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Sinclair R, Wong XL, Shumack S, Baker C, MacMahon B. The role of micrometastasis in high-risk skin cancers. Australas J Dermatol 2024; 65:143-152. [PMID: 38156714 DOI: 10.1111/ajd.14206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/30/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024]
Abstract
The propensity to metastasize is the most important prognostic indicator for solid cancers. New insights into the mechanisms of early carcinogenesis have revealed micrometastases are generated far earlier than previously thought. Evidence supports a synergistic relationship between vascular and lymphatic seeding which can occur before there is clinical evidence of a primary tumour. Early vascular seeding prepares distal sites for colonisation while regional lymphatics are co-opted to promote facilitative cancer cell mutations. In response, the host mounts a global inflammatory and immunomodulatory response towards these cells supporting the concept that cancer is a systemic disease. Cancer staging systems should be refined to better reflect cancer cell loads in various tissue compartments while clinical perspectives should be broadened to encompass this view when approaching high-risk cancers. Measured adjunctive therapies implemented earlier for low-volume, in-transit cancer offers the prospect of preventing advanced disease and the need for heroic therapeutic interventions. This review seeks to re-appraise how we view the metastatic process for solid cancers. It will explore in-transit metastasis in the context of high-risk skin cancer and how it dictates disease progression. It will also discuss how these implications will influence our current staging systems and its consequences on management.
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Affiliation(s)
- Robert Sinclair
- Queensland Institute of Dermatology, Brisbane, QLD, Australia
| | - Xin Lin Wong
- St George Dermatology and Skin Cancer Centre, New South Wales, Kogarah, Australia
| | - Stephen Shumack
- St George Dermatology and Skin Cancer Centre, New South Wales, Kogarah, Australia
- Department of Dermatology, Royal North Shore Hospital, New South Wales, Sydney, Australia
| | - Christopher Baker
- Department of Dermatology, St Vincents Hospital, Victoria, Melbourne, Australia
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Zhang B, Zheng GL, Zhang Y, Zhao Y, Zhu HT, Zhang T, Liu Y, Zheng ZC. [Clinicopathological factors and clinical significance of No.12b lymph node metastasis in gastric antrum cancer]. Zhonghua Wei Chang Wai Ke Za Zhi 2024; 27:167-174. [PMID: 38413085 DOI: 10.3760/cma.j.cn441530-20230412-00121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Objective: To investigate the clinicopathological factors and clinical significance of (micro)metastasis in No.12b lymph node in patients with gastric antrum cancer. Methods: This was a retrospective cohort study of data of 242 patients with gastric adenocarcinoma without distant metastasis, complete follow-up data, and no preoperative anti-tumor therapy or history of other malignancies. All study patients had undergone radical gastrectomy (at least D2 radical range) + No.12b lymph node dissection in the Department of Gastric Surgery of Liaoning Cancer Hospital from January 2007 to December 2012. Immunohistochemical staining with antibody CK8/18 was used to detect micrometastasis to lymph nodes. Patients with positive findings on hematoxylin and eosin stained specimens and/or CK8/18 positivity in No.12b lymph node were diagnosed as having No.12b (micro)metastasis and included in the No.12b positive group. All other patients were classified as 12b negative. We investigated the impact of No.12b (micro)metastasis by comparing the clinicopathological characteristics and recurrence free survival (RFS) of these two groups of patients and subjecting possible risk factors to statistical analysis. Results: Traditional hematoxylin-eosin staining showed that 15/242 patients were positive for No.12b lymph nodes and 227 were negative. A total of 241 negative No. 12b lymph nodes were detected. Immunohistochemical testing revealed that seven of these 241 No.12b lymph nodes (2.9%) were positive for micrometastasis. A further seven positive nodes were identified among the 227 nodes (3.1%) that had been evaluated as negative on hematoxylin-eosin-stained sections. Thus, 22 /242 patients' (9.1%) No.12b nodes were positive for micrometastases, the remaining 220 (90.9%) being negative. Factor analysis showed that No.12b lymph node (micro) metastasis is associated with more severe invasion of the gastric serosa (HR=3.873, 95%CI: 1.676-21.643, P=0.006), T3 stage (HR=1.615, 95%CI: 1.113-1.867, P=0.045), higher N stage (HR=1.768, 95%CI: 1.187-5.654, P=0.019), phase III of TNM stage (HR=2.129, 95%CI: 1.102-3.475, P=0.046), and lymph node metastasis in the No.1/No.8a/No.12a groups (HR=0.451, 95%CI: 0.121-0.552, P=0.035; HR=0.645, 95%CI:0.071-0.886, P=0.032; HR=1.512, 95%CI: 1.381-2.100, P=0.029, respectively). Survival analysis showed that the 5-year RFS of patients in the No.12b positive group was worse than that of those in the No.12b negative group (18.2% vs. 34.5%, P<0.001). Independent predictors of RFS were poorer differentiation of the primary tumor (HR=0.528, 95%CI:0.288-0.969, P=0.039), more severe serous invasion (HR=1.262, 95%CI:1.039-1.534, P=0.019), higher T/N/TNM stage (HR=4.880, 95%CI: 1.909-12.476, P<0.001; HR=2.332, 95%CI: 1.640-3.317, P<0.001; HR=0.139, 95%CI: 0.027-0.713, P=0.018, respectively), and lymph node metastasis in the No.12a/No.12b group(HR=0.698, 95%CI:0.518-0.941, P=0.018; HR=0.341, 95%CI:0.154-0.758,P=0.008, respectively). Conclusion: Detection of micrometastasis can improve the rate of positive lymph nodes. In patients with gastric antrum cancer, dissection of group No.12b lymph nodes may improve the prognosis of those with intraoperative evidence of tumor invasion into the serosa, more than two lymph node metastases, and suspicious lymph nodes in groups No.1 / No.8a / 12a.
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Affiliation(s)
- B Zhang
- Department of Gastric Surgery, Liaoning Cancer Hospital & Institute, Cancer Hospital of Dalian University of Technology, Cancer Hospital of China Medical University, Shenyang 110042,China
| | - G L Zheng
- Department of Gastric Surgery, Liaoning Cancer Hospital & Institute, Cancer Hospital of Dalian University of Technology, Cancer Hospital of China Medical University, Shenyang 110042,China
| | - Y Zhang
- Department of Pathology, Liaoning Cancer Hospital & Institute, Cancer Hospital of Dalian University of Technology, Cancer Hospital of China Medical University, Shenyang 110042, China
| | - Y Zhao
- Department of Gastric Surgery, Liaoning Cancer Hospital & Institute, Cancer Hospital of Dalian University of Technology, Cancer Hospital of China Medical University, Shenyang 110042,China
| | - H T Zhu
- Department of Gastric Surgery, Liaoning Cancer Hospital & Institute, Cancer Hospital of Dalian University of Technology, Cancer Hospital of China Medical University, Shenyang 110042,China
| | - T Zhang
- Department of Gastric Surgery, Liaoning Cancer Hospital & Institute, Cancer Hospital of Dalian University of Technology, Cancer Hospital of China Medical University, Shenyang 110042,China
| | - Y Liu
- Department of Gastric Surgery, Liaoning Cancer Hospital & Institute, Cancer Hospital of Dalian University of Technology, Cancer Hospital of China Medical University, Shenyang 110042,China
| | - Z C Zheng
- Department of Gastric Surgery, Liaoning Cancer Hospital & Institute, Cancer Hospital of Dalian University of Technology, Cancer Hospital of China Medical University, Shenyang 110042,China
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Bilani N, Patel R, Crowley F, Tiersten A. Outcomes in Premenopausal Patients with HR+/HER2- Breast Cancer and Lymph Node Micrometastasis Based on the 21-Gene Recurrence Score. Oncologist 2023; 28:1049-1054. [PMID: 37682780 PMCID: PMC10712725 DOI: 10.1093/oncolo/oyad234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/21/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Postmenopausal patients with hormone receptor positive, HER2-negative (HR+/HER2-) early breast cancer (EBC) and 21-gene OncotypeDX (ODX) recurrence scores (RS) <26 do not benefit from chemoendocrine therapy ("CET") compared to endocrine monotherapy ("E"), regardless of nodal status. In premenopausal patients, nodal status is significant in interpretation of RS. However, guidelines are not explicit in recommendations for patients with micrometastasis ("pN1mi" staging). METHODS A cohort of patients aged <50 years with HR+/HER2- EBC who underwent ODX testing was identified within the National Cancer Database 2004-2019 dataset. We confirmed the prognostic value of ODX in pN1mi disease with multivariate Cox regression for overall survival (OS). We explored how patterns of practice differed by nodal status in cases of low RS (<26) with chi-squared testing. Finally, we performed Kaplan-Meier models comparing OS for those with RS <26 receiving E versus CET, controlling for nodal status. RESULTS Of 72 068 patients aged <50 years with HR+/HER2- EBC, 6.1% (n = 4402) had micrometastasis. Multivariate Cox regression confirmed prognostic value of ODX in this pN1mi cohort (P < .001). In the context of RS <26, CET was used most commonly in patients with 1-3 involved lymph nodes ("pN1a-c" disease), less frequently in pN1mi disease, and least in node-negative ("pN0") disease. A benefit in OS was observed in cases with RS <26 and pN1a-c receiving CET vs. E (P = .017), but not in pN1mi (P = .49) or pN0 (P = .57) disease. CONCLUSION Our large registry analysis found CET was associated with improved OS in pN1a-c, but not in pN1mi or pN0 disease.
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Affiliation(s)
- Nadeem Bilani
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside-West Hospital System, New York, NY, USA
| | - Rima Patel
- Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai/Tisch Cancer Institute, New York, NY, USA
| | - Fionnuala Crowley
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside-West Hospital System, New York, NY, USA
| | - Amy Tiersten
- Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai/Tisch Cancer Institute, New York, NY, USA
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Pavone M, Spiridon IA, Lecointre L, Seeliger B, Scambia G, Venkatasamy A, Querleu D. Full-field optical coherence tomography imaging for intraoperative microscopic extemporaneous lymph node assessment. Int J Gynecol Cancer 2023; 33:1985-1987. [PMID: 37945058 DOI: 10.1136/ijgc-2023-005050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Affiliation(s)
- Matteo Pavone
- Institut Hospitalo-Universitaire (IHU) Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Irene A Spiridon
- Institut Hospitalo-Universitaire (IHU) Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- Department of Morpho-Functional Sciences I-Pathology, Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Lise Lecointre
- Institut Hospitalo-Universitaire (IHU) Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- Department of Gynecologic Surgery, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Barbara Seeliger
- Institut Hospitalo-Universitaire (IHU) Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- Department of Digestive and Endocrine Surgery, University Hospitals of Strasbourg, Strasbourg, France
| | - Giovanni Scambia
- Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Aïna Venkatasamy
- Institut Hospitalo-Universitaire (IHU) Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - Denis Querleu
- Institut Hospitalo-Universitaire (IHU) Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Nitecki R, Ramirez PT, Dundr P, Nemejcova K, Ribeiro R, Vieira Gomes MT, Schmidt RL, Bedoya L, Isla DO, Pareja R, Rendón Pereira GJ, Lopez A, Kushner D, Cibula D. MILACC study: could undetected lymph node micrometastases have impacted recurrence rate in the LACC trial? Int J Gynecol Cancer 2023; 33:1684-1689. [PMID: 37652529 DOI: 10.1136/ijgc-2023-004711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVE The etiology of inferior oncologic outcomes associated with minimally invasive surgery for early-stage cervical cancer remains unknown. Manipulation of lymph nodes with previously unrecognized low-volume disease might explain this finding. We re-analyzed lymph nodes by pathologic ultrastaging in node-negative patients who recurred in the LACC (Laparoscopic Approach to Cervical Cancer) trial. METHODS Included patients were drawn from the LACC trial database, had negative lymph nodes on routine pathologic evaluation, and recurred to the abdomen and/or pelvis. Patients without recurrence or without available lymph node tissue were excluded. Paraffin tissue blocks and slides from all lymph nodes removed by lymphadenectomy were re-analyzed per standard ultrastaging protocol aimed at the detection of micrometastases (>0.2 mm and ≤2 mm) and isolated tumor cells (clusters up to 0.2 mm or <200 cells). RESULTS The study included 20 patients with median age of 42 (range 30-68) years. Most patients were randomized to minimally invasive surgery (90%), had squamous cell carcinoma (65%), FIGO 2009 stage 1B1 (95%), grade 2 (60%) disease, had no adjuvant treatment (75%), and had a single site of recurrence (55%), most commonly at the vaginal cuff (45%). Only one patient had pelvic sidewall recurrence in the absence of other disease sites. The median number of lymph nodes analyzed per patient was 18.5 (range 4-32) for a total of 412 lymph nodes. A total of 621 series and 1242 slides were reviewed centrally by the ultrastaging protocol. No metastatic disease of any size was found in any lymph node. CONCLUSIONS There were no lymph node low-volume metastases among patients with initially negative lymph nodes who recurred in the LACC trial. Therefore, it is unlikely that manipulation of lymph nodes containing clinically undetected metastases is the underlying cause of the higher local recurrence risk in the minimally invasive arm of the LACC trial.
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Affiliation(s)
- Roni Nitecki
- Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Pedro T Ramirez
- Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas, USA
| | - Pavel Dundr
- Pathology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Kristyna Nemejcova
- Pathology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Reitan Ribeiro
- Surgery, Hospital Erasto Gaertner, Curitiba, Hospital, Brazil
| | | | | | - Lucio Bedoya
- Gynecologic Oncology, Hospital Misercordia, Cordoba, Argentina
| | - David Ortiz Isla
- Gynecologic Oncology, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - Rene Pareja
- Gynecologic Oncology, Clinica Astorga, Medellin, and Instituto Nacional de Cancerología, Bogotá, Medellin, Colombia
| | | | - Aldo Lopez
- Gynecologic Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - David Kushner
- Gynecologic Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - David Cibula
- Obstetrics and Gynecology, University of Prague, Prague, Czech Republic
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Ma S, Sun B, Li M, Han T, Yu C, Wang X, Zheng X, Li S, Zhu S, Wang Q. High-precision detection and navigation surgery of colorectal cancer micrometastases. J Nanobiotechnology 2023; 21:403. [PMID: 37919717 PMCID: PMC10621104 DOI: 10.1186/s12951-023-02171-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023] Open
Abstract
Surgical resection is an effective treatment for colorectal cancer (CRC) patients, whereas occult metastases hinder the curative effect. Currently, there is no effective method to achieve intraoperatively diagnosis of tumor-positive lymph nodes (LNs). Herein, we adopt a near-infrared-II (NIR-II) organic donor-pi-acceptor-pi-donor probe FE-2PEG, which exhibits bright fluorescence over 1100 nm, excellent photostability, blood circulation time, and biocompatibility, to achieve high-performance bioimaging with improved temporal and spatial resolution. Importantly, the FE-2PEG shows efficient passive enrichment in orthotopic CRC, metastatic mesenteric LNs, and peritoneal metastases by enhanced permeability and retention effect. Under NIR-II fluorescence-guided surgery (FGS), the peritoneal micrometastases were resected with a sensitivity of 94.51%, specificity of 86.59%, positive predictive value (PPV) of 96.57%, and negative predictive value of 79.78%. The PPV still achieves 96.07% even for micrometastases less than 3 mm. Pathological staining and NIR-II microscopy imaging proved that FE-2PEG could successfully delineate the boundary between the tumor and normal tissues. Dual-color NIR-II imaging strategy with FE-2PEG (1100 ~ 1300 nm) and PbS@CdS quantum dots (> 1500 nm) successfully protects both blood supply and normal tissues during surgery. The NIR-II-based FGS provides a promising prospect for precise intraoperative diagnosis and minimally invasive surgery of CRC.
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Affiliation(s)
- Shengjie Ma
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, 130012, People's Republic of China
- Joint Laboratory of Opto-Functional Theranostics in Medicine and Chemistry, The First Hospital of Jilin University, Changchun, 130021, People's Republic of China
| | - Bin Sun
- Joint Laboratory of Opto-Functional Theranostics in Medicine and Chemistry, The First Hospital of Jilin University, Changchun, 130021, People's Republic of China
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun, 130012, People's Republic of China
| | - Mengfei Li
- Joint Laboratory of Opto-Functional Theranostics in Medicine and Chemistry, The First Hospital of Jilin University, Changchun, 130021, People's Republic of China
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun, 130012, People's Republic of China
| | - Tianyang Han
- Joint Laboratory of Opto-Functional Theranostics in Medicine and Chemistry, The First Hospital of Jilin University, Changchun, 130021, People's Republic of China
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun, 130012, People's Republic of China
| | - Chenlong Yu
- Joint Laboratory of Opto-Functional Theranostics in Medicine and Chemistry, The First Hospital of Jilin University, Changchun, 130021, People's Republic of China
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun, 130012, People's Republic of China
| | - Xin Wang
- Joint Laboratory of Opto-Functional Theranostics in Medicine and Chemistry, The First Hospital of Jilin University, Changchun, 130021, People's Republic of China
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun, 130012, People's Republic of China
| | - Xue Zheng
- Joint Laboratory of Opto-Functional Theranostics in Medicine and Chemistry, The First Hospital of Jilin University, Changchun, 130021, People's Republic of China
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun, 130012, People's Republic of China
| | - Shuang Li
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, 130012, People's Republic of China
| | - Shoujun Zhu
- Joint Laboratory of Opto-Functional Theranostics in Medicine and Chemistry, The First Hospital of Jilin University, Changchun, 130021, People's Republic of China.
- State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun, 130012, People's Republic of China.
| | - Quan Wang
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, 130012, People's Republic of China.
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Di Micco R, Fontana SKR, Gentilini OD, Galimberti V. Micrometastases in the sentinel node after neoadjuvant therapy. Is axillary dissection still required? Eur J Cancer Prev 2023; 32:544-547. [PMID: 37401512 DOI: 10.1097/cej.0000000000000821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
The present review intends to discuss the controversies and strengths in clinically node-positive patients with axillary nodal status ypN i+ / mi after neoadjuvant chemotherapy. Over the past 20 years, a de-escalation approach toward axillary surgery has been observed in patients with breast cancer. The worldwide use of sentinel node biopsy in the upfront setting and after primary systemic therapy substantially reduced surgical complications or late sequelae and eventually improving quality of life of patients. However, the role of axillary dissection is still unclear in patients with low residual disease post-chemotherapy, namely those with micrometastases in the sentinel node, and its prognostic role is still not very clear. The aim of the present narrative review is to report the available evidence on this topic, discussing the pros and cons of performing axillary lymph node dissection in the infrequent finding of micrometastases in the sentinel node after neoadjuvant chemotherapy. We will also describe the ongoing prospective studies which are expected to shed light and guide future decisions.
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Affiliation(s)
- Rosa Di Micco
- Breast Surgery Unit, University and Research Hospital San Raffaele, IRCCS and
| | - Sabrina K R Fontana
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Oreste D Gentilini
- Breast Surgery Unit, University and Research Hospital San Raffaele, IRCCS and
| | - Viviana Galimberti
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy
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Cabrera S, Gómez-Hidalgo NR, García-Pineda V, Bebia V, Fernández-González S, Alonso P, Rodríguez-Gómez T, Fusté P, Gracia-Segovia M, Lorenzo C, Chacon E, Roldan Rivas F, Arencibia O, Martí Edo M, Fidalgo S, Sanchis J, Padilla-Iserte P, Pantoja-Garrido M, Martínez S, Peiró R, Escayola C, Oliver-Pérez MR, Aghababyan C, Tauste C, Morales S, Torrent A, Utrilla-Layna J, Fargas F, Calvo A, Aller de Pace L, Gil-Moreno A. Accuracy and Survival Outcomes after National Implementation of Sentinel Lymph Node Biopsy in Early Stage Endometrial Cancer. Ann Surg Oncol 2023; 30:7653-7662. [PMID: 37633852 PMCID: PMC10562309 DOI: 10.1245/s10434-023-14065-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/23/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Sentinel lymph node (SLN) biopsy has recently been accepted to evaluate nodal status in endometrial cancer at early stage, which is key to tailoring adjuvant treatments. Our aim was to evaluate the national implementation of SLN biopsy in terms of accuracy to detect nodal disease in a clinical setting and oncologic outcomes according to the volume of nodal disease. PATIENTS AND METHODS A total of 29 Spanish centers participated in this retrospective, multicenter registry including patients with endometrial adenocarcinoma at preoperative early stage who had undergone SLN biopsy between 2015 and 2021. Each center collected data regarding demographic, clinical, histologic, therapeutic, and survival characteristics. RESULTS A total of 892 patients were enrolled. After the surgery, 12.9% were suprastaged to FIGO 2009 stages III-IV and 108 patients (12.1%) had nodal involvement: 54.6% macrometastasis, 22.2% micrometastases, and 23.1% isolated tumor cells (ITC). Sensitivity of SLN biopsy was 93.7% and false negative rate was 6.2%. After a median follow up of 1.81 years, overall surivial and disease-free survival were significantly lower in patients who had macrometastases when compared with patients with negative nodes, micrometastases or ITC. CONCLUSIONS In our nationwide cohort we obtained high sensitivity of SLN biopsy to detect nodal disease. The oncologic outcomes of patients with negative nodes and low-volume disease were similar after tailoring adjuvant treatments. In total, 22% of patients with macrometastasis and 50% of patients with micrometastasis were at low risk of nodal metastasis according to their preoperative risk factors, revealing the importance of SLN biopsy in the surgical management of patients with early stage EC.
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Affiliation(s)
- Silvia Cabrera
- Gynecologic Oncology Unit, Hospital Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| | - Natalia R Gómez-Hidalgo
- Gynecologic Oncology Unit, Hospital Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | | | - Vicente Bebia
- Gynecologic Oncology Unit, Hospital Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | | | - Paula Alonso
- Department of Obstetrics and Gynecology, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Tomás Rodríguez-Gómez
- Department of Obstetrics and Gynecology, Hospital Virgen de la Victoria, Málaga, Spain
| | - Pere Fusté
- Gynecologic Oncology Unit, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
| | | | - Cristina Lorenzo
- Department of Obstetrics and Gynecology, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
| | - Enrique Chacon
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Fernando Roldan Rivas
- Department of Obstetrics and Gynecology, Hospital Clínico Universitario de Zaragoza, Zaragoza, Spain
| | - Octavio Arencibia
- Department of Obstetrics and Gynecology, Hospital Universitario Gran Canarias Dr. Negrín, Las Palmas, Spain
| | - Marina Martí Edo
- Department of Obstetrics and Gynecology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Soledad Fidalgo
- Department of Obstetrics and Gynecology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Josep Sanchis
- Gynecologic Oncology Unit, Instituto Valenciano de Oncologia (IVO), Valencia, Spain
| | - Pablo Padilla-Iserte
- Gynecologic Oncology Unit, Hospital Politécnico Universitario La Fe, Valencia, Spain
| | - Manuel Pantoja-Garrido
- Department of Obstetrics and Gynecology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Sergio Martínez
- Department of Gynecology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Ricard Peiró
- Department of Obstetrics and Gynecology, Hospital General de Catalunya, Barcelona, Spain
| | - Cecilia Escayola
- Department of Obstetrics and Gynecology, El Pilar Quiron, Barcelona, Spain
| | - M Reyes Oliver-Pérez
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, 12 de Octubre Research Institute (i+12), Complutense University of Madrid, Madrid, Spain
| | - Cristina Aghababyan
- Department of Obstetrics and Gynecology, Hospital General Universitario de Valencia, Valencia, Spain
| | - Carmen Tauste
- Department of Obstetrics and Gynecology, Hospital Universitario de Navarra, Pamplona, Spain
| | - Sara Morales
- Department of Obstetrics and Gynecology, Hospital Infanta Leonor, Madrid, Spain
| | - Anna Torrent
- Department of Obstetrics and Gynecology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Jesus Utrilla-Layna
- Department of Obstetrics and Gynecology, Fundación Jimenez Diaz, Madrid, Spain
| | - Francesc Fargas
- Department of Obstetrics and Gynecology, Hospital Universitari Quirón Dexeus, Barcelona, Spain
| | - Ana Calvo
- Department of Obstetrics and Gynecology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Laura Aller de Pace
- Department of Obstetrics and Gynecology, Hospital Marqués de Valdecilla, Santander, Spain
| | - Antonio Gil-Moreno
- Gynecologic Oncology Unit, Hospital Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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Zhong J, Zou Z, Hu T, Sun W, Wang C, Yan W, Luo Z, Liu X, Xu Y, Chen Y. Survival impact of immediate complete lymph node dissection for Chinese acral and cutaneous melanoma with micrometastasis in sentinel nodes: a retrospective study. Clin Exp Med 2023; 23:4003-4010. [PMID: 37300655 PMCID: PMC10618307 DOI: 10.1007/s10238-023-01107-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023]
Abstract
Sentinel node biopsy (SNB) has become a critical part of standard surgical treatment for melanoma with no clinical metastatic evidence. However, for patients with a positive sentinel node, the MSLT-II and DeCOG-SLT trials have shown that immediate complete lymph node dissection (CLND) does not bring further survival benefits. There is still an argument among the Chinese population dominated by acral subtypes on whether CLND can be omitted. Thus, this study aims to investigate the impact of immediate CLND on relapse-free survival (RFS) in Chinese melanoma patients with a positive sentinel node. Patients with acral or cutaneous melanoma of clinical Stages I-II who received SNB procedure and were detected with nodal micrometastasis were retrospectively collected at Fudan University Cancer Center (FUSCC) from January 2017 to December 2021. The clinicopathologic features and prognostic factors for RFS were analyzed. Out of 381 patients who received SNB in the past 5 years, 130 (34%) cases with SN micrometastasis detected were included in this study. Ninety-nine patients underwent immediate CLND while the other 31 patients received observation alone. Among patients who received CLND, the non-SN(NSN)-positive rate was 22.2%. Most of the clinicopathologic factors were balanced well between the CLND and non-CLND groups. However, more patients in the CLND group were detected with BRAF and NRAS mutation (P = 0.006) and received adjuvant PD-1 monotherapy (P = 0.042) as well. There were slightly fewer N1 patients in the CLND group, although the difference did not reach statistical significance (P = 0.075). The study found no significant difference in RFS between the two groups (P = 0.184). Even for patients with the acral subtype (P = 0.925), primary T4 lesion (P = 0.769), or presence of ulceration (P = 0.249), immediate CLND did not bring more survival benefits. Immediate CLND did not bring further RFS benefit for Chinese melanoma patients with SN micrometastasis in real-world clinical practice, even for patients with acral subtype or more tumor burden such as thick Breslow invasion and ulceration.
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Affiliation(s)
- Jingqin Zhong
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Zijian Zou
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Tu Hu
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Wei Sun
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Chunmeng Wang
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Wangjun Yan
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Zhiguo Luo
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xin Liu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yu Xu
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
| | - Yong Chen
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
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10
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van Haaren ERM, Poodt IGM, Spiekerman van Weezelenburg MA, van Bastelaar J, Janssen A, de Vries B, Lobbes MBI, Bouwman LH, Vissers YLJ. Impact of analysis of the sentinel lymph node by one-step nucleic acid amplification (OSNA) compared to conventional histopathology on axillary and systemic treatment: data from the Dutch nationwide cohort of breast cancer patients. Breast Cancer Res Treat 2023; 202:245-255. [PMID: 37495799 PMCID: PMC10505596 DOI: 10.1007/s10549-023-07065-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/05/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE The outcome of the sentinel lymph node in breast cancer patients affects adjuvant treatment. Compared to conventional histopathology, analysis by one-step nucleic acid amplification (OSNA) harvests more micrometastasis, potentially inducing overtreatment. In this study we investigated the impact of OSNA analysis on adjuvant treatment, compared to histopathological analysis. METHODS Data from T1-3 breast cancer patients with sentinel nodes analysed between January 2016 and December 2019 by OSNA (OSNA group, n = 1086) from Zuyderland Medical Centre, the Netherlands, were compared to concurrent data from the Netherlands Cancer Registry (NKR) where sentinel nodes were examined by histology (histology group, n = 35,143). Primary outcomes were micro- or macrometastasis, axillary treatments (axillary lymph node dissection (ALND) or axillary radiotherapy (ART)), chemotherapy, and endocrine therapy. Statistics with Pearson Chi-square. RESULTS In the OSNA group more micrometastasis (14.9%) were detected compared to the histology group (7.9%, p < 0.001). No difference in axillary treatment between groups was detected (14.3 vs. 14.4%). In case of mastectomy and macrometastasis, ALND was preferred over ART in the OSNA group (14.9%) compared to the histology group (4.4%, p < 0.001). In cases of micrometastasis, no difference was seen. There was no difference in administration of adjuvant chemotherapy between groups. Endocrine treatment was administrated less often in the OSNA group compared to the histology group (45.8% vs. 50.8%, p < 0.002). CONCLUSION More micrometastasis were detected by OSNA compared to histopathology, but no subsequent increase in adjuvant axillary and systematic treatment was noticed. When performing mastectomy and OSNA, there was a preference for ALND compared to ART.
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Affiliation(s)
- Elisabeth R M van Haaren
- Department of Surgery, Zuyderland Medical Centre, Dr. H. Van Der Hoffplein 1, 6162BG, Sittard-Geleen, The Netherlands.
| | - Ingrid G M Poodt
- Department of Surgery, Zuyderland Medical Centre, Dr. H. Van Der Hoffplein 1, 6162BG, Sittard-Geleen, The Netherlands
| | | | - James van Bastelaar
- Department of Surgery, Zuyderland Medical Centre, Dr. H. Van Der Hoffplein 1, 6162BG, Sittard-Geleen, The Netherlands
| | - Alfred Janssen
- Department of Surgery, Zuyderland Medical Centre, Dr. H. Van Der Hoffplein 1, 6162BG, Sittard-Geleen, The Netherlands
| | - Bart de Vries
- Department of Pathology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Marc B I Lobbes
- Department of Radiology and Nuclear Medicine, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Lee H Bouwman
- Department of Surgery, Zuyderland Medical Centre, Dr. H. Van Der Hoffplein 1, 6162BG, Sittard-Geleen, The Netherlands
- Department of Clinical Engineering, Faculty of Science and Engineering, Maastricht University, Maastricht, The Netherlands
| | - Yvonne L J Vissers
- Department of Surgery, Zuyderland Medical Centre, Dr. H. Van Der Hoffplein 1, 6162BG, Sittard-Geleen, The Netherlands
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11
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Zhu YY, Song L, Zhang YQ, Liu WL, Chen WL, Gao WL, Zhang LX, Wang JZ, Ming ZH, Zhang Y, Zhang GJ. Development of a Rare Earth Nanoprobe Enables In Vivo Real-Time Detection of Sentinel Lymph Node Metastasis of Breast Cancer Using NIR-IIb Imaging. Cancer Res 2023; 83:3428-3441. [PMID: 37540231 PMCID: PMC10570679 DOI: 10.1158/0008-5472.can-22-3432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 05/09/2023] [Accepted: 08/02/2023] [Indexed: 08/05/2023]
Abstract
Sentinel lymph node (SLN) biopsy plays a critical role in axillary staging of breast cancer. However, traditional SLN mapping does not accurately discern the presence or absence of metastatic disease. Detection of SLN metastasis largely hinges on examination of frozen sections or paraffin-embedded tissues post-SLN biopsy. To improve detection of SLN metastasis, we developed a second near-infrared (NIR-II) in vivo fluorescence imaging system, pairing erbium-based rare-earth nanoparticles (ErNP) with bright down-conversion fluorescence at 1,556 nm. To visualize SLNs bearing breast cancer, ErNPs were modified by balixafortide (ErNPs@POL6326), a peptide antagonist of the chemokine receptor CXCR4. The ErNPs@POL6326 probes readily drained into SLNs when delivered subcutaneously, entering metastatic breast tumor cells specifically via CXCR4-mediated endocytosis. NIR fluorescence signals increased significantly in tumor-positive versus tumor-negative SLNs, enabling accurate determination of SLN breast cancer metastasis. In a syngeneic mouse mammary tumor model and a human breast cancer xenograft model, sensitivity for SLN metastasis detection was 92.86% and 93.33%, respectively, and specificity was 96.15% and 96.08%, respectively. Of note, the probes accurately detected both macrometastases and micrometastases in SLNs. These results overall underscore the potential of ErNPs@POL6326 for real-time visualization of SLNs and in vivo screening for SLN metastasis. SIGNIFICANCE NIR-IIb imaging of a rare-earth nanoprobe that is specifically taken up by breast cancer cells can accurately detect breast cancer macrometastases and micrometastases in sentinel lymph nodes.
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Affiliation(s)
- Yuan-Yuan Zhu
- Department of Breast-Thyroid-Surgery and Cancer Center, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Fujian Key Laboratory of Precision Diagnosis and Treatment in Breast Cancer (Xiang'an Hospital of Xiamen University), Xiamen, China
- Xiamen Key Laboratory for Endocrine Related Cancer Precision Medicine, Xiang'an Hospital of Xiamen University, Xiamen, China
- Xiamen Research Center of Clinical Medicine in Breast & Thyroid Cancers, Xiamen, China
| | - Liang Song
- State Key Laboratory of Structural Chemistry, Fujian Institute of Research on the Structure of Matter, Chinese Academy of Sciences, Fuzhou, China
- Xiamen Key Laboratory of Rare Earth Photoelectric Functional Materials, Xiamen Institute of Rare Earth Materials, Haixi Institute, Chinese Academy of Sciences, Xiamen, China
| | - Yong-Qu Zhang
- Department of Breast-Thyroid-Surgery and Cancer Center, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Fujian Key Laboratory of Precision Diagnosis and Treatment in Breast Cancer (Xiang'an Hospital of Xiamen University), Xiamen, China
- Xiamen Key Laboratory for Endocrine Related Cancer Precision Medicine, Xiang'an Hospital of Xiamen University, Xiamen, China
- Xiamen Research Center of Clinical Medicine in Breast & Thyroid Cancers, Xiamen, China
| | - Wan-Ling Liu
- Department of Breast-Thyroid-Surgery and Cancer Center, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Fujian Key Laboratory of Precision Diagnosis and Treatment in Breast Cancer (Xiang'an Hospital of Xiamen University), Xiamen, China
- Xiamen Key Laboratory for Endocrine Related Cancer Precision Medicine, Xiang'an Hospital of Xiamen University, Xiamen, China
- Xiamen Research Center of Clinical Medicine in Breast & Thyroid Cancers, Xiamen, China
| | - Wei-Ling Chen
- Department of Breast-Thyroid-Surgery and Cancer Center, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Fujian Key Laboratory of Precision Diagnosis and Treatment in Breast Cancer (Xiang'an Hospital of Xiamen University), Xiamen, China
- Xiamen Key Laboratory for Endocrine Related Cancer Precision Medicine, Xiang'an Hospital of Xiamen University, Xiamen, China
- Xiamen Research Center of Clinical Medicine in Breast & Thyroid Cancers, Xiamen, China
| | - Wen-Liang Gao
- Department of Breast-Thyroid-Surgery and Cancer Center, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Fujian Key Laboratory of Precision Diagnosis and Treatment in Breast Cancer (Xiang'an Hospital of Xiamen University), Xiamen, China
- Xiamen Key Laboratory for Endocrine Related Cancer Precision Medicine, Xiang'an Hospital of Xiamen University, Xiamen, China
- Xiamen Research Center of Clinical Medicine in Breast & Thyroid Cancers, Xiamen, China
| | - Li-Xin Zhang
- Department of Breast-Thyroid-Surgery and Cancer Center, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Fujian Key Laboratory of Precision Diagnosis and Treatment in Breast Cancer (Xiang'an Hospital of Xiamen University), Xiamen, China
- Xiamen Key Laboratory for Endocrine Related Cancer Precision Medicine, Xiang'an Hospital of Xiamen University, Xiamen, China
- Xiamen Research Center of Clinical Medicine in Breast & Thyroid Cancers, Xiamen, China
| | - Jia-Zheng Wang
- Department of Breast-Thyroid-Surgery and Cancer Center, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Fujian Key Laboratory of Precision Diagnosis and Treatment in Breast Cancer (Xiang'an Hospital of Xiamen University), Xiamen, China
- Xiamen Key Laboratory for Endocrine Related Cancer Precision Medicine, Xiang'an Hospital of Xiamen University, Xiamen, China
- Xiamen Research Center of Clinical Medicine in Breast & Thyroid Cancers, Xiamen, China
| | - Zi-He Ming
- Department of Breast-Thyroid-Surgery and Cancer Center, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Fujian Key Laboratory of Precision Diagnosis and Treatment in Breast Cancer (Xiang'an Hospital of Xiamen University), Xiamen, China
- Xiamen Key Laboratory for Endocrine Related Cancer Precision Medicine, Xiang'an Hospital of Xiamen University, Xiamen, China
- Xiamen Research Center of Clinical Medicine in Breast & Thyroid Cancers, Xiamen, China
| | - Yun Zhang
- State Key Laboratory of Structural Chemistry, Fujian Institute of Research on the Structure of Matter, Chinese Academy of Sciences, Fuzhou, China
- Xiamen Key Laboratory of Rare Earth Photoelectric Functional Materials, Xiamen Institute of Rare Earth Materials, Haixi Institute, Chinese Academy of Sciences, Xiamen, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Guo-Jun Zhang
- Department of Breast-Thyroid-Surgery and Cancer Center, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Fujian Key Laboratory of Precision Diagnosis and Treatment in Breast Cancer (Xiang'an Hospital of Xiamen University), Xiamen, China
- Xiamen Key Laboratory for Endocrine Related Cancer Precision Medicine, Xiang'an Hospital of Xiamen University, Xiamen, China
- Xiamen Research Center of Clinical Medicine in Breast & Thyroid Cancers, Xiamen, China
- Cancer Research Center, School of Medicine, Xiamen University, Xiamen, China
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12
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Selvaraj V, Sekaran S, Rajamani Sekar SK. Surgical intervention paradoxically enhances micrometastasis - targeting perioperative variables. Int J Surg 2023; 109:3226-3227. [PMID: 37462983 PMCID: PMC10583896 DOI: 10.1097/js9.0000000000000555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/02/2023] [Indexed: 10/19/2023]
Affiliation(s)
- Vimalraj Selvaraj
- Department of Prosthodontics, Saveetha Dental College and Hospitals, Saveetha Institute for Medical and Technical Sciences, Chennai, Tamil Nadu, India
| | - Saravanan Sekaran
- Department of Prosthodontics, Saveetha Dental College and Hospitals, Saveetha Institute for Medical and Technical Sciences, Chennai, Tamil Nadu, India
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13
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Nguyen CGT, Phillips S, Chen A, Harrison R. Isolated tumor cells in a patient with early-stage cervical cancer. Int J Gynecol Cancer 2023; 33:1479-1481. [PMID: 37268310 DOI: 10.1136/ijgc-2022-004115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Affiliation(s)
- Christine G T Nguyen
- Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Sara Phillips
- Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Athena Chen
- Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Ross Harrison
- Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
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14
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Wang H, Peng Y, Wu J, Chen Z, Zhang H. Effectiveness of post-mastectomy adjuvant chemotherapy for the treatment of patients with prognostic stage IB breast cancer: A SEER-based study. Asian J Surg 2023; 46:3634-3641. [PMID: 37210259 DOI: 10.1016/j.asjsur.2023.04.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/18/2023] [Accepted: 04/26/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Adjuvant chemotherapy (AC) is an important, effective treatment for breast cancer. This study evaluates the effectiveness of post-mastectomy AC in treating patients with prognostic stage IB breast cancer. METHOD We conducted a retrospective cohort-based study using Surveillance, Epidemiology, and End-Results database. Overall survival (OS) and breast cancer-specific survival (BCSS) were calculated using the Kaplan-Meier method. Multivariate Cox risk models were used to identify the impact of AC. Stratified analysis was performed according to molecular subtypes, anatomic stages, and other risk factors to evaluate the effect of AC on survival. RESULTS 28,825 women diagnosed with prognostic stage IB breast cancer were included. The 5-year OS was significantly higher in AC group than in non-adjuvant chemotherapy (NAC) group (P < 0.0001); however, the 5-year BCSS in AC group was significantly lower than in NAC group (P = 0.039). Multivariate analysis revealed that AC was a favorable prognostic factor for OS (P < 0.001), but not BCSS (P = 0.407). AC was not an independent prognostic factor for BCSS in patients with hormone receptor-positive, human epidermal growth factor receptor 2-negative (HR[+]/HER2[-]) subtype or pT1a-1b/N0-1 stage with HER2 overexpression (HER2[+]) subtype, regardless of whether HR was positive or negative (P > 0.05). Meanwhile, AC is not an independent prognostic factor for OS and BCSS in patients with lymph node micrometastases. CONCLUSION Our study demonstrates that patients with prognostic stage IB do not fully benefit from AC. Individualized treatment management is required for patients with pT1a-1b/N0-1 tumors, lymph node micrometastases, or HR(+)/HER2(-) subtypes.
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Affiliation(s)
- HongMei Wang
- Department of Breast Surgery, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian Province, 350001, PR China
| | - Yi Peng
- Department of Breast Surgery, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian Province, 350001, PR China
| | - Jianbin Wu
- Department of Breast Surgery, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian Province, 350001, PR China
| | - ZhuangWei Chen
- Department of Breast Surgery, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian Province, 350001, PR China.
| | - HuaLe Zhang
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian Province, 350001, PR China.
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15
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Matsushima J, Sato T, Yoshimura Y, Mizutani H, Koto S, Matsusaka K, Ikeda JI, Sato T, Fujii A, Ono Y, Mitsui T, Ban S, Matsubara H, Hayashi H. Clinical utility of artificial intelligence assistance in histopathologic review of lymph node metastasis for gastric adenocarcinoma. Int J Clin Oncol 2023; 28:1033-1042. [PMID: 37256523 DOI: 10.1007/s10147-023-02356-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/16/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Advances in whole-slide image capture and computer image analyses using deep learning technologies have enabled the development of computer-assisted diagnostics in pathology. Herein, we built a deep learning algorithm to detect lymph node (LN) metastasis on whole-slide images of LNs retrieved from patients with gastric adenocarcinoma and evaluated its performance in clinical settings. METHODS We randomly selected 18 patients with gastric adenocarcinoma who underwent surgery with curative intent and were positive for LN metastasis at Chiba University Hospital. A ResNet-152-based assistance system was established to detect LN metastases and to outline regions that are highly probable for metastasis in LN images. Reference standards comprising 70 LN images from two different institutions were reviewed by six pathologists with or without algorithm assistance, and their diagnostic performances were compared between the two settings. RESULTS No statistically significant differences were observed between these two settings regarding sensitivity, review time, or confidence levels in classifying macrometastases, isolated tumor cells, and metastasis-negative. Meanwhile, the sensitivity for detecting micrometastases significantly improved with algorithm assistance, although the review time was significantly longer than that without assistance. Analysis of the algorithm's sensitivity in detecting metastasis in the reference standard indicated an area under the curve of 0.869, whereas that for the detection of micrometastases was 0.785. CONCLUSIONS A wide variety of histological types in gastric adenocarcinoma could account for these relatively low performances; however, this level of algorithm performance could suffice to help pathologists improve diagnostic accuracy.
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Affiliation(s)
- Jun Matsushima
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, Japan
- Center for Frontier Medical Engineering, Chiba University, 1-33 Yayoi-Cho, Inage-Ku, Chiba, Chiba, 263-8522, Japan
- Department of Diagnostic Pathology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, Chiba, Japan
| | - Tamotsu Sato
- Toshiba Digital Solutions Corporation, 72-34 Horikawa-Cho, Saiwai-Ku, Kawasaki, Kanagawa, Japan
| | - Yuichiro Yoshimura
- Center for Frontier Medical Engineering, Chiba University, 1-33 Yayoi-Cho, Inage-Ku, Chiba, Chiba, 263-8522, Japan
| | - Hiroyuki Mizutani
- Toshiba Digital Solutions Corporation, 72-34 Horikawa-Cho, Saiwai-Ku, Kawasaki, Kanagawa, Japan
| | - Shinichiro Koto
- Toshiba Digital Solutions Corporation, 72-34 Horikawa-Cho, Saiwai-Ku, Kawasaki, Kanagawa, Japan
| | - Keisuke Matsusaka
- Department of Pathology, Chiba University Hospital, 1-8-1 Inohana, Chuo-Ku, Chiba, Chiba, Japan
| | - Jun-Ichiro Ikeda
- Department of Diagnostic Pathology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, Chiba, Japan
| | - Taiki Sato
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, Japan
| | - Akiko Fujii
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, Japan
| | - Yuko Ono
- Department of Diagnostic Pathology, Dokkyo Medical University, 880 Kitakobayashi, Shimotusugagun, Mibu, Tochigi, Japan
| | - Takashi Mitsui
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya, Japan
| | - Shinichi Ban
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, Chiba, Japan
| | - Hideki Hayashi
- Center for Frontier Medical Engineering, Chiba University, 1-33 Yayoi-Cho, Inage-Ku, Chiba, Chiba, 263-8522, Japan.
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, Chiba, Japan.
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16
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Mangla A. Dissecting the Need for Adjuvant Therapy in Patients With Early-Stage Melanoma With Micrometastases. J Clin Oncol 2023; 41:1324-1325. [PMID: 36455169 DOI: 10.1200/jco.22.01903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/18/2022] [Indexed: 12/05/2022] Open
Affiliation(s)
- Ankit Mangla
- Ankit Mangla, MD, Seidman Cancer Center, University Hospitals, Cleveland, OH, Division of Hematology and Oncology, Case Western Reserve University School of Medicine, Cleveland, OH
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Guerlain J, Marhic A, Casiraghi O, Lumbroso J, Garcia G, Breuskin I, Janot F, Temam S, Gorphe P, Moya-Plana A. Occult nodal metastases in T1-T2cN0 oral squamous cell carcinoma: Correlation between sentinel node positivity and completion neck dissection analysis. Oral Oncol 2023; 139:106338. [PMID: 36807087 DOI: 10.1016/j.oraloncology.2023.106338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/31/2023] [Accepted: 02/12/2023] [Indexed: 02/21/2023]
Abstract
OBJECTIVES Sentinel node procedure (SN) is a standard procedure that has shown its safety and effectiveness for T1/T2 cN0 oral squamous cell carcinoma (OSCC), with completion neck dissection (CND) for patients with positive SN. The aim of this study was to characterize the nodal involvement in a cohort of SN + OSCC. MATERIALS AND METHODS Patients with T1/T2 cN0 OSCC with positive SN with CND were included in this single-center, prospective cohort study between 2000 and 2013. RESULTS 54/301 patients had at least one positive SN. In 43/54 (80 %) cases, only the SN(s) were invaded; with only one SN involved (SN+=1) in 36/54 (67 %) cases. No predictive factors of nodal involvement in the CND were found considering the followings: SN micro/macrometastases, primary tumor's depth of invasion (DOI), perineural spread, lymphovascular involvement, primary tumor location, T stage and extranodal extension. The SN micrometastatic involvement (n = 22) was significantly associated with only one SN + CND- (p = 0.017). In the group of patients with unique micrometastatic involvement in the SN (n = 20/54), there was a higher isolated nodal recurrence free time (p = 0.017). CONCLUSION 80% of T1/T2 cN0 OSCC with positive SN had no other lymph node metastases in the CND, questioning the potential benefits of this procedure. Predictive factors such as the size of the SN metastasis need to be tested to stratify the risk of positive non-SN lymph nodes leading to a personalized treatment, lowering the therapeutic morbidity while maintaining the oncologic safety.
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Affiliation(s)
- J Guerlain
- Head & Neck Oncology Department, Gustave Roussy Cancer Campus, Grand Paris, France.
| | - A Marhic
- Head & Neck Oncology Department, Gustave Roussy Cancer Campus, Grand Paris, France
| | - O Casiraghi
- Department of Pathology, Gustave Roussy Cancer Campus, Grand Paris, France
| | - J Lumbroso
- Nuclear Medicine Department, Gustave Roussy Cancer Campus, Grand Paris, France
| | - G Garcia
- Department of Medical Imaging, Gustave Roussy Cancer Campus, Grand Paris, France
| | - I Breuskin
- Head & Neck Oncology Department, Gustave Roussy Cancer Campus, Grand Paris, France
| | - F Janot
- Head & Neck Oncology Department, Gustave Roussy Cancer Campus, Grand Paris, France
| | - S Temam
- Head & Neck Oncology Department, Gustave Roussy Cancer Campus, Grand Paris, France
| | - P Gorphe
- Head & Neck Oncology Department, Gustave Roussy Cancer Campus, Grand Paris, France
| | - A Moya-Plana
- Head & Neck Oncology Department, Gustave Roussy Cancer Campus, Grand Paris, France
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18
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Dostálek L, Benešová K, Klát J, Kim SH, Falconer H, Kostun J, Dos Reis R, Zapardiel I, Landoni F, Ortiz DI, van Lonkhuijzen LRCW, Lopez A, Odetto D, Borčinová M, Jarkovsky J, Salehi S, Němejcová K, Bajsová S, Park KJ, Javůrková V, Abu-Rustum NR, Dundr P, Cibula D. Stratification of lymph node metastases as macrometastases, micrometastases, or isolated tumor cells has no clinical implication in patients with cervical cancer: Subgroup analysis of the SCCAN project. Gynecol Oncol 2023; 168:151-156. [PMID: 36442426 PMCID: PMC10413820 DOI: 10.1016/j.ygyno.2022.11.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/14/2022] [Accepted: 11/17/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND In cervical cancer, presence of lymph-node macrometastases (MAC) is a major prognostic factor and an indication for adjuvant treatment. However, since clinical impact of micrometastases (MIC) and isolated tumor-cells (ITC) remains controversial, we sought to identify a cut-off value for the metastasis size not associated with negative prognosis. METHODS We analyzed data from 967 cervical cancer patients (T1a1L1-T2b) registered in the SCCAN (Surveillance in Cervical CANcer) database, who underwent primary surgical treatment, including sentinel lymph-node (SLN) biopsy with pathological ultrastaging. The size of SLN metastasis was considered a continuous variable and multiple testing was performed for cut-off values of 0.01-1.0 mm. Disease-free survival (DFS) was compared between N0 and subgroups of N1 patients defined by cut-off ranges. RESULTS LN metastases were found in 172 (18%) patients, classified as MAC, MIC, and ITC in 79, 54, and 39 patients, respectively. DFS was shorter in patients with MAC (HR 2.20, P = 0.003) and MIC (HR 2.87, P < 0.001), while not differing between MAC/MIC (P = 0.484). DFS in the ITC subgroup was neither different from N0 (P = 0.127) nor from MIC/MAC subgroups (P = 0.449). Cut-off analysis revealed significantly shorter DFS compared to N0 in all subgroups with metastases ≥0.4 mm (HR 2.311, P = 0.04). The significance of metastases <0.4 mm could not be assessed due to limited statistical power (<80%). We did not identify any cut-off for the size of metastasis with significantly better prognosis than the rest of N1 group. CONCLUSIONS In cervical cancer patients, the presence of LN metastases ≥0.4 mm was associated with a significant negative impact on DFS and no cut-off value for the size of metastasis with better prognosis than N1 was found. Traditional metastasis stratification based on size has no clinical implication.
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Affiliation(s)
- Lukáš Dostálek
- Department of Obstetrics and Gynecology, General Teaching Hospital and The First Faculty of Medicine of Charles University in Prague, Prague, Czech Republic
| | - Klára Benešová
- Institute of Biostatistics and Analyses, Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jaroslav Klát
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospital and University of Ostrava, Ostrava, Czech Republic
| | - Sarah H Kim
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Henrik Falconer
- Department of Pelvic Cancer, Karolinska University Hospital and Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Jan Kostun
- Department of Gynaecology and Obstetrics, University Hospital Pilsen, Charles University, Prague, Czech Republic
| | - Ricardo Dos Reis
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain
| | - Fabio Landoni
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, Department of Obstetrics and Gynecology, Gynaecologic Oncology Surgical Unit, ASST-Monza, San Gerardo Hospital, Monza, Italy
| | - David Isla Ortiz
- Gynecology Oncology Center, National Institute of Cancerology Mexico, Ciudad De Mexico, Mexico
| | - Luc R C W van Lonkhuijzen
- Department of Gynecological Oncology, Amsterdam University Medical Center-Center for Gynecological Oncology Amsterdam, Amsterdam, Netherlands
| | - Aldo Lopez
- Department of Gynecological Surgery, National Institute of Neoplastic Diseases, Lima, Peru
| | - Diego Odetto
- Department of Gynecologic Oncology, Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina
| | - Martina Borčinová
- Department of Obstetrics and Gynecology, General Teaching Hospital and The First Faculty of Medicine of Charles University in Prague, Prague, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Sahar Salehi
- Department of Pelvic Cancer, Karolinska University Hospital and Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Kristýna Němejcová
- Department of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Sylva Bajsová
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospital and University of Ostrava, Ostrava, Czech Republic
| | - Kay J Park
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Veronika Javůrková
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospital and University of Ostrava, Ostrava, Czech Republic
| | - Nadeem R Abu-Rustum
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Pavel Dundr
- Department of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - David Cibula
- Department of Obstetrics and Gynecology, General Teaching Hospital and The First Faculty of Medicine of Charles University in Prague, Prague, Czech Republic.
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Moncrieff MD, Lo SN, Scolyer RA, Heaton MJ, Nobes JP, Snelling AP, Carr MJ, Nessim C, Wade R, Peach AH, Kisyova R, Mason J, Wilson ED, Nolan G, Pritchard Jones R, Johansson I, Olofsson Bagge R, Wright LJ, Patel NG, Sondak VK, Thompson JF, Zager JS. Clinical Outcomes and Risk Stratification of Early-Stage Melanoma Micrometastases From an International Multicenter Study: Implications for the Management of American Joint Committee on Cancer IIIA Disease. J Clin Oncol 2022; 40:3940-3951. [PMID: 35849790 DOI: 10.1200/jco.21.02488] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 05/04/2022] [Accepted: 06/17/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Indications for offering adjuvant systemic therapy for patients with early-stage melanomas with low disease burden sentinel node (SN) micrometastases, namely, American Joint Committee on Cancer (AJCC; eighth edition) stage IIIA disease, are presently controversial. The current study sought to identify high-risk SN-positive AJCC stage IIIA patients who are more likely to derive benefit from adjuvant systemic therapy. METHODS Patients were recruited from an intercontinental (Australia/Europe/North America) consortium of nine high-volume cancer centers. All were adult patients with pathologic stage pT1b/pT2a primary cutaneous melanomas who underwent SN biopsy between 2005 and 2020. Patient data, primary tumor and SN characteristics, and survival outcomes were analyzed. RESULTS Three thousand six hundred seven patients were included. The median follow-up was 34 months. Pairwise disease comparison demonstrated no significant survival difference between N1a and N2a subgroups. Survival analysis identified a SN tumor deposit maximum dimension of 0.3 mm as the optimal cut point for stratifying survival. Five-year disease-specific survival rates were 80.3% and 94.1% for patients with SN metastatic tumor deposits ≥ 0.3 mm and < 0.3 mm, respectively (hazard ratio, 1.26 [1.11 to 1.44]; P < .0001). Similar findings were seen for overall disease-free and distant metastasis-free survival. There were no survival differences between the AJCC IB patients and low-risk (< 0.3 mm) AJCC IIIA patients. The newly identified high-risk (≥ 0.3 mm) subgroup comprised 271 (66.4%) of the AJCC IIIA cohort, whereas only 142 (34.8%) patients had SN tumor deposits > 1 mm in maximum dimension. CONCLUSION Patients with AJCC IIIA melanoma with SN tumor deposits ≥ 0.3 mm in maximum dimension are at higher risk of disease progression and may benefit from adjuvant systemic therapy or enrollment into a clinical trial. Patients with SN deposits < 0.3 mm in maximum dimension can be managed similar to their SN-negative, AJCC IB counterparts, thereby avoiding regular radiological surveillance and more intensive follow-up.
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Affiliation(s)
- Marc D Moncrieff
- Norfolk and Norwich University Hospital NHS Trust, Norwich, United Kingdom
| | - Serigne N Lo
- Melanoma Institute of Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Richard A Scolyer
- Melanoma Institute of Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- NSW Health Pathology, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Martin J Heaton
- Norfolk and Norwich University Hospital NHS Trust, Norwich, United Kingdom
| | - Jenny P Nobes
- Norfolk and Norwich University Hospital NHS Trust, Norwich, United Kingdom
| | - Andrew P Snelling
- Norfolk and Norwich University Hospital NHS Trust, Norwich, United Kingdom
| | | | - Carolyn Nessim
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Ryckie Wade
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - A Howard Peach
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Rumi Kisyova
- North Bristol Hospital NHS Trust, Bristol, United Kingdom
| | - Jennifer Mason
- North Bristol Hospital NHS Trust, Bristol, United Kingdom
| | - Ewan D Wilson
- North Bristol Hospital NHS Trust, Bristol, United Kingdom
| | - Grant Nolan
- St Helens and Knowsley NHS Teaching Hospitals Trust, Liverpool, United Kingdom
| | | | - Iva Johansson
- Sahlgrenska Centre for Cancer Research, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Roger Olofsson Bagge
- Sahlgrenska Centre for Cancer Research, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lucie J Wright
- United Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Nakul G Patel
- United Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | | | - John F Thompson
- Melanoma Institute of Australia, The University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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20
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Gužvić M, Engelmann S, Burger M, Mayr R. [Disseminated tumour cells in bladder cancer]. Urologie 2022; 61:728-733. [PMID: 35925248 DOI: 10.1007/s00120-022-01849-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Abstract
Molecular analysis of disseminated tumour cells (DTC) may aid in predicting the course of the disease and response to therapies in individual patients. It has been shown in bladder cancer and many other cancer types that the presence of disseminated tumour cells or occult micrometastases in bone marrow or lymph nodes is associated with shorter survival. This type of analysis is particularly important for patients who have been declared disease-free after postsurgery histopathological and clinical imaging analysis. However, comprehensive molecular analysis of disseminated tumour cells is challenging due to the low amount of material and great heterogeneity of the disease. Therefore, currently the routine molecular analysis of these cells is hardly possible in daily clinical practice. Nevertheless, we see daily advances in clinical utility of analysis of cellular or cell-free liquid biopsy analytes taken before, during or after surgery. These advances will enable an integration of translational research workflows into clinical decision-making.
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Affiliation(s)
- Miodrag Gužvić
- Lehrstuhl für Urologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Simon Engelmann
- Klinik für Urologie, Universität Regensburg, Caritas-Krankenhaus St. Josef, Landshuter Str. 65, 93053, Regensburg, Deutschland
| | - Maximilian Burger
- Lehrstuhl für Urologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
- Klinik für Urologie, Universität Regensburg, Caritas-Krankenhaus St. Josef, Landshuter Str. 65, 93053, Regensburg, Deutschland
| | - Roman Mayr
- Lehrstuhl für Urologie, Universitätsklinikum Regensburg, Regensburg, Deutschland.
- Klinik für Urologie, Universität Regensburg, Caritas-Krankenhaus St. Josef, Landshuter Str. 65, 93053, Regensburg, Deutschland.
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21
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Sun J, Wu S, Jin Z, Ren S, Cho WC, Zhu C, Shen J. Lymph node micrometastasis in non-small cell lung cancer. Biomed Pharmacother 2022; 149:112817. [PMID: 35303567 DOI: 10.1016/j.biopha.2022.112817] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/25/2022] [Accepted: 03/09/2022] [Indexed: 11/18/2022] Open
Abstract
Lung cancer has some of the highest morbidity and mortality rates of all cancers, and an important risk factor for mortality in patients with lung cancer is tumor metastasis. Even if a tumor is completely removed at an early stage of the disease, quite a number of patients still have the risk of recurrence. With the advent of molecular diagnostic and therapeutics, more and more studies have found that a poor prognosis may be related to lymph node micrometastasis. However, clinicians still find that predicting the prognosis and choosing the type of surgery and postoperative adjuvant chemotherapy are still challenging. Thus, this article reviews the current research status of lymph node micrometastasis in non-small cell lung cancer, envision to provide some updates and insights in this area.
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Affiliation(s)
- Jiajing Sun
- Taizhou Hospital, Zhejiang University, Taizhou, China
| | - Sikai Wu
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Zixian Jin
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Sijia Ren
- Taizhou Hospital, Zhejiang University, Taizhou, China
| | - William C Cho
- Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong, China
| | - Chengchu Zhu
- Taizhou Hospital, Zhejiang University, Taizhou, China.
| | - Jianfei Shen
- Taizhou Hospital, Zhejiang University, Taizhou, China.
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22
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Chuang WY, Chen CC, Yu WH, Yeh CJ, Chang SH, Ueng SH, Wang TH, Hsueh C, Kuo CF, Yeh CY. Identification of nodal micrometastasis in colorectal cancer using deep learning on annotation-free whole-slide images. Mod Pathol 2021; 34:1901-1911. [PMID: 34103664 PMCID: PMC8443445 DOI: 10.1038/s41379-021-00838-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 01/17/2023]
Abstract
Detection of nodal micrometastasis (tumor size: 0.2-2.0 mm) is challenging for pathologists due to the small size of metastatic foci. Since lymph nodes with micrometastasis are counted as positive nodes, detecting micrometastasis is crucial for accurate pathologic staging of colorectal cancer. Previously, deep learning algorithms developed with manually annotated images performed well in identifying micrometastasis of breast cancer in sentinel lymph nodes. However, the process of manual annotation is labor intensive and time consuming. Multiple instance learning was later used to identify metastatic breast cancer without manual annotation, but its performance appears worse in detecting micrometastasis. Here, we developed a deep learning model using whole-slide images of regional lymph nodes of colorectal cancer with only a slide-level label (either a positive or negative slide). The training, validation, and testing sets included 1963, 219, and 1000 slides, respectively. A supercomputer TAIWANIA 2 was used to train a deep learning model to identify metastasis. At slide level, our algorithm performed well in identifying both macrometastasis (tumor size > 2.0 mm) and micrometastasis with an area under the receiver operating characteristics curve (AUC) of 0.9993 and 0.9956, respectively. Since most of our slides had more than one lymph node, we then tested the performance of our algorithm on 538 single-lymph node images randomly cropped from the testing set. At single-lymph node level, our algorithm maintained good performance in identifying macrometastasis and micrometastasis with an AUC of 0.9944 and 0.9476, respectively. Visualization using class activation mapping confirmed that our model identified nodal metastasis based on areas of tumor cells. Our results demonstrate for the first time that micrometastasis could be detected by deep learning on whole-slide images without manual annotation.
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Affiliation(s)
- Wen-Yu Chuang
- Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | | | | | - Chi-Ju Yeh
- Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Shang-Hung Chang
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shir-Hwa Ueng
- Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
- Chang Gung Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Tong-Hong Wang
- Tissue Bank, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chuen Hsueh
- Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chang-Fu Kuo
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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23
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Abstract
Immune checkpoint blockade (ICB) is transforming treatment for many cancers. While ICB alone initially demonstrated efficacy in patients with metastatic melanoma, it has expanded to other types and to earlier-stage cancers. We describe ICB history, mechanisms underlying variation in response, and how ICB is being integrated into adjuvant and neoadjuvant treatment approaches.
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Affiliation(s)
- Yelena Y Janjigian
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA.
| | - Jedd D Wolchok
- Melanoma and Immunotherapeutics, Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA; Gastric and Mixed Tumor Service, Department of Surgery, Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
| | - Charlotte E Ariyan
- Department of Surgery, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
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24
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Wettstein MS, David LA, Pazhepurackel C, Qureshi AA, Zisman A, Nesbitt M, Saba K, Herrera-Caceres JO, Fankhauser CD, Ahmad A, Hamilton RJ, Eberli D, Zlotta AR, Sulser T, Fleshner NE, Poyet C, Finelli A, Hermanns T, Kulkarni GS. Benefit of a more extended pelvic lymph node dissection among patients undergoing radical prostatectomy for localized prostate cancer: A causal mediation analysis. Prostate 2021; 81:286-294. [PMID: 33599318 DOI: 10.1002/pros.24105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 12/31/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND The therapeutic role of extended (ePLND) versus nonextended pelvic lymph node dissection (nePLND) to remove occult micrometastases in men undergoing radical prostatectomy for localized prostate cancer (PC) is conflicting. Therefore, our aim was to quantify the direct effect of ePLND versus nePLND (removal of occult micrometastases), which is not mediated through the detection of nodal disease and potential adjuvant therapy (indirect effect). METHODS Retrospective, bi-center cohort study of consecutive patients undergoing radical prostatectomy and PLND for PC (January 2006 and December 2016). Patients were followed until April 2018 for the occurrence of either biochemical recurrence or secondary therapy (composite outcome). ePLND was compared to nePLND by unweighted and weighted survival analysis (total effect) as well as by causal mediation analysis (direct and indirect effect). RESULTS Positive nodal disease was detected in 71 (7%) out of 1008 patients undergoing radical prostatectomy and PLND for PC (ePLND: 368 [36.5%]; nePLND: 640 [63.5%]). Survival analysis demonstrated results in favor of ePLND (unweighted hazard ratio: 0.77 [95% confidence interval: 0.59-1.01], p = .056; weighted hazard ratio: 0.75 [0.56-0.99], p = .044). The causal mediation analysis confirmed the total effect of 0.77 (0.71-0.82). After disentangling this total effect into an indirect effect (via detection of nodal disease and potential adjuvant therapy) and a direct effect (via removal of occult micrometastases), we identified an even more protective direct effect of 0.69 (0.63-0.75). CONCLUSIONS Our results not only indicate the utility of ePLND but also that its impact is not restricted to a staging benefit and probably involves a therapeutic benefit mediated through the removal of occult micrometastases.
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Affiliation(s)
- Marian S Wettstein
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Urology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Luke A David
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Clinsy Pazhepurackel
- Department of Urology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Aatif A Qureshi
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Alex Zisman
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Michael Nesbitt
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Karim Saba
- Department of Urology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Jaime O Herrera-Caceres
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Christian D Fankhauser
- Department of Urology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Ardalan Ahmad
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Eberli
- Department of Urology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Alexandre R Zlotta
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Tullio Sulser
- Department of Urology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Neil E Fleshner
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Cédric Poyet
- Department of Urology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Antonio Finelli
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Hermanns
- Department of Urology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Girish S Kulkarni
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
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25
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Hintzen KFH, de Rooij L, Schouten N, van Bastelaar J, Cörvers SAJ, Janssen A, van Haaren ERM, Vissers YLJ. Molecular analysis of sentinel lymph nodes in patients with breast cancer using one-step nucleic acid amplification (OSNA): Does not lead to overtreatment in the current era of de-escalating axillary management. Surg Oncol 2020; 35:224-228. [PMID: 32932218 DOI: 10.1016/j.suronc.2020.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/24/2020] [Accepted: 09/07/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE OSNA is a molecular technique for sentinel lymph node (SN) analysis in breast cancer. Compared to histology, OSNA may yield more (micro)metastases and thereby result in more axillary lymph node dissections or radiotherapy. We investigated whether axillary treatments increase when using OSNA, applying current guidelines for de-escalating axillary management. METHODS All patients treated for cT1-3N0 breast cancer in our hospital between December 2013 and February 2016 were included. In 148 prospectively included patients (January 2015-February 2016), SN's were examined with OSNA. In a retrospective cohort of 123 patients (December 2013-December 2014), SN's were examined with conventional histology. Outcomes were: number of macro and micrometastases, amount of patients receiving axillary dissection or irradiation, number of patients receiving adjuvant systemic therapy. Data were analyzed using Mann-Whitney and Pearson Chi-square test. P < 0.05 was considered statistically significant. RESULTS 230 SN's from 123 patients were examined with conventional histology. 229 SN's from 148 patients were evaluated with OSNA. Amount of macrometastases was equal between groups (histology 17.9% versus OSNA 16.2%, p = 0.715). We found significantly more micrometastases when using OSNA (histology 11.4% versus OSNA 25.0%, p = 0.004). Total number of axillary lymph node dissections was comparable in both groups (histology 12.2%, OSNA 12.2%, p = 0.993), as well as number of axillary radiations (histology 8.9%, OSNA 11.5%, p = 0.493). Also, the number of patients receiving adjuvant systemic therapy was similar between conventional histology and OSNA (histology 53.7% versus OSNA 58.1%, p = 0.462). CONCLUSION OSNA analysis for SN in breast cancer is a highly sensitive technique, detecting more micrometastases than standard histology. When applying current guidelines, OSNA analysis does not lead to overtreatment with more axillary dissections or irradiation.
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Affiliation(s)
- K F H Hintzen
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | - L de Rooij
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands.
| | - N Schouten
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | - J van Bastelaar
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | - S A J Cörvers
- Department of Pathology, Zuyderland Medical Center, Sittard, the Netherlands
| | - A Janssen
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | - E R M van Haaren
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | - Y L J Vissers
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands.
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Marano A, Sodano B, Vitiello C, Martini AM, Baldassarre F, Siciliano A, Iannaci G. Sentinel lymph node biopsy with intraoperative touch imprint cytology (TIC) in breast cancer: experience of a mild-volume center. G Chir 2020; 41:94-98. [PMID: 32038018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Although considered the gold standard in treatment of EBC, sentinel node biopsy still remains a debated issue. What to do in case of positive sentinel node and the need of intraoperative histological examination are the most topics under discussion. In this study we have retrospectively evaluate our case series of 359 sentinel node biopsy in the managing of breast cancer from January 2011 to December 2018, focusing on the TIC technique for performing intraoperative examination. It results in 12,8% "FALSE NEGATIVE" rate, in which only 4,2% in macrometastases, with an overall sensitivity of 68,4% (macrometastases: 86%; micrometastases: 11%), overall specificity of 98,7% and an overall accuracy of 89,7%. The intraoperative examination of SLN allows to reduce delayed surgery procedures and greater therapeutic safety in case of mastectomy. The TIC method can be considered valid, simple and rapid in identifying macrometastases, also allowing to avoid under-staging. The low sensitivity for micrometastases is not a limit, considering that recent evidence has drastically reduced the indications for ALND in these cases. Further ongoing trials and the possible validation of NOMOGRAMMS and SCORE are necessary to identify low risk cases in which to definitively omit the ALND and/or even the SLNB itself.
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Basnet H, Tian L, Ganesh K, Huang YH, Macalinao DG, Brogi E, Finley LWS, Massagué J. Flura-seq identifies organ-specific metabolic adaptations during early metastatic colonization. eLife 2019; 8:e43627. [PMID: 30912515 PMCID: PMC6440742 DOI: 10.7554/elife.43627] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/06/2019] [Indexed: 12/20/2022] Open
Abstract
Metastasis-initiating cells dynamically adapt to the distinct microenvironments of different organs, but these early adaptations are poorly understood due to the limited sensitivity of in situ transcriptomics. We developed fluorouracil-labeled RNA sequencing (Flura-seq) for in situ analysis with high sensitivity. Flura-seq utilizes cytosine deaminase (CD) to convert fluorocytosine to fluorouracil, metabolically labeling nascent RNA in rare cell populations in situ for purification and sequencing. Flura-seq revealed hundreds of unique, dynamic organ-specific gene signatures depending on the microenvironment in mouse xenograft breast cancer micrometastases. Specifically, the mitochondrial electron transport Complex I, oxidative stress and counteracting antioxidant programs were induced in pulmonary micrometastases, compared to mammary tumors or brain micrometastases. We confirmed lung metastasis-specific increase in oxidative stress and upregulation of antioxidants in clinical samples, thus validating Flura-seq's utility in identifying clinically actionable microenvironmental adaptations in early metastasis. The sensitivity, robustness and economy of Flura-seq are broadly applicable beyond cancer research.
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Affiliation(s)
- Harihar Basnet
- Cancer Biology and Genetics Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer CenterNew YorkUnited States
| | - Lin Tian
- Cancer Biology and Genetics Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer CenterNew YorkUnited States
| | - Karuna Ganesh
- Cancer Biology and Genetics Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer CenterNew YorkUnited States
- Department of MedicineSloan Kettering Institute, Memorial Sloan Kettering Cancer CenterNew YorkUnited States
| | - Yun-Han Huang
- Cancer Biology and Genetics Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer CenterNew YorkUnited States
- Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD ProgramNew YorkUnited States
- Louis V. Gerstner, Jr. Graduate School of Biomedical Sciences, Memorial Sloan Kettering Cancer CenterNew YorkUnited States
| | - Danilo G Macalinao
- Cancer Biology and Genetics Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer CenterNew YorkUnited States
- Louis V. Gerstner, Jr. Graduate School of Biomedical Sciences, Memorial Sloan Kettering Cancer CenterNew YorkUnited States
| | - Edi Brogi
- Department of PathologyMemorial Sloan Kettering Cancer CenterNew YorkUnited States
| | - Lydia WS Finley
- Cell Biology ProgramSloan Kettering Institute, Memorial Sloan Kettering Cancer CenterNew YorkUnited States
| | - Joan Massagué
- Cancer Biology and Genetics Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer CenterNew YorkUnited States
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Hambálek J, Maděrka M, Kolečková M, Pilka R. Low-volume metastatic nodal disease in endometrial cancer. Ceska Gynekol 2019; 84:458-462. [PMID: 31948256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIM To review contemporary knowledge of the low volume metastatic disease in patients with endometrial cancer. TYPE OF STUDY A literatue review. SETTINGS Department of Obstetrics and Gynecology, University Hospital Olomouc; Department of Clinical and Molecular Pathology, University Hospital Olomouc. INTRODUCTION The presence of micrometastases or isolated tumor cells in the sentinel node detected by ultrastaging leads to the change of tumor stage. Low volume lymph node involvement represents up to 30% of the affected lymph nodes in patients with endometrial cancer. The enhanced sentinel lymph node investigation aims to more accurately determine the extent of illness from stage I to stage IIIC. Particularly important is the detection of low-volume metastatic nodal involvement in low-risk tumors, because compared with macrometastases, micrometastases may occure earlier in tumours with lower carcinologic aggressiveness. CONCLUSION Detection of low volume metastatic disease decrease the false negativity of nodal involvement and is helpful for adjuvant treatment planning.
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Brito MJ, Honavar M, Cipriano MA, Lopes J, Coelho H, Silva AR, Silva M, Guimarães S, Frutuoso A, Gomes A, Barbosa E, Carlos S. Molecular Staging of Patients with Colon Cancer. The C-Closer-II Study: A Multicentre Study in Portugal. ACTA MEDICA PORT 2018; 31:661-669. [PMID: 30521460 DOI: 10.20344/amp.9696] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 08/28/2018] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Approximately 20% - 30% of histological lymph node-negative patients with colorectal cancer relapse at five years after surgical treatment. This recurrence is likely due to occult nodal disease undetected by standard histopathological practice which has implications in terms of the clinical management of patients. MATERIAL AND METHODS Lymph nodes were collected from colectomy specimens. A central section from each lymph node was histologically examined following haematoxylin-eosin staining and the remaining tissue was subjected to OSNA - one step nucleic acid amplification analysis. RESULTS A total of 1046 lymph nodes from 59 pN0 patients were assessed. Of these, 753 lymph nodes were examined by both methods. The median number of lymph nodes assessed with OSNA - one step nucleic acid amplification was 12 (IQR: 7;16). Among pN0 patients, 17 had OSNA - one step nucleic acid amplification-positive lymph nodes, resulting in a positive molecular staging rate of 28.8% (95% CI: 17.8 - 42.1). Among these patients, 12 (70.59%) were molecular-staged as pN1 and 5 (29.41%) were molecular staged as pN2. The tumour burden of lymph nodes assessed with OSNA - one step nucleic acid amplification ranged from 270 to 17 000 cytokeratin 19 mRNA copies/μL. Most of these patients (88.2%) were found to have lymph nodes with micrometastases only (250 - 4999 copies/μL). DISCUSSION We provide the results from the first study of the use of the OSNA - one step nucleic acid amplification assay in colorectal cancer patients in Portugal. Our results are in-line with other international studies, showing the improvement on patients' staging by molecular examination of lymph nodes. CONCLUSION In our study, 28.8% of patients with histologically negative lymph nodes were found to have metastatic lymph nodes using OSNA - one step nucleic acid molecular assessment. OSNA - one step nucleic acid assay allows a more accurate staging of patients with colorectal cancer and standardizes lymph node assessment.
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Affiliation(s)
- Maria José Brito
- Serviço de Anatomia Patológica. Hospital Garcia de Orta. Almada. Portugal
| | - Mrinalini Honavar
- Serviço de Anatomia Patológica. Hospital Pedro Hispano. Matosinhos. Portugal
| | - Maria Augusta Cipriano
- Serviço de Anatomia Patológica. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Joanne Lopes
- Serviço de Anatomia Patológica. Centro Hospitalar de São João. Porto. Portugal
| | - Helder Coelho
- Serviço de Anatomia Patológica. Hospital Garcia de Orta. Almada. Portugal
| | | | - Mário Silva
- Serviço de Anatomia Patológica. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Susana Guimarães
- Serviço de Anatomia Patológica. Centro Hospitalar de São João. Porto. Portugal
| | - Amaro Frutuoso
- Serviço de Anatomia Patológica. Hospital Pedro Hispano. Matosinhos. Portugal
| | - Ana Gomes
- Serviço de Anatomia Patológica. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Elisabete Barbosa
- Serviço de Cirurgia Geral. Centro Hospitalar de São João. Porto. Portugal
| | - Sandra Carlos
- Serviço de Cirurgia Geral. Hospital Garcia de Orta. Almada. Portugal
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Abstract
The aim of this study was to evaluate the effect of laparoscopic radical hysterectomy on expressions of circulating tumor cells (CTCs) of cytokeratin 19 (CK19), cytokeratin 20 (CK20), and squamous cell carcinoma antigen (SCC-Ag) mRNA.We collect 78 patients with stage IA2-IIA1 cervical cancer who underwent radical hysterectomy by laparotomy or laparoscopy in our study, and 34 uterine fibroids patients and 32 healthy subjects were recruited as the positive control group and negative control group, respectively. Blood samples were taken from early-stage primary cervical squamous cell carcinoma patients. Real-time reverse transcription polymerase chain reaction (RT-PCR) was used to amplify peripheral blood CK19, CK20 and SCC-Ag from total RNA. We measured the expression of CK19, CK20, and SCC-Ag before laparoscopic radical hysterectomy, 24 hours and 30 days after surgery. Meanwhile, the expression of these markers was compared between laparoscopic and laparotomy groups.The expressions of CK19, CK20, and SCC-Ag in the experimental group before surgery were (0.0035 ± 0.0018), (1.06 ± 0.49), and (1.48 ± 0.46), respectively, and the positive rates were 32.1%, 33.3%, and 35.9%, respectively. The expression levels of CK19, CK20, and SCC-Ag in the experimental group before surgery was significantly higher than the positive and negative control groups, and there were no significant differences between the positive and negative control groups. The expressions and positive rates of CK19, CK20, and SCC-Ag before laparoscopic radical hysterectomy were significantly lower than the stage at 24 hours after surgery (P < .05), but higher than the stage at 30 days after surgery (P > .05). There were no significant differences in CK19, CK20, and SCC-Ag expressions before surgery, 24 hours and 30 days after surgery between laparoscopic group and laparotomy group (P > .05).Both laparotomy and laparoscopic radical mastectomy tend to increase the expression of CTCs in peripheral blood, and the expressions have no differences between these 2 groups. So, the use of CK19, CK20, and SCC-Ag expression levels from peripheral blood from early stage cervical cancer radical patients before hysterectomy can aid to overcome the lack of radiographic examination and tumor markers measurement, and provide clues for postoperative treatment and prognosis determination.
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Affiliation(s)
- Xiang-Qun Wei
- Department of Gynecology, The Second People's Hospital of Yunnan Province (Fourth Affiliated Hospital of Kunming Medical University), 176 Qingnian Road, Kunming, Yunnan Province
| | - Yuan Ma
- Department of Gynecology, Hospital of Maternal and Child Health of Tangshan, Tangshan, Hebei Province, China
| | - Yan Chen
- Yunnan Tumor Institute, Third Affiliated Hospital of Kunming Medical University (Tumor Hospital of Yunnan Province), Kunming, Yunnan Province
| | - Xin Liu
- Yunnan Tumor Institute, Third Affiliated Hospital of Kunming Medical University (Tumor Hospital of Yunnan Province), Kunming, Yunnan Province
| | - Min Zhao
- Yunnan Tumor Institute, Third Affiliated Hospital of Kunming Medical University (Tumor Hospital of Yunnan Province), Kunming, Yunnan Province
| | - Li-Wen Zhou
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou Province, China
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Tvedskov TF. The evolution of the sentinel node procedure in the treatment of breast cancer. Dan Med J 2017; 64:B5402. [PMID: 28975889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This thesis is based on 10 original articles, of which 3 were previously included in the PhD thesis "Staging of women with breast cancer after introduction of sentinel node guided axillary dissection". In the PhD thesis is was shown that the introduction of sentinel lymph node dissection (SLND) in the treatment of breast cancer in Denmark has resulted in an increased identification of patients with micrometastases or isolated tumor cells (ITC) in the lymph nodes. Not all these small metastases are likely to disseminate to non-sentinel nodes. This thesis provides evidence that a previous surgical excision of a breast tumor is likely to lead to iatrogenic displacement of tumor cells resulting in a nearly four-fold increased risk of ITC in the sentinel node. These tumor cells are not associated with non-sentinel node metastases. Especially ITC, but also micrometastases and some macrometastases, are not identified on perioperative frozen sections, but found postoperatively at the conventional histopathological examination. These patients are offered an axillary lymph node dissection (ALND) as a second procedure. It has been suggested that this two-stage procedure reduces the number of lymph nodes removed, because of fibroses from previous surgery. In this thesis it was shown that a two-stage procedure does not result in a clinically relevant impairment of the number of lymph nodes removed by ALND. Based on patient, tumor, and sentinel node characteristics from the Danish Breast Cancer Group database, two predictive models for non-sentinel node metastases, when only micrometastases or ITC are found in the sentinel node, were developed, as a part of the PhD thesis. These two models have now been internally validated, and a cross-validation in a Finnish patient material has been performed in cooperation with researchers from Helsinki. The model for patients with micrometastases proved to be robust under internal as well as external validation and could be used to identify patients with micrometastases that might still benefit from an ALND. Efforts should continue to improve the model. As a part of the PhD thesis, new molecular markers were tested for prediction of non-sentinel node metastases. In addition, method of detection of the breast cancer could be a possible predictor of non-sentinel node metastases. It has been hypothesized that breast cancers detected by screening represent a clinical indolent group of cancers with lower risk of non-sentinel node metastases compared to symptomatic cancers. This hypothesis was tested in this thesis in a large Danish dataset. No significant difference in the risk of non-sentinel node metastases was found between patients with screen-detected and symptomatic breast cancers, and a less aggressive treatment of the axilla in patients with screen-detected breast cancers cannot be supported. Likewise, the method of detection is not expected to be able to improve the predictive models. Until 2012, the standard treatment of Danish patients with micrometastases or ITC in the sentinel node was ALND. Still, in selected patients ALND was not performed. This thesis includes a comparison of the risk of axillary recurrence and survival between patients with and without ALND. The overall axillary recurrence rate was only 1.6% after 6 years of follow-up, despite between 9 - 18 % of these patients are expected to have non-sentinel node metastases. No significant difference was seen in axillary recurrence and overall survival between patients with and without ALND. These results support the safety of omitting ALND in patients with only micrometastases or ITC in the sentinel node and since 2012 Danish breast cancer patients with ITC or up to two micrometastatic sentinel nodes are no longer offered an ALND. In Denmark the standard surgical treatment of the axilla in locally recurrent breast cancer is no further treatment of the axilla in case of previous ALND, and ALND in case of previous SLND. To investigate whether SLND can be extended to this patient group, a Danish multicenter study was performed. Despite a reduced detection rate, especially after previous ALND, SLND seemed to be a feasible procedure in locally recurrent breast cancer. The procedure can spare a clinically significant number of patients an unnecessary ALND and improve staging and local control after previous ALND. The increased number of patients with aberrant drainage underlines the importance of preoperative lymphoscintigraphy at local recurrence.
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Otsubo R, Hirakawa H, Oikawa M, Baba M, Inamasu E, Shibata K, Hatachi T, Matsumoto M, Yano H, Abe K, Taniguchi H, Nakashima M, Nagayasu T. Validation of a Novel Diagnostic Kit Using the Semidry Dot-Blot Method to Detect Metastatic Lymph Nodes in Breast Cancer: Distinguishing Macrometastases From Nonmacrometastases. Clin Breast Cancer 2017; 18:e345-e351. [PMID: 28778378 DOI: 10.1016/j.clbc.2017.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 07/05/2017] [Accepted: 07/11/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The semidry dot-blot method is a diagnostic procedure for detecting lymph node (LN) metastases using the presence of cytokeratin (CK) in lavage fluid from sectioned LNs. We evaluated 2 novel kits that use newly developed anti-CK-19 antibodies to diagnose LN metastases in breast cancer. PATIENTS AND METHODS We examined 159 LNs dissected that we sliced at 2-mm intervals and washed with phosphate-buffered saline. The suspended cells in the lavage were centrifuged and lysed to extract protein. This extracted protein was used with a low-power and a high-power kit to diagnose LN metastasis. Diagnoses on the basis of the kits were compared with pathological diagnoses. RESULTS Of the 159 LNs, 68 were assessed as positive and 91 as negative in permanent section examination. Sensitivity, specificity, and accuracy of the low-power kit for detecting LN metastases was 83.8%, 100%, and 93.1%, respectively. Those of the high-power kit were 92.6%, 92.3%, and 92.5%, respectively. Combining the low- and high-power kit results, those for distinguishing macrometastases were 94.5%, 95.2%, and 95.0%, respectively. Diagnosis was achieved in approximately 20 minutes, at a cost of less than $30 USD. CONCLUSION The kits were accurate, fast, and cost-effective in diagnosing LN metastases without the loss of LN tissue.
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Affiliation(s)
- Ryota Otsubo
- Division of Surgical Oncology, Nagasaki University Hospital, Nagasaki, Japan.
| | - Hiroshi Hirakawa
- Department of Gynecology, Aiyuukai Memorial Hospital, Chiba, Japan
| | - Masahiro Oikawa
- Division of Surgical Oncology, Nagasaki University Hospital, Nagasaki, Japan; Division of Breast Surgery, New-wa-kai Oikawa Hospital, Fukuoka, Japan
| | - Masayuki Baba
- Division of Surgical Oncology, Nagasaki University Hospital, Nagasaki, Japan
| | - Eiko Inamasu
- Division of Surgical Oncology, Nagasaki University Hospital, Nagasaki, Japan
| | - Kenichiro Shibata
- Department of Surgery, The Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Toshiko Hatachi
- Division of Surgical Oncology, Nagasaki University Hospital, Nagasaki, Japan
| | - Megumi Matsumoto
- Division of Surgical Oncology, Nagasaki University Hospital, Nagasaki, Japan
| | - Hiroshi Yano
- Division of Surgical Oncology, Nagasaki University Hospital, Nagasaki, Japan
| | - Kuniko Abe
- Department of Pathology, Nagasaki University Hospital, Nagasaki, Japan
| | - Hideki Taniguchi
- Department of Surgery, The Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Masahiro Nakashima
- Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Takeshi Nagayasu
- Division of Surgical Oncology, Nagasaki University Hospital, Nagasaki, Japan
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Suh SW, Choi YS. Predictors of Micrometastases in Patients with Barcelona Clinic Liver Cancer Classification B Hepatocellular Carcinoma. Yonsei Med J 2017; 58:737-742. [PMID: 28540985 PMCID: PMC5447103 DOI: 10.3349/ymj.2017.58.4.737] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 02/01/2017] [Accepted: 02/15/2017] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Transarterial chemoembolization (TACE) is indicated for Barcelona Clinic Liver Cancer (BCLC) B hepatocellular carcinoma (HCC). Whether TACE provides any long-term survival benefits remains unclear. We aimed to investigate micrometastases predictors with which to identify patients who would benefit from surgical resection (SR). MATERIALS AND METHODS First, we analyzed risk factors of micrometastases, microvascular invasion, and poor histologic grade in 38 patients with newly diagnosed resectable BCLC stage B HCC limited to one or two segments with well-preserved liver function and who underwent SR between January 2006 and December 2013. Second, we validated identified risk factors in 54 newly diagnosed resectable BCLC B HCC patients with well-preserved liver function who underwent TACE during the same period to determine their influence on survival. RESULTS Risk factors of micrometastases in SR patients were α-fetoprotein (AFP) ≥110 [hazard ratio (HR)=5.166; 95% confidence interval (CI), 1.031-25.897; p=0.046] and prothrombin induced by vitamin K absence-II (PIVKA-II) ≥800 (HR=5.166; 95% CI, 1.031-25.897; p=0.046). The cumulative probability of tumor recurrence (p=0.009) after SR differed according to levels of AFP and PIVKA-II. After validation of these risk factors in the TACE group, patients with SR and AFP <110 and PIVKA-II <800 had superior survival outcomes than other patients (HR=0.116; 95% CI, 0.027-0.497; p=0.004). CONCLUSION AFP and PIVKA-II levels predict micrometastases and survival. Therefore, they should be considered when selecting SR for BCLC B HCC.
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Affiliation(s)
- Suk Won Suh
- Department of Surgery, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Yoo Shin Choi
- Department of Surgery, College of Medicine, Chung-Ang University, Seoul, Korea.
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Maj J, Jankowska-Konsur A, Gruber J, Woźniak Z, Nockowski P, Hryncewicz-Gwóźdź A. Diffuse melanosis cutis related to dermal micrometastases as the first clinical symptom of distant metastatic malignant melanoma: Case report. Medicine (Baltimore) 2017; 96:e6470. [PMID: 28403076 PMCID: PMC5403073 DOI: 10.1097/md.0000000000006470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Diffuse melanosis cutis (DMC) is a very rare sign of malignant melanoma progression. The condition usually develops after approximately one year from melanoma diagnosis in a patient with metastatic tumors and after anticancer treatment with cytostatic medications. PATIENT CONCERNS A 72-year old Caucasian man was admitted to the Department of Dermatology with DMC for 4 months and the history of two melanomas treated surgically 30 years and 9 months before present hospitalization. DIAGNOSIS Histological and immunohistochemical examinations of DMC biopsy indicated melanoma metastatic cells as well as free deposits of melanin and melanophage presence in the dermis. INTERVENTIONS The patient refused to the treatment. OUTCOMES The patient died eight months after DMC appeared. LESSONS DMC is a rare presentation of advanced MM and is a bad prognostic factor. The pathomechanisms of the discoloration of the skin are not fully explained. The role of micrometastases, as well as melanin precursors, released during lysis of MM metastases, and growth factors may play a role in the development of the symptom.
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Affiliation(s)
- Joanna Maj
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University
| | | | - Joanna Gruber
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University
| | - Zdzisław Woźniak
- Department of Pathomorphology, Wroclaw Medical University, Wroclaw, Poland
| | - Piotr Nockowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University
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Hong KD, Um JW, Min BW, Ji WB, Choi JW, Kim YS. Lymph Node Micrometastasis Cannot Be Considered as Positive Lymph Node in Nonmetastatic Colorectal Cancer. Am Surg 2017; 83:127-133. [PMID: 28228198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The prognostic value of micrometastasis in colorectal cancer (CRC) remains controversial. The study investigated whether lymph node (LN) micrometastasis can have prognostic value in CRC as compared with macrometastasis. The study included 488 patients with curatively resected stage I, II, or III CRC treated between 2004 and 2011. Immuohistochemical staining with monoclonal antibody CAM 5.2 was performed on negative LNs by hematoxylin-eosin staining. The prognostic value of LN micrometastasis was investigated in multivariate analysis. Regression analysis was performed to identify a causal relationship between micro- and macrometastasis. Survival differences were compared between conventional N staging and hypothetic N staging taking micrometastasis in the positive node. A total of 93 patients (19.1%) showed LN micrometastasis. Patients with micrometastasis had more advanced tumor characteristics in terms of tumor size, grade, T stage, N stage, lymphatic invasion, and vascular invasion. In multivariate analysis, micrometastasis was not related with recurrence. Preoperative carcinoembryonic antigen level, neural invasion, and macrometastasis were independent risk factors in the analysis. Regression analysis showed that there was not a causal relationship between micro- and macrometastasis (R2 = 0.004, P = 0.153). When the cumulative numbers of micro- and macrometastatic LNs were calculated together, the discriminative power of survival difference between each node stage became less prominent, compared with conventional N staging. LN micrometastasis is related with advanced tumor characteristics, but does not reflect poor prognosis in nonmetastatic CRC. Micrometastasis cannot be considered as positive LN to predict poor prognosis.
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Morlino A, La Torre G, Patitucci G, Cammarota A. Axillary treatment of patients with breast cancer and micrometastatic disease in the sentinel lymph node Our experience. Ann Ital Chir 2017; 88:360-364. [PMID: 29051403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM Since the introduction of the sentinel lymph node biopsy (SLNB) in patients with breast cancer, micrometastases are detected frequently in the sln. PATIENTS AND METHODS Between July 2005 and June 2016, 1244 patients were submitted to surgery for breast cancer. 431 patients cT1-2 N0 underwent to sentinel lymph node (SLN) and micrometastases were found in 68 of 431 screen-detected patients. Nearly all patients with both micro and macrometastases had axillary lymph node dissection (ALND). RESULTS The SLN was negative in 69% of patients (296 of 431), 121 patients (28%) instead turned positive for lymph node metastases and in 14 patients (3%) were identified isolated tumor cells (ITC). SLN micrometastases were detected in 15,7% of patients (68 of 431). All patients with micrometastases underwent a completion ALND. In 85% of cases, therefore, the sentinel node with micrometastases was the only site of nodal disease. Neither loco-regional recurrences or distant metastases occurred in any of the Patients with sln micrometastases. DISCUSSION There is considerable interest in foregoing axillary dissection (AD) when the sentinel node (SN) is positive in early breast cancer, particularly when axillary involvement is minimal (micrometastases or isolated tumor cells). Several trials are addressing the problem. In breast cancer patients survival is not affected by the presence of micrometastatic lymph node involvement. CONCLUSION In our experience we always underwent to ALND all patients with micrometastases. In the light of the results we observed our attitude no longer provides for the axillary lymphadenectomy. KEY WORDS Axillary dissection ,Breast cancer, Sentinel Lymph Node Biopsy.
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Pereira MA, Ramos MFKP, Dias AR, Yagi OK, Faraj SF, Zilberstein B, Cecconello I, Mello ESD, Ribeiro U. DETECTION OF OCCULT LYMPH NODE TUMOR CELLS IN NODE-NEGATIVE GASTRIC CANCER PATIENTS. Arq Bras Cir Dig 2017; 30:30-34. [PMID: 28489165 PMCID: PMC5424683 DOI: 10.1590/0102-6720201700010009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 12/13/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND 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. AIM 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. METHODS 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). RESULTS 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). CONCLUSION 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.
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Affiliation(s)
- Marina Alessandra Pereira
- Hospital das Clínicas
- Cancer Institute, University of São Paulo Medical School, São Paulo, SP, Brazil
| | | | - Andre Roncon Dias
- Hospital das Clínicas
- Cancer Institute, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Osmar Kenji Yagi
- Hospital das Clínicas
- Cancer Institute, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Sheila Friedrich Faraj
- Hospital das Clínicas
- Cancer Institute, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Bruno Zilberstein
- Hospital das Clínicas
- Cancer Institute, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Ivan Cecconello
- Hospital das Clínicas
- Cancer Institute, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Evandro Sobroza de Mello
- Hospital das Clínicas
- Cancer Institute, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Ulysses Ribeiro
- Hospital das Clínicas
- Cancer Institute, University of São Paulo Medical School, São Paulo, SP, Brazil
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Stocke NA, Sethi P, Jyoti A, Chan R, Arnold SM, Hilt JZ, Upreti M. Toxicity evaluation of magnetic hyperthermia induced by remote actuation of magnetic nanoparticles in 3D micrometastasic tumor tissue analogs for triple negative breast cancer. Biomaterials 2016; 120:115-125. [PMID: 28056401 DOI: 10.1016/j.biomaterials.2016.12.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 11/10/2016] [Accepted: 12/16/2016] [Indexed: 12/20/2022]
Abstract
Magnetic hyperthermia as a treatment modality is acquiring increased recognition for loco-regional therapy of primary and metastatic lung malignancies by pulmonary delivery of magnetic nanoparticles (MNP). The unique characteristic of magnetic nanoparticles to induce localized hyperthermia in the presence of an alternating magnetic field (AMF) allows for preferential killing of cells at the tumor site. In this study we demonstrate the effect of hyperthermia induced by low and high dose of MNP under the influence of an AMF using 3D tumor tissue analogs (TTA) representing the micrometastatic, perfusion independent stage of triple negative breast cancer (TNBC) that infiltrates the lungs. While application of inhalable magnetic nanocomposite microparticles or magnetic nanocomposites (MnMs) to the micrometastatic TNBC model comprised of TTA generated from cancer and stromal cells, showed no measureable adverse effects in the absence of AMF-exposure, magnetic hyperthermia generated under the influence of an AMF in TTA incubated in a high concentration of MNP (1 mg/mL) caused significant increase in cellular death/damage with mechanical disintegration and release of cell debris indicating the potential of these inhalable composites as a promising approach for thermal treatment of diseased lungs. The novelty and significance of this study lies in the development of methods to evaluate in vitro the application of inhalable composites containing MNPs in thermal therapy using a physiologically relevant metastatic TNBC model representative of the microenvironmental characteristics in secondary lung malignancies.
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Affiliation(s)
- Nathanael A Stocke
- Department of Chemical and Materials Engineering, University of Kentucky, Lexington, KY 40506, USA
| | - Pallavi Sethi
- Department of Pharmaceutical Science, University of Kentucky, Lexington, KY 40506, USA
| | - Amar Jyoti
- Department of Pharmaceutical Science, University of Kentucky, Lexington, KY 40506, USA
| | - Ryan Chan
- Department of Pharmaceutical Science, University of Kentucky, Lexington, KY 40506, USA
| | - Susanne M Arnold
- College of Medicine, Department of Internal Medicine, University of Kentucky, Lexington, KY 40506, USA
| | - J Zach Hilt
- Department of Chemical and Materials Engineering, University of Kentucky, Lexington, KY 40506, USA
| | - Meenakshi Upreti
- Department of Pharmaceutical Science, University of Kentucky, Lexington, KY 40506, USA.
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Youssef MMG, Cameron D, Pucher PH, Olsen S, Ferguson D. The significance of sentinel lymph node micrometastasis in breast cancer: Comparing outcomes with and without axillary clearance. Breast 2016; 30:101-104. [PMID: 27668857 DOI: 10.1016/j.breast.2016.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 08/04/2016] [Accepted: 09/08/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Management of micrometastasis in the sentinel node is a controversial topic. Most of the guidelines don't recommend further axillary treatment if micrometastasis are the only finding in the sentinel node. However, some evidence suggests that micrometastasis have significant effect on long term outcomes and therefore indicate systemic treatment. METHOD Retrospective cohort study reviewing the management of patients with micrometastasis in the sentinel nodes. Two groups were compared, those who had further axillary clearance and those who had not. The primary endpoints were loco-regional recurrence and lymphedema rate. The secondary endpoints were distant metastasis rate, OS and DFS. RESULTS 95 patients were found to have micrometastasis or ITC in the axillary SNB over a period of 10 years. Of those, 38 patients had axillary clearance after SNB, while 57 did not. Lymphedema rate was 18.4% in the axillary clearance group versus 0% in the no axillary clearance group (p < 0.001). The LRR event was rare therefore not compared. Distant metastasis rate was 7.01% in the SNB group versus 2.6% in the axillary clearance group. There were no mortalities in the axillary clearance group. This compares to 7.01% among the patients who didn't have axillary clearance. All the patients who died had developed distant metastasis as a cause of death. There was a difference in OS between the two groups in favor of the axillary clearance group (p = 0.004). DISCUSSION Although not an indication for axillary clearance recent guidelines, micrometastasis and ITC found in the SNB are a sign of a biologically different disease. This important information should be taken in consideration when planning the adjuvant treatment in those patients among other factors considered.
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Affiliation(s)
- Mina M G Youssef
- Department of Breast Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
| | - Diane Cameron
- Department of Breast Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | - Sisse Olsen
- Department of Breast Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Douglas Ferguson
- Department of Breast Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
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40
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Wang C, Zhang S, Yang L. [Application of sentinel lymph node tracer techniques in prostate caner]. Zhonghua Nan Ke Xue 2016; 22:850-855. [PMID: 29071886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The sentinel lymph node (SLN) is the first node receiving lymphatic drainage of a tumor and best reflects tumor metastasis. Whether there is a micrometastasis in SLN determines the choice of pelvic lymph node dissection for prostate cancer and is closely related to later treatment and prognosis. Therefore, precise localization of SLN is essential. This review discusses the application of SLN tracer techniques, such as preoperative imaging and intraoperative lymphoscintigraphy and localization of SLN, in prostate cancer.
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Affiliation(s)
- Cheng Wang
- Research Institute of Urology / Key Laboratory for Urological Diseases of Gansu Province / Gansu Clinical Center of Nephro-Urology, The Second Hospital of Lanzhou University, Lanzhou, Gansu 730030, China
| | - Su Zhang
- Research Institute of Urology / Key Laboratory for Urological Diseases of Gansu Province / Gansu Clinical Center of Nephro-Urology, The Second Hospital of Lanzhou University, Lanzhou, Gansu 730030, China
| | - Li Yang
- Research Institute of Urology / Key Laboratory for Urological Diseases of Gansu Province / Gansu Clinical Center of Nephro-Urology, The Second Hospital of Lanzhou University, Lanzhou, Gansu 730030, China
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Abstract
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.
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Affiliation(s)
- Simona Gurzu
- Department of Pathology, University of Medicine and Pharmacy of Tirgu-Mures, Tirgu-Mures, Romania
| | - Ioan Jung
- Department of Pathology, University of Medicine and Pharmacy of Tirgu-Mures, Tirgu-Mures, Romania
| | - Zoltan Kadar
- Department of Pathology, University of Medicine and Pharmacy of Tirgu-Mures, Tirgu-Mures, Romania
- Department of Oncology, University of Medicine and Pharmacy of Tirgu-Mures, Tirgu-Mures, Romania
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Jeuck TLA, Wittekind C. Gastric carcinoma: stage migration by immunohistochemically detected lymph node micrometastases. Gastric Cancer 2015; 18:100-8. [PMID: 24550066 DOI: 10.1007/s10120-014-0352-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 02/01/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Immunohistochemically detected micrometastases of the regional lymph nodes in previously pN0-classified gastric cancer have been incorporated in the TNM staging system. This study aims to determine the incidence of such micrometastases in gastric carcinoma and to investigate their impact on stage grouping and prognosis. METHODS Ninety-five patients with gastric carcinoma classified as pN0 by conventional histological examination were enrolled. All patients underwent gastric resection with regional lymphadenectomy between 2006 and 2010. A total of 2018 lymph nodes was obtained (median, 20 Lymph nodes) and immunohistostained with anti-pan cytokeratin antibody (KL1). RESULTS Micrometastases were detected in regional lymph nodes by immunohistostaining in 16 out of all 95 patients. Fourteen patients were upstaged by micrometastasis-positive regional lymph nodes. Three patients demonstrated lymph nodes with isolated tumor cells alone. A significantly higher incidence of micrometastases was observed in patients with diffuse histologic type (p = 0.007) and total gastrectomy (p = 0.007). When isolated tumor cells were also regarded as lymph node involvement, the recurrence rate was significantly higher for node-positive than for node-negative patients and for those younger than 70 years (33.3 and 6.7 %, respectively; p = 0.026; n = 39). Overall survival analysis revealed no significant difference between micrometastasis-positive and micrometastasis-negative patients. CONCLUSION Immunohistostaining of regional lymph nodes in node-negative gastric carcinoma patients leads to an increased detection of micrometastases with significant implications for the staging system. Although no impact on survival time was shown, the higher recurrence rate for node-positive patients younger than 70 years indicates a prognostic value of immunohistochemically detectable micrometastases.
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Affiliation(s)
- Theresa L A Jeuck
- Institute of Pathology, University Hospital Leipzig, Liebigstrasse 24, 04103, Leipzig, Germany,
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Stojanoski S, Ristevska N, Pop Gjorceva D, Antevski B, Petrusevska G. Sentinel lymph node detection in breast cancer - first experience. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2015; 36:145-151. [PMID: 26076784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Breast cancer accouns for 22.9% of all cancers in women and 13.7% of cancer deaths. Positive axillary lymphnodes (ALN) predict the development of distant metastases. The status of the sentinel lymphnode (SLN) is crutial for the treatment selection. AIM To determine the benefits of SLN detection in patients with breast cancer. MATERIAL AND METHODOLOGY 38 female patients (pts), age 44 ± 12 years, with T1-2 N0 M0 breast cancer, without enlarged ALN on ultrasound (US), were included. SLN detection was performed using gamma camera and gamma detection probe after periareolar subcutaneous and/or peritumoral injection of (99m-Technetium-SENTISCINT). Blue dye was administered 20 min before the operation. SLN was extirpated and ex tempore histopathology was performed. RESULTS Ex tempore SLN evaluation was negative and the lymphatic pathways preserved in 28/38 (74%) pts. In 10/38 (26%) pts SLN was positive, followed by radical surgery. In 3/28 ex tempore negative patients, histopathological analysis showed metastatic involvement (false negative). In 3/10 ex tempore positive patients micro metastases 0,2-2 mm were detected. 12 pts had 2 SLN, 8/12 (66%) had negative and 4/12 (34%) had positive SLN. 3 pts had a rare double drainage to axilla and a. mammaria int. CONCLUSION Our results confirm that SLN detection technique is non-invasive, safe and reliable and should be incorporated into the guidelines for breast cancer pts (T1-2 N0 M0). The most reliable option for colloid application is the combined technique of periareolar and peritumoral injection. Patients with drainage to a. mammaria interna should be selected for adjuvant protocols.
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Affiliation(s)
- S Stojanoski
- Institute of Pathophysiology and Nuclear Medicine, Acad. "Isak S. Tadzer", Skopje, R. Macedonia
| | - N Ristevska
- Institute of Pathophysiology and Nuclear Medicine, Acad. "Isak S. Tadzer", Skopje, R. Macedonia
| | - D Pop Gjorceva
- Institute of Pathophysiology and Nuclear Medicine, Acad. "Isak S. Tadzer", Skopje, R. Macedonia
| | - B Antevski
- Clinic for Thoracovascular surgery, Skopje, R. Macedonia
| | - G Petrusevska
- Institute of Pathology, Medical Faculty, Skopje, R. Macedonia
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Hanagiri T, Fukumoto M, Koyanagi Y, Furutani Y, Tanaka F. Regulatory T-cells and micrometastasis in lymph nodes of stage I NSCLC. Anticancer Res 2014; 34:7185-7190. [PMID: 25503147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Regulatory T-cells (Tregs) have a pivotal role not only in abrogating autoimmune disease, but also in tumor immune escape. The purpose of the present study was to evaluate the clinical significance of the relative expression of forkhead/winged helix transcription factor (FOXP3) and micrometastasis in the regional lymph nodes (RLNs) of patients with stage I non-small cell lung cancer (NSCLC). MATERIALS AND METHODS The RLNs in 131 patients who underwent complete surgical resection for stage I NSCLC were collected at the time of surgery. The relative expression levels of FOXP3 and cytokeratin 19 (CK19) in RLNs were determined by quantitative RT-PCR. RESULTS The pathological stage was diagnosed as stage IA in 97 patients (74.0%) and stage IB in 34 patients (26.0%). The relative expression levels of FOXP3 and CK19 in the RLNs were 0.062±0.0083% and 0.025±0.056%, respectively. The relative expression of FOXP3 tended to increase with increasing relative expression of CK19. The five-year overall survival rate of the patients with low expression of FOXP3 was better (90.3%) than that of patients with high expression (79.3%) (p=0.0419). A multivariate analysis using the significant variables (gender, age, histology and FOXP3 expression) showed that the FOXP3 expression in RLNs was a significant independent prognostic factor. CONCLUSION The expression of CK19 tended to be positively correlated with the expression of FOXP3. High expression of FOXP3 in RLNs was a significant unfavorable prognostic factor in patients with stage I NSCLC.
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Affiliation(s)
- Takeshi Hanagiri
- Department of Chest Surgery, Iizuka Hospital, Iizuka, Fukuoka, Japan
| | - Misako Fukumoto
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yukiko Koyanagi
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yukari Furutani
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Fumihiro Tanaka
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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Augustine D, Patil S, Rao RS. Micrometastasis in head and neck squamous cell carcinoma. J Contemp Dent Pract 2014; 15:i. [PMID: 25825117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Dominic Augustine
- Assistant Professor, Department of Oral and Maxillofacial Pathology Faculty of Dental Sciences, MS Ramaiah University of Applied Sciences MSR Nagar, Bangalore-560054, Karnataka, India
| | - Shankargouda Patil
- Associate Professor, Department of Oral and Maxillofacial Pathology Faculty of Dental Sciences, MS Ramaiah University of Applied Sciences MSR Nagar, Bangalore-560054, Karnataka, India
| | - Roopa S Rao
- Professor and Head, Department of Oral and Maxillofacial Pathology Faculty of Dental Sciences, MS Ramaiah University of Applied Sciences MSR Nagar, Bangalore-560054, Karnataka, India
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Chong C, Harris M, Fox J, Mirbagheri N. Resurveying micrometastases in breast cancer: have we now turned the corner? ANZ J Surg 2014; 84:401-2. [PMID: 25013886 DOI: 10.1111/ans.12564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bailey-Downs LC, Thorpe JE, Disch BC, Bastian A, Hauser PJ, Farasyn T, Berry WL, Hurst RE, Ihnat MA. Development and characterization of a preclinical model of breast cancer lung micrometastatic to macrometastatic progression. PLoS One 2014; 9:e98624. [PMID: 24878664 PMCID: PMC4039511 DOI: 10.1371/journal.pone.0098624] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 05/06/2014] [Indexed: 11/19/2022] Open
Abstract
Most cancer patients die with metastatic disease, thus, good models that recapitulate the natural process of metastasis including a dormancy period with micrometastatic cells would be beneficial in developing treatment strategies. Herein we report a model of natural metastasis that balances time to complete experiments with a reasonable dormancy period, which can be used to better study metastatic progression. The basis for the model is a 4T1 triple negative syngeneic breast cancer model without resection of the primary tumor. A cell titration from 500 to 15,000 GFP tagged 4T1 cells implanted into fat pad number four of immune proficient eight week female BALB/cJ mice optimized speed of the model while possessing metastatic processes including dormancy and beginning of reactivation. The frequency of primary tumors was less than 50% in animals implanted with 500–1500 cells. Although implantation with over 10,000 cells resulted in 100% primary tumor development, the tumors and macrometastases formed were highly aggressive, lacked dormancy, and offered no opportunity for treatment. Implantation of 7,500 cells resulted in >90% tumor take by 10 days; in 30–60 micrometastases in the lung (with many animals also having 2–30 brain micrometastases) two weeks post-implantation, with the first small macrometastases present at five weeks; many animals displaying macrometastases at five weeks and animals becoming moribund by six weeks post-implantation. Using the optimum of 7,500 cells the efficacy of a chemotherapeutic agent for breast cancer, doxorubicin, given at its maximal tolerated dose (MTD; 1 mg/kg weekly) was tested for an effect on metastasis. Doxorubicin treatment significantly reduced primary tumor growth and lung micrometastases but the number of macrometastases at experiment end was not significantly affected. This model should prove useful for development of drugs to target metastasis and to study the biology of metastasis.
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Affiliation(s)
| | - Jessica E. Thorpe
- DormaTarg, Inc., Oklahoma City, Oklahoma, United States of America
- Department of Pharmaceutical Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, Oklahoma, United States of America
| | - Bryan C. Disch
- DormaTarg, Inc., Oklahoma City, Oklahoma, United States of America
| | - Anja Bastian
- Department of Pharmaceutical Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, Oklahoma, United States of America
| | - Paul J. Hauser
- DormaTarg, Inc., Oklahoma City, Oklahoma, United States of America
- Department of Urology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, United States of America
| | - Taleah Farasyn
- DormaTarg, Inc., Oklahoma City, Oklahoma, United States of America
| | - William L. Berry
- Department of Cell Biology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, United States of America
| | - Robert E. Hurst
- DormaTarg, Inc., Oklahoma City, Oklahoma, United States of America
- Department of Urology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, United States of America
- Department of Biochemistry and Molecular Biology, of Oklahoma College of Medicine, Oklahoma City, Oklahoma, United States of America
| | - Michael A. Ihnat
- DormaTarg, Inc., Oklahoma City, Oklahoma, United States of America
- Department of Pharmaceutical Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, Oklahoma, United States of America
- * E-mail:
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Vrána D, Gatěk J, Cwiertka K, Srámek V. [Continuing progress in withdrawal of axillary dissection in early stage breast cancer]. Klin Onkol 2014; 27:143-145. [PMID: 24739052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
For a long period of time, axillary dissection represented a standard approach for axillary node management in the case of sentinel node biopsy positivity during early stage breast cancer treatment. In recent years, there has been a trend to highlight the morbidity of such an axillary procedure considering longterm survival of early stage breast cancer patients. Two big trials, AMAROS and Z0011, were initiated to answer the question whether axillary dissection should be performed in the case of positivity of axillary sentinel node considering the fact that more than 70% of these patients will have no metastasis found during the axillary dissection and such a procedure only increases the morbidity of the surgery. Considering the results of the above mentioned trials, axillary dissection may be avoided in the case of fulfilling of inclusion criteria of these trials without any impact on the patient survival. IBCSG 23- 01 study brought similar conclusion in the case of micrometastasis in axillary sentinel node.
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Peiris PM, Toy R, Abramowski A, Vicente P, Tucci S, Bauer L, Mayer A, Tam M, Doolittle E, Pansky J, Tran E, Lin D, Schiemann WP, Ghaghada KB, Griswold MA, Karathanasis E. Treatment of cancer micrometastasis using a multicomponent chain-like nanoparticle. J Control Release 2013; 173:51-8. [PMID: 24188960 DOI: 10.1016/j.jconrel.2013.10.031] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 10/17/2013] [Accepted: 10/25/2013] [Indexed: 12/30/2022]
Abstract
While potent cytotoxic agents are available to oncologists, the clinical utility of these agents is limited due to their non-specific distribution in the body and toxicity to normal tissues leading to use of suboptimal doses for eradication of metastatic disease. Furthermore, treatment of micrometastases is impeded by several biobarriers, including their small size and high dispersion to organs, making them nearly inaccessible to drugs. To circumvent these limitations in treating metastatic disease, we developed a multicomponent, flexible chain-like nanoparticle (termed nanochain) that possesses a unique ability to gain access to and be deposited at micrometastatic sites. Moreover, coupling nanochain particles to radiofrequency (RF)-triggered cargo delivery facilitated widespread delivery of drug into hard-to-reach cancer cells. Collectively, these features synergistically facilitate effective treatment and ultimately eradication of micrometastatic disease using a low dose of a cytotoxic drug.
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Affiliation(s)
- Pubudu M Peiris
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; Department of Radiology, Case Western Reserve University, Cleveland, OH 44106, USA; Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Randall Toy
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Aaron Abramowski
- Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH 44106, USA; Department of Biochemistry, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Pete Vicente
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Samantha Tucci
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Lisa Bauer
- Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH 44106, USA; Department of Physics, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Aaron Mayer
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Morgan Tam
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Elizabeth Doolittle
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Jenna Pansky
- Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH 44106, USA; Department of Biochemistry, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Emily Tran
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Dishen Lin
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH 44106, USA
| | - William P Schiemann
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Ketan B Ghaghada
- Edward B. Singleton Department of Pediatric Radiology, Texas Children's Hospital, Houston, TX 77030, USA; Department of Radiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Mark A Griswold
- Department of Radiology, Case Western Reserve University, Cleveland, OH 44106, USA; Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Efstathios Karathanasis
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA; Department of Radiology, Case Western Reserve University, Cleveland, OH 44106, USA; Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH 44106, USA; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA.
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Delides A, Maniadakis M, Stathopoulos E. Probabilities of identifying a micrometastasis in a cervical lymph node from laryngeal cancer. A stereometric approach. Anticancer Res 2013; 33:3213-3216. [PMID: 23898081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Lymph node micrometastases are important for prognosis and treatment. Their identification in neck dissection specimens with large numbers of nodes is a matter of chance unless serial sectioning or step sectioning at intervals of 200 μm is used, a method which is impractical. MATERIALS AND METHODS For a case of squamous cell laryngeal carcinoma where a micrometastasis was found in one of the lymph nodes, we performed a stereometric analysis of the probability of identifying the lesion. RESULTS One section at a depth of 100 μm from the surface of each bisected lymph node revealed a micrometastasis, with a range of conditional probability of 75-98%. CONCLUSION Serial sectioning of all excised nodes is unrealistic for routine practice. Knowing the probability of actually identifying a micrometastasis could be important additional information for the clinician and the management of the patient. By performing three sections, the probability of missing a micrometastasis within a normally appearing node would be 2-25%.
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