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Metinel node--the first lymph node draining a metastasis--contains tumor-reactive lymphocytes.

Dahl K, Karlsson M, Marits P, Hoffstedt A, Winqvist O, Thörn M - Ann. Surg. Oncol. (2008)

Bottom Line: The primary tumor site was colorectal cancer in seven patients, malignant melanoma in four, ovarian cancer and breast cancer in two, and one each with pancreatic cancer, cholangiocarcinoma, leiomyosarcoma, and squamous cellular cancer of the tongue.In six patients, a preoperative lymphoscintigraphy was performed.Eight of the nineteen patients received immunotherapy on the basis of tumor-reactive T cells derived from the metinel nodes.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Stockholm South General Hospital, Stockholm, 118 83, Sweden. kjell.dahl@sodersjukhuset.se

ABSTRACT

Background: We previously identified tumor-reactive lymphocytes in the first lymph nodes that drain the primary tumor. In this study, we performed lymphatic mapping to investigate the possibility of finding the first lymph nodes that drain metastases, and of learning whether these lymph nodes contained tumor-reactive lymphocytes suitable for adoptive immunotherapy.

Methods: Nineteen patients were studied. The primary tumor site was colorectal cancer in seven patients, malignant melanoma in four, ovarian cancer and breast cancer in two, and one each with pancreatic cancer, cholangiocarcinoma, leiomyosarcoma, and squamous cellular cancer of the tongue. By injection of Patent blue dye or radioactive tracers around the metastases, we identified draining lymph nodes from liver metastases (n = 9), intra-abdominal local recurrences (n = 3), and regional lymph node metastases (n = 7). In six patients, a preoperative lymphoscintigraphy was performed.

Results: We located the first draining lymph node or nodes from metastases or local recurrences; we named them "metinel nodes." Lymphocytes from the metinel nodes proliferated, showed clonal expansion, and produced interferon gamma (via in vitro expansions on stimulation with tumor homogenate) and interleukins, all of which demonstrate the characteristics of tumor-reactive lymphocytes. Eight of the nineteen patients received immunotherapy on the basis of tumor-reactive T cells derived from the metinel nodes.

Conclusions: We demonstrate that it is possible to locate the first lymph nodes draining subcutaneous, lymphatic, and visceral metastases, the so-called metinel nodes. Metinel node-derived lymphocytes may be used to treat disseminated solid cancer, and clinical trials should evaluate the effect of such treatment.

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Related in: MedlinePlus

(A) After intraoperative injection of Patent blue dye around liver metastasis in patient 18, the metinel node in the hepatoduodenal ligament is blue. (B) Preoperative percutaneous injection of 4 × 15 MBq Tc-nanokolloid around ovarian cancer groin local recurrence (patient 8) demonstrates a medially and distally situated metinel node after 10 minutes.
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Fig1: (A) After intraoperative injection of Patent blue dye around liver metastasis in patient 18, the metinel node in the hepatoduodenal ligament is blue. (B) Preoperative percutaneous injection of 4 × 15 MBq Tc-nanokolloid around ovarian cancer groin local recurrence (patient 8) demonstrates a medially and distally situated metinel node after 10 minutes.

Mentions: Tracer was injected around liver metastases (n = 9), intra-abdominal recurrences (n = 3), or close to subcutaneous metastases (n = 7). Draining metinel nodes appeared visually blue (Fig. 1A) within 3 to 10 minutes after the injection of PB or were found to be disease positive by lymphoscintigraphy (Fig. 1B). No complications due to the lymph node mapping procedure were observed. The method seems valid for detecting the draining metinel node regardless of tumor type because the following were identified by this method: colorectal cancer (n = 7), malignant melanoma (n = 4), ovarian cancer (n = 2), breast cancer (n = 2), pancreatic cancer (n = 1), squamous cell cancer (n = 1), cholangiocarcinoma (n = 1), and leiomyosarcoma (n = 1). Thus, we conclude that lymph nodes draining liver metastases or local recurrences can readily be identified by this simple, safe, and quick procedure.Fig. 1.


Metinel node--the first lymph node draining a metastasis--contains tumor-reactive lymphocytes.

Dahl K, Karlsson M, Marits P, Hoffstedt A, Winqvist O, Thörn M - Ann. Surg. Oncol. (2008)

(A) After intraoperative injection of Patent blue dye around liver metastasis in patient 18, the metinel node in the hepatoduodenal ligament is blue. (B) Preoperative percutaneous injection of 4 × 15 MBq Tc-nanokolloid around ovarian cancer groin local recurrence (patient 8) demonstrates a medially and distally situated metinel node after 10 minutes.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2277445&req=5

Fig1: (A) After intraoperative injection of Patent blue dye around liver metastasis in patient 18, the metinel node in the hepatoduodenal ligament is blue. (B) Preoperative percutaneous injection of 4 × 15 MBq Tc-nanokolloid around ovarian cancer groin local recurrence (patient 8) demonstrates a medially and distally situated metinel node after 10 minutes.
Mentions: Tracer was injected around liver metastases (n = 9), intra-abdominal recurrences (n = 3), or close to subcutaneous metastases (n = 7). Draining metinel nodes appeared visually blue (Fig. 1A) within 3 to 10 minutes after the injection of PB or were found to be disease positive by lymphoscintigraphy (Fig. 1B). No complications due to the lymph node mapping procedure were observed. The method seems valid for detecting the draining metinel node regardless of tumor type because the following were identified by this method: colorectal cancer (n = 7), malignant melanoma (n = 4), ovarian cancer (n = 2), breast cancer (n = 2), pancreatic cancer (n = 1), squamous cell cancer (n = 1), cholangiocarcinoma (n = 1), and leiomyosarcoma (n = 1). Thus, we conclude that lymph nodes draining liver metastases or local recurrences can readily be identified by this simple, safe, and quick procedure.Fig. 1.

Bottom Line: The primary tumor site was colorectal cancer in seven patients, malignant melanoma in four, ovarian cancer and breast cancer in two, and one each with pancreatic cancer, cholangiocarcinoma, leiomyosarcoma, and squamous cellular cancer of the tongue.In six patients, a preoperative lymphoscintigraphy was performed.Eight of the nineteen patients received immunotherapy on the basis of tumor-reactive T cells derived from the metinel nodes.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Stockholm South General Hospital, Stockholm, 118 83, Sweden. kjell.dahl@sodersjukhuset.se

ABSTRACT

Background: We previously identified tumor-reactive lymphocytes in the first lymph nodes that drain the primary tumor. In this study, we performed lymphatic mapping to investigate the possibility of finding the first lymph nodes that drain metastases, and of learning whether these lymph nodes contained tumor-reactive lymphocytes suitable for adoptive immunotherapy.

Methods: Nineteen patients were studied. The primary tumor site was colorectal cancer in seven patients, malignant melanoma in four, ovarian cancer and breast cancer in two, and one each with pancreatic cancer, cholangiocarcinoma, leiomyosarcoma, and squamous cellular cancer of the tongue. By injection of Patent blue dye or radioactive tracers around the metastases, we identified draining lymph nodes from liver metastases (n = 9), intra-abdominal local recurrences (n = 3), and regional lymph node metastases (n = 7). In six patients, a preoperative lymphoscintigraphy was performed.

Results: We located the first draining lymph node or nodes from metastases or local recurrences; we named them "metinel nodes." Lymphocytes from the metinel nodes proliferated, showed clonal expansion, and produced interferon gamma (via in vitro expansions on stimulation with tumor homogenate) and interleukins, all of which demonstrate the characteristics of tumor-reactive lymphocytes. Eight of the nineteen patients received immunotherapy on the basis of tumor-reactive T cells derived from the metinel nodes.

Conclusions: We demonstrate that it is possible to locate the first lymph nodes draining subcutaneous, lymphatic, and visceral metastases, the so-called metinel nodes. Metinel node-derived lymphocytes may be used to treat disseminated solid cancer, and clinical trials should evaluate the effect of such treatment.

Show MeSH
Related in: MedlinePlus