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At least 127 records · Page 7Linked to original sources
PubMed2001

A mathematical model of axillary lymph node involvement considering lymph node size in patients with breast cancer.

BACKGROUND: Surgical sampling for assessing axillary status has not been considered as a well defined surgical procedure. We have reported that MRI is a good instrument for assessing lymph node size and identifying lymph node position. We also developed a mathematical model that takes into consideration the size of axillary lymph nodes, and retrospectively determined the number and size of the axillary lymph nodes that need to be sampled from level I-II to achieve a greater than 90% probability of metastasis detection after surgical sampling, with the future aim of using MR-axillography to assess lymph node size. METHODS: One thousand nine hundred and thirty four lymph nodes from 102 level I-II dissections performed on T1 and T2 breast cancer patients with nodal metastases were examined histologically and the greatest long-axis dimension on histologic slides was measured. RESULTS: This model permitted determination of the cutoff level necessary for an expected probability of detection of metastasis of over 90%. The cutoff level, regardless of tumor size, is a maximum of 6 nodes removed from level I-II in which the greatest long-axis measurement is greater than or equal to 6 mm. The cutoff level in patients with macrometastatic nodes is a maximum of 3 or 4 nodes in which the long-axis dimensions are greater than or equal to 9 or 7 mm, respectively, removed from level I-II. CONCLUSIONS: This model showed that surgical sampling on the basis of lymph node size might have good potential to detect lymph nodes metastases.

Adult↗
PubMed1982

Transabdominal fine needle aspiration of retroperitoneal lymph nodes in staging of genitourinary tract cancer (correlation with lymphography and lymph node dissection findings).

Percutaneous fine needle aspiration of retroperitoneal pelvic and abdominal lymph nodes was done in 100 patients with clinically localized bladder, prostatic, testis and penile cancer. A diagnosis of metastases to regional lymph nodes was detected by this method in 20 patients. Fine needle aspiration revealed evidence of regional lymph node involvement in 6 of 40 patients (15 per cent) with negative findings on lymphography and computerized tomography scan. Lymph node aspiration was followed by lymph node dissection in 50 patients. The correlation between aspiration and dissection was 68 per cent. The accuracy of obtaining representative material from the lymph node aspiration was 83 per cent. Negative results of lymph node aspiration cannot be used in clinical management. However, positive aspiration results provide the clinician with valuable information obtainable otherwise only by laparotomy or lymph node dissection. Positive aspiration results may spare patients with prostatic and bladder cancer an unnecessary radical operation, and may indicate early chemotherapy or surgery in patients with testis and penile cancer.

Biopsy, Needle↗
PubMed2003

The influence of serial sections, immunohistochemistry, and extension of pelvic lymph node dissection on the lymph node status in clinically localized prostate cancer.

OBJECTIVES: Pelvic lymph node metastases indicate a poor prognosis for patients with clinically localized prostate cancer. The aim of the study was to investigate the value of extended histopathological techniques considering the extent of pelvic lymphadenectomy and preoperative risk factors. METHODS: Total of 194 patients with prostate cancer were examined. At first all patients had a sampling of the sentinel lymph nodes (SLN) followed in most cases by a modified or extended pelvic lymphadenectomy. Step sections, serial sections and immunohistochemistry (IHC, pancytokeratin antibody) were analyzed in all SLN and so-called non-SLN of the first 100 patients. Later serial sections and IHC of non-SLN were left out. RESULTS: In 26.8% lymphatic metastases were found. The detection rate of lymph node-positive patients depend significantly on the chosen extension of pelvic lymphadenectomy. Limiting the histopathological investigation to the lymph node specimen of the obturator fossa only 44.2% of lymph node-positive cases would have been identified. An additional inclusion of all lymph nodes surrounding the external iliac vessels improves the sensitivity to 65.4% (46.7% and 73.3% for the first 100 patients). Compared to the extension of pelvic lymphadenectomy the diagnostic gain of serial section and IHC (13.8% versus 53.3%) was comparably low. CONCLUSIONS: The extension of pelvic lymph node dissection is of outstanding value for the identification of node-positive patients. Limiting the number of lymph nodes to the ones with the highest probability of bearing lymphatic spread (SLN) makes the use of extensive histopathological techniques more feasible.

Humans↗
PubMed1999

The influence of lymph node counts on the detection of pelvic lymph node metastasis in prostate cancer.

The present study was done to determine the influence of tumor stage and the patients' age on the number of pelvic lymph nodes obtained during standard pelvic lymphadenectomy before radical retropubic prostatectomy. Furthermore, we assessed whether the number of pelvic lymph nodes examined affects the sensitivity of pN-classification. The data of 283 consecutive patients who had undergone standardized open pelvic lymphadenectomy and radical retropubic prostatectomy for clinically organ-confined prostate cancer were reviewed retrospectively. There were striking interindividual differences in the number of lymph nodes (5-40; median: 16). The quantity was independent of pathologic tumor stage (pT) and the patients' age. In cases with 13 or more lymph nodes examined, the rate of metastatic involvement was twice as high as in lower lymph node counts. The detection of lymph node metastases--and consequently the prognostic accuracy of pN-classification--is mainly influenced by the total number of lymph nodes examined. These data suggest that at least 13 lymph nodes should be investigated to achieve optimum information.

Adenocarcinoma↗
PubMed2003

The prognostic significance of total lymph node number in patients with axillary lymph node-negative breast cancer.

AIM: In node-negative breast cancer patients, several factors for survival have been evaluated and currently, some of them are accepted for their prognostic and/or predictive values after validation in the separate data sets. The prognostic significance of increases in the number of pathologically detectable axillary lymph nodes in the node-negative patients could not been established clearly. To address this question, we have reviewed our patients' records. METHODS: A retrospective cohort study was conducted in pathologically node-negative patients who underwent modified radical mastectomy for stage I and II breast cancer. Survival and multivariate prognostic factor analyses were carried out to determine whether the number of tumour-free lymph nodes in complete axillary dissection material in addition to known factors was significant for the outcomes. RESULTS: Two hundred and seventy consecutive patients were eligible to enter the trial. The median observation time and the median number of tumour-free lymph nodes were 61 (from 30 to 120) months and 18 (from 10 to 44), respectively. The cohort was divided into the groups according to the number of nodes. The 5-year event-free and overall survivals were 92.5 and 98.3% for patients who had 18 lymph nodes or less, and 70 and 86.7% for those who had more than 18 negative nodes, respectively (P < 0.00001). Multivariate analysis for event-free survival demonstrated that the number of lymph nodes (Relative risk: 3.2 and 95% confidence interval: 1.7 to 5.9) in addition to the pathological tumour size and age was the most important independent prognosticator. In similar, multivariate analysis for overall survival showed that the number of lymph nodes together with the tumour size was the significant indicator (RR of cancer-specific dying in patients who had more than 18 nodes: 3.1 and 95% CI: 1.2 to 8.5). CONCLUSION: The increases in number of tumour-free lymph nodes are clinically important and this parameter should be taken into consideration in the breast cancer patients without metastatic lymph nodes.

Adult↗
PubMed2002

Real-time rapid reverse transcriptase-polymerase chain reaction for intraoperative diagnosis of lymph node micrometastasis: clinical application for cervical lymph node dissection in esophageal cancers.

BACKGROUND: New molecular techniques have been designed to detect cancer micrometastases that are otherwise missed by conventional histologic examination. The aim of this study was to establish a sensitive and rapid genetic assay to detect lymph node micrometastasis and to assess its usefulness clinically for cervical lymphadenectomy in esophageal cancer. We have recently shown that metastasis in the lymph node chain along the recurrent laryngeal nerves (rec LNs) is a predictor of cervical node metastasis in esophageal cancer. In our retrospective study, the positive rate of cervical lymph node metastasis with rec LNs metastasis was 51.6%, and the rate without rec LNs metastasis was 11.6%. There was a significant difference in both positive rates (P =.0002). METHODS: Rec LNs obtained from 50 patients with esophageal cancer were assessed prospectively by intraoperative histopathologic examination (HE) and genetic analysis. The latter involved a real-time quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) system with multiple markers, carcinoembryonic antigen, squamous cell carcinoma, and melanoma antigen-3, whose messenger RNAs are highly and frequently expressed in esophageal cancers. Cervical lymphadenectomy was subsequently performed in a subset of these patients. RESULTS: Ten of 50 patients (20%) were scored as node positive by HE, and 24 patients (48%) were scored positive by genetic diagnosis, including 9 HE-positive cases. Genetic diagnosis of rec LNs accurately predicted all 9 cases with cervical lymph node metastasis and 2 cases with cervical lymph node recurrence, whereas HE missed 2 cases with cervical lymph node metastasis and 2 cases with cervical lymph node recurrence. CONCLUSIONS: Our real-time rapid RT-PCR assay can improve the sensitivity of HE for detection of lymph node metastasis and might be potentially useful for intraoperative genetic diagnosis for subsequent cervical lymphadenectomy in esophageal cancer surgery.

Aged↗
PubMed1984

Distribution of radiolabelled lymph cells in lymph nodes and the migratory properties of blood lymphocytes in sheep.

The results found in this study supported the concept of lymphocyte populations with preferential migratory pathways. Preferential localization of lymphocytes in lymph nodes could not explain the non-random lymphocyte migration patterns observed in sheep. The migration of lymphocytes isolated from the blood was similar to that of lymphocytes in the efferent lymph of a subcutaneous lymph node, but was different from the migration of lymphocytes isolated from efferent intestinal lymph. The subcutaneous lymph node did not need to be selective for lymphocytes which entered from blood. However, there must be a selective entry of a population of lymphocytes with preference for migrating through mesenteric lymph nodes into efferent intestinal lymph in order to observe the differential lymphocyte migration patterns exhibited by the lymphocytes in the efferent intestinal lymph of sheep.

Animals↗
PubMedDate not supplied

Indications for paraaortic lymph node dissection in gastric cancer patients with paraaortic lymph node involvement.

BACKGROUND/AIMS: The surgical results for stage IVb gastric cancer remain very poor. The purpose of the current study is to reveal indications for paraaortic lymph node dissection in stage IVb gastric cancer patients with paraaortic lymph node involvement by analyzing prognostic factors for 3-year survival of stage IVb gastric cancer patients followed by curative B resection. METHODOLOGY: The 3-year survival in clinicopathologic variables were compared by univariate analysis. Using Cox proportional hazards regression model, independent prognostic factors were identified from 11 variables. RESULTS: Overall 5-year survival in stage IVb was 26.5%; mean survival was 19 months. Using univariate analysis, p53 expression significantly influenced 3-year survival. Using Cox proportional hazards regression model, the number of total positive lymph nodes, the number of positive paraaortic lymph nodes, and p53 expression were independent prognostic factors. CONCLUSIONS: In stage IVb, paraaortic lymph node dissection should be indicated in patients with < or = 10 total positive lymph nodes, and < or = 3 positive paraaortic lymph nodes or p53 expression < or = 50%. This indication can be applied according to the preoperative imaging, the staining of p53 by endoscopic biopsy specimens and the intraoperative microscopic evaluation of dissected lymph nodes.

Adult↗
PubMed2001

[Lymph node excision with laparotomy and chemo-radiation therapy for a hepatocellular carcinoma patient with multiple lymph node metastases].

We reported a case of hepatocellular carcinoma (HCC) with multiple lymph node metastases. The patient was a 67-year-old male with C type liver cirrhosis. He underwent microwave coagulation therapy (MCT) for HCC (5 cm and 1.5 cm) 1.5 years before admission. Abdominal CT scan revealed a well-enhanced tumor (2 cm) in caudate lobe of the liver and excessive lymph node metastases, locating in the inferior phrenic, periportal and para-aortic area. The preoperative serum AFP and AFP-L3 levels were 41.9 ng/ml and 93.1%, respectively. At laparotomy, systematic dissection of the enlarged lymph nodes and MCT of the hepatic tumor was performed. After operation, residual inferior phrenic lymph node was treated with irradiation therapy (total 50.4 Gy). The lymph node showed complete response (CR) for about a year and the AFP-L3 level returned to the normal range. After 9 months, a supra-clavicular lymph node was detected on abdominal CT scan. Irradiation therapy (total 45 Gy) in combination with CDDP (100 mg) and 5-FU (4,000 mg) was applied. The lymph node had been assessed as partial response for 6 months. The patient lived quite well after these therapies, but died of hepatic failure 32 months after the initial operation. In conclusion, we recommend this therapeutic strategy using operative excision and chemo-radiation therapy for HCC with multiple lymph node metastases.

Aged↗
PubMed1975

High concentration of bilirubin in post-nodal lymph associated with red blood cell catabolism in lymph nodes of the sheep.

Qualitative and quantitative analysis of post-nodal lymph of the sheep has shown that the distinct yellow colour of this fluid pool is due to the presence of relatively large amounts of bilirubin. In efferent lymph from thepopliteal, prefemoral, prescapular, renal and intestinal lymph nodes total bilirubin concentrations were 3-8 times higher than the corresponding concentrations in blood plasma. In contrast the total bilirubin concentrations in afferent lymph from the lower leg and kidney were less than the corresponding concentrations in blood plasma. Histological examination of several popliteal and mesenteric lymph nodes revealed the presence of free iron and bilirubin in the cytoplasm of cells located near the lymphatic sinuses of the node. In addition, the concentration of bilirubin in efferent lymph from the popliteal node was observed to increase following an induced rise in the number of red blood cells reaching the node by way of the afferent lymphatic duct. These latter observations suggest that the bilirubin in post-nodal lymph is associated with the catabolism of extravascular red cells by reticulo-endothelial cells within the lymph nodes.

Albumins↗
PubMed1985

Radiographic imaging of lymph nodes in lymph node dissection specimens.

A new method of identifying and locating lymph nodes in lymph node dissection specimens using a radiographic imaging technique is described. The specimen is immersed in 96% ethyl alcohol which possesses a radiographic density similar to fat tissue. Even small immersed lymph nodes contrast well with 96% ethyl alcohol. Thus, a radiograph of a nodal dissection specimen, immersed in 96% ethyl alcohol, does not show the interfering projection of variations in thickness of the specimen. Simultaneously, lymph nodes are clearly imaged. Using this procedure, we could visualize 97% of all lymph nodes present in the fat tissue of lymph node dissection specimens, which were dissected free from large radiodense structures like muscle and submandibular glands. Thus, a simple method was established for radiographic documentation of lymph nodes in lymph node dissection specimens.

Humans↗
PubMed1997

[Rational extent of lymph node dissection for carcinoma of the lower third of the thoracic ESOP-hagus of T2 or T3 stage with abdominal lymph node metastasis].

We discussed the rational extent of the lymph node dissection for carcinoma of the lower third of the esophagus of T2 or T3 stage with abdominal lymph node metastasis. Lymph node metastasis developed in 89.5% of patients. Cervical lymph node metastasis was seen in 35.8%. In the cases with positive abdominal lymph node, 40.9% of the patients had cervical node metastasis. The most frequent site of the positive node in the neck is the area along the right recurrent laryngeal nerve. On the stand point of removal of metastatic lymph node, neck dissection should be required. Three-field dissection yielded better survival rate than two-field dissection but statistical significance was not obtained. When the patients have cervical lymph node metastasis, they have greater possibility of developing blood borne metastasis. However, this observation does not deny the validity of the three-field dissection. Because this dissection may help reducing nodal spread and nodal recurrence. We have to wait for accumulation of the patients to analyze the definite extent of node dissection for T2 or T3 stage of carcinoma of the lower third of the esophagus with positive abdominal lymph node.

Abdomen↗
PubMed1993

The size of regional lymph nodes does not correlate with the presence or absence of metastasis in lymph nodes in rectal cancer.

We evaluated the relationship between the size of regional lymph nodes and the presence of metastasis in them in rectal cancer. Of 1,064 lymph nodes in 46 specimens, 133 (13%) were found to have metastases. A half of the positive nodes and most of the negative ones were less than 5 mm in diameter. Therefore, we must find lymph nodes smaller than 5 mm in diameter for assessment of lymph node metastasis. Although positive nodes were larger than negative ones, there was no significant difference. However, when comparing the size of lymph nodes in relation to their location, the epi- and pararectal lymph nodes larger than 10 mm in diameter were highly suggestive of metastases, but the size of the lymph node was not a reliable indicator of lymph node metastases in other situations.

Humans↗
PubMed1984

Plasma-lymph albumin kinetics, total lymph flow, and tissue hematocrit in normally hydrated dog lungs.

Lung lymph flow was normalized for lung weight and total lung lymph flows were calculated in five mongrel dogs using a kinetic analysis of albumin distribution between the pulmonary capillaries, interstitial fluid, and pulmonary lymph. Using prenodal tracheobronchial lymph an intravenous bolus of 125I-labeled albumin equilibrated between plasma and lymph with mean T1/2 of 2 hr 22 min. The mean volume of interstitial fluid drained by the cannulated lymphatics was 9.9 ml which corresponded to the extravascular albumin distribution volume of 31% of the total lung weight. Lung tissue hematocrit was determined using 51Cr-labeled red cells and 125I-albumin and averaged 92% of the simultaneous mixed venous hematocrit. The extravascular albumin and 99mTc-DTPA (diethylenetriamine pentacetic acid) spaces in lung were corrected for differences between tissue and mixed venous hematocrit and were 18.5 and 33.0 ml/100 g, respectively. This indicated that albumin distributed in 57% of the interstitial volume at 4 hr after injection. Lung lymph flow normalized to postmortem lung mass during baseline conditions was 0.060 ml/min/100 g after correction for tissue hematocrit differences. Normalized lymph flows are used for quantitative comparisons of lung lymph protein flux data between different types of experiments.

Albumins↗
PubMedDate not supplied

Lymph pools in the basement, sump pumps in the attic: the anuran dilemma for lymph movement.

Amphibians are a vertebrate group transitional between aquatic and terrestrial environments. Consequently, both increases and decreases in blood volume are a natural biological stress associated with aquatic and terrestrial environments. In comparison with other vertebrate classes, anuran amphibians have the most rapid compensation and greatest capacity to compensate for changes in blood volume and survive dehydration. Unlike in mammals, a Starling transcapillary uptake mechanism does not account for this fluid mobilization because lymph flow is a substantial and important additional factor. The role of the lymphatic system in flux of fluids back into the circulation varies interspecifically in anurans and is an order of magnitude greater in anurans than in mammals. Current models of lymph movement in anurans are centered on the role of lymph hearts, but we suggest that these models are untenable. We present a new hypothesis for lymph movement involving (1) pressure differences created by compartmentalization of the hind limb lymph spaces into sacs of serially graded compliance to move lymph horizontally and (2) both negative and positive pressure differences created by contraction of skeletal muscles to move lymph vertically. The primary function of some of these skeletal muscles may be solely for lymph movement, but some may also be involved with other functions such as pulmonary ventilation.

Animals↗
PubMed1997

Asymptomatic HIV infection is characterized by rapid turnover of HIV RNA in plasma and lymph nodes but not of latently infected lymph-node CD4+ T cells.

OBJECTIVES: To study the kinetics of plasma viraemia and HIV-infected lymph-node cells in stable asymptomatic HIV infection with high CD4+ T-cell counts. METHODS: Nine asymptomatic HIV-infected patients with stable CD4+ T-cell counts (510-1350 x 10(6)/l) were treated with a triple-drug combination. Plasma viraemia was determined at days 0, 3, 7, 10, 14, 21 and 28 of treatment [Roche polymerase chain reaction (PCR) and ultrasensitive PCR assay]. Sequential lymph-node biopsies were examined in four patients before and after 4 weeks of treatment. Productively infected cells were counted in lymph-node sections (in situ hybridization). The infection rates of FACS-sorted CD4+ lymph-node T cells and the expression of single-spliced, double-spliced and full-length HIV transcripts were determined. RESULTS: HIV plasma RNA half-lives ranged from 1.4 to 2.7 days. Viral turnover varied between 0.07 and 7.54 x 10(8) copies per day. The number of productively infected lymph-node cells as well as the amount of extracellular virus in germinal centres was markedly reduced during treatment, paralleled by a clearance of single-spliced, double-spliced and full-length HIV transcripts from CD4+ lymph-node T cells. Plasma viraemia remained detectable with an ultrasensitive PCR assay in three out of four patients. The percentage of lymph-node CD4+ T cells harbouring proviral DNA decreased only slightly. CONCLUSIONS: The kinetics of HIV replication are rapid in stable asymptomatic infection, and the magnitude of replication varies considerably. Productively infected lymph-node cells and extracellular virus in germinal centres undergo a rapid turnover, whereas latently infected CD4+ T cells have a lower rate of turnover. The latter may contribute substantially to viral persistence during therapy.

Adult↗
PubMed2003

Tumor cells in lymph vessels and lymph nodes closely associated with nodal metastasis by invasive ductal carcinoma of the breast.

No studies have ever precisely investigated the mechanism of nodal metastasis based on the histological characteristics of tumor cells in lymph vessels and lymph nodes. The purpose of this study was to investigate whether the histological characteristics of tumor cells in lymph vessels and lymph nodes of 393 patients with invasive ductal carcinoma (IDC) were significantly associated with increased nodal metastasis compared with well known histological characteristics of their primary-invasive tumor cells. Multivariate analyses showed that having a single nodal metastasis was closely dependent on primary-invasive tumor size or distance of lymph vessel tumor emboli from the margin of the primary-invasive tumor (P < 0.05) and that having 2 or more nodal metastases was significantly associated with the histological characteristics of the nodal metastatic tumors independently of the size of the primary-invasive tumor, and the number of nodes with extra-nodal invasion (ENI) significantly increased the relative risk (RR) of 4 or more nodal metastases in IDCs </= 20 mm and > 20 to </= 50 mm in size (P < 0.05). In IDCs > 50 mm in size, number of lymph vessels invaded, severe fibrosis of the stroma of extra-nodal invasive tumors, and distance of ENI from the node significantly increased the RR of 10 or more nodal metastases in the multivariate analysis (P < 0.05). The results of this study strongly suggest that the histological characteristics of tumor cells in lymph nodes and lymph vessels play an important role in nodal metastasis in IDCs of the breast.

Adult↗
PubMed1986

Lymph pressure in rat intestinal lymph duct with lymphatic obstruction.

Lymph pressure (PL) in the main intestinal lymph duct with obstruction of lymph flow was determined. Under various conditions, the rate of lymph flow (JL) was essentially the same in either A rats (with communications between hepatic and intestinal lymphatics) or B rats (without such communications), but PL of A rats was significantly lower (P less than 0.01) than that of B rats. When the intestine was in the basal state, JL of A and B rats was 0.2-0.3 ml/h per rat, and PL was 1.5 +/- 0.2 and 3.3 +/- 0.2 mm/Hg, respectively. During fluid absorption, JL of A and B rats increased to 0.8-0.9 ml/h, and PL was 2.1 +/- 0.4 and 6.4 +/- 0.7 mmHg, respectively. During intravenous saline infusion, JL of A and B rats increased greatly to approximately 14 ml/h, and PL was 3.1 +/- 0.3 and 10.4 +/- 1.1 mmHg, respectively. The lower PL in A rats is apparently due to the possibility that during lymphatic obstruction most lymph could be drained off by the hepatic lymphatics. In A rats, luminal distension pressure had no effect on PL but in B rats PL decreased when distension pressure was 20 mmHg or higher. Furthermore, lymph pressure waves indicate the occurrence of rhythmical contractions of the lymph duct or its surrounding tissues, which may play a role in the propulsion of lymph.

Animals↗