Lymphatic Drainage Routes Research Articles

Tracking Lymphatic Drainage Pathways Through Inner Ear Channels: A Systematic Review.

The search for potential lymphatic routes through the cochlea, or membranous portions of the inner ear labyrinth, remains a significant challenge. Researchers often focus on lower mammals rather than humans to uncover these pathways. This review aims to delineate the speculated lymphatic routes within the inner ear to date. It follows the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, conducting a comprehensive search of PubMed, Scopus, Crossref, and Google databases using the terms "inner ear" and "lymph." The problem, intervention, comparison, outcome (PICO) search strategy was employed, and analysis was performed using equation and scope metrics. Articles were screened and filtered using the CADIMA automation tool, resulting in 33 articles being reviewed, of which 23 were selected. Potential lymphatic drainage routes identified include the round window, oval window, scala tympani, spiral limbus, and lateral wall of the cochlea. The vestibular side of Reissner's membrane was noted as a key nodal point for lymphocytes within the inner ear. This review maps the proposed lymphatic networks in the inner ear and highlights existing gaps. It systematically gathers, evaluates, and synthesizes available evidence on the lymphatic pathways of the inner ear, offering valuable insights into their presence, structure, function, and clinical significance.

Revisited Surgical Anatomy of the Left Colonic Angle for Tailored Carcinologic Colectomy: A Review.

Although several types of surgical procedure have been advocated to date, the optimal resection of the left colonic angle in cancer treatment remains controversial. Located at the border of the transverse and descending colons, the anatomy of the left colonic angle is complex and characterized by numerous anatomic variations. Recent advances in preoperative (three-dimensional CT angiography with colonography) and/or intraoperative (indocyanine green staining) imaging have allowed for a better identification of these variations. We performed a methodological review of studies assessing the anatomical variations of the left colic artery. While the left colonic angle is classically vascularized by branches of the superior and inferior mesenteric arteries, an accessory middle colonic artery has been identified from 6 % to 36% of cases, respectively, leading to their classification of five types. In the absence of a left colic artery, this artery becomes predominant. In parallel to the variations in the venous drainage of the left colonic angle, which has been classified into four types, new lymphatic drainage routes have also been identified via this accessory artery and the inferior mesenteric vein. Collectively, these newly obtained findings plead for preoperative identification in cases of cancer of the left colonic angle and a surgical strategy adapted to these anatomical variations.

Lymph node metastatic patterns and the development of multidisciplinary treatment for esophageal cancer.

Abundant lymphatic flow and the anatomical location of the esophagus can result in the widespread distribution of lymph node metastasis of esophageal cancer from the cervical to the abdominal field. Historically, the Japan Esophageal Society and American Joint Committee on Cancer offer two different classifications of lymph node group location surrounding the esophagus. The location of sentinel lymph nodes in midthoracic esophageal cancer reflects the variety of lymphatic drainage routes. In fact, in cT1N0 esophageal cancer, pathological lymph node metastasis has been observed from the cervical to the abdominal field, and the locations were shown to be closely linked to the primary tumor location in advanced stages. While the impact of histology on the distribution of LN metastasis has been extensively debated, a recent prospective study on esophagogastric junction cancer found that metastatic patterns did not differ by histology. Thoracic duct lymph nodes were defined as one of the regional lymph node stations in the mediastinum. Although lymph node metastasis around the thoracic duct has occasionally been observed, the oncologic impact of thoracic duct lymph node dissection has not been fully elucidated. To eradicate tumors locoregionally, three-field lymph node dissection, a strategy for extended lymph node clearance, has been established. In esophagectomy, three-field lymph node dissection is defined as a procedure for complete regional cervico-thoraco-abdominal lymph node dissection. However, its therapeutic efficacy must be evaluated based on the balance between oncological outcomes and possible added surgical risk. To further improve survival, multidisciplinary treatment consisting of surgery, chemotherapy, and radiotherapy has been established worldwide as a standard treatment for esophageal cancer. Now that neoadjuvant therapy followed by esophagectomy is the standard, adding adjuvant therapy including immunotherapy could be a promising treatment option. The ideal combination of various multidisciplinary treatment approaches and extensive LN dissection need to be established to improve the oncological outcomes for EC patients.

PATTERN OF NECK LYMPH NODE METASTASIS AND FACTORS AFFECTING THE LYMPH NODE METASTASIS IN SQUAMOUS CELL CARCINOMAS OF HEAD AND NECK

Background: Head and neck cancer exhibits metastases to cervical lymph nodes through certain lymphatic drainage routes. The 5-year survival rate for patients with neck metastases reduces depending on the number and level of nodes involved. To assess the patterns of lymph Objective: node metastasis for squamous cell carcinoma of head and neck and analyse the prognostic factors of cervical node status and highlight their effect on treatment and prognosis. The study entailed a cross sectional analysis of Method: 66 patients with squamous cell carcinoma of head and neck radiologically or pathologically proven. Data collected and was analysed by a chi square test using SPSS (version 20). Of the 66 clinically Results: node-positive patients, 18 had bilateral lymph node metastasis and 48 had ipsilateral LNM. In all primary sites pattern of lymph drainage was followed except for in 1 case of carcinoma larynx where metastasis was to level II and IV without involvement of level III. We Conclusion: concluded majority of the HNSCC cases followed normal pattern of drainage and in individuals with oral cavity and oropharynx SCC, the incidence of bilateral neck LNMs are high particularly to level II of contralateral side. With higher stage of the disease and long duration of symptoms chances of lymph node metastasis is high thus worsening the prognosis. Bilateral neck dissection is recommended for primary surgical treatment, with the exception of early stages, when ipsilateral neck dissection may be performed

Retroperitoneal, Para-aortocaval Lymphatic Resection as the Surgical Treatment of Choice in Seminoma Grade II

Background Testicular cancer remains one of the most common malignant diseases in young men. The highest incidence was seen in the ages of 25-29 years. A significant part of them come from germ cell tumors, which are divided into seminoma and non-seminoma. Although the aggressiveness of tumors with germ cells remains high, it should be noted that there is a very high response to surgical and chemotherapeutic treatment, where a 5-year disease-free survival is evident in more than 95% of cases. The metastatic spread of these tumors follows the lymphatic drainage of the testes. The retroperitoneal and pre-aortocaval spread, which are resistant to chemotherapy, requires the intervention of an extended surgical procedure, which consists in the removal of the lymph nodes in these regions. The purpose of this procedure is the resection of pre-aortocaval lymph nodes remaining after orchidectomy, a procedure which represents one of the major components of the curative treatment. Case presentation There are three cases of patients, aged 37/32/39-years-old, who have undergone the surgical procedure of right orchidectomy. The biopsy obtained after the surgical intervention showed grade II seminoma. All three patients, who underwent orchidectomy in different years, were subjected to chemotherapeutic treatment with the 3 preparations bleomycin, etoposide and cisplatin. After that, for a period of 1.5-2 years, they carried out occasional checks, which they then stopped. The lack of control for a 5-year period, as well as the limitation of the surgical procedure only in the right orchidectomy, has led to the metastasis of the seminoma in the pre-aortocaval region. In this study, we consider the fact of performing the retroperitoneal lymphatic drainage procedure according to the lymphatic drainage route of the tests, in the cases of the biopsy result "Seminoma grade II" and above, as one of the major components of the curative treatment in addition to Chemotherapeutic treatment. Discussion The implementation of retroperitoneal, pre-aortocaval lymphadenectomy is considered mandatory, especially in the results of "Seminoma grade II" biopsy. In cases where laboratory and imaging examinations indicate residual retroperitoneal, pre-aortocaval masses, the surgical procedure of lymphadenectomy should be performed as soon as possible. The principle of the lymphadenectomy according to the way of drainage of the testes is important when we talk about oncological principles. Statistical data show the advantage of the extended surgical procedure, consisting of a disease-free survival period of 5 years at a rate of 95%. The choice of the retroperitoneal lymphadenectomy procedure has resulted in the normalization of tumor markers for at least a 2-year period after the intervention, also showing an improvement in the patient's prognosis. Conclusion In cases of histopathological response, where the result of Seminoma grade II and above is concluded, the surgical procedure should not be limited to simple orchidectomy or radical inguinal orchidectomy with the aim of avoiding metastatic spread along the lymphatic drainage route. Keywords: General surgery, Testicular cancer, Seminoma, Para-aortocaval retroperitoneal lymphatic resection, RPLND. DOI: 10.7176/ALST/95-06 Publication date: November 30 th 2022

Performance of Indocyanine Green Fluorescence for Detecting Lymph Node Metastasis in Prostate Cancer: A Systematic Review and Meta-analysis

The use of sentinel lymph node dissection in several cancers has been gaining attention with the emergence of indocyanine green fluorescence. We performed a meta-analysis to assess the diagnostic performance of indocyanine green fluorescence in detecting lymph node metastasis in prostate cancer patients. A literature search was conducted using PubMed, Cochrane Library, and SCOPUS on November 30, 2020, to identify eligible studies. Studies were eligible if they investigated the diagnostic performance of indocyanine green fluorescence before pelvic lymph node dissection in prostate cancer patients and reported the number of true positives, false positives, false negatives, and true negatives on lymph node-based analysis in comparison to histopathologic findings in the dissected specimen. Our systematic review covered 11 studies published between 2011 and 2020, with 519 patients, and our meta-analysis included 9 studies with 479 patients. Based on lymph node analysis of indocyanine green fluorescence, the results showed pooled sensitivity and specificity at 0.75 (95% confidence interval [CI] 0.49 to 0.90) and 0.66 (95% CI 0.61 to 0.70), respectively. The diagnostic odds ratio was 6.0 (95%CI 2 to 21). Several lymphatic drainage routes also showed sentinel lymph nodes localized outside the ordinal pelvic lymph node template. We noted relatively low diagnostic performance for lymph node metastasis, suggesting that indocyanine fluorescence may not currently be a viable alternative to pelvic lymph node dissection in prostate cancer patients. However, this technique shows novel lymphatic drainage routes and underscores the importance of lymph nodes not removed in ordinary dissection.

Embryological Development and Topographic Anatomy of Pelvic Compartments-Surgical Relevance for Pelvic Lymphonodectomy.

Background: The oncological outcome of surgery for the treatment of pelvic malignancies can be improved by performing pelvic lymphonodectomy. However, the extent and regions of lymph node harvest are debated and require profound knowledge of anatomy in order to avoid collateral damage. Methods: The embryological development and topographic anatomy of pelvic compartments in relation to pelvic lymphonodectomy for rectal, uterine, and prostate cancer are reviewed. Based on pre-dissected anatomical specimens, lymph node regions and drainage routes of the posterior and urogenital pelvic compartments are described in both genders. Anatomical landmarks are highlighted to identify structures at risk of injury during pelvic lymphonodectomy. Results: The ontogenesis of urogenital and anorectal compartments and their lymphatic supply are key factors for adequate lymphonodectomy, and have led to compartment-based surgical resection strategies. However, pelvic lymphonodectomy bears the risk of injury to somatic and autonomic nerves, vessels, and organs, depending on the regions and extent of surgery. Conclusion: Embryologically defined, compartment-based resection of pelvic malignancies and their lymphatic drainage routes are based on clearly delineated anatomical landmarks, which permit template-oriented pelvic lymphonodectomy. Comprehensive knowledge of pelvic anatomy, the exchange of surgical concepts between specialties, and minimally invasive techniques will optimize pelvic lymphonodectomy and reduce complications.

Abstract 2148: Screening of cancer-reactive T cells in lymph nodes in colorectal cancer patients

Abstract Tumor draining lymph nodes (TDLNs) are located in the routes of lymphatic drainage from a primary tumor and have the highest metastasis in various types of solid tumors. TDLNs are considered as a tissue to activate the antitumor immunity, where antigen-specific effector T cells are generated and released to the blood stream. These effector T cells then infiltrate into the tumor site and attack cancer cells. However, it has not been investigated whether cancer-reactive T cells are present in lymph nodes. Through T cell receptor (TCR) repertoire analysis of cancer tissues and total 203 regional lymph nodes from 23 colorectal cancer patients, we previously found that regional lymph nodes, especially metastasis-positive lymph nodes, contain T cells with TCR shared with primary cancer tissues. In this study, we collected surgically-resected fresh cancer tissues and total 12 regional lymph nodes from 4 colorectal cancer patients. From these freshly-obtained cancer tissues and lymph nodes, we isolated single cells and then cultured T cells and patient-derived cancer cells. We co-cultured each of T cells from the 12 lymph nodes with autologous cancer cells, and examined their cancer-reactivity using IFN-γ ELISPOT assay. Six among the 7 metastasis-positive lymph nodes, shows significant production of INF-γ, suggesting the presence of cancer-reactive T cells in the lymph nodes. We also detected cancer-reactive T cells in 3 out of 5 metastasis-negative lymph nodes. In FACS analysis, we found the proportion of TIM3+ cells in CD8+PD1+ T cells were lower in T cells in lymph nodes compared to T cells in primary tumor. These data suggest that lymph nodes may be a good source of T cells for cancer immunotherapy. Citation Format: Kazuma Kiyotani, Kazumi Okamura, Satoshi Nagayama, Yusuke Nakamura. Screening of cancer-reactive T cells in lymph nodes in colorectal cancer patients [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2148.

Impact of indocyanine green‐guided extended pelvic lymph node dissection during robot‐assisted radical prostatectomy

To evaluate the effectiveness of indocyanine green-guided extended pelvic lymph node dissection during robot-assisted radical prostatectomy for intermediate- to high-risk prostate cancer. After institutional review board approval, between July 2017 and December 2018, we carried out 100 indocyanine green-guided extended pelvic lymph node dissections in patients with localized intermediate- and high-risk prostate cancer, using the Firefly (Novadaq Technologies, Mississauga, ON, Canada) and da Vinci Xi surgical system (Intuitive Surgical, Sunnyvale, CA, USA). Indocyanine green was injected transrectally using ultrasound sonography before each surgery. Then, lymphatic drainage patterns and pathological findings were recorded. Lymphatic drainage routes were successfully determined in 91 right-sided and 90 left-sided cases. Five main lymphatic pathways and sites were identified: (i) an internal route (57%); (ii) a lateral route (50%); (iii) a presacral route (20%); (iv) a paravesical artery site (20%); and (v) a pre-prostatic site (5%). Lymph node metastasis was positive in 15 patients, with 44 pathologically confirmed metastatic lymph nodes. Metastatic fluorescent lymph nodes were found in 15 out of 44 lymph nodes (34.1%). For sentinel lymph node identification, the 34% sensitivity and 64.8% specificity rates were detected in regard to identification of lymph node metastasis. Lymphatic drainage patterns from the prostate can be identified and classified using indocyanine green-guided extended pelvic lymph node dissections. Although the direct role of fluorescent lymph nodes in sentinel lymph node identification appears to be limited, the identification of lymphatic pathways could contribute to high-quality extended pelvic lymph node dissection during robot-assisted radical prostatectomy.

Fluorescence image-guided lymphadenectomy using indocyanine green and near infrared technology during robotic gastrectomy: a prospective pilot study: IG-MIG Study

Background: Gastric cancer is a worldwide challenge due to its spread, even epidemic in some areas, and the high mortality rates. Lymphadenectomy is considered the fundamental step during radical gastrectomy. In recent years, some researchers have tried to find a way to improve the surgical identifi cation of the lymphatic drainage routes and lymph node stations. This new surgical frontier is the so called “navigation surgery”. Among the diff erent reported solutions, lately, the indocyanine green (ICG) has drawn attention. It is a fluorescence dye, that can be detected in the near infrared spectral band (NIR). The development of specific fluorescence imaging devices has allowed surgeons to visualize tumors, vascular and lymphatic structures. The Da Vinci Xi robotic system has an integrated imaging technology that has been used in colo-rectal and hepatobiliary surgery. However, up to date, the combined use of fluorescence imaging and robotic technology has not been evaluated during lymphadenectomy in gastric cancer. Methods: General design: to evaluate the role of fluorescence imaging during robotic lymphadenectomy for gastric cancer. Type of study: interventional prospective pilot study. Duration: 18 months. Experimental group: patients undergoing dissection assisted by ICG. Control group: patients undergoing the same surgery without the injection of ICG. Primary outcomes: Fluorescent lymph nodes (FLNs) identification rate, accuracy of the procedure, comparison with the control group on the total number of lymph nodes retrieved. Sample size: 20 patients in the experimental group, 20 patients in the control group. Ethics: This study is conducted in compliance with ethical principles originating from the Helsinki Declaration, within the guidelines of Good Clinical Practice and relevant laws/regulations. Trial registration number: NCT03931044

Preliminary study of real-time three-dimensional contrast-enhanced ultrasound of sentinel lymph nodes in breast cancer.

To investigate the clinical value of real-time three-dimensional contrast-enhanced ultrasound (3D-CEUS) in the detection of sentinel lymph nodes (SLNs) and drainage lymphatics in breast cancer patients. The prospective study was performed in women with pathology-confirmed T1/2 breast cancer between June 2016 and December 2017 who underwent sentinel lymph node biopsy and 3D-CEUS. The number, size, location, enhancement pattern of SLNs, and the lymphatic drainage patterns were reviewed. The routes, location of SLNs, and lymph channels (LCs) on the surface were marked. All patients underwent blue dye-guided sentinel lymph node biopsy (SLNB) finally. According to the postoperative pathology findings and the blue dye staining of the lymphatic drainage routes, there are six patterns of lymphatic drainage routes and the coincidence rate of the 3D-CEUS was 97.4%; the sensitivity, specificity, positive predictive value, negative predictive value, the LN detection rate, and the correct diagnosis rate of the 3D-CEUS were 75%, 93.0%, 81.8%, 89.9%, 95.3%, and 87.7%, respectively. 3D-CEUS is a new feasible and useful approach to detect the SLNs and LCs. 3D-CEUS can accurately localize the LCs and SLNs and estimate the presence of metastatic lymph nodes. • The three-dimensional contrast-enhanced ultrasound can detect the sentinel lymph nodes. • The three-dimensional contrast-enhanced ultrasound can show the stereo direction of sentinel lymph nodes and lymph drainage routes. • The three-dimensional contrast-enhanced ultrasound can accurately localize the LCs and SLNs and estimate the presence of metastatic lymph nodes.

Incidental dose distribution to locoregional lymph nodes of breast cancer patients undergoing adjuvant radiotherapy with tomotherapy - is it time to adjust current contouring guidelines to the radiation technique?

Purpose/objective(s)Along with breast-conserving surgery (BCS), adjuvant radiotherapy (RT) of patients with early breast cancer plays a crucial role in the oncologic treatment concept. Conventionally, irradiation is carried out with the aid of tangentially arranged fields. However, more modern and more complex radiation techniques such as IMRT (intensity-modulated radio therapy) are used more frequently, as they improve dose conformity and homogeneity and, in some cases, achieve better protection of adjacent risk factors. The use of this technique has implications for the incidental- and thus unintended- irradiation of adjacent loco regional lymph drainage in axillary lymph node levels I-III and internal mammary lymph nodes (IMLNs). A comparison of a homogeneous “real-life” patient collective, treated with helical tomotherapy (TT), patients treated with 3D conformal RT conventional tangentially arranged fields (3DCRT) and deep inspiration breath hold (3DCRT-DIBH), was conducted.Materials/methodsThis study included 90 treatment plans after BCS, irradiated in our clinic from January 2012 to August 2016 with TT (n = 30) and 3D-CRT (n = 30), 3DCRT DIBH (n = 30). PTVs were contoured at different time points by different radiation oncologists (> 7). TT was performed with a total dose of 50.4 Gy and a single dose of 1.8 Gy with a simultaneous integrated boost (SIB) to the tumor cavity (TT group). Patients irradiated with 3DCRT/3DCRT DIBH received 50 Gy à 2 Gy and a sequential boost. Contouring of lymph drainage routes was performed retrospectively according to RTOG guidelines.ResultsAverage doses (DMean) in axillary lymph node Level I/Level II/Level III were 31.6 Gy/8.43 Gy/2.38 Gy for TT, 24.0 Gy/11.2 Gy/3.97 Gy for 3DCRT and 24.7 Gy/13.3 Gy/5.59 Gy for 3DCRT-DIBH patients. Internal mammary lymph nodes (IMLNs) Dmean were 27.8 Gy (TT), 13.5 Gy (3DCRT), and 18.7 Gy (3DCRT-DIBH). Comparing TT to 3DCRT-DIBH dose varied significantly in all axillary lymph node levels and the IMLNs. Comparing TT to 3DCRT significant dose difference in Level I and IMLNs was observed.ConclusionDose applied to locoregional lymph drainage pathways varies comparing tomotherapy plans to conventional tangentially arranged fields. Studies are warranted whether dose variations influence loco-regional spread and must have implications for target volume definition guidelines.

Abstract 1091: Comparison of TCR repertoires between cancer tissues and lymph nodes in colorectal cancer patients

Abstract Tumor draining lymph nodes (TDLNs) are located in the routes of lymphatic drainage from a primary tumor and have the highest metastasis in various types of solid tumors. TDLNs are considered as a tissue to activate the antitumor immunity, where antigen-specific effector T cells are generated and released to the blood stream. These effector T cells then infiltrate into the tumor site and attack cancer cells. However, T cell receptor (TCR) repertoire in TDLNs has not been well characterized. We performed TCR sequencing of cancer tissues, corresponding normal mucosa tissues and a total of 203 regional lymph nodes, including 67 metastasis-positive lymph nodes from 23 colorectal cancer patients with lymph node metastasis. Metastasis-positive lymph nodes showed a significantly lower TCR diversity and shared TCR clones more frequently with primary tumor tissues compared to metastasis-negative TDLNs. Hierarchical clustering and principal component analyses also supported that TCR repertoires in metastasis-positive TDLNs were more similar to primary tumor tissues than metastasis-negative TDLNs. These finding suggest that cancer-reactive T cell clones might expand in the metastasis-positive TDLNs, although we have not tested their reactivity against cancer cells. We are now examining whether the T cells in TDLNs can recognized autologous cancer cells. Citation Format: Kazuma Kiyotani, Tatsuo Matsuda, Eisaku Miyauchi, Yu-Wen Hsu, Satoshi Nagayama, Makda Zewde, Jae-Hyun Park, Taigo Kato, Makiko Harada, Nobuaki Suzuki, Hiroaki Nagano, Shoichi Hazama, Yusuke Nakamura. Comparison of TCR repertoires between cancer tissues and lymph nodes in colorectal cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1091.

Relationship between Upper Extremity Lymphatic Drainage and Sentinel Lymph Nodes in Patients with Breast Cancer

Purpose The purpose of this study was to identify the relationship between upper extremity lymphatics and sentinel lymph nodes (SLNs) in breast cancer patients. Methods Forty-four patients who underwent axillary reverse mapping (ARM) during axillary lymph node dissection (ALND) with SNL biopsy (SLNB) between February 2017 and October 2017 were investigated. ARM was performed using indocyanine green (ICG) to locate the upper extremity lymphatics; methylene blue dye was injected intradermally for SLN mapping. Results ARM nodes were found in the ALND fields of all examined patients. The rate of identification of upper extremity lymphatics within the SLNB field was 65.9% (29 of 44). The ARM nodes were involved in metastases arising from primary breast tumors in 7 of the patients (15.9%), while no metastases were detected in pathologic axillary lymph node-negative patients. Lymphatics from the upper extremity drained into the SLNs in 5 of the 44 patients (11.4%); their ARM-detected nodes were found to be in close proximity to the SLNs. Conclusions The ARM nodes and SLNs are closely related and share lymphatic drainage routes. The ARM procedure using fluorescence imaging is both feasible and, in patients who are SLN negative, oncologically safe. ARM using ICG is therefore effective for identifying and preserving upper extremity lymphatics, and SLNB combined with ARM appears to be a promising surgical refinement for preventing upper extremity lymphoedema. Clinical Trial Registration This trial is registered with ClinicalTrial.gov: NCT02651142.

TCR sequencing analysis of cancer tissues and tumor draining lymph nodes in colorectal cancer patients

ABSTRACTTumor draining lymph nodes (TDLNs) are located in the routes of lymphatic drainage from a primary tumor and have the highest risk of metastasis in various types of solid tumors. TDLNs are also considered as a tissue to activate the antitumor immunity, where antigen-specific effector T cells are generated. However, T cell receptor (TCR) repertoires in TDLNs have not been well characterized. We collected 23 colorectal cancer tumors with 203 lymph nodes with/without metastatic cancer cells (67 were metastasis-positive and the remaining 136 were metastasis-negative) and performed TCR sequencing. Metastasis-positive TDLNs showed a significantly lower TCR diversity and shared TCR clonotypes more frequently with primary tumor tissues compared to metastasis-negative TDLNs. Principal component analysis indicated that TDLNs with metastasis showed similar TCR repertoires. These findings suggest that cancer-reactive T cell clones could be enriched in the metastasis-positive TDLNs.

Utilizing complete decongestive therapy and pneumatic compression on patients with breast carcinoma for treatment of postoperative arm lymphedema-A review

Lymphedema can be defined as an abnormal accumulation of interstitial fluid that occurs primarily as a consequence of malformation or acquired disruption of the lymphatic circulation system. Breast cancer-related lymphedema refers to a swelling of the arm caused by damage to the axillary lymph drainage routes during breast cancer treatment. Lymphedema is one of the predominant physical sequelae, and it has an impact on the physical function of the shoulder; shoulder impairment is higher in patients with lymphedema than in patients without lymphedema. The objective of this paper is to review the evidence from contemporary literature to see the effectiveness of complete decongestive therapy and pneumatic compression on patients with breast cancer-related lymphedema. The aim of this paper is to comprehensively review the literature concerning this topic and summarize existing knowledge. From present study, it can be concluded that complete decongestive therapy, including manual lymphatic drainage, compression bandaging, exercise and skincare, improves shoulder mobility and overall quality of life and helps in reduction of lymphedema volume, pain, and heaviness. The use of pneumatic compression together with complete decongestive therapy was found to be effective in increasing the range of shoulder joint motion but further studies with larger sample sizes are needed to draw more reliable conclusions regarding the effectiveness of pneumatic compression. Furthermore, this review identifies areas for further research and makes recommendations for clinical practice.

Fluorescence image-guided lymphadenectomy using indocyanine green and near infrared technology in robotic gastrectomy.

In recent years, some researchers have tried to find a way to improve the surgical identification of the lymphatic drainage routes and lymph node stations during radical gastrectomy, thus starting a new research frontier in this field called " navigation surgery”. Among the different reported solutions, the introduction of the indocyanine green (ICG) has drawn attention for its characteristics, a fluorescence dye that can be detected in the near infrared spectral band (NIR). A fluorescence imaging technology has been integrated in the latest version of the Da Vinci robotic system and surgeons have extensively reported their experiences in colorectal and hepato-biliary surgery for tumors, vascular and lymphatic structures visualization. However, up to date, the combined use of fluorescence imaging and robotic technology has not been adequately investigated during lymphadenectomy in gastric cancer.

Detection of sentinel lymph node in patients with breast cancer: Application of 3D contrast enhanced ultrasound (3D-CEUS).

e12095 Background: Sentinel lymph node biopsy (SLNB) has became widely accepted as the gold standard procedure for axilla nodal staging .The main methods for the detection of Sentinel lymph nodes (SLNs) are dye-guided and g-probe-guided method.Currently, studies suggest that 2D - Contrast Enhanced Ultrasound(2D-CEUS) may be as good as the accepted techniques for SLNs detection .But the 2D-CEUS can not image the spatial relationship of the lymph vessel and SLNs.The objective of this study was to explore whether three-dimensional contrast enhanced ultrasonography (3D-CEUS) poses higher diagnostic value of in SLNs and lymphatic drainage routes of breast cancer than conventional ultrasonography (US) or 2D-CEUS.To our knowledge, this is the first study to investigate the value of 3D-CEUS in the preoperative diagnosis of SLN metastases in patients with early breast cancer. Methods: By using postoperative pathological results as gold standard, the accuracy and sensitivity of conventional US, 2D-CEUS and 3D-CEUS for SLNs were retrospectively tested in 73 patients with early breast cancer confirmed by pathology between December 2015 and June 2016, all patients underwent US, 2D-CEUS and 3D-CEUS before operation. Injection of the Blue dye was performed half an hour before the operation. Results: According to the postoperative pathology, 25 of 73 patients were with lymphatic metastasis. The lymph nodes detection rate of 2D-US,2D-CEUS and 3D-CEUS was 35.2%, 73.4%, 79.4% ,respectively.The correct rate of 2D-US,2D-CEUS and 3D-CEUS was 74%,90.4%,91.8%, respectively(p<0.05).The lymph drainage route of SLNs are divided into 7 types by 3D-CEUS and the enhancement modes of the lymphatic vessels and the lymph nodes are divided into six categories by 2D-CEUS. Conclusions: The 2D-CEUS and 3D-CEUS can clearly display the SLNs and the lymph drainage routes. 3D-CEUS possesses advantages over 2D-CEUS in displaying lesions with spatial relationship which is informative to preoperative assessment of the stage, the operative type and surgical prognosis in patients with breast cancer, and can contribute greatly to the easy detection of SLNs during SLNB. Clinical trial information: Approval NO,SCPPHEC-D-2015-75.

Prediction of lymph node metastasis and sentinel node navigation surgery for patients with early-stage gastric cancer.

Accurate prediction of lymph node (LN) status is crucially important for appropriate treatment planning in patients with early gastric cancer (EGC). However, consensus on patient and tumor characteristics associated with LN metastasis are yet to be reached. Through systematic search, we identified several independent variables associated with LN metastasis in EGC, which should be included in future research to assess which of these variables remain as significant predictors of LN metastasis. On the other hand, even if we use these promising parameters, we should realize the limitation and the difficulty of predicting LN metastasis accurately. The sentinel LN (SLN) is defined as first possible site to receive cancer cells along the route of lymphatic drainage from the primary tumor. The absence of metastasis in SLN is believed to correlate with the absence of metastasis in downstream LNs. In this review, we have attempted to focus on several independent parameters which have close relationship between tumor and LN metastasis in EGC. In addition, we evaluated the history of sentinel node navigation surgery and the usefulness for EGC.

Tumor-Associated Macrophages Extend Along Lymphatic Flow in the Pre-metastatic Lymph Nodes of Human Gastric Cancer.

Tumor-associated macrophages (TAMs) correlate with lymphangiogenesis in primary lesions and with lymph node (LN) metastasis of several cancers. However, the association of TAMs in regional LNs with lymphatic spread of cancer remains unclear. The purpose of this study was to evaluate the distribution of TAMs in draining LNs and the impact of TAMs on the establishment of LN metastasis of gastric cancer. The number and distribution of TAMs in regional LNs that were obtained from 49 patients who underwent radical surgery for gastric cancer at Osaka City University Hospital in 2011 were assessed. TAMs were defined as immunohistochemically CD163 positive cells. The association of the TAM density with lymph node metastasis and the lymphatic drainage route of the stomach were investigated. A high density of TAMs was significantly associated with pathologically positive lymph nodes and pathological TNM stage. The density of TAMs was increased in LNs with micro metastasis compared with those without metastasis. There was a significant, positive correlation between TAM number and lymphatic vessel density in LNs. In nonmetastatic LNs, TAMs were likely to accumulate in the neighborhood of the primary lesion. In addition, the density of TAMs in distant LNs was significantly increased in patients in whom LN metastasis was observed in perigastric LNs. Accumulated TAMs may induce lymphangiogenesis and prepare an environment that facilitates cancer proliferation in LNs. Our findings might provide a conceptual framework for understanding the lymphatic spreading of cancer and for designing future therapeutic strategies for gastric cancer.