Evaluation Of Pelvic Nodes Research Articles

Surgical treatment of microinvasive cervical cancer: analysis of pathologic features with implications on radicality.

To evaluate pathologic features with implications on surgical radicality in women treated with radical hysterectomy and pelvic lymphadenectomy for cervical cancer stage IA1 with lymph vascular space invasion (LVSI) and stage IA2 by correlating findings in conization and hysterectomy specimens. Women with cervical cancer stage IA1 with LVSI and stage IA2 diagnosed by loop electrosurgical excisional procedure or cold knife conization were treated with radical hysterectomy and pelvic lymphadenectomy from January 1999 to December 2011 in 2 institutions. Fifty patients were enrolled: 40 with stage IA2 and 10 with stage IA1 with LVSI. Median age was 43 (30-67) years. All patients underwent cervical conization for diagnosis (45 loop electrosurgical excisional procedure, 5 cold knife). Lymph vascular space invasion was detected in 15 patients (30%). Two patients had positive pelvic nodes. No parametrial involvement was detected in the entire cohort. Positive margins were present in 35 patients, and residual disease was detected in 22 patients (44%). Positive margins predicted residual disease at radical hysterectomy (P = 0.02). Medium follow-up time was 51 months. One patient developed a pelvic recurrence, and there were no disease-related deaths. Patients with positive margins in cone biopsy specimens have an increased risk of residual disease at radical hysterectomy and require careful evaluation before conservative surgery. Pelvic lymph node evaluation is essential because lymph node metastasis may occur even in early stages. The lack of parametrial invasion in this study reinforces the knowledge that the select group of patients with microinvasive cervical carcinoma stages IA1 LVSI and stage IA2 have a very low risk of parametrial infiltration. Less radical surgery can be carefully considered for these patients.

Hyaline globules in ectopic decidua in a pregnant woman with cervical squamous cell carcinoma

Decidual reaction in pelvic lymph nodes has been increasingly documented during pregnancy. This may pose diagnostic difficulty during intraoperative frozen section (FS) and cytological consultation in women undergoing surgical procedures for cervical Squamous cell carcinoma (SCC). A 34-year-woman diagnosed to have invasive SCC (stage IB1) of the cervix at 14th week of her first pregnancy underwent abdominal radical trachelectomy and pelvic lymphadenectomy at 22 weeks of gestation. Cytological smears of two of the lymph nodes from intraoperative FS revealed isolated eosinophilic hyaline globules (HG) measuring 45-50 microns, in addition to large polygonal cells with amphophilic cytoplasm and hypochromatic nuclei and occasional squamous-looking cells with atypical hyperchomatic nuclei. These findings posed a diagnostic dilemma at intraoperative consultation and no definitive diagnosis was rendered. The formlin-fixed, paraffin-embedded histological sections of the same lymph nodes showed ectopic decidua with no evidence of metastatic SCC. Decidual cells are a cause of concern for both cytologists and histopathologists. In pregnant women complicated by cervical cancer intraoperative evaluation of pelvic lymph nodes is of utmost importance in order to adopt the optimal conservative treatment modality. In the absence of clear cut evidence of malignancy, a diagnosis of metastatic SCC should not be rendered.

The Usefulness of MRI and PET Imaging for the Detection of Parametrial Involvement and Lymph Node Metastasis in Patients with Cervical Cancer

The purpose of this study is to elucidate the usefulness of magnetic resonance imaging (MRI) and positron emission tomography (PET) for the detection of parametrial involvement and lymph node metastasis in patients with cervical cancer. Thirty-six patients with cervical cancer were retrospectively enrolled. MRI and PET scans were performed for all patients within a week before radical surgery. The criterion for malignancy on MRI was >1 cm short axis diameter of the suspected lymph node. On PET, only fluorodeoxyglucose (FDG) uptake was significantly higher than the background and, if this FDG uptake showed on at least two consecutive axial slices, then the lesion was considered as a malignancy. We compared the extent of tumor on the surgical findings with the FIGO staging, MRI and PET scans. The accuracy of FIGO and MRI staging was 67 and 84.4%, respectively. The accuracy for detecting pelvic lymph node metastasis was better for PET than for MRI (78 versus 67%, respectively). All FDG uptake lymph nodes were confirmed as metastatic lymph nodes by pathological evaluation; this included five lymph nodes <1 cm in diameter. MRI provides an improved evaluation of local tumor extension, but PET is more useful for the evaluation of pelvic lymph nodes than MRI; however, PET still misses microscopic disease. Further studies are necessary to evaluate the usefulness of PET/computed tomography (CT) for the accuracy of the disease extension and the cost-effectiveness of MRI, PET or PET/CT in patients with cervical cancer.

Should laparoscopy be the standard approach used for pelvic lymph node dissection?

Involvement of the pelvic lymph nodes in patients with prostate cancer worsens the overall prognosis of this common disease entity. Prior radiographic staging techniques, including fine-needle aspiration, are limited by a poor sensitivity and are not reliable. The gold standard for the evaluation of pelvic lymph nodes in men with prostate cancer involves performing a lymphadenectomy. Historically, this procedure was performed using an open surgical technique. Unfortunately, this invasive procedure is associated with significant morbidity. In response, modern surgical technology has provided newer, less invasive techniques, including laparoscopic pelvic lymphadenectomy (LPLND). Improved detection of localized prostate cancer through the institution of screening protocols and early detection programs has decreased the number of patients presenting with lymph node involvement. Various clinical indicators, including prostate-specific antigen, grade, and stage, have been used to improve the selection of "high-risk" patients that are appropriate candidates for pelvic lymph node dissection. The technique of LPLND is a valid option in the armamentarium for staging of prostate cancer. The laparoscopic approach provides the same staging accuracy as the open surgical technique and is superior with respect to morbidity. LPLND is limited to patients who present with a high risk of advanced prostate cancer. In addition, the urologist must accept the additional training, financial expense, and "learning curve" associated with this technique.

Mesothelial Pelvic Lymph Node Inclusions Mimicking Metastatic Thyroid Carcinoma

Benign lymph node inclusions are commonly encountered during surgery for gynecologic neoplasms and are potential mimics of metastatic disease. A 52-year-old woman presented with ascites, a complex adnexal mass, and a CA-125 of 1891 units/mL. A staging laparotomy was performed, diagnosing struma ovarii. Pathologic evaluation of pelvic lymph nodes demonstrated mesothelial inclusions in nodal sinuses suspicious for metastatic disease. Immunocytochemical evaluation revealed benign mesothelial inclusions rather than metastatic thyroid carcinoma. Benign mesothelial lymph node inclusions in nodal sinuses are potential mimics of metastatic carcinoma. Their presence in pelvic lymph nodes has not previously been reported. Given the potential difficulty in determining the origin of these inclusions, immunocytochemical evaluation is useful in reaching the correct diagnosis.

Comparison between abdominal and laparoscopic lymphadenectomy

In cervical cancer the pathologic stage is determined for two reasons: choice of treatment (surgical-radiotherapy-medical) and prognostic evaluation. In early cervical carcinoma the evaluation of pelvic lymph nodes is important. The clinical noninvasive approach using ultrasound, CT, MRI, and lymphography is of limited use because of low accuracy. Therefore, the clinical evaluation has to be performed surgically. This is required in FIGO I and FIGO IIa carcinoma with circumference < 4 cm. If the pelvic nodes are negative a radical hysterectomy is indicated; but if the nodes are positive, this procedure could be avoided and the treatment of choice is pelvic radiotherapy. In some cases radical hysterectomy is performed when the pathology of the lymph nodes is not yet known and subsequent pelvic radiotherapy is performed when the nodes are positive. This sequence of events is a major cause of complications (fistula of the intestinal or the urinary tract, ileus and lymphocysts). Laparoscopic lymphadenectomy may be the method of choice to stage these tumors with minimal discomfort for the patients. This study demonstrates that laparoscopic lymphadenectomy is comparable to open lymphadenectomy in the clinical staging of cervical cancer.

Pelvic Lymph Node Evaluation in Uterine Cervical Carcinoma Using Contrast Enhanced MR Imaging

Pelvic Lymph Node Evaluation in Uterine Cervical Carcinoma Using Contrast Enhanced MR Imaging

The role of radical prostatectomy in the management of prostatic cancer.

The indications for radical prostatectomy must reflect the following: an understanding of the natural history of the disease, the projected life span of the patient, the stage of the disease, and the relative morbidity and efficacy of alternative therapeutic regimens. The integration of clinical stage, histologic grade, and pelvic lymph node evaluation has improved the selection of the ideal candidate for radical prostatectomy. In men with localized disease, there is no evidence that any treatment other than radical prostatectomy produces better control of the primary lesion and of distant metastases than does total surgical excision of the prostate. Recently the morbidity of radical prostatectomy has been reduced by improvements in surgical technique. Intraoperative identification and preservation of the branches of the pelvic plexus that innervate the corpora cavernosa has resulted in long-term postoperative potency rates of 70% without compromising complete excision of the tumor. Thus it appears possible today to preserve sexual function in a majority of patients undergoing radical prostatectomy without compromising the cancer operation, an observation that may encourage more physicians to take greater interest in diagnosing prostatic cancer in young men at a stage when it is still curable.

Sensitivity of computed tomography in evaluation of pelvic lymph node metastases from carcinoma of bladder and prostate

Pelvic lymph node evaluation by computed tomography was correlated with histologic diagnosis in patients with prostate and bladder carcinoma. Based on computed tomography alone, the stage of the carcinomas would have been underestimated in 38 per cent of cases and overestimated in 6 per cent. Over-all, the sensitivity of pelvic CT scanning in detecting lymph node involvement was only 14 per cent with specificity of 89 per cent. Although this series is relatively small and both second and fourth generation scanners were used, the limitations of computed tomography in recognizing minimal nodal disease or microscopic invasion of adjacent organs is reemphasized.

Computed tomography in the evaluation, staging, and therapy of carcinoma of the bladder and prostate.

Computed tomography was performed in 24 patients with bladder carcinoma, 29 patients with prostate carcinoma, and one patient with simultaneous bladder and prostate carcinoma. In nine patients (16%), the stage of the carcinoma would have been underestimated based on CT alone. Six of these nine patients had only microscopic or laboratory evidence (elevated serum acid phosphatase level) of more widespread disease than what was demonstrated by CT. The overall accuracy of pelvic lymph node evaluation by CT was 79% in 34 patients. The 21% inaccuracy arises from five false-negative cass in which there was microscopic involvement within normal-sized nodes (4 patients) or only minimally enlarged (2.0 cm or less) nodes (1 patient), and two false-positive cases related to benign changes in nodes. CT was unable to differentiate Stage A, B1, and B2 bladder tumors. CT was used in planning portals for 16 patients who underwent external beam radiation therapy. CT was also used to measure the volume of the prostate prior to placement of 125I seeds for therapy, and to assess the positioning of the seeds.

The Value of Computerized Tomography in Evaluation of Pelvic Lymph Nodes

To assess the accuracy of computerized tomography in the preoperative detection of pelvic lymph node enlargement we evaluated prospectively 23 patients with potentially resectable cancer of the prostate. Subsequent staging pelvic lymphadenectomy revealed falsely negative studies in 7 patients and a falsely positive study in 1. The inaccuracy of computerized tomography mitigates against its use as a preoperative staging modality and confirms the value of pelvic lymphadenectomy as a means of detecting pelvic lymph node enlargement in patients with cancer of the prostate.