Mean Short Axis Research Articles

Radiological Characteristics of Immunization Adenitis in the Axilla Following the Covid-19 Vaccine

It was aimed to investigate the ultrasonography (US) features of axillary COVID-19 immunization adenitis. Patients with axillary COVID-19 immunization adenitis detected between April 2021 and January 2022 were included. US features of the lymph nodes identified at the patient's initial US were all recorded. Radiological follow-up information and if exists pathology results were investigated. 104 immunization adenitis in the axilla following Covid-19 vaccine were detected. Only 18.3 percent had axillary pain or edema. Biopsy was recommended for 4 patients and follow-up was recommended for the other 100 patients. Core biopsy results were lymphoid tissue with focal micro-abscess formations, reactive lymphoid hyperplasia and plasma cell increase. All of the patients had a history of vaccination in the last 3 months. After immunization, initial US imaging was conducted mean 24-days later. The mean long and short axis were 22-mm and 13-mm, respectively. The mean long-short axes ratio was 2.2. The mean thickness of the cortex was 4.8-mm. The long and short axes of the lymph nodes in the first US and control examinations were compared statistically and they decreased in time. The hilum existed (96%). Elastography revealed soft features. The majority of the immunization adenitis are just enlarged benign-appearing lymph nodes. The majority were found during the extensive immunization campaign and were asymptomatic. Patients and their physicians should be aware of the vaccination and imaging evaluation of specific patient groups considering that these vaccinations will continue to be used for a while in the next years.

Predictive value of sphericity index and other multidetector computed tomography findings in perforated acute appendicitis.

Early radiological prediction and diagnosis of perforated acute appendicitis remain controversial. In the current study, it was aimed to examine the predictive value of multidetector computed tomography (MDCT) findings in perforated acute appendicitis. The patients (n=542) who underwent appendectomy between January 2019 and December 2021 were retrospectively evaluated. The patients were divided into two groups as non-perforated appendicitis and perforated appendicitis. Preoperative abdom-inal MDCT findings, appendix sphericity index (ASI) scores, and laboratory findings were evaluated. The sample consisted of 427 cases in the non-perforated group and 115 cases in the perforated group, with a mean age of 33.88±12.84 years. The mean time until admission was 2.06±1.43 days. Appendicolith, free fluid, wall defect, abscess, free air, and retroperitoneal space (RPS) involvement were all found to be significantly higher in the perforated group (P<0.001). The mean long axis, short axis, and ASI values were found to be higher in the perforated group (P<0.001; P=0.004; and P<0.001, respectively). C-reac-tive protein (CRP) was found to be significantly higher in the perforated group (P=0.008), but the mean white blood count was found to be similar between the groups (P=0.613). Among MDCT findings, free fluid, wall defect, abscess, high CRP, long axis, and ASI were observed to be predictive values for perforation. According to receiver operating characteristic analysis, ASI had a cut-off value of 1.30, a sensitivity of 80.87%, and a specificity of 93.21%. MDCT findings, namely, appendicolith, free fluid, wall defect, abscess, free air, and RPS involvement are significant findings for perforated appendicitis. With a high sensitivity and specificity, the ASI appears to be a key predictive parameter for perfo-rated acute appendicitis.

Efficacy and Safety of Regimens Used for the Treatment of Multicentric Castleman Disease: A Systematic Review

Introduction:Multicentric Castleman disease (MCD) is a rare lymphoproliferative disorder characterized by lymph node enlargement in multiple regions of the body. It includes two heterogeneous subtypes: human herpesvirus 8 (HHV-8) associated MCD and idiopathic MCD (iMCD). This study is focused on the efficacy and safety of treatment regimens for MCD in clinical trials.Methods:A systematic literature search was conducted using PubMed, Embase, Cochrane, Web of Science, Clinicaltrials.gov, ASH, and ASCO meeting websites from inception to May 9, 2021. The initial search revealed 1323 articles. After excluding reviews, duplicates, and non-relevant articles, we included data from 13 articles.Results:Data on 311 patients was included.Siltuximab based regimens:In the two clinical trials where siltuximab was used for iMCD, Cheson criteria (modified to include cutaneous lesions) was used to assess response. In a phase 2 trial by Van Rhee et al. (2014, n=79), the overall response rate (ORR) was 34% vs 0% and grade≥3 adverse events (AEs) were seen in 47% vs 54% of the siltuximab (n=53) and placebo (n=26) groups respectively. In a phase 1 trial by Kurzrock et al. (2013, n=37), 86% of patients improved in at least one clinical benefit response (CBR) component, 33% had confirmed radiological ORR, and 11% had grade≥3 AEs. Van Rhee et al. (2020, n=60) conducted an extension analysis of patients from these two trials. After a median follow-up of 6 years (IQR 5∙11-7∙76), serious AEs were reported in 42% of patients and stable disease (SD) or better of up to 6 years was recorded in 70% of patients.Tocilizumab based regimens:In a phase 2 trial by Ramaswami et al. (2020, n=8), ORR was 63% vs 100%, progression-free survival (PFS) at 4 months was 25% vs 33%, and grade≥3 AEs were reported in 25% vs 67% of HHV-8 associated MCD patients receiving tocilizumab alone vs tocilizumab alongside zidovudine (AZT) and valganciclovir (VGC), respectively. Nishimoto et al. (2005, n=28) reported a 30% reduction (p<0.001) in the mean short axis of swollen lymph nodes, after 1 year of therapy. The 5 year extension study by Nishimoto et al. (2007, n=35) reported 2.3 AEs / patient year.Rituximab based regimens:In a phase 2 trial by Bower et al. (2007, n=21), 67% of HIV-associated MCD patients had a partial response (PR) and 29% had SD on rituximab. The 2-year overall survival (OS) and relapse-free survival were 95% (95% CI, 86% to 100%) and 79% (95% CI, 52% to 100%) respectively. No grade≥3 toxicity was observed. In a phase 2 trial by Gerard et al. (2007, n=24) on rituximab in HIV-associated MCD, the sustained remission rate was 92% (95% CI, 80% to 103%) at day 60. Estimated 1-year OS was 92% (95%CI, 71% to 98%). In a phase 2 trial by Uldrick et al. (2014, n=17), rituximab and doxorubicin (R-dox) were administered to HHV-8 MCD patients. ORR was 82% and OS was 81% (95%CI, 57% to 93%) at 3 years. Ramaswami et al. (2021) reported survival outcomes from the same trial. The 5-year PFS with rituximab (n=8), R-dox followed by no maintenance (n=16), R-dox followed by AZT+VGC (n=10) and R-dox followed by interferon-alpha (n=10) were 71% (95%CI, 26% to 92%), 62% (95%CI, 23% to 85%), 87% (95%CI, 39% to 98%) and 70% (95%CI, 33% to 89%) respectively.Immunomodulatory drug-based regimens:In a phase 2 study by Zhang et al. (2019, n=25), ORR was 48% in iMCD patients on thalidomide, cyclophosphamide, and prednisone. Estimated 1-year OS and PFS were 88% and 60% respectively. Grade≥3 AEs were rash and pneumonitis in 1 (4%) patient each.Proteasome Inhibitor based regimens:Zhang et al. (2020, n=20) reported the efficacy of bortezomib, cyclophosphamide, and dexamethasone in relapsed and refractory (R/R) iMCD patients. Seventy-five percent had PR and 10% had SD. Estimated 1-year PFS and OS were 85% and 90% respectively. No grade≥3 AEs occurred.Antiviral Regimens:In a phase 2 trial by Uldrick et al. (2011, n=14), ORR was 28% in HHV-8 MCD patients on AZT and VGC. Clinical complete response (CR) occurred in 50% of patients. Ramaswami et al. (2021) reported the efficacy of AZT+VGC in 17 patients from the same trial. The 5-year PFS was 26% (95%CI, 8% to 49%).Conclusion:Siltuximab- and thalidomide-based regimens have acceptable efficacy and safety profiles for the treatment of iMCD. Bortezomib appears to be effective for R/R iMCD. Tocilizumab and rituximab showed promising outcomes for the treatment of HHV-8 associated MCD. However, more prospective clinical trials need to be conducted. [Display omitted] DisclosuresAnwer: Allogene Therapeutics: Research Funding; BMS / Celgene: Honoraria, Research Funding; GlaxoSmithKline: Research Funding; Janssen pharmaceutical: Honoraria, Research Funding.

Comparitive Study of Human Lymph Nodes

All the lymph nodes observed were typically bean shaped irrespective of their age or sex. The cervical lymph nodes were the largest of all the four groups in size. The mean maximum short axis axial diameter was 7.19mm (Range 5.67mm - 8.12mm). The mesentericl lymph nodes were the smallest of all the four groups in size. The mean maximum short axis axial diameter was 3.89mm (Range 2.7mm -6.lmm). The lymph nodes showed well defined deep cortical regions often containing large lymphoblasts and prominent endothelial cells in small blood vessels. The thickness of the deep cortex was however reduced when compared to its foetal counterpart. The mean thickness of the deep cortical region was 423 microns. To reconfirm the age related involution of the paracortical region, the mesenteric lymph nodes were observed. In sharp· distinction, axillary lymph nodes showed fewer germinal centres which were relatively smaller in size.Mean actual diameter of the germinal centre was77 microns also had had fewer and smaller germinal centres. Mean actual diameter of the germinal centre was 68 microns.

Lymph Node Assessment in Prostate Cancer: Evaluation of Iodine Quantification With Spectral Detector CT in Correlation to PSMA PET/CT.

The aims of this study were to evaluate spectral detector CT (SDCT)-derived iodine concentration (IC) of lymph nodes diagnosed as metastatic and benign in prostate-specific membrane antigen (PSMA) PET/CT and to assess its potential use for lymph node assessment in prostate cancer. Thirty-four prostate cancer patients were retrospectively included: 16 patients with and 18 without lymph node metastases as determined by PSMA PET/CT. Patients underwent PSMA PET/CT as well as portal venous phase abdominal SDCT for clinical cancer follow-up. Only scan pairs with a stable nodal status indicated by constant size as well as comparable prostate-specific antigen (PSA) levels were included. One hundred benign and 96 suspected metastatic lymph nodes were annotated and correlated between SDCT and PSMA PET/CT. Iodine concentration in SDCT-derived iodine maps and SUVmax in ultra-high definition reconstructions from PSMA PET/CT were acquired based on the region of interest. Metastatic lymph nodes as per PSMA PET/CT showed higher IC than nonmetastatic nodes (1.9 ± 0.6 mg/mL vs 1.5 ± 0.5 mg/mL, P < 0.05) resulting in an AUC of 0.72 and sensitivity/specificity of 81.3%/58.5%. The mean short axis diameter of metastatic lymph nodes was larger than that of nonmetastatic nodes (6.9 ± 3.6 mm vs 5.3 ± 1.3 mm; P < 0.05); a size threshold of 1 cm short axis diameter resulted in a sensitivity/specificity of 12.8%/99.0%. There was a significant yet weak positive correlation between SUVmax and IC (rs = 0.25; P < 0.001). Spectral detector CT-derived IC was increased in lymph nodes diagnosed as metastatic in PSMA PET/CT yet showed considerable data overlap. The correlation between IC and SUVmax was weak, highlighting the role of PSMA PET/CT as important reference imaging modality for detection of lymph node metastases in prostate cancer patients.

PD51-02 PLANNED SECONDARY ANALYSIS OF PURE-01

INTRODUCTION AND OBJECTIVE: FDG-PET/CT has limited utility in clinical N0 (cN0) patients (pts) with MIBC who receive neoadjuvant chemotherapy and RC or RC alone (Dason, AUA19). We present a secondary analysis aimed at evaluating the role of PET/CT in lymph node (LN) involvement assessment. METHODS: In PURE-01 (NCT02736266), 3 courses of 200 mg pembrolizumab, every 3 weeks, were administered prior to RC. Pts were assessed with thorax-abdomen CT scan and with PET/CT scan during screening and after treatment, before RC. Imaging review and analysis was performed by two experienced nuclear medicine physicians blinded to clinical information. Semiquantitative and volumetric analysis was performed. For each patient with LN increased uptake in abdomino-pelvic area, the SUVmax and the short-axis size of the most intense LN were recorded. All pts underwent templated pelvic LN dissection (LND) with packeted node submission. PET/TC diagnostic ability was assessed using sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy. RESULTS: From 02/17 to 06/2019, 114 pts were enrolled ad treated. 11 pts received additional chemotherapy post-pembrolizumab and were excluded from the analyses, resulting in 103 total evaluable pts (and 206 PET/TC scans). Six pts (5.8%) had positive nodes at baseline PET/CT: mean SUVmax=2.75; mean short axis: 6.2 mm. Eight pts (7.8%) had positive LN at PET/CT post-pembrolizumab: mean SUVmax=4.21; mean short axis: 7.2mm. The rate of pathologic LN positive (pN+) disease was 15.5% (16 pts). The performance of post-pembrolizumab PET/CT in predicting pN+ disease is indicated in the Table. 4/6 pts (66.7%) with baseline FDG uptake revealed as pN+ vs 12/97 (12.4%) with no baseline FDG uptakes (p=0.005). A total of 39 pts (37.9%) developed inflammatory FDG-uptakes post-pembrolizumab in several target organs/regions: top 5 sites were thyroid (N=21, 61.8%), stomach and mediastinum (13 pts each, 12.6%), lung (N=10, 9.7%), other lymph nodes (N=4, 3.9%). These changes were clinically evident (signs/symptoms or laboratory changes) in 15 pts (38.5%). CONCLUSIONS: Criteria for eligibility of cN0 pts to single-agent neoadjuvant pembrolizumab trials may be enhanced with PET/CT use. Three cycles of pembrolizumab determined profound inflammatory changes, whose long-term impact on safety is still to be determined.Source of Funding: None

Secondary analysis of PURE-01: Role of FDG-PET/CT in evaluating lymph node involvement of patients with muscle invasive bladder cancer (MIBC) receiving neoadjuvant pembrolizumab and radical cystectomy (RC).

445 Background: FDG-PET/CT has limited utility in clinical N0 (cN0) patients (pts) with MIBC who receive neoadjuvant chemotherapy and RC or RC alone (Dason, AUA19). Methods: In PURE-01 (NCT02736266), 3 courses of 200 mg pembrolizumab, q3 weeks, were administered prior to RC. Pts were assessed with thorax-abdomen CT scan and with PET/CT scan during screening and before RC. Imaging review and analysis was internally performed. For each pt with lymph node (LN) increased uptake in abdomino-pelvic area, the SUVmax and the short-axis size of the most intense LN were recorded. All pts underwent extended pelvic LN dissection (LND) with packeted node submission. Results: From 02/17 to 06/2019, 103 total evaluable pts (206 PET/TC scans) were enrolled ad treated. Six pts (5.8%) had LN uptake at baseline PET/CT: mean SUVmax=2.75; mean short axis: 6.2 mm. Eight pts (7.8%) had LN uptake at PET/CT post-pembrolizumab: mean SUVmax=4.21; mean short axis: 7.2mm. The rate of pathologic LN positive (pN+) disease was 15.5% (16 pts). The performance of post-pembrolizumab PET/CT in predicting pN+ disease is indicated in the Table. In total, 4/6 pts (66.7%) with baseline FDG uptake revealed as pN+ vs 12/97 (12.4%) with no baseline FDG uptakes (p=0.005). A total of 39 pts (37.9%) developed inflammatory FDG-uptakes post-pembrolizumab in several target organs/regions: top 5 sites were thyroid (N=21, 61.8%), stomach and mediastinum (13 pts each, 12.6%), lung (N=10, 9.7%), other lymph nodes (N=4, 3.9%). These changes were clinically evident (signs/symptoms or laboratory changes) in 15 pts (38.5%). Conclusions: Criteria for eligibility of cN0 pts to single-agent neoadjuvant pembrolizumab trials may be enhanced with PET/CT use. Three cycles of pembrolizumab determined profound inflammatory changes, whose long-term impact on safety is still to be determined. Clinical trial information: NCT02736266 . [Table: see text]

SAĞLIKLI ÇOCUKLARDA MEDİASTİNAL LENF GANGLİONLARI; YAŞA GÖRE SIKLIK, BOYUT ARALIĞI VE DAĞILIM

<div><!--block-->Objective: Decision making about clinically significant lymph nodes (LN) is crucial. We elaborated the mediastinal LNs based on location, size and age groups.&nbsp;<br><br>Material and Method: Contrast enhanced chest computed tomography scans of 150 children who were referred to the radiology department after trauma, were evaluated retrospectively. All participants were divided into five age groups (0-24, 25-60, 61120, 121-180 and 181-216 months) which included thirty children each. We documented the shortest and longest axis diameters of the largest LNs and their location along with the age and gender of the children. Kolmogorov-Smirnov test, t test, Spearman’s correlation analysis assessment and descriptive statistics were expressed using SPSS 22.&nbsp;<br><br>Results: Mean ages were 11.53±10.1, 39.4±11.1, 84±15.9, 154.9±17.6, 190±9.3 months in consecutive age groups and 96±69.17 months in general. The most frequent locations with detectable LNs were subcarinal (n:98, 64%), right lower paratracheal (n:88, 57%), right tracheobronchial (n:82, 56%), right upper paratracheal (n:75, 49%) and left tracheobronchial (n:61, %39) lymphatic stations. Mean short and long axis diameters were 3.97±1mm (interquartile range:3.4-5.2) and 7.48±1.98mm (interquartile range:6.3-9.1) among detected 648 LNs, respectively. Both short and long axis diameters of LNs in low cervical, prevascular, subcarinal, right-left paratracheal and right-left tracheobronchial locations were correlated with the age (p&lt;0.05). Both short and long axis diameters of subcarinal LNs (4.78±1.05mm, 9.30±1.8mm) were significantly larger than right lower paratracheal (4.03±0.9mm, 7.94±1.6mm; p:0.001), right tracheobronchial (4.42±1.26mm, 8.59±2.1mm; p:0.04) and right upper paratracheal LNs (3.64±0.79mm, 7.1±1.49mm).&nbsp;<br><br>Conclusion: Being aware of the size range for normal mediastinal LNs according to ages and locations would facilitate management and reduce unnecessary interventions and medications.</div>

Endobronchial ultrasound-guided transbronchial needle aspiration mediastinal lymph node staging in malignant pleural mesothelioma.

Given poor survival of patients with malignant pleural mesothelioma (MPM) and extrapleural nodal metastasis, pre-operative mediastinal lymph node (LN) staging has been advocated. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) may be a useful pre-operative adjunct in patients with MPM. This study aims to assess performance of EBUS-TBNA for mediastinal LN staging in MPM. A retrospective chart review of patients with diagnosis of MPM referred to the mesothelioma program at a tertiary Canadian cancer center between January 1, 2012 and December 31, 2014 who received mediastinal LN staging with EBUS-TBNA. Forty-eight patients were included. Average age was 70 years (range, 48-84 years). Mesothelioma subtypes were as follows: epithelioid 34/48 (70.8%), sarcomatoid 4/48 (8.3%), biphasic 7/48 (14.6%) and other 3/48 (6.3%). Stage distribution was as follows: I 18.8%, II 10.4%, III 47.9%, and IV 22.9%. On average 3.4 LNs were sampled per patient (range, 1-5). The mean short axis of a sampled LN was 6.8±3.8 mm. Rapid on Site Evaluation (ROSE) was available in 75.0% (36/48) of the assessments. Prevalence of N2/N3 disease was 35.4% (17/48). EBUS-TBNA sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were: 16.7%, 100%, 100%, 68.8%, and 70.6%, respectively. EBUS-TBNA mediastinal LN staging prevented unnecessary surgery in 18.8% (9/48 patients) by detection of N2/N3 disease (8 patients) and metastatic secondary malignancy (1 patient). There were no EBUS-TBNA related complications. EBUS-TBNA mediastinal LN staging may impact significantly management of patients with MPM by detecting mediastinal metastatic disease, therefore, preventing morbidity and mortality of surgical management.

First-in-human phase 1 PET study of CTT1057, a novel 18F-labeled imaging agent targeting prostate specific membrane antigen (PSMA) in prostate cancer.

e16562 Background: Urea-based 68Ga-PSMA PET is increasingly being utilized for diagnostic purposes in prostate cancer; however high tracer uptake within the salivary gland and kidney may be dose-limiting upon translation to radiotherapy. We developed a novel 18F labeled agent, CTT1057, a PSMA inhibitor based on a phosphoramidate scaffold with nanomolar and irreversible binding affinity to PSMA and robust internalization, and performed a first-in-human imaging study. Methods: Patients (pts) with metastatic castration resistant prostate cancer (mCRPC) were eligible. 10 mCi (370 MBq) of CTT1057 was injected and whole body PET/MR imaging (SIGNA PET/MR, GE) was performed 60 min post-injection. SUVmean in normal organs was recorded by drawing a 1 cm3 volume-of-interest. SUVmax was determined for each PSMA-avid metastasis. 10 randomly selected, consecutive 68Ga-PSMA PET scans from an independent cohort were used for descriptive comparison. Results: 5 pts with mCRPC were enrolled, with average age of 66 years (range 35–85) and median PSA of 12.2 (range 0.73 – 157.7). 55 PSMA-avid metastases were seen, including 37 osseous (average SUVmax = 8.1 ± 4.4), 15 lymph node (SUVmax = 11.0 ± 6.1), and 3 pulmonary (SUVmax = 3.2 ± 0.6). 31 (83%) and 12 (32%) of the PSMA-avid osseous lesions were visible on CT and bone scan, respectively. The mean short axis diameter of PSMA-avid lymph nodes was 0.7 ± 0.4 cm. Tumor-to-background ratios (liver, muscle, blood pool) were 2.8 ± 2.3, 14.9 ± 11.6, and 3.2 ± 2.4, respectively. SUVmean in salivary gland and kidney were 3.6 ± 0.4 and 9.1 ± 0.8 for CTT1057 and 15.8 ± 2.7 and 35.9 ± 9.6 for 68Ga-PSMA, respectively. No tracer-related adverse events were observed and radiation dose estimates for organs and whole-body effective dose were within acceptable limits. Conclusions: 18F-labeled CTT1057 targeting PSMA, detected mCRPC lesions in the soft tissue and bone at greater sensitivity than conventional imaging. CTT1057 distribution of uptake was similar to urea-based PSMA imaging, with preliminary evidence of lower uptake in the salivary gland and kidney. Further clinical studies of the CTT1057 backbone as a diagnostic and therapeutic agent in mCRPC are warranted. Clinical trial information: NCT02916537.

Computed Tomographic Evaluation of Presumptively Normal Canine Sternal Lymph Nodes.

The sternal lymph nodes receive drainage from a wide variety of structures in the thoraco-abdominal region. Evaluation of these lymph nodes is essential, especially in cancer patients. Computed tomography (CT) can detect sternal lymph nodes more accurately than radiography or ultrasonography, and the criteria of the sternal lymphadenopathy are unknown. The purpose of this retrospective study was to describe the CT characteristics of the sternal lymph nodes in dogs considered unlikely to have lymphadenopathy. The ratio of the short axis dimension of the sternal lymph nodes to the thickness of the second sternebra was also investigated. At least one sternal lymph node was identified in each of the 152 dogs included in the study. The mean long axis and short axis dimensions were 0.700 cm and 0.368 cm, respectively. The mean ratio of the sternal lymph nodes to the second sternebrae was 0.457, and the 95% prediction interval ranged from 0.317 to 0.596 (almost a fixed value independent of body weight). These findings will be useful when evaluating sternal lymphadenopathy using CT.

Endobronchial ultrasound-guided transbronchial needle aspiration in the staging of lung cancer patients.

Objective:Mediastinoscopy as diagnostic procedure for evaluation of mediastinum in patients with non-small-cell lung cancer has long been considered the reference standard. However, less invasive method has occurred. Endobronchial ultrasound–guided transbronchial needle aspiration came into widespread use and has resulted in controversy as to whether it is a good replacement for mediastinoscopy. We chose to demonstrate the usefulness of endobronchial ultrasound–guided transbronchial needle aspiration in evaluating the mediastinum in patients with non-small-cell lung cancer.Material and methods:Over a 48-month period, 1841 patients underwent endobronchial ultrasound–guided transbronchial needle aspiration at our healthcare centre. In all patients, 2964 biopsies from the lymph node group N2 and 783 from group N1 were taken. The mean short axis of the lymph nodes biopsied was 2.0 (range: 0.6–2.6). The mean number of lymph node stations biopsied per patient was 2.6. Patients with a negative result of endobronchial ultrasound–guided transbronchial needle aspiration underwent mediastinoscopy. All patients with a negative result in endobronchial ultrasound–guided transbronchial needle aspiration and mediastinoscopy underwent surgical resection with lymph node sampling.Results:The metastases to lymph nodes N2/N3 and N1 were found in 1111 (60.3%) and 199 (9.3%), respectively. Mediastinoscopy was performed in 730 patients with a positive result in 83 (11.4%) patients. In the group of operated patients, metastatic N1 disease was found in 264 (14.1%). In the group of the operated patients, mediastinal involvement of disease (N2) was found in 30 patients (4.5%). The sensitivity, negative predictive value and diagnostic accuracy for hilar lymph node staging for endobronchial ultrasound–guided transbronchial needle aspiration were 57%, 96% and 96%, respectively. The sensitivity, negative predictive value and diagnostic accuracy per patient for mediastinal lymph node staging for endobronchial ultrasound–guided transbronchial needle aspiration and mediastinoscopy were 91%, 85%, 93% and 73%, 95.5%, 97%, respectively. The specificity and positive predictive value of both tests were 100%.Conclusion:The clinical usefulness of endobronchial ultrasound–guided transbronchial needle aspiration is undeniable according to diagnostic performance data. Endobronchial ultrasound–guided transbronchial needle aspiration should be considered complementary to mediastinoscopy in the evaluation of patients with radiographically abnormal mediastinum.

Diagnostic application of computerised nuclear morphometric image analysis in fine needle aspirates of breast lesions

Background: Alterations in nuclear structure are the indications of cancer diagnosis. This study has thus focused on variation in nuclear morphometry in breast lesions. Aim: The aim of the study is to compare morphometric characteristics of different types of breast lesions and evaluate its utility in differentiating benign against malignant. Study Design: Sixty fine needle aspiration cytology (FNAC) of ethanol fixed samples were obtained and stained with Papanicolou stain. All diagnoses reported were confirmed histopathologically. Nuclear morphometric parameters for free cells in smears were calculated using the ImageJ 1.47 morphometric computer software. Result: The nuclear morphometric parameters including mean nuclear area, perimeter, diameter, long axis, and short axis were found to be statistically significant (ANOVA, P < 0.0001) in differentiating benign and malignant breast aspirates. Conclusion: Nuclear morphometry has been found to be a valuable objective method in differentiating benign and malignant breast lesions, especially in the grey zones, when diagnostic dilemmas are encountered. This study results demonstrate that the size-related parameters (area, perimeter, diameter, long, and short axes) of the nucleus are the most appropriate nuclear morphometric parameters for differentiating between benign lesions and infiltrative ductal carcinoma of the breast.

Evaluation of dual energy spectral CT in differentiating metastatic from non-metastatic lymph nodes in rectal cancer: Initial experience

ObjectivesTo investigate the value of dual energy spectral CT (DEsCT) imaging in differentiating metastatic from non-metastatic lymph nodes in rectal cancer. MethodsFifty-five patients with rectal cancer underwent the arterial phase (AP) and portal venous phase (PP) contrast-enhanced DEsCT imaging. The virtual monochromatic images and iodine-based material decomposition images derived from DEsCT imaging were interpreted for lymph nodes (LNs) measurement. The short axis diameter and the normalized iodine concentration (nIC) of metastatic and non-metastatic LNs were measured. The two-sample t test was used to compare the short axis diameters and nIC values of metastatic and non-metastatic LNs. ROC analysis was performed to assess the diagnostic performance. ResultsOne hundred and fifty two LNs including 92 non-metastatic LNs and 60 metastatic LNs were matched using the radiological-pathological correlation. The mean short axis diameter of metastatic LNs was significantly larger than that of the non-metastatic LNs (7.28±2.28mm vs. 4.90±1.64mm, P<0.001). The mean nIC value for metastatic LNs was significantly lower than that of non-metastatic LNs (0.24±0.08 vs. 0.34±0.21, P=0.001 in AP; 0.47±0.18 vs. 0.64±0.17, P<0.001 in PP). Combining nIC (PP) with the short axis diameter, the overall accuracy could be improved to 82.9%. ConclusionsWith the combination of nIC value in PP and conventional size criterion, dual energy spectral imaging may be used to differentiate metastatic from non-metastatic lymph nodes in rectal cancer.

Chest CT findings in EBUS-TBNA-proven anthracosis in enlarged mediastinal lymph nodes.

We demonstrate the multislice computed tomography (MSCT) findings of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)-proven hilar and mediastinal lymph node enlargement with signs of anthracosis. 53 enlarged lymph nodes in 39 patients (28 male, 11 female) with EBUS-TBNA-confirmed anthracosis were analyzed retrospectively. The mean short axis diameter of the enlarged lymph nodes with signs of anthracosis was 13.7 mm. Lymph nodes most often showed an oval shape (84 %) and were well defined in 66 % of cases. Lymph node confluence was observed in 32 % of cases. Calcifications were documented in 24.5 % of cases. Contrast enhancement and fatty involution were seen seldom (3.8 %). Lymph node necrosis was not seen. Lymph node anthracosis may be found most often in enlarged, well defined lymph nodes with an oval shape, frequently associated with confluence and calcifications.

Diagnostic accuracy of high resolution MR imaging in local staging of bladder tumors.

To determine the diagnostic accuracy of high-resolution MR imaging done at 1.5T in distinguishing bladder-restricted tumor from non-bladder-restricted tumor and compare the mean short axis dimension of metastatic pelvic lymph nodes with benign pelvic lymph nodes. Analytical study. Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan, from March 2008 to July 2011. Patients with bladder cancer were enrolled. Based on pathologic T-staging following radical cystectomy, patients were assigned to one of two groups. Patients with stage T1 and T2 disease were assigned to the bladder-restricted tumor (BRT) group and those with stage T3 and T4 disease to the non-bladder-restricted tumor (NBRT). High-resolution unenhanced MR imaging done prior to cystectomy was reviewed retrospectively (1.5 T MRI unit; GE Healthcare). Results from MR imaging-based categorization were compared with pathology reports to fulfill the objective. Mean short-axis diameter of largest visible lymph nodes in patients with nodal metastasis was compared with mean short-axis diameter of largest visible lymph nodes in patients with benign lymph nodes. The accuracy of MRI in differentiating distinguishing bladder-restricted tumor from non-bladder-restricted tumor was 67.72%. The mean short axis diameter of metastatic lymph nodes was greater than that of non-metastatic lymph nodes, i.e., 7.4 mm and 5.4 mm respectively. Conventional high resolution 1.5T MRI does not appear to offer advantage over imaging done at low field strength scanners.

Mediastinal lymph node staging by EBUS-TBNA and CT: Characteristics of lymph node enlargement caused by anthracosis and other benign conditions

Objectives: Aim of this comparative study was to assess the accuracy of computed tomography (CT) and endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) for mediastinal lymph node staging in cases of lymph node enlargement due to anthracosis and other benign conditions. Methods: In a retrospective analysis we report on the MSCT findings of 39 patients (28 males, 11 females) with EBUS-TBNA confirmed diagnosis of 53 enlarged lymph nodes due to anthracosis. A control group comprised 20 consecutive patients with 27 enlarged lymph nodes (11 males, 9 females) due to chronic lymphadenopathy (n = 14) or sarcoidosis (n = 13). Results: No significant differences were observed between the two groups regarding size (mean short axis diameter 13.7mm vs. 14.5mm), shape (most often oval) or presence of lymph node confluence (32.1% vs. 33.3%), contrast enhancement (3.8% vs. 3.7%), and fatty involution (3.8% vs. 3.7%). In comparison with the control group anthracotic lymph nodes were significantly less often ill-defined in EBUS (5.7 vs. 25.9, p = 0.025) as well as in CT (1.9% vs. 18.5%, p = 0.01), but more often showed calcifications in CT (24.5% vs. 3.7%, p = 0.017). Lymph node colliquation was seen neither in anthracosis nor in other benign conditions. Conclusions: Mediastinal lymph node enlargement due to anthracosis, lymphadenopathy and sarcoidosis show some different findings in EBUS and CT but cannot definitely be differentiated. Advances in knowledge: Radiologists should be aware of mediastinal lymph node enlargement due to anthracosis.

Inguinal lymph nodes: size, number, and other characteristics in asymptomatic patients by CT

The purpose of this study was to establish normative data for the CT appearance of inguinal lymph nodes. After Institutional Review Board approval, search of the radiology information system identified 500 consecutive CT examinations of the pelvis. Patients were included if no lower extremity or perineum pathology, or history of malignancy at the time of CT examination, and a clinical note documenting no tumor at least 2 years after the CT. The final study group was 77 patients. CT examinations were retrospectively reviewed and bilateral inguinal lymph nodes were characterized by size (short axis and largest size in general), number, and presence of fat attenuation. The mean short-axis inguinal lymph node size was 5.4 mm (range 2.1-13.6 mm), measured at 8.8 mm two standard deviations above the mean. The mean number of superficial and deep inguinal lymph nodes was 10.7 (range 3-18) and 1.2 per patient (range 1-2), respectively. Superficial and deep inguinal nodes showed internal fat attenuation in 85 and 78% of nodes, and were oval in shape in 95 and 78%, respectively. Inguinal lymph nodes in asymptomatic patients have a mean short axis of 5.4 mm, a short axis of 8.8 mm at two standard deviations above the mean, and are multiple and symmetric in size and number (4-20 per patient). Normal inguinal lymph nodes were commonly oval in shape and contained fat, although such findings may be absent in smaller lymph nodes.

Diagnostic value of endobronchial ultrasound guided transbronchial needle aspiration in superior vena cava syndrome

Background The pathological diagnosis is of critical importance to the subsequent treatment for the pathients with superior vena cava syndrome (SVCS). The aim of this study is to report our experience in the diagnosis of SVCS by endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA). Methods The data of 520 patients who underwent EBUS-TBNA from September 2009 to May 2012 at our institution were reviewed. Of these, there were 14 males and 6 females (mean age of 59.1 years) with SVCS who received EBUS-TBNA that were included in the analysis. Results The mean short axis diameter of the paratracheal lesions was (3.32±1.79) cm (range, 1.69 to 9.50 cm) and 6 cases also had subcarinal lymph node enlargement with a mean short axis diameter of (2.14±0.49) cm (range, 1.73 to 3.01 cm). An average of 4.3 punctures was performed per lesion. Malignancy was confirmed in 16 cases (10 small cell carcinomas, 4 adenocarcinomas, 1 squamous cell carcinoma and 1 Hodgkin lymphoma). In two patients, pathological examination of tissue revealed no evidence of malignancy and for 13 to 24 months of follow-up. One patient from whom adequate tissue was not obtained refused further surgical biopsy since he had undergone endovascular stenting of the SVC. One patient in whom a diagnosis was not obtained by EBUS-TBNA underwent thoracoscopic biopsy and the final diagnosis was B cell non-Hodgkin's lymphoma. The diagnosis accuracy of EBUS-TBNA in SVCS was 18/20 patients. Conclusion EBUS-TBNA is a highly effective and safe procedure for the diagnosis of SVCS.

ADC maps in the prediction of pelvic lymph nodal metastatic regions in endometrial cancer

To evaluate the usefulness of apparent diffusion coefficient (ADC) in discriminating metastatic from non-metastatic pelvic lymph nodal sites in endometrial cancer. This retrospective study included 40 patients with endometrial cancer who underwent MRI [T2-weighted, dynamic T1-weighted images and diffusion-weighted images with body background suppression (DWIBS), b-values 0 and 1,000 s/mm(2)], total hysterectomy and pelvic lymphadenectomy. Lymph nodes identifiable on DWIBS were evaluated, classified into six nodal regions, and for each node ADC values, short- and long-axis diameters were measured by two readers. Histopathological findings and follow-up information served as the reference standard. Average (± standard deviation) mean and minimum ADC region value (0.87 ± 0.15 and 0.74 ± 0.07 × 10(-3) mm(2)/s) of metastatic sites (n = 7) were significantly lower than those of non-metastatic ones (n = 89; 1.07 ± 0.20 and 1.02 ± 0.20; p-value = 0.010 and 0.0004). Mean short-axis and short-to-long axis ratios of metastatic nodes were 7.47 mm and 0.68. Using the minimum ADC region value with threshold 0.807 × 10(-3) mm(2)/s, sensitivity, specificity, positive and negative predictive value and accuracy were 100 %, 98.3 %, 63.6 %, 100 % and 98.3 %, respectively (reader 1). In endometrial cancer, mean and minimum ADC region values of metastatic nodal sites are significantly lower than those found at normal sites.