A greater lymph node yield is required during pathological examination in microsatellite instability-high gastric cancer

Abstract Background The impact of microsatellite status on lymph node (LN) yield during lymphadenectomy and pathological examination has never been assessed in gastric cancer (GC). In this study, we aimed to appraise the association between microsatellite instability-high (MSI-H) and LN yield after curative gastrectomy. Methods We retrospectively analyzed 1757 patients with GC undergoing curative gastrectomy and divided them into two groups: MSI-H (n = 185(10.5%)) and microsatellite stability (MSS) (n = 1572(89.5%)), using a five-Bethesda-marker (NR-24, BAT-25, BAT-26, CAT-25, MONO-27) panel. The median LN count and the percentage of specimens with a minimum of 16 LNs (adequate LN ratio) were compared between the two groups. The log odds (LODDS) of positive LN count (PLNC) to negative LN count (NLNC) and the target LN examined threshold (TLNT(x%)) were calculated in both groups. Results Statistically significant differences were found in the median LN count between MSI-H and MSS groups for the complete cohort (30 vs. 28, p = 0.031), for patients undergoing distal gastrectomy (DG) (30 vs. 27, p = 0.002), for stage II patients undergoing DG (34 vs. 28, p = 0.005), and for LN-negative patients undergoing DG (28 vs. 24, p = 0.002). MSI-H was an independent factor for higher total LN count in patients undergoing DG (p = 0.011), but it was not statistically correlated to the adequate LN ratio. Statistically significant differences in PLNC, NLNC and LODDS were found between MSI-H GC and MSS GC (all p < 0.001). The TLNT(90%) for MSI-H and MSS groups were 31 and 25, respectively. TLNT(X%) of MSI-H GC was always higher than that of MSS GC regardless of the given value of X%. Conclusions MSI-H was associated with higher LN yield in patients undergoing gastrectomy for GC. Although MSI-H did not affect the adequacy of LN harvest, we speculate that a greater lymph node yield is required during pathological examination in MSI-H GC.

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A High Lymph Node Yield is Associated with Prolonged Survival in Elderly Patients Undergoing Curative Gastrectomy for Cancer: A Dutch Population-Based Cohort Study

Annals of Surgical Oncology ◽

10.1245/s10434-017-5815-5 ◽

2017 ◽

Vol 24 (8) ◽

pp. 2213-2223 ◽

Cited By ~ 6

Author(s):

Hylke J. F. Brenkman ◽

Lucas Goense ◽

Lodewijk A. Brosens ◽

Nadia Haj Mohammad ◽

Frank P. Vleggaar ◽

...

Keyword(s):

Cohort Study ◽

Lymph Node ◽

Elderly Patients ◽

Population Based ◽

Prolonged Survival ◽

Dutch Population ◽

Curative Gastrectomy ◽

Lymph Node Yield ◽

High Lymph Node ◽

Node Yield

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Fat clearance of upper gastrointestinal resection specimens increases lymph node yield and may result in nodal upstaging

Journal of Clinical Pathology ◽

10.1136/jclinpath-2018-205457 ◽

2018 ◽

Vol 72 (1) ◽

pp. 86-89

Author(s):

Jon Griffin ◽

Clare Bunning ◽

Asha Dubé

Keyword(s):

Lymph Node ◽

Gastrointestinal Cancers ◽

Historical Cohort ◽

Lymph Node Yield ◽

Patient Demographics ◽

Lymph Node Retrieval ◽

Nodal Upstaging ◽

The Impact ◽

Upper Gastrointestinal ◽

Node Yield

IntroductionLymph node retrieval and quantification is an important element in staging upper gastrointestinal cancers. Our department introduced fat clearance for oesophagectomy and gastrectomy specimens in 2014. This study assessed the impact of this change on lymph node yield and upstaging.MethodsWe reviewed histopathology data for upper gastrointestinal resection specimens. Patient demographics, clinical, macroscopic and microscopic data were compared with a historical cohort who did not undergo fat clearance.ResultsOf 158 patients, 133 resection specimens received fat clearance resulting in a significantly higher lymph node yield than the historical cohort (22 vs 13 lymph nodes, p<0.0001). Fat clearance found additional positive nodes in 24.1% of patients and increased the number of cases achieving a minimum node yield of 15. Nodes found by fat clearance caused upstaging in 15% of the cohort.DiscussionFat clearance increases node yield in upper gastrointestinal resection specimens and may cause nodal upstaging.

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Impact of Lymph Node Yield in Patients Undergoing Total Laryngectomy and Neck Dissection

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420964824 ◽

2020 ◽

pp. 000348942096482

Author(s):

Michael C. Topf ◽

Ramez Philips ◽

Joseph Curry ◽

Linda C. Magana ◽

Madalina Tuluc ◽

...

Keyword(s):

Radiation Therapy ◽

Lymph Node ◽

Neck Dissection ◽

Total Laryngectomy ◽

Single Institution ◽

Level Of Evidence ◽

Lymph Node Yield ◽

Positive Margins ◽

The Impact ◽

Node Yield

Objectives: To determine the impact of lymph node yield (LNY) in patients undergoing neck dissection at the time of total laryngectomy (TL). To determine the impact of radiation therapy (RT) on LNY. Methods: Retrospective review of LNY and clinical outcomes in 232 patients undergoing primary or salvage total laryngectomy (TL) with ND. Results: Preoperative RT significantly decreased mean LNY from 31.7 to 23.9 nodes ( P < .001). In primary TL patients, age ( P < .001) and positive margins ( P = .044) were associated with decreased OS. In salvage TL patients, only positive margins was associated with poorer OS ( P = .009). No LNY cutoff provided significant OS or DFS benefit. Conclusions: Radiotherapy significantly reduces LNY in patients undergoing TL and ND. Within a single institution cohort, positive margins, but not LNY, is associated with survival in both primary and salvage TL patients. Level of Evidence: 4

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