Pattern Of Lymph Node Involvement Research Articles

467. DISTRIBUTION OF LYMPH NODE INVOLVEMENT IN PATIENTS WITH GASTRO-ESOPHAGEAL JUNCTION ADENOCARCINOMA

Abstract Background Curative cancer surgery relies on understanding the lymphatic spread of the tumour to guide lymphadenectomy. The lymphatic involvement in patients with esophageal squamous cell carcinoma (SCC) has been evaluated extensively in large cohort studies from the East where SCC predominates, but the pattern of lymph node spread in gastro-esophageal junction (GEJ) adenocarcinoma is less clear. The primary aim of this study was to compare differences in the pattern of lymph node involvement according to the Siewert classification. Methods Consecutive patients who underwent curative resection for GEJ adenocarcinoma between February 2010 and April 2023 were analysed from a prospectively maintained database. Patient demographic data, neo-adjuvant treatment, operation type and histopathological report data were collected and analysed according to the pathological Siewert classification of GEJ cancer. Results 807 patients who underwent curative surgery for GEJ adenocarcinoma were analysed. The median lymph node yield was 26 (5-81). Comparing positive para-esophageal node yields, Type I and II tumours were similar but both significantly higher than Type III. For positive para-gastric nodes, Type 2 and 3 tumours were similar but both significantly higher than type 1. The significance of these comparisons is presented in table 1. There were no differences comparing other specific nodal groups. Evaluating the effect of node involvement on overall survival positive node status and positive hepatic artery nodes were found to be independent factors adversely affecting survival. Conclusion Siewert type I tumours have greater proximal lymph node involvement compared to type III tumours with higher proportions of positive para-esophageal nodes. Type III tumours on the other hand have higher proportions of para-gastric nodes. Type II tumours have similar para-esophageal node involvement to type 1 tumours and similar para-gastric involvement to type III tumours. Involvement of more specific nodal groups does not seem to vary between the sub types.

Patterns of lymph node involvement for oral cavity squamous cell carcinoma

AimWhereas the prevalence of lymph node level (LNL) involvement in oral cavity squamous cell carcinomas (OCSCC) has been reported, the details of lymphatic progression patterns are insufficiently quantified. We investigate how the risk of metastases in each LNL depends on the involvement of adjacent LNLs, T-category, subsite, primary tumor lateralization, and other risk factors. MethodsWe retrospectively analyzed patients with newly diagnosed OCSCC from two institutions, totaling 348 patients. Involvement of LNLs I-V was recorded individually based on pathology after neck dissection with clinicopathological factors. The dataset is publicly available in a previously developed web-app, which allows querying patients with specific combinations of co-involved LNLs and tumor characteristics. ResultsIpsilateral involvement prevalence of levels I-III was higher for advanced T-category (T3/T4) patients (32 %, 38 %, 14 %) compared to early (T1/T2) patients (14 %, 23 %, 11 %). Involvement of level I increased the involvement probability in levels II and III. Similarly, involvement of level II increased the involvement probability in levels I and III. However, there was significant isolated involvement of level I or II. Advanced nodal involvement (>1 LNL involved) was more frequent for patients with extracapsular extension. Overall contralateral involvement in levels I-III was 7 %, 4 %, 3 % and more frequent for more advanced ipsilateral involvement and for midline-crossing tumors. Involvement of levels IV and V was rare: 3 % ipsilateral and 1 % contralateral in both levels. ConclusionsDetailed quantification of LNL involvement in OCSCC depending on involvement of adjacent LNLs and clinicopathological factors may allow further personalizing guidelines on elective nodal treatment.

Imaging of extranodal lymphomas in the head and neck: A case series and review of the literature

Extranodal lymphomas (ENLs) are relatively rare malignancies of the head and neck. Clinical presentation varies greatly depending on location, pattern of nodal involvement, and histologic subtype. The most frequently involved sites include the palatine tonsils and nasal cavity/paranasal sinuses, and over half of patients have concurrent nodal disease. Most are non-Hodgkin’s lymphomas of B-cell lineage. While the clinical presentation may mimic other pathologies of the head and neck, various radiographic features and patterns may help raise suspicion for ENL as a differential consideration. This is of critical importance given that the management and treatment of lymphomas differ significantly from other pathologies of the head and neck. In this case series, three cases of ENL in the head and neck are described, with an emphasis on radiographic findings. A review of epidemiology and treatment paradigms is also provided.

Pattern of Lymph Node Involvement and Clinical Presentations of Tuberculous Cervical Lymphadenitis in a Single Center Tertiary Level Hospital

Introduction: Tuberculous cervical lymphadenitis, also known as scrofula, is a common manifestation of extra pulmonary tuberculosis. It primarily affects the lymph nodes in the neck region and is caused by Mycobacterium tuberculosis. TCL presents with distinct clinical features and a characteristic pattern of lymph node involvement. This short overview aims to analyze the pattern of lymph node involvement and clinical presentations of TCL to improve diagnostic accuracy and patient care. Aim of the study: The aimed to analyze the pattern of lymph node involvement and clinical presentations of TCL. Methods: This prospective observational study was conducted at the Dhaka Medical College Hospital, Dhaka, Bangladesh, over a period of four years. A total of 189 TCL patients were included in the study, with data collected on socio-demographic characteristics, clinical presentations, neck swelling-related characteristics, and various laboratory findings. Result: The majority of the participants were between the ages of 15-30 years (71.43%) and were predominantly female (68.25%). Fever was the most common clinical presentation (66.67%), followed by abscess (49.21%) and cough (30.16%). Unilateral neck swelling on the right side was the most prevalent (41.27%). Swollen nodes were frequently observed, primarily at node levels II, III, IV, V, and VI. High ESR (58.73%) and positive CGD on FNAC (100%) were common laboratory findings. Gene-Xpert testing showed positive results in 87.50% of cases. During the follow-up period, fever, neck pain, and neck swelling gradually decreased, while new abscess occurrences decreased over time. Surgery was performed on 4.23% of participants with single-level swollen nodes and 19.10% with multi-level swollen nodes after 1 year. Conclusion: In summary, this study on tuberculous lymphadenitis (TCL) identified consistent patterns in lymph node involvement and clinical presentations. Fever, abscess formation, and cough were common symptoms, .......

Consensus Delineation Guidelines for Pelvic Lymph Node Radiation Therapy of Prostate Cancer: On Behalf of the Francophone Group of Urological Radiation Therapy (GFRU)

Clinical target volume (CTV) delineation for pelvic lymph nodes in prostate cancer is currently based on 3 consensus guidelines with some inherent discrepancies. To improve the reproducibility in nodal delineation, the Francophone Group of Urological Radiotherapy (Groupe Francophone de Radiothérapie Urologique [GFRU]) worked toward proposing an easily applicable, reproducible, and practice-validated contouring guideline for pelvic nodal CTV. The nodal CTV data sets of a high-risk node-negative prostate cancer clinical case contoured by 86 radiation oncologists participating in a GFRU contouring workshop were analyzed. CTV volumes were defined before and after a structured presentation of literature data on lymphatic drainage pathways and patterns of nodal involvement and relapse, illustrated using a reference contour (CRef) defined by 3 GFRU experts. The consistency between the participants' contours and CRef was assessed quantitively by means of the Simultaneous Truth and Performance Level Estimation (STAPLE) method, the Dice coefficient, and the Hausdorff distance and qualitatively using a count map. These results combined with the literature review were thoroughly discussed among GFRU experts to reach a consensus. From the 86 workshop participants, the volume of the STAPLE CTV was 591 cc compared with 502 cc for CRef. The Dice coefficient of the STAPLE CTV compared with the experts' CRef was 0.736 (±0.084) before and 0.823 (±0.070) after the workshop; the standard deviation decreased from 11.5% to 8.5% over the workshop. The Hausdorff distance of the STAPLE CTV compared with the CRef was 34.5 mm (±12.4) before the workshop and 21.8 mm (±9.3) after the workshop. Four areas of significant interobserver variability were identified, and a consensus was reached. Using a robust methodology, our cooperative group proposed an easily applicable, reproducible, and practice-validated guideline for the delineation of the pelvic CTV in prostate cancer, useful for implementation in daily practice and clinical trials.

STUDY OF PREDICTORS OF INGUINAL LYMPH NODE METASTASIS IN CARCINOMA PENIS

Background:Penile cancer although a rare cancer, its not uncommon in India. Indian incidence ranges from 0.7-3/100000 males.Clinical guidelines available for decision making, still it remains a complex issue as far as predicting the outcome. The presence of metastatic disease produces considerable morbidity in patients with penile cancer. By doing this study we want to study which factors both clinically and histologically were predictive of lymph node involvement, pattern of lymph node involvement and extent of disease in nodal regions. Patients and Methods:A total of 38 cases between January 2018 to February 2020 were included in study. Metastatic carcinoma penis were excluded. The study was conducted in the Department of surgical oncology MNJIO&RCC OSMANIA MEDICAL COLLEGE.All cases of biopsy proven carcinoma penis were evaluated. Time period of study was from January 2018 to January 2020.Lymph node status was predicted preoperatively by clinical examination and imaging using ultra sound and CT scan. All cases irrespective of lymph node status were managed by surgery of primary and bilateral inguinal node dissection .Both clinical and histological factors were assessed. A total of 43 patients presented with penile cancer in the specified duration to our institute , of which, 1 patient had lung mets and was excluded, 2 patients were not willing for lymph nodal addressing surgery and were omitted from the study. Results: In our study post surgery 14 patients {35%} had positive lymph nodal disease of which 10 patients had unilateral inguinal lymph node involvement and 4 had bilateral inguinal lymph node involvement . 2 patients had pelvic lymph node involvement.Of the 40 cases in our study 23 patients had clinically involved nodes , 17 had no clinical involvement of lymph nodes . Of the 23 cases of clinically involved nodes 11 patients had histopathological conformation of nodal involvement {47.8%}. The relative risk of histopathological node positivity in clinical involved nodes is 2.71. odds ratio was 4.27 .The p value is 0.0479, so clinical node involvement is a significant criteria for pathological node involvement in our study. Conclusion:In clinically positive nodes only 50% of patients have actual histopathological involvement of disease. And 15 to 20% of patients with clinically negative nodes had post op histopathological confirmation of nodal involvement. Most significant predictive factors for lymphnode involvement in our study though with small sample size were tumor grade 3{poorly differentiated,tumor} ,depth of invasion greater than 1cm ,Clinical node involvement ,lymphovascular invasion. Other factors which had high relative risk and odds ratio were grade 2 tumor,size of greater than 4cms , perineural invasion, depth between 0.5 to 1cm.

The Relationship Between Body Mass Index and Different Regional Patterns of Lymph Node Involvement in Papillary Thyroid Cancers.

IntroductionLymph node (LN) metastasis is the first site of metastasis of papillary thyroid cancer (PTC). LN status influences clinical management and the prognosis of patients. We explored the relationship between patient obesity and regional patterns of LN involvement in PTC.Materials and MethodsThis study retrospectively analyzed the data from 12,772 PTC patients. The rate of LN metastasis, number of LN metastasis, maximum diameter of positive LN, number of dissected LN, and LN ratios (LNR) were compared between normal-weight and obese patients. Statistical methods have been adjusted for the confounders in hypothesis testing.ResultsOverweight and obesity were independent risk factor for metastatic LNs (OR1 = 1.125, 95% CI 1.042-1.214, P1 = 0.003; OR2 = 1.554, 95% CI 1.339-1.802, P2 <0.001). Obesity was an independent risk factor for the number of metastatic CLNs (OR=1.159, 95% CI 0.975-1.377, P=0.045), however not for number of metastatic lateral LNs (P=0.907). Furthermore, obesity was not an independent risk factor for number of CLNs when dissected more than five (P=0.653), still an independent risk factors for number of metastatic lateral LNs when more than six (OR=1.185, 95% CI 1.010-1.391, P=0.037). As for LNR, obesity was an independent risk factor for the central LNR when more than 0.12 (OR adjusted 1 = 1.099, 95% CI 1.011-1.194, P1 = 0.027; OR adjusted 2 = 1.177, 95% CI 1.003-1.381, P2 = 0.045), for the lateral LNR more than 0.05 (P2 = 0.283).ConclusionsObesity was associated with poor prognoses with PTC respecting LNs. Surgeons should be extreme caution when performing central neck dissection in obese patients.

Lymph Nodes Involvement and Lymphadenectomy in Thymic Tumors: Tentative Answers for Unsolved Questions.

Simple SummaryThe standard treatment for thymic tumors is radical thymectomy with en bloc resection of the surrounding tissue for early stages, while multimodality therapy has to be considered in the advanced stages. Due to the rarity of nodal metastases in thymic tumors, little attention has been paid to their incidence, pattern and prognostic significance and, consequently, no standard nodal mapping or consensus on lymph node dissection has currently been established. Moreover, no data indicate which subgroup of patients would be appropriate candidates for lymph node dissection D or the extent to which lymph nodes should be harvested. The aim of this review is to collect evidence from the useful literature to help physicians in designing the best surgical procedure when dealing with thymic malignancies and to plan the best multidisciplinary strategy in case of advanced stage thymic tumors.Thymic tumors are the most common primary neoplasms of the anterior mediastinum, although, when compared with the entire thoracic malignancies, they are still rare. Few studies addressed the questions about lymph node involvement pattern in thymic neoplasms, about which subgroup of patients would be appropriate candidates for lymph node dissection or about the extent of lymphadenectomy or which lymph nodes should be harvested. The aim of this review is to collect evidence from the literature to help physicians in designing the best surgical procedure when dealing with thymic malignancies. A literature review was performed through PubMed and Scopus in May 2021 to identify any study published in the last 20 years evaluating the frequency and the extent of lymph node dissection for thymic tumors, its impact on prognosis and on postoperative management. Fifteen studies met the inclusion criteria and were included in this review, with a total of 9452 patients with thymic cancers; lymph node metastases were found in 976 (10.3%) patients in total. The current literature is heterogeneous in the classification and reporting of lymph node metastases in thymic carcinoma, and data are hardly comparable. Surgical treatment should be guided by the few literature-based pieces of evidence and by the experience of the physicians.

Prognostic impact of extranodal extension in patients with pN1-N2 lung adenocarcinoma.

Lymph node involvement is one of the important prognostic factors of patients with lung adenocarcinoma. In the tumor, node, and metastasis classification, lymph node involvement is categorized only according to the anatomical station and not the involvement pattern. The aim of this study was to investigate which morphological pattern of lymph node involvement affects the prognosis of patients with surgically resected lung adenocarcinoma. We retrospectively reviewed 168 consecutive patients who underwent surgical resection for primary lung adenocarcinoma with lymph node involvement. The morphological patterns of lymph node involvement (tumor area, number of metastatic lymph nodes, presence of necrosis, and extranodal extension) were histologically examined. The relationships between the patterns of lymph node involvement, clinicopathological features, and survival of patients were analyzed. Eighty patients had N1 disease, and 88 patients had N2 disease. Univariate analysis revealed that invasive size, history of adjuvant chemotherapy, and presence of extranodal extension were significant prognostic factors in N1 patients, and vascular invasion, pleural invasion, presence of epidermal growth factor receptor mutation, history of adjuvant chemotherapy, and presence of extranodal extension were significant prognostic factors in N2 patients. In a bivariate analysis including other clinicopathological factors and patterns of lymph node involvement, the presence of extranodal extension was significantly associated with poor 3-year overall and recurrence-free survival of both N1 and N2 patients. In patients who underwent surgical resection for lung adenocarcinoma with lymph node involvement, the extranodal extension was the most important prognostic factor among morphological lymph node involvement patterns.

FDG-PET/CT and Pathology in Newly Diagnosed Head and Neck Cancer: ACRIN 6685 Trial, FDG-PET/CT cN0.

FDG-PET/CT (fluorodeoxyglucose-positron emission tomography/computed tomography) is effective to assess for occult neck nodal disease. We report risks and patterns of nodal disease based on primary site and nodal level from data on the dissected cN0 per the results from ACRIN 6685. Prospective nonrandomized enrollment included participants with first-time head and neck squamous cell carcinoma and at least 1 cN0 neck side to be dissected. Twenty-four ACRIN-certified centers internationally (American College of Radiology Imaging Network). A total of 287 participants were enrolled. Preoperative FDG-PET/CT findings were centrally reviewed and compared with pathology. Incidence, relative risk, pattern of lymph node involvement, and impact upon neck dissection were reported. An overall 983 nodal levels were dissected (n = 261 necks, n = 203 participants). The highest percentages of ipsilateral positive nodes by primary location and nodal level were oral cavity (level I, 17/110, 15.5%), pharynx (level II, 6/30, 20.0%), and larynx (level VI, 1/3, 33.3%). Levels at greatest risk for nodal disease in cN0 in terms of ipsilateral neck dissection are level I (oral cavity), II (pharynx), and VI (larynx). These data should be considered when treating patients presenting with cN0. This is the first study to comprehensively report the incidence, location, and risk of metastases in cN0 in the FDG-PET/CT era.

Lymph Node Subcapsular Sinus Microenvironment-On-A-ChipModeling Shear Flow Relevant to Lymphatic Metastasis and Immune Cell Homing.

SummaryA lymph node sinus-on-a-chip adhesion microfluidic platform that recapitulates the hydrodynamic microenvironment of the lymph node subcapsular sinus was engineered. This device was used to interrogate the effects of lymph node remodeling on cellular adhesion in fluid flow relevant to lymphatic metastasis. Wall shear stress levels analytically estimated and modeled after quiescent and diseased/inflamed lymph nodes were experimentally recapitulated using a flow-based microfluidic perfusion system to assess the effects of physiological flow fields on human metastatic cancer cell adhesion. Results suggest that both altered fluid flow profiles and presentation of adhesive ligands, which are predicted to manifest within the lymph node subcapsular sinus as a result of inflammation-induced remodeling, and the presence of lymph-borne monocytic cells may synergistically contribute to the dynamic extent of cell adhesion in flow relevant to lymph node invasion by cancer and monocytic immune cells during lymphatic metastasis.

Comparisons of Treatment Outcomes and Patterns of Lymph Node Involvement in T4 Prostate Cancer Patients

Little is known about the clinical behaviors and optimal treatment of T4 prostate cancer. Previous studies on locally advanced prostate cancers have a critical lack of T4 patients to compare. In this study, we analyzed patterns of lymph node (LN) involvement and associations between treatment outcomes in a large cohort of T4 prostate cancer patients. Patients with T4 prostate cancer were identified using Natural Language Processing. Patients who had received previous treatment prior to presentation at our institution were excluded. A dedicated GU radiologist (T.B.) reviewed all existing pretreatment imaging to identify LN involvement and T4 status. Categorical variables were compared utilizing the chi-squared test while overall survival was calculated via the Kaplan Meier method with comparisons via the log rank test. Hazard ratio was calculated using Cox proportional Hazards Regression. 481 patients with T4 prostate cancer were diagnosed between 1996 and 2017; 103 met our inclusion criteria for treatment-naïve T4 condition. T4 status was identified by either clinical examination (colonoscopy, cystoscopy, and digital rectal exam; 56.3%) or imaging (43.7%); 45% of patients were M0, 55% M1, 25% N0, and 75% N1. The median age was 62 (range 44-88) and median pre-treatment PSA was 17.5 (range 0.5-900). The majority of patients presented with an adenocarcinoma histology (78.6%) followed by ductal (8.7%) and small cell (5.8%). The median follow-up time was 103.5 months (mo). Patients with any rectal involvement by the primary tumor (n = 42) exhibited significantly increased rates of perirectal and mesorectal lymph node (LN) involvements than patients without (n = 61) (45% vs 26%, p = 0.046), with no significant links with disease invasion to the bladder or pelvic side wall (p = 0.61, 0.67). Definitive local treatment (LT: surgery, definitive radiation therapy, or both) was given to 56 patients (54%). Patients who received LT demonstrated significantly higher rates of survival (median 80 vs 39 mo; HR = 0.37, p = 0.0002). Subgroup analyses revealed a trend towards improved survival with LT among N1 patients (74 vs 39 mo; p = 0.08) as well as M1 patients (74 vs 37.5 mo, p = 0.14). This analysis identified an increased frequency of perirectal and mesorectal LN involvement among patients with rectal invasion by the primary tumor. LT was associated with significantly improved overall survival, which appears to extend to patients with M1 and N1 disease. These results support the utilization of definitive local therapy among T4 prostate cancer patients with benefits that possibly extend to those with regional or metastatic disease. Further consideration should also be given to include mesorectal and perirectal LNs in pelvic radiation fields in patients with rectal involvement from the primary disease.

Nodal Involvement Pattern in Clinical Stage IA Non-Small Cell Lung Cancer According to Tumor Location.

PurposeThe purpose of this study was to investigate lymph node involvement pattern in clinical stage IA non-small cell lung cancer (NSCLC).Patients and MethodsClinical stage ⅠA NSCLC patients who underwent lobectomy and lymph node resection were included in this retrospective study. Mediastinal lymph node involvement was distinguished by different lobes and tumor size.ResultsFrom 2000 to 2015, a total of 759 patients were identified: 282 (37.2%) with tumors in the right upper lobe (RUL), 183 (24.1%) in the left upper lobe (LUL), 124 (16.3%) in the right lower lobe (RLL), 103 (13.6%) in the left lower lobe (LLL), and 67 (8.8%) in the right middle lobe (RML). Patients with tumor size ≤1 cm accounted for 19.6%, >1 and ≤2 cm for 47.8%, >2 and ≤3 cm for 32.5%. Patients with pN1 accounted for 8.2%, and pN2 for 12.5%. Among patients with pN2, the inferior mediastinum was involved in 9.7% of RULs and 17.4% of LULs; the superior mediastinum was involved in 52.2% of RLLs and 36.4% of LLLs. Mediastinal lymph node metastasis was found in 13.2% of patients with size >1 and ≤2 cm, and 19.0% of >2 and ≤3 cm. Patients with tumors ≤1 cm had no N2 lymph node involved.ConclusionSelective lymph node dissection based on tumor location is not recommended in clinical stage ⅠA NSCLC, and systemic lymph node dissection should be performed for NSCLC with size >1 cm.

Prognostic factors for and pattern of lymph-node involvement in patients with operable cervical cancer.

Lymph node metastases significantly worsen the prognosis in cervical carcinoma. Risk factors-pathological and patient related-could select patients at high risk for lymph node involvement. This retrospective analysis was performed by analyzing data from patients with cervical carcinoma treated between 2000 and 2017 at the Department of Obstetrics and Gynecology of the University Hospital Ulm. In total, 261 patients with cervical carcinoma (International Federation of Gynecology and Obstetrics (FIGO) stage IA-IIB) and lymphadenectomy with at least 10 removed lymph nodes were available for analysis. Overall, 86 (33.0%) patients had lymph node metastases; 73 patients had pelvic lymph node metastases only and 13 patients had both pelvic and paraaortic lymph node metastases. Lymph node metastases were found most often in the region of the external iliac artery and obturator fossa, with 57.0% and 54.7% of all 86 node-positive patients, respectively. Univariable analyses showed that presence of lymph node metastases was significantly associated with both preoperative FIGO stage (p = 0.001) and final pathological tumor stage (p < 0.001), status of resection margin (p = 0.002), lymphovascular space invasion (LVSI), (p < 0.001) and vascular space invasion, (p < 0.001). In a multivariable logistic regression model with presence of lymph node metastases (yes/no) as binary response variable, only LVSI (p < 0.001) and body mass index (BMI), (p = 0.035) remained as significant independent predictors of lymph node involvement. Subgroup analyses showed that LVSI was a significant predictive factor for lymph node involvement in patients with a preoperatively assessed FIGO stage < IIB (p < 0.001), but not for patients with a preoperatively assessed FIGO stage ≥ IIB (p = 0.122). The risk factor LVSI should play an important role in deciding whether an individualized therapy concept is based on escalating or deescalating treatment. In future, the sentinel concept could reduce morbidity and at the same time provide an important prognostic assessment for a subset of cervical cancer patients.

WS05.04 Particularities of Lymphadenectomy in Malignant Pleural Mesothelioma

WS05.04 Particularities of Lymphadenectomy in Malignant Pleural Mesothelioma

Extracapsular Lymph Node Involvement in Ovarian Carcinoma.

Ovarian cancer (OC) spread to retro-peritoneal lymph nodes is detected in about one out of two patients at primary diagnosis. Whether the histologic pattern of lymph node involvement i.e., intra-(ICG) or extracapsular (ECG) cancer growth may affect patients’ prognosis remains unknown. The aim of the current study was to analyze the prevalence of ECG and ICG in lymph node positive ovarian cancer. We further investigated whether ECG may be related to patients’ prognosis and whether biomarkers expressed in the primary tumor may predict the pattern of lymph node involvement. Lymph node samples stemming from 143 OC patients were examined for presence of ECG. Capsular extravasation was tested for statistical association with clinico-pathological variables. We further tested 27 biomarkers that had been determined in primary tumor tissue for their potential to predict ECG in metastatic lymph nodes. ECG was detected in 35 (24.5%) of 143 lymph node positive patients. High grade (p = 0.043), histologic subtype (p = 0.006) and high lymph node ratio (LNR) (p < 0.001) were positively correlated with presence of ECG. Both ECG (p = 0.024) and high LNR (p = 0.008) were predictive for shortened overall survival. A four-protein signature determined from the primary tumor tissue was associated with presence of concomitant extracapsular spread in lymph nodes of the respective patient. This work found extracapsular spread of lymph node metastasis to be a common feature of lymph node positive ovarian cancer. Since ECG was positively associated with grade, LNR and shortened overall survival, we hypothesize that the presence of ECG may be interpreted as an indicator of tumor aggressiveness.

Patterns of lymph node involvement and role of common iliac lymphadenectomy in early-stage cervical cancers: A retrospective analysis from tertiary care cancer center in Eastern India

Aims: The aim of the study was to analyze the patterns of lymph node metastasis in early cervical cancer cases operated and to measure the metastatic burden in common iliac nodes and subsequently assess the need for its dissection. Materials and Methods: The study included all the cases of early carcinoma of cervix (Stage IA to IIA) that were operated in our institute. The cases with positive (metastatic) lymph nodes were isolated incorporating the data in tabular form and the patterns of lymph node metastasis analyzed with special reference to common iliac node involvement. Results: A total of 250 patients were operated in our study cohort and 50 cases (20%) had positive lymph node metastasis. External iliac nodes (58%) were most commonly involved, whereas 20% of cases had common iliac nodal involvement and isolated common iliac nodal involvement was seen only in 8% of these cases. Among all the lymph node positive cases, 74% had two or more of the three intermediate-risk factors including deep stromal invasion, lymphovascular space invasion positivity, or large-sized lesion (>4 cm). All the isolated common iliac lymph node positive cases had either positive parametrium or at least two intermediate-risk factors. Conclusion: Isolated common iliac nodal involvement being very low (8%), and this isolated involvement having been demonstrated only in cases with other risk factors; the role of common iliac lymph node dissection in early-stage cancer cervix becomes questionable.

Metastatic lymphadenomegaly in dogs - cytological study.

Enlarged lymph nodes are frequently examined cytologically in dogs and metastatic lymphadenomegaly of various origin is a common cytological finding in these cases. In this study we aimed to examine epidemiological data, and to determine factors affecting the location of neoplastic metastases in the lymph nodes. Samples for cytological examination were obtained by fine-needle biopsy (FNB) of enlarged lymph nodes and stained with Giemsa solution. Cases meeting the following criteria were enrolled in the study: lymphadenomegaly detected in clinical examination, presence of primary mass confirmed by cytopathology or histopathology as a solid malignant tumour, and cytological diagnosis of metastatic tumour. Cytological pattern of lymph node involvement was classified as low, medium and massive. During study period 125 dogs met the eligibility criteria, with age ranged from 1.8 to 19 years. No sex predisposition to particular types of tumors was observed, except for adenocarcinoma which was diagnosed in females more often. Metastatic tumors were various in origin, with predominance of mast cell tumors, adenocarcinomas, and melanomas. Massive involvement predominated in all lymph nodes affected. Neoplastic lymphadenomegally is recognized usually in older dogs, with female predisposition related to dissemination of mammary cancers. Mast cell tumor, adenocarcinoma and melanoma are the most common causes of metastatic lymphadenomegaly, and in the vast majority of the cases massive lymph node involvement is observed.

Pretherapeutic staging of locally advanced cervical cancer: Inframesenteric paraaortic lymphadenectomy accuracy to detect paraaortic metastases in comparison with infrarenal paraaortic lymphadenectomy.

Extended-field chemoradiation therapy is usually performed in patients with locally advanced cervical cancer (LACC) and paraaortic (PA) node metastases. Considering the very low rate of skip metastases above inferior mesenteric artery, ilio-inframesenteric paraaortic lymph node dissection (IM-PALND) seems to be an adequate pattern of PALND. Our objective was to assess the accuracy of this management to determine PA nodal status in comparison with infrarenal paraaortic lymphadenectomy (IR-PALND) in case of squamous or glandular cervical cancer. All patients with LACC and negative MRI and PET/CT imaging at paraaortic level had laparoscopic staging (followed, if negative, by extraperitoneal paraaortic lymphadenectomy). From January 2011 to September 2015, patients who had IM-PALND were included and were compared to a previous historical series of IR-PALND patients. The two groups differed only at the upper level of dissection. Characteristics of nodal involvement at paraaortic level depending on level of dissection, PET/CT imaging and histology were studied. 119 women were included in our study, with 56 patients in the IM-PALND group and 63 in the IR-PALND group. In the IM-PALND group, fewer nodes were resected (p<0.001). There was no difference between the two groups regarding nodal status at paraaortic level (p=0.77). Patterns of nodal involvement were similar whichever the histological subtype of cervical cancer (squamous or glandular). IM-PALND appears to be equally effective to assess paraaortic nodal involvement in LACC for both histological subtypes - glandular and squamous carcinomas - and to select patients for extended-field chemoradiation therapy.

Characteristics of T- and NK/T-cell lymphomas with different pathological subtypes on 18F-FDG PET/CT

Objective To investigate the imaging presentation of T- and NK/T-cell lymphomas with different pathology subtypes on 18F-FDG PET/CT. Methods A total of 95 patients (66 males, 29 females, average age 38.42 years) with T- and NK/T-cell lymphoma proved by pathology from June 2006 to February 2016 were retrospectively analyzed. 18F-FDG uptake (SUVmax), nodal invasion, nodal distribution, extra-nodal involvement and staging were compared among 7 pathological subtypes of T- and NK/T-cell lymphomas. One-way analysis of variance, Fisher exact test and Kruskal-Wallis H test were used for data analysis. Results There were significant differences in terms of 18F-FDG uptake, nodal invasion, nodal distribution, extra-nodal involvement and staging among different pathological subtypes of T- and NK/T-cell lymphomas (F=2.937, P<0.05; Fisher exact test, all P<0.01; H=19.883, P<0.01). NK/T-cell lymphoma was found to be prone to invade the nasal cavity and nasopharynx, enteropathic type T-cell lymphoma was specific to the intestine, and subcutaneous panniculitis-like T-cell lymphoma presented with subcutaneous infiltration. All those 3 subtypes were quite specific in their extra-nodal involvement. Most patients with angioimmunoblastic T-cell lymphoma (ATCL), peripheral unspecified T-cell lymphoma (PUTCL) and T immunoblastic lymphoma (TIBL) presented as stage Ⅳ disease. Widespread lymph node disease associated with splenic, parotid and serous membrane involvement were often seen in ATCL patients (most commonly to involve the parotid glands and serous membrane among the 7 subtypes). Nodal involvement was found in PUTCL patients, but extranodal involvement was rather non-specific. TIBL had a non-specific pattern of nodal involvement with low 18F-FDG uptake, lower than ATCL and the other 5 subtypes. Anaplastic large cell lymphoma subtypes had the highest 18F-FDG uptake when compared with the other 6 subtypes, but were less often to manifest as stage Ⅳ disease despite their preponderance for marrow and nodal infiltration. Conclusion Different pathological subtypes of T- and NK/T-cell lymphoma manifest different imaging presentations on 18F-FDG PET/CT, which are useful for understanding their biological characteristics. Key words: Lymphoma, T-cell; Natural killer T-cells; Positron-emission tomography; Tomography, X-ray computed; Deoxyglucose