Lymph Node Staging In Patients Research Articles

Additional Value of FDG-PET/MRI Complementary to Sentinel Lymphonodectomy for Minimal Invasive Lymph Node Staging in Patients with Endometrial Cancer: A Prospective Study.

Lymph node metastases (LNM) are rare in early-stage endometrial cancer, but a diagnostic systematic lymphadenectomy (LNE) is often performed to achieve reliable N-staging. Therefore, this prospective study aimed to evaluate the benefit of [18F]-Fluorodeoxyglucose (FDG) PET/MRI complementary to SPECT/CT guided sentinel lymphonodectomy (SLNE) for a less invasive N-staging Methods: 79 patients underwent a whole-body FDG-PET/MRI, SLN mapping with 99mTc-Nanocolloid SPECT/CT and indocyanine green (ICG) fluoroscopy followed by LNE which served as ground truth. FDG-PET/MRI was highly specific in N-staging (97.2%) but revealed limited sensitivity (66.7%) due to missed micrometastases. In contrast, bilateral SLN mapping failed more often in patients with macrometastases. The combination of SLN mapping and FDG-PET/MRI increased the sensitivity from 66.7% to 77.8%. Additional SLN labeling with dye (ICG) revealed a complete SLN mapping in 80% (8/10) of patients with failed or incomplete SLN detection in SPECT/CT, reducing the need for diagnostic systematic LNE up to 87%. FDG-PET/MRI detected para-aortic LNM in three out of four cases and a liver metastasis. The combination of FDG-PET/MRI and SLNE can reduce the need for diagnostic systematic LNE by up to 87%. PET/MRI complements the SLN technique particularly in the detection of para-aortic LNM and occasional distant metastases.

Lymph node dissection in small peripheral lung cancer: Supplemental analysis of JCOG0802/WJOG4607L

ObjectiveThe optimal region of lymph node dissection (LND) during segmentectomy in patients with small peripheral non–small cell lung cancer requires clarification. Through a supplemental analysis of the Japan Clinical Oncology Group (JCOG) 0802/West Japan Oncology Group (WJOG) 4607L, we investigated the associated factors, distribution, and recurrence pattern of lymph node metastases (LNMs) and proposed the optimal LND region. MethodsOf the 1106 patients included in the JCOG0802/WJOG4607L, 1056 patients with LNDs were included in this supplemental analysis. We investigated the distribution and recurrence pattern of LNMs along with the radiologic findings (with ground-glass opacity, part-solid tumor; without ground-grass opacity component, pure-solid tumor). ResultsThe radiologic findings were the only significant factor for LNMs. Of 533 patients with part-solid tumors, 8 (1.5%) had LNMs. Further, only 3 (0.5%) patients had pN2 disease, and no patients had interlobar LNMs from nonadjacent segments. Of the 523 patients with pure-solid tumors, 55 (10.5%) had LNMs, and 28 (5.4%) had pN2 disease. Five patients had metastases to nonadjacent interlobar lymph nodes (LNs). Two (2.0%) patients with S6 tumors had upper mediastinal LNMs. In addition, the incidence of mediastinal LN recurrence in patients with S6 lung cancer was greater in those who underwent selective LND than those who underwent systematic LND (P = .0455). ConclusionsNonadjacent interlobar and mediastinal LND have little impact on pathologic nodal staging in patients with part-solid tumors. In contrast, selective LND is recommended at least for patients with pure-solid tumors.

The minimal number of examined lymph nodes for accurate nodal staging and favorable prognosis in T1-2 supraglottic laryngeal squamous cell carcinoma

ObjectiveThe study aimed to investigate the minimal number of examined lymph nodes (ELNs) for accurate assessment of lymph node status and favorable prognosis in patients with stage T1-2 supraglottic laryngeal squamous cell carcinoma (LSCC) who received radical resection. MethodsPatients with stage T1-2 supraglottic LSCC from the Surveillance, Epidemiology, and End Results (SEER) database and the Chinese Academy of Medical Sciences, Cancer Hospital/National Cancer Center (NCC) were reviewed. The association of the ELN count with the identification of nodal metastasis and overall survival (OS) was analyzed using a multivariate regression model. Locally weighted scatterplot smoothing fitting curve and the ‘changepoint’ package were adopted to identify the optimal cut points using R. ResultsA total of 429 patients from the SEER database and 53 patients from NCC were enrolled. The probability of identifying nodal metastasis was positively related to the ELN count. For patients diagnosed with pathological stage N0 (pN0) disease, the mortality risks rapidly decreased when the amount of ELNs exceeded ten, and those with ELNs >10 had better OS. ConclusionAn adequate amount of ELNs benefits precise nodal staging in patients with stage T1-2 supraglottic LSCC. Ten lymph nodes are the minimum number of ELNs. For pN0 patients, an ELN count ≤10 is an unfavorable prognostic factor.

Negative predictive value of PSMA PET scan for lymph node staging in patients undergoing robotic radical prostatectomy and pelvic lymph node dissection

To assess the negative predictive value of PSMA PET scan for lymph node staging in patients undergoing robotic radical prostatectomy and pelvic lymph node dissection. A retrospective analysis of patients who underwent robotic-assisted radical prostatectomy with pelvic lymph node dissection and had a preoperative negative PSMA PET scan for metastasis was performed. The documented pre-operative variables studied included age, BMI, PSA at diagnosis, Gleason score, and biopsy ISUP grades. Patients were categorised as low, intermediate and high risk according to the D Amico classification. The post-op variables included were number of lymph nodes harvested, number of positive nodes, positivity rate, size of the node metastasis, T staging and ISUP grading. The overall negative predictive value of PSMA PET scan was 71.6%. Further sub-classification according to risk stratification demonstrated a NPV of 58.02%, 92.7% and 90% for high, intermediate and low risk, respectively. Pelvic lymph node dissection cannot be excluded based on a negative preop PSMA PET/CT scan.

Prospective Evaluation of Quantitative F-18-FDG-PET/CT for Pre-Operative Thoracic Lymph Node Staging in Patients with Lung Cancer as a Target for Computer-Aided Diagnosis

Pre-operative assessment of thoracic lymphonodal (LN) involvement in patients with lung cancer (LC) is crucial when choosing the treatment modality. Visual assessment of F-18-FDG-PET/CT (PET/CT) is well established, however, there is still a need for prospective quantitative data to differentiate benign from malignant lesions which would simplify staging and guide the further implementation of computer-aided diagnosis (CAD). In this prospective study, 37 patients with confirmed lung cancer (m/f = 24/13; age: 70 [52-83] years) were analyzed. All patients underwent PET/CT and quantitative data (standardized uptake values) were obtained. Histological results were available for 101 thoracic lymph nodes. Quantitative data were matched to determine cut-off values for delineation between benign vs. malignant lymph nodes. Furthermore, a scoring system derived from these cut-off values was established. Statistical analyses were performed through ROC analysis. Quantitative analysis revealed the optimal cut-off values (p < 0.01) for the differentiation between benign and malignant thoracic lymph nodes in patients suffering from lung cancer. The respective areas under the curve (AUC) ranged from 0.86 to 0.94. The highest AUC for a ratio of lymph node to healthy lung tissue was 0.94. The resulting accuracy ranged from 78.2% to 89.1%. A dedicated scoring system led to an AUC of 0.93 with a negative predictive value of 95.4%. Quantitative analysis of F-18-FDG-PET/CT data provides reliable results for delineation between benign and malignant thoracic lymph nodes. Thus, quantitative parameters can improve diagnostic accuracy and reliability and can also facilitate the handling of the steadily increasing number of clinical examinations.

Editorial Comment.

No AccessJournal of UrologyAdult Urology1 Feb 2023Editorial CommentThis article comments on the following:Radioisotope-guided Lymphadenectomy for Pelvic Lymph Node Staging in Patients With Intermediate- and High-risk Prostate Cancer (The Prospective SENTINELLE Study) Izak Faiena and Eric A. Singer Izak FaienaIzak Faiena Columbia University Medical Center, New York, New York More articles by this author and Eric A. SingerEric A. Singer * E-mail Address: [email protected] The Ohio State University Comprehensive Cancer Center, Columbus, Ohio More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003043.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, 209(2), pp. 372–373

Usefulness of pyruvate dehydrogenase-E1α expression to determine SUVmax cut-off value of [18F]FDG-PET for predicting lymph node metastasis in lung cancer

A more accurate cut-off value of maximum standardized uptake value (SUVmax) in [18F]fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG-PET/CT) is necessary to improve preoperative nodal staging in patients with lung cancer. Overall, 223 patients with lung cancer who had undergone [18F]FDG-PET/CT within 2 months before surgery were enrolled. The expression of glucose transporter-1, pyruvate kinase-M2, pyruvate dehydrogenase-E1α (PDH-E1α), and carbonic anhydrase-9 was evaluated by immunohistochemistry. Clinicopathological background was retrospectively investigated. According to PDH-E1α expression in primary lesion, a significant difference (p = 0.021) in SUVmax of metastatic lymph nodes (3.0 with PDH-positive vs 4.5 with PDH-negative) was found, but not of other enzymes. When the cut-off value of SUVmax was set to 2.5, the sensitivity and specificity were 0.529 and 0.562, respectively, and the positive and negative predictive values were 0.505 and 0.586, respectively. However, when the cut-off value of SUVmax was set according to PDH-E1α expression (2.7 with PDH-positive and 3.2 with PDH-negative), the sensitivity and specificity were 0.441 and 0.868, respectively, and the positive and negative predictive values were 0.738 and 0.648, respectively. The SUVmax cut-off value for metastatic lymph nodes depends on PDH-E1α expression in primary lung cancer. The new SUVmax cut-off value according to PDH-E1α expression showed higher specificity for [18F]FDG-PET in the diagnosis of lymph node metastasis.

18F-JK-PSMA-7 PET/CT for staging intermediate- or high-risk prostate cancer patients before radical prostatectomy: a pilot study

BackgroundPositron emission tomography/computed tomography (PET/CT) using radiotracers that bind to the prostate-specific membrane antigen (PSMA) is mainly used in biochemical recurring prostate cancer. The aim of our study was to assess the usefulness of 18F-JK-PSMA-7 PET/CT for local and nodal staging in patients with intermediate- and high-risk prostate cancer (PCa) prior to radical prostatectomy, as compared to conventional imaging techniques.MethodsWe enrolled a total of 10 patients with intermediate- and high-risk PCa diagnosed by multiparametric-MRI followed by systematic and targeted biopsies, eligible for radical prostatectomy with extended lymph node dissection. Clinical team was blind to the results of the pre-surgery 18F-JK-PSMA-7 PET/CT at times of clinical decision and surgery. One month post-surgery, 18F-JK-PSMA-7 PET/CT was repeated and the results of both scans were unblinded. A third 18F-JK-PSMA-7 PET/CT could be acquired at a later time point depending on PSA progression.ResultsAll pre-surgery 18F-JK-PSMA-7 PET/CT was positive in the prostatic region, while MRI was negative in the prostate in one patient. We also detected positive pelvic lymph nodes in two patients (one high-risk, one intermediate-risk PCa) on pre-surgery and post-surgery 18F-JK-PSMA-7 PET/CT. No positive pelvic lymph nodes were reported on pre-surgical CT and MRI. 18F-JK-PSMA-7 PET/CT detected bladder involvement in one patient and seminal vesicles involvement in two patients; this malignant extension was undetected by the conventional imaging techniques. SUVmax in prostate lesions had an average value of 11.51 (range 6.90–21.49). SUVmean in prostate lesions had an average value of 7.59 (range 5.26–14.02).ConclusionThis pilot study indicates that pre-surgery 18F-JK-PSMA-7 PET/CT provides valuable information in intermediate- and high-risk PCa, for surgery planning with curative intent.

Preoperative Hilar and Mediastinal Lymph Node Staging in Patients with Suspected or Diagnosed Lung Cancer: Accuracy of 18F-FDG-PET/CT:A Retrospective Cohort Study of 138 Patients.

The aim of this study was to evaluate the diagnostic accuracy of integrated 18F-fluorodeoxyglucose positron emission computed tomography (18F-FDG-PET/CT) in hilar and mediastinal lymph node (HMLN) staging of suspected or proven lung cancer, and to investigate potential risk factors for false negative and false positive HMLN metastases. We retrospectively analyzed 162 consecutive patients with suspected or pathologically proven non-small cell lung cancer (NSCLC). The receiver operating characteristic (ROC) curve was generated to determine the diagnostic efficacy of 18F-FDG-PET/CT. Univariate and multivariate analyses were conducted to detect risk factors of false positives and false negatives. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of integrated 18F-FDG-PET/CT in detecting HMLN metastases were 59.1% (26/44), 69.1% (65/94), 47.3% (26/55), 78.3% (65/83), and 65.9% (91/138), respectively. The ROC curve showed an area under the curve (AUC) of 0.625 (95%-CI 0.468-0.782). The incidence of false negative and false positive HMLN metastases was 21.7% (18/83) and 52.7% (29/55), respectively. Our data shows that integrated 18F-FDG-PET/CT staging provides lower specificity and sensitivity. This confirms the ESTS guideline on lymph node staging for PET-positive HMLN. Yet it advocates more invasive staging even for PET-negative HMLN.

Diffusion-weighted imaging and apparent diffusion coefficient mapping of head and neck lymph node metastasis: a systematic review.

Head and neck squamous cell cancer (HNSCC) is the ninth most common tumor worldwide. Neck lymph node (LN) status is the major indicator of prognosis in all head and neck cancers, and the early detection of LN involvement is crucial in terms of therapy and prognosis. Diffusion-weighted imaging (DWI) is a non- invasive imaging technique used in magnetic resonance imaging (MRI) to characterize tissues based on the displacement motion of water molecules. This review aims to provide an overview of the current literature concerning quantitative diffusion imaging for LN staging in patients with HNSCC. This systematic review performed a literature search on the PubMed database (https://pubmed.ncbi.nlm.nih.gov/) for all relevant, peer-reviewed literature on the subject following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) criteria, using the keywords: DWI, MRI, head and neck, staging, lymph node. After excluding reviews, meta-analyses, case reports, and bibliometric studies, 18 relevant papers out of the 567 retrieved were selected for analysis. DWI improves the diagnosis, treatment planning, treatment response evaluation, and overall management of patients affected by HNSCC. More robust data to clarify the role of apparent diffusion coefficient (ADC) and DWI parameters are needed to develop models for prognosis and prediction in HNSCC cancer using MRI.

Derivation of a Modified Novel Pathologic Nodal Classification System for Non-Small Cell Lung Cancer

<h3>Purpose/Objective(s)</h3> For decades, nodal staging for non-small cell lung cancer (NSCLC) has been based predominantly on location. Given increasing evidence of the prognostic power of quantitative nodal burden across solid tumors, it is possible that positive lymph node (LN+) count is a primary driver of survival among surgically staged patients with NSCLC. <h3>Materials/Methods</h3> Retrospective cohort analysis was performed on patients with NSCLC undergoing upfront surgery and nodal evaluation, excluding those receiving neoadjuvant chemotherapy in the National Cancer Database (NCDB). Tumor stage was recoded to conform to the current American Joint Committee on Cancer, 8^th Edition (AJCC 8E) based on size and tumor extension. The association between number of positive LNs and survival was modeled with restricted cubic splines in multivariable Cox regression analysis. Recursive partitioning analysis (RPA) was used to develop a modified nodal classification system based on nodal factors independently associated with survival. The proposed nodal classification system was independently validated in patients with NSCLC, now allowing for patients who received neoadjuvant chemotherapy ± radiation, from Surveillance, Epidemiology, and End Results-18 (SEER-18). <h3>Results</h3> Overall, 126,473 patients (62,428 men [49.4%]; mean [SD] age, 67.1 [9.9] years; 32,958 node-positive patients) were included in the NCDB discovery cohort. Mortality risk increased continuously with increasing number of positive LNs in multivariable analysis, with the greatest correlation with the first 3 LN+ (0-3 LN+: HR per LN, 1.38; 95% CI, 1.36-1.41; P<0.001; ≥4 LN+: HR per LN, 1.06; 95% CI, 1.05-1.07; P<0.001). Location of LN (ipsilateral mediastinum) was also a predictor of survival (HR, 1.30; 95% CI, 1.24-1.36; P<0.001). Univariate RPA identified six clusters of patients stratified only by nodal count and not by LN location. On multivariable analysis, these groups demonstrated continuously increasing and non-overlapping mortality risk: N0 (0 LN; reference); N1a (1 LN+; HR, 1.68; 95% CI, 1.61-1.75); N1b (2-3 LN+; HR 1.90; 95% CI, 1.82-1.99); N2a (4 LN+; HR, 2.19; 95% CI, 2.03-2.37); N2b (5-8 LN+; HR, 2.51; 95% CI, 2.35-2.68); N3 (≥9 LN+; HR, 3.35; 95% CI, 3.04-3.70). By contrast, the AJCC 8E nodal classification system spanned a more limited range of mortality risk: N0 (0 LN; reference); N1 (HR, 1.24; 95% CI, 1.09-1.42); N2 (HR, 1.62; 95% CI, 1.41-1.86); N3 (HR, 1.11; 95% CI, 0.75-1.64). The proposed nodal system was validated for overall survival (log-rank P<0.001) and cause-specific survival (k-sample P<0.001) among 112,153 patients with or without neoadjuvant treatment from the SEER-18 validation cohort. <h3>Conclusion</h3> Number of positive LNs is a dominant predictor of outcomes in patients with NSCLC undergoing surgical resection and nodal evaluation, whereas LN location has more limited independent prognostic information in this context. Thus, nodal count should serve as a backbone for pathologic nodal staging in patients with NSCLC.

Systematic endoscopic staging of mediastinum to determine impact on radiotherapy for locally advanced lung cancer (SEISMIC): protocol for a prospective single arm multicentre interventional study

BackgroundEndobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is established as the preferred method of mediastinal lymph node (LN) staging in non-small cell lung cancer (NSCLC). Selective (targeted) LN sampling is most commonly performed however studies in early stage NSCLC and locally advanced NSCLC confirm systematic EBUS-TBNA evaluation improves accuracy of mediastinal staging. This study aims to establish the rate of detection of positron emission tomography (PET)-occult LN metastases following systematic LN staging by EBUS-TBNA, and to determine the utility of systematic mediastinal staging for accurate delineation of radiation treatment fields in patients with locally advanced NSCLC.MethodsConsecutive patients undergoing EBUS-TBNA for diagnosis/staging of locally advanced NSCLC will be enrolled in this international multi-centre single arm study. Systematic mediastinal LN evaluation will be performed, with all LN exceeding 6 mm to be sampled by TBNA. Where feasible, endoscopic ultrasound staging (EUS-B) may also be performed. Results of minimally invasive staging will be compared to FDG-PET. The primary end-point is proportion of patients in whom systematic LN staging identified PET-occult NSCLC metastases. Secondary outcome measures include (i) rate of nodal upstaging, (ii) false positive rate of PET for mediastinal LN assessment, (iii) analysis of clinicoradiologic risk factors for presence of PET-occult LN metastases, (iv) impact of systematic LN staging in patients with discrepant findings on PET and EBUS-TBNA on target coverage and dose to organs at risk (OAR) in patients undergoing radiotherapy.DiscussionWith specificity of PET of 90%, guidelines recommend tissue confirmation of positive mediastinal LN to ensure potentially early stage patients are not erroneously denied potentially curative resection. However, while confirmation of pathologic LN is routinely sought, the exact extent of mediastinal LN involvement in NSCLC in patient with Stage III NSCLC is rarely established. Studies examining systematic LN staging in early stage NSCLC report a significant discordance between PET and EBUS-TBNA. In patients with locally advanced disease this has significant implications for radiation field planning, with risk of geographic miss in the event of PET-occult mediastinal LN metastases. The SEISMIC study will examine both diagnostic outcomes following systematic LN staging with EBUS-TBNA, and impact on radiation treatment planning.Trial registrationACTRN12617000333314, ANZCTR, Registered on 3 March 2017.

Sentinel Lymph Node Biopsy in Prostate Cancer Patients: Results From an Injection Technique Targeting the Index Lesion in the Prostate Gland.

ObjectivesTo determine the accuracy of nodal staging in patients with prostate cancer (PCa) when 99 mTc-nanocolloid radiotracer is injected into an index lesion (IL).MethodsThis prospective study was conducted at our institution between June 2016 and October 2020. It included 64 patients with localized PCa with at least a 5% possibility for lymph node involvement in the Memorial Sloan Kettering Cancer Center nomogram, suitable for surgical treatment. All patients underwent magnetic resonance imaging (MRI) with IL and were pathologically confirmed. The day before surgery, transrectal ultrasound-guided injection (TRUS) of 99 mTc-nanocolloid into the IL was performed. Surgical procedures included radical prostatectomy (RP), sentinel lymph node biopsy (SLNB), and extended pelvic lymphadenectomy (ePLND). Analysis was performed, including histopathological findings of RP, ePLND, and SLNB. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), false negative (FN), false positive (FP), diagnostic yield, and non-diagnostic rate were calculated.ResultsA total of 1,316 lymph nodes were excised, including 1,102 from the ePLND (83.7%) and 214 (16.3%) sentinel lymph nodes (SLN). 26 SLN were dissected outside the ePLND template. The final pathology demonstrated 46 (3.5%) lymph node metastasis, 31 (67.4%) in the SLNB and 15 (32.6%) in the non-SLN ePLND. At the patient level, 18 (28.1%) patients had pN1. With a mean follow-up of 33.1 months, 4/19 (21.1%) pN1 patients had undetectable PSA, and 3/19 (15.8%) had a PSA < 0.1 ng/mL. Lymph node dissection included 20.6 lymph nodes per patient (IQR 15–24.2), with 3.3 SLNB nodes per patient (IQR 2–4.2). PPV and NPV were 100 and 97.8%, respectively. Sensitivity and specificity were 94.4 and 100%, respectively. FN was 5.5% and FP was 4.3%. Diagnostic yields were 95.3% and the non-diagnostic rate was 4.7%.ConclusionRadiotracer injection into the prostate IL offers promising results for staging purposes in cases in which ePLND is considered. Negative SLNB is a predictor of negative ePLND. Patients with a limited burden of nodal metastasis have a significant chance of remaining free of biochemical recurrence at mid-term follow-up.

USPIO-enhanced MRI for Nodal Staging in Patients with Head and Neck Cancer.

HomeRadiology: Imaging CancerVol. 4, No. 5 PreviousNext Research HighlightsUSPIO-enhanced MRI for Nodal Staging in Patients with Head and Neck CancerJenna SalehJenna SalehJenna SalehPublished Online:Sep 30 2022https://doi.org/10.1148/rycan.229020MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Highlighted ArticleDriessen DAJJ, Zámecnik P, Dijkema T, et al. High-accuracy nodal staging of head and neck cancer with USPIO-enhanced MRI: a new reading algorithm based on node-to-node matched histopathology [published online ahead of print, July 1, 2022]. Invest Radiol 2022;doi:https://doi.org/10.1097/RLI.0000000000000902 Crossref, Medline, Google ScholarArticle HistoryPublished online: Sept 30 2022 FiguresReferencesRelatedDetailsRecommended Articles Near-Infrared Labeling of EGFR+ Cells Can Allow Differentiation between Benign and Metastatic Lymph NodesRadiology: Imaging Cancer2020Volume: 2Issue: 1Advanced Imaging Techniques in Evaluation of Colorectal CancerRadioGraphics2018Volume: 38Issue: 3pp. 740-765Why Thyroid Surgeons Are Frustrated with Radiologists: Lessons Learned from Pre- and Postoperative USRadioGraphics2016Volume: 36Issue: 7pp. 2141-2153Ten Things You Might Not Know about Iron Oxide NanoparticlesRadiology2017Volume: 284Issue: 3pp. 616-629Functional and Targeted Lymph Node Imaging in Prostate Cancer: Current Status and Future ChallengesRadiology2017Volume: 285Issue: 3pp. 728-743See More RSNA Education Exhibits Diffusion-Weighted Imaging in the Head and Neck: Usefulness of the Qualitative Point-of-View for Patient CareDigital Posters2019Assessing Immunotherapy with Functional and Molecular Imaging and Radiomics: Whence and WitherDigital Posters2019Cystic Cervical Lymph Nodes: A Systematic Approach and Useful Imaging Features for their DifferentiationDigital Posters2020 RSNA Case Collection Synovial sarcoma of neckRSNA Case Collection2020"Cold" Sentinel Lymph Node in Cutaneous Melanoma RSNA Case Collection2020Dedifferentiated Thyroid CancerRSNA Case Collection2020 Vol. 4, No. 5 Metrics Altmetric Score PDF download

Metastasis of melanoma in non-sentinel nodes in patients with metastatic sentinel node. Can we avoid complementary lymphadenectomy?

Lymph mapping with sentinel node biopsy is the standard procedure for lymph node staging in patients with cutaneous melanoma with a tumor thickness of 1 mm or greater. Patients who have metastases in sentinel node must undergo complementary lymphadenectomy; however, it has not been shown to improve survival. To know the prevalence in our setting of metastases in the product of complementary lymphadenectomy in patients with metastatic sentinel node. Evaluation of a descriptive, retrospective, observational and analytical cohort of patients with metastatic sentinel node submitted to lymphadenectomy. Multivariate analysis of tumor thickness, neural invasion, location, sentinel node number, serum DHL level, lymph nodes dissected and extracapsular spread. 67 patients, 35 women and 32 men with a mean of 66 years, 22% had metastases in lymph nodes from complementary lymphadenectomy, 19% of them with extracapsular spread; no relationship with the Breslow level. Extracapsular spread in the sentinel node, lymphadenectomy time, and perineural invasion in the primary tumor were prognostic factors for non-sentinel node metastasis. In this series, 22% of the patients with a sentinel node-positive have metastases in the non-sentinel nodes, 19% of them with extracapsular spread, which justifies complementary lymphadenectomy.

Oncologic outcomes of surgical para-aortic lymph node staging in patients with advanced cervical carcinoma undergoing chemoradiation

ObjectivesWe aimed to evaluate the utilization and impact of surgical para-aortic lymph node staging on the survival of patients with locally advanced stage cervical carcinoma receiving definitive chemoradiation.MethodsWe identified patients...

The utility of endobronchial ultrasound-guided transbronchial needle aspiration in a community with a high HIV and tuberculosis burden

Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become the gold standard in diagnosing and performing nodal staging in patients with suspected lung cancer and diagnosing other malignant and benign diseases. Studies from countries with low tuberculosis (TB) incidence suggest that it has a sensitivity of 90 - 95% and a specificity of 100%. Objectives To investigate the utility of EBUS-TBNA in a community with a high HIV and TB burden. Methods We retrospectively reviewed all patients who underwent EBUS-TBNA to confirm a tissue diagnosis during a 2-year period from January 2017 - December 2018. Only patients with complete medical, pathology and radiology records and follow-up were included Results During the 2 years, a total of 201 patients underwent EBUS-TBNA. Some patients (n=19) had incomplete notes or follow-up and 104 cases were ultimately diagnosed with benign nodal disease. In the 182 patients who were ultimately included in the present study, EBUS-TBNA had a sensitivity of 95.1% (95% confidence interval (CI) 88.6 - 98.2), specificity of 100% (95% CI 94.20 - 100), positive predictive value (PPV) of 100.00% (95% CI 95.3 - 100) and negative predictive value (NPV) of 94.1% (95% CI 86.0 - 97.8) for all diagnoses. The overall diagnostic accuracy was 97.3% (95% CI 93.9 - 99.2). Out of the 64 patients who had lung cancer, EBUS-TBNA had a sensitivity of 95.2% (95% CI 86.7 - 99.0), specificity of 100% (95% CI 5.5 - 100), PPV of 100.0% and NPV of 58.3% (95% CI 31.7 - 80.9). The overall diagnostic accuracy for lung cancer was 95.5% (95% CI 87.2 - 99.1%). Conclusion EBUS-TBNA has high diagnostic accuracy, even in a population with a high HIV and TB burden.

Optimization of Preoperative Lymph Node Staging in Patients with Muscle-Invasive Bladder Cancer Using Radiomics on Computed Tomography.

Approximately 25% of the patients with muscle-invasive bladder cancer (MIBC) who are clinically node negative have occult lymph node metastases at radical cystectomy (RC) and pelvic lymph node dissection. The aim of this study was to evaluate preoperative CT-based radiomics to differentiate between pN+ and pN0 disease in patients with clinical stage cT2-T4aN0-N1M0 MIBC. Patients with cT2-T4aN0-N1M0 MIBC, of whom preoperative CT scans and pathology reports were available, were included from the prospective, multicenter CirGuidance trial. After manual segmentation of the lymph nodes, 564 radiomics features were extracted. A combination of different machine-learning methods was used to develop various decision models to differentiate between patients with pN+ and pN0 disease. A total of 209 patients (159 pN0; 50 pN+) were included, with a total of 3153 segmented lymph nodes. None of the individual radiomics features showed significant differences between pN+ and pN0 disease, and none of the radiomics models performed substantially better than random guessing. Hence, CT-based radiomics does not contribute to differentiation between pN+ and pN0 disease in patients with cT2-T4aN0-N1M0 MIBC.

Diagnostic Value of Nodal Staging of Lung Cancer With Usual Interstitial Pneumonia Using PET

BackgroundPreoperative staging of lymph node metastasis in patients with usual interstitial pneumonia (UIP) and non–small cell lung cancer (NSCLC) is difficult because inflammation can lead to false-positive imaging findings and clinical upstaging. We aimed to evaluate the accuracy of computed tomography (CT) and positron emission tomography (PET)/CT in nodal staging of NSCLC in patients with and without UIP. MethodsBetween November 2016 and June 2018, 198 patients underwent both preoperative CT and PET/CT and anatomic lung resection with mediastinal nodal dissection at our institute. Diagnosis of interstitial pneumonia (IP) was based on the presence of UIP or probable UIP pattern on CT. We retrospectively evaluated the diagnostic performance of PET/CT in nodal staging of NSCLC in patients with and without IP, with or without 18F-fluorodeoxyglucose (FDG) uptake in the lung. ResultsThe sensitivity, specificity, and accuracy for nodal staging were 36%, 94%, and 77%, respectively, in patients without IP and 25%, 89%, and 73%, respectively, in those with IP. Of 49 patients with IP, 23 had FDG uptake in the lung. The sensitivity, specificity, and accuracy were 13%, 93%, and 65%, respectively, in patients with IP with FDG uptake and 50%, 86%, and 81%, respectively, in those without FDG uptake. ConclusionsWe showed that the diagnostic performance of PET/CT in patients with IP was lower than that in patients without IP. Furthermore, the accuracy of nodal staging in patients with NSCLC and IP with FDG uptake was further decreased.

Is Performance of Fluorine-18-fluorodeoxyglucose Positron Emission Tomography/Computed tomography (CT) or Contrast-enhanced CT Efficient Enough to Guide the Hilar Lymph Node Staging for Patients with Esophageal Squamous Cell Carcinoma?

IntroductionWe evaluated the diagnostic performance of fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) and contrast-enhanced CT in the detection of hilar lymph node metastasis (LNM) in esophageal squamous cell carcinoma (ESCC) to determine their value in guiding hilar lymph node staging and delineating radiation target volume.MethodsConsecutive patients with ESCC who underwent both PET/CT and contrast-enhanced CT before radical lymphadenectomy and esophagectomy at our institution from September 2009 to November 2018 were enrolled. The sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) of FDG-PET/CT and contrast-enhanced CT for diagnosing hilar LNM were calculated.ResultsOf the 174 patients included, contrast-enhanced CT predicted nine positive cases, while PET/CT predicted one, and eight (4.6%) were identified as pathologically positive for their resected hilar lymph nodes. The SE, SP, PPV, and NPV of PET/CT and contrast-enhanced CT were 0.000, 0.994, 0.000, and 0.954; and 0.125, 0.952, 0.111, and 0.958, respectively. The specificity showed a significant difference (P=0.037). PET/CT is slightly more specific than contrast-enhanced CT.ConclusionsPET/CT and contrast-enhanced CT may be useful tools for predicting the negativity of hilar LN status, but they are not recommended for guiding the hilar lymph node staging and the delineating of hilar LNM in radiotherapy planning of ESCC patients based on their low PPV.