Lymph Node Groups Research Articles

Factors Affecting Cervical Lymph Node Suppuration in Oropharyngeal Tularemia Cases.

To determine the factors associated with cervical lymph node suppuration in oropharyngeal tularemia. Observational study. Departments of Infectious Diseases and Clinical Microbiology, Faculties of Medicine, Duzce University and Bolu Abant Izzet Baysal University Turkey, between January 2016 and August 2019. Tularemia was diagnosed in clinically compatible cases by micro-agglutination test (≥1/160 titres). Positive cases were divided into two groups according to development of suppurated and discharging lymph nodes. If the cases did not develop suppuration and discharge lymph nodes, they were defined as completely healed. If they did, they were defined as "suppurated and drained lymph node group." Demographic and clinical characteristics and acute phase reactants of these groups were compared as to investigate any significant difference between the groups. There were 88 tularemia cases in the current study. Of these, 60 cases were completely healed (68.2%) and 28 cases had suppurated and drained lymph nodes (31.8%). Tonsillopharyngitis was found significantly lower in suppurated and drained lymph node group compared to the completely healed group (p= 0.016). However, late presentation (>14 days) was found significantly more frequent in suppurated and drained lymph node group compared to the completely healed group (p=0.033). In order to prevent suppurative lymphadenitis in oropharyngeal tularemia, it is advisable to start appropriate antimicrobials within 14 days after the appearance of symptoms. Key Words: Oropharyngeal tularemia, Cervical lymph node suppuration, Antibiotic initiation time.

Evaluation of superior rectal artery Preservation in Sigmoidectomy for sigmiod colon cancer

Background: In the conventional radical treatment of sigmoid colonic cancer, the ligation of root of inferior mesenteric artery is performed to verify harvesting of D2 and D3 lymph nodes (I.e. intermediate and central lymph node groups) and improve the surgical prognosis. IMA ligation may compromise the blood supply at site of anastomosis and risk injury of autonomic nerve plexus, so preservation of superior rectal artery (SRA) may lead to increase blood flow and decrease postoperative bowel complications. Aim of the study: evaluation of SRA preservation in open sigmoidectomy for sigmoid colon cancer as regard impact on both radicality and vascularization in the remaining rectum. Patients and Methods: In this prospective study we do open radical sigmoidectomy on (30 patients) with preservation of SRA for sigmoid colonic cancer to preserve blood supply to the anastomotic site. In the operation, we dissect the trunk of IMA and lymphatic tissue around is dissected out with the tumor. Results: Lymph nodes harvested 15.2, hospital stay average 8 days (7 d-15 d). There was one case of Post operative leak treated conservatively. There were 5 cases complicated of wound infection treated by antibiotics and daily dressings. Recurrence rate (0%), mean follow up time 18 months. Conclusion: SRA can be preserved. Although the operation time is slightly increased, but dissected out lymph nodes are comparable with IMA high ligation surgery. Preservation of the SRA seems to be associated with lowering incidence of anastomotic leakage in sigmoid colonic cancer surgery

Lymph Nodal Metastatic Pattern in Carcinoma Gallbladder with Multidetector Computed Tomography: An Institutional Experience

Objective This work aimed to study the distribution of lymph nodal metastatic pattern in carcinoma gallbladder with multidetector computed tomography (CT). Materials and Methods A retrospective observational study was conducted including 80 patients with carcinoma gallbladder who underwent triple-phase CT angiography or single-phase contrast-enhanced CT scan of the abdomen between January 2019 and November 2019. Results In our study, 75 (93.7%) out of 80 cases showed metastasis to lymph nodes, with distribution as follows: periportal (69), peripancreatic (62), and aortocaval (47). The most common involved combination included all three lymph nodal groups (periportal, peripancreatic, and aortocaval), involving 40 (50%) cases. The combination of only periportal and peripancreatic lymph nodes was seen in 17 (21%) cases. Isolated periportal lymph nodes were seen in eight cases (10%) cases. The combination of only periportal and aortocaval lymph nodes was seen in four (5%) cases. Isolated peripancreatic lymph nodes were seen in three (3.7%) cases. The combination of periportal and aortocaval was seen in four (5%) cases followed by peripancreatic and aortocaval lymph nodes that was seen in two (2.5%) cases. Isolated aortocaval lymph nodes were seen in one (1.2%) case. Conclusion Periportal lymph nodes were the single most commonly involved station followed by peripancreatic and aortocaval lymph nodes. The combination of periportal, peripancreatic, and aortocaval lymph nodes was seen most commonly. The second most commonly involved combination was found to be periportal and peripancreatic lymph nodes followed by isolated periportal lymph nodes.

A clinicopathological study of cervical lymphadenopathy – A hospital-based cross-sectional study

Introduction: The enlargement of lymph nodes is an index of spread of infection and malignancy. Fine-needle aspiration cytology (FNAC) has the ability to provide rapid diagnosis and has good economic saving, reduces patient anxiety, and can be used for patients who have anesthetic risks. Aims and Objectives: The aim of the study is to study the various clinical presentations of cervical lymphadenopathy. Materials and Methods: This study was conducted from June 2019 to August 2020 over a period of 14 months. The study consists of 100 consecutive cases, both outpatients and inpatients at the surgical outpatient/wards at Malla Reddy Institute of Medical Sciences, Hyderabad. In all cases, FNAC was done. Excisional biopsy was done in all 100 cases. Results: The incidence of cervical lymphadenopathy was highest in the 12–40 years age group (73%). Males were more affected than females with a male-to-female ratio of 1.22:1. Tuberculosis was the most common etiology accounting for 51%. Posterior group of cervical lymph nodes were the most common to get involved in tuberculosis (31.3%). Sixteen cases out of 51 cases of tubercular lymphadenitis showed constitutional symptoms. The sensitivity of FNAC for tuberculosis – 86%, chronic nonspecific lymphadenitis – 73.3%, malignant secondaries – 87.5%, and lymphomas – 90%. Histopathological examination is the most dependable diagnostic tool. Conclusion: The most common disease affecting lymph nodes is tuberculosis. Dependence on clinical evidence alone would lead to erroneous diagnosis in most of the cases. FNAC is an important frontline investigation. Histopathological examination remains the most dependable diagnostic tool.

A study on clinical presentation and pathological features of cervical lymphadenopathy

In the present study, all the patients had cervical lymphadenopathy (100%) and 8% had the history of pain and fever 21%. The commonest group of lymph nodes involved is level 5 which accounts for 34% in the present series. In investigation fine needle aspiration cytology was found to be accurate, reliable and cheapest method of diagnosis without any significant morbidity and with good patient compliance. Histopathological examination of the lympnode to confirm the diagnosis before starting the treatment is a must. The patient diagnosed as tuberculous cervical lymphdenitis were on ATT drugs for 6 months. Patient diagnosed as nonspecific cervical lymphadenitis were treated with antibiotics and those diagnosed as secondaries/hodgkins lymphoma and non-Hodgkins lymphoma were given chemotherapy/radiotherapy/ surgery accordingly. With the advent of powerful and effective ATT surgery has limited value in the resent years. Surgery has come as complement to medical treatment but not as a replacement.

Robotic left hemihepatectomy with lymph node dissection for a large intrahepatic cholangiocarcinoma

Purpose: Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver tumor following HCC. The incidence of ICC is low in most parts of the world. However, incidence has been rising. The only curative treatment option involves surgical resection as part of a multidisciplinary treatment. The goal of surgery is to obtain negative section margins while leaving an adequate future liver remnant. The role of regional lymphadenectomy is still debated, as it might add to a higher postoperative morbidity. An expert consensus statement states that regional lymphadenectomy should be considered a standard part of surgical therapy for patients undergoing resection of ICC. Another question remains about the role of minimal invasive surgery for ICC. A laparoscopic approach may lead to lower morbidity without compromising oncological adequacy. However, some doubts remain about the extent of lymph node dissection in laparoscopic approach. This video aims to demonstrate the advantages of a robotic approach using the Da Vinci© XI for left hemihepatectomy with lymph node dissection for a large intrahepatic cholangiocarcinoma. Methods: After screening for hepatic of peritoneal metastases, an extensive lymph node dissection of lymph node groups one and two is performed. Hilar structures are divided selectively. Next, a left hemihepatectomy is performed using the robotic vessel sealer. Finally, the left hepatic vein is divided using a vascular stapler and resection is finished. Results: Operative time was 270 min and blood loss was 20ml. The postoperative course was uneventful and the patient was discharged on postoperative day 3. Pathologic investigation showed an intrahepatic cholangiocarcinoma of 5cm, with tumorfree margins of 17mm. 0/10 lymph nodes were positive. Conclusions: The robotic approach to major hepatectomy with lymph node dissection for intrahepatic cholangiocarcinoma is safe and feasible with an acceptable number of lymph nodes prelevated.

A prospective observational study on lymph node mapping of sentinel lymph node biopsy using methylene blue in carcinoma breast

Background: Modern screening methods has made it possible to diagnose breast cancer in as early stage as possible and axillary lymph node status is still the most important prognostic indicator in carcinoma breast. In this study we are trying to analyse the preference of lymph nodal staining in SLNB using methylene blue in early breast cancer, so that surgeons will be more aware of anatomical positions of the stained nodes, thus favouring more precise dissection, reducing the morbidity.Methods: This was a prospective observational study conducted in the Department of General Surgery, Government Medical College, Kottayam. All cases of clinically N0 carcinoma breast undergoing modified radical mastectomy were included. We injected 3 ml of methylene blue in the subareolar region in three places depending on the quadrant in which tumour was situated, before putting the skin incision for modified radical mastectomy and the pathologist segregated the stained lymph nodes after confirming the anatomical locations.Results: The study here was diagnostic test evaluation and the diagnostic test being evaluated was sentinel lymph node biopsy using methylene blue. Commonest group of lymph nodes, where sentinel lymph nodes were identified were anterior group (30 out of 34 sentinel lymph nodes).Conclusions: Though sentinel lymph node biopsy using methylene blue is not a fool proof method; knowing the mode of methylene blue flow i.e., anterior more than central and then posterior group of lymph nodes will definitely reduce the morbidity involved, and above all saving time of the surgery.

The Value of 18 Fluorine-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Imaging in Breast Cancer Staging

BACKGROUND: Accurate staging is important for management decisions in patients with newly diagnosed breast cancer.
 AIM: This study was conducted to evaluate the value of 18 fluorine-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) imaging in breast cancer staging..
 METHODS: A prospective study of 80 patients (1 male and 79 female) mean age 51.13 years with histologically confirmed breast cancer. The staging procedures included history, physical examination, mammography, and CT of neck, chest, abdomen, and pelvis; then, PET/CT was performed in a time interval <30 days. The findings of PET/CT were compared with those of the other conventional methods.
 RESULTS: The agreement between conventional methods (mammography, breast ultrasound, contrast-enhanced CT of the neck, chest, abdomen, and pelvis) and 18F FDG-PET/CT was 0.6 for assessing the T stage, 0.39 for N stage, and 0.75 for M stage. There was moderate agreement between CT and 18F FDG-PET/CT in the detection of nodal lesions (K=0.6) and pulmonary lesions (K=0.51), while a perfect agreement was noted for detecting osseous (K=0.82) and liver lesions (K=0.81). In total, 50 patients (62.5%) were concordantly staged between the conventional imaging and 18F-FDG PET/CT, while 30 patients (37.5%) showed a different tumor, node, and metastasis stage. The changes were driven by the detection of additional findings (n=26) or exclusion of findings (n=4), mainly at the lymph nodes (LNs) and/or distant sites. Regarding N status, 18F FDG-PET/CT revealed previously unknown regional lymphatic spread in supraclavicular (n=4; 5%), infraclavicular (n=11; 13.7%), and internal mammary (n=12; 15%) lymph node groups. 18F-FDG PET/CT changed M status in a total of four patients (5%); three of them were upstaged by detecting distant metastases, while osseous deposits were excluded in one patient leading to downstaging.
 CONCLUSION: 18F-FDG-PET/CT is considered a valuable imaging tool in the initial staging of breast cancer, which significantly impacts the overall American Joint Committee on Cancer staging in 37.5% of our study population.

Morphological patterns of FNAC of lymph nodes

Introduction: Fine needle aspiration cytology is fast becoming preoperative method of choice for diagnosis and management of various lumps and lesions since few decades. It helps clinician to decide mode of treatment in most cases in both non-neoplastic and neoplastic disorders. The aim of our study was to assess utility of FNAC in the diagnosis and management of lymph node disorders and distribution of these lesions according to different lymph node groups and age and sex distribution of these lesions. Materials and Methods: The present study was done during the period between December 2015 and May 2017 in the department of pathology (central clinical laboratory), Koppal Institute of medical sciences, Koppal. 10ml syringe and 23/24 gauge needles were used for the procedure. Material obtained was expressed on slide and smears were made by standard smearing technique. Both wet and air dried smears were made. Wet smears were stained with Haematoxylin and Eosin stain and dry smears with Lieshman stain and Giemsa stain. Ziehl-Neelson staining for acid fast bacilli was done wherever required. Results: We assessed 204 cases of lymphadenopathy cases. We got satisfactory aspirate in most (97.1%) cases. Cervical group of lymph nodes were most commonly (82%) involved. Granulomatous lesions were most common in young adults and reactive nonspecific lesions were most common in paediatric group. Metastatic carcinomas were most common type after 50yrs age group. Conclusion: Fine needle aspiration is simple, rapid and cost effective method to know the cause of lymphadenopathy. It significantly reduced unnecessary surgical biopsy for diagnosis of lymphadenopathies in our case. Keywords: FNAC, Lymph node, Morphology, Lymphadenopathy.

Spectrum of diseases presenting with lymphadenopathy in elderly: Fine needle aspiration cytology of 60 cases

Introduction: Lymphadenopathy is one of the common clinical presentations in patients of all age group. Lymphadenopathy can be due to reactive or infective cause, but malignancy including metastastic deposits in are not uncommon in elderly. Fine needle aspiration cytology (FNAC) is a useful diagnostic rapider in many mass lesions like lymphadenopathy. Aims and Objectives: Three years study was conducted to know the spectrum of diseases causing enlargement of lymph nodes in elderly patients with age 60 years and above. Materials and Methods: We have collected all the clinical data from the registers from June 2014 to June 2017 in Medical records section, KIMS, Koppal and reviewed FNAC slides of lymph node aspirates of elderly. Results: A total of 60 elderly patients of age 60 years and above with lymphadenopathy were included in this study. Cervical group of lymph nodes were the predominant site for lymphadenopathy. The commonest cause of lymphadenopathy was reactive, seen in 29 patients, followed by 23 patients with metastatic deposits and squamous cell differentiation was commonest type. Tubercular and suppurative lymphadenitis were observed in four cases each. CBNNAT is an useful diagnostic modality in microbiological confirmation of tuberculosis. Males showed preponderance of reactive as well as in metastatic lymphadenopathy. Conclusion: Though reactive lymphadenitis is the commonest cause for enlargement of lymph nodes but metastatic deposits are not uncommon in elderly. FNAC as a diagnostic rapider useful screening tool for all elderly patients presenting with lymphadenopathy. Keywords: Lymphadenopathy, Reactive, Metastatic, FNAC, Tubercular, CBNAAT.

Deaths of colon neuroendocrine tumors are associated with increasing metastatic lymph nodes and lymph node ratio.

Colon neuroendocrine tumors (NETs) are uncommon. Currently, the impact of the number of metastatic lymph nodes (LNs) and lymph node ratio (LNR) on survival has been well investigated in other colon malignancies, but both remain nebulous for patients with colon NETs. Surgically resected patients with histologically proven nonmetastatic colon NETs were queried from the Surveillance, Epidemiology, and End Results database between 1988 and 2011. Patients with lymph nodes involved were investigated and categorized into four LNs-based classifications (≤4, >4-10, >10-13, and >13) or three LNR-based subgroups (≤0.51, >0.51-0.71, and >0.71) according to the threshold, determined by Harrell's C statistic. Univariate and multivariate survival analyses were performed by log-rank test and Cox stepwise regression analysis, respectively. Eight hundred fifty-one patients met the inclusion criteria. Among them, higher LNR and LNs classification are associated with a worse prognosis. The 10-year NETs-specific survival rate was 78.3% (74.2-82.6%), 61.3% (52.4-71.7%), 40.8% (20.7-80.7%) for patients in the ≤4, >4-10, and 10-13 LNs groups, respectively. When patients were classified with LNR, the observed 10-year NETs-specific survival rate was 79.9% (74.8-85.5%) for ≤0.51, 57.4% (43.8-75.2%) for >0.51-0.71, and 40.0% (31.0-51.5%) for >0.71. In stratified analysis, higher LNs and LNR groups have worse prognosis only in patients with advanced T stage (T3-T4). Regarding stage migration, the LNR-based system did not show superiority to LNs-based classification. Current TNM staging classification could be improved by considering the count of metastatic nodes and LNR instead of a simple record of lymph node status (N1 or N0) for colon NETs.

High rate of IIA/IIB neck groups involvement supports complete lateral neck dissection in thyroid carcinoma.

Although therapeutic lateral neck dissection (LND) may be indicated in thyroid carcinoma, the cervical lymph node groups IIA and IIB, according to Robbins classification, are often not removed. The aim of our study was to determine the relevance of complete comprehensive LND in thyroid carcinoma. We conducted a retrospective study between January 2011 and August 2018 in a university teaching hospital. Histopathological analysis of LND performed during total thyroidectomy in thyroid carcinoma was reviewed according to lymph node level. To demonstrate that neck dissection of upper groups, IIA/IIB, is necessary when therapeutic LND is indicated in thyroid carcinoma, we compared histopathological involvement in complete comprehensive LND of the upper groups IIA/IIB to the lower groups III/IV/V. A total of 30 LND (24 patients) were suitable for analysis. Analysis by neck side revealed that comprehensive LND dissection samples were negative in 3 cases, and positive in 27. In those 27 positive LND, 15 demonstrated involvement of the groups IIA/IIB, and 12 were positive for involvement of the III/IV/V groups only. The combined presence of positive IIA/IIB and positive III/IV/V was observed in 15 of the 27 neck sides. There was no positive IIA/IIB without positive involvement of III/IV/V groups. The high rate of positive cervical lymph nodes in the upper groups IIA/IIB supports complete comprehensive LND rather than selective III/IV/V LND in thyroid carcinoma surgery. However, impact on survival and whether postoperative radioactive iodine treatment may be modulated remain to be studied.

Reduced lymphedema after sentinel lymph node biopsy versus lymphadenectomy for endometrial cancer

ObjectiveEndometrial cancer surgical staging includes lymph node assessment which can lead to lower extremity lymphedema. The aim of this study was to estimate prevalence after sentinel lymph node biopsy versus...

Adjuvant radiochemotherapy in locally advanced gastric cancer: from evidence to daily clinical practice in a single institution

BackgroundGastric cancer is one of the main important causes of cancer death in Chile.ObjectiveTo report the results of adjuvant radiochemotherapy in advanced gastric cancer.Material and MethodsBetween 2000 and 2018, 214 subjects aged 23–85 (median, 62) years with lymph node and/or serosa involvement were treated with adjuvant chemoradiotherapy after curative resection.ResultsWith a median follow-up of 41 months, overall 3- and 5-year survival was 54.9% and 40.85%, respectively. On multivariate analysis, the factors associated with lower survival were aged >65 years, stage group and number of lymph nodes involved.ConclusionIn patients with locoregionally advanced gastric cancer treated with curative intent with surgery and adjuvant radiochemotherapy, the overall 5-year survival reported from local clinical practice is similar to that reported in randomised series and supports its use as an effective treatment for this type of patients in our country.

CT and Pathological Control Study on Small Cluster Lymph Nodes Metastases of Esophageal Cancer and Construction of Nomogram Prediction Model

Aim of this study was to explorer the predictor of small cluster lymph nodes metastasis of esophageal cancer and construction of nomogram prediction model. We retrospectively analyzed the 202 patients with pathologically confirmed esophageal cancer from Fujian Provincial Tumor Hospital between January 2008 and December 2009. The clinical and imaging features of preoperative enhanced CT of small clustered lymph nodes in the mediastinal and supraclavicular region were recorded in detail, and compared with postoperative pathological data. We have identified using single factor χ2 test or Fisher's exact test to explorer the predictors of small cluster lymph nodes metastasis of esophageal cancer, and using Logistic multivariate analysis. Based on binary Logistic regression analysis results, a nomogram model was established by using R software. The predicting accuracy of the nomogram was evaluated by C-index and calibration curve. The total of 961 small lymph node stations of 202 patients met with inclusion criteria were observed. The pathological positive rates of small cluster lymph nodes group and small non-clustered lymph nodes group were 55.3%(187/338) and 16.7%(104/623),The difference was statistically significant (P<0.05).Univariate χ2 test or Fisher's exact test showed that histological grading, vascular invasion and the short-axis diameter of lymph nodes were significantly associated with small cluster lymph node metastasis of esophageal cancer in supraclavicular area and mediastinal (all P < 0.05). Logistic multivariate analysis showed that histological grading, vascular invasion and the short-axis diameter of lymph nodes (≥0.545cm) were independent predictor factors for small cluster lymph node metastasis (P < 0.05).After the predictor factors were include into the nomogram, and its AUC was 0.5931 (95%CI 0.5363-0.6498).The calibration curve show that the predicted and actual lymph node metastasis were consistent. Histological grading, vascular invasion and the short-axis diameter of lymph nodes (≥0.545cm) were independent predictor factors for small cluster lymph node (≥ 3 lymph nodes clustered and nonfusion) metastasis of esophageal cancer patients in the supraclavicular and mediastinal and construction of nomogram prediction model.

A Dosimetric Comparison of Pelvic Lymph Node Volume Delineation Using Magnetic Resonance Imaging Versus Computed Tomography in Gynecological Cancers

Definitive external beam radiotherapy (EBRT) targets the primary tumor and at-risk pelvic lymph node groups. Magnetic resonance imaging (MRI), with its superior soft tissue definition compared with computed tomography (CT), is routinely used in cervical cancer EBRT planning to accurately define the primary tumor. MRI can also provide more accurate visualization of lymph nodes, vessels and tissue planes, such that MRI-based nodal clinical target volume (CTVn) delineation may result in smaller volumes and reduced dose to organs at risk (OAR). The aim of this study was to dosimetrically compare EBRT plans in patients with CTVn delineation using MRI fused with CT (CT-MRI) and CT alone. This study was important to examine the advantage of MRI in radiotherapy; prior to the addition of a new MRI simulator and MRI Linac in our center. Nine patients with cervical cancer and two patients with recurrent endometrial cancer were treated using definitive EBRT at our institution with diagnostic MRI scans and were included in this study. The planning CT (pCT) scan for each patient was obtained and fused with T2-weighted MRI scan using bony landmarks and deformable registration. Two separate CTVn volumes were contoured by a radiation oncologist, one based on pCT and a second based on MRI. All other structures including primary CTV (CTVp) and OAR (rectum, sigmoid, bowel, bladder, and femurs) were contoured on the pCT only. Planning target volume (PTV) contours were created by combining CTVn and CTVp with a 1 cm margin. Volumetric modulated arc therapy (VMAT) plans were generated for both pCT-based PTVs and CT-MRI-based PTVs using institutional protocol. Plans were evaluated for PTV volume, coverage (D98) and dose to OAR. Differences between pCT and CT-MRI were analyzed using paired t-tests and results are presented as means and SD (standard deviation). Twenty-two VMAT plans were generated. The mean (SD) PTV volume was 1485.9 cm³ (171.7) for pCT and 1424.5 cm³ (168.0) for the CT-MRI plan (p<0.001). The mean (SD) PTV D98 for pCT and CT-MRI was the same at 43.1 Gy (0.3) (p = 0.677). There was no significant dosimetric difference noted to any of the OAR (Table). This novel method for reducing the CTVn volume by using MRI to avoid anatomical boundaries such as fascial planes and bowel produced an overall reduction in the target volume. However, this did not result in a dosimetric advantage to the surrounding OAR. The most clinically relevant benefit of MRI in gynecological EBRT planning remains in the accurate definition of the primary tumor.Tabled 1Abstract 3080; Table;Organ at RiskpCT, Mean (SD)CT-MRI, Mean (SD)p-valueRectum (V40)56.9% (5.2)49.8% (11.8)0.111Sigmoid (V40)82.2% (20.6)78.7% (28.7)0.588Sigmoid (V45)27.5% (13.9)26.5% (17.8)0.787Bowel (V40)197.8cm³ (97.8)210.8cm³ (103.5)0.605Bowel (V45)73.3cm³ (43.1)67.3cm³ (45.9)0.664Bladder (V45)22.5% (4.1)24.5% (5.9)0.172Right Femur (V30)10.9% (2.3)10.3% (2.9)0.458Left Femur (V30)12.0% (3.1)11.6% (2.2)0.570 Open table in a new tab

C-Reactive Protein is a Poor Marker of Baseline Inflammation in Prostate Cancer and Response to Radiotherapy or Androgen Ablation

C-Reactive Protein (CRP) is an acute phase reactant used as a general marker for inflammation. There is some evidence that elevated levels are associated with increased risk of prostate cancer development, PSA, Gleason score, and decreased response to chemotherapy and radiotherapy (RT). Available literature largely focuses on pre-therapeutic levels as a prognostic marker. We seek to establish whether CRP levels reflect inflammation caused by prostate cancer before and in response to RT with or without prior androgen ablation (AA). This study included 209 patients who had a CBC, PSA, and CRP taken at up to four different time points. Labs were performed prior to AA via leuprolide injection (pre-AA), up to one week prior to RT (pre-RT), during the final week of RT (post-RT), and 3 months following RT completion (FU). Prior to RT, 33% of patients had received prior prostatectomy and 50.7% had received AA. Radiation fields included pelvic lymph nodes in 82% of patients. For comparisons at each time point, CRP had a significant relationship with WBCs pre-AA (p-value = 0.0050), pre-RT (p-value = 0.0170), and post-RT (p-value = 0.0113), but not at FU (p = .096). CRP had no significant relationship with PSA at any time points. For those who did or did not receive AA, pre-RT mean PSA was significantly lower (2.3 vs 5.4, p-value = 0.0072) while CRP was not. Pre-AA, pre-RT, and post-RT CRP levels were not significantly related to FU-PSA. No CRP levels were associated with risk groups. Only PSA significantly changed from pre-AA to pre-RT (p-value<0.0001). PSA, WBCs, and lymphocytes significantly decreased from pre-RT to post-RT, with significant recovery from post-RT to FU (p-value<0.0001 for all six comparisons), though still with overall significant change from pre-RT to FU (p-value = 0.0054, p-value<0.0001, p-value<0.0001, respectively). CRP did not significantly change during any period, nor significantly relate to changes in WBCs or PSA. There was a significant difference between the treated vs. untreated lymph node groups in post-RT lymphocytes (p-value<0.0001), FU-lymphocytes (p-value<0.0001), post-RT-WBCs (p-value = 0.0004), and FU-WBCs (p-value = 0.0141). CRP was not significantly different between these groups. Our results demonstrate a lack of clinical utility for CRP as a marker of the inflammatory effects of prostate cancer. It has no correlation with PSA levels or trends, before or after radiation therapy, with or without androgen ablation. It does not change with significant PSA decrease after androgen ablation and corresponding decrease in cancer activity. It does not change at the end of radiation therapy despite significant changes in lymphocytes and WBCs. It does not change with 3-month follow-up to correspond with either significant recovery of lymphocytes and WBCs or a decrease of radiation-induced inflammation.

Intravital study of lymphatic drainage in lung cancer using indocyanine green

Introduction . The knowledge of lymph efflux and its features seems to be significant for diagnosis and treatment of cancer diseases. The purpose of this paper is exploration of the lymph efflux from lungs by infrared fluorescence in patients with lung cancer. Materials and methods . Indocyanine green (ICG) was injected peritumorally during the lung resection in 92 patients with non-small cells lung cancer (NSCLC). We managed to reliably visualize ICG fluorescence in at least 1 regional lymph node (LN) of the lung root or mediastinum in 70 patients (76%), they are included in the study. Results . The accumulation of ICG was detected in 63% of patients in the LN of the root and mediastinum, in 27% of cases - in the mediastinum only, in 10% of patients - in the hilar nodes only. There was no correlation between lesion of lymph node group and ICG injection in any lung lobe. Conclusions . The lymph efflux from different lung lobe is variable in patients with lung cancer. The lymph can run toward the nodes of both lung root and mediastinum.

S2572 Post-Liver Transplantation Lymphoproliferative Disorder Presenting as Biliary Stricture

INTRODUCTION: A 63 year-old man with non-alcoholic steatohepatitis (NASH) cirrhosis who underwent orthotopic liver transplant (OLT) presented 1 year later with obstructive jaundice due to a biliary stricture. Further investigation revealed encasement of the bile duct by a tumor, later determined to be post-transplant lymphoproliferative disorder (PTLD). PTLD represents a rare cause of post-OLT biliary stricture. CASE DESCRIPTION/METHODS: Post-transplant course was complicated by Grade 2 acute rejection, necessitating high-intensity immunosuppression. He later developed laboratory derangements, intermittent fevers, weight loss, and sweating episodes which were ascribed to active cytomegalovirus (CMV) and Epstein-Barr Virus (EBV) viremia. One year post-transplantation, an acute elevation in total bilirubin prompted an MRCP which revealed a soft tissue mass arising from segment VIII of the liver, extending into the porta hepatis and encasing the common bile duct at the surgical anastomosis. Biopsy showed diffuse large B cell lymphoma, later classified as stage IV disease with diffuse lymph node and bony metastasis. His tacrolimus was discontinued and systemic chemotherapy with R-CHOP was initiated. DISCUSSION: PTLD includes a heterogenous group of lymphoproliferative disorders that occur after solid organ or allogenic hematopoietic stem-cell transplantation, generally in the setting of EBV. PTLD may occur in up to 5.5% of adults following liver transplant. The clinical presentation of PTLD is heterogenous, and may range from incidental findings to fulminant organ failure. Treatment for PTLD consists of reduction of immunotherapy and systemic chemotherapy regimens, such as R-CHOP. Biliary complications after OLT are reported in up to 40% of cases, and usually involve biliary strictures. Biliary strictures are classified as anastomotic or non-anastomotic and are usually secondary to vascular or surgical complications. Post-OLT biliary stricture resulting from PTLD is quite rare. This case demonstrates the difficulties of prevention and diagnosis of PTLD-related biliary stricture. The presence of acute rejection necessitated high-intensity immunosuppression, which predisposed the patient to both CMV and EBV. These active viral infections were used to explain persistent “B symptoms” and abnormal laboratory findings that may have actually been the direct result of PTLD. This case illustrates the need to consider PLTD-related biliary stricture in any post-OLT transplant patient presenting with obstructive jaundice.Figure 1.: This demonstrates an isointense mass on T2-weighted imaging, which involves hepatic segment 8 and extends towards the porta hepatis with resultant stricture of the post-transplant biliary anastomosis and subsequent intrahepatic biliary dilatation.Figure 2.: On diffusion weighted imaging, the mass demonstrates marked diffusion restriction, with corresponding low signal on ADC.Figure 3.: 18F-FDG PET demonstrates intense FDG uptake within the mass, with multifocal hypermetabolic metastatic disease involving several lymph node groups as well as multiple osseous structures.

A retrospective study on the impact of the number of resected lymph nodes on the survival outcome of stage IV rectal cancer patients after preoperative therapy.

There is no consensus on the optimal number of examined LNs for stage IV rectal cancer patients after preoperative therapy. We aimed to explore the impact of the number of resected lymph nodes (LNs) on the survival outcomes of stage IV rectal cancer patients after preoperative therapy. Clinicopathologic data of 556 patients diagnosed with stage IV rectal cancer between 1st January, 2010 and 31st December, 2015 from the Surveillance, Epidemiology, and End Results (SEER) database after preoperative therapy were reviewed. The patients were further divided into two groups: the ≥15 resected LNs group and <15 resected LNs group based on the X-tile software analysis results of the number of resected LNs. Both univariate and multivariate regression analyses revealed that the number of resected LNs and N status were significantly positively correlated with the survival outcome of the patients. Patients in the ≥15 resected LNs group had a significant better cancer-specific survival (CSS) (P=0.003) than those in the <15 resected LNs group. The 3-year CSS rate was 63.2% for patients with ≥15 resected LNs compared with 55.7% for those with <15 resected LNs. The 5-year CSS rate was 50.2% and 30.5% for patients in the ≥15 resected LNs group and those in the <15 resected LNs group, respectively. The number of resected LNs is an important independent prognostic factor that influences the survival outcome of stage IV rectal cancer patients after receiving preoperative therapy.