• Asian Pacific Journal of Cancer Prevention
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• 제14권10호
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• pp.5731-5734
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• 2013

Background: The object of this study was to examine whether a new protocol including step-sectioning and immunohistochemistry (IHC) staining of axillary sentinel nodes (SN) would lead to detection of more metastases in patients with breast cancer. Materials and Methods: Sixty-nine tumor free sentinel lymph nodes were examined. Step frozen sectioning was performed on formalin fixed SN and stained both by hematoxylin and eosin (H and E) and cytokeratin markers using IHC. Any tumoral cell in IHC stained slides were considered as a positive result. Metastases up to 0.2 mm were considered as isolated tumor cells and 0.2 up to 2 mm as micrometastasis. Results: Mean age of the patients was $48.7{\pm}12.2$ years. Step sectioning of the SN revealed 11 involved by metastasis which was statistically significant (p<0.001). Furthermore, 15 (21.7%) of the patients revealed positive results in IHC staining for pan-CK marker and this was also statistically significant (p=0.001). Ten patients had tumoral involvement in lymph nodes harvested from axillary dissection and 4 out of 15 lymph nodes with positive result for CK marker were isolated tumor cells. However, 4 of 10 patients with tumor positive lymph nodes in axillary dissection were negative for CK marker and in contrast 6 of the pan-CK positive SN were in patients with tumor-free axillary lymph nodes. Conclusions: Both IHC and step sectioning improve the detection rate of metastases. Considering the similar power of these two methods, we recommend using either IHC staining or step sectioning for better evaluation of harvested SNs.

• Asian Pacific Journal of Cancer Prevention
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• 제15권11호
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• pp.4705-4709
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• 2014

Objective: To determine the accuracy of magnetic resonance imaging (MRI) in detection of metastasis in pelvic and para-aortic lymph nodes from different gynecological malignancies. Materials and Methods: This retrospective cross sectional analytic study was conducted at the Department of Diagnostic Radiology, Aga Khan University Hospital Karachi Pakistan from January 2011 to December 2012. A sample of 48 women, age range between 20-79 years, fulfilling inclusion criteria were included. All patients had histopathologically proven gynecological malignancies in the cervix, endometrium or ovary and presented for a pretreatment MRI to our radiology department. Results: MRI was 100% sensitive and had a 100% positive predictive value to detect lymph node metastasis in lymph nodes with spiculated margins and 100% sensitive with a 75% positive predictive value to detect lymph node metastasis in a lymph node with lobulated margins. The sensitivity and positive predictive value of MRI to detect heterogeneous nodal enhancement were 100% and 75% respectively. Conclusions: Our study results reinforce that MRI should be used as a modality of choice in the pretreatment assessment of lymph nodes in proven gynaecological malignancies in order to determine the line of patientmanagement, distinguishing surgical from non-surgical cases.

• Asian Pacific Journal of Cancer Prevention
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• 제14권6호
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• pp.3769-3772
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• 2013

Background: To investigate the impact of the lymph node ratio (LNR) on the prognosis of patients with locally advanced rectal cancer undergoing pre-operative chemoradiation. Methods: Clinicopathologic and follow up data of 128 patients with stage III rectal cancer who underwent curative resection from 1996 to 2007 were reviewed. The patients were divided into two groups according to the lymph node ratio: LNR ${\leq}$ 0.2 (n=28), and >0.2 (n=100). Kaplan-Meier and the Cox proportional hazard regression models were used to evaluate the prognostic effects according to LNR. Results: Median numbers of lymph nodes examined and lymph nodes involved by tumour were 10.3 (range 2-28) and 5.8 (range 1-25), respectively, and the median LNR was 0.5 (range, 0-1.6). The 5-year survival rate significantly differed by LNR (${\leq}$ 0.2, 69%; >0.2, 19%; Log-rank p value < 0.001). LNR was also a significant prognostic factor of survival adjusted for age, sex, post-operative chemotherapy, total number of examined lymph nodes, metastasis and local recurrence (${\leq}$ 0.2, HR=1; >0.2, HR=4.8, 95%CI=2.1-11.1) and a significant predictor of local recurrence and distant metastasis during follow-up independently of total number of examined lymph node. Conclusions: Total number of examined lymph nodes and LNR were significant prognostic factors for survival in patients with stage III rectal cancer undergoing pre-operative chemoradiotherapy.

• Asian Pacific Journal of Cancer Prevention
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• 제16권16호
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• pp.7291-7294
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• 2015

Purpsoe: To investigate the diagnostic value of quantitative analysis of a tissue diffusion and virtual touch tissue imaging quantification (VTIQ) technique with acoustic radiation force impulse (ARFI) elastography for assessing enlarged cervical lymph nodes. Materials and Methods: Fifty-six enlarged cervical lymph nodes confirmed by pathologic diagnoses were covered in the study. According to the results of pathologic diagnosis, patients were classified into benign and malignant groups. All the patients were examined by both conventional ultrasonography and elastography. AREA% and shear wave velocity (SWV) in ROI of different groups were calculated and compared using ROC curves. Cut-off points of AREA% and SWV were determined with receiver operating characteristic curves. Results: Final histopathological results revealed 21 cases of benign and 35 cases of malignant lymph nodes. The mean values of AREA% and SWV in benign and malignant groups were $45.0{\pm}17.9%$ and $2.32{\pm}0.57m/s$, and $61.3{\pm}21.29%$ and $4.36{\pm}1.25$)m/s, respectively. For the parameters of elastography, "AREA%" and SWV demonstrated significant differences between groups (p=0.002). AREA% was positively correlated with SWV with a correlation coefficient of 0.809 (P<0.001). Conclusions: Stiffness of different lymph node diseases in patients may differ. Elastography can evaluate changes sensitively and provide valuable information to doctors. The study proved that the VTIQ elastography technique can play an important role in differential diagnosis of lymph nodes.

• 대한두경부종양학회지
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• 제10권1호
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• pp.3-6
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• 1994

Neck dissection has become an integral part of the staging and management of head and neck tumors. This paper reports a series of head and neck patients who had pathological findings in their neck dissection specimens, which were unrelated to their primary tumors. In 7 cases, there was unexpected pathology in the cervical lymph nodes which was not related to the primary tumor. Four cases were squamous cell carcinomas and 3 were thyroid carcinomas. In 3 cases of squamous cell carcinomas, there were no evidence of metastatic squamous cell carcinoma in neck dissection specimen; however, the lymph nodes were found to be involved by metastatic papillary carcinoma in one larynx cancer, metastatic adenocarcinoma in the other larynx cancer, tuberculosis in one nasopharynx cancer. In three of neck dissection specimen of carcinoma(two thyroid carcinomas, one laryngeal carcinoma), dual nodal pathology was found: Each of these specimen contained carcinoma with tuberculosis of the lymph nodes in three cases. In one thyroid carcinoma, there was no evidence of metastasis; however, the lymph nodes were found to be involved by tuberculosis. Preoperative assessment did not reveal any findings to alert us to the possibility of a synchronous pathological process in the cervical nodes of this group of 7 patients. In particular, there was no evidence of active pulmonary tuberculosis in the 5 patients with active lymph node disease.

• 대한영상의학회지
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• 제83권6호
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• pp.1240-1258
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• 2022

림프계는 염증 및 악성 세포의 확산 경로를 제공한다. 종양이 확산되는 림프절의 위치와 림프 배액 경로를 인지하는 것은 종양의 병기 결정, 치료 방법 선택 및 환자의 예후 예측에 중요하다. 복강 내 악성 종양에서 림프절 전이는 흔하기 때문에 림프절 전이를 발견하고 질병의 확산 방식을 이해하는 것은 영상의학과 의사에게 필수적이다. 이 임상화보에서는 도식적인 그림들과 림프절을 색으로 표시한 CT 영상을 사용하여, 상부 및 하부 위장관, 간, 담낭, 담관 및 췌장의 림프절 위치와 이름, 그리고 림프 배수 경로에 관해 기술하였다. 또한 각 장기에서 발생하는 악성 종양의 국소 림프절의 종류에 대해 기술하고 몇몇 증례의 영상을 제시하였다.

• Asian Pacific Journal of Cancer Prevention
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• 제13권5호
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• pp.2081-2085
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• 2012

Background: To investigate the value of ultrasound elastography (UE) in the differentiation between benign and malignant enlarged cervical lymph nodes (LNs). Methods: B-mode ultrasound, power Doppler imaging and UE were examined to determine LN characteristics. Two kinds of methods, 4 scores of elastographic classification and a strain ratio (SR) were used to evaluate the ultrasound elastograms. Results: The cutoff point of SR had high utility in differential diagnosis of benign and malignant of cervical lymph nodes, with good sensitivity, specificity and accuracy. Conclusion: UE is an important aid in differential diagnosis of benign and malignant cervical LNs.

• Asian Pacific Journal of Cancer Prevention
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• 제14권5호
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• pp.3319-3322
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• 2013

Background: Helicobacter pylori (H. pylori) is one of the risk factors for gastric cancer (GC). Any prognostic effect of HER-2 status in gastric lymph node metastasis in H. pylori positive cases is unknown. Materials and Methods: A total of 74 patients, 47 (64%) male, and 27 (34%) female, who had subtotal or total gastrectomy and also positive lymph nodes, were included in the study. Age range was 29-87 years, and median age was 58 years. HER-2 expression was assessed in both gastric resection samples and lymph node material with carcinoma metastasis of the same patient by immunohistochemistry (IHC) and silver in situ hybridization (SISH) methods. H. pylori status was examined in gastric materials of all patients. Relationships between HER-2 status in gastric cancers and lymph nodes and H. pylori status were investigated. Results: H. pylori was positive in 40 cases (54%), and negative in 34 (46%). While in the primary tissues of H. pylori positive cases, SISH positivity for HER-2 was observed in 13 cases (86%), SISH negativity was observed in 2 (14%), in metastatic lymph nodes 21 cases (72%) were SISH positive and 8 cases (28%) were SISH negative (P=0.005 and P=0.019, respectively). Initial CEA values were high in 18 cases (78%) with positive H. pylori and in 5 cases (22%) with negative H. pylori (P=0.009). While SISH data of patients were negative in 59 cases (80%) and positive in 15 cases (20%) in primary tissues, they were negative in 56 cases (75%) and positive in 18 cases (25%) in lymph nodes. Discrepancy between primary tissue and lymph node results was detected in 3 cases, in which SISH was negative in the primary tissue and HER-2 expression was positive in the lymph nodes. Conclusions: Clinical progression was poor in H. pylori positive cases with HER-2 negativity in primary gastric tissue, but HER-2 positivity in the lymph nodes. SISH positivity can be expected in H. pylori positive cases, and it may be predicted that these cases can benefit from trastuzumab treatment.

• Asian Pacific Journal of Cancer Prevention
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• 제13권11호
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• pp.5505-5510
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• 2012

Objective: The aim of this retrospective study is to analyze the clinical and pathological factors related to the prognosis of Chinese patients with stage Ib to IIb cervical cancer. Methods and Results: 13 clinical pathological factors in 255 patients with stage Ib to IIb cervical cancer undergoing radical hysterectomy and systematic lymphadenectomy were analyzed to screen for factors related to prognosis. The cumulative 5-year survival of the 255 patients was 75.7%. The result of the univariate analysis suggested that clinical stage, cell differentiation, depth of cervical stromal invasion, parametrial tissue involvement, and lymph node metastasis were prognostic factors for patients with stage Ib to IIb cervical cancer (P<0.05). Compared with cases with involvement of iliac nodes, obturator nodes, or inguinal lymph nodes, cases with metastasis to the common iliac lymph nodes had a poorer prognosis (P<0.05). Cases with involvement of four or more lymph nodes had a poorer prognosis than those with involvement of three or fewer lymph nodes (P<0.05). Using multivariate Cox proportional hazards model regression analysis, non-squamous histological type, poor differentiation, parametrial tissue involvement, and outer 1/3 stromal invasion were found to be independently related to patients poor prognosis (P<0.05). Conclusion: Non-squamous histological type, poor cell differentiation, parametrial tissue involvement, and outer 1/3 stromal invasion are the independent poor prognostic factors for patients with stage Ib to IIb cervical cancer.

• Asian Pacific Journal of Cancer Prevention
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• 제15권24호
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• pp.10607-10611
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• 2015

Background: HER2 expression in the primary tumor and its lymph node metastases vary in gastric cancer, reflecting intratumoral heterogeneity. This finding also suggests that proliferation of a different clone in metastatic nodes is possible. In the current study, we aimed to determine the cause of discordance in HER-2 expression in the primary tumor and lymph node metastases for patients with gastric cancer. Materials and Methods: Eighty-one patients with gastric cancer who had undergone radical gastrectomy and were found to have lymph node metastasis upon pathological examination were included. Histopathological samples were obtained from biopsies obtained during patient gastrectomies and lymph node dissection. HER2 status was evaluated by both immunohistochemistry (IHC) and silver in situ hybridization (SISH). Results: Sixty-four (79%) patients were SISH (-), while 17 (21%) were SISH (+) in the primary tumor. However, in metastatic lymph nodes, HER2 status was SISH positive in 5 (28.3%) of the 64 SISH (-) primary tumor specimens. One of the 17 SISH (+) primary tumors was SISH (-) in the metastatic lymph nodes. Thus, SISH results for HER2 in both primary tumors and lymph node metastases were comparable, showing a concordance of 92.5%. In total, six patients demonstrated discordance between the primary tumor and lymph node metastases. The prevalence of HER2 discordance was significantly higher for patients in the pN2 and N3 stages (p=0.007). Although discordant patients had worse survival rates than concordant patients, the differences were not significant (p>0.05).Conclusions: Our study indicates that the frequency of concordance in HER2 status, as determined by IHC or SISH, is high in primary tumors and their corresponding lymph node metastases for patients with gastric cancer. If there is a discrepancy in HER2 status, its evaluation by both IHC and SISH may be useful for detecting patients who would benefit from trastuzumab, and it would therefore help guide decision-making processes in administering treatment.