Features Of Lymph Node Metastasis Research Articles

Predictors of treatment response in lymphogenic metastasized papillary thyroid cancer: a histopathological study.

Lymph node metastases in papillary thyroid cancer (PTC) increase the risk for persistent and recurrent disease. Data on the predictive value of histopathological features of lymph node metastases, however, are inconsistent. The aim of this study was to evaluate the prognostic significance of known and new histopathological features of lymph node metastases in a well-defined cohort of PTC patients with clinically evident lymph node metastases. A total of 1042 lymph node metastases, derived from 129 PTC patients, were reexamined according to a predefined protocol and evaluated for diameter, extranodal extension, cystic changes, necrosis, calcifications, and the proportion of the lymph node taken up by tumor cells. Predictors for a failure to achieve a complete biochemical and structural response to treatment were determined. The presence of more than 5 lymph node metastases was the only independent predictor for a failure to achieve a complete response to treatment (odds ratio [OR] 3.39 [95% CI, 1.57-7.33], P < .05). Diameter nor any of the other evaluated lymph node features were significantly associated with the response to treatment. Detailed reexamination of lymph nodes revealed that only the presence of more than 5 lymph node metastases was an independent predictor of failure to achieve a complete response to treatment. No predictive value was found for other histopathological features, including the diameter of the lymph node metastases. These findings have the potential to improve risk stratification in patients with PTC and clinically evident lymph node metastases.

Relationship between sonographic features, clinicopathological characteristics and lymph node metastasis of papillary thyroid carcinoma in children

Objective: This study aimed to evaluate the relationship between sonographic features, clinicopathological characteristics and lymph node metastasis (LNM) of papillary thyroid carcinoma (PTC) in children ( 18 years). S ≤ ubject and method: A total of 46 pediatric patients who were histopathologically diagnosed with PTC from January 2015 to March 2022 were included in this study. The preoperative ultrasonography, histological, and LNM features after surgery were retrospectively analyzed. Result: PTC in children accounted for 0.6% of all PTC, with a higher rate of females (67.4%), aged 15-18 years was 71.7%. The tumors weremostly classic type (87.0%), tumor size &gt; 10mm (76.1%), with high rates of central and lateral LNM (69.6% and 45.7%, respectively). Central LNM was significantly related to extrathyroidal extension (ETE). A significant relationship was observed between lateral LNM and tumor size, multifocality, ETE, intrathyroidal spread, microcalcification, and abnormal lymph nodes on ultrasound. Conclusion: Central and lateral LNM in pediatric PTC were common (69.6% and 45.7%, respectively). Several sonographic and clinicopathologic features had a significant relationship with LNM, especially lateral LNM. Patients with risk factors should undergo both clinical and neck ultrasound examinations in order to find evidence of LNM.

Hashimoto's thyroiditis is negatively associated with lymph node metastasis in PTMC.

The association between Hashimoto's thyroiditis (HT) and lymph node metastasis (LNM) of papillary thyroid microcarcinoma (PTMC) remains poorly understood. We aimed to elucidate the impact of HT on PTMC and its association with LNM. A retrospective cohort study was conducted at a single cancer referral center. Patients diagnosed with PTMC and complete clinicopathological results between January 2013 and June 2018 were included. Propensity score matching (PSM) and logistic regression analysis were performed to evaluate the difference in LNM characteristics between patients with and without HT. Among the 9929 PTMC patients, 2389 (24.1%) were pathologically diagnosed with HT. After PSM using variables including age, sex, primary tumor size, central neck dissection, extrathyroidal extension (ETE), gross ETE, multifocality and bilaterality, we identified 2324 pairs of patients for analysis. Patients with HT had a significantly lower incidence of LNM in the central neck (40.9% vs 56.2%, P < 0.001) and lateral neck (11.6% vs 14.2%, P = 0.016), a lower incidence of extranodal extension (ENE) (10.1% vs 17.0%, P < 0.001), fewer positive lymph nodes (median [IQR], 0 [0 to 2] vs 1 [0 to 3], P < 0.001), and a lower lymph node ratio (median [IQR], 0.00 [0.00 to 0.15] vs 0.12 [0.00 to 0.33], P < 0.001) than those without HT. Logistic regression analysis indicated that patients with HT had a significantly reduced risk of CLNM and LLNM compared to those without HT. Our study indicated a negative association between HT and LNM in PTMC.

Development and Validation of Models to Predict Lymph Node Metastasis in Early Gastric Cancer Using Logistic Regression and Gradient Boosting Machine Methods.

To identify important features of lymph node metastasis (LNM) and develop a prediction model for early gastric cancer (EGC) using a gradient boosting machine (GBM) method. The clinicopathologic data of 2556 patients with EGC who underwent gastrectomy were used as training set and the internal validation set (set 1) at a ratio of 8:2. Additionally, 548 patients with EGC who underwent endoscopic submucosal dissection (ESD) as the initial treatment were included in the external validation set (set 2). The GBM model was constructed, and its performance was compared with that of the Japanese guidelines. LNM was identified in 12.6% (321/2556) of the gastrectomy group (training set & set 1) and 4.3% (24/548) of the ESD group (set 2). In the GBM analysis, the top five features that most affected LNM were lymphovascular invasion, depth, differentiation, size, and location. The accuracy, sensitivity, specificity, and the area under the receiver operating characteristics of set 1 were 0.566, 0.922, 0.516, and 0.867, while those of set 2 were 0.810, 0.958, 0.803, and 0.944, respectively. When the sensitivity of GBM was adjusted to that of Japanese guidelines (beyond the expanded criteria in set 1 [0.922] and eCuraC-2 in set 2 [0.958]), the specificities of GBM in sets 1 and 2 were 0.516 (95% confidence interval, 0.502-0.523) and 0.803 (0.795-0.805), while those of the Japanese guidelines were 0.502 (0.488-0.509) and 0.788 (0.780-0.790), respectively. The GBM model showed good performance comparable with the eCura system in predicting LNM risk in EGCs.

Imaging Approach for Cervical Lymph Node Metastases from Unknown Primary Tumor

Neck swelling due to lymph node (LN) metastasis is one of the initial symptoms of head and neck cancer, and in some cases, the primary tumor is not clinically evident. The purpose of imaging for LN metastasis from an unknown primary site is to identify the primary tumor or detect its absence, which leads to the correct diagnosis and optimal treatment. The authors discuss diagnostic imaging approaches for identifying the primary tumor in cases of unknown primary cervical LN metastases. The distribution and characteristics of LN metastases may help locate the primary site. Unknown primary LN metastasis often occurs at nodal levels II and III, and in recent reports, these were mostly related to human papillomavirus (HPV)-positive squamous cell carcinoma of the oropharynx. Another characteristic imaging finding suggestive of metastasis from HPV-associated oropharyngeal cancer is a cystic change in LN metastases. Other characteristic imaging findings such as calcification may help predict the histologic type and locate the primary site. In cases of LN metastases at nodal levels IV and VB, a primary lesion located outside the head and neck region must also be considered. One clue for detecting the primary lesion at imaging is the disruption of anatomic structures, which can help in identifying small mucosal lesions or submucosal tumors at each subsite. Additionally, fluorine 18 fluorodeoxyglucose PET/CT may help identify a primary tumor. These imaging approaches for identifying primary tumors enable prompt identification of the primary site and assist clinicians in making the correct diagnosis. © RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.

Features of lymph node metastasis depending on intratumoral heterogeneity of non-small cell lung cancer in patients with different morphological changes in the bronchial epithelium

The aim of the study: to examine the relationship between the morphological diversity of non-small cell lung cancer and the frequency of lymph node metastasis in groups of patients with different epithelial conditions in the bronchi adjacent to the tumor. Material and methods. Surgical specimens from 90 patients with non-small cell lung cancer, who were treated in the Thoracoabdominal Department Of The Research Institute Of Oncology Of The Tomsk National Research Medical Center in the period from 2009 to 2017 were studied. The histological type of cancer was determined according to the who classification (2020). Lepidic, acinar, papillary, micropapillary, solid and solitary tumor cells were isolated in the parenchymal component of adenocarcinoma. In the parenchymal component of squamous cell carcinoma, 5 types of structures were distinguished: with keratinization, consisting of atypical cells of the prickly type without keratinization, consisting of atypical cells of the basaloid type, built of atypical cells with pronounced polymorphism, single tumor cells. Results. In patients with isolated basal cell hyperplasia, acinar (37 %), papillary (29 %) and solid (27 %) patterns were found less frequently in cases with metastatic regional lymph nodes compared to those without metastatic lymph nodes (63 %; p=0.05; 71 %; p=0.05; 73 %; p=0.01, respectively). In patients with isolated basal cell hyperplasia of the bronchial epithelium, in cases with the presence of lymph node metastasis in the parenchymal component of squamous cell carcinoma, structures 1 (with keratinization) (17 %), 2 (spiky pattern) (33 %) and 4 (polymorphic pattern) (29 %) were less frequently detected compared to those without metastases in regional lymph nodes (83 %; p=0.01; 67 %; p=0.02 and 71 %; p=0.01, respectively). In patients with a combination of basal cell hyperplasia and squamous metaplasia, a spiny pattern (65 %), a basaloid pattern (100 %), a polymorphic pattern (82 %) and single tumor cells (89 %) were more frequently detected in cases with metastatic lymph nodes than in cases without metastatic lymph nodes (35 %; р=0.04; 0 %; р=0.01; 18 %; р=0.01; 11 %; р=0.01, respectively). Conclusion. The data obtained clarify the available information on the significance of the morphological heterogeneity of the tumor for predicting the course of adenocarcinoma and squamous cell carcinoma of the lung.

Comparisons of minimally invasive esophagectomy and open esophagectomy in lymph node metastasis/dissection for thoracic esophageal cancer.

The study aimed to clarify the characteristics of lymph node metastasis (LNM) and to compare the oncologic outcomes of minimally invasive esophagectomy (MIE) with open esophagectomy (OE) in terms of lymph node dissection (LND) in thoracic esophageal cancer patients. The data from esophageal cancer patients who underwent MIE or OE from January 2016 to January 2019 were retrospectively reviewed. The characteristics of LNM in thoracic esophageal cancer were discussed, and the differences in numbers of LND, LND rate, and LNM rate/degree of upper mediastinum between MIE and OE were compared. For overall characteristics of LNM in 249 included patients, the highest rate of LNM was found in upper mediastinum, while LNM rate in middle and lower mediastinum, and abdomen increased with the tumor site moving down. The patients were divided into MIE ( n = 204) and OE groups ( n = 45). In terms of number of LND, there were significant differences in upper mediastinum between MIE and OE groups (8 [5, 11] vs. 5 [3, 8], P < 0.001). The comparative analysis of regional lymph node showed there was no significant difference except the subgroup of upper mediastinal 2L and 4L group (3 [1, 5] vs. 0 [0, 2], P < 0.001 and 0 [0, 2] vs. 0, P = 0.012, respectively). Meanwhile, there was no significant difference in terms of LND rate except 2L (89.7% [183/204] vs. 71.1% [32/45], P = 0.001) and 4L (41.2% [84/204] vs . 22.2% [10/45], P = 0.018) groups. For LNM rate of T3 stage, there was no significant difference between MIE and OE groups, and the comparative analysis of regional lymph node showed that there was no significant difference except 2L group (11.1% [5/45] vs . 38.1% [8/21], P = 0.025). The LNM degree of OE group was significantly higher than that of MIE group (27.2% [47/173] vs . 7.6% [32/419], P < 0.001), and the comparative analysis of regional LNM degree showed that there was no significant difference except 2L (34.7% [17/49] vs . 7.7% [13/169], P < 0.001) and 4L (23.8% [5/21] vs . 3.9% [2/51], P = 0.031) subgroups. MIE may have an advantage in LND of upper mediastinum 2L and 4L groups, while it was similar to OE in other stations of LND.

Perforation During Endoscopic Submucosal Dissection for Early Colon Cancer: Are Oncological Outcomes Impacted?

Introduction: Endoscopic submucosal dissection (ESD) is accepted in the treatment of early colorectal carcinoma with low pathological risk features for lymph node metastasis. ESD provides higher en-bloc resection and lower recurrence rates but is associated with higher perforation rates. Given the limited data available about the impact of intraprocedural perforation during ESD on the oncological outcomes, this study aims to assess the short and long-term oncological outcomes of ESD on malignant colorectal lesions Methods: Retrospectively, patients who underwent ESD in a tertiary care center from Jan 2011 to Dec 2021 and had cancer in the final pathology were included. Patients were divided into 3 groups: 1) patients who successfully underwent ESD followed by survivorship; 2) patients who underwent organ resection during or after ESD either because perforation occurred during the procedure, or the lesion was deemed to be invasive; 3) patients who underwent organ resection within 2-8 weeks of ESD based on pathology results. Primary outcome was cancer recurrence. Results: Sixty-eight of 906 patients (7.5%) who underwent ESD had invasive carcinoma. 63 patients were included in the analysis. There were 12, 10 and 41 patients in the first, second and third groups, respectively. Intergroup demographics were similar. En-bloc and R0 resection rates were 83% in the first group. Mean follow up duration was 21.2 months. Cancer recurrence was not observed. Conclusion: ESD can be safely performed in carefully selected early colorectal cancers. Intraprocedural perforation during ESD does not negatively impact oncological outcomes. Larger series with long-term follow-up are warranted.

Development and validation of a predictive model combining clinical, radiomics, and deep transfer learning features for lymph node metastasis in early gastric cancer.

BackgroundThis study aims to develop and validate a predictive model combining deep transfer learning, radiomics, and clinical features for lymph node metastasis (LNM) in early gastric cancer (EGC).Materials and methodsThis study retrospectively collected 555 patients with EGC, and randomly divided them into two cohorts with a ratio of 7:3 (training cohort, n = 388; internal validation cohort, n = 167). A total of 79 patients with EGC collected from the Second Affiliated Hospital of Soochow University were used as external validation cohort. Pre-trained deep learning networks were used to extract deep transfer learning (DTL) features, and radiomics features were extracted based on hand-crafted features. We employed the Spearman rank correlation test and least absolute shrinkage and selection operator regression for feature selection from the combined features of clinical, radiomics, and DTL features, and then, machine learning classification models including support vector machine, K-nearest neighbor, random decision forests (RF), and XGBoost were trained, and their performance by determining the area under the curve (AUC) were compared.ResultsWe constructed eight pre-trained transfer learning networks and extracted DTL features, respectively. The results showed that 1,048 DTL features extracted based on the pre-trained Resnet152 network combined in the predictive model had the best performance in discriminating the LNM status of EGC, with an AUC of 0.901 (95% CI: 0.847–0.956) and 0.915 (95% CI: 0.850–0.981) in the internal validation and external validation cohorts, respectively.ConclusionWe first utilized comprehensive multidimensional data based on deep transfer learning, radiomics, and clinical features with a good predictive ability for discriminating the LNM status in EGC, which could provide favorable information when choosing therapy options for individuals with EGC.

Acetone Compression Improves Lymph Node Harvesting.

To the editor The review article by Díaz del Arco et al1 provides a comprehensive review of the methods used for the surgical removal and gross room retrieval of lymph nodes from gastric carcinoma excisions, TNM staging of gastric carcinoma, and multiple additional histologic features of lymph node metastases used for accurate prognosis of gastric carcinoma. The authors mention methods beyond manual palpation to improve lymph node harvesting, such as fat clearing. Omitted from the comprehensive review is an entirely new method for lymph node harvesting first reported in the United States in 2004.2 This method, currently used more extensively in Germany (the early reports are based on over 700 cases), is the “acetone compression” method for lymph node retrieval.3-5 The acetone compression method decreases adipose tissue volume through dissolving fat in fat solvents (elution) and extracting the dissolved fat with compression. Tissue volume is decreased up...

Features of Lymph Node Metastasis and Structural Recurrence in Papillary Thyroid Carcinoma Located in the Upper Portion of the Thyroid: A Retrospective Cohort Study.

BackgroundThis study aims to reveal the features of lymph node metastasis (LNM) and recurrence in papillary thyroid carcinoma (PTC) tumors located in the upper portion of the thyroid.MethodsA total of 1075 PTC patients were retrospectively reviewed, including 314 patients with a tumor in the upper portion of the thyroid. Another 103 PTC patients with upper portion diagonsis from three clinical centers were included for external validation.ResultsThe results showed no difference between the patients with a tumor in the upper portion of the thyroid and those with a tumor in the non-upper portion in terms of overall LNM rates. However, patients with a tumor in the upper portion were significantly more prone to LLNM and exhibited a significantly worse recurrence outcome than those with a tumor in other subregions. Multivariate analysis showed that four factors—age no more than 40, maximum tumor diameter no less than1.0 cm, the presence of thyroid capsular invasion, and tumor with ipsilateral nodular goiter—were independent risk factors for LLNM of the tumor in the upper thyroid. A predictive risk-scoring model was established based on these factors.ConclusionsPatients with PTC located in the upper portion may have an exclusive lymphatic drainage pathway to the lateral neck region and are more prone to suffer from LLNM and tumor recurrence than those with a tumor located in other subregions. A new postoperative strategy selection flow chart was established based on our newly created risk-scoring model that can effectively predict the individualized possibility of LLNM for PTC patients with a tumor in the upper portion.

Kikuchi-Fujimoto Disease Masquerading as Bilateral Lymph Node Metastasis in a Patient With Papillary Thyroid Carcinoma: A Case Report and Literature Review

Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is common in young Asian women under the age of 30, and is usually characterized by fever, myalgia, fatigue, and cervical lymphadenopathy. Because patients with KFD often present with necrotic lesions that are also features of lymph node metastasis, ipsilateral or bilateral lymph node enlargement in head and neck cancer patients can be disguised as lymph node metastasis. We present an unusual case of KFD mimicking bilateral metastatic papillary carcinoma of the thyroid. This study emphasizes that KFD should be considered when diagnosing lymph nodes with necrotic lesions but without malignant cells in young women.

Cost comparisons of endoscopic and surgical resection of stage T1 rectal cancer

Background and study aims Management of T1 rectal cancer is complex and includes several resection methods, making cost comparisons challenging. The aim of this study was to compare costs of endoscopic and surgical resection and to investigate hypothetical cost scenarios for the treatment of T1 rectal cancer. Patients and methods Retrospective population-based cost minimization study on prospectively collected data on T1 rectal cancer patients treated using endoscopic submucosal dissection (ESD), transanal endoscopic microsurgery (TEM), open, laparoscopic, or robotic resection, in Skåne County, Sweden (2011–2017). The hypothetical cost scenarios were based on the distribution of high-risk features of lymph node metastases in a national cohort (2009–2017). Results Eighty-five patients with T1 RC undergoing ESD (n = 16), TEM (n = 17), open (n = 35), laparoscopic (n = 9), and robotic (n = 8) resection were included. ESD had a total 1-year cost of 5165 € and was significantly ( P < 0.05) less expensive compared to TEM (14871€), open (21 453 €), laparoscopic (22 488 €) and robotic resection (26 562 €). Risk factors for lymph node metastases were seen in 68 % of 779 cases of T1 rectal cancers included in the national cohort. The hypothetical scenario of performing ESD on all T1 RC had the lowest total 1-year per patient cost compared to all other alternatives. Conclusions This is the first study analyzing total 1-year costs of endoscopic and surgical methods to resect T1 rectal cancer, which showed that the cost of ESD was significantly lower compared to TEM and surgical resection. In fact, based on hypothetical cost scenarios, ESD is still justifiable from a cost perspective even when all high-risk cases are followed by surgery in accordance to guidelines.

Prognostic significance of histomorphologic features of lymph node metastases in prostate cancer patients treated with radical prostatectomy: A single center study

ObjectiveWe assessed the prognostic value of histomorphologic features of lymph node (LN) metastases in patients with prostate cancer treated with radical prostatectomy Materials and MethodsWe evaluated the effect of the features of LN metastasis on the risk of biochemical recurrence (BCR) in 280 LN-positive patients who underwent radical prostatectomy between 2006 to 2018. LN specific parameters recorded included number of metastatic LNs, size of the largest metastatic focus, Gleason Grade (GG) of the metastatic focus, and extranodal extension (ENE). ResultsA solitary positive LN was found in 166/280 (59%), 95/280 (34%) patients had 2-4 positive LNs, and 19/280 (7%) had 5 or more positive LNs. The size of the largest metastatic focus > 2 mm (macrometastasis) in 154/261 (59%). GG of the metastatic focus was as follows: GG 1-2: 29/224 (13%); GG 3: 27/224 (12%); and GG 4-5: 168/224 (75%). ENE was identified in 99/244 (41%). We found the number of LNs positive (2-4 vs. 1 Hazard ratio (HR) = 1.60; 95% CI: 1.02 to 2.5; P = 0.04) and GG of the metastatic focus (GG 4&5 vs. 1-3 HR = 1.90; 95% CI: 1.14-3.2; P= 0.014) to be independent predictors of the risk of BCR after surgery on multivariate analysis. ConclusionsOur study showed the number of LNs positive and GG of the LN metastatic focus to be significant independent predictors of BCR after radical prostatectomy. We recommend reporting histomorphologic parameters of LN metastasis as they may help in defining BCR risk categorization.

Feasibility of MRI-based radiomics features for predicting lymph node metastases and VEGF expression in cervical cancer

PurposeTo investigate the predictive value of MRI-based radiomics features for lymph node metastasis (LNM) and vascular endothelial growth factor (VEGF) expression in patients with cervical cancer. MethodA total of 163 patients with cervical cancer were enrolled in this study. A total of 134 patients were included for LNM differentiation, and 118 were included for VEGF expression discrimination. The patients were randomly assigned to the training group or test group at a ratio of 2:1. Radiomics features were extracted from T1WI enhanced and T2WI MRI scans of each patient, and tumor stage was also documented according to the International Federation of Gynecology and Obstetrics (FIGO) guidelines. The least absolute shrinkage and selection operator algorithm was used for feature selection. The results of 5-fold cross validation were applied to select the best classification models. The performances of the constructed models were further evaluated with the test group. ResultsSixteen radiomics features and the FIGO stage were selected to construct the LNM discrimination model. The LNM prediction model achieved the best diagnostic performance, with areas under the receiver operating curve (AUCs) of 0.95 and 0.88 in the training group and test group, respectively. Nine radiomics characteristics were screened to build the VEGF prediction model, with AUCs of 0.82 and 0.70 in the training group and test group, respectively. Decision curve analysis confirmed their clinical usefulness. ConclusionsThe presented radiomics prediction models demonstrated potential to noninvasively differentiate LNM and VEGF expression in cervical cancer.

Identification of relevant prognostic values of cytokeratin 20 and cytokeratin 7 expressions in lung cancer.

Lung cancer is one of the most common malignant tumors harmful to human health. Cytokeratin (CK) is highly conserved and differentiated related to the proliferation and differentiation of epithelial cells. The aim of the study was to explore expressions of CK20 and CK7 and corresponding prognostic values in patients with lung cancer. Our study included 258 cases of patients confirmed with lung cancer. Expressions of CK20 and CK7 mRNA and protein were detected using real-time quantitative PCR (qRT-PCR) and Western blot, respectively, followed by the performance of immunohistochemistry staining. Associations of CK20 and CK7 with the clinical parameters and prognosis of lung cancer patients were further analyzed. There were obvious differences regarding the positive expression of CK20 in different T stage, lymph node metastasis, invasion, size, and clinical stage subgroups; besides, significant differences in the positive expression of CK7 were also observed in subgroups of different sex, age, lymph node metastasis, invasion, and differentiation. Furthermore, effects of age, smoking, T stage, lymph node metastasis and invasion, size, and CK7 expressions were significant on the survival of patients (all P<0.05). Multivariate analysis revealed that lymph node metastasis, T stage, and CK7 expression were independent risk factors for poor prognosis of involved patients (all P<0.05), while age, smoking, and invasion had no marked relation to the survival time of patients with lung cancer (all P>0.05). Positive CK20 and CK7 expressions are detected in patients with lung cancer; positive expression of CK7 associated with pathological features of lymph node metastasis and T stage may be independent clinical parameters for poor prognosis of patients with lung cancer.

Extra-nodal extension is a significant prognostic factor in lymph node positive breast cancer.

Presence of lymph node (LN) metastasis is a strong prognostic factor in breast cancer, whereas the importance of extra-nodal extension and other nodal tumor features have not yet been fully recognized. Here, we examined microscopic features of lymph node metastases and their prognostic value in a population-based cohort of node positive breast cancer (n = 218), as part of the prospective Norwegian Breast Cancer Screening Program NBCSP (1996–2009). Sections were reviewed for the largest metastatic tumor diameter (TD-MET), nodal afferent and efferent vascular invasion (AVI and EVI), extra-nodal extension (ENE), number of ENE foci, as well as circumferential (CD-ENE) and perpendicular (PD-ENE) diameter of extra-nodal growth. Number of positive lymph nodes, EVI, and PD-ENE were significantly increased with larger primary tumor (PT) diameter. Univariate survival analysis showed that several features of nodal metastases were associated with disease-free (DFS) or breast cancer specific survival (BCSS). Multivariate analysis demonstrated an independent prognostic value of PD-ENE (with 3 mm as cut-off value) in predicting DFS and BCSS, along with number of positive nodes and histologic grade of the primary tumor (for DFS: P = 0.01, P = 0.02, P = 0.01, respectively; for BCSS: P = 0.02, P = 0.008, P = 0.02, respectively). To conclude, the extent of ENE by its perpendicular diameter was independently prognostic and should be considered in line with nodal tumor burden in treatment decisions of node positive breast cancer.

Diagnostic accuracy of ultrasonographic features for lymph node metastasis in papillary thyroid microcarcinoma: a single-center retrospective study

BackgroundWhether sonography is an appropriate imaging modality for cervical lymph nodes in patients with papillary thyroid microcarcinoma (PTMC) remains unclear. Hence, this study aimed to evaluate the diagnostic value of ultrasonography (US) features for lymph node metastasis in PTMC.MethodsSeven hundred twelve patients with PTMC who underwent conventional ultrasonography examinations of the cervical lymph nodes were included. All included cases underwent total thyroidectomy plus prophylactic central lymph node dissection. The included lymph nodes were marked superficially, and the corresponding lymph nodes were completely removed and sent for pathological examination. The US features of lymph nodes with and without metastasis were compared, and the odds ratios of the suspicious US features were determined with univariate and multivariate analyses.ResultsRound shape, loss of an echogenic fatty hilum, cystic change, calcification, and abnormal vascularity were significantly more common in metastatic than nonmetastatic lymph nodes, whereas the boundary and echo did not significantly differ. Multivariate logistic regression analysis showed that round shape, loss of echogenic fatty hilum, cystic change, calcification, and abnormal vascularity were independent predictive factors for the assessment of metastatic lymph nodes. Round shape had the highest sensitivity of all variables, while loss of an echogenic fatty hilum had the highest specificity and accuracy. The area under the receiver operating characteristic curve, which was calculated to verify the relationship between the various US features and metastatic lymph nodes, was 0.793.ConclusionsOur study found that the US features of round shape, cystic change, calcification, loss of echogenic fatty hilum, and abnormal vascularity were useful sonographic criteria for differentiating between cervical lymph nodes with and without metastasis.

Clinical features of lymph node metastasis in papillary thyroid microcarcinoma with (131)I treatment

Objective To analyze the clinical features of lymph node metastasis in papillary thyroid microcarcinoma(PTMC). Methods 198 patients with PTMC who have underwent total thyroidectomy and at least one 131I treatment were divided into two groups according to the occurrence of lymph node metastasis. The clinical features of lymph node metastasis in PTMC were retrospective analyzed, and independent risk factors of the central and lateral lymph node metastasis in PTMC patients were further analyzed. Results Clinical features of PTMC patients with cervical lymph node metastasis: (1)Most of them were<45 years old(63.4% vs 44.9%, P=0.012); (2)More patients with cancer in bilateral lobes and extrathyroidal extension in lymph node metastasis groups(56.7% vs 42.0%, P=0.043; 63.6% vs 36.4%, P=0.034); (3)The average tumor size of the patients of lymph node metastasis was larger than that of the patients without lymph node metastasis[(0.71±0.25 vs 0.64±0.24)cm, P=0.047]; (4)Preoperative thyroglobulin antibody(TgAb)level of PTMC patients with cervical lymph node metastasis was higher than the control group[(65.27±139.179 vs 36.36±95.647)IU/L, P=0.03]; (5)After the 131I treatments and by 1-6 years of follow-up, it is found no statistically significant difference in cure rate between patients with cervical lymph node metastasis after total thyroidectomy and its control group. But the frequency of 131I treatment required in patients with cervical lymph node metastasis was higher than that of the control group(1.77±0.77 vs 1.49±0.74, P=0.006). Univariate analysis revealed that central lymph node metastasis was correlated with age, tumor size and other factors. There were more patients with cancer in bilateral lobes and extrathyroidal extension in lymph node metastasis group. And lateral lymph node metastasis was correlated with Hashimoto′s thyroiditis. Multivariate analysis showed that age, tumor size, involvement of bilateral glandular lobes and extrathyroidal extension were independent risk factors for central lymph node metastasis. Conclusion The risk factors of lymph node metastasis should be fully evaluated to carry out individualized treatment for the first operation of PTMC patients. (Chin J Endocrinol Metab, 2016, 32: 900-905) Key words: Papillary thyroid microcarcinoma; Lymph node metastasis; Clinical feature; Risk factors

The Value of HBME-1 and Claudin-1 Expression Profile in the Distinction of BRAF-Like and RAS-Like Phenotypes in Papillary Thyroid Carcinoma.

This study compared the expression profile of HBME-1 and claudin-1 in 90 papillary thyroid carcinomas (PTCs) with respect to the tumor architecture and invasive growth as reflected in 46 BRAF-like, 31 non-invasive RAS, and 13 invasive RAS-like phenotypes. Individual tumors were given an expression score (max 300) by multiplying the percent positive tumor cells by the intensity score (range 0-3). The higher expression of HBME-1 and claudin-1 distinguished BRAF-like phenotype from RAS-like phenotype. The same correlation was also retained for both markers when comparing BRAF-like phenotype with non-invasive and invasive RAS-like phenotypes. The expression scores and positivity rates for both markers did not yield any statistical difference among BRAF-like PTCs. Except the higher positivity rate of HBME-1, invasive RAS-like tumors were not statistically different than their non-invasive counterparts with respect to the positivity rate of claudin-1 and the expression scores of both markers. A central lymph node dissection or selective lymph node sampling was available in 20 specimens. The absence of claudin-1 expression has not been a feature of lymph node metastasis in this series. Despite the limited number of nodal sampling, BRAF-like phenotype and claudin-1 positivity status have been considered the best determinants of positive predictive value and negative predictive value in the prediction of lymph node metastasis among variables, respectively. Adoption of the simplified architectural classification approach to PTCs showed distinct biomarker expression profile in this series; however, immunohistochemistry for HBME-1 and claudin-1 does not seem to be useful in the distinction of invasive RAS-like PTCs from their non-invasive counterparts. Given the overlapping molecular signatures within the RAS-like phenotype, further studies with additional biomarkers are still needed to identify distinct protein expression signatures of non-invasive RAS-like phenotype as this diagnostic category still remains a surgical diagnosis at this time.