Excised Lymph Nodes Research Articles

Sentinel lymph node biopsy in patients with malignant melanoma: analysis of post‐operative complications

This study investigates the incidence of post-operative complications and risk factors of sentinel lymph node biopsy (SLNB) in melanoma patients. A retrospective cohort study was conducted at a single cancer institution on 408 consecutive SLNBs. Fifty-five post-operative complications occurred in 39 (9.5%) patients and included: wound infection in 24 (5.9%), seroma and lymphorrhea in 15 (3.7%), wound dehiscence in seven (1.7%), lymphocele in six (1.5%) and others in three (0.7%). Univariate analysis failed to identify possible risk factors (i.e. gender, age, lymph node region, number of excised lymph nodes, Breslow index, pT levels, comorbidities, length of surgery and hospital stay). Metastatic sentinel nodes occurred in four of 135 (3%) patients with thin melanoma (Breslow <1 mm) and in 68 of 262 (25.9%) patients with Breslow >1 mm. For patients with thin melanoma in whom the incidence of lymph node metastasis is low, the reported post-operative morbidity of almost 10% of SLNB highlights the need for careful patient selection.

Dynamical lymphadenectomy as a component of multidisciplinary approach while doing operative interventions for pancreatic cancer

Objective. To improve the results of treatment of pancreatic cancer, using modification of volumes of lymphadenectomy and application of multidisciplinary approach.&#x0D; Materials and methods. Into the investigation 16 patients, suffering a moderately differentiated (G2) adenocarcinoma of the pancreatic gland head (II stage of the disease) were included. There were 10 men and 6 women. The average age of the patients have constituted 62.4 yrs old. The patients were divided into two groups – the main and the comparative one, equally - by 8 of every group. In all the patients pancreaticoduodenal resection was done. All the patients in postoperative period have obtained gemcitabine in combination with 5-fluorouracyl. In patients of the main group a dynamical personalized intraoperative lymphadenectomy in accordance to our elaborated scheme, was performed. In patients of the comparison group lymphadenectomy was performed in accordance to the volumes adjusted, and it is called a standard one.&#x0D; Results. Average duration of the operation have constituted (347 ± 48) min, lymphadenectomy – (42 ± 12) min in the main group, and (31 ± 9) in the comparison group. Average volume of the blood loss have constituted (342 ± 272) ml. Average duration of hospitalization have constituted (8.2 ± 4.3) days, general rate of postoperative complications – 24.3% in both groups. After the operation the mortality was absent.&#x0D; Clinically significant lymphorrhea was observed in 3 patients in the main group, and in 5 – from the comparison group. In patients of the main group 9 ± 2 lymph nodes were excised, and in a comparative one – 13 ± 2, there were revealed 7 ± 1 (77.7%) and 9 ± 2 (60%) lymph nodes affected, accordingly. Postoperative diarrhea have occurred in 4 patients: in 3 – from comparative group, and in 1 – from the main group. Duration of the recurrence-free period in the main group have constituted (18 ± 2.3) mo, and in a comparative one – (13 ± 1.5) mo. Two years have survived 12/16 (75%) patients. In the main group one patient died, and in a comparative one - 3. The two-year survival in the main group have constituted 87.5%, and in a comparative one – 62.5%.&#x0D; Conclusion. Dynamical lymphadenectomy as a component of multidisciplinary approach gives possibility to reduce the quantity of the lymph nodes excised, unaffected by the tumor, to enhance the quantity of the excised lymph nodes trustworthily affected by the tumor, to lower the morbidity rate and to prolong the duration of the recurrence free period.

Lymph node ratio has impact on relapse and outcome in patients with stage III melanoma.

Even though both the involvement of regional lymph nodes and the number of metastatic lymph nodes are regarded as major determinants of survival in cutaneous melanoma, the extent of node dissection has been analyzed as an independent prognostic indicator in only a few studies. This study aims to determine how the lymph node ratio (NR) (ratio of positive nodes to total nodes removed) might predict the disease relapse and survival in node-positive melanoma. A total of 317 patients with stage III primary melanoma were included in the study and reviewed retrospectively. All patients had nodal staging (N) by radical lymph node dissection. Patients were divided into three groups based on NR1 ≤ 10%, NR2 10-25%, and NR3 > 25%. The median age was 50years (range 16-86) and men were predominant (59.3%). The majority of the patients had thicker Breslow depth (> 2mm) (83.3%), higher mitotic rate (> 2/mm2) (64.1%) and ulcerated lesions (69.4%). The median number of positive nodes was 1 (range 1-32). The largest group was N1 (52.4%), which was followed by N2 (29.6%) and N3 (18%). The ratios of patients were 37.5%, 35.3%, and 27.1% in NR1, NR2, and NR3, respectively. The median number of excised lymph nodes was 13 (range 1-73). For all patients the estimated 5-and 10-year relapse-free survival (RFS) rates were 41% and 39%, respectively; and the estimated 5-and 10-year overall survival (OS) rates were 51% and 42%, respectively. Nodular histopathology, ulcerated lesions, higher mitotic rates, and higher node substages were the independent variables that were inversely correlated with survival for all patients; and NR was one of the significant prognostic factors and strongest predictors of relapse and survival (p = 0.03 and p = 0.01, respectively). Our results suggest that, apart from the conventional nodal status, NR is an independent prognostic factor-regarding both RFS and OS in stage III cutaneous melanoma.

Abstract P2-14-15: Breast cancer-related lymphedema: Morbidity of sentinel node biopsy

Abstract Purpose: Sentinel lymph node biopsy (SLNB) lowers morbidity of lymphedema then axillary lymph node dissection (ALND). However, there has been concern about incidence of lymphedema after SLNB especially when the number of harvested nodes during sentinel node biopsy procedure is more than a few. In this study, we assessed lymphedema incidence and its risk factors including the number excised lymph nodes in patients who underwent SLNB. Methods: Between January, 2011 and April, 2012, the records of 910 consecutive patients who underwent breast surgery with axillary staging (SLNB/ALND) for breast cancer at Seoul National University Hospital were reviewed. Lymphedema was assessed by circumferential upper extremity measurements. The lymphedema was defined as &amp;gt; 1cm for either the upper arm or the forearm. Patients with clinical records of the treatment for lymphedema in the rehabilitation clinic were regarded as having lymphedema. Univariate and multivariate analyses were performed to identify potential risk factors associated with lymphedema. Association of number of excised lymph nodes with lymphedema was analyzed by Spearman rank correlation coefficient. Results: At median follow-up of 69.8 months, 231 patients (25.4%) presented with lymphedema. In univariate analysis, body mass index (BMI) (P&amp;lt;0.001), T stage (P&amp;lt;0.001), N stage (P&amp;lt;0.001), type of surgery (P&amp;lt;0.001), ALND (P&amp;lt;0.001), neoadjuvant chemotherapy (P&amp;lt;0.001) and adjuvant chemotherapy (P=0.027) were significantly associated with lymphedema. In multivariate analysis BMI (P&amp;lt;0.001), ALND (P&amp;lt;0.001), neoadjuvant chemotherapy (P=0.044), and radiation therapy (P=0.046) were significantly associated with lymphedema. In patients treated with SLNB only (n=595), the incidence of lymphedema was 16.3% (n=97). In SLNB only subgroup, BMI was only significant risk factor of lymphedema. There was no correlation between number of excised lymph nodes during sentinel lymph node biopsy procedure with incidence of lymphedema (P=0.138). Conclusion: The risk of lymphedema is multifactorial in breast cancer surgery and adjuvant treatments. In SLNB alone patients, higher BMI was only significant factor correlated with lymphedema. Excised number of lymph nodes during sentinel biopsy procedure was not associated with lymphedema. Citation Format: Ju YW, Jung JG, Kim KE, Kim Y, Lee E, Lee H-B, Moon H-G, Han W, Noh D-Y. Breast cancer-related lymphedema: Morbidity of sentinel node biopsy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-14-15.

The use of single-photon emission computed tomography-computed tomography in detecting multiple metastatic lymph nodes in patients with breast cancer.

The aim of the present study was to determine the accuracy of single-photon emission computed tomography-computed tomography (SPECT-CT) with technetium-99m-sestamibi (Tc-MIBI) for detecting multiple (>2 nodes) axillary lymph node involvement in patients with breast cancer (BC). A total of 184 women with BC were examined. Clinically, axillary lymph nodes were classified as N0 in all cases. Patients underwent SPECT-CT breast and axillary region imaging 10-15 min after a 740 mBq intravenous injection of Tc-MIBI. SPECT-CT data were then verified by definitive histopathological examination (sentinel-node biopsy and/or axillary lymph node dissection were used as reference standard). Diagnostic values of different CT and SPECT signs of multiple (>2) lymph node involvement were evaluated. Histological examination of excised lymph nodes showed metastatic involvement in 62 (33.7%) out of 184 patients. In fact, 25 (13.6%) patients had more than two lymph node involvements. In another 37 (20.1%) cases the metastasis was revealed in one or two sentinel lymph nodes only. The main SPECT-CT criteria of multiple (>2) lymph node involvement were as follows: the maximum size of the primary tumor (>20 mm), lymph node dimensions (>12 mm along the long axis and >10 mm along the short axis), nodal cortical thickness (>4 mm), round shape, solid structure, quantity of identified abnormal lymph nodes (>1), and intensity of tracer uptake. The developed integrated model offers the possibility to exclude multiple lymph node metastasis (>2) in BC patients with a probability of 99%. This single-center study showed that in patients with BC, a combination of functional and anatomical data that were obtained by using SPECT-CT with Tc-MIBI can significantly improve detectability of multiple (>2) axillary metastases.

Topographical distribution of sentinel nodes and metastases from T1–T2 oral squamous cell carcinomas

ObjectiveThe objective is to investigate the topographical distribution of sentinel nodes (SNs) and lymph node metastases in T1-2cN0 oral squamous cell carcinomas (OSCCs). MethodsThe study entailed a prospective enrolment of 220 patients with clinical T1-2N0 OSCCs who underwent preoperative lymphoscintigraphy (LSG) followed by gamma probe–guided sentinel lymph node biopsy (SLNB). Patients with positive SNs were treated with completion neck dissection. Excised lymph nodes were grouped into the neck level according to the international guidelines. ResultsThe SN detection rate by LSG was 99.1%. Patients with midline tumours had bilateral lymphatic drainage on LSG in 15/21 (71.5%). There were 45/199 (22.6%) patients with lateralised tumours that had unexpected bilateral or contralateral drainage patterns on LSG. Fifty-five patients (25.0%) were SLNB positive, and metastases were found in 72/781 (9.2%) of the excised SNs. Metastatic involvement of neck level IV was rare and only observed in patients with anterior tongue cancer. No patients had level V involvement. Eleven patients developed isolated cervical recurrences, with no new primary tumour as origin. The SLNB procedure ensured an overall sensitivity of 83.3% and a negative predictive value of 93.3%. ConclusionCompletion neck dissection of level I–III in SLNB-positive patients might be sufficient in most patients with OSCC except patients with anterior tongue cancer, but further studies are needed to support this potential therapeutic algorithm. Our study showed that SLNB was helpful in clarifying unexpected bilateral or contralateral metastatic drainage patterns. In our cohort, 8/55 patients with occult metastasis would have been missed by elective neck dissection of the ipsilateral neck.

Association Between Lymph Node Ratio and Recurrence and Survival Outcomes in Patients With Oral Cavity Cancer

Oral cavity squamous cell carcinoma (OCSCC) is associated with often-delayed clinical diagnosis, poor prognosis, and expensive therapeutic approaches. Prognostic accuracy is important in improving treatment outcomes of patients with this disease. To assess lymph node ratio (LNR) and other factors in estimating response to treatment and provide prognostic information helpful for clinical decision making. A retrospective cohort study was conducted from January 1, 2000, to December 31, 2015, at an academic hospital in Denver, Colorado. Participants included 149 patients with primary OCSCC who received curative-intent surgery and/or postoperative adjuvant therapies. Analysis was performed from December 8, 2017, to August 15, 2018. Overall survival (OS), disease-free survival (DFS), locoregional disease-free survival (LRDFS), and distant metastasis-free survival (DMDFS) adjusted for known prognostic risk factors, as well as correlation of LNR with other histopathologic prognostic factors. Of the 149 patients included in analysis, 105 were men (70.5%); the median age at diagnosis was 59 years (range, 28-88 years). Using the Kaplan-Meier method, the 5-year survival estimates for OS rate was 40.4% (95% CI, 31.3%-49.3%); DFS, 48.6% (95% CI, 38.6%-58.0%); LRDFS, 57.7% (95% CI, 46.6%-67.2%); and DMDFS, 74.7% (95% CI, 65.1%-82.0%). The median follow-up was 20 months for all patients and 34.5 months (range, 0-137 months) for surviving patients. Nonwhite race (hazard ratio [HR], 2.15; 95% CI, 1.22-3.81), T3-T4 category (HR, 1.99; 95% CI, 1.18-3.35), and LNR greater than 10% (HR, 2.71; 95% CI, 1.39-5.27) were associated with poorer OS. Nonwhite patients also had higher risk of locoregional failures (HR, 2.47; 95% CI, 1.28-4.79), whereas women were more likely to have distant metastasis (HR, 2.55; 95% CI, 1.14-5.71). Floor-of-mouth subsite had fewer locoregional recurrences than did other subsites (HR, 0.45, 95% CI, 0.21-0.99). An LNR greater than 10% independently was associated with worse OS (HR, 2.71; 95% CI, 1.39-5.27), DFS (HR, 2.48; 95% CI, 1.18-5.22), and DMDFS (HR, 6.05; 95% CI, 1.54-23.71). The LNR was associated with N-stage (Cramer V, 0.69; 95% CI, 0.58-0.78), extracapsular extension (Cramer V, 0.55; 95% CI, 0.44-0.66), lymphovascular invasion (Cramer V, 0.46; 95% CI, 0.27-0.61); number of excised lymph nodes (Cramer V, 0.24; 95% CI, 0.06-0.37), margin (Cramer V, 0.22; 95% CI, 0.05-0.38), and tumor thickness combined with depth of invasion (Cramer V, 0.25; 95% CI, 0.05-0.38). Locoregional treatment failure remained the predominant pattern of failure. An advanced pathologic stage and nonwhite race were found to be associated with worse outcomes. The findings from this study suggest that LNR is the most robust prognostic factor and appears to have implications for risk stratification in this disease.

Hypofractionated whole breast radiotherapy with or without hypofractionated boost in early stage breast cancer patients: a mono-institutional analysis of skin and subcutaneous toxicity.

Our study evaluated skin and subcutaneous toxicity analyzing its correlation with patient- and treatment-related factors in a large mono-institutional series of women with early stage breast cancer treated with adjuvant hypofractionated whole breast radiotherapy (WBRT) with or without a sequential hypofractionated boost (HB). Two hundred and nineteen patients, median age 62years, received adjuvant hypofractionated WBRT in 16 fractions to a total dose of 42.4Gy. Patients with negative prognostic factors received a HB of 2.65Gy for 4 or 5 (patients with focal positive surgical margins) fractions. Systemic adjuvant treatments were hormonal therapy (HT) and/or chemotherapy (CHT) and/or Trastuzumab. Toxicities were assessed using the Common Terminology Criteria for Adverse Events (CTCAE 4.03) scale at 5th, 10th, 16th, 20th day from the start of radiotherapy (RT) and 1, 6 and 12months after the end of RT. Univariate and multivariate analysis estimated toxicity predictive factors. No case of treatment interruption and no acute or late G3 toxicities occurred. In the univariate analysis HB administration resulted a risk factor for acute toxicity, while CHT administration and number of excised lymph nodes ≥ 10 resulted a risk factor for late toxicity. In the multivariate analysis none of the evaluated factors emerged a risk factor for acute and/or late toxicity. Our results confirmed that hypofractionated WBRT even followed by a HB resulted safe and well tolerated. Longer follow-up is warranted to estimate late toxicity and treatment outcomes.

Spectrum of Haematological malignancies managed at tertiary centre: A one-year retrospective review

Introduction: Hematological malignancies are not uncommon and all ages and genders are affected. Hematological malignancies are a group of cancers that arise from a malignant transformation of cells of the bone marrow or lymphatic system. There are several classification systems for Hematological Malignancies. The WHO classification was the first worldwide consensus classification on hematological tumors.&#x0D; Methods: We retrospectively collected data from the Department of Pathology and Hematology Unit of Internal medicine from 2015 to 2016. Hematological malignancies were analyzed clinically and with laboratory parameters. They were initially analyzed with complete blood counts and peripheral smear and diagnosed on the basis of Bone marrow morphological assessment, Immunophenotyping and cytogenetic and molecular markers and histopathology and Immunohistochemistry of Excised lymph node when applicable. Plasma cell dyscrasias were assessed clinically for features of CRAB (hypercalcemia, renal impairment, anemia and lytic lesion) and evaluation was done by hemogram, biochemical parameters and skeletal survey. Later plasma cell dyscrasias was diagnosed on the basis of bone marrow study, Immunofixation electrophoresis, serum free light chain assay, serum protein electrophoresis and myeloma defining events.&#x0D; Results: There were 110 cases of hematological neoplasm from Feb 2015 till Jan 2016. Lymphoid neoplasm was the commonest hematological malignancies with 60.9% followed by myeloid neoplasm of 37.3% then histiocytic neoplasm of 1.5%. Median age at diagnosis for all Hematological malignancies was 55 years of age. In patients under 20 years of age, T ALL and LCH accounted each with o.9%. In young adult Patient, NHL was the most common HM whereas; MPN was the most common HM in adults. In older patients, PCN was the most common HM. Male were more prevalent than female in Hematological malignancies. Male accounted for 73.6% and female were 26.4% with male female ratio 2.7:1. In both male and female, Lymphoid Neoplasm was most frequent HM. In male PCN was the most frequent HM. In female, NHL, PCN and MPN was the most frequent HM. Lymphoid neoplasm included Mature B cell Neoplasm (MBCN) 43.6%, Acute Lymphoblastic Leukemia (ALL) 7.3%, Hodgkins Lymphoma (HL) 5.5% and Mature T cell Neoplasm (MTCN) 3.6%. Plasma cell Neoplasm (PCN) (29%) was the commonest lymphoid neoplasm. Among the myeloid neoplasm (MN), Myeloproliferative neoplasm (MPN) accounted 19.1% followed by acute myeloid leukemia (AML) with 14.5% then Myelodysplastic syndrome (MDS) 4.5%. Chronic Myeloid Leukemia (CML) is the commonest HM among different subtypes of MPN.&#x0D; Conclusion: HM can occur at any age group with median age at diagnosis of 55 years. Overall men are more affected with HM than women. In both male and female Lymphoid malignancies are frequent HM. There is difference in distribution pattern and subtypes of Hematological malignancies at different age group.

Lymph node density in papillary thyroid carcinoma is a prognostic factor after adjusting for pathological stage.

We investigated the possible association between the lymph node density and survival outcomes in differentiated papillary thyroid carcinoma, and examined whether the lymph node density was a predictor in a multivariate analysis adjusted for the pathological stage in the eighth edition of the Union for International Cancer Control Tumor-Node Metastasis Classification of Malignant Tumors. A total of 543 patients with papillary thyroid carcinoma were enrolled. We performed restaging according to the eighth edition. The lymph node density was the ratio between number of positive lymph nodes and total number of excised lymph nodes. A log-rank test and Cox's proportional hazards model were used for univariate and multivariate analysis with adjustment for the pathological stage in the eighth edition, respectively. In both the univariate and multivariate analyses of 150 patients with pN1bM0, the presence of a lymph node density of ≥ 0.3 with pN1b was significantly associated with shorter disease-specific survival. In both the univariate and multivariate analyses of all 543 patients, a lymph node density of ≥ 0.3 with pN1b were also significantly associated with shorter overall and disease-specific survival. In conclusion, these results suggest that the lymph node density can be used as a predictor for the survival outcomes after adjustment for the pathological stage in the eighth edition.

The Effects of Body Mass Index on Lymph Node Dissection and Complications in Total Gastrectomy

Objective; The aim of this study was to investigate the effects of body mass index (BMI) on postoperative complications and on the total number of excised and metastatic lymph nodes in cases with total gastrectomy + D2 lymph node dissections because of gastric cancer.&#x0D; Methods: The patients were divided into three groups according to their BMI: those with BMI of 24.9 (kg/m2) and less were normal (Group 1), those with BMI between 25 and 30 (kg/m2) were overweight (Group 2), and those with BMI greater than 30 (kg/m2) were obese (Group 3).&#x0D; Results: There were 27 patients in Group I, 28 in Group 2 and 25 in Group 3. When the groups were examined, only Group 3 had a higher rate of comorbidity. Otherwise, the clinical characteristics and the rates of intraoperative and postoperative complications were similar among the groups. The pathological analyses conducted among the groups revealed that BMI had no effect on the number of excised lymph nodes, the number of metastatic lymph nodes, and the ratio of metastatic lymph nodes to excised lymph nodes.&#x0D; Conclusion: We believe that BMI does not affect pathological outcomes in gastric cancer surgery and does not increase surgical complications.

Lymph node ratio as an alternative to pN staging for predicting prognosis after neoadjuvant chemotherapy in breast cancer

Axillary nodal status is one of the most important prognostic factors in breast cancer. The lymph node ratio (LNR) has been suggested as an independent prognostic factor because the number of dissected and involved lymph nodes might differ across institutions. Neoadjuvant chemotherapy (NAC) has been the preferred treatment method for reducing tumor mass in the breast and axillary area. However, NAC can reduce total number of excised lymph nodes compared with upfront surgery. Therefore, an emerging question is whether axillary nodal status and LNR following NAC can accurately predict prognosis. We evaluated the prognostic value of axillary nodal status and LNR after NAC. A total of 236 patients were enrolled. Patients were divided into four groups according to the following cut-off values for LNR: 0 (n = 107), 0.01–0.20 (n = 68), 0.21–0.65 (n = 50) and >0.65 (n = 11). Pathologic complete responses were observed in 16.9% of the overall cohort. In univariate analysis, pathologic N stage was a significant prognostic factor of disease free survival (DFS, p = 0.013) and overall survival (OS, p = 0.004). However, in multivariate analysis, hormone receptor status (p = 0.043) and LNR (p = 0.028) were significantly associated with DFS and LNR (p = 0.017) showed statistical significance for OS; however, pathologic N stage was no longer significantly associated with DFS or OS. Traditional nodal staging has been accepted as an important prognostic factor; however, our result indicated that the nodal ratio could be an alternative to pN staging as a prognostic factor after NAC in breast cancer.

Next-Generation Functional Drug Screening for Patients with Aggressive Hematologic Malignancies

Background. Patients with aggressive hematologic malignancies failing at least two lines of therapy are without further standard treatment options and have a poor prognosis. Identifying effective therapies with genomic-based precision medicine is hampered by intratumor heterogeneity and incomplete understanding of the contribution of various mutations within specific cancer phenotypes. Next-generation functional drug screening (ngFDS) in patient samples promises to overcome these challenges, however, proof of its clinical utility is limited.Methods. We investigated the feasibility and clinical impact of ngFDS measured at single-cell resolution using high-throughput automated microscopy in blood, bone marrow, pleural effusions, or excised lymph node biopsies (Figure 1A and Valdimer G et al. Nat Chem Biol. 2017). First, the accuracy of ngFDS to predict clinical outcome was evaluated in a retrospective cohort of 20 previously untreated patients with acute myeloid leukemia (AML). Then, 48 patients with aggressive hematologic malignancies failing at least two lines of treatment were prospectively evaluated for ngFDS guided therapy, of which 17 could receive ngFDS-guided treatment. Individual ngFDS-guided treatment regimens were selected by a committee (EXALT-board) of hemato-oncologists, pathologist, and pharmacists based on top-candidate treatments identified by ngFDS, considering drug availability as well as safety profiles of single agents and previously reported combinations (Figure 1B). The majority of these patients (12/17) presented with aggressive lymphoma and had seen in median three (2-7) prior treatment lines (Figure 2A). Overall response rate (ORR) and progression-free survival (PFS) of ngFDS-guided treatment were compared with ORR and PFS for the most recent regimen (MRR) on which patients had previously progressed.Results. ngFDS accurately predicted individual clinical response of AML patients to initial therapy. From prospectively analyzed patients receiving ngFDS guided treatment the ORR-ngFDS was 88% (15/17) compared to ORR-MRR of 24% (4/17; P<0.0004). Twelve (70%) of 17 patients had a PFS ratio of ≥1.3 and the mean PFS increased 3.9-fold, from 5.7 weeks to 22.6 weeks (P<0.007) (Figure 2B). Furthermore, analysis of an independent cohort revealed that ngFDS could positively and negatively predict patients' outcome to drug treatment.Conclusions. Automatedmicroscopy-based ngFDS is feasible and accurately predicts clinical response. It can successfully guide personalized treatment of aggressive refractory hematological malignancies. [Display omitted] DisclosuresStaber:Takeda: Honoraria; Abbie: Honoraria, Membership on an entity's Board of Directors or advisory committees; Roche: Honoraria, Membership on an entity's Board of Directors or advisory committees; MSD: Honoraria; Amgen: Honoraria; Gilad: Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Morphosys: Membership on an entity's Board of Directors or advisory committees. Snijder:Allcyte: Equity Ownership, Other: founder and shareholder of Allcyte GmbH that holds a worldwide exclusive license for and commercializes the Pharmacoscopy high content imaging technology.. Vladimer:Allcyte Gmbh: Equity Ownership. Krall:Allcyte Gmbh: Equity Ownership. Hoermann:Ariad: Honoraria; Novartis: Honoraria; Amgen: Honoraria; Gilead: Honoraria, Research Funding. Sperr:Teva: Honoraria; Meda: Research Funding; Celgene: Consultancy, Honoraria; Amgen: Consultancy, Honoraria, Research Funding; Phadia: Research Funding; Novartis: Other: Register. Gisslinger:Janssen Cilag: Honoraria; Takeda: Honoraria; Shire: Honoraria; PharmaEssentia: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; AOP Orphan Pharmaceuticals AG: Consultancy, Honoraria. Valent:Incyte: Honoraria; BMS: Honoraria; Pfizer: Honoraria; Deciphera: Honoraria, Research Funding; Novartis: Honoraria, Research Funding; Ariad: Honoraria, Research Funding; Teva: Honoraria; Celgene: Honoraria, Research Funding; Blueprint: Research Funding. Jaeger:Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses; Novartis Pharmaceuticals Corporation: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations, Expenses. Superti-Furga:Allcyte GmbH: Equity Ownership.

Association of Lymph Node Density With Survival of Patients With Papillary Thyroid Cancer

Lymph node metastases are common in papillary thyroid cancer (PTC), yet the impact of nodal metastases on survival remains unclear. Lymph node density (LND) is the ratio between the number of positive lymph nodes excised and the total number of excised lymph nodes. Lymph node density has been suggested as a prognostic factor in many types of cancer. To evaluate the prognostic role of LND in PTC. This cohort study reviewed medical records of patients with PTC who were treated at the University of Texas MD Anderson Cancer Center between January 1, 2000, and December 31, 2015. Survival and recurrence outcomes were calculated by using the Kaplan-Meier method. Significant variables on univariate analysis were subjected to a Cox proportional hazards regression multivariate model. Primary study outcome was disease-specific survival (DSS); other measurements included overall survival (OS). The study cohort included data for 2542 patients (1801 [71%] male; median age, 48 years [range, 18-97 years]) with a median follow-up of 55 months (range, 4-192 months). The 10-year disease-specific survival rate was 98% for patients with LND of 0.19 or less, compared with 90% for those with LND greater than 0.19 (effect size, 8%; 95% CI, 4%-15%). The 10-year overall survival was 87% for patients with LND of 0.19 or less, compared with 79% for patients with LND greater than 0.19 (effect size, 8%; 95% CI, 3%-15%). Multivariable analysis revealed that LND greater than 0.19 was independently associated with an adverse DSS (hazard ratio [HR], 4.11; 95% CI, 2.11-8.97) and OS (HR, 1.96; 95% CI, 1.24-4.11). Subgroup analysis of patients with 18 or more lymph nodes analyzed revealed that LND greater than 0.19 remained a significant marker for DSS (HR, 2.94; 95% CI, 1.36-9.81) and OS (HR, 2.26; 95% CI, 1.12-5.34). Incorporating LND into the current American Joint Committee on Cancer staging system successfully stratified risk groups compared with the traditional TNM staging system. This single-institute study demonstrates the reproducibility of LND as a predictor of outcomes in PTC. Lymph node density can potentially assist in identifying patients with poorer survival who may benefit from more aggressive adjuvant therapy.

PERIPHERAL LYMPH GLANDS;

Background: Enlarged lymph glands almost always represent a local or systemicdisease that may be benign or malignant. We see many patients including the referred onesin our OPD clinic and subsequently do the excision of quite a big proportion of the enlargedglands especially the cervical glands. Study Design: Descriptive study. Setting: Retrospectby reviewing the operative and histopathology department of King Edward Medical University.Period: April 2016 to April 2017. Methods: We will analyse the record of 121 patients who hadperipheral lymph gland enlargement and presented to us. Results: Ours results show that themean age of our patients was 25.03±18.06 years. We found that 40% of our patients had adefinitive diagnosis from the histopathology of excised lymph nodes while 35.5% of the patientshad reactive hyperplasia and 25% of the patients had inconclusive results and we were unableto help them. Conclusion: Our results conclude that the lymph nodes are a very good source ofgetting the diagnosis especially the cervical lymph nodes with a diagnostic yield of 76.4% andwe may need to have a more robust criteria for excising the peripheral lymph glands in order toimprove the diagnostic yield from 40%.

Identifiable Risk Factors for Lymph Node Metastases in Grade 1 Endometrial Carcinoma.

The aim of this study was to evaluate the clinicopathological features related to lymph node metastases in grade 1 endometrial carcinomas. Five hundred ninety-nine cases of endometrial carcinoma treated with total hysterectomy bilateral salpingo-oophorectomy and pelvic lyphadenectomy between 2001 and 2015 were retrieved from the pathology files of IASO Women's Hospital, Athens, Greece. Of these, 345 were grade 1 endometrioid carcinomas and were included in the study. Features such as the age of the patients, the stage, the location, and size of the tumors, as well as the existence of microcystic, elongated, and fragmented pattern invasion or lymph vascular space invasion, were estimated. In our cohort of endometrial carcinomas, features related to an increased risk of lymph node metastases were stages IB or higher; the location of the tumor in the lower uterine segment; the identification of microcystic, elongated, and fragmented pattern of invasion; and the existence of lymph vascular emboli. When considering the size of the tumors, only stage IA myoinvasive cancers of larger than 4 cm in diameter were significantly associated with nodal disease. In addition, a statistically significant relationship was found between the number of excised lymph nodes and the possibility to detect nodal disease. Full surgical staging carries a substantial risk of operative complications, and, indeed, it can be avoided in most cases of grade 1 endometrial carcinomas. Nevertheless, even in the low-risk group of patients, there are clinicopathological parameters that should alert the clinician for the possibility of a more disseminated disease.

English

Background: Enlarged lymph glands almost always represent a local or systemicdisease that may be benign or malignant. We see many patients including the referred onesin our OPD clinic and subsequently do the excision of quite a big proportion of the enlargedglands especially the cervical glands. Study Design: Descriptive study. Setting: Retrospectby reviewing the operative and histopathology department of King Edward Medical University.Period: April 2016 to April 2017. Methods: We will analyse the record of 121 patients who hadperipheral lymph gland enlargement and presented to us. Results: Ours results show that themean age of our patients was 25.03±18.06 years. We found that 40% of our patients had adefinitive diagnosis from the histopathology of excised lymph nodes while 35.5% of the patientshad reactive hyperplasia and 25% of the patients had inconclusive results and we were unableto help them. Conclusion: Our results conclude that the lymph nodes are a very good source ofgetting the diagnosis especially the cervical lymph nodes with a diagnostic yield of 76.4% andwe may need to have a more robust criteria for excising the peripheral lymph glands in order toimprove the diagnostic yield from 40%.

Value of 18F-FDG PET/CT in staging of pancreatic cancer

Objective To evaluate the value of 18F-FDG PET/CT in tumor staging in patients with pancreatic cancer. Methods A total 77 patients (from June 2010 to August 2015; 44 males, 33 females, age range 36-83 years) who underwent 18F-FDG PET/CT examination for pancreatic cancer and confirmed with pathology were enrolled in this retrospective study. All patients had not been treated before the PET/CT scanning and received surgery or biopsy 4 weeks after the scanning. Two-sample t test and ROC curve analysis were used for data analysis. Results 18F-FDG uptake was higher in 94.8%(73/77) of pancreatic lesions than that in normal pancreatic tissue. The range of SUVmax of pancreatic lesions was 2.4-13.4(mean: 6.2±2.4). SUVmax of patients with smaller primary lesion (minor axis≤2.0 cm) was significantly lower than that of larger lesion group (minor axis >2.0 cm; t=-2.661, P<0.05). A total of 46 patients underwent lymph node excision, and the mean number of excised lymph nodes per patient was 13.8±9.2. About 56.5%(26/46)cases with lymph nodes metastases were confirmed with pathology. When the cut-off value of minor axis of regional lymph nodes was 0.45 cm, ROC curve showed that the sensitivity, specificity and AUC were 84.8%(39/46), 65.2%(30/46) and 0.788, respectively. When the cut-off value of SUVmax of regional lymph nodes was 2.05, the sensitivity, specificity and AUC were 54.3%(25/46), 80.4%(37/46) and 0.759, respectively. 18F-FDG PET/CT changed 18.2%(14/77)of patients′ treatment plan. Conclusions 18F-FDG PET/CT is a useful tool in pancreatic cancer staging. Though 18F-FDG PET/CT has no significant advantages in N-staging, it really helps to make a more accurate M-staging for clinical decision. Key words: Pancreatic neoplasms; Neoplasm staging; Positron-emission tomography; Tomography, X-ray computed; Deoxyglucose

Lymphoid tissue neoplasms in the neck region - epidemiological and clinical analysis over 15 years.

Epidemiological and clinical analysis of lymphoid tissue neoplasms in the neck region over a 15-year period. There was performed retrospective analysis of 97 patients, aged 17 to 88 years, mean age of 60.3 years. The analysis included data from subjective study, physical examination, image and histopathological studies Results: Almost all cases were lymphoid neoplasms - 95 patients (98%). B cell lymphoma was the most commonly diagnosed lymphoma - 74 cases (76%), followed by Hodgkin&apos;s lymphoma- 19 cases (20%). Only two patients had T-cell lymphoma (2%). There was observed prevalence among women, K: M ratio for the whole group was 51: 46, while male predominance was reported in Hodgkin&apos;s lymphoma patients (K: M = 7: 12). Over the 15-year period, there was an increase in the number of lymphoid tumors. The most common location on the neck were lymph nodes - 71 (73.2%). Extranodal localizations (26.8%) were most often associated with salivary glands: parotid and submandibular involvement and with the dominant lymphoma of the marginal zone MALT (14 cases). In 57% of patients the fine needle aspiration biopsy (FNAB) results were false, with positive results only in 32% of patients. Tumors from lymphoid tissue in the neck region are most commonly B-cell lymphomas or Hodgkin,s lymphomas. Non-specific clinical signs and non-specific radiological images, as well as non-diagnostic results o FNAB, make it difficult to effectively differentiate lymphomas with cancer metastasis in neck lymph nodes. Histopathology results of the excised lymph nodes remains a standard for lymphoma diagnosis.

Role of fibrin glue in seroma reduction after modified radical mastectomy

Background: Seroma is one of the most common morbidity occurring post modified radical mastectomy (MRM). It can delay post-operative initiation of adjuvant therapy. This study was designed to determine the role of fibrin glue spray in reduction of seroma volume and duration after breast surgeries.Methods: A prospective, randomized, controlled study over forty female patients who underwent (MRM) was done. The study cohort was randomized into control group where only conventional drain placement was used and experimental group where double dose of fibrin glue has been sprayed to the axillary and mammary beds plus conventional drain placement. Data regarding the amount of drained fluid in the first post-operative day, hospital stay, length of drain placement, amount and duration of post-operative seroma, number of excised lymph nodes (L. Ns) and pathological results were recorded.Results: No difference in mean age, number of excised L. Ns and rate of post-operative infection between both groups was detected. There was significant reduction in hospital stay time favouring fibrin glue group (p=0.006). Fibrin glue group had a significant reduction in the length of drain placement (p=0.001). The amount of post-operative serous fluid was reduced and the incidence of occurrence of post-operative seroma was (7/20) 35% in control group compared to (1/20) 5% in fibrin glue group giving significant reduction in incidence and amount.Conclusions: Use of fibrin glue sealant during MRM resulted in noticeable and significant decrease of post-operative rate of seroma formation, its amount and the length of drain placement.