Cervical Lymph Nodes In Patients Research Articles

A study on the correlation of Doppler ultrasound in the diagnosis of cervical lymph nodes in patients with laryngeal and hypopharyngeal cancers: An observational study.

The objective was to assess the diagnostic efficacy of Doppler ultrasound in detecting cervical lymph nodes in patients diagnosed with laryngeal and hypopharyngeal cancers. Patients undergoing surgery for laryngeal and hypopharyngeal cancers in the Otolaryngology Department from January 2021 to January 2023 were included. Two groups, with equal numbers, underwent ultrasound examination and intensive CT examination in the experimental and control groups, respectively, along with routine cervical lymph node dissection. A resident with over 6 years of clinical experience in the otolaryngology department performed routine bilateral cervical lymph node palpation. Sensitivity, specificity, and validity were compared among different examination methods. The McNemar test assessed specificity and sensitivity between palpation, color Doppler ultrasonography, and enhanced CT, while the Kappa concordance test evaluated the concordance between the 2 examination methods. Data were statistically analyzed using SPSS 23.0. Palpation showed a diagnostic sensitivity (DS) of 52.83% and specificity of 91.11% for all patients with cervical lymph node metastasis. Ultrasonography demonstrated a DS of 77.78% and specificity of 81.82% in patients with cervical lymph node metastasis, while intensive CT had a DS of 75.86% and specificity of 60.00%. Statistical significance (P < .05) was observed in the sensitivity between palpation and ultrasonography, and between palpation and enhanced CT. The specificity between enhanced CT and ultrasonography (P = .021) and between palpation and enhanced CT scan (P = .003) both showed statistical significance (P < .05). Doppler ultrasound yields diagnostic results highly consistent with pathological diagnoses in patients with laryngeal and hypopharyngeal cancers. Utilizing Doppler ultrasound can enhance the accuracy of diagnosing these cancers, aiding physicians in devising more suitable treatment plans for patients.

Evaluation of the risk factors of metastasis to central cervical lymph nodes in patients with papillary thyroid carcinoma

Background: Papillary thyroid cancer, comprising 80% of thyroid malignancies in iodine-sufficient areas, can be effectively treated if detected early before metastasis. Cervical lymph nodes are a common site of metastasis, prompting some surgeons to suggest prophylactic dissection in all patients. To minimize potential side effects, this study aims to identify patients benefiting from this procedure by assessing risk factors for central lymph node metastasis. Methods and materials: This descriptive-analytical study was conducted on 150 patients with papillary thyroid cancer. The samples included cases in which central lymph node involvement was ruled out clinically and radiologically. After proving papillary cancer in the pathology sample, the variables of age, sex, frequency of central lymph node involvement, tumor size, location of thyroid involvement, multi-centric involvement, multi-focal involvement, presence of microcalcification, capsular invasion, lymphovascular invasion, and pathology were analyzed. The results were presented with descriptive statistics. Results: The percentage of central lymph node involvement in this study was reported as 9.3%. In the analysis, capsular invasion (P=0.01), lymphovascular invasion (P=0.0001) and involvement of the upper thyroid pole (P=0.001) were identified as risk factors for central lymph node involvement. There was no significant relationship between the variables of age, sex, tumor size, pathology, multi-centricity and multifocality and central lymph node involvement. Conclusion: Involvement of central lymph nodes in patients with capsular invasion, lymphovascular invasion, and involvement of the upper thyroid bridge is far more common than in other patients, and central lymph node dissection is recommended in patients with several of the above risk factors.

Evaluation of the risk factors of metastasis to central cervical lymph nodes in patients with papillary thyroid carcinoma.

Papillary thyroid cancer, comprising 80% of thyroid malignancies in iodine-sufficient areas, can be effectively treated if detected early before metastasis. Cervical lymph nodes are a common site of metastasis, prompting some surgeons to suggest prophylactic dissection in all patients. To minimize potential side effects, this study aims to identify patients benefiting from this procedure by assessing risk factors for central lymph node metastasis. This descriptive-analytical study was conducted on 150 patients with papillary thyroid cancer. The samples included cases in which central lymph node involvement was ruled out clinically and radiologically. After proving papillary cancer in the pathology sample, the variables of age, sex, frequency of central lymph node involvement, tumor size, location of thyroid involvement, multi-centric involvement, multi-focal involvement, presence of microcalcification, capsular invasion, lymphovascular invasion, and pathology were analyzed. The results were presented with descriptive statistics. The percentage of central lymph node involvement in this study was reported as 9.3%. In the analysis, capsular invasion (P=0.01), lymphovascular invasion (P=0.0001) and involvement of the upper thyroid pole (P=0.001) were identified as risk factors for central lymph node involvement. There was no significant relationship between the variables of age, sex, tumor size, pathology, multi-centricity and multifocality and central lymph node involvement. Involvement of central lymph nodes in patients with capsular invasion, lymphovascular invasion, and involvement of the upper thyroid bridge is far more common than in other patients, and central lymph node dissection is recommended in patients with several of the above risk factors.

Use superb microvascular imaging to diagnose and predict metastatic cervical lymph nodes in patients with papillary thyroid carcinoma

PurposePapillary thyroid carcinoma (PTC) with metastatic lymph nodes (LNs) is closely associated with disease recurrence. This study accessed the value of superb microvascular imaging (SMI) in the diagnosis and prediction of metastatic cervical LNs in patients with PTC.MethodsA total of 183 cervical LNs (103 metastatic and 80 reactive) from 116 patients with PTC were analysed. Metastatic cervical LNs were confirmed by pathology or/and cytology; reactive cervical LNs were confirmed by pathology or clinical features. The characteristic of conventional ultrasound (US) was extracted using univariate and multivariate analyses. The diagnostic performance of US and SMI were compared using the area under the receiver operating curve (AUC) with corresponding sensitivity and specificity. A nomogram was developed to predict metastatic LNs in patients with PTC, based on multivariate analyses.ResultsL/S < 2, ill-defined border, absence of hilum, isoechoic or hyperechoic, heterogeneous internal echo, peripheral or mixed vascular pattern on color Doppler flow imaging (CDFI) and SMI, and a larger SMI vascular index appeared more frequently in metastatic LNs in the training datasets than in reactive LNs (P < 0.05). The diagnostic sensitivity, specificity and accuracy of SMI vs US are 94.4% and 87.3%, 79.3% and 69.3%, and 87.6% and 79.1%, respectively; SMI combined with US exhibited a higher AUC [0.926 (0.877–0.975)] than US only [0.829 (0.759–0.900)]. L/S < 2, peripheral or mixed vascular type on CDFI, and peripheral or mixed vascular types on SMI were independent predictors of metastatic LNs with PTC. The nomogram based on these three parameters exhibited excellent discrimination, with an AUC of 0.926.ConclusionSMI was superior to US in diagnosing metastatic LNs in PTC. US combined with SMI significantly improved the diagnostic accuracy of metastatic cervical LNs with PTC. SMI is efficacious for differentiating and predicting metastatic cervical LNs.

Effect of Hashimoto’s thyroiditis on the dual-energy CT quantitative parameters and performance in diagnosing metastatic cervical lymph nodes in patients with papillary thyroid cancer

BackgroundTo evaluate the effect of Hashimoto’s thyroiditis (HT) on dual-energy computed tomography (DECT) quantitative parameters of cervical lymph nodes (LNs) in patients with papillary thyroid cancer (PTC), and its effect on the diagnostic performance and threshold of DECT in preoperatively identifying metastatic cervical LNs.MethodsA total of 479 LNs from 233 PTC patients were classified into four groups: HT+/LN+, HT+/LN−, HT−/LN + and HT−/LN − group. DECT quantitative parameters including iodine concentration (IC), normalized IC (NIC), effective atomic number (Zeff), and slope of the spectral Hounsfield unit curve (λHU) in the arterial phase (AP) and venous phase were compared. Receiver operating characteristic curve analyses were performed to evaluate DECT parameters’ diagnostic performance in differentiating metastatic from nonmetastatic LNs in the HT − and HT + groups.ResultsThe HT+/LN + group exhibited lower values of DECT parameters than the HT−/LN + group (all p < 0.05). Conversely, the HT+/LN − group exhibited higher values of DECT parameters than the HT−/LN − group (all p < 0.05). In the HT + group, if an AP-IC of 1.850 mg/mL was used as the threshold value, then the optimal diagnostic performance (area under the curve, 0.757; sensitivity, 69.4%; specificity, 71.0%) could be obtained. The optimal threshold value of AP-IC in the HT − group was 2.050 mg/mL. In contrast, in the HT − group, AP-NIC demonstrated the highest area under the curve of 0.988, when an optimal threshold of 0.243 was used. The optimal threshold value of AP-NIC was 0.188 in the HT + group.ConclusionsHT affected DECT quantitative parameters of LNs and subsequent the diagnostic thresholds. When using DECT to diagnose metastatic LNs in patients with PTC, whether HT is coexistent should be clarified considering the different diagnostic thresholds.

Improved Cervical Lymph Node Characterization among Patients with Head and Neck Squamous Cell Carcinoma Using MR Texture Analysis Compared to Traditional FDG-PET/MR Features Alone.

Accurate differentiation of benign and malignant cervical lymph nodes is important for prognosis and treatment planning in patients with head and neck squamous cell carcinoma. We evaluated the diagnostic performance of magnetic resonance image (MRI) texture analysis and traditional 18F-deoxyglucose positron emission tomography (FDG-PET) features. This retrospective study included 21 patients with head and neck squamous cell carcinoma. We used texture analysis of MRI and FDG-PET features to evaluate 109 histologically confirmed cervical lymph nodes (41 metastatic, 68 benign). Predictive models were evaluated using area under the curve (AUC). Significant differences were observed between benign and malignant cervical lymph nodes for 36 of 41 texture features (p < 0.05). A combination of 22 MRI texture features discriminated benign and malignant nodal disease with AUC, sensitivity, and specificity of 0.952, 92.7%, and 86.7%, which was comparable to maximum short-axis diameter, lymph node morphology, and maximum standard uptake value (SUVmax). The addition of MRI texture features to traditional FDG-PET features differentiated these groups with the greatest AUC, sensitivity, and specificity (0.989, 97.5%, and 94.1%). The addition of the MRI texture feature to lymph node morphology improved nodal assessment specificity from 70.6% to 88.2% among FDG-PET indeterminate lymph nodes. Texture features are useful for differentiating benign and malignant cervical lymph nodes in patients with head and neck squamous cell carcinoma. Lymph node morphology and SUVmax remain accurate tools. Specificity is improved by the addition of MRI texture features among FDG-PET indeterminate lymph nodes. This approach is useful for differentiating benign and malignant cervical lymph nodes.

MRI and PET/CT in the assessment of lymph node metastases in head and neck cancer

The aim of this study is to present the diagnostic accuracy of MRI and PET/CT in the evaluation of cervical lymph nodes in patients with head and neck cancer (HNC). Data of 114 patients who underwent MRI and PET/CT prior to surgery in the time period between January 2010 and September 2021 in our center is analyzed retrospectively. Histopathological results of surgical preparations serve as the gold standard. The mean time from MRI to surgery is 22.9 (± 18.7) days, and from PET/CT to surgery 21.7 (± 19.9) days. Sensitivities of 80.4% and 80.4%, specificities of 85.7% and 87.3%, PPVs of 82.0% and 83.7% and NPVs of 84.4% and 84.6% are registered for MRI and PET/CT, respectively. 37 false results are further analyzed with respect to side and level of the affected lymph node, as well as intersections of the two imaging modalities. In 29 patients (25.4%), additional findings are described in PET/CT, 7 (6.1%) of which were histologically confirmed to be further malignancies. A combination of both MRI and PET/CT imaging modalities could improve diagnostic accuracy, especially with regard to sensitivity. A notable number of additional findings in whole body acquisition leads to the potential diagnosis of further malignancies.

Effects of COVID-19 vaccination on cervical lymph nodes in patients with thyroid cancer.

Cervical lymph node enlargement caused by coronavirus disease 2019 (COVID-19) vaccination has been reported, but little is known on whether the vaccination would influence preoperative cervical lymph node evaluation and its risk of lymph node metastasis in thyroid cancer. We retrospectively analyzed data of patients who underwent thyroid cancer surgery in Tangdu Hospital, China, from 1 March 2021 to 30 June 2021. A total of 182 patients were included in the cohort study. All patients with suspected malignant tumors underwent ultrasound (US)-guided fine needle aspiration (FNA) of thyroid lesions before surgery to confirm the diagnosis. Cervical lymph nodes were evaluated by preoperative physical examination and imaging. Wilcoxon rank-sum test and Fisher's exact test were used to evaluate the effect of vaccination on cervical lymph nodes in patients with thyroid cancer. Statistical significance was defined at P<0.05. The patients were divided into two groups according to whether they had been vaccinated or not. Our results showed that there were no significant differences between the two groups in the brand of the vaccine, operation method, and the extent of surgery. Moreover, there was no significant difference in the evaluation of US characteristics of cervical lymph nodes between the two groups regardless of having the vaccination or not. Interestingly, US evaluation found that the experimental group's proportion of cervical lymph node enlargement increased significantly within 14 days after vaccination, which was statistically significant. This study found that vaccination against COVID-19 did not increase the number of cervical lymph node metastases, but inaccurate assessment of cervical lymph nodes in thyroid cancer patients within 14 days of vaccination (due to temporary lymph node enlargement) may lead to more extensive surgery.

Quantitative Evaluation of the Lymph Node Metastases in the Head and Neck Malignancies Using Diffusion-Weighted Imaging and Apparent Diffusion Coefficient Mapping: A Bicentric Study

This study aimed to determine if diffusion-weighted imaging (DWI) can differentiate between benign and malignant lymph nodes in patients with head and neck cancer. A total of 55 patients with confirmed head and neck cancer and enlarged neck nodes were enrolled and evaluated by two radiologists using a workstation. Lymph nodes were analyzed using 3D regions of interest (ROIs) placed on T2-weighted images and compared to the corresponding DWI images. This study found that DWI and ADC values can be used to assess metastatic lymph nodes in the neck and that the sensitivity, specificity, and AUC of a narrower ROI for recognizing metastases were greater compared to the ADC value of the whole node. The study also found that the size of the ROI affects ADC values. The results suggest that DWI can accurately predict the status of cervical lymph nodes in patients with head and neck cancer and that it may be useful in diagnosing, determining the stage, developing a treatment plan, and monitoring these patients.

AIUM Practice Parameter for the Performance and Interpretation of Diagnostic Ultrasound of the Thyroid and Extracranial Head and Neck.

AIUM Practice Parameter for the Performance and Interpretation of Diagnostic Ultrasound of the Thyroid and Extracranial Head and Neck.

Efficacy of texture analysis of ultrasonographic images in the differentiation of metastatic and non-metastatic cervical lymph nodes in patients with squamous cell carcinoma of the tongue

We investigated the efficacy of using texture analysis of ultrasonographic images of the cervical lymph nodes of patients with squamous cell carcinoma of the tongue to differentiate between metastatic and non-metastatic lymph nodes. We analyzed 32 metastatic and 28 non-metastatic lymph nodes diagnosed by histopathologic examination on presurgical US images. Using the LIFEx texture analysis program, we extracted 36 texture features from the images and calculated the statistical significance of differences in texture features between metastatic and non-metastatic lymph nodes using the t test. To assess the diagnostic ability of the significantly different texture features to discriminate between metastatic and non-metastatic nodes, we performed receiver operating characteristic curve analysis and calculated the area under the curve. We set the cutoff points that maximized the sensitivity and specificity for each curve according to the Youden J statistic. We found that 20 texture features significantly differed between metastatic and non-metastatic lymph nodes. Among them, only the gray-level run length matrix feature of run length non-uniformity and the gray-level zone length matrix features of gray-level non-uniformity and zone length non-uniformity showed an excellent ability to discriminate between metastatic and non-metastatic lymph nodes as indicated by the area under the curve and the sum of sensitivity and specificity. Analysis of the texture features of run length non-uniformity, gray-level non-uniformity, and zone length non-uniformity values allows for differentiation between metastatic and non-metastatic lymph nodes, with the use of gray-level non-uniformity appearing to be the best means of predicting metastatic lymph nodes.

Added value of quantitative parameters derived from dual-layer spectral detector computed tomography for diagnosing metastatic cervical lymph nodes in patients with papillary thyroid cancer

Added value of quantitative parameters derived from dual-layer spectral detector computed tomography for diagnosing metastatic cervical lymph nodes in patients with papillary thyroid cancer

Ablation of Cervical Lymph Nodes in Patients with Thyroid Cancer: A Comparison between Cryoablation and Percutaneous Ethanol Injection

The purpose of this study was to retrospectively evaluate the safety and efficacy of cryoablation and compare the outcomes with those of percutaneous ethanol injection (PEI) for the treatment of metastatic cervical lymph nodes (CLNs) in patients with thyroid cancer. The study included 24 patients with 47 CLNs treated with PEI and 7 patients with 11 CLNs treated with cryoablation. Three of 7 (42.9%) patients did not respond to PEI and progressed to cryoablation. There were more local recurrences in CLNs treated with PEI (7/47, 14.9%) compared with cryoablation (0/11, 0%), but this did not reach significance (P = .33). There was no difference in mild/moderate (3/24, 12.5% vs 2/7, 28.6%; P = .31) or severe (1/24, 4.2% vs 0/7, 0%; P = 1) adverse events in the PEI and cryoablation cohorts. The number of treatments required for CLNs treated with PEI (2 ± 1.1) was significantly greater than those for CLNs treated with cryoablation (1 ± 0) (P = .002). These limited data suggest that the treatment of metastatic CLNs with cryoablation or PEI may both be safe and effective; however, further data are needed to confirm superiority of cryoablation.

Current Applications of Artificial Intelligence to Classify Cervical Lymph Nodes in Patients with Head and Neck Squamous Cell Carcinoma—A Systematic Review

Locally-advanced head and neck squamous cell carcinoma (HNSCC) is mainly defined by the presence of pathologic cervical lymph nodes (LNs) with or without extracapsular spread (ECS). Current radiologic criteria to classify LNs as non-pathologic, pathologic, or pathologic with ECS are primarily shape-based. However, significantly more quantitative information is contained within imaging modalities. This quantitative information could be exploited for classification of LNs in patients with locally-advanced HNSCC by means of artificial intelligence (AI). Currently, various reviews exploring the role of AI in HNSCC are available. However, reviews specifically addressing the current role of AI to classify LN in HNSCC-patients are sparse. The present work systematically reviews original articles that specifically explore the role of AI to classify LNs in locally-advanced HNSCC applying Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and the Study Quality Assessment Tool of National Institute of Health (NIH). Between 2001 and 2022, out of 69 studies a total of 13 retrospective, mainly monocentric, studies were identified. The majority of the studies included patients with oropharyngeal and oral cavity (9 and 7 of 13 studies, respectively) HNSCC. Histopathologic findings were defined as reference in 9 of 13 studies. Machine learning was applied in 13 studies, 9 of them applying deep learning. The mean number of included patients was 75 (SD ± 72; range 10-258) and of LNs was 340 (SD ± 268; range 21-791). The mean diagnostic accuracy for the training sets was 86% (SD ± 14%; range: 43-99%) and for testing sets 86% (SD ± 5%; range 76-92%). Consequently, all of the identified studies concluded AI to be a potentially promising diagnostic support tool for LN-classification in HNSCC. However, adequately powered, prospective, and randomized control trials are urgently required to further assess AI's role in LN-classification in locally-advanced HNSCC.

Initial Ultrasound Criteria for the Diagnosis of Cervical Lymph Node Metastases from Papillary Thyroid Cancer

Introduction: Cervical lymph node metastases from papillary thyroid cancer were classified into three categories according to ultrasound: 1) Metastases were not visible on ultrasound; 2) Metastases met initial criteria for the diagnosis; 3) Metastases met typical criteria for the diagnosis. Purpose: To develop initial ultrasound criteria for the diagnosis of cervical lymph node metastases from papillary thyroid cancer. Material and methods: We studied three groups of cervical lymph nodes in patients with papillary thyroid cancer. The first group consisted of 4307 lymph nodes that were not visible on ultrasound. However, in some of them histology revealed a metastasis. The second lymph node group consisted of 242 metastases, and the third one comprised 17 metastases causing first signs. Ultrasound imaging was performed by use of standard ultrasound machines that are widely used in clinical practice. The presence of metastases in the three groups was confirmed by histology and cytology. Results: According to histological data, metastases were present in 961 (22.3 %) of 4307 cervical lymph nodes of level VI located in the fatty tissue and removed for disease prevention. These lymph nodes were missed on ultrasound, so that metastases remained undetected. Typical criteria for the diagnosis of metastases were: an additional space-occupying lesion in the fatty tissue of the neck, local fat deformation, depth/width ratio over 0.5, no differentiation between the cortical and cerebral layers, predominance of the tissue nature, avascularity, calcifications. Cervical lymph nodes with extranodal extension showed some changes in the shape and outlines, metastatic spread to the adjacent fatty tissue, muscles and vessels. Initial sonographic features that helped to identify a metastasis included microcalcifications and an additional nodal space-occupying lesion occupying a part of the cortical and cerebral layers and being seen as the hyperechoic tissue or a cavity with fluid, or as a mixture of the hyperechoic tissue with fluid. The space-occupying lesion was round or ovoid in shape. There was no extranodal extension of early metastases. The space-occupying lesion was 0.5–0.7 cm in size. Conclusion: Ultrasound can detect metastases that cause first signs. Besides, it helps guide biopsies.

Contrast-enhanced ultrasound–based nomogram for predicting malignant involvements among sonographically indeterminate/suspicious cervical lymph nodes in patients with differentiated thyroid carcinoma

This prospective study was aimed at assessing the value of nomograms based on conventional and contrast-enhanced ultrasound (CEUS) features in the pre-operative diagnosis of sonographically indeterminate/suspicious lymph node metastasis (LNM) in patients with differentiated thyroid carcinoma (DTC). A total of 72 cervical LNs from 47 patients with DTC from January to June 2018 were included in the primary data set, and 30 LNs from 15 patients with DTC from July to August 2018 were included in the external validation data set. The LNs of the included patients were preoperatively evaluated by conventional ultrasound (US) and CEUS. Each included LN was labeled by puncture localization with carbon nanoparticle suspension injection (Canalin) under US guidance and dissected separately to ensure the one-to-one correspondence between ultrasonic features and pathology status. Univariate logistic regression analysis was used to identify risk factors for LNM. A nomogram was used to construct a prediction model for cervical metastatic LNs. Round shape, absence of hilar structure, peripheral or mixed blood flow and centripetal or mass enhancement were risk factors for lymph node metastases. The area under the receiver operating characteristic curve of the nomogram model based on conventional US and CEUS features was 0.93 (95% confidence interval: 0.872-0.985), which was superior to that of the nomogram based on conventional US features(0.85, 95% confidence interval: 0.707-0.989). CEUS features can provide incremental benefit in the diagnosis of LNM among DTC cohorts. Nomograms based on conventional US and CEUS features can predict LN status with high accuracy.

Abstract No. 263 Ablative treatment of metastatic cervical lymph nodes in patients with thyroid cancer: a comparison of ethanol ablation and cryoablation

Ethanol ablation (EA) has also been described as a viable treatment option in thyroid cancer (TC) patients with spread to cervical lymph nodes (cLN). While EA has been documented to be safe, the treatment often requires multiple therapies and the difficulty of ensuring alcohol permeates and therefore destroys all of the target tissue is well known. While thermal ablation techniques such as cryoablation have been shown to be more effective than alcohol ablation in other settings, to the authors knowledge no report of thermal ablation in cervical lymph nodes has been reported.

Is elective neck dissection necessary for patients with cT3-4N0 parotid gland cancer?

ObjectiveManagement of the cervical lymph nodes in patients with cT3-4N0 parotid gland cancer (PGC) has been controversial. This study investigated the need for elective neck dissection (END) in patients with cT3-4N0 PGC. MethodsWe retrospectively examined cervical lymph node metastasis, overall survival (OS), and disease-free survival (DFS) rates in 40 patients with cT3-4N0 PGC according to whether or not END was performed. ResultsCervical lymph node metastasis occurred in 27.5% of patients and level II was the most common area. Recurrence could be treated by salvage neck dissection. There was no significant difference in OS (P=0.581) or DFS (P=0.728) between the group that underwent END and the group that did not. ConclusionEND at level II is worth performing because of the occult lymph node metastasis rate. The area of neck dissection should be limited because there is no evidence that END improves the prognosis of cT3-4N0 PGC.

Cervical lymph nodes and ovarian teratomas as germinal centres in NMDA receptor-antibody encephalitis.

Autoantibodies against the extracellular domain of the N-methyl-d-aspartate receptor (NMDAR) NR1 subunit cause a severe and common form of encephalitis. To better understand their generation, we aimed to characterize and identify human germinal centres actively participating in NMDAR-specific autoimmunization by sampling patient blood, CSF, ovarian teratoma tissue and, directly from the putative site of human CNS lymphatic drainage, cervical lymph nodes. From serum, both NR1-IgA and NR1-IgM were detected more frequently in NMDAR-antibody encephalitis patients versus controls (both P < 0.0001). Within patients, ovarian teratoma status was associated with a higher frequency of NR1-IgA positivity in serum (OR = 3.1; P < 0.0001) and CSF (OR = 3.8, P = 0.047), particularly early in disease and before ovarian teratoma resection. Consistent with this immunoglobulin class bias, ovarian teratoma samples showed intratumoral production of both NR1-IgG and NR1-IgA and, by single cell RNA sequencing, contained expanded highly-mutated IgA clones with an ovarian teratoma-restricted B cell population. Multiplex histology suggested tertiary lymphoid architectures in ovarian teratomas with dense B cell foci expressing the germinal centre marker BCL6, CD21+ follicular dendritic cells, and the NR1 subunit, alongside lymphatic vessels and high endothelial vasculature. Cultured teratoma explants and dissociated intratumoral B cells secreted NR1-IgGs in culture. Hence, ovarian teratomas showed structural and functional evidence of NR1-specific germinal centres. On exploring classical secondary lymphoid organs, B cells cultured from cervical lymph nodes of patients with NMDAR-antibody encephalitis produced NR1-IgG in 3/7 cultures, from patients with the highest serum NR1-IgG levels (P < 0.05). By contrast, NR1-IgG secretion was observed neither from cervical lymph nodes in disease controls nor in patients with adequately resected ovarian teratomas. Our multimodal evaluations provide convergent anatomical and functional evidence of NMDAR-autoantibody production from active germinal centres within both intratumoral tertiary lymphoid structures and traditional secondary lymphoid organs, the cervical lymph nodes. Furthermore, we develop a cervical lymph node sampling protocol that can be used to directly explore immune activity in health and disease at this emerging neuroimmune interface.

Pattern of Metastases of Squamous Cell Carcinoma in Cervical Lymph Node In Patients With Occult Primary

Introduction: Squamous cell carcinoma is the most common cancer of the upper aerodigestive tract, accounting for more than 90% of cancers. Its method of spread is through lymphatic channels, with a high propensity toward deposition in the regional lymph nodes. Objective: To determine the pattern of metastesis of squamous cell carcinoma in cervical lymph node in patients with occult primary. Methods: This was an observational cross sectional study which was carried out in the Dept. of ENT, Abdul Malek Ukil Medical College Hospital, Noakhali, Bangladesh from January 2017 to June-2019. A Total 31 patients were selected according to selection criteria and level of involved lymph node and nodal staging was determined by careful clinical examination, biopsy of all suspicious site, CT scan, MRI, USG and X-ray. Results: Thirty One patients with metastatic neck node in whom the primary tumour was not found despite of extensive diagnostic procedure were studied in this series. Patients distribution Male were 78% and female 22%. In this study majority of patients were within 40-80 years and most of patients were male. Unilateral neck node metastasis was found in 90.32% cases and bilateral in 09.68% cases. There is high incidence of unilateral metastatic neck node. Involved lymph node was found single in 54.83% and multiple in 45.17% cases in our study. Consistency of lymph nodes were found hard in 51.61%, firm to hard in 32.25% and firm in 16.12% cases in our study. In this study nodes were found less than 3 cm in 38.70% cases, 3-6 cm in 48.38% cases and more than 6 cm in 12.90% cases. While levelling of the lymph node was concerned, in this study the most commonly involved lymph node region was level-II (41.93%) followed by level-III (16.12%). In this study 38.70% cases were in stage N1, 48.38% in stage N2 and 12.90% in stage N3. Maximum lymph nodes were 3-6 cm in size. Conclusion: Metastetic squamous cell carcinoma in cervical lymph node of occult primary common in .........