Lymph Node Staging In Patients Research Articles

The role of sentinel lymph node mapping in lower genital tract melanoma.

Vulvar and vaginal melanomas are rare cancers of the female genital tract and account for 1% to 3% of all melanomas diagnosed in women. Due to the rarity of the disease, few data are available on the clinical and pathologic features of these cancers. Furthermore, treatment options are generally based on extrapolations of the information available for the more common cutaneous counterparts. Surgery represents the mainstay of treatment for lower genital tract melanoma. Moreover, the role of sentinel lymph node (SLN) assessment is controversial because no prospective data are available. Data were collected from Medline, Embase, Web of Sciences and Scopus databases. On July 10, 2020, we used the search comprising the terms "vulvar melanoma," "genital melanoma" and "vulvovaginal melanoma" including only studies in which SLN biopsy was performed. Ten retrospective studies have been found. No randomized trials have been reported. The studies included 132 patients while only 63 (47%) undergone SLN. 99mTC with or without blue dye followed by ultrastaging was highly accurate and is currently the gold standard. Mean detection rate was 98.3%. No clear evidence supported the execution of back lymphadenectomy (after SLN mapping), in fact, extrapolating data from cutaneous melanomas of other sites, completion of lymphadenectomy does not confer a melanoma-specific survival advantage. Although the small amount of available data, sentinel lymph node procedure is feasible and capable of identifying patients who have occult lymph node metastases. However, the potential role of the sentinel lymph node procedure as an alternative method of lymph node staging in patients with vulvar or vaginal melanoma needs further investigation.

Combining Wire Localization of Clipped Nodes with Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy in Node-Positive Breast Cancer: Preliminary Results from a Prospective Study.

The ideal technique for lymph node staging for patients with pathologically confirmed node-positive breast cancer at diagnosis and neoadjuvant chemotherapy (NAC) is unclear. The aim of this study was to analyze the feasibility of wire/clip localization and sentinel lymph node biopsy (SLNB) for the axillary staging of these patients. We conducted a prospective study in which lymph node staging was performed using wire localization of positive lymph nodes and an SLNB with dual tracer. All patients who presented no metastatic involvement of the sentinel lymph node (SLN) or clip/wire-marked lymph node were spared an axillary lymph node dissection (ALND). The multidisciplinary committee agreed on axillary treatment for patients with lymph node involvement. Forty-two patients met the inclusion criteria. We identified and extirpated the clip/wire-marked node in all patients (100%), with SLNB performed successfully in 95.3% of patients. The SLN and wire-marked node matched in 80% of patients; 73.8% of patients did not undergo ALND. Several studies have evaluated the efficacy of various procedures for lymph node marking for women with prechemotherapy lymph node involvement. Most of the studies reported high identification rates (> 94.8%), with false negative rates of < 7%. Similarly, our study allows us to conclude that combined axillary marking (clip and SLNB) in patients with metastatic lymph node at diagnosis and NAC offers a high identification rate (100%) and a high correlation between the wire-marked lymph node and the SLN (80%). This procedure has enabled the suppression of ALND for a significant number of patients (73%).

Endobronchial ultrasound- guided transbronchial needle aspiration for mediastinal lymph node staging in patients with typical pulmonary carcinoids

BackgroundPulmonary carcinoids, which are well-differentiated lung neuroendocrine carcinomas, account for only 1–2 % of primary lung malignancies. Although fluorodeoxyglucose positron-emission tomography/computed tomography performs poorly in the identification of mediastinal lymph node metastases, particularly for pulmonary carcinoids, endobronchial ultrasound-guided (EBUS) transbronchial needle aspiration (TBNA) may be a useful means of preoperative nodal assessment in patients with these conditions. However, the diagnostic performance of EBUS TBNA is unknown. This study was designed to determine the sensitivity of EBUS for mediastinal staging in patients with typical carcinoid. Study design and methodsA retrospective review of all patients with carcinoids who underwent EBUS TBNA and/or surgical resection with lymphadenectomy at The University of Texas MD Anderson Cancer Center was performed. The sensitivity of EBUS –TBNA in diagnosis of mediastinal lymph node metastases was determined. ResultsOf the 212 patients with pulmonary carcinoids we identified, 137 had surgery with no preoperative EBUS TBNA, 68 had EBUS TBNA followed by surgery, and 7 had EBUS TBNA only. The sensitivity rate for EBUS TBNA in diagnosis of mediastinal lymph node metastases was 77.78 % overall (95 % CI, 57.7−91.3%) and it was 87.5 % (95 % CI, 67.6−97.3%) when we considered only patients with EBUS TBNA-accessible lymph nodes. DiscussionThe sensitivity of EBUS TBNA for diagnosis of mediastinal lymph node metastases of pulmonary carcinoids was slightly lower than that reported previously for non-small cell lung cancer. Preoperative EBUS TBNA identified nodal metastases not previously identified by imaging.

Endoscopic Ultrasound/Fine Needle Aspiration Is Effective for Lymph Node Staging in Patients With Cholangiocarcinoma.

Presence of malignant regional lymph nodes (MRLNs) precludes curative oncological resection or liver transplantation for cholangiocarcinoma (CCA). Limited data support the utility of endoscopic ultrasound (EUS)/fine needle aspiration (FNA) for detection of MRLNs in extrahepatic CCA, but there are no data for its role in intrahepatic CCA (iCCA). The aim of this study is to evaluate the staging impact of EUS for CCA, including analysis by subtype. We identified consecutive patients with CCA who underwent EUS staging at a single tertiary care center from October 2014 to April 2018. Among this cohort, we abstracted clinical demographic, radiographical, procedural, cytopathological, and surgical data. STATA 15 software was used for comparative analysis calculations (StataCorp LP, College Station, TX). The study cohort included 157 patients; 24 (15%), 124 (79%), and 9 (6%) with intrahepatic, perihilar, and distal CCA, respectively. EUS was able to identify regional lymph nodes (RLNs) in a higher percentage of patients compared to cross-sectional imaging (86% vs. 47%; P<0.001). FNA was performed in 133 (98.5%) patients with RLNs, with a median of three passes per node. EUS-FNA identified MRLN in 27 of 31 (87.1%) patients ultimately found to have MRLNs. For iCCA, EUS detected a higher percentage of RLN compared to cross-sectional imaging (83% vs. 50%; P=0.048), with MRLNs identified in 4 (17%) patients. Among the entire cohort, identification of at least one MRLN by EUS was associated with lower median survival (353 vs. 1,050days; P<0.001) and increased risk of death (hazard ratio=4.1; P<0.001). EUS-FNA is effective for identifying MRLN in patients with CCA, and should be routinely incorporated into staging of all CCA subtypes given the impact of MRLN on prognosis and management decisions.

Use of Nodal Staging Score in Evaluating the Accuracy of Pathologic Nodal Status in Node-Negative Ampullary Carcinoma

BackgroundThe minimum number of lymph nodes (LNs) that should be resected for accurate nodal staging in patients with ampullary carcinoma (AC) remains controversial. This study aimed to establish a nodal staging score (NSS) to evaluate whether a pathological node-negative AC patient is indeed free of a nodal disease. MethodsA total of 2539 AC patients with stages I–III were retrieved from the Surveillance, Epidemiology and End Result database (design cohort [DC], n = 2382) and First Affiliated Hospital of Sun Yat-sen University (validation cohort [VC], n = 157). NSS was developed to represent the probability that a node-negative patient was correctly staged as a function of the number of examined LNs (ELNs) and pathologic T stage with a beta-binomial model. Its prognostic value in node-negative patients was assessed by survival analysis. ResultsThe probability of missing a metastatic LN decreased as the number of the ELNs increased. NSS was escalated as the number of ELNs increased. For patients with early-stage (T1–T2) and late-stage (T3–T4) tumors, examining 7 and 33 lymph nodes could ensure an NSS of 80.0%, respectively. Multivariate analysis showed that higher NSS was an independent favorable prognostic factor for overall survival in node-negative patients with AC (DC, p < 0.001; VC, p = 0.001). ConclusionsNSS model could be used to evaluate the accuracy of nodal staging and predict the prognosis of node-negative AC patients. It could assist in making clinical strategies in node-negative AC patients.

Nomogram Based on Shear-Wave Elastography Radiomics Can Improve Preoperative Cervical Lymph Node Staging for Papillary Thyroid Carcinoma.

Background: Accurate preoperative prediction of cervical lymph node (LN) metastasis in patients with papillary thyroid carcinoma (PTC) provides a basis for surgical decision-making and the extent of tumor resection. This study aimed to develop and validate an ultrasound radiomics nomogram for the preoperative assessment of LN status. Methods: Data from 147 PTC patients at the Wuhan Tongji Hospital and 90 cases at the Hunan Provincial Tumor Hospital between January 2017 and September 2019 were included in our study. They were grouped as the training and external validation set. Radiomics features were extracted from shear-wave elastography (SWE) images and corresponding B-mode ultrasound (BMUS) images. Then, the minimum redundancy maximum relevance algorithm and the least absolute shrinkage and selection operator regression were used to select LN status-related features and construct the SWE and BMUS radiomics score (Rad-score). Multivariate logistic regression was performed using the two radiomics scores together with clinical data, and a nomogram was subsequently developed. The performance of the nomogram was assessed with respect to discrimination, calibration, and clinical usefulness in the training and external validation set. Results: Both the SWE and BMUS Rad-scores were significantly higher in patients with cervical LN metastasis. Multivariate analysis indicated that the SWE Rad-scores, multifocality, and ultrasound (US)-reported LN status were independent risk factors associated with LN status. The radiomics nomogram, which incorporated the three variables, showed good calibration and discrimination in the training set (area under the receiver operator characteristic curve [AUC] 0.851 [CI 0.791-0.912]) and the validation set (AUC 0.832 [CI 0.749-0.916]). The significantly improved net reclassification improvement and index-integrated discrimination improvement demonstrated that SWE radiomics signature was a very useful marker to predict the LN metastasis in PTC. Decision curve analysis indicated that the SWE radiomics nomogram was clinically useful. Furthermore, the nomogram also showed favorable discriminatory efficacy in the US-reported LN-negative (cN0) subgroup (AUC 0.812 [CI 0.745-0.860]). Conclusions: The presented radiomics nomogram, which is based on the SWE radiomics signature, shows a favorable predictive value for LN staging in patients with PTC.

Re: Effects of Extended Pelvic Lymph Node Dissection on Oncologic Outcomes in Patients with D’Amico Intermediate and High Risk Prostate Cancer Treated with Radical Prostatectomy: A Multi-institutional Study

Purpose:Pelvic lymph node dissection represents the gold standard of lymph node staging in patients with prostate cancer. We sought to assess the effect of extended pelvic lymph node dissection on ...

Time Trends in Axillary Surgery and Regional Recurrence in Older Patients with Clinically Node-Negative Breast Cancer

Background: Axillary surgery has changed since the sentinel lymph node biopsy (SLNB) has replaced axillary lymph node dissection (ALND) for nodal staging in patients with breast cancer without clinically suspect axillary lymph nodes. Furthermore, it has been shown that an ALND after a positive SLNB can be omitted in selected patients. Especially in older patients, a small benefit may not weigh up against the risk of significant morbidity including long-term pain and impaired arm function due to lymphoedema. Therefore, the aim of this study was to assess changes in surgical axillary treatment in unselected older patients over time and the effect on regional recurrence.

Is it necessary to sample the contralateral nodal stations by EBUS-TBNA in patients with lung cancer and clinical N0 / N1 on PET-CT?

ObjectivesSystematic mediastinal staging (sampling all visible nodes measuring ≥ 5 mm from N3 station to N1, regardless of PET/CT (positron emission tomography/computed tomography) by endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a decisive step in patients with non-small cell lung cancer (NSCLC). We analyzed the prevalence of N3 disease and the utility of systematic staging in the subgroup of patients who underwent EBUS-TBNA staging without showing mediastinal lesions on the PET/CT (N0/N1). Material and methodsWe conducted a retrospective analysis of a prospectively collected database that included 174 patients with a final diagnosis of NSCLC, with N0/N1 disease on PET/CT who underwent a systematic EBUS-TBNA staging. Results174 consecutive patients were included. Systematic EBUS-TBNA detected N2 mediastinal involvement in 21 (12 %) cases, and no cases of N3 disease were detected (neither hilar nor mediastinal). Of the remaining 153 patients N0/N1 EBUS-TBNA, 122 underwent lung resection that revealed 4 cases of N2 disease while 117 were confirmed to be N0/N1. Thirty-three patients with N0/1 disease after EBUS-TBNA did not undergo surgery and were excluded for the NPV calculation. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and overall accuracy of systematic EBUS was 84 %, 100 %, 96.7 %, 100 % and 97 % respectively. ConclusionSystematic EBUS-TBNA is a very accurate method for lymph node staging in patients with NSCLC without mediastinal involvement on PET/CT. Pending more studies, the absence of contralateral hilar nodal involvement in our series, questions the need for a contralateral hilar sampling in this subgroup of patients.

Near-Infrared Labeling of EGFR+ Cells Can Allow Differentiation between Benign and Metastatic Lymph Nodes.

HomeRadiology: Imaging CancerVol. 2, No. 1 PreviousNext Research HighlightsFree AccessNear-Infrared Labeling of EGFR+ Cells Can Allow Differentiation between Benign and Metastatic Lymph NodesAdeline N. BoettcherAdeline N. BoettcherAdeline N. BoettcherPublished Online:Jan 31 2020https://doi.org/10.1148/rycan.2020194014MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Take-Away Points■ Major focus: Improving ex vivo identification of benign and metastatic lymph nodes for solid tumor staging.■ Key result: Panitumumab-IRDye800CW (anti-EGFR) imaging of resected lymph nodes from patients with solid tumors enhanced ex vivo classification of benign and metastatic lymph nodes.■ Impact: This imaging methodology can increase efficiency and accuracy of lymph node characterization and can be further developed for in vivo imaging during resection surgeries to easily visualize metastatic lymph nodes.Standard staging of head and neck squamous cell carcinomas is performed by histopathologic assessment of resected lymph nodes from the neck. Metastatic or benign status of resected lymph nodes can be used in the tumor, node, metastasis (TNM) staging system to stage patient tumors. Proper staging of tumors is critical for determining the optimal treatment plan. Current practice requires assessing as many as possible collected lymph nodes for staging. Lymph nodes are typically analyzed by hematoxylin-eosin (H-E) staining to detect differences in tissue architecture for benign or metastatic classification, which can be a time-consuming and subjective process. Nishio et al describe the use of panitumumab-IRDye800CW (anti–epidermal growth factor receptor [EGFR]) as a near-infrared fluorescently labeled agent to selectively label metastatic lymph nodes during ex vivo evaluation.In this single-center, nonrandomized, phase I study, 22 patients underwent surgical resection of primary tumors, as well as either a unilateral or bilateral neck dissection. Panitumumab-IRDye800CW was infused into patients 1–5 days prior to surgery with an average dose of 0.67 mg/kg (range, 0.26–1.05 mg/kg). Resected lymph nodes were subjected to closed-field fluorescence imaging, as well as standard H-E staining, to determine the sensitivity and specificity of fluorescent EGFR labeling. Nishio et al quantified two imaging parameters: (a) mean fluorescence intensity (MFI) and (b) signal-to-background (SBR) and compared these results to histopathologic findings of the lymph nodes. Metastatic lymph nodes had significantly higher MFI and SBR than benign lymph nodes. Taking both MFI and SBR into account, metastatic lymph nodes could be identified with high sensitivity (84.6%), specificity (94.0%), negative predictive value (99.3%), and an acceptable positive predictive value (36.2%).In all, using panitumumab-IRDye800CW to label metastatic lymph nodes could reduce the total number of lymph nodes required for histologic determination of benign or metastatic status. Additionally, regular implementation of the described anti-EGFR labeling approach could help to increase standardization and efficacy of lymph node identification.Highlighted ArticleNishio, N, van den Berg NS, van Keulen S, et al. Optical molecular imaging can differentiate metastatic benign lymph nodes in head and neck cancer. Nat Commun 2019;10:5044. doi: https://doi.org/10.1038/s41467-019-13076-7Highlighted ArticleNishio, N, van den Berg NS, van Keulen S, et al. Optical molecular imaging can differentiate metastatic benign lymph nodes in head and neck cancer. Nat Commun 2019;10:5044. doi: https://doi.org/10.1038/s41467-019-13076-7 Crossref, Medline, Google ScholarArticle HistoryPublished online: Jan 31 2020 FiguresReferencesRelatedDetailsRecommended Articles USPIO-enhanced MRI for Nodal Staging in Patients with Head and Neck CancerRadiology: Imaging Cancer2022Volume: 4Issue: 5Advances in Diagnosis and Multidisciplinary Management of Oropharyngeal Squamous Cell Carcinoma: State of the ArtRadioGraphics2019Volume: 39Issue: 7pp. 2055-2068Application of N Descriptors Proposed by the International Association for the Study of Lung Cancer in Clinical StagingRadiology2021Volume: 300Issue: 2pp. 450-457CT-based Radiomic Signatures for Predicting Histopathologic Features in Head and Neck Squamous Cell CarcinomaRadiology: Imaging Cancer2020Volume: 2Issue: 3Impact of 18F-DCFPyL PET on Staging and Treatment of Unfavorable Intermediate or High-Risk Prostate CancerRadiology2022Volume: 304Issue: 3pp. 600-608See More RSNA Education Exhibits AJCC 2018 Head and Neck Cancer Staging Manual: Get Prepared for the ENT Tumor BoardDigital Posters2018Cystic Cervical Lymph Nodes: A Systematic Approach and Useful Imaging Features for their DifferentiationDigital Posters2020Esophageal Cancer: Role of Imaging in Primary Staging and Assessment of Response to Neoadjuvant TherapyDigital Posters2018 RSNA Case Collection Synovial sarcoma of neckRSNA Case Collection2020Multiple Endocrine Neoplasia Type 1 SyndromeRSNA Case Collection2021Horner syndrome in neuroblastomaRSNA Case Collection2020 Vol. 2, No. 1 Metrics Altmetric Score PDF download

Diagnostic performance of axillary ultrasound and standard breast MRI for differentiation between limited and advanced axillary nodal disease in clinically node-positive breast cancer patients

Preoperative differentiation between limited (pN1; 1–3 axillary metastases) and advanced (pN2–3; ≥4 axillary metastases) nodal disease can provide relevant information regarding surgical planning and guiding adjuvant radiation therapy. The aim was to evaluate the diagnostic performance of preoperative axillary ultrasound (US) and breast MRI for differentiation between pN1 and pN2–3 in clinically node-positive breast cancer. A total of 49 patients were included with axillary metastasis confirmed by US-guided tissue sampling. All had undergone breast MRI between 2008–2014 and subsequent axillary lymph node dissection. Unenhanced T2-weighted MRI exams were reviewed by two radiologists independently. Each lymph node on the MRI exams was scored using a confidence scale (0–4) and compared with histopathology. Diagnostic performance parameters were calculated for differentiation between pN1 and pN2–3. Interobserver agreement was determined using Cohen’s kappa coefficient. At final histopathology, 67.3% (33/49) and 32.7% (16/49) of patients were pN1 and pN2–3, respectively. Breast MRI was comparable to US in terms of accuracy (MRI reader 1 vs US, 71.4% vs 69.4%, p = 0.99; MRI reader 2 vs US, 73.5% vs 69.4%, p = 0.77). In the case of 1–3 suspicious lymph nodes, pN2–3 was observed in 30.4% on US (positive predictive value (PPV) 69.6%) and in 22.2–24.3% on MRI (PPV 75.7–77.8%). In the case of ≥4 suspicious lymph nodes, pN1 was observed in 33.3% on US (negative predictive value (NPV) 66.7%) and in 38.5–41.7% on MRI (NPV 58.3–61.5%). Interobserver agreement was considered good (k = 0.73). In clinically node-positive patients, the diagnostic performance of axillary US and breast MRI is comparable and limited for accurate differentiation between pN1 and pN2–3. Therefore, there seems no added clinical value of preoperative breast MRI regarding nodal staging in patients with positive axillary US.

Diagnostic Value of 18F-fluorodeoxyglucose Positron Emission Tomography with Computed Tomography for Lymph Node Staging in Patients with Upper Tract Urothelial Carcinoma

BackgroundPresence of lymph node metastases (LNM) is an important prognostic factor for cancer-specific survival (CSS) in patients with upper tract urothelial carcinoma (UTUC). In various neoplasms, 18F-fluorodeoxyglucose positron emission tomography with computed tomography (FDG-PET/CT) is an established modality for preoperative lymph node (LN) staging. In UTUC, the diagnostic value of FDG-PET/CT for LN staging is unknown. ObjectiveTo determine the diagnostic value of FDG-PET/CT for LN staging in patients with UTUC. Design, setting, and participantsData of 152 patients with UTUC who underwent FDG-PET/CT followed by surgical treatment in eight centers between 2007 and 2017 were retrospectively collected. Patients receiving neoadjuvant chemotherapy were excluded. Outcome measurements and statistical analysisFDG-PET/CT results were compared with histopathology after lymph node dissection (LND). Recurrence-free survival (RFS), CSS, and overall survival (OS) were analyzed using Kaplan-Meier estimates, and compared for patients with and without suspicious LNs on FDG-PET/CT. Results and limitationsWe included 117 patients, of whom 62 underwent LND. Seventeen patients had LNM at histopathological evaluation. Sensitivity and specificity of FDG-PET/CT for diagnosis of LNM were 82% (95% confidence interval [CI]: 57–96) and 84% (95% CI: 71–94), respectively. RFS was significantly worse in patients with LN-positive FDG-PET/CT than in those with LN-negative FDG-PET/CT (p=0.03). CSS (p=0.11) and OS (p=0.5) were similar between groups. This study is limited by its retrospective design and by its sample size. Our results warrant further validation. ConclusionsFDG-PET/CT has 82% sensitivity and 84% specificity for the detection of LNM in patients with UTUC. Presence of suspicious LNs on FDG-PET/CT is associated with worse RFS. Patient summaryIn patients with upper tract urothelial cancer, positron emission tomography with computed tomography (PET/CT) scans can detect lymph node metastases with noteworthy accuracy. Presence of suspicious lymph nodes on 18F-fluorodeoxyglucose PET/CT is associated with worse recurrence-free survival.

Effect of Extended Pelvic Lymph Node Dissection on Oncologic Outcomes in Patients with D'Amico Intermediate and High Risk Prostate Cancer Treated with Radical Prostatectomy: A Multi-Institutional Study.

Pelvic lymph node dissection represents the gold standard of lymph node staging in patients with prostate cancer. We sought to assess the effect of extended pelvic lymph node dissection on oncologic outcomes in patients with characteristics of D'Amico intermediate or high risk prostate cancer treated with radical prostatectomy. In a multi-institutional database of 4 centers we identified 9,742 patients who underwent radical prostatectomy from 2000 to 2017 with or without pelvic lymph node dissection. Only patients with a greater than 5% probability of lymph node invasion according to the Briganti nomogram were included in study. We performed 2:1 propensity score matching to account for potential differences between the 2 cohorts. Cox regression models were used to test the effect of pelvic lymph node dissection on biochemical recurrence, metastasis and cancer specific mortality. Overall 707 patients (7.3%) did not undergo pelvic lymph node dissection, of whom 520 and 187 harbored D'Amico intermediate and high risk characteristics, respectively. A median of 14 lymph nodes (IQR 8-21) were removed in the pelvic lymph node dissection cohort and 1,714 of these cases (19.0%) harbored lymph node metastasis. After propensity score matching the biochemical recurrence-free, metastasis-free and cancer specific mortality-free survival rates were 60.4% vs 65.6% (p=0.07), 87.0% vs 90.0% (p=0.06) and 95.2% vs 96.4% (p=0.2) for pelvic lymph node dissection vs no pelvic lymph node dissection 120 months after radical prostatectomy. Multivariable Cox regression models adjusted for postoperative and preoperative tumor characteristics revealed that pelvic lymph node dissection performed at radical prostatectomy was no independent predictor of biochemical recurrence, metastasis or cancer specific mortality (all p ≥0.1). There was no significant difference in oncologic outcomes in patients with D'Amico high or intermediate risk prostate cancer in whom pelvic lymph node dissection was or was not performed at radical prostatectomy. The therapeutic value of pelvic lymph node dissection remains unclear.

Prospective evaluation of the performance of [68Ga]Ga-PSMA-11 PET/CT(MRI) for lymph node staging in patients undergoing superextended salvage lymph node dissection after radical prostatectomy

PurposeTo assess the accuracy of [68Ga]-PSMA-11 PET/CT or [68Ga]-PSMA-11 PET/MRI (PSMA-11 PET/CT(MRI)) for lymph node (LN) staging using salvage LN dissection (SLND) in patients with biochemical recurrence (BCR) after radical prostatectomy (RP).Patients and methodsIn a prospective study, 65 consecutive patients who developed BCR after RP underwent SLND after PSMA-11 PET/CT(MRI) between 2014 and 2018. Extended SLND up to the inferior mesenteric artery was performed in all patients. Regional and template-based correlations between the presence of LN metastases on histopathology and whole-body PSMA-11 PET/CT(MRI) results were evaluated. The diagnostic accuracy of PSMA-11 PET/CT(MRI) was also evaluated in relation to PSA level at the time of SLND.ResultsThe median age of the patients at the time of SLND was 65 years (IQR 63–69 years) and the median PSA level was 1.4 ng/ml (IQR 0.8–2.9 ng/ml). Before SLND, 50 patients (77%) had additional therapy after RP (26.2% androgen-deprivation therapy and 50.8% radiotherapy). The median number of LNs removed on SLND was 40 (IQR 33–48) and the median number of positive nodes was 4 (IQR 2–6). LN metastases were seen in 13.8% of resected LNs (317 of 2,292). LNs positive on PSMA-11 PET/CT(MRI) had a median diameter of 7.2 mm (IQR 5.3–9 mm). Metastatic LNs in regions negative on PSMA-11 PET had a median diameter of 3.4 mm (IQR 2.1–5.4 mm). In a regional analysis, the sensitivity of PSMA-11 PET/CT(MRI) ranged from 72% to 100%, and the specificity from 96% to 100%. Region-specific positive and negative predictive values ranged from 95% to 100% and 93% to 100%, respectively.ConclusionPSMA-11 PET/CT(MRI) has a very good performance for the identification of LN metastases in patients with BCR after RP. The high diagnostic accuracy in the regional and subregional analyses demonstrates the potential of this approach to enable a region-directed instead of a complete bilateral therapeutic intervention. The performance of PSMA-11 PET/CT(MRI) is dependent on the PSA level and the size of the metastatic deposit.

Modelling the probability of erroneous negative lymph node staging in patients with colon cancer

BackgroundPatients in who with insufficient number of analysed lymph nodes (LNs) are more likely to receive an incorrect LN staging. The ability to calculate the overall probability of undiagnosed LN involvement errors in these patients could be very useful for approximating the real patient prognosis and for giving possible indications for adjuvant treatments. The objective of this work was to establish the predictive capacity and prognostic discriminative ability of the final error probability (FEP) among patients with colon cancer and with a potentially incorrectly-staged LN-negative disease.MethodsThis was a retrospective multicentric population study carried out between January 2004 and December 2007. We used a mathematical model based on Bayes’ theorem to calculate the probability of LN involvement given a FEP test result. Cumulative sum graphs were used to calculate risk groups and the survival rates were calculated, by month, using the Kaplan–Meier method.ResultsA total of 548 patients were analysed and classified into three risk groups according to their FEP score: low-risk (FEP < 2%), intermediate-risk (FEP 2%–15%), and high-risk (FEP > 15%). Patients with LN involvement had the lowest overall survival rate when compared to the three risk groups. This difference was statistically significant for the low- and intermediate-risk groups (P = 0.002 and P = 0.004, respectively), but high-risk group presented similar survival curves to pN+ group (P = 0.505). In terms of disease-free survival, the high-risk group presented similar curves to the intermediate-risk group until approximately 60 months’ follow-up (P = 0.906). After 80 months’ follow-up, the curve of high-risk group coincided with that of the pN+ group (P = 0.172). Finally, we summarized the FEP according to the number of analysed LNs and accompanied by a contour plot which represents its calculation graphically.ConclusionsThe application of Bayes’ theorem in the calculation of FEP is useful to delimit risk subgroups from among patients without LN involvement.

Sentinel lymph node detection using fluorescein and blue light-emitting diodes in patients with breast carcinoma: A single-center prospective study

Sentinel lymph node (SLN) biopsy is an essential procedure for lymph node staging in patients with breast carcinoma. Technetium-99m-labelled nanocolloid (99mTc) is the most accurate and widely used lymphatic mapping agent; however, there are concerns pertaining to the associated exposure to radiation. Studies focusing on new agents are required. We aimed to evaluate the feasibility and safety of SLN detection using fluorescein and blue light-emitting diodes (LEDs) in breast carcinoma patients. In this prospective study, a total of 61 patients with breast carcinoma, requiring SLN biopsy, were enrolled. Both fluorescein and 99mTc were intradermally injected into the areola of the affected breast of each patient. SLNs stained with fluorescein were detected using blue LED light first, and then, any remaining SLNs were detected using a gamma detection probe. The detection rate was analyzed, and the presence of complications was investigated. SLNs dyed with fluorescein using blue LED light were visualized in 57 of 61 patients (93.4%). None of the patients experienced complications related to the use of fluorescein or blue LED light. The detection of SLNs using fluorescein and blue LED light was feasible and safe in patients with breast carcinoma. This technique involves the use of visible light, allowing for SLNs to be viewed with the naked eye, and is quantifiable, easy to use, and economical.

737 - Diagnostic value of FDG-positron emission tomography (PET/CT) for lymph node staging in patients with upper tract urothelial carcinoma (UTUC)

737 - Diagnostic value of FDG-positron emission tomography (PET/CT) for lymph node staging in patients with upper tract urothelial carcinoma (UTUC)

159 - Diagnostic efficacy of 18F-rhPSMA7 positron emission tomography for lymph node staging in patients with high-risk primary prostate cancer

159 - Diagnostic efficacy of 18F-rhPSMA7 positron emission tomography for lymph node staging in patients with high-risk primary prostate cancer

Systematic and combined endosonographic staging of lung cancer (SCORE study).

Guidelines recommend endosonography for mediastinal nodal staging in patients with resectable nonsmall cell lung cancer (NSCLC). We hypothesise that a systematic endobronchial ultrasound (EBUS) evaluation combined with an oesophageal investigation using the same EBUS bronchoscope (EUS-B) improves mediastinal nodal staging versus the current practice of targeted positron emission tomography (PET)-computed tomography (CT)-guided EBUS staging alone.A prospective, multicentre, international study (NCT02014324) was conducted in consecutive patients with (suspected) resectable NSCLC. After PET-CT, patients underwent systematic EBUS and EUS-B. Node(s) suspicious on CT, PET, EBUS and/or EUS-B imaging and station 4R, 4L and 7 (short axis ≥8 mm) were sampled. For patients without N2/N3 disease determined on endosonography, surgical-pathological staging was the reference standard.229 patients were included in this study. The prevalence of N2/N3 disease was 103 out of 229 patients (45%). A PET-CT-guided targeted approach by EBUS identified 75 patients with N2/N3 disease (sensitivity 73%, 95% CI 63-81%; negative predictive value (NPV) 81%, 95% CI 74-87%). Four additional patients with N2/N3 disease were found by systematic EBUS (sensitivity 77%, 95% CI 67-84%; NPV 84%, 95% CI 76-89%) and five more by EUS-B (84 patients total; sensitivity 82%, 95% CI 72-88%; NPV 87%, 95% CI 80-91%). Additional clinical relevant staging information was obtained in 23 out of 229 patients (10%).Systematic EBUS followed by EUS-B increased sensitivity for the detection of N2/N3 disease by 9% compared to PET-CT-targeted EBUS alone.

Integrated analysis of 18F-FDG PET/CT improves preoperative lymph node staging for patients with invasive bladder cancer.

Preoperative 18F-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) is controversial to assess lymph node (LN) staging in patients with invasive bladder cancer. We proposed to use the maximum standardized uptake value (SUVmax) associated with axial-based LN size to improve the detection of regional LN metastasis. From May 2015 to May 2017, we prospectively included patients with urothelial bladder cancer who underwent radical cystectomy with extended pelvic LN dissection. All patients underwent preoperative 18F-FDG PET/CT staging before surgery. The gold standard comparator was the pathological examination of resected LNs. The data were reported on a regional per area- and patient-based model according to SUVmax values and axial-based LN size criteria. In total, 1012 LNs were identified in 61 patients with clinically localized invasive bladder cancer who underwent radical cystectomy and extended pelvic LN dissection. Loco-regional involvement of 24 LN areas was confirmed in 17 patients. In per area analysis, diagnostic accuracy of PET/CT and CT alone were respectively 84% and 78% (p = 0.039). On patient-based analysis, combined PET/CT correctly classified pelvic LN status in 5/61 (+ 8%) additional patients using optimal thresholds compared to CT alone, with accuracies of 82% and 74%, respectively (p = 0.13). Combining SUVmax and axial-based LN size criteria using 18F-FDG PET/CT improved the diagnostic accuracy for preoperative LN staging in patients with invasive bladder cancer, in per area analysis. • Combining metabolical and morphological features using18F-FDG PET/CT improves the detection of malignant lymph node in patients with bladder cancer. • 18 F-FDG PET/CT may help for initial staging of patients with muscle invasive bladder cancer.