Nodal Level Research Articles

Network signatures of nuclear and cytoplasmic density alterations in a model of pre and postmetastatic colorectal cancer

Cells contributing to the pathogenesis of cancer possess cytoplasmic and nuclear structural alterations that accompany their aberrant genetic, epigenetic, and molecular perturbations. Although it is known that architectural changes in primary and metastatic tumor cells can be quantified through variations in cellular density at the nanometer and micrometer spatial scales, the interdependent relationships among nuclear and cytoplasmic density as a function of tumorigenic potential has not been thoroughly investigated. We present a combined optical approach utilizing quantitative phase microscopy and partial wave spectroscopic microscopy to perform parallel structural characterizations of cellular architecture. Using the isogenic SW480 and SW620 cell lines as a model of pre and postmetastatic transition in colorectal cancer, we demonstrate that nuclear and cytoplasmic nanoscale disorder, micron-scale dry mass content, mean dry mass density, and shape metrics of the dry mass density histogram are uniquely correlated within and across different cellular compartments for a given cell type. The correlations of these physical parameters can be interpreted as networks whose nodal importance and level of connection independence differ according to disease stage. This work demonstrates how optically derived biophysical parameters are linked within and across different cellular compartments during the architectural orchestration of the metastatic phenotype.

Prospective study of 583 neck dissections in oral cancers: Implications for clinical practice

Determining the level of nodal metastases may help decrease the extent of neck dissections and reduce morbidity. A prospective study of neck dissections in patients with oral cancer was conducted. Each nodal level was delineated, sent for histopathology, and reported level-wise. Incidence of overall and isolated metastatic nodes at different levels was calculated. Logistic regression was used to find factors predicting metastases to levels IIB and V. Five hundred eighty-three neck dissections were prospectively evaluated. A total of 95.7% metastases occurred at levels I to IV. Overall incidence of metastases to levels IIB and V was 3.8% and 3.3%, respectively. Multivariate analysis revealed IIA positivity as an independent predictive factor for metastases to both IIB and V. This study of lymph node mapping in patients with oral cancer showed a predictable pattern of lymph node metastasis according to primary site. Selective neck dissection (levels I-IV) in patients with oral cancers may be adequate. Determining status of level IIA is important to guide dissection of levels IIB and V.

Novel luteolytic mechanisms in equine corpora lutea: the role of Nodal signaling pathway and its interaction with Tumor necrosis factor alpha, Interferon gamma and Fas ligand

Novel luteolytic mechanisms in equine corpora lutea: the role of Nodal signaling pathway and its interaction with Tumor necrosis factor alpha, Interferon gamma and Fas ligand

Incidence and location of positive nonsentinel lymph nodes in head and neck melanoma

The complex lymphatic drainage in the head and neck makes sentinel lymph node biopsy (SLNB) for melanomas in this region challenging. This study describes the incidence, and location of additional positive nonsentinel lymph nodes (NSLN) in patients with cutaneous head and neck melanoma following a positive SLNB. A retrospective review was performed using a single institution prospective database. Patients with a primary melanoma in the head or neck with a positive cervical SLNB were identified. The lymphadenectomy specimen was divided intraoperatively into lymph node levels I-V, and NSLN status determined for each level. Of 387 patients with melanoma of the head and neck who underwent cervical SLNB, 54 had a positive SLN identified (14%). Thirty six patients (67%) underwent immediate completion lymph node dissection (CLND) of whom eight patients (22%) had a positive NSLN. The remaining 18 patients (33%) did not undergo CLND and were observed. Half of positive NSLNs (50%) were in the same lymph node level as the SLN and 33% were in an immediately adjacent level; only two patients were found to have NSLNs in non-adjacent levels. The only factor predictive of NSLN involvement was the size of the tumor deposit in the SLN>0.2mm (p=0.05). Superficial parotidectomy at CLND revealed metastatic melanoma only in patients with a positive parotid SLN. A positive NLSN was identified in 22% of patients undergoing CLND after a positive SLNB. The majority of positive NSLNs are found within or immediately adjacent to the nodal level containing the SLN.

Occult nodal disease in patients with failed laryngeal preservation undergoing surgical salvage

The primary objective was to determine the incidence of pathologically positive lymph nodes in clinically N0 larynx cancer patients undergoing salvage surgery following nonsurgical primary therapy. Secondary aims included assessment of the impact of laryngeal subsite and neck dissection on disease status and survival. Retrospective chart review. Sixty-eight patients with recurrent laryngeal cancer and no evidence of neck disease who underwent salvage laryngectomy and neck dissection after undergoing failed primary radiotherapy or chemoradiation were examined. Main outcome measures included: standard demographics, primary, clinical, radiologic, and pathologic recurrent TNM stage, laryngeal subsite, nodal neck level, surgical intervention, margin status, disease status, survival, and imaging results. Fifty-three men and 15 women, aged 33 to 88 years (mean=62.7 years) with recurrent laryngeal cancer were included. Overall, 28.3% of patients had pathologic nodal disease, with supraglottic cancer showing the highest rate (60%, P=.02). Survival was not associated with laryngectomy type (P=.35). However, on multivariate analysis, laryngeal subsite was significantly predictive of survival with transglottic recurrences demonstrating decreased mean survival (20.7 months, P=.02), and supraglottic recurrences demonstrating prolonged mean survival (37.1 months, P=.03). Metabolic imaging (negative predictive value=0.86) proved more reliable than anatomic imaging (negative predictive value=0.71). The incidence of pathologically positive lymph nodes in clinically negative patients with recurrent laryngeal carcinoma following nonsurgical therapy warrants standard selective neck dissection. Subsite of recurrence, specifically supraglottis and transglottis, correlates with pathologic neck node positivity and survival. Metabolic imaging proved more reliable than anatomic imaging in negative predictability for nodal disease. 4.

Accurate Prediction of Nodal Status in Preoperative Patients with Pancreatic Ductal Adenocarcinoma Using Next-Gen Nanoparticle

OBJECTIVE: The objective of this study is to assess lymphotropic nanoparticle-enhanced magnetic resonance imaging (LNMRI) in identifying malignant nodal involvement in patients with pancreatic ductal adenocarcinoma. METHODS: Magnetic resonance imaging was performed in 13 patients with known or high index of suspicion of pancreatic cancer and who were scheduled for surgical resection. Protocols included T2*-weighted imaging before and after administration of Ferumoxytol (Feraheme) for the evaluation of lymph node involvement. Eleven of the 13 patients underwent a Whipple procedure and lymph node dissection. Nodes that lacked contrast uptake were deemed malignant, and those that demonstrated homogeneous uptake were deemed benign. RESULTS: A total of 264 lymph nodes were resection, of which 17 were malignant. The sensitivity and specificity of LNMRI was 76.5% and 98.4% at a nodal level and 83.3% and 80% at a patient level. CONCLUSION: LNMRI demonstrated high sensitivity and specificity in patients with pancreatic ductal adenocarcinoma.

Volumes cibles en radiothérapie des adénopathies cervicales de primitif inconnu : état des lieux et pistes vers une approche sélective raisonnée sous l’égide du Refcor (Réseau d’expertise français des cancers ORL rares)

The treatment of carcinomas of unknown primary revealed by cervical lymphadenopathy is based on neck dissection and nodal and pan-mucosal irradiation to control the neck and avoid the emergence of a metachronous primary. The aim of this review was to assess diagnostic and therapeutic approaches and criteria that may be used for a customized selective approach to avoid severe toxicities of pan-mucosal irradiation. A literature search was performed with the following keywords: cervical lymphadenopathy, unknown primary, upper aerodigestive tract, cancer, radiotherapy, squamous cell carcinoma, variants. The diagnostic workup includes a head and neck scanner or MRI, (18F)-FDG PET CT, a panendoscopy and tonsillectomy. Squamous cell carcinoma represents over two thirds of cases. The number of metastatic cervical nodes, nodal level, and histological variant (associated with HPV/EBV status) may determine the primary site origin and might be weighted for the determination of radiation target volumes on a multidisciplinary basis. A selective customized approach is relevant to decrease radiation toxicity only if neck and mucosal control is not impaired. Although no recommendation can yet be made in the absence of sufficient level of evidence, the relevance of systematic pan-mucosal irradiation appears questionable in a number of clinical situations. Accordingly, a customized selective redefinition of target volumes may be discussed and be prospectively evaluated in relation to the therapeutic index obtained.

Risk of Lymph Node Metastasis and Nodal Level Involvement Based on Site and Histology in the Paranasal Sinus: A SEER Analysis

The risk of nodal involvement in patients with cancer of the nasal cavity and paranasal sinuses has not been well defined. Current decision-making on whether to cover specific nodal regions is based on interpretation of single-institution retrospective analyses.

The role of SHP-1 promoter 2 hypermethylation detection of lymph node micrometastasis in resectable stage I non-small cell lung cancer as a prognostic marker of disease recurrence

Despite adequate surgical management of stage I non-small cell lung cancer (NSCLC), many patients still relapse. Nodal micrometastases which cannot be detected by the standard hematoxylin and eosin (H&E) method are the postulated mechanism. We conducted a study of an epithelial-specific methylation marker, SHP-1 promoter 2 (SHP1P2) methylation, as a potential molecular marker to determine its association with a high risk of disease relapse. Lymph nodes from stage II-IIIA NSCLC patients were examined to explore the potential role of SHP1P2 methylation in detecting metastatic carcinoma according to H&E staining. Further study was done in lymph nodes from stage I NSCLC patients who underwent curative resection and follow-up at The King Chulalongkorn Memorial Hospital, Bangkok, Thailand. No adjuvant treatment was given, according to the standard treatment in that stage. Patients who relapsed within 40 months after resection were defined as high risk. The nodal SHP1P2 methylation level from stage II-IIIA NSCLC patients was significantly higher in the metastasis group, median 674 [0-3536] ng, compared with the no metastasis group, median 230 [0-3832] ng (p = 0.004). One-hundred and ninety-eight lymph nodes from stage I NSCLC patients were analyzed, including hilar and mediastinal nodes. With a median follow-up period of 65 [46-109] months, high SHP1P2 methylation levels of more than 140 ng in hilar lymph nodes were associated with early relapse, with sensitivity and specificity of 85 and 54 %, respectively (hazard ratio 5.3; 95 % confidence interval 5.0-5.6; p < 0.0001). A high level of SHP1P2 methylation of hilar lymph nodes from stage I NSCLC patients is associated with early relapse of disease.

Phase II study of de-intensification of radiation and chemotherapy for low-risk HPV-related oropharyngeal squamous cell carcinoma.

TPS6097 Background: The prognosis is excellent for low-risk human papillomavirus (HPV) associated oropharyngeal squamous cell carcinoma (OPSCC). Current standard chemoradiotherapy (CRT) regimens cure most patients but cause significant acute (mucositis) and long-term toxicities (xerostomia and dysphagia). Toxicity is primarily determined by the dose of radiotherapy and the intensity of chemotherapy. The aim of this study is to evaluate the pathological complete response (pCR) rate of low-risk HPV-associated OPSCC after de-intensified CRT. Methods: The major inclusion criteria are: 1) T0-T3, N0-N2c, M0, 2) HPV or p16 positive, and 3) &lt;/= 10 pack-years smoking history. Patients receive 60 Gy of intensity modulated radiotherapy (IMRT) with concurrent weekly intravenous cisplatinum (30 mg/m2). CT scans are obtained 4 to 8 weeks after completion of CRT to assess response. All patients have a surgical resection of any clinically apparent residual primary tumor or biopsy of the primary site if there is no evidence of residual tumor and a selective neck dissection to encompass at least those nodal level(s) that were positive pre-treatment, within 4 to 14 weeks after CRT. Longitudinal assessments of quality of life (EORTC QLQ-C30 &amp; H&amp;N35, NDII), patient reported outcomes (PRO-CTCAE, EAT-10), and swallowing evaluations (modified barium swallow) are obtained prior to, during, and after CRT. The primary endpoint of this study is the rate of pCR after CRT. The null hypothesis is that the pCR rate for de-intensified CRT is at least 87%, the historical rate (based on the reported 3-year local regional control rate of 87% in the RTOG 0129). Power computations were performed for N=40, with a type I error of 14.2% if the true pCR rate is 0.87. The study will be done in 3 stages with 15+15+10 patients with interim analyses at 15 and 30 patients. The trial will be stopped if the pCR rate is &lt;/= 9/15 and 21/30. The null hypothesis will be accepted if the pCR rate is &gt;/= 33/40. Clinical trial information: NCT01530997.

The Reproducibility of Patient Setup for Head and Neck Cancers Treated with Image-Guided and Intensity-Modulated Radiation Therapies Using Thermoplastic Immobilization Device

The reproducibility of patient setup is an important issue for head and neck cancers treated with intensity-modulated radiation therapy (IMRT). In this study, an image-guided radiation therapy (IGRT) system has been used to minimize the uncertainty of patient setup while standard thermoplastic masks were used to provide adequate immobilization for the head and neck. However, they do not provide sufficient immobilization of the shoulders, which is an important requirement in comprehensive nodal irradiation. Therefore, we investigated the setup and rotational shifts in head and neck cancer patients undergoing IMRT for which this immobilization device had been used together with an IGRT system. The setup and rotational shifts of patients were analyzed using the ExacTrac X-ray 6D IGRT system. The patients were classified as having head and neck tumors in the upper or lower regions. The upper neck nodes included lymph nodal level II while the lower neck nodes included lymph nodal levels III and IV. Clinical data from 227 treatment sessions of 12 head and neck cancer patients were analyzed. The random translational error in inter-and intra-fraction errors of the anterio-posterior (AP) direction might influence the rotational errors of pitch and roll in the upper region. At the same time, the random translational error in the inter-and intra-fraction errors of the AP direction might influence the rotational error of roll in the lower region. We believe that these random translational errors should be considered during treatment. We found variability in random translational errors for different regions in the anatomy of head and neck cancer patients due to rotational shifts. Depending on the location of the primary lesion or the selected nodal treatment targets, these relative positional variations should be considered when setup and rotational shifts are corrected with IGRT systems before treatment.

Proposed Lymph Node Staging System Using the International Consensus Guidelines for Lymph Node Levels Is Predictive for Nasopharyngeal Carcinoma Patients From Endemic Areas Treated With Intensity Modulated Radiation Therapy

To propose a lymph node (N) staging system for nasopharyngeal carcinoma (NPC) based on the International Consensus Guidelines for lymph node (LN) levels and MRI-determined nodal variables. The MRI scans and medical records of 749 NPC patients receiving intensity modulated radiation therapy with or without chemotherapy were retrospectively reviewed. The prognostic significance of nodal level, laterality, maximal axial diameter, extracapsular spread, necrosis, and Union for International Cancer Control/American Joint Committee on Cancer (UICC/AJCC) size criteria were analyzed. Nodal level and laterality were the only independent prognostic factors for distant failure and disease failure in multivariate analysis. Compared with unilateral levels Ib, II, III, and/or Va involvement (hazard ratio [HR] 1), retropharyngeal lymph node involvement alone had a similar prognostic value (HR 0.71; 95% confidence interval [CI] 0.43-1.17; P=.17), whereas bilateral levels Ib, II, III, and/or Va involvement (HR 1.65; 95% CI 1.06-2.58; P=.03) and levels IV, Vb, and/or supraclavicular fossa involvement (HR 3.47; 95% CI 1.92-6.29; P<.01) both significantly increased the HR for distant failure. Thus we propose that the N category criteria could be revised as follows: N0, no regional LN metastasis; N1, retropharyngeal lymph node involvement, and/or unilateral levels Ib, II, III, and/or Va involvement; N2, bilateral levels Ib, II, III, and/or Va involvement; N3, levels IV, Vb, and/or supraclavicular fossa involvement. Compared with the 7th edition of the UICC/AJCC criteria, the proposed N staging system provides a more satisfactory distinction between the HRs for regional failure, distant failure, and disease failure in each N category. The proposed N staging system defined by the International Consensus Guidelines and laterality is predictive and practical. However, because of no measurements of the maximal nodal diameter on MRI slices, the prognostic significance of LN size needs further evaluation.

Intensity Modulated Radiation Therapy and Level 1B Nodal Coverage for Oropharyngeal Carcinoma

The rate of pathologic level IB lymph node involvement in clinically node negative oropharyngeal cancer is very low, ranging from 0 to 3%. It is controversial whether or not this nodal level should be included in intensity modulated radiation therapy (IMRT) plans. Common practice is to irradiate at least the ipsilateral IB level. However, elective irradiation of level IB increases dose to the larynx, oral cavity, and mandible, potentially increasing acute and long-term toxicity. This study reports regional control rates and long-term toxicity for employing a policy of withholding radiation to the level IB lymph nodes unless clinically indicated.

Lymph node metastasis between sternocleidomastoid and sternohyoid muscle in clinically node‐positive papillary thyroid carcinoma

There have been few reports on lymph node metastasis between sternocleidomastoid and sternohyoid muscle (originally LNSS) in clinically node positive (cN+) papillary thyroid carcinoma (PTC). Therefore, our objective was to investigate the significance of LNSS metastasis. A total of 115 patients with cN+ PTC underwent a neck dissection with LNSS, as a separate pathologic specimen to be analyzed for the correlation between LNSS and sex, age, tumor size, tumor site, initial or reoperative treatment, lateral cervical lymph nodes, and central compartment metastasis. The positive rate of LNSS was 22.6%. LNSS metastasis was correlated with a primary site in the inferior pole, the lateral nodal metastasis, level III and level IV nodal metastasis, but not with other clinical parameters. In cN+ PTC, especially a primary site in the inferior pole, level III and/or level IV metastasis, attention should be given to excising the nodal tissue in LNSS.

Analysis of PET for Nodal Metastasis following Radiotherapy

Objective: 1) Determine the ability of PET scan to predict pathologically positive nodes in patients with persistent nodal disease following radiation with or without chemotherapy. 2) Evaluate whether performing a single level neck dissection is feasible in patients with persistent nodal disease. Method: Study design: Retrospective analysis. Setting: Tertiary care center. Patients were evaluated with PET after definitive (chemo) radiation and before neck dissection. The SUV of PET-positive nodes were recorded and compared to pathology reports of subsequent neck dissections. Data regarding follow-up, recurrence rates, and survival of these patients was recorded. Results: When compared to pathology reports, post-radiation PET scans failed to identify positive nodes in 4/11 separate cervical levels (sensitivity of 63.6%, P = .005). It successfully identified 33/40 negative neck levels (specificity of 82.5%, P = .005). This data suggest that PET scan alone may be inadequate for predicting pathologically positive nodal levels for persistent neck disease after (chemo) radiation. It was also shown that 6/13 (46.2%) nodal levels with SUV greater than 3 on PET scan were pathologically positive. Conversely, a PET negative nodal level with SUV less than 3 had a 27.3% chance (3/11) of being found positive upon pathologic evaluation. Conclusion: While the relatively high specificity demonstrated here may help support the case for selective neck dissection when PET shows positive nodes, the low sensitivity makes it difficult to exclude PET negative levels from the planned dissection. Larger prospective studies are needed to confirm these findings.

Poster - Thur Eve - 66: A planning comparison between RapidArc and intensity modulated radiotherapy for head and neck cancer.

Volumetric modulated arc therapy (VMAT) has recently been used to improve the dose distribution and efficiency of treatment delivery over the standard intensity-modulated radiotherapy (IMRT) technique. This study compares the dosimetry between RapidArc plan and standard IMRT plan for head and neck cancer. Three head and neck patients treated clinically with sliding window intensity-modulated radiotherapy (IMRT) technique at Grand River Regional Cancer Center were selected randomly and re-planned using RapidArc technique with 6 MV photon beams generated by a Varian 21EX linac with 120-leaf multileaf collimator. Three dose prescriptions were used to deliver 70 Gy, 63 Gy and 58.1 Gy to the regions of the primary tumors, intermediate-risk nodes and low-risk nodal level, respectively, in 35 fractions. Dosimetric comparison based on the dose-volume histogram, target coverage, organ at risk (OAR) dose sparing were studied between the RapidArc plan and IMRT plan. RapidArc technique from Varian Medical Systems showed superior target coverage, better OAR sparing, fewer monitor units per fraction with less treatment time over IMRT technique for head and neck cancers. The average homogeneity index, defined as the difference between the percentage dose covering 5% and 95% of the PTV, is 9.5 for RapidArc plan and 10.5 for IMRT plan. All RapidArc plans met the dose objectives for the primary OAR: spinal cord, brainstem, brain etc. Both parotid mean dose and D50% are lower for RapidArc plan than those of the IMRT plan. The technique is currently being used clinically at our cancer center.

187 IS [11C]CHOLINE PET/CT RECOMMENDED FOR RESTAGING PROSTATE CANCER PATIENTS AFTER RADICAL PROSTATECTOMY WHEN PSA IS LOWER THAN 1 NG/ML?

You have accessJournal of UrologyProstate Cancer: Staging I1 Apr 2012187 IS [11C]CHOLINE PET/CT RECOMMENDED FOR RESTAGING PROSTATE CANCER PATIENTS AFTER RADICAL PROSTATECTOMY WHEN PSA IS LOWER THAN 1 NG/ML? Manuela Tutolo, Alberto Briganti, Nazareno Suardi, Andrea Gallina, Firas Abdollah, Rita Garcia Parra, Maria Picchio, Giampiero Giovacchini, Luigi Gianolli, Maria Cristina Messa, Ettore Di Trapani, Giuseppe Zanni, Niccolò Maria Passoni, Nicola Fossati, Giorgio Guazzoni, Patrizio Rigatti, and Francesco Montorsi Manuela TutoloManuela Tutolo Milan, Italy More articles by this author , Alberto BrigantiAlberto Briganti Milan, Italy More articles by this author , Nazareno SuardiNazareno Suardi Milan, Italy More articles by this author , Andrea GallinaAndrea Gallina Milan, Italy More articles by this author , Firas AbdollahFiras Abdollah Milan, Italy More articles by this author , Rita Garcia ParraRita Garcia Parra Milan, Italy More articles by this author , Maria PicchioMaria Picchio Milan, Italy More articles by this author , Giampiero GiovacchiniGiampiero Giovacchini Milan, Italy More articles by this author , Luigi GianolliLuigi Gianolli Milan, Italy More articles by this author , Maria Cristina MessaMaria Cristina Messa Milan, Italy More articles by this author , Ettore Di TrapaniEttore Di Trapani Milan, Italy More articles by this author , Giuseppe ZanniGiuseppe Zanni Milan, Italy More articles by this author , Niccolò Maria PassoniNiccolò Maria Passoni Milan, Italy More articles by this author , Nicola FossatiNicola Fossati Milan, Italy More articles by this author , Giorgio GuazzoniGiorgio Guazzoni Milan, Italy More articles by this author , Patrizio RigattiPatrizio Rigatti Milan, Italy More articles by this author , and Francesco MontorsiFrancesco Montorsi Milan, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.239AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES [11C]choline PET/CT is currently recommended in restaging prostate cancer (PCa) patients previously treated with radical prostatectomy (RP) when prostate-specific antigen (PSA) values are higher than 1 ng/mL. The role of clinical and pathological variables in patients with lower PSA values to detect early PC recurrences by [11C]choline PET/CT was investigated. METHODS A total of 72 patients (mean age: 66 years, range: 51-80 years), treated with RP for PCa, who showed during follow-up (FU) a mild increase (< 1 ng/mL) of PSA serum levels (mean PSA: 0,57 ng/mL, range: 0,22-0,99 ng/mL) were retrospectively evaluated. Inclusion criterion was previous RP treatment and biochemical failure, defined as at least two consecutive PSA measurements greater than 0,2 ng/mL. [11C]choline PET/CT findings were validated using histological and follow-up clinical and imaging criteria in all cases. In order to identify predictive factors of a positive [11C]choline PET/CT, Cox regression analyses was using the following variables: age, Gleason Score, TNM staging, time from RP to the biochemical relapse, anti-androgen therapy at the time of [11C]choline PET/CT scan, trigger PSA value, PSA doubling time (PSADT) and PSA velocity (PSAV). RESULTS [11C]choline PET/CT suggested the presence of recurrences in 17/72 patients (23,6%): 6/17 (35,3%) in prostatectomy bed; 6/17 (35,3%) at lymph nodal level and 5/17 (29,4%) in the skeleton. At Cox regression analyses performed in patients with PSA increase < 1 ng/mL, only advanced pathological stage and short PSADT were significant (P < 0.05) predictors of positive [11C]choline PET/CT. CONCLUSIONS [11C]choline PET/CT can be useful in patients with PSA < 1 ng/mL, reporting a detection rate of recurrent disease in 24% of patients. Patients with PSA increase < 1 ng/mL after radical prostatectomy may be referred to [11C]choline PET/CT when advanced pathological stage and short PSADT occur. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e78-e79 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Manuela Tutolo Milan, Italy More articles by this author Alberto Briganti Milan, Italy More articles by this author Nazareno Suardi Milan, Italy More articles by this author Andrea Gallina Milan, Italy More articles by this author Firas Abdollah Milan, Italy More articles by this author Rita Garcia Parra Milan, Italy More articles by this author Maria Picchio Milan, Italy More articles by this author Giampiero Giovacchini Milan, Italy More articles by this author Luigi Gianolli Milan, Italy More articles by this author Maria Cristina Messa Milan, Italy More articles by this author Ettore Di Trapani Milan, Italy More articles by this author Giuseppe Zanni Milan, Italy More articles by this author Niccolò Maria Passoni Milan, Italy More articles by this author Nicola Fossati Milan, Italy More articles by this author Giorgio Guazzoni Milan, Italy More articles by this author Patrizio Rigatti Milan, Italy More articles by this author Francesco Montorsi Milan, Italy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The Impact of 18F-FDG PET CT Prior to Chemoradiotherapy for Stage III/IV Head and Neck Squamous Cell Carcinoma

Introduction. To determine the value of a FDG-PET-CT scan in patients with locally advanced head and neck squamous cell carcinoma (HNSCC) prior to chemoradiotherapy. Materials and Methods. Consecutive patients with stage III or IV HNSCC who had undergone a staging FDG-PET-CT scan prior to chemoradiotherapy between August 2008 and April 2011 were included. Clinical details and conventional imaging (CT and/or MRI) were, retrospectively, reviewed, a TNM stage was assigned, and levels of cervical lymph node involvement were documented. This process was repeated with the addition of FDG-PET-CT. Radiotherapy plans were reviewed for patients with an alteration identified on TNM staging and/or nodal level identification with FDG-PET-CT and potential alterations in radiotherapy planning were documented. Results. 55 patients were included in the analysis. FDG-PET-CT altered the TNM stage in 17/55 (31%) of patients, upstaging disease in 11 (20%) and downstaging in 6 (11%); distant metastases were identified by FDG-PET-CT in 1 (2%) patient. FDG-PET-CT altered the lymph node levels identified in 22 patients (40%), upclassifying disease in 16 (29%) and downclassifying in 6 (11%). Radiotherapy plans were judged retrospectively to have been altered by FDG-PET-CT in 10 patients (18%). Conclusions. The use of FDG-PET-CT potentially impacts upon both treatment decisions and radiotherapy planning.

Evaluation of Displacement-Based, Force-Based and Plastic Hinge Elements for Structural Non-Linear Static Analysis

This paper evaluates accuracies and applicabilities of frame elements constructed by displacement-based (DB), force-based (FB) and plastic hinge (PH) methods for structural non-linear static analysis. The theoretical bases of the three frame elements are compared and the global response (nodal level) and local response (sectional level) of the three frame elements are evaluated. The results lead to the conclusions that more DB elements than FB elements need to be employed to obtain accurate post-yielding global responses in the cases of sections undergoing hardening or zero post stiffness. Both DB and FB elements fail to provide consistent and rational evaluation of the post-yielding global responses in the case of sections undergoing softening. The post-yielding global responses presented by the PH element are strongly influenced by the preset hinge length. The three frame elements present consistent local response results but different maximum responses in most cases. The preferred numbers of integration points to be used in DB and FB elements are also advised from the points of view of both consistency and stability.

A framework for quantifying node-level community structure group differences in brain connectivity networks.

We propose a framework for quantifying node-level community structures between groups using anatomical brain networks derived from DTI-tractography. To construct communities, we computed hierarchical binary trees by maximizing two metrics: the well-known modularity metric (Q), and a novel metric that measures the difference between inter-community and intra-community path lengths. Changes in community structures on the nodal level were assessed between generated trees and a statistical framework was developed to detect local differences between two groups of community structures. We applied this framework to a sample of 42 subjects with major depression and 47 healthy controls. Results showed that several nodes (including the bilateral precuneus, which have been linked to self-awareness) within the default mode network exhibited significant differences between groups. These findings are consistent with those reported in previous literature, suggesting a higher degree of ruminative self-reflections in depression.