Regional Lymph Nodes In Patients Research Articles

Analysis of CD1a-Positive Monocyte-Derived Cells in the Regional Lymph Nodes of Patients with Gallbladder Cancer.

Dendritic cells (DCs) are known to be major antigen-presenting cells, and lymph nodes (LNs) play an important role in DC-mediated immune response. CD1a is known as a marker of monocyte-derived DCs. The present study focused on the infiltration of CD1a-positive DCs (CD1a-DCs) into regional LNs in 70 cases of gallbladder cancer (GBC). After univariate analyses, the results showed that LN infiltration by CD1a-DCs was associated with unfavorable clinical outcomes in patients with GBC, with all cases categorized in the CD1a-DCs high group had nodal metastasis. LN infiltration by CD1a-DCs was not an independent prognostic factor identified by multivariate analyses. After subgroup analyses of cases with LN metastasis (n = 32), no significant impacts of CD1a-DCs infiltration into metastatic LNs were observed. In contrast, CD1a-DCs infiltration into primary tumors had a significant impact on surgical outcomes. The results of strong confounding between CD1a-DCs and LN metastasis support the theory that CD1a-DCs are developed from monocytes at tumor sites. As the results of previous research focused on CD1a-DCs infiltration into regional LNs of other organs varied, the role and significance of CD1a-DCs infiltration in regional LNs may be different according to the tumor histology or its primary site. Thus, further studies are needed to clarify the role and significance of CD1a-DCs infiltration into regional LNs of solid cancers.

Supraclavicular lymph node metastasis should not be defined as regional lymph node metastasis in cervical and upper thoracic esophageal squamous cell carcinoma.

The importance of supraclavicular lymph node (SCLN) metastasis in cervical and upper thoracic esophageal squamous cell carcinoma (ESCC) has not been determined. The aim of the present study was to provide a detailed definition of the range of SCLN regions and to explore whether SCLNs should be considered as a regional lymph nodes for patients with cervical and upper thoracic ESCC. A retrospective analysis was performed on 230 patients with locally advanced cervical or upper thoracic ESCC who underwent radical radiotherapy and chemotherapy. The range of SCLN regions was defined in detail on contrast enhanced computed tomography images of the neck. According to whether the patient had lymph node metastasis in the supraclavicular region, the included patients were divided into two groups, and the survival differences and reasons for treatment failure between the two groups were analyzed. Of the 230 patients with ESCC, 71 (30.87%) exhibited lymph node metastases in the supraclavicular region. The median overall survival time of ESCC patients with and without SCLN metastasis was 17 and 30 months, respectively (P<0.001). After propensity score matching (PSM), the median overall survival time of ESCC patients with and without SCLN metastasis was 17 and 28 months, respectively (P<0.001). During the follow-up period, there were a total of 101 cases of failure of treatment in the irradiation field, 6 cases had esophageal metastasis in the non-irradiated field and 27 cases had regional lymph node metastasis in the non-irradiated field. In addition, there were 33 cases of metastasis to the distant lymph nodes or organs. There was no significant difference in the local treatment failure rate between the groups with or without SCLN metastasis in both the irradiation field and the non-irradiation field, but the probability of distant metastasis in the SCLN metastasis group was significantly higher than that in the group without SCLN metastasis (P=0.025). In conclusion, patients with cervical and upper thoracic ESCC with SCLN metastasis have a poor prognosis and the median overall survival time is closer to that of metastatic ESCC than ESCC with regional lymph node metastasis; therefore, SCLNs should not be defined as regional lymph nodes in patients with cervical and upper thoracic ESCC.

Abstract PO2-07-12: Analysis Of Malignity Rates Of Percutaneous Biopsy In Lymph Nodes Of Breast Cancer Patients

Abstract BACKGROUND: The evaluation of regional lymph nodes in patients with breast cancer is one of the main predictive and prognostic factors for treatment. The methods of percutaneous biopsies of suspicious lymph nodes frequently used are fine-needle aspiration cytology (FNA) and core needle biopsy (CORE). According to the international literature, CORE and FNA are considered diagnostic methods with high specificity (98% vs. 99%), however, the FNA may present up to 21% of inconclusive results by insufficient material. Although CORE is well established as a percutaneous method for diagnostic evaluation of suspected breast lesions, the literature is scarce on the use of this technique for the evaluation of suspicious lymph nodes in breast cancer patients. OBJECTIVE: Analyze the positivity of FNA and CORE performed in suspicious lymph nodes for breast cancer metastasis according to the anatomical location of biopsies and the type of needle used, verifying which technique was preferred. METHODS: A retrospective study was conducted by evaluating the database of patients treated in a public hospital in São Paulo, Brazil. Women submitted to ultrasound-guided percutaneous biopsy of lymph nodes from May 2015 to November 2019 were included in the study. The data were analyzed using IBM-SPSS version 27 and Microsoft EXCEL version 2010. RESULTS: A total of 499 biopsies were performed and the mean age of the women was 54.2 years (SD± 11.9) in the CORE group and 53.4 years (SD± 11.8) in the FNA group (p=0.619). According to the anatomical location, 385 were axillary (77.2%), 62 supraclavicular (12.4%), 48 cervical (9.6%) and 4 infraclavicular (0.8%). Regarding the type of needle, 393 were CORE (78.8%) and 106 were FNA (21.2%). When analyzing the results of the FNA, 38 (35.8%) did not present enough material, 31 (29.2%) were positive, 32 (30.2%) were negative and 5 (4.8%) showed atypical cells. Among the 393 CORE performed, 255 (64.9%) were positive, 132 (33.6%) were negative, 1 (0.3%) showed atypical cells and 5 (1.3%) had no representative material. No complications were reported after the procedures. CONCLUSION: CORE was the preferred diagnostic technique in our center, being considered a feasible procedure to evaluate lymph nodes in different sites and with low rates of inconclusive results by insufficient material. In the future, studies evaluating indirect costs may confirm the feasibility of CORE in patients with suspicious lymph nodes in terms of obtaining greater agility and resolutive conducts in the public healthcare system. Citation Format: Marina Diogenes, Andressa Amorim, ANDRE MATTAR, MARCELO ANTONINI, Luiz Henrique Gebrim, REGINALDO COELHO LOPES, Luciana Damous. Analysis Of Malignity Rates Of Percutaneous Biopsy In Lymph Nodes Of Breast Cancer Patients [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-07-12.

Abstract P3-05-47: Regional Lymph node percutaneous analysis in patients with breast cancer

Abstract Background: The evaluation of regional lymph nodes in patients with breast cancer is one of the main predictive and prognostic factors for treatment. The most frequently methods of percutaneous evaluation for suspicious lymph nodes are fine needle aspiration (FNA) and core needle biopsy (CNB). According to the international literature, CNB and FNA are considered diagnostic methods with high specificity (98% vs. 99%), however FNA can present up to 21% of inconclusive results due to insufficient material, which leads to recall and delay in treatment approach. Although CNB is well established as a percutaneous method for the diagnostic evaluation of suspicious breast lesions, the literature is still scarce regarding the use of this method for the evaluation of suspicious regional lymph nodes in patients with breast cancer. Objectives: To analyze the results of percutaneous biopsies performed in suspected lymph nodes according to the topography and the type of needle used, and to verify the preferred method used. Methods: This was a retrospective study evaluating a public Hospital in São Paulo – Brazil (Pérola Byington Hospital database). Patients who underwent ultrasound-guided percutaneous lymph node biopsy from May 2015 to November 2017 were included. Data were analyzed and the type of biopsy (FNA or CNB) and the results were analyzed. Results: 106 medical records of patients with previous breast cancer and that underwent lymph node biopsy were reviewed. The mean age was 54.7 years (SD±12.4) in the CNB group and 54.7 years (SD±10.8) in the FNA group. Most of the patients were submitted to CNB (66% - 71 patients) and 34% were evaluated with FNA (35 patients). According to the topography of the lymph nodes, 80% were in the axilla (n=84), 10% in the supraclavicular region (n=11) and 10% in the cervical region (n=11). When analyzing the FNA results, 31% did not present sufficient material (n=11), 37% were malignant (n=13), 20% were benign (n=7) and 12% showed cellular atypia (n=12). Among the CNB performed in suspected lymph nodes, 53% were malignant (n=38) and 31% were benign (n=33), and no one had insufficient material. There were no reports of complications related to the procedures. In the insufficient material group, 27% (n=3) of the patients underwent a new percutaneous biopsy (2 CNB with malignant result and 1 FNA with inconclusive result) and 73% (8) were maintained in follow-up. The mean follow-up time was 24 months, and clinical and imaging stability was confirmed after this period. In the CNB group with malignant result, 10% (4) were diagnosed with neoplasia of other sites (cervix, lymphoma, melanoma and gastrointestinal), 78% (30) presented immunohistochemistry in agreement with that of the breast, 3% (1) presented different immunohistochemistry and in 9% (3) this evaluation was not performed. Conclusion: CNB was the preferred diagnostic method in our Hospital (66% vs 34%), being considered a viable procedure to evaluate lymph nodes in various topographies and with low rates of inconclusive results. Besides that, immunohistochemistry was done in 91% of the cases showing the importance of this analysis in the treatment of the recurrence or even in the diagnosis of other primary tumors. In the future, studies that assess indirect costs may confirm the applicability of CNB in patients with suspicious lymph nodes in terms of achieving greater agility and resolution. Citation Format: Marina Diogenes, ANDRE MATTAR, Andressa Amorim, Maria Isabela Caldas Sawada, Luiz Henrique Gebrim, Jorge Shida. Regional Lymph node percutaneous analysis in patients with breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-05-47.

Mathematical models for intraoperative prediction of metastasis to regional lymph nodes in patients with clinical stage I non-small cell lung cancer.

It remains challenging to determine the regions of metastasis to lymph nodes during operation for clinical stage I non-small cell lung cancer (NSCLC). This study aimed to establish intraoperative mathematical models with nomograms for predicting the hilar-intrapulmonary node metastasis (HNM) and the mediastinal node metastasis (MNM) in patients with clinical stage I NSCLC. The clinicopathological variables of 585 patients in a derivation cohort who underwent thoracoscopic lobectomy with complete lymph node dissection were retrospectively analyzed for their association with the HNM or the MNM. After analyzing the variables, we developed multivariable logistic models with nomograms to estimate the risk of lymph node metastasis in different regions. The predictive efficacy was then validated in a validation cohort of 418 patients. It was confirmed that carcinoembryonic antigen (>5.75 ng/mL), CYFRA211 (>2.85 ng/mL), the maximum diameter of tumor (>2.75 cm), tumor differentiation (grade III), bronchial mucosa and cartilage invasion, and vascular invasion were predictors of HNM, and carcinoembryonic antigen (>8.25 ng/mL), CYFRA211 (>2.95 ng/mL), the maximum diameter of tumor (>2.75 cm), tumor differentiation (grade III), bronchial mucosa and cartilage invasion, vascular invasion, and visceral pleural invasion were predictors of MNM. The validation of the prediction models based on the above results demonstrated good discriminatory power. Our predictive models are helpful in the decision-making process of specific therapeutic strategies for the regional lymph node metastasis in patients with clinical stage I NSCLC.

Reporting of Surgically Removed Lymph Nodes for Breast Tumors: Recommendations From the International Collaboration on Cancer Reporting.

The International Collaboration on Cancer Reporting (ICCR), supported by major pathology and cancer organizations, aims at the standardization of evidence-based pathology reporting of different types of cancers, with the inclusion of all parameters deemed to be relevant for best patient care and future data collection. Lymph node metastasis is one of the most important prognostic factors in breast cancer. To produce a histopathology reporting guide by a panel of recognized experts from the fields of pathology and surgery with elements deemed to be core (required) and noncore (recommended) to report when assessing regional lymph nodes of patients with breast cancer. Published literature, previous guidelines/recommendations, and current cancer staging principles were the basis of the data set drafted by the expert panel. This was discussed in a series of teleconferences and email communications. The draft data set was then made available for public consultation through the ICCR Web site. After this consultation and ICCR ratification, the data set was finalized. The ICCR has published a data set for the reporting of surgically removed lymph nodes (including sentinel lymph node biopsy, axillary lymph node dissection, targeted axillary surgery, and lymph node sampling specimens) for breast tumors. This is part of a series of 4 ICCR breast cancer-related data sets. It includes 10 core elements along with 2 noncore elements. This should allow for synoptic reporting, which is more precise, uniform, and complete than nonsynoptic reporting, and leads to improved patient outcomes.

Reevaluation of regional lymph nodes in patients with pancreatic ductal adenocarcinoma in the pancreatic body and tail.

In patients with pancreatic ductal adenocarcinoma (PDAC) in the pancreatic body (Pb) and tail (Pt), the appropriate area for lymphadenectomy is controversial. This study aimed to reevaluate the extent of lymph node (LN) metastasis in Pb- and Pt-PDAC, and to define the optimal area of LN dissection. This single-center retrospective study evaluated patients with Pb- and Pt-PDAC who underwent distal pancreatectomy with extended lymphadenectomy between 2006 and 2020. LN metastasis in >3.0% of patients were defined as new regional LN. The study cohort included 135 patients with Pb-PDAC and 42 patients with Pt-PDAC. In patients with Pb-PDAC, LNs around the splenic artery (SPA) had the highest metastasis-positive rate (54.1%). LNs along the left gastric artery, common hepatic artery, celiac axis (CA), superior mesenteric artery (SMA), and splenic hilus were defined as new regional LNs. In patients with Pt-PDAC, LNs at the splenic hilum had the highest metastasis-positive rate (38.1%). The station and LN around the SPA were defined as new regional LNs in those with Pt-PDAC. Metastasis beyond the newly defined regional LNs was not associated with survival. The incidence of LN metastasis was lower in patients who received preoperative chemotherapy than in those who underwent upfront surgery in both Pb- and Pt-PDAC. Although it needs to be verified in future multicenter studies, LN of both the CA and SMA systems should be dissected in patients with Pb-PDAC. However, only those around the SPA and splenic hilus should be dissected routinely in those with Pt-PDAC.

Prognosis Associated with Glycolytic Activity in Regional Lymph Nodes of Patients with Previously Untreated Metastatic Breast Cancer: A Preliminary Study.

Better mechanisms of predicting prognoses in patients with metastatic breast cancer will improve the identification of patients for whom curative treatments may be the most effective. In this study, the prognostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) was assessed in patients with metastatic breast cancer. A retrospective analysis of women who underwent 18F-FDG PET/CT for staging of newly diagnosed metastatic breast cancer was conducted. In each patient, the maximum standardized uptake value (SUV) and total lesion glycolysis (TLG) of primary tumors and regional lymph nodes were measured and analyzed for association with survival using the Cox proportional hazards regression model. From 346 consecutive patients, 32 with metastatic invasive ductal carcinoma of the breast were included in the study. The median duration of follow-up was 22.5 months. Disease progression occurred in 26 patients, and 11 patients died. When multivariate analyses with a stepwise forward regression were applied, only the maximum SUV and TLG of regional lymph nodes showed a significant correlation with progression-free survival and overall survival, respectively. This study demonstrates that increased 18F-FDG uptake in regional lymph nodes is a strong independent predictor of survival in women with metastatic invasive ductal carcinoma of the breast.

Patterns of lymph node metastases and their implications in individualized radiotherapeutic clinical target volume delineation of regional lymph nodes in patients with endometrial cancer.

Purpose: To study the patterns of lymph node metastasis (LNM) of endometrial cancer (EC) and to clarify the individualized clinical target volume delineations of regional lymph nodes (CTVn). Methods: Data from a total of 556 patients with EC who had undergone total hysterectomy associated with bilateral salpingo-oophorectomy (TH/BSO) and systematic lymphadenectomy were retrospectively examined. The clinicopathological factors related to LNM were analyzed using logistic regression analysis. Results: LNM was found in 76 of 556 patients, resulting in a metastasis rate of 13.67%. The rates of LNM in patients with fundus and cornua lesions were 7.56% for para-aortic nodes and 14.41% for pelvic lymph nodes. The rates of LNM in patients with sidewall lesions were 3.15% for para-aortic nodes and 10.22% for pelvic lymph nodes. The rates of LNM in patients with lower uterine segment and cervix lesions were 12.50% for para-aortic nodes and 26.67% for pelvic lymph nodes. Deep myometrial invasion, histological type, histological differentiation, and lymphovascular space invasion (LVSI) emerged as statistically significant risk factors for pelvic LNM of EC (P = 0.008, 0.015, < 0.001, 0.005, respectively). Grade 3 differentiation had a strong influence on LNM to the para-aortic nodes (P = 0.015). Conclusions: Myometrial invasion, histological type, histological differentiation, and LVSI were related to pelvic LNM and grade 3 was associated with para-aortic LNM. These factors should be considered comprehensively to design the CTVn for intensity-modulated radiation therapy (IMRT) of EC. For patients with lower uterine segment/cervix and fundus/cornua lesions, delineating the irradiation field of the para-aortic nodal region may confer a benefit.

Prediction of pathological response using 18F FDG PET/CT derived metabolic parameters in locally advanced breast cancer patients.

This study aims to assess the value of flurodeoxyglucose (FDG)-PET derived metabolic parameters for prediction of pathologic response in LABC postneoadjuvant therapy. Totally 47 patients with LABC underwent initial and postneoadjuvant therapy PET scans. ΔSUVmax%, ΔTLG% and ΔMTV% were calculated. Post-therapy histopathologic therapeutic response was assessed. In total 91.5% of patients had invasive duct carcinoma and the remaining (8.5%) had invasive lobular carcinoma. Postneoadjuvant PET/CT was able to detect 91.7% of patients with pathologically proven complete response in primary tumor, 69% of those with Pathologic partial response and 88.3% of those with pathological no response (P value <0.001). However, 40 out of the 47 patients had regional nodal metastases. PET/CT was able to predict 57.1% of the patients with pathologically nonresponding nodal deposits and 93.9% of those revealed pathologic therapeutic effect (P value <0.001). Receiver operating characteristic curve (ROC) curve marked Δ1ry SUVmax of 26.25% (P value 0.003), Δ1ry TLG of 48.5% (P value 0.018). PET and pathological response correlated well with ΔSUVmax%, and Δ1ry TLG% correlated well with PET, pathologic response and expression of HER II receptors (P value <0.001, 0.003 and 0.037 respectively). ROC curve marked ΔLN SUVmax% of 80.15% (P value 0.012), ΔLN TLG% of 86.6% (P value 0.002), whereas for ΔLN MTV% cut off point of 55% (P value 0.003). ΔSUVmax%, ΔTLG % and ΔMTV% for regional nodal metastases, were significantly correlated with PET (P values <0.001, <0.001 and 0.003, respectively) and pathologic (P values 0.018, 0.001 and 0.002, respectively) response. FDG-PET is a useful tool for monitoring the neoadjuvant therapeutic effect for primary and regional nodes in patients with LABC.

Molecular genetic predictors of metastatic lesions of regional lymph nodes in patients with breast cancer

Objective: to identify molecular genetic predictors of metastatic spread to regional lymph nodes in patients with breast cancer (BC) based on the analysis of gene expression profile of the primary tumor.Materials and methods. The study included 358 patients with BC who underwent surgical treatment in breast cancer department of Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia. Among all included into the study patients, 132 (36.9 %) had metastases in at least one axillary lymph node. Molecular genetic examination of the tumor tissue was carried out using reverse transcription polymerase chain reaction; the diagnostic panel consisted of 45 functional and 3 reference genes. Results. Patients with metastases to regional lymph nodes were generally younger (p = 0.006), had larger primary tumor (p&lt;0.001) and higher total malignancy score (p&lt;0.001). The groups were also significantly different in tumor location (p = 0.005). Comparative analysis of transcriptome tumor profiling revealed statistically significant differences between groups in the level of expression of three genes: TMEM45A (p = 0.016), CCND1 (p = 0.019), and MIA (p = 0.046). Based on the data obtained we used mathematical modeling and created a predictive model, which with a high degree of probability (AUC = 0.791) allowed to predict the presence of regional lymph nodes metastases in patients with BC.Conclusion. TMEM45A, CCND1 and MIA gene expression in the primary tumor were the markers of lymph node involvement in BC. The developed predictive genetic signature can become an additional diagnostic tool to predict the risk of lymph node metastases at the point of planning the volume of axillary surgery in patients with BC.

Hypofractionated Radiation Therapy (HFRT) of Breast/Chest Wall and Regional Nodes in Locally Advanced Breast Cancer: Toxicity Profile and Survival Outcomes in Retrospective Monoistitutional Study

AIMTo evaluate the efficacy and safety of hypofractionated radiation therapy (HFRT) of the breast/chest wall and regional nodes in patients with locally advanced breast cancer and positive lymph nodes. Materials and MethodsOne hundred and twenty-two patients treated between October 2016 and March 2020 with HFRT were retrospectively reviewed. A total dose of 42.4 Gy was delivered to the chest wall and lymph nodes in 16 fractions of 2.65 Gy each, using the IMRT technique. Patients treated with breast-conserving surgery received an overdose (concomitant boost of 3 Gy daily) with the SIB (Simultaneous Integrated Boost) technique. ResultsMedian age at diagnosis was 58 years (range 34-86 years) and median follow-up was 22 months (range 6-48 months). Overall survival (OS) at 1, 2 and 3 years was 100%, 97.3% and 90%, respectively. Disease-free survival (DFS) at 1, 2, and 3 years was 91.4%, 87%, and 84.8%, respectively. Distant metastasis-free survival (MFS) at 1, 2 and 3 years was 93.1%, 88% and 85.7%, respectively. Two patients (1.6%) experienced local recurrence on the chest wall during FUP. Twenty-one patients (17%) showed a grade 2 dermal toxicity, no grade 3 acute skin toxicity was found. Sixteen patients (13%) showed early-stage arm lymphedema (grade ≤ 2). Twenty-three patients (19%) showed a grade 2 late skin toxicity. Twenty patients (16%) had grade ≤ 2 late arm lymphedema. ConclusionGiven the excellent local control, survival rates and the low toxicity profile demonstrated, HFRT could be considered a valid therapeutic option in patients with locally advanced breast cancer.

Development and validation of nomograms to intraoperatively predict metastatic patterns in regional lymph nodes in patients diagnosed with esophageal cancer

BackgroundAn accurate intraoperative prediction of lymph node metastatic risk can help surgeons in choosing precise surgical procedures. We aimed to develop and validate nomograms to intraoperatively predict patterns of regional lymph node (LN) metastasis in patients with esophageal cancer.MethodsThe prediction model was developed in a training cohort consisting of 487 patients diagnosed with esophageal cancer who underwent esophagectomy with complete LN dissection from January 2016 to December 2016. Univariate and multivariable logistic regression were used to identify independent risk factors that were incorporated into a prediction model and used to construct a nomogram. Contrast-enhanced computed tomography reported LN status and was an important comparative factor of clinical usefulness in a validation cohort. Nomogram performance was assessed in terms of calibration, discrimination, and clinical usefulness. An independent validation cohort comprised 206 consecutive patients from January 2017 to December 2017.ResultsUnivariate analysis and multivariable logistic regression revealed three independent predictors of metastatic regional LNs, three independent predictors of continuous regional LNs, and two independent predictors of skipping regional LNs. Independent predictors were used to build three individualized prediction nomograms. The models showed good calibration and discrimination, with area under the curve (AUC) values of 0.737, 0.738, and 0.707. Application of the nomogram in the validation cohort yielded good calibration and discrimination, with AUC values of 0.728, 0.668, and 0.657. Decision curve analysis demonstrated that the three nomograms were clinically useful in the validation cohort.ConclusionThis study presents three nomograms that incorporate clinicopathologic factors, which can be used to facilitate the intraoperative prediction of metastatic regional LN patterns in patients with esophageal cancer.

Выбор оптимального алгоритма оценки состояния регионарных лимфатических узлов у больных раком молочной железы с использованием современных возможностей ультразвуковой диагностики

Выбор оптимального алгоритма оценки состояния регионарных лимфатических узлов у больных раком молочной железы с использованием современных возможностей ультразвуковой диагностики

Липидные маркеры метастатического поражения регионарных лимфоузлов у больных раком молочной железы

Липидные маркеры метастатического поражения регионарных лимфоузлов у больных раком молочной железы

MRI Lymph Node Evaluation for Prediction of Metastases in Rectal Cancer.

To explore whether the size and characteristics of the largest regional lymph node in patients with rectal cancer, based on magnetic resonance imaging (MRI), following neoadjuvant therapy and before surgery, is able to identify patients at high risk of developing metachronous metastases. A retrospective case-control study with data from the Swedish Colo-Rectal Cancer Registry. Forty patients were identified with metachronous metastases (M+), and 40 patients without metastases (M0) were matched as controls. Patients with M+ disease were more likely to have a regional lymph node measuring ≥5 mm than patients with M0. (87% vs. 65%, p=0.02). There was also a significant difference between the groups regarding the presence of an irregular border of the largest lymph node (68% vs. 40%, p=0.01). Lymph nodes measuring ≥5 mm with/without displaying irregular borders at MRI performed after neoadjuvant therapy emerged as risk factors for metachronous metastases in patients with rectal cancer. Intensified follow-up programmes may be indicated in these patients.

Isolated tumor cells in the regional lymph nodes in patients with squamous cell carcinoma of the esophagus are rarely observed but often represent part of a true metastasis

The most common malignancy of the esophagus is squamous cell carcinoma (SCC) and regional lymph node metastases are an important prognostic factor. Isolated tumor cells (ITCs) are defined as single tumor cells or small clusters of tumor cells not exceeding 0.2 mm. The prognostic role of ITCs is not clear. This study aimed to determine the prevalence of ITCs in regional lymph nodes in patients with esophageal SCC and to investigate how frequently ITCs represent part of a true metastasis. Surgical specimens from 100 patients with SCC of the esophagus were included. All original H&E stained slides containing lymph nodes were reviewed by two gastrointestinal pathologists. In lymph nodes containing ITCs, additional levels were cut and stained with a H&E- and a cytokeratin stain. Areas of tumor cells that measured >0.2 mm on the deeper sections were classified as metastases. A total of 2460 lymph nodes were examined. ITCs were detected in 10 lymph nodes (0.4%) from nine patients (9%). Deeper sections revealed metastases in five out of the 10 lymph nodes (50%). ITCs in regional lymph nodes of patients with SCC of the esophagus is a rare finding compared with patients with adenocarcinoma of the esophagogastric junction. However, deeper sections often revealed metastases. Therefore, in patients with SCC of the esophagus, we recommend additional sectioning and immunohistochemical examination of lymph nodes when ITCs are detected on the first slide.

A Prospective Cohort Study of Ultrasound Surveillance of Regional Lymph Nodes in Patients with Intermediate-Risk Cutaneous Melanoma

Background: Sentinel Node Biopsy (SNB) is the most accurate staging investigation to assess regional lymph node involvement in patients with cutaneous melanoma and determines whether they will receive adjuvant treatment. Prior to the era of effective adjuvant therapy, SNB was considered principally to be a staging investigation which gave important prognostic information. It was also considered to be of therapeutic benefit because surveillance of regional lymph node basins by clinical examination alone had been reported to result in a 3 fold higher number of lymph nodes involved by melanoma on relapse than if patients had a SNB and completion dissection at the time of the primary diagnosis. This may have resulted in worse regional control for patients undergoing clinical surveillance. We conducted a prospective study of regular clinical examination and nodal ultrasound surveillance to assess the nodal burden on relapse when compared to historical controls of patients undergoing SNB and completion dissection at the time of primary diagnosis.

Cutaneous melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†.

Cutaneous melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†.

The Landmark Series: MSLT-1, MSLT-2 and DeCOG (Management of Lymph Nodes).

Management of regional lymph nodes in patients with melanoma has evolved significantly in recent years. The value of nodal intervention, long utilized for its perceived therapeutic benefit, has now shifted to that of a critical prognostic procedure used to guide clinical decision making. This review focuses on the three landmark, randomized controlled trials evaluating the role of surgery for regional lymph nodes in melanoma: Multicenter Selective Lymphadenectomy Trial I (MSLT-I), German Dermatologic Cooperative Oncology Group-Selective Lymphadenectomy Trial (DeCOG-SLT), and Multicenter Selective Lymphadenectomy Trial II (MSLT-II).