Evaluation Of Lymph Node Involvement Research Articles

Clinical importance of serum and pleural fluid prominin-1 and hypoxia-inducible factor-1α concentration in the evaluation of lymph node involvement in patients with malignant pleural effusion.

Malignant pleural effusion (MPE) and lymph node metastasis (LNM) presence are poor prognostic factors that have importance for cancer patients. The study objective was to determine whether hypoxia-inducible factor-1α (HIF-1α) and prominin-1 (CD133) in pleural fluid (P) and serum (S) could be used as biomarkers for diagnosis of lymph node involvement in patients with MPE. Fifty-six patients with MPE and 30 healthy control subjects were included. Computerized tomography (CT) and positron emission tomography (PET) were used to diagnose pleural effusion. Patients with malignant cells in pleural fluid cytological examination were included in the MPE group. Thirty-five patients with lymph node metastases on CT were included in the LNM-positive MPE group. Serum and pleural fluid HIF-1α and CD-133 concentrations were measured manually via enzyme-linked immunosorbent assay (ELISA). Serum concentrations of HIF-1α and CD133 were higher in MPE patients. It was found that CD133/HIF-1α (S) ratio was higher in the malignant patient group with positive lymph node involvement than in the negative group, while concentrations of HIF-1α (P) were lower. Pleural fluid HIF-1α and CD133/HIF-1α (S) ratio had sufficient performance in diagnosing lymphatic metastases in patients with MPE (AUC = 0.90 and 0.83, respectively). In conclusion, serum HIF-1α and CD133 concentrations were higher in patients with MPE, consistent with our hypothesis. Concentrations of HIF-1α (P) and CD133/HIF-1α (S) ratio can be used as biomarkers in diagnosing lymph node involvement in MPE patients, according to this experiment.

Surgical Planning after Neoadjuvant Treatment in Breast Cancer: A Multimodality Imaging-Based Approach Focused on MRI

Neoadjuvant chemotherapy (NACT) today represents a cornerstone in the treatment of locally advanced breast cancer and highly chemo-sensitive tumors at early stages, increasing the possibilities of performing more conservative treatments and improving long term outcomes. Imaging has a fundamental role in the staging and prediction of the response to NACT, thus aiding surgical planning and avoiding overtreatment. In this review, we first examine and compare the role of conventional and advanced imaging techniques in preoperative T Staging after NACT and in the evaluation of lymph node involvement. In the second part, we analyze the different surgical approaches, discussing the role of axillary surgery, as well as the possibility of non-operative management after-NACT, which has been the subject of recent trials. Finally, we focus on emerging techniques that will change the diagnostic assessment of breast cancer in the near future.

Tumorous tissue characterization using integrated 18F-FDG PET/dual-energy CT in lung cancer: Combining iodine enhancement and glycolytic activity

Positron emission tomography/computed tomography (PET/CT) with 18F-fluorodeoxyglucose (18F-FDG) has become the method of choice for tumor staging in lung cancer patients with improved diagnostic accuracy for the evaluation of lymph node involvement and distant metastasis. Due to its spectral capabilities, dual-energy CT (DECT) employs a material decomposition algorithm enabling precise quantification of iodine concentrations in distinct tissues. This technique enhances the characterization of tumor blood supply and has demonstrated promising results for the assessment of therapy response in patients with lung cancer.Several studies have demonstrated that DECT provides additional value to the PET-based evaluation of glycolytic activity, especially for the evaluation of therapy response and follow-up of patients with lung cancer. The combination of PET and DECT in a single scanner system enables the simultaneous assessment of glycolytic activity and iodine enhancement, offering further insight to the characterization of tumorous tissues. Recently a new approach of a novel integrated PET/DECT was investigated in a pilot study on patients with non-small cell lung cancer (NSCLC). The study showed a moderate correlation between PET-based standard uptake values (SUV) and DECT-based iodine densities in the evaluation of lung tumorous tissue but with limited assessment of lymph nodes.The following review on tumorous tissue characterization using PET and DECT imaging describes the strengths and limitations of this novel technique.

Locoregional CT staging of colon cancer: does a learning curve exist?

To evaluate the learning curve for locoreginal staging of colon cancer in radiologist trainees. Eighty-eight cases of colon cancer CT were included in this retrospective study. Four senior radiology residents staged the CTs according to TNM classification. Two out of four radiologists received feedback after reading every 20 cases. Radiologic staging was compared with pathologic staging and the learning curve, diagnostic performance, reader confidence and reading time were evaluated and compared between the two groups (feedback vs. no feedback). Generalized estimating equations logistic regression, QICu statistic, ANOVA and t test/Mann-Whitney test were utilized. Radiologists demonstrated a significant increase in their performance to distinguish between ≤ T2 and ≥ T3 and reached an inflection point at 38 cases, with a significant association with increased number of cases reviewed (P < 0.001). Sensitivity (P < 0.001), specificity (P = 0.030) and NPV (P = 0.002) demonstrated significant associations with increased experience. The overall reader's confidence was significantly higher in the group which received feedback (P < 0.001). There was no significant improvement in performance nor in reader's confidence for N staging (N0 vs. ≥ N1) for all readers. Reading time decreased with experience and showed a significant negative association with experience (P < 0.001). Diagnostic performance of senior radiology trainees in differentiating between T2 and T3 colon cancer on CTs improved with increased experience. In contrast, evaluation of lymph node involvement did not improve with more experience. Feedback had no significant effect on improvement of diagnostic performances.

Determining the Adequate Examined Lymph Node Count in Resected Ampullary Adenocarcinoma—A National Cohort Study

BackgroundThe evaluation of lymph node involvement is an essential component of cancer staging. Examining an inadequate number of lymph nodes potentially results in understaging. Current guidelines for lymph node retrieval for ampullary adenocarcinoma are based on data extrapolated from other periampullary malignancies and may not be applicable. The aim of this study was to determine the number of lymph nodes that should be examined in resection specimens to optimize staging in ampullary adenocarcinoma. MethodsPatients with ampullary adenocarcinoma from 2004 to 2014 were identified in the National Cancer Database. We determined the minimum examined lymph node (ELN) count by modeling each potential ELN count from 2 to 30 in a multivariable regression analysis and confirmed the results with a sensitivity analysis. ResultsWe identified 7451 patients of whom 52.2% had T3 or T4 disease and 51.4% had lymph node metastases. The median ELN count was 13 (interquartile range, 8–19). Increasing ELNs were independently associated with an increased likelihood of having positive nodal disease (odds ratio, 1.03; 95% confidence interval [CI], 1.03–1.04) and improved overall survival in both node-negative (hazard ratio [HR], 0.98; 95% CI, 0.97–0.99) and node-positive patients (HR, 0.99; 95% CI, 0.986–0.998). We determined that at least 17 lymph nodes should be examined. Overall survival for patients with 17 or more ELNs was superior than for those with fewer than 17 ELNs. ConclusionIncreasing ELNs were independently associated with improved overall survival in patients with resected ampullary adenocarcinoma. At least 17 lymph nodes should be examined for optimal nodal staging.

Carcinoma escamocelular cutáneo del tronco y las extremidades: utilidad del ganglio centinela en su estadificación

Squamous Cell Carcinoma (SCC) is associated with a more aggressive biological behaviour in the presence of risk factors. High risk SCC may present with lymph node metastasis in 21% of patients, with the consequent reduction in overall survival. The physical examination lymph nodes can have a false-negative rate between 15% and 39%, thus requiring the need to find a new diagnostic tool that allows a more precise evaluation of lymph node involvement. Sentinel lymph node biopsy has been reported in case series of patients with head and neck SCC, and genital SCC, but there are few case reports about skin SCC of the trunk and extremities. The aim of this review is to describe the indications and feasibility of using sentinel lymph node biopsy to assess lymph node status in patients with skin SCC of trunk and limbs.

Preoperative MRI evaluation of mesorectum in cases of rectal carcinoma

Objectives The aim of this study was to evaluate the accuracy of MRI in preoperative staging, in the prediction of negative circumferential resection margin (CRM), and in the planning of surgical management for rectal carcinoma. Background Rectal cancer constitutes about one-third of all gastrointestinal tumors. Preoperative imaging for staging of rectal cancer has become an important aspect of the current approach to rectal cancer management because it helps to select suitable patients for neoadjuvant chemoradiotherapy and determine the appropriate surgical technique. The purpose of this study was to assess the accuracy of MRI in the preoperative staging of rectal carcinoma, in the prediction of negative CRM, and for planning its surgical management. To this end we aimed to study its efficacy in preoperative local staging of rectal carcinoma (T and N stages), in evaluating mesorectal fat and fascia involvement, and in the prediction of negative CRM. Patients and methods Thirty-seven patients with pathologically proven rectal carcinoma underwent pelvic MRI on a 1.5 T magnet with pelvic phased array coil with transrectal gel administration. The MRI protocol was adhered to. All cases were operated upon and their postoperative specimens were compared with preoperative MRI results. Results Comparable to histopathological examination, MRI correctly diagnosed in 34 out of 37 patients in different T stages (accuracy 91.9%) and in 32 out of 37 patients in different N stages (accuracy 86.5%). Accuracy in the evaluation of mesorectal fat invasion was 97.3%, that in the evaluation of mesorectal fascia invasion was 94.5%, and that in the evaluation of CRM was 97.3%. Conclusion MRI of rectal cancer is accurate for preoperative staging, evaluation of mesorectal fat and fascia, prediction of negative CRM, and evaluation of lymph node involvement.

The Relevance of Ultrasound Imaging of Suspicious Axillary Lymph Nodes and Fine-needle Aspiration Biopsy in the Post-ACOSOG Z11 Era in Early Breast Cancer

Evaluation of nodal involvement in early-stage breast cancers (T1 or T2) changed following the Z11 trial; however, not all patients meet the Z11 inclusion criteria. Hence, the relevance of ultrasound imaging of the axilla and fine-needle aspiration biopsy (FNA) in early-stage breast cancers was investigated. In this single-center, retrospective study, 758 subjects had pathology-verified breast cancer diagnosis over a 3-year period, of which 128 subjects with T1 or T2 breast tumors had abnormal axillary lymph nodes on ultrasound, had FNA, and proceeded to axillary surgery. Ultrasound images were reviewed and analyzed using multivariable logistic regression to identify the features predictive of positive FNA. Accuracy of FNA was quantified as the area under the receiver operating characteristic curve with axillary surgery as reference standard. Of 128 subjects, 61 were positive on FNA and 65 were positive on axillary surgery. Sensitivity, specificity, positive predictive value, and negative predictive value of FNA were 52 of 65 (80%), 54 of 63 (85.7%), 52 of 61(85.2%), and 54 of 67 (80.5%), respectively. After adjusting for neoadjuvant chemotherapy between FNA and surgery, a positive FNA was associated with higher likelihood for positive axillary surgery (odds ratio: 22.7; 95% confidence interval [CI]: 7.2-71.3, P < .0001), and the accuracy of FNA was 0.801 (95% CI: 0.727-0.876). Among ultrasound imaging features, cortical thickness and abnormal hilum were predictive (P < .017) of positive FNA with accuracy of 0.817 (95% CI: 0.741-0.893). Ultrasound imaging and FNA can play an important role in the management of early breast cancers even in the post-Z11 era. Higher weightage can be accorded to cortical thickness and hilum during ultrasound evaluation.

Investigation of optical coherence micro-elastography as a method to visualize micro-architecture in human axillary lymph nodes.

BackgroundEvaluation of lymph node involvement is an important factor in detecting metastasis and deciding whether to perform axillary lymph node dissection (ALND) in breast cancer surgery. As ALND is associated with potentially severe long term morbidity, the accuracy of lymph node assessment is imperative in avoiding unnecessary ALND. The mechanical properties of malignant lymph nodes are often distinct from those of normal nodes. A method to image the micro-scale mechanical properties of lymph nodes could, thus, provide diagnostic information to aid in the assessment of lymph node involvement in metastatic cancer. In this study, we scan axillary lymph nodes, freshly excised from breast cancer patients, with optical coherence micro-elastography (OCME), a method of imaging micro-scale mechanical strain, to assess its potential for the intraoperative assessment of lymph node involvement.MethodsTwenty-six fresh, unstained lymph nodes were imaged from 15 patients undergoing mastectomy or breast-conserving surgery with axillary clearance. Lymph node specimens were bisected to allow imaging of the internal face of each node. Co-located OCME and optical coherence tomography (OCT) scans were taken of each sample, and the results compared to standard post-operative hematoxylin-and-eosin-stained histology.ResultsThe optical backscattering signal provided by OCT alone may not provide reliable differentiation by inspection between benign and malignant lymphoid tissue. Alternatively, OCME highlights local changes in tissue strain that correspond to malignancy and are distinct from strain patterns in benign lymphoid tissue. The mechanical contrast provided by OCME complements the optical contrast provided by OCT and aids in the differentiation of malignant tumor from uninvolved lymphoid tissue.ConclusionThe combination of OCME and OCT images represents a promising method for the identification of malignant lymphoid tissue. This method shows potential to provide intraoperative assessment of lymph node involvement, thus, preventing unnecessary removal of uninvolved tissues and improving patient outcomes.

Diagnostic strategy for the assessment of axillary lymph node status in breast cancer.

The nodal status in breast cancer is a major prognostic factor in terms of survival. It also plays a role in the therapeutic decision-making process. Therefore, the evaluation of lymph node involvement in breast cancer is imperative in establishing a personalized treatment scheme. The sentinel lymph node procedure has proved successful for small breast tumors (T1-T2), limiting axillary lymphadenectomy and its side effects without changing overall survival. Even so, a substantial number of women must undergo axillary lymphadenectomy during a second surgery when the analysis of the sentinel node discloses major nodal involvement. Imaging can improve patient selection, especially those who appear eligible for immediate axillary lymphadenectomy. Ultrasound is able to depict morphological abnormalities in the lymph nodes such as cortical thickening, peripheral vascularization, hilar infiltration and loss of the kidney-shaped appearance of a normal node. When ultrasound is negative, the risk of massive nodal involvement is limited, thus allowing the oncologist to take an approach with the sentinel lymph node procedure. Magnetic resonance imaging (MRI) can also be useful in detecting pathological lymph nodes, particularly with diffusion-weighted MRI sequence.

Para-aortic nodal metastases in cervical cancer: a blind spot in the International Federation of Gynecology and Obstetrics staging system: current diagnosis and management.

In cervical cancer, para-aortic nodal (PALN) metastases at presentation is a strong indicator of poor prognosis. Despite this, International Federation of Gynecology and Obstetrics staging system does not require evaluation of lymph node involvement and does not incorporate clinically detected PALN into the staging system. In the USA, despite screening, a significant number of women still present at an advanced stage often with nodal metastases. While the presence of PALN metastases often indicates occult systemic disease, it is possible with modern therapies to provide long-term control of disease in a percentage of patients. We review the epidemiology, diagnosis and treatment of PALN metastases in cervical cancer outlining advances in modern imaging and combined modality therapies (surgery, chemotherapy and radiation therapy).

Diagnosis and treatment of lymph node metastases in pediatric rhabdomyosarcoma in the Netherlands: A retrospective analysis

BackgroundIn pediatric rhabdomyosarcoma (RMS), evaluation of lymph node involvement (N1) is an important staging aspect, but difficult to assess. The aim of our study was to evaluate the assessment of lymph node infiltration and impact on outcome in N1 RMS patients. MethodsWe identified 277 non-metastatic RMS patients diagnosed and treated between 1990 and 2008. Patients with recorded N1 disease were evaluated for their diagnostic procedures and outcome. ResultsIn 13.7% N1 status was reported. In 19 of 34 N1 patients, lymph node biopsies were performed for histologically confirmation. Different treatment modalities were used to treat lymph node metastases. In total 23 of 31 patients received local treatment of the node (11/23 RT, 4/23 surgery, and 8/23 both). All patients received chemotherapy. Lymph node relapse occurred in 7 of 31 patients who were treated with one or two modalities. Only 1 (14%) of 8 patients treated with three modalities relapsed. In N0 patients 10 (4.2%) of 239 had a regional lymph node relapse, and 9 of 10 died. ConclusionLymph node metastases are an essential part of staging. Node positivity contributes to relapse of disease. Nodal relapse is also associated with a high mortality rate. These data imply that nodal assessment needs to be optimal and standardized for improved staging.

Accurate Prediction of Nodal Status in Preoperative Patients with Pancreatic Ductal Adenocarcinoma Using Next-Gen Nanoparticle

OBJECTIVE: The objective of this study is to assess lymphotropic nanoparticle-enhanced magnetic resonance imaging (LNMRI) in identifying malignant nodal involvement in patients with pancreatic ductal adenocarcinoma. METHODS: Magnetic resonance imaging was performed in 13 patients with known or high index of suspicion of pancreatic cancer and who were scheduled for surgical resection. Protocols included T2*-weighted imaging before and after administration of Ferumoxytol (Feraheme) for the evaluation of lymph node involvement. Eleven of the 13 patients underwent a Whipple procedure and lymph node dissection. Nodes that lacked contrast uptake were deemed malignant, and those that demonstrated homogeneous uptake were deemed benign. RESULTS: A total of 264 lymph nodes were resection, of which 17 were malignant. The sensitivity and specificity of LNMRI was 76.5% and 98.4% at a nodal level and 83.3% and 80% at a patient level. CONCLUSION: LNMRI demonstrated high sensitivity and specificity in patients with pancreatic ductal adenocarcinoma.

Diagnostische Wertigkeit der Cholin-PET / CT bei Patienten mit Prostatakarzinom

Die Cholin-Positronen-Emissionstomografie/Computertomografie (Cholin-PET/CT) wird zunehmend zur Bildgebung des Prostatakarzinoms (PCA) angewandt. In der vorliegenden Übersichtsarbeit werden die Relevanz der Cholin-PET/CT in Primärdiagnostik, Staging und Rezidivdiagnostik des PCA näher beleuchtet und sinnvolle Einsatzmöglichkeiten in der klinischen Praxis aufgezeigt. Hierzu erfolgte eine systematische Literaturrecherche über die elektronischen Datenbanken Pubmed und Medline nach Originalarbeiten, Übersichtsarbeiten und Leitartikeln zum Thema Cholin-PET/CT und Prostatakarzinom. In der Primärdiagnostik des PCA kann die Durchführung einer Cholin-PET/CT-Untersuchung aufgrund fehlender valider Daten nicht grundsätzlich empfohlen werden. In der Ausbreitungsdiagnostik nimmt die Cholin-PET/CT zur Beurteilung des lokalen Tumorwachstums (T-Staging) aufgrund ihrer geringen räumlichen Auflösung einen untergeordneten Stellenwert ein. Bei der Beurteilung des Lymphknotenstatus (N-Staging) weist sie einen hohen positiv prädiktiven Wert auf und in der Detektion von Knochenmetastasen (M-Staging) zeigt sie gegenüber der konventionellen Ganzkörperskelettszintigrafie vergleichbare Ergebnisse. In der Rezidivdiagnostik scheint die Cholin-PET/CT für Patienten, die nach bestimmten Kriterien (PSA-Wert > 1,0 ng/ml und/ oder PSA-doubling-time < 6 Monate und/oder Gleason-Score > 7 und/oder Radiatio als Primärtherapie) selektioniert wurden, eine geeignete Untersuchung zur Unterscheidung eines Lokalrezidives von einem systemischen Rezidiv zu sein. Die routinemäßige, unkritische Anwendung der Cholin-PET/CT bei Patienten mit PCA erscheint nicht zuletzt aufgrund der hohen Kosten der Untersuchung als wenig sinnvoll. Sie sollte nach sorgfältiger Auswahl von geeigneten Patienten auf bestimmte klinische Fragestellungen angewandt werden.

Prospective, comparative study for the evaluation of lymph node involvement in gastric cancer: Maruyama computer program versus sentinel lymph node biopsy

Stage-adapted surgery guarantees the best outcome for patients with gastric cancer. Successful identification of lymph node involvement may help to reduce the number of extended lymphadenectomies. Preoperative diagnostic tools have low sensitivity and specificity for determining lymph node involvement. Evaluation of sentinel lymph nodes (SLNs) intraoperatively has good results, while the accuracy of the Maruyama computer program (MCP) is controversial. We investigated 40 patients by the Maruyama computer model and labeled lymph nodes with blue dye for SLN mapping. To compare the probability calculations by MCP and the results of SLN mapping, we had to define a cutoff level; we did this using receiver-operating characteristics analysis. Sentinel lymph nodes were examined in frozen sections intraoperatively and by standard hematoxylin and eosin staining postoperatively. A total of 795 lymph nodes were removed and examined. The Maruyama computer model had a sensitivity of 91.3 %, specificity of 64 %, and accuracy of 80 % by the best cutoff point. The false-negative rate was 8.7 %. The sensitivity of SLN mapping was 95.7 %, the false-negative rate was 4.3 %, and the specificity was 100 %. The accuracy of SLN mapping was 97.4 %. Only the sensitivity of MCP and SLN biopsy was proven equivalent. Our results suggest that intraoperative SLN examination is superior to preoperative estimation with the MCP. Correct definition of lymph node involvement helps in planning the best stage-adapted surgery in gastric cancer.

Positron tomography with 18F-fluorodeoxyglucose in the preoperative evaluation of gallbladder lesions suspicious of malignancy: Diagnostic utility and clinical impact

Background Gallbladder carcinoma is a neoplasm having a poor prognosis in which the role of positron emission tomography with 18F-fluordeoxyglucose as a diagnostic tool, although of possible usefulness, has not been well-defined. Methods/design It is a prospective cohort of patients with radiologically malignant suspicious gallbladder lesions. A staging diagnostic presurgical FDG-PET study was carried out in each patient using both dedicated PET and multimodality PET-CT scanners. Diagnostic accuracy parameters were calculated from the results of PET imaging and were correlated with the condition and/or the clinical course of the patients. The clinical impact of its implementation in the diagnosis of gallbladder carcinoma was also analyzed. Results A total of 42 patients were recruited (22 malignant lesions, 20 benign). Overall diagnostic accuracy was 83.33% for the diagnosis of the primary lesion, 88.89% for the evaluation of lymph node involvement and 85.1% for the evaluation of metastatic disease. Mean SUVmax in malignant gallbladder lesions was 6.14 ± 2.89. ROC curve showed a cut-off value of 3.65 in the SUVmax for malignancy. Accuracy of PET studies alone ( n = 21) was slightly lower than that of the PET/CT ( n = 21). FDG-PET changed the management of 14.8% of the population due to the identification of unsuspected metastatic disease. Comments FDG-PET accurately diagnoses malignancy or benignity of suspicious gallbladder lesions, with the addition of its capacity to identify unsuspected metastatic disease. PET-CT improves the diagnostic accuracy of the procedure, due to the metabolic-structural complementarity of their information. The SUVmax has a complementary value added to the visual analysis.

Diagnostische Wertigkeit der Cholin-PET / CT bei Patienten mit Prostatakarzinom

The choline-positron emissiontomography / computed tomography (choline-PET / CT) is a widely used imaging method for prostate cancer. This review concentrates on the relevance of choline-PET / CT for primary diagnosis, staging and re-staging of prostate cancer and highlights possible -applications in clinical practice. Therefore, we performed a systematic literature research via Pubmed and Medline database for original articles, reviews and editorials on choline-PET / CT and prostate cancer. Choline-PET / CT should not be routinely used for primary diagnosis of prostate cancer due to a lack of data. With regard to the definition of the local tumour extent (T-stag-ing) choline-PET / CT plays only a minor role, in contrast, for the evaluation of lymph node involvement it has a high positive predictive value and is equal to conventional scintigraphy in detecting bone metastases. Moreover, in cases of biochemical relapse following local therapy, choline-PET / CT seems to be appropriate for differentiating between local recurrence and systemic prostate cancer metastasis, particularly when patients are selected by defined criteria (PSA value > 1.0 ng / mL and / or PSAdt < 6 months and / or Gleason score > 7 and / or primary radiotherapy). The non-critical routine use of choline-PET / CT for patients with prostate cancer cannot be recommended, and this not only because of its high costs. It should be applied to definite clinical questions after thorough selection of appropriate patients.

Tomografía por emisión de positrones con 18F-fluorodesoxiglucosa en la evaluación preoperatoria de lesiones de vesícula biliar sospechosas de malignidad. Utilidad diagnóstica e impacto clínico

Background Gallbladder carcinoma is a neoplasm having a poor prognosis in which the role of the positron emission tomography with 18F-fluordeoxyglucose as a diagnostic tool, although of possible usefulness, has not been well-defined. Methods/design It is a prospective cohort of patients with radiologically malignant suspicious gallbladder lesions. A staging diagnostic presurgical FDG-PET study was carried out in each patient using both dedicated PET and multimodality PET-CT scanners. Diagnostic accuracy parameters were calculated from the results of PET imaging and were correlated with the condition and/or the clinical course of the patients. The clinical impact of its implementation in the diagnosis of gallbladder carcinoma was also analyzed. Results A total of 42 patients were recruited (22 malignant lesions, 20 benign). Overall diagnostic accuracy was 83.33% for the diagnosis of the primary lesion, 88.89% for the evaluation of lymph node involvement and 85.1% for the evaluation of metastatic disease. Mean SUVmax in malignant gallbladder lesions was 6.14 ± 2.89. ROC curve showed a cut-off value of 3.65 in the SUVmax for malignancy. Accuracy of PET studies alone (n = 21) was slightly lower than that of the PET/CT (n = 21). FDG-PET changed the management of 14.8% of the population due to the identification of unsuspected metastatic disease. Comments FDG-PET accurately diagnoses malignancy or benignity of suspicious gallbladder lesions, with the addition of its capacity to identify unsuspected metastatic disease. PET-CT improves the diagnostic accuracy of the procedure, due to the metabolic-structural complementarity of their information. The SUVmax has a complementary value added to the visual analysis.

Whole-body MRI of neuroblastoma

Whole-body MRI (WBMRI) is an emerging imaging method that has a great potential in pediatric oncologic imaging. It appears useful in staging and monitoring neuroblastoma although its clinical impact has not been thoroughly evaluated. Among various imaging techniques currently available for WBMRI, coronal and sagittal STIR imaging with a quadrature body coil at 1.5T MR system is recommended for a standard protocol. Nevertheless, further technical improvements are anticipated at 3.0T MR system and multi-channel surface coil system. Scan time of WBMRI is reasonably short ranging from 20 min to 60 min. In localized neuroblatoma, WBMRI may help in predicting surgical risks by evaluating image-defined risk factors accurately. In addition, WBMRI is quite useful in detecting distant metastasis, assessing initial treatment responses, and identifying tumor recurrence of neuroblastoma. We should understand limitations of WBMRI in the evaluation of lymph node involvement, in the differentiation between viable tumor and non-viable residual lesion, and in the detection of calcified lesion. Diffusion-weighted imaging may improve diagnostic accuracy of WBMRI. Complementary use of WBMRI and other metabolic imaging method such as MIBG scintigraphy or PET probably increases diagnostic accuracy and, subsequently, improves clinical outcome of children with neuroblastoma.

Lymph Node Dissection for Lung Cancer: Significance, Strategy, and Technique

Since Cahan (1960) reported the first 48 cases that successfully underwent lobectomy with regional lymph node dissection, which was called "radical lobectomy", this procedure was universally accepted and has remained a standard surgery for lung cancer. In recent decades, the intrathoracic reevaluation of disease at thoracotomy for lung cancer has evolved into a detailed and sophisticated assessment of disease extent. Central to this is an evaluation of nodal involvement at the mediastinal and hilar levels. This technique, termed "systematic nodal dissection" (SND), has been accepted by the IASLC to be an important component of intrathoracic staging. In this manuscript, the significance, recent strategy, and technique of lymph node dissection for lung cancer are described.