Evaluation of lymph node ratio and morphologic patterns of nodal reactive hyperplasia in primary organ malignancy

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dc.contributor.authorSweety, SVen_US
dc.contributor.authorNarayankar, ASen_US
dc.date.accessioned2020-04-10T01:50:10Z
dc.date.available2020-04-10T01:50:10Z
dc.date.issued2019-06
dc.description.abstractBackground: Lymph node ratio (LNR) in cancer staging is the ratio of nodal metastases (LNM) to total nodes harvested (LNH). Reactive nodal hyperplasia can exhibit morphological patterns I to VI. Aims: To measure LNR and evaluate it with tumor stage, tumor grade, LN reactive patterns, and LN size. Setting and Design: Retrospective, observational study of 100 cancer resections including breast, gastrointestinal (GIT), genitourinary (GUT), and head, face, neck, and thyroid (HFNT). Materials and Methods: Total 1463 LNs were reviewed for metastases and reactivity patterns I–VI as per the World Health Organization (WHO) protocol. LNR was calculated from LNM and LNH. Statistical Analysis Used: Association between qualitative variables was assessed by the Chi-square test and Fisher's exact test, those between quantitative variables using the unpaired t-test and Mann–Whitney U test. Results: Mean LNH (23.7) was highest in HFNT and lowest (6.6) in GIT (P = 0.008). Mean LNR was highest (0.29) in breast and least (0.06) in HFNT (P = 0.861). Commonest LN reactive patterns were sinus histiocytosis (60), mixed (48), and follicular hyperplasia (46) (P = 0.000). Maximum cases of breast (59.6%), GUT (53.8%), and HFNT (45%) belonged to stage T2, while GIT (60.0%) to stage T3 (P = 0.000). Maximum well-differentiated cases belonged to HFNT (13, 59.0%), while moderately poorly differentiated cases of breast (38, 55.8% and 7, 70.0%) (P = 0.000). The largest and smallest metastatic LN was 2.4 cm and 0.4 cm (P = 0.009). LNs with thickened capsule showed nodal metastases in 75.7% (P = 0.003871). Conclusions: LNH and LNR cut-off values show organ-wise variation and need standardization. LNR shows stronger relation with tumor grade than tumor stage. Commonest LN reactive patterns include sinus histiocytosis and follicular hyperplasia. Thickened LN capsule strongly suggests nodal metastases. A longitudinal follow-up is warranted to study prognostic association between LNR and LN reactive pattern.en_US
dc.identifier.affiliationsDepartment of Pathology, T.N Medical College and B.Y.L Nair Hospital, Mumbai, Maharashtra, Indiaen_US
dc.identifier.citationSweety SV, Narayankar AS. Evaluation of lymph node ratio and morphologic patterns of nodal reactive hyperplasia in primary organ malignancy. Indian Journal of Pathology and Microbiology. 2019 Jun; 62(2): 216-221en_US
dc.identifier.issn0377-4929
dc.identifier.issn0974-5130
dc.identifier.placeIndiaen_US
dc.identifier.urihttps://imsear.searo.who.int/handle/123456789/196359
dc.languageenen_US
dc.publisherIndian Association of Pathologists and Microbiologistsen_US
dc.relation.issuenumber2en_US
dc.relation.volume62en_US
dc.source.urihttps://dx.doi.org/10.4103/IJPM.IJPM_62_18en_US
dc.subjectLymph node harvesten_US
dc.subjectlymph node metastasesen_US
dc.subjectlymph node ratioen_US
dc.subjectlymph node reactive patternsen_US
dc.titleEvaluation of lymph node ratio and morphologic patterns of nodal reactive hyperplasia in primary organ malignancyen_US
dc.typeJournal Articleen_US
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