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Pathologic Assessment of Lymph Node Metastasis

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Cancer Metastasis Through the Lymphovascular System

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Abstract

The pathologic assessment and evaluation of lymph node status plays a central role in the diagnosis, staging, and management of most malignancies. The pathologic status of the lymph node plays a central role in the staging, and thus subsequent treatment of diseases, which is codified in the AJCC/UICC staging system. Lymph node metastasis may be subclinical and detected microscopically during surgical resection of a sentinel node or regional lymphadenectomy for initial therapy, or it may present clinically as the first manifestation of a metastatic malignancy. Different protocols exist for the pathologic evaluation of lymph nodes in these distinct settings. These involve systematic gross assessment, careful light microscopic evaluation, judicious and sometimes stepwise application of immunohistochemical methods, and accurate pathologic reporting. The evaluation of a lymph node metastasis in a patient with unknown primary malignancy requires knowledge of the relative frequencies of malignancies, their most common sites of presentation, and an algorithmic approach to immunohistochemical testing. Molecular analysis by gene expression profiling offers modest improvement in diagnostic accuracy, but these improvements have not yet been translated into clinical improvements.

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Author information

Authors and Affiliations

  1. Department of Dermatology and Cutaneous Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA

    James Isom & Jane L. Messina

  2. Departments of Pathology and Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA

    Jane L. Messina

  3. Departments of Pathology and Cell Biology and Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA

    Jane L. Messina

Authors
  1. James Isom
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Correspondence to Jane L. Messina .

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Editors and Affiliations

  1. Department of Surgery and Melanoma Center, California Pacific Medical Center and Research Institute, San Francisco, CA, USA

    Stanley P. Leong

  2. Henry Ford Cancer Institute, Detroit, MI, USA

    S. David Nathanson

  3. Moffitt Cancer Center, Tampa, FL, USA

    Jonathan S. Zager

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Isom, J., Messina, J.L. (2022). Pathologic Assessment of Lymph Node Metastasis. In: Leong, S.P., Nathanson, S.D., Zager, J.S. (eds) Cancer Metastasis Through the Lymphovascular System. Springer, Cham. https://doi.org/10.1007/978-3-030-93084-4_6

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