Metastatic Neck Nodes Research Articles

CYTOLOGICAL EVALUATION OF NECK LYMPH NODES FOR METASTATIC DISEASE

Background: Fine needle aspiration cytology (FNAC) is a simple, rapid and cost effective procedure with minimal complications for evaluating enlarged neck nodes, but also gives clue. Neck lymph nodes are a common site of metastasis for various carcinomas, usually from the upper aerodigestive tract and salivary gland or carcinoma of unknown primary. Objectives: To study different cytomorphological patterns of metastatic neck nodes. To evaluate the diagnostic utility of FNAC in diagnosis of metastatic lesions of lymph node. Methods: It is a one year prospective study comprised of all aspirates 139 lymphnodes of 968 patients. FNACs conducted in the Department of Pathology, Vydehi Institute of Medical Sciences, Bangalore, between January 2019 to December 2019. A total of 70 out of 139 peripheral neck nodes in patients diagnosed with metastatic neck lymph node on FNAC were included in the study. Results: Out of 70 cases included in our study, metastasis to the neck lymph nodes were most common in the age group 51 to 60 years (38.6%) followed by 61 to 70 years (28.6%). Male preponderance was noted with male to female ratio of 1.7:1. On cytological examination, squamous cell carcinoma was found to be the most common tumor metastasizing to the neck nodes, accounting for 37 (52.9%) cases followed by each 10 (14.3%) cases each of undifferentiated carcinoma and thyroid carcinoma, 9 (12.9%) cases of adenocarcinoma, 3 (4.3%) cases of parotid gland carcinoma and 1 (1.4%) case of germ cell tumor of testis. Conclusion: FNAC is an early and reliable tool for the diagnosis of metastatic neck nodes. Any enlarged neck node should be investigated to rule out metastasis.

Pattern of Metastases of Squamous Cell Carcinoma in Cervical Lymph Node In Patients With Occult Primary

Introduction: Squamous cell carcinoma is the most common cancer of the upper aerodigestive tract, accounting for more than 90% of cancers. Its method of spread is through lymphatic channels, with a high propensity toward deposition in the regional lymph nodes. Objective: To determine the pattern of metastesis of squamous cell carcinoma in cervical lymph node in patients with occult primary. Methods: This was an observational cross sectional study which was carried out in the Dept. of ENT, Abdul Malek Ukil Medical College Hospital, Noakhali, Bangladesh from January 2017 to June-2019. A Total 31 patients were selected according to selection criteria and level of involved lymph node and nodal staging was determined by careful clinical examination, biopsy of all suspicious site, CT scan, MRI, USG and X-ray. Results: Thirty One patients with metastatic neck node in whom the primary tumour was not found despite of extensive diagnostic procedure were studied in this series. Patients distribution Male were 78% and female 22%. In this study majority of patients were within 40-80 years and most of patients were male. Unilateral neck node metastasis was found in 90.32% cases and bilateral in 09.68% cases. There is high incidence of unilateral metastatic neck node. Involved lymph node was found single in 54.83% and multiple in 45.17% cases in our study. Consistency of lymph nodes were found hard in 51.61%, firm to hard in 32.25% and firm in 16.12% cases in our study. In this study nodes were found less than 3 cm in 38.70% cases, 3-6 cm in 48.38% cases and more than 6 cm in 12.90% cases. While levelling of the lymph node was concerned, in this study the most commonly involved lymph node region was level-II (41.93%) followed by level-III (16.12%). In this study 38.70% cases were in stage N1, 48.38% in stage N2 and 12.90% in stage N3. Maximum lymph nodes were 3-6 cm in size. Conclusion: Metastetic squamous cell carcinoma in cervical lymph node of occult primary common in .........

Clinical Presentation of Advanced Extragonadal Embryonal Carcinoma Mimicking Classical Hodgkin Lymphoma

A 22-year-old man presented with a 2-week history of abdominal pain, fatigue, fever, and night sweats. Enlarged neck and paraaortic lymph nodes were noted, but no testicular lesions were found using imaging tools. Pathology revealed poorly differentiated embryonal carcinoma (EC) of the metastatic neck lymph node. The patient presented with clinical symptoms similar to Hodgkin lymphoma (HL), but the final diagnosis was advanced-stage extragonadal EC. To our knowledge, this is a rare case report of EC presenting as classic HL.

Evaluation of metastatic neck nodes search for primary and subsequent management.

Cancers in the head-and-neck region are the sixth most common cancers worldwide with an increasing incidence in developing countries. This study was carried out in the department of ENT and head-and-neck surgery in collaboration with the department of radiotherapy for a period of 1 year extending from May 01, 2014, to April 30, 2015. A total of 48 cases of metastatic secondary nodes were included in the study. The male-to-female ratio in the present study was 4.33:1. Maximum number of patients were seen in the seventh decade. The youngest patient was a female 30 years old and the oldest was a male of 80 years. About 95.84% of primary tumors were squamous cell carcinomas and 40.47% of the patients of head-and-neck cancer with metastatic lymph nodes had well-differentiated squamous cell carcinomas. Majority of cases presented with N2 nodes, while N1 nodes were highest in cases of carcinomas larynx. Metastatic neck disease is a major problem in patients with head-and-neck cancer. The therapeutic goal includes not only known disease but also the elimination of possible subclinical disease. The judicious use of moderate doses of irradiation and modified surgical procedures should be used in specific clinical situations to significantly decrease neck recurrences while eliminating morbidity.

Diagnostic efficacy of combined CT and MRI in detecting nodal metastasis in patients with oral cancer

The objective of this study was to assess the diagnostic efficacy of combined computed tomography (CT) and magnetic resonance imaging (MRI) in detecting metastases of oral cancers to lymph nodes in the neck. In total, 105 patients with previously untreated oral squamous cell carcinoma underwent both CT and MRI within 6 weeks before tumor excision and selective neck dissection. The diagnostic efficacy of combined CT and MRI was compared with published data on the efficacy of CT and MRI alone. The sensitivity, specificity, positive and negative predictive values, and accuracy of diagnosis based on CT and MRI were 80%, 90%, 80%, 90%, and 87%, respectively. These values were similar to or higher than those reported in a meta-analysis for CT or MRI alone. The highest and lowest sensitivities were found for metastatic nodes at levels I (75%) and III (33%). The highest and lowest specificities were discovered for nodes at levels IV (99%) and I (88%). Combined CT and MRI may be superior to a single modality alone in detecting metastatic neck nodes. This may have an advantage in both preoperative planning and neck surveillance in superficial oral cancers.

Clinical, subclinical characteristics of thyroid cancer patients were treated by endoscopic surgery

Background: Thyroid cancer accounts for 1% of all cancers. This is the most common type of malignant tumor affecting the endocrine system. The disease usually progresses slowly, mainly develops locally and metastases of neck lymph nodes. If detected early, it is possible to select appropriate treatment methods which will result in high efficiency. Objectives: Analyzing the clinical and subclinical characteristics of selected differentiated thyroid cancer patients in laparoscopic surgery. Methods: 115 thyroid cancer patients were performed endoscopic thyroidectomy at National Hospital of Endocrinology from March 2012 to April 2018. Results: 115 thyroid cancer patients were undergone endoscopic thyroidectomy at National Hospital of Endocrinology included 109 females (94.8%) and 6 males (5.2%). The proportion of female/male is 18/1. Age of patient is 15 to 45. Mean age of male was 30.4 ± 6.4 and 33.2 ± 4.5 of female. The mean age for the whole world is 32.7 ± 6.8. Mainly disease ages 25 - 35 (74.8%). 68.7% of patients were treated by surgery 12 months after diagnosis and after 36 months of diagnosis: 13.9%. The mean time from detected until done by surgery was 10.3 ± 6.7 months. 100% of patients with thyroid nodule. 80% of patients with solid density. The most of nodules were not clear boundaries (92.2%). 21.7% surface roughness, 80% nodules with solid density. 60/115 (52.18%) with metastatic neck lymph nodes, of which 61.7% central cavity lymph nodes; 38.3% bilateral metastatic neck lymph nodes. Papillary cancer accounted for 76.5%; 10.4% follicular, 13.1% papillary-follicular. Compare the results of FNA with pathology: 78.9% positive and false-negative rate was 7.8%.

The Value of Intraoperative Ultrasound in Selective Lateral Cervical Neck Lymphadenectomy for Papillary Thyroid Cancer: A Prospective Pilot Study.

Simple SummarySelective neck dissection is currently accepted as the standard of care for lateral cervical nodal disease from papillary thyroid cancer. However, the clinical intraoperative detection of metastatic nodal involvement may be challenging, especially in difficult-to-spot neck levels behind the sternocleidomastoid muscle, and hinges on imaging investigations. In this respect, the significance of diagnostic intraoperative US in metastatic papillary thyroid cancer seems to be under-investigated in literature. We ran a prospective diagnostic study where an intraoperative ultrasound (IOUS) showed increased sensitivity for the detection of lateral neck nodes with respect to preoperative US scans, especially in the difficult-to-spot neck levels: in sublevels such as IIb and V, up to one quarter of patients examined had nodes newly detected by IOUS that were confirmed at pathology. This study offers evidence that IOUS may provide accurate intraoperative node mapping, supporting precise and more reliable selective neck dissection.(1) Background: Lymph node metastases from papillary thyroid cancer (PTC) are frequent. Selective neck dissection (SND) is indicated in PTC with clinical or imaging evidence of lateral neck nodal disease. Both preoperative ultrasound (PreUS) and intraoperative palpation or visualization may underestimate actual lateral neck nodal involvement, particularly for lymph-nodes located behind the sternocleidomastoid muscle, where dissection may also potentially increase the risk of postoperative complications. The significance of diagnostic IOUS in metastatic PTC is under-investigated. (2) Methods: We designed a prospective diagnostic study to assess the diagnostic accuracy of IOUS compared to PreUS in detecting metastatic lateral neck lymph nodes from PTC during SND. (3) Results: There were 33 patients with preoperative evidence of lateral neck nodal involvement from PTC based on PreUS and fine-needle cytology. In these patients, IOUS guided the excision of additional nodal compartments that were not predicted by PreUS in nine (27.2%) cases, of which eight (24.2%) proved to harbor positive nodes at pathology. The detection of levels IIb and V increased, respectively, from 9% (PreUS) to 21% (IOUS) (p < 0.0001) and from 15% to 24% (p = 0.006). (4) Conclusions: In the context of this study, IOUS showed higher sensitivity and specificity than PreUS scans in detecting metastatic lateral cervical nodes. This study showed that IOUS may enable precise SND to achieve oncological radicality, limiting postoperative morbidity.

Anaplastic Thyroid Carcinoma in Metastatic Lateral Cervical Neck Lymph Node. Case Report and Review literatures

Introduction: Papillary thyroid carcinoma is one of the commonest human malignancies. It usually follows an indolent clinical course with localized disease and rare metastasis [1]. Anaplastic transformation of thyroid carcinoma although rare but is well-accepted phenomena. It goes through multiple steps of genetic alterations leading to an ultimate de-differentiation. Most of the anaplastic carcinoma occurs in the thyroid glands with very aggressive behavior and locally advanced disease [2]. Recently some case reports described the anaplastic transformation of thyroid carcinoma in a distant site. It occurred either synchronously or years after diagnosis of thyroid carcinoma.

A study on the immunohistochemical expression of napsin A in oral squamous cell carcinomas, intraepithelial neoplasia, and normal oral mucosa

ABSTRACT Napsin A is an aspartic proteinase expressed in some types of carcinomas, such as lung adenocarcinomas and renal cell carcinomas but rarely in squamous cell carcinomas. No specific studies have been carried out focusing on napsin A antibody expression in oral squamous cell carcinomas (OSCC). The aim of this study was to investigate the reactivity of this antibody in primary OSCC. This retrospective study included 70 OSCC cases of which 31 (44.3%) presented metastasis involvement. Patient data, including age, gender, tumor location, histological grade, regional and distant metastasis, were collected. OSCC edge epithelium with intraepithelial neoplasia and healthy oral mucosa (n = 10) were included in the analysis. Sections of lung adenocarcinomas (n = 2) were used as the positive control and an immunohistochemical assay for napsin A was performed on all cases. Napsin A expression was negative in all 70 cases of OSCC, as well as in the intraepithelial neoplasia adjacent to the carcinoma area and in healthy oral mucosa epithelium. Metastatic neck lymph nodes and distant organs were also negative for napsin A. This study shows that napsin A is consistently not expressed in oral squamous cell carcinoma, or in metastatic sites of primary OSCC, intraepithelial neoplasia, and healthy oral mucosa

956P Combined accuracy of computed tomography and magnetic resonance imaging in detecting level wise metastatic neck nodes and extracapsular spread

The presence of metastatic neck node and extracapsular spread(ECS) has a poorer survival impact on oral squamous cell carcinoma(OSCC) patients. The debate of addressing the neck in superficial tumors <3 mm is still ongoing. Moreover, ECS has been recently added in the new clinical staging system and imaging plays an important role for the same. There are several studies reporting accuracy of individual imaging modalities in detecting metastatic node. However, combined use of these imaging techniques may be supplementary, especially with equivocal finding.

Prevalence of Metastatic Neck Nodes

Background: Head and neck cancers include cancers of the lips, mouth, nasal cavity, paranasal sinuses, pharynx and larynx. Most of these cancers are squamous cell carcinomas (SCCs). The presence of metastatic cervical lymphadenopathy is of particular importance as with every single nodal metastasis, survival of the patient is reduced by one half.&#x0D; Objective: To see the prevalence of metastatic neck node.&#x0D; Methods: The prospective cross-sectional clinical study was carried out in the Department of ENT and Head Neck Surgery, Combined Military Hospital, Dhaka during March’2018 to March, 2019. All 100 patients were included in this study and were treated at the Department of Otolaryngology of Combined Military Hospital, Dhaka.&#x0D; Results: Total 26 cases were found parotid among them 8(30.8%) in metastatic neck node and 18(69.2%) in without metastatic neck node. Total 10 cases were found paranasal sinuses among them 1(10.0%) in metastatic neck node and 9(90.0%) in without metastatic neck node. Which were statistically significant (p&lt;0.05) between two groups.&#x0D; Conclusion: In this study observed that majority of metastatic neck node were found pyriform fossa, supraglottic larynx, base of tongue which were 68.2%, 68%, 77.8% respectively. In oral cavity and parotid site also found 48.1% and 30.8% metastatic neck node.&#x0D; Bangladesh J Otorhinolaryngol; October 2019; 25(2): 102-107

Classifying Neck Lymph Nodes of Head and Neck Squamous Cell Carcinoma in MRI Images with Radiomic Features

The aim of this study is to develop a computer-aided diagnosis method to help classify medical images of neck lymph nodes in head and neck cancer patients. According to the current practice guidelines, the classification of lymph node status is critical for patient stratification before treatment. Take extra-nodal extension (ENE) of metastatic neck lymph nodes, the status of ENE has been considered a single factor affecting the decision of whether systemic treatment with toxicity should be given to patients with otherwise non-advanced cancer status. Medical imaging prior to surgery serves as tools for clinical staging and determining the extent of neck lymph node dissection during the tumor resection surgery. The information contained in these images may also help determine the status of ENE and thus stratify patients for more precise treatment. In the current practice, there has been not a reliable computer-aided tool for this task. In this study, we used open-source software to investigate radiomic features that help distinguish malignant from benign and ENE from non-ENE lymph nodes. We have identified 89 features that can differentiate malignant from benign and 4 features that can differentiate ENE from non-ENE lymph nodes. Furthermore, we fed the significant features to a multilayer perceptron neural network to predict malignancy and ENE of lymph nodes and achieved 84% and 77% of accuracy in each task, respectively.

Prophylactic Central Neck Dissection in Well-differentiated Thyroid Cancer.

SUMMARYWell-differentiated cancers, both papillary and follicular, account for 90% of all diagnosed thyroid cancers. They have an indolent disease course with a 20-year disease-specific survival over 90%. According to current guidelines, the therapy of choice for well-differentiated thyroid carcinoma is total thyroidectomy or lobectomy. The indication for prophylactic central neck dissection is still a controversial issue and the subject of unfinished and ongoing debate. There is no indication for prophylactic central neck dissection in follicular thyroid carcinomas, which primarily metastasize hematogenously. In small solitary papillary thyroid carcinomas (T1 and T2), prophylactic central neck dissection is not indicated as it does not bring benefits in terms of improved patient survival and at the same time significantly increases the risk of temporary and permanent postoperative complications. Prophylactic central neck dissection is indicated in advanced papillary thyroid cancers (T3 and T4) and all other high-risk well-differentiated thyroid cancer, as well as in the presence of metastatic lymph nodes in the lateral neck.

Ультразвукові та цитологічні характеристики радіойодчутливості метастазів папілярного раку щитоподібної залози

Мета — дослідження ультразвукових і цитологічних характеристик метастазів, виявлених у поопераційний період, залежно від їх йоднакопичувальної здатності. Матеріал і методи. Ультразвукові, цитологічні, імуноцитохімічні дослідження проводили на групі метастазів папілярного раку щитоподібної залози, виявлених у поопераційний період (після тиреоїдектомії та радіойодтерапії): 30 радіойодчутливих метастазів і 65 радіойодрезистентних. Оцінювали такі ультразвукові характеристики, як локалізація метастазів, чи є вони множинними або поодинокими, ехогенність, ехоструктуру та наявність гіперехогенних включень. Цитологічні та імуноцитохімічні дослідження проводили на пункційному матеріалі даних метастазів, забарвленому за Романовським. Використовували непрямий імунопероксидазний метод із моноклональними антитілами до тиреоїдної пероксидази та тиреоглобуліну. Статистичний аналіз проводили за непараметричним критерієм Манна – Уїтні та методом χ2 у програмі Statistica 11.0. Результати. Проведені дослідження ультразвукових і цитологічних характеристик поопераційних метастазів папілярних карцином щитоподібної залози не виявили значущої різниці між групами радіойодрезистентних і радіойодчутливих метастазів за такими ультразвуковими характеристиками, як ехогенність, ехоструктура та наявність гіперехогенних включень. Показано, що у випадках виявлення гіпоехогенних метастазіву латеральних лімфатичних колекторах імовірність радіойодрезистентності метастазів становить 93±2%. Ультразвукову ознаку кістозної дегенерації виявляли в 1,8 раза частіше в радіойодрезистентних метастазах порівняно з радіойодчутливими. Цитологічні дослідження демонструють фенотипову гетерогенность епітелію радіойодрезистентних метастазів порівняно з радіойодчутливими та вірогідну різницю в експресії тиреоглобуліну й тиреоїдної пероксидази. Висновки. За даними ультразвукового дослідження не виявлено достовірних змін, які дозволили б проводити диференційну діагностику між радіойодрезистентними та радіойодчутливими метастазами папілярного раку щитоподібної залози. Визначено цитологічні ознаки радіойодрезистентних метастазів папілярного тиреоїдного раку, які дозволяють їх передопераційне прогнозування. Продемонстровано значущу редукцію експресії тиреоїдної пероксидази та тиреоглобуліну в пунктатах радіойодрезистентних метастазів порівняно з радіойодчутливими, що є підставою передопераційного прогнозування радіойодрезистентності поопераційних метастазів папілярного тиреоїдного раку. Виявлені за даними ультразвукової діагностики метастатичні лимфатичні вузли шиї дозволяють проводити подальші імуноцитохімічні та цитологічні дослідження, що може підвищити ефективність діагностики метастазів високодиференційованого раку щитоподібної залози й полегшити вибір подальшого лікування.

An approach towards metastatic neck nodes and most common site of primaries: a retrospective study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Head and neck cancer is one of the most common cancers in India and worldwide. It accounts for 30 percent of the total cancer burden. Head and neck cancers are notorious for loco regional spread presenting late with metastastasis to cervical lymph nodes.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Our study was carried out on patients presenting with metastatic neck nodes at Silchar Medical College and Hospital, Assam from 1&lt;sup&gt;st&lt;/sup&gt; April 2013 to 30&lt;sup&gt;th&lt;/sup&gt; March 2015. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study 167 patients presented with head and neck cancer with metastatic neck nodes. Metastatic nodes involving level II accounted for 51.4% of cases with primaries in oral cavity, base of tongue. Level III lymph nodes were involved in 48.6% of cases with primaries in the hypopharynx and larynx.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; In our study it was found that hypopharynx is the most common primary head and neck cancer with metastatic neck node. The most commonly involved lymph nodes are level II and level III. This helps in understanding the pattern of micrometastases in head and neck cancer patients with N0 neck which makes way for the role of selective neck dissection in these groups of patients.&lt;/p&gt;

A combined analysis of maximum standardized uptake value on FDG-PET, genetic markers, and clinicopathological risk factors in the prognostic stratification of patients with resected oral cavity squamous cell carcinoma.

Clinical outcomes of patients with resected oral cavity squamous cell carcinoma (OCSCC) chiefly depend on the presence of specific clinicopathological risk factors (RFs). Here, we performed a combined analysis of FDG-PET, genetic markers, and clinicopathological RFs in an effort to improve prognostic stratification. We retrospectively reviewed the clinical records of 2036 consecutive patients with first primary OCSCC who underwent surgery between 1996 and 2016. Of them, 345 underwent ultra-deep targeted sequencing (UDTS, between 1996 and 2011) and 168 whole exome sequencing (WES, between 2007 and 2016). Preoperative FDG-PET imaging was performed in 1135 patients from 2001 to 2016. Complete data on FDG-PET, genetic markers, and clinicopathological RFs were available for 327 patients. Using log-ranked tests based on 5-year disease-free survival (DFS), the optimal cutoff points for maximum standardized uptake values (SUV-max) of the primary tumor and neck metastatic nodes were 22.8 and 9.7, respectively. The 5-year DFS rates were as follows: SUVtumor-max ≥ 22.8 or SUVnodal-max ≥ 9.7 (n = 77) versus SUVtumor-max < 22.8 and SUVnodal-max < 9.7 (n = 250), 32%/62%, P < 0.001; positive UDTS or WES gene panel (n = 64) versus negative (n = 263), 25%/62%, P < 0.001; pN3b (n = 165) versus pN1-2 (n = 162), 42%/68%, P < 0.001. On multivariate analyses, SUVtumor-max ≥ 22.8 or SUVnodal-max ≥ 9.7, a positive UDTS/WES gene panel, and pN3b disease were identified as independent prognosticators for 5-year outcomes. Based on these variables, we devised a scoring system that identified four distinct prognostic groups. The 5-year rates for patients with a score from 0 to 3 were as follows: loco-regional control, 80%/67%/47%/24% (P < 0.001); distant metastases, 13%/23%/55%/92% (P < 0.001); DFS, 74%/58%/28%/7% (P < 0.001); and disease-specific survival, 80%/64%/35%/7% (P < 0.001) respectively. The combined assessment of tumor and nodal SUV-max, genetic markers, and pathological node status may refine the prognostic stratification of OCSCC patients.

Differentiation of lymphomatous, metastatic, and non-malignant lymphadenopathy in the neck with quantitative diffusion-weighted imaging: systematic review and meta-analysis.

To perform a systematic review and meta-analysis of literature comparing average apparent diffusion coefficient (ADC) for differentiating lymphomatous, metastatic, and non-malignant cervical lymphadenopathy. We performed a comprehensive literature search of Ovid MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science Core Collection. Studies comparing average ADC of lymphomatous, metastatic, and non-malignant neck lymph nodes were included. The standardized mean difference and 95% confidence interval (CI) was calculated using random-effects models. In subgroup analysis of those studies applying ADC threshold for differentiation of cervical lymphadenopathy, pooled diagnostic odds ratio (DOR) and summary receiver operating characteristics (sROC) area under the curve (AUC) were determined. A total of 27 studies with 1165 patients were included, pooling data from 225 lymphomatous, 1162 metastatic, and 1333 non-malignant cervical lymph nodes. The average ADC values were lower in lymphomatous compared to metastatic nodes, and in metastatic compared to non-malignant nodes with a standardized mean difference of - 1.36 (95% CI: - 1.71 to - 1.01, p < 0.0001) and - 1.61 (95% CI: - 2.19 to - 1.04, p < 0.0001), respectively. In subgroup analysis, applying ADC threshold could differentiate lymphomatous from metastatic lymphadenopathy with DOR of 52.07 (95% CI 25.45-106.54) and sROC AUC of 0.936 (95% CI 0.896-0.979) and differentiate metastatic from non-malignant nodes with DOR of 39.45 (95% CI 16.92-92.18) and sROC AUC of 0.929 (95% CI 0.873-0.966). Quantitative assessment of ADC can help with differentiation of suspicious cervical lymph nodes, particularly in those patients without prior history of malignancy or unknown primary cancer site.

Diagnostic Value of Diffusion Weighted Magnetic Resonance Imaging in Evaluation of Metastatic Neck Lymph Nodes in Head and Neck Cancer: A Sample of Iranian Patient.

Objective:To evaluate the diagnostic value of DWI in assessment of metastatic neck lymph node in a sample of Iranian patients with Head and Neck cancer. Methods:25 patients with 80 neck lymph nodes were analyzed using 1.5 T MRI. DWI was performed with b values of 0 and 1,000 s/mm2. Short axis diameter and ADC values (min, max and mean) were calculated for metastatic and non-metastatic neck LNs and results were compared with histopathological findings. The optimal ADC thresholds were analyzed using receiver coefficient characteristic (ROC) curves for discriminating between metastatic and benign neck lymph nodes. Result:Histopathological findings revealed that there are 45% (n=36) metastatic and 55% (n=44) non-metastatic neck LNs respectively. There was no statistically significant difference in short axis diameter between the two groups (p = 0.346). However, The ADC values of metastatic neck LNs were significantly lower than those of non-metastatic neck LNs (p < 0.001); 0.90 ± 0.10 × 10-3 mm2/s vs 1.06 ± 0.12 × 10-3 mm2/s ( ADC mean ), 0.78 ± 0.08 × 10-3 mm2/s vs 0.92 ± 0.20× 10-3 mm2/s ( ADC min ) and 1.02 ± 0.12 × 10-3 mm2/s vs 1.24 ± 0.15 × 10-3 mm2/s (ADC max ). The optimal mean ADC threshold value was equal to 0.996 × 10-3 mm2/s for differentiating malignant from benign lymph nodes with sensitivity, specificity and accuracy of 80.56 %, 77.27 % and 71.59 % respectively. Conclusion:MR diffusion imaging and ADC values as a non-invasive technique can assess metastatic neck LNs in head and neck cancer with higher sensitivity, specificity and accuracy.

The Role of Calcitonin in Predicting the Extent of Surgery in Medullary Thyroid Carcinoma: A Nationwide Population-Based Study in Norway

Background: Preoperative predictors for the need of prophylactic lymph node dissection in the lateral neck have been studied in patients with medullary thyroid carcinoma (MTC). Objectives: To evaluate the ability of serum calcitonin to predict the extent of surgery needed in the lateral neck. Methods: This retrospective population-based cohort study includes data from 94 of 139 patients with MTC surgically treated in Norway from 2003 to 2016. Patients were identified in the 4 regional centers treating MTC and by the Cancer Registry of Norway, and grouped according to calcitonin levels. In 58 patients without distant metastases or disease progression to the next tumor level (NPNL), data were compared in prognostic groups (N0-NPNL), (N1a-NPNL), and (N1b-NPNL). Results: At calcitonin levels ≤500, 501–1,000, and >1,000 pmol/L, metastatic lymph nodes in the lateral neck were found in 16, 50, and 71% of the patients, respectively. In the prognostic groups, 19% of N0-NPNL patients had calcitonin >500 pmol/L and 17% of N1b-NPNL patients had calcitonin ≤500 pmol/L. In multivariate analysis, factors predicting biochemical cure and calcitonin level ≤500 pmol/L were no metastatic lymph nodes in the lateral neck (p = 0.030) and tumor diameter ≤20 mm (p < 0.001), respectively. Factors related to metastatic lymph nodes in the lateral neck were extrathyroidal extension (p = 0.007) and no biochemical cure (p = 0.028). Conclusions: Basal calcitonin cannot predict the need for prophylactic lateral lymph node dissection in patients with MTC. Further prospective, randomized studies are warranted.

MON-566 Early Diagnosis of Lymph Node Metastases by Serum Tg and Neck Ultrasonography, and Long Term Follow Up After Radioiodine and/or Surgical Treatment in Patients with Papillary or Follicular Thyroid Cancer.

We aimed to evaluate the early detection of metastatic lateral neck lymph nodes (LNL) in patients with papillary or follicular differentiated thyroid cancer (DTC), and long-term follow-up after I131 and/or surgery. LNL evaluation has been made by thyroglobulin (Tg) measurement and neck ultrasonography (NU). We have enrolled 710 patients with DTC that previously underwent a near-total thyroidectomy and I131 ablation of residual tissue, and a follow-up by Tg, NU, diagnostic and post-therapy whole body scan (WBS), alone or in combination. LNL were detected by TSH-stimulated Tg alone with a sensitivity of 86%, and a negative predictive value (NPV) of 84%; whereas NU had a sensitivity of 70%, and NPV of 68%. TSH-stimulated Tg plus NU increased the sensitivity to 98%, and of NPV to 96%. In patients with LNL uptaking radioiodine and then treated with I131, the following outcomes were observed: 49% responded after a median of 4 cycles (median 354 mCi, cumulative dose; 7.4 years median follow-up) with “disappearence of uptake at post-therapy WBS and Tg<1 ng/ml” (complete remission, CR); 12% of not responding cases had CR following other treatments. Nine% of LNL patients not uptaking or not responder to I131 were treated with surgery, and subsequent I131 readministration with CR in 23% of cases (6.5 years median follow-up). In conclusion, an early detection of LNL in DTC-patients may be helpful to obtain a CR by I131 in 49% after 4 or less I131 treatments. A combination of different therapies could aid patients not responder/not uptaking I131 to achieve a CR in 24% of cases.