Node Lesions Research Articles

Impact of macroscopic on-site evaluation on the diagnostic outcomes of endoscopic ultrasound-guided fine-needle aspiration.

Endoscopic ultrasound (EUS)-guided tissue acquisition is the preferred modality for diagnosing pancreatic lesions and mediastinal and abdominal lymph nodes. Rapid on-site cytologic evaluation improves the diagnostic outcome of EUS-guided fine-needle aspiration (FNA) but is unavailable at many centers. Alternatively, macroscopic on-site evaluation (MOSE) may improve the diagnostic outcome of EUS-FNA, but data are limited. Hence, the present study was conducted to assess the efficacy of MOSE in improving adequacy and accuracy. We retrospectively analyzed data of consecutive patients with pancreatic or lymph nodal lesions undergoing EUS-guided FNA at a tertiary care center from December 2020 to December 2022. The study's primary outcomes were adequacy and diagnostic accuracy of the EUS-guided tissue acquisition, with secondary analysis of predictors of adequacy and accuracy. Data from 124 patients (44.4% male, median age: 54 years) who underwent EUS-FNA were included in the present analysis. The presence of macroscopic visible core (MVC) on MOSE was reported in 93/124 (75%) cases. An adequate sample for histopathological or cytological examination was obtained in 110/124 (88.7%) cases, while the diagnostic accuracy was 85.5%. On multivariate analysis, the absence of MVC on MOSE was found to be the independent negative predictor of both adequacy (OR 0.092, 95% CI: 0.024-0.349) and accuracy (OR 0.175, 95% CI: 0.057-0.536). The presence of MVC on MOSE can be an indicator of specimen adequacy and can improve the diagnostic yield of EUS-FNA.

A phase 2, open-label, multicenter study investigating efficacy and safety of RP3 oncolytic immunotherapy combined with other therapies in patients with locoregionally advanced or recurrent squamous cell carcinoma of the head and neck.

TPS6106 Background: Head and neck (HN) cancers were estimated to account for > 50,000 new cancer diagnoses and > 11,000 deaths in the US in 2022. Squamous cell carcinoma of the head and neck (SCCHN) comprises about 90% of HN cancers. For locally advanced (LA) SCCHN, standard initial therapy is concurrent chemoradiation therapy (CCRT) or definitive resection followed by adjuvant radiation ± chemotherapy; > 50% of patients (pts) relapse within 2 years. For recurrent/metastatic (R/M) SCCHN, standard first-line therapy includes immune checkpoint inhibitors (anti–PD-1) ± chemotherapy or cetuximab, chemotherapy ± cetuximab, or salvage surgery; prognoses are poor, and benefit of anti–PD-1 therapy is generally limited to pts with positive PD-L1 combined positive score (CPS). RP3 is an enhanced potency, modified version of herpes simplex virus type 1 expressing the fusogenic gibbon ape leukemia virus glycoprotein with the R sequence deleted (GALV-GP-R−), an anti–CTLA-4 antibody-like molecule, and costimulatory CD40- and 4-1BB–activating ligands. Intratumoral (IT) RP3 delivery may promote immunogenic tumor cell death and systemic antitumor response (abscopal effect), both of which may be further enhanced by standard therapies (eg, chemotherapy, anti–PD-1). This phase 2 study will evaluate the efficacy and safety of RP3 combined with other therapies in pts with advanced, inoperable LA or R/M SCCHN. Methods: Pts in the LA cohort (up to ~100 pts) must have inoperable, previously untreated, high-risk SCCHN eligible for curative intent CCRT and will be randomized 1:1 to receive RP3 + standard of care cisplatin-based CCRT, followed by nivolumab (nivo), vs CCRT alone. A formal safety assessment will be performed 3 weeks after the tenth patient randomized to RP3 + CCRT + nivo has completed CCRT. RP3 will be injected IT into primary tumor sites and/or superficial or deep nodal lesions. Pts in the RP3 group will receive up to 4 doses of RP3 every 3 weeks (Q3W; first dose at a concentration of 1 × 106 plaque-forming units [PFU]/mL; subsequent doses 1 × 107 PFU/mL). Nivo will be given at 240 mg Q2W or 480 mg Q4W (after CCRT completion, concurrent with fourth RP3 dose, for up to 1 year). The primary endpoint for the LA cohort is progression-free survival. Pts in the R/M cohort (up to ~30 pts) must have R/M SCCHN eligible for first-line systemic therapy for locoregional recurrence and/or distant metastases and PD-L1 CPS < 20, and will receive RP3 + nivo + carboplatin/paclitaxel. RP3 will be injected IT as described above for up to 8 doses Q3W (first dose 1 × 106 PFU/mL; subsequent doses 1 × 107 PFU/mL; carboplatin/paclitaxel started at first RP3 dose). Nivo will be given as above, concurrent with third RP3 dose, for up to 2 years. The primary endpoint for the R/M cohort is overall response rate. Clinical trial information: NCT05743270 .

Differentiated, immunobased approach of anaplastic large cell lymphoma treatment in children and adolescents: literature review and protocol ALCL-NII DOG-2003 results

Background. Anaplastic large cell lymphoma (ALCL) is a rare variant of highly aggressive lymphomas in children and adolescents. ALCL is characterized by a heterogeneous clinical manifestation with nodal and extranodal lesions, various morphological variants, variable expression of T-cell markers and cytogenetic aberrations involving the ALK gene. Due to the rarity of this disease (up to 10–15 % of all non-Hodgkin’s lymphomas in children), there are no uniform standards for ALCL therapy. Block treatment schemes similar to those applied in the treatment of B-cell non-Hodgkin’s lymphomas are used; less often there can be used protocols similar to the therapy of acute lymphoblastic leukemia. Taking into account the unfavorable effect on the prognosis of T-cell markers expression in ALCL, we developed protocol ALCL-NII DOG-2003, which considered the immunological features of the tumor.Aim. To assess the effectiveness of differentiated immunobased ALCL therapy by domestic protocol ALCL-NII DOG-2003.Materials and methods. From 01.03.1997 to 01.10.2022, 60 patients with primary diagnosed ALCL were included in the study. The diagnosis was based on histological, immunohistochemical and cytogenetic criteria of WHO classification of hematopoietic and lymphoid tissues tumors. According to treatment program, patients were subdivided in 2 groups: patients treated by NHL-BFM 95 protocol (n = 21) and by ALCL-NII DOG-2003 (n = 39). The male:female ratio was 1,3:1 in group of patients with NHL-BFM 95 protocol and 1,4:1 – in ALCL-NII DOG 2003. The effectiveness assessment was based on overall, event-free and relapse-free survival with SPSS 21.0 computed program. The differences between groups were significant with p ≤0.05.Results. The use of risk-adopted, immuno-oriented protocol made it possible to obtain a 10‑year EFS in 97.4 ± 2.6 %, whereas results of the standard NHL-BFM 95 protocol are 63.9 ± 10 % (p = 0.001).Conclusion. The use of a differentiated approach to ALCL treatment, considering not only the stage and prognostic risk group, but also the immunological features of the tumor, is more effective, and allows achieving significantly higher survival rates, than standard program (NHL-BFM 95).

ХИРУРГИЧЕСКИЕ АСПЕКТЫ ЛЕЧЕНИЯ МЕЛАНОМЫ КОЖИ (обзор литературы)

The article deals with the problems of surgical treatment of skin melanoma. Modern surgical treatment of skin melanoma includes various surgical interventions: wide excision of primary skin melanoma, amputation of the finger or disarticulation of the phalanx of the finger, resection of the auricle with its reconstruction, and other operations.
 The paper discusses the importance of assessing the state of regional lymph nodes in skin melanoma to decide whether to perform lymph node dissection. In addition to adequate excision of primary skin melanoma, to ensure the radicalness of surgical treatment, according to indications, lymph node dissection is performed in case of met astatic lesions of regional lymph nodes.
 A modern approach to detecting latent metastases involves performing a biopsy of sentinel lymph nodes. The information obtained is extremely important not only in assessing the damage to regional lymph nodes, determin ing the stage of the disease, but also in choosing the tactics of treatment and predicting the course of the tumor.
 Significant in the work is the conclusion that regional lymph node dissection is performed only in case of met astatic lesions of regional lymph nodes, confirmed morphologically. Accordingly, the best option is to perform regional lymph node dissection simultaneously with excision of primary skin melanoma. Prophylactic lymph node dissection for skin melanoma is not recommended. In conclusion, the latest trends in the surgical treatment of skin melanoma are indicated: an adequate reduction in the indentation and volume of operations when removing primary melanomas, an increase in the role of sentinel lymph node biopsy, the need for morphological verification of lymph node involvement in justifying lymph node dissection, and an increase in the number of metastasectomy.

EUS‐guided FNAC in intra‐abdominal lesions: Technique of tissue acquisition, ancillary testing, pearls and perils, and prospects

Endoscopic ultrasound enables visualization of lesions within and in the vicinity of the gastrointestinal tract. Endoscopic ultrasound guided fine needle aspiration cytology (EUS-FNAC) helps in targeting various luminal and extraluminal lesions both diagnostically and therapeutically. Various intra-abdominal organs amenable to EUS-FNA include the gastrointestinal tract (GIT), pancreas, kidney, adrenal gland, liver, bile duct, gallbladder, spleen, and lymph nodes. EUS-FNAC is mostly done for pancreatic and intra-abdominal lymph nodal lesions. In the present review, we have discussed various aspects of EUS-FNAC.

A CLINICAL, CYTOLOGICAL, HISTOMORPHOLOGICAL EVALUTION OF LYMPHNODES IN CHILDREN

Lymphadenopathy is a common clinical presentation of patients attending outdoor patient departments. The etiology varies with a wide spectrum ranging from inammatory causes on one end to malignant on the other. In the present study, cytological and relevant histopathological diagnoses were done in 200 cases received in Department of Pathology. The present study aimed to nd out the percentage of various lesions of lymph node and their prevalence according to age group and sex of patients. It also correlated the histo-cytodiagnosis in cases where both histology and cytology were available and compared the results of present study with similar other studies. It included 200 cases of lymphadenopathies. The cases were selected randomly. Lymph nodes included were of neck region, axilla, groin, from the extremities and the internal . Apart from haematoxylin and eosin (H & E) stain, special stains like Ziehl–Neelsen stain and giemsa stain were done wherever needed. Out of 200 cases, 93 (46.5%) cases were of reactive hyperplasia. Females were affected more commonly than males. Tuberculosis occurred more in younger patients whereas metastases were more common in older age group. Axillary lymph node was the most common lymph node involved. Histopathology gave accurate and conrmatory results than cytology. Lymph node evaluation is an integral part of patient management

ЛУЧЕВАЯ ТЕРАПИЯ ПРИ РАКЕ МОЛОЧНОЙ ЖЕЛЕЗЫ рТ1–3N0–1М0 ПОСЛЕ МАСТЭКТОМИИ ИЛИ ПОДКОЖНОЙ КОЖЕСОХРАННОЙ МАСТЭКТОМИИ С РЕКОНСТРУКЦИЕЙ. ОБЗОР ЛИТЕРАТУРЫ

Purpose: The literature review analyzes publications over the past decades on the need for radiation therapy after mastectomy or subcutaneous/skin-preserving mastectomy with reconstruction. Results: Risk factors for breast cancer recurrence were analyzed. The effect of radiation therapy on the recurrence of breast cancer after mastectomy, subcutaneous and skin-preserving mastectomy with reconstruction was evaluated depending on the stage, lymph node lesions, and the presence of unfavorable molecular biological types. Indications for radiation therapy are described. The effect of radiation therapy on early and late complications of the reconstructed breast and options for reducing the percentage of complications were analyzed. Conclusion: The exclusion of radiation therapy from the breast cancer treatment plan is a decrease in the percentage of complications caused by radiation therapy, for example, during implant reconstruction – a decrease in capsular contractures. And, as a result, improving the quality of life of patients, reducing repeated operations in case of complications, which means it is economically profitable. In recent years, due to the increasing need for various breast reconstruction options, the surgeon and radiotherapist have faced the task of choosing the optimal sequence of breast reconstruction, as well as reducing the risk of post-radiation complications. Radiation therapy, along with reducing the risk of relapse of the disease, increases the risk of complications after breast reconstruction, and vice versa, the reconstructed mammary gland can cause difficulties for the radiologist to correctly deliver the required dose of radiation. Minimizing the frequency and severity of complications after radiation therapy on the reconstructed gland without compromising oncological or cosmetic results is an important and common interdisciplinary goal for oncologists and radiotherapists.

Influence of surgical margin width on survival rate after resection of intrahepatic cholangiocarcinoma: a systematic review and meta-analysis

ObjectivesHepatectomy is the best treatment for patients with intrahepatic cholangiocarcinoma (ICC) at present, but there has been controversy about the width of surgical margins. In this study, we systematically investigated...

Whole body MRI with Diffusion Weighted Imaging versus 18F-fluorodeoxyglucose-PET/CT in the staging of lymphomas

PurposeTo assess the diagnostic performance of Whole Body (WB)-MRI in comparison with 18F-Fluorodeoxyglucose-PET/CT (18F-FDG-PET/CT) in lymphoma staging and to assess whether quantitative metabolic parameters from 18F-FDG-PET/CT and Apparent Diffusion Coefficient (ADC) values are related.Materials and methodsWe prospectively enrolled patients with a histologically proven primary nodal lymphoma to undergo 18F-FDG-PET/CT and WB-MRI, both performed within 15 days one from the other, either before starting treatment (baseline) or during treatment (interim). Positive and negative predictive values of WB-MRI for the identification of nodal and extra-nodal disease were measured. The agreement between WB-MRI and 18F-FDG-PET/CT for the identification of lesions and staging was assessed through Cohen's coefficient k and observed agreement. Quantitative parameters of nodal lesions derived from 18F-FDG-PET/CT and WB-MRI (ADC) were measured and the Pearson or Spearman correlation coefficient was used to assess the correlation between them. The specified level of significance was p ≤ 0.05.ResultsAmong the 91 identified patients, 8 refused to participate and 22 met exclusion criteria, thus images from 61 patients (37 men, mean age 30.7 years) were evaluated. The agreement between 18F-FDG-PET/CT and WB-MRI for the identification of nodal and extra-nodal lesions was 0.95 (95% CI 0.92 to 0.98) and 1.00 (95% CI NA), respectively; for staging it was 1.00 (95% CI NA). A strong negative correlation was found between ADCmean and SUVmean of nodal lesions in patients evaluated at baseline (Spearman coefficient rs = − 0.61, p = 0.001).ConclusionWB-MRI has a good diagnostic performance for staging of patients with lymphoma in comparison with 18F-FDG-PET/CT and is a promising technique for the quantitative assessment of disease burden in these patients.

PD-0069 Anatomic pattern of recurrence after single or multifraction SBRT for lymph nodal lesions.

PD-0069 Anatomic pattern of recurrence after single or multifraction SBRT for lymph nodal lesions.

Brief Communication on Pathologic Assessment of Persistent Stable Metastatic Lesions in Patients Treated With Anti-CTLA-4 or Anti-CTLA-4 + Anti-PD-1 Therapy.

Despite the wide use of immune checkpoint inhibition for the treatment of melanoma, the mechanisms leading to long-term stable disease are incompletely understood. Patients with metastatic melanoma who had received ipilimumab alone or ipilimumab plus nivolumab 2+years prior and attained at least 6 months of stable disease were identified. Positron emission tomography/computed tomography (PET/CT) was performed. Pretreatment and posttreatment biopsies of areas of stable disease were assessed for tumor, fibrosis, and inflammation. Seven patients underwent PET/CT and tissue biopsy. Fluorodeoxyglucose avid lesions on PET/CT ranged from no activity to an SUV of 22. In 6 patients, the residual stable lesions were composed of necrosis and fibrosis with a prominent pigment containing macrophages and no residual melanoma. In 1 patient, a nodal lesion demonstrated melanoma with active inflammation. In most patients with durable stable disease after treatment with ipilimumab or ipilimumab/nivolumab, residual lesions demonstrated predominantly necrosis and fibrosis consistent with resolving lesions. The presence of melanophages in these samples may suggest ongoing immune surveillance. One patient did demonstrate residual melanoma, indicating the need for ongoing monitoring of this patient population.

Problems of staging complicated forms of colon carcinoma in patients who were urgently operated in a general surgical hospital

The aim of the study: to analyze the results of surgical treatment and pathomorphological examination of preparations of patients who were urgently operated on for complicated forms of colon cancer, and to assess their influence on the correct staging of the tumor process in the postoperative period. Materials and methods. An analysis of data from pathomorphological studies of 71 (100 %) patients who underwent treatment at the surgical department for complicated forms of colon cancer was carried out. Results. Colon adenocarcinoma was detected in all 71 (100 %) patients (mucinous adenocarcinoma in 3 (4.23 %) patients, and the rest 68 (95.77 %) – unspecified adenocarcinoma). 44 (61.97 %) patients were diagnosed with moderately differentiated adenocarcinoma of the colon, 25 (35.21 %) – with poorly differentiated, and 2 (2.82 %) – with highly differentiated tumors. Conclusions. In the case of surgical interventions for complicated forms of colon cancer, lymphatic dissection in the minimum extent (D1) was performed in 54 (76.06 %) patients, and 17 (23.94 %) patients were operated on without removal of lymph nodes. The insufficient level of performing lymphatic dissections in patients with complicated forms of malignant pathology of the large intestine does not make it possible to assess the real picture of metastatic lesions of regional lymph nodes and to assign the correct stage of pN according to TNM 8 (in 17 (23.94 %) patients, no pathomorphological assessment was performed at all, and in 40 (56.34 %) patients, the number of examined lymph nodes were not indicated in the preparation). In the structure of staging of oncopathology, in 12 (16.90 %) patients, the stage of cancer was assign only according to the criterion of the degree of invasion (T) and in 5 (7.04 %) patients – only according to the data of instrumental examination and intraoperative revision (clinically), and was overestimated. Lack of a clear consistent assessment of the macroscopic, microscopic, immunohistochemical and molecular characteristics of the tumor process in 17 (23.94 %) patients leads to inaccuracies in the assessment of the stage of the tumor process, which in turn affects the prognosis for relapse and survival of the patient, and the tactic of postoperative treatment.

Kidney cancer with thyroid metastasis combined with thyroid carcinoma, a case report

BackgroundThyroid cancer is the most common malignant tumor of the endocrine system. There have been some reports on kidney cancer with thyroid metastasis. However, kidney cancer has rarely been detected during thyroid cancer surgery.Case presentationWe present a rare case of kidney cancer with thyroid metastasis, combined with thyroid carcinoma. A 66-year-old woman was admitted to our hospital in September 2021 due to enlarged left thyroid nodules for two years. The patient was diagnosed with a left thyroid nodule on physical examination in 2012. Extended radical resection of the thyroid cancer was performed. Intraoperatively, two thyroid lesions were identified. Thus, the patient was definitively diagnosed with kidney cancer with thyroid metastasis and papillary thyroid carcinoma. Furthermore, two metastatic nodules due to kidney cancer and one metastatic lymph node lesion due to thyroid cancer were found in the loose connective tissue adjacent to the thyroid.ConclusionsKidney cancer with thyroid metastasis and thyroid carcinoma rarely co-occur, and it is difficult to identify the primary tumor. Although clinical examination methods are increasingly updated, the past medical history and physical examination are still very important.

Streptococcus suis contributes to inguinal lymph node lesions in piglets after highly pathogenic porcine reproductive and respiratory syndrome virus infection.

The swine pathogens porcine reproductive and respiratory syndrome virus (PRRSV) and Streptococcus suis have both been reported to cause damage to the immune organs. Inguinal lymph node (ILN) injury has been reported in PRRSV-infected pigs with secondary S. suis infection, but not much is known about the mechanism. In this study, secondary S. suis infection after highly pathogenic (HP)-PRRSV infection caused more severe clinical symptoms, mortality, and ILN lesions. Histopathological lesions were seen in ILNs with a marked decrease in lymphocyte numbers. Terminal deoxynucleotidyl transferase (TdT)-mediated de-oxyuridine triphosphate (dUTP)-biotin nick end-labeling (TUNEL) assays revealed that HP-PRRSV strain HuN4 alone induced ILN apoptosis, but dual-infection with S. suis strain BM0806 induced greater levels of apoptosis. Besides, we found that some HP-PRRSV-infected cells underwent apoptosis. Furthermore, anti-caspase-3 antibody staining confirmed that ILN apoptosis was mainly induced by a caspase-dependent pathway. Pyroptosis was also observed in HP-PRRSV-infected cells, and there was more pyroptosis in piglets infected with HP-PRRSV alone compared with those with secondary S. suis infection, and HP-PRRSV-infected cells underwent pyroptosis. Altogether, this is the first report to identify pyroptosis in ILNs and which signaling pathway is related to ILN apoptosis in single or dual-infected piglets. These results contribute to a better understanding of the pathogenic mechanisms during secondary S. suis infection.

Is there more than meets the eye in PSMA imaging in prostate cancer with PET/MRI? Looking closer at uptake time, correlation with PSA and Gleason score

BackgroundIn patients with increasing PSA and suspicion for prostate cancer, but previous negative biopsies, PET/MRI is used to test for tumours and target potential following biopsy. We aimed to determine different PSMA PET timing effects on signal kinetics and test its correlation with the patients’ PSA and Gleason scores (GS).MethodsA total of 100 patients were examined for 900 s using PET/MRI approximately 1–2 h p.i. depending on the tracer used (68Ga-PSMA-11, 18F-PSMA-1007 or 18F-rhPSMA7). The scans were reconstructed in static and dynamic mode (6 equal frames capturing “late” PSMA dynamics). TACs were computed for detected lesions as well as linear regression plots against time for static (SUV) and dynamic (SUV, SUL, and percent injected dose per gram) parameters. All computed trends were tested for correlation with PSA and GS.ResultsStatic and dynamic scans allowed unchanged lesion detection despite the difference in statistics. For all tracers, the lesions in the pelvic lymph nodes and bones had a mostly negative activity concentration trend (78% and 68%, resp.), while a mostly positive, stronger trend was found for the lesions in the prostate and prostatic fossa following RPE (84% and 83%, resp.). In case of 68Ga-PSMA-11, a strong negative (Rmin = − 0.62, Rmax = − 0.73) correlation was found between the dynamic parameters and the PSA. 18F-PSMA-1007 dynamic data showed no correlation with PSA, while for 18F-rhPSMA7 dynamic data, it was consistently low positive (Rmin = 0.29, Rmax = 0.33). All tracers showed only moderate correlation against GS (Rmin = 0.41, Rmax = 0.48). The static parameters showed weak correlation with PSA (Rmin = 0.24, Rmax = 0.36) and no correlation with GS.Conclusion“Late” dynamic PSMA data provided additional insight into the PSMA kinetics. While a stable moderate correlation was found between the PSMA kinetics in pelvic lesions and GS, a significantly variable correlation with the PSA values was shown depending on the radiotracer used, the highest being consistently for 68Ga-PSMA-11. We reason that with such late dynamics, the PSMA kinetics are relatively stable and imaging could even take place at earlier time points as is now in the clinical routine.

Comparative assessment of 18F-PSMA-1007 biodistribution at 60 and 120 minutes after administration by PET/CT in prostate cancer patients

INTRODUCTION: Positron emission tomography combined with computed tomography (PET/CT) with prostate-specific membrane antigen-targeted (PSMA) radiopharmaceuticals is a valuable method for prostate cancer (PCa) imaging. Both 68Ga- and 18F-labelled PSMA ligands are used in clinical practice now, for example, 18F-PSMA-1007. Currently there is no consensus on time interval between 18F-PSMA-1007 administration and scanning start that served as the basis for this study. OBJECTIVE: The aim of this study was to determinate the optimal time interval between 18F-PSMA-1007 administration and scanning start at PET/CT in PCa patients. MATERIALS AND METHODS: This prospective analysis included the results of 18F-PSMA-1007 PET/CT of 26 patients with PCa (mean age — 69.1±7.1 years, mean PSA value — 3.9 (0.5; 10) ng/ml), 4 patients — at primary staging, 10 patients — with therapy assessment and 12 patients — with biochemical recurrence. The PET/CT scanning was performed at 60 and 120 minutes after 18F-PSMA-1007 administration with subsequent measurement and comparison of the pathological and physiological uptake. TBR value (Tumor-to-Background Ratio) was calculated for the pathological uptake in the prostate or prostate bed and lymph nodes lesions relative to the physiological uptake in urinary bladder and abdominal aortic blood pool respectively. Statistics: Statistical analysis was carried out using the software SPSS Statistics 28 to analyse the significance of the differences in median SUVmax (for pathological 18F-PSMA-1007 uptake), SUVmean (for physiological 18F-PSMA-1007 uptake) and TBR between two stages of scanning. RESULTS: There was a significant decrease of physiological 18F-PSMA-1007 uptake from median SUVmean 1.5 (1.0; 1.73) to 0.9 (0.5; 0.9), p<0.001 in the abdominal aortic blood pool, 2.6 (1.3; 3.6) to 1.7 (1.1; 2.8), p<0.05 in the urinary bladder, 0.4 (0.35; 0.44) to 0.33 (0.3; 0.37), p<0.05 in the right gluteus medius muscle in the second scan. Moreover, there was a significant increase of physiological 18F-PSMA-1007 uptake from median SUVmean 8.9±2.8 to 10.3±3.4, p<0.001 in the liver, 7.5±3.5 to 8.3±3.8, p<0,001 in the spleen, 9.8±3.7 to 11.6±4.3, p<0.001 in the right parotid salivary gland. Uptake in the bone marrow remained stable with median SUVmean 1 (0.8; 1.3), p=0.917. There was a significant increase of pathological uptake from median SUVmax 4.6 (2.7; 7.7) to 5.25 (3.2; 9.0), p<0.001 in 76 lesions without appearance of new lesions in the second scan at 120 minutes. Mean TBR value also significantly increased for the ratios «prostate or prostate bed/urinary bladder» from 1.7 (1.1; 4.7) to 3.6 (2.1; 9.5), p<0.05 and «lymph node/aortic blood pool»: per-lesion analysis from 2.8 (2.5; 5.2) to 6.2 (5; 10.1), p<0.001 and per-patient analysis from 4,6 (2.7; 5.5) to 9.8 (4.9; 12.1), p<0.05. DISCUSSION: It’s not justified to use time interval in 120 minutes routinely because of the lack of new lesions in the second scan, irrational spending of the department resources and time of medical staff. However, there was an increase in the TBR values indicating the higher quality of images in the second scan at 120 minutes. CONCLUSION: Due to the lack of clinical benefits of the 120 minutes interval and the associated time cost, a 60 minutes interval between 18F-PSMA-1007 administration and the start of a PET/CT scan in PCa patients is more optimal, however, delayed scan is justified in cases of obtaining unclear results.

Blood biomarkers and Ki-67 proliferation marker in breast cancer

Metastasis is the leading cause of death in patients with breast cancer (BC). It is known that the lesion of regional lymph nodes by tumor cells is more common in tumors with higher proliferative activity. Moreover, there is literature evidence on effects of cytokines and proteins upon the migration potential of the tumor. The aim of our work was to study the correlation between the concentrations of cytokines, proteins, and expression of Ki-67 proliferation marker in breast cancer with histology of non-specific invasive carcinoma.On the basis of pathological findings, 16 patients had metastases in regional lymph nodes (group I), and 18 patients had no detectable metastases (group II). Solid-phase enzyme immunoassay was used to determine concentrations of 14 cytokines in the supernatants of immunocompetent blood cells, i.e., IL-2, IL-6, IL-8, IL-10, IL-17, IL-18, IL-1β, IL-1ra, TNFα, IFNγ, G-CSF, GM-CSF, VEGF and MCP-1, and concentrations of 6 proteins were determined in blood serum: estrogen and progesterone receptors, cadherin-E (CDH1), plasminogen activator type 1 (PAI-1), mucin 1 (MUC1), heat shock protein 90αA1 (HSP90αA1). Immunohistochemical study of Ki-67 expression was performed in paraffin sections of tumors using monoclonal antibodies.The study showed that Ki-67 expression in tumor tissues and blood concentrations of IL-6, IL-8, IL-1β and TNFα were higher in group I patients. On the contrary, blood concentrations of CDH1 and PAI-1 were higher in group II patients. It was found that Ki-67 showed both inverse correlations with CDH1 and PAI1, and direct correlations with IL-8 and TNFα. CDH1 had a direct correlation with PAI1, and inverse correlations with IL-6, IL-1β and TNFα. The studied cytokines showed direct correlations with each other. The analysis of ROC curves showed good quality and optimal values of the cut-off points for Ki-67 expression, cytokine and protein concentrations, thus allowing best prediction for detectable lymphatic metastasis.On the basis of these results, a quotient was proposed, which represents a ratio of CDH1 contents to the sum of IL-1β and TNFα concentrations in blood samples, which can help identification of the patients with breast cancer at risk for lymphatic metastasis.

Abstract 134: Lymph node metastases are seeded via two distinct ways in phylogenetic study of gastric cancer

Abstract Backgrounds: Gastric cancer (GC) ranked 5th and 8th on the list of cancer related deaths worldwide and in Taiwan, respectively. Due to its high frequency of lymph node spread, lymph node dissection has become a standard procedure in surgical treatment. A randomized trial showed that patients who underwent D2 lymphadenectomy had a better 5-year survival outcome than ones who had D1 dissection in advanced gastric cancer, implying the D2 lymph node might serve as an outpost before tumor cells spread to distant organs. This clinical observation raises a possibility that the regional lymphatic spread could be under strict selection but not a passive process. Materials and Methods: To understand the evolutionary relationship between primary tumors, perigastric lymph nodes, and second tier of lymph nodes in the extra-perigastric area, we reconstruct their phylogeny using genetic variants in hypermutable DNA regions where the mutation rate is 102~104-fold than unique sequence. We have assembled a cohort of 10 gastric cancer patients, including intestinal-, diffuse- and mixed type GC. For each case, we collected all workable lymph node metastases and intensely sampled primary tumors. On average, we have over fifteen samples per case on the phylogenetic tree. Results: Preliminary data of the first two patients show high heterogeneity within primary tumors as well as between different lesions of lymph nodes or peritoneal metastases in gastric cancer. Interestingly, in stark contrast to all other lymph node metastases which intermingle with primary tumors, a clade consisting of one proximal and one distal lymph node with a bootstrap value above 90% is observed in each phylogeny, and it is worth noting that samples on these clades are from intestinal type tumor. Conclusion: Our results indicate that most tumor cells arrive both regional and distal lymph nodes passively via lymphatic drainage in GC while a selective process also exists which coincides with clinical observation. Whether the existence of tumor cells under a relatively stricter selection process would lead to different clinical outcomes is under investigation. Citation Format: Pei-Chi Cheng, Wei-Ting Hung, Yung-Ming Jeng, I-Rue Lai. Lymph node metastases are seeded via two distinct ways in phylogenetic study of gastric cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 134.

A CLINICOPATHOLOGICAL STUDY OF PATIENTS WITH CERVICAL LYMPHADENOPATHY BY FNAC AND ITS HISTOPATHOLOGICAL CORRELATION

Background- Cervical lymphadenopathy is one of the most frequent clinical presentation of patients attending out patient department and also the most common manifestations of underlying pathology of the head and neck region, with numerous differential diagnoses such as neoplasms and infections Fine needle aspiration cytology (FNAC) is considered as a safe, easy, quick and also the rst line diagnostic technique for evaluation of cervical lymphadenopathy. The study comprised of 150 Materials and methodpatients clinically presenting with cervical lymph node swelling coming for FNAC to the department of pathology. Out of 150 patients, 25 patients underwent surgery and histopathological correlation was done for these patients. Results: Among the 150 cases majority of the patients were males 70 % with M:F ratio 2.33:1.Age of the patients ranged from 1 to 90 years with a mean age of 40.44 years.Most of the lymph node lesions were seen in the age group of 21-30 years(20.67%). Level IIb lymph node was most commonly affected(36%).In FNAC 63.70 % cases were benign and 36.29 % cases were malignant.Among the benign lesions Reactive lymphoid hyperplasia was most common(25.9%) and in the malignant lesions metastatic carcinoma was most common(19.25%). In HPE 82.5% were benign and 17.5% were malignant.There was a strong correlation among the FNAC and HPE ndings where reactive lymphoid hyperplasia was found to be most common benign lesion. Conclusion: Fine Needle Aspiration Cytology is a rapid, safe, efcient, cost-effective and the rst line investigation for diagnosis of cervical lymph node lesions. Histopathological examination however remains the gold standard for denitive diagnosis of in certain malignant lymph node lesion

MP67-03 IDENTIFYING THE OPTIMAL CANDIDATES FOR A SUPER-EXTENDED STAGING PELVIC LYMPH-NODE DISSECTION IN PROSTATE CANCER PATIENTS TREATED IN THE PET-PSMA ERA. RESULTS FROM A MULTI-INSTITUTIONAL SERIES

MP67-03 IDENTIFYING THE OPTIMAL CANDIDATES FOR A SUPER-EXTENDED STAGING PELVIC LYMPH-NODE DISSECTION IN PROSTATE CANCER PATIENTS TREATED IN THE PET-PSMA ERA. RESULTS FROM A MULTI-INSTITUTIONAL SERIES