Podoplanin, lymphatic vessel endothelial hyaluronic acid receptor-1, prospero-related homeobox-1 and vascular endothelial growth factor receptor 3 have been demonstrated to have crucial roles in the development of the lymphatic system and lymphangiogenesis process by combining with their corresponding receptors. Thus, the four markers have been widely used in labelling lymphatic vessels for the detection of lymphangiogenesis and lymphatic vessel invasion. Numerous authors have aimed to identify the roles of these four markers in the lymphatic system and the mechanisms have been partly clarified at the molecular level. The aim of the present review was to comprehensively clarify the characteristics and latent action modes of the four markers in order to determine which is the best one for the detection of lymphangiogenesis and lymphatic vessel invasion.

BackgroundThe objective of this study was to assess the feasibility of detecting the variation of sentinel lymphatic channels (SLCs) and sentinel lymph nodes (SLNs) in breast cancer patients using contrast-enhanced ultrasound (CEUS).MethodsA total of 46 breast cancer patients were prospectively recruited in the study. All the participants received intradermal and peritumoral injection of microbubbles as contrast agent, and SLCs and SLNs were assessed preoperatively. Blue dye was injected subareolarly and peritumorally during the surgery. The SLNs detected by CEUS and blue dye were sent to the pathology laboratory for histopathological analysis.ResultsAt least one SLC and SLN were detected by CEUS in all 46 cases. Three types of SLCs were detected, including superficial sentinel lymphatic channels (SSLCs), penetrating sentinel lymphatic channels (PSLCs), and deep sentinel lymphatic channels (DSLCs). Five lymphatic drainage patterns (LDPs) were found, including SSLC, PSLC, SSLC + PSLC, SSLC + DSLC, and SSLC + PSLC + DSLC. Only SSLC was detected on CEUS in 24 cases; only PSLC was detected in 3 cases; both SSLC and PSLC were detected in 8 cases; both SSLC and DSLC were detected in 7 cases; SSLC, PSLC, and DSLC were all detected in the remaining 4 cases. An actual LDP was defined on the combination of CEUS and dissection of the specimen. The accuracy rate of CEUS was 43/46. Interestingly, a bifurcated SLC was found in 8 patients. In 3 patients, a discontinuous SLC and non-enhanced SLN were found by CEUS. Also, no dyed SLNs were detected during the surgery. The axillary lymph nodes turned out tumor involved histologically.ConclusionCEUS is feasible to assess the variation of SLCs and SLNs preoperatively in breast cancer patients. SLNB is not suggested when a discontinuous SLC and non-enhanced SLN were detected by CEUS.

ObjectivesThis meta-analysis of randomized controlled trials was conducted to give a more precise estimation of the efficacy and drawbacks of total gastrectomy (TG) versus subtotal gastrectomy (SG) for proven distal gastric cancer.MethodsThe electronic databases Cochrane and PubMed (updated on April 10, 2016) were searched for randomized controlled trials comparing TG with SG as surgical procedures for distal gastric cancer. Five outcome variables were analyzed, including postoperative complications, anastomotic fistula rate, hospital mortality rate, mortality rate of recurrence (the patient’s death is caused by the recurrence of gastric cancer, rather than caused by other diseases), and 5-year survival rate. Random or fixed effect model was used to perform this meta-analysis.ResultsSix trials, including 573 cases treated with TG and 791 cases treated with SG, were included. Compared with patients in the SG group, patients in the TG group did not show a higher rate of postoperative complications (odds ratio [OR]: 1.46, 95% confidence interval [CI]: 0.71–3.03, P=0.30). However, patients in the TG group showed a significantly higher rate of anastomotic fistula than patients in the SG group (OR: 3.78, 95% CI: 1.97–7.27, P<0.0001). Hospital mortality rate, which was analyzed in four trials, including 510 TG versus 729 SG patients, showed no significant difference between the two groups (OR: 1.80, 95% CI: 0.85–3.78, P=0.12). Importantly, there was no significant difference in the 5-year survival between the two groups (OR: 0.68, 95% CI: 0.39–1.19, P=0.18). Mortality rate of recurrence, which was also analyzed in three trials, including 396 TG versus 407 SG patients, showed a significantly higher rate in the TG group (OR: 0.07, 95% CI: 0.01–0.13, P=0.03).ConclusionThis meta-analysis demonstrated that postoperative complications, hospital mortality rate, and 5-year survival rate in TG patients was similar to the SG group. Furthermore, SG was associated with significantly fewer anastomotic fistula and lower mortality rate of recurrence compared with TG. However, lower mortality rate of recurrence was probably related to the criteria of these two procedures.