위암 환자에서 절제된 림프절 수의 차이와 관련이 있는 인자

정귀애,박정희,변익건,김경종,장정환,김권천,민영돈 朝鮮大學校 附設 醫學硏究所 2004 The Medical Journal of Chosun University Vol.29 No.1

Purpose: By the definition of UICC TNM classification (fifth edition), the nodal stage of gastric cancer is based on the number of metastatic lymph nodes, which is influenced by the number of resected lymph nodes. And individual differences in the number of resected lymph nodes had been observed in patients with gastric cancer. The aim of this study is to verify the factors which are associated with the difference in the number of resected lymph nodes in patients with gastric cancer. Methods: We reviewed 613 patients with gastric cancer who underwent curative resection and D2 lymph node dissection with 15 or more resected lymph nodes. The number of resected lymph nodes was analyzed according to the characteristics of patients, the types of operation and prognostic factors of gastric cancer. Results: The mean number of resected lymph nodes per patient was 33.0 (median: 31.0, range: 15-88). The number of resected lymph nodes was significantly associated with the types of operation, the location and size of tumor, macroscopic types, depth of tumor invasion and the number of metastatic lymph nodes. Patient's age, gender and the histopathological finding's had no relationship with the number of resected lymph nodes. Conclusions: The number of resected lymph nodes from gastric cancer was different in each patient despite of same D2 lymph node dissection and it was associated with several prognostic factors of gastric cancer.

Measurement of Intra-Fraction Displacement of the Mediastinal Metastatic Lymph Nodes Using Four-Dimensional CT in Non-Small Cell Lung Cancer

Suzhen Wang,Jianbin Li,Yingjie Zhang,Wei Wang,Fengxiang Li,Tingyong Fan,Min Xu,Qian Shao 대한영상의학회 2012 Korean Journal of Radiology Vol.13 No.4

Objective: To measure the intra-fraction displacements of the mediastinal metastatic lymph nodes by using four-dimensional CT (4D-CT) in non-small cell lung cancer (NSCLC). Materials and Methods: Twenty-four patients with NSCLC, who were to be treated by using three dimensional conformal radiation therapy (3D-CRT), underwent a 4D-CT simulation during free breathing. The mediastinal metastatic lymph nodes were delineated on the CT images of 10 phases of the breath cycle. The lymph nodes were grouped as the upper, middle and lower mediastinal groups depending on the mediastinal regions. The displacements of the center of the lymph node in the left-right (LR), anterior-posterior (AP), and superior-inferior (SI) directions were measured. Results: The mean displacements of the center of the mediastinal lymph node in the LR, AP, and SI directions were 2.24 mm, 1.87 mm, and 3.28 mm, respectively. There were statistically significant differences between the displacements in the SI and LR, and the SI and AP directions (p < 0.05). For the middle and lower mediastinal lymph nodes, the displacement difference between the AP and SI was statistically significant (p = 0.005; p = 0.015), while there was no significant difference between the LR and AP directions (p < 0.05). Conclusion: The metastatic mediastinal lymph node movements are different in the LR, AP, and SI directions in patients with NSCLC, particularly for the middle and lower mediastinal lymph nodes. The spatial non-uniform margins should be considered for the metastatic mediastinal lymph nodes in involved-field radiotherapy. Objective: To measure the intra-fraction displacements of the mediastinal metastatic lymph nodes by using four-dimensional CT (4D-CT) in non-small cell lung cancer (NSCLC). Materials and Methods: Twenty-four patients with NSCLC, who were to be treated by using three dimensional conformal radiation therapy (3D-CRT), underwent a 4D-CT simulation during free breathing. The mediastinal metastatic lymph nodes were delineated on the CT images of 10 phases of the breath cycle. The lymph nodes were grouped as the upper, middle and lower mediastinal groups depending on the mediastinal regions. The displacements of the center of the lymph node in the left-right (LR), anterior-posterior (AP), and superior-inferior (SI) directions were measured. Results: The mean displacements of the center of the mediastinal lymph node in the LR, AP, and SI directions were 2.24 mm, 1.87 mm, and 3.28 mm, respectively. There were statistically significant differences between the displacements in the SI and LR, and the SI and AP directions (p < 0.05). For the middle and lower mediastinal lymph nodes, the displacement difference between the AP and SI was statistically significant (p = 0.005; p = 0.015), while there was no significant difference between the LR and AP directions (p < 0.05). Conclusion: The metastatic mediastinal lymph node movements are different in the LR, AP, and SI directions in patients with NSCLC, particularly for the middle and lower mediastinal lymph nodes. The spatial non-uniform margins should be considered for the metastatic mediastinal lymph nodes in involved-field radiotherapy.

직장암에서 직장림프절의 새로운 분류 방식

김진천,이문규,이인철,황대용,김병식,박건춘 대한대장항문학회 1992 Annals of Coloproctolgy Vol.8 No.2

Characteristics of Metastatic Mediastinal Lymph Nodes of Non-Small Cell Lung Cancer on Preoperative F-18 FDG PET/CT

이아영,최수정,정경표,박지선,이석모,배상균 대한핵의학회 2014 핵의학 분자영상 Vol.48 No.1

Purpose The aim of this study was to evaluate the characteristicsof PETand CT features of mediastinalmetastatic lymph nodeson F-18 FDG PET/CTand to determine the diagnostic criteriain nodal staging of non-small cell lung cancer. Methods One hundred four non-small cell lung cancerpatients who had preoperative F-18 FDG PET/CT wereincluded. For quantitative analysis, the maximum SUV ofthe primary tumor, maximum SUV of the lymph nodes(SUVmax), size of the lymph nodes, and average Hounsfieldunits (aHUs) and maximum Hounsfield units (mHUs) of thelymph nodes were measured. The SUVmax, SUV ratio of thelymph node to blood pool (LN SUV/blood pool SUV), SUVratio of the lymph node to primary tumor (LN SUV/primarytumor SUV), size, aHU, and mHU were compared betweenthe benign and malignant lymph nodes. Results Among 372 dissected lymph node stations that werepathologically diagnosed after surgery, 49 node stations weremalignant and 323 node stations benign. SUVmax, LN SUV/blood pool SUV, and size were significantly different betweenthe malignant and benign lymph node stations (P <0.0001). However, there was no significant difference in LN SUV/primary tumor SUV (P =0.18), mHU (P =0.42), and aHU(P =0.98). Using receiver-operating characteristic curveanalyses, there was no significant difference among thesethree variables (SUVmax, LN SUV/blood pool SUV, andsize). The optimal cutoff values were 2.9 for SUVmax, 1.4for LN SUV/blood pool SUV, and 5 mm for size. When thecutoff value of SUVmax≥2.9 and size≥5 mm were used incombination, the positive predictive value was 44.2%, and thenegative predictive value was 90.9 %. When we evaluated theresults based on the histology of the primary tumor, thenegative predictive value was 92.3 % in adenocarcinoma(cutoff values of SUVmax≥2.3 and size≥5 mm) and 97.2 %in squamous cell carcinoma (cutoff values of SUVmax≥3.6and size≥8 mm), separately. Conclusions In the lymph node staging of non-small cell lungcancer, SUVmax, LN SUV/blood pool SUV, and size showstatistically significant differences between malignant andbenign lymph nodes. These variables can be used to differentiatemalignant from benign lymph nodes. The combination of theSUVmax and size of lymph node might have a good negativepredictive value.

정상 경부임프절의 크기 및 모양

이상훈 ( Sang Hoon Lee ),이영환 ( Young Hwan Lee ),최기철 ( Ki Chul Choi ),정수현 ( Su Hyun Jeong ),정경호 ( Gyung Ho Chung ) 전북대학교 의과학연구소 2001 全北醫大論文集 Vol.25 No.2

본논문은 한국인의 정상 경부임프절의 각 구역에 따른 크기 및 모양의 분포를 알고자 하였고 정상지원자 5명을 포함하여 총 19명을 분석하였다. 저자등의 CT상 나타난 정상임프절의 평균직경과 96 percentile은 각각 상내경정맥임프절이 5mm, 10mm, 악하임프절이 4.3mm, 9mm, 설하임프절이 3.8mm, 7.5mm인 반면, 부척수임파절이 3mm, 3mm, 외측후인두임파절이 3.4mm, 5.3mm, 중내경정맥임프절은 3.3mm, 4.9mm이었다. 그리고 경부 정상임프절의 모양은 난형이 65%, 세장형이 24%, 원형이 11%이었다. 그러므로 비정상적 임프절을 판정하는 크기 기준을 구역에 따라 차이를 두어야 하며, 그 크기의 기준은 상내경정맥임프절, 악하임프절, 설하임프절은 10mm, 부척수임프절, 외측후인두임파절, 중내경정맥임프절은 6mm를 기준으로 하는 것이 합리적이라 판단된다. 또한 임프절의 모양도 크기가 경계선인 경우 원형은 난형이나 세장형에 비해 비정상적인 임프절로 간주해야 할 것이다. Objectives: The purpose of this study was to evaluated the size and shape of normal cervical lymph node. Material and Methods: Nineteen patients with a wide variety of diagnoses provide the database for this normal population to establish the range of normal variation in these nodal groups. Lymph node location, number, diameter, and shape were recorded. Minimal axial diameter was used to estimate the lymph node diameter. Results: A minimal axial diameter of 6 mm was determined to be the effective size criterion in middle jugular lymph nodes, spinal accessory lymph nodes, and retropharyngeal (lateral group) lymph nodes. A minimal axial diameter of 10 mm was determined to be the effective size criterion in superior internal jugular lymph nodes, submental lymph nodes, and submandibular lymph nodes. The shapes of the lymph node in CT scan were mostly oval in all nodal groups. Conclusion: CT can precisely determine the size and shape of normal lymph nodes. This should have important application in the management of patients with head and neck cancer.

Effect of Neoadjuvant Chemotherapy on Axillary Lymph Node Positivity and Numbers in Breast Cancer Cases

Uyan, Mikail,Koca, Bulent,Yuruker, Savas,Ozen, Necati Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.3

Background: The aim of this study is to compare the numbers of axillary lymph nodes (ALN) taken out by dissection between patients with breast cancer operated on after having neoadjuvant chemotherapy (NAC) treatment and otherswithout having neoadjuvant chemotherapy, and to investigate factors affecting lymph node positivity. Materials and Methods: A total of 49 patients operated due to advanced breast cancer after neoadjuvant chemotherapy and 144 patients with a similar stage of the cancer having primary surgical treatment without chemotherapy at the general surgery clinic of Ondokuz Mayis University Medicine Faculty between the dates 01.01.2006 and 31.10.2012 were included in the study. The total number of lymph nodes taken out by axillary dissection (ALND) was categorized as the number of positive lymph nodes and divided into <10 and ${\geq}10$. The variables to be compared were analysed using the program SPSS 15.0 with P<0.05 accepted as significant. Results: Median number of dissected lymph nodes from the patient group having neoadjuvant chemotherapy was 16 (16-33) while it was 20 (5-55) without chemotherapy. The respective median numbers of positive lymph nodes were 5 (0-19) and 10 (0-51). In 8 out of 49 neoadjuvant chemotherapy patients (16.3%), the number of dissected lymph nodes was below 10, and it was below 10 in 17 out of 144 primary surgery patients. Differences in numbers of dissected total and positive lymph nodes between two groups were significant, but this was not the case for numbers of <10 lymph nodes. Conclusions: The number of dissected lymph nodes from the patients with breast cancer having neoadjuvant chemotherapy may be less than without chemotherapy. This may not always be attributed to an inadequate axillary dissection. More research to evaluate the numbers of positive lymph nodes are required in order to increase the reliability of staging in the patients with breast cancer undergoing neoadjuvant chemotherapy.

Is T classification still correlated with lymph node status after preoperative chemoradiotherapy for rectal cancer?

Kim, Duck-Woo,Kim, Dae Yong,Kim, Tae Hyun,Jung, Kyung Hae,Chang, Hee Jin,KyungSohn, Dae,Lim, Seok-Byung,Choi, Hyo Seong,Jeong, Seung-yong,Park, Jae-Gahb Wiley Subscription Services, Inc., A Wiley Company 2006 Cancer Vol.106 No.8

<B>BACKGROUND</B><P>It is well known that the risk of lymph node involvement increases according to pathologic T classification in rectal cancers, but to the authors' knowledge, the correlation between risk of lymph node involvement and ypT classification in rectal cancers treated with preoperative chemoradiotherapy (CRT) remains unclear. The current study investigated the correlation between tumor involvement in regional lymph nodes and rectal mural tumor status in patients who underwent preoperative CRT for rectal cancer.</P><B>METHODS</B><P>Between October 2001 and February 2005, 282 patients underwent preoperative CRT followed by proctectomy for locally advanced rectal adenocarcinoma. Correlations between lymph node status and ypT classification, Dworak regression grade, and magnetic resonance (MR) volumetry findings were explored.</P><B>RESULTS</B><P>Lymph nodes harboring tumors were found in 87 of 282 (30.9%) patients. The rate of lymph node involvement was found to be correlated with ypT-classification (P < .001); positive lymph nodes were detected in 1 of 45 (2.2%) ypT0 patients, 1 of 13 (7.7%) ypT1 patients, 13 of 77 (16.9%) ypT2 patients, 69 of 140 (49.3%) ypT3 patients, and 3 of 7 (42.9%) ypT4 patients. The rate of lymph node involvement decreased as Dworak regression grade increased (P < .001); tumor-harboring lymph nodes were found in 62.3% of Grade 1 patients, 31.4% of Grade 2 patients, 16.1% of Grade 3 patients, and 2.2% of Grade 4 patients. There were no differences noted with regard to MR volumetry findings, including mean volume of pre- or post-CRT tumor and the tumor volume reduction rate between lymph node-negative and lymph node-positive patients.</P><B>CONCLUSIONS</B><P>Pathologic T classification is still the most reliable predictor of lymph node metastasis in rectal cancer patients who have undergone preoperative CRT. The risk of lymph node metastasis was found to be 3.4% in rectal cancer that had regressed to ypT0 or ypT1. Cancer 2006. © 2006 American Cancer Society.</P>

Does skip metastasis or other lymph node parameters have additional effects on survival of patients undergoing radical cystectomy for bladder cancer?

Ozgur Ugurlu,Sumer Baltaci,Guven Aslan,Cavit Can,Cag Cal,Atilla Elhan,Levent Turkeri,Aydin Mungan 대한비뇨의학회 2015 Investigative and Clinical Urology Vol.56 No.5

Purpose: To investigate the effects of lymph node metastasis, skip metastasis, and other factors related to lymph node status on survival in patients who underwent radical cystectomy (RC) and extended lymph node dissection (eLND). Materials and Methods: RC and eLND were performed in 85 patients with a diagnosis of bladder cancer. Disease-free survival (DFS) and overall survival (OS) were determined by using a Cox proportional hazards model that included the number of excised lymph nodes, the presence of pathological lymph node metastasis, the anatomical level of positive nodes, the number of positive lymph nodes, lymph node density, and the presence of skip metastasis. Results: The mean number of lymph nodes removed per patient was 29.4±9.3. Lymph node positivity was detected in 85 patients (34.1%). The mean follow-up duration was 44.9±27.4 months (2–93 months). Five-year estimated OS and DFS for the 85 patients were 62.6% and 57%, respectively. Three of 29 lymph node-positive patients (10.3%) had skip metastasis. Only lymph node positivity had a significant effect on 5-year OS and DFS (p<0.001). No difference in OS and DFS was found between the three patients with skip metastasis and other lymph node-positive patients. Other factors related to lymph node status had no significant effect on 5-year OS and DFS. Conclusions: No factors related to lymph node status predict DFS and OS, except for lymph node positivity. OS and DFS were comparable between patients with skip metastasis and other lymph node-positive patients.

갑상선 유두암과 결핵성 경부 림프절염이 동반된 환자들에서 경부 림프절의 평가

정은욱,장영수,이정복,최성용,이낙준,소윤경,정한신 대한이비인후과학회 2012 대한이비인후과학회지 두경부외과학 Vol.55 No.9

Background and Objectives To determine the diagnostic clues to differentiate tuberculous lymph node infection from nodal metastasis in patients with both papillary thyroid carcinoma and cervical tuberculous lymphadenitis. Subjects and Method We retrospectively reviewed 11 patients suffering concurrently from papillary thyroid carcinomas with cervical tuberculous lymphadenitis. Nine of the 11 patients underwent preoperative neck ultrasonography (US) and seven CT scans. Using the surgical pathology as the reference standards, the results of the preoperative diagnostic tools were re-evaluated according to lymph node level-based analysis. US and CT features were also compared between metastatic nodes and tuberculous lymphadenitis. Results Preoperative CT could localize the involved lymph node levels and differentiate tuberculous infection from metastasis of thyroid carcinoma in only two of seven patients. The site of the involved lymph nodes, the presence of pulmonary tuberculosis, and the tumor volume of the thyroid carcinoma were the clues to diagnose the lymph node status. However, in five of seven cases, CT could not differentiate tuberculosis from metastasis in the lymph nodes. The morphological characteristics of lymph nodes seen on CT and US did not differ between tuberculous infection and metastasis of papillary thyroid carcinomas. Conclusion Pre-operative CT or US does not provide differential information about lymph node status between tuberculous infection and metastasis in patients with concurrent papillary thyroid carcinomas and cervical tuberculous lymphadenitis. Rather, clinical characteristics such as the site of the involved lymph nodes, the primary tumor burden, and the associated clinical features can help the physician differentiate between them.

Differential Diagnosis of Axillary Inflammatory and Metastatic Lymph Nodes in Rabbit Models by Using Diffusion-Weighted Imaging: Compared with Conventional Magnetic Resonance Imaging

Junping Wang,Qian Liao,Yunting Zhang,Chunshui Yu,Renju Bai,Haoran Sun 대한영상의학회 2012 Korean Journal of Radiology Vol.13 No.4

Objective: This experiment aims to determine the diagnostic value of diffusion-weighted imaging (DWI) in the differentiation of axillary inflammatory lymph nodes from metastatic lymph nodes in rabbit models in comparison with conventional magnetic resonance imaging (MRI). Materials and Methods: Conventional MRI and DWI were performed at 4 weeks after successful inoculation into the forty female New Zealand white rabbits’ mammary glands. The size-based and signal-intensity-based criteria and the relative apparent diffusion coefficient (rADC) value were compared between the axillary inflammatory lymph nodes and metastatic lymph nodes, with histopathological findings as the reference standard. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of the aforementioned criteria and rADC value in differentiating the axillary inflammatory lymph nodes from metastatic lymph nodes. Results: Thirty-two axillary inflammatory lymph nodes and 46 metastatic ones were successfully isolated and taken into pathological analysis. The differences of the aforementioned criteria between the two groups were not statistically significant (p > 0.05). However, the rADC value of the inflammatory lymph nodes (0.9 ± 0.14) was higher than that of metastatic ones (0.7 ± 0.18), with significant difference (p = 0.016). When the rADC value was chosen as 0.80, the area under the ROC curve is greater than all other criteria, and the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for differentiating two groups were 86.2%, 79.3%, 81.2%, 84.2%, and 85.6%, respectively. Conclusion: Diffusion-weighted imaging is a promising new technique for differentiating axillary inflammatory lymph nodes from metastatic lymph nodes. Compared with routine magnetic resonance sequences, DWI could provide more useful physiological and functional information for diagnosis. Objective: This experiment aims to determine the diagnostic value of diffusion-weighted imaging (DWI) in the differentiation of axillary inflammatory lymph nodes from metastatic lymph nodes in rabbit models in comparison with conventional magnetic resonance imaging (MRI). Materials and Methods: Conventional MRI and DWI were performed at 4 weeks after successful inoculation into the forty female New Zealand white rabbits’ mammary glands. The size-based and signal-intensity-based criteria and the relative apparent diffusion coefficient (rADC) value were compared between the axillary inflammatory lymph nodes and metastatic lymph nodes, with histopathological findings as the reference standard. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of the aforementioned criteria and rADC value in differentiating the axillary inflammatory lymph nodes from metastatic lymph nodes. Results: Thirty-two axillary inflammatory lymph nodes and 46 metastatic ones were successfully isolated and taken into pathological analysis. The differences of the aforementioned criteria between the two groups were not statistically significant (p > 0.05). However, the rADC value of the inflammatory lymph nodes (0.9 ± 0.14) was higher than that of metastatic ones (0.7 ± 0.18), with significant difference (p = 0.016). When the rADC value was chosen as 0.80, the area under the ROC curve is greater than all other criteria, and the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for differentiating two groups were 86.2%, 79.3%, 81.2%, 84.2%, and 85.6%, respectively. Conclusion: Diffusion-weighted imaging is a promising new technique for differentiating axillary inflammatory lymph nodes from metastatic lymph nodes. Compared with routine magnetic resonance sequences, DWI could provide more useful physiological and functional information for diagnosis.