Diagnosis Of Lymph Node Metastasis Research Articles

Detection of lymph node metastasis in lung cancer patients using a one-step nucleic acid amplification assay: a single-centre prospective study

BackgroundThe use of one-step nucleic acid amplification (OSNA) allows for lymph node (LN) metastasis to be detected rapidly and accurately. We conducted a prospective single-centre clinical trial to evaluate OSNA assay in detecting LN metastasis of lung cancer.Patients and methodsA total of 705 LNs from 160 patients with clinical stage IA to IVA lung cancer were included in this study. The LNs were divided and submitted to routine histological diagnosis and OSNA assay and the results were compared. We also examined keratin 19 expression of different histological types lung primary tumours.ResultsWhen the cut-off value was set to 250 copies/µl, the concordance rate between the two methods was 96.17% and the sensitivity 97.14%. Discordant results were observed in 27 LNs of 21 patients. Most of these discordant results were molecular micrometastasis expressing a very low number of copies with negative histology. Most thoracic tumours were positive for keratin 19.ConclusionsOur data show that the OSNA assay might be a useful and sensitive method to diagnose LN metastasis in lung cancer and could be applied to intraoperative decision-making in personalised lung cancer surgery based on LN status and a more accurate staging of patients.

Diagnosis of lymph node metastasis on rectal cancer by PET-CT computer imaging combined with MRI technology

To compare the diagnostic efficacy and clinical application value of Positron Emission Tomography-Computed Tomography (PET-CT) metabolic computer Imaging imaging and Magnetic Resonance Imaging (MRI) diffusion imaging technology for regional lymph node metastasis in rectal cancer, 41 patients with rectal cancer confirmed by colonoscopy were collected and underwent 3.0T pelvic MRI and PET-CT examination, respectively. PET-CT/MRI fusion software was used to fuse magnetic resonance images and PET-CT images and accurately locate the rectal cancer lesions and lymph nodes, and image-operation-pathology control method was used to identify the lymph nodes around the rectum. In addition, independent sample t-test or Mann-Whitney U test were used to compare the differences in the values of various parameters between the two groups of metastatic lymph nodes and non-metastatic lymph nodes, Spearman correlation was used to analyze the correlation between SUV value and ADC value of metastatic lymph node, and the diagnostic value of SUV value and ADC value was evaluated by drawing ROC curve. The results showed that when SUV took 2.0 as the diagnostic threshold, the accuracy of PET-CT in diagnosing metastatic lymph nodes was 90.1%; when the diagnostic threshold of ADC was 1.0×10−3mm2/s, the accuracy of DWI in diagnosing metastatic lymph nodes was 84.2%; the accuracy of the combination of the two methods for the diagnosis of metastatic lymph nodes was 94.4%. Therefore, it can be concluded that both PET-CT and MRI diffusion images were of high diagnostic value in the diagnosis of lymph node metastasis of rectal cancer, and their diagnostic results were highly consistent. When combined, the diagnostic accuracy can be further improved.

Abstract 2579: Genomewide transcriptomic profiling identifies a novel miRNA signature for predicting lymph node metastasis in patients with pancreatic ductal adenocarcinoma

Abstract Purpose: Pancreatic ductal adenocarcinoma (PDAC) is an extremely lethal cancer, and is projected to become the second leading cause of cancer-related deaths in the US by 2030. The lymph node (LN) status is an important predictor of survival outcomes in PDAC patients undergoing curative resection. The National Comprehensive Cancer Network guidelines recommend neoadjuvant therapy in patients with high-risk features such as large regional LNs, elevated CA-19-9 levels, large primary tumors, excessive weight loss, and extreme pain. Therefore, a pre-treatment diagnosis of LN metastasis (LNM) is critical in developing a more personalized treatment strategy in PDAC patients. Herein, for the first time, we performed a genomewide analysis to identify and develop a miRNA signature for the detection of LNM in PDAC patients. Methods: We analyzed a total of 518 PDAC patients, which included 269 patients from three genomewide miRNA-expression datasets (TCGA, GSE24279 and GSE35688) and 249 from two, independent clinical patient cohorts. During the biomarker discovery phase, we used rigorous computational and bioinformatic approaches to identify candidate miRNA biomarkers, which later were subjected to in-silico validations. The robustness and performance of this miRNA-signature was subsequently interrogated in two independent clinical cohorts (training cohort: n=150, validation cohort: n=99) using qRT-PCR assays. Furthermore, the clinical potential value of the miRNA signature was evaluated and compared to several clinicopathological factors using logistic regression analysis. Results: Through a comprehensive miRNA expression profiling analysis of LNM-positive and negative patients, we identified a panel of 7 miRNAs that significantly predicted LNM [the area under curve (AUC)=0.76, 0.75 and 0.92, respectively]. Using logistic regression analysis, we then optimized and trained a 6-miRNA risk-prediction model in the training cohort of patients, which robustly distinguished PDAC patients with LNM (AUC: 0.84, 95%CI: 0.76-0.89). The performance of this trained model was subsequently confirmed in an independent, large clinical validation cohort (AUC: 0.73, 95%CI: 0.64-0.82). Interestingly, multivariate analysis which incorporated several pre-operative clinical factors, revealed that our 6-miRNA signature was as an independent predictor of LNM in both patient cohorts (training cohort: OR=34.97; P<0.01, validation cohort: OR=10.11; P<0.01, respectively). Conclusion: We identified and developed a novel 6-miRNA signature that is highly robust in predicting presence of LNM in PDAC patients; highlighting the clinical impact of these findings in more appropriate patient selection and development of improved individualized treatment strategies for PDAC patients. Citation Format: Satoshi Nishiwada, Kensuke Yamamura, Raju Kandimalla, Takahiro Akahori, Kota Nakamura, Hideo Baba, Masayuki Sho, Ajay Goel. Genomewide transcriptomic profiling identifies a novel miRNA signature for predicting lymph node metastasis in patients with pancreatic ductal adenocarcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 2579.

Discrepancy Between the Clinical and Final Pathological Findings of Lymph Node Metastasis in Superficial Esophageal Cancer.

Recent advances in endoscopic examinations have resulted in the detection of a larger number of early esophageal cancers; however, there have been many cases with clinically negative but pathologically positive lymph node metastasis (LNM). In this study, we aimed to evaluate the discrepancy between the clinical and pathological diagnoses of LNM in patients with cT1a-MM/cT1b N0M0 esophageal cancer, and assess LNM size in these patients to clarify the presence of LNM that cannot be detected with current modalities. This study included 50 patients who underwent surgery for cT1a-MM/cT1b N0M0 thoracic esophageal squamous cell carcinoma between January 2012 and November 2016 at our institution. The maximum size of involved LNs and metastatic nests were measured, and the distribution of LNM was investigated. Of the 50 patients, 13 (26%) had LNM on pathological examination. Lymphatic invasion was significantly more frequent in the LNM-positive group than in the LNM-negative group (p=0.005). The median sizes of 28 involved LNs and metastatic nests were 3 and 1.6mm, respectively. Of these LNs, 20 (71%) were classified as micrometastases (≤2mm). The involved nodes were distributed across three fields. There was a discrepancy between the clinical and final pathological findings of LNM in patients with cT1a-MM/cT1b N0M0 esophageal cancer. The detection of involved nodes with current modalities in these patients was difficult because of the small size of LNM. Therefore, continued strong consideration for extended LN dissection is necessary in these patients to ensure appropriate diagnosis and treatment.

Clinical application of diffusion-weighted magnetic resonance imaging in radiotherapy for nasopharyngeal carcinoma.

To explore the clinical application of diffusion-weighted magnetic resonance imaging (DWI) in nasopharyngeal carcinoma (NPC) diagnosis, detection of lymph node metastasis, radiotherapy and prognosis. Twenty patients with diagnosed NPC in an early stage of radiotherapy were enrolled in our department between May 2010 and May 2013. T1 and T2 weighted magnetic resonance imaging and DWI of the nasopharynx and neck were performed 1 week before radiotherapy, during radiotherapy at a dose of 60 Gy, and 1 month after radiotherapy. Pertinent measurements and related data were recorded. In comparison with that before radiotherapy, the ADC value of the nasopharyngeal primary lesion increased significantly during radiotherapy at a dose of 60 Gy and at 1 month after radiotherapy (F = 187.160, P = 0.000). When the dose of radiotherapy reached 60 Gy, the DWI signals from both the neck and the retropharyngeal lymph nodes were significantly lower than those before radiotherapy. DWI can be used for sensitive and accurate diagnosis of lymph node metastasis in the neck and retropharyngeal space, monitoring of the radiotherapy effect in early stages of NPC and development of new medical treatment strategies.

MON-566 Early Diagnosis of Lymph Node Metastases by Serum Tg and Neck Ultrasonography, and Long Term Follow Up After Radioiodine and/or Surgical Treatment in Patients with Papillary or Follicular Thyroid Cancer.

We aimed to evaluate the early detection of metastatic lateral neck lymph nodes (LNL) in patients with papillary or follicular differentiated thyroid cancer (DTC), and long-term follow-up after I131 and/or surgery. LNL evaluation has been made by thyroglobulin (Tg) measurement and neck ultrasonography (NU). We have enrolled 710 patients with DTC that previously underwent a near-total thyroidectomy and I131 ablation of residual tissue, and a follow-up by Tg, NU, diagnostic and post-therapy whole body scan (WBS), alone or in combination. LNL were detected by TSH-stimulated Tg alone with a sensitivity of 86%, and a negative predictive value (NPV) of 84%; whereas NU had a sensitivity of 70%, and NPV of 68%. TSH-stimulated Tg plus NU increased the sensitivity to 98%, and of NPV to 96%. In patients with LNL uptaking radioiodine and then treated with I131, the following outcomes were observed: 49% responded after a median of 4 cycles (median 354 mCi, cumulative dose; 7.4 years median follow-up) with “disappearence of uptake at post-therapy WBS and Tg<1 ng/ml” (complete remission, CR); 12% of not responding cases had CR following other treatments. Nine% of LNL patients not uptaking or not responder to I131 were treated with surgery, and subsequent I131 readministration with CR in 23% of cases (6.5 years median follow-up). In conclusion, an early detection of LNL in DTC-patients may be helpful to obtain a CR by I131 in 49% after 4 or less I131 treatments. A combination of different therapies could aid patients not responder/not uptaking I131 to achieve a CR in 24% of cases.

Does FDG-PET/CT Have a Role in Cervical Nodal Staging for Esophageal Cancer? Results of a Multicenter, Prospective Clinical Trial

Background: Cervical lymph node metastasis (LNM) is common in patients with esophageal cancer. Accurate nodal staging is crucial because treatment strategies can differ when cervical LNM has occurred. Methods: From June 2018 to November 2018, we performed a prospective, open label, clinical research in four institutions in China to assess the value of [18F] fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) for diagnosing cervical LNM of esophageal cancer. A total of 110 patients with resectable esophageal cancer were prospectively enrolled in the study. Esophagectomy with three-field (cervical-mediastinal-abdominal) lymphadenectomy were performed within 2 weeks after FDG-PET/CT scanning. The primary end-point was cervical LNM determined via postoperative histological examination. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FDG-PET/CT for the assessment of LNM were determined using histological results as reference standards. Findings: The primary cancer exhibited FDG uptake in 107/110 patients (97.2%), with a mean SUVmax of 9.9 ± 6.3. Positive cervical lymph nodes as determined via FDG-PET/CT were detected in 13/110 patients (11.8%). All patients underwent esophagectomy with three-field lymphadenectomy. The median number of lymph nodes resected was 39 (interquartile range 31-46). Cervical LNM occurred in 20 patients (18.2%). With regard to diagnosing cervical LNM, the parameter values associated with FDG-PET/CT were sensitivity 45.0%, specificity 95.6%, positive predictive value 69.2%, negative predictive value 88.7%, and accuracy 86.4%. Of the 110 patients, 90 underwent both FDG-PET/CT scanning and ultrasonography in the neck, and there were no significant differences in sensitivity, specificity, positive predictive value, negative predictive value, or accuracy with respect to cervical LNM diagnosis in these 90 patients. Interpretation: When used to diagnose cervical LNM, PET/CT scanning exhibited high specificity, but low sensitivity, suggesting that it is of limited value for this purpose. Funding Statement: This study was funded by the National Natural Science Foundation of China (Grant 81572253), Shanghai Shen Kang Hospital Development Center City Hospital Emerging Cutting-edge Technology Joint Research Project (Grant SHDC12017102), Shanghai Municipal Health Commission Key Discipline Project (2017ZZ02025), and Ethicon “Excellence in Surgery” (Grant HZB-20181119-23). Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: The study protocol was individually approved by the Institutional Review Boards of all four participating centers. All patients enrolled provided written informed consent.

Diagnosis of Lymph Node Metastasis in Colorectal Cancer by a Semi-dry Dot-blot Method.

This study aimed to examine whether the semi-dry dot-blot (SDB) method can correctly identify metastasis to lymph nodes in colorectal cancer. A total of 200 dissected lymph nodes from 83 patients with colorectal cancer who underwent surgery between November 2013 and May 2016 were examined. Each lymph node was first examined by SDB using anti-pancytokeratin antibody (AE1/AE3). Pathological Stage I/II patients with a negative reaction were further analyzed by SDB using anti-cytokeratin 20 antibody (CK-20) to detect micrometastasis or isolated tumor cells. The sensitivity, specificity, and accuracy of SDB using AE1/AE3 were 91.3%, 100%, and 98.0%, respectively. Five of 99 lymph nodes of pathological Stage I/II patients had a negative reaction to AE1/AE3, but were positive to CK-20, while 3 showed isolated tumor cells. The SDB is a useful diagnostic tool to detect lymph node metastases in colorectal cancer.

Evaluation of Accuracy of One-Step Nucleic Acid Amplification (OSNA) in Diagnosis of Lymph Node Metastases of Papillary Thyroid Carcinoma

Evaluation of Accuracy of One-Step Nucleic Acid Amplification (OSNA) in Diagnosis of Lymph Node Metastases of Papillary Thyroid Carcinoma

Abstract P3-03-09: A nomogram predicting lymph node metastasis in T1 breast cancer based on the surveillance, epidemiology, and end results program

Abstract Background: In developed countries, T1 stage breast cancers have become the most frequently diagnosed invasive breast diseases. Patients with early stage breast cancer with lymph nodes metastasis have been proven to have more aggressive biologically phenotypes. The risk of missing metastases using sentinel lymph node biopsy can range from 1% to 4%, with a false negative rate of 10%. This evidence implies that SLNB might not be sufficient for the diagnosis of lymph node metastasis in T1 breast cancer patients. The aim of this study was to build a nomogram to predict lymph node metastasis in patients with T1 breast cancer. Methods: We identified female patients with T1 breast cancer diagnosed between 2010 and 2014 in the Surveillance, Epidemiology and End Results database. The patients were randomized into training and validation sets. Univariate and multivariate logistic regressions were carried out to assess the relationships between lymph node metastasis and age, race, and tumour size, primary site, pathological grade, histologic type, and molecular subtype. A nomogram was developed in the training set and validated by a calibration curve with the bootstrapping method and receptor operating characteristic curve analysis. Result: A total of 91,364 T1 breast cancer patients were included in the present study. For patients with T1 breast cancer, age, race, tumour size, tumour primary site, pathological grade, oestrogen receptor status, progesterone receptor status and human epidermal growth factor receptor 2 status were independent predictive factors of positive lymph node metastasis (P&amp;lt;0.001). Increasing age, tumour size and pathological grade were positively correlated with the risk of lymph node metastasis. Based on multivariate logistic regression analysis, we successfully developed a nomogram to predict lymph node metastasis by summing the scores of each variables. The nomogram was further validated it in a validation set, with areas under the receiver operating characteristic curves of 0.733 (95% CI: 0.722-0.744) and 0.741 (95% CI: 0.731-0.752) in the training and validation sets, respectively. We determined the cut-off value of total points to predict lymph node metastasis according to Youden's index in the training set. Both the training set and validation set were divided into two groups: the low score group (total points≤182) and the high score group (total points&amp;gt;182). We found a significant difference in the probability of lymph node metastasis between the high and low score groups in univariate analysis in both the training set (OR=4.15, 95% CI:3.77-4.57, P&amp;lt;0.001) and the validation set (OR=4.53, 95% CI 4.10-5.00, P&amp;lt;0.001). Conclusions: A better understanding of the clinicopathological characteristics of T1 breast cancer patients could be vital for the assessment of their metastatic lymph node status. The nomogram developed here, if further validated in other large T1 patient cohorts, might provide additional information regarding lymph node metastasis. Together with sentinel lymph node biopsy, this nomogram can help comprehensively predict lymph node metastasis. Citation Format: Zhao Y-X, Liu Y-R, Jiang Y-Z, Xie S, Shao Z-M. A nomogram predicting lymph node metastasis in T1 breast cancer based on the surveillance, epidemiology, and end results program [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-03-09.

Abstract P6-02-16: The efficacy of preoperative pathological features to improve diagnosis accuracy in lymph node metastasis by axillary ultrasound

Abstract Purpose Recently a sentinel lymph node biopsy has been a part of standard surgical procedure instead of an axillary dissection with a mastectomy for breast cancers. It is necessary to make an accurate diagnosis of lymph node metastasis for deciding surgical procedure either a sentinel lymph node biopsy or an axillary dissection. Preoperative ultrasound is one of widely used tools to make a diagnosis of sentinel lymph node. This study presents results regarding preoperative pathological features to improve diagnosis accuracy of sentinel lymph node by preoperative axillary ultrasound. Materials and methods One doctor performed preoperative ultrasound. He used HITACHI HI VISION Ascendus. Axillary lymph node metastasis was suspected when these findings were observed such as partial thickening of lymph node cortex, loss of lymph nodes' hilum, circular swelling shape change and difference compared to a contralateral axillary lymph node. When we suspected axillary lymph node metastasis, we performed fine needle aspiration cytology except other findings such as CT, MRI or physical appearance showed obvious axillary lymph node metastasis. Preoperative core needle biopsies were performed to determine pathologic types and hormone characters. Clinical cases such that ductal carcinoma in situ, lobular carcinoma and ones with primary systemic treatment (neoadjuvant therapy) were excluded from statistical analysis. Results During a study period between April 2015 and December 2017, altogether 662 patients were participated in this study. 304 cases were analyzed by statistical analysis. 268 cases were diagnosed as negative and 36 case as positive in axillary lymph node metastasis by preoperative ultrasound. In the 268 cases 225 cases were diagnosed as negative by sentinel lymph node biopsy during operations (84.0%) but 43 cases were diagnosed as positive (16.0%). 23% cases included less than 20mm micro metastasis (10/43). To investigate correlation between false negative ratio of axillary lymph node metastasis diagnosed by an ultrasound and preoperative pathological features such as hormone receptor, HER2, Ki-67, nuclear grade and subtypes (Luminal, Her2 and triple negative). The false negative ratio was 17.0% vs 11.1% in hormone receptor (positive vs negative, p = 0.434), 14.5% vs 16.0% in HER2 (positive vs negative, p = 0.887), 15.4% vs 19.1% in Ki-67 (&amp;lt;20% vs ≥20%, p = 0.441), 18.4% vs 9.38% in nuclear grade (1 vs 2 and 3, p = 0.997), 11.3% vs 23.8% vs 16.7% vs 16.7% (Luminal A vs Luminal B vs Her2 vs triple negative, p&amp;gt;0.05). Conclusion There were no statistical significant difference between the axillary lymph node metastasis diagnosed by an ultrasound and the preoperative pathological features. However cases categorized in Luminal B by preoperative pathology had relatively high false negative ratio of axillary lymph node metastasis diagnosed by an ultrasound. It is necessary to investigate a way to improve diagnosis accuracy of sentinel lymph node by a preoperative axillary ultrasound. Citation Format: Koike R, Fujita T, Sata N, Shiozawa M, Miyazaki C, Sakuragi M, Shiba S, Tanaka Y. The efficacy of preoperative pathological features to improve diagnosis accuracy in lymph node metastasis by axillary ultrasound [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-02-16.

The significance of [18F] fluorodeoxyglucose-positron emission tomography/computed tomography in detection of pelvic nodal metastases in endometrial cancer

Objective This study was conducted to assess the accuracy of [18F] fluorodeoxyglucose-positron emission tomography/computed tomography (18FDG PET-CT) in detection of pelvic nodal metastases in endometrial cancer. Methods Patients with endometrial cancer from January 2015 to June 2017 confirmed by the postoperative pathology were retrospectively analyzed. 30 patients finished PET-CT before operation. The findings on histopathology were compared with 18FDG-PET/CT findings to calculate the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 18FDG-PET/CT. To analyze the efficacy of maximum standardized uptake (SUVmax) and lymph node maximum standardized uptake (LN-SUVmax) of PET-CT in the diagnosis of pelvic lymph node metastasis. Results For detection of pelvic nodes, based on patient analysis, 18FDG-PET/CT had a sensitivity of 75.0%, specificity of 88.5%, PPV of 50.0%, NPV of 95.8% and accuracy of 86.7%. Based on a nodal region analysis, 18FDG-PET/CT had a sensitivity of 83.3%, specificity of 98.3%, PPV of 55.0%, NPV of 99.6%, and accuracy of 98.3%. When maximum standardized uptake values (SUVmax)>8, area under curve (AUC)=0.64, Yonden Index=0.42. When maximum standardized uptake values of lymphonodus (LN -SUVmax)>3 (AUC=0.79, Yonden Index=0.63), the sensitivity and specificity of diagnosis of lymph node metastasis were 100%, 42.31%, and 75.0%, 88.5%, but without statistically significant difference. Although AUC of LN-SUVmax was higher than SUVmax of primary lesion, but the difference was not statistically significant (P>0.05). Conclusions 18FDG-PET/CT has high specificity, NPV for detection of pelvic LN metastasis area in endometrial cancer, which can provide preoperative basis for patients with endometrial cancer to avoid lymph node resection, thereby reducing the risk of early endometrial cancer surgery and improving the quality of life after surgery.We concluded that, there were no exact cutoffs of SUVmax for the prediction of lymph node metastases, neither primary lesion, nor lymph node. There is clearly a need for multicenter, large-scale trials to find out better parameters in judging metastasis of lymphnodes. Key words: Fluorodeoxyglucose F18; Positron-emission tomography; Endometrial neoplasms; Lymphatic metastasis

Fine-needle aspiration for the diagnosis of lymph node metastasis in papillary thyroid carcinoma

Objective: To investigate the diagnostic performance of fine-needle aspiration (FNA) cytology for the detection of lateral lymph node metastases in patients with papillary thyroid carcinoma (PTC). Methods: A total of 109 lateral lymph nodes with suspicious metastases from 85 patients were retrospectively subjected to FNAC, fine-needle aspiration thyroglobulin measurement (FNATg), and FNATg/SerumTg measurement. Lymph node pathological results after surgery were taken as the gold standard. Using Mann-Whitney U test, Pearson linear model and ROC curve were used for data analysis. Results: The sensitivity, specificity and accuracy of FNATg for the diagnosis of lateral neck lymph node metastasis were respectively 93.7%, 90.0% and 93.3% and those of FNATg/SerumTg were respectively 89.9%, 90.0% and 93.2% respectively, the threshold values for FNATg and FNATg/SerumTg were 0.925 ng/ml and 1.007, respectively. The sensitivity, specificity and accuracy of FNATg combined with FNAC were respectively 91.0%,93.5% and 94.4%. The existence of thyroid tissue and the expression of serum Tg did not affect the expression of lymph node FNATg. The FNATg cutoff value of 0.925 ng/ml showed the best diagnostic performance in patients with a thyroid gland, while the FNATg/SerumTg cutoff ratio of 14.95 showed the best diagnostic performance in patients without a thyroid gland. The serum TgAb significantly interfered with the expression of FNATg in the lateral neck metastatic lymph nodes (P=0.049). Conclusions: FNATg alone or the combination of FNATg with FNAC are highly reliable in the diagnosis of lateral neck lymph node metastases in patients with PTC. The expression of TgAb may interfere with the accuracy of the diagnostic performance of FNATg.

Value of contrast-enhanced ultrasound combined with elastography in evaluating cervical lymph node metastasis in papillary thyroid carcinoma.

BACKGROUNDCervical lymph node metastasis in papillary thyroid carcinoma (PTC) affects the treatment and prognosis of patients. Ultrasound is a common imaging method for detecting cervical lymph nodes in PTC patients; however, it is not accurate in determining lymph node metastasis.AIMTo evaluate the value of contrast-enhanced ultrasound combined with elastography in evaluating cervical lymph node metastasis in PTC.METHODSA total of 94 patients with PTC were recruited. According to pathological results, lymph nodes were divided into two groups: metastatic group (n = 50) and reactive group (n = 63). The routine ultrasound findings, contrast-enhanced ultrasound and elastography data were recorded and compared. Logistic regression was used to generate predictive probability distributions for the diagnosis of lymph node metastasis with different indicators. Receiver operating characteristic curve analysis was used to test the efficacy of contrast-enhanced ultrasound combined with elastography based on routine ultrasound in evaluating PTC cervical lymph node metastasis.RESULTSThe ratio of long diameter/short diameter (L/S) ≤ 2, irregular marginal morphology, missing lymphatic portal, peripheral or mixed blood flow distribution, peak intensity (PI), non-uniform contrast distribution and elasticity score in the metastatic group were significantly higher than those in the reactive group (P < 0.05). L/S ratio, missing lymphatic portal, PI and elasticity score had a significant influence on the occurrence of PTC cervical lymph node metastasis (P < 0.05). Furthermore, the area under the curve (AUC) for lymph node metastasis diagnosed using the combination of PI ratio, elasticity score, missing lymphatic portal and LS was 0.936, which was significantly higher than the AUC for PI ratio alone. The difference was statistically significant (P < 0.05). The fitting equation for the combined diagnosis was logit(P) = -12.341 + 1.482 × L/S ratio + 3.529 × missing lymphatic portal + 0.392 × PI + 3.288 × elasticity score.CONCLUSIONBased on the gray-scale ultrasound, the combination of contrast-enhanced ultrasound and elastography can accurately assess PTC cervical lymph node metastasis.

OCT4 immunohistochemistry after staging laparoscopic retroperitoneal lymphadenectomy for testicular tumor.

SUMMARYTwenty to thirty percent of patients with clinical stage I testicular tumor have metastases in the retroperitoneum. The aim of this study was to evaluate the role of OCT4 immunohistochemistry in histopathologic diagnosis of lymph node metastases in patients with nonseminomatous germ cell testicular tumors. All clinical stage I patients with staging laparoscopic retroperitoneal lymphadenectomy from 2001 until 2009 were included. Archived materials of dissected lymph nodes were reassessed and additional immunohistochemical staining with OCT4 antibody was performed in patients diagnosed as free from metastases. Each slide was visually estimated for the percentage of tumor cells showing nuclear immunoreactivity for OCT4. The study included 93 patients, of which 30 (32.3%) had initially positive retroperitoneal lymph nodes. Of the remaining 63 patients, materials were missing for 5 patients, so additional immunohistochemical staining was performed in 58 patients. Of these, two (3.4%) patients were OCT4 positive, suggesting a conclusion that they were initially misdiagnosed as stage I and metastasis free. OCT4 proved its value in detecting retroperitoneal metastases. Staging laparoscopic retroperitoneal lymphadenectomy for nonseminomatous germ cell testicular tumors in clinical stage I is a reasonable option for selected patients.

Ultrasound-guided immunofunctional photoacoustic imaging for diagnosis of lymph node metastases.

Metastases, rather than primary tumors, determine mortality in the majority of cancer patients. A non-invasive immunofunctional imaging method was developed to detect sentinel lymph node (SLN) metastases using ultrasound-guided photoacoustic (USPA) imaging combined with glycol-chitosan-coated gold nanoparticles (GC-AuNPs) as an imaging contrast agent. GC-AuNPs, injected peritumorally into breast tumor-bearing mice, were taken up by immune cells, and subsequently transported to the SLN. Two-dimensional and three-dimensional USPA imaging was used to isolate the signal from GC-AuNP-tagged cells. Volumetric analysis was used to quantify GC-AuNP accumulation in the SLN after cellular uptake and transport by immune cells. The results show that the spatio-temporal distribution of GC-AuNPs in the SLN was affected by the presence of metastases. The parameter describing the spatial distribution of GC-AuNP-tagged cells within the SLN was more than 2-fold lower in metastatic lymph nodes compared with non-metastatic controls. Histological analysis confirmed that the distribution of GC-AuNP-tagged immune cells is changed by the presence of metastatic cells. The USPA immunofunctional imaging successfully distinguished metastatic from non-metastatic lymph nodes using biocompatible nanoparticles. This method could aid physicians in the detection of micrometastases, thus guiding SLN biopsy and avoiding unnecessary biopsy procedures.

Evaluation of the Diagnostic Value of Digital Rectal Examination for Lymph Node Metastasis in Mid-Low Rectal Cancer

Background: NCCN’s guidelines for the diagnosis and treatment of rectal cancer suggest that accurate preoperative clinical staging of rectal cancer is very important. Reliable preoperative evaluation is the key to the development of surgical protocols, in order to investigate the diagnostic value of digital rectal diagnosis for lymph node metastasis of middle and low rectal cancer. Methods: We prospectively performed digital rectal examination in 258 patients with mid-low rectal cancer before operation, to analyze the distance from the lower margin of the tumor to the margin of the anus, the diameter of the invasion of the intestinal wall of the tumor, the accuracy between the general type and depth of invasion of the tumor and the pathological results of the postoperative specimen, and the predictability of the lymph node metastasis rate of the rectal digital examination. Results: The results of the analysis showed that the above indicators and postoperative pathological findings have high accuracy. Conclusions: It is concluded that accurate and detailed digital rectal examination before operation can predict lymph node metastasis rate of mid-low rectal cancer at a higher level and accurately.

Value of multi-slice spiral computed tomography in the diagnosis of metastatic lymph nodes and N-stage of gastric cancer.

ObjectiveTo establish new diagnostic criteria for improvement of the accuracy of multi-slice spiral computed tomography (MSCT) in diagnosing the N-stage and lymph node (LN) metastasis of gastric cancer (GC).MethodsMSCT was performed with plain and triphasic dynamic contrast enhancement. Different regions of LN metastasis and N-staging were determined according to the herein-proposed combined diagnostic criteria and were then correlated with the pathological analysis. The Kappa consistency test was used to study the accuracy of MSCT.ResultsThe accuracy of MSCT in diagnosing the N-stage as a whole was 86.3%, and that in diagnosing LN metastasis was 79.1% to 98.9%. The Kappa values for stages N0, N1, and N3 ranged from 0.449 to 0.662, indicating good consistency in diagnosing these three stages between MSCT and the postsurgical pathological results. The Ktotal value was 0.567 between MSCT and the postsurgical pathological results in diagnosing LN metastasis. The risk of LN metastasis increased with the progression of lesion infiltrates.ConclusionsApplication of the combined diagnostic criteria increased the diagnostic performance of MSCT in not only judging the N-stage but also diagnosing LN metastasis. This study will provide valuable reference data for surgical planning for patients with GC in the clinical setting.

Direct comparison of choline PET/CT and MRI in the diagnosis of lymph node metastases in patients with prostate cancer.

Background:Lymph node detection in prostate cancer is challenging and critical to determine treatment policy. Choline PET/CT (positron emission tomography/computed tomography) and magnetic resonance imaging (MRI) have been used for the evaluation of lymph node metastasis in patients with prostate cancer for the past decade. However, only limited patients underwent direct comparison studies.Purpose:To evaluate the diagnostic performance of choline PET/CT compared with MRI imaging for detecting lymph node metastases in prostate cancer patients.Material and Methods:Relevant English-language articles published before February 2018 were searched in PubMed database, Embase database, and Cochrane Library databases search using the keywords: (Prostate Neoplasm OR Prostate Cancer OR prostate carcinoma) and (Lymph Node) and (PET/CT OR positron emission tomography/computed tomography) and (choline or 2-hydroxy-N,N,N-trimethylethanaminium) and (magnetic resonance imaging OR MRI). Articles were included that directly compare the diagnostic performance and clinical utility of choline PET/CT and MRI for detecting lymph node metastases in prostate cancer patients. Study quality was assessed with QUADAS criteria. Analyses were performed on a per patient and a per node basis. The pooled sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (LR+), and negative likelihood ratio (LR−) were calculated using Meta-Disc 1.4 software. Summary receiver-operating characteristic (SROC) curves constructed.Results:A total of 362 patients from 8 studies involving fulfilled the inclusion criteria. On patient-based analysis, the pooled sensitivity, specificity, and DOR with a 95% confidence interval (CI) for choline PET/CT imaging were 0.59 (95%CI, 0.50–0.67), 0.92 (95%CI, 0.87–0.96), 17.37 (95%CI, 4.42–68.33), and for MRI imaging, they were 0.52 (95%CI, 0.44–0.61), 0.87 (95%CI, 0.81–0.92), 6.05 (95%CI, 3.09–11.85), respectively. On node-based, the corresponding values for choline PET/CT imaging were 0.51 (95%CI, 0.46–0.57), 0.99 (95%CI, 0.98–0.99), 65.55 (95%CI, 23.55–182.45), and for MRI imaging, they were 0.39 (95%CI, 0.34–0.44), 0.97 (95%CI, 0.96–0.97), 15.86 (95%CI, 8.96–28.05), respectively.Conclusion:Choline PET/CT performed better than MRI imaging in evaluating the lymph nodes metastasis of prostate cancer patients and had the potential to be broadly applied in clinical practice.

Contrast-enhanced computed tomography image assessment of cervical lymph node metastasis in patients with oral cancer by using a deep learning system of artificial intelligence

Although the deep learning system has been applied to interpretation of medical images, its application to the diagnosis of cervical lymph nodes in patients with oral cancer has not yet been reported. The purpose of this study was to evaluate the performance of deep learning image classification for diagnosis of lymph node metastasis. The imaging data used for evaluation consisted of computed tomography (CT) images of 127 histologically proven positive cervical lymph nodes and 314 histologically proven negative lymph nodes from 45 patients with oral squamous cell carcinoma. The performance of a deep learning image classification system for the diagnosis of lymph node metastasis on CT images was compared with the diagnostic interpretations of 2 experienced radiologists by using the Mann-Whitney U test and χ2 analysis. The performance of the deep learning image classification system resulted in accuracy of 78.2%, sensitivity of 75.4%, specificity of 81.0%, positive predictive value of 79.9%, negative predictive value of 77.1%, and area under the receiver operating characteristic curve of 0.80. These values were not significantly different from those found by the radiologists. The deep learning system yielded diagnostic results similar to those of the radiologists, which suggests that this system may be valuable for diagnostic support.