Micrometastases in lymph nodes

M7. Miyake, Y., Fujiwara, Y., Ohue, M., Yamamoto, H., Sugita, Y., Tomita, N., et al.. Quantification of micrometastases in lymph nodes of colorectal cancer using real-time fluorescence polymerase chain reaction. Int. J. Oncol 16, 289-293 (2000). 

M9. Mori, M., Mimori, K., Inoue, H., Barnard, G. F., Tsuji, K., Nanbara, S., et al.. Detection of cancer micrometastases in lymph nodes by reverse transcriptase-polymerase chain reaction. Cancer Res. 55, 3417-3420 (1995). 

The presence of benign ectopic epithelial structures in lymph nodes and soft tissue parts can be an error source while screening of lymph nodes and surgical margins for micrometastases. These epithelial structures can be of different origin such as Mullerian epithelial inclusions and endometriosis in pelvic and abdominal lymph nodes or heterotopic ducts and glands in abdominal, thoracic and cervical lymph nodes. Microscopic examination of H E tissue sections prior to molecular examination can be helpful to exclude the presence of such epithelial structures. 

IIIB Any tumor thickness with ulceration and one to three lymph nodes involved and micrometastases Or any tumor thickness without ulceration and one to three lymph nodes involved and macrometastases Or any tumor thickness ulceration with in transit metastases/satellite lesions without metastatic lymph nodes 46-59% 36-48%... 

Rapid immunohistochemical study of frozen sections is necessary for intraoperative diagnosis in some cases. Rapid immunostaining is also helpful in confirming or excluding tumor clearance in resection margins or in detecting micrometastases in sentinel lymph nodes in breast cancer patients. Two methods to immunostain frozen sections are the enhanced polymer one-step staining (EPOS) system and the EnVision system both systems are detailed later. 

For detection of micrometastasis, immunohistochemical method was first introduced in 1987 (S3) and has been evaluated as a reliable method because the presence of tumor cells can be confirmed visually based on their morphology. To date, this immunohistochemical method is still widely used for detection of micrometastases in the lymph nodes and bone marrow (T3). 

In the field of colorectal cancer, there are over 15 reports on the immunohistochemical detection of micrometastasis in the lymph node (Al, Ol). Most studies concluded that immunohistochemically detected micrometastasis does not correlate with a poorer outcome. However, the prognostic significance of immunohistochemically detected micrometastases remains still controversial (G7, S2), similar to that for gastric cancer. 

At. Adell, G., Boeryd, B., Franlund, B., Sjodahl, R., and Hakansson, L., Occurrence and prognostic importance of micrometastases in regional lymph nodes in Dukes B colorectal carcinoma An immunohistochemical study. Eur. J. Surg. 162, 637-642 (1996). 

F4. Fukagawa, T., Sasako, M., Mann, G. B., Sano, T., Katai, H., Maruyama, K., et al., Immunohistochemically detected micrometastases of the lymph nodes in patients with gastric carcinoma. Cancer 92, 753-760 (2001). 

E. W., Jr., Identification of occult micrometastases in pericolic lymph nodes of Duke s B colorectal cancer patients using monoclonal antibodies against cytokeratin and CC49. Correlation with long-term survival. Cancer 73, 563-569 (1994). 

K9. Kubota, K., Nakanishi, H., Hiki, N., Shimizu, N., Tsuji, E., Yamaguchi, H., et al.. Quantitative detection of micrometastases in the lymph nodes of gastric cancer patients with real-time RT-PCR A comparative study with immunohistochemistry. Int. J. Cancer 105, 136-143 (2003). 

Oberg, A., Stenling, R., Tavelin, B., and Lindmark, G., Are lymph node micrometastases of any clinical significance in Dukes Stages A and B colorectal cancer Dis. Colon Rectum 41, 1244-1249 (1998). 

Schoenfeld, A., Luqmani, Y., Smith, D., O Reilly, S., Shousha, S., Sinnett, H. D., etal.. Detection of breast cancer micrometastases in axillary lymph nodes by using polymerase chain reaction. Cancer Res. 54, 2986-2990 (1994). 

In conclusion, the amplification of CK 20 mRNA in blood, bone marrow, lymph nodes or body fluids is an informative method for the detection of micrometastases or circulating tumor cells originated from colorectal and gastric adenocarcinomas. 

Detection of breast cancer micrometastases in axillary lymph nodes by means of reverse-transcriptase polymerase chain reaction. Am J Pathol, 148, 649-656. 

Ooka, M., Sakita, I., Fujiwara, Y. et al. (2000) Selection of mRNA markers for detection of lymph node micrometastases in breast cancer patients. Oncdogy Rep, 7, 561-566. 

Clinical significance of micrometastases in axillary lymph nodes assessed by reverse transcription-polymerase chain reaction in breast cancer patients. Clin Cancer Res, 6, 4176-4185. 

Saintigny, P., Coulon, S., Kambouchner, M. et al. (2005) real-time RT-PCR detection of CK19, CK7 and MUCl mRNA of diagnosis of lymph node micrometastases in non small cell lung carcinoma. Int J Cancer, 115, 777-782. 

Futamura, M., Takagi, Y., Koumura, H. et al. (1998) Spread of colorectal cancer micrometastases in regional lymph nodes by reverse-transcriptase polymerase chain reactions for carcinoembryonic antigen and CK20. 

Dorudi, S., Kinrade, E., Marshall, N.C. etal. (1998) Genetic detection of lymph node micrometastases in patients with colorectal cancer. Br J Surg, 85, 98—100. 

Kurahashi, T., Hara, L, Oka, N. et al. (2005) Detection of micrometastases in pelvic lymph nodes in patients undergoing radical cystectomy for focally invasive bladder cancer by real-time reverse transcriptase-PCR for cytokeratinl9 and uroplakin II. Clin Cancer Res, 11, 3773-3777. 

---