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Objective:To analyze the risk factors of the number of central lymph node metastasis (CLNM) >5 in papillary thyroid microcarcinoma (PTMC) with clinical lymph node negative (cN0) .Methods:A total of 1567 cases of unilateral cN0 PTMC patients undergoing surgery at Endocrine and Breast Surgery Department of the First Affiliated Hospital of Chongqing Medical University from Jan. 2013 to Dec. 2018 were analyzed retrospectively. There were 405 cases of male and 1162 cases of female among them. According to the CLNM, they were divided into 0-5 and ≥5 groups. Clinicopathological characteristics of two groups were compared with Chi-square test and χ 2 test, et al. Results:The case of CLNM>5 involved was 4.1% (65/1567) .Univariate analysis showed that male, age ≤50 years old, tumor diameter> 8 mm, multifocal cancer all were related to CLNM>5 involved ( P<0.05) , multivariate logistic regression analysis found that male ( OR=1.886, P=0.017) , age ≤50 years ( OR=3.778, P=0.002) , tumor diameter>8 mm ( OR=2.483, P<0.001) and multifocal cancer ( OR=2.362, P=0.005) were independent risk factors for CLNM>5. Subgroup analysis showed that the number of Delphian lymph nodes metastasis≥1 ( OR=13.475, P<0.001) , pretracheal lymph nodes metastasis≥2 ( OR=41.695, P<0.001) , and Delphian+pretracheal lymph nodes metastasis≥2 ( OR=28.750, P<0.001) were also independent risk factors for CLNM>5. Conclusions:Unilateral PTMC patients who are male and age ≤50 years old with tumor diameter>8 mm, multifocal cancer have higher risk of central lymph nodes more than 5 involved, surgical treatment and prophylactic central neck dissection are recommended to such patients instead of long-term follow-up observation.Total thyroidectomy should be selected appropriately according to the intraoperative situation.
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Objective@#To investigate the therapeutic strategy in patients with early gastric cancer after noncurative endoscopic submucosal dissection (ESD).@*Methods@#A total of 107 cases with early gastric cancer receiving noncurative endoscopic submucosal dissection were collected and the patients were classified into an additional gastrectomy group (n=41) and a simple follow-up group (n=66) according to the therapeutic method used after noncurative ESD. The clinicopathological information, short- and long-term clinical outcomes between the two groups were analyzed and compared.@*Results@#The mean age of the patients in the gastrectomy group and follow-up group was(59.2±8.7)years old and(64.7±8.8)years old, respectively. The depth of submucosal invasion was (1445.83±803.12) and (794.71±815.79) μm, respectively. The difference between the two groups was statistically significant (P=0.020 for age and P=0.010 for depth of submucosal invasion). Compared with follow-up group, the patients with undifferentiated histologic type, deep invasion of submucosa (SM2), diffuse type, lymphovascular invasion and neural invasion were more common in the gastrectomy group (P<0.05). The R0 resection rate of ESD in the gastrectomy group was significantly lower than the follow-up group(26.8% vs 65.2%, P<0.001). The positive residual tumor rate and LNM rate of additional gastrectomy group were 31.7%(13/41)and 9.76%(4/41)according to the pathological results after gastrectomy. The gastrectomy group had 2 cases of local recurrence (2/41, 4.9%), while 5(5/66, 7.6%)in the follow-up group(4.9% vs 7.6%, P=0.883). There was no significant difference in overall survival (OS) and disease-free survival (DFS) between the two study groups (P=0.066 and 0.938, respectively).@*Conclusions@#Assessment of LNM risk should be performed in patients with noncurative endoscopic resection. For patients with low risk of LNM who are intolerance of additional gastrectomy due to old age and comorbidities, close follow-up with endoscopy can be considered as an alternative.
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Objective@#To investigate the diagnostic value of ultrasound-guided fine-needle aspiration cytology (FNAC) and fine-needle aspiration washout fluid thyroglobulin (FNA-Tg) detection for neck lymph nodes metastasis in patients with papillary thyroid carcinoma (PTC).@*Methods@#A total of 214 PTC patients confirmed by pathology biopsy in Baoji Central Hospital from August 2015 to October 2018 were collected, and they all underwent ultrasound-guided FNAC, and FNA-Tg was measured by using electrochemiluminescence immunoassay. The histopathologic detection was performed for all suspicious lymph nodes after lymphadenectomy, and the results were analyzed by using statistics.@*Results@#There were 282 suspicious enlarged lymph nodes detected from 214 PTC patients. Histopathological examination showed 220 lymph node metastases were positive, 62 were negative. FNAC examination showed 193 lymph nodes were positive and 89 were negative. The sensitivity, specificity, Youden index, positive predictive value, negative predictive value, accuracy of FNAC for diagnosing the lymph nodes of metastasis PTC was 84.55%, 88.71%, 73.26%, 96.37%, 61.80%, 85.46%, respectively. FNA-Tg test showed that 198 lymph nodes were diagnosed as positive metastasis and 84 were negative metastasis. The sensitivity, specificity, Youden index, positive predictive value, negative predictive value, accuracy of FNA-Tg for diagnosing the lymph nodes of metastasis PTC was 88.64%, 95.16%, 83.80%, 98.48%, 70.24%, 90.07%, respectively. Both FNAC and FNA-Tg test showed 215 lymph nodes were diagnosed as positive metastasis and 76 were negative metastasis. The sensitivity, specificity, Youden index, positive predictive value, negative predictive value, accuracy of combined treatments were 97.63%, 87.32%, 84.95%, 95.81%, 92.54%, 96.81%, respectively. The sensitivity and accuracy of combined detection were higher than those of single detection, and there were statistically significant differences (all P < 0.05).@*Conclusions@#FNAC and FNA-Tg detection are simple, safe and accurate. The combined detection of FNAC and FNA-Tg can improve the sensitivity and accuracy for the diagnosis of PTC lymph node metastasis.
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@#Objective: To investigate the potential genes associated with lymph nodes metastasis in endometrial cancer (EC) through microarray data analysis and bioinformatics methods. Methods: We screened mRNA expression profiling chip data related to lymph node metastasis of EC from the GEO database and analyzed mRNAexpression profile to screen the differentially expressed genes; with the integrated bioinformatics approach, such as biological process annotation, biological signaling pathway enrichment, text mining and protein/gene interactions, we further explored the signaling pathways and genes associated with lymph node metastasis in endometrial cancer. Results: GSE2109 and GSE39099 accessions were obtained in the GEO database, and 8 signaling pathways related to lymph node metastasis in EC (type I interferon, interferon-gamma-mediated, PI3K-Akt, Rap1, TGF-beta, cGMP-PKG, Wnt and Ras) and 14 differentially expressed genes that regulate these pathways were found though the signaling pathways enrichment of common differentially expressed genes. Among them, 11 genes were associated with lymph node metastasis of EC and formed a protein-protein interaction network. PI3K-Akt signaling pathway may be an important signaling pathway for lymph node metastasis in EC. VEGFC and IRS1 may be the important candidate genes related to the regulation of lymph node metastasis in EC. Conclusion: Eight signaling pathways and 11 differentially expressed genes were identified to be associated with lymph node metastasis in EC by bioinformatics analysis.
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Objective To investigate the diagnostic value of ultrasound-guided fine-needle aspiration cytology (FNAC) and fine-needle aspiration washout fluid thyroglobulin (FNA-Tg) detection for neck lymph nodes metastasis in patients with papillary thyroid carcinoma (PTC). Methods A total of 214 PTC patients confirmed by pathology biopsy in Baoji Central Hospital from August 2015 to October 2018 were collected, and they all underwent ultrasound-guided FNAC, and FNA-Tg was measured by using electrochemiluminescence immunoassay. The histopathologic detection was performed for all suspicious lymph nodes after lymphadenectomy, and the results were analyzed by using statistics. Results There were 282 suspicious enlarged lymph nodes detected from 214 PTC patients. Histopathological examination showed 220 lymph node metastases were positive, 62 were negative. FNAC examination showed 193 lymph nodes were positive and 89 were negative. The sensitivity, specificity, Youden index, positive predictive value, negative predictive value, accuracy of FNAC for diagnosing the lymph nodes of metastasis PTC was 84.55％, 88.71％, 73.26％, 96.37％,61.80％, 85.46％, respectively. FNA-Tg test showed that 198 lymph nodes were diagnosed as positive metastasis and 84 were negative metastasis. The sensitivity, specificity, Youden index, positive predictive value, negative predictive value, accuracy of FNA-Tg for diagnosing the lymph nodes of metastasis PTC was 88.64％, 95.16％, 83.80％, 98.48％, 70.24％, 90.07％, respectively. Both FNAC and FNA-Tg test showed 215 lymph nodes were diagnosed as positive metastasis and 76 were negative metastasis. The sensitivity, specificity, Youden index, positive predictive value, negative predictive value, accuracy of combined treatments were 97.63％, 87.32％, 84.95％, 95.81％, 92.54％, 96.81％, respectively. The sensitivity and accuracy of combined detection were higher than those of single detection, and there were statistically significant differences (all P< 0.05). Conclusions FNAC and FNA-Tg detection are simple, safe and accurate. The combined detection of FNAC and FNA-Tg can improve the sensitivity and accuracy for the diagnosis of PTC lymph node metastasis.
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Objective: To investigate the characteristics and clinical value of lymph node metastasis according to the clinical data of re-gional lymph node resection in pancreatic head carcinoma. Methods: We summarized and statistically analyzed the lymph node num-bers in lymph node dissection specimens of 160 cases of pancreatic duct adenocarcinoma from February 2010 to October 2013 in Fu-dan University, Shanghai Cancer Center retrospectively and explored the relationship between various clinical factors and lymph node metastasis; and summarized the clinical data in group 16 lymph node metastasis of the patients and investigated the clinical signifi-cance of lymph node dissection in these patients. Results: After the pathological diagnosis of pancreatic adenocarcinoma, 72.5% of all the 160 patients had lymph node metastasis (116 cases of 656 lymph node metastases). Among them, 26 patients had group 16 lymph node metastasis. Lymph node metastasis was not related to gender, age, tumor size, or differentiation, but related to tumor clinical staging. In this study, we found that the lymph node metastasis in group 16 was in subgroup 16b1. patients without lymph nodes me-tastasis, patients with lymph nodes metastasis while without group 16 lymph nodes metastasis and patients with both lymph nodes metastasis and group 16 lymph nodes metastasis, the postoperative median survival time was 25.6 months, 17.25 months and 10.95 months, respectively (P<0.001). Patients with lymph node metastasis in subgroup 16b1 and cancer antigen 19-9>370 U/mL had a shorter survival period. Conclusions: Proper subgroup 16b1 lymph node resection is necessary for radical pancreaticoduodenectomy.
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Objective To observe the expressions of Slug, BRAF V600E and STIP1 proteins in papillary thyroid carcinoma (PTC), and to explore their correlation with capsular invasion and regional lymph node metastasis. Methods Slug, BRAF V600E and STIP1 expressions in 107 cases of differentiated PTC were examined by immunohistochemical staining. The expressions of three proteins and clinicopathological data were statistically analyzed. Results Positive rates of Slug, BRAF V600E and STIP1 in PTC were 65.4 % (70/107), 61.7 % (66/107) and 66.4 % (71/107), respectively, and overexpression of Slug, BRAF V600E and STIP1 was significantly associated with capsular invasion and regional lymph node metastasis in PTC (P< 0.05). There are a significant correlation between expression of Slug and BRAF V600E in PTC (r= 0.235, P< 0.05). Conclusion Overexpression of Slug, BRAF V600E and STIP1 proteins is associated with capsular invasion and regional lymph node metastasis in PTC, which maybe useful for predicting regional lymph node metastasis and prognostic evaluation.
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Objective To investigate the miRNA expression profiles in rectal cancer tissues and their associations with clinical pathological stage, depth of tumor invasion, and lymph node metastasis, and to evaluate the potential of miRNA as diagnostic and prognostic markers of rectal cancer. Methods Human miRNA microarray was used to profile miRNA expression in rectal cancer tissues and matched adjacent normal tissues (n=71). The up-regulated miR-93-5p and down-regulated miR-27a-3p were screened out, and the top differentially expressed miRNA were validated by quantitative real-time polymerase chain reaction ( qRT-PCR) . The relationship between the expression of miRNA and clinical parameters was analyzed by ANOVA and Spearman correlation. Results The expression of miR-27a-3p was down-regulated in miRNA microarray, but was up-regulated in qRT-PCR analysis;the data were relatively discrete. The expression of miR-93-5p was up-regulated in both miRNA microarray and qRT-PCR analysis;the expression level of miR-93-5p in rectal cancer tissues was 3165 times that in adjacent normal tissues ( P=00058);the expression level was correlated with tumor volume ( P= 0004 ) , and was positively correlated with the level of carcinoembryonic antigen ( CEA) before treatment ( P=0001) and the number of lymph nodes metastases (rs=0534, P=0005). Conclusions There is a differential miRNA expression pattern between rectal cancer tissues and matched adjacent normal tissues. The miR-93-5p is highly up-regulated in rectal cancer tissues and may serve as a diagnostic and prognostic marker of rectal cancer.
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Objective To investigate the miRNA expression profiles in rectal cancer tissues and their associations with clinical pathological stage, depth of tumor invasion, and lymph node metastasis, and to evaluate the potential of miRNA as diagnostic and prognostic markers of rectal cancer. Methods Human miRNA microarray was used to profile miRNA expression in rectal cancer tissues and matched adjacent normal tissues (n=71). The up-regulated miR-93-5p and down-regulated miR-27a-3p were screened out, and the top differentially expressed miRNA were validated by quantitative real-time polymerase chain reaction ( qRT-PCR) . The relationship between the expression of miRNA and clinical parameters was analyzed by ANOVA and Spearman correlation. Results The expression of miR-27a-3p was down-regulated in miRNA microarray, but was up-regulated in qRT-PCR analysis;the data were relatively discrete. The expression of miR-93-5p was up-regulated in both miRNA microarray and qRT-PCR analysis;the expression level of miR-93-5p in rectal cancer tissues was 3165 times that in adjacent normal tissues ( P=00058);the expression level was correlated with tumor volume ( P= 0004 ) , and was positively correlated with the level of carcinoembryonic antigen ( CEA) before treatment ( P=0001) and the number of lymph nodes metastases (rs=0534, P=0005). Conclusions There is a differential miRNA expression pattern between rectal cancer tissues and matched adjacent normal tissues. The miR-93-5p is highly up-regulated in rectal cancer tissues and may serve as a diagnostic and prognostic marker of rectal cancer.
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Objective To investigate the relationship between Ezrin expression and subcellular localization of E?cadherin(E?cad),and explore the clinical significance of this relationship to pathological features such as lymph nodes metastasis in breast cancer. Methods Ninety four cases of breast cancer tissue samples with lymph node metastasis were collected. The expression of Ezrin and E?cad was detected by immunohistochemi?cal method. Results The positive rates of and E?cad and Ezrin were respectively 45.7%and 58.5%in 94 nodes positive breast cancer,containing membranal expression of E?cad(E?cadm)in 20 cases and cytoplasmic expression of E?cad(E?cadc)in 23 cases;the frequency of E?cadc positive staining was significantly higher in Ezrin(+)tissues than that in Ezrin(-)tissues(P=0.025);E?cad expression level was significantly lower in TNMⅡ?Ⅲstage cases(P=0.001),and Ezrin expression(P=0.036)and E?cadc(P=0.013)was significantly increased in bigger cases;com?pared with E?cad(+),Ezrin(-),E?cadm tissues,the number of lymph node metastasis in E?cad(-)(P=0.011),Ezrin(+)(P=0.002),E?cadc (P=0.020)tissues were increased significantly;in the order of E?cad(+)/Ezrin(-),E?cad(-)/Ezrin(-),E?cad(+)/Ezrin(+),and E?cad(-)/Ezrin(+),the number of lymph node metastasis was increased significantly(P<0.001);similarly,in the order of E?cadm/Ezrin(-),E?cadc/Ezrin(-),E?cadm/Ezrin(+),and E?cadc/Ezrin(+),the number of lymph node metastasis was increased significantly(P=0.007). Conclusion Ezrin may regulate the subcellular localization of E?cad in metastatic breast cancer ,which may affect the course of breast cancer and promote the metastasis of lymph nodes.
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Objective: To assess, the safety and early oncologic results of minimally invasive esophagectomy (MIE) combined with super-extended two-field lymph node dissection for treating esophageal squamous cell carcinoma. Methods A total of 49 patients who underwent MIE through McKeown approach (right chest, left neck, and abdomen) between May 2012 and Dec. 2013 were enrolled in this study. Lymph node dissection fields included whole mediastinum, lower para-esophagus via thoracoscope route, and abdomen. Results: The patients included 44 males and 5 females, with an age range of 45-78 years old and a median of 58 years old. Sixteen (32. 7%) patients were at Stage I. Forty-eight (98. 0%) patients received complete resection, and 18 (36. 7%) patients had post-operation complications, including 9(18. 4%) with neck leakage and 7 (14. 3%) with vocal cord paralysis. Post-operative early death occurred in one case. The mean number of removed lymph nodes was 18 and the lymph node metastasis rate was 42. 9% (21/49); 28. 6% (6/21) of the positive nodes were found in the upper mediastinum and lower para-esophagus areas. Seven of the 18 patients who were followed up had recurrence, with a recurrent rate of 38. 9%. The 7 cases included 5 in the locoregional areas and 2 in distant organs. Conclusion: MIE combined with super two-field dissection can achieve the lymphadenectomy effect recommended by National Comprehensive Cancer Network (NCCN), with satisfactory safety. Short-term follow-up indicates that the locoregional recurrence is more frequent than distant metastases, demanding more thorough mediastinal lymph node dissection.
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We report a case of axillary lymph node metastasis (LNM) as a recurrence of papillary thyroid carcinoma (PTC) in a 68-year-old male. The patient initially presented in 2009 with a 3.4x5.4 cm sized neck swelling and left cervical lymphadenopathy. He underwent total thyroidectomy and central compartment neck dissection (CCND) with left modified radical neck dissection (MRND). The pathological report confirmed PTC with metastasis of neck lymph node. On a regular follow up of positron emission tomography (PET), LNM was found on the right supraclavicular area and on the left axillary area. It was 17 months after the initial thyroid cancer had been diagnosed. The right MRND and left axillary lymph node dissections were performed in April of 2012. Pathological result confirmed metastatic PTC of left axillary lymph nodes. After recovery from the surgery, the patient got radioactive iodine therapy with I-131 180 mCi.
Subject(s)
Aged , Humans , Male , Follow-Up Studies , Iodine , Lymph Node Excision , Lymph Nodes , Lymphatic Diseases , Neck , Neck Dissection , Neoplasm Metastasis , Positron-Emission Tomography , Recurrence , Thyroid Neoplasms , ThyroidectomyABSTRACT
Background and purpose: Postoperative chemotherapy targets the metastatic cancer in the remaining lymph nodes, but the heterogeneity in multidrug resistance (MDR) of metastatic cancer cells is a main factor affecting chemotherapeutic efficacy. Recent studies only examined the primary lesion of esophageal squamous cell carcinoma(ESCC). There is no report about heterogeneity between the primary tumor and metastases lymph node. The purpose of this study was to explore the heterogenous expression and clinical signiifcance of multidrug resistance (MDR) associated proteins in primary tumors and metastatic lymph nodes in patients with thoracic ESCC. Methods:The expressions of lung cancer associated resistance protein (LRP), P-glycoprotein (P-gp), topoisomeraseⅡ(TOPO-Ⅱ), thymidylate synthase (TS), glutathione S-transferase-π (GST-π) were examined by immunohistochemistry in primary lesions and corresponding metastatic lymph nodes in 54 patients with thoracic ESCC. The differences between expression of primary lesions and matched metastatic lymph nodes were compared and analyzed in relationship with tissue differentiation degree. Results: The discordant rates of the expression and drug resistance between primary lesions and corresponding metastatic lymph nodes in LRP, P-gp, TS, TOPO-Ⅱ and GST-π were 63.0% and 26.9%, 42.6%and 22.2%, 48.1%and 25.9%, 50.0%and 29.6%, 18.5%and 1.9%respectively. The expression of LRP showed signiifcant difference between the primary tumors and lymph nodes (P=0.026). No signiifcant differences were found for the other four proteins, and GST-πwas expressed in all patients in both the primary tumors and lymph nodes. Protein expression was not associated with degree of differentiation. Conclusion:There is evident of heterogenous expression of MDR associated proteins in metastatic lymph nodes compared to the primary tumors of ESCC. The examination of expression levels of MDR associated proteins in metastatic lymph nodes is helpful to select the postoperative rational chemotherapy plan.
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Objective To explore the prognosis impact of lymph nodes metastasis in pancreatic cancer.Methods The clinical data of 61 patients with pancreatic cancer who underwent pancreaticoduodenectomy from January 2004 to September 2011 were analyzed retrospectively.Patients were categorized into different groups by lymph nodes metastasis status,count of positive lymph nodes,location of positive lymph nodes,lymph nodes ratio (LNR) and other factors.Kaplan-Meier,log-rank and COX proportional hazard models were used to evaluate the prognostic effect.Results Median survival for the overall 61 patients was 13 months (95％ CI 9.158-16.842),with 6 months,1 year,3 years,5 years survival rates of 84.6％,47.7％,14.3％ and 9.1％ respectively.Univariate analysis showed:the median survival of patients with and without lymph nodes metastasis had statistical significant outcome (P ＜ 0.01).Patients within the first station lymph nodes metastasis had a better outcome than those lymph nodes metastasis beyond the first station (P ＜0.05).Patients with LNR ≤0.2 had better prognosis than those LNR ＞ 0.2 (P ＜ 0.01).The number of lymph nodes examined had no effect on overall survival in either nodes-positive patients or nodes-negative patients (P ＞ 0.05).The count of positive lymph nodes did not affect the prognosis in the pN1 patients (P＞ 0.05).Multivariate analysis showed:location of positive lymph nodes and LNR were independent predictors of the prognosis in the pN1 patients.Conclusions Lymph nodes metastasis status has significant effect on the prognosis of the pancreatic cancer.Location of positive lymph nodes and LNR are independent predictors of the prognosis in the pN1 patients.The number of lymph nodes examined and the number of positive lymph nodes have no effect on the prognosis of the pancreatic cancer.
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Objective To study the function of the important members of MMPs in breast cancer and their correlation with lymph nodes metastasis through making groups according to vascular thrombosis status showed by pathological diagnosis and detecting the expression of MMP-2,-9,-13,-14 in order.Methods Fluorescent quantitative RT-PCR was used to detect mRNA expression of MMP-2,-9,-13,-14 in 30 cases of breast cancer patients in both groups (negative and positive vascular thrombosis groups).Streptavidin-peroxidase methods (S-P) immunohistochemical method was employed to detect the expression of ER,PR,HER2,P53 and Ki-67 in breast cancer tissues.The data were analyzed by t test etc.Results Lymph nodes metastasis was significantly more in vascular thrombosis positive group than in negative group(P ＜ 0.05 ).MMP-2 and -13 were overexpressed in vascular thrombosis negative group (P ＜ 0.05).Conclusions Breast cancer patients with positive vascular thrombosis have a more apparent trend of lymph nodes metastasis.MMP-2 and MMP-13 mRNA play a negative regulatory role in intravasation of tumor cells by producing substances that may inhibit tumor angiogenesis and intravasation.
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PURPOSE: To compare the diagnostic accuracy of US/CT with US/CT/¹⁸F-FDG PET-CT in the diagnosis of cervical lymph nodes metastasis in papillary thyroid carcinoma. METHODS: From July 2008 to May 2010, 36 patients with papillary thyroid carcinoma, confirmed by aspiration cytology analysis, underwent neck US, neck CT and ¹⁸F-FDG PET-CT preoperatively. The sensitivity, specificity and diagnostic accuracy of the US/CT, US/CT/PET-CT was analyzed according to lymph node level (all: levels I~VI, central: level VI, lateral: levels I~V). RESULTS: At all lymph nodes group (level I~VI), US/CT/ PET-CT showed a sensitivity of 66.6%, a specificity of 61.9% and a diagnostic accuracy of 63.8%. The corresponding values for US/CT were 60.0%, 85.7%, 75.0% respectively. Considering the central cervical nodes group (level VI), US/CT/PET-CT showed a sensitivity of 57.1%, a specificity of 68.1%, and a diagnostic accuracy of 63.8%. The corresponding values of US/CT were 57.1%, 90.9%, 77.7% respectively. Considering the lateral cervical nodes group (level I~V), US/CT/PET-CT showed a sensitivity of 100%, a specificity of 84.3%, and a diagnostic accuracy of 86.1%. The corresponding values of US/CT were 75.0%, 84.3%, 83.3% respectively. The diagnostic results of US/ CT, US/CT/PET-CT in initial evaluation of the cervical nodes metastasis did not differ significantly. CONCLUSION: Our preliminary results suggest that additional PET-CT evaluation in US/CT does not provide statistically significant benefit for initial diagnosis of cervical lymph nodes metastasis in papillary thyroid carcinoma.
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Humans , Diagnosis , Lymph Nodes , Neck , Neoplasm Metastasis , Sensitivity and Specificity , Thyroid Gland , Thyroid NeoplasmsABSTRACT
BACKGROUND AND OBJECTIVES: Little information about the incidence of retropharyngeal adenopathy and its impact on prognosis has been published. The purpose of this study is to investigate the incidence and prognostic significance of metastatic retropharyngeal adenopathy in patients with squamous cell carcinoma of the hypopharynx. SUBJECTS AND METHOD: The pretreatment CT/MRI of 121 patients with squamous cell carcinoma of the hypopharynx were reviewed for the presence of metastatic retropharyngeal lymph nodes. All patients were treated between 1996 and 2005. The influence on recurrence (local and regional), distant metastasis, and survival was retrospectively analyzed. Mean follow-up was 28.3 months. RESULTS: Retropharyngeal node involvement was present in 21 (17.4%) patients. The clinical T staging was the most significant factor relating to the incidence of retropharyngeal adenopathy in multivariate analysis (p=0.006). The rates of regional recurrence and distant metastasis were significantly higher in patients with retropharyngeal adenopathy. Disease specific survival rate was significantly lower in the retropharyngeal node positive group (p=0.013). CONCLUSION: Retropharyngeal node involvement has a negative impact on the prognosis of squamous cell carcinoma of the hypopharynx. Patients are particularly at risk for distant metastasis, resulting in worse disease-specific survival. Retropharyngeal node involvement should be taken into account in designing the treatment plan for these patients.
Subject(s)
Humans , Carcinoma, Squamous Cell , Follow-Up Studies , Hypopharynx , Incidence , Lymph Nodes , Multivariate Analysis , Neoplasm Metastasis , Prognosis , Recurrence , Retrospective Studies , Survival RateABSTRACT
PURPOSE: In breast cancer patients, information of the axillary nodal status is essential for staging, determining the necessity of systemic therapy, and predicting the prognosis. The necessity of an axillary lymph node dissection in small breast cancers is controversial. The aim of this study is to identify the factors associated with axillary lymph node metastases and to determine the necessity of axillary lymph node dissections in T1 invasive ductal carcinomas of the breast. METHODS: From the June 1991 to the March 2004, of a total 919 cases who underwent surgery for breast cancer in Korea University Hospital, 230 cases of T1 invasive ductal carcinomas were reviewed retrospectively. All subjects were classified as T1a, T1b, or T1c. The rate of axillary lymph node metastasis was calculated for each group and the factors that have a statistically significant correlations with axillary lymph nodes metastases were investigated. RESULTS: Of the 230 cases of T1 invasive ductal carcinomas, 22 cases were T1a, 27 cases were T1b, and 181 cases were T1c. Axillary lymph node metastases were encountered in 4 T1a case (18%), 5 T1b cases (18.5%), and 67 T1c cases (30.3%). The overall rate of axillary lymph node metastases rate in T1 was 33% (76/230). The T stage had a statistically significant correlation (p=0.043) with the axillary lymph node metastases. Lymphovascular invasion of the tumor had a significant correlations with an axillary lymph node metastases (p=0.032). The MIB-1 labeling index was increased according to the tumor size, and correlated with the presence of an axillary lymph node metastasis (p=0.032, p=0.18). However age, hormone receptors, p53, HER2/neu , and nm23 were not associated with an axillary lymphnodes metastasis. CONCLUSIONS: The tumor size and the lymphovascular invasion could be significantly prognostic factors suggesting an axillary lymph node metastasis in T1 invasive ductal carcinomas. The MIB-1 immunostain was higher in the T1c cases. Therefore, a combination of the tumor size and MIB-1 immunostain would be an indicator for an axillary lymph node dissection. A sentinel lymph node biopsy may be of more benefit in T1a invasive ductal carcinomas of the breast.
Subject(s)
Humans , Breast Neoplasms , Breast , Carcinoma, Ductal , Korea , Lymph Node Excision , Lymph Nodes , Neoplasm Metastasis , Prognosis , Retrospective Studies , Sentinel Lymph Node BiopsyABSTRACT
PURPOSE: In breast cancer patients, information of the axillary nodal status is essential for staging, determining the necessity of systemic therapy, and predicting the prognosis. The necessity of an axillary lymph node dissection in small breast cancers is controversial. The aim of this study is to identify the factors associated with axillary lymph node metastases and to determine the necessity of axillary lymph node dissections in T1 invasive ductal carcinomas of the breast. METHODS: From the June 1991 to the March 2004, of a total 919 cases who underwent surgery for breast cancer in Korea University Hospital, 230 cases of T1 invasive ductal carcinomas were reviewed retrospectively. All subjects were classified as T1a, T1b, or T1c. The rate of axillary lymph node metastasis was calculated for each group and the factors that have a statistically significant correlations with axillary lymph nodes metastases were investigated. RESULTS: Of the 230 cases of T1 invasive ductal carcinomas, 22 cases were T1a, 27 cases were T1b, and 181 cases were T1c. Axillary lymph node metastases were encountered in 4 T1a case (18%), 5 T1b cases (18.5%), and 67 T1c cases (30.3%). The overall rate of axillary lymph node metastases rate in T1 was 33% (76/230). The T stage had a statistically significant correlation (p=0.043) with the axillary lymph node metastases. Lymphovascular invasion of the tumor had a significant correlations with an axillary lymph node metastases (p=0.032). The MIB-1 labeling index was increased according to the tumor size, and correlated with the presence of an axillary lymph node metastasis (p=0.032, p=0.18). However age, hormone receptors, p53, HER2/neu , and nm23 were not associated with an axillary lymphnodes metastasis. CONCLUSIONS: The tumor size and the lymphovascular invasion could be significantly prognostic factors suggesting an axillary lymph node metastasis in T1 invasive ductal carcinomas. The MIB-1 immunostain was higher in the T1c cases. Therefore, a combination of the tumor size and MIB-1 immunostain would be an indicator for an axillary lymph node dissection. A sentinel lymph node biopsy may be of more benefit in T1a invasive ductal carcinomas of the breast.
Subject(s)
Humans , Breast Neoplasms , Breast , Carcinoma, Ductal , Korea , Lymph Node Excision , Lymph Nodes , Neoplasm Metastasis , Prognosis , Retrospective Studies , Sentinel Lymph Node BiopsyABSTRACT
Objective To study the diagnostic value of digital mammography(DM) and color Doppler ultrasonography (CDUS) for small breast carcinoma and axillary lymph nodes metastasis.Methods DM and ultrasonographic findings of 60 cases with breast nodules less than 2.0 cm in diameter were analyzed and diagnosed by experienced radiologists and ultrasonography doctors with double blind method and compared with pathological results.Results Among 60 cases, 60 breast nodules and 96 axillary lymph nodes (45/96 metastatic nodes) were both found by DM and CDUS,including 36 cases of breast cancer and 24 cases of benign lesions. The sensitivity and accuracy of DM in diagnosis of small breast cancer and axillary lymph nodes metastasis were significantly higher than that of CDUS, especially for the lesions were less than 1 cm in size (P