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Journal of Surgical Oncology Jan 2019The publication of recent randomized trials has prompted a significant shift in both our understanding and the management of patients with melanoma. Here, the current... (Review)
Review
The publication of recent randomized trials has prompted a significant shift in both our understanding and the management of patients with melanoma. Here, the current management of the regional lymph nodes in patients with melanoma is discussed. This review focuses on selection for sentinel lymph node biopsy, management of the positive sentinel node, management of the clinically positive node, and the controversy over the therapeutic value of early nodal intervention.
Topics: Disease Management; Humans; Lymph Node Excision; Lymph Nodes; Melanoma; Prognosis; Skin Neoplasms
PubMed: 30481384
DOI: 10.1002/jso.25316 -
Archives of Pathology & Laboratory... Aug 2016-Sentinel lymph node biopsy has been established as the new standard of care for axillary staging in most patients with invasive breast carcinoma. Historically, all... (Review)
Review
CONTEXT
-Sentinel lymph node biopsy has been established as the new standard of care for axillary staging in most patients with invasive breast carcinoma. Historically, all patients with a positive sentinel lymph node biopsy result underwent axillary lymph node dissection. Recent trials show that axillary lymph node dissection can be safely omitted in women with clinically node negative, T1 or T2 invasive breast cancer treated with breast-conserving surgery and whole-breast radiotherapy. This change in practice also has implications on the pathologic examination and reporting of sentinel lymph nodes.
OBJECTIVE
-To review recent clinical and pathologic studies of sentinel lymph nodes and explore how these findings influence the pathologic evaluation of sentinel lymph nodes.
DATA SOURCES
-Sources were published articles from peer-reviewed journals in PubMed (US National Library of Medicine) and published guidelines from the American Joint Committee on Cancer, the Union for International Cancer Control, the American Society of Clinical Oncology, and the National Comprehensive Cancer Network.
CONCLUSIONS
-The main goal of sentinel lymph node examination should be to detect all macrometastases (>2 mm). Grossly sectioning sentinel lymph nodes at 2-mm intervals and evaluation of one hematoxylin-eosin-stained section from each block is the preferred method of pathologic evaluation. Axillary lymph node dissection can be safely omitted in clinically node-negative patients with negative sentinel lymph nodes, as well as in a selected group of patients with limited sentinel lymph node involvement. The pathologic features of the primary carcinoma and its sentinel lymph node metastases contribute to estimate the extent of non-sentinel lymph node involvement. This information is important to decide on further axillary treatment.
Topics: Breast; Breast Neoplasms; Female; Humans; Lymphatic Metastasis; Neoplasm Staging; Practice Guidelines as Topic; Reproducibility of Results; Sentinel Lymph Node; Sentinel Lymph Node Biopsy
PubMed: 27472237
DOI: 10.5858/arpa.2015-0140-RA -
Journal of Immunology (Baltimore, Md. :... Oct 2019Unlike the blood, the interstitial fluid and the deriving lymph are directly bathing the cellular layer of each organ. As such, composition analysis of the lymphatic...
Unlike the blood, the interstitial fluid and the deriving lymph are directly bathing the cellular layer of each organ. As such, composition analysis of the lymphatic fluid can provide more precise biochemical and cellular information on an organ's health and be a valuable resource for biomarker discovery. In this study, we describe a protocol for cannulation of mouse and rat lymphatic collectors that is suitable for the following: the "omic" sampling of pre- and postnodal lymph, collected from different anatomical districts; the phenotyping of immune cells circulating between parenchymal organs and draining lymph nodes; injection of known amounts of molecules for quantitative immunological studies of nodal trafficking and/or clearance; and monitoring an organ's biochemical omic changes in pathological conditions. Our data indicate that probing the lymphatic fluid can provide an accurate snapshot of an organ's physiology/pathology, making it an ideal target for liquid biopsy.
Topics: Animals; Catheterization; Female; Lymph; Lymph Nodes; Lymphatic Vessels; Male; Mice; Mice, Inbred C57BL; Rats; Rats, Sprague-Dawley
PubMed: 31519866
DOI: 10.4049/jimmunol.1900375 -
Proceedings of the National Academy of... Aug 2022A large number of neutrophils infiltrate the lymph node (LN) within 4 h after skin infection (4 h postinfection [hpi]) and prevent systemic dissemination. It is not...
A large number of neutrophils infiltrate the lymph node (LN) within 4 h after skin infection (4 h postinfection [hpi]) and prevent systemic dissemination. It is not clear how infection in the skin can remotely and effectively recruit neutrophils to the LN. Here, we found that lymphatic vessel occlusion substantially reduced neutrophil recruitment to the LN. Lymphatic vessels effectively transported bacteria and proinflammatory chemokines (i.e., Chemokine [C-X-C motif] motif 1 [CXCL1] and CXCL2) to the LN. However, in the absence of lymph flow, alone in the LN was insufficient to recruit neutrophils to the LN at 4 hpi. Instead, lymph flow facilitated the earliest neutrophil recruitment to the LN by delivering chemokines (i.e., CXCL1, CXCL2) from the site of infection. Lymphatic dysfunction is often found during inflammation. During oxazolone (OX)-induced skin inflammation, CXCL1/2 in the LN was reduced after infection. The interrupted LN conduits further disrupted the flow of lymph and impeded its communication with high endothelial venules (HEVs), resulting in impaired neutrophil migration. The impaired neutrophil interaction with bacteria contributed to persistent infection in the LN. Our studies showed that both the flow of lymph from lymphatic vessels to the LN and the distribution of lymph in the LN are critical to ensure optimal neutrophil migration and timely innate immune protection in infection.
Topics: Animals; Chemokines; Immunity, Innate; Inflammation; Lymph; Lymph Nodes; Mice; Mice, Inbred C57BL; Neutrophil Infiltration; Neutrophils; Skin Diseases, Bacterial; Staphylococcal Infections; Staphylococcus aureus
PubMed: 35914162
DOI: 10.1073/pnas.2111726119 -
Annals of the American Thoracic Society May 2022
Topics: Chyle; Chylothorax; Humans; Lymphatic System; Lymphatic Vessels; Pericardial Effusion
PubMed: 35486085
DOI: 10.1513/AnnalsATS.202202-121ED -
Urology Annals 2023Penile cancer is a rare malignancy which inguinal and pelvic lymph node involvement plays a major role in patients' survival. The prognosis of patients with lymph node...
BACKGROUND
Penile cancer is a rare malignancy which inguinal and pelvic lymph node involvement plays a major role in patients' survival. The prognosis of patients with lymph node metastasis is poorer.
OBJECTIVE
The objective of the study was to evaluate the prognostic factors for inguinal lymph node and pelvic lymph node involvement.
MATERIALS AND METHODS
This was a retrospective analytic study of medical records between January 2010 and December 2020.
RESULTS
Thirty-nine patients were diagnosed with penile cancer, median age of 59 ± 14.898 (range: 32-86 years) were included in the analysis. Twenty-eight patients underwent inguinal lymph node dissection, 13 patients had inguinal lymph node metastasis (46.4%), 8 patients underwent pelvic lymph node dissection, and 5 patients had pelvic lymph node metastasis (62.5%). Inguinal lymph node metastasis was associated with tumor grading (odds ratio [OR]: 2.92, confidence interval [CI]: 0.123-0.704), lymphovascular invasion (LVI) (OR: 5.182, CI: 0.430-0.996), perineural invasion (PNI) (OR: 3.687, CI: 0.277-0.975), and fixation of inguinal node (OR: 2.463, CI: 0.078-1.195). Pelvic lymph node metastasis was associated with tumor grading (OR: 2.619, CI: 0.033-0.967).
CONCLUSION
Grading, LVI and PNI of primary tumor, and fixation of inguinal node are significantly associated with inguinal lymph node metastasis. While primary tumor grading is significantly associated with pelvic lymph node metastasis. These factors are associated with poorer prognosis.
PubMed: 37664092
DOI: 10.4103/ua.ua_6_22 -
Annals of Coloproctology Jun 2019Lymph node metastasis is regarded as an indubitable prognostic factor for predicting disease recurrence and survival in patients with colorectal cancer. Lymph node... (Review)
Review
Lymph node metastasis is regarded as an indubitable prognostic factor for predicting disease recurrence and survival in patients with colorectal cancer. Lymph node status based on examination of a resected specimen is a key element of the current staging system and is also a crucial factor to determine use of adjuvant chemotherapy after surgical resection. However, the current tumor-node-metastasis (TNM) staging system only incorporates the number of metastatic lymph nodes in the N category. Numerous attempts have been made to supplement this simplified N staging including lymph node ratio, distribution of metastatic lymph nodes, tumor deposits, or extracapsular invasion. In addition, several attempts have been made to identify more specific prognostic factors in resected colorectal specimens than lymph node status. In this review, we will discuss controversies in lymph node staging and factors that may influence survival beyond lymph node status.
PubMed: 31288500
DOI: 10.3393/ac.2019.06.12 -
BMC Gastroenterology Jul 2022Standard treatment strategy for low rectal cancer in Japan is different from Western countries. Total mesorectum excision (TME) + lateral lymph node dissection...
INTRODUCTION
Standard treatment strategy for low rectal cancer in Japan is different from Western countries. Total mesorectum excision (TME) + lateral lymph node dissection (LLND) is mainly carried out in Japan, whereas neoadjuvant chemoradiotherapy (nCRT) + TME is selected in Western countries. There is no clear definition of preoperative diagnosis of lateral lymph node metastasis. If we can predict lateral lymph node swelling that can be managed by nCRT from lateral lymph node swelling that require surgical resection, clinical benefit is significant. In the current study we assessed characteristics of the lateral lymph node recurrence (LLNR) and LLND that can be managed by nCRT.
PATIENTS AND METHODS
Patients with low rectal cancer (n = 168) underwent nCRT between 2009 and 2016. We evaluated CEA, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and lateral lymph node short axis pre and post nCRT, respectively, and also evaluated tumor shrinkage rate, tumor regression grade (TRG). We evaluated the relationship between each and LLNR.
RESULTS
LLND was not carried out all patients. Factors associated with LLNR were PLR and lymph node short axis pre and post nCRT. (p = 0.0269, 0.0278, p < 0.0001, p < 0.0001, respectively). Positive recurrence cut-off values of lateral lymph node short-axis calculated were 11.6 mm pre nCRT and 5.5 mm post nCRT.
CONCLUSION
Results suggest that PLR before and after CRT was associated with control of LLNR, and LLND should be performed on lateral lymph nodes with short-axis of 5 mm and 11 mm pre and post nCRT.
Topics: Chemoradiotherapy; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Neoplasm Staging; Rectal Neoplasms; Retrospective Studies; Treatment Outcome
PubMed: 35804299
DOI: 10.1186/s12876-022-02414-7 -
Journal of Plastic, Reconstructive &... Feb 2022Completion lymph node dissection (CLND) following positive sentinel lymph node biopsy (SLNB) for cutaneous melanoma is a topic of controversy. The second Multicenter...
Completion lymph node dissection (CLND) following positive sentinel lymph node biopsy (SLNB) for cutaneous melanoma is a topic of controversy. The second Multicenter Selective Lymphadenectomy Trial (MSLT-II) suggested no survival benefit with CLND over observation amongst patients with a positive SLNB. The findings of the MSLT-II may have limited applicability to our high-risk population where nodal ultrasound and non-surgical melanoma treatment is rationed. In this regional, retrospective study, we reviewed primary melanoma, SLNB and CLND histopathological reports in the Bay of Plenty District Health Board (BOPDHB) across a 10-year period. The primary outcomes measured were size of sentinel lymph node metastases and non-sentinel node (NSN) positivity on CLND for patients with a positive SLNB. In the 157 SLNB identified, the mean sentinel lymph node metastatic deposit size was larger in BOPDHB compared with MSLT-II (3.53 vs 1.07/1.11mm). A greater proportion of BOPDHB patients (54.8%) had metastatic deposits larger than 1mm compared with MSLT-II (33.2/34.5%) and the rate of NSN involvement on CLND was also higher (23.8% vs 11.5%). These findings indicate that the BOPDHB is a high-risk population for nodal melanoma metastases. Forgoing CLND in the context of a positive SLNB may place these patients at risk.
Topics: Hospitals; Humans; Lymph Node Excision; Lymph Nodes; Melanoma; Retrospective Studies; Sentinel Lymph Node; Sentinel Lymph Node Biopsy; Skin Neoplasms; Melanoma, Cutaneous Malignant
PubMed: 34789434
DOI: 10.1016/j.bjps.2021.09.077 -
Brazilian Journal of Otorhinolaryngology 2021Lymph node metastasis is a well-known prognostic factor for laryngeal carcinoma. However, current nodal staging systems provide limited information regarding prognosis....
INTRODUCTION
Lymph node metastasis is a well-known prognostic factor for laryngeal carcinoma. However, current nodal staging systems provide limited information regarding prognosis. Additional parameters should be considered to improve prognostic capacity.
OBJECTIVES
To assess the prognostic values of metastatic lymph node number, ipsilateral/contralateral harvested lymph nodes, and lymph node ratio in patients undergoing surgical treatment of laryngeal squamous cell carcinoma.
METHODS
Seventy-four patients diagnosed with laryngeal squamous cell carcinoma primarily managed surgically were included in this study. The patients' pathological and survival data were obtained from their medical records. The effects of harvested lymph nodes and lymph node ratio on disease-free survival, disease-specific survival, and overall survival were analyzed.
RESULTS
Ipsilateral, contralateral, and bilateral evaluations of harvested lymph nodes showed no significant associations with prognosis. Lymph node ratio was significantly associated with overall survival when evaluated bilaterally. Metastatic lymph node number showed more suitable stratification than TNM classification.
CONCLUSIONS
Metastatic lymph node number and bilateral lymph node ratio parameters should be taken into consideration to improve the prognostic capacity of TNM.
Topics: Carcinoma, Squamous Cell; Head and Neck Neoplasms; Humans; Lymph Node Excision; Lymph Node Ratio; Lymph Nodes; Neoplasm Staging; Prognosis; Retrospective Studies; Squamous Cell Carcinoma of Head and Neck
PubMed: 32988784
DOI: 10.1016/j.bjorl.2020.07.012