Determining Lymph Node Metastasis Research Articles

Synovial myxoma or myxosarcoma? Lymph node metastasis in 2 dogs.

Synovial myxoma, a rare joint tumor in dogs, has traditionally been considered benign, acknowledging that local invasion into regional tissues including bone may be present. Given the diagnostic challenges in distinguishing synovial myxoma from other joint lesions through clinical features and diagnostic imaging, definitive diagnosis relies on characteristic gross and histologic features. Within the inner surface of the joint capsule, synovial myxomas form nodules of stellate-to-spindle cells within abundant myxomatous matrix. We present here 2 cases of synovial myxoma with metastasis to regional lymph nodes and compare these 2 cases to 3 cases without evidence of lymph node metastasis. Aside from lymphovascular invasion in one case with metastasis, there were no overt histologic features of the primary tumor to suggest aggressive biologic behavior. The finding of lymph node metastasis warrants reconsideration of the term "synovial myxoma" for this neoplasm. We suggest the term "synovial myxosarcoma," considering that histologic features of the primary tumor do not predict biologic behavior. Our case series highlights the importance of lymph node sampling in suspected synovial myxosarcoma cases as well as thorough histologic examination, emphasizing careful evaluation for lymphovascular invasion.

Deep learning approach for predicting lymph node metastasis in non-small cell lung cancer by fusing image–gene data

The determination of lymph node metastasis is critical to the selection of treatment options for non-small cell lung cancer. Invasive pathological examinations cannot be performed frequently in clinical practice, thus non-invasive and reproducible methods are needed. The current research on non-invasive prediction methods based on image and genetic information has shortcomings such as small data sample size, high data dimension, and poor multimodal fusion effect. In this research, we propose a method for predicting lymph node metastasis in non-small cell lung cancer by fusing imaging data and genetic data to overcome these challenges. An attention-based multimodal information fusion module is designed to fuse image data and genetic data in the mid-fusion, and a bilinear fusion module based on Tucker decomposition is inserted into the model for late fusion, which significantly improves the performance of multimodal fusion. The 3D spiral transformation method is used to extract 2D images from 3D data, and the transformed images inherit and retain the spatial correlation of the original texture and edge information while increasing the image data sample size for subsequent prediction. The random forest method of important measurement is used for feature selection, and redundant data in gene information is eliminated. The experiments are carried out on the NSCLC-Radiogenomics dataset. The accuracy and AUC of the proposed model are 0.968 and 0.963, respectively. The experimental results show that the model is ideal performance in predicting lymph node metastasis, providing a new method for non-invasive lymph node metastasis prediction, which is beneficial to the application of precision medicine.

Histomorphological and Demographic Profile of Breast Carcinoma in Anatomical Pathology Department FKUI/RSCM 2016-2019

BackgroundInvasive breast carcinoma (IBC) is the most commonly diagnosed cancer in woman in the world and Indonesia. IBC is classified into two main categories: IBC of no special type (NST) and special types. This retrospective study aims to provide histomorphological profile of mastectomy cases of IBC in Anatomical Pathology Department, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital (PA FKUI/RSCM) 2016-2019.MethodsThis is a descriptive research with cross-sectional design of mastectomy cases, using secondary data from the archives of PA FKUI/RSCM, starting from 2016- 2019. Collecting clinical data as well as observing several histopathologic parameters including histological type, grade, atypical mitotic features, lymphovascular invasion, and lymph node metastases. Tumour classification was made based on the WHO breast criteria in 2019.ResultsDuring the 2016-2019 period there were 144 cases of IBC. 99.3% of cases occurred in female patients, mostly in the age group from 40 to 59 years and unilateral. The majority had tumour sizes ranging >2-5 cm and were stage II. About a third of cases had received neoadjuvant chemotherapy, most commonly in advanced local stage tumors. Most histologic type (65.3%) were IBC of NST and 52.8% of cases were grade 2. There were 92 (63.4%) cases with atypical mitotic features, most commonly found in stage III. Lymphovascular invasion was found in 38.9% of cases and lymph node metastasis was found in 63.2% of cases.ConclusionIBC is the most common cancer in woman, with the most common histologic type were IBC, grade 2, stage II or more. Most of the cases show atypical mitosis, which is most commonly found in stage III. The findings of lymphovascular invasion did not always coincide with the findings of lymph node metastases.

Minor components of micropapillary and solid subtypes in lung invasive adenocarcinoma (≤ 3cm): PET/CT findings and correlations with lymph node metastasis.

To investigate the PET/CT findings in lung invasive adenocarcinoma with minor components of micropapillary or solid contents and its association with lymph node metastasis. A total of 506 lung invasive adenocarcinoma (≤ 3cm) patients who underwent a PET/CT examination and resection surgery were included. According to the proportion of solid/micropapillary components, the patients were classified into three groups: solid/micropapillary-negative (SMPN) (n = 258), solid/micropapillary-minor (SMPM; > 5% not predominant) (n = 158) and solid/micropapillary-predominant (SMPP; > 5% most dominant) (n = 90). The patients' PET/CT findings, including SUVmax, MTV, TLG and CT characteristics, and other clinical factors were compared by one-way ANOVA test. Logistic regression analysis was done to identify the most predictive findings for lymph node metastasis. The value of SUVmax, MTV, TLG and tumor size was highest in SMPP group, followed by SMPM and SMPN group (P < 0.001).The areas under the curve for SUVmax, MTV and TLG for node metastasis were 0.822, 0.843 and 0.835, respectively. Univariate analysis found that the SMPP and SMPM group had more lymph node metastasis than the SMPN group (P < 0.001). Furthermore, the lymph node metastasis group had higher CEA, SUVmax, MTV, TLG, tumor size and more pleural invasion (P < 0.001). Logistic regression analysis found that SMPP pathological type, SMPM pathological type, higher CEA and male patients were risk factors for lymph node metastasis (P < 0.01). Lung invasive adenocarcinoma with micropapillary or solid contents had higher SUVmax, MTV, TLG and tumor size and was associated with lymph node metastasis, even if they were not predominant.

Discrepancy Between the Clinical and Final Pathological Findings of Lymph Node Metastasis in Superficial Esophageal Cancer.

Recent advances in endoscopic examinations have resulted in the detection of a larger number of early esophageal cancers; however, there have been many cases with clinically negative but pathologically positive lymph node metastasis (LNM). In this study, we aimed to evaluate the discrepancy between the clinical and pathological diagnoses of LNM in patients with cT1a-MM/cT1b N0M0 esophageal cancer, and assess LNM size in these patients to clarify the presence of LNM that cannot be detected with current modalities. This study included 50 patients who underwent surgery for cT1a-MM/cT1b N0M0 thoracic esophageal squamous cell carcinoma between January 2012 and November 2016 at our institution. The maximum size of involved LNs and metastatic nests were measured, and the distribution of LNM was investigated. Of the 50 patients, 13 (26%) had LNM on pathological examination. Lymphatic invasion was significantly more frequent in the LNM-positive group than in the LNM-negative group (p=0.005). The median sizes of 28 involved LNs and metastatic nests were 3 and 1.6mm, respectively. Of these LNs, 20 (71%) were classified as micrometastases (≤2mm). The involved nodes were distributed across three fields. There was a discrepancy between the clinical and final pathological findings of LNM in patients with cT1a-MM/cT1b N0M0 esophageal cancer. The detection of involved nodes with current modalities in these patients was difficult because of the small size of LNM. Therefore, continued strong consideration for extended LN dissection is necessary in these patients to ensure appropriate diagnosis and treatment.

Risk factors of axillary nodes metastasis in breast cancer and construction of prediction model

Objective To analyze the relationship between axillary lymph node metastasis and clinical factors, and to construct a mathematical model of axillary lymph node metastasis in breast cancer patients. Methods Univariate analysis was performed on 423 female patients with breast cancer in terms of age, tumor size, hormone receptor, oncogene, menopause, fertility, tumor location and multifocal nature, and a mathematical diagnostic model for breast cancer axillary lymph node status was constructed by Bayes discrimination. Results The correlation between tumor size and axillary lymph node metastasis showed that the larger the primary tumor was, the more likely the axillary lymph node metastasis, the location of the tumor was also closely related to lymph node metastasis, and the lymph node metastasis rate was highest in patients with polycentric tumor. However, age of onset, hormone receptor, oncogene expression, menopause, fertility, and multifocal tumor could not be independent factors in the determination of axillary lymph node metastasis. The accuracy of self-verification and cross-validation was 89.4% and 74.7% for the mathematical diagnostic model of axillary lymph node shape of breast cancer constructed by Bayes discrimination. Conclusion The location and size of the tumor were independent factors in the determination of lymph node metastasis. The establishment of mathematical function has important clinical significance for the preoperative diagnosis of axillary lymph node metastasis in breast cancer. Key words: Breast carcinoma; Axillary lymph node; Metastasis; Bayes mathematical model

PS02.192: TWO CASES OF PRIMARY MALIGNANT MELANOMA OF ESOPHAGUS TREATED WITH SUBTOTAL ESOPHAGECTOMY

Abstract Background Malignant melanoma of the primary esophagus is rare, in general it has high malignancy and poor prognosis. We report two cases of early-stage primary malignant melanoma of esophagus (PMME) underwent subtotal esophagectomy. Methods Case presentation Results [Case 1]A 66-year-old man was pointed out a black legion on the lower esophagus by upper gastrointestinal endoscope for screening purposes. The lesion was diagnosed as malignant melanoma by biopsy. In addition, another black lesion was also found in the pharynx, but there was no malignant cell. Other examinations did not reveal any findings of lymph node metastasis and distant metastasis. We diagnosed PMME (T1aN0M0 Stage 0) and performed surgical resection. Pathologically it was pT1a (LPM), pN0. There is no recurrence, and it is under observation. [Case 2] A 51-year-old woman was conducted upper gastrointestinal endoscopy for the purpose of scarring epigastric pain, and a black lesion was pointed out in lower esophagus. Surgical resection was performed with diagnosis of PMME (T1bN0M0 Stage I). The pathological stage was pT1a (MM), pN0. Conclusion The 5 year survival rate of malignant melanoma of primary esophagus is poor with about 30 to 35%, and especially in cases with lymph node metastasis, the survival rate further decreases. The both cases were discovered accidentally by endoscopic examination, leading to early diagnosis and early treatment. Therefore, long survival is expected. There is also a report that melanosis is associated with melanoma, so case 1 requires careful follow-up observation. Disclosure All authors have declared no conflicts of interest.

Value of MRI morphologic features with pT1-2 rectal cancer in determining lymph node metastasis.

To investigate the different features between metastatic lymph node and nonmetastatic lymph node on magnetic resonance imaging (MRI) and the relationship between the rectal lesion and lymph node metastasis (LNM). Eighty-two patients with retrospectively consecutive pT1-2 stage rectal cancer in 2016 were divided into lymph node metastasis (LNM+) and lymph node nonmetastasis (LNM-) group based on their histopathologic examinations. We evaluated the following features of lymph nodes: number, shape, signal heterogeneity, border, and diameter of the largest lymph node on T2-weight images. We also calculated tumor apparent diffusion coefficient ratio and tumor percent enhancement. Fisher's exact test was applied for inspecting lymph node numbers on MRI and logistic regression analysis in examining risk factors for LNM. The MR-LN number was significantly different between the LNM+ and LNM- group (median: 4 vs 1, P = 0.001). Multivariate logistic regression analysis exhibited that the diameter of the largest lymph node and the tumor percent enhancement of the arterial phase were independent risk factors of LNM (P = 0.005 vs 0.021, respectively). The largest lymph node's diameter and the tumor percent enhancement of arterial phase on MRI were helpful in determining LNM in pT1-2 rectal cancer.

Comparison of the diagnostic performances of ultrasonography, CT and fine needle aspiration cytology for the prediction of lymph node metastasis in patients with lymph node dissection of papillary thyroid carcinoma: A retrospective cohort study

PurposeTo evaluate the diagnostic performances of ultrasonographic (US) findings, computed tomography (CT) findings and fine needle aspiration cytology (FNAC) for the prediction of cervical lymph node (LN) metastases of papillary thyroid carcinoma (PTC) to determine which LN should be dissected. Methods376 LNs in 302 patients who underwent both US-guided skin surface LN markings and CT before LN dissection were analyzed retrospectively. Indications for LN dissection were suspicious US findings of LN metastases (n = 300), suspicious CT findings (n = 67) or surgeon's request (n = 9). Diagnostic performances of US, CT and FNAC (including thyroglobulin (Tg)) were evaluated. The correlations of suspicious US, CT finding or malignant FNAC with the size, number and the presence of extranodal extension of metastatic LNs were analyzed. ResultsUS indication of LN dissection was significantly correlated with malignancy (p < .0001). Values of area under the curve of highly suspicious US findings and FNAC+Tg were significantly higher than that of CT (0.786, 0.878, 0.585, p < .0001, respectively). Suspicious US, CT findings and malignant FNAC+Tg were significantly associated with the largest size of metastatic LNs (p = .003, p = .0003, and p = .0006, respectively) and total number of metastatic LNs (p = .007, p = .038, and p = .005, respectively). ConclusionThe diagnostic performance of US or FNAC was superior to CT and highly suspicious US findings could be complimentary to FNAC results in predicting LN metastases of PTC. LN dissection should be performed for the LNs with any suspicious US findings or malignant FNAC results rather than LNs with only suspicious CT findings.

Analysis of Contrast-Enhanced Ultrasound Perfusion Patterns and Time-Intensity Curves for Metastatic Lymph Nodes From Lung Cancer: Preliminary Results.

To retrospectively summarize the similarities and differences in contrast-enhanced ultrasound (US) findings for lymph node metastasis from adenocarcinoma, squamous carcinoma, and small cell lung cancer. Patients who had received contrast-enhanced US examinations and had a histologic diagnosis of supraclavicular lymph node metastasis from lung cancer were included. The perfusion patterns on contrast-enhanced US images and time-intensity curve parameters were analyzed for the different pathologic types. The microvascular density and microvascular diameter were evaluated. Totally, 61 patients were enrolled in this study, including 26 cases with lung squamous carcinoma, 26 with lung adenocarcinoma, and 9 with small cell lung cancer. Contrast-enhanced US perfusion showed no significant differences in enhancement uniformity during the arterial phase and in the presence of unenhanced areas of metastatic lymph nodes with the 3 different pathologic origins (P > .05), but fewer unenhanced areas could be seen in metastatic lymph nodes from adenocarcinoma. The analysis of the time-intensity curve parameters showed that there were significant differences in the peak intensity between metastatic lymph nodes from lung squamous carcinoma and lung adenocarcinoma (P < .05). The microvascular density of metastatic lymph nodes from adenocarcinoma was significantly higher than that of metastatic lymph nodes from squamous carcinoma and small cell lung cancer (P < .001; P = .0444), whereas the microvascular diameter of metastatic lymph nodes from adenocarcinoma was significantly smaller than that from squamous carcinoma and small cell lung cancer (P = .0277; P < .001). Effects of the pathologic diagnosis should be considered when analyzing quantitative parameters of metastatic lymph nodes during contrast-enhanced US examinations, even in the same organ.

Diagnostic and prognostic value of preoperative 18F-fluorodeoxyglucose positron emission tomography/computed tomography for colorectal cancer: comparison with conventional computed tomography.

Background/Aims18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) has been used for preoperative staging of colorectal cancer (CRC). However, the diagnostic accuracy of FDG-PET/CT for detection of lymph node or distant metastasis and its prognostic role have not been well established. We therefore evaluated the diagnostic and prognostic value of FDG-PET/CT in comparison with conventional CT for CRC.MethodsWe investigated 220 patients who underwent preoperative FDG-PET/CT and CT, followed by curative surgery for CRC. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of FDG-PET/CT and CT for detection of lymph node metastasis and distant metastasis were evaluated. In addition, we assessed the findings of FDG-PET/CT and CT according to outcomes, including cancer recurrence and cancer-related death, for evaluation of prognostic value.ResultsFor detection of lymph node metastasis, FDG-PET/CT had a sensitivity of 44%, a specificity of 84%, and an accuracy of 67%, compared with 59%, 65%, and 62%, respectively, for CT (P=0.029, P=0.000, and P=0.022). For distant metastasis, FDG-PET/CT had a sensitivity of 79%, a specificity of 94%, and an accuracy of 93%, compared with 79%, 87%, and 86%, respectively, for CT (P=1.000, P=0.004, and P=0.037). In addition, positive findings of lymph node metastasis and distant metastasis on FDG-PET/CT were associated significantly with cancer recurrence or cancer-related death (P=0.009, P=0.001, respectively).ConclusionsPreoperative FDG-PET/CT had a higher specificity and accuracy compared to CT for detection of lymph node metastasis and distant metastasis of CRC. In addition, FDG-PET/CT could be a valuable prognostic tool for CRC.

CCR7 as a predictive biomarker associated with computed tomography for the diagnosis of lymph node metastasis in bladder carcinoma.

The aim of the present study was to investigate whether the expression levels of CC-chemokine receptor 7 (CCR7) combined with computed tomography (CT) was associated with lymph node metastasis in bladder transitional cell carcinoma (BTCC). For this purpose, 115 cases of BTCC were analyzed at the Department of Urology of Xiangya Hospital, Central South University (Changsha, China). Preoperative CT scans of abdomen and pelvis, immunohistochemistry of CCR7 expression in the tumor specimens and pathological findings for lymph node metastasis were assessed. In addition, the sensitivity, specificity and accuracy of CCR7 and CT for the diagnosis of lymph node metastasis in BTCC were evaluated separately and jointly. The expression levels of CCR7 were observed to be significantly higher in BTCC than in normal controls (P<0.01). Multivariate analysis indicated that the overexpression of CCR7 was an independent predictor for lymph node metastasis in BTCC (P<0.05). The sensitivity, specificity and accuracy of CCR7 combined with CT scan for the diagnosis of lymph node metastasis in BTCC were 92.3, 83.6 and 70.0%, respectively. By contrast, the sensitivity, specificity and accuracy of CCR7 alone were 88.1, 69.9 and 76.5%, respectively, while the sensitivity, specificity and accuracy of CT alone were 52.4, 79.5 and 69.6%, respectively. The results of the present study indicated that CCR7 is an independent predictor of lymph node metastasis in BTCC. Therefore, the use of CCR7 combined with CT may improve the accuracy of the diagnosis of lymph node metastasis in BTCC.

HER2 expression in fine needle aspirates of lymph nodes detected by preoperative axillary ultrasound in breast cancer patients.

The purpose of this study was to assess the usefulness of HER2 levels in ultrasonographically guided fine-needle aspiration biopsy (US-FNA) aspirates of axillary lymph nodes (ALNs) in the determination of lymph node metastasis or the characterization of primary breast cancer, and to correlate the HER2 levels in US-FNA aspirates (FNA-HER2s) of metastatic ALNs with the HER2 statuses of corresponding primary breast cancers. An institutional review board approved the study. Between January and October 2010, 164 patients with 167 ALNs examined by US-FNA were included. FNA-HER2s of ALNs were measured by chemiluminescence immunoassay, and they were correlated with cytologic/final diagnoses. Receiver operating characteristics (ROC) curve analysis was performed to evaluate the diagnostic ability to differentiate benign and metastatic ALNs. Additionally, FNA-HER2s of metastatic ALNs were correlated with HER2 status and other clinicopathologic variables of the primary breast cancers. Among the 167 ALNs, 138 were metastatic and 29 were benign. The mean FNA-HER2 (6.3 ng/ml) of metastatic ALNs was higher than that of benign ALNs. All 29 benign ALNs showed no measurable value of FNA-HER2 (0.0 ng/ml). The area under the ROC curves of FNA-HER2 of ALNs was 0.679 for the diagnosis of ALN metastasis. The FNA-HER2 statuses of 108 metastatic ALNs (79.4%) were concordant with the HER2 statuses of the corresponding primary breast cancers. In a subgroup analysis of HER2-positive cancers with ALN metastasis, distant metastasis was significantly associated with FNA-HER2-negativity of metastatic ALNs (P = 0.04). Although FNA-HER2 of ALNs did not improve the diagnostic performance of FNA cytology in preoperative diagnosis of ALN metastasis of overall patients, FNA-HER2-positive metastatic ALNs were significantly associated with HER2-positivity of primary breast cancers. Additionally, FNA-HER2 analysis of ALN may help to develop more personalized treatment protocol for breast cancer patients by determining the concordance or discordance of HER2 status between primary cancers and metastatic ALNs.

Accuracy of Intraoperative Determination of Central Lymph Node Metastasis by Surgeon in Papillary Thyroid Carcinoma

Objectives: Prophylactic central neck dissection (CND) in papillary thyroid carcinoma (PTC) remains controversial because of its potential morbidity and unclear benefit. If we can judge central lymph node metastasis preoperatively or intraoperatively, we can avoid unnecessary CND. However, ultrasound (US)/computed tomography (CT) or sentinel node biopsy is not enough to determine central lymph node metastasis accurately. The aim of this study was to evaluate the accuracy of intraoperative determination of central lymph node metastasis by surgeon during thyroidectomy. Methods: From October 2011 to September 2012, 122 consecutive patients with clinically node negative PTC on US and CT were enrolled. Any suspicious metastatic lymph node on palpation or inspection was sent for frozen biopsy, and then bilateral CND with total thyroidectomy was completed in all patients. The criteria of suspicious lymph node included dark cystic or hard palpable lymph node, or larger than about 7 mm in diameter. We compared the intraoperative surgeon’s judgment with final pathologic results. Results: Suspicious metastatic lymph nodes were found in 37 (30.3%) patients, and 15 of them had metastasis in permanent biopsy. Of 85 patients with no suspicious lymph node, 27 patients had metastasis in permanent biopsy. Sensitivity, specificity, positive predictive value, and negative predictive value of intraoperative determination of lymph node metastasis was 35.7%, 72.5%, 40.5%, and 68.2%, respectively. In 22 of false positive patients, 14 (63.6%) had Hashimoto’s thyroiditis. Conclusions: Intraoperative determination of central lymph node metastasis by surgeon is limited to guide CND in clinically node negative PTC because of its low sensitivity.

A large retrospective multicenter study of vaginal melanomas

The outcome of patients presenting with vaginal melanoma has been assessed in a large multicentric retrospective study. The databases of 12 French institutions were searched for primary vaginal melanomas managed between 1990 and 2007. Among the 54 patients recorded, 46 were managed with a curative intent and included in the study. The clinical characteristics, treatments, and detection of c-KIT protein expression have been studied. The median age of the patients was 63.5 years (42-88). Twenty-eight patients were classified as International Federation of Gynecology and Obstetrics (FIGO) stage I, five as stage II, six as stage III, and one as stage IVA. c-KIT protein was overexpressed in 80% of the patients. Forty-two patients underwent surgical resection of the tumor, nine patients received local adjuvant treatment, and 10 received systemic adjuvant therapy. The median relapse-free survival was 10.9 months. c-KIT-negative status (P=0.01) and stage I (P=0.02) were associated with locoregional recurrence. The rate of metastasis was increased for advanced FIGO stages (P<0.01). The median overall survival (OS) was 28.4 months. The finding of lymph node metastasis adversely affected OS (P<0.01). Conservative surgery and radiotherapy were associated with a decrease in metastasis-free and OS (P<0.01) compared with surgery alone, this group of patients presenting with advanced FIGO stages (P=0.02). Despite the use of limited data, conservative surgery combined with a sentinel lymph node procedure, followed by adjuvant radiotherapy could be proposed to patients with early FIGO stage in the absence of validated management. c-KIT negativity by immunochemistry appears to be a poor prognosis marker in terms of locoregional recurrences but not for metastatic spread nor survival. Further assessment of the role of c-KIT expression in this disease is thus mandatory to select patients for targeted therapy.

Ausgedehnte Salvage-Lymphknotenentfernung aus Becken- und Retroperitoneum bei Prostatakarzinomrezidiv

Treatment of a biochemical prostate cancer relapse represents a difficult clinical dilemma, which has remained without a definitive solution so far. Based on clinical studies, we combine radical prostatectomy with extended pelvic lymph node dissection in intermediate and high risk patients as a routine procedure at our clinic. In this paper, we report on a case of extended salvage lymphadenectomy performed due to biochemical prostate cancer recurrence. The 56-year-old patient came to our clinic in April 2012 with a finding of lymph node metastasis according to PET-CT imaging. Laparoscopic radical retropubic prostatectomy with lymphadenectomy had been performed in 2008 [pT3a, N0 (0/4), M0, R0, GS 5+4=9, iPSA 26.67 ng/mL], and followed by radiotherapy as of September 2009. The extended salvage lymphadenectomy was performed in April 2012 due to a PSA-level rise up to 24 ng/mL and the aforementioned PET-CT findings. A total of 22 lymph nodes were removed, among them 3 lymph nodes with metastases. In the fossa obturatoria on the right we identified a walnut-size lymph node relapse with tumour necrosis, which fully corresponded to the PET-CT scan. The PSA level subsequently dropped to 0.4 ng/mL postoperatively, and further to the current value of 0.02 ng/mL (August 2012).

Fertility-Sparing Management for Bulky Cervical Cancer Using Neoadjuvant Transuterine Arterial Chemotherapy Followed by Vaginal Trachelectomy

Fertility-sparing management for bulky cervical cancer remains under investigation. We investigated the safety of neoadjuvant transuterine arterial chemotherapy (TUAC) followed by a simple vaginal trachelectomy for patients with tumors larger than 3 cm in diameter who desired uterine preservation. First, to assess the safety and efficacy of TUAC, survival and pathological complete response data from 39 patients with a diagnosis of stage IB2 to stage IIB cervical cancer who participated in 2 consecutive trials during 1997-2006 were analyzed. The neoadjuvant chemotherapy regimens were a combination of TUAC using cisplatin with intravenous nedaplatin or irinotecan. Second, to assess the safety of fertility-sparing management with TUAC, medical records of patients matching the following criteria were reviewed during the same period: (1) International Federation of Gynecology and Obstetrics stages IB1 to IIA; (2) maximum diameter of tumor, 3 cm or more; (3) squamous cell carcinoma; (4) no radiological findings of lymph node metastasis; and (5) patient's strong desire for preservation of the uterus and to undergo TUAC. The overall 5-year survival rate of the 39 enrolled patients was 81.0% (95% confidence interval, 64.8%-93.7%). No malignant cells were found in pathologically examined surgical specimens from 14 patients (35.9%), all of whom were alive without recurrence for more than 7 years after treatment. Based on medical records, 7 patients were eligible according to the fertility-sparing criteria, 1 patient with International Federation of Gynecology and Obstetrics stage IB1 cancer, 5 patients with stage IB2, and 1 patient with stage IIA. One patient with stage IB1 cancer and 2 patients with stage IB2 cancer underwent simple vaginal trachelectomy, resection of paracervical tissues, and abdominal lymphadenectomy. Their disease-free intervals were 86, 120, and 65 months, respectively. All 3 patients had regular menses after surgery but no pregnancies, for personal reasons unrelated to fertility. Powerful neoadjuvant chemotherapy regimens resulted in a pathological complete response. Long-term disease-free interval was achieved after fertility-sparing management for bulky cervical cancer in 3 cases.

Complications of Central Neck Dissection in Patients with Papillary Thyroid Carcinoma: Results of a Study on 1087 Patients and Review of the Literature

Prophylactic central neck dissection (CND) has been proposed in the treatment of patients affected by papillary thyroid carcinoma (PTC) with clinically negative neck lymph nodes. The procedure allows pathologic staging of lymph nodes of the central compartment and treatment of the micrometastases. Nevertheless, the morbidity that its routine use adds to the total thyroidectomy must be taken into account. The aim of this study was to characterize the morbidity that CND adds to the total thyroidectomy. This was a retrospective study of 1087 patients with PTC and clinically negative neck lymph nodes. Patients were divided into three study groups: Group A, total thyroidectomy; Group B, total thyroidectomy and ipsilateral CND; Group C, total thyroidectomy and bilateral CND. Primary endpoints of the study were evaluated by comparing the rates of transient and permanent recurrent laryngeal nerve (RLN) injury and hypoparathyroidism in the three study groups. Analysis of data showed no significant differences in the rate of transient (Group A: 3.6%, Group B: 3.9%, and Group C: 5.5%; p=0.404) and permanent (Group A: 1%, Group B: 0.5%, and Group C: 2.3%; p=0.099) RLN injury between the three study groups. Both ipsilateral CND and bilateral CND were associated with a higher rate of transient hypoparathyroidism (Group: A 27.7%, Group B: 36.1%, and Group C: 51.9%; p=0.014; odds ratio [OR]: 1.477; 95% confidence interval [CI]: 1.091-2.001; p<0.001; OR: 2.827; 95% CI: 2.065-3.870, respectively). Bilateral CND had a higher rate of permanent hypoparathyroidism (Group A: 6.3%, Group B: 7%, and Group C: 16.2%; p<0.001; OR: 2.860; 95% CI: 1.725-4.743). The increased rates of transient and permanent hypoparathyroidism in our series suggest a critical review of indications for the routine use of prophylactic CND for PTC. Prophylactic CND ipsilateral to the tumor associated with total thyroidectomy may represent an effective strategy for reducing the rate of permanent hypoparathyroidism. Concomitant completion contralateral paratracheal lymph node neck dissection should be performed in presence of lymph node metastasis on intraoperative frozen-section pathology. This approach limits the use of bilateral CND to patients with intraoperative pathological findings of lymph node metastases.

Vascular Endothelial Growth Factor-C Associated with Computed Tomography Used in the Diagnosis of Lymph Node Metastasis of Bladder Carcinoma

Vascular endothelial growth factor C (VEGF-C) has been demonstrated to stimulate the growth of lymphatic vascular endothelium. The purpose of this study is to determine whether VEGF-C associated with computed tomography (CT) has a relationship with lymph node metastasis in bladder transitional cell carcinoma (BTCC). One hundred twenty seven cases of BTCC were studied: first, both plain and enhanced CT scans of abdomen and pelvis were performed preoperatively; second, VEGF-C protein expressions in tumor cells were tested by immunohistochemistry postoperatively; and finally, detailed pathological findings for lymph node metastasis were recorded. VEGF-C expressions in tumor bladder cells were significantly higher than those in normal bladder epithelium. In the group of BTCC-positive, VEGF-C was significantly correlated with lymph node metastasis (p <0.01). Sensitivity, specificity and accuracy of VEGF-C in the diagnosis of lymph node metastasis of bladder carcinoma were 87.0, 67.9, and 74.8%, respectively. Sensitivity, specificity and accuracy of CT were 47.8, 80.2, and 68.5%, respectively. When VEGF-C visually correlated with CT scan in the detection of lymph node metastasis, sensitivity was 91.3%; specificity was 84.0% and accuracy was 86.6%. Positive VEGF-C was significantly correlated with lymph node metastasis of bladder carcinoma. VEGF-C expression in biopsy specimens may be beneficial in predicting pelvic lymph nodes. It can improve accuracy when combined with CT.

MRI of gastric carcinoma: Results of T and N-staging in an in vitro study

To determine the accuracy of 1.5-T magnetic resonance imaging (MRI) in the evaluation of gastric wall invasion and perigastric lymph node metastasis in gastric adenocarcinoma. Twenty resected gastric specimens containing 20 tumors were studied with a 1.5-T MR system using a commercial head surface coil. MR scanning was performed with a T1 weighted image (TR/TE = 500/20), and a T2 weighted image (TR/TE = 2500/90). MR findings were compared with pathologic findings. A T1-weighted image demonstrated three layers in the normal gastric wall. All of the gastric tumors were well demonstrated by lesions and location. In a MRI findings of gastric wall invasion, there was 1 case of T1, 7 of T2, 11 of T3. Pathologic results of resected specimens included 3 cases of pT1, 4 of pT2, and 12 of pT3. The accuracy of T staging with MRI was 74% (14 of 19). MRI findings of lymph node metastasis included 6 cases of N0, 13 cases of N1. The accuracy of the N staging with MRI was 47% (9 of 19). MRI has a high diagnostic accuracy in the evaluation of the T staging of gastric cancer in vitro and thus potentially enables preoperative histopathologic staging.