Diagnosis Of Metastatic Nodes Research Articles

Regularity and correlation analysis of regional lymph node metastasis in nonoperative patients with non-small cell lung cancer based on positron emission tomography/computed tomography images

BackgroundDefinitive concurrent chemoradiotherapy (CCRT) is the standard treatment for locally advanced, inoperable non-small cell lung cancer (NSCLC). Previous studies have mainly focused on examining local failure and recurrence patterns after surgery and the principles of lymph node metastasis (LNM) in surgical candidates with NSCLC. However, these studies were just only able to guide postoperative radiotherapy (PORT) and the patterns of LNM in patients with resected NSCLC was inadequate to represent that in locally advanced inoperable NSCLC patients for guiding target volume delineation of CCRT. In this study, we aimed to analyze the metastasis regularities and establish the correlations between different lymph node levels in NSCLC patients without any intervention using positron emission tomography/computed tomography (PET/CT) images.MethodsOverall, 358 patients with N1–N3 NSCLC admitted in our hospital between 2018 and 2022 were retrospectively analyzed. The diagnosis of metastatic lymph nodes was reviewed and determined using the European Organization for Research and Treatment of Cancer standard and the standardized value of the PET/CT examination. Univariate and multivariate analysis were performed to investigate the correlations between the different levels were evaluated by using of the chi-square test and logistic regression model.ResultsThe lymph nodes with the highest metastasis rates in patients with left lung cancer were in order as follows: 10L, 4L, 5, 4R, and 7; while in those with right lung cancer they were 10R, 4R, 7, 2R, and 1R. Notably, we found left lung patients were more likely to have contralateral hilar, mediastinal and supraclavicular lymph nodes involved, and the right lung group exhibited a higher propensity for ipsilateral mediastinum and supraclavicular lymph node invasion. Furthermore, correlation analysis revealed there were significant correlative patterns in the LNM across different levels.ConclusionsThis study elucidated the patterns of primary LNM in patients with NSCLC who had not undergone surgery (without any treatment interventions) and the correlations between lymph node levels. These findings were expected to provide useful reference for target volume delineation in definitive concurrent chemoradiotherapy in locally advanced NSCLC patients.

Enhancement on CT for preoperative diagnosis of metastatic lymph nodes in thyroid cancer: a comparison across experience levels.

To investigate the diagnostic performance and interobserver agreement of quantitative CT parameters indicating strong lymph node (LN) enhancement in differentiated thyroid cancer (DTC), comparing them with qualitative analysis by radiologists of varying experience. This study included 463 LNs from 399 patients with DTC. Three radiologists independently analyzed strong LN enhancement on CT. Qualitative analysis of strong enhancement was defined as LN cortex showing greater enhancement than adjacent muscles on the arterial phase. Quantitative analysis included the mean attenuation value (MAV) of LN on arterial phase (LNA) and venous phase (LNV), LNA normalized to the common carotid artery (NAVCCA), internal jugular vein (NAVIJV), and sternocleidomastoid muscle (NAVSCM), attenuation difference [AD; (LNA - MAVSCM)], and relative washout ratio [((LNA - LNV)/LNA) × 100]. The interobserver agreement and diagnostic performance of the quantitative and qualitative analyses were evaluated. Interobserver agreement was excellent for all quantitative CT parameters (ICC, 0.83-0.94) and substantial for qualitative assessment (κ = 0.61). All CT parameters except for LNV showed good diagnostic performance for metastatic LNs (AUC, 0.81-0.85). NAVCCA (0.85, 95% CI: 0.8-0.9) and AD (0.85, 95% CI: 0.81-0.89) had the highest AUCs. All quantitative parameters except for NAVIJV had significantly higher AUCs than qualitative assessments by inexperienced radiologists, with no significant difference from assessments by an experienced radiologist. Quantitative assessment of LN enhancement on arterial phase CT showed higher interobserver agreement and AUC values than qualitative analysis by inexperienced radiologists, supporting the need for a standardized quantitative CT parameter-based model for determining strong LN enhancement. When assessing strong LN enhancement in DTC, quantitative CT parameters indicating strong enhancement can improve interobserver agreement, regardless of experience level. Therefore, the development of a standardized diagnostic model based on quantitative CT parameters might be necessary. Accurate preoperative assessment of LN metastasis in thyroid cancer is crucial. Quantitative CT parameters indicating strong LN enhancement demonstrated excellent interobserver agreement and good diagnostic performance. Quantitative assessment of contrast enhancement offers a more objective model for the identification of metastatic LNs.

Washout CYFRA 21-1: A tool to improve diagnostic accuracy of fine needle aspiration in the diagnosis of metastatic lymph nodes in papillary thyroid cancer

Thyroid carcinoma has an increasing incidence of endocrine system cancers. Fine needle aspiration cytology (FNAC) and thyroglobulin (Tg) are the primary diagnostic modalities employed for assessing metastatic lymph nodes (LNs) in thyroid cancer. Due to the limited accuracy, rare patients benefited from these procedures. In this research, we aimed to discover a dependable biomarker that could increase the accuracy of FNAC's ability to diagnose metastatic LNs among patients suffering from papillary thyroid cancer (PTC). From March 2021 to July 2023, 99 LNs from PTC patients who had thyroid ultrasonography suspicions of metastases were examined. All patients underwent FNAC, washout Tg and CYFRA 21-1 measurements. Surgical histology and a subsequent FNAC were utilized to validate the outcomes of LNs. In our study, the optimal cut-off value for CYFRA 21-1 washout fluid was 1.145 ng/mL, with a specificity of 94.00 % (slightly lower than Tg and FNAC at 98 %). However, CYFRA 21-1 demonstrated significantly higher diagnostic sensitivity (85.71 %) and accuracy (86.41 %) compared to Tg (71.43 %, 81.55 %) and FNAC (69.39 %, 80.58 %). Furthermore, FNAC plus washout CYFRA 21-1 performed better in diagnosing the metastatic LNs in PTC than FNAC plus Tg, which may indicate a novel solution for metastatic LNs diagnosis in PTC.

Risk factors associated with false negative rate of sentinel lymph node biopsy in endometrial cancer: a systematic review and meta-analysis.

Currently, sentinel lymph node biopsy (SLNB) is increasingly used in endometrial cancer, but the rate of missed metastatic lymph nodes compared to systemic lymph node dissection has been a concern. We conducted a systematic review and meta-analysis to evaluate the false negative rate (FNR) of SLNB in patients with endometrial cancer and to explore the risk factors associated with this FNR. Three databases (PubMed, Embase, Web of Science) were searched from initial database build to January 2023 by two independent reviewers. Studies were included if they included 10 or more women diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage I or higher endometrial cancer, the study technique used sentinel lymph node localization biopsy, and the reported outcome metrics included false negative and/or FNR. Two authors independently reviewed the abstracts and full articles. The FNR and factors associated with FNR were synthesized through random-effects meta-analyses and meta-regression. We identified 62 eligible studies. The overall FNR for the 62 articles was 4% (95% CL 3-5).There was no significant difference in the FNR in patients with high-risk endometrial cancer compared to patients with low-risk endometrial cancer. There was no difference in the FNR for whether frozen sections were used intraoperatively. The type of dye used intraoperatively (indocyanine green/blue dye) were not significantly associated with the false negative rate. Cervical injection reduced the FNR compared with alternative injection techniques. Indocyanine green reduced the FNR compared with alternative Tc-99m. Postoperative pathologic ultrastaging reduced the FNR. Alternative injection techniques (other than the cervix), Tc-99m dye tracer, and the absence of postoperative pathologic ultrastaging are risk factors for a high FNR in endometrial cancer patients who undergo SLNB; therefore, we should be vigilant for missed diagnosis of metastatic lymph nodes after SLNB in such populations. http://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023433637.

PET Imaging of Fibroblast Activation Protein in Various Cancers Using [18F]AlF‑NOTA‑FAPI‑04: Comparison with 18F-FDG in a Single-Center, Prospective Study

ObjectivesTargeting fibroblast-activation protein is a newer diagnostic approach for the visualization of tumor stroma, and a novel aluminum-[18F] fluoride (Al18F)-labeled fibroblast-activation protein inhibitor-4 (FAPI-04), hereafter [18F] AlF-NOTA-FAPI-04, presents a promising alternative to gallium 68 (68Ga)–labeled FAPI owing to its relatively longer half-life. This study sought to evaluate the clinical usefulness of [18F] AlF-NOTA-FAPI-04 PET/CT for the diagnosis of various types of cancer, compared with [18F] FDG PET/CT. Materials and MethodsIn this prospective study conducted from October 2021 to January 2024, a total of 148 patients with 16 different tumor entities underwent contemporaneous 18F-FDG and 18F-FAPI-04 PET/CT either for an initial assessment or for recurrence detection. Uptake of 18F-FDG and 18F-FAPI-04 was quantified by the maximum standard uptake value (SUV max). Diagnostic sensitivity, specificity and accuracy were compared by using the McNemar test between these two imaging agents. Results18F-FAPI-04 PET/CT could clearly depict 16 different types of cancer with excellent image contrast, thereby leading to a higher detection rate of primary tumors than did 18F-FDG PET/CT (98.06% vs. 81.55%, P＜0.001). In per-lymph node analysis, the sensitivity, specificity, and accuracy in the diagnosis of metastatic lymph nodes were 92.44%, 90.44%, and 91.56%, respectively, which was much higher than that 18F-FDG PET/CT (80.23%, 79.41% and 79.87%, respectively). Meanwhile, 18F-FAPI-04 PET/CT outperformed 18F-FDG PET/CT in identifying more suspected distant metastases (86.57% vs. 74.13%, P＜0.001). Furthermore, 18F-FAPI-04 PET/CT upgraded tumor staging in 36/101 patients (35.6%), and detected tumor recurrence or metastases in 43/47 patients (91.49%). ConclusionOur findings demonstrated that primary and metastatic lesions in patients with various types of malignant tumors are well-visualized on 18F-FAPI-04 PET/CT, which exhibited a superior diagnostic performance than 18F-FDG PET/CT. Moreover, 18F-FAPI-04 PET/CT is a promising tool for tumor staging and follow-up of various malignancies.

An Intelligent System of Predicting Lymph Node Metastasis in Colorectal Cancer Using 3D CT Scans

In colorectal cancer (CRC), accurately predicting lymph node metastasis (LNM) contributes to developing appropriate treatment plans and serves as the key to long‐term survival of patients. In the clinical settings, preoperative LNM diagnosis in CRC predominantly depends on computed tomography (CT). Nevertheless, lymph nodes are small in size and difficult to identify on 3D CT scans, and CT‐based diagnosis of metastatic lymph nodes is prone to a significant misdiagnosis rate and lacks consistency across clinicians. Currently, there is no automatic system available for LNM prediction in CRC via 3D CT scans. In addition, existing deep learning‐ (DL‐) based lymph node detection models present low detection accuracy and high false‐positive rates, and most existing DL‐based lymph node metastasis prediction models mainly use tumor area characteristics but fail to adequately utilize lymph node information, thus not yielding satisfactory results. To tackle these issues, we propose an intelligent diagnosis system for this challenging task, mainly including a lymph node detection (LND) model and a lymph node metastasis prediction (LNMP) model. In detail, the LND model utilizes an encoder‐decoder network to detect lymph nodes, and the LNMP model employs an innovative attention‐based multiple instance learning (MIL) network. An instance‐level self‐attention feature enhancement module is designed to extract and augment lymph node features as a bag of instances. Furthermore, a bag‐level MIL prediction module is employed to extract instance features and create a bag representation for the ultimate LNM prediction. As far as we know, the proposed intelligent system represents the pioneering method for addressing this complex clinical challenge. In experiments, our proposed intelligent system achieves the AUC of 75.4% and the accuracy of 73.9%, showcasing a significant enhancement compared to physicians specialising in CRC and highlighting its strong clinical applicability. The accessible code can be found at https://github.com/SCU-MI/IS-LNM.

Correction to: Correlation of Diffusion-weighted MR imaging and FDG PET/CT in the Diagnosis of Metastatic Lymph Nodes of Head and Neck Malignant Tumors

Correction to: Correlation of Diffusion-weighted MR imaging and FDG PET/CT in the Diagnosis of Metastatic Lymph Nodes of Head and Neck Malignant Tumors https://doi.org/10.58600/eurjther.20232902-450.y The original version of this article [1], unfortunately contained an error. The name of Aslıhan Semiz Oysu, who is one of the co-authors and took part in every stage of the study, was not inadvertently added to the author list by the corresponding author. The author apologizes for this confusion. Given in this article are the correct author names. Publisher's Note: The original article was corrected, and a correction note was added. Şahin Ş, Duymaz YK, Erkmen B, Karabulut B, Deveci İ, Sürmeli M, Şahin Yılmaz A, Semiz Oysu A, Oysu Ç (2023) Correlation of Diffusion-weighted MR imaging and FDG PET/CT in the Diagnosis of Metastatic Lymph Nodes of Head and Neck Malignant Tumors. Eur J Ther. 29(2):135-142. https://doi.org/10.58600/eurjther.20232902-450.y

Preoperative diagnosis of metastatic lymph nodes by CT-histopathologic matching analysis in gastric adenocarcinoma using dual-layer spectral detector CT.

There still remain challenges to accurate diagnosis of lymph node (LN) involvement in gastric cancer (GC) on conventional CT. This study evaluated the quantitative data derived from dual-layer spectral detector CT (DLCT) for preoperative diagnosis of metastatic LNs compared to conventional CT images. Patients with adenocarcinoma scheduled for gastrectomy were enrolled in this prospective study from July, 2021, to February, 2022. Regional LNs were labeled on preoperative DLCT. The LNs were located and matched using carbon nanoparticle solution during surgery according to their locations and anatomic landmarks on preoperative images. The matched LNs were randomly split into training and validation cohorts in a ratio of 2:1. The DLCT quantitative parameters in the training cohort were investigated using logistic regression models to identify independent predictors of metastatic LNs, and these predictors were subsequently applied to the validation cohort. Receiver operating characteristic curves were compared between the DLCT parameters and conventional CT images. Fifty-five patients were included in the study, with 267 successfully matched LNs (90 metastatic, 177 nonmetastatic). Independent predictors included arterial phase CT attenuation on 70-keV images, venous phase electron density, and clustered feature. These combination predictors had areas under the curve (AUC) of 0.855 and 0.907 in the training and validation cohorts, respectively. Compared to conventional CT criteria alone, the model had higher AUC and accuracy (0.741 vs. 0.907, 75.28% vs. 87.64%; p < 0.01) for LN diagnosis. Incorporating DLCT parameters improved preoperative diagnosis of LN metastasis in GC, increasing the accuracy of clinical N stage. Compared to conventional CT criteria, quantitative parameters from dual-layer spectral detector CT showed higher diagnostic efficacy for the preoperative diagnosis of lymph node metastases in gastric cancer, increasing the accuracy of clinical N stage. • Quantitative parameters from dual-layer spectral detector CT are useful for the preoperative diagnosis of lymph node metastases in gastric adenocarcinoma, increasing the accuracy of clinical N stage. • The values for metastatic lymph nodes are higher than those of nonmetastatic ones. The arterial phase of CT attenuation on 70-keV images, venous phase of electron density, and clustered feature independently predicted lymph node metastases. • Prediction model had area under the curve of 0.907, sensitivity of 81.82%, specificity of 91.07%, and accuracy of 87.64% for the preoperative diagnosis of lymph node metastasis.

Correlation of Diffusion-weighted MR imaging and FDG PET/CT in the Diagnosis of Metastatic Lymph Nodes of Head and Neck Malignant Tumors

Objectives: The aim of this study was to investigate the efficacy of DW-MRI as a reliable imaging modality for detecting metastatic neck lymph nodes of head and neck SCC.&#x0D; Methods: 32 patients underwent FDG PET/CT and diffusion-weighted MRI were evaluated. Histopathologic analysis of lymph node metastases was used as the gold standard for assessment. We analyzed differences in sensitivity, specificity, accuracy, positive predictive value and negative predictive value among the imaging modalities using the Chi-square test. Their discriminative power evaluated using the Receiver-Operating Characteristic curve and calculation of the area under the curve. The correlation between ADCmin and SUVmax was calculated using the Spearman test. SPSS 24 was used for statistical analyses. P value of 0.05 indicates a statistically significant difference.&#x0D; Results: A total of 32 patients with 50 neck dissections with head and neck SCC included. Sensitivity, specificity, accuracy, positive and negative predictive value of neck palpation was %72, %60, %70, %62 and %80 respectively. Sensitivity, specificity, accuracy, positive and negative predictive value of DW-MRI was %87,5, %96,2, %92, %95,5 and %89,3 respectively, according to ADCmin cutoff value 0.82×10-3s/mm2 . Sensitivity, specificity, accuracy, positive and negative predictive value of FDG-PET/CT was %91,7, %100, %96, %100 and %92,9 , respectively ,according to SUVmax cutoff value 3.4. For all neck dissections, there was a statistically significant inverse correlation between ADCmin and SUVmax (P&lt;001).&#x0D; Conclusion: DW-MRI is reliable as detecting cervical lymph node metastases as FDG-PET/CT. DWI and FDG PET/CT could play a complementary role in clinical assessment.

Diagnosis of Metastatic Lymph Nodes in Patients With Hepatocellular Carcinoma Using Dual-Energy Computed Tomography.

Our study aimed to investigate the role of quantitative parameters derived from dual-energy computed tomography (DECT) in discriminating metastatic from nonmetastatic lymph nodes in hepatocellular carcinoma (HCC). Forty-two patients (34 males; mean age, 53.7 years) with HCC underwent unenhanced computed tomography scans and triple-phase DECT scans of the upper abdomen. A total of 72 suspected lymph nodes were resected, including 43 nonmetastatic and 29 metastatic lymph nodes. The maximum short-axis diameter of the lymph nodes, iodine concentration, normalized iodine concentration (NIC), and slope of the spectral curve were analyzed for the HCC primary lesions and the suspected lymph nodes. Lymph node metastasis was confirmed by pathologic examination. A maximum short-axis diameter of >10 mm had a sensitivity and a specificity of 75.9% (22/29) and 53.5% (23/43) in diagnosing metastatic lymph nodes. The iodine concentration, NIC, and slope of the spectral curve of the nonmetastatic lymph nodes were significantly higher than those of the primary HCC lesions and the metastatic lymph nodes (all P < 0.05). Among all the analyzed spectral parameters, the NIC in the arterial phase had the highest sensitivity and specificity of 88.4% and 86.2% in diagnosing metastatic lymph nodes. The arterial phase NIC of DECT has superior diagnostic performance than the traditional lymph node size in diagnosing metastatic lymph nodes in HCC.

Non-invasive molecular imaging for precision diagnosis of metastatic lymph nodes: opportunities from preclinical to clinical applications.

Lymph node metastasis is an indicator of the invasiveness and aggressiveness of cancer. It is a vital prognostic factor in clinical staging of the disease and therapeutic decision-making. Patients with positive metastatic lymph nodes are likely to develop recurrent disease, distant metastasis, and succumb to death in the coming few years. Lymph node dissection and histological analysis are needed to detect whether regional lymph nodes have been infiltrated by cancer cells and determine the likely outcome of treatment and the patient's chances of survival. However, these procedures are invasive, and tissue biopsies are prone to sampling error. In recent years, advanced molecular imaging with novel imaging probes has provided new technologies that are contributing to comprehensive management of cancer, including non-invasive investigation of lymphatic drainage from tumors, identifying metastatic lymph nodes, and guiding surgeons to operate efficiently in patients with complex lesions. In this review, first, we outline the current status of different molecular imaging modalities applied for lymph node metastasis management. Second, we summarize the multi-functional imaging probes applied with the different imaging modalities as well as applications of cancer lymph node metastasis from preclinical studies to clinical translations. Third, we describe the limitations that must be considered in the field of molecular imaging for improved detection of lymph node metastasis. Finally, we propose future directions for molecular imaging technology that will allow more personalized treatment plans for patients with lymph node metastasis.

Accurate preoperative staging with [68Ga]Ga-FAPI PET/CT for patients with oral squamous cell carcinoma: a comparison to 2-[18F]FDG PET/CT.

To evaluate the potential value of [68Ga]Ga-labelled fibroblast activation protein inhibitor ([68Ga]Ga-FAPI) positron emission tomography/computed tomography (PET/CT) in preoperative staging for patients with oral squamous cell carcinoma (OSCC) as compared to 2-[18F]fluoro-2-deoxy-D-glucose (2-[18F]FDG) PET/CT. Thirty-six treatment-naïve patients with OSCC who underwent 2-[18F]FDG and [68Ga]Ga-FAPI PET/CT for preoperative staging were enrolled. The maximum standardised uptake value (SUVmax) of the primary tumour and suspected cervical metastatic lymph nodes, and the tumour-to-background ratio (TBR) of the primary tumour, were measured. The accuracy of two imaging modalities for preoperative diagnosis of metastatic lymph nodes was analysed. Histopathology served as the standard of reference. Thirty-seven primary lesions of 36 patients were accurately detected by both [68Ga]Ga-FAPI and 2-[18F]FDG PET/CT. Regarding primary tumours, the SUVmax and TBR of the two imaging modalities in stage T3-T4 were significantly higher than those of stage T1-T2 (all p < 0.05). On the patient analysis, the accuracy for the evaluation of N1-N3 neck status was 52.6% (10/19) for [68Ga]Ga-FAPI PET/CT and 57.9% (11/19) for 2-[18F]FDG PET/CT. Notably, the accuracy for the evaluation of the N0 neck status between [68Ga]Ga-FAPI and 2-[18F]FDG PET/CT was 100% (17/17) and 29% (5/17), respectively. Based on the patient, neck side and neck level, [68Ga]Ga-FAPI PET/CT resulted in higher specificity and accuracy in diagnosing metastatic neck lymph nodes than 2-[18F]FDG PET/CT (all p < 0.05). [68Ga]Ga-FAPI PET/CT is a promising tool for preoperative staging of OSCC, and appears to reduce the false positivity seen with 2-[18F]FDG PET/CT for the detection of neck lymph node metastases. • [68Ga]Ga-FAPI PET/CT is a promising tool targeting cancer-associated fibroblasts with comparable diagnostic performance to 2-[18F]FDG PET/CT for identifying the primary lesions of OSCC. • [68Ga]Ga-FAPI PET/CT showed higher specificity and accuracy for the evaluation of neck lymph node metastases of OSCC than 2-[18F]FDG PET/CT, especially for N0 neck status.

Malignant Cervical Lymphadenopathy among Fine Needle Aspiration Cytology in a Tertiary Care Center in Far Western Nepal: A Descriptive Cross-sectional Study

Introduction Metastatic cervical lymphadenopathy is a diagnostic and therapeutic challenge. The utility of Fine Needle Aspiration Cytology is well established in the diagnosis of metastatic lymph nodes, new-onset, or recurrence. This study aims to find the prevalence of metastatic cervical lymphadenopathy among fine needle aspiration cytology in a tertiary care center in far western Nepal. Materials and Methods This is a descriptive cross-sectional study carried out in Seti Provincial Hospital and Maya Metro Hospital, Dhangadhi, Kailali, Nepal between July 2018 to December 2019. Total 534 cervical lymph node aspirations were performed during this period out of which 48 cases were cytologically proven as malignant lymph nodes. Clinical charts and cytology reports of patients with malignant lymph nodes were reviewed. Results Out of 534 cervical lymph node aspirations performed during the study period, the number of malignant lymph nodes was 48 (8.99%). Among malignant lymph nodes (n=48), primary hematolymphoid malignancy was 14 (29.17%) and metastatic cervical lymphadenopathy was 34 (70.83%). Metastatic squamous cell carcinoma was the most common etiology of metastatic cervical lymphadenopathy followed by nasopharyngeal carcinoma and papillary carcinoma of the thyroid. Conclusion Fine needle aspiration cytology has been proved to be a valuable tool in the initial evaluation of metastatic cervical lymphadenopathy in resource-limited settings. Metastatic squamous cell carcinoma is the most common diagnosis in metastatic cervical lymphadenopathy.

Comparative study of core needle biopsy and fine needle aspiration in the treatment of metastatic lymph nodes guided by contrast-enhanced ultrasound.

Objectives:To compare the diagnostic efficacy of fine needle aspiration (FNA) and core needle biopsy (CNB) for metastatic lymph nodes guided by contrast-enhanced ultrasound (CEUS), and to provide reference for clinical selection of puncture methods.Methods:A total of 168 patients who were admitted to Baoding No.1 Central Hospital from June 2020 to January 2021 and required puncture of the diseased lymph nodes were included. Seventy six patients were guided by conventional ultrasound, of which 37 received FNA and 39 received CNB. 92 patients were guided by CEUS, of which 41 received FNA and 51 received CNB. The diagnostic accuracy of FNA and CNB guided by conventional ultrasound and CEUS was compared, and the sensitivity, specificity, positive predictive value, and negative predictive value of FNA and CNB in the diagnosis of metastatic lymph nodes guided by CEUS were further compared.Results:The diagnostic accuracy of FNA and CNB guided by CEUS were higher than that guided by conventional ultrasound, with a statistically significant difference (P<0.05). The sensitivity, specificity, positive predictive value, and negative predictive value of FNA and CNB in the diagnosis of metastatic lymph nodes were 95.0%, 95.2%, 95.0%, 95.2%, 100%, 100%, 100%, 100%, respectively, with statistically significant differences (P>0.05).Conclusion:CEUS can guide puncture and improve diagnosis accuracy. No statistical difference can be seen in the diagnostic efficacy of CNB and FNA for metastatic lymph nodes, CNB can provide more diagnostic information, while FNA can replace CNB for metastatic lymph nodes adjacent to blood vessels and difficult to operate.

The role of apparent diffusion coefficient (ADC) in the evaluation of lymph node status in patients with locally advanced cervical cancer: our experience and a review.

PurposeTo evaluate the role of apparent diffusion coefficient (ADC) value measurement in the diagnosis of meta-static lymph nodes (LNs) in patients with locally advanced cervical cancer (LACC) and to present a systematic review of the literature.Material and methodsMagnetic resonance imaging (MRI) exams of patients with LACC were retrospectively eva-luated. Mean ADC, relative ADC (rADC), and correct ADC (cADC) values of enlarged LNs were measured and compared between positron emission tomography (PET)-positive and PET-negative LNs. Comparisons were made using the Mann-Whitney U-test and Student’s t-test. ROC curves were generated for each parameter to identify the optimal cut-off value for differentiation of the LNs. A systematic search in the literature was performed, exploring several databases, including PubMed, Scopus, the Cochrane library, and Embase.ResultsA total of 105 LNs in 34 patients were analysed. The median ADC value of PET-positive LNs (0.907 × 10-3 mm2/s [0.780-1.080]) was lower than that in PET-negative LNs (1.275 × 10-3 mm2/s [1.063-1.525]) (p < 0.05). rADC and cADC values were lower in PET-positive LNs (rADC: 0.120 × 10-3 mm2/s [–0.060-0.270]; cADC: 1.130 [0.980-1.420]) than in PET-negative LNs (rADC: 0.435 × 10-3 mm2/s [0.225-0.673]; cADC: 1.615 [1.210-1.993]) LNs (p < 0.05). ADC showed the highest area under the curve (AUC 0.808).ConclusionsMean ADC, rADC, and cADC were significantly lower in the PET-positive group than in the PET-negative group. The ADC cut-off value of 1.149 × 10-3 mm2/s showed the highest sensitivity. These results confirm the usefulness of ADC in differentiating metastatic from non-metastatic LNs in LACC.

Ultrasensitive magnetogenoassay for detection of microRNA for diagnosis of metastatic lymph nodes in head and neck cancer using disposable electrodes

A fast and simple magnetogenoassay is proposed for diagnosis of metastatic lymph nodes in patients with head and neck squamous cell carcinoma (HNSCC). The developed method involved the construction of a low-cost disposable electrochemical sensor (DES) for the detection of microRNA-203 (miRNA-203) as a biomarker in lymph node samples from patients with HNSCC. A hairpin DNA designed for selectively binding the miRNA-203 was immobilized in magnetic particles (MPs) and used to capture and separate the biomarker from the sample solution. Gold nanoparticles (AuNPs) decorated with single-stranded DNA with a sequence complementary to the hairpin terminal section were prepared and used for biomarker detection. The miRNA-203 magneto-bioconjugate obtained was added to the DES and the biomarker was quantitatively determined by means of the redox properties of the gold present in the AuNPs, using square-wave voltammetry in 0.2 mol L-1 HCl. The proposed method presented a linear range from 1.0 to 500.0 fmol L−1, with a limit of detection of 0.52 fmol L−1. The magnetogenoassay was able to detect the miRNA-203 in 90 min, showing similar results when compared with qRT-PCR for the discrimination of positive and negative metastatic lymph nodes from HNSCC patients. The proposed molecular test requires no amplification steps, offering an effective, simple, and fast alternative for the detection of microRNAs as biomarkers for cancer diagnosis.

Evaluation of the combined role of axillary ultrasound with fine-needle aspiration cytology and sentinel lymph node biopsy in detecting axillary metastasis in clinically N0 axilla at tertiary care center Kerala

Background: Sentinel lymph node biopsy (SLNB) is the gold standard for histopathological staging of early breast cancer. Combination of axillary ultrasound with fine-needle aspiration cytology (Ax US with FNAC) of suspicious lymph nodes, specificity for diagnosis of metastatic lymph nodes can be increased.Methods: This prospective study was done among 205 cases with clinically N0 axilla visited at surgical oncology department at Amrita institute of medical sciences from January 2014 to February 2017. Exclusion criteria was patients with locally advanced breast cancer, previous axillary surgery, prior breast irradiation, proven distant metastasis, inflammatory breast cancer and neo-adjuvant chemotherapy. All patients were subjected to ultrasound of breast and axilla during preoperative evaluation. Suspicious looking nodes were subjected to image guided FNAC. Benign appearing nodes or a negative FNAC, a SLNB procedure with intra-operative frozen section sentinel node (FS SN) was performed at the time of surgery.Results: Present study found sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of Ax US was 62.9%, 84.4%, 67.7%, 81.4% and 77.1% respectively. Sensitivity, specificity, PPV, NPV and accuracy of Ax US with FNAC was 90.0%, 100.0%, 100.0%, 83.3% and 93.3% respectively. Sensitivity, specificity, PPV, NPV and accuracy of SLNB with FS SN was 64.5%, 97.5%, 87.0%, 91.5% and 90.8% respectively.Conclusions: US guided fine-needle aspiration biopsy (FNAB) has highest specificity and sensitivity. Combining Ax US±FNAC and intra-operative FS SN in the detecting axillary metastasis very much decrease the chance of false results. The results of sonography would allow patients with sonographically positive axillae to be directed to axillary lymph node dissection (ALND). The remaining patients would be candidates for SN biopsy.

Comparative study of two contrast agents for intraoperative identification of sentinel lymph nodes in patients with early breast cancer.

The use of contrast-enhanced ultrasound (CEUS) to locate sentinel lymph nodes (SLNs) in breast cancer has been studied more and more in recent years. This prospective study aimed to compare periareolar injection of two different contrast agents, SonoVue® (SNV) and Sonazoid® (SNZ), followed by CEUS to identify SLNs in breast cancer patients with clinically negative nodes. A total of 205 patients with T1-2N0M0 breast cancer were divided into the SNV group and SNZ group. All were administered a periareolar injection of SNV or SNZ and underwent US to identify contrast-enhanced SLNs. Each contrast-enhanced SLN underwent a biopsy with blue dye and examined again by CEUS in vitro. In all cases, contrast-enhanced lymphatic vessels were clearly visualized using US soon after the periareolar injection of SNZ, and the SLNs were easily identified. The SLN identification rates were 75.27% (210/279) for SNV and 93.58% (102/109) for SNZ. Although the accuracy of detecting SLN metastasis was slightly different between the two groups, there was no statistically significant difference between those groups (P=0.615). Moreover, it was possible to identify SLNs in vitro in the SNZ group, and these could be compared with the lymph nodes (LNs) located using SNZ during the preoperative stage and with blue dye during the procedure. This helped in determining the resection requirements. When comparing the subdermal use of SNV and SNZ, no significant differences in the number of detected SLNs and the diagnosis of metastatic LNs were observed. Because SLNs can be detected for a longer time in living tissues with SNZ, this contrast agent may provide more intraoperative information for complete resection of all preoperative localization of SLN.

Biochip test systems in differential diagnosis of metastatic lymph nodes.

Biochip test systems in differential diagnosis of metastatic lymph nodes.

Is ultrasonographic evaluation sensitive enough to detect multicentric papillary thyroid carcinoma?

This study aimed to investigate the preoperative ultrasonographic (US) evaluation of multicentric papillary thyroid carcinoma (PTC) and to evaluate the association of US findings with lymph node metastasis and extracapsular extension in PTC. Preoperative US evaluations of patients with PTC who underwent total thyroidectomy were retrospectively investigated. Pathological perspectives and US features of PTC were analyzed. The sensitivity of US in detecting multicentric PTC was evaluated. The present study included 89 PTC patients who underwent total thyroidectomy. In total, 164 nodules were detected by preoperative US. Significant differences in US pattern were found between benign and malignant nodules. Of the 89 patients with PTC, 33 (37.08%) cases were confirmed as multicentric PTC by operation and pathological examination, 22 (66.67%) of which were bilateral. Before surgery, only 23 patients were suspected as multicentric PTC based on US findings. Pathological examination revealed that malignant nodules in 17 (51.51%) patients with multicentric PTC had been missed by preoperative US. The malignant nodules that went undetected by US were micronodulars (1-4 mm). Furthermore, ultrasonography was less sensitive for the diagnosis of metastatic lymph nodes in the neck. US had more than 80% sensitivity for detection of extracapsular extension of cases. US evaluation is not sensitive enough to detect multicentric PTC. The minute size of some nodules in multicentric PTC, may lead to them being missed by US evaluation. Ultrasonography is an optional tool for the detection of extracapsular extension, but it is less sensitive for diagnosing lymph node metastasis.