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Background and Objectives: This study investigated predictive risk factors for cervical nodal recurrence or metastasis in papillary thyroid carcinoma (PTC). Materials and Methods: From September 2014 to February 2015, a total of 321 PTC patients were enrolled retrospectively. Except for 154 N0 patients, the remaining 167 patients were divided into two groups as follows: Group I (n=140), central lymph node (LN) metastasis (pN1a); Group II (n=27), lateral LN metastasis (pN1b, n=23) or LN recurrence (n=4). The patients who had LN metastasis or recurrence underwent selective LN dissection or recurrent LN excision. Results: Central LN metastases were found in 44.0% (142/321) of patients. Two hundred thirty patients (71.7%) were classified as being at low-risk for LN disease, as evidenced by N0 or fewer than five micrometastases. The mean size of central metastatic LNs was 0.37±0.34 cm. A total of 76 patients (46.6%) presented with micrometastasis, and ten (3.1%) presented with extranodal extension (ENE). The multiple/bilateral cancer, Extrathyroidal extension, size of metastatic LN, ENE, high risk LN disease (＞5, macrometastasis, ＞3.0 cm) and high thyroglobulin were significant risk factors in predicting LN recurrence or lateral LN metastasis (p＜0.05) in univariate analysis. Patients with ENE were 10.3 times more at risk for recurrence or metastasis than patients without ENE. Conclusion: We consider the ENE was the most potent risk factors for LN recurrence or lateral LN metastasis in PTC.

Purpose: Papillary thyroid microcarcinoma (PTMC) has an excellent prognosis and can be managed with active surveillance or surgery, dependingon its location and numbers. The authors investigated the role of preoperative staging ultrasound for PTMC with statistical parameters. Methods : : This study included 159 patients with PTMC who underwent thyroidectomy at Kyungpook National University Chilgok Hospital. The tumor size of PTMC, location, bilaterality and multifocality, anterior or posterior aspect of ETE, and metastasis of central/lateral neck lymph nodes were assessed by preoperative thyroid ultrasound and compared with the pathology results. The statistical parameters were calculated and compared. Results : : The incidence of bilaterality of PTMC was similar in the ultrasound and pathology findings, and multifocalitywas identified in 27 cases (17.0%) and 35 cases (22.0%) in ultrasound and pathologic results, respectively. On the other hand, anterior and posterior ETE was identified only in 19 cases (11.9%) in the pathology findings,which was only approximately 50% of that in the preoperative ultrasound (36 cases, 22.6%). In the statistical parameters, most of the parameters were highest when evaluating metastatic lateral neck lymph node and lowest when evaluating metastatic central neck lymph nodes. Conclusion : : Preoperative ultrasound for PTMC was useful to assess the size of PTMC, multifocality, anterior or posterior ETE, and metastatic lateral neck lymph nodes. On the other hand, as it is difficult to predict a central neck lymph node metastasis, it would be better for the operator to consider additional surgery based on the intraoperative findings.

Purpose: This study evaluated the efficiency of preoperative ultrasound (US)-guided tattooing of the axillary lymph nodes with activated charcoal and the correlation between sonographically suspicious nodes and final histologic results by node-to-node analysis. The concordance rate between the tattooed nodes and sentinel nodes was also determined. Methods : : US-guided tattooing of sonographically suspicious axillary nodes was performed preoperatively by an injection of activated charcoal. The identification of black pigment and the concordance between the sentinel and tattooed nodes was evaluated. Results : : Regarding node-to-node analysis, the false-negative rate of US-fine needle aspiration (FNA) was 43.3%. The sensitivity and negative predictive values were 56.7% and 81.7%, respectively. The specificity and positive predictive values were 100%. The accuracy of US-FNA was 85.2%. In the final pathology, 45/125 patients (36.0%) had positive nodes, including two micrometastases. The false-negative rate of sentinel lymph node biopsy (SLNB) was 4.0%, but there were no skip metastases. The sensitivity and specificity of SLNB were 95.6% and 100%, respectively. The negative predictive value was 97.6%, and the positive predictive value was 100%. The accuracy of SLNB was 98.4%. In 117 of 125 patients (93.6%), there was concordance between the charcoal tattooed axillary lymph nodes and SLNs. Conclusion : : SLNB, in conjunction with US-guided tattooing of sonographically suspicious axillary lymph nodes, is a useful procedure to reduce the false-negative rate of SLNB and improve the accuracy of an intraoperative evaluation of axillary nodes in breast cancer patients. This paper proposes the concept of targeted axillary node biopsy with preoperative US-guided tattooing for the most accurate axillary staging in patients with breast cancer.

Purpose: Axillary lymph node status is an important prognostic factor in breast cancer. Axillary lymph nodes can be evaluated using fine-needle aspiration cytology (FNAC) or core needle biopsy (CNB) before surgery. This study compared the accuracy and false-negative rates between FNAC and CNB in patients with breast cancer who either did or did not receive neoadjuvant chemotherapy (NAC). Methods : : The clinicopathological factors of the patients were analyzed retrospectively, and the sensitivity, specificity, positive and negative predictive values, false-positive and false-negative rates, and accuracy of FNAC (n = 27) and CNB (n = 23) were compared. Results : : Regardless of whether or not NAC was performed, the CNB evaluation of the metastatic axillary lymph nodes had a 100.0% sensitivity, specificity, negative predictive value, and accuracy, except for one case with an inadequate sample. In the FNAC group, the false-negative rate was higher in patients with breast cancer who received NAC before evaluating the lymph nodes (9.1% vs. 7.7%). Moreover, ultrasound imaging was the most sensitive imaging modality that can detect the suspicious axillary lymph node. Conclusion : : CNB was more effective in evaluating the axillary lymph nodes in breast cancer than FNAC and was performed without major complications.

Additional file 11: Supplemental Figure 11. Taxonomic contributions to gene expression profiles for proteins involved in cell wall biogenesis for jejunum samples collected at day 40. Each node in the network indicates groups of orthologs corresponding to a specific E. coli gene (as indicated) involved in cell wall biogenesis. Links between nodes indicate a functional interaction as previously defined [53]. Size of the node indicates the relative expression of genes associated with each set of orthologs, with sector colours indicating the taxonomic contribution to gene expression (see key for color code). Red arrows indicate sets of orthologs that are significantly up-regulated in comparisons involving the presence/absence of AGPs.

Additional file 8: Supplemental Figure 8. Taxonomic contributions to expressed enzymes in Purine metabolic pathway across different AGP treatments and diets with Day40 ceca samples. Shown here are the De novo biosynthesis and salvage pathways for purine, integrated with data generated from ceca collected at day 40. Each pie chart represents the taxonomic distributions of an enzyme (see key for color code). The size of pie charts indicates the average expression value (with log2 transform) of genes encoding that enzyme. Pie charts with red arrows refer to enzymes that are significantly up-regulated relative to the paired (+/- AGPs) sample. The abbreviations used here can be found in Supplemental Table 11.

Additional file 4: Supplemental Figure 4. Principal component analysis based on annotated metabolic enzymes expression in ceca samples. Each node represents an individual ceca sample, with colours and shapes indicating specific treatment types (see inset key).

Additional file 7: Supplemental Figure 7. Taxonomic contributions to expressed enzymes in Purine metabolic pathway across different AGP treatments and diets with Day24 ceca samples. Shown here are the De novo biosynthesis and salvage pathways for purine, integrated with data generated from ceca collected at day 24. Each pie chart represents the taxonomic distributions of an enzyme (see key for color code). The size of pie charts indicates the average expression value (with log2 transform) of genes encoding that enzyme. Pie charts with red arrows refer to enzymes that are significantly up-regulated relative to the paired (+/- AGPs) sample. The abbreviations used here can be found in Supplemental Table 11.

Additional file 5: Supplemental Figure 5. Expression heatmap of metabolic pathways enriched in significantly differentially expressed enzymes. There are 35 KEGG metabolic pathways enriched in significantly differentially expressed enzymes associated with samples from either ceca or jejunum. Changes of the average expression value (log2) of each gene associated with an enzyme in that pathway are indicated by red-green or blue-yellow gradients for ceca and jejunum samples, respectively.

Additional file 9: Supplemental Figure 9. AGPs disrupt age related changes in metabolite profiles from chicken serum. PCA of metabolomic profiles generated from either AGP+ or AGP- samples. Samples are coloured and grouped based on age of bird from which the sample was taken.

Additional file 2: Supplemental Figure 2. Heatmap showing normalized abundance of taxa for taxa exhibiting significant differential abundance in at least one of the comparisons shown on the right. Each column in the heatmap represents a single sample, grouped by treatment. Each row indicates an individual taxon. Columns on the right indicate significant differences in abundance across each of eight pair-wise comparisons. Taxa are ordered on the basis of magnitude of fold change across the various pairwise comparisons.

Additional file 3: Supplemental Figure 3. Pie-chart heatmap of metabolic pathways enriched with significantly differentially expressed enzymes through comparisons between diets. There are 35 KEGG metabolic pathways enriched with significantly differentially expressed enzymes which were annotated from either ceca or jejunum samples based on comparisons between diets. Each node in the heatmap is a pie chart showing proportion of enzymes that were significantly up-regulated (orange), significantly down-regulated (blue), and not significantly different (white) with the wheat diet. In addition, the size of each node indicates the number of expressed enzymes in each KEGG pathway.