Lymph node metastasis informs prognosis and is a key factor in deciding further management, particularly adjuvant chemotherapy. It is core to all contemporary staging systems, including the widely used tumor node meta...Lymph node metastasis informs prognosis and is a key factor in deciding further management, particularly adjuvant chemotherapy. It is core to all contemporary staging systems, including the widely used tumor node metastasis staging system. Patients with nodenegative disease have 5-year survival rates of 70%-80%, implying a significant minority of patients with occult lymph node metastases will succumb to disease recurrence. Enhanced staging techniques may help to identify this subset of patients, who might benefit from further treatment. Obtaining adequate numbers of lymph nodes is essential for accurate staging. Lymph node yields are affected by numerous factors, many inherent to the patient and the tumour, but others related to surgical and histopathological practice. Good lymph node recovery relies on close collaboration between surgeon and pathologist. The optimal extent of surgical resection remains a subject of debate. Extended lymphadenectomy, extra-mesenteric lymph node dissection, high arterial ligation and complete mesocolic excision are amongst the surgical techniques with plausible oncological bases, but which are not supported by the highest levels of evidence. With further development and refinement, intra-operative lymphatic mapping and sentinel lymph node biopsy may provide a guide to the optimum extent of lymphadenectomy, but in its present form, it is beset by false negatives, skip lesions and failures to identify a sentinel node. Once resected, histopathological assessment of the surgical specimen can be improved by thorough dissection techniques, step-sectioning of tissue blocks and immunohistochemistry. More recently, molecular methods have been employed. In this review, we consider the numerous factors that affect lymph node yields, including the impact of the surgical and histopathological techniques. Potential future strategies, including the use of evolving technologies, are also discussed.展开更多
目的:探讨磁共振全身弥散加权成像(whole body diffusion-weighted imaging,WB-DWI)在恶性肿瘤淋巴结转移瘤中的应用价值。方法:对110例疑似恶性肿瘤淋巴结转移患者行WB-DWI检查,并于扫描后1周内对可疑骨转移部位及原发恶性肿瘤部位行常...目的:探讨磁共振全身弥散加权成像(whole body diffusion-weighted imaging,WB-DWI)在恶性肿瘤淋巴结转移瘤中的应用价值。方法:对110例疑似恶性肿瘤淋巴结转移患者行WB-DWI检查,并于扫描后1周内对可疑骨转移部位及原发恶性肿瘤部位行常规MRI/CT检查。根据MRI/CT及临床综合诊断结果,将所有患者分为淋巴结转移组及非淋巴结转移组,对资料进行统计学分析,比较单独应用WB-DWI、MRI/CT及二者联合应用(WB-DWI+MRI/CT)在恶性肿瘤淋巴结转移中的诊断价值。分别测定淋巴结转移组及非淋巴结转移组的ADC值,比较其在良恶性病变鉴别诊断中的价值。结果:①将淋巴结按长径大小分为<2cm,2～3cm,>3cm,WB-DWI、MRI/CT及WB-DWI+MRI/CT对长径<2cm淋巴结转移的检出差异具有统计学意义。进一步两两比较,单独应用MRI/CT与WB-DWI+MRI/CT的差异具有统计学意义(χ2=6.519,P=0.011)。②ROC分析结果显示,WB-DWI+MRI/CT诊断恶性肿瘤淋巴结转移的特异度、诊断准确性、阳性预测值及阴性预测值诊断最高。③淋巴结转移组ADC值明显低于良性淋巴结病变组,在良恶性淋巴结转移鉴别诊断中具有一定作用。结论:WB-DWI是常规MRI、CT的有益补充,与MRI/CT的联合应用可以提高恶性肿瘤淋巴结转移的诊断率,结合ADC值测定,在恶性肿瘤淋巴结转移诊断和鉴别方面具有一定价值。展开更多
文摘Lymph node metastasis informs prognosis and is a key factor in deciding further management, particularly adjuvant chemotherapy. It is core to all contemporary staging systems, including the widely used tumor node metastasis staging system. Patients with nodenegative disease have 5-year survival rates of 70%-80%, implying a significant minority of patients with occult lymph node metastases will succumb to disease recurrence. Enhanced staging techniques may help to identify this subset of patients, who might benefit from further treatment. Obtaining adequate numbers of lymph nodes is essential for accurate staging. Lymph node yields are affected by numerous factors, many inherent to the patient and the tumour, but others related to surgical and histopathological practice. Good lymph node recovery relies on close collaboration between surgeon and pathologist. The optimal extent of surgical resection remains a subject of debate. Extended lymphadenectomy, extra-mesenteric lymph node dissection, high arterial ligation and complete mesocolic excision are amongst the surgical techniques with plausible oncological bases, but which are not supported by the highest levels of evidence. With further development and refinement, intra-operative lymphatic mapping and sentinel lymph node biopsy may provide a guide to the optimum extent of lymphadenectomy, but in its present form, it is beset by false negatives, skip lesions and failures to identify a sentinel node. Once resected, histopathological assessment of the surgical specimen can be improved by thorough dissection techniques, step-sectioning of tissue blocks and immunohistochemistry. More recently, molecular methods have been employed. In this review, we consider the numerous factors that affect lymph node yields, including the impact of the surgical and histopathological techniques. Potential future strategies, including the use of evolving technologies, are also discussed.
文摘目的:探讨磁共振全身弥散加权成像(whole body diffusion-weighted imaging,WB-DWI)在恶性肿瘤淋巴结转移瘤中的应用价值。方法:对110例疑似恶性肿瘤淋巴结转移患者行WB-DWI检查,并于扫描后1周内对可疑骨转移部位及原发恶性肿瘤部位行常规MRI/CT检查。根据MRI/CT及临床综合诊断结果,将所有患者分为淋巴结转移组及非淋巴结转移组,对资料进行统计学分析,比较单独应用WB-DWI、MRI/CT及二者联合应用(WB-DWI+MRI/CT)在恶性肿瘤淋巴结转移中的诊断价值。分别测定淋巴结转移组及非淋巴结转移组的ADC值,比较其在良恶性病变鉴别诊断中的价值。结果:①将淋巴结按长径大小分为<2cm,2～3cm,>3cm,WB-DWI、MRI/CT及WB-DWI+MRI/CT对长径<2cm淋巴结转移的检出差异具有统计学意义。进一步两两比较,单独应用MRI/CT与WB-DWI+MRI/CT的差异具有统计学意义(χ2=6.519,P=0.011)。②ROC分析结果显示,WB-DWI+MRI/CT诊断恶性肿瘤淋巴结转移的特异度、诊断准确性、阳性预测值及阴性预测值诊断最高。③淋巴结转移组ADC值明显低于良性淋巴结病变组,在良恶性淋巴结转移鉴别诊断中具有一定作用。结论:WB-DWI是常规MRI、CT的有益补充,与MRI/CT的联合应用可以提高恶性肿瘤淋巴结转移的诊断率,结合ADC值测定,在恶性肿瘤淋巴结转移诊断和鉴别方面具有一定价值。
