Lymph Node State

Abstract: In 65 patients with primary invasive ductal breast carcinoma the relation between classic prognosticators describing the extent of disease (lymph node metastases and tumour size) and newer promising morphometric and DNA flow cytometric prognostic factors was studied. There was no relation between DNA ploidy, lymph node state, and tumour size. Tumours with a mitotic activity index of more than 10 were predominantly DNA aneuploid (61%) compared with those with a mitotic activity index of less than 10 which showed a DNA aneuploid pattern in 27%. The strongest prognosticator, the morphometric prognostic index (a multivariate combination of mitotic activity index, tumour size, and lymph node state) correlated positively with the DNA index in 63% of the cases (p = 0.038). Thus there was a discrepancy between the morphometric and DNA flow cytometric prognostic variables in 37% of the cases. These results indicate that morphometric and flow cytometric analysis may provide additional information on the prognosis in primary breast cancer.

Abstract: The prognostic value of clinical, quantitative, and qualitative microscopical features of both the primary tumour and also of the affected lymph nodes were investigated in 71 patients with breast cancer with spread to lymph nodes (T X N + M0) Age, tumour size, and localisation of the tumour comprised the clinical features; morphometry included assessment of the cellularity index, the mitotic activity index, and seven nuclear indices; the qualitative features investigated were histological type and grade, nuclear grade, oestrogen receptor content, number of lymph nodes affected, capsule infiltration of the nodes, presence of metastatic deposits in the efferent lymph vessels, percentage area of lymph node occupied by tumour Immunohistochemistry was performed to show the presence of carcinoembryonic antigen and peanut agglutinin All the patients had a minimum follow up of 24 months (maximum 48 months, mean 36 months) Analysis of the results showed that the combined results of morphometry (of the primary tumour and the axillary lymph node metastatic deposits) yielded more information than analysis of axillary lymph node state, or morphometry of the primary tumour, or the lymph node metastases alone Patients with a nuclear axes ratio of greater than 141 in the primary tumour and greater than 136 in the lymph node metastatic deposits were less likely to develop distant metastases than patients with values below any of these thresholds (recurrence rates 52% and 46%, respectively) Thus the preliminary results of this prospective study indicate that morphometry provides important prognostic information in patients with breast cancer that has spread to lymph nodes

Abstract: The aim of this study was to assess the value of sentinel lymph node procedures in gynecologic cancers. A systematic literature overview, using the PubMed database, was performed. In early stage vulvar, endometrial and cervical cancer, lymph node status is the most important prognostic factor. Lymphadenectomy, performed for adequate staging, is associated with high morbidity rates. Sentinel node procedures hold the promise of adequate staging with less treatment-related morbidity. Sentinel lymph node procedures in patients with early-stage vulvar cancer are associated with low recurrence rates, excellent survival, lower morbidity and shorter hospital stay compared to classical inguinal dissection. Therefore, these procedures should be the standard of care in early-stage unilateral vulvar cancer. Reports on sentinel lymph node procedures in endometrial and cervical cancer are ambiguous. The procedures in these cancers are reported in small studies only. Detection rates vary depending on the used injection sites and the used tracers. Bilateral detection rates are low and are not mentioned by default. Large controlled multi-institutional studies are necessary to evaluate the validity and the prognostic significance of the sentinel lymph node procedures in endometrial and cervical cancer.

Abstract: OBJECTIVE: To summarize the characteristics of regional lymph node metastasis in patients with early gastric cancer and analyze the risk factors for lymphatic metastasis. METHODS: 103 cases surgically treated for early gastric cancer in the Third Hospital of Peking University between March, 1988 and March, 2009 were analyzed retrospectively. Several clinical pathologic variables including patients' age, gender, size of tumor, tumor location, macroscopic type, histological type, invasion depth were investigated by using chi-square test and logistic regression analysis for the possible relationship to lymphatic metastasis. RESULTS: The rate of lymph node metastasis in early gastric cancer was 17.5% (18/103), which in mucosal cancer was 4.1% (2/49). Submucosal cancer had a lymph node metastatic rate of 29.6% (16/54). Logistic regression indicated that invasion to submucosa and tumor size > 2 cm were independent risk factors for lymph node metastasis of early gastric cancer. Metastatic cases of mucosal cancer were all signet ring cell cancer with diameters more than 2 cm. Lymph node metastatic rate in submucosal cancers within 2 cm was 16.1%(5/31), that in > 2 cm submucosal cancers was 47.8% (11/23) (P = 0.012). Rate of lymph node metastasis in well-differentiated cancers was 0(0/13), that in moderately-differentiated, poorly differentiated and signet ring cell cancers were 18.2% (4/22), 16.7% (5/30) and 23.7% (9/38) respectively (P = 0.294). Patients' age, gender, tumor location and macroscopic type showed no relationship with lymph node state. CONCLUSION: The tumor size and invasion depth are related with lymph node metastasis in early gastric cancer, considering these factors and assessing lymph node state is essential to appropriate therapeutic options for early gastric cancer.