Diagnosis Of Lymph Node Metastasis Research Articles

Abstract P4-02-04: Evaluation of novel diagnostic kits for detecting metastatic lymph nodes in breast cancer patients using the semi-dry dot-blot method combined with an automatic reader

Abstract Background: The semi-dry dot-blot (SDB) method is a diagnostic procedure for detecting lymph node (LN) metastases. Metastases are confirmed by the presence of cytokeratin (CK) in the lavage fluid of sectioned LNs using anti-CK antibody on the basis of the theory that epithelial components such as CK are not found in normal LNs. We evaluated novel SDB kits that use a newly developed anti-CK19 antibody and an automatic reader for diagnosing LN metastases in breast cancer patients. Methods: We obtained 127 LNs dissected from 78 breast cancer patients between January 2017 and April 2019 at Nagasaki University Hospital, including 18 dissected axillary LNs and 109 sentinel LNs. These were sliced at 2-mm intervals and washed with phosphate-buffered saline. The suspended cells in the lavage fluid of sliced LNs were centrifuged and lysed to extract protein. The extracted protein was applied to the SDB kit to diagnose LN metastasis using an automatic reader that evaluates absorbance. The washed LNs were blindly diagnosed by pathologists using hematoxylin and eosin (H&E) staining and immunohistochemical (IHC) analysis with anti-CK19 antibody. Diagnoses based on absorbance were also compared with CK19 protein concentration detected by enzyme-linked immunosorbent assay (ELISA).Results: Of the 127 LNs, 52 were assessed as positive and 75 as negative by histological examination with H&E and CK19 IHC. With a borderline CK19 absorbance of seven milli-absorbance (mAbs) for detecting LN metastases excluding isolated tumor cells, the sensitivity, specificity, and accuracy of the SDB kit were 92.3%, 100%, and 96.9%, respectively. In four false-negative cases, there were two CK-19-negative breast cancers and two micrometastases with obvious heat denaturation. With a borderline CK19 absorbance of 50 mAbs for distinguishing macrometastases from micrometastases, the sensitivity, specificity and accuracy of the SDB kit were 81.8%, 97.6%, and 92.1%, respectively. Diagnoses based on the kits and CK19 protein concentration, as determined by ELISA, were well correlated (r=0.90). Furthermore, diagnosis was achieved in approximately 20 min using the kits, at a cost of less than 30 USD. Conclusions: The kits used in our study with an automatic reader were accurate, quick, and cost-effective in diagnosing LN metastases without the loss of LN tissue. However, measures should be taken for clinical use in CK19-negative breast cancer and regarding heat denaturation during surgery. Citation Format: Ryota Otsubo, Hiroshi Yano, Megumi Matsumoto, Ayako Fukushima, Han-Seung Yoon, Hiroshi Hirakawa, Masahiro Oikawa, Katsuya Matsuda, Masahiro Nakashima, Takeshi Nagayasu. Evaluation of novel diagnostic kits for detecting metastatic lymph nodes in breast cancer patients using the semi-dry dot-blot method combined with an automatic reader [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-02-04.

Discrimination of mediastinal metastatic lymph nodes in NSCLC based on radiomic features in different phases of CT imaging

BackgroundWe aimed to develop radiomic models based on different phases of computed tomography (CT) imaging and to investigate the efficacy of models for diagnosing mediastinal metastatic lymph nodes (LNs) in non-small cell lung cancer (NSCLC).MethodsEighty-six NSCLC patients were enrolled in this study, and we selected 231 mediastinal LNs confirmed by pathology results as the subjects which were divided into training (n = 163) and validation cohorts (n = 68). The regions of interest (ROIs) were delineated on CT scans in the plain phase, arterial phase and venous phase, respectively. Radiomic features were extracted from the CT images in each phase. A least absolute shrinkage and selection operator (LASSO) algorithm was used to select features, and multivariate logistic regression analysis was used to build models. We constructed six models (orders 1–6) based on the radiomic features of the single- and dual-phase CT images. The performance of the radiomic model was evaluated by the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV).ResultsA total of 846 features were extracted from each ROI, and 10, 9, 5, 2, 2, and 9 features were chosen to develop models 1–6, respectively. All of the models showed excellent discrimination, with AUCs greater than 0.8. The plain CT radiomic model, model 1, yielded the highest AUC, specificity, accuracy and PPV, which were 0.926 and 0.925; 0.860 and 0.769; 0.871 and 0.882; and 0.906 and 0.870 in the training and validation sets, respectively. When the plain and venous phase CT radiomic features were combined with the arterial phase CT images, the sensitivity increased from 0.879 and 0.919 to 0.949 and 0979 and the NPV increased from 0.821 and 0.789 to 0.878 and 0.900 in the training group, respectively.ConclusionsAll of the CT radiomic models based on different phases all showed high accuracy and precision for the diagnosis of LN metastasis (LNM) in NSCLC patients. When combined with arterial phase CT, the sensitivity and NPV of the model was be further improved.

Prediction of lymph node metastasis in early gastric cancer using artificial intelligence technology.

289 Background: Early gastric cancer shows lymph node involvement in about 10-15% of patients. Despite the fact, we perform radical lymphadenectomy for all patients because predicting lymph node metastasis has yet to be successful. In this study, we hypothesize that image analysis using artificial intelligence (AI) technology may help solve the problem. Methods: We retrospectively collected 82 patients with clinical T1N0 and pathological node negative and 82 patients with clinical T1N0 and pathological node positives and then divided the 164 patients into a training:validation set in ratio of 9:1. Endoscopic images of the early tumors were analyzed by transfer learning using AlexNet, a deep neural network containing 5 convolutional layers and 3 fully-connected layers. The model was validated with newly-collected 40 images from 20 clinical T1N0 and pathological node negative and 20 patients with clinical T1N0 and pathological node positives as a test set. For comparison, three methods of prediction were implemented: prediction at random, by logistic regression, and by skilled endoscopists. Results: The AI predicted LNM with accuracy of 80.9% in the validation set and 66.9% in the test set. (48.3% for node negative cancers and 85.4% for node positive cancers) On the other hand, prediction at random, by logistic regression, and by 2 endoscopists resulted in 50.3%, 50.0%, and 47.5%, respectively. Conclusions: Although the accuracy still needs to be improved, image analysis using the AI technology resulted in the best prediction of lymph node metastasis, indicating that AI is a promising technology for the diagnosis of lymph node metastasis in early gastric cancer.

Multiple Level CT Radiomics Features Preoperatively Predict Lymph Node Metastasis in Esophageal Cancer: A Multicentre Retrospective Study.

Background: Lymph node (LN) metastasis is the most important prognostic factor in esophageal squamous cell carcinoma (ESCC). Traditional clinical factor and existing methods based on CT images are insufficiently effective in diagnosing LN metastasis. A more efficient method to predict LN status based on CT image is needed.Methods: In this multicenter retrospective study, 411 patients with pathologically confirmed ESCC were registered from two hospitals. Quantitative image features including handcrafted-, computer vision-(CV-), and deep-features were extracted from preoperative arterial phase CT images for each patient. A handcrafted-, CV-, and deep-radiomics signature were built, respectively. Then, multiple radiomics models were constructed by merging independent clinical risk factor into radiomics signatures. The performance of models were evaluated with respect to the discrimination, calibration, and clinical usefulness. Finally, an independent external validation cohort was used to validate the model's predictive performance.Results: Five, seven, and nine features were selected for building handcrafted-, CV-, and deep-radiomics signatures from extracted features, respectively. Those signatures were statistically significant different between LN-positive and LN-negative patients in all cohorts (p < 0.001). The developed multiple level CT radiomics model that integrates multiple radiomics signatures with clinical risk factor, was superior to traditional clinical factors and the results reported by existing methods, and achieved satisfactory discrimination performance with C-statistic of 0.875 in development cohort, 0.874 in internal validation cohort and 0.840 in independent external validation cohort. Nomogram and decision curve analysis (DCA) further confirmed our method may serve as an effective tool for clinicians to evaluate the risk of LN metastasis in patients with ESCC and further choose treatment strategy.Conclusions: The proposed multiple level CT radiomics model which integrate multiple level radiomics features into clinical risk factor can be used for preoperative predicting LN metastasis of patients with ESCC.

Clinical application of the ultrasound-guided fine needle aspiration for thyroglobulin measurement to diagnose lymph node metastasis from differentiated thyroid carcinoma-literature review.

Papillary thyroid carcinoma (PTC) generally has a good prognosis, but disease recurs in 25% to 30% of PTC patients and significantly reduces the survival rate. Lymph node metastasis (LNM) is reported in 20% to 50% of PTC patients, mainly in the neck, and 20% originates from recurrence. LNM of papillary thyroid carcinoma are a plausible prognostic factor to determine disease recurrence. Currently, fine needle lymph node aspiration for cytology (LN-FN-cytology) is the best modality to diagnose LNM but is limited by diagnostic sensitivity and sample error. Fine needle lymph node aspiration for thyroglobulin measurement (LN-FNA-Tg) could offer a reliable and quantitative diagnostic method for LNM. The combination of LN-FNA-cytology and LN-FNA-Tg could achieve almost 100% diagnostic sensitivity and specificity for LNM. Both treatment guidelines of the American Thyroid Association and European Thyroid Association recommend LN-FNA-Tg to diagnose LNM after total thyroidectomy. Diagnostic accuracy of the LN-FNA-Tg depends on optimal equipment, scanning protocol, skill, and experience of operators. Normal saline is mainly used for aspiration needle wash-out and buffer solution. And radioimmunoassay or immunoradiometric assay are widely used for the LN-FNA-Tg measurement. So far, there is no consensus about the diagnostic threshold of LN-FNA-Tg for positive LNM, but high LN-FNA-Tg, especially higher than 10 ng/mL, strongly favors LNM.

Plasma exo-hsa_circRNA_0056616: A potential biomarker for lymph node metastasis in lung adenocarcinoma.

Background: To investigate the relationship between CXCR4-related circular RNAs (circRNAs) in exosomes and lymph node metastasis of lung adenocarcinoma.Methods: Totally 41 lung adenocarcinoma tissues (21 with lymph node metastasis and 20 without) were collected. Expression of CXCR4 protein was detected by western blotting analysis. A stable PC9/CXCR4-shRNA and PC14/CXCR4-shRNA knockdown lung adenocarcinoma cell lines were established and subjected to functional assays (cell proliferation, colony formation, migration and invasion) for phenotype changes. Exo-hsa-circRNAs (has-circRNAs in exosomes) were detected in vivo and in vitro. The diagnostic value of differentially expressed exo-has-circRNAs was evaluated.Results: Expression levels of CXCR4 were higher in patients with lymph node metastasis than in those without (P = 0.001). Silencing CXCR4 expression in PC9 and PC14 cell lines with short hairpin RNA could effectively abolish colony formation frequency, proliferation rate, migration rate, and the number of invasive cells (all P < 0.001). Exo_circRNA_0056616 was detected in both PC-9/CXCR4-shRNA cells and lung adenocarcinoma plasma at significantly higher levels than in the corresponding control (P < 0.001). When a receiver operating characteristic (ROC) curve for plasma exo-hsa_circRNA_0056616 levels and diagnosis of lymph node metastasis of lung adenocarcinoma was generated, a cutoff value of 0.394 was identified with an area under the curve of 0.812 (95% confidence interval 0.720-0.903), a sensitivity of 0.792, and specificity of 0.810.Conclusions: Taken together, our findings suggested that CXCR4 was higher in the lung adenocarcinoma tissues with lymph node metastasis. Higher plasma levels of exo-hsa_circRNA_0056616 in these patients also suggest that this circRNA represents a potential biomarker for lymph node metastasis predictor in lung adenocarcinoma.

Diagnostic Value Investigation and Bioinformatics Analysis of miR-31 in Patients with Lymph Node Metastasis of Colorectal Cancer.

Colorectal cancer (CRC) is one of the most frequent cancers occurring in developed countries. Distant CRC metastasis causes more than 90% of CRC-associated mortality. MicroRNAs (miRNAs) play a key role in regulating tumor metastasis and could be potential diagnostic biomarkers in CRC patients. This study is aimed at identifying miRNAs that can be used as diagnostic biomarkers for CRC metastasis. Towards this goal, we compared the expression of five miRNAs commonly associated with metastasis (i.e., miR-10b, miR-200c, miR-155, miR-21, and miR-31) between primary CRC (pCRC) tissues and corresponding metastatic lymph nodes (mCRC). Further, bioinformatics analysis of miR-31 was performed to predict target genes and related signaling pathways. Results showed that miR-31, miR-21, miR-10b, and miR-155 expression was increased to different extents, while miR-200c expression was lower in mCRC than that in pCRC. Moreover, we found that the level of both miR-31 and miR-21 was notably increased in pCRC when lymph node metastasis (LNM) was present, and the increase of miR-31 expression was more profound. Hence, upregulated miR-31 and miR-21 expression might be a miRNA signature in CRC metastasis. Moreover, we detected a higher miR-31 level in the plasma of CRC patients with LNM compared to patients without LNM or healthy individuals. With the bioinformatics analysis of miR-31, 121 putative target genes and transition of mitotic cell cycle and Wnt signaling pathway were identified to possibly play a role in CRC progression. We next identified seven hub genes via module analysis; of these, TNS1 was most likely to be the target of miR-31 and had significant prognostic value for CRC patients. In conclusion, miR-31 is significantly increased in the cancer tissues and plasma of CRC patients with LNM; thus, a high level of miR-31 in the plasma is a potential biomarker for the diagnosis of LNM of CRC.

Early Lymph Node Metastasis May Predict Poor Prognosis in Soft Tissue Sarcoma.

Background Lymph node metastasis (LNM) is a relatively rare event in soft tissue sarcoma. An association between the timing of LNM detection and patient prognosis is presently unknown. Patients and Methods We retrospectively analyzed the clinicopathological features of 33 patients with LNM between 2001 and 2015. Analysis of the timing of LNM diagnosis was grouped according to patients presenting LNM in either <8 months (the median time from primary tumor diagnosis to LNM) or ≥8 months after primary tumor diagnosis. Results A relationship between the primary tumor size and the timing of the LNM was not significantly found (Rs = 0.0088, p=0.96). Sixteen patients had an LNM detection duration of <8 months, and 17 patients had a duration of ≥8 months. The 5-year survival for patients with an LNM detection duration of <8 months and ≥8 months was 19% and 71%, respectively (p=0.0016). There were 19 patients with pulmonary metastases. Among them, there were 13 patients with a duration of primary tumor diagnosis to LNM of <8 months and 6 with a duration of ≥8 months (p=0.01). Conclusion Early LNM (<8 months) may predict poor prognosis in soft tissue sarcoma.

Does [18F] fluorodeoxyglucose–positron emission tomography/computed tomography have a role in cervical nodal staging for esophageal squamous cell carcinoma?

ObjectiveAccurate nodal staging is crucial for esophageal cancer. A prospective study was performed to assess the value of [18F] fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) for diagnosing cervical lymph node metastasis (LNM) of esophageal squamous cell carcinoma. MethodsFrom June 2018 to November 2018, 110 patients with resectable esophageal cancer were prospectively enrolled. Esophagectomy with 3-field lymphadenectomy was performed after FDG-PET/CT scanning. The primary end point was cervical LNM determined via postoperative histologic examination. The sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and accuracy (AC) of FDG-PET/CT for the assessment of LNM were determined using histologic results as reference standards. ResultsPositive lymph nodes as determined via FDG-PET/CT were detected in 61 patients (55.5%), of whom 13 (11.8%) had positive cervical lymph nodes. After surgery, 59 patients (53.6%) exhibited pathologic LNM, of whom 20 (18.2%) had cervical LNM. SE, SP, PPV, NPV, and AC were 65.6%, 61.2%, 67.8%, 58.8%, and 63.6%, respectively, with regards to diagnosing overall LNM, and were 45.0%, 95.6%, 69.2%, 88.7%, and 86.4%, respectively, for diagnosing cervical LNM. Of the 110 patients, 90 underwent both FDG-PET/CT scanning and ultrasonography in the neck, and there were no significant differences in SE, SP, PPV, NPV, or AC with respect to cervical LNM diagnosis between FDG-PET/CT and ultrasonography. ConclusionsFor cervical LNM of esophageal squamous cell carcinoma, FDG-PET/CT scanning exhibited high specificity but low sensitivity, suggesting that it is of limited value for this purpose.

Diagnostic value and clinical significance of MRI and CT in detecting lymph node metastasis of early cervical cancer.

Diagnostic value and clinical significance of magnetic resonance imaging (MRI) and computed tomography (CT) in detecting lymph node metastasis of early cervical cancer were investigated. From April 2015 to April 2019, 160 patients with lymph node metastasis (stage I–II) of early cervical cancer in Jining No. 1 People's Hospital were retrospectively analyzed. All the patients underwent MRI, CT diagnosis and MRI combined with CT diagnosis before operation. Sensitivity, specificity and diagnostic accordance rate, the diagnostic value and clinical significance of MRI, CT and MRI combined with CT in the diagnosis of lymph node metastasis of early cervical cancer were compared. The sensitivity, specificity and diagnostic accordance rate of MRI in the diagnosis of lymph node metastasis of early cervical cancer in stage Ia-Ib were 75.00, 72.92 and 77.50%, respectively, which were significantly higher than those of PET/CT in the same period (P<0.05). The sensitivity, specificity and diagnostic accordance rate of MRI combined with CT in the diagnosis of early cervical cancer in stage Ia-Ib were 78.13, 87.50 and 83.75%, respectively, which were significantly higher than those of MRI or CT alone (P<0.05). However, the sensitivity, specificity and diagnostic accordance rate of MRI combined with CT in the diagnosis of lymph node metastasis of early cervical cancer in stage IIa-IIb were 91.66, 82.81 and 88.13%, respectively, which were significantly higher than those of MRI or CT alone (P<0.05). MRI is superior to CT in the diagnosis of lymph node metastasis of early cervical cancer. However, the diagnostic efficiency of combined scans of the two is far higher than that of MRI or CT alone, which has more diagnostic value. In clinic, MRI and CT should be combined to improve the diagnostic accuracy of diseases.

Comparison of hair medulla from lymph node metastasis and non-lymph node metastasis gastric cancer patients using synchrotron radiation infrared microspectroscopy

Lymph node metastasis often occurs in gastric cancer, hence it is important to explore new methods for diagnosing lymph node metastasis before surgery. In this study, synchrotron radiation infrared (SR-IR) microspectroscopy was used to compare hair medulla from lymph node metastasis and non-metastasis gastric cancer patients. Peak-area ratios indicated that significant alterations might occur in lipids, proteins and nucleic acids after lymph node metastasis. Discriminant analysis was implemented on the basis of peak-area ratios and obtained the following results: the sensitivity was 80.56%, the specificity was 82.76%, the positive predictive value was 85.29% and the accuracy was 81.54%. This study showed that biomacro-molecules in hair medulla were influenced by lymph node metastasis, indicating that IR spectra of hair medulla may be potentially used to diagnose lymph node metastasis before gastric cancer surgery.

Usefulness of real-time elastography for diagnosing lymph node metastasis of skin cancer: does elastography potentially eliminate the need for sentinel lymph node biopsy in squamous cell carcinoma?

The metastatic involvement of regional lymph nodes is the most important prognostic factor for overall survival of skin cancer patients. The sonographic technique of freehand real-time tissue elastography (RTE), which displays tissue rigidity as a colour overlay of the tissue image, was developed. Our purpose was to evaluate the benefit of RTE for detecting lymph node metastases of skin cancer non-invasively before operation. We first selected lymph nodes of skin cancer patients which had already been diagnosed by biopsy as being reactive or metastatic, and then retrospectively collected images of RTE and B-mode and colour Doppler ultrasound on those lymph nodes performed preoperatively. Twenty-one lymph nodes from 12 patients with squamous cell carcinoma (SCC), 23 lymph nodes from 14 patients with malignant melanoma (MM) and 14 lymph nodes from six patients with extramammary Paget disease (Paget) were investigated. Elastographic images were assessed on a scale of one to four according to the percentage of high elasticity (hard) area (HEA) in the lymph node. In all three skin cancers, lymph nodes evaluated as grade 3 or 4 by RTE were metastatic. All lymph nodes evaluated as grade 1 or 2 by RTE were reactive in SCC, whereas some lymph nodes evaluated as grade 1 or 2 were metastatic in MM and Paget. Real-time tissue elastography may aid in distinguishing reactive lymph nodes from metastatic ones especially in SCC.

Diagnostic value of cytology, thyroglobulin, and combination of them in fine-needle aspiration of metastatic lymph nodes in patients with differentiated thyroid cancer: A systematic review and network meta-analysis.

Background:To investigate the diagnostic performance of cytology (fine-needle aspiration cytology [FNAC]), thyroglobulin (fine-needle aspiration thyroglobulin [FNA-Tg]), and combination of them in the washout of fine-needle aspiration for those patients who have suspicious metastatic lymph nodes of differentiated thyroid cancer.Methods:Databases, including PubMed, EMbase, Web of Science and Cochrane Library were searched up to June 2019. The quality assessment of diagnostic accuracy scale-2 was used to conduct quality assessments, and publication bias was evaluated using the Deeks funnel plot. STATA version 14.0 was used to perform the meta-analysis.Results:A total of 2257 patients with 2786 samples of suspicious metastatic lymph nodes of differentiated thyroid cancer were included in the meta-analysis. The results showed that the diagnostic value for detecting lymph node metastasis of differentiated thyroid cancer was as follows: combination of FNAC and FNA-Tg > FNA-Tg > FNAC. All differences of superiority among them are statistically significant. The sensitivity of the combination was 0.968 (95% confidence interval [CI]: 0.942–0.983), the specificity was 0.932 (95% CI: 0.856–0.969), the diagnostic score was 6.036 (95% CI: 4.892–7.181), the diagnostic odds ratio was 418.424 (95% CI: 133.167–1314.729), and the score of summary receiver operating characteristic was 0.99 (95% CI: 0.97–0.99).Conclusions:The combination of FNAC and FNA-Tg is an excellent procedure in diagnosis of lymph nodes metastasis of patients with differentiated thyroid cancer, which should be highly recommended.

Study on the sensitivity of multi-slice spiral CT in diagnosis of lymph node metastasis in different lymph node stations of gastric cancer

Objective: To study the sensitivity of multi-slice spiral CT in the diagnosis of lymph node metastasis in different lymph node stations of gastric cancer. Methods: A retrospective series of case study was employed in the research. Inclusion criteria: (1) patients undergoing preoperative abdominal CT scan plus enhanced examination, and data in the image archiving and communication system of Sun Yat-sen University Cancer Center; (2) patients undergoing total or subtotal gastrectomy plus D2 or D1+ lymphadenectomy, with more than 15 harvested lymph nodes and more than 1 metastatic lymph node confirmed by postoperative pathology; (3) WHO pathological classification defined as gastric adenocarcinoma; (4) no history of lymph node tuberculosis, giant lymph node hyperplasia, lymphoma or other diseases resulting in enlarged lymph nodes; (5) no history of gastrectomy; (6) no preoperative neoadjuvant therapy. Clinicopathologic data of gastric cancer patients at the Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center from January 2009 to December 2012 were retrospectively analyzed. Using the pathologically positive lymph nodes as a reference, the sensitivity of CT-positive lymph nodes was calculated (total number of positive image lymph nodes/total number of positive pathological lymph nodes) and complete coincidence rate (number of case defined as complete coincidence/number of case with positive pathologic lymph nodes; complete coincidence indicated that the number of positive image lymph nodes was consistent with the number of positive pathologic lymph nodes in each lymph node station). The χ(2) test was used to compare the sensitivity of CT in the diagnosis of lymph node metastasis in each lymph node station. Results: A total of 228 patients with pathology-proven gastric cancer were enrolled in the study, including 147 male and 81 female. The overall sensitivity of CT in diagnosis of metastatic lymph nodes in gastric cancer was 68.7% (1769/2576). The sensitivity of CT in diagnosis of lymph node metastasis of groups 1 to 8 from high to low was group 3 [81.1% (506/624)], group 7 [73.9% (246/333)], group 2 [70.3% (111/158)], group 6 [68.7% (248/361)], group 4 [68.1% (262/385)], group 8 [60.4% (116/192)], group 1 [53.8% (155/288)], group 5 [47.1% (82/174)]. The CT diagnostic sensitivity of group 3 was significantly higher than the overall level (χ(2)=37.689, P<0.001). The CT diagnostic sensitivity of group 5 was significantly lower than the overall level (χ(2)=34.387, P<0.001). The CT diagnostic sensitivity of group 1 was also significantly lower than the overall level (χ(2)=25.918, P<0.001). Significant differences were not found in the CT diagnostic sensitivity of group 2, 4, 6, 7, 8 compared with the overall level (all P>0.05). The complete coincidence rate was 56.9% (536/942) between pathological positive lymph nodes and CT positive lymph nodes. The highest complete coincidence rate was observed in group 3 (68.0%, 123/181) and the lowest was in group 1 (41.4%, 46/111), whose difference was statistically significant (χ(2)=9.673, P=0.002). Conclusion: The sensitivity of CT in diagnosis of lymph nodes in different lymph node stations of gastric cancer is different.

1880 Usefulness of Sentinel Lymph Node Mapping using Indocyanine Green and Fluorescent Imaging in the Diagnosis of Lymph Node Metastasis During Robotic or Laparoscopic Surgery for Endometrial Cancer

Study Objective The lymph node status is the most important prognostic factor for endometrial cancer. This study aimed to assess whether sentinel lymph node mapping (SLNM) is applicable in endometrial cancer. Design A retrospective review of patients with endometrial cancer who were diagnosed and treated at a single institute (Asan Medical Center, Seoul, Korea) from September 2015 to December 2017 was conducted. One hundred patients underwent robotic (da Vinci®) or laparoscopic surgical treatment, including SLNM with indocyanine green (ICG) fluorescence detection using the Firefly® and NIR/ICG systems. Setting University Hospital. Patients or Participants 100 patients with early stage endometrial cancer. Interventions Robotic or laparoscopic staging surgery. Measurements and Main Results All patients underwent intraoperative SLNM. At least one lymph node area was observed in 100% of SLNM cases. Sentinel node detection and frozen biopsy were performed in all cases, and all patients with metastasis were found on SLNM. The sensitivity and negative predictive value were both 100% in the patient-by-patient and station-by-station analyses. Conclusion SLNM appears to be a feasible method to reduce the morbidity and increase the detection rate in early-stage endometrial carcinoma.

Diagnostic Value of 18F-fluorodeoxyglucose Positron Emission Tomography with Computed Tomography for Lymph Node Staging in Patients with Upper Tract Urothelial Carcinoma

BackgroundPresence of lymph node metastases (LNM) is an important prognostic factor for cancer-specific survival (CSS) in patients with upper tract urothelial carcinoma (UTUC). In various neoplasms, 18F-fluorodeoxyglucose positron emission tomography with computed tomography (FDG-PET/CT) is an established modality for preoperative lymph node (LN) staging. In UTUC, the diagnostic value of FDG-PET/CT for LN staging is unknown. ObjectiveTo determine the diagnostic value of FDG-PET/CT for LN staging in patients with UTUC. Design, setting, and participantsData of 152 patients with UTUC who underwent FDG-PET/CT followed by surgical treatment in eight centers between 2007 and 2017 were retrospectively collected. Patients receiving neoadjuvant chemotherapy were excluded. Outcome measurements and statistical analysisFDG-PET/CT results were compared with histopathology after lymph node dissection (LND). Recurrence-free survival (RFS), CSS, and overall survival (OS) were analyzed using Kaplan-Meier estimates, and compared for patients with and without suspicious LNs on FDG-PET/CT. Results and limitationsWe included 117 patients, of whom 62 underwent LND. Seventeen patients had LNM at histopathological evaluation. Sensitivity and specificity of FDG-PET/CT for diagnosis of LNM were 82% (95% confidence interval [CI]: 57–96) and 84% (95% CI: 71–94), respectively. RFS was significantly worse in patients with LN-positive FDG-PET/CT than in those with LN-negative FDG-PET/CT (p=0.03). CSS (p=0.11) and OS (p=0.5) were similar between groups. This study is limited by its retrospective design and by its sample size. Our results warrant further validation. ConclusionsFDG-PET/CT has 82% sensitivity and 84% specificity for the detection of LNM in patients with UTUC. Presence of suspicious LNs on FDG-PET/CT is associated with worse RFS. Patient summaryIn patients with upper tract urothelial cancer, positron emission tomography with computed tomography (PET/CT) scans can detect lymph node metastases with noteworthy accuracy. Presence of suspicious lymph nodes on 18F-fluorodeoxyglucose PET/CT is associated with worse recurrence-free survival.

Evaluation of accuracy of one-step nucleic acid amplification (OSNA) in diagnosis of lymph node metastases of papillary thyroid carcinoma. Diagnostic study.

BackgroundThe incidence of node metastases in papillary thyroid carcinoma (PTC) is high, ranging from 20% to 90%. Prophylactic central lymph node compartment dissection (CLND), suggested from the latest guidelines for high-risk tumors, meets resistance due to the high incidence of postoperative complications. Recently, new molecular biologic techniques, such as One Step Nucleic Acid Amplification (OSNA), have spread widely, allowing to quickly isolate, amplify and quantify mRNA encoding for proteins selectively present in neoplastic cells, as Cytokeratine-19. The aim of this study is to evaluate the application of OSNA to intraoperative diagnosis of node metastases of PTC.MethodsWe included in the study patients with preoperative diagnosis of PTC; from each patient one or more lymph nodes were collected. To assess OSNA accuracy, each lymph node was divided into two halves: the first one was analysed with histopathological and immunohistochemical examination, whereas the second was studied with OSNA.ResultsTwenty-six lymph nodes from 13 patients were included in the study. Overall, OSNA sensitivity was 87.5%, specificity 94.4%, positive predictive value 87.5%, negative predictive value 94.4% and accuracy 92.8%.Discussion and conclusionOSNA is effective in detecting lymph node metastases of PTC. Considering the high risk of complications in CLND, and the uncertain prognostic value of lymph node metastases of PTC, OSNA seems to be a promising tool to identify intraoperatively patients who may benefit from CLND.

Pilot study to evaluate the efficacy of lymphotropic nanoparticle enhanced MRI for diagnosis of metastatic disease in canine head and neck tumours.

This pilot study is designed to determine if lymphotropic nanoparticle enhanced MRI (LNMRI) is a viable technique for staging of naturally occurring canine malignant head and neck tumours. Previous imaging studies in veterinary medicine have shown variable sensitivity and specificity for determining metastasis for local lymph nodes in head and neck tumours. LNMRI utilizes ultra-small superparamagnetic iron oxide nanoparticles (USPIOs) to help in the detection of metastatic disease in lymph nodes. USPIOs are phagocytized and localized to normal lymph nodes where they assist in evaluation for regions of effacement by cancerous cells. Six dogs underwent LNMRI for the diagnosis of metastatic lymph nodes. A truncated MRI consisting of transverse images of T2, T1 pre- and post-contrast and T2* sequences were evaluated for presence of metastasis. Sentinel lymph nodes and lymph nodes with possible metastatic lesions were surgically excised for histological evaluation. In the initial phase of this study, 24 lymph nodes were included in analysis. Subjective observation by the primary investigator had a calculated sensitivity and specificity of 100% and 88% based on histological results. There were no negative side effects to the USPIOs noted in the limited number of patients in this study. Percentage signal intensity loss was calculated and found to be significantly different between metastatic and non-metastatic lymph nodes (P-value = .038). In conclusion, this pilot study shows that LNMRI has the potential to be a sensitive and specific method of diagnosing lymph node metastasis. Further research is warranted to determine if this method is clinically applicable and accurate.

Analysis on CT in diagnosis of lymph node metastasis of thoracic esophageal cancer with minimum diameter greater than 1 cm

Objectives: To evaluate the diagnostic value of CT for lymph node metastasis of thoracic esophageal carcinoma with a diameter of more than 1 cm, and to find the optimal diagnostic index by comparing relevant CT indexes. Methods: Totally 80 patients with pathologically proved thoracic esophageal cancer with preoperative CT examination revealed lymph node diameter greater than 1 cm admitted at Department of Thoracic Surgery, the First Affiliated Hospital of University of Science and Technology of China from January 2016 to January 2018 were enrolled in this study. There were 70 males and 10 females, aging of (60±14) years (range: 40-85 years). According to the pathological result of lymph nodes, all the patients and lymph nodes were divided into two groups (N+group: 47 patients, 62 lymph nodes; N-group: 33 patients, 39 lymph nodes). The average number of dissected lymph nodes were 21±4 and 101 lymph nodes' diameter were greater than 1 cm. The clinicopathologic factors, postoperative complications, lymph node dissection and relevant CT indexes like the minimum diameter of lymph nodes (Min D), the maximum diameter of lymph node (Max D), lymph node axial ratio(LAR), the enhancement of lymph node (ELN) and the boundary of lymph node (BLN) were compared. The clinicopathological data, lymph node dessection and CT parameters of the two groups were compared by t test, χ(2) test or Wilcoxon rank sum test. Receiver operating characteristic (ROC) curve analysis was used to compare the ability to predict lymph node metastasis between Min D, Max D, LAR, ELN and BLN. Multiple Logistic regression analysis were performed to determine the independent variables for prediction of lymph node metastasis. Results: The difference of tumor segmentation, pN stage, pTNM stage, total number of metastatic lymph nodes, total number of abdominal lymph node metastases, Min D, Max D, ELN and BLN between the two groups were statistically significant. The results of univariate and multivariate analyses showed that gender (OR=0.128, 95%CI: 0.019 to 0.858, P=0.034), pTNM stage (OR=1.514, 95%CI: 1.020 to 2.247, P=0.039), Min D (OR=0.102, 95%CI: 0.010 to 0.995, P=0.050) and LAR (OR=0.195, 95%CI: 0.052 to 0.731, P=0.015) were the independent relative factors. The area under the curve of ROC curve analysis of Min D, Max D, LAR, ELN and BLN were 0.679, 0.666, 0.561, 0.650 and 0.820, respectively. BLN was the best CT index to diagnosis lymph node metastasis, while the accuracy of dignosis of lymph node metastasis of BLN was 97.0%. The Youden index of Min D, Max D and LAR were 1.25 cm, 1.64 cm and 0.77, respectively. Combining the BLN and ELN had a higher diagnostic rate (97.0%) of lymph node metastasis. Conclusions: CT has high diagnostic value for lymph node metastasis in thoracic esophagel cancer when the lymph node diameter is greater than 1 cm. BLN is the best diagnostic index for lymph node metastasis.

The impact of histological type on the accuracy of preoperative N staging in patients with gastric cancer

BackgroundThe low accuracy of preoperative diagnosis of lymph node metastasis in gastric cancer (GC) complicates decisions on patient indication for neoadjuvant chemotherapy.MethodsWe investigated the use of preoperative clinical diagnosis of lymph node involvement (cN) in GC patients compared with postoperative pathological diagnosis.ResultsIn a series of 265 patients enrolled at the University of Yamanashi Hospital, the overall sensitivity was 44.4% and specificity was 93.4% of CT for detecting lymph node metastasis. The positive and negative predictive values were 80.0% and 73.8%, respectively. The negative predictive value was lower for undifferentiated adenocarcinoma than that for differentiated adenocarcinoma (64.9% vs. 78.7%, p = 0.034). In cT2 ≤ and cN2 ≤ GC, overdiagnosis of lymph node metastasis was significantly more frequent in patients with differentiated (50.0%) than in undifferentiated (13.3%) adenocarcinoma (p = 0.046).ConclusionsDiagnostic accuracy of lymph node involvement depended on histological type and cT-stage. Thus, considering preoperative histological type in GC, it may be useful to decide treatment plan.