No abstract available.
Neoplasm Micrometastasis* ; Stomach Neoplasms*

Recently, lymph node micrometastasis has been evaluated for its prognostic value in gastric cancer. Lymph node micrometastasis cannot be detected via a usual pathologic examination, but it can be detected by using some other techniques including immunohistochemistry and reverse transcription-polymerase chain reaction assay. With the development of such diagnostic techniques, the detection rate of lymph node micrometastasis is constantly increasing. Although the prognostic value of lymph node micrometastasis remains debatable, its clinical impact is apparently remarkable in both early and advanced gastric cancer. At present, studies on the prognostic value of lymph node micrometastasis are evolving to overcome its current limitations and extend the scope of its application.
Immunohistochemistry ; Lymph Nodes* ; Neoplasm Micrometastasis* ; Stomach Neoplasms*

No abstract available.
Bone Marrow* ; Breast Neoplasms* ; Breast* ; Neoplasm Micrometastasis*

There have been some controversies on prognostic significance of lymph node (LN) micrometastasis (MM) in advanced gastric carcinomas (AGCs). The present study aimed at 1) determination of prognostic significance of MM, 2) evaluation of the relationship between MM and clinicopathological parameters, and 3) determination of LN group where MMs were frequently found. We studied 70 cases of AGC without LN metastasis on initial examination. The tumors were examined for location, size, depth of invasion, differentiation, histologic type, lymphatic invasion, and c-erbB-2 expression. To evaluate MM, pancytokeratin immunohistochemistry was performed in all LNs from 70 cases of AGCs. Among 2,203 dissected LNs from 70 patients, 37 (1.6%) LNs from 19 (27.1%) patients revealed MM. Micrometastases were seen in only group 1 and 2 LNs: none had group 3 and 4 LN involvement. The gender, age, tumor size, location of tumor, histologic type, differentiation, depth of invasion, lymphatic invasion, and c-erbB-2 expression were not significantly associated with MM status. The survival time of the MM-positive group (mean: 62 months) was significantly shorter than that of the MM-negative group (mean: 72 months) (p=0.046). The findings of this study indicate that the presence of MM in LNs is an important prognostic factor in AGC patients.
Humans ; Immunohistochemistry ; Keratins ; Lymph Nodes* ; Neoplasm Metastasis ; Neoplasm Micrometastasis*

Gastric cancer is the most prevalent cancer in Korea and comprises the second cause of cancer death. Surgery only can provide chance of cure, but most locally advanced cancers recur after a curative resection, even though important advances in the surgical and nonsurgical treatments of gastric cancer have taken place. Preoperative chemotherapy theoretically can provide the advantages of reducing the bulk of tumor, which might improve the R0 resection rate, and of treating micrometastases early. Also, preoperative chemotherapy is expected to render unresectable tumors resectable without increasing postoperative morbidity and mortality. There are many new chemotherapeutic agents available for the treatment of advanced gastric cancer, but still the most effective agent, the optimal time and number of cycle for administration are still not known. The addition of postoperative chemotherapy through an intraperitoneal route and/or radiotherapy might affect the outcome of surgery favorably, but that hasn't been proved yet. A multicenter prospective randomized phase III trial should be performed to answer for those questions and to improve the curability of gastric cancer treatment.
Drug Therapy* ; Korea ; Mortality ; Neoplasm Micrometastasis ; Radiotherapy ; Stomach Neoplasms*

The current TNM staging including N staging has been suggested as a gold standard for the appropriate therapy in the well differentiated thyroid cancer patients. N staging was established based on histopathologic findings, however, the newly suggested prognostic factors for the revision of N staging include some clinicopathologic factors, such as clinical metastasis (macrometastasis), large node metastasis (> or =3 cm), extranodal extension and the number of metastatic node. Recently, American Thyroid Association reported the possibility that the low-risk group patients would be overestimated as high-risk group patients that leads to the overtreatment, the following unnecessary complication and the economic cost. The preexisting N1a/N1b classification by anatomical location of metastatic node still remains as a strong prognostic factor; however, many evidences indicated that the clinicopathologic factors described above should be considered in the risk stratification in the near future. Thus, it needs to be stressed that the four factors of micrometastasis, large node metastasis (> or =3 cm), gross or microscopic extranodal extension and multiple metastatic node (>5 cm) have been established as negative or positive prognostic factors and should be noted in clinical practice.
Humans ; Neoplasm Metastasis ; Neoplasm Micrometastasis ; Neoplasm Staging ; Thyroid Gland ; Thyroid Neoplasms

PURPOSE: Sentinel lymph node (SLN) biopsy is thought to be a highly accurate method of assessing axillary nodal status in breast cancer. Furthermore, it can improve axillary staging by providing a more detailed examination of selected lymph nodes with a high probability of metastasis rather than the entire axillary nodes. The purpose of this study was to assess the incidence of SLN micrometastasis in node-negative breast cancer. METHODS: SLN biopsy was performed in 40 patients with clinically node-negative breast cancer using vital blue dye and/or radioisotope methods; the blue dye method was used in 21 cases, the isotope method in 14 cases, and a combination of both methods in 5 cases. All lymph nodes were evaluated by routine pathologic examination, and a more detailed examination was performed on sentinel nodes in node-negative cases; sentinel nodes were serially sectioned at an interval of 40nm depth followed by H&E and cytokeratin immunohistochemical (IHC) staining. RESULTS: Sentinel nodes were detected in 35 of 40 patients (87.5%). The mapping technique used in the remaining 5 cases was vital blue dye method only. Axillary node metastasis was found in 16 of 40 patients. Sentinel node biopsy accurately reflected the axillary node status in all cases; the sensitivity, specificity, and overall accuracy were 100, 100 and 100%, respectively. In 11 of 16 node-positive patients (68.8%), sentinel nodes were the only metastatic nodes. Occult micrometastases were found in SLN by serial sectionand IHC staining in 4 of 19 patients diagnosed as node- negative by routine pathological examination (21.1%). Occult micrometastasis of SLN was not correlated with primary tumor size, histologic grade or lymphovascular invasion with the exception of the S-phase fraction (P=0.023). CONCLUSION: SLN biopsy was a highly accurate method of assessing axillary node metastasis in breast cancer. Serial sectioning and IHC staining of SLN were sensitive methods in the detection of occult lymph node metastasis.
Biopsy ; Breast Neoplasms* ; Breast* ; Humans ; Incidence ; Keratins ; Lymph Nodes* ; Neoplasm Metastasis ; Neoplasm Micrometastasis* ; Sensitivity and Specificity

PURPOSE: The aim of this study was to compare the micrometastasis group with the macrometastasis group, and to analyze clinical and pathological variables to determine what factors might predict non-sentinel lymph node (NSLN) involvement in the women with sentinel nodes that contained only micrometastasis. METHODS: Between June 2003 and September 2005, 650 patients with primary breast cancer and who underwent a SLN procedure were retrospectively reviewed. Of those 650 patients, 138 patients with metastasis in the SLNs were analyzed. RESULTS: The median number of harvested sentinel lymph nodes (SLNs) was 2.5 (range: 1~7) and the median number of tumor positive LNs was 2.1 (range: 1~22). Of the 138 patients with a positive SLN, macrometastasis was identified in 105 patients and micrometastasis was noted in 33 patients. The SLN micrometastases were smaller than 0.2 mm in 18 patients and it was between 0.2 to 2.0 mm in 15 patients. Completion axillary dissection was performed in 17 (51.5%) patients with SLN micrometastasis and in 105 (100%) patients with SLN macrometastasis. NSLN involvement was found in 43/105 (41.0%) patients with SLN macrometastasis, while it was not found in the patients with SLN micrometastasis. Univariate analysis showed that T stage, multiplicity, lymphovascular invasion and histologic type were significantly associated with the difference between micrometastasis and macrometastasis in the SLNs. Multivariate analysis identified T stage as a significant factor. CONCLUSION: This study suggests that NSLN metastasis is associated with size of metastasis found in the SLN and completion axillary dissection may not be necessary in patients who have micrometastatic disease in the SLN.
Breast Neoplasms* ; Breast* ; Female ; Humans ; Lymph Nodes* ; Multivariate Analysis ; Neoplasm Metastasis ; Neoplasm Micrometastasis* ; Retrospective Studies

PURPOSE: Despite advances in the treatment of cancer, recurrence and metastasis continue to pose major problems in clinical mamagement. Recently, molecular based peripheral blood assay using the reverse transcriptase-polymerase chain reaction(RT-PCR) has been shown to be highly sensitive molecular staging modality for detecting extraprostatic disease pre-and post-operatively. The assay uses primers those are specific for prostate specific antigen(PSA) and prostate specific membrane antigen(PSMA). MATERIALS AND METHODS: We compared the application of RT-PCR assay for PSA versus PSMA. These assays were applied to ribonucleic acids extracts from the peripheral blood lymphocyte fraction of 29 patients with metastaic prostate cancer, in which, 13 cases were non neoadjuvant hormonal therapy(NHT) group. In addition, blood specimens from 5 clinically localized cancer were tested. RESULTS: Of 13 metastatic untreated patients 6 had positive for PSA, while 10 cases had positive results for PSMA. Among the 16 patients with hormone treated metastatic cancer patients, 8 (50%) had positive for PSMA while only 1 had positive for PSA. Of 5 localized prostatic cancer, only 1 had positive result just for PSMA. In neoadjuvant hormone treated group, marked reduction in incidence of positive RT-PCR for PSA was noted. An additional explanation is that PSMA may be expressed in hormone refractory cancer. CONCLUSIONS: Presently RT-PCR assay using PSMA is highly sensitive and more accurate than PSA RT-PCR for predicting micrometastasis. We are continuing to increase our patient number and may increase our ability to detect early localized cancer using a molecular approach.
Humans ; Incidence ; Lymphocytes ; Membranes ; Neoplasm Metastasis ; Neoplasm Micrometastasis* ; Prostate ; Prostatic Neoplasms* ; Recurrence ; RNA

PURPOSE: Lymph node metastasis is the most important prognostic factor in colorectal cancer. However, 20~30% of patients with lymph node negative colorectal cancer die of recurrent disease. We investigated whether the detection of micrometastasis is of any clinical significance in Dukes' stage A & B colorectal cancer. METHODS: Ninety patients who underwent curative resection of colorectal cancer from Aug. of 1996 to Jan. of 1999 were entered the study. For examination, we used paraffin blocks of lymph nodes which were metastasis-free by conventional histopathology. After preparation of tissue blocks using the serial sectioning technique, the specimens were stained with immunohistochemical method using anticytokeratin antibody. And the hematoxylin-eosin staining was repeated. RESULTS: We disclosed micrometastases in 15 of 90 cases, mostly located in subcapsular sinuses. And in 8 of 15 cases, we also found metastases in repeated H&E staining. There were no significant relationship between the detection of micrometastases and the depth of wall invasion, the histological grade and the status of lymphovascular invasion. With median follow-up of 15 months, we found no significant difference in recurrence between the micrometasis positive and negative groups. CONCLUSIONS: The result showed that the micrometastasis of lymph node in colorectal caner might increase the risk for development of tumor recurrence. But because of small numbers of recurrent cases and relatively short follow-up period, there was no statistically significant relationship between micrometastasis negative and positive groups.
Colorectal Neoplasms* ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Keratins ; Lymph Nodes* ; Neoplasm Metastasis ; Neoplasm Micrometastasis* ; Paraffin ; Recurrence