Pelvic Node Metastasis Research Articles

Association Between Adenomyosis and Cervical Cancer: A Retrospective Cohort Study

Objective The main purpose of the study was to explore the clinicopathological features and survival outcomes of patients with cervical cancer (CC) and adenomyosis and without the latter and to gain insight into the timely association between adenomyosis and CC. Methods 991 patients with CC and adenomyosis and 3964 patients without the latter were included in this retrospective cohort study. The clinicopathological characteristics including tumor size, depth of stromal invasion, presence of lymphovascular space invasion (LVSI), infiltration into vagina or uterine body, status of surgical vaginal margin, parametrial involvement, and pelvic or para-aortic lymph nodes metastasis were compared between the CC patients with/without coexisting adenomyosis by Student’s t-tests, chi-square or Fisher’s exact tests. The Cox proportional hazards model was employed to evaluate potential risk factors. Survival curves were constructed using the Kaplan–Meier method. Results Among the cervical cancer cohort, the coexistence of adenomyosis is associated with a lower likelihood of deep stromal invasion (50.2% vs 54.6%, p < 0.0001) and vaginal infiltration (25.8% vs 29.1%, p = 0.041) compared with CC patients without adenomyosis. There were no significant differences in tumor size, presence of LVSI, uterine body infiltration, status of surgical vaginal margin, parametrial involvement, and pelvic or para-aortic lymph nodes metastasis between both groups. However, adenomyosis did not remain as an independent prognostic factor for CC (HR 0.938, 95% CI: [0.72–1.22], p = 0.636) and did not reach statistical significance in the survival analysis (log rank test, p = 0.587). Conclusion CC patients with coexistent adenomyosis were associated with less aggressive tumor behavior including deep stromal invasion and vaginal infiltration. However, adenomyosis was not a prognostic factor for CC survival.

Development of a radiomic model for cervical cancer staging based on pathologically verified, retrospective metastatic lymph node data.

Cervical cancer is a major cause of morbidity and mortality among gynecological malignancies. Diagnostic imaging of lymph node (LN) metastasis for prognosis and staging is used; however, the accuracy in classifying the stage needs to improve. To examine the accuracy of AI-based radiomics in diagnosis, prognosis assessment and predicting the diagnostic value of radiomics for pelvic LN metastasis in cervical cancer patients. The study included 118 female patients with 660 LNs and 118 merged LNs. Four imaging histology models-decision tree, random forest, logistic regression, and support vector machine (SVM)-were created in this study. The imaging histology features were extracted from both the independent and merged LN groups. The AUC values for the test sets and the training sets of the four imaging histology models were compared for the independent LN group and the merged LN group. The DeLong test was used to compare the models. The imaging histology prediction model developed in the merged LN group outperformed the independent LN group in terms of test set AUC (0.668 vs. 0.535 for decision tree, 0.841 vs. 0.627 for logistic regression, 0.785 vs. 0.637 for random forest, 0.85 vs. 0.648 for SVM) and accuracy (0.754 vs. 0.676 for decision tree, 0.780 vs. 0.671 for random forest, 0.848 vs. 0.685 for logistic regression, 0.822 vs. 0.657 for SVM). The constructed SVM imaging histology model for the merged LN group might be advantageous in predicting pelvic LN metastasis in cervical cancer.

Features of Lateral Pelvic Lymph Nodes Associated With Pathological Involvement After Total Neoadjuvant Therapy in Patients Undergoing Lateral Pelvic Lymph Node Dissection

BACKGROUND: There is a lack of consensus regarding treating involved lateral pelvic lymph nodes in rectal cancer. OBJECTIVE: This study aimed to evaluate the clinical and magnetic resonance imaging-based factors associated with pathological lateral pelvic lymph node metastasis in patients undergoing total neoadjuvant therapy and lateral pelvic lymph node dissection. DESIGN: This is a retrospective study. SETTINGS: This study was conducted at a single comprehensive cancer center. PATIENTS: A total of 107 patients with advanced low rectal cancer with pretreatment enlarged lateral pelvic lymph nodes (≥7 mm in long-axis) undergoing total neoadjuvant therapy with long-course chemoradiotherapy, followed by total mesorectal excision and lateral pelvic lymph node dissection, were enrolled. MAIN OUTCOME MEASURES: Pathological lateral pelvic lymph node metastasis and survival. RESULTS: Among 107 patients, 48 had a short-axis lateral node diameter &lt;7 mm at baseline, while 59 had ≥7 mm. The ≥7 mm group showed significantly higher rates of pathological lateral pelvic lymph node metastasis (44.1% vs. 2.1%; p &lt; 0.0001). In this group, pathological lateral pelvic lymph node metastasis was independently associated with pre-treatment malignant features and post-treatment short-axis diameter ≥4 mm. Five-year relapse-free survival was significantly lower in patients with post-treatment lateral node diameter ≥ 4 mm than those with &lt;4 mm (71.1% vs. 86.2%, p = 0.0364). Patients with pathological lateral pelvic lymph node metastasis had significantly lower overall survival, relapse-free survival, and local recurrence-free survival rates. LIMITATIONS: Selection bias exists in a retrospective analysis. CONCLUSIONS: Pathological lateral pelvic lymph node metastasis is rare in patients with pre-treatment short-axis diameter &lt;7 mm. In patients with pre-treatment short-axis diameter ≥7 mm, pre-treatment malignant features and post-treatment short-axis diameter are both associated with pathological lateral pelvic lymph node metastasis. These factors should be considered when deciding whether to proceed with lateral pelvic lymph node dissection after total neoadjuvant therapy. See Video Abstract.

Comparison of the predictive value of multiparametric MRI and prostate-specific membrane antigen PET/CT for pelvic lymph node metastasis in prostate cancer

Objective: To compare the diagnostic performance of multiparametric magnetic resonance imaging (mpMRI) and prostate-specific membrane antigen (PSMA) PET/CT in detecting pelvic lymph node metastasis in prostate cancer. Methods: This is a retrospective case series study. A retrospective analysis was conducted on the data of 115 prostate cancer patients who underwent both mpMRI and PSMA PET/CT before undergoing radical prostatectomy and extended pelvic lymph node dissection at the Department of Urology, Xiangya Hospital, Central South University, between March 2020 and September 2023. The age (M(IQR)) was 67(10) years (range: 45 to 84 years), and the body mass index was 24(4) kg/m2 (range: 18 to 30 kg/m2). Pathological and imaging data were obtained from the patients. Lymph node pathology results were used as the gold standard to evaluate the diagnostic performance of mpMRI and PSMA PET/CT for detecting pelvic lymph node metastasis in PCa through diagnostic evaluation tests. Comparisons between groups were performed using independent samples t-test, Mann-Whitney U test, or χ2 test. Results: The positive rate for detecting pelvic lymph node metastasis was 18.3% (21/115) with mpMRI and 25.2% (29/115) with PSMA PET/CT. The pathological positive rate for lymph nodes was 28.7% (33/115). In patient-based analysis, the diagnostic sensitivity of PSMA PET/CT was significantly higher than that of mpMRI (63.6% vs. 30.3%, χ2=7.36, P=0.007). In lesion-based analysis, both the sensitivity and positive predictive value of PSMA PET/CT were significantly higher than those of mpMRI (sensitivity: 68.0% vs. 21.6%, χ2=42.20, P<0.01; positive predictive value: 50.0% vs. 23.1%, χ2=7.54, P=0.006). Conclusions: PSMA PET/CT and mpMRI both demonstrates good specificity in predicting pelvic lymph node metastasis in prostate cancer. However, PSMA PET/CT is significantly superior to mpMRI in terms of sensitivity and the detection rate of pathologically positive lymph nodes.

Paraaortic lymph node metastasis in endometrial cancer patients: a comprehensive analysis of rates, survival outcomes, and risk factors through systematic review and meta-analysis.

This study aims to explore the incidence of different metastatic patterns in paraaortic lymph nodes and their corresponding survival outcomes in patients with endometrial cancer, as well as to identify the associated risk factors of such metastasis. PubMed, Embase, Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform, and Clinical Trials.gov were searched from inception to February 10, 2024.The analysis was conducted using R version 4.2.3. A total of 47 studies involving 33,425 endometrial cancer patients were analyzed. Meta-analysis results revealed that the rate of isolated paraaortic lymph node metastasis, where pelvic lymph nodes were negative but paraaortic lymph nodes were positive (PLN-PAN+), was found to be 2.58% (95% CI 0.0195-0.0329). The rates for PLN+PAN- and PLN+PAN+ were notably higher at 8.54% (95% CI 0.0642-0.1092) and 8.37% (95% CI 0.0613-0.1090), respectively. For clinical stage I EC, the occurrence rate was 5.92% for PLN+PAN- (95% CI 0.0258-0.1032), 1.00% for PLN-PAN+ (95% CI 0.0081-0.0120), and 2.99% for PLN+PAN+ (95% CI 0.0188-0.0431). The survival outcomes indicate a decreasing trend from the PLN-PAN+ and PLN+PAN- groups to the PLN+PAN+ group. Additionally, the survival outcomes of patients with isolated paraaortic lymph node metastasis appear to be comparable to, or not inferior to, those of the PLN+PAN- group. The analysis indicated that pelvic lymph node metastasis (OR 16.72, 95% CI 10.03-27.86), myometrial invasion ≥50% (OR 5.18, 95% CI 3.09-8.69), lymph-vascular space invasion (LVSI) (OR 3.46, 95% CI 2.49-4.81), cervical invasion (OR 4.00, 95% CI 2.09-7.66), and non-endometrioid cancer (OR 2.39, 95% CI 1.17-4.86) were risk factors for paraaortic lymph node metastasis. Isolated paraaortic lymph node metastasis, though relatively rare, can still occur even in clinical stage I endometrial cancer. The survival outcomes of patients with isolated paraaortic lymph node metastasis appear to be comparable to, or not inferior to, those of the PLN+PAN- group. Even in patients with negative pelvic lymph nodes, careful consideration should be given to the possibility of paraaortic lymph node metastasis, especially in those with high-risk factors. https://www.crd.york.ac.uk/prospero/, identifier CRD42024503959.

Locally advanced cervical cancer: Neoadjuvant chemotherapy plus radical surgery an alternative approach to chemo-radiation in a low-income setting: A descriptive study.

To describe the treatment outcomes of locally advanced cervical cancer managed with neoadjuvant chemotherapy (NACT) plus radical surgery at a gynecology oncology center in Ethiopia. This was a retrospective descriptive study of management of locally advanced cervical cancer (LACC) at St. Paul's Hospital Millennium Medical College (Ethiopia) over 5 years. Data were collected by reviewing patient records. Data were analyzed using SPSS version 23. Simple descriptive analysis was employed to analyze clinical, histologic, and treatment outcomes of LACC managed with NACT+ radical surgery. Frequency and proportions were used to present the results' significance. A total of 98 patients were analyzed. One-third (31.6%) of cervical cancer patients with locally advanced disease were operable after neoadjuvant chemotherapy. Out of this, nodal metastasis was found in 2 patients (all pelvic lymph node metastasis). Disease recurrence within 2 years was 3% (1 recurrence within 6-12 months and 2 recurrences at 12-24 months). This study supports utilization of NACT plus radical surgery for locally advanced cervical cancer, where chemoradiation is not readily available. Our findings imply that this treatment modality is a life-saving alternative treatment in a low-income setting, which is often married by shortage or unavailability of radiotherapy at the needed time before disease progression ensues.

Para-aortic and pelvic lymphadenectomy in locally advanced cervical cancer with pelvic lymph node metastasis

ObjectiveThis study sought to explore the efficiency of para-aortic and pelvic lymphadenectomy in the treatment of locally advanced cervical cancer (LACC) with pelvic lymph node (PLN) metastasis.MethodsA total of 171 LACC patients with imaging-confirmed pelvic lymph node metastasis were included in this study. These patients were divided into two groups: the surgical staging group, comprising 58 patients who had received para-aortic and pelvic lymphadenectomy (surgical staging) along with concurrent chemoradiation therapy (CCRT), and the imaging staging group, comprising 113 patients who had received only CCRT. The two groups’ progression-free survival (PFS), overall survival (OS) and treatment-related complications were compared.ResultsThe surgical staging group started radiotherapy 10.2 days (range 9–12 days) later than the imaging staging group. The overall incidence of lymphatic cysts was 9.30%. In the surgical staging group, para-aortic lymph node metastasis was identified in 34.48% (20/58) of patients, while pathology-negative PLN was observed in 12.07% (7/58). Over a median follow-up period of 52 months, no significant differences in PFS and OS rates were found between the two groups (p > 0.05). Subgroup analysis of patients with lymph node diameters of ≥ 1.5 cm revealed a five-year PFS rate of 75.0% and an OS rate of 80.0% in the surgical staging group, compared to 41.5% and 50.1% in the imaging staging group, respectively, showing statistically significant differences (p = 0.022, HR:0.34 [0.13, 0.90] and p = 0.038, HR: 0.34 [0.12,0.94], respectively for PFS and OS). Additionally, in patients with two or more metastatic lymph nodes, the five-year PFS and OS rates were 69.2% and 73.1% in the surgical staging group, versus 41.0% and 48.4% in the imaging staging group, with these differences also being statistically significant (p = 0.025, HR: 0.41[0.19,0.93] and p = 0.046, HR: 0.42[0.18,0.98], respectively).ConclusionPerforming surgical staging before CCRT is safe and delivers accurate lymph node details crucial for tailoring radiotherapy. This approach merits further investigation, particularly in women with pelvic lymph nodes measuring 1.5 cm or more in diameter or patients with two or more imaging-positive PLNs.Graphical

Pattern of Failure in Patients with Biochemical Recurrence After PSMA Radioguided Surgery.

Prostate-specific membrane antigen (PSMA)-targeted radioguided surgery (RGS) is evolving as a new treatment modality for patients with early biochemical recurrence of prostate cancer and disease limited to locoregional lymph nodes on PSMA-ligand PET/CT. Nevertheless, the pattern of failure (locoregional vs. systemic) after PSMA RGS remains unknown. Therefore, the aim of this retrospective analysis was to evaluate the pattern of disease using PSMA-ligand PET in patients experiencing relapse after PSMA RGS. Methods: We evaluated 100 patients with biochemical recurrence after previous PET-guided PSMA RGS who underwent PSMA-ligand PET (median prostate-specific antigen [PSA], 0.9 ng/mL; range, 0.2-14.2 ng/mL). All suspicious lesions for recurrent prostate cancer were grouped according to the molecular imaging TNM classification system. Detection rates and lesion localization were determined and stratified by PSA values and the International Society of Urological Pathology grade group. Further, lesion localization was compared before and after PSMA RGS. Results: The median time between PSMA RGS and PSMA-ligand PET for relapse was 11.4 mo (range, 5.5-25.6 mo). In total, 91 of 100 (91%) patients showed PSMA-ligand-positive findings. PSMA PET detection rates were 82.6%, 92.6%, 91.3%, and 96.3% for PSA levels of 0.2-0.49, 0.5-0.99, 1-1.99, and at least 2 ng/mL, respectively. More than half of the patients (53%; 48/91) showed local recurrence or pelvic lymph node metastases only. Extrapelvic lymph node metastases, bone metastases, and visceral metastases were present in 22% (20/91), 16% (15/91), and 9% (8/91) of the patients, respectively. With increasing International Society of Urological Pathology grade group, the percentage of patients with bone and visceral metastases increased, whereas the number of patients with only locoregional disease decreased. Conclusion: PSMA-ligand PET is a useful method to detect and localize recurrent disease in patients with biochemical failure after PSMA RGS, with more than half of the patients presenting with locoregional recurrence, offering the potential for a second local therapy (e.g., radiation therapy or repeated surgery).

Association of MORC2 expression with progression-free survival in cervical cancer patients treated with concurrent chemoradiotherapy.

MORC family CW-type zinc finger 2 (MORC2) is a newly identified chromatin remodeling protein, and has been proposed as a prognostic biomarker associated with survival in some types of human cancer, but the role of MORC2 in cervical cancer remains unknown. Here, we investigated the role of MORC2 expression in predicting the survival outcomes of locally advanced cervical cancer patients treated with cisplatin-based concurrent chemoradiotherapy (CCRT). In this retrospectively study, we detected MORC2 immunohistochemical expression on 55 biopsies from patients who underwent CCRT. The association between the MORC2 expression and various clinicopathological characteristics were analyzed, as were association between MORC2 expression and locoregional failure and progression-free survival (PFS) of cervical cancer patients. MORC2 expression was positively associated with pelvic node metastasis and locoregional failure. Higher MORC2 expression was a significant indicator of worse PFS. Our results suggest that MORC2 expression may be a prognostic indicator in patients with locally advanced cervical cancer undergoing CCRT.

Advanced female urethral adenocarcinoma: A case report.

Urethral cancer in females is a rare occurrence. Although initially believed to be derived from skene glands, there is no consensus on the cell of origin. Squamous cell carcinoma is the most common, whereas adenocarcinoma is the least common. We report the case of a 58-years-old lady with a history of voiding lower urinary tract symptoms, later requiring a suprapubic cystostomy for retention. Cystoscopy and biopsy showed prostate-specific antigen (PSA) negative adenocarcinoma and postiron emission computed tomography (PETCT) showing pelvic and inguinal nodal metastasis. The patient underwent neoadjuvant chemotherapy followed by anterior exenteration with pelvic lymphadenectomy and ileal conduit. Final histology showed ypT4 yN1 adenocarcinoma, not otherwise specified.

The diagnostic value of two-dimensional ultrasound score, contrast-enhanced ultrasound score and ultrasound elastography score in prostate cancer.

Prostate cancer (PCa) is a prevalent malignancy in men, with early diagnosis being crucial for treatment and prognosis. This study evaluates the diagnostic efficacy of two-dimensional ultrasound imaging score (2DUS), contrast-enhanced ultrasound score (CEUS), and ultrasound elastography score (UES) in PCa. The PCa group consisted of patients diagnosed with primary PCa who underwent radical prostatectomy at the second hospital of Shanxi Medical University between January 2022 and December 2023. The benign lesion group consisted of patients diagnosed with benign prostatic hyperplasia (BPH)through prostate biopsy during the same period. We compared ultrasound scores at PCa and BPH patients using receiver operating characteristic (ROC) curve analysis. The study collected comprehensive patient data and analyzed variations in 2DUS, CEUS, and UES to identify relationships between preoperative ultrasound findings and the pathological states of PCa patients. PCa patients exhibited significantly higher ultrasound scores (P<0.001). Optimal cut-offs were 2.110 for 2DUS, 3.235 for CEUS, and 2.790 for UES, yielding area under curves (AUC) of 0.789, 0.817, and 0.898. The combined score provided an AUC of 0.933, with 83.33% sensitivity and 90.70% specificity. In the form of that patients with tumor stage III-IV, pathological grade III, poor differentiation, and pelvic lymph node metastasis exhibited significantly higher scores in 2DUS, CEUS, and UES compared to those with tumor stages I-II, pathological grades I-II, moderate and high differentiation without pelvic lymph node metastasis, respectively (P<0.05). The combined use of 2DUS, CEUS, and UES scores is highly effective for early PCa detection, surpassing individual scores in accuracy, and is beneficial for staging and differentiation.

Unusual Scenario: Ipsilateral Pelvic Lymph Node Metastasis in High- Grade Serous Ovarian Carcinoma without Peritoneal Extension - A Case Report

Introduction:: Ovarian cancers are the third most common gynecological cancers worldwide with serous carcinomas being the most common subtype with 90% of them as high-grade carcinomas. Case Presentation:: In the present case report a 60 years postmenopausal, nulliparous woman presented with complaints of bleeding per vaginum for 1-2 months with a left-sided solid-cystic ovarian mass of size 4x5 cm and ipsilateral enlarged external iliac and obturator lymph nodes which were diagnosed on histopathological examination as high-grade serous ovarian carcinoma (HGSOCs) with ipsilateral pelvic lymph node metastasis in presence of intact ovarian capsule and no metastatic deposits over the uterus, contralateral ovary and fallopian tubes, omentum, or any other gross peritoneal deposits. There was coexisting non-atypical endometrial hyperplasia. The patient was managed successfully with staging laparotomy with modified radical hysterectomy, and bilateral pelvic lymphadenectomy followed by six cycles of adjuvant chemotherapy with Paclitaxel and Carboplatin injections. Conclusion:: Patients with HGSOCs can have varied presentations with unusual involvement of lymph nodes in the absence of peritoneal spread. Hence, the clinician must be aware of these unusual presentations for the successful management of such cases.

Post-hoc analysis of clinicopathological factors affecting lateral lymph node metastasis based on STELLAR study for rectal cancer

PurposeIn post-hoc analyses of phaseIII randomized controlled study(STELLAR), to analyzethe prognostic impact oflateral pelvic lymph node (LPLN)metastasis in locally advanced rectal cancer (LARC). MethodsLPLN metastasis was defined as a short diameter > 7 mm on magnetic resonance imaging (MRI).The studyincluded 591 patients with LARC.All patients received neoadjuvant (chemo)radiotherapy combined withradical resection. ResultsAmong 591 patients, 99 (16.8 %) were diagnosed with LPLN metastasis, mostly with unilateral metastasis (79.8 %), with internal iliac lymph node metastasis being more common (81.8 %).Significant differences were found among with and without LPLN metastasis in rectal segmentation (P=0.001),N disease (P<0.001), mesenteric LN metastasis or not (P=0.030). The median follow-up timewas 34.0 months, three-year disease-free survival (DFS),overall survival (OS), andmetastasis-free survival (MFS)were significantly lower in LPLN metastaticgroup than those in LPLN non-metastaticgroup (51.4 % vs. 68.2 %, P<0.001; 71.8 % vs. 84.2 %, P=0.006; 60.8 % vs. 80.1 %,P<0.001), respectively; while there were no significant differences in locoregional recurrence(11.4 % vs. 8.5 %, P=0.564). Multivariate analysis found that LPLN metastasis was an independent prognostic factor affecting DFS (P=0.005), OS (P=0.036),MFS (P=0.001).No significantly survival benefit was observed for the short-term radiotherapy based total neoadjuvant therapy compared to long-term concurrent chemoradiotherapy. ConclusionsLPLN metastasis observed byMRI should be considered in LARC patients, especially in populations with lowrectal cancer, N2 disease, and mesenteric LN metastasis. LPLN metastasis diagnosed by MRI is a significant and independent risk factor and is associated with worse DFS, OS, MFS.

Risk factors for and prognostic impact of lateral pelvic lymph node metastasis in patients with rectal neuroendocrine tumors: a single-center retrospective analysis of 214 cases with radical resection.

Lateral pelvic lymph node (LPLN) metastasis of rectal neuroendocrine tumors (NETs) is rare, with unknown oncological features. We investigated the oncological impact of LPLN metastasis in patients with rectal NETs. This study included 214 patients with rectal NETs who underwent curative surgery. We evaluated their clinicopathological characteristics and short- and long-term outcomes. LPLN dissection was performed in 15 patients with LPLN swelling ≥ 7mm (preoperative imaging); 12 patients had LPLN metastases, 6 of whom had LPLN metastases without mesorectal lymph node metastases (skip metastasis). The short-term outcomes were similar between the groups with and without LPLN dissection. The median follow-up period was 59.4months, and patients with LPLN metastasis showed significantly shorter disease-free and overall survival rates than those without metastasis. Among 199 patients who did not undergo LPLN dissection, only 1 had LPLN recurrence. In a univariate analysis, tumor depth, tumor grade, and LPLN metastasis were associated with the overall survival. In the multivariate analysis, only LPLN metastasis was an independent predictor of the overall survival. LPLN metastasis is a poor prognostic factor for patients with rectal NETs. LPLN enlargement can be considered an indication for dissection, owing to its high rate of metastasis and associated poor prognosis.

Switching cisplatin to carboplatin in chemotherapy for metastatic penile cancer in a patient intolerant to cisplatin.

Cisplatin is currently the key drug in the chemotherapy regimen for metastatic penile cancer. There are few reports of alternative medicines for patients who cannot tolerate cisplatin. This report describes a case in which carboplatin was used instead. The patient presented with a chief complaint of edema in the groin area. On close examination, penile cancer (cT2-3N3M0 stage IV) with pelvic lymph node metastasis was diagnosed. He was started on chemotherapy with cisplatin (50 mg/m2 on days 1 and 2), paclitaxel (120 mg/m2 on day 1), and 5-fluorouracil (1000 mg/m2 on days 2-5), but he developed acute kidney failure on the 12th day, thought to be caused by cisplatin. Cisplatin was changed to carboplatin, and chemotherapy was continued. He has received nine courses of chemotherapy and is doing well. A case of penile cancer safely and effectively treated with chemotherapy using carboplatin was reported.

Lateral pelvic lymph nodes dissection of rectal neuroendocrine neoplasms: A prospective case-series and literature review

BackgroundRectal neuroendocrine neoplasms are relatively rare. Patients with rectal neuroendocrine neoplasms undergoing radical surgery have a higher rate of lymph node metastases. Robust evidence on the status of lateral pelvic lymph node metastases and the role of lateral pelvic lymph node dissection in those patients is lacking. This case-series study aimed to explore and address these issues. MethodsThis single-center, prospective case series consecutively enrolled patients with biopsy-proven rectal neuroendocrine neoplasms in a tertiary referral hospital between June 2022 and January 2024. All eligible patients underwent laparoscopic total mesorectal excision surgery and bilateral lateral pelvic lymph node dissection under general anesthesia. The clinicopathologic features, surgical outcomes, and postoperative complications were presented. The last follow-up was conducted in March 2024. ResultsA total of 11 patients with rectal neuroendocrine neoplasms—3 female and 8 male—were enrolled. The average age was 60.0 years (range, 53.5–65.5 years), and the median tumor size was 2.0 cm (range, 1.6–2.5 cm). Tumors invaded the muscularis propria in 7 patients. There were 3 cases of neuroendocrine tumor G1, 6 cases of neuroendocrine tumor G2, and 2 cases of neuroendocrine carcinoma. Among these patients, 11 (100.0%) had lymph node metastases, and 6 (54.5%) had lateral pelvic lymph node metastases. In addition, in 2 patients, only lateral pelvic lymph node metastases were observed, without involvement of the mesenteric lymph nodes. Five patients had tumors located on the left wall of the rectum, and only left-sided lateral pelvic lymph node metastases were observed. The other patient had both sides of lateral pelvic lymph node metastases due to circumferential growth of the tumor around the rectum. Anal preservation was achieved in all patients. The median operating time was 235.0 minutes (range, 210.5–335.5 minutes), and the median estimated blood loss was 50.0 mL (range, 45.0–75.0 mL). Two patients experienced postoperative dysuria and recovered spontaneously within 2–4 months after surgery. ConclusionOn the basis of a prospective case series, we demonstrate, for the first time, the lateral pelvic lymph node metastasis status in patients with rectal neuroendocrine neoplasms requiring radical total mesorectal excision surgery. Simultaneous bilateral lateral pelvic lymph node dissection may be a feasible and beneficial procedure for preventing local recurrence in these patients due to the lack of definitive neoadjuvant or adjuvant therapy options.

Utility of 64Cu-Sarcophagine-Bombesin PET/CT in Men with Biochemically Recurrent Prostate Cancer and Negative or Equivocal Findings on 68Ga-PSMA-11 PET/CT.

Despite a high detection rate of 68Ga-prostate-specific membrane antigen (PSMA) PET/CT in biochemical recurrence (BCR) of prostate cancer, a significant proportion of men have negative 68Ga-PSMA-11 PET/CT results. Gastrin-releasing peptide receptor, targeted by the copper-chelated bombesin analog 64Cu-sarcophagine-bombesin (SAR-BBN) PET/CT, is also overexpressed in prostate cancer. In this prospective imaging study, we investigate the detection rate of 64Cu-SAR-BBN PET/CT in patients with BCR and negative or equivocal 68Ga-PSMA-11 PET/CT results. Methods: Men with confirmed adenocarcinoma of the prostate, prior definitive therapy, and BCR (defined as a prostate-specific antigen [PSA] level > 0.2 ng/mL) with negative or equivocal 68Ga-PSMA-11 PET/CT results within 3 mo were eligible for enrollment. 64Cu-SAR-BBN PET/CT scans were acquired at 1 and 3 h after administration of 200 MBq of 64Cu-SAR-BBN, with further delayed imaging undertaken optionally at 24 h. PSA (ng/mL) was determined at baseline. All PET (PSMA and bombesin) scans were assessed visually. Images were read with masking of the clinical results by 2 experienced nuclear medicine specialists, with a third reader in cases of discordance. Accuracy was defined using a standard of truth that included biopsy confirmation, confirmatory imaging, or response to targeted treatment. Results: Twenty-five patients were enrolled. Prior definitive therapy was radical prostatectomy (n = 24, 96%) or radiotherapy (n = 1, 4%). The median time since definitive therapy was 7 y (interquartile range [IQR], 4-11 y), and the Gleason score was 7 or less (n = 15, 60%), 8 (n = 3, 12%), or 9 (n = 7, 28%). The median PSA was 0.69 ng/mL (IQR, 0.28-2.45 ng/mL). Baseline PSMA PET scans were negative in 19 patients (76%) and equivocal in 6 (24%). 64Cu-SAR-BBN PET-avid disease was identified in 44% (11/25): 12% (3/25) with local recurrence, 20% (5/25) with pelvic node metastases, and 12% (3/25) with distant metastases. The κ-score between readers was 0.49 (95% CI, 0.16-0.82). Patients were followed up for a median of 10 mo (IQR, 9-12 mo). Bombesin PET/CT results were true-positive in 5 of 25 patients (20%), false-positive in 2 of 25 (8%), false-negative in 7 of 25 (28%), and unverified in 11 of 25 (44%). Conclusion: 64Cu-SAR-BBN PET/CT demonstrated sites of disease recurrence in 44% of BCR cases with negative or equivocal 68Ga-PSMA-11 PET/CT results. Further evaluation to confirm diagnostic benefit is warranted.

Comparing the diagnostic value of 68Ga-prostate-specific membrane antigen PET/CT and multiparametric MRI in pelvic lymph node metastasis of locally advanced prostate cancer.

Multiparametric magnetic resonance imaging (mpMRI) is a commonly used method to diagnose pelvic lymph node metastasis (PLNM) in prostate cancer (PCa) patients, but there are few comparative studies on mpMRI and 68Ga-prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) in locally advanced PCa (LAPC) patients. Therefore, we designed a retrospective study to compare the diagnostic value of 68Ga-PSMA PET/CT and mpMRI for PLNM of LAPC. A retrospective study was performed on 50 patients with LAPC who underwent radical prostatectomy (RP) in Tongji Hospital from 2021 to 2023. All patients underwent PET/CT and mpMRI examination, and were diagnosed as LAPC before surgery, followed by robot-assisted laparoscopic prostatectomy or laparoscopic RP and extended pelvic lymph node dissection (ePLND). Routine postoperative pathological examination was performed. According to the results, the sensitivity, specificity, positive predictive value, and negative predictive value of 68Ga-PSMA PET/CT and mpMRI for the diagnosis of PLNM of LAPC were compared. Among the 50 patients, the mean age was 65.5±10.3 years, the preoperative total serum prostate-specific antigen (PSA) was 30.7±12.3 ng/mL, and the Gleason score was 7 [7, 8]. The difference in diagnostic efficacy between 68Ga-PSMA PET/CT and mpMRI in the preoperative diagnosis of PLNM of PCa was determined by postoperative pathological results. Based on the number of patients who developed PLNM, the sensitivity, specificity, positive predictive value, and negative predictive value of 68Ga-PSMA PET/CT were as follows: 93.75%, 100.00%, 100.00%, 97.14%, and 68.75%, 97.06%, 91.67%, 86.84% for mpMRI, respectively. Based on the number of pelvic metastatic lymph nodes, the sensitivity, specificity, positive predictive value, and negative predictive value of 68Ga-PSMA PET/CT were 95.24%, 100.00%, 100.00%, 99.48%, and 65.08%, 99.13%, 89.13%, 96.30% for mpMRI, respectively. It turned out that PET/CT was more sensitive than mpMRI in detecting PLNM of PCa, and the difference was statistically significant. 68Ga-PSMA PET/CT is more sensitive than mpMRI in the detection of PLNM in patients with LAPC. It is a promising method in the diagnosis and preoperative assessment of PLNM in LAPC.

Biparametric MRI of the prostate radiomics model for prediction of pelvic lymph node metastasis in prostate cancers : a two-centre study

ObjectivesExploring the value of adding correlation analysis (radiomic features (RFs) of pelvic metastatic lymph nodes and primary lesions) to screen RFs of primary lesions in the feature selection process of establishing prediction model.MethodsA total of 394 prostate cancer (PCa) patients (263 in the training group, 74 in the internal validation group and 57 in the external validation group) from two tertiary hospitals were included in the study. The cases with pelvic lymph node metastasis (PLNM) positive in the training group were diagnosed by biopsy or MRI with a short-axis diameter ≥ 1.5 cm, PLNM-negative cases in the training group and all cases in validation group were underwent both radical prostatectomy (RP) and extended pelvic lymph node dissection (ePLND). The RFs of PLNM-negative lesion and PLNM-positive tissues including primary lesions and their metastatic lymph nodes (MLNs) in the training group were extracted from T2WI and apparent diffusion coefficient (ADC) map to build the following two models by fivefold cross-validation: the lesion model, established according to the primary lesion RFs selected by t tests and absolute shrinkage and selection operator (LASSO); the lesion-correlation model, established according to the primary lesion RFs selected by Pearson correlation analysis (RFs of primary lesions and their MLNs, correlation coefficient > 0.9), t test and LASSO. Finally, we compared the performance of these two models in predicting PLNM.ResultsThe AUC and the DeLong test of AUC in the lesion model and lesion-correlation model were as follows: training groups (0.8053, 0.8466, p = 0.0002), internal validation group (0.7321, 0.8268, p = 0.0429), and external validation group (0.6445, 0.7874, p = 0.0431), respectively.ConclusionThe lesion-correlation model established by features of primary tumors correlated with MLNs has more advantages than the lesion model in predicting PLNM.

Treatment Patterns and Surgical Outcomes of Stage IA1 Cervical Carcinoma

OBJECTIVE The primary objective was to determine the 5-year overall survival rate and 5-year disease-free survival rate of patients with CACx 1A1 treated at Chiang Mai University Hospital and the secondary objective was to describe treatment modalities as well as their associated complications. METHODS Patients with stage IA1 cervical cancer diagnosed from January 2001 to June 2018 at Chiang Mai University Hospital were retrospectively reviewed. Inclusion criteria included previously untreated patients diagnosed with stage IA1 cervical cancer (2018 FIGO staging system). Exclusion criteria were patients with recurrent cervical cancer, other gynecologic malignancies, and those in a pregnant state. The analysis included treatment patterns, surgical types, and clinicopathologic variables, i.e., nodal metastasis, parametrial involvement, positive surgical margins, deep stromal invasion (DSI), lymph-vascular space invasion (LVSI), adjuvant treatment, 5-year disease-free survival, and 5-year overall survival. All pathologic slides were reviewed by gynecologic pathologists. The Kruskal-Wallis test, Fisher’s exact test, the Kaplan-Meier method and log-rank test were used for statistical analysis. RESULTS Of the 184 patients included in this study, simple hysterectomy was the most common treatment (57.3%), followed by modified radical hysterectomy (MRH) and radical hysterectomy (RH) (27.6% and 9.7% respectively). Conization and radiation were chosen in a few cases. At the median follow up time of 40.8 months, the 5-year disease free survival rate was 99.1% and the 5-year overall survival rate was 95.0%. Pelvic lymph node dissection was done in 62 cases (33.7%), but only one case (0.54%) had pelvic lymph node metastasis. CONCLUSIONS The surgical and survival outcomes for women with stage IA1 cervical cancer are excellent. They can be effectively treated with less radical interventions such as simple hysterectomy and conization. Lymph node metastasis is rare at this stage (0.54%); therefore, lympha-denectomy may possibly be omitted. KEYWORDS cervical cancer, IA1, treatment outcome