Postoperative intra-arterial methylene blue injection of colorectal cancer specimens increases the number of lymph nodes recovered

Törnroos A, Shabo I, Druvefors B, Arbman G & Olsson H
(2011) Histopathology 58 , 408–413
Postoperative intra‐arterial methylene blue injection of colorectal cancer specimens increases the number of lymph nodes recovered Aims: To determine the possible advantage of intra‐arterial injection of methylene blue with a view to improving lymph node recovery in postoperative examination of colorectal cancer specimens. Methods and results: Thirty‐two colorectal cancer specimens were assigned randomly to either dissection with intra‐arterial methylene blue injection or to routine dissection (without methylene blue injection). Immediately postoperatively, the specimens in the staining group were injected intra‐arterially with methylene blue dye. The two procedures were compared with respect to the number of lymph nodes recovered. The number of recovered lymph nodes was significantly higher in the intra‐arterial methylene blue injection group than in the group investigated with routine procedures (P < 0.0001). Conclusion: The intra‐arterial methylene blue injection method is fairly easy to use postoperatively and increases significantly the number of lymph nodes recovered in colorectal cancer specimens.     

Upstaging of early colorectal cancers following improved lymph node yield after methylene blue injection

Jepsen R K, Ingeholm P & Lund E L
(2012) Histopathology  61, 788–794 Upstaging of early colorectal cancers following improved lymph node yield after methylene blue injection Aims: To evaluate whether the use of intra‐arterial methylene blue injection improves lymph node yield, and to determine whether a higher lymph node count results in upstaging in colorectal cancer. Method and results: We performed a retrospective study of colorectal cancer specimens (n = 234) 1 year after implementation of the method. All colorectal cancer specimens from the previous year served as our control group. Data concerning tumour characteristics, lymph node count, number of positive lymph nodes and success of methylene injection had been prospectively collected in accordance with the department’s ongoing registration. The method was easy to implement and perform with a high rate of success (86%). The number of identified lymph nodes was highly significantly improved in the study group (P < 0.0001). In resections with pT1/T2 tumours, we demonstrated a significant increase in the number of resection specimens containing positive lymph nodes, with an increase in pN1 resections from 9.4% in the control group to 26.7% in the study group (P = 0.04). Conclusions: The methylene blue technique significantly improves lymph node identification in colorectal cancer specimens, and the improved lymph node identification leads to upstaging of International Union Against Cancer (UICC) pT1/pT2 cancers.     

Methylene blue-assisted lymph node dissection in combination with ex vivo sentinel lymph node mapping in gastric cancer

Aims:  Lymph node (LN) stage is still the strongest prognostic marker in potentially curable gastric cancer. Accuracy of histopathological lymph node assessment depends on the number of investigated LNs and detection rate of metastases and micrometastases. The aim was to perform a feasibility study employing intra-arterial methylene blue injection – a novel method to improve LN harvest – and ex vivo sentinel LN mapping.
Methods and results:  A total of 33 cases were enrolled, including 14 retrospective cases that served as a control group. The methylene group showed a highly significant improved mean LN harvest compared with unstained cases, with 38 ± 14 versus 21 ± 10 LNs ( P  < 0.001), respectively. The detection rate of ex vivo sentinel mapping was 88%. No skip metastases occurred.
Conclusion:  Both techniques have the potential to improve the accuracy of histopathological LN staging and can be combined successfully.     

Additional lymph node examination from entire submission of residual mesenteric tissue in colorectal cancer specimens may not add clinical and pathologic relevance

The examination of lymph nodes in colorectal cancer is a critical procedure for determining the stage, which determines prognosis and need for adjuvant therapy. The current recommendation is to harvest at least 12 lymph nodes by conventional manual node dissection (MND). Recent studies have suggested that all lymph nodes in mesenteric tissue should be retrieved using a special method such as the entire submission of residual mesenteric tissue (ESMT) after MND. We investigated the efficacy of ESMT with its potential impact on the pN stage. After an MND in 48 consecutive colorectal cancer resection specimens, the residual mesenteric tissues were entirely submitted for routine histologic examination by ESMT. After initial MND, 933 (mean, 19.4) lymph nodes were found, and there were 29 pN0, 10 pN1, and 9 pN2 cases. By ESMT after MND, 1132 (mean, 23.6) additional lymph nodes were found. Most (88.6%) of them were 2.0 mm or less in maximum dimension, and of the 1132 additional lymph nodes, 14 (1.2%) lymph nodes revealed tumor metastases. Although there was no additional nodal metastasis in any of the initial 29 pN0 cases, additional nodal metastases were found in 10 of the original 19 node-positive cases. Two of the 10 cases with additional positive nodes identified would be upstaged from pN1 to pN2. Both of these cases had fewer than 12 nodes identified by MND but had 1 and 2 additional nodes identified by ESMT. Our study demonstrated that MND seems to be accurate and efficient in evaluating tumors with pN stage of pN0. Although ESMT may be useful to assess the correct pN stage in pN1 cases with fewer than 12 lymph nodes in MND, it may not add any additional information in pN0 cases or in node-positive cases with 12 or more lymph nodes found by MND.     

Microsatellite instability status does not predict total lymph node or negative lymph node retrieval in stage III colon cancer

The relationship between higher total lymph node resection number in colorectal cancer resection specimens and improved overall survival is well known. Recent studies describe an association between a high rate of microsatellite instability and a high total lymph node count in colorectal cancer. Higher lymph node retrieval may potentially explain the improved survival seen in cancers with microsatellite instability. We investigate whether these associations can be validated in a cohort of American Joint Committee on Cancer stage III colon cancers. Medical records from 200 cases of stage III colon cancer resection specimens were reviewed, and sufficient tissue was available for 168. Expression of DNA mismatch repair proteins was determined by immunohistochemistry, and microsatellite status, by polymerase chain reaction. The mean total lymph node count in cases with microsatellite instability versus microsatellite stable tumors (15.9 versus 16.9; P = .664) and the mean number of negative lymph nodes in each respective category (12.2 versus 13.6; P = .522) were not significantly different. There was no difference between microsatellite stable cases and cases with microsatellite instability when total lymph node counts (P = .953) or negative lymph node counts (P = .381) were analyzed with respect to percentage of cases above and below the medians. This cohort of stage III colon cancers does not support a significant relationship between microsatellite status and a higher retrieval of total or negative lymph nodes. Although microsatellite instability is associated with improved overall survival in our cohort (P = .026), the reason for this does not appear to be related to higher numbers of retrieved lymph nodes.     

荧光成像技术联合美蓝在乳腺癌术中探寻前哨淋巴结的应用价值

目的:探讨采用荧光成像技术联合美蓝示踪剂在女性乳腺癌手术治疗中探寻前哨淋巴结的临床应用价值.方法:选取我院收治的150例常规检测为原发性乳腺癌患者,随机分为3组,每组各50例,分别接受联合注射吲哚菁绿(indocyanine green,ICG)及美蓝(联合组)、单独注射ICG(ICG组)和单独注射美蓝(美蓝组)行前哨淋巴结活检手术(sentinel lymph node biopsy,SLNB),后将探寻的前哨淋巴结取出进行冰冻病理检查或常规石蜡病理检查.结果:联合组患者体外淋巴管显影率为94%(47/50),剩余3例有2例为切开后淋巴结显影,淋巴结荧光显影率为92%(46/50).联合组前哨淋巴结(sentinel lymph nodes,SLNs)的总检出率98%(49/50),检出SLNs数量为180枚,其中阳性患者10例(20.41%);ICG组的总检出率为90%(45/50),检出数量为158枚,阳性患者8例(17.78%);美蓝组的总检出率为88%(44/50),检出数量为150枚,阳性患者7例(15.91%);联合组相关观察指标均要优于ICG组和美蓝组.结论:ICG联合美蓝示踪法,相比单独注射ICG或美蓝,能明显提高乳腺癌患者前哨淋巴结的检出率和检出数量,为乳腺癌患者手术方案的选择提供更准确的指导.     

胃癌转移淋巴结的显影进展

 为了在胃癌根治术中施行精确的淋巴结切除,对术前及术中的淋巴结转移的检查评估手段提出了挑战。以往的CT、PET-CT和MRI等都存在准确率较低、特异性欠佳、以及假阴性率较高等缺点,为了实现这个目标先后发展出了红外线电子内窥镜、高分辨率PET-CT、MRI等设备及高分子纳米复合微粒分子靶向显影剂。     

乳腺癌前哨淋巴结活检术中不同染色淋巴结与肿瘤转移的关系

目的探讨乳腺癌前哨淋巴结活检术(SLNB)中不同染色情况的淋巴结与肿瘤转移的关系。方法选择我院2014年1月至2018年1月行前哨淋巴结活检的乳腺癌患者92例,以亚甲蓝为示踪剂,根据92例乳腺癌患者SLNB中淋巴结染色情况的不同分为无染色组、完全染色组和染色不均组,病理检测3组患者淋巴结的肿瘤转移情况并作比较。结果92例乳腺癌SLNB共取得淋巴结256枚,平均每例患者2.8枚,无染色组(80枚)肿瘤转移率为13.8%,完全染色组(112枚)肿瘤转移率为43.8%,染色不均组(64枚)肿瘤转移率为62.5%,3组间肿瘤转移率差异有统计学意义(P<0.05)。结论乳腺癌SLNB中染色不均的淋巴结最易出现肿瘤转移,其次为完全染色的淋巴结,染色淋巴结附近看到的未染色淋巴结也有肿瘤转移的可能,宜一并切除送检,有利于降低假阴性率。     

Prognostic roles of lymph node micrometastasis in non-small cell lung cancer

Objective

This study aimed to confirm the prognostic roles of lymph node (LN) micrometastasis (LNMM) in non-small cell lung cancer (NSCLC) through a meta-analysis.

亚甲蓝治疗缺血性脑卒中的研究进展

脑卒中作为全球高致死、高致残的疾病,一直被广泛研究。亚甲蓝作为一种被美国食品药品管理局（FDA）批准用于治疗高铁血红蛋白血症和氰化物中毒的药物已有一百二十余年,而在近期研究中发现其具有神经保护作用,并在缺血性脑卒中的动物模型中展现出良好的保护作用。我们就近年来亚甲蓝治疗缺血性脑卒中的研究进行简要综述。     

乳腺癌非前哨淋巴结转移的预测

目的 :预测非前哨淋巴结 (non SLN)转移 ,以筛选出转移局限于前哨淋巴结 (SLN)的乳腺癌患者。方法 :采用99mTc SC作为示踪剂 ,对 95例乳腺癌患者行前哨淋巴结活检 ,对乳腺癌非前哨淋巴结转移进行单因素和多因素分析。结果 :95例患者中成功发现 91例患者有SLN (95 8% ) ,其中 85例患者SLN能准确反映腋窝淋巴结的病理状况 (93 4% )。临床肿块大小(P =0 0 2 8)、肿瘤分级 (P =0 0 40 )和原发灶cyclinD1蛋白 (P =0 0 17)的表达与non SLN转移显著相关。而Logistic多因素分析证实 ,临床肿块大小、肿瘤分级为独立的预测非前哨淋巴结转移的因子。结论 :可根据临床病理学特征 ,筛选出乳腺癌转移只局限于前哨淋巴结的患者 ,也存在免除腋窝淋巴结清扫的可能性     

Lymphangiogenesis in breast cancer is associated with non-sentinel lymph node metastases in sentinel node positive patients

Axillary lymph node dissection (ALND) is not suggested in breast cancer patients with negative sentinel lymph node (SLN) biopsies, and SLN is the only positive node in 40-70% of the remaining cases. To distinguish a subgroup in which ALND would be omitted, we investigated the role of lymphangiogenesis in primary breast cancer as a risk factor for distal lymph node involvements in patients with positive SLNs. 86 patients were included in this study. The frequency of proliferative lymphatic endothelial cells (LECP%) was evaluated in each specimen after immunohistochemical double staining for D2-40 and Ki-67. Larger primary tumor size, increased number of positive SLNs, lymphatic vessel invasion and LECP% were significantly associated with non-SLN metastases in the univariate analysis, but only LECP% retained significance in the multivariate model. A positive correlation between LECP% and lymphatic vessel invasion was also revealed. Our study confirmed the important role of lymphangiogenesis in tumor spread, and suggested that LECP% is a promising predictor for additional axillary lymph node involvements.     

L-CAM expression in lymph node and liver metastases of colorectal carcinomas

L-CAM, also known as E-cadherin, is a cell adhesion molecule expressed on the plasma membranes of epithelial cells at the intercellular interface. From in vitro gene transfection experiments the idea has been conceived that loss of L-CAM expression might be related to the invasive capacity as well as metastatic potential of tumour cells. In several tumours a relation between the grade of differentiation and L-CAM expression has been noticed: loss of differentiation appears to be associated with loss of L-CAM immunoreactivity. Also, in lymph node metastases of poorly differentiated carcinomas loss of L-CAM expression was demonstrated. In this study we describe L-CAM expression in lymphogenous and haematogenous metastases of large bowel adenocarcinomas, using an indirect immunoperoxidase method with the monoclonal anti-L-CAM antibody 6F9. All the metastases studied—lymphogenous as well as haematogenous—demonstrated L-CAM immunoreactivity in a pattern comparable to that of primary tumours. Intratumour heterogeneity in expression was noted, with normal intercellular, apical (non-functional), and focally negative areas in the same tumour. The data indicate that primary tumours and their metastases do not differ strikingly in their pattern of L-CAM expression. This would be consistent with transient rather than constitutive down-regulation of L-CAM in invasive and metastatic cancer cells.