Occult Lymph Node Metastases In Patients Research Articles

JAAD Game Changers∗: High-risk cutaneous squamous cell carcinoma and the emerging role of sentinel lymph node biopsy: A literature review

Capsule Summary•Most patients with squamous cell carcinoma have a favorable prognosis; however, high-risk squamous cell carcinoma is associated with aggressive clinical behavior and higher morbidity/mortality.•The extent of regional nodal involvement is an important prognostic factor for survival.•Sentinel lymph node biopsy may identify occult nodal metastases in patients at risk.How did this article change the practice of dermatology?Cutaneous SCC (cSCC) is the second most common skin cancer, and some of these patients are at risk for nodal metastasis and death. This article demonstrated that there is some evidence that supports considering sentinel lymph node biopsy for staging, prognostication, and therapeutic planning in cSCC classified as American Joint Committee on Cancer–7th Edition T2 larger than 2 cm in diameter or T2b in the alternative staging system.1 Patients with other high-risk factors. such as recurrent cSCC, and patients who are immunosuppressed should be included in trials evaluating the utility of sentinel lymph node biopsy in cSCC.

Risk factors for predicting the occult nodal metastasis in T1–2N0M0 NSCLC patients staged by PET/CT: Potential value in the clinic

Background and objectiveThe aims of our study were to evaluate the occult nodal metastasis in clinical stage I patients by PET/CT, further investigate the potential risk factors for nodal involvement, since a successful prediction could be helpful in selection appropriate candidates for SABR or limited surgery. MethodsWe retrospectively reviewed the records of 189 patients who diagnosed as clinical stage I NSCLC by 18F-FDG PET/CT from January 2004 to July 2011. All patients underwent lobectomy and systematic lymph node dissection and preoperative 18F-FDG PET/CT scanning. The prevalence of occult nodal metastasis in patients as clinical N0 was analyzed according to clinicopathological factors such as tumor location, tumor size, tumor subtype, grade of differentiation and primary tumor SUVmax. Risk factors for occult nodal metastasis were defined by univariate and multivariate analysis. ResultsOccult nodal metastasis was detected in 18.0% (34/189) of the patients. SUVmax of the primary tumor and tumor size were independent predictors of occult nodal metastasis for patients with clinical N0 NSCLC by FDG PET/CT. Accordingly we divided our patients into three groups: group 1 (low-risk group) ∼T≤3cm and SUVmax≤4.3; group 2 (moderate-risk group) ∼T≤3cm and SUVmax>4.3 or SUVmax≤4.3 and T>3cm; group 3 (high-risk group) ∼T>3cm and SUVmax>4.3. The occult lymph node metastasis rate in groups 1, 2, 3 was 1/82 (1.2%), 19/75 (25.3%) and 14/32 (43%) respectively. ConclusionsT1–2N0M0 NSCLC patients by PET/CT showing larger tumor size and high SUVmax constitute a high-risk group for occult nodal metastasis. The combined information of primary tumor SUVmax and tumor size before treatment have potential values in the clinic. These findings would be helpful in selection of SABR or limited surgery candidates.

Occult nodal metastasis in patients with non‐small cell lung cancer at clinical stage IA by PET/CT

The introduction of ¹⁸F-FDG PET/CT has enhanced the diagnostic accuracy of nodal staging for non-small cell lung cancer (NSCLC). We analysed risk factors for occult nodal metastasis in patients with clinical stage IA NSCLC as determined by ¹⁸F-FDG PET/CT. Data for 147 patients diagnosed as clinical stage IA NSCLC by PET/CT from 2005 to 2007 were retrospectively reviewed. All study patients underwent ¹⁸F-FDG PET/CT for lung cancer staging. They also underwent cervical mediastinoscopy or systematic lymph node dissection. Cervical mediastinoscopy was performed in 78 patients (53.1%), and N2 involvement was detected in 3.8% (3/78) of these patients. Thoracotomy with systematic lymph node dissection was done in 144 patients. Four patients (2.8%, 4/144) were diagnosed with N2 disease after systematic lymph node dissection. Total N2 involvement was 4.8% (7/147). As 9.5% (14/147) of study patients had N1 disease, 14.3% (21/147) of patients had occult nodal (N1 or N2) metastasis. In univariate analyses, larger tumour size and a higher primary tumour maximum standardized uptake value >7.3 (SUV(max)) were associated with occult nodal metastasis. Multivariate analysis demonstrated that a primary tumour SUV(max) >7.3 was an independent predictor of occult nodal metastasis (odds ratio: 7.574; P = 0.001). Preoperative PET/CT scans contribute to reduce the frequency of occult nodal metastasis compared with those reported in the pre-PET/CT era. The higher SUV(max) in primary tumour was an independent predictor of occult nodal metastasis in patients with clinical stage IA NSCLC by PET/CT.

Indirect MR lymphangiography of the head and neck using conventional gadolinium contrast: A pilot study in humans

To evaluate indirect magnetic resonance lymphangiography (MR-LAG) using interstitial injection of conventional gadolinium contrast (gadoteridol and gadopentetate dimeglumine) for delineating the primary lymphatic drainage of head-and-neck sites. We performed head-and-neck MR-LAG in 5 healthy volunteers, with injection of dermal and mucosal sites. We evaluated the safety of the procedure, the patterns of enhancement categorized by injection site and nodal level, the time course of enhancement, the optimal concentration and volume of contrast, and the optimal imaging sequence. The worst side effects of interstitial contrast injection were brief, mild pain and swelling at the injected sites that were self-limited. MR-LAG resulted in consistent visualization of the primary lymphatic drainage pattern specific to each injected site, which was reproducible on repeated examinations. The best enhancement was obtained with injection of small volumes (0.3-0.5 mL) of either agent diluted, imaging within 5-15 min of injection, and a three-dimensional fast spoiled gradient echo sequence with magnetization transfer. We found head-and-neck MR-LAG to be a safe, convenient imaging method that provides functional information about the lymphatic drainage of injected sites. Applied to head-and-neck cancer, it has the potential to identify sites at highest risk of occult metastatic spread for radiotherapy or surgical planning, and possibly to visualize micrometastases.

Lymphocintigraphy using a hybrid SPECT/CT system for oral cavity SCC sentinel node mapping

Objectives: The role of lymphocyntigraphy and sentinel node biopsy (SNB) for the detection of occult nodal metastases in patients with oral cavity SCC is still under investigation. Fused SPECT/CT images may provide an accurate anatomic localization of the sentinel node preoperatively and facilitate intraoperative localization and SNB. The purpose of this study was to assess the clinical benefit of fused SPECT/CT images for SN mapping of head and neck squamous cell carcinoma. Methods: Eighteen consecutive untreated patients with a biopsy proven SCC of the oral cavity (14 oral tongue, 4 retro molar trigon) were included. Peritumoral Tc-99m was injected 24 hours preoperatively and the sentinel nodes localized on SPECT/CT images 3–6 hours later. Blue dye was injected intraoperatively. The sentinel node(s) were located with the use of a gamma probe based on the location of the fused SPECT/CT images. A neck dissection was then performed. Careful pathologic examination as well as immunohistochemistry staining of the sentinel nodes (for cytokeratin complex) was performed in all patients. Results: At least 1 sentinel node (average, 2.7) was identified in all patients. Metastatic carcinoma was found in the neck dissection specimen of 8 patients. The sentinel node biopsy was positive in 7 of these patients (Overall accuracy in predicting nodal metastases, 94.4%; sensitivity, 87.5%). A sentinel node containing metastasis was found outside the region of the planned neck dissection in 2 patients. Conclusions: Lymphocintigraphy using a SPECT/CT hybrid may be an important tool for the identification of cervical sentinel nodes.

Sentinel Lymph Node Biopsy Identifies Occult Nodal Metastasis in Patients with Marjolin's Ulcers

Sentinel Lymph Node Biopsy Identifies Occult Nodal Metastasis in Patients with Marjolin's Ulcers

Intraoperative radiolymphoscintigraphy for detection of occult nodal metastasis in patients with head and neck squamous cell carcinoma

OBJECTIVESWe sought to determine the feasibility and utility of intraoperative radiolymphoscintigraphy as a screening procedure for the detection of occult metastatic disease in selected cases of head and neck squamous cell carcinoma (HNSCC).METHODSPatients with accessible primary HNSCC and no evidence of metastatic disease who were already undergoing planned surgical resection of the primary tumor and elective neck dissection met the inclusion criteria. Before resection, a handheld gamma probe was used to find the radiolabeled sentinel lymph node (SLN). The neck specimen was examined ex vivo by using the gamma probe; the SLN or SLNs were dissected free from the specimen and sent separately for histopathologic examination.RESULTSAt least one SLN was identified in all patients enrolled thus far. Four patients had microscopic carcinoma found in the SLN. Two of these had cancer only in the SLN, and two had disease both in the SLN and the remaining specimen.CONCLUSIONSIntraoperative radiolymphoscintigraphy appears to be a feasible and promising procedure to aid the surgeon in more accurately detecting occult metastatic HNSCC.

Intraoperative radiolymphoscintigraphy for detection of occult nodal metastasis in patients with head and neck squamous cell carcinoma

Objectives: We sought to determine the feasibility and utility of intraoperative radiolymphoscintigraphy as a screening procedure for the detection of occult metastatic disease in selected cases of head and neck squamous cell carcinoma (HNSCC). Methods: Patients with accessible primary HNSCC and no evidence of metastatic disease who were already undergoing planned surgical resection of the primary tumor and elective neck dissection met the inclusion criteria. Before resection, a handheld gamma probe was used to find the radiolabeled sentinel lymph node (SLN). The neck specimen was examined ex vivo by using the gamma probe; the SLN or SLNs were dissected free from the specimen and sent separately for histopathologic examination. Results: At least one SLN was identified in all patients enrolled thus far. Four patients had microscopic carcinoma found in the SLN. Two of these had cancer only in the SLN, and two had disease both in the SLN and the remaining specimen. Conclusions: Intraoperative radiolymphoscintigraphy appears to be a feasible and promising procedure to aid the surgeon in more accurately detecting occult metastatic HNSCC. (Otolaryngol Head Neck Surg 2000;122:662-6.)

Can we detect or predict the presence of occult nodal metastases in patients with squamous carcinoma of the oral tongue?

When to do a neck dissection as part of the surgical treatment for a patient with squamous carcinoma of the oral tongue is controversial, particularly when the primary can be resected without entering the neck. If the patient who is at high risk for having occult nodal disease in the neck can be identified, node dissection with the glossectomy could be justified. To better identify patients for this procedure, we correlated various tumor and patient factors along with preoperative diagnostic studies with the presence or absence of pathologically positive nodes in a group of patients who underwent node dissection. Ninety-one previously untreated patients with biopsy-proved squamous carcinoma of the oral tongue were prospectively studied. All patients had a glossectomy and neck dissection as their initial treatment. The pathology findings (ie, lymph nodes with squamous cancer) were correlated with many preoperative and intraoperative factors, and a statistical analysis was made. The use of computed tomography and ultrasound was not better than the clinical examination in determining the presence or absence of nodal metastases. The best predictors were depth of muscle invasion, double DNA aneuploidy, and histologic differentiation of the tumor. All patients with stage T2-T4 squamous cancers of the oral tongue should have an elective dissection of the neck. Patients with T1N0 cancer who have a double DNA-aneuploid tumor, depth of muscle invasion > 4 mm, or have a poorly differentiated cancer should definitely undergo elective neck dissection. Ultrasound and computed tomography are of little value in predicting which patients have positive nodes.

Detection of occult nodal metastases in patients with colorectal cancer

Detection of occult nodal metastases in patients with colorectal cancer

Detection of occult nodal metastases in patients with colorectal cancer

Detection of occult nodal metastases in patients with colorectal cancer

Detection of occult nodal metastases in patients with colorectal carcinoma

Immunohistochemical study may be used for detecting micrometastases by their expression of tumor-associated antigens. In 48 specimens of colorectal cancer from 47 patients, 49 of 249 lymph nodes (median, five per patient; range, 2-11) examined by light microscopic study contained tumor deposits. Sections of all lymph nodes were also examined by immunohistochemical study for carcinoembryonic antigen (CEA) and epithelial membrane antigen (EMA) expression using the indirect immunoperoxidase staining method. All 49 lymph node metastases (100%) from 20 patients stained positively for CEA and 45 (92%) expressed EMA. Of the 200 lymph nodes without metastases on light microscopic examination, anti-CEA revealed a single micrometastasis in a patient staged as Dukes' B. No additional metastases were detected with anti-EMA. In this series of patients immunohistochemical study has, therefore, influenced the histologic staging in only one patient (2%) and thus does not offer a significant benefit over conventional histologic staging.