Palpable Nodes Research Articles

Diagnostic value of 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography imaging in acral melanoma-predominant Asian patients.

Tumor staging is crucial for melanoma, of which acral melanoma is the predominant subtype in Asians. 18F-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) and 18F-FDG-PET/computed tomography (18F-FDG-PET/CT) serve as non-invasive imaging tools for tumor staging. However, the literature is scarce on the diagnostic value of PET for acral melanoma. From January 1, 2006, to November 30, 2022, a total of 352 patients were diagnosed with melanoma at our hospital. Of them, 90 were diagnosed with cutaneous melanoma and underwent preoperative PET/CT for staging and sentinel lymph node biopsy or complete lymph node dissection. Staging of PET/CT was confirmed by histopathology or following imaging. The lymph node biopsy, distant metastasis status, and PET/CT imaging results were analyzed. Of all the 90 patients with cutaneous melanoma, 72 of them were diagnosed as acral melanoma(80.0%). Compared with the histopathologic results, the lymph nodes were true-positive, true-negative, false-positive, and false-negative in 12, 54, seven, and 17 cases, respectively. The sensitivity of PET/CT for local lymph nodes was 41.4% (95% confidence interval [CI], 23.5-61.1%), while its specificity was 88.5% (95% CI, 77.8-95.3%). As for the detection of distal metastasis, the PET results were true-positive, true-negative, false-positive, and false-negative in six, 65, 15, and four cases, respectively. The sensitivity of PET for distal metastasis detection was 60.0% (95% CI, 26.2-87.8%), while its specificity was 81.3% (95% CI, 71.0-89.1%). Although non-invasive, PET/CT has relatively low sensitivity in regional lymph node evaluations and fair sensitivity in distal metastasis detection in Asian patients with acral melanoma. Thus, PET/CT may be more useful in patients with clinically palpable nodes or more advanced disease stage.

A Comparative Analysis of Liquid-Based Cytology and Conventional Smears in Fine-Needle Aspirates of Thyroid Lesions.

Background Palpable nodules in the thyroid are present in 4-7% of the general population. Fine-needle aspiration cytology is a safe and cost-effective method of choice for evaluating thyroid nodules. Aspirated samples can be manually spread directly onto the slide and stained in the conventional smear method. The liquid-cased cytology method has been recently introduced, which is an automated machine-based method, yielding a single slide with a clean background and greater preservation of cells and consuming less time for screening. This study aimed to compare the cytomorphological features and diagnostic accuracy of conventional smears and liquid-based cytologysmears. Methodology This prospective study comprised 250 cases of thyroid lesions. Fine-needle aspiration cytology using conventional smears and liquid-based cytology smears was reported per the Bethesda system of reporting thyroid cytopathology. Detailed cytomorphological features were evaluated and compared in both techniques. Results The cellularity of conventional smears was significantly higher for scores 2+ and 3+ than paired liquid-based cytology smears (paired t-test, p < 0.001). The overall diagnostic efficacy of conventional smears and liquid-based cytology smears was equivalent in the majority of cases (n = 171, 68.4%). Conventional smears were better than liquid-cased cytology smears in 34 (13.6%) cases, and liquid-based cytology smears were better than conventional smears in eight (3.2%) cases. Liquid-based cytology smears showed a higher unsatisfactory rate compared to conventional Smears (15.6% vs. 5.2%). The sensitivity and specificity of conventional smears were 84.6% and 94.4%, respectively, compared to 68.7% and 92.4%, respectively, of liquid-based cytology smears. Conclusions Conventional smears are a cost-effective and easy method for diagnosing thyroid nodules. Liquid-based cytology smears can be used in association with conventional smears to enhance the accuracy of the evaluation of malignant thyroid nodules.

Comparison of CBNAAT and AFB screening using Ziehl Neelsen stain and fluorescent stain on FNAC sample for rapid diagnosis of tubercular lymphadenitis

: Tuberculous lymphadenitis is the most common etiology of cervical lymphadenopathy in endemic countries. Fine needle aspiration of palpable lymph nodes is done for rapid diagnosis of tuberculous lymphadenitis This study presents a comparative evaluation of fine needle aspiration cytology (FNAC) with acid fast bacilli screening using Ziehl Neelsen stain, Fluorescent stain with Cartridge based nucleic acid amplification test (CBNAAT) for the rapid diagnosis of tubercular lymphadenitis.: An observational cross sectional study was done over a period of 15 months from January 2020 to March 2021. All newly diagnosed cases of tubercular lymphadenitis irrespective of age and sex were included. Fine needle aspiration was performed from the palpable lymph node. Smears were prepared using Giemsa, Papanicolaou, Ziehl Neelsen and Auramine O stain.Rest of the sample was used for Mycobacterial growth indicator test (MGIT) and CBNAAT. Statistical Analysis was performed using McNemar test. For gold standard, MGIT as well as a composite reference standard on parameters that included MGIT, radiological findings of tuberculosis, Positive Mantoux test and Positive response to ATT seen in the form of complete resolution of clinical and radiological findings.: The diagnostic value of CBNAAT differed with respect to the chosen gold standard. With MGIT as gold standard, CBNAAT had the highest sensitivity, specificity, positive predictive value and negative predictive value. The diagnostic accuracy of CBNAAT was also the highest. Using CRS (Composite Reference standard) as gold standard, CBNAAT showed the highest specificity and positive predictive value.: With CBNAAT showing statistically significant data of a higher diagnostic value in our study as well as showing rapid result, being automated and not subjected to observer interpretation, we conclude that CBNAAT is more efficient in the diagnosis of tubercular lymphadenitis as compared to AFB screening methods. The only limitation of CBNAAT in our study was its ability to show positive results for three atypical mycobacteria due to possible cross contamination.

907 An Audit of Breast Ultrasonography in Patients Under 35

Abstract Introduction Breast Ultrasonography (USS) is a major part of the triple assessment for breast presentations in those under 35 years. Currently, most institutions are running targeted separate U-35 clinics. The aim of this study is to audit the outcome of breast USS in patients under 35 years. Method Over a 5-month period, December 2021- May 2022, retrospective data was collected across 3 clinics. In total, 300 patients were analyzed. Results The age distribution was as follows: 16-20 years (30), 21-25 years (51), 26-30 years (107), 31-35 years (104). Of the 300 patients, 68% of referrals to clinic were for breast lump (fibroadenoma, cysts and on one occasion papilloma), with the 26-30 age group being the majority at 36%. Half of the patients had USS, with the most common indication being lumps, followed by nodularity at 28%. Other indications for ultrasound included: nipple discharge, palpable nodes, eczema, nipple inversion. The radiological findings were fibroadenoma 21% (32), cysts and abscess with 15% (23) and 2.6% (4) respectively. No cancers identified. Fifty four percent had no identified lesions. Conclusions Our studies showed that of those referred for USS, only 46% had a lesion detected. No cancers diagnosed. Thus, these targeted clinics are effective in meeting demand for services. To increase efficiency, it might be a worthy consideration to have even clearer guidelines on ultrasonography specifically for patients under 35 years.

Diagnostic Accuracy of Ultrasound to Differentiate Neoplastic and Non-Neoplastic causes of Cervical Lymphadenopathy taking Histopathology as the Gold Standard

Objective: To evaluate the efficacy of high-resolution ultrasound and colour Doppler in differentiating neoplastic and nonneoplastic causes of cervical lymphadenopathy compared to histopathological diagnosis.&#x0D; Study Design: Cross-Sectional study.&#x0D; Place and Duration of Study: Pakistan Institute of Medical Sciences, Islamabad Pakistan, from Jan to Jun 2019.&#x0D; Methodology: The study included 110 patients with palpable cervical lymph nodes undergoing neck ultrasound and Fine needle aspiration cytology/Biopsy. Certain important sonological features were considered to categorize them into nonneoplastic and neoplastic groups. Colour Doppler imaging was employed along with grey-scale imaging. The histopathology results were compared with sonographic findings to determine the diagnostic accuracy of ultrasound in differentiating neoplastic from non-neoplastic causes of enlarged cervical lymph nodes.&#x0D; Results: Our study revealed that High-resolution sonography has 94.4% sensitivity and 88.8% specificity, differentiating between neoplastic and non-neoplastic causes of cervical lymphadenopathy. At the same time, the overall accuracy of ultrasound is 90.9%. The most consistent grey-scale feature in the non-neoplastic nodal group was preserved central fatty hilum, while its loss was significantly associated with neoplastic etiologies.Conclusion: Due to high sensitivity and negative predictive value, high-resolution sonography can be deployed as a first-line investigating tool for enlarged lymph nodes, and invasive procedures like Fine needle aspiration cytology (FNAC) can be abandoned in non-neoplastic lymphadenopathies.

Povidone-iodine-induced transient triiodothyronine thyrotoxicosis in a Japanese patient with prolonged habitual gargling: A case report and literature review.

Iodine-induced hyperthyroidism and triiodothyronine (T3) thyrotoxicosis in patients who routinely gargle with povidone-iodine (PVP-I) gargling solution are rare in Japan. A 50-year-old man presented to our hospital for a close examination of an enlarged thyroid, which was noted during a complete health checkup. The thyroid was slightly enlarged with no palpable nodules. He had an increased appetite but no weight gain. He had been routinely gargling with PVP-I gargling solution 4 times daily for >10 years. He had no history of thyroid disease. Test results revealed suppressed thyroid-stimulating hormone, normal free thyroxine, and increased free triiodothyronine levels, leading to the diagnosis of T3 thyrotoxicosis. The patient agreed to stop gargling with PVP-I gargle solution. The free triiodothyronine and thyroid-stimulating hormone levels returned to normal at 18 and 21 weeks, respectively, after discontinuation of PVP-I gargling. After an improvement in thyroid function, he gained 5 kg in 1 year. To our knowledge, this is the first case report that describes PVP-I gargle-induced T3 thyrotoxicosis in a healthy individual without thyroid disease. In Japan, which is an iodine-sufficient country, considering the possibility of high-dose iodine intake-induced thyrotoxicosis due to long-term PVP-I gargling or other causes is necessary, even in individuals with no history of thyroid disease.

Study of the Relation between 8_Hydroxy-2′-deoxyguanosin (8_OHDG) and Suspicious Thyroid Nodule in a Patients with Multinodular Goiter

Abstract Background Nodular disease of the thyroid gland is prevalent. The lifetime risk for developing a palpable thyroid nodule is estimated to be 5-10%, however, high resolution ultrasound has revealed thyroid nodules in 19-68% of randomly selected individuals. The condition affects more women than men. Aim of the Work In this study we aimed to study the relation between 8_Hydroxy-2'deoxyguanosin (8_OHDG) and Suspicious Thyroid nodule in a Patients with Multinodular Goiter. Patients and Methods The present study was a case-control study that was conducted on 60 subjects patients presented with MNG at Ain Shams University hospital during the period from January to December 2019. Results The results of our study demonstrated that plasma 8_OHDG levels were higher in patients with Multinodular goiter than in control group, and were higher in MNG patients with cancer than MNG without cancer. Which confirms the presence of oxidative stress in patients with non-toxic multinodular goiter and 8-OHDG levels may be markers of the carcinogenic potential of Multinodular goiter. Conclusion Our study confirms the presence of oxidative stress in patients with non-toxic multinodular goitre. The plasma 8-OHDG levels may be markers of the carcinogenic potential of multinodular goiter and could be used for early detection of different cancer types, including thyroid cancer. This warrants nutritional support with antioxidant agents in patients with non-toxic multinodular goiter. Further studies are warranted for better understanding of underlying pathogenic mechanism of oxidative stress in non-toxic Multinodulargoitre.

Ectopic spleen in testicular parenchyma: case report

Clinical case description: This report presents the case of a 32-year-old man with palpable solid nodule in the left testicle with a diagnostic hypothesis of testicular cancer, which turned out to be splenic tissue through pathological anatomy analysis. Relevance: The splenogonadal fusion is a rare and benign congenital anomaly related to the presence of ectopic spleen tissue in the gonadal parenchyma, caused by fusion between these two tissues during the fifth or sixth week of embryonic development. This condition is of great importance because its diagnosis is difficult and often confused with other gonadal disorders such as testicular neoplasm. Clinical implications: The most common consequence of this testicular disorder is the unnecessary orchiectomy, in which a variety of cases are submitted. To avoid testicle removal, intraoperative pathological examination can be used in these cases. Conclusions: The ectopic spleen in testicular parenchyma is a rare condition and its diagnosis is difficult. It is important to consider this condition as a differential diagnosis in testicular disorders, especially in the case of diagnostic hypothesis of testicular cancer, so that testicle removal can be prevented by the use of intraoperative pathological exam.

Tract Implantation of Thyroid Carcinoma After Transoral Thyroidectomy

Transoral thyroidectomy is a promising technique because of its superior postoperative cosmesis. Although tract implantation after remote-access thyroidectomy is extremely rare, it can result in poor outcomes. A 45-year-old female presented with multiple palpable nodules in the anterior neck after a transoral thyroidectomy for which thyroid function tests, CT, ultrasonography, and fine-needle aspiration were performed. The thyroid function test results were normal. CT and ultrasonography revealed multiple, well-defined nodules at levels Ia and VI along the tracks left by the endoscopic instrument inserted during transoral thyroidectomy. Fineneedle aspiration revealed a microfollicular structure derived from thyroid tissue without evidence of atypia. Wash-out fluid from the nodules revealed elevated thyroglobulin levels. Initially, the patient was hesitant about surgical removal, but the nodules grew larger, so surgical removal was performed. Final histopathological examination revealed follicular thyroid carcinoma. The patient was recommended extensive resection but was lost to follow-up.

The impact of the COVID-19 pandemic in the clinical assistance to breast cancer patients.

We aimed to disclose the impact of the pandemic on breast cancer patients in a specialized breast cancer center (BCC). A total of 501 breast cancer patients with a first appointment in the BCC from April 1st, 2019 to March 31st, 2021 were divided into four consecutive periods of 6months. Data from the homologous semesters was compared. Patients with an appointment in the BCC during the study period were eligible for the secondary aim of our study (BCC workload). After the pandemic declaration (period 3), we found a decrease in the referral by screening programs (p = 0.002) and a reduction in the waiting time between the primary care referral and the first BCC appointment (p < 0.001). There were higher rates of palpable axillary nodes (p = 0.001), an increase in N stage 2 and 3 (p = 0.050), and a trend for primary endocrine therapy as the first treatment (p = 0.021) associated with higher rates of complete axillary node dissection (p = 0.030). In period 4, there were more outward diagnoses (p = 0.003) and a higher rate of surgery as the first treatment (p = 0.013). COVID-19 pandemic implied a more advanced nodal stage, which may be related to the delay in breast cancer screening.

Impact of the Standardization of Penile Cancer Care on the Quality of Care, Outcomes, and Academic-driven Centralization in a Single eUROGEN Referral Center

BackgroundPenile cancer (PeCa) represents a diagnostic and therapeutic challenge given the low patient volume, which may result in inadequate physician expertise and poor guideline adherence. Since 2015, we have developed a specific care pathway for PeCa in our tertiary referral center. ObjectiveTo evaluate the impact of a dedicated PeCa care pathway on patient management, the adequacy of pathological reporting, and oncological outcomes. Design, setting, and participantsWe retrospectively queried our institutional registry (S-66482) to identify patients who were surgically treated for PeCa between January 1989 and April 2022. The patient numbers were evaluated within a broader national context. Outcome measurements and statistical analysisWe compared patient, surgery, tumor, and pathological data before and after 2015. Kaplan-Meier analysis was used to compare local and regional recurrence rates and cancer-specific survival (CSS). Results and limitationsOverall, 313 patients were included, of whom 204 (65.1%) were surgically treated after 2015. The median number of patients treated yearly was significantly higher after 2015 (26 vs 5; p < 0.01). Patients treated after 2015 more frequently had no palpable lymph nodes at diagnosis, despite similar primary tumor stage. After adoption of the PeCa care pathway, organ-sparing surgery (OSS) was more commonly performed (79.9% vs 57.8%; p < 0.01) despite local staging being similar and without observing a significant increase in positive margins. Surgical staging in patients with European Association of Urology intermediate- or high-risk tumors was conducted more frequently after 2015 (90% vs 41%; p < 0.01). Pathology reporting was standardized, and there was more frequent reporting of p16 staining status (81.4% vs 8.3%; p < 0.01), lymphovascular invasion (93.8% vs 44.3%; p < 0.01), and perineural invasion (92.4% vs 44.3%; p < 0.01) following implementation. ConclusionsImplementation of a standardized care pathway for PeCa resulted in higher rates of OSS and pathological nodal staging and more complete pathology reports. Considering that these changes were associated with an increase in the number of patients treated, academic-driven centralization may play a role in optimizing the management of these patients. Patient summaryWe evaluated the impact of a care pathway for patients with penile cancer on patient management, the completeness of pathology reporting, and cancer control. We found that implementation of this pathway was associated with an increase in the number of patients treated, higher rates of organ-sparing surgery and lymph node staging, and more complete pathology reports. Centralization of care may play a role in optimizing the management of penile cancer.

Immediately repaired penile fractures: age is the only predictor of postoperative long-term functional outcomes.

Penile fractures can lead to many functional complications, especially erectile dysfunction (ED). Few studies have evaluated the factors that predict late complications of an immediately repaired penile fracture. To identify the potential predictors of long-term poor functional outcomes following immediate surgical intervention for penile fractures. Sixty-eight consecutive patients with suspected penile fracture between 2003 and 2022 were retrospectively reviewed. Functional outcomes, postoperative complications, and follow-up duration were obtained from the records of follow-up visits. Age at presentation, location and length of the tunical tear, the presence of urethral rupture, and time to surgery were all analyzed as potential risk factors for postoperative functional outcomes. Postoperative erectile function and intercourse satisfaction were measured by the IIEF-5 (the 5-item version of the International Index of Erectile Function). Penile curvature, a palpable nodule, and paresthesia/numbness were detected by physical examination. Uroflowmetry was used to assess urinary flow in patients who underwent urethral repair. Fifty-eight patients were analyzed. The mean ± SD age was 38.1 ± 10.4years; the median follow-up was 79.0 months (range, 13-180); the median time to surgery was 9.8 hours (4-30); and the median tunical tear length was 15.5 mm (4-40). Urethral rupture was observed in 8 patients (13.8%). In univariable analyses, urethral rupture was associated with postoperative complications (P = .034). In addition, age at presentation and tunical tear size were significantly associated with postoperative complications and ED (P < .05). However, in multivariable analyses, only age at presentation significantly predicted postoperative complications and ED (P = .004 and P = .037). Age at presentation is the most important factor determining the prognosis of immediate surgical repair of the penile fracture, which aids in predicting potential complications and discussing them with patients prior to surgical intervention and during the follow-up period. The study's retrospective design is an important limitation. Furthermore, there were no data on an IIEF-5 outcome measuring preoperative erectile function. These results revealed an association between (1) urethral rupture, longer tunical tears, and older age and (2) the development of late complications. The remarkable finding of this study was that age at presentation was the only significant predictor of functional complications based on multivariable analyses. This relationship also remained robust in tests evaluating the covariance of the effects of aging on ED.

Granuloma annulare on ultrasound: a diagnosis to consider in pediatric skin lesions.

Granuloma annulare (GA) is a rare, benign, inflammatory, self-limited, granulomatous dermatosis that affects children and young adults. The most frequent clinical form is localized GA. Deep GA generally presents as painless palpable subcutaneous nodules in the lower extremities, buttocks, hands and scalp. They may have a fast-growing firm subcutaneous mass presentation, mimicking a malignant lesion which requires an imaging evaluation. Diagnosis of deep GA can be more difficult and imaging evaluation is frequently performed, ultrasound being one of the techniques used. To describe the US characteristics of GA in a pediatric series. Descriptive, retrospective, 14-year study of all pediatrics GA cases. Twelve pediatric cases with GA. 66% females. The lesions were mainly distributed in the extremities: 50% in the lower extremities and 42% in the upper extremities, mostly with multiple lesions. A total of 45 lesions were analyzed, 8 superficial lesions and 37 deep lesions. On ultrasound, the superficial GA corresponded to hypoechoic poorly defined solid plaque like or nodular lesions, located in the dermal-epidermal plane. The deep GA presented as solid nodular, poorly defined hypoechoic lesions that compromised the deep subcutaneous-aponeurotic plane. GA is an inflammatory lesion that presents as a superficial or deep palpable nodule that predominantly affects children. Superficial and deep GA present characteristic findings on US that can guide the diagnosis. The radiologist needs to know its US appearance to be able to suggest the diagnosis, especially in multiples lesions.

EFFICACY OF DOPPLER ULTRASOUND IN DETECTING MALIGNANT PALPABLE THYROID NODULES

This study aimed to assess the efficacy of Doppler Ultrasound in detecting malignant palpable thyroid nodules. A Cross-sectional, descriptive study was conducted in the Department of Radiology, Nishtar Medical College and Hospital, Multan, from January 2022 to December 2022. A total of 196 patients with palpable thyroid nodules were included in the study. Doppler ultrasound was performed on all patients. Samples were sent for histopathology to the same laboratory whose pathologist was blinded to ultrasound results. On histopathology, 37 patients (18.9%) showed malignancy, and 159 (81.1%) showed no malignant nodules. On Doppler ultrasound, 36 (18.37%) patients were positive for malignancy, and 160(81.63%) showed no malignancy. Doppler ultrasound showed excellent sensitivity (86.4%), specificity (97.4%), positive predictive value (88.9%), negative predictive value (96.8%), and diagnostic accuracy (95.4%). Doppler ultrasound has a higher diagnostic accuracy for palpable thyroid nodules than histopathology.

Penile fracture in burkina faso: our experience on the management of 21 cases

BackgroundPenile fracture is relatively a rare urological emergency and has been the topic of a few publications in the literature through clinical cases or case series. Despite this relative scarcity, it is increasingly reported as one of the andrological emergencies in Burkina Faso. The purpose of this study was to report our experience of the management of such andrological emergency in the two main university teaching hospitals of Burkina Faso.MethodsThis was a cross-sectional study, including retrospectively patients managed for a penile fracture between January 2016 and September 2021, and having a minimum postoperative follow-up of 6 months. The literature review was performed by analyzing the content of the following documents: consultation logs, patient records, operative report protocol. The parameters studied were age, mechanism of occurrence, clinical data, delay of management, operative technique and functional and morphological results after surgery. Erectile function was assessed by the IIEF5 score and rigidity by the EHS scale.ResultsAmong the 24 cases of penile fracture, 21 patients were included with a median age of 32.7 ± 5.74 years (23–43 years). The most common mechanism was a coital misstep or coitus interruptus (14 patients or 66.7%). Forced self-manipulation/masturbation was noted in 4 cases (19%), and direct trauma to the penis was noted in 3 cases (14.3%). Urethrorrhagia was reported by 5 patients. The mean delay of management was 65 h (6–432 h). The main sign found was the painful swelling of the penis with an “eggplant” appearance. The surgical approach was a circumferential balanopreputial incision in all our patients. Involvement of the spongy body and urethra associated with involvement of the cavernous body was noted in 4 patients, with a single case of spongy body and urethral involvement. The mean length of hospital stay was 3 days. Postoperatively, erectile dysfunction was noted in 6 patients. A palpable nodule at the penis was observed in 12 patients. No patient reported curvature of the penis.ConclusionPenile fracture is a clinical diagnosis requiring early exploration and surgical repair to ensure better functional and morphological outcomes.

Association of Axillary Dissection With Systemic Therapy in Patients With Clinically Node-Positive Breast Cancer

The role of axillary lymph node dissection (ALND) to determine nodal burden to inform systemic therapy recommendations in patients with clinically node (cN)-positive breast cancer (BC) is currently unknown. To address the association of ALND with systemic therapy in cN-positive BC in the upfront surgery setting and after neoadjuvant chemotherapy (NACT). This was a prospective, observational, cohort study conducted from August 2018 to June 2022. This was a preplanned study within the phase 3 randomized clinical OPBC-03/TAXIS trial. Included were patients with confirmed cN-positive BC from 44 private, public, and academic breast centers in 6 European countries. After NACT, residual nodal disease was mandatory, and a minimum follow-up of 2 months was required. All patients underwent tailored axillary surgery (TAS) followed by ALND or axillary radiotherapy (ART) according to TAXIS randomization. TAS removed suspicious palpable and sentinel nodes, whereas imaging-guidance was optional. Systemic therapy recommendations were at the discretion of the local investigators. A total of 500 patients (median [IQR] age, 57 [48-69] years; 487 female [97.4%]) were included in the study. In the upfront surgery setting, 296 of 335 patients (88.4%) had hormone receptor (HR)-positive and Erb-B2 receptor tyrosine kinase 2 (ERBB2; formerly HER2 or HER2/neu)-negative disease: 145 (49.0%) underwent ART, and 151 (51.0%) underwent ALND. The median (IQR) number of removed positive lymph nodes without ALND was 3 (1-4) nodes compared with 4 (2-9) nodes with ALND. There was no association of ALND with the proportion of patients undergoing adjuvant chemotherapy (81 of 145 [55.9%] vs 91 of 151 [60.3%]; adjusted odds ratio [aOR], 0.72; 95% CI, 0.19-2.67) and type of systemic therapy. Of 151 patients with NACT, 74 (51.0%) underwent ART, and 77 (49.0%) underwent ALND. The ratio of removed to positive nodes was a median (IQR) of 4 (3-7) nodes to 2 (1-3) nodes and 15 (12-19) nodes to 2 (1-5) nodes in the ART and ALND groups, respectively. There was no observed association of ALND with the proportion of patients undergoing postneoadjuvant systemic therapy (57 of 74 [77.0%] vs 55 of 77 [71.4%]; aOR, 0.86; 95% CI, 0.43-1.70), type of postneoadjuvant chemotherapy (eg, capecitabine: 10 of 74 [13.5%] vs 10 of 77 [13.0%]; trastuzumab emtansine-DM1: 9 of 74 [12.2%] vs 11 of 77 [14.3%]), or endocrine therapy (eg, aromatase inhibitors: 41 of 74 [55.4%] vs 36 of 77 [46.8%]; tamoxifen: 8 of 74 [10.8%] vs 6 of 77 [7.8%]). Results of this cohort study suggest that patients without ALND were significantly understaged. However, ALND did not inform systemic therapy recommendations.

Pathological characteristics of breast nodules after large-volume fat grafting for breast augmentation.

The complications of large-volume fat grafting (LVFG) for breast augmentation remain unpredictable and include palpable breast nodules, oil cysts, and calcifications. This study was aimed to provide an optimal treatment option for breast nodules after LVFG and evaluate their pathological characteristics. We effectively performed complete resection of breast nodules in 29 patients after LVFG using a minimal skin incision with the vacuum-assisted breast biopsy (VABB) system under ultrasound guidance. And we further carried on histologic examination of excised nodules and evaluated their pathological characteristics. The breast nodules were excised thoroughly with cosmetic effect satisfactorily. Interestingly, subsequent histologic examination showed that type I and VI collagens were strongly expressed in the fibrotic area and type IV collagen were positively expressed around the blood vessel. Furthermore, we found that the type VI collagen+ area appeared around mac2+ macrophages and α-SMA+ myofibroblasts. The VABB system may be the optimal treatment option for breast nodules after LVFG. And type VI collagens may serve as a biomarker of grafted adipose tissue fibrosis. The relationship between macrophages, fibroblasts, and collagen formation may be therapeutic targets for regulating fibrosis.

Diagnosis of Epidermoid Carcinoma of the Tongue after Treatment of Epidermoid Carcinoma of the Esophagus

Abstract In the present case report, a patient with esophageal squamous cell carcinoma (SCC) developed a second primary tumor in the tongue at the same time. Stage III middle esophageal SCC was discovered in a 60-year-old Caucasian male patient who was institutionalized, a smoker, and had previously struggled with alcoholism. Following treatment, the patient was admitted to the hospital for 15 days due to dysphagia and malnutrition. According to him, he had mouth pain while in the hospital. An intraoral examination revealed tooth mobility, bacterial plaque, dental calculus, and a 1.3-cm ulcerated lesion on the right lateral edge of the tongue. During the extraoral examination, no palpable lymph nodes were found in the submandibular or cervical regions. The tongue lesion was excisionally biopsied, and the histological evaluation agreed. The patient was advised to seek treatment for tongue SCC. Given that patients with esophageal SCC have a 9.3%–11.4% risk of developing head-and-neck SCC, multiprofessional follow-up of patients with esophageal SCC is critical for early detection of this cancer.

PA24 Abnormal interferon signature in a patient with chilblain lupus

Abstract A 5-year-old girl of Sri Lankan ancestry with no history of parental relatedness presented with the clinical features of chilblain lupus. This was particularly florid over her dorsal fingers, toes and the soles of her feet with areas in keeping with panniculitis on her calves and an epidermal naevus on the right side of her trunk. There was no ulceration or necrosis. Her parent reported occasional fevers and palpable lymph nodes in her neck. She also has bilateral astigmatism and mild valvular and supravalvular pulmonary stenosis. Blood tests showed a persisting mild transaminitis, an antinuclear antibody of 1 in 160 and a negative double-stranded DNA. She had a skin biopsy that showed supporting features for chilblain lupus. A lymph node biopsy showed nonspecific changes. The clinical suspicion was of a mild form of Aicardi–Goutières syndrome (AGS), and a genetic panel was performed that included TREX1, RNASEH2B, TMEM173 and SAMHD1 (all negative). The common mechanism behind these conditions is a type I interferonopathy. We sent blood on a research basis for RNA extraction and testing of her interferon (IFN) gene signature (IGS), which came back as abnormal (11.895; cutoff score of 2.758); she had normal expression of neutrophil-associated genes. This IFN score is on par with patients who have confirmed AGS or STING-associated vasculopathy with onset in infancy. An IGS is derived from the expression of IFN-regulated genes. A raised IGS has not only been reported to be useful as a biomarker in many rheumatic diseases, but is also used to help identify type I interferonopathies where genetic testing has not identified any clear pathogenic mutations (Crow YJ, Stetson DB. The type I interferonopathies: 10 years on. Nat Rev Immunol 2022; 22:471–83). National Institute for Health and Care Excellence guidelines allow for treatment of interferonopathies with baricitinib in patients with two documented high IFN gene signatures, which is our current plan for this patient.

Accuracy of dynamic sentinel lymph node biopsy for inguinal lymph node staging in cN0 penile cancer

BackgroundPenile cancer is characterized by an early lymphatic dissemination. In intermediate and high-risk primary tumors without palpable inguinal lymph nodes, there is a 6–30% risk of micro-metastatic disease. Invasive lymph node staging in these patients is performed using dynamic sentinel lymph node biopsy (DSNB). In this study, the role of DSNB in cN0 penile cancer was studied, evaluating features of sentinel lymph node (SN) visualization and outcome parameters. Patients with penile cancer without inguinal lymph node metastases who were referred for DSNB at our center between January 2015 and May 2021 and had a follow-up period of at least 18 months, were retrospectively included. After injection of 85 ± 20 MBq [99mTc]Tc-nanocolloid peritumorally, dynamic, static planar and SPECT/CT imaging was performed. Primary endpoints were sensitivity of the diagnostic procedure, disease-free survival and DSNB-related adverse events. Secondary endpoints were SN detection rate, number of SNs and the number of counts of the most active SN.ResultsSeventy-seven penile DSNB procedures in 75 patients (67 ± 11 years) were included. The detection rate of DSNB was 91% and 96% per procedure and groin, respectively. Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) were 79%, 100%, 97% and 100%, respectively. More SNs were seen on SPECT/CT than on static planar imaging (1.33 vs. 1.17, p = 0.001). The mean counts per SN on static planar imaging was lower compared to SPECT/CT (1343 vs. 5008; p < 0.0001). There was a positive correlation between the total counts of the SN on the static planar image and the SPECT/CT (r = 0.79, p < 0.0001). Only one out of seventy-five patients (1%) experienced DSNB-related adverse events. After 18 months, 58 patients remained disease free (77%), 13 developed local recurrence (17%), and 4 developed lymphatic or distant metastases (5%).ConclusionDNSB is a safe diagnostic procedure with a good detection rate and in particular high negative predictive value. It can therefore prevent overtreatment of patients with negative inguinal groins on clinical examination and DSNB examination. Finally, DSNB enables an early detection of occult metastases which would not be visualized with standardized imaging modalities.