Neoadjuvant immunotherapy is increasingly used in resectable stage III melanoma, with major pathological response (MPR) closely linked to improved outcomes. Predictive biomarkers are needed to identify responders and potentially allow surgical de-escalation. [¹⁸F]FDG-PET/CT is a non-invasive method to assess metabolic response, and the index lymph node (ILN) may reflect response of the entire nodal bain. This retrospective analysis of largely prospectively collected data included patients with resectable stage III melanoma treated with two cycles of neoadjuvant pembrolizumab at two Dutch melanoma centres. [¹⁸F]FDG-PET/CT was performed before and after treatment, with metabolic response classified using EORTC criteria. Volumetric PET parameters, metabolic tumour volume (MTV) and total lesion glycolysis (TLG), were analysed retrospectively. Pathological response was assessed according to INMC criteria. In patients undergoing therapeutic lymph node dissection, ILN response was compared with the entire nodal basin. Forty-seven patients initiated neoadjuvant pembrolizumab, and 39 underwent surgery. Twenty-four patients had evaluable PET/CT scans: complete metabolic response (CMR) in 12.5%, partial metabolic response (PMR) in 37.5%, stable disease in 16.7%, and progressive metabolic disease (PMD) in 33%. Overall, 59% achieved MPR. All patients with CMR achieved MPR; 64% with PMR achieved MPR, compared with only 12.5% with PMD. All patients with pathological complete or near-complete response showed reductions in both ΔTLG and ΔMTV. ILN response was fully concordant with total nodal basin response in all evaluable cases. Three patients who declined surgery after CMR remained recurrence-free during follow-up. Metabolic response on [¹⁸F]FDG-PET/CT, particularly CMR, strongly correlates with pathological response after neoadjuvant pembrolizumab. ILN response accurately reflects total nodal basin response, supporting response-adapted surgical strategies.

Background: Prostate cancer lacks reliable biomarkers to distinguish between indolent and aggressive forms, posing diagnostic and prognostic challenges. Sall4, primarily found in embryonic stem cells, is reactivated in various cancers, but its role in prostate cancer remains unclear. Objectives: This study aims to evaluate Sall4 protein and mRNA levels in malignant and normal prostate tissues and explore their association with clinical data. Materials and methods: This study was conducted from December 2022 to April 2024 at Al-Hussein Teaching Hospital, Thi-Qar, Iraq. Sall4 protein and mRNA expression levels were assessed in 40 normal tissues and 194 malignant prostate tissues using immunohistochemistry and RNAscope® methods. The data were analyzed using unpaired t-tests. Results: The study identified a significant increase in nuclear Sall4 protein expression, assessed by immunohistochemistry, in prostate cancer tissues compared to normal tissues (p=0.001). Similarly, Sall4 mRNA levels, measured using RNAscope®, were significantly higher in malignant tissues (p<0.001). Increased Sall4 expression at both protein and mRNA levels was significantly associated with higher Gleason scores (protein: p=0.003; mRNA: p=0.009), lymph node involvement (protein: p=0.002; mRNA: p=0.006), and metastasis (protein: p=0.001; mRNA: p=0.017). However, no significant correlation was found between Sall4 expression and tumor size. Conclusion: Elevated Sall4 expression may be associated with prostate tumorigenesis and aggressiveness. Further studies are needed to clarify its role and evaluate its potential as a prognostic biomarker for prostate cancer.

Redefining the role of carbon nanoparticles in colorectal cancer surgery: From lymph node yield to diagnostic paradox.

Lymph Node Harvest and Survival Among Patients With Locally Advanced Appendiceal Adenocarcinoma.

Lymph nodes (LNs) are essential tissues in generating and modulating effective immune responses. In this study, we investigated the intra-lymphatic delivery of immunotherapy cues encapsulated in degradable microparticles (MPs). We demonstrate that co-localization of antigens and adjuvants within the same lymph node generates robust antigen-specific T cell responses and significant anti-tumor protection, while spatial separation of cargos across different lymph nodes diminishes immune efficacy. While co-encapsulation of signals in the same particle within a lymph node ensures efficient delivery of both cargos, immune function is equally effectively when particles carrying a single cue are mixed and localized in the same node. This finding demonstrates a strategy for focused, potent responses in lymph nodes using degradable particles that offer attractive translational features, including the flexibility to load individual immunotherapeutic cargos into particles, followed by mixing prior to administration. This feature dramatically simplifies chemistry and manufacturing control (CMC) processes needed for development by avoiding manufacture of candidate immunotherapies that require simultaneous tuning of pharmacokinetic profiles.

Data-driven thresholds for tumor size and nodal involvement in oncocytic thyroid carcinoma: A population-based analysis.

To determine how often lymph node assessment alters post-operative risk classification or adjuvant therapy in p53-abnormal endometrial carcinoma and to calculate the number needed to stage to obtain 1 management-changing result. This multicenter retrospective study included patients with biopsy-confirmed p53-abnormal endometrial carcinoma who underwent pre-operative expert ultrasound, molecular classification, and definitive surgery. Pre-operative risk groups were based on ultrasound-assessed invasion and molecular subtype; post-operative groups incorporated final pathology and lymph node status. The number needed to stage was defined as the number of patients staged divided by the number with management-changing results. Among 120 patients, lymph node status was evaluable in 107, with metastases identified in 19 (17.8%) cases. Concordance between pre-operative and post-operative risk groups was 84.2%. Reclassification occurred in 15.8% of patients and was driven entirely by uterine pathological findings. Lymph node findings altered guideline-based post-operative management in only 2 of 107 patients (1.9%; 95% confidence interval 0.2% to 6.6%), both through treatment de-escalation based on negative nodal status. No escalation of adjuvant therapy was triggered by nodal metastases. The number needed to stage was 53.5. In this multicenter cohort of p53-abnormal endometrial carcinoma, lymph node assessment had a limited impact on guideline-based post-operative management, with treatment decisions largely driven by molecular subtype and uterine pathological factors. Prospective, molecularly stratified studies are needed to clarify the optimal role of nodal staging in this patient population.

Multi-omics identifies an epithelial-B cell cross-talk that drives functional B cell diversion in breast cancer lymph node metastasis.

Purpose To develop a multiparametric MRI-based radiomics model and deep learning-radiomics (DLR) fusion model for preoperative prediction of lymph node metastasis (LNM) in early-stage cervical cancer. Materials and Methods In this multicenter retrospective study (January 2020-December 2022), preoperative MRI data from patients with early-stage cervical cancer were split into training, internal testing, and external testing cohorts. Radiomic and deep learning (DL) features of both the tumor and lymph node were extracted separately from the MRI scans. Multivariable logistic regression was used to construct predictive models for LNM based on tumor and lymph node radiomic features (Rad_T+LN) and based on radiomic and DL features from both the tumor and lymph node (DLR_T+LN). The models' effectiveness and clinical applicability were evaluated using receiver operating characteristic curves, calibration curves, and decision curve analysis. A two-tailed P value of <.05 was considered statistically significant. Results The overall dataset included 862 patients (median age, 53 years [IQR, 45-60 years]). Rad_T+LN resulted in areas under the receiver operating characteristic curve (AUCs) of 0.81 (95% CI: 0.76, 0.86), 0.79 (95% CI: 0.72, 0.87), and 0.77 (95% CI: 0.71, 0.82) in the training, internal testing, and external testing cohorts, respectively. DLR_T+LN achieved AUCs of 0.83 (95% CI: 0.76, 0.91) and 0.79 (95% CI: 0.74, 0.84) in the internal and external testing cohorts, respectively, and did not improve over Rad_T+LN (P > .05). Both models demonstrated good calibration and positive net benefit on decision curve analysis. Conclusion Rad_T+LN and DLR_T+LN exhibited robust diagnostic performance for LNM prediction. Keywords: MR-Diffusion Weighted Imaging, MR Imaging, Genital/Reproductive, Cervix, Metastases, Decision Analysis, Segmentation, Radiomics, Diagnosis, Uterine Cervical Neoplasms, Lymphatic Metastasis, Magnetic Resonance Imaging, Deep Learning Supplemental material is available for this article. © RSNA, 2026.

Operated bronchial carcinoid tumors: impact of lymph node status and histological type on long-term outcomes.

Integrating nonlinear modeling with pT stage and nodal variables: A multi-center Con-pTN model for prognosis prediction in gastric cancer (pT2-4b).

Postoperative lymph node irradiation can affect shoulder morbidity in breast cancer patients, yet widely accepted dose-volume constraints for the shoulder joint are lacking. The SENOMAC trial randomized patients with breast cancer and 1-2 sentinel lymph node (SLN) macrometastases to axillary lymph node dissection (ALND) or SLN biopsy only. We aimed to analyze the association between the radiation dose to the shoulder joint and patient-reported arm morbidity one and three years after surgery using SENOMAC data. Radiotherapy plans from 868 Swedish SENOMAC patients randomized 2015-2019 were collected. The humeral head was auto-segmented, and a 1cm margin added to represent the shoulder joint. Arm morbidity was assessed using the Lymph-ICF questionnaire, focusing on questions regarding physical arm function and shoulder-related mobility tasks. The radiation dose was evaluable for 386 patients receiving ALND and 421 receiving SLN biopsy. The dose distribution to the shoulder joint was similar in both study groups. In the SLN group, a higher near-maximum dose (D0.5cc) was associated with significantly worse arm morbidity scores three years after surgery, particularly among patients treated with breast-conserving surgery. No association was found in the ALND group. No dose thresholds for development of arm/shoulder related side effects could be identified. Our results indicate a possible association between maximum radiation dose to the shoulder joint and subsequent side effects. Extended follow-up within SENOMAC will provide further insights into the incidence of arm morbidity in relation to radiotherapy dose over time.

SS18::POU5F1 fusion–associated sarcoma of the shoulder presenting with lymph node metastases in a 5-year-old male: A case report

To evaluate the usefulness of [18F] fluoro- d -glucose PET combined with computed tomography ([ 18 F]FDG PET/CT) in staging T1 lung tumors with pure solid morphology on CT, focusing on the different histology subtypes, accuracy, detection rate of metastases, and its impact on changes in TNM staging. Retrospectively, 238 patients with lung cancer and T1 nodules with pure solid morphology on CT scan, staged with [ 18 F]FDG PET/CT and chest contrast-enhanced CT (ceCT) were included. Primary tumor (T) sizes were assessed on chest ceCT and PET/CT. Maximum standardized uptake values (SUVmax) of the primary lung tumor were obtained from PET. Prevalence of lymph node and distant metastases was assessed for the three substages of T1 lung cancer (T1a, T1b, and T1c). Sixty-two (26%) patients with solid T1 lung cancer had lymph node metastases (T1a: 22%, T1b: 16%, T1c: 38%), and 29 (12%) showed distant metastases (T1a: 11%, T1b: 11%, T1c: 14%) in PET/CT imaging. [ 18 F]FDG PET/CT detected distant metastases in 12 patients with negative chest ceCT. [ 18 F]FDG PET/CT upstaged 26 patients (11%) and downstaged 13 patients (6%) compared with ceCT. Primary tumor histological subtypes and SUVmax values significantly correlated with the risk of lymph node and distant metastases ( P < 0.001). However, the sensitivity for mediastinal nodal detection (N+) was poor with both CT (35%) and [ 18 F]FDG PET/CT (47.5%). [ 18 F]FDG PET/CT is useful for staging of pure solid T1 lung cancer with a detection rate of 26% for lymph node metastases and 12% for distant metastases. [ 18 F]FDG PET/CT is more accurate and has a higher positive predictive value than chest ceCT and leads to a change in the TNM stage in 17% of patients. Due to the limited sensitivity of FDG PET/CT in detecting lymph node metastases, lymphadenectomy cannot be omitted even in small pure solid T1 lung cancer.

Molecular subtypes are potential prognostic and predictive tools in muscle-invasive bladder cancer (MIBC). However, subtype concordance between primary tumors and metastases, as well as subtype-specific differences in metastatic patterns, remain poorly characterized. The present study aimed to evaluate the concordance of molecular subtypes between primary tumors and matched lymph node (LN) metastases and to explore their association with metastatic patterns. Gene expression-based molecular subtypes were determined according to the five-tiered Lund Taxonomy in 182 primary tumor samples and 34 matched LN metastases from patients with MIBC who underwent upfront radical cystectomy. Subtypes identified in the primary tumors were compared with those in matched positive LNs and patterns of distant metastasis were analyzed. In addition, the association between molecular and histological subtypes was also investigated. We found an overall 62% subtype concordance between primary tumors and corresponding LN metastases, with complete concordance in the basal/squamous subtype, lower concordance in the luminal subtypes (genomically unstable: 67%; urothelial-like: 57%), and low concordance (33%) in the mesenchymal-like (Mes) subtype. Luminal subtypes were associated with LN-only metastases and less frequent distant metastases. In contrast, the Mes subtype was associated with a higher rate of distant metastases (43%), and more frequent multiorgan involvement (≥3 organs: 40%). Higher expression of the mesenchymal gene CDH2 and the neuronal-differentiation genes GNG4 and ENO2 was associated with a higher number of metastatic sites. Gene expression-based molecular subtypes may change between primary MIBCs and matched LN metastases, and these differences appear to be subtype-dependent. Mes subtype and the expression of CDH2 as well as GNG4 and ENO2 are associated with more frequent and extensive metastases, indicating highly aggressive forms of MIBC.

To define the role of post-mastectomy radiotherapy (PMRT) in triple-negative breast cancer (TNBC), employing lymph node ratio (LNR, ratio of positive over excised lymph nodes) to offer personalized treatment strategies for this aggressively behaving cancer type. The study included a total of 6474 women diagnosed with T1-4 N1-3 M0 TNBC from 2010 to 2017 using the SEER database, all of whom underwent mastectomy. Breast cancer-specific survival (BCSS) was defined as the time from diagnosis until death attributable to the breast cancer. Overall survival (OS) was defined as the time from diagnosis until death from any cause. A 1:1 propensity score matching (PSM) method was utilized to balance the baseline characteristics between the PMRT and non-PMRT groups. Kaplan-Meier analysis, together with the log-rank test, was applied to estimate survival outcomes. After PSM, the PMRT group displayed better OS (HROS = 0.898, 95% CI = 0.819-0.984, p = 0.021). Subgroup analyses indicated that PMRT improved BCSS outcomes in the high-LNR group (HRBCSS = 0.762, 95% CI = 0.636-0.913; p = 0.003) rather than low- (HRBCSS = 1.125, 95% CI = 0.938-1.348; p = 0.203) or intermediate-LNR groups (HRBCSS = 0.925, 95% CI = 0.778-1.099; p = 0.374). Compared with the non-PMRT group, patients receiving PMRT had better OS in the intermediate-LNR (HROS = 0.834, 95% CI = 0.715-0.972, p = 0.021) and high-LNR groups (HROS = 0.757, 95% CI = 0.643-0.893, p = 0.001), whereas the difference was not significant in the low-LNR group (HROS = 1.044, 95% CI = 0.889-1.226, p = 0.599). PMRT substantially improves the survival outcomes for individuals who fall into the intermediate to high-risk groups as determined by LNR, an essential prognostic factor. This helps in developing personalized PMRT treatment strategies for TNBC patients, thereby enabling precision medicine approaches.

Pathobiological characterization and estimation of the basic reproduction number of a recombinant african swine fever virus in contact-exposed pigs in Vietnam.

T1b gastric cancer, characterized by tumor invasion into the submucosa, presents a therapeutic dilemma regarding the need for adjuvant therapy owing to varying rates of lymph node metastasis (LNM). This study aimed to develop and validate comprehensive nomogram models for predicting LNM risk and long-term survival outcomes in patients with T1b gastric cancer. A retrospective cohort study was conducted on 362 patients with pathologically confirmed T1b gastric cancer who underwent radical gastrectomy with D2 lymph node dissection at a single institution between 2014 and 2024. Patients were stratified into LN+ (lymph node-positive) and LN- (lymph node-negative) groups. Multivariate logistic regression identified independent risk factors for LNM, while Cox proportional hazards models assessed prognostic factors for overall survival (OS) and recurrence-free survival (RFS). Nomogram models were constructed and internally validated using bootstrap resampling. Among 362 patients, 92 (25.4%) had LNM. Independent predictors of LNM included tumor size ≥ 3 cm (odds ratio [OR] 2.84, 95% confidence interval [CI]: 1.62-4.98, p < 0.001), lymphovascular invasion (OR 4.21, 95% CI: 2.45-7.23, p < 0.001), poor differentiation (OR 3.12, 95% CI: 1.78-5.47, p < 0.001), and perineural invasion (OR 2.56, 95% CI: 1.23-5.32, p = 0.012). The LNM prediction nomogram showed excellent discrimination (area under the curve [AUC] 0.843, 95% CI: 0.801-0.885) and calibration. The integrated survival nomogram incorporating LNM risk demonstrated superior predictive performance for 5-year OS (C-index 0.782) compared with traditional staging (C-index 0.681). Decision curve analysis confirmed clinical utility across relevant threshold probabilities. Our validated nomogram models provide accurate individualized predictions for LNM risk and long-term survival in patients with T1b gastric cancer, potentially guiding personalized treatment decisions regarding adjuvant therapy and extent of lymphadenectomy.

Concurrent Chemotherapy With Adjuvant Radiation for Patients With High-risk Locally Advanced Breast Cancer: Safety and Outcomes.

A 37-year-old woman with metastatic invasive ductal carcinoma, resistant to anti-HER 2 therapy, underwent [ 177 Lu]Lu-FAPI-2286 radionuclide therapy combined with antibody-drug conjugate chemotherapy. Baseline [ 68 Ga]Ga-FAPI-2286 PET/CT confirmed extensive fibroblast activation protein expression in metastatic sites. After 5 cycles, follow-up imaging showed a significant reduction in FAPI uptake in skin lesions, resolution of bone lesions, and decreased pleural thickening. Clinically, the patient reported pain relief and resolution of lymphedema. However, new metastases emerged in cervical, mediastinal, and abdominopelvic lymph nodes, indicating a heterogeneous response, and biopsy of these newly emerged lymph nodes confirmed disease recurrence.