Presence Of Metastatic Nodes Research Articles

Which is important in the evaluation of metastatic lymph nodes in head and neck cancer: palpation, ultrasonography, or computed tomography?

Objective Evaluate palpation, ultrasonography (USG), and computed tomography (CT) with respect to their value for comparative determination of metastatic lymph nodes in head and neck cancer. Study design A prospective study was conducted in a tertiary referral hospital. During September 1996 and April 1999, clinical investigation, USG, and CT were performed preoperatively on 48 patients who would undergo neck dissection for primary head and neck malignancy. The presence of metastatic lymph nodes in pathologic specimens were compared with the findings of palpation, CT, and USG. Results Twenty-two of the patients had positive lymph nodes on pathologic investigation. The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy for palpation are 64%, 85%, 74%, 78%, and 75% respectively. Respective values for USG and CT for sensitivity, specificity, negative predictive value, positive predictive value, and accuracy are 72%, 96%, 80%, 94%, and 85% and 81%, 96%, 85%, 90%, and 87%. Conclusion All of the pretreatment evaluation methods, palpation, CT, and USG yield results that are significantly different from the histopathologic results, suggesting that no pretreatment study can accurately assess the requirement to histopathologically stage the neck. USG findings are more correlated with the pathologic findings than palpation, but CT gives the most effective and reliable results when it is combined with USG in neck staging. Preoperative USG and CT scanning of the neck by an experienced radiologist is essential and useful for diagnosis, staging, and therapy choices. Significance Statistical analysis was done with χ 2 test. The difference between histologic findings and palpation is significant ( P = 0.0005). The difference between histologic findings and USG and CT is significant ( P = 0.0001 and P = 0.0001).

Overexpression of the c-Met/HGF receptor and its prognostic significance in uterine cervix carcinomas

Objective The purpose of this study is to evaluate the significance of the c-Met/hepatocyte growth factor receptor expression in invasive cervical carcinoma. Methods Ninety-Four patients with FIGO stage 1B disease, treated primarily with surgery, were studied immunohistochemically. Of the cases, 67 were squamous carcinoma and 27 were nonsquamous (10 were adenocarcinoma, 15 were adenosquamous carcinoma, and 2 were indifferentiated carcinoma). Immunohistochemically stained c-Met slides of primary malignancies were evaluated blindly of clinical outcome and other histopathological factors. Results Overexpression of c-Met was found in 56 of 94 specimens. Primary tumors which show recurrences were found to be c-Met overexpressors. Univariate survival analysis (Kaplan–Meier) showed that c-Met overexpression is significantly correlated with disease-free survival. Moreover the diameter of the primary tumor, deep cervical stromal invasion, presence of metastatic lymph node, number of metastatic lymph nodes and c-Met overexpression were significantly correlated with overall 5-year survival. Furthermore multivariant analysis with Cox regression showed that the presence of metastatic lymph node and immunopositivity for c-Met are significantly correlated with overall survival, while c-Met overexpression was found to be an independent variable for disease-free survival. Conclusion. These results reveal that c-Met oncogene overexpression is an important parameter for disease progression, recurrence, and survival in early-stage invasive uterine cervix carcinomas.

Survival advantage of using autologous blood transfusion during surgery for esophageal cancer.

There is evidence that blood transfusion is associated with an increased rate of tumor recurrence. This study was conducted to assess the survival advantage of giving autologous blood instead of allogeneic blood during surgery for esophageal cancer. We retrospectively analyzed 62 patients who underwent esophagectomy for thoracic esophageal cancer between January 1991 and February 1995 and received allogeneic blood transfusion, and 61 patients operated on between March 1995 and February 1998, who received autologous blood transfusion. The clinicopathological factors and survival rates were compared between the two groups. The clinicopathological factors that influenced prognosis were similar in the two groups; however, a definite survival advantage was evident in the autologous blood transfusion group. According to multivariate analyses, the transfusion of allogeneic blood was an independent prognostic factor ( P = 0.0222), as was the presence of metastatic lymph nodes. Patients who received allogeneic blood transfusions perioperatively had more than a twofold greater risk (Hazard ration 2.406) of death over patients who received autologous blood transfusions. Autologous blood transfusion appears to be an independent prognostic factor for the survival of patients with esophageal cancer.

Sentinel node in breast cancer--a Swedish pilot study of 75 patients.

To find out if the sentinel node can be detected in sufficient numbers of women with breast cancer to be useful as a prognostic sign, whether it reflects that state of the entire axilla, and whether it detects micrometastases that would otherwise be missed. Prospective study. 3 teaching hospitals, Sweden. 75 patients with breast cancer who were listed to have axillary dissection as well as resection of their tumour. Injection of 99Tc nanocolloid 0.4 ml and patent blue dye 1 ml around the tumour or under the skin above the tumour, followed by preoperative lymphoscintigraphy and then identification of the sentinel node during operation either because it had turned blue or with a gamma probe. Removal of the sentinel node and complete axillary dissection. Identification of the sentinel node and presence of metastatic nodes in the axilla. The sentinel node was identified in 69/75 (92%). It correctly predicted the state of the axilla in 66/69 (96%), and detected metastases in 24 of the 27 with invaded nodes in the axilla (89%). The false negative rate was 11%. In 14/27 with axillary metastases (52%) the sentinel node was the only involved node. In 3/24, metastases were detected by immunohistochemistry alone. Biopsy of the sentinel node predicted the presence or absence of axillary metastases with acceptable accuracy. However, before axillary node dissection is rejected in favour of sentinel node biopsy alone, large multicentre studies are needed to establish the true false negative rate.

Telomerase in relation to clinicopathologic prognostic factors and survival in cervical cancer.

We investigated, in cervical cancer, the relation between telomerase activity, telomerase RNA (hTR) and mRNA of the catalytic subunit of telomerase, hTERT, with "classic" clinicopathological factors as well as survival. Frozen specimens were obtained from 107 consecutive patients with cervical cancer, treated with surgery or radiotherapy with or without chemotherapy. Telomerase activity was determined with fluorescence-based TRAP and hTR and hTERT with semi-quantitative RT-PCR. Eight normal cervical specimens served as controls. Analysis of prognostic factors and survival was limited to early-stage patients, treated primarily with radical hysterectomy. Telomerase activity was not detected in normal cervices and was present in 85 of 107 (79%) cervical cancers (p < 0.001). hTR was detected in all normal cervices and cervical cancers, while hTERT mRNA was detected in 1 of 8 (13%) normal cervices and in 83 of 104 (80%) cervical cancers (p < 0.001). In contrast to semi-quantitative hTR expression levels, semi-quantitative hTERT mRNA levels were related to telomerase activity levels (p < 0.01). In all patients, telomerase activity levels were related to differentiation grade (p < 0.05) but not to stage and histotype. In early-stage patients, telomerase activity, hTR and hTERT were not related to tumor volume, vascular invasion or presence of metastatic lymph nodes. Tumor volume, vascular invasion and presence of metastatic lymph nodes were related to (progression-free) survival, while telomerase activity and its subunits were not. Frequent up-regulation of telomerase activity and hTERT mRNA is especially observed in cervical cancers, while hTR is also detected in normal cervices. Telomerase is not applicable as a prognostic factor in early-stage cervical cancer patients.

Mortalidad en el cáncer de laringe en estadios avanzados

Patients with advanced laryngeal carcinoma present a high mortality rate due to locoregional recurrence, distant metastases and second cancer. We present a report about the most important prognostic factors in mortality in patients included in III and IV stages. The most importants are the presence of metastatic lymph nodes (p=0.001), extracapsular spread (p=0.002) and N stage (p=0.005).

Prognostic relevance of altered Fas (CD95)-system in human breast cancer.

The Fas ligand (FasL) and its receptor Fas (APO-1 or CD95) are members, respectively, of the tumor necrosis factor family that, upon interaction with each other, play a key role in the initiation of one apoptotic pathway. Faulty regulation of the Fas system has been described in a variety of human tumors with different histogenetic origin. Here, we describe the expression and distribution of Fas receptor and ligand pair antigens in surgical samples collected from a cohort of 186 patients bearing breast neoplasms (45 benign and 141 malignant lesions). Immunoperoxidase staining of formalin-fixed tissues showed that 91.1% of benign lesions expressed Fas, which was present in only 56.7% of malignant tumors. On the other hand, FasL was found positive in 22.2% of benign neoplasms and up-regulated in in situ as well as invasive carcinomas (53.9%). Moreover, in malignant tumors, the expression of receptor and ligand antigens appeared to be inversely related. When these findings were correlated with pathological parameters of prognostic relevance, a significant association was observed between FasL and the presence of metastatic lymph nodes and larger tumor size while Fas expression correlated to node-negative status and smaller tumor size. Patients with Fas positive tumors exhibited longer disease-free survival than those with Fas-negative carcinoma while FasL did not influence patient outcome. These relationships indicate that benign and malignant mammary lesions are characterized by differential cellular expression of Fas and FasL and suggest that a neoplastic Fas negative/FasL positive phenotype may be linked to breast cancer progression.

Importance of the level of axillary involvement in relation to traditional variables in the prognosis of breast cancer.

Survival in breast cancer correlates with the presence of metastatic lymph nodes, so that removal and pathological examination of the axillary nodes provides the most important prognostic information and basis for planning subsequent therapy. However as the size of primary tumours at diagnosis is decreasing, the likelihood of axillary involvement is also declining, so that the indications for axillary dissection are undergoing radical revision. To definitively establish the value of removing all three axillary lymph node levels (as defined by Berg) in node positive breast cancer, retrospective analysis of a large series receiving complete dissection was carried out. consecutive breast cancer patients (n=1003) with positive axillary nodes were analyzed: all received identical axillary treatment and the three levels were tagged with metal disks to facilitate recognition and pathological examination. Follow-up (mean 97 months) was exceptionally complete. The length of disease-free and overall survival were taken as the primary endpoints. The variables considered in the statistical analysis were tumour size, number of metastatic nodes, axillary invasion by level (the three classic levels), perilymphnodal invasion and age. By univariate analysis, overall and disease-free survival decreased significantly as tumour diameter, number of involved lymph nodes, and involvement by axillary level increased. Multivariate analysis assessing the relative importance of these variables when all were considered together found that they were all important independent predictive factors for survival. This study confirms the importance of tumour size and number of metastatic axillary nodes as predictors of outcome in breast cancer. In addition, the level of axillary invasion as a third independent factor of equal importance to the established indicators was identified. When axillary dissection is performed it should be complete, and all three Berg levels tagged separately, so that involvement by level can be ascertained. This provides additional important prognostic information on which to base subsequent treatment decisions.

Role of endosonography in the evaluation of gastric malignancies.

The aims of this study were to stage gastric malignancies and differentiate between carcinomas and lymphomas. Twenty-two patients were evaluated with endosonography. Tumoral infiltration depth (T stage) and presence of metastatic lymph nodes (N stage) were investigated. Five percent of the cases were staged as T2, 36% as T3, and 59% as T4. According to the endosonographic examination, 14% were NO, 68% were N1, and 18% were N2 malignancies. When compared with results of surgery and histopathologic examination, the accuracy was 82% for both T and N stages. It can be concluded that endosonography is a valuable imaging modality for the local staging of gastric malignancies. Early stage lymphomas can be differentiated from carcinomas, but in advanced stages both have similar appearance.

Prognostic factors in T3,N0-1 glottic and transglottic carcinoma. A multifactorial study of 221 cases treated by surgery or radiotherapy.

To evaluate prognostic factors in patients with T3,N0-1 glottic and transglottic carcinoma treated in a single institution. Retrospective, nonrandomized case series. Tertiary case referral centers, ambulatory or hospitalized care. Two hundred twenty-one consecutive cases of stage III glottic or transglottic squamous cell carcinoma. Tumor stage was T3,N0,M0 in 167 cases and T3,N1,M0 in 54 cases. Surgery in 176 cases and radiotherapy in 45 cases. Recurrences and survival (multivariate). Almost 7% of the patients who underwent surgery and 39.6% who had radiotherapy had local recurrences. Recurrences in the neck were seen in 16.4% of the patients who underwent surgery and in 10.5% of those who had radiotherapy. Distant metastases were diagnosed only in patients who underwent surgery (4.6%). The 5-year actuarial overall survival rates were 56.3% in the surgical group and 35.2% in the radiotherapy group (P = .007). Age involvement of pyriform sinus, N stage, and history of tracheostomy were independent prognostic factors for risk of death. The presence of metastatic lymph nodes, age, and involvement of the pyriform sinus were the important prognostic factors in patients who underwent surgery. A small group of patients with T3,N0,M0 tumors could benefit from radiotherapy, with surgery reserved for recurrence.

Endosonography-guided treatment of esophageal carcinoma.

Endosonography is helpful in managing patients with esophageal cancer due to its capacity to stage the tumor for the depth of tumoral invasion and the presence of metastatic lymph nodes. Thus, ES will help the surgeon to determine if surgery is advisable. If the patient does not undergo surgery, it will provide a very accurate prognosis and allow the adaptation of non-surgical multimodal therapy to determine tumor extension. Finally, following the initial phase of treatment. ES will be useful in the follow-up, especially to detect and stage recurrences.

Combined chemoradiation therapy for anal cancer. A report of 56 cases.

Fifty-six consecutive patients with primary epidermoid cancer of the anus were treated with combined chemoradiotherapy (CRT). No patient had been previously treated. There were 44 women and 12 men, with an age range of 25 to 88 years (median, 62 years). Cancer was located at the anal verge in five and at the anal canal in 51 patients. The tumor extended from the canal to adjacent sites in 37 cases. All patients had their tumors histologically assessed: 54 were squamous cell and two were basaloid carcinoma. Twelve patients had T1, 27 had T2, and 17 had T3 primaries, and eight had inguinal metastatic nodes. The protocol treatment consisted of three cycles of 5-fluorouracil (FU) (750 mg/m2/day x 5 days continuous infusion) and mitomycin C (MMC) (15 mg/m2 intravenous (I.V.) bolus on day 1 of each course) given every 6 weeks. Radiotherapy (RT) was started simultaneously: 36 Gy was given in 4 weeks to the anal region with perineum and the lower and middle pelvis, including inguinal and external iliac nodes. After 2 weeks of rest, a boost of 18 Gy was delivered to the anoperineal region in 10 fractions. Because of toxicity, the planned treatment was performed in 50% of patients: 28 patients received less than three cycles of chemotherapy, and seven patients received less than 49 Gy radiation therapy. Toxicities were mild to moderate, and no patients needed hospitalization. A complete response (CR) was observed in 49 patients (87%), eight of whom had metastatic nodes. A partial response (PR) was assessed in five patients (9%) and stable and progressive disease in 2 patients (4%). Objective response (OR) had no evident relationship with extent of primary, presence of metastatic nodes, number of cycles of chemotherapy, and doses of radiotherapy. Of 49 patients who achieved CR, 12 (24%) developed a local recurrence after a median interval of 8 months (range, 2 to 45 months); 11 of them were submitted to surgical rescue and 8 are alive without evidence of disease. Local recurrence was correlated with the main characteristics of patient and tumor and with treatment, but no clear correlation was observed. Actuarial survival rate at 5 years was 81%. Results of present study are compared with those reported by others, and crucial questions concerning combined chemoradiationtherapy are discussed. The authors conclude that chemoradiotherapy is a highly effective treatment of anal cancer, which should be employed as primary approach regardless of different characteristics of patient and tumor.

Retroperitoneal lymph node aspiration biopsy in staging of pelvic cancer: a cytological study of 228 consecutive cases.

Knowledge of the status of the pelvic lymph nodes is important for accurate staging and adequate treatment of patients with genitourinary tract cancer (bladder and prostatic carcinoma, testicular tumors, and uterine carcinoma). A total of 228 consecutive patients underwent preoperative evaluation of the lymph node status by lymphangiography combined with fine-needle aspiration biopsy. A lymphadenectomy was performed in 94 patients. The overall diagnostic accuracy was 93%. There were 5% false-negative results and no false-positive diagnoses. Fine-needle aspiration biopsy is an inexpensive method with which to detect the presence of metastatic lymph nodes visualized by bipedal lymphangiography. It is also a safe and well-tolerated method, with a low morbidity and no mortality. The various cytological features are described as are some possible pitfalls.

Recurrence of carcinomaof the oral cavity, oropharynx and maxillary sinus after radical neck dissection

Cervical recurrence was studied in 63 patients who had undergone radical neck dissection for the treatment of carcinoma of the oral cavity, oropharynx and maxillary sinus. Over the whole series, recurrence occurred in 17 patients (27%). The rate of recurrence did not decrease in patients who remained free of carcinoma at the primary site, but was significantly lower in patients in whom elective neck dissection was performed than in those who were treated by therapeutic or secondary neck dissection. With the exception of two patients, cervical recurrence was associated with the presence of metastatic lymph nodes. Although the rate of recurrence was not affected by the number of metastatic lymph nodes, it was very high (80%) in patients having metastatic lymph nodes with histological evidence of extra-nodal spread. The results indicate that elective treatment by irradiation or surgery may be needed to reduce cervical recurrence because of a high tendency of carcinoma of the oral cavity and adjacent regions to metastasize.