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PubMed1984

Formation of lymph follicles and germinal centers in draining lymph nodes after local injection of phytohemagglutinin and lipopolysaccharide in mice.

Changes in the number of lymph follicles and germinal centers in draining popliteal lymph nodes were investigated in 8-week-old mice injected with either phytohemagglutinin (PHA) or lipopolysaccharide (LPS) into the footpad of the left hind leg. The dose of PHA injected ranged from 10 micrograms to 1 mg, and that of LPS, from 2 to 200 micrograms. In unstimulated animals, the popliteal lymph nodes contained only a small number of germinal centers, and many of the lymph follicles in the nodes were in the form of primary follicles. In the draining lymph nodes, regardless of the dose injected, PHA induced germinal center development in existing primary follicles, but eventually failed to stimulate the formation of new lymph follicles and germinal centers. On the other hand, LPS not only induced germinal centers in the existing follicles, but also stimulated the formation of new primary follicles, many of which then developed germinal centers. The occurrence of new follicles in the LPS-treated lymph nodes was dose-dependent, and LPS appeared to cause de novo formation of follicles.

Animals↗
PubMed2002

Formation of lymph follicles and germinal centers in the somatic and mesenteric lymph nodes of growing mice during ontogenesis.

We investigated the age-dependent changes that occur in the numbers of lymph follicles and germinal centers in various lymph nodes in BALB/C and ICR mice aged between four days and 16 to 18 weeks. Young adult BALB/C mice have a relatively small body size, compared to ICR mice at the same stage, where there is a relatively large body size. In BALB/C mice somatic (popliteal, brachial, axillary, inguinal, submandibular and deep cervical) and mesenteric lymph nodes were examined. In ICR mice only the somatic (popliteal, brachial and axillary) lymph nodes were examined. In both BALB/C and ICR mice, the primary follicles were apparent in most somatic nodes by the 6th postnatal day. Up to 28 days of age, the number of follicles per node increased, reaching different levels in nodes from different locations. Thereafter, in most of the somatic nodes in BALB/C mice the number of follicles increased only slightly, although there was a substantial increase in ICR mice, reaching a peak or a plateau at 8 or 12 weeks of age. In the mesenteric (ileocecal) nodes in BALB/C mice, the primary follicles first appeared at 10 to 12 days, then there was a linear increase until a plateau level was reached at 8 weeks of age. Germinal centers appeared in the mesenteric nodes at 28 days and increased rapidly in number thereafter. In most somatic nodes germinal centers were scarcely observable until 8 weeks of age. Based on our observations we have three suggestions. Firstly, in BALB/C mice there were two different patterns of age-dependent changes in the numbers of lymph follicles in the somatic and the mesenteric nodes during ontogenesis. These different patterns are probably due to variations in the magnitude of the exogenous antigen stimulatory effect. Secondly, it seems likely that the variations in the numbers of lymph follicles that are produced in somatic nodes at different locations during the first 28 days after birth relate to the dimensions of the body regions that are drained by that particular somatic node at that stage of development. Thirdly, in the relatively small BALB/C mice, the ontogenetic production of lymph follicles in a somatic node is mostly completed during the first four weeks of life, whereas in the relatively larger ICR mice, this process may continue until the young adult stage of 8 weeks.

Age Factors↗
PubMedDate not supplied

First drainage lymph node(s) in gastric cancer: analysis of the topographical pattern of lymph node metastasis in patients with pN-1 stage tumors.

BACKGROUND: We attempted to identify the first lymph node(s) involved in metastasis of gastric cancer by studying the topographical pattern of metastasis to regional lymph nodes in patients with pN-1 stage tumors. MATERIALS AND METHODS: A total of 190 patients (108 males and 82 females; age range, 27 to 83 years; mean, 59.7 years), who had undergone curative resection combined with lymphadenectomy for solitary carcinoma of the stomach and were histologically diagnosed as having pN-1 stage tumors, were enrolled in the present study. The topographical patterns of metastasis to regional lymph nodes were reviewed from the pathology records of these patients. RESULTS: A total of 7561 lymph nodes (mean, 39.8/patient; range 15-99/patient) were dissected and metastasis was histologically observed in 523 nodes (6.9%, mean, 2.7/patient). Although perigastric lymph nodes were a common site of metastasis, the distribution of positive nodes depended on tumor location. As the number of positive nodes increased, a more diffuse pattern of regional involvement was noted. Skip metastasis was identified in 10 (5%) out of 190 patients. This unusual pattern of metastasis was found in 9 (14%) out of 63 patients with single positive nodes, while only one (1%) out of 127 patients with 2-6 positive nodes exhibited this pattern of metastasis. The difference between the two groups was statistically significant (p < 0.0001). CONCLUSION: Although perigastric lymph nodes are important first sites of drainage from pN-1 stage gastric tumors, the pattern of lymph node metastasis varies widely within a regional area even in pN-1 stage patients.

Adult↗
PubMed1992

[Efficacy of preoperative adjuvant chemotherapy using adriamycin targeting the regional lymph nodes for gastric cancer--lymph node-targeting delivery of adriamycin in rabbits].

Chemotherapy targeting the regional lymph nodes for gastric cancer may be more effective preoperatively than postoperatively since anticancer drugs can be transported to the regional lymph nodes via the lymphatic flow through the stomach. Distribution of Adriamycin (ADR) among the various organs was assessed following its intravenous injection in rabbits. The delivery index of the drug to each organ was assessed by the ratio of the area under the concentration-time curve (AUC) of each organ to the AUC of the regional lymph nodes following the intravenous administration. The delivery index was 0.14 for the stomach, 0.11 for the heart, 0.53 for bone marrow, 0.74 for the spleen, and 0.14 for the liver. These data suggest that preoperative adjuvant chemotherapy by intravenous administration of ADR may be effective in targeting ADR at the regional lymph nodes. Tissue ADR concentrations in the regional lymph nodes were assessed following gastric submucosal administration of ADR in rabbits. The targeting index for the regional lymph nodes was 8.20, measured by the ratio of AUC following a gastric submucosal injection to AUC after the intravenous injection of ADR. This suggests that it may be possible to selectively target chemotherapy to regional lymph nodes by employing a gastric submucosal administration of ADR.

Animals↗
PubMed1985

[Lymph node involvement in carcinoma of the esophagus--re-evaluation for the grouping of lymph nodes].

Based on the analysis of the lymph nodes dissected during resection of 234 esophageal carcinomas and the long-term results of the patient, lymph nodes of the esophagus were grouped into 3 categories, n1, n2 and n3. The lymph nodes of n1 group were frequently involved in metastases and the long-term results of the patients with these lymph nodes metastases were excellent. The n2 lymph nodes were frequently involved in metastases but the survival rates of the patients were low. The n3 lymph nodes were rarely involved and the prognoses of the patients were poor. In comparison with the classification of lymph nodes for surgical dissection as described by the Japanese Society for Esophageal Disease, some problems in this category are discussed. However, this category was revealed to have close relation to the long-term results of the patients with carcinoma of the esophagus and was considered to be of clinical use.

Adult↗
PubMed1984

Lymphocyte recognition of lymph node high endothelium. VI. Evidence of distinct structures mediating binding to high endothelial cells of lymph nodes and Peyer's patches.

Lymphocytes migrate from blood into lymph nodes (LN) and Peyer's patches (PP) of rats specifically at segments of venules lined by high endothelium (HEV). We previously identified and isolated a lymphocyte surface component termed high endothelial binding factor (HEBF) that appears to be involved in lymphocyte adhesion to high endothelial cells of LN. HEBF has also been isolated from thoracic duct lymph and is antigenically related to the cell surface component. Soluble HEBF derived from detergent lysates of thoracic duct lymphocytes (TDL) or directly from lymph has affinity for HEVLN in vitro, and is able to block sites where lymphocytes would normally attach. In the present study, lymphocyte binding sites of HEVLN and HEVPP were investigated through the use of lymph-derived HEBF and rabbit antibody to this factor. The results show that treatment of rat TDL with anti-HEBF Fab did not block binding to HEVPP, even though adhesion to HEVLN was reduced by 80% or more. Similarly, HEBF isolated by anti-HEBF F(ab')2 affinity chromatography blocked lymphocyte binding sites of HEVLN but not HEVPP. This material is therefore designated HEBFLN, and antibody to it is designated anti-HEBFLN Ig. Fractionation of thoracic duct lymph revealed that it contained an antigenically distinct component, HEBFPP, which blocked lymphocyte binding to HEVPP but not to HEVLN. Lymph components precipitating between 40 and 60% (NH4)2SO4 saturation contained both factors, which were separated from the bulk of lymph proteins by DEAE-Sepharose chromatography and then from each other by fractionation on the anti-HEBFLN F(ab')2-Sepharose column. The unbound fraction from this column contained HEBFPP, which was then partially purified by CM-Sepharose filtration. HEBFPP appeared to be a glycoprotein because it was destroyed by trypsin, bound to lentil lectin, and was eluted with alpha-methyl-mannoside. Together, the results demonstrate the existence of two antigenically distinct species of HEBF, and imply that lymphocyte binding sites of HEVLN and HEVPP are structurally different. We interpret the results to mean that distinct high endothelial adhesion molecules on lymphocytes mediate their entry into LN and PP.

Animals↗
PubMed1984

Forelimb vascular pressures, skin lymph flow and lymph protein concentration as affected by vasoactive intestinal polypeptide and bombesin.

Vasoactive intestinal polypeptide (VIP) and bombesin are peptides that have been identified in several mammalian tissues including skin. In this study, we have examined the actions of these peptides on forelimb vascular pressures, skin lymph flow, lymph total protein concentration and lymph total protein transport in the canine forelimb perfused at constant arterial inflow. Local intraarterial infusion of sequentially increasing infusion rates of VIP of 300, 600, and 1500 ng/min for twenty minutes at each infusion rate resulted in dose-dependent decreases in forelimb arterial pressures but no change in skin small vein pressure. At the two higher infusion rates, systemic pressure was significantly decreased whereas heart rate significantly increased. Skin lymph parameters were not a significantly altered with the exception of a small but significant decrease in lymph flow at the highest infusion rate of VIP. Infusion of bombesin at 500 ng/min for sixty minutes resulted in significant increases in forelimb arterial and systemic pressures, no change in skin small vein pressure and a significant bradycardia. Skin lymph flow, protein concentration and protein transport were not significantly changed during the infusion of bombesin. These data indicate that while VIP and bombesin possess potent vasodilator and vasoconstrictor effects respectively, they do not significantly affect transmicrovascular fluid and macromolecular efflux in the canine forelimb perfused at constant flow, as assessed by changes in lymph flow and protein concentration.

Animals↗
PubMed1995

Lymph node dissection for thoracic esophageal carcinoma. Two- and 3-field lymph node dissection.

Patients' records were analyzed to evaluate the effect of lymph node dissection on the survival of patients with thoracic esophageal carcinoma. Patients who underwent incomplete resection of the tumor were excluded from this study. A conventional lower mediastinal and abdominal lymph node dissection (conventional 2-field dissection) had been performed in 410 patients. A complete dissection of the upper mediastinal nodes was performed in addition in 121 patients (extended 2-field dissection). Sixty-four patients underwent a further dissection of the cervical periesophageal lymph nodes through the thoracic cavity (super-extended 2-field dissection). A cervical, mediastinal, and abdominal lymph node dissection was carried out in another 100 patients (3-field dissection). Background factors in the latter three groups were similar. Mean numbers of dissected lymph nodes in extended 2-field, super extended 2-field, and 3-field dissections were 32, 57, and 77, respectively. Operative mortality rates were 11%, 9%, and 3%, respectively. The five-year survival rates for patients who underwent extended 2-field or 3-field dissection were 43% and 61%; the difference was statistically significant (P = 0.000113). The four-year survival rate for super-extended 2-field dissection was 53%. Among those patients who underwent 3-field dissection, 58 (58%) had histologically positive lymph nodes. Their five-year survival rate was 47%. The patients' survival has been improved by increasing the field of lymph node dissection without deterioration of operative mortality.

Adenocarcinoma↗
PubMed2002

Dynamic lymph flow imaging in patients with oedema of the lower limb for evaluation of the functional outcome after autologous lymph vessel transplantation: an 8-year follow-up study.

The purpose of this study was to monitor the functional outcome of microsurgical intervention on lymph drainage by means of non-invasive, readily available lymphoscintigraphy. Eight patients with primary or secondary lymphoedema of the lower limb were investigated before and for 8 years after autologous lymph vessel transplantation. For scintigraphy, technetium-99m labelled nanocolloid was subcutaneously injected into the first interdigital space of the affected limb. Sequential images were acquired up to 6 h p.i.; for semiquantitative evaluation a numerical transport index was established by assigning scores of up to 9 on each of five criteria: lymphatic transport kinetics, distribution pattern of the radiopharmaceutical, time to appearance of lymph nodes, visualisation of lymph nodes and visualisation of lymph vessels/grafts. Ti values <10 were considered normal. In all eight patients, lymphatic function significantly (P</=0.01) improved after microsurgical treatment. Permanent function of vessel grafts was indicated by persistently low Ti values during the entire observation period, impressively demonstrating the success of this complex microsurgical technique. Patients with scintigraphic visualisation of the vessel graft (n=2/8) showed a substantially better postoperative outcome than those without visualisation of the vessel graft. The findings indicate that lymph vessel transplantation significantly improves lymph drainage in patients with primary or secondary lymphoedema of the lower limb. Thus, lymphoscintigraphy is helpful not only in planning microsurgical treatment but also in monitoring the postoperative outcome.

Adult↗
PubMed1991

The morphometric prognostic index is the strongest prognosticator in premenopausal lymph node-negative and lymph node-positive breast cancer patients.

Earlier studies on breast cancer have shown the strong prognostic value of morphometric parameters (especially the morphometric prognostic index [MPI]) in comparison with clinical and classical pathologic parameters. It remained to be proven whether the prognostic value of the MPI holds for the subgroup of premenopausal patients. We have therefore investigated the value of different prognosticators in a group of 211 premenopausal breast cancer patients with long-term follow-up, 121 cases being lymph node-negative and 90 cases being lymph node-positive. The MPI, a multivariate combination of the mitotic activity index (MAI), lymph node status, and tumor size, was the best combined prognosticator (P less than .0001), exceeding the prognostic value of MAI, lymph node status, and tumor size as individual parameters and as indicators of histologic grade. Of all the features studied, the MPI had the best prognostic value in the lymph node-negative patients, while the MAI and MPI had the best prognostic value in the lymph node-positive patients. Since the MPI has been shown to be reproducible in intra- and interlaboratory studies and can be assessed with standard equipment in routine histologic sections, it is an attractive indicator for selecting high-risk lymph node-negative patients for systemic adjuvant therapy trials.

Adult↗
PubMed1997

Lymph-node revealing solution: a new method for detecting minute lymph nodes in cystectomy specimens.

OBJECTIVE: To describe the use of a new lymph-node revealing solution (LNRS) for detecting lymph node involvement in total cystectomy specimens from patients with locally confined invasive transitional cell carcinoma (TCC) of the bladder, and to compare the results obtained with those using the conventional method (palpation and sectioning perivesical fat) that may fail to detect very small lymph nodes. MATERIALS AND METHODS: Of 12 cystectomy specimens obtained from patients with TCC, six in which 0-3 metastatic nodes were identified by the conventional method were further investigated using LNRS. The revealing solution comprised 95% ethanol, diethyl ether, glacial acetic acid and buffered formalin (65:20:5:10 v/v) prepared under a fume-hood. After evaluation using the conventional method, the specimens were immersed for 6-12 h in the solution, washed under running tap water and the adipose tissue sectioned at intervals of 2-3 mm. Lymph nodes were identified as white, chalky nodules against the background of yellow fat. The number of the lymph nodes identified by conventional and the LNRS methods was recorded and classified according the TNM system. RESULT: Twenty-two lymph nodes were detected by the conventional method, of which four were positive for tumour metastasis. Using the LNRS, an additional 21 nodes were identified among which 12 were positive. The mean size of the lymph nodes detected by the conventional and LNRS methods was 7.96 mm and 3.81 mm, respectively. The stage of three patients was increased (Nx to N2, N0 to N2 and N1 to N2) and therefore two of these patients received adjuvant chemotherapy. CONCLUSIONS: LNRS significantly enhanced the yield of normal and metastatic nodes of cystectomy specimens and may identify smaller nodes. The LNRS method allows a more accurate staging with better assessment of the prognosis and need for adjuvant therapy.

Carcinoma, Transitional Cell↗
PubMed2000

Esophageal cancer with distant lymph node metastasis: prognostic significance of metastatic lymph node ratio.

The cervical and celiac lymph node metastases are defined as distant metastasis (Mlym) from thoracic esophageal carcinoma by TNM (primary tumor, regional lymph nodes, and distant metastasis) classification. The prognostic factors, however, of such distant node metastases are not fully understood. Of 85 patients with node-positive thoracic esophageal carcinoma who were treated with the same modalities of treatment, 31 (37%) had Mlym. Prognostic factors for long-term survival were analyzed by univariate and multivariate analyzes. Three patients are alive and free of cancer, and two patients survived over 5 years. Fifteen patients died of recurrent esophageal cancer and 11 patients succumbed to causes unrelated to esophageal cancer. Two patients with a single Mlym died without recurrence of esophageal cancer at 1.4 years and after more than 5 years, respectively. The 1-, 2-, 3-, and 5-year overall survival rates of all 31 patients were 64.5%, 24.8%, 17.0%, and 12.8%, respectively. The factors influencing survival rate were depth of invasion (pT1,2 vs. pT3,4) and metastatic lymph node ratio (< or =0.104 vs. > or =0.105). The survival rates were not influenced by number of lymph node metastasis, number of Mlym, or by metastatic lymph node ratio of Mlym. Among those two significant variables verified by univariate analysis, independent prognostic factor for survival determined by multivariate analysis was the metastatic lymph node ratio (risk ratio = 3.4, p = 0.0345). The results of this study indicate that a significant number of patients can be cured of esophageal carcinoma by extensive resection along with extended lymph node dissection even when the disease metastasizes to distant nodes.

Abdomen↗
PubMed1997

Effects of coronary blood flow, myocardial contractility, and heart rate on cardiac lymph circulation in open-chest dogs. Use of a direct cannulation method for subepicardial lymph vessel.

The study was conducted to evaluate the effects of increased coronary blood flow (CBF), myocardial contractility, and heart rate on cardiac lymph circulation using a subepicardial lymph channel in anesthetized open-chest dogs. A subepicardial lymph vessel along the left anterior descending coronary artery (LAD) was cannulated directly with a small polyethylene tube, and lymph flow (LF) and protein concentration of lymph (PC) were measured. Coronary blood flow (CBF) was increased with intracoronary infusion of adenosine, and myocardial contractility with isoproterenol (isoprenaline) infusion. Effects of an increase in CBF using a constant flow system were also studied. Heart rate was increased by atrial pacing. The control cardiac LF in 17 adult mongrel dogs varied from 5.3 to 12.6 microliters/min (mean 8.4 +/- 2.8). With an increase in CBF, LF and protein efflux to lymph (PEF) increased both adenosine and isoproterenol infusion, while PC was decreased by adenosine and increased by isoproterenol. The increase in CBF using the constant flow system elicited the essentially similar extent of changes in LF and PC in relation to a change in CBF as those during infusion of adenosine. The increase in LF and PEF was significantly smaller during the infusion of adenosine than isoproterenol infusion in relation to a change in CBF. In contrast, pacing-induced tachycardia which caused a relative shortening of the diastolic phase in the heart cycle reduced LF and PEF despite of a slight increase in CBF. These findings suggest that CBF and relative duration of diastole in the heart cycle play an important role in regulation of lymph circulation, and isoproterenol can change capillary permeability in addition to increasing CBF.

Adenosine↗
PubMed1997

[Reasonable lymph node dissection for T2 or T3 midthoracic esophageal cancer with cervical lymph-node metastasis].

In order to determine the reasonable lymph node dissection for T2 or T3 midthoracic esophageal cancer with cervical lymph node metastasis, a retrospective study was carried out on 106 patients receiving resection between 1983 and 1996. Metastasis to cervical lymph node was obtained in 27.4% (29/106) of patients with T2 or T3 midthoracic esophageal cancer. Within 29 patients, metastasis in cervical node only, in two fields and in three fields occupied 17.2%, 41.4% and 41.4%, respectively. And according to the histologic examination of dissected lymph nodes, metastatic sites spreaded from neck to perigastric region. Five-year survival rate of 23 patients receiving curative operation was 33.0%, and that of 13 patients excluding 3-field metastasis was 51.9%. But the main sites of nodal recurrence were cervical or superior mediastinal nodes along the bilateral recurrent laryngeal nerves, and the rate of nodal recurrence was 47.8%. These results of actual state of lymph node metastasis and prognostic benefit of aggressive dissection suggest that 3-field lymph node dissection is mandatory for T2 or T3 midthoracic esophageal cancer with cervical lymph node metastasis. And we should endeavor to upgrade the precise dissection in order to decrease the nodal recurrence.

Esophageal Neoplasms↗
PubMed2001

Characteristics of the sentinel lymph node in breast cancer predict further involvement of higher-echelon nodes in the axilla: a study to evaluate the need for complete axillary lymph node dissection.

BACKGROUND: Sentinel lymph node (SLN) biopsy techniques provide accurate nodal staging for breast cancer. In the past, complete lymph node dissection (CLND) (levels 1 and 2) was performed for breast cancer staging, although the therapeutic benefit of this more extensive procedure has remained controversial. HYPOTHESIS: It has been demonstrated that if the axillary SLN has no evidence of micrometastases, the nonsentinel lymph nodes (NSLNs) are unlikely to have metastases. OBJECTIVE: To determine which variables predict the probability of NSLN involvement in patients with primary breast carcinoma and SLN metastases. METHODS: An analysis of 101 women with SLN metastases and subsequent CLND was performed. Variables included size of the primary tumor, tumor volume in the SLN, staining techniques used to initially identify the micrometastases (cytokeratin immunohistochemical vs hematoxylin-eosin), number of SLNs harvested, and number of NSLNs involved with the metastases. Tumor size was determined by the invasive component of the primary tumor. Patients with ductal carcinoma in situ who were upstaged with cytokeratin staining were considered to have stage T1a tumors. RESULTS: Sentinel lymph node micrometastases (<2 mm) detected initially by cytokeratin staining were associated with a 7.6% (2/26) incidence of positive CLND compared with a 25% (5/20) incidence when micrometastases were detected initially by routine hematoxylin-eosin staining. Sentinel lymph node micrometastases, regardless of identification technique, inferred a risk of 15.2% (7/46) for NSLN involvement. As the volume of tumor in the SLN increased (ie, <2 mm, >2 mm, grossly visible tumor), so did the risk of NSLN metastases (P<.001). CONCLUSIONS: Our study demonstrated that patients with micrometastases detected initially by cytokeratin staining had low-volume disease in the SLN with a small chance of having metastases in higher-echelon nodes in the regional basin other than the SLN. Characteristics of the SLN can provide information to determine the need for a complete axillary CLND. Complete lymph node dissection may not be necessary in patients with micrometastases detected initially by cytokeratin staining since the disease is confined to the SLN 92.4% of the time. However, the therapeutic value of CLND in breast cancer remains to be determined by further investigation.

Axilla↗
PubMed1985

The lymph-borne response of foetal lamb lymph nodes to challenge with Brucella abortus in utero.

The cannulated prescapular lymph node of the foetal lamb was challenged with killed Brucella abortus. Usually, both efferent prescapular ducts were cannulated and one node left as a control. Nodes were given primary or secondary challenges with doses of 10(9) - 2 X 10(10) brucella organisms and the lymph-borne response of the nodes followed. The foetal lymph node produced a vigorous cellular response to the injected brucella, restricted to the challenged side. The total cell output and, more strikingly, large cell output increased to reach a peak value 4-5 days after challenge. This cellular response was seemingly dose-dependent. The output of antibody after a primary challenge was delayed considerably and could not be detected in the lymph until well after the cellular response had subsided. The concentrations of antibody produced were quite low and almost all mercaptoethanol-sensitive. With secondary challenges the output of antibody occurred much more quickly, in phase with the cellular response, and appreciable amounts of mercaptoethanol-resistant antibody were produced. Under exceptional circumstances, high titre, highly specific anti-brucella antibody has been produced in foetal lymph. The foetal lymph node provides a powerful tool for further studies of the ontogeny of the immune response, and might help elucidate the failure of newborn animals to respond to some important bacterial antigens.

Animals↗
PubMed2004

200 Sentinel lymph node biopsies without axillary lymph node dissection -- no axillary recurrences after a 3-year follow-up.

The aim of this study is to evaluate the rate of axillary recurrences in sentinel lymph node (SLN)-negative breast cancer patients after sentinel lymph node biopsy (SLNB) alone without further axillary lymph node dissection (ALND). Between May 1999 and February 2002, 333 consecutive patients with primary invasive breast cancer up to 4 cm and clinically negative axillae were entered into this prospective study. Sentinel lymph nodes were identified using the combined method with blue dye (Patent blue V) and technetium 99m-labelled albumin (Nanocoll). Sentinel lymph nodes were examined by frozen sections, standard haematoxylin and eosin staining and immunohistochemistry staining. In SLN-positive patients, ALND was performed. Sentinel lymph node-negative patients had no further ALND. The SLN identification rate was 98.5% (328 out of 333). In all, 128 out of 328 (39.0%) patients had positive SLNs and complete ALND. A total of 200 out of 328 (61.0%) patients were SLN negative and had no further ALND. The mean tumour size of SLN-negative patients was 16.5 mm. The mean number of SLNs removed was 2.1 per patient. There were no local or axillary recurrences at a median follow-up of 36 months. The absence of axillary recurrences after SLNB without ALND in SLN-negative breast cancer patients supports the hypothesis that SLNB is accurate and safe while providing less surgical morbidity than ALND. Short-term results are very promising that SLNB without ALND in SLN-negative patients is an excellent procedure for axillary staging in a cohort of breast cancer patients with small tumours.

Axilla↗
PubMed2002

Lymph node dissection for clinically evident lymph node metastases of malignant melanoma.

AIMS: A considerable number of melanoma patients present with clinically evident regional lymph node metastases. Factors influencing prognosis following therapeutic lymph node dissection (TLND) were evaluated. METHODS: In total 140 patients (68 women, 72 men, median age 53 years) with established regional lymph node metastases, but without clinically detectable distant metastases, received cervical, axillary or ilioinguinal TLND between 1978 and 1997 and were retrospectively reviewed. Uni- and multivariate survival analysis was performed. RESULTS: Median survival for all 140 patients was 25 months; the observed overall 5 year survival rate was 30%. Age greater than 50 years, primary tumour site on the trunk, more than three lymph node metastases and extracapsular spread were associated with a poor prognosis. In multivariate analysis age (< or =50 years vs >50 years, P=0.02), location of the primary tumour (non-truncal vs truncal, P=0.005), number of lymph nodes involved ( n< or =3 vsn >3, P=0.01) and extracapsular spread (none vs present, P=0.04) proved to be independent prognostic factors. CONCLUSIONS: TLND is worthwhile and offers a potential chance of cure in about one-third of melanoma patients with established regional lymph node metastases. There are subgroups with a particularly poor prognosis in whom the benefit of radical surgery alone is limited.

Adolescent↗