Nodal Disease Research Articles

Technical Considerations for Oncologic Colectomy

AbstractColectomy for malignant tumors or unresectable benign tumors requires preoperative planning based on cross-sectional imaging, consideration of neoadjuvant therapy, a decision on the extent of lymphadenectomy, and comprehensive knowledge of the relevant anatomy. Imaging review is critical for determining resectability and noting any aberrant anatomy. Based on the imaging, neoadjuvant therapy should be considered for bulky or locally advanced disease. The anatomical resection of the colon, mesentery, and lymph node basins is performed in accordance with the concept of complete mesocolic excision (CME), entailing the resection of the mesentery with visceral peritoneum intact, appropriate proximal and distal margins taken en bloc, and high ligation of the primary feeding vessels along which the lymph nodes are positioned. High ligation of the colic arteries is part of a standard lymphadenectomy and is intended to address possible micrometastatic nodal disease and proper staging for adjuvant therapy. Extended lymphadenectomy in the form of CME with central vascular ligation is indicated for patients with advanced T stage or clinical lymphadenopathy. Whether extended lymphadenectomy should be performed routinely is subject to debate. In this article, we review the indications and operative strategies for management of colon cancer in various locations in the colon, as well as key considerations for minimally invasive colectomy and advanced techniques such as CME with central vascular ligation.

Current Paradigm and Future Directions in the Management of Nodal Disease in Locally Advanced Cervical Cancer

Approximately 36% of patients with cervical cancer present with regional nodal metastasis at diagnosis, which is associated with adverse survival outcomes after definitive treatment. In the modern era of chemoradiotherapy (CRT) and image-guided adaptive brachytherapy (IGABT), where excellent local control is achieved for patients with locally advanced cervical cancer (LACC), nodal failure remains a major challenge to cure. To optimize treatment outcomes for node-positive LACC and reduce the incidence of nodal failure, various treatment approaches have been explored, including methods of surgical nodal staging or dissection, RT dose escalation strategies, such as intensity-modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) to involved nodes, and elective treatment of subclinical para-aortic (PAO) disease. Additionally, there is growing interest in emerging precision RT techniques, such as magnetic resonance-guided radiotherapy (MRgRT) and proton therapy, which may allow for further improvement in the therapeutic ratio. This review outlines the various methods of detection of nodal metastasis, treatment options for node-positive LACC, techniques of nodal radiotherapy and their clinical evidence in efficacy and toxicity profiles. Furthermore, recent advances in systemic therapy and promising novel therapeutic directions that may shape the management of node-positive LACC are discussed.

Trends in Investigations for Suspected Head and Neck Carcinoma of the Unknown Primary: A HNCIG andIFHNOS International Survey of Practice.

The aim of this clinical survey was to assess variations in head and neck squamous cell carcinoma from an unknown primary (HNSCCUP) diagnostic practices across international centers. Clinical practice survey of experts nominated by Head and Neck Cancer International Group (HNCIG) and International Federation of Head and Neck Oncologic Societies (IFHNOS). Responses were received from 48/49 (97.9%) participants. Outpatient laryngoscopy, CT, and 18-FDG-PETCT were used always or most of the time by 81.3%, 77.1%, and 79.2%, but only 50% regularly used MRI. Unilateral and bilateral tonsillectomy were frequently performed in 41.6% and 27.1% of unilateral nodal disease, and in 18.8% and 52.1% for bilateral disease. Ipsilateral Tongue Base Mucosectomy (TBM) was used always or most of the time in 12.5% of unilateral and 6.3% of bilateral HNSCCUP. Bilateral TBM was used in 10.4% for unilateral and 22.9% for bilateral cancers. While there is broad agreement regarding examination and cross-sectional imaging, there are considerable differences in the surgical strategies used to identify occult primaries.

The prognostic significance of circulating tumor DNA in patients with positive lymph node disease after robotic-assisted radical cystectomy: A contemporary analysis

Background and objectiveNeoadjuvant therapy followed by radical cystectomy with lymphadenectomy remains the gold standard of treatment in patients with muscle-invasive bladder cancer. Pathologically positive lymph node (pN+) disease is known to convey a poor prognosis. Tumor-informed circulating tumor DNA (ctDNA) has emerged as a possible novel prognostic biomarker in the field. We seek to assess recurrence-free survival (RFS) for patients undergoing robotic-assisted radical cystectomy (RARC) with extended pelvic lymphadenectomy (ePLND) and to assess whether ctDNA status can be a prognostic marker for RFS outcomes in patients with pN+ disease. MethodsPatients who underwent RARC + ePLND during 2015 to 2023 were included. A sub-group analysis (n = 109) of patients who had prospectively collected serial-longitudinal tumor-informed ctDNA analyses during 2021-2023 was performed. Survival analysis and Cox-regression models were conducted. ResultsIncluded were 458 patients with a median age of 69 (IQR 63–76), and a median follow-up time of 20 months (IQR 10-37). RFS for pN0 (n = 353) and pN+ (n = 105) at 12, 24 and 36 months were 87% vs. 54%, 80% vs. 39%, and 74% vs. 35%, respectively (log-rank, P < 0.0001). On Cox multivariate analysis ≥pT3 disease (Hazzard ratio [HR] = 3.36 [2.18–5.18], P < 0.001), pN+ disease (HR = 2.39 [1.55–3.7], P < 0.001), and recipients of neoadjuvant treatment (HR = 1.61 [1.11–2.34], P = 0.013) were predictive of disease relapse. Patients with pN+ disease and undetectable precystectomy or postcystectomy ctDNA status had similar RFS to patients with pN0 with undetectable ctDNA. On Cox-regression multivariate sub-group analysis, detectable precystectomy ctDNA status (HR = 3.89 [1.32–11.4], P = 0.014), detectable ctDNA status in the minimal residual disease window ([MRD], HR = 2.89 [1.12–7.47], P = 0.028), and having ≥pT3 with pN+ disease (HR = 4.2 [1.43–12.3], P = 0.009) were predictive of disease relapse. ConclusionsPatients with pN+ .after RARC had worse oncological outcomes than patients with pN0 disease. Undetectable ctDNA status was informative of RFS regardless of nodal status at both the precystectomy and the MRD window. Patients with undetectable ctDNA status and pN+ disease may benefit from treatment de-escalation.

Correspondence on “Predicting the Risk of nOdal disease with histological and Molecular features in Endometrial cancer the prospective (PROME) trial” by Bogani et al

Correspondence on “Predicting the Risk of nOdal disease with histological and Molecular features in Endometrial cancer the prospective (PROME) trial” by Bogani et al

Radiologic findings of occult nodal metastasis during clinically-N0 salvage total laryngectomy.

Occult nodal disease (OND) during clinically-N0 salvage total laryngectomy (TL) can be detected with the Neck-Imaging-Reporting-and-Data-Systems (NI-RADS). However, some patients will still have OND revealed on final pathology. A retrospective study on all patients who had OND during salvage TL with elective neck dissection (END) between 2009 and 2021 was performed. Repeat CT and PET scan interpretation was performed to evaluate their preoperative imaging for suspicious features. Among 81 salvage TL patients undergoing END, 12 (16%) had OND and a total of 26 occult nodes were identified. On pathology, the average node length [SD] was 0.6 cm [0.3]. On CT, 31% (8 of 26) had rounded morphology. On PET, most had SUVmax below blood pool. One patient scored NI-RADS 2; the rest scored 1. On re-review of preoperative imaging, occult nodes were subtle and challenging to identify. Despite no clear impact on survival, performing an END may provide prognostic information.

Laryngeal Carcinoma Radiologic Staging and What the Surgeon Wants to Know

Laryngeal cancer accounts for approximately 25% of head and neck cancers and is an extremely morbid malignancy, severely affecting quality of life by impeding the ability to communicate, swallow, and breathe. Patients can present with a myriad of symptoms including hoarseness, pain, dysphagia, and even otalgia. Initial clinical evaluation often includes laryngoscopy, assessing for mucosal lesions and vocal fold mobility. Imaging has a secondary role in laryngeal cancer confined to the mucosal surface, as clinical evaluation is more sensitive for the detection and evaluation of small mucosal lesions. However, T1 and T2 lesions may still be encountered as part of an initial evaluation or incidental presentation. While laryngoscopy can determine the superficial extent and size of a lesion, CT and MRI are central in determining deep tissue extent, invasion into adjacent tissues, and evidence of nodal metastases. Treatment options include surgical resection, chemotherapy, and/or chemoradiation therapy. Surgical options can be as limited as transoral laser microsurgery or as extensive as total laryngopharyngectomy. In this setting, the radiologist plays a vital role, as imaging interpretation will help determine the treatment regimen. Imaging findings largely dictate the T stage based on compartment/subsite location, additional subsite or adjacent tissue invasion, visible involvement of the vocal cord(s), and invasion beyond the larynx. Imaging is also key to the assessment for nodal or metastatic disease. Accurate staging is key, as overstaging could lead to unnecessary total laryngectomy, whereas understaging could contribute to treatment failure.

Colorectal cancer lymph node dissection and disease survival.

The debate regarding the two possible roles of lymphadenectomy in surgical oncology, prognostic or therapeutic, is still ongoing. Furthermore, the use of lymphadenectomy as a proxy for the quality of the surgical procedure is another feature of discussion. Nevertheless, this reckoning depends on patient conditions, aggressiveness of the tumor, the surgeon, and the pathologist, and then it is not an absolute surrogate for the surgical quality. The international guidelines recommend a minimum of 12 lymph nodes harvested for pathological examination in colorectal cancer (CRC) surgery. There is a growing literature on reporting better survival when the lymph node yield is high, even when these nodes are negative for malignancy. On the other hand, there are studies reporting no survival benefit with high lymph node yield in stage I-II of CRC. Herein we review the roles of the lymphadenectomy in CRC, and discuss the results of studies on lymph node harvesting.

Unusual metastatic lymph node to retro-scapular area in occult breast cancer, a case report

Introduction: Breast cancer typically metastases to axillary, internal mammary and supraclavicular lymph node chains. In contrast, occult breast cancer (OBC), a rare form of breast cancer, usually presents as axillary lymphadenopathy, and rarely metastasize regionally or distally. Case presentation: In this case report, we present a 45-year-old female patient with unusual presentation of breast cancer initially as axillary lymphadenopathy without breast mass. She was diagnosed by magnetic resonance imaging (MRI) as OBC, and later presented with a rare pathological spread to the ipsilateral subscapular region. The retro-scapular nodal disease was first detected via follow up computed tomography (CT) scan and confirmed by positron emission tomography (PET) after 18 months of her initial diagnoses. This occurred following completion of OBC management, which included neoadjuvant chemotherapy, axillary lymph node dissection, without mastectomy, followed by adjuvant radiation treatment to regional lymph nodes and ipsilateral whole breast. Her recurrent nodal disease was subsequently managed by surgical resection followed by radiation therapy to surgical bed. This case report emphasizes the diverse locations where metastatic breast cancer can manifest and underscores the advancements in diagnostic tools that have enhanced the detection of these metastatic sites.

The Frequency of Mediastinal Lymph Node Calcification in Sarcoidosis Patients and the Influencing Factors

Background and Objectives: This study investigates the prevalence of calcification in mediastinal lymph nodes among sarcoidosis patients and the influencing factors. Sarcoidosis is a multisystemic inflammatory disease characterized by non-caseating epithelioid granulomas. Bilateral hilar lymphadenopathy (LAP) is the most common radiographic finding, with studies showing a correlation between the frequency of lymph node calcification and disease duration, with a frequency of 3% relating to a duration of 5 years and a frequency of 20% relating to one of 10 years. Materials and Methods: This study involved fifty-seven patients diagnosed with sarcoidosis at our chest disease outpatient clinic from January 2020 to September 2022. We examined patient records to determine demographics, radiological findings, and respiratory function parameters. Results: The mean age of patients was 55.07 ± 13.53 (21–90). We identified eighty percent of patients with stage 2 sarcoidosis. Hilar lymph node calcification was observed in 13 cases (22.8%). Among the 13 cases, punctate calcification was detected in 2 (15.4%), while diffuse calcification was observed in 11 (84.6%). The mean duration of sarcoidosis diagnosis in patients was 4.1 ± 3.2 years (range: 1–14 years). Within the first 5 years after diagnosis, calcification in lymph nodes was detected in 18.6% of cases, while of patients diagnosed more than 5 years ago, 35.71% showed lymph node calcification. Conclusions: Our findings suggest that mediastinal lymph node calcification is more common than previously reported, and integrating clinical evaluation and patient history in cases with bilateral hilar LAP can help to avoid unnecessary invasive and costly procedures.

Oncologic outcomes for invasive squamous cell carcinoma with a clinically resolved biopsy site managed by watchful waiting: A retrospective cohort study.

Treatment of cutaneous squamous cell carcinoma largely involves surgical excision. Few studies have examined oncologic outcomes of tumors managed by watchful waiting when the lesion appears resolved after the biopsy site has healed. To describe oncologic outcomes for patients diagnosed with cutaneous squamous cell carcinoma that was determined clinically resolved at follow-up and subsequently managed by watchful waiting. This retrospective cohort included pathology proven cases of cutaneous squamous cell carcinoma occurring from 1/1/2013 to 4/31/2023. Each required documented clinical resolution more than 4 weeks after biopsy, management by watchful waiting, and at least 12 months of follow-up. Of 148 tumors managed by watchful waiting, there were two cases of local recurrence, and no cases of nodal metastasis, distant metastasis, or disease specific death. Log-rank test found significant risk of recurrence in immunocompromised participants (HR=12.87, p=0.0193) and those with rheumatologic disease (HR=16.18, p=0.0075). Retrospective, single-center design. The recurrence rate in this cohort compares favorably to reported recurrence rates for surgically managed cutaneous squamous cell carcinoma. In select cases, watchful waiting may be a reasonable management option for low-risk lesions that appear clinically resolved after healing of the biopsy site.

Tampa difficulty score: a scoring system for difficulty of robotic pancreaticoduodenectomy.

Robotic platforms are increasingly utilized in surgery, offering unique technical advantages, though there is a scarcity of difficulty scoring systems (DSS) for these procedures. DSS aids in understanding operative complexities and enhancing preoperative planning. With IRB approval, data were collected on 200 consecutive adult patients who underwent robotic pancreaticoduodenectomy at a high-volume institution from 2019 to 2022. Linear regression was employed on clinical variables to analyze operative time and estimated blood loss as markers of surgical complexity. Weighted scoring system was developed using significant linear coefficient values, and an ANOVA analysis created the difficulty-level grouping system. Significant variables affecting operative time and/or EBL included: history of alcoholism, preoperative endoscopic intervention, tumor size, nodal disease on preoperative imaging, pancreatic duct dilation. These factors created the DSS ranging from 0 to 33. Group 1 (0-8, n = 9), Group 2 (9-20, n = 145), Group 3 (21-26, n = 37), and Group 4 (27-33, n = 9) showed significant differences in age, history of alcoholism, preoperative jaundice, tumor size, nodal disease, and operative metrics. Our novel DSS for robotic pancreaticoduodenectomy effectively predicts intraoperative challenges and aids in preoperative planning. Future steps include validating the system internally and externally.

Level V metastases in node positive oral squamous cell carcinoma - beyond level IIA and III.

Introduction Surgical management of level V in clinically node positive (cN+) oral squamous cell carcinomas (OSCC) is controversial. The objectives of the study were to identify predictors of level V metastases in cN+ OSCC. Methods This retrospective study is based on institutional data of operated cN+ OSCC between April 2018 and December 2022. Clinical and pathological parameters were subjected to univariate analysis. Significant parameters in univariate analysis were further subjected to multivariate analysis. A p-value of less than 0.05 was considered statistically significant. Results None of cN1 or pN1 patients had a level V metastasis. No skip metastasis to level-V was noticed. Total number of positive lymph nodes, lymph node ratio (LNR), extranodal extension, pN classification, and presence of level II and III metastases were found to be significant predictors for level V metastases. The post hoc analysis suggested that ≥5 positive nodes, LNR >0.1 and pN3 status were independent risk factors for level V metastases. Conclusion Selective neck dissection for N+ OSCC is feasible in the N1 neck, preferably where nodal metastases is limited to level-I only. Patients with a bulky nodal disease, particularly those with N3 neck, ≥5 positive nodes, ENE, and metastatic lymph nodes in level II and III should be offered comprehensive neck dissection.

Human Papilloma Virus Circulating Cell-Free DNA Kinetics in Cervical Cancer Patients Undergoing Definitive Chemoradiation.

The human papillomavirus (HPV) is a significant cause of cervical cancer. We hypothesized that detecting viral cell-free HPV DNA (cfDNA) before, during, and after chemoradiation (chemoRT) could provide insights into disease extent, clinical staging, and treatment response. Sixty-six patients with locally advanced cervical cancer were enrolled between 2017 and 2023. 49 received standard-of-care (SOC) treatment and 17 participated in a clinical trial combining a therapeutic HPV vaccine (PDS0101; IMMUNOCERV). Plasma was collected at baseline, weeks 1, 3, and 5 of chemoRT, and 3-4 months after chemoRT. HPV cfDNA was quantified using droplet digital PCR targeting the HPV E6/E7 oncogenes of 13 high-risk types. MRI was performed at baseline and before brachytherapy. The median follow-up was 23 months, with recurrence-free survival (RFS) of 78.4% at 2 years. Baseline nodal disease extent correlated with HPV cfDNA levels. HPV cfDNA levels peaked in week 1 of radiation and decreased through treatment. Patients receiving the PDS0101 vaccine had a higher rate of undetectable HPV type 16 cfDNA compared to SOC. HPV cfDNA clearance correlated with better 2-yr RFS (92.9% vs. 30%, log-rank p=0.0067). The strongest predictor of RFS was HPV cfDNA clearance in follow-up achieving a concordance index (CI) 0.83, which improved when combined with MRI response (CI 0.88). HPV cfDNA levels change dynamically during chemoRT. HPV cfDNA at follow-up predicts RFS. Delivery of therapeutic HPV vaccine with chemoRT was linked to rapid HPV cfDNA decline. Monitoring HPV cfDNA during and after chemoRT may guide tailoring of personalized treatment.

De‐Escalating Surgery in Merkel Cell Carcinoma With Clinical Nodal Disease

ABSTRACTBackgroundMerkel cell carcinoma (MCC) is a radiosensitive aggressive skin cancer that spreads via the lymphatics. There is uncertainty regarding the optimal management of the nodal basin for patients with MCC with clinically positive nodes. We study the efficacy of single node excision (SNE) as an alternative to a therapeutic lymph node dissection (TLND) in patients with limited nodal disease.MethodsWe performed a retrospective cohort study of patients with MCC with clinical nodal disease who underwent resection in the form of either SNE or TLND using the National Cancer Database. The association between type of surgery and overall survival (OS) was estimated using the Kaplan–Meier method and Cox proportional hazards modeling.Results1835 patients met all inclusion criteria with 281 patients undergoing SNE and the remainder undergoing TLND. Patients receiving SNE and TLND were equally likely to receive radiation to the nodal basin (SNE 44.5% vs. TLND 48.5%, p = 0.22). There was no difference in 5‐year OS between patients who received SNE versus TLND (SNE 43.9% vs. TLND 44.7%, p = 0.36). This persisted in a multivariable Cox proportional hazards model in which receipt of SNE remained not significantly associated with survival after adjusting for clinical and treatment factors including receipt of radiation (Hazard Ratio [HR] 1.17, 95% CI 0.96–1.42, p = 0.11). In patients undergoing SNE with radiation, 5‐year OS was 54.4% (95% CI 44.1–63.6).ConclusionsTLND is not associated with a survival advantage over SNE. Further prospective study into patterns of recurrence and safety of SNE is needed.

Diagnostic Value of Endobronchial Ultrasound-Guided Intranodal Forceps Biopsies Combined with Rapid On-Site Evaluation for Mediastinal/Hilar Lymph Node Disease

Aims/Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the standard method for sampling mediastinal/hilar lymph node disease. However, the smaller samples obtained via needle aspiration have a lower diagnostic rate for benign compared to malignant diseases. The low diagnostic rates have been reported to be improved through using endobronchial ultrasound-guided intranodal forceps biopsy (EBUS-IFB), but the implementation of IFB presents technical challenges, as described with variable results in certain studies. The main objective of this study was to investigate the diagnostic value and safety of EBUS-IFB for mediastinal/hilar lymph node disease. Methods A retrospective analysis was conducted on 150 patients with mediastinal/hilar lymph node disease at Tianjin Medical University General Hospital. EBUS-TBNA was performed using a rigid bronchoscope on the same lymph node of each patient under general anesthesia, with rapid on-site evaluation (ROSE) conducted to determine the presence of pathological tissue. Following this, a tunnel was established, and a 1.5 mm biopsy forceps was employed for EBUS-IFB. Subsequently, diagnostic rates and safety of the methods used were determined. Results EBUS-IFB + EBUS-TBNA (the combined strategy) exhibited the highest diagnostic rates, with the addition of bronchial mucosa biopsy/transbronchial lung biopsy/neoplasm biopsy contributing to a successful diagnostic rate of 97.2% (139/143). The combined strategy (90.2%) and EBUS-IFB alone (88.1%) contributed to successful diagnosis for all diseases, with rates significantly higher than that of EBUS-TBNA (60.1%) (p &lt; 0.001). The diagnostic rates for malignant disease detected with the combined strategy (97.4%) and EBUS-IFB alone (93.6%) were significantly higher than that with EBUS-TBNA alone (71.8%) (p &lt; 0.001). Both the diagnostic rates for sarcoidosis detected with the combined strategy and EBUS-IFB alone were 87.8%, which was significantly higher than that with EBUS-TBNA alone (46.9%) (p &lt; 0.001). The procedures implemented did not engender major complications. Conclusion Routine EBUS-TBNA followed by ROSE to acquire pathological tissue, followed by tunnel formation and EBUS-IFB, can enhance the overall diagnostic rate for mediastinal/hilar lymph node lesions. This approach is particularly valuable for diagnosing malignant diseases and sarcoidosis. EBUS-IFB serves as a safe and feasible complement to EBUS-TBNA, despite the fact that the procedure was extended in duration.

The impact of extent of nodal involvement on Stage IIIA(N2) NSCLC outcomes

ObjectivesStage IIIA(N2) non-small cell lung cancer (NSCLC) treatment can depend on the extent of nodal involvement, with surgery considered for limited disease and definitive chemoradiation preferred for bulky or multi-station disease. Evidence to support management is limited. This study evaluated the impact of the extent of Stage IIIA(N2) nodal involvement on outcomes after surgery. MethodsPatients who underwent surgical resection of T1-2N2M0 NSCLC in the Surveillance, Epidemiology, and End Results (SEER) database from 2004-2019 were stratified as having limited (1 positive node) versus more extensive (>1 positive node) nodal disease, and survival was evaluated with Kaplan-Meier and Cox analyses. ResultsOf the 6,933 patients identified surgical patients, 2,129 (30.7%) had limited nodal disease while 4,804 (69.3%) had more extensive nodal involvement. The limited nodal group had higher 5-year overall survival than the more extensive node group (39.3% vs 30.3%, p<0.001), and more extensive nodal involvement (Hazard Ratio 1.26, p<0.001) was independently associated with worse survival in Cox analysis. Surgical patients had a higher 5-year overall survival than 1,644 comparable N2 patients with extensive nodal involvement who received definitive chemoradiation (30.9% vs 18.9%, p<0.001). ConclusionsIncreasing nodal involvement is associated with worse survival for Stage IIIA(N2) NSCLC patients but select patients with more extensive nodal disease may still benefit from surgery compared to chemoradiation.

Computer Assisted Nodule Analysis and Risk Yield is Associated with Occult Lymph Node Status in Clinical Stage I-IIA Lung Adenocarcinoma Undergoing Resection

BackgroundCurrent staging work-up does not capture all occult lymph node (OLN) disease. We sought to determine if Computer Assisted Nodule Analysis and Risk Yield (CANARY) analysis could help distinguish OLN status in early-stage lung adenocarcinoma. MethodsRetrospective review of resected lung cancer patients from 2016-2021 was performed. Patients with surgically resected clinical stage I-IIA lung adenocarcinoma were included. Preoperative imaging was entered into the CANARY software, and each lesion was categorized into good, intermediate, and poor risk. OLN status was determined per pathology results. Pearson's Chi-square correlation, univariate and multivariate logistic regression models were used to assess OLN metastases as a function of CANARY risk profile, with statistical significance at α=0.05. ResultsIn total, the study cohort included 228 patients with median age of 70. By clinical stage, 195 (85.5%), 24 (10.5%), and 9 (3.9%) patients were determined to be in IA, IB, and IIA, respectively. 28 (12.3%) patients were found to have OLN metastases. Among them, 1 (3.6%), 3 (10.7%), and 24 (85.7%) patients had a good, intermediate, and poor CANARY risk profile, respectively. CANARY risk profile was significantly associated with OLN metastases (χ2=9.9, p=0.007). Relative to the good/intermediate group, patients with poor risk had a more-than 3-fold increase in likelihood of having OLN metastases (odd ratio [OR]=3.3, 95% confidence interval [CI]:1.6-9.2, p=0.007). ConclusionCANARY analysis was able to risk-stratify the likelihood of OLN metastases in early-stage lung adenocarcinoma. CANARY can provide an adjunctive non-invasive tool to aid in determining an appropriate individualized treatment plan. Micro-abstractWe were able to identify potential prognostic capability of the Computer Assisted Nodule Analysis and Risk Yield (CANARY) program in the determination of occult lymph node metastasis in clinical stage I-IIA lung adenocarcinoma. In a single-institution cohort of 228 patients, those with poor risk determined by Score Indicative of Lung Cancer Aggression (SILA) has a 3-fold increase in likelihood of having occult lymph node metastasis (odds ratios = 3.3 [1.6-9.2]).

Prognostic Implications of the Number of Lymph Node Metastases in Oral Tongue Squamous Cell Carcinoma: A Population Study of the SEER Database and an Institutional Registry.

To investigate the impact of the number of positive lymph nodes (PLNs) on long-term survival and pathological nodal stage in patients with oral tongue squamous cell carcinoma (OTSCC). Newly diagnosed and nonmetastatic adult patients with OTSCC who underwent curative resection were identified between January 2010 and December 2020. External validation was performed via the SEER registry. Multivariate Cox proportional hazards model was employed to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of pathological nodal features. Propensity score matching (PSM) was used to assess effect of adjuvant chemoradiotherapy (ACRT). Among 518 curative-intent OTSCC patients, the number of PLNs independently predicted overall survival (OS), surpassing other pathological nodal features, including extranodal extension, laterality, and lower neck involvement. Patients with 1 or 2 PLNs had comparable worse OS than those with no PLN (median OS of 1 PLN vs. 2 PLNs vs. 0 PLN: 35.1 vs. 30.5 vs. 40.2 months), but better than those with ≥ 3 PLNs (median OS of 1-2 PLNs vs. 3 PLNs: 32.1 vs. 19.0 months). A proposed nodal category with 0, 1-2 PLNs, and ≥ 3 PLNs exhibited increasingly worse OS (HR of 1-2 PLNs and ≥ 3 PLNs vs. 0 PLN: 2.98 [95% CI: 1.89-4.71], p < 0.001; 5.47 [95% CI: 3.33-9], p < 0.001; respectively) and showed improved prediction power versus current pN staging (C-index: 0.717 vs. 0.713, p < 0.001). PSM analysis revealed that ACRT benefited patients with advanced nodal disease (≥ 3 PLNs) and improved OS. These findings were validated in SEER registry. The number of PLNs is a better predictor of overall tumor burden for OTSCC and could be a more accurate metric for survival estimation, which should be considered in future simplified pathological nodal staging for better risk stratification and decision-making in subsites of the oral cavity.

More than Skin Deep: Imaging of Dermatologic Disease in the Head and Neck.

Evaluation, staging, and treatment of skin cancers involve a multidisciplinary team, with radiology playing an integral role. Imaging evaluation of dermatologic disease that involves the head and neck is especially important due to the proximity of important structures such as nerves, bone, muscle, and lymph nodes. The authors review the pathophysiology of the most common types of skin cancer, as well as cutaneous lymphoma, and the available treatment modalities and algorithms. Emphasis is placed on pretreatment evaluation and posttreatment surveillance. In the pretreatment setting, a checklist of key radiologic features that are important in the staging of dermatologic disease is discussed, namely superficial and dermal lymphatic spread, perineural tumor invasion and spread, osseous invasion, and metastatic nodal disease. In the setting of high-risk or metastatic disease, a contrast-enhanced CT scan of the neck or a PET/CT scan is typically obtained approximately 12 weeks after treatment; imaging may be used first to detect residual or recurrent disease, metastatic nodal disease, or unexpected complications such as osteoradionecrosis. The authors highlight the radiologist's role in the care of patients with dermatologic disease, which can be more than skin deep. ©RSNA, 2024.