scholarly journals Lymph node metastases near the celiac trunk should be considered separately from other nodal metastases in patients with cancer of the esophagus or gastroesophageal junction after neoadjuvant treatment and surgery

2018 ◽  
Vol 10 (3) ◽  
pp. 1511-1521 ◽  
Author(s):  
Sjoerd M. Lagarde ◽  
Martinus C. J. Anderegg ◽  
Suzanne S. Gisbertz ◽  
Sybren L. Meijer ◽  
Maarten C. C. M. Hulshof ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastases ◽  
Gastroesophageal Junction ◽  
Neoadjuvant Treatment ◽  
Celiac Trunk ◽  
Nodal Metastases ◽  
Patients With Cancer ◽  
Cancer Of The Esophagus ◽  
Node Metastases

PS02.084: PROSPECTIVE EVALUATION OF 18F-FDG PET-CT AFTER NEOADJUVANT CHEMORADIOTHERAPY FOR DETECTING LYMPH NODE METASTASES NEAR THE CELIAC TRUNK IN PATIENTS WITH ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 144-144
Author(s):  
Jasper Groen ◽  
Suzanne Gisbertz ◽  
Mark I Van Berge Henegouwen ◽  
Annelijn E Slaman ◽  
Sybren Meijer ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastases ◽  
Predictive Value ◽  
Neoadjuvant Chemoradiotherapy ◽  
Celiac Trunk ◽  
Pet Ct ◽  
Resection Specimen ◽  
Node Metastases ◽  
18F Fdg

Abstract Background Celiac trunk metastases are an independent factor for inferior survival in patients with esophageal cancer. Detecting these metastases before esophagostomy would aid clinical decision making. The aim of our study was to evaluate the accuracy of integrated PET and CT (PET-CT) using 18F-FDG in detecting these metastases in patients with esophageal cancer after neoadjuvant chemoradiotherapy (nCRTx) followed by esophagectomy. Methods All patients with a carcinoma of the mid-to-distal esophagus or the gastroesophageal junction (GEJ) who underwent esophageal resection with curative intent following nCRTx between January 2011 and January 2017 were included. The PET-CT scans after nCRTx were reviewed by nuclear radiologists and lymph nodes within a margin of 2 cm around the celiac trunk were expressed in SUVmax. Lymph nodes with SUVmax > 2.0 were deemed positive. The truncal nodes were extracted during esophagectomy and reviewed by different pathologists using standard pathology protocol. To assess the accuracy of the PET-CT in detecting lymph node metastases near the celiac trunk the sensitivity, specificity and positive and negative predictive value were calculated. Results A total of 448 patients were included. There were 24 patients (5.4%) with positive truncal nodes on the PET-CT versus 424 patients (90.6%) with negative truncal nodes on the PET-CT. Out of these 24 patients 20 (83.3%) had truncal node metastases confirmed in the resection specimen (positive predictive value of 83.3%). In the other 424 patients 40 (9.4%) had truncal node metastases confirmed in the resection specimen (negative predictive value of 90.6%). This results in a sensitivity of 33.3% and a specificity of 99.0%. Conclusion The sensitivity and specificity of the PET-CT in detecting lymph node metastases near the celiac trunk in patients with esophageal cancer who underwent nCRTx were respectively 33.3% and 99.0% This shows that the PET-CT is accurate in detecting truncal lymph node metastases in this patient group. Disclosure All authors have declared no conflicts of interest.

scholarly journals The Value of Paratracheal Lymphadenectomy in Esophagectomy for Adenocarcinoma of the Esophagus or Gastroesophageal Junction: A Systematic Review of the Literature

2021 ◽  
Author(s):  
Amaia Gantxegi ◽  
B. Feike Kingma ◽  
Jelle P. Ruurda ◽  
Grard A. P. Nieuwenhuijzen ◽  
Misha D. P. Luyer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Lymph Node ◽  
Lymph Node Metastases ◽  
Mediastinal Lymph Node ◽  
Gastroesophageal Junction ◽  
Transthoracic Esophagectomy ◽  
Mediastinal Lymphadenectomy ◽  
Node Metastases ◽  
Upper Mediastinum ◽  
Mediastinal Lymph Node Metastases

Abstract Background The role of upper mediastinal lymphadenectomy for distal esophageal or gastroesophageal junction (GEJ) adenocarcinomas remains a matter of debate. This systematic review aims to provide a comprehensive overview of evidence on the incidence of nodal metastases in the upper mediastinum following transthoracic esophagectomy for distal esophageal or GEJ adenocarcinoma. Methods A literature search was performed using Medline, Embase and Cochrane databases up to November 2020 to include studies on patients who underwent transthoracic esophagectomy with upper mediastinal lymphadenectomy for distal esophageal and/or GEJ adenocarcinoma. The primary endpoint was the incidence of metastatic nodes in the upper mediastinum based on pathological examination. Secondary endpoints were the definition of upper mediastinal lymphadenectomy, recurrent laryngeal nerve (RLN) palsy rate and survival. Results A total of 17 studies were included and the sample sizes ranged from 10-634 patients. Overall, the median incidence of upper mediastinal lymph node metastases was 10.0% (IQR 4.7-16.7). The incidences of upper mediastinal lymph node metastases were 8.3% in the 7 studies that included patients undergoing primary resection (IQR 2.0-16.6), 4,4% in the 1 study that provided neoadjuvant therapy to the full cohort, and 10.6% in the 9 studies that included patients undergoing esophagectomy either with or without neoadjuvant therapy (IQR 8.9-15.8%). Data on survival and RLN palsy rates were scarce and inconclusive. Conclusions The incidence of upper mediastinal lymph node metastases in distal esophageal adenocarcinoma is up to 10%. Morbidity should be weighed against potential impact on survival.

856 NODAL METASTASES AFTER NEOADJUVANT CHEMORADIATION AND R0 RESECTION IN ESOPHAGEAL ADENOCARCINOMA: PATTERNS AND PROGNOSIS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Caitlin Harrington ◽  
Rebecca Carr ◽  
Smita Sihag ◽  
Prasad Adusumilli ◽  
Manjit Bains ◽  
...  
Keyword(s):  
Lymph Node ◽  
Esophageal Adenocarcinoma ◽  
Lymph Node Metastases ◽  
Cox Regression ◽  
Neoadjuvant Chemoradiation ◽  
Nodal Metastasis ◽  
Nodal Metastases ◽  
Risk Of Recurrence ◽  
Increased Risk ◽  
Node Metastases

Abstract   Although the pattern of nodal metastasis and the prognosis of number and location of positive nodes have been well described with esophageal cancer undergoing upfront surgery, little is known about nodal metastasis after neoadjuvant treatment. The aim of this study is to assess the pattern of nodal metastases in esophageal adenocarcinoma treated with neoadjuvant chemoradiation and surgery and evaluate its effect on prognosis. Methods All patients with esophageal adenocarcinoma who had undergone neoadjuvant chemoradiation and an R0 esophagectomy between 2010 and 2018 at our institution were included (n = 577). Pathology reports were reviewed for sites of lymph node metastases. Patients were excluded if nodal stations were not listed separately (n = 40). Age, sex, race, tumor location, TRG, pT stage, number of positive lymph nodes, number of positive nodal stations, and specific nodal stations were analyzed for risk of recurrence using univariable Cox regression, and significant covariates were included in multivariable Cox regression model. Results Of 537 patients, 193(36%) had pathologic nodal metastases. 153 patients(28%) had single-station disease: 135(88%) at the paraesophageal station, 16(10%) at the left gastric, 1 at the subcarinal and 1 at the paratracheal station(0.65% each). 32 patients(6.0%) had two-station and 8(1.5%) had three-station disease. The majority of patients with multiple positive nodal stations had positive nodes in the paraesophageal(90%) and/or left gastric artery stations(60%). On multivariable analysis, the number of positive nodal stations (HR 1.59, CI 1.35–1.84, p < 0.001), subcarinal (HR 2.78, CI 1.54–5.03, p < 0.001), and paraesophageal stations (HR 2.0, CI 1.58–2.54, p < 0.001) were associated with increased risk of recurrence. Conclusion Patients who have undergone neoadjuvant and R0 esophagectomy for adenocarcinoma often have lymph node metastases at time of surgery, most commonly at the paraesophageal station. The number of nodal stations, along with subcarinal and paraesophageal metastases, were associated with increased risk of recurrence.

The risk of nodal metastasis in early adenocarcinoma of the uterine cervix*

2004 ◽  
Vol 14 (1) ◽  
pp. 104-109 ◽  
Author(s):  
J. Balega ◽  
H. Michael ◽  
J. Hurteau ◽  
D. H. Moore ◽  
J. Santiesteban ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastases ◽  
Medical Center ◽  
Conservative Surgery ◽  
Disease Recurrence ◽  
Nodal Metastasis ◽  
Pelvic Lymphadenectomy ◽  
Depth Of Invasion ◽  
Nodal Metastases ◽  
Node Metastases

A functional and widely accepted definition of microinvasive cervical adenocarcinoma remains elusive. The purpose of this study was to determine at which depth of invasion the likelihood of lymph node metastasis or disease recurrence was so small that conservative surgery could be considered appropriate. Charts of patients with adenocarcinoma of the cervix (ACC) who underwent radical hysterectomy and pelvic lymphadenectomy (n = 98) at Indiana University Medical Center from 1987 to 1998 were retrospectively reviewed. Patients with stage IA1–IB1 lesions were included in the study. Patients treated with preoperative radiotherapy were excluded. Pathologic parameters evaluated included histologic type, depth of stromal invasion (DOI), and the presence of lymphatic vascular space invasion, or lymph node metastases. The patient median age was 39 years (20–65). The median time of follow-up was 30 months (4–124). Lymph node metastases were found in ten patients and 11 developed recurrences. The precise DOI could be measured in 84 patients. Of the 48 patients with cancers with a DOI ≤ 5 mm, none had involved parametria or nodes; whereas eight of the 36 with a DOI > 5 mm had nodal metastases (P = 0.00069). None of these 48 patients with a tumor DOI ≤ 5 mm developed a recurrence whereas six of the 36 patients with a tumor DOI > 5 mm developed recurrent disease (P = 0.0048). The risk of nodal metastases and recurrence is so low in patients with ACC and DOI ≤ 5 mm that for patients with such depth documented on conization with negative margins pelvic lymphadenectomy may be omitted.

scholarly journals Assessment of Microvascular Density in Cholangiocarcinoma

2021 ◽  
Vol 8 (01) ◽  
pp. 6-11
Author(s):  
Neenu Jojan ◽  
Geetha Sukumaran
Keyword(s):  
Lymph Node ◽  
Prognostic Factor ◽  
Lymph Node Metastases ◽  
Microvascular Density ◽  
Treatment Modalities ◽  
Significant Prognostic Factor ◽  
Incomplete Resection ◽  
Nodal Metastases ◽  
Dismal Prognosis ◽  
Node Metastases

BACKGROUND Cholangiocarcinoma is a highly malignant but rare tumour arising from the bile duct, with a dismal prognosis owing to the advanced stage at presentation. A complete surgical resection is the only curative treatment available till date. There is an increase in the incidence of this tumour, especially intrahepatic cholangiocarcinoma. The objective of the present study was to assess the microvascular density in cholangiocarcinoma and its relationship to grade, which itself is a separate and important prognostic factor. METHODS All the specimens of cholangiocarcinomas received in the Department of Pathology, Government Medical College, Trivandrum, during a two-year period is included in the study (n = 26). Grading of tumours was done from H & E sections. Microvascular density was assessed using immunostaining with CD34 and counted using the method published by Weidner et al. RESULTS A total of 26 cases were studied. There was a male preponderance (57.7 %) with a mean age incidence of 55.77 years. Most of the tumours were located extra hepatically. 53.8 % were moderately differentiated tumours. Only 15 % of tumours showed lymph node metastases. Median microvascular density score was 15 vessels per high power field. High microvascular density was found in higher grade tumours. Although 75 % of the cases with lymph node metastases had high microvascular density, there was no significant correlation between microvascular density and nodal metastases, probably due to few cases of nodal metastases in the present study. CONCLUSIONS This study concludes that microvascular density in cholangiocarcinoma has a positive correlation with the grade of the tumour which itself is a significant prognostic factor. Hence, microvascular density can be used as a prognostic indicator especially in cases of incomplete resection and inadequate lymph node harvest. It may also be helpful in studying the possibility of newer therapeutic measures like anti-angiogenic treatment modalities. KEYWORDS VD, CD34, Grade, Cholangiocarcinoma

An evaluation of chemotherapy in patients with cancer of the cervix and lymph node metastases

1995 ◽  
Vol 256 (1) ◽  
pp. 1-4 ◽  
Author(s):  
H. -T. Ng ◽  
C. -C. Yuan ◽  
Y. -Y. Kan ◽  
E. S. -C. Ho ◽  
M. -S. Yen ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastases ◽  
Patients With Cancer ◽  
Node Metastases ◽  
Cancer Of The Cervix

scholarly journals Genomic and Transcriptomic Characterization of Papillary Microcarcinomas With Lateral Neck Lymph Node Metastases

2019 ◽  
Vol 104 (10) ◽  
pp. 4889-4899 ◽  
Author(s):  
Dilmi Perera ◽  
Ronald Ghossein ◽  
Niedzica Camacho ◽  
Yasin Senbabaoglu ◽  
Venkatraman Seshan ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastases ◽  
Predictive Value ◽  
Nodal Metastases ◽  
Lateral Neck ◽  
Nodal Disease ◽  
Node Metastases ◽  
Papillary Microcarcinomas ◽  
Molecular Classifier

Abstract Context Most papillary microcarcinomas (PMCs) are indolent and subclinical. However, as many as 10% can present with clinically significant nodal metastases. Objective and Design Characterization of the genomic and transcriptomic landscape of PMCs presenting with or without clinically important lymph node metastases. Subjects and Samples Formalin-fixed paraffin-embedded PMC samples from 40 patients with lateral neck nodal metastases (pN1b) and 71 patients with PMC with documented absence of nodal disease (pN0). Outcome Measures To interrogate DNA alterations in 410 genes commonly mutated in cancer and test for differential gene expression using a custom NanoString panel of 248 genes selected primarily based on their association with tumor size and nodal disease in the papillary thyroid cancer TCGA project. Results The genomic landscapes of PMC with or without pN1b were similar. Mutations in TERT promoter (3%) and TP53 (1%) were exclusive to N1b cases. Transcriptomic analysis revealed differential expression of 43 genes in PMCs with pN1b compared with pN0. A random forest machine learning–based molecular classifier developed to predict regional lymph node metastasis demonstrated a negative predictive value of 0.98 and a positive predictive value of 0.72 at a prevalence of 10% pN1b disease. Conclusions The genomic landscape of tumors with pN1b and pN0 disease was similar, whereas 43 genes selected primarily by mining the TCGA RNAseq data were differentially expressed. This bioinformatics-driven approach to the development of a custom transcriptomic assay provides a basis for a molecular classifier for pN1b risk stratification in PMC.

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