Detection Of Metastatic Nodes Research Articles

Integrating features from lymph node stations for metastatic lymph node detection.

Metastasis on lymph nodes (LNs), the most common way of spread for primary tumor cells, is a sign of increased mortality. However, metastatic LNs are time-consuming and challenging to detect even for professional radiologists due to their small sizes, high sparsity, and ambiguity in appearance. It is desired to leverage recent development in deep learning to automatically detect metastatic LNs. Besides a two-stage detection network, we here introduce an additional branch to leverage information about LN stations, an important reference for radiologists during metastatic LN diagnosis, as supplementary information for metastatic LN detection. The branch targets to solve a closely related task on the LN station level, i.e., classifying whether an LN station contains metastatic LN or not, so as to learn representations for LN stations. Considering that a metastatic LN station is expected to significantly affect the nearby ones, a GCN-based structure is adopted by the branch to model the relationship among different LN stations. At the classification stage of metastatic LN detection, the above learned LN station features, as well as the features reflecting the distance between the LN candidate and the LN stations, are integrated with the LN features. We validate our method on a dataset containing 114 intravenous contrast-enhanced Computed Tomography (CT) images of oral squamous cell carcinoma (OSCC) patients and show that it outperforms several state-of-the-art methods on the mFROC, maxF1, and AUC scores, respectively.

Diagnosing cervical lymph node metastasis in oral squamous cell carcinoma based on third-generation dual-source, dual-energy computed tomography

ObjectivesTo investigate the potential of dual-energy computed tomography (DECT) parameters in identifying metastatic cervical lymph nodes in oral squamous cell carcinoma (OSCC) patients and to explore the relationships between DECT and pathological features.MethodsClinical and DECT data were collected from patients who underwent radical resection of OSCC and cervical lymph node dissection between November 2019 and June 2021. Microvascular density was assessed using the Weidner counting method. The electron density (ED) and effective atomic number (Zeff) in non - contrast phase and iodine concentration (IC), normalized IC, slope of the energy spectrum curve (λHU), and dual-energy index (DEI) in parenchymal phase were compared between metastatic and non - metastatic lymph nodes. Student’s t-test, Pearson’s rank correlation, and receiver operating characteristic curves were performed.ResultsThe inclusion criteria were met in 399 lymph nodes from 103 patients. Metastatic nodes (n = 158) displayed significantly decreased ED, IC, normalized IC, λHU, and DEI values compared with non-metastatic nodes (n = 241) (all p < 0.01). Strong correlations were found between IC (r = 0.776), normalized IC (r = 0.779), λHU (r = 0.738), DEI (r = 0.734), and microvascular density. Area under the curve (AUC) for normalized IC performed the highest (0.875) in diagnosing metastatic nodes. When combined with the width of nodes, AUC increased to 0.918.ConclusionDECT parameters IC, normalized IC, λHU, and DEI reflect pathologic changes in lymph nodes to a certain extent, and aid for detection of metastatic cervical lymph nodes from OSCC.Key Points• Electron density, iodine concentration, normalized iodine concentration, λHU, and dual-energy index values showed significant differences between metastatic and non-metastatic nodes.• Strong correlations were found between iodine concentration, normalized iodine concentration, slope of the spectral Hounsfield unit curve, dual-energy index, and microvascular density.• DECT qualitative parameters reflect the pathologic changes in lymph nodes to a certain extent, and aid for the detection of metastatic cervical lymph nodes from oral squamous cell carcinoma.

Value of MRI and diffusion-weighted imaging in diagnosing normal-sized pelvic lymph nodes metastases in patients with cervical cancer.

To investigate the value of conventional MRI and diffusion-weighted imaging (DWI) in diagnosing normal-sized pelvic lymph nodes metastases in patients with cervical cancer. 102 patients with cervical cancer who underwent MRI and DWI scan were included. 137 lymph nodes were analyzed, including 44 metastatic lymph nodes (MLNs) and 93 non-metastatic lymph nodes (non-MLNs). The morphology and apparent diffusion coefficient (ADC) value of lymph nodes were measured including short-axis diameter (DS), long-axis diameter (DL), ratio of short-to-long-axis diameter (DR), fatty hilum, asymmetry, ADCmax, ADCmean and ADCmin. The Mann-Whitney U-test, independent sample t-test and Chi-square test were employed to compare the differences of all criteria between MLNs and non-MLNs. Logistic regression and decision tree were used to develop the combined diagnostic model. ROC analyses were used to evaluate the diagnostic performance. The DS and DR of MLNs were significantly higher than those of non-MLNs (p < 0.05), the ADCmax, ADCmean and ADCmin of MLNs were significantly lower than those of non-MLNs (p < 0.05). Presence of fatty hilum and asymmetric lymph nodes between MLNs and non-MLNs were significantly different (p＜0.05). Combined measurement of ADCmin, DS and DR had the highest AUC 0.937 with 90.9% sensitivity and 87.1% specificity. The accuracy of decision tree was 88.3%. MRI with DWI had potential in diagnosing normal-sized pelvic lymph nodes metastases in patients with cervical cancer. The combined evaluation of DS, DR and ADCmin of lymph nodes and decision tree of the combined measure showed better diagnostic performances than sole criteria. The short-axis diameter, ratio of short-to-long-axis diameter and ADCmin of lymph nodes have moderate value in the diagnosis of the metastases of the normal-sized lymph nodes for the patient with cervical cancer as the sole indices. The combined evaluation of DS, DR and ADCmin is much more valuable in the detection of metastatic lymph nodes.

Role of magnetic resonance imaging in detection of metastatic axillary lymph nodes in breast cancer patients

Background: Magnetic resonance imaging has been evolved as a very important tool in diagnosing the axillary lymph nodes pre-operatively. In recent studies, in women with various risk profiles, the sensitivity ranges between 81% and 100%, which is approximately twice as high as the sensitivity of mammography. Methods: This prospective study was performed at PGIMS, Haryana from December 2018 to March 2020. Total 30 patients (n=30) were included in the study. All the patients presenting with clinically palpable breast lump, underwent triple assessment test. All the patient underwent modified radical mastectomy and the final histopathological report of the specimen was then compared with the preoperative clinical and MRI assessment of the metastatic axillary lymph nodes. Results: This study aimed at detection of axillary lymph node metastasis in breast malignancies by breast MRI. The sensitivity of this MRI came to be about 80.00%, specificity of about 80%, positive predictive value of about 95.24%, negative predictive value of about 44.44% and accuracy of about 80.0% with 95% confidence interval.Conclusions: Magnetic resonance imaging is a very important investigation in detection of breast malignancies, their depth, muscles and skin involvement as well as axillary lymph node detection. Axillary lymph nodes can although be detected by clinical examination, but problem lies in their sensitivity and specificity as axillary lymph nodes of small size cannot be detected by clinical examination.

Quantitative hypoxia mapping using a self-calibrated activatable nanoprobe

Hypoxia is a distinguished hallmark of the tumor microenvironment. Hypoxic signaling affects multiple gene expressions, resulting in tumor invasion and metastasis. Quantification of hypoxic status although challenging, can be useful for monitoring tumor development and aggressiveness. However, hypoxia-independent factors such as nonspecific binding and heterogenous probe delivery considerably influence the probe signal thereby disenabling reliable quantitative imaging in vivo. In this study, we designed a self-calibrated activatable nanoprobe Cy7-1/PG5-Cy5@LWHA that specifically detects nitroreductase activity upregulated in hypoxic tumor cells. Dual fluorescence emission of the nanoprobe enables ratiometric calibration and eliminates the target-independent interference. In orthotopic and metastatic breast cancer mouse models, Cy7-1/PG5-Cy5@LWHA demonstrated remarkable hypoxia sensing capability in vivo. Moreover, ratiometric processing provided quantitative hypoxia assessment at different tumor developmental stages and facilitated tumor burden assessment in the metastatic lymph nodes. Therefore, our study demonstrates that ratiometric imaging of Cy7-1/PG5-Cy5@LWHA can be a prospective noninvasive tool to quantitatively monitor tumor hypoxia, which would be beneficial for investigating the fundamental role of hypoxia in tumor progression and for evaluating response to novel anti-hypoxia therapeutics. Furthermore, successful detection of metastatic lymph nodes with the proposed imaging approach illustrates its potential clinical application in assessing lymph node status during surgery.Graphical

Specific diagnosis of lymph node micrometastasis in breast cancer by targeting activatable near-infrared fluorescence imaging

Axillary lymph node metastasis has always been defined as the most important prognostic factor in the treatment of early breast cancer. Ultrasound and MRI can detect only 10% of lymph node micrometastases in early breast cancer. Therefore, it is crucial to detect early breast cancer with lymph node metastasis, however, there is no current examination method for accurate diagnosis. When breast cancer presents a malignant tendency, colony stimulating factor-1 and chemokine CCL-2 absorb mononuclear cells from the surrounding environment and differentiate into M2 Tumor associated macrophages (TAM), which increase the invasion of tumor cells and further promote the development of tumors. Mannose, as a simple natural ligand, can selectively bind to TAM surface CD206 (macrophage mannose receptor, MMR). In this study, mannose was connected with near infrared dye (NIR) IR780 via disulfide bond to obtain Mannose-IR780 conjugate (MR780), which was further self-assembled into near infrared nanoprobe (MR780 NPs) with quenched fluorescence. When selectively targeting CD206 highly expressed on the surface of TAM, disulfide bond was cleaved by the glutathione enriched in the microenvironment, resulting in fluorescence recovery, thus achieving NIR fluorescence molecular imaging of TAM and diagnosis of tumor lymph node metastasis in mouse models. Our findings suggest that targeted imaging of TAM enable noninvasive and sensitive detection of metastatic lymph nodes in vivo, which is instructive for tumor therapy.

Evaluation of Diagnostic Value of SPECT/CT Imaging in Post-radioiodine Therapy in Thyroid Cancer.

ObjectivesThis study aimed to investigate the value of single photon emission computed tomography/computed tomography (SPECT/CT) imaging in well-differentiated thyroid cancer (DTC) after radioiodine (I-131) ablation/therapy for clinical staging and risk stratification. It also aimed to determine whether SPECT/CT would change the management plan or predict the clinical outcomes of DTC patients.MethodsA total of 78 DTC patients underwent first post radioiodine therapy “Whole body iodine-131 scintigraphy (WBS) along with SPECT/CT” at the Department of Radiology and Molecular imaging, Sultan Qaboos University Hospital, Muscat, Oman, between January 2014 and August 2017. Differences between WBS and SPECT/CT, change in clinical staging, risk stratification and management were recorded. The clinical outcome at 6–12 months was recorded. A generalised McNemar test was used to assess disagreement between WBS and SPECT/CT.ResultsAccording to the American Thyroid Association (ATA) risk stratification, the sample showed low (35.8%), intermediate (53.8%) and high-risk groups (10.2%) on WBS, which changed to 44.8%, 38.4% and 16.6%, respectively, on SPECT/CT imaging. Overall change in risk stratification was noted in 16.7% and TNM stage in 11.5% of patients after SPECT/CT imaging. SPECT/CT changed the therapeutic plan and clinical outcome in 19.2% of patients.ConclusionSPECT/CT allows better detection and characterisation of metastatic lymph nodes and distant metastasis in DTC patients compared to WBS imaging alone. It alters TNM staging, ATA risk classification and management in a significant number of patients. It is recommended that SPECT/CT should be done routinely along with WBS in well-differentiated thyroid carcinoma.

Whole Body MRI in the Detection of Lymph Node Metastases in Patients with Testicular Germ Cell Cancer.

Whole-Body Magnetic Resonance Imaging (WB-MRI) is increasingly used for metastatic screening in oncology. This prospective single center study assesses the diagnostic value of WB-MRI including diffusion weighted imaging (DWI) and identifies the sufficient protocol for metastatic lymph node detection in patients with testicular germ cell cancer (TGCC). Forty-three patients underwent contrast enhanced thoraco-abdominopelvic CT (TAP-CT) and WB-MRI with DWI for metastatic lymph node screening. Two independent readers reviewed CTs and WB-MRIs. The diagnostic performance of different imaging protocols (CT, complete WB-MRI, T1W + DWI, T2W + DWI), the agreement between these protocols and the reference standard, the reproducibility of findings and the image quality (Signal and contrast to Noise Ratios, Likert scale) were studied. Reproducibility was very good regardless of both lesion locations (retroperitoneal vs distant lymph nodes, other lesions) and the reader. Diagnostic accuracy of MRI was ≥95% (regardless of the locations and imaging protocol); accuracy of CT was ≥93%. There was a strict overlap of 95% CIs associated with this accuracy between complete WB-MRI, T1W + DWI and T2W + DWI, regardless of the reader. Higher Likert score and SNR were observed for DWI, followed by T2W and T1W sequences. In conclusion, a fast WB-MRI protocol including T2W and DWI is a sufficient, accurate, non-irradiating alternative to TAP-CT for metastatic lymph node screening in TGCC.

Near-infrared-II ratiometric fluorescence probes for non-invasive detection and precise navigation surgery of metastatic sentinel lymph nodes.

Sentinel lymph node (SLN) biopsy is the key diagnostic procedure to determine tumor metastasis and treatment plan. Current SLN biopsy has considerable drawbacks in that SLNs (both malignant and normal) must be removed by navigation surgery, followed by a time-consuming pathological examination. The selective, non-invasive, and real-time diagnosis of metastatic status in SLNs is becoming essential.Methods: Here, we design two lanthanide-doped nanoparticles as a pair of NIR-II ratiometric fluorescence probes, one of which is conjugated with tumor-targeting moiety, while the other is conjugated with PEG as an internal reference. The NIR-II ratiometric fluorescence signal (I1060 nm/I1525 nm) from two well-separated channels were used to identify the tumor-draining SLNs. The precise navigation surgery of metastatic SLNs was performed and we further evaluated their surgery outcomes.Results: The NIR-II ratiometric fluorescence facilitates an ideal fluorescence-guided surgery with only resection of tumor-positive SLNs, thereby avoiding unnecessary removal of the normal SLNs. In addition, our system has a time-saving operation procedure and can be performed under the operation light without altering the appearance of surgical settings.Conclusion: The present study enables non-invasive and real-time detection metastatic status in SLNs with high sensitivity and selectivity. Our investigations will provide a new direction for SLN biopsy and substantially improve cancer surgery outcomes.

Early detection of neck lymph node metastases in breast cancer patients: the role of ultrasound and fine needle biopsy

Purpose: To analyze the distribution and pattern of neck metastasis in breast cancer (BC) patients.&#x0D; Methods: The clinicopathological characteristics of 41 patients with BC and confirmed neck metastasis (NM) treated at our institution between 2010 and 2016 were retrospectively analyzed by reviewing medical records. The diagnosis of NM was confirmed by fine needle aspiration cytology, and node localization was classified into six levels according to Robbins' classification. Statistical analysis was performed using descriptive statistics, Pearson’s correlation and multidimensional correspondence analysis. All statistical analyses were performed using SPSS.&#x0D; Results: At the time of neck ultrasonography, 34 (85%) patients had developed distant metastases, 38% of the patients were asymptomatic, and 17% had no palpable nodes. The average time from BC diagnosis to the development of NM was 5.8 years (range, 0–26 years). Lymph node metastasis occurred at level V in 53.7% of patients and level IV in 19.5% of patients. Two-level involvement occurred in 9.8% and one-level involvement in 75% of patients. There were significant correlations (p &lt; 0.01) between patient age andtime from diagnosis to development of NM, age and stage of the disease, and stage and appearance of conglomerates.&#x0D; Conclusion: The most common site of NM from BC was next to the supraclavicular fossa, although they occurred at other levels. Ultrasonography combined with fine needle aspiration cytology is effective for the detection of early occult metastatic lymph nodes.

Differential detection of metastatic and inflammatory lymph nodes using inflow-based vascular-space-occupancy (iVASO) MR imaging

PurposeTo investigate the potential value of inflow-based vascular-space-occupancy (iVASO) MR imaging in differentiating metastatic from inflammatory lymph nodes (LNs). MethodsTen female New Zealand rabbits with 2.5–3.0 kg body weight were studied. VX2 cells and egg yolk emulsion were inoculated into left and right thighs, respectively, to induce ten metastatic and ten inflammatory popliteal LNs. Conventional MRI and iVASO were performed 2 h prior to, and 10, 20 days after inoculation (D0, D10, D20). The short-axis diameter (S), short- to long-axis diameter ratio (SLR), and arteriolar blood volume (BVa) at each time point and their longitudinal changes of each model were recorded and compared. At D20, all rabbits were sacrificed to perform histological evaluation after the MR scan. ResultsThe mean values of S, SLR and BVa showed no significant difference between the two groups at D0 (P = 0.987, P = 0.778, P = 0.975). The BVa of the metastatic group was greater than that of the inflammatory at both D10 and D20 (P < 0.05; P < 0.001), whereas the S and SLR of the metastatic group were greater only at D20 (P < 0.001; P = 0.001). Longitudinal analyses showed that the BVa of the metastatic group increased at both D10 and D20 (P = 0.004; P = 0.001), while that of the inflammatory group only increased at D10 (P = 0.024). ConclusionThe BVa measured with iVASO has the potential to detect early metastatic LNs.

A pilot study of near-infrared fluorescence guided surgery for primary tumor localization and lymph node mapping in colorectal cancer.

BackgroundThis pilot study aimed to evaluate the feasibility of near-infrared fluorescence imaging for primary tumor localization, lymph node mapping, and metastatic lymph node detection in colorectal cancer (CRC) using indocyanine green (ICG).MethodsA total of 11 patients with CRC were prospectively enrolled. ICG (25 mg dissolved in 30 mL sterile water) was intravenously injected preoperatively, and the fluorescence intensity of the primary tumor, lymph nodes, and normal tissues, as well as the signal-to-background ratio (SBR) and contrast-to-noise ratio (CNR) were measured at 0.5, 1, 2, 4, and 24 h after ICG injection.ResultsThe primary tumor could be located intraoperatively, and the tumor boundary was clear at 2–4 h. There was good contrast in the fluorescence intensity between tumor and normal tissues (SBR =2.11±0.36, CNR =8.74±0.35). The lymph node detection rate was 95% (38/40), and the SBR threshold of lymph nodes was 1.13.ConclusionsThis pilot study showed that primary tumor localization and lymph node mapping in CRC is feasible using near-infrared fluorescence imaging technology, though metastatic lymph nodes cannot be discriminated from benign ones. In addition, cancer nodules missed by both white light mode and palpation by the surgeon were unexpectedly found, resulting in a change in the surgical prognosis in 9.1% (1/11) of patients.

Efficacy of Computed Tomography and Ultrasonography in Diagnosis of Metastatic Cervical Lymph Nodes in Orofacial Cancer.

Introduction:There is no consensus on which imaging modality is better for the detection of metastatic cervical lymph nodes in orofacial malignancies. This study evaluates the efficacy of computed tomography (CT) and ultrasonography (US) in diagnosis of metastatic cervical lymph nodes in orofacial cancer. Materials and Methods:Sixty patients with various histologically diagnosed orofacial malignant lesions and clinical evidence of cervical lymph node metastasis were examined using US and CT. Further, the affected lymph nodes were biopsied and examined histologically. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the techniques were calculated. The data was analyzed using Statistical Package for Social Sciences (SPSS) version 19 (SPSS Inc., Chicago, IL, USA) and Microsoft Excel 2010 (Microsoft, Redmond, WA, USA). Test of statistical significance was set at 0.05. Results:US recorded a sensitivity, specificity, PPV, NPV, and accuracy of 80.0%, 57.1%, 77.5%, 60.0%, and 71.7%, respectively (P = 0.004), while CT recorded a sensitivity, specificity, PPV, NPV, and accuracy of 87.1%, 71.4%, 85.0%, 75.0%, and 81.7%, respectively (P< 0.0001). Lymph node size was the commonest criterion in the diagnoses of metastases in cases with cervical lymph nodes.Conclusion:Although we obtained great results using US, our results indicated CT to be a better imaging modality for detecting metastatic cervical lymph nodes in orofacial malignancies.

Comparison of 18F FDG PET / CT, MRI (DWI DCE) and MRI 18F FDG PET/CT in the detection of axillary metastatic lymph nodes in patients with newly diagnosed breast cancer

Aim: We visually and quantitatively investigated the success of using 2-deoxy-2-[fluorine-18] fluoro-D-glucose integrated with computed tomography (18F-FDG PET/CT) and magnetic resonance imaging (MRI) [Dynamic contrast enhancement (DCE) and diffusion weighted imaging (DWI)] separately and together in detecting axillary lymph node metastasis in patients with newly diagnosed breast cancer. Methods: One hundred and thirteen patients who underwent 18F FDG PET/CT were evaluated, 102 patients of these patients had also MRI (DEC + DWI). Primary tumour size (Tsize), SUVmax of primary tumour (SUVmaxT), short diameter of largest axillary lymph node on PET/CT (LnDPET/CT), SUVmax of axillary lymph node (SUVmaxLn), metabolic tumour volume of the primary tumour (MTV), short diameter of largest axillary lymph node on MRI (LnDMRI), the presence of fatty hilum absence and apparent diffusion coefficient (ADC) were evaluated. Results: In visual analysis, sensitivity and specificity values of 18F FDG PET/CT, MRI and MRI+18F FDG PET/CT were 78.85, 94% – 72.27%, 96.15 – 83.87%, 98.04%, respectively. In the quantitative evaluation, ADC≤1.2 x 10-3 mm2/sec (OR = 6.665, p = 0.001, 95CI%: 2.181–20.370) and LnSUVmax> 2 (OR = 15.2, p<0.001, 95CI%: 4.587–50.376) were independent predictors in detecting axillary lymph node metastasis. Conclusion: LnSUVmax >2 and ADC ≤ 1.2 x 10-3 mm2/sec can be used as independent predictors of detecting axillary lymph node metastasis in patients with newly diagnosed breast cancer. t predictors in detecting axillary lymph node metastasis in patients with newly diagnosed breast cancer.

Driver Gene Mutations and Risk of Lymph Node Metastasis in Non-Small Cell Lung Cancer

Non-Small Cell Lung Cancer (NSCLC) lymph node status is closely related to its diagnosis, treatment, and prognosis. The lymph node status is an important basis for formulating clinical treatment strategies of NSCLC, therefore comprehensive and profound understanding of risk factors for lymph node metastasis is essential. There are many known factors for lymph node metastasis in NSCLC, such as pathological subtypes, tumor size, tumor location. Meanwhile, whether the mutation of the driver gene affects the lymph node metastasis is still lacking enough research. This article aims to elaborate the relationship between NSCLC driver gene mutation and lymph node metastasis, from NSCLC lymph node metastasis-related risk factors, driver genes and lymph node metastasis, metastatic lymph node mutation status analysis and detection these several aspects to summarize the latest research progress in NSCLC driver gene mutation and lymph node metastasis risk. It also fully explained the correlation between driver gene mutations and NSCLC tumor biological behaviors such as lymph node metastasis.

P150 - Role of SPECT/CT in detection of the marked metastatic lymph node and the sentinel node, after neoadjuvant chemotherapy in patients with breast cancer

P150 - Role of SPECT/CT in detection of the marked metastatic lymph node and the sentinel node, after neoadjuvant chemotherapy in patients with breast cancer

High Sensitivity of Endoscopic Ultrasound-Guided Fine-Needle Aspiration and Endoscopic Ultrasound-Guided Fine-Needle Biopsy in Lymphadenopathy Caused by Metastatic Disease: A Prospective Comparative Study.

Background/AimsThe diagnostic work-up of lymphadenopathy is challenging but important to determine the correct therapy. Nevertheless, few studies have addressed the topic of endosonography (EUS)-guided tissue acquisition in lymphadenopathy. Therefore, we aimed to evaluate the accuracy and safety of EUS-guided fine-needle biopsy sampling (EUS-FNB) in intrathoracic and intraabdominal lymphadenopathy. MethodsIn a tertiary care center, patients with lymphadenopathy referred for EUS-guided sampling were included prospectively from 2014 to 2019 (NCT02360839). In all cases, EUS-FNB (22 gauge) and EUS-guided fine-needle aspiration (EUS-FNA) (25 gauge) were performed. The patients were randomized to the first needle pass with FNB or FNA. Study outcomes were the diagnostic accuracy and adverse event rate. ResultsForty-eight patients were included (median age: 69 years [interquartile range, 59–76]; 24/48 females [50%]). The final diagnoses were metastasis (n=17), lymphoma (n=11), sarcoidosis (n=6), and inflammatory disease (n=14). The diagnostic performance of the two modalities was comparable, including a high sensitivity for metastatic nodes (EUS-FNB: 87% vs. EUS-FNA: 100%, p=0.5). The sensitivity for lymphoma was borderline superior in favor of EUS-FNB (EUS-FNB: 55% vs. EUS-FNA: 9%, p=0.06). No adverse events were recorded. ConclusionsIn lymphadenopathy, both EUS-FNB and EUS-FNA are safe and highly sensitive for metastatic lymph node detection. Lymphoma diagnosis is challenging regardless of the needle used.

Indocyanine Green Use in the Minimally Invasive Gastrointestinal Surgery

AbstractIndocyanine green (ICG) is a fluorescent dye that has been used in some medical specialties already for almost 60 years and has gained popularity in recent years due to the clinical applications recently proposed in the surgical field. This review article details the current use of the ICG in the minimally invasive gastrointestinal surgery. There is abundant evidence validating the usefulness of ICG fluorescence angiography in the gastrointestinal surgery, leading to a decrease of complications. Other uses, such as its lymphographic use for sentinel lymph node mapping or detection of metastatic lymph nodes, need further investigation to prove its benefit. The heterogeneity and subjective nature of the data remain the greatest challenge when analyzing the possible effects ICG can bring to the gastrointestinal surgery.

Role of positron emission tomography/computed tomography for the staging of primary colorectal cancers

ObjectiveThe aim of this paper was to evaluate the role of positron emission tomography (PET) combined with contrast-enhanced computed tomography (CECT) in staging patients with primary colorectal cancer (CRC).BackgroundCRC is the second leading cause of cancer-related deaths and the fourth most common malignancy worldwide. Cross-sectional imaging studies such as CT and MRI have evolved as the best modalities for staging rectal cancer. PET combined with CT is widely used not only for preoperative staging, but also for assessing the outcomes of rectal carcinoma.Patients and methodsThis prospective study was carried out on 50 patients: 30 (60%) men and 20 (40%) women in the age range from 27 to 74 years, who were diagnosed or suspected to have cancer colon by other radiological imaging.ResultsOur results showed that PET-CT had equal sensitivity (95.4%) and specificity (82%), positive predictive value (PPV) (80.7%), negative predictive value (NPV) (95.8%), and accuracy (88%) for the detection of regional lymph node metastasis compared to CECT. But PET-CT and CECT had higher sensitivity and higher specificity, PPV, NPV, and accuracy more than PET for detection of metastatic lymph nodes and PET-CT had equal sensitivity (92.8%) and specificity (86.2%), PPV (72.2%), NPV (96.8%), and accuracy (88%) for detection of lung metastasis compared to PET. But PET-CT and PET had higher sensitivity and higher specificity, PPV, NPV, and accuracy more than CECT for detection of pulmonary deposits.ConclusionAccording to our results, fluorine-18 fluorodeoxyglucose PET/CT has contributed positively to the staging of primary CRC patients.

Assessment of metastatic lymph nodes in head and neck squamous cell carcinomas using simultaneous 18F-FDG-PET and MRI

In this study, we investigate the feasibility of using dynamic contrast enhanced magnetic resonance imaging (DCE-MRI), diffusion weighted imaging (DWI), and dynamic positron emission tomography (PET) for detection of metastatic lymph nodes in head and neck squamous cell carcinoma (HNSCC) cases. Twenty HNSCC patients scheduled for lymph node dissection underwent DCE-MRI, dynamic PET, and DWI using a PET-MR scanner within one week prior to their planned surgery. During surgery, resected nodes were labeled to identify their nodal levels and sent for routine clinical pathology evaluation. Quantitative parameters of metastatic and normal nodes were calculated from DCE-MRI (ve, vp, PS, Fp, Ktrans), DWI (ADC) and PET (Ki, K1, k2, k3) to assess if an individual or a combination of parameters can classify normal and metastatic lymph nodes accurately. There were 38 normal and 11 metastatic nodes covered by all three imaging methods and confirmed by pathology. 34% of all normal nodes had volumes greater than or equal to the smallest metastatic node while 4 normal nodes had SUV > 4.5. Among the MRI parameters, the median vp, Fp, PS, and Ktrans values of the metastatic lymph nodes were significantly lower (p = <0.05) than those of normal nodes. ve and ADC did not show any statistical significance. For the dynamic PET parameters, the metastatic nodes had significantly higher k3 (p value = 8.8 × 10−8) and Ki (p value = 5.3 × 10−8) than normal nodes. K1 and k2 did not show any statistically significant difference. Ki had the best separation with accuracy = 0.96 (sensitivity = 1, specificity = 0.95) using a cutoff of Ki = 5.3 × 10−3 mL/cm3/min, while k3 and volume had accuracy of 0.94 (sensitivity = 0.82, specificity = 0.97) and 0.90 (sensitivity = 0.64, specificity = 0.97) respectively. 100% accuracy can be achieved using a multivariate logistic regression model of MRI parameters after thresholding the data with Ki < 5.3 × 10−3 mL/cm3/min. The results of this preliminary study suggest that quantitative MRI may provide additional value in distinguishing metastatic nodes, particularly among small nodes, when used together with FDG-PET.