Lymph Node Involvement In Patients Research Articles

Quantifying the rate and predictors of occult lymph node involvement in patients with clinically node-negative non-small cell lung cancer

Purpose It is essential to evaluate the risk of occult lymph node (LN) disease in early-stage non-small cell lung cancer (NSCLC), especially because delivering stereotactic ablative radiotherapy (SABR) assumes no occult spread. This study was designed to assist clinicians in roughly quantifying this risk for cN0 NSCLC. Methods The National Cancer Data Base was queried for cN0 cM0 lung squamous cell or adenocarcinoma who underwent surgery and LN dissection without neoadjuvant therapy. Statistics included multivariable logistic regression to evaluate factors associated with pN + disease. Results 109,964 patients were included. For tumors with size ≤1.0, 1.1–2.0, 2.1–3.0, 3.1–4.0, 4.1–5.0, 5.1–6.0, 6.1–7.0, and >7.0 cm, the pN + rate was 4.4, 7.7, 12.9, 18.0, 20.2, 22.5, 24.4, and 26.4%, respectively. When examining patients with more complete LN dissections (defined as removal of at least 10 LNs), the respective values were 6.6, 11.5, 17.6, 25.3, 26.8, 29.7, 30.7, and 31.6%. Moderately-poorly differentiated disease and adenocarcinomas were associated with a higher rate of pN + disease (p < .001 for both). For every cm increase in tumor size, the relative occult nodal risk increased by 10–14% (p < .001). For every elapsed day from initial diagnosis, the relative risk increased by ∼1% (p < .001). Graphs with best-fit lines were created based on tumor size, histology, and differentiation to aid physicians in estimating the pN + risk. Conclusions This nationwide study can allow clinicians to roughly estimate the rate of occult LN disease in cN0 NSCLC. These data can also assist in guiding enrollment on randomized trials of SABR ± immunotherapy, individualizing follow-up imaging surveillance, and patient counseling to avoid post-diagnosis delays.

P-OGC25 Prognostic significance of extracapsular lymph node involvement after gastrectomy for gastric adenocarcinoma

Abstract Background Lymph node involvement is a key prognostic indicator in gastric adenocarcinoma. Little is known of the impact of extracapsular lymph node involvement (LNI) upon the prognosis of patients undergoing curative resection of gastric cancer. The aim of this study was to assess the incidence and prognostic significance of extracapsular LNI in patients undergoing a gastrectomy for gastric adenocarcinoma. Methods Consecutive patients who underwent a subtotal or total gastrectomy with curative intent for adenocarcinoma of the stomach or gastro-oesophageal junction in a single, high-volume U.K. centre between 2010 and 2018 were identified from contemporaneously maintained database. Patients with a pN0 status on final histology and those who died in-hospital were excluded from analysis. Factors associated with survival were studied with univariable and multivariable cox regression analysis. A p value of &amp;lt; 0.05 was deemed significant. Results The study included 235 patients. A median (IQR) of 32 (24-43) lymph nodes were resected and median (IQR) 4 (1-9) lymph nodes were positive. Of them, extracapsular LNI was identified in 123 (52%) of patients. Factors associated with survival on univariable analysis were R1 resection (p = 0.001), p/ypT stage (p &amp;lt; 0.001), p/ypN stage (p &amp;lt; 0.001) and extracapsular LNI (p = 0.001). Median survival among patients who had extracapsular LNI was 19 months versus 49 months among patients who did not (p &amp;lt; 0.001). Extracapsular LNI was not an independent predictor of survival on multivariable analysis (p = 0.535). Conclusions Extracapsular LNI is associated with poor prognosis among patients undergoing a curative gastrectomy. However, it is not an independent predictor of survival among this patient population.

Pathologic Primary Tumor Factors Associated With Risk of Lymph Node Involvement in Patients With High-Risk Endometrial Cancer

National Comprehensive Cancer Network guidelines recommend adjuvant systemic therapy with or without external beam radiation and/or intravaginal brachytherapy for high-risk endometrial cancer histologies. Being able to estimate the risk of pelvic/para-aortic lymph node (LN) involvement could assist in making clinical decisions regarding whether to treat with external beam versus brachytherapy alone. The National Cancer Data Base was queried to develop predictive nomograms based on primary uterine factors to estimate the risk of pathologic LN involvement.Patients diagnosed with pathologic T1-T2 clear cell, uterine papillary serous (UPS), carcinosarcoma, or mixed endometrial cancer between 2004-2016 undergoing primary surgery with at least 10 LNs sampled in the National Cancer Data Base were identified. Logistic regression was performed to identify primary pathologic tumor predictors of LN positivity. Pathologic variables assessed included primary tumor histology, pathologic tumor stage, tumor size, and presence/absence of lymphovascular invasion (LVI). Nomograms were created to predict overall, pelvic only, and paraaortic and/or pelvic LN involvement.Among 7,918 patients included, 1,407 (18%) were node positive. On multivariable analysis, relative to carcinosarcoma, both clear cell (odds ratio [OR] 1.77, 95% confidence interval [CI] 1.34-2.32, P < 0.001) and UPS (OR 1.76, 95% CI 1.46-2.13, P < 0.001) histology were significantly associated with a higher risk of LN positivity while mixed histology was not (OR 1.14, 95% CI 0.95-1.37, P = 0.16). Furthermore, increasing pathologic tumor stage (pT2 versus pT1a, OR 3.62, 95% CI 3.04-4.28, P < 0.001), increase in tumor size per centimeter (OR 1.09, 95% CI 1.06-1.11, P < 0.001), and presence of LVI (OR 5.23, 95% CI 4.58-6.02, P < 0.001) were predictive of overall LN positivity. Nomograms demonstrated that the impact of primary tumor pathologic variables was comparable for predicting any LN involvement, pelvic only, and paraaortic with or without pelvic LN involvement.Among endometrial cancer patients with high-risk histologies, predictors of LN positivity are similar to those with endometrial adenocarcinoma. Patients with carcinosarcoma are the least likely to be diagnosed with node positive disease relative to other high-risk histologies. Predictive nomograms can help to individualize the risk of pelvic and paraaortic LN involvement and may assist in adjuvant treatment decisions.E. Anderson: None. M. Luu: None. D.J. Lu: None. E.M. Chung: None. M. Kamrava: American Board of Radiology, Brachytherapy Journal, American Brachytherapy Society Board of Directors. Co-Editor; Journal of Contemporary Brachytherapy.

A Novel Scoring System for Predicting the Metastases of Posterior Right Recurrent Laryngeal Nerve Lymph Node Involvement in Patients With Papillary Thyroid Carcinoma by Preoperative Ultrasound.

ObjectiveOur goal was to investigate the correlation between papillary thyroid carcinoma (PTC) characteristics on ultrasonography and metastases of lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN). There is still no good method for clinicians to judge whether a patient needs LN-prRLN resection before surgery, and we also wanted to establish a new scoring system to determine whether patients with papillary thyroid carcinoma require LN-prRLN resection before surgery.Patients and MethodsThere were 482 patients with right or bilateral PTC who underwent thyroid gland resection from December 2015 to December 2017 recruited as study subjects. The relationship between the PTC characteristics on ultrasonography and the metastases of LN-prRLN was analyzed by univariate and logistic regression analyses. Based on the risk factors identified in univariate and logistic regression analysis, a nomogram-based LN-prRLN prediction model was established.ResultLN-prRLN were removed from all patients, of which 79 had LN-prRLN metastasis, with a metastasis rate of 16.39%. Multivariate logistic regression analysis revealed that LN-prRLN metastasis was closely related to sex, age, blood supply, larger tumors (> 1 cm) and capsular invasion. A risk prediction model has been established and fully verified. The calibration curve used to evaluate the nomogram shows that the consistency index was 0.75 ± 0.065.ConclusionPreoperative clinical data, such as sex, age, abundant blood supply, larger tumor (> 1 cm) and capsular invasion, are positively correlated with LN-prRLN metastasis. Our scoring system can help surgeons non-invasively determine which patients should undergo LN-prRLN resection before surgery. We recommend that LN-prRLN resection should be performed when the score is above 103.1.

Lymph node involvement in gastric adenocarcinoma.

Endoscopic management of early gastric cancer is limited by the risk of lymph node metastasis. We aimed to examine the incidence and predictors of nodal metastasis in early gastric adenocarcinoma in a large national US cohort. Cases were abstracted from the National Cancer Database from 2004 to 2016. The incidence and predictors of lymph node involvement for patients with Tis, T1a, and T1b tumors were examined. A total of 202,216 cases of gastric adenocarcinoma were identified in the NCDB. Cases with unknown patient or tumor characteristics, presence of other cancers, and prior neoadjuvant chemotherapy or radiotherapy were excluded. 1839 cases of Tis, T1a, and T1b tumors were identified. Lymph node metastases were present in 18.1% of patients. Lymphovascular invasion (LVI), high-grade histology, stage T1b, and larger size (> 3cm) were independently associated with an increased risk of nodal metastasis on multivariate analysis (P < 0.05). The presence of LVI was the strongest predictor of nodal metastasis with an OR (95% CI) of 5.7 (4.3-7.6), P < 0.001. No lymph node metastasis was found in any Tis tumors. Small T1a low-grade tumors with no LVI had a low risk of nodal metastasis (0.6% < 2cm and 0.9% < 3cm). In this large national cohort, size, lymphovascular invasion, higher grade histology, and T stage were independently associated with lymph node metastasis. For patients with low-grade tumors, < 3cm, without lymphovascular invasion, the risk of nodal involvement was very low, suggesting that this Western cohort could be considered for endoscopic resection.

Sentinel lymph node mapping detection and recurrence rates in clinical stage I endometrial cancer

Objectives: The literature suggests that sentinel lymph node biopsy (SLNB) is an acceptable alternative to pelvic and paraaortic lymph node dissection (PPALND) in patients with clinical stage I endometrial cancers. The referenced data is largely published from high-volume specialized institutions and a complete PPALND is still performed by many surgeons at smaller, non-specialized centers. Our aim is to demonstrate that SLNB is feasible, reproducible, and sensitive without affecting cancer-specific outcomes when implemented at a non-specialized center. Methods: A retrospective review of patients with clinical stage I endometrial cancer was performed from September 2016 through February 2020. All patients had undergone either a robot-assisted or laparoscopic hysterectomy with SLNB. Endometrioid, uterine papillary serous (UPSC), malignant mixed mesodermal tumor (MMMT), and clear cell (CC) histologies were included. Indocyanine green was injected into the cervix bilaterally as per a previously described protocol. Paraaortic LND was performed at the discretion of the surgeon. In addition to SLNB, complete PPALND was performed for patients with MMMT, UPSC or CC. Sentinel lymph nodes (SLN) were evaluated using ultra-staging protocols including serial sectioning and cytokeratin staining. The medical record was queried for clinical or radiographic evidence of recurrence. Results: A total of 92 patients were included: 69 stage IA, 12 stage IB, 3 stage II and 8 stage III (2 IIIA, 2 IIIC1, 4 IIIC2). The majority of patients were endometrioid (73%), followed by UPSC (15.0%), MMMT (5.0%) and CC (4%). At least one SLN was detected in 95.4% of cases. The rate of bilateral SLN detection was 74.3% and improved over time from 2017-2019: 70% (2017), 74.4% (2018), 80% (2019). Twenty patients underwent PPALND. Non-SLN were positive in 3 patients, all with high-risk histology. There were no other patients with false-negative SLNB. There have been 3 (3%) recurrences to date; one rectal recurrence, one pelvic side wall and one paraaortic lymph node recurrence. All three patients had detected bilateral SLN which were negative at the time of their initial surgery; all three recurrences were high grade histology. Conclusions: SLNB is a sensitive and specific method for assessing lymph node involvement in patients with clinical stage I endometrial cancers. Our detection and recurrence rates are comparable to the rates reported in the literature and demonstrate that when applied at non-specialized centers this approach is safe and reproducible without affecting cancer-specific outcomes.

How to predict para-aortic node involvement in advanced cervical cancer? Development of a predictive score. A FRANCOGYN study

IntroductionNode involvement is one of the main prognostic factors for cervical cancer. Para-aortic lymph node (PALN) assessment is crucial for treating advanced cervical cancer, to define irradiation fields. Objective of this study was to develop a score predicting para-aortic lymph node involvement in patients with advanced cervical cancer. Patients and methodWe performed a multicenter, retrospective, study on 9 French centers from 2000 to 2015, including patients with advanced squamous cell cervix carcinoma who had PALN status assessed by imaging and/or by surgery. Factors associated with a risk of PALN involvement were determined by univariate and multivariate analysis using a logistic regression model. A score was then developed and validated. ResultsA total of 1446 patients treated for cervical cancer were included. Of these, 498 had an advanced squamous cell cervical cancer. Ninety-one patients (18.3%) had positive PALN. After univariate and multivariate analysis, tumor size on pelvic MRI, initial SCC, and suspected pelvic node involvement on PET-CT were included in our score. This model allowed the population to be divided into 3 risk groups. Area under the ROC curve of the score was 0.81 (95%CI = 0.72–0.90). In the low-risk group, 9% (28/287) had PALN involvement, whereas in the high-risk group, 43% (22/51) had PALN involvement. ConclusionWe developed a simple score predicting PALN involvement in advanced cervical cancers. Three risk groups can be defined, and patients considered to be at low risk may avoid para-aortic staging as well as extensive field irradiation.

What can we learn from the 10 mm lymph node size cut-off on the CT in advanced ovarian cancer at the time of interval debulking surgery?

IntroductionThe benefit of a systematic lymphadenectomy is still debated in patients undergoing neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) in ovarian cancer (OC). The objective of this study was to evaluate the predictive value of the pre-NACT and post-NACT CT in predicting definitive histological lymph node involvement. The prognostic value of a positive node on the CT was also assessed. Materiel and methodsA retrospective, unicentric cohort study was performed including all patients with ovarian cancer who underwent NACT and IDS with a lymphadenectomy between 2005 and 2018. CT were analyzed blinded to pathology, and nodes with small axis ≥ 10 mm on CT were considered positive. Sensitivity (Se), specificity (Sp), and negative (NPV) and positive predictive values (PPV) and their CI95% were calculated. The 2-year recurrence free survival (RFS) and 5-year overall survival (OS) was compared. Results158 patients were included, among which 92 (58%) had histologically positive lymph nodes. CT had a Se, Sp, NPV and PPV of 35%, 82%, 47% and 73% before NACT and 20%, 97%, 47% and 91% after NACT, respectively. Patients with nodes considered positive had a non-significant lower 2-year RFS and 5-year OS on the pre-NACT and post-NACT CT. Patients at ‘high risk’ (nodes stayed positive on the CT or became positive after NACT) also had a non-significant lower 2-year RFS and 5-year OS. ConclusionPresence of enlarged lymph nodes on CT is a weak indicator of lymph node involvement in patients with advanced ovarian cancer undergoing NACT. However, it could be used to assess prognosis.

ASO Author Reflections: Lymphovascular Invasion has a Similar Prognostic Value as Lymph Node Involvement in Patients with Early Gastric Cancer.

ASO Author Reflections: Lymphovascular Invasion has a Similar Prognostic Value as Lymph Node Involvement in Patients with Early Gastric Cancer.

External validation of the Memorial Sloan Kettering Cancer Centre and Briganti nomograms for the prediction of lymph node involvement of prostate cancer using clinical stage assessed by magnetic resonance imaging.

To evaluate the impact of using clinical stage assessed by multiparametric magnetic resonance imaging (mpMRI) on the performance of two established nomograms for the prediction of pelvic lymph node involvement (LNI) in patients with prostate cancer. Patients undergoing robot-assisted extended pelvic lymph node dissection (ePLND) from 2015 to 2019 at three teaching hospitals were retrospectively evaluated. Risk of LNI was calculated four times for each patient, using clinical tumour stage (T-stage) assessed by digital rectal examination (DRE) and by mpMRI, in the Memorial Sloan Kettering Cancer Centre (MSKCC; 2018) and Briganti (2012) nomograms. Discrimination (area under the curve [AUC]), calibration, and the net benefit of these four strategies were assessed and compared. A total of 1062 patients were included, of whom 301 (28%) had histologically proven LNI. Using DRE T-stage resulted in AUCs of 0.71 (95% confidence interval [CI] 0.70-0.72) for the MSKCC and 0.73 (95% CI 0.72-0.74) for the Briganti nomogram. Using mpMRI T-stage, the AUCs were 0.72 (95% CI 0.71-0.73) for the MSKCC and 0.75 (95% CI 0.74-0.76) for the Briganti nomogram. mpMRI T-stage resulted in equivalent calibration compared with DRE T-stage. Combined use of mpMRI T-stage and the Briganti 2012 nomogram was shown to be superior in terms of AUC, calibration, and net benefit. Use of mpMRI T-stage led to increased sensitivity for the detection of LNI for all risk thresholds in both models, countered by a decreased specificity, compared with DRE T-stage. T-stage as assessed by mpMRI is an appropriate alternative for T-stage assessed by DRE to determine nomogram-based risk of LNI in patients with prostate cancer, and was associated with improved model performance of both the MSKCC 2018 and Briganti 2012 nomograms.

Prognostic value of regional lymph node involvement in patients with metastatic colorectal cancer: palliative versus curative resection

BackgroundApproximately 20% of patients with colorectal cancer are initially diagnosed with stage IV disease. This study aims to examine the role of regional lymph node (LN) status in metastatic colorectal cancer (mCRC) with respect to clinicopathologic features and survival outcomes.MethodsWe investigated 1147 patients diagnosed with mCRC and had undergone surgical resection of the primary CRC. A total of 167 patients were placed in the LN-negative (LN−) group and another 980 in the LN-positive (LN+) group.ResultsLN+ patients exhibited a significantly higher rate of T4 tumors (p = 0.008), poorly differentiated adenocarcinoma (p < 0.001), lymphovascular invasion (p < 0.001), and perineural invasion (p < 0.001) than those in the LN− group. LN− patients had a significantly higher rate of lung metastasis (p < 0.001), whereas the rate of peritoneal seeding (p < 0.001) and systemic node metastasis (p < 0.001) was both significantly higher in the LN+ group. The 5-year overall survival (OS) in the LN+ group was significantly poorer than that in the LN− group (LN− vs. LN+ 23.2% vs. 18.1%; p = 0.040). In patients with curative resection, the 5-year OS rate has no significant difference between the two groups (LN− vs. LN+ 19.5% vs. 24.3%; p = 0.890).ConclusionsMetastatic CRC patients with LN+ who underwent primary tumor resection may present with more high-risk pathological features, more peritoneal seeding, and systemic node metastasis, but less lung metastasis than LN− patients. LN+ patients had poorer long-term outcomes compared with that in LN− patients. Nevertheless, with curative resection, LN+ patients could have similar survival outcomes as LN− patients.

82P Predicting invasive disease and lymph node involvement in patients with preoperative diagnosis of ductal carcinoma in situ

Eight to 56% patients undergoing a mastectomy with preoperative diagnosis of ductal carcinoma in situ (DCIS) upgrade to invasive disease on final histopathological evaluation. Sentinel node biopsy in this cohort of patients cannot be safely excluded due to the high probability of finding invasive disease on final histopathological evaluation. We were keen to identify factors predictive of invasiveness and therefore probable nodal involvement.

Lymph node positivity and association with long-term survival for different histologies of appendiceal cancer.

Appendiceal cancers represent a diverse group of malignancies with varying biological behavior. The significance of lymph node metastases in relation to long-term survival and chemotherapy response is poorly defined. The National Cancer Database was queried to find patients diagnosed with appendiceal cancer from 1998 to 2012. Kaplan-Meier curves and multivariable Cox regression analyses were used to study the association between lymph node status and overall survival. Stage IV patients were excluded. The rate of nodal positivity of the 9841 patients with known node status was: signet ring 47.4%, carcinoid 42.3%, nonmucinous adenocarcinoma 28.8%, goblet cell 21.9%, and mucinous adenocarcinoma 20.4%. Node-positive patients had worse long-term survival for all subtypes with the exception of carcinoid tumors (p < 0.001). The strongest association was for signet cell and goblet cell. Adjuvant chemotherapy in node-positive patients improved survival for mucinous, nonmucinous, and signet ring cell histology (p < 0.01), but not for goblet cell. Nodal involvement in patients with appendiceal cancer varies in incidence, association with adverse survival, and response to systemic therapy. Individualized treatment algorithms for the management of the subtypes of appendiceal cancer are needed.

Impact of lymph nodal stage on gallbladder cancer survival after extended cholecystectomy and adjuvant radiochemotherapy: long-term results from an oncology institute, Chile.

IntroductionGallbladder cancer (GBC) is one of the most important causes of cancer death in Chile.Materials and methodsA retrospective review of 103 patients with a diagnosis of GBC who were treated with surgery and adjuvant radiochemotherapy (RT-CT) was carried out at the Oncological Institute of Viña del Mar, Chile. Of these, 56 underwent surgery with oncological criteria, in which the impact of lymph node involvement and prognostic factors for survival were analysed.ResultsThe median follow-up was 47.5 months. The 5-year survival of the patients operated on with oncological surgery was 55%, and for those resected without oncological criteria, it was 32% (p = 0.02). Regarding the impact of lymph node involvement, 5-year overall survival (OS) in patients with compromised lymph nodes was 32% versus 68% for patients without compromised lymph nodes (p = 0.006). Five-year OS in patients without involved nodes, with 1 involved node or with>1 involved node was 68%, 44% and 12%, respectively (p = 0.0002). The N ratio was grouped in 0, <10% and ≥10%. Five-year OS was 71%, 0% and 24%, respectively (p = 0.003). There was no evidence of differences in survival with respect to the number of lymph nodes studied.ConclusionOur data provide information regarding the importance of lymph node involvement in patients with GBC undergoing surgery with oncological criteria and adjuvant RT-CT. In the absence of randomised studies, it is suggested to have a more aggressive therapeutic approach in those patients with two or more involved nodes or with a lymph node ratio >10%.

Lymph Node Involvement in Axillary Hidradenitis Suppurativa: A Clinical, Ultrasonographic and Bacteriological Study Conducted during Radical Surgery.

Background: Hidradenitis suppurativa (HS) is an inflammatory and chronic-recurrent disease of the hair follicle. Its aetiopathogenesis is not completely known. Although bacterial colonization and superinfection are clinically relevant, lymph node involvement has rarely been studied. Objectives: In this pilot retrospective study, we evaluated the clinical and microbiological nodal involvement in patients with axillary hidradenitis suppurativa. Materials and methods: We retrospectively analyzed patients suffering from axillary hidradenitis suppurativa and referred to the Dermatology Unit of the Foundation Ca’ Granda Ospedale Maggiore Policlinico in Milan between October 2018 and November 2019. The sampling procedure took place during the surgical excision of lesions at the Operative Unit of Plastic and Reconstructive Surgery of Policlinico San Donato Hospital. Three types of sample were sent to microbiological analysis: exudate swab, axillary lymph node, fistula. Result: In total, we recruited 10 patients. Two of them underwent bilateral axillary surgery. Nine lymph nodes were analyzed. In one patient, bacterial culture in lymph nodes, skin lesions and fistulae matched. Conclusions: Unequivocable conclusions cannot be drawn due to the low number of patients. Further studies are necessary to confirm the preliminary results of our retrospective pilot study.

ASO Author Reflections: Clinical Significance of Mesenteric Lymph Node Involvement in Patients with Ovarian Cancer

ASO Author Reflections: Clinical Significance of Mesenteric Lymph Node Involvement in Patients with Ovarian Cancer

Abstract PS11-02: Comprehensive comparative analysis of invasive ductal and lobular breast cancer cases in great lakes breast cancer consortium

Abstract Background: Invasive lobular breast cancer (ILC) is the second most common histologic subtype of breast cancer following invasive ductal cancer (IDC). ILC accounts for ~10-15% of all breast cancers (~26-40,000 cases annually in the US) and ranks as the 6th most common cancer in women in the US. While there is increasing recognition that ILC has distinct clinical, histologic, molecular, and biological characteristics compared to IDC, it remains understudied. There are very few large cohort analyses comparing clinic-pathological features of ILC, and therefore we performed a large multi-institutional retrospective cohort study. Methods: Investigators from UPMC Hillman Cancer Center, James Cancer Hospital/OSU, and Cleveland Clinic Taussig Cancer Institute/CWRU formed the Great Lakes Breast Cancer consortium, and worked with their respective cancer registries to collect comprehensive data on patients with IDC and ILC seen at their institutions between 1990 and 2017. Descriptive statistics were performed to compare clinic-pathological features, treatments, metastases sites, and co-morbidities. Survival rates were analyzed using the Kaplan-Meier (KM) method and compared using the Cox proportional hazards model. A total of N=38,175 records (N=15,792 for UPMC, N=13,040 for CCF, and N=9,343 for OSU) were included in the study. Results Among the N=38,175 records, we identified N=30,100 unique IDC (not otherwise specific, NOS) (89.3%) and N=3,618 unique ILC cases (10.7%). There were no significant differences between IDC and ILC with respect to laterality of the cancer (IDC: Left 51%, Right 49%; 0.2% Other vs ILC: Left 51%, Right 48%, Other 0.5%) and body mass index (IDC: 28.4 vs ILC: 28.2). In contrast, we observed significant difference with respect to age - patients with ILC were significantly older (61.2 vs 57.5 years; p&amp;lt;0.0001), and there were significant differences in race (7.6% vs 9.2% African American patients in ILC vs IDC, respectively; p=0.004). Among ILC cases, there were fewer grade III tumors (11.4% vs 40.3% in IDC; p&amp;lt;0.0001). ILCs were more frequently stage III (16.6% vs 8.0% in IDC) and stage IV (3.7% vs 2.4% in IDC) (p&amp;lt;0.0001), and ILC were significantly larger than IDC (13.7% T3 vs 2.8% in IDC, p&amp;lt;0.0001). There was also significantly more lymph node involvement in patients with ILC (N2: 5.3% vs 4.0%; N3: 4.6% vs 1.5%) (p&amp;lt;0.0001). The ILC cohort had significantly fewer HER2+ cases (5.5% vs 18.1% in IDC) (p&amp;lt;0.0001), and the proportion of patients with a high recurrence score as determined by 21 gene recurrence score was significantly lower in ILC compared to IDC (1.7% vs 10.4% in IDC; p&amp;lt;0.0001). As expected, there was a significant enrichment of ER+ tumors in ILC (96.1% compared to IDC (76.6%) (p&amp;lt;0.0001). Age, stage, grade, ER, Her2, and lymph node involvement remained significantly associated with histology in a logistic regression analysis. KM analysis showed significantly shortened disease-free (p=0.041) and overall survival (p&amp;lt;0.0001) for patients with ER+ ILC (N=2,565) compared to ER+ IDC N=17,278). The estimated 5yr and 10yr DFS rates for patients with IDC are 0.94 and 0.89, and for ILC 0.94 and 0.86, confirming prior data of late recurrences in patients with ILC. Conclusions: In the largest cohort of patients with ILC made possible by multi-center collaborations we show that lobular histology carries distinct prognostic implications and that outcomes are significantly worse. This highlights the need for more ILC research and clinical trials for patients with ILC. Citation Format: Steffi Oesterreich, Azadeh Nasrazadani, Jian Zou, Tiffany Onger, Matthew Wright, George Tseng, Bhuvana Ramaswamy, Adrian V Lee, Nicole Williams, Megan Kruse. Comprehensive comparative analysis of invasive ductal and lobular breast cancer cases in great lakes breast cancer consortium [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS11-02.

False negative rate at 18F-FDG PET/CT in para-aortic lymphnode involvement in patients with locally advanced cervical cancer: impact of PET technology

BackgroundThe identification of factors responsible for false negative (FN) rate at 18F- Fluorodeoxyglucose (FDG) Positron Emission Tomography /Computed Tomography (PET/CT) in para-aortic (PA) lymph nodes in the presurgical staging of patients with locally advanced cervical cancer (LACC) is challenging. The aim of this study was to evaluate the impact of PET/CT technology.MethodsA total of 240 consecutive patients with LACC (International Federation of Gynecology and Obstetrics, FIGO, stage IB2-IVA) and negative Magnetic Resonance Imaging (MRI) and/or Computed Tomography (CT) and negative 18F-FDG PET/CT in the PA region, undergoing laparoscopic PA lymphadenectomy before chemoradiotherapy were included. The FN rate in patients studied with Time of flight (TOF) PET/CT (TOF PET) or non-Time of flight PET/CT (no-TOF PET) technology was retrospectively compared.ResultsPatients presented with FIGO stage IB (n = 78), stage IIA-B (n = 134), stage III (n = 18) and stage IVa (n = 10), squamous cell carcinoma (n = 191) and adenocarcinoma (n = 49). 141/240 patients were evaluated with no-TOF PET/CT and 99/240 with TOF PET/CT. Twenty-two patients (9%) had PA nodal involvement at histological analysis and considered PET/CT FN findings. The FN rate was 8.5% for no-TOF PET and 10% for TOF PET subgroup respectively (p = 0.98). Ninety patients (38%) presented with pelvic node uptakes at PET/CT. The FN rate in the PA region was 18% (16/90) and 4% (6/150) in patients with and without pelvic node involvement at PET/CT respectively (19 vs 3% for no-TOF PET and 17 vs 5% for TOF PET subgroup).ConclusionsIn LACC, FN rate in PA lymph nodes detection is a clinical issue even for modern PET/CT, especially in patients with pelvic uptake. Surgical lymphadenectomy should be performed in case of negative PET/CT at PA level in these patients, while it could be discussed in the absence of pelvic uptake.

Predicting Lymph Node Involvement in Borderline Ovarian Tumors with a Quantitative Model and Nomogram: A Retrospective Cohort Study.

PurposeThis study aimed to establish a predictive model for lymph node involvement (LNI) in patients with borderline ovarian tumor (BOT) using clinicopathological factors.Patients and MethodsWe collected clinical data from consecutive patients who underwent lymphadenectomy for BOT between 2001 and 2018 and analyzed their clinicopathological features. Multivariate logistic regression was used to identify all independent risk factors associated with LNI; these were then incorporated into the prediction model.ResultsIn total, we included 248 patients with BOT who were undergoing lymphadenectomy. These were divided into a training cohort (n=174) and a validation cohort (n=74). When considering histopathological data, 16 and 5 patients were identified to have LNI in the training and validation cohorts, respectively. Overall, 13.5% (21/156) patients with serous BOT had LNI while 0% (0/92) patients with non-serous BOT had LNI. We identified several predictors of LNI: the largest tumor being ≥ 12.2cm in diameter, the presence of lesions on the ovarian surface, and the presence of pelvic or abdominal lesions. We created a prediction model and nomogram that incorporated these three risk factors for serous BOT. The model achieved good discriminatory abilities of 0.951 and 0.848 when predicting LNI in the training and validation cohorts, respectively. The LNI-predicting nomogram had an area under curve (AUC) of 0.951 and generated well-fitted calibration curves.ConclusionNon-serous BOT may not require lymphadenectomy as part of surgical staging. The individual risk of LNI in patients with serous BOT can be accurately estimated using our prediction model and nomogram. The use of LNI criteria provides a practical way to support the clinician in making an optimal decision relating to surgical scope for patients with BOT.

Incidence of and Risk Factors for Gastroepiploic Lymph Node Involvement in Patients with Cancer of the Transverse Colon Including the Hepatic Flexure.

To define the incidence of gastroepiploic lymph node (GLN) metastasis in patients with cancer of the transverse colon, including the hepatic flexure, and to identify the preoperative predictors of GLN involvement in a large-volume center in China. This retrospective monocentric cross-sectional study respected the STROBE statement. Of 3208consecutive patients who underwent colon cancer resection, a total of 371patients with cancer of the transverse colon including the hepatic flexure who underwent complete mesocolic excision and GLN resection in our center were retrospectively reviewed between November2010 and November2017. Logistic regression was performed to identify predictors of GLN metastasis. Endoscopic obstruction was defined as a luminal obstruction of the colon severe enough to prevent the colonoscope from passing beyond the tumor regardless of the presenting symptoms. The GLN involvement rate was 4.0 (2.0-6.1)%. Patients who had GLN involvement had a significantly higher rate of endoscopic obstruction (P = 0.030), higher rate of signet ring adenocarcinoma or lymphovascular invasion (P < 0.05), higher preoperative CEA level (P = 0.037), more advanced pN stage (P < 0.001) and more advanced M stage (P = 0.003) than the patients without GLN involvement. ROC curve analyses showed that the cutoff value for CEA was 17.0ng/ml (46.7% sensitivity, 84.3% specificity, P = 0.037) for the prediction of GLN metastasis. Multivariate analysis showed that endoscopic obstruction, signet ring adenocarcinoma, a CEA level ≥17ng/ml and M1 stagewere independentlycorrelated with the GLN metastasis. The incidence rate of GLN metastasis was low. To the best of our knowledge, the present study was the first to evaluate the preoperative predictors of GLN metastasis. Combinations of predictive factors may be useful for stratifying patients at high risk of GLN metastasis.