Biopathologic features and clinical significance of micrometatasis in the lymph node of early gastric cancer

Intraoperative diagnosis of «sentinel» lymph nodes in the patients with mammary gland cancer

Objective. To improve intraoperative determination of «sentinel» lymph nodes in patients, suffering mammary gland cancer. Materials and methods. In the 2016 – 2021 yrs period on the base of the Odessa Regional Clinical Hospital 200 patients, suffering mammary gland cancer Stages Т1–Т3N0М0, were operated, using two dyes: the blue patented dye and fluorescent dye indocyanine green. All the patients were distributed into two groups. In Group I in 100 patients the "sentinel" lymph nodes biopsy was conducted. The blue patented dye was used for the lymph nodes staining. The same was conducted in 100 patients of Group II with the "sentinel" lymph nodes biopsy. For the lymph nodes staining there were applied the blue patented dye and fluorescent dye indocyanine green, which were introduced intravenously into the upper extremity on the side of the affected mammary gland along outflow from the upper extremity to mammary gland. Results. General five–year survival after axillary lympho–dissection and after biopsy of «sentinel» lymph nodes have constituted 91 and 92%, accordingly, while recurrence–free five–year survival – 82.2 and 83.9% accordingly. Only in 1.1% patient a regional recurrence in «sentinel» lymph nodes on the affected mammary gland side was revealed. In 57% patients the unaffected «sentinel» lymph nodes were diagnosed, that's why further lympho–dissection was accomplished. In 43% women–patients there was revealed metastatic affection of the lymph nodes. Recurrence was registered in 0.2% patients as an isolated metastases in axillary lymph nodes. Conclusion. The method of the «sentinel» lymph nodes diagnosis in mammary gland cancer, using the dyes, permits to escape the performance of traumatic operations in favor of organ–preserving interventions with biopsy of «sentinel» lymph nodes.

HER2 as a potential biomarker of lymph node metastasis in undifferentiated early gastric cancer

Human epidermal growth factor receptor 2 (HER2) is implicated in several cancers, including gastric cancer. However, limited data are available regarding its clinical significance in early gastric cancer (EGC). We evaluated the clinical significance of HER2 overexpression in patients with EGC. We retrospectively reviewed 727 patients who underwent surgical treatment for EGC between October 2010 and August 2017. HER2 expression was analysed in 680 EGC cases by immunohistochemistry and classified as negative (0 and 1+), equivocal (2+), or positive [overexpression (3+)]. Among patients with differentiated EGC, the number of patients with HER2 overexpression was not significantly different from that of HER2-negative patients in terms of age, sex, tumour size, location, gross type, depth of invasion, presence of lymphovascular invasion (LVI), and presence of lymph node metastasis (LNM). However, in patients with undifferentiated EGC, HER2 overexpression was significantly correlated with LVI and presence of LNM compared with HER2-negative patients. Multivariate analysis indicated HER2 overexpression as a good predictive marker of LNM in patients with undifferentiated EGC. HER2 expression is associated with LNM in undifferentiated EGC. Therefore, the importance of HER2 overexpression in EGC should not be overlooked, and further studies are needed to identify its clinical significance.

Safety and feasibility of laparoscopic gastrectomy accompanied by D1+ lymph node dissection for early gastric cancer in elderly patients

INTRODUCTION

The age of patients with gastric cancer has increased worldwide. The aim of this study was to investigate the safety and feasibility of laparoscopic gastrectomy (LG) for early gastric cancer in elderly patients.

METHODS

We retrospectively investigated 221 consecutive patients who underwent LG for early gastric cancer during a 5-year period (January 2010 to December 2014). We divided the patients into two groups: elderly patients (≥75 years old) and younger patients (<75 years old). We compared these two groups with respect to clinical characteristics, histopathological findings, intraoperative factors, and postoperative outcomes.

RESULTS

The preoperative characteristics were similar in both groups. Except for the number of harvested lymph nodes (42.0 vs 34.9; P = 0.0016), the short-term operative outcomes, including postoperative complications and histopathological findings, were comparable between the two groups. Although significantly fewer lymph nodes were harvested in the elderly group, the overall survival and relapse-free survival rates did not significantly differ between the groups. Postoperative complications, such as acute cholecystitis and internal hernia, occurred during the long-term postoperative period after LG, and these unexpected complications were more frequently observed in elderly patients. All elderly patients required additional emergent surgeries for delayed complications.

CONCLUSION

The outcomes of LG for early gastric cancer in elderly patients seem to be reasonable. Aggressive lymph node dissection may be omissible in elderly patients with acceptable results. LG can be a safe and feasible procedure in elderly patients. However, the higher rate of delayed but urgent complications during the long-term postoperative period must be considered.

Prognostic Significance of Solitary Lymphnode Metastasis and Micrometastasis in Gastric Cancer

Gastric cancer (GC) used to be one of the most common malignancies in the world and still is the second leading cause of malignancy-related death in the Far East. The most significant factors that were found to be associated with the clinical outcome in patients with non-metastatic (M₀) gastric cancer is tumor's depth of invasion, the presence and the extend of lymphnode involvement, as well as the histological type according to Lauren (intestinal or diffuse). Although it is generally accepted that D2 gastrectomy is the procedure of choice to achieve adequate oncologic excision, there are quite many concerns for its use in patients with early gastric cancer (EGC), where N_o or N₁ specimens are frequently reported. The last two decades, with the evolvement of cancer cell detection techniques, the attend of the medical community is focused on GC patients with solitary lymphnode metastasis (SLN) or micrometastasis (mM). There is a discussion whether SLN should be attributed as the “real” sentinel node (SN) and its projection on patients' survival. The aim of this study is to review the recent literature and attempt to clarify the clinical significance of SLN in gastric cancer.

[Morphological and immunohistochemical features of severe gastric dysplasia and early gastric cancer]

AIM

to investigate the morphological and immunohistochemical features of severe gastric dysplasia (SGD) and early gastric cancer (EGC).

MATERIAL AND METHODS

The fragments of gastric tumor tissue with adjacent mucosal portions from 50 patients aged from 34 to 79 years (mean age 63.8 years), which had been removed during organ-sparing endoscopic surgery, were histologically, histochemical, and immunohistochemically (IHC) examined.

RESULTS

In EGC, there was a preponderance of intestinal-type cancer; the adjacent mucosal areas showed foci of SGD and colonic metaplasia in 100%. Cancer emboli were absent in the lumen of blood and lymphatic vessels in EGC at a рТ1а stage. Relapse of cancer occurred in 10% of the patients with EGC within 6-24 months after endoscopic dissection.

CONCLUSION

Complex morphological and IHC examination allows timely diagnosis of SGD and EGC, namely: the ability to assess the histologic type and depth of invasion of EGC, the presence or absence of cancer emboli in the blood and lymphatic vessels, which is crucial in determining treatment policy and prognosis. The immunophenotype of SGD and EGC with a number of antibodies (Abs) (cytokeratins 7, 8/18, mucins 1, 2 and 5AC, and p53) was assessed, the most significant ones of which were, in our opinion, Abs to p53 and mucin 5AC.

Routinely reported 'equivocal' lymphovascular invasion in prostatectomy specimens is associated with adverse outcomes

OBJECTIVE

To evaluate the significance of routinely reported 'equivocal' lymphovascular invasion (LVI) in prostatectomy specimens of patients with clinically localized prostate cancer.

MATERIALS AND METHODS

Prospectively collected data from men who underwent prostatectomy for clinically localized prostate cancer were retrospectively reviewed. Rates of adverse pathological features and biochemical recurrence (BCR) were compared between tumours positive, negative or 'equivocal' for LVI. Multivariable Cox regression analysis was performed to identify independent predictors of BCR.

RESULTS

Of 1 310 consecutive cases, LVI was present definitively in 82 (6.3%) and equivocally in 43 (3.3%) cases. Similar to definitive LVI, equivocal LVI was significantly associated with other adverse pathological features, including advanced stage, higher Gleason grade and positive surgical margins. BCR occurred more frequently in patients with tumours that were equivocal (61%) or positive for LVI (71%) than in patients with negative results (14.7%). In addition, patients with both definitive and equivocal LVI had a significantly shorter BCR-free survival time compared with those with negative LVI. Multivariable Cox regression analysis indicated that the presence of either definitive or equivocal LVI were independent predictors of disease recurrence (hazard ratio [HR] 3.32, 95% confidence interval [CI] 2.3-4.8; P <0.001 vs HR 1.66, 95% CI 1.05-2.65; P = 0.032, respectively).

CONCLUSION

In this single-institution study, equivocal LVI had a similar association with adverse pathological features and rate of BCR to that of definitive LVI. If our observations are validated in an independent cohort, consideration should be given to the inclusion of equivocal LVI as part of routine pathological reporting.

Sentinel node biopsy using blue dye and technetium99 in advanced gastric cancer: anatomical drainage and clinical application

Lymph node metastases are an independent prognosis factor in gastric carcinoma (GC) patients. Radical lymphadenectomy can improve survival but it can also increase surgical morbidity. As a principle, sentinel node (SN) navigation surgery can avoid unnecessary lymphadenectomy without compromising prognosis. In this pilot study, 24 patients with untreated GC were initially screened for SN navigation surgery, of which 12 were eligible. Five patients had T2 tumors, 5 had T3 tumors and 2 had T1 tumors. In 33% of cases, tumor diameter was greater than 5.0 cm. Three hundred and eighty-seven lymph nodes were excised with a median of 32.3 per patient. The SN navigation surgery was feasible in all patients, with a median of 4.5 SNs per patient. The detection success rate was 100%. All the SNs were located in N1 and N2 nodal level. In 70.9% of cases, the SNs were located at lymphatic chains 6 and 7. The SN sensitivity for nodal staging was 91.6%, with 8.3% of false negative. In 4 patients who were initially staged as N0, the SNs were submitted to multisection analyses and immunohistochemistry, confirming the N0 stage, without micrometastases. In one case initially staged as negative for nodal metastases based on SN analyses, metastases in lymph nodes other than SN were found, resulting in a 20% skip metastases incidence. This surgery is a reproducible procedure with 100% detection rate of SN. Tumor size, GC location and obesity were factors that imposed some limitations regarding SN identification. Results from nodal multisection histology and immunohistochemistry analysis did not change initial nodal staging.

Aberrant metastatic behavior and particular features of early gastric cancer

In this paper, we have focused on the metastatic behavior of EGC and its particularities. The main factors that are currently considered as predictors of the metastatic behavior and that are used in the therapeutic decision (endoscopic resection vs surgical removal) are the tumor size (upper or bellow 2 cm), depth of infiltration, angiolymphatic invasion, the presence or absence of ulceration, and histologic type (undifferentiated vs differentiated carcinomas). However, most of the metastatic cases were published as case reports or case series. This is the reason why a proper estimation of metastatic risk in EGC is not well known. To date, 79 cases presenting bone metastases, three reports of brain metastases, and one EGC that was associated with skin metastasis were published. However, occult metastasis, lymph node micrometastasis, and skip metastasis can also occur and should be identified. Making a synthesis of the literature data that is correlated with our experience, we finally proposed the inclusion of the six Japanese subgrouping system, tumor size, angiolymphatic invasion, and micrometastasis as components of the pTNM staging system, which should be particularly adapted for EGC.

Ki-67 Expression in CRC Lymph Node Metastasis Does Not Predict Survival

Colorectal cancer is one of the most common malignancies and a leading cause of cancer death worldwide. Molecular markers may improve clinicopathologic staging and provide a basis to guide novel therapeutic strategies which target specific tumour-associated molecules according to individual tumour biology; however, so far, no ideal molecular marker has been found to predict disease progression. We tested Ki-67 proliferation marker in primary and lymph node metastasis of CRC. We observed a statistical significant difference between the positive rates of neoplastic cells positively stained by Ki-67 in both sites, with remarkable increased number of Ki-67 positive cells in primary tumor cells compared to cancer cells that invaded lymph nodes. We can speculate that the metastatic CRC in lymph node can be more resistant to the drugs that target cellular division.

Advances in research of fluorescence imaging for detection of gastrointestinal tumors

Fluorescence imaging, which has a high sensitivity, produces images by capturing fluorescence signal from the inside of organisms. Over the past few years, notable development of fluorescence imaging technique has been made in the field of gastrointestinal cancer. Imaging instruments and fluorescent probes for fluorescence imaging are being improved and innovated, making it a promising technique for broad clinical applications in the near future. Future clinical applications of fluorescence imaging include aiding diagnosis and surgical treatment of gastrointestinal tumors, which are important development directions of this technique. However, increasing the safety and the accuracy for tumor detection is a challenge for fluorescence imaging. Besides, in order to acquire better diagnostic effects, the combination of fluorescence imaging and other imaging modalities which require novel imaging probes for tumor is also an important trend for fluorescence imaging development.