Objective To assess the applied significance of carbon nanoparticles in central compartment lymph node dissection in treatment of cN0 papillary thyroid carcinoma. Methods Sixty-eight patients with cN0 papillary thyroid carcinoma who were treated in Tongji Hospital of Tongji Medical College from May. to Oct. in 2012 were randomly allocated to the control group （n=32） and the carbon nanoparticles trace group （tracer group， n=36）， receiving non-carbon nanoparticles trace and carbon nanoparticles trace respectively. All patients were received total resection of thyroid plus the affected side and （or） contralateral side central compartment lymph node dissection. The lymph node-related indexes（including number of dissected lymph node at Ⅵarea and lymph node metastasis rate at Ⅵarea） and operative indexs （including operation time， blood loss， drainage time， complication， and hospital stay） were collected and compared between the 2 groups. Results There were 205 and 324 dissected lymph node at central compartment in control group and tracer group respectively. The results of postoperative pathology showed that the number of lymph node in central compartment of the tracer group was much more than those of control group （8.99±2.24 vs. 6.41±1.56， P＜0.001）. The metastasis rate of central compartment lymph node were 40.6% （13/32） in control group and 47.2% （17/36） in tracer group， but there was no significant difference between the 2 groups （P=0.762）. But in medial area of laryngeal recurrent nerve， the metastasis rate in the tracer group （38.9%， 14/36） was much higher than those of control group （12.5%， 4/32）， P=0.029. There were no significant differences in the operation time， blood loss， drainage time， hospital stay， and complication incidence such as bleeding， temporary hypocalcemia， and injury of superior laryngeal nerve between 2 groups （P＞0.05）. All the patients in 2 groups had followed-up for 6 months without death， recurrence， and metastasis.Conclusions The lymphatic tracer technique of carbon nanoparticles may improve the number of dissected lymph nodes in central region of cN0 papillary thyroid carcinoma， without increasing （or prolonging） operation time， intraoperative blood loss， and postoperative hospital stay， and can accurately represent the metastasis of lymph node， thus to make the staging of the tumor accurately and guide postoperative treatment.
Abstract： Objective To analyze the modes and rules of subcarinal lymph node metastasis in non-small cell lung cancer patients， and explore appropriate surgical dissection strategy of subcarinal lymph nodes for patients with non-small cell lung cancer. Methods The clinical data of 608 patients with non-small cell lung cancer who underwent lung resection and systematic lymph node dissection in Henan Cancer Hospital from September 2002 to October 2011 were analyzed retrospectively. There were 388 males and 220 females with an average age of 62.3 （45-78） years. There were 122 patients with left upper lobe tumor， 119 patients with left lower lobe tumor， 158 patients with right upper lobe tumor， 40 patients with right middle lobe tumor and 169 patients with right lower lobe tumor. Subcarinal lymph node metastasis was observed in 118 patients （19.4%）. There were 244 patients with squamous carcinoma， 285 patients with adenocarcinoma and 79 patients with other types of carcinoma. The relationship of subcarinal lymph node metastasis with tumor location， pathological types and clinicopathological characteristics were analyzed. Results There was statistical difference in subcarinal lymph node metastasis rate among different tumor locations （P=0.000）. Subcarinal lymph node metastasis rate was the highest ［45.8% （54/118）］ in patients with right lower lobe tumor. For patients with different pathological types， subcarinal lymph node metastasis rate was the highest ［55.9% （66/118）］ in patients with adenocarcinoma， and then squamous carcinoma （P=0.034）. Subcarinal lymph node metastasis rate increased with the increase in T staging， and patients with tumors located in the middle or lower lobe of the left or right lung had a significantly higher subcarinal lymph node metastasis rate than patients with upper lobe tumor. Conclusion Subcarinal lymph node metastasis rate are lower in patients with left or right upper lobe tumor， patients with squamous carcinoma whose clinical T staging is within cT 1 .
Objective To explore the effect of carbon nanoparticles dyeing on axillary lymph node dissection in modified radical mastectomy for breast cancer. Methods Eighty-eight patients with breast cancer who received modified radical mastectomy in Mianyang Central Hospital between Mar. 2012 and May. 2013 were recruited in the study, and they were equally divided into areola group and peripheral tumor group. After induction of anesthesia before operation, carbon nanoparticles were injected around the areolar in the areola group, and carbon nanoparticles were injected around the tumor in the peripheral tumor group. The number of dissected lymph nodes(be dyed or not be dyed), metastatic lymph nodes, and black dyed lymph nodes, as well as value of operation related indexes were recorded and compared. Results In the areola group, lymph nodes were detected in 1 453, in which 1 396 lymph nodes were stained black(96.1%); the average number of dissected lymph nodes were 33.0±7.1 per case; and 19 patients (43.2%, in total of 220 metastatic lymph nodes) of them were suffered from lymph node metastasis with the average number of metastatic lymph nodes of 5±2 per case. in addition, in the areola group, operative time were(122.1±10.2) min, blood loss were(83.8±10.1) mL, postoperative hospital stay were(7±1) d, and postoperative complications occurred in 3 patients. In the peripheral tumor group, lymph nodes were detected in 909, in which 594 lymph nodes were stained black (65.3%); the average number of dissected lymph nodes were 20.7±3.2 per case; 20 patients (45.5%, in total of 88 metastatic lymph nodes) of them were suffered from lymph nodes metastasis, with the average number of metastatic lymph nodes of 2±1 per case. In addition, in the peripheral tumor group, operative time were (121.6±11.4) min, blood loss were (84.2±11.3) mL, postoperative hospital stay were (7±2) d, postoperative complications occurred in 3 patients. The black staining rate of lymph nodes, the number of lymph nodes retrieved, and the number of metastatic lymph nodes in areola group were significantly higher than those of peripheral tumor group(P < 0.01). Operative time, blood loss, postoperative hospital stay, and postoperative complication rate did not significantly differ between the 2 groups (P > 0.05). Conclusion The dyeing effect of carbon nanoparticles suspension, which was injected at areola area after induction of anesthesia, is better than that of injected around the tumor, without increasing the incidence of complication.
Objective To investigate the expression of syndecan-1 protein in gastric carcinoma and normal gastric mucosa tissues, and find out the correlation between the expression of syndecan-1 protein and the clinicopathologic characteristics of gastric carcinoma. Methods The expression of syndecan-1 protein was detected by immunohistochemistry (ABC) in 60 cases of gastric carcinoma, including gastric carcinoma tissues and normal gastric mucosa tissues. Results Syndecan-1 protein expressed in all of the 60 normal gastric mucosa tissues, however, only 10 of 60 gastric carcinoma tissues (16.67%) showed positive expression. The positive rate of syndecan-1 expression in normal gastric mucosa tissues was higher than that in gastric carcinoma tissues, and this difference was statistically significant (χ2=65.88, P＜0.05). The expression level of syndecan-1 protein in gastric carcinoma tissues with lymph node metastasis was lower than that without lymph node metastasis, and this difference was also statistically significant (χ2 =18.62, P＜0.05). In addition, syndecan-1 expression was not correlated with patients’ age and position of tumor (Pgt;0.05), but correlated with the diameter， invasion depth and TNM stage of tumor (Plt;0.05). Conclusion The positive expression of syndecan-1 protein is low in gastric carcinoma tissue and has b correlation with tumor stage and lymph node metastasis.
Objective To investigate the expression of cerb B2 and CathepsinD in gastric carcinoma and its correlation with the biological behavior of gastric carcinoma (GC). MethodsThe expression was studied by immunohistochemical technique. The expression of cerb B2 and CathepsinD were analyzed with their relation to histologic types, depth of invasion, growth pattern, lymph node metastasis and prognosis of gastric carcinoma. ResultsThirtynine of the 102 gastric carcinoma specimens (38.24%) were positive for cerb B2 and correlated with depth of invasion (P＜0.05) and lymph node metastasis (P＜0.05); eightythree of the 102 gastric carcinoma specimens (81.37%) were positive for CathepsinD and correlated with depth of invasion (P＜0.05), growth pattern (P＜0.05), lymph node metastasis (P＜0.05) and blood vessels cancer embolus (P＜0.05). Prognosis of patients with gastric carcinoma with positive expression of cerb B2 or CathepsinD was poor. The 5year survival rate was significantly lower in gastric carcinoma patients with positive expression of cerb B2 or CathepsinD. Conclusion cerb B2 and CathepsinD are highly related to growth, invasion, metastasis and prognosis of gastric carcinoma.
ObjectiveTo investigate the expressions of CD133 and CD44 protein in primary lesions of gastric cancer and its clinical significance. MethodsThe expressions of CD44 and CD133 protein in gastric cancer tissues of 100 patients with gastric cancer were detected by immunohistocheimcal stainings.The relation between the expressions of CD44 and CD133 protein and the clinicopathologic characters were analyzed. ResultsBoth CD44 and CD133 protein were expressed on the cell membranes.No correlation were found between CD44/CD133 and the clinicopathologic parameters include gender and age (P > 0.05), but the positive expression rate of CD44/CD133 with diameter>5 cm was significantly higher than that tumor with diameter≤5 cm (CD44 P=0.150;CD133 P=0.056), and correlated with the tissue differentiation (CD44 P=0.008;CD133 P=0.007), vascular invasion (CD44 P=0.043;CD133 P=0.023), lymphatic vessel invasion (CD44 P=0.020;CD133 P=0.044), lymph nodes metastasis (CD44 P=0.002;CD133 P=0.004), inva-sion depth of tumor (CD44 P=0.006;CD133 P=0.021), and pTNM stage (CD44 P=0.034;CD133 P=0.001).No correlation were found between the co-expression of CD44 and CD133 protein and the clinicopathologic parameters include gender, age, tissue differentiation, and vascular invasion (P > 0.05), but the positive co-expression rate of CD44 and CD133 with diameter>5 cm was significantly higher than that tumor with diameter≤5 cm (P=0.010), and correlated with lymphatic vessel invasion (P=0.003), lymph nodes metastasis (P=0.045), invasion depth of tumor (P=0.041), and pTNM stage (P=0.049).The Spearman rank correlation analysis showed that there was positive correlation between the expressions of CD44 and CD133 protein (r=0.207, P=0.039).Univariate analysis showed that lymph nodes metastasis (P < 0.001), pTNM stages (P=0.013), CD44 protein expression (P=0.005), CD133 protein expression (P=0.002), and co-expression of CD44 and CD133 protein (P < 0.001) were significantly correlated with 3-year survival rate of pati-ents with gastric cancer respectively.Logistic regression analysis revealed that lymph node metastasis (P=0.038) was independent risk factor for co-expression of CD44 and CD133 protein.Multivariate analysis with the Cox regression models showed that co-expression of CD44 and CD133 protein (P=0.003) and lymph node metastasis (P=0.006) were significantly associated with poor prognosis. ConclusionsCD44 and CD133 protein may be considered as robust cancer stem cell markers in gastric cancer.The co-expression of CD44 and CD133 protein is the independent prognosis factor for gastric cancer and strongly associated with poor prognosis when they are expressed more high.
Barrett’s esophagus is considered an important risk factor for the pathogenesis of esophageal adenocarcinoma. Treatment strategies for diseases from high-grade dysplasia （HGD） to adenocarcinoma are different. The recurrence rates of endoscopic treatment and anti-reflux surgery are comparatively higher. Abnormal lesions of the esophagus can be completely resected by esophagectomy for the treatment of HGD to adenocarcinoma, and treatment outcomes are confirmed.But appropriate surgical strategies and lymph node dissection scopes should be chosen according to different cancer staging.Lymph node metastasis is a major factor in determining prognosis.
ObjectiveTo investigate the risk factors for neck lymph node metastasis (LNM) in papillary thyroid microcarcinoma, analyze the diagnostic value of high resolution ultrasonography in lateral neck LNM, and evaluate the safety of lymph node dissection. MethodsThe clinical data of 284 patients with papillary thyroid microcarcinoma from Janaury 2004 to June 2010 in this hospital were analyzed retrospectively. ResultsNeck LNMs were found in 83 of 284 patients (29.2%), only central LNMs in 63 of 284 patients (22.2%), skip LNMs (only lateral LNMs) in 6 of 284 patients (2.1%), and both central and lateral LNMs in 14 of 284 patients (4.9%). Age lt;45 years, multifocality, tumor diameter ≥5 mm, and extrathyroidal invasion were the risk factors for LNM (Plt;0.05), and no risk factor for skip LNM was found. Patients underwent central and lateral lymph node dissection had longer postoperative hospital stay than those without dissection or with central lymph node dissection only (Plt;0.05). Both parathyroid gland and recurrent laryngeal nerve injuries were temporary postoperatively. There were no differences in injury rate among three methods (Pgt;0.05). The sensitivity, specificity, false negative rate, and false positive rate of high resolution ultrasonography for only lateral neck LNM were 95.0%, 75.0%, 5.0%, and 25.0%, repectively. The positive predictive value and negative predictive value were 90.5% and 85.7%, respectively. ConclusionsTotal thyroidectomy should be performed in patients with risk factors for LNM, and simultaneous central lymph node dissection is safe. High resolution ultrasonography is of great value in diagnosing skip LNM, and functional lymph node dissection also should be applied in patients who are highly suspected to have skip LNM.
Objective To evaluate the adoption of carbon nano-particle in the pathologic examination of lymph node for lower rectal cancer. Methods Sixty consecutive patients with rectal cancers located at or below the peritoneal reflection were randomly allocated to the routine method group or the group using carbon nano-particle. Resultsof pathologic examination were compared. Results Altogether, 1 070 lymph nodes were examined from the 2 study groups. The average examined number of the carbon nano-particle group was (20.2±4.9)/case, which was significantly higher than the other group 〔(15.4±6.8)/case〕, P=0.003. More tiny lymph nodes were examined in the nano-particle group (P=0.029) and more metastases were proved from the lymph nodes dyed by nano-particle (P=0.000). The majority of examined lymph nodes were located along the superior rectal vessel and its branches. ConclusionAdoption of nano-particle in pathologic examination of rectal cancer surgery can increase the examined number of lymph nodes, while detect small nodes harboring cancer, thus ensuring the correctness of pathologic report. The distribution of mesorectal lymph nodes underlines the execution of TME principle in dissection.
Objective To summarize and analyze the different views on the lymph node metastasis and the extent of lymphadenectomy in gastric cancer.Methods The current domestic and foreign reports on lymph node metastasis and lymphadenectomy in gastric cancer were reviewed.Results Lymph node dissection of gastric cancer is based on clinical stage and the location of the tumor. Laparoscopic-assisted gastrectomy in treatment of gastric cancer is a safe， feasible， effective， and minimally invasive technique with good outcomes for patients. Sentinel lymph node（SLN） in the clinical assessment of early gastric cancer is feasible，besides with high accuracy and sensitivity. Lymphatic mapping is an effective， easy， and safe method to guide lymphadenectomy in gastric cancer. Evidence-based lymphadenectomy in gastric cancer provide a new perspective to the extent. Conclusions It is difficult to evaluate those methods exactly. Researchers over the world should learn from each other and explore further in order to develop guiding principles in the end.