title: Is lymph-node micrometastasis in gallbladder cancer a significant prognostic factor?
abstract: OBJECTIVE
  The purpose of our study was to investigate prognostic significance of lymph-node micrometastasis in gallbladder carcinoma.
  
  
  METHODS
  In total, 1,094 lymph nodes from 41 patients who had undergone radical resection with lymph-node dissection, including para-aortic lymph nodes were stained with hematoxylin and eosin (H&E) and immunostained with anti-cytokeratin 7/8 antibody. Micrometastasis in each lymph node was defined as tumor cells that were detectable only by immunohistochemical evaluation and were not detected by H&E staining.
  
  
  RESULTS
  Metastases were detected in 163 lymph nodes (14.9%) by H&E staining. Micrometastases were found in 25 of the remaining lymph nodes (2.3%). Among 24 patients with lymph node metastasis based on the H&E staining, 12 had micrometastases. Of the 17 patients in whom lymph-node metastasis was not detected by the H&E staining, one was found to have micrometastasis. Micrometastasis correlated significantly with lymph node metastasis on H&E staining and pN (Tumor-Node-Metastasis 5th ed.). On multivariate analysis of data from 17 node-positive patients who underwent curative resection, micrometastasis and microscopic venous invasion were significant prognostic factors.
  
  
  CONCLUSIONS
  Our findings suggest that micrometastasis might be traces of scatter of cancer cells to the whole body rather than an event in an initial stage of the metastasis.
authors.affiliation: Department of Gastroenterological Surgery, Yokoham City University, Yokohama, Japan. betanam@yokohama-cu.ac.jp
authors.forename: Mikiko
authors.initials: M
authors.lastname: Tanabe
authors.forename: Itaru
authors.initials: I
authors.lastname: Endo
authors.forename: Hideki
authors.initials: H
authors.lastname: Masunari
authors.forename: Mitsutaka
authors.initials: M
authors.lastname: Sugita
authors.forename: Daisuke
authors.initials: D
authors.lastname: Morioka
authors.forename: Takashi
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ichikawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shimada
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D007564:Japan; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D061206:Neoplasm Micrometastasis; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013194:Staining and Labeling; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome