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Background: Cervical cancer is a major cause of morbidity and mortality among gynecological malignancies. Diagnostic imaging of lymph node (LN) metastasis for prognosis and staging is used; however, the accuracy in classifying the stage needs to improve. Purpose: To examine the accuracy of AI-based radiomics in diagnosis, prognosis assessment and predicting the diagnostic value of radiomics for pelvic LN metastasis in cervical cancer patients. Material and Methods: The study included 118 female patients with 660 LNs and 118 merged LNs. Four imaging histology models—decision tree, random forest, logistic regression, and support vector machine (SVM)—were created in this study. The imaging histology features were extracted from both the independent and merged LN groups. The AUC values for the test sets and the training sets of the four imaging histology models were compared for the independent LN group and the merged LN group. The DeLong test was used to compare the models. Result: The imaging histology prediction model developed in the merged LN group outperformed the independent LN group in terms of test set AUC (0.668 vs. 0.535 for decision tree, 0.841 vs. 0.627 for logistic regression, 0.785 vs. 0.637 for random forest, 0.85 vs. 0.648 for SVM) and accuracy (0.754 vs. 0.676 for decision tree, 0.780 vs. 0.671 for random forest, 0.848 vs. 0.685 for logistic regression, 0.822 vs. 0.657 for SVM). Conclusion: The constructed SVM imaging histology model for the merged LN group might be advantageous in predicting pelvic LN metastasis in cervical cancer. [ABSTRACT FROM AUTHOR]

Schwannomas are usually benign tumors typically found in the head, neck, and extremities, with approximately 3% originating in the retroperitoneum. In this case, a young male presented with incidental masses in the left kidney and retroperitoneum. Abdominal pelvic enhanced computerized tomography (CT) revealed a tumor apparently originating from the left kidney, along with a retroperitoneal mass suspected to be a metastatic lymph node. Subsequently, a radical nephrectomy of the left kidney and retroperitoneal mass resection was performed. Pathological examination confirmed the left kidney mass as renal clear cell carcinoma and the retroperitoneal mass as schwannoma. The patient recovered uneventfully and was discharged from the hospital. A 6-month postoperative follow-up showed no evidence of recurrence. Preoperative diagnosis of schwannomas concurrent with other concurrent malignancies in rare sites, such as the retroperitoneum, is challenging due to their rare and nonspecific radiological features. Although retroperitoneal schwannomas are rare, they should be considered in the differential diagnosis during CT examinations for renal cancer. Additionally, the advantages of a multidisciplinary team approach should be utilized in tumor management. [ABSTRACT FROM AUTHOR]

Background: The recurrence of thyroid cancer poses challenges compounded by postoperative fibrosis and anatomic changes. By overcoming the limitations of current localizing dye techniques, indocyanine green-macroaggregated albumin-hyaluronic acid (ICG-MAA-HA) mixture dye promises improved localization. This study aimed to evaluate the efficacy and safety of the dye for recurrent thyroid cancer. Methods: The nine patients in this study underwent surgery and postoperative ultrasonography. The dye was injected into recurrent lesions in all the patients preoperatively. During surgery, the lesions were confirmed with an imaging system before and after excision. If the lesion was unidentifiable with the naked eye, surgical excision was performed under the corresponding fluorescent guide. Side effects related to the dye injection and completeness of the surgery were evaluated. Results: No side effects such as bleeding, skin tattooing, or pain during or after the dye injection were reported, and no discoloration occurred that interfered with the surgical field of view during surgery. In three cases (33.3 %), because it was difficult to localize metastatic lesions with the naked eye, the operation was successfully completed using an imaging system. The completeness of the surgical resection was confirmed by ultrasonography after an average of 5 months postoperatively. Conclusion: The study found that ICG-MAA-HA dye effectively located metastatic and recurrent thyroid cancer and had favorable results in terms of minimal procedural side effects and potential for assisting the surgeon. A large-scale multi-institutional study is necessary to prove the clinical significance regarding patient survival and disease control. [ABSTRACT FROM AUTHOR]

Simple Summary: Cervical lymph node (LN) metastasis is a critical prognostic factor for patients with head and neck squamous cell carcinoma (HNSCC), rendering accurate diagnosis of LN metastasis crucial for improving patient outcomes. Our study aimed to develop deep learning models for metastatic LN detection using YOLOv7, the fastest single-stage object detection model, on B-mode and power Doppler (D-mode) ultrasonography in patients with HNSCC and investigate their utility in supporting the diagnosis by comparing their performance to that of highly experienced radiologists and less experienced residents. A total of 462 B- and D-mode ultrasound images were used to train, validate, and test the B- and D-mode models, respectively. The detection performances of the B- and D-mode models for metastatic LNs were higher than those of less experienced residents; the performance of the D-mode model was comparable to that of highly experienced radiologists, suggesting that YOLOv7-based models are useful for supporting the diagnosis. Ultrasonography is the preferred modality for detailed evaluation of enlarged lymph nodes (LNs) identified on computed tomography and/or magnetic resonance imaging, owing to its high spatial resolution. However, the diagnostic performance of ultrasonography depends on the examiner's expertise. To support the ultrasonographic diagnosis, we developed YOLOv7-based deep learning models for metastatic LN detection on ultrasonography and compared their detection performance with that of highly experienced radiologists and less experienced residents. We enrolled 462 B- and D-mode ultrasound images of 261 metastatic and 279 non-metastatic histopathologically confirmed LNs from 126 patients with head and neck squamous cell carcinoma. The YOLOv7-based B- and D-mode models were optimized using B- and D-mode training and validation images and their detection performance for metastatic LNs was evaluated using B- and D-mode testing images, respectively. The D-mode model's performance was comparable to that of radiologists and superior to that of residents' reading of D-mode images, whereas the B-mode model's performance was higher than that of residents but lower than that of radiologists on B-mode images. Thus, YOLOv7-based B- and D-mode models can assist less experienced residents in ultrasonographic diagnoses. The D-mode model could raise the diagnostic performance of residents to the same level as experienced radiologists. [ABSTRACT FROM AUTHOR]

Abstract Background Immune checkpoint blockade (ICB) elicits a strong and durable therapeutic response, but its application is limited by disparate responses and its associated immune-related adverse events (irAEs). Previously, in a murine model of lymph node (LN) metastasis, we showed that intranodal administration of chemotherapeutic agents using a lymphatic drug delivery system (LDDS) elicits stronger therapeutic responses in comparison to systemic drug delivery approaches, while minimizing systemic toxicity, due to its improved pharmacokinetic profile at the intended site. Importantly, the LN is a reservoir of immunotherapeutic targets. We therefore hypothesized that metastatic LN-targeted ICB can amplify anti-tumor response and uncouple it from ICB-induced irAEs. Methods To test our hypothesis, models of LN and distant metastases were established with luciferase expressing LM8 cells in MXH10/Mo-lpr/lpr mice, a recombinant inbred strain of mice capable of recapitulating ICB-induced interstitial pneumonia. This model was used to interrogate ICB-associated therapeutic response and immune related adverse events (irAEs) by in vivo imaging, high-frequency ultrasound imaging and histopathology. qPCR and flowcytometry were utilized to uncover the mediators of anti-tumor immunity. Results Tumor-bearing LN (tbLN)-directed CTLA4 blockade generated robust anti-tumor response against local and systemic metastases, thereby improving survival. The anti-tumor effects were accompanied by an upregulation of effector CD8T cells in the tumor-microenvironment and periphery. In comparison, non-specific CTLA4 blockade was found to elicit weaker anti-tumor effect and exacerbated ICI-induced irAEs, especially interstitial pneumonia. Together these data highlight the importance of tbLN-targeted checkpoint blockade for efficacious response. Conclusions Intranodal delivery of immune checkpoint inhibitors to metastatic LN can potentiate therapeutic response while minimizing irAEs stemming from systemic lowering of immune activation threshold.

BackgroundPreoperative detection of lymph node (LN) metastasis is critical for planning treatments in colon cancer (CC). The clinical diagnostic criteria based on the size of the LNs are not sensitive to determine metastasis using CT images. In this retrospective study, we investigated the potential value of CT texture features to diagnose LN metastasis using preoperative CT data and patient characteristics by developing quantitative prediction models.MethodsA total of 390 CC patients, undergone surgical resection, were enrolled in this monocentric study. 390 histologically validated LNs were collected from patients and randomly separated into training (312 patients, 155 metastatic and 157 normal LNs) and test cohorts (78 patients, 39 metastatic and 39 normal LNs). Six patient characteristics and 146 quantitative CT imaging features were analyzed and key variables were determined using either exhaustive search or least absolute shrinkage algorithm. Two kernel-based support vector machine classifiers (patient-characteristic model and radiomic-derived model), generated with 10-fold cross-validation, were compared with the clinical model that utilizes long-axis diameter for diagnosis of metastatic LN. The performance of the models was evaluated on the test cohort by computing accuracy, sensitivity, specificity, and area under the receiver operating curve (AUC).ResultsThe clinical model had an overall diagnostic accuracy of 64.87%; specifically, accuracy of 65.38% and 62.82%, sensitivity of 83.87% and 84.62%, and specificity of 47.13% and 41.03% for training and test cohorts, respectively. The patient-demographic model obtained accuracy of 67.31% and 73.08%, the sensitivity of 62.58% and 69.23%, and specificity of 71.97% and 76.23% for training and test cohorts, respectively. Besides, the radiomic-derived model resulted in an accuracy of 81.09% and 79.49%, sensitivity of 83.87% and 74.36%, and specificity of 78.34% and 84.62% for training and test cohorts, respectively. Furthermore, the diagnostic performance of the radiomic-derived model was significantly higher than clinical and patient-demographic models (p

Background: Immune checkpoint blockade (ICB) elicits a strong and durable therapeutic response, but its application is limited by disparate responses and its associated immune-related adverse events (irAEs). Previously, in a murine model of lymph node (LN) metastasis, we showed that intranodal administration of chemotherapeutic agents using a lymphatic drug delivery system (LDDS) elicits stronger therapeutic responses in comparison to systemic drug delivery approaches, while minimizing systemic toxicity, due to its improved pharmacokinetic profile at the intended site. Importantly, the LN is a reservoir of immunotherapeutic targets. We therefore hypothesized that metastatic LN-targeted ICB can amplify anti-tumor response and uncouple it from ICB-induced irAEs. Methods: To test our hypothesis, models of LN and distant metastases were established with luciferase expressing LM8 cells in MXH10/Mo-lpr/lpr mice, a recombinant inbred strain of mice capable of recapitulating ICB-induced interstitial pneumonia. This model was used to interrogate ICB-associated therapeutic response and immune related adverse events (irAEs) by in vivo imaging, high-frequency ultrasound imaging and histopathology. qPCR and flowcytometry were utilized to uncover the mediators of anti-tumor immunity. Results: Tumor-bearing LN (tbLN)-directed CTLA4 blockade generated robust anti-tumor response against local and systemic metastases, thereby improving survival. The anti-tumor effects were accompanied by an upregulation of effector CD8T cells in the tumor-microenvironment and periphery. In comparison, non-specific CTLA4 blockade was found to elicit weaker anti-tumor effect and exacerbated ICI-induced irAEs, especially interstitial pneumonia. Together these data highlight the importance of tbLN-targeted checkpoint blockade for efficacious response. Conclusions: Intranodal delivery of immune checkpoint inhibitors to metastatic LN can potentiate therapeutic response while minimizing irAEs stemming from systemic lowering of immune activation threshold. [ABSTRACT FROM AUTHOR]

Yanrui Liang,1,* Weihong Guo,1,* Chuangji Li,1,* Guodong Shen,1,* Haoxian Tan,2 Peiwen Sun,2 Zhian Chen,1 Huilin Huang,1 Zhenhao Li,1 Zhenyuan Li,1 Yingxin Ren,1 Guoxin Li,1 Yanfeng Hu1 1Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China; 2The First School of Clinical Medicine, Southern Medical University, Guangzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Guoxin Li; Yanfeng Hu, Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, No. 1838 North Guangzhou Ave, Baiyun District, Guangzhou, 510515, People’s Republic of China, Tel +86-20-6164-1681 ; +86-20-6164-1682, Fax +86-20-6164-1681, Email yfenghu@qq.com; gzliguoxin@163.comPurpose: Lymphadenectomy with lymph node (LN) mapping is essential for surgical removal of solid tumors. Existing agents do not provide accurate multimodal mapping and antitumor therapy for metastatic LNs; therefore, we fabricated a polydopamine (PDA) nanoparticle (NP)-based tumor-targeted LN mapping agent capable of multimodal mapping and guided photothermal therapy (PTT) for metastatic LNs.Materials and Methods: PDA NPs modified with polyethylene glycol (PEG) were obtained by polymerization under alkaline conditions. The PEG-PDA NPs were loaded with the circular tripeptide Arg-Gly-Asp (cRGD) to achieve tumor-targeting capacity and with the fluorescent dye IR820 and magnetic resonance imaging (MRI) contrast Gd(NH2)2 for in situ detection. The resulting cRGD-PEG-PDA@IR820/Gd(NH2)2 (cRGD-PPIG) NPs were tested for their biosafety and metastatic LN mapping ability. They were drained specifically into LNs and selectively taken up by gastric MKN45 cells via αvβ 3 integrin-mediated endocytosis.Results: This phenomenon enabled MR/optical/near-infrared fluorescence multimodal metastatic LN mapping, guiding the creation of accurate and highly efficient PTT for gastric cancer metastatic LNs in mice.Conclusion: In summary, we fabricated tumor-targeted cRGD-PPIG NPs with MR/optical/near-infrared fluorescence multimodal metastatic LN mapping capacity for surgery and efficient PTT guidance post-surgery.Keywords: multimodal imaging, lymph node mapping, metastatic lymph node, photothermal therapy

This study aims to determine the diagnostic accuracy of staging PET/CT and neck MRI in patients with laryngeal carcinoma and to assess the value of PET/CT in predicting progression-free survival (PFS) and overall survival (OS). Sixty-eight patients who had both modalities performed before treatment between 2014 and 2021 were included in this study. The sensitivity and specificity of PET/CT and MRI were evaluated. PET/CT had 93.8% sensitivity, 58.3% specificity, and 75% accuracy for nodal metastasis, whereas MRI had 68.8%, 61.1%, and 64.7% accuracy, respectively. At a median follow-up of 51 months, 23 patients had developed disease progression and 17 patients had died. Univariate-survival analysis revealed all utilized PET parameters as significant prognostic factors for OS and PFS (p-value < 0.03 each). In multivariate analysis, metabolic-tumor volume (MTV) and total lesion glycolysis (TLG) predicted better PFS (p-value < 0.05 each). In conclusion, PET/CT improves the accuracy of nodal staging in laryngeal carcinoma over neck MRI and adds to the prognostication of survival outcomes through the use of several PET metrics. [ABSTRACT FROM AUTHOR]

Simple Summary: Indocyanine green (ICG)-based fluorescence imaging has been used to detect several types of tumors; however, its ability to detect metastatic lymph nodes (LNs) remains unclear. The feasibility of ICG for detecting tumors and metastatic LNs was evaluated in patients with lung or esophageal cancer, detected with computed tomography (CT) or positron-emission tomography (PET)/CT, and scheduled to undergo surgical resection. ICG-based fluorescence imaging could identify metastatic lymph nodes and enable surgeons to dissect them, potentially preventing cancer recurrence. However, the feasibility of ICG-based intraoperative detection of metastatic lymph nodes needs to be validated with further studies. Indocyanine green (ICG) has been used to detect several types of tumors; however, its ability to detect metastatic lymph nodes (LNs) remains unclear. Our goal was to determine the feasibility of ICG in detecting metastatic LNs. We established a mouse model and evaluated the potential of ICG. The feasibility of detecting metastatic LNs was also evaluated in patients with lung or esophageal cancer, detected with computed tomography (CT) or positron-emission tomography (PET)/CT, and scheduled to undergo surgical resection. Tumors and metastatic LNs were successfully detected in the mice. In the clinical study, the efficacy of ICG was evaluated in 15 tumors and fifty-four LNs with suspected metastasis or anatomically key regional LNs. All 15 tumors were successfully detected. Among the fifty-four LNs, eleven were pathologically confirmed to have metastasis; all eleven were detected in ICG fluorescence imaging, with five in CT and seven in PET/CT. Furthermore, thirty-four LNs with no signals were pathologically confirmed as nonmetastatic. Intravenous injection of ICG may be a useful tool to detect metastatic LNs and tumors. However, ICG is not a targeting agent, and its relatively low fluorescence makes it difficult to use to detect tumors in vivo. Therefore, further studies are needed to develop contrast agents and devices that produce increased fluorescence signals. [ABSTRACT FROM AUTHOR]

Head and neck cancers of unknown primary (CUP) represent up to 10% of all cancers located in the head and neck. True cancers of unknown primary, which remain of undetected primary origin after a correct clinical, imaging, surgical evaluation, have a reported frequency of between 1% and 2%. Cancers of unknown primary of the head and neck are a diagnostic challenge, considering that their main clinical manifestation is represented by the appearance of lymph node metastases in the cervical region. In general, the detection of cancers with an unknown starting point is late, difficult, with significant therapeutic failure. The diagnostic-therapeutic approach starts from the histopathological structure of the lymph node metastasis and continues with a correct and complete imaging evaluation. In this review are presented the diagnosis and therapeutic challenges and importance of head and neck cancers with unknown primary. [ABSTRACT FROM AUTHOR]

Background and Objectives: The purpose of this study is to evaluate the relationship between lymph node status (the number of resected lymph nodes; the number of metastatic lymph nodes, LNM, and lymph node ratio, LNR) and biochemical recurrence, disease-free survival (DFS), as well as overall survival (OS) in medullary thyroid carcinoma (MTC). Methods: This study enrolled MTC patients at Tianjin Medical University Cancer Institute and Hospital between 2011 and 2019. We used Logistic regression analysis, Cox regression models and Kaplan-Meier test to identify risk factors influencing biochemical recurrence, DFS, and OS. Results: We identified 160 patients who satisfied the inclusion criteria from 2011 to 2019. We used ROC analysis to define the cut-off value of LNR with 0.24. Multifocality, preoperative calcitonin levels, pathologic N stage, resected lymph nodes, LNM, LNR, and the American Joint Committee on Cancer (AJCC) clinical stage were significant (P < 0.05) prognostic factors influencing biochemical cure. In univariable analyses, gross extrathyroidal extension, preoperative calcitonin levels, pathologic T classification, pathologic N stage, resected lymph nodes, LNM, LNR, AJCC clinical stage, and biochemical cure were significant (P < 0.05) factors of DFS. When the multivariable analysis was performed, LNR was identified as predictor of DFS (HR = 4.818, 95% CI [1.270–18.276]). Univariable Cox regression models reflected that tumor size, pathologic N stage, and LNR were predictor of OS. Furthermore, multivariable analysis manifested that LNR was predictor of OS (HR = 10.061, 95% CI [1.222–82.841]). Conclusions: This study illustrated that LNR was independent prognostic factor of DFS and OS in MTC. In addition, LNR influenced biochemical cure. Further investigations are needed to determine the optimal cut-off value for predicting prognosis. [ABSTRACT FROM AUTHOR]

The purpose of this study was to develop a radiomics signature for distinguishing stage in advanced colon cancer (CC). 195 colon cancer patients were enrolled in this study (stage III, n = 146 vs. stage IV, n = 49) and divided into training cohort (n = 136) and validation cohort (n = 59). A total of 286 radiomic features were extracted from tumor and LN images. A radiomics signature was generated using the least absolute shrinkage and selection operator (LASSO) technique. The relationship between radiomics signature and CC staging was explored using a kernel-based support vector machine (SVM) classifier model. The classification performance was assessed by accuracy and the receiver operating characteristics (ROC) curve. A total of 5 features (2 for tumor and 3 for LN) were selected among 286 features. Radiomics signature built from extracted features successfully differentiated stage III from stage IV CC with no known distant metastases on imaging preoperatively. Furthermore, the SVM classifier model generated using tumor and LN images together achieved better performance than the tumor alone, with accuracies of 86.03% vs. 78.68% and 83.05% vs. 76.27% in training and validation cohorts, respectively. In ROC analysis, the model showed a significant improvement for training (AUC 89.16% vs. 69.5%) and validation cohorts (AUC 75.15% vs. 55%) in comparison with the combined analysis and the tumor alone. In conclusion, the radiomics signature based on preoperative CT may distinguish stage III from stage IV CC with no known distant metastases. In addition, the radiomic features from combined images achieved better classification performance than tumor alone.

Cervical cancer (CC) is one of the most frequent female malignancies worldwide. However, the molecular mechanism of lymph node metastasis in CC remains unclear. In this study, we investigated the transcriptome profile of 51,507 single cells from primary tumors, positive lymph nodes (P-LN), and negative lymph nodes (N-LN) using single-cell sequencing. Validation experiments were performed using bulk transcriptomic datasets and immunohistochemical assays. Our results indicated that epithelial cells in metastatic LN were associated with cell- cycle-related signaling pathways, such as E2F targets, and mitotic spindle, and immune response-related signaling pathways, such as allograft rejection, IL2_STAT5_signaling, and inflammatory response. However, epithelial cells in primary tumors exhibited high enrichment of epithelial-mesenchymal translation (EMT), oxidative phosphorylation, and interferon alpha response. Our analysis then indicated that metastasis LN exhibited an early activated tumor microenvironment (TME) characterized by the decrease of naive T cells and an increase of cytotoxicity CD8 T cells, NK cells, FOXP3+ Treg cells compared with normal LN. By comparing the differently expressed gene of macrophages between tumor and metastatic LN, we discovered that C1QA+ MRC1low macrophages were enriched in a tumor, whereas C1QA+ MRC1high macrophages were enriched in metastatic LN. Finally, we demonstrated that cancer-associated fibroblasts (CAFs) in P-LN were associated with immune regulation, while CAFs in tumor underwent EMT. Our findings offered novel insights into the mechanisms of research, diagnosis, and therapy of CC metastasis. [ABSTRACT FROM AUTHOR]

Sentinel lymph node biopsy holds significant importance in cancer management, yet the challenge persists in early detection and precise resection of metastasis lymph nodes (LNs) due to the absence of specific and sensitive optical probes. This study reports metastatic LN reporters (MLRs) with an activatable optical output for accurate spatiotemporal mapping of lymphatic metastases in gastric cancer. MLRs are self-assembled entities incorporating mixed amphiphiles with a lipophilic tail and a tumor-targeting ligand or a fluorescent moiety that is caged with a switch cleavable by tumor-specific β-galactosidase (β-Gal). After draining into LNs, MLRs selectively activate their near-infrared fluorescence in the presence of spreading tumor cells. In orthotopic gastric cancer mouse models, the representative reporter MLR1 distinguishes macro/micrometastatic LNs from benign LNs and enables early detection of skip LNs metastasis patterns in a spatial-dependent manner. Such an active sensing mechanism provides a high level of sensitivity and specificity comparable to those of flow cytometry analysis. In surgically resected patient specimens, MLR1 differentiates cancerous tissues and metastatic LNs from normal tissues and benign LNs within 1 h. This study thus presents NIRF nanoprobes that permit facile detection of LN metastases in GC patient samples and highlights a generic translatable nanoprobe design for understanding metastatic progression.

This is a case of [68 Ga]Ga-Prostate-specific membrane antigen (PSMA)-11 PET/CT in a 73-years old patient presenting high Prostate Specific Antigen (PSA) levels despite both multi-parametric magnetic resonance imaging (mpMRI) and 12-core saturation biopsy negative for prostate cancer (Pca). This is a highly interesting case because, despite the advanced metastatic spread at initial presentation as showed by [68Ga]Ga-PSMA-PET/CT, the primary Pca was detected by none of the diagnostic techniques (12 random sample biopsy, mpMRI, PSMA PET/CT). However, [68Ga]Ga-PSMA-PET/CT showed a suspicious axillary lesion suitable for biopsy, which finally resulted as Pca metastasis. This case report is therefore a brilliant example of how [68Ga]Ga-PSMA-PET/CT optimized patient’s management.

Abstract Background Individuals with pN3 gastric cancer (GC) account for a large proportion of pN + GC, and exhibit poor survival outcomes. The pN3 stage is defined based upon the number of metastatic lymph nodes (mLNs), but the subclassification of pN3 patients based upon the number of examined LNs (eLNs) is rarely performed. Methods In total, 2894 pTxN3M0 GC patients in the Surveillance, Epidemiology, and End Results database that had undergone surgery from 2000 to 2016 were selected for analysis. The X-tile software was used to select the optimal cutoff values. Cox proportional regression analyses were used to evaluated hazard ratios corresponding to the risk of death. Selection bias was minimized via propensity score matching (PSM). Results As the number of eLNs rose, the risk of death for patients trended downwards. Survival analyses indicated that patients with ≤ 31 eLNs exhibited significantly poorer survival outcomes as compared to patients with > 31 eLNs (5-year OS: 18.4% vs. 24.7%), and this result remained significant when analyzing 857 pairs of patients following PSM analysis. Significant differences in prognosis were additionally observed when comparing pN3a and pN3b patients with ≤ 31 or > 31 eLNs under pT3/4a stage. For pT4b stage, pN3a patients with > 31 eLNs also exhibited a better prognosis than other patients. The novel TNM staging system designed exhibited excellent utility as a tool for the prognostic evaluation of this GC patient population. Conclusions These results suggest that in pN3 GC, a minimum of 32 LNs should be examined. The novel TNM staging system for pN3 patients described herein, which was developed based upon the number of eLNs, may thus be of value in clinical settings.

Abstract Background In cases of papillary thyroid carcinoma (PTC), lymph nodes are a typical site of metastasis. Extrathyroidal tissue involvement in differentiated thyroid carcinoma causes the disease to progress and affects the patients’ treatment options. Papillary thyroid carcinoma (PTC) is the common type in differentiated thyroid carcinoma (DTC), the other type is follicular thyroid carcinoma (FTC). Ectopic sites, such as intrathyroidal lymph node invasion in classical papillary thyroid malignancy, are extremely uncommon. It can be difficult to detect an intrathyroidal lymph node (ITLN) during a histopathological test, but it is important to do so since it affects the stage of the disease and subsequent treatment. Case presentation We present the case of a 63-year-old woman who presented with multinodular goitre and underwent total thyroidectomy. She was diagnosed with aberrant intrathyroidal lymph node metastases during pathological testing, resulting in an upgrade in treatment. Owing to the exceptionally unusual ectopic position of lymph node metastasis, in this case, there is a risk of diagnostic and therapeutic misinterpretation. This patient was treated with high-dose radioactive iodine in view of lymph node metastases. Conclusions Identification of ITLN by imaging characteristics is sometimes difficult, being often an intraoperative discovery and histopathological correlation that lead to upstage the disease and alter the final management.

Objective: To compare the value of thyroglobulin(Tg) measurement by fine needle aspiration and by fine needle capillary techniques for diagnosing node metastases from thyroid papillary carcinoma(PTC). Methods: Fifty-four patients with suspicious metastatic lymph nodes from PTC were enrolled during January 2018 to December 2018. Ultrasound guided fine needle aspiration cytology(FNAC) and fine needle capillary cytology(FNCC) were performed for detecting suspicious lymph nodes, and the level of Tg in the eluent was measured. According to the post-operative pathologic results and clinical follow-up results, the difference of diagnostic efficacy between the two groups was compared. Results: A total of 76 suspicious lymph nodes were examined, and 48 of them were confirmed as metastasis by pathology. The mean level of Tg in needle washouts by FNAC and by FNCC were （4 588.02±1 042.09） ng/mL and (1 678.57±420.57) ng/mL (P=0.010 6), respectively. The area under receiver operating characteristic curve of Tg value in washouts by FNAC and by FNCC were 0.943 and 0.913, respectively. The difference was significant between methods (P=0.032). The cut-off value of Tg in FNAC group was 14.385 ng/mL, and the diagnostic sensitivity and specificity were 0.938 and 0.893, respectively. The cut-off value of Tg in FNCC group was 12.155 ng/mL, and the diagnostic sensitivity and specificity were 0.875 and 0.893, respectively. Conclusions: Both measurement of Tg in the eluent by FNCC and by FNAC are helpful to the diagnosis of metastatic lymph nodes from PTC. However, FNAC had more advantage over FNCC in diagnosing metastatic lymph nodes.

Medical diagnostic imaging is essential for the differential diagnosis of cervical lymphadenopathy. Here we develop an ultrasound radiomics method for accurately differentiating cervical lymph node tuberculosis (LNTB), cervical lymphoma, reactive lymph node hyperplasia, and metastatic lymph nodes especially in the multi-operator, cross-machine, multicenter context. The inter-observer and intra-observer consistency of radiomics parameters from the region of interest were 0.8245 and 0.9228, respectively. The radiomics model showed good and repeatable diagnostic performance for multiple classification diagnosis of cervical lymphadenopathy, especially in LNTB (area under the curve, AUC: 0.673, 0.662, and 0.626) and cervical lymphoma (AUC: 0.623, 0.644, and 0.602) in the whole set, training set, and test set, respectively. However, the diagnostic performance of lymphadenopathy among skilled radiologists was varied (Kappa coefficient: 0.108, * p < 0.001). The diagnostic performance of radiomics is comparable and more reproducible compared with those of skilled radiologists. Our study offers a more comprehensive method for differentiating LNTB, cervical lymphoma, reactive lymph node hyperplasia, and metastatic LN. [ABSTRACT FROM AUTHOR]

Abstract Background Triple Negative breast cancer (TNBC) includes a heterogeneous group of tumors with different clinico-pathological features, molecular alterations and treatment responsivity. Our aim was to evaluate the clinico-pathological heterogeneity and prognostic significance of TNBC histologic variants, comparing “special types” to high-grade invasive breast carcinomas of no special type (IBC-NST). Methods This study was performed on data obtained from TNBC Database, including pathological features and clinical records of 1009 TNBCs patients diagnosed between 1994 and 2015 in the four most important Oncology Units located in different hospitals in Sardinia, Italy. Kaplan-Meier analysis, log-rank test and multivariate Cox proportional-hazards regression were applied for overall survival (OS) and disease free survival (DFS) according to TNBC histologic types. Results TNBC “special types” showed significant differences for several clinico-pathological features when compared to IBC-NST. We observed that in apocrine carcinomas as tumor size increased, the number of metastatic lymph nodes manifestly increased. Adenoid cystic carcinoma showed the smallest tumor size relative to IBC-NST. At five-year follow-up, OS was 92.1, 100.0, and 94.5% for patients with apocrine, adenoid cystic and medullary carcinoma, respectively; patients with lobular and metaplastic carcinoma showed the worst OS, with 79.7 and 84.3%, respectively. At ten-years, patients with adenoid cystic (100.0%) and medullary (94.5%) carcinoma showed a favourable prognosis, whereas patients with lobular carcinoma showed the worst prognosis (73.8%). TNBC medullary type was an independent prognostic factor for DFS compared to IBC-NST. Conclusions Our study confirms that an accurate and reliable histopathologic definition of TNBC subtypes has a significant clinical utility and is effective in the therapeutic decision-making process, with the aim to develop innovative and personalized treatments.

Abstract Background Preoperative detection of lymph node (LN) metastasis is critical for planning treatments in colon cancer (CC). The clinical diagnostic criteria based on the size of the LNs are not sensitive to determine metastasis using CT images. In this retrospective study, we investigated the potential value of CT texture features to diagnose LN metastasis using preoperative CT data and patient characteristics by developing quantitative prediction models. Methods A total of 390 CC patients, undergone surgical resection, were enrolled in this monocentric study. 390 histologically validated LNs were collected from patients and randomly separated into training (312 patients, 155 metastatic and 157 normal LNs) and test cohorts (78 patients, 39 metastatic and 39 normal LNs). Six patient characteristics and 146 quantitative CT imaging features were analyzed and key variables were determined using either exhaustive search or least absolute shrinkage algorithm. Two kernel-based support vector machine classifiers (patient-characteristic model and radiomic-derived model), generated with 10-fold cross-validation, were compared with the clinical model that utilizes long-axis diameter for diagnosis of metastatic LN. The performance of the models was evaluated on the test cohort by computing accuracy, sensitivity, specificity, and area under the receiver operating curve (AUC). Results The clinical model had an overall diagnostic accuracy of 64.87%; specifically, accuracy of 65.38% and 62.82%, sensitivity of 83.87% and 84.62%, and specificity of 47.13% and 41.03% for training and test cohorts, respectively. The patient-demographic model obtained accuracy of 67.31% and 73.08%, the sensitivity of 62.58% and 69.23%, and specificity of 71.97% and 76.23% for training and test cohorts, respectively. Besides, the radiomic-derived model resulted in an accuracy of 81.09% and 79.49%, sensitivity of 83.87% and 74.36%, and specificity of 78.34% and 84.62% for training and test cohorts, respectively. Furthermore, the diagnostic performance of the radiomic-derived model was significantly higher than clinical and patient-demographic models (p

Medical diagnostic imaging is essential for the differential diagnosis of cervical lymphadenopathy. Here we develop an ultrasound radiomics method for accurately differentiating cervical lymph node tuberculosis (LNTB), cervical lymphoma, reactive lymph node hyperplasia, and metastatic lymph nodes especially in the multi-operator, cross-machine, multicenter context. The inter-observer and intra-observer consistency of radiomics parameters from the region of interest were 0.8245 and 0.9228, respectively. The radiomics model showed good and repeatable diagnostic performance for multiple classification diagnosis of cervical lymphadenopathy, especially in LNTB (area under the curve, AUC: 0.673, 0.662, and 0.626) and cervical lymphoma (AUC: 0.623, 0.644, and 0.602) in the whole set, training set, and test set, respectively. However, the diagnostic performance of lymphadenopathy among skilled radiologists was varied (Kappa coefficient: 0.108, *p < 0.001). The diagnostic performance of radiomics is comparable and more reproducible compared with those of skilled radiologists. Our study offers a more comprehensive method for differentiating LNTB, cervical lymphoma, reactive lymph node hyperplasia, and metastatic LN.

Objective: The aim of this study is to investigate whether the number of metastatic lymph nodes (LNs) could be used as a basis in the radioactive iodine (RAI) dose selection for patients with papillary thyroid carcinoma (PTC). Patients: A total of 595 patients with PTC who received first RAI therapy after total or near‐total thyroidectomy and had no evidence of disease in treatment response assessment were retrospectively enroled from five hospitals. The patients were classified into two subgroups based on the number of metastatic LNs (>5). The multivariate Cox‐proportional hazard model was performed to identify the significant factors for recurrence prediction in each group as well as all enroled patients. Results: Overall, 22 (3.7%) out of 595 patients had the recurrent disease during the follow‐up period. The number of metastatic LNs (>5) was only a significant factor for recurrence prediction in all enroled patients (odds ratio: 7.834, p <.001). In the subgroup with ≤5 metastatic LNs, the presence of extrathyroidal extension was only associated with recurrence (odds ratio: 7.333, p =.024) in multivariate analysis. RAI dose was significantly associated with recurrence rate in which the patients with high‐dose RAI (3.7 GBq or higher) had less incidence of recurrence than those with low‐dose RAI (1.11 GBq) in the subgroup with more than five metastatic LNs (odds ratio: 6.533, p =.026). Conclusions: High‐dose RAI (≥3.7 GBq) therapy significantly lowered the recurrence rate in patients with more than five metastatic LNs. Therefore, RAI dose should be determined based on the number of metastatic LNs as well as conventional risk factors. [ABSTRACT FROM AUTHOR]

Background: Individuals with pN3 gastric cancer (GC) account for a large proportion of pN + GC, and exhibit poor survival outcomes. The pN3 stage is defined based upon the number of metastatic lymph nodes (mLNs), but the subclassification of pN3 patients based upon the number of examined LNs (eLNs) is rarely performed.Methods: In total, 2894 pTxN3M0 GC patients in the Surveillance, Epidemiology, and End Results database that had undergone surgery from 2000 to 2016 were selected for analysis. The X-tile software was used to select the optimal cutoff values. Cox proportional regression analyses were used to evaluated hazard ratios corresponding to the risk of death. Selection bias was minimized via propensity score matching (PSM).Results: As the number of eLNs rose, the risk of death for patients trended downwards. Survival analyses indicated that patients with ≤ 31 eLNs exhibited significantly poorer survival outcomes as compared to patients with > 31 eLNs (5-year OS: 18.4% vs. 24.7%), and this result remained significant when analyzing 857 pairs of patients following PSM analysis. Significant differences in prognosis were additionally observed when comparing pN3a and pN3b patients with ≤ 31 or > 31 eLNs under pT3/4a stage. For pT4b stage, pN3a patients with > 31 eLNs also exhibited a better prognosis than other patients. The novel TNM staging system designed exhibited excellent utility as a tool for the prognostic evaluation of this GC patient population.Conclusions: These results suggest that in pN3 GC, a minimum of 32 LNs should be examined. The novel TNM staging system for pN3 patients described herein, which was developed based upon the number of eLNs, may thus be of value in clinical settings. [ABSTRACT FROM AUTHOR]

• The developed MLNs counting model demonstrated acceptable ability in NPC. • LNNs counted by AMLNC showed favorable discriminatory in predicting prognostic. • AMLNC may serve as a reference tool for younger radiologists to evaluate MLNs. The number of metastatic lymph nodes (MLNs) is crucial for the survival of nasopharyngeal carcinoma (NPC), but manual counting is laborious. This study aims to explore the feasibility and prognostic value of automatic MLNs segmentation and counting. We retrospectively enrolled 980 newly diagnosed patients in the primary cohort and 224 patients from two external cohorts. We utilized the nnUnet model for automatic MLNs segmentation on multimodal magnetic resonance imaging. MLNs counting methods, including manual delineation-assisted counting (MDAC) and fully automatic lymph node counting system (AMLNC), were compared with manual evaluation (Gold standard). In the internal validation group, the MLNs segmentation results showed acceptable agreement with manual delineation, with a mean Dice coefficient of 0.771. The consistency among three counting methods was as follows 0.778 (Gold vs. AMLNC), 0.638 (Gold vs. MDAC), and 0.739 (AMLNC vs. MDAC). MLNs numbers were categorized into three-category variable (1–4, 5–9, > 9) and two-category variable (<4, ≥ 4) based on the gold standard and AMLNC. These categorical variables demonstrated acceptable discriminating abilities for 5-year overall survival (OS), progression-free, and distant metastasis-free survival. Compared with base prediction model, the model incorporating two-category AMLNC-counting numbers showed improved C-indexes for 5-year OS prediction (0.658 vs. 0.675, P = 0.045). All results have been successfully validated in the external cohort. The AMLNC system offers a time- and labor-saving approach for fully automatic MLNs segmentation and counting in NPC. MLNs counting using AMLNC demonstrated non-inferior performance in survival discrimination compared to manual detection. [ABSTRACT FROM AUTHOR]

ObjectiveTo evaluate the safety and efficacy of radiofrequency ablation (RFA) for metastatic lymph nodes (LNs) in children and adolescents with papillary Thyroid Carcinoma (PTC).Materials and MethodsFrom December 2014 to March 2018, 10 metastatic LNs(mean volume 0.30 ± 0.38 ml, range 0.06-1.23ml) in 5 children and adolescents (3 females, 2 males; mean age 15.60 ± 2.97 years, range 12-19 years) with PTC treated by RFA were evaluated in this study. The mean number of surgical procedures performed before RFA was 1.2 (range 1-2) and the mean number of treated metastatic LNs per patient was 2 (rang 1-3). RFA was performed with an 18–gauge bipolar RF applicator under local anesthesia. Follow-up consisted of US and serum thyroglobulin (Tg) level at 1, 3, 6, 12 months and every 12 months thereafter.ResultsAll the patients were well tolerant to RFA procedure and no procedure-related complications occurred. During a mean follow-up time of 52.00 ± 21.44 months, the initial volume of LNs was 0.30 ± 0.38 ml, which significantly decreased to 0.01 ± 0.03 ml (P = 0.005) with a mean VRR of 99.28 ± 2.27%. A total of 9 metastatic LNs (90.00%) completely disappeared. After RFA, 2 patients developed newly metastases. One patient had additional RFA. The other one with multiple LN metastases underwent total thyroidectomy with central neck dissection.ConclusionAs a less invasive and effective technique, RFA may provide another alternative to the existing therapeutic modalities for cervical metastatic LNs in children and adolescents with PTC.

Papillary thyroid carcinoma (PTC) mostly occurs within the thyroid gland (entopic site), with its occurrence within an ectopic thyroid tissue being rare comprising less than 1% of all thyroid cancers. The coexistence of PTC in entopic and ectopic sites is even rarer, and differentiating ectopic PTC from a metastatic cervical lymph node may pose a diagnostic conundrum. This report is aimed at highlighting the diagnostic challenges and treatment of this rare condition. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the safety and efficacy of radiofrequency ablation (RFA) for metastatic lymph nodes (LNs) in children and adolescents with papillary Thyroid Carcinoma (PTC). Materials and Methods: From December 2014 to March 2018, 10 metastatic LNs(mean volume 0.30 ± 0.38 ml, range 0.06-1.23ml) in 5 children and adolescents (3 females, 2 males; mean age 15.60 ± 2.97 years, range 12-19 years) with PTC treated by RFA were evaluated in this study. The mean number of surgical procedures performed before RFA was 1.2 (range 1-2) and the mean number of treated metastatic LNs per patient was 2 (rang 1-3). RFA was performed with an 18–gauge bipolar RF applicator under local anesthesia. Follow-up consisted of US and serum thyroglobulin (Tg) level at 1, 3, 6, 12 months and every 12 months thereafter. Results: All the patients were well tolerant to RFA procedure and no procedure-related complications occurred. During a mean follow-up time of 52.00 ± 21.44 months, the initial volume of LNs was 0.30 ± 0.38 ml, which significantly decreased to 0.01 ± 0.03 ml (P = 0.005) with a mean VRR of 99.28 ± 2.27%. A total of 9 metastatic LNs (90.00%) completely disappeared. After RFA, 2 patients developed newly metastases. One patient had additional RFA. The other one with multiple LN metastases underwent total thyroidectomy with central neck dissection. Conclusion: As a less invasive and effective technique, RFA may provide another alternative to the existing therapeutic modalities for cervical metastatic LNs in children and adolescents with PTC. [ABSTRACT FROM AUTHOR]

Objectives: The cause of cervical lymphadenopathy varies from inflammation to malignancy. Accurate and prompt diagnosis is crucial as delayed detection of malignant lymph node can lead to a worse prognosis. To improve the diagnostic accuracy of metastatic lymph node, electrical spectroscopy was employed to study human normal and metastatic lymph nodes using a hypodermic needle with fine interdigitated electrodes on its tip (EoN).Subjects and Methods: The electrical impedance of samples collected from 8 patients were analyzed in the sweeping frequency range from 1 Hz to 1 MHz. To align the impedance level data of the patients, normalized impedance was employed.Results: The optimal frequency exhibiting the best discrimination results between the normal and cancerous tissues was introduced based on a discrimination index. A high sensitivity (86.2%) and specificity (88.9%) were obtained, which implied that the EoN holds the potential to improve the in vivo diagnostic accuracy of metastatic lymph node during biopsy and surgery.Conclusion: EoN has a promising potential to be utilized in real-time in actual clinical trials without a need for any pre/post-treatment during FNA or surgery. We believe that the EoN could reduce unnecessary operations with its associated morbidity. [ABSTRACT FROM AUTHOR]

Lymph node (LN) metastasis is a negative prognostic factor in dogs with cutaneous mast cell tumours (cMCTs). While elective lymphadenectomy of metastatic LNs improves outcome, the benefit of adjuvant medical therapy in dogs with early metastatic (HN2) LNs is debated. The aim of this retrospective multicentre study was to evaluate the therapeutic benefit of adjuvant medical therapy following surgical removal of the primary low‐grade cMCT (Patnaik grade 1‐2 and Kiupel low‐grade) and lymphadenectomy of HN2 LNs by analysing survival rates and patterns of recurrence. Seventy‐three dogs were included: 42 received adjuvant medical treatment (chemotherapy and/or kinase inhibitors), and 31 did not. The median follow‐up time for medically treated dogs was 619 days: two experienced local recurrence, three nodal relapse and four distant relapse. For dogs undergoing surgery only, the median follow‐up time was 545 days. None of them experienced local recurrence, nodal, or distant relapse. Time to progression was significantly shorter in dogs receiving adjuvant medical treatment (P =.021). A similar tendency was observed for overall survival (P =.056). The current study shows that dogs with low‐grade cMCTs, that undergo surgical excision of the primary tumour and elective lymphadenectomy of the HN2 regional LN harbour a good prognosis. The use of adjuvant medical treatment in these dogs does not seem to provide any benefit in terms of progression and survival. [ABSTRACT FROM AUTHOR]

Background: Triple Negative breast cancer (TNBC) includes a heterogeneous group of tumors with different clinico-pathological features, molecular alterations and treatment responsivity. Our aim was to evaluate the clinico-pathological heterogeneity and prognostic significance of TNBC histologic variants, comparing "special types" to high-grade invasive breast carcinomas of no special type (IBC-NST).Methods: This study was performed on data obtained from TNBC Database, including pathological features and clinical records of 1009 TNBCs patients diagnosed between 1994 and 2015 in the four most important Oncology Units located in different hospitals in Sardinia, Italy. Kaplan-Meier analysis, log-rank test and multivariate Cox proportional-hazards regression were applied for overall survival (OS) and disease free survival (DFS) according to TNBC histologic types.Results: TNBC "special types" showed significant differences for several clinico-pathological features when compared to IBC-NST. We observed that in apocrine carcinomas as tumor size increased, the number of metastatic lymph nodes manifestly increased. Adenoid cystic carcinoma showed the smallest tumor size relative to IBC-NST. At five-year follow-up, OS was 92.1, 100.0, and 94.5% for patients with apocrine, adenoid cystic and medullary carcinoma, respectively; patients with lobular and metaplastic carcinoma showed the worst OS, with 79.7 and 84.3%, respectively. At ten-years, patients with adenoid cystic (100.0%) and medullary (94.5%) carcinoma showed a favourable prognosis, whereas patients with lobular carcinoma showed the worst prognosis (73.8%). TNBC medullary type was an independent prognostic factor for DFS compared to IBC-NST.Conclusions: Our study confirms that an accurate and reliable histopathologic definition of TNBC subtypes has a significant clinical utility and is effective in the therapeutic decision-making process, with the aim to develop innovative and personalized treatments. [ABSTRACT FROM AUTHOR]

Thyroid nodules with ultrasound (US) cancer risk features and extra-thyroid lesions suggesting malignant lymph nodes, require prompt diagnosis, especially in children. The US pattern of intrathyroidal ectopic thymus (IET) can strongly suggest papillary thyroid carcinoma (PTC). The extra-thyroid ectopic thymic tissue (EET) can mimic pathological lymph nodes in US. The aim of the study has been to demonstrate US features and diagnostic methods, allowing finally to confirm the presence of IET and EET in children. The US and elastographic features of 16 ectopic thymic tissue (ET) lesions were analyzed so as to describe the typical characteristics of ET and to define the best method to differentiate ET and malignant lesions. Among 16 analyzed lesions, 11 lesions were IET, and 5 were EET adjacent to the thyroid connective tissue capsule. Most of IET were located in the middle part of the right lobe and were fusiform or oval in shape. All the lesions were solid, hypoechoic, and heterogeneous with bright internal echoes. Among IET, 73% of lesions had well- or very well-defined margins. In strain elastography of IET lesions, the strain ratio was similar in all lesions, and its value ranged from 0.95 to 1.09. Despite the low prevalence of IET and cervical EET, clinicians and radiologists should be aware of US characteristics of such lesions. The confirmation of their benign character is absolutely required. Elastography is a useful tool to initially differentiate PTC and IET. However, due to high risk of malignancy in thyroid lesions in children, similarity of US features of PTC and IET, and due to the possibility of malignancy in ET, only cytological evaluation provides definitive diagnosis.

Photothermal therapy has been established recently as a non-invasive treatment protocol for cancer metastatic lymph nodes. Although this treatment approach shows efficient tumour ablation towards lymph node metastasis, the monitoring and reporting of treatment progress using the lymphatic delivery channel still need to be explored. Herein, we investigated the anti-tumour effect of pegylated gold nanorods with a high aspect ratio (PAuNRs) delivered via the lymphatic route in a mouse model. In this study, breast carcinoma (FM3A-Luc) cells were inoculated in the subiliac lymph node (SiLN) to induce metastasis in the proper axillary lymph node (PALN). The treatment was initiated by injecting the PAuNRs into the accessory axillary lymph node (AALN) after tumour metastasis was confirmed in the PALN followed by external NIR laser irradiation under a temperature-controlled cooling system. The anti-tumour impact of the treatment was evaluated using an in vivo bioluminescence imaging system (IVIS). The results showed a time-dependent reduction in tumour activity with significant treatment response. Tumour growth was inhibited in all mice treated with PAuNRs under laser irradiation; results were statistically significant (** p < 0.01) even after treatment was concluded on day 3. We believe that this non-invasive technique would provide more information on the dynamics of tumour therapy using the lymphatically administered route in preclinical studies.

Thyroid nodules with ultrasound (US) cancer risk features and extra-thyroid lesions suggesting malignant lymph nodes, require prompt diagnosis, especially in children. The US pattern of intrathyroidal ectopic thymus (IET) can strongly suggest papillary thyroid carcinoma (PTC). The extra-thyroid ectopic thymic tissue (EET) can mimic pathological lymph nodes in US. The aim of the study has been to demonstrate US features and diagnostic methods, allowing finally to confirm the presence of IET and EET in children. The US and elastographic features of 16 ectopic thymic tissue (ET) lesions were analyzed so as to describe the typical characteristics of ET and to define the best method to differentiate ET and malignant lesions. Among 16 analyzed lesions, 11 lesions were IET, and 5 were EET adjacent to the thyroid connective tissue capsule. Most of IET were located in the middle part of the right lobe and were fusiform or oval in shape. All the lesions were solid, hypoechoic, and heterogeneous with bright internal echoes. Among IET, 73% of lesions had well- or very well-defined margins. In strain elastography of IET lesions, the strain ratio was similar in all lesions, and its value ranged from 0.95 to 1.09. Despite the low prevalence of IET and cervical EET, clinicians and radiologists should be aware of US characteristics of such lesions. The confirmation of their benign character is absolutely required. Elastography is a useful tool to initially differentiate PTC and IET. However, due to high risk of malignancy in thyroid lesions in children, similarity of US features of PTC and IET, and due to the possibility of malignancy in ET, only cytological evaluation provides definitive diagnosis. [ABSTRACT FROM AUTHOR]

Background and Objectives: There is evidence or consensus on the use of 18F-2-fluorodeoxyglucose-positron emission tomography with computed tomography (PET-CT) in evaluating the effects of treatment at 12 weeks after chemoradiotherapy for head and neck squamous cell carcinoma with cervical lymph node metastasis. However, the use of imaging to evaluate the effects of treatment within 12 weeks after chemoradiotherapy is controversial. The aim of this study was to evaluate the usefulness of ultrasonography in the diagnosis of lymph nodes metastasis after chemoradiotherapy according to the criteria of the “Evaluation of the effects of treatment on metastatic cervical lymph nodes using ultrasonography”, which evaluated lymph nodes metastasis based on size change and presence of degeneration. Materials and methods: This prospective study included 34 head and neck squamous cell carcinoma patients with cervical lymph nodes metastasis. Thirty-two patients who completed treatment were analyzed. Ultrasonography was performed at 4 and 8 weeks after chemoradiotherapy and we judged whether a favorable prognosis could be expected or whether additional treatments should be considered. Ultrasonography and PET-CT were performed at 12 weeks after chemoradiotherapy. Neck dissection was performed if residual disease was suspected based on the PET-CT findings. Results: The accuracy and negative predictive value of ultrasonography were 81.3% and 96.3%, respectively. According to the Ultrasonography findings, the size of lymph nodes metastasis after chemoradiotherapy was significantly smaller than those before chemoradiotherapy (p < 0.05). The fluid and blood flow of lymph nodes metastasis showed a significantly reduced at 12 weeks after chemoradiotherapy (p < 0.05, p < 0.05, respectively). The echo density significantly changed from low to high echoic density after chemoradiotherapy (p < 0.05). Conclusions: Ultrasonography was useful for evaluating cervical lymph nodes metastasis after chemoradiotherapy for head and neck squamous cell carcinoma.

ObjectivesThe extracapsular spread (ECS) of metastatic lymph nodes is associated with aggressive tumor behavior, and is regarded as a major risk factor for local recurrence in patients with head and neck squamous cell carcinoma. However, the significance of ECS of metastatic lymph nodes has not been well established in well-differentiated thyroid carcinoma. The purpose of this study was to examine this question.MethodsA retrospective review was performed of 335 patients with papillary thyroid carcinoma who underwent total thyroidectomy with lymph node dissection from April 2001 to December 2009. We analyzed various clinical characteristics, pathologic factors, and the size, number, and ECS of foci in metastatic lymph nodes.ResultsOn pathologic review, 201 of the patients (56.6%) had lymph node metastasis. This was significantly related to age and tumor size. ECS was noted in 64 of these 201 patients (31.8%), and was significantly related to male gender, tumor size, presence of extrathyroidal extension, metastatic lymph node size, and focus size. Recurrence occurred in 13 patients (3.9%), and the presence of ECS was significantly related to recurrence.ConclusionECS of metastatic lymph nodes is an important prognostic factor for loco-regional recurrence in papillary thyroid carcinoma.

Objective: To characterize current use of open neck mass biopsy for diagnosis of squamous cell carcinoma in patients presenting with a neck mass. Methods: Using the University of Michigan Specialized Program of Research Excellence in Head and Neck Cancer patient database (2008–2014), we reviewed patients' referral documentation to identify those who received open neck mass biopsies as part of their squamous cell carcinoma diagnosis. We compared subsequent treatment between patients who did and did not receive an open neck mass biopsy. Results: Of 940 patients, 50 patients had received open neck mass biopsy leading to squamous cell carcinoma diagnosis. Only 19 of 50 patients (38%) had undergone fine‐needle aspiration prior to open neck mass biopsy. There were no statistically significant differences in treatment or outcomes between patients who did and those who did not receive open neck mass biopsy. Conclusion: Optimal care for patients who present with a neck mass is fine‐needle aspiration. Unfortunately, these data show that many patients undergo open neck mass biopsy for diagnosis, often without prior fine‐needle aspirate. Compared to fine‐needle aspiration, open biopsy incurs additional risks of general anesthesia and greater surgical risks. While our data did not find statistically significant differences between treatment offered and outcomes, this small study was not expected to demonstrate a difference in outcomes. Further work is needed to promote the utility of fine‐needle aspiration for diagnosis of neck mass and to discourage use of open neck mass biopsy as a primary diagnostic intervention. Level of Evidence: 2c (Outcomes Research) [ABSTRACT FROM AUTHOR]

Graphical abstract Abstract The combination of photothermal therapy and targeted chemotherapy can produce much greater cytotoxicity than chemotherapy. Herein, we developed multifunctional targeted polymeric nanoparticles (NPs) loaded with indocyanine green (ICG) and doxorubicin (DOX) for the targeted photoacoustic imaging and photothermal ablation of oral cancer cells. The chemokine SDF-1, a specific antibody, was conjugated to NPs by the carbodiimide method. The NPs were automatically targeted to tumour tissue in vitro and in vivo through CXCR4-SDF-1 interactions. The results of in vivo and in vitro photoacoustic imaging and photothermal therapy experiments showed that the multifunctional NPs had excellent photoacoustic imaging characteristics and photothermal therapy capabilities. The photothermal material heated rapidly after laser irradiation, and the resulting heat increased cell metabolism and membrane permeability, which increased cellular NP uptake. The encapsulated drug (DOX) was released immediately after the liquid core was transformed into a gas via laser effects, which killed tumour cells while producing strong photoacoustic signals in vitro and in vivo. Thus, we concluded that the chemokine SDF-1 can be applied for the targeted chemotherapy of metastatic lymph nodes of oral squamous cell carcinoma (OSCC) and is more effective for treating oral cancer when combined with photothermal therapy than when used alone. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the safety and efficiency of microwave ablation (MWA) with low power of 20 w, respectively, in the treatment of cervical metastatic lymph node (CMLN) from papillary thyroid carcinoma (PTC) with a mean of 32-month follow-up.Methods: Eleven patients in total with 24 cervical lymph nodes (LNs) diagnosed with CMLN from PTC underwent MWA at a power of 20 w. We recorded images of the LNs under ultrasound first before MWA and 1, 3, 6, 12, months after MWA, and then every 6 months, respectively. The volumes of the LNs were compared before MWA and at each follow-up point after MWA. The thyroglobulin (Tg) test was performed before MWA and 3 months after MWA.Results: All patients were successfully treated, and they showed no major complications. Before MWA, the mean volume of the LNs was 364.15 ± 306.89 mm3, which decreased to 234.10 ± 230.34 mm3, 107.51 ± 129.47 mm3, 20.88 ± 39.27 mm3, 3.38 ± 12.74 mm3, and completely disappeared at the follow-up point of 1, 3, 6, 12, and 18 months after MWA, respectively. The mean Tg was 11.81 ± 7.50 ng/ml, a data significantly decreased to 0.43 ± 0.11 ng/ml 3 months after MWA (P = 0.000). In the follow-up period, no recurrent lesions were found.Conclusions: For the treatment of CMLN from PTC, low power MWA showed good safety and efficacy. MWA is likely to be a candidate for patients with high risks or who refuse reoperation. [ABSTRACT FROM AUTHOR]

Objectives Genetic profiles of primary and metastatic lung tumor have been investigated by previous studies. However, whether they can be replaced by each other to guide treatment remains controversial. Moreover, it is unclear that whether genetic profiles of plasma can reflect genetic divergence between primary and metastatic lesions. Materials and methods In this prospective study, we collected 35 pairs of matched primary tumor tissue, metastatic lymph nodes and plasma from treatment-naïve patients with advanced non-squamous non-small cell lung cancer (NSCLC) and applied to capture-based sequencing using a panel consisting 56 NSCLC-related genes to interrogate the heterogeneity and similarity among the 3 sites. Results We observed 62.0% (67/108) by-variant concordance rate among primary tumor, metastatic lymph nodes and plasma as well as 76.4% (81/106) by-variant concordance rate between primary tumor and metastatic lymph nodes. When the analysis restricted to driver genes, we achieved 60.9% (28/46) and 77.3% (34/44) concordance, respectively. Furthermore, there is no statistically significant difference in progression-free survival (PFS) of 17 patients who used matched targeted therapy between patients having 100% concordance rate between primary tumor and metastatic lymph nodes and patients having partially matched mutational profiles. Conclusion Collectively, our study revealed a similar genetic profile shared between primary tumor and metastatic lymph nodes. The limited discordance observed can be partially reflected by plasma. Sequencing results obtained from either site can be utilized for providing treatment guidance. [ABSTRACT FROM AUTHOR]

The present study aimed to investigate the usefulness of contrast-enhanced ultrasonography (CEUS) and a newly developed analysis software for the detection of microcapillary network distribution in lymph nodes of patients with head and neck cancer (HNC) by comparing the CEUS and histopathological findings. Patients that were diagnosed with HNC between February and September 2016 were enrolled. A total of five patients underwent resection of the primary tumor and neck dissection as their initial treatment. The cervical lymph nodes of these patients were analyzed by CEUS intraoperatively, and their surgical specimens were examined histopathologically. The patients were diagnosed using a combination of physical examination, computed tomography, magnetic resonance imaging and fluorodeoxyglucose-positron emission tomography. For CEUS examination, the microbubble contrast agent Sonazoid? was injected into a peripheral vein. Video images of the metastatic lymph nodes were captured, and these were subjected to analysis by a newly developed image-analysis software. It was possible to perform intraoperative CEUS of metastatic lymph nodes and obtain accurate matched sections for histopathological examination. Hematoxylin and eosin and cluster of differentiation (CD)34 staining revealed that the software was able to accurately detect capillary vessels in metastatic lymph nodes. However, a number of perfusion deficits were observed in these lymph nodes. In conclusion, by using CEUS with the analysis software, the density and distribution of blood vessels in the metastatic lymph nodes of patients with HNC was revealed. Although the present study was limited and preliminary, it was concluded that this method may be useful to evaluate and to map the capillary vessels in the metastatic lymph nodes of patients with HNC. [ABSTRACT FROM AUTHOR]

A 67-year-old man consulted our department with gross hematuria. Computed tomography (CT) revealed a huge renal tumor with a paracaval metastatic lymph node (mLN). Right total nephrectomy was planned for the renal tumor diagnosed as renal cell carcinoma preoperatively. Just before the resection of the renal vein and artery, intraoperative ultrasonography revealed an inferior vena caval tumor thrombus (IVCTT) extending from the mLN. Ultrasonography clearly and dynamically demonstrated a rhythmic flapping movement of the IVCTT with blood flow in the inferior vena cava. Following right radical nephrectomy, IVCTT resection with the vessel wall was performed to reduce the risk of pulmonary tumor thrombus. Histopathological diagnosis of the renal tumor was clear cell renal cell carcinoma, and the resected IVCTT was confirmed histopathologically as tumor involvement from the mLN of the renal cell carcinoma. Intraoperative ultrasonography can detect IVCTT extending from the mLN, whereas CT cannot. [ABSTRACT FROM AUTHOR]

The objective of this study is to compare the targeting ability of activated carbon nanoparticles and nanoliposomes, which are used as carriers for delivering docetaxel (DTX) to the metastatic lymph nodes. In this study, we first prepared the DTX-loaded activated carbon nanoparticles (DTX-AC-NPs) by modifying the activated carbon with nitric acid oxidation and absorbing DTX in the concentrated nitro-oxide nanocarbon. We then prepared DTX-loaded nanoliposomes (DTX-LPs) by the proliposome method. The physiochemical properties of DTX-AC-NPs and DTX-LPs were carefully evaluated in vitro. The metastatic lymph node uptake and the injection site retention were investigated by analyzing the DTX concentration in metastatic lymph nodes and injection sites. The result showed that DTX-AC-NPs and DTX-LPs with suitable and stable physicochemical properties could be used for in vivo lymph node targeting studies. DTX-AC-NPs significantly increased DTX-AUC(0–24) and prolonged DTX-retention in metastatic lymph nodes compared to DTX-LPs and non-modified activate carbon in vivo. This study demonstrated activated carbon nanoparticles may be potential intralymphatic drug delivery system to preferentially target regional metastatic lymph nodes.