Search

We present a novel tool designed for the semiautomatic detection and assessment of prostate cancer during recurrence diagnostics using PET-CT with prostate-specific membrane antigen (PSMA). The tool automatically generates a structured report, which is enhanced by 3D images and ensures the reproducibility of the findings. Moreover, the area of the findings is automatically determined and can be corrected manually. Image data from 50 patients following radical prostatectomy was used. Our approach and its user interface were qualitatively evaluated by a nuclear medicine specialist. The segmentation analysis revealed a requirement for further automation. The resulting report was deemed highly beneficial, particularly in terms of the resulting reproducibility and the presentation of 3D images depicting the findings. The presented tool has great potential for much-needed support in everyday clinical practice, as it facilitates the communication of the diagnostic results to colleagues and patients and thus prevents misunderstandings. [ABSTRACT FROM AUTHOR]

Introduction: Neck swellings are commonly found and can be presented as simple benign to malignant. Due to extensive differential diagnosis and similar presentation, the evaluation of neck swellings is more challenging. Most of the cases can be diagnosed after a detailed history and clinical examination of the head and neck, but the final diagnosis will be achieved by histopathological examination. Materials and Methods: The study was conducted from February 2020 to February 2023 on the basis of retrospective and prospective sampling. This study included all the patients with neck swellings, excluding thyroid, who had undergone excisional or incisional biopsy. The present study was carried out on 74 patients with non-thyroid neck swellings, which were classified five into main headings, i.e. lymph node swelling, salivary gland swellings, adipose tissue, neural tissue and skin and soft-tissue swellings as miscellaneous. Data were collected from patient records for retrospective sampling and radiological investigation, and ultrasonography (USG) and excisional or incisional biopsy were done for prospective sampling. A radiological and pathological correlation was analysed as benign and malignant. Results: Out of the 74 patients, n = 60, 81% were benign and n = 14, 19% were malignant. The most common swelling according to the tissue of origin was lymph node (n = 31, 41.9%) followed by salivary gland n = 15 (20.3%), adipose tissue (n = 7, 9.5%) and neural tissue (n = 6, 8.1%) origin. Other soft-tissue swellings were 20.3%. The overall sensitivity, specificity, positive predictive value, negative predictive value and radiological (USG) diagnosis accuracy to differentiate between benign and malignant are very similar to gold standard histopathological examination. Conclusion: Lymph node swellings were the most common swelling involving the neck region. USG diagnosis is highly sensitive for diagnosing malignant swellings but less good at confirming benign swellings. Radiological diagnosis is not a substitute for conventional surgical histopathology but is regarded as a precious complement in diagnosis. Newer diagnostic techniques are required to be infallible and accurate for further management. [ABSTRACT FROM AUTHOR]

Context • Nasopharyngeal carcinoma (NPC) is a malignant tumor with a high incidence. Regional lymph node metastasis (RLNM) affects the benefits to and prognosis of patients after treatment. Researchers speculate that CRNDE expression might have a correlation with NPC lymph node metastasis (LNM), but studies on the subject are relatively few. Objective • The study intended to explore the predictive value of the level of serum colorectal neoplasia differentially expressed (CRNDE) for RLNM in NPC patients and to analyze the effects of RLNM on their long-term prognosis after radiotherapy and chemotherapy, to provide a reference for early prediction, diagnosis, and treatment of RLNM in NPC. Design • The research team performed a retrospective case-control study. Setting • The study took place at Taizhou People’s Hospital in Taizhou, China. Participants • Participants were 80 NPC patients who received treatment using radiotherapy and chemotherapy at the hospital between January 2014 and December 2017. Groups • The research team divided participants into two groups: (1) an observation group diagnosed with RLNM, with 52 participants, and a control group that had no RLNM, with 28 participants. Outcome Measures • The research team: (1) determined the level of colorectal neoplasia differentially expressed (CRNDE) in participants’ serum to predict the risk of RLNM, (2) compared clinical total response rates (TRRs) between the groups, and (3) analyzed the five-year overall survival (OS), local relapse-free survival (LRFS), and distant metastasis-free survival (DMFS). Results • Compared with control group, the observation group’s CRNDE level was significantly higher, and its five- year OS and DMFS rates were significantly lower (all P < .01). No significant differences existed in the TRR and five-year LRFS rate between the observation and control groups (P > .05). The cut-off value for serum CRNDE was set at 3.540, the area under curve (AUC) value for the observation group was 0.805, and the 95% confidence interval (CI) was 0.715-0.889. In addition, the sensitivity was 88.5%, specificity was 57.1%, and Yoden index was 0.463. The five-year OS rates were significant lower in the observation group patients with metastatic lymph nodes > 2 in number (P = .025) and > 6 cm in diameter (P = .002) and with posterior pharyngeal LNM (P = .049). Conclusions • An abnormal increase in serum CRNDE can be a basis to diagnose RLNM in NPC patients. RLNM affected the long-term prognosis of NPC patients, and the number and diameter of lymph nodes and posterior pharyngeal metastasis were the factors affecting patients’ long-term. The current study’s findings can provide a reference for the realization of the early diagnosis of NPC RLNM, formulating the treatment schemes and improving the long-term survival outcome of NPC patients. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effectiveness of the texture analysis of axillary high-resolution 3D T2-weighted imaging (T2WI) in distinguishing positive and negative lymph node (LN) metastasis in patients with clinically node-negative breast cancer. Methods: Between December 2017 and May 2021, 242 consecutive patients underwent high-resolution 3D T2WI and were classified into the training (n = 160) and validation cohorts (n = 82). We performed manual 3D segmentation of all visible LNs in axillary level I to extract the texture features. As the additional parameters, the number of the LNs and the total volume of all LNs for each case were calculated. The least absolute shrinkage and selection operator algorithm and Random Forest were used to construct the models. We constructed the texture model using the features from the LN with the largest least axis length in the training cohort. Furthermore, we constructed the 3 models combining the selected texture features of the LN with the largest least axis length, the number of LNs, and the total volume of all LNs: texturenumber model, texture-volume model, and texture-number-volume model. As a conventional method, we manually measured the largest cortical diameter. Moreover, we performed the receiver operating curve analysis in the validation cohort and compared area under the curves (AUCs) of the models. Results: The AUCs of the texture model, texture-number model, texture-volume model, texture-numbervolume model, and conventional method in the validation cohort were 0.7677, 0.7403, 0.8129, 0.7448, and 0.6851, respectively. The AUC of the texture-volume model was higher than those of other models and conventional method. The sensitivity, specificity, positive predictive value, and negative predictive value of the texture-volume model were 90%, 69%, 49%, and 96%, respectively. Conclusion: The texture-volume model of high-resolution 3D T2WI effectively distinguished positive and negative LN metastasis for patients with clinically node-negative breast cancer. [ABSTRACT FROM AUTHOR]

Objective: Accurate radiological staging of colon cancer is essential for appropriately selecting patients who might benefit from neoadjuvant chemotherapy. Lymph node staging and the detection of metastatic lymph nodes form an integral part of the local staging. This study aimed to determine the efficacy of computed tomography texture analysis (CTTA) in characterizing lymph nodes in patients with sigmoid cancers. Materials and Methods: Forty-five patients diagnosed with sigmoid adenocarcinoma, who underwent computed tomography (CT) scans, were included in this retrospective study. Based on post-surgery histopathological results, 25 patients were classified as stage N1-2, and 20 patients were classified as stage N0. CTTA was conducted on 51 metastatic lymph nodes from the 25 N1-2 patients and 30 benign lymph nodes from the 20 N0 patients. Histogram analysis was employed to calculate texture features, and the texture features of both groups were statistically compared. Receiver operating characteristic (ROC) analysis was used to evaluate the predictive performance of the parameters. Results: The maximum of the histogram, 99th percentile of the histogram, and entropy values were significantly higher in the metastatic lymph nodes. Conversely, skewness, uniformity, and kurtosis values were significantly higher in benign lymph nodes (p<0.05). ROC analysis for uniformity and skewness revealed area under the curve (AUC) values of 0.904 and 0.909, respectively. Conclusion: In patients with sigmoid cancer, CTTA can serve as a useful tool for lymph node staging. [ABSTRACT FROM AUTHOR]

Context: Management of sporadic medullary thyroid microcarcinoma smaller than 1 cm (micro-MTC) is controversial because of conflicting reports of prognosis. As these cancers are often diagnosed incidentally, they pose a management challenge when deciding on further treatment and follow-up. Objective: We report the outcomes of surgically managed sporadic micro-MTC in a specialist endocrine surgery and endocrinology unit and identify associations for recurrence and disease-specific survival in this population. Methods: Micro-MTCs were identified from a prospectively maintained surgery database, and slides were reviewed to determine pathological grade. The primary end points were recurrence, time to recurrence and disease-specific survival. Prognostic factors assessed included size, grade, lymph node metastasis (LNM), and postoperative calcitonin. Results: From 1995 to 2022, 64 patients were diagnosed with micro-MTC with 22 excluded because of hereditary disease. The included patients had a median age of 60 years, tumor size of 4 mm, and 28 (67%) were female. The diagnosis was incidental in 36 (86%) with 4 (10%) being high grade, 5 (12%) having LNM and 9 (21%) having elevated postoperative calcitonin. Over a 6.6-year median follow-up, 5 (12%) developed recurrence and 3 (7%) died of MTC. High grade and LNM were associated with 10-year survival estimates of 75% vs 100% for low grade and no LNM (hazard ratio = 831; P < .01). High grade, LNM, and increased calcitonin were associated with recurrence (P < .01). Tumor size and type of surgery were not statistically significantly associated with recurrence or survival. No patients with low grade micro-MTC and normal postoperative calcitonin developed recurrence. Conclusion: Most sporadic micro-MTCs are detected incidentally and are generally associated with good outcomes. Size is not significantly associated with outcomes. Using grade, LNM, and postoperative calcitonin allows for the identification of patients at risk of recurrence to personalize management. [ABSTRACT FROM AUTHOR]

Tularemia has many atypical presentations which can represent a diagnostic challenge. The history is essential in the investigation of this disease. Biteinduced primary skin lesions should be distinguished from the infrequent immune-mediated secondary skin lesions. Herein, we present an atypical pseudovesicular rash secondary to Francisella tularensis. [ABSTRACT FROM AUTHOR]

In this study, we explored the risk factors for lymph node metastasis in patients with type II endometrial carcinoma (EC). Patients diagnosed with type II EC who underwent staged surgery and lymph node dissection were included. Univariate analysis was performed using a chi-square test for factors such as age, body mass index (BMI), menopausal status, histologic type, histologic grade, myometrial invasion, lymphatic vascular invasion (LVSI), tumor volume index, and para-aortic lymph node (PALN) or pelvic lymph node (PLN) metastasis. An analysis of multivariate factors was performed on the factors that were statistically significant in the univariate analysis. Pelvic lymph node metastasis was identified in 38 of the 184 patients with type II EC. Univariate analyses revealed that age =55 years, menopause, more than one-half myometrial invasion, and LVSI were risk factors for pelvic lymph node metastasis. Multivariate analysis indicated that myometrial invasion of more than one-half (hazard ratio (HR): 4.259) and LVSI (HR: 3.317) were independent risk factors for pelvic lymph node metastasis. Para-aortic lymph node metastasis was identified in 13 of the 184 patients with type II EC. Univariate analysis indicated that para-aortic lymph node metastasis was significantly associated with LVSI and pelvic lymph node metastases. Multivariate analysis suggested that pelvic lymph node metastasis (HR: 5.887) was an independent risk factor for para-aortic lymph node metastasis. LVSI and myometrial invasion depth >1/2 were significant predictors of pelvic lymph node metastasis in patients with type II EC. Patients with type II EC who have pelvic lymph node metastasis may be at risk of para-aortic lymph node metastasis. [ABSTRACT FROM AUTHOR]

Copyright of Ege Journal of Medicine is the property of Ege University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The term non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was proposed in 2016 and incorporated as a new entity in the World Health Organization (WHO) classification of tumours of endocrine organs in 2017. Since then, there has been debate regarding the histological criteria for the diagnosis, the need for molecular studies or the risk of lymph node metastasis or recurrence associated with this entity. Over the years, the concept of NIFTP evolved, now including both small (<1 cm) and large (>4 cm) tumours and oncocytic lesions. On the other hand, recent data on NIFTP in the setting of thyroid follicular nodular disease or frequent coexistence of malignant tumours raised concerns regarding the follow-up of these patients. Today, both pathologists and clinicians still face several challenges in the diagnosis, treatment, and follow-up of patients with NIFTP. [ABSTRACT FROM AUTHOR]

Lymph node metastasis is related to poor prognosis in oral squamous cell carcinoma (OSCC), and few studies have explored the relevance of postoperative drainage fluid (PDF) in metastasis. Extracellular vesicles (EVs) are nanosized vesicles that can transfer oncogenic molecules to regulate tumorigenesis. However, the proteomic profile of postoperative drainage fluid–derived EVs (PDF-EVs) in OSCC has not been elucidated. Herein, we collected drainage fluid from OSCC patients after neck dissection to investigate the difference in PDF-EVs between patients with metastatic lymph nodes (the LN+ group) and nonmetastatic lymph nodes (the LN− group). The proteomic profile of PDF-EVs from the LN+ and LN− groups was compared using label-free liquid chromatography tandem-mass spectrometry–based protein quantification. The results revealed that PDF-EVs were mainly derived from epithelial cells and immune cells. A total of 2,134 proteins in the PDF-EVs were identified, and 313 were differentially expressed between the LN+ and LN− groups. Metabolic proteins, such as EHD2 and CAVIN1, were expressed at higher levels in the LN+ group than in the LN− group, and the levels of EHD2 and CAVIN1 in the postoperative drainage fluid were positively correlated with lymph node metastasis. Our study revealed previously undocumented postoperative drainage fluid–associated proteins in patients with metastatic OSCC, providing a starting point for understanding their role in metastatic and nonmetastatic OSCC. [ABSTRACT FROM AUTHOR]

Background: Vascular transformation of lymph nodes, or plexiform vasculopathy, is an uncommon condition, which has been reported in inguinal and cervical lymph nodes in cats, but not before in a serosal location. Case report: An eight-year-old male neutered Domestic Shorthair Cat presented with vomiting, hyporexia, and abdominal pain of 24-hour duration. A mass lesion at the ileocolic junction was identified on abdominal ultrasound. A vascular mass arising from the serosal surface of the caecum was present on exploratory laparotomy. Histopathology was consistent with plexiform vasculopathy. There was concern over malignant transformation of the lesion based on histopathology, however at 98 days following surgery there was no evidence of recurrence on abdominal imaging. Conclusion: To the authors' knowledge this is the first described case of plexiform vasculopathy in a serosal lymph node. This should be considered as a differential for vascular gastrointestinal mass lesions in cats. [ABSTRACT FROM AUTHOR]

Background: It is important to predict lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC) preoperatively; however, the relationship between the American College of Radiology Thyroid Imaging, Reporting and Data System (ACR TI-RADS) score and cervical LNM remains unclear. Purpose: To evaluate the association between the ACR TI-RADS score and cervical LNM in patients with PTC. Material and Methods: This retrospective study consisted of 474 patients with 548 PTCs. Cervical LNM including central LNM (CLNM) and lateral LNM (LLNM) were confirmed by pathology. Univariate and multivariate analyses were performed to investigate the risk factors of CLNM and LLNM. Results: Multivariate logistic regression analyses indicated that younger age and multifocality were risk factors for CLNM in PTCs with TR5. In addition, younger age, larger tumor size, and Hashimoto's thyroiditis (HT) were risk factors for LLNM in PTCs ≥ 10 mm with TR5. In PTCs with TR4, ACR TI-RADS scores 5–6 conferred risks for LNM. In PTCs ≥ 10 mm with TR5, ACR TI-RADS scores ≥9 were risk factors for LLNM. Conclusion: A higher ACR TI-RADS score is a predictor for cervical LNM in PTCs with TR4 and PTCs ≥ 10 mm with TR5. [ABSTRACT FROM AUTHOR]

Background: Deep learning (DL) has been used on medical images to grade, differentiate, and predict prognosis in many tumors. Purpose: To explore the effect of computed tomography (CT)-based deep learning nomogram (DLN) for predicting cervical cancer lymph node metastasis (LNM) before surgery. Material and Methods: In total, 418 patients with stage IB-IIB cervical cancer were retrospectively enrolled for model exploration (n = 296) and internal validation (n = 122); 62 patients from another independent institution were enrolled for external validation. A convolutional neural network (CNN) was used for DL features extracting from all lesions. The least absolute shrinkage and selection operator (Lasso) logistic regression was used to develop a deep learning signature (DLS). A DLN incorporating the DLS and clinical risk factors was proposed to predict LNM individually. The performance of the DLN was evaluated on internal and external validation cohorts. Results: Stage, CT-reported pelvic lymph node status, and DLS were found to be independent predictors and could be used to construct the DLN. The combination showed a better performance than the clinical model and DLS. The proposed DLN had an area under the curve (AUC) of 0.925 in the training cohort, 0.771 in the internal validation cohort, and 0.790 in the external validation cohort. Decision curve analysis and stratification analysis suggested that the DLN has potential ability to generate a personalized probability of LNM in cervical cancer. Conclusion: The proposed CT-based DLN could be used as a personalized non-invasive tool for preoperative prediction of LNM in cervical cancer, which could facilitate the choice of clinical treatment methods. [ABSTRACT FROM AUTHOR]

Background: A universal and systematic protocol is essential for accurate reporting of biomarker studies. For unity in reporting biomarker studies, many guidelines were introduced, Recommendations for Tumor Marker Prognostic Studies (REMARK) being one of them. Aim: The purpose of this review is to evaluate the quality of published articles of biomarkers that predict metastasis in lymph nodes in oral squamous cell carcinoma (OSCC) by the use of the reporting recommendations for tumor marker prognostic (REMARK) guidelines. Methods: Comprehensive search was done in MEDLINE via PubMed and Cochrane from January 2015 to December 2019 to identify manuscripts evaluating biomarkers predicting lymph node metastasis in OSCC. The significance of the univariate and multivariate analysis was assessed for each manuscript, and P < 0.05 was considered statistically significant. Results: Thirty-six results were included for the qualitative synthesis. The mean REMARK score was 11.13 (range: 5.01--17.15). Biomarkers with the highest REMARK score were phospholipase C, cyclin D, CD44+/CD133+, and matrix metalloproteinase-9 (MMP-9). While biomarkers such as LGALS1, NCOA7, and TMOD1 were associated with high risk of bias, hence its use as a biomarker predicting lymph node metastasis is questionable. Conclusions: In our review of 36 manuscripts, manuscripts examining biomarkers evaluating lymph node metastasis in OSCC need an improvement in their reporting. Biomarkers such as phospholipase C, cyclin D, CD44+/CD133+, and MMP-9 can be used as a predictor of lymph node metastasis in OSCC. [ABSTRACT FROM AUTHOR]

Background/Aim: Chemoradiation is the recommended initial treatment for locally advanced squamous anal cancer. However, there is still no consensus on the course of treatment for anal canal cancer with distant metastasis, and the significance of surgical resection of distant metastases is also unclear. Case Report: A 48-year-old woman presented to the referral hospital complaining of prolonged bleeding for the past 6 months. On examination, a mass was identified in the anal canal and the upper part of the rectum that was diagnosed as squamous cell carcinoma. Liver, ovarian, and right internal iliac lymph node metastases were found on further examination, and the patient was referred to our department for treatment. Systemic chemotherapy was planned, and six courses of modified FOLFOX6 were administered. After chemotherapy, the liver and right internal iliac lymph node metastases tended to shrink, and no new lesions appeared. Therefore, a total posterior pelvic resection and a bilateral lymph node dissection were performed for the primary tumour and ovarian metastases, and a simultaneous laparoscopic right partial hepatectomy was undertaken for the liver metastases. R0 resection was achieved, and the final diagnosis was T3N3M1a(H) stage IV. The patient remains alive 2 years after the surgery without recurrence. Conclusion: We report a rare case of anal canal cancer with distant metastases who achieved R0 resection after modified FOLFOX6 chemotherapy. [ABSTRACT FROM AUTHOR]

Cancer of unknown primary is defined as cancer with an unknown primary origin. Occult breast cancer (OBC) is a rare diagnosis in which physical examination, imaging methods, and even surgical procedures are insufficient to put on a primary tumoral site in the breasts. This definition leads to only 0.3-1% of all breast cancer cases. The diagnosis of OBC is usually obtained with an axillary lymph node biopsy. A 52-year-old female presented with right arm weakness and a neck lump. On the physical examination, multiple masses were palpated at the right axillary, right supraclavicular, and anterior cervical areas. Mammography, breast ultrasonography, breast magnetic resonance imaging, and 18-fluorodeoxyglucose positron emission tomography (18-FDG PET) scan could not show a suspicious tumoral area as the primary origin. 18-FDG PET scan put on the massive tumoral burden at multiple bones and lymph nodes, but there were no lesions to suspect as the tumoral origin. Finally, the supraclavicular lymph node biopsy result has revealed the diagnosis; hormone receptor-positive and C-erbB2 positive occult breast cancer. Cervical lymph node metastasis is also a scarce condition for breast cancer. The lymphatic drainage pathway is not clear in explaining the breast cancer involvement of the cervical. [ABSTRACT FROM AUTHOR]

A portion of gastric cancer patients with negative lymph node metastasis at an early stage eventually die from tumor recurrence or advanced metastasis. Occult lymph node metastasis (OLNM] is a potential risk factor for the recurrence and metastasis in these patients, and it is highly important for clinical prognosis. Positron emission tomography (PET)/computed tomography (CT) is used to assess lymph node metastasis in gastric cancer due to its advantages in anatomical and functional imaging and non-invasive nature. Among the major metabolic parameters of PET, the maximum standardized uptake value (SUVmax) is commonly used for examining lymph node status. However, SUVmax is susceptible to interference by a variety of factors. In recent years, the exploration of new PET metabolic parameters, new PET imaging agents and radiomics, has become an active research topic. This paper aims to explore the feasibility and predict the effectiveness of using PET/CT to detect OLNM. The current landscape and future trends of primary metabolic parameters and new imaging agents of PET are reviewed. For gastric cancer patients, the possibility to detect OLNM non-invasively will help guide surgeons to choose the appropriate lymph node dissection area, thereby reducing unnecessary dissections and providing more reasonable, personalized and comprehensive treatments. [ABSTRACT FROM AUTHOR]

The lymph node plays an important role in the lymphatic spread of abnormal antigens from exogenous or endogenous sources, including infectious agents, foreign bodies, self-antigens, and malignant cells, by harboring various immune cells that react to abnormal antigens and their sources. This often leads to enlargement of the lymph node, also known as "lymphadenopathy." In this review article, malignancy of the lymph node is the main focus, especially regarding how general practitioners and pathologists can achieve a definitive diagnosis. The basic principle relies on the normal structure, cellular components, and functions of the lymph node as well as the types of malignancy found. Careful clinical history taking of any possible cause of lymphadenopathy warrants exclusion of any mimics of malignancy of the lymph node, including drug reactions and immunodeficiency states. An adequate cell or tissue sample allows pathologists to work efficiently by mastering the multimodality approach under good clinical collaboration. Effective communication between pathologists and physicians regarding relevant laboratory investigations should make it easier to diagnose a specific type of malignancy. This review article also focuses on how general pathologists handle cell or tissue samples by conventional morphologic evaluation and panels of immunohistochemistry so that general practitioners understand the diagnostic process and understand how to diagnose malignancy of the lymph node. [ABSTRACT FROM AUTHOR]

We retrospectively investigated the significance of metastatic lymph nodes in patients with locally recurrent or persistent cervical cancer in a previously irradiated field and subsequently had salvage hysterectomy. Clinical data were obtained from a chart review, and the prognostic impact of the presence, number (1–2 versus ≥3), and location (pelvic versus pelvic plus para-aortic) of lymph node metastasis was investigated by comparing recurrence and survival. In total, 50 patients were included in this study, of which 21 (42.0%) showed pathological evidence of lymph node metastasis (node-positive group). Both the univariate and multivariate analyses showed that lymph node metastasis was an independent prognostic factor for postoperative recurrence (hazard ratio (HR) 5.36; 95% CI 1.41–6.66; p = 0.0020). The predominant sites of recurrence after salvage surgery were the visceral organs and lymph nodes in the node-negative and node-positive groups, respectively. Patients with ≥3 node metastases showed similar survival to those with 1–2 node metastases. Patients with pelvic node metastasis showed similar survival to those with pelvic and para-aortic node metastases. The presence, not number or location, of lymph node metastasis was an independent poor prognostic factor for post-operative recurrence in patients who developed locally recurrent or persistent cervical cancer treated with salvage hysterectomy plus lymphadenectomy. [ABSTRACT FROM AUTHOR]

Context. A few papillary thyroid microcarcinomas (PTMCs) may have skip metastasis (SLNM), but the risk factors remain controversial and the prognosis is unclear. Objectives. To investigate the incidence, lymph node metastasis (LNM) patterns, risk factors, and prognosis of SLNM in PTMCs. Methods. We reviewed the medical records of PTMC patients who underwent thyroid surgery in our institution. Analyses of risk factors were performed for SLNM. Recurrence-free survival (RFS) of SLNM, central lymph node metastasis (CLNM), and continuous metastasis (CLNM and lateral lymph node metastasis [CLNM + LLNM]) were compared after propensity score matching (PSM). Results. SLNM was detected in 1.7% (50/3923) and frequently involved level III (66.7%). Compared with CLNM + LLNM, SLNM had more LNM at a single level (P < 0.01) and less LNM at 2 levels (P < 0.05). A tumor size of 0.5 to 1 cm (odds ratio [OR], 2.26; 95% CI, 1.27-4.00) and location in the upper pole (OR, 3.30; 95% CI, 2.02-5.40) were independent risk factors for SLNM. A total of 910 (23.2%) PTMCs with LNM were included in the prognostic analysis. At a median follow-up of 60 months, the RFS of SLNM did not differ from that of CLNM (P = 0.10) but was significantly higher than that of CLNM + LLNM (P < 0.01) after using PSM. Conclusions. When the tumor size is 0.5 to 1 cm or its location is in the upper pole, we must remain vigilant to SLNM in PTMC. Because its prognosis is comparable to that of only CLNM and better than that of CLNM + LLNM, less intensive treatment should be considered. [ABSTRACT FROM AUTHOR]

Objective: The purpose is to discuss abdominal tuberculosis mimicking malignancy involving the lymph nodes, peritoneum, and the GI tract. Conclusion: Awareness of the pathophysiology and imaging appearance on various modalities of abdominal tuberculosis involving the lymph nodes, peritoneum, and the GI tract that may simulate malignancy can aid differentiation, diagnosis, and therapy, particularly in areas where tuberculosis is endemic. [ABSTRACT FROM AUTHOR]

Background: The incidence of, and factors associated with, lymph node metastasis (LN+) in non-functional gastroenteropancreatic (GEP) neuroendocrine tumors (NETs) are not well characterized.Methods: Patients were identified from the 2010-2015 National Cancer Database who underwent surgical resection with lymphadenectomy for clinical stage I-III non-functional GEP NETs. Among a randomly selected training subset of 75% of the study population, variables associated with LN+ were identified using multivariable logistic regression analysis, and these variables were used to create a risk-score model for LN+, which was internally validated among the remaining 25% of the cohort.Results: Of 12,228 patients evaluated, 6,902 (56.4%) had LN+. Among the training set, variables associated with LN+ included age (70 years of age or older: odds ratio [OR] 1.12, 95% CI 1.00-1.24; ref: less than 70 years), tumor location (stomach: OR 3.72, 95% CI 2.94-4.71; small intestine: OR 19.60, 95% CI 17.31-22.19; ref: pancreas), tumor grade (moderately differentiated: OR 1.47, 95% CI 1.30-1.67; poorly differentiated/anaplastic: OR 1.53, 95% CI 1.21-1.95; ref: well-differentiated), tumor size (2-4 cm: OR 2.40, 95% CI 2.13-2.70; >4 cm: OR 5.25, 95% CI 4.47-6.17; ref: <2 cm), and lymphovascular invasion (OR 5.62, 95% CI 5.08-6.21; ref: no lymphovascular invasion). After internal validation, a risk-score model for LN+ using these variables was developed composed of low- (N = 2,779), intermediate- (N = 2,598), high- (N = 3,433), and very-high-risk (N = 3,418) groups; within each group the rate of LN+ was 8.7%, 48.6%, 64.9%, and 92.8%, respectively.Conclusions: This developed risk-score model, including both patient and tumor variables, can be used to calculate the risk for LN metastases in patients with GEP NETs. [ABSTRACT FROM AUTHOR]

Background: Malignant epithelioid neoplasm with ACTB-GLI1 fusion are considered different from the more common pericytic lesions, such myopericytoma, because they have a spectrum of different genetic abnormalities. They appear to pursue a benign clinical course in young adults, although in sporadic cases lymph node metastasis were described. The categorization of this new type of tumor may also lead to new therapeutic strategies, because they might be sensitive to SHH pathway inhibitors.Case Presentation: The case involves a 72-years-old multiparous woman who accessed our department after an incidental finding of a right adnexal mass of 43 mm with contrast-enhancement on a control computed tomography scan made for suspected diverticulitis. Our intervention was a detailed ultrasound description of the suspected neoplasm; a diagnostic laparoscopy and the contextual laparotomic removal of abdominal mass; its histological and immunohistochemical analysis. Our main outcome measure is the definition and future recognition of new pathologic entity called malignant epithelioid neoplasm with ACTB-GLI1 fusion.Conclusions: We described for the first time the ultrasound characteristic of this type of lesion using standardized terminology and we believe that it may be the first step to improve the acknowledgement of this novel pathologic entity defined as malignant epithelioid neoplasm with GLI-1 fusions. [ABSTRACT FROM AUTHOR]

Introduction: cervical lymphadenopathy refers to swelling of lymph nodes in the neck and is a common presentation of various diseases. An emerging new prognostic marker, neutrophil to lymphocyte ratio, is proving to be useful in differentiating between malignant and non-malignant lymphadenopathy. Aim: to investigate whether a neutrophil to lymphocyte ratio helps with determining early the cause of cervical lymphadenopathy. Materials and methods: a retrospective case-control study was conducted at the Department of Otorhinolaryngology of the Clinical Centre University of Sarajevo. Records of patients with cervical lymphadenopathy who underwent a diagnostic excisional lymph node biopsy in a five-year period between 2016 and 2021 were retrospectively reviewed and NLR ratios were compared. Results: a total of 37 patients were reviewed and 21 patients were included and sorted into three groups: Reactive lymphadenopathy (RAL), Hodgkin's lymphoma (HL) and non - Hodgkin's lymphoma (NHL). There was no statistically significant difference between th e groups (p=0.2798) in age and gender (p=0.8487). An almost statistically significant difference was recorded between the NHL and HL groups in the obtained values of the ratio of NLR (p=0.073). Conclusion: careful assessment of the complete blood count and differential blood count can be useful in differentiating between benign and malignant diseases. Measurement of NLR and established inflammation marker is an easy and costeffective way of assessing the potential of malignancy in cervical lymphadenopathy. The final diagnosis should be done by excisional biopsy. [ABSTRACT FROM AUTHOR]

Small bowel neoplasms are rare and account for 3-6% of all gastrointestinal neoplasms. For the diagnosis of small bowel neoplasms, differentiating normal bowel tissue from tumor is critical and depends on imaging modality and scanning techniques. The detection and characterization of small bowel neoplasms have recently improved with the advance of computed tomography (CT) technology. Post-contrast multiphasic CT is an aid to detection and recognition of the vascular nature of small bowel neoplasms. Understanding the typical post-contrast multiphasic CT features of small bowel neoplasms is important because of overlapping features and the necessity of evaluating associated complications and metastases to lymph node and other organs. However, accurate classification of pathologies is still challenging in clinical practice. Texture analysis can quantify complex mathematical patterns within the gray-level distribution of the pixels and voxels of digital images, and texture analysis of the post-contrast multidetector CT data of various tumors has been attracting attention in recent years. The aim of this article is to provide a comprehensive guide to the relevant imaging features for different types of malignant small bowel neoplasms. [ABSTRACT FROM AUTHOR]

Objectives: Thyroid-stimulating hormones (TSHs) are associated with the risk of differentiated thyroid cancer. The relationship between pre-operative TSH levels and aggressive features is unclear. We aimed to evaluate the relationship between pathological features of papillary thyroid carcinoma (PTC) and high TSH levels. Methods: Patients who were operated between 2012 and 2017 and who were found to have PTC in their pathology were included in the study. The relationship between TSH and the features of tumor aggressiveness was evaluated in the patients. Results: Of the 132 patients, TSH level was significantly higher in those with lymphovascular invasion than those without (p=0.048), in those with central metastases than in those without (p=0.014), and in those with extrathyroidal spread than in those without (p=0.003). When patients were categorized into four 25% quartiles according to TSH (mUI/mL) level; the rate of extrathyroidal invasion increased as the TSH level increased, and the level was significantly higher in quartile 1 than the others, with significant difference (p=0.030). Conclusion: Pre-operative increase in TSH level is associated with an increased risk of extrathyroidal spread and central lymph node metastasis. TSH level may be a pre-operative valuable predictive factor for patients' risk of central metastasis. [ABSTRACT FROM AUTHOR]

Objective: Complete en bloc supraglottic tumor excision with transoral laser microsurgery (TLM) can be achieved with good postoperative outcomes. We report surgical feasibility and the postsurgical outcomes of en bloc resection of supraglottic laryngeal squamous cell carcinomas (LSCC) with TLM. Methods: Seventeen patients who underwent TLM for supraglottic laryngeal cancer were included in the study. Demographic and pathological data, clinic and follow-up outcomes of the patients were reviewed and analyzed. Results: Type 1 TLM was performed in three patients, type 2a in one patient, type 3b in 12 patients, and type 4b in one patient. Negative surgical margins were achieved in all of the cases. Re-excision or any adjuvant treatment for positive resection margins was not required in any of the cases. Eight patients received adjuvant radiotherapy due to lymph node metastasis. Mean followup time was 33.8±15.7 months (range: 10-65 months). None of the patients had recurrence or distant metastasis. Conclusion: The transoral approach with the use of CO2 laser and microscopy offers complete tumor excision for treating supraglottic LSCC. The three-dimensional structure of the supraglottis can be achieved with adequate exposure. En bloc resection is possible with safe margins. [ABSTRACT FROM AUTHOR]

Copyright of Ege Journal of Medicine is the property of Ege University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Context: How lymph node metastasis (LNM)-associated mortality risk is affected by BRAF V600E in papillary thyroid cancer (PTC) remains undefined.Objective: To study whether BRAF V600E affected LNM-associated mortality in PTC.Design, Setting, and Participants: We retrospectively analyzed the effect of LNM on PTC-specific mortality with respect to BRAF status in 2638 patients (2015 females and 623 males) from 11 centers in 6 countries, with median age of 46 [interquartile range (IQR) 35-58] years and median follow-up time of 58 (IQR 26-107) months.Results: Overall, LNM showed a modest mortality risk in wild-type BRAF patients but a strong one in BRAF V600E patients. In conventional PTC (CPTC), LNM showed no increased mortality risk in wild-type BRAF patients but a robustly increased one in BRAF V600E patients; mortality rates were 2/659 (0.3%) vs 4/321 (1.2%) in non-LNM vs LNM patients (P = 0.094) with wild-type BRAF, corresponding to a hazard ratio (HR) (95% CI) of 4.37 (0.80-23.89), which remained insignificant at 3.32 (0.52-21.14) after multivariate adjustment. In BRAF V600E CPTC, morality rates were 7/515 (1.4%) vs 28/363 (7.7%) in non-LNM vs LNM patients (P < 0.001), corresponding to an HR of 4.90 (2.12-11.29) or, after multivariate adjustment, 5.76 (2.19-15.11). Adjusted mortality HR of coexisting LNM and BRAF V600E vs absence of both was 27.39 (5.15-145.80), with Kaplan-Meier analyses showing a similar synergism.Conclusions: LNM-associated mortality risk is sharply differentiated by the BRAF status in PTC; in CPTC, LNM showed no increased mortality risk with wild-type BRAF but a robust one with BRAF mutation. These results have strong clinical relevance. [ABSTRACT FROM AUTHOR]

Purpose: : The use of sentinel lymph node dissection in several cancers has been gaining attention with the emergence of indocyanine green fluorescence. We performed a meta-analysis to assess the diagnostic performance of indocyanine green fluorescence in detecting lymph node metastasis in prostate cancer patients. Methods: : A literature search was conducted using PubMed, Cochrane Library, and SCOPUS on November 30, 2020, to identify eligible studies. Studies were eligible if they investigated the diagnostic performance of indocyanine green fluorescence before pelvic lymph node dissection in prostate cancer patients and reported the number of true positives, false positives, false negatives, and true negatives on lymph node-based analysis in comparison to histopathologic findings in the dissected specimen. Results: : Our systematic review covered 11 studies published between 2011 and 2020, with 519 patients, and our meta-analysis included 9 studies with 479 patients. Based on lymph node analysis of indocyanine green fluorescence, the results showed pooled sensitivity and specificity at 0.75 (95% confidence interval [CI] 0.49 to 0.90) and 0.66 (95% CI 0.61 to 0.70), respectively. The diagnostic odds ratio was 6.0 (95%CI 2 to 21). Several lymphatic drainage routes also showed sentinel lymph nodes localized outside the ordinal pelvic lymph node template. Conclusions: : We noted relatively low diagnostic performance for lymph node metastasis, suggesting that indocyanine fluorescence may not currently be a viable alternative to pelvic lymph node dissection in prostate cancer patients. However, this technique shows novel lymphatic drainage routes and underscores the importance of lymph nodes not removed in ordinary dissection. [ABSTRACT FROM AUTHOR]

Copyright of Hamidiye Medical Journal is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose To investigate the efficacy and safety of radiofrequency ablation (RFA) for papillary thyroid microcarcinoma (PTMC) after > 10 years of follow-up. Materials and Methods This study included five patients who underwent RFA to treat PTMCs (five lesions, mean diameter 0.5 cm, range 0.4–0.7 cm) between November 2006 and December 2009. The inclusion criteria were histopathologically confirmed PTMCs, a single PTMC lesion without extrathyroidal extension, no metastasis, and ineligibility or refusal to undergo surgery. RFA was performed by a single radiologist using a radiofrequency generator and an internally cooled electrode. We retrospectively analyzed the procedure-induced complications, serial changes in ablated tumors, recurrence, and local as well as lymph node metastasis based on data obtained from medical records and radiological images. Results The mean follow-up period was 130.6 months (range 121–159 months). Three patients underwent a single RFA session, and two patients underwent two RFA sessions. We observed no procedure-induced complications. Three tumors completely disappeared after ablation, and ablation of the other two tumors resulted in the formation of a small scar that showed long-term stability (mean duration 16.8 months, range 12–27 months). At the last follow-up, no patient showed recurrence or lymph node metastasis, and serum thyroglobulin levels were within normal limits in all patients. Conclusion RFA may be effective and safe to treat low-risk PTMC in patients who refuse or are ineligible for surgery. [ABSTRACT FROM AUTHOR]

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is useful for diagnosing hilar and mediastinal lymph node enlargement; however, specimens obtained are often small and inadequate for pathologic diagnosis. In June 2017, EchoTip ProCore, a puncture needle with a side trap, was launched in Japan. In this single-center prospective interventional study, 57 patients with lymph nodes, intrapulmonary tumor or pleural mass were diagnosed using EBUS-TBNA with EchoTip ProCore between June 2017 and February 2020. EBUS-TBNA was performed for 57 patients and 53 patients had sufficient specimen for histologic diagnosis. The following pathologic subtypes were diagnosed: non-small cell lung cancer, 22; small cell lung cancer, 8; cancer of unknown primary, 2; neuroendocrine tumor (G2) recurrence, 1; lymphoma, 2; metastatic renal cell carcinoma, 3; thymoma recurrence, 1; sarcoidosis, 4; tuberculosis, 1; and non-malignancy, 9. In addition, the cytology showed Class V in 31 out of 57 cases (54.4%). In total, a definitive pathological diagnosis was obtained in 50 out of 57 cases (87.7%). The only complication was pneumonia caused by BAL simultaneously combined with EBUS-TBNA in one patient. Among 13 patients with inadequate specimens or without malignancy, only one patient was subsequently diagnosed with malignancy, and the median follow-up period was 300 days. EBUS-TBNA using EchoTip ProCore can obtain a sufficient specimen size for pathologic diagnosis. [ABSTRACT FROM AUTHOR]

Background/Aim: Preoperative fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET-CT) is a non-invasive and useful diagnostic tool to evaluate mediastinal lymph node (LN) metastasis in lung cancer. However, there are often false-positive LN cases in FDG PET-CT. This study aimed to explore the clinical characteristics and outcome of pathologic N0 non-small cell lung cancer patients with false-positive mediastinal LN on FDG PET-CT. Patients and Methods: We enrolled 147 patients who underwent preoperative FDG PET-CT scan and mediastinal LN dissection. These patients were re-evaluated for post-operative pathologic nodal metastasis and divided into a false-positive group and a group of others. Results: Among 40 patients diagnosed with clinical N1-3 on FDG PET-CT, 19 (47.5%) patients were pathologic N0, meaning false-positive LN by PET-CT. Preoperative absolute platelet count and platelet-lymphocyte ratio were significantly higher in patients with pathologic N0. The presence of lymphatic invasion was significantly lower in patients with pathologic N0 than in the group of others. Recurrence-free survival was significantly shorter in patients with false positive LN than in patients with true positive LN or true negative LN at the same pathologic stage. Conclusion: Higher absolute platelet count and PLR, lower proportion of lymphatic invasion and shorter recurrence-free survival were associated with false positive mediastinal LN on preoperative FDG PET-CT. [ABSTRACT FROM AUTHOR]

The aims of this study were: determination of the CTV to PTV margins for prostate and pelvic lymph nodes. Investigation of the impact of registration modality (pelvic bones or prostate) on the CTV to PTV margins of pelvic lymph nodes. Investigation of the variations of bladder and rectum over the treatment course. Investigation of the impact of bladder and rectum variations on prostate position. This study included 15 patients treated for prostate adenocarcinoma. Daily kilo voltage images and weekly CBCT scans were performed to assess prostate displacements and common and external iliac vessels motion. These data was used to calculate the CTV to PTV margins using Van Herk equation in the setting of a daily bone registration. We also compared the CTV to PTV margins of pelvic lymph nodes according to registration method; based on pelvic bone or prostate. We delineated bladder and rectum on all CBCT scans to assess their variations over treatment course at 4 anatomic levels [1.5 cm above pubic bone (PB), superior edge, mid- and inferior edge of PB]. Using Van Herk equation, the prostate CTV to PTV margins (bone registration) were 8.03 mm, 5.42 mm and 8.73 mm in AP, ML and SI direction with more than 97% of prostate displacements were less than 5 mm. The CTV to PTV margins ranged from 3.12 mm to 3.25 mm for external iliac vessels and from 3.12 mm to 4.18 mm for common iliac vessels. Compared to registration based on prostate alignment, bone registration resulted in an important reduction of the CTV to PTV margins up to 54.3% for external iliac vessels and up to 39.6% for common iliac vessels. There was no significant variation of the mean bladder volume over the treatment course. There was a significant variation of the mean rectal volume before and after the third week of treatment. After the third week, the mean rectal volume seemed to be stable. The uni- and multivariate analysis identified the anterior wall of rectum as independent factor acting on prostate motion in AP direction at 2 levels (superior edge of, mid PB). The right rectal wall influenced the prostate motion in ML direction at inferior edge of PB. The bladder volume tends toward significance as factor acting on prostate motion in AP direction. We recommend CTV to PTV margins of 8 mm, 6 mm and 9 mm in AP, ML and SI directions for prostate. And, we suggest 4 mm and 5 mm for external and common iliac vessels respectively. We also prefer registration based on bony landmarks to minimize bowel irradiation. More CBCT scans should be performed during the first 3 weeks and especially the first week to check rectum volume. [ABSTRACT FROM AUTHOR]

The morphological characteristics of the largest lymphatic vessels and lymph nodes of the body have been described through ultrasonography, although food and gas in the gastrointestinal tract can often have negative effects on the response of small abdominal structures. The aim of the study was to describe the size of normal abdominal lymph nodes (ALs) in dogs affected by disease, not including lymphadenomegaly or lymphadenopathy, and divided according to body weight and age. The ALs studied included the jejunal, medial iliac, portal, gastric, splenic, and pancreaticoduodenal lymph nodes. Statistical correlation considering body weight and age as continuous variables showed that all measurements of the ALs increased according to body weight changes (p < 0.01). The most reliable values were the volume measurements (p < 0.001) compared to the length, thickness, and width. Mixed results emerged from a comparison of weight categories and age; only the jejunal lymph nodes showed a significant correlation (p < 0.05). Other characteristics (shape, attenuation, and enhancement) are subsequently reported. The resulting data can be used to categorize CT measurements of normal ALs displayed based on the body weight and age of the subjects. This study aimed to propose a new parameter of normalcy that may serve as a reference for the evaluation of infectious or neoplastic events. [ABSTRACT FROM AUTHOR]

Sentinel lymph node biopsy is a revolutionary approach used in a complex management of patients with invasive breast cancer. Only a few decades ago, all patients diagnosed with this condition underwent a radical removal of all axillary lymph nodes to determine the stage of the cancer and to prevent further lymphatic metastasis. This surgery has been associated with numerous side effects, sometimes even more serious than complications after the removal of the primary tumour. The growing understanding of lymph circulation and its drainage patterns led to the concept of sentinel lymph nodes, which in turn led to the development of assorted techniques used for their mapping/detection. This review paper discusses the classic methods of sentinel lymph node detection, their status in clinical practice and novel emerging approaches. The classic is a "gold standard" combination of lymphoscintigraphy and blue dye. Although dominant in practice, it has numerous drawbacks. Novel techniques implement superparamagnetic iron oxide nanoparticles, indocyanine green fluorescence and contrast-enhanced ultrasound. These have a potential to establish a new gold standard, which will meet all the most important criteria in this regard -- optimal sensitivity, specificity, economic and technical availability and least burden for a patient (Ref. 60). [ABSTRACT FROM AUTHOR]

The long noncoding RNASBF2-AS1 can promote the occurrence and development of many kinds of tumours, but its role in oesophageal squamous cell carcinoma (ESCC) is unknown. We found that SBF2-AS1 was up-regulated in ESCC, and its expression was positively correlated with tumor size (P = 0.0001), but was not related to gender, age, TNM stage, histological grade, and lymphnode metastasis (P > 0.05). It was further found that the higher the expression of SBF2-AS1, the lower the survival rate. COX multivariate analysis showed that the expression of SBF2-AS1 was an independent prognostic factor. Functional experiments show that inhibition of SBF2-AS1 can inhibit the proliferation of ESCC through in vivo and in vitro, and overexpression of SBF2-AS1 can promote the proliferation of ESCC and inhibit its apoptosis. In mechanism, SBF2-AS1/miR-338-3P, miR-362-3P/E2F1 axis are involved in the regulation of ESCC growth. In general, SBF2-AS1 may be used as ceRNA to combine with miR-338-3P and miR-362-3P to up-regulate the expression ofE2F1, and ultimately play a role in promoting cancer. It may be used as a therapeutic target and a biomarker for prognosis. [ABSTRACT FROM AUTHOR]

The preoperative accurate diagnosis is difficult in the patients with intraductal papillary mucinous neoplasm (IPMN). The aim of the present study was to elucidate the roles of systemic inflammation responses and nutritional status indexes in IPMN. High-grade dysplasia was classified as a malignant neoplasm in the study. We retrospectively reviewed 155 patients who underwent pancreatectomy. The correlation between the clinical factors and several indexes of a systemic inflammation response and nutritional status was analyzed. Among the biomarkers, prognostic nutritional index (PNI) value of malignant IPMN patients was significantly lower than that of benign IPMN patients (P = 0.023), whereas PNI was not significant predictor for malignant IPMN. The multivariate analysis showed that a PNI < 43.5 (odds ratio [OR] 16.1, 95% CI 1.88–138.5, P = 0.011) and a carbohydrate antigen (CA) 19–9 level > 22.5 U/mL (OR 6.64, 95% CI 1.73–25.6, P = 0.006) were significant independent predictors of the presence of lymph node metastasis (LNM). Our scoring system developed based on these two factors. Patients with a score of 0 had no LNM and zero disease-related death. The present study suggested the roles of PNI on the IPMN patients who undergo curative pancreatectomy. [ABSTRACT FROM AUTHOR]

Yearling crossbred beef steers [ N = 238; initial shrunk body weight (BW) = 402 ± 31.2 kg] were used to investigate the influence of a Bacillus subtilis probiotic on animal growth performance, efficiency of dietary net energy (NE) utilization, carcass characteristics, and fecal and subiliac lymph node Salmonella prevalence during a 140-d finishing period at the Southeast Research Farm in Beresford, SD. Steers were allotted to 1 of 24 pens (N = 9–10 steers/pen) and assigned to 1 of 2 dietary treatments (12 pens/treatment): no probiotic (CON) or 0.5 g/steer/d of a B. subtilis PB6 probiotic (CLOSTAT500, Kemin Industries, Des Moines, IA; CLO). Bunks were managed according to a slick bunk management approach. Fecal samples were collected on study days 1, 28, 56, 112, and 140 from a subsample of steers from each pen (N = 5 steers/pen) via rectal palpation and composited by pen for the determination of Salmonella prevalence using selective enrichment and culture media. Upon harvest, subiliac lymph nodes were obtained from an equal number of steers from each treatment (collected from every other steer) following evisceration and hide removal. Data were analyzed as a randomized complete block design and pen served as the experimental unit; an α of 0.05 determined significance. Live-basis final BW and average daily gain tended (P ≤ 0.06) to be reduced for CLO. No differences were detected (P ≥ 0.11) between treatments for dry matter intake or gain efficiency. Treatment neither altered the efficiency of dietary NE utilization nor calculated dietary NE content based upon observed performance (P ≥ 0.46). No differences were detected between treatments for any carcass traits (P ≥ 0.15). No Salmonella was recovered in any fecal samples collected on study days 1, 28, or 56. On day 112, steers from CLO had a numerically lower (P = 0.17; 25.0 vs. 8.3%) incidence of fecal Salmonella compared to CON. On study day 140, fecal Salmonella incidence did not differ between treatments (P = 0.34; 0.0 vs. 8.3%) for CON and CLO, respectively. Upon harvest, no Salmonella was recovered in any subiliac lymph nodes. These data indicate that B. subtilis PB6 did not influence feedlot phase growth performance or fecal Salmonella prevalence. Additionally, Salmonella was not observed in the subiliac lymph nodes of any steers upon harvest. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the influence of microcystic, elongated and fragmented (MELF) pattern invasion on preoperative evaluation of lymph node (LN) metastasis and myometrial invasion in patients with lowgrade endometrial carcinoma. Methods: The study included 192 consecutive patients with low-grade endometrial carcinoma who underwent preoperative computed tomography (CT) and magnetic resonance imaging (MRI), followed by surgery. One hundred sixty one of 192 patients underwent LN dissection and were analyzed for LN metastasis. All patients were analyzed for myometrial invasion. Presence of enlarged LN was evaluated by using size criteria on CT. Depth of myometrial invasion was evaluated on MRI using T2-weighted imaging, diffusion-weighted imaging and contrast-enhanced T1-weighted imaging comprehensively. Sensitivity and specificity for LN metastasis and deep myometrial invasion were evaluated for MELF group and non-MELF group. The difference of sensitivity between two groups was compared using Chi-square and Fisher's exact test. Results: MELF pattern invasion was identified in 43/192 patients (22%). LN metastases were observed in 18/39 patients in MELF group and 6/122 patients in non-MELF group for pelvic LN and 11/29 patients in MELF group and 4/57 patients in non-MELF group for para-aortic LN. Sensitivity for the detection of pelvic LN metastasis in MELF group was significantly lower than in non-MELF group (16.7% vs 66.7%). As for the assessment of the deep myometiral invasion, pathological deep myometrial invasion were found in 31/43 patients in MELF group and 32/149 patients in non-MELF group. Sensitivity in MELF group showed lower values than in non-MELF group (54.8% vs 78.1% for reader 1, 54.8% vs 62.5% for reader 2), although there was no statistically significant difference (P = 0.09 for reader 1 and P = 0.72 for reader 2). [ABSTRACT FROM AUTHOR]

Our aim was to assess the long-term clinical outcome of boron neutron capture therapy (BNCT) using 10B-para-boronophenylalanine (BPA) as the boron delivery agent for cutaneous melanoma. Eight patients (eight lesions) were treated between October 2003 and April 2014. Their ages ranged from 48 to 86 years at the time of treatment. All of the targets were primary lesions and they were located on the sole or face. No patient had evidence of regional lymph node involvement, distant metastases or an active secondary cancer. The clinical stage was cT1-2N0M0 and performance scores were <2. BNCT was carried out at the Kyoto University Research Reactor (KUR). The patients were irradiated with an epithermal neutron beam between the curative tumor dose and the tolerable skin dose. Eight patients were evaluated and six showed a complete response (CR), while two patients had a partial response (PR). Of the two patients with a PR, one has remained a PR with brown spots persisting for 7.5 years following BNCT. The tumor in the other patient recurred after 6 years at the site of persisting brown macula. The overall control rate (CR + PR without recurrence) for the cohort was 88% (7/8). There have never been any adverse events >Grade 2 for the long follow-up period. Our results suggest that BNCT may be a promising treatment modality in the management of early stage cutaneous melanoma when wide local excision is not feasible. [ABSTRACT FROM AUTHOR]

Background: Triple negative breast cancer (TNBC) is a heterogeneous disease group with a higher recurrence risk and poorer prognosis. In this study, we aimed to investigate the frequency and prognostic value of androgen receptor (AR) expression in tissues of TNBC patients. Methods: In this study a total of 60 TNBC patients treated between 2011 - 2016 in Shahid Sadoughi and Mortaz Hospital were included and their medical records were analyze. The available paraffin blocks were assessed immunohistochemically to determine AR expression. Tumors with ≥10% nuclear staining were considered AR-positive, while the ones with <10% staining were considered AR-negative. The association between AR expression, and clinical-pathologic characteristics and prognosis in TNBC was analyzed. Results: The result showed that AR expression in TBNC correlated with high risk of recurrence but no significant correlation with the age, grade, tumor size, lymph node status, type of diagnosis, tumor location, and Ki-67 level was observed. Positive immunoreactivity for AR was observed in 19 out of 60 (11%) specimens. No correlation was observed between the AR expression and the age, grade, tumor size, lymph node status, type of diagnosis, tumor location, and Ki-67 level. The AR-positive patients exhibited high risk of recurrence (P=0.016) and death (P=0.015) in comparison with the AR-negative patients. Concusions: AR may not be a suitable biomarker and treatment target for the Iranian Yazd patients with TNBC. [ABSTRACT FROM AUTHOR]

Background: In the field of melanoma, clinical trials evaluating the impact of sentinel node biopsy, completion lymph node dissection and adjuvant medical therapies on patient outcomes have provided evidence that has changed practice significantly over the past five years. Objective: The aim of this article is to discuss key evidence that has informed new Cancer Council Australia melanoma management guidelines. Discussion: General practitioners play a critical role in melanoma diagnosis and follow-up. Complete excisional biopsy to achieve accurate tumour microstaging is essential for obtaining reliable prognostic information, planning further management and accessing adjuvant medical therapies. The management of patients with Stage III disease has changed dramatically over the past few years. Less surgery is now recommended, and patients may be offered potentially life-prolonging systemic therapies. Multidisciplinary discussion of management is recommended. Rapid advances in therapeutic options for patients with advanced melanoma have placed new emphasis on the importance of accurate staging and early management. Accordingly, the Australian national melanoma management guidelines have recently been updated. These evidence-based guidelines are now readily available on Cancer Council Australia's electronic Wiki platform, which facilitates regular further updating. [ABSTRACT FROM AUTHOR]

Introduction: A key survival prognosis factor for patients treated for ovarian cancer is complete cytoreductive surgery where all macroscopic neoplastic implants, including enlarged metastatic lymph nodes, are removed. We presume that investigating the involvement of the lymphatic system can result in a more individualized approach to the treatment of ovarian cancer patients. The main aim of our study was to analyze the relationship between the presence, number and types of lymph node metastases and ovarian cancer patient prognosis. Material and methods: We carried out a retrospective analysis of patients who underwent cytoreduction due to primary ovarian cancer, between 2010 and 2015. We analyzed the number of metastatic lymph nodes, the lymph node ratio defined as the ratio of the number of metastatic lymph nodes to the total number of lymph nodes removed, extracapsular involvement, and the histopathological pattern of metastases. Results: The study group included 651 patients. Of these, 377 had lymphadenectomy, 144 presented with lymph node metastases, and 233 had no lymph node metastases. We also included a group of 274 patients who did not have lymphadenectomy. Patients with more than 4 metastatic lymph nodes and a lymph node ratio of ≤ 0.1 had significantly poorer overall survival. Extracapsular involvement had no relation to patient overall survival. Multivariant survival analysis indicated that a lymph node ratio of ≥ 0.1 was an independent predictor of poor survival. Conclusions: The analysis of lymph node metastases in ovarian cancer patients can have predictive value for patient overall survival. [ABSTRACT FROM AUTHOR]

Background There is a lack of data exploring the use and optimal timing of immunotherapy and chemoradiation therapy (CRT) in node-positive cervical cancer. Further translational research into mechanisms of response and resistance to immunotherapy in advanced cervical cancer is warranted. Primary Objective(s) To determine if sequencing of atezolizumab and CRT result in differential immune activation, as determined by clonal expansion of T cell receptor beta (TCRB) repertoires in peripheral blood on day 21. Study Hypothesis There is a difference for clonal expansion of T cell receptor beta repertoires in the peripheral blood at day 21 between the priming and concurrent atezolizumab and CRT in Arm A vs the concurrent atezolizumab and CRT in Arm B. Trial Design Locally advanced cervical cancer patients with lymph node-positive disease will be randomized on this open-label, randomized trial with two experimental arms. Arm A will get one dose of atezolizumab prior to cisplatin CRT, and then two subsequent doses of atezolizumab during the CRT, and Arm B will get three doses during CRT. Patients will be followed for 2 years to assess outcomes. Major Inclusion/Exclusion Criteria Patients must have histologically confirmed, newly diagnosed advanced cervical cancer (squamous cell carcinoma, adenocarcinoma, and adenosquamous cell carcinoma): FIGO 2009 clinical stages IB2/IIA with positive para-aortic nodes, or FIGO 2009 clinical stages IIB/IIIB/IVA with positive pelvic or para-aortic lymph nodes. Exclusion criteria include those who had a prior hysterectomy or lymph node dissection. [ABSTRACT FROM AUTHOR]

Lichen planus (LP) is a chronic inflammatory mucocutaneous disease involving the oral mucosa and skin. Both oral LP (OLP) and cutaneous LP (CLP) are histopathologically characterized by dense subepithelial lymphocyte infiltrates; however, the mechanisms underlying lymphocyte recruitment to sites of LP lesions are not fully understood. Here, we assessed the induction of peripheral lymph node addressin (PNAd)-expressing high endothelial venule (HEV)-like vessels in 19 OLP and 17 CLP cases. To do so, we performed immunohistochemical staining for PNAd and CD34, followed by quantitative analysis. We also conducted triple immunohistochemistry for PNAd and either CD3 and CD20 or CD4 and CD8 to identify the lymphocyte subset preferentially recruited via HEV-like vessels. PNAd-expressing HEV-like vessels were induced in and around lymphocyte aggregates in all cases of OLP and in 10 of 17 CLP cases, and these vessels were more frequently observed in OLP relative to CLP. Although the number of T-cells attached per HEV-like vessel exceeded the number of B-cells in both OLP and CLP, the number of CD4+ T-cells attached was greater than the number of CD8+ T-cells only in OLP. These findings combined suggest that PNAd-expressing HEV-like vessels play a more important role in the pathogenesis of OLP compared with CLP. [ABSTRACT FROM AUTHOR]

Aim: Gastric cancer is one of most common malignancies in the world. In developed countries including Europe and United States, despite the advanced technology, advanced stages of gastric cancer are still common with a poor survival. In this study, we aimed to describe clinicopathological characteristics and outcomes of gastric cancer in patients who were operated in our clinic. Material and Methods: We respectively evaluated a total of 200 patients who underwent gastrectomy, D2 lymph node dissection due to gastric cancer between November 2006 and December 2015. Data including clinicopathologic features, postoperative complications, overall survival and prognostic factors affecting prognosis were analyzed and statistical analysis was performed. Data including clinicopathologic features, postoperative complications, overal survival and prognostic factors affecting prognosis were analyzed and statistical analysis was performed. Results: Of the patients, 134 (67%) were males and 66 (33%) were females. The mean age was 61.36±11.92 (28-91) years. Tumor localization was frequently low (57%). The most common postoperative complication, regardless of the type of gastrectomy, was the surgical site infection. The major of the patients had Stage 3 disease. The median overall survival was 24.9 (0.07-116.3) months and overall survival was 43.7%. Conclusion: Except for early stage, the chance of curative treatment is low in gastric cancer. Early diagnosis and treatment can yield improved outcomes for this patient population. Therefore, it is important to develop national programs for early diagnosis and to develop experienced endoscopists . [ABSTRACT FROM AUTHOR]

The role of radiotherapy in the postmastectomy setting with substantial lymph node burden or locally advanced disease has been well described. In the last decade, the indications for postmastectomy radiotherapy (PMRT) have expanded in light of a measurable disease-free survival benefit, even in T1-2N1-patient subgroup. Concurrently, immediate breast reconstruction (IBR) rates after mastectomy are rapidly increasing. Optimal integration of IBR and PMRT is challenging, as PMRT has a known deleterious effect on reconstruction outcomes and IBR has been reported to pose challenges to PMRT delivery. Implant-based reconstruction is the most common type of IBR performed nowadays. This article reviews the current problems regarding integration of the implant-based IBR with optimum radiation delivery and discusses the advantages and disadvantages of each reconstruction method with PMRT. [ABSTRACT FROM AUTHOR]