Abstract
Nodal staging is a crucial factor in choosing the treatment option for non-small cell lung cancer (NSCLC). However, so far as we know, a computer-based histomorphometric analysis of lymph nodes in NSCLC has never been developed. We studied 299 surgically resected lymph nodes from 108 patients with NSCLC. Microscopic digital images were analyzed with Scion Image software. Seventy lymph nodes had at least one metastatic focus. The metastasis occupancy area per node ranged from 0.01 to 209.58 mm2 (mean, 29.58 ± 5.87 mm2). The metastasis occupancy ratio ranged from 0.01% to 100% (mean, 48.70% ± 42.10%). The short-axis diameter of malignant lymph nodes was significantly longer than that of benign lymph nodes (P = 0.0002). The average metastasis occupancy area in the regional lymph nodes of NSCLC is quite small. Various inflammatory conditions can result in a false-positive diagnosis when these techniques are used. Studies that combine analysis of primary tumor size and serum carcinoembryonic antigen (CEA) levels with imaging methods should be considered. Finally, the use of mediastinoscopy or video-assisted thoracoscopic surgery is encouraged in determining the exact nodal status in NSCLC.
Similar content being viewed by others
References
Rosell R, Gomez-Codina J, Camps C, Maestre J, Padille J, Canto A, Mate JL, Li S, Roig J, Olazabal A, Canela M, Ariza A, Skacel Z, Morera-Prat J, Abad A (1994) A randomized trial comparing preoperative chemotherapy plus surgery with surgery alone in patients with non-small-cell lung cancer. N Engl J Med 330: 153–158
Ichinose Y, Kato H, Koike T, Tsuchiya R, Fujisawa T, Shimizu N, Watanabe Y, Mitsudomi T, Yoshimura M (2001) Overall survival and local recurrence of 406 completely resected stage IIIa-N2 non-small cell lung cancer patients: questionnaire survey of the Japan Clinical Oncology Group to plan for clinical trials. Lung Cancer 34:29–36
Postmus PE, Rocmans P, Asamura H, Ball D, Belderbos J, Cappello M, Jassem J, Novello S, Pass H, Passlick B (2003) Consensus report IASLC workshop Bruges, September 2002: pretreatment minimal staging for non-small cell lung cancer. Lung Cancer 42:3–6
Glazer GM, Gross BH, Quint LE, Francis IR, Bookstein FL, Orringer MB (1985) Normal mediastinal lymph nodes: number and size according to American Thoracic Society mapping. AJR Am J Roentgenol 144:261–265
Quint LE, Glazer GM, Orringer MB, Francis IR, Bookstein FL (1986) Mediastinal lymph node detection and sizing at CT and autopsy. AJR Am J Roentgenol 147:469–472
Webb WR, Gatsonis C, Zerhouni EA, Heelan RT, Glazer GM, Francis IR, McNeil BJ (1991) CT and MR imaging in staging non-small cell bronchogenic carcinoma: report of the Radiologic Diagnostic Oncology Group. Radiology 178:705–713
Lee N, Inoue K, Yamamoto R, Kinoshita H (1992) Patterns of internal echoes in lymph nodes in the diagnosis of lung cancer metastasis. World J Surg 16:986–993; discussion 993–994
Kerr KM, Lamb D, Wathen CG, Walker WS, Douglas NJ (1992) Pathological assessment of mediastinal lymph nodes in lung cancer: implications for non-invasive mediastinal staging. Thorax 47:337–341
McLoud TC, Bourgouin PM, Greenberg RW, Kosiuk JP, Templeton PA, Shepard JA, Moore EH, Wain JC, Mathisen DJ, Grillo HC (1992) Bronchogenic carcinoma: analysis of staging in the mediastinum with CT by correlative lymph node mapping and sampling. Radiology 182:319–323
Arita T, Matsumoto T, Kuramitsu T, Kawamura M, Matsunaga N, Sugi K, Esato K (1996) Is it possible to differentiate malignant mediastinal nodes from benign nodes by size? Reevaluation by CT, transesophageal echocardiography, and nodal specimen. Chest 110:1004–1008
Prenzel KL, Monig SP, Sinning JM, Baldus SE, Brochhagen HG, Schneider PM, Holscher AH (2003) Lymph node size and metastatic infiltration in non-small cell lung cancer. Chest 123:463–467
Wahl RL, Quint LE, Greenough RL, Meyer CR, White RI, Orringer MB (1994) Staging of mediastinal non-small cell lung cancer with FDG-PET, CT, and fusion images: preliminary prospective evaluation. Radiology 191:371–377
Guhlmann A, Storck M, Kotzerke J, Moog F, Sunder-Plassmann L, Reske SN (1997) Lymph node staging in non-small cell lung cancer: evaluation by [18F]FDG positron emission tomography (PET). Thorax 52:438–441
Boiselle PM, Patz EF Jr, Vining DJ, Weissleder R, Shepard JA, McLoud TC (1998) Imaging of mediastinal lymph nodes: CT, MR, and FDG-PET. Radiographics 18:1061–1069
Gupta NC, Graeber GM, Rogers JS II, Bishop HA (1999) Comparative efficacy of positron emission tomography with FDG and computed tomographic scanning in preoperative staging of non-small cell lung cancer. Ann Surg 229:286–291
Gupta NC, Graeber GM, Bishop HA (2000) Comparative efficacy of positron emission tomography with fluorodeoxyglucose in evaluation of small (<1 cm), intermediate (1 to 3 cm), and large (>3 cm) lymph node lesions. Chest 117:773–778
Gould MK, Maclean CC, Kuschner WG, Rydzak CE, Owens DK (2001) Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis. JAMA 285:914–924
Ohno Y, Sugimura K, Hatabu H (2002) MR imaging of lung cancer. Eur J Radiol 44:172–181
Takenaka D, Ohno Y, Hatabu H, Ohbayashi C, Yoshimura M, Ohkita Y, Sugimura K (2002) Differentiation of metastatic versus non-metastatic mediastinal lymph nodes in patients with non-small cell lung cancer using respiratory-triggered short inversion time inversion recovery (STIR) turbo spin-echo MR imaging. Eur J Radiol 44:216–224
Antoch G, Stattaus J, Nemat AT, Marnitz S, Beyer T, Kuehl H, Bockisch A, Debatin JF, Freudenberg LS (2003) Non-small cell lung cancer: dual-modality PET/CT in preoperative staging. Radiology 229:526–533
Lardinois D, Weder W, Hany TF, Kamel EM, Korom S, Seifert B, von Schulthess GK, Steinert HC (2003) Staging of non-small-cell lung cancer with integrated positron-emission tomography and computed tomography. N Engl J Med 348:2500–2507
Vansteenkiste JF (2003) PET scan in the staging of non-small cell lung cancer. Lung Cancer 42:S27–S37
Funatsu T, Matsubara Y, Ikeda S, Hatakenaka R, Hanawa T, Ishida H (1994) Preoperative mediastinoscopic assessment of N factors and the need for mediastinal lymph node dissection in T1 lung cancer. J Thorac Cardiovasc Surg 108:321–328
Detterbeck FC, DeCamp MM Jr, Kohman LJ, Silvestri GA (2003) Lung cancer. Invasive staging: the guidelines. Chest 123:167S–175S
Passlick B (2003) Initial surgical staging of lung cancer. Lung Cancer 42:S21–S25
Sebastian-Quetglas F, Molins L, Baldo X, Buitrago J, Vidal G (2003) Clinical value of video-assisted thoracoscopy for preoperative staging of non-small cell lung cancer: a prospective study of 105 patients. Lung Cancer 42:297–301
Ishida T, Tateishi M, Kaneko S, Sugimachi K (1990) Surgical treatment of patients with non-small cell lung cancer and mediastinal lymph node involvement. J Surg Oncol 43:161–166
Crippa F, Leutner M, Belli F, Gallino F, Greco M, Pilotti S, Cascinelli N, Bombardieri E (2000) Which kinds of lymph node metastases can FDG PET detect? A clinical study in melanoma. J Nucl Med 41:1491–1494
Kubota R, Yamada S, Kubota K, Ishiwata K, Tamahashi N, Ido T (1992) Intratumoral distribution of fluorine-18-fluorodeoxyglucose in vivo: high accumulation in macrophages and granulation tissues studied by microautoradiography. J Nucl Med 33:1972–1980
Kubota R, Kubota K, Yamada S, Tada M, Ido T, Tamahashi N (1994) Active and passive mechanisms of [fluorine-18] fluorodeoxyglucose uptake by proliferating and prenecrotic cancer cells in vivo: a microautoradiographic study. J Nucl Med 35:1067–1075
Deichen JT, Prante O, Gack M, Schmiedehausen K, Kuwert T (2003) Uptake of [18F]fluorodeoxyglucose in human monocytemacrophages in vitro. Eur J Nucl Med Mol Imaging 30:267–273
Ohtsuki Y, Uomoto M, Hachisuka Y, Kato M, Iguchi M, Lee GH, Furihata M (2008) A rare case of coexistence of pulmonary adenocarcinoma with Langerhans’ cell histiocytosis. Med Mol Morphol 41:175–178
Genereux GP, Howie JL (1984) Normal mediastinal lymph node size and number: CT and anatomic study. AJR Am J Roentgenol 142:1095–1100
Kiyono K, Sone S, Sakai F, Imai Y, Watanabe T, Izuno I, Oguchi M, Kawai T, Shigematsu H, Watanabe M (1988) The number and size of normal mediastinal lymph nodes: a postmortem study. AJR Am J Roentgenol 150:771–776
Suzuki K, Nagai K, Yoshida J, Nishimura M, Takahashi K, Nishiwaki Y (1999) Clinical predictors of N2 disease in the setting of a negative computed tomographic scan in patients with lung cancer. J Thorac Cardiovasc Surg 117:593–598
Takamochi K, Nagai K, Suzuki K, Yoshida J, Ohde Y, Nishiwaki Y (2000) Clinical predictors of N2 disease in non-small cell lung cancer. Chest 117:1577–1582
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gotoh, H., Kanomata, N., Yoshimura, M. et al. Morphometric analysis of regional lymph nodes in surgically resected non-small cell lung cancer. Med Mol Morphol 42, 162–166 (2009). https://doi.org/10.1007/s00795-009-0455-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00795-009-0455-x