Abstract
BackgroundAccurate evaluation of lymph node (LN) status is the key factor to determine the treatment and evaluate prognosis for patients with cancer. However, traditional pathological examination resulted in a 30% false-negative rate of detection of metastases in LNs. This study aimed to utilize Lugol’s iodine (I2-IK)-enhanced micro-CT imaging to reveal the 3-dimensional structure of regional LNs and decrease the false-negative rate in pathological examination.MethodsTo explore the feasibility of I2-IK-enhanced micro-CT imaging in locating metastatic lesion in LNs, nonmetastatic and metastatic LNs from mice were used to mimic the imaging process. Then, the LNs from oral squamous cell carcinoma (OSCC) patients were applied to verify the value of I2-IK-enhanced micro-CT imaging in revealing LN structure and locating metastatic lesions in LNs. The glycogen content in nonmetastatic and metastatic LNs was further detected by the use of a glycogen assay kit and periodic acid–Schiff (PAS) staining to explain the imaging differences between them.ResultsIn nude mice, 0.5% I2-IK staining for 4 h was the best parameter for normal LN. The metastatic foci in metastatic LNs were also clearly outlined in this condition. For nonmetastatic LNs from patients with OSCC, 1% I2-IK staining for 12 h was the best parameter. However, due to the increased volume of metastatic LNs, the image effect of 3% I2-IK staining for 12 h was superior to 1% I2-IK staining [tumor background ratio (TBR), 3% vs. 1%, 1.89 ± 0.10 vs. 1.27 ± 0.07, p < 0.001]. Compared with subsequent pathological sections, we found the CT intensity of metastatic foci in LNs and muscle tissues was significantly higher than in nonmetastatic regions. Meanwhile, the glycogen content of metastatic foci in LNs detected was also significantly higher than in nonmetastatic region.ConclusionsI2-IK-enhanced micro-CT imaging could identify the spatial location of metastatic foci in LNs. This will be an effective method to assist in decreasing the LN false-negative rate for cancer pathology.
Highlights
Metastasis is closely related to the prognosis of patients with malignant cancers [1]
By comparing the micro-computed tomography (CT) image with pathological image, we found that Lugol’s iodine (I2-IK)-enhanced micro-CT imaging could clearly locate the metastatic foci in lymph node (LN) (Figure 4)
The results showed that the content of glycogen in metastasis LN tissue were higher than nonmetastatic LN tissue (Figure 6B)
Summary
Metastasis is closely related to the prognosis of patients with malignant cancers [1]. The treatment regimens vary widely depending on the status of regional LNs. Take OSCC as an example; tumors in T1–T2 stages without LNs metastases are often treated with elective neck dissection, while radical neck dissection and postoperative radiotherapy are recommended for tumors with LNs metastases [5, 6]. Take OSCC as an example; tumors in T1–T2 stages without LNs metastases are often treated with elective neck dissection, while radical neck dissection and postoperative radiotherapy are recommended for tumors with LNs metastases [5, 6] It is important for treatment plan formulation and prognosis estimation to accurately assess the status of regional LNs. Accurate evaluation of lymph node (LN) status is the key factor to determine the treatment and evaluate prognosis for patients with cancer. This study aimed to utilize Lugol’s iodine (I2-IK)-enhanced micro-CT imaging to reveal the 3-dimensional structure of regional LNs and decrease the false-negative rate in pathological examination
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