Node Lesions Research Articles

Polyarthritis and erythema nodosum: an unusual presentation of tuberculosis

Reactive arthritis and erythema nodosum occur in presence of active tubercular infection and both are immunological phenomenon. Author described a case report of a 17year old female with 10months history of symmetrical polyarthritis and presence of healed lesions of erythema nodosum. She was also found to have caseating granulomatous lesion in right supraclavicular lymph node which led us to diagnosis of tuberculous lymphadenitis presenting as reactive polyarthritis (poncet’s disease) and erythema nodosum. Her joint pain and swelling dramatically resolved after 2weeks of ATT. Thus, tuberculosis may manifest as reactive polyarthritis (poncet’s disease) and erythema nodosum and they should be kept in mind even in the absence of other clinical clues of TB, to provide patients with a good clinical outcome.

FAK inhibition reduces metastasis of α4 integrin-expressing melanoma to lymph nodes by targeting lymphatic VCAM-1 expression

Malignant melanoma typically metastasizes to lymph nodes (LNs) as a primary or in-transit lesion before secondary metastasis occurs, and LN biopsy is a common procedure to diagnose melanoma progression. Since cancer metastasis is a complex process where various interactions between tumor cells and the stroma play key roles in establishing metastatic lesions, the exact mechanisms underlying melanoma metastasis to LNs remains unknown. It has been known that focal adhesion kinase (FAK) activity promotes the expression of proinflammatory vascular cell adhesion molecule-1 (VCAM-1). As VCAM-1 is a major receptor for α4 integrin and plays a key role in leukocyte recruitment, we reasoned that inhibition of FAK activity may reduce VCAM-1 expression within LNs and thus reduce metastasis of α4 integrin-expressing melanoma to LNs. First, we found that a pharmacological FAK inhibitor, PF-271, blocked tumor necrosis factor-α (TNF-α)-mediated VCAM-1 expression on human dermal lymphatic endothelial cells (HDLECs). In vitro, PF-271 significantly decreased B16F10 melanoma adhesion to and transmigration through HDLECs compared to TNF-α treated cells. Furthermore, in vivo FAK inhibition by oral PF-271 administration reduced VCAM-1 expression in inguinal, cervical, and popliteal LNs compared to vehicle treated mice. Finally, in a footpad metastasis model, B16F10 melanoma cells were injected into the right footpad of C57BL/6 mice, and PF-271 (50 mg/kg, twice daily for 6 days) was orally administrated after 1 week of tumor transplantation. While untreated mice exhibited significant metastatic melanoma lesions in popliteal LNs, PF-271 treated mice showed only marginal melanoma metastasis. These results support the possibility that FAK inhibitors may be a novel preventative option in melanoma metastasis by blocking VCAM-1 expression in LNs.

SMARCB1- and vimentin-positive esophageal carcinoma with undifferentiated components, rhabdoid features, and a good prognosis: a case report

BackgroundUndifferentiated carcinoma of the esophagus with rhabdoid features is a very rare histologic finding that is occasionally associated with the loss of SWI/SNF-related matrix-associated actin-dependent regulator of chromatin subfamily B member 1 (SMARCB1); however, until now, few survey reports of this type of tumor have been published. In this study, we describe a case of esophageal carcinoma with undifferentiated components and rhabdoid features that was exclusively positive for vimentin and SMARCB1 in a patient with prolonged survival.Case presentationA 67-year-old man complained of a stomachache and loss of appetite persisting for 1 month. He was then admitted to the hospital. Diagnostic imaging studies revealed a transdiaphragmatic circular ulcerative tumor of the esophagogastric region. Biopsy specimens showed undifferentiated round cell carcinoma. The patient underwent lower esophageal resection and total gastrectomy with lymph node dissection. Microscopic analysis revealed that most of the primary tumor consisted of large undifferentiated round cells and scattered rhabdoid cells. The tumor invaded the muscular layer in the esophagus and the subserosal layer in the stomach, and metastasis was noted in only one lymph node. Immunohistochemical analysis revealed that the round and rhabdoid cells found in the primary tumor were diffusely positive for SMARCB1 and vimentin. The tumor displayed focal positivity for the anti-pan-cytokeratin antibody AE1/AE3. In the positive lymph node, round undifferentiated carcinoma cells were admixed with squamous carcinoma cells that were positive for cytokeratin 5/6 and 34βE12. The MIB-1 index was 19.7% and 0.5% for the round cells from the primary tumor and epithelial cells from the metastatic lymph node lesion, respectively, and 70.1% for the round cells from the metastatic lymph node lesion. The patient has been alive for 10 years after surgery without tumor recurrence.ConclusionsWe reported a rare case of esophageal carcinoma with undifferentiated components, rhabdoid features, and a good prognosis.

Small-cell bladder cancer: literature review

Worldwide, bladder cancer is the 7 th most common cancer type in men and 11 th in both sexes. The standardized by age incidence is 9.0 cases per 100.000 people among men and 2.2 cases per 100.000 people among women. The most common (>90 %) histological form of malignant epithelial tumors of the bladder is transitional cell carcinoma. Transitional cell carcinoma with squamous cell, glandular, or trophoblastic differentiation is rare. Squamous cell carcinoma comprises about 5 % of malignant epithelial bladder tumors, adenocarcinomas from 0.5 to 2.0 %. Small-cell and spindle-cell carcinomas are exceptionally rare (<0.5 %). Primary small-cell, or neuroendocrine, carcinoma is a very rare disease with incidence of <0.5 % of all bladder tumors. Presumably, small-cell carcinoma of the bladder (SCCB) is similar to small-cell carcinoma of the lung and consists of a population of a relatively homogenous cells with scant cytoplasm and hyperchromatic nuclei; extensive necrosis is also common. Histogenesis of SCCB is unknown, but there are 2 hypotheses on development of cancerous cells: from rare neuroendocrine cells and multipotent stem cells of the bladder. Prognosis is poor for most patients: in the report by I. Trias et al., median survival was less than 1 year, long-term survival for 5 or more years was extremely rare. In more than a half of patients, metastatic lesions of the regional lymph nodes, liver, or bones were observed during diagnosis. In the Russian literature, the problem of SCCB remains insufficiently investigated due to low incidence of this morphological type. Treatment is mostly administered empirically.

Which Clinicopathologic Factors Affect the Prognosis of Gingival Squamous Cell Carcinoma: A Population Analysis of 4,345 Cases

The purpose of this study was to present the characteristics and survival outcomes of primary gingival squamous cell carcinoma (SCC). We performed a retrospective cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) tumor registry. Patients who received a diagnosis of primary gingival SCC were included in the analyses. The predictor variables were chosen from baseline demographic and tumor characteristics. The outcome of interest was survival, and Kaplan-Meier analyses were used to estimate rates of overall survival (OS) and disease-specific survival (DSS). Cox proportional hazards regression models were used for multivariate analyses. In total, 4,345 patients (mean age, 70.2years) with primary gingival SCCs were identified. There was a significantly positive association between T category and both nodal and distant metastases. The 2-, 5-, and 10-year OS rates were 63.1%, 46.5%, and 28.1%, respectively, whereas the DSS rates were 78.2%, 70.7%, and 62.2%, respectively. Multivariate Cox proportional hazards regression showed that the independent predictors of overall and disease-specific death were older age, intermediate and high histologic grade, tumor size, nodal disease, and the absence of surgery. T4 classification was significantly associated with only DSS. Race, gingival location (maxillary vs mandibular), verrucous histology, and the presence of distant metastases did not significantly affect survival when all other predictors were controlled for. Older age at diagnosis, higher grade, increased tumor size, nodal disease, and the absence of surgery were each individually associated with lower OS and DSS. Because of low nodal disease rates, both T1N0M0 lesions and verrucous subtypes may be candidates for neck observation.

Rapidly and Slowly Growing Lineages in Chromosomal Instability-Type Gland-Forming Gastric Carcinomas as Revealed by Multisampling Analysis of DNA Copy-Number Profile

Background: To examine whether gastric carcinoma (GC) with chromosomal instability (CIN-type GC), the largest category in the Cancer Genome Atlas classification, consists of a single genetic lineage, we conducted a multisampling analysis of genomic DNA copy-number profile. Methods: We performed array-based comparative genomic hybridization using formalin-fixed paraffin-embedded tissues from 54 gland-forming GCs containing a total of 106 DNA samples from mucosal, extramucosal invasive, and lymph node lesions. Microarray data were analyzed by unsupervised hierarchical clustering and penetrance plots. Epstein-Barr virus infection status and mismatch repair (MMR) enzyme-silencing/p53/mucin expression were examined by in situ hybridization and immunohistochemistry, respectively. Results: The samples examined were divided into gain-rich cluster A and loss-rich cluster B, which were different in tumor locus and patient age. The T1/T2–4 ratio, the frequency of small cancers (diameter ≤2–4 cm), and<unterline></unterline> intestinal mucin expression were higher in cluster B than in cluster A, but there were no significant differences in the frequencies of MMR silencing, mutant p53 pattern, and lymph node metastasis between the 2 clusters. Conclusions: We demonstrated that CIN-type GC could be categorized into 2 genetic lineages which are different in terms of rapidity of local extension but similar in terms of nodal metastasis risk.

Preoperative ultrasound evaluation of laterocervical lymph nodes: timing and experience modify the treatment of patients with differentiated thyroid cancer.

Since laterocervical lymphadenectomyis never routinely performed, all patients who undergo thyroidectomy for differentiated cancer must have an ultrasound examination (US). The aim of this study is to assess the accuracy of the preoperative US conducted at the time of surgery as a staging US (time 0) compared to the US performed sometime before in a location other than the surgical department as screening/diagnostic US (time - 1), to determine the necessity of always performing a preoperative US before surgery. 4060 patients with cytologic diagnosis (FNAB) of differentiated thyroid neoplasm (Tyr 4 and Tyr 5) were recruited at Surgery 2 of the Department of General and Specialist Surgery of the Tertiary Care Hospital "A. Cardarelli" of Naples. All patients had a screening US prior to admission into our hospital (time - 1) and were rescanned in the operating room before surgery (time 0) by the same team of surgeons experienced in the field of thyroid diseases. The examinations conducted at time 0 revealed a sensitivity of 100% and a specificity of 92.3%, while examinations performed at time - 1 showed a sensitivity of 22.8% and a specificity of 72.7%. The statistical analysis shows how the diagnostic timing and the experience of the examiner can make a difference both in terms of PPV and NPV to not only to assist in identifying all the lymph node lesions that would remain indeterminate if not specifically researched during surgery, but also helps avoid surgical overtreatment. The systematic execution of a staging US (time 0) in addition to a screening/diagnostic US (time - 1) results in forming a more appropriate therapeutic plan.

Cervical Lymph Node Schwannoma-An Unexpected Diagnosis.

Introduction:Schwannomas—Schwann cells–originating tumors—may develop in many locations. However, primary schwannomas arising within lymph nodes are extremely rare, with only a few cases described to this date in the English literature. For the intranodal location, most of the cases are described in the abdominal cavity. In these cases, clinicians may consider and check for familial disorders, such as neurofibromatosis type 2 (NF2) and schwannomatosis also called neurofibromatosis type 3. Schwannomas are benign neoplasms. Histologically, differential diagnosis for spindle-cell lesions in lymph nodes is important and must be done carefully, mainly because they may be attributable to metastatic disease. We report a case of a primary schwannoma arising in a cervical lymph node.Background:Primary schwannomas arising within lymph nodes are extremely rare, with only a few cases reported. Since they are benign neoplasms, the differential diagnosis with other intranodal spindle cell lesions, mostly malignant, is important.Methods:An asymptomatic 69-year-old woman, previously submitted to left hemithyroidectomy for a benign folicular nodule, underwent thyroidectomy totalization following the identification of a large thyroid nodule in routine evaluation.Results:Gross and microscopic examination and ancillary studies were consistent with the diagnosis of intranodal schwannoma. The patient had acquired bilateral hypoacusia. Therefore, type 2 neurofibromatosis was considered and vestibular schwannomas ruled out.Conclusion:Herein, we present the second case of a primary schwannoma in a cervical lymph node reported so far. The relevance of the differential diagnosis is highlighted.

Enhanced protective immune response to PCV2 adenovirus vaccine by fusion expression of Cap protein with InvC in pigs.

The major immunogenic protein capsid (Cap) of porcine circovirus type 2 (PCV2) is critical to induce neutralizing antibodies and protective immune response against PCV2 infection. This study was conducted to investigate the immune response of recombinant adenovirus expressing PCV2b Cap and C-terminal domain of Yersinia pseudotuberculosis invasin (Cap-InvC) fusion protein in pigs. The recombinant adenovirus rAd-Cap-InvC, rAd-Cap and rAd were generated and used to immunize pigs. The phosphate-buffered saline was used as negative control. The specific antibodies levels in rAd-Cap-InvC and ZJ/C-strain vaccine groups were higher than that of rAd-Cap group (p < 0.05), and the neutralization antibody titer in rAd-Cap-InvC group was significantly higher than those of other groups during 21–42 days post-immunization (DPI). Moreover, lymphocyte proliferative level, interferon-γ and interleukin-13 levels in rAd-Cap-InvC group were increased compared to rAd-Cap group (p < 0.05). After virulent challenge, viruses were not detected from the blood samples in rAd-Cap-InvC and ZJ/C-strain vaccine groups after 49 DPI. And the respiratory symptom, rectal temperature, lung lesion and lymph node lesion were minimal and similar in the ZJ/C-strain and rAd-Cap-InVC groups. In conclusion, our results demonstrated that rAd-Cap-InvC was more efficiently to stimulate the production of antibody and protect pigs from PCV2 infection. We inferred that InvC is a good candidate gene for further development and application of PCV2 genetic engineering vaccine.

Comparative Study between 18F FDG-PET/CT and Whole Body MRI DWIBS in Assessment of Recurrent Breast Cancer (Prospective, Comparative, Cross-sectional Study Design).

Aim:This study aims to assess the diagnostic performance of 18F-fluorodeoxyglucose-positron emission tomography/computerized tomography (18FDG-PET/CT) compared to whole body (WB) magnetic resonance diffusion-weighted imaging (DWI) with background body signal suppression (MR/DWIBS) in lesions detection in patients with recurrent breast cancer.Materials and Methods:Twenty-three female patients with suspected breast cancer recurrence by clinical, laboratory, or conventional imaging underwent both 18FDG-PET/CT and WB MR/DWIBS. WB 18FDG-PET/CT was performed using the standard technique. WB MR/DWIBS acquired sequences were WB DWI with short tau inversion recovery (STIR), coronal T1, and coronal STIR. Both 18FDG-PET/CT and WB-magnetic resonance imaging/DWIBS were independently interpreted using visual qualitative and quantitative analysis. Pathological findings and combined clinical/radiological follow-up data were used as a reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated for both techniques.Results:PET/CT demonstrated higher specificity and sensitivity indices than MR/DWIBS in the detection of the nodal and distant lesions, while the latter displayed higher sensitivity in the detection of local breast lesions. The overall sensitivity, specificity, NPV, PPV, and accuracy of PET/CT were 84.8%, 86.3%, 90.4%, 78.7%, and 85.4% versus 82.1%, 78.0%, 85.2%, 74.0%, and 80.5% for MR/DWIBS. A high degree of agreement existed between PET/CT and MR-DWIBS.Conclusion:18FDG-PET/CT is more sensitive and has superiority in the assessment of nodal and distant lesions than DWIBS that has a potential superior role in the assessment of local breast lesions. DWIBS has a promising and helpful complementary tool for 18FDG-PET/CT in the evaluation of patients with proven malignancies.

Complete remission of refractory Hepatoblastoma post liver transplantation in a child with sorafenib monotherapy – A new hope?

Background: Hepatoblastoma (HB), in children has a good survival chance in standard risk cases, while the prognosis for recurrent HB is guarded. Complete remission of hepatoblastoma with Sorafenib monotherapy has never been documented previously. Methods: 5 year old female child, born prematurely with birth weight of 2030grams was diagnosed with embryonal epithelial hepatoblastoma of PRETEXT stage 3, was treated with cisplatin and doxorubicin. Inoperability after four cycles prompted therapy with irinotecan followed by liver transplantation 1 year after the initial diagnosis. She had an initial recurrence in pericardium and diaphragm and 9 months later further metastatic lesions in lung, adrenal and mesenteric lymph nodes. Chemotherapy with carboplatin, vincristine and irinotecan were not effective. Metastatic disease following liver transplantation and exhaustion of all feasible chemotherapeutic and surgical options, and based on the fact that the tumor was behaving like a transitional liver cell tumor (older age at diagnosis and recurrence after conventional chemotherapy) single agent chemotherapy with Sorafenib was initiated. Results: PET-CT done at 14 months later showed complete resolution of lung nodules and with no areas of abnormal uptake confirming complete remission. There were no adverse events noted during 8 months of continuation therapy with good graft function. Conclusion: This is the first report of complete remission in paediatric hepatoblastoma on sorafenib monotherapy.

Quantitative feature analysis of CT images of transbronchial dye markings mimicking true pulmonary ground-glass opacity lesions.

Transbronchial dye marking is a preoperative localization technique aiding pulmonary resection. Post-marking computed tomography (CT) is performed to confirm the locations of the actual markings. This study aimed to evaluate the CT images of dye markings that present as ground-glass opacities (GGO), using quantitative feature analysis. Thin-slice (1 mm) CT images of the dye markings and true ground glass nodule (GGN) lesions were obtained for quantitative analysis with gray-level co-occurrence matrix (GLCM) features. The quantification features including correlation, auto correlation, contrast, energy, entropy, and homogeneity were evaluated. Statistical analysis with boxplot was performed. GLCM features of multi-detector computed tomography (MDCT) images of the dye markings (n=13) and true GGN lesions (n=13) differed significantly in contrast, energy, entropy, auto correlation, and homogeneity. Cone beam computed tomographic (CBCT) image features of another group of dye markings (n=15) also showed a different distribution of feature values, than those of the MDCT images. Quantitative analysis of the dye marking images revealed a discriminative variance, compared with those of the true GGN lesions. Furthermore, the image textures of dye markings on MDCT and CBCT also presented with obvious discrepancies.

Cytomorphological study of lymph node lesions at tertiary care centre

Cytomorphological study of lymph node lesions at tertiary care centre

Effectiveness of mediastinal lymphadenectomy in surgical treatment of generalized destructive pulmonary tuberculosis

Bronchopleural complications after pneumonectomy in generalized destructive tuberculosis are associated with the presence of intrathoracic lymph nodes (ITLN) with caseous alterations.&#x0D; Aim. To improve the effectiveness of surgical treatment of patients with generalized destructive pulmonary tuberculosis by development and introduction of the method of mediastinal lymphadenectomy in tuberculous lesion of mediastinal lymph nodes.&#x0D; Materials and Methods. Results of surgical treatment of 515 patients with generalized destructive pulmonary tuberculosis were analyzed. In 274 of them the surgical treatment was supplemented with mediastinal lymphadenectomy (the main group). In the control group (241 patients) only resection was performed without removing lymph nodes.&#x0D; Results. Analysis of the postoperative course of the disease in both groups of patients (with mediastinal lymphadenectomy and without it) showed that bronchopleural complications occurred in 7 (2.6%) cases in the main group and in 30 (12.4%, p&lt;0.05) cases in the control group. In the main group exacerbation of the specific process was noted in 1 patient (0.4%), and in comparison group in 9 patients (3.7%, p&lt;0.05). Elimination of macroscopically altered ITLN in widespread destructive tuberculosis permitted to reduce the complications rate in the postoperative period by 64.8% (p&lt;0.05). Indications to removal of IHLN included: a) enlargement of ITLN (&gt;2 sm) and in duration; b) fusion with the surrounding tissues, softening of the node tissue in its caseous melting, c) existence of yellowish or whiter in comparison with the surrounding tissue inclusions in the node being manifestations of tuberculous granuloma. In histological, cytological and bacteriological examination, these macroscopic signs in 97% of cases indicated active tuberculosis of mediastinal lymph nodes.&#x0D; Conclusions. In 97% of cases, widespread destructive secondary pulmonary tuberculosis runs with an active specific process in mediastinal lymph nodes which makes it reasonable to perform a selective lymphadenectomy in such group of patients. Secondary damage of different groups of intrathoracic lymph nodes by the active process depended on localization of lung destructions and occurred along the routes of lymph drainage from them. Reliable signs of active tuberculous of ITLN include: more than 2.0 cm lymph node enlargement, in duration, periadenitis, fluctuation and in homogeneity. Removal of macroscopically altered intra-thoracic lymph nodes in widespread destructive pulmonary tuberculosis permits to reduce the rate of complications in the postoperative period by 64.8%.

Real-World Use of Talimogene Laherparepvec in German Patients with Stage IIIB to IVM1a Melanoma: A Retrospective Chart Review and Physician Survey.

IntroductionTalimogene laherparepvec is a first-in-class oncolytic immunotherapy for intratumoral injection with proven efficacy and tolerability in patients with unresectable early metastatic melanoma (stage IIIB–IVM1a) in the pivotal phase III OPTiM study. The objective was to characterize melanoma patients treated with talimogene laherparepvec in routine clinical practice in Germany.MethodsA retrospective chart review was conducted in unresectable stage IIIB–IVM1a melanoma patients. Data on demographics, disease and medical history, and use of talimogene laherparepvec were collected. A survey was also conducted to understand physician treatment decisions.ResultsData for 27 patients who initiated talimogene laherparepvec between June 2016 and July 2017 were analyzed (median age 68; stage IIIB/C disease 56%). All patients had prior surgery, and over half had repeated resections for recurrent disease (median 3). Overall, 48% of patients received at least one prior local treatment, mainly radiation therapy or electrochemotherapy. Talimogene laherparepvec was first-line systemic therapy in 63% of patients. The most frequent prior systemic treatment was immunotherapy (7/27 patients). At end of follow-up, 13 patients were still on talimogene laherparepvec and 14 patients had discontinued treatment. Among those who discontinued, 8 (57%) did not receive subsequent systemic therapy. Only one patient receiving first-line talimogene laherparepvec received a subsequent systemic therapy. Three patients stopped treatment because of no remaining injectable lesions. Median treatment duration was 22.1 weeks overall and 27.9 weeks in stage IIIB/C disease patients. Nearly all cutaneous lesions (93%) were injected with talimogene laherparepvec compared to subcutaneous (83%) and nodal lesions (77%). No new safety signals were reported. The main reasons given in the physician survey for treating with talimogene laherparepvec were good tolerability, overall efficacy, and lack of contraindications.ConclusionTalimogene laherparepvec is now included as a routine treatment option for unresectable early metastatic melanoma in Germany. This study characterizes the first patients treated with talimogene laherparepvec in Europe and confirms the good tolerability observed in clinical trials.Trial RegistrationEUPAS registry, EUPAS17410.FundingAmgen Inc.Electronic supplementary materialThe online version of this article (10.1007/s12325-018-0850-6) contains supplementary material, which is available to authorized users.

Role of Endobronchial Ultrasound in Diagnosis of Mediastinal and Pulmonary Lesions

AbstractBackground: Lung cancer is one of the most common tumors worldwide. Now it ranks as the leading cause of cancer related death in the world, both in men and women. Pulmonary lesions detected during screening for lung cancer need to be evaluated further and tissue should be obtained. Technical development in last two decades has made it possible for pulmonologists to do endobronchial ultrasound “EBUS”.Aim of Study: The aim of the work is Assessment of the role of endobronchial ultrasound TBNA in diagnosis of me-diastinal lesions as accurate rapid less invasive procedure.Subjects and Methods: This is a Prospective study was conducted on 30 patients presented with chest symptoms (dyspnea, cough, expectoration, chest pain and hemoptysis) diagnosed as mediastinal, hilar and pulmonary lesions as confirmed by CT chest, routine labs and proper history taking and through clinical examination and underwent EBUS-TBNA and the sampled lesion was sent for histopathological exam-ination and reporting at Kobbry Al-Kobba Military Hospital during the period from (November 2015 to October 2016).Results: The mean age of the patients participating in this study was 44.9±15.9 years (ranges 17–73). 56.7% of them were males while 43.3% were femles. Radiological finding showed Hilar & mediastinal lymphadenopathy in 40.0%, mediastinal lymphadenopathy (6.7%), hilar lymphadenopathy (10.0%), pulmonary lesions (33.3%), pulmonary lesions with mediastinal lymphadenopathy (6.7%), pulmonary lesions with mediastinal and hilar lymphadenopathy (3.3%). EBUS findings were 20 patients were having lymph node lesions (85% were benign and 15% were malignant by pathology) and 10 patients were having mass lesions (100% were malignant). No com-plications were detected only minor hemorrhage in 1 patients (3.3%).Conclusion: Endobronchial ultrasound guided transbron-chial fine needle aspiration EBUS-TBNA is the procedure of choice for staging of lung cancers and for the investigation of unexplained mediastinal lymphadenopathy and masses. EBUS guided TBNA is an accurate, cost effective and mini-mally invasive procedure and if successfully performed, TBNA may spare patients additional, more invasive procedures or surgery.

Computerize classification of Benign and malignant thyroid nodules by ultrasound imaging

Introduction: Early detection and treatment of thyroid nodules increase the cure rate and provide optimal treatment. Ultrasound is the chosen imaging technique for assessment of thyroid nodules. Confirmation of the diagnosis usually demands repeated fine needle aspiration biopsy (FNAB). So, current management, has morbidity and non zero mortality. The goal of the present study is to explore diagnostic potential of automatic texture analysis (TA) methods in differentiation benign and malignant thyroid nodules by ultrasound imaging in order to help for reliable diagnosis and monitoring of the thyroid nodules with no need more biopsy. Materials and Methods: The database consist of 70 thyroid patients (26 benign and 44 malignant). They under- went thyroid sonography which were reported by radiologist and proven by the biopsy. One ultrasound image per patient was loaded in Mazda Software version 4.6 for automatic texture analysis. Regions of interests (ROIs) were defined within the abnormal part of the thyroid nodules ultrasound images. Gray levels intensity within a ROIs normalized and then up to 270 multi scale texture features parameters per ROIs per normalization schemes were computed via statistical methods employed in Mazda software. From the statistical point of view, all calculated texture features parameters are not useful for texture analysis. So, the features based on F: maximum Fisher coefficient and P: minimum probability of classification error and average correlation coefficients (POE+ACC) eliminated to 10 best and most effective features per normalization schemes. We analyze this feature under two standardization states standard (S) and nonstandard (nS) with Linear Discriminate Analysis (LDA) and None Linear Discriminate Analysis (NDA). The first nearest neighbor (1NN) and artificial neural network (A-NN) classifier were performed for features obtained via LDA and NDA respectively to differential diagnosis benign versus malignant thyroid nodules. The confusion matrix applied between visual and automated texture analysis results to find out sensitivity and specificity of the applied texture analysis methods under different applied options. The Receiver operating characteristic (ROC) curve analysis used for comparison discrimination performance of the employed texture analysis methods.Results: The results demonstrated the influence of the normalization, reduction and standardization on the effectiveness of the obtained features in discrimination tasks by LDA and NDA texture analysis.In comparison with LDA, The selected subset features represent the highest discrimination performance for NDA in distinguishing benign from malignant thyroid with sensitivity of 94%, specificity of 100%, and Az value of 0.97. It means that via our method 97% patient with thyroid nodules lesions can be diagnostic without doing clinical biopsy. For LDA, this discrimination result has sensitivity of 85.7%, specificity of 87.5%, and Az value of 0.86.Conclusion: Our results indicate Computer aided diagnosis can provide useful information to help radiologists in classification of benign and malignant thyroid nodules.

Clinical, morphological, and molecular genetic predictors of metastatic lesions in the regional lymph nodes in breast cancer

Despite the sufficient amount of data accumulated in the literature, there are still no factors, on the basis of which it would be possible to estimate the regional lymph nodes status in breast cancer with a high degree of accuracy. The review presents literature data relating to the influence of clinicopathological, molecular-biological and genetic characteristics of primary tumor on lymph node metastases. Data of 66 foreign and Russian articles are included.

Abstract 17198: Asymmetric Bifurcation Angle of Common Iliac Artery is Associated With Unilateral Calcified Nodule Lesion of Common Iliac Artery

Background and aim: It has been known that bifurcation angles of common iliac artery (CIA) are not always bilateral symmetry. Previous study reported that mechanical stress initiate calcification in aortic valve. The aim of this study was to investigate the impact of CIA anatomical features on lesion characteristic of CIA. Methods and results: This study enrolled 72 patients with intermittent claudication who had undergone endovascular-therapy (EVT) for de novo CIA atherosclerotic lesions in our hospital during April 2012 to March 2017. Anatomical analysis of CIA bifurcation was assessed by frontal view of initial angiography at EVT. We calculated the bilateral CIA angles between axis of terminal aorta and axis of proximal CIA, and bilateral symmetry was expressed as absolute value of the difference between both CIA angles (Δangle). The patients were divided into 2 groups: symmetry group (Δangle≦10 degrees, n=40) and asymmetry group (Δangle&gt;10 degrees, n=32), according to the mean of Δangle. Distribution characteristics were classified into 2 patterns: bilateral lesions pattern and unilateral lesion pattern, furthermore we assessed calcified nodule of CIA lesion using intravascular ultrasound. There was no difference between 2 groups about patient characteristics. Unilateral lesion was observed in asymmetry group much more than symmetry group (63% vs 22%, P&lt;0.05). Calcified nodule lesion was observed in asymmetry group much more than symmetry group (28% vs 5%, P&lt;0.05). Conclusions: These findings suggested that asymmetric bifurcation angle of CIA was associated with unilateral lesion and calcified nodule lesion. Asymmetry of CIA bifurcation might be predictor of unilateral calcified nodule lesion of CIA.

Non-palliative radiotherapy in ab initio oligometastatic prostate cancer: an Italian national survey.

The purpose of this survey was to investigate the current opinion among Italian radiation oncologists regarding the non-palliative radiotherapy in ab initio oligometastatic prostate cancer (OMPC) patients. A link to complete the survey was sent via e-mail to Italian radiation oncologists on February 2018. It was requested that only one physician per facility completed the survey, and that he/she was dedicated to PC management in his/her daily clinical practice. The questionnaire consisted of 15 questions concerning the management of OMPC. One hundred and eleven radiation oncologists filled in the questionnaire. The majority of them see ≤ 10 patients affected by OMPC in a year. More than 80% of respondents would perform radiotherapy (RT) to both the prostate and all metastases sites, but mostly up to 2-3 metastases; furthermore, > 80% of physicians would perform RT on both nodal and bone secondary lesions. Most respondents deem a choline- or prostate-specific membrane antigen (PSMA)-positron emission tomography (PET) mandatory before considering a patient affected by OMPC for non-palliative RT. The association of RT with androgen deprivation therapy for at least 12months would be recommended by > 50% of respondents. In the follow-up phase, the majority would suggest a clinical examination and PSA every 3-6months and a choline- or PSMA-PET only at biochemical progression. More than 90% of respondents confirmed to be interested in participating in a multicentre study regarding this subject. This survey investigated the current opinion of Italian radiation oncologists and confirmed their interest in OMPC management.