Metastatic Node Involvement Research Articles

The Role of Lymphadenectomy in Early-Stage NSCLC.

Lung cancer remains the leading cause of cancer-related death worldwide. The involvement of lymph nodes by the tumor has a strong impact on survival of patients. For this reason, lymphadenectomy plays a crucial role in the staging and prognosis of NSCLC, to define the most appropriate therapeutic strategies concerning the stage of the disease. To date, the benefit, in terms of survival, of the different extents of lymphadenectomy remains controversial in the scientific community. It is recognized that metastatic involvement of mediastinal lymph nodes in lung cancer is one of the most significant prognostic factors, in terms of survival, and it is therefore mandatory to identify patients with lymph node metastases who may benefit from adjuvant therapies, to prevent distant disease and local recurrences. The purpose of this review is to evaluate the role of lymphadenectomy in early-stage NSCLC in terms of efficacy and accuracy, comparing systematic, sampling, and lobe-specific lymph node dissection and analyzing the existing critical issue, through a search of the most relevant articles published in the last decades.

The Evaluation of Sentinel Lymph Node Biopsy Using Radiocolloid in First Stage Endometrial Cancer.

Detection of a sentinel lymph node (SLN) in patients with endometrial cancer (EC) reduces the rate of unnecessary systemic lymph dissection. The aim of this study was to assess the SLN detection rate, accuracy of the method using Tc-99m-SENTI-SCINT and the rate of metastatic nodal involvement in patients with preoperative first stage EC. A prospective study of SLN biopsy of 41 patients with stage I EC was conducted after cervical application of 4mCi Tc-99m-SENTI-SCINT. Planar lymphoscintigraphy and single-photon emission computed tomography/computed tomography (SPECT/CT) of the pelvis were performed, followed by site-specific lymphadenectomy in intermediate-risk patients if no SLN was detected per hemipelvis and pelvic lymphadenectomy in all high-risk patients. Pre-operative detection rate of planar lymphoscintigraphy was 80.49 [95% confidence interval (CI): 68.36-92.62] and of SPECT/CT 95.12 (95% CI: 88.52-101.7). The total intraoperative SLN detection rate was 95.12 (95% CI: 88.52-101.7) per patient and 26.83 (95% CI: 19.91-33.75) bilaterally. The average number of SLNs removed was 1.6±0.8. The most common anatomical location of SLN was the right external iliac region. The SLN metastatic rate was 17%. Both sensitivity and negative predictive value regarding metastatic involvement were 100%. The SLN detection rate, sensitivity and negative predictive value using Tc-99m-SENTI-SCINT in patients with EC in our study were high. The application of ultra-staging in the histopathological analysis of SLN increases the detection of nodal metastases and improves the staging in these patients.

Predicting skip metastasis in lateral lymph nodes of papillary thyroid carcinoma based on clinical and ultrasound features.

Skip metastasis in papillary thyroid cancer (PTC), defined as lateral lymph node metastasis (LLNM) without the involvement of central lymph node metastasis (CLNM), is generally unpredictable. Our study aimed to develop a model to predict skip metastasis by using clinicopathological and ultrasound factors of PTC. We retrospectively reviewed the medical records of patients who underwent total thyroidectomy and central lymph node dissection (CLND) plus lateral lymph node dissection (LLND) between January 2019 and December 2021 at the First Affiliated Hospital of Soochow University. Furthermore, univariate and multivariate analyses assessed the clinical and ultrasound risk factors. Receiver operating characteristic (ROC) curves were used to find the optimal cut-off values for age and dominant nodule diameter. Multivariate logistic regression analysis results were used to construct a nomogram and were validated internally. In all patients, the skip metastasis rate was 15.4% (41/267). Skip metastasis was more frequently found in patients with a tumour size ≤10 mm (OR 0.439; P = 0.033), upper tumour location (OR 3.050; P=0.006) and fewer CLNDs (OR 0.870; P = 0.005). After analysing the clinical and ultrasound characteristics of the tumour, five factors were ultimately associated with lateral lymph node skip metastasis and were used to construct the model. These factors were an age >40 years, tumour diameter <9.1 mm, upper tumour location, non-smooth margin and extrathyroidal extension. The internally evaluated calibration curves indicated an excellent correlation between the projected and actual skip metastasis probability. The nomogram performed well in discrimination, with a concordance index of 0.797 (95% CI, 0.726 to 0.867). This study screened for predictors of skip metastasis in PTC and established a nomogram that effectively predicted the risk of potential skip metastasis in patients preoperatively. The method can predict and distinguish skip metastases in PTC in a simple and inexpensive manner, and it may have future therapeutic utility.

Factors Influencing Lymph Node Positivity in HER2/neu+ Breast Cancer Patients

Axillary lymph node metastases are a key prognostic factor in breast cancer treatment. Our aim was to evaluate how tumor size, tumor location, and imaging results correlate to axillary lymph node diseases for patients with stage I-III HER2/neu+ breast cancer. This is a single-institution retrospective chart review of female breast cancer patients diagnosed with primary invasive Her2/neu+ breast cancer who were treated with upfront surgical resection from 2000-2021. Of 75 cases, 44/75 (58.7%) had nodal metastasis, and there was a significant association of larger tumor size to nodal metastases (p ≤ 0.001). Patients with negative nodes had a smaller mean tumor size (n = 30; 15.10 mm) than patients with positive nodes (n = 45; 23.9 mm) (p = 0.002). Preoperative imaging detected suspicious nodes in 36 patients, and ultrasound detected the most positive nodes (14/18; p = 0.027). Our data confirms that tumor size at diagnosis is correlated with a higher likelihood of axillary involvement in patients with Her2/neu+ breast cancer; notably, a large proportion of Her2/neu+ breast cancers have metastatic involvement of axillary lymph nodes even with small primary lesions.

Surgical anatomy of the lingual lymph nodes: systematic literature analysis and proposition for topographic classification.

Metastatic involvement of the lingual lymph nodes (LLNs) in oral cavity squamous cell cancer (SCC) has recently been proven to significantly reduce locoregional control and survival. Despite recent refinements in the detection of these lesions, the understanding of the LLN topographic anatomy among clinicians is limited. A proposition of a topographic division on LLN based on a comprehensive literature search and synthesis may be helpful in this condition. A literature search and election based on contemporary PRISMA guidelines was performed for sources on LLN anatomy with special attention on their subdivision. Four topographic LLN subgroups were defined: median-between genioglossal and geniohyoid muscles; intermediate parahyoid-medial to the hyoglossal muscle, at the greater cornu of the hyoid bone; lateral sublingual (paraglandular) LLNs-at the sublingual salivary gland; lateral submandibular (paraglandular) LLNs -lateral to the hyoglossal muscle, at the deep surface of the submandibular salivary gland. The development and implementation of a unified anatomical topographic classification of LLN subgroups may be among the important conditions for improving the detection and treatment of LLN lesions.

Extension of lymph node dissection in the surgical treatment of esophageal and gastroesophageal junction cancer: seven questions and answers.

The role of two- or three-field nodal dissection in the surgical treatment of esophageal and gastroesophageal junction cancer in the minimally invasive era is still controversial. This review aims to clarify the extension of nodal dissection in esophageal and gastroesophageal junctional cancer. A basic evidence-based analysis was designed, and seven research questions were formulated and answered with a narrative review. Reports with little or no data, single cases, small series and review articles were not included. Three-field lymph node dissection improves staging accuracy, enhances locoregional disease control and might improve survival in the group of patients with cervical and upper mediastinal metastatic lymph nodal involvement from middle and proximal-third esophageal cancer.

Central Compartment Neck Dissection in Laryngeal and Hypopharyngeal Squamous Cell Carcinoma: Clinical Considerations.

Metastatic lymph node involvement represents the most relevant prognostic factor in head and neck squamous cell carcinomas (HNSCCs), invariably affecting overall survival, disease-specific survival, and relapse-free survival. Among HNSCCs, laryngeal and hypopharyngeal cancers are known to be at highest risk to metastasize to the central neck compartment (CNC). However, prevalence and prognostic implications related to the CNC involvement are not well defined yet, and controversies still exist regarding the occult metastasis rate. Guidelines for the management of CNC in laryngeal and hypopharyngeal cancers are vague, resulting in highly variable selection criteria for the central neck dissection among different surgeons and institutions. With this review, the authors intend to reappraise the existing data related to the involvement of CNC in laryngeal and hypopharyngeal malignancies, in the attempt to define the principles of management while highlighting the debated aspects that are lacking in evidence and consensus. Furthermore, as definition and boundaries of the CNC have changed over the years, an up-to-date anatomical-surgical description of the CNC is provided.

Immunological characteristics of primary tumor and bone marrow in patients with breast cancer

Introduction. The Implementation of immunotherapy in cancer requires a thorough analysis of the biological characteristics of the tumor. Therefore, the study of tumor immunophenotype is the leading scientific direction. Molecules of the major histocompatibility complex are considered as promising markers for evaluating the possibility of using immunotherapy. Objective. To study the immunophenotype of the primary tumor in molecular subtypes of breast cancer and analyze it depending on the frequency of bone marrow damage. Materials and methods. The study included 99 patients with breast cancer. Tumor tissue and bone marrow samples were studied. Stages: T1 (51.5%), T2 (44.4%), T3 (2.0%). Metastatic involvement of lymph nodes (N+) was noted in 39.4% (n = 39) of cases. Immunophenotyping of the tumor was carried out on cryostat sections by immunofluorescence. Antibodies to HLA-I, HLA-II, KL1, FITC-labeled F(ab2) antiserum fragments (Becton Dickinson, USA) were used. The bone marrow was studied by morphological (Zeiss microscope, Axioskop, Germany) and immunological methods (flow cytometry, FACS Canto II, USA), data analysis – Kaluza Analysis v2.1 software. Used monoclonal antibodies: CD45, EPCAM (Becton Dickinson, USA). Statistical data processing was performed using the IBM-SPSS Statistics 21 package. Results . The HLA-I antigen is absent or expressed by single tumor cells in 50.8% of cases of luminal breast cancer. Pronounced or partial expression was noted in 36.9% of cases. With the Erb-B2 subtype, all samples had the expression of antigens of the HLA-I class. Loss of HLA-I antigen or weak expression was observed in 30% (3/10) of cases of the triple-negative subtype, in the same percentage of cases the expression of HLA-II molecules was noted. There were no significant differences in the expression of HLA molecules between subtypes. Using flow cytometry, bone marrow involvement was detected in 40% (26/65) of cases. There were no significant relationships between bone marrow damage and the size of the primary tumor, stage, grade of breast cancer, or expression of HLA molecules. Conclusions. The expression of HLA molecules does not differ in significant differences depending on the biological subtype. The frequency of bone marrow damage did not depend on the expression of HLA-I, class II molecules.

SIGNIFICANCE OF ADC MEASUREMENTS AS RADIOLOGICAL MRI MARKER IN DETECTION OF METASTATIC LYMPH NODE INVOLVEMENT IN PATIENTS WITH PROSTATE CANCER.

In spite of significant advances in diagnosis of prostate cancer (PCa), thedetection and differential diagnosis of metastatic lymph node involvement remains an important clinical dilemma in a large number of cases. Contrast-enhanced abdominal computed tomography and magnetic resonance imaging (MRI), in part when using T1-weighed images (T1-WI and T2-WI), allow evaluating indirectly thepresence of invasion in regional lymph nodes by assessing their diameter and morphology. Nonetheless, these techniques do not appear to be sufficiently sensitive for direct identification of lymph nodes with metastatic lesions. To study thesignificance of theapparent diffusion coefficient (ADC) of diffusion-weighted MRI in detection of metastatic lymph node involvement in PCa patients. Thestudy involved 35patients with histologically verified PCa. Based on multiparametric prostatic MRI findings and pathomorphological reports, we have performed ADC measurements for pelvic lymph nodes either with (n = 15, mean size 1.78±0.59cm) or without metastases (n = 20, mean size: 0.94±0.06cm) in PCa patients who underwent radical prostatectomy with lymph node dissection. No significant diffe-rences were observed when comparing mean sizes of N+ and N- pelvic lymph nodes. At thesame time, when comparing mean ADC values for N+ and N- pelvic lymph nodes, we observed a statistically significant difference: 0.74±0.09 · 10-3mm2/s in metastatic lymph node vs 1.05±0.23 · 10-3mm2/s in lymph nodes without metastatic involvement (p<0.001). Theuse of ADC for diffusion-weighted MRI may provide valuable information for detection of metastatic lymph node involvement in patients with PCa.

Fluorescence-guided extended pelvic lymphadenectomy during robotic radical prostatectomy.

We evaluated and described the impact of prostatic indocyanine green (ICG) injection on extended pelvic lymph node (LN) dissection (ePLND) in robotic-assisted radical prostatectomy (RARP). Between January 2019 and December 2021, we included consecutive 50 PCa patients who underwent ePLND during RARP with (n = 25) or without (n = 25) prostatic ICG injection. ICG injection was performed during abdominal port placement and robot docking. Pelvic LNs reflecting green color were initially excised and then the template was completed. The outcomes of two groups were compared. Overall, nine (36%) and five (20%) of the patients had metastatic LN involvement in the ICG and non-ICG groups, respectıvely. Of the 509 dissected LNs in the ICG group, 122 (23.9%) were fluorescence active. 20 LNs (3.9%) were metastatic in this group, 9 (45%) of which were ICG+. 408 LNs were resected on the non-ICG group with 8(1.9%) being metastatic. Eight (88.9%) of nine pN+ patients were florescent positive in the ICG group. Out of six patients with pN+ disease,Ga68 PSMA-PET/CTdetected positive LNs preoperatively. In addition to preoperative Ga68 PSMA-PET/CT investigation, ICG-guided ePLND might increase identification and removal of metastatic LNs duirng RARP. Improvements ın stagıng and oncologıc outcomes may also be seen ın intermediate- and high-risk patients.

&lt;sup&gt;18&lt;/sup&gt;F-FDG PET/CT in the Diagnosis of Cervical Cancer

Positron emission tomography coupled with computed tomography (PET/CT) has proven to be highly informative in the diagnosis of various malignant tumours. PET/CT examination takes into account biological and morphological data, which allow accurate tumour localisation and full staging of the disease, respectively. Cervical cancer (CC) is one of the most common, high-mortality cancers in women. The effectiveness of CC treatment depends on early diagnosis, which is connected to the assessment of local tumour spread and metastatic lymph node involvement and to the detection of disease recurrence. The aim of the study was to analyse the possibility of using PET/CT with 18 F-FDG for the diagnosis of CC and the evaluation of treatment effectiveness. Additionally, the study aimed to analyse the potential of using other radiopharmaceuticals as biomarkers for the assessment of tumour response. Cervical malignancies are characterised by high glycolytic activity, which explains the superiority of 18 F-FDG PET/CT over other traditional imaging methods in comprehensive diagnosis of patients with CC and, especially, in detecting nodal involvement and distant metastases. Also, 18 F-FDG PET/CT plays an important part in the assessment of treatment effectiveness in CC patients. Further development of 18 F-FDG PET/CT potential in the visualisation of malignant cervical lesions is associated with investigating the possibilities of using other specific radiopharmaceuticals to obtain information about the biological processes that support tumour cell growth: metabolism, proliferative activity, and oxygenation.

ODP025 Adrenocortical Carcinoma: A Rare but Life-Threatening Malignancy

Abstract Introduction Adrenocortical carcinoma (ACC) is a rare malignancy of the adrenal glands, but often presents an aggressive behavior with variable prognosis. Median age of diagnosis is in the fifth to sixth decade of life with a median survival rate of 3-4 years. Complete surgical resection is the first line and only curative therapy. In patients with high-risk ACC, adjuvant therapy with mitotane, alone or in combination with other cytotoxic agents, may be used. Case description Case of a 33-year-old female with history of thyroid nodules presenting with a one year history of amenorrhea and hirsutism. One year prior to evaluation, the patient developed an intense right flank pain requiring abdominal-pelvic CT. It showed a solid heterogeneous right flank mass measuring 16×16×12 cm, 44Hounsfield units without enhanced contrast washout. Hormonal workup at that time resulted with DHEA-S &amp;gt; 10,000ng/mL(nl 350-4300), androstenedione 10.7 ng/mL (nl 0.35–2.78), total testosterone 3.21 ng/mL (nl &amp;lt; 0.52), midnight salivary cortisol at 14 nmol/L (nl &amp;lt; 3.6) and normal FSH, ACTH and serum morning cortisol. Staging chest CT exhibited bilateral pulmonary embolisms. Patient underwent right open total adrenalectomy of a necrotic/hemorrhagic mass measuring 20×16×9 cm with complete resection. Histology consistent with a low-grade ACC with a mitotic rate 18/50 HPF, with capsular invasion but no lymphovascular invasion and clear margins. It was stratified as stage T2N0M0. Immunohistochemistry's were positive for Melan-A, calretinin, synaptophysin, and inhibin. Ki67 was 80%. She was started on hydrocortisone replacement. PET/CT scan showed hypermetabolic focus at the right thyroid lobe (previously biopsied with benign findings), but otherwise no pathologic 18 FDG uptake related to known oncologic disease. Due to her high risk of recurrence, the patient was started on mitotane 2 g daily as adjuvant therapy but had to discontinue therapy after 1 month due to lack of availability. One year after initial presentation, she was evaluated at our clinics and after discussion with Oncology Service restarting mitotane was recommended. However, marked transaminitis was noted along with right abdominal discomfort. Abdominal MRI revealed hepatic hypo-enhancing masses suggestive of liver metastases, with the largest measuring 6.7cm. Patient underwent right partial hepatectomy and was found with extensive metastatic carcinoma and lymph node involvement. Therapy with mitotane was restarted, pending chemotherapy initiation. Conclusion The goal of any therapy for ACC is to alleviate symptoms and prolong survival. Mitotane, an adrenolytic drug used as palliative treatment, is among therapeutic options. Due to the rarity of the disease, data regarding its use is mixed due to limited randomized controlled trials. Nevertheless, it supports improvement in recurrence-free and possibly overall-survival after complete radical resection in stage I, II or III ACC. Unfortunately, there is still marked individual variation in outcomes. Presentation: No date and time listed

The Prognostic Value of Nodal Skip Metastasis in Patients with Esophageal Cancer: A Systematic Review and Meta-Analysis.

Esophageal cancer (EC) is the sixth leading cause of cancer deaths worldwide. Nodal skip metastasis (NSM), a common form of lymphatic spread in EC, can be defined as the metastatic involvement of distant lymph nodes (LNs) without prior involvement of adjacent LNs. The results of the previous studies investigating the association between NSM and survival outcomes in patients with EC were inconsistent and even contradictory. The aim of this systematic review and meta-analysis is to investigate the prognostic value of NSM and to summarize the NSM definitions of EC in previous studies. Four databases were used in this meta-analysis. The association between NSM and overall survival (OS) was evaluated by using pooled HRs and their 95% confidence interval (CI). The sensitivity analysis and funnel plot were used to assess the publication bias. Nine studies were included in this meta-analysis. The pooled results of meta-analysis indicated that there was no significant association between NSM and OS (HR = 0.99, 95% CI: 0.75-1.31; P = 0.951). Meanwhile, according to the results of sub-group analysis on the basis of histological feature, method of lymphadenectomy, node staging system, and NSM definitions, no significant association was found between NSM and OS. On the basis of available evidences, NSM could not be used as a prognostic factor for patients with EC. For future studies investigating the prognostic value of NSM, only three-field lymphadenectomy with adequate harvested LNs can be performed. NSM definitions based on lymph node station and anatomical compartment could both be feasible classification for EC.

Estimation of colon cancer grade and metastatic lymph node involvement using DWI/ADC sequences.

The potential benefit of neoadjuvant chemotherapy (NAC) in colon cancer is under evaluation. There is a need to improve preoperative non-invasive diagnostics using techniques that provide more accurate staging information in assessing patient eligibility for NAC. To investigate the link between the tumor grade (pathohistological confirmed) and the N status (corresponding to lymph node involvement) with apparent diffusion coefficient (ADC) values. A total of 17 patients planned for surgical resection had a biopsy confirming colon carcinoma and participated in the study. Abdominal magnetic resonance imaging with diffusion-weighted imaging/ADC sequence was recorded before surgery. The tumor and all visible lymph nodes were manually delineated directly on a grayscale ADC map for every single slice and detected to access the total tumor and summarized lymph node volume. The mean ADC value was further calculated for the mean tumor and mean lymph node values. Low-grade tumors had a mean ADC equivalent to 1225 ± 170×10-6 mm2/s, and the coefficient of high-grade tumors was 1444 ± 69×10-6 mm2/s. The group of patients with positive lymph nodes in operative tissue samples (N+) exhibited lower mean ADC values (1023 ± 142×10-6 mm2/s) as opposed to the group without metastatic lymph nodes (N-) with ADC values of 1260 ± 231×10-6 mm2/s. The mean whole-tumor ADC is associated with the histological tumor grade, and the mean ADC value of whole-volume abdominal lymph nodes could assume real nodal infiltration.

Early gastric cancer.

Early gastric cancer is defined histopathologically as a tumour with limited local progression to the mucosa and submucosa. The concept of early cancer was developed in the 1960s in Japan and is now widely accepted. The term of early gastric cancer included cases with/without metastatic lymph node involvement. However, a common characteristic is a favourable prognosis of the disease. The task of the endoscopist is primarily to diagnose (identify) the tumour (precancerous lesions) and to verify it by biopsy. Successful identification must be followed by its correct classification, leading to the choice of an adequate approach, which includes surveillance, endoscopic treatment (resection) or surgical treatment (with or without chemotherapy). The method of treatment is determined primarily by the nature or risk of lymph node involvement.

Persistent lymph nodes after curative chemoradiotherapy for head and neck cancer: imaging predictors of response for decision-making.

To identify response predictors in patients with head and neck squamous cell carcinoma (N + HNSCC) and persistent lymph nodes after curative chemoradiotherapy treatment (CCRT). Consecutive patients with N + HNSCC treated with CCRT and persistent lymph nodes at first follow-up between 2015 and 2021 were identified and analyzed. Complete response was defined as the absence of lymph node metastatic involvement in patients with salvage lymphadenectomy or the absence of progression after 1 year of successive follow-ups. Tumour type and location, staging, and human papillomavirus (HPV) status were considered for analysis. The number and size of lymph nodes, type, shape, enhancement and margins on diagnostic and follow-up CT were also analyzed. The cohort included 46 patients with 134 pathological lymph nodes. Logistic regression models showed the following variables to be significant: performance of salvage lymphadenectomy (OR 0.094, [CI 95% 0.004-0.61], p = 0.037); the type of lymphadenopathy on diagnostic CE-CT (solid vs. cystic) (N1: OR = 4.11, [CI 95% 1.11-17.93], p = 0.042 and N3: OR 6.42, [CI 95% 1.2-42.56], p = 0.036); the change of shape (round to oval) on the follow-up CE-CT (OR 9.76, [CI 95% 1.79-8.57], p = 0.016) and the time in days between CCRT and the first follow-up CE-CT (OR 1.06, [CI 95% 1.004-1.13], p = 0.048). In our experience, the presence of solid lymph nodes on pre-treatment CT and the change in shape from round to oval on post-treatment CT are predictors of response to treatment in patients with N + HNSCC persistent lymph nodes after CCRT. Increasing the temporal interval between treatment and follow-up CT should be considered to avoid unnecessary nodal dissections.

Use of positron emission tomography/ computed tomography in the initial staging of head and neck squamous cell carcinoma: Accuracy in evaluation of the primary site of the tumor, metastases to cervical lymph nodes, and distant metastases.

Our study aimed to evaluate the use of positron emission tomography/computed tomography (PET/CT) in the initial staging of head and neck squamous cell carcinoma (HNSCC), including assessment of local and distant spread of the disease. We also aimed to compare the accuracy of PET/CT in the evaluation of human papillomavirus (HPV) positive and HPV-negative oropharyngeal carcinoma. This single-center, prospective study was conducted between August 2016 and September 2021. A total of 198 patients with HNSCC who underwent PET/CT within the primary staging were included. We compared PET/CT results with histological findings. We calculated the accuracy, sensitivity, specificity, and positive and negative predictive values to assess the primary tumor, cervical lymph nodes, and distant metastases. PET/CT showed a high success rate (32%) in revealing the primary site of carcinoma of unknown primary (CUP). The accuracy of PET/CT in displaying the primary tumor, cervical lymph node metastases, and distant metastases was 89.4%, 85.4%, and 87.4%, respectively. The method provided high sensitivity but lower specificity in all three areas. Specifically, PET/CT showed low specificity in the assessment of small tumors (75%), metastatic involvement of cervical lymph nodes (69.6%), and HPV-positive oropharyngeal carcinoma (55.6%). The high accuracy of PET/CT to identify distant metastases and whole-body staging in one diagnostic step accelerated primary staging and resulted in earlier commencement of therapy. However, it also led to an overestimation of clinical findings and thus to extensive surgical treatment, especially in patients with small tumors, metastatic involvement of cervical lymph nodes, and HPV- positive oropharyngeal carcinoma. PET/CT is also useful for CUP diagnostics.

OA11.03 Nonregional Lymph Nodes as the Only Metastatic Site in Stage IV Non-Small Cell Lung Cancer: A Marker of Better Prognosis

Metastatic involvement of nonregional lymph nodes is currently a stage IV determinant (M1b) for non-small cell lung cancer (NSCLC). However, the management and outcome of patients whose distant disease is limited to nonregional lymph nodes is unknown.

Ultrasound patterns of metastases from papillary thyroid cancer in soft tissues of the neck

Purpose of the study. To assess ultrasound features and patterns of features for metastatic papillary thyroid cancer (PTC) in soft tissues of the neck.Materials and methods. The study included 335 histologically confirmed metastases and 102 benign lymph nodes (LN). Statistical processing was carried out in the SPSS program. The reliability between the groups was assessed by criterion t with a significance level of p &lt; 0.05. The informative value of ultrasound signs and patterns of signs, and the probability of the presence of metastasis using binary logistic regression are calculated.Results. The 14 criteria for metastasis have been studied. There are 33 signs, i.e. types of criteria. During the statistical analysis, six most informative criteria were established: calcifications, contours, shape, depth-to-width ratio in the transverse scanning plane, state (differentiation) of the cortical and cerebral layers, echostructure. To create complexes (patterns) of ultrasonic signs, a combination of these signs was used among themselves, and five patterns were established. The first pattern, including the depth-to-width ratio in the transverse scanning plane and the echo structure, has a sensitivity (Se) of 97 %, diagnostic accuracy (Ac) of 96.5 %, area under the curve (AUC) of 96 %, the probability ranges from 95 to 99 %. The Se of the second pattern, including the ratio of depth to width in the transverse scanning plane, echostructure and shape, was 97.2 %, Ac – 96.8 %, AUC – 97.3 %, probability – 95–100 %. The third pattern, including the ratio of depth to width in the transverse scanning plane, nature, shape and contours, and the fourth pattern, including the following criteria, the ratio of depth to width in the transverse scanning plane, echostructure, shape, contours and differentiation into cortical and cerebral layers, have Se 96.9 %, Ac – 97.1 %, AUC – 98.7 %, probability – 88–100 %. The fifth pattern, including the ratio of depth to width in the transverse scanning plane, echostructure, shape; contours; state (differentiation) of the cortical and cerebral layers; calcinates, has Se – 99.6 %, Ac – 99.5 %, AUC – 99.9 %, probability – 94–100 %.Conclusion. Five patterns of metastatic involvement of lymph nodes in PTC were found. The informative value of US increased from the first to the fifth pattern achieving a Se of 99.6 %, Ac of 99.5 %, AUC of 99.9 %. The probability ranged from 94 % to 100 %.

Computer-aided diagnostic models to classify lymph node metastasis and lymphoma involvement in enlarged cervical lymph nodes using PET/CT.

It is a clinical problem to identify histological component in enlarged cervical lymph nodes, particularly in differentiation between lymph node metastasis and lymphoma involvement. To construct two kinds of deep learning (DL)-based computer-aided diagnosis (CAD) systems including DL-convolutional neural networks (DL-CNN) and DL-machine learning for pathological diagnosis of cervical lymph nodes by positron emission tomography (PET)/computed tomography (CT) images. We collected CT, PET, and PET/CT images series from 165 patients with enlarged cervical lymph nodes receiving examinations from January 2014 to June 2018. Six CNNs pretrained on ImageNet as DL architectures were used for two kinds of DL-based CAD models, including DL-CNN and DL-machine learning models. The DL-CNN models were constructed via transfer learning for classification of lymphomatous and metastatic lymph nodes. The DL-machine learning models were developed by DL-based features extractors and support vector machine (SVM) classifier. As for DL-SVM models, we also evaluate the effect of handcrafted radiomics features in combination of DL-based features. The DL-CNN model with ResNet50 architecture on PET/CT images had the best diagnostic performance among all six algorithms with an area under the receiver operating characteristic curve (AUC) of 0.845 and accuracy of 78.13% in the testing cohort. The DL-SVM model on ResNet50 extractor showed great performance for the testing cohort with an AUC of 0.901, accuracy of 86.96%, sensitivity of 76.09%, and specificity of 94.20%. The combination of DL-based and handcrafted features yielded the improvement of diagnostic performance. Our DL-based CAD systems on PET/CT images were developed for classifying metastatic and lymphomatous involvement with favorable diagnostic performance in enlarged cervical lymph nodes. Further clinical practice of our systems may improve quality of the following therapeutic interventions and optimize patients' outcomes.