Comparison of Dose Distribution in Regional Lymph Nodes in Whole-Breast Radiotherapy vs. Whole-Breast Plus Regional Lymph Node Irradiation: An In Silico Planning Study in Participating Institutions of the Phase III Randomized Trial (KROG 1701)

The purpose of the current in silico planning study is to compare radiation doses of whole-breast irradiation (WBI) and whole-breast plus regional lymph node irradiation (WBI+RNI) administered to the regional lymph nodes (RLN) in pN1 breast cancer. Twenty-four participating institutions were asked to create plans of WBI and WBI+RNI for two dummy cases. To compare target coverage between the participants, an isodose line equal to 90% of the prescribed dose was converted to an isodose contour (contour90% iso). The relative nodal dose (RND) was obtained using the ratio of RLN dose to the target dose. The Fleiss’s kappa values which represent inter-observer agreement of contour90% iso were over 0.68. For RNI, 6 institutions included axillary lymph node (ALN), supraclavicular lymph node (SCN), and internal mammary lymph node (IMN), while 18 hospitals included only ALN and SCN. The median RND between the WBI and WBI+RNI were as follows: 0.64 vs. 1.05 (ALN level I), 0.27 vs. 1.08 (ALN level II), 0.02 vs. 1.12 (ALN level III), 0.01 vs. 1.12 (SCN), and 0.54 vs. 0.82 (IMN). In all nodal regions, the RND was significantly lower in WBI than in WBI+RNI (p < 0.01). In this study, we could identify the nodal dose difference between WBI and WBI+RNI.

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Modern view on the issues of diagnosis and verification of axillary lymph nodes involvement in early breast cancer

Modern Oncology ◽

10.26442/18151434.2020.1.200018 ◽

2020 ◽

Vol 22 (1) ◽

pp. 46-52

Author(s):

Irina V. Kolyadina ◽

Tatiana Yu. Danzanova ◽

Svetlana V. Khokhlova ◽

Oksana P. Trofimova ◽

Ekaterina V. Kovaleva ◽

...

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Lymph Node ◽

Lymph Nodes ◽

Early Breast Cancer ◽

Regional Lymph Node ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

High Quality ◽

Regional Lymph Nodes

The involvement of axillary lymph nodes is one of the most important prognostic factors, significantly affecting the treatment strategy for early breast cancer (BC). The risk of axillary lymph node metastases depends directly on a number of factors (age of women, size of tumor, presence of lymphovascular invasion and biological characteristics of cancer). The evaluation of regional lymph node status in patients with early BC includes the clinical examination of regional zones and the ultrasound study (US), using these methods can help to study lymph nodes shape, borders, margins and structure. The sensitivity of ultrasound in the evaluation of regional lymph nodes status directly depends on the biological subtype of the tumor; the minimum level of ultrasound sensitivity in the evaluation of lymph nodes status is detected for luminal HER2-negative cancer (less than 40%), and maximum sensitivity is detected for triple negative and HER2-positive subtypes (6871%). Clinical examination and modern ultrasound are the most accessible methods for the evaluation of regional lymph nodes status, but the possibility to misjudge metastatic process can be detected in 1/4 of patients. Verification of the diagnosis in the preoperative phase (fine-needle aspiration biopsy/core-needle biopsy under ultrasound guidance) allows minimize the number of errors for the regional staging. The sentinel lymph node biopsy (SLNB) is the gold standard of regional treatment in patients with early stage BC, nowadays. The randomized trials (NSABP B-32, ACOSOG q0011) show the safety of recession of performing regional lymph node dissection in favor of SLNB not only in case of clinically negative lymph nodes, but also in patients with metastases in 2 sentinel lymph nodes, upon condition that organ-conservative treatment and subsequent radiation therapy will be used. High-quality regional staging, the choice of the therapeutic algorithm in accordance with the biological characteristics of carcinoma, the application of the most effective modern drug regimes, the optimal radiation therapy allow not only minimize the extent of surgery, but also achieve high long-term survival results, provide excellent functional results and high quality of life in patients with the involvement of axillary lymph nodes.

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Simultaneous Renal Oncocytoma and Lymphoma: Interest of Lymphadenectomy

Case Reports in Urology ◽

10.1155/2013/729108 ◽

2013 ◽

Vol 2013 ◽

pp. 1-2

Author(s):

Angela Orcurto ◽

Benoît Lhermitte ◽

Alain Sermier ◽

Dominik Berthold

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Regional Lymph Node ◽

Renal Oncocytoma ◽

Node Dissection ◽

Regional Lymph Nodes ◽

Regional Lymph Node Dissection ◽

Histological Confirmation ◽

Kidney Lesions

Kidney lesions may be difficult to diagnose only by radiological exams, often requiring proof by tissue biopsy. Moreover, if enlarged regional lymph nodes are also present, the spectrum of differential diagnoses is even greater. The role of regional lymph node dissection in this setting is not clearly established. We show the case of a patient with a kidney mass associated with a conglomerate of para-aortic and iliac lymphadenopathies corresponding to an oncocytoma and a nodular lymphocyte predominant Hodgkin' lymphoma, respectively. Diagnosis of these two lesions was performed by morphology and immunohistochemistry. This case reflects how imaging can mislead to diagnosis and how histological confirmation helps decide treatment management.

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Dermatofibrosarcoma Protuberans of Scalp With Cervical Lymph Node Metastasis

Sarcoma ◽

10.1080/13577140410001679257 ◽

2004 ◽

Vol 8 (1) ◽

pp. 43-45 ◽

Cited By ~ 11

Author(s):

Pawan Lal ◽

Arun Goel ◽

A. K. Mandal

Keyword(s):

Lymph Node ◽

Lymph Node Metastasis ◽

Lymph Nodes ◽

Regional Lymph Node ◽

Radical Neck Dissection ◽

Dermatofibrosarcoma Protuberans ◽

Wide Excision ◽

High Rate ◽

Regional Lymph Nodes ◽

Node Metastasis

Dermatofibrosarcoma protuberans (DFSP) is an uncommon, slow growing and locally aggressive tumor of the skin with a high rate of recurrence even after supposedly wide excision. The reports of regional lymph node metastasis and distant metastasis are very rare. Because of the extreme rarity of these cases with metastasis, the experience with management of such patients is very limited. A case of recurrent DFSP of scalp, with metastasis to the regional lymph nodes, in a 17-year-old boy is reported here. This is the second case of DFSP involving scalp and 16th case of DFSP of all sites metastasizing to the regional lymph nodes reported in literature. The patient was treated with wide excision of the lesion and ipsilateral radical neck dissection (including excision of overlying involved skin).

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Safety and Benefit Of Sentinel Lymph Nodes Biopsy Compared to Regional Lymph Node Dissection in Primary Vulvar Cancer Patients Without Distant Metastasis and Adjacent Organ Invasion: A Retrospective Population Study

Frontiers in Oncology ◽

10.3389/fonc.2021.676038 ◽

2021 ◽

Vol 11 ◽

Author(s):

Weili Zhou ◽

Yang Bai ◽

Yangyang Yue

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Distant Metastasis ◽

Regional Lymph Node ◽

Invasion Depth ◽

Regional Lymph Nodes ◽

Adjacent Organ ◽

Regional Lymph Node Dissection ◽

Adjacent Organ Invasion ◽

Organ Invasion

BackgroundThe safety and benefit of sentinel lymph node biopsy (SLNB) compared with regional lymph node dissection (RLND) and no lymph nodes removed (NA) in patients with vulvar squamous cell cancer (VSCC) was not well studied.MethodsA retrospective analysis on VSCC patients without distant metastasis and adjacent organ invasion from the Surveillance, Epidemiology, and End Results Program database between 2004 and 2016 was carried out. Within subgroups stratified by negative (LN−) or positive (LN+) regional lymph node findings, inverse probability weighting (IPW) adjusted multivariate Fine-Gray compete risk (CR) model and accelerated failure time (AFT) model was used to investigate the factors associated with and cancer-specific survival (CSS) and overall survival (OS).ResultsOf the 3,161 VSCC patients treated with surgery, 287 (9.1%) underwent SLNB, 1,716 (54.3%) underwent RLND, and 1,158 (36.6%) had no regional lymph nodes removed. As illustrated by IPW adjusted multivariate regressions, SLNB was significantly associated with prolonged CSS (LN−, adjusted sub-proportional hazard ratio [sHR] = 0.42; 95% confidence interval [CI], 0.19–0.93; P=0.032; LN+, adjusted sHR = 0.29; 95% CI, 0.16–0.54, P<0.001) and OS (LN−, adjusted time ratio [TR] = 1.38; 95% CI, 0.82–2.32; P=0.226; LN+, adjusted TR = 2.68; 95% CI, 1.73–4.14; P<0.001), although the effect of SLNB on OS was not significant within the LN− cohort. Moreover, SLNB led to improved CSS (adjusted sHR = 0.40; 95% CI, 0.23–0.70; P = 0.001) and OS (adjusted TR=1.15, 95% CI 0.76-1.73, P=0.279) compared with NA. Age was a significant prognostic factor of CSS and OS, whereas tumor size, surgery type, and invasion depth were not.ConclusionsSLNB leads to significantly prolonged CSS and OS in VSCC surgery patients without distant metastasis and adjacent organ invasion than RLND, except for the similar OS in the LN− cohort. SLNB could be carried out preferentially for VSCC surgery patients without distant metastasis and adjacent organ invasion, irrespective of tumor size, surgery type, invasion depth, and regional lymph nodes metastasis. Further prospective clinical trials are warranted to confirm the findings of this study.

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Relevance of Regional Lymph Node Invasion in Radical Hepatectomy and Lymphadenectomy for Alveolar Echinococcosis: A Retrospective Cohort Study

10.21203/rs.3.rs-67132/v1 ◽

2020 ◽

Author(s):

Xianwei Yang ◽

Tao Wang ◽

Shu Shen ◽

Wentao Wang

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Alveolar Echinococcosis ◽

Regional Lymph Node ◽

Regional Lymph Nodes ◽

Node Number ◽

Lymph Node Enlargement ◽

Group A ◽

Group B ◽

Node Diameter

Abstract Background Hepatic Alveolar echinococcosis (AE) is also known as worm cancer, parasitic cancer, and it often invades the regional lymph nodes of the liver. The present study was to investigate the clinical value of radical hepatectomy and lymphadenectomy in AE patients. Methods Our study enrolled consecutive AE patients who underwent radical hepatectomy with removal the regional lymph nodes between January 2009 and April 2019. Patients with inflammatory lymph node enlargement was included in group A, and patients with AE lymph node invasion were included in group B. The clinical characteristics, survival and recurrence rates were compared.Results A total of 103 patients were enrolled group A, and 24 in group B. Preoperative computed tomography showed that the lymph node positivity rate in group B was 70.8% while that in group A was 43.7% (p=0.017). The lymph node diameter was 1.8±0.9 cm in group A vs 2.5±1.1 cm in group B (p=0.004), and the lymph node number (p=0.035) and lymph node location (p=0.001). A total of 10 patients (7.9%) had recurrent lesions, and 6 patients (4.7%) died (P>0.05). Conclusions lymph node diameter, number, and distance from the liver were important characteristics for describing lymph node invasion. There was no difference in the long-term efficacy of lymphadenectomy between patients with lymph node enlargement and those with invasion.

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Lymph Node Radiotherapy Instead of Extended Axillary Surgery - the New Standard

Breast Care ◽

10.1159/000489892 ◽

2018 ◽

Vol 13 (3) ◽

pp. 173-175 ◽

Cited By ~ 2

Author(s):

Peter Niehoff ◽

Silla Hey-Koch

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Axillary Dissection ◽

Early Stage ◽

Axillary Staging ◽

Lymph Node Staging ◽

Axillary Lymph ◽

Regional Lymph Nodes

Breast cancer treatment has undergone major changes in the last 20 years. Specifically, the role of axillary lymph node dissection has changed from radical axillary dissection with excision of a high number of lymph nodes to sentinel lymph node biopsy (SLNB). This paradigm shift is associated with a controversial debate regarding the significance of axillary staging, the need for surgery, and the role of radiotherapy. Looking ahead, lymph node staging and axillary treatment might shift from SLNB and/or axillary dissection to ultrasound-guided needle biopsy and irradiation of regional lymph nodes in order to reduce treatment-related sequelae in early-stage breast cancer.

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Apocrine Gland Anal Sac Adenocarcinoma in Dogs: 22 Cases (2015-2020)

Indian Journal of Animal Research ◽

10.18805/ijar.b-4371 ◽

2021 ◽

Author(s):

A.K. Sahoo ◽

I. Nath ◽

S.B. Senapati ◽

S.K. Panda ◽

M.R. Das ◽

...

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Regional Lymph Node ◽

Clinical Signs ◽

Clinical Staging ◽

Apocrine Gland ◽

Survival Times ◽

Regional Lymph Nodes ◽

Iliac Lymph Node ◽

Anal Sac

Background: Apocrine gland anal sac adenocarcinoma (AGASACA) is a highly malignant disease mostly invading regional lymph nodes at the time of disease diagnosis.Methods: Twenty- two cases of Apocrine gland anal sac adenocarcinoma (AGASACA) were treated during five years. Contrast radiography with Iohexol and Lipidol were carried out to detect primary anal sac mass and regional lymph node through indirect lymphography technique. For clinical staging, ultrasonography, fine-needle aspiration cytology, histopathology of both primary tumor mass and regional lymph node were performed. Closed anal Sacculectomy was performed as curative therapy for anal sac adenocarcinoma.Result: The median age and weight of dogs at presentation were 8.4 years and 20.9 kg, respectively. Diagnostic radiology, histopathology and biochemical assay confirm twenty-two cases of anal sac adenocarcinoma and medial iliac lymph node to be sentinel lymph node. Carcinoma was of unilateral occurrence in all the dogs. Four (18%) dogs had hypercalcemia and twelve (54%) had metastases to the regional lymph nodes with clinical signs of tenesmus or constipation, polyuria -polydipsia and anorexia. Apocrine gland Adenocarcinoma of anal sac was found to initially metastasize to the medial iliac lymph node. Survival times of dogs treated with the surgical procedure only (8 out of 22 dogs) were appreciably longer than the dogs with therapeutic only. Animals with metastasis to regional lymph nodes or lymphadenopathy had poor prognosis.

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Cytology and Radiology as a Diagnostic Tool to Detect Metastasis in Mammary Tumor Affected Dogs

Indian Journal of Animal Research ◽

10.18805/ijar.b-4445 ◽

2021 ◽

Author(s):

K.P. Prabhakaran ◽

G.A. Balasubramaniam ◽

R. Madheswaran ◽

A. Raja ◽

A. Kumerasan

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Mammary Tumor ◽

Diagnostic Tool ◽

Ductal Carcinoma ◽

Regional Lymph Node ◽

Serum Biochemistry ◽

Clinical Staging ◽

Regional Lymph Nodes ◽

Elevated Alkaline Phosphatase

Background: Malignant mammary gland tumors can metastasize to various organs; of which, lungs and regional lymph nodes are most frequently affected. Chest radiographs and regional lymph node FNAs are important diagnostic tool to detect metastasis as per oncology practice guidelines. The present study was aimed to develop suitable diagnostic tool to detect metastasis in mammary tumor affected dogs. Methods: Between September 2017 to July 2018, thirty three dogs (n=33) affected with mammary tumors were included in the study. Out of thirty three dogs, three dogs (n=3) showed swollen regional lymph nodes and pulmonary metastases. Different parameters such as haematology, serum biochemistry, radioimmunoassay, radiology, cytology, histopathology and immunohistochemistry were analysed. Result: TNM clinical staging revealed that all the three dogs showed stage IV tumors which were usually malignant and showed frequent metastases. Haematological abnormalities such as anemia, leucocytosis and reduced platelet count were noticed. Serum biochemistry showed reduced protein and electrolyte level with elevated alkaline phosphatase and alanine transaminase. Radioimmunoassay showed many-fold elevation of estradiol and progesterone. Radiography of lungs revealed severe pulmonary metastasis. Cytological examination of swollen accessory lymph node revealed mixed population of lymphocytes and neoplastic cells. Grossly, the lymph nodes were found to be enlarged, blood tinged and covered with subcutaneous adipose tissue. Histopathology of tumor masses from three dogs revealed cystic papillary carcinoma, ductal carcinoma and anaplastic carcinoma. Immunohistochemistry revealed that dogs were affected with triple negative tumors which were highly malignant, poor prognosis and not responding to therapy.

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Metastasis of neuroendocrine tumor mimicking primary breast cancer: case report

Mastology ◽

10.29289/259453942020v30s1033 ◽

2020 ◽

Vol 30 (Suppl 1) ◽

Author(s):

Yuki Tany Hirakawa Vieira ◽

Andre Luiz de Freitas Perina ◽

Daniela Ferreira Vieira Vendramini ◽

Thatyanne Cunha Esposito Gallo ◽

Felipe Eduardo Martins Andrade

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Neuroendocrine Tumor ◽

Axillary Lymph Node ◽

Cervical Lymph Node ◽

Ileocecal Valve ◽

Axillary Lymph ◽

Regional Lymph Nodes ◽

The Right

Introduction: Neuroendocrine tumor has an annual incidence of 2–5 cases/100,000 inhabitants, most of them asymptomatic, and may clinically present as carcinoid syndrome: facial flushing, diarrhea, and bronchospasm. It has a great tendency to metastasize to regional lymph nodes and liver, being unusual in the breast. Clinical case: A black 47-year-old woman without comorbidities presented a nodule with progressive growth for 2 years in the right upper inner quadrant (RUIQ), biopsied and diagnosed as breast cancer, without a specific subtype or immunohistochemistry (IHC). Physical examination revealed a 3 cm nodule, hard and fixed axillary lymph node, and enlarged yet fibroelastic and mobile anterior cervical lymph node. Ultrasound (US) identified two irregular nodules in the RUIQ and the junction of the right outer quadrants (JROQ) measuring 2.5 cm and 0.7 cm, respectively, and level I axillary lymph node with cortical thickening. The JROQ nodule and the axillary lymph node were biopsied. The cervical lymph node did not show loss of hilum or suspicious abnormalities on US and was not biopsied. Anatomopathological results of the nodule were compatible with invasive carcinoma without a specific subtype, with estrogen receptor weakly positive (10%), Ki-67 7%, and negative for other markers. The axillary lymph node was negative for metastasis. During staging, an abdominal computed tomography identified a 1.9 cm lesion of likely neuroendocrine origin in the ileocecal valve with metastasis to the liver, regional lymph nodes, and breast. Complementary IHC of the biopsy slide was later performed with chromogranin, synaptophysin, and CDX-2, and the diagnosis reached was breast metastasis of neuroendocrine tumor. An external review of biopsy slides of the RUIQ nodule was requested, and the patient was referred to the oncology department to continue treatment. Conclusion: Metastasis of gastrointestinal tumors to the breast corresponds to less than 0.5% of cancers, with 15 reports in the literature, of which only 7 were asymptomatic, and their clinical presentation started with breast lesion, as in the case described herein. Given its rarity, as well as the clinical and radiological difficulties in differentiating these lesions, special attention must be paid to differential diagnoses, especially in cases of discrepancies between the tumor histology and IHC or lack of correlation between image and clinical condition.

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Lymphoscintigraphy in Detection of the Regional Lymph Node Involvement in Gastric Cancer

Annals of The Royal College of Surgeons of England ◽

10.1308/003588406x149200 ◽

2006 ◽

Vol 88 (7) ◽

pp. 632-638 ◽

Cited By ~ 6

Author(s):

M Mahir Ozmen ◽

Baris Zulfikaroglu ◽

N Ozlem Kucuk ◽

Necdet Ozalp ◽

Gulseren Aras ◽

...

Keyword(s):

Gastric Cancer ◽

Computed Tomography ◽

Lymph Node ◽

Lymph Nodes ◽

Regional Lymph Node ◽

Lymph Node Involvement ◽

Regional Lymph Nodes ◽

Abdominal Ultrasonography ◽

Regional Lymph Node Involvement ◽

Node Involvement

INTRODUCTION Involvement of regional lymph node is a critical sign in prognosis of gastric cancer. Radiological techniques are commonly used to evaluate the extension of gastric cancer. But their sensitivity and specificity are low especially in the early stage. Our aim was to assess the value of gastric lymphoscintigraphy in identifying regional lymph node involvement in patients with gastric cancer, as compared to the abdominal ultrasonography, computed tomography and postoperative histopathological evaluation. PATIENTS AND METHODS 50 patients (12 females) with a median age of 61 years (range, 35–73 years) were included in the study. Pre-operative staging in all cases included upper gastrointestinal endoscopy and biopsy, followed by ultrasound, computed tomography and lymphoscintigraphy. 148 MBq Technetium-99m lymphoscint was injected around the tumour during endoscopy and immediately after injection, anterior, lateral and posterior images were taken in 5-min intervals using a gamma camera. Findings were compared to the findings of other tests. The sensitivity, specificity, positive predictive value, and negative predictive value of each test were calculated and compared. RESULTS Histologically, 68% of cases (34/50) had metastasis in regional lymph nodes and all cases were accurately diagnosed by lymphoscintigraphy. Lymphoscintigraphy was significantly more sensitive for detecting lymph node involvement (P < 0.01). Both abdominal ultrasonography and CT had very low sensitivity in identifying lymph nodes. CONCLUSIONS Lymphoscintigraphy is a promising test in the identification of regional lymph nodes pre-operatively in patients with gastric cancer. It might help the surgeon to plan the extent of dissection before surgery which may decrease postoperative complications related to unnecessary extensive lymph node dissection.

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