Cervical Node Metastasis Research Articles

Dual-energy CT in head and neck applications.

Dual-energy CT (DECT), also known as spectral CT, has advanced diagnostic capabilities in head and neck pathologies beyond those of conventional single-energy CT (SECT). By having images at two distinct energy levels, DECT generates virtual monoenergetic images (VMIs), iodine maps, and quantitative features such as iodine concentration (IC) and spectral Hounsfield unit attenuation curves (SHUAC), which leads to enhancing tissue characterization, reducing artifacts, and differentiating head and neck pathologies. This review highlights DECT's applications in evaluating head and neck squamous cell carcinoma (SCC), thyroid cartilage invasion, cervical lymph node metastasis, radiation therapy planning, post-treatment assessment, and role in other head and neck conditions, such as infection and sialolithiasis. Additionally, it explores emerging applications of DECT in radiomics and artificial intelligence. The review also discusses about integrating DECT into clinical practice requires overcoming workflow challenges and ensuring radiologist proficiency with its diverse image reconstructions. As DECT technology evolves, its integration promises to further enhance the efficacy of managing head and neck pathologies.

Ultrasound‑guided Percutaneous Radiofrequency and Microwave Ablation for Cervical Lymph Node Metastasis from Papillary Thyroid Carcinoma: A Systematic Review and Meta‑analysis of Clinical Efficacy and Safety.

To evaluate the efficacy and safety of radiofrequency ablation (RFA) and microwave ablation (MWA) for treating cervical lymph node metastasis (CLNM) from papillary thyroid carcinoma (PTC). Medline, EMBASE, Web of Science, and Cochrane Library were searched for studies on the efficacy and safety of thermal ablations for treating CLNM from PTC until July 2024. Among 544 papers, 11 articles were reviewed involving 233 patients and 432 CLNM cases. Random- or fixed-effects models assessed pooled proportions of volume reduction rate (VRR), complete disappearance, recurrence, major and minor or other complications. Similarly, pooled estimates of changes in the largest diameter, volume, and serum thyroglobulin (Tg) were evaluated post-ablation. Subgroup analysis by treatment modality was performed. Study heterogeneity was analyzed using Q statistics and inconsistency index (I2). The quality of the studies was assessed using the MINORS scale. Eleven studies with 233 patients and 432 CLNM were analyzed. The pooled VRR was 95.24% [95% Confidence Interval (CI): 91.97- 98.51%], complete disappearance was 63.1%, and recurrence was 1.6%. Changes in largest diameter, volume, and serum Tg were 8.36mm (95%CI: 6.46-10.26mm), 216.09mm³, and 6.12ng/ml, respectively. Major complications occurred at 3.0%, while minor complications were 25.6%. Significant heterogeneity was found for diameter, volume, VRR, Tg, and minor complications. Subgroup analysis showed that MWA had a higher VRR (97.18%) than RFA (93.84%) (P < 0.001). Both RFA and MWA were effective and safe for treating CLNM from PTC. However, RFA showed lower volume reduction than MWA with significant heterogeneity in VRR. The original contributions revealed in the study are included in the article/Supplemental Material. Further inquiries can be made to the corresponding author.

Thyroid cancer survival and prognostic factors in Yantai, China (2012–2022): a population-based study

Abstract Background Although thyroid cancer is associated with low mortality rates, significant racial disparities in thyroid cancer outcomes have not been adequately studied in Asia. Moreover, the Asian population consists of different ethnic groups that are not homogeneous. This study aimed to perform a population-based analysis of survival outcomes and prognostic factors in thyroid cancer patients. Methods The demographic data and tumor characteristics of all the thyroid cancer patients identified were obtained from the Yantai Cancer Registry. The thyroid cancer-specific death risk in patients was evaluated using the proportion of deaths, standardized mortality ratio (SMR) and absolute excess risk (AER). The Kaplan‒Meier method and the Cox proportional hazards regression model were used to evaluate overall survival (OS) and prognosis. Results A total of 10,852 new cases of thyroid cancer occurred with a 5-year OS of 96.20% in Yantai from 2012 to 2022. The SMR decreased from 1.06 (95%CI: 0.93 − 1.33) in 2012 to 0.50 (95%CI: 0.42 − 0.63) in 2022 and the AER decreased from 11.07 (95%CI: -13.42 − 47.39) per 10,000 population in 2012 to -105.02 (95%CI: -149.53 − -63.02) per 10,000 population in 2022. Disparities in the OS of thyroid cancer patients were found across different diagnosis periods, genders, age groups, places of residence, occupational classes, tumor sites and sizes, cervical lymph node metastasis statuses, TgAb levels, pathological types, clinical stages and treatment timings (all p &lt; 0.05). Multivariate analysis showed that age group (≥ 65 years: HR = 1.727), tumor site (location in the isthmus: HR = 3.117), tumor size (&gt; 3 cm: HR = 3.170), cervival lymph node metastasis (HR = 1.876), TgAb levels (115 − 500 IU/ml: HR = 7.103; &gt; 500 IU/ml: HR = 13.554), pathological types (MTC: HR = 2.060; ATC: HR = 10.747), clinical stages (stage II: HR = 2.224; stage III: HR = 3.361; stage IV: HR = 3.494), treatment timing (&gt; 3 months: HR = 2.594), diagnosis period (2017 − 2022: HR = 0.633) and gender (female: HR = 0.711) were found to be associated with the risk of death; after stratified adjustment, significant differences in prognostic factors were identified among thyroid cancer patients with varying pathological types. Conclusion The risk of death from thyroid cancer in Yantai has significantly decreased and the OS of patients has improved significantly in the past decade. The prognosis of thyroid cancer in this area was notably impacted by various factors and the resolution of survival study outcomes for thyroid cancer patients should be enhanced.

The predictive value of thyroid hormone sensitivity parameters for cervical lymph node metastasis in patients with differentiated thyroid cancer

Objective To comprehensively investigate the predictive value of thyroid hormone sensitivity parameters for cervical lymph node metastasis in patients diagnosed with differentiated thyroid cancer (DTC) undergoing total thyroidectomy and neck lymph node dissection. Methods A retrospective cohort study was conducted involving patients diagnosed with DTC and evaluated for cervical lymph node metastasis. Relevant demographic, tumour, lymph node and thyroid hormone sensitivity parameter data were extracted from medical records and laboratory reports. Thyroid hormone sensitivity parameters including thyroxine (T4), triiodothyronine (T3), thyroid-stimulating hormone (TSH), thyroglobulin (Tg), thyroglobulin antibodies (TgAbs), thyroid peroxidase antibody, thyroid hormone receptor α and TSH receptor antibody were assessed. Statistical analyses including descriptive statistics, comparative analysis, Pearson’s correlation analysis, logistic regression analysis, receiver operating characteristic (ROC) analysis and construction of a multivariable prediction model based on machine learning using the xgbTree method were employed to evaluate the associations and predictive value of thyroid hormone sensitivity parameters for cervical lymph node metastasis. Results The study revealed significant associations between several thyroid hormone sensitivity parameters and cervical lymph node metastasis in patients with DTC. Specifically, higher levels of T4, T3, Tg, TgAbs and TSH receptor antibody were associated with lymph node metastasis. Pearson’s correlation analysis, logistic regression analysis and ROC analysis further underscored the predictive performance of these parameters, with strong overall discriminative abilities. The machine learning-based prediction model demonstrated promising performance with a high area under the curve (AUC) of 0.979. Conclusions The findings provide compelling evidence for the predictive value of thyroid hormone sensitivity parameters, particularly T3, T4, Tg, TgAbs and TSH receptor antibody, in identifying and evaluating the likelihood of cervical lymph node metastasis in patients with DTC. These parameters hold potential implications for risk stratification, clinical decision-making and personalized management strategies, contributing to improved outcomes for patients at risk of lymph node metastasis.

Radiological Sublingual Space Invasion in Tongue Squamous Cell Carcinoma: Clinicopathological Associations and Impact on Survival.

We investigate if sublingual space invasion (SLI) determined on magnetic resonance imaging confers differences in clinicopathological manifestations and treatment outcomes of oral tongue squamous cell carcinoma (OTSCC). Retrospective cohort study. Tertiary Academic Medical Center. 221 OTSCC patients were included. Cox regression models and Kaplan-Meier methods were used, and nomogram construction was performed, incorporating SLI with other adverse factors, to predict the prognosis. On multivariable analysis, the following were associated with cervical nodal metastasis: (1) greater MRI T classification of T3/T4 versus T1/T2: adjusted odds ratio (aOR) 2.784, 95% CI = 1.459 to 5.313, P = .001; (2) gender (female vs male): aOR 4.117, 95% CI = 1.602 to 10.576, P = .003; (3) presence of MRI-determined SLI: aOR 2.588, 95% CI = 1.393 to 4.808, P = .002. For survival outcomes, extranodal extension (adjusted hazard ratio [aHR]: 3.380, 95% CI = 2.024-5.644, P < .001), poorly-differentiated type (aHR: 1.720, 95% CI = 1.006-2.943, P = .047), lymphovascular invasion (aHR: 2.100, 95% CI = 1.220-3.614, P = .007), and SLI (aHR: 1.700, 95% CI = 1.086-2.661, P = .020) were statistically significant prognosticators of disease-free survival. In overall survival, when controlled for age, gender, overall TNM stage, Charlson morbidity index, surgical margins, depth of invasion and adjuvant therapy, SLI was a statistically significant prognosticator (aHR: 1.622, 95% CI = 1.012-2.602, P = .044). A proposed novel nomogram for overall survival combining SLI and other risk factors showed a higher concordance index compared to a nomogram with TNM staging alone (0.783 vs 0.629, P < .001). SLI is an independent prognostic factor for treatment outcomes in OTSCC. Incorporating SLI into a novel nomogram demonstrated improved predictive accuracy for post-treatment outcomes.

Dual-Time Point 68Ga-FAPI-04 PET/CT Improves Tumor Delineation and Cervical Lymph Node Metastasis Identification in Patients With Head and Neck Squamous Cell Carcinoma.

The purpose of this study was to evaluate the benefit of dual-time point 68Ga-FAPI-04 PET/CT in staging head and neck squamous cell carcinoma (HNSCC). Sixty-nine treatment-naive patients with HNSCC were enrolled. Each patient underwent whole-body 68Ga-FAPI-04 PET/CT at approximately 30 minutes postinjection and a delayed scan in head and neck region at 2 hours. Radiotracer uptake (SUVmax), tumor-to-background ratio, change in SUVmax (∆SUVmax), retention index, diagnostic performance, and staging were explored. Histopathology was the reference standard. Primary tumors showed similar average SUVmax between early (17.89) and delayed scans (17.86, P = 0.241). However, the tumor-to-background ratios of delayed imaging were all significantly higher than those of early imaging (all P < 0.001). In 38 patients who underwent neck dissection, metastatic lymph nodes showed higher mean SUVmax on delayed imaging than on early imaging (early 10.53 ± 5.98 vs delayed 11.71 ± 6.36, P < 0.001), whereas nonmetastatic lymph nodes showed the opposite result (early 3.51 ± 0.51 vs delayed 2.58 ± 0.63, P = 0.002). The mean ∆SUVmax and retention index of metastatic and nonmetastatic lymph nodes were 1.19 versus -0.93 and 12.79% versus -26.55%, respectively. N staging was correctly altered in 3 (3/38) patients based on delayed images. Delayed 68Ga-FAPI-04 PET/CT can effectively acquire high-contrast images, better tumor delineation, and detect hidden lesions near or within the tissues influenced by physiological uptake for HNSCC. In addition, dual-time point imaging adds diagnostic value for the differentiation of metastatic from nonmetastatic lymph nodes.

Radiofrequency Ablation for Recurrent Papillary Thyroid Carcinoma at the Central Compartment Node: A Case Report

AbstractPapillary thyroid carcinoma is the most common thyroid cancer with a good prognosis. However, local recurrence or cervical lymph node metastasis is frequent. Reoperation is a standard treatment but may be challenging due to the formation of fibrosis, cervical anatomy distortion, and the small size of recurrent lesions. Radiofrequency ablation (RFA) is a minimally invasive modality for recurrent thyroid cancer in high-risk patients or those who refuse surgery. Here, we describe the case of a 41-year-old woman who underwent total thyroidectomy with central neck dissection because of papillary thyroid carcinoma. Follow-up ultrasonography 14 months after the second surgery revealed two abnormal lymph nodes in the right neck at level VI. She underwent RFA of the lymph nodes. Eighteen months after RFA, the metastasis lymph nodes disappeared completely.

Prediction model construction of cervical central lymph node metastasis in papillary thyroid carcinoma combined with Hashimoto’s thyroiditis utilizing conventional ultrasound and elastography

Prediction model construction of cervical central lymph node metastasis in papillary thyroid carcinoma combined with Hashimoto’s thyroiditis utilizing conventional ultrasound and elastography

Risk factors for cervical lymph node metastasis at different lateral levels in papillary thyroid cancer: level III as the central hub.

As the most prevalent histological type of thyroid cancer, the prognosis of papillary thyroid cancer (PTC) is closely related to cervical lymph node metastasis (LNM), particularly in the case of lateral LNM (LLNM). The patterns of cervical LNM in PTC remain inconclusive. We aim to assess the risk factors for LLNM and extranodal extension (ENE) at different lateral levels in N1b PTC patients. A total of 486 PTC patients with pathologically diagnosed N1b, who underwent thyroidectomy with central and lateral neck lymph node dissection at our hospital between January 2019 and December 2021, were retrospectively retrieved. The metastatic status of different lateral levels was recorded. Further correlation analysis was conducted. Based on the correlation analysis, binary logistic regression analysis indicated that upper location [odds ratio (OR) =3.067; P<0.001; 95% confidence interval (CI): 2.075-4.534] and central LNM-ENE (CLNM-ENE) (OR =2.036; P=0.04; 95% CI: 1.044-3.970) are predictive factors for level II metastasis. Additionally, upper location (OR =2.106; P<0.001; 95% CI: 1.404-3.159) and CLNM (OR =2.664; P<0.001; 95% CI: 1.681-4.222) were found to be predictive factors for level III metastasis. LLNM at level IV was closely associated only with CLNM. Level III-ENE (OR =2.347; P=0.03; 95% CI: 1.065-5.176) was found to be highly correlated with level V metastasis. As for ENE, level III-ENE was found to be a risk factor for ENE in all other levels (II, IV, V), while ENE in the other lateral cervical regions also increased the risk for level III. Despite some uncertainties, LLNM remains closely associated with the upper location of PTC. Meanwhile, level III functions as the hub of the lateral neck, with level III-ENE increasing the risk of LLNM in level V, and significantly raising the probability of ENE in other lateral cervical regions. LLNM have its inherent patterns, as evidenced in the study, but also have a degree of unpredictability, therefore an accurate preoperative assessment is essential.

Evaluating the efficacy of the endoscopic thyroidectomy via sternocleidomastoid muscle posteroinferior approach in identifying occult lateral cervical lymph node metastasis.

Lateral cervical lymph node metastasis (LLNM) is a well-established prognostic factor influencing recurrence and survival in patients with papillary thyroid carcinoma (PTC). However, the accuracy of preoperative imaging examinations is limited. We have pioneered a minimally invasive technique-endoscopic thyroidectomy via sternocleidomastoid muscle posteroinferior approach (ETSPIA). This technique facilitates selective lateral neck lymph node dissection while excising thyroid lesions, effectively eradicating occult lateral cervical lymph node metastasis (OLLNM) without the need for extended incisions. This study investigates the diagnostic and therapeutic value of ETSPIA in managing OLLNM in PTC. A retrospective analysis was conducted on the clinical data of 142 patients with primary PTC who underwent ETSPIA at Beijing Tongren Hospital from November 2022 to June 2024. All patients underwent lateral cervical lymph node exploration: intraoperative examination first targeted the medial lymph nodes of the internal jugular vein, with frozen section analysis; if positive, the external lymph nodes of the internal jugular vein were subsequently addressed. The study recorded cases of LLNM and analyzed factors influencing OLLNM. Excluding 8 patients with preoperatively detected evident LLNM via ultrasound, 33 out of 134 patients (24.6%) exhibited OLLNM. This subgroup included 19 males and 14 females, with a median age of 34 years. The tumor-node-metastasis (TNM) staging revealed 17 cases of T1a, 7 cases of T1b, 4 cases of T2, and 4 cases of T3b. The tumors were located in the thyroid upper pole in 12 cases, the middle part in 15 cases, and the lower pole in 6 cases, with 26 cases presenting with solitary tumors and 7 with multiple lesions. Extrathyroidal extension was observed in 4 cases. Over a median follow-up period of 17 months, no severe complications were reported. Univariate analysis identified male gender, younger age, tumor T stage, preoperative ultrasound indication of upper pole thyroid tumors, and extrathyroidal extension as factors associated with OLLNM (P<0.001, P=0.02, P=0.007, P<0.001, P=0.003 respectively). Multivariate regression analysis demonstrated that male gender, younger age, and preoperative ultrasound indication of upper pole thyroid tumors were independent risk factors for OLLNM in PTC (P=0.001, P=0.006, P=0.02, P=0.002, respectively). As a novel minimally invasive endoscopic thyroid approach, ETSPIA allows for the excision of thyroid lesions while addressing lateral cervical metastatic lymph nodes. It demonstrates favorable cosmetic outcomes and safety, offering a viable alternative for the management of thyroid cancer.

A nomogram for individualized prediction for cervical lymph node metastasis of papillary thyroid carcinoma.

Cervical lymph node metastasis in papillary thyroid carcinoma plays a crucial role in the development of surgical strategy for thyroid patients. The aim of this study was to determine the predictors of cervical lymph node metastasis based on ultrasound features of papillary thyroid carcinoma, and to develop and validate nomogram to help predict cervical lymph node metastasis. Patients who underwent thyroid ultrasound examination in Department of Ultrasonography of The First Affiliated Hospital of Nanjing Medical University between January 1, 2021 and October 31, 2021 were selected. Patients with at least one Thyroid Imaging Reporting and Data System (TI-RADS) class 4 or higher nodule and postoperative pathologically confirmed primary papillary thyroid carcinoma with cervical lymph node metastasis were identified or not, and ultrasound image characteristics of the nodules were recorded to screen for cervical lymph node metastasis predictors. Subsequently, nomogram was developed and validated to help predict cervical lymph node metastasis. The overall echogenicity of the thyroid gland, the number of malignant nodules, nodule left-right diameter, the location of the nodules, the relationship between the nodules and the thyroid capsule, and the elasticity score of the nodules were considered to be independent predictors of papillary thyroid carcinoma related cervical lymph node metastasis; the model had a good discrimination rate. We developed a nomogram to predict metastasis in the neck lymph nodes of papillary thyroid carcinoma, and the nomogram showed good performance for prediction aspects.

Bilateral Modified Radical Neck Dissection

Radical neck dissection was once the standard of care for the surgical management of patients with thyroid cancer and cervical lymph node metastases. However, due to the significant morbidity of this procedure, the development of cervical lymphadenectomy procedures that could provide oncologic cure while minimizing morbidity was undertaken by many surgeons. Such investigation has led to the development of the modified radical neck dissection (MRND). Still, many institutions are not familiar with performing a comprehensive MRND in the setting of thyroid cancer metastatic to the lateral lymph node compartments. We present such an operation under general anesthesia.

Assessment and evaluate the eminence of depth of invasion in gingivobuccal sulcus carcinoma with the use of preoperative computed tomography and to compare it with depth of invasion measured histopathologically in the resected primary tumor, with the cervical nodal metastasis

Background: Depth of invasion (DOI) being one of the significant predictors in determining the prognosis of the disease, hence this data is available only post operatively but now with the advance technology we can assess DOI preoperatively. Here in our study, we used contrast enhanced computed tomography scan (CECT) to determine preoperative DOI. This measured data eventually helps the surgeon to plan resection of the oral primary tumor 3 dimensionally with safe margins. Methods: Prospective study was conducted between 2019 to 2021 with patients diagnosed with Gingivobuccal sulcus (GBS) carcinoma who were subjected for resection with neck dissection procedures. Preoperative CECT scan was performed to evaluate the depth of invasion (DOI). This was then compared with the DOI measured post operatively of resected specimen by histological assessment. A cut-off value for DOI was derived, beyond which nodal metastasis was evident. Results: Out of 51 patients 40 (78.4%) were male patients and 11 (21.6%) were female. Age ranged from 20 to 70 years. Preoperative DOI measured from CECT scan showed average value of 18.84 mm, with sensitivity of 100% which was highly statistically significant. Histopathological DOI showed average value of 7.26 mm. lowest DOI at which nodal metastasis observed was 3.4mm, so the cut-off value of DOI above which metastasis was probable decided was 3.5mm for this series. Conclusions: Hence CECT scan showed better sensitivity and specificity in determining early bony invasion in GBS carcinomas. Thus, making DOI a very reliable and predictable prognostic factor in oral GBS carcinoma.

Multimodal separation and cross fusion network based on Raman spectroscopy and FTIR spectroscopy for diagnosis of thyroid malignant tumor metastasis

The diagnosis of cervical lymph node metastasis from thyroid cancer is an essential stage in the progression of thyroid cancer. The metastasis of cervical lymph nodes directly affects the prognosis and survival rate of patients. Therefore, timely and early diagnosis is crucial for effective treatment and can significantly improve patients’ survival rate and quality of life. Traditional diagnostic methods, such as ultrasonography and radionuclide scanning, have limitations, such as complex operations and high missed diagnosis rates. Raman spectroscopy and FTIR spectroscopy can well reflect the molecular information of samples, have characteristics such as sensitivity and specificity, and are simple to operate. They have been widely used in clinical research in recent years. With the development of intelligent medical diagnosis technology, medical data shows a multi-modal trend. Compared with single-modal data, multi-modal data fusion can achieve complementary information, provide more comprehensive and valuable diagnostic information, significantly enhance the richness of data features, and improve the modeling effect of the model, helping to achieve better results. Accurate disease diagnosis. Existing research mostly uses cascade processing, ignoring the important correlations between multi-modal data, and at the same time not making full use of the intra-modal relationships that are also beneficial to prediction. We developed a new multi-modal separation cross-fusion network (MSCNet) based on deep learning technology. This network fully captures the complementary information between and within modalities through the feature separation module and feature cross-fusion module and effectively integrates Raman spectrum and FTIR spectrum data to diagnose thyroid cancer cervical lymph node metastasis accurately. The test results on the serum vibrational spectrum data set of 99 cases of cervical lymph node metastasis showed that the accuracy and AUC of a single Raman spectrum reached 63.63% and 63.78% respectively, and the accuracy and AUC of a single FTIR spectrum reached 95.84% respectively and 96%. The accuracy and AUC of Raman spectroscopy combined with FTIR spectroscopy reached 97.95% and 98% respectively, which is better than existing diagnostic technology. The omics correlation verification obtained correlation pairs of 5 Raman frequency shifts and 84 infrared spectral bands. This study provides new ideas and methods for the early diagnosis of cervical lymph node metastasis of thyroid cancer.

Nomogram for predicting cervical lymph node metastasis of papillary thyroid carcinoma using deep learning-based super-resolution ultrasound image

ObjectivesTo investigate the feasibility and effectiveness of a deep learning (DL) super-resolution (SR) ultrasound image reconstruction model for predicting cervical lymph node status in patients with papillary thyroid carcinoma(PTC).MethodsIn this retrospective study, researchers recruited 544 patients with PTC and randomly assigned them to training and test sets. SR ultrasound images were acquired using SR technology to improve image resolution, and artificial features and DL features were extracted from the original (OR) and SR images, respectively, to construct a ML, DL model. The best model was selected and aggregated with clinical parameters to construct the nomogram. The performance of the model is evaluated by ROC curves, calibration curves and decision curves.ResultsIn distinguishing the presence or absence of metastatic lymph nodes, the predictive performance of the SR_ResNet 101 and SR_SVM models based on SR outperformed those based on OR. In the test set, SR_SVM AUC was 0.878 (95% CI 0.8203–0.9358), accuracy 0.854, while OR_SVM AUC was 0.822 (95% CI 0.7500–0.8937), accuracy 0.665. SR_ResNet 101 AUC was 0.799 (95% CI 0.7175–0.8806), accuracy 0.793, and OR_ResNet101 AUC was 0.751 (95% CI 0.6620–0.8401), accuracy 0.713. Subsequently, Nomogram_A and Nomogram_B were constructed by integrating the SR_SVM model and SR_ResNet 101 model, respectively, with clinical parameters, while Nomogram_C was constructed solely based on clinical indicators. In the test set, Nomogram_A demonstrated the best performance with an AUC of 0.930 (95% CI 0.8913–0.9682) and accuracy was 0.829. Nomogram_B AUC 0.868 (95% CI 0.8102–0.9261) and accuracy was 0.829, while Nomogram_C AUC 0.880 (95% CI 0.8257–0.9349) and accuracy was 0.787. The DeLong test revealed that the diagnostic performance of Nomogram_A based on SR_SVM was significantly higher than that of Nomogram_B, Nomogram_C, and the level of Radiologist (P < 0.05). The calibration curves and Hosmer–Lemeshow tests confirmed a high degree of fit, and the decision curve analysis demonstrated clinical value and potential patient benefit.ConclusionsThe predictive model constructed using SR reconstructed ultrasound images demonstrated superior performance in predicting preoperative cervical lymph node metastasis in PTC compared to OR images. The nomogram prediction model based on SR images has the potential to enhance the accuracy of predictive models and aid in clinical decision-making.

The Effectiveness of Tonsillectomy in the Diagnostic Workup of Squamous Cell Carcinoma Unknown Primary in the Head and Neck Based on p16 Immunohistochemistry.

Background and Objectives: Despite the distinct entity of both p16-positive and p16-negative squamous cell carcinoma unknown primary in the head and neck (HNSCCUP), the diagnostic workup did not differ. The aim of the study was to determine the effectiveness of palatine tonsillectomy in the identification of primary tumours in two groups of p16-positive and p16-negative HNSCCUP. Materials and Methods: Patients with HNSCCUP managed in two tertiary care referral centres from 1 January 2014 to 31 December 2020 were analysed retrospectively. Results: Sixty-six patients with HNSCCUP diagnosis were included consecutively. HPV status of metastatic cervical lymph nodes using immunohistochemistry with p16 protein was available for all patients. The proportion of both p16-positive and p16-negative groups was not significantly different (p = 0.242). Of the 39 patients who underwent palatine tonsillectomy, tonsillar cancers were revealed histologically in 6 (15.4%) patients, and all these patients were p16-positive. No primary tonsillar tumour was found in the p16-negative group (0 of 17). The primary tumour identification rate in p16-positive HNSCCUP patients using palatine tonsillectomy was 27% (6 of 22). Conclusions: The diagnostic workup of HNSCCUP should be guided according to HPV/p16 status. Palatine tonsillectomy is a useful procedure in identifying primary cancer in p16-positive SCCUP patients, however, its effectiveness in p16-negative patients is debatable.

Exploring the Application of FNA-Tg for the Diagnosis of Cervical Lymph Node Metastasis in PTC

BackgroundCurrently, fine-needle aspiration washout thyroglobulin (FNA-Tg) are mainly utilized to assist in the detection of lateral lymph node metastasis (LLNM) in papillary thyroid carcinoma (PTC). However, there is currently no clear definition of the method, procedure, and diagnostic value of FNA-Tg testing. MethodsProspectively collected data from 215 PTC patients who underwent lateral neck LNs dissection in the 900th hospital from 2022 to 2024. A total of 249 suspicious lymph nodes were included and were categorized into a metastasis group (n = 176) and a non-metastasis group (n = 73) based on postoperative pathological findings. ResultsOverall analysis revealed that FNA-Tg demonstrated superior diagnostic efficacy for LLNM in PTC compared to FNAC (area under the curve [AUC] = 0.950 versus 0.766). The optimal diagnostic thresholds were determined to be 16.45 μg/L for the primary LLNM group and 0.15 μg/L for the recurrent LLNM. Subgroup analysis indicated that a statistically significant difference in the diagnostic performance of FNA-Tg and FNAC for PTC LLNM was observed only when the LN short diameter was ≤0.8 cm (p < 0.001). Further more, when thyroglobulin antibody (TgAb) results were negative, the combination of the optimal threshold for FNA-Tg and the FNA-Tg/serum thyroglobulin (sTg) ratio was determined to be the most effective diagnostic criterion (criterion ③; AUC = 0.943). ConclusionFNA-Tg has a higher diagnostic value for PTC LLNM, especially in small LNs.

Deep learning based analysis of dynamic video ultrasonography for predicting cervical lymph node metastasis in papillary thyroid carcinoma

Deep learning based analysis of dynamic video ultrasonography for predicting cervical lymph node metastasis in papillary thyroid carcinoma

A Prediction Model for Lymph Node Metastasis of Oral Squamous Cell Carcinoma Based on Multiple Risk Factors.

Cervical lymph node metastasis (CLNM) frequently occurs in oral cancer patients. This study aims to investigate risk factors associated with CLNM and predict CLNM preoperatively in patients with oral squamous cell carcinoma (OSCC). This population-based, hospital retrospective cohort study included 158 patients with oral cancer. We performed regression analysis to determine risk factors and establish a model for predicting CLNM in patients with OSCC. To distinguish and validate the prediction model, we used the area under the receiver operating characteristic (ROC) curve (AUC). Lymph node size, tumor size, degree of differentiation, and LVI were risk factors for cancer metastasis. The OR values were 1.245, 2.847, 2.527, and 6.945, respectively. The AUC value for the clinical prediction model was 0.8736 (95% CI: 0.8043-0.9429). The prediction model for OSCC patients predicts CLNM and provides a new method for preoperative assessment of whether cervical lymph nodes are metastatic, as well as a guide for surgical treatment, including whether to carry out neck dissection and which neck dissection procedure to use.

Cervical Lymph Node Metastasis of Unknown Origin and Remote Primary at a Tertiary Cancer Centre in North India: Case Series with Review of Literature

Cervical Lymph Node Metastasis of Unknown Origin and Remote Primary at a Tertiary Cancer Centre in North India: Case Series with Review of Literature