• 대한종양외과학회지
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• 제14권2호
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• pp.135-141
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• 2018

Purpose: Axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB) are important for staging of patients with node-positive breast cancer. However, these can be avoided in select micrometastatic diseases, preventing postoperative complications. The present study evaluated the ability of axillary lymph node maximum standardized uptake value (SUVmax) on positron emission tomography-computed tomography (PET-CT) to predict axillary metastasis of breast cancer. Methods: The records of invasive breast cancer patients who underwent pretreatment (surgery and/or chemotherapy) PET-CT between January 2006 and December 2014 were reviewed. ALNs were preoperatively evaluated by PET-CT. Lymph nodes were dissected by SLNB or ALND. SUVmax was measured in both the axillary lymph node and primary tumor. Student t-test and chi-square test were used to analyze sensitivity and specificity. Receiver operating characteristic (ROC) and area under the ROC curve (AUC) analyses were performed. Results: SUV-tumor (SUV-T) and SUV-lymph node (SUV-LN) were significantly higher in the triple-negative breast cancer (TNBC) group than in other groups (SUV-T: 5.99, P<0.01; SUV-LN: 1.29, P=0.014). The sensitivity (0.881) and accuracy (0.804) for initial ALN staging were higher in fine needle aspiration+PET-CT than in other methods. For PET-CT alone, the subtype with the highest sensitivity (0.870) and negative predictive value (0.917) was TNBC. The AUC for SUV-LN was greatest in TNBC (0.797). Conclusion: The characteristics of SUV-T and SUV-LN differed according to immunohistochemistry subtype. Compared to other subtypes, the true positivity of axillary metastasis on PET-CT was highest in TNBC. These findings could help tailor management for therapeutic and diagnostic purposes.

• Journal of Breast Cancer
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• 제21권4호
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• pp.433-4341
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• 2018

Purpose: This study aimed to evaluate the effects of sentinel lymph node biopsy (SLNB) on recurrence and survival after neoadjuvant chemotherapy (NAC) in breast cancer patients with cytology-proven axillary node metastasis. Methods: We selected patients who were diagnosed with invasive breast cancer and axillary lymph node metastasis and were treated with NAC followed by curative surgery between January 2007 and December 2014. We classified patients into three groups: group A, negative sentinel lymph node (SLN) status and no further dissection; group B, negative SLN status with backup axillary lymph node dissection (ALND); and group C, no residual axillary metastasis on pathology with standard ALND. Results: The median follow-up time was 51 months (range, 3-122 months) and the median number of retrieved SLNs was 5 (range, 2-9). The SLN identification rate was 98.3% (234/238 patients), and the false negative rate of SLNB after NAC was 7.5%. There was no significant difference in axillary recurrence-free survival (p=0.118), disease-free survival (DFS; p=0.578) or overall survival (OS; p=0.149) among groups A, B, and C. In the subgroup analysis of breast pathologic complete response (pCR) status, there was no significant difference in DFS (p=0.271, p=0.892) or OS (p=0.207, p=0.300) in the breast pCR and non-pCR patients. Conclusion: These results suggest that SLNB can be feasible and oncologically safe after NAC for cytology-determined axillary node metastasis patients and could help reduce arm morbidity and lymphedema by avoiding ALND in SLN-negative patients.

• Nuclear Medicine and Molecular Imaging
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• 제41권1호
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• pp.16-21
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• 2007

목적: 우리나라와 같이 만성 염증성 폐질환이 호발하는 지역에서는 폐문 및 종격동 림프절에 석회화가 동반될 수 있고 이 부위에 FDG 섭취가 될 수 있기 때문에 FDG 섭취만 고려할 경우 위양성률이 높다. 이 연구에서는 비소세포 폐암환자에서 림프절의 PET/CT 판독 시 FDG 섭취 정도뿐만 아니라 CT 영상에서의 림프절 석회화 혹은 감쇠 정도를 고려하여 진단율을 평가하였고 조직학적 종류에 따라 향상 정도의 차이가 있는지 또한 알아 보았다. 대상 및 방법: 2004년 9월부터 2005년 12월사이 화순전남대학교병원에서 비소세포 폐암으로 처음 진단 받고 PET/CT와 림프절 절제술을 시행 받은 53명(평균나이; 62세, 남:여=38:15)을 대상으로 수술 후 림프절 전이에 대한 PET/CT 결과를 병리결과와 비교하였다. 림프절의 maxSUV값이 3.0 이상인 경우를 악성으로 분류하여 PET의 진단율을 조사하였다. PET/CT의 경우에는 maxSUV값이 3.0 이상이라도 CT 영상에서 석회화가 있거나 높은 감쇠를 보이는 림프절은 양성으로 분류하였으며, 조직학적 분류에 따라 진단율의 차이를 보이는지 조사 하였다. 결과: 각 림프절 군에서 maxSUV 값에 따른 PET 진단의 전체적인 민감도, 특이도, 정확도는 각각 45%, 91%, 86%였고, 편평세포암종 71%, 91%, 90%, 샘암종에서는 36%, 91%, 84%이였다. PET/CT의 민감도, 특이도, 정확도는 각각 45%, 97%, 92%였고 편평세포암종인 경우에서는 71%, 98%, 95%. 샘암종에서는 36%, 97%, 89%이였다. 결론: PET 진단에 비해 PET/CT 진단의 특이도가 유의하게 향상되었고, 이는 편평세포암종 및 샘암종 모두에서 유의하게 향상되었으며, 향상되는 정도는 조직학적 분류와 관계가 없었다.

• 핵의학기술
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• 제18권1호
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• pp.26-32
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• 2014

수술 전 림프절 전이 여부를 진단하고 병리학적 소견 및 원발 주위조직 전이 평가법을 이용하여 두경부암 PET-MRI 검사의 임상적 유용성을 평가하였다. 두경부암 환자 100명을 대상으로 $^{18}F-FDG$ (5.18 MBq/kg)를 정맥주사하고 60분 안정을 취한 후, BiographTM mMR 3T를 사용하여 torso(body tim coil, Vibe-Dixon)와 dedication (head/neck tim coil, UTE, Dotarem injection) 검사를 시행하였다. 반복계산법을 적용하여 데이터를 재구성한 후 workstation으로 림프절 전이 여부를 판독하고, 본원 종합의료정보시스템으로 수술 전/후 병리학적 검사 소견을 조사하였다. 환자의 진단 정보를 $2{\times}2$ 판정행렬의 각 항목에 기입하여 진양성, 진음성, 위양성, 위음성으로 구분하고 이렇게 구분된 검사결과를 토대로 예민도, 특이도, 정확도, 위음성률, 위양성률을 산출하였다. 두경부암 환자의 PET-MRI 검사 결과에서 림프절 전이 양성 및 음성 판정을 받은 경우는 각 49건, 51건이었으며 수술 전-후 병리학적 결과를 통해 림프절 전이 양성 및 음성 판정을 받은 경우는 각 46건, 54건으로 나타났다. 이 중 두 검사 모두 림프절 전이 양성 판정을 받은 진양성은 45건, PET-MRI 검사에서는 림프절 전이 양성이지만 병리학적 검사에서 림프절 전이 음성 판정을 받은 위양성은 4건, PET-MRI 검사에서 림프절 전이 음성이지만 병리학적 검사에서 양성 판정을 받은 위음성은 1건, 두 검사 모두 림프절 전이 음성 판정을 받은 진음성은 50건으로 분석되었다. 따라서 두경부암 환자의 PET-MRI 검사의 예민도는 97.8%, 특이도는 92.5%, 정확도는 95%, 위음성률은 2.1%, 위양성률은 7.0%로 나타났다. 따라서 PET-MRI는 두경부암의 진단에 있어 수술 전 병기 결정이나 치료 후 재발 및 원격전이의 발견, 불분명한 원발 경부 림프절 전이 등의 평가에 유용할 것으로 판단된다.

• 대한두경부종양학회지
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• 제31권2호
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• pp.86-90
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• 2015

Cystic lymph node metastasis of head and neck squamous cell carcinoma(HNSCC) which presumed to be mainly originated from oropharynx including Waldeyer's ring may present as a benign cystic mass on lateral neck such as branchial cleft cyst. Branchial cleft cyst is one of the most common lateral neck cystic mass which may result in regional infection or lymph adenopathy. Many of previously reported literatures showed the incidence of cystic lymph node metastasis from oropharynx including Waldeyer's ring. Preoperative imaging studies and fine needle aspiration cytology cannot provide the accurate results until excision of cystic mass for the diagnostic or therapeutic purpose. Recently, we experienced the rare case of cystic lymph node metastasis from ipsilateral tonsil, which mimicked infected 2nd branchial cleft cyst. Thus, we reported our experience with presentation of case and review of literatures.

• 대한두경부종양학회지
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• 제33권2호
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• pp.81-84
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• 2017

Langerhans cell histiocytosis (LCH) is a heterogeneous disease, characterized by accumulation of dendritic cells with features similar to epidermal Langerhans cells. It is a rare entity that may involve various organ levels such as the skeletal, pulmonary, hematopoietic and lympho-vascular systems. The patient was a 1-year-old female presented with fever associated with otorrhea and palpable cervical lymph node for 4 days. Neck ultrasonography and Computed tomography imaging revealed multiple enlarged lymph nodes suggesting suspicious malignant morphology. Lymph node biopsy was performed under general anesthesia. Histological and immunophenotypic examination showed the lymph node to be consistent with LCH. The patient was given chemotherapy.

• Tuberculosis and Respiratory Diseases
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• 제78권1호
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• pp.23-26
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• 2015

Metastatic squamous cell carcinoma from a cancer of unknown primary (CUP) affecting the intrathoracic lymph node is very rare. We reported a case of metastatic squamous cell carcinoma in the hilar and interlobar lymph node from a patient with CUP and reviewed the associated literature. Abnormal mass in the right hilar area was incidentally detected. A chest computed tomography scan showed a 2.5-cm diameter mass in the right hilum that had changed little in size for 3 years. The patient underwent a right pneumonectomy and mediastinal lymph node dissection. A metastatic squamous cell carcinoma in the hilar and interlobar lymph nodes without a primary lung or other lesion was diagnosed. The patient received adjuvant chemotherapy for a diagnosis of T0N1M0 lung cancer.

• Journal of Gastric Cancer
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• 제10권3호
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• pp.87-90
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• 2010

Early gastric cancer (EGC) is defined as tumor invasion confined to the mucosa or submucosa, regardless of the presence of regional lymph node metastasis. Lymph node metastasis is the most powerful and important prognostic factor for gastric cancer. Based on the risk of lymph node metastasis in EGC obtained from a large number of surgical cases in Japan, it was suggested that the criteria for endoscopic mucosal resection (EMR) and endoscopic submucosal resection (ESD) as local treatment for EGC might be extended. However, extending the indications for EMR and ESD remains controversial because the long-term outcomes of these procedures have not been fully documented, and there is a risk for lymph node metastasis. Furthermore, current diagnostic imaging techniques are unsatisfactory for accurately predicting metastasis to lymph nodes. Moreover, the long-term results of standard radical gastrectomy including minimally invasive procedures for stage IA have been increasing and have reached 99 to 100%. To determine the true efficacy of endoscopic resection of EGC, we need more evidence of long-term follow-up, standardization of techniques, and pathological interpretation.

• Journal of Gastric Cancer
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• 제16권1호
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• pp.14-20
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• 2016

Purpose: Early diagnosis of gastric cancer is still the exception in Western countries. In the East, as in Japan and Korea, this disease is an endemic disorder. More conservative surgical procedures are frequently performed in early gastric cancer cases in these countries where sentinel lymph node navigation surgery is becoming a safe option for some patients. This study aims to evaluate preliminary outcomes of patients with early gastric cancer who underwent sentinel node navigation surgeries in Brazil, a country with non-endemic gastric cancer levels. Materials and Methods: From September 2008 to March 2014, 14 out of 205 gastric cancer patients underwent sentinel lymph node navigation surgeries, which were performed using intraoperative, endoscopic, and peritumoral injection of patent blue dye. Results: Antrectomies with Billroth I gastroduodenostomies were performed in seven patients with distal tumors. The other seven patients underwent wedge resections. Sentinel basin resections were performed in four patients, and lymphadenectomies were extended to stations 7, 8, and 9 in the other 10. Two patients received false-negative results from sentinel node biopsies, and one of those patients had micrometastasis. There was one postoperative death from liver failure in a cirrhotic patient. Another cirrhotic patient died after two years without recurrence of gastric cancer, also from liver failure. All other patients were followed-up for 13 to 79 months with no evidence of recurrence. Conclusions: Sentinel lymph node navigation surgery appears to be a safe procedure in a country with non-endemic levels of gastric cancer.

• 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.