Magnetic resonance imaging-based lymph node radiomics for predicting the metastasis of evaluable lymph nodes in rectal cancer

BACKGROUND Lymph node(LN)staging in rectal cancer(RC)affects treatment decisions and patient prognosis.For radiologists,the traditional preoperative assessment of LN metastasis(LNM)using magnetic resonance imaging(MRI)poses a challenge.AIM To explore the value of a nomogram model that combines Conventional MRI and radiomics features from the LNs of RC in assessing the preoperative metastasis of evaluable LNs.METHODS In this retrospective study,270 LNs(158 nonmetastatic,112 metastatic)were randomly split into training(n=189)and validation sets(n=81).LNs were classified based on pathology-MRI matching.Conventional MRI features[size,shape,margin,T2-weighted imaging(T2WI)appearance,and CE-T1-weighted imaging(T1WI)enhancement]were evaluated.Three radiomics models used 3D features from T1WI and T2WI images.Additionally,a nomogram model combining conventional MRI and radiomics features was developed.The model used univariate analysis and multivariable logistic regression.Evaluation employed the receiver operating characteristic curve,with DeLong test for comparing diagnostic performance.Nomogram performance was assessed using calibration and decision curve analysis.RESULTS The nomogram model outperformed conventional MRI and single radiomics models in evaluating LNM.In the training set,the nomogram model achieved an area under the curve(AUC)of 0.92,which was significantly higher than the AUCs of 0.82(P<0.001)and 0.89(P<0.001)of the conventional MRI and radiomics models,respectively.In the validation set,the nomogram model achieved an AUC of 0.91,significantly surpassing 0.80(P<0.001)and 0.86(P<0.001),respectively.CONCLUSION The nomogram model showed the best performance in predicting metastasis of evaluable LNs.

Screening of lymph nodes metastasis associated lncRNAs in colorectal cancer patients

AIM: To screen lymph nodes metastasis associated long noncoding RNAs (lncRNAs) in colorectal cancer through microarray analysis.

The value and association of CC chemokine receptor 7 expression in non-small cell lung cancer with lymph nodes metastasis

Objective： The aim of this study was to analyze the expression of CC chemokine receptor 7 （CCR7） in pulmonary tumor tissue and metastasized lymph nodes of non-small cell lung cancer （NSCLC）, explore the relationship between the expressions of CCR7 in pulmonary tumor tissue and metastasized lymph nodes, and discuss the significance. Methods： SABC immunohistochemical staining was used to investigate the expression of CCR7 by rabbit anti-human CCR7 monoclonal antibody, and the specimens were 17 cases of adenocarcinoma, 17 cases of squamous cell carcinoma, 12 cases of adenosquamous carcinoma, 4 cases of large cell carcinoma and 28 cases of metastasized lymph nodes of lung cancer. Negative control sections used 5 cases of inflammatory pseudotumor and 20 cases of normal lung tissue. Two independent pathologists observed all the specimens in the high power field （x 400） of microscope by double blind method. Results： （1） The expression of CCR7 in pulmonary tumor tissue was stronger than normal lung tissue （P 〈 0.005）; （2） The expressions of CCR7 in pulmonary tumor tissues and metastasized lymph nodes had no significant differences （P = 0.177）; （3） The expression of CCR7 had correlation with lymph nodes metastasis, and the expression in lymph nodes metastasis group was more than that of no lymph nodes metastasis group （P = 0.016）; （4） Along with the increment of clinical stage, the CCR7 expression had a tendency to increase （P = 0.003）. Conclusion： CCR7 has rich expression in carcinoma cell nests and lymph node metastasis. It demonstrates that CCR7 may be related to the development of lymph node metastasis in NSCLC.

Gastrointestinal stromal tumor of stomach with inguinal lymph nodes metastasis: A case report

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor in the alimentary tract. To the best of our knowledge, few cases have been reported in the literature about the peripheral lymph node metastasis of GIST. Here we report an unusual case of gastric GIST with inguinal lymph nodes metastasis. After the metastatic lymph nodes were resected, the. patient started to take imatinib 400 mg/d for 12 mo. There were no signs of tumor recurrence at follow-up after 29 mo. This case suggests that the inguinal lymph nodes can be a potential metastatic site of GIST.

Significance of the lymph nodes in the 7th station in rational dissection for metastasis of distal gastric cancer with different T categories

Objective： To determine the clinicopathological characteristics, and evaluate the appropriate extent of lymph node dissection in distal gastric cancer patients with comparable T category. Methods： A retrospective study was conducted on 570 distal gastric cancer patients, who underwent gastric resection with D2 nodal dissection, which was performed by the same surgical team from January 1997 to January 2011. We compared the differences in lymph node metastasis rates and metastatic lymph node ratios between different T categories. Additionally, we investigated the impact of lymph node metastasis in the 7th station on survival rate of distal gastric cancer patients with the same TNM staging. Results： Among the 570 patients, the overall lymph node metastasis rate of advanced distal gastric cancer was 78.1%, and the metastatic lymph node ratio was 27%. The lymph node metastasis rate in the 7th station was similar to that of perigastric lymph nodes. There was no statistical significance in patients with the same TNM stage （stage Ⅱ and Ⅲ）, irrespective of the metastatic status in the 7th station. Conclusions： Our results suggest that to a certain extent, it is reasonable to include lymph nodes in the 7th station in the D 1 lymph node dissection.

Adjuvant chemotherapy may improve outcome of patients with non-small-cell lung cancer with metastasis of intrapulmonary lymph nodes after systematic dissection of N1 nodes

Objective: Survival benefit of adjuvant chemotherapy(AC) of patients with intrapulmonary lymph node(IPLN)metastasis(level 12-14) needs investigation.We evaluated the impact of AC on patients whose metastatic nodes were limited to intrapulmonary levels after systematic dissection of N1 nodes.Methods: First,155 consective cases of lung cancer confirmed as pathologic N1 were collected and evaluated.Patients received systematic dissection of N2 and N1 nodes.For patients with IPLN metastasis,survival outcomes were compared between those receiving AC and those not receiving AC.Results: In this group,112 cases(72.3%) had IPLN metastasis and 55 cases(35.5%) had N1 involvement limited to level 13-14 without further disease spread to higher levels.Patients with IPLN involvement had a better prognosis than that of patients with hilar-interlobar involvement.For the intrapulmonary N1 group(level 12-14-positive,level 10-11-negative or unknown,n=112),no survival benefit was found between the AC group and nonAC group [5-year overall survival(OS): 54.6±1.6 vs.50.4±2.4 months,P=0.177].However,76 of 112 cases for whom harvesting of level-10 and level-11 nodes was done did not show cancer involvement in pathology reports(level 12-14-positive,level 10-11 both negative),oncologic outcome was better for patients receiving AC than those not receiving AC in this subgroup(5-year OS: 57.3±1.5 vs.47.1±3.2 months,P=0.002).Conclusions: Oncologic outcome may be improved by AC for patients with involvement of N1 nodes limited to intrapulmonary levels after complete examination of N1 nodes.

Seven synchronous early gastric cancer with 28 lymph nodes metastasis

An 85 year male patient complaining epigastric discomfort was admitted.From the esophagogastroduodenoscopy,three early gastric cancer(EGCa)lesions had been identified and these were diagnosed as adenocarcinoma with poorly differentiated cell type.The patient underwent operation.From the post-operative mapping,however,additional 4 EGCa lesions were found,and the patient was diagnosed with 7 synchronous EGCa.Out of the 7 EGCa lesions,6 had shown invasion only to the mucosal layer and one had shown invasion into the 1/3layer of submucosa.In spite of such superficial invasions,28 of 48 lymph nodes had been identified as metastases.The multiple lesions of EGCa do not increase the risk of lymph node metastasis,but if their differentiations are poor or if they have lympho-vascular invasion,multiple lymph node metastases could incur even if the depth of invasion is limited to the mucosal layer or the upper portion of the submucosal layer.

T1 rectal mucinous adenocarcinoma with bilateral enlarged lateral lymph nodes and unilateral metastasis:A case report

BACKGROUND There are a few cases of lateral lymph node(LLN)metastasis(LLNM)of T1 rectal cancer.Moreover,LLNM is easily missed,especially in patients with early-stage rectal cancer.To our knowledge,the possibility of bilateral LLNM before surgery has not been reported in previous studies.CASE SUMMARY A 36-year-old woman underwent endoscopic submucosal dissection at a local hospital owing to a clinical diagnosis of a rectal polyp.The pathology report showed a diagnosis of T1 rectal mucinous adenocarcinoma.She was considered to have bilateral LLNM after the examination at our hospital.Laparoscopic total mesorectal excision plus bilateral LLN dissection was performed and the pathological outcomes indicated unilateral LLNM.The patient received longcourse adjuvant chemoradiotherapy with no recurrence or metastasis observed during the 1-year follow-up period.CONCLUSION T1 rectal cancer could lead to LLNM and possibly,bilateral LLNM.Therefore,adequate clinical evaluation is essential for these patients.

A clinical study of thoracic esophageal carcinoma metastasis into abdominal lymph nodes

Objective The aim of this study was to analyze the potential of thoracic esophageal carcinoma to metas-tasize into abdominal lymph nodes. Methods The data on abdominal lymph node metastasis in 164 patients who had undergone resection of thoracic esophageal carcinoma were analyzed retrospectively and grouped according to tumor position in the upper, middle, or lower thoracic esophagus. The dif erence in tumor infiltration depth, dif erentiation degree, pathological type, pathological stage, and the metastasis rate in abdominal lymph nodes among the three groups was evaluated and the correlation of abdominal lymph node metastasis with tumor infiltra-tion depth, dif erentiation degree, and pathological type was analyzed. Results Clinical characteristics such as tumor infiltration depth, dif erentiation degree, pathological type, and pathological stage were not significantly dif erent between the patients with upper, middle, and lower thoracic esophageal carcinomas. Although there was a dif erence in the metastasis rate in abdominal lymph nodes between the three groups （6.9%, 27.4%, and 39.6% for the upper, middle, and lower thoracic esophageal carcinomas, respectively）, it was not statistical y significant. There was also no association between the rate of abdominal lymph node metastasis and tumor infiltration depth, dif erentiation degree, and pathological type. Conclusion Esophageal carcinoma specifical y metastasizes into lymph nodes. If the tumor infiltrates the upper thoracic submucosa, it could metastasize down to abdominal lymph nodes via the lymphatic cap-il ary net. The majority of esophageal carcinomas were of T1b or higher pathological stage at the diagnosis, indicating infiltration of the submucosa. Thus, tumors of the early stage, high degree of dif erentiation, or position in the upper thoracic esophagus were not less prone to metastasis into abdominal lymph nodes. Therefore, routine abdominal lymph node dissection during radical surgery for esophageal carcinoma is necessary.

Log odds of positive lymph nodes is a better prognostic factor for oesophageal signet ring cell carcinoma than N stage

BACKGROUND Signet ring cell carcinoma is a rare type of oesophageal cancer,and we hypothesized that log odds of positive lymph nodes(LODDS)is a better prognostic factor for oesophageal signet ring cell carcinoma.AIM To explore a novel prognostic factor for oesophageal signet ring cell carcinoma by comparing two lymph node-related prognostic factors,log odds of positive LODDS and N stage.METHODS A total of 259 cases of oesophageal signet ring cell carcinoma after oesophagectomy were obtained from the Surveillance,Epidemiology,and End Results database between 2006 and 2016.The prognostic value of LODDS and N stage for oesophageal signet ring cell carcinoma was evaluated by univariate and multivariate analyses.The Akaike information criterion and Harrell’s C-index were used to assess the value of two prediction models based on lymph nodes.External validation was performed to further confirm the conclusion.RESULTS The 5-year cancer-specific survival(CSS)and 5-year overall survival(OS)rates of all the cases were 41.3%and 27.0%,respectively.The Kaplan-Meier method showed that LODDS had a higher score of log rank chi-squared(OS:46.162,CSS:41.178)than N stage(OS:36.215,CSS:31.583).Univariate analyses showed that insurance,race,T stage,M stage,TNM stage,radiation therapy,N stage,and LODDS were potential prognostic factors for OS(P<0.1).The multivariate Cox regression model showed that LODDS was an significant independent prognostic factor for oesophageal signet ring carcinoma patients after surgical resection(P<0.05),while N stage was not considered to be a significant prognostic factor(P=0.122).Model 2(LODDS)had a higher degree of discrimination and fit than Model 1(N stage)(LODDS vs N stage,Harell’s C-index 0.673 vs 0.656,P<0.001;Akaike information criterion 1688.824 vs 1697.519,P<0.001).The results of external validation were consistent with those in the study cohort.CONCLUSION LODDS is a superior prognostic factor to N stage for patients with oesophageal signet ring cell carcinoma after oesophagectomy.

Prognostic relevance of number and ratio of metastatic lymph nodes in resected carcinoma of the ampulla of Vater

Objectives： To explore the prognostic relevance of the number and ratio of metastatic lymph nodes in resected Carcinoma of the ampulla of Vater （CAV）. Methods： The clinical data of 155 patients who underwent pancreaticoduodenectomy （PD） for cancer of the ampulla of Vater between January 1990 and December 2010 were retrospectively analyzed. Kaplan- Meier method was used in survival analysis and Log rank method in comparison. Multivariate analysis was performed using Cox proportional hazards model. Results： Among these 155 patients, the in-hospital mortality rate was 4.5%, lymph node positive disease was 21.3%, and the 5-year survival rate was 51.6%. Patients with a lymph node ratio （LNR） 〉20% were more likely to have tumor differentiation, depth of duodenal involvement, depth of pancreatic invasion, T-stage and TNM-Stage. The number of the metastatic lymph nodes is important prognostic factors of the CAV. Univariate analysis showed that the factors associated with the prognosis included tumor size （P=0.036）, tumor differentiation （P=0.019）, LNR （P=0.032）, mtmber of metastatic lymph nodes （P=0.024）, lymph node metastasis （P=0.03）, depth of pancreatic invasion （P=0.001）, T-stage （P=0.002）, TNM stage （P=0.001）, elevated CA 19-9 （P=0.000）, and jaundice （P=0.021）. Multivariate analysis showed that the factors associated with the prognosis were the number of metastatic lymph nodes （P=0.032; RR： 1.283; 95% CI： 1.022-1.611）, tumor size （P=0.043; RR： 1.736; 95% CI： 1.017-2.963）, and elevated CA 19-9 （P=0.003; RR： 3.247; 95% CI： 1.504-7.010）. Conclusions： LNR is a useful factor for predicting the prognosis of the radical treatment for CAV,, whereas the number of metastatic lymph nodes is the most important factor. Further research on the locations, number, and LNR will be clinically meaningful to improve survival in patients with CAV.

Advantage of log odds of positive lymph nodes in prognostic evaluation of patients with early-onset colon cancer

BACKGROUND Colon cancer(CC)is one of the most common cancers of the digestive tract,the third most common cancer worldwide,and the second most common cause of cancer-related deaths.Previous studies have demonstrated a higher risk of lymph node metastasis(LNM)in young patients with CC.It might be reasonable to treat patients with early-onset locally advanced CC with extended lymph node dissection.However,few studies have focused on early-onset CC(ECC)patients with LNM.At present,the methods of predicting and evaluating the prognosis of ECC patients with LNM are controversial.From the data of patients with CC obtained from the Surveillance,Epidemiology,and End Results(SEER)database,data of young patients with ECC(≤50 years old)was screened.Patients with unknown data were excluded from the study,while the remaining patients were included.The patients were randomly divided into a training group(train)and a testing group(test)in the ratio of 7:3,while building the model.The model was constructed by the training group and verified by the testing group.Using multiple Cox regression models to compare the prediction efficiency of LNM indicators,nomograms were built based on the best model selected for overall survival(OS)and cause-specific survival(CSS).In the two groups,the performance of the nomogram was evaluated by constructing a calibration plot,time-dependent area under the curve(AUC),and decision curve analysis.Finally,the patients were grouped based on the risk score predicted by the prognosis model,and the survival curve was constructed after comparing the survival status of the high and low-risk groups.RESULTS Records of 26922 ECC patients were screened from the SEER database.N classification,positive lymph nodes(PLN),lymph node ratio(LNR)and log odds of PLN(LODDS)were considered to be independent predictors of OS and CSS.In addition,independent risk factors for OS included gender,race,marital status,primary site,histology,grade,T,and M classification,while the independent prognostic factors for CSS included race,marital status,primary site,grade,T,and M classification.The prediction model including LODDS is composed of minimal Akaike information criterion,maximal concordance indexes,and AUCs.Factors including gender,race,marital status,primary site,histology,grade,T,M classification,and LODDS were integrated into the OS nomogram,while race,marital status,primary site,grade,T,M classification,and LODDS were included into the CSS nomogram.The nomogram representing both cohorts had been successfully verified in terms of prediction accuracy and clinical practicability.CONCLUSION LODDS is superior to N-stage,PLN,and LNR of ECC.The nomogram containing LODDS might be helpful in tumor evaluation and clinical decision-making,since it provides an appropriate prediction of ECC.

SPIO-enhanced magnetic resonance imaging for differentiating metastatic from hyperplastic lymph nodes: A study in rabbits

Objective: To investigate the potential of superparamagnetic iron oxide particles (SPIO) in MR imaging for the differentiation between hyperplastic and metastatic lymph node. Methods: Animal models of malignant lymph node metastasis were established in 6 New-Zealand rabbits by a unilateral intra-muscular injection of VX2 carcinoma cells, and models of hyperplastic lymph nodes were induced in another 6 rabbits by a unilateral intra-muscular injection of egg yolk emulsion. MR images of the lymph nodes were obtained before and 12 h after interstitial injection of SPIO. Image results were analyzed and compared with pathological findings. Results: On unenhanced images, the signal intensity of hyperplastic and metastatic lymph nodes did not differ significantly. After administration of SPIO, the signal intensity of both hyperplastic and metastatic lymph nodes remained unchanged on T1-weighted SE images. On T2-weighted SE images, the signal intensity of hyperplastic lymph nodes decreased heterogeneously, while that of all metastatic ones remained unchanged. On T2-weighted GRE images, the signal intensity of hyperplastic lymph nodes decreased significantly and homogeneously, while that of 4 metastatic ones remained unchanged and that of the rest 2 decreased heterogeneously. Conclusion: SPIO-enhanced MR imaging may enable the differentiation between the hyperplastic and metastatic lymph nodes.

Endoscopic ultrasound elastography for malignant pancreatic masses and associated lymph nodes:Critical evaluation of strain ratio cutoff value

BACKGROUND Endoscopic ultrasound(EUS)can detect small lesions throughout the digestive tract;however,it remains challenging to accurately identify malignancies with this approach.EUS elastography measures tissue hardness,by which malignant and nonmalignant pancreatic masses(PMs)and lymph nodes(LNs)can be differentiated.However,there is currently little information regarding the strain ratio(SR)cutoff in Hispanic populations.AIM To determine the diagnostic accuracy of EUS elastography for PMs and LNs with an SR cutoff value in Hispanics.METHODS A retrospective study of patients who underwent EUS elastography for PMs between December 2013 and December 2014.A qualitative(analysis of color maps)and quantitative(SR)analysis of PMs and their associated LNs was performed.The accuracy of EUS elastography in identifying malignant PMs and LNs and cutoff value for SR were analyzed.A PM and/or its associated LNs were considered malignant based on histopathological findings from fine-needle aspiration biopsy samples.RESULTS A sample of 121 patients was included,45.4%of whom were female.69(57.0%)PMs were histologically malignant,with a median SR of 50.4 vs 33.0 for malignant vs nonmalignant masses(P<0.001).EUS evaluation identified associated LNs in 43/121 patients(35.5%),in whom 22/43(51.2%)patients had histologically confirmed malignant diagnosis,with a median SR of 30 vs 40 for malignant vs nonmalignant LNs(P=0.7182).In detecting malignancy in PMs,an SR cutoff value of>21.5 yielded a sensitivity of 94.2%,while a cutoff value of>121 yielded a specificity of 96.2.2%.There were significant differences in the Giovannini scores,a previously established elastic score system,between the patients grouped by their final histology results(P<0.001).For LNs,SR cutoff values of>14.0 and>155 yielded a sensitivity of 90.9%and a specificity of 95.2%,respectively,in detecting malignancy.CONCLUSION EUS elastography is a helpful technique for the diagnosis of solid PMs and their associated LNs.The proposed SR cutoff values have a high sensitivity and specificity for the detection of malignancy.

Dual energy computed tomography for detection of metastatic lymph nodes in patients with hepatocellular carcinoma

BACKGROUND Regional lymph node metastasis in patients with hepatocellular carcinoma(HCC)is not uncommon, and is often under-or misdiagnosed. Regional lymph node metastasis is associated with a negative prognosis in patients with HCC, and surgical resection of lymph node metastasis is considered feasible and efficacious in improving the survival and prognosis. It is critical to characterize lymph node preoperatively. There is currently no consensus regarding the optimal method for the assessment of regional lymph nodes in patients with HCC.AIM To evaluate the diagnostic value of single source dual energy computed tomography(CT) in regional lymph node assessment for HCC patients.METHODS Forty-three patients with pathologically confirmed HCC who underwent partial hepatectomy with lymphadenectomy were retrospectively enrolled. All patients underwent dual-energy CT preoperatively. Regional lymph nodes(n = 156) were divided into either a metastatic(group P, n = 52) or a non-metastasis group(group N, n = 104), and further, according to pathology, divided into an active hepatitis(group P1, n = 34; group N1, n = 73) and a non-active hepatitis group(group P2, n = 18; group N2, n = 31). The maximal short axis diameter(MSAD),iodine concentration(IC), normalized IC(NIC), and the slope of the spectralcurve(λ_(HU)) of each group in the arterial phase(AP), portal phase(PP), and delayed phase(DP) were analyzed.RESULTS Analysis of the MSAD, IC, NIC, and λ_(HU) showed statistical differences between groups P and N(P < 0.05) during all three phases. To distinguish benign from metastatic lymph nodes, the diagnostic efficacy of IC, NIC, and λ_(HU) in the PP was the best among the three phases(AP, PP, and DP), with a sensitivity up to 81.9%,83.9%, and 81.8%, and a specificity up to 82.4%, 84.1% and 84.1%, respectively.The diagnostic value of combined analyses of MSAD with IC, NIC, or λ_(HU) in the PP was superior to the dual energy CT parameters alone, with a sensitivity up to84.5%, 86.9%, and 86.2%, and a specificity up to 83.0%, 93.6% and 89.8%,respectively. Between groups P1 and P2 and groups N1 and N2, only IC, NIC,and λ_(HU) between groups N1 and N2 in the PP had a statistically significant difference(P < 0.05).CONCLUSION Dual-energy CT contributes beneficially to regional lymph node assessment in HCC patients. Combination of MSAD with IC, NIC, or λ_(HU) values in the PP is superior to using any single parameter alone. Active hepatitis does not deteriorate the capabilities for characterization of metastatic lymph nodes.

Ultrasound features of extranodal extension in the metastatic cervical lymph nodes of papillary thyroid cancer:a case-control study

Objective：Extranodal extension in cervical lymph nodes is an important risk factor for the progression and prognosis of papillary thyroid cancer.The purpose of this study was to identify the common and characteristic preoperative ultrasonography features that are associated with the pathologic extranodal extension of metastatic papillary thyroid carcinoma.Methods：We retrospectively assessed and compared clinicopathologic and ultrasound features between 60 papillary thyroid cancer patients with extranodal extension and 120 control patients with papillary thyroid cancer without extranodal extension.Results：With respect to the pathological N stage and clinicopathologic features,N1b stage papillary thyroid carcinomas were more frequently found in patients who were extranodal extension-positive,in comparison with those who were extranodal extension-negative（78.3%vs.63.3%,P=0.043）.Extranodal extension was detected most frequently in level VI cervical lymph nodes（48.7%）.In our univariate analysis of patients with papillary thyroid carcinoma,cervical lymph nodes with extranodal extension showed higher incidences of node matting,microcalcification,cystic area,aspect ratio＆lt;2,and larger diameter than those without extranodal extension（all P〈0.05）.Our multivariate analysis demonstrated that node matting and cystic area were independent risk factors for the presence of extranodal extension[odds ratio（OR）：4.751,95%confidence interval（CI）：1.212~18.626,P=0.025;OR：2.707,95%CI：1.127~6.502,P=0.026].Conclusions：Common ultrasound features may indicate the presence of extranodal extension in patients with metastatic cervical lymph nodes of papillary thyroid carcinoma.

Prognostic implication of isolated tumor cells and micrometastases in regional lymph nodes of gastric cancer

AIM： To determine the prognostic significance of isolated tumor cells （ITCs） and lymph node micrometastases in gastric cancer. METHODS： Hematoxylin and eosin-stained slides of lymph node dissections of 632 consecutive gastric cancers were reviewed. Cytokeratin immunostaining was performed in 280 node-negative cases and 5 cases indefinite for lymph node metastases. Lymph node metastases were divided into ITCs, micrometastases, or macrometastases, according to the sizes of tumor deposits in largest dimension. ITCs were further classified into four groups according to metastasis pattern. RESULTS： Lymph node metastases were identified by immunostaining in 58 of 280 node-negative cases （20.7%） and were not significantly associated with patient survival （P = 0.3460）. After cytokeratin immunostaining, 196 cases were classified as pN1, which consisted of 20 cases with micrometastases detected by immunostaining （pNlmi（i＋））, 34 cases with only micrometastases （pNlmi）, and 142 cases with pN1 with one or more macrometastases （pN1）. Cases with pNlmi and pNlmi（i＋） had a significantly better prognosis than the cases with pN1 （P = 0.0037）. ITCs were found in 38 of these 58 cases, and could be divided into four groups： 12 cases with only a single cell pattern, 7 cases with multiple individual cells, 5 cases with single small cluster, and 14 cases with multiple small clusters. Among these four groups, cases with ITCs of multiple individual cell pattern showed the worst survival （median survival： 28 mo, P〈0.0001）.CONCLUSION： Both size and pattern of lymph node metastases can give prognostic information on the survival of gastric cancer patients.

Which Lymph Nodes Should Be Exactly Removed during Breast Cancer Surgery to Prevent Metastasis?

The aim of the study was to identify the relationship between molecular subtypes of breast cancer (BC) and the morphological characteristics of axillary lymph nodes (ALN) and metastatic risk in BC patients to clarify danger degree and justification of removal before metastases appear. Material and methods. Tumor molecular subtypes of 116 female BC patients aged 24 - 75 (53.9 ± 0.8) were determined by tumor tissue immunohistological examination (obtained by tru-cut biopsy), and the BC was classified as Luminal A, Luminal B/HER2−, Luminal B/HER2+, TNBC, and HER2+ subtypes. To interpret the results for the BC receptor status, immunohistochemical analysis was performed and interpreted according to the Allred scale. Lymph node size, shape, structure and conglomerates availability were recorded according to ultrasonography (USG) examination evaluated on “LOGIQ C5-Premium” (2012). Blood CA-15-3 levels were analyzed using a COBAS-e 411 automated analyzer. Statistical analysis of the obtained results was carried out using the SPSS-26 software package, and based on the t-Student-Bonferroni and H-Kruskal-Wallis criteria. The sensitivity and specificity of the indicators studied were determined using ROC statistical analysis. Results showed a significant association of some subtypes, as well as receptor expression, with tumor metastasis to ALN. Conclusion: 1) The HER2+ subtype is the most aggressive in terms of ALN metastasis. Although TNBC is the most aggressive subtype in general, it is characterized by fewer metastases to the ALN than the HER2+ subtype. 2) Metastatic ALNs can be distinguished based on their cortical structure before tumor tissue biopsy, which is economically profitable. These LNs can be removed without biopsy.

Metastatic patterns and surgical methods for lymph nodes No.5 and No.6 in proximal gastric cancer

Objective: The current surgical treatment guidelines for early proximal gastric cancer(PGC) still lack agreement. Lymphadenectomy of lymph nodes No. 5 and No. 6 is the major difference between total and proximal gastrectomy. We elucidated the appropriate surgical procedure for PGC by investigating the pathological characteristics and prognostic significance of lymph nodes No. 5 and No. 6.Methods: In total, 333 PGC patients who underwent total gastrectomy were enrolled in this study. We investigated their clinicopathological characteristics and the metastatic patterns of the lymph nodes. Patients with metastasis in lymph nodes No. 5 and No. 6 were combined into one group and we compared the difference in survival between those with and without metastasis in lymph nodes No. 5, 6(lymph nodes No. 5 and No. 6 in any group of metastasis) for different subgroups.Results: The metastatic rates for lymph nodes No. 5 and No. 6 in PGC were 9.91% and 16.11%, respectively.The metastatic rate for both lymph nodes No. 5, 6 was 20.42%. Multivariate analysis showed that positive metastasis in lymph node No. 4, depth of invasion, and tumor size were independently correlated with the presence of metastasis in lymph nodes No. 5, 6.Conclusions: When lymph node No. 4 is positive(intraoperative pathology) or tumor size ≥5 cm or T4 stage,lymphadenectomy should be performed for lymph nodes No. 5 and No. 6, and total gastrectomy is recommended.

Clinical utilities and biological characteristics of melanoma sentinel lymph nodes

An estimated 73870 people will be diagnosed with melanoma in the United States in 2015,resulting in 9940 deaths.The majority of patients with cutaneous melanomas are cured with wide local excision.However,current evidence supports the use of sentinel lymph node biopsy(SLNB) given the 15%-20% of patients who harbor regional node metastasis.More importantly,the presence or absence of nodal micrometastases has been found to be the most important prognostic factor in earlystage melanoma,particularly in intermediate thickness melanoma.This review examines the development of SLNB for melanoma as a means to determine a patient's nodal status,the efficacy of SLNB in patients with melanoma,and the biology of melanoma metastatic to sentinel lymph nodes.Prospective randomized trials have guided the development of practice guidelines for use of SLNB for melanoma and have shown the prognostic value of SLNB.Given the rapidly advancing molecular and surgical technologies,the technical aspects of diagnosis,identification,and management of regional lymph nodes in melanoma continues to evolve and to improve.Additionally,there is ongoing research examining both the role of SLNB for specific clinical scenarios and the ways to identify patients who may benefit from completion lymphadenectomy for a positive SLN.Until further data provides sufficient evidence to alter national consensusbased guidelines,SLNB with completion lymphadenectomy remains the standard of care for clinically node-negative patients found to have a positive SLN.