Factors Predictive of Tumor-Positive Nonsentinel Lymph Nodes After Tumor-Positive Sentinel Lymph Node Dissection for Melanoma

2004 ◽  
Vol 22 (18) ◽  
pp. 3677-3684 ◽  
Author(s):  
Jonathan H. Lee ◽  
Richard Essner ◽  
Hitoe Torisu-Itakura ◽  
Leslie Wanek ◽  
Hejing Wang ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Dissection ◽  
Tumor Size ◽  
Risk Group ◽  
Wald Test ◽  
Positive Sentinel Lymph Node ◽  
High Risk Group ◽  
Node Dissection ◽  
Nodal Disease ◽  
Univariate Analyses

Purpose Approximately 20% of sentinel node (SN) positive melanoma patients have additional non-SN (NSN) metastasis. The rationale for this study was to identify the factors associated with additional nodal disease, as a method to determine which patients may most benefit from completion lymph node dissection (CLND). Patients and Methods During 1990 to 2002, 1,599 patients have undergone SN biopsy at our institute. 19.5% underwent CLND for tumor-positive SN. One hundred ninety-one of these patients had clinicopathologic information available for review. Univariate analyses used χ2 test, Wilcoxson rank sum test, and χ2 test for trend. Multivariate analyses used logistic regression and Wald test. Results Forty-six (24%) patients had tumor-positive NSN. Univariate analyses showed that primary thickness (Breslow and Clark), primary site, SN tumor size, and number of tumor-positive SNs were significantly associated with tumor-positive NSN. Multivariate analysis (167 patients), confirmed that Breslow and SN tumor size were independently predictive. Sex, histology, ulceration, mitotic index, and SN basin location were not predictive. Risk stratification by the number of prognostic factors present (Breslow ≥ 3 mm and SN tumor size ≥ 2 mm) showed that probability of finding tumor-positive NSN was 12.3% in the low-risk group (0 factors), 30.9% in the intermediate-risk group (1 factor), and 41.9% in the high-risk group (2 factors). Conclusion Thicker primary and larger SN tumor size are factors that correlate best with tumor-positive NSN. Although none of these factors are absolutely predictive of residual nodal disease, these factors must be strongly considered if the SN contains metastasis, as they provide enhanced risk assessment for NSN tumor-positivity.

2001 NODAL DISEASE IN THE SETTING OF METASTATIC RENAL CELL CARCINOMA CAN A LYMPH NODE DISSECTION POTENTIALLY ALTER PATIENT OUTCOMES?

2012 ◽  
Vol 187 (4S) ◽  
Author(s):  
Brian F. Chapin ◽  
Scott E. Delacroix ◽  
Patrick A. Kemney ◽  
Graciela M. Nogueras-Gonzalez ◽  
Pheroze Tamboli ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Lymph Node ◽  
Cell Carcinoma ◽  
Patient Outcomes ◽  
Lymph Node Dissection ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Node Dissection ◽  
Nodal Disease ◽  
Alter Patient

Axillary Recurrence is Low in Patients with Breast Cancer who do not Undergo Completion Axillary Lymph Node Dissection for Micrometastases in Sentinel Lymph Nodes

2010 ◽  
Vol 76 (10) ◽  
pp. 1088-1091 ◽  
Author(s):  
Jessica Rayhanabad ◽  
Sara Yegiyants ◽  
Krishna Putchakayala ◽  
Philip Haigh ◽  
Lina Romero ◽  
...  
Keyword(s):  
Lymph Node ◽  
Axillary Lymph Node Dissection ◽  
Lymph Node Dissection ◽  
Axillary Lymph Node ◽  
Retrospective Chart Review ◽  
Positive Sentinel Lymph Node ◽  
Lymph Node Biopsy ◽  
Axillary Recurrence ◽  
Axillary Lymph ◽  
Node Dissection

Completion axillary lymph node dissection (CLND) is presently the standard of care after a positive sentinel lymph node biopsy (SLNB). We hypothesize that the incidence of axillary recurrence in patients who do not undergo CLND for micrometastases is low, and CLND is not necessary for locoregional control. We performed a retrospective chart review of patients with invasive breast carcinoma and micrometastases detected on SLNB. The Memorial Sloan Kettering Nomogram (MSKN) predicting the likelihood of nonsentinel lymph node (NSN) metastases was compared with the incidence of positive NSN. There were 61 patients identified with a mean follow-up of 70 months. The average tumor size was 2 cm. The median number of positive SLNs was one. Twenty-eight (46%) patients had a CLND; of these, 20 patients had one positive NSN (2 of 28 [7%]) and the mean MSKN score was 12 per cent. There were 33 (54%) patients who had SLNB alone, and their mean MSKN score was 13 per cent. Axillary recurrence in this group was 1.6 per cent. We conclude the incidence of axillary recurrence in patients with micrometastases detected by SLN biopsy who do not undergo CLND is low. The use of a predictive nomogram to estimate likelihood of metastatic disease to NSN may overestimate the actual incidence of positive NSN in patients with micrometastases.

An Evaluation of Frozen Section and Lymph Node Dissection Results for Mucinous Ovarian Tumors

2018 ◽  
Vol 28 (1) ◽  
pp. 92-98 ◽  
Author(s):  
Marisa R. Moroney ◽  
Miriam D. Post ◽  
Amber A. Berning ◽  
Jeanelle Sheeder ◽  
Bradley R. Corr
Keyword(s):  
Lymph Node ◽  
Lymph Node Dissection ◽  
Tumor Size ◽  
Frozen Section ◽  
Ovarian Tumors ◽  
Node Dissection ◽  
Cross Sectional ◽  
Mucinous Histology ◽  
Final Pathology ◽  
Mucinous Ovarian Tumors

ObjectivesIntraoperative frozen section has greater than 90% accuracy for ovarian tumors; however, mucinous histology has been shown to be associated with increased frozen section inaccuracy. Recent data demonstrate that primary ovarian mucinous carcinomas have no lymph node involvement, even when extraovarian disease is present, and therefore may not require lymph node dissection. Our primary objective is to evaluate the accuracy of identifying mucinous histology on frozen section.Methods/MaterialsA cross-sectional review of mucinous ovarian tumors in surgical patients at one institution from 2006 to 2016 was performed. Cases reporting a mucinous ovarian tumor on frozen section or final pathology were identified. Frozen section results were compared with final diagnosis to calculate concordance rates. Analyses with χ2 and t tests were performed to identify variables associated with pathology discordance.ResultsA total of 126 mucinous ovarian tumors were identified. Of these, 106 were reported as mucinous on frozen section and 103 (97.2%) were concordant on final pathology. Discordant cases included 2 serous and 1 clear cell tumor. Among the 103 mucinous tumors, classification as malignant, borderline, or benign was concordant in 74 (71.8%) of 103 cases, whereas 22 (21.4%) of 103 were discordant and 7 (6.8%) were deferred to final pathology. Lymph node dissection was performed in 33 cases; the only case with lymph node metastasis was a gastrointestinal mucinous adenocarcinoma. Discordance between frozen section and final pathology was associated with larger tumor size and diagnosis other than benign: discordant cases had a mean tumor size of 21.7 cm compared with 14.4 cm for concordant cases (P < 0.001), and 93.5% of discordant cases were borderline or malignant, compared with 30.5% of concordant cases (P < 0.001).ConclusionsIntraoperative identification of mucinous histology by frozen section is reliable with a concordance rate to final pathology of 97.2%. No lymph node metastases were present in any malignant or borderline primary ovarian cases.

scholarly journals [Table 5.5.a.1] Tumor size and treatment (rate of resectability) [Figure 5.5.a.2] Cumulative survival of the patients after pancreatectomy for TS1 cancer according to residual tumors [Figure 5.5.a.3] Cumulative survival of the patients with TS1 cancer according to extent of lymph node dissection [Figure 5.5.a.4] Combined resection of portal vein and cumulative survival of the patients after pancreatectomy for TS1 cancer of UICC Stage IIa or IIb in the pancreatic head [Figure 5.5.a.5] Combined resection of peripancreatic plexus and cumulative survival of the patients after pancreatectomy for TS1 cancer of UICC Stage IIa or IIb in the pancreatic head [Figure 5.5.a.6] Combined resection of peripancreatic plexus when there is no plexus infiltration and cumulative survival of the patients after pancreatectomy for TS1 cancer of UICC Stage IIa or IIb in the pancreatic head [Figure 5.5.a.7] Combined resection of artery and cumulative survival of the patients after pancreatectomy for TS1 cancer of UICC Stage IIa or IIb in the pancreatic head [Figure 5.5.a.8] Combined resection of portal vein and cumulative survival of the patients after pancreatectomy for TS2 (2.1-4.0 cm) cancer of UICC Stage IIa or IIb in the pancreatic head [Figure 5.5.a.9] Combined resection of peripancreatic plexus and cumulative survival of the patients after pancreatectomy for TS2 (2.1-4.0 cm) cancer of UICC Stage IIa or IIb in the pancreatic head

Suizo ◽  
2007 ◽  
Vol 22 (1) ◽  
pp. e239-e247
Keyword(s):  
Lymph Node ◽  
Portal Vein ◽  
Lymph Node Dissection ◽  
Tumor Size ◽  
Pancreatic Head ◽  
Uicc Stage ◽  
Node Dissection ◽  
Treatment Rate ◽  
Cumulative Survival ◽  
Combined Resection

scholarly journals Utilization and impact of surgical technique on the performance of pelvic lymph node dissection at radical prostatectomy: Results from the SEARCH database.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 73-73
Author(s):  
Kathleen F. McGinley ◽  
Xizi Sun ◽  
Lauren E. Howard ◽  
William J. Aronson ◽  
Martha K. Terris ◽  
...  
Keyword(s):  
Lymph Node ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Surgical Technique ◽  
Lymph Node Dissection ◽  
Risk Group ◽  
Pelvic Lymph Node Dissection ◽  
Low Risk ◽  
Node Dissection ◽  
Over Time

73 Background: Performance of a pelvic lymph node dissection (PLND) with radical prostatectomy (RP) is critical for staging and treatment of high-risk prostate cancer (PC). Conversely, performance of a PLND in low-risk PC contributes to morbidity with minimal benefit. Robot-assisted laparoscopic RP (RARP) is associated with decreased PLND use. We evaluated PLND use over time, stratified by PC risk group and surgical technique. Methods: We used SEARCH to identify men who had open RP (ORP) or RARP from 2006-2013 with complete data. Univariable logistic regression was used to test the association between age, race, BMI, number of positive cores, AUA risk group, year, center, and surgical technique on PLND use. Multivariable logistic analysis was used to examine surgical technique and PLND performance stratified by AUA risk-group. Spearman correlation was used to examine temporal changes in PLND utilization stratified by risk-group and surgical technique. Results: 1,439 men met inclusion criteria. Of these, 66% had a PLND. On univariable analysis, age, year, number of positive cores, AUA risk group, center, and surgical technique were significantly associated with PLND performance (all p<0.02). On multivariable analysis, when adjusted for age, race, BMI, number of positive cores, year, and center, RARP was associated with a 89% decreased use of PLND in the low-risk group, 85% decreased in intermediate risk, and 86% decreased in high risk men (all p≤0.002). Over time, PLND was increasingly used with RARP in low-risk patients (p=0.022); a trend of increased PLND performance with RARP in high risk men was noted (p=0.077) reaching ~85% in 2012-2013 vs. ~95% in ORP. For ORP, PLND use did not significantly change over time except a trend of fewer PLND in low-risk men which decreased to ~35% (p=0.064) in 2012-2013. Conclusions: Regardless of risk group, PLND is markedly less likely to be performed when a RARP is done. While improved over time, PLND remains over-utilized in low-risk men and under-utilized in high risk men regardless of surgical technique.

Clinico-epidemiologic characteristics and patterns of care in Merkel cell carcinoma: Data from a single-institution series.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21049-e21049
Author(s):  
Michael Del Rosario ◽  
Eric Anderson ◽  
Yani Lu ◽  
Stephanie Farrell ◽  
Steven C. Plaxe ◽  
...  
Keyword(s):  
Lymph Node ◽  
Statistical Analysis ◽  
Cell Carcinoma ◽  
Lymph Node Dissection ◽  
Merkel Cell Carcinoma ◽  
Tumor Size ◽  
Primary Tumor ◽  
Merkel Cell ◽  
Node Dissection ◽  
Primary Tumor Size

e21049 Background: Merkel cell carcinoma (MCC) is associated with increased sun exposure. There is an average of 348 days of sunshine per year in our geographic area. Methods: With the IRB approval, we performed a retrospective chart review of all consecutive MCC patients seen at our institution between 2006-2017. Clinico-epidemiologic data such as age, gender, race, stage, tumor size, stage at presentation, and disease course were collected. Therapy and survival were analyzed. Using the surveillance, epidemiology, and end results program (SEER), we identified 4,256 patients with MCC from the years 2006-2013. We compared our data with the SEER findings . Statistical analysis: Chi-square and Fishers’ exact tests were used to assess the significance of associations in large and small populations, respectively. Survival analyses were performed using the Cox proportional hazards. Results: We identified 40 patients with MCC (n = 40) with a median age of 77. Compared to SEER data, our population was entirely Caucasian (100% vs. 95%; p = 0.11) and male predominant (75% vs. 63%; p = 0.11). The patients in our cohort were diagnosed more often with TNM stage I (50% vs. 39%; p = 0.00003) and found to have more often a primary tumor size < 2cm (58% vs. 34%; p < 0.01). Our patients were more frequently treated with lymph node dissection (70% vs. 63%, p = 0.002) and radiation therapy (60% vs. 50%; p = 0.24). Conclusions: Compared to the general population, MCC patients treated at our institution had similar mean age at diagnosis, gender and racial distribution and radiation treatment frequency (all p-values > 0.05). However, our patient population was significantly more likely to be diagnosed at stage I disease, have a primary tumor size less than 2 cm and receive lymph node dissection. Final statistical analysis, including survival analysis, and significance are to be discussed.

Inguinal Lymph Node Dissection Does Not Improve Overall Survival in Anal Cancer Nodal Disease

2020 ◽  
Vol 255 ◽  
pp. 13-22
Author(s):  
Andrew C.H. Lin ◽  
Abraham Hakim ◽  
Alec S. Kellish ◽  
Puja Singh ◽  
Marisa Wozniak ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lymph Node ◽  
Lymph Node Dissection ◽  
Anal Cancer ◽  
Inguinal Lymph Node ◽  
Node Dissection ◽  
Nodal Disease ◽  
Inguinal Lymph Node Dissection

Prognostic assessments in patients with upper tract urothelial carcinoma undergoing radical nephroureterectomy and systematic regional lymph node dissection

2021 ◽  
pp. 039156032110349
Author(s):  
Ryo Sato ◽  
Kyohei Watanabe ◽  
Yuto Matsushita ◽  
Hiromitsu Watanabe ◽  
Daisuke Motoyama ◽  
...  
Keyword(s):  
Lymph Node ◽  
Urothelial Carcinoma ◽  
Lymph Node Dissection ◽  
Regional Lymph Node ◽  
Upper Tract Urothelial Carcinoma ◽  
Radical Nephroureterectomy ◽  
Node Dissection ◽  
Upper Tract ◽  
Regional Lymph Node Dissection ◽  
Univariate Analyses

Objectives: Systematic regional lymph node dissection (LND) combined with radical nephroureterectomy (RNU) has been reported to improve the outcomes of upper tract urothelial carcinoma (UTUC) patients. The objective of the present study was to assess the prognostic outcomes of UTUC patients undergoing systematic regional LND combined with RNU. Patients and methods: We conducted a retrospective evaluation of prognostic outcomes of 68 consecutive UTUC patients treated with RUN and systematic regional LND. Results: The median durations of recurrence-free survival (RFS) and overall survival (OS) were 45 and 166 months, respectively. Univariate analyses of several parameters showed that despite the lack of a significant predictor for RFS, the presence of lymph node metastasis correlated with poor OS. Conclusion: These results suggest that comparatively favorable outcomes are achievable in UTUC patients by RNU and systematic regional LND; however, special attention is needed for patients with nodal involvement even after systematic regional LND due to the adverse impact of this factor on OS.

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