Mediastinal Lymph Node Metastasis Research Articles

Systemic Immune Inflammation Index, Lowest Total Lymphocyte Count and Hemoglobin Level Are Prognostic Factors in Patients with Postoperative Recurrence of Esophageal Carcinoma Treated with Salvage Radiotherapy and Chemotherapy

To analyze the effects of clinical features, chemoradiotherapy related factors, hematological different nutritional indexes, and inflammatory indexes on the survival of postoperative recurrence of esophageal carcinoma treated with salvage chemoradiotherapy, and to explore the predictive factors of treatment-related toxic and side effects. A total of 242 postoperative esophageal carcinoma patients with local/regional recurrence during January 2008 to December 2016 treated with chemoradiotherapy were analyzed. Recurrence included anastomotic recurrence and regional lymph node metastasis (supraclavicular, mediastinal, and abdominal lymph node metastasis involved). The clinical features (sex, age, tumor location, T stage, N stage, TNM stage, regional recurrence site, number of recurrence areas, postoperative recurrence time), chemoradiotherapy related factors (post-recurrence treatment, radiotherapy target area, radiotherapy dose, chemotherapy regimen, chemotherapy cycle), hematological inflammation related indicators, including the absolute monocyte count (AMC), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), lymphocyte monocyte ratio (LMR), systemic immune-inflammation index (SII), systemic inflammation score (SIS), and hematological nutrition-related indicators, including total lymphocyte count (TLC), hemoglobin (HB), albumin (ALB), prognostic nutritional index (PNI)，body mass index (BMI) on survival, toxic and side effects were analyzed. The median survival time was 16.6 months, and the 1-, 2-, 3-and 5-year survival rates were 65.6%, 36.7%, 25.5% and 11.5%, respectively. Univariate analysis showed that T stage, N stage, TNM stage, chemotherapy cycle, NLR level, PLR level, LMR level, SII level, HB level, PNI level before chemoradiotherapy, and the minimum level of TLC during chemoradiotherapy were the influencing factors of OS. Multivariate analysis showed that the minimum level of TLC during chemoradiotherapy, SII and HB level before chemoradiotherapy were independent influencing factors of OS (P=0.001; P=0.009; P=0.009, respectively). AMC level, HB level and TLC minimum level were the main factors affecting hematological toxicity. The incidence of grade 2 hematological toxicity in the high AMC group was similar to that in the low AMC group, and the incidence of the non-anemia group and the G0-2 group in the lowest TLC was even lower than that in the corresponding group. No factors affecting hematological toxicity and radiation pneumonia were found in hematology. The minimum level of TLC during chemoradiotherapy, the level of SII and HB before chemoradiotherapy were the independent prognostic factors for postoperative esophageal carcinoma patients treated with salvage chemoradiotherapy.

Carbon-ion Radiotherapy for Isolated Lymph Node Metastasis After Surgery or Radiotherapy for Lung Cancer.

Purpose: Mediastinal and hilar lymph node metastasis is one of the recurrence patterns after definitive treatment of lung cancer. Salvage radiotherapy (RT) can be a treatment option for lymph node metastasis. However, the usefulness of additional RT remains unclear after surgery or RT for the primary lung tumor. We retrospectively evaluated the efficacy and safety of hypofractionated carbon-ion RT for isolated lymph node metastasis.Methods and Materials: Between April 2013 and August 2016, 15 consecutive patients with isolated lymph node metastasis underwent carbon-ion RT. The pretreatment evaluations confirmed the isolated lymph node metastasis and the absence of local recurrence or distant metastasis, which was oligometastatic disease. The median age was 72 (range, 51–83) years, with 11 male patients. The first treatments for primary lung tumors were carbon-ion RT for 8 patients and surgery for 7 patients. There were 9 adenocarcinomas, 4 squamous cell carcinomas, 1 adenosquamous cell carcinoma, and 1 mucoepidermoid carcinoma. Most patients (93%) were irradiated with 52.8 Gy relative biological effectiveness in 12 fractions for 3 weeks. There were no patients treated with concurrent or adjuvant therapy such as chemotherapy, molecular-targeted therapy, or immunotherapy. Adverse events were evaluated according to the Common Terminology Criteria for Adverse Events (version 4.0).Results: The median follow-up for surviving patients was 28 months. One patient experienced local lymph node recurrence, and the 2-year local control rate was 92% for all patients. Distant metastasis was observed in 7 patients, and 2-year progression-free survival rate was 47%. During follow-up, there were 4 deaths from lung cancer, and the 2-year overall survival rate was 75%. There were 2 patients with acute grade 2 esophagitis and 2 with late grade 2 cough, which were improved by conservative therapy. There were no other grade 2 or higher adverse events.Conclusions: Hypofractionated carbon-ion RT showed excellent local control and overall survival without severe toxicities in lung cancer patients with isolated lymph node metastasis after surgery or carbon-ion RT for primary lung tumors. A multi-institutional prospective study is required to establish the efficacy and safety of carbon-ion RT.

Identification of differentially expressed genes between primary lung cancer and lymph node metastasis via bioinformatic analysis

Lung cancer (LC), with its high morbidity and mortality rates, is one of the most widespread and malignant neoplasms. Mediastinal lymph node metastasis (MLNM) severely affects postoperative survival of patients with LC. Additionally, the molecular mechanisms of LC with MLNM (MM LC) remain not well understood. To identify the key biomarkers in its carcinogenesis and development, the datasets GSE23822 and GSE13213 were obtained from the Gene Expression Omnibus database. The differentially expressed genes (DEGs) were identified, and the Database for Annotation, Visualization and Integrated Discovery was used to perform functional annotations of DEGs. Search Tool for the Retrieval of Interacting Genes and Cytoscape were utilized to obtain the protein-protein interaction (PPI) network, and to analyze the most significant module. Subsequently, a Kaplan-Meier plotter was used to analyze overall survival (OS). Additionally, one co-expression network of the hub genes was obtained from cBioPortal. A total of 308 DEGs were identified in the two microarray datasets, which were mainly enriched during cellular processes, including the Gene Ontology terms ‘cell’, ‘catalytic activity’, ‘molecular function regulator’, ‘signal transducer activity’ and ‘binding’. The PPI network was composed of 315 edges and 167 nodes. Its significant module had 11 hub genes, and high expression of actin β, MYC, arginine vasopressin, vesicle associated membrane protein 2 and integrin subunit β1, and low expression of NOTCH1, synaptojanin 2 and intersectin 2 were significantly associated with poor OS. In summary, hub genes and DEGs presented in the present study may help identify underlying targets for diagnostic and therapeutic methods for MM LC.

The Pilot Study of Spectral CT for the Diagnosis of Mediastinal Lymph Node Metastasis in Primary Lung Cancer

Objective: To investigate the application value of spectral CT for the diagnosis of mediastinal lymph node metastasis in primary lung cancer. Materials and Methods: 32 patients who had primary lung cancer with 90 enlarged mediastinal lymph nodes underwent spectral CT by using gemstone spectral imaging (GSI) mode. The spectral curves of regions of interest (ROI) in primary lung cancer and mediastinal lymph nodes were measured with GSI post-processing software. The spectral curve slope between 40 and 140 keV was calculated and compared between them for the diagnosis of mediastinal lymph node metastasis. The data were divided into metastatic group (group A) and non-metastatic group (group B) according to the pathologic findings. SPSS17.0 software with paired sample t test was used for statistical analysis and P < 0.05 was considered statistically significant difference. Results: The spectral curve slopes in primary lung cancer and mediastinal lymph node in group B were 0.96 ± 0.13 and 1.32 ± 0.17. There was significant difference between them (t = –2.68, P < 0.05). While there was no significant difference between them in group A (t = –1.62, P > 0.05) with the values of 1.06 ± 0.09 and 1.09 ± 0.12. The accuracy, sensitivity and specificity of diagnosing mediastinal lymph node metastasis were 84.21%, 86.67% and 82.77%, respectively in line with spectral curve. Conclusions: Spectral CT, as a new and non-invasive method, has valuable effect for the diagnosis of mediastinal lymph node metastasis in pre-operative staging of lung cancer.

Clinicopathologic features and lymph node metastatic characteristics in patients with adenocarcinoma manifesting as part-solid nodule exceeding 3 cm in diameter

PurposeThe purpose of this study was to elucidate the clinicopathologic and lymph node metastatic characteristics in patients with adenocarcinoma manifested as persistent ground glass mass (GGM, ground glass opacity [GGO] exceeding 3 cm in diameter). Materials and Methods304 patients with adenocarcinoma manifested as persistent GGM > 3 cm, who underwent complete surgical resection between November 2013 and December 2017 were included in this study. We elucidated the lymph node metastatic incidence and characteristics according to the primary tumor lobe location and extracted the associated clinicopathological factors, especially thin-section computed tomographic findings, with lymph node involvement. ResultsAll of the GGMs were invasive adenocarcinoma in histopathology. The total incidence of lymph node metastasis was 2.0% (6/304). All of the 6 cases with hilar or mediastinal lymph node metastasis were manifested as solid-predominant GGM > 3 cm and no cases with lymph node metastasis were identified in GGO-predominant GGM > 3 cm. Lymph node metastases were more likely to present in younger patients (p = 0.032), tumors with solid size >2.0 cm (p = 0.000), more advanced clinical T stage (p = 0.000), radiological solid-predominant tumors (p = 0.002) and acinar-predominant or papillary-predominant adenocarcinoma (p = 0.002). As for solid-predominant GGMs >3 cm, lymph node metastases were more likely to be found in tumors with solid size >2.0 cm (p = 0.026), more advanced clinical T stage(p = 0.026), acinar-predominant or papillary-predominant adenocarcinoma (p = 0.029). Whole tumor size was not associated with the presence of lymph node metastases. There were 2 right upper-lobe cases with upper mediastinal lymph nodes skip metastasis without intrapulmonary, interlobar, and hilar lymph node metastasis. ConclusionAll of the GGMs >3 cm were invasive adenocarcinoma. The incidence of lymph node metastasis in GGO-predominant GGMs >3 cm was extremely low. Solid size would be a better predictor of lymph node metastasis than whole tumor size in sold-predominant GGMs >3 cm.

The optimal extent of lymph node dissection in gastroesophageal junctional cancer: retrospective case control study

BackgroundRecently, the incidence of gastroesophageal junction (GEJ) cancer has been increasing in Eastern countries. Mediastinal lymph node (MLN) metastasis rates among patients with GEJ cancer are reported to be 5–25%. However, survival benefits associated with MLN dissection in GEJ cancer has been a controversial issue, especially in Eastern countries, due to its rarity and potential morbidity.MethodsWe retrospectively reviewed 290 patients who underwent surgery for GEJ cancer at the National Cancer Center in Korea from June 2001 to December 2015. Clinicopathologic characteristics and surgical outcomes were compared between patients without MLN dissection (Group A) and patients with MLN dissection (Group B). Prognostic factors associated with the survival rate were identified in a multivariate analysis.ResultsTwenty-nine (10%) patients underwent MLN dissection (Group B). Three of 29 patients (10.3%) showed a metastatic MLN in Group B. The 5-year disease-free survival rate was 79.5% in Group A and 33.9% in Group B (P < 0.001). The multivariate analysis revealed that abdominal LN dissection, pT category, and pN category were statistically significant prognostic factors. LNs were the most common site for recurrence in both groups.ConclusionAbdominal LN dissection and pathologic stage are the important prognostic factors for type II and III GEJ cancer rather than mediastinal lymph node dissection.

PD-1 and PD-L1 expression in pulmonary carcinoid tumors and their association to tumor spread.

Pulmonary carcinoid (PC) tumors are rare tumors that account for approximately 1% of all lung cancers. The primary treatment option is surgery, while there is no standard treatment for metastatic disease. As the number of PCs diagnosed yearly is increasing, there is a need to establish novel therapeutic options. This study aimed to investigate programmed death protein 1 (PD-1) and programmed death ligand 1 (PD-L1) expression in PC tumors since blocking of the PD-1/PD-L1 pathway is a promising therapeutic option in various other malignancies. A total of 168 PC patients treated between 1990 and 2013 were collected from the Finnish biobanks. After re-evaluation of the tumors, 131 (78%) were classified as typical carcinoid (TC) and 37 (22%) as atypical carcinoid (AC) tumors. Primary tumor samples were immunohistochemically labeled for PD-1, PD-L1 and CD8. High PD-1 expression was detected in 16% of the tumors. PD-L1 expression was detected in 7% of TC tumors; all AC tumors were PD-L1 negative. PD-L1 expression was associated with mediastinal lymph-node metastasis at the time of diagnosis (P = 0.021) as well as overall metastatic potential of the tumor (P = 0.010). Neither PD-1 expression, PD-L1 expression nor CD8+ T cell density was associated with survival. In conclusion, PD-1 and PD-L1 were expressed in a small proportion of PC tumors and PD-L1 expression was associated with metastatic disease. Targeting of the PD-1/PD-L1 pathway with immune checkpoint inhibitors may thus offer a treatment option for a subset of PC patients.

Association between BMP4 expression and pathology, CT characteristics and prognosis of non-small cell lung cancer.

To investigate the association between bone morphogenetic protein 4 (BMP4) expression and clinical pathology, computed tomography (CT) characteristics and prognosis of patients with non-small cell lung cancer (NSCLC). A total of 76 NSCLC patients treated in our hospital from July 2012 to March 2015 were enrolled. The paired NSCLC and para-carcinoma tissues, as well as their CT image data were collected. The messenger ribonucleic acid (mRNA) and protein levels of BMP4 in NSCLC were detected via quantitative polymerase chain reaction (qPCR) and immunohistochemistry (IHC). The association between BMP4 level and clinicopathological indexes of NSCLC patients was analyzed. Moreover, Kaplan-Meier method was introduced for analyzing the progression-free survival (PFS) and overall survival (OS) in NSCLC patients with high-level or low-level BMP4. The correlation between CT manifestations and BMP4 level in NSCLC patients was analyzed using the Chi-square test. The mRNA level of BMP4 in NSCLC tissues was 2.15 times higher than that in para-carcinoma tissues (p<0.05). IHC results revealed 59.21% (45/76) of BMP4-positive NSCLC tissues and 40.79% (31/76) in para-carcinoma tissues. BMP4 level was higher in NSCLC patients with lymph node metastasis and those in clinical stage III and IV than those without lymph node metastasis and in clinical stage I and II (p<0.05). Besides, BMP4 level was not correlated to the gender, age and differentiation degree of NSCLC patients (p>0.05). According to the Kaplan-Meier survival curve, both PFS and OS were significantly shortened in NSCLC patients with high level of BMP4 compared with patients with low level of BMP4 (PFS: 13.28 months vs. 19.34 months, Log-rank test, p=0.016; OS: 15.14 months vs. 22.08 months, Log-rank test, p=0.027). BMP4 level was associated with lobulation sign, spinous process sign, tumor diameter and mediastinal lymph node metastasis in CT findings (p<0.05), rather than spiculation sign, ground glass sign, calcification lesion and CT enhancement value of lung cancer (p>0.05). BMP4 overexpression is closely associated with the occurrence and development of NSCLC and CT signs. Detection of BMP4 is helpful for evaluating the malignant degree and prognosis of NSCLC.

Role of low dose 256-slice CT perfusion imaging in predicting mediastinal lymph node metastasis of lung cancer.

CT perfusion (CTP) is an imaging technique that can be used to evaluate the changes in the microcirculation of tumor tissues. Our study aimed to investigate the role of CTP in predicting mediastinal lymph node metastasis. Clinical data of 58 patients who received surgical resection of lung cancer and lymph node dissection in our hospital from June 2012 to December 2014 were collected. Patients were divided into a positive lymph node metastasis group and a negative lymph node metastasis group. Parameters of CTP, including peak enhancement intensity (PEI), perfusion value (PV), as well as blood volume (BV), were compared between the two groups. The receiver-operating characteristic (ROC) curve was used to predict mediastinal lymph node metastasis. The PV of the positive lymph node metastasis group was significantly higher than that of the negative group (p < 0.001). The ROC curve analysis showed that PV can be used as an index to predict mediastinal lymph node metastasis of lung cancer. The sensitivity and specificity of a PV greater than 7.5ml·min-1·ml-1 in predicting lymph node metastasis of lung cancer were 78.3 % and 91.4 %, respectively. The PV of low dose CT perfusion can be used as an index for predicting mediastinal lymph node metastasis of lung cancer.

Response assessment in non-small cell lung cancer immunotherapy: initial experiences in utilizing FDG PET/CT and the PD-1 blocker nivolumab

Most Non-Small-Cell lung cancer (NSCLC) patients need systemic treatment. Immunotherapy is now current standard in first- and second-line treatment. In all pivotal studies, staging was performed using conventional computer tomography (CT) scans. PET/CT-based treatment monitoring is on the contrary recommended in NSCLC guidelines. This investigation aims at describing the benefits, challenges and possible pitfalls of using PET/CT-based monitoring for lung cancer during immunotherapy. We analyzed 11 NSCLC patients treated with nivolumab at a German tertiary care lung cancer center between 2015 and 2016. All patients received at least two follow-up PET-CTs. Evaluation of response was based on both Response Evaluation Criteria in Solid Tumors (RECIST) and PET Response Criteria in Solid Tumors (PERCIST) criteria. In 7 out of 11 cases, the RECIST and PERCIST results concurred, but two patients with initial stable disease regarding RECIST were reclassified as progressive metabolic disease based on PERCIST criteria. Additionally we identified one case of pseudoprogression using PERCIST criteria in contrast to stable disease using RECIST criteria and one case showing an early and durable response to nivolumab treatment using RECIST, despite a highly hypermetabolic mediastinal lymph node metastasis. The findings indicate that the PERCIST-based evaluation could identify progressive disease earlier. Early identification of nonresponders could lead to prevention of overtreatment and to an early switch to a more effective therapy.

Occult mediastinal lymph node metastasis in FDG-PET/CT node-negative lung adenocarcinoma patients: Risk factors and histopathological study.

BackgroundThe aim of this study was to investigate predictive factors of occult mediastinal lymph node metastasis (MLNM) in preoperative 18F‐fluorodeoxy‐glucose PET/CT node‐negative lung adenocarcinoma patients.MethodsWe reviewed the clinical data and PET/CT parameters of 360 consecutive pulmonary adenocarcinoma patients who were scheduled to undergo anatomical pulmonary resection and systemic mediastinal node dissection. The nodal metastasis was pathologically defined and all resected tumors were classified according to the 2011 IASLC/ATS/ERS classification. Univariate and multivariate analysis were conducted to evaluate the associations between clinicopathological variables and MLNM.ResultsOf all 360 patients, 54 (15.0%) had pathological N2 diseases. The serum CEA level, nodule type, hilar nodal SUVmax, tumor SUVmax, size, location and histologic subtype were associated with MLNM significantly on univariate analysis. On multivariate analysis, CEA ≥ 5.0 ng/mL (P < 0.001), solid nodule (P = 0.012), tumor SUVmax ≥ 3.7 (P < 0.027), hilar nodal SUVmax ≥ 2.0 (P < 0.001) and centrally located tumor (P = 0.035) were independent risk factors for MLNM. The area under the ROC curve (AUC) for tumor SUVmax and hilar nodal SUVmax in predicting MLNM was 0.764 and 0.730, respectively, and the combined use of five factors yielded a higher AUC of 0.885.ConclusionIncreased primary tumor and hilar lymph node SUVmax, solid nodule, centrally located tumor and increased CEA level predicted the increased risk of mediastinal lymph node metastasis. Combined use of these factors improved the diagnostic capacity for predicting N2 disease preoperatively. Invasive mediastinal staging should be considered for patients with these risk factors, even those with a negative mediastinum on PET/CT.

Superior Vena Cava Syndrome: An Uncommon Presentation of a Rare Colon Carcinoma Metastasis.

IntroductionSuperior vena cava (SVC) syndrome is caused by obstruction of the superior vena cava due to vascular compression by a mass or intrinsic obstruction. The authors describe SVC syndrome caused by an isolated metastatic mediastinal mass from a resected primary colon carcinoma.Case ReportAn 81-year-old woman was referred to the hospital with swelling of the neck and upper left limb, dysphonia and dysphagia, associated with an involuntary weight loss of 16 kg. Mediastinal metastasis of colon adenocarcinoma was found, causing the SVC syndrome. The mass was unresectable and the patient was referred to palliative radiotherapy.DiscussionOnly 12 cases of mediastinal metastasis from colorectal cancer have been reported in the English literature.ConclusionAs a rare manifestation of colorectal cancer, the presented case highlights the need for clinicians to be aware of rare metastases at the time of diagnosis.LEARNING POINTSSuperior vena cava (SVC) syndrome can result from vascular compression by a mass.Although mediastinal lymph node metastasis is rare in colorectal cancer, physicians should be aware of less common locations.Patients should have a close follow-up in order to avoid the growth of unresectable metastases, since surgery, when possible, can lead to a better prognosis.

Mediastinal Nodal Involvement After Neoadjuvant Chemoradiation for Siewert II/III Adenocarcinoma

Adenocarcinoma of the gastroesophageal junction (AEG) poses a management challenge, as preoperative prediction of occult mediastinal nodal metastasis is difficult. We sought to identify factors predictive of mediastinal involvement among patients undergoing trimodality therapy. Patients undergoing trimodality therapy for Siewert II and III AEG at a single institution between 2000 and 2015 were identified. Mediastinal involvement was defined as pathologic nodal involvement after neoadjuvant chemoradiation (ypN+) in mediastinal stations or mediastinal recurrence 2 years or less after resection. Maximal χ2 analysis and Youden's J index were used to identify the pretreatment proximal tumor extent that best discriminated mediastinal involvement. In all, 204 patients (151 [74%] AEG II, 53 [26%] AEG III) were included, of whom 47 (23%) had clinical evidence of thoracic nodal disease. Thirty-one of the 204 patients (15%) met criteria for mediastinal involvement (24 of 31 ypN+, 10 of 31 mediastinal recurrence). Patients with mediastinal involvement had greater proximal tumor extent (median 2 cm [interquartile range, 1.0 to 3.0 cm] vs 1.4 cm [interquartile range, 0.7 to 3.0 cm], P= .030), were more frequently Siewert II lesions (27 of 31 [87.1%] vs 124 of 173 [71.7%], P= .071), and were more often observed to have clinical thoracic nodal metastasis (cN) evidence (13 of 31 [42%] vs 34 of 173 [20%], P= .007) than patients who did not. On multivariable analysis of patients with intrathoracic cN0, esophageal extent of 1.5 cm or greater was independently predictive of mediastinal involvement (odds ratio 5.46, P= .011), whereas Siewert classification was not (Siewert II odds ratio 3.48, P= .116). Pretreatment proximal tumor extent, rather than Siewert classification, is an independent predictor of mediastinal involvement among AEG II/III patients without clinical evidence of mediastinal metastasis and should be considered during treatment planning.

Reply to 'Is there really no difference of mediastinal lymph node metastasis pattern between esophageal adenocarcinoma and squamous cell carcinoma?'

Reply to 'Is there really no difference of mediastinal lymph node metastasis pattern between esophageal adenocarcinoma and squamous cell carcinoma?'

Is there really no difference of mediastinal lymph node metastasis pattern between esophageal adenocarcinoma and squamous cell carcinoma?

Is there really no difference of mediastinal lymph node metastasis pattern between esophageal adenocarcinoma and squamous cell carcinoma?

Next Steps after Negative Results Obtained by EBUS-TBNA from Patients Suspected Clinically Lung Cancer with Mediastinal Lymphnode Metastasis

背景与目的超声气管镜针吸活检（endobronchial ultrasound guided tranbronchial needle aspiration, EBUS-TBNA）是肺癌诊断和分期的重要手段，但经活检阴性结果的患者后续处理尚无标准流程。本文通过分析来自单中心的临床疑诊肺癌纵隔淋巴结转移但EBUS-TBNA病理结果阴性患者，以探讨此类患者处理方式。方法对北京协和医院2010年9月-2016年12月进行EBUS-TBNA的1, 412例患者资料进行分析，选取临床疑诊肺癌纵隔淋巴结转移但EBUS-TBNA病理诊断阴性的患者51例进行回顾性分析。结果入选51例患者按临床情况和后续处理方式分为以下5组：①经同一次气管镜下其他检查组（9例）：该组患者大多（8例）存在镜下异常表现，通过活检、毛刷、灌洗或经支气管镜肺活检（transbronchial lung biopsy, TBLB）取得明确诊断；②再次EBUS-TBNA组（11例）：该组患者气管粘膜及管腔大致正常，再次行EBUS-TBNA取得诊断；③手术治疗组（6例）：该组患者因EBUS结果除外纵隔淋巴结转移，接受手术治疗。其中5例术后确诊无淋巴结转移癌；④进行其他病理检查组（15例）：该组患者有其他部位转移，针对可能的转移灶进行计算机断层扫描（computed tomography, CT）引导下穿刺、淋巴结活检等确诊。⑤随访组（10例）：该组患者未进行其他有创检查，中位随访时间38个月，其中1例随访中诊断为淋巴瘤。结论对于经EBUS-TBNA未能确定诊断而临床怀疑肺癌的患者，应该根据患者的具体情况，综合多种方式进行诊断。对于暂时无法确诊的患者，仍需要长期随访。

Comparison of whole body 131Iodine scan results in four, seven and nine days after radio-iodine therapy of differentiated thyroid cancer

Introduction: Finding optimum time of post ablation whole body iodine scan in patients with differentiated thyroid cancer(DTC) treated with I-131.Material and Methods: 20 patients with DTC, who were treated with I131 underwent post ablation whole body iodine scan (WBIS) in days 4, 7 and 9 after treatment. A dual head gamma camera (e-cam, Siemens) equipped with high energy parallel hole collimator was used for imaging. The images were acquired with 7cm/min and stored in a 1024 ×256 matrix. Results: 3 Patients had negative WBIS in all three sets of imaging and 17 patients had postsurgical thyroid remnants on all 3 scans. On days 4 and 7 we detected 11 patients with cervical lymph node metastases while on day 9 only 9 patients showed cervical lymph node metastases.(P=0.135)On all 3 sets of images, we encountered 4 patients with mediastinal lymph node metastases and 1 patient with bone metastasis. In addition, all 3 sets of images detected lung metastases in three patients. The total number of affected foci did not have any statistical differences in whole body scan of day 4, 7 and 9. (P = 0.083)Conclusion: According to the radiation safety hazards for staff and technicians of nuclear medicine department and lack of difference in scan findings between 4 and 7 days after RAI, scanning the DTC patients in the day 7 after RAI administration , is more practicable, with less probability of missing the sites of involvement. Performing whole body iodine scans after 1 week is not recommended.

18 Fluorodeoxyglucose-positron emission tomography/computed tomography features of suspected solitary pulmonary lesions in breast cancer patients following previous curative treatment.

BackgroundDifferentiating pulmonary metastasis from primary lung cancer can be challenging in patients with breast malignancy. This study aimed to characterize the imaging features of 18fluorodeoxyglucose‐positron emission tomography/computed tomography (18F‐FDG‐PET/CT) for distinguishing between these diseases.MethodsWe enrolled 52 patients who received curative treatment for breast cancer but later presented with suspected solitary pulmonary lesions (SPLs) and subsequently underwent 18F‐FDG‐PET/CT to investigate.ResultsSubsolid lesions, ill‐defined borders, lung lesions with negative maximum standardized uptake value, and lesions without 18F‐FDG‐PET/CT‐diagnosed hilar and/or mediastinal lymph nodes and pleural metastases were more likely to be associated with primary lung cancer.ConclusionsCT border, FDG uptake, hilar and/or mediastinal lymph node metastasis, and pleural metastasis are potential markers for diagnosis.

A patient using an airway stent for tracheal stenosis caused by mediastinal lymph node metastasis after surgery for tongue cancer

A patient using an airway stent for tracheal stenosis caused by mediastinal lymph node metastasis after surgery for tongue cancer

Allogenic V\u03b39V\u03b42 T cell as new potential immunotherapy drug for solid tumor: a case study for cholangiocarcinoma

BackgroundCholangiocarcinoma (CCA) is a highly aggressive and fatal tumor. CCA occurs in the epithelial cells of bile ducts. Due to increasing incidences, CCA accounts for 3% of all gastrointestinal malignancies. In addition to comprehensive treatments for cancer, such as surgery, chemotherapy, and radiotherapy, during the past few years, cellular immunotherapy has played an increasingly important role. As a result of our research, we have discovered the γδ T cell-based immunotherapy for CCA.Case presentationA 30-year-old male (https://www.clinicaltrials.gov/ ID: NCT02425735) was diagnosed with recurrent mediastinal lymph node metastasis after liver transplantation because of Cholangiocarcinoma (stage IV). In the course of his therapy sessions, he only received allogenic γδ T cell immunotherapy from August, 2017 through February, 2018 (8 infusions in total). γδ T cells were expanded from peripheral blood mononuclear cells (PBMCs) of healthy donor, and ~ 4 × 108 cells were adoptive transferred to the patient.ConclusionIn the above case report of the Cholangiocarcinoma (stage IV) patient who had received liver transplantation and afterward was diagnosed with recurrent mediastinal lymph node metastasis, we clinically proved that allogenic γδ T cell treatment had no adverse effects. We observed that allogenic γδ T cell treatments positively regulated peripheral immune functions of the patient, depleted tumor activity, improved quality of life, and prolonged his life span. After 8 γδ T cell treatments, the size of lymph nodes was remarkably reduced with activity depletion. This clinical work suggested that allogenic γδ T cell immunotherapy could be developed into a promising therapy drug for CCA.