CLINICAL FEATURES IN DIFFERENTIATED THYROID CARCINOMA STRATIFIED BY LYMPH NODE STATUS

2020 ◽  
Vol 26 (8) ◽  
pp. 909-914
Author(s):  
Jawairia Shakil ◽  
Trisha D. Cubb ◽  
Ahmad Yehya ◽  
Ashkan Zand ◽  
Jaiqiong Xu ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Cervical Lymph Node ◽  
Differentiated Thyroid Cancer ◽  
Central Compartment ◽  
Lymph Node Involvement ◽  
Lymph Node Status ◽  
Node Status ◽  
Node Involvement

Objective: Cervical lymph node (CLN) metastases (mets) often occur in differentiated thyroid cancer (DTC), especially in the central compartment, and are a major predictor of local recurrence. We examined clinical endpoints in three groups of patients based on status of lymph node involvement: those with definite lymph node involvement (N1), negative lymph nodes (N0), and no lymph nodes resected (Nx). We correlated these endpoints with clinical and pathologic features of these patients. Methods: Medical records of 261 patients with DTC who underwent thyroidectomy between 2006 and 2018 at our center were reviewed. Lymph node status of patients was categorized based on American Joint Committee on Cancer (AJCC) 8th edition criteria as N1, N0, and Nx. We performed statistical analysis to assess the differences among these groups, using one-way analysis of variance. When significant differences were found, pairwise comparisons were conducted among the three groups. Statistical significance was defined as 2-tailed P<.05 for all tests. Results: There were significant differences among the groups in tumor multicentricity, tumor category/size, AJCC stage, and the presence of thyroglobulin auto-antibodies (TgAbs). There were no difference in age, gender, or histopathology. N1 patients had a higher incidence of multicentricity, larger tumor sizes, and were more likely to have elevated TgAbs. There were no significant differences between the N0 and Nx groups. Conclusion: This study shows that larger and multi-centric tumors are associated with increased likelihood of CLN mets in DTC. We suggest increased vigilance for CLN mets in tumors >2 cm, multicentric tumors, and patients with elevated TgAbs. Abbreviations: AJCC = American Joint Committee on Cancer; CLN = cervical lymph node; DTC = differentiated thyroid cancer; FTC = follicular thyroid cancer; mets = metastases; N0 = no cancer in any lymph nodes; N1 = cancer in a lymph node; N1a = cancer in a central compartment lymph node; N1b = cancer in a lateral neck lymph node; Nx = lymph nodes not resected or examined; PTC = papillary thyroid cancer; TgAb = thyroglobulin auto-antibody

scholarly journals Quality of Life and Anxiety in Adolescents with Differentiated Thyroid Cancer

2012 ◽  
Vol 97 (10) ◽  
pp. E1933-E1937 ◽  
Author(s):  
Asaf Oren ◽  
Melissa Anne Benoit ◽  
Anne Murphy ◽  
Fiona Schulte ◽  
Jill Hamilton
Keyword(s):  
Quality Of Life ◽  
Thyroid Cancer ◽  
Lymph Node ◽  
Differentiated Thyroid Cancer ◽  
Lymph Node Involvement ◽  
Autoimmune Hypothyroidism ◽  
Control Subjects ◽  
Node Involvement ◽  
Anxiety Levels

Abstract Context: Adolescents with differentiated thyroid cancer (DTC) require lifelong monitoring with a high possibility of reoperation or radioactive iodine. Although adult DTC survivors have similar or slightly worse quality of life (QOL), this has not been evaluated in the pediatric population. Objective: Our objective was to compare QOL and anxiety in adolescents with DTC to patients with acquired autoimmune hypothyroidism. Design, Setting, and Patients: In this cross-sectional pilot study, three validated questionnaires were administered to 16 adolescents with DTC and 16 controls for assessment of QOL and anxiety levels. These included teen and parent PedsQL, Multidimensional Anxiety Scale for Children, and Coddington Life Events Scales for Adolescents. The contribution of age, time since diagnosis, and biochemical variables were compared with the outcome measures. Results: There were 16 DTC patients (seven males); 13 had papillary carcinoma, one had follicular carcinoma, and two had mixed type. At diagnosis, five DTC patients had lymph node involvement and two had lung metastases, although at time of assessment, only one DTC patient had lymph node involvement. DTC patients were older than control subjects (P = 0.004) and had lower TSH levels than control subjects at time of assessment (P = 0.013). QOL and anxiety levels did not differ between DTC patients compared with control subjects and with previously reported scores in a healthy cohort. QOL and anxiety level parameters were not influenced by age, time since diagnosis, or free T4 levels measured at the time of assessment. Conclusions: Adolescents with DTC have similar QOL and anxiety levels compared with autoimmune hypothyroidism patients and with a healthy normative population.

The value of tumor marker and cytokine analysis for the assessment of regional lymph node status in cervical cancer patients

2008 ◽  
Vol 18 (6) ◽  
pp. 1279-1284 ◽  
Author(s):  
B. Kotowicz ◽  
M. Fuksiewicz ◽  
M. Kowalska ◽  
J. Jonska-Gmyrek ◽  
M. Bidzinski ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Lymph Node Metastases ◽  
Regional Lymph Node ◽  
Serum Levels ◽  
Lymph Node Involvement ◽  
Lymph Node Status ◽  
Node Status ◽  
Node Involvement ◽  
Node Metastases

The aim of the study was to evaluate the utility of the measurements of the circulating tumor markers, squamous cell carcinoma antigen (SCCA), CA125, carcinoembryonic antigen (CEA), cytokeratin fragment 19 (CYFRA 21.1), and the cytokines, interleukin-6 and vascular endothelial growth factor (VEGF), to estimate regional lymph node involvement in patients with cervical cancer. The study comprised 182 untreated patients with cervical cancer. The regional lymph node status was assessed either by the postsurgical histopathologic examination or by the computed tomography (CT). Concentrations of SCCA, CEA, and CA125 were determined using the Abbott Instruments system, of CYFRA 21.1 by the Roche kits, and of IL-6 and VEGF by the ELISA of R&D Systems (Minneapolis, MN). For the statistical analyses, Mann–Whitney U test and χ2 test were applied. Serum levels of SCCA, CEA, CA125, CYFRA 21.1, IL-6, and VEGF were measured in patients with specified pelvic and para-aortic lymph node status. SCCA, CA125, and IL-6 levels were found to be significantly higher in patients with lymph node metastases than in those with no lymph node involvement. Also, the percentage of patients with simultaneously elevated concentrations of SCCA and CA125 or SCCA and IL-6 differed depending on the lymph node status and was significantly higher in the series of patients with lymph node metastases. Simultaneous assessment of serum levels of SCCA and CA125 or SCCA and IL-6 in patients with cervical cancer may be useful for the regional lymph node evaluation, especially in patients with advanced stages, when the lymph nodes are examined only by CT, with no histologic confirmation.

Is there a need for sentinel lymph node biopsy in microinvasive breast cancer?

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1105-1105 ◽  
Author(s):  
Nimmi S. Kapoor ◽  
Jamie Shamonki ◽  
Jeong Lim Yoon ◽  
Cathie T. Chung ◽  
Armando E. Giuliano
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Disease Recurrence ◽  
Lymph Node Involvement ◽  
Lymph Node Status ◽  
High Grade ◽  
Node Involvement ◽  
Microinvasive Breast Cancer ◽  
The Impact

1105 Background: There is limited data on the long-term outcome of patients with microinvasive breast cancer. Moreover, predictors of lymph node involvement and the impact of multifocal microinvasion are not well understood. We examined the occurrence of nodal metastasis and the significance of multifocality on disease recurrence. Methods: Patients with T1mic breast cancer, defined as tumors ≤1mm, surgically managed at our institute between 1995-2010 were identified. Specimen slides were independently reviewed. Multivariable analysis (MVA) was used to predict lymph node involvement and disease recurrence. Results: Fifty-two patients with T1mic breast cancers were identified. Median patient age was 53 (range 30-92), median size of in-situ disease was 3cm (range 0.1-12cm). Ten patients (19.2%) had multiple foci of microinvasion (range 2-7). The majority of tumors were high-grade (76.9%). When the invasive tumor component was evaluated, 31 of 41 (73.8%) were ER positive, 40.5% were HER2+(15/37), and only one was ER-/PR-/HER2-. Twenty-nine patients (55.8%) had breast conserving surgery and 23 had mastectomies. Lymph nodes were assessed in 48 patients; there was 1 macrometastasis (2.1%), 4 micrometastases (8.3%) and 4 (8.3%) with isolated tumor cells. Seven of 9 patients with lymph node involvement underwent adjuvant chemotherapy. Univariable analysis showed that ER(-) invasive disease and high-grade DCIS tumors were more likely to have involved lymph nodes. On MVA, only negative ER status was a significant predictor of lymph node metastasis (p<0.02). At median follow-up of 83 months (range 6-172 months), 3 patients (6.3%) had disease recurrence (1 local, 1 distant, 1 local and distant) at 8, 17, and 130 months from presentation. All patients with recurrence had negative lymph nodes and only one focus of microinvasion. No factors predicted disease recurrence. Conclusions: Microinvasive breast cancer clearly has the ability to metastasize and recur, but in this series only 2% of patients presented with nodal macrometastasis. The evaluation of lymph nodes in T1mic cancer is unnecessary in the majority of patients. In our cohort, neither lymph node status nor multifocal microinvasion predicts recurrence.

scholarly journals Isolated submandibular lymph node metastasis in pancreatic adenocarcinoma

2019 ◽  
Vol 101 (3) ◽  
pp. e94-e95
Author(s):  
Taiwo Oyebola ◽  
Akash Mavilakandy ◽  
Peter Conboy ◽  
Neil Bhardwaj
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Pancreatic Adenocarcinoma ◽  
Late Stage ◽  
Cervical Lymph Node ◽  
Lymph Node Involvement ◽  
Node Metastasis ◽  
Submandibular Lymph Node ◽  
Node Involvement

Pancreatic adenocarcinoma is a highly aggressive malignancy that usually presents at a late stage. Common sites of metastasis include the liver, lung and adjacent lymph nodes. Cervical lymph node involvement has been reported previously but there are no documented cases of submandibular lymph node metastasis in the available literature. We describe a case of pancreatic adenocarcinoma metastasis to the left submandibular lymph node with no confirmed concurrent sites of metastasis.

scholarly journals Significance of ipsilateral lobar lymph node dissection in the surgical treatment of non-small cell lung cancer with regional lymph node involvement

2017 ◽  
Vol 98 (1) ◽  
pp. 137-140
Author(s):  
A F Gil’metdinov ◽  
V P Potanin
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Regional Lymph Node ◽  
Lymph Node Involvement ◽  
Lymph Node Status ◽  
Node Dissection ◽  
Small Cell Lung ◽  
Regional Lymph Node Involvement ◽  
Node Involvement

Aim. Analysis of significance of ipsilateral lobar lymph node dissection in the surgical treatment of non-small cell lung cancer with regional lymph node involvement.Methods. We have analyzed medical records of inpatients and outpatients observed in Republican Clinical Oncology Dispensary of Tatarstan Ministry of Healthcare and operated in 2000-2009. Patients were divided into the groups according to the stage (IB, IIB, IIIA), clinical and anatomic form (peripheral or central cancer), volume of surgery (lobectomy and pulmonectomy) and degree of primary tumor spread and lymph node involvement according to TxNx (T2N0, T2N1, T3N0, T2N2). Total of 803 patients were included. Five-year survival rate in each group was counted by the method of Kaplan-Meier based on volume of surgery (lobectomy and pulmonectomy) and lymph node status (N1, N2).Results. In peripheral cancer with regional lymph nodes status N1-2 pulmonectomy with removal of ipsilateral lobar lymph nodes is associated with low survival. In central cancer regional lymph node status change from N0 to N1 does not influence survival after lobectomy/pulmonectomy indicating the positive effect of removal of ipsilateral lobar lymph nodes on survival in this group of patients. In central cancer with N2 survival after pulmonectomy decreases by 2 times indicating no influence of removal of ipsilateral lobar lymph nodes on survival in this group of patients.Conclusion. In peripheral cancer with morphologic confirmation of regional lymph node involvement N1-2, as well as in central cancer with morphologic confirmation of regional lymph node involvement N2, ipsilateral lobar lymph node dissection is irrational; in all other cases (central cancer N0-1 or peripheral cancer N0) ipsilateral lobar lymph node dissection is rational.

scholarly journals Influence of Covariates on Involved Lymph Nodes in Primary Breast Cancer Patients: Mixture Distribution Zero-Inflated Modeling Methodological Framework

2020 ◽  
Author(s):  
Madiha Liaqat ◽  
Shahid Kamal ◽  
Florian Fischer ◽  
Nadeem Zia
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Primary Breast Cancer ◽  
Negative Binomial ◽  
Lymph Node Involvement ◽  
Breast Cancer Patients ◽  
Node Involvement ◽  
Study Population

Abstract Background: Involvement of lymph nodes has been an integral part of breast cancer prognosis and survival. This study aimed to explore factors influencing on the number of auxiliary lymph nodes in women diagnosed with primary breast cancer by choosing an efficient model to assess excess of zeros and over-dispersion presented in the study population. Methods: The study is based on a retrospective analysis of hospital records among 5,196 female breast cancer patients in Pakistan. Zero-inflated Poisson and zero-inflated negative binomial modeling techniques are used to assess the association between under-study factors and the number of involved lymph nodes in breast cancer patients. Results: The most common breast cancer was invasive ductal carcinoma (54.5%). Patients median age was 48 years, from which women aged 46 years and above are the majority of the study population (64.8%). Examination of tumors revealed that over 2,662 (51.2%) women were ER-positive, 2,652 (51.0%) PR-positive, and 2,754 (53.0%) were Her2.neu-positive. The mean tumor size was 3.06 cm and histological grade 1 (n=2021, 38.9%) was most common in this sample. The model performance was best in the zero-inflated negative binomial model. Findings indicate that most factors related to breast cancer have a significant impact on the number of involved lymph nodes. Age is not contributed to lymph node status. Women having a larger tumor size suffered from greater number of involved lymph nodes. Tumor grades 11 and 111 contributed to higher numbers of positive lymph node.Conclusions: Zero-inflated models have successfully demonstrated the advantage of fitting count nodal data when both “at-harm” (lymph node involvement) and “not-at-harm” (no lymph node involvement) groups are important in predicting disease on set and disease progression. Our analysis showed that ZINB is the best model for predicting and describing the number of involved nodes in primary breast cancer, when overdispersion arises due to a large number of patients with no lymph node involvement. This is important for accurate prediction both for therapy and prognosis of breast cancer patients.

scholarly journals Correlation of lymph node size and their metastatic infiltration in gastric adenocarcinoma

2020 ◽  
Vol 7 (7) ◽  
pp. 2151
Author(s):  
Pratap Kumar Deb ◽  
Syed Abul Fazal
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Significant Proportion ◽  
Metastatic Potential ◽  
Lymph Node Involvement ◽  
Reliable Criterion ◽  
Lymph Node Size ◽  
Node Involvement ◽  
Carcinoma Stomach ◽  
High Chance

Background: In adenocarcinoma stomach, lymph node involvement is a significant predictor of survival, and a decisive factor in planning management. Size has always been an important criterion while considering the metastatic status of the node, in its radiological evaluation or otherwise. However, to what extent the size of a node can be considered as a reliable criterion for its metastatic potential remains a question.Methods: The present study is based on retrieving lymph nodes per operatively from patients of carcinoma stomach, measuring each node, evaluating its metastatic status and comparing the results to find a correlation between these two parameters.Results: The present study, examined a total of 187 nodes from 30 gastrectomy specimens. Among them, metastasis was found in 59 nodes (31.55%). Among these metastatic nodes, 34 (57.62%) were actually less than 5mm in size. Among the total sizes of all the lymph nodes examined, the mean±SD (standard deviation) of the metastasis positive nodes were found to be 6.42±3.86 mm, while that of the non-metastatic nodes were found to be 5.51±1.99 mm. However, it was also observed that larger nodes (>1 cm), tend to have a high chance of being malignant (62.5%).Conclusions: The above study shows though large nodes tend to be malignant, ignoring small nodes can lead to gross under staging or incomplete clearance while treating patients of adenocarcinoma stomach. Smaller nodes constitute a significant proportion of malignant nodes and must be evaluated. Size is not a reliable criterion of metastasis in lymph nodes of carcinoma stomach.

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