Utility of PET-CT CMR after neoadjuvant chemotherapy with DCF for esophageal cancer as a predictive factor of recurrence.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 434-434
Author(s):  
Suzuki Kosuke ◽  
Shibata Tomotaka ◽  
Nishiki Kohei ◽  
Fumoto Shoichi ◽  
Hirarsuka Takahiro ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Neoadjuvant Chemotherapy ◽  
Lymph Nodes ◽  
Accumulation Rate ◽  
Clinical Stage ◽  
Operation Time ◽  
Regional Lymph Nodes ◽  
Pet Ct ◽  
Significant Difference

434 Background: PET-CT is considered as standard modality for evaluating metastasis of esophageal cancer before treatment. On the other hand, it is unclear whether PET-CT CMR (complete metabolic response) could be useful for assessment after neoadjuvant chemotherapy. To clarify the utility of PET-CT CMR as an adequate modality of prediction for recurrence after neoadjuvant chemotherapy with DCF for esophageal cancer. Methods: Fifty-eight cases of esophageal cancer (cStageII-IVa) who received the esophagectomy with neoadjuvant chemotherapy of DCF since June 2013 in Oita University. We evaluated the clinicopathological factors, RFS and OS between CMR group (n=22, 38%) and non-CMR group (n=36, 62%). Results: In the clinical stage before chemotherapy, T-factor was higher in the non-CMR group (p = 0.044), but there were no significant differences of lymph node metastasis (p = 0.27) and stage (p = 0.94) between the two groups. There was no significant difference of the SUV max (16.4 ± 6.5 vs 15.7 ± 6.5, p = 0.98) of the main lesion before chemotherapy and the FDG accumulation rate of lymph nodes (14 cases (63.6%) vs 21 cases) (58.3%), p = 0.69) between the two groups. There were no significant differences of the surgical procedure, lymph node dissection area, number of harvested lymph nodes, amount of bleeding, operation time, curability, and intra/post-operative complications between the two groups. There were 5 cases (15%) with postoperative recurrence in the CMR group (lung 1 case, extra-regional lymph nodes 3 cases, bone 1 case), 17 cases (47%) in the non-CMR group (local 4 cases, lung 3 cases, livers 5 cases, extra regional lymph nodes 6 cases, bone 4 cases, pleura 2 cases), but there was no significant difference between the two groups (p = 0.062). There were significant differences between the two groups for 3-year RFS (81.3 vs 65.3 months, p=0.021) and 3-year OS (93.8 vs 61.6 months, p=0.011). Conclusions: PET-CR CMR could not predict recurrence at present. PET-CR CMR cases had better prognosis compared to non-CMR cases in terms of 3-year RFS and 3-years OS.

PS02.022: INDOCYANINE GREEN: A USEFUL TOOL IN MINIMALLY INVASIVE ESOPHAGEAL CANCER SURGERY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 126-126
Author(s):  
Victor Turrado-Rodriguez ◽  
Dulce Nombre De Maria Momblan ◽  
Ainitze Ibarzabal ◽  
Alba Torroella ◽  
Rafael Gerardo Diaz Del Gobo ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
Indocyanine Green ◽  
Esophageal Surgery ◽  
Gastric Conduit ◽  
Early Esophageal Cancer ◽  
Regional Lymph Nodes ◽  
Vascular Assessment

Abstract Background Minimally invasive approach to esophageal cancer has been accepted as the standard of care in many centers. Nontheless, some technical difficulties are encountered during surgery. A proper vascularization of the gastric tube is mandatory to avoid the dreadful complication of a leak or of gastric conduit necrosis. On the other hand, there is controversy on the identification of sentinel lymph node in early esophageal cancer and on the extent of lymphadenectomy in locally advanced tumours. Indocyanine green (ICG) is a sterile, anionic, water-soluble but relatively hydrophobic, tricarbocyanine molecule, which is bound to plasma proteins when intravenously injected. It is extracted by the liver appearing in the bile around 8 minutes after injection. When injected outside the blood vessels, ICG reaches the nearest lymph node within 15 minutes and after 1 to 2 hours it binds to the regional lymph nodes. The usual dose of ICG is 0.1 - 0.5mg/mL/kg. ICG becomes fluorescent once excited with near-infrared (NIR) light at about 820 nm. The fluorescence released by ICG may be detected using specially developed cameras. Methods A systematic review of the literature of ICG in esophageal surgery was carried on February 2018 using the following terms: esophagus, indocyanine green, ICG, surgery, angiography, lymph node, and combinations of the above. Results The technique of ICG angiography for vascular assessment of the gastroepiploic arcade and gastric conduit is explained and the published results are review. The use of ICG for the evaluation of sentinel lymph node in early esophageal cancer and of lymph node mapping for regional lymph nodes is explained and current evidence is reviewed. Conclusion ICG use in esophageal surgery is still a novel and promising technique. It could help to reduce anastomotic leak by means of vascular assessment of the gastric conduit, locate lymph nodes out of the usual fields of lymphadenectomy and locate the sentinel lymph node in early esophageal cancer Disclosure All authors have declared no conflicts of interest.

RA09.01: NORMAL LYMPH NODE APPEARANCE IN THE THORAX

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 39-40
Author(s):  
Tomas Hansen ◽  
Magnus Nilsson ◽  
Daniel Lindholm ◽  
Johan Sundström ◽  
Jakob Hedberg
Keyword(s):  
Computed Tomography ◽  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Conflicts Of Interest ◽  
Clinical Stage ◽  
Diagnostic Assessment ◽  
Clinical Staging ◽  
Short Axis ◽  
Nodal Stage

Abstract Background Modern treatment of esophageal cancer is multimodal and highly dependent on detailed diagnostic assessment of clinical stage which includes nodal stage. Clinical appraisal of nodal stage requires knowledge of normal radiological appearance, information of which is scarce. We aimed to describe lymph node appearance on computed tomography (CT) investigations in a randomly selected cohort of healthy subjects. Methods In a sample of 426 healthy Swedish volunteers aged 50–64 years, CT scans were studied in detail concerning intrathoracic node stations relevant in clinical staging of esophageal cancer. With stratification for sex, the short axis of visible lymph nodes was measured and distribution of lymph node sizes was calculated as well as proportion of patients with visible nodes above 5 and 10 millimeters for each station. Probability of having any lymph node station above 5 and 10 millimeters was calculated with a logistic regression model adjusted for age and sex. Results In the 214 men (age 57.3 ± 4.1 years) and 212 women (57.8 ± 4.4years) included in the study, a total of 309 (72.5%) had a lymph node with a short axis of 5 mm or above was seen in one of the node stations investigated. When using 10 mm as a cutoff, nodes were visible in 29 (6.81%) patients. Men had three times higher odds of having any lymph node with short axis 5 mm or above (OR 3.03 95% CI 1.89–4.85, P < 0.001) as well as 10mm or above (OR 2.31 95% CI 1.02–5.23, P = 0.044) compared to women. Higher age was not associated with propensity for lymph nodes above 5 or 10 millimeters in this sample. Conclusion In a randomly selected cohort of patients between 50 and 64 years, almost ten percent of the men and four percent of the women had lymph nodes above ten millimeters, most frequently in the subcarinal station (station 107). More than half of the patients had nodes above five millimeters on computed tomography and men were much more prone to have this finding. The probability of finding lymph nodes in specific stations relevant of esophageal cancer is now described. Disclosure All authors have declared no conflicts of interest.

Normal radiological lymph node appearance in the thorax

2018 ◽  
Vol 32 (10) ◽  
pp. 1-6 ◽  
Author(s):  
T Hansen ◽  
M Nilsson ◽  
D Lindholm ◽  
J Sundström ◽  
J Hedberg
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Healthy Subjects ◽  
Clinical Stage ◽  
Diagnostic Assessment ◽  
Clinical Staging ◽  
Short Axis ◽  
Swedish Population ◽  
Nodal Stage

SUMMARY Modern treatment of esophageal cancer is multimodal and highly dependent on a detailed diagnostic assessment of clinical stage, which includes nodal stage. Clinical appraisal of nodal stage is highly dependent on knowledge of normal radiological appearance, information of which is scarce. We aimed to describe lymph node appearance on computed tomography (CT) investigations in a randomly selected cohort of healthy subjects. In a sample of the Swedish Cardiopulmonary bioimage study, which investigates a sample of the Swedish population aged 50–64 years, the CT scans of 426 subjects were studied in detail concerning intrathoracic node stations relevant in clinical staging of esophageal cancer. With stratification for sex, the short axis of visible lymph nodes was measured and the distribution of lymph node sizes was calculated as well as proportion of patients with visible nodes above 5 and 10 millimeters for each station. Probability of having any lymph node station above 5 and 10 millimeters was calculated with a logistic regression model adjusted for age and sex. In the 214 men (aged: 57.3 ± 4.1 years) and 212 women (aged: 57.8 ± 4.4 years) included in this study, a total of 309 (72.5%) had a lymph node with a short axis of 5 mm or above was seen in at least one of the node stations investigated. When using 10 mm as a cutoff, nodes were visible in 29 (6.81%) of the subjects. Men had higher odds of having any lymph node with short axis 5 mm or above (OR 3.03 95% CI 1.89–4.85, P &lt; 0.001) as well as 10 mm or above (OR 2.31 95% CI 1.02–5.23, P = 0.044) compared to women. Higher age was not associated with propensity for lymph nodes above 5 or 10 millimeters in this sample. We conclude that, in a randomly selected cohort of patients between 50 and 64 years, almost 10% of the men and 4% of the women had lymph nodes above 10 millimeters, most frequently in the subcarinal station (station 107). More than half of the patients had nodes above 5 millimeters on CT and men were much more prone to have this finding. The probability of finding lymph nodes in specific stations relevant of esophageal cancer is now described.

Does Neoadjuvant Chemotherapy for Breast Cancer Affect Lymph Node Harvest Rates?

2019 ◽  
Vol 85 (7) ◽  
pp. 690-694
Author(s):  
Richard L. White ◽  
Pooja P. Palmer ◽  
Sally J. Trufan ◽  
Deba Sarma
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Neoadjuvant Chemotherapy ◽  
Lymph Nodes ◽  
Axillary Dissection ◽  
Axillary Lymph ◽  
Significant Difference ◽  
Chi Squared ◽  
Patient Groups ◽  
Neo Adjuvant Chemotherapy

Some authors report that patients receiving neoadjuvant chemotherapy have fewer lymph nodes harvested during axillary dissection and more dissections with < 10 nodes compared with patients who undergo surgery initially. We sought to determine whether there was a difference between these patient groups in terms of number of nodes harvested and number of dissections with < 10 nodes. Retrospective review of 258 patients diagnosed with breast cancer who underwent an axillary lymph node dissection between July 1,2015, and December 31, 2017 was performed. Chi-squared test was used to assess differences between patient groups. Of 258 patients undergoing dissection, 48 per cent received neoadjuvant chemotherapy; 52 per cent underwent surgery as first therapeutic intervention. Mean number of nodes resected; 14.3 + 6.3 for patients with no prior chemotherapy versus 14.9 + 6.6 for patients with neoadjuvant chemotherapy ( P = 0.48). For patients undergoing surgery as first intervention, 21 per cent had < 10 nodes harvested. For patients receiving neo-adjuvant chemotherapy, 20 per cent had < 10 nodes harvested. Patients who received neoadjuvant chemotherapy showed no statistically significant difference in the number of lymph nodes harvested during axillary dissection compared with patients undergoing surgery as first intervention. Neoadjuvant chemotherapy does not reduce the node harvest at the time of axillary dissection.

scholarly journals Impact of retrieved lymph nodes count on short-term complications in patients with gastric cancer: a retrospective study

2020 ◽  
Author(s):  
Feng Sun ◽  
Song Liu ◽  
Peng Song ◽  
Chen Zhang ◽  
Zhijian Liu ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Postoperative Complications ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Operation Time ◽  
Short Term ◽  
Node Metastasis ◽  
Significant Difference ◽  
Univariate Analyses

Abstract Background: It is well established that retrieved lymph nodes (RLNs) count were positively correlated with better overall survival in gastric cancer (GC). But little is known about the relationship between RLNs count and short-term complications after radical surgery. Methods: A total of 1487 consecutive GC patients between January 2016 and December 2018 at Nanjing Drum Tower Hospital were retrospectively analyzed. Univariate analyses were performed to elucidate the association between RLNs count and postoperative complications. We further identified clinical factors that might affect the RLNs count.Results: Among all of the patients, postoperative complications occurred in 435 (29.3%) patients. The mean RLNs count was 25.1 and 864 (58.1%) patients were diagnosed with lymph node metastasis. Univariate analyses showed no significant difference between RLNs count and postoperative complications (both overall and stratified by CDC grade). We further explored that preoperative serum albumin, type of resection, operation time, tumor invasion, lymph node metastasis, and pTNM stage were associated with RLNs count. Conclusions: The current study demonstrated that RLNs count was not associated with postoperative short-term complications following gastrectomy of GC, which provided a rationale for the determination of a proper RLNs count of curative gastrectomy.

scholarly journals Impact of Retrieved Lymph Nodes Count on Short-Term Complications in Patients with Gastric Cancer

2020 ◽  
Author(s):  
Feng Sun ◽  
Song Liu ◽  
Peng Song ◽  
Chen Zhang ◽  
Zhijian Liu ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Postoperative Complications ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Operation Time ◽  
Short Term ◽  
Node Metastasis ◽  
Significant Difference ◽  
Univariate Analyses

Abstract Background: It is well established that retrieved lymph nodes (RLNs) count were positively correlated with better overall survival in gastric cancer (GC). But little is known about the relationship between RLNs count and short-term complications after radical surgery. Methods: A total of 1487 consecutive GC patients between January 2016 and December 2018 at Nanjing Drum Tower Hospital were retrospectively analyzed. Univariate analyses were performed to elucidate the association between RLNs count and postoperative complications. We further identified clinical factors that might affect the RLNs count.Results: Among all of the patients, postoperative complications occurred in 435 (29.3%) patients. The mean RLNs count was 25.1 and 864 (58.1%) patients were diagnosed with lymph node metastasis. Univariate analyses showed no significant difference between RLNs count and postoperative complications (both overall and stratified by CDC grade). We further explored that preoperative serum albumin, type of resection, operation time, tumor invasion, lymph node metastasis, and pTNM stage were associated with RLNs count. Conclusions: The current study demonstrated that RLNs count was not associated with postoperative short-term complications following gastrectomy of GC, which provided a rationale for the determination of a proper RLNs count of curative gastrectomy.

Correlation between change of FA score and postoperative recurrence in esophageal cancer patients who received neoadjuvant treatment.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 41-41
Author(s):  
Satoru Matsuda ◽  
Hiroya Takeuchi ◽  
Kazumasa Fukuda ◽  
Rieko Nakamura ◽  
Tsunehiro Takahashi ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Cancer Patients ◽  
Clinical Stage ◽  
Univariate Analysis ◽  
Neoadjuvant Treatment ◽  
Postoperative Recurrence ◽  
Transthoracic Esophagectomy ◽  
Clinicopathological Factors ◽  
Significant Difference

41 Background: We previously reported that fibrinogen and albumin score (FA score), which was consisted of plasma fibrinogen level (FNG) and serum albumin level (Alb), was shown to predict postoperative survival in esophageal cancer patients who underwent transthoracic esophagectomy. In this study, in patients who received neoadjuvant chemotherapy (NAC), change of FA score during NAC was reviewed and the correlation with recurrence free survival (RFS) was investigated. Methods: We retrospectively reviewed 125 patients who received neoadjuvant chemotherapy and underwent transthoracic esophagectomy in our institution between 2001 and 2012. FNG and Alb before (preTx) and after (preope) NAC were confirmed in 92 patients. Based on our previous reports, patients with elevated fibrinogen ( > 350 mg/dL) and decreased albumin ( < 3.8 g/dl) levels were allocated a FA score of 2, those with only one of these abnormalities were allocated a FA score of 1, and those with neither of these abnormalities were allocated a FA score of 0. Regarding change of FA score, based on the preTx and preope FA score, we classified into decrease group and increase (no change or increase) group. Patient characteristics, clinicopathological factors, preTx FA score, and preope FA score were reviewed, and correlation with RFS was investigated. Results: The number of preTx and preope FA score 0/1/2 was 39/41/12, 36/37/19. Regarding change of FA score, FA score decreased in 70 patients (76%), increased in 22 (24%). There was no significant difference in patient background and clinicopathological factors between groups. In survival univariate analysis, change of FA score (Increase group, HR 2.023, p = 0.025) were significantly correlated with RFS. In multivariate analysis, using preTx clinical stage as a covariate, FA score was shown to be an independent predict factor (Increase group, HR 2.076, p = 0.023) for RFS significantly. Conclusions: Change of FA score between before and after NAC was shown to be a predictive factor of RFS in esophageal cancer patients who received NAC. Both fibrinogen and albumin are popular indicators routinely measured in daily clinical practice, FA score may be highly validate and feasible.

PS02.068: CORRELATION BETWEEN 18F-FDG PET/CT METABOLIC PARAMETERS AND LYMPH NODE METASTASIS OF ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 139-140
Author(s):  
Jiancheng Li ◽  
Shaoxing Chen ◽  
Haishan Wu ◽  
Zhiyu Huan
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Roc Curve ◽  
Diagnostic Value ◽  
Primary Lesion ◽  
Metabolic Parameters ◽  
Regional Lymph Nodes ◽  
Node Metastasis ◽  
Pet Ct

Abstract Background The regional lymph nodes metastasis plays a crucial role in treatment strategies selection. Nowadays, computed tomography (CT) scan and endoscopic ultrasound (EUS) were main examination techniques to assess the regional lymph nodes metastasis. PET/CT metabolic parameters correlated to the lymph node metastasis, but the value of the prediction of lymph node metastasis need to be confirmed in additional studies. Methods 82 esophageal cancer patients that were pathologically confirmed and received initial treatment in our hospital from October 2011 to September 2016 were retrospectively analyzed. All patients underwent systemic 18F-FDG PET/CT examination within two weeks before operation. The metabolic parameters of primary lesions and postoperative pathological lymph node metastasis of esophageal cancer patients were recorded. The correlation between lymph node metastasis and metabolic parameters of primary lesion of esophageal cancer were analyzed by ROC curve and logistic binary regression. Results 1. The correlation between metabolic parameters of primary lesion (including SUVmax, SUVmean, MTV, TLG, HF) and lymph node metastasis were analyzed by ROC curve and logistic binary regression. Results showed that the P value obtained from the two methods was less than 0.05, suggesting that there was correlation between metabolic parameters of primary lesion and lymph node metastasis of esophageal cancer. 2. Multivariate analysis showed that only TLG had statistical significance, P = 0.027, suggesting that TLG of primary lesion had a certain diagnostic value for the lymph node metastasis of esophageal cancer. 3. ROC curve analysis showed that, the area under the curve (AUC) was 0.722 when TLG > 24.08, P = 0.001, suggesting that the minimum TLG of lymph node metastasis of esophageal cancer was 24.08. In addition, the thoracic esophageal cancers at the upper and middle segment were statistically significant. When TLG > 23.06, its AUC was 0.755, P = 0.001, suggesting that the minimum TLG was 23.06. Conclusion 18FDG-PET/CT metabolic parameters (SUVmax, SUVmean, MTV, TLG, HF) is closely related to lymph node metastasis of esophageal cancer. The TLG has a certain diagnostic value for the lymph node metastasis of esophageal cancer. Disclosure All authors have declared no conflicts of interest.

scholarly journals Impact of Retrieved Lymph Nodes Count on Short-term Complications in Patients With Gastric Cancer: A Retrospective Study

2020 ◽  
Author(s):  
Feng Sun ◽  
Song Liu ◽  
Peng Song ◽  
Chen Zhang ◽  
Zhijian Liu ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Postoperative Complications ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Operation Time ◽  
Short Term ◽  
Node Metastasis ◽  
Significant Difference ◽  
Univariate Analyses

Abstract Background:It is well established thatretrieved lymph nodes (RLNs) count were positively correlated with better overall survival in gastric cancer (GC). But little is known about the relationship between RLNs count and short-term complications after radical surgery.Methods: A total of 1487 consecutive GC patients between January 2016 and December 2018 at Nanjing Drum Tower Hospital were retrospectively analyzed. Univariate analyses were performed to elucidate the association between RLNs count and postoperative complications. We further identified clinical factors that might affect the RLNs count.Results: Among all of the patients, postoperative complications occurred in 435 (29.3%) patients. The mean RLNs count was 25.1 and 864 (58.1%) patients were diagnosed with lymph node metastasis. Univariate analyses showed no significant difference between RLNscount and postoperative complications (both overall and stratified by CDC grade). We further explored that preoperative serum albumin, type of resection, operation time, tumor invasion, lymph node metastasis, and pTNM stage were associated with RLNs count.Conclusions: The current study demonstrated that RLNs count was not associated with postoperative short-term complications following gastrectomy of GC, which provided a rationale for the determination of a proper RLNs count of curative gastrectomy.

scholarly journals Normalization of lymphocyte count after high ablative dose of I-131 in a patient with chronic lymphoid leukemia and secondary papillary carcinoma of the thyroid. Case report

2014 ◽  
Vol 12 (1) ◽  
pp. 100-105
Author(s):  
Anneliese Rosmarie Gertrud Fischer Thom ◽  
Nelson Hamerschlak ◽  
Verônica Goes Teles ◽  
Akemi Osawa ◽  
Fabio Pires de Souza Santos ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Papillary Carcinoma ◽  
Radioiodine Therapy ◽  
Radiation Treatment ◽  
Thyroid Tissue ◽  
Regional Lymph Nodes ◽  
Lymphoid Leukemia ◽  
Chronic Lymphoid Leukemia ◽  
Pet Ct

The authors report the case of a 70-year-old male patient with chronic lymphoid leukemia who presented subsequently a papillary carcinoma of the thyroid with metastases to regional lymph nodes. The patient was treated with surgical thyroidectomy with regional and cervical lymph node excision and radioiodine therapy (I-131). The protocolar control scintigraphy 4 days after the radioactive dose showed I-131 uptake in both axillae and even in the inguinal regions. PET/CT showed faint FDG-F-18 uptake in one lymph node of the left axilla. An ultrasound guided fine needle biopsy of this lymph node identified by I-131 SPECT/CT and FDG-F-18 PET/CT revealed lymphoma cells and was negative for thyroid tissue and thyroglobulin content. The sequential blood counts done routinely after radiation treatment showed a marked fall until return to normal values of leucocytes and lymphocytes (absolute and relative), which were still normal in the last control 19 months after the radioiodine administration. Chest computed tomography showed a decrease in size of axillary and para-aortic lymph nodes. By immunohistochemistry, cells of the lymphoid B lineage decreased from 52% before radioiodine therapy to 5% after the procedure. The authors speculate about a possible sodium iodide symporter expression by the cells of this lymphoma, similar to some other non-thyroid tumors, such as breast cancer cells.

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