85, 85, 78%, respectively) was used to compare lymph node examination quality to other studies. We found no impact of a lymph node count <12 on overall, cancer-specific or recurrence-free survival for any tumour stage. Compared to studies reporting an adverse prognostic impact of a low lymph node count in stages II and III the stage-specific shares of patients with ?12 nodes were markedly higher in this study (85% vs. 24-58% in previous analyses) and this correlated with increased rates of stage III compared to stage II cancers. In conclusion our data indicate, that the previously reported effect of a low lymph node count on the patients' outcomes is eliminated by improved lymph node examination quality and thus question the general applicability of a 12 lymph node cut off for adjuvant chemotherapy decision making in stage II disease. PMID:25231924

Bläker, Hendrik; Hildebrandt, Bert; Riess, Hanno; von Winterfeld, Moritz; Ingold-Heppner, Barbara; Roth, Wilfried; Kloor, Matthias; Schirmacher, Peter; Dietel, Manfred; Tao, Sha; Jansen, Lina; Chang-Claude, Jenny; Ulrich, Alexis; Brenner, Hermann; Hoffmeister, Michael

2015-04-15

161

Biological ablation of sentinel lymph node metastasis in submucosally invaded early gastrointestinal cancer.  

PubMed

Currently, early gastrointestinal cancers are treated endoscopically, as long as there are no lymph node metastases. However, once a gastrointestinal cancer invades the submucosal layer, the lymph node metastatic rate rises to higher than 10%. Therefore, surgery is still the gold standard to remove regional lymph nodes containing possible metastases. Here, to avoid prophylactic surgery, we propose a less-invasive biological ablation of lymph node metastasis in submucosally invaded gastrointestinal cancer patients. We have established an orthotopic early rectal cancer xenograft model with spontaneous lymph node metastasis by implantation of green fluorescent protein (GFP)-labeled human colon cancer cells into the submucosal layer of the murine rectum. A solution containing telomerase-specific oncolytic adenovirus was injected into the peritumoral submucosal space, followed by excision of the primary rectal tumors mimicking the endoscopic submucosal dissection (ESD) technique. Seven days after treatment, GFP signals had completely disappeared indicating that sentinel lymph node metastasis was selectively eradicated. Moreover, biologically treated mice were confirmed to be relapse-free even 4 weeks after treatment. These results indicate that virus-mediated biological ablation selectively targets lymph node metastasis and provides a potential alternative to surgery for submucosal invasive gastrointestinal cancer patients. PMID:25523761

Kikuchi, Satoru; Kishimoto, Hiroyuki; Tazawa, Hiroshi; Hashimoto, Yuuri; Kuroda, Shinji; Nishizaki, Masahiko; Nagasaka, Takeshi; Shirakawa, Yasuhiro; Kagawa, Shunsuke; Urata, Yasuo; Hoffman, Robert M; Fujiwara, Toshiyoshi

2015-03-01

162

A Model to Estimate the Risk of Breast Cancer-Related Lymphedema: Combinations of Treatment-Related Factors of the Number of Dissected Axillary Nodes, Adjuvant Chemotherapy, and Radiation Therapy  

SciTech Connect

Purpose: The development of breast cancer-related lymphedema (LE) is closely related to the number of dissected axillary lymph nodes (N-ALNs), chemotherapy, and radiation therapy. In this study, we attempted to estimate the risk of LE based on combinations of these treatment-related factors. Methods and Materials: A total of 772 patients with breast cancer, who underwent primary surgery with axillary lymph node dissection from 2004 to 2009, were retrospectively analyzed. Adjuvant chemotherapy (ACT) was performed in 677 patients (88%). Among patients who received radiation therapy (n=675), 274 (35%) received supraclavicular radiation therapy (SCRT). Results: At a median follow-up of 5.1 years (range, 3.0-8.3 years), 127 patients had developed LE. The overall 5-year cumulative incidence of LE was 17%. Among the 127 affected patients, LE occurred within 2 years after surgery in 97 (76%) and within 3 years in 115 (91%) patients. Multivariate analysis showed that N-ALN (hazard ratio [HR], 2.81; P<.001), ACT (HR, 4.14; P=.048), and SCRT (HR, 3.24; P<.001) were independent risk factors for LE. The total number of risk factors correlated well with the incidence of LE. Patients with no risk or 1 risk factor showed a significantly lower 5-year probability of LE (3%) than patients with 2 (19%) or 3 risk factors (38%) (P<.001). Conclusions: The risk factors associated with LE were N-ALN, ACT, and SCRT. A simple model using combinations of these factors may help clinicians predict the risk of LE.

Kim, Myungsoo; Kim, Seok Won; Lee, Sung Uk; Lee, Nam Kwon; Jung, So-Youn; Kim, Tae Hyun; Lee, Eun Sook; Kang, Han-Sung [Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of)] [Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Shin, Kyung Hwan, E-mail: shin.kyunghwan@gmail.com [Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of)

2013-07-01

163

Preoperative Axillary Staging with 3.0-T Breast MRI: Clinical Value of Diffusion Imaging and Apparent Diffusion Coefficient  

PubMed Central

The axillary staging in newly diagnosed breast cancer is under major evolution. The aims of this study were to define the diagnostic performance of 3.0-T diffusion-weighted imaging (DWI) in the detection of axillary metastases in newly diagnosed breast cancer, to assess apparent diffusion coefficients (ADCs) for histopathologically confirmed metastatic lymph nodes in a clinical setting. Altogether 52 consecutive breast cancer patients underwent magnetic resonance imaging and DWI in addition to axillary ultrasound. ADCs of axillary lymph nodes were analysed by two breast radiologists and ultrasound-guided core biopsies were taken. In a separate reading by one radiologist two types of region of interests were used for a smaller group of patients. Altogether 56 axillae (121 lymph nodes) were included in the statistical analysis. Metastatic axillae (51.8%) had significantly lower ADCs (p<0.001). Mean ADCs were 0.663–0.676 x 10-3 mm2/s for the histologically confirmed metastatic LNs and 1.100–1.225 x 10-3 mm2/s for the benign. The sensitivity, specificity, and accuracy of DWI were 72.4%, 79.6%, and 75.9%, respectively with threshold ADC 0.812 x 10-3 mm2/s. Region of interest with information on the minimum value increased the diagnostic performance (area under the curve 0.794 vs. 0.619). Even though ADCs are significantly associated with histopathologically confirmed axillary metastases the diagnostic performance of axillary DWI remains moderate and ultrasound-guided core biopsies or sentinel lymph node biopsies cannot be omitted. PMID:25823016

Rautiainen, Suvi; Könönen, Mervi; Sironen, Reijo; Masarwah, Amro; Sudah, Mazen; Hakumäki, Juhana; Vanninen, Ritva; Sutela, Anna

2015-01-01

164

Learning Curve for Identification of Sentinel Lymph Node Based on a Cumulative Sum Analysis in Gastric Cancer  

Microsoft Academic Search

Background\\/Aims: Lymph node metastasis is the most important point to consider when deciding on the modality of resection in patients with early gastric cancer. This study was conducted to evaluate the learning curve for identification of sentinel lymph nodes in patients with gastric cancer. Methods: The investigators included the results from 2 prospective series of sentinel lymph node mapping. Cumulative

J. H. Lee; K. W. Ryu; S. E. Lee; S. J. Cho; C. G. Kim; I. J. Choi; M. C. Kook; M. J. Kim; S. R. Park; J. S. Lee; B. H. Nam; Y. W. Kim

2009-01-01

165

Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS):a randomised, multicentre, open-label, phase 3 non-inferiority trial  

PubMed Central

Summary Background If treatment of the axilla is indicated in patients with breast cancer who have a positive sentinel node, axillary lymph node dissection is the present standard. Although axillary lymph node dissection provides excellent regional control, it is associated with harmful side-effects. We aimed to assess whether axillary radiotherapy provides comparable regional control with fewer side-effects. Methods Patients with T1–2 primary breast cancer and no palpable lymphadenopathy were enrolled in the randomised, multicentre, open-label, phase 3 non-inferiority EORTC 10981-22023 AMAROS trial. Patients were randomly assigned (1:1) by a computer-generated allocation schedule to receive either axillary lymph node dissection or axillary radiotherapy in case of a positive sentinel node, stratified by institution. The primary endpoint was non-inferiority of 5-year axillary recurrence, considered to be not more than 4% for the axillary radiotherapy group compared with an expected 2% in the axillary lymph node dissection group. Analyses were by intention to treat and per protocol. The AMAROS trial is registered with ClinicalTrials.gov, number NCT00014612. Findings Between Feb 19, 2001, and April 29, 2010, 4823 patients were enrolled at 34 centres from nine European countries, of whom 4806 were eligible for randomisation. 2402 patients were randomly assigned to receive axillary lymph node dissection and 2404 to receive axillary radiotherapy. Of the 1425 patients with a positive sentinel node, 744 had been randomly assigned to axillary lymph node dissection and 681 to axillary radiotherapy; these patients constituted the intention-to-treat population. Median follow-up was 6·1 years (IQR 4·1–8·0) for the patients with positive sentinel lymph nodes. In the axillary lymph node dissection group, 220 (33%) of 672 patients who underwent axillary lymph node dissection had additional positive nodes. Axillary recurrence occurred in four of 744 patients in the axillary lymph node dissection group and seven of 681 in the axillary radiotherapy group. 5-year axillary recurrence was 0·43% (95% CI 0·00–0·92) after axillary lymph node dissection versus 1·19% (0·31–2·08) after axillary radiotherapy. The planned non-inferiority test was underpowered because of the low number of events. The one-sided 95% CI for the underpowered non-inferiority test on the hazard ratio was 0·00–5·27, with a non-inferiority margin of 2. Lymphoedema in the ipsilateral arm was noted significantly more often after axillary lymph node dissection than after axillary radiotherapy at 1 year, 3 years, and 5 years. Interpretation Axillary lymph node dissection and axillary radiotherapy after a positive sentinel node provide excellent and comparable axillary control for patients with T1–2 primary breast cancer and no palpable lymphadenopathy. Axillary radiotherapy results in significantly less morbidity. Funding EORTC Charitable Trust. PMID:25439688

Donker, Mila; van Tienhoven, Geertjan; Straver, Marieke E; Meijnen, Philip; van de Velde, Cornelis J H; Mansel, Robert E; Cataliotti, Luigi; Westenberg, A Helen; Klinkenbijl, Jean H G; Orzalesi, Lorenzo; Bouma, Willem H; van der Mijle, Huub C J; Nieuwenhuijzen, Grard A P; Veltkamp, Sanne C; Slaets, Leen; Duez, Nicole J; de Graaf, Peter W; van Dalen, Thijs; Marinelli, Andreas; Rijna, Herman; Snoj, Marko; Bundred, Nigel J; Merkus, Jos W S; Belkacemi, Yazid; Petignat, Patrick; Schinagl, Dominic A X; Coens, Corneel; Messina, Carlo G M; Bogaerts, Jan; Rutgers, Emiel J T

2014-01-01

166

The association of cytokeratin-only-positive sentinel lymph nodes and subsequent metastases in breast cancer  

Microsoft Academic Search

IntroductionThe purpose of this study was to better characterize the clinical significance of cytokeratin immunohistochemistry (IHC)-only-positive lymph node metastases among patients with breast cancer.

Philip S. Mullenix; Tommy A. Brown; Micheal O. Meyers; Lydia R. Giles; Elin R. Sigurdson; Marcia C. Boraas; John P. Hoffman; Burton L. Eisenberg; Michael H. Torosian

2005-01-01

167

maxPET, a dedicated mammary and axillary region PET imaging system for breast cancer  

Microsoft Academic Search

Presents initial measurements from a high-performance prototype dedicated PET camera (maxPET) designed for mammary and axillary region imaging. The system consists of two 15×15 cm2 planar scintillation detector plates operating in coincidence, with each plate composed of 25 modular detectors. The modular detectors are comprised of a 9×9 array of 3×3×20 mm3 lutetium oxyorthosilicate (LSO) detector elements, read out by

N. K. Doshi; R. W. Silverman; Y. Shao; S. R. Cherry

2001-01-01

168

Eight-year experience with the intraoperative frozen section examination of sentinel lymph node biopsy for breast cancer in a North-Italian university center  

PubMed Central

Sentinel lymph node biopsy (SLNB) completely changed the impact of breast surgery on patients psycho-physical wellness, reducing morbidity associated with complete axillary lymph node dissection (CALND) while granting an adequate breast cancer staging. We reviewed our experience with the SLNB in a University Clinic. We collected data about all breast cancer patients submitted to SLNB from 2002 to 2010, and analyzed them with R (version 2.15.2), considering significant p<0.05. We performed 615 SLNBs on 607 patients, with a mean age of 59.86 (±10.76). Sentinel node detection rate resulted 99,7%, with a mean number of biopsied nodes of 1.64 (±0.67), axillary localization in 98% of cases, and negative intraoperative histological finding in the 86.2% of cases. Prevalence of ITCs, micrometastasis, macrometastasis and pericapsular metastasis resulted respectively 0.6%, 4.9%, 7.5% and 8.8%. Among women who received CALND, mean number of examined nodes was 16.36 (±6.19) and mean number of metastatic non-sentinel nodes was 0.97 in case of micrometastasis, 2.65 in case of macrometastasis, and up to 9.88 when pericapsular invasion was described. To conclude, our data confirm the role of nodal metastasis size in the prediction of non-sentinel node involvement, but further studies are required in order to better assess the role of ITCs and micrometastasis in the diagnostic and therapeutic management of breast cancer, with the final aim to reduce the surgical complications of axilla demolition when unnecessary. PMID:24427358

Cedolini, Carla; Bertozzi, Serena; Seriau, Luca; Londero, Ambrogio P; Concina, Serena; Cattin, Federico; Geatti, Onelio; Loreto, Carla Di; Risaliti, Andrea

2014-01-01

169

A New Formula for Prostate Cancer Lymph Node Risk  

SciTech Connect

Introduction: The successful treatment of prostate cancer depends on the accurate estimation of the risk of regional lymph node (LN) involvement. The Roach formula (RF) has been criticized as overestimating LN risk. A modification of the RF has been attempted by other investigators using simplified adjustment ratios: the Nguyen formula (NF). Methods and Materials: The National Cancer Institute Surveillance, Epidemiology, and End Results database was investigated for patients treated in 2004 through 2006 for whom at least 10 LN were examined at radical prostatectomy, cT1c or cT2 disease, and prostate-specific antigen (PSA) <26 ng/ml (N = 2,930). The Yale formula (YF) was derived from half of the sample (n = 1,460), and validated in the other half (n = 1,470). Results: We identified 2,930 patients. Only 4.6% of patients had LN+, and 72.6% had cT1c disease. Gleason (GS) 8-10 histology was found in 14.4% of patients. The YF for prediction of %LN+ risk is [GS - 5]x [PSA/3 + 1.5 x T], where T = 0, 1, and 2 for cT1c, cT2a, and cT2b/cT2c. Within each strata of predicted %LN+ risk, the actual %LN+ was closest to the YF. Using a >15% risk as an indicator of high-risk disease, the YF had increased sensitivity (39.0% vs. 13.6%) compared with the NF, without a significant reduction in specificity (94.9% vs. 98.8%). The NF was overly restrictive of the high-risk group, with only 2% of patients having a >15% risk of LN+ by that formula. Conclusion: The YF performed better than the RF and NF and was best at differentiating patients at high risk for LN+ disease.

Yu, James B., E-mail: james.b.yu@yale.ed [Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT (United States); Yale Cancer Center, New Haven, CT (United States); Makarov, Danil V. [Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, New Haven, CT (United States); Section of Urology, Yale School of Medicine, New Haven, CT (United States); Department of Veterans Affairs Connecticut Healthcare System, West Haven, CT (United States); Gross, Cary [Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, New Haven, CT (United States); Department of Internal Medicine, Yale School of Medicine, New Haven, CT (United States)

2011-05-01

170

Mitotic indexes as prognostic predictors in female breast cancer  

Microsoft Academic Search

Summary A series of 688 women with breast cancer were followed-up for a mean of 13 years. Tumour size, axillary lymph node status, histological grade, histological type and two mitotic indexes (M\\/V; MAI) were assessed and related to disease outcome. Primary tumour size (PPP=0.0001), and histological grade (P=0.0074) predicted axillary lymph node status. Recurrence as well as recurrence-free survival was

S. Aaltomaa; P. Lipponen; M. Eskelinen; V.-M. Kosma; S. Marin; E. Alhava; K. Syrjänen

1992-01-01

171

Dose-dense paclitaxel versus docetaxel following FEC as adjuvant chemotherapy in axillary node-positive early breast cancer: a multicenter randomized study of the Hellenic Oncology Research Group (HORG).  

PubMed

Adding a taxane to anthracycline-based adjuvant chemotherapy prolongs survival in node-positive early breast cancer. However, which is the preferable taxane in a dose-dense regimen remains unknown. We conducted a randomized study to compare the efficacy of dose-dense paclitaxel versus docetaxel following 5-fluorouracil, epirubicin, and cyclophosphamide (FEC) as adjuvant chemotherapy in women with node-positive early breast cancer. Following surgery women with HER2-negative breast cancer and at least one infiltrated axillary lymph node were randomized to receive four cycles of FEC (700/75/700 mg/m(2)) followed by four cycles of either paclitaxel (175 mg/m(2)) or docetaxel (75 mg/m(2)). All cycles were administered every 14 days with G-CSF support. The primary endpoint was disease-free survival (DFS) at 3 years. Between 2004 and 2007, 481 women were randomized to paclitaxel (n = 241) and docetaxel (n = 240). After a median follow-up of 6 years, 51 (21%) and 48 (20%) women experienced disease relapse (p = 0.753) and there was no significant difference in DFS between the paclitaxel- and docetaxel-treated groups (3-year DFS 87.4 vs. 88.3%, respectively; median DFS not reached; p = 0.633). Toxicities were manageable, with grade 2-4 neutropenia in 21 versus 31% (p = 0.01), thrombocytopenia 0.8 versus 3.4% (p = 0.06), any grade neurotoxicity 17 versus 7.5% (p = 0.35) and onycholysis 4.9 versus 12.1% (p = 0.03) for patients receiving paclitaxel and docetaxel, respectively. There were no toxic deaths. Dose-dense paclitaxel versus docetaxel after FEC as adjuvant chemotherapy results in a similar 3-year DFS rate in women with axillary node-positive early breast cancer. Due to its more favorable toxicity profile, paclitaxel is the taxane of choice in this setting. PMID:25399229

Saloustros, Emmanouil; Malamos, Nikolaos; Boukovinas, Ioannis; Kakolyris, Stylianos; Kouroussis, Charalampos; Athanasiadis, Athanasios; Ziras, Nikolaos; Kentepozidis, Nikolaos; Makrantonakis, Parisis; Polyzos, Aristidis; Christophyllakis, Charalampos; Georgoulias, Vassilios; Mavroudis, Dimitrios

2014-12-01

172

Computed tomography and magnetic resonance imaging evaluation of lymph node metastasis in early colorectal cancer  

PubMed Central

AIM: To assess the role of computed tomography (CT) and magnetic resonance imaging (MRI) and establish imaging criteria of lymph node metastasis in early colorectal cancer. METHODS: One hundred and sixty patients with early colorectal cancer were evaluated for tumor location, clinical history of polypectomy, depth of tumor invasion, and lymph node metastasis. Two radiologists assessed preoperative CT and/or MRI for the primary tumor site detectability, the presence or absence of regional lymph node, and the size of the largest lymph node. Demographic, imaging, and pathologic findings were compared between the two groups of patients based on pathologic lymph node metastasis and optimal size criterion was obtained. RESULTS: The locations of tumor were ascending, transverse, descending, sigmoid colon, and rectum. One hundred and sixty early colorectal cancers were classified into 3 groups based on the pathological depth of tumor invasion; mucosa, submucosa, and depth unavailable. A total of 20 (12.5%) cancers with submucosal invasion showed lymph node metastasis. Lymph nodes were detected on CT or MRI in 53 patients. The detection rate and size of lymph nodes were significantly higher (P = 0.000, P = 0.044, respectively) in patients with pathologic nodal metastasis than in patients without nodal metastasis. Receiver operating curve analysis showed that a cut-off value of 4.1 mm is optimal with a sensitivity of 78.6% and specificity of 75%. CONCLUSION: The short diameter size criterion of ? 4.1 mm for metastatic lymph nodes was optimal for nodal staging in early colorectal cancer. PMID:25593474

Choi, Joonsung; Oh, Soon Nam; Yeo, Dong-Myung; Kang, Won Kyung; Jung, Chan-Kwon; Kim, Sang Woo; Park, Michael Yong

2015-01-01

173

Physiotherapy After Breast Cancer Surgery: Results of a Randomised Controlled Study to Minimise Lymphoedema  

Microsoft Academic Search

The development of secondary arm lymphoedema after the removal of axillary lymph nodes remains a potential problem for women with breast cancer. This study investigated the incidence of arm lymphoedema following axillary dissection to determine the effect of prospective monitoring and early physiotherapy intervention. Sixty-five women were randomly assigned to either the treatment (TG) or control group (CG) and assessments

Robyn C. Box; Hildegard M. Reul-Hirche; Joanne E. Bullock-Saxton; Colin M. Furnival

2002-01-01

174

Prospective evaluation of fluorine-18 fluorodeoxyclucose positron emission tomography in breast cancer for staging of the axilla related to surgery and immunocytochemistry  

Microsoft Academic Search

The noninvasive staging of axillary lymph nodes for metastases is investigated in patients with breast cancer prior to surgery by positron emission tomography (PET) with fluorine- l8-fluoro-2-deoxy-d-glucose (18F-FDG). In 124 patients with newly diagnosed breast cancer, whole-body PET was performed to determine the average differential uptake ratio (DUR) of18F-FDG in the axillary lymph nodes. Results were correlated with the number

Christa I. Utech; Carter S. Young; Peter F. Winter

1996-01-01

175

Use of Fluorescence Imaging in Combination with Patent Blue Dye versus Patent Blue Dye Alone in Sentinel Lymph Node Biopsy in Breast Cancer  

PubMed Central

Purpose Near-infrared fluorescence imaging with indocyanine green (ICG) has the potential to improve sentinel lymph node (SLN) mapping in breast cancer. In this clinical trial, we compared the potential value of ICG combined with blue dye with that of blue dye alone for detecting SLNs. Methods Patients undergoing SLN biopsy (SLNB) between November 2010 and November 2013 were included. Up to December 2011, SLNs were detected by using patent blue (PB) alone, and since January 2012, by using PB in combination with ICG. The patients were divided into the following two groups: group A (ICG-PB; n=96) and group B (PB; n=73), and SLN detection parameters were compared between the groups. All patients underwent level I and II axillary dissections after SLNB. Results In group A, the SLN detection rate was 96.9% (93/96), the accuracy of detection was 98.9% (92/93), and the false-negative rate (FNR) was 3.4% (1/29). In group B, the SLN detection rate was 84.9% (62/73), the accuracy of detection was 96.8% (60/62), and the FNR was 11.1% (2/18). The ICG-PB group showed significantly superior results compared to the PB group for SLN detection (p=0.005) and a greatly improved FNR. Conclusion The combined fluorescence and blue dye-based tracer technique was superior to the use of blue dye alone for identifying SLNs, and for predicting axillary lymph node status in patients with breast cancer; in addition, the combined technique had reduced false-negative results. PMID:25320623

Tong, Meng; Gao, Wei

2014-01-01

176

Video-assisted thoracoscopic surgery (VATS) right upper lobectomy and systematic lymph node dissection for lung cancer  

PubMed Central

Video-assisted thoracoscopic surgery (VATS) represents a new trend in the development of minimally invasive thoracic surgery. When applied in lung cancer surgeries, VATS can be used for both pulmonary lobectomy and regional lymph node dissection. Currently the main concerns are focused on the completeness of lymph node dissection for lung cancer and the safety of surgery. The lymph node dissection includes two parts: (I) dissection of interlobar and hilar lymph nodes; and (II) dissection of mediastinal lymph nodes. The demonstrated surgical procedures are featured by: (I) the interlobar and hilar lymph nodes are not removed separately; rathr, they are taken out en bloc with the pulmonary lobes during the surgery; and (II) systematic lymph node dissection, instead of systematic sampling, is applied for the removal of mediastinal lymph nodes. Also, during the fully anatomical resection, each blood vessel and bronchus underwent anatomical dissociation, indicating that this surgery is safe. PMID:24040542

Yang, Hong; Zheng, Ying-Bin; Huang, Qing-Yuan

2013-01-01

177

Feasibility study of sentinel lymph node biopsy in esophageal cancer with conservative lymphadenectomy  

Microsoft Academic Search

Introduction  Lymphoscintigraphy and sentinel node mapping is established in breast cancer and melanoma but not in esophageal cancer, even\\u000a though many centers have shown that occult tumor deposits in lymph nodes influence prognosis. We report our initial experience\\u000a with lymphoscintigraphy and sentinel lymph node biopsy in patients undergoing resection for esophageal cancer.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Sixteen of 17 consecutive patients underwent resection for invasive

Sarah K. Thompson; Dylan Bartholomeusz; Peter G. Devitt; Peter J. Lamb; Andrew R. Ruszkiewicz; Glyn G. Jamieson

2011-01-01

178

Is it necessary to do staging pelvic lymph node dissection for T1c prostate cancer?  

PubMed

The necessity of pelvic lymph node dissection has been questioned in recent years as a result of improved pre-treatment staging based on clinical and pathologic factors. Accurate evaluation of nodal status allows rational selection of therapy and improved outcomes. Nevertheless, lymph node dissection may play a role even in patients with low stage disease (clinical T1c) despite an overall low risk for metastases. Herein we discuss recent advances in the evaluation of lymph nodes in stage T1c prostate cancer with respect to accurate prediction, radiologic imaging, molecular characterization, and operative considerations. PMID:12084271

Meng, M V; Carroll, P R

2001-06-01

179

Noninvasive Detection of Clinically Occult LymphNode Metastases in Prostate Cancer  

Microsoft Academic Search

background Accurate detection of lymph-node metastases in prostate cancer is an essential com- ponent of the approach to treatment. We investigated whether highly lymphotropic superparamagnetic nanoparticles, which gain access to lymph nodes by means of in- terstitial-lymphatic fluid transport, could be used in conjunction with high-resolution magnetic resonance imaging (MRI) to reveal small nodal metastases. methods Eighty patients with presurgical

Mukesh G. Harisinghani; Jelle Barentsz; Peter F. Hahn; Willem M. Deserno; Shahin Tabatabaei; Christine Hulsbergen van de Kaa; Jean de la Rosette; Ralph Weissleder

2003-01-01

180

Microwave detection of metastasized breast cancer cells in the lymph node; potential application for sentinel lymphadenectomy  

E-print Network

Kwon2 1 Breast Cancer Center, Department of Surgery, Hallym University Sacred Heart Hospital, Hallym cancer cells in the lymph nodes, using broad-band microwaves in attempts to detect metastases, i.e., permittivity in mid-band frequency (3­5 GHz), conductivity in high-band frequencies (25­30 GHz

Kwon, Youngwoo

181

Gallstone Disease after Extended (D2) Lymph Node Dissection for Gastric Cancer  

Microsoft Academic Search

Few studies have reported the incidence and clinical outcomes of gallstone disease after extended (D2) lymph node dissection for gastric cancer. The present study was designed to retrospectively compare limited (D1) and D2 dissections in terms of gallstone formation, presentation of gallstones, and surgery for gallstone disease. A total of 805 Japanese gastric cancer patients (595 male, 210 female) who

Tomotaka Akatsu; Masashi Yoshida; Tetsuro Kubota; Motohide Shimazu; Masakazu Ueda; Yoshihide Otani; Go Wakabayashi; Koichi Aiura; Minoru Tanabe; Toshiharu Furukawa; Yoshiro Saikawa; Shigeyuki Kawachi; Yukako Akatsu; Koichiro Kumai Masaki Kitajima

2005-01-01

182

Fox Chase study finds age tied to spread of rectal cancer to lymph nodes  

Cancer.gov

Rectal cancer is more likely to spread to the lymph nodes in younger patients, according to new findings that Fox Chase Cancer Center researchers presented on October 29 at the American Society for Radiation Oncology’s 54th Annual Meeting. The results—which are the first of their kind—suggest that doctors should search for spreading more aggressively in these patients.

183

Radical lymph node dissection for gallbladder cancer: indications and limitations.  

PubMed

Radical lymph node dissection provides survival benefit for patients with pT2 or more advanced gallbladder carcinoma tumors only if potentially curative resection is feasible; it must always be considered when planning a resection or re-resection for robust patients with pT2 or more advanced gallbladder carcinoma tumors. The degree of radical lymphadenectomy depends on clinically assessed nodal status: portal lymph node dissection is limited to cN0 disease; extended portal nodal dissection is indicated for cN0 and a modest degree of cN1 disease; peripancreatic lymph node dissection with pancreaticoduodenectomy is indicated for selected cases of evident peripancreatic nodal disease and/or direct organ involvement. Extended resection with extensive lymphadenectomy should be limited to expert surgeons because it may cause serious morbidity and mortality. PMID:17336245

Shirai, Yoshio; Wakai, Toshifumi; Hatakeyama, Katsuyoshi

2007-01-01

184

Co-existing tubercular axillary lymphadenitis with carcinoma breast can falsely over-stage the disease--case series.  

PubMed

The synchronous occurrence of tuberculosis and carcinoma in breast is unusual. The simultaneous occurrence of both the diseases can complicate the neoplastic disease. The diagnosis and treatment of tuberculosis in a patient with cancer assumes importance as it can prevent high mortality in patients with co-existent disease and thereby create problems in treatment decision. Axillary lymph node enlargement in breast cancer patient is not always caused by metastatic tumour of the breast even in the ipsilateral axillary nodes. We present here six case reports as an example of tuberculous axillary lymphadenitis co-existing with invasive ductal carcinoma of the breast. Accurate diagnosis has helped in down-staging carcinoma of the breast and also in identifying curable disease. PMID:21114180

Munjal, Kavita; Jain, Vishal K; Agrawal, Ashish; Bandi, Prasann K

2010-04-01

185

Optimization of surgical approach and lymph node dissection in patients with gastric cancer.  

PubMed

In 2012 there were nearly 1 million new gastric cancer cases (952,000 cases or 6.8% of all cancer cases). That has put the gastric cancer on 5th place in frequency, and on 3th placeas leading cause of death in both sexes in the world--723,000 fatalities or 8.8% of all. According to the data of the World Health Organization, in 2005 Bulgaria was on 23rd place in absolute number of gastric cancer deaths among the men and on 25th place among the women. In 2011, we were on 11th place in absolute number of gastric cancer deaths among the men and on 12th place among the women. According to NCCN (National Comprehensive Cancer Network) there are 2 basic types of surgical interventions that are used for radical gastric cancer treatment- total and subtotal gastrectomy. The scientific society however is still divided on the matter of the volume of lymph dissection. The gastrectomy with D2 lymph dissection is the standard treatment for resectable gastric carcinoma in Asia. In the Western countries, the D2 lymph dissection is considered an advisable, but not mandatory procedure. Despite that, there is a rule that the removal of more than 15 lymph nodes is in favor of the NCCN. Nowadays in Japan the comparative studies between D1 and D2 gastrectomy are considered unethical. PMID:25507001

Angelov, K

2014-01-01

186

Optimization of surgical approach and lymph node dissection in patients with gastric cancer.  

PubMed

In 2012 there were nearly 1 million new gastric cancer cases (952,000 cases or 6.8% of all cancer cases). That has put the gastric cancer on 5th place in frequency, and on 3th placeas leading cause of death in both sexes in the world--723,000 fatalities or 8.8% of all. According to the data of the World Health Organization, in 2005 Bulgaria was on 23rd place in absolute number of gastric cancer deaths among the men and on 25th place among the women. In 2011, we were on 11th place in absolute number of gastric cancer deaths among the men and on 12th place among the women. According to NCCN (National Comprehensive Cancer Network) there are 2 basic types of surgical interventions that are used for radical gastric cancer treatment- total and subtotal gastrectomy. The scientific society however is still divided on the matter of the volume of lymph dissection. The gastrectomy with D2 lymph dissection is the standard treatment for resectable gastric carcinoma in Asia. In the Western countries, the D2 lymph dissection is considered an advisable, but not mandatory procedure. Despite that, there is a rule that the removal of more than 15 lymph nodes is in favor of the NCCN. Nowadays in Japan the comparative studies between D1 and D2 gastrectomy are considered unethical. PMID:25417273

Angelov, K

2014-01-01

187

Use of Axillary Deodorant and Effect on Acute Skin Toxicity During Radiotherapy for Breast Cancer: A Prospective Randomized Noninferiority Trial  

SciTech Connect

Purpose: To prospectively determine the effect of deodorant use on acute skin toxicity and quality of life during breast radiotherapy (RT). Methods and Materials: Before breast RT, 84 patients were randomly assigned to the deodorant group (n = 40) or the no-deodorant group (n = 44). The patients were stratified by axillary RT and previous chemotherapy. Toxicity evaluations were always performed by the principal investigator, who was unaware of the group assignment, at the end of RT and 2 weeks after completion using the Radiation Therapy Oncology Group acute skin toxicity criteria. Symptoms of acute skin toxicity (i.e., discomfort, pain, pruritus, sweating) and quality of life were self-evaluated. For each criterion, the point estimate of rate difference with the 95% one-sided upper confidence limit was computed. To claim noninferiority owing to deodorant use, the 95% one-sided upper confidence limit had to be lower than the noninferiority margin, fixed to 12.8%. Results: In the deodorant vs. no-deodorant groups, Grade 2 axillary radiodermatitis occurred in 23% vs. 30%, respectively, satisfying the statistical criteria for noninferiority (p = .019). Grade 2 breast radiodermatitis occurred in 30% vs. 34% of the deodorant vs. no-deodorant groups, respectively, also satisfying the statistical criteria for noninferiority (p = .049). Similar results were observed for the self-reported evaluations. The deodorant group reported less sweating (18% vs. 39%, p = .032). No Grade 3 or 4 radiodermatitis was observed. Conclusion: According to our noninferiority margin definition, the occurrence of skin toxicity and its related symptoms were statistically equivalent in both groups. No evidence was found to prohibit deodorant use (notwithstanding the use of an antiperspirant with aluminum) during RT for breast cancer.

Theberge, Valerie, E-mail: valerie.theberge.1@ulaval.c [Departement de Radio-Oncologie, L'Hotel-Dieu de Quebec, Centre Hospitalier Universitaire de Quebec, Quebec, QB (Canada); Harel, Francois [Centre de Recherche de L'Hotel-Dieu de Quebec, L'Hotel-Dieu de Quebec, Centre Hospitalier Universitaire de Quebec, Centre de Recherche en Cancerologie de l'Universite Laval, Quebec, QB (Canada); Dagnault, Anne [Departement de Radio-Oncologie, L'Hotel-Dieu de Quebec, Centre Hospitalier Universitaire de Quebec, Quebec, QB (Canada); Centre de Recherche de L'Hotel-Dieu de Quebec, L'Hotel-Dieu de Quebec, Centre Hospitalier Universitaire de Quebec, Centre de Recherche en Cancerologie de l'Universite Laval, Quebec, QB (Canada)

2009-11-15

188

Intra-operative rapid diagnostic method based on CK19 mRNA expression for the detection of lymph node metastases in breast cancer  

PubMed Central

Staging by sentinel node (SN) biopsy is the standard procedure for clinically node-negative breast cancer patients. Intra-operative analysis of the SN allows immediate axillary lymph node (ALN) dissection in SN positive patients, but a quick, reliable and reproducible method is lacking. We tested the suitability of a quantitative cytokeratin 19 (CK19) mRNA one step nucleic acid amplification (OSNA#) technique (OSNA-CK19) for intra-operative SN analysis. OSNA-CK19 involves a short manual sample preparation step and subsequent fully automated amplification of CK19 mRNA based on reverse transcription loop-mediated isothermal amplification, with results available within 30–40 min. OSNA-CK19 was compared to histological staining (Hematoxylin&Eosin and CAM5.2 and CK19 immunostaining) of 346 frozen ALNs from 32 breast cancer patients, using half of the lymph node for each method. 267 samples were negative and 61 positive by both methods. Three samples were histology positive and OSNA-CK19 negative. Fifteen samples were histology negative and OSNA-CK19 positive, 11 of which had copy numbers close to the cut-off level of OSNA-CK19. Seven of these 15 samples were RT-PCR positive for epithelial markers and/or showed CK19 protein expression by Western blot suggesting the presence of tumor deposits in the lymph node part investigated by OSNA-CK19. Concordance with histology was 94.8%, and 96.8% after exclusion of the latter 7 discordant cases. Sensitivity was 95.3% and specificity was 94.7% before and 97.1% after discordant case investigation. Our results indicate that OSNA-CK19 can potentially be useful in an intra-operative clinical setting to detect SN tumor involvement in breast cancer patients. PMID:18324628

Visser, Mike; Jiwa, Mehdi; Horstman, Anja; Brink, Antoinette ATP; Pol, Rene P; van Diest, Paul; Snijders, Peter JF; Meijer, Chris JLM

2008-01-01

189

Does Lymphovascular Invasion Predict Regional Nodal Failure in Breast Cancer Patients With Zero to Three Positive Lymph Nodes Treated With Conserving Surgery and Radiotherapy? Implications for Regional Radiation  

SciTech Connect

Purpose: To examine the relationship between lymphovascular invasion (LVI) and regional nodal failure (RNF) in breast cancer patients with zero to three positive nodes treated with breast-conservation therapy (BCT). Methods and Materials: The records of 1,257 breast cancer patients with zero to three positive lymph nodes were reviewed. All patients were treated with BCT at Massachusetts General Hospital from 1980 to December 2003. Lymphovascular invasion was diagnosed by hematoxylin and eosin-stained sections and in some cases supported by immunohistochemical stains. Regional nodal failure was defined as recurrence in the ipsilateral supraclavicular, axillary, or internal mammary lymph nodes. Regional nodal failure was diagnosed by clinical and/or radiologic examination. Results: The median follow-up was 8 years (range, 0.1-21 years). Lymphovascular invasion was present in 211 patients (17%). In univariate analysis, patients with LVI had a higher rate of RNF (3.32% vs. 1.15%; p = 0.02). In multivariate analysis, only tumor size, grade, and local failure were significant predictors of RNF (p = 0.049, 0.013, and 0.0001, respectively), whereas LVI did not show a significant relationship with RNF (hazard ratio = 2.07; 95% CI, 0.8-5.5; p = 0.143). The presence of LVI in the T2/3 population did not increase the risk of RNF over that for those with no LVI (p = 0.15). In addition, patients with Grade 3 tumors and positive LVI did not have a higher risk of RNF than those without LVI (p = 0.96). Conclusion: These results suggest that LVI can not be used as a sole indicator for regional nodal irradiation in breast cancer patients with zero to three positive lymph nodes treated with BCT.

Boutrus, Rimoun; Abi-Raad, Rita; Niemierko, Andrzej [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Brachtel, Elena F. [Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Rizk, Levi; Kelada, Alexandra [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Taghian, Alphonse G., E-mail: ataghian@partners.or [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States)

2010-11-01

190

Clinicopathologic factors and molecular markers related to lymph node metastasis in early gastric cancer  

PubMed Central

AIM: To analyze predictive factors for lymph node metastasis in early gastric cancer. METHODS: We analyzed 1104 patients with early gastric cancer (EGC) who underwent a gastrectomy with lymph-node dissection from May 2003 through July 2011. The clinicopathologic factors and molecular markers were assessed as predictors for lymph node metastasis. Molecular markers such as microsatellite instability, human mutL homolog 1, p53, epidermal growth factor receptor (EGFR) and human epidermal growth factor receptor 2 (HER2) were included. The ?2 test and logistic regression analysis were used to determine clinicopathologic parameters. RESULTS: Lymph node metastasis was observed in 104 (9.4%) of 1104 patients. Among 104 cases of lymph node positive patients, 24 patients (3.8%) were mucosal cancers and 80 patients (16.7%) were submucosal. According to histologic evaluation, the number of lymph node metastasis found was 4 (1.7%) for well differentiated tubular adenocarcinoma, 45 (11.3%) for moderately differentiated tubular adenocarcinoma, 36 (14.8%) for poorly differentiated tubular adenocarcinoma, and 19 (8.4%) for signet ring cell carcinoma. Of 690 EGC cases, 77 cases (11.2%) showed EGFR overexpression. HER2 overexpression was present in 110 cases (27.1%) of 406 EGC patients. With multivariate analysis, female gender (OR = 2.281, P = 0.009), presence of lymphovascular invasion (OR = 10.950, P < 0.0001), diameter (? 20 mm, OR = 3.173, P = 0.01), and EGFR overexpression (OR = 2.185, P = 0.044) were independent risk factors for lymph node involvement. CONCLUSION: Female gender, tumor size, lymphovascular invasion and EGFR overexpression were predictive risk factors for lymph node metastasis in EGC. PMID:25593477

Jin, Eun Hyo; Lee, Dong Ho; Jung, Sung-Ae; Shim, Ki-Nam; Seo, Ji Yeon; Kim, Nayoung; Shin, Cheol Min; Yoon, Hyuk; Jung, Hyun Chae

2015-01-01

191

One-step nucleic acid amplification testing in medullary thyroid cancer lymph nodes: a case series  

PubMed Central

Introduction Locoregional relapse in medullary thyroid cancer (MTC) may be caused by nodal micrometastases. Medullary thyroid cancer lymph nodes have not yet been evaluated by one-step nucleic acid amplification (OSNA). Therefore, the aim of this study was to detect MTC cells by OSNA in cervical lymph nodes and compare the obtained outcomes with conventional histopathology. Material and methods Twenty-one randomized, unenlarged lymph nodes from 5 patients with MTC were examined by histopathology and OSNA. Lymph nodes were divided into four representative blocks by a sterile, single use, special cutting device in the same way as in the clinical protocol study performed by Tsujimoto et al. Two blocks were used for histopathology and immunohistochemistry, 2 for OSNA. Results Positive results of histopathology and OSNA were revealed in 4 patients. The outcomes of OSNA and histopathology were corresponding in 3 patients. Positive histopathology results of 2 lymph nodes from 2 patients were confirmed by OSNA. In 1 patient there were only negative results of both examinations. One-step nucleic acid amplification failed to detect metastasis in 1 lymph node in 2 patients although it did not change the TNM status in these patients. There were no false positive results in the OSNA test. Conclusions One-step nucleic acid amplification may be an alternative method to histopathology in detecting nodal involvement in MTC. Further studies should evaluate the sensitivity and specificity of OSNA and the impact on staging in MTC. PMID:25861300

Fendler, Wojciech; Borowiec, Maciej; M?ynarski, Wojciech; Paduszynska, Katarzyna; Grzegory, Anna; Pomorski, Lech

2015-01-01

192

Clinical Outcome of Patients with Lymph Node-Positive Prostate Cancer following Radical Prostatectomy and Extended Sentinel Lymph Node Dissection.  

PubMed

Objective: This study sought to evaluate the clinical outcome after extended sentinel lymph node dissection (eSLND) and radical retropubic prostatectomy (RRP) in patients with clinically localized prostate cancer (PCa). Subjects and Methods: From August 2002 until February 2011, a total of 819 patients with clinically localized PCa, confirmed by biopsy, were treated with RRP plus eSLND. Biochemical recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were assessed with Kaplan-Meier curves. Various histopathological parameters were analyzed by univariate and multivariate analysis. Results: The mean follow-up was 5.3 years. Lymph node (LN) metastases occurred in 140 patients. We removed an average of 10.9 LNs via eSLND from patients with pN1 PCa. Postoperatively, 121 pN1 patients temporarily received adjuvant androgen deprivation therapy. The mean survival periods for RFS, RFS after secondary treatment, CSS, and OS were 4.7, 7.0, 8.8, and 8.1 years, respectively. The cancer-specific death rate of the 140 pN1 patients was 13.6%. RFS, CSS, and OS were significantly correlated with pathological margin status, LN density, the total diameter of evident metastases, and membership in the subgroup 'micrometastases only'. Conclusion: Despite the presence of LN metastases, patients with a low nodal tumor burden demonstrate a remarkable clinical outcome after undergoing eSLND and RRP, thus suggesting a potential curative therapeutic approach. © 2014 S. Karger AG, Basel. PMID:25170747

Muck, Alexander; Langesberg, Christian; Mugler, Michael; Rahnenführer, Jörg; Wullich, Bernd; Schafhauser, Wolfgang

2014-08-20

193

Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial  

Microsoft Academic Search

PURPOSE: The extent of lymph node dissection appropriate for gastric cancer is still under debate. We have conducted a randomized trial to compare the results of a limited (D1) and extended (D2) lymph node dissection in terms of morbidity, mortality, long-term survival and cumulative risk of relapse. We have reviewed the results of our trial after follow-up of more than

H. H. Hartgrink; Velde van de C. J. H; H. Putter; J. J. Bonenkamp; E. Meershoek-Klein Kranenbarg; I. Songun; K. Welvaart; S. Meijer; J. T. M. Plukker; P. J. van Elk; H. Obertop; D. J. Gouma; J. J. B. van Lanschot; C. W. Taat; P. W. de Graaf; M. F. von Meyenfeldt; H. W. Tilanus; M. Sasako

2004-01-01

194

Colon cancer metastasis to mediastinal lymph nodes without liver or lung involvement: A case report.  

PubMed

Colon cancer is the second most common type of cancer in females and the third in males, worldwide. The most common sites of colon cancer metastasis are the regional lymph nodes, liver, lung, bone and brain. In this study, an extremely rare case of colon adenocarcinoma with extensive metastasis to the mediastinal lymph nodes without any other organ involvement is presented. A 44-year-old Caucasian male presented with abdominal pain, a change in bowel habits, melena and weight loss. Colonoscopy revealed a large friable, ulcerated, circumferential mass in the ascending colon. Biopsies were consistent with the diagnosis of invasive moderately differentiated adenocarcinoma. Subsequently, right colon resection was performed, and pathological analysis revealed moderately differentiated adenocarcinoma of the right colon with extensive regional lymph node involvement. Computed tomography (CT) scans of the chest, abdomen and pelvis were performed preoperatively as part of routine staging for colon cancer. No liver or lung pathology was identified; however, multiple pathologically enlarged mediastinal lymph nodes were observed. Endoscopic ultrasound with fine needle aspiration of the largest mediastinal lymph node, which measured 5.2×3.5 cm on CT scans, was performed. The pathology was again consistent with the diagnosis of metastatic colorectal primary adenocarcinoma. At present, no optimum treatment has been identified for metastatic colon cancer to the mediastinal lymph nodes. The patient in the current case received chemotherapy with folinic acid, fluorouracil and oxaliplatin (FOLFOX), as well as with bevacizumab. Initial follow-up CT scans of the chest revealed a positive response to treatment. Physicians, in particular, radiologists, must consider the mediastinum during the first evaluation and further follow-up of patients with colorectal carcinoma even in the absence of metastasis. PMID:25289100

El-Halabi, Mustapha M; Chaaban, Said A; Meouchy, Joseph; Page, Seth; Salyers, William J

2014-11-01

195

Solitary mediastinal lymph node recurrence after curative resection of colon cancer  

PubMed Central

We report two cases of solitary mediastinal lymph node recurrence after colon cancer resection. Both cases had para-aortic lymph node metastasis at the time of initial surgery and received adjuvant chemotherapy for 4 years in case 1 and 18 mo in case 2. The time to recurrence was more than 8 years in both cases. After resection of the recurrent tumor, the patient is doing well with no recurrence for 6 years in case 1 and 4 mo in case 2. Patients should be followed up after colon cancer surgery considering the possibility of solitary mediastinal lymph node recurrence if they had para-aortic node metastasis at the time of initial surgery. PMID:25161766

Matsuda, Yasuhiro; Yano, Masahiko; Miyoshi, Norikatsu; Noura, Shingo; Ohue, Masayuki; Sugimura, Keijiro; Motoori, Masaaki; Kishi, Kentaro; Fujiwara, Yoshiyuki; Gotoh, Kunihito; Marubashi, Shigeru; Akita, Hirofumi; Takahashi, Hidenori; Sakon, Masato

2014-01-01

196

SEER Lymph Node Fields  

Cancer.gov

1 1 SEER Lymph Node Codes www.seer.cancer.gov SEER Lymph Node Codes Revisited SEER Program Training Materials October 2002 2 SEER Lymph Node Codes www.seer.cancer.gov EOD Lymph Node Involvement Number of Regional Nodes Positive Number of Regional

197

Occurrence of lymph node metastasis in early-stage parotid gland cancer.  

PubMed

Lymph node metastasis is one of the most important factors in therapy and prognosis for patients with parotid gland cancer. Nevertheless, the extent of the primary tumor resection and the necessity of a neck dissection still is a common issue. Since little is known about lymph node metastasis in early-stage parotid gland cancer, the purpose of the present study was to evaluate the occurrence of lymph node metastases in T1 and T2 carcinomas and its impact on local control and survival. We retrospectively analyzed 70 patients with early-stage (T1 and T2) primary parotid gland cancer. All patients were treated with parotidectomy and an ipsilateral neck dissection from 1987 to 2009. Clinicopathological and survival parameters were calculated. The median follow-up time was 51.7 months. A positive pathological lymph node stage (pN+) was found in 21.4% of patients with a significant correlation to the clinical lymph node stage (cN) (p = 0.061). There were no differences in the clinical and histopathological data between pN- and pN+ patients. In 73.3% of pN+ patients, the metastases were located intraparotideal. The incidence of occult metastases (pN+/cN-) was 17.2%. Of all patients with occult metastases, 30.0% had extraparotideal lymphatic spread. A positive lymph node stage significantly indicated a poorer 5-year overall as well as 5-year disease-free survival rate compared to pN- patients (p = 0.048; p = 0.011). We propose total parotidectomy in combination with at least a level II-III selective neck dissection in any case of early-stage parotid gland cancer. PMID:21671057

Stenner, Markus; Molls, Christoph; Luers, Jan C; Beutner, Dirk; Klussmann, Jens P; Huettenbrink, Karl-Bernd

2012-02-01

198

Quantitative, Architectural Analysis of Immune Cell Subsets in Tumor-Draining Lymph Nodes from Breast Cancer Patients and Healthy Lymph Nodes  

PubMed Central

Background To date, pathological examination of specimens remains largely qualitative. Quantitative measures of tissue spatial features are generally not captured. To gain additional mechanistic and prognostic insights, a need for quantitative architectural analysis arises in studying immune cell-cancer interactions within the tumor microenvironment and tumor-draining lymph nodes (TDLNs). Methodology/Principal Findings We present a novel, quantitative image analysis approach incorporating 1) multi-color tissue staining, 2) high-resolution, automated whole-section imaging, 3) custom image analysis software that identifies cell types and locations, and 4) spatial statistical analysis. As a proof of concept, we applied this approach to study the architectural patterns of T and B cells within tumor-draining lymph nodes from breast cancer patients versus healthy lymph nodes. We found that the spatial grouping patterns of T and B cells differed between healthy and breast cancer lymph nodes, and this could be attributed to the lack of B cell localization in the extrafollicular region of the TDLNs. Conclusions/Significance Our integrative approach has made quantitative analysis of complex visual data possible. Our results highlight spatial alterations of immune cells within lymph nodes from breast cancer patients as an independent variable from numerical changes. This opens up new areas of investigations in research and medicine. Future application of this approach will lead to a better understanding of immune changes in the tumor microenvironment and TDLNs, and how they affect clinical outcomes. PMID:20811638

Setiadi, A. Francesca; Ray, Nelson C.; Kohrt, Holbrook E.; Kapelner, Adam; Carcamo-Cavazos, Valeria; Levic, Edina B.; Yadegarynia, Sina; van der Loos, Chris M.; Schwartz, Erich J.; Holmes, Susan; Lee, Peter P.

2010-01-01

199

Landmark Trials Affecting the Surgical Management of Invasive Breast Cancer  

PubMed Central

SYNOPSIS Significant progress has been made in the surgical management of breast cancer. Historically, women with invasive breast cancer underwent a Halsted radical mastectomy; morbid procedure removing the breast, underlying muscle and regional lymph nodes. In contemporary practice, the majority of women diagnosed with early stage invasive breast cancer can now be managed with breast conserving therapy to include a segmental mastectomy followed by radiation. Axillary lymph nodes are routinely assessed by sentinel lymph node biopsy. Axillary lymph node dissection is reserved for patients with documented nodal metastasis, however, here too progress has been made as a population of low risk patients has been identified in whom a complete dissection is not required even in the setting of a positive sentinel lymph node. This chapter details the landmark clinical trials that have guided the surgical management of breast cancer. PMID:23464699

Black, Dalliah M.

2014-01-01

200

Preoperative Detection of Cervical Lymph Node Metastases in Papillary Thyroid Cancer: A Surgical Perspective  

Microsoft Academic Search

SummaryDespite its relatively benign biological behavior, papillary thyroid cancer is frequently associated with cervical lymph node metastases at the time of diagnosis. These metastases have a limited impact on overall survival, but are recognized as a significant risk factor for locoregional recurrence of the disease. This may significantly alter quality of life, and may require further therapeutic interventions which may

George H. Sakorafas; Spiros Christodoulou; Christos Lappas; Michael Safioleas

2009-01-01

201

Sentinel Lymph Node Occult Metastases Have Minimal Survival Effect in Node-Negative Breast Cancer Patients  

Cancer.gov

Detailed examination of sentinel lymph node tissue from breast cancer patients revealed previously unidentified metastases in about 16% of the samples, but the difference in 5-year survival between patients with and without these metastases was very small and likely not clinically meaningful. The results were published in the February 3, 2011 New England Journal of Medicine.

202

Refining Post-Surgical Therapy for Women with Lymph Node-Positive Breast Cancer  

Cancer.gov

In this phase III trial, women with HER2-negative, HR-positive breast cancer and 1-3 positive lymph nodes with recurrence scores of 25 or lower will be randomly assigned either to undergo adjuvant chemotherapy before starting endocrine therapy or to begin endocrine therapy without chemotherapy.

203

An operative gamma camera for sentinel lymph node procedure in case of breast cancer  

Microsoft Academic Search

Large field of view gamma cameras are widely used to perform lymphoscintigraphy in the sentinel lymph nodes (SLN) procedure in case of breast cancer. However, they are not specified for this application and their sizes do not enable their use in the operative room to control the excision of the all SLN. We present the results obtained with a prototype

S. Salvador; V. Bekaert; C. Mathelin; J. L. Guyonnet; D. Huss

2007-01-01

204

Intratumoral Lymphangiogenesis and Lymph Node Metastasis in Head and Neck Cancer1  

Microsoft Academic Search

How tumors access and spread via the lymphatics is not understood. Although it is clear that dissemination via the blood system involves hemangiogenesis, it is uncertain whether tumors also induce lymphangio- genesis or simply invade existing peritumoral vessels. To address the issue we quantitated tumor lymph vessels in archival specimens of head and neck cancer by immunostaining for the recently

Nigel J. P. Beasley; Remko Prevo; Suneale Banerji; Russell D. Leek; John Moore; Philippe van Trappen; Graham Cox; Adrian L. Harris; David G. Jackson

2002-01-01

205

Overexpression of LI-cadherin in gastric cancer is associated with lymph node metastasis.  

PubMed

Gastric cancer remains the second leading cause of cancer deaths worldwide. Patients usually present late with local invasion or metastatic diseases. The present study investigated the expression level of liver-intestine cadherin (LI-cadherin) by RT-PCR and its correlation with clinicopathological data in 71 pairs of tumor and non-cancerous gastric mucosa. Protein expression level of LI-cadherin was determined by Western blotting and immunohistochemistry. The mRNA of LI-cadherin was highly expressed in tumor as compared to non-cancerous mucosa. Lymph node metastasis was significantly associated with the expression of LI-cadherin (p=0.038). On multivariate analysis, T staging and LI-cadherin expression were found to be independent factors associated with lymph node metastasis. PMID:15178443

Ko, Samuel; Chu, Kent-Man; Luk, John M; Wong, Bonnie W; Yuen, Siu-Tsan; Leung, Suet-Yi; Wong, John

2004-06-25

206

ZEB1 Expression in Endometrial Biopsy Predicts Lymph Node Metastases in Patient with Endometrial Cancer  

PubMed Central

Purpose. The purpose of this study was to analyze the expression of zinc-finger E-box-binding homeobox 1 (ZEB1) in endometrial biopsy and its correlation with preoperative characteristics, including lymph node metastases in patient with endometrial cancer. Methods. Using quantitative RT-PCR, ZEB1 expressions in endometrial biopsy from 452 patients were measured. The relationship between ZEB1 expression and preoperative characteristics was analyzed. Results. ZEB1 expressions were significantly associated with subtype, grade, myometrial invasion, and lymph node metastases. Lymph node metastases could be identified with a sensitivity of 57.8% at specificity of 74.1% by ZEB1 expression in endometrial biopsy. Based on combination of preoperative characteristics and ZEB1 expression, lymph node metastases could be identified with a sensitivity of 62.1% at specificity of 96.2% prior to hysterectomy. Conclusion. ZEB1 expression in endometrial biopsy could help physicians to better predict the lymph node metastasis in patients with endometrial cancer prior to hysterectomy. PMID:25544793

Feng, Gang; Wang, Xiangming; Cao, Xiaozhi; Shen, Lijuan; Zhu, Jiansheng

2014-01-01

207

Histologic Changes Associated With False-Negative Sentinel Lymph Nodes After Preoperative Chemotherapy in Patients With Confirmed Lymph Node-Positive Breast Cancer Before Treatment  

PubMed Central

BACKGROUND A wide range of false-negative rates has been reported for sentinel lymph node (SLN) biopsy after preoperative chemotherapy. The purpose of this study was to determine whether histologic findings in negative SLNs after preoperative chemotherapy are helpful in assessing the accuracy of SLN biopsy in patients with confirmed lymph node-positive disease before treatment. METHODS Eighty-six patients with confirmed lymph node-positive disease at presentation underwent successful SLN biopsy and axillary dissection after preoperative chemotherapy at a single institution between 1994 and 2007. Available hematoxylin and eosin-stained sections from patients with negative SLNs were reviewed, and associations between histologic findings in the negative SLNs and SLN status (true negative vs false negative) were evaluated. RESULTS Forty-seven (55%) patients had at least 1 positive SLN, and 39 (45%) patients had negative SLNs. The false-negative rate was 22%, and the negative predictive value was 67%. The negative SLNs from 17 of 34 patients with available slides had focal areas of fibrosis, some with associated foamy parenchymal histiocytes, fat necrosis, or calcification. These histologic findings occurred in 15 (65%) of 23 patients with true-negative SLNs and in only 2 (18%) of 11 patients with false-negative SLNs (P =.03, Fisher exact test, 2-tailed). The lack of these histologic changes had a sensitivity and specificity for identifying a false-negative SLN of 82% and 65%, respectively. CONCLUSIONS Absence of treatment effect in SLNs after chemotherapy in patients with lymph node-positive disease at initial presentation has good sensitivity but low specificity for identifying a false-negative SLN. PMID:20564394

Brown, Alexandra S.; Hunt, Kelly K.; Shen, Jeannie; Huo, Lei; Babiera, Gildy V.; Ross, Merrick I.; Meric-Bernstam, Funda; Feig, Barry W.; Kuerer, Henry M.; Boughey, Judy C.; Ching, Christine D.; Gilcrease, Michael Z.

2015-01-01

208

Results of optical Monte Carlo simulations of a compact ? camera for the detection of sentinel lymph nodes  

NASA Astrophysics Data System (ADS)

Breast cancer is most often treatable when detected in the early stages, before the primary disease spreads to sentinel lymph nodes in the axilla and supraclavicular region. A sentinel lymph node is the closest adjacent lymph node to receive lymphatic drainage from a primary breast tumour. It is from these nodes that cancer cells metastasise throughout the lymphatic system, spreading the disease. This work details the optical Monte Carlo modelling of an ultra compact, nuclear medicine ? camera that will be used intra-operatively to detect malignant sentinel lymph nodes. This development will improve the identification and localisation of these sentinel nodes, thereby facilitating improved techniques for axillary lymph node dissection, and sentinel lymph node biopsy.

Lowe, Dean; Truman, Andrew; Kwok, Harry; Bergman, Alanah

2001-07-01

209

Improvement of the sentinel lymph node detection rate of cervical sentinel lymph node biopsy using real-time fluorescence navigation with indocyanine green in head and neck skin cancer.  

PubMed

The standard technique using lymphoscintigraphy, blue dye and a gamma probe has established a reliable method for sentinel node biopsy for skin cancer. However, the detection rate of cervical sentinel lymph nodes (SLN) is generally lower than that of inguinal or axillary SLN because of the complexity of lymphatic drainage in the head and neck region and the "shine-through" phenomenon. Recently, indocyanine green fluorescence imaging has been reported as a new method to detect SLN. We hypothesized that fluorescence navigation with indocyanine green in combination with the standard technique would improve the detection rate of cervical sentinel nodes. We performed cervical sentinel node biopsies using the standard technique in 20 basins of 18 patients (group A) and using fluorescence navigation in combination with the standard technique in 12 basins of 16 patients (group B). The mean number of sentinel nodes was two per basin (range, 1-4) in group A and three per basin (range, 1-5) in group B. The detection rate of sentinel nodes was 83% (29/35) in group A and 95% (36/38) in group B. The false-negative rate was 6% (1/18 patients) in group A and 0% in group B. Fluorescence navigation with indocyanine green may improve the cervical sentinel node detection rate. However, greater collection of data regarding the usefulness of cervical sentinel node biopsy using indocyanine green is necessary. PMID:23621899

Nakamura, Yasuhiro; Fujisawa, Yasuhiro; Nakamura, Yoshiyuki; Maruyama, Hiroshi; Furuta, Jun-ichi; Kawachi, Yasuhiro; Otsuka, Fujio

2013-06-01

210

Preoperative Diagnosis of Lymph Node Metastases of Colorectal Cancer by FDG-PET\\/CT  

Microsoft Academic Search

Purpose: The purpose of this study was to assess the diagnostic value of 18F-fluorodeoxy- glucose positron emission tomography\\/computed tomography (FDG-PET\\/CT) for lymph node (LN) metastasis of colorectal cancer. Methods: FDG-PET\\/CT was used to preoperatively evaluate 88 patients with colorectal cancer. In this study, LN sites were divided into proximal and distant according to their dis- tance from the primary tumor.

Yoshiyuki Tsunoda; Masaaki Ito; Hirofumi Fujii; Hiroyuki Kuwano; Norio Saito

211

Cytokine/Chemokine Responses in Activated CD4+ and CD8+ T Cells Isolated from Peripheral Blood, Bone Marrow, and Axillary Lymph Nodes during Acute Simian Immunodeficiency Virus Infection  

PubMed Central

ABSTRACT Understanding the cytokine/chemokine networks in CD4+ and CD8+ T cells during the acute phase of infection is crucial to design therapies for the control of early human immunodeficiency virus (HIV)/simian immunodeficiency virus (SIV) replication. Here, we measured early changes in CD4+ and CD8+ T cells in the peripheral blood (PB), bone marrow (BM), and axillary lymph node (ALN) tissue of rhesus macaques infected with SIVMAC251. At 21 days after infection, all tissues showed a statistically significant loss of CD4+ T cells along with immune activation of CD8+ T cells in PB and ALN tissue. Twenty-eight different cytokines/chemokines were quantified in either anti-CD3/28 antibody- or staphylococcal enterotoxin B-stimulated single-positive CD4+ and CD8+ T cells. PB CD4+ T cells produced predominantly interleukin-2 (IL-2), whereas CD4+ and CD8+ T-cell subsets in tissues produced ?-chemokines both before and 21 days after SIV infection. Tissues generally exhibited massive upregulation of many cytokines/chemokines following infection, possibly in an attempt to mitigate the loss of CD4+ T cells. There was no evidence of a T-helper 1 (TH1)-to-TH2 shift in CD4+ T cells or a T-cytotoxic 1 (TC1)-to-TC2 cytokine shift in CD8+ T cells in PB, BM, and ALN T-cell subsets during the acute phase of SIV infection. Despite the upregulation of several important effector cytokines/chemokines (IL-2, IL-12, IL-17, gamma interferon, granulocyte-macrophage colony-stimulating factor) by CD4+ and CD8+ T cells, upregulation of ?-chemokines (CCL2 and CCL22), basic fibroblast growth factor (FGF-basic), hepatocyte growth factor (HGF), and migration inhibition factor (MIF) may provide a poor prognosis either by inducing increased virus replication or by other unknown mechanisms. Therefore, drugs targeting ?-chemokines (CCL2 and CCL22), FGF-basic, HGF, or MIF might be important for developing effective vaccines and therapeutics against HIV. IMPORTANCE Human immunodeficiency virus (HIV)/simian immunodeficiency virus (SIV) infection results in early depletion of CD4+ T cells and dysregulation of protective immune responses. Therefore, understanding the cytokine/chemokine networks in CD4+ and CD8+ T cells in different tissues during the acute phase of infection is crucial to the design of therapies for the control of early viral replication. Here, we measured early changes in CD4+ and CD8+ T cells in peripheral blood (PB), bone marrow (BM), and axillary lymph node (ALN) tissue of rhesus macaques infected with SIVMAC251. There was no evidence of a T-helper 1 (TH1)-to-TH2 shift in CD4+ T cells or a T-cytotoxic 1 (TC1)-to-TC2 cytokine shift in CD8+ T cells in PB, BM, and ALN T-cell subsets during the acute phase of SIV infection. Despite the upregulation of several important effector cytokines/chemokines by CD4+ and CD8+ T cells, upregulation of ?-chemokines, fibroblast growth factor-basic, hepatocyte growth factor, and migration inhibition factor may provide a poor prognosis. PMID:24920807

Kenway-Lynch, Carys S.; Das, Arpita; Lackner, Andrew A.

2014-01-01

212

Evaluation of 18F-fluorodeoxyglucose uptake in enlarged mediastinal lymph nodes in patients with lung cancer  

PubMed Central

Accurate lymph nodal staging of lung cancer is critical for determining the treatment options. With the help of 18F-fluorodeoxyglucose positron emission tomography/computer tomography (18F-FDG-PET/CT), the clinician can rule out/in the regional lymph nodes positive for metastasis in the patients with lung cancer in a majority of cases. However, a small proportion of cases with false positivity of metastasis have been reported. Transbronchial needle aspirations and mediastinoscopic biopsies are still necessary to determine whether enlarged hypermetabolic mediastinal lymph nodes are positive for lung cancer metastasis. Here we report three intricate cases showing hypermetabolic activity in the mediastinal lymph nodes in the patients with pathologically diagnosed lung cancer on PET/CT. The first patient had squamous cell carcinoma in the left upper lobe of the lung with surrounding necrotizing granulomas and concurrent with silicosis and granulomatous inflammation in the lymph nodes; the second presented with symptoms of viral pneumonia, which was pathologically diagnosed as a lung adenocarcinoma, stage IA, concurrent with sarcoidosis involving the lymph nodes; the last case was diagnosed as squamous cell carcinoma in the right upper lobe of the lung, but lymph nodes showed reactive hyperplasia. These cases suggest that some cases are so complex that avid 18F-FDG uptake in the mediastinal lymph nodes in the patients with pathologically diagnosed lung cancer should be carefully analyzed based on individual patients’ clinical background. PMID:25550877

Ji, Cheng; Zhang, Bin; Zhu, Weidong; Ling, Chunhua; Hu, Xudong; Chen, Yanbin; Huang, Jianan; Guo, Lingchun; Xu, Haodong

2014-01-01

213

Prognostic significance of cervical lymph node metastases in differentiated thyroid cancer.  

PubMed

During the last decade, several analyses of prognostic factors for differentiated thyroid cancer (DTC) have been reported. Although these studies have established a framework for rational treatment planning, they have not fully answered questions regarding the prognostic significance of cervical lymph node metastases. An analysis of patients treated for DTC at our institution over a 34-year period has shown several factors to be significant by log-rank analysis, including the presence of cervical lymph node metastases, age greater than or equal to 50 years, a primary cancer size of greater than 3.0 cm, and distant metastases. Further analysis has shown the node-negative and node-positive patient groups to be similar in regard to age, size of primary cancer, and the presence of distant metastases. This report compares our data with those of other studies that have investigated the association of cervical lymph node metastases and a poorer prognosis in patients with DTC. When considered as a group, these studies support the finding of the prognostic significance of cervical lymph node metastases, particularly that of palpable lymphadenopathy in older patients. PMID:1463103

Sellers, M; Beenken, S; Blankenship, A; Soong, S J; Turbat-Herrera, E; Urist, M; Maddox, W

1992-12-01

214

Diagnostic accuracy of preoperative tests for lymph node status in endometrial cancer: a systematic review  

PubMed Central

Abstract Background: Approximately 72% of endometrial cancers are FIGO stage I at diagnosis and about 10% have lymph node metastases. An ideal diagnostic test for nodal disease would be able to prevent both overtreatment (i.e. unnecessary lymphadenectomy) and undertreatment (i.e. withholding lymphadenectomy or adjuvant postoperative treatment to patients with lymph node metastases). Objectives: In this review we compare the accuracy of preoperative tests (computed tomography, magnetic resonance imaging, positron emission tomography-computed tomography, CA-125 serum levels, and ultrasonography) for the detection of lymph node metastases in endometrial cancers with the final histopathologic diagnosis after complete pelvic and para-aortic lymphadenectomy as the gold standard. Method: A systematic search in MEDLINE (using PubMed), Embase and The Cochrane Library was performed up to 23 July 2012. Results: We found one article that met our inclusion criteria for computed tomography, none for magnetic resonance imaging, 2 for positron emission tomography/computed tomography), 2 for CA-125 and none for ultrasonography. Conclusions: Due to the lack of high-quality articles on a preoperative test for lymph node status in endometrial cancer, no proper comparison between these modalities can be made. PMID:23876490

Trum, J.W.; Bakers, F.C.H.; Beets-Tan, R.G.H.; Smits, L.J.M.; Kruitwagen, R.F.P.M.

2013-01-01

215

Lymph node, peritoneal and bone marrow micrometastases in gastric cancer: Their clinical significance.  

PubMed

The 7th TNM classification clearly states that micrometastases detected by morphological techniques (HE stain and immunohistochemistry) should always be reported and calculated in the staging of the disease (pN1mi or M1), while patients in whom micrometastases are detected by non-morphological techniques (e.g., flow cytometry, reverse-transcriptase polymerase chain reaction) should still be classified as N0 or M0. In gastric cancer patients, micrometastases have been detected in lymph nodes, the peritoneal cavity and bone marrow. However, the clinical implications and/or their prognostic significance are still a matter of debate. Current literature suggests that lymph node micrometastases should be encountered for the loco-regional staging of the disease, while skip lymph node micrometastases should also be encountered in the total number of infiltrated lymph nodes. Peritoneal fluid cytology examination should be obligatorily performed in pT3 or pT4 tumors. A positive cytology classifies gastric cancer patients as stage IV. Although a curative resection is not precluded, these patients face an overall dismal prognosis. Whether patients with a positive cytology should be treated similarly to patients with macroscopic peritoneal recurrence should be evaluated further. Gastric cancer cells are detected with high incidence in the bone marrow. However, the published results make comparison of data between groups almost impossible due to severe methodological problems. If these methodological problems are overcome in the future, specific target therapies may be designed for specific groups of patients. PMID:22403737

Griniatsos, John; Michail, Othon; Dimitriou, Nikoletta; Karavokyros, Ioannis

2012-02-15

216

The Prognosis of T3N0 Colon Cancer Is Dependent on the Number of Lymph Nodes Examined  

Microsoft Academic Search

Background: T3N0 colon cancer is the target of many adjuvant studies. Very few studies have examined the relationship of the number of lymph nodes examined to the prognosis of this stage. We examined data from the National Cancer Data Base (NCDB) to determine whether the number of examined lymph nodes is prognostic for T3N0 colon cancer.Methods: A total of 35,787

Richard S. Swanson; Carolyn C. Compton; Andrew K. Stewart; Kirby I. Bland

2003-01-01

217

Colon cancer lymph node evaluation among Military Health System beneficiaries: An analysis by race/ethnicity  

PubMed Central

Background The number of lymph nodes examined during colon cancer surgery falls below nationally recommended guidelines in the general population, with blacks and Hispanics less likely to have adequate nodal evaluation in comparison to whites. The Department of Defense’s (DoD’s) Military Health System (MHS) provides equal access to medical care for its beneficiaries, regardless of racial/ethnic background. This study aimed to investigate whether racial/ethnic treatment differences exist in the MHS, an equal access medical care system. Methods Linked data from the DoD cancer registry and administrative claims databases were used and included 2,155 colon cancer cases. Multivariate logistic regression assessed the association between race/ethnicity and the number of lymph nodes examined (<12 and ? 12) overall and for stratified analyses. Results No overall racial/ethnic difference in the number of lymph nodes examined was identified. Further stratified analyses yielded similar results, except potential racial/ethnic differences were found among persons with poorly differentiated tumors, where non-Hispanic blacks (NHBs) tended to be less likely to have ?12 lymph nodes dissected (OR: 0.34, 95% CI: 0.14-0.80, p-value: 0.01) compared to non-Hispanic whites. Conclusion Racial/ethnic disparities in the number of lymph nodes evaluated among patients with colon cancer were not apparent in an equal-access healthcare system. However, among poorly differentiated tumors, there might be racial/ethnic differences in nodal yield, suggesting the possible effects of factors other than access to healthcare. PMID:25059789

Gill, Abegail A.; Zahm, Shelia H.; Shriver, Craig D.; Stojadinovic, Alexander; McGlynn, Katherine A.; Zhu, Kangmin

2014-01-01

218

Tumor Lymphangiogenesis and Metastasis to Lymph Nodes Induced by Cancer Cell Expression of Podoplanin  

PubMed Central

The membrane glycoprotein podoplanin is expressed by several types of human cancers and might be associated with their malignant progression. Its exact biological function and molecular targets are unclear, however. Here, we assessed the relevance of tumor cell expression of podoplanin in cancer metastasis to lymph nodes, using a human MCF7 breast carcinoma xenograft model. We found that podoplanin expression promoted tumor cell motility in vitro and, unexpectedly, increased tumor lymphangiogenesis and metastasis to regional lymph nodes in vivo, without promoting primary tumor growth. Importantly, high cancer cell expression levels of podoplanin correlated with lymph node metastasis and reduced survival times in a large cohort of 252 oral squamous cell carcinoma patients. Based on comparative transcriptional profiling of tumor xenografts, we identified endothelin-1, villin-1, and tenascin-C as potential mediators of podoplanin-induced tumor lymphangiogenesis and metastasis. These unexpected findings identify a novel mechanism of tumor lymphangiogenesis and metastasis induced by cancer cell expression of podoplanin, suggesting that reagents designed to interfere with podoplanin function might be developed as therapeutics for patients with advanced cancer. PMID:20616339

Cueni, Leah N.; Hegyi, Ivan; Shin, Jay W.; Albinger-Hegyi, Andrea; Gruber, Silke; Kunstfeld, Rainer; Moch, Holger; Detmar, Michael

2010-01-01

219

Collagen I fiber density increases in lymph node positive breast cancers: pilot study  

NASA Astrophysics Data System (ADS)

Collagen I (Col1) fibers are a major structural component in the extracellular matrix of human breast cancers. In a preliminary pilot study, we explored the link between Col1 fiber density in primary human breast cancers and the occurrence of lymph node metastasis. Col1 fibers were detected by second harmonic generation (SHG) microscopy in primary human breast cancers from patients presenting with lymph node metastasis (LN+) versus those without lymph node metastasis (LN-). Col1 fiber density, which was quantified using our in-house SHG image analysis software, was significantly higher in the primary human breast cancers of LN+ (fiber volume=29.22%±4.72%, inter-fiber distance=2.25±0.45 ?m) versus LN- (fiber volume=20.33%±5.56%, inter-fiber distance=2.88±1.07 ?m) patients. Texture analysis by evaluating the co-occurrence matrix and the Fourier transform of the Col1 fibers proved to be significantly different for the parameters of co-relation and energy, as well as aspect ratio and eccentricity, for LN+ versus LN- cases. We also demonstrated that tissue fixation and paraffin embedding had negligible effect on SHG Col1 fiber detection and quantification. High Col1 fiber density in primary breast tumors is associated with breast cancer metastasis and may serve as an imaging biomarker of metastasis.

Kakkad, Samata M.; Solaiyappan, Meiyappan; Argani, Pedram; Sukumar, Saraswati; Jacobs, Lisa K.; Leibfritz, Dieter; Bhujwalla, Zaver M.; Glunde, Kristine

2012-11-01

220

A New Model for Predicting Non-Sentinel Lymph Node Status in Chinese Sentinel Lymph Node Positive Breast Cancer Patients  

PubMed Central

Background Our goal is to validate the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram and Stanford Online Calculator (SOC) for predicting non-sentinel lymph node (NSLN) metastasis in Chinese patients, and develop a new model for better prediction of NSLN metastasis. Methods The MSKCC nomogram and SOC were used to calculate the probability of NSLN metastasis in 120 breast cancer patients. Univariate and multivariate analyses were performed to evaluate the relationship between NSLN metastasis and clinicopathologic factors, using the medical records of the first 80 breast cancer patients. A new model predicting NSLN metastasis was developed from the 80 patients. Results The MSKCC and SOC predicted NSLN metastasis in a series of 120 patients with an area under the receiver operating characteristic curve (AUC) of 0.688 and 0.734, respectively. For predicted probability cut-off points of 10%, the false-negative (FN) rates of MSKCC and SOC were both 4.4%, and the negative predictive value (NPV) 75.0% and 90.0%, respectively. Tumor size, Kiss-1 expression in positive SLN and size of SLN metastasis were independently associated with NSLN metastasis (p<0.05). A new model (Peking University People's Hospital, PKUPH) was developed using these three variables. The MSKCC, SOC and PKUPH predicted NSLN metastasis in the second 40 patients from the 120 patients with an AUC of 0.624, 0.679 and 0.795, respectively. Conclusion MSKCC nomogram and SOC did not perform as well as their original researches in Chinese patients. As a new predictor, Kiss-1 expression in positive SLN correlated independently with NSLN metastasis strongly. PKUPH model achieved higher accuracy than MSKCC and SOC in predicting NSLN metastasis in Chinese patients. PMID:25111296

Liu, Miao; Wang, Shu; Pan, Lu; Yang, Deqi; Xie, Fei; Liu, Peng; Guo, Jiajia; Zhang, Jiaqing; Zhou, Bo

2014-01-01

221

Clinical and Histological Prognostic Factors in Axillary Node-Negative BreastCancer: Univariate and Multivariate Analysis with Relation to 5-Year Recurrence.  

PubMed

In the recent years several studies have shown that about 30% of cases with axillary node-nagative breast cancer suffer relapse of the disease. Our attempt was made to evaluate the most significant prognostic factors to predict this high risk group which may be benefited from adjuvant treatment. For this purpose, we selected 9 patients out of 80 cases of node-negative breast cancer who had been followed up at least for 5 years and had the recurrence of the disease. For comparison, 16 patients from the same group who did not have relapse were selected on a random basis. Histology, receptor status, AgNOR, DNA flow cytometry and various immunohistochemical parameters were compared between the groups with recurrence and that without recurrence. On univariate analysis, tumor size, immunohistochemical expressions of PCNA, MIB-1, c-erbB-2 and S-phase fraction were significantly different between the above two groups. By multivariate analysis, immunohistochemical c-erbB-2 expression (more than 50% of cancer cells) was an independent parameter. As a summary from our studies, c-erbB-2 immunohistochemical staining on paraffin sections might be the best independent prognostic factor in axillary node-negative breast cancers. PMID:11091532

Khanna; Tokuda; Shibuya; Tanaka; Sekine; Tajima; Osamura; Mitomi

1995-04-30

222

Splicing mutation analysis reveals previously unrecognized pathways in lymph node-invasive breast cancer  

PubMed Central

Somatic mutations reported in large-scale breast cancer (BC) sequencing studies primarily consist of protein coding mutations. mRNA splicing mutation analyses have been limited in scope, despite their prevalence in Mendelian genetic disorders. We predicted splicing mutations in 442 BC tumour and matched normal exomes from The Cancer Genome Atlas Consortium (TCGA). These splicing defects were validated by abnormal expression changes in these tumours. Of the 5,206 putative mutations identified, exon skipping, leaky or cryptic splicing was confirmed for 988 variants. Pathway enrichment analysis of the mutated genes revealed mutations in 9 NCAM1-related pathways, which were significantly increased in samples with evidence of lymph node metastasis, but not in lymph node-negative tumours. We suggest that comprehensive reporting of DNA sequencing data should include non-trivial splicing analyses to avoid missing clinically-significant deleterious splicing mutations, which may reveal novel mutated pathways present in genetic disorders. PMID:25394353

Dorman, Stephanie N.; Viner, Coby; Rogan, Peter K.

2014-01-01

223

Cranial location of level II lymph nodes in laryngeal cancer: Implications for elective nodal target volume delineation  

SciTech Connect

Purpose: To analyze the cranial distribution of level II lymph nodes in patients with laryngeal cancer to optimize the elective radiation nodal target volume delineation. Methods and Materials: The most cranially located metastatic lymph node was delineated in 67 diagnostic CT data sets. The minimum distance from the base of the skull (BOS) to the lymph node was determined. Results: A total of 98 lymph nodes were delineated including 62 ipsilateral and 36 contralateral lymph nodes. The mean ipsilateral and contralateral distance from the top of the most cranial metastatic lymph node to the BOS was 36 mm (range, -9-120; standard deviation [SD], 17.9) and 35 mm (range, 14-78; SD 15.0), respectively. Only 5% and 12% of the ipsilateral and 3% and 9% of the contralateral metastatic lymph nodes were located within 15 mm and 20 mm below the BOS, respectively. No significant differences were found between patients with only ipsilateral metastatic lymph nodes and patients with bilateral metastatic lymph nodes. Between tumors that do cross the midline and those that do not, no significant difference was found in the distance of the most cranial lymph node to the BOS and the occurrence ipsilateral or contralateral. Conclusions: Setting the cranial border of the nodal target volume 1.5 cm below the base of the skull covers 95% of the lymph nodes and should be considered in elective nodal irradiation for laryngeal cancer. Bilateral neck irradiation is mandatory, including patients with unilateral laryngeal cancer, when elective irradiation is advised.

Braam, Petra M. [Department of Radiotherapy, University Medical Center Utrecht, Utrecht (Netherlands)]. E-mail: P.M.Braam@umcutrecht.nl; Raaijmakers, Cornelis P.J. [Department of Radiotherapy, University Medical Center Utrecht, Utrecht (Netherlands); Terhaard, Chris [Department of Radiotherapy, University Medical Center Utrecht, Utrecht (Netherlands)

2007-02-01

224

Detection of Telomerase Expression in Mediastinal Lymph Nodes of Patients with Lung Cancer  

Microsoft Academic Search

Mediastinal lymph nodes are the most common site of tumor spread nodes by a transesophageal approach by fine-needle aspiration in non-small cell lung cancer (NSCLC). We hypothesized that micro- and can be performed under conscious sedation on an outpa- metastatic disease could be detected by reverse transcription-poly- tient basis. Others and we have shown that EUS-guided fine- merase chain reaction

Michael B. Wallace; Mark Block; Brenda J. Hoffman; Robert H. Hawes; Gerard Silvestri; Carolyn E. Reed; Michael Mitas; James Ravenel; Mostafa Fraig; Scott Miller; Edward T. Jones; Alice Boylan

225

Radiation safety of the sentinel lymph node technique in breast cancer  

Microsoft Academic Search

.   Many publications attest to the potential of the sentinel lymph node technique in advancing the clinical management of melanoma\\u000a and, more recently, breast cancer. Whilst not yet universally regarded as the standard of care, the technique is gaining wide\\u000a acceptance. Use of a radiolabelled colloidal tracer is central to optimising sensitivity, and this brings with it the need\\u000a to

W. A. Waddington; M. R. S. Keshtgar; I. Taylor; S. R. Lakhani; M. D. Short; P. J. Eli

2000-01-01

226

Screening of lymph nodes metastasis associated lncRNAs in colorectal cancer patients  

PubMed Central

AIM: To screen lymph nodes metastasis associated long noncoding RNAs (lncRNAs) in colorectal cancer through microarray analysis. METHODS: Metastatic lymph node (MLN), normal lymph node (NLN) and tumor tissues of 3 colorectal cancer (CRC) patients were collected during the operation and validated by pathological examinations. RNAs were extracted from MLN, NLN, and cancer tissues separately. RNA quantity and quality were measured with a NanoDrop ND-1000 spectrophotometer and RNA integrity was assessed by standard denaturing agarose electrophoresis. Agilent Feature Extraction Software (Version 11.0.1.1) was used to analyze acquired array images. Four differently expressed lncRNAs were confirmed by quantitative real-time polymerase chain reaction (qRT-PCR) in 26 subsets of MLN, NLN, and tumor tissues. RESULTS: Of 33045 lncRNAs, 1133 were differentially expressed in MLN compared with NLN, of which 260 were up-regulated and 873 down-regulated (? 2 fold-change). Five hundred and forty-five lncRNAs were differentially expressed in MLN compared with tumor tissues, of which 460 were up-regulated and 85 down-regulated (? 2 fold-change). Compared with NLN and cancer tissues, 14 lncRNAs were specifically up-regulated and 5 specifically down-regulated in MLN. AK307796, ENST00000425785, and AK021444 were confirmed to be specifically up-regulated in MLN and ENST00000465846 specifically down-regulated in MLN by qRT-PCR in 26 CRC patients. CONCLUSION: The specifically expressed lncRNAs in MLN may exert a partial or key role in the progress of lymph nodes metastasis of CRC. PMID:25009386

Han, Jun; Rong, Long-Fei; Shi, Chuan-Bin; Dong, Xiao-Gang; Wang, Jie; Wang, Bao-Lin; Wen, Hao; He, Zhen-Yu

2014-01-01

227

Mode of lymph node metastases in esophageal cancer induced in rabbits with Vx2 carcinoma  

Microsoft Academic Search

We carried out experimental studies in which Vx2 carcinoma was inoculated submucosally into the esophagi of 57 rabbits. The\\u000a purpose was to clarify the mode of tumor growth and lymph node metastasis of esophageal cancer. The inoculation was given\\u000a into five different segments of the esophagus and the cardia in six different groups of rabbits: the cervical (Ce), the cervicothoracic

Hiroyuki Mine; Teruhisa Nakamura

1983-01-01

228

Overexpression of Bcl-x L in Human Breast Cancer Cells Enhances Organ-Selective Lymph Node Metastasis  

Microsoft Academic Search

Lymph node metastasis are the first prognostic factor in breast cancer diagnosis and an early event in metastatic spread. To assess the role of anti-apoptotic proteins in lymph node metastatic progression of human breast cancer cells we analyzed the metastatic activity of MDA-MB-435 cells transfected with the Bcl-xL gene, after orthotopic inoculation in Nude Balb\\/c and in SCID mice. The

Laura España; Yolanda Fernández; Nuria Rubio; Angels Torregrosa; Jeronimo Blanco; Angels Sierra

2004-01-01

229

Downregulation of glutathione peroxidase 3 is associated with lymph node metastasis and prognosis in cervical cancer.  

PubMed

Glutathione peroxidase 3 (GPX3) is a member of the glutathione peroxidase family of selenoproteins and is one of the key defensive enzymes against oxidative damages to host cells. Downregulation of GPX3 due to its promoter hypermethylation has been documented in several different types of cancer, indicating that GPX3 functions as a possible tumor suppressor. In the present study, we showed that GPX3 is also significantly downregulated in cervical cancer tissues compared to normal cervical tissues by qRT-PCR analyses and immunohistostainings. GPX3 expression was significantly related to lymph node metastasis and prognosis in cervical cancer patients. Treatment of cervical cancer cells with 5-aza-2'-deoxycytidine restored the expression of GPX3 and methylation-specific PCR (MSP) confirmed the CpG methylation of the GPX3 gene. Our results indicate that promoter methylation is one of the major causes of GPX3 downregulation in cervical cancer and GPX3 could serve as a predictive biomarker for lymph node metastasis and prognosis of cervical cancer. PMID:24788695

Zhang, Xianglan; Zheng, Zhenlong; Yingji, Shen; Kim, Hyeyeon; Jin, Renshun; Renshu, Li; Lee, Doo Young; Roh, Mi Ryung; Yang, Sanghwa

2014-06-01

230

Association between Expression of Vascular Endothelial Growth Factor C, Chemokine Receptor CXCR4 and Lymph Node Metastasis in Colorectal Cancer  

Microsoft Academic Search

Objectives: Lymph node metastasis is one of the determining factors of a poor prognosis for colorectal cancer. Recent studies have reported that cancer cells can promote lymphangiogenesis and that chemokine receptors expressed by cancer cells might play a role in metastasis. In this study, we examined the correlation between the expression of vascular endothelial growth factor (VEGF) C, the chemokine

S. Fukunaga; K. Maeda; E. Noda; T. Inoue; K. Wada; K. Hirakawa

2006-01-01

231

Axillary lipogranuloma mimicking carcinoma metastasis after silicone breast implant rupture: a case report.  

PubMed

Silicone-gel-filled breast implants have been widely used for breast augmentation and reconstruction after mastectomy. However, silicone implants have some well-known complications, such as implant rupture, which requires surgical intervention. Dissemination of silicone particles out of the implant causes a granulomatous reaction, a phenomenon known as silicone granuloma, in breast parenchyma as well as axillary, breast and chest wall lymph nodes, which mimics breast cancer metastasis. However, lipogranuloma after silicone breast implant rupture has not been reported in the literature, although it is a common complication after mineral oil or liquid silicone injection. We present a case report of an axillary lymphadenopathy resulting from lipogranuloma after silicone-gel-filled implant rupture. Review of the literature suggests that this is the first report of a lipogranuloma resulting from implant rupture. PMID:23245917

Gundeslioglu, A Ozlem; Hakverdi, Sibel; Erdem, Ozlem; Ozen, E Cigdem; Inan, Irfan; Emlik, Dilek

2013-03-01

232

Molecular Investigation of Lymph Nodes in Colon Cancer Patients Using One-Step Nucleic Acid Amplification (OSNA)  

PubMed Central

BACKGROUND A new diagnostic system, called one-step nucleic acid amplification (OSNA), has recently been designed to detect cytokeratin 19 mRNA as a surrogate for lymph node metastases. The objective of this prospective investigation was to compare the performance of OSNA with both standard hematoxylin and eosin (H&E) analysis and intensive histopathology in the detection of colon cancer lymph node metastases. METHODS In total, 313 lymph nodes from 22 consecutive patients with stage I, II, and III colon cancer were assessed. Half of each lymph node was analyzed initially by H&E followed by an intensive histologic workup (5 levels of H&E and immunohistochemistry analyses, the gold standard for the assessment of sensitivity/specificity of OSNA), and the other half was analyzed using OSNA. RESULTS OSNA was more sensitive in detecting small lymph node tumor infiltrates compared with H&E (11 results were OSNA positive/H&E negative). Compared with intensive histopathology, OSNA had 94.5% sensitivity, 97.6% specificity, and a concordance rate of 97.1%. OSNA resulted in an upstaging of 2 of 13 patients (15.3%) with lymph node-negative colon cancer after standard H&E examination. CONCLUSIONS OSNA appeared to be a powerful and promising molecular tool for the detection of lymph node metastases in patients with colon cancer. OSNA had similar performance in the detection of lymph node metastases compared with intensive histopathologic investigations and appeared to be superior to standard histology with H&E. Most important, the authors concluded that OSNA may lead to a potential upstaging of >15% of patients with colon cancer. Cancer 2012. © 2012 American Cancer Society. PMID:22684906

Güller, Ulrich; Zettl, Andreas; Worni, Mathias; Langer, Igor; Cabalzar-Wondberg, Daniela; Viehl, Carsten T; Demartines, Nicolas; Zuber, Markus

2012-01-01

233

STAT3 activation in tumor cell-free lymph nodes predicts a poor prognosis for gastric cancer  

PubMed Central

STAT3 is constitutively activated in many human cancers including gastric cancer and plays crucial roles in modulating cancer cell proliferation, survival, metastasis as well as the microenvironment of pre-metastatic niches. Accumulating evidence has implicated STAT3 as a promising target for cancer therapy and it has been well established that tumor cell metastasized to lymph node is associated with poor prognosis. However, little is known about the relation between STAT3 activation in tumor cell-free lymph nodes and patient clinical outcomes. The objective of the current study was to investigate the role of STAT3 activity in tumor cell-free lymph nodes in tumor progression and prognosis for gastric cancer patients. Immunohistochemical analyses for p-STAT3, Ki-67, CD68 and Bcl-xL were performed in tumor cell-free lymph nodes from 60 gastric cancer patients. Survival analysis was conducted by using the Kaplan-Meier method. Immunohistochemical analyses showed that hyperactivity of STAT3 in tumor cell-free lymph nodes was significantly associated with tumor recurrence, and STAT3 activation pattern coincides with expression Ki-67, CD68, Bcl-xL. Survival analysis revealed that persistent STAT3 activation in uninvolved lymph nodes was positively associated with poor overall survival (P<0.05). These findings suggest that STAT3 activation in tumor-free lymph nodes is involved in the pathogenesis and metastasis of gastric cancer and that elevated STAT3 activity in lymph nodes prior to tumor cell arrival may indicate a poorer prognosis. These clinical studies support our findings in mouse tumor models showing that STAT3 activation is crucial for pre-metastatic niche formation and metastasis. PMID:24696730

Wu, Li-Jun; Li, Hai-Xia; Luo, Xiao-Ting; Lu, Rong-Ze; Ma, Yun-Fang; Wang, Rui; Zhang, Jun; Yang, Dong-Qin; Yu, Hua; Liu, Jie

2014-01-01

234

Can CA-125 Predict Lymph Node Metastasis in Epithelial Ovarian Cancers in Turkish Population?  

PubMed Central

Objective. The role of single preoperative serum CA-125 levels in predicting pelvic or paraaortic lymph node metastasis in patients operated for epithelial ovarian cancer has been investigated. Methods. 176 patients diagnosed with epithelial ovarian carcinoma after staging laparotomy between January 2002 and May 2010 were evaluated retrospectively. Results. The mean, geometric mean, and median of preoperative serum CA-125 levels were 632,6, 200,29, and 191,5?U/mL, respectively. The cut-off value predicting lymph node metastases in the ROC curve was 71,92?U/mL, which is significant in logistic regression analysis (P = 0.005). The preoperative log CA-125 levels were also statistically significant in predicting lymph node metastasis in logistic regression analysis (P = 0.008). Conclusions. The tumor marker CA-125, which increases with grade independent of the effect of stage in EOC, is predictive of lymph node metastasis with a high rate of false positivity in Turkish population. The high false positive rate may obscure the predictive value of CA-125. PMID:24795494

Köro?lu, Nadiye; Y?ld?r?m, Gökhan; Ülker, Volkan; Gülk?l?k, Ahmet; Dansuk, Ramazan

2014-01-01

235

Pathology Case Study: Enlarged Axillary Lymph Node  

NSDL National Science Digital Library

This is a case study presented by the University of Pittsburgh Department of Pathology, which describes a 73 year old female who had a history of thyroidectomy for benign nodules who presented with a lump in her thyroidectomy scar. Visitors are given a patient history, microscopic description, and immunohistochemistry, including images. They are also given an opportunity to diagnose the patient before clicking on the "Final Diagnosis" section, which provides a discussion of the findings as well as references. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student learning in hematopatholgy.

Contis, Lydia C.

236

A comparative analysis of endoscopic thyroidectomy versus conventional thyroidectomy in clinically lymph node negative thyroid cancer  

PubMed Central

Purpose Differentiated thyroid cancer has a good prognosis and high incidence in young women. Since endoscopic techniques were first recorded in 1996, surgical indications of endoscopic thyroidectomy have broadened. Therefore, the aim of this study is to investigate the usefulness of endoscopic thyroidectomy in clinically lymph node negative (cN0) thyroid cancer patients, based on oncologic completeness and safety, considering cosmetic outcomes. Methods From July 2009 to June 2011, a total of 166 cases had undergone endoscopic thyroidectomy using the BABA (bilateral axillo-breast approach) method or conventional open thyroidectomy by one surgeon. Finally, excluding 72 patients, 94 patients with cN0 thyroid cancer were divided into two groups according to operative methods and analyzed to compare differences between the two methods retrospectively (endoscopic group, n = 49; conventional open group, n = 45). Results We practiced comparative analysis for clinicopathologic characteristics, surgical outcomes including postoperative complications, and recurred cases during follow-up periods of each group. The results showed there was a tendency for patients, young, women rather than men, and having small size of thyroid cancer, to prefer endoscopic surgery to open surgery. Meanwhile, in postoperative complications, there were no statistically significant differences. During short follow-up periods, no recurrence or mortality case was observed. Conclusion Endoscopic thyroidectomy is a feasible and safe method for the treatment of clinically lymph node negative (cN0) thyroid cancer. PMID:25692117

Cho, Min Ji; Cho, Min Jeng; Yoo, Young Bum; Yang, Jung Hyun

2015-01-01

237

Noninvasive photoacoustic sentinel lymph node mapping using Au nanocages as a lymph node tracer in a rat model  

NASA Astrophysics Data System (ADS)

Sentinel lymph node biopsy (SLNB) has been widely performed and become the standard procedure for axillary staging in breast cancer patients. In current SLNB, identification of SLNs is prerequisite, and blue dye and/or radioactive colloids are clinically used for mapping. However, these methods are still intraoperative, and especially radioactive colloids based method is ionizing. As a result, SLNB is generally associated with ill side effects. In this study, we have proposed near-infrared Au nanocages as a new tracer for noninvasive and nonionizing photoacoustic (PA) SLN mapping in a rat model as a step toward clinical applications. Au nanocages have great features: biocompatibility, easy surface modification for biomarker, a tunable surface plasmon resonance (SPR) which allows for peak absorption to be optimized for the laser being used, and capsule-type drug delivery. Au nanocage-enhanced photoacoustic imaging has the potential to be adjunctive to current invasive SLNB for preoperative axillary staging in breast cancer patients.

Song, Kwang Hyun; Kim, Chulhong; Cobley, Claire M.; Xia, Younan; Wang, Lihong V.

2009-02-01

238

Effect of Gleason scores of lymph node metastases on prognosis of patients with prostate cancer  

PubMed Central

The long-term mortality risk from prostate cancer increases in lymph node (LN) positive patients. This study was done to assess the effect of lymph node Gleason score (LNGS) on prognosis in patients with LN-positive prostate cancer. Among the 1,415 patients who received pelvic lymph node dissection (PLND), 117 (8.4%) patients had a positive LN. The PGS of the prostate specimens and the LNGS of the positive LNs were assessed by uropathologists. The median age of patients at surgery was 67 years (interquartile range [IQR], 62-71 years) and the median follow-up duration was 44.3 months (IQR, 27.0-78.5 months). Pathologic Gleason scores (PGS) of 6-9 included one (0.9%), 53 (49.5%), 22 (20.6%), and 31 (29.0%) patients. The median total number of retrieved LNs was 9.0 (IQR, 5.3-12.8). The median number of positive LNs was one (IQR, 1-2). Cancer architecture with a Gleason pattern and score were observed in LNs as in ordinary prostate specimens. LNGS 6-9 included nine (8.1%), 57 (51.4%), 31 (27.9%), and 14 (12.6%) patients. The speaman’s analysis showed the meaningful correlation between PGS and LNGS (P = 0.249, P = 0.011). The univariate analysis showed that the number of positive LNs and LNGS were significantly associated with prostate cancer-specific survival (P = 0.028; P = 0.005). The same architecture that is seen in the prostate was seen in positive LNs, and LNGS may be a significant prognostic factor in patients with LN-positive prostate cancer. PMID:25337262

Ko, Kyungtae; Jeong, In Gab; Choi, Woo Suk; Lim, Ju Hyun; Suh, Ja Hee; Ku, Ja Hyeon; Park, Yangsoon; Moon, Kyung Cheol; Kim, Hyeon Hoe; Kim, Choung-Soo; Kwak, Cheol

2014-01-01

239

Sentinel lymph node detection and accuracy in vulvar cancer: Experience of a tertiary center in Turkey  

PubMed Central

Objective To explore the accuracy of sentinel lymph node (SLN) dissection in predicting regional lymph node status by using either only Technetium-99m-labelled (Tc-99m) or in combination with a blue dye in patients with squamous cell cancer of vulva. Material and Methods Twenty-one patients who had T1 (?2 cm) or T2 (>2cm) tumors that did not encroach into the urethra, vagina or anus were included in the study. For the first twelve patients, Tc-99m was used for SLN identification, and the combined technique was used in subsequent patients. Preoperatively, Tc-99m and a blue dye was injected intradermally around the tumor. Following SLN dissection, complete inguinofemoral lymphadenectomy was performed. Results We could detect SLN in all 21 patients (100%) by either Tc-99m or the combined method. SLN was found to be histopathologically negative in 13 groins via Tc-99m and 10 groins via the combined method. Twenty-one of these 23 (91.3%) groin non-SLN were also negative, but in two groins, we detected metastatic non-SLN. Conclusion Although SLN dissection appears promising in vulvar cancer, false negative cases are reported in the literature. Sentinel lymph node dissection without complete lymphadenectomy does not seem appropriate for routine clinical use, since it is known that groin metastasis is fatal. PMID:24592094

Boran, Nurettin; C?r?k, Derya Akda?; I??kdo?an, Zuhal; K?r, Metin; Turan, Taner; Tulunay, Gökhan; Köse, Mehmet Faruk

2013-01-01

240

Fluorescence diagnostics of metastatic lesion of regional lymph nodes upon surgical treatment of breast cancer  

NASA Astrophysics Data System (ADS)

We have performed intraoperative fluorescence diagnostics of 60 patients for metastases of breast cancer to regional lymph nodes. All the patients were divided into two groups. The first group consisted of 50 patients, which were surgically treated at the first stage. The second group consisted of ten patients, which underwent combined treatment. At the first stage, they received from two to four courses of neoadjuvant chemotherapy, and, at the second stage, the surgical intervention was performed. The intraoperative fluorescence diagnostics was performed using the preparation alasens (precursor of protoporphyrin IX in the human organism). The occurrence of fluorescence of alasens-induced protoporphyrin IX was determined visually and using the local fluorescence spectroscopy method. Altogether, 498 lymph nodes were examined: 408 in the first group and 90 in the second one. For the first group, the sensitivity of the method was found to be 87.2%, and its specificity, 94.8%; in the second group, these parameters were determined to be 77 and 78%, respectively. The first experience of the application of the intraoperative fluorescence diagnostics of metastatic lesion of lymph nodes in patients with breast cancer has shown its high efficiency and application potential.

Filonenko, E. V.; Pak, D. D.; Yanikova, A. G.

2013-06-01

241

Sentinel lymph node biopsy in breast cancer patients with previous breast augmentation surgery.  

PubMed

The number of breast augmentation surgeries (BAS) has increased. Therefore, the number of breast cancer patients with history of BAS has also increased. In this paper, we present two cases of sentinel lymph node biopsy (SLNB) in patients with previous BAS who were diagnosed with breast cancer. The patients were augmented using different approach; the first case was augmented through transaxillary incision, whereas the second case was augmented through periareolar incision. Lymphoscintigraphy (LPG) was performed on the patients 1 day prior to operation, enabling confirmation of lymphatic flow and SLN in both patients. SLNB was successfully performed in both cases. In one patient, SLNB was performed using indocyanine green (ICG) fluorescence and the Photodynamic Eye (PDE) system. Regardless of history of BAS, ICG and PDE system showed lymphatic flow and SLN in real time. LPG and ICG fluorescence were useful methods for SLN detection in patients with previous BAS, being able to confirm lymph flow before operation. Biopsy methods using LPG and PDE system were considered useful for difficult confirmation of lymph flow after breast augmentation. This is the first report of SLNB using ICG and PDE system for patients with previous BAS. PMID:21671037

Nagao, Tomoya; Hojo, Takashi; Kurihara, Hiroaki; Tsuda, Hitoshi; Tanaka-Akashi, Sadako; Kinoshita, Takayuki

2014-09-01

242

Patient-Reported Outcomes in Sentinel Node–Negative Adjuvant Breast Cancer Patients Receiving Sentinel-Node Biopsy or Axillary Dissection: National Surgical Adjuvant Breast and Bowel Project Phase III Protocol B-32  

PubMed Central

Purpose Sentinel lymph node resection (SNR) may reduce morbidity while providing the same clinical utility as conventional axillary dissection (AD). National Surgical Adjuvant Breast and Bowel Project (NSABP) B-32 is a randomized phase III trial comparing SNR immediately followed by AD (SNAD) to SNR and subsequent AD if SN is positive. We report the definitive patient-reported outcomes (PRO) comparisons. Patients and Methods Eligible patients had clinically node-negative, operable invasive breast cancer. The PRO substudy included all SN-negative participants enrolled May 2001 to February 2004 at community institutions in the United States (n = 749; 78% age ? 50; 87% clinical tumor size ? 2.0 cm; 84% lumpectomy; 87% white). They completed questionnaires presurgery, 1 and 2 to 3 weeks postoperatively, and every 6 months through year 3. Arm symptoms, arm use avoidance, activity limitations, and quality of life (QOL) were compared with intent-to-treat two-sample t-tests and repeated measures analyses. Results Arm symptoms were significantly more bothersome for SNAD compared with SNR patients at 6 months (mean, 4.8 v 3.0; P < .001) and at 12 months (3.6 v 2.5; P = .006). Longitudinally, SNAD patients were more likely to experience ipsilateral arm and breast symptoms, restricted work and social activity, and impaired QOL (P ? .002 all items). From 12 to 36 months, fewer than 15% of either SNAD or SNR patients reported moderate or greater severity of any given symptom or activity limitation. Conclusion Arm morbidity was greater with SNAD than with SNR. Despite considerable fears about complications from AD for breast cancer, this study demonstrates that initial problems with either surgery resolve over time. PMID:20679600

Land, Stephanie R.; Kopec, Jacek A.; Julian, Thomas B.; Brown, Ann M.; Anderson, Stewart J.; Krag, David N.; Christian, Nicholas J.; Costantino, Joseph P.; Wolmark, Norman; Ganz, Patricia A.

2010-01-01

243

Clinical significance of molecular diagnosis for gastric cancer lymph node micrometastasis  

PubMed Central

Advances in molecular diagnostic tools have allowed the identification of lymph node micrometastasis (LNM), including isolated tumor cells, in cancer patients. While immunohistochemistry and reverse transcription-polymerase chain reaction have been used to identify LNM in patients with gastric cancer, the clinical significance of this finding remains unclear. Recently, minimally invasive treatments, such as endoscopic submucosal dissection and laparoscopic surgery, are widely performed to help improve postsurgical quality of life (QOL). However, it is important to maintain the balance between QOL and curability when making treatments decision for patients with gastric cancer. If minimally invasive surgery based on accurate intraoperative LNM diagnosis was established, it could be performed safely. Therefore, we reviewed the clinical significance of LNM detected by molecular techniques as an important target for treatment decision making with gastric cancer patients. PMID:25320510

Sonoda, Hiromichi; Tani, Tohru

2014-01-01

244

Differential expression of angiogenesis associated genes in prostate cancer bone, liver and lymph node metastases.  

PubMed

Our objective was to elucidate phenotypic differences between prostate cancer (PCa) liver, lymph node, and bone metastases. PCa metastases were obtained through a rapid tissue acquisition necropsy protocol. We grossly dissected metastatic foci from frozen samples and performed expression analyses using cDNA microarrays. Immunohistochemical analyses using a tissue microarray from thirty individuals with PCa metastases to lymph nodes, liver, and bone was used to confirm the gene expression changes associated with each metastatic site. Transcript alterations statistically-associated with bone metastases included increased expression of IBSP (Bone sialoprotein), F13A1 (factor XIII), and decreased expression of EFNA1 (ephrin-A1) and ANGPT2 (angiopoietin-2) when compared to liver and lymph node metastases. The metastasis-associated changes in proteins involved in coagulation and angiogenesis prompted further analysis of additional factors known to participate in the clotting cascade and blood vessel formation (angiopoitein-1, PAI-1, uPA, PAI-RBP-1 and hepsin). We also assessed tumor-associated microvessel density and distribution in liver, lymph node, and bone metastasis. Intense fibrin(ogen) and fibulin-1 staining was localized to epithelial cells at the periphery of metastatic tumors possibly to facilitate angiogenesis. The expression of hepsin, uPA, PAI-RBP1, PAI-1, and factor XIII may influence fibrinolysis and are regulated by the tumor microenvironment. The expression of angiopoietin-2 and apparent silencing of angiopoietin-1 in PCa bone, liver, and lymph node metastases may be critical for angiogenesis in this tumor type. In addition, the resulting tumor-associated microvessel density and distribution was significantly different between liver and bone metastasis possibly in response to the protein expression changes detailed above. PMID:17972146

Morrissey, Colm; True, Lawrence D; Roudier, Martine P; Coleman, Ilsa M; Hawley, Sarah; Nelson, Peter S; Coleman, Roger; Wang, Ya-Chun; Corey, Eva; Lange, Paul H; Higano, Celestia S; Vessella, Robert L

2008-01-01

245

Correlation of nucleolar organizer regions and nuclear morphometry assessed by automatic image analysis in breast cancer with aneuploidy, K167 immunostaining, histopathologic grade and lymph node involvement.  

PubMed

Silver-stained nucleolar organizer regions (AgNORs) in human breast carcinoma were studied using a computer-assisted system of image analysis. Standardized, automatic measurements of 7 morphometric parameters (area, perimeter, shape factor, bend energy, angle, and small and large diameters) performed on paraffin sections and cell imprint were compared and correlated with nuclear morphometry, histopathological grading, tumor growth fraction, (monoclonal Ki67-immunostaining), DNA nuclear content (stoechiometric Feulgen staining) and axillary lymph node invasion. The major findings were as follows: (i) variations in AgNORs and nuclear parameters were correlated, (ii) the ratio of AgNOR area/nuclear area was significantly different in low and high grade tumors, (iii) mean AgNOR parameter values increased significantly with the tumor growth fraction and tumor hyperploidy and were significantly higher in patients with axillary lymph node metastases and (iv) AgNOR evaluation was more accurate for cell preparations than for tissue sections. PMID:1300597

Charpin, C; Bonnier, P; Piana, L; Kouzhami, H; Devictor, B; Lavaut, M N; Andrac, L; Allasia, C

1992-12-01

246

Determination of standard number, size and weight of mediastinal lymph nodes in postmortem examinations: reflection on lung cancer surgery  

PubMed Central

Background Mediastinal lymph node dissection is an essential component of lung cancer surgery. Literature lacks established information regarding the number and size of the healthy lymph nodes. In this postmortem autopsy study, we aim to define the number, size and weight of the lymph nodes in each mediastinal lymph node station. To implement the data for the clinical practice, we analyzed the possible number of nodes to be dissected in a systematic mediastinal lymph node dissection from the right and left sides during lung cancer surgery. Methods Sixty-two samples obtained from cadavers who did not die from chest malignancies, extrathoracic malignancies, any kind of infections or previous hospitalization before the death were included to the study. The locations of the nodes were recorded according to the American Thoracic Society Mediastinal Lymph Node Map. The number, size and weight of the nodes were determined at each station. Results Median age of the cadavers was 39 years. Primary causes of death were asphyxia in 10 (16.1%) subjects, trauma in 29 (46.8%) subjects, cardiovascular problems in 10 (16.1%) subjects, and undetermined in 13 (21%) subjects. The median number of lymph nodes resected from each patient was 23 (range: 11–54). The right sided paratracheal lymph nodes (Station 2R and 4R) were more frequent, heavier and longer than left sided lymph nodes (Station 2L and 4L) at the paratrecheal region. Right sided inferior mediastinal lymph nodes were heavier and longer than the left ones; however, their availability was more often on the left. Conclusions The properties of mediastinal lymph nodes at particular stations are different for number, size and weight. Station 4R and 7 have the highest number of nodes followed by stations 5 and 6. We recommend removing the lymph nodes of these stations completely in lung cancer patients to rule out the possibility of micrometastatic disease. Diameter of normal lymph node may be 1 cm for the stations other than 4R and 7, but the definition of normal diameter of a lymph node at the stations 4R and 7 may be changed as 1,5 cm and 2,0 cm, respectively. Weight of the nodes may be a new subject to study and may be defined as a new modality to define a staging to be more accurate and the issue needs further investigations. PMID:23591054

2013-01-01

247

Lymph node metastasis of oral cancer visualized in live tissue by green fluorescent protein expression.  

PubMed

Here, we report the establishment of a stably transfected cell line which expresses high levels of green fluorescent protein (GFP), thus permitting the detection and visualization of developing tumors and lymph node metastases after injection into nude mice. Cells of the human oral squamous carcinoma cell line (SAS-L1) were transfected with an expression vector containing a cDNA encoding humanized GFP and the neomycin resistance gene. A clone with stable high-level expression of GFP was selected in vitro using G418. To study metastasis formation, GFP-expressing cells were injected orthotopically into the tongue of nude mice. The resultant tumor growth in the tongue and micrometastases in the lymph nodes could be visualized by GFP fluorescence. Therefore a useful model has been developed for the study of oral cancer, firstly to understand the metastatic process and secondly for the evaluation of potential treatments. PMID:12167418

Shintani, Satoru; Mihara, Mariko; Nakahara, Yuuji; Aida, Tadateru; Tachikawa, Tetsuhiko; Hamakawa, Hiroyuki

2002-10-01

248

Pre-treatment of mice with tumor-conditioned media accelerates metastasis to lymph nodes and lungs: a new spontaneous breast cancer metastasis model  

PubMed Central

Current spontaneous metastasis models require a long period of observation after establishment of primary tumors to see significant metastatic progression. The degree of metastasis is not consistent among animals: this is problematic since it requires the use of a large number of animals to obtain reliable statistics. Here we report that pre-treatment of animals with tumor-conditioned media (TCM) consistently accelerates spontaneous metastasis in breast cancer. An inguinal breast tumor model facilitated by TCM showed robust anterior metastasis to the axillary and brachial lymph nodes (LN), and the lungs compared to the serum-free media (SFM) treated group. The LN in TCM-treated animals showed enhanced angiogenesis and lymphangiogenesis. Primary tumors and lungs in TCM-treated animals showed enhanced lymphangiogenesis with no significant change in angiogenesis. TCM-treated animals also showed metastatic dissemination to abdomen from the primary injection site: this would generally enhance metastasis to other organs. In sum, the addition of TCM pre-treatment to current metastasis models results in accelerated and robust metastasis which would enable more efficient evaluation of anti-metastatic agents. PMID:23963763

Lee, Esak; Pandey, Niranjan B.; Popel, Aleksander S.

2013-01-01

249

MD Anderson study finds African American women with breast cancer less likely to have newer, recommended surgical procedure  

Cancer.gov

African American women with early stage, invasive breast cancer were 12 percent less likely than Caucasian women with the same diagnosis to receive a minimally invasive technique, axillary sentinel lymph node (SLN) biopsy, years after the procedure had become the standard of surgical practice, according to research from The University of Texas MD Anderson Cancer Center. The study, presented at the 2012 CTRC-AACR San Antonio Breast Cancer Symposium, also found that those African American women who underwent the older, more invasive procedure, axillary lymph node (ALN) dissection, had higher rates of lymphedema.

250

A modified radiofrequency ablation approach for treating distant lymph node metastasis in two patients with late-stage cancer  

PubMed Central

Patients with late-stage cancer commonly have distant lymph node metastasis; however, poor health often contraindicates surgical treatment. Although the quality of life and overall survival for these patients are low, there is neither a consensus nor a guide for treatment. Ablation technique and surrounding tissue damage are two possible reasons for limited study of radiofrequency ablation in patients with superficial distant lymph node metastasis. Here, we report two patients treated successfully with ultrasound-guided radiofrequency ablation for superficial distant lymph node metastasis. In these patients, deionized water was injected to the surrounding tissues of the lymph node to decrease heat injury. Results from these patients suggest that radiofrequency ablation may play an important role in the treatment of patients with distant lymph node metastasis. PMID:23544449

Zou, Ru-Hai; Li, Qi-Jiong; Qiu, Ji-Liang; Liao, Ya-Di; Yuan, Yun-Fei; Li, An-Hua

2013-01-01

251

Mapping lymph nodes in cancer management – role of 99mTc-tilmanocept injection  

PubMed Central

Two decades ago, lymphatic mapping of sentinel lymph nodes (SLN) was introduced into surgical cancer management and was termed sentinel node navigated surgery. Although this technique is now routinely performed in the management of breast cancer and malignant melanoma, it is still under investigation for use in other cancers. The radioisotope technetium (99mTc) and vital blue dyes are among the most widely used enhancers for SLN mapping, although near-infrared fluorescence imaging of indocyanine green is also becoming more commonly used. 99mTc-tilmanocept is a new synthetic radioisotope with a relatively small molecular size that was specifically developed for lymphatic mapping. Because of its small size, 99mTc-tilmanocept quickly migrates from its site of injection and rapidly accumulates in the SLN. The mannose moieties of 99mTc-tilmanosept facilitate its binding to mannose receptors (CD206) expressed in reticuloendothelial cells of the SLN. This binding prevents transit to second-echelon lymph nodes. In Phase III trials of breast cancer and malignant melanoma, and Phase II trials of other malignancies, 99mTc-tilmanocept had superior identification rates and sensitivity compared with blue dye. Trials comparing 99mTc-tilmanocept with other 99mTc-based agents are required before it can be routinely used in clinical settings. PMID:25028560

Tausch, Christoph; Baege, Astrid; Rageth, Christoph

2014-01-01

252

Anthracosis Mimicking Mediastinal Lymph Node Metastases With 18F-FCholine in High-Risk Prostate Cancer.  

PubMed

A 62-year-old patient with prostate adenocarcinoma underwent PET with radiolabeled choline (F-Fcholine) for pretreatment staging of a high-risk prostate cancer. Images showed a significant mediastinal lymph node uptake of F-Fcholine. Owing to the rarity of spread to supradiaphragmatic lymph nodes, a surgical removal was performed, revealing anthracosis and no malignant cells. Even if its specificity seems better than F-FDG, false positives have been reported and other pathologies could mimic lymph node metastases. Consequently, histology should be performed so that the appropriate treatment can be initiated. PMID:25674859

Pinaquy, Jean-Baptiste; Fernandez, Philippe; Pasticier, Gilles; Parrens, Marie; De Clermont, Henri

2015-04-01

253

NCI and University of Minnesota study sees large increase in number of lymph nodes evaluated for colon cancer:  

Cancer.gov

During the past two decades there has been a significant increase in the percentage of patients who have a high number of lymph nodes evaluated during colon cancer operations, but this improvement is not associated with an increase in the overall proportion of colon cancers that are node positive, according to a study in the September 14 issue of JAMA.

254

Revised ESTS guidelines for preoperative mediastinal lymph node staging for non-small-cell lung cancer.  

PubMed

Accurate preoperative staging and restaging of mediastinal lymph nodes in patients with potentially resectable non-small-cell lung cancer (NSCLC) is of paramount importance. In 2007, the European Society of Thoracic Surgeons (ESTS) published an algorithm on preoperative mediastinal staging integrating imaging, endoscopic and surgical techniques. In 2009, the International Association for the Study of Lung Cancer (IASLC) introduced a new lymph node map. Some changes in this map have an important impact on mediastinal staging. Moreover, more evidence of the different mediastinal staging technique has become available. Therefore, a revision of the ESTS guidelines was needed. In case of computed tomography (CT)-enlarged or positron emission tomography (PET)-positive mediastinal lymph nodes, tissue confirmation is indicated. Endosonography [endobronchial ultrasonography (EBUS)/esophageal ultrasonography (EUS)] with fine-needle aspiration (FNA) is the first choice (when available), since it is minimally invasive and has a high sensitivity to rule in mediastinal nodal disease. If negative, surgical staging with nodal dissection or biopsy is indicated. Video-assisted mediastinoscopy is preferred to mediastinoscopy. The combined use of endoscopic staging and surgical staging results in the highest accuracy. When there are no enlarged lymph nodes on CT and when there is no uptake in lymph nodes on PET or PET-CT, direct surgical resection with systematic nodal dissection is indicated for tumours ? 3 cm located in the outer third of the lung. In central tumours or N1 nodes, preoperative mediastinal staging is indicated. The choice between endoscopic staging with EBUS/EUS and FNA or video-assisted mediastinoscopy depends on local expertise to adhere to minimal requirements for staging. For tumours >3 cm, preoperative mediastinal staging is advised, mainly in adenocarcinoma with high standardized uptake value. For restaging, invasive techniques providing histological information are advisable. Both endoscopic techniques and surgical procedures are available, but their negative predictive value is lower compared with the results obtained in baseline staging. An integrated strategy using endoscopic staging techniques to prove mediastinal nodal disease and mediastinoscopy to assess nodal response after induction therapy needs further study. PMID:24578407

De Leyn, Paul; Dooms, Christophe; Kuzdzal, Jaroslaw; Lardinois, Didier; Passlick, Bernward; Rami-Porta, Ramon; Turna, Akif; Van Schil, Paul; Venuta, Frederico; Waller, David; Weder, Walter; Zielinski, Marcin

2014-05-01

255

Role of FDG PET-CT in evaluation of locoregional nodal disease for initial staging of breast cancer  

PubMed Central

Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is not indicated or recommended in the initial staging of early breast cancer. Although it is valuable for detecting distant metastasis, providing prognostic information, identifying recurrence and evaluating response to chemotherapy, the role of FDG PET/CT in evaluating locoregional nodal status for initial staging of breast cancer has not yet been well-defined in clinical practice. FDG PET/CT has high specificity but compromised sensitivity for identifying axillary nodal disease in breast cancer. Positive axillary FDG PET/CT is a good predictor of axillary disease and correlates well with sentinel lymph node biopsy (SLNB). FDG PET/CT may help to identify patients with high axillary lymph node burden who could then move directly to axillary lymph node dissection (ALND) and would not require the additional step of SLNB. However, FDG PET/CT cannot replace SLNB or ALND due to unsatisfactory sensitivity. The spatial resolution of PET instruments precludes the detection of small nodal metastases. Although there is still disagreement regarding the management of internal mammary node (IMN) disease in breast cancer, it is known that IMN involvement is of prognostic significance, and IMN metastasis has been associated with higher rates of distant metastasis and lower overall survival rates. Limited clinical observations suggested that FDG PET/CT has advantages over conventional modalities in detecting and uncovering occult extra-axillary especially IMN lesions with upstaging the disease and an impact on the adjuvant management. PMID:25493234

Liu, Yiyan

2014-01-01

256

A Prognostic Index for Predicting Lymph Node Metastasis in Minor Salivary Gland Cancer  

SciTech Connect

Purpose: Large studies examining the clinical and pathological factors associated with nodal metastasis in minor salivary gland cancer are lacking in the literature. Methods and Materials: Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified 2,667 minor salivary gland cancers with known lymph node status from 1988 to 2004. Univariate and multivariate analyses were conducted to identify factors associated with the use of neck dissection, the use of external beam radiation therapy, and the presence of cervical lymph node metastases. Results: Four hundred twenty-six (16.0%) patients had neck nodal involvement. Factors associated with neck nodal involvement on univariate analysis included increasing age, male sex, increasing tumor size, high tumor grade, T3-T4 stage, adenocarcinoma or mucoepidermoid carcinomas, and pharyngeal site of primary malignancy. On multivariate analysis, four statistically significant factors were identified, including male sex, T3-T4 stage, pharyngeal site of primary malignancy, and high-grade adenocarcinoma or high-grade mucoepidermoid carcinomas. The proportions (and 95% confidence intervals) of patients with lymph node involvement for those with 0, 1, 2, 3, and 4 of these prognostic factors were 0.02 (0.01-0.03), 0.09 (0.07-0.11), 0.17 (0.14-0.21), 0.41 (0.33-0.49), and 0.70 (0.54-0.85), respectively. Grade was a significant predictor of metastasis for adenocarcinoma and mucoepidermoid carcinoma but not for adenoid cystic carcinoma. Conclusions: A prognostic index using the four clinicopathological factors listed here can effectively differentiate patients into risk groups of nodal metastasis. The precision of this index is subject to the limitations of SEER data and should be validated in further clinical studies.

Lloyd, Shane; Yu, James B. [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT (United States); Ross, Douglas A. [Department of Surgery, St. Vincent's Medical Center, Bridgeport, CT (United States); Wilson, Lynn D. [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT (United States); Decker, Roy H., E-mail: roy.decker@yale.ed [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT (United States)

2010-01-15

257

Automatic FDG-PET-based tumor and metastatic lymph node segmentation in cervical cancer  

NASA Astrophysics Data System (ADS)

Treatment of cervical cancer, one of the three most commonly diagnosed cancers worldwide, often relies on delineations of the tumour and metastases based on PET imaging using the contrast agent 18F-Fluorodeoxyglucose (FDG). We present a robust automatic algorithm for segmenting the gross tumour volume (GTV) and metastatic lymph nodes in such images. As the cervix is located next to the bladder and FDG is washed out through the urine, the PET-positive GTV and the bladder cannot be easily separated. Our processing pipeline starts with a histogram-based region of interest detection followed by level set segmentation. After that, morphological image operations combined with clustering, region growing, and nearest neighbour labelling allow to remove the bladder and to identify the tumour and metastatic lymph nodes. The proposed method was applied to 125 patients and no failure could be detected by visual inspection. We compared our segmentations with results from manual delineations of corresponding MR and CT images, showing that the detected GTV lays at least 97.5% within the MR/CT delineations. We conclude that the algorithm has a very high potential for substituting the tedious manual delineation of PET positive areas.

Arbonès, Dídac R.; Jensen, Henrik G.; Loft, Annika; Munck af Rosenschöld, Per; Hansen, Anders Elias; Igel, Christian; Darkner, Sune

2014-03-01

258

Methods of Investigating Metastatic Lymph Nodes in Head and Neck Cancer  

PubMed Central

ABSTRACT When dealing with patients who have head and neck cancer - squamous cell carcinoma and have clinically N0 neck disease it is very difficult to assess the real extension of the malignant proccess. This is why several techniques are curently in use to determine the actual TNM clasiffication for each patient in order to apply best suited therapy management. Up until today the staging of the neck has been done by using a combination of the physical exam and conventional imaging studies. Recent studies and research have tried to determine weather the use of sentinel lymph node biopsy is a more reliable tool in predicting occult metastasis in cancer patients with clinically N0 neck disease. There are no guidelines in this matter and as such the use of the sentinel lymph node detection technique is yet to be used on a routine basis. The authors are trying to assess the benefits of different paraclinical investigation regarding the improvement of overall survival rates in patients with T1/T2 squamous cell carcinoma of the head and neck and N0 neck disease. PMID:24790674

POPESCU, Bogdan; ENE, Patricia; BERTESTEANU, Serban Vifor Gabriel; ENE, Razvan; CIRSTOIU, Catalin; POPESCU, Cristian Radu

2013-01-01

259

Gene expression profiling for the prediction of lymph node metastasis in patients with cervical cancer.  

PubMed

We investigated whether gene expression profiling of primary cervical tumor tissue could be used to predict lymph node (LN) metastasis and compared this with conventional magnetic resonance imaging. We obtained 43 primary cervical cancer samples (16 with LN metastasis and 27 without LN metastasis) for microarray analysis. A prediction model for LN metastasis from the training set was developed by support vector machine methods using a 10-fold cross-validation. The 'LN prediction model' derived from the signature of 156 distinctive genes (P < 0.01) had a prediction accuracy of 77%. Correlation between mRNA expressions measured by microarray and semiquantitative reverse transcription-polymerase chain reaction was ascertained in four (RBM8A, SDHB, SERPINB13, and gamma-interferon) out of 10 genes. Magnetic resonance imaging showed accuracy (69%) for the prediction of LN metastasis. These results suggest that gene expression profiling allows reliable prediction of LN metastasis in cervical cancer. PMID:17986283

Kim, Tae-Joong; Choi, Jung-Joo; Kim, Woo Young; Choi, Chel Hun; Lee, Jeong-Won; Bae, Duk-Soo; Son, Dae-Soon; Kim, Jhingook; Park, Byung Kwan; Ahn, Geunghwan; Cho, Eun Yoon; Kim, Byoung-Gie

2008-01-01

260

Application of Nano-Carbon in Lymph Node Dissection for Thyroid Cancer and Protection of Parathyroid Glands  

PubMed Central

Background The aim of this study was to explore a new method to identify and protect parathyroid glands in neck lymph node dissection for patients with thyroid cancer. Material/Methods One hundred patients with thyroid cancer underwent total thyroidectomy combined with central neck lymph node dissection. During the operation, 50 patients receiving nano-carbon suspension were included in the experiment group, and 50 patients without nano-carbon suspension were included in the control group. We compared changes in parathyroid hormone levels before surgery and at 48 h after surgery between the 2 groups and of serum Ca2+ level within 48 h after surgery, as well as postoperative parathyroid pathological and lymph node dissection results. Results Eight and 1 parathyroid glands were detected pathologically in the control and experimental group, respectively. Decrease in parathyroid hormone level at 48 h occurred in 7 patients in the control group and 1 patient in the experimental group. Hypocalcemia was found at 48 h after surgery in 10 patients in the control group and 2 patients in the experimental group. Conclusions Nano-carbon suspension can cause development of the thyroid gland and the central lymph node and a negative development of parathyroid glands. Careful identification and removal of black-stained lymphatic tissues in the process of total thyroidectomy with neck lymph node dissection can ensure a complete lymph node dissection and prevent parathyroid damage, thus effectively reducing the incidence of hypoparathyroidism. PMID:25311844

Tian, Wuguo; Jiang, Yan; Gao, Bo; Zhang, Xiaohua; Zhang, Shu; Zhao, Jianjie; He, Yujun; Luo, Donglin

2014-01-01

261

Sentinel lymph node in oesophageal cancer—a systematic review and meta-analysis  

PubMed Central

Background Sentinel lymph nodes (SLNs) have been used to predict regional lymph node metastasis in patients with melanoma and breast cancer. However, the validity of the SLN hypothesis is still controversial for oesophageal cancer. We performed this meta-analysis to evaluate the feasibility and accuracy of radio-guided SLN mapping for oesophageal cancer. Methods A systematic search was conducted using MEDLINE, PubMed, EMBASE, Current Contents Connect, Cochrane library, Google scholar, Science Direct, and Web of Science. Original data was abstracted from each study and used to calculate a pooled event rates and 95% confidence interval (95% CI). Results The search identified 23 relevant articles. The overall detection rate was 0.93 (95% CI: 0.894-0.950), sensitivity 0.87 (95% CI: 0.811-0.908), negative predictive value 0.77 (95% CI: 0.568-0.890) and the accuracy was 0.88 (95% CI: 0.817-0.921). In the adenocarcinoma cohort, detection rate was 0.98 (95% CI: 0.923-0.992), sensitivity 0.84 (95% CI: 0.743-0.911) and the accuracy was 0.87(95% CI: 0.796-0.913). In the squamous cell carcinoma group, detection rate was 0.89 (95% CI: 00.792-0.943), sensitivity 0.91 (95% CI: 0.754-0.972) and the accuracy was 0.84 (95% CI: 0.732-0.914). Conclusions It is possible to identify and obtain a SLN before neoadjuvant therapy in oesophageal cancer. However, further work is needed to optimize radiocolloid type, refine the technique and develop a quick and accurate way to determine SLN status intraoperatively. This technique has to be further evaluated before it can be applied widely. PMID:24772341

Nagaraja, Vinayak; Cox, Michael R.

2014-01-01

262

Case of isolated lateral lymph node recurrence occurring after TME for T1 lower rectal cancer treated with lateral lymph node dissection: report of a case.  

PubMed

We experienced a rare case of isolated lateral lymph node (LLN) recurrence after laparoscopic intersphincteric resection with total mesorectal excision for T1 lower rectal cancer that was successfully treated using LLN dissection with en bloc resection of the left superior vesical artery, the left ovary and the left obturator nerve, artery and vein. There are no guidelines for treating patients with isolated LLN recurrence because isolated LLN recurrence is rare, especially in patients with T1 rectal cancer. However, in patients with pT1N0 lower rectal cancer, follow-up examinations of the pelvis should be performed periodically. Patients with isolated LLN recurrence treated with surgery might have good long-term prognoses. Therefore, for such patients, surgical resection should be considered as a curative treatment only. PMID:22832928

Sueda, Toshinori; Noura, Shingo; Ohue, Masayuki; Shingai, Tatsushi; Imada, Shinya; Fujiwara, Yoshiyuki; Ohigashi, Hiroaki; Yano, Masahiko; Tomita, Yasuhiko; Ishikawa, Osamu

2013-07-01

263

The Correlation between miRNA and Lymph Node Metastasis in Gastric Cancer  

PubMed Central

Lymph node metastasis (LNM) in gastric cancer is associated with higher rate of cancer recurrence and poor prognosis. As a result, a reliable biomarker for the prediction of LNM is important and would be valuable in the clinical practice. MiRNA microarray revealed that ten miRNAs were expressed significantly different among patients with or without LNM. A total of 46 gastric cancer patients were enrolled and divided into two groups (23 in each group) according to the presence or absence of LNM. RT-PCR of these 10 miRNAs was investigated and compared between the two groups. MiR-1207-5p was significantly upregulated in gastric cancer patients without LNM compared with those with LNM. Patients with upregulated miR-1207-5p had less scirrhous stromal reaction, less lymphovascular invasion, and earlier pathological T category, N category, and TNM stage, compared with those with downregulated or unchanged miR-1207-5p. Multivariate analysis showed that stromal reaction type, lymphovascular invasion, pathological T category and TNM stage, and expression of miR-1207-5p were independent risk factors of LNM. MiR-1207-5p could serve as a useful biomarker in the prediction of LNM in gastric cancer. PMID:25688358

Huang, Kuo-Hung; Lan, Yuan-Tzu; Chen, Jen-Hao; Lo, Su-Shun; Li, Anna Fen-Yau; Chiou, Shih-Hwa; Wu, Chew-Wun; Shyr, Yi-Ming

2015-01-01

264

Predicting Pelvic Lymph Node Involvement in Current-Era Prostate Cancer  

SciTech Connect

Purpose: The Roach formula [2/3 Multiplication-Sign prostate-specific antigen + (Gleason score - 6) Multiplication-Sign 10], derived in 1993 during the early prostate specific antigen (PSA) screening era, has been used to predict the risk of pelvic lymph node involvement in patients with prostate cancer. In the current era of widespread PSA screening with a shift to earlier disease stages, there is evidence to suggest that the Roach score overestimates risk of nodal metastasis. This study retrospectively reviews the validity of this formula as a prediction tool. Methods and Materials: We conducted a retrospective institutional review including men with clinical T1c-T3 prostate cancer, with baseline PSA levels and biopsy-obtained Gleason scores who underwent radical prostatectomy with pelvic node dissection from 2001 through 2009 (N = 1,022). The predicted risk of nodal involvement was calculated for each patient using the Roach formula and then compared with actual rates following surgery. Results: The study included 1,022 patients; 99.6% had clinical T1c/T2 disease, with a mean of 10.3 lymph nodes surgically evaluated. Overall, 42 patients (4.1%) had nodal metastasis. For every range of scores, the Roach formula overestimates the risk of nodal involvement. Observed nodal positivity was 1%, 6.3%, 10%, 15.2%, and 16.7% for Roach scores {<=}10%, >10%-20%, >20%-30%, >30%-40%, and >40%, respectively. The Roach score overestimates the risk by approximately 4.5-fold in patients with scores {<=}10%, by 2.5-fold for all scores between 10% and 40%, and by 4-fold for scores >40%. Conclusion: The Roach formula overpredicts the risk of pelvic nodal involvement in current-era prostate cancer patients undergoing regular PSA screening and with mainly T1c/T2 disease. Contemporary patients are much less likely to have nodal involvement for a given PSA and Gleason score.

Rahman, Sophia, E-mail: sophs1578@yahoo.com [Kaiser Permanente Medical Center, Department of Radiation Oncology, Los Angeles, CA (United States); Cosmatos, Harry [Kaiser Permanente Medical Center, Department of Radiation Oncology, Los Angeles, CA (United States); Dave, Giatri [Kaiser Permanente Medical Center, Department of Radiation Oncology, Fresno, CA (United States); Williams, Stephen [Kaiser Permanente Medical Center, Department of Urology, Los Angeles, CA (United States); Tome, Michael [Kaiser Permanente Medical Center, Department of Radiation Oncology, Los Angeles, CA (United States)

2012-02-01

265

TLR3 correlated with cervical lymph node metastasis in patients with papillary thyroid cancer  

PubMed Central

Papillary thyroid cancer (PTC) is the most rapidly increasing endocrine malignancy worldwide. Although less aggressive than the majority malignancies, PTC exhibits extensive cervical lymph node metastasis in early stage of PTC. However, the underlying molecular mechanism of this early-metastasis remains unknown. Toll like receptors (TLRs) constitute a crucial component of the innate immune response to bacterial and viral pathogens. Emerging evidence suggests that TLRs play important roles in cancer progression, invasion and immune evasion, whereas whether TLRs have any role in PTC remains to be clarified. In this study, we found that TLR3 was present in both PTC specimen and various thyroid cancer cell lines. Further IHC analysis of 63 PTC patients revealed that TLR3 expression was associated with cervical metastasis, but not correlated with patients’ TNM staging, extrathyroidal invasion. In addition, TLR3 promoted migration of K1 cells in vitro. Activation of TLR3 increased cancer stem cell marker and migration promoting CD44 expression in vitro, indicating that TLR3 might promote metastasis of PTC via modulating CD44 expression. Taken together, our data revealed that TLR3 is correlated with cervical metastasis of PTC and might be an essential prognostic indicator and target for PTC metastasis. PMID:25664012

Li, Dapeng; Gu, Runxia; Yang, Xiaoyong; Hu, Chuanxiang; Li, Yigong; Gao, Ming; Yu, Yang

2014-01-01

266

Sentinel lymph node metastases in cancer: Causes, detection and their role in disease progression.  

PubMed

Malignant tumors of ectodermal or endodermal origin may metastasize to the sentinel lymph node, the first lymph node encountered by tumor cells that enter lymphatics in the organ of origin. This pathway is enabled by the anatomy of the disease and the causes of metastasis are the result of complex interactions that include mechanical forces within the tumor and host tissues, and molecular factors initiated by tumor cell proliferation, elaboration of cytokines and changes in the tumor microenvironment. Mechanical stresses may influence complex biochemical, genetic and other molecular events and enhance the likelihood of metastasis. This paper summarizes our understanding of interacting molecular, anatomical and mechanical processes which facilitate metastasis to SLNs. Our understanding of these interacting events is based on a combination of clinical and basic science research, in vitro and in vivo, including studies in lymphatic embryology, anatomy, micro-anatomy, pathology, physiology, molecular biology and mechanobiology. The presence of metastatic tumor in the SLN is now more accurately identifiable and, based upon prospective clinical trials, paradigm-changing SLN biopsy has become the standard of clinical practice in breast cancer and melanoma. PMID:25444847

Nathanson, S D; Shah, R; Rosso, K

2014-11-01

267

Fusion of SPECT and Multidetector CT Images for Accurate Localization of Pelvic Sentinel Lymph Nodes in Prostate Cancer Patients  

Microsoft Academic Search

Objective: The present study was performed to investigate the feasibility of fusion of images obtained by SPECT and multidetector CT (MDCT) for the accurate localization of sentinel lymph nodes in prostate cancer patients. Methods: To facilitate the fusion of both SPECT and CT images, a pelvic MDCT scan was performed with 3 markers of small plastic bullets attached to the

Hiroto Kizu; Teruhiko Takayama; Mamoru Fukuda; Masayuki Egawa; Hiroyuki Tsushima; Masato Yamada; Kenji Ichiyanagi; Kunihiko Yokoyama; Masahisa Onoguchi; Norihisa Tonami

268

Impact of preoperative radiation for rectal cancer on subsequent lymph node evaluation: A population-based analysis  

Microsoft Academic Search

Purpose: To determine the impact of preoperative radiotherapy (RT) on the accuracy of lymph node staging (LNS). Preoperative RT is a well-established component of rectal cancer treatment but its impact on LNS is unknown. Methods and materials: The Surveillance, Epidemiology and End Results (SEER) registry, representing 14% of the U.S. population, was used to assess the impact of preoperative RT

Nancy N.. Baxter; Arden M. Morris; David A. Rothenberger; Joel E. Tepper

2005-01-01

269

Sentinel Lymph Node Identification with Technetium99m-Labeled Nanocolloid in Squamous Cell Cancer of the Vulva  

Microsoft Academic Search

In patients with early-stage squamous cell cancer of the vulva, inguinofemoral lymphadenectomy is performed primarily as a diag nostic procedure. The morbidity of this procedure, however, is not negligible. The aim of this study was to evaluate the feasibility of minimally invasive detection of the sentinel inguinofemoral lymph node (SILN) and to investigate whether the histopathology of the SILNs is

Joanne A. de Hullu; Edwina Doting; Do A. Piers; Harrie Hollema; Jan G. Aalders; Schraffordt Koops; Henk Boonstra

270

What evidence do we need to support the use of extended pelvic lymph node dissection in prostate cancer?  

PubMed

Currently available clinical studies are not able to provide a definitive answer to the question concerning the therapeutic role of lymph node dissection in patients with prostate cancer. Novel biomarkers and genetic tests are needed to allow for the selection of men who might benefit from this procedure in terms of oncologic outcomes. PMID:25281390

Briganti, Alberto; Giannarini, Gianluca; Karnes, R Jeffrey; Gandaglia, Giorgio; Ficarra, Vincenzo; Montorsi, Francesco

2015-04-01

271

High dose para-aortic lymph node irradiation for gynecologic cancer: technique, toxicity, and results  

SciTech Connect

A technique for high dose (5600-6100 cGy) extended field irradiation to the para-aortic lymph nodes is described. Fourteen patients have been treated with this technique, of whom 10 have had histologic confirmation of para-aortic node metastases. With follow-up ranging from 11 to 78 months, 7 of 14 patients are alive and clinically cancer-free. Acute effects of extended field treatment on patient weight and circulating blood counts are analyzed, and late treatment morbidity assessed. The findings suggest that such treatment, executed with modern equipment and appropriate technique, is not significantly more hazardous than pelvic irradiation, and can result in a substantial probability of disease-free survival.

Russell, A.H.; Jones, D.C.; Russell, K.J.; Gerdes, A.J.; Figge, D.C.; Greer, B.E.; Tamimi, H.K.; Cain, J.M.

1987-02-01

272

Adjuvant Therapy in Lymph Node–Positive Vulvar Cancer: The AGO-CaRE-1 Study  

PubMed Central

Background: Women with node-positive vulvar cancer have a high risk for disease recurrence. Indication criteria for adjuvant radiotherapy are controversial. This study was designed to further understand the role of adjuvant therapy in node-positive disease. Methods: Patients with primary squamous-cell vulvar cancer treated at 29 gynecologic cancer centers in Germany from 1998 through 2008 were included in this retrospective exploratory multicenter cohort study. Of 1618 documented patients, 1249 had surgical groin staging and known lymph node status and were further analyzed. All statistical tests were two-sided. Results: Four hundred forty-seven of 1249 patients (35.8%) had lymph node metastases (N+). The majority of N+ patients had one (172 [38.5%]) or two (102 [22.8%]) positive nodes. The three-year progression-free survival (PFS) rate of N+ patients was 35.2%, and the overall survival (OS) rate 56.2% compared with 75.2% and 90.2% in node-negative patients (N-). Two hundred forty-four (54.6%) N+ patients had adjuvant therapy, of which 183 (40.9%) had radiotherapy directed at the groins (+/-other fields). Three-year PFS and OS rates in these patients were better compared with N+ patients without adjuvant treatment (PFS: 39.6% vs 25.9%, hazard ratio [HR] = 0.67, 95% confidence interval [CI[= 0.51 to 0.88, P = .004; OS: 57.7% vs 51.4%, HR = 0.79, 95% CI = 0.56 to 1.11, P = .17). This effect was statistically significant in multivariable analysis adjusted for age, Eastern Cooperative Oncology Group, Union internationale contre le cancer stage, grade, invasion depth, and number of positive nodes (PFS: HR = 0.58, 95% CI = 0.43 to 0.78, P < .001; OS: HR = 0.63, 95% CI = 0.43 to 0.91, P = .01). Conclusion: This large multicenter study in vulvar cancer observed that adjuvant radiotherapy was associated with improved prognosis in node-positive patients and will hopefully help to overcome concerns regarding adjuvant treatment. However, outcome after adjuvant radiotherapy remains poor compared with node-negative patients. Adjuvant chemoradiation could be a possible strategy to improve therapy because it is superior to radiotherapy alone in other squamous cell carcinomas. PMID:25618900

Jueckstock, Julia; Hilpert, Felix; Neuser, Petra; Harter, Philipp; de Gregorio, Nikolaus; Hasenburg, Annette; Sehouli, Jalid; Habermann, Annika; Hillemanns, Peter; Fuerst, Sophie; Strauss, Hans-Georg; Baumann, Klaus; Thiel, Falk; Mustea, Alexander; Meier, Werner; du Bois, Andreas; Griebel, Lis-Femke; Woelber, Linn

2015-01-01

273

Comments to young surgeons concerning laparoscopic spleen-preserving D2 lymph node dissection for advanced gastric cancer on the upper body.  

PubMed

Qualified radical gastrectomy with lymph node dissection is very important to the prognosis of patients with gastric cancer. Now D2 lymph node dissection is standard procedure for gastric cancer surgery, and spleen hilar lymph node dissection is mandatory for gastric cancer in upper body. Because the anatomy of vessels in this area is very complicated, D2 lymph node dissection is technical challenging not only for open gastrectomy but also for laparoscopic one. Adapting a new technique is important to all surgeons, but we surgeons should always consider a patient's safety as the most important factor during surgery and that efforts should be based on scientific rationale with oncologic principles. I hope that the recent report by Huang et al. about laparoscopic spleen preserving hilar lymph node dissection would be helpful to young surgeons who will perform laparoscpic total gastrectomy for gastric cancer. PMID:25035646

Choi, Yoon Young; An, Ji Yeong; Hyung, Woo Jin; Noh, Sung Hoon

2014-06-01

274

Lateral lymph node dissection with preoperative chemoradiation for locally advanced lower rectal cancer through a laparoscopic approach  

Microsoft Academic Search

Background  Lateral lymph node (LLN) dissection contributes to a decrease in local recurrence and prolongs survival in locally advanced\\u000a lower rectal cancer patients as compared with total mesorectal excision (TME) alone [1, 2]. However, this procedure is also accompanied by increased bleeding and postoperative complications [3, 4]. Recently, laparoscopic TME has become a safe and feasible approach for lower rectal cancer

Tsuyoshi KonishiHiroya; Hiroya Kuroyanagi; Masatoshi Oya; Masashi Ueno; Yoshiya Fujimoto; Takashi Akiyoshi; Hidehiko Yoshimatsu; Toshiaki Watanabe; Toshiharu Yamaguchi; Tetsuichiro Muto

2011-01-01

275

Robotic Image-Guided Stereotactic Radiotherapy, for Isolated Recurrent Primary, Lymph Node or Metastatic Prostate Cancer  

SciTech Connect

Purpose: To evaluate the outcome of robotic CyberKnife (Accuray, Sunnyvale, CA)-based stereotactic radiotherapy (CBK-SRT) for isolated recurrent primary, lymph node, or metastatic prostate cancer. Methods and Materials: Between May 2007 and December 2009, 34 consecutive patients/38 lesions were treated (15 patients reirradiated for local recurrence [P], 4 patients reirradiated for anastomosis recurrence [A], 16 patients treated for single lymph node recurrence [LN], and 3 patients treated for single metastasis [M]). In all but 4 patients, [{sup 11}C]choline positron emission tomography/computed tomography was performed. CBK-SRT consisted of reirradiation and first radiotherapy in 27 and 11 lesions, respectively. The median CBK-SRT dose was 30 Gy in 4.5 fractions (P, 30 Gy in 5 fractions; A, 30 Gy in 5 fractions; LN, 33 Gy in 3 fractions; and M, 36 Gy in 3 fractions). In 18 patients (21 lesions) androgen deprivation was added to CBK-SRT (median duration, 16.6 months). Results: The median follow-up was 16.9 months. Acute toxicity included urinary events (3 Grade 1, 2 Grade 2, and 2 Grade 3 events) and rectal events (1 Grade 1 event). Late toxicity included urinary events (3 Grade 1, 2 Grade 2, and 2 Grade 3 events) and rectal events (1 Grade 1 event and 1 Grade 2 event). Biochemical response was observed in 32 of 38 evaluable lesions. Prostate-specific antigen stabilization was seen for 4 lesions, and in 2 cases prostate-specific antigen progression was reported. The 30-month progression-free survival rate was 42.6%. Disease progression was observed for 14 lesions (5, 2, 5, and 2 in Groups P, A, LN, and M respectively). In only 3 cases, in-field progression was seen. At the time of analysis (May 2010), 19 patients are alive with no evidence of disease and 15 are alive with disease. Conclusions: CyberKnife-based stereotactic radiotherapy is a feasible approach for isolated recurrent primary, lymph node, or metastatic prostate cancer, offering excellent in-field tumor control and a low toxicity profile. Further investigation is warranted to identify the patients who benefit most from this treatment modality. The optimal combination with androgen deprivation should also be defined.

Jereczek-Fossa, Barbara Alicja, E-mail: barbara.jereczek@ieo.it [Department of Radiotherapy, European Institute of Oncology, Milan (Italy); University of Milan, Milan (Italy); Beltramo, Giancarlo [CyberKnife Center CDI, Milan (Italy); Fariselli, Laura [Radiotherapy Unit, Carlo Besta Neurological Institute Foundation, Milan (Italy); Fodor, Cristiana [Department of Radiotherapy, European Institute of Oncology, Milan (Italy); Santoro, Luigi [Department of Epidemiology and Statistics, European Institute of Oncology, Milan (Italy); Vavassori, Andrea; Zerini, Dario [Department of Radiotherapy, European Institute of Oncology, Milan (Italy); Gherardi, Federica [Department of Radiotherapy, European Institute of Oncology, Milan (Italy); University of Milan, Milan (Italy); Ascione, Carmen [Department of Radiotherapy, European Institute of Oncology, Milan (Italy); Seconda Universita degli Studi di Napoli, Naples (Italy); Bossi-Zanetti, Isa; Mauro, Roberta [Department of Radiotherapy, European Institute of Oncology, Milan (Italy); University of Milan, Milan (Italy); Bregantin, Achille; Bianchi, Livia Corinna [CyberKnife Center CDI, Milan (Italy); De Cobelli, Ottavio [Department of Urology, European Institute of Oncology, Milan (Italy); Orecchia, Roberto [Department of Radiotherapy, European Institute of Oncology, Milan (Italy); University of Milan, Milan (Italy)

2012-02-01

276

Normal Fibroblasts Induce E-Cadherin Loss and Increase Lymph Node Metastasis in Gastric Cancer  

PubMed Central

Background A tumor is considered a heterogeneous complex in a three-dimensional environment that is flush with pathophysiological and biomechanical signals. Cell-stroma interactions guide the development and generation of tumors. Here, we evaluate the contributions of normal fibroblasts to gastric cancer. Methodology/Principal Findings By coculturing normal fibroblasts in monolayers of BGC-823 gastric cancer cells, tumor cells sporadically developed short, spindle-like morphological characteristics and demonstrated enhanced proliferation and invasive potential. Furthermore, the transformed tumor cells demonstrated decreased tumor formation and increased lymphomatic and intestinal metastatic potential. Non-transformed BGC-823 cells, in contrast, demonstrated primary tumor formation and delayed intestinal and lymph node invasion. We also observed E-cadherin loss and the upregulation of vimentin expression in the transformed tumor cells, which suggested that the increase in metastasis was induced by epithelial-to-mesenchymal transition. Conclusion Collectively, our data indicated that normal fibroblasts sufficiently induce epithelial-to-mesenchymal transition in cancer cells, thereby leading to metastasis. PMID:24845259

Xu, Wen; Hu, Xinlei; Chen, Zhongting; Zheng, Xiaoping; Zhang, Chenjing; Wang, Gang; Chen, Yu; Zhou, Xinglu; Tang, Xiaoxiao; Luo, Laisheng; Xu, Xiang; Pan, Wensheng

2014-01-01

277

Can adjuvant chemoradiotherapy replace extended lymph node dissection in gastric cancer?  

PubMed

Surgical resection remains the essential part in the curative treatment of gastric cancer. However, with surgery only, long-term survival is poor (5-year survival <25 % in Europe). Randomized studies, which compared limited (D1) lymph node dissection with more extended (D2) resections in the Western world, failed to show a survival benefit for more extensive surgery. A substantial increase in survival was found with perioperative chemotherapy in the MAGIC study. In addition, the SWOG/Intergroup 0116 study showed that postoperative chemoradiotherapy (CRT) prolonged 5-year overall survival compared to surgery only. However, it has been argued that surgical undertreatment undermined survival in this trial. In a randomized Korean study, patients with advanced stage gastric cancer who received postoperative CRT had better outcome after a D2 dissection. At our institute phase I-II studies with adjuvant cisplatin and capecitabine-based CRT have been performed in over 120 patients with resected gastric cancer. Retrospective comparison of patients treated in these studies with those that had surgery only in the D1D2 study, demonstrated that postoperative CRT was associated with better outcome, especially after D1 or a R1 resection. For daily practice, it remains unclear whether patients after optimal (D2) gastric surgery will benefit from postoperative CRT. This is currently being tested in prospective randomized phase III trials (CRITICS; TOPGEAR). PMID:23129378

Jansen, Edwin P M; Boot, Henk; van de Velde, Cornelis J H; van Sandick, Johanna; Cats, Annemieke; Verheij, Marcel

2012-01-01

278

Ultrastaging of colorectal cancer by sentinel lymph node mapping technique--a multicenter trial.  

PubMed

Sentinel lymph node (SLN) mapping accurately diagnoses the status of nodal basin with >95% accuracy in melanoma and breast cancer. A multicenter trial for SLN mapping was performed on 203 patients with colorectal cancer to determine accuracy, upstaging, skip metastasis, and aberrant drainage. Lymphazurin 1% was injected subserosally around the tumor and 1-4 blue staining nodes were marked as SLNs for detailed histological analysis. SLN mapping was successful in 98% of patients with an average of 1.7 SLNs per patient. SLNs were negative in 63% of the patients and positive in 37% of the patients. Skip metastasis was seen in 8 of the patients. Occult micrometastasis was found in 14% of patients. In 5% of the patients, unusual lymphatic drainage lead to an alteration of the extent of lymphadenectomy. This multicenter trial proved that SLN mapping in patients with colorectal cancer is simple, cost effective, and upstages at least 14% of patients from AJCC stage I/II to stage III. These patients may then benefit from adjuvant chemotherapy. PMID:11599912

Saha, S; Bilchik, A; Wiese, D; Espinosa, M; Badin, J; Ganatra, B K; Desai, D; Kaushal, S; Singh, T; Arora, M

2001-10-01

279

Sentinel Lymph Node Biopsy  

Cancer.gov

A fact sheet that describes the sentinel lymph node biopsy (SLNB) procedure, its use in determining the extent, or stage, of cancer in the body, and the results of research on the use of SLNB in breast cancer and melanoma.

280

Near-infrared fluorescence sentinel lymph node mapping in breast cancer: a multicenter experience.  

PubMed

Near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) has the potential to improve the sentinel lymph node (SLN) procedure by facilitating percutaneous and intraoperative identification of lymphatic channels and SLNs. Previous studies suggested that a dose of 0.62 mg (1.6 mL of 0.5 mM) ICG is optimal for SLN mapping in breast cancer. The aim of this study was to evaluate the diagnostic accuracy of NIR fluorescence for SLN mapping in breast cancer patients when used in conjunction with conventional techniques. Study subjects were 95 breast cancer patients planning to undergo SLN procedure at either the Dana-Farber/Harvard Cancer Center (Boston, MA, USA) or the Leiden University Medical Center (Leiden, the Netherlands) between July 2010 and January 2013. Subjects underwent the standard-of-care SLN procedure at each institution using (99)Technetium-colloid in all subjects and patent blue in 27 (28 %) of the subjects. NIR fluorescence-guided SLN detection was performed using the Mini-FLARE imaging system. SLN identification was successful in 94 of 95 subjects (99 %) using NIR fluorescence imaging or a combination of both NIR fluorescence imaging and radioactive guidance. In 2 of 95 subjects, radioactive guidance was necessary for initial in vivo identification of SLNs. In 1 of 95 subjects, NIR fluorescence was necessary for initial in vivo identification of SLNs. A total of 177 SLNs (mean 1.9, range 1-5) were resected: 100 % NIR fluorescent, 88 % radioactive, and 78 % (of 40 nodes) blue. In 2 of 95 subjects (2.1 %), SLNs-containing macrometastases were found only by NIR fluorescence, and in one patient this led to upstaging to N1. This study demonstrates the safe and accurate application of NIR fluorescence imaging for the identification of SLNs in breast cancer patients, but calls into question what technique should be used as the gold standard in future studies. PMID:24337507

Verbeek, Floris P R; Troyan, Susan L; Mieog, J Sven D; Liefers, Gerrit-Jan; Moffitt, Lorissa A; Rosenberg, Mireille; Hirshfield-Bartek, Judith; Gioux, Sylvain; van de Velde, Cornelis J H; Vahrmeijer, Alexander L; Frangioni, John V

2014-01-01

281

Near-infrared fluorescence sentinel lymph node mapping in breast cancer: a multicenter experience  

PubMed Central

NIR fluorescence imaging using indocyanine green (ICG) has the potential to improve the SLN procedure by facilitating percutaneous and intraoperative identification of lymphatic channels and SLNs. Previous studies suggested that a dose of 0.62 mg (1.6 ml of 0.5 mM) ICG is optimal for SLN mapping in breast cancer. The aim of this study was to evaluate the diagnostic accuracy of near-infrared (NIR) fluorescence for sentinel lymph node (SLN) mapping in breast cancer patients when used in conjunction with conventional techniques. Study subjects were 95 breast cancer patients planning to undergo SLN procedure at either the Dana-Farber/Harvard Cancer Center (Boston, MA, USA) or the Leiden University Medical Center (Leiden, the Netherlands) between July 2010 and January 2013. Subjects underwent the standard-of-care SLN procedure at each institution using 99Technetium-colloid in all subjects and patent blue in 27 (28%) of the subjects. NIR fluorescence-guided SLN detection was performed using the Mini-FLARE imaging system. SLN identification was successful in 94 of 95 subjects (99%) using NIR fluorescence imaging or a combination of both NIR fluorescence imaging and radioactive guidance. In 2 of 95 subjects, radioactive guidance was necessary for initial in vivo identification of SLNs. In 1 of 95 subjects, NIR fluorescence was necessary for initial in vivo identification of SLNs. A total of 177 SLNs (mean = 1.9, range = 1–5) were resected: 100% NIR fluorescent, 88% radioactive, and 78% (of 40 nodes) blue. In 2 of 95 subjects (2.1%), SLNs containing macrometastases were found only by NIR fluorescence, and in 1 patient this led to upstaging to N1. This study demonstrates the safe and accurate application of NIR fluorescence imaging for the identification of SLNs in breast cancer patients, but calls into question what technique should be used as the gold standard in future studies. PMID:24337507

Verbeek, Floris P.R.; Troyan, Susan L.; Mieog, J. Sven D.; Liefers, Gerrit-Jan; Moffitt, Lorissa A.; Rosenberg, Mireille; Hirshfield-Bartek, Judith; Gioux, Sylvain; van de Velde, Cornelis J.H.; Vahrmeijer, Alexander L.; Frangioni, John V.

2014-01-01

282

PRC2/EED-EZH2 Complex Is Up-Regulated in Breast Cancer Lymph Node Metastasis Compared to Primary Tumor and Correlates with Tumor Proliferation In Situ  

PubMed Central

Background Lymph node metastasis is a key event in the progression of breast cancer. Therefore it is important to understand the underlying mechanisms which facilitate regional lymph node metastatic progression. Methodology/Principal Findings We performed gene expression profiling of purified tumor cells from human breast tumor and lymph node metastasis. By microarray network analysis, we found an increased expression of polycomb repression complex 2 (PRC2) core subunits EED and EZH2 in lymph node metastatic tumor cells over primary tumor cells which were validated through real-time PCR. Additionally, immunohistochemical (IHC) staining and quantitative image analysis of whole tissue sections showed a significant increase of EZH2 expressing tumor cells in lymph nodes over paired primary breast tumors, which strongly correlated with tumor cell proliferation in situ. We further explored the mechanisms of PRC2 gene up-regulation in metastatic tumor cells and found up-regulation of E2F genes, MYC targets and down-regulation of tumor suppressor gene E-cadherin targets in lymph node metastasis through GSEA analyses. Using IHC, the expression of potential EZH2 target, E-cadherin was examined in paired primary/lymph node samples and was found to be significantly decreased in lymph node metastases over paired primary tumors. Conclusions/Significance This study identified an over expression of the epigenetic silencing complex PRC2/EED-EZH2 in breast cancer lymph node metastasis as compared to primary tumor and its positive association with tumor cell proliferation in situ. Concurrently, PRC2 target protein E-cadherin was significant decreased in lymph node metastases, suggesting PRC2 promotes epithelial mesenchymal transition (EMT) in lymph node metastatic process through repression of E-cadherin. These results indicate that epigenetic regulation mediated by PRC2 proteins may provide additional advantage for the outgrowth of metastatic tumor cells in lymph nodes. This opens up epigenetic drug development possibilities for the treatment and prevention of lymph node metastasis in breast cancer. PMID:23251464

Yu, Hongxiang; Simons, Diana L.; Segall, Ilana; Carcamo-Cavazos, Valeria; Schwartz, Erich J.; Yan, Ning; Zuckerman, Neta S.; Dirbas, Frederick M.; Johnson, Denise L.; Holmes, Susan P.; Lee, Peter P.

2012-01-01

283

Left lower sleeve lobectomy and systematic lymph node dissection by complete video-assisted thoracic surgery  

PubMed Central

Sleeve lobectomy for selected cases of central lung cancer has better functional outcomes comparing to pneumonectomy. With improved technology and increased experiences in complete video-assisted thoracic surgery (VATS) lobectomy, complete VATS sleeve lobectomy has been applied in major medical centers recently. A 64-year-old male patient with left lower central lung cancer underwent thoracoscopic sleeve lobectomy and systemic mediastinal lymph node dissection. The major incision, of four incisions in total, was a 4 cm mini-incision in the 4th intercostal space of anterior axillary line. The patient had recovered uneventfully after the surgery. PMID:25589982

Fan, Jun-Qiang; Chang, Zhi-Bo; Wang, Qi; Zhao, Bai-Qin

2014-01-01

284

[Preoperative diagnosis of lymph node metastases and sentinel node navigation surgery in patients with upper gastrointestinal cancer].  

PubMed

In spite of recent advances in diagnostic tools such as computed tomography, endoscopic ultrasonography, and positron-emission tomography, preoperative diagnosis of lymph node metastases in patients with upper gastrointestinal (GI) cancer has been problematic because of the low sensitivity and accuracy in the detection of micrometastases. To overcome this issue, the sentinel node (SN) concept has attracted attention in recent years and is anticipated to become a novel diagnostic tool for the identification of clinically undetectable lymph node metastases in patients with early upper GI cancer. For early-stage gastric cancer, in which a better prognosis can generally be achieved using conventional surgical approaches, individualized, minimally invasive gastrectomy based on a combination of laparoscpic surgery with SN navigation surgery should be established as the next surgical milestone. Several issues remain to be resolved in laparoscopic gastrectomy with three-dimensional computed tomography navigation. PMID:18409586

Takeuchi, Hiroya; Kitagawa, Yuko

2008-03-01

285

Integration of single-fiber reflectance spectroscopy into ultrasound-guided endoscopic lung cancer staging of mediastinal lymph nodes  

NASA Astrophysics Data System (ADS)

We describe the incorporation of a single-fiber reflectance spectroscopy probe into the endoscopic ultrasound fine-needle aspiration (EUS-FNA) procedure utilized for lung cancer staging. A mathematical model is developed to extract information about the physiological and morphological properties of lymph tissue from single-fiber reflectance spectra, e.g., microvascular saturation, blood volume fraction, bilirubin concentration, average vessel diameter, and Mie slope. Model analysis of data from a clinical pilot study shows that the single-fiber reflectance measurement is capable of detecting differences in the physiology between normal and metastatic lymph nodes. Moreover, the clinical data show that probe manipulation within the lymph node can perturb the in vivo environment, a concern that must be carefully considered when developing a sampling strategy. The data show the feasibility of this novel technique; however, the potential clinical utility has yet to be determined.

Kanick, Stephen Chad; van der Leest, Cor; Aerts, Joachim G. J. V.; Hoogsteden, Henk C.; Kaš?áková, Slávka; Sterenborg, Henricus J. C. M.; Amelink, Arjen

2010-01-01

286

Intraoperative Evaluation of Sentinel Lymph Nodes for Metastatic Breast Carcinoma by Imprint Cytology  

Microsoft Academic Search

Background: The increasing utilization of lymphatic mapping techniques for breast carcinoma has made intraoperative evaluation of sentinel lymph nodes attractive. Axillary lymph node dissection can be performed during the initial surgery if the sentinel lymph node is positive, potentially avoiding a second operative procedure. At present the optimal technique for rapid sentinel lymph node assessment has not been determined. Both

Andrew J. Creager; Kim R. Geisinger; Stephen A. Shiver; Nancy D. Perrier; Perry Shen; Jo Ann Shaw; Peter R. Young; Edward A. Levine

2002-01-01

287

Drug Allergy and the Risk of Lymph Node Metastasis in Rectal Cancer  

PubMed Central

Background Previous epidemiologic studies have reported that a history of allergy is associated with reduced risk of colorectal cancer and other malignancies. However, no information is available for the association between allergy and the risk of lymph node metastasis. Our study was designed to determine this association in rectal cancer. Methods Patients who were treated at our hospital in the period from January 2003 to June 2011, and with a pathologically hospital discharge diagnosis of rectal adencarcinoma, were included. The clinical, laboratory, and pathologic parameters were analyzed. A multivariate logistic regression model was used to determine the association. Moreover, for type of allergic drug, sub-group analysis was performed. Results 469 patients were included, including 231 with pathological lymph node metastasis (pLNM) (49.3%) and 238 without pLNM. Univariate analysis showed, compared with patients without pLNM, patients with pLNM had a younger age (60.6±12.8 yr vs. 63.6±12.2 yr, P?=?0.012), a lower percentage of drug allergy (8.7% vs. 16.0%, P?=?0.016), an increased CEA (median/interquartile-range 5.40/2.40–13.95 vs. 3.50/2.08–8.67, P?=?0.009), and a lower serum sodium (141±3.1 mmol/L vs. 142±2.9 mmol/L, P?=?0.028). Multivariate analysis showed that drug allergy was associated with a reduced risk of pLNM (OR?=?0.553; 95% CI, 0.308–0.994; P?=?0.048). In addition, our results showed that: (1) for tumor classification, patients with drug allergy had a higher percentage of group patients with pT1/pT2; and (2) for type of allergic drug, this inverse association was found for penicillins, not for other allergic drugs. Conclusion Drug allergy is associated with a reduced risk of pLNM in rectal cancer. PMID:25162236

Gao, Chun; Li, Jing-Tao; Fang, Long; Xu, Ying-Ying; Zhao, Hong-Chuan

2014-01-01

288

Hypofractionated Intensity-Modulated Arc Therapy for Lymph Node Metastasized Prostate Cancer  

SciTech Connect

Purpose: To determine the planning results and acute toxicity after hypofractionated intensity-modulated arc radiotherapy and androgen deprivation for lymph node metastasized (Stage N1) prostate cancer. Methods and Materials: A total of 31 patients with Stage T1-T4N1M0 prostate cancer were treated with intensity-modulated arc radiotherapy and 3 years of androgen deprivation as primary treatment. The clinical target volume (CTV{sub p}) was the prostate and seminal vesicles. Elective lymph node areas ({sub e}) were delineated and expanded by 2 mm to create the CTV{sub e}. The planning target volumes (PTV{sub p} and PTV{sub e}) were created using a three-dimensional expansion of the CTV{sub p} and CTV{sub e}, respectively, of 7 mm. A median dose of 69.3 Gy and 50 Gy was prescribed to the PTV{sub p} and PTV{sub e} respectively, to be delivered in 25 fractions. Upper and lower gastrointestinal toxicity was scored using the Radiation Therapy Oncology Group toxicity and radiotherapy-induced lower intestinal toxicity scoring system. Genitourinary toxicity was scored using a combined Radiation Therapy Oncology Group, LENT-SOMA (late effects normal tissue-subjective, objective, management, analytic), and Common Toxicity Criteria toxicity scoring system. Results: The median follow-up time was 3 months. The mean prescription dose to the CTV{sub p} and PTV{sub p} was 70.4 Gy and 68.6 Gy, respectively. The minimal dose to the CTV{sub e} and PTV{sub e} was 49.0 Gy and 47.0 Gy, respectively. No acute Grade 2 or greater gastrointestinal toxicity occurred. Fourteen patients developed acute Grade 2 lower gastrointestinal toxicity. Acute Grade 3 and 2 genitourinary toxicity developed in 2 and 14 patients, respectively. Conclusion: The results of our study have shown that hypofractionated intensity-modulated arc radiotherapy as primary therapy for N1 prostate cancer is feasible with low toxicity.

Fonteyne, Valerie, E-mail: valerie.fonteyne@uzgent.b [Department of Radiotherapy, Ghent University Hospital, Ghent (Belgium); De Gersem, Werner; De Neve, Wilfried; Jacobs, Filip [Department of Radiotherapy, Ghent University Hospital, Ghent (Belgium); Lumen, Nicolaas [Department of Urology, Ghent University Hospital, Ghent (Belgium); Vandecasteele, Katrien [Department of Radiotherapy, Ghent University Hospital, Ghent (Belgium); Villeirs, Geert [Department of Radiology, Ghent University Hospital, Ghent (Belgium); De Meerleer, Gert [Department of Radiotherapy, Ghent University Hospital, Ghent (Belgium)

2009-11-15

289

Sentinel Lymph Node Biopsy: Is It Indicated in Patients With High-Risk Ductal Carcinoma-In-Situ and Ductal Carcinoma-In-Situ With Microinvasion?  

Microsoft Academic Search

Background: Axillary lymph node status is the strongest prognostic indicator of survival for women with breast cancer. The purpose of this study was to determine the incidence of sentinel node metastases in patients with high-risk ductal carcinoma-in-situ (DCIS) and DCIS with microinvasion (DCISM). Methods: From November 1997 to November 1999, all patients who underwent sentinel node biopsy for high-risk DCIS

Nancy Klauber-DeMore; Lee K. Tan; Laura Liberman; Stamatina Kaptain; Jane Fey; Patrick Borgen; Alexandra Heerdt; Leslie Montgomery; Michael Paglia; Jeanne A. Petrek; Hiram S. Cody III; Kimberly J. Van Zee

2000-01-01

290

A dual-modality photoacoustic and ultrasound imaging system for noninvasive sentinel lymph node detection: preliminary clinical results  

NASA Astrophysics Data System (ADS)

Sentinel lymph node biopsy (SLNB) has emerged as an accurate, less invasive alternative to axillary lymph node dissection, and it has rapidly become the standard of care for patients with clinically node-negative breast cancer. The sentinel lymph node (SLN) hypothesis states that the pathological status of the axilla can be accurately predicted by determining the status of the first (i.e., sentinel) lymph nodes that drain from the primary tumor. Physicians use radio-labeled sulfur colloid and/or methylene blue dye to identify the SLN, which is most likely to contain metastatic cancer cells. However, the surgical procedure causes morbidity and associated expenses. To overcome these limitations, we developed a dual-modality photoacoustic and ultrasound imaging system to noninvasively detect SLNs based on the accumulation of methylene blue dye. Ultimately, we aim to guide percutaneous needle biopsies and provide a minimally invasive method for axillary staging of breast cancer. The system consists of a tunable dye laser pumped by a Nd:YAG laser, a commercial ultrasound imaging system (Philips iU22), and a multichannel data acquisition system which displays co-registered photoacoustic and ultrasound images in real-time. Our clinical results demonstrate that real-time photoacoustic imaging can provide sensitive and specific detection of methylene blue dye in vivo. While preliminary studies have shown that in vivo detection of SLNs by using co-registered photoacoustic and ultrasound imaging is feasible, further investigation is needed to demonstrate robust SLN detection.

Erpelding, Todd N.; Garcia-Uribe, Alejandro; Krumholz, Arie; Ke, Haixin; Maslov, Konstantin; Appleton, Catherine; Margenthaler, Julie; Wang, Lihong V.

2014-03-01

291

Subtotal gastrectomy with limited lymph node dissection is a feasible treatment option for patients with early gastric stump cancer.  

PubMed

The de facto standard treatment for early gastric stump cancer (GSC) has been total gastrectomy combined with radical lymph node dissection. However, some patients could benefit if partial resection of the gastric stump is feasible. We investigated the feasibility of subtotal gastrectomy for early GSC as less invasive surgery. Subtotal gastrectomy was defined as a segmental resection of the gastric remnant including the anastomosis with limited lymph node dissection. A total of 66 patients with early GSC were enrolled and 24 patients (36.4 %) underwent subtotal gastrectomy (SG group). Clinicopathological characteristics were analyzed along with those of the other 42 patients (63.6 %) who underwent total gastrectomy (TG group). There were no significant differences between the two groups in the number of lymph nodes harvested (p = 0.880). Lymph node involvement was detected in 2 patients (8.3 %) in SG group and 5 patients (11.9 %) in TG group (p = 1.000). The previous disease (benign or malignant) and surgery (Billroth I or II) did not affect the rate of nodal involvement. The 5-year overall survival rate of SG group (94.7 %) was acceptable. Subtotal gastrectomy of the gastric remnant could be a feasible treatment option for patients with early gastric stump cancer when indicated. PMID:24944156

Irino, Tomoyuki; Hiki, Naoki; Nunobe, Souya; Ohashi, Manabu; Tanimura, Shinya; Sano, Takeshi; Yamaguchi, Toshiharu

2014-08-01

292

Primary axillary hydatid cyst.  

PubMed

Echinococcosis (hydatid disease) is a zoonosis caused by the larval stage of Echinococcus granulosus (or Taenia echinococcus). The adult form of the parasite lives in the gut of the dog, while the intermediate hosts, where the tapeworm develops to larval stage are cats, cattle, pigs and humans(considered to be accidental intermediate hosts). The parasite has a worldwide distribution, but the endemic areas are Canada and Alaska, Australia, New Zealand, South America and the Mediterranean region. Hydatid cyst can grow many years before the symptoms and clinical signs appear. The liver and the lungs are the most affected organs, but primary location of the hydatid disease in the axilla is extremely rare. In our country we did not find any records of axillary hydatid disease, while the literature contains only 12 cases of axillary location. We present the case of a woman, 60 years old, with a primary axillary location of hydatid cyst, who underwent a total cystectomy. PMID:25149625

Mercu?, D; Andri?oiu, A; Tra?c?, Et; Silo?i, C; Resceanu, A; Mercu?, R

2014-01-01

293

Ratio of metastatic lymph nodes is more important for rectal cancer patients treated with preoperative chemoradiotherapy  

PubMed Central

AIM: To evaluate the predictive value of the lymph node (LN) ratio (LNR, number of metastatic LNs/ examined LNs) for recurrence in patients with rectal cancer and to compare its applicability according to preoperative chemoradiotherapy (PCRT). METHODS: From 2000 to 2009, 967 patients with metastatic LNs after curative resection for locally advanced rectal cancer were identified. Patients were categorized according to PCRT (PCRT vs No PCRT). The cut-off LNR was determined based on the pN1 vs pN2 when the recommended number of LNs was harvested. The 5-year recurrence-free survival (RFS) rates using the Kaplan-Meier method were compared according to p/yp N stage and the LNR in each group. RESULTS: Among patients with the same p/ypN stage, the 5-year RFS rate differed according to the LNR. In addition, the 5-year RFS rate was significantly different between pN and LNR groups in patients with No PCRT. In PCRT group, however, only LNR was associated with prognosis. On multivariate analysis, both pN and LNR were significant independent prognostic factors for 5-year RFS in the No PCRT group. In the PCRT group, only LNR category was found to be associated with RFS (HR = 2.36, 95%CI: 1.31-3.84, and P = 0.001). CONCLUSION: The LNR is an important prognostic predictor of RFS in rectal cancer patients especially treated with PCRT. Current pN categories could not discriminate between prognostic groups of RFS after PCRT. PMID:25805934

Park, In Ja; Yu, Chang Sik; Lim, Seok-Byung; Yoon, Yong Sik; Kim, Chan Wook; Kim, Tae Won; Kim, Jong Hoon; Kim, Jin Cheon

2015-01-01

294

L1 Cell Adhesion Molecule Expression Is Associated With Pelvic Lymph Node Metastasis and Advanced Stage in Diabetic Patients With Endometrial Cancer: A Matched Case Control Study  

PubMed Central

Background: Diabetic patients with endometrial cancer had more lymph node metastasis than non-diabetic patients with endometrial cancer. L1 cell adhesion molecule (L1CAM) could be possibly associated with lymph node metastasis in diabetic patients with endometrial cancer via epithelial-mesenchymal transition. We aimed to investigate the association between L1CAM expression and lymph node metastasis in diabetic patients with endometrial cancer. Methods: We conducted a matched case control study of 68 endometrial cancer patients who comprise each 34 diabetic and non-diabetic patients. L1CAM expression was evaluated by immunohistochemistry using fresh formalin-fixed paraffin-embedded tissue block of the patients. The association between L1CAM expression and pelvic lymph node metastasis was assessed according to the presence of diabetes. Results: Of the 68 patients, 13 (19.1%) were positive for L1CAM immunostaining. Positive rate of L1CAM expression in diabetic endometrial cancer patients was similar to that in non-diabetic endometrial cancer patients (14.7% vs. 23.5%, P = 0.355). Tumor recurred more frequently in patients with positive L1CAM expression than those with negative L1CAM expression (33.3% vs. 1.6%, P = 0.019). However, we failed to find any significant association between L1CAM expression and lymph node metastasis. Only for the diabetic patients (n = 34), patients with pelvic lymph node metastasis had more L1CAM expression than those without lymph node metastasis (50.0% vs. 3.6%, P = 0.035). Advanced stage was the only risk factor for recurrence that showed a significant association with L1CAM expression for the diabetic endometrial cancer patients (P = 0.006), as well as all the enrolled patients (P = 0.014). Conclusion: L1CAM expression is associated with pelvic lymph node metastasis and advanced stage in diabetic patients with endometrial cancer. PMID:25337593

Suh, Dong Hoon; Kim, Min A; Kim, Hee Seung; Chung, Hyun Hoon; Park, Noh Hyun; Song, Yong Sang; Kang, Soon-Beom

2014-01-01

295

The Clinical Significance and Risk Factors of Solitary Lymph Node Metastasis in Gastric Cancer  

PubMed Central

Aims To assess the clinical significance and risk factors of solitary lymph node metastasis (SLM) in gastric carcinoma and establish a more accurate method to evaluate the possibility of lymph node metastasis (LM). Methods A total of 385 patients with gastric carcinoma who underwent D2 lymphadenectomy at the Cancer Center of Sun Yat-Sen University were included in this research. Then we used a group of data from Sun Yat-sen University Gastrointestinal Hospital (SYSUGIH) to validate the accuracy of our developed method. The ?2 test, Kaplan–Meier analysis, log-rank test, COX model, and discriminate analysis were used to analyze the data with SPSS13.0. Results We found that the LM number and pathological T staging were independent prognostic risk factors. CEA grading, LN status by CT, and T staging by CT were independent risk factors for LM in gastric carcinoma. In addition, we developed the equation Y = -5.0 + X1 + 1.8X3 + 0.7X4 (X1 = CEA grading, X3 = LN status by CT, X4 = T staging by CT) to evaluate the situation of LM. The data from SYSUGIH shows this equation has a better accuracy compared with CT. Conclusions SLM is an independent risk factor in gastric cancer. And there was no survival difference between the skip metastasis group and the other SLM group (P = 0.659). It is inappropriate for the patient with SLM doing a standard D2 lymphadenectomy, due to the fact that LM rarely occurs in the splenic artery, splenic hilum. The risk factors for LM include CEA grading, LN status by CT, and T staging by CT. And we can use Y = -5.0 + X1 + 1.8X3 + 0.7X4 (X1, CEA grading, X3 = LN status by CT, X4 = T staging by CT, the critical value is 0.3) to estimate the possibility of LM, which has a better accuracy compared with CT. PMID:25633364

Ma, Min; Chen, Shi; Zhu, Bao-yan; Zhao, Bai-Wei; Wang, Hua-She; Xiang, Jun; Wu, Xiao-Bin; Lin, Yi-Jia; Zhou, Zhi-Wei; Peng, Jun-Sheng; Chen, Ying-Bo

2015-01-01

296

Increased Expression of ATG10 in Colorectal Cancer Is Associated with Lymphovascular Invasion and Lymph Node Metastasis  

PubMed Central

Background Autophagy has paradoxical and complex functions in cancer development, and autophagy-related genes (ATG) are key regulators in autophagy. Until now, more than 30 different ATG proteins have been identified in yeast, and their mammalian counterparts also have been reported. Although the roles of a few ATG proteins in cancer have been characterized, the role of ATG10 is almost completely unknown. Methodology/Principal Findings To investigate the clinicopathological role of ATG10 in colorectal cancer, we analyzed ATG10 expression in colorectal cancer tissues and cell lines. Protein expression analysis showed that ATG10 is highly increased in colorectal cancer (tissue - 18/37 cases, 48%; cell line –8/12 cell lines, 66%). Immunohistochemical analysis with clinicopathological features indicated a strong association of the up-regulation of ATG10 with tumor lymph node metastasis (p?=?0.005) and invasion (p<0.001). Moreover, both 5-year disease free survival and overall survival rates of patients bearing tumors that did not express ATG10 were significantly higher than those of patients bearing ATG10-expressing tumors (p?=?0.012). Conclusion/Significance Increased expression of ATG10 in colorectal cancer is associated with lymphovascular invasion and lymph node metastasis indicating that ATG10 may be a potential prognostic maker in colorectal cancer. PMID:23285162

Jo, Yoon Kyung; Kim, Seung Cheol; Park, In Ja; Park, So Jung; Jin, Dong-Hoon; Hong, Seung-Woo; Cho, Dong-Hyung; Kim, Jin Cheon

2012-01-01

297

Ultrasonic dissection system technology in breast cancer: a case-control study in a large cohort of patients requiring axillary dissection.  

PubMed

In the sentinel node era, axillary dissection (ALND) for breast cancer (BC) is required much less frequently than in the past. However, complications, such as prolonged drainage output and seroma formation, are still observed. Harmonic dissection devices (HDDs) are widely used in laparoscopic and minimally invasive surgery to reduce collateral damage during tissue dissection, but its usefulness in breast surgery is unclear. The aim of this study was to evaluate the efficacy of HDDs compared to that of conventional dissection in performing ALND. One hundred thirty-nine women (median age 61 years, range 34-71 years) with confirmed pT1-2 primary infiltrating ductal BC undergoing curative surgery were enrolled in the study. The population was prospectively randomized between two age- and stage-matched arms: group A (cases)-68 (48.9 %) patients (HDD technique), versus group B (controls)-71 (51.1 %) patients (conventional technique). In group B, skin flaps were obtained using a scalpel, scissors, and electrocautery which was never used for ALND. In group A, for each operation time, the HDDs were used exclusively. The mean operative time, intraoperative blood loss, and drainage output were (A vs. B) 95 ± 22 versus 109 ± 25 min, 56 ± 12 versus 86 ± 15 mL, and 412 ± 83 versus 456 ± 69 mL, respectively (p < 0.01). Twenty-nine (20.9 %) patients developed an axillary seroma: 9 (13.2 %) and 20 (28.2 %) for groups A and B, respectively (p = 0.030). Our study confirms that in patients with BC requiring ALND the use of HDDs is more time efficient than conventional surgery, and reduces intraoperative bleeding, the amount of drainage, and the risk of seroma formation. These results may lead to several short- and long-term advantages. Thus, a careful evaluation of the cost-benefits of nontraditional tools, such as HDDs, should be performed in all patients undergoing modified radical or partial mastectomy and ALND for BC. PMID:24186056

Lumachi, F; Basso, S M M; Santeufemia, D A; Bonamini, M; Chiara, G B

2013-11-01

298

[Imaging procedures in preoperative lymph node staging of invasive bladder cancer. Necessary or superfluous?].  

PubMed

A staging programme for detection of lymph node involvement before radical cystectomy has been carried out in 22 patients. The programme includes: intravenous pyelography, chest X-ray, abdominal sonography, bone scan, CT and MRI. Also an immunoscintigraphic examination using monoclonal anti-CEA antibody (TUMAK BW 421/26) was done in every patient. Preoperative lymph node staging using CT, MRI and immunoscintigraphy was compared with post-operative histological staging: a total of 5 patients were found to have lymph node involvement. In none of them had lymph node involvement been predicted on the basis of CT, MRI or immunoscintigraphy. PMID:8447046

Gottfried, H W; Miller, K; Brandes, H; Henze, E; Waidelich, H A

1993-01-01

299

Biopathologic features and clinical significance of micrometatasis in the lymph node of early gastric cancer  

PubMed Central

AIM: To evaluate the biopathologic features and clinical significance of nodal micrometastasis (MI) in early gastric cancer (EGC). METHODS: Among 1022 EGC patients who underwent gastrectomy with lymphadenectomy of D1 + ? or more from March 2001 to December 2005 at the Korean National Cancer Center, available nodal metastasis was found in 90 pT1N1 patients. Nodal metastasis was confirmed by immunohistochemistry (IHC) with cytokeratin and patients were classified into MI and macrometastasis (MA) groups based on the main tumor burden according to the 6th International Union Against Cancer/American Joint Committee on Cancer staging system; the main tumor burden with a diameter of greater than 0.2 mm but no greater than 2 mm as MI, and greater than 2 mm as MA of the representative metastatic node. Proliferative and apoptotic activities of the primary tumor and the nodal metastasis were measured by IHC with Ki-67 and terminal deoxynucleotidyl transferase dUTP nick end labeling, respectively. Biopathologic and clinical features of the patients were analyzed and compared between MI and MA groups. Patients with recurrence were compared with those without recurrence to identify risk factors for recurrence. RESULTS: Thirty-seven patients showed MI and the other 53 patients revealed MA in the lymph node; the incidence of patients with MI and MA was 41.1% and 58.9%. The main tumor burden was 0.9 and 4.6 mm in the representative metastatic node, respectively. Japanese N2 stations were more frequently involved in MA group (20.9%) than in MI group (10.3%) but the difference was not statistically different (P = 0.338). Proliferative and apoptotic activities of MI were decreased than those of MA (26.7% vs 40.5%, P = 0.004 and 1.0% vs 3.0%, P < 0.001, respectively). However, nodal MI in the current study showed a relatively high proliferative activity and an equivalent apoptotic activity compared to other cancers in the previously published studies. Recurrence was observed in 6 patients during the mean follow up period of 87.6 ± 26.2 mo. The recurrence was significantly associated with the presence of MA (P = 0.041) and lymphovascular invasion of the primary tumor (P = 0.032). CONCLUSION: Lymphadenectomy of D1 + ? or more might be necessary in patients with MI in sentinel node to prevent recurrence by clearing MI involving Japanese N2 station. PMID:25593497

Jo, Min Jung; Park, Ji Yeon; Song, Joon Seon; Kook, Myeong-Cherl; Ryu, Keun Won; Cho, Soo-Jeong; Lee, Jun Ho; Nam, Byung-Ho; Hong, Eun Kyung; Choi, Il Ju; Kim, Young-Woo

2015-01-01

300

Gaint axillary lipoma following excision.  

PubMed

Lipomas are benign tumors and are most common mesenchymal soft tissue tumors, composed of mature lipocytes. Frequent site are trunk and extremities. Axilla is an uncommon site of lipoma while giant axillary lipomas are rare. We report a case of recurrence of small axillary lipoma into giant axillary lipoma following excision. PMID:24426549

Bashir, Mudasir; Zaki, Imtiyaz Ahmad; Mahajan, Manoj Kumar

2013-06-01

301

Lymph node CEA and MUC2 mRNA as useful predictors of outcome in colorectal cancer.  

PubMed

The aim was to explore the utility for staging and prognostic impact of carcinoembryonic antigen (CEA), cytokeratin 20 (CK20), guanylyl cyclase C (GCC), CUB (complement protein subcomponents C1r/C1s, urchin embryonic growth factor, and bone morphogenic protein 1) containing domain protein 1 (CDCP1) and mucin 2 (MUC2) mRNA levels in mesenteric lymph nodes of colorectal cancer (CRC) patients. Lymph nodes were collected at surgery and bisected; one half was subjected to biomarker mRNA analysis using real-time quantitative RT-PCR and the other half to routine histopathology. Lymph nodes from 174 CRC patients and 24 controls were analyzed. The median follow-up time was 59 (range 17-131) months. Cut-off levels were defined by analyzing quintiles by Cox regression model. CEA mRNA showed the best discriminating power between patients with recurrence in CRC after surgery and patients who were apparently disease-free (p = 0.015). The risk of recurrence for the CEA(+) patients was 4.6 times greater than for the CEA(-) patients (p < 0.0001). The other biomarkers gave lower hazard ratios. Cumulative survival analysis demonstrated that the average survival time was 99 months for CEA(-) patients compared to 39 months for CEA(+) patients, a difference of 60 months (p < 0.0001). Six to nine percent of the Stage I and Stage II patients [H&E(-)] had CEA(+), CK20(+), GCC(+) and/or MUC2(+) lymph nodes. Two of these patients died from recurrent CRC. Low lymph node MUC2/CEA mRNA ratio identified patients with high risk for recurrence (p = 0.011). Thus, quantitative reverse transcriptase-polymerase chain reaction of CEA mRNA is a sensitive method to identify tumor cells in lymph nodes of CRC patients and, in combination with MUC2 mRNA, allows improved prediction of clinical outcome. PMID:21618511

Ohlsson, Lina; Israelsson, Anne; Öberg, Åke; Palmqvist, Richard; Stenlund, Hans; Hammarström, Marie-Louise; Hammarström, Sten; Lindmark, Gudrun

2012-04-15

302

Muscular Variations During Axillary Dissection: A Clinical Study in Fifty Patients  

PubMed Central

Aim: The present study was conducted to detect the musculature variations during axillary dissection for breast cancer surgery. Methods: The anatomy of axilla regarding muscular variations was studied in 50 patients who had an axillary dissection for the staging and treatment of invasive primary breast cancer over one year. Results: In a period of one year, two patients (4%) with axillary arch and one patient (2%) with absent pectoralis major and minor muscles among fifty patients undergoing axillary surgery for breast cancer were identified. Conclusions: Axillary arch when present should always be identified and formally divided to allow adequate exposure of axillary contents, in order to achieve a complete lymphatic dissection. Complete absence of pectoralis major and minor muscles precludes the insertion of breast implants and worsens the prognosis of breast cancer.

Upasna; Kumar, Ashwani; Singh, Bimaljot; Kaushal, Subhash

2015-01-01

303

Curative Chemoradiotherapy in Patients With Stage IVB Cervical Cancer Presenting With Paraortic and Left Supraclavicular Lymph Node Metastases  

SciTech Connect

Purpose: To evaluate the efficacy and toxicity of concurrent chemoradiotherapy (CCRT) with curative intent in patients with stage IVB cervical cancer initially presenting with paraortic and left supraclavicular lymph node metastases. Methods and Materials: The medical records of 25 patients with both paraortic and left supraclavicular lymph nodal metastases (group I) were reviewed and compared with those of 101 women with paraortic lymph node metastases alone (group II). Group I received a mean 59.4 Gy to the paraortic and left supraclavicular areas and 50.4 Gy to the pelvis, followed by 30 Gy of high-dose-rate brachytherapy in 6 fractions. Group II received the same dose to the paraortic area and pelvis followed by intracavitary brachytherapy. All patients received platinum-based chemotherapy simultaneously. Results: Of the 25 patients in group I, 16 (64%) experienced acute grade 3-4 hematologic toxicities, and 1 had a late grade 3 genitourinary toxicity. Complete responses, including the primary mass and pelvic, paraortic, and left supraclavicular lymph nodes, were observed in 13 patients (52%). At a median follow-up of 32 months for surviving patients, 3 experienced in-field failure, 6 showed distant failure, and 9 showed both. The 3-year overall and disease-free survival rates were 49% and 33%, respectively. In comparison, of the 101 patients in group II, 16 showed in-field failure, 14 experienced distant failure, and 11 showed both. The 3-year overall and disease-free survival rates were 69% and 57%, respectively. Conclusions: Curative CCRT is feasible in patients with stage IVB cervical cancer presenting with paraortic and left supraclavicular lymph nodal metastases, with acceptable late toxicity and high response rates, despite high rates of acute hematologic toxicity.

Kim, Ji-Yoon [Department of Radiation Oncology, Catholic University of Korea, College of Medicine, Seoul (Korea, Republic of)] [Department of Radiation Oncology, Catholic University of Korea, College of Medicine, Seoul (Korea, Republic of); Kim, Joo-Young [Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of)] [Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Kim, Jin Hee [Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu (Korea, Republic of)] [Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu (Korea, Republic of); Yoon, Mee Sun [Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam-do (Korea, Republic of)] [Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam-do (Korea, Republic of); Kim, Juree [Department of Radiation Oncology, Cheil General Hospital and Women's Healthcare Center, Kwandong University, College of Medicine, Seoul (Korea, Republic of)] [Department of Radiation Oncology, Cheil General Hospital and Women's Healthcare Center, Kwandong University, College of Medicine, Seoul (Korea, Republic of); Kim, Young Seok, E-mail: ysk@amc.seoul.kr [Department of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul (Korea, Republic of)

2012-11-01

304

Activin type IB receptor signaling in prostate cancer cells promotes lymph node metastasis in a xenograft model  

SciTech Connect

Highlights: Black-Right-Pointing-Pointer ActRIB signaling induces Snail and S100A4 expressions in prostate cancer cells. Black-Right-Pointing-Pointer The prostate cancer cell lines expressing an active form of ActRIB were established. Black-Right-Pointing-Pointer ActRIB signaling promotes EMT and lymph node metastasis in xenograft model. -- Abstract: Activin, a member of the transforming growth factor-{beta} family, has been known to be a growth and differentiating factor. Despite its pluripotent effects, the roles of activin signaling in prostate cancer pathogenesis are still unclear. In this study, we established several cell lines that express a constitutive active form of activin type IB receptor (ActRIBCA) in human prostate cancer cells, ALVA41 (ALVA-ActRIBCA). There was no apparent change in the proliferation of ALVA-ActRIBCA cells in vitro; however, their migratory ability was significantly enhanced. In a xenograft model, histological analysis revealed that the expression of Snail, a cell-adhesion-suppressing transcription factor, was dramatically increased in ALVA-ActRIBCA tumors, indicating epithelial mesenchymal transition (EMT). Finally, mice bearing ALVA-ActRIBCA cells developed multiple lymph node metastases. In this study, we demonstrated that ActRIBCA signaling can promote cell migration in prostate cancer cells via a network of signaling molecules that work together to trigger the process of EMT, and thereby aid in the aggressiveness and progression of prostate cancers.

Nomura, Masatoshi, E-mail: nomura@med.kyushu-u.ac.jp [Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582 (Japan)] [Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582 (Japan); Tanaka, Kimitaka; Wang, Lixiang; Goto, Yutaka; Mukasa, Chizu; Ashida, Kenji; Takayanagi, Ryoichi [Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582 (Japan)] [Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582 (Japan)

2013-01-04

305

The microRNA-218~Survivin axis regulates migration, invasion, and lymph node metastasis in cervical cancer  

PubMed Central

Cervical cancer is the third most common cancer in women worldwide. In the present study, global microRNA profiling for 79 cervical cancer patient samples led to the identification of miR-218 down-regulation in cervical cancer tissues compared to normal cervical tissues. Lower miR-218 expression was associated significantly with worse overall survival (OS), disease-free survival (DFS), and pelvic/aortic lymph node recurrence. In vitro, miR-218 over-expression decreased clonogenicity, migration, and invasion. Survivin (BIRC5) was subsequently identified as an important cervical cancer target of miR-218 using in silico prediction, mRNA profiling, and quantitative real-time PCR (qRT-PCR). Concordant with miR-218 over-expression, survivin knockdown by siRNA decreased clonogenicity, migration, and invasion. YM155, a small molecule survivin inhibitor, significantly suppressed tumor growth and lymph node metastasis in vivo. Our findings demonstrate that the miR-218~survivin axis inhibits cervical cancer progression by regulating clonogenicity, migration, and invasion, and suggest that the inhibition of survivin could be a potential therapeutic strategy to improve outcome in this disease. PMID:25473903

Kogo, Ryunosuke; How, Christine; Chaudary, Naz; Bruce, Jeff; Shi, Wei; Hill, Richard P.; Zahedi, Payam; Yip, Kenneth W.; Liu, Fei-Fei

2015-01-01

306

Salvage Pelvic Lymph Node Dissection in Recurrent Prostate Cancer: Surgical and Early Oncological Outcome  

PubMed Central

Methodology. Seventeen patients with prostate-specific antigen (PSA) rise following local treatment for prostate cancer with curative intent underwent open or minimally invasive salvage pelvic lymph node dissection (SLND) for oligometastatic disease (<4 synchronous metastases) or as staging prior to salvage radiotherapy. Biochemical recurrence after complete biochemical response (cBR) was defined as 2 consecutive PSA increases >0,2?ng/mL; and after incomplete biochemical response as 2 consecutive PSA rises. Newly found metastasis on imaging defined clinical progression (CP). Palliative androgen deprivation therapy (ADT) was initiated if >3 metastases were detected or if patients became symptomatic. Kaplan-Meier statistics were applied. Results. Clavien-Dindo grade 1, 2, 3a, and 3b complications were seen in 6, 1, 1, and 2 patients, respectively. Median follow-up time was 22 months. Among 13 patients treated for oligometastatic disease, 8 (67%) had a PSA decline, with 3 patients showing cBR. Median PSA progression-free survival (FS) was 4.1 months and median CP-FS 7 months. Three patients started ADT, resulting in a 2-year ADT-FS rate of 79.5%. Conclusion. SLND is feasible, but postoperative complication rate seems higher than that for primary LND. Biochemical and clinical response duration is limited, but as part of an oligometastatic treatment regime it can defer palliative ADT. PMID:25695051

Van Praet, Charles; Lumen, Nicolaas; Ost, Piet; Fonteyne, Valérie; De Meerleer, Gert; Lambert, Bieke; Delrue, Louke; De Visschere, Pieter; Villeirs, Geert; Decaestecker, Karel

2015-01-01

307

Salvage pelvic lymph node dissection in recurrent prostate cancer: surgical and early oncological outcome.  

PubMed

Methodology. Seventeen patients with prostate-specific antigen (PSA) rise following local treatment for prostate cancer with curative intent underwent open or minimally invasive salvage pelvic lymph node dissection (SLND) for oligometastatic disease (<4 synchronous metastases) or as staging prior to salvage radiotherapy. Biochemical recurrence after complete biochemical response (cBR) was defined as 2 consecutive PSA increases >0,2?ng/mL; and after incomplete biochemical response as 2 consecutive PSA rises. Newly found metastasis on imaging defined clinical progression (CP). Palliative androgen deprivation therapy (ADT) was initiated if >3 metastases were detected or if patients became symptomatic. Kaplan-Meier statistics were applied. Results. Clavien-Dindo grade 1, 2, 3a, and 3b complications were seen in 6, 1, 1, and 2 patients, respectively. Median follow-up time was 22 months. Among 13 patients treated for oligometastatic disease, 8 (67%) had a PSA decline, with 3 patients showing cBR. Median PSA progression-free survival (FS) was 4.1 months and median CP-FS 7 months. Three patients started ADT, resulting in a 2-year ADT-FS rate of 79.5%. Conclusion. SLND is feasible, but postoperative complication rate seems higher than that for primary LND. Biochemical and clinical response duration is limited, but as part of an oligometastatic treatment regime it can defer palliative ADT. PMID:25695051

Claeys, Tom; Van Praet, Charles; Lumen, Nicolaas; Ost, Piet; Fonteyne, Valérie; De Meerleer, Gert; Lambert, Bieke; Delrue, Louke; De Visschere, Pieter; Villeirs, Geert; Decaestecker, Karel

2015-01-01

308

Tumor differentiation as related to sentinel lymph node status in gastric cancer  

PubMed Central

AIM: To investigate the influence of tumor grade on sentinel lymph node (SLN) status in patients with gastric cancer (GC). METHODS: We retrospectively studied 71 patients with GC who underwent SLN mapping during gastric surgery to evaluate the relationship between SLN status and tumor grade. RESULTS: Poorly differentiated tumors were detected in 50/71 patients, while the other 21 patients had moderately differentiated tumors. SLNs were identified in 58/71 patients (82%). In 41 of the 58 patients that were found to have stained nodes (70.7%), the tumor was of the poorly differentiated type (group?I), while in the remaining patients with stained nodes 17/58 (29.3%), the tumor was of the moderately differentiated type (group II). Positive SLNs were found in 22/41 patients in group I (53.7%) and in 7/17 patients in group II (41.2%) (P = 0.325). The rate of positivity for the SLNs in the two groups (53.7% vs 41.2%) was not statistically significant (P = 0.514). CONCLUSION: Most of our patients were found to have poorly differentiated adenocarcinoma of the stomach and there was no correlation between tumor grade and SLN involvement. PMID:24627734

Lavy, Ron; Kapiev, Andronik; Hershkovitz, Yehuda; Poluksht, Natan; Rabin, Igor; Chikman, Bar; Shapira, Zahar; Wasserman, Ilan; Sandbank, Judith; Halevy, Ariel

2014-01-01

309

Comparison of Nodal Risk Formula and MR Lymphography for Predicting Lymph Node Involvement in Prostate Cancer  

SciTech Connect

Purpose: To compare the nodal risk formula (NRF) as a predictor for lymph node (LN) metastasis in patients with prostate cancer with magnetic resonance lymphography (MRL) using Ultrasmall Super-Paramagnetic particles of Iron Oxide (USPIO) and with histology as gold standard. Methods and Materials: Logistic regression analysis was performed with the results of histopathological evaluation of the LN as dependent variable and the nodal risk according to the NRF and the result of MRL as independent input variables. Receiver operating characteristic (ROC) analysis was performed to assess the performance of the models. Results: The analysis included 375 patients. In the single-predictor regression models, the NRF and MRL results were both significantly (p <0.001) predictive of the presence of LN metastasis. In the models with both predictors included, NRF was nonsignificant (p = 0.126), but MRL remained significant (p <0.001). For NRF, sensitivity was 0.79 and specificity was 0.38; for MRL, sensitivity was 0.82 and specificity was 0.93. After a negative MRL result, the probability of LN metastasis is 4% regardless of the NRF result. After a positive MRL, the probability of having LN metastasis is 68%. Conclusions: MRL is a better predictor of the presence of LN metastasis than NRF. Using only the NRF can lead to a significant overtreatment on the pelvic LN by radiation therapy. When the MRL result is available, the NRF is no longer of added value.

Deserno, Willem M.L.L.G., E-mail: w.deserno@rad.umcn.nl [Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Debats, Oscar A. [Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Rozema, Tom [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Fortuin, Ansje S. [Department of Radiology, Deventer Ziekenhuis, Deventer (Netherlands); Heesakkers, Roel A.M.; Hoogeveen, Yvonne [Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Peer, Petronella G.M. [Department of Biostatistics, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Barentsz, Jelle O. [Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Lin, Emile N.J.T. van [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands)

2011-09-01

310

Extended Salvage Pelvic Lymph Node Dissection in Patients with Recurrent Prostate Cancer  

PubMed Central

Background. Treatment of patients with a biochemical recurrence (BCR) of prostate cancer (PCa) is generally difficult and without valid treatment options. Since 2004 we have been developing therapeutic possibilities for these patients. Methods. We retrospectively analyzed a cohort of 41 patients with a BCR of PCa and a mean followup of 40.3 ± 20.8 months. Group 1 (n = 10): salvage radical prostatectomy (sRP) with SePLND (salvage extended pelvic lymph nodes dissection) (initial treatment: combined brachytherapy). Group 2 (n = 22): SePLND (initial treatment: radical prostatectomy (RP)). Group 3 (n = 9): SePLND (initial treatment: RP and adjuvant radiation therapy (RT)). We observed PSA, PSA-velocity, localization of LNs and LNs+, BCR-free period, and BR (biochemical response). Results. Group 1: 60% with BCR-freedom (mean 27.2 months). Group 2: 63.6% with BCR-freedom (mean 17.5 months). Group 3: 33.3% with BCR-freedom (mean 17.6 months). In total, BCR-freedom was observed in 23 of 41 patients (56.1%) after salvage surgery. 75.6% of all patients showed a BR. 765?LNs were removed and 14.8% of these were LN+. Conclusions. The BCR-free period and BR are comparable in all three groups. Sensibility to ADT can be reestablished and prolonged as a result of SePLND. Multicenter studies are needed for a reliable output. PMID:24688536

Osmonov, Daniar K.; Aksenov, Alexey V.; Boller, Annkathrin; Kalz, Almut; Heimann, Diana; Janssen, Isa; Jünemann, Klaus-Peter

2014-01-01

311

Can the Tumor Deposits Be Counted as Metastatic Lymph Nodes in the UICC TNM Staging System for Colorectal Cancer?  

PubMed Central

Objective The 7th edition of AJCC staging manual implicitly states that only T1 and T2 lesions that lack regional lymph node metastasis but have tumor deposit(s) will be classified in addition as N1c, though it is not consistent in that pN1c is also an option for pT3/T4a tumors in the staging table. Nevertheless, in this TNM classification, how to classify tumor deposits (TDs) in colorectal cancer patients with lymph node metastasis (LNM) and TDs simultaneously is still not clear. The aim of this study is to investigate the possibility of counting TDs as metastatic lymph nodes in TNM classification and to indentify its prognostic value for colorectal cancer patients. Methods and Results In this retrospective study, 513 cases of colorectal cancer with LNM were reviewed. We proposed a novel pN (npN) category in which TDs were counted as metastatic lymph nodes in the TNM classification. Cancer-specific survival according to the npN or pN category was analyzed using Kaplan-Meier survival curves. Univariate and multivariate analyses were performed to indentify significant prognostic factors. Harrell's C statistic was used to test the predictive capacity of the prognostic models. The results revealed that the TD was a significant prognostic factor in colorectal cancer. Univariate and multivariate analyses uniformly indicated that the npN category was significantly correlated with prognosis. The results of Harrell's C statistical analysis demonstrated that the npN category exhibited a superior predictive capacity compared to the pN category of the 7th edition TNM classification. Moreover, we also found no significant prognostic differences in patients with or without TD in the same npN categories. Conclusions The counting of TDs as metastatic lymph nodes in the TNM classification system is potentially superior to the classification in the 7th edition of the TNM staging system to assess prognosis and survival for colorectal cancer patients. PMID:22461900

Wang, Zhen-Ning; Liang, Ji-Wang; Sun, Zhe; Wang, Mei-Xian; Dong, Yu-Lan; Wang, Xin-Fang; Xu, Hui-Mian

2012-01-01

312

Lymph node revealing solutions in colorectal cancer: should they be used routinely?  

PubMed

The Royal College of Pathologists (RCPath) and College of American Pathologists recommend that at least 12 lymph nodes should be harvested for adequate staging of colorectal carcinoma. Just one nodal tumour deposit upstages the malignancy from pN0 to pN1. This is critically important as node-positive patients (pN1) are considered for adjuvant chemotherapy whereas node-negative patients (pN0) may not be. It is not always easy to harvest the required number, especially in patients with rectal carcinoma who may have received neoadjuvant therapy-an increasingly common treatment. The use of neoadjuvant therapy is known to further decrease the number and size of identifiable lymph nodes within specimens, meaning that the lymph node harvest often fails to reach RCPath guidelines. Lymph node revealing solutions consisting of either single chemicals such as alcohol or acetone or compounds have been investigated to help improve the lymph node harvest in difficult specimens, for example, those received following neoadjuvant therapy. Published research evidence reviewed here suggests that lymph node revealing solutions significantly improve lymph node harvesting, and that glacial acetic acid, ethanol, water and formalin is advantageous in comparison with other revealing solutions in that it is safe, cheap, easy to use and relatively quick. However, the quantity of good evidence is limited and the clinical implications of improving lymph node harvesting require further research. PMID:24493650

Horne, Joanne; Bateman, Adrian C; Carr, Norman J; Ryder, Isobel

2014-05-01

313

Preoperative mediastinal lymph node staging for non-small cell lung cancer: 2014 update of the 2007 ESTS guidelines  

PubMed Central

Accurate preoperative staging and restaging of mediastinal lymph nodes in patients with potentially resectable non-small cell lung cancer (NSCLC) is of paramount importance. In 2007, the European Society of Thoracic Surgeons (ESTS) published an algorithm on preoperative mediastinal staging integrating imaging, endoscopic and surgical techniques. Over the last years more evidence of the different mediastinal staging technique has become available. Therefore, a revision of the ESTS guidelines was needed. In case of CT-enlarged or PET-positive mediastinal lymph nodes, tissue confirmation is indicated. Endosonography (EBUS/EUS) with fine needle aspiration is the first choice (when available) since it is minimally invasive and has a high sensitivity to rule in mediastinal nodal disease. If negative, surgical staging with nodal dissection or biopsy is indicated. Video-assisted mediastinoscopy is preferred over mediastinoscopy. The combined use of endoscopic staging and surgical staging results in the highest accuracy. When there are no enlarged lymph nodes on CT and when there is no uptake in lymph nodes on PET or PET-CT, direct surgical resection with systematic nodal dissection is indicated for tumors ?3 cm located in the outer third of the lung. In central tumors or N1 nodes, preoperative mediastinal staging is indicated. The choice between endoscopic staging with EBUS/EUS and fine needle aspiration or video-assisted mediastinoscopy depends on local expertise to adhere to minimal requirements for staging. For tumors larger than 3 cm, preoperative mediastinal staging is advised, mainly in adenocarcinoma with high SUV uptake.

Dooms, Christophe; Kuzdzal, Jaroslaw; Lardinois, Didier; Passlick, Bernward; Rami-Porta, Ramon; Turna, Akif; Van Schil, Paul; Venuta, Frederico; Waller, David; Weder, Walter; Zielinski, Marcin

2014-01-01

314

Lymph nodes  

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... and conveying lymph and by producing various blood cells. Lymph nodes play an important part in the ... the microorganisms being trapped inside collections of lymph cells or nodes. Eventually, these organisms are destroyed and ...

315

Expression of nestin in lymph node metastasis and lymphangiogenesis in non-small cell lung cancer patients.  

PubMed

Stem cell marker nestin has been reported to be activated in various neoplasms, and its expression is correlated with poor prognosis. However, nestin expression in non-small cell lung cancer still remains unclear. The present study aimed to investigate nestin expression in 52 tissue samples of non-small cell lung cancer by immunohistochemical staining and explore its correlation with some clinicopathologic characteristics. The associations of nestin with lymphatic vessel density, microvessel density, vascular endothelial growth factor, vascular endothelial growth factor-C, and cyclooxygenase-2 (COX-2) were further observed to determine the linkage between nestin and lymphangiogenesis. The results showed that nestin expressed in tumor cells of 45 samples. High nestin expression correlated significantly with poor differentiation (P = .007), adenocarcinoma (P = .000), N2 lymph node metastasis (P = .006), high microvessel density (P = .033), and lymphatic vessel density (P = .020). Multivariate analysis of N1 and N2 lymph node metastasis revealed a 1.086-fold increase in hazard ratio of N2 lymph node involvement (P = .011) in patients with high nestin expression in primary tumor. More important, multivariate analysis showed a significant correlation of lymphatic vessel density with nestin and vascular endothelial growth factor-C expression (P = .039 and P = .045), independent of vascular endothelial growth factor, COX-2, and other clinicopathologic characteristics. The results demonstrated that nestin expressed in most tumor cells of non-small cell lung cancer tissue and had a direct linkage to lymph node metastasis and tumor-induced lymphangiogenesis, independent of COX-2 signal pathway. PMID:20132963

Chen, Zhenguang; Wang, Tao; Luo, Honghe; Lai, Yingrong; Yang, Xuhui; Li, Fugui; Lei, Yiyan; Su, Chunhua; Zhang, Xiuming; Lahn, Bruce T; Xiang, Andy Peng

2010-05-01

316

?2microglobulin mRNA expression levels are prognostic for lymph node metastasis in colorectal cancer patients  

PubMed Central

Colorectal cancer (CRC) is the fourth most common non-cutaneous malignancy in the United States and the second most frequent cause of cancer-related death. One of the most important determinants of CRC survival is lymph node metastasis. To determine whether molecular markers might be prognostic for lymph node metastases, we measured by quantitative real-time RT–PCR the expression levels of 15 cancer-associated genes in formalin-fixed paraffin-embedded primary tissues derived from stage I–IV CRC patients with (n=20) and without (n=18) nodal metastases. Using the mean of the 15 genes as an internal reference control, we observed that low expression of ?2microglobulin (B2M) was a strong prognostic indicator of lymph node metastases (area under the curve (AUC)=0.85; 95% confidence interval (CI)=0.69–0.94). We also observed that the expression ratio of B2M/Spint2 had the highest prognostic accuracy (AUC=0.87; 95% CI=0.71–0.96) of all potential two-gene combinations. Expression values of Spint2 correlated with the mean of the entire gene set at an R2 value of 0.97, providing evidence that Spint2 serves not as an independent prognostic gene, but rather as a reliable reference control gene. These studies are the first to demonstrate a prognostic role of B2M at the mRNA level and suggest that low B2M expression levels might be useful for identifying patients with lymph node metastasis and/or poor survival. PMID:18506145

Shrout, J; Yousefzadeh, M; Dodd, A; Kirven, K; Blum, C; Graham, A; Benjamin, K; Hoda, R; Krishna, M; Romano, M; Wallace, M; Garrett-Mayer, E; Mitas, M

2008-01-01

317

Efficacy and feasibility of the immunomagnetic separation based diagnosis for detecting sentinel lymph node metastasis from breast cancer  

PubMed Central

A purpose of this study was to establish a novel molecular diagnostic model and provide new insight into the intraoperative evaluation of the sentinel lymph node (SLN) metastasis in breast cancer. A total of 124 breast cancer patients who met the criteria of sentinel lymph node biopsy (SLNB) and underwent intraoperative biopsy were consecutively enrolled in this study. After the SLNs obtained from each patient were labeled, MOC-31 monoclonal antibody-mediated immunomagnetic separation (IMS) and flow cytometry were used to determine the expressions of breast cancer metastasis-related markers, including Mucin 1 (MUC1), CD44v6, and HER2. Alternatively, conventional intraoperative hematoxylin and eosin (HE) staining and cytokeratin immunohistochemistry (CK-IHC) were performed to detect potential SLN metastasis. The sensitivity, specificity, and false-negative rate of the three intraoperative diagnostic methods were compared and analyzed. A total of 55 positive-SLNs were found in 38 breast cancer patients using IMS, yielding a sensitivity of 86.4% (38/44), specificity of 94.7% (36/38), accuracy of 93.5% (116/124), false-positive rate of 2.5% (2/80), false-negative rate of 13.6% (6/44), positive predictive value of 95.5% (42/44), and negative predictive value of 93.0% (80/86). Patients with high expressions of CD44v6, MUC1, and HER2 in SLNs tended to have higher number of positive lymph nodes, among which the MUC1 and HER2 showed significant differences (P<0.05). Therefore, compared with conventional HE staining and CK-IHC, IMS technology has remarkably higher sensitivity and specificity and relative lower false-negative rate, thus making it an effective and feasible intraoperative detection method of SLN for breast cancer diagnosis to some extent.

Zhi, Xiang-Cheng; Zhang, Min; Meng, Ting-Ting; Zhang, Xiao-Bei; Shi, Zhen-Dong; Liu, Yan; Liu, Jing-Jing; Zhang, Sheng; Zhang, Jin

2015-01-01

318

Prognostic Value of Gene Signatures and Proliferation in Lymph-Node-Negative Breast Cancer  

PubMed Central

Introduction The overall survival rate is good for lymph-node-negative breast cancer patients, but they still suffer from serious over- and some undertreatments. Prognostic and predictive gene signatures for node-negative breast cancer have a high number of genes related to proliferation. The prognostic value of gene sets from commercial gene-expression assays were compared with proliferation markers. Methods Illumina WG6 mRNA microarray analysis was used to examine 94 fresh-frozen tumour samples from node-negative breast cancer patients. The patients were divided into low- and high-risk groups for distant metastasis based on the MammaPrint-related genes, and into low-, intermediate- and high-risk groups based on the recurrence score algorithm with genes included in Oncotype DX. These data were then compared to proliferation status, as measured by the mitotic activity index, the expressions of phosphohistone H3 (PPH3), and Ki67. Results Kaplan-Meier survival analysis for distant-metastasis-free survival revealed that patients with weak and strong PPH3 expressions had 14-year survival rates of 87% (n?=?45), and 65% (n?=?49, p?=?0.014), respectively. Analysis of the MammaPrint classification resulted in 14-year survival rates of 80% (n?=?45) and 71% (n?=?49, p?=?0.287) for patients with low and high risks of recurrence, respectively. The Oncotype DX categorization yielded 14-year survival rates of 83% (n?=?18), 79% (n?=?42) and 68% (n?=?34) for those in the low-, intermediate- and high-risk groups, respectively (p?=?0.52). Supervised hierarchical cluster analysis for distant-metastasis-free survival in the subgroup of patients with strong PPH3 expression revealed that the genes involved in Notch signalling and cell adhesion were expressed at higher levels in those patients with distant metastasis. Conclusion This pilot study indicates that proliferation has greater prognostic value than the expressions of either MammaPrint- or Oncotype-DX-related genes. Furthermore, in the subgroup of patients with high proliferation, Notch signalling pathway genes appear to be expressed at higher levels in patients who develop distant metastasis. PMID:24599057

Jonsdottir, Kristin; Assmus, Jörg; Slewa, Aida; Gudlaugsson, Einar; Skaland, Ivar; Baak, Jan P. A.; Janssen, Emiel A. M.

2014-01-01

319

Design and development of a dedicated mammary and axillary region positron emission tomography system  

NASA Astrophysics Data System (ADS)

Breast cancer is the second leading cause of cancer death in women. Currently, mammography and physical breast examination, both non-invasive techniques, provide the two most effective methods available for screening potential breast cancer patients. During the management of patients, however, several invasive techniques such as axillary lymph node dissection, core biopsies and lumpectomies, are utilized to determine the stage or malignancy of the disease with significant cost and morbidity associated with them. Positron Emission Tomography (PET), using [F-18] fluorodeoxyglucose (FDG) tracer is a sensitive and non-invasive imaging modality that may be a cost-effective alternative to certain invasive procedures. In this project we have developed a low cost, high performance, dedicated PET camera (maxPET) for mammary and axillary region imaging. The system consists of two 15x15 cm2 planar scintillation detector arrays composed of modular detectors operating in coincidence. The modular detectors are comprised of a 9x9 array of 3x3x20 mm3 lutetiurn oxyorthosilicate (LSO) detector elements, read out by a 5x5 array of position- sensitive photomultiplier tubes. The average measured intrinsic spatial resolution of a detector module is 2.26 mm with a sensitivity of up to 40% for a central point source. The measured coincidence timing resolution for two modules is 2.4 ns. The average energy resolution measured across the entire two detector plates is 21.6%. The coincidence timing resolution for the entire system is 8.1 ns. A line bar phantom was imaged and images were reconstructed using the focal plane tomography algorithm. A 4 mm projection image resolution was measured based on profiles taken through the line bar phantom images. The goal of the maxPET system will be to aid in breast cancer patient management by assisting in imaging women with dense, fibro-glandular breasts, detecting axillary lymph node metastases without surgery, monitoring chemotherapy effectiveness and assisting in visualization of recurrence and tumoral boundaries.

Doshi, Niraj Kumar

320

Stratifying the risk of lymph node metastasis in undifferentiated-type early gastric cancer  

PubMed Central

AIM: To study how lymph node metastasis (LNM) risk is stratified in undifferentiated-type early gastric cancer (undiff-EGC) dependent on combinations of risk factors. METHODS: Five hundred and sixty-seven cases with undiff-EGC undergoing gastrectomy with lymphadenectomy were examined retrospectively. Using clinicopathological factors of patient age, location, size, an endoscopic macroscopic tumor form, ulceration, depth, histology, lymphatic involvement (LI) and venous involvement (VI), LNM risk was examined and stratified by conventional statistical analysis and data-mining analysis. RESULTS: LNM was positive in 44 of 567 cases (7.8%). Univariate analysis revealed > 2 cm, protrusion, submucosal (sm), mixed type, LI and VI as significant prognostic factors and > 2 cm and LI-positive were independent factors by multivariate analysis. In preoperatively evaluable factors excluding LVI, sm and > 2 cm were independent factors. According to the depth and size, cases were categorized into the low-risk group [m and ? 2 cm, 0% (LNM incidence)], the moderate-risk group (m and > 2 cm, 5.6%; and sm and ? 2 cm, 6.0%), and the high-risk group (sm and > 2 cm, 19.3%). On the other hand, LNM occurred in 1.4% in all LI-negative cases, greatly lower than 28.2% in all LI-positive cases, and LNM incidence was low in LI-negative cases even in the moderate- and high-risk groups. CONCLUSION: LNM-related factors in undiff-EGC were depth and size preoperatively while those were LI and size postoperatively. Among these factors, LI was the most significantly correlated factor. PMID:25759537

Asakawa, Yukiko; Ohtaka, Masahiko; Maekawa, Shinya; Fukasawa, Mitsuharu; Nakayama, Yasuhiro; Yamaguchi, Tatsuya; Inoue, Taisuke; Uetake, Tomoyoshi; Sakamoto, Minoru; Sato, Tadashi; Kawaguchi, Yoshihiko; Fujii, Hideki; Mochizuki, Kunio; Hada, Masao; Oyama, Toshio; Yasumura, Tomotaka; Omata, Kosaku; Nishiyama, Atsushi; Naito, Keiichi; Hata, Hideo; Haba, Yoshiaki; Miyata, Kazuyuki; Saitoh, Haruhisa; Yamadera, Yoichi; Miura, Kazuo; Kawaoi, Akira; Abe, Tohru; Tsunoda, Hajime; Honda, Yuji; Kurosaki, Masayuki; Enomoto, Nobuyuki

2015-01-01

321

Evaluation of Automatic Atlas-Based Lymph Node Segmentation for Head-and-Neck Cancer  

SciTech Connect

Purpose: To evaluate if automatic atlas-based lymph node segmentation (LNS) improves efficiency and decreases inter-observer variability while maintaining accuracy. Methods and Materials: Five physicians with head-and-neck IMRT experience used computed tomography (CT) data from 5 patients to create bilateral neck clinical target volumes covering specified nodal levels. A second contour set was automatically generated using a commercially available atlas. Physicians modified the automatic contours to make them acceptable for treatment planning. To assess contour variability, the Simultaneous Truth and Performance Level Estimation (STAPLE) algorithm was used to take collections of contours and calculate a probabilistic estimate of the 'true' segmentation. Differences between the manual, automatic, and automatic-modified (AM) contours were analyzed using multiple metrics. Results: Compared with the 'true' segmentation created from manual contours, the automatic contours had a high degree of accuracy, with sensitivity, Dice similarity coefficient, and mean/max surface disagreement values comparable to the average manual contour (86%, 76%, 3.3/17.4 mm automatic vs. 73%, 79%, 2.8/17 mm manual). The AM group was more consistent than the manual group for multiple metrics, most notably reducing the range of contour volume (106-430 mL manual vs. 176-347 mL AM) and percent false positivity (1-37% manual vs. 1-7% AM). Average contouring time savings with the automatic segmentation was 11.5 min per patient, a 35% reduction. Conclusions: Using the STAPLE algorithm to generate 'true' contours from multiple physician contours, we demonstrated that, in comparison with manual segmentation, atlas-based automatic LNS for head-and-neck cancer is accurate, efficient, and reduces interobserver variability.

Stapleford, Liza J. [Department of Radiation Oncology, Emory University School of Medicine and Winship Cancer Institute of Emory University Atlanta, GA (United States); Lawson, Joshua D. [Department of Radiation Oncology, Emory University School of Medicine and Winship Cancer Institute of Emory University Atlanta, GA (United States); Department of Radiation Oncology, University of California, San Diego, School of Medicine, La Jolla, CA (United States); Perkins, Charles; Edelman, Scott; Davis, Lawrence [Department of Radiation Oncology, Emory University School of Medicine and Winship Cancer Institute of Emory University Atlanta, GA (United States)

2010-07-01

322

A Methylene Blue–assisted Technique for Harvesting Lymph Nodes After Radical Surgery for Gastric Cancer  

PubMed Central

Harvesting lymph nodes (LNs) after gastrectomy is essential for accurate staging. This trial evaluated the efficiency and quality of a conventional method and a methylene blue–assisted method in a randomized manner. The key eligibility criteria were as follows: (i) histologically proven adenocarcinoma of the stomach; (ii) clinical stage I-III; (iii) R0 resection planned by gastrectomy with D1+ or D2 lymphadenectomy. The primary endpoint was the ratio of the pathologic number of harvested LNs per time (minutes) as an efficacy measure. The secondary endpoint was the number of harvested LNs, as a quality measure. Between August 2012 and December 2012, 60 patients were assigned to undergo treatment using the conventional method (n=29) and the methylene blue dye method (n=31). The baseline demographics were mostly well balanced between the 2 groups. The number of harvested LNs (mean±SD) was 33.6±11.9 in the conventional arm and 43.4±13.9 in the methylene blue arm (P=0.005). The ratio of the number of the harvested LNs per time was 1.12±0.46 LNs/min in the conventional arm and 1.49±0.59 LNs/min in the methylene blue arm (P=0.010). In the subgroup analyses, the quality and efficacy were both superior for the methylene blue dye method compared with the conventional method. The methylene blue technique is recommended for harvesting LNs during gastric cancer surgery on the basis of both the quality and efficacy. PMID:25356528

Aoyama, Toru; Fujikawa, Hirohito; Cho, Haruhiko; Ogata, Takashi; Shirai, Junya; Hayashi, Tsutomu; Rino, Yasushi; Masuda, Munetaka; Oba, Mari S.; Morita, Satoshi

2015-01-01

323

Imaging of Lymph Flow in Breast Cancer Patients after Microdose Administration of a Near-Infrared Fluorophore: Feasibility Study1  

PubMed Central

Purpose To prospectively demonstrate the feasibility of using indocyanine green, a near-infrared (NIR) fluorophore at the minimum dose needed for noninvasive optical imaging of lymph nodes (LNs) in breast cancer patients undergoing sentinel lymph node mapping (SLNM). Materials and Methods Informed consent was obtained from 24 women (age range, 30–85 years) who received intradermal subcutaneous injections of 0.31–100 ?g indocyanine green in the breast in this IRB-approved, HIPAA-compliant, dose escalation study to find the minimum microdose for imaging. The breast, axilla, and sternum were illuminated with NIR light and the fluorescence generated in the tissue was collected with an NIR-sensitive intensified charged-coupled device. Lymphoscintigraphy was also performed. Resected LNs were evaluated for the presence of radioactivity, blue dye accumulation, and fluorescence. The associations between the resected LNs that were fluorescent and (a) the time elapsed between NIR fluorophore administration and resection and (b) the dosage of NIR fluorophores were tested with the Spearman rank and Pearson product moment correlation tests, respectively. Results Lymph imaging consistently failed with indocyanine green microdosages between 0.31 and 0.77 ?g. When indocyanine green dosages were 10 ?g or higher, lymph drainage pathways from the injection site to LNs were imaged in eight of nine women; lymph propulsion was observed in seven of those eight. When propulsion in the breast and axilla regions was present, the mean apparent velocities ranged from 0.08 to 0.32 cm/sec, the time elapsed between “packets” of propelled fluid varied from 14 to 92 seconds. In patients who received 10 ?g of indocyanine green or more, a weak negative correlation between the fluorescence status of resected LNs and the time between NIR fluorophore administration and LN resection was found. No statistical association was found between the fluorescence status of resected LNs and the dose of NIR fluorophore. Conclusion NIR fluorescence imaging of lymph function and LNs is feasible in humans at microdoses that would be needed for future molecular imaging of cancer-positive LNs. PMID:18223125

Sevick-Muraca, Eva M.; Sharma, Ruchi; Rasmussen, John C.; Marshall, Milton V.; Wendt, Juliet A.; Pham, Hoang Q.; Bonefas, Elizabeth; Houston, Jessica P.; Sampath, Lakshmi; Adams, Kristen E.; Blanchard, Darlene Kay; Fisher, Ronald E.; Chiang, Stephen B.; Elledge, Richard; Mawad, Michel E.

2011-01-01

324

Pathogenesis and treatment of neoplastic diseases of the papilla of Vater: Kausch-Whipple procedure with lymph node dissection in cancer of the papilla of Vater.  

PubMed

Cancer of the papilla or the ampulla of Vater appears, from a clinical point of view, to be an intraduodenal or ampullary cancer. An adenoma-dysplasia-carcinoma sequence has been established. In 20%-40% of the patients with an adenoma of the papilla, a cancerous lesion in the adenoma is additionally observed. Oncological resection using a Kausch-Whipple technique or a pylorus-preserving partial pancreatico-duodenectomy (PPPD) offers a 5-year survival probability of between 45% and 65%. The hospital mortality after oncological resection at experienced centers is below 5%. The most frequent treatment-related complication is pancreatic fistula, which occurs in around 20% of the patients. In about 10% of the patients with a pT1 cancer and in 25% to 67% with pT2 and pT3 cancer, lymph node involvement has been observed. Lymph nodes in front of and behind the head of the pancreas are the primary targets for cancer cell disseminations. In more than one-third of the patients, lymph nodes in the inter-aortocaval space and the lymph nodes around the superior mesenteric artery and the nodes in the pancreatic segment of the hepatoduodenal ligament are involved. Therefore, tissue dissection, including, selectively, the N2 lymph nodes, is an essential component of radical surgery for cancer of the papilla. A standard Kausch-Whipple resection or PPPD without a selective extended lymph node dissection, including the interaortocaval and superior mesenteric artery nodes, results in about 30% of the patients having an R2-resection, i.e., with cancer left behind. The long-term survival is determined by the tumor biological factors: (1) absence of lymph node involvement and (2) absence of infiltration into the pancreas. The surgeon's contribution to the cure of cancer of the papilla is to perform an R0-resection with low hospital mortality and low postoperative morbidity. Patients without lymph node involvement, and with absence of infiltration into the pancreas, no lymph vessel invasion, and tumor-negative margins have major benefits from oncological resection in regard to curability of the cancer. PMID:15368106

Beger, Hans G; Thorab, F Chikh; Liu, Z; Harada, N; Rau, B M

2004-01-01

325

Intraoperative examination of sentinel lymph nodes by ultrarapid immunohistochemistry.  

PubMed

The recently developed method of ultrarapid immunohistochemistry (IHC) was applied to the intraoperative examination of sentinel lymph nodes (SLNs) in breast cancer patients. In a prospective study of 50 patients with invasive breast carcinomas, a total of 60 SLNs were studied. Among them, 33 SLNs from 30 patients were studied intraoperatively using a direct immunoperoxidase method with anticytokeratin antibody clone MNF116. This technique has a turnaround time of less than 20 minutes. Ultrarapid IHC revealed 15 positive SLNs compared to 14 positive SLNs using hematoxylin and eosin (H and E) frozen sections. The one SLN missed in H and E frozen sections presented with cytokeratin-positive isolated tumor cells in the lymph node sinus. After paraffin embedding, H and E-stained serial step sections of the SLN specimens detected another two patients with isolated tumor cells. We also examined the remaining axillary lymph nodes (ALNs) by H and E-stained serial step paraffin sections. From 17 of the 30 patients with positive SLNs, 6 patients also had metastatic involvement of the ALNs of level I or II. Thus ultrarapid IHC was a very sensitive and rapid technique for the intraoperative detection of metastatic involvement of SLNs in breast cancer patients. This technique may be a useful complementary tool for the intraoperative study of SLNs, particularly in tumors that are a diagnostic challenge, such as lobular carcinoma. PMID:12846860

Nährig, Jörg M; Richter, Thomas; Kuhn, Walther; Avril, Norbert; Flatau, Birgit; Kowolik, Jurgen; Höfler, Heinz; Werner, Martin

2003-01-01

326

High Occurrence of Aberrant Lymph Node Spread on Magnetic Resonance Lymphography in Prostate Cancer Patients With a Biochemical Recurrence After Radical Prostatectomy  

SciTech Connect

Purpose: To investigate the pattern of lymph node spread in prostate cancer patients with a biochemical recurrence after radical prostatectomy, eligible for salvage radiotherapy; and to determine whether the clinical target volume (CTV) for elective pelvic irradiation in the primary setting can be applied in the salvage setting for patients with (a high risk of) lymph node metastases. Methods and Materials: The charts of 47 prostate cancer patients with PSA recurrence after prostatectomy who had positive lymph nodes on magnetic resonance lymphography (MRL) were reviewed. Positive lymph nodes were assigned to a lymph node region according to the guidelines of the Radiation Therapy Oncology Group (RTOG) for delineation of the CTV for pelvic irradiation (RTOG-CTV). We defined four lymph node regions for positive nodes outside this RTOG-CTV: the para-aortal, proximal common iliac, pararectal, and paravesical regions. They were referred to as aberrant lymph node regions. For each patient, clinical and pathologic features were recorded, and their association with aberrant lymph drainage was investigated. The distribution of positive lymph nodes was analyzed separately for patients with a prostate-specific antigen (PSA) <1.0 ng/mL. Results: MRL detected positive aberrant lymph nodes in 37 patients (79%). In 20 patients (43%) a positive lymph node was found in the pararectal region. Higher PSA at the time of MRL was associated with the presence of positive lymph nodes in the para-aortic region (2.49 vs. 0.82 ng/mL; p = 0.007) and in the proximal common iliac region (1.95 vs. 0.59 ng/mL; p = 0.009). There were 18 patients with a PSA <1.0 ng/mL. Ten of these patients (61%) had at least one aberrant positive lymph node. Conclusion: Seventy-nine percent of the PSA-recurrent patients had at least one aberrant positive lymph node. Application of the standard RTOG-CTV for pelvic irradiation in the salvage setting therefore seems to be inappropriate.

Meijer, Hanneke J.M., E-mail: H.Meijer@rther.umcn.nl [Department of Radiation Oncology, Radboud University Nijmegen Medical Center, Nijmegen (Netherlands); Lin, Emile N. van [Department of Radiation Oncology, Radboud University Nijmegen Medical Center, Nijmegen (Netherlands); Debats, Oscar A. [Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen (Netherlands); Witjes, J. Alfred [Department of Urology, Radboud University Nijmegen Medical Center, Nijmegen (Netherlands); Span, Paul N.; Kaanders, Johannes H.A.M. [Department of Radiation Oncology, Radboud University Nijmegen Medical Center, Nijmegen (Netherlands); Barentsz, Jelle O. [Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen (Netherlands)

2012-03-15

327

Lymph node spread of gallbladder cancer from the perspective of embryologically-based anatomy and significance of the lymphatic basin along the embryonic right hepatic artery  

PubMed Central

Lymph node metastasis from gallbladder cancer is often found in the pericholedochal area; however, these regional lymph nodes are not typically accompanied by arteries. We hypothesized that the artery accompanying pericholedochal lymph nodes was either the regressed embryonic right hepatic artery (eRHA) or an aberrant right hepatic artery (aRHA) remaining without regression. This study aimed to determine the artery supplying pericholedochal lymph nodes. We obtained serial tissue sections of resected specimens from 10 patients who underwent pancreaticoduodenectomy with combined resection of the superior mesenteric artery and vein and investigated the association between the distribution of enlarged lymph nodes and the course of blood vessels in each section. In 2 cases with aRHA, enlarged lymph nodes were distributed in the posterosuperior area, pancreaticoduodenal region and retroportal area along this artery. By contrast, no blood vessels accompanied enlarged lymph nodes in 8 patients exhibiting a normal hepatic artery branching pattern, although these nodes exhibited a distribution pattern similar to that of patients with the aRHA. Thus, the artery supplying pericholedochal lymph nodes appears to be either the regressed eRHA or an aRHA persisting without regression. PMID:25279182

NAKAGAWARA, HISATOSHI; TAJIMA, HIDEHIRO; MIYASHITA, TOMOHARU; KITAGAWA, HIROHISA; MAKINO, ISAMU; SAKAI, SEISHO; HAYASHI, HIRONORI; NAKANUMA, SHINICHI; OYAMA, KATSUNOBU; TAKAMURA, HIROYUKI; FUSHIDA, SACHIO; FUJIMURA, TAKASHI; OHTA, TETSUO

2014-01-01

328

Placa axilar compresiva fija para prevenir el seroma persistente postlinfadenectomía. Comparación con controles históricos* Compressive axillary plates for persistent seroma after axillary lymphadenectomy  

Microsoft Academic Search

SUMMARY Background: Persistent axillary post-lymphadenectomy seroma is a frequent complication of breast cancer treatment. Aim: To evaluate the benefit of fixed compressive axillary plates for this complication. Material and methods: Retrospective comparison of 30 patients in whom this technique was used with a randomized historic group of 30 women, handled with a standard technique that included suction drains and external

ARTÍCULOS DE INVESTIGACIÓN

329

Whole-Pelvis or Bladder-Only Chemoradiation for Lymph Node-Negative Invasive Bladder Cancer: Single-Institution Experience  

SciTech Connect

Purpose: Whole-pelvis (WP) concurrent chemoradiation (CCRT) is the standard bladder preserving option for patients with invasive bladder cancer. The standard practice is to treat elective pelvic lymph nodes, so our aim was to evaluate whether bladder-only (BO) CCRT leads to results similar to those obtained by standard WP-CCRT. Methods and Materials: Patient eligibility included histopathologically proven muscle-invasive bladder cancer, lymph nodes negative (T2-T4, N-) by radiology, and maximal transurethral resection of bladder tumor with normal hematologic, renal, and liver functions. Between March 2005 and May 2006, 230 patients were accrued. Patients were randomly assigned to WP-CCRT (120 patients) and BO-CCRT (110 patients). Data regarding the toxicity profile, compliance, initial complete response rates at 3 months, and occurrence of locoregional or distant failure were recorded. Results: With a median follow-up time of 5 years (range, 3-6), WP-CCRT was associated with a 5-year disease-free survival of 47.1% compared with 46.9% in patients treated with BO-CCRT (p = 0.5). The bladder preservation rates were 58.9% and 57.1% in WP-CCRT and BO-CCRT, respectively (p = 0.8), and the 5-year overall survival rates were 52.9% for WP-CCRT and 51% for BO-CCRT (p = 0.8). Conclusion: BO-CCRT showed similar rates of bladder preservation, disease-free survival, and overall survival rates as those of WP-CCRT. Smaller field sizes including bladder with 2-cm margins can be used as bladder preservation protocol for patients with muscle-invasive lymph node-negative bladder cancer to minimize the side effects of CCRT.

Tunio, Mutahir A., E-mail: drmutahirtonio@hotmail.com [Department of Radiation Oncology, Sindh Institute of Urology and Transplantation, Karachi (Pakistan); Hashmi, Altaf [Department of Urology, Sindh Institute of Urology and Transplantation, Karachi (Pakistan); Qayyum, Abdul [Department of Medical Oncology, Sindh Institute of Urology and Transplantation, Karachi (Pakistan); Mohsin, Rehan [Department of Urology, Sindh Institute of Urology and Transplantation, Karachi (Pakistan); Zaeem, Ahmed [Department of Medical Physics, Sindh Institute of Urology and Transplantation, Karachi (Pakistan)

2012-03-01

330

Transcriptional profile of fibroblasts obtained from the primary site, lymph node and bone marrow of breast cancer patients  

PubMed Central

Cancer-associated fibroblasts (CAF) influence tumor development at primary as well as in metastatic sites, but there have been no direct comparisons of the transcriptional profiles of stromal cells from different tumor sites. In this study, we used customized cDNA microarrays to compare the gene expression profile of stromal cells from primary tumor (CAF, n = 4), lymph node metastasis (N+, n = 3) and bone marrow (BM, n = 4) obtained from breast cancer patients. Biological validation was done in another 16 samples by RT-qPCR. Differences between CAF vs N+, CAF vs BM and N+ vs BM were represented by 20, 235 and 245 genes, respectively (SAM test, FDR < 0.01). Functional analysis revealed that genes related to development and morphogenesis were overrepresented. In a biological validation set, NOTCH2 was confirmed to be more expressed in N+ (vs CAF) and ADCY2, HECTD1, HNMT, LOX, MACF1, SLC1A3 and USP16 more expressed in BM (vs CAF). Only small differences were observed in the transcriptional profiles of fibroblasts from the primary tumor and lymph node of breast cancer patients, whereas greater differences were observed between bone marrow stromal cells and the other two sites. These differences may reflect the activities of distinct differentiation programs. PMID:25249769

Del Valle, Paulo Roberto; Milani, Cintia; Brentani, Maria Mitzi; Katayama, Maria Lucia Hirata; de Lyra, Eduardo Carneiro; Carraro, Dirce Maria; Brentani, Helena; Puga, Renato; Lima, Leandro A.; Rozenchan, Patricia Bortman; Nunes, Bárbara dos Santos; Góes, João Carlos Guedes Sampaio; Azevedo Koike Folgueira, Maria Aparecida

2014-01-01

331

Impact of preoperative radiation for rectal cancer on subsequent lymph node evaluation: A population-based analysis  

SciTech Connect

Purpose: To determine the impact of preoperative radiotherapy (RT) on the accuracy of lymph node staging (LNS). Preoperative RT is a well-established component of rectal cancer treatment but its impact on LNS is unknown. Methods and materials: The Surveillance, Epidemiology and End Results (SEER) registry, representing 14% of the U.S. population, was used to assess the impact of preoperative RT on LNS. Our study population consisted of adults with rectal cancer between 1998 and 2000 who underwent radical resection. Results: In our 3-year study period, 5647 patients met the selection criteria and 1034 (19.5%) underwent preoperative RT. The preoperative RT group was younger (average age, 61 years) than those who did not undergo preoperative RT (average age, 69 years) and more likely to be male (22% of men vs. 16% of women). On average, fewer nodes were examined in patients who underwent preoperative RT (7 nodes) vs. those who did not (10 nodes); this difference was statistically significant, controlling for potential confounders (p {<=} 0.0001). In 16% of the preoperative RT patients (vs. 7.5% without), no nodes were identified (p {<=} 0.0001). If one used a minimum of 12 nodes as the standard, only 20% of patients who underwent preoperative RT underwent adequate LNS. Conclusion: Lymph node staging in patients who undergo preoperative RT must be interpreted with caution. Studies are needed to evaluate the clinical relevance of node number and pathologic staging after preoperative RT for rectal cancer.

Baxter, Nancy N. [Department of Surgery, University of Minnesota, Minneapolis, MN (United States)]. E-mail: baxte025@umn.edu; Morris, Arden M. [Department of Surgery, University of Michigan, Ann Arbor, MI (United States); Rothenberger, David A. [Department of Surgery, University of Minnesota, Minneapolis, MN (United States); Tepper, Joel E. [Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC (United States)

2005-02-01

332

Solitary peritoneal lymph node metastasis of head and neck cancer diagnosed with FDG-PET/CT imaging.  

PubMed

Distant metastasis of head and neck squamous cell carcinoma (SCC) to the infraclavicular lymph nodes-with the exception of the upper mediastinal lymph nodes-is rare. We report the case of a 44-year-old man who was treated with surgery and radiotherapy for SCC of the floor of the mouth. During regular follow-up 6 months after the cessation of radiotherapy, F18-fluorodeoxyglucose positron-emission tomography/computed tomography (FDG-PET/CT) detected a hypermetabolic lesion in the left lobe of the liver that was diagnosed as a metastasis of the head and neck SCC; no locoregional recurrence was found. The metastasis was surgically removed and more radiotherapy was administered, but the SCC recurred at the same site and the patient died of disseminated disease 12 months after the appearance of the first metastasis. To the best of our knowledge, this is the first reported case of a solitary peritoneal lymph node metastasis from an SCC of the floor of the mouth. We believe that regular FDG-PET/CT follow-up scans are useful for the detection of unusual distant metastases of head and neck cancers. PMID:25531851

Kim, Yong-Wan; Lee, Byung-Joo; Lee, Jin-Choon; Jeon, Tae-Yong; Kim, Hak-Jin

2014-12-01

333

Papillary Thyroid Cancer: Dual-Energy Spectral CT Quantitative Parameters for Preoperative Diagnosis of Metastasis to the Cervical Lymph Nodes.  

PubMed

Purpose To evaluate the use of dual-energy spectral computed tomographic (CT) quantitative parameters compared with the use of conventional CT imaging features for preoperative diagnosis of metastasis to the cervical lymph nodes in patients with papillary thyroid cancer. Materials and Methods This study was approved by the ethics committee and all patients provided written informed consent. Analyses of quantitative gemstone spectral imaging data and qualitative conventional CT imaging features were independently performed by different groups of radiologists. Excised lymph nodes were located and labeled during surgery according to location on preoperative CT images and were evaluated histopathologically. Single and combined parameters were fitted to simple and multiple logistic regression models, respectively, by means of the generalized estimating equations method. Sensitivity and specificity analyses were performed by using receiver operating characteristic curves and were compared with data from the qualitative analysis. Results The slope of the spectral Hounsfield unit curve ( ?HU slope of the spectral Hounsfield unit curve ), normalized iodine concentration, and normalized effective atomic number measured during both arterial and venous phases were significantly higher in metastatic than in benign lymph nodes. The best single parameter for detection of metastatic lymph nodes was venous phase ?HU, with sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 62.0%, 91.1%, 80.6%, 79.7%, and 81.0%, respectively. The best combination of parameters was venous phase ?HU slope of the spectral Hounsfield unit curve and arterial phase normalized iodine concentration, with values of 73.0%, 88.4%, 82.9%, 78.0%, and 85.3%, respectively. Compared with qualitative analysis, the venous phase ?HU slope of the spectral Hounsfield unit curve showed higher specificity (91.1% vs 83.0%, P < .001) and similar sensitivity (62.0% vs 61.9%, P > .99), and the combined venous phase ?HU slope of the spectral Hounsfield unit curve and arterial phase normalized iodine concentration showed higher sensitivity (73.0% vs 61.9%, P < .001) and specificity (88.4% vs 83.0%, P < .001). Conclusion Quantitative assessment with gemstone spectral imaging quantitative parameters showed higher accuracy than qualitative assessment of conventional CT imaging features for preoperative diagnosis of metastatic cervical lymph nodes in patients with papillary thyroid cancer. (©) RSNA, 2014 Online supplemental material is available for this article. PMID:25521777

Liu, Xuewen; Ouyang, Dian; Li, Hui; Zhang, Rong; Lv, Yanchun; Yang, Ankui; Xie, Chuanmiao

2015-04-01

334

Preoperative mediastinal lymph node staging for non-small cell lung cancer: 2014 update of the 2007 ESTS guidelines.  

PubMed

Accurate preoperative staging and restaging of mediastinal lymph nodes in patients with potentially resectable non-small cell lung cancer (NSCLC) is of paramount importance. In 2007, the European Society of Thoracic Surgeons (ESTS) published an algorithm on preoperative mediastinal staging integrating imaging, endoscopic and surgical techniques. Over the last years more evidence of the different mediastinal staging technique has become available. Therefore, a revision of the ESTS guidelines was needed. In case of CT-enlarged or PET-positive mediastinal lymph nodes, tissue confirmation is indicated. Endosonography (EBUS/EUS) with fine needle aspiration is the first choice (when available) since it is minimally invasive and has a high sensitivity to rule in mediastinal nodal disease. If negative, surgical staging with nodal dissection or biopsy is indicated. Video-assisted mediastinoscopy is preferred over mediastinoscopy. The combined use of endoscopic staging and surgical staging results in the highest accuracy. When there are no enlarged lymph nodes on CT and when there is no uptake in lymph nodes on PET or PET-CT, direct surgical resection with systematic nodal dissection is indicated for tumors ?3 cm located in the outer third of the lung. In central tumors or N1 nodes, preoperative mediastinal staging is indicated. The choice between endoscopic staging with EBUS/EUS and fine needle aspiration or video-assisted mediastinoscopy depends on local expertise to adhere to minimal requirements for staging. For tumors larger than 3 cm, preoperative mediastinal staging is advised, mainly in adenocarcinoma with high SUV uptake. PMID:25806304

De Leyn, Paul; Dooms, Christophe; Kuzdzal, Jaroslaw; Lardinois, Didier; Passlick, Bernward; Rami-Porta, Ramon; Turna, Akif; Van Schil, Paul; Venuta, Frederico; Waller, David; Weder, Walter; Zielinski, Marcin

2014-08-01

335

SERPINE2 is a possible candidate promotor for lymph node metastasis in testicular cancer  

SciTech Connect

Testicular germ cell tumors (TGCTs) commonly metastasize to the lymph node or lung. However, it remains unclear which genes are associated with TGCT metastasis. The aim of this study was to identify gene(s) that promoted human TGCT metastasis. We intraperitoneally administered conditioned medium (CM) from JKT-1, a cell-line from a human testicular seminoma, or JKT-HM, a JKT-1 cell sub-line with high metastatic potential, into mice with JKT-1 xenografts. Administration of CM from JKT-HM significantly promoted lymph node metastasis. A cDNA microarray analysis showed that JKT-HM cells highly expressed the Serpine peptidase inhibitor, clade E, member 2 (SERPINE2), which encodes a secreted protein. Administration of CM from SERPINE2-silenced JKT-HM cells inhibited lymph node metastasis in the xenograft model, compared with administration of CM from JKT-HM cells. There was no significant difference in xenograft volume. Moreover, administration of CM from SERPINE2-over-expressing JKT-1 was likely to promote lymph node metastasis in the xenograft model. There was no difference in the in vitro proliferation or migration of JKT-1 cells cultured with CM from JKT-HM cells, compared to that with CM from JKT-1. There was no promotion of proliferation or lymphangiogenesis in the xenografts, as measured by Ki-67 and LYVE-1 immunohistochemistry, respectively. Although we could not clarify how SERPINE2 promoted lymph node metastasis, it may be a promoter in the development of lymph node metastasis in the human seminoma cells in a mouse xenograft model.

Nagahara, Akira; Nakayama, Masashi; Oka, Daizo; Tsuchiya, Mutsumi; Kawashima, Atsunari; Mukai, Masatoshi; Nakai, Yasutomo; Takayama, Hitoshi [Department of Urology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City, Osaka 565-0871 (Japan)] [Department of Urology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City, Osaka 565-0871 (Japan); Nishimura, Kazuo [Department of Urology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamachi, Higashinari-ku, Osaka, 537-8511 (Japan)] [Department of Urology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamachi, Higashinari-ku, Osaka, 537-8511 (Japan); Jo, Yoshimasa; Nagai, Atsushi [Department of Urology, Kawasaki Medical University, 577 Matsushima, Kurashiki-City, Okayama 701-0192 (Japan)] [Department of Urology, Kawasaki Medical University, 577 Matsushima, Kurashiki-City, Okayama 701-0192 (Japan); Okuyama, Akihiko [Department of Urology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City, Osaka 565-0871 (Japan)] [Department of Urology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City, Osaka 565-0871 (Japan); Nonomura, Norio, E-mail: nono@uro.med.osaka-u.ac.jp [Department of Urology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City, Osaka 565-0871 (Japan)] [Department of Urology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City, Osaka 565-0871 (Japan)

2010-01-22

336

The Effect of Extent of Surgery and Number of Lymph Node Metastases on Overall Survival in Patients with Medullary Thyroid Cancer  

PubMed Central

Context: Total thyroidectomy with central lymph node dissection is recommended in patients with medullary thyroid cancer (MTC). However, the relationship between disease severity and extent of resection on overall survival remains unknown. Objective: The aim of the study was to identify the effect of surgery on overall survival in MTC patients. Methods: Using data from 2968 patients with MTC diagnosed between 1998 and 2005 from the National Cancer Database, we determined the relationship between the number of cervical lymph node metastases, tumor size, distant metastases, and extent of surgery on overall survival in patients with MTC. Results: Older patient age (5.69 [95% CI, 3.34–9.72]), larger tumor size (2.89 [95% CI, 2.14–3.90]), presence of distant metastases (5.68 [95% CI, 4.61–6.99]), and number of positive regional lymph nodes (for ?16 lymph nodes, 3.40 [95% CI, 2.41–4.79]) were independently associated with decreased survival. Overall survival rate for patients with cervical lymph nodes resected and negative, cervical lymph nodes not resected, and 1–5, 6–10, 11–16, and ?16 cervical lymph node metastases was 90, 76, 74, 61, 69, and 55%, respectively. There was no difference in survival based on surgical intervention in patients with tumor size ? 2 cm without distant metastases. In patients with tumor size > 2.0 cm and no distant metastases, all surgical treatments resulted in a significant improvement in survival compared to no surgery (P < .001). In patients with distant metastases, only total thyroidectomy with regional lymph node resection resulted in a significant improvement in survival (P < .001). Conclusions: The number of lymph node metastases should be incorporated into MTC staging. The extent of surgery in patients with MTC should be tailored to tumor size and distant metastases. PMID:24276457

Hughes, David T.; Yin, Huiying; Banerjee, Mousumi; Haymart, Megan R.

2014-01-01

337

Nodal Ratios in Node-Positive Breast Cancer-Long-Term Study to Clarify Discrepancy of Role of Supraclavicular and Axillary Regional Radiotherapy  

SciTech Connect

Purpose: To study the absolute number of involved nodes/the number of nodes examined or the nodal ratio (NR) in breast cancer. The primary study endpoint was to evaluate the role of supraclavicular and axillary radiotherapy (SART) according to the NR. Methods and Materials: From the Saskatchewan provincial registry of 1981-1995, the charts of 5,996 consecutive patients were retrieved to collect detailed prognostic factors. Among these patients, 1,985 were node positive. Because the NRs are more reliable the greater the number of nodes examined, we analyzed 1,255 patients with {>=}10 nodes examined. Of these 1,255 patients, 667, 389, and 199 were categorized into three NR groups-low ({<=}25%), medium (>25% to {<=}75%), and high (>75%) nodal involvement, respectively. Results: The NR correlated significantly with the primary tumor size ({<=}2 cm, >2 to {<=}5 cm, and >5 cm; p = 2.2 x 10{sup -16}), clinical stage group (p = 5.5 x 10{sup -16}), pathologic stage group (p < 2.2 x 10{sup -16}), and the risk of any first recurrence (p = 5.0 x 10{sup -15}) using chi-square tests. For a low NR, the 10-year overall survival rate with and without SART was 57% and 58% (p 0.18), and the cause-specific survival rate was 68% and 71% (p = 0.32), respectively. For a medium NR, the 10-year overall survival rate with and without SART was 48% and 34% (p = 0.007), and the cause-specific survival rate was 57% and 43% (p = 0.002), respectively. For a high NR, the 10-year overall survival rate with and without SART was 19% and 10% (p = 0.005), and the cause-specific survival rate was 26% and 14% (p = 0.005), respectively. Conclusion: This is the first study demonstrating that for patients with {>=}10 nodes examined, SART significantly improved the survival for the median and high NR groups but not for the low NR group.

Tai, Patricia [Department of Oncology, Allan Blair Cancer Center, University of Saskatchewan, Regina, SK (Canada)]. E-mail: patricia.tai@scf.sk.ca; Joseph, Kurian [Department of Oncology, Cross Cancer Center, University of Alberta, Edmonton, AB (Canada); Sadikov, Evgeny [Department of Oncology, Allan Blair Cancer Center, University of Saskatchewan, Regina, SK (Canada); Mahmood, Shazia [Department of Oncology, Allan Blair Cancer Center, University of Saskatchewan, Regina, SK (Canada); Lien, Francis [Department of Oncology, Allan Blair Cancer Center, University of Saskatchewan, Regina, SK (Canada); Yu, Edward [Radiation Oncology Program, London Regional Cancer Center, University of Western Ontario, London, ON (Canada)

2007-07-01

338

Automatic detection of axillary lymphadenopathy on CT scans of untreated chronic lymphocytic leukemia patients  

NASA Astrophysics Data System (ADS)

Patients with chronic lymphocytic leukemia (CLL) have an increased frequency of axillary lymphadenopathy. Pretreatment CT scans can be used to upstage patients at the time of presentation and post-treatment CT scans can reduce the number of complete responses. In the current clinical workflow, the detection and diagnosis of lymph nodes is usually performed manually by examining all slices of CT images, which can be time consuming and highly dependent on the observer's experience. A system for automatic lymph node detection and measurement is desired. We propose a computer aided detection (CAD) system for axillary lymph nodes on CT scans in CLL patients. The lung is first automatically segmented and the patient's body in lung region is extracted to set the search region for lymph nodes. Multi-scale Hessian based blob detection is then applied to detect potential lymph nodes within the search region. Next, the detected potential candidates are segmented by fast level set method. Finally, features are calculated from the segmented candidates and support vector machine (SVM) classification is utilized for false positive reduction. Two blobness features, Frangi's and Li's, are tested and their free-response receiver operating characteristic (FROC) curves are generated to assess system performance. We applied our detection system to 12 patients with 168 axillary lymph nodes measuring greater than 10 mm. All lymph nodes are manually labeled as ground truth. The system achieved sensitivities of 81% and 85% at 2 false positives per patient for Frangi's and Li's blobness, respectively.

Liu, Jiamin; Hua, Jeremy; Chellappa, Vivek; Petrick, Nicholas; Sahiner, Berkman; Farooqui, Mohammed; Marti, Gerald; Wiestner, Adrian; Summers, Ronald M.

2012-03-01

339

Comparative Assessment of Lymph Node Micrometastasis in Cervical, Endometrial and Vulvar Cancer: Insights on the Real Time qRT-PCR Approach versus Immunohistochemistry, Employing Dual Molecular Markers  

PubMed Central

To address the value of qRT-PCR and IHC in accurately detecting lymph node micrometastasis in gynecological cancer, we performed a systematic approach, using a set of dual molecular tumor-specific markers such as cytokeratin 19 (CK19) and carbonic anhydrase 9 (CA9), in a series of 46 patients (19 with cervical cancer, 18 with endometrial cancer, and 9 with vulvar cancer). A total of 1281 lymph nodes were analyzed and 28 were found positive by histopathology. Following this documentation, 82 lymph nodes, 11 positive and 71 negative, were randomly selected and further analyzed both by IHC and qRT-PCR for CK19 and CA9 expression. All 11 (100%) expressed CK19 by IHC, while only 6 (54.5%) expressed CA9. On the contrary, all the histologically negative for micrometastases lymph nodes were also negative by IHC analysis for both markers. The comparative diagnostic efficacy of the two markers using qRT-PCR, however, disclosed that the analysis of the same aliquots of the 82 lymph nodes led to 100% specificity for the CK19 biomarker, while, in contrast, CA9 failed to recapitulate a similar pattern. These data suggest that qRT-PCR exhibits a better diagnostic accuracy compared to IHC, while CK19 displays a consistent pattern of detection compared to CA9. PMID:24527437

Pappa, Kalliopi I.; Rodolakis, Alexandros; Christodoulou, Ioanna; Gazouli, Maria; Markaki, Sofia; Antsaklis, Aris; Anagnou, Nicholas P.

2014-01-01

340

Effects of HLEC on the secreted proteins of epithelial ovarian cancer cells prone to metastasize to lymph nodes  

PubMed Central

Objective To study explores the effect of HLEC on the secreted proteins of epithelial ovarian cancer (EOC) cells (SKOV3-PM4) with directional highly lymphatic metastasis. Methods Supernatants of four groups of cultured cells, namely, SKOV3 (A), SKOV3+HLEC (B), SKOV3-PM4 (C), SKOV3-PM4+HLEC (D), were collected, and their proteins were detected by antibody arrays and iTRAQ-2D-LC-MALDI-TOF/TOF/MS. Significantly differential proteins were further analyzed via bioinformatics and validated in human serums and cell media via ELISA. Results Results of antibody arrays and mass spectrometry demonstrated that GRN and VEGFA were upregulated in group C (compared with group A), whereas IGFBP7 and SPARC were downregulated in group D (compared with group C). Comprehensive bioinformatics analysis results showed that IGFBP7 and VEGFA were closely linked to each other. Further validation with serums showed statistical significance in VEGFA and IGFBP7 levels among groups of patients with ovarian cancers, benign tumors, and control groups. Two proteins were upegulated in the first group. VEGFA in the control group was downregulated. For IGFBP, upregulation in the control group and down-regulation in the first group were also observed. Conclusion The HLEC microenvironment is closely associated with directional metastasis to lymph nodes and with differential proteins including cell stromal proteins and adhesion factors. The upregulation of VEGFA and GRN and the downregulation of SPARC and IGFBP7 are closely associated with directional metastasis to lymph nodes in EOC cells. PMID:24349832

Zhang, Xin-Ying; Yin, Fu-Qiang; Liu, Li; Gao, Ting; Ruan, He-Yun; Guan, Xiao; Lu, Ying-Xin; Li, Dan-Rong

2013-01-01

341

Angiopoietin-like protein ANGPTL2 gene expression is correlated with lymph node metastasis in lung cancer.  

PubMed

Inflammation plays key roles at various stages of tumor development, including invasion and metastasis. In mice, the angiopoietin-like protein (ANGPTL2) gene has been implicated in inflammatory carcinogenesis. ANGPTL2 mRNA expression was investigated by real-time polymerase chain reaction (RT-PCR) assay using LightCycler in surgically treated non-small cell lung cancer (NSCLC) cases. In total, 110 surgically resected NSCLC cases were used for mRNA level analyses. The ANGPTL2/?-actin mRNA levels were not significantly different between lung cancer (1598.481±6465.781) and adjacent normal lung tissues (2116.639±8337.331, P=0.5453). The tumor/normal (T/N) ratio of ANGPTL2/?-actin mRNA levels was not different between gender, age, smoking status and pathological stages. The T/N ratio of ANGPTL2/?-actin mRNA levels was significantly higher in lymph node metastasis-positive cases (2.173±3.151) compared with lymph node metastasis-negative cases (1.212±1.778, P=0.0464). However, ANGPTL2 mRNA status was not correlated with tumor invasion status. Thus, ANGPTL2 may drive metastasis and provide a candidate for blockade of its function as a strategy to antagonize the metastatic process in NSCLC. PMID:23205131

Sasaki, Hidefumi; Suzuki, Ayumi; Shitara, Masayuki; Hikosaka, Yu; Okuda, Katsuhiro; Moriyama, Satoru; Yano, Motoki; Fujii, Yoshitaka

2012-12-01

342

Angiopoietin-like protein ANGPTL2 gene expression is correlated with lymph node metastasis in lung cancer  

PubMed Central

Inflammation plays key roles at various stages of tumor development, including invasion and metastasis. In mice, the angiopoietin-like protein (ANGPTL2) gene has been implicated in inflammatory carcinogenesis. ANGPTL2 mRNA expression was investigated by real-time polymerase chain reaction (RT-PCR) assay using LightCycler in surgically treated non-small cell lung cancer (NSCLC) cases. In total, 110 surgically resected NSCLC cases were used for mRNA level analyses. The ANGPTL2/?-actin mRNA levels were not significantly different between lung cancer (1598.481±6465.781) and adjacent normal lung tissues (2116.639±8337.331, P=0.5453). The tumor/normal (T/N) ratio of ANGPTL2/?-actin mRNA levels was not different between gender, age, smoking status and pathological stages. The T/N ratio of ANGPTL2/?-actin mRNA levels was significantly higher in lymph node metastasis-positive cases (2.173±3.151) compared with lymph node metastasis-negative cases (1.212±1.778, P=0.0464). However, ANGPTL2 mRNA status was not correlated with tumor invasion status. Thus, ANGPTL2 may drive metastasis and provide a candidate for blockade of its function as a strategy to antagonize the metastatic process in NSCLC. PMID:23205131

SASAKI, HIDEFUMI; SUZUKI, AYUMI; SHITARA, MASAYUKI; HIKOSAKA, YU; OKUDA, KATSUHIRO; MORIYAMA, SATORU; YANO, MOTOKI; FUJII, YOSHITAKA

2012-01-01

343

Intra-tumoral budding in preoperative biopsy specimens predicts lymph node and distant metastasis in patients with colorectal cancer.  

PubMed

Tumor budding, a histological hallmark of epithelial-mesenchymal transition in colorectal cancer, is a parameter of tumor progression and according to the International Union Against Cancer/American Joint Committee on Cancer an 'additional' prognostic factor. The current definition of tumor budding is reserved for the invasive tumor front of colorectal cancer (so called peri-tumoral budding), but tumor buds can also be observed in small preoperative biopsy specimens. Whereas the prognostic value of peri-tumoral budding assessed in resection specimens has found wide acceptance, the value of budding in preoperative biopsies, which normally do not encompass the invasive tumor margin and hence can be called intra-tumoral budding, has not been systematically investigated yet. Therefore, the aim of this study is to assess the predictive value of intra-tumoral budding for lymph node and distant metastasis in preoperative biopsies. Preoperative biopsy samples and consecutive resection specimens from 72 patients with pathological information on TNM stage, vascular, lymphatic and perineural invasion, and tumor border configuration were used to evaluate intra-tumoral budding and peri-tumoral budding. Both parameters were scored semiquantitatively as 'high' (detectable at low power magnification × 2.5) and 'low' (occasional budding at intermediate magnification × 10, difficult to find or absent). In biopsy samples high intra-tumoral budding was observed in 12/72 patients (17%) and associated with high peri-tumoral budding in the corresponding resection specimens (P=0.008). Additionally, there was a correlation between high intra-tumoral budding and lymph node metastasis (P=0.034), distant metastasis (P=0.007) and higher tumor grade (P=0.025). Peri-tumoral budding was associated with higher N stage (P=0.004), vascular (P=0.046) and lymphatic invasion (P=0.019) as well as with an infiltrating tumor border (P<0.001), reflecting the predictive power of peri-tumoral budding for tumor progression. High intra-tumoral budding in preoperative biopsy samples of colorectal cancer patients predicts high peri-tumoral budding at the invasive margin and lymph node metastasis in the corresponding resection specimens as well as distant metastasis. PMID:22481282

Giger, Olivier T; Comtesse, Sarah C M; Lugli, Alessandro; Zlobec, Inti; Kurrer, Michael O

2012-07-01

344

Value of sentinel lymph node biopsy in papillary thyroid cancer: initial results of a prospective trial.  

PubMed

The objectives of the study were to evaluate the performance of sentinel lymph node biopsy (SLNB) in detecting occult metastases in papillary thyroid carcinoma (PTC) and to correlate their presence to tumor and patient characteristics. Twenty-three clinically node-negative PTC patients (21 females, mean age 48.4 years) were prospectively enrolled. Patients were submitted to sentinel lymph node (SLN) lymphoscintigraphy prior to total thyroidectomy. Ultrasound-guided peritumoral injections of (99m)Tc-phytate (7.4 MBq) were performed. Cervical single-photon emission computed tomography and computed tomography (SPECT/CT) images were acquired 15 min after radiotracer injection and 2 h prior to surgery. Intra-operatively, SLNs were located with a gamma probe and removed along with non-SLNs located in the same neck compartment. Papillary thyroid carcinoma, SLNs and non-SLNs were submitted to histopathology analysis. Sentinel lymph nodes were located in levels: II in 34.7 % of patients; III in 26 %; IV in 30.4 %; V in 4.3 %; VI in 82.6 % and VII in 4.3 %. Metastases in the SLN were noted in seven patients (30.4 %), in non-SLN in three patients (13.1 %), and in the lateral compartments in 20 % of patients. There were significant associations between lymph node (LN) metastases and the presence of angio-lymphatic invasion (p = 0.04), extra-thyroid extension (p = 0.03) and tumor size (p = 0.003). No correlations were noted among LN metastases and patient age, gender, stimulated thyroglobulin levels, positive surgical margins, aggressive histology and multifocal lesions. Sentinel lymph node biopsy can detect occult metastases in PTC. The risk of a metastatic SLN was associated with extra-thyroid extension, larger tumors and angio-lymphatic invasion. This may help guide future neck dissection, patient surveillance and radioiodine therapy doses. PMID:24695942

Cabrera, R N; Chone, C T; Zantut-Wittmann, D; Matos, P; Ferreira, D M; Pereira, P S G; Ferrari, R J R; Santos, A O; Crespo, A N; Etchebehere, E C S C

2015-04-01

345

A Unique Presentation of Occult Primary Breast Cancer with a Review of the Literature  

PubMed Central

We are reporting a case of a 34-year-old woman with occult primary breast cancer discovered after initially presenting with neurological symptoms. She was successfully treated with neoadjuvant chemotherapy followed by definitive axillary lymph node dissection and ipsilateral whole breast radiotherapy. The case presented is unique due to the rarity of occult primary breast cancer, especially in light of her initial confounding neurological signs and symptoms, which highlights the importance of careful staging.

Dharmarajan, Kavita; Tiersten, Amy; Bleiweiss, Ira; Green, Sheryl; Bakst, Richard L.

2015-01-01

346

Doxorubicin Hydrochloride, Cyclophosphamide, and Paclitaxel With or Without Bevacizumab in Treating Patients With Lymph Node-Positive or High-Risk, Lymph Node-Negative Breast Cancer  

ClinicalTrials.gov

Estrogen Receptor Negative; Estrogen Receptor Positive; HER2/Neu Negative; Male Breast Carcinoma; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage IIA Breast Cancer; Stage IIB Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer

2015-03-31

347

A pilot study to assess the utility of SPECT\\/CT-based lymph node imaging to localize lymph nodes that drain the arm in patients undergoing treatment for breast cancer  

Microsoft Academic Search

Image-guided treatment planning that minimizes irradiation of critical lymph nodes (LNs) may reduce the incidence and severity\\u000a of long term complications following breast cancer treatment. This localization cannot be obtained with conventional imaging\\u000a techniques and we undertook this proof of concept study to determine whether a coordinated use of SPECT and CT has sufficient\\u000a precision to inform radiation planning and

Andrea L. Cheville; Indra Das; Shyam Srinivas; Josh Schuerman; Luke Velders; Lawrence J. Solin; Sandip Basu; Abass Alavi

2009-01-01

348

High Frequency of CD8 Positive Lymphocyte Infiltration Correlates with Lack of Lymph Node Involvement in Early Rectal Cancer  

PubMed Central

Aims. A trend towards local excision of early rectal cancers has prompted us to investigate if immunoprofiling might help in predicting lymph node involvement in this subgroup. Methods. A tissue microarray of 126 biopsies of early rectal cancer (T1 and T2) was stained for several immunomarkers of the innate and the adaptive immune response. Patients' survival and nodal status were analyzed and correlated with infiltration of the different immune cells. Results. Of all tested markers, only CD8 (P = 0.005) and TIA-1 (P = 0.05) were significantly more frequently detectable in early rectal cancer biopsies of node negative as compared to node positive patients. Although these two immunomarkers did not display prognostic effect “per se,” CD8+ and, marginally, TIA-1 T cell infiltration could predict nodal involvement in univariate logistic regression analysis (OR 0.994; 95% CI 0.992–0.996; P = 0.009 and OR 0.988; 95% CI 0.984–0.994; P = 0.05, resp.). An algorithm significantly predicting the nodal status in early rectal cancer based on CD8 together with vascular invasion and tumor border configuration could be calculated (P < 0.00001). Conclusion. Our data indicate that in early rectal cancers absence of CD8+ T-cell infiltration helps in predicting patients' nodal involvement. PMID:25609852

Däster, Silvio; Eppenberger-Castori, Serenella; Hirt, Christian; Zlobec, Inti; Delko, Tarik; Nebiker, Christian A.; Soysal, Savas D.; Amicarella, Francesca; Iezzi, Giandomenica; Sconocchia, Giuseppe; Heberer, Michael; Lugli, Alessandro; Spagnoli, Giulio C.; Kettelhack, Christoph; Terracciano, Luigi; Oertli, Daniel; von Holzen, Urs; Tornillo, Luigi; Droeser, Raoul A.

2014-01-01

349

Clinical significance of sentinel lymph node isolated tumour cells in breast cancer  

Microsoft Academic Search

The advent of sentinel lymph node biopsy (SLNB) and improvements in histopathological and molecular analysis have increased\\u000a the rate at which isolated tumour cells (ITC) are identified. However, their biological and clinical significance has been\\u000a the subject of much debate. In this article we review the literature concerning SLNB with particular reference to ITC. The\\u000a controversies regarding histopathological assessment, clinical

Neill Patani; Kefah Mokbel

2011-01-01

350

Radiation Therapy Field Extent for Adjuvant Treatment of Axillary Metastases From Malignant Melanoma  

SciTech Connect

Purpose: To compare treatment-related outcomes and toxicity for patients with axillary lymph node metastases from malignant melanoma treated with postoperative radiation therapy (RT) to either the axilla only or both the axilla and supraclavicular fossa (extended field [EF]). Methods and Materials: The medical records of 200 consecutive patients treated with postoperative RT for axillary lymph node metastases from malignant melanoma were retrospectively reviewed. All patients received postoperative hypofractionated RT for high-risk features; 95 patients (48%) received RT to the axilla only and 105 patients (52%) to the EF. Results: At a median follow-up of 59 months, 111 patients (56%) had sustained relapse, and 99 patients (50%) had died. The 5-year overall survival, disease-free survival, and distant metastasis-free survival rates were 51%, 43%, and 46%, respectively. The 5-year axillary control rate was 88%. There was no difference in axillary control rates on the basis of the treated field (89% for axilla only vs. 86% for EF; p = 0.4). Forty-seven patients (24%) developed treatment-related complications. On both univariate and multivariate analyses, only treatment with EF irradiation was significantly associated with increased treatment-related complications. Conclusions: Adjuvant hypofractionated RT to the axilla only for metastatic malignant melanoma with high-risk features is an effective method to control axillary disease. Limiting the radiation field to the axilla only produced equivalent axillary control rates to EF and resulted in lower treatment-related complication rates.

Beadle, Beth M. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Guadagnolo, B. Ashleigh [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)], E-mail: aguadagn@mdanderson.org; Ballo, Matthew T. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Lee, Jeffrey E.; Gershenwald, Jeffrey E.; Cormier, Janice N.; Mansfield, Paul F.; Ross, Merrick I. [Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Zagars, Gunar K. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)

2009-04-01

351

Is extended-field concurrent chemoradiation an option for radiologic negative paraaortic lymph node, locally advanced cervical cancer?  

PubMed Central

Background The aim was to evaluate whether extended-field concurrent chemoradiation (EF-CCRT) leads to results better than those obtained by standard whole-pelvis concurrent chemoradiation (WP-CCRT) in locally advanced cervical cancer with radiologic negative paraaortic lymph nodes (PALNs). Patients and methods A total of 102 patients with histopathologically proven squamous cell carcinoma, adenocarcinoma, or adenosquamous cell carcinoma, and radiologic negative PALN locally advanced cervical cancer, stage IIB-IVA, were accrued between July 2007 and April 2008 and were randomly assigned to WP-CCRT (50 patients) or EF-CCRT (52 patients), followed by high-dose rate brachytherapy. Data regarding the safety profile, response rates, and occurrence of local, PALN, or distant failure were recorded. Results During a median follow-up time of 60 months (18–66), 74/102 patients completed the treatment protocol and were analyzed. Overall PALN, distant-metastasis control, disease-free survival, and overall survival rates were 97.1%, 86.9%, 80.3%, and 72.4% in EF-CCRT respectively in comparison with WP-CCRT (82.1%,74.7%, 69.1%, and 60.4%), with P-values of 0.02, 0.03, 0.03 and 0.04 respectively. No difference in acute toxicity profile was seen between the groups, and late toxicities were mild and minimal. Conclusion Prophylactic EF-CCRT can be a reasonable option in patients with locally advanced cervical cancer with radiologic positive pelvic lymph nodes and radiologic negative PALN. PMID:25228820

Asiri, Mushabbab Al; Tunio, Mutahir A; Mohamed, Reham; Bayoumi, Yasser; Alhadab, Abdulrehman; Saleh, Rasha M; AlArifi, Muhannad Saud; Alobaid, Abdelaziz

2014-01-01

352

Correlation of Point B and Lymph Node Dose in 3D-Planned High-Dose-Rate Cervical Cancer Brachytherapy  

SciTech Connect

Purpose: To compare high dose rate (HDR) point B to pelvic lymph node dose using three-dimensional-planned brachytherapy for cervical cancer. Methods and Materials: Patients with FIGO Stage IB-IIIB cervical cancer received 70 tandem HDR applications using CT-based treatment planning. The obturator, external, and internal iliac lymph nodes (LN) were contoured. Per fraction (PF) and combined fraction (CF) right (R), left (L), and bilateral (Bil) nodal doses were analyzed. Point B dose was compared with LN dose-volume histogram (DVH) parameters by paired t test and Pearson correlation coefficients. Results: Mean PF and CF doses to point B were R 1.40 Gy +- 0.14 (CF: 7 Gy), L 1.43 +- 0.15 (CF: 7.15 Gy), and Bil 1.41 +- 0.15 (CF: 7.05 Gy). The correlation coefficients between point B and the D100, D90, D50, D2cc, D1cc, and D0.1cc LN were all less than 0.7. Only the D2cc to the obturator and the D0.1cc to the external iliac nodes were not significantly different from the point B dose. Significant differences between R and L nodal DVHs were seen, likely related to tandem deviation from irregular tumor anatomy. Conclusions: With HDR brachytherapy for cervical cancer, per fraction nodal dose approximates a dose equivalent to teletherapy. Point B is a poor surrogate for dose to specific nodal groups. Three-dimensional defined nodal contours during brachytherapy provide a more accurate reflection of delivered dose and should be part of comprehensive planning of the total dose to the pelvic nodes, particularly when there is evidence of pathologic involvement.

Lee, Larissa J. [Harvard Radiation Oncology Program, Brigham and Women's Hospital, Boston, MA (United States); Sadow, Cheryl A. [Department of Radiology, Brigham and Women's Hospital, Boston, MA (United States); Russell, Anthony [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Viswanathan, Akila N., E-mail: aviswanathan@lroc.harvard.ed [Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA (United States)

2009-11-01

353

Identification of a DNA methylation marker that detects the presence of lymph node metastases of gastric cancers  

PubMed Central

The accurate detection of the presence of lymph node metastases (LNM) of gastric cancers (GCs) is useful for the implementation of necessary and sufficient treatment, but current methods of detection are unsatisfactory. In the present study, we focused on DNA methylation markers since they have several advantages, including biological and chemical stability and informativeness even in the presence of contaminating cells. Using three metastatic lymph nodes and three primary GCs without LNM, methylation bead array analyses were performed, which enabled the interrogation of 485,577 CpG sites. A total of 31 CpG sites that were hypermethylated in the metastatic lymph nodes, compared with the GCs without LNM, were isolated. Using primary GCs with and without LNM (28 GCs with LNM and 10 without), their methylation levels were measured using quantitative PCR following treatment with sodium bisulfite or a methylation-sensitive restriction enzyme. Of the genomic regions around the 31 CpG sites, 10 regions demonstrated higher methylation levels in the GCs with LNM compared with the GCs without LNM (P<0.05). Finally, the hypermethylation of the 10 regions was validated using another set of samples (129 GCs with LNM and 20 without). Hypermethylation of the region around the cg06436185 CpG site predicted the presence of LNM at a sensitivity of 43% and specificity of 85%. Additionally, the hypermethylation of the region was associated with a poor survival rate among GC patients with LNM. The results of the present study indicated that the methylation status of the region was a promising candidate marker to detect the presence of LNM of GCs and may reflect the malignant potential of GCs. PMID:22844368

SHIGEMATSU, YASUYUKI; NIWA, TOHRU; YAMASHITA, SATOSHI; TANIGUCHI, HIROKAZU; KUSHIMA, RYOJI; KATAI, HITOSHI; ITO, SEIJI; TSUKAMOTO, TETSUYA; ICHINOSE, MASAO; USHIJIMA, TOSHIKAZU

2012-01-01

354

High expression of gabarapl1 is associated with a better outcome for patients with lymph node-positive breast cancer  

PubMed Central

Background: This study evaluates the relation of the early oestrogen-regulated gene gabarapl1 to cellular growth and its prognostic significance in breast adenocarcinoma. Methods: First, the relation between GABARAPL1 expression and MCF-7 growth rate was analysed. Thereafter, by performing macroarray and reverse transcriptase quantitative-polymerase chain reaction (RT–qPCR) experiments, gabarapl1 expression was quantified in several histological breast tumour types and in a retrospective cohort of 265 breast cancers. Results: GABARAPL1 overexpression inhibited MCF-7 growth rate and gabarapl1 expression was downregulated in breast tumours. Gabarapl1 mRNA levels were found to be significantly lower in tumours presenting a high histological grade, with a lymph node-positive (pN+) and oestrogen and/or progesterone receptor-negative status. In univariate analysis, high gabarapl1 levels were associated with a lower risk of metastasis in all patients (hazard ratio (HR) 4.96), as well as in pN+ patients (HR 14.96). In multivariate analysis, gabarapl1 expression remained significant in all patients (HR 3.63), as well as in pN+ patients (HR 5.65). In univariate or multivariate analysis, gabarapl1 expression did not disclose any difference in metastasis risk in lymph node-negative patients. Conclusions: Our data show for the first time that the level of gabarapl1 mRNA expression in breast tumours is a good indicator of the risk of recurrence, specifically in pN+ patients. PMID:20197771

Berthier, A; Seguin, S; Sasco, A J; Bobin, J Y; De Laroche, G; Datchary, J; Saez, S; Rodriguez-Lafrasse, C; Tolle, F; Fraichard, A; Boyer-Guittaut, M; Jouvenot, M; Delage-Mourroux, R; Descotes, F

2010-01-01

355

The Impact of the Size of Nodal Metastases on Recurrence Risk in Breast Cancer Patients With 1-3 Positive Axillary Nodes After Mastectomy  

SciTech Connect

Purpose: Use of postmastectomy radiation therapy (PMRT) in breast cancer patients with 1-3 positive nodes is controversial. The objective of this study was to determine whether the size of nodal metastases in this subset could predict who would benefit from PMRT. Methods and Materials: We analyzed 250 breast cancer patients with 1-3 positive nodes after mastectomy treated with contemporary surgery and systemic therapy at our institution. Of these patients, 204 did not receive PMRT and 46 did receive PMRT. Local and regional recurrence risks were stratified by the size of the largest nodal metastasis measured as less than or equal to 5 mm or greater than 5 mm. Results: The median follow-up was 65.6 months. In the whole group, regional recurrences occurred in 2% of patients in whom the largest nodal metastasis measured 5 mm or less vs 6% for those with metastases measuring greater than 5 mm. For non-irradiated patients only, regional recurrence rates were 2% and 9%, respectively. Those with a maximal nodal size greater than 5 mm had a significantly higher cumulative incidence of regional recurrence (P=.013). The 5-year cumulative incidence of a regional recurrence in the non-irradiated group was 2.7% (95% confidence interval [CI], 0.7%-7.2%) for maximal metastasis size of 5 mm or less, 6.9% (95% CI, 1.7%-17.3%) for metastasis size greater than 5 mm, and 16% (95% CI, 3.4%-36.8%) for metastasis size greater than 10 mm. The impact of the maximal nodal size on regional recurrences became insignificant in the multivariable model. Conclusions: In patients with 1-3 positive lymph nodes undergoing mastectomy without radiation, nodal metastasis greater than 5 mm was associated with regional recurrence after mastectomy, but its effect was modified by other factors (such as tumor stage). The size of the largest nodal metastasis may be useful to identify high-risk patients who may benefit from radiation therapy after mastectomy.

Harris, Eleanor E.R., E-mail: Eleanor.harris@moffitt.org [Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida (United States); Freilich, Jessica [Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida (United States)] [Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida (United States); Lin, Hui-Yi [Biostatistics Core, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida (United States)] [Biostatistics Core, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida (United States); Chuong, Michael [Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida (United States)] [Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida (United States); Acs, Geza [Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida (United States)] [Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida (United States)

2013-03-01

356

Identification of EGFR expression status association with metastatic lymph node density (ND) by expression microarray analysis of advanced gastric cancer  

PubMed Central

Metastatic lymph node density (ND) has been reproducibly proven to be a prognostic factor in gastric cancer. The molecular mechanisms that underlie this aggressiveness are underexplored. Here, we aimed to identify molecules associated with this unique phenotype. Tumor specimens from patients with stage III gastric cancer with high or low ND (n = 4 for both) were compared at the mRNA level using Affymetrix microarray (harboring 54,675 genes). The expression data were prioritized, and genes that correlated with ND were selected. Ultimately, the EGFR was validated as such a candidate molecule in patients with primary advanced gastric cancer who underwent standard treatment (n = 167). Expression data of the microarray were prioritized based on gene expression ratio and frequency of gene expression. The first priority genes to be selected were genes that are known to be amplified in cancer, which included NKX2.1, CHST9, CTNND2, SLC25A27, FGFR2, EGFR, and PTGER1. Of these genes, the EGFR gene was of particular interest. EGFR expression in primary gastric cancer was examined using immunohistochemistry (IHC). The Student's t-test elucidated a significant difference in EGFR expression between IHC 2+/3+ and IHC 1+ according to ND (P = 0.0035). The Chi-square test also indicated a significant difference between high and low levels of EGFR immunohistochemical staining (IHC2+/3+ and IHC1+, respectively) and ND status (P = 0.0023). According to the least squares method, as ND increased, the risk that EGFR staining levels changed from IHC 1+ to IHC 2+ also increased. In this study, we determined that high EGFR expression may underlie the aggressive mechanism of advanced gastric cancer with high ND. PMID:25154973

Ema, Akira; Waraya, Mina; Yamashita, Keishi; Kokubo, Kenichi; Kobayashi, Hirosuke; Hoshi, Keika; Shinkai, Yoshiko; Kawamata, Hiroshi; Nakamura, Kazunori; Nishimiya, Hiroshi; Katada, Natsuya; Watanabe, Masahiko

2015-01-01

357

Lymph node dissection during laparoscopic (LRC) and open (ORC) radical cystectomy due to muscle invasive bladder urothelial cancer (pT2-3, TCC)  

PubMed Central

Aim The aim of the study was to compare the number of nodes dissected during laparoscopic and open radical cystoprostatectomy in men or anterior exenteration in women due to muscle invasive bladder urothelial cancer (IBC). Material and methods Fifty-one patients treated with laparoscopic radical cystectomy (LRC) and 63 with open radical cystectomy (ORC) were compared. The LRC group consisted of 47 pT2 tumours and 4 pT3, while the ORC group was composed of 27 pT2 tumours and 36 pT3. During ORC external, internal, common iliac and obturator lymph nodes were removed separately, but were added and analysed together for each side. Nodes dissected from one side during ORC were compared to en bloc dissected nodes in the LRC group. Results There were no complications associated with extended pelvic lymph node dissection during LRC or ORC. There were significant differences in the mean number of resected lymph nodes between LRC and ORC for pT2 tumours. The laparoscopic approach allowed about 8-9 more lymph nodes to be removed than open surgery in the pT2 group. In 15% of patients with pT2 disease treated with open radical cystectomy node metastases were observed. Active disease was detected in 18% of nodes resected laparoscopically due to pT2 disease. Fourty-seven percentage of patients with pT3 disease treated with open surgery were diagnosed as harbouring metastatic lymph nodes. The laparoscopic group with pT3 disease was too small to analyse. Conclusions We have found that laparoscopic radical cystectomy can be performed without any compromise in lymph node dissection. The technique of lymph node dissection (LND) during laparoscopic cystectomy (LRC) resulted in sufficient resected lymphatic tissue, especially in patients with bladder-confined tumours with a low volume of lymph nodes. PMID:23255970

Chlosta, Piotr; Siekiera, Jerzy; Jaskulski, Jaros?aw; Petrus, Andrzej; Kamecki, Krzysztof; Miko?ajczak, Witold; Obarzanowski, Mateusz; Wronczewski, Andrzej; Krasnicki, Krzysztof; Jasinski, Milosz

2011-01-01

358

Position determine system for lymph node relating breast cancer using a high- Tc SQUID  

NASA Astrophysics Data System (ADS)

The performance of a lymph-node detection system used with a high- Tc superconducting quantum interference device was investigated. Ultra-small iron oxide particles containing 360 pg in weight of iron could be detected at a distance of 1 mm using Helmholtz coils. When a pair of angled field coils, which were of a more practical design, were used this value was increased to 2.8 ng. This value is still large enough to apply the technique for sentinel-node biopsy and lymphatic mapping.

Tanaka, Saburo; Ota, Hajime; Kondo, Yoichi; Tamaki, Yasuhiro; Noguchi, Shinzaburo; Hasegawa, Masakatsu

2002-03-01

359

Correlation between Duffy blood group phenotype and breast cancer incidence  

PubMed Central

Background Different ethnicities have different distribution of Duffy blood group (DBG) phenotypes and different breast cancer morbidity. A study in our lab demonstrated that Duffy antigen/receptor for chemokines (DARC, also known as DBGP, the Duffy protein phenotype), led to the inhibition of tumorigenesis. Therefore, we tested the hypothesis that DBGP is correlated with breast cancer occurrence. Methods DBGP proteins were examined by indirect antiglobulin testing with anti-FYa and anti-FYb antibodies. The phenotypes were classified into four groups according to the agglutination reactions: FYa + FYb+, FYa + FYb-, FYa-FYb + and FYa-FYb-. The phenotypes and pathological diagnosis of consecutively hospitalized female patients (n = 5,022) suffering from breast cancer at the Shanghai Cancer Hospital and Henan Province Cancer Hospital were investigated. The relationships between DBGP expression with breast cancer occurrence, axillary lymph status, histological subtype, tumor size pathological grade and overall survival were analyzed. Results The incidence of breast cancer was significantly different between FYa + FYb + (29.8%), FYa + FYb- (33.2%), FYa-FYb + (45.6%) and FYa-FYb- (59.1%; P = 0.001). Significant different numbers of breast cancer patients had metastases to the axillary lymph nodes in the FYa + FYb + group (25.1%), FYa + FYb- (36.9%), FYa-FYb + (41.0%) and FYa-FYb- (50.0%, (P = 0.005). There was a statistical significance (p = 0.022) of the overall survival difference between patients with difference phenotypes. No significant difference was observed in cancer size (t-test, p > 0.05), histological cancer type (Fisher's exact test, p > 0.05) or histological grade (Fisher's exact test, p > 0.05) between every each DBGP group. Conclusions DBGP is correlated with breast cancer incidence and axillary lymph node metastasis and overall survival. Further investigations are required to determine the underlying mechanism of Duffy blood group phenotype on breast cancer risk. PMID:22928984

2012-01-01

360

Regional Lymph Node Metastases, a Singular Manifestation of the Process of Clinical Metastases in Cancer: Contemporary Animal Research And Clinical Reports Suggest Unifying Concepts  

Microsoft Academic Search

Extensive animal research into the process of metastatic development of cancers over recent years provides insight into clinical\\u000a findings in patients. Clinical research and reports provide strong support for the translation of these research conclusions\\u000a from the laboratory and animals to human cancers (1–6), particularly in understanding the role of lymph node metastases but\\u000a also more distant metastases in almost

Blake Cady

361

Peritumoural versus subareolar administration of technetium-99m nanocolloid for sentinel lymph node detection in breast cancer: preliminary results of a prospective intra-individual comparative study  

Microsoft Academic Search

The scintigraphic detection of sentinel lymph nodes (SNs) in early-stage breast cancer is a widely accepted diagnostic method. However, which radiotracer administration mode should be used is still controversial. This prospective study aimed to intra-individually compare the detection rates obtained after peritumoural versus subareolar injection with regard to SN number and localisation. Fifty-one women (age, 32-76 years) with breast cancer

Sofiane Maza; Ray Valencia; Lilli Geworski; Andreas Zander; Hans Guski; Klaus J. Winzer; Dieter L. Munz

2003-01-01

362

Robotic and laparoscopic pelvic lymph node dissection for rectal cancer: short-term outcomes of 21 consecutive series  

PubMed Central

Purpose The aim of this study is to describe our initial experience and assess the feasibility and safety of robotic and laparoscopic lateral pelvic node dissection (LPND) in advanced rectal cancer. Methods Between November 2007 and November 2012, extended minimally invasive surgery for LPND was performed in 21 selected patients with advanced rectal cancer, including 11 patients who underwent robotic LPND and 10 who underwent laparoscopic LPND. Extended lymphadenectomy was performed when LPN metastasis was suspected on preoperative magnetic resonance imaging even after chemoradiation. Results All 21 procedures were technically successful without the need for conversion to open surgery. The median operation time was 396 minutes (range, 170-581 minutes) and estimated blood loss was 200 mL (range, 50-700 mL). The median length of stay was 10 days (range, 5-24 days) and time to removal of the urinary catheter was 3 days (range, 1-21 days). The median total number of lymph nodes harvested was 24 (range, 8-43), and total number of lateral pelvic lymph nodes was 7 (range, 2-23). Six patients (28.6%) developed postoperative complications; three with an anastomotic leakages, two with ileus and one patient with chyle leakage. Two patients (9.5%) developed urinary incontinence. There was no mortality within 30 days. During a median follow-up of 14 months, two patients developed lung metastasis and there was no local recurrence. Conclusion Robotic and laparoscopic LPND is technically feasible and safe. Minimally invasive techniques for LPND in selected patients can be an acceptable alternative to an open LPND. PMID:24761412

Bae, Sung Uk; Saklani, Avanish P.; Hur, Hyuk; Min, Byung Soh; Baik, Seung Hyuk; Lee, Kang Young

2014-01-01

363

Use of Indocyanine Green for Detecting the Sentinel Lymph Node in Breast Cancer Patients: From Preclinical Evaluation to Clinical Validation  

PubMed Central

Assessment of the sentinel lymph node (SLN) in patients with early stage breast cancer is vital in selecting the appropriate surgical approach. However, the existing methods, including methylene blue and nuclides, possess low efficiency and effectiveness in mapping SLNs, and to a certain extent exert side effects during application. Indocyanine green (ICG), as a fluorescent dye, has been proved reliable usage in SLN detection by several other groups. In this paper, we introduce a novel surgical navigation system to detect SLN with ICG. This system contains two charge-coupled devices (CCD) to simultaneously capture real-time color and fluorescent video images through two different bands. During surgery, surgeons only need to follow the fluorescence display. In addition, the system saves data automatically during surgery enabling surgeons to find the registration point easily according to image recognition algorithms. To test our system, 5 mice and 10 rabbits were used for the preclinical setting and 22 breast cancer patients were utilized for the clinical evaluation in our experiments. The detection rate was 100% and an average of 2.7 SLNs was found in 22 patients. Our results show that the usage of our surgical navigation system with ICG to detect SLNs in breast cancer patients is technically feasible. PMID:24358319

Chi, Chongwei; Ye, Jinzuo; Ding, Haolong; He, De; Huang, Wenhe; Zhang, Guo-Jun; Tian, Jie

2013-01-01

364

Judging the therapeutic value of lymph node dissections for melanoma> 2 1 >No competing interests declared. 2 2 Supported by NIH grant PO NCI CA 29605 and by funding from the Wrather Family Foundation, Los Angeles, CA. Dr Essner is a recipient of an American Cancer Society Career Development Award  

Microsoft Academic Search

Background: The management of the regional lymph nodes remains controversial for early-stage melanoma and for those patients with lymph node metastases; American Joint Committee on Cancer stage III. This study examines the importance of quality of the surgical resection measured by the extent of lymph node dissection (quartile of the total number of lymph nodes removed) to determine if this

Arden D Chan; Richard Essner; Leslie A Wanek; Donald L Morton

2000-01-01

365

Survival of Proper Hepatic Artery Lymph Node Metastasis in Patients with Gastric Cancer: Implications for D2 Lymphadenectomy  

PubMed Central

Background and Aims There is a discrepancy between the American Joint Committee on Cancer (AJCC) guidelines (7th edition) and the Japanese treatment guidelines (3rd edition) with regard to the extent of D2 lymphadenectomy for gastric cancer. In the AJCC, hepatic artery station (No.12a) lymph node (LN) metastasis is classified as distant metastasis, whereas in the Japanese guidelines, this classified is regional metastasis. This study aimed to evaluate whether it is appropriate to reclassify No.12a LN metastasis as distant metastasis in consideration of survival outcome. Methods In this retrospective analysis, data from patients with gastric cancer who underwent regular D2 or greater lymphadenectomy between 1996 and 2006 were evaluated to determine any association between the clinicopathological features of hepatic artery LNs and survival prognosis. Results Among the 247 patients with gastric cancer who underwent No.12 LN harvest, 45 (18.2%) were positive for No.12a LN metastasis. No.12a LN metastasis was significantly associated with poor clinicopathological features, advanced tumor stage, and poor overall survival. The 5-year survival rate of patients with No.12a LN metastasis was significantly better than that of patients with distant metastasis (P < 0.05), but was similar to that of patients with LN involvement in the D2 lymphadenectomy region (P > 0.05). No.12a LN metastasis was shown to significantly influence survival outcome in univariate analysis, but was not identified as a significant independent predictor in multivariate analysis. In logistic multivariate regression analysis, T stage, N stage, and station No.3, 5, and 6 LN metastasis were independent predictors of No.12a LN involvement. Conclusions It is inappropriate to reclassify No.12a LN metastasis as distant metastasis. We propose that this be considered as regional metastasis and be included in the extent of D2 lymphadenectomy to improve survival outcomes in patients with gastric cancer. PMID:25768441

Chuangqi, Chen; Kaiming, Wu; Xinhua, Zhang; Wu, Song; Yulong, He

2015-01-01

366

Influence of Microsatellite Instability and KRAS and BRAF Mutations on Lymph Node Harvest in Stage I–III Colon Cancers  

PubMed Central

Lymph node (LN) harvest is influenced by several factors, including tumor genetics. Microsatellite instability (MSI) is associated with improved node harvest, but the association to other genetic factors is largely unknown. Research methods included a prospective series of stage I–III colon cancer patients undergoing ex vivo sentinel-node sampling. The presence of MSI, KRAS mutations in codons 12 and 13, and BRAF V600E mutations was analyzed. Uni- and multivariate regression models for node sampling were adjusted for clinical, pathological and molecular features. Of 204 patients, 67% had an adequate harvest (?12 nodes). Adequate harvest was highest in patients whose tumors exhibited MSI (79%; odds ratio [OR] 2.5, 95% confidence interval [CI] 1.2–4.9; P = 0.007) or were located in the proximal colon (73%; 2.8, 1.5–5.3; P = 0.002). In multiple linear regression, MSI was a significant predictor of the total LN count (P = 0.02). Total node count was highest for cancers with MSI and no KRAS/BRAF mutations. The independent association between MSI and a high LN count persisted for stage I and II cancers (P = 0.04). Tumor location in the proximal colon was the only significant predictor of an adequate LN harvest (adjusted OR 2.4, 95% CI 1.2–4.9; P = 0.01). An increase in the total number of nodes harvested was not associated with an increase in nodal metastasis. In conclusion, number of nodes harvested is highest for cancers of the proximal colon and with MSI. The nodal harvest associated with MSI is influenced by BRAF and KRAS genotypes, even for cancers of proximal location. Mechanisms behind the molecular diversity and node yield should be further explored. PMID:23979710

Berg, Marianne; Guriby, Marianne; Nordgård, Oddmund; Nedrebø, Bjørn S; Ahlquist, Terje C; Smaaland, Rune; Oltedal, Satu; Søreide, Jon Arne; Kørner, Hartwig; Lothe, Ragnhild A; Søreide, Kjetil

2013-01-01

367

Gene expression variation to predict 10-year survival in lymph-node-negative breast cancer  

Microsoft Academic Search

BACKGROUND: It is of great significance to find better markers to correctly distinguish between high-risk and low-risk breast cancer patients since the majority of breast cancer cases are at present being overtreated. METHODS: 46 tumours from node-negative breast cancer patients were studied with gene expression microarrays. A t-test was carried out in order to find a set of genes where

Elin Karlsson; Ulla Delle; Anna Danielsson; Björn Olsson; Frida Abel; Per Karlsson; Khalil Helou

2008-01-01

368

[A case of gastric cancer with N2 lymph node metastasis and pancreatic invasion effectively treated with docetax-el/S-1 as a neoadjuvant chemotherapy].  

PubMed

A 74-year-old man was diagnosed with advanced gastric cancer(cStage III B). Laparotomy showed N2 lymph node metastasis and pancreatic invasion. Radical resection appeared impossible and was thus not performed. Chemotherapy consisting of a combination of S-1(80mg/m 2, 2-week administration and 1-week rest), and docetaxel(40mg/m2day 1)was administered with the expectation of tumor downstaging. A partial response(PR)was obtained after five courses of this regimen in which the primary lesion and lymph node swelling remarkably improved. Total gastrectomy, splenectomy, partial colectomy, and D2 lymph node dissection were then performed. Pathological analysis revealed very few cancer cells in the primary lesion and that the lymph nodes had become scarred and fibrotic. The histological appearance was judged to be grade 2 and the final diagnosis was T1N0H0P0CY0M0, fStage I A, curability A. Currently, more than 6 years and 4 months after the operation, the patient is alive without any evidence of recurrence. Thus, docetaxel/S-1 combination therapy was an effective neoadjuvant chemotherapy for this case of advanced gastric cancer. PMID:25132034

Omori, Keita; Wakabayashi, Kazuhiko; Ishibashi, Yuji; Ito, Yutaka

2014-08-01

369

Optimized Dose Coverage of Regional Lymph Nodes in Breast Cancer: The Role of Intensity-Modulated Radiotherapy  

SciTech Connect

Purpose: To determine whether the use of intensity-modulated radiotherapy (IMRT) would lead to improved dosimetry for the breast and regional nodes. Methods and Materials: Ten patients with left-sided breast cancer were selected. The clinical target volume included left breast and internal mammillary (IM), supraclavicular (SC), and axillary (AX) nodes. The critical structures included heart, right and left lungs, contralateral breast, esophagus, thyroid, and humeral head. Conventional and a series of IMRT plans were generated for comparison. Results: The average heart D{sub 3} was reduced from 31.4 {+-} 18.9 with three-dimensional conformal radiotherapy (3D-CRT) to 15 {+-} 7.2 Gy with 9-field (9-FLD IMRT). The average left lung D{sub 30} was also decreased from 27.9 {+-} 11.5 Gy (3D-CRT) to 12.6 {+-} 8.2 Gy (9-FLD IMRT). The average contralateral breast D{sub 2} was reduced from 4.4 {+-} 5.3 Gy (3D-CRT) to 1.8 {+-} 1.2 Gy (4-FLD IMRT). Esophagus D{sub 2} was increased from 9.3 {+-} 8.1 Gy (3D-CRT) to 29.4 {+-} 5.4 (9-FLD IMRT); thyroid D{sub 50} was increased from 0.9 {+-} 0.6 Gy (3D-CRT) to 11.9 {+-} 6.6 (9-FLD IMRT); humeral head D{sub 2} was increased from 36.1 {+-} 13.1 Gy (3D-CRT) to 39.9 {+-} 6.5 (9-FLD IMRT). Conclusions: The use of IMRT improves breast and regional node coverage while decreasing doses to the lungs, heart, and contralateral breast when compared with 3D-CRT. Doses to esophagus, thyroid, and humeral head, however, were increased with IMRT.

Dogan, Nesrin [Department of Radiation Oncology, Virginia Commonwealth University Medical Center, Richmond, VA (United States)]. E-mail: ndogan@mcvh-vcu.edu; Cuttino, Laurie [Department of Radiation Oncology, Virginia Commonwealth University Medical Center, Richmond, VA (United States); Lloyd, Rick C [Department of Radiation Oncology, Virginia Commonwealth University Medical Center, Richmond, VA (United States); Bump, Edward A. C [Department of Radiation Oncology, Virginia Commonwealth University Medical Center, Richmond, VA (United States); Arthur, Douglas W. [Department of Radiation Oncology, Virginia Commonwealth University Medical Center, Richmond, VA (United States)

2007-07-15

370

In vivo carbon nanotube-enhanced non-invasive photoacoustic mapping of the sentinel lymph node.  

PubMed

Sentinel lymph node biopsy (SLNB), a less invasive alternative to axillary lymph node dissection (ALND), has become the standard of care for patients with clinically node-negative breast cancer. In SLNB, lymphatic mapping with radio-labeled sulfur colloid and/or blue dye helps identify the sentinel lymph node (SLN), which is most likely to contain metastatic breast cancer. Even though SLNB, using both methylene blue and radioactive tracers, has a high identification rate, it still relies on an invasive surgical procedure, with associated morbidity. In this study, we have demonstrated a non-invasive single-walled carbon nanotube (SWNT)-enhanced photoacoustic (PA) identification of SLN in a rat model. We have successfully imaged the SLN in vivo by PA imaging (793 nm laser source, 5 MHz ultrasonic detector) with high contrast-to-noise ratio (=89) and good resolution ( approximately 500 microm). The SWNTs also show a wideband optical absorption, generating PA signals over an excitation wavelength range of 740-820 nm. Thus, by varying the incident light wavelength to the near infrared region, where biological tissues (hemoglobin, tissue pigments, lipids and water) show low light absorption, the imaging depth is maximized. In the future, functionalization of the SWNTs with targeting groups should allow the molecular imaging of breast cancer. PMID:19430111

Pramanik, Manojit; Song, Kwang Hyun; Swierczewska, Magdalena; Green, Danielle; Sitharaman, Balaji; Wang, Lihong V

2009-06-01

371

In vivo carbon nanotube-enhanced non-invasive photoacoustic mapping of the sentinel lymph node  

NASA Astrophysics Data System (ADS)

Sentinel lymph node biopsy (SLNB), a less invasive alternative to axillary lymph node dissection (ALND), has become the standard of care for patients with clinically node-negative breast cancer. In SLNB, lymphatic mapping with radio-labeled sulfur colloid and/or blue dye helps identify the sentinel lymph node (SLN), which is most likely to contain metastatic breast cancer. Even though SLNB, using both methylene blue and radioactive tracers, has a high identification rate, it still relies on an invasive surgical procedure, with associated morbidity. In this study, we have demonstrated a non-invasive single-walled carbon nanotube (SWNT)-enhanced photoacoustic (PA) identification of SLN in a rat model. We have successfully imaged the SLN in vivo by PA imaging (793 nm laser source, 5 MHz ultrasonic detector) with high contrast-to-noise ratio (=89) and good resolution (~500 µm). The SWNTs also show a wideband optical absorption, generating PA signals over an excitation wavelength range of 740-820 nm. Thus, by varying the incident light wavelength to the near infrared region, where biological tissues (hemoglobin, tissue pigments, lipids and water) show low light absorption, the imaging depth is maximized. In the future, functionalization of the SWNTs with targeting groups should allow the molecular imaging of breast cancer.

Pramanik, Manojit; Song, Kwang Hyun; Swierczewska, Magdalena; Green, Danielle; Sitharaman, Balaji; Wang, Lihong V.

2009-06-01

372

Feasibility of Eradication of Breast Cancer Cells Remaining in Post-Lumpectomy Cavity and Draining Lymph Nodes Following Intracavitary Injection of Radioactive Immunoliposomes  

PubMed Central

Most diagnosed early stage breast cancer cases are treated by lumpectomy and adjuvant radiation therapy, which significantly decreases the locoregional recurrence but causes inevitable toxicity to normal tissue. By using a technique of preparing liposomes carrying technetium-99m (99mTc), rhenium-186 (186Re), or rhenium-188 (188Re) radionuclides, as well as chemotherapeutic agents, or their combination, for cancer therapy with real time image-monitoring of pharmacokinetics and prediction of therapy effect, this study investigated the potential of a novel targeted focal radiotherapy with low systemic toxicity using radioactive immunoliposomes to treat both the surgical cavity and draining lymph nodes in a rat breast cancer xenograft positive surgical margin model. Immunoliposomes modified with either panitumumab (anti-EGFR), or bevacizumab (anti-VEGF) were remote loaded with 99mTc diagnostic radionuclide, and injected into the surgical cavity of female nude rats with positive margins post lumpectomy. Locoregional retention and systemic distribution of 99mTc-immunoliposomes were investigated by nuclear imaging, stereofluorescent microscopic imaging and gamma counting. Histopathological examination of excised draining lymph nodes was performed. The locoregional retention of 99mTc-immunoliposomes in each animal was influenced by the physiological characteristics of surgical site of individual animals. Panitumumab- and bevacizumab-liposome groups had higher intracavitary retention compared with the control liposome groups. Draining lymph node uptake was influenced by both the intracavitary radioactivity retention level and metastasis status. Panitumumab-liposome group had higher accumulation on the residual tumor surface and in the metastatic lymph nodes. Radioactive liposomes that were cleared from the cavity were metabolized quickly and accumulated at low levels in vital organs. Therapeutic radionuclide-carrying specifically targeted panitumumab- and bevacizumab- liposomes have increased potential compared to non-antibody targeted liposomes for post-lumpectomy focal therapy to eradicate remaining breast cancer cells inside the cavity and draining lymph nodes with low systemic toxicity. PMID:22894603

Li, Shihong; Goins, Beth; Hrycushko, Brian A.; Phillips, William T.; Bao, Ande

2012-01-01

373

Prognostic significance and surgical management of locoregional lymph node metastases in papillary thyroid cancer  

Microsoft Academic Search

We studied the records of 342 patients with papillary thyroid carcinoma out of a total of 728 thyroid cancer patients treated at the Medical School of Hannover (MHH) from 1972 through 1992. The comprehensive data-abstracting forms were designed, and the acquired information was coded, stored, maintained, and evaluated by the Clinical Cancer Registry of the MHH. A total of 160

Georg F. W. Scheumann; Oliver Gimm; Gerd Wegener; H. Hundeshagen; Henning Dralle

1994-01-01

374

Outcome Analysis of Patients With Oral Cavity Cancer and Extracapsular Spread in Neck Lymph Nodes  

SciTech Connect

Purpose: Extracapsular spread (ECS) in neck lymph nodes is a major adverse prognostic factor in patients with oral cavity squamous cell carcinoma (OSCC). We conducted a retrospective analysis of prognostic factors in this patient group and tried to identify a subset of patients with a worse prognosis suitable for more aggressive therapeutic interventions. Methods and Materials: Enrolled in the study were 255 OSCC patients with ECS in neck nodes and without evidence of distant metastasis. All participants were followed-up for at least 2 years or censored at last follow-up. The 5-year rates of control, distant metastasis, and survival were the main outcome measures. Results: Level IV/V lymph node metastases and tumor depth {>=}12 mm were independent predictors of 5-year survival and identified three prognostic groups. In the low-risk group (no level IV/V metastases and tumor depth <12 mm), the 5-year disease-free, disease-specific, and overall survival rates were 60%, 66%, and 50%, respectively. In the intermediate-risk group (no level IV/V metastases and tumor depth {>=}12 mm), the 5-year disease-free, disease-specific, and overall survival rates were 39%, 41%, and 28%, respectively. In the high-risk group (evidence of level IV/V metastases), the 5-year disease-free, disease-specific, and overall survival rates were 14%, 12%, and 10%, respectively. Conclusions: Among OSCC patients with ECS, those with level IV/V metastases appear to have the worst prognosis followed by without level IV/V metastases and tumor depth {>=}12 mm. An aggressive therapeutic approach may be suitable for intermediate- and high-risk patients.

Liao, Chun-Ta, E-mail: liaoct@adm.cgmh.org.tw [Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (China); Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (China); Lee, Li-Yu [Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (China); Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (China); Huang, Shiang-Fu; Chen, I-How; Kang, Chung-Jan [Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (China); Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (China); Lin, Chien-Yu; Fan, Kang-Hsing [Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (China)