共查询到20条相似文献,搜索用时 15 毫秒
1.
The surgical treatment of localized breast cancer has become progressively less aggressive over the years. The management of the axillary lymph nodes has been modified by the introduction of sentinel lymph node biopsy. Axillary dissection can be avoided in patients with sentinel lymph node negative biopsies. Based on randomized trials data, it has been proposed that no lymph node dissection should be carried out even in certain patients with sentinel lymph node positive biopsies. This commentary discusses the basis of such recommendations and cautions against a general omission of lymph node dissection in breast cancer patients with positive sentinel lymph node biopsies. Instead, an individualized approach based on axillary tumor burden and biology of the cancer should be considered. 相似文献
2.
H. Yamagishi K. Shirono T. Sonoyama H. Itoi H. Kubo Y. Ueda T. Oka M. Nakata 《International journal of clinical oncology / Japan Society of Clinical Oncology》1998,3(5):334-336
In May, 1993, we operated upon a 40-year-old woman with lower rectal cancer with jumping metastasis to a solitary right obturator
lymph node only. For the rectal cancer with submucosal invasion, we performed low anterior resection with regional lymph node
dissection as far as the second group, based on theGeneral rules for clinical and pathological studies on cancer of colon, rectum and anus, 4th edition, of the Japanese Society for Cancer of the Colon and Rectum, including the obturator lymph nodes. Well differentiated
adenocarcinoma and mucinous carcinoma were seen in the submucosal invasive front. The risk of obturator metastasis must be
considered during operation for rectal cancer. 相似文献
3.
4.
Seok Ho Lee Seung Heon Lee Kyu Chan Lee Kwang Beom Lee Jin Woo Shin Chan Yong Park Sun Jin Sym Jun-Ho Lee 《Journal Of Gynecologic Oncology》2012,23(3):159-167
Objective
We wanted to evaluate the outcomes of cervical cancer patients with supraclavicular lymph node (SCLN) involvement and who received radiation therapy (RT) combined with chemotherapy.Methods
From August 2001 to April 2009, nine cervical cancer patients with SCLN involvement were treated by RT and cisplatin-based chemotherapy. Most of the patients (8/9, 88.9%) also had a positive para-aortic lymph node (PALN). The RT field was designed to include the whole pelvis, the involved PALNs and the SCLN area. The median SCLN RT dose was 66.6 Gy (range, 60 to 70 Gy).Results
The median follow-up period was 61 months (range, 13 to 98 months). The 3- and 5-year overall survival rates were 66.7% and 55.6%, respectively and the 3- and 5-year progression-free survival rates were 66.7% and 44.4%, respectively. The acute hematologic toxicities according to the criteria of Radiation Therapy of Oncology Group (RTOG) were G1/2 leucopenia in 3 (33.3%), G3/4 leukopenia in 6 (66.7%), G1/2 anemia in 7 (77.8%), G3 anemia in 1 (11.1%), G2 thrombocytopenia in 2 (22.2%), and G3/4 thrombocytopenia in 2 (22.2%). Within 6 months after RT, most of the patients (5/6, 83.3%) recovered from the G3/4 leukopenia, except for 1 patient who received chemotherapy after completing RT due to subsequent bone metastasis.Conclusion
For patients with advanced cervix cancer and SCLN involvement, RT with chemotherapy as active therapy can be expected to provide favorable results, although there is an increased risk of G3/4 hematologic toxicity. 相似文献5.
非小细胞肺癌淋巴结转移规律分析 总被引:2,自引:0,他引:2
背景与目的:淋巴结转移是肺癌最常见的转移途径,影响分期和预后,胸内淋巴结(包括肺门和纵隔)转移是影响肺癌预后的重要因素之一。本研究旨在对非小细胞肺癌(non-small cell lung cancer,NSCLC)术后淋巴结转移特点进行分析,为手术选择淋巴结清扫范围提供参考依据。方法:205例NSCLC手术病例,比较胸内各组淋巴结转移情况,从肿瘤原发部位和肿瘤组织类型两方面比较各分组之间淋巴结转移率及跳跃性转移率的差异。结果:205例NSCLC术中共清扫胸内淋巴结977组共3 577枚,平均每例17.4枚。其中220组共508个淋巴结存在转移,有胸内淋巴结转移病例98例,转移率为47.8%。发生跳跃性转移35例,转移率为17.1%。第4、5、7、10、11组淋巴结转移频度较高。肺上叶癌比肺下(中)叶癌更容易发生跳跃性转移。腺癌的淋巴结转移率明显高于鳞癌。结论:NSCLC的淋巴结转移多数是按肺内淋巴结到肺门淋巴结再到纵隔淋巴结的顺序进行逐级转移,纵隔淋巴结的跳跃性转移比较常见。NSCLC的淋巴结转移特点与肿瘤的原发部位、肿瘤组织类型有密切关系。手术应根据淋巴结转移规律对胸内淋巴结进行系统性清扫,特别注意转移频率较高的第4、5、7、10、11组淋巴结。 相似文献
6.
7.
The procedure known as sentinel lymph node biopsy (SLNB) under local anesthesia (LA) allows surgical teams to avoid the uncertainties of frozen tissue examination and to perform axillary dissection on patients who have been informed of the risks of lymph node invasion prior to the procedure. 相似文献
8.
From Oct 1992 to Jun 1998, 398 patients with lung carcinoma underwent radical pulmonectomy in our hospital, pathological study was carried out on the removed lymph nodes in purpose to explore the characteristics of mediastinal lymph node metastasis (N2) of lung cancer and to provide the theoretic basis for reasonable lymphadenectomy.MATERIALS AND METHODSClinical DataOf the 398 patients in our group, 227 cases were with central lung cancer, 171 with peripheral lung cancer. 97 patients … 相似文献
9.
10.
目的探讨乳腺癌锁骨上淋巴结转移癌的综合治疗方法.方法所有病例均于术前行新辅助化疗,其中12例乳腺癌锁骨上转移癌患者再行乳癌根治术和颈淋巴结清扫术(手术组),并与15例同期术前行放疗,再行乳癌根治术、化疗和放疗("三明治"疗法)患者(放疗组)对比,观察1~3年存活率和复发时间.结果手术组1年生存12例,1~3年存活7例,复发时间18~47个月;放疗组1年生存12例,1~3年存活4例,复发时间11~43个月.结论乳腺癌锁骨上淋巴结转移癌行乳癌根治术和颈淋巴结清扫术及综合治疗,对提高患者生存率和延长复发时间有积极作用. 相似文献
11.
Solitary metastasis to the left axillary lymph node after curative gastrectomy in gastric cancer 总被引:2,自引:0,他引:2
Osamu Kobayashi Yuka Sugiyama Kazuo Konishi Masahiro Kanari Haruhiko Cho Akira Tsuburaya Motonori Sairenji Hisahiko Motohashi Takaki Yoshikawa 《Gastric cancer》2002,5(3):0173-0176
Regional lymph node metastasis in advanced gastric cancer is common, whereas axillary lymph node metastasis (ALNM) is rare.
We experienced a patient with a solitary ALNM in gastric cancer. A 48-year-old woman underwent curative distal gastrectomy
for advanced gastric cancer (P0H0T3N3M0CY0, stage IV). Twenty-one months after the surgery, she complained of an asymptomatic
left axillary tumor. Mammography and computed tomography (CT) scans showed the presence of tumors in neither breast nor lung.
Fine-needle aspiration of the axillary tumor demonstrated poorly differentiated adenocarcinoma cells, which coincided with
the cells of the resected gastric carcinoma. We diagnosed ALNM from gastric cancer and operated on the patient with radical
left axillary lymph node dissection. One year after the reoperation, she has had no recurrence. We conclude that gastric cancer
can metastasize to unusual sites. A re-radical resection is recommended if curative resection is feasible.
Received: March 6, 2002 / Accepted: April 23, 2002
Offprint request to: O. Kobayashi 相似文献
12.
Motomura K Komoike Y Nagumo S Kasugai T Hasegawa Y Inaji H Noguchi S Koyama H 《Breast cancer (Tokyo, Japan)》2002,9(4):337-343
The role of sentinel node biopsy in breast cancer has increased over the last few years. Sentinel nodes can predict the status of all axillary lymph nodes precisely and select patients with negative nodes for whom axillary dissection is unnecessary. Many problems remain, such as the ideal injection technique, ideal agents, and ideal histological detection of sentinel node metastases, and must be addressed before sentinel node biopsy becomes the standard of care for patients with breast cancer. 相似文献
13.
结直肠癌单个转移淋巴结分布情况及其临床意义 总被引:1,自引:0,他引:1
目的:回顾研究结直肠癌单个转移淋巴结的分布情况,预测结直肠癌中前哨淋巴结(SLN)概念的适用性及分布情况,并为进一步结直肠癌SLN的前瞻性研究提供参考。方法:收集中山大学附属肿瘤医院腹科1998年1月~2003年9月根治术后常规病理检测只有一个淋巴结转移的125例结直肠癌患者有关资料。其中男67例(53.3%),女58例(46.5%);平均年龄55.8岁(25~82岁)。结果:125例患者共计淋巴结1065枚,平均每例患者8.52枚(1~32枚)。单个转移淋巴结分布情况结果显示肠旁组淋巴结转移81例(64.8%),中间组淋巴结转移40例(32.0%),中央组淋巴结转移4例(3.2%)。非肠旁组织转移的“跳跃”转移44例(35.2%)。结论:大部分结直肠癌SLN分布于肠旁,但相当部分可出现“跳跃”现象。必须进行深入的前瞻性研究,探索理想的结直肠癌SLN示踪方法,全面研究结直肠癌SLN的分布规律。 相似文献
14.
Si-Qi Qiu Merel Aarnink Marissa C. van Maaren Monique D. Dorrius Arkajyoti Bhattacharya Jeroen Veltman Caroline A.H. Klazen Jan H. Korte Susanne H. Estourgie Pieter Ott Wendy Kelder Huan-Cheng Zeng Hendrik Koffijberg Guo-Jun Zhang Gooitzen M. van Dam Sabine Siesling 《European journal of surgical oncology》2018,44(5):700-707
Purpose
This study aimed to validate and update a model for predicting the risk of axillary lymph node (ALN) metastasis for assisting clinical decision-making.Methods
We included breast cancer patients diagnosed at six Dutch hospitals between 2011 and 2015 to validate the original model which includes six variables: clinical tumor size, tumor grade, estrogen receptor status, lymph node longest axis, cortical thickness and hilum status as detected by ultrasonography. Subsequently, we updated the original model using generalized linear model (GLM) tree analysis and by adjusting its intercept and slope. The area under the receiver operator characteristic curve (AUC) and calibration curve were used to assess the original and updated models. Clinical usefulness of the model was evaluated by false-negative rates (FNRs) at different cut-off points for the predictive probability.Results
Data from 1416 patients were analyzed. The AUC for the original model was 0.774. Patients were classified into four risk groups by GLM analysis, for which four updated models were created. The AUC for the updated models was 0.812. The calibration curves showed that the updated model predictions were better in agreement with actual observations than the original model predictions. FNRs of the updated models were lower than the preset 10% at all cut-off points when the predictive probability was less than 12.0%.Conclusions
The original model showed good performance in the Dutch validation population. The updated models resulted in more accurate ALN metastasis prediction and could be useful preoperative tools in selecting low-risk patients for omission of axillary surgery. 相似文献15.
Clinical and pathologic factors predicting axillary lymph node involvement in breast cancer 总被引:1,自引:0,他引:1
Noguchi M Kurosumi M Iwata H Miyauchi M Ohta M Imoto S Motomura K Sato K Tsugawa K 《Breast cancer (Tokyo, Japan)》2000,7(2):114-123
The diagnosis of axillary disease remains a challenge in the management of breast cancer and is a subject of controversy. In 1998, the Japanese Breast Cancer Society conducted a study assessing axillary lymph node involvement in breast cancer. The study included (a) clinical assessment by pre-operative imaging modalities, (b) histologic assessment for peritumoral lymphatic invasion, (c) biologic assessment by gelatinolytic activity using film in situ zymography, and (d) sentinel lymph node (SLN) biopsy. Clinical assessments by CT, PET, and US as well as biologic assessment were limited in their ability to detect axillary lymph node disease, although these imaging techniques may be useful to exclude node-positive patients from the need for SLN biopsy. Histologic assessment for peritumoral lymphatic invasion was useful, particularly for detecting false-negative cases by SLN biopsy. Nevertheless, the utility of SLN biopsy in assessing axillary nodal status was confirmed. Axillary lymph node dissection (ALND) can be avoided in patients with a small tumor and a negative SLN. However, further studies will be required to investigate the value of SLN biopsy for predicting regional control and survival before it can replace routine ALND as the optimal staging procedure for operable breast cancer. 相似文献
16.
17.
18.
Aims
Currently, it is standard practice to avoid ALND in patients with negative SLN, whereas this procedure is mandated for those with positive SLN. However, there has been some debate regarding the necessity of complete ALND in all patients with positive SLN. This review article discusses the issues related to eliminating the need for ALND in selected patients with positive nodes.Methods
A review of the English language medical literature was performed using the MEDLINE database and cross-referencing major articles on the subject, focusing on the last 10 years.Results
Currently, complete ALND is mandated in patients with SLN macrometastases as well as those with clinically positive nodes. It is not clear whether SLN biopsy is appropriate for axillary staging in patients with initially clinically positive nodes (N1) that become clinically node-negative (N0) after neoadjuvant chemotherapy. Although there is debate regarding whether ALND should be performed in patients with micrometastases in the SLN, it seems premature to abandon ALND in clinical practice. Moreover, it remains unclear whether it is appropriate to avoid complete ALND in patients with ITC-positive SLN alone.Conclusions
In the absence of data from randomised trials, the long-term impact of SLN biopsy alone on axillary recurrence and survival rate in patients with SLN micrometastases as well as those with ITC-positive SLN remains uncertain. These important issues must be determined by careful analysis of the results of ongoing clinical trials. 相似文献19.
目的 了解影响宫颈癌盆腔淋巴结转移的影响因素。方法 对 116例宫颈癌临床资料进行回顾性分析。结果 Ⅰ期宫颈癌盆腔淋巴结转移率为 6 .6 7% ,Ⅱ期宫颈癌淋巴结转移率为 34.6 1% ,放疗未控及复发癌盆腔淋巴结转移率为 35 .2 9%。盆腔淋巴结转移率与患者的临床分期、病理类型、肿瘤体积及生长方式有直接关系。结论 宫颈癌病人的临床分期、病理类型、肿瘤体积、生长方式是影响宫颈癌盆腔淋巴结转移的预后因素 ,术前应充分考虑这些高危因素 相似文献
20.
Noguchi M 《Breast cancer (Tokyo, Japan)》2001,8(3):184-193
This paper reviews the Japanese literature regarding sentinel lymph node (SLN) biopsy in an attempt to provide an overview of existing controversies and to suggest a method for the identification of the SLN and the detection of micrometastases in the SLN to eliminate unnecessary axillary lymph node dissection (ALND). The combined dye- and gamma probe-guided method resulted in the accurate identification of the SLN in 96% of patients, compared with 80% when the dye-guided method alone was used. Although neither 99m-Tc sulfur colloid nor 99m-Tc colloidal albumin is commercially available in Japan, 99m-Tc stannous phytate and 99m-Tc rhenium colloid appear to be ideal tracers for identifying SLNs. Moreover, subdermal injection over the primary tumor or subareolar injection was found to enhance SLN identification, although these injection routes do not lead to detection of internal mammary SLNs. Furthermore, the accuracy of SLN diagnosis using frozen sections as well as imprint cytology improved with an increase in the number of sections, and could attain a sensitivity comparable to that obtained with routine histologic examination of permanent sections. As a result, several surgeons have begun to offer the option of forgoing ALND to patients with negative SLN. Although subsequent relapse in the axilla has not yet been reported, longer follow-up periods are needed to assess accurately the incidence of axillary failure in these negative SLN patients. 相似文献