Direct lymphatic drainage of lung segments to the mediastinal nodes

Riquet, Marc; Hidden, G; Debesse, B

doi:10.1016/s0022-5223(19)34555-6

Cited by 196 publications

(60 citation statements)

References 8 publications

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“…The reason for the occurrence of skip metastases has not been elucidated in detail. However, in an autopsy study of 260 patients, a 24% incidence of segmental lymph channels draining directly into mediastinal lymph nodes was reported 36. This is similar to the incidence of skip metastases reported in the literature.…”

Section: Discussionsupporting

confidence: 81%

Skip metastasis in nonsmall cell lung carcinoma

Prenzel

Baldus

Mönig

et al. 2004

Cancer

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BACKGROUND Skip metastasis to mediastinal lymph nodes is a prognostic factor for patients with nonsmall cell lung carcinoma (NSCLC). Little is known about the biologic behavior of tumors with noncontinuous spread to the mediastinal lymph nodes. In patients with pN2 skip metastases, micrometastases to N1 lymph nodes, which only mimic skip metastases, have not been investigated. METHODS In a retrospective study, the authors analyzed the primary tumor specimens from 45 patients with pN2 NSCLC (18 patients had squamous cell carcinomas, 23 had adenocarcinomas, and 4 had large cell carcinomas). They immunohistochemically evaluated the expression of p21, p53, MUC‐1, Bcl‐2, c‐ErbB‐2, and E‐cadherin. Survival rates and biomarker expression levels were compared between patients with pN2 disease and infiltration of N1 lymph nodes (without skip metastasis [n = 28]) and patients with pN2 disease without N1 infiltration (with skip metastasis [n = 17]). To evaluate micrometastasis in the pN1 lymph nodes of 17 patients with skip metastases, lymph nodes were stained using the anticytokeratin antibody, AE1/AE3. RESULTS The 5‐year survival rate of patients with skip metastases was 41%, compared with 14% for patients without skip metastases (P = 0.019). In a multivariate analysis, the incidence of skip metastases did not vary significantly according to gender, age, histology, pT status, or cM status. Three skip‐positive patients (17.6%) had micrometastatic tumor involvement of pN1 lymph nodes. After adding these patients to the group of patients without skip metastases, there was still a significant difference in survival between the two groups. p53, MUC‐1, c‐ErbB‐2, and E‐cadherin expression levels in primary tumor specimens were not significantly different in patients with continuous metastasis and patients with skip metastases. Patients with skip metastases expressed lower levels of p21 (P = 0.026), whereas Bcl‐2 expression levels were considerably higher (P = 0.019) compared with the corresponding levels in patients without skip metastases. CONCLUSIONS Patients with NSCLC and pN2 skip metastases have a more favorable prognosis than do patients with pN2 disease without skip metastases. Tumor specimens from these patients exhibit elevated expression of the antiapoptosis gene BCL2 and lower expression levels of p21 relative to patients with pN2 disease without skip metastases. Micrometastases occurred in 3 of 17 (17.6%) patients with pN2 disease and skip metastases diagnosed by routine histopathology. Cancer 2004. © 2004 American Cancer Society.

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Section: Discussionsupporting

confidence: 81%

Skip metastasis in nonsmall cell lung carcinoma

Prenzel

Baldus

Mönig

et al. 2004

Cancer

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“…We found direct mediastinal lymphatic drainage in four cases (23%), which is consistent with others series. 19,20,[22][23][24] The intraoperative sentinel node mapping is an accurate method to identify "skip metastasis," although in our study routine systematic nodal dissection had removed the stations where the N2 SLNs were located.…”

Section: Discussionmentioning

confidence: 82%

Feasibility of the Detection of the Sentinel Lymph Node in Peripheral Non-small Cell Lung Cancer With Radio Isotopic and Blue Dye Techniques

Tiffet

Nicholson

Khaddage

et al. 2005

Chest

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“…[ However, mediastinal metastases may occur through direct lymphatic drainage that bypasses the hilar nodes (13,14). This is most commonly seen in the upper lobes.…”

Section: View Larger Version (28k)mentioning

confidence: 99%

Patterns of Lymphadenopathy in Thoracic Malignancies

Sharma¹,

Fidias²,

Hayman³

et al. 2004

RadioGraphics

151

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There are different lymphatic drainage pathways in the thorax that are relevant in the staging of lung cancer, breast cancer, lymphoma, esophageal cancer, and malignant mesothelioma. To properly search for metastatic spread, it is important to carefully evaluate the specific nodal stations that drain the thoracic structures from which a primary tumor originates. Because size criteria have limitations in the prediction of nodal status, pathologic confirmation is essential for accurate staging. Computed tomography (CT) is useful in helping the surgeon or interventional radiologist determine the most appropriate approach for nodal sampling. Fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) has an increasing role in detection of diseased lymph nodes that appear normal at CT alone, particularly when FDG PET images are fused with CT images. However, the role of radiologic imaging extends beyond initial staging and the guidance of interventions to include posttreatment assessment and the detection of recurrent disease. Therefore, at all levels of cancer imaging, it is essential to identify the relevant lymph node regions and their relations to the primary tumor.

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Direct lymphatic drainage of lung segments to the mediastinal nodes

Cited by 196 publications

References 8 publications

Skip metastasis in nonsmall cell lung carcinoma

Skip metastasis in nonsmall cell lung carcinoma

Feasibility of the Detection of the Sentinel Lymph Node in Peripheral Non-small Cell Lung Cancer With Radio Isotopic and Blue Dye Techniques

Patterns of Lymphadenopathy in Thoracic Malignancies

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