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Sample records for localize lymph nodes

  1. Localized Lymph Node Light Chain Amyloidosis

    Directory of Open Access Journals (Sweden)

    Binod Dhakal

    2015-01-01

    Full Text Available Immunoglobulin-derived light chain amyloidosis can occasionally be associated with localized disease. We present a patient with localized lymph node light chain amyloidosis without an underlying monoclonal protein or lymphoproliferative disorder and review the literature of lymph node amyloidosis discussing work-up and risk factors for systemic progression.

  2. The local lymph node assay (LLNA).

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    Rovida, Costanza; Ryan, Cindy; Cinelli, Serena; Basketter, David; Dearman, Rebecca; Kimber, Ian

    2012-02-01

    The murine local lymph node assay (LLNA) is a widely accepted method for assessing the skin sensitization potential of chemicals. Compared with other in vivo methods in guinea pig, the LLNA offers important advantages with respect to animal welfare, including a requirement for reduced animal numbers as well as reduced pain and trauma. In addition to hazard identification, the LLNA is used for determining the relative skin sensitizing potency of contact allergens as a pivotal contribution to the risk assessment process. The LLNA is the only in vivo method that has been subjected to a formal validation process. The original LLNA protocol is based on measurement of the proliferative activity of draining lymph node cells (LNC), as determined by incorporation of radiolabeled thymidine. Several variants to the original LLNA have been developed to eliminate the use of radioactive materials. One such alternative is considered here: the LLNA:BrdU-ELISA method, which uses 5-bromo-2-deoxyuridine (BrdU) in place of radiolabeled thymidine to measure LNC proliferation in draining nodes. © 2012 by John Wiley & Sons, Inc.

  3. Sentinel lymph node biopsy in local recurrence of cutaneous melanoma

    International Nuclear Information System (INIS)

    Junqueira, G. Jr.; Bodanese, B.; Boff, M.F.; Espindola, M.B.; Haack, R.L.; Frigeri, C.D.L.

    2004-01-01

    Full text: Locally recurrent disease in patients with melanoma is usually defined as cutaneous or subcutaneous arising within 5 cm of the primary site after complete excision of the primary lesion. It may represent residual disease not excised with the primary tumor or the outgrowth of the satellite lesions, which are common with melanoma. Lymphatic mapping and sentinel lymph node (SLN) biopsy is highly accurate in staging nodal basins at risk of regional metastases in primary melanoma patients and identifies those who may benefit from earlier lymphadenectomy. Our purpose was to evaluate the efficacy of sentinel lymph node mapping and biopsy in local recurrence of cutaneous melanoma when the primary lesion was less than 1.0mm thick. Three patients with local recurrence of cutaneous melanoma underwent sentinel lymph node mapping and biopsy. All patients underwent preoperative lymphoscintigraphy to identify the lymphatic basin and the site of the sentinel node. All patients subsequently underwent intra-operative lymphatic mapping and selective lymph node biopsy with vital blue dye and hand-held gamma probe. Excised SLN were analysed by conventional histological staining (H and E) and immunohistochemical staining. In all patients the lymphatic mapping and sentinel lymph node biopsy was successful. The SLN biopsy was negative in two patients and positive in one who underwent therapeutic lymph node dissection. Our results indicate that the SLN mapping and biopsy is also possible in patients having local recurrence of cutaneous melanoma. Although long-term results are not available, early results are promising. (author)

  4. Sentinel Lymph Node Dissection in Locally Recurrent Breast Cancer

    DEFF Research Database (Denmark)

    Uth, Charlotte Caspara; Christensen, Mette Haulund; Oldenbourg, Mette Holmqvist

    2015-01-01

    BACKGROUND: The aim of this study was to investigate the use of sentinel lymph node dissection (SLND) in the treatment of patients with locally recurrent breast cancer. METHODS: A total of 147 patients with locally recurrent breast cancer were included from five different breast surgery departments...

  5. [Improvement of local lymph node assay for cosmetics safety evaluation].

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    Liu, Zhen; Liu, Junping; Wang, Fei; Xu, Guifeng; Hou, Juan; Wan, Xuying; Zhang, Tianbao

    2009-09-01

    To improve the local lymph node assay (LLNA) as an alternative method to detect chemicals for both sensitization and irritation. The following chemicals: one negative control: 4-Aminobenzoic Acid, three sensitizers: 2,4-dinitrochlorobenzene (DNCB), Hexyl cinnamic aldehyde (HCA), 2-Aminophenol (2-APC) and two irritations: potassium hydroxide (KOH), sodium lauryl sulphate (SLS) were selected. According to the normal LLNA, groups of female Balb/c mice were treated with test solutions. The thickness of each ear was measured and each auricle was weighed. On the sixth day, the bilateral draining auricular lymph nodes were excised and weighed. The single cell suspensions were prepared, the lymphocyte were counted and the proliferations of lymph cells were detected by cell counting kit-8 (CCK-8). Significant increase in ear thickness and weight were found in groups of KOH, SLS and DNCB (above 0.5%) (P LLNA using auricle thickness and weighing as observed markers for irritation, and using lymph nodes weighing and proliferation of lymphocyte as observed markers for sensitization, could evaluate both sensitization and irritation at the same time.

  6. The local lymph node assay and skin sensitization testing.

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    Kimber, Ian; Dearman, Rebecca J

    2010-01-01

    The mouse local lymph node assay (LLNA) is a method for the identification and characterization of skin sensitization hazards. In this context the method can be used both to identify contact allergens, and also determine the relative skin sensitizing potency as a basis for derivation of effective risk assessments.The assay is based on measurement of proliferative responses by draining lymph node cells induced following topical exposure of mice to test chemicals. Such responses are known to be causally and quantitatively associated with the acquisition of skin sensitization and therefore provide a relevant marker for characterization of contact allergic potential.The LLNA has been the subject of exhaustive evaluation and validation exercises and has been assigned Organization for Economic Cooperation and Development (OECD) test guideline 429. Herein we describe the conduct and interpretation of the LLNA.

  7. The local lymph node assay being too sensitive?

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    Hans-Werner, Vohr; Jürgen, Ahr Hans

    2005-12-01

    The local lymph node assay (LLNA) and modifications thereof were recently recognized by the OECD as stand-alone methods for the detection of skin-sensitizing potential. However, although the validity of the LLNA was acknowledged by the ICCVAM, attention was drawn to one major problem, i.e., the possibility of false positive results caused by non-specific cell activation as a result of inflammatory processes in the skin (irritation). This is based on the fact that inflammatory processes in the skin may lead to non-specific activation of dendritic cells, cell migration and non-specific proliferation of lymph node cells. Measuring cell proliferation by radioactive or non-radioactive methods, without taking the irritating properties of test items into account, leads thus to false positive reactions. In this paper, we have compared both endpoints: (1) cell proliferation alone and (2) cell proliferation in combination with inflammatory (irritating) processes. It turned out that a considerable number of tests were "false positive" to the definition mentioned above. By excluding such false positive results the LLNA seems not to be more sensitive than relevant guinea pig assays. These various methods and results are described here.

  8. Cross-reactivity between methylisothiazolinone, octylisothiazolinone and benzisothiazolinone using a modified local lymph node assay

    DEFF Research Database (Denmark)

    Schwensen, J. F.; Bonefeld, C. Menne; Zachariae, C.

    2017-01-01

    , and between MI and BIT. Methods Immune responses to MI, OIT and BIT were studied in vehicle and MI-sensitized female CBA mice by a modified local lymph node assay. The inflammatory response was measured by ear thickness, cell proliferation of CD4+ and CD8+ T cells, and CD19+ B cells in the auricular draining...... lymph nodes. Results MI induced significant, strong, concentration-dependent immune responses in the draining lymph nodes following a sensitization phase of three consecutive days. Groups of MI-sensitized mice were challenged on day 23 with 0·4% MI, 0·7% OIT and 1·9% BIT – concentrations corresponding...

  9. Identification of the sentinel lymph node using hemosiderin in locally advanced breast cancer

    Directory of Open Access Journals (Sweden)

    PAULO HENRIQUE WALTER DE AGUIAR

    Full Text Available ABSTRACT Objective: to verify the agreement rate in the identification of sentinel lymph node using an autologous marker rich in hemosiderin and 99 Technetium (Tc99 in patients with locally advanced breast cancer. Methods: clinical trial phase 1, prospective, non-randomized, of 18 patients with breast cancer and clinically negative axilla stages T2=4cm, T3 and T4. Patients were submitted to sub-areolar injection of hemosiderin 48 hours prior to sentinel biopsy surgery, and the identification rate was compared at intraoperative period to the gold standard marker Tc99. Agreement between methods was determined by Kappa index. Results: identification rate of sentinel lymph node was 88.9%, with a medium of two sentinel lymph nodes per patients. The study identified sentinel lymph nodes stained by hemosiderin in 83.3% patients (n=15, and, compared to Tc99 identification, the agreement rate was 94.4%. Conclusion: autologous marker rich in hemosiderin was effective to identify sentinel lymph nodes in locally advanced breast cancer patients.

  10. Automatic localization of IASLC-defined mediastinal lymph node stations on CT images using fuzzy models

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    Matsumoto, Monica M. S.; Beig, Niha G.; Udupa, Jayaram K.; Archer, Steven; Torigian, Drew A.

    2014-03-01

    Lung cancer is associated with the highest cancer mortality rates among men and women in the United States. The accurate and precise identification of the lymph node stations on computed tomography (CT) images is important for staging disease and potentially for prognosticating outcome in patients with lung cancer, as well as for pretreatment planning and response assessment purposes. To facilitate a standard means of referring to lymph nodes, the International Association for the Study of Lung Cancer (IASLC) has recently proposed a definition of the different lymph node stations and zones in the thorax. However, nodal station identification is typically performed manually by visual assessment in clinical radiology. This approach leaves room for error due to the subjective and potentially ambiguous nature of visual interpretation, and is labor intensive. We present a method of automatically recognizing the mediastinal IASLC-defined lymph node stations by modifying a hierarchical fuzzy modeling approach previously developed for body-wide automatic anatomy recognition (AAR) in medical imagery. Our AAR-lymph node (AAR-LN) system follows the AAR methodology and consists of two steps. In the first step, the various lymph node stations are manually delineated on a set of CT images following the IASLC definitions. These delineations are then used to build a fuzzy hierarchical model of the nodal stations which are considered as 3D objects. In the second step, the stations are automatically located on any given CT image of the thorax by using the hierarchical fuzzy model and object recognition algorithms. Based on 23 data sets used for model building, 22 independent data sets for testing, and 10 lymph node stations, a mean localization accuracy of within 1-6 voxels has been achieved by the AAR-LN system.

  11. Histological and autoradiographic changes in locally irradiated lymph nodes (an experimental study on rabbits)

    International Nuclear Information System (INIS)

    Kett, K.; Csere, T.; Lukacs, L.; Szilagyi, K.; Illenyi, L.

    1979-01-01

    The authors studied the local effect of 3000 Rxl X-ray irradiation on the popliteal lymph nodes of rabbits. Beside the morpho-histological description autoradiography was performed after injection of H 3 -thymidine in the afferent lymphatic of the irradiated knee node. The main finding is the appearence of newly-formed germinal centers between the 6-10 days after irradiation. (orig.) [de

  12. The respiratory local lymph node assay as a tool to study respiratory sensitizers

    NARCIS (Netherlands)

    Arts, J.H.E.; Jong, W.H. de; Triel, J.J. van; Schijf, M.A.; Klerk, A. de; Loveren, H. van; Kuper, C.F.

    2008-01-01

    The local lymph node assay (LLNA) is used to test the potential of low molecular weight (LMW) compounds to induce sensitization via the skin. In the present study, a respiratory LLNA was developed. Male BALB/c mice were exposed head/nose-only during three consecutive days for 45, 90, 180, or 360

  13. Breast Conserving Surgery and Sentinel Lymph Node Biopsy in Locally Advanced Breast Cancer: Single Center Experience

    Directory of Open Access Journals (Sweden)

    Atakan Sezer

    2011-06-01

    Full Text Available Objective: Patients with locally advanced breast cancer may undergo breast conserving surgery after neoadjuvant chemotherapy. The aim of the study is to evaluate the results of locally advanced breast cancer patients who underwent breast conserving surgery, axillary dissection and sentinel lymph node biopsy in a single center. Material and Methods: 12 patients with locally advanced breast cancer stage IIIA/IIIB were included in the study between 2002-2009. The patients were given anthracycline-based regimen before surgery. Patients underwent breast conserving surgery, axillary dissection, and sentinel lymph node biopsy followed by radiotherapy. Results: There were five patients in stage IIIA, six in stage IIIB, and one in stage IIIC. Patients had received 3-6 regimen of FAC/FEC. Eight had partial and four had complete response. Five positive axilla were detected. The median value of the lymph nodes was 12 (n:8-19. Five patients underwent sentinel lymph node biopsy. The biopsy has failed in one patient and the median value of dissected sentinel node was 3.5 (n:3-4. Locoregional recurrence was not observed in any patients. The mean follow-up of the patients was 29.8 months and median time was 16 (n:2-80 months.Of the 12 patients 10 are alive and 2 were deceased. Conclusion: In selected locally advanced patients, breast conserving surgery and sentinel lymph node biopsy may be applied by a multidisciplinary approach, and excellent success may be achieved in those patients as in early breast cancer patients.

  14. Development and Utilization of an Ex Vivo Bromodeoxyuridine Local Lymph Node Assay (LLNA) Protocol for Assessing Potential Chemical Sensitizers

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    The murine local lymph node assay (LLNA) is widely used to identify chemicals that may cause allergic contact dermatitis. Exposure to a dermal sensitizer results in proliferation of local lymph node T cells, which has traditionally been measured by in vivo incorporation of [3H]m...

  15. Lymph node culture

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    Culture - lymph node ... or viruses grow. This process is called a culture. Sometimes, special stains are also used to identify specific cells or microorganisms before culture results are available. If needle aspiration does not ...

  16. Immunophenotyping does not improve predictivity of the local lymph node assay in mice.

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    Strauss, Volker; Kolle, Susanne N; Honarvar, Naveed; Dammann, Martina; Groeters, Sibylle; Faulhammer, Frank; Landsiedel, Robert; van Ravenzwaay, Bennard

    2015-04-01

    The local lymph node assay (LLNA) is a regulatory accepted test for the identification of skin sensitizing substances by measuring radioactive thymidine incorporation into the lymph node. However, there is evidence that LLNA is overestimating the sensitization potential of certain substance classes in particular those exerting skin irritation. Some reports describe the additional use of flow cytometry-based immunophenotyping to better discriminate irritants from sensitizing irritants in LLNA. In the present study, the 22 performance standards plus 8 surfactants were assessed using the radioactive LLNA method. In addition, lymph node cells were immunophenotyped to evaluate the specificity of the lymph node response using cell surface markers such as B220 or CD19, CD3, CD4, CD8, I-A(κ) and CD69 with the aim to allow a better discrimination above all between irritants and sensitizers, but also non-irritating sensitizers and non-sensitizers. However, the markers assessed in this study do not sufficiently differentiate between irritants and irritant sensitizers and therefore did not improve the predictive capacity of the LLNA. Copyright © 2014 John Wiley & Sons, Ltd.

  17. Lumpectomy and sentinel lymph node navigation surgery for breast cancer under local anesthesia

    International Nuclear Information System (INIS)

    Nakajima, Hiroo; Fujiwara, Ikuya; Mizuta, Naruhiko; Sakaguchi, Koichi; Hachimine, Yasushi; Nakatsukasa, Katsuhiro; Kobayashi, Aya

    2007-01-01

    We studied and analyzed therapeutic outcomes of a radical surgery under local anesthesia for breast cancer in our department. Subjects were 53 patients with breast cancer whose diagnoses were definitely made before surgery. Indications were: localized ductal carcinoma in situ (DCIS) diagnosed preoperatively; invasive carcinoma less than 3 cm in tumor diameter on ultrasound and magnetic resonance imaging scan; and clinically tumors with negative axillary lymph nodes. Operative procedures included microdochectomy or lumpectomy associated with sentinel lymph node navigation biopsy (SLNB). We could perform the operation under local anesthesia in all the 53 patients, and were not demanded to shift from local to general anesthesia. Surgical stumps were positive in 10 patients (18.9%). Of the ten patients, additional resection was performed in one, and irradiation was added to the remaining nine patients. SLNB was performed in a total of 39 patients, six (15.4%) patients of them had metastasis and two out of the six patients underwent additional axillary lymph node dissection. None of serious complications were encountered. Local recurrence and hepatic metastasis occurred in each one patient in an averaged observation period of 15.1 months. This day's radical operation under local anesthesia for breast cancer is a useful procedure as minimally invasive surgery as for the indications employed in this study. (author)

  18. Effects of strain differences and vehicles on results of local lymph node assays.

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    Anzai, Takayuki; Ullmann, Ludwig G; Hayashi, Daisuke; Satoh, Tetsuo; Kumazawa, Takeshi; Sato, Keizo

    2010-01-01

    The Local Lymph Node Assay (LLNA) is now regarded as the worldwide standard. The analysis of accumulated LLNA data reveals that the animal strains and vehicles employed are likely to affect LLNA results. Here we show that an obvious strain difference in the local lymph node response was observed between DMSO-treated CBA/CaOlaHsd and CBA/CaHsdRcc mice. We also show that a vehicle difference in the response was observed when CBA/CaHsdRcc mice were exposed to 6 vehicles; 4:1 v/v acetone/olive oil (AOO), ethanol/water (70% EtOH), N,N-dimethylformamide (DMF), 2-butanone (BN), propylene glycol (PG), and dimethylsulfoxide (DMSO). The dpm/LN level was lowest in the 70% EtOH group and highest in the DMSO group. When alpha-hexylcinnamaldehyde (HCA) was used as a sensitizer for the LLNA, HCA was a weak sensitizer when AOO or DMSO was used as a vehicle, but a moderate sensitizer when the other 4 vehicles were used. This study showed that there are vehicle differences in the local lymph node response (dpm/LN level) in the LLNA and that the sensitization potency of HCA may be classified in different categories when using different vehicles. This suggests that careful consideration should be exercised in selecting a vehicle for the LLNA. A further comprehensive study will be needed to investigate why vehicle differences are observed in the LLNA.

  19. The respiratory local lymph node assay as a tool to study respiratory sensitizers.

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    Arts, Josje H E; de Jong, Wim H; van Triel, Jos J; Schijf, Marcel A; de Klerk, Arja; van Loveren, Henk; Kuper, C Frieke

    2008-12-01

    The local lymph node assay (LLNA) is used to test the potential of low molecular weight (LMW) compounds to induce sensitization via the skin. In the present study, a respiratory LLNA was developed. Male BALB/c mice were exposed head/nose-only during three consecutive days for 45, 90, 180, or 360 min/day to various LMW allergens. Ear application (skin LLNA) was used as a positive control. Negative controls were exposed to the vehicle. Three days after the last exposure, proliferation was determined in the draining mandibular lymph nodes, and the respiratory tract was examined microscopically. Upon inhalation, the allergens trimellitic anhydride, phthalic anhydride, hexamethylene diisocyanate, toluene diisocyanate, isophorone diisocyanate (IPDI), dinitrochlorobenzene, and oxazolone were positive and showed stimulation indices (SIs) up to 11, whereas trimeric IPDI, formaldehyde, and methyl salicylate were negative (viz. SI LLNA.

  20. New approach to predict photoallergic potentials of chemicals based on murine local lymph node assay.

    Science.gov (United States)

    Maeda, Yosuke; Hirosaki, Haruka; Yamanaka, Hidenori; Takeyoshi, Masahiro

    2018-05-23

    Photoallergic dermatitis, caused by pharmaceuticals and other consumer products, is a very important issue in human health. However, S10 guidelines of the International Conference on Harmonization do not recommend the existing prediction methods for photoallergy because of their low predictability in human cases. We applied local lymph node assay (LLNA), a reliable, quantitative skin sensitization prediction test, to develop a new photoallergy prediction method. This method involves a three-step approach: (1) ultraviolet (UV) absorption analysis; (2) determination of no observed adverse effect level for skin phototoxicity based on LLNA; and (3) photoallergy evaluation based on LLNA. Photoallergic potential of chemicals was evaluated by comparing lymph node cell proliferation among groups treated with chemicals with minimal effect levels of skin sensitization and skin phototoxicity under UV irradiation (UV+) or non-UV irradiation (UV-). A case showing significant difference (P < .05) in lymph node cell proliferation rates between UV- and UV+ groups was considered positive for photoallergic reaction. After testing 13 chemicals, seven human photoallergens tested positive and the other six, with no evidence of causing photoallergic dermatitis or UV absorption, tested negative. Among these chemicals, both doxycycline hydrochloride and minocycline hydrochloride were tetracycline antibiotics with different photoallergic properties, and the new method clearly distinguished between the photoallergic properties of these chemicals. These findings suggested high predictability of our method; therefore, it is promising and effective in predicting human photoallergens. Copyright © 2018 John Wiley & Sons, Ltd.

  1. Evaluation of an ex vivo murine local lymph node assay: multiple endpoint comparison.

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    Piccotti, Joseph R; Knight, Stephanie A; Gillhouse, Kimberly; Lagattuta, Mark S; Bleavins, Michael R

    2006-01-01

    The local lymph node assay (LLNA) is used to assess the skin sensitization potential of chemicals. In the standard assay, mice are treated topically on the dorsum of both ears with test substance for 3 days. Following 2 days of rest, the initiation of the hypersensitivity response is evaluated by injecting (3)H-thymidine into a tail vein, and then measuring the levels of radioisotope incorporated into the DNA of lymph node cells draining the ears. In the current study, BALB/c mice were treated with the contact sensitizers hexylcinnamic aldehyde (HCA) and oxazolone, and the nonsensitizer methyl salicylate. The proliferative response of lymph node cells was evaluated in an ex vivo assay, in which isolated cells were cultured in vitro with (3)H-thymidine. Treatment of mice with HCA at 5-50% resulted in concentration-related increases in (3)H-thymidine incorporation, with stimulation indices ranging from 3 to 14. Low animal-to-animal variability was seen in three replicate assays testing HCA at 25%. As anticipated, the proliferative response induced by the potent sensitizer oxazolone at 0.25% was greater than HCA at all concentrations tested. Stimulation indices of 1.5 and 3 were seen in two independent experiments with methyl salicylate. These equivocal findings were likely due to the irritancy properties of the compound. Importantly, measuring ex vivo (3)H-thymidine incorporation was more sensitive than evaluating lymph node weight and cellularity, and in vitro bromodeoxyuridine incorporation. Furthermore, the results of the ex vivo LLNA were comparable to the standard assay. This study provided evidence that supports the use of an ex vivo LLNA for hazard assessment of contact hypersensitivity. Copyright 2006 John Wiley & Sons, Ltd.

  2. B220 analysis with the local lymph node assay: proposal for a more flexible prediction model.

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    Betts, Catherine J; Dearman, Rebecca J; Kimber, Ian; Ryan, Cindy A; Gerberick, G Frank; Lalko, Jon; Api, Anne Marie

    2007-01-01

    The mouse local lymph node assay (LLNA) has been developed and validated for the identification of chemicals that have the potential to induce skin sensitisation. In common with other predictive test methods the accuracy of the LLNA is not absolute and experience has revealed that a few chemicals, including for instance a minority of skin irritants, may elicit false-positive reactions in the assay. To improve further the performance of the LLNA, and to eliminate or reduce false-positives, there has been interest in an adjunct method in which the ability of chemicals to cause increases in the frequency of B220(+) lymphocytes in skin-draining lymph nodes is measured. Previous studies suggest that the use of B220 analyses aligned with the standard LLNA may serve to distinguish further between contact allergens and skin irritants. In the original predictive model, chemicals were regarded as being skin sensitisers if they were able to induce a 1.25-fold or greater increase in the percentage of B220(+) cells within lymph nodes compared with concurrent vehicle controls. Although this first prediction model has proven useful, in the light of more recent experience, and specifically as a consequence of some variability observed in the frequency of B220(+) lymphocytes in nodes taken from vehicle control-treated animals, it is timely now to reconsider and refine the model. As a result a new prediction model is proposed in which reliance on the use of absolute thresholds is reduced, and in which small changes in control values can be better accommodated. (c) 2007 John Wiley & Sons, Ltd.

  3. An European inter-laboratory validation of alternative endpoints of the murine local lymph node assay

    International Nuclear Information System (INIS)

    Ehling, G.; Hecht, M.; Heusener, A.; Huesler, J.; Gamer, A.O.; Loveren, H. van; Maurer, Th.; Riecke, K.; Ullmann, L.; Ulrich, P.; Vandebriel, R.; Vohr, H.-W.

    2005-01-01

    The original local lymph node assay (LLNA) is based on the use of radioactive labelling to measure cell proliferation. Other endpoints for the assessment of proliferation are also authorized by the OECD Guideline 429 provided there is appropriate scientific support, including full citations and description of the methodology (OECD, 2002. OECD Guideline for the Testing of Chemicals; Skin Sensitization: Local Lymph Node Assay, Guideline 429. Paris, adopted 24th April 2002.). Here, we describe the outcome of the second round of an inter-laboratory validation of alternative endpoints in the LLNA conducted in nine laboratories in Europe. The validation study was managed and supervised by the Swiss Agency for Therapeutic Products (Swissmedic) in Bern. Ear-draining lymph node (LN) weight and cell counts were used to assess LN cell proliferation instead of [3H]TdR incorporation. In addition, the acute inflammatory skin reaction was measured by ear weight determination of circular biopsies of the ears to identify skin irritation properties of the test items. The statistical analysis was performed in the department of statistics at the university of Bern. Similar to the EC 3 values defined for the radioactive method, threshold values were calculated for the endpoints measured in this modification of the LLNA. It was concluded that all parameters measured have to be taken into consideration for the categorisation of compounds due to their sensitising potencies. Therefore, an assessment scheme has been developed which turned out to be of great importance to consistently assess sensitisation versus irritancy based on the data of the different parameters. In contrast to the radioactive method, irritants have been picked up by all the laboratories applying this assessment scheme

  4. Correlation of N-myc downstream-regulated gene 1 subcellular localization and lymph node metastases of colorectal neoplasms

    Energy Technology Data Exchange (ETDEWEB)

    Song, Yan [Medical Research Center, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014 (China); Lv, Liyang [Department of Health, Jinan Military Area Command, Jinan 250022 (China); Du, Juan; Yue, Longtao [Medical Research Center, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014 (China); Cao, Lili, E-mail: cllly22@163.com [Medical Research Center, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014 (China)

    2013-09-20

    Highlights: •We clarified NDRG1 subcellular location in colorectal cancer. •We found the changes of NDRG1 distribution during colorectal cancer progression. •We clarified the correlation between NDRG1 distribution and lymph node metastasis. •It is possible that NDRG1 subcellular localization may determine its function. •Maybe NDRG1 is valuable early diagnostic markers for metastasis. -- Abstract: In colorectal neoplasms, N-myc downstream-regulated gene 1 (NDRG1) is a primarily cytoplasmic protein, but it is also expressed on the cell membrane and in the nucleus. NDRG1 is involved in various stages of tumor development in colorectal cancer, and it is possible that the different subcellular localizations may determine the function of NDRG1 protein. Here, we attempt to clarify the characteristics of NDRG1 protein subcellular localization during the progression of colorectal cancer. We examined NDRG1 expression in 49 colorectal cancer patients in cancerous, non-cancerous, and corresponding lymph node tissues. Cytoplasmic and membrane NDRG1 expression was higher in the lymph nodes with metastases than in those without metastases (P < 0.01). Nuclear NDRG1 expression in colorectal neoplasms was significantly higher than in the normal colorectal mucosa, and yet the normal colorectal mucosa showed no nuclear expression. Furthermore, our results showed higher cytoplasmic NDRG1 expression was better for differentiation, and higher membrane NDRG1 expression resulted in a greater possibility of lymph node metastasis. These data indicate that a certain relationship between the cytoplasmic and membrane expression of NDRG1 in lymph nodes exists with lymph node metastasis. NDRG1 expression may translocate from the membrane of the colorectal cancer cells to the nucleus, where it is involved in lymph node metastasis. Combination analysis of NDRG1 subcellular expression and clinical variables will help predict the incidence of lymph node metastasis.

  5. Correlation of N-myc downstream-regulated gene 1 subcellular localization and lymph node metastases of colorectal neoplasms

    International Nuclear Information System (INIS)

    Song, Yan; Lv, Liyang; Du, Juan; Yue, Longtao; Cao, Lili

    2013-01-01

    Highlights: •We clarified NDRG1 subcellular location in colorectal cancer. •We found the changes of NDRG1 distribution during colorectal cancer progression. •We clarified the correlation between NDRG1 distribution and lymph node metastasis. •It is possible that NDRG1 subcellular localization may determine its function. •Maybe NDRG1 is valuable early diagnostic markers for metastasis. -- Abstract: In colorectal neoplasms, N-myc downstream-regulated gene 1 (NDRG1) is a primarily cytoplasmic protein, but it is also expressed on the cell membrane and in the nucleus. NDRG1 is involved in various stages of tumor development in colorectal cancer, and it is possible that the different subcellular localizations may determine the function of NDRG1 protein. Here, we attempt to clarify the characteristics of NDRG1 protein subcellular localization during the progression of colorectal cancer. We examined NDRG1 expression in 49 colorectal cancer patients in cancerous, non-cancerous, and corresponding lymph node tissues. Cytoplasmic and membrane NDRG1 expression was higher in the lymph nodes with metastases than in those without metastases (P < 0.01). Nuclear NDRG1 expression in colorectal neoplasms was significantly higher than in the normal colorectal mucosa, and yet the normal colorectal mucosa showed no nuclear expression. Furthermore, our results showed higher cytoplasmic NDRG1 expression was better for differentiation, and higher membrane NDRG1 expression resulted in a greater possibility of lymph node metastasis. These data indicate that a certain relationship between the cytoplasmic and membrane expression of NDRG1 in lymph nodes exists with lymph node metastasis. NDRG1 expression may translocate from the membrane of the colorectal cancer cells to the nucleus, where it is involved in lymph node metastasis. Combination analysis of NDRG1 subcellular expression and clinical variables will help predict the incidence of lymph node metastasis

  6. Experience with local lymph node assay performance standards using standard radioactivity and nonradioactive cell count measurements.

    Science.gov (United States)

    Basketter, David; Kolle, Susanne N; Schrage, Arnhild; Honarvar, Naveed; Gamer, Armin O; van Ravenzwaay, Bennard; Landsiedel, Robert

    2012-08-01

    The local lymph node assay (LLNA) is the preferred test for identification of skin-sensitizing substances by measuring radioactive thymidine incorporation into the lymph node. To facilitate acceptance of nonradioactive variants, validation authorities have published harmonized minimum performance standards (PS) that the alternative endpoint assay must meet. In the present work, these standards were applied to a variant of the LLNA based on lymph node cell counts (LNCC) run in parallel as a control with the standard LLNA with radioactivity measurements, with threshold concentrations (EC3) being determined for the sensitizers. Of the 22 PS chemicals tested in this study, 21 yielded the same results from standard radioactivity and cell count measurements; only 2-mercaptobenzothiazole was positive by LLNA but negative by LNCC. Of the 16 PS positives, 15 were positive by LLNA and 14 by LNCC; methylmethacrylate was not identified as sensitizer by either of the measurements. Two of the six PS negatives tested negative in our study by both LLNA and LNCC. Of the four PS negatives which were positive in our study, chlorobenzene and methyl salicylate were tested at higher concentrations than the published PS, whereas the corresponding concentrations resulted in consistent negative results. Methylmethacrylate and nickel chloride tested positive within the concentration range used for the published PS. The results indicate cell counts and radioactive measurements are in good accordance within the same LLNA using the 22 PS test substances. Comparisons with the published PS results may, however, require balanced analysis rather than a simple checklist approach. Copyright © 2011 John Wiley & Sons, Ltd.

  7. Use of an ex vivo local lymph node assay to assess contact hypersensitivity potential.

    Science.gov (United States)

    Piccotti, Joseph R; Kawabata, Thomas T

    2008-07-01

    The local lymph node assay (LLNA) is used to assess the contact hypersensitivity potential of compounds. In the standard assay, mice are treated topically with test compound to the dorsum of both ears on Days 1-3. The induction of a hypersensitivity response is assessed on Day 6 by injecting [(3)H]-thymidine into a tail vein and measuring thymidine incorporation into DNA of lymph node cells draining the ears. The ex vivo LLNA is conducted similarly except lymphocyte proliferation is assessed after in vitro incubation of lymph node cells with [(3)H]-thymidine, which significantly reduces the amount of radioactive waste. The current study tested the use of this approach for hazard assessment of contact hypersensitivity and to estimate allergenic potency. Female BALB/c mice were treated on Days 1-3 with two nonsensitizers (4' -methoxyacetophenone, diethyl phthalate), three weak sensitizers (hydroxycitronellal, eugenol, citral), one weak-to-moderate sensitizer (hexylcinnamic aldehyde), two moderate sensitizers (isoeugenol, phenyl benzoate), and one strong sensitizer (dinitrochlorobenzene). On Day 6, isolated lymph node cells were incubated overnight with [(3)H]-thymidine and thymidine incorporation was measured by liquid scintillation spectrophotometry. The ex vivo LLNA accurately distinguished the contact sensitizers from the nonsensitizing chemicals, and correctly ranked the relative potency of the compounds tested. The EC3 values, i.e., the effective concentration of test substance needed to induce a stimulation index of 3, were as follows: 4' -methoxyacetophenone (> 50%), diethyl phthalate (> 50%), hydroxycitronellal (20.4%), eugenol (13.6%), citral (8.9%), isoeugenol (3.8%), hexylcinnamic aldehyde (2.7%), phenyl benzoate (2%), and dinitrochlorobenzene (0.02%). In addition, low inter-animal and inter-experiment variability was seen with 25% hexyl-cinnamic aldehyde (assay positive control). The results of the ex vivo LLNA in the current study were consistent with

  8. Potency values from the local lymph node assay: application to classification, labelling and risk assessment.

    Science.gov (United States)

    Loveless, S E; Api, A-M; Crevel, R W R; Debruyne, E; Gamer, A; Jowsey, I R; Kern, P; Kimber, I; Lea, L; Lloyd, P; Mehmood, Z; Steiling, W; Veenstra, G; Woolhiser, M; Hennes, C

    2010-02-01

    Hundreds of chemicals are contact allergens but there remains a need to identify and characterise accurately skin sensitising hazards. The purpose of this review was fourfold. First, when using the local lymph node assay (LLNA), consider whether an exposure concentration (EC3 value) lower than 100% can be defined and used as a threshold criterion for classification and labelling. Second, is there any reason to revise the recommendation of a previous ECETOC Task Force regarding specific EC3 values used for sub-categorisation of substances based upon potency? Third, what recommendations can be made regarding classification and labelling of preparations under GHS? Finally, consider how to integrate LLNA data into risk assessment and provide a rationale for using concentration responses and corresponding no-effect concentrations. Although skin sensitising chemicals having high EC3 values may represent only relatively low risks to humans, it is not possible currently to define an EC3 value below 100% that would serve as an appropriate threshold for classification and labelling. The conclusion drawn from reviewing the use of distinct categories for characterising contact allergens was that the most appropriate, science-based classification of contact allergens according to potency is one in which four sub-categories are identified: 'extreme', 'strong', 'moderate' and 'weak'. Since draining lymph node cell proliferation is related causally and quantitatively to potency, LLNA EC3 values are recommended for determination of a no expected sensitisation induction level that represents the first step in quantitative risk assessment. 2009 Elsevier Inc. All rights reserved.

  9. The use of ethanol:diethylphthalate as a vehicle for the local lymph node assay.

    Science.gov (United States)

    Betts, Catherine J; Beresford, L; Dearman, R J; Lalko, J; Api, A P; Kimber, I

    2007-02-01

    The murine local lymph node assay (LLNA) is used for the prospective identification of contact allergens. This method is not only accepted as a stand-alone test for the identification of contact allergenic hazard but also used increasingly for the measurement of the relative potency of skin-sensitizing chemicals as an integral component of the risk assessment process. During the development and validation phases of the method, a list of standard vehicles for use in the LLNA was identified, among them being the vehicle most commonly used acetone/olive oil (4:1, AOO). We have now explored the performance in the LLNA of a non-standard vehicle, ethanol:diethyl phthalate (1:3, EtOH:DEP), that is used frequently to evaluate dermal effects of fragrance materials in both human and experimental studies. Current investigations have demonstrated that EtOH:DEP induces similar levels of background proliferative responses in lymph nodes comparable with the standard vehicle AOO. Moreover, expected levels of activity are observed when EtOH:DEP is used to deliver a known contact allergen in the LLNA. The conclusion drawn is that EtOH:DEP provides a suitable vehicle for use in the LLNA and that the approach described provides a basis for future evaluation of novel vehicles.

  10. Use of the local lymph node assay in assessment of immune function

    International Nuclear Information System (INIS)

    Berg, Femke A. van den; Baken, Kirsten A.; Vermeulen, Jolanda P.; Gremmer, Eric R.; Steeg, Harry van; Loveren, Henk van

    2005-01-01

    The murine local lymph node assay (LLNA) was originally developed as a predictive test method for the identification of chemicals with sensitizing potential. In this study we demonstrated that an adapted LLNA can also be used as an immune function assay by studying the effects of orally administered immunomodulating compounds on the T-cell-dependent immune response induced by the contact sensitizer 2,4-dinitrochlorobenzene (DNCB). C57Bl/6 mice were treated with the immunotoxic compounds cyclosporin A (CsA), bis(tri-n-butyltin)oxide (TBTO) or benzo[a]pyrene (B[a]P). Subsequently, cell proliferation and interferon-γ (IFN-γ) and interleukin (IL)-4 release were determined in the auricular lymph nodes (LNs) after DNCB application on both ears. Immunosuppression induced by CsA, TBTO and B[a]P was clearly detectable in this application of the LLNA. Cytokine release measurements proved valuable to confirm the results of the cell proliferation assay and to obtain an indication of the effect on Th1/Th2 balance. We believe to have demonstrated the applicability of an adapted LLNA as an immune function assay in the mouse

  11. Use of the local lymph node assay in assessment of immune function.

    Science.gov (United States)

    van den Berg, Femke A; Baken, Kirsten A; Vermeulen, Jolanda P; Gremmer, Eric R; van Steeg, Harry; van Loveren, Henk

    2005-07-01

    The murine local lymph node assay (LLNA) was originally developed as a predictive test method for the identification of chemicals with sensitizing potential. In this study we demonstrated that an adapted LLNA can also be used as an immune function assay by studying the effects of orally administered immunomodulating compounds on the T-cell-dependent immune response induced by the contact sensitizer 2,4-dinitrochlorobenzene (DNCB). C57Bl/6 mice were treated with the immunotoxic compounds cyclosporin A (CsA), bis(tri-n-butyltin)oxide (TBTO) or benzo[a]pyrene, (B[a]P). Subsequently, cell proliferation and interferon-gamma (IFN-gamma) and interleukin (IL)-4 release were determined in the auricular lymph nodes (LNs) after DNCB application on both ears. Immunosuppression induced by CsA, TBTO and B[a]P was clearly detectable in this application of the LLNA. Cytokine release measurements proved valuable to confirm the results of the cell proliferation assay and to obtain an indication of the effect on Th1/Th2 balance. We believe to have demonstrated the applicability of an adapted LLNA as an immune function assay in the mouse.

  12. The local lymph node assay and the assessment of relative potency: status of validation.

    Science.gov (United States)

    Basketter, David A; Gerberick, Frank; Kimber, Ian

    2007-08-01

    For the prediction of skin sensitization potential, the local lymph node assay (LLNA) is a fully validated alternative to guinea-pig tests. More recently, information from LLNA dose-response analyses has been used to assess the relative potency of skin sensitizing chemicals. These data are then deployed for risk assessment and risk management. In this commentary, the utility and validity of these relative potency measurements are reviewed. It is concluded that the LLNA does provide a valuable assessment of relative sensitizing potency in the form of the estimated concentration of a chemical required to produce a threefold stimulation of draining lymph node cell proliferation compared with concurrent controls (EC3 value) and that all reasonable validation requirements have been addressed successfully. EC3 measurements are reproducible in both intra- and interlaboratory evaluations and are stable over time. It has been shown also, by several independent groups, that EC3 values correlate closely with data on relative human skin sensitization potency. Consequently, the recommendation made here is that LLNA EC3 measurements should now be regarded as a validated method for the determination of the relative potency of skin sensitizing chemicals, a conclusion that has already been reached by a number of independent expert groups.

  13. Local lymph node assay: how testing laboratories apply OECD TG 429 for REACH purposes.

    Science.gov (United States)

    Rovida, Costanza

    2011-01-01

    The Local Lymph Node Assay (LLNA) is the official method for assessing the allergic contact dermatitis potential of chemicals for the purposes of REACH regulation. The LLNA went through a validation process that allowed the delineation of a robust protocol for performing new tests. The OECD accepted this method in 2002 and published OECD TG 429. The European Chemical Agency (ECHA) recently published data that were submitted in the registration dossiers of chemicals. This database was analysed to determine how testing laboratories apply OECD TG 429. This analysis comes after a detailed analysis of four full study reports that were also prepared for REACH purposes. Although the majority of the tests are fully compliant with OECD TG 429, some showed major deviations, and a number of others used more animals than necessary. This suggests that in vivo tests need to be planned more carefully and consciously to obtain meaningful results with the minimum animal number necessary.

  14. Evaluation of a toxicogenomic approach to the local lymph node assay (LLNA).

    Science.gov (United States)

    Boverhof, Darrell R; Gollapudi, B Bhaskar; Hotchkiss, Jon A; Osterloh-Quiroz, Mandy; Woolhiser, Michael R

    2009-02-01

    Genomic technologies have the potential to enhance and complement existing toxicology endpoints; however, assessment of these approaches requires a systematic evaluation including a robust experimental design with genomic endpoints anchored to traditional toxicology endpoints. The present study was conducted to assess the sensitivity of genomic responses when compared with the traditional local lymph node assay (LLNA) endpoint of lymph node cell proliferation and to evaluate the responses for their ability to provide insights into mode of action. Female BALB/c mice were treated with the sensitizer trimellitic anhydride (TMA), following the standard LLNA dosing regimen, at doses of 0.1, 1, or 10% and traditional tritiated thymidine ((3)HTdR) incorporation and gene expression responses were monitored in the auricular lymph nodes. Additional mice dosed with either vehicle or 10% TMA and sacrificed on day 4 or 10, were also included to examine temporal effects on gene expression. Analysis of (3)HTdR incorporation revealed TMA-induced stimulation indices of 2.8, 22.9, and 61.0 relative to vehicle with an EC(3) of 0.11%. Examination of the dose-response gene expression responses identified 9, 833, and 2122 differentially expressed genes relative to vehicle for the 0.1, 1, and 10% TMA dose groups, respectively. Calculation of EC(3) values for differentially expressed genes did not identify a response that was more sensitive than the (3)HTdR value, although a number of genes displayed comparable sensitivity. Examination of temporal responses revealed 1760, 1870, and 953 differentially expressed genes at the 4-, 6-, and 10-day time points respectively. Functional analysis revealed many responses displayed dose- and time-specific induction patterns within the functional categories of cellular proliferation and immune response, including numerous immunoglobin genes which were highly induced at the day 10 time point. Overall, these experiments have systematically illustrated

  15. Local lymph node assay (LLNA) for detection of sensitization capacity of chemicals.

    Science.gov (United States)

    Gerberick, G Frank; Ryan, Cindy A; Dearman, Rebecca J; Kimber, Ian

    2007-01-01

    The local lymph node assay (LLNA) is a murine model developed to evaluate the skin sensitization potential of chemicals. The LLNA is an alternative approach to traditional guinea pig methods and in comparison provides important animal welfare benefits. The assay relies on measurement of events induced during the induction phase of skin sensitization, specifically lymphocyte proliferation in the draining lymph nodes which is a hallmark of a skin sensitization response. Since its introduction the LLNA has been the subject of extensive evaluation on a national and international scale, and has been successfully validated and incorporated worldwide into regulatory guidelines. Experience gained in recent years has demonstrated that adherence to published procedures and guidelines for the LLNA (e.g., with respect to dose and vehicle selection) is critical for the successful conduct and eventual interpretation of the data. In addition to providing a robust method for skin sensitization hazard identification, the LLNA has proven very useful in assessing the skin sensitizing potency of test chemicals, and this has provided invaluable information to risk assessors. The primary method to make comparisons of the relative potency of chemical sensitizers is to use linear interpolation to estimate the concentration of chemical required to induce a stimulation index of three relative to concurrent vehicle-treated controls (EC3). In certain situations where there are available less than optimal dose response data a log-linear extrapolation method can be used to estimate an EC3 value which can reduce significantly the need for repeat testing of chemicals. The LLNA, when conducted according to published guidelines, provides a robust method for skin sensitization testing that not only provides reliable hazard identification information but also data necessary for effective risk assessment and risk management.

  16. The respiratory allergen glutaraldehyde in the local lymph node assay: Sensitization by skin exposure, but not by inhalation

    NARCIS (Netherlands)

    Triel, J.J. van; Bree, B.W.J. van; Roberts, D.W.; Muijser, H.; Duistermaat, E.; Woutersen, R.A.; Kuper, C.F.

    2011-01-01

    Previously, a selection of low molecular weight contact and respiratory allergens had tested positive in both a skin and a respiratory local lymph node assay (LLNA), but formaldehyde was negative for sensitization by inhalation. To investigate whether this was due to intrinsic properties of aldehyde

  17. 76 FR 45254 - Report and Recommendations on the Usefulness and Limitations of the Murine Local Lymph Node Assay...

    Science.gov (United States)

    2011-07-28

    ... includes recommendations on the usefulness and limitations of the local lymph node assay (LLNA) for... testing using the LLNA can be used to further categorize some chemicals and products as strong skin... In 1999, ICCVAM evaluated the validation status of the LLNA as a stand-alone alternative test method...

  18. Local lymph node activation in rats after dermal application of the sensitizers 2,4-dinitrochlorobenzene and trimellitic anhydride

    NARCIS (Netherlands)

    Arts, J.H.E.; Dröge, S.C.M.; Bloksma, N.; Kuper, C.F.

    1996-01-01

    Five rat strains were compared for their performance in the local lymph node assay (LLNA) a promising test system for the identification of the skin-sensitizing potential of chemicals in the mouse. The contact sensitizer 2,4-dinitrochlorobenzene (DNCB) and the contact and respiratory sensitizer

  19. Handy-type gamma probe-guided sentinel lymph node biopsy for breast cancer under ambulatory local anesthesia

    International Nuclear Information System (INIS)

    Fujiwara, Ikuya; Nagata, Hiroaki; Takaki, Wataru

    2016-01-01

    Prior to surgery for clinically node-negative breast cancer, we diagnosed metastases on the basis of permanent sections and sentinel lymph node biopsy (SNB) using the combined radio isotope (RI)/blue dye method with a hand-type gamma probe under ambulatory local anesthesia. SNB was performed for 99 patients with 103 lesions, including 4 patients with bilateral breast cancer. We achieved an identification rate of 100%, in which the identification pattern included detection by RI and blue-dye in 65 patients (63.1%), detection by RI alone in 37 patients (35.9%), and blue-dye alone in one patient (1.0%). Sentinel lymph node metastasis was macrometastasis in 21 patients (20.4%), micrometastasis in 8 patients (7.8%), and isolated tumor cells in patients (4.9%). In the 80 patients who did not undergo post-SNB axillary lymph node dissection, the median observation period was 33 months and there were no recurrences in the axillary lymph nodes observed. Although the present procedure requires two surgeries, it is a useful method that enables metastasis detection and highly accurate SNB. (author)

  20. Further experience with the local lymph node assay using standard radioactive and nonradioactive cell count measurements.

    Science.gov (United States)

    Kolle, Susanne N; Basketter, David; Schrage, Arnhild; Gamer, Armin O; van Ravenzwaay, Bennard; Landsiedel, Robert

    2012-08-01

    In a previous study, the predictive capacity of a modified local lymph node assay (LLNA) based on cell counts, the LNCC, was demonstrated to be closely similar to that of the original assay. In addition, a range of substances, including some technical/commercial materials and a range of agrochemical formulations (n = 180) have also been assessed in both methods in parallel. The results in the LNCC and LLNA were generally consistent, with 86% yielding an identical classification outcome. Discordant results were associated with borderline data and were evenly distributed between the two methods. Potency information derived from each method also demonstrated good consistency (n = 101), with 93% of predictions being close. Skin irritation was observed only infrequently and was most commonly associated with positive results; it was not associated with the discordant results. Where different vehicles were used with the same test material, the effect on sensitizing activity was modest, consistent with historical data. Analysis of positive control data indicated that the LNCC and LLNA displayed similar levels of biological variation. When taken in combination with the previously published results on LLNA Performance Standard chemicals, it is concluded that the LNCC provides a viable non-radioactive alternative to the LLNA for the assessment of substances, including potency predictions, as well as for the evaluation of preparations. Copyright © 2012 John Wiley & Sons, Ltd.

  1. Mechanistic applicability domain classification of a local lymph node assay dataset for skin sensitization.

    Science.gov (United States)

    Roberts, David W; Patlewicz, Grace; Kern, Petra S; Gerberick, Frank; Kimber, Ian; Dearman, Rebecca J; Ryan, Cindy A; Basketter, David A; Aptula, Aynur O

    2007-07-01

    The goal of eliminating animal testing in the predictive identification of chemicals with the intrinsic ability to cause skin sensitization is an important target, the attainment of which has recently been brought into even sharper relief by the EU Cosmetics Directive and the requirements of the REACH legislation. Development of alternative methods requires that the chemicals used to evaluate and validate novel approaches comprise not only confirmed skin sensitizers and non-sensitizers but also substances that span the full chemical mechanistic spectrum associated with skin sensitization. To this end, a recently published database of more than 200 chemicals tested in the mouse local lymph node assay (LLNA) has been examined in relation to various chemical reaction mechanistic domains known to be associated with sensitization. It is demonstrated here that the dataset does cover the main reaction mechanistic domains. In addition, it is shown that assignment to a reaction mechanistic domain is a critical first step in a strategic approach to understanding, ultimately on a quantitative basis, how chemical properties influence the potency of skin sensitizing chemicals. This understanding is necessary if reliable non-animal approaches, including (quantitative) structure-activity relationships (Q)SARs, read-across, and experimental chemistry based models, are to be developed.

  2. The reduced local lymph node assay: the impact of group size.

    Science.gov (United States)

    Ryan, Cindy A; Chaney, Joel G; Kern, Petra S; Patlewicz, Grace Y; Basketter, David A; Betts, Catherine J; Dearman, Rebecca J; Kimber, Ian; Gerberick, G Frank

    2008-05-01

    The local lymph node assay (LLNA) is a skin sensitization test that provides animal welfare benefits. To reduce animal usage further, a modified version (rLLNA) was proposed. Conducting the rLLNA as a screening test with a single high dose group and vehicle control differentiated accurately between skin sensitizers and non-sensitizers. This study examined whether a reduction in animal number/group is feasible. Historical data were utilized to examine the impact of conducting the rLLNA with two mice/group. To assess the effect on the stimulation index (SI) 41 datasets with individual animal data derived using five mice/group were analysed. SIs were calculated on all possible combinations of two control and two high dose group disintegrations per minute (dpm) values. For 25 of 33 sensitizer datasets, > 96% of possible dpm combinations resulted in a calculated SI > 3. The lowest percentages of positive SIs were observed with weak allergens when, in the standard LLNA, the mean SIs would have been nearer to the threshold value of 3. The results indicate that moderate, strong and extreme allergens are more likely than weak allergens to be identified as sensitizers when group sizes of two mice are used within the rLLNA. It is concluded that a rLLNA with two mice/group would display decreased sensitivity and is inappropriate for use in hazard identification. Copyright (c) 2007 John Wiley & Sons, Ltd.

  3. Evaluation of allergenicity of constituents of myoga using the murine local lymph node assay.

    Science.gov (United States)

    Wei, Q J; Wei, C N; Harada, K; Minamoto, K; Okamoto, Y; Otsuka, M; Ueda, A

    2010-01-01

    Myoga (Zingiber Myoga Roscoe) is a perennial plant with a pungent smell from its flower buds. It is native to East Asia and has been reported to cause allergic contact dermatitis. The purpose of this study is to assess the allergenicity of myoga related to its major chemical components, alpha-pinene, beta-pinene, limonene, limonene oxide and beta-phellandrene, which are supposed to be the causative agents of contact dermatitis among myoga cultivators. We performed a toxicity study of the volatile constituents of myoga using the local lymph node assay (LLNA), in which limonene, limonene oxide and beta-phellandrene had positive responses and the EC3 was 35.8%, 8.22%, and 0.54%, respectively. EC3 for both alpha-pinene and beta-pinene was over 100%. Both chemicals failed to induce positive responses in the LLNA. While the maximization rating of limonene, limonene oxide and phellandrene were evaluated as moderate, extreme, and extreme respectively, alpha-pinene and beta-pinene were evaluated as weak in the previously reported GPMT. The usage of LLNA was also confirmed by comparing with previously reported GPMT results to detect the allergenicity of myoga constituents. The actual risk of humans developing an allergy to myoga constituents depends on many factors. The concentration of the compounds, the frequency and duration of exposure and the condition of the skin are supposed to be important factors.

  4. The murine local lymph node assay: Regulatory and potency considerations under REACH

    International Nuclear Information System (INIS)

    McGarry, Helen F.

    2007-01-01

    From June 2007, new chemicals legislation on the registration, evaluation, authorisation and restriction of chemicals (REACH) will come into force across the European Union. This will require the submission of data on human health effects of chemicals, including chemical safety assessments which will require measurements of potency. For skin sensitization hazard identification, REACH states that the first-choice in vivo assay is the local lymph node assay (LLNA). This test has also been the UK competent authority's preferred test for skin sensitization since 2002, and has now replaced guinea pig tests in dossiers submitted to it under the Notification of New Substances Regulations. Advantages of the LLNA over guinea pig tests include improvements in animal welfare, a more scientific approach to hazard identification, and the inclusion of a dose-response element in the endpoint, which enables an estimation of potency. However, notifiers to the UK competent authority have sometimes been reluctant to use the assay because of concerns over false-positive reactions. Across Europe, these concerns have been heightened in the lead-up to the introduction of REACH, since the use of in vivo alternatives to the LLNA will require scientific justification. This review will address some of these concerns from a regulatory perspective

  5. Evaluation of the performance of the reduced local lymph node assay for skin sensitization testing.

    Science.gov (United States)

    Ezendam, Janine; Muller, Andre; Hakkert, Betty C; van Loveren, Henk

    2013-06-01

    The local lymph node assay (LLNA) is the preferred method for classification of sensitizers within REACH. To reduce the number of mice for the identification of sensitizers the reduced LLNA was proposed, which uses only the high dose group of the LLNA. To evaluate the performance of this method for classification, LLNA data from REACH registrations were used and classification based on all dose groups was compared to classification based on the high dose group. We confirmed previous examinations of the reduced LLNA showing that this method is less sensitive compared to the LLNA. The reduced LLNA misclassified 3.3% of the sensitizers identified in the LLNA and misclassification occurred in all potency classes and that there was no clear association with irritant properties. It is therefore not possible to predict beforehand which substances might be misclassified. Another limitation of the reduced LLNA is that skin sensitizing potency cannot be assessed. For these reasons, it is not recommended to use the reduced LLNA as a stand-alone assay for skin sensitization testing within REACH. In the future, the reduced LLNA might be of added value in a weight of evidence approach to confirm negative results obtained with non-animal approaches. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. The murine local lymph node assay: regulatory and potency considerations under REACH.

    Science.gov (United States)

    McGarry, Helen F

    2007-09-05

    From June 2007, new chemicals legislation on the registration, evaluation, authorization and restriction of chemicals (REACH) will come into force across the European Union. This will require the submission of data on human health effects of chemicals, including chemical safety assessments which will require measurements of potency. For skin sensitization hazard identification, REACH states that the first-choice in vivo assay is the local lymph node assay (LLNA). This test has also been the UK competent authority's preferred test for skin sensitization since 2002, and has now replaced guinea pig tests in dossiers submitted to it under the Notification of New Substances Regulations. Advantages of the LLNA over guinea pig tests include improvements in animal welfare, a more scientific approach to hazard identification, and the inclusion of a dose-response element in the endpoint, which enables an estimation of potency. However, notifiers to the UK competent authority have sometimes been reluctant to use the assay because of concerns over false-positive reactions. Across Europe, these concerns have been heightened in the lead-up to the introduction of REACH, since the use of in vivo alternatives to the LLNA will require scientific justification. This review will address some of these concerns from a regulatory perspective.

  7. Skin irritation, false positives and the local lymph node assay: a guideline issue?

    Science.gov (United States)

    Basketter, David A; Kimber, Ian

    2011-10-01

    Since the formal validation and regulatory acceptance of the local lymph node assay (LLNA) there have been commentaries suggesting that the irritant properties of substances can give rise to false positives. As toxicology aspires to progress rapidly towards the age of in vitro alternatives, it is of increasing importance that issues relating to assay selectivity and performance are understood fully, and that true false positive responses are distinguished clearly from those that are simply unpalatable. In the present review, we have focused on whether skin irritation per se is actually a direct cause of true false positive results in the LLNA. The body of published work has been examined critically and considered in relation to our current understanding of the mechanisms of skin irritation and skin sensitisation. From these analyses it is very clear that, of itself, skin irritation is not a cause of false positive results. The corollary is, therefore, that limiting test concentrations in the LLNA for the purpose of avoiding skin irritation may lead, unintentionally, to false negatives. Where a substance is a true false positive in the LLNA, the classic example being sodium lauryl sulphate, explanations for that positivity will have to reach beyond the seductive, but incorrect, recourse to its skin irritation potential. Copyright © 2011 Elsevier Inc. All rights reserved.

  8. Immunosuppressive potential of bardoxolone methyl using a modified murine local lymph node assay (LLNA).

    Science.gov (United States)

    Kitsukawa, Mika; Tsuchiyama, Hiromi; Maeda, Akihisa; Oshida, Keiyu; Miyamoto, Yohei

    2014-08-01

    2-Cyano-3, 12-dioxooleana-1, 9-dien-28-oic acid methyl ester (CDDO-Me; bardoxolone methyl) is one of the synthetic oleanane triterpenoids (SOs). It is known that it is the strongest Nrf2/ARE signaling inducer of SOs and slightly inhibits immune response. Little was known about the immunomodulatory action of CDDO-Me in vivo. We assessed its immunosuppressive potential by using the modified mouse lymph node assay (LLNA) including immunosuppression-related gene expression analysis. In the modified LLNA, CDDO-Me showed a significant decrease in lymph node weight and changes in expressions of the immunosuppression-related genes, Zfp459 and Fmo2. It has been already reported that a decrease in lymph node weight was induced by several types of immunosuppressive chemicals such as calcineurin inhibitors, antimetabolites, steroids, and alkylators. In addition, changes in Zfp459 and Fmo2 expression was reported in response after only treatment of antimetabolites. From these results, CDDO-Me is considered to have an immunosuppressive action and similar mechanism to antimetabolites.

  9. Study of the sensitising potential of various textile dyes using a biphasic murine local lymph node assay.

    Science.gov (United States)

    Ahuja, V; Platzek, T; Fink, H; Sonnenburg, A; Stahlmann, R

    2010-09-01

    Disperse dyes, which are suitable for dyeing synthetic fibres, are responsible for the great majority of allergic contact dermatitis (ACD) cases to textile dyes. The aim of the present study was to investigate the sensitising potential of various disperse dyes using a biphasic protocol of the local lymph node assay (LLNA). Briefly, mice were shaved over a surface of approximately 2 cm(2) on their backs and treated using a "sensitisation-challenge protocol". The shaved surface was treated once daily on days 1-3 with 50 microl of the test solution. Animals remained untreated on days 4-14. On days 15-17, mice were treated with 25 microl of the test solution on the dorsum of both ears. Mice were killed on day 19 with deep CO(2) anaesthesia, the lymph nodes prepared and various end points, such as ear thickness, ear punch weight, lymph node weight, lymph node cell count and the proportion of various lymphocyte subpopulations, were determined by flow cytometry. The results were compared to control group treated with the vehicle alone. Our results showed that almost all of the tested textile dyes caused a significant increase in lymph node cell count and lymph node weight. We also observed an increase in ear thickness and ear punch weight in most of the concentrations tested for various textile dyes. We observed a decrease in CD4+ and CD8+ cells and an increase in CD19+, CD45+ and CD45+/1A+ cells in most of the cases, which is characteristic for allergens. The CD4+/CD69+ cells increased in only few experiments mainly with Disperse Blue 124 and Disperse Blue 106. Based on our results, the disperse dyes could be arranged in four groups on the basis of their sensitising potency in the following decreasing order (in parenthesis: lowest concentration causing a significant increase in lymph node cell number): group 1, strong: Disperse Blue 124 and Disperse Blue 106 (0.003%); group 2, moderate: Disperse Red 1 and Disperse Blue 1 (3%); group 3, weak: Disperse Orange 37 and

  10. Repeat CT-scan assessment of lymph node motion in locally advanced cervical cancer patients

    International Nuclear Information System (INIS)

    Bondar, Luiza; Velema, Laura; Mens, Jan Willem; Heijmen, Ben; Hoogeman, Mischa; Zwijnenburg, Ellen

    2014-01-01

    In cervical cancer patients the nodal clinical target volume (CTV, defined using the major pelvic blood vessels and enlarged lymph nodes) is assumed to move synchronously with the bony anatomy. The aim of this study was to verify this assumption by investigating the motion of the major pelvic blood vessels and enlarged lymph nodes visible in CT scans. For 13 patients treated in prone position, four variable bladder-filling CT scans per patient, acquired at planning and after 40 Gy, were selected from an available dataset of 9-10 CT scans. The bladder, rectum, and the nodal-vessels structure containing the iliac vessels and all visible enlarged nodes were delineated in each selected CT scan. Two online patient setup correction protocols were simulated. The first corrected bony anatomy translations and the second corrected translations and rotations. The efficacy of each correction was calculated as the overlap between the nodal-vessels structure in the reference and repeat CT scans. The motion magnitude between delineated structures was quantified using nonrigid registration. Translational corrections resulted in an average overlap of 58 ± 13% and in a range of motion between 9.9 and 27.3 mm. Translational and rotational corrections significantly improved the overlap (64 ± 13%, p value = 0.007) and moderately reduced the range of motion to 7.6-23.8 mm (p value = 0.03). Bladder filling changes significantly correlated with the nodal-vessels motion (p [de

  11. The local lymph node assay in practice: a current regulatory perspective.

    Science.gov (United States)

    Cockshott, A; Evans, P; Ryan, C A; Gerberick, G F; Betts, C J; Dearman, R J; Kimber, I; Basketter, D A

    2006-07-01

    Following the formal acceptance of the local lymph node assay (LLNA) as an Organization for Economic Cooperation and Development (OECD) guideline in April 2002, the UK Health and Safety Executive (HSE) informed notifiers that this was now the method of choice for the assessment of skin sensitization potential under the EU notification scheme for new industrial chemicals (NONS). This paper summarizes the experience of the HSE for the 2-year period immediately following the issuing of this statement, during which 48 LLNA study reports were assessed for notification purposes. The issues discussed here include adherence to the OECD guideline, interpretation of results, and classification outcomes. Generally, notifying laboratories followed the OECD guideline successfully, with regard to the sex/ strain/numbers of mice used, the precise process used for measurement of cell proliferation, and the use of recommended vehicles and positive controls. Initially, use of the individual animal approach (measuring the cell proliferation in each animal rather than for a pooled dose group) highlighted problems caused by technical inexperience, but these were overcome by practice. Toxicity or irritation were found to be minor factors in dose selection; more important was the choice of vehicle to correctly maximize the test substance concentration, while maintaining appropriate application properties. Contrary to concerns that the LLNA would prove to be less sensitive or more sensitive than the traditionally used Guinea Pig Maximization Test (GPMT), the proportion of new substances classified as skin sensitizers was within the range observed in previous years. Although the sample size is relatively small, the experience of the HSE indicates that the LLNA is satisfactory for routine regulatory use.

  12. QSAR Study of Skin Sensitization Using Local Lymph Node Assay Data

    Directory of Open Access Journals (Sweden)

    Eugene Demchuk

    2004-01-01

    Full Text Available Abstract: Allergic Contact Dermatitis (ACD is a common work-related skin disease that often develops as a result of repetitive skin exposures to a sensitizing chemical agent. A variety of experimental tests have been suggested to assess the skin sensitization potential. We applied a method of Quantitative Structure-Activity Relationship (QSAR to relate measured and calculated physical-chemical properties of chemical compounds to their sensitization potential. Using statistical methods, each of these properties, called molecular descriptors, was tested for its propensity to predict the sensitization potential. A few of the most informative descriptors were subsequently selected to build a model of skin sensitization. In this work sensitization data for the murine Local Lymph Node Assay (LLNA were used. In principle, LLNA provides a standardized continuous scale suitable for quantitative assessment of skin sensitization. However, at present many LLNA results are still reported on a dichotomous scale, which is consistent with the scale of guinea pig tests, which were widely used in past years. Therefore, in this study only a dichotomous version of the LLNA data was used. To the statistical end, we relied on the logistic regression approach. This approach provides a statistical tool for investigating and predicting skin sensitization that is expressed only in categorical terms of activity and nonactivity. Based on the data of compounds used in this study, our results suggest a QSAR model of ACD that is based on the following descriptors: nDB (number of double bonds, C-003 (number of CHR3 molecular subfragments, GATS6M (autocorrelation coefficient and HATS6m (GETAWAY descriptor, although the relevance of the identified descriptors to the continuous ACD QSAR has yet to be shown. The proposed QSAR model gives a percentage of positively predicted responses of 83% on the training set of compounds, and in cross validation it correctly identifies 79% of

  13. Quantitative relationship between the local lymph node assay and human skin sensitization assays.

    Science.gov (United States)

    Schneider, K; Akkan, Z

    2004-06-01

    The local lymph node assay (LLNA) is a new test method which allows for the quantitative assessment of sensitizing potency in the mouse. Here, we investigate the quantitative correlation between results from the LLNA and two human sensitization tests--specifically, human repeat insult patch tests (HRIPTs) and human maximization tests (HMTs). Data for 57 substances were evaluated, of which 46 showed skin sensitizing properties in human tests, whereas 11 yielded negative results in humans. For better comparability data from mouse and human tests were transformed to applied doses per skin area, which ranged over four orders of magnitude for the substances considered. Regression analysis for the 46 human sensitizing substances revealed a significant positive correlation between the LLNA and human tests. The correlation was better between LLNA and HRIPT data (n=23; r=0.77) than between LLNA and HMT data (n=38; r=0.65). The observed scattering of data points is related to various uncertainties, in part associated with insufficiencies of data from older HMT studies. Predominantly negative results in the LLNA for another 11 substances which showed no skin sensitizing activity in human maximization tests further corroborate the correspondence between LLNA and human tests. Based on this analysis, the LLNA can be considered a reliable basis for relative potency assessments for skin sensitizers. Proposals are made for the regulatory exploitation of the LLNA: four potency groups can be established, and assignment of substances to these groups according to the outcome of the LLNA can be used to characterize skin sensitizing potency in substance-specific assessments. Moreover, based on these potency groups, a more adequate consideration of sensitizing substances in preparations becomes possible. It is proposed to replace the current single concentration limit for skin sensitizers in preparations, which leads to an all or nothing classification of a preparation as sensitizing to

  14. The local lymph node assay: current position in the regulatory classification of skin sensitizing chemicals.

    Science.gov (United States)

    Basketter, David A; Gerberick, G Frank; Kimber, Ian

    2007-01-01

    The local lymph node assay (LLNA) is being used increasingly in the identification of skin sensitizing chemicals for regulatory purposes. In the context of new chemicals legislation (REACH) in Europe, it is the preferred assay. The rationale for this is that the LLNA quantitative and objective approach to skin sensitization testing allied with the important animal welfare benefits that the method offers. However, as with certain guinea pig sensitization tests before it, this increasing use also brings experience with an increasingly wide range of industrial and other chemicals where the outcome of the assay does not always necessarily meet with the expectations of those conducting it. Sometimes, the result appears to be a false negative, but rather more commonly, the complaint is that the chemical represents a false positive. Against this background we have here reviewed a number of instances where false positive and false negative results have been described and have sought to reconcile science with expectation. Based on these analyses, it is our conclusion that false positives and false negatives do occur in the LLNA, as they do with any other skin sensitization assay (and indeed with all tests used for hazard identification), and that this occurs for a number of reasons. We further conclude, however, that false positive results in the LLNA, as with the guinea pig maximization test, arise most commonly via failure to distinguish what is scientifically correct from that which is unpalatable. The consequences of this confusion are discussed in the article, particularly in relation to the need to integrate both potency measurement and risk assessments into classification and labelling schemes that aim to manage potential risks to human health.

  15. Interlaboratory validation of the modified murine local lymph node assay based on adenosine triphosphate measurement.

    Science.gov (United States)

    Omori, Takashi; Idehara, Kenji; Kojima, Hajime; Sozu, Takashi; Arima, Kazunori; Goto, Hirohiko; Hanada, Tomohiko; Ikarashi, Yoshiaki; Inoda, Taketo; Kanazawa, Yukiko; Kosaka, Tadashi; Maki, Eiji; Morimoto, Takashi; Shinoda, Shinsuke; Shinoda, Naoki; Takeyoshi, Masahiro; Tanaka, Masashi; Uratani, Mamoru; Usami, Masahito; Yamanaka, Atsushi; Yoneda, Tomofumi; Yoshimura, Isao; Yuasa, Atsuko

    2008-01-01

    The murine local lymph node assay (LLNA) is a well-established alternative to the guinea pig maximization test (GPMT) or Buehler test (BT) for the assessment of the skin sensitizing ability of drugs and chemicals. Daicel Chemical Industries Ltd. has developed a modified LLNA based on the adenosine triphosphate (ATP) content (LLNA-DA). We conducted 2 interlaboratory validation studies to evaluate the reliability and relevance of LLNA-DA. The experiment involved 17 laboratories, wherein 14 chemicals were examined under blinded conditions. In the first study, 3 chemicals were examined in 10 laboratories and the remaining 9 were examined in 3 laboratories. In the second study, 1 chemical was examined in 7 laboratories and the remaining 4 chemicals were examined in 4 laboratories. The data were expressed as the ATP content for each chemical-treated group, and the stimulation index (SI) for each chemical-treated group was determined as the increase in the ATP content relative to the concurrent vehicle control group. An SI of 3 was set as the cut-off value for exhibiting skin sensitization activity. The results of the first study obtained in the experiments conducted for the 3 chemicals that were examined in all the 10 laboratories and for 5 of the remaining 9 chemicals were sufficiently consistent with small variations in their SI values. The sensitivity, specificity, and accuracy of LLNA-DA against those of GPMT/BT were 7/8 (87.5%), 3/3 (100%), and 10/11 (90.9%), respectively. In the second study, all the 5 chemicals studied demonstrated acceptably small interlaboratory variations. In the first study, a large variation was observed for 2 chemicals; in the second study, this variation was small. It was attributed to the application of dimethylsulfoxide as the solvent for the metallic salts. In conclusion, these 2 studies provide good evidence for the reliability of the LLNA-DA.

  16. Sentinel nodes outside lymph node basins in patients with melanoma

    NARCIS (Netherlands)

    Roozendaal, GK; de Vries, JDH; van Poll, D; Jansen, L; Nieweg, OE; Kroon, BBR; Schraffordt Koops, H.

    Background: Lymphoscintigraphy occasionally reveals hot spots outside lymph node basins in patients with melanoma. The aim of this study was to evaluate such abnormally located hot spots. Methods: Sentinel node biopsy was studied prospectively in 379 patients with clinically localized cutaneous

  17. Local behavior and lymph node metastases of Wilms' tumor: accuracy of computed tomography; Comportamento local e metastases linfonodais do tumor de Wilms: acuracia da tomografia computadorizada

    Energy Technology Data Exchange (ETDEWEB)

    Silva, Eduardo Just da Costa e, E-mail: eduardojust@oi.com.br [Universidade Federal de Pernambuco (UFPE), Recife, PE (Brazil); Instituto Materno Infantil de Pernambuco (IMIP), Recife, PE (Brazil); Silva, Giselia Alves Pontes da [Universidade Federal de Pernambuco (UFPE), Recife, PE (Brazil). Dept. Maternal Infantil

    2014-01-15

    Objective: to evaluate the accuracy of computed tomography for local and lymph node staging of Wilms' tumor. Materials and methods: each case of Wilms' tumor was evaluated for the presence of abdominal lymph nodes by a radiologist. Signs of capsule and adjacent organ invasion were analyzed. Surgical and histopathological results were taken as the gold standard. Results: sensitivity was 100% for both mesenteric and retroperitoneal lymph nodes detection, and specificity was, respectively, 12% and 33%, with positive predictive value of 8% and 11% and negative predictive value of 100%. Signs of capsular invasion presented sensitivity of 87%, specificity of 77%, positive predictive value of 63% and negative predictive value of 93%. Signs of adjacent organ invasion presented sensitivity of 100%, specificity of 78%, positive predictive value of 37% and negative predictive value of 100%. Conclusion: computed tomography tumor showed low specificity and low positive predictive value in the detection of lymph node dissemination. The absence of detectable lymph nodes makes their presence unlikely, and likewise regarding the evaluation of local behavior of tumors. (author)

  18. Qualitative and quantitative evaluation of a local lymph node assay based on ex vivo interleukin-2 production.

    Science.gov (United States)

    Azam, Philippe; Peiffer, Jean-Luc; Ourlin, Jean-Claude; Bonnet, Pierre-Antoine; Tissier, Marie-Hélène; Vian, Laurence; Fabre, Isabelle

    2005-01-15

    The local lymph node assay (LLNA) is a regular method for the detection of sensitizing chemicals in mice which measures the incorporation of tritiated thymidine in lymph node cells. We have evaluated an alternative to this method based on the interleukin-2 (IL-2) production of lymph node cells. At the mRNA level, no change in the IL-2 gene expression level was detected by real-time PCR analysis. At the protein level, various experimental conditions were checked in order to improve the irritant versus sensitizer discrimination with a restricted set of prototypic compounds. In particular, the use of phytohemagglutinin A (PHA) in an ex vivo cell culture step showed an improvement of both signal and discrimination. In these optimised conditions, a panel of irritants and potency-graded sensitizers was used to assess the performance of the modified method. IFN-gamma production was used as a positive control. For each compound, a dose-response was performed and stimulation indexes (SI) were determined. Effective concentrations (EC) for each sensitizers were then extracted and compared to the literature data of the regular LLNA. The IL-2-based LLNA showed similar performances at both qualitative and quantitative levels compared to regular LLNA.

  19. Intraoperative Sentinel Lymph Node Evaluation

    DEFF Research Database (Denmark)

    Shaw, Richard; Christensen, Anders; Java, Kapil

    2016-01-01

    BACKGROUND: Intraoperative analysis of sentinel lymph nodes would enhance the care of early-stage oral squamous cell carcinoma (OSCC). We determined the frequency and extent of cytokeratin 19 (CK19) expression in OSCC primary tumours and surrounding tissues to explore the feasibility of a "clinic......-ready" intraoperative diagnostic test (one step nucleic acid amplification-OSNA, sysmex). METHODS: Two cohorts were assembled: cohort 1, OSCC with stage and site that closely match cases suitable for sentinel lymph node biopsy (SLNB); cohort 2, HNSCC with sufficient fresh tumour tissue available for the OSNA assay (>50......% of tumours. Discordance between different techniques indicated that OSNA was more sensitive than qRT-PCR or RNA-ISH, which in turn were more sensitive than IHC. OSNA results showed CK19 expression in 80% of primary cases, so if used for diagnosis of lymph node metastasis would lead to a false-negative result...

  20. Safety Assessment of Allergic Contact Dermatitis Hazards: An Analysis Supporting Reduced Animal Use for the Murine Local Lymph Node Assay

    OpenAIRE

    Haseman, Joseph K.; Strickland, Judy; Allen, David; Salicru, Eleni; Paris, Michael; Tice, Raymond R.; Stokes, William S.

    2010-01-01

    The original Organisation for Economic Co-operation and Development Test Guideline 429 (OECD TG 429) for the murine local lymph node assay (LLNA) required five mice/group if mice were processed individually. We used data from 83 LLNA tests (275 treated groups) to determine the impact on the LLNA outcome of reducing the group size from five to four. From DPM measurements, we formed all possible four-mice and five-mice combinations for the treated and control groups. Stimulation index (SI) valu...

  1. Chemical applicability domain of the Local Lymph Node Assay (LLNA) for skin sensitisation potency. Part 2. The biological variability of the murine Local Lymph Node Assay (LLNA) for skin sensitisation.

    Science.gov (United States)

    Roberts, David W; Api, Anne Marie; Aptula, Aynur O

    2016-10-01

    The Local Lymph Node Assay (LLNA) is the most common in vivo regulatory toxicology test for skin sensitisation, quantifying potency as the EC3, the concentration of chemical giving a threefold increase in thymidine uptake in the local lymph node. Existing LLNA data can, along with clinical data, provide useful comparator information on the potency of sensitisers. Understanding of the biological variability of data from LLNA studies is important for those developing non-animal based risk assessment approaches for skin allergy. Here an existing set of 94 EC3 values for 12 chemicals, all tested at least three times in the same vehicle have been analysed by calculating standard deviations (SD) for logEC3 values. The SDs range from 0.08 to 0.22. The overall SD for the 94 logEC3 values is 0.147. Thus the 95% confidence limits (2xSD) for LLNA EC3 values are within a factor of 2, comparable to those for physico-chemical measurements such as partition coefficients and solubility. The residual SDs of Quantitative Mechanistic Models (QMMs) based on physical organic chemistry parameters are similar to the overall SD of the LLNA, indicating that QMMs of this type are unlikely to be bettered for predictive accuracy. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. An European inter-laboratory validation of alternative endpoints of the murine local lymph node assay: 2nd round.

    Science.gov (United States)

    Ehling, G; Hecht, M; Heusener, A; Huesler, J; Gamer, A O; van Loveren, H; Maurer, Th; Riecke, K; Ullmann, L; Ulrich, P; Vandebriel, R; Vohr, H-W

    2005-08-15

    The original local lymph node assay (LLNA) is based on the use of radioactive labelling to measure cell proliferation. Other endpoints for the assessment of proliferation are also authorized by the OECD Guideline 429 provided there is appropriate scientific support, including full citations and description of the methodology (OECD, 2002. OECD Guideline for the Testing of Chemicals; Skin Sensitization: Local Lymph Node Assay, Guideline 429. Paris, adopted 24th April 2002.). Here, we describe the outcome of the second round of an inter-laboratory validation of alternative endpoints in the LLNA conducted in nine laboratories in Europe. The validation study was managed and supervised by the Swiss Agency for Therapeutic Products (Swissmedic) in Bern. Ear-draining lymph node (LN) weight and cell counts were used to assess LN cell proliferation instead of [3H]TdR incorporation. In addition, the acute inflammatory skin reaction was measured by ear weight determination of circular biopsies of the ears to identify skin irritation properties of the test items. The statistical analysis was performed in the department of statistics at the university of Bern. Similar to the EC(3) values defined for the radioactive method, threshold values were calculated for the endpoints measured in this modification of the LLNA. It was concluded that all parameters measured have to be taken into consideration for the categorisation of compounds due to their sensitising potencies. Therefore, an assessment scheme has been developed which turned out to be of great importance to consistently assess sensitisation versus irritancy based on the data of the different parameters. In contrast to the radioactive method, irritants have been picked up by all the laboratories applying this assessment scheme.

  3. Localization studies of metastatic axillary lymph node by radioimmunoimmaging with monoclonal antibody C50 in breast cancer

    International Nuclear Information System (INIS)

    Feng Jue; Gao Yougong

    1993-01-01

    Eleven patients with breast cancer and 2 normal controls (26 axillary lymph-nodes) were studied by the radio immunoimaging with 131 I labelled anti-CEA monoclonal antibody C 50 . Among them, the imaging was positive in 8 patients and negative in 3 patients. 7 of the 8 positive patients were proven by the pathological examination of postoperative lymph nodes. Other one had proved with the presence of CEA-antigen and antigen-antibody immuno complexes in the lymphoid sinus by immuno histochemistry. Cancer cell was not found by pathology in the axillary lymph node of 3 negative imaging patients. 2 normal controls was also negative

  4. Repeat CT-scan assessment of lymph node motion in locally advanced cervical cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Bondar, Luiza; Velema, Laura; Mens, Jan Willem; Heijmen, Ben; Hoogeman, Mischa [Erasmus Medical Center Cancer Institute, Department of Radiation Oncology, 3008 AE, Rotterdam (Netherlands); Zwijnenburg, Ellen [Radboud University Medical Center, Department of Radiation Oncology, Nijmegen (Netherlands)

    2014-12-15

    In cervical cancer patients the nodal clinical target volume (CTV, defined using the major pelvic blood vessels and enlarged lymph nodes) is assumed to move synchronously with the bony anatomy. The aim of this study was to verify this assumption by investigating the motion of the major pelvic blood vessels and enlarged lymph nodes visible in CT scans. For 13 patients treated in prone position, four variable bladder-filling CT scans per patient, acquired at planning and after 40 Gy, were selected from an available dataset of 9-10 CT scans. The bladder, rectum, and the nodal-vessels structure containing the iliac vessels and all visible enlarged nodes were delineated in each selected CT scan. Two online patient setup correction protocols were simulated. The first corrected bony anatomy translations and the second corrected translations and rotations. The efficacy of each correction was calculated as the overlap between the nodal-vessels structure in the reference and repeat CT scans. The motion magnitude between delineated structures was quantified using nonrigid registration. Translational corrections resulted in an average overlap of 58 ± 13% and in a range of motion between 9.9 and 27.3 mm. Translational and rotational corrections significantly improved the overlap (64 ± 13%, p value = 0.007) and moderately reduced the range of motion to 7.6-23.8 mm (p value = 0.03). Bladder filling changes significantly correlated with the nodal-vessels motion (p < 0.001). The motion of the nodal-vessels was large, nonrigid, patient-specific, and only moderately synchronous with the bony anatomy. This study highlights the need for caution when reducing the CTV-to-PTV (PTV planning target volume) margin of the nodal CTV for highly conformal radiation techniques. (orig.) [German] Bei Zervixkarzinompatientinnen wird davon ausgegangen, dass das nodale klinische Zielvolumen (CTV, definiert anhand der grossen Blutgefaesse des Beckens und vergroesserter Lymphknoten) sich synchron mit

  5. An European inter-laboratory validation of alternative endpoints of the murine local lymph node assay: first round.

    Science.gov (United States)

    Ehling, G; Hecht, M; Heusener, A; Huesler, J; Gamer, A O; van Loveren, H; Maurer, Th; Riecke, K; Ullmann, L; Ulrich, P; Vandebriel, R; Vohr, H-W

    2005-08-15

    The new OECD guideline 429 (skin sensitization: local lymph node assay) is based upon a protocol, which utilises the incorporation of radioactivity into DNA as a measure for cell proliferation in vivo. The guideline also enables the use of alternative endpoints in order to assess draining lymph node (LN) cell proliferation. Here we describe the first round of an inter-laboratory validation of alternative endpoints in the LLNA conducted in seven laboratories. The validation study was managed and supervised by the Swiss Agency for Therapeutic Products, Swissmedic. Statistical analyses of all data were performed by an independent centre at the University of Bern, Department of Statistics. Ear-draining, LN weight and cell count were used to assess proliferation instead of radioactive labeling of lymph node cells. In addition, the acute inflammatory skin reaction was measured by ear swelling and weight of circular biopsies of the ears to identify skin irritating properties of the test items. Hexylcinnamaldehyde (HCA) and three blinded test items were applied to female, 8--10 weeks old NMRI and BALB/c mice. Results were sent via the independent study coordinator to the statistician. The results of this first round showed that the alternative endpoints of the LLNA are sensitive and robust parameters. The use of ear weights added an important parameter assessing the skin irritation potential, which supports the differentiation of pure irritative from contact allergenic potential. There were absolute no discrepancies between the categorisation of the three test substances A--C determined by each single participating laboratories. The results highlighted also that many parameters do have an impact on the strength of the responses. Therefore, such parameters have to be taken into consideration for the categorisation of compounds due to their relative sensitizing potencies.

  6. An European inter-laboratory validation of alternative endpoints of the murine local lymph node assay: First round

    International Nuclear Information System (INIS)

    Ehling, G.; Hecht, M.; Heusener, A.; Huesler, J.; Gamer, A.O.; Loveren, H. van; Maurer, Th.; Riecke, K.; Ullmann, L.; Ulrich, P.; Vandebriel, R.; Vohr, H.-W.

    2005-01-01

    The new OECD guideline 429 (skin sensitization: local lymph node assay) is based upon a protocol, which utilises the incorporation of radioactivity into DNA as a measure for cell proliferation in vivo. The guideline also enables the use of alternative endpoints in order to assess draining lymph node (LN) cell proliferation. Here we describe the first round of an inter-laboratory validation of alternative endpoints in the LLNA conducted in seven laboratories. The validation study was managed and supervised by the Swiss Agency for Therapeutic Products, Swissmedic. Statistical analyses of all data were performed by an independent centre at the University of Bern, Department of Statistics. Ear-draining, LN weight and cell count were used to assess proliferation instead of radioactive labeling of lymph node cells. In addition, the acute inflammatory skin reaction was measured by ear swelling and weight of circular biopsies of the ears to identify skin irritating properties of the test items. Hexylcinnamaldehyde (HCA) and three blinded test items were applied to female, 8-10 weeks old NMRI and BALB/c mice. Results were sent via the independent study coordinator to the statistician. The results of this first round showed that the alternative endpoints of the LLNA are sensitive and robust parameters. The use of ear weights added an important parameter assessing the skin irritation potential, which supports the differentiation of pure irritative from contact allergenic potential. There were absolute no discrepancies between the categorisation of the three test substances A-C determined by each single participating laboratories. The results highlighted also that many parameters do have an impact on the strength of the responses. Therefore, such parameters have to be taken into consideration for the categorisation of compounds due to their relative sensitizing potencies

  7. Performance standard-based validation study for local lymph node assay: 5-bromo-2-deoxyuridine-flow cytometry method.

    Science.gov (United States)

    Ahn, Ilyoung; Kim, Tae-Sung; Jung, Eun-Sun; Yi, Jung-Sun; Jang, Won-Hee; Jung, Kyoung-Mi; Park, Miyoung; Jung, Mi-Sook; Jeon, Eun-Young; Yeo, Kyeong-Uk; Jo, Ji-Hoon; Park, Jung-Eun; Kim, Chang-Yul; Park, Yeong-Chul; Seong, Won-Keun; Lee, Ai-Young; Chun, Young Jin; Jeong, Tae Cheon; Jeung, Eui Bae; Lim, Kyung-Min; Bae, SeungJin; Sohn, Soojung; Heo, Yong

    2016-10-01

    Local lymph node assay: 5-bromo-2-deoxyuridine-flow cytometry method (LLNA: BrdU-FCM) is a modified non-radioisotopic technique with the additional advantages of accommodating multiple endpoints with the introduction of FCM, and refinement and reduction of animal use by using a sophisticated prescreening scheme. Reliability and accuracy of the LLNA: BrdU-FCM was determined according to OECD Test Guideline (TG) No. 429 (Skin Sensitization: Local Lymph Node Assay) performance standards (PS), with the participation of four laboratories. Transferability was demonstrated through successfully producing stimulation index (SI) values for 25% hexyl cinnamic aldehyde (HCA) consistently greater than 3, a predetermined threshold, by all participating laboratories. Within- and between-laboratory reproducibility was shown using HCA and 2,4-dinitrochlorobenzene, in which EC2.7 values (the estimated concentrations eliciting an SI of 2.7, the threshold for LLNA: BrdU-FCM) fell consistently within the acceptance ranges, 0.025-0.1% and 5-20%, respectively. Predictive capacity was tested using the final protocol version 1.3 for the 18 reference chemicals listed in OECD TG 429, of which results showed 84.6% sensitivity, 100% specificity, and 88.9% accuracy compared with the original LLNA. The data presented are considered to meet the performance criteria for the PS, and its predictive capacity was also sufficiently validated. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. The respiratory allergen glutaraldehyde in the local lymph node assay: sensitization by skin exposure, but not by inhalation.

    Science.gov (United States)

    van Triel, Jos J; van Bree, Bianca W J; Roberts, David W; Muijser, Hans; Duistermaat, Evert; Woutersen, Ruud A; Kuper, C Frieke

    2011-01-11

    Previously, a selection of low molecular weight contact and respiratory allergens had tested positive in both a skin and a respiratory local lymph node assay (LLNA), but formaldehyde was negative for sensitization by inhalation. To investigate whether this was due to intrinsic properties of aldehyde sensitizers, the structurally related allergen glutaraldehyde (GA) was tested. BALB/c mice were exposed by inhalation to 6 or 18ppm GA (respiratory LLNA), both generated as a vapor and as an aerosol. Other groups received 0.25% or 2.5% GA on the skin of the ears (skin LLNA). Lymphocyte proliferation and cytokine production were measured in the draining lymph nodes. GA was positive in the skin LLNA and its cytokine profile (IL-4/IFN-γ) skewed towards a Th2-type immune response with increasing dose. Inhalation exposure did not result in increased lymphocyte proliferation or increased cytokine levels, despite comparable tissue damage (irritation) in the skin and respiratory tract. We hypothesize that the highly reactive and hydrophilic GA oligomerizes in the protein-rich mucous layer of the respiratory tract, which impedes sensitization but still facilitates local irritation. Within the context of risk assessment in respiratory allergy, our results stress the importance of prevention of skin--besides inhalation-- exposure to aldehydes like GA. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  9. The respiratory allergen glutaraldehyde in the local lymph node assay: Sensitization by skin exposure, but not by inhalation

    International Nuclear Information System (INIS)

    Triel, Jos J. van; Bree, Bianca W.J. van; Roberts, David W.; Muijser, Hans; Duistermaat, Evert; Woutersen, Ruud A.; Kuper, C. Frieke

    2011-01-01

    Previously, a selection of low molecular weight contact and respiratory allergens had tested positive in both a skin and a respiratory local lymph node assay (LLNA), but formaldehyde was negative for sensitization by inhalation. To investigate whether this was due to intrinsic properties of aldehyde sensitizers, the structurally related allergen glutaraldehyde (GA) was tested. BALB/c mice were exposed by inhalation to 6 or 18 ppm GA (respiratory LLNA), both generated as a vapor and as an aerosol. Other groups received 0.25% or 2.5% GA on the skin of the ears (skin LLNA). Lymphocyte proliferation and cytokine production were measured in the draining lymph nodes. GA was positive in the skin LLNA and its cytokine profile (IL-4/IFN-γ) skewed towards a Th2-type immune response with increasing dose. Inhalation exposure did not result in increased lymphocyte proliferation or increased cytokine levels, despite comparable tissue damage (irritation) in the skin and respiratory tract. We hypothesize that the highly reactive and hydrophilic GA oligomerizes in the protein-rich mucous layer of the respiratory tract, which impedes sensitization but still facilitates local irritation. Within the context of risk assessment in respiratory allergy, our results stress the importance of prevention of skin - besides inhalation - exposure to aldehydes like GA.

  10. CT perfusion study of neck lymph nodes

    International Nuclear Information System (INIS)

    Zhong Jin; Liu Jun; Hua Rui; Qiao Hui; Gong Yi

    2011-01-01

    Objective: To study the CT perfusion features of various lymph nodes in the neck. Methods: Dynamic perfusion CT scanning was performed in 83 neck lymph nodes proved by pathology, including tuberculosis lymph nodes, lymphoma and metastatic lymph nodes. The shapes, blood flow modes, and perfusion parameters of these lymph nodes were compared among 3 groups. Statistical analysis of L/T and CT perfusion parameters was performed by one-way ANOVA and LSD test. Results: The values of MTT of tuberculosis lymph nodes, lymphoma and metastatic lymph nodes were (28.13±5.08), (31.08±5.82), and (11.24±5.31) s, respectively. The MTT of metastatic lymph nodes was statistically lower than that of tuberculosis lymph nodes and lymphoma (P -1 · 100 g -1 , respectively. The values of BV were (24.68±2.84), (25.30±3.16), and (25.15± 8.81) ml·100 g -1 respectively. The values of TTP were (40.90±8.85), (40.67±6.45), and (40.98±6.62) s, respectively. There were no significant differences in L/T, BF, BV and TTP among tuberculosis lymph nodes, lymphoma and metastatic lymph nodes (P>0.05). Conclusion: CT perfusion, especially combination functional imaging with perfusion images may be helpful in judging the nature of neck lymph nodes. (authors)

  11. Localization of tritiated vitamin A in lymph nodes of the mouse: an autoradiographic study of vitamin A-storing cells

    International Nuclear Information System (INIS)

    Hirosawa, K.; Yamada, E.

    1981-01-01

    Localization of tritiated vitamin A in lymph nodes of the mouse was investigated by the use of light- and electron-microscopic autoradiography. Young male mice were fed a diet containing 3H-vitamin A acetate for a week. Lymph nodes were removed and prepared for autoradiography. Lipid droplets in fibroblast-like cells showed high concentrations of radioactivity. These cells were distributed around lymphatic sinuses and blood vessels. The cells can, therefore, be classified as ''vitamin A-storing cells'' according to criteria proposed earlier by Yamada and Hirosawa (1976). Control animals from the same litter were maintained on ordinary laboratory food for the same period and examined by electron microscopy. Lipid-droplet-containing cells were found in the same areas as in the experimental animals but in fewer numbers. This suggests that the increased number of vitamin A-containing lipid droplets is due to hypervitaminosis A in the experimental animals. The presence of some cells containing these droplets in the control animals would imply that even under normal feeding conditions the animals ingested excess amounts of vitamin A, which was retained in lipid droplets. The stored vitamin A probably participates in metabolic processes such as the formation of glycoproteins in ground substance

  12. The regulatory use of the Local Lymph Node Assay for the notification of new chemicals in Europe.

    Science.gov (United States)

    Angers-Loustau, Alexandre; Tosti, Luca; Casati, Silvia

    2011-08-01

    The regulatory use of the Local Lymph Node Assay (LLNA) for new chemicals registration was monitored by screening the New Chemicals Database (NCD), which was managed by the former European Chemicals Bureau (ECB) at the European Commission Joint Research Centre (JRC). The NCD centralised information for chemicals notified after 1981, where toxicological information has been generated predominantly according to approved test methods. The database was searched to extract notifications for which the information for skin sensitisation labelling was based on results derived with the LLNA. The details of these records were extracted and pooled, and evaluated with regard to the extent of use of the LLNA over time, as well as for analysing the information retrieved on critical aspects of the procedure e.g. strain and amount of animals used, lymph node processing, solvent and doses selected, stimulation indices, and for assessing their level of compliance to the OECD Test Guideline 429. In addition the accuracy of the reduced LLNA when applied to new chemicals was investigated. Copyright © 2011 Elsevier Inc. All rights reserved.

  13. Investigation of allergenicity of some cosmetic mixtures by using ex vivo local lymph node assay-BrdU endpoints.

    Science.gov (United States)

    Ulker, Ozge Cemiloglu; Kaymak, Yesim; Karakaya, Asuman

    2014-01-01

    Balsam of Peru and fragrance mix are commonly used in cosmetic products. Allergy to fragrance is the most common cause of cosmetic contact dermatitis. In the present study, ex vivo local lymph node assay-5-bromo-2'-deoxyuridine (LLNA-BrdU) was used to evaluate the dermal sensitization potential of these cosmetic mixtures. The stimulation index values and estimated concentration (EC3) values were calculated and the potency classification was found for each mixture. At the same time, in order to measure the irritant effect without having to use additional animals, a combination of ex vivo LLNA-BrdU and the irritancy assay was conducted. Th1 [interleukin (IL)-2, interferon-γ] and Th2 cytokine (IL-4, IL-5) releases from lymph node cell culture were investigated as non-radioactive endpoints. According to the results of ex vivo LLNA-BrdU assays, EC3 values were found to be 3.09% (moderate) for balsam of Peru and 4.44% (moderate) for fragrance mix. Cytokine analysis results indicate that both Th1 and Th2 cytokines are involved in the regulation of murine contact allergy and can be considered as useful endpoints. In conclusion, according to our results, fragrance mix and balsam of Peru can be considered as moderate sensitizers; however, in high concentrations, both of them have irritation properties. The cytokines investigated can be considered as the endpoints of the ex vivo LLNA-BrdU assay. © 2014 S. Karger AG, Basel.

  14. Sentinel lymph node biopsy in oral cancer

    DEFF Research Database (Denmark)

    Thomsen, Jørn Bo; Sørensen, Jens Ahm; Grupe, Peter

    2005-01-01

    PURPOSE: To validate lymphatic mapping combined with sentinel lymph node biopsy as a staging procedure, and to evaluate the possible clinical implications of added oblique lymphoscintigraphy and/or tomography and test the intra- and interobserver reproducibility of lymphoscintigraphy. MATERIAL......: Eleven (28%) patients were upstaged. The sentinel lymph node identification rate was 97.5%. Sentinel lymph node biopsy significantly differentiated between patients with or without lymph node metastasis (P = 0.001). Lymphatic mapping revealed 124 hotspots and 144 hot lymph nodes were removed by sentinel...

  15. The predictive value of single-photon emission computed tomography/computed tomography for sentinel lymph node localization in head and neck cutaneous malignancy.

    Science.gov (United States)

    Remenschneider, Aaron K; Dilger, Amanda E; Wang, Yingbing; Palmer, Edwin L; Scott, James A; Emerick, Kevin S

    2015-04-01

    Preoperative localization of sentinel lymph nodes in head and neck cutaneous malignancies can be aided by single-photon emission computed tomography/computed tomography (SPECT/CT); however, its true predictive value for identifying lymph nodes intraoperatively remains unquantified. This study aims to understand the sensitivity, specificity, and positive and negative predictive values of SPECT/CT in sentinel lymph node biopsy for cutaneous malignancies of the head and neck. Blinded retrospective imaging review with comparison to intraoperative gamma probe confirmed sentinel lymph nodes. A consecutive series of patients with a head and neck cutaneous malignancy underwent preoperative SPECT/CT followed by sentinel lymph node biopsy with a gamma probe. Two nuclear medicine physicians, blinded to clinical data, independently reviewed each SPECT/CT. Activity within radiographically defined nodal basins was recorded and compared to intraoperative gamma probe findings. Sensitivity, specificity, and negative and positive predictive values were calculated with subgroup stratification by primary tumor site. Ninety-two imaging reads were performed on 47 patients with cutaneous malignancy who underwent SPECT/CT followed by sentinel lymph node biopsy. Overall sensitivity was 73%, specificity 92%, positive predictive value 54%, and negative predictive value 96%. The predictive ability of SPECT/CT to identify the basin or an adjacent basin containing the single hottest node was 92%. SPECT/CT overestimated uptake by an average of one nodal basin. In the head and neck, SPECT/CT has higher reliability for primary lesions of the eyelid, scalp, and cheek. SPECT/CT has high sensitivity, specificity, and negative predictive value, but may overestimate relevant nodal basins in sentinel lymph node biopsy. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  16. Safety assessment of allergic contact dermatitis hazards: an analysis supporting reduced animal use for the murine local lymph node assay.

    Science.gov (United States)

    Haseman, Joseph K; Strickland, Judy; Allen, David; Salicru, Eleni; Paris, Michael; Tice, Raymond R; Stokes, William S

    2011-02-01

    The original Organisation for Economic Co-operation and Development Test Guideline 429 (OECD TG 429) for the murine local lymph node assay (LLNA) required five mice/group if mice were processed individually. We used data from 83 LLNA tests (275 treated groups) to determine the impact on the LLNA outcome of reducing the group size from five to four. From DPM measurements, we formed all possible four- and five-mice combinations for the treated and control groups. Stimulation index (SI) values from each four-mice combination were compared with those from five-mice combinations, and agreement (both SILLNA performance. This analysis supported the recent update to OECD TG 429 allowing a minimum of four mice/group when each mouse is processed individually. Published by Elsevier Inc.

  17. Targeted Delivery of Immunomodulators to Lymph Nodes

    Directory of Open Access Journals (Sweden)

    Jamil Azzi

    2016-05-01

    Full Text Available Active-targeted delivery to lymph nodes represents a major advance toward more effective treatment of immune-mediated disease. The MECA79 antibody recognizes peripheral node addressin molecules expressed by high endothelial venules of lymph nodes. By mimicking lymphocyte trafficking to the lymph nodes, we have engineered MECA79-coated microparticles containing an immunosuppressive medication, tacrolimus. Following intravenous administration, MECA79-bearing particles showed marked accumulation in the draining lymph nodes of transplanted animals. Using an allograft heart transplant model, we show that targeted lymph node delivery of microparticles containing tacrolimus can prolong heart allograft survival with negligible changes in tacrolimus serum level. Using MECA79 conjugation, we have demonstrated targeted delivery of tacrolimus to the lymph nodes following systemic administration, with the capacity for immune modulation in vivo.

  18. Development and utilization of an ex vivo bromodeoxyuridine local lymph node assay protocol for assessing potential chemical sensitizers.

    Science.gov (United States)

    Williams, W C; Copeland, C; Boykin, E; Quell, S J; Lehmann, D M

    2015-01-01

    The murine local lymph node assay (LLNA) is widely used to identify chemicals that may cause allergic contact dermatitis. Exposure to a dermal sensitizer results in proliferation of local lymph node T cells, which has traditionally been measured by in vivo incorporation of [(3) H]methyl thymidine. A more recent non-isotopic variation of the assay utilizes bromodeoxyuridine (BrdU) incorporation in vivo. To further improve the utility of this assay, we developed an ex vivo BrdU labeling procedure eliminating the need for in vivo injections. The results of this assay correctly identified a strong sensitizer (i.e., trimellitic anhydride) as well as weak/moderate sensitizers (i.e., eugenol, cinnamaldehyde and hexylcinnaminic aldehyde). As anticipated, neither non-sensitizers isopropanol and lactic acid nor the false negative chemical nickel II sulfate hexahydrate induced a positive threshold response in the assay. The results of this assay are in close agreement with those of the in vivo LLNA:BrdU-enzyme-linked immunosorbent assay labeling procedure. We also used the ex vivo BrdU LLNA procedure to evaluate ammonium hexachloroplatinate, ammonium tetrachloroplatinate and cis-diamminedichloroplatinum(II) and the assay correctly identified them as sensitizers based on the calculation of EC2 values. We conclude that this ex vivo BrdU labeling method offers predictive capacity comparable to previously established LLNA protocols while eliminating animal injections and the use of radioisotope. Published 2014. This article is a U.S. Government work and is in the public domain in the USA. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

  19. Lymph scintigraphy and pre- and intraoperative gamma probe measurements for localization of sentinel lymph nodes (SLN) in breast cancer; Lymphszintigraphie sowie prae- und intraoperative Sondenmessung zur Darstellung des Sentinel Lymph Node (SLN) beim Mammakarzinom

    Energy Technology Data Exchange (ETDEWEB)

    Brenner, W.; Czech, N.; Felde, U. zum; Kampen, W.U.; Henze, E. [Kiel Univ. (Germany). Klinik fuer Nuklearmedizin; Ostertag, H. [Kiel Univ. (Germany). Klinik fuer Gynaekologie und Geburtshilfe; Klutmann, S.; Bohuslavizki, K.H. [Universitaetskrankenhaus Eppendorf, Hamburg (Germany). Abt. fuer Nuklearmedizin; Luettges, J.; Sprenger, A. [Kiel Univ. (Germany). Inst. fuer Allgemeine und Pathologische Anatomie

    2000-05-01

    Aim of this study was to prove the clinical value of nuclear medicine procedures to detect the sentinel lymph node (SLN) for SLN biopsy. Methods: In 132 patients with breast cancer we performed lymph scintigraphy of the breast as well as both pre- and intraoperative gamma probe measurements correlating the results with the findings of histopathology. Results: SLN were detectable in 62 of 110 patients according to a sensitivity of 56% when scanning was performed only at 1-2 h p.i. while the sensitivity increased to 86% (19 of 22 pts.) if sequential images were acquired up to 2 h p.i. One or more SLN were identified by a handheld gamma probe transcutaneously prior to surgery in 96% (113 of 118 pts.) of the patients who showed up with no clinically suspected lymph node metastases. Intraoperatively, in additionally 2 patients the SLN could be found resulting in a sensitivity of 97% (115 of 118 pts.). In only 3 patients with clinically no tumor spread to axillary lymph nodes no SLN could be identified by the probe. Skip lesions, i.e. lymph node metastases in patients with tumorfree SLN, occurred in 2 cases: Due to SLN biopsy in these patients lymph node staging was false negative compared to conventional staging by means of axillary lymph node dissection. Conclusion: The results demonstrate a high preoperative detection rate of SLN in patients with breast cancer using lymph scintigraphy and gamma probe measurements. Thus, nuclear medicine is capable of providing the basic requirements for SLN biopsy in the daily routine. (orig.) [German] Ziel der vorliegenden Arbeit im Vorfeld einer geplanten Multicenterstudie zur Wertigkeit der Sentinel-Lymphknoten (SLN) Biopsie war, die Zuverlaessigkeit der SLN-Detektion mit nuklearmedizinischen Methoden im klinischen Routinebetrieb zu ueberpruefen. Methoden: Bei 132 Patientinnen mit stanzbioptisch gesichertem Mammakarzinom fuehrten wir eine Lymphszintigraphie der Brust sowie eine prae- und intraoperative Gammasondenmessung durch und

  20. Pattern of Colon Cancer Lymph Node Metastases in Patients Undergoing Central Mesocolic Lymph Node Excision

    DEFF Research Database (Denmark)

    Bertelsen, Claus A; Kirkegaard-Klitbo, Anders; Nielsen, Mingyuan

    2016-01-01

    BACKGROUND: Extended mesocolic lymph node dissection in colon cancer surgery seems to improve oncological outcome. A possible reason might be related to metastases in the central mesocolic lymph nodes. OBJECTIVE: The purpose of this study was to describe the pattern of mesocolic lymph node...... metastases, particularly in central lymph nodes, and the risk of skip, aberrant, and gastrocolic ligament metastases as the argument for performing extended lymph node dissection. DATA SOURCES: EMBASE and PubMed were searched using the terms colon or colorectal with sentinel node, lymph node mapping, or skip...... node; lymph node resection colon; and complete or total and mesocolic excision. STUDY SELECTION: Studies describing the risk of metastases in central, skip, aberrant, and gastrocolic ligament lymph node metastases from colon adenocarcinomas in 10 or more patients were included. No languages were...

  1. Local lymph node assay (LLNA): comparison of different protocols by testing skin-sensitizing epoxy resin system components.

    Science.gov (United States)

    Gamer, Armin O; Nies, Eberhard; Vohr, Hans-Werner

    2008-12-01

    Thirteen epoxy resin system components were tested in the LLNA with regard to their sensitizing potency. Lymph node stimulation was quantified not only by measuring the incorporation of [3H]-thymidine into the ear lymph nodes but also the counts of cells recovered from these organs. Equivalent figures were obtained with both endpoints used for the evaluation of lymph node cell proliferation if the reference stimulation indices were adjusted. When dissolved in acetone, all test substances showed skin-sensitizing potential, mainly on the boundary between "strong" and "moderate" according to common potency evaluation schemes. Replacing acetone with acetone/olive oil (4:1) as a vehicle for four selected test items, resulted in considerably lower estimated concentrations for sensitization induction. The challenges in comparing the results obtained by different LLNA variations are discussed.

  2. Characterization and evaluation of a modified local lymph node assay using ATP content as a non-radio isotopic endpoint.

    Science.gov (United States)

    Idehara, Kenji; Yamagishi, Gaku; Yamashita, Kunihiko; Ito, Michio

    2008-01-01

    The murine local lymph node assay (LLNA) is an accepted and widely used method for assessing the skin-sensitizing potential of chemicals. Here, we describe a non-radio isotopic modified LLNA in which adenosine triphosphate (ATP) content is used as an endpoint instead of radioisotope (RI); the method is termed LLNA modified by Daicel based on ATP content (LLNA-DA). Groups of female CBA/JNCrlj mice were treated topically on the dorsum of both ears with test chemicals or a vehicle control on days 1, 2, and 3; an additional fourth application was conducted on day 7. Pretreatment with 1% sodium lauryl sulfate solution was performed 1 h before each application. On day 8, the amount of ATP in the draining auricular lymph nodes was measured as an alternative endpoint by the luciferin-luciferase assay in terms of bioluminescence (relative light units, RLU). A stimulation index (SI) relative to the concurrent vehicle control was derived based on the RLU value, and an SI of 3 was set as the cut-off value. Using the LLNA-DA method, 31 chemicals were tested and the results were compared with those of other test methods. The accuracy of LLNA-DA vs LLNA, guinea pig tests, and human tests was 93% (28/30), 80% (20/25), and 79% (15/19), respectively. The estimated concentration (EC) 3 value was calculated and compared with that of the original LLNA. It was found that the EC3 values obtained by LLNA-DA were almost equal to those obtained by the original LLNA. The SI value based on ATP content is similar to that of the original LLNA as a result of the modifications in the chemical treatment procedure, which contribute to improving the SI value. It is concluded that LLNA-DA is a promising non-RI alternative method for evaluating the skin-sensitizing potential of chemicals.

  3. Lack of TAK1 in dendritic cells inhibits the contact hypersensitivity response induced by trichloroethylene in local lymph node assay.

    Science.gov (United States)

    Yao, Pan; Hongqian, Chu; Qinghe, Meng; Lanqin, Shang; Jianjun, Jiang; Xiaohua, Yang; Xuetao, Wei; Weidong, Hao

    2016-09-15

    Trichloroethylene (TCE) is a ubiquitous environmental contaminant. Occupational TCE exposure has been associated with severe, generalized contact hypersensitivity (CHS) skin disorder. The development of CHS depends on innate and adaptive immune functions. Transforming growth factor-β activated kinase-1 (TAK1) controls the survival of dendritic cells (DCs) that affect the immune system homeostasis. We aimed to investigate the role of TAK1 activity in DC on TCE-induced CHS response. Control mice and DC-specific TAK1 deletion mice were treated with 80% (v/v) TCE using local lymph node assay (LLNA) to establish a TCE-induced CHS model. The draining lymph nodes (DLNs) were excised and the lymphocytes were measure for proliferation by BrdU-ELISA, T-cell phenotype analysis by flow cytometry and signaling pathway activation by western blot. The ears were harvested for histopathological analysis. Control mice in the 80% TCE group displayed an inflammatory response in the ears, increased lymphocyte proliferation, elevated regulatory T-cell and activated T-cell percentages, and more IFN-γ producing CD8(+) T cells in DLNs. In contrast to control mice, DC-specific TAK1 deletion mice in the 80% TCE group showed an abolished CHS response and this was associated with defective T-cell expansion, activation and IFN-γ production. This effect may occur through Jnk and NF-κB signaling pathways. Overall, this study demonstrates a pivotal role of TAK1 in DCs in controlling TCE-induced CHS response and suggests that targeting TAK1 function in DCs may be a viable approach to preventing and treating TCE-related occupational health hazards. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. The impact of vehicle on the relative potency of skin-sensitizing chemicals in the local lymph node assay.

    Science.gov (United States)

    Jowsey, Ian R; Clapp, Catherine J; Safford, Bob; Gibbons, Ben T; Basketter, David A

    2008-01-01

    The identification and characterization of chemicals that possess skin-sensitizing potential are typically performed using predictive tests. However, human exposure to skin-sensitizing chemicals often occurs via a matrix (vehicle) that differs from that used in these tests. It is thus important to account for the potential impact of vehicle differences when undertaking quantitative risk assessment for skin sensitization. This is achieved through the application of a specific sensitization assessment factor (SAF), scaled between 1 and 10, when identifying an acceptable exposure level. The objective of the analysis described herein is to determine the impact of vehicle differences on local lymph node assay (LLNA) EC3 values (concentrations of test chemical required to provoke a 3-fold increase in lymph node cell proliferation). Initially, the inherent variability of the LLNA was investigated by examining the reproducibility of EC3 values for 14 chemicals that have been tested more than once in the same vehicle (4:1 acetone:olive oil, AOO). This analysis reveals that the variability in EC3 value for these chemicals following multiple assessments is LLNA using at least 2 of 15 different vehicles. These data demonstrate that often the variability in EC3 values observed for a given chemical in different vehicles is no greater than the 5-fold inherent variability observed when assessing a chemical in the same vehicle on multiple occasions. However, there are examples where EC3 values for a chemical differ by a factor of more than 10 between different vehicles. These observations were often associated with an apparent underestimation of potency (higher EC3 values) with predominantly aqueous vehicles or propylene glycol. These data underscore the need to consider vehicle effects in the context of skin-sensitization risk assessments.

  5. Differential gene expression responses distinguish contact and respiratory sensitizers and nonsensitizing irritants in the local lymph node assay.

    Science.gov (United States)

    Adenuga, David; Woolhiser, Michael R; Gollapudi, B Bhaskar; Boverhof, Darrell R

    2012-04-01

    Genomic approaches have the potential to enhance the specificity and predictive accuracy of existing toxicology endpoints, including those for chemical sensitization. The present study was conducted to determine whether gene expression responses can distinguish contact sensitizers (1-chloro-2,4-dinitrobenzene [DNCB] and hexyl cinnamic aldehyde [HCA]), respiratory sensitizers (ortho-phthalaldehyde and trimellitic anhydride [TMA]), and nonsensitizing irritants (methyl salicylate [MS] and nonanoic acid [NA]) in the local lymph node assay (LLNA). Female Balb/c mice received doses of each chemical as per the standard LLNA dosing regimen on days 1, 2, and 3. Auricular lymph nodes were analyzed for tritiated thymidine ((3)HTdR) incorporation on day 6 and for gene expression responses on days 6 and 10. All chemicals induced dose-dependent increases in stimulation index, which correlated strongly with the number of differentially expressed genes. A majority of genes modulated by the irritants were similarly altered by the sensitizers, consistent with the irritating effects of the sensitizers. However, a select number of responses involved with immune-specific functions, such as dendritic cell activation, were unique to the sensitizers and may offer the ability to distinguish sensitizers from irritants. Genes for the mast cell proteases 1 and 8, Lgals7, Tim2, Aicda, Il4, and Akr1c18 were more strongly regulated by respiratory sensitizers compared with contact sensitizers and may represent potential biomarkers for discriminating between contact and respiratory sensitizers. Collectively, these data suggest that gene expression responses may serve as useful biomarkers to distinguish between respiratory and contact sensitizers and nonsensitizing irritants in the LLNA.

  6. Appraisal of the sensitising potential of orally and dermally administered mercaptobenzothiazole by a biphasic protocol of the local lymph node assay.

    Science.gov (United States)

    Ahuja, Varun; Wanner, Reinhard; Platzek, Thomas; Stahlmann, Ralf

    2009-10-01

    Mercaptobenzothiazole (MBT) is used while manufacturing natural rubber products. Our study deals with assessing its allergenic potential following dermal and oral routes of exposure, using a biphasic local lymph node assay (LLNA). Female Balb/c mice were treated with MBT (dermally 3, 10, 30% concentrations in DMSO; orally 1, 10, 100 mg/kg doses in corn oil) on the back (dermal study) or through oral administration (oral study) on days 1-3 followed by auricular application of 3, 10 and 30% concentrations, respectively, on days 15-17. End points determined on day 19 included ear thickness, ear punch weight, lymph node weight, lymph node cell count, and lymphocyte subpopulations (CD4+, CD8+, CD45+). After dermal application of 3% or 10% solution, a significant increase in cell count and lymph node weight along with significant decrease in CD8+ cells was observed. After initial oral administration of 1 mg/kg, we noticed a significant amplification in cell count. Following oral administration of 10 mg/kg, we observed a similar increase in cell count and lymph node weight. The results of our study show that the modified biphasic LLNA protocol can be used to study the sensitising potential of a compound also following the oral route of exposure.

  7. Clinical results of sentinel lymph node (SN) biopsy for oral cancer. Relationship between SN localization and metastasis in tongue cancer

    International Nuclear Information System (INIS)

    Shintani, Satoru; Nakashiro, Koh-ichi; Hino, Satoshi; Terakado, Nagaaki; Hamakawa, Hiroyuki

    2005-01-01

    Attempts were made to detect micrometastasis in N0 neck of oral cancer patients using sentinel lymph node (SN) biopsy (SNB). We previously described our approach to identify SN using a radioisotope ( 99m Tc-Tin colloid)-guided and dye-guided method. Micrometastases were detected by means of serial sections and real-time polymerase chain reaction (PCR) based on squamous cell carcinoma (SCC) antigen mRNA. In this study, we evaluated the radiolocalization of SN and identification of metastatic lymph node in N0 oral cancer patients. The positive rate of metastatic lymph node in N0 oral cancer was 35% and the diagnostic sensitivity of SNB was 95%. The SNB detected subclinical metastases in 4 of 10 N0 patients with tongue cancer. Moreover, in 3 of these 4 cases, all metastatic lymph nodes consisted with SNs. Postoperative cervical metastasis was observed in a patient whose SNB was negative. While more experience is needed, we believe the SN concept for tongue cancer is established, and practical application in clinical settings is anticipated. (author)

  8. Assessment of radiation doses to the para-aortic, pelvic, and inguinal lymph nodes delivered by image-guided adaptive brachytherapy in locally advanced cervical cancer

    DEFF Research Database (Denmark)

    Mohamed, Sandy M I; Aagaard, Torben; Fokdal, Lars U

    2015-01-01

    PURPOSE: This study evaluated the dose delivered to lymph nodes (LNs) by brachytherapy (BT) and the effect of BT image-guided optimization on the LN dose. METHODS AND MATERIALS: Twenty-five patients with locally advanced cervical cancer were retrospectively analyzed, 16 patients of them had LN...

  9. Axillary Lymph Nodes and Breast Cancer

    Science.gov (United States)

    ... white blood cells that help fight illness. If breast cancer spreads, the lymph nodes in the underarm (called ... if they contain cancer cells. This helps determine breast cancer stage and guide treatment. Sentinel node biopsy and ...

  10. [Anatomy and histology characteristics of lymph node in nude mice].

    Science.gov (United States)

    Sun, R; Gao, B; Guo, C B

    2017-10-18

    To compare the differences of anatomical and histological characteristics of lymph nodes between BALB/c nude mice and BALB/c mice. Firstly, twenty BALB/c nude mice and twenty BALB/c mice were dissected by using a surgical microscope. Secondly, the differences of T cells and B cells at the lymph node were compared by the expressions of CD 3 and CD 20 immunohistochemistry dyes. There were, on average, 23 nodes per mouse contained within the large lymph node assembly in the BALB/c nude mouse. The anatomical features of the lymph node distribution in the nude mice were mainly found in the neck with relatively higher density. There were two lymph nodes both in the submandible lymph nodes group and in the superficial cervical lymph nodes group (the constituent ratios were 95% and 90%, respectively) in the BALB/c nude mice, but there were four lymph nodes (the constituent ratios were 95% and 90%, respectively) in the BALB/c mice. There were significant difference between the BALB/c nude mice and the BALB/c mice. Mostly there were two lymph nodes of deep cervical lymph nodes both in the BALB/c nude mice and the BALB/c mice (the constituent ratios were 95% and 100%, respectively). There were no significant difference between the BALB/c nude mice and the BALB/c mice. We confirmed that the number of CD 3 -positive T lymphocytes in lymph nodes of the nude mice decreased greatly as compared with the BALB/c mice. Expressions of CD3 in T cells were 95% and 100% in the BALB/c nude mice and in the BALB/c mice, respectively. There were significant differences between the BALB/c nude mice and the BALB/c mice. Expressions of CD20 in B cells were 95% and 100% in the BALB/c nude mice and in the BALB/c mice, respectively. There was no significant difference between the BALB/c nude mice and BALB/c mice. The anatomical pictures of lymph node distribution in the nude mouse will be benefit to those who are interested. The anatomical features of the lymph node local higher density in neck of

  11. Gene expression profiles in auricle skin as a possible additional endpoint for determination of sensitizers: A multi-endpoint evaluation of the local lymph node assay.

    Science.gov (United States)

    Tsuchiyama, Hiromi; Maeda, Akihisa; Nakajima, Mayumi; Kitsukawa, Mika; Takahashi, Kei; Miyoshi, Tomoya; Mutsuga, Mayu; Asaoka, Yoshiji; Miyamoto, Yohei; Oshida, Keiyu

    2017-10-05

    The murine local lymph node assay (LLNA) is widely used to test chemicals to induce skin sensitization. Exposure of mouse auricle skin to a sensitizer results in proliferation of local lymph node T cells, which has been measured by in vivo incorporation of H 3 -methyl thymidine or 5-bromo-2'-deoxyuridine (BrdU). The stimulation index (SI), the ratio of the mean proliferation in each treated group to that in the concurrent vehicle control group, is frequently used as a regulatory-authorized endpoint for LLNA. However, some non-sensitizing irritants, such as sodium dodecyl sulfate (SDS) or methyl salicylate (MS), have been reported as false-positives by this endpoint. In search of a potential endpoint to enhance the specificity of existing endpoints, we evaluated 3 contact sensitizers; (hexyl cinnamic aldehyde [HCA], oxazolone [OXA], and 2,4-dinitrochlorobenzene [DNCB]), 1 respiratory sensitizer (toluene 2,4-diisocyanate [TDI]), and 2 non-sensitizing irritants (MS and SDS) by several endpoints in LLNA. Each test substance was applied to both ears of female CBA/Ca mice daily for 3 consecutive days. The ears and auricle lymph node cells were analyzed on day 5 for endpoints including the SI value, lymph node cell count, cytokine release from lymph node cells, and histopathological changes and gene expression profiles in auricle skin. The SI values indicated that all the test substances induced significant proliferation of lymph node cells. The lymph node cell counts showed no significant changes by the non-sensitizers assessed. The inflammatory findings of histopathology were similar among the auricle skins treated by sensitizers and irritants. Gene expression profiles of cytokines IFN-γ, IL-4, and IL-17 in auricle skin were similar to the cytokine release profiles in draining lymph node cells. In addition, the gene expression of the chemokine CXCL1 and/or CXCL2 showed that it has the potential to discriminate sensitizers and non-sensitizing irritants. Our results

  12. Early and delayed prediction of axillary lymph node neoadjuvant response by {sup 18}F-FDG PET/CT in patients with locally advanced breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Garcia Vicente, Ana Maria; Soriano Castrejon, Angel; Jimenez Londono, German Andres [University General Hospital, Nuclear Medicine Department, Ciudad Real (Spain); Leon Martin, Alberto [University General Hospital, Investigation Unit, Ciudad Real (Spain); Relea Calatayud, Fernanda [University General Hospital, Pathology Department, Ciudad Real (Spain); Munoz Sanchez, Maria del Mar [Virgen de la Luz Hospital, Oncology Department, Cuenca (Spain); Cruz Mora, Miguel Angel [Virgen de la Salud Hospital, Oncology Department, Toledo (Spain); Espinosa Aunion, Ruth [La Mancha Centro Hospital, Oncology Department, Ciudad Real (Spain)

    2014-07-15

    To determine the utility of {sup 18}F-FDG (FDG) PET/CT performed in an early and delayed phase during neoadjuvant chemotherapy in the prediction of lymph node histopathological response in patients with locally advanced breast cancer. FDG PET/CT studies performed in 76 patients (mean age 53 years) at baseline (PET-1), after the second course of chemotherapy (PET-2) and after the last course of chemotherapy (PET-3) were prospectively analysed. Inclusion criteria were lymph node involvement detected by PET/CT and non-sentinel node biopsy before or after the baseline PET/CT scan. Following the recommendations of the 12th International Breast Conference (St. Gallen), the patients were divided into five subgroups in relation to biological prognostic factors by immunohistochemistry. For diagnosis visual and semiquantitative analyses was performed. Absence of detectable lymph node uptake on the PET-2 or PET-3 scan with respect to the PET-1 scan was considered metabolic complete response (mCR). Lymph nodes were histopathologically classified according the lymph node regression grade and in response groups as pathological complete response (pCR) or not pCR (type A/D or B/C of the Smith grading system, respectively). ROC analysis was performed to determine a cut-off value of Δ% SUV1-2 and SUV1-3 for prediction of nodal status after chemotherapy. An association between mCR and pCR was found (Cohen's kappa analysis), and associations between phenotypes and metabolic behaviour and the final histopathological status were also found. Lymph node pCR was seen in 34 patients. The sensitivity, specificity, and positive and negative predictive values of PET-2 and PET-3 in establishing the final status of the axilla after chemotherapy were 52 %, 45 %, 50 % and 47 %, and 33 %, 84 %, 67 % and 56 %, respectively. No significant relationship was observed between mCR on PET-2 and PET-3 and pCR (p = 0.31 and 0.99, respectively). Lymph node metabolism on PET-1 was not able to predict

  13. Sentinel lymph node identification with magnetic nanoparticles

    NARCIS (Netherlands)

    Pouw, Joost Jacob

    2016-01-01

    Most solid malignancies have a tendency to spread through the lymphatic system to locoregional lymph nodes. Presence of metastasis is an important prognostic factor, and is used to determine the optimal treatment of the patient. The sentinel lymph nodes (SLNs) receive direct lymphatic drainage from

  14. Contrast enhanced ultrasound of sentinel lymph nodes

    Directory of Open Access Journals (Sweden)

    XinWu Cui

    2013-03-01

    Full Text Available Sentinel lymph nodes are the first lymph nodes in the region that receive lymphatic drainage from a primary tumor. The detection or exclusion of sentinel lymph node micrometastases is critical in the staging of cancer, especially breast cancer and melanoma because it directly affects patient’s prognosis and surgical management. Currently, intraoperative sentinel lymph node biopsies using blue dye and radioisotopes are the method of choice for the detection of sentinel lymph node with high identification rate. In contrast, conventional ultrasound is not capable of detecting sentinel lymph nodes in most cases. Contrast enhanced ultrasound with contrast specific imaging modes has been used for the evaluation and diagnostic work-up of peripherally located suspected lymphadenopathy. The method allows for real-time analysis of all vascular phases and the visualization of intranodal focal “avascular” areas that represent necrosis or deposits of neoplastic cells. In recent years, a number of animal and human studies showed that contrast enhanced ultrasound can be also used for the detection of sentinel lymph node, and may become a potential application in clinical routine. Several contrast agents have been used in those studies, including albumin solution, hydroxyethylated starch, SonoVue®, Sonazoid® and Definity®. This review summarizes the current knowledge about the use of ultrasound techniques in detection and evaluation of sentinel lymph node.

  15. Penile Cancer: Contemporary Lymph Node Management.

    Science.gov (United States)

    O'Brien, Jonathan S; Perera, Marlon; Manning, Todd; Bozin, Mike; Cabarkapa, Sonja; Chen, Emily; Lawrentschuk, Nathan

    2017-06-01

    In penile cancer, the optimal diagnostics and management of metastatic lymph nodes are not clear. Advances in minimally invasive staging, including dynamic sentinel lymph node biopsy, have widened the diagnostic repertoire of the urologist. We aimed to provide an objective update of the recent trends in the management of penile squamous cell carcinoma, and inguinal and pelvic lymph node metastases. We systematically reviewed several medical databases, including the Web of Science® (with MEDLINE®), Embase® and Cochrane databases, according to PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines. The search terms used were penile cancer, lymph node, sentinel node, minimally invasive, surgery and outcomes, alone and in combination. Articles pertaining to the management of lymph nodes in penile cancer were reviewed, including original research, reviews and clinical guidelines published between 1980 and 2016. Accurate and minimally invasive lymph node staging is of the utmost importance in the surgical management of penile squamous cell carcinoma. In patients with clinically node negative disease, a growing body of evidence supports the use of sentinel lymph node biopsies. Dynamic sentinel lymph node biopsy exposes the patient to minimal risk, and results in superior sensitivity and specificity profiles compared to alternate nodal staging techniques. In the presence of locoregional disease, improvements in inguinal or pelvic lymphadenectomy have reduced morbidity and improved oncologic outcomes. A multimodal approach of chemotherapy and surgery has demonstrated a survival benefit for patients with advanced disease. Recent developments in lymph node management have occurred in penile cancer, such as minimally invasive lymph node diagnosis and intervention strategies. These advances have been met with a degree of controversy in the contemporary literature. Current data suggest that dynamic sentinel lymph node biopsy provides excellent

  16. Lack of TAK1 in dendritic cells inhibits the contact hypersensitivity response induced by trichloroethylene in local lymph node assay

    Energy Technology Data Exchange (ETDEWEB)

    Yao, Pan; Hongqian, Chu; Qinghe, Meng; Lanqin, Shang; Jianjun, Jiang; Xiaohua, Yang; Xuetao, Wei; Weidong, Hao, E-mail: whao@bjmu.edu.cn

    2016-09-15

    Trichloroethylene (TCE) is a ubiquitous environmental contaminant. Occupational TCE exposure has been associated with severe, generalized contact hypersensitivity (CHS) skin disorder. The development of CHS depends on innate and adaptive immune functions. Transforming growth factor-β activated kinase-1 (TAK1) controls the survival of dendritic cells (DCs) that affect the immune system homeostasis. We aimed to investigate the role of TAK1 activity in DC on TCE-induced CHS response. Control mice and DC-specific TAK1 deletion mice were treated with 80% (v/v) TCE using local lymph node assay (LLNA) to establish a TCE-induced CHS model. The draining lymph nodes (DLNs) were excised and the lymphocytes were measure for proliferation by BrdU-ELISA, T-cell phenotype analysis by flow cytometry and signaling pathway activation by western blot. The ears were harvested for histopathological analysis. Control mice in the 80% TCE group displayed an inflammatory response in the ears, increased lymphocyte proliferation, elevated regulatory T-cell and activated T-cell percentages, and more IFN-γ producing CD8{sup +} T cells in DLNs. In contrast to control mice, DC-specific TAK1 deletion mice in the 80% TCE group showed an abolished CHS response and this was associated with defective T-cell expansion, activation and IFN-γ production. This effect may occur through Jnk and NF-κB signaling pathways. Overall, this study demonstrates a pivotal role of TAK1 in DCs in controlling TCE-induced CHS response and suggests that targeting TAK1 function in DCs may be a viable approach to preventing and treating TCE-related occupational health hazards. - Highlights: • Lack of TAK1 in DC caused an abolished TCE-induced CHS response. • TAK1 in DCs was essential to maintain the homeostasis of T cells in TCE-induced CHS. • Intact TAK1 in DCs was critical to promote T-cell priming in TCE-induced CHS. • DC-specific TAK1 deficiency abolished the TCE-mediated phosphorylation of Jnk.

  17. Lack of TAK1 in dendritic cells inhibits the contact hypersensitivity response induced by trichloroethylene in local lymph node assay

    International Nuclear Information System (INIS)

    Yao, Pan; Hongqian, Chu; Qinghe, Meng; Lanqin, Shang; Jianjun, Jiang; Xiaohua, Yang; Xuetao, Wei; Weidong, Hao

    2016-01-01

    Trichloroethylene (TCE) is a ubiquitous environmental contaminant. Occupational TCE exposure has been associated with severe, generalized contact hypersensitivity (CHS) skin disorder. The development of CHS depends on innate and adaptive immune functions. Transforming growth factor-β activated kinase-1 (TAK1) controls the survival of dendritic cells (DCs) that affect the immune system homeostasis. We aimed to investigate the role of TAK1 activity in DC on TCE-induced CHS response. Control mice and DC-specific TAK1 deletion mice were treated with 80% (v/v) TCE using local lymph node assay (LLNA) to establish a TCE-induced CHS model. The draining lymph nodes (DLNs) were excised and the lymphocytes were measure for proliferation by BrdU-ELISA, T-cell phenotype analysis by flow cytometry and signaling pathway activation by western blot. The ears were harvested for histopathological analysis. Control mice in the 80% TCE group displayed an inflammatory response in the ears, increased lymphocyte proliferation, elevated regulatory T-cell and activated T-cell percentages, and more IFN-γ producing CD8 + T cells in DLNs. In contrast to control mice, DC-specific TAK1 deletion mice in the 80% TCE group showed an abolished CHS response and this was associated with defective T-cell expansion, activation and IFN-γ production. This effect may occur through Jnk and NF-κB signaling pathways. Overall, this study demonstrates a pivotal role of TAK1 in DCs in controlling TCE-induced CHS response and suggests that targeting TAK1 function in DCs may be a viable approach to preventing and treating TCE-related occupational health hazards. - Highlights: • Lack of TAK1 in DC caused an abolished TCE-induced CHS response. • TAK1 in DCs was essential to maintain the homeostasis of T cells in TCE-induced CHS. • Intact TAK1 in DCs was critical to promote T-cell priming in TCE-induced CHS. • DC-specific TAK1 deficiency abolished the TCE-mediated phosphorylation of Jnk.

  18. Locally advanced pancreatic cancer: association between prolonged preoperative treatment and lymph-node negativity and overall survival.

    Science.gov (United States)

    Kadera, Brian E; Sunjaya, Dharma B; Isacoff, William H; Li, Luyi; Hines, O Joe; Tomlinson, James S; Dawson, David W; Rochefort, Matthew M; Donald, Graham W; Clerkin, Barbara M; Reber, Howard A; Donahue, Timothy R

    2014-02-01

    Treatment of patients with locally advanced/borderline resectable (LA/BR) pancreatic ductal adenocarcinoma (PDAC) is not standardized. To (1) perform a detailed survival analysis of our institution's experience with patients with LA/BR PDAC who were downstaged and underwent surgical resection and (2) identify prognostic biomarkers that may help to guide a decision for the use of adjuvant therapy in this patient subgroup. Retrospective observational study of 49 consecutive patients from a single institution during 1992-2011 with American Joint Committee on Cancer stage III LA/BR PDAC who were initially unresectable, as determined by staging computed tomography and/or surgical exploration, and who were treated and then surgically resected. Clinicopathologic variables and prognostic biomarkers SMAD4, S100A2, and microRNA-21 were correlated with survival by univariate and multivariate Cox proportional hazard modeling. All 49 patients were deemed initially unresectable owing to vascular involvement. After completing preoperative chemotherapy for a median of 7.1 months (range, 5.4-9.6 months), most (75.5%) underwent a pylorus-preserving Whipple operation; 3 patients (6.1%) had a vascular resection. Strikingly, 37 of 49 patients were lymph-node (LN) negative (75.5%) and 42 (85.7%) had negative margins; 45.8% of evaluable patients achieved a complete histopathologic (HP) response. The median overall survival (OS) was 40.1 months (range, 22.7-65.9 months). A univariate analysis of HP prognostic biomarkers revealed that perineural invasion (hazard ratio, 5.5; P=.007) and HP treatment response (hazard ratio, 9.0; P=.009) were most significant. Lymph-node involvement, as a marker of systemic disease, was also significant on univariate analysis (P=.05). Patients with no LN involvement had longer OS (44.4 vs 23.2 months, P=.04) than LN-positive patients. The candidate prognostic biomarkers, SMAD4 protein loss (P=.01) in tumor cells and microRNA-21 expression in the stroma (P=.05

  19. Evaluation of 4-methylcyclohexanemethanol (MCHM) in a combined irritancy and Local Lymph Node Assay (LLNA) in mice.

    Science.gov (United States)

    Johnson, Victor J; Auerbach, Scott S; Luster, Michael I; Waidyanatha, Suramya; Masten, Scott A; Wolfe, Mary S; Burleson, Florence G; Burleson, Gary R; Germolec, Dori R

    2017-07-01

    4-Methylcyclohexanemethanol (MCHM) is a flotation reagent used in fine coal beneficiation. On January 9, 2014, crude MCHM, a mixture containing predominantly MCHM, was inadvertently released into the Elk River, a municipal water source that serves about 300,000 people in the Charleston, WV area, resulting in temporary contamination of 15 percent of the state's tap water and causing significant dermal exposure. The current studies were undertaken to determine whether crude MCHM or MCHM has the potential to produce dermal irritancy and/or sensitization. BALB/c female mice were treated daily for 3 consecutive days by direct epicutaneous application of 25 μL of various concentrations of crude MCHM or MCHM to the dorsum of each ear. A mouse ear-swelling test was used to determine irritancy potential and was undertaken in combination with the standardized Local Lymph Node Assay (LLNA) to determine skin sensitizing potential. MCHM was found to produce skin irritation at concentrations above 20% and did not produce sensitization. Crude MCHM also produced irritation, although weaker, and in addition was found to be a weak to moderate skin sensitizer. The results are discussed in terms of potential human health hazard. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. The local lymph node assay and skin sensitization: a cut-down screen to reduce animal requirements?

    Science.gov (United States)

    Kimber, Ian; Dearman, Rebecca J; Betts, Catherine J; Gerberick, G Frank; Ryan, Cindy A; Kern, Petra S; Patlewicz, Grace Y; Basketter, David A

    2006-04-01

    The local lymph node assay (LLNA), an alternative approach to skin-sensitizing testing, has made a significant contribution to animal welfare by permitting a reduction and refinement of animal use. Although there is clearly an aspiration to eliminate the use of animals in such tests, it is appropriate also to consider other opportunities for refinement and reduction of animal use. We have therefore explored the use of a modified version of the LLNA for screening purposes when there is a need to evaluate the sensitizing activity of a large number of chemicals, as will be the case under the auspices of registration, evaluation and authorization of chemicals (REACH). Using an existing LLNA database of 211 chemicals, we have examined whether a cut-down assay comprising a single high-dose group and a concurrent vehicle control would provide a realistic approach for screening chemicals for sensitizing potential. The analyses reported here suggest this is the case. We speculate that the animal welfare benefits may be enhanced further by reducing the number of animals per experimental group. However, a detailed evaluation will be necessary to provide reassurance that a reduction in group size would provide adequate sensitivity across a range of skin sensitization potencies.

  1. Gammascintigraphy of metastases of the lymph nodes

    International Nuclear Information System (INIS)

    Mechev, D.S.; Shishkina, V.V.

    1985-01-01

    It was indicated that according to the degree of informative value all the methods used in this study can be listed as follows: the method of combined use of positive and negative scintigraphy, the method of positive scintigraphy with Ga 67 -citrate (the tymph nodes above the diagram) and Tc 99 -pertechnate (the lymph nodes below the diaphragm), the method of indirect radionuclide lymphography with colloids. The main indices of radionuclide methods in the diagnosis of the lymph node metastatic involvement are presented

  2. Prognostic significance of pathological response of primary tumor and metastatic axillary lymph nodes after neoadjuvant chemotherapy for locally advanced breast carcinoma.

    Science.gov (United States)

    Machiavelli, M R; Romero, A O; Pérez, J E; Lacava, J A; Domínguez, M E; Rodríguez, R; Barbieri, M R; Romero Acuña, L A; Romero Acuña, J M; Langhi, M J; Amato, S; Ortiz, E H; Vallejo, C T; Leone, B A

    1998-01-01

    The prognostic significance of pathological response of primary tumor and metastatic axillary lymph nodes after neoadjuvant chemotherapy was assessed in patients with noninflammatory locally advanced breast carcinoma. Between January 1989 and April 1995, 148 consecutive patients with locally advanced breast carcinoma participated in the study. Of these, 140 fully evaluable patients (67, stage IIIA; 73, stage IIIB) were treated with three courses of 5-fluorouracil, doxorubicin, and cyclophosphamide (FAC), followed by modified radical mastectomy when technically feasible or definitive radiation therapy. The median age was 53 years (range, 26 to 75 years); 55% of patients were postmenopausal. Objective response was recorded in 99 of 140 patients (71%; 95% confidence interval, 63% to 79%). Complete response occurred in 11 patients (8%), and partial response occurred in 88 patients (63%). No change was recorded in 37 patients (26%), and progressive disease occurred in 4 patients (3%). One hundred and thirty-six patients underwent the planned surgery. Maximal pathological response of the primary tumor (in situ carcinoma or minimal microscopic residual tumor) was observed in 24 (18%); 112 patients (82%) presented minimal pathological response of the primary tumor (gross residual tumor). The number of metastatic axillary nodes after neoadjuvant chemotherapy was as follows: N0, 39 patients (29%); N1-N3, 35 patients (26%); > N3, 62 patients (45%). Considering the initial TNM status, 75% of the patients had decreases in tumor compartment after neoadjuvant chemotherapy. Also, 31% and 23% of patients with clinical N1 and N2, respectively, showed uninvolved axillary lymph nodes. A significant correlation was noted between pathological response of primary tumor and the number of metastatic axillary lymph nodes. Median disease-free survival was 34 months, whereas median overall survival was 66 months. Pathological responses of both primary tumor and metastatic axillary lymph nodes

  3. Proliferative responses in the local lymph node assay associated with concomitant exposure to 1,4-phenylenediamine and methyldibromo glutaronitrile: evidence for synergy?

    Science.gov (United States)

    Jowsey, Ian R; Basketter, David A; Irwin, Anita

    2008-08-01

    A key consideration when undertaking risk assessments should be the potential for synergy between contact allergens. Previously, this concept has only been investigated during elicitation in contact allergic individuals. To determine whether there exists evidence for synergy between contact allergens during the induction phase of skin sensitization using the mouse local lymph node assay (LLNA) as a model system. Proliferative responses in draining lymph nodes were assessed with increasing concentrations of 1,4-phenylenediamine (PPD), methyldibromo glutaronitrile (MDBGN), and a combination of PPD and MDBGN. Data from each of two independent experiments show that lymph node cell proliferation associated with combined exposure to PPD and MDBGN was, in general, only modestly increased relative to that predicted from a simple summation of their individual responses. Although the increase in response is very modest, it does imply a relationship between this combination of sensitizers that may not be simply additive in terms of their ability to stimulate proliferative responses in draining lymph nodes. The reproducibility of this observation should be confirmed in future studies with additional pairs of contact allergens to ascertain whether or not this represents evidence of synergy.

  4. 18F-FDG PET for detecting recurrent head and neck cancer, local lymph node involvement and distant metastases. Comparison of qualitative visual and semiquantitative analysis

    International Nuclear Information System (INIS)

    Schmidt, M.; Schmalenbach, M.; Theissen, P.; Dietlein, M.; Eschner, W.; Schicha, H.; Jungehuelsing, M.; Schroeder, U.; Stennert, E.

    2004-01-01

    Aim: Assessment of the clinical value of 18 F-FDG-PET for detection of recurrent head and neck cancer, local lymph node involvement and distant metastases comparing a qualitative visual with a semiquantitative analysis (SUV values). Patients, methods: Retrospective evaluation of 73 18 F-FDG PET studies in 55 patients by use of a four-step qualitative visual grading system and calculation of standard uptake values in pathological lesions. Calculation of SUV values in normal regions for generating a map of physiological 18 F-FDG distribution. Correlation to histopathological findings and clinical follow-up. Results: 1. Qualitative visual analysis of 18 F-FDG PET studies: a) local recurrence sensitivity 79%, specificity 97%, positive predictive value 95%, negative predictive value 85%, and diagnostic accuracy 89%; b) local metastatic lymph nodes 100%, 95%, 85%, 100%, 96%; c) distant metastases 100%, 98%, 86%, 100%, 98%, respectively. 2. Semiquantitative analysis had only little incremental, non-significant value in comparison to qualitative visual analysis for the detection of a local recurrence in two patients: a) local recurrence: sensitivity 83%, specificity 100%, positive predictive value 100%, negative predictive value 88%, and diagnostic accuracy 93%; b) local metastatic lymph nodes or c) distant metastases did not change in comparison to qualitative visual analysis. Conclusion: 18 F-FDG PET is an effective tool for re-staging of patients with suspected recurrence after therapy for head and neck cancer. (orig.)

  5. Local hyperthermia of cervical N2/N3 lymph node metastases - a phase-I/II-study

    International Nuclear Information System (INIS)

    Stahl, H.; Wust, P.; Graf, R.; Loeffel, J.; Bier, J.; Riess, H.; Jahnke, V.; Felix, R.

    1997-01-01

    50 patients with primary advanced, recurrent or persistent N2/N3 lymph node metastases were treated with microwave hyperthermia in addition to their standard therapy (radiotherapy or radiochemotherapy). For the thermometry, closed-end catheters were implanted in the cervical lesions under CT monitoring. Temperature/time and temperature/position curves were analysed with regard to power density, effective perfusion, tissue depth, index temperatures T 90 , T 50 , T 20 , cum min T 60 ≥40.5 C, and equ min T 90 at 43 C. Radiation dose, total irradiation time and chemotherapy were also recorded as therapy parameters. Repeated CT scans for assessing response were taken for a subgroup of 32 patients following primary potentially curative radiotherapy (with and without chemotherapy) and local hyperthermia. All therapy parameters were subjected to a variance analysis with regard to response. At a tissue depth of 3 cm, relative and absolute power densities were on average of 50% less than at the surface. Therapeutic temperature increases of more than 4 C (i.e. more than 41 C) were not reached at tissue depths greater than 5 cm. The effective perfusion under local hyperthermia is significantly higher than under basal conditions. The mean T 90 was 39.9 C, and the mean T 20 value was 42.3 C. T 90 , cum min T 90 ≥40.5 C, equ min T 90 43 C, radiation dose and total irradiation time have a significant influence on response. The tumor volume correlates negatively with response, and this results in the thermal gradients correlating negatively with response and survival. The quality of the temperature distribution, represented by the value of cum min T 90 ≥40.5 C, showed a tendency to correlate positively with the survival in the subgroup of patients who underwent primary therapy. (orig./AJ) [de

  6. Sentinel lymph node biopsy from the vantage point of an oncologic surgeon.

    Science.gov (United States)

    Wilson, Lori L

    2009-01-01

    Sentinel lymph node biopsy has greatly influenced the surgical management of clinically localized primary melanoma. Lymphatic mapping and sentinel lymph node biopsy have been used for the selective management of the draining regional lymph node basin of primary cutaneous melanoma. Oncologic surgeons have adopted this procedure to selectively identify occult nodal status in melanoma patients who are at a higher risk of regional metastasis. The current standard of treatment of tumor-positive sentinel lymph node metastasis is immediate completion lymphadenectomy, but considerable debate surrounds the utility of this procedure. This contribution reviews development, technical aspects, selective management of the lymph node basin, and sentinel lymph node biopsy techniques.

  7. Outcome of patients with localized prostate cancer treated by radiotherapy after confirming the absence of lymph node invasion

    International Nuclear Information System (INIS)

    Suzuki, Noriyuki; Shimbo, Masaki; Amiya, Yoshiyasu; Tomioka, Susumu; Shima, Takayuki; Murakami, Shino; Nakatsu, Hiroomi; Oota, Sayako; Shimazaki, Jun

    2010-01-01

    Management of lymph nodes in radiotherapy for prostate cancer is an issue for curative intent. To find the influence of lymph nodes, patients with T1-T3 prostate cancer and surgically confirmed negative nodes were treated with radiotherapy. After lymphadenectomy, 118 patients received photon beam radiotherapy with 66 Gy to the prostate. No adjuvant treatment was performed until biochemical failure. After failure, hormone therapy was administered. Follow-up period was 57 months (mean). Biochemical failure occurred in 47 patients. Few failures were observed in patients with low (24%) and intermediate risks (14%). In contrast, 64% of high-risk patients experienced failure, 97% of whom showed until 36 months. Most patients with failure responded well to hormone therapy. After 15 months (mean), a second biochemical failure occurred in 21% of patients who had the first failure, most of them were high risk. Factors involving failure were high initial and nadir prostate-specific antigen, advanced stage, short prostate-specific antigen-doubling time and duration between radiation and first failure. Failure showed an insufficient reduction in prostate-specific antigen after radiotherapy. Factor for second failure was prostate-specific antigen-doubling time at first failure. Half of high-risk patients experienced biochemical failure, indicating one of the causes involves factors other than lymph nodes. Low-, intermediate- and the other half of high-risk patients did not need to take immediate hormone therapy after radiotherapy. After failure, delayed hormone therapy was effective. Prostate-specific antigen parameters were predictive factors for further outcome. (author)

  8. Sentinel lymph node biopsy using dye alone method is reliable and accurate even after neo-adjuvant chemotherapy in locally advanced breast cancer - a prospective study

    Directory of Open Access Journals (Sweden)

    Mishra Ashwani

    2011-02-01

    Full Text Available Abstract Background Sentinel lymph node biopsy (SLNB is now considered a standard of care in early breast cancers with N0 axillae; however, its role in locally advanced breast cancer (LABC after neo-adjuvant chemotherapy (NACT is still being debated. The present study assessed the feasibility, efficacy and accuracy of sentinel lymph node biopsy (SLNB using "dye alone" (methylene blue method in patients with LABC following NACT. Materials and methods Thirty, biopsy proven cases of LABC that had received three cycles of neo-adjuvant chemotherapy (cyclophosphamide, adriamycin, 5-fluorouracil were subjected to SLNB (using methylene blue dye followed by complete axillary lymph node dissection (levels I-III. The sentinel node(s was/were and the axilla were individually assessed histologically. The SLN accuracy parameters were calculated employing standard definitions. The SLN identification rate in the present study was 100%. The sensitivity of SLNB was 86.6% while the accuracy was 93.3%, which were comparable with other studies done using dual lymphatic mapping method. The SLN was found at level I in all cases and no untoward reaction to methylene blue dye was observed. Conclusions This study confirms that SLNB using methylene blue dye as a sole mapping agent is reasonably safe and almost as accurate as dual agent mapping method. It is likely that in the near future, SLNB may become the standard of care and provide a less morbid alternative to routine axillary lymph node dissection even in patients with LABC that have received NACT.

  9. Nothing is perfect, not even the local lymph node assay: a commentary and the implications for REACH.

    Science.gov (United States)

    Basketter, David A; McFadden, John F; Gerberick, Frank; Cockshott, Amanda; Kimber, Ian

    2009-02-01

    For many regulatory authorities, the local lymph node assay (LLNA) is the preferred assay for the predictive identification of skin-sensitizing chemicals. It is the initial requirement for sensitization testing within the new REACH (Registration, Evaluation, Authorization and Restriction of Chemical substances) regulations in the European Union. The primary reasons for the preferment of the LLNA are the animal welfare benefits it provides compared with traditional guinea-pig methods (refinement and reduction of animal usage) and the general performance characteristics of the assay with regard to overall reliability, accuracy, and interpretation. Moreover, a substantial published literature on the LLNA is available making it appropriate for use as a benchmark against which new approaches, including in vitro alternatives, can be evaluated and validated. There is, therefore, a view that the LLNA represents the 'gold standard' for skin sensitization testing. However, although this is probably correct, it is important to recognize and acknowledge that in common with all other predictive tests (whether they be validated or not), the LLNA has limitations, in addition to strengths, some of which were mentioned above. Arguably, it is the limitations (e.g., the occurrence of false positive and false negative results) of test methods that are most important to understand. With respect to the LLNA, these limitations are similar to those associated with guinea-pig skin sensitization methods. Among these are the occurrence of false positive and false negative results, susceptibility of results to changes in vehicle, and the possibility that interspecies differences may confound interpretation. In this commentary, these issues are reviewed and their impact on the utility of the LLNA for identification, classification, and potency assessment of skin sensitizers are considered. In addition, their relevance for the future development and validation of novel in vitro and in silico

  10. Inter-laboratory validation of the modified murine local lymph node assay based on 5-bromo-2'-deoxyuridine incorporation.

    Science.gov (United States)

    Kojima, Hajime; Takeyoshi, Masahiro; Sozu, Takashi; Awogi, Takumi; Arima, Kazunori; Idehara, Kenji; Ikarashi, Yoshiaki; Kanazawa, Yukiko; Maki, Eiji; Omori, Takashi; Yuasa, Atsuko; Yoshimura, Isao

    2011-01-01

    The murine local lymph node assay (LLNA) is a well-established alternative to the guinea pig maximization test (GPMT) or Buehler test (BT) for the assessment of the skin sensitizing ability of a drug, cosmetic material, pesticide or industrial chemical. Instead of radioisotope using in this method, Takeyoshi M. et al. (2001) has developed a modified LLNA based on the 5-bromo-2'-deoxyuridine (BrdU) incorporation (LLNA:BrdU-ELISA). The LLNA:BrdU-ELISA is practically identical to the LLNA methodology excluding the use of BrdU, for which a single intraperitoneal injection of BrdU is made on day 4, and colorimetric detection of cell turnover. We conducted the validation study to evaluate the reliability and relevance of LLNA:BrdU-ELISA. The experiment involved 7 laboratories, wherein 10 chemicals were examined under blinded conditions. In this study, 3 chemicals were examined in all laboratories and the remaining 7 were examined in 3 laboratories. The data were expressed as the BrdU incorporation using an ELISA method for each group, and the stimulation index (SI) for each chemical-treated group was determined as the increase in the BrdU incorporation relative to the concurrent vehicle control group. An SI of 2 was set as the cut-off value for exhibiting skin sensitization activity. The results obtained in the experiments conducted for all 10 chemicals were sufficiently consistent with small variations in their SI values. The sensitivity, specificity, and accuracy of LLNA:BrdU-ELISA against those of GPMT/BT were 7/7 (100%), 3/3 (100%), and 10/10 (100%), respectively. Copyright © 2010 John Wiley & Sons, Ltd.

  11. Comparison of outcomes obtained in murine local lymph node assays using CBA/J or CBA/Ca mice.

    Science.gov (United States)

    Maeda, Yosuke; Hirosaki, Haruka; Yakata, Naoaki; Takeyoshi, Masahiro

    2016-08-01

    CBA/J and CBA/Ca mice are the recommended strains for local lymph node assays (LLNAs). Here, we report quantitative and qualitative comparisons between both mouse strains to provide useful information for the strain selection of sensitization testing. LLNA was conducted, in accordance with Organisation for Economic Co-operation and Development Test Guideline No. 429, with CBA/J and CBA/Ca mice using five chemicals including typical contact sensitizers and non-sensitizers: 2,4-dinitrochlorobenzene (DNCB), isoeugenol, α-hexylcinnamic aldehyde (HCA), propylene glycol (PG), and hexane; then outcomes were compared based on the raw data (disintegrations per minute, DPM), stimulation index (SI) values, EC3 values and positive/negative decisions. Although a significant difference was noted between DPM values derived from each strain of mice, SI values exhibited no considerable difference. The EC3 values for DNCB in CBA/J and CBA/Ca mice were 0.04 and 0.03, those for isoeugenol were 1.4 and 0.9, and those for HCA were 7.7 and 6.0, respectively. All EC values derived from each test system were almost equivalent and were within the range of acceptance criteria of the ICCVAM performance standard for LLNA. Positive/negative outcomes for all test chemicals were consistent. In conclusion, no considerable differences were observed in the final outcomes derived from CBA/J and CBA/Ca mice in LLNA. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  12. 4D-Fingerprint Categorical QSAR Models for Skin Sensitization Based on Classification Local Lymph Node Assay Measures

    Science.gov (United States)

    Li, Yi; Tseng, Yufeng J.; Pan, Dahua; Liu, Jianzhong; Kern, Petra S.; Gerberick, G. Frank; Hopfinger, Anton J.

    2008-01-01

    Currently, the only validated methods to identify skin sensitization effects are in vivo models, such as the Local Lymph Node Assay (LLNA) and guinea pig studies. There is a tremendous need, in particular due to novel legislation, to develop animal alternatives, eg. Quantitative Structure-Activity Relationship (QSAR) models. Here, QSAR models for skin sensitization using LLNA data have been constructed. The descriptors used to generate these models are derived from the 4D-molecular similarity paradigm and are referred to as universal 4D-fingerprints. A training set of 132 structurally diverse compounds and a test set of 15 structurally diverse compounds were used in this study. The statistical methodologies used to build the models are logistic regression (LR), and partial least square coupled logistic regression (PLS-LR), which prove to be effective tools for studying skin sensitization measures expressed in the two categorical terms of sensitizer and non-sensitizer. QSAR models with low values of the Hosmer-Lemeshow goodness-of-fit statistic, χHL2, are significant and predictive. For the training set, the cross-validated prediction accuracy of the logistic regression models ranges from 77.3% to 78.0%, while that of PLS-logistic regression models ranges from 87.1% to 89.4%. For the test set, the prediction accuracy of logistic regression models ranges from 80.0%-86.7%, while that of PLS-logistic regression models ranges from 73.3%-80.0%. The QSAR models are made up of 4D-fingerprints related to aromatic atoms, hydrogen bond acceptors and negatively partially charged atoms. PMID:17226934

  13. Inhomogeneous dose escalation increases expected local control for NSCLC patients with lymph node involvement without increased mean lung dose

    DEFF Research Database (Denmark)

    Nielsen, Tine B; Hansen, Olfred; Schytte, Tine

    2014-01-01

    in mediastinum, and the thorax wall. The dose was escalated using a TCP model implemented into the planning system. The difference in TCP values between the homogeneous and inhomogeneous plans were evaluated using two different TCP models. RESULTS: Dose escalation was possible for all patients. TCP values based...... to the mediastinum were observed: 2.5 Gy for aorta, 4.4 Gy for the connective tissue, 1.6 Gy for the heart, and 2.6 Gy for trachea + bronchi. CONCLUSION: Increased target doses and TCP values using inhomogeneous dose distributions could be achieved for all patients, regardless of lymph node involvement, tumour stage...

  14. Enhancement characteristics of retroperitoneal lymphomatous lymph nodes

    International Nuclear Information System (INIS)

    Hagtvedt, Trond; Smith, Hans-Joergen; Kolbenstvedt, Alf; Aaloekken, Trond Mogens; Graff, Bjoern Anton; Holte, Harald

    2013-01-01

    Background: Previous studies of CT enhancement of lymphomatous lymph nodes (LLN) of the neck and the mediastinum showed that the LLN had lower enhancement values than normal lymph nodes. Purpose: To elucidate the contrast medium enhancement curves of LLN in the retroperitoneum by comparing the curves of LLN with those of normal lymph nodes, to test whether differences between these curves could be of diagnostic value, and to compare the present enhancement curves of LLN of the retroperitoneum with the curves of LLN of the neck and the mediastinum from previous similar investigations. Material and Methods: Twenty-eight consecutive patients with LLN of the retroperitoneum (three with Hodgkin's lymphoma [HL]) and 21 control patients with sarcomas and thus presumably normal retroperitoneal nodes underwent dynamic CT examinations. The previous, similar investigation of lymph nodes of the neck comprised 28 patients with LLN and the investigation of mediastinal lymph nodes comprised 24 patients with LLN. Results: The enhancement curves of the retroperitoneal LLN had significantly lower attenuation than those of the retroperitoneal control nodes. A combination of peak contrast value and time to peak adjusted to total body weight yielded a diagnostic accuracy which at the best showed a sensitivity of 90.5% with a specificity of 82.6%. The LLN of the retroperitoneum had higher attenuation values than corresponding nodes of the mediastinum but no significant difference was found between LLN of the retroperitoneum and LLN of the neck in previous similar investigations. Conclusion: The comparison of enhancement curves of retroperitoneal LLN with retroperitoneal control nodes showed a marked similarity with and substantiates our previous findings in lymph nodes of the neck and of the mediastinum. The best diagnostic accuracy was achieved by combining the parameters peak contrast value and time to peak and adjusting these values to the body weight. Peak enhancement of the

  15. Lymphatic uptake and biodistribution of liposomes after subcutaneous injection - IV. Fate of liposomes in regional lymph nodes

    NARCIS (Netherlands)

    Oussoren, C; Scherphof, G; van der Want, JJ; van Rooijen, N; Storm, G

    1998-01-01

    The ability of clodronate-containing liposomes to deplete lymph nodes of macrophages was used as a tool to investigate the fate of liposomes in regional lymph nodes after subcutaneous (s.c.) administration. Reduced lymph node localization of liposomes in macrophage-depleted lymph nodes confirmed

  16. Status of lymph node staging

    NARCIS (Netherlands)

    Nieweg, O. E.; Estourgie, S. H.; Deurloo, E. E.; Rutgers, E. J. Th; Kroon, B. B. R.

    2002-01-01

    Sentinel node biopsy has the potential to provide more accurate staging information than axillary node dissection. Given the considerable morbidity of axillary node dissection this less invasive approach is attractive. However, there are a number of issues to be resolved before the best technique of

  17. Distribution of involved regional lymph nodes in recurrent and locally advanced breast cancer and its impact on target definition

    International Nuclear Information System (INIS)

    Chen Jian; Ma Jinli; Zhang Shengjian; Yang Zhaozhi; Cai Gang; Feng Yan; Guo Xiaomao; Chen Jiayi

    2011-01-01

    Objective: The frequency and the anatomic distribution of involved regional nodes in recurrent and locally advanced breast cancer were analyzed, in order to evaluate the rational of conventional regional node radiation technique and provide evidence for target definition of breast cancer . Methods: Patients with recurrent or locally advanced breast cancer who were treated in our hospital from August 2003 to December 2009 were included in this study. 111 patients had contrast enhanced chest CT images of the whole regional nodes before treatment. The regional nodes were categorized into 8 anatomical substructures including medial and lateral supraclavicular nodes ( SC-M, SC-L), axilla nodes ( ALN )- I , II , III, infra clavicular nodes (IFN), Rotter's nodes (RN) and internal mammary nodes (IMN). The frequency of involvement and anatomical distribution of the involved nodes on CT images were analyzed. Results: A total of 111 patients were enrolled this study and 199 anatomical substructures with involved nodes were identified. The frequency of involvement were : SC-M 33, SC-L 21, ALN- I 30, ALN-II 25, ALN-III + IFN 35, RN 27, IMN 28. Supraclavicular region and axilla were the most frequently involved area (72.3%). The average depth of the SC-M and SC-L nodes was 33.48 mm ± 10. 57 mm and 45.62 mm ±20. 45 mm, and 51.5% and 71.4% of the SC-M and SC-L nodes were located more than 3 cm deep from the skin. The axilla nodes were located cranial and caudal to the axillary vein in 5 and 20 locally advanced breast cancer patients and in 64 and 28 patients who received prior axillary dissection. The majority of involved IMN was located within the first 3 intercostal spaces (26/28). The average distance between the center of involved IMN and chest skin was 24. 23 mm ± 10. 28 mm. The average distance between the center of involved IMN and midline of the body was 29. 38 mm ±6. 7 mm. The center of involved IMN was 6.19 mm ±5.73 mm lateral and 5.73 mm ± 4. 56 mm posterior to

  18. Transfer of immunoglobulins through the mammary endothelium and epithelium and in the local lymph node of cows during the initial response after intramammary challenge with E. coli endotoxin

    Directory of Open Access Journals (Sweden)

    Lun Shichun

    2008-07-01

    Full Text Available Abstract Background The first hours after antigen stimulation, interactions occur influencing the outcome of the immunological reaction. Immunoglobulins originate in blood and/or are locally synthesized. The transfer of Ig isotypes (Igs in the udder has been studied previously but without the possibility to distinguish between the endothelium and the epithelium. The purpose of this study was to map the Ig transfer through each barrier, separately, and Ig transfer in the local lymph nodes of the bovine udder during the initial innate immune response. Methods The content of IgG1, IgG2, IgM, IgA and albumin (BSA was examined in peripheral/afferent mammary lymph and lymph leaving the supramammary lymph nodes, and in blood and milk before (0 h and during 4 hours after intramammary challenge with Esherichia coli endotoxin in 5 cows. Results Igs increased most rapidly in afferent lymph resulting in higher concentrations than in efferent lymph at postinfusion hour (PIH 2, contrary to before challenge. Ig concentrations in milk were lower than in lymph; except for IgA at 0 h; and they increased more slowly. Afferent lymph:serum and efferent lymph:serum concentration ratios (CR of Igs were similar to those of BSA but slightly lower. Milk:afferent lymph (M:A CRs of each Ig, except for IgG2, showed strikingly different pattern than those of BSA. The M:A CR of IgG1, IgM and IgA were higher than that of BSA before challenge and the CR of IgA and IgG1 remained higher also thereafter. At PIH 2 there was a drop in Ig CRs, except for IgG2, in contrast to the BSA CR which gradually increased. The M:A CR of IgM and Ig A decreased from 0 h to PIH 4, in spite of increasing permeability. Conclusion The transfer of Igs through the endothelium appeared to be merely a result of diffusion although their large molecular size may hamper the diffusion. The transfer through the epithelium and the Ig concentrations in milk seemed more influenced by selective mechanisms and

  19. Uptake and retention of insufflated tantalum by lymph nodes

    International Nuclear Information System (INIS)

    Kilpper, R.W.; Bianco, A.; Gibb, F.R.; Landman, S.; Morrow, P.E.

    1976-01-01

    A nonsacrifice, radiographic technique is presented for evaluating the lymph node uptake of radiographically dense materials from the lungs of beagle dogs into which the material was insufflated. With tantalum as the contrast agent, lymph nodes sometimes become visible within 2 days after exposure when the insufflation resulted in radiographic ''alveolarization'' of some of the tantalum. Localization of the material within the nodes was observed in subsequent radiographs as well as persistent retention after as much as 1 year. Through the use of preinsufflation control films and tantalum foils of varying thickness, densitometric methods for determining the amount of tantalum within the lymph nodes are being investigated. Tantalum-182 is being used to follow the lung retention of the material as well as to verify estimates of burdens in harvested nodes. Preliminary lymphokinetic data are presented from experiments utilizing powders of 1 and 5 μm (mean) particle sizes

  20. Advantage of using CBA/N strain mice in a non-radioisotopic modification of the local lymph node assay.

    Science.gov (United States)

    Takeyoshi, Masahiro; Noda, Shuji; Yamasaki, Kanji; Kimber, Ian

    2006-01-01

    The murine local lymph node assay (LLNA) is currently recognized as a stand-alone test method for determining the skin sensitizing potential of chemicals. It has been incorporated into the official test guidelines published by some authorities, including the OECD. To avoid the use of radioisotopes, efforts have been made recently to develop non-radioisotopic modifications of the LLNA. A non-radioisotopic modification of the LLNA was developed previously using 5-bromo-2'-deoxyuridine (BrdU) incorporation (non-RI LLNA). However, the non-RI LLNA was found to be somewhat less sensitive than the standard assay. This study reports the advantage of using mice of the CBA/N strain in the non-RI LLNA to improve the sensitivity of this method. The non-RI LLNA was performed using CBA/JN and CBA/N mice exposed to one of four confirmed skin sensitizers, 2,4-dinitrochlorobenzene (DNCB), eugenol (EG), isoeugenol (IEG) or alpha-hexylcinnamic aldehyde (HCA), and to one non-sensitizer, propylene glycol (PG). The EC3 values for DNCB, IEG, EG, HCA and PG were calculated to be 0.1%, 9.6%, 40.6%, 45.5% and >50% in CBA/JN mice and 0.08%, 1.9%, 10.7%, 20.3% and >50% in CBA/N mice, respectively. The EC3 values for DNCB, IEG, EG, HCA and PG in the standard LLNA using CBA/Ca mice and radioisotopes were reported elsewhere as being 0.08%, 1.3%, 13.0%, 8.0% and >50%, respectively. The EC3 values derived from the CBA/N mice in the non-RI LLNA were nearly equivalent to the EC3 values obtained using the standard radioisotopic LLNA with CBA/Ca mice. These data suggest that the use of CBA/N mice may provide a realistic opportunity to develop a version of the LLNA that does not have a requirement for the use of radioisotopes, but which nevertheless has sensitivity approaching, or comparable to, the standard method. 2005 John Wiley & Sons, Ltd.

  1. Tolerance and efficiency of radiation therapy treatment of the pelvic lymph nodes in patients with prostate cancer

    International Nuclear Information System (INIS)

    Hegemann, Nina-Sophie

    2013-01-01

    Tolerance and efficiency of radiation therapy treatment of the pelvic lymph nodes were assessed in 122 patients with prostate cancer. With no severe observed late toxicity the incidence for lymph node metastases was between 3,0% (primarily irradiated patients without lymph node or distant metastases) and 100% (primarily irradiated patients with lymph node and distant metastases) after 3 years. As it seems, the following subgroups might possibly profit the most from a dose escalation in the pelvic lymph nodes: primarily irradiated patients with positive lymph nodes and postoperatively irradiated patients in adjuvant/additive situation, with a biochemical or a local/lymph node recurrence.

  2. Sentinel lymph node biopsy: clinical relevance

    International Nuclear Information System (INIS)

    Howman-Giles, R.

    2002-01-01

    Sentinel lymph node biopsy (SLNB) has become an important technique in the management of patients with intermediate level melanoma, clinical operable breast cancer and some other cancers. The technique relies on lymphatic mapping to define the lymph drainage from a primary tumour with the premise that the lymph nodes, which directly drain from that area, will reflect the tumour status of the remainder of the node field. Current techniques use lymphoscintigraphy where a radioactive labelled particle and / or blue dye are injected intradermally or intraparenchymally to map the lymph drainage, often in conjunction with a radioactive gamma probe at surgery. In patients with melanoma the SLNB has improved the staging and prognostic information by more accurate determination of whether regional lymph nodes have metastatic spread. This has a major impact on patient management as those patients with negative nodes do not require regional lymph node dissection and have a significantly better prognosis. In our experience of over 3000 patients the combined sentinel node biopsy technique localised accurately 98% of sentinel lymph nodes. Lymphoscintigraphy in patients with melanoma to locate the sentinel lymph nodes involves the intradermal injection of a radiocolloid around the melanoma site or the excision biopsy site. Injections of 5 -10 MBq in 0.05-0.1ml/inj are used and typically 4 injections are usually required. Following tracer injection dynamic imaging is performed to follow the lymphatic collecting vessels until they reach the draining sentinel nodes. An image should be acquired as the vessels reach the node field so that the sentinel nodes directly receiving the channels can be identified and distinguished from any second tier nodes which may sometimes be seen. Delayed scans are performed 2 hours later at which time all regions which can possible drain the primary melanoma site are examined with 5-10 minute static images. The surface location of all sentinel nodes is

  3. Simultaneous dual pathology in lymph node

    Directory of Open Access Journals (Sweden)

    Prakas Kumar Mandal

    2014-05-01

    Full Text Available [Abstract] Tubercuous lymphadenitis and Non Hodgkins’ Lymphoma are common in India. As both diseases can occur in elderly persons there is a definite chance of co-existence of both diseases; but that coexistence has not been reported. Here we present a unique case in an elderly woman who had synchronous double pathology of tuberculosis (TB and Diffuse Large B cell Lymphoma (DLBCL of the lymph nodes.     Key words:- lymph nodes, tuberculosis (TB, Diffuse Large B cell Lymphoma (DLBCL.

  4. SOME ASPECTS OF THE ANATOMY OF AXILLARY LYMPH NODES

    Directory of Open Access Journals (Sweden)

    A. I. Shvedavchenko

    2009-01-01

    Full Text Available The paper concisely reviews the classifications of axillary lymph nodes (LN and considers various approaches to their formation. The authors identify the axillary lymph chain consisting of lateral, central, and apical groups of nodes through which lymph outflows into the overlying lymph collectors, as well as of subscapular and medial groups of nodes from where lymph makes its way into the auxil- lary lymph chain.

  5. Allergenicity evaluation of fragrance mix and its ingredients by using ex vivo local lymph node assay-BrdU endpoints.

    Science.gov (United States)

    Ulker, Ozge Cemiloglu; Kaymak, Yesim; Karakaya, Asuman

    2014-03-01

    The present studies were performed to compare the differences between sensitization potency of fragrance mix and its ingredients (oak moss absolute, isoeugenol, eugenol, cinnamal, hydroxycitronellal, geraniol, cinnamic alcohol, alpha amyl cinnamal), by using ex vivo LLNA-BrdU ELISA. The SI and EC3 values were calculated and potency classification was found for the mixture and for each ingredients. TH1 cytokines (IL-2, IFN-γ) and TH2 cytokines (IL-4, IL-5) releases from lymph node cell culture were also investigated as contact sensitization endpoints. The EC3 values were calculated and the potency of contact sensitization were classified for fragrance mix, oak moss absolute, isoeugenol, eugenol, cinnamal, hydroxycitronellal, geraniol, cinnamic alcohol, alpha amyl cinnamal respectively: 4.4% (moderate), 3.4% (moderate), 0.88% (strong), 16.6% (weak), 1.91% (moderate), 9.77% (moderate), 13.1% (weak), 17.93% (weak), 7.74% (moderate). According to our results it should be concluded that exposure to fragrance mix does not constitute an evidently increased hazard compared to exposure to each of the eight fragrance ingredients separately. Cytokine analyses results indicate that both TH1 and TH2 cytokines are involved in the regulation of murine contact allergy and can be considered as useful endpoints. Copyright © 2014 Elsevier Ltd. All rights reserved.

  6. B cell increases and ex vivo IL-2 production as secondary endpoints for the detection of sensitizers in non-radioisotopic local lymph node assay using flow cytometry.

    Science.gov (United States)

    Jung, Kyoung-Mi; Jang, Won-Hee; Lee, Yong-Kyoung; Yum, Young Na; Sohn, Soojung; Kim, Bae-Hwan; Chung, Jin-Ho; Park, Young-Ho; Lim, Kyung-Min

    2012-03-25

    Non-radioisotopic local lymph node assay (LLNA) using 5-bromo-2'-deoxyuridine (BrdU) with flow cytometry (FCM) is gaining attention since it is free from the regulatory issues in traditional LLNA (tLLNA) accompanying in vivo uses of radioisotope, (3)H-thymidine. However, there is also concern over compromised performance of non-radioisotopic LLNA, raising needs for additional endpoints to improve the accuracy. With the full 22 reference substances enlisted in OECD Test Guideline No. 429, we evaluated the performance of LLNA:BrdU-FCM along with the concomitant measurements of B/T cell ratio and ex vivo cytokine production from isolated lymph node cells (LNCs) to examine the utility of these markers as secondary endpoints. Mice (Balb/c, female) were topically treated with substances on both ears for 3 days and then, BrdU was intraperitoneally injected on day 5. After a day, lymph nodes were isolated and undergone FCM to determine BrdU incorporation and B/T cell sub-typing with B220+ and CD3e+. Ex vivo cytokine production by LNCs was measured such as IL-2, IL-4, IL-6, IL-12, IFN-γ, MCP-1, GM-CSF and TNFα. Mice treated with sensitizers showed preferential increases in B cell population and the selective production of IL-2, which matched well with the increases in BrdU incorporation. When compared with guinea pig or human data, BrdU incorporation, B cell increase and IL-2 production ex vivo could successfully identify sensitizers with the accuracy comparable to tLLNA, suggesting that these markers may be useful for improving the accuracy of LLNA:BrdU-FCM or as stand-alone non-radioisotopic endpoints. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  7. Sentinel lymph node imaging in breast cancer

    International Nuclear Information System (INIS)

    Kim, Byung Tae

    1999-01-01

    Currently, dissection of the axillary or regional lymph nodes is considered the standard staging procedure in breast cancer. However, accumulating evidence is becoming available that the sentinel node concept may provide the same or even better staging information. In the case of melanoma, it is proven that the histological characteristics of the sentinel node reflect the histological characteristics of the distal part of the lymphatic basin. Morbidity can be reduced significantly by the use of sentinel node dissection as several authors have reported successful introduction of this technique into clinical practice. But in breast cancer patients, there are significant differences in practice relating to the technology, such as radiopharmaceuticals, injection sites, volume of injectate, combination with vital blue dye, preoperative lymphoscintigraphy, etc. Valuable reports on these topics appeared in recent journals. This review is a summary of those reports for nuclear physicians interested in sentinel node detection by lymphoscintigraphy in breast cancer patients

  8. Sentinel lymph node biopsy: An audit of intraoperative assessment ...

    African Journals Online (AJOL)

    2015-07-02

    Jul 2, 2015 ... Sentinel lymph node biopsy: An audit of ... cytotechnology service ... To audit results from intraoperative assessment of sentinel lymph node ..... out, and turnaround time in gynecologic cytology quality assurance: Findings.

  9. Clinical evaluation of esophageal lymph flow system based on the RI uptake of removed regional lymph nodes following lymphoscintigraphy

    International Nuclear Information System (INIS)

    Tanabe, Gen; Baba, Masamichi; Kuroshima, Kazunao; Natugoe, Shouji; Yoshinaka, Heiji; Aikou, Takashi; Kajisa, Takashi

    1986-01-01

    For surgical treatment of esophageal cancer, the importance of evaluating lymph node metastasis and the lymph flow of the esophagus can not be overemphasized. In order to investigate the lymph flow of the esophagus, we preoperatively performed lymphoscintigraphy by endoscopic local injection of 99m Tc Renium Colloid into the esophageal wall in 42 esophageal cancer cases and 4 gastric cancer cases. Postoperatively, the RI uptake of each dissected regional lymph nodes was examined by a Scintillation Counter. The findings were as follows. 1. From the upper third of the thoracic esophagus, the main lymph flow was ascending to the neck and upper mediastinum. 2. From the middle third, the lymph flow was ascending to the neck and upper mediastinum and descending into the abdomen. 3. From the lower third, the main lymph flow was descending to the abdomen. In some cases, the lymph flow to the tracheal bifurcation nodes or to the lymph nodes around the left renal vein was observed. 4. In 61 % of the esophageal cancer cases with a partial bilateral neck dissection, the lymph flow to the bilateral supraclavicular lymph nodes was predominant compared to the upper mediastinum nodes. (author)

  10. Experimental studies of metastases of esophageal carcinoma to lymph nodes

    International Nuclear Information System (INIS)

    Inoue, Kazumasa

    1977-01-01

    Marked progress has been made in surgery for esophageal carcinoma, however, when compared to results of surgery for other carcinomas of the digestive tract, much research remains to be done. The author transplanted VX2 carcinoma, a transplantable tumor of the rabbit, to the esophagus in attempt to determine the mode of metastases of esophageal carcinoma to lymph nodes and also to observe the effect of chemotherapy (Bleomycin) and radiotherapy (Betatron). Carcinoma of the cervical esophagus metastasized to the cervical lymph nodes and then to the paratracheal lymph nodes. Carcinoma of the upper thoracic esophagus metastasized to the paratracheal lymph nodes and then to the cervical lymph nodes. Carcinoma of the mid-thoracic esophagus metastasized to the intrathoracic lymph nodes and then to the intraperitoneal lymph nodes. Carcinoma of the abdominal esophagus metastasized to the intraperitoneal lymph nodes and then to the intrathoracic lymph nodes. Skipping metastasis was rarely observed. Carcinoma of the thoracic esophagus with metastases of lymph nodes in the cervical or abdominal portion was considerably advanced, therefore it is considered that cleaning of the intrathoracic lymph nodes and simultaneous chemotherapy are required when such cases are encountered clinically. Irradiation resulted in regression in the size of the tumor and metastases to lymph nodes and there was a decrease in metastases to the distant lymph nodes. Effects of irradiation were similar on tumors and lymph nodes with positive metastases located within the field of irradiation. Bleomycin medication resulted in regression in the size of tumor and metastases to lymph nodes. Effects of Bleomycin medication were similar on tumors and lymph nodes with positive metastases. (auth.)

  11. A Longitudinal Comparison of Arm Morbidity in Stage I-II Breast Cancer Patients Treated with Sentinel Lymph Node Biopsy, Sentinel Lymph Node Biopsy Followed by Completion Lymph Node Dissection, or Axillary Lymph Node Dissection

    NARCIS (Netherlands)

    Kootstra, Jan J.; Hoekstra-Weebers, Josette E. H. M.; Rietman, Johan S.; de Vries, Jakob; Baas, Peter C.; Geertzen, Jan H. B.; Hoekstra, Harald J.

    Background. Long-term shoulder and arm function following sentinel lymph node biopsy (SLNB) may surpass that following complete axillary lymph node dissection (CLND) or axillary lymph node dissection (ALND). We objectively examined the morbidity and compared outcomes after SLNB, SLNB + CLND, and

  12. The histogenesis of lymph nodes in rat and rabbit

    NARCIS (Netherlands)

    Eikelenboom, P.; Nassy, J. J.; Post, J.; Versteeg, J. C.; Langevoort, H. L.

    1978-01-01

    The histogenesis of the popliteal lymph node in the rat and the popliteal and inguinal lymph nodes in the rabbit was examined by light microscopy. Special emphasis has been laid on the initial lymphocyte population in the lymph node anlage. In the rat on the seventeenth day of gestation lymphoid

  13. A longitudinal comparison of arm morbidity in stage I-II breast cancer patients treated with sentinel lymph node biopsy, sentinel lymph node biopsy followed by completion lymph node dissection, or axillary lymph node dissection

    NARCIS (Netherlands)

    Kootstra, Jan J.; Hoekstra-Weebers, Josette E.; Rietman, Johan Swanik; de Vries, Jakob; Baas, Peter C.; Geertzen, Jan H.B.; Hoekstra, Harald J.

    2010-01-01

    Background: Long-term shoulder and arm function following sentinel lymph node biopsy (SLNB) may surpass that following complete axillary lymph node dissection (CLND) or axillary lymph node dissection (ALND). We objectively examined the morbidity and compared outcomes after SLNB, SLNB + CLND, and

  14. Effects of a Diphtheria-Tetanus-Acellular Pertussis Vaccine on Immune Responses in Murine Local Lymph Node and Lung Allergy Models▿

    Science.gov (United States)

    Vandebriel, Rob J.; Gremmer, Eric R.; van Hartskamp, Michiel; Dormans, Jan A. M. A.; Mooi, Frits R.

    2007-01-01

    We have previously shown that in mice, diphtheria-tetanus-acellular pertussis (DTaP) vaccination before Bordetella pertussis infection resulted in, besides effective clearance, immediate hypersensitivity (lung eosinophilia, increased total serum immunoglobulin E [IgE], and increased ex vivo Th2 cytokine production by cells from the bronchial lymph nodes). To better appreciate the extent of these findings, we measured DTaP vaccination effects in the local lymph node assay (LLNA) and an ovalbumin (OVA) lung allergy model. In the LLNA, mice were vaccinated or adjuvant treated before being sensitized with trimellitic anhydride (TMA; inducing a Th2-directed response) and dinitrochlorobenzene (DNCB; inducing a Th1-directed response). Compared to the adjuvant-treated controls, the vaccinated mice showed a decreased response to TMA and (to a much lesser extent) an increased response to DNCB. The decreased response to TMA coincided with increased transforming growth factor β levels. With the exception of filamentous hemagglutinin, all vaccine constituents contributed to the decreased response to TMA. In the lung allergy model, sensitization induced OVA-specific IgE, lung pathology (peribronchiolitis, perivasculitis, and hypertrophy of the bronchiolar mucus cells) and increased the number of eosinophils, lymphocytes, and neutrophils in the bronchoalveolar lavage fluid. Vaccination failed to modulate these parameters. In conclusion, although DTaP vaccination may affect the LLNA response, we found no evidence of an effect on lung allergy. PMID:17202304

  15. Investigation of the sensitising and cross-sensitising potential of textile dyes and beta-lactam antibiotics using a biphasic mice local lymph node assay.

    Science.gov (United States)

    Ahuja, Varun; Schreiber, Clemens; Platzek, Thomas; Stahlmann, Ralf

    2009-07-01

    We used a modified protocol of the murine local lymph node assay (LLNA) to study the cross-sensitising potential of (a) textile dye disperse yellow 3 and its metabolite 2-amino-p-cresol, (b) two antibiotics, penicillin G and cefotiam. The test substances were applied in a biphasic manner, i.e. first on the shaved skin of the back followed by application on the dorsal side of the ears after 2 weeks. The end-points analysed included thickness and weight of an ear-biopsy, weight and cell number of the draining lymph node, and lymphocyte cell surface markers analysed by flow-cytometry. Disperse yellow 3 and its metabolite significantly altered the various end-points at both the tested concentrations (0.5 and 1%), thus demonstrating the sensitising potential of the two substances. The cross-sensitisation study showed significant modulation in the tested variables in the treated group as compared to the control, signifying cross-sensitisation potential of the two substances. Penicillin G and cefotiam showed significant changes in various end-points, pointing towards their sensitising potential. However, even at 50% concentration of the beta-lactams no significant change in any end-point indicating absence of cross-reactivity of the antibiotics was noticed. We conclude that a biphasic, modified protocol of the LLNA is a suitable approach to test for a cross-reactivity potential of two related compounds.

  16. Comparative analysis of skin sensitization potency of acrylates (methyl acrylate, ethyl acrylate, butyl acrylate, and ethylhexyl acrylate) using the local lymph node assay.

    Science.gov (United States)

    Dearman, Rebecca J; Betts, Catherine J; Farr, Craig; McLaughlin, James; Berdasco, Nancy; Wiench, Karin; Kimber, Ian

    2007-10-01

    There are currently available no systematic experimental data on the skin sensitizing properties of acrylates that are of relevance in occupational settings. Limited information from previous guinea-pig tests or from the local lymph node assay (LLNA) is available; however, these data are incomplete and somewhat contradictory. For those reasons, we have examined in the LLNA 4 acrylates: butyl acrylate (BA), ethyl acrylate (EA), methyl acrylate (MA), and ethylhexyl acrylate (EHA). The LLNA data indicated that all 4 compounds have some potential to cause skin sensitization. In addition, the relative potencies of these acrylates were measured by derivation from LLNA dose-response analyses of EC3 values (the effective concentration of chemical required to induce a threefold increase in proliferation of draining lymph node cells compared with control values). On the basis of 1 scheme for the categorization of skin sensitization potency, BA, EA, and MA were each classified as weak sensitizers. Using the same scheme, EHA was considered a moderate sensitizer. However, it must be emphasized that the EC3 value for this chemical of 9.7% is on the borderline between moderate (10%) categories. Thus, the judicious view is that all 4 chemicals possess relatively weak skin sensitizing potential.

  17. Primary lymph node responses to mosquito bites.

    Science.gov (United States)

    Mellink, J J; Vos, B J

    1977-03-29

    Post-auricular lymph node responses and changes in fresh weight of thymus and spleen of hamsters and mice at 4 and 8 days after primary exposure of both ears to 20 bites by the mosquito Aedes aegypti were studied quantitatively. In both hosts lymph node changes characteristic of the development of cell-mediated immune responses and those which are believed to lead to antibody production occurred, with the emphasis on the latter phenomena. No reactions of thymus and spleen were observed. The responses recorded are considered to be immunologically specific. In hamsters, but not in mice, the responses related to humoral sensitization coincided in time to a large extent with those of the cell-mediated immune processes. The stronger humoral responses in mice were probably in the first place the result of the relatively higher dosages applied.

  18. Sentinel lymph node concept in oral cancer

    International Nuclear Information System (INIS)

    Hasegawa, Shogo; Omura, Ken; Harada, Hiroyuki; Shimamoto, Hiroaki; Yoshida, Yoshihiko; Uekusa, Masaru; Togawa, Takashi

    2005-01-01

    The cervical lymph node (CLN) status is one of the most important prognostic factors in oral cancer. However, the main method of addressing the CLN depends on diagnostic imaging. Sentinel lymph node (SN) biopsy combined with lymphoscintigraphy may be a minimally invasive technique that samples first-echelon lymph node to predict the need for neck dissection. Focused analysis of the SN is highly accurate in identifying metastases. In this study, we investigate the possibility of identifying the SN in oral cancer and the detection of metastases in SN by HE stain, cytokeratin IHC and cytokeratin 17 reverse transcription polymerase chain reaction (RT-PCR). Twenty-four consecutive patients who had clinically negative CLN underwent SN biopsy, followed by elective neck dissection. SNs were detected by means of mapping with isotope labeling 99m Tc-phytate. All lymph nodes were examined by conventional HE staining for evaluating metastasis. In addition, each SN was cut into multiple sections for cytokeratin IHC staining and for RT-PCR for cytokeratin 17. SNs were identified in 24 (100%) of 24 patients by lymphoscintigraphy and gamma probe. One to seven SNs were identified in each patient. Both HE and immunohistochemical staining of SN identified metastasis in 7 patients (29.2%), and the expression of cytokeratin 17 by RT-PCR of SN was positive in 8 patients (34.8%). No metastases were identified using HE, cytokeratin IHC staining in non-SNs. Neck failure has not developed in 23 (95.8%) of 24 patients. The results strongly suggest the usefulness of the SN concept in oral cancer and for better assessing the status of the CLN. (author)

  19. Lymphoscintigraphic diagnosis of the lymph node metastasis of esophageal cancer

    International Nuclear Information System (INIS)

    Terui, Shoji; Kawai, Hideo; Hirashima, Toshio; Yamaguchi, Hajime; Kato, Hoichi; Iizuka, Norifumi

    1985-01-01

    Lymphoscintigraphy with 99m Tc-labeled rhenium sulfur colloid was performed preoperatively in 30 patients with esopohageal cancer. It showed hot nodes in a total of 267 lymph nodes, 176 mediastinal nodes and 91 celiac artery nodes. Of these 267 nodes, 47 (18 %) were found to have metastasis, including 34 (19 %) mediastinal nodes and 13 (14 %) celiac artery nodes. On the other hand, the number of non-visualized lymph nodes (cold nodes) was 542. Of them, 78 (14 %) had metastasis; 46 (15 %) were mediastinal nodes and 32 (14 %) were celiac artery nodes. (Namekawa, K.)

  20. Retroperitoneal unicentric Castleman's disease (giant lymph node hyperplasia: case report

    Directory of Open Access Journals (Sweden)

    Jaques Waisberg

    Full Text Available CONTEXT AND OBJECTIVE: Castleman's disease, or giant lymph node hyperplasia, is a rare disorder of the lymphoid tissue that causes lymph node enlargement. It is considered benign in its localized form, but aggressive in the multicentric type. The definitive diagnosis is based on postoperative pathological findings. The aim here was to describe a case of retroperitoneal unicentric Castleman's disease in the retroperitoneum. CASE REPORT: A 61-year old white male with weight loss and listlessness presented with moderate arterial hypertension and leukopenia. Abdominal tomography revealed a 5 x 4 x 5 cm oval mass of low attenuation, with inner calcification and intense enhancement on intravenous contrast, located in the retroperitoneal region, between the left kidney and the aorta, at the renal hilus. Exploratory laparotomy revealed a non-pulsatile solid oval mass situated in the retroperitoneum, adjacent to the left renal hilus. The retroperitoneal lesion was removed in its entirety. Examination of frozen samples revealed benign lymph node tissue and histopathological examination of the surgical sample revealed hyaline-vascular giant lymph node hyperplasia (Castleman's disease. The patient was discharged on the 12th day without significant events. Two months after the operation, the patient was readmitted with severe cardiac insufficiency, acute renal failure and bronchopneumonia, which progressed to acute respiratory insufficiency, sepsis and death.

  1. Lymph Node Assessment in Endometrial Cancer: Towards Personalized Medicine

    Directory of Open Access Journals (Sweden)

    Fabien Vidal

    2013-01-01

    Full Text Available Endometrial cancer (EC is the most common malignancy of the female reproductive tract and is increasing in incidence. Lymphovascular invasion and lymph node (LN status are strong predictive factors of recurrence. Therefore, the determination of the nodal status of patients is mandatory to optimally tailor adjuvant therapies and reduce local and distant recurrences. Imaging modalities do not yet allow accurate lymph node staging; thus pelvic and aortic lymphadenectomies remain standard staging procedures. The clinical data accumulated recently allow us to define low- and high-risk patients based on pre- or peroperative findings that will allow the clinician to stratify the patients for their need of lymphadenectomies. More recently, several groups have been introducing sentinel node mapping with promising results as an alternative to complete lymphadenectomy. Finally, the use of peroperative algorithm for risk determination could improve patient's staging with a reduction of lymphadenectomy-related morbidity.

  2. Sentinel lymph node biopsy is indicated for patients with thick clinically lymph node-negative melanoma.

    Science.gov (United States)

    Yamamoto, Maki; Fisher, Kate J; Wong, Joyce Y; Koscso, Jonathan M; Konstantinovic, Monique A; Govsyeyev, Nicholas; Messina, Jane L; Sarnaik, Amod A; Cruse, C Wayne; Gonzalez, Ricardo J; Sondak, Vernon K; Zager, Jonathan S

    2015-05-15

    Sentinel lymph node biopsy (SLNB) is indicated for the staging of clinically lymph node-negative melanoma of intermediate thickness, but its use is controversial in patients with thick melanoma. From 2002 to 2012, patients with melanoma measuring ≥4 mm in thickness were evaluated at a single institution. Associations between survival and clinicopathologic characteristics were explored. Of 571 patients with melanomas measuring ≥4 mm in thickness and no distant metastases, the median age was 66 years and 401 patients (70.2%) were male. The median Breslow thickness was 6.2 mm; the predominant subtype was nodular (45.4%). SLNB was performed in 412 patients (72%) whereas 46 patients (8.1%) presented with clinically lymph node-positive disease and 113 patients (20%) did not undergo SLNB. A positive SLN was found in 161 of 412 patients (39.1%). For SLNB performed at the study institution, 14 patients with a negative SLNB developed disease recurrence in the mapped lymph node basin (false-negative rate, 12.3%). The median disease-specific survival (DSS), overall survival (OS), and recurrence-free survival (RFS) for the entire cohort were 62.1 months, 42.5 months, and 21.2 months, respectively. The DSS and OS for patients with a negative SLNB were 82.4 months and 53.4 months, respectively; 41.2 months and 34.7 months, respectively, for patients with positive SLNB; and 26.8 months and 22 months, respectively, for patients with clinically lymph node-positive disease (Pthick melanoma and a negative SLNB appear to have significantly prolonged RFS, DSS, and OS compared with those with a positive SLNB. Therefore, SLNB should be considered as indicated for patients with thick, clinically lymph node-negative melanoma. © 2015 American Cancer Society.

  3. Mediastinal lymph node detection and station mapping on chest CT using spatial priors and random forest

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Jiamin; Hoffman, Joanne; Zhao, Jocelyn; Yao, Jianhua; Lu, Le; Kim, Lauren; Turkbey, Evrim B.; Summers, Ronald M., E-mail: rms@nih.gov [Imaging Biomarkers and Computer-aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center Building, 10 Room 1C224 MSC 1182, Bethesda, Maryland 20892-1182 (United States)

    2016-07-15

    Purpose: To develop an automated system for mediastinal lymph node detection and station mapping for chest CT. Methods: The contextual organs, trachea, lungs, and spine are first automatically identified to locate the region of interest (ROI) (mediastinum). The authors employ shape features derived from Hessian analysis, local object scale, and circular transformation that are computed per voxel in the ROI. Eight more anatomical structures are simultaneously segmented by multiatlas label fusion. Spatial priors are defined as the relative multidimensional distance vectors corresponding to each structure. Intensity, shape, and spatial prior features are integrated and parsed by a random forest classifier for lymph node detection. The detected candidates are then segmented by the following curve evolution process. Texture features are computed on the segmented lymph nodes and a support vector machine committee is used for final classification. For lymph node station labeling, based on the segmentation results of the above anatomical structures, the textual definitions of mediastinal lymph node map according to the International Association for the Study of Lung Cancer are converted into patient-specific color-coded CT image, where the lymph node station can be automatically assigned for each detected node. Results: The chest CT volumes from 70 patients with 316 enlarged mediastinal lymph nodes are used for validation. For lymph node detection, their system achieves 88% sensitivity at eight false positives per patient. For lymph node station labeling, 84.5% of lymph nodes are correctly assigned to their stations. Conclusions: Multiple-channel shape, intensity, and spatial prior features aggregated by a random forest classifier improve mediastinal lymph node detection on chest CT. Using the location information of segmented anatomic structures from the multiatlas formulation enables accurate identification of lymph node stations.

  4. Mediastinal lymph node detection and station mapping on chest CT using spatial priors and random forest

    International Nuclear Information System (INIS)

    Liu, Jiamin; Hoffman, Joanne; Zhao, Jocelyn; Yao, Jianhua; Lu, Le; Kim, Lauren; Turkbey, Evrim B.; Summers, Ronald M.

    2016-01-01

    Purpose: To develop an automated system for mediastinal lymph node detection and station mapping for chest CT. Methods: The contextual organs, trachea, lungs, and spine are first automatically identified to locate the region of interest (ROI) (mediastinum). The authors employ shape features derived from Hessian analysis, local object scale, and circular transformation that are computed per voxel in the ROI. Eight more anatomical structures are simultaneously segmented by multiatlas label fusion. Spatial priors are defined as the relative multidimensional distance vectors corresponding to each structure. Intensity, shape, and spatial prior features are integrated and parsed by a random forest classifier for lymph node detection. The detected candidates are then segmented by the following curve evolution process. Texture features are computed on the segmented lymph nodes and a support vector machine committee is used for final classification. For lymph node station labeling, based on the segmentation results of the above anatomical structures, the textual definitions of mediastinal lymph node map according to the International Association for the Study of Lung Cancer are converted into patient-specific color-coded CT image, where the lymph node station can be automatically assigned for each detected node. Results: The chest CT volumes from 70 patients with 316 enlarged mediastinal lymph nodes are used for validation. For lymph node detection, their system achieves 88% sensitivity at eight false positives per patient. For lymph node station labeling, 84.5% of lymph nodes are correctly assigned to their stations. Conclusions: Multiple-channel shape, intensity, and spatial prior features aggregated by a random forest classifier improve mediastinal lymph node detection on chest CT. Using the location information of segmented anatomic structures from the multiatlas formulation enables accurate identification of lymph node stations.

  5. Selective Changes in the Immune Profile of Tumor-Draining Lymph Nodes After Different Neoadjuvant Chemoradiation Regimens for Locally Advanced Cervical Cancer

    International Nuclear Information System (INIS)

    Battaglia, Alessandra; Buzzonetti, Alexia; Martinelli, Enrica; Fanelli, Mara; Petrillo, Marco; Ferrandina, Gabriella; Scambia, Giovanni; Fattorossi, Andrea

    2010-01-01

    Purpose: To assess how neoadjuvant chemoradiation regimens modulate the immune system state in tumor-draining lymph nodes (TDLN), in the setting of advanced cervical cancer. Methods and Materials: Tumor-draining lymph nodes of patients undergoing chemotherapy only (nonirradiated, NI-TDLN) and chemoradiation with lower-dose (39.6 Gy, LD-TDLN) and higher-dose radiation (50 Gy, HD-TDLN) were analyzed by multicolor flow cytometry. Results: Enlarging our previous data, LD-TDLN showed features overall indicative of an enhanced antitumor response as compared with NI-TDLN, namely a significant Th1 and Tc1 polarization and a lower amount of the potent CD4 + Foxp3 + CD25 high regulatory T cell (Treg) subset identified by neuropilin-1 expression. Conversely, compared with NI-TDLN, HD-TDLN showed features overall indicative of an impaired antitumor response, namely a significantly inverted CD4/CD8 cell ratio, a higher Nrp1 + Treg frequency, and a higher frequency of CCR4 + Treg, a Treg subset facilitated in migrating out from TDLN to suppress the immune response against distant cancer cells. Moreover, the Th1 and Tc1 polarization induced by LD radiation was lost, and there was an unfavorable tolerogenic/immunogenic dendritic cell ratio compared with LD-TDLN. Conclusions: Even minor differences in radiation dose in neoadjuvant regimens for locally advanced cervical cancer are crucial for determining the balance between a tolerogenic and an efficacious antitumor immune response in TDLN. Because most of the anticancer immune response takes place in TDLN, the present findings also emphasize the importance of chemoradiation protocols in the context of immunotherapeutic trials.

  6. Assessment of the skin sensitization potency of eugenol and its dimers using a non-radioisotopic modification of the local lymph node assay.

    Science.gov (United States)

    Takeyoshi, Masahiro; Noda, Shuji; Yamazaki, Shunsuke; Kakishima, Hiroshi; Yamasaki, Kanji; Kimber, Ian

    2004-01-01

    Allergic contact dermatitis is a serious health problem. There is a need to identify and characterize skin sensitization hazards, particularly with respect to relative potency, so that accurate risk assessments can be developed. For these purposes the murine local lymph node assay (LLNA) was developed. Here, we have investigated further a modi fi cation of this assay, non-radioisotopic LLNA, which in place of tritiated thymidine to measure lymph node cell proliferation employs incorporation of 5-bromo-2'-deoxyuridine. Using this method we have examined the skin sensitizing activity of eugenol, a known human contact allergen, and its dimers 2,2'-dihydroxyl-3,3'-dimethoxy-5,5'-diallyl-biphenyl (DHEA) and 4,5'-diallyl-2'-hydroxy-2,3'-dimethoxy phenyl ether (DHEB). Activity in the guinea pig maximization test (GPMT) also measured. On the basis of GPMT assays, eugenol was classified as a mild skin sensitizer, DHEA as a weak skin sensitizer and DHEB as an extreme skin sensitizer. In the non-radioisotopic LLNA all chemicals were found to give positive responses insofar as each was able to provoke a stimulation index (SI) of >or=3 at one or more test concentrations. The relative skin sensitizing potency of these chemicals was evaluated in the non-radioisotopic LLNA by derivation of an ec(3) value (the concentration of chemical required to provoke an SI of 3). The ec(3) values calculated were 25.1% for eugenol, >30% for DHEA and 2.3% for DHEB. Collectively these data suggest that assessments of relative potency deriving from non-radioisotopic LLNA responses correlate well with evaluations based on GPMT results. These investigations provide support for the proposal that the non-radioisotopic LLNA may serve as an effective alternative to the GPMT where there is a need to avoid the use of radioisotopes. Copyright 2004 John Wiley & Sons, Ltd.

  7. Comparison of BALB/c and CBA/J mice for the local lymph node assay using bromodeoxyuridine with flow cytometry (LLNA: BrdU-FCM).

    Science.gov (United States)

    Lee, Yong Sun; Yi, Jung-Sun; Seo, Souk Jin; Kim, Joo Hwan; Jung, Mi-Sook; Seo, Im-Kwon; Ahn, Ilyoung; Ko, Kyungyuk; Kim, Tae Sung; Lim, Kyung Min; Sohn, Soojung

    2017-02-01

    The local lymph node assay using 5-bromo-2-deoxyuridine (BrdU) with flow cytometry (LLNA: BrdU-FCM) is a modified LLNA that is used to identify skin sensitizers by counting BrdU-incorporated lymph node cells (LNCs) with flow cytometry. Unlike other LLNA methods (OECD TG 429, 442A and 442B) in which the CBA/J mouse strain is used, LLNA: BrdU-FCM was originally designed to be compatible with BALB/c, a mouse strain that is more widely used in many countries. To justify the substitution of CBA/J for BALB/c, the equivalence of the test results between two strains shall be established prior to the official implementation of LLNA: BrdU-FCM. This study aims to compare the test results of LLNA: BrdU-FCM produced in BALB/c mice with those in CBA/J mice for 18 reference substances, including 13 sensitizers and 5 non-sensitizers, listed in OECD Test Guideline 429. Based on the LLNA: BrdU-FCM test procedure, we selected an appropriate solvent and then performed preliminary tests to determine the non-irritating dose ranges for the main study, which revealed the difference in the irritation responses to 8 of the 18 chemicals between the two strains. In the main study, we measured the changes in the number of total LNCs, which indicated differences in the responses to test chemicals between the two strains. However, the stimulation index obtained with the counts of BrdU-incorporated LNCs with 7-AAD using flow cytometry yielded comparable results and 100% concordance between the BALB/c and CBA/J mouse strains was achieved, suggesting that the performance of LLNA: BrdU-FCM using BALB/c mice was equivalent to that with CBA/J mice. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Predictive capacity of a non-radioisotopic local lymph node assay using flow cytometry, LLNA:BrdU-FCM: Comparison of a cutoff approach and inferential statistics.

    Science.gov (United States)

    Kim, Da-Eun; Yang, Hyeri; Jang, Won-Hee; Jung, Kyoung-Mi; Park, Miyoung; Choi, Jin Kyu; Jung, Mi-Sook; Jeon, Eun-Young; Heo, Yong; Yeo, Kyung-Wook; Jo, Ji-Hoon; Park, Jung Eun; Sohn, Soo Jung; Kim, Tae Sung; Ahn, Il Young; Jeong, Tae-Cheon; Lim, Kyung-Min; Bae, SeungJin

    2016-01-01

    In order for a novel test method to be applied for regulatory purposes, its reliability and relevance, i.e., reproducibility and predictive capacity, must be demonstrated. Here, we examine the predictive capacity of a novel non-radioisotopic local lymph node assay, LLNA:BrdU-FCM (5-bromo-2'-deoxyuridine-flow cytometry), with a cutoff approach and inferential statistics as a prediction model. 22 reference substances in OECD TG429 were tested with a concurrent positive control, hexylcinnamaldehyde 25%(PC), and the stimulation index (SI) representing the fold increase in lymph node cells over the vehicle control was obtained. The optimal cutoff SI (2.7≤cutoff <3.5), with respect to predictive capacity, was obtained by a receiver operating characteristic curve, which produced 90.9% accuracy for the 22 substances. To address the inter-test variability in responsiveness, SI values standardized with PC were employed to obtain the optimal percentage cutoff (42.6≤cutoff <57.3% of PC), which produced 86.4% accuracy. A test substance may be diagnosed as a sensitizer if a statistically significant increase in SI is elicited. The parametric one-sided t-test and non-parametric Wilcoxon rank-sum test produced 77.3% accuracy. Similarly, a test substance could be defined as a sensitizer if the SI means of the vehicle control, and of the low, middle, and high concentrations were statistically significantly different, which was tested using ANOVA or Kruskal-Wallis, with post hoc analysis, Dunnett, or DSCF (Dwass-Steel-Critchlow-Fligner), respectively, depending on the equal variance test, producing 81.8% accuracy. The absolute SI-based cutoff approach produced the best predictive capacity, however the discordant decisions between prediction models need to be examined further. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Preoperative diagnosis of lymph node metastasis in thoracic esophageal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Eguchi, Reiki; Yamada, Akiyoshi; Ueno, Keiko; Murata, Yoko [Tokyo Women`s Medical Coll. (Japan)

    1996-10-01

    From 1994 to 1995, to evaluate the utility of preoperative CT, EUS (endoscopic ultrasonography) and US in the diagnosis of lymph node metastasis in thoracic esophageal cancer, 94 patients with thoracic esophageal cancer who underwent esophagectomy were studied clinicopathologically. The sensitivity of EUS diagnosis of upper mediastinal lymph node metastasis (85%), left-sided paragastrin lymph node metastasis (73-77%), and especially lower paraesophageal lymph node metastasis (100%) were good. But due to their low-grade specificity in EUS diagnosis, their overall accuracy was not very good. On the other hand, the overall accuracy of the CT diagnosis of lymph node metastasis was fine. However, sensitivity, the most important clinical factor in the CT diagnosis of lymph node metastasis was considerably inferior to EUS. The assessment of the diagnosis of lymph node metastasis around the tracheal bifurcation and the pulmonary hilum and the left para-cardial lesion by CT or EUS was poor. It was concluded that lymph node metastasis of these area must be the pitfall in preoperative diagnosis. The average diameter of the lymph nodes and the proportion of cancerous tissue in the lymph nodes diagnosed as metastatic lymph nodes by CT was larger than that of the false negative lymph nodes. However, the lymph nodes diagnosed as true positives by EUS showed no such tendency. This must be the reason the sensitivity of the EUS diagnosis and specificity of the CT diagnosis were favorable, but the specificity of the EUS diagnosis and especially the sensitivity of the CT diagnosis were not as good. (author)

  10. Preoperative diagnosis of lymph node metastasis in thoracic esophageal cancer

    International Nuclear Information System (INIS)

    Eguchi, Reiki; Yamada, Akiyoshi; Ueno, Keiko; Murata, Yoko

    1996-01-01

    From 1994 to 1995, to evaluate the utility of preoperative CT, EUS (endoscopic ultrasonography) and US in the diagnosis of lymph node metastasis in thoracic esophageal cancer, 94 patients with thoracic esophageal cancer who underwent esophagectomy were studied clinicopathologically. The sensitivity of EUS diagnosis of upper mediastinal lymph node metastasis (85%), left-sided paragastrin lymph node metastasis (73-77%), and especially lower paraesophageal lymph node metastasis (100%) were good. But due to their low-grade specificity in EUS diagnosis, their overall accuracy was not very good. On the other hand, the overall accuracy of the CT diagnosis of lymph node metastasis was fine. However, sensitivity, the most important clinical factor in the CT diagnosis of lymph node metastasis was considerably inferior to EUS. The assessment of the diagnosis of lymph node metastasis around the tracheal bifurcation and the pulmonary hilum and the left para-cardial lesion by CT or EUS was poor. It was concluded that lymph node metastasis of these area must be the pitfall in preoperative diagnosis. The average diameter of the lymph nodes and the proportion of cancerous tissue in the lymph nodes diagnosed as metastatic lymph nodes by CT was larger than that of the false negative lymph nodes. However, the lymph nodes diagnosed as true positives by EUS showed no such tendency. This must be the reason the sensitivity of the EUS diagnosis and specificity of the CT diagnosis were favorable, but the specificity of the EUS diagnosis and especially the sensitivity of the CT diagnosis were not as good. (author)

  11. EANM practice guidelines for lymphoscintigraphy and sentinel lymph node biopsy in melanoma

    DEFF Research Database (Denmark)

    Bluemel, Christina; Herrmann, Ken; Giammarile, Francesco

    2015-01-01

    PURPOSE: Sentinel lymph node biopsy is an essential staging tool in patients with clinically localized melanoma. The harvesting of a sentinel lymph node entails a sequence of procedures with participation of specialists in nuclear medicine, radiology, surgery and pathology. The aim of this docume...

  12. Intraoperative examination of sentinel lymph nodes using scrape ...

    African Journals Online (AJOL)

    2014-08-03

    Aug 3, 2014 ... Background. In breast cancer, sentinel lymph node biopsy (SLNB) is widely used to assess the axilla when the nodes appear normal on palpation and ultrasonography. When the sentinel lymph nodes (SLNs) are negative, no further dissection is required. Surgical dissection or radiotherapy of the axilla is ...

  13. Intraoperative examination of sentinel lymph nodes using scrape ...

    African Journals Online (AJOL)

    Background. In breast cancer, sentinel lymph node biopsy (SLNB) is widely used to assess the axilla when the nodes appear normal on palpation and ultrasonography. When the sentinel lymph nodes (SLNs) are negative, no further dissection is required. Surgical dissection or radiotherapy of the axilla is indicated for ...

  14. Hidradenocarcinoma of the Scrotum with Lymph Node Metastasis

    OpenAIRE

    Maria Inês Simões; Isabel Marcão; Mário Toscano; Luís Borges

    2018-01-01

    Hidradenocarcinoma is a rare neoplasm of the eccrine cells of the sweat glands, usually asymptomatic with slow growing and higher incidence between 50 and 80 years, occurring in both sexes and preferentially located in the palmar, plantar, frontal, axillary and nuchal regions. It has an aggressive behavior, with high rate of local recurrence and distance metastasis, associated with a poor prognosis. We present a case of hidradenocarcinoma of the scrotum manifested by lymph node metastasis thr...

  15. Histological step sectioning of pelvic lymph nodes increases the number of identified lymph node metastases

    DEFF Research Database (Denmark)

    Engvad, Birte; Poulsen, Mads H; Staun, Pia W

    2014-01-01

    Pathological examinations of lymph nodes (LN) in prostate cancer patients are handled differently at various institutions. The objective of this study is to provide means to improve the guidelines by examining the impact of step sectioning on LN status in patients with intermediate and high...

  16. Critical Issues in Modelling Lymph Node Physiology

    Directory of Open Access Journals (Sweden)

    Dmitry Grebennikov

    2016-12-01

    Full Text Available In this study, we discuss critical issues in modelling the structure and function of lymph nodes (LNs, with emphasis on how LN physiology is related to its multi-scale structural organization. In addition to macroscopic domains such as B-cell follicles and the T cell zone, there are vascular networks which play a key role in the delivery of information to the inner parts of the LN, i.e., the conduit and blood microvascular networks. We propose object-oriented computational algorithms to model the 3D geometry of the fibroblastic reticular cell (FRC network and the microvasculature. Assuming that a conduit cylinder is densely packed with collagen fibers, the computational flow study predicted that the diffusion should be a dominating process in mass transport than convective flow. The geometry models are used to analyze the lymph flow properties through the conduit network in unperturbed- and damaged states of the LN. The analysis predicts that elimination of up to 60%–90% of edges is required to stop the lymph flux. This result suggests a high degree of functional robustness of the network.

  17. Inflammatory myofibroblastic tumor of inguinal lymph nodes, simulating lymphoma

    Directory of Open Access Journals (Sweden)

    Akansha Gandhi

    2015-01-01

    Full Text Available Multiple enlarged lymph nodes in an elderly female patient can have varied etiologies as well as histologic pictures. We are presenting the case of a 53-year-old female who presented with inguinal lymphadenopathy with fever, which was clinically misconstrued as lymphoma. Cytology could not exclude a lymphoma. Histology led to the unusual diagnosis of inflammatory myofibroblastic tumor of lymph node in this case. Inflammatory myofibroblastic tumor of the lymph node is a rare, distinctive reactive proliferative pattern in the lymph node which involves proliferation of the connective tissue elements of the lymph node, admixed with lymphocytes, plasma cells, eosinophils, and histiocytes. Multiple etiologic agents have been suggested in existing literature. Despite extensive search, no definite attributable cause could be sought. It is now widely accepted that inflammatory pseudotumor of the lymph node is a non-neoplastic proliferation which has a benign clinical course and excellent prognosis after surgical resection.

  18. Para-aortic lymph node radiation in advanced cervical cancer

    International Nuclear Information System (INIS)

    Emami, B.; Watring, W.G.; Tak, W.; Anderson, B.; Piro, A.J.

    1980-01-01

    Thirty-six patients with advanced carcinoma of the uterine cervix and with iliac or para-aortic nodes interpreted as un-equivocally positive on lymphangiography have received radiation therapy to the para-aortic area at the Department of Therapeutic Radiology at Tufts-New England Medical Center Hospital. Of 29 patients who received para-aortic area irradiation as part of their initial treatment, local control was achieved in 18 patients (62%). Overall, four patients developed major complications requiring surgical intervention. Detailed results and our current pre-treatment evaluation policy including lymphangiography, percutaneous needle biopsy and selective extra-peritoneal lymph node biopsy will be discussed

  19. Sentinel lymph node detection in canine oncological patients

    International Nuclear Information System (INIS)

    Balogh, L.; Andocs, G.; Mathe, D.

    2002-01-01

    Sentinel lymph node detection was investigated in dogs with spontaneously occurring tumours. In this pilot study, 24 client-owned spontaneously tumorous dogs presented for sentinel lymph node detection. A multiple method was used with a nuclear medicine technique (injection of 99mT c human serum albumin colloid) with scintigraphy and intraoperative guidance, and blue dye injection. Of the 35 lymph nodes histologically demonstrated to contain metastases, 34 (97%) were found by radioguided surgery, which means that one would have been missed in the intraoperative localisation process; 31 nodes (89%) were clearly visualised in the gamma camera images; only 27 (77%) were blue-stained by vital dye; a mere 8 lymph nodes (23%) were enlarged and therefore easily detectable by palpation. Data obtained from the harmless application of the sentinel node concept are useful for the radiopharmaceutist. The sentinel lymph node concept is well applicable in the veterinary clinic. (author)

  20. Clinical significance of lymph node metastasis in gastric cancer

    Science.gov (United States)

    Deng, Jing-Yu; Liang, Han

    2014-01-01

    Gastric cancer, one of the most common malignancies in the world, frequently reveals lymph node, peritoneum, and liver metastases. Most of gastric cancer patients present with lymph node metastasis when they were initially diagnosed or underwent surgical resection, which results in poor prognosis. Both the depth of tumor invasion and lymph node involvement are considered as the most important prognostic predictors of gastric cancer. Although extended lymphadenectomy was not considered a survival benefit procedure and was reported to be associated with high mortality and morbidity in two randomized controlled European trials, it showed significant superiority in terms of lower locoregional recurrence and disease related deaths compared to limited lymphadenectomy in a 15-year follow-up study. Almost all clinical investigators have reached a consensus that the predictive efficiency of the number of metastatic lymph nodes is far better than the extent of lymph node metastasis for the prognosis of gastric cancer worldwide, but other nodal metastatic classifications of gastric cancer have been proposed as alternatives to the number of metastatic lymph nodes for improving the predictive efficiency for patient prognosis. It is still controversial over whether the ratio between metastatic and examined lymph nodes is superior to the number of metastatic lymph nodes in prognostic evaluation of gastric cancer. Besides, the negative lymph node count has been increasingly recognized to be an important factor significantly associated with prognosis of gastric cancer. PMID:24744586

  1. X-ray appearance of intrathoracic lymph nodes in lymphogranulomatosis

    International Nuclear Information System (INIS)

    Zagorodskaya, M.M.; Antonova, R.A.

    1980-01-01

    Analysis of clinico-roentgenological data obtained when examining 174 patients with lymphogranulomatosis is carried out. Roentgenological semiotics of the lesions of intrathoracic lymp nodes according to the Rouviere classification supplemented by Zhdanov has been specified. Technique of layer-by-layer examination with an account of roentgenotopography of intrathoracic lymph nodes promoting to their determination is developed. Dynamics of the lymph node changes under treatment is traced. Rarely occurring wide-spread decalcification of prevascular nodes after the radiotherapy is described

  2. SENTINEL LYMPH NODE CONCEPT IN DIFFERENTIATED THYROID CANCER

    Directory of Open Access Journals (Sweden)

    Markovic Ivan

    2014-12-01

    Full Text Available Introduction: Differentiated thyroid carcinoma (DTC account up to 90% of all thyroid malignacies, and represents the most common malignant tumors of endocrine system. The incidence of papillary thyroid carcinoma (PTC, especially small tumors is rapidly increasing during past three decades. At the time of diagnosis, the incidence of lymph node metastases (LNM ranges from 80 to 90%. During the last 15 years, LNM were recognized as bad prognostic factor for both local-regional relapse (LRR and cancer specific survival. There is general agreement that neck dissections are indicated in cases of clinically apparent LNM. The subject of the current controversy is the surgical treatment of occult LNM that remain unrecognized on preoperative diagnosis (cN0. The extent of operations of the lymph nodes ranges from “wait and see” so-called “Western school” principle substantiated the role of applying ablative I131therapy and frequency peroperative complications (recurrent laryngeal nerve injury and hypoparathyroidism, especially for less experienced teams to mutual prophylactic dissection of the central and lateral compartments so-called “Japanese school” due to the limited use of radioactive iodine therapy and significantly lower operating morbidity if dissetion was done during primary operation. Despite high prevalence of occult LNM, existing controversies regarding diagnosis, longterm prognostic impact and extent of lymph node surgery, motivated some authors to apply consept of sentinel lymph node biopsy (SLNb in DTC, taking into account excellent results of SLN concept in breast cancer and skin melanoma. This review presents the summarized results of relevant studies and three meta-analysis of accuracy and applicability of SLN concept in patients with differentiated thyroid carcinoma.

  3. Prognosis comparison of three-dimensional conformal radiotherapy/intensity modulated radiation therapy for esophageal carcinoma with local regional lymph node metastasis

    International Nuclear Information System (INIS)

    Wang Yuxiang; Wang Jun; Wang Yi; Tian Dandan; Yang Jie; Zhu Shuchai

    2011-01-01

    Objective: To explore the prognosis and related factor of esophageal carcinoma with locoregional lymph node metastasis (N 1 ) treated with three-dimensional conformal radiotherapy (3DCRT) or intensity modulated radiation therapy (IMRT). Methods: From January 2001 to December 2008, 60 patients of esophageal carcinoma with local regional lymph node metastasis were treated with 3DCRT and 52 with IMRT. For all patients,dose of tumor was 56 - 70 Gy/28 - 35 fraction/5.6 - 7.0 weeks. Among them, 58 cases was treated with chemotherapy including cisplatin and 5-fluorouracil; 40 with concurrent chemoradiotherapy and 18 with sequential radiotherapy and chemotherapy. Results: After radiotherapy,the total efficiency rate was 98.2%, 96.7% in 3DCRT and 100% in IMRT (χ 2 =1.77, P =0.184). The follow-up rate was 99.1%. The number of patients completed follow-up were 68 and 53, respectively at 2-year and 3-year. The 1 and 3-year overall survival rates were 62.5%, 23.7%, respectively; the median survival time was 17 months. The 1 and 3-year survival rates and median were 52%, 19% and 12.4 months in 3DCRT and 75%, 40% and 17 months in IMRT, respectively (χ 2 =4.74, P =0.030). The 1 and 3-year free-recurrence survival rates were 64%, 45% in 3DCRT and 72%, 59% in IMRT (χ 2 =2.27, P =0.132), respectively. With univariate analysis, for female, ages ≤ 65, tumor located in cervical and upper-thoracic, >5 cm lesion length in barium esophagogram, ≤4 cm the largest diameter of lesion in CT scanning image, T 4 stage, or semiliquid or liquid diet before radiotherapy, survival rate were higher in IMRT than in 3DCRT group (χ 2 =4.63, 5.56, 7.19, 5.08, 4.43, 4.48, 8.25; P=0.031, 0.018, 0.007, 0.025, 0.035, 0.034, 0.004, respectively); but for male, ages > 65, tumor located in middle and lower-thoracic, ≤5 cm lesion length in barium esophagogram, >4 cm the largest diameter of lesion in CT scanning image, T 1-3 stage, or normal diet before radiotherapy, chemotherapy and dose of radiotherapy

  4. Lymph Node Failure Pattern and Treatment Results of Esophageal Cancer Patients Treated with Definitive Radiotherapy

    International Nuclear Information System (INIS)

    Lee, Sun Young; Kwon, Hyoung Cheol; Kim, Jung Soo; Lee, Heui Kwan; Kim, Soo Geon

    2008-01-01

    We evaluated the failure pattern of the celiac axis, gastric lymph node, and treatment outcome in the upper and mid-esophageal region of cancer patients treated by definitive radiotherapy, except when treating the celiac axis and gastric lymph node for treatment volume, retrospectively. Materials and Methods: The study constituted the evaluation 108 patients with locally advanced esophageal cancer receiving radiotherapy or a combination of radiotherapy and chemotherapy at Chonbuk National University Hospital from January 1986 to December 2006. In total, 82 patients treated by planned radiotherapy, except when treating the celiac axis and gastric lymph node for treatment volume, were analysed retrospectively. The study population consisted of 78 men and 2 women (mean age of 63.2 years). In addition, 51 patients received radiotherapy alone, whereas 31 patients received a combination of radiation therapy and chemotherapy. The primary cancer sites were located in the upper portion (17 patients), and mid portion (65 patients), respectively. Further, the patients were in various clinical stages including T1N0-1M0 (7 patients), T2N0-1M0 (18 patients), T3N0-1M0 (44 patients) and T4N0-1M0 (13 patients). The mean follow up period was 15 months. Results: The various treatment outcomes included complete response (48 patients), partial response (31 patients) and no response (3 patients). The failure patterns of the lymph node were comprised of the regional lymph node (23 patients) and the distance lymph node which included celiac axis and gastric lymph node (13 patients). However, metastasis was not observed in the regional and distant lymph node in 10 patients, whereas 36 patients were not evaluated. Furthermore, of the 13 patients who developed celiac axis and gastric lymph node metastases, 3 were in stage T1N0-1M0 and 10 were in stage T2-4N0-1M0. A complete response appeared in 12 patients, whereas a partial response appeared in 1 patient. The mean survival time of the

  5. Skin sensitization potency of methyl methacrylate in the local lymph node assay: comparisons with guinea-pig data and human experience.

    Science.gov (United States)

    Betts, Catherine J; Dearman, Rebecca J; Heylings, Jon R; Kimber, Ian; Basketter, David A

    2006-09-01

    There is compelling evidence that contact allergens differ substantially (by 4 or 5 orders of magnitude) with respect to their inherent skin-sensitizing potency. Relative potency can now be measured effectively using the mouse local lymph node assay (LLNA) and such data form the basis of risk assessment and risk management strategies. Such determinations also facilitate distinctions being drawn between the prevalence of skin sensitization to a particular contact allergen and inherent potency. The distinction is important because chemicals that are implicated as common causes of contact allergy are not necessarily potent sensitizers. One example is provided by nickel that is undoubtedly a common cause of allergic contact dermatitis, but is a comparatively weak sensitizer in predictive tests. In an attempt to explore other examples of contact allergens where there may exist a discrepancy between prevalence and potency, we describe here analyses conducted with methyl methacrylate (MMA). Results of LLNA studies have been interpreted in the context of historical clinical data on occupational allergic contact dermatitis associated with exposure to MMA.

  6. Unsaturated fatty acids show clear elicitation responses in a modified local lymph node assay with an elicitation phase, and test positive in the direct peptide reactivity assay.

    Science.gov (United States)

    Yamashita, Kunihiko; Shinoda, Shinsuke; Hagiwara, Saori; Miyazaki, Hiroshi; Itagaki, Hiroshi

    2015-12-01

    The Organisation for Economic Co-operation and Development (OECD) Test Guidelines (TG) adopted the murine local lymph node assay (LLNA) and guinea pig maximization test (GPMT) as stand-alone skin sensitization test methods. However, unsaturated carbon-carbon double-bond and/or lipid acids afforded false-positive results more frequently in the LLNA compared to those in the GPMT and/or in human subjects. In the current study, oleic, linoleic, linolenic, undecylenic, fumaric, maleic, and succinic acid and squalene were tested in a modified LLNA with an elicitation phase (LLNA:DAE), and in a direct peptide reactivity assay (DPRA) to evaluate their skin-sensitizing potential. Oleic, linoleic, linolenic, undecylenic and maleic acid were positive in the LLNA:DAE, of which three, linoleic, linolenic, and maleic acid were positive in the DPRA. Furthermore, the results of the cross-sensitizing tests using four LLNA:DAE-positive chemicals were negative, indicating a chemical-specific elicitation response. In a previous report, the estimated concentration needed to produce a stimulation index of 3 (EC3) of linolenic acid, squalene, and maleic acid in the LLNA was LLNA. However, the skin-sensitizing potential of all LLNA:DAE-positive chemicals was estimated as weak. These results suggested that oleic, linoleic, linolenic, undecylenic, and maleic acid had skin-sensitizing potential, and that the LLNA overestimated the skin-sensitizing potential compared to that estimated by the LLNA:DAE.

  7. Skin sensitization potency of isoeugenol and its dimers evaluated by a non-radioisotopic modification of the local lymph node assay and guinea pig maximization test.

    Science.gov (United States)

    Takeyoshi, Masahiro; Iida, Kenji; Suzuki, Keiko; Yamazaki, Shunsuke

    2008-05-01

    Allergic contact dermatitis is the serious unwanted effect arising from the use of consumer products such as cosmetics. Isoeugenol is a fragrance chemical with spicy, carnation-like scent, is used in many kinds of cosmetics and is a well-known moderate human sensitizer. It was previously reported that the dimerization of eugenol yielded two types of dimer possessing different sensitization potencies. This study reports the differences in skin sensitization potencies for isoeugenol and two types of dimer, beta-O-4-dilignol and dehydrodiisoeugenol (DIEG), as evaluated by the non-radioisotopic local lymph node assay (non-RI LLNA) and guinea pig maximization test. In the guinea pig maximization test, isoeugenol, beta-O-4-dilignol and DIEG were classified as extreme, weak and moderate sensitizers, respectively. As for the results of non-RI LLNA, the EC3 for isoeugenol, beta-O-4-dilignol and DIEG were calculated as 12.7%, >30% and 9.4%, respectively. The two types of isoeugenol dimer showed different sensitizing activities similar to the case for eugenol dimers. A reduction of sensitization potency achieved by dimerization may lead to developing safer cosmetic ingredients. Isoeugenol dimers are not currently used for fragrance chemicals. However, the dimerization of isoeugenol may yield a promising candidate as a cosmetic ingredient with low sensitization risk. The data may also provide useful information for the structure-activity relationship (SAR) in skin sensitization. Copyright (c) 2007 John Wiley & Sons, Ltd.

  8. Analysis of the Local Lymph Node Assay (LLNA) variability for assessing the prediction of skin sensitisation potential and potency of chemicals with non-animal approaches.

    Science.gov (United States)

    Dumont, Coralie; Barroso, João; Matys, Izabela; Worth, Andrew; Casati, Silvia

    2016-08-01

    The knowledge of the biological mechanisms leading to the induction of skin sensitisation has favoured in recent years the development of alternative non-animal methods. During the formal validation process, results from the Local Lymph Node Assay (LLNA) are generally used as reference data to assess the predictive capacity of the non-animal tests. This study reports an analysis of the variability of the LLNA for a set of chemicals for which multiple studies are available and considers three hazard classification schemes: POS/NEG, GHS/CLP and ECETOC. As the type of vehicle used in a LLNA study is known to influence to some extent the results, two analyses were performed: considering the solvent used to test the chemicals and without considering the solvent. The results show that the number of discordant classifications increases when a chemical is tested in more than one solvent. Moreover, it can be concluded that study results leading to classification in the strongest classes (1A and EXT) seem to be more reliable than those in the weakest classes. This study highlights the importance of considering the variability of the reference data when evaluating non-animal tests. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  9. Chemical applicability domain of the local lymph node assay (LLNA) for skin sensitisation potency. Part 4. Quantitative correlation of LLNA potency with human potency.

    Science.gov (United States)

    Roberts, David W; Api, Anne Marie

    2018-07-01

    Prediction of skin sensitisation potential and potency by non-animal methods is the target of many active research programmes. Although the aim is to predict sensitisation potential and potency in humans, data from the murine local lymph node assay (LLNA) constitute much the largest source of quantitative data on in vivo skin sensitisation. The LLNA has been the preferred in vivo method for identification of skin sensitising chemicals and as such is potentially valuable as a benchmark for assessment of non-animal approaches. However, in common with all predictive test methods, the LLNA is subject to false positives and false negatives with an overall level of accuracy said variously to be approximately 80% or 90%. It is also necessary to consider the extent to which, for true positives, LLNA potency correlates with human potency. In this paper LLNA potency and human potency are compared so as to express quantitatively the correlation between them, and reasons for non-agreement between LLNA and human potency are analysed. This leads to a better definition of the applicability domain of the LLNA, within which LLNA data can be used confidently to predict human potency and as a benchmark to assess the performance of non-animal approaches. Copyright © 2018. Published by Elsevier Inc.

  10. The local lymph node assay compared with the human maximization test as an indicator of allergic potency in humans using patch test clinic populations.

    Science.gov (United States)

    Zaghi, Danny; Maibach, Howard I

    2009-01-01

    The human maximization test (HMT) is a method to evaluate potency in humans, while the local lymph node assay (LLNA) is a test method that allows for the measuring of the allergic potency of a substance in a rodent. It has been proposed that an EC3 value (the value obtained by the LLNA test, ie, the concentration of an allergen leading to a 3-fold increase of baseline proliferation rate) would be a reliable indicator for a compound's allergic potency in humans. This paper compares the correlation between the EC3 value of a compound and its allergic occurrence in the general population with the correlation between the HMT of the compound and its allergic occurrence in the general population, to determine the relationship to potency. The correlation values when outliers were removed from the sample were -0.56 and -0.71 for LLNA and HMT, respectively, suggesting that there is a possible 20% error margin in LLNA's ability to predict potency. The data also suggest that other factors (such as exposure) could play up to a 30% role in the determination of allergic occurrence in the general population. The potency assays might be made more clinically relevant for predicting allergic frequencies by including a frequency factor and other factors in its dermatotoxicological interpretation.

  11. Segmentation of 3-D High-Frequency Ultrasound Images of Human Lymph Nodes Using Graph Cut With Energy Functional Adapted to Local Intensity Distribution.

    Science.gov (United States)

    Kuo, Jen-Wei; Mamou, Jonathan; Wang, Yao; Saegusa-Beecroft, Emi; Machi, Junji; Feleppa, Ernest J

    2017-10-01

    Previous studies by our group have shown that 3-D high-frequency quantitative ultrasound (QUS) methods have the potential to differentiate metastatic lymph nodes (LNs) from cancer-free LNs dissected from human cancer patients. To successfully perform these methods inside the LN parenchyma (LNP), an automatic segmentation method is highly desired to exclude the surrounding thin layer of fat from QUS processing and accurately correct for ultrasound attenuation. In high-frequency ultrasound images of LNs, the intensity distribution of LNP and fat varies spatially because of acoustic attenuation and focusing effects. Thus, the intensity contrast between two object regions (e.g., LNP and fat) is also spatially varying. In our previous work, nested graph cut (GC) demonstrated its ability to simultaneously segment LNP, fat, and the outer phosphate-buffered saline bath even when some boundaries are lost because of acoustic attenuation and focusing effects. This paper describes a novel approach called GC with locally adaptive energy to further deal with spatially varying distributions of LNP and fat caused by inhomogeneous acoustic attenuation. The proposed method achieved Dice similarity coefficients of 0.937±0.035 when compared with expert manual segmentation on a representative data set consisting of 115 3-D LN images obtained from colorectal cancer patients.

  12. Sentinel lymph node biopsy in breast cancer and melanoma

    NARCIS (Netherlands)

    Doting, Meintje Hylkje Edwina

    2007-01-01

    Summary and conclusions In the introduction, a short overview of the development of the sentinel lymph node biopsy concept is presented. In addition to melanoma and breast cancer, the usefulness of sentinel lymph node biopsy as a surgical assessment method for squamous cell carcinoma of penis and

  13. Sentinel lymph nodes in cancer of the oral cavity

    DEFF Research Database (Denmark)

    Thomsen, Jørn Bo; Christensen, Rikke Kølby; Sørensen, Jens Ahm

    2007-01-01

    when compared with (B) step-sectioning and immunostaining of the entire sentinel lymph node at 250 microM levels. METHODS: Forty patients with T1/T2 cN0 oral cancer were enrolled. Three patients were excluded. In one patient no sentinel lymph node was identified. The remaining two had unidentified...

  14. Effects of transuranics on pulmonary lymph nodes of rodents

    International Nuclear Information System (INIS)

    Sanders, C.L.

    1976-01-01

    Pulmonary lymph nodes have been suggested as the ''critical'' tissue for insoluble, inhaled transuranic compounds owing to the high concentration of transuranics in these lymph nodes. About 800 rats were given from 0.2 to 3600 nCi of 238 PuO 2 or 239 PuO 2 by inhalation, intratracheal instillation, intrapleural injection, or intraperitoneal injection. From about 1 to 10 percent of deposited plutonium was translocated to pulmonary lymph nodes, the amount depending on the time after deposition and the route of administration; 238 PuO 2 was cleared from pulmonary lymph nodes faster than 239 PuO 2 owing to the greater in vivo solubility of 238 PuO 2 . No primary tumors of pulmonary lymph nodes were observed, indicating that this tissue was not the critical tissue for carcinogenic induction

  15. [Prediction of lateral lymph node metastasis by magnetic resonance imaging].

    Science.gov (United States)

    Hatano, Satoshi; Kumamoto, Kensuke; Ishibashi, Keiichiro; Ishiguro, Toru; Ohsawa, Tomonori; Okada, Norimichi; Nakata, Hiroshi; Yokoyama, Masaru; Haga, Norihiro; Ishida, Hideyuki

    2010-11-01

    Considering the advantages and disadvantages of lateral lymph node dissection in patients with advanced lower rectal cancer, it would be ideal to select candidates for lateral lymph node dissection by preoperative imaging study including magnetic resonance imaging(MRI). We have reported that the cut-off value of minimal diameter of lateral lymph node could be set at 6 mm for indication of lateral lymph node dissection. In the present study, we evaluated whether it would be appropriate to apply the cut-off value of minimal diameter of lateral lymph node in MRI. Forty-four patients with advanced lower rectal cancer underwent a curative surgery with lateral lymph node dissection or sampling from 1997 to 2009 in our institute. Among them, 25 patients received MRI preoperatively and analyzed. The images were obtained by a sagittal method that was diagonal along sacro-iliac joint with 5 mm thick sections. Lateral lymph node metastasis was detected in 5 cases, one side in 4 cases and both sides in 1 case. The sensitivity, specificity, positive predict value, and accuracy for predicting metastasis was 50%, 90%, 42.9% and 84.8% respectively, when the cut-off value of the minimal diameter was set at 6 mm in MRI. Our results indicated that a 6 mm set as the cut-off value of minimal diameter of lateral lymph node was suitable for the prediction of lateral lymph node metastasis since the accuracy was relatively high (84.8%), though it was hardly to detect metastatic lymph node less than 6 mm.

  16. Prediction of lateral lymph node metastasis by magnetic resonance imaging

    International Nuclear Information System (INIS)

    Hatano, Satoshi; Kumamoto, Kensuke; Ishibashi, Keiichiro

    2010-01-01

    Considering the advantages and disadvantages of lateral lymph node dissection in patients with advanced lower rectal cancer, it would be ideal to select candidates for lateral lymph node dissection by preoperative imaging study including magnetic resonance imaging (MRI). We have reported that the cut-off value of minimal diameter of lateral lymph node could be set at 6 mm for indication of lateral lymph node dissection. In the present study, we evaluated whether it would be appropriate to apply the cut-off value of minimal diameter of lateral lymph node in MRI. Forty-four patients with advanced lower rectal cancer underwent a curative surgery with lateral lymph node dissection or sampling from 1997 to 2009 in our institute. Among them, 25 patients received MRI preoperatively and analyzed. The images were obtained by a sagittal method that was diagonal along sacro-iliac joint with 5 mm thick sections. Lateral lymph node metastasis was detected in 5 cases, one side in 4 cases and both sides in 1 case. The sensitivity, specificity, positive predict value, and accuracy for predicting metastasis was 50%, 90%, 42.9% and 84.8% respectively, when the cut-off value of the minimal diameter was set at 6 mm in MRI. Our results indicated that a 6 mm set as the cut-off value of minimal diameter of lateral lymph node was suitable for the prediction of lateral lymph node metastasis since the accuracy was relatively high (84.8%), though it was hardly to detect metastatic lymph node less than 6 mm. (author)

  17. Sentinel lymph node surgery in prostate cancer using magnetic particles.

    Science.gov (United States)

    Winter, Alexander; Engels, Svenja; Wawroschek, Friedhelm

    2018-03-01

    Superparamagnetic iron oxide nanoparticles (SPIONs) are tested to identify sentinel lymph nodes (SLNs) to exploit the advantages of targeted pelvic SLN dissection (sPLND), while circumventing the disadvantages of established radioactive labeling. Here we review recent studies about sPLND in prostate cancer (PCa), including the first results of SLN detection using intraprostatic SPION-injection. A recent systematic literature review reveals that the diagnostic accuracy of sPLND is comparable with extended PLND (ePLND). sPLND combined with ePLND achieve better node removal by increasing the number of affected nodes. The first sentinel-based nomogram predicting lymph node invasion is established. A sentinel-nomogram update provides comparative predictions relative to ePLND models. sPLND using a magnetometer and SPIONs as a tracer is successful whenever applied to PCa, and SLN identification using MRI after intraprostatic injection of SPIONs is feasible. SLNs are present in an unexpectedly high number outside the ePLND template. SLN detection outside the ePLND template and the increased diagnostic value of sPLND compared with ePLND supports the individualized extension of PLND using sPLND in PCa. SPION-MRI, combined with a hand-held magnetometer, provides a nonradioactive technique for preoperative and intraoperative SLN localization. Further studies are required to evaluate the effects of sPLND on oncological outcomes.

  18. Lymph node metastasis in maxillary sinus carcinoma

    International Nuclear Information System (INIS)

    Le, Q.-T.; Fu, Karen K.; Kaplan, Michael J.; Terris, David J.; Fee, Willard E.; Goffinet, Don R.

    2000-01-01

    Purpose: To evaluate the incidence and prognostic significance of lymph node metastasis in maxillary sinus carcinoma. Methods and Materials: We reviewed the records of 97 patients treated for maxillary sinus carcinoma with radiotherapy at Stanford University and at the University of California, San Francisco between 1959 and 1996. Fifty-eight patients had squamous cell carcinoma (SCC), 4 had adenocarcinoma (ADE), 16 had undifferentiated carcinoma (UC), and 19 had adenoid cystic carcinoma (AC). Eight patients had T2, 36 had T3, and 53 had T4 tumors according to the 1997 AJCC staging system. Eleven patients had nodal involvement at diagnosis: 9 with SCC, 1 with UC, and 1 with AC. The most common sites of nodal involvement were ipsilateral level 1 and 2 lymph nodes. Thirty-six patients were treated with definitive radiotherapy alone, and 61 received a combination of surgical and radiation treatment. Thirty-six patients had neck irradiation, 25 of whom received elective neck irradiation (ENI) for N0 necks. The median follow-up for alive patients was 78 months. Results: The median survival for all patients was 22 months (range: 2.4-356 months). The 5- and 10-year actuarial survivals were 34% and 31%, respectively. Ten patients relapsed in the neck, with a 5-year actuarial risk of nodal relapse of 12%. The 5-year risk of neck relapse was 14% for SCC, 25% for ADE, and 7% for both UC and ACC. The overall risk of nodal involvement at either diagnosis or on follow-up was 28% for SCC, 25% for ADE, 12% for UC, and 10% for AC. All patients with nodal involvement had T3-4, and none had T2 tumors. ENI effectively prevented nodal relapse in patients with SCC and N0 neck; the 5-year actuarial risk of nodal relapse was 20% for patients without ENI and 0% for those with elective neck therapy. There was no correlation between neck relapse and primary tumor control or tumor extension into areas containing a rich lymphatic network. The most common sites of nodal relapse were in the

  19. Adenocarcinoma arising at a colostomy site with inguinal lymph node metastasis: report of a case.

    Science.gov (United States)

    Iwamoto, Masayoshi; Kawada, Kenji; Hida, Koya; Hasegawa, Suguru; Sakai, Yoshiharu

    2015-02-01

    Inguinal lymph node metastasis from adenocarcinoma arising at a colostomy site is extremely rare, and the significance of surgical resection for metastatic inguinal lymph nodes has not been established. An 82-year-old woman who had undergone abdominoperineal resection 27 years earlier was admitted to our hospital complaining of bleeding from a colostomy. Physical examination revealed that a tumor at the colostomy site directly invaded into the peristomal skin, and that a left inguinal lymph node was firm and swollen. Positron emission tomography/computed tomography scan demonstrated accumulation of (18)F-fluorodeoxy glucose into both the colostomy tumor and the left swollen inguinal lymph node, while there was no evidence of metastasis to liver or lungs. She underwent open left hemicolectomy with wide local resection of the colostomy, and dissection of left inguinal lymph nodes. Histological diagnosis was a moderately differentiated adenocarcinoma that directly invaded into the surrounding skin and metastasized to the left inguinal lymph node. The patient has been followed up for >5 years without any sign of recurrence. In general, inguinal lymph node metastasis from colorectal cancers is regarded as a systemic disease with a poor prognosis, and so systemic chemotherapy and radiotherapy, but not surgical lymph node dissection, are recommended. Considering the lymphatic drainage route in the present case, inguinal lymph node metastasis does not represent a systemic disease but rather a sentinel nodal metastasis from adenocarcinoma at a colostomy site. Surgical dissection of metastatic inguinal lymph nodes should be considered to enable a favorable prognosis in the absence of distant metastasis to other organs. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  20. Selective sentinel lymph node biopsy in papillary thyroid carcinoma in patients with no preoperative evidence of lymph node metastasis.

    Science.gov (United States)

    González, Óscar; Zafon, Carles; Caubet, Enric; García-Burillo, Amparo; Serres, Xavier; Fort, José Manuel; Mesa, Jordi; Castell, Joan; Roca, Isabel; Ramón Y Cajal, Santiago; Iglesias, Carmela

    2017-10-01

    Lymphadenectomy is recommended during surgery for papillary thyroid carcinoma when there is evidence of cervical lymph node metastasis (therapeutic) or in high-risk patients (prophylactic) such as those with T3 and T4 tumors of the TNM classification. Selective sentinel lymph node biopsy may improve preoperative diagnosis of nodal metastases. To analyze the results of selective sentinel lymph node biopsy in a group of patients with papillary thyroid carcinoma and no evidence of nodal involvement before surgery. A retrospective, single-center study in patients with papillary thyroid carcinoma and no clinical evidence of lymph node involvement who underwent surgery between 2011 and 2013. The sentinel node was identified by scintigraphy. When the sentinel node was positive, the affected compartment was removed, and when sentinel node was negative, central lymph node dissection was performed. Forty-three patients, 34 females, with a mean age of 52.3 (±17) years, were enrolled. Forty-six (27%) of the 170 SNs resected from 24 (55.8%) patients were positive for metastasis. In addition, 94 (15.6%) out of the 612 lymph nodes removed in the lymphadenectomies were positive for metastases. Twelve of the 30 (40%) low risk patients (cT1N0 and cT2N0) changed their stage to pN1, whereas 12 of 13 (92%) high risk patients (cT3N0 and cT4N0) changed to pN1 stage. Selective sentinel lymph node biopsy changes the stage of more than 50% of patients from cN0 to pN1. This confirms the need for lymph node resection in T3 and T4 tumors, but reveals the presence of lymph node metastases in 40% of T1-T2 tumors. Copyright © 2017 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Evaluation of local immune response to Fasciola hepatica experimental infection in the liver and hepatic lymph nodes of goats immunized with Sm14 vaccine antigen

    Directory of Open Access Journals (Sweden)

    Ricardo E Mendes

    2010-08-01

    Full Text Available Protection against Fasciola hepatica in goats immunized with a synthetic recombinant antigen from Schistosoma mansoni fatty acid-binding protein 14 (rSm14 was investigated by assessing worm burdens, serum levels of hepatic enzymes, faecal egg count and hepatic damage, which was evaluated using gross and microscopic morphometric observation. The nature of the local immune response was assessed by examining the distribution of CD2+, CD4+, CD8+ and γ´+ T lymphocytes along with IgG+, IL-4+ and IFN-γ+ cells in the liver and hepatic lymph nodes (HLN. The goats used consisted of group 1 (unimmunized and uninfected, group 2 [infected control - immunized with Quillaia A (Quil A] and group 3 (immunized with rSm14 in Quil A and infected, each containing seven animals. Immunization with rSm14 in Quil A adjuvant induced a reduction in gross hepatic lesions of 56.6% (p < 0.001 and reduced hepatic and HLN infiltration of CD2+, CD4+, CD8+ and γ´+ T lymphocytes as well as IL-4+ and IFN-γ+ cells (p < 0.05. This is the first report of caprine immunization against F. hepatica using a complete rSm14 molecule derived from S. mansoni. Immunization reduced hepatic damage and local inflammatory infiltration into the liver and HLN. However, considering that Quil A is not the preferential/first choice adjuvant for Sm14 immunization, further studies will be undertaken using the monophosphoryl lipid A-based family of adjuvants during clinical trials to facilitate anti-Fasciolavaccine development.

  2. Annexin A7 suppresses lymph node metastasis of hepatocarcinoma cells in a mouse model

    International Nuclear Information System (INIS)

    Jin, Yanling; Wang, Shaoqing; Chen, Wenjing; Zhang, Jun; Wang, Bo; Guan, Hongwei; Tang, Jianwu

    2013-01-01

    Hepatocellular carcinoma (HCC) is one of the leading causes of cancer death in China. This study investigated the effects of Annexin A7 (ANXA7) on the inhibition of HCC lymph node metastasis in a mouse model. The stable knockup and knockdown of Annexin A7-expressing HCC cells using Annexin A7 cDNA and shRNA vectors, respectively, were injected into a mouse footpad to establish primary and metastatic tumors in mice. On the 14th, 21st, and 28th days after HCC cells inoculation, the mice were sacrificed for inspection of primary and secondary tumors and immunohistochemistry of Annexin A7 expression. The lymph node metastasis rate of the F ANXA7-control group was 77%, and the lymph node metastasis rate of the F ANXA7-down group was 100% (p < 0.05). In contrast, the lymph node metastasis rate of the P ANXA7-up group was 0% and that of the P ANXA7-control group was 36% (p < 0.05). Furthermore, immunohistochemistry experiments revealed that the subcellular localization of Annexin A7 protein in both primary and lymph node-metastasized tumors was mainly in the cytosol. In addition, the expression of the 47 kDa and 51 kDa isoforms of Annexin A7 protein changed during tumor progression. This study indicated that Annexin A7 expression was able to inhibit HCC lymph node metastasis, whereas knockdown of Annexin A7 expression significantly induced HCC metastasis to local lymph nodes

  3. Lymph-scintigraphic identification of sentinel lymph nodes in breast carcinoma and malignant melanoma patients

    International Nuclear Information System (INIS)

    Sergieva, S; Bajchev, G.; Aleksandrova, E.

    1999-01-01

    It is the purpose of the study to assay the possibilities of lymphoscintigraphy (LS) in evaluating local lymphatic drainage and sentinel lymph nodes (SLNs) location in patients presenting breast carcinoma and malignant melanoma. Twenty-nine women with breast carcinoma (TI-IIa clinical stage, age range 31 to 74 y) and 7 patients with malignant melanoma (Clark III-V) are scanned in the period 1997 through 1998. 99m Tc-sulphur colloid (Solco Lymphoscint, SORIN) with mean size of particles 50 nm is used. Planar images are obtained at 20 and 120-180 min after sc injection in the region of primary tumor, at mean radioactivity 20 MBq per injection site in a volume 0.2-0.3 ml. In the breast cancer patients Patent Blue V or Mitoxantrone is injected around the tumor twice - 20 and 3 to 1/2 hours prior to surgery. In malignant melanoma patients immunoscintigraphy using 740 MBq 99m Tc-anti-melanoma monoclonal antibodies (Technemab-K-1) is carried out before lymph node dissection. SLNs are visualized in 25 patients (86.2%) with breast cancer. In 21 (72%) patients to 4 SLNs are scanned in level I of the local axillary region, in 4 cases (14%) - in the region of axillary level II, in one female patient (3%) - at axillary level III, and in 3 patients (10%) i psilateral internal mammary lymph nodes are scanned. Two patients are suspected for the so-called s kip t ype of tumor lymphatic dissemination. In 4 patients no SLN images are visible. In breast carcinoma patients SLN are additionally stained blue and following intraoperative revision, evidence of metastatic involvement is established in 12 instances (41.3%). In 3 patients with melanoma in the abdomen and back SLNs are located in the region of inguinal and axillary lymph node groups, while in 3 patients presenting lesions to the surface of extremities only local lymph nodes draining the melanoma are visualized. Immunoscintigraphy shows enhanced uptake in the region of SLNs in 3 cases with the metastatic changes in them

  4. [Intraoperative detection of the sentinel lymph nodes in lung cancer].

    Science.gov (United States)

    Akopov, A L; Papayan, G V; Chistyakov, I V

    2015-01-01

    An analysis of the scientific data was made. It was used the literature devoted to the intraoperative visualization of the sentinel lymph nodes in patients with lung cancer. Correct detection of such lymph nodes with following pathologic investigation allowed limiting the volume of lympho-dissection in a number of patients. There is the possibility of maximal in-depth study of the sentinel lymph nodes by purposeful application of most sensible pathologic and molecular methods for detection their micrometastatic lesions. At the same time the treatment strategy and prognosis could be determined. The authors present the results of an application of dye techniques, radioactive preparation and fluorescence imaging for sentinel lymph node detection. Advantages and disadvantages of the methods are shown in the article. There are validated the prospects of technical development, study of information value of new applications and the most perspective method of fluorescence indocyanine green visualization by lymph outflow.

  5. Elastography in the assessment of sentinel lymph nodes prior to dissection

    Energy Technology Data Exchange (ETDEWEB)

    Tourasse, Christophe, E-mail: christophe.tourasse@radiologie-lyon.com [Radiology Department, Hopital Prive Jean Mermoz, 55 avenue Jean Mermoz, 69008 Lyon (France); Denier, Jean Francois [Anatomopathology Department, Technipath, 41 allee des Cypres, 69760 Limonest (France); Awada, Azzam; Gratadour, Anne-Christel; Nessah-Bousquet, Karima [Gynaecological and Breast Surgery Department, Hopital Prive Jean Mermoz, 69008 Lyon (France); Gay, Joeel [SuperSonic Imagine, Les Jardins de la Duranne - Bat. F, 510, rue Rene Descartes, 13857 Aix-en-Provence Cedex (France)

    2012-11-15

    Objective: Breast cancer starts as a local tumor but can become metastatic and spread via the lymph nodes. When the pre-operative assessment of the axillary lymph nodes is negative patients generally undergo sentinel node biopsy (SNB), followed by a secondary surgical axillary lymph node dissection (ALND) if the SNB is positive. The extemporaneous anatomo-pathological analysis of the sentinel lymph node enables metastases to be detected and an ALND at the same time of the SNB. The goal of this study was to evaluate the added value of ShearWave Elastography (SWE), compared with the conventional pre-operative assessment, in the screening of sentinel lymph nodes with a high metastatic risk, which could then benefit from an extemporaneous anatomo-pathological analysis. Patients and methods: Women undergoing breast surgery with SNB were prospectively enrolled. Before surgery, they underwent ultrasound and elastography imaging of axillary lymph nodes using the SuperSonic Imagine device and its ShearWave Trade-Mark-Sign elastography mode (SWE Trade-Mark-Sign ). The results obtained were compared to the immunohistochemical results for the removed lymph nodes. Results: 65 patients were enrolled. From the 103 lymph nodes examined by elastography and the 185 lymph nodes removed we were able to pair 81; 70 were healthy and 11 were malignant. The stiffness measurements (mean and maximal values) were significantly different between the healthy and metastatic lymph nodes, (p < 0.05). The areas under the ROC curves were 0.76 (95% confidence interval (CI): 0.58-0.94) and 0.75 (95%CI: 0.55-0.95) for the mean and the maximal stiffness, respectively. Conclusion: These encouraging results show a correlation between the metastatic risk of lymph nodes and their increased mean stiffness. Elasticity variables and potential thresholds that seem to predict the metastatic status of axillary lymph nodes were identified. If confirmed by further larger studies, these results could be useful in

  6. Hidradenocarcinoma of the Scrotum with Lymph Node Metastasis

    Directory of Open Access Journals (Sweden)

    Maria Inês Simões

    2018-03-01

    Full Text Available Hidradenocarcinoma is a rare neoplasm of the eccrine cells of the sweat glands, usually asymptomatic with slow growing and higher incidence between 50 and 80 years, occurring in both sexes and preferentially located in the palmar, plantar, frontal, axillary and nuchal regions. It has an aggressive behavior, with high rate of local recurrence and distance metastasis, associated with a poor prognosis. We present a case of hidradenocarcinoma of the scrotum manifested by lymph node metastasis through an exercise of clinical and histological differential diagnosis of an inguinal adenopathy in a young adult.

  7. [Hidradenocarcinoma of the Scrotum with Lymph Node Metastasis].

    Science.gov (United States)

    Simões, Maria Inês; Marcão, Isabel; Toscano, Mário; Borges, Luís

    2018-03-29

    Hidradenocarcinoma is a rare neoplasm of the eccrine cells of the sweat glands, usually asymptomatic with slow growing and higher incidence between 50 and 80 years, occurring in both sexes and preferentially located in the palmar, plantar, frontal, axillary and nuchal regions. It has an aggressive behavior, with high rate of local recurrence and distance metastasis, associated with a poor prognosis. We present a case of hidradenocarcinoma of the scrotum manifested by lymph node metastasis through an exercise of clinical and histological differential diagnosis of an inguinal adenopathy in a young adult.

  8. Thoracic lymph node station recognition on CT images based on automatic anatomy recognition with an optimal parent strategy

    Science.gov (United States)

    Xu, Guoping; Udupa, Jayaram K.; Tong, Yubing; Cao, Hanqiang; Odhner, Dewey; Torigian, Drew A.; Wu, Xingyu

    2018-03-01

    Currently, there are many papers that have been published on the detection and segmentation of lymph nodes from medical images. However, it is still a challenging problem owing to low contrast with surrounding soft tissues and the variations of lymph node size and shape on computed tomography (CT) images. This is particularly very difficult on low-dose CT of PET/CT acquisitions. In this study, we utilize our previous automatic anatomy recognition (AAR) framework to recognize the thoracic-lymph node stations defined by the International Association for the Study of Lung Cancer (IASLC) lymph node map. The lymph node stations themselves are viewed as anatomic objects and are localized by using a one-shot method in the AAR framework. Two strategies have been taken in this paper for integration into AAR framework. The first is to combine some lymph node stations into composite lymph node stations according to their geometrical nearness. The other is to find the optimal parent (organ or union of organs) as an anchor for each lymph node station based on the recognition error and thereby find an overall optimal hierarchy to arrange anchor organs and lymph node stations. Based on 28 contrast-enhanced thoracic CT image data sets for model building, 12 independent data sets for testing, our results show that thoracic lymph node stations can be localized within 2-3 voxels compared to the ground truth.

  9. Sentinel Lymph Node Biopsy (SLNB) for Breast Cancer (BC) - Validation Protocol of the Technique

    International Nuclear Information System (INIS)

    Blidaru, A.; Bordea, C.I.; Condrea, Ileana; Albert, Paul

    2006-01-01

    Full text: The sentinel ganglion concept originates in the assumption according to which the primary tumor drains into a specific ganglionar area and then runs through the lymphatic nodes in an orderly, sequential mode. When neoplastic dissemination along the lymphatic pathway occurs, there is an initial invasion of a specific lymph node (rarely more than one) located on the drainage route. That firstly lymph node has been identified as the sentinel node, which mirrors the regional ganglionar status. In order to establish the indication for lymphadenectomy and avoid the situations in which such a surgical procedure would be of no use (N-), the only correct method consists in the identification and biopsy of the sentinel node. Radioactive tracing and/or use of vital staining enable the identification of the regional ganglionar group towards which the primary lesion is draining. The technique of sentinel lymph node identification and biopsy by means of radioactive tracing includes: - pre-surgical lymphoscintigraphy, - identification of the sentinel lymph node and its excisional biopsy, - intra-operative histopathological examination and immunohistochemical stains of the sentinel lymph node. Regional lymphadenectomy serves two major purposes: - diagnosis (axillary lymph node invasion represents an important prognostic factor) and therapeutic (to ensure local control of the disease). Regional lymph node invasion in breast cancer is directly related to the primary tumour size. In the less advanced stages (T1), as there is rarely invasion of the axillary lymph nodes, lymphadenectomy can be avoided in most cases. The paper presents the refinement of the technique, the validation of the method for the identification and biopsy of the sentinel lymph node in breast cancer using Tc99 and the intra-operative use of NEOPROBE 2000 gamma camera at the 'Prof. Dr. Alexandru Trestioreanu' Oncological Institute in Bucharest. 93 patients with primary breast cancer (T1, T2, N0

  10. [The incidence of human papilloma virus associated vulvar cancer in younger women is increasing and wide local excision with sentinel lymph node biopsie has become standard].

    Science.gov (United States)

    Fehr, Mathias K

    2011-10-01

    Sentinel lymph node (SLN) dissections have been shown to be sensitive for the evaluation of nodal basins for metastatic disease and are associated with decreased short-term and long-term morbidity when compared with complete lymph node dissection. There has been increasing interest in the use of SLN technology in gynecologic cancers. This review assesses the current evidence-based literature for the use of SLN dissections in gynecologic malignancies. Recent literature continues to support the safety and feasibility of SLN biopsy for early stage vulvar cancer with negative predictive value approaching 100 % and low false negative rates. Alternatively, for endometrial cancer most studies have reported low false-negative rates, with variable sensitivities and have reported low detection rates of the sentinel node. Studies examining the utility of SLN biopsy in early-stage cervical cancer remain promising with detection rates, sensitivities, and false-negative rates greater than 90 % for stage 1B1 tumors. SLN dissections have been shown to be effective and safe in certain, select vulvar cancer patients and can be considered an alternative surgical approach for these patients. For endometrial and cervical cancer, SLN dissection continues to have encouraging results and however needs further investigation.

  11. Interlaboratory validation of 1% pluronic l92 surfactant as a suitable, aqueous vehicle for testing pesticide formulations using the murine local lymph node assay.

    Science.gov (United States)

    Boverhof, Darrell R; Wiescinski, Connie M; Botham, Phil; Lees, David; Debruyne, Eric; Repetto-Larsay, Marina; Ladics, Gregory; Hoban, Denise; Gamer, Armin; Remmele, Marina; Wang-Fan, Weizheng; Ullmann, Ludwig G; Mehta, Jyotigna; Billington, Richard; Woolhiser, Michael R

    2008-09-01

    The mouse local lymph node assay (LLNA) has become the preferred test for evaluating the dermal sensitization potential of chemicals and requirements are now emerging for its use in the evaluation of their formulated products, especially in the European Union. However, despite its widespread use and extensive validation, the use of this assay for directly testing mixtures and formulated products has been questioned, which could lead to repeat testing using multiple animal models. As pesticide formulations are typically a specific complex blend of chemicals for use as aqueous-based dilutions, traditional vehicles prescribed for the LLNA may change the properties of these formulations leading to inaccurate test results and hazard identification. The objective of this study was to evaluate the effectiveness of an aqueous solution of Pluronic L92 block copolymer surfactant (L92) as a vehicle in the mouse LLNA across five laboratories. Three chemicals with known sensitization potential and four pesticide formulations for which the sensitization potential in guinea pigs and/or humans had previously been assessed were used. Identical LLNA protocols and test materials were used in the evaluation. Assessment of the positive control chemicals, hexylcinnamaldehyde, formaldehyde, and potassium dichromate revealed positive results when using 1% aqueous L92 as the vehicle. Furthermore, results for these chemicals were reproducible among the five laboratories and demonstrated consistent relative potency determinations. The four pesticide formulations diluted in 1% aqueous L92 also demonstrated reproducible results in the LLNA among the five laboratories. Results for these test materials were also consistent with those generated previously using guinea pigs or from human experience. These data support testing aqueous compatible chemicals or pesticide formulations using the mouse LLNA, and provide additional support for the use of 1% aqueous L92 as a suitable, aqueous-based vehicle.

  12. Novel approach for classifying chemicals according to skin sensitizing potency by non-radioisotopic modification of the local lymph node assay.

    Science.gov (United States)

    Takeyoshi, Masahiro; Iida, Kenji; Shiraishi, Keiji; Hoshuyama, Satsuki

    2005-01-01

    The murine local lymph node assay (LLNA) is currently recognized as a stand-alone sensitization test for determining the sensitizing potential of chemicals, and it has the advantage of yielding a quantitative endpoint that can be used to predict the sensitization potency of chemicals. The EC3 has been proposed as a parameter for classifying chemicals according to the sensitization potency. We previously developed a non-radioisotopic endpoint for the LLNA based on 5-bromo-2'-deoxyuridine (BrdU) incorporation (non-RI LLNA), and we are proposing a new procedure to predict the sensitization potency of chemicals based on comparisons with known human contact allergens. Nine chemicals (i.e. diphencyclopropenone, p-phenylenediamine, glutaraldehyde, cinnamicaldehyde, citral, eugenol, isopropyl myristate, propyleneglycol and hexane) categorized as human contact allergen classes 1-5 were tested by the non-RI LLNA with the following reference allergens: 2,4-dinitrochlorobenzene (DNCB) as a class 1 human contact allergen, isoeugenol as a class 2 human contact allergen and alpha-hexylcinnamic aldehyde (HCA) as a class 3 human contact allergen. Consequently, nine test chemicals were almost assigned to their correct allergen class. The results suggested that the new procedure for non-RI LLNA can provide correct sensitization potency data. Sensitization potency data are useful for evaluating the sensitization risk to humans of exposure to new chemical products. Accordingly, this approach would be an effective modification of LLNA with regard to its experimental design. Moreover, this procedure can be applied also to the standard LLNA with radioisotopes and to other modifications of the LLNA. Copyright 2005 John Wiley & Sons, Ltd.

  13. Assessment of statistic analysis in non-radioisotopic local lymph node assay (non-RI-LLNA) with α-hexylcinnamic aldehyde as an example

    International Nuclear Information System (INIS)

    Takeyoshi, Masahiro; Sawaki, Masakuni; Yamasaki, Kanji; Kimber, Ian

    2003-01-01

    The murine local lymph node assay (LLNA) is used for the identification of chemicals that have the potential to cause skin sensitization. However, it requires specific facility and handling procedures to accommodate a radioisotopic (RI) endpoint. We have developed non-radioisotopic (non-RI) endpoint of LLNA based on BrdU incorporation to avoid a use of RI. Although this alternative method appears viable in principle, it is somewhat less sensitive than the standard assay. In this study, we report investigations to determine the use of statistical analysis to improve the sensitivity of a non-RI LLNA procedure with α-hexylcinnamic aldehyde (HCA) in two separate experiments. Consequently, the alternative non-RI method required HCA concentrations of greater than 25% to elicit a positive response based on the criterion for classification as a skin sensitizer in the standard LLNA. Nevertheless, dose responses to HCA in the alternative method were consistent in both experiments and we examined whether the use of an endpoint based upon the statistical significance of induced changes in LNC turnover, rather than an SI of 3 or greater, might provide for additional sensitivity. The results reported here demonstrate that with HCA at least significant responses were, in each of two experiments, recorded following exposure of mice to 25% of HCA. These data suggest that this approach may be more satisfactory--at least when BrdU incorporation is measured. However, this modification of the LLNA is rather less sensitive than the standard method if employing statistical endpoint. Taken together the data reported here suggest that a modified LLNA in which BrdU is used in place of radioisotope incorporation shows some promise, but that in its present form, even with the use of a statistical endpoint, lacks some of the sensitivity of the standard method. The challenge is to develop strategies for further refinement of this approach

  14. Evaluation of radioisotopic and non-radioisotopic versions of local lymph node assays for subcategorization of skin sensitizers compliant to UN GHS rev 4.

    Science.gov (United States)

    Ha, Soojin; Ahn, Il Young; Kim, Da-Eun; Lee, Jong Kwon; Sohn, Soojung; Jung, Mi-Sook; Heo, Yong; Omori, Takashi; Bae, SeungJin; Lim, Kyung-Min

    2017-04-01

    Recently UN GHS has introduced the sub-categorization of skin sensitizers for which ECt (concentration estimated to induce stimulation index above threshold) of the murine local lymph node assay (LLNA) is used as criteria. Non-radioisotopic variants of LLNA, LLNA: DA, LLNA: BrdU-ELISA, LNCC and LLNA: BrdU-FCM were developed yet their utilities for potency sub-categorization are not established. Here we assessed the agreement of LLNA variants with LLNA or human data in potency sub-categorization for 22 reference substances of OECD TG429. Concordance of sub-categorization with LLNA was highest for LLNA: BrdU-FCM(91%, κ = 0.833, weighted kappa) followed by LLNA: BrdU-ELISA (82%, κ = 0.744) and LLNA: DA (73%, κ = 0.656) whereas LNCC only showed a modest association (64%, κ = 0.441). With human data, LLNA agreed best (77%) followed by LLNA: DA and LLNA: BrdU-FCM(73%), LLNA: BrdU-ELISA (68%) and LNCC(55%). Bland-Altman plot revealed that ECt's of LLNA variants largely agreed with LLNA where most values fell within 95% limit of agreement. Correlation between ECt's of LLNA and LLNA variants were high except for LNCC(pair-wise with LLNA, LLNA: DA, r = 0.848, LLNA: BrdU-ELISA, r = 0.744, LLNA: BrdU-FCM, r=0.786, and LNCC, r = 0.561 by Pearson). Collectively, these results demonstrated that LLNA variants exhibit performance comparable to LLNA in the potency sub-categorization although additional substances shall be analyzed in the future. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. A comparative evaluation of in vitro skin sensitisation tests: the human cell-line activation test (h-CLAT) versus the local lymph node assay (LLNA).

    Science.gov (United States)

    Ashikaga, Takao; Sakaguchi, Hitoshi; Sono, Sakiko; Kosaka, Nanae; Ishikawa, Makie; Nukada, Yuko; Miyazawa, Masaaki; Ito, Yuichi; Nishiyama, Naohiro; Itagaki, Hiroshi

    2010-08-01

    We previously developed the human cell-line activation test (h-CLAT) in vitro skin sensitisation test, based on our reported finding that a 24-hour exposure of THP-1 cells (a human monocytic leukaemia cell line) to sensitisers is sufficient to induce the augmented expression of CD86 and CD54. The aim of this study is to confirm the predictive value of h-CLAT for skin sensitisation activity by employing a larger number of test chemicals. One hundred chemicals were selected, according to their categorisation in the local lymph node assay (LLNA), as being: extreme, strong, moderate and weak sensitisers, and non-sensitisers. The correlation of the h-CLAT results with the LLNA results was 84%. There were some false negatives (e.g. benzoyl peroxide, hexyl cinnamic aldehyde) and some false positives (e.g. 1-bromobutane, diethylphthalate). Eight out of the 9 false negatives (89%) were water-insoluble chemicals. The h-CLAT could positively predict not only extreme and strong sensitisers, but also moderate and weak sensitisers, though the detection rates of weak sensitisers and non-sensitisers were comparatively low. Some sensitisers enhanced both CD86 and CD54 levels, and some enhanced the level of only one of them. The use of the combination of CD86 and CD54 induction as a positive indicator, improved the accuracy of the test. In conclusion, the h-CLAT is expected to be a useful cell-based in vitro method for predicting skin sensitisation potential. 2010 FRAME.

  16. Assessment of statistic analysis in non-radioisotopic local lymph node assay (non-RI-LLNA) with alpha-hexylcinnamic aldehyde as an example.

    Science.gov (United States)

    Takeyoshi, Masahiro; Sawaki, Masakuni; Yamasaki, Kanji; Kimber, Ian

    2003-09-30

    The murine local lymph node assay (LLNA) is used for the identification of chemicals that have the potential to cause skin sensitization. However, it requires specific facility and handling procedures to accommodate a radioisotopic (RI) endpoint. We have developed non-radioisotopic (non-RI) endpoint of LLNA based on BrdU incorporation to avoid a use of RI. Although this alternative method appears viable in principle, it is somewhat less sensitive than the standard assay. In this study, we report investigations to determine the use of statistical analysis to improve the sensitivity of a non-RI LLNA procedure with alpha-hexylcinnamic aldehyde (HCA) in two separate experiments. Consequently, the alternative non-RI method required HCA concentrations of greater than 25% to elicit a positive response based on the criterion for classification as a skin sensitizer in the standard LLNA. Nevertheless, dose responses to HCA in the alternative method were consistent in both experiments and we examined whether the use of an endpoint based upon the statistical significance of induced changes in LNC turnover, rather than an SI of 3 or greater, might provide for additional sensitivity. The results reported here demonstrate that with HCA at least significant responses were, in each of two experiments, recorded following exposure of mice to 25% of HCA. These data suggest that this approach may be more satisfactory-at least when BrdU incorporation is measured. However, this modification of the LLNA is rather less sensitive than the standard method if employing statistical endpoint. Taken together the data reported here suggest that a modified LLNA in which BrdU is used in place of radioisotope incorporation shows some promise, but that in its present form, even with the use of a statistical endpoint, lacks some of the sensitivity of the standard method. The challenge is to develop strategies for further refinement of this approach.

  17. Categorical QSAR models for skin sensitization based on local lymph node assay measures and both ground and excited state 4D-fingerprint descriptors

    Science.gov (United States)

    Liu, Jianzhong; Kern, Petra S.; Gerberick, G. Frank; Santos-Filho, Osvaldo A.; Esposito, Emilio X.; Hopfinger, Anton J.; Tseng, Yufeng J.

    2008-06-01

    In previous studies we have developed categorical QSAR models for predicting skin-sensitization potency based on 4D-fingerprint (4D-FP) descriptors and in vivo murine local lymph node assay (LLNA) measures. Only 4D-FP derived from the ground state (GMAX) structures of the molecules were used to build the QSAR models. In this study we have generated 4D-FP descriptors from the first excited state (EMAX) structures of the molecules. The GMAX, EMAX and the combined ground and excited state 4D-FP descriptors (GEMAX) were employed in building categorical QSAR models. Logistic regression (LR) and partial least square coupled logistic regression (PLS-CLR), found to be effective model building for the LLNA skin-sensitization measures in our previous studies, were used again in this study. This also permitted comparison of the prior ground state models to those involving first excited state 4D-FP descriptors. Three types of categorical QSAR models were constructed for each of the GMAX, EMAX and GEMAX datasets: a binary model (2-state), an ordinal model (3-state) and a binary-binary model (two-2-state). No significant differences exist among the LR 2-state model constructed for each of the three datasets. However, the PLS-CLR 3-state and 2-state models based on the EMAX and GEMAX datasets have higher predictivity than those constructed using only the GMAX dataset. These EMAX and GMAX categorical models are also more significant and predictive than corresponding models built in our previous QSAR studies of LLNA skin-sensitization measures.

  18. Lymph node metastasis of carcinomas of transverse colon including flexures. Consideration of the extramesocolic lymph node stations.

    Science.gov (United States)

    Perrakis, Aristotelis; Weber, Klaus; Merkel, Susanne; Matzel, Klaus; Agaimy, Abbas; Gebbert, Carol; Hohenberger, Werner

    2014-10-01

    Complete mesocolic excision (CME) is nowadays state of the art in the treatment of colon cancer. In cases of carcinoma of transverse colon and of both flexures an extramesocolic lymph node metastasis can be found in the infrapancreatic lymph node region (ILR) and across the gastroepiploic arcade (GLR). These direct metastatic routes were not previously systematically considered. In order to validate our hypothesis of these direct metastatic pathways and to obtain evidence of our approach of including dissection of these areas as part of CME, we initiated a prospective study evaluating these lymph node regions during surgery. Forty-five consecutive patients with primary tumour manifestation in transverse colon and both flexures between May 2010 and January 2013 were prospectively analyzed. Patients were followed up for at least 6 months. Mode of surgery, histopathology, morbidity and mortality were evaluated. Twenty-six patients had a carcinoma of transverse colon, 16 patients one of hepatic flexure and four patients one of splenic flexure. The median lymph node yield was 40. Occurrence of lymph node metastasis in ILR was registered in five patients and in GLR in four patients. The mean lymph node ratio was 0.085. Postoperative complications occurred in nine patients, and postoperative mortality was 2 %. We were able to demonstrate this novel metastatic route of carcinomas of the transverse colon and of both flexures in ILR and GLR. These could be considered as regional lymph node regions and have to be included into surgery for cancer of the transverse colon including both flexures.

  19. Application of BALB/c mouse in the local lymph node assay:BrdU-ELISA for the prediction of the skin sensitizing potential of chemicals.

    Science.gov (United States)

    Hou, Fenxia; Xing, Caihong; Li, Bin; Cheng, Juan; Chen, Wei; Zhang, Man

    2015-01-01

    Allergic contact dermatitis (ACD) is a skin disease characterized by eczema and itching. A considerable proportion of chemicals induce ACD in humans. More than 10,000 substances should be tested for skin sensitization potential under the Registration, Evaluation, Authorization and Restriction of Chemical substances (REACH) regulation. The Local Lymph Node Assay (LLNA) has been designated as the first-choice in vivo assay for sensitization testing by REACH. The LLNA:BrdU-ELISA is a validated non-radioactive modification to the LLNA. For both the LLNA and the LLNA:BrdU-ELISA, CBA/JN mouse is the preferred mouse strain recommended in the regulatory guidelines. However, the availability of CBA/JN mouse in China is only limited to a few animal suppliers, which makes the mouse difficult to obtain. BALB/c mouse, which is widely commercially available, is considered for alternative use but it can only be used in the assay after it has been evaluated by formal validation study. Thus, a validation study was conducted in our laboratory to determine if BALB/c mouse could also be used in the LLNA:BrdU-ELISA. Forty-three test substances including 32 LLNA sensitizers and 11 LLNA non-sensitizers, their vehicles and each concentration used were the same as that used in the formal validation study for the LLNA:BrdU-ELISA using CBA/JN mouse. Female BALB/c mice of 8-10 weeks old were randomly allocated to groups (four mice per group). The test substance (25 μl) or the vehicle alone was applied to the dorsum of both ears daily for 3 consecutive days. A single intraperitoneal injection of 0.5 ml of BrdU (10mg/ml) solution was given on day 5. On day 6, a pair of auricular lymph nodes from each mouse was excised, weighed and stored at -20°C until BrdU-ELISA was conducted. This validation study for the LLNA:BrdU-ELISA using BALB/c mouse correctly identified 30 of 31 sensitizers and 8 of 11 non-sensitizers. The accuracy, sensitivity, specificity, false positive rate, false negative rate

  20. Sentinel node biopsy before neoadjuvant chemotherapy spares breast cancer patients axillary lymph node dissection.

    Science.gov (United States)

    van Rijk, Maartje C; Nieweg, Omgo E; Rutgers, Emiel J T; Oldenburg, Hester S A; Olmos, Renato Valdés; Hoefnagel, Cornelis A; Kroon, Bin B R

    2006-04-01

    Neoadjuvant chemotherapy in breast cancer patients is a valuable method to determine the efficacy of chemotherapy and potentially downsize the primary tumor, which facilitates breast-conserving therapy. In 18 studies published about sentinel node biopsy after neoadjuvant chemotherapy, the sentinel node was identified in on average 89%, and the false-negative rate was on average 10%. Because of these mediocre results, no author dares to omit axillary clearance just yet. In our institute, sentinel lymph node biopsy is performed before neoadjuvant chemotherapy. The aim of this study was to evaluate our experience with this approach. Sentinel node biopsy was performed before neoadjuvant chemotherapy in 25 T2N0 patients by using lymphoscintigraphy, a gamma ray detection probe, and patent blue dye. Axillary lymph node dissection was performed after chemotherapy if the sentinel node contained metastases. Ten patients had a tumor-positive axillary sentinel node, and one patient had an involved lateral intramammary node. Four patients had additional involved nodes in the completion lymph node dissection specimen. The other 14 patients (56%) had a tumor-negative sentinel node and did not undergo axillary lymph node dissection. No recurrences have been observed after a median follow-up of 18 months. Fourteen (56%) of the 25 patients were spared axillary lymph node dissection when the sentinel node was found to be disease free. Performing sentinel node biopsy before neoadjuvant chemotherapy seems successful and reliable in patients with T2N0 breast cancer.

  1. Computed tomography (CT) of cervical lymph nodes in patients with oral cancer. Comparison of low-attenuation areas in lymph nodes on CT images with pathological findings

    International Nuclear Information System (INIS)

    Fukunari, Fumiko; Okamura, Kazuhiko; Yuasa, Kenji; Kagawa, Toyohiro; Zeze, Ryousuke

    2008-01-01

    The objective of this study was to clarify the histopathological features of low-attenuation areas in computed tomography (CT) images of cervical metastatic and benign lymph nodes in patients with oral squamous cell carcinoma (SCC). CT images of 230 lymph nodes from 37 patients with oral SCC were classified into four categories and compared with histopathological findings. Metastatic lymph nodes were evaluated in terms of focal necrosis, keratinization, fibrous tissue, and the proportion of the lymph node showing focal necrosis. Benign lymph nodes were evaluated in terms of adipose tissue, follicular hyperplasia, sinus histiocytosis, hyperemia, focal hemorrhaging, and the amount of adipose tissue. Histopathologically, all 13 metastatic lymph nodes with rim enhancement on CT images included focal necrosis. However, most of the lymph nodes showed no focal necrosis. In addition, tumor cells, keratinization, and fibrous tissue were observed in the lymph nodes. Of the 26 metastatic lymph nodes with a heterogeneous appearance on CT images, four did not show focal necrosis. These lymph nodes showed keratinization or accumulation of lymph fluid. Histopathologically, 20 of 24 benign lymph nodes with a heterogeneous appearance on CT images (83.3%) had accompanying adipose tissue. Focal necrosis was the most important factor contributing to low attenuation in metastatic lymph nodes. However, other factors, such as tumor cells, keratinization, fibrous tissue, and accumulation of lymph fluid, also contributed. In benign lymph nodes, the presence of adipose tissue was a contributing factor in low-attenuation areas, as was focal hemorrhaging. (author)

  2. Ultrasound elastography for evaluation of cervical lymph nodes

    Directory of Open Access Journals (Sweden)

    Young Jun Choi

    2015-07-01

    Full Text Available Ultrasound (US elastography has been introduced as a noninvasive imaging technique for evaluating cervical lymph nodes. US elastography techniques include strain elastography and shear wave-based elastography. The application of this technique is based on the fact that stiff tissues tend to deform less and show less strain than compliant tissues when the same force is applied. In general, metastatic lymph nodes demonstrate higher stiffness than benign lymph nodes. Overall, preliminary studies suggest that US elastography may be useful in differentiating benign and malignant cervical lymph nodes, thereby informing decisions to perform a biopsy and facilitating follow-up. For US elastography to be accepted into clinical practice, however, its techniques, associated diagnostic criteria, and reliability need to be further refined.

  3. Lymph Node Micrometastases are Associated with Worse Survival in Patients with Otherwise Node-Negative Hilar Cholangiocarcinoma

    NARCIS (Netherlands)

    Mantel, Hendrik T. J.; Wiggers, Jim K.; Verheij, Joanne; Doff, Jan J.; Sieders, Egbert; van Gulik, Thomas M.; Gouw, Annette S. H.; Porte, Robert J.

    2015-01-01

    Background. Lymph node metastases on routine histology are a strong negative predictor for survival after resection of hilar cholangiocarcinoma. Additional immunohistochemistry can detect lymph node micrometastases in patients who are otherwise node negative, but the prognostic value is unsure. The

  4. Analysis of the movement of calcified lymph nodes during breathing

    International Nuclear Information System (INIS)

    Jenkins, Peter; Salmon, Clare; Mannion, Cathy

    2005-01-01

    Purpose: To identify and measure the respiratory-induced movement of calcified mediastinal lymph nodes. Methods and materials: Twenty-one patients receiving radiation therapy for primary lung or pleural tumors were noted to have calcification within one or more mediastinal lymph nodes. The breathing motion of 27 such nodes was measured with orthogonal fluoroscopic imaging during quiet respiration. Results: All 27 nodes showed some motion synchronous with breathing. The mean respiratory movement was 6.6 mm, 2.6 mm, and 1.4 mm in the craniocaudal, dorsoventral, and mediolateral planes, respectively. There was a significant difference in the amplitude of motion in the craniocaudal plane compared with movement in the other two directions (p < 0.001). No differences were seen in the movement of lymph nodes dependent on position within the mediastinum (supracarinal vs. infracarinal or hilar vs. mediastinal). Neither size of the primary tumor nor spirometric parameters were correlated with the amplitude of lymph node movement. Conclusions: Mediastinal lymph nodes move during breathing, and this needs to be accounted for when the internal margin component of the PTV is defined. The amplitude of this movement is anisotropic and seems to be less than that reported for primary lung tumors. This should permit a modest reduction in the margin allowed for breathing movement around involved mediastinal nodes, particularly in the mediolateral and dorsoventral planes

  5. Transarterial chemoperfusion of the pelvis. Results in symptomatic locally recurrent tumors and lymph node metastases; Transarterielle Chemoperfusion des Beckens. Ergebnisse bei symptomatischen Rezidivtumoren und Lymphknotenmetastasen

    Energy Technology Data Exchange (ETDEWEB)

    Vogl, T.J.; Zangos, S.; Eichler, K.; Balzer, J.O.; Bauer, R.W. [Inst. fuer Diagnostische und Interventionelle Radiologie, J. W. Goethe-Univ. Frankfurt (Germany); Jacob, U.; Keilhauer, R. [Fachklinik fuer Innere Medizin, Leonardis-Klinik, Bad Heilbrunn (Germany)

    2007-11-15

    Purpose: To evaluate local transarterial chemoperfusion (TACP) of therapy-resistant, locally recurrent malignant tumors and lymph node metastases in the pelvis with respect to clinical response, tumor response and survival. Materials and methods: Between 2003 and 2005, 24 outpatients (median age 56.5 years, range 33 - 82) were treated with 128 TACPs (min. 3; mean 5 sess/patient) in 4-week intervals. Depending on the tumor location and vascularization, a fluoroscopy catheter was placed either in the abdominal aorta or internal pelvic artery. A combination of mitomycin C (6 mg/m{sup 2}) and gemcitabine (1500 mg/m{sup 2}) was administered over 60 minutes. The tumor size was measured using CT or MRI. The radiological response was classified according to RECIST (Response Evaluation Criteria In Solid Tumors) as 'complete response' (CR), 'partial response' (PR), 'stable disease' (SD) and 'progressive disease' (PD). The clinical response was classified as 'response{sub clinical}' if the symptoms improved distinctly, 'stable disease{sub clinical}' if complaints were stabilized, and 'progression{sub clinical}' if symptoms deteriorated or new symptoms appeared. After the third TACP, patients were evaluated for clinical and radiological response. In the case of clinical and radiological progression, therapy was stopped and the patient was referred to the hospital's tumor board. In the case of radiological response and clinical progression or clinical response and radiological progression, therapy was continued. Therapy could be stopped by the patient at any time. Results: Treatment was tolerated well by all patients. No clinically relevant problems and no grade III or IV toxicity according to CTC (Common Toxicity Criteria) appeared. Tumor-related pain, bleeding, restricted mobility of the lower extremities, incontinence, urinary tract obstruction, and constipation were reduced in 9/17, 5/6, 3/3, 1/3, 2

  6. Sentinel lymph nodes in cancer of the oral cavity

    DEFF Research Database (Denmark)

    Thomsen, Jørn Bo; Sørensen, Jens Ahm; Krogdahl, Annelise

    2005-01-01

    BACKGROUND: Sentinel lymph node biopsy, step sectioning and immunohistochemistry have changed detection of tumour deposits. Isolated tumour cells (ITC) are detected more frequently than earlier because of a changed level of detection. METHODS: A total of 108 sentinel lymph nodes from 30 patients ...... with macrometastasis, five with micrometastasis and two with ITC. CONCLUSION: The ITC are probably precursors of micrometastasis waiting to grow and should be treated as such. Benign inclusions and dendritic cells did not cause problems, but can mimic ITC....

  7. CT in the staging of bronchogenic carcinoma: Analysis by correlative lymph node mapping and sampling

    International Nuclear Information System (INIS)

    McLoud, T.C.; Woldenberg, R.; Mathisen, D.J.; Grillo, H.C.; Bourgoulin, P.M.; Shepard, J.O.; Moore, E.H.

    1987-01-01

    Although previous studies have evaluated the accuracy of CT in staging the mediastinum in bronchogenic carcinoma, none has determined the sensitivity and specificity of CT in the assessment of individual lymph node groups by correlative nodal sampling at surgery. CT scans were performed on 84 patients with bronchogenic carcinoma. Abnormal nodes (≥ 1 cm) were localized according to the ATS classification of regional lymph node mapping. Seventy-nine patients had mediastinoscopy and 64 patients underwent thoracotomy. In each case, biopsies of lymph node groups 2R, 4R, 2L, 4L (paratracheal), 7 (subcarinal), and 5 (aorticopulmonary) were performed on the appropriate side. Hilar nodes (10R and 11R, 10L and 11L) were resected with the surgical specimen. A total of 292 nodes were sampled. Overall sensitivity for all lymph node groups was 40%, and specificity, 81%. Sensitivity was highest for the 4R (paratracheal) group (82%) and lowest for the subcarinal area (20%). Specificity ranged from 71% for 11R nodes (right hilar) to 94% for 10L (left peribronchial). The positive predictive value was 34%, and the negative predictive value, 84%. This study suggests that the more optimistic results previously reported may have resulted from lack of correlation of individual lymph node groups identified on CT with those sampled at surgery

  8. Lymph node segmentation by dynamic programming and active contours.

    Science.gov (United States)

    Tan, Yongqiang; Lu, Lin; Bonde, Apurva; Wang, Deling; Qi, Jing; Schwartz, Lawrence H; Zhao, Binsheng

    2018-03-03

    Enlarged lymph nodes are indicators of cancer staging, and the change in their size is a reflection of treatment response. Automatic lymph node segmentation is challenging, as the boundary can be unclear and the surrounding structures complex. This work communicates a new three-dimensional algorithm for the segmentation of enlarged lymph nodes. The algorithm requires a user to draw a region of interest (ROI) enclosing the lymph node. Rays are cast from the center of the ROI, and the intersections of the rays and the boundary of the lymph node form a triangle mesh. The intersection points are determined by dynamic programming. The triangle mesh initializes an active contour which evolves to low-energy boundary. Three radiologists independently delineated the contours of 54 lesions from 48 patients. Dice coefficient was used to evaluate the algorithm's performance. The mean Dice coefficient between computer and the majority vote results was 83.2%. The mean Dice coefficients between the three radiologists' manual segmentations were 84.6%, 86.2%, and 88.3%. The performance of this segmentation algorithm suggests its potential clinical value for quantifying enlarged lymph nodes. © 2018 American Association of Physicists in Medicine.

  9. Prognostic relevance of lymph node ratio and total lymph node count for small bowel adenocarcinoma.

    Science.gov (United States)

    Tran, Thuy B; Qadan, Motaz; Dua, Monica M; Norton, Jeffrey A; Poultsides, George A; Visser, Brendan C

    2015-08-01

    Nodal metastasis is a known prognostic factor for small bowel adenocarcinoma. The goals of this study were to evaluate the number of lymph nodes (LNs) that should be retrieved and the impact of lymph node ratio (LNR) on survival. Surveillance, Epidemiology, and End Results was queried to identify patients with small bowel adenocarcinoma who underwent resection from 1988 to 2010. Survival was calculated with the Kaplan-Meier method. Multivariate analysis identified predictors of survival. A total of 2,772 patients underwent resection with at least one node retrieved, and this sample included equal numbers of duodenal (n = 1,387) and jejunoileal (n = 1,386) adenocarcinomas. There were 1,371 patients with no nodal metastasis (N0, 49.4%), 928 N1 (33.5%), and 474 N2 (17.1%). The median numbers of LNs examined for duodenal and jejunoileal cancers were 9 and 8, respectively. Cut-point analysis demonstrated that harvesting at least 9 for jejunoileal and 5 LN for duodenal cancers resulted in the greatest survival difference. Increasing LNR at both sites was associated with decreased overall median survival (LNR = 0, 71 months; LNR 0-0.02, 35 months; LNR 0.21-0.4, 25 months; and LNR >0.4, 16 months; P < .001). Multivariate analysis confirmed number of LNs examined, T-stage, LN positivity, and LNR were independent predictors of survival. LNR has a profound impact on survival in patients with small bowel adenocarcinoma. To achieve adequate staging, we recommend retrieving a minimum of 5 LN for duodenal and 9 LN for jejunoileal adenocarcinomas. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Lymphatic mapping and sentinel lymph node detection in patients with breast cancer

    International Nuclear Information System (INIS)

    Chen, S.L.; Du, Q.Q.; Shi, H.C.; Chen, J.X.; Wang, H.

    2002-01-01

    Objectives: To localize sentinel lymph node (SLN) and to test the hypothesis that the histologic characteristics of the SLN can predict the histologic characteristic of the remaining lymph nodes along the lymphatic chain. To calculate the absorbed dose of patients, doctors and nurses. Methods: Seventy-one patients with early-stage breast cancer underwent SLN localization using filtered technetium-99m labeled sulfur colloid, blue dye, or combination of them. SLN was identified as a blue lymph node and/or a 'hot lymph node' detected by ex vivo gamma probe. A 'hot lymph node' is the lymph node the radioactivity of which was 10 times higher than that of background. Pathological examination was performed with all resected lymph nodes. The approximate absorbed dose of the patients, doctors and nurses was calculated by using MIRD techniques. Results: For patients who were injected with only blue dye, the sensitivity, accuracy and false negative rate was 80.0%, 90.7% and 20.0% respectively. For patients who were injected with only radioactive colloids, the sensitivity, accuracy and false negative rate was 100%, 100% and 0% respectively. For patients who were injected with both blue dye and radioactive colloids, the sensitivity, accuracy and false negative rate was 100%, 100% and 100% respectively. The absorbed dose of breast tissue was 26.52 rad. The absorbed dose of nuclear medicine doctors, surgeons, nurses and pathologists was 1.9x10 -2 rad, 9.6x10 -3 rad, 3.8x10 -4 rad and 9.6x10 -3 rad respectively. Conclusions: Lymphatic mapping and SLN biopsy were the most effective when a combination of blue dye and radio-labeled sulfur colloid was used. Radio-labeled sulfur colloid was safe to patients and the medical staff. SLN biopsy had the potential value for avoiding unnecessary axillary lymph nodes resection for patients with early-stage breast cancer

  11. The Nodal Location of Metastases in Melanoma Sentinel Lymph Nodes

    DEFF Research Database (Denmark)

    Riber-Hansen, Rikke; Nyengaard, Jens; Hamilton-Dutoit, Stephen

    2009-01-01

    BACKGROUND: The design of melanoma sentinel lymph node (SLN) histologic protocols is based on the premise that most metastases are found in the central parts of the nodes, but the evidence for this belief has never been thoroughly tested. METHODS: The nodal location of melanoma metastases in 149...

  12. Sentinel lymph node mapping in melanoma with technetium-99m dextran.

    Science.gov (United States)

    Neubauer, S; Mena, I; Iglesis, R; Schwartz, R; Acevedo, J C; Leon, A; Gomez, L

    2001-06-01

    The aim of this work is to evaluate the capability of Tc99m B Dextran as a lymphoscintigraphic agent in the detection of the sentinel node in skin lesions. Forty-one patients with melanomas (39) and Merkel cell tumors (2) had perilesional intradermal injection of Tc99m-Dextran 2 hours before surgery. Serial gamma camera images and a handheld gamma probe were used to direct sentinel node biopsy. In 39/41 patients, lymph channels and 52 sentinel nodes (one to three sentinel nodes/patient) could be visualized. In one patient, with a dorsal melanoma, no lymph channels or lymph nodes could be demonstrated on the images and only minimal radioactivity was found in the regional nodes with the probe. Another patient with a facial lesion failed to demonstrate lymph channels or nodes. No adverse reactions were observed. Tc99m-Dextran provided good definition of lymph channels and sentinel node localization, without the risks related to the use of potentially hazardous labeled materials of biological origin.

  13. Predictive Factors for Nonsentinel Lymph Node Metastasis in Patients With Positive Sentinel Lymph Nodes After Neoadjuvant Chemotherapy: Nomogram for Predicting Nonsentinel Lymph Node Metastasis.

    Science.gov (United States)

    Ryu, Jai Min; Lee, Se Kyung; Kim, Ji Young; Yu, Jonghan; Kim, Seok Won; Lee, Jeong Eon; Han, Se Hwan; Jung, Yong Sik; Nam, Seok Jin

    2017-11-01

    Axillary lymph node (ALN) status is an important prognostic factor for breast cancer patients. With increasing numbers of patients undergoing neoadjuvant chemotherapy (NAC), issues concerning sentinel lymph node biopsy (SLNB) after NAC have emerged. We analyzed the clinicopathologic features and developed a nomogram to predict the possibility of nonsentinel lymph node (NSLN) metastases in patients with positive SLNs after NAC. A retrospective medical record review was performed of 140 patients who had had clinically positive ALNs at presentation, had a positive SLN after NAC on subsequent SLNB, and undergone axillary lymph node dissection (ALND) from 2008 to 2014. On multivariate stepwise logistic regression analysis, pathologic T stage, lymphovascular invasion, SLN metastasis size, and number of positive SLN metastases were independent predictors for NSLN metastases (P Samsung Medical Center NAC nomogram was developed to predict the likelihood of additional positive NSLNs. The Samsung Medical Center NAC nomogram could provide information to surgeons regarding whether to perform additional ALND when the permanent biopsy revealed positive findings, although the intraoperative SLNB findings were negative. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Lymph Node Yield as a Predictor of Survival in Pathologically Node Negative Oral Cavity Carcinoma.

    Science.gov (United States)

    Lemieux, Aaron; Kedarisetty, Suraj; Raju, Sharat; Orosco, Ryan; Coffey, Charles

    2016-03-01

    Even after a pathologically node-negative (pN0) neck dissection for oral cavity squamous cell carcinoma (SCC), patients may develop regional recurrence. In this study, we (1) hypothesize that an increased number of lymph nodes removed (lymph node yield) in patients with pN0 oral SCC predicts improved survival and (2) explore predictors of survival in these patients using a multivariable model. Case series with chart review. Administrative database analysis. The SEER database was queried for patients diagnosed with all-stage oral cavity SCC between 1988 and 2009 who were determined to be pN0 after elective lymph node dissection. Demographic and treatment variables were extracted. The association of lymph node yield with 5-year all-cause survival was studied with multivariable survival analyses. A total of 4341 patients with pN0 oral SCC were included in this study. The 2 highest lymph node yield quartiles (representing >22 nodes removed) were found to be significant predictors of overall survival (22-35 nodes: hazard ratio [HR] = 0.854, P = .031; 36-98 nodes: HR = 0.827, P = .010). Each additional lymph node removed during neck dissection was associated with increased survival (HR = 0.995, P = .022). These data suggest that patients with oral SCC undergoing elective neck dissection may experience an overall survival benefit associated with greater lymph node yield. Mechanisms behind the demonstrated survival advantage are unknown. Larger nodal dissections may remove a greater burden of microscopic metastatic disease, diminishing the likelihood of recurrence. Lymph node yield may serve as an objective measure of the adequacy of lymphadenectomy. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

  15. Increased cell proliferation in spleen and lymph nodes peripheral to contact allergen application site

    International Nuclear Information System (INIS)

    Chipinda, Itai; Anderson, Stacey E.; Butterworth, Leon F.; Beezhold, Donald; Siegel, Paul D.

    2009-01-01

    The local lymph node assay (LLNA) is widely used to identify chemicals that are contact sensitizers. The assay involves dosing mice with the chemical on both ears and pooling the superficial parotid lymph nodes for assessment of lymphocyte proliferation as a marker of sensitization. The present study explored potential reduction in animal usage by dosing one ear with the allergen and the other with vehicle-only. The respective draining lymph nodes were processed separately for tritiated thymidine ( 3 H-TdR) incorporation. Cell proliferation in proper axillary and renal nodes, as well as in the spleen was also assessed. Cross-contamination of the chemicals from the dosed ears to other parts of the body via preening was prevented by dosing restrained animals and washing off the residual chemical with saline after 4 h. Dosing the left ear with 0.02% oxazolone (OX) on unrestrained animals resulted in marked cell proliferation in its draining lymph node (stimulation index, SI = 12.8) and in the lymph node draining the contra-lateral vehicle-dosed ear (SI = 6), as well as the proper axillary lymph nodes (SI = 3.3). Increased 3 H-TdR incorporation was not observed in the renal lymph nodes (SI = 1.1). Similar stimulation of cells was observed in the lymph node draining the ear contra-lateral to the 30% hexylcinnamaldehyde (HCA)-dosed ear. Increased proliferative activity was observed in contra-lateral draining lymph nodes of restrained mice demonstrating that these results cannot be attributed to cross-contamination of adjacent skin. A significant increase in proliferation of splenocytes was also observed. It is concluded that dermal application of a contact allergen, as exemplified by OX and HCA, may induce cell proliferation in the neighboring lymph nodes and spleen indicative of hapten and/or haptenated proteins diffusing through the skin to peripheral nodes and the blood to produce systemic sensitization. It is also possible that lymphatic capillaries may communicate

  16. Isolated perifacial lymph node metastasis in oral squamous cell carcinoma with clinically node-negative neck.

    Science.gov (United States)

    Agarwal, Sangeet Kumar; Arora, Sowrabh Kumar; Kumar, Gopal; Sarin, Deepak

    2016-10-01

    The incidence of occult perifacial nodal disease in oral cavity squamous cell carcinoma is not well reported. The purpose of this study was to evaluate the incidence of isolated perifacial lymph node metastasis in patients with oral squamous cell carcinoma with a clinically node-negative neck. The study will shed light on current controversies and will provide valuable clinical and pathological information in the practice of routine comprehensive removal of these lymph node pads in selective neck dissection in the node-negative neck. Prospective analysis. This study was started in August 2011 when intraoperatively we routinely separated the lymph node levels from the main specimen for evaluation of the metastatic rate to different lymph node levels in 231 patients of oral squamous cell cancer with a clinically node-negative neck. The current study demonstrated that 19 (8.22%) out of 231 patients showed ipsilateral isolated perifacial lymph node involvement. The incidence of isolated perifacial nodes did not differ significantly between the oral tongue (7.14%) and buccal mucosa (7.75%). Incidence was statistically significant in cases with lower age group (oral squamous cell carcinoma with a clinically node-negative neck. The incidence of isolated perifacial involvement is high in cases of buccal mucosal and tongue cancers. A meticulous dissection of the perifacial nodes seems prudent when treating the neck in oral cavity squamous cell carcinoma. 4 Laryngoscope, 126:2252-2256, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  17. Breast cancer with axillary lymph node involvement

    International Nuclear Information System (INIS)

    Belaid, A.; Kanoun, S.; Kallel, A.; Ghorbel, I.; Azoury, F.; Heymann, S.; Marsiglia, H.; Bourgier, C.; Belaid, A.; Ghorbel, I.; Kanoun, S.; Kallel, A.; Pichenot, C.; Verstraet, R.; Marsiglia, H.

    2010-01-01

    Breast cancer is the most frequent cancer of women in western countries. There are one million new cases per year in the world which represents 22% of all female cancers, and more than 370.000 deaths due to breast cancer per year (14% of cancer mortality). More than half of breast cancers are associated with axillary nodal involvement. Post-operative radiation therapy (XRT) is a crucial part of locoregional treatment in axillary nodal involvement breast cancer owing to a 15-years risk reduction of locoregional recurrence of 70% and to a 5.4% risk reduction of specific mortality. In 3D-conformal irradiation in such breast cancers, target volumes are chest wall when mastectomy was performed or breast and boost of tumor bed in case of breast conservative surgery, and supra-clavicular and/or axillary and/or internal mammary node areas. The main organs at risk are ipsilateral lung, heart and brachial plexus. The aim of this article is to describe epidemiologic, radio anatomic and prognostic features of axillary nodal involvement breast cancer and to propose guidelines for 3D-conformal treatment planning in locally advanced breast cancers. This review is illustrated by a case report. (authors)

  18. Sentinel lymph node and its applications in cancer. Review of literature

    International Nuclear Information System (INIS)

    Leon A, L.; Vigil R, C.; Velarde G, R.; Abugattas S, J.; Leon R, M.; Caceres G, E.; Cano P, R.; Morales G, R.; Aguilar R, C.

    2001-01-01

    In the human body, the lymph nodes groups like in the groin, axilla, neck and others regions, receive the lymphatic drainage from a determined corporal territory, and the first node to receive it is called the sentinel node and as the name suggest, it is the most likely node to contain metastases if present; in the axilla the sentinel node is usually localized in level I. The presence of regional lymph node involvement remains the most reliable prognostic factor and provides accurate nodal staging for woman with epithelial cancers. The most commonly use indicator of prognosis for patients with operable carcinoma of the breast is the histological presence or absence of axillary lymph node metastases. The sentinel node biopsy is a new procedure composed of two steps: the first is the lymphatic mapping where the sentinel node can be identified in the preoperative period by lymphoscintigraphy, and in the operating room by injection of a vital blue dye, and with technetium labeled sulfur colloid injected into the same area as the vital blue dye or in place of the blue dye. In the second step the extracted and a rigorous assessment of the accuracy by pathological examination. Multiple studies have showed that if the sentinel lymph node is negative for metastatic disease, the remaining lymph nodes are also likely to be negative. The value of the sentinel lymph node biopsy is based in the pathologic diagnosis, when it is negative it is possible to avoid axillary dissection. The technique of identification of sentinel lymph node is applied to different types of cancers and distinct localizations, in the penis, malignant melanoma, breast, head and neck (oral cavity, epidermoid carcinoma, malignant melanoma), vulva, gastric, colorectal, 'non small cell lung cancer' and for merkel cell carcinoma. This publication regarding the sentinel lymph node technique and its applications in cancer, represents the routine followed in the Department of Breast Bone and Mixed Tumours of the

  19. [The lymph nodes imprint for the diagnosis of lymphoid neoplasms].

    Science.gov (United States)

    Peniche-Alvarado, Carolina; Ramos-Peñafiel, Christian Omar; Martínez-Murillo, Carlos; Romero-Guadarrama, Mónica; Olarte-Carrillo, Irma; Rozen-Fuller, Etta; Martínez-Tovar, Adolfo; Collazo-Jaloma, Juan; Mendoza-García, Carlos Alberto

    2013-01-01

    lymphoma is the most frequent lymphoid neoplasm in our country. Its diagnosis is based on histopathological findings. The lymph node imprint has been used for more than 40 years. The aim was to establish the sensitivity, specificity, positive predictive value and negative predictive value of lymph node imprint and estimate the inter-observer rate. we did an observational, retrospective, prolective study, based on the lymph node imprint obtained by excisional biopsies over a period of 6 years. the inclusion criteria was met on 199 samples, 27.1 % were considered as reactive (n = 54), 16.1 % Hodgkin lymphoma (n = 32), 40.2 % (n = 80) non-Hodgkin lymphoma and 16.6 % (n = 33) as metastatic carcinoma. Comparing with the final histopathology report, the sensitivity and specificity of lymph node imprint were 88 % (0.81-0.95) and 64 % (0.55-0.73) respectively, the positive predictive value was 67 % (0.59-0.76) and the negative predictive value was 86 % (0.79-0.94). The interobserver kappa index was 0.467. the lymph node imprint remains as a useful tool for the diagnosis of lymphoid neoplasm. The agreement between observers was acceptable.

  20. Detection of Genetic Alterations in Breast Sentinel Lymph Node by Array-CGH

    National Research Council Canada - National Science Library

    Cavalli, Luciane R

    2005-01-01

    The sentinel lymph node (SLN) is the first node in the mammary gland to harbor malignant cells in breast tumors with metastasis, and SLN positivity is an indication for axillary lymph node dissection...

  1. Detection of Genetic Alterations in Breast Sentinel Lymph Node by Array-CGH

    National Research Council Canada - National Science Library

    Cavalli, Luciane R

    2006-01-01

    The sentinel lymph node (SLN) is the first node in the mammary gland to harbor malignant cells in breast tumors with metastasis, and SLN positivity is an indication for axillary lymph node dissection...

  2. Reoperative sentinel lymph node biopsy after previous mastectomy.

    Science.gov (United States)

    Karam, Amer; Stempel, Michelle; Cody, Hiram S; Port, Elisa R

    2008-10-01

    Sentinel lymph node (SLN) biopsy is the standard of care for axillary staging in breast cancer, but many clinical scenarios questioning the validity of SLN biopsy remain. Here we describe our experience with reoperative-SLN (re-SLN) biopsy after previous mastectomy. Review of the SLN database from September 1996 to December 2007 yielded 20 procedures done in the setting of previous mastectomy. SLN biopsy was performed using radioisotope with or without blue dye injection superior to the mastectomy incision, in the skin flap in all patients. In 17 of 20 patients (85%), re-SLN biopsy was performed for local or regional recurrence after mastectomy. Re-SLN biopsy was successful in 13 of 20 patients (65%) after previous mastectomy. Of the 13 patients, 2 had positive re-SLN, and completion axillary dissection was performed, with 1 having additional positive nodes. In the 11 patients with negative re-SLN, 2 patients underwent completion axillary dissection demonstrating additional negative nodes. One patient with a negative re-SLN experienced chest wall recurrence combined with axillary recurrence 11 months after re-SLN biopsy. All others remained free of local or axillary recurrence. Re-SLN biopsy was unsuccessful in 7 of 20 patients (35%). In three of seven patients, axillary dissection was performed, yielding positive nodes in two of the three. The remaining four of seven patients all had previous modified radical mastectomy, so underwent no additional axillary surgery. In this small series, re-SLN was successful after previous mastectomy, and this procedure may play some role when axillary staging is warranted after mastectomy.

  3. Lymph node hemangioma in one-humped camel

    Directory of Open Access Journals (Sweden)

    M.A. Aljameel

    2015-12-01

    Full Text Available Hemangioma is a benign tumor of blood and lymphatic vessels. It is common in skin, mucosa and soft tissues, and its occurrence in lymph nodes is extremely rare. A 10 year-old she-camel was slaughtered at Nyala slaughterhouse, South Darfur State, Sudan. Grossly, the carcass was emaciated. The left ventral superficial cervical lymph node was enlarged, hard on palpation and protruded outside the body. Its cut surface was dark red in color and measured (18 cm in diameter. Histopathologically, the sections revealed vascular masses were composed of non-encapsulated clusters of small and medium sized with thick and thin-walled, filled with blood, separated by courageous stroma and surrounded by closely packed proliferating capillaries. To the best of our knowledge, this is the first record of the left ventral superficial cervical lymph node hemangioma in a camel in the Sudan.

  4. Angiosarcoma of the Thyroid and Regional Lymph Node Metastasis

    Directory of Open Access Journals (Sweden)

    Lutfi Dogan

    2013-10-01

    Full Text Available Thyroid angiosarcomas are typically infiltrative and large tumors with very similar clinical findings of anaplastic carcinoma of thyroid. Early hematogenous metastasis is very frequent, but regional lymph node metastasis is quite rare. We present a case of angiosarcoma of the thyroid gland in a 68 years old man with regional lymph node metastasis. Total thyroidectomy with right modified radical neck dissection was applied. Four out of 19 lymph nodes dissected were seen to contain metastasis. Metastatic tumor was composed of sarcomatous areas containing large numbers of blood filled clefts. There after the surgery PET-CT was performed and multiple metastatic involvements were reported. Thyroid angiosarcomas are completely different tumors from angiomatoid anaplastic carcinomas. Longer survival with these tumors is only possible with agressive surgery and in case of regional LN metastasis, neck dissection should be done.

  5. Accuracy of abdominal lymph node scintigraphy in tumor diagnostics

    International Nuclear Information System (INIS)

    Kucharczyk, D.

    1978-01-01

    In view of the diagnostical correspondence between lymph node scintigraphy and X-ray lymphograpy, this dissertation, which is based on 110 systematic comparative evaluations, examines the diagnostical weight of the scintigraphic criteria for tumor growth, discusses diagnostical discrepancies and confirms the efficacy of lymph node scintigraphy in detecting malignomas. In discussing the diagnostical results in the light of previous experience, the shortcomings of the nuclear medical method in tumor diagnostics are shown to be attributable to the uncertainty of the individual scintigraphic criteria. Owing to the variability of the lymph node system as to topography, anatomy and retention rate and the fact that it cannot morphologically be well differentiated in the scintigram, X-ray lymphography to verify the scintigraphic result and preclude misinterpretation remains an indispensable measure. (orig.) [de

  6. Importance of Metastatic Lymph Node Ratio in Non-Metastatic, Lymph Node-Invaded Colon Cancer: A Clinical Trial

    Science.gov (United States)

    Isik, Arda; Peker, Kemal; Firat, Deniz; Yilmaz, Bahri; Sayar, Ilyas; Idiz, Oguz; Cakir, Coskun; Demiryilmaz, Ismail; Yilmaz, Ismayil

    2014-01-01

    Background The aim of this study was to evaluate the prognostic importance of the metastatic lymph node ratio for stage III colon cancer patients and to find a cut-off value at which the overall survival and disease-free survival change. Material/Methods Patients with pathological stage III colon cancer were retrospectively evaluated for: age; preoperative values of Crp, Cea, Ca 19-9, and Afp; pathologic situation of vascular, perineural, lymphatic, and serosal involvement; and metastatic lymph node ratio values were calculated. Results The study included 58 stage III colon cancer patients: 20 (34.5%) females and 38 (65.5%) males were involved in the study. Multivariate analysis was applied to the following variables to evaluate significance for overall survival and disease-free survival: age, Crp, Cea, perineural invasion, and metastatic lymph node ratio. The metastatic lymph node ratio (<0.25 or ≥0.25) is the only independent variable significant for overall and disease-free survival. Conclusions Metastatic lymph node ratio is an ideal prognostic marker for stage III colon cancer patients, and 0.25 is the cut-off value for prognosis. PMID:25087904

  7. Contribution of the sentinel lymph node detection in oral cavity and oropharynx cancer

    International Nuclear Information System (INIS)

    Comte, F.; Barge, M.L.; Chevalier, J.; Rossi, M.; Zanca, M.; Alovisetti, C.; Garrel, R.; Guerrier, B.; Costes, V.

    2004-01-01

    The histopathological features of lymph nodes removal in head and neck cancer bring major prognostic information. Molecular biology or immuno histological techniques allow a far better detection sensitivity while underlining micrometastases. However, due to the great number of removed lymph nodes, an exhaustive histological analysis is impossible and an efficient targeting is desirable. The aim of this study was to establish the feasibility of the gamma probe directed biopsy of the sentinel lymph node in oral and oropharyngeal carcinoma. Up to date, 13 patients with oral and oropharyngeal cancers (T1pNO) were included. The sentinel lymph node was detected during surgery and selectively resected before traditional neck lymph dissection. The sentinel lymph node (SLN) was detected in 92 % of patients. In one case, the immunohistochemical analysis of the SLN showed a micro-metastatic involvement while the classical histological analysis remained negative.The preliminary analysis of our study attests the SLN radio-localization efficiency in head and neck cancers and allows the systematic detection of micro-metastatic involvement. The pursuit of this study will continue to confirm these results from a larger population and to precise the prognostic value of the micro-metastatic stage. (author)

  8. CONSIDERATIONS ON ANATOMY AND PHYSIOLOGY OF LYMPH VESSELS OF UPPER AERO DIGESTIVE ORGANS AND CERVICAL SATELLITE LYMPH NODE GROUP.

    Science.gov (United States)

    Ciupilan, Corina; Stan, C I

    2016-01-01

    The almost constant local regional development of the cancers of upper aero digestive organs requires the same special attention to cervical lymph node metastases, as well as to the primary neoplastic burning point. The surgical therapy alone or associated has a mutilating, damaging character, resulting in loss of an organ and function, most of the times with social implications, involving physical distortions with aesthetic consequences, which make the reintegration of the individual into society questionable. The problem of cervical lymph node metastases is vast and complex, reason why we approached several anatomical and physiological aspects of lymph vessels of the aero digestive organs. Among the available elements during treatment, the headquarters of the tumour, its histologic degree, and its infiltrative nature, each of them significantly influences the possibility of developing metastases.

  9. CT diagnosis of abdominal lymph node metastases in hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Tanaka, T; Nakamura, H; Choi, S; Morimoto, K; Kawamoto, S; Hori, S; Tokunaga, K; Yoskioka, H; Kuroda, C

    1985-08-01

    CT scanning is useful for diagnosing abdominal lymph node metastasis. Using this technique, histologically confirmed abdominal lymph node metastases were detected in nine of 49 patients (33 autopsy cases and 16 laparotomy cases) with hepatocellular carcinoma (hepatoma). Among the 49 patients, three had periportal (6.1%), six peripancreatic (12.2.%) and six para-aortic adenopathies (12.2%). Two of the patients had adenopathy at all three sites. Retrospectively, CT detected two periportal, four peripancreatic and all six para-aortic adenopathies. Most of the hepatomas with adenopathy showed infiltrative growth; tumour thrombosis of the portal vein was a common complication.

  10. Metastasis in the subcarinal lymph node with unknown primary tumor

    DEFF Research Database (Denmark)

    Eckardt, J.; Olsen, K. E.; Petersen, H.

    2011-01-01

    -differentiated squamous cell carcinoma but no primary tumor was visible on PET-computed tomography. Because of his previous lymphoma the patient was scheduled for mediastinoscopy where the diagnosis was confirmed. Subsequent gastroscopy was normal and a right-sided thoracotomy showed no evidence of cancer elsewhere, only...... an inoperable metastasis in a subcarinal lymph node which infiltrated the trachea, esophagus and aorta. Such isolated squamous cell carcinoma in a subcarinal lymph node without a primary tumor despite invasive work-up has not been reported before....

  11. Cavitatory mesenteric lymph node syndrome: A rare entity

    International Nuclear Information System (INIS)

    Vibhuti; Vishal, Kalia; Gill, Anakhvir

    2010-01-01

    Celiac disease is a gluten sensitive enteropathy that involves an abnormal immunological response to glutens in wheat, rye etc. It predominantly involves the small intestinal mucosa, though, extra luminal manifestations can also occur. One rare extraluminal manifestation is cavitatory mesenteric lymph node syndrome. It occurs in refractory celiac disease and is associated with poor prognosis due to various complications. The diagnosis is often made on imaging when cystic mesenteric lymph nodes with fat-fluid levels are seen and this can then be confirmed by histopathological examination. We recently had a typical case where we were able to make this diagnosis

  12. Computed Tomography–Guided Interstitial High-Dose-Rate Brachytherapy in Combination With Regional Positive Lymph Node Intensity-Modulated Radiation Therapy in Locally Advanced Peripheral Non–Small Cell Lung Cancer: A Phase 1 Clinical Trial

    Energy Technology Data Exchange (ETDEWEB)

    Xiang, Li; Zhang, Jian-wen; Lin, Sheng; Luo, Hui-Qun; Wen, Qing-Lian; He, Li-Jia; Shang, Chang-Ling; Ren, Pei-Rong; Yang, Hong-Ru; Pang, Hao-Wen; Yang, Bo; He, Huai-Lin [Department of Oncology, Affiliated Hospital of Luzhou Medical College, Luzhou (China); Chen, Yue, E-mail: chenyue5523@126.com [Department of Nuclear Medicine, Affiliated Hospital of Luzhou Medical College, Luzhou (China); Wu, Jing-Bo, E-mail: wjb6147@163.com [Department of Oncology, Affiliated Hospital of Luzhou Medical College, Luzhou (China)

    2015-08-01

    Purpose: To assess the technical safety, adverse events, and efficacy of computed tomography (CT)-guided interstitial high-dose-rate (HDR) brachytherapy in combination with regional positive lymph node intensity modulated radiation therapy in patients with locally advanced peripheral non–small cell lung cancer (NSCLC). Methods and Materials: Twenty-six patients with histologically confirmed NSCLC were enrolled in a prospective, officially approved phase 1 trial. Primary tumors were treated with HDR brachytherapy. A single 30-Gy dose was delivered to the 90% isodose line of the gross lung tumor volume. A total dose of at least 70 Gy was administered to the 95% isodose line of the planning target volume of malignant lymph nodes using 6-MV X-rays. The patients received concurrent or sequential chemotherapy. We assessed treatment efficacy, adverse events, and radiation toxicity. Results: The median follow-up time was 28 months (range, 7-44 months). There were 3 cases of mild pneumothorax but no cases of hemothorax, dyspnea, or pyothorax after the procedure. Grade 3 or 4 acute hematologic toxicity was observed in 5 patients. During follow-up, mild fibrosis around the puncture point was observed on the CT scans of 2 patients, but both patients were asymptomatic. The overall response rates (complete and partial) for the primary mass and positive lymph nodes were 100% and 92.3%, respectively. The 1-year and 2-year overall survival (OS) rates were 90.9% and 67%, respectively, with a median OS of 22.5 months. Conclusion: Our findings suggest that HDR brachytherapy is safe and feasible for peripheral locally advanced NSCLC, justifying a phase 2 clinical trial.

  13. Lymph node detection in IASLC-defined zones on PET/CT images

    Science.gov (United States)

    Song, Yihua; Udupa, Jayaram K.; Odhner, Dewey; Tong, Yubing; Torigian, Drew A.

    2016-03-01

    Lymph node detection is challenging due to the low contrast between lymph nodes as well as surrounding soft tissues and the variation in nodal size and shape. In this paper, we propose several novel ideas which are combined into a system to operate on positron emission tomography/ computed tomography (PET/CT) images to detect abnormal thoracic nodes. First, our previous Automatic Anatomy Recognition (AAR) approach is modified where lymph node zones predominantly following International Association for the Study of Lung Cancer (IASLC) specifications are modeled as objects arranged in a hierarchy along with key anatomic anchor objects. This fuzzy anatomy model built from diagnostic CT images is then deployed on PET/CT images for automatically recognizing the zones. A novel globular filter (g-filter) to detect blob-like objects over a specified range of sizes is designed to detect the most likely locations and sizes of diseased nodes. Abnormal nodes within each automatically localized zone are subsequently detected via combined use of different items of information at various scales: lymph node zone model poses found at recognition indicating the geographic layout at the global level of node clusters, g-filter response which hones in on and carefully selects node-like globular objects at the node level, and CT and PET gray value but within only the most plausible nodal regions for node presence at the voxel level. The models are built from 25 diagnostic CT scans and refined for an object hierarchy based on a separate set of 20 diagnostic CT scans. Node detection is tested on an additional set of 20 PET/CT scans. Our preliminary results indicate node detection sensitivity and specificity at around 90% and 85%, respectively.

  14. Sentinel lymph node detection through radioguided surgery in patients with breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Abreu, Benedita Andrade Leal de; Santos, Adriana de Morais; Soares, Livia de Almeida; Santos, Antonio Ricardo dos; Barros, Idna de Carvalho; Abreu, Everardo Leal de; Cruz Filho, Alexandre Jorge Gomes da; Abreu, Joao Batista de; Vieira, Sabas Carlos [Universidade Estadual do Piaui, Teresina, PI (Brazil); Centro Federal de Educacao Tecnologica do Piaui (CEFET-PI), Teresina, PI (Brazil); Faculdade Sao Gabriel, PI (Brazil); Hospital Sao Marcos, PI (Brazil); Universidade Federal do Piaui (UFPI), Teresina, PI (Brazil)

    2008-12-15

    Biopsy of the sentinel lymphnode (SLNB), the first lymphnode to receive lymphatic drainage from the primary tumor, accurately predicts the axillary lymph node status and, when negative, obviates the need for axillary lymphadenectomy (AL). The aim of this study was, to verify the SLN localization in breast cancer through preoperative lymphoscintigraphy and intraoperative gamma-probe, as well as to demonstrate the benefits of such techniques in preventing complications of AL. Medical records of 228 patients with breast carcinoma, who were underwent SLN localization and, radioguided surgery, from March 2005 to December 2007 were analyzed retrospectively. Data regarding age, tumor characteristic, breast involved, type of surgery, radiopharmaceutical drainage pattern, axillary assessment (SLNB or AL) and number of lymph nodes dissected were collected. It was ascertained that radioguided surgery is a selective method of axillary assessment in breast cancer, which makes this technique a safe alternative to radical assessment of total dissection of axillary lymph nodes and its subsequent complications. (author)

  15. Sentinel lymph node detection through radioguided surgery in patients with breast cancer

    International Nuclear Information System (INIS)

    Abreu, Benedita Andrade Leal de; Santos, Adriana de Morais; Soares, Livia de Almeida; Santos, Antonio Ricardo dos; Barros, Idna de Carvalho; Abreu, Everardo Leal de; Cruz Filho, Alexandre Jorge Gomes da; Abreu, Joao Batista de; Vieira, Sabas Carlos

    2008-01-01

    Biopsy of the sentinel lymphnode (SLNB), the first lymphnode to receive lymphatic drainage from the primary tumor, accurately predicts the axillary lymph node status and, when negative, obviates the need for axillary lymphadenectomy (AL). The aim of this study was, to verify the SLN localization in breast cancer through preoperative lymphoscintigraphy and intraoperative gamma-probe, as well as to demonstrate the benefits of such techniques in preventing complications of AL. Medical records of 228 patients with breast carcinoma, who were underwent SLN localization and, radioguided surgery, from March 2005 to December 2007 were analyzed retrospectively. Data regarding age, tumor characteristic, breast involved, type of surgery, radiopharmaceutical drainage pattern, axillary assessment (SLNB or AL) and number of lymph nodes dissected were collected. It was ascertained that radioguided surgery is a selective method of axillary assessment in breast cancer, which makes this technique a safe alternative to radical assessment of total dissection of axillary lymph nodes and its subsequent complications. (author)

  16. Cervical Lymph Node Metastasis: Unusual Presentation of Adenoid Cystic Carcinoma - Diagnosed By FNAC

    Directory of Open Access Journals (Sweden)

    Archana Buch

    2015-01-01

    Full Text Available Adenoid cystic carcinoma (ACC is a rare neoplasm that usually arises from minor salivary glands. It is characteristically locally infiltrative, exhibiting perineural invasion, has a tendency for local recurrence and prolonged clinical course. A 60 year old male, chronic smoker presented with swelling of the left cervical lymph node since two months. Examination revealed a solitary firm, non tender, non mobile left cervical swelling measuring 2 x 1 cm. Fine Needle Aspiration Cytology (FNAC was done from the cervical lymph node. The diagnosis of metastatic deposits of ACC was given. Detail examination of the oral cavity revealed a small swelling at the floor of the mouth. Biopsy of the swelling confirmed ACC on histopathological examination. An unusual feature of adenoid cystic carcinoma is the low incidence of metastases to regional lymph nodes. The case is presented to highlight its unusual presentation and utility of FNAC in rapid diagnosis.

  17. Comparison of the skin sensitizing potential of unsaturated compounds as assessed by the murine local lymph node assay (LLNA) and the guinea pig maximization test (GPMT).

    Science.gov (United States)

    Kreiling, R; Hollnagel, H M; Hareng, L; Eigler, D; Lee, M S; Griem, P; Dreessen, B; Kleber, M; Albrecht, A; Garcia, C; Wendel, A

    2008-06-01

    The skin sensitization potential of eight unsaturated and one saturated lipid (bio)chemicals was tested in both the LLNA and the GPMT to address the hypothesis that chemicals with unsaturated carbon-carbon double bonds may result in a higher number of unspecific (false positive) results in the LLNA compared to the GPMT. Seven substances (oleic acid, linoleic acid, linolenic acid, undecylenic acid, maleic acid, squalene and octinol) gave clear positive results in the LLNA (stimulation index (SI)> or = 3) and thus would require labelling as skin sensitizer. Fumaric acid and succinic acid gave clearly negative results. In the GPMT, besides some sporadic skin reactions, reproducible skin reactions indicating an allergic response were found in a few animals for four test substances. Based on the GPMT results, only undecylenic acid would have to be classified and labelled as a skin sensitizer according to the European Dangerous Substance Directive (67/548/EEC) (results for linoleic acid were inconclusive), while the other seven test substances would not require labelling. Possible mechanisms for unspecific skin cell stimulation and lymph node responses are discussed. In conclusion, the suitability of the LLNA for unsaturated compounds bearing structural similarity to the tested substances should be carefully considered and the GPMT should remain available as an accepted test method for skin sensitization hazard identification.

  18. Evaluation of non-radioactive endpoints of ex vivo local lymph node assay-BrdU to investigate select contact sensitizers.

    Science.gov (United States)

    Ulker, Ozge Cemiloglu; Ates, Ilker; Atak, Aysegul; Karakaya, Asuman

    2013-01-01

    The present study sought to verify the utility of the non-radioactive endpoints LLNA BrdU (5-bromo-2'-deoxyuridine) ex vivo incorporation and cytokine release using auricular lymph node cells isolated from BALB/c mice topically treated with a strong (formaldehyde or p-phenylene-diamine [PPD]), moderate sensitizer (cinnamal), or weak sensitizer (eugenol). Stimulation index (SI) and EC₃ values were calculated for each agent. Based on the results of ex vivo LLNA-BrdU assays, EC₃ values were calculated to be 0.29, 0.09, 1.91, and 16.60% for formaldehyde, PPD, cinnamal, and eugenol, respectively. These results were in good agreement with data from previous standard radioactive LLNA. Cytokine analyses indicated T(H)1 and T(H)2 cytokine involvement in the regulation of murine contact allergy and these could be utilized as endpoints in assessments of contact allergy in mice. In conclusion, the current study provided evidence that the non-radioactive endpoint LLNA BrdU ex vivo incorporation could be of use as a viable alternative approach to assess the skin sensitization potential of test compound with respect to improving animal welfare. This is of particular importance in the case of any laboratory where it might be difficult to handle and/or readily employ radioisotopes. Further studies will be required to confirm--across test agents--the reproducibility as well as the limits of utility of this new ex vivo BrdU method.

  19. Ultrasound differentiation of benign and malignant cervical lymph nodes

    Directory of Open Access Journals (Sweden)

    Md. Mizanur Rahman

    2009-01-01

    Full Text Available This study was conducted to see whether the size (measured by maximal short axis diameter, shape (expressed in terms of ratio dividing long axis diameter of the node by short axis diameter or L/S ratio, marginal clarity (regular or irregular margin, internal echo-pattern (homogeneous hypoechoic or heterogeneous and hilar echogenicity (presence or absence of echo-genicity in hilum are good criteria for differentiating benign from malignant cervical lymph nodes using high frequency (high resolution ultrasound probe. The study was carried out from January 1998 to December 1998, among patients with enlarged cervical lymph nodes who were scanned with a high frequency (5.0 MHz curvilinear probe. Chi-Square test was done to see the statistical correlation between two groups of nodes. A p value of <0.05 was taken as significant. Out of 65 nodes studied, 26 (100% enlarged cervical nodes with short axis diameter more than 1 cm were all malignant. In contrast 31 (79.5% of 39 enlarged nodes with short axis diameter less than 1cm were benign and rest were malignant (p<0.001. Of 34 enlarged nodes with L/S ratio <2, 30 (88.2% nodes were found malignant and 4 (11.8% were benign. Among the rest 31 enlarged nodes, 27 (87.1% with L/S ratio  2 were benign while 4 (12.9% were malignant (p <0.001. Among the 39 nodes with regular margin 28 (71.8% were found benign, where as among 26 nodes with irregular margin 23 (88.5% were malignant (p <0.001. When the internal echopattern was taken in account, 32 nodes had homogeneous hypoechoic echo of which 28 (87.5% were benign and among 33 nodes with heterogeneous echopattern 30 (90.9% were malignant (p <0.001. Among the 43 enlarged nodes with presence of hilar echogenicity 31(72.1% were found benign and 22 (100% nodes with no hilar echogenicity were all malignant (p <0.001. Such findings suggest that real time high resolution ultrasound might assist in differentiation of benign and malignant enlarged cervical lymph nodes

  20. Lymph Node Metastases Optical Molecular Diagnostic and Radiation Therapy

    Science.gov (United States)

    2017-03-01

    Pogue CONTRACTING ORGANIZATION: Trustees of Dartmouth College Hanover, NH 03755 REPORT DATE: March 2017 TYPE OF REPORT: Annual PREPARED FOR: U.S...FORM TO THE ABOVE ADDRESS. 1. REPORT DATE March 2017 2. REPORT TYPE Annual 3. DATES COVERED 1 Mar 2016 - 28 Feb 2017 4. TITLE AND SUBTITLE Lymph...Gamma imaging of sentinel nodes is not a disease diagnostic, but rather just used to find the node and remove it for pathological inspection. As a result

  1. Sheep lymph-nodes as a biological indicator of environmental exposure to fluoro-edenite

    International Nuclear Information System (INIS)

    Ledda, Caterina; Loreto, Carla; Pomara, Cristoforo; Rapisarda, Giuseppe; Fiore, Maria; Ferrante, Margherita; Bracci, Massimo; Santarelli, Lory; Fenga, Concettina; Rapisarda, Venerando

    2016-01-01

    A significantly increased incidence of pleural mesothelioma in Biancavilla (Sicily, Italy) has been attributed to exposure to fluoro-edenite (FE), a fibrous amphibole extracted from a local stone quarry. The lymph-nodes draining the pulmonary lobes of sheep grazing around the town were examined, to gain insights into fibre diffusion. The pasture areas of six sheep flocks lying about 3 km from Biancavilla were located using the global positioning system. The cranial tracheobronchial and one middle mediastinal lymph-node as well as four lung tissue samples were collected from 10 animals from each flock and from 10 control sheep for light and scanning electron microscopy (SEM) examination. The lymph-nodes from exposed sheep were enlarged and exhibited signs of anthracosis. Histologically, especially at the paracortical level, they showed lymph-follicle hyperplasia with large reactive cores and several macrophages (coniophages) containing grey-brownish particulate interspersed with elements with a fibril structure, forming aggregates of varying dimensions (coniophage nodules). Similar findings were detected in some peribronchiolar areas of the lung parenchyma. SEM examination showed that FE fibres measured 8–41 µm in length and 0.4–1.39 µm in diameter in both lymph-nodes and lung tissue. Monitoring of FE fibres in sheep lymph-nodes using appropriate techniques can help set up environmental pollution surveillance. - Highlights: • Lymph-nodes draining sheep lung were used to assess environmental fluoro-edenite exposure. • Monitoring fluoro-edenite fibres in sheep lung nodes can provide pollution surveillance. • Our findings document a risk of fluoro-edenite fibre inhalation a few kilometres from the source. • Sheep appear to be a valuable bioindicator species.

  2. Sheep lymph-nodes as a biological indicator of environmental exposure to fluoro-edenite

    Energy Technology Data Exchange (ETDEWEB)

    Ledda, Caterina, E-mail: cledda@unict.it [Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania (Italy); Hygiene and Public Health, Department of Medical Sciences, Surgical and Advanced Technologies “GF Ingrassia”, University of Catania, Catania (Italy); Loreto, Carla [Human Anatomy and Histology, Department of Bio-Medical Sciences, University of Catania, Catania (Italy); Pomara, Cristoforo [Department of Anatomy, School of Medicine, University of Malta, Msida (Malta); Rapisarda, Giuseppe [Department of Veterinary Medicine, ASP Catania, Catania (Italy); Fiore, Maria; Ferrante, Margherita [Hygiene and Public Health, Department of Medical Sciences, Surgical and Advanced Technologies “GF Ingrassia”, University of Catania, Catania (Italy); Bracci, Massimo; Santarelli, Lory [Occupational Medicine, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona (Italy); Fenga, Concettina [Occupational Medicine, Department of the Environment, Safety, Territory, Food and Health Sciences, University of Messina, Messina (Italy); Rapisarda, Venerando [Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania (Italy)

    2016-05-15

    A significantly increased incidence of pleural mesothelioma in Biancavilla (Sicily, Italy) has been attributed to exposure to fluoro-edenite (FE), a fibrous amphibole extracted from a local stone quarry. The lymph-nodes draining the pulmonary lobes of sheep grazing around the town were examined, to gain insights into fibre diffusion. The pasture areas of six sheep flocks lying about 3 km from Biancavilla were located using the global positioning system. The cranial tracheobronchial and one middle mediastinal lymph-node as well as four lung tissue samples were collected from 10 animals from each flock and from 10 control sheep for light and scanning electron microscopy (SEM) examination. The lymph-nodes from exposed sheep were enlarged and exhibited signs of anthracosis. Histologically, especially at the paracortical level, they showed lymph-follicle hyperplasia with large reactive cores and several macrophages (coniophages) containing grey-brownish particulate interspersed with elements with a fibril structure, forming aggregates of varying dimensions (coniophage nodules). Similar findings were detected in some peribronchiolar areas of the lung parenchyma. SEM examination showed that FE fibres measured 8–41 µm in length and 0.4–1.39 µm in diameter in both lymph-nodes and lung tissue. Monitoring of FE fibres in sheep lymph-nodes using appropriate techniques can help set up environmental pollution surveillance. - Highlights: • Lymph-nodes draining sheep lung were used to assess environmental fluoro-edenite exposure. • Monitoring fluoro-edenite fibres in sheep lung nodes can provide pollution surveillance. • Our findings document a risk of fluoro-edenite fibre inhalation a few kilometres from the source. • Sheep appear to be a valuable bioindicator species.

  3. Investigating the role of SPECT/CT in dynamic sentinel lymph node biopsy for penile cancers

    Energy Technology Data Exchange (ETDEWEB)

    Saad, Ziauddin Zia; Bomanji, Jamshed [University College Hospitals London, Department of Nuclear Medicine, London (United Kingdom); UCLH NHS Foundation Trust, Institute of Nuclear Medicine, 5th Floor, London (United Kingdom); Omorphos, Savvas; Malone, Peter; Nigam, Raj; Muneer, Asif [University College Hospitals London, Department of Urology, London (United Kingdom); Michopoulou, Sofia; Gacinovic, Svetislav [University College Hospitals London, Department of Nuclear Medicine, London (United Kingdom)

    2017-07-15

    Currently, most centres use 2-D planar lymphoscintigraphy when performing dynamic sentinel lymph node biopsy in penile cancer patients with clinically impalpable inguinal nodes. This study aimed to investigate the role of SPECT/CT following 2-D planar lymphoscintigraphy (dynamic and static) in the detection and localization of sentinel lymph nodes in the groin. A qualitative (visual) review was performed on planar followed by SPECT/CT lymphoscintigraphy in 115 consecutive patients (age 28-86 years) who underwent injection of {sup 99m}Tc-nanocolloid followed by immediate acquisition of dynamic (20 min) and early static scans (5 min) initially and further delayed static (5 min) images at 120 min followed by SPECT/CT imaging. The lymph nodes detected in each groin on planar lymphoscintigraphy and SPECT/CT were compared. A total of 440 and 467 nodes were identified on planar scintigraphy and SPECT/CT, respectively. Overall, SPECT/CT confirmed the findings of planar imaging in 28/115 cases (24%). In the remaining 87 cases (76%), gross discrepancies were observed between planar and SPECT/CT images. SPECT/CT identified 17 instances of skin contamination (16 patients, 13%) and 36 instances of in-transit lymphatic tract activity (24 patients, 20%) that had been interpreted as tracer-avid lymph nodes on planar imaging. In addition, SPECT/CT identified 53 tracer-avid nodes in 48 patients (42%) that were not visualized on planar imaging and led to reclassification of the drainage basins (pelvic/inguinal) of 27 tracer-avid nodes. The addition of SPECT/CT improved the rate of detection of true tracer-avid lymph nodes and delineated their precise (3-D) anatomic localization in drainage basins. (orig.)

  4. Abdominal lymph node metastases of hepatocellular carcinoma diagnosed by computed tomography and angiography

    Energy Technology Data Exchange (ETDEWEB)

    Nakamura, Hironobu; Oi, Hiromichi [Osaka Univ. (Japan). Research Inst. for Microbial Diseases; Tanaka, Takeshi; Sai, Soomi; Hori, Shinichi

    1984-04-01

    CT scans of 164 patients with hepatocellular carcinoma were studied, and abdominal lymph node metastases were detected in 13 cases. Most of these lymph node metastases occured in periportal, peripancreatic and paraaortic lymph nodes. Ten instances of each these metastases were identified by CT. Six of the patients had metastases in all three sites. In 9 of 13 cases, lymph node metastases were demonstrated by angiography and various degrees of contrast material stain were seen. Lymph node metastasis of hepatocellular carcinoma is apt to be hypervascular. Most of hepatocellular carcinoma with lymph node metastasis showed infiltrative growth, and tumor thrombosis in the portal vein was commonly complicated.

  5. Adjuvant radiotherapy after salvage lymph node dissection because of nodal relapse of prostate cancer versus salvage lymph node dissection only

    International Nuclear Information System (INIS)

    Rischke, Hans Christian; Schultze-Seemann, Wolfgang; Kroenig, Malte; Schlager, Daniel; Jilg, Cordula Annette; Wieser, Gesche; Drendel, Vanessa; Stegmaier, Petra; Henne, Karl; Volegova-Neher, Natalia; Grosu, Anca-Ligia; Krauss, Tobias; Kirste, Simon

    2015-01-01

    Nodal pelvic/retroperitoneal recurrent prostate cancer (PCa) after primary therapy can be treated with salvage lymph node dissection (salvage-LND) in order to delay disease progression and offer cure for a subset of patients. Whether adjuvant radiotherapy (ART) in affected regions improves the outcome by elimination of residual tumour burden remains unclear. A total of 93 patients with exclusively nodal PCa relapse underwent choline-positron-emission tomography-computed-tomography-directed pelvic/retroperitoneal salvage-LND; 46 patients had surgery only and 47 patients received ART in regions with proven lymph node metastases. In case of subsequent prostate specific antigen (PSA) progression, different imaging modalities were performed to confirm next relapse within or outside the treated region (TR). Mean follow-up was 3.2 years. Lymphatic tumour burden was balanced between the two groups. Additional ART resulted in delayed relapse within TR (5-year relapse-free rate 70.7 %) versus surgery only (5-year relapse-free rate 26.3 %, p < 0.0001). In both treatment arms, time to next relapse outside the TR was almost equal (median 27 months versus 29.6 months, p = 0.359). With respect to the detection of the first new lesion, regardless if present within or outside the TR, 5 years after the treatment 34.3 % of patients in the group with additional ART were free of relapse, versus 15.4 % in the surgery only group (p = 0.0122). ART had no influence on the extent of PSA reduction at latest follow-up compared to treatment with surgery only. ART after salvage-LND provides stable local control in TR and results in overall significant improved next-relapse-free survival, compared to patients who received surgery only in case of nodal PCa-relapse. (orig.) [de

  6. Regional Lymph Node Uptake of [{sup 18}F]Fluorodeoxyglucose After Definitive Chemoradiation Therapy Predicts Local-Regional Failure of Locally Advanced Non-Small Cell Lung Cancer: Results of ACRIN 6668/RTOG 0235

    Energy Technology Data Exchange (ETDEWEB)

    Markovina, Stephanie [Mallinckrodt Institute of Radiology and Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri (United States); Duan, Fenghai [Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island (United States); Snyder, Bradley S. [Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island (United States); Siegel, Barry A. [Mallinckrodt Institute of Radiology and Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri (United States); Machtay, Mitchell [Department of Radiation Oncology, Case Western Reserve University, Cleveland, Ohio (United States); Bradley, Jeffrey D., E-mail: jbradley@radonc.wustl.edu [Mallinckrodt Institute of Radiology and Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri (United States)

    2015-11-01

    Purpose: The American College of Radiology Imaging Network (ACRIN) 6668/Radiation Therapy Oncology Group (RTOG) 0235 study demonstrated that standardized uptake values (SUV) on post-treatment [{sup 18}F]fluorodeoxyglucose-positron emission tomography (FDG-PET) correlated with survival in locally advanced non-small cell lung cancer (NSCLC). This secondary analysis determined whether SUV of regional lymph nodes (RLNs) on post-treatment FDG-PET correlated with patient outcomes. Methods and Materials: Included for analysis were patients treated with concurrent chemoradiation therapy, using radiation doses ≥60 Gy, with identifiable FDG-avid RLNs (distinct from primary tumor) on pretreatment FDG-PET, and post-treatment FDG-PET data. ACRIN core laboratory SUV measurements were used. Event time was calculated from the date of post-treatment FDG-PET. Local-regional failure was defined as failure within the treated RT volume and reported by the treating institution. Statistical analyses included Wilcoxon signed rank test, Kaplan-Meier curves (log rank test), and Cox proportional hazards regression modeling. Results: Of 234 trial-eligible patients, 139 (59%) had uptake in both primary tumor and RLNs on pretreatment FDG-PET and had SUV data from post-treatment FDG-PET. Maximum SUV was greater for primary tumor than for RLNs before treatment (P<.001) but not different post-treatment (P=.320). Post-treatment SUV of RLNs was not associated with overall survival. However, elevated post-treatment SUV of RLNs, both the absolute value and the percentage of residual activity compared to the pretreatment SUV were associated with inferior local-regional control (P<.001). Conclusions: High residual metabolic activity in RLNs on post-treatment FDG-PET is associated with worse local-regional control. Based on these data, future trials evaluating a radiation therapy boost should consider inclusion of both primary tumor and FDG-avid RLNs in the boost volume to maximize local

  7. Staging of Cervical Lymph Nodes in Oral Squamous Cell Carcinoma

    DEFF Research Database (Denmark)

    Norling, Rikke; Buron, Birgitte Marie Due; Therkildsen, Marianne Hamilton

    2014-01-01

    INTRODUCTION: Clinical staging of patients with oral squamous cell carcinoma (OSCC) is crucial for the choice of treatment. Computed tomography (CT) and/or magnetic resonance imaging (MRI) are typically recommended and used for staging of the cervical lymph nodes (LNs). Although ultrasonography (US...

  8. Echo pattern of lymph nodes in colorectal cancer

    DEFF Research Database (Denmark)

    Rafaelsen, Søren Rafael; Kronborg, Ole; Fenger, Claus

    1992-01-01

    Surgical specimens from 75 patients with colorectal cancer were examined within 15 min of removal with a 7.5 MHz linear-array transducer. The echo pattern of 139 lymph nodes was analysed to evaluate previous criteria of malignancy and to establish other possible criteria, which could be tested...

  9. Metastatic Carcinoma Of The BreastWith Inguinal Lymph Node ...

    African Journals Online (AJOL)

    To report two cases of advanced breast carcinoma with metastases to the inguinal lymph nodes in two Nigerian women. The University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. Two Nigerian women, one aged 40 years with an invasive lobular carcinoma of the right breast, and the other aged 48 yearswith ...

  10. Optical biopsy of lymph node morphology using optical coherence tomography.

    Science.gov (United States)

    Luo, Wei; Nguyen, Freddy T; Zysk, Adam M; Ralston, Tyler S; Brockenbrough, John; Marks, Daniel L; Oldenburg, Amy L; Boppart, Stephen A

    2005-10-01

    Optical diagnostic imaging techniques are increasingly being used in the clinical environment, allowing for improved screening and diagnosis while minimizing the number of invasive procedures. Diffuse optical tomography, for example, is capable of whole-breast imaging and is being developed as an alternative to traditional X-ray mammography. While this may eventually be a very effective screening method, other optical techniques are better suited for imaging on the cellular and molecular scale. Optical Coherence Tomography (OCT), for instance, is capable of high-resolution cross-sectional imaging of tissue morphology. In a manner analogous to ultrasound imaging except using optics, pulses of near-infrared light are sent into the tissue while coherence-gated reflections are measured interferometrically to form a cross-sectional image of tissue. In this paper we apply OCT techniques for the high-resolution three-dimensional visualization of lymph node morphology. We present the first reported OCT images showing detailed morphological structure and corresponding histological features of lymph nodes from a carcinogen-induced rat mammary tumor model, as well as from a human lymph node containing late stage metastatic disease. The results illustrate the potential for OCT to visualize detailed lymph node structures on the scale of micrometastases and the potential for the detection of metastatic nodal disease intraoperatively.

  11. Breast and Axillary Lymph Nodes Metastasis five years after Radical ...

    African Journals Online (AJOL)

    Breast is an uncommon and rare site for metastasis. Primary and secondary tumors of the breast need to be differentiated as management is different. We present a 67 year old female patient with two breast lumps and an axillary lymph node, 5 years after nephrectomy for Renal Cell Carcinoma (RCC). Mammogram report ...

  12. [Flow cytometry in datecting lymph node micrometastasis in colorectal cancer].

    Science.gov (United States)

    Sun, Q; Ding, Y; Zhang, J

    2001-01-25

    To study the methodology and significance of flow cytometry in detecting lymph node micrometastasis of colorectal cancer. One hundred sixty-two cellular suspensions were prepared with lymph nodes which were resected radically on 25 patients with colorectal cancer and in which no cancer cells were found by HE staining. Different concentrations of cultured Lovo colorectal cancer cells were added into the celular suspension prepared from lymph node tissue of persons without colorectal cancer in order to prepare a control model. Dual staining with CK/FTTC and PI was made to the sedimetns from those 2 kinds of suspension. Flow cytometry was used to detect cancer cells. An ideal correlation was obtained between the detection value and the theoretical value of cancer cells in the specimen suspensions and control models (r = 0.097 6) with a sensitivity rate of 10/10(5). Cancer cells were detected from 7 out of the 25 patients and 30 of the 162 cellular suspensions. The detection rate was correlated with the size and infiltrating depth of the cancer. Flow cytometry is a reliable, rapid, and quantitative method for detecting lymph node micrometastasis in colorectal cancer.

  13. Uptake kinetics of relatively insoluble particles by tracheobronchial lymph nodes

    International Nuclear Information System (INIS)

    Thomas, R.G.

    1976-01-01

    Tracheobronchial lymph nodes accumulate a portion of material deposited in the deep lung following inhalation of relatively insoluble particles. Experiments involving a variety of compounds, inhaled singly or repeatedly, indicate that the kinetics of lymph node uptake are fairly independent of particle characteristics and mammalian species. The buildup per unit weight of nodal tissue compared with that of lung tissue, with time, can be represented by a linear logarithmic function. However, since the scatter in experimental points may be large at any given time after inhalation exposure, a number of different kinetic descriptions of uptake can be derived. The logarithmic pattern of accumulation can be approximated over an extended time range (several years) by use of a combination of first-order kinetics of loss from the lung and of buildup in lymph nodes, but it is recognized that the processes are much more complicated than this treatment would indicate. Clearance (loss) from the lymph nodes is not well defined, but this aspect is discussed in light of the kinetic models presented

  14. Lymph nodes tuberculosis: A retrospective study on clinical and ...

    African Journals Online (AJOL)

    Lymph nodes tuberculosis represents 30 percent of extra pulmonary tuberculosis in Morocco. We report here the experience of the pulmonology unit of the Avicenne Military Hospital in Marrakech for a period of 4 years. Our study interested 30 patients (15 males and 15 females) with an average age of 29 years old (10 to 62 ...

  15. Salmonella in peripheral lymph nodes of healthy cattle at slaughter

    Science.gov (United States)

    To more fully characterize the burden of Salmonella enterica in bovine peripheral lymph nodes (PLN), PLN (n=5,450) were collected from healthy cattle at slaughter in 12 commercial abattoirs that slaughtered feedlot-fattened (FF) cattle exclusively (n=7), cattle removed (or culled) from breeding herd...

  16. LCP nanoparticle for tumor and lymph node metastasis imaging

    Science.gov (United States)

    Tseng, Yu-Cheng

    A lipid/calcium/phosphate (LCP) nanoparticle formulation (particle diameter ˜25 nm) has previously been developed to delivery siRNA with superior efficiency. In this work, 111In was formulated into LCP nanoparticles to form 111In-LCP for SPECT/CT imaging. With necessary modifications and improvements of the LCP core-washing and surface-coating methods, 111In-LCP grafted with polyethylene glycol exhibited reduced uptake by the mononuclear phagocytic system. SPECT/CT imaging supported performed biodistribution studies, showing clear tumor images with accumulation of 8% or higher injected dose per gram tissue (ID/g) in subcutaneous, human-H460, lung-cancer xenograft and mouse-4T1, breast cancer metastasis models. Both the liver and the spleen accumulated ˜20% ID/g. Accumulation in the tumor was limited by the enhanced permeation and retention effect and was independent of the presence of a targeting ligand. A surprisingly high accumulation in the lymph nodes (˜70% ID/g) was observed. In the 4T1 lymph node metastasis model, the capability of intravenously injected 111In-LCP to visualize the size-enlarged and tumor-loaded sentinel lymph node was demonstrated. By analyzing the SPECT/CT images taken at different time points, the PK profiles of 111In-LCP in the blood and major organs were determined. The results indicated that the decrement of 111In-LCP blood concentration was not due to excretion, but to tissue penetration, leading to lymphatic accumulation. Larger LCP (diameter ˜65 nm) nanoparticles were also prepared for the purpose of comparison. Results indicated that larger LCP achieved slightly lower accumulation in the tumor and lymph nodes, but much higher accumulation in the liver and spleen; thus, larger nanoparticles might not be favorable for imaging purposes. We also demonstrated that LCP with a diameter of ˜25 nm were better able to penetrate into tissues, travel in the lymphatic system and preferentially accumulate in the lymph nodes due to 1) small

  17. Preliminary experiences with sentinel lymph node detection in cases of vulvar malignancy

    International Nuclear Information System (INIS)

    Zambo, Katalin; Schmidt, Erzsebet; Dehghani, Babak; Hartmann, Tamas; Bodis, Jozsef; Kornya, Laszlo; Tinneberg, Hans Rudolf

    2002-01-01

    Lymph node status is the most important prognostic factor in vulvar malignancy. The aim of this pilot study was to explore the clinical significance of radionuclide lymphoscintigraphy in the management of vulvar neoplasms. Eight patients with squamous cell carcinoma and two patients with malignant melanoma of the vulva were studied with 100 MBq technetium-99m nanocolloid (Sentiscint, OSSKI, Budapest) 1 day before surgery. The location of the sentinel lymph node was checked by a single-head gamma camera-computer system (MB 9200, Mediso, Budapest). Vulvectomy with bilateral inguinofemoral lymphadenectomy was performed in each case. At lymphadenectomy, the sentinel lymph node was separately removed and histologically studied. Three of the ten patients had positive sentinel lymph nodes (micrometastasis). Five months later one of them had local recurrence of the vulvar cancer, and another had inguinal recurrence of the tumour 6 months postoperatively; the third patient was operated on only recently. Our preliminary results are impressive and suggest that lymphoscintigraphy is an easy and reliable method for detection of the sentinel lymph node in vulvar malignancy. (orig.)

  18. FDG PET/MR for lymph node staging in head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Platzek, Ivan, E-mail: ivan.platzek@uniklinikum-dresden.de [Dresden University Hospital, Department of Radiology, Fetscherstr. 74, 01307 Dresden (Germany); Beuthien-Baumann, Bettina, E-mail: bettina.beuthien-baumann3@uniklinikum-dresden.de [Dresden University Hospital, Department of Nuclear Medicine, Fetscherstr. 74, 01307 Dresden (Germany); Schneider, Matthias, E-mail: m.schneider@mkgdresden.de [Dresden University Hospital, Department of Oral and Maxillofacial Surgery, Fetscherstr. 74, 01307 Dresden (Germany); Gudziol, Volker, E-mail: volker.gudziol@uniklinikum-dresden.de [Dresden University Hospital, Department of Otolaryngology, Fetscherstr. 74, 01307 Dresden (Germany); Kitzler, Hagen H., E-mail: hagen.kitzler@uniklinikum-dresden.de [Dresden University Hospital, Department of Neuroradiology, Fetscherstr. 74, 01307 Dresden (Germany); Maus, Jens, E-mail: j.maus@hzdr.de [Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Bautzner Landstr. 400, 01328 Dresden (Germany); Schramm, Georg, E-mail: g.schramm@hzdr.de [Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Bautzner Landstr. 400, 01328 Dresden (Germany); Popp, Manuel, E-mail: manuel.popp@praxisklinik-dresden.de [Dresden University Hospital, Department of Nuclear Medicine, Fetscherstr. 74, 01307 Dresden (Germany); Laniado, Michael, E-mail: michael.laniado@uniklinikum-dresden.de [Dresden University Hospital, Department of Radiology, Fetscherstr. 74, 01307 Dresden (Germany); Kotzerke, Jörg, E-mail: Joerg.Kotzerke@uniklinikum-dresden.de [Dresden University Hospital, Department of Nuclear Medicine, Fetscherstr. 74, 01307 Dresden (Germany); Hoff, Jörg van den, E-mail: j.van_den_hoff@hzdr.de [Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Bautzner Landstr. 400, 01328 Dresden (Germany)

    2014-07-15

    Objective: To assess the diagnostic value of PET/MR (positron emission tomography/magnetic resonance imaging) with FDG (18F-fluorodeoxyglucose) for lymph node staging in head and neck cancer. Materials and methods: This prospective study was approved by the local ethics committee; all patients signed informed consent. Thirty-eight patients with squamous cell carcinoma of the head and neck region underwent a PET scan on a conventional scanner and a subsequent PET/MR on a whole-body hybrid system after a single intravenous injection of FDG. The accuracy of PET, MR and PET/MR for lymph node metastases were compared using receiver operating characteristic (ROC) analysis. Histology served as the reference standard. Results: Metastatic disease was confirmed in 16 (42.1%) of 38 patients and 38 (9.7%) of 391 dissected lymph node levels. There were no significant differences between PET/MR, MR and PET and MR (p > 0.05) regarding accuracy for cervical metastatic disease. Based on lymph node levels, sensitivity and specificity for metastatic involvement were 65.8% and 97.2% for MR, 86.8% and 97.0% for PET and 89.5% and 95.2% for PET/MR. Conclusions: In head and neck cancer, FDG PET/MR does not significantly improve accuracy for cervical lymph node metastases in comparison to MR or PET.

  19. Economic consequence of local control with radiotherapy: Cost analysis of internal mammary and medial supraclavicular lymph node radiotherapy in breast cancer

    International Nuclear Information System (INIS)

    Lievens, Yolande; Kesteloot, Katrien; Bogaert, Walter van den

    2005-01-01

    Purpose: To investigate the financial implications of radiotherapy (RT) to the internal mammary and medial supraclavicular lymph node chain (IM-MS) in postoperative breast cancer. Methods and Materials: A cost-effectiveness and cost-utility analysis were performed, using Markov models, comparing the early and delayed costs and effects of IM-MS during a 20-year time span from a societal viewpoint. The outcome estimates were based on Level I evidence from postoperative RT literature and the cost estimates on the standard practice of the Leuven University Hospitals, with the RT costs derived from an activity-based costing program developed in the department. Results: On the basis of the assumptions of the model and seen during a 20-year time span, primary treatment including IM-MS RT results in a cost savings (approximately EURO 10,000) compared with a strategy without RT. Because IM-MS RT also results in better clinical effectiveness and greater quality of life, the treatment with IM-MS dominates the approach without IM-MS. Sensitivity analyses confirmed the robustness of these results in all tested circumstances. Although threshold values were found for the cost of IM-MS, the cost at relapse, and the quality of life after treatment, these were substantially different from the baseline estimates, indicating that it is very unlikely that omitting IM-MS would become superior. Conclusion: This ex-ante cost evaluation of IM-MS RT showed that the upfront costs of locoregional RT are easily compensated for by avoiding the costs of treating locoregional and distant relapse at a later stage. The cost-sparing effect of RT should, however, be evaluated for a sufficiently long time span and is most specifically found in tumors with a rather slow natural history and a multitude of available systemic treatments at relapse, such as breast cancer

  20. Gangliocytic paraganglioma of duodenum metastatic to lymph nodes and liver and extending into the retropancreatic space

    DEFF Research Database (Denmark)

    Amin, S M; Albrechtsen, N Wewer; Forster, J

    2013-01-01

    Gangliocytic paraganglioma (GP) is a rare benign neuroendocrine tumour found most often in the duodenum. To our knowledge, only a dozen cases of possibly malignant duodenal GP with local lymph node metastasis and only one case with liver metastasis have previously been published. Herein, we report...... an unusual case of GP of the duodenum spreading to the retropancreatic space and metastatic to the liver and lymph nodes. Additionally, the present tumour secreted pancreatic polypeptide (PP) which was detected in the serum during the follow-up period. We suggest that serum PP could be a valuable marker...

  1. Sentinel lymph node (Sln) detection in vulvar cancer

    International Nuclear Information System (INIS)

    Grimm, J.; Mende, T.; Lantzsch, T.; Seliger, G.; Koelbl, H.; Buchmann, J.

    2002-01-01

    Full text: The purpose of the study is to verify the feasibility of the sentinel lymph node (SLN) procedure in patients with evidence of vulva cancer. We studied 13 women with early stage (T1/T2) carcinoma of the vulva. One day before surgery a lymphoscintigraphy was done. We injected intradermally an average 76 MBq of 99m Tc-labelled human colloides (Albu-Res(r) in 0.4-0.6 ml NaCI at 4 locations round the tumor regarding the midline. Because of the large particles the colloid was filtered before to obtain the small particle fraction between 200-450 nm. Immediately alter injection a dynamic scintigraphy was performed with 28 images, 1 minute per frame. Additional we made static images, 5 minutes per image, 30 and 120 minutes after injection. The location of the SLN was marked on the skin. The SLN was intraoperatively identified using a hand-held gamma probe. In every case a complete inguino-femoral lymph node dissection was done. In all cases we could show one or more (on average 3) SLN by means of lymphoscintigraphy and in 11/13 cases we could detect SLN by using the gamma probe. Lymph channels were seen in 7/13 dynamic studies. 4/13 patients had lymph node metastasis in the SLN (3/4 cases only the SLN and in 1/4 cases the SLN and one additional lymph node were positive). We did not found any tumor-positive non-sentinel lymph node in case of tumor-negative SLN. The morbidity after operation of patients with vulva cancer is considerable and related to the groin dissection. The selective SLN-biopsy instead of radical groin dissection is feasible to reduce the morbidity without a loss of staging and prognostic factors. This method should be restricted to patients with early stage vulva cancer with clinically uninvolved lymph nodes. Further studies are needed to evaluate the accuracy and clinical validity of this procedure. (author)

  2. Differential Motion Between Mediastinal Lymph Nodes and Primary Tumor in Radically Irradiated Lung Cancer Patients

    International Nuclear Information System (INIS)

    Schaake, Eva E.; Rossi, Maddalena M.G.; Buikhuisen, Wieneke A.; Burgers, Jacobus A.; Smit, Adrianus A.J.; Belderbos, José S.A.; Sonke, Jan-Jakob

    2014-01-01

    Purpose/Objective: In patients with locally advanced lung cancer, planning target volume margins for mediastinal lymph nodes and tumor after a correction protocol based on bony anatomy registration typically range from 1 to 1.5 cm. Detailed information about lymph node motion variability and differential motion with the primary tumor, however, is lacking from large series. In this study, lymph node and tumor position variability were analyzed in detail and correlated to the main carina to evaluate possible margin reduction. Methods and Materials: Small gold fiducial markers (0.35 × 5 mm) were placed in the mediastinal lymph nodes of 51 patients with non-small cell lung cancer during routine diagnostic esophageal or bronchial endoscopic ultrasonography. Four-dimensional (4D) planning computed tomographic (CT) and daily 4D cone beam (CB) CT scans were acquired before and during radical radiation therapy (66 Gy in 24 fractions). Each CBCT was registered in 3-dimensions (bony anatomy) and 4D (tumor, marker, and carina) to the planning CT scan. Subsequently, systematic and random residual misalignments of the time-averaged lymph node and tumor position relative to the bony anatomy and carina were determined. Additionally, tumor and lymph node respiratory amplitude variability was quantified. Finally, required margins were quantified by use of a recipe for dual targets. Results: Relative to the bony anatomy, systematic and random errors ranged from 0.16 to 0.32 cm for the markers and from 0.15 to 0.33 cm for the tumor, but despite similar ranges there was limited correlation (0.17-0.71) owing to differential motion. A large variability in lymph node amplitude between patients was observed, with an average motion of 0.56 cm in the cranial-caudal direction. Margins could be reduced by 10% (left-right), 27% (cranial-caudal), and 10% (anteroposterior) for the lymph nodes and −2%, 15%, and 7% for the tumor if an online carina registration protocol replaced a

  3. The Prognostic Value of Lymph Nodes Dissection Number on Survival of Patients with Lymph Node-Negative Gastric Cancer

    Directory of Open Access Journals (Sweden)

    Wu Song

    2014-01-01

    Full Text Available Objective. The study was designed to explore the prognostic value of examined lymph node (LN number on survival of gastric cancer patients without LN metastasis. Methods. Between August 1995 and January 2011, 300 patients who underwent gastrectomy with D2 lymphadenectomy for LN-negative gastric cancer were reviewed. Patients were assigned to various groups according to LN dissection number or tumor invasion depth. Some clinical outcomes, such as overall survival, operation time, length of stay, and postoperative complications, were compared among all groups. Results. The overall survival time of LN-negative GC patients was 50.2±30.5 months. Multivariate analysis indicated that LN dissection number (P30. Besides, it was not correlated with operation time, transfusion volume, length of postoperative stay, or postoperative complication incidence (P>0.05. Conclusions. The number of examined lymph nodes is an independent prognostic factor of survival for patients with lymph node-negative gastric cancer. Sufficient dissection of lymph nodes is recommended during surgery for such population.

  4. Subcarinal lymph node in upper lobe non-small cell lung cancer patients: is selective lymph node dissection valid?

    Science.gov (United States)

    Aokage, Keiju; Yoshida, Junji; Ishii, Genichiro; Hishida, Tomoyuki; Nishimura, Mitsuyo; Nagai, Kanji

    2010-11-01

    Little is known about selective lymph node dissection in non-small cell lung cancer (NSCLC) patients. We sought to gain insight into subcarinal node involvement for its frequency and impact on outcome to evaluate whether it is valid to omit subcarinal lymph node dissection in upper lobe NSCLC patients. We reviewed node metastases distribution according to node region, tumor location, and histology among 1099 patients with upper lobe NSCLC. We paid special attention to subcarinal metastases patients without superior mediastinal node metastases, because their pathological stages would have been underdiagnosed if subcarinal node dissection had been omitted. We also assessed the outcome and the pattern of failure among subcarinal metastases patients. To identify subcarinal node involvement predictors, we analyzed 7 clinical factors. Subcarinal node metastases were found in 20 patients and were least frequent among squamous cell carcinoma patients (0.5%). Two of them were free from superior mediastinal metastases but died of the disease at 1 month and due to an unknown cause at 18 months, respectively. Seventeen of the 20 patients developed multi-site recurrence within 37 months. The 5-year survival rate of the 20 patients with subcarinal metastases was 9.0%, which was significantly lower than 32.0% of patients with only superior mediastinal metastases. Clinical diagnosis of node metastases was significantly predictive of subcarinal metastases. Subcarinal node metastases from upper lobe NSCLC were rare and predicted an extremely poor outcome. It appears valid to omit subcarinal node dissection in upper lobe NSCLC patients, especially in clinical N0 squamous cell carcinoma patients. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  5. Chest CT findings in EBUS-TBNA-proven anthracosis in enlarged mediastinal lymph nodes

    Energy Technology Data Exchange (ETDEWEB)

    Kirchner, J. [Allgemeines Krankenhaus Hagen (Germany). Dept. of Interventional and Diagnostic Radiology; Mueller, P. [Allgemeines Krankenhaus Hagen (Germany). Dept. of Medicine; Broll, M.; Kirchner, E.M. [Sana Klinikum Duisburg (Germany). Dept. of Medicine; Pomjanski, N.; Biesterfeld, S. [University Hospital Duesseldorf (Germany). Dept. of Pathology; Liermann, D. [Marien Hospital, Herne (Germany). Dept. of Diagnostic and Interventional Radiology and Nuclear Medicine; Kickuth, R. [University Hospital Wuerzburg (Germany). Dept. of Radiology

    2014-12-15

    We demonstrate the multislice computed tomography (MSCT) findings of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)-proven hilar and mediastinal lymph node enlargement with signs of anthracosis. 53 enlarged lymph nodes in 39 patients (28 male, 11 female) with EBUS-TBNA-confirmed anthracosis were analyzed retrospectively. The mean short axis diameter of the enlarged lymph nodes with signs of anthracosis was 13.7 mm. Lymph nodes most often showed an oval shape (84%) and were well defined in 66% of cases. Lymph node confluence was observed in 32% of cases. Calcifications were documented in 24.5% of cases. Contrast enhancement and fatty involution were seen seldom (3.8%). Lymph node necrosis was not seen. Lymph node anthracosis may be found most often in enlarged, well defined lymph nodes with an oval shape, frequently associated with confluence and calcifications.

  6. Outcomes by Ethnicity: Sentinel Lymph Node Status in Women With Breast Cancer

    National Research Council Canada - National Science Library

    Hassett, Mary; Hunt, Kelly K; Keyomarsi, Khandan

    2005-01-01

    .... Race/ethnicity and tumor biology may affect outcomes. Since regional lymph node status and tumor markers are strong prognostic indicators, this study examines the role of sentinel lymph node status (SLNS...

  7. Persistent postoperative pain and sensory changes following lymph node excision in melanoma patients

    DEFF Research Database (Denmark)

    Slagelse, Charlotte; Petersen, Karin L; Dahl, Jørgen B

    2014-01-01

    Studies on complications related to chronic nerve injury following sentinel lymph node biopsy (SLNB) and complete lymph node dissection (CLND) for melanoma are sparse. This review summarizes the existing literature on pain and neuropathic complications in melanoma patients undergoing SLNB...

  8. Accurate Prediction of Submental Lymph Nodes Using Magnetic Resonance Imaging for Lymphedema Surgery

    Directory of Open Access Journals (Sweden)

    Mora-Ortiz Asuncion, MD

    2018-03-01

    Conclusions:. The preoperative MRI is a useful tool for the detection of mean 7.2 submental lymph nodes. Mean 72.2% of submental lymph nodes can be successfully transferred for extremity lymphedema with optimal functional recovery.

  9. Endoscopic ultrasound, endoscopic sonoelastography, and strain ratio evaluation of lymph nodes with histology as gold standard

    DEFF Research Database (Denmark)

    Larsen, Michael Hareskov; Fristrup, Claus Wilki; Hansen, Tine Plato

    2012-01-01

    . Endoscopic sonoelastography (ESE) assesses the elasticity of lymph nodes and has been used to differentiate lymph nodes with promising results. The aim of this study was to evaluate the use of EUS, EUS - FNA, ESE, and ESE-strain ratio using histology as the gold standard. PATIENTS AND METHODS: Patients......, EUS - FNA and EUS - FNM were performed. The marked lymph node was isolated during surgery for histological examination. RESULTS: The marked lymph node was isolated for separate histological examination in 56 patients, of whom 22 (39 %) had malignant lymph nodes and 34 (61 %) had benign lymph nodes...... - FNM technique enabled the identification of a specific lymph node and thereby the use of histology as gold standard. ESE and ESE-strain ratio were no better than standard EUS in differentiating between malignant and benign lymph nodes in patients with resectable upper gastrointestinal cancer....

  10. Prognostic factors for lymph node metastasis from advanced squamous cell carcinoma of the skin of the trunk and extremities

    Directory of Open Access Journals (Sweden)

    Carvalho Andre

    2008-07-01

    Full Text Available Abstract Background Squamous cell carcinoma (SCC of the skin of the trunk and extremities may present lymph node metastasis with difficult disease control and poor survival. The purpose of this study was to identify risk factors for lymph node metastasis and outcome. Patients/Methods Retrospective review of 57 patients with locally advanced SCC of the trunk and extremities was performed and several clinical variables including age, gender, ethnicity, previously injured skin (burns, scars, ulcers and others, patient origin (rural or urban, anatomic site and treatment were studied. Results Fifteen patients presented with previous skin lesions. Thirty-six were classified as T3 tumors and 21 as T4; 46 were N0, and 11, N1. Eleven N0 patients presented lymph node metastasis during follow up. Univariate analysis identified previous skin lesions (ulcers and scars as risk factor for lymph node metastasis (p = 0.047. Better survival was demonstrated for T3 (p = 0.018 classification. N0 patients who presented lymph node metastasis during follow up (submitted to lymphadenectomy had similar survival to patients without lymph node recurrence (p = 0.219. Conclusion Local advanced tumors are at risk of lymph node metastasis. Increased risk is associated to previous lesions at tumor site. T4 classification have worse prognosis. Lymph node recurrences in N0 patients, once treated, did not affect survival. For these patients, we propose close follow up and prompt treatment of lymph node metastasis. These results do not support indication for elective lymphadenectomy or sentinel node mapping. Further prospective studies must address this issue.

  11. Sentinel Lymph Node Biopsy in Breast Cancer: Predictors of Axillary and Non-Sentinel Lymph Node Involvement

    Directory of Open Access Journals (Sweden)

    Hakan Postacı

    2013-12-01

    Full Text Available Background: Sentinel lymph node biopsy is a standard method for the evaluation of axillary status in patients with T1-2N0M0 breast cancers. Aims: To determine the prognostic significance of primary tumour-related clinico-histopathological factors on axillary and non-sentinel lymph node involvement of patients who underwent sentinel lymph node biopsy. Study design: Retrospective clinical study. Methods: In the present study, 157 sentinel lymph node biopsies were performed in 151 consecutive patients with early stage breast cancer between June 2008 and December 2011. Results: Successful lymphatic mapping was obtained in 157 of 158 procedures (99.4%. The incidence of larger tumour size (2.543±1.21 vs. 1.974±1.04, lymphatic vessel invasion (70.6% vs. 29.4%, blood vessel invasion (84.2% vs. 15.8%, and invasive lobular carcinoma subtype (72.7% vs. 27.3% were statistically significantly higher in patients with positive SLNs. Logistic stepwise regression analysis disclosed tumour size (odds ratio: 1.51, p=0.0021 and lymphatic vessel invasion (odds ratio: 4.68, p=0.001 as significant primary tumour-related prognostic determinants of SLN metastasis. Conclusion: A close relationship was identified between tumour size and lymphatic vessel invasion of the primary tumour and axillary lymph node involvement. However, the positive predictive value of these two independent variables is low and there is no compelling evidence to recommend their use in routine clinical practice.

  12. Abnormal position of lymph nodes in a freemartin sheep

    Directory of Open Access Journals (Sweden)

    Salazar PA

    2012-03-01

    Full Text Available Angela M Gonella-Diaza, Luz Zoraya Duarte, Sergio Dominguez, Pedro A SalazarClínica de Grandes Animales, Facultad de Medicina Veterinaria y de Zootecnia, Universidad Cooperativa de Colombia, Bucaramanga, Santander, ColombiaAbstract: In this freemartin case report the authors present the clinical and morphological findings of a freemartin ewe with an abnormal position of two lymph nodes. Freemartins, infertile females from mixed-sex twin pregnancies, are chimeras, having two cell populations: one of their own (XX DNA and one from their male twin (XY DNA. Freemartins can have varying degrees of phenotypic masculinization, including, in some cases, having active male gonads and exhibiting male behaviors such as heat detection and aggressiveness. During the clinical examination of the freemartin ewe, a morphological abnormality of the vulva, the presence of scrotal sacs, and a lack of mammary tissue development were noted. On inspection of the vaginal channel, an extremely enlarged clitoris, resembling a penis, was found. The clinical evidence suggested freemartinism. After the karyotyping diagnosis confirmation, a necropsy was performed and samples were taken for histology and immunohistochemistry. There were two structures found in the scrotal sacs; however, these were found to be lymph nodes, not testicles, and this was confirmed by CD3 lymph protein coloration. On histological study, the phallic structure showed corpus cavernosum and tunica albuginea. The testicles were found retained inside the abdominal cavity, with the presence of atrophic seminiferous tubules. Although the position of the testicles in freemartins has been reported as highly variable, this is the first time, to the best of the authors' knowledge, that a case has been reported where lymph nodes have been found inside the scrotal sacs. It is possible that these were the inguinal lymph nodes, trapped inside the scrotum during fetal growth and development.Keywords: freemartinism

  13. Evaluation of mesenteric lymph nodes in children with abdominal pain

    International Nuclear Information System (INIS)

    Jedrzejewski, G.

    2008-01-01

    The aim of this study was to evaluate the prevalence of enlarged mesenteric lymph nodes seen on pediatric abdominal ultrasound examinations performed in children with abdominal pain. Ultrasound was performed with Sonoline Elegra and Philips iU-22 units with convex-array 2-5 MHz transducer for the general abdominal examination, and in addition with convex 5-8 MHz or linear 7.5 MHz transducers specially to detect lymph nodes. Enlarged lymph nodes were found in 248 (21,2%) out of 1171 symptomatic patients. In 53 patients some other abnormalities were found. The nodes were mostly disc-like and oval in shape. They had usually a homogeneous appearance and were iso- or hypoechoic relative to the surrounding tissues and intestinal loops. Mesenteric lymphadenitis is commonly reported in children with acute, chronic or recurrent abdominal pain and no evidence of other pathologies, and has been reported as one of the most common explanation for acute right lower quadrant abdominal pain. (authors)

  14. Current Status and Scope of Lymph Node Micrometastasis in Gastric Cancer

    OpenAIRE

    Lee, Chang Min; Park, Sung-Soo; Kim, Jong-Han

    2015-01-01

    Recently, lymph node micrometastasis has been evaluated for its prognostic value in gastric cancer. Lymph node micrometastasis cannot be detected via a usual pathologic examination, but it can be detected by using some other techniques including immunohistochemistry and reverse transcription-polymerase chain reaction assay. With the development of such diagnostic techniques, the detection rate of lymph node micrometastasis is constantly increasing. Although the prognostic value of lymph node ...

  15. Mulig forbedret behandling af kolorektal cancer med sentinel lymph node-diagnostik

    DEFF Research Database (Denmark)

    Burgdorf, Stefan Kobbelgaard; Eriksen, Jens Ravn; Gögenur, Ismail

    2014-01-01

    Possibly improved treatment of colorectal cancer by sentinel lymph node mapping Prognosis for colorectal cancer is dependent on radical surgical intervention. Chemotherapy in patients with advanced disease has improved the survival. A considerable proportion of the patients going through radical...... surgery will subsequently relapse. Adjuvant chemotherapy is reserved for patients with lymph node metastases, why undetected malignant lymph nodes will result in understaging and exclusion from the possible benefit of adjuvant chemotherapy. With sentinel lymph node mapping it may be possible to detect...

  16. Internal mammary lymph node management – further direction

    Directory of Open Access Journals (Sweden)

    Vrana D

    2017-02-01

    Full Text Available D Vrana,1,2 J Gatek3,4 1Department of Oncology, 2Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, Olomouc, 3Department of Surgery, Atlas Hospital, 4Faculty of Humanities, Tomas Bata University in Zlín, Zlín, Czech Republic We read the article titled “Internal mammary sentinel lymph node biopsy: abandon or persist?” by Qiu et al with high interest. This was an excellent paper regarding the contemporary management of internal mammary lymph nodes (IMLN in early-stage breast cancer1 and we would like to take this opportunity to comment on this paper.There are several unresolved questions regarding early-stage breast management including axillary staging, clear resection margin, or IMLN.2–4 We have been focusing on the issues of IMLN for almost a decade and just recently published our data regarding IMLN management. We absolutely agree that one has to carefully balance the benefit and potential risks of biopsy or radiotherapy of IMLN.  Authors' reply Peng-Fei Qiu, Yong-Sheng WangBreast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, People’s Republic of China  We appreciate the letter from Professors Vrana and Gatek regarding our article titled “Internal mammary sentinel lymph node biopsy: abandon or persist?”.1 We have been following their publications regarding internal mammary lymph nodes (IMLN management since the publication of their article titled “Prognostic influence of internal mammary node drainage in patients with early-stage breast cancer” in December 20162 and we share their interest on this topic.  View the original paper by Qiu and colleagues.

  17. Comparison of Functional Outcome after Extended versus Super-Extended Pelvic Lymph Node Dissection during Radical Prostatectomy in High-Risk Localized Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Heikki Seikkula

    2017-11-01

    Full Text Available BackgroundUrinary continence and erectile function (EF are best preserved when meticulous dissection of prostate and nerve sparing technique are used during radical prostatectomy (RP. However, extent of lymph node dissection (LND may also adversely affect functional results.ObjectiveTo determine whether performing a super-extended LND (seLND has a significant effect on recovery of urinary continence and EF after RP.Design, setting, and participantsAll patients who underwent RP from January 2007 until December 2013 were handed questionnaires assessing continence and EF. All patients in whom at least an extended LND (eLND was performed were selected. This search yielded 526 patients. 172 of these patients had filed out 2 or more questionnaires and were included in our analysis.Outcome measurements and statistical analysisAll questionnaires were reviewed. We used Kaplan–Meier analyses and multivariate Cox analysis to assess the difference in recovery of continence and EF over time for eLND/seLND. Primary endpoints were full recovery of continence (no loss of urine and full recovery of EF (successful intercourse possible. Patients who did not reach the endpoint when the last questionnaire was filled out were censored at that time. Median follow-up was 12.43 months for continence, and 18.97 months for EF.Results and limitationsPatients undergoing seLND have a lower chance of regaining both urinary continence [hazard ratio (HR 0.59, 95% CI 0.39–0.90, p = 0.026] and EF (HR 0.28, 95% CI 0.13–0.57, p = 0.009. Age at surgery had a significant influence on both continence and EF in multivariate analysis. Major limitation of the study was that no formal preoperative assessment of continence and potency was done.ConclusionExtending the LND template beyond the eLND template may cause at least a significant delay in recovery of urinary continence and leads to less recovery of EF.

  18. A critical evaluation of lymph node ratio in head and neck cancer

    NARCIS (Netherlands)

    de Ridder, M.; Marres, C. C. M.; Smeele, L. E.; van den Brekel, M. W. M.; Hauptmann, M.; Balm, A. J. M.; van Velthuysen, M. L. F.

    2016-01-01

    In head and neck squamous cell carcinoma (HNSCC), the search for better prognostic factors beyond TNM-stage is ongoing. Lymph node ratio (LNR) (positive lymph nodes/total lymph nodes) is gaining interest in view of its potential prognostic significance. All HNSCC patients at the Netherlands Cancer

  19. Occurrence of lymph node metastasis in early-stage parotid gland cancer.

    Science.gov (United States)

    Stenner, Markus; Molls, Christoph; Luers, Jan C; Beutner, Dirk; Klussmann, Jens P; Huettenbrink, Karl-Bernd

    2012-02-01

    Lymph node metastasis is one of the most important factors in therapy and prognosis for patients with parotid gland cancer. Nevertheless, the extent of the primary tumor resection and the necessity of a neck dissection still is a common issue. Since little is known about lymph node metastasis in early-stage parotid gland cancer, the purpose of the present study was to evaluate the occurrence of lymph node metastases in T1 and T2 carcinomas and its impact on local control and survival. We retrospectively analyzed 70 patients with early-stage (T1 and T2) primary parotid gland cancer. All patients were treated with parotidectomy and an ipsilateral neck dissection from 1987 to 2009. Clinicopathological and survival parameters were calculated. The median follow-up time was 51.7 months. A positive pathological lymph node stage (pN+) was found in 21.4% of patients with a significant correlation to the clinical lymph node stage (cN) (p = 0.061). There were no differences in the clinical and histopathological data between pN- and pN+ patients. In 73.3% of pN+ patients, the metastases were located intraparotideal. The incidence of occult metastases (pN+/cN-) was 17.2%. Of all patients with occult metastases, 30.0% had extraparotideal lymphatic spread. A positive lymph node stage significantly indicated a poorer 5-year overall as well as 5-year disease-free survival rate compared to pN- patients (p = 0.048; p = 0.011). We propose total parotidectomy in combination with at least a level II-III selective neck dissection in any case of early-stage parotid gland cancer.

  20. Intranodal Palisaded Myofibroblastoma in a Submandibular Lymph Node

    Directory of Open Access Journals (Sweden)

    Leila Bouhajja

    2017-01-01

    Full Text Available Intranodal palisaded myofibroblastoma (IPM, also known as “intranodal hemorrhagic spindle cell tumor with amianthoid fibers,” is a rare benign mesenchymal tumor originating from smooth muscle cells and myofibroblasts, often with the presence of amianthoid fibers. Usually IPM affects inguinal lymph nodes, but three cases have been described in the submandibular and cervical lymph nodes. We report a new case of a 44-year-old women with submandibular mass. Cervical ultrasound showed a suspect right submandibular adenomegaly. The patient underwent an excision of the submandibular mass. Histological features of the tumor include an encapsulated fusocellular proliferation, with nuclear palisading, amianthoid fibers, hemosiderin pigment, and extravasated erythrocytes. In the light of these results, we made the diagnosis of IPM. No recurrence was found 5 years after surgery.

  1. Thyroidectomy and Lymph Node Dissection in Papillary Thyroid Carcinoma

    Directory of Open Access Journals (Sweden)

    Yasuhiro Ito

    2011-01-01

    Full Text Available Papillary carcinoma is a prominent malignancy originating from follicular cells. This disease generally shows an indolent character, but patients demonstrating certain clinicopathological features have a dire prognosis. At present, Western countries adopted almost routine total thyroidectomy with radioactive iodine (RAI ablation, while limited thyroidectomy with extensive prophylactic lymph node dissection has traditionally been performed for most patients in Japan. Recently, accurate evaluation of carcinoma stage can be performed on preoperative imaging studies, especially on ultrasonography. It is therefore important to treat papillary carcinoma patients depending on clinicopathological features rather than in a stereotyped fashion. In this paper, appropriate extension of thyroidectomy and lymph node dissection is discussed based on Western and recently published Japanese guidelines and the experience in Kuma Hospital.

  2. Ex vivo sentinel lymph node investigation in colorectal cancer

    Directory of Open Access Journals (Sweden)

    Antônio Hilário Alves Freitas

    2013-01-01

    Full Text Available Introduction: In Brazil, about 26,000 cases of colorectal cancer are diagnosed per year. Pa- tients considered at the early stage of disease (without lymph node evolve with tumor relapse or recurrence in up to a quarter of cases, probably due to understaging. Objective: Research on ex vivo sentinel lymph node in patients with colorectal adenocarcinoma. Materials and methods: We studied 37 patients who underwent curative surgical resection. The marker used to identify lymph nodes was patent blue dye injected into the peritu- moral submucosa of the open surgical specimen immediately after its removal from the abdominal cavity. Results: Ex vivo identification of sentinel lymph node with marker occurred in 13 (35.1% patients. The sensitivity was 40% and 60% false negative. The detailed histological examina- tion of sentinel lymph nodes with multilevel section and immunohistochemistry showed metastasis in one (4.3% individual, considered ultra-staging. Conclusion: The ex vivo identification of sentinel lymph node had questionable benefits, and worse results when include patients with rectal cancer. Restaging of one patient was possible after multilevel section and immunohistochemistry of the sentinel lymph node, but more research is needed to evaluate the role of micrometastases in patients with colorectal cancer. Resumo: Introdução: No Brasil, a cada ano são diagnosticados cerca de 26.000 casos de câncer colorre- tal. Pacientes com estadiamento considerado inicial, sem linfonodo metastático, evoluem com recorrência ou recidiva do tumor em até um quarto dos casos, por provável subesta- diamento. Objetivo: pesquisar sobre linfonodo-sentinela ex vivo em pacientes com adeno- carcinoma colorretal. Objetivo: Foram estudados 37 pacientes, submetidos à cirurgia oncológica com ressecção caráter curativo. O marcador de linfonodos utilizado foi o corante azul patente, injetado na submucosa peritumoral da peça cirúrgica aberta imediatamente

  3. Thyroidectomy and lymph node dissection in papillary thyroid carcinoma.

    Science.gov (United States)

    Ito, Yasuhiro; Miyauchi, Akira

    2010-11-10

    Papillary carcinoma is a prominent malignancy originating from follicular cells. This disease generally shows an indolent character, but patients demonstrating certain clinicopathological features have a dire prognosis. At present, Western countries adopted almost routine total thyroidectomy with radioactive iodine (RAI) ablation, while limited thyroidectomy with extensive prophylactic lymph node dissection has traditionally been performed for most patients in Japan. Recently, accurate evaluation of carcinoma stage can be performed on preoperative imaging studies, especially on ultrasonography. It is therefore important to treat papillary carcinoma patients depending on clinicopathological features rather than in a stereotyped fashion. In this paper, appropriate extension of thyroidectomy and lymph node dissection is discussed based on Western and recently published Japanese guidelines and the experience in Kuma Hospital.

  4. RADIONUCLIDE INDICATION OF SENTINEL LYMPH NODES IN LARYNX AND LARYNGOPHARYNX CANCER

    Directory of Open Access Journals (Sweden)

    I. G. Sinilkin

    2014-01-01

    Full Text Available Aim: to determine the possibility of radionuclide methods in the identification of "sentinel" lymph node (SLN in larynx and laryngopharynx cancer patients.Material and methods: 17 patients with larynx and laryngopharynx cancer were included in research. In all patients for SLN visualization nanocolloid radiopharmaceutical was injection around tumor into mucous coat with the subsequent SPECT and radioguided study.Results: Sensitivity and specificity of SPECT and radioguided study for SLN identification were 100%. We found 22 SLN in 17 patients (from 1 to 2 per patient, on average 1.3. Most often SLN were located in the III level of a neck (lymph nodes around of carotid arteries – 12 SLN (54.5% and IIA level (under lower jaw lymph nodes – 6 (27.2%. One SLN (4.5% was localized in IV level and 3 nodes (13.6% in VI level. In 2 patients (11.8% metastasis in SLN were found. In these patients within 2 years cancer progressing was revealed. Fifteen patients (88.2% had no metastatic in SLN and had no progressing of a cancer.Conclusions: Sensitivity and specificity of SPECT and radioguided study for SLN identification are 100%. In patients with metastatic SLN radical surgery with lymph node dissection is helpful.

  5. Lymph node metastasis in the biliary tract carcinoma: CT evaluation

    International Nuclear Information System (INIS)

    Lee, Byung Hee; Lee, Ah Ra; Kim, Kie Hwan; Do, Young Soo; Chin, Soo Yil

    1994-01-01

    The primary biliary carcinoma is usually unresectable at presentation, because of early lymphatic spread. To determine the incidence and the spread pattern of lymph node metastases according to the location of the primary tumor, we analyzed the CT scans of the patients with primary biliary adenocarcinoma. We reviewed the CT scans of 92 patients with pathologically proven primary biliary adenocacinima, including 45 peripheral cholangiocarcinomas, 22 hilar cholangiocarcinomas, 18 gallbladder carcinomas, and 7 common bile duct carcinomas. Positive adenopathy was diagnosed when the node exceeded 10 mm in short axis. The overall incidence of nodal metastases was 59.8% (55/92); 66.7% in peripheral cholangiocarcinoma, 54.5% in hilar cholangiocarcinoma, 55.6% in gallbladder carcinoma, and 42.9% in common bile duct carcinoma. The most commonly involved nodal group was the lesser omentum, followed by the celiac, periaortic, and peripancreatic group. The phrenic node group was only involved in the cases with the peripheral or hilar cholangiocarcinoma. The primary biliary carcinoma has a high incidence of lymph node metastases at the time of diagnosis, and shows different nodal spread pattern according to the location of the primary tumor. Involvement of the phrenic node was limited to the peripheral and hilar cholangiocarcinoma

  6. Lymph node metastasis in the biliary tract carcinoma: CT evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Byung Hee; Lee, Ah Ra; Kim, Kie Hwan; Do, Young Soo; Chin, Soo Yil [Korea Cancer Center Hospital, Seoul (Korea, Republic of)

    1994-07-15

    The primary biliary carcinoma is usually unresectable at presentation, because of early lymphatic spread. To determine the incidence and the spread pattern of lymph node metastases according to the location of the primary tumor, we analyzed the CT scans of the patients with primary biliary adenocarcinoma. We reviewed the CT scans of 92 patients with pathologically proven primary biliary adenocacinima, including 45 peripheral cholangiocarcinomas, 22 hilar cholangiocarcinomas, 18 gallbladder carcinomas, and 7 common bile duct carcinomas. Positive adenopathy was diagnosed when the node exceeded 10 mm in short axis. The overall incidence of nodal metastases was 59.8% (55/92); 66.7% in peripheral cholangiocarcinoma, 54.5% in hilar cholangiocarcinoma, 55.6% in gallbladder carcinoma, and 42.9% in common bile duct carcinoma. The most commonly involved nodal group was the lesser omentum, followed by the celiac, periaortic, and peripancreatic group. The phrenic node group was only involved in the cases with the peripheral or hilar cholangiocarcinoma. The primary biliary carcinoma has a high incidence of lymph node metastases at the time of diagnosis, and shows different nodal spread pattern according to the location of the primary tumor. Involvement of the phrenic node was limited to the peripheral and hilar cholangiocarcinoma.

  7. Anatomic distribution of supraclavicular lymph node in patients with esophageal cancer

    Directory of Open Access Journals (Sweden)

    Xing J

    2016-09-01

    Full Text Available Jun Xing,1 Yijun Luo,1,2 Xiaoli Wang,1,2 Min Gao,1 Mingping Sun,1 Xiuping Ding,1 Tingyong Fan,1 Jinming Yu1 1Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University, 2School of Medical and Life Sciences, Shandong Academy of Medical Sciences, University of Jinan, Jinan, People’s Republic of China Purpose: Definitive chemoradiation therapy remains the standard of care for patients with localized esophageal carcinoma who choose nonsurgical management. However, there is no consensus regarding delineation of the nodal clinical target volume (CTVn, especially for lower cervical lymph nodes. This study aimed to map the location of metastatic supraclavicular lymph nodes in thoracic esophageal carcinoma patients with supraclavicular node involvement and generate an atlas to delineate the CTVn for elective nodal radiation of esophageal squamous cell carcinoma. Patients and methods: In this study, the supraclavicular regional lymph node was further divided into four subgroups. The locations of the involved supraclavicular nodes for all patients were then transferred onto a template computed tomography (CT image. A volume probability map was then generated with nodal volumes, and was displayed on the template CT to provide a visual impression of nodal frequencies and anatomic distribution. Results: We identified 154 supraclavicular nodal metastases based on CT image in 96 patients. Of these, 29.2% were located in group I region, 59.7% in group II region, 10.4% in group III region, and 0.7% in group IV region. Conclusion: On the basis of our study, we suggest that the appropriate radiation field of CTVn should include the group I and II regions and the CTVn exterior margin along the lateral side of the internal jugular vein may be suitable. Keywords: esophageal carcinoma, lymph node metastasis, clinical target volume, cervical lymph node

  8. Regional Lymph Node Uptake of ["1"8F]Fluorodeoxyglucose After Definitive Chemoradiation Therapy Predicts Local-Regional Failure of Locally Advanced Non-Small Cell Lung Cancer: Results of ACRIN 6668/RTOG 0235

    International Nuclear Information System (INIS)

    Markovina, Stephanie; Duan, Fenghai; Snyder, Bradley S.; Siegel, Barry A.; Machtay, Mitchell; Bradley, Jeffrey D.

    2015-01-01

    Purpose: The American College of Radiology Imaging Network (ACRIN) 6668/Radiation Therapy Oncology Group (RTOG) 0235 study demonstrated that standardized uptake values (SUV) on post-treatment ["1"8F]fluorodeoxyglucose-positron emission tomography (FDG-PET) correlated with survival in locally advanced non-small cell lung cancer (NSCLC). This secondary analysis determined whether SUV of regional lymph nodes (RLNs) on post-treatment FDG-PET correlated with patient outcomes. Methods and Materials: Included for analysis were patients treated with concurrent chemoradiation therapy, using radiation doses ≥60 Gy, with identifiable FDG-avid RLNs (distinct from primary tumor) on pretreatment FDG-PET, and post-treatment FDG-PET data. ACRIN core laboratory SUV measurements were used. Event time was calculated from the date of post-treatment FDG-PET. Local-regional failure was defined as failure within the treated RT volume and reported by the treating institution. Statistical analyses included Wilcoxon signed rank test, Kaplan-Meier curves (log rank test), and Cox proportional hazards regression modeling. Results: Of 234 trial-eligible patients, 139 (59%) had uptake in both primary tumor and RLNs on pretreatment FDG-PET and had SUV data from post-treatment FDG-PET. Maximum SUV was greater for primary tumor than for RLNs before treatment (P<.001) but not different post-treatment (P=.320). Post-treatment SUV of RLNs was not associated with overall survival. However, elevated post-treatment SUV of RLNs, both the absolute value and the percentage of residual activity compared to the pretreatment SUV were associated with inferior local-regional control (P<.001). Conclusions: High residual metabolic activity in RLNs on post-treatment FDG-PET is associated with worse local-regional control. Based on these data, future trials evaluating a radiation therapy boost should consider inclusion of both primary tumor and FDG-avid RLNs in the boost volume to maximize local-regional control.

  9. Clinicopathologic risk factors for right paraesophageal lymph node metastasis in patients with papillary thyroid carcinoma.

    Science.gov (United States)

    Yu, Q A; Ma, D K; Liu, K P; Wang, P; Xie, C M; Wu, Y H; Dai, W J; Jiang, H C

    2018-03-17

    To investigate risk factors associated with right paraesophageal lymph node (RPELN) metastasis in patients with papillary thyroid carcinoma (PTC) and to determine the indications for right lymph node dissection. Clinicopathologic data from 829 patients (104 men and 725 women) with PTC, operated on by the same thyroid surgery team at the First Affiliated Hospital of Harbin Medical University from January 2013 to May 2017, were analyzed. Overall, 309 patients underwent total thyroidectomy with bilateral lymph node dissection, 488 underwent right thyroid lobe and isthmic resection with right central compartment lymph node dissection, and 32 underwent near-total thyroidectomy (ipsilateral thyroid lobectomy with contralateral near-total lobectomy) with bilateral lymph node dissection. The overall rate of central compartment lymph node metastasis was 43.5% (361/829), with right central compartment lymph node and RPELN metastasis rates of 35.5% (294/829) and 19.1% (158/829), respectively. Tumor size, number, invasion, and location, lymph node metastasis, right central compartment lymph node metastasis, and right lateral compartment lymph node metastasis were associated with RPELN in the univariate analysis, whereas age and sex were not. Multivariate analysis identified tumors with a diameter ≥ 1 cm, multiple tumors, tumors located in the right lobe, right central compartment lymph node metastasis, and right lateral compartment lymph node metastasis as independent risk factors for RPELN metastasis. Lymph node dissection, including RPELN dissection, should be performed for patients with PTC with a tumor diameter ≥ 1 cm, multiple tumors, right-lobe tumors, right central compartment lymph node metastasis, or suspected lateral compartment lymph node metastasis.

  10. Hilar and mediastinal lymph node metastases from lung cancer

    International Nuclear Information System (INIS)

    Koganemaru, Michihiko; Fujimoto, Kiminori; Nishimura, Hiroshi; Tabuchi, Akinori; Ohtake, Hisashi; Nishimura, Yutaka

    1990-01-01

    Sixty-one patients with primary lung cancer, who had CT and MR imaging before surgery, were studied. MR imaging used spin-echo sequences with T1 weighted image and T2 weighted image (C-MRI), and included STIR technique (Stir-MRI). The accuracy of diagnosis of mediastinal lymphadenopathy (regarding 10 mm or larger in short transverse diameter as positive) was 89% by CT, 84% by C-MRI and 89% by Stir-MRI. The accuracy of diagnosis of hilar lymphadenopathy was 42% by CT, 67% by C-MRI, and 75% by Stir-MRI. The accuracy of diagnosis of mediastinal lymph node metastases was 89% by CT, 94% by C-MRI and 96% by Stir-MRI. The accuracy of diagnosis of hilar lymph node metastases was 78% by CT, 87% by C-MRI and 89% by Stir-MRI. The possibility of enhancement of diagnostic accuracy of lymph node metastases from lung cancer was suggested by combining MR imaging including STIR technique, with CT. (author)

  11. The importance of lymph node biopsy in diagnosis on lymphadenopathy

    International Nuclear Information System (INIS)

    Abdullah, P.; Mubarik, A.; Zahir, N.

    2000-01-01

    A study of 826 consecutive lymph node biopsies received during the period of four year from 1993-1996 was conducted to determine its role in arriving at a diagnosis and to see the pattern of diseases with which patient presented. These biopsies was interpreted. In the Department of Pathology, PNS Shifa Naval Hospital, a tertiary care center for the armed forces personnel in the southern part of Pakistan. The age of the patients varied from 10 months to 88 years. The commonest pathology encountered was tuberculosis (50.9%), followed by reactive hyperplasia (33.2%), malignant lymphomas (5.8%) and metastatic tumors (4.9%). Miscellaneous conditions like necrotizing lymphadenitis, infections mononucleosis, sarcoidosis, castle man's disease and lepromatous leprosy comprised 0.3% each. Cases of lymphadenopathy can now be diagnosed by other means such as fine needle aspiration cytology (FNAC) of the palpable lymph node but still lymph node biopsy plays an important role in typing of lymphomas and helps in those cases which cannot be diagnosed definitely by fine needle aspiration cytology. (author)

  12. Lymph Node Micrometastases are Associated with Worse Survival in Patients with Otherwise Node-Negative Hilar Cholangiocarcinoma

    NARCIS (Netherlands)

    Mantel, Hendrik T. J.; Wiggers, Jim K.; Verheij, Joanne; Doff, Jan J.; Sieders, Egbert; van Gulik, Thomas M.; Gouw, Annette S. H.; Porte, Robert J.

    2015-01-01

    Lymph node metastases on routine histology are a strong negative predictor for survival after resection of hilar cholangiocarcinoma. Additional immunohistochemistry can detect lymph node micrometastases in patients who are otherwise node negative, but the prognostic value is unsure. The objective of

  13. Predicting biochemical recurrence-free survival for patients with positive pelvic lymph nodes at radical prostatectomy.

    Science.gov (United States)

    von Bodman, Christian; Godoy, Guilherme; Chade, Daher C; Cronin, Angel; Tafe, Laura J; Fine, Samson W; Laudone, Vincent; Scardino, Peter T; Eastham, James A

    2010-07-01

    We evaluated predictors of freedom from biochemical recurrence in patients with pelvic lymph node metastasis at radical prostatectomy. Of 207 patients with lymph node metastasis treated with radical prostatectomy and bilateral pelvic lymph node dissection 45 received adjuvant androgen deprivation therapy and 162 did not. Cox proportional hazards regression models were used to investigate predictors of biochemical recurrence after radical prostatectomy. Recurrence probability was estimated using the Kaplan-Meier method. A median of 13 lymph nodes were removed. Of the patients 122 had 1, 44 had 2 and 41 had 3 or greater positive lymph nodes. Of patients without androgen deprivation therapy 103 had 1, 35 had 2 and 24 had 3 or greater positive lymph nodes while 69 experienced biochemical recurrence. Median time to recurrence in patients with 1, 2 and 3 or greater lymph nodes was 59, 13 and 3 months, respectively. Only specimen Gleason score and the number of positive lymph nodes were independent predictors of biochemical recurrence. Recurrence-free probability 2 years after prostatectomy in men without androgen deprivation with 1 positive lymph node and a prostatectomy Gleason score of 7 or less was 79% vs 29% in those with Gleason score 8 or greater and 2 or more positive lymph nodes. Prognosis in patients with lymph node metastasis depends on the number of positive lymph nodes and primary tumor Gleason grade. Of all patients with lymph node metastasis 80% had 1 or 2 positive nodes. A large subset of those patients had a favorable prognosis. Full bilateral pelvic lymph node dissection should be done in patients with intermediate and high risk cancer to identify those likely to benefit from metastatic node removal. Copyright (c) 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  14. Mulig forbedret behandling af kolorektal cancer med sentinel lymph node-diagnostik

    DEFF Research Database (Denmark)

    Burgdorf, Stefan Kobbelgaard; Eriksen, Jens Ravn; Gögenur, Ismail

    2014-01-01

    Possibly improved treatment of colorectal cancer by sentinel lymph node mapping Prognosis for colorectal cancer is dependent on radical surgical intervention. Chemotherapy in patients with advanced disease has improved the survival. A considerable proportion of the patients going through radical...... surgery will subsequently relapse. Adjuvant chemotherapy is reserved for patients with lymph node metastases, why undetected malignant lymph nodes will result in understaging and exclusion from the possible benefit of adjuvant chemotherapy. With sentinel lymph node mapping it may be possible to detect...... and resect more malignant lymph node and maybe even avoid extensive resections....

  15. Advanced malignant melanoma during pregnancy: technical description of sentinel lymph node biopsy followed by radical lymph node dissection

    Directory of Open Access Journals (Sweden)

    Alberto Julius Alves Wainstein

    2015-12-01

    Full Text Available Abstract Introduction: melanoma is a very aggressive cancer, with increasing incidence, and is currently the fifth most common cancer in men and the sixth most common in women in the United States. Melanoma is not unusual in pregnancy, with an estimated occur-rence rate of 1:1.000. Although not the most common cancer in pregnancy, melanoma is the tumor with the highest incidence ofplacenta and fetus metastases. Description: a 29-year-old lady, 4 weeks after conception underwent resection of an atypical pigmented lesion after a diagnosis of stage T4b melanoma. At 16 weeks she underwent a broad local excision and sentinel lymph node (SLN biopsy. SLN was evaluated histologically and tested positive for melanoma. A radical axillary lymphadenectomy was performed on the patient without evidence of metas-tasis in any other LN. In the 40th week of pregnancy, labor was induced and a healthy newborn was deli-vered via cesarean. Discussion: melanoma management in pregnancy is more complex and requires multidisciplinary coor-dination, as well as extensive discussion with the patient and her family. We present a case report description in which treatment recommendations are established according to no pregnancy experience.

  16. Prognostic significance of the total number of harvested lymph nodes for lymph node-negative gastric cancer patients.

    Science.gov (United States)

    Ji, Xin; Bu, Zhao-De; Li, Zi-Yu; Wu, Ai-Wen; Zhang, Lian-Hai; Zhang, Ji; Wu, Xiao-Jiang; Zong, Xiang-Long; Li, Shuang-Xi; Shan, Fei; Jia, Zi-Yu; Ji, Jia-Fu

    2017-08-22

    The relationship between the number of harvested lymph nodes (HLNs) and prognosis of gastric cancer patients without an involvement of lymph nodes has not been well-evaluated. The objective of this study is to further explore this issue. We collected data from 399 gastric cancer patients between November 2006 and October 2011. All of them were without metastatic lymph nodes. Survival analyses showed that statistically significant differences existed in the survival outcomes between the two groups allocated by the total number of HLNs ranging from 16 to 22. Therefore, we adopted 22 as the cut-off value of the total number of HLNs for grouping (group A: HLNs <22; group B: HLNs≥22). The intraoperative and postoperative characteristics, including operative blood loss (P=0.096), operation time (P=0.430), postoperative hospital stay (P=0.142), complications (P=0.552), rate of reoperation (P=0.966) and postoperative mortality (P=1.000), were comparable between the two groups. T-stage-stratified Kaplan-Meier analyses revealed that the 5-year survival rate of patients at the T4 stage was better in group B than in group A (76.9% vs. 58.5%; P=0.004). An analysis of multiple factors elucidated that the total number of HLNs, T stage, operation time and age were independently correlated factors of prognosis. Regarding gastric cancer patients without the involvement of lymph nodes, an HLN number ≥22 would be helpful in prolonging their overall survival, especially for those at T4 stage. The total number of HLNs was an independent prognostic factor for this population of patients.

  17. A preliminary study on sentinel lymph node biopsy. Feasibility and predictive ability in oral cavity cancer

    International Nuclear Information System (INIS)

    Chikamatsu, Kazuaki; Kamada, Hideo; Ninomiya, Hiroshi; Takahashi, Katsumasa; Sakurai, Tsutomu; Oriuchi, Noboru; Furuya, Nobuhiko

    2004-01-01

    The main factor that affects the prognosis of patients with head and neck cancer (HNC) is regional lymph node metastases. For this reason, the accurate evaluation of neck metastases is required for neck management. This study investigates the sentinel lymph node identification and the accuracy of the histopathology of the sentinel lymph node in patients with HNC. Eleven patients with histologically proven oral squamous cell carcinoma accessible to radiocolloid injection were enrolled in this study. Using both lymphoscintigraphy and a handheld gamma probe, the sentinel lymph node could be identified in all 11 patients. Subsequently, the sentinel lymph nodes and the neck dissection specimen were examined for lymph node involvement due to tumor. The histopathology of sentinel lymph nodes was consistent with the pathological N classification in all 11 patients. Furthermore, the histopathology of sentinel lymph nodes was superior to physical examination, computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) scan. The results of this study indicate that sentinel lymph node identification is technically feasible and predicts cervical metastases in patients with oral cavity cancer. This may be a useful diagnostic technique for identifying lymph node disease in staging lymph node dissection. (author)

  18. Gray-scale contrast-enhanced utrasonography in detecting sentinel lymph nodes: An animal study

    International Nuclear Information System (INIS)

    Wang Yuexiang; Cheng Zhigang; Li Junlai; Tang Jie

    2010-01-01

    Objective: To investigate the usefulness of gray-scale contrast-enhanced ultrasonography for detecting sentinel lymph nodes. Methods: Contrast-enhanced ultrasonography was performed in five normal dogs (four female and one male) after subcutaneous administration of a sonographic contrast agent (Sonovue, Bracco, Milan, Italy). Four distinct regions in each animal were examined. After contrast-enhanced ultrasonography, 0.8 ml of blue dye was injected into the same location as Sonovue and the sentinel lymph nodes were detected by surgical dissection. The findings of contrast-enhanced ultrasonography were compared with those of the blue dye. Results: Twenty-one sentinel lymph nodes were detected by contrast-enhanced ultrasonography while 23 were identified by blue dye with surgical dissection. Compared with the blue dye, the detection rate of enhanced ultrasonography for the sentinel lymph nodes is 91.3% (21/23). Two patterns of enhancement in the sentinel lymph nodes were observed: complete enhancement (5 sentinel lymph nodes) and partial enhancement (16 sentinel lymph nodes). The lymphatic channels were demonstrated as hyperechoic linear structures leading from the injection site and could be readily followed to their sentinel lymph nodes. Histopathologic examination showed proliferation of lymphatic follicles or lymphatic sinus in partial enhanced sentinel lymph nodes while normal lymphatic tissue was demonstrated in completely enhanced sentinel lymph nodes. Conclusions: Sonovue combined with gray-scale contrast-enhanced ultrasonography may provide a feasible method for detecting sentinel lymph nodes.

  19. Radical nephrectomy and regional lymph node dissection for locally advanced type 2 papillary renal cell carcinoma in an at-risk individual from a family with hereditary leiomyomatosis and renal cell cancer: a case report

    International Nuclear Information System (INIS)

    Kamai, Takao; Abe, Hideyuki; Arai, Kyoko; Murakami, Satoshi; Sakamoto, Setsu; Kaji, Yasushi; Yoshida, Ken-Ichiro

    2016-01-01

    Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) is an autosomal dominant tumor susceptibility syndrome, and the disease-related gene has been identified as fumarate hydratase (fumarase, FH). HLRCC-associated kidney cancer is an aggressive tumor characterized by early metastasis to regional lymph nodes and distant organs. Since early diagnosis and provision of definitive therapy is thought to be the best way to reduce the tumor burden, it is widely accepted that germline testing and active surveillance for an at-risk individual from a family with HLRCC is very important. However, it still remains controversial how we should treat HLRCC-associated kidney cancer. We successfully treated the patient with locally advanced HLRCC-associated kidney cancer, who has received active surveillance because of at-risk individual, by radical nephrectomy and extended retroperitoneal lymph node dissection, and examined surgically resected samples from a molecular point of view. We recommended that 13 at-risk individuals from a family with HLRCC should receive active surveillance for early detection of renal cancer. A 48-year-old woman with a left renal tumor and involvement of multiple regional lymph nodes with high accumulation of fluorine-18-deoxyglucose on positron emission tomography was treated with axitinib as a neoadjuvant therapy. Preoperative axitinib induced the shrinkage of the tumor with decreased fluorine-18-deoxyglucose accumulation. Resected samples showed two thirds tumor tissue necrosis as well as high expression of serine/threonine kinase Akt and low expression of nuclear factor E2-related factor 2 (Nrf2) which activates anti-oxidant response and protects against oxidative stress in viable cancer cells. Targeted next-generation sequencing revealed that FH mutation and loss of the second allele were completely identical between blood and tumor samples, suggesting that FH mutation plays a direct role in FH-deficient RCC. She has remained well after radical

  20. Extended lymphodissection for resectable gastric cancer. The true incidence of regional lymph node metastasis and adequate extent of lymphodissection

    International Nuclear Information System (INIS)

    Bayramov, R.B.; Abdullayeva, R.T.

    2009-01-01

    In order to determine the true incidence of regional lymph node metastasis in resectable gastric cancer it was analyzed the results of pathohistologic analysis of lymph nodes taken by extended lymphodissection carried out by our surgical staff from January 2001 till December 2008. According to the received data it was supposed that dissection of 7,8,9,11 zones' lymph nodes in distal third gastric cancer; 7,9,10,11 zones' in middle third gastric cancer and 7,9,11 zones' proximal third gastric cancer is mandatory procedure. Enlargement of lymph nodes of indicated zones should stimulate dissection of lymph nodes on the antegrade lymph flow route, minimally such as 12, 13 zones' in distal third gastric cancer; 8,12,13 in middle third gastric cancer and 8,12,13,110 in proximal third gastric cancer. Dissection of 14,15, 16 zones' lymph nodes in gastric cancer of any localization and 10 zone's in distal and proximal third gastric cancer should only be performed in their obvious enlargement

  1. The lymphoscintigraphy and intraoperative gamma detection of sentinel lymph node in oral cavity carcinoma

    International Nuclear Information System (INIS)

    Zhao Xinming; Zhang Jingmian; Wang Jianfang; Li Dezhi; Sun Li; Dai Chunnuan; He Yang

    2006-01-01

    Objective: To evaluate the role of lymphoscintigraphy and intraoperative gamma probe detection of sentinel lymph node (SLN) in oral cavity carcinoma. Methods: 99 Tc m labeled dextran (DX) was injected submucously at the center of oral cavity carcinoma before operation. The SLN identified by lymphoscintigraphy and intraoperative gamma counter probe were dissected out from the exited tissue. All sentinel and other lymph nodes were sent for pathological examination. Results: In all 33 cases, SLN and other lymph nodes were clear identified by lymphoscintigraphy. Forty-three SLNs were seen, among them 1 in 25 cases, 2 in 6 cases and 3 in 2 cases. Metastases were detected by biopsy in SLN in 9 cases, however, 11 cases showed positive neck lymph node metastases. The sensitivity of SLN gamma detection was 100% and in biopsy sensitivity was 81.82%, accuracy was 93.94%, false positive rate was 0, and false negative rate was 18.18%. Conclusions: Intraoperative gamma probe detection is the reliable approach to identify SLN in oral cavity carcinoma. Lymphoscintigraphy is the base of localization for oral cavity carcinoma. (authors)

  2. Prophylactic irradiation of para-aortic lymph nodes in carcinoma of the uterine cervix

    International Nuclear Information System (INIS)

    Chatani, M.; Matayoshi, Y.; Masaki, N.; Narumi, Y.; Teshima, T.; Inoue, T.

    1995-01-01

    For assessment of the advantages and side effects of para-aortic lymph nodes irradiation under the evaluation by computer tomography, a prospective randomized study was started in 1986. The results for survival, local control and late complications are presented in the following. From November 1986 to October 1990, 93 patients with cervical carcinoma were randomly allocated for treatment with either pelvic irradiation (pelvic group) or pelvic plus para-aortic lymph nodes irradiation (para-aortic group). Thirty-six patients underwent external irradiation and intracavitary therapy (RT arm) and 57 patients, extended radical hysterectomy and external irradiation (OP-RT arm). Para-aortic lymph nodes irradiation delivered 45 Gy in 1.8 Gy per day for 5 days per week through anterior-posterior fields. The 3-year cause specific survival rates were para-aortic group: 57% and pelvic group: 89% in RT arm group, and para-aortic group: 70% and pelvic group: 86% in OP-RT arm group. Differences for the 2 groups in each treatment arm were not significant. In pelvic failure, para-aortic lymph nodes metastases and distant metastases showed no statistically significant differences for the 2 groups in each treatment arm. In the para-aortic group, complications were more frequent than in the pelvic group (13/45 vs. 2/48, p [de

  3. Immune complexes stimulate CCR7-dependent dendritic cell migration to lymph nodes

    Science.gov (United States)

    Clatworthy, Menna R.; Aronin, Caren E. Petrie; Mathews, Rebeccah J.; Morgan, Nicole; Smith, Kenneth G.C.; Germain, Ronald N.

    2014-01-01

    Antibodies are critical for defence against a variety of microbes but may also be pathogenic in some autoimmune diseases. Many effector functions of antibody are mediated by Fcγ receptors (FcγRs), which are found on most immune cells, including dendritic cells (DCs). DCs are important antigen presenting cells and play a central role in inducing antigen-specific tolerance or immunity1,2. Following antigen acquisition in peripheral tissues, DCs migrate to draining lymph nodes via lymphatics to present antigen to T cells. In this study we demonstrate that FcγR engagement by IgG immune complexes (IC) stimulates DC migration from peripheral tissues to the paracortex of draining lymph nodes. In vitro, IC-stimulated murine and human DCs showed enhanced directional migration in a CCL19 gradient and increased CCR7 expression. Using intravital two-photon microscopy, we observed that local administration of IC resulted in dermal DC mobilisation. We confirmed that dermal DC migration to lymph nodes was CCR7-dependent and increased in the absence of the inhibitory receptor, FcγRIIb. These observations have relevance to autoimmunity, because autoantibody-containing serum from mice and humans with SLE also increased dermal DC migration to lymph nodes in vivo, suggesting that this process may occur in lupus, potentially driving the inappropriate localisation of autoantigen-bearing DCs. PMID:25384086

  4. The impact of postoperative supraclavicular radiotherapy on tracheoesophageal groove lymph node metastasis in esophageal carcinoma

    International Nuclear Information System (INIS)

    Qian Pudong; Lu Jinchen; Mei Zeru; Zhu Jun

    2005-01-01

    Objective: To evaluate the prognostic factors of tracheoesophageal groove lymph node (TEGLN) metastasis in postoperative esophageal carcinoma. Methods: From January 1996 to December 1997, 101 postoperative cervical and thoracic esophageal carcinoma patients proved absence from tracheoesophageal groove lymph node (TEGIAN) metastasis before and after operation by physical examination and computer tomography examination were entered into this study. The patients were divided into three groups according to the treatment of supraclavicular region: no prophylactic radiotherapy (group A-, 30 patients); prophylactic radiotherapy with local dose < 45 Gy (Group B-, 71 patients); and prophylactic radiotherapy with local dose ≥45 Gy (Group C-, 19 patients). Radiotherapy was delivered by cobalt- 60 or 6 MV X-ray with the prescribed dose normalized to the point of tracheoesophageal groove, i. e, 5 cm in depth. The tracheoesophageal groove lymph node metastasis after treatment was observed. Results: The incidence of tracheoesophageal groove lymph node metastasis was 20% (6/30), 9.6% (5/71) and 0% (0/19) in groups A, B and C. Univariate analysis showed that there was significant difference of TEGLN metastasis between groups A and C only (P=0.039), but higher dose to supraclavicular region tended to lower the incidence of TEGLN metastasis. Multivariate analysis showed that only prophylactic radiotherapy to the supraclavicular region was independent prognostic factor for TEGLN metastasis (P=0.037). Gender, primary tumor site and pathological stage had no significant impact on TEGLN metastasis. Conclusions: Postoperative prophylactic supraclavicular region irradiation can lower the incidence of tracheoesophageal groove lymph node metastasis in esophageal carcinoma. Radiotherapy dose should not be less than 45 Gy and should be routinely normalized to a point 5 cm deep in the tracheoesophageal groove. (authors)

  5. Management of the Regional Lymph Nodes Following Breast-Conservation Therapy for Early-Stage Breast Cancer: An Evolving Paradigm

    Energy Technology Data Exchange (ETDEWEB)

    Warren, Laura E.G. [Harvard Radiation Oncology Program, Boston, Massachusetts (United States); Punglia, Rinaa S.; Wong, Julia S. [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Bellon, Jennifer R., E-mail: jbellon@lroc.harvard.edu [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts (United States)

    2014-11-15

    Radiation therapy to the breast following breast conservation surgery has been the standard of care since randomized trials demonstrated equivalent survival compared to mastectomy and improved local control and survival compared to breast conservation surgery alone. Recent controversies regarding adjuvant radiation therapy have included the potential role of additional radiation to the regional lymph nodes. This review summarizes the evolution of regional nodal management focusing on 2 topics: first, the changing paradigm with regard to surgical evaluation of the axilla; second, the role for regional lymph node irradiation and optimal design of treatment fields. Contemporary data reaffirm prior studies showing that complete axillary dissection may not provide additional benefit relative to sentinel lymph node biopsy in select patient populations. Preliminary data also suggest that directed nodal radiation therapy to the supraclavicular and internal mammary lymph nodes may prove beneficial; publication of several studies are awaited to confirm these results and to help define subgroups with the greatest likelihood of benefit.

  6. Allergenicity evaluation of p-chloro-m-cresol and p-chloro-m-xylenol by non-radioactive murine local lymph-node assay and multiple-dose guinea pig maximization test

    International Nuclear Information System (INIS)

    Yamano, Tetsuo; Shimizu, Mitsuru; Noda, Tsutomu

    2003-01-01

    p-Chloro-m-cresol (PCMC) and p-chloro-m-xylenol (PCMX) are known to cause allergic contact dermatitis. For risk assessment of skin sensitizers, information on dose-response profiles in the induction and elicitation phases and cross-reactivity with analogous chemicals are important. In the non-radioactive local lymph-node assay (LLNA) using 5-bromo-2'-deoxyuridine instead of 3 H-methyl thymidine, significant effect on lymph node cell proliferation was detected at 10% PCMC and 25% PCMX, while in the multiple-dose guinea pig maximization test (GPMT) at least one animal tested in the group was sensitized at a 5 ppm induction dose of either chemical. When mean skin reaction score in an animal group maximally sensitized with each allergen with the GPMT was plotted against log challenge concentration, linear regression lines with high correlations were obtained in both cases. The calculated elicitation threshold was lower for PCMC than PCMX. The area under the linear regression line between the threshold point and 1% of the elicitation concentration, another index of relative elicitation potency, was also greater for PCMC. Bidirectional cross-reactivity between PCMX and PCMC was detected in the GPMT. PCMC was thus identified in both LLNA and GPMT as a stronger sensitizer than PCMX in both the induction and elicitation phases. These results suggest that the non-radioactive LLNA is a simple and useful method for evaluating allergenicity in the induction phase, while the GPMT using a maximally sensitized animal group is more suitable for assessing the dose-response profile and cross-reactivity in the elicitation phase

  7. Development of LLNA:DAE: a new local lymph node assay that includes the elicitation phase, discriminates borderline-positive chemicals, and is useful for cross-sensitization testing.

    Science.gov (United States)

    Yamashita, Kunihiko; Shinoda, Shinsuke; Hagiwara, Saori; Itagaki, Hiroshi

    2014-02-01

    We developed a new local lymph node assay (LLNA) that includes the elicitation phase termed LLNA:DAE for discrimination of borderline-positive chemicals as classified by the LLNA modified by Daicel based on ATP content (LLNA:DA) and for cross-sensitization testing. Although the LLNA:DA method could help identify skin sensitizers, some skin irritants classified as non-sensitizers by the LLNA were classified as borderline positive. In addition, the evaluation for the cross-sensitization potential between chemicals was impossible. In the LLNA:DAE procedure, test group of mice received four applications of chemicals on the dorsum of the right ear for induction and one application on the dorsum of the left ear for elicitation. Control group of mice received one chemical application on the dorsum of the left ear. We evaluated the sensitizing potential by comparing the weights of the lymph nodes from the left ears between the two groups. The results of using the LLNA:DAE method to examine 24 chemicals, which contained borderline-positive chemicals, were consistent with those from the LLNA method, except for nickel chloride (NiCl2). Two chemical pairs, 2,4-dinitrochlorobenzene (DNCB) with 2,4-dinitrofluorobenzene (DNFB) and hydroquinone (HQ) with p-benzoquinone (p-BQ), showed clear cross-sensitization with each other, while another chemical pair, DNFB with hexylcinnamic aldehyde (HCA) did not. Taken together, our results suggest that the LLNA:DAE method is useful for discriminating borderline-positive chemicals and for determining chemical cross-sensitization.

  8. Arm morbidity following sentinel lymph node biopsy or axillary lymph node dissection: a study from the Danish Breast Cancer Cooperative Group

    DEFF Research Database (Denmark)

    Husted, Madsen A.; Haugaard, K.; Soerensen, J.

    2008-01-01

    BACKGROUND: Sentinel lymph node biopsy was implemented in the treatment of early breast cancer with the aim of reducing shoulder and arm morbidity. Relatively few prospective studies have been published where the morbidity was assessed by clinical examination. Very few studies have examined...... lymph node biopsy with node negative patients having a lymph node dissection of levels I and II of the axilla, we found significant increase in arm volume among the patients who had an axillary dissection. Only minor, but significant, differences in shoulder mobility were observed comparing the two...... groups of node negative patients. Highly significant difference was found comparing sensibility. Comparing the morbidity in node positive patients who had a one-step axillary dissection with patients having a two-step procedure (sentinel lymph node biopsy followed by delayed axillary dissection) revealed...

  9. [Utility and advantages of single tracer subareolar injection in sentinel lymph node biopsy in breast cancer].

    Science.gov (United States)

    Armas, Fayna; Hernández, María Jesús; Vega, Víctor; Gutiérrez, Isabel; Jiménez, Concepción; Pavcovich, Marta; Báez, Beatriz; Pérez-Correa, Pedro; Núñez, Valentín

    2005-10-01

    Sentinel lymph node (SLN) biopsy is a reliable technique for determining axillary status in patients with early breast cancer. This technique is a minimally invasive procedure that can avoid the use of lymphadenectomy in patients without axillary involvement. We present a validation study of SLN biopsy with subareolar injection of 99mTc-nanocolloids. We studied 100 patients with early breast cancer (T1 and T2) over a 2-year period. All patients underwent deep subareolar-injection of 99mTc-nanocoloid for localization of the sentinel node. Images were obtained and when the sentinel node was seen, it was marked on the skin. All patients underwent tumor excision and radioguided SLN biopsy followed by complete lymphadenectomy. Histopathological analysis of sentinel nodes was performed by hematoxylin-eosin and immunohistochemistry with cytokeratins. The sentinel node was identified in all patients, and a mean of 1.95 sentinel nodes per patient were found. Lymphatic metastases in the sentinel node were found in 44 patients and in 15 of these tumoral spread was also found in the remaining axillary nodes. In the 56 remaining patients the sentinel node was free of metastasis, but in two of them a non-sentinel node was found to be positive (4.5% false negative rate). Sensitivity was 95.7% (44/46), specificity was 100% (54/54), the positive predictive value was 100% and the negative predictive value was 96.4% (54/56). SLN biopsy is an accurate alternative to complete axillary lymph node dissection in patients with early-stage breast cancer. This technique improves the staging of these patients and decreases the morbidity associated with lymphadenectomy. The advantages of subareolar injection are that a single injection site is required, the tumor does not have to be located by other techniques, it allows rapid visualization of the sentinel node and avoids the "shine through phenomenon" when the tumor is located near the axilla.

  10. Staging of early lymph node metastases with the sentinel lymph node technique and predictive factors in T1/T2 oral cavity cancer

    DEFF Research Database (Denmark)

    Pedersen, Nicklas Juel; Jensen, David Hebbelstrup; Hedbäck, Nora

    2015-01-01

    BACKGROUND: The purpose of this study was to examine the diagnostic accuracy of detecting lymph node metastases and to identify predictive and prognostic clinicopathological factors in patients with oral squamous cell carcinoma (OSCC) undergoing sentinel lymph node biopsy (SLNB). METHODS: All...

  11. Feasibility of contrast-enhanced ultrasound-guided biopsy of sentinel lymph nodes in dogs.

    Science.gov (United States)

    Gelb, Hylton R; Freeman, Lynetta J; Rohleder, Jacob J; Snyder, Paul W

    2010-01-01

    Our goal was to develop and validate a technique to identify the sentinel lymph nodes of the mammary glands of healthy dogs with contrast-enhanced ultrasound, and evaluate the feasibility of obtaining representative samples of a sentinel lymph node under ultrasound guidance using a new biopsy device. Three healthy intact female adult hounds were anesthetized and each received an injection of octafluoropropane-filled lipid microspheres and a separate subcutaneous injection of methylene blue dye around a mammary gland. Ultrasound was then used to follow the contrast agent through the lymphatic channel to the sentinel lymph node. Lymph node biopsy was performed under ultrasound guidance, followed by an excisional biopsy of the lymph nodes and a regional mastectomy procedure. Excised tissues were submitted for histopathologic examination and evaluated as to whether they were representative of the node. The ultrasound contrast agent was easily visualized with ultrasound leading up to the sentinel lymph nodes. Eight normal lymph nodes (two inguinal, one axillary in two dogs; two inguinal in one dog) were identified and biopsied. Lymphoid tissue was obtained from all biopsy specimens. Samples from four of eight lymph nodes contained both cortical and medullary lymphoid tissue. Contrast-enhanced ultrasound can be successfully used to image and guide minimally invasive biopsy of the normal sentinel lymph nodes draining the mammary glands in healthy dogs. Further work is needed to evaluate whether this technique may be applicable in patients with breast cancer or other conditions warranting evaluation of sentinel lymph nodes in animals.

  12. Lymph Node Micrometastases are Associated with Worse Survival in Patients with Otherwise Node-Negative Hilar Cholangiocarcinoma.

    Science.gov (United States)

    Mantel, Hendrik T J; Wiggers, Jim K; Verheij, Joanne; Doff, Jan J; Sieders, Egbert; van Gulik, Thomas M; Gouw, Annette S H; Porte, Robert J

    2015-12-01

    Lymph node metastases on routine histology are a strong negative predictor for survival after resection of hilar cholangiocarcinoma. Additional immunohistochemistry can detect lymph node micrometastases in patients who are otherwise node negative, but the prognostic value is unsure. The objective of this study was to assess the effect on survival of immunohistochemically detected lymph node micrometastases in patients with node-negative (pN0) hilar cholangiocarcinoma on routine histology. Between 1990 and 2010, a total of 146 patients underwent curative-intent resection of hilar cholangiocarcinoma with regional lymphadenectomy at two university medical centers in the Netherlands. Ninety-one patients (62 %) without lymph node metastases at routine histology were included. Micrometastases were identified by multiple sectioning of all lymph nodes and additional immunostaining with an antibody against cytokeratin 19 (K19). The association with overall survival was assessed in univariable and multivariable analysis. Median follow-up was 48 months. Micrometastases were identified in 16 (5 %) of 324 lymph nodes, corresponding to 11 (12 %) of 91 patients. There were no differences in clinical variables between K19 lymph node-positive and -negative patients. Five-year survival rates in patients with lymph node micrometastases were significantly lower compared to patients without micrometastases (27 vs. 54 %, P = 0.01). Multivariable analysis confirmed micrometastases as an independent prognostic factor for survival (adjusted Hazard ratio 2.4, P = 0.02). Lymph node micrometastases are associated with worse survival after resection of hilar cholangiocarcinoma. Immunohistochemical detection of lymph node micrometastases leads to better staging of patients who were initially diagnosed with node-negative (pN0) hilar cholangiocarcinoma on routine histology.

  13. Combined modality therapy for localized prostate carcinoma using Iridium-192 brachytherapy and external beam radiotherapy: results, morbidity, and the lack of value of surgical lymph node staging

    International Nuclear Information System (INIS)

    Baird, Michael; Ordorica, Edward; Dawson, Anne

    1997-01-01

    Purpose/Objective: (1) To quantitate the morbidity and 5 and 10 year bNED survival of Ir-192 temporary implant combined with external beam radiotherapy in the treatment of clinically localized Prostate Carcinoma. (2) To determine the need for nodal staging prior to implant. Materials and Methods: 335 consecutively treated patients seen between 8/17/84 and 8/13/93 were analyzed. All patents had retropertoneal nodal dissection and were implanted with Ir-192 using the Syed-Neblett template. Thirteen percent who completed treatment per protocol were found to have microscopically involved nodes on permanent section. 277 patients had completed the entire treatment protocol and had at least 2 years follow-up with DRE and serial serum PSAs. All patients were evaluated for morbidity using the standard RTOG morbidity scales. The bNED survival was determined using Kaplan-Meier methods with a non-rising PSA value of < 1.0 used as an indicator of disease control. All patients received 30 Gy in 50 hrs. to the implant volume, followed in two weeks by 34.2 Gy external beam (19 fx/ 25 days). The median follow up for the group is 55 months. Results: Morbidity: 69.2% of the patients experienced no reportable morbidity. Urinary morbidity was usually transient and mild (Grade 1 or 2 in 9.7%). 4.9 % experienced grade 3 urinary complaints (6.6% stress incontinence) and the incidence of grade 4 urinary complaints was 0.6%. Urinary complications were 2.5 times more common in patients who had previously undergone a TURP. Rectal complications were mild or moderate in 10.5% and usually consisted of asymptomatic rectal bleeding (6.9%). Severe rectal ulcer requiring temporary colostomy occurred in 1.4% and always healed after colostomy. Other morbidity consisted of mild, self-limited edema (2.1%). One patient had persistent edema post treatment, and there was one death from a CVA perioperatively (0.3%). 75% of patients who were potent prior to treatment maintained useful sexual function post

  14. The importance of tattoo pigment in sentinel lymph nodes.

    Science.gov (United States)

    Soran, Atilla; Menekse, Ebru; Kanbour-Shakir, Amal; Tane, Kaori; Diego, Emilia; Bonaventura, Marguerite; Johnson, Ronald

    2017-01-01

    The presence of pigment in axillary lymph nodes (LN) secondary to migration of tattoo ink can imitate the appearance of a blue sentinel lymph node (SLN) on visual inspection, causing the operator to either miss the true SLN or excise more than is needed. We present patients with tattoos ipsilateral to an early stage breast cancer who underwent a SLN biopsy. Patients were retrospectively reviewed from medical records and clinicopathologic data was collected. A total of 52 LNs were retrieved from 15 patients for sentinel mapping and 29 of them had tattoo pigmentation on pathologic evaluation. Of those 29 SLNs, 2 of them (6.9%) were pigmented, but did not contain either blue dye or Tc-99m (pseudopigmented SLN). Two (3.8%) SLNs were positive for metastasis; both of these had either blue dye or Tc99m uptake, and 1 demonstrated tattoo pigment in the node. In this cohort of patients with ipsilateral tattoos, removed more LNs lead to unnecessary excision which may important for increasing the risk of arm morbidity from SLN biopsy. However, the presence of tattoo pigment did not interfere with understaging for axillary mapping and it did not effect of pathological identification of SLNs positivity.

  15. Selective sentinel lymph node biopsy in male breast cancer.

    Science.gov (United States)

    Martin-Marcuartu, J J; Alvarez-Perez, R M; Sousa Vaquero, J M; Jimenez-Hoyuela García, J M

    To evaluate the reproducibility of the sentinel lymph node (SLN) technique in male breast cancer. We retrospectively analysed 21 male patients diagnosed with breast cancer in our hospital from 2008 to 2016 with, at least, 18 months follow-up. Fifteen patients underwent selective sentinel lymph node biopsy (SLNB) following the usual protocols with peritumoral injection of 18.5-111MBq of 99m Tc-nanocoloides and acquisition of planar images 2hours after the injection. In 2 cases it was necessary to perform a SPECT/CT to locate the SLN. Immunohistochemistry and molecular techniques (OSNA) were used for their analysis. Six patients did not undergo SLNB because they had pathological nodes or distant disease at the time of diagnosis. SLNB was performed in 15 patients. The SLN was negative in 6 patients and positive in the remaining 9. Three patients with positive SLNB did not need axillary lymphadenectomy because of the low number of copies by molecular analysis OSNA. Axillary lymphadenectomy was performed in the remaining 6 patients with the result of 4 positive axillary lymphadenectomies and 2 that did not show further extension of the disease. According to our experience, SLNB in males is a reproducible, useful, safe and reliable technique which avoids unnecessary axillary lymphadenectomy and prevents the appearance of undesirable effects. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  16. Studies of plutonium in human tracheobronchial lymph nodes

    International Nuclear Information System (INIS)

    McInroy, J.F.; Stewart, M.W.; Moss, W.D.

    1976-01-01

    Since 1959, tissues from 70 occupationally exposed former employees of the Los Alamos Scientific Laboratory have been examined following autopsy. Exposure in most cases was to inhaled plutonium oxide aerosols. Chemical analyses of selected tissues were performed to determine the amount of plutonium retained in the body at the time of death. On the basis of the measured tissue concentrations of plutonium, extrapolations of total-body burdens were made. Thirty-three of the measured cases had plutonium depositions in the tracheobronchial lymph nodes ranging from 0.1 to 4000 dpm per gram of tissue (0.05 to 1800 pCi/g). The duration of exposures ranged from 4 to 30 years. Microscopic examination of representative sections of these lymph nodes revealed no abnormalities other than those which were directly attributable to the basic disease that caused the demise of the various persons in this study. The size distribution of plutonium particles in nodes from one individual was determined by exposing tissue sections to nuclear track film. The estimated mass median diameter of the particles was 0.3 μm, and the distribution had a geometric standard deviation of 1.6. It is estimated that 95 percent of the individual particles had corresponding plutonium concentrations between 0.001 and 0.22 pCi

  17. PROSTATE CANCER TOPOGRAPHY AND PATTERNS OF LYMPH NODE METASTASIS

    Science.gov (United States)

    Tokuda, Yuji; Carlino, Lauren J.; Gopalan, Anuradha; Tickoo, Satish K.; Kaag, Matthew G.; Guillonneau, Bertrand; Eastham, James A.; Scher, Howard I.; Scardino, Peter T.; Reuter, Victor E.; Fine, Samson W.

    2012-01-01

    Pelvic lymph node (LN) metastasis is a well-recognized route of prostate cancer spread. However, the relationship between topography and pathologic features of primary prostatic cancers and patterns of pelvic LN metastasis has not been well studied. We reviewed original slides of radical prostatectomies and pelvic LN dissections from 125 patients with LN metastasis and recorded total # of LN excised / laterality of positive LN, as well as localization, staging parameters, lymphovascular invasion and tumor volume of primary tumors. LN Quantity and Distribution 14.6 (mean) and 13 (median) LN were resected. 76 (61%), 33 (26%) and 16 (13%) cases had 1, 2 and > 2 positive LN, while 58, 44 and 20 cases had LN metastasis on the right (R), left (L), and bilaterally. Pathologic Features 86% (108/125) and 37% (46/125) demonstrated extraprostatic extension and seminal vesicle invasion, while 64% showed lymphovascular invasion. Mean and median total tumor volume was 6.39 and 3.92 cc, with ≥ 50% and ≥ 90% Gleason patterns 4/5 in 105 (84%) and 73 (58%) cases, respectively. Correlation with Dominant Tumor Location Dominant lesions on RP: 50 R lobe, 44 L lobe, 31 bilateral. 15/50 (30%) R lobe and 18/44 (41%) L lobe dominant tumors had LN metastasis on the contralateral side. Only 4% (5/125) of cases were associated with anterior dominant tumors. 30–40% of LN metastases occur contralateral to the dominant tumor. LN metastasis is overwhelmingly associated with high grade, high stage and large volume disease. LN positivity is rarely associated with anterior dominant tumors. PMID:21107093

  18. Value of FNAC in abnormal axillary lymph nodes with non specific mammograms

    Directory of Open Access Journals (Sweden)

    Rania S.M. Ibrahim

    2018-06-01

    Conclusions: FNAC was a good cytological predictor in the majority of patients with abnormal lymph nodes and nonspecific mammography. FNAC is cost effective in assessing axillary lymph node status especially in limited resource setting like in our developing country. FNAC is preferred diagnostic tool in all cases of abnormal axillary lymph adenopathy.

  19. The sentinel lymph node spread determines quantitatively melanoma seeding to non-sentinel lymph nodes and survival.

    Science.gov (United States)

    Ulmer, Anja; Dietz, Klaus; Werner-Klein, Melanie; Häfner, Hans-Martin; Schulz, Claudia; Renner, Philipp; Weber, Florian; Breuninger, Helmut; Röcken, Martin; Garbe, Claus; Fierlbeck, Gerhard; Klein, Christoph A

    2018-03-01

    Complete lymph node dissection (CLND) after a positive sentinel node (SN) biopsy provides important prognostic information in melanoma patients but has been questioned for therapeutic use recently. We explored whether quantification of the tumour spread to SNs may replace histopathology of non-sentinel nodes (NSNs) for staging purposes. We quantified melanoma spread in SNs and NSNs in 128 patients undergoing CLND for a positive SN. In addition to routine histopathology, one-half of each of all 1496 SNs and NSNs was disaggregated into a single cell suspension and stained immunocytochemically to determine the number of melanoma cells per 10 6 lymph node cells, i.e. the disseminated cancer cell density (DCCD). We uncovered melanoma spread to NSNs in the majority of patients; however, the tumour load and the proportion of positive nodes were significantly lower in NSNs than in SNs. The relation between SN and NSN spread could be described by a mathematical function with DCCD NSN  = DCCD SN c /10 1 - c (c = 0.69; 95% confidence interval [CI]: 0.62-0.76). At a median follow-up of 67 months, multivariable Cox regression analyses revealed that DCCD SN (p = 0.02; HR 1.34, 95% CI: 1.05-1.71) and the total number of pathologically positive nodes (p = 0.02; HR 1.53, 95% CI: 1.07-2.22) were significant risk factors after controlling for age, gender, thickness of melanoma and ulceration status. A prognostic model based on DCCD SN and melanoma thickness predicted outcome as accurately as a model including pathological information of both SNs and NSNs. The assessment of DCCD SN renders CLND for staging purposes unnecessary. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Quantifying the number of lymph nodes identified in one-stage versus two-stage axillary dissection in breast cancer

    DEFF Research Database (Denmark)

    Damgaard, Olaf E; Jensen, Maj-Britt; Kroman, Niels

    2013-01-01

    To establish whether a different number of lymph nodes is identified in a delayed versus an immediate axillary lymph node dissection (ALND) in breast cancer patients.......To establish whether a different number of lymph nodes is identified in a delayed versus an immediate axillary lymph node dissection (ALND) in breast cancer patients....

  1. Methylation signature of lymph node metastases in breast cancer patients

    International Nuclear Information System (INIS)

    Barekati, Zeinab; Radpour, Ramin; Lu, Qing; Bitzer, Johannes; Zheng, Hong; Toniolo, Paolo; Lenner, Per; Zhong, Xiao Yan

    2012-01-01

    Invasion and metastasis are two important hallmarks of malignant tumors caused by complex genetic and epigenetic alterations. The present study investigated the contribution of aberrant methylation profiles of cancer related genes, APC, BIN1, BMP6, BRCA1, CST6, ESR-b, GSTP1, P14 (ARF), P16 (CDKN2A), P21 (CDKN1A), PTEN, and TIMP3, in the matched axillary lymph node metastasis in comparison to the primary tumor tissue and the adjacent normal tissue from the same breast cancer patients to identify the potential of candidate genes methylation as metastatic markers. The quantitative methylation analysis was performed using the SEQUENOM’s EpiTYPER™ assay which relies on matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). The quantitative DNA methylation analysis of the candidate genes showed higher methylation proportion in the primary tumor tissue than that of the matched normal tissue and the differences were significant for the APC, BIN1, BMP6, BRCA1, CST6, ESR-b, P16, PTEN and TIMP3 promoter regions (P<0.05). Among those candidate methylated genes, APC, BMP6, BRCA1 and P16 displayed higher methylation proportion in the matched lymph node metastasis than that found in the normal tissue (P<0.05). The pathway analysis revealed that BMP6, BRCA1 and P16 have a role in prevention of neoplasm metastasis. The results of the present study showed methylation heterogeneity between primary tumors and metastatic lesion. The contribution of aberrant methylation alterations of BMP6, BRCA1 and P16 genes in lymph node metastasis might provide a further clue to establish useful biomarkers for screening metastasis

  2. Distinct Ezrin Truncations Differentiate Metastases in Sentinel Lymph Nodes from Unaffected Lymph Node Tissues, from Primary Breast Tumors, and from Healthy Glandular Breast Tissues

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    Claudia Röwer

    2018-02-01

    Full Text Available BACKGROUND: Lymph node metastasis status is a prognostic factor for further lymph node involvement and for patient survival in breast cancer patients. Frozen section analysis of lymph nodes is a reliable method for detection of macro-metastases. However, this method is far less effective in detecting micro-metastases, requesting improved diagnostic procedures. METHODS: We investigated expression and truncation of ezrin in (i sentinel lymph node metastases, (ii unaffected axillary lymph nodes, (iii primary breast tumors, and (iv healthy glandular breast tissues using 2D gel electrophoresis, SDS-PAGE, and mass spectrometry in addition to Western blotting. RESULTS: Full-length ezrin (E1; amino acids 1–586 is present in all four investigated tissues. Two truncated ezrin forms, one missing about the first hundred amino acids (E2a and the other lacking about 150 C-terminal amino acids (E2b were detectable in primary tumor tissues and in sentinel lymph node metastases but not in glandular tissues. Strikingly, an ezrin truncation (E3 which consists approximately of amino acids 238–586 was found strongly expressed in all sentinel lymph node metastases. Moreover, an N-terminal ezrin fragment (E4 that consists approximately of amino acids 1–273 was identified in sentinel lymph node metastases as well. CONCLUSIONS: We show for the first time the existence of tissue-dependent specific ezrin truncations. The distinguished strong Western blot staining of ezrin E3 in sentinel lymph node metastases underlines its capability to substantiate the occurrence of lymph node (micrometastases in breast cancer patients.

  3. Differentiation of Metastatic and Non-Metastatic Mesenteric Lymph Nodes by Strain Elastography in Surgical Specimens

    DEFF Research Database (Denmark)

    Havre, R F; Leh, S M; Gilja, O H

    2016-01-01

    Purpose: To investigate if strain elastography could differentiate between metastatic and non-metastatic mesenteric lymph nodes ex-vivo. Materials and Methods: 90 mesenteric lymph nodes were examined shortly after resection from 25 patients including 17 patients with colorectal cancer and 8...... patients with Crohn's disease. Ultrasound-based strain elastography was performed with a linear probe. Tissue hardness in lymph nodes was assessed using visual scales and measuring the strain ratio. B-mode characteristics were also recorded. Pathological diagnosis with grading of fibrosis served...... non-metastatic nodes, but the difference was not significant (65.5 vs. 55.0, p = 0.055). There was no difference between lymph nodes in Crohn's and non-metastatic cancer specimens. The metastatic lymph nodes were significantly more fibrotic than the non-metastatic lymph nodes by the ordinal fibrosis...

  4. The value of STIR sequence in the characterization of mediastinal lymph nodes

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    Aylin Okur

    2013-12-01

    Full Text Available INTRODUCTION: To investigate availability of Short Time Inversion Recovery Turbo Spin Echo Magnetic Resonance imaging (STIR TSE MRI in the detection of mediastinal lymph nodes and in the distinguishing malign and benign lymph nodes detected in cases with pulmonary lesions. METHODS: Overall, 46 patients having mediastinal lymph nodes with confirmed or suspected lung cancer were included to the study. All patients underwent STIR TSE MR imaging before mediastinoscopy. Lymph nodes were assessed by signal characteristics on STIR TSE MRI. The results of histopathological evaluation and STIR TSE MRI were compared after mediastinoscopy. As data were qualitative, distributions were expressed as percentage and chi-square test was used to determine the difference between variables. RESULTS: Overall, 92 lymph nodes were analyzed. When a comparison was made between malign and benign lymph nodes, a significant difference was found between STIR MRI signal properties of lymph nodes and lymph node size. The specificity, sensitivity, positive predictive value and negative predictive value of STIR TSE MRI were estimated as 75.0%, 75.0%, 61.5% and 83.3%, respectively. DISCUSSION AND CONCLUSION: Although the negative predictive value is high in STIR TSE MRI, it has a low positive predictive value. Thus, the case may directly undergo surgery without performing mediastinoscopy when no malign lymph node is detected in STIR TSE MRI, while mediastinoscopy is warranted when a malign lymph node is detected.

  5. Radiation Protection Considerations about gamma probe-guided intraoperative sentinel lymph node surgery

    International Nuclear Information System (INIS)

    Rodriguez, C.; Jimenez-Hoyuela Garcia, J. L.; Rebollo Aguirre, J. M.; Custodio, A.

    2002-01-01

    The sentinel node concept is based on the sequential dissemination hypothesis. According to it, there's a lymph node (named sentinel node) which is the first receiving cancer cells metastasizing from a primary tumor. Further, others nodes sequentially located might be affected. Surgical performance for several types of cancer includes the complete removal of the tumor and a complete local lymph node dissection (LND). so removing and analyzing the sentinel node may avoid the complete LND. To locate the sentinel node, it's usual the local administration (intradermal injection) of a radiopharmaceutical Tc-99, sulfur colloid (activity about 1 mCi( several hours prior to surgery, and using an intraoperative gamma probe very sensitive to the gamma radiation. Although the activity is injected by the Nuclear Medicine staff, and be exposed to the gamma radiation. In this study we estimated maximum possible doses that would be received by personnel (surgical staff during surgery and pathologists during lumpectomy of the sentinel node). For the surgical staff, to avoid dose errors due to the very low residual activities and not to interfere with the personnel in the surgery room, we estimated doses by taking into account only the physical decay of Tc99m injected. for the pathologists, we estimated the residual activity in the sentinel node with the gamma probe. The highest effective dose rate found was to the surgeon (o,44 μSv/h, respectively. so a surgeon could perform 407 hours/yr, and a pathologist 1717 hours/yr, dedicated exclusively to sentinel node biopsy, before being classified as professionally exposed to radiation, and 4070 and 17170 hours per year, respectively, to surpass the annual limits (national regulations of the European Communities). In short, radiation doses to clinical staff involved in the technique are low, and in normal conditions, by establishing appropriate procedures (precautions during surgery, during manipulation surgical specimen...) control

  6. Recurrent lymph node metastases after craniocervical tumours: Computerized tomography

    International Nuclear Information System (INIS)

    Helmberger, H.; Lenz, M.; Kersting-Sommerhoff, B.; Bautz, W.; Kretz, S.

    1992-01-01

    A total of 544 CT examinations of the craniocervical region carried out in 231 patients were analyzed on a retrospective basis in order to assess the clinical value of contrast-enhanced computerized tomography, being carried out either for comparison with or in combination with clinical control examinations, in the post-therapeutic surveillance of patients treated for craniocervical tumours. The diagnostic accuracy attained with computerized tomography in the detection of recurrent lymph node metastases was 95% and thus superior to that determined for clinical control examinations (80%). (orig./GDG) [de

  7. Simultaneous lymph node involvement by Castleman disease and Kaposi sarcoma

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    Luciana Wernersbach Pinto

    2011-02-01

    Full Text Available Both multicentric Castleman disease and Kaposi sarcoma are more frequently observed in HIV infected patients. The coexistence of these Human herpesvirus 8 related lesions, in the same tissue, has been observed, but literature reports are scant. On the other hand, the expression of HHV-8-LANA-1 is easily demonstrable by immunohistochemistry. This has been shown to be a powerful tool for the diagnosis of these entities. The aim of this report is to communicate our experience with a case of multicentric Castleman disease occurring in the setting of HIV infection, which demonstrated microscopic Kaposi sarcoma in the same lymph node during the pathological work-up

  8. Lymph nodes cytology in HIV seropositive cases with haematological alterations

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    Neelima Tirumalasetti

    2014-01-01

    Full Text Available Background & objectives: Lymphadenopathy and haematological alterations are the earliest manifestations with other associated opportunistic infections and malignancies. Hence, there is a need for simple investigations like fine needle aspiration cytology (FNAC for evaluation of HIV lymphadenopathy and a haemogram to interpret the haematological alterations. This study was undertaken to analyze the cytological patterns of lymph node lesions in HIV/AIDS patients, to compare with available clinico-pathological and haematological parameters to segregate lymphadenopathy cases for further evaluation. Methods: In the present study, 129 HIV seropositive patients were included. Lymph node aspirates were stained routinely with hematoxylin and eosin and Ziehl-Neelsen (Z-N stains. Special stains and cultures were done in selected patients. Peripheral smears were taken from all the patients and CD4 counts were recorded. Tuberculous lymphadenitis was further categorized. Acid fast bacilli (AFB grading was done on Z-N positive smears. Each lesion was compared with CD4 counts, WHO clinical staging and haematological picture. Results: Cytological diagnosis in 129 patients included tuberculous (n=54, 41.9%, reactive lymphadenopathy (n=46, 35.6%, suppurative (n=16, 12.4% lymphadenitis, non-Hodgkin′s lymphoma (n=4, 3.1%, and Hodgkin′s lymphoma, secondary deposits, other granulomatous lesions, and cryptoccocal lymphadenitis in one patient each. The predominant cytomorphological pattern in tuberculous lymphadenitis was caseous necrosis + epithelioid granuloma formation (51.85%. Grade 2+ Z-N grading was noted in 62.96 per cent of AFB positive smears. CD4 counts showed a descending pattern with progression of WHO clinical staging. Cytopenia was more common in WHO clinical stage IV disease. Interpretation & conclusions: Lymph node cytology was found to be a useful tool for segregating lymphadenopathy cases for further evaluation and for identification of

  9. Predictors of non-sentinel lymph node metastasis in breast cancer patients with positive sentinel lymph node (Pilot study)

    International Nuclear Information System (INIS)

    Eldweny, H.; Alkhaldy, Kh.; Alsaleh, N.; Abdulsamad, M.; Abbas, A.; Hamad, A.; Mounib, Sh.; Essam, T.; Kukawski, P.; Bobin, J.; Oteifa, M.; Amangoono, H.; Abulhoda, F.; Usmani, Sh.; Elbasmy, A.

    2012-01-01

    Background: Sentinel Lymph Node Biopsy [SLNB) procedure was found to be an accurate method of staging the axilla in patients with early stage breast cancer. The standard of care for breast cancer patients with positive SLN metastasis includes complete Axillary Lymph Node Dissection (ALND). Haw ever, in 40-70% of patients, the SLN the only involved axillary node. Factors predicting non SLW metastasis should be identified in order to define subgroups of patient with positive SLN in whom the axilla may be staged by SLNB done. Objective: To identify the factors predicting metastatic involvement of the non-SLNs in breast cancer patients having SLN metastases. Patients and Methods: Data were collected and analyzed from 80 patients with early stage invasive breast cancer (T1, T2, N0, M0) who underwent SLNB at the surgical Oncology Department, Kuwait Cancel control Center (KCCC) between November 2004 and February 2009. SLNB was perfomed using a combined technique (radioactive colloid, and blue dye) in the majority of cases in some cases, only one technique was used. Complete ALND was performed in the case of failure of SLN identification and in patients with positive SLN. Multiple variables (patient, tumor and of SLN identification and in patients with positive SLN. Multiple variables (patient, tumor, and SLN characteristics) with tested as possible predictors of non sentinel lymph node metastasis. Results: The mean age of patients at diagnosis was 46.6 years. The median tumor size was 2 cm. The SLN identification rate was 96.2% (77 out of 80 patients). The SLN was positive in 24 patients(31%), and half of these showed evidence of capsular invasion. The median number of SLNs removed was two. The median number positive SLNs was one. The incidence of non-SLN metatasis associated with positive SLN was 50% (12 out of 24 patients). lymphovascular invasion was found to be the only factor associated with non-SLN metastases. In addition, two trends were observed, though they did

  10. Cross-Disciplinary Analysis of Lymph Node Classification in Lung Cancer on CT Scanning.

    Science.gov (United States)

    El-Sherief, Ahmed H; Lau, Charles T; Obuchowski, Nancy A; Mehta, Atul C; Rice, Thomas W; Blackstone, Eugene H

    2017-04-01

    Accurate and consistent regional lymph node classification is an important element in the staging and multidisciplinary management of lung cancer. Regional lymph node definition sets-lymph node maps-have been created to standardize regional lymph node classification. In 2009, the International Association for the Study of Lung Cancer (IASLC) introduced a lymph node map to supersede all preexisting lymph node maps. Our aim was to study if and how lung cancer specialists apply the IASLC lymph node map when classifying thoracic lymph nodes encountered on CT scans during lung cancer staging. From April 2013 through July 2013, invitations were distributed to all members of the Fleischner Society, Society of Thoracic Radiology, General Thoracic Surgical Club, and the American Association of Bronchology and Interventional Pulmonology to participate in an anonymous online image-based and text-based 20-question survey regarding lymph node classification for lung cancer staging on CT imaging. Three hundred thirty-seven people responded (approximately 25% participation). Respondents consisted of self-reported thoracic radiologists (n = 158), thoracic surgeons (n = 102), and pulmonologists who perform endobronchial ultrasonography (n = 77). Half of the respondents (50%; 95% CI, 44%-55%) reported using the IASLC lymph node map in daily practice, with no significant differences between subspecialties. A disparity was observed between the IASLC definition sets and their interpretation and application on CT scans, in particular for lymph nodes near the thoracic inlet, anterior to the trachea, anterior to the tracheal bifurcation, near the ligamentum arteriosum, between the bronchus intermedius and esophagus, in the internal mammary space, and adjacent to the heart. Use of older lymph node maps and inconsistencies in interpretation and application of definitions in the IASLC lymph node map may potentially lead to misclassification of stage and suboptimal management of lung

  11. Factors Predictive of Sentinel Lymph Node Involvement in Primary Breast Cancer.

    Science.gov (United States)

    Malter, Wolfram; Hellmich, Martin; Badian, Mayhar; Kirn, Verena; Mallmann, Peter; Krämer, Stefan

    2018-06-01

    Sentinel lymph node biopsy (SLNB) has replaced axillary lymph node dissection (ALND) for axillary staging in patients with early-stage breast cancer. The need for therapeutic ALND is the subject of ongoing debate especially after the publication of the ACOSOG Z0011 trial. In a retrospective trial with univariate and multivariate analyses, factors predictive of sentinel lymph node involvement should be analyzed in order to define tumor characteristics of breast cancer patients, where SLNB should not be spared to receive important indicators for adjuvant treatment decisions (e.g. thoracic wall irradiation after mastectomy with or without reconstruction). Between 2006 and 2010, 1,360 patients with primary breast cancer underwent SLNB with/without ALND with evaluation of tumor localization, multicentricity and multifocality, histological subtype, tumor size, grading, lymphovascular invasion (LVI), and estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 status. These characteristics were retrospectively analyzed in univariate and multivariate logistic regression models to define significant predictive factors for sentinel lymph node involvement. The multivariate analysis demonstrated that tumor size and LVI (pbreast cancer. Because of the increased risk for metastatic involvement of axillary sentinel nodes in cases with larger breast cancer or diagnosis of LVI, patients with these breast cancer characteristics should not be spared from SLNB in a clinically node-negative situation in order to avoid false-negative results with a high potential for wrong indication of primary breast reconstruction or wrong non-indication of necessary post-mastectomy radiation therapy. The prognostic impact of avoidance of axillary staging with SLNB is analyzed in the ongoing prospective INSEMA trial. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  12. Hodgkin's disease: internal mammary lymph nodes relapse diagnosed by Gallium-67 scintigraphy

    International Nuclear Information System (INIS)

    Ruiz Hernandez, G.; Ampudia, J.; Castillo, F.J.; Romero, C.; Pallardo, Y.; Garcia Conde, J.; Ramos, D.

    1999-01-01

    This article presents the case of a 62-year-old man with treated Hodgkin's disease who had internal mammary lymph nodes relapse after a complete initial response. These masses were gallium avid. These findings were explained by histologically documented Hodgkin's relapse, the first such case reported in that localization without chest wall involvement. The literature on mediastinal Hodgkin's disease and diagnostic procedures are reviewed. (orig.) [de

  13. Renal lymph nodes for tumor staging: appraisal of 871 nephrectomies with examination of hilar fat.

    Science.gov (United States)

    Mehta, Vikas; Mudaliar, Kumaran; Ghai, Ritu; Quek, Marcus L; Milner, John; Flanigan, Robert C; Picken, Maria M

    2013-11-01

    Despite decades of research, the role of lymphadenectomy in the management of renal cell carcinoma (RCC) is still not clearly defined. Before the implementation of targeted therapies, lymph node metastases were considered to be a portent of markedly decreased survival, regardless of the tumor stage. However, the role of lymphadenectomy and the relative benefit of retroperitoneal lymph node dissection in the context of modern adjunctive therapies have not been conclusively addressed in the clinical literature. The current pathologic literature does not offer clear recommendations with regard to the minimum number of lymph nodes that should be examined in order to accurately stage the pN in renal cell carcinoma. Although gross examination of the hilar fat to assess the nodal status is performed routinely, it has not yet been determined whether this approach is adequate. To evaluate the status of lymph nodes and their rate of identification in the pathologic examination of nephrectomy specimens in adult renal malignancies. We reviewed the operative and pathology reports of 871 patients with renal malignancies treated by nephrectomy. All tumors were classified according to the seventh edition of the Tumor-Nodes-Metastasis classification. Patients were divided into 3 groups: Nx, no lymph nodes recovered; N0, negative; and N1, with positive lymph nodes. Grossly visible lymph nodes were submitted separately; as per grossing protocol, hilar fatty tissue was submitted for microscopic examination. We evaluated the factors that affected the number of lymph nodes identified and the variables that allowed the prediction of nodal involvement. Lymph nodes were recovered in 333 of 871 patients (38%): hilar in 125 patients, nonhilar in 137 patients, and hilar and nonhilar in 71 patients. Patients with positive lymph nodes (n = 87) were younger, had larger primary tumors, and had lymph nodes of average size, as well as a higher pT stage, nuclear grade, and rate of metastases

  14. Morphological analysis of lymph nodes in Odontocetes from north and northeast coast of Brazil.

    Science.gov (United States)

    De Oliveira e Silva, Fernanda Menezes; Guimarães, Juliana Plácido; Vergara-Parente, Jociery Einhardt; Carvalho, Vitor Luz; De Meirelles, Ana Carolina Oliveira; Marmontel, Miriam; Ferrão, Juliana Shimara Pires; Miglino, Maria Angelica

    2014-05-01

    The morphology and location of lymph nodes from seven species of Odontocetes, of both sexes and different age groups, were described. All animals were derived from stranding events along the North and Northeastern coasts of Brazil. After the identification of lymph nodes in situ, tissue samples were analyzed for light and electron microscopy. Vascular volume density (VVD) and vascular length density (VLD) were evaluated in the mesenteric lymph nodes. Lymph nodes occurred as solitary nodules or in groups, varying in shape and size. In addition to using the nomenclature recommended by Nomina Anatomica Veterinaria, new nomenclatures were suggested based on the lymph nodes topography. Lymph nodes were covered by a highly vascularized and innervated capsule of dense connective tissue, below which muscle fibers were observed, inconsistently, in all studied species. There was no difference in VLD among different age groups. However, VVD was higher in adults. Lymph nodes parenchyma was divided into an outer cortex, containing lymph nodules and germinal centers; a paracortical region, transition zone with dense lymphoid tissue; and an inner medulla, composed of small irregular cords of lymphatic tissue, blood vessels, and diffuse lymphoid tissue. Abundant collagen fibers were observed around arteries and arterioles. Germinal centers were more evident and developed in calves and young animals, being more discrete and sparse in adults. The morphology of lymph nodes in Odontocetes was typical of that observed in other terrestrial mammals. However, new groups of lymph nodes were described for seven species occurring in the Brazilian coast. Copyright © 2014 Wiley Periodicals, Inc.

  15. Mesenteric lymph nodes in children: what is normal?

    International Nuclear Information System (INIS)

    Karmazyn, Boaz; Werner, Elizabeth A.; Rejaie, Babak; Applegate, Kimberly E.

    2005-01-01

    Enlarged mesenteric lymph nodes (MLN) are frequently seen in children with abdominal pain and, in the absence of other disorders, have been attributed to primary mesenteric lymphadenitis. To evaluate the prevalence of enlarged MLN (short axis ≥5 mm) as detected by abdominal CT in children with a low likelihood for mesenteric lymphadenopathy. During a 14-month period, we identified all non-contrast abdominal CT examinations performed at a tertiary care pediatric hospital for evaluation of suspected or known renal stones. Two radiologists reviewed the examinations and recognized all enlarged MLN, measured the short-axis diameter, and noted the quadrant location. Sixty-one children were identified who met entry criteria; mean age was 10.7 years (range 1.1-17.3 years). Enlarged MLN were found in 33 (54%) of the 61 children; the largest enlarged MLN was most frequently in the right lower quadrant (RLQ) (29 of 33, 88%). Seventeen of the 61 children (28%) had three or more enlarged MLN; all were in the RLQ. The largest short-axis diameter measured was 10 mm. Summary: MLN with a short-axis diameter of >5-10 mm are commonly found on abdominal CT examination of children with a low likelihood for mesenteric lymphadenopathy and should be considered a non-specific finding. A short-axis diameter of 8 mm might better define the upper limit of normal mesenteric lymph node size in children. (orig.)

  16. Investigation of cervical lymph node metastasis from primary unknown carcinoma

    International Nuclear Information System (INIS)

    Sagawa, Kosuke; Terada, Tomonori; Saeki, Nobuo; Uwa, Nobuhiro; Mohri, Takeshi; Sakagami, Masafumi

    2012-01-01

    We retrospectively evaluated 41 patients with metastatic cervical tumors from unknown primary sites at the Hyogo College of Medicine between 1997 and 2007. The N stage classification of cervical lymph nodes was: N1 in 3 cases, N2a in 10 cases, N2b in 10 cases, N2c in 4 cases, and N3 in 14 cases. The histopathological diagnoses of cervical lymph node were: squamous cell carcinoma in 33 cases, adenocarcinoma in 5 cases, undifferentiated carcinoma in 2 cases, and papillary carcinoma in 1 cases. Primary tumor sites were: tonsil in 5 cases, esophaguses in 2 cases, hypopharynxies in 2 cases, and thyroid, oral floor, submandibular gland, lung, gastric and colon in 1 case each. The useful tests were gastric endoscope, positron emission tomography-computed tomography (PET-CT), and blind biopsy of tonsil. We treated 24 of the 41 patients. Therapies were: neck dissection with postoperative radiation therapy in 11 cases, neck dissection alone in 1 case, only radiation or chemoradiation therapy alone in 8 cases, and chemotherapy alone in 4 cases. The 5-year survival rate was 40.1% in all cases and 81.5% in cases who underwent neck dissection. (author)

  17. Normal mediastinal and hilar lymph nodes in children on multi-detector row chest computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Jong, Pim A. de; Nievelstein, Rutger-Jan A. [University Medical Center Utrecht and Wilhelmina Children' s Hospital, Department of Radiology, Utrecht (Netherlands)

    2012-02-15

    To study normal mediastinal and hilar lymph nodes on multi-detector chest computed tomography (CT). A cohort of 120 children aged 1-17 years underwent emergency CT, including the chest, after high-energy trauma. Axial 5-mm reconstructions were evaluated for lymph nodes at hilar and various mediastinal levels and the short-axis diameters were measured. At least one lymph node was found in 115 (96%) children, with subcarinal (69%), lower paratracheal (64%) and hilar (60%) nodes being most common. Up to 10 years of age most lymph nodes were smaller than or equal to 7 mm. In older children lymph nodes measuring up to 10-mm-short-axis diameter were found. Lymph nodes were rare along the mammary vessels, at lower oesophageal and at prevascular and posterior mediastinal levels in children. Mediastinal and hilar lymph nodes are more common than previously thought, probably because of increased detection by modern multi-detector CT. Lymph node location and age have to be taken into account when evaluating lymph nodes in the paediatric chest. (orig.)

  18. Normal mediastinal and hilar lymph nodes in children on multi-detector row chest computed tomography

    International Nuclear Information System (INIS)

    Jong, Pim A. de; Nievelstein, Rutger-Jan A.

    2012-01-01

    To study normal mediastinal and hilar lymph nodes on multi-detector chest computed tomography (CT). A cohort of 120 children aged 1-17 years underwent emergency CT, including the chest, after high-energy trauma. Axial 5-mm reconstructions were evaluated for lymph nodes at hilar and various mediastinal levels and the short-axis diameters were measured. At least one lymph node was found in 115 (96%) children, with subcarinal (69%), lower paratracheal (64%) and hilar (60%) nodes being most common. Up to 10 years of age most lymph nodes were smaller than or equal to 7 mm. In older children lymph nodes measuring up to 10-mm-short-axis diameter were found. Lymph nodes were rare along the mammary vessels, at lower oesophageal and at prevascular and posterior mediastinal levels in children. Mediastinal and hilar lymph nodes are more common than previously thought, probably because of increased detection by modern multi-detector CT. Lymph node location and age have to be taken into account when evaluating lymph nodes in the paediatric chest. (orig.)

  19. Usefulness of CT-guided trans-bronchial needle aspiration biopsy for mediastinal lymph nodes

    International Nuclear Information System (INIS)

    Cui Bing; Rong Fu

    2001-01-01

    Objective: To determine the nature of enlarged mediastinal lymph nodes, the study of CT-guided trans-bronchial needle aspiration biopsy (CT-TBNA) was conducted. Methods: According to classification and locating standard of mediastinal lymph nodes, CT-TBNA was performed in 158 mediastinal lymph nodes of 73 patients, including 54 primary lung cancer with enlarged mediastinal lymph nodes, 5 malignant lymphoma, 3 mediastinal abscess and 11 mediastinal inflammatory adenopathy. Results: CT confirmed that the needles were inside all 158 lymph nodes. Adequate aspirates for histologic and/or cytologic diagnosis were obtained in 136 of 158(86%) lymph node biopsies. No serious complications occurred. Conclusion: Locating standard of CT-guided TBNA was reliable. Puncture was safe and cost-effective. CT-TBNA was important for ascertaining the nature of mediastinal adenopathy and staging of neoplasms

  20. Preoperative 18F-FDG-PET/CT imaging and sentinel node biopsy in the detection of regional lymph node metastases in malignant melanoma.

    Science.gov (United States)

    Singh, Baljinder; Ezziddin, Samer; Palmedo, Holger; Reinhardt, Michael; Strunk, Holger; Tüting, Thomas; Biersack, Hans-Jürgen; Ahmadzadehfar, Hojjat

    2008-10-01

    The objective of this study was to evaluate the role of preoperative 18F-fluorodeoxyglucose-positron emission tomography/computed tomography scanning, preoperative lymphoscintigraphy (LS), and sentinel lymph node biopsy in patients with malignant melanoma. Fifty-two patients (36 men: 16 women; mean age 55.0+/-13.0 years; median age 61 years; range 17-76 years) with malignant melanoma were selected. According to the latest version of the American Joint Committee on Cancer staging system, the disease in the study patients was initially classified as either stage I or II. The other primary tumor characteristics were mean Breslow depth=2.87 mm and median=2 mm; range 1-12.0 mm and Clarks levels III-V. None of the study patients had clinical or radiological evidence of regional lymph node metastatic disease. At least one sentinel node was identified in all patients. Preoperative LS detected a total of 111 sentinel lymph nodes (average 2.13 sentinel lymph node per patient) and demonstrated a single nodal draining basin in 38 (73%) patients and multiple (2-3 draining basins) in the remaining 14 (27%) patients. Fourteen out of the 52 patients (27%) had at least one involved sentinel node. Positron emission tomography was true positive in two patients with a sentinel node greater than 1 cm and false positive in two other patients. In this study, the detection of sentinel lymph node by LS and gamma probe had a sensitivity of 100%. In contrast, 18F-FDG-PET imaging demonstrated very low sensitivity (14.3%; 95% CI, 2.5 to 44%) and positive predictive value (50%; 95% CI, 9 to 90%) for localizing the subclinical nodal metastases. The specificity, net present value, and diagnostic accuracy were 94.7, 75, and 73%, respectively. Preoperative fluorodeoxyglucose-positron emission tomography/computed tomography imaging is not able to substitute LS/sentinel lymph node biopsy in patients at stage I or II.

  1. A simplified CT-based definition of the lymph node levels in the node negative neck

    International Nuclear Information System (INIS)

    Wijers, O.B.; Levendag, P.C.; Tan, T.; Dieren, E.B. van; Sornsen de Koste, J. van; Est, H. van der; Senan, S.; Nowak, P.J.C.M.

    1999-01-01

    Using three dimensional (3D) conformal radiotherapy (CRT) techniques for elective neck irradiation (ENI) may allow for local disease control to be maintained while diminishing xerostomia by eliminating major salivary glands (or parts thereof) from the treatment portals. The standardization of CT based target volumes for the clinically negative (elective) neck is a prerequisite for 3DCRT. The aim of the present study was to substantially modify an existing ('original') CT-based protocol for the delineation of the neck tar-et volume, into a more practical ('simplified') protocol. This will allow for rapid contouring and the implementation of conformal ENI in routine clinical procedures. An earlier ('original') version of the CT-based definition for elective neck node re-ions 2-5 was re-evaluated, using 15 planning CT scans of previously treated patients. The contouring guidelines were simplified by (1) using a smaller number of easily identifiable soft tissue- and bony anatomical landmarks, which in turn had to be identified in only a limited number of CT slices, and (2) by subsequently interpolating the contoured lymph node regions. The adequacy of target coverage and the sparing using both 'original' and 'simplified' delineation protocols was evaluated by DVH analysis after contouring the primary tumor, the neck and the major salivary glands in a patient with supraglottic laryngeal (SGL) carcinoma who was treated using a 3DCRT technique. The BEV projections of the 'original' and the 'simplified' versions of the 3D elective neck target showed good agreement and were found to be reproducible. The DVH's of the target and parotid glands were not significantly different using both contouring protocols. The 'simplified' protocol for the delineation of the 3D elective neck target produced both comparable target coverage and sparing of the major salivary glands. When used together with an interpolation program, this 'simplified' protocol substantial reduced the contouring

  2. Modified methylene blue injection improves lymph node harvest in rectal cancer.

    Science.gov (United States)

    Liu, Jianpei; Huang, Pinjie; Zheng, Zongheng; Chen, Tufeng; Wei, Hongbo

    2017-04-01

    The presence of nodal metastases in rectal cancer plays an important role in accurate staging and prognosis, which depends on adequate lymph node harvest. The aim of this prospective study is to investigate the feasibility and survival benefit of improving lymph node harvest by a modified method with methylene blue injection in rectal cancer specimens. One hundred and thirty-one patients with rectal cancer were randomly assigned to the control group in which lymph nodes were harvested by palpation and sight, or to the methylene blue group using a modified method of injection into the superior rectal artery with methylene blue. Analysis of clinicopathologic records, including a long-term follow-up, was performed. In the methylene blue group, 678 lymph nodes were harvested by simple palpation and sight. Methylene blue injection added 853 lymph nodes to the total harvest as well as 32 additional metastatic lymph nodes, causing a shift to node-positive stage in four patients. The average number of lymph nodes harvested was 11.7 ± 3.4 in the control group and 23.2 ± 4.7 in the methylene blue group, respectively. The harvest of small lymph nodes (rectal cancer, especially small node and metastatic node retrieval, which provided more accurate staging. However, it was not associated with overall survival. © 2014 Royal Australasian College of Surgeons.

  3. Lymph node enhancement at MRI with MnDPDP in primary hepatic carcinoma. Technical report

    International Nuclear Information System (INIS)

    Burkill, Guy J.C.; Mannion, Ethna M.; Healy, Jeremiah C.

    2001-01-01

    AIMS: To report two cases of lymph node enhancement in primary hepatic carcinoma following the administration of Mangafodipir trisodium (MnDPDP, Teslascan[reg ], Nycomed Amersham U.K.), an hepatocyte specific magnetic resonance imaging (MRI) contrast agent. To review our experience with this contrast agent and the literature to establish if such enhancement occurs in normal lymph nodes or has been previously described in hepatocellular carcinoma (HCC) or other lesions. MATERIALS AND METHODS: The radiological reports of all MnDPDP enhanced abdominal MRI examinations were reviewed for lymph node enlargement. The MR images from examinations with reported nodal enlargement were re-evaluated for evidence of nodal enhancement and the hospital notes and histological reports were reviewed. Nodal enhancement was considered present if lymph node signal intensity was greater than that of the spleen following MnDPDP. Literature searches were performed on Medline and PubMed for previous descriptions of lymph node enhancement following MnDPDP. RESULTS: The reports of 90 MnDPDP abdominal MRI examinations were reviewed. Of 18 cases of lymph node enlargement, two had evidence of lymph node enhancement following MnDPDP. These two cases had hepatocellular carcinoma and fibrolamellar hepatocellular carcinoma, respectively, confirmed on liver biopsy. No reports of lymph node enhancement following MnDPDP were identified in the literature. CONCLUSION: Two cases of lymph node enhancement following MnDPDP have been presented. Although histological confirmation of the lymph nodes was not obtained, the authors propose that the lymph node enhancement was due to functioning hepatocytes in lymph node metastases from the patients' histologically confirmed hepatocellular carcinomas. Burkill, G.J.C., Mannion, E.M. and Healy, J.C. (2001)

  4. CT appearance of hilar and mediastinal enlarged lymph nodes of coal worker's pneumoconiosis

    International Nuclear Information System (INIS)

    Ma Daqing; Guan Yansheng; Tang Hongqu; He Wen; Chen Budong; Zhang Yansong; Li Jun

    2000-01-01

    Objective: To study the CT appearance of the hilar and mediastinal enlarged lymph nodes in coal worker's pneumoconiosis (CWP), its pathological basis and diagnostic value for CWR complicated with lung cancer. Methods: (1) Twelve isolated lungs with CWP obtained at autopsy were inflated and fixed. CT scan was performed. The pathologic findings of enlarged lymph nodes were identified. (2) CT findings of hilar and mediastinal enlarged lymph nodes of 71 cases with CWP and 22 cases of CWP complicated with lung cancer were analyzed. Results: (1) Most of the enlarged hilar and mediastinal lymph nodes in simple CWR was in third stage of fibrosis. The fourth stage of fibrosis was only seen in lymph nodes of a case with complicated CWP. In this case the necrotic materials of lymph nodes eroded adjacent bronchi and vessels, and coalesced with progressive massive fibrosis (PMF). (2) The average number of lymph nodes in cases of complicated CWP was more than that of simple CWP (P 2 cm was 7.4%. (3) The prevalence of lymph nodes calcification in CWP was 61.1%, but egg shell calcification was only 14.7%. (4) In the cases of CWP complicated with lung cancer, lymph node > 2 cm was 20.8%, that was more than CWP (P 3 cm was 7.6%. Conclusion: Lymph nodes up to 1 cm may have dust fibrosis and coal silicosis nodules. The lymph nodes >2 cm is more common in CWP complicated with lung cancer than in simple CWP. The lymph nodes > 3 cm indicates higher probability of CWP with lung cancer than PMF

  5. Dual-energy CT can detect malignant lymph nodes in rectal cancer

    DEFF Research Database (Denmark)

    Al-Najami, I.; Lahaye, M. J.; Beets-Tan, Regina G H

    2017-01-01

    a pelvic DECT scan and a standard MRI. The Dual Energy CT quantitative parameters were analyzed: Water and Iodine concentration, Dual-Energy Ratio, Dual Energy Index, and Effective Z value, for the benign and malignant lymph node differentiation. Results DECT scanning showed statistical difference between...... quantitative parameters between benign and malignant lymph nodes. There were no difference in the accuracy of lymph node staging between DECT and MRI....

  6. Prophylactic central lymph nodes dissection (VI level in papillary thyroid cancer

    Directory of Open Access Journals (Sweden)

    Pavel Olegovich Rumiantsev

    2015-05-01

    Full Text Available Metastatic involvement of central lymph nodes in patients with papillary thyroid cancer (PTC is very common. However, prophylactic central lymph nodes dissection additionally to thyroidectomy does not significantly affect disease-free and overall survival of PTC patients. Meanwhile its routine conduction is tangibly increase postsurgical complications. From efficacy/safety point of view prophylactic central lymph nodes dissection couldn't be recommended as substantiated in all PTC patients.

  7. Number of evaluated lymph nodes and positive lymph nodes, lymph node ratio, and log odds evaluation in early-stage pancreatic ductal adenocarcinoma: numerology or valid indicators of patient outcome?

    Science.gov (United States)

    Lahat, G; Lubezky, N; Gerstenhaber, F; Nizri, E; Gysi, M; Rozenek, M; Goichman, Y; Nachmany, I; Nakache, R; Wolf, I; Klausner, J M

    2016-09-29

    We evaluated the prognostic significance and universal validity of the total number of evaluated lymph nodes (ELN), number of positive lymph nodes (PLN), lymph node ratio (LNR), and log odds of positive lymph nodes (LODDS) in a relatively large and homogenous cohort of surgically treated pancreatic ductal adenocarcinoma (PDAC) patients. Prospectively accrued data were retrospectively analyzed for 282 PDAC patients who had pancreaticoduodenectomy (PD) at our institution. Long-term survival was analyzed according to the ELN, PLN, LNR, and LODDS. Of these patients, 168 patients (59.5 %) had LN metastasis (N1). Mean ELN and PLN were 13.5 and 1.6, respectively. LN positivity correlated with a greater number of evaluated lymph nodes; positive lymph nodes were identified in 61.4 % of the patients with ELN ≥ 13 compared with 44.9 % of the patients with ELN < 13 (p = 0.014). Median overall survival (OS) and 5-year OS rate were higher in N0 than in N1 patients, 22.4 vs. 18.7 months and 35 vs. 11 %, respectively (p = 0.008). Mean LNR was 0.12; 91 patients (54.1 %) had LNR < 0.3. Among the N1 patients, median OS was comparable in those with LNR ≥ 0.3 vs. LNR < 0.3 (16.7 vs. 14.1 months, p = 0.950). Neither LODDS nor various ELN and PLN cutoff values provided more discriminative information within the group of N1 patients. Our data confirms that lymph node positivity strongly reflects PDAC biology and thus patient outcome. While a higher number of evaluated lymph nodes may provide a more accurate nodal staging, it does not have any prognostic value among N1 patients. Similarly, PLN, LNR, and LODDS had limited prognostic relevance.

  8. Differential Gene Expression in Primary Breast Tumors Associated with Lymph Node Metastasis

    Science.gov (United States)

    Ellsworth, Rachel E.; Field, Lori A.; Love, Brad; Kane, Jennifer L.; Hooke, Jeffrey A.; Shriver, Craig D.

    2011-01-01

    Lymph node status remains one of the most useful prognostic indicators in breast cancer; however, current methods to assess nodal status disrupt the lymphatic system and may lead to secondary complications. Identification of molecular signatures discriminating lymph node-positive from lymph node-negative primary tumors would allow for stratification of patients requiring surgical assesment of lymph nodes. Primary breast tumors from women with negative (n = 41) and positive (n = 35) lymph node status matched for possible confounding factors were subjected to laser microdissection and gene expression data generated. Although ANOVA analysis (P 1.5) revealed 13 differentially expressed genes, hierarchical clustering classified 90% of node-negative but only 66% of node-positive tumors correctly. The inability to derive molecular profiles of metastasis in primary tumors may reflect tumor heterogeneity, paucity of cells within the primary tumor with metastatic potential, influence of the microenvironment, or inherited host susceptibility to metastasis. PMID:22295210

  9. Differential Gene Expression in Primary Breast Tumors Associated with Lymph Node Metastasis

    International Nuclear Information System (INIS)

    Ellsworth, R.E.; Field, L.A.; Kane, J.L.; Love, B.; Hooke, J.A.; Shriver, C.D.

    2011-01-01

    Lymph node status remains one of the most useful prognostic indicators in breast cancer; however, current methods to assess nodal status disrupt the lymphatic system and may lead to secondary complications. Identification of molecular signatures discriminating lymph node-positive from lymph node-negative primary tumors would allow for stratification of patients requiring surgical assesment of lymph nodes. Primary breast tumors from women with negative (n=41) and positive (n=35) lymph node status matched for possible confounding factors were subjected to laser micro dissection and gene expression data generated. Although ANOVA analysis (P 1.5) revealed 13 differentially expressed genes, hierarchical clustering classified 90% of node-negative but only 66% of node-positive tumors correctly. The inability to derive molecular profiles of metastasis in primary tumors may reflect tumor heterogeneity, paucity of cells within the primary tumor with metastatic potential, influence of the microenvironment, or inherited host susceptibility to metastasis

  10. Differential Gene Expression in Primary Breast Tumors Associated with Lymph Node Metastasis

    Directory of Open Access Journals (Sweden)

    Rachel E. Ellsworth

    2011-01-01

    Full Text Available Lymph node status remains one of the most useful prognostic indicators in breast cancer; however, current methods to assess nodal status disrupt the lymphatic system and may lead to secondary complications. Identification of molecular signatures discriminating lymph node-positive from lymph node-negative primary tumors would allow for stratification of patients requiring surgical assesment of lymph nodes. Primary breast tumors from women with negative (=41 and positive (=35 lymph node status matched for possible confounding factors were subjected to laser microdissection and gene expression data generated. Although ANOVA analysis (1.5 revealed 13 differentially expressed genes, hierarchical clustering classified 90% of node-negative but only 66% of node-positive tumors correctly. The inability to derive molecular profiles of metastasis in primary tumors may reflect tumor heterogeneity, paucity of cells within the primary tumor with metastatic potential, influence of the microenvironment, or inherited host susceptibility to metastasis.

  11. Evaluation of fast neutron irradiation in the treatment of squamous cell carcinoma in cervical lymph nodes

    International Nuclear Information System (INIS)

    Duncan, W.; Orr, J.A.; Arnott, S.J.; Jack, W.J.; Kerr, G.R.

    1987-01-01

    Analyses have been made of the response of metastatic cervical lymph nodes following neutron therapy, either as part of a randomized trial or in patients treated electively. In the trial patients, the overall regression and local control rates were similar after photons and neutrons. Mobile nodes, less than 3.0 cm, appeared to respond better to neutron therapy, and node masses greater than 3.0 cm had better control after photon therapy. The differences observed however were not statistically significant. There was a highly significant association between the control of the primary tumor and control of nodal disease. No survival advantage for neutrons was observed in association with apparently better control rates in cervical nodes

  12. The significance of extended lymphadenectomy for colorectal cancer with isolated synchronous extraregional lymph node metastasis

    Directory of Open Access Journals (Sweden)

    Atsushi Ogura

    2017-07-01

    Conclusion: Findings from our study suggest that extended lymphadenectomy for colorectal cancer with synchronous isolated extraregional lymph node metastasis might be effective in carefully selected patients.

  13. Normal mediastinal and hilar lymph nodes evaluated by 5 mm slice bolus injection CT scan

    International Nuclear Information System (INIS)

    Yamamoto, Takako; Tsukada, Hiroshi; Koizumi, Naoya; Akita, Shinichi; Oda, Junichi; Sakai, Kunio

    1995-01-01

    We evaluated the number and size of normal mediastinal and hilar lymph nodes by 5 mm slice bolus injection CT (12 patients), compared with 10 mm slice CT (12 patients). More lymph nodes were clearly demonstrated by 5 mm slice CT than by 10 mm slice CT. Especially left-sided tracheobronchial (no.4), subaortic (no.5), subcarinal (no.7) and hilar lymph nodes were clearly visible. We concluded 5 mm slice bolus injection CT was useful to evaluate mediastinal and hilar lymph nodes. (author)

  14. Dense volumetric detection and segmentation of mediastinal lymph nodes in chest CT images

    Science.gov (United States)

    Oda, Hirohisa; Roth, Holger R.; Bhatia, Kanwal K.; Oda, Masahiro; Kitasaka, Takayuki; Iwano, Shingo; Homma, Hirotoshi; Takabatake, Hirotsugu; Mori, Masaki; Natori, Hiroshi; Schnabel, Julia A.; Mori, Kensaku

    2018-02-01

    We propose a novel mediastinal lymph node detection and segmentation method from chest CT volumes based on fully convolutional networks (FCNs). Most lymph node detection methods are based on filters for blob-like structures, which are not specific for lymph nodes. The 3D U-Net is a recent example of the state-of-the-art 3D FCNs. The 3D U-Net can be trained to learn appearances of lymph nodes in order to output lymph node likelihood maps on input CT volumes. However, it is prone to oversegmentation of each lymph node due to the strong data imbalance between lymph nodes and the remaining part of the CT volumes. To moderate the balance of sizes between the target classes, we train the 3D U-Net using not only lymph node annotations but also other anatomical structures (lungs, airways, aortic arches, and pulmonary arteries) that can be extracted robustly in an automated fashion. We applied the proposed method to 45 cases of contrast-enhanced chest CT volumes. Experimental results showed that 95.5% of lymph nodes were detected with 16.3 false positives per CT volume. The segmentation results showed that the proposed method can prevent oversegmentation, achieving an average Dice score of 52.3 +/- 23.1%, compared to the baseline method with 49.2 +/- 23.8%, respectively.

  15. Accuracy of multidetector-row CT in diagnosing lymph node metastasis in patients with gastric cancer

    Energy Technology Data Exchange (ETDEWEB)

    Saito, Takuro; Kurokawa, Yukinori; Takiguchi, Shuji; Miyazaki, Yasuhiro; Takahashi, Tsuyoshi; Yamasaki, Makoto; Miyata, Hiroshi; Nakajima, Kiyokazu; Mori, Masaki; Doki, Yuichiro [Osaka University, Graduate School of Medicine, Department of Gastroenterological Surgery, Suita, Osaka (Japan)

    2014-08-06

    The purpose of this study was to determine the optimal cut-off value of lymph node size for diagnosing metastasis in gastric cancer with multidetector-row computed tomography (MDCT) after categorizing perigastric lymph nodes into three regions. The study included 90 gastric cancer patients who underwent gastrectomy. The long-axis diameter (LAD) and short-axis diameter (SAD) of all visualized lymph nodes were measured with transverse MDCT images. The locations of lymph nodes were categorized into three regions: lesser curvature, greater curvature, and suprapancreatic. The diagnostic value of lymph node metastasis was assessed with receiver operating characteristic (ROC) analysis. The area under the curve was larger for SAD than LAD in all groups. The optimal cut-off values of SAD were determined as follows: overall, 9 mm; differentiated type, 9 mm; undifferentiated type, 8 mm; lesser curvature region, 7 mm; greater curvature region, 6 mm; and suprapancreatic region, 9 mm. The diagnostic accuracies for lymph node metastasis using individual cut-off values were 71.1 % based on histological type and 76.6 % based on region of lymph node location. The diagnostic accuracy of lymph node metastasis in gastric cancer was improved by using individual cut-off values for each lymph node region. (orig.)

  16. Clinical value of sentinel lymph node diagnostics in head and neck cancer; Klinische Wertigkeit der Sentinel-Lymph-Node-Diagnostik bei Kopf-Hals-Tumoren

    Energy Technology Data Exchange (ETDEWEB)

    Kampen, W.U. [Klinik fuer Nuklearmedizin am Universitaetsklinikum Schleswig-Holstein, Campus Kiel (Germany); Hoeft, S. [Klinik fuer Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie am Universitaetsklinikum Schleswig-Holstein, Campus Kiel (Germany); Maune, S. [Praxis fuer Hals-Nasen-Ohrenheilkunde, Kiel (Germany)

    2006-06-15

    The concept of the so-called sentinel lymph node (SLN), being the first node draining a malignant tumor and thus carrying the highest risk of metastatic disease, is already frequently applied in patients suffering from malignant melanoma and breast cancer. It is the aim of this concept, to reduce postoperative morbidity by omitting a conventional lymph node dissection if the SLN is proven to be free of any tumor cells. First clinical studies showed promising results also in patients with head and neck cancer. However, both the anatomical localization of the primary tumor and the very complex lymphatic, frequently bilateral drainage pattern may lead to significant methodological problems. Besides a skilful intraoperative usage of the gamma probe, the precise preoperative staging of the respective patient for determination of the N0 status and the assiduous histopathological analysis of the excised SLN are extremely important to reach a maximum of sensitivity in this clinical setting. This paper summarizes the data published on the SLN concept in patients with head and neck cancer, describes the several methodological aspects of labeling the SLN with radiocolloides and reviews the today's impact of the SLN method in clinical routine. (orig.)

  17. Predictors of axillary lymph node metastases in women with early breast cancer in Singapore.

    Science.gov (United States)

    Tan, L G L; Tan, Y Y; Heng, D; Chan, M Y

    2005-12-01

    The presence of axillary lymph node metastases is an important prognostic factor in breast cancer. Sentinel lymph node biopsy (SLNB) is an emerging method for the staging of the axilla. It is hoped that with SLNB, the morbidity from axillary lymph node dissection (ALND) can be avoided without compromising the staging and management of early breast cancer. However, only patients found to be SLNB negative benefit from this procedure, as those with positive SLNB may still require ALND. Our objective is to study the various clinico-pathological factors to find predictive factors for axillary lymph node involvement in early breast cancer. It is hoped that with these factors, we will be better able to identify groups of patients most likely to benefit from SLNB. A retrospective study of 380 early breast cancer cases (stage T1 and T2, N0, N1, M0) in women treated in the Department of General Surgery, Tan Tock Seng Hospital, between January 1999 and August 2002, was conducted. Incidence of nodal metastases was correlated with clinico-pathological factors, and analysed by univariate and multivariate analyses. Approximately 35 percent of the 380 cases of early breast cancer had nodal metastases. Multivariate analyses revealed four independent predictors of node positivity: tumour size (p-value equals 0.0001), presence of lymphovascular invasion (p-value is less than 0.0001), tumours with histology other than invasive ductal or lobular carcinoma (p-value equals 0.04), and presence of progesterone receptors (p-value equals 0.05). We have found independent preoperative predictive factors in our local population for the presence of nodal metastases. This information can aid patient selection for SLNB and improve patient counselling.

  18. Lymph node scintigraphy with sup(99m)Tc-rhenium colloid

    International Nuclear Information System (INIS)

    Mitsuhata, Naoki; Suyama, Bunzo; Matsumura, Yosuke; Ohmori, Hiroyuki

    1981-01-01

    Lymph node scintigraphy with sup(99m)Tc-rhenium colloid in evaluation of nodal involvement by urological malignancy were performed on twelve cases (4 bladder cancer, 3 prostatic cancer, 2 penile cancer and 3 testicular tumor). These cases had been examined the extent of disease on the basis of findings at pedal lymphangiography, urography, computed tomography or laparotomy. sup(99m)Tc-rhenium colloid in a volume of 0.2 ml (2 mCi) was injected into the first interdigital webs of each foot without local anesthesia. In one case of penile cancer radioactive colloid was directly injected into the glans penis and prepuce including tumor area. Our clinical experience reported here reveals that lymph node scintigraphy with sup(99m)Tc-rhenium colloid can provide a useful method of investigating the lymphatic system. This technique is reproducible and can be performed in poor risk patients or pediatric patients readily and safely. (author)

  19. Association between lymph node size and metastasis in dogs with oral malignant melanoma: 100 cases (1987-2001).

    Science.gov (United States)

    Williams, Laurel E; Packer, Rebecca A

    2003-05-01

    To determine the association between lymph node size and metastasis and to assess measurement of lymph node size as an accurate and reliable means of tumor staging in dogs with oral malignant melanoma. Retrospective study. 100 dogs with histologically confirmed oral malignant melanoma. Clinical records for dogs with oral malignant melanoma were reviewed. Data regarding size and results of cytologic or histologic examination of lymph nodes were evaluated. The association between lymph node size and metastasis was determined. Forty-seven (47%) dogs, of which 23 (49%) had enlarged mandibular lymph nodes, had no cytologic or histologic evidence of metastasis. Of 53 (53%) dogs with cytologic or histologic evidence of mandibular lymph node metastasis, 37 (70%) had enlarged mandibular lymph nodes, and 16 (30%) had mandibular lymph nodes of normal size. Overall, 16 of the 40 (40%) dogs with normal-sized lymph nodes had microscopic evidence of metastatic disease. Sensitivity and specificity of lymph node size as a predictor of metastasis were 70 and 51%, respectively, and the positive and negative predictive values were 62 and 60%, respectively. Although a significant relationship was identified between lymph node size and metastasis to the lymph node, this association did not appear strong enough to be clinically relevant. Results suggest that lymph node size alone is insufficient for accurate clinical staging of oral malignant melanoma in dogs; cytologic or histologic examination of regional lymph nodes should routinely be performed, regardless of size of those nodes.

  20. Treatment of Metastatic Lymph Nodes in the Neck from Papillary Thyroid Carcinoma with Percutaneous Laser Ablation

    Energy Technology Data Exchange (ETDEWEB)

    Mauri, Giovanni, E-mail: vanni.mauri@gmail.com [European Institute of Oncology, Division of Interventional Radiology (Italy); Cova, Luca [General Hospital of Busto Arsizio, Unit of Interventional Oncology (Italy); Ierace, Tiziana [IRCCS Istituto Clinico Humanitas, Unit of Interventional Radiology (Italy); Baroli, Alberto; Di Mauro, Enzo [General Hospital of Busto Arsizio, Department of Nuclear Medicine (Italy); Pacella, Claudio Maurizio [Regina Apostolorum Hospital, Department of Diagnostic Imaging (Italy); Goldberg, Shraga Nahum [Hadassah Hebrew University Medical Center, Image-guided Therapy and Interventional Oncology Unit (Israel); Solbiati, Luigi [IRCCS Istituto Clinico Humanitas, Unit of Interventional Radiology (Italy)

    2016-07-15

    PurposeTo assess the effectiveness of percutaneous laser ablation (PLA) of cervical lymph node metastases from papillary thyroid carcinoma.Materials and Methods24 patients (62.3 ± 13.2 year; range 32–80) previously treated with thyroidectomy, neck dissection, and radioiodine ablation underwent ultrasound-guided PLA of 46 {sup 18}FDG-PET/CT—positive metachronous nodal metastases. All patients were at high surgical risk or refused surgery and were unsuitable for additional radioiodine ablation. A 300 µm quartz fiber and a continuous-wave Nd-YAG laser operating at 1.064 mm were used. Technical success, rate of complications, rate of serological conversion, and local control at follow-up were derived. Fisher’s exact test and Mann–Whitney U test were used and Kaplan–Meier curve calculated.ResultsTechnical success was obtained in all 46 lymph nodes (100 %). There were no major complications. Thyroglobulin levels decreased from 8.40 ± 9.25 ng/ml before treatment to 2.73 ± 4.0 ng/ml after treatment (p = 0.011), with serological conversion in 11/24 (45.8 %) patients. Overall, local control was obtained in 40/46 (86.9 %) lymph nodes over 30 ± 11 month follow-up, with no residual disease seen at imaging in 19/24 (79.1 %) patients. Local control was achieved in 40/46 (86.9 %) lymph nodes at 1 year and in all of the 25 nodes (100 %) followed for 3 years. Estimated mean time to progression was 38.6 ± 2.7 m.ConclusionUltrasound-guided PLA is a feasible, safe, and effective therapy for the treatment of cervical lymph node metastases from papillary thyroid carcinoma.

  1. Nomogram for prediction of level 2 axillary lymph node metastasis in proven level 1 node-positive breast cancer patients.

    Science.gov (United States)

    Jiang, Yanlin; Xu, Hong; Zhang, Hao; Ou, Xunyan; Xu, Zhen; Ai, Liping; Sun, Lisha; Liu, Caigang

    2017-09-22

    The current management of the axilla in level 1 node-positive breast cancer patients is axillary lymph node dissection regardless of the status of the level 2 axillary lymph nodes. The goal of this study was to develop a nomogram predicting the probability of level 2 axillary lymph node metastasis (L-2-ALNM) in patients with level 1 axillary node-positive breast cancer. We reviewed the records of 974 patients with pathology-confirmed level 1 node-positive breast cancer between 2010 and 2014 at the Liaoning Cancer Hospital and Institute. The patients were randomized 1:1 and divided into a modeling group and a validation group. Clinical and pathological features of the patients were assessed with uni- and multivariate logistic regression. A nomogram based on independent predictors for the L-2-ALNM identified by multivariate logistic regression was constructed. Independent predictors of L-2-ALNM by the multivariate logistic regression analysis included tumor size, Ki-67 status, histological grade, and number of positive level 1 axillary lymph nodes. The areas under the receiver operating characteristic curve of the modeling set and the validation set were 0.828 and 0.816, respectively. The false-negative rates of the L-2-ALNM nomogram were 1.82% and 7.41% for the predicted probability cut-off points of level 1 axillary lymph node metastasis. Patients with a low probability of L-2-ALNM could be spared level 2 axillary lymph node dissection, thereby reducing postoperative morbidity.

  2. Engineering intranasal mRNA vaccines to enhance lymph node trafficking and immune responses.

    Science.gov (United States)

    Li, Man; Li, You; Peng, Ke; Wang, Ying; Gong, Tao; Zhang, Zhirong; He, Qin; Sun, Xun

    2017-12-01

    Intranasal mRNA vaccination provides immediate immune protection against pandemic diseases. Recent studies have shown that diverse forms of polyethyleneimine (PEI) have potent mucosal adjuvant activity, which could significantly facilitate the delivery of intranasal mRNA vaccines. Nevertheless, optimizing the chemical structure of PEI to maximize its adjuvanticity and decrease its toxicity remains a challenge. Here we show that the chemical structure of PEI strongly influences how well nanocomplexes of PEI and mRNA migrate to the lymph nodes and elicit immune responses. Conjugating cyclodextrin (CD) with PEI600 or PEI2k yielded CP (CD-PEI) polymers with different CD/PEI ratios. We analyzed the delivery efficacy of CP600, CP2k, and PEI25k as intranasal mRNA vaccine carriers by evaluating the lymph nodes migration and immune responses. Among these polymers, CP2k/mRNA showed significantly higher in vitro transfection efficiency, stronger abilities to migrate to lymph nodes and stimulate dendritic cells maturation in vivo, which further led to potent humoral and cellular immune responses, and showed lower local and systemic toxicity than PEI25k/mRNA. These results demonstrate the potential of CD-PEI2k/mRNA nanocomplex as a self-adjuvanting vaccine delivery vehicle that traffics to lymph nodes with high efficiency. As we face outbreaks of pandemic diseases such as Zika virus, intranasal mRNA vaccination provides instant massive protection against highly variant viruses. Various polymer-based delivery systems have been successfully applied in intranasal vaccine delivery. However, the influence of molecular structure of the polymeric carriers on the lymph node trafficking and dendritic cell maturation is seldom studied for intranasal vaccination. Therefore, engineering polymer-based vaccine delivery system and elucidating the relationship between molecular structure and the intranasal delivery efficiency are essential for maximizing the immune responses. We hereby

  3. THE MURINE LOCAL LYMPH NODE ASSAY: AN ALTERNATIVE TEST METHOD FOR THE EVALUATION OF THE POTENTIAL FOR CHEMICALS TO ELICIT ALLERGIC CONTACT DERMATITIS

    Science.gov (United States)

    ABSTRACTThe process that a new toxicology test method must undergo to attain acceptance and regulatory implementation may seem daunting. As the first test method to undergo Interagency Coordinating Committee on the Validation of Alternative Methods (ICCVAM) review, the local...

  4. Skin sensitization potency and cross-reactivity of p-phenylenediamine and its derivatives evaluated by non-radioactive murine local lymph node assay and guinea-pig maximization test.

    Science.gov (United States)

    Yamano, Tetsuo; Shimizu, Mitsuru

    2009-04-01

    p-Phenylenediamine (PPD)-related chemicals have been used as antioxidants in rubber products, and many cases of contact dermatitis caused by these chemicals have been reported. The aim of this study was to investigate relative sensitizing potency and cross-reactivity among PPD derivatives. Five PPD derivatives, p-aminodiphenylamine (PADPA), N,N'-diphenyl-p-phenylenediamine (DPPD), N-isopropyl-N'-phenyl-p-phenylenediamine (IPPD), N-(1,3-dimethylbutyl)-N'-phenyl-p-phenylenediamine (DMBPPD), N-(1-methylheptyl)-N'-phenyl-p-phenylenediamine (MHPPD), and the core chemical PPD were evaluated for their sensitizing potency and cross-reactivity using the non-radioactive murine local lymph node assay (LLNA) and the guinea-pig maximization test (GPMT). PPD and all the derivatives were identified as primary sensitizers in both tests. The order of potency in the LLNA was as follows: IPPD and PADPA > PPD > DMBPPD and MHPPD > DPPD. In the GPMT, all six groups of animals sensitized with one of these chemicals cross-reacted to four other derivatives. Specifically, the five groups that have a common basic PADPA structure, that is PADPA, DPPD, IPPD, DMBPPD, and MHPPD, all reacted to each other at almost the same scores, while none of them reacted to PPD. The cross-reactivity profile found in the study was to some extent different from that in previous human data, where distinction between cross-reaction and concomitant primary sensitization is not always clear.

  5. Chemical applicability domain of the Local Lymph Node Assay (LLNA) for skin sensitisation potency. Part 3. Apparent discrepancies between LLNA and GPMT sensitisation potential: False positives or differences in sensitivity?

    Science.gov (United States)

    Roberts, David W; Schultz, Terry W; Api, Anne Marie

    2016-10-01

    The Local Lymph Node Assay (LLNA) is the gold standard regulatory toxicology test for skin sensitisation along with the guinea pig maximisation test (GPMT). Compared with the GPMT, LLNA uses fewer animals, it is quantitative, and it gives a numerical prediction of potency. However several concerns have been raised with this assay, mainly related to false positives and false negatives. Over the years, many authors, including the developers of the assay, have presented cases where there have been discrepancies between the GMPT and LLNA results. Several theories have been put forward for these discrepancies, the main one being the "over-sensitivity" of the GPMT. This paper analyses the data from a systematic study, published in three papers from 2008 to 2011, covering several classes of chemicals, in particular unsaturated fatty acids, sugar surfactants and ethoxylated alcohols, with many cases of chemicals testing positive in the LLNA being negative in the GPMT. Based on consideration of reaction chemistry and structural alerts, it is concluded that these discrepancies are not LLNA false positives, but can be rationalised in terms of the different protocols of the assays. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Quantitative comparison of the results obtained by the multiple-dose guinea pig maximization test and the non-radioactive murine local lymph-node assay for various biocides.

    Science.gov (United States)

    Yamano, Tetsuo; Shimizu, Mitsuru; Noda, Tsutomu

    2005-07-01

    We compared the results of the multiple-dose guinea pig maximization test (GPMT) and the non-radioactive murine local lymph-node assay (LLNA) for various biocides. Thirteen out of 17 positive biocides in the GPMT gave positive results in the LLNA. In the GPMT, the minimum first induction doses ranged over four orders (0.00005-0.5%), while elicitation-threshold doses, which were evaluated using an optimally sensitized group of animals in the multiple-dose studies, ranged over five orders (0.00006-2.8%). In the LLNA, minimum induction doses ranged over more than three orders (0.01-30%). With respect to 13 biocides that were positive in both the GPMT and the LLNA, results were quantitatively compared. When compared after conversion to corresponding area doses (microg/cm), the minimum doses required to elicit skin reaction in guinea pigs were always lower than that for induction in mice with all biocides. Correlation between minimum induction doses from the GPMT and the LLNA seemed poor (r=0.57), while that between minimum induction doses in the LLNA and elicitation-threshold doses in the GPMT was relatively good (r=0.73). The results suggest the possibility to estimate human elicitation-threshold doses, which are definitely lacking in the process of risk assessment for skin-sensitizers, from the data of the LLNA.

  7. Quantitative comparison of the results obtained by the multiple-dose guinea pig maximization test and the non-radioactive murine local lymph-node assay for various biocides

    International Nuclear Information System (INIS)

    Yamano, Tetsuo; Shimizu, Mitsuru; Noda, Tsutomu

    2005-01-01

    We compared the results of the multiple-dose guinea pig maximization test (GPMT) and the non-radioactive murine local lymph-node assay (LLNA) for various biocides. Thirteen out of 17 positive biocides in the GPMT gave positive results in the LLNA. In the GPMT, the minimum first induction doses ranged over four orders (0.00005-0.5%), while elicitation-threshold doses, which were evaluated using an optimally sensitized group of animals in the multiple-dose studies, ranged over five orders (0.00006-2.8%). In the LLNA, minimum induction doses ranged over more than three orders (0.01-30%). With respect to 13 biocides that were positive in both the GPMT and the LLNA, results were quantitatively compared. When compared after conversion to corresponding area doses (μg/cm), the minimum doses required to elicit skin reaction in guinea pigs were always lower than that for induction in mice with all biocides. Correlation between minimum induction doses from the GPMT and the LLNA seemed poor (r = 0.57), while that between minimum induction doses in the LLNA and elicitation-threshold doses in the GPMT was relatively good (r = 0.73). The results suggest the possibility to estimate human elicitation-threshold doses, which are definitely lacking in the process of risk assessment for skin-sensitizers, from the data of the LLNA

  8. Prognostic impact of incomplete surgical clearance of radioiodine sensitive local lymph node metastases diagnosed by post-operative {sup 124}I-NaI-PET/CT in patients with papillary thyroid cancer

    Energy Technology Data Exchange (ETDEWEB)

    Sabet, Amir; Binse, Ina; Grafe, Hong; Goerges, Rainer; Poeppel, Thorsten D.; Bockisch, Andreas; Rosenbaum-Krumme, Sandra J. [University Duisburg-Essen, Department of Nuclear Medicine, Essen (Germany); Ezziddin, Samer [Saarland University, Department of Nuclear Medicine, Homburg (Germany)

    2016-10-15

    Nodal involvement is an independent risk factor of recurrence in papillary thyroid cancer (PTC). Neither the international guidelines nor the recently introduced ongoing risk adaptation concept consider the extent of initial surgical clearance of radioiodine sensitive lymph node metastases in their stratification systems. We investigated the prognostic relevance of incomplete initial surgical clearance in patients with purely lymphogeneous metastatic PTC (pN1 M0) despite successful radioiodine therapy. Accurate assessment of pre-ablative nodal status was attempted using PET/CT studies with both {sup 124}I-NaI and {sup 18}F-FDG along with high-resolution cervical ultrasound. Sixty-five patients with histologically diagnosed lymph node metastases (pN1 M0) were retrospectively analyzed. Patients with iodine-negative lymph node metastases diagnosed by {sup 18}F-FDG PET/CT or distant metastases were excluded from the analysis. The association of disease recurrence with the pre-ablative nodal status, as well as other baseline characteristics, were examined applying nonparametric tests for independent samples and multiple regression analysis. Patients with persistent lymph node metastases in {sup 124}I-NaI PET/CT were further divided according to the additional presence or absence of FDG-uptake in {sup 18}F-FDG PET/CT. Survival analyses were performed using Kaplan-Meier curves and the Cox proportional hazards model for uni- and multivariate analyses to assess the influence of prognostic factors on progression free survival (PFS). Incomplete metastatic lymph node resection captured by {sup 124}I-NaI PET/CT (n = 33) was an independent risk factor for recurrence (61 % vs 25 %, p = 0.006) and shorter PFS (46 months vs not reached, HR 4.0 [95 %-CI, 1.7-9.2], p = 0.001). Ultrasound could detect lymph node metastases only in 19/33 patients (58 %). Among patients with positive nodal status, FDG-avidity of metastatic iodine positive lymph nodes worsened the outcome (16 vs 69

  9. Sentinel Lymph Node Biopsy Following Neoadjuvant Chemotherapy: Review of the Literature and Recommendations for Use in Patient Management

    Directory of Open Access Journals (Sweden)

    Yan Xing

    2004-10-01

    Full Text Available Breast cancer is a significant health problem worldwide and is one of the leading causes of cancer-related mortality in women. Preoperative chemotherapy has become the standard of care for patients with locally advanced disease and is being used more frequently in patients with early-stage breast cancer. Sentinel lymph node biopsy has shown great promise in the surgical management of breast cancer patients, but its use following preoperative chemotherapy is yet to be determined. Eleven studies have been published with respect to the accuracy of sentinel lymph node biopsy following neoadjuvant chemotherapy. Ten studies showed favourable results, with the ability to identify a sentinel lymph node in 84% to 98% of cases, and reported false negative rates ranging from 0% to 20%. The accuracy of sentinel lymph node biopsy following preoperative chemotherapy for breast cancer ranges from 88% to 100%, with higher rates when specific techniques and inclusion criteria are applied. The published literature supports the use of sentinel lymph node biopsy for assessment of the axilla in patients with clinically node-negative disease following preoperative chemotherapy.

  10. Sentinel lymph node detection with Tc-99m tin colloids in patients with esophagogastric cancer

    International Nuclear Information System (INIS)

    Yasuda, Seiei; Shimada, Hideo; Chino, Osamu

    2003-01-01

    The aim of this study was to determine by radioisotope use whether the sentinel lymph node concept is applicable to esophagogastric cancers. In addition, we examined radioactivities of hot nodes and compared them with the sensitivity of a gamma probe. The subjects were 44 patients, 23 with esophageal cancer and 21 with gastric cancer. The day before surgery, patients underwent endoscopic submucosal injection of 184 MBq of Tc-99m tin colloids into sites surrounding the tumor. Radioisotope activities of lymph nodes dissected at surgery were measured with a well-typed gamma detector and each lymph node was categorized as a hot or cold node. Histopathology of the lymph nodes was examined by hematoxylin and eosin staining. Radioisotope activities and histopathological results were compared to determine whether radioisotope flow reflects lymphatic flow to regional lymph nodes. The sensitivity of a gamma probe was measured in a laboratory study and the relation between the radioisotope activities of hot nodes and the detection sensitivity of the gamma probe was examined. Histopathological examination revealed lymph node metastasis in 18 of the 44 patients. In 15 of these 18 patients, metastatic foci were recognized in at least one hot node. Subsequent analysis was performed on the 36 patients in whom tumor invasion was confined to the muscle layer and in whom endoscopic clippings had not been applied. Lymph node metastases were observed in 12 of these 36 patients. In these 12 patients, at least one hot node was positive for metastasis. The laboratory study revealed that the gamma probe was able to detect radioisotope activities of ≥0.02μCi. Thirty-two of 63 (51%) esophageal cancer hot nodes and 16 of 86 (19%) gastric cancer hot nodes showed radioisotope activities below the detection sensitivity of the gamma probe. The sentinel lymph node concept is applicable to patients with esophageal and gastric cancers; however, further studies are necessary to identify hot nodes

  11. Multi-detector row CT in the assessment of axillary lymph node metastasis in breast cancer

    International Nuclear Information System (INIS)

    Murakami, Shogo

    2003-01-01

    The purpose of this study is to evaluate the diagnostic capability instead of clinical efficacy of multi-detector row CT (MDCT) in the assessment of axillary lymph node metastasis in breast cancer. MDCT was performed in 63 patients with breast cancer, and multiplanar reformation (MPR) and volume rendering (VR) images were reconstructed for the evaluation of bilateral axillary lymph nodes. Two hundred sixty eight lymph nodes were depicted with MDCT, and correlation with pathological findings was performed. The short axis length of lymph node was measured on MPR image, and the shape of the nodes was analyzed with the pathological results statistically. The diagnostic criteria on size and shape of lymph node metastasis were discussed Dynamic study with contrast media was also performed, and the CT value ratios (CTVR) of the lymph nodes and breast tumors were calculated. No relevance of axillary lymph node metastasis was noted to the pathological types of breast cancer. The average short axis length of the ipsilateral axillary nodes was 8.9 mm±3.8 (SD) while that of the contralateral nodes was 4.9 mm±1.1 (SD) showing significant difference. More than 6.5 mm in short length of the lymph node was thought to be an effective criterion for positive metastasis, and its sensitivity was 96%. Soybean-shape lymph node was statistically common in metastasis, while non-metastatic nodes were commonly demonstrated as letter ''c'' shape or ring-like shape. Statistical relevance was obtained between the CTVR of axillary lymph nodes and that of breast tumors, suggesting clinical usefulness of dynamic study using contrast media in the evaluation of lymph node metastasis. With MPR and VR images using MDCT, more accurate morphological evaluation of axillary lymph nodes was possible. When soybean-shape node with more than 6.5 mm in short axis is depicted in the axillar region on MDCT metastasis should be the consideration. Comparison with the contralateral side as a control in coronal

  12. Extent of lymph node dissection for adenocarcinoma of the stomach.

    Science.gov (United States)

    Mocellin, Simone; McCulloch, Peter; Kazi, Hussain; Gama-Rodrigues, Joaquin J; Yuan, Yuhong; Nitti, Donato

    2015-08-12

    The impact of lymphadenectomy extent on the survival of patients with primary resectable gastric carcinoma is debated. We aimed to systematically review and meta-analyze the evidence on the impact of the three main types of progressively more extended lymph node dissection (that is, D1, D2 and D3 lymphadenectomy) on the clinical outcome of patients with primary resectable carcinoma of the stomach. The primary objective was to assess the impact of lymphadenectomy extent on survival (overall survival [OS], disease specific survival [DSS] and disease free survival [DFS]). The secondary aim was to assess the impact of lymphadenectomy on post-operative mortality. We searched CENTRAL, MEDLINE and EMBASE until 2001, including references from relevant articles and conference proceedings. We also contacted known researchers in the field. For the updated review, CENTRAL, MEDLINE and EMBASE were searched from 2001 to February 2015. We considered randomized controlled trials (RCTs) comparing the three main types of lymph node dissection (i.e., D1, D2 and D3 lymphadenectomy) in patients with primary non-metastatic resectable carcinoma of the stomach. Two authors independently extracted data from the included studies. Hazard ratios (HR) and relative risks (RR) along with their 95% confidence intervals (CI) were used to measure differences in survival and mortality rates between trial arms, respectively. Potential sources of between-study heterogeneity were investigated by means of subgroup and sensitivity analyses. The same two authors independently assessed the risk of bias of eligible studies according to the standards of the Cochrane Collaboration and the quality of the overall evidence based on the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) criteria. Eight RCTs (enrolling 2515 patients) met the inclusion criteria. Three RCTs (all performed in Asian countries) compared D3 with D2 lymphadenectomy: data suggested no significant difference in OS

  13. Stromal infrastructure of the lymph node and coordination of immunity.

    Science.gov (United States)

    Chang, Jonathan E; Turley, Shannon J

    2015-01-01

    The initiation of adaptive immune responses depends upon the careful maneuvering of lymphocytes and antigen into and within strategically placed lymph nodes (LNs). Non-hematopoietic stromal cells form the cellular infrastructure that directs this process. Once regarded as merely structural features of lymphoid tissues, these cells are now appreciated as essential regulators of immune cell trafficking, fluid flow, and LN homeostasis. Recent advances in the identification and in vivo targeting of specific stromal populations have resulted in striking new insights to the function of stromal cells and reveal a level of complexity previously unrealized. We discuss here recent discoveries that highlight the pivotal role that stromal cells play in orchestrating immune cell homeostasis and adaptive immunity. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. First Robotic SPECT for Minimally Invasive Sentinel Lymph Node Mapping.

    Science.gov (United States)

    Fuerst, Bernhard; Sprung, Julian; Pinto, Francisco; Frisch, Benjamin; Wendler, Thomas; Simon, Hervé; Mengus, Laurent; van den Berg, Nynke S; van der Poel, Henk G; van Leeuwen, Fijs W B; Navab, Nassir

    2016-03-01

    In this paper we present the usage of a drop-in gamma probe for intra-operative Single-Photon Emission Computed Tomography (SPECT) imaging in the scope of minimally invasive robot-assisted interventions. The probe is designed to be inserted and reside inside the abdominal cavity during the intervention. It is grasped during the procedure using a robotic laparoscopic gripper enabling full six degrees of freedom handling by the surgeon. We demonstrate the first deployment of the tracked probe for intra-operative in-patient robotic SPECT enabling augmented-reality image guidance. The hybrid mechanical- and image-based in-patient probe tracking is shown to have an accuracy of 0.2 mm. The overall system performance is evaluated and tested with a phantom for gynecological sentinel lymph node interventions and compared to ground-truth data yielding a mean reconstruction accuracy of 0.67 mm.

  15. Nanoparticles in Sentinel Lymph Node Assessment in Breast Cancer

    Directory of Open Access Journals (Sweden)

    Michael Douek

    2010-11-01

    Full Text Available The modern management of the axilla in breast cancer relies on surgery for accurate staging of disease and identifying those patients at risk who would benefit from adjuvant chemotherapy. The introduction of sentinel lymph node biopsy has revolutionized axillary surgery, but still involves a surgical procedure with associated morbidity in many patients with no axillary involvement. Nanotechnology encompasses a broad spectrum of scientific specialities, of which nanomedicine is one. The potential use of dual-purpose nanoprobes could enable imaging the axilla simultaneous identification and treatment of metastatic disease. Whilst most applications of nanomedicine are still largely in the laboratory phase, some potential applications are currently undergoing clinical evaluation for translation from the bench to the bedside. This is an exciting new area of research where scientific research may become a reality.

  16. Comparison of four staging systems of lymph node metastasis in gastric cancer.

    Science.gov (United States)

    Zhang, Ming; Zhu, Guanyu; Ma, Yan; Xue, Yingwei

    2009-11-01

    The classification of lymph node metastasis in patients with gastric cancer is still controversial. Our aim was to evaluate the relative merits of four staging systems of lymph node metastasis. In our study, the nodal status was classified according to the 5th edition of the tumor node metastasis (TNM) system, the Japanese Classification of Gastric Carcinoma (JCGC), the ratio of metastatic lymph nodes, and the size of the largest metastatic lymph node. Each staging system was scored as good (+2), fair (+1), or poor (0) with respect to the theoretical value (extent of the anatomical lymphatic tumor spread), convenience (simplicity), surgical applicability (extent of lymph node dissection), and prognostic value (ability to predict survival rate). In the multivariate analysis including the four staging systems and other potential prognostic factors, stepwise Cox regression revealed that the ratio of metastatic lymph nodes was the most independent prognostic factor. The TNM, ratio, and size systems were convenient because they had no consideration for the location of the tumor and lymph node. Although the JCGC system had advantages in theoretical value and surgical application, it was most optional due to the complexity of the system. Although all different staging systems are comparable, the metastatic lymph node ratio system is convenient, reproducible, and has the highest ability to predict survival.

  17. Peroperative diagnosis and treatment of metastases to the regional lymph nodes in papillary carcinoma of the thyroid gland

    International Nuclear Information System (INIS)

    Hamming, J.F.; van de Velde, C.J.; Goslings, B.M.; Fleuren, G.J.; Hermans, J.; Delemarre, J.F.; van Slooten, E.A.

    1989-01-01

    The management of two groups of patients with papillary carcinoma of the thyroid gland (n = 165) was evaluated retrospectively. Total thyroidectomy was the standard procedure in both groups, but the peroperative diagnosis and treatment of metastases to the regional lymph nodes differed. In group 1 (n = 84), only clinically positive lymph nodes were resected, and if residual postoperative 131I uptake was found, an ablation dose of 131 I was given. In group 2 (n = 81), all of the tissue in the tracheoesophageal groove was removed routinely at total thyroidectomy and frozen section was done of the lymph nodes lying along the internal jugular vein. If metastases were found, a modified radical dissection of the neck was performed on the affected side. The two patient groups were comparable with regard to risk factors--local tumor stage, age and sex. Almost twice as many patients were found to have metastases to the lymph nodes in group 2. There was no significant difference in the ten year over-all or recurrence free survival time between the two groups. In group 1, there were more recurrences on the explored side of the neck but fewer distant metastases; however, both findings were not significant. In group 2, significantly more instances of hypoparathyroidism and palsy of the accessory nerve were found (p less than 0.05). Thus, when a more extensive search was carried out, more metastases to the lymph node were discovered and treated, but this did not prevent recurrences in the neck nor did it improve survival time. This approach resulted in more postoperative morbidity. There seems to be no justification for prophylactic removal of regional lymph nodes in instances of papillary carcinoma of the thyroid gland, but modified radical neck dissection may be beneficial if clinically suspect regional lymph nodes are present in the lateral part of the neck. 52 references

  18. EANM practice guidelines for lymphoscintigraphy and sentinel lymph node biopsy in melanoma

    Energy Technology Data Exchange (ETDEWEB)

    Bluemel, Christina; Herrmann, Ken; Lassmann, Michael [Universitaetsklinikum Wuerzburg, Department of Nuclear Medicine, Wuerzburg (Germany); Giammarile, Francesco; Dubreuil, Julien [Universite Claude Bernard Lyon 1, Medecine Nucleaire, Hospices Civils de Lyon and EA 3738, Lyon (France); Nieweg, Omgo E.; Chakera, Annette H. [The Poche Centre, Melanoma Institute Australia, North Sydney (Australia); Testori, Alessandro [European Institute of Oncology, Milan (Italy); Audisio, Riccardo A. [University of Liverpool, St Helens Teaching Hospital, St Helens (United Kingdom); Zoras, Odysseas [University Hospital of Heraklion, Department of Surgical Oncology, Heraklion (Greece); Uren, Roger [The University of Sydney, Sydney Medical School, Sydney, NSW (Australia); Alfred Nuclear Medicine and Ultrasound, RPAH Medical Centre, Newtown, NSW (Australia); Chondrogiannis, Sotirios; Rubello, Domenico [' Santa Maria della Misericordia' Hospital, Department of Nuclear Medicine, PET/CT Centre, Radiology, NeuroRadiology, Medical Physics, Rovigo (Italy); Colletti, Patrick M. [University of Southern California, Department of Radiology, Los Angeles, CA (United States)

    2015-10-15

    Sentinel lymph node biopsy is an essential staging tool in patients with clinically localized melanoma. The harvesting of a sentinel lymph node entails a sequence of procedures with participation of specialists in nuclear medicine, radiology, surgery and pathology. The aim of this document is to provide guidelines for nuclear medicine physicians performing lymphoscintigraphy for sentinel lymph node detection in patients with melanoma. These practice guidelines were written and have been approved by the European Association of Nuclear Medicine (EANM) to promote high-quality lymphoscintigraphy. The final result has been discussed by distinguished experts from the EANM Oncology Committee, national nuclear medicine societies, the European Society of Surgical Oncology (ESSO) and the European Association for Research and Treatment of Cancer (EORTC) melanoma group. The document has been endorsed by the Society of Nuclear Medicine and Molecular Imaging (SNMMI). The present practice guidelines will help nuclear medicine practitioners play their essential role in providing high-quality lymphatic mapping for the care of melanoma patients. (orig.)

  19. PET/CT in breast carcinoma, combined with sarcoidosis, imitating mediastinal lymph node metastases

    International Nuclear Information System (INIS)

    Garcheva, M.; Hadhyiska, V.; Bochev, P.

    2013-01-01

    PET/CT is a high sensitive, but low-specific method visualizing all the metabolic active processes. Fluoro-deoxyglucose (18F-FDG) uptake is high in tumors, as well as in infections, inflammations, granulomatous processes, post-radiotherapy alterations and in activated organs and tissues like brown fat, adrenals, thyroid, thymus, or bone marrow. This uptake can represent differential diagnostic problem. The clinical case is a young patient with invasive ductal and lobular breast carcinoma, after sectorial resection, without lymph node dissection. The chemotherapy was stopped after 3 courses due to thrombosis of vena cephalica. The local clinical status raises suspicion of recurrence, as the ultrasound. PET/CT was not conclusive about mediastinal lymph node involvement. The histology proves sarcoidosis, which frequently demonstrates symmetric 18F-FDG avid mediastinal and hilar lymph nodes. However the biopsy is mandatory, because of the low specificity of PET/CT for discrimination of this systemic disorder from tumor involvement. Keywords: PET/CT. Differential Diagnostic Problems

  20. Comparison of flow cytometry and immunohistochemistry in non-radioisotopic murine lymph node assay using bromodeoxyuridine.

    Science.gov (United States)

    Jung, Kyoung-Mi; Bae, Il-Hong; Kim, Bae-Hwan; Kim, Wang-Ki; Chung, Jin-Ho; Park, Young-Ho; Lim, Kyung-Min

    2010-02-01

    Non-radioisotopic local lymph node assay (LLNA) employing 5-bromo-2'-deoxyuridine (BrdU) with flow cytometry (FACS) or immunohistochemistry (IHC) is gaining attention due to a regulatory issue of using radioisotope, (3)H-thymidine, in vivo in traditional LLNA. In this study, to compare the performance of these non-radioisotopic endpoints, 7 chemicals with known sensitizing potencies were examined in LLNA. Mice were topically treated with chemicals or vehicle on both ears for 3 days. After intraperitoneal injection of BrdU, bilateral lymph nodes were isolated separately and undergone respectively, FACS or IHC to determine BrdU incorporated lymph node cells (LNCs). Weight and histology of treated ears were also examined to evaluate chemical-induced edema and irritation. Both FACS and IHC could successively identify the skin sensitizers from non-sensitizers. Comparison of FACS and IHC with traditional LLNA revealed that FACS has a higher sensitivity although both assays produced comparable sensitivity and performance to traditional LLNA. In conclusion, non-radioisotopic LLNA using FACS and IHC can successfully detect sensitizers with a good correlation to traditional LLNA. Notably, FACS showed almost equivalent sensitivity and accuracy to traditional LLNA. 2009 Elsevier Ireland Ltd. All rights reserved.

  1. An analysis of lymphographic signs for differentiating cancerous, lymphomatous, and normal lymph nodes

    International Nuclear Information System (INIS)

    Tatsuzaki, Hideo; Nakajima, Teiichi; Okumura, Toshiyuki; Akisada, Masayoshi

    1987-01-01

    Twenty-four lymphographic signs, obtained from a total of 204 cancerous (C), lymphomatous (L), and normal (N) lymph nodes, were analyzed based on the final diagnosis. Univariate analyses with correlation coefficient and multivariate regression analyses were employed to differentiate C, L, or N lymph nodes. Based on univariate analyses, lymphographic sings for C nodes were - enlarged node, irregular or deficient capsules or marginal sinuses, block of lymph vessels, extravasation, and defect in lymph-vascular and nodal phase (combination defect). The signs for L node were - enlarged node, elliptic shape from 2 projections, irregular or deficient capsules or marginal sinuses, and extravasation. Using multivariate analyses, the following signs were necessary for differentiating individual lymph nodes: (a) combination defect, specific pattern, granularity, nodal shape and stasis or preservation of lymph vessels for differentiating C from N nodes; (b) deficiencies of capsules, nodal shape, specific pattern, dislocation of lymph vessels, and nodal contrast for differentiating L from N nodes; and (c) character of defect, specific pattern, deformity, soft tissue shadow and nodal shape for differentiating C from L nodes. Should lymphography be used in the visualization of inside structure and lymphatic canal, it would even more increase the ability to diagnose cancer and malignant lymphomas. (Namekawa, K.)

  2. The significance of a uniform definition of pathological lymph nodes in Hodgkin lymphoma: Impact of different thresholds for positive lymph nodes in CT imaging on staging and therapy

    International Nuclear Information System (INIS)

    Vorwerk, Hilke; Obenauer, Silvia; Schmidberger, Heinz; Hess, Clemens F.; Weiss, Elisabeth

    2008-01-01

    Background and Purpose: The most commonly used approach for the assessment for differentiating malignant versus reactive lymph nodes is the measurement of the cross-section diameter of the lymph nodes in the transversal CT-planes. The intention of this article is to assess the impact of varying definitions of pathological lymph node size in CT-imaging in patients with Hodgkin lymphoma and to evaluate its effect on staging, chemotherapy regimes and radiation field size. Materials and methods: Pretherapeutic CT-scans of 10 consecutive patients with Hodgkin lymphoma have been evaluated based on two different definitions for malignant lymph node size; the classification of the German study group for Hodgkin lymphoma (1.0 cm) and the classification according to the results of the Cotswold consensus meeting 1989 (1.5 cm). Results: Applying the definitions of the DHSG and the Cotswold meeting we found more affected lymph node regions compared to the evaluation of the referring institutions in 9/10 and 6/10 patients, higher stages in 2/10 and 1/10 patients, more intense chemotherapy regimes in 3/10 and 1/10 and larger radiation fields in 10/10 and 6/10 patients, respectively. Conclusions: Varying definitions of pathologic lymph node size and inconsequent application of definitions reduce the comparability between different studies and within each study

  3. Anatomy and nomenclature of murine lymph nodes: Descriptive study and nomenclatory standardization in BALB/cAnNCrl mice.

    Science.gov (United States)

    Van den Broeck, Wim; Derore, Annie; Simoens, Paul

    2006-05-30

    Murine lymph nodes are intensively studied but often assigned incorrectly in scientific papers. In BALB/cAnNCrl mice, we characterized a total of 22 different lymph nodes. Peripheral nodes were situated in the head and neck region (mandibular, accessory mandibular, superficial parotid, cranial deep cervical nodes), and at the forelimb (proper axillary, accessory axillary nodes) and hindlimb (subiliac, sciatic, popliteal nodes). Intrathoracic lymph nodes included the cranial mediastinal, tracheobronchal and caudal mediastinal nodes. Abdominal lymph nodes were associated with the gastrointestinal tract (gastric, pancreaticoduodenal, jejunal, colic, caudal mesenteric nodes) or were located along the major intra-abdominal blood vessels (renal, lumbar aortic, lateral iliac, medial iliac and external iliac nodes). Comparative and nomenclative aspects of murine lymph nodes are discussed. The position of the lymph nodes of BALB/cAnNCrl mice is summarized and illustrated in an anatomical chart containing proposals for both an official nomenclature according to the Nomina Anatomica Veterinaria and English terms.

  4. Ultrasound of neck lymph nodes: How to do it and how do they look?

    Energy Technology Data Exchange (ETDEWEB)

    Ying, Michael [Department of Optometry and Radiography, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong (China); Ahuja, Anil T. [Department of Diagnostic Radiology and Organ Imaging, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin New Territories, Hong Kong (China)]. E-mail: aniltahuja@cuhk.edu.hk

    2006-05-15

    Cervical lymphadenopathy is commonly caused by metastases, lymphoma, tuberculosis and reactive hyperplasia. Before making an accurate diagnosis of pathologic lymph nodes, a clear understanding of the normal appearances of cervical nodes is crucial. Ultrasound examination of cervical lymph nodes is common in routine clinical practice because of its high sensitivity and specificity when combined with ultrasound-guided fine-needle aspiration cytology (FNAC). This article reviews the ultrasound of cervical lymph nodes including classification of the nodes, equipment, scanning technique and sonographic appearances of normal and common abnormal lymph nodes. The sonographic appearance of unusual cervical lymphadenopathy and the value of three-dimensional ultrasound in the volumetric measurements of cervical nodes are also discussed.

  5. Ultrasound of neck lymph nodes: How to do it and how do they look?

    International Nuclear Information System (INIS)

    Ying, Michael; Ahuja, Anil T.

    2006-01-01

    Cervical lymphadenopathy is commonly caused by metastases, lymphoma, tuberculosis and reactive hyperplasia. Before making an accurate diagnosis of pathologic lymph nodes, a clear understanding of the normal appearances of cervical nodes is crucial. Ultrasound examination of cervical lymph nodes is common in routine clinical practice because of its high sensitivity and specificity when combined with ultrasound-guided fine-needle aspiration cytology (FNAC). This article reviews the ultrasound of cervical lymph nodes including classification of the nodes, equipment, scanning technique and sonographic appearances of normal and common abnormal lymph nodes. The sonographic appearance of unusual cervical lymphadenopathy and the value of three-dimensional ultrasound in the volumetric measurements of cervical nodes are also discussed

  6. Vascularity and grey-scale sonographic features of normal cervical lymph nodes: variations with nodal size

    International Nuclear Information System (INIS)

    Ying, Michael; Ahuja, Anil; Brook, Fiona; Metreweli, Constantine

    2001-01-01

    AIM: This study was undertaken to investigate variations in the vascularity and grey-scale sonographic features of cervical lymph nodes with their size. MATERIALS AND METHODS: High resolution grey-scale sonography and power Doppler sonography were performed in 1133 cervical nodes in 109 volunteers who had a sonographic examination of the neck. Standardized parameters were used in power Doppler sonography. RESULTS: About 90% of lymph nodes with a maximum transverse diameter greater than 5 mm showed vascularity and an echogenic hilus. Smaller nodes were less likely to show vascularity and an echogenic hilus. As the size of the lymph nodes increased, the intranodal blood flow velocity increased significantly (P 0.05). CONCLUSIONS: The findings provide a baseline for grey-scale and power Doppler sonography of normal cervical lymph nodes. Sonologists will find varying vascularity and grey-scale appearances when encountering nodes of different sizes. Ying, M. et al. (2001)

  7. Persistent pain, sensory disturbances and functional impairment after immediate or delayed axillary lymph node dissection

    DEFF Research Database (Denmark)

    Geving Andersen, Kenneth; Jensen, Maj-Britt Raaby; Tvedskov, Tove Filtenborg

    2013-01-01

    BACKGROUND: Patients treated with 2-step axillary lymph node dissection (ALND) may be at increased risk of nerve damage due to more challenging surgery than an ALND immediately after a sentinel lymph node biopsy (SLNB), and thus more at risk for persistent pain after breast cancer treatment (PPBCT...

  8. Sentinel lymph node procedure is highly accurate in squamous cell carcinoma of the vulva

    NARCIS (Netherlands)

    de Hullu, JA; Hollema, H; Piers, DA; Verheijen, RHM; van Diest, PJ; Mourits, MJE; Aalders, JG; van der Zee, AGJ

    Purpose: To determine the diagnostic accuracy of the sentinel lymph node procedure in patients with squamous cell carcinoma of the vulva and to investigate whether step sectioning and immunohistochemistry of sentinel lymph nodes increase the sensitivity for detection of metastases. Patients and

  9. Factors influencing sentinel lymph node identification failure in breast cancer surgery

    DEFF Research Database (Denmark)

    Straalman, K.; Kristoffersen, U.S.; Galatius, H.

    2008-01-01

    The purpose of this study was to investigate potential risk factors for failed sentinel lymph node identification in breast cancer surgery. Patient characteristics, tumour characteristics, surgeon experience and detection success/failure were registered at 748 sentinel lymph node biopsy procedures...... at our inpatient clinic. Data were analysed with backward stepwise multiple logistic regression with a cut-off point of p

  10. Omics-based profiling of carcinoma of the breast and matched regional lymph node metastasis

    DEFF Research Database (Denmark)

    Li, J.; Gromov, P.; Gromova, I.

    2008-01-01

    Axillary lymph node (ALN) status is currently used as an important clinical indicator of breast cancer prognosis. However, the molecular mechanisms underlying lymph node metastasis are poorly understood and the relationship between ALN metastasis and the primary tumor remains unclear. In an effor...

  11. MR imaging in squamous cell carcinoma of the head and neck with no palpable lymph nodes

    International Nuclear Information System (INIS)

    Yucel, T.; Sennaroglu, L.; Kaya, S.; Saatci, I.; Cekirge, S.; Aydingoz, U.

    1997-01-01

    Purpose: To assess the efficacy of MR imaging in the detection of lymph node metastasis in patients with no palpable lymph nodes ('N 0 neck') who have squamous cell carcinoma of the head and neck region. Material and Methods: MR neck imagings in 18 patients who underwent neck dissection (bilaterally in 2) for squamous cell carcinoma of the head and neck region were examined preoperatively for the purpose of detecting lymph node metastases. The imaging features taken into consideration were: size (cutoff point 10 mm), grouping, presence of central necrosis, and appearance of extracapsular spread. The MR examinations comprised spin-echo T1- and T2-weighted sequences. The MR findings were compared with those of surgery and histopathological examination. Results: MR suggested metastatic lymph node involvement in 5 necks. In 2 of these, central necrosis was seen in the enlarged lymph nodes. In a third, a grouping of the lymph nodes was noted. Extracapsular spread was not present. Histopathological examination revealed metastatic lymph nodes in 7 of 20 necks, the rate of clinically occult disease being 35%, and 4 of then had been accurately graded by MR. There was one false-positive MR examination. The MR sensitivity was 57.1% and specificity 92.3%. Conclusion: MR may reveal metastatic lymph nodes in patients with no clinical evidence of metastasis. However, conventional MR techniques are not always sufficient for decision-making on surgery in cases of 'N 0 neck'. (orig.)

  12. Prognostic value of lymph node involvement in oral cancers: a study of 137 cases.

    Science.gov (United States)

    Tankéré, F; Camproux, A; Barry, B; Guedon, C; Depondt, J; Gehanno, P

    2000-12-01

    The aim of this study was to assess the prognostic value of lymph node involvement in patients with squamous cell carcinoma of the oral cavity. Retrospective study of 137 patients with T4 squamous cell carcinoma of the oral cavity treated by surgery and radiotherapy (84 N0, 23 N1, 16 N2,14 N3). Twenty-three patients in the N0 group had a history of surgery or radiotherapy. One hundred fourteen patients underwent limited or radical neck dissection unilaterally or bilaterally. The histological charts were reviewed and correlated with preoperative lymph node clinical stage. The local failure rate and the overall survival curves were calculated with respect to clinical and histological stages. The causes of death were analyzed. No evidence of lymph node metastasis was found in 47.4% of cases (54 of 114 patients). Among the node-positive (N+) patients, 39 had rupture of the lymph node capsule (R+). In the N0 group, 27.8% of patients were N+. Regional control rates after surgery and radiotherapy were 95% at 1 year and 85.4% at 5 years. The local failure rates were 6% in N0, 8.7% in N1, 31.2% in N2, 51.7% in N3, 9% in node-negative (N-), and 29% in N+R+ patients. The overall survival rates at 3 and 5 years were, respectively, 44.7% and 34.8% in the N0 group, 37.7% and 37.7% (same rate at 3 and 5 years) in the N1 group, and 31.2% and 15.8% in the N2 group. None of the patients in the N3 group survived beyond 2 years. The overall survival rates at 5 years were 42.8% and 17.5% in the N- and N+ groups, respectively. In patients with locally advanced tumors (T4), clinical nodal status and histological nodal invasion were key prognostic factors. The presence of occult metastases in the N0 group justifies routine neck dissection.

  13. Outcomes of Post Mastectomy Radiation Therapy in Patients Receiving Axillary Lymph Node Dissection After Positive Sentinel Lymph Node Biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Stauder, Michael C., E-mail: mstauder@mdanderson.org [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Caudle, Abigail S. [Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Allen, Pamela K.; Shaitelman, Simona F.; Smith, Benjamin D.; Hoffman, Karen E.; Buchholz, Thomas A. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Chavez-Macgregor, Mariana [Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Hunt, Kelly K.; Meric-Bernstam, Funda [Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Woodward, Wendy A. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2016-11-01

    Purpose: We sought to determine the rate of postmastectomy radiation therapy (PMRT) among women treated with axillary lymph node dissection (ALND) after positive sentinel lymph node (SLN) biopsy results and to establish the effect of negative ALND results and PMRT on locoregional recurrence (LRR) and overall survival (OS). Methods and Materials: All patients were treated with mastectomy and ALND after positive SLN biopsy results. All patients had clinical N0 or NX disease at the time of mastectomy and received no neoadjuvant therapy. The presence of lymphovascular space invasion, presence of multifocality, number of positive SLNs and non-SLNs, clinical and pathologic stage, extranodal extension, age, and use of PMRT were evaluated for significance regarding the rates of OS and LRR. Results: A total of 345 patients were analyzed. ALND after positive SLN biopsy results was negative in 235 patients (68.1%), and a total of 112 patients (32.5%) received radiation therapy. On multivariate analysis, only pathologic stage III predicted for lower OS (hazard ratio, 3.32; P<.001). The rate of 10-year freedom from LRR was 87.9% and 95.3% in patients with positive ALND results and patients with negative ALND results, respectively. In patients with negative ALND results with ≥3 positive SLNs, the rate of freedom from LRR was 74.7% compared with 96.7% in those with <3 positive SLNs (P=.009). In patients with negative ALND results, ≥3 positive SLNs predicted for an increase in LRR on multivariate analysis (hazard ratio, 10.10; P=.034). Conclusions: A low proportion of cT1-2, N0 patients with positive SLNs who undergo mastectomy receive PMRT after ALND. Even in this low-risk cohort, patients with ≥3 positive SLNs and negative ALND results are at increased risk of LRR and may benefit from PMRT.

  14. Outcomes of Post Mastectomy Radiation Therapy in Patients Receiving Axillary Lymph Node Dissection After Positive Sentinel Lymph Node Biopsy

    International Nuclear Information System (INIS)

    Stauder, Michael C.; Caudle, Abigail S.; Allen, Pamela K.; Shaitelman, Simona F.; Smith, Benjamin D.; Hoffman, Karen E.; Buchholz, Thomas A.; Chavez-Macgregor, Mariana; Hunt, Kelly K.; Meric-Bernstam, Funda; Woodward, Wendy A.

    2016-01-01

    Purpose: We sought to determine the rate of postmastectomy radiation therapy (PMRT) among women treated with axillary lymph node dissection (ALND) after positive sentinel lymph node (SLN) biopsy results and to establish the effect of negative ALND results and PMRT on locoregional recurrence (LRR) and overall survival (OS). Methods and Materials: All patients were treated with mastectomy and ALND after positive SLN biopsy results. All patients had clinical N0 or NX disease at the time of mastectomy and received no neoadjuvant therapy. The presence of lymphovascular space invasion, presence of multifocality, number of positive SLNs and non-SLNs, clinical and pathologic stage, extranodal extension, age, and use of PMRT were evaluated for significance regarding the rates of OS and LRR. Results: A total of 345 patients were analyzed. ALND after positive SLN biopsy results was negative in 235 patients (68.1%), and a total of 112 patients (32.5%) received radiation therapy. On multivariate analysis, only pathologic stage III predicted for lower OS (hazard ratio, 3.32; P<.001). The rate of 10-year freedom from LRR was 87.9% and 95.3% in patients with positive ALND results and patients with negative ALND results, respectively. In patients with negative ALND results with ≥3 positive SLNs, the rate of freedom from LRR was 74.7% compared with 96.7% in those with <3 positive SLNs (P=.009). In patients with negative ALND results, ≥3 positive SLNs predicted for an increase in LRR on multivariate analysis (hazard ratio, 10.10; P=.034). Conclusions: A low proportion of cT1-2, N0 patients with positive SLNs who undergo mastectomy receive PMRT after ALND. Even in this low-risk cohort, patients with ≥3 positive SLNs and negative ALND results are at increased risk of LRR and may benefit from PMRT.

  15. Can radiological changes in lymph node volume during treatment predict success of radiation therapy in patients with locally advanced head and neck squamous cell carcinoma?

    International Nuclear Information System (INIS)

    Mishra, Sanju; Hammond, Alexander; Read, Nancy; Venkatesan, Varagur; Warner, Andrew; Winquist, Eric; Nichols, Anthony

    2013-01-01

    Assessment of nodal response after radiotherapy (RT) for head and neck squamous cell carcinoma is difficult, as both CT and positron emission tomography scanning have limited predictive value for residual disease. We sought to measure changes in nodal volume during RT to determine whether such changes are predictive of nodal disease control. Patients with locally advanced head and neck squamous cell carcinoma treated with 70Gy of radical RT (±chemotherapy or anti-epidermal growth factor receptor (EGFR) antibodies) were eligible. Baseline pre-RT scans and cone-beam CT scans done at the outset of treatment and at weeks 3, 5 and 7 (cone-beam CTs 1, 2, 3 and 4, respectively) were deformably coregistered, and 3D nodal volumes were measured. Thirty-eight eligible patients were identified. The main primary tumour site was oropharyngeal; most patients had stage IVa disease. Twenty-seven patients received concurrent platinum-based chemotherapy, 10 received only an EGFR inhibitor with RT and one received RT alone. Twelve patients had a failure in the neck. After week 1 of treatment, a 4% mean decrease in nodal volume was observed, increasing to 40% at week 7. Platinum-based chemotherapy achieved significantly greater decreases in nodal volume than EGFR inhibitors (44 vs. 25%; P=0.026). Advanced tumour stage predicted neck failure (P=0.002), but nodal volumes did not correlate with neck control. Changes in nodal volume are minimal initially during RT but accelerate during the latter weeks of therapy. This study suggests that chemotherapy achieves a greater decrease in nodal volume than EGFR inhibitors and that nodal changes do not predict disease control in the neck.

  16. [Technical points of laparoscopic splenic hilar lymph node dissection--The original intention of CLASS-04 research design].

    Science.gov (United States)

    Huang, Changming; Lin, Mi

    2018-02-25

    According to Japanese gastric cancer treatment guidelines, the standard operation for locally advanced upper third gastric cancer is the total gastrectomy with D2 lymphadenectomy, which includes the dissection of the splenic hilar lymph nodes. With the development of minimally invasive ideas and surgical techniques, laparoscopic spleen-preserving splenic hilar lymph node dissection is gradually accepted. It needs high technical requirements and should be carried out by surgeons with rich experience of open operation and skilled laparoscopic techniques. Based on being familiar with the anatomy of splenic hilum, we should choose a reasonable surgical approach and standardized operating procedure. A favorable left-sided approach is used to perform the laparoscopic spleen-preserving splenic hilar lymph node dissection in Department of Gastric Surgery, Fujian Medical University Union Hospital. This means that the membrane of the pancreas is separated at the superior border of the pancreatic tail in order to reach the posterior pancreatic space, revealing the end of the splenic vessels' trunk. The short gastric vessels are severed at their roots. This enables complete removal of the splenic hilar lymph nodes and stomach. At the same time, based on the rich clinical practice of laparoscopic gastric cancer surgery, we have summarized an effective operating procedure called Huang's three-step maneuver. The first step is the dissection of the lymph nodes in the inferior pole region of the spleen. The second step is the dissection of the lymph nodes in the trunk of splenic artery region. The third step is the dissection of the lymph nodes in the superior pole region of the spleen. It simplifies the procedure, reduces the difficulty of the operation, improves the efficiency of the operation, and ensures the safety of the operation. To further explore the safety of laparoscopic spleen-preserving splenic hilar lymph node dissection for locally advanced upper third gastric cancer

  17. Near-infrared-fluorescence imaging of lymph nodes by using liposomally formulated indocyanine green derivatives.

    Science.gov (United States)

    Toyota, Taro; Fujito, Hiromichi; Suganami, Akiko; Ouchi, Tomoki; Ooishi, Aki; Aoki, Akira; Onoue, Kazutaka; Muraki, Yutaka; Madono, Tomoyuki; Fujinami, Masanori; Tamura, Yutaka; Hayashi, Hideki

    2014-01-15

    Liposomally formulated indocyanine green (LP-ICG) has drawn much attention as a highly sensitive near-infrared (NIR)-fluorescence probe for tumors or lymph nodes in vivo. We synthesized ICG derivatives tagged with alkyl chains (ICG-Cn), and we examined NIR-fluorescence imaging for lymph nodes in the lower extremities of mice by using liposomally formulated ICG-Cn (LP-ICG-Cn) as well as conventional liposomally formulated ICG (LP-ICG) and ICG. Analysis with a noninvasive preclinical NIR-fluorescence imaging system revealed that LP-ICG-Cn accumulates in only the popliteal lymph node 1h after injection into the footpad, whereas LP-ICG and ICG accumulate in the popliteal lymph node and other organs like the liver. This result indicates that LP-ICG-Cn is a useful NIR-fluorescence probe for noninvasive in vivo bioimaging, especially for the sentinel lymph node. Copyright © 2013 Elsevier Ltd. All rights reserved.

  18. Expansion of lymph node metastasis in mixed-type submucosal invasive gastric cancer.

    Science.gov (United States)

    Mikami, Koji; Hirano, Yukiko; Futami, Kitaro; Maekawa, Takafumi

    2017-07-18

    Mixed-type early gastric cancer (differentiated and undifferentiated components) incurs a higher risk of lymph node metastasis than pure-type early gastric cancer (only differentiated or only undifferentiated components). Therefore, we investigated the expansion of lymph node metastasis in mixed-type submucosal invasive gastric cancer in order to establish the most appropriate treatment for mixed-type cancer. We retrospectively analyzed 279 consecutive patients with submucosal invasive gastric cancer who underwent curative gastrectomy for gastric cancer between 1996 and 2015. We classified the patients into the mixed-type and pure-type groups according to histologic examination and evaluated the expansion of lymph node metastasis. The rate of lymph node metastasis was 23.7% (66/279) in the total patients, 36.4% (36/99) in the mixed-type group, and 16.6% (30/180) in the pure-type group. The significant independent risk factors for lymph node metastasis were tumor size ≥2.0 cm (P = 0.014), mixed-type gastric cancer (P mixed-type group. The rates of no. 7 lymph node metastasis in the total patients and mixed-type group were 2.9% (8/279) and 5.1% (5/99), respectively; the rates of no. 8a lymph node metastasis were 1.4% (4/279) and 4.0% (4/99), respectively. Mixed histological type is an independent risk factor for lymph node metastasis. Lymph node metastasis in mixed-type gastric cancer involves expansion to the no. 7 and no. 8a lymph nodes. Therefore, lymphadenectomy for mixed-type submucosal invasive gastric cancer requires D1+ or D2 dissection. Copyright © 2017. Published by Elsevier Taiwan.

  19. Sentinel lymph node biopsy in node-negative squamous cell carcinoma of the oral cavity and oropharynx.

    LENUS (Irish Health Repository)

    Burns, P

    2012-02-01

    OBJECTIVES: Considerable controversy exists regarding the merits of elective neck dissection in patients with early stage oral cavity and oropharyngeal squamous cell carcinoma. It is highly desirable to have a method of identifying those patients who would benefit from further treatment of the neck when they are clinically node-negative. The purpose of the present study was to examine the use of sentinel lymph node biopsy in identifying occult neck disease in a cohort of patients with node-negative oral cavity and oropharyngeal squamous cell carcinoma. DESIGN: We evaluated a total of 13 patients with oral cavity and oropharyngeal cancer who were clinically and radiologically node-negative. RESULTS: A sentinel lymph node was found in all 13 patients, revealing metastatic disease in five patients, four of whom had one or more positive sentinel lymph nodes. There was one false negative result, in which the sentinel lymph node was negative for tumour whereas histological examination of the neck dissection specimen showed occult disease. CONCLUSION: In view of these findings, we would recommend the use of sentinel lymph node biopsy in cases of oral cavity and oropharyngeal squamous cell carcinoma, in order to aid the differentiation of those patients whose necks are harbouring occult disease and who require further treatment.

  20. Ultrasound of the axilla: where to look for the sentinel lymph node

    International Nuclear Information System (INIS)

    Britton, P.; Moyle, P.; Benson, J.R.; Goud, A.; Sinnatamby, R.; Barter, S.; Gaskarth, M.; Provenzano, E.; Wallis, M.

    2010-01-01

    Aims: The aim of this paper is to guide the radiologist to the most likely location of the sentinel lymph node (SLN). Materials and methods: Patients with invasive breast cancer underwent axillary ultrasound examination. The position and morphological appearances of the lymph nodes were noted and core biopsy (CB) was performed of the largest or most suspicious node. Those patients whose biopsy revealed no evidence of malignancy proceeded to a surgical sentinel lymph node (SLN) biopsy (SLNB) looking for histopathological evidence of previous CB. Results: Of 121 patients who underwent axillary ultrasound and CB no malignancy was identified in 73, all of whom subsequently underwent SLNB. Histological evidence of CB in the SLN was identified in 47 (64%) patients. The position of all the lymph nodes identified on ultrasound and the 47 patients whose SLNs were identified were drawn on composite diagrams of the axilla. Of the 36 nodes identified as sentinel whose position relative to other nodes could be determined, 29 (81%) represented the lowest node identified in the axilla, four (11%) were the second lowest, and three (8%) were the third lowest node. None of the four patients whose CB was from the fourth lowest node had the CB site identified at subsequent SLNB. Conclusion: Ultrasound of the axilla should be carried out in a systematic fashion focusing on level I nodes paying particular attention to the lowest one or two lymph nodes.

  1. Ultrasound of the axilla: where to look for the sentinel lymph node

    Energy Technology Data Exchange (ETDEWEB)

    Britton, P., E-mail: peter.britton@addenbrookes.nhs.u [Cambridge Breast Unit, Addenbrooke' s Hospital, Cambridge (United Kingdom); Moyle, P.; Benson, J.R.; Goud, A.; Sinnatamby, R.; Barter, S.; Gaskarth, M.; Provenzano, E.; Wallis, M. [Cambridge Breast Unit, Addenbrooke' s Hospital, Cambridge (United Kingdom)

    2010-05-15

    Aims: The aim of this paper is to guide the radiologist to the most likely location of the sentinel lymph node (SLN). Materials and methods: Patients with invasive breast cancer underwent axillary ultrasound examination. The position and morphological appearances of the lymph nodes were noted and core biopsy (CB) was performed of the largest or most suspicious node. Those patients whose biopsy revealed no evidence of malignancy proceeded to a surgical sentinel lymph node (SLN) biopsy (SLNB) looking for histopathological evidence of previous CB. Results: Of 121 patients who underwent axillary ultrasound and CB no malignancy was identified in 73, all of whom subsequently underwent SLNB. Histological evidence of CB in the SLN was identified in 47 (64%) patients. The position of all the lymph nodes identified on ultrasound and the 47 patients whose SLNs were identified were drawn on composite diagrams of the axilla. Of the 36 nodes identified as sentinel whose position relative to other nodes could be determined, 29 (81%) represented the lowest node identified in the axilla, four (11%) were the second lowest, and three (8%) were the third lowest node. None of the four patients whose CB was from the fourth lowest node had the CB site identified at subsequent SLNB. Conclusion: Ultrasound of the axilla should be carried out in a systematic fashion focusing on level I nodes paying particular attention to the lowest one or two lymph nodes.

  2. Occult Pelvic Lymph Node Involvement in Bladder Cancer: Implications for Definitive Radiation

    Energy Technology Data Exchange (ETDEWEB)

    Goldsmith, Benjamin; Baumann, Brian C.; He, Jiwei; Tucker, Kai; Bekelman, Justin; Deville, Curtiland; Vapiwala, Neha [Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania (United States); Vaughn, David; Keefe, Stephen M. [Department of Medical Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania (United States); Guzzo, Thomas; Malkowicz, S. Bruce [Department of Urology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania (United States); Christodouleas, John P., E-mail: christojo@uphs.upenn.edu [Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania (United States)

    2014-03-01

    Purpose: To inform radiation treatment planning for clinically staged, node-negative bladder cancer patients by identifying clinical factors associated with the presence and location of occult pathologic pelvic lymph nodes. Methods and Materials: The records of patients with clinically staged T1-T4N0 urothelial carcinoma of the bladder undergoing radical cystectomy and pelvic lymphadenectomy at a single institution were reviewed. Logistic regression was used to evaluate associations between preoperative clinical variables and occult pathologic pelvic or common iliac lymph nodes. Percentages of patient with involved lymph node regions entirely encompassed within whole bladder (perivesicular nodal region), small pelvic (perivesicular, obturator, internal iliac, and external iliac nodal regions), and extended pelvic clinical target volume (CTV) (small pelvic CTV plus common iliac regions) were calculated. Results: Among 315 eligible patients, 81 (26%) were found to have involved pelvic lymph nodes at the time of surgery, with 38 (12%) having involved common iliac lymph nodes. Risk of occult pathologically involved lymph nodes did not vary with clinical T stage. On multivariate analysis, the presence of lymphovascular invasion (LVI) on preoperative biopsy was significantly associated with occult pelvic nodal involvement (odds ratio 3.740, 95% confidence interval 1.865-7.499, P<.001) and marginally associated with occult common iliac nodal involvement (odds ratio 2.307, 95% confidence interval 0.978-5.441, P=.056). The percentages of patients with involved lymph node regions entirely encompassed by whole bladder, small pelvic, and extended pelvic CTVs varied with clinical risk factors, ranging from 85.4%, 95.1%, and 100% in non-muscle-invasive patients to 44.7%, 71.1%, and 94.8% in patients with muscle-invasive disease and biopsy LVI. Conclusions: Occult pelvic lymph node rates are substantial for all clinical subgroups, especially patients with LVI on biopsy. Extended

  3. Detection of abdominal lymph node metastases from esophageal and cardia cancer by computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Shima, S; Sugiura, Y; Yonekawa, H; Ogata, T [National Defence Medical Coll., Tokorosawa, Saitama (Japan)

    1982-03-01

    In order to evaluate the sensitivity of computed tomography (CT) scan in detecting the abdominal lymph node metastases, preoperative CT scan was performed in 16 patients with carcinoma of the esophagus and gastric cardia. Ten patients (62.5%) had pathological evidence of lymph node metastases in the abdominal cavity and 4 of them were identified to involve the para-aortic nodes. CT scan correctly demonstrated the lymph node metastases in the para-aortic and celiac axisis areas, but failed to detect other abdominal lymph node involvements, which were small enough to be excised by operation. The para-aortic nodes on the CT scan showed the following two features; one was nodular mass in shape, which did not obscure the aorta or inferior vena cava, and the other was conglomerated mass, which was difficult to be distinguished from the aorta. The former was resectable and the latter was not.

  4. Prevalence of enlarged mediastinal lymph nodes in heavy smokers - a comparative study

    Energy Technology Data Exchange (ETDEWEB)

    Kirchner, Johannes; Lorenz, Vivian-Wilma [Allgemeines Krankenhaus Hagen, Department of Diagnostic and Interventional Radiology, Hagen (Germany); Kirchner, Esther Maria [Staedtisches Klinikum Wedau, Clinic for Medicine, Duisburg (Germany); Goltz, Jan Peter; Kickuth, Ralph [University Hospital of Wuerzburg, Department of Radiology, Wuerzburg (Germany)

    2011-08-15

    To evaluate the frequency of enlarged hilar or mediastinal lymph nodes in heavy smokers (more than 10 pack years) compared with non- smokers. In a prospective study the CT findings of 88 consecutive patients (44 heavy smokers, 44 non- smokers) were analysed. Exclusion criteria were history of thoracic malignancy, sarcoidosis, occupational dust exposure or clinical evidence of pneumonia. Prevalence, size and site of enlarged lymph nodes were assessed by multidetector computed tomography (MDCT) and correlated with the cigarette consumption and the CT- findings of bronchitis and emphysema. Twenty-three of the 44 heavy smokers (52%) showed enlarged mediastinal lymph nodes. Non- smokers showed enlarged lymph nodes in 9% (4/44). The most common site of enlarged lymph nodes was the regional station 7 according to the ATS mapping (subcarinal). The difference between the frequency of enlarged lymph nodes in heavy smokers and non- smokers was significant (chi- square 19.3, p < 0.0001). Airway wall thickening and emphysema were often associated with an increased number of enlarged nodes. The present study demonstrates that enlarged mediastinal lymph nodes may occur in a rather high percentage of heavy smokers, especially in those with a MDCT finding of severe bronchitis. (orig.)

  5. Prevalence of enlarged mediastinal lymph nodes in heavy smokers - a comparative study

    International Nuclear Information System (INIS)

    Kirchner, Johannes; Lorenz, Vivian-Wilma; Kirchner, Esther Maria; Goltz, Jan Peter; Kickuth, Ralph

    2011-01-01

    To evaluate the frequency of enlarged hilar or mediastinal lymph nodes in heavy smokers (more than 10 pack years) compared with non- smokers. In a prospective study the CT findings of 88 consecutive patients (44 heavy smokers, 44 non- smokers) were analysed. Exclusion criteria were history of thoracic malignancy, sarcoidosis, occupational dust exposure or clinical evidence of pneumonia. Prevalence, size and site of enlarged lymph nodes were assessed by multidetector computed tomography (MDCT) and correlated with the cigarette consumption and the CT- findings of bronchitis and emphysema. Twenty-three of the 44 heavy smokers (52%) showed enlarged mediastinal lymph nodes. Non- smokers showed enlarged lymph nodes in 9% (4/44). The most common site of enlarged lymph nodes was the regional station 7 according to the ATS mapping (subcarinal). The difference between the frequency of enlarged lymph nodes in heavy smokers and non- smokers was significant (chi- square 19.3, p < 0.0001). Airway wall thickening and emphysema were often associated with an increased number of enlarged nodes. The present study demonstrates that enlarged mediastinal lymph nodes may occur in a rather high percentage of heavy smokers, especially in those with a MDCT finding of severe bronchitis. (orig.)

  6. Appraisal of within- and between-laboratory reproducibility of non-radioisotopic local lymph node assay using flow cytometry, LLNA:BrdU-FCM: comparison of OECD TG429 performance standard and statistical evaluation.

    Science.gov (United States)

    Yang, Hyeri; Na, Jihye; Jang, Won-Hee; Jung, Mi-Sook; Jeon, Jun-Young; Heo, Yong; Yeo, Kyung-Wook; Jo, Ji-Hoon; Lim, Kyung-Min; Bae, SeungJin

    2015-05-05

    Mouse local lymph node assay (LLNA, OECD TG429) is an alternative test replacing conventional guinea pig tests (OECD TG406) for the skin sensitization test but the use of a radioisotopic agent, (3)H-thymidine, deters its active dissemination. New non-radioisotopic LLNA, LLNA:BrdU-FCM employs a non-radioisotopic analog, 5-bromo-2'-deoxyuridine (BrdU) and flow cytometry. For an analogous method, OECD TG429 performance standard (PS) advises that two reference compounds be tested repeatedly and ECt(threshold) values obtained must fall within acceptable ranges to prove within- and between-laboratory reproducibility. However, this criteria is somewhat arbitrary and sample size of ECt is less than 5, raising concerns about insufficient reliability. Here, we explored various statistical methods to evaluate the reproducibility of LLNA:BrdU-FCM with stimulation index (SI), the raw data for ECt calculation, produced from 3 laboratories. Descriptive statistics along with graphical representation of SI was presented. For inferential statistics, parametric and non-parametric methods were applied to test the reproducibility of SI of a concurrent positive control and the robustness of results were investigated. Descriptive statistics and graphical representation of SI alone could illustrate the within- and between-laboratory reproducibility. Inferential statistics employing parametric and nonparametric methods drew similar conclusion. While all labs passed within- and between-laboratory reproducibility criteria given by OECD TG429 PS based on ECt values, statistical evaluation based on SI values showed that only two labs succeeded in achieving within-laboratory reproducibility. For those two labs that satisfied the within-lab reproducibility, between-laboratory reproducibility could be also attained based on inferential as well as descriptive statistics. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  7. Predictors of sentinel lymph node metastases in breast cancer-radioactivity and Ki-67.

    Science.gov (United States)

    Thangarajah, Fabinshy; Malter, Wolfram; Hamacher, Stefanie; Schmidt, Matthias; Krämer, Stefan; Mallmann, Peter; Kirn, Verena

    2016-12-01

    Since the introduction of the sentinel node technique for breast cancer in the 1990s patient's morbidity was reduced. Tracer uptake is known to be dependent from lymph node integrity and activity of macrophages. The aim of this study was to assess whether radioactivity of the tracer can predict sentinel lymph node metastases. Furthermore, a potential association with Ki-67 index was examined. Non-invasive prediction of lymph node metastases could lead to a further decrease of morbidity. We retrospectively analyzed patients with primary breast cancer who underwent surgery at the Department of Obstetrics and Gynecology in the University Hospital of Cologne between 2012 and 2013. Injection of radioactive tracer was done a day before surgery in the department of Nuclear Medicine. Clinical data and radioactivity of the sentinel node measured the day before and intraoperatively were abstracted from patient's files. Of 246 patients, 64 patients had at least one, five patients had two and one patient had three positive sentinel lymph nodes. Occurrence of sentinel lymph node metastases was not associated with preoperative tracer activity (p = 0,319), intraoperative tracer activity of first sentinel node (p = 0,086) or with loss of tracer activity until operation (p = 0,909). There was no correlation between preoperative Ki-67 index and occurrence of lymph node metastases (p = 0,403). In our cohort, there was no correlation between radioactivity and sentinel node metastases. Tracer uptake might not only be influenced by lymph node metastases and does not predict metastatic lymph node involvement. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Lymph Node Metastases and Prognosis in Left Upper Division Non-Small Cell Lung Cancers: The Impact of Interlobar Lymph Node Metastasis

    Science.gov (United States)

    Kuroda, Hiroaki; Sakao, Yukinori; Mun, Mingyon; Uehara, Hirofumi; Nakao, Masayuki; Matsuura, Yousuke; Mizuno, Tetsuya; Sakakura, Noriaki; Motoi, Noriko; Ishikawa, Yuichi; Yatabe, Yasushi; Nakagawa, Ken; Okumura, Sakae

    2015-01-01

    Background Left upper division segmentectomy is one of the major pulmonary procedures; however, it is sometimes difficult to completely dissect interlobar lymph nodes. We attempted to clarify the prognostic importance of hilar and mediastinal nodes, especially of interlobar lymph nodes, in patients with primary non-small cell lung cancer (NSCLC) located in the left upper division. Methods We retrospectively studied patients with primary left upper lobe NSCLC undergoing surgical pulmonary resection (at least lobectomy) with radical lymphadenectomy. The representative evaluation of therapeutic value from the lymph node dissection was determined using Sasako’s method. This analysis was calculated by multiplying the frequency of metastasis to the station and the 5-year survival rate of the patients with metastasis to the station. Results We enrolled 417 patients (237 men, 180 women). Tumors were located in the lingular lobe and at the upper division of left upper lobe in 69 and 348 patients, respectively. The pathological nodal statuses were pN0 in 263 patients, pN1 in 70 patients, and pN2 in 84 patients. Lymph nodes #11 and #7 were significantly correlated with differences in node involvement in patients with left upper lobe NSCLC. Among those with left upper division NSCLC, the 5-year overall survival in pN1 was 31.5% for #10, 39.3% for #11, and 50.4% for #12U. The involvement of node #11 was 1.89-fold higher in the anterior segment than that in the apicoposterior segment. The therapeutic index of estimated benefit from lymph node dissection for #11 was 3.38, #4L was 1.93, and the aortopulmonary window was 4.86 in primary left upper division NSCLC. Conclusions Interlobar node involvement is not rare in left upper division NSCLC, occurring in >20% cases. Furthermore, dissection of interlobar nodes was found to be beneficial in patients with left upper division NSCLC. PMID:26247881

  9. Lymph Node Metastases and Prognosis in Left Upper Division Non-Small Cell Lung Cancers: The Impact of Interlobar Lymph Node Metastasis.

    Directory of Open Access Journals (Sweden)

    Hiroaki Kuroda

    Full Text Available Left upper division segmentectomy is one of the major pulmonary procedures; however, it is sometimes difficult to completely dissect interlobar lymph nodes. We attempted to clarify the prognostic importance of hilar and mediastinal nodes, especially of interlobar lymph nodes, in patients with primary non-small cell lung cancer (NSCLC located in the left upper division.We retrospectively studied patients with primary left upper lobe NSCLC undergoing surgical pulmonary resection (at least lobectomy with radical lymphadenectomy. The representative evaluation of therapeutic value from the lymph node dissection was determined using Sasako's method. This analysis was calculated by multiplying the frequency of metastasis to the station and the 5-year survival rate of the patients with metastasis to the station.We enrolled 417 patients (237 men, 180 women. Tumors were located in the lingular lobe and at the upper division of left upper lobe in 69 and 348 patients, respectively. The pathological nodal statuses were pN0 in 263 patients, pN1 in 70 patients, and pN2 in 84 patients. Lymph nodes #11 and #7 were significantly correlated with differences in node involvement in patients with left upper lobe NSCLC. Among those with left upper division NSCLC, the 5-year overall survival in pN1 was 31.5% for #10, 39.3% for #11, and 50.4% for #12U. The involvement of node #11 was 1.89-fold higher in the anterior segment than that in the apicoposterior segment. The therapeutic index of estimated benefit from lymph node dissection for #11 was 3.38, #4L was 1.93, and the aortopulmonary window was 4.86 in primary left upper division NSCLC.Interlobar node involvement is not rare in left upper division NSCLC, occurring in >20% cases. Furthermore, dissection of interlobar nodes was found to be beneficial in patients with left upper division NSCLC.

  10. Preoperative US-guided hook-needle insertion in recurrent lymph nodes of papillary thyroid cancer: A help for the surgeon

    International Nuclear Information System (INIS)

    Duprez, Raphaelle; Lebas, Patrick; Marc, Olivier Saint; Mongeois, Elise; Emy, Philippe; Michenet, Patrick

    2010-01-01

    Objective: The objective of this study is to investigate whether preoperative ultrasound guided insertion of a hook-needle is useful in reoperations for cervical recurrent lymph node metastases of papillary thyroid cancer. Patients and methods: 8 patients with operated papillary thyroid cancer were included in this study. They all had suspicious nonpalpable cervical lymph nodes discovered during follow-up. These lymph nodes were identified by ultrasound imaging and their metastatic nature was confirmed by fine needle aspiration cytology and measurement of in situ thyroglobulin. In all cases, surgical excision of these lymph nodes was decided. All 8 patients had a hook-needle inserted in the suspicious lymph node(s) preoperatively and under ultrasound guidance. Results and conclusion: In all 8 patients, the suspicious lymph nodes were removed and their metastatic nature was confirmed by the final pathological examination. This localization technique is very helpful for the surgeon during the excision of small and nonpalpable lymph nodes, especially in previously operated area.

  11. Sentinel lymph node in breast cancer using a radiocolloid particle produced in Argentina

    International Nuclear Information System (INIS)

    Velazquez Espeche, M.H.; Soroa, V.E.; Castiglia, S.G. de

    2004-01-01

    Full text: A number of different approaches have been adopted in the application of technique to detect sentinel lymph node. The main variables are related to size of colloid used, the time to surgery following administration of the colloid, the volume of injection and the site of administration. Optimal detections of sentinel lymph node requires the use of radiopharmaceuticals which clear rapidly from the site of injection and which will be wholly retained at the level of first tier nodes. Our objective was to apply a radiocolloid particle of size between 100-220 nm produced in Argentina by CNEA and to determine its efficacy in sentinel node detections in breast cancer. The particle size was determinate by successive filtrations of a single sample through 450, 220, 100 and 20 nm pore size filters (Whatmaan, UK). The product stability was determined by chromatography controls with ITLC, The pattern of biodistribution in animal was studied in Wistar rats. Twenty female patients with breast cancer diagnosed by clinical, mammography and cytology, were investigated. Four injections of 7.4-22 MBq of 99mTc human albumin radio colloid in volume of 0.5 ml, were injected along the subcutaneous peripheral tumor margins when the tumor was palpable. Peri-subareolar subcutaneous injection in volume of 0.1 ml was also employed as an alternative in few cases. After the injection the patient massaged the injection site for about five minutes. Lymphoscintigrams were acquired in dynamic, static and transmission modes. The sentinel node was marked with a demographic pencil with the patient lying supine and with the arm on the affected side abducted at approximately 90 0 to ensure the same anatomical localization as during the surgery. During the surgery a gamma probe localized the sentinel node by count and sound. Based on the size of particles, the distribution was 90% between 100-220 nm, 7.3% between 200 and 450 nm and 2.7% less than 100 nm. The radiolabel purity was greater than

  12. Influence of colloid particle profile on sentinel lymph node uptake

    Energy Technology Data Exchange (ETDEWEB)

    Fernandez Nunez, Eutimio Gustavo [Radiopharmacy Center, Institute of Energetic and Nuclear Research, Sao Paulo, SP 05508-000 (Brazil)], E-mail: eutimiocu@yahoo.com; Linkowski Faintuch, Bluma; Teodoro, Rodrigo; Pereira Wiecek, Danielle [Radiopharmacy Center, Institute of Energetic and Nuclear Research, Sao Paulo, SP 05508-000 (Brazil); Martinelli, Jose Roberto [Center of Materials Science and Technology, Institute of Energetic and Nuclear Research, Sao Paulo, SP 05508-000 (Brazil); Gomes da Silva, Natanael; Castanheira, Claudia E. [Radiopharmacy Center, Institute of Energetic and Nuclear Research, Sao Paulo, SP 05508-000 (Brazil); Santos de Oliveira Filho, Renato [Faculty of Medicine, Federal University of Sao Paulo, SP 04020-041 (Brazil); Pasqualini, Roberto [CIS bio international, Research and Development, Gif sur Yvette, 91192 (France)

    2009-10-15

    Introduction: Particle size of colloids employed for sentinel lymph node (LN) detection is not well studied. This investigation aimed to correlate particle size and distribution of different products with LN uptake. Methods: All agents (colloidal tin, dextran, phytate and colloidal rhenium sulfide) were labeled with {sup 99m}Tc according to manufacturer's instructions. Sizing of particles was carried out on electron micrographs using Image Tool for Windows (Version 2.0). Biodistribution studies in main excretion organs as well as in popliteal LN were performed in male Wistar rats [30 and 90 min post injection (p.i.)]. The injected dose was 0.1 ml (37 MBq) in the footpad of the left posterior limb. Dynamic images (0-15 min p.i.) as well as static ones (30 and 90 min) were acquired in gamma camera. Results: Popliteal LN was clearly reached by all products. Nevertheless, particle size remarkably influenced node uptake. Colloidal rhenium sulfide, with the smallest diameter (5.1x10{sup -3}{+-}3.9x10{sup -3} {mu}m), permitted the best result [2.72{+-}0.64 percent injected dose (%ID) at 90 min]. Phytate displayed small particles (<15 {mu}m) with favorable uptake (1.02{+-}0.14%ID). Dextran (21.4{+-}12.8 {mu}m) and colloidal tin (39.0{+-}8.3 {mu}m) were less effective (0.55{+-}0.14 and 0.06{+-}0.03%ID respectively). Particle distribution also tended to influence results. When asymmetric, it was associated with biphasic uptake which increased over time; conversely, symmetric distribution (colloidal tin) was consistent with a constant pattern. Conclusion: The results are suggesting that particle size and symmetry may interfere with LN radiopharmaceutical uptake.

  13. Mediastinal lymph node enlargement on CT scans in idiopathic pulmonary fibrosis

    International Nuclear Information System (INIS)

    Ahn, Joong Mo; Im, Jung Gi; Yu, Kyu In; Kim, Hyeong Seog; Kim, Dae Young; Yu, Pil Mun

    1992-01-01

    The increase in size of lymph node on CT scan is the single most important finding of lymphadenopathy. The purpose of this study was to evaluate the size of mediastinal lymph nodes in patients with idiopathic pulmonary fibrosis with no evidence of malignancy or current infection. CT scans of 70 patients (16 with conventional CT and 54 with high-resolution CT) were assessed for lymph node size and location. The duration of symptoms, and the extent and pattern of the parenchymal lung disease on CT scans were correlated with lymph node enlargement. In 54 of 70 patients, more than one lymph nodes were large than 1-1.5 cm. The prevalence of node enlargement increased significant with a longer duration of symptom (p=0.001), large extent of the disease (p=0.043), and with a greater proportion of honeycomb pattern (p=0.033). Right paratracheal, subcarinal, right tracheobronchial, and paraesophageal nodes were the most common sites of node enlargement. In conclusion, mediastinal lymph node enlargement is common in patients with idiopathic pulmonary fibrosis and is more frequently seen in patients with a longer duration of clinical symptoms, greater extent of the disease, and with a larger proportion of honeycomb pattern

  14. Mediastinal lymph node enlargement on CT scans in idiopathic pulmonary fibrosis

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Joong Mo; Im, Jung Gi; Yu, Kyu In; Kim, Hyeong Seog [Seoul National University College of Medicine, Seoul (Korea, Republic of); Kim, Dae Young [Chung Buk National University College of Medicine, Chungju (Korea, Republic of); Yu, Pil Mun [Dankuk University College of Medicine, Seoul (Korea, Republic of)

    1992-09-15

    The increase in size of lymph node on CT scan is the single most important finding of lymphadenopathy. The purpose of this study was to evaluate the size of mediastinal lymph nodes in patients with idiopathic pulmonary fibrosis with no evidence of malignancy or current infection. CT scans of 70 patients (16 with conventional CT and 54 with high-resolution CT) were assessed for lymph node size and location. The duration of symptoms, and the extent and pattern of the parenchymal lung disease on CT scans were correlated with lymph node enlargement. In 54 of 70 patients, more than one lymph nodes were large than 1-1.5 cm. The prevalence of node enlargement increased significant with a longer duration of symptom (p=0.001), large extent of the disease (p=0.043), and with a greater proportion of honeycomb pattern (p=0.033). Right paratracheal, subcarinal, right tracheobronchial, and paraesophageal nodes were the most common sites of node enlargement. In conclusion, mediastinal lymph node enlargement is common in patients with idiopathic pulmonary fibrosis and is more frequently seen in patients with a longer duration of clinical symptoms, greater extent of the disease, and with a larger proportion of honeycomb pattern.

  15. Should internal mammary lymph nodes in breast cancer be a target for the radiation oncologist?

    International Nuclear Information System (INIS)

    Freedman, Gary M.; Fowble, Barbara L.; Nicolaou, Nicos; Sigurdson, Elin R.; Torosian, Michael H.; Boraas, Marcia C.; Hoffman, John P.

    2000-01-01

    Purpose: The elective treatment of internal mammary lymph nodes (IMNs) in breast cancer is controversial. Previous randomized trials have not shown a benefit to the extended radical mastectomy or elective IMN irradiation overall, but a survival benefit has been suggested by some for subgroups of patients with medial tumors and positive axillary lymph nodes. The advent of effective systemic chemotherapy and potential for serious cardiac morbidity have also been factors leading to the decreased use of IMN irradiation during the past decade. The recent publishing of positive trials testing postmastectomy radiation that had included regional IMN irradiation has renewed interest in their elective treatment. The purpose of this study is to critically review historical and new data regarding IMNs in breast cancer. Methods and Materials: The historical incidence of occult IMN positivity in operable breast cancer is reviewed, and the new information provided by sentinel lymph node studies also discussed. The results of published randomized prospective trials testing the value of elective IMN dissection and/or radiation are analyzed. The data regarding patterns of failure following elective IMN treatment is studied to determine its impact on local-regional control, distant metastases, and survival. A conclusion is drawn regarding the merits of elective IMN treatment based on this review of the literature. Results: Although controversial, the existing data from prospective, randomized trials of IMN treatment do not seem to support their elective dissection or irradiation. While it has not been shown to contribute to a survival benefit, the IMN irradiation increases the risk of cardiac toxicity that has effaced the value of radiation of the chest wall in reducing breast cancer deaths in previous randomized studies and meta-analyses. Sentinel lymph node mapping provides an opportunity to further evaluate the IMN chain in early stage breast cancer. Biopsy of 'hot' nodes may be

  16. Clinical and pathologic factors affecting lymph node yields in colorectal cancer.

    Directory of Open Access Journals (Sweden)

    Ta-Wen Hsu

    Full Text Available OBJECTIVE: Lymph node yield is recommended as a benchmark of quality care in colorectal cancer. The objective of this study was to evaluate the impact of various factors upon lymph node yield and to identify independent factors associated with lymph node harvest. MATERIALS AND METHODS: The records of 162 patients with Stage I to Stage III colorectal cancers seen in one institution were reviewed. These patients underwent radical surgery as definitive therapy; high-risk patients then received adjuvant treatment. Pathologic and demographic data were recorded and analyzed. The subgroup analysis of lymph node yields was determined using a t-test and analysis of variants. Linear regression model and multivariable analysis were used to perform potential confounding and predicting variables. RESULTS: Five variables had significant association with lymph node yield after adjustment for other factors in a multiple linear regression model. These variables were: tumor size, surgical method, specimen length, and individual surgeon and pathologist. The model with these five significant variables interpreted 44.4% of the variation. CONCLUSIONS: Patients, tumor characteristics and surgical variables all influence the number of lymph nodes retrieved. Physicians are the main gatekeepers. Adequate training and optimized guidelines could greatly improve the quality of lymph node yields.

  17. Reproducible isolation of lymph node stromal cells reveals site-dependent differences in fibroblastic reticular cells

    Directory of Open Access Journals (Sweden)

    Anne L Fletcher

    2011-09-01

    Full Text Available Within lymph nodes, non-hematopoietic stromal cells organize and interact with leukocytes in an immunologically important manner. In addition to organizing T and B cell segregation and expressing lymphocyte survival factors, several recent studies have shown that lymph node stromal cells shape the naïve T cell repertoire, expressing self-antigens which delete self-reactive T cells in a unique and non-redundant fashion. A fundamental role in peripheral tolerance, in addition to an otherwise extensive functional portfolio, necessitates closer study of lymph node stromal cell subsets using modern immunological techniques; however this has not routinely been possible in the field, due to difficulties reproducibly isolating these rare subsets. Techniques were therefore developed for successful ex vivo and in vitro manipulation and characterization of lymph node stroma. Here we discuss and validate these techniques in mice and humans, and apply them to address several unanswered questions regarding lymph node composition. We explored the steady-state stromal composition of lymph nodes isolated from mice and humans, and found that marginal reticular cells and lymphatic endothelial cells required lymphocytes for their normal maturation in mice. We also report alterations in the proportion and number of fibroblastic reticular cells (FRCs between skin-draining and mesenteric lymph nodes. Similarly, transcriptional profiling of FRCs revealed changes in cytokine production from these sites. Together, these methods permit highly reproducible stromal cell isolation, sorting, and culture.

  18. Reproducible isolation of lymph node stromal cells reveals site-dependent differences in fibroblastic reticular cells.

    Science.gov (United States)

    Fletcher, Anne L; Malhotra, Deepali; Acton, Sophie E; Lukacs-Kornek, Veronika; Bellemare-Pelletier, Angelique; Curry, Mark; Armant, Myriam; Turley, Shannon J

    2011-01-01

    Within lymph nodes, non-hematopoietic stromal cells organize and interact with leukocytes in an immunologically important manner. In addition to organizing T and B cell segregation and expressing lymphocyte survival factors, several recent studies have shown that lymph node stromal cells shape the naïve T cell repertoire, expressing self-antigens which delete self-reactive T cells in a unique and non-redundant fashion. A fundamental role in peripheral tolerance, in addition to an otherwise extensive functional portfolio, necessitates closer study of lymph node stromal cell subsets using modern immunological techniques; however this has not routinely been possible in the field, due to difficulties reproducibly isolating these rare subsets. Techniques were therefore developed for successful ex vivo and in vitro manipulation and characterization of lymph node stroma. Here we discuss and validate these techniques in mice and humans, and apply them to address several unanswered questions regarding lymph node composition. We explored the steady-state stromal composition of lymph nodes isolated from mice and humans, and found that marginal reticular cells and lymphatic endothelial cells required lymphocytes for their normal maturation in mice. We also report alterations in the proportion and number of fibroblastic reticular cells (FRCs) between skin-draining and mesenteric lymph nodes. Similarly, transcriptional profiling of FRCs revealed changes in cytokine production from these sites. Together, these methods permit highly reproducible stromal cell isolation, sorting, and culture.

  19. Normal mediastinal lymph node size and shape; CT and cadaver study

    International Nuclear Information System (INIS)

    Im, Chung Kie; Lee, Kyung Soo; Han, Man Chung; Kim, Chu Wan

    1985-01-01

    With the view point of size, shape and arrangement pattern, authors present normal mediastinal lymph node from the analysis of 61 cases of CT scan and multidirectional section of 2 cadavers. The result were as follows: 1. Transverse diameter of the lymph nodes, demonstrated in cadaver section, was 3 to 6mm in upper paratracheal area and 5 to 14mm in juxta-carinal and AP-window area. Arrangement of the lymph nodes showed tendency of longitudinal direction in lower paratracheal, and juxtacarinal area, while that of AP window showed tendency of AP direction as long axis. 2. Mean and the largest size of the lymph nodes demonstrated in CT scan were 3.7mm, 8mm in upper paratracheal area, and 6mm, 12mm in lower paratracheal area, and 7.1mm, 14mm in juxtacarinal area, and 6.3mm and 11mm in aorticopulmonary window area. 3. Size of the lymph nodes in CT scan showed linear increasing tendency according to increasing age (y=0.32, p<0.005). 4. Shape of the lymph nodes in CT scan were mostly round in upper paratracheal area while that of aorticopulmonary window showed higher incidence of oval and elongated shape. 5. Recommended size criterior of abnormal lymph node is 10mm in upper paratracheal area and 15mm in the other area

  20. Study of metastatic lymph nodes in advanced gastric cancer with spiral computed tomograph

    International Nuclear Information System (INIS)

    Su Yijuan

    2008-01-01

    Objective: To study the characteristics of spiral computed tomography (SCT) in the diagnosis of lymph nodes metastases in gastric cancer. Methods: The characteristics of spiral computed tomography (SCT) of metastatic lymph nodes in 35 gastric cancer patients were analyzed and compared with operation and pathology. Results: A total amount of 379 lymph nodes (positive 173, negative 206) were detected by SCT and confirmed by pathology in metastasis-positive or metastasis-negative patients. The positive rate with diameter of lymph nodes ≥ 10 mm is 62.7%. The positive rate with ir- regular shape and uneven enhancement lymph nodes were 96.3% and 89.4%. If the attenuation values, more than or equal to 25 HU in plain scan or 70 HU in arterial phase or 80 HU in venous phase, were used as the threshold to detect the metastasis-positive lymph nodes, the positive rate were 55.7%, 56.3%, 67.8% respectively. Conclusion: SCT is valuable in judging the metastasis in gastric cancer. The reference of diameter ≥ 10mm, combining with the shape and the attenuation values can dramatically improve the diagnosis of lymph node metastasis in gastric cancer. (authors)

  1. Tumor suppressor genes are frequently methylated in lymph node metastases of breast cancers

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    Xu Jia

    2010-07-01

    Full Text Available Abstract Introduction Metastasis represents a major adverse step in the progression of breast carcinoma. Lymph node invasion is the most relevant prognostic factor; however little is known on the molecular events associated with lymph node metastasis process. This study is to investigate the status and role of methylation in lymph node metastatic tumors. Materials and methods Bisulfite pyrosequencing is used to screen 6 putative tumor suppressor genes (HIN-1, RASSF1A, RIL, CDH13, RARβ2 and E-cadherin in 38 pairs of primary breast tumors and lymph node metastases. Results We found that HIN-1, CDH13, RIL, RASSF1A and RARβ2 were frequently methylated both in primary and metastatic tissues (range: 55.3%~89.5%. E-cadherin was not frequently methylated in either setting (range: 18.4%~23.7%. The methylation status of HIN-1, CDH13, RIL, and RARβ2 in lymph nodes metastasis were correlated with that in primary tumors. The Pearson correlation values ranged from 0.624 to 0.472 (p values HIN-1 methylation and hormone status in metastatic lymph nodes. Hypermethylation of HIN-1 in metastasis lymph nodes was significantly associated with expression of ER (odds ratio, 1.070; P = 0.024 and with PR (odds ratio, 1.046; P = 0.026. Conclusions This study suggests that hypermethylation of tumor suppressor genes is extended from primary to metastatic tumors during tumor progression.

  2. National equipment of intraoperatory gamma detection in the identification of sentinel lymph node in animal model

    International Nuclear Information System (INIS)

    Santos, Paula Cristina Fada dos; Santos, Ivan Dunshee de Abranches Oliveira; Nahas, Fabio Xerfan; Ferreira, Lydia Masako; Oliveira Filho, Renato Santos de

    2009-01-01

    Purpose: To investigate a national equipment of intraoperatory gamma detection in the identification of sentinel lymph node. Methods: Thirty young adult male rats were used. After anesthetized, animals were divided into two groups of 15 animals each. Animals from group A received dextram 500 - Tc 99 radiopharmaceutical and patent blue V and those from group B received only patent blue V to map the lymphatic drainage. The presence of radiation in the background area, in the area of injection and of the ex vivo sentinel lymph node of group A were measured. After the exeresis, each lymph node in group A and in group B was mixed forming a new random sequence and the radioactive reading of each lymph node was carried out, using both pieces of equipment. Results: The hottest sentinel lymph node was identified by the national equipment when radiation was measured in the area of lymphatic drainage after the Dextran 500 was injected. Also, the ex vivo sentinel lymph node. The national equipment has also detected radiation in the lymph nodes that had not received radiopharmaceutical, leading to false positive, checked by the application of Mann-Whitney tests and Student's paired t-tests. The Cronbach alpha has shown high internal consistency of data 0,9416. Conclusions: The national equipment of intraoperatory gamma detection identifies the LS and showed false positives LS and needs improvement. (author)

  3. Topographic distribution of inguinal lymph nodes metastasis: significance in determination of treatment margin for elective inguinal lymph nodes irradiation of low pelvic tumors

    International Nuclear Information System (INIS)

    Wang, C.J.; Chin, Y.Y.; Leung, Stephen Wan; Chen, H.C.; Sun, L.M.; Fang, F.M.

    1996-01-01

    Purpose: To study the distribution of gross inguinal lymph node metastasis and, in particular, its correlation with major pelvic bony structures on a simulation film. Methods and Materials: Thirty-seven cases of low pelvic tumors having gross inguinal lymph node metastasis that were treated with radiation therapy between November 1987 and December 1992 were segregated for study. The patient's nodes were palpated and marked with lead wire before the simulation film was taken. The geometric center of the usually round or elliptical node on the film was assumed to be the origin of the previously uninfested node. A total of 84 such labeled nodes was obtained from these 37 cases. These centers were transferred to and mapped collectively on a new simulation film showing major pelvic bony structures of left hemipelvis and upper femur. Results: Distribution of gross inguinal lymph nodes was found confined to the following area, as related to major pelvic bony structure: laterally, just abutting the tangential line that passes through lateral border of the femoral head; medially: 3 cm away from the body's midline axis; superiorly: 1 cm below the line that joins both upper borders of the femoral head; inferiorly: 2.5 cm below the low borders of ischial tuberosity. According to this rectangular boundary, three nodes were out of field, nine nodes near the border less than 1 cm margin. This area adequately covered 86% (72 of 84) of the studied nodes. Conclusion: Distribution study is important in determining the treatment margin. In general, an additional 1-2 cm beyond the area described above is the recommended treatment margin for elective inguinal lymph nodes irradiation with high confidence level of coverage.

  4. DETECTION OF OCCULT LYMPH NODE TUMOR CELLS IN NODE-NEGATIVE GASTRIC CANCER PATIENTS.

    Science.gov (United States)

    Pereira, Marina Alessandra; Ramos, Marcus Fernando Kodama Pertille; Dias, Andre Roncon; Yagi, Osmar Kenji; Faraj, Sheila Friedrich; Zilberstein, Bruno; Cecconello, Ivan; Mello, Evandro Sobroza de; Ribeiro, Ulysses

    2017-01-01

    The presence of lymph nodes metastasis is one of the most important prognostic indicators in gastric cancer. The micrometastases have been studied as prognostic factor in gastric cancer, which are related to decrease overall survival and increased risk of recurrence. However, their identification is limited by conventional methodology, since they can be overlooked after routine staining. To investigate the presence of occult tumor cells using cytokeratin (CK) AE1/AE3 immunostaining in gastric cancer patients histologically lymph node negative (pN0) by H&E. Forty patients (T1-T4N0) submitted to a potentially curative gastrectomy with D2 lymphadenectomy were evaluated. The results for metastases, micrometastases and isolated tumor cells were also associated to clinicopathological characteristics and their impact on stage grouping. Tumor deposits within lymph nodes were defined according to the tumor-node-metastases guidelines (7th TNM). A total of 1439 lymph nodes were obtained (~36 per patient). Tumor cells were detected by immunohistochemistry in 24 lymph nodes from 12 patients (30%). Neoplasic cells were detected as a single or cluster tumor cells. Tumor (p=0.002), venous (p=0.016), lymphatic (p=0.006) and perineural invasions (p=0.04), as well as peritumoral lymphocytic response (p=0.012) were correlated to CK-positive immunostaining tumor cells in originally negative lymph nodes by H&E. The histologic stage of two patients was upstaged from stage IB to stage IIA. Four of the 28 CK-negative patients (14.3%) and three among 12 CK-positive patients (25%) had disease recurrence (p=0.65). The CK-immunostaining is an effective method for detecting occult tumor cells in lymph nodes and may be recommended to precisely determine tumor stage. It may be useful as supplement to H&E routine to provide better pathological staging. A presença de metástase em linfonodos é um dos indicadores prognósticos mais importantes no câncer gástrico. As micrometástases têm sido

  5. [The related factors of head and neck mocosal melanoma with lymph node metastasis].

    Science.gov (United States)

    Yin, G F; Guo, W; Chen, X H; Huang, Z G

    2017-12-05

    Objective: To investigate the related factors of mucosal melanoma of head and neck with lymph node metastasis for early diagnosis and further treatments. Method: A retrospective analysis of 117 cases of head and neck mucosal malignant melanoma patients which received surgical treatment was performed. Eleven cases of patients with pathologically confirmed lymph node metastasis and 33 cases without lymph node metastasis (1∶3) were randomly selected to analyze. The related factors of lymph node metastasis of head and neck mucosal melanoma patients including age, gender, whether the existence of recurrence, bone invasion, lesion location were analyzed. The single factor and logistic regression analysis were performed, P difference was statistically significant. Result: The lymph node metastasis rate of head and neck mucosal melanoma was 9.40%(11/117), the single factor analysis showed that there were 3 factors to be associated with lymph node metastasis, which was recurrence ( P =0.0000), bone invasion ( P =0.001), primary position ( P =0.007). Recurrence ( P =0.021) was a risk factor for lymph node metastasis according to the Logistic regression analysis, and the impact of bone invasion ( P =0.487) and primary location ( P =0.367) remained to be further explored. Conclusion: The patients of head and neck mucosal melanoma with the presence of recurrent usually accompanied by a further progression of the disease, such as lymph node metastasis, so for recurrent patients should pay special attention to the situation of lymph node and choose the reasonable treatment. Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.

  6. Roles of preoperative lymphoscintigraphy for sentinel lymph node biopsy in breast cancer patients

    International Nuclear Information System (INIS)

    Sun Xiao; Liu Juanjuan; Wang Yongsheng; Wang Lei; Yang Guoren; Zhou Zhengbo; Li Yongqing; Liu Yanbing; Li Taiyu

    2010-01-01

    The objective of this study was to evaluate roles of preoperative lymphoscintigraphy for sentinel lymph node biopsy in breast cancer patients. Five hundred and sixty-five consecutive breast cancer patients were prospectively randomized into groups with or without preoperative lymphoscintigraphy. In a group with lymphoscintigraphy, 238 patients had sentinel lymph nodes spotted in lymphoscintigram. The visualization of sentinel lymph nodes in lymphoscintigram was not associated with patients' age, primary tumor size and location, histopathologic type and time interval from injection of radiocolloid to lymphoscintigraphy. However, patients with axillary metastasis had a lower identification rate of sentinel lymph nodes by lymphoscintigraphy than those without metastasis (P=0.003). The identification rate of axillary sentinel lymph nodes was 99.3% in the group and the rate was similar whether there was sentinel lymph nodes spotted in axillary in lymphoscintigram or not (99.6% vs. 98.1%, P=0.327). The false-negative rate in this group was 4.2%. While in a group without lymphoscintigraphy, the identification rate and the false-negative rate were 99.6% and 4.8%, respectively. There was no significant difference between the two groups in the identification rate of axillary sentinel lymph nodes (P=0.594) and in the false-negative rate (P=1.00). Preoperative lymphoscintigraphy could neither improve the identification rate nor reduce the false-negative rate of breast cancer sentinel lymph node biopsy, and it is not necessary for sentinel lymph node biopsy in breast cancer patients. (author)

  7. FDG uptake in cervical lymph nodes in children without head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Vali, Reza; Bakari, Alaa A.; Marie, Eman; Kousha, Mahnaz; Shammas, Amer [University of Toronto, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON (Canada); Charron, Martin [Brampton Nuclear Services, Toronto, ON (Canada)

    2017-06-15

    Reactive cervical lymphadenopathy is common in children and may demonstrate increased {sup 18}F-fluoro-deoxyglucose ({sup 18}F-FDG) uptake on positron emission tomography/computed tomography (PET/CT). We sought to evaluate the frequency and significance of {sup 18}F-FDG uptake by neck lymph nodes in children with no history of head and neck cancer. The charts of 244 patients (114 female, mean age: 10.4 years) with a variety of tumors such as lymphoma and post-transplant lymphoproliferative diseases (PTLD), but no head and neck cancers, who had undergone {sup 18}F-FDG PET/CT were reviewed retrospectively. Using the maximum standardized uptake value (SUVmax), increased {sup 18}F-FDG uptake by neck lymph nodes was recorded and compared with the final diagnosis based on follow-up studies or biopsy results. Neck lymph node uptake was identified in 70/244 (28.6%) of the patients. In 38 patients, the lymph nodes were benign. In eight patients, the lymph nodes were malignant (seven PTLD and one lymphoma). In 24 patients, we were not able to confirm the final diagnosis. Seven out of the eight malignant lymph nodes were positive for PTLD. The mean SUVmax was significantly higher in malignant lesions (4.2) compared with benign lesions (2.1) (P = 0.00049). {sup 18}F-FDG uptake in neck lymph nodes is common in children and is frequently due to reactive lymph nodes, especially when the SUVmax is <3.2. The frequency of malignant cervical lymph nodes is higher in PTLD patients compared with other groups. (orig.)

  8. FDG uptake in cervical lymph nodes in children without head and neck cancer.

    Science.gov (United States)

    Vali, Reza; Bakari, Alaa A; Marie, Eman; Kousha, Mahnaz; Charron, Martin; Shammas, Amer

    2017-06-01

    Reactive cervical lymphadenopathy is common in children and may demonstrate increased 18 F-fluoro-deoxyglucose ( 18 F-FDG) uptake on positron emission tomography/computed tomography (PET/CT). We sought to evaluate the frequency and significance of 18 F-FDG uptake by neck lymph nodes in children with no history of head and neck cancer. The charts of 244 patients