Surgical Approach to Cervical Lymph Node Metastasis in Differentiated Thyroid Cancer

Background Precautionary locoregional lymph node dissection in thyroid carcinomas for diagnostic and/or staging purposes is useless both in differentiated (papillary and follicular) and undifferentiated forms. It is only indicated in medullary carcinomas because of their frequent spread to regional lymph nodes. The objective of lymphadenectomy is to contain tumor spread; however, the procedure may be associated with intraoperative complications and postoperative sequelae. In order to improve the therapeutic management of patients with thyroid carcinoma, diagnostic scintigraphy with 201Tl or 99mTc-sestamibi is used in the advanced and undifferentiated forms of this tumor. Methods We have treated a woman submitted three years previously to total thyroidectomy for papillary carcinoma (pT3) without subsequent radiometabolic treatment. On physical examination we noticed a swelling on the left side of the neck. The lesion was confirmed by ultrasonography, CT scan, and scintigraphic examination with 99mTc-sestamibi 24 hours before planned lymphadenectomy. During the surgical procedure we performed radiodetection to localize metastatic lesions. Results Intraoperative radiodetection may help to identify residual disease, which is often difficult to trace in the presence of post-surgical fibrosis. In our patient, histological examination of the removed tissue specimens demonstrated that intraoperative radiolocalization had been highly accurate. The eradication of residual disease was confirmed by scintigraphic follow-up after 12 months. Discussion and conclusions Scintigraphy with 99mTc-sestamibi has been proposed as a means to localize metastatic spread and possible residual disease after a supposedly radical thyroidectomy. Surgical eradication of all residual tumor guarantees the best disease control without having to resort to radiometabolic therapy. This approach will reduce the incidence of iatrogenic comorbidity and consequently improve the patients' quality of life.

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BIOPSY OF THE SIGNALING LYMPH NODES IN GASTRIC CANCER - CURRENT STATUS OF THE PROBLEM AND PROSPECTS

Problems in oncology ◽

10.37469/0507-3758-2018-64-3-335-344 ◽

2018 ◽

Vol 64 (3) ◽

pp. 335-344

Author(s):

Aleksey Karachun ◽

Yuriy Pelipas ◽

Oleg Tkachenko ◽

D. Asadchaya

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Lymph Nodes ◽

Stomach Cancer ◽

Current Status ◽

Regional Lymph Nodes ◽

Systematic Analysis ◽

Tumor Spread ◽

Special Value

The concept of biopsy of sentinel lymph node as the first lymph node in the pathway of lymphogenous tumor spread has been actively discussed over the past decades and has already taken its rightful place in breast and melanoma surgery. The goal of this method is to exclude vain lymphadenectomy in patients without solid tumor metastases in regional lymph nodes. In the era of minimally invasive and organ-saving operations interventions it seems obvious an idea to introduce a biopsy of sentinel lymph node in surgery of early gastric cancer. Meanwhile the complexity of lymphatic system of the stomach and the presence of so-called skip metastases are factors limiting the introduction of a biopsy of sentinel lymph node in stomach cancer. This article presents a systematic analysis of biopsy technology of signaling lymph node as well as its safety and oncological adequacy. Based on literature data it seems to us that the special value of biopsy of sentinel lymph nodes in the future will be in the selection of personalized surgical tactics for stomach cancer.

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Clinical, morphological, and molecular genetic predictors of metastatic lesions in the regional lymph nodes in breast cancer

Advances in molecular oncology ◽

10.17650/2313-805x-2018-5-3-8-16 ◽

2018 ◽

Vol 5 (3) ◽

pp. 8-16

Author(s):

Yu. A. Dergunova ◽

V. V. Podionov ◽

V. K. Bozhenko ◽

V. V. Kometova ◽

M. V. Dardyk

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Molecular Genetic ◽

Regional Lymph Nodes ◽

Genetic Characteristics ◽

Metastatic Lesions ◽

Genetic Predictors ◽

Node Metastases ◽

High Degree

Despite the sufficient amount of data accumulated in the literature, there are still no factors, on the basis of which it would be possible to estimate the regional lymph nodes status in breast cancer with a high degree of accuracy. The review presents literature data relating to the influence of clinicopathological, molecular-biological and genetic characteristics of primary tumor on lymph node metastases. Data of 66 foreign and Russian articles are included.

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Determination of Cervical Metastases by Lymphoscintigraphy in Patients with Oral Cancer: A Single Institute Experience

Bangladesh Journal of Nuclear Medicine ◽

10.3329/bjnm.v21i1.40244 ◽

2019 ◽

Vol 21 (1) ◽

pp. 12-15

Author(s):

Md Ahsan Habib ◽

Quazi Billur Rahman ◽

Pupree Mutsuddy ◽

Shamim MF Begum ◽

Sadia Sultana ◽

...

Keyword(s):

Lymph Node ◽

Oral Cancer ◽

Predictive Value ◽

Cervical Lymph Node Metastasis ◽

Lymph Node Involvement ◽

Nodal Metastasis ◽

Histopathological Diagnosis ◽

Regional Lymph Nodes ◽

Oral Cancer Patients ◽

Lymphatic Obstruction

Background: Oral cancer is the sixth most common cancer in the world. Cervical metastasis is an important adverse prognostic factor and about 40% of the patients with oral cancer develop lymphatic metastasis. Lymphoscintigraphy is the minimally invasive method for the detection of cervical nodal metastasis. The aim of the study was to detect the lymphatic involvement with the aid of lymphoscnitigraphy in patient with oral cancer undergoing surgical procedure and to find out the accuracy of the findings with the post operative histopathological diagnosis. Patients and methods: A total of 30 patients with histologically proven oral cancer underwent lymphoscintigraphic evaluation to detect the lymphatic spread of the tumor. The findings and results of lymphoscintigraphy were compared with the postoperative histopathological diagnosis. Results: Among the 30 patients, lymphatic obstruction was observed in 19 patients of whom 15 patients had perfusion defect and 4 patients had gap defect. No lymphatic obstruction was evident in the rest 11 patients by lymphoscintigraphy. The calculated sensitivity of lymphoscintigraphy in diagnosis of cervical lymph node metastasis was 100%, specificity 78.6%, accuracy 90% and positive predictive value was 84.2% and negative predictive value was 100%. Conclusion: Lymphoscintigraphy was found to be an effective method in detecting lymph node involvement and can be used as an alternative to identify regional lymph nodes metastases pre-operatively in oral cancer patients. Thereby, it will help the surgeon to plan the extent of dissection before surgery which may decrease postoperative complications related to unnecessary extensive lymph node dissection and morbidity. Bangladesh J. Nuclear Med. 21(1): 12-15, January 2018

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Characterization of Minimal Residual Disease

Blood ◽

10.1182/blood.v126.23.sci-52.sci-52 ◽

2015 ◽

Vol 126 (23) ◽

pp. SCI-52-SCI-52

Author(s):

Alberto Orfao ◽

Bruno Paiva ◽

Juan Flores-Montero ◽

Noemi Puig ◽

Laura Gutierrez ◽

...

Keyword(s):

High Risk ◽

Induction Therapy ◽

Residual Disease ◽

Residual Tumor ◽

Disease Recurrence ◽

Response To Therapy ◽

Genetic Profiles ◽

Minimal Residual

Abstract Minimal residual disease (MRD) defines persistence of minimal numbers (<10-2-10-6) of residual tumor cells after treatment. In recent years, evaluation of MRD has become more frequently used as a mean to assess the quality of response to therapy in multiple myeloma (MM), particularly among those patients who have reached complete remission (CR). At the same time, it has become one of the most relevant prognostic factors in MM, both among patients with standard-risk and those with high-risk cytogenetics. In parallel, the introduction of novel therapies has led to significantly higher CR rates, with also lower rates of MRD-positivity and lower MRD levels. Such improvement in response to therapy of MM has fostered the development of progressively more sensitive approaches that allow deeper evaluation of the quality of the response achieved. However, it is well-known that while most cases that show persistence of MRD after therapy will eventually relapse, some of these patients show persistence of MRD in the absence of disease recurrence. In turn, a significant fraction of MM patients with high-risk cytogenetics, despite reaching deep responses to therapy, show early relapse. Altogether, these findings point out the potential relevance of the biological features of MRD cells, in addition to the MRD levels, in determining long-term MRD control vs. disease recurrence. Therefore, understanding the biologic signature of MRD cells may provide important insight into the mechanisms involved in chemoresistance and the discovery of novel potential therapeutic targets. At present, information about the phenotypic and genetic/genomic features of the chemoresistant myeloma plasma cell (PC) clones remains limited; this is mainly due the minimal levels of residual tumor cells, particularly among the MRD+ patients identified at advanced stages of therapy. Characterization of the phenotypic and genetic profiles of MRD+ myeloma PC which are resistant to induction therapy vs. paired diagnostic myeloma PC from elderly patients treated with novel drugs in the GEM2010MAS65 clinical trial, unravel that therapy-induced clonal selection can be already identified at the MRD stage, after induction therapy. In these settings, chemoresistant myeloma PC showed a specific phenotypic signature that may result from the persistence of clones with unique cytogenetic alterations. Thus, MRD myeloma PC which persisted after induction therapy showed increased expression levels of integrins and adhesion molecules (e.g. CD11c, CD29, CD44, CD49d, CD49e, CD54 and CD138, suggesting that among the initial tumor bulk, the few chemoresistant cells are likely to be those with stronger adhesion properties. Such cells also showed overall different gene expression profiles, with de-regulated genes/pathways related to proteasome-inhibition chemoresistance (e.g.: genes encoding for proteasome subunits or endoplasmic reticulum proteins), and that may influence survival of MM patients. Comparison of both iFISH and copy number variation profiles between patient-paired diagnostic vs. MRD PC revealed different genetic profiles in a substantial percentage of cases, which may potentially be due to the acquisition of new alterations during therapy that render the cell more chemoresistant, and/or the emergence of ultra-chemoresistant MRD cells that represented a subclone of all PC present at diagnosis. Disclosures Paiva: Celgene: Consultancy; Binding Site: Consultancy; Janssen: Consultancy; BD Bioscience: Consultancy; Onyx: Consultancy; EngMab AG: Research Funding; Millenium: Consultancy; Sanofi: Consultancy. Puig:The Binding Site: Consultancy; Janssen: Consultancy. San Miguel:Millennium: Honoraria; Onyx: Honoraria; Bristol-Myers Squibb: Honoraria; Novartis: Honoraria; Celgene: Honoraria; Sanofi-Aventis: Honoraria; Janssen-Cilag: Honoraria.

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A randomized phase III trial of cisplatin and tumor volume directed irradiation followed by carboplatin and paclitaxel vs. carboplatin and paclitaxel for optimally debulked, advanced endometrial carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.5505 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 5505-5505 ◽

Cited By ~ 51

Author(s):

Daniela Matei ◽

Virginia L. Filiaci ◽

Marcus Randall ◽

Margaret Steinhoff ◽

Paul DiSilvestro ◽

...

Keyword(s):

Local Recurrence ◽

Residual Disease ◽

Uterine Cancer ◽

Residual Tumor ◽

Phase Iii ◽

Stage Iii ◽

Open Label ◽

Significant Treatment ◽

Phase Iii Trial

5505 Background: Patients with stage III/IVA uterine cancer (UC) carry high risk of systemic and local recurrence. Chemotherapy was shown to reduce systemic recurrence, however the risk of local failure remains high. Methods: The primary endpoint of this open label, randomized phase III trial was to determine if treatment with cisplatin and volume-directed radiation followed by carboplatin and paclitaxel for 4 cycles (C-RT, experimental arm) reduces the rate of recurrence or death (i.e., increases recurrence-free survival, RFS) when compared to carboplatin and paclitaxel for 6 cycles (CT, control arm) in patients with stages III-IVA (<2 cm residual disease) or FIGO 2009 stage I/II serous or clear cell UC and positive cytology. Secondary objectives were assessment of overall survival (OS), acute and late toxicities, and quality of life. A 28.5% reduction in the rate of recurrence or death was considered significant. Treatment randomization and analysis were stratified by gross residual tumor and age. Results: Between 6/2009 and 7/2014, 813 patients were enrolled and randomized (407 C-RT and 406-CT). Of those, 733 were eligible (344 C-RT and 360 CT), and 680 received the trial intervention (333 C-RT and 347 CT). Median follow up is 47 months. Patients characteristics were balanced between arms. There were 201 (58%) > grd 3 toxicity events in the C-RT arm and 227 (63%) in the CT arm. The most common > grd 3 events were myelosupression (40% vs. 52%), gastrointestinal (13% vs. 4%), metabolic (15% vs. 19%), neurological (7% vs. 6%), infectious (4% vs. 5%). Treatment hazard ratio for RFS was 0.9 (C-RT vs. CT; CI 0.74 to 1.10). C-RT reduced the incidence of vaginal (3% vs. 7%, HR = 0.36, CI 0.16 to 0.82), pelvic and paraaortic recurrences (10% vs. 21%, HR=0.43, CI 02.8 to 0.66) compared to CT, but distant recurrences were more common with C-RT vs. CT (28% vs. 21%, HR 1.36, CI 1 to 1.86). The analysis is premature for OS comparison. Conclusions: Although C-RT reduced the rate of local recurrence compared to CT; the combined modality regimen did not increase RFS in optimally debulked, stage III/IVA UC. Clinical trial information: NCT00942357.

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PAPILLARY THYROID CARCINOMA SIZE;

The Professional Medical Journal ◽

10.29309/tpmj/2017.24.07.1038 ◽

2017 ◽

Vol 24 (07) ◽

pp. 1084-1087

Author(s):

Amjad Ali Khan ◽

Abdul Shaheed Asghar ◽

Muhammad Ishaq ◽

Israr Ahmed Akhund

Keyword(s):

Lymph Node ◽

Papillary Thyroid Carcinoma ◽

Lymph Node Metastasis ◽

Thyroid Carcinoma ◽

Cervical Lymph Node ◽

Cervical Lymph Node Metastasis ◽

Papillary Thyroid ◽

Regional Lymph Nodes ◽

Primary Tumor Size ◽

Node Metastasis

Background: Papillary thyroid carcinoma (PTC) is the most common malignancyof thyroid gland. It constitutes about 90% of all well differentiated thyroid carcinomas and has anindolent course with excellent prognosis.1,2,3 Death due to papillary thyroid carcinoma is rare andaccounts for only 0.2% of cancer deaths in United States of America.4 The prevalence of PTChas increased world over due to the wider use of ultrasonography and fine needle aspirationcytology (FNAC) in the routine diagnostic workup. Also papillary thyroid microcarcinomas(PTMC) are being increasingly diagnosed as incidental findings in thyroid gland removed forother thyroid pathologies, like follicular adenoma, multi-nodular goiter or diffuse goiter, etc. Dueto uncertainty for this tumor to metastasize to the regional lymph nodes, it is usually not clearwhether the surgeon should take the patient to the operating room and proceed with lymphnode dissection or to wait and observe. Study Design: In this retrospective study from the yearPeriod: January 2012 to January 2015, a total of 43 cases of total thyroidectomy with regionallymph node dissection and with histopathological diagnosis of papillary thyroid carcinomawere retrieved from archives of Setting: Charsada Teaching Hospital affiliated with JinnahMedical College Peshawar. The slides and diagnoses of all the retrieved cases were reviewed.Information regarding primary tumor size, any metastasis in regional lymph nodes, patient’sage and presence or absence of any associated thyroid disease was noted and analyzed.Results: The analysis of the 43 cases of PTC showed that papillary thyroid carcinoma was morecommon in females than males. It affected age groups between 10 and 80 years of age andwas most common in the 4th decade of life. Cervical lymph node metastasis was directly relatedwith the size of primary papillary thyroid carcinoma. The commonly associated thyroid diseasesincluded Hashimoto’s thyroiditis, followed by multinodular goiter and rarely Graves’ disease.Conclusions: Papillary thyroid carcinoma is more common in females; it affects patients in theirfourth decade of life and is commonly associated with Hashimoto’s thyroiditis. Moreover thechances of cervical lymph node metastasis are directly proportional to the primary tumor size.

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Transitional cell carcinoma of urinary bladder with cervical lymph node metastasis: a case report and review of literature

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20190130 ◽

2019 ◽

Vol 6 (1) ◽

pp. 194

Author(s):

Ramya V. ◽

Sahayaraj J.

Keyword(s):

Bladder Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Urinary Bladder ◽

Lymph Nodes ◽

Cervical Lymph Node ◽

Cervical Lymph Node Metastasis ◽

Regional Lymph Nodes ◽

Cervical Lymph Nodes ◽

Node Metastasis

Bladder cancer usually spreads via the lymphatic and hematogenous routes, the common sites of metastases of urinary bladder cancers being the regional lymph nodes, liver, lung, bone, peritoneum, pleura, kidney, adrenal gland and intestines. Metastasis to non-regional lymph nodes especially cervical lymph nodes is extremely rare presentation. Metastasis to head and neck region is associated with poor prognosis and low survival rate. Here-in we report a case of cervical lymph node metastasis in patient with muscle invasive bladder cancer.

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