scholarly journals Concordant PET/CT and ICG positive lymph nodes in endometrial cancer: a case of mistaken identity

2020 ◽  
Vol 2020 (1) ◽  
Author(s):  
Hong L Lee ◽  
Rhonda Farrell ◽  
Vasanth Kamath ◽  
Ivan Ho-Shon ◽  
Francis Yap
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Cancer Metastasis ◽  
Early Stage ◽  
Pathological Finding ◽  
Developed Countries ◽  
Lymph Node Status ◽  
Prognostic Information ◽  
Pet Ct

Abstract Endometrial carcinoma is the most common gynecological malignancy in developed countries. In early stage endometrial cancer, routine systemic pelvic lymphadenectomy showed no survival benefits and results in increased morbidity. The role of PET/CT imaging for the pre-operative detection of lymph node metastases in endometrial cancer is unclear. Sentinel lymph node (SLN) mapping may reduce the surgical staging morbidity while maintaining prognostic information of the lymph node status. Recently, indocyanine green (ICG) SLN mapping has been utilized to detect nodal metastasis in endometrial cancer. Endosalpingiosis is defined as the presence of tubal-like epithelium outside of the fallopian tube and can sometimes be misinterpreted as cancer metastasis. Here, we discuss a patient with newly diagnosed endometrial cancer who had pelvic and para-aortic lymph nodes with high glucose avidity on PET/CT, and ICG positivity on SLN mapping, suspected clinically to be metastatic adenocarcinoma, but with the pathological finding of endosalpingiosis only.

Lymph node status assessment in head and neck squamous cell carcinoma in patients with clinically non palpable lymph nodes: Meta-analysis

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hany Riad ◽  
Samer Ibrahim ◽  
Amr Gouda ◽  
Ossama Mustafa ◽  
Heba Mohamed
Keyword(s):  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Meta Analysis ◽  
Lymph Node Status ◽  
Lymph Node Staging ◽  
Pet Ct

Abstract Background The most important prognostic factor in squamous cell carcinoma of the head and neck (HNSCC) is the presence or absence of clinically involved neck nodes. The presence of metastases in a lymph node is said to reduce the 5-years survival rate by about 50%. The appropriate diagnosis of the presence of metastatic node is very important for the management of HNSCC Aim To compare difTerent diagnostic modalities for assessment of the clinically non palpable lymph nodes in HNSCC including by meta-analysis: CT, MRI, US, USFNAC and PET/CT for the proper cervical lymph node staging. Methods Met-analysis study on patients with HNSCC of clinically non palpable lymph nodes (cN0). Results Analysis was divided in 6 groups .Each group contain analysis of one modality according to available studies per patient, per level and per lesion .US is fair test per patient and per lesion.CT is good test per patient and excellent test per lesion.MRI is poor test per patient and fair test per lesion.CT-MRl combined is fair per patient and excellent per level.PET/CT is good per patient, fair per lesion and excellent per level. USFNAC is excellent per lesion. Conclusion CT, CT-MRI combined, PET/CT and USFNAC proved to be excellent in detecting cN0.MRI was poor test in detecting cN0.US was a fair test in detecting cN0 if used alone.

scholarly journals Challenges Posed by Embryonic and Anatomical Factors in Systematic Lymphadenectomy for Endometrial Cancer

2020 ◽  
Vol 9 (12) ◽  
pp. 4107
Author(s):  
Damaris Freytag ◽  
Julian Pape ◽  
Juhi Dhanawat ◽  
Veronika Günther ◽  
Nicolai Maass ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Surgical Staging ◽  
Current Evidence ◽  
Lymph Node Status ◽  
Prognostic Information ◽  
Systematic Lymphadenectomy ◽  
Lymph Node Mapping ◽  
Node Status ◽  
Wide Range

Lymph node involvement has been shown to be one of the most relevant prognostic factors in a variety of malignancies; this is also true of endometrial cancer. The determination of the lymph node status is crucial in order to establish the tumor stage, and to consider adjuvant treatment. A wide range of surgical staging practices are currently used for the treatment of endometrial cancer. The necessity and extent of lymph node dissection is an ongoing controversial issue in gynecological oncology. Lymph node surgery in endometrial cancer is technically challenging, and can be time consuming because of the topographic complexity of lymphatic drainage as such, and the fact that the lymph nodes are directly adjacent to both blood vessels and nerves. Therefore, profound and exact knowledge of the anatomy is essential. Sentinel lymph node mapping was recently introduced in surgical staging with the aim of reducing morbidity, whilst also obtaining useful prognostic information from a patient’s lymph node status. The present review summarizes the current evidence on the role of lymph node surgery in endometrial cancer, focusing on the embryological, anatomical, and technical aspects.

Standard ultrastaging compared to one-step nucleic acid amplification (OSNA) for the detection of sentinel lymph node metastases in early stage cervical cancer

2020 ◽  
Vol 30 (12) ◽  
pp. 1871-1877
Author(s):  
Angela Santoro ◽  
Giuseppe Angelico ◽  
Frediano Inzani ◽  
Damiano Arciuolo ◽  
Saveria Spadola ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
Early Stage ◽  
Sentinel Lymph Nodes ◽  
Nucleic Acid Amplification ◽  
Lymph Node Status ◽  
Pelvic Lymph Nodes ◽  
Lymph Node Assessment ◽  
Node Metastases

ObjectiveWe compared ultrastaging and one-step nucleic acid amplification (OSNA) examination of sentinel lymph nodes in two homogeneous patient populations diagnosed with early stage cervical cancer. The primary aim of our study was to evaluate the rate and type of sentinel lymph node metastases detected by ultrastaging and OSNA assay. Secondary aims were to define the sensitivity and the negative predictive value of sentinel lymph node biopsy assessed with OSNA and ultrastaging and to define the role of sentinel lymph node assessment in predicting non-sentinel lymph node status.MethodsConsecutive patients who underwent surgery (radical hysterectomy or trachelectomy or cervical conization) at our institution, between January 2018 and March 2020, were enrolled. All patients had a preoperative diagnosis of early-stage cervical carcinoma (International Federation of Gynecology and Obstetrics (FIGO) 2018 stages IA–IIB) and underwent sentinel lymph node assessment with ultrastaging or OSNA. Patients with advanced FIGO stages and special histology subtypes (other than squamous cell carcinoma, adenocarcinoma or adenosquamous carcinoma) or patients with sentinel lymph nodes analyzed only with hematoxylin and eosin were excluded. Clinical data were compared using the χ2 test and Fisher’s exact test. A κ coefficient was determined with respect to lymph node assessment. A p value <0.05 was considered statistically significant.ResultsA total of 116 patients were included in this retrospective analysis (53 ultrastaging, 63 OSNA). Overall, 531 and 605 lymph nodes were removed in the ultrastaging and OSNA groups, respectively, and 140 and 129 sentinel lymph nodes were analyzed in the ultrastaging and OSNA groups, respectively. 22 patients had metastatic sentinel lymph nodes: 6 (11.3%) of 53 patients in the ultrastaging group and 16 (25.4%) of 63 patients in the OSNA group. The total amount of positive SLNs was 7 (5%) of 140 in the ultrastaging group and 21 (16.3%) of 129 in the OSNA group, respectively (p=0.0047). Pelvic lymphadenectomy was performed in 26 (49.1%) of 53 patients in the ultrastaging group and in 34 (54%) of 63 patients in the OSNA group due to comorbidities. Metastatic non-sentinel lymph nodes were found in 4 patients: 2 (7.7%) of 26 patients in the ultrastaging group and 2 (5.9%) of 34 patients in the OSNA group, respectively. The total amount of positive pelvic lymph nodes was 3 (0.6%) of 531 in the ultrastaging group and 4 (0.7%) of 605 in the OSNA group (p=0.61). In the OSNA group, only 2 patients with negative sentinel lymph nodes had metastatic disease in the pelvic lymph nodes. By contrast, no patients with OSNA-positive sentinel lymph nodes had metastases in the pelvic lymph nodes. In the ultrastaging group, all patients with negative sentinel lymph nodes did not have metastatic disease in other pelvic lymph nodes.ConclusionsOSNA assessment of sentinel lymph nodes was associated with a negative predictive value of 91% but poor reliability in detecting node metastases in non-sentinel pelvic lymph nodes. Of note, the ultrastaging protocol revealed higher sensitivity and more reliability in predicting pelvic non-sentinel lymph node status.

P219 THE ROLE OF PET-CT IN THE EVALUATION OF LYMPH NODE INVOLVEMENT IN ESOPHAGEAL AND GASTROESOPHAGEAL JUNCTION CARCINOMA - A 5-YEAR SINGLE CENTER EXPERIENCE

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Chrysovalantis Vergadis ◽  
Eustratia Mpaili ◽  
Athanasios Syllaios ◽  
Maria Mpoura ◽  
Adamantios Michalinos ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
False Positive ◽  
Gastroesophageal Junction ◽  
Preoperative Staging ◽  
False Negative ◽  
Clinical Staging ◽  
Lymph Node Status ◽  
Pathology Report ◽  
Pet Ct

Abstract Aim To determine the efficacy of positron emission tomography-computed tomography (PET-CT) in the evaluation of lymph node status during preoperative staging on patients with esophageal and gastrοesophageal junction carcinoma compared to the final histopathological findings. Background & Methods Data on patients that underwent esophagectomy from 01/03/2014 to 01/03/2019 were prospectively collected and retrospectively reviewed. Based on the medical records, the following parameters were extracted and analyzed: patient demographics, histopathological parameters, surgical and oncological outcomes. All patients were staged according to the AJCC 8th edition. Results A total of 79 patients underwent Ivor Lewis or McKeown esophagectomy for either squamous cell carcinoma (n= 7 patients) or adenocarcinoma of esophagus or gastroesophageal junction (n= 72 patients). In 60 cases, clinical staging was conducted without performing PET- CT, while 19 cases underwent PET-CT. Among the 19 patients, 16 (84.2%) were men, and 3 (15.8 %) were women. Mean age was 62 years, (range 41- 72). Mean nodal harvest per patient was 30.6 lymph nodes. Twelve out of 19 patients (63.2%) revealed lymph node invasion, with a mean of 5.6 positive lymph nodes per patient. PET-CT identified the primary tumor in all 19 patients (100%). PET-CT demonstrated 100% compliance with the final histopathological reports regarding N status in only 5 out of 19 cases (26.3%). Four patients were staged as N0 both pre- and postoperatively, while one was deemed positive by PET-CT in right paracardial lymph nodes which was histopathologically confirmed. In other 4 patients (21.1%), PET-CT was 100% false negative, whereas in 3 patients (15.8%) PET-CT was 100% false positive. In the remaining 7 patients, PET-CT findings were in accordance with the pathology report in 7 out of 25 examined lymph node stations, false positive in 9 out of 25 and false negative in 9 out of 25. Conclusion PET-CT seems to have a considerable number of false positive and false negative results in esophageal cancer in our study as far as N-staging is concerned. Further studies with larger sample size are needed to reach more conclusive results.

Number of lymph nodes harvested from a mediastinal lymphadenectomy: Results of the randomized, prospective ACOSOG Z0030 trial

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 7555-7555
Author(s):  
M. S. Allen ◽  
G. E. Darling ◽  
P. A. Decker ◽  
J. B. Putnam ◽  
R. A. Malthaner ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Early Stage ◽  
Mediastinal Lymph Node ◽  
Large Cell ◽  
Lymph Node Status ◽  
Early Stage Lung Cancer ◽  
Mediastinal Lymphadenectomy ◽  
Lymph Node Sampling

7555 Background: Lymph node status is a major determinant of stage and survival in patients with lung cancer; however, little information is available about the yield of a mediastinal lymphadenectomy done at the time of pulmonary resection. Methods: The ACOSOG Z0030 trial is a prospective, randomized trial of mediastinal lymph node sampling versus complete mediastinal lymphadenectomy during an operation for early stage lung cancer. Total enrollment from July 1999 to February 2004 was 1,111 patients, of which 1,023 were eligible and/or evaluable. There were 524 patients who underwent complete mediastinal lymph node resection after randomization to this arm that were declared eligible and/or evaluable with lymph node data available. The number of lymph nodes examined from each station was collected beginning in January 2002. Prospectively collected data from these patients was analyzed to determine the number of lymph nodes obtained. Results: Median age was 67 (range 37–87) and 267 (52%) were men. Histology was squamous cell in 141 (27%), adenocarcinoma in 227 (44%), large cell in 22 (4%), bronchoavelolar in 32 (6%) and other non-small cell in 99 (19%). There were 317 right sided cancers and 207 left sided cancers. For lymphadenectomy for cancers in the right lung the yield from station 2R was a median of 2 lymph nodes (range 1 to 15), station 4R was 2 (1 –17), station 7 was 2 (1–24), station 8 was 1 (1–5), station 9 was 1 (1–6) and station 10R was 1 (1–10). For lymphadenectomy for cancers on the left side the yield from station 2L was 2 (1–4), station 4L was 1 (1–12), station 5 was 2 (1–18), station 6 was 2 (1–11), station 7 was 2 (1–16), station 8 was 1 (1–3), station 9 was 1 (1–8) and 10L was 2 (1–12). The total number of lymph nodes or fragments obtained for right sided cancers was a median of 13.5 (range 1 to 56) and for left sided tumors 15 (range 4 to 81). Conclusions: Although high variability exists in the actual number of lymph nodes obtained from various nodal stations, a complete mediastinal lymphadenectomy should obtain one or more lymph nodes from each mediastinal station. Adequate mediastinal lymphadenectomy should include exploration and remove of lymph nodes from stations 2R, 4R, 7, 8, and 9 for right sided cancers and stations 4L, 5, 6, 7, 8 and 9 for left sided cancers. No significant financial relationships to disclose.

Lymph Node Status Did Not Significantly Improve the Predictability of Survival in Patients With Clinically Early-Stage Endometrial Cancer

2014 ◽  
Vol 24 (8) ◽  
pp. 1449-1454
Author(s):  
Hyo Sook Bae ◽  
Jong-Min Lee ◽  
Jae-Kwan Lee ◽  
Jae-Weon Kim ◽  
Chi-Heum Cho ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Early Stage ◽  
Lymph Node Status ◽  
Survival Prediction ◽  
Concordance Index ◽  
Node Metastasis ◽  
Node Status ◽  
Early Stage Endometrial Cancer ◽  
Cause Specific Survival

ObjectiveThe aim of this study was to determine whether knowledge of lymph node status improves survival prediction in clinically early-stage endometrial cancer.MethodsThe records of 661 patients with apparently uterine-confined disease were reviewed. The performance in predicting overall survival and cause-specific survival was compared between a multivariate prognostic model with nodal status and a model without nodal status by calculating Harrell concordance index.ResultsAmong 661 patients with clinically early-stage endometrial cancer, the lymph node metastasis rate was 8.3% (55/661). Lymph node metastasis independently associated with cause-specific survival only when no stratification according to adjuvant treatment was applied (P= 0.035). After stratification according to adjuvant radiotherapy, lymph node status marginally associated with cause-specific survival (P =0.073), whereas myometrial invasion retained its strong association with cause-specific survival (P< 0.001). However, there was no significant difference in the performance of the survival model using only uterine factors and the model using lymph node status and uterine factors (concordance index, 0.77 vs 0.77, respectively;P= 0.798).ConclusionsKnowledge of lymph node status did not significantly improve the performance of survival prediction in apparently uterine-confined endometrial cancer, although it was independently associated with survival. In the patients with clinically early-stage endometrial cancer, the accuracy of the prediction of survival was comparable between risk grouping without lymph node status and that including lymph node status.

scholarly journals Can Tumor-Infiltrating Lymphocytes (TILs) Be a Predictive Factor for Lymph Nodes Status in Both Early Stage and Locally Advanced Breast Cancer?

2019 ◽  
Vol 8 (4) ◽  
pp. 545 ◽  
Author(s):  
Alexandra Caziuc ◽  
Diana Schlanger ◽  
Giorgiana Amarinei ◽  
George Calin Dindelegan
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Early Stage ◽  
Locally Advanced ◽  
Lymph Node Status ◽  
Breast Cancers ◽  
Axillary Clearance ◽  
Node Status ◽  
Response To Chemotherapy

The status of axillary lymph nodes is an important prognostic factor in the outcome of breast cancer tumors. New trials changed the attitude towards axillary clearance. In the era of development of new immune therapies for breast cancer, it is important to identify a biomarker that can predict lymph node status. Tumor-infiltrating lymphocytes (TILs) are a valuable indicator of the immune microenvironment that plays the central role in new anticancer drugs. Although the correlation between TILs and response to chemotherapy was established by previous studies, our retrospective study investigated the correlation between TILs and lymph node status. We analyzed data on 172 patients. According to stage, patients were divided in two groups: patients who underwent primary surgical treatment (breast-conserving or mastectomy and sentinel lymph node (SLN) biopsy +/− axillary clearance in conformity with lymph node status) and patients who received chemotherapy prior to surgical treatment (breast-conserving or mastectomy + axillary clearance). We showed a good inverse correlation between TILs and lymph nodes status for both early stage and locally advanced breast cancers. Moreover, TILs are a predictor for positive lymph nodes in the axilla in patients undergoing axillary clearance after SLN biopsy, with no statistical difference between the intrinsic or histological subtype of breast cancers. We also obtained a significant correlation between TILs and response to chemotherapy with no significative difference according to histological subtype. Although further data have still to be gathered before meeting the criteria for clinical utility, this study demonstrates that TILs are one of the most accredited forthcoming biomarkers for breast cancer (BC) patients.

The Incidence and Clinical Significance of the Micrometastases in the Sentinel Lymph Nodes During Surgical Staging for Early Endometrial Cancer

2015 ◽  
Vol 25 (4) ◽  
pp. 673-680 ◽  
Author(s):  
Domenico Ferraioli ◽  
Nicolas Chopin ◽  
Frederic Beurrier ◽  
Nicolas Carrabin ◽  
Annie Buenerd ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Clinical Significance ◽  
Prognostic Significance ◽  
Case Series ◽  
Lymph Node Status ◽  
Type I ◽  
Gynecology And Obstetrics ◽  
Histopathologic Features

IntroductionThe status of regional node remains one of the most important factors to guide adjuvant therapy in endometrial cancer (EC). Pelvic recurrence occurs in up to 15% of early EC patients with negative pelvic lymph nodes (LNs). The prognostic significance of detecting micrometastases (μM) in LN is debated. This retrospective case-control study performed in the Oncological Gynecology Department in Lyon between December 1998 and June 2012 reports the incidence and the clinical significance of μM detected during ultrastaging of negative sentinel lymph node (SLN) in EC.Patients and MethodsNinety-three patients affected by type I and II EC were submitted to surgery with SLN. Dual-labeling method was used to detect SLN. All the SLNs were subjected to ultrastaging researching μM. The patients with a locoregional or distant relapse represented the case-series (CS). The patients without locoregional or distant recurrences were the case-controls (CC).They were matched (1:2 ratio) according to age, International Federation of Gynecology and Obstetrics stage, and histopathologic features.ResultsTen patients presenting a relapse represented CS. In the remaining 83 patients without recurrence, 20 CC were individualized. The detection rate of SLN per hemipelvis was of 17 (85%) of 20 hemipelvis and of 33 (82.5%) of 40 hemipelvis for CS and CC, respectively. Two SLN of CS arm were positives at frozen section. One of the 8 patients of CS arm with negative SLNs was positive for μM by immunohistochemistry analysis.ConclusionsLymph node status is one of the most important histopathologic features to determine the adjuvant treatment. The SLN technique could be proposed in selected patients affected by early EC. The μM in SLN could be researched and could help to modulate the following treatment. The multicenter study must be performed to clarify the optimal method of research of SLN in EC and the significance of μM in the LN.

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