scholarly journals Role of “Second Look” Lymph Node Search in Harvesting Optimal Number of Lymph Nodes for Staging of Colorectal Carcinoma

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Ameer Hamza ◽  
Ramen Sakhi ◽  
Sidrah Khawar ◽  
Ahmed Alrajjal ◽  
Jacob Edens ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Scientific Evidence ◽  
Quality Standard ◽  
Optimal Number ◽  
Lymph Node Staging ◽  
Lymph Node Count ◽  
National Quality ◽  
Node Count

As with other malignancies, lymph node metastasis is an important staging element and prognostic factor in colorectal carcinomas. The number of involved lymph nodes is directly related to decreased 5-year overall survival for all pT stages according to United States Surveillance, Epidemiology, and End Results (SEER) cancer registry database. The National Quality Forum specifies that the presence of at least 12 lymph nodes in a surgical resection is one of the key quality measures for the evaluation of colorectal cancer. Therefore, the harvesting of a minimum of twelve lymph nodes is the most widely accepted standard for evaluating colorectal cancer. Since this is an accepted quality standard, a second attempt at lymph node dissection in the gross specimen is often performed when the initial lymph node count is less than 12, incurring a delay in reporting and additional expense. However, this is an arbitrary number and not based on any hard scientific evidence. We decided to investigate whether the additional effort and expense of submitting additional lymph nodes had any effect on pathologic lymph node staging (pN). We identified a total of 99 colectomies for colorectal cancer in which the prosector subsequently submitted additional lymph nodes following initial review. The mean lymph node count increased from 8.3 ± 7.5 on initial search to 14.6 ± 8.0 following submission of additional sections. The number of cases meeting the target of 12 lymph nodes increased from 14 to 69. Examination of the additional lymph nodes resulted in pathologic upstaging (pN) of five cases. Gross reexamination and submission of additional lymph nodes may provide more accurate staging in a limited number of cases. Whether exhaustive submission of mesenteric fat or fat-clearing methods is justified will need to be further investigated.

Clinical lymph node staging by imaging in colorectal cancer: A flip of the coin?

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15160-e15160 ◽  
Author(s):  
Nelleke Pietronella Maria Brouwer ◽  
Rutger Carel Hubert Stijns ◽  
Lemmens Valery ◽  
Iris D. Nagtegaal ◽  
Regina GH Beets-Tan ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Colon Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Neoadjuvant Therapy ◽  
Cancer Patients ◽  
Lymph Node Staging ◽  
Preoperative Treatment ◽  
Positive Lymph Nodes

e15160 Background: Clinical lymph node staging by MRI and CT is important in stratification for neoadjuvant therapy in colorectal cancer. Overstaging may result in unnecessary neoadjuvant therapy, but understaging may refrain patients from adequate preoperative treatment. This study aims to provide insight in current daily practice in clinical lymph node staging in CRC in the Netherlands. Methods: All patients with primary CRC, diagnosed between 2003-2014, who underwent lymph node dissection were selected from the nationwide population-based Netherlands Cancer Registry (n=100,211). Trends in patient- and tumor-characteristics, and lymph node staging were analyzed. For the years 2011-2014, sensitivity, specificity, positive (PPV) and negative predictive value (NPV) were calculated for clinical lymph node staging, with histology as the gold standard. Only patients without preoperative treatment were analyzed. Since prospective studies have shown that 5x5 Gy radiotherapy (RT) followed by total mesorectal excision within 10 days does not lead to nodal downstaging, an additional analysis was performed in this group. Results: The proportion clinically positive lymph nodes increased significantly between 2003-2014; from 7% to 22% for colon cancer and from 7% to 53% for rectal cancer. The proportion histological positive lymph nodes remained fairly stable over time (±35% colon, ±33% rectum). During 2011-2014, clinical lymph node staging was available in the registry in 86% of colon cancer patients, 92% of rectal cancer patients without neoadjuvant treatment and 95% of rectal cancer patients with 5x5 Gy RT. The parameters based on data from this period are presented in table 1. Conclusions: With a sensitivity and PPV of approximately 50%, clinical lymph node staging is about as accurate as flipping a coin. This leads to overtreatment in patients with rectal cancer with neoadjuvant RT. Acceptable specificity and NPV limit the risk of undertreatment. [Table: see text]

Early-stage carcinosarcoma of the uterus: the significance of lymph node count

2007 ◽  
Vol 17 (1) ◽  
pp. 215-219 ◽  
Author(s):  
S. M. Temkin ◽  
M. Hellmann ◽  
Y.-C. Lee ◽  
O. Abulafia
Keyword(s):  
Overall Survival ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Early Stage ◽  
Disease Free Survival ◽  
Myometrial Invasion ◽  
Lymph Node Count ◽  
Pathologic Features ◽  
Node Count ◽  
Disease Free

Carcinosarcoma is a rare tumor of the uterus with a poor prognosis, even when identified and treated at an early stage. The purpose of this study was to identify and analyze prognostic pathologic features and treatment outcomes in patient with stages I and II carcinosarcoma of the uterus. Patients with carcinosarcoma of the uterus who received primary surgical treatment between 1984 and 2004 were identified through an institutional tumor registry. Inclusion criteria were clinical stage I/II disease following hysterectomy and selective pelvic and para-aortic lymph node sampling. Regression analysis was used to determine risk factors for recurrence and survival. Disease-free and overall survival were then determined using Kaplan–Meier analysis. Forty-seven patients with stages I and II carcinosarcoma of the uterus were identified. Age, heterologous or homologous histology, and type of adjuvant treatment were not associated with recurrence or survival. Depth of myometrial invasion was found to correlate to disease-free survival but not overall survival. The number of lymph nodes collected correlated to risk of recurrence and survival. Disease-free and overall survival were greater in patients with higher lymph node count. We conclude that the number of lymph nodes collected was the only risk factor that was found to be correlated to recurrence and survival in patients with early-stage carcinosarcoma. These results support mounting evidence that lymphadenectomy is crucial in patients with carcinomas of the uterus in order to discover occult metastatic disease and potentially provide patients with a therapeutic benefit

The association between microsatellite instability and lymph node count in colorectal cancer

2017 ◽  
Vol 471 (1) ◽  
pp. 57-64 ◽  
Author(s):  
Alexander Arnold ◽  
Matthias Kloor ◽  
Lina Jansen ◽  
Jenny Chang-Claude ◽  
Hermann Brenner ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymph Node ◽  
Microsatellite Instability ◽  
Lymph Node Count ◽  
Node Count

scholarly journals Impact of Examined Lymph Node Count and Lymph Node Density on Overall Survival of Penile Cancer

2021 ◽  
Vol 11 ◽  
Author(s):  
Pan Gao ◽  
Tianle Zhu ◽  
Jingjing Gao ◽  
Hu Li ◽  
Xi Liu ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Penile Cancer ◽  
Node Density ◽  
Lymph Node Count ◽  
Lymph Node Density ◽  
Cutoff Values ◽  
Node Count

BackgroundFew studies have explored the optimal examined lymph node count and lymph node density cutoff values that could be used to predict the survival of patients with penile cancer. We further clarify the prognostic value of lymph node density and examined lymph node count in penile cancer.MethodsThe Surveillance, Epidemiology, and End Results (SEER) database was explored to recruit penile cancer patients from 2010 to 2015. A retrospective analysis of penile cancer patients’ data from the First Affiliated Hospital of Anhui Medical University was performed for verification (2006–2016). The cutoff values of examined lymph node count and lymph node density were performed according to the ROC curve. Kaplan-Meier survival analysis was used to compare survival differences among different groups. Univariate and multivariate Cox proportional hazard regression analyses were used to determine the significant variables. On the basis of Cox proportional hazards regression model, a nomogram was established and validated by calibration plot diagrams and concordance index (C-index).ResultsA total of 528 patients in the Surveillance, Epidemiology, and End Results cohort and 156 patients in the Chinese cohort were included in this study. Using the ROC curve, we found that the recommended cutoff values of ELN and LND were 13 and 9.3%, respectively (P <0.001). Kaplan–Meier curves suggested the significant differences of overall survival among different examined lymph nodes and lymph node density. Multivariate analysis indicated ELN and LND were independent prognostic factor for OS of penile cancer patients. Nomogram showed the contribution of ELN and LND to predicting OS was large. The C-index at 3-, and 5-year were 0.744 for overall survival (95% CI 0.711–0.777).ConclusionsThe more lymph nodes examined, the lower the density of lymph nodes, and the higher the long-term survival rate of penile cancer. We recommended 13 examined lymph nodes and lymph node density >9.3% as the cutoff value for evaluating the prognosis of penile cancer patients.

scholarly journals Applied Anatomy of Pelvic Lymph Nodes and Its Clinical Significance for Prostate Cancer:A Single-Center Cadaveric Study

2019 ◽  
Author(s):  
Chen Jia-Jun ◽  
Zhu Zai-Sheng ◽  
Zhu Yi-Yi ◽  
Shi Hong-Qi
Keyword(s):  
Lymph Node ◽  
Radical Prostatectomy ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Adult Male ◽  
Pelvic Lymph Node Dissection ◽  
Node Dissection ◽  
Lymph Node Count ◽  
Pelvic Lymph Nodes ◽  
Node Count

Abstract Background Pelvic lymph node dissection (PLND) is one of the most important steps in radical prostatectomy (RP). Not only can PLND provide accurate clinical staging to guide treatment after prostatectomy but PLND can also improve the prognosis of patients by eradicating micro-metastases. However, reports of the number of pelvic lymph nodes have generally come from incomplete dissection during surgery, there is no anatomic study that assesses the number and variability of lymph nodes. Our objective is to assess the utility of adopting the lymph node count as a metric of surgical quality for the extent of lymph node dissection during RP for prostate cancer by conducting a dissection study of pelvic lymph nodes in adult male cadavers. Methods All 30 adult male cadavers underwent pelvic lymph node dissection (PLND), and the lymph nodes in each of the 9 dissection zones were enumerated and analyzed. Results A total of 1267 lymph nodes were obtained. The number of lymph nodes obtained by local PLND was 4-22 (14.1±4.5), the number obtained by standard PLND was 16-35 (25.9±5.6), the number obtained by extended PLND was 17-44 (30.0±7.0), and the number obtained by super-extended PLDN was 24-60 (42.2±9.7). Conclusions There are substantial inter-individual differences in the number of lymph nodes in the pelvic cavity. These results have demonstrated the rationality and feasibility of adopting lymph node count as a surrogate for evaluating the utility of PLND in radical prostatectomy, but these results need to be further explored.

Sign in / Sign up

Export Citation Format

Share Document