Prediction of pelvic lymph node metastases in parents with clinically localized prostatic carcinoma by algorithm using systematic biopsies

To prospectively validate an algorithm to predict pelvic lymph node metastases in patients with clinically localized prostatic carcinoma. 293 patients with prostatic cancer were classified before pelvic lymph node dissection according to an algorithm developed with classification and regression tree analysis into high risk [more than 3 sextant biopsies containing any Gleason grade 4 or 5 cancer], intermediate risk [at least one biopsy dominated by Gleason grade 4 or 5 cancer but not high risk] and low risk [all other patients]. Observed and predicted frequencies of pelvic lymph node metastases were compared. The observed frequencies of lymph node metastases were remarkably similar to the predicted frequencies: 2.8% vs. 2.2% in the 85.7% of patients in the low-risk group, 16.7% vs. 19.4% in the 10.2% of patients in the intermediate-risk group and 41.7% vs. 45.5% in the 4.1% of patients in the high-risk group. If patients in the low-risk group were considered to be node-negative, the specificity and negative predictive value of the algorithm were 88.4% and 97.2%, respectively. Our algorithm, is valid as a simple and accurate tool for the prediction of pelvic lymph node metastases in patients with clinically localized prostatic cancer. 85.7% of patients classified by the algorithm to have a low risk of lymphatic spread should be spared a pelvic lymph node dissection before definitive local treatment

new practical classification of axillary lymph nodes

Leveling of axillary nodes in relation to the pectoralis minor muscle is not practical anymore as the muscle is not included in the operative field or the surgical specimen removed. In this study, 21 axillae in the postmortem room were examined. In ten subjects, the axillary vessels were injected with polyvinyl chloride latex and the relation of their branches to the pectoralis minor was assessed. In the remaining eleven subjects, axillary evacuation was done in relation to the lateral and supreme thoracic vessels. The removed specimens were fixed, defatened and transilluminated for nodes dissection and counting. Accordingly, the axillary nodes were classified into three major groups: The lateral thoracic group with an average number of 14 nodes [SD +/- 6.1], the interthoracic group average of 6 nodes [SD +/- 3.78]and the supreme thoracic group average of 3 nodes [SD +/- 2.38]