Outcomes of stereotactic body radiotherapy for supraclavicular lymph node metastasis among patients with metastatic prostate cancer.

Internal mammary chain and medial supraclavicular lymph node irradiation in stage I-III breast cancer (EORTC trial 22922/10925): an unplanned subset analysis of 20-year outcomes in patients with node-negative breast cancer.

Background Accurate staging of lung cancer is essential for appropriate treatment planning. Supraclavicular lymph nodes are commonly involved in advanced disease and are easily accessible for sampling. Ultrasound-guided fine needle aspiration cytology (US-FNAC) provides a minimally invasive method for their evaluation. Objectives This study aims to evaluate the diagnostic performance of ultrasound-guided fine needle aspiration cytology (US-FNAC) of supraclavicular lymph nodes in patients with suspected lung cancer. Methods This prospective study included 40 patients with suspected lung cancer and detectable supraclavicular lymph nodes. US-FNAC was performed under ultrasound guidance. Cytological findings were compared with histopathology from lung biopsy in 27 patients. Diagnostic indices were calculated. Results Among 40 patients, initial US-FNAC diagnosed 28 malignant, 5 suspicious, 6 benign/reactive, and 1 inadequate. Repeat FNAC of suspicious cases yielded 4 malignant and 1 benign; the inadequate case was excluded. Histopathology (n = 27) confirmed 24 malignant and 3 benign lesions. Final FNAC correctly identified all malignant cases, misclassifying 1 benign case. The diagnostic performance showed a sensitivity of 100%, specificity of 66.7%, positive predictive value of 96%, negative predictive value of 100%, and an overall accuracy of 96.3%. Conclusions US-FNAC is a highly sensitive and reliable technique for detecting metastatic lung cancer. Despite occasional false-positive findings, it remains a valuable tool for staging and guiding clinical management.

This retrospective study evaluated the efficacy and safety of neoadjuvant chemotherapy-immunotherapy combined with radical resection in 7 patients with limited-stage small cell lung cancer (LS-SCLC). Patients received a median of 3 cycles of neoadjuvant therapy with PD-1/PD-L1 inhibitor-based regimens (etoposide combined with cisplatin/carboplatin), followed by surgical resection and adjuvant chemoimmunotherapy. Imaging and biomarker assessments demonstrated significant tumor regression: 3 patients achieved partial response (PR) and 3 achieved complete response (CR) per RECIST criteria. Pathological examination confirmed complete pathological response (pCR) in all 7 patients. All patients successfully underwent R0 resection with low perioperative complication rates and no perioperative mortality. At median follow-up of 42 months, 6 patients maintained durable disease-free survival, while one patient developed left supraclavicular lymph node and cerebral metastases 16 months post-surgery, resulting in death 3 months after diagnosis. Treatment-related adverse events were manageable, predominantly mild to moderate in severity, with no treatment-related deaths. The findings suggest that neoadjuvant chemoimmunotherapy significantly induces tumor regression, enhances resectability, and improves long-term survival in LS-SCLC patients, though larger-scale clinical trials are needed to validate these results and optimize therapeutic strategies for this aggressive malignancy.

Ultrasound-, CT-, and MRI-based logistic regression models for the diagnosis of supraclavicular lymph node metastasis in esophageal squamous cell carcinoma.

The optimal staging of supraclavicular lymph node metastasis (SCLNM) in upper esophageal squamous cell carcinoma (UESCC) remains debated. This study aimed to evaluate its prognostic significance and clinical implications in patients treated with definitive chemoradiotherapy. This study included 435 newly diagnosed UESCC patients who received definitive chemoradiotherapy between January 2013 and October 2022. Survival and prognostic factors were analyzed by Kaplan-Meier and Cox regression methods. SCLNM was diagnosed in 49 patients (11.3%) and was strongly associated with metastasis at stations 101, 106rec, 106pre, and 106tb. Multivariate analysis confirmed SCLNM as an independent prognostic factor. Patients with SCLNM had poorer survival than those with M0 disease but better than those with other distant metastases (median overall survival: 24.0 vs. 67.0 vs. 8.0 months). Survival was significantly lower in SCLNM patients compared to N0M0 (P < 0.001) and N1M0 (P = 0.004) patients, but no significant difference was observed compared to N2M0 (P = 0.477) or N3M0 (P = 0.204) patients. After reclassifying SCLNM as a regional lymph node metastasis, N1 patients with SCLNM exhibited worse overall survival than those without SCLNM, although the statistical significance was marginal (P = 0.048); however, this difference was not seen in N2 or N3 categories. In the revised staging system where SCLNM was assigned to N2 or higher, survival differentiation across stages became more distinct, yielding a higher prognostic accuracy compared to the current AJCC staging system. SCLNM in UESCC patients undergoing definitive CRT shows prognostic similarity to N2-3 disease, but this finding is preliminary and requires further validation.

Robot-assisted versus conventional minimally invasive oesophagectomy for oesophageal squamous cell carcinoma (RAMIE): a multicentre, open-label, randomised, phase 3, non-inferiority trial.

A preoperative ultrasound-based radiomics-clinical nomogram to assess metastasis of ipsilateral supraclavicular lymph nodes in patients with primary breast cancer: A biomarker based on breast and axillary images.

Metastatic presentation of breast cancer in India: evidence from national cancer registry (2009-2020).

This study aimed to investigate the impact of the treatment duration, initiation timing, and inflammatory factors on immunotherapy maintenance in patients with stage III unresectable lung squamous cell carcinoma. A retrospective analysis was conducted on 100 patients with stage III unresectable lung squamous cell carcinoma who received comprehensive treatment consisting of induction chemotherapy followed by concurrent chemoradiotherapy and consolidation immunotherapy (i.e., the "induction + concurrent chemoradiotherapy + consolidation immunotherapy" regimen) between January 2019 and December 2022. The analysis focused on treatment efficacy and prognostic factors. All statistical analyses were performed using SPSS software (version 25.0). Survival analysis was conducted using the Kaplan-Meier method, with between-group comparisons assessed by the Log-rank test (for univariate analysis, significance level α = 0.10). Multivariate analysis was performed using the Cox proportional hazards regression model (significance level α = 0.05). Optimal cutoff values for the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) were determined using SPSS, and their sensitivity and specificity were calculated. Subsequently, based on these optimal cutoff values, patients were stratified into high- and low-value groups, thereby converting these continuous variables into categorical variables for further analysis. Among the 100 patients who received induction chemotherapy followed by concurrent chemoradiotherapy and consolidation immunotherapy, the 1-, 3-, and 5-year overall survival (OS) rates were 88.8%, 61.6%, and 43.6%, respectively. The corresponding 1-, 3-, and 5-year progression-free survival (PFS) rates were 74.6%, 45.3%, and 39.7%. Until the last follow-up, disease recurrence or metastasis occurred in 46 cases, including 15 cases of local recurrence, 16 cases of distant metastasis (8 with intracranial metastasis, 5 with liver metastasis, and 3 with bone metastasis), and 15 cases of regional lymph node metastasis (involving station 2, 4, 7 and supraclavicular lymph nodes).Univariate analysis identified TNM stage (p = 0.002), maintenance immunotherapy duration (p < 0.001), and interval between immunotherapy initiation and the last chemotherapy (p = 0.054) as factors associated with overall survival (OS).Multivariate Cox analysis confirmed that TNM stage (p = 0.03) and maintenance immunotherapy duration (p = 0.005) remained independently associated with OS. For progression-free survival (PFS), univariate analysis showed that the maintenance immunotherapy duration (p = 0.012) and TNM stage (p < 0.001) were significantly associated with PFS. Multivariate Cox analysis further demonstrated that both TNM stage (p = 0.01) and the maintenance immunotherapy duration (p = 0.034) retained independent associations with PFS. For patients with locally advanced lung squamous cell carcinoma, the comprehensive regimen of induction chemotherapy followed by concurrent chemoradiotherapy and consolidation immunotherapy-initiating consolidation immunotherapy two weeks after completing concurrent chemoradiotherapy and continuing for two years-yielded favorable outcomes, with efficacy comparable to that reported in previous studies. In this cohort, more advanced clinical stage, higher neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), and lower lymphocyte-to-monocyte ratio (LMR) were associated with poorer prognosis. The prognostic prediction model constructed based on TNM stage, NLR, PLR, and LMR demonstrated good predictive performance and clinical utility, representing a simple, economical, and effective tool worthy of further exploration for guiding clinical decision-making.

Evaluating regional breast lymph nodes is a critical aspect of breast cancer imaging, directly affecting staging, treatment planning, and overall patient outcomes. Clinical practice is moving toward de-escalation in the axilla, fueled by evidence of unchanged survival rates and low local recurrence rates, as well as the risk of lymphedema. Radiologists need to be skilled at identifying and characterizing suspicious lymph nodes and guiding interventions on them. This approach aligns with the American Society of Breast Surgeons' Choosing Wisely initiative, which advocates for less invasive management when appropriate. Although the sixth edition of the Breast Imaging Reporting and Data System (BI-RADS) atlas has not yet been published, the BI-RADS committee has previewed expected changes at multiple national meetings. A key anticipated update is introduction of a dedicated lymph node category across imaging modalities, accompanied by expanded guidance on lymph node morphology and location. The authors review the expected changes in the context of multimodality imaging, including mammography, US, and MRI, with a focus on axillary, intramammary, internal mammary, and supraclavicular lymph nodes. They present a systematic approach to lymph node evaluation, highlighting modality selection, imaging features suggestive of metastasis, and the role of US-guided core biopsy or fine-needle aspiration for histologic confirmation. Differential considerations and nodal staging are also discussed. ©RSNA, 2026.

BackgroundAdjuvant radiotherapy can be considered the standard of care for patients diagnosed with primary breast cancer who have undergone breast-conserving surgery. Left breast cancer receiving adjuvant deep inspiration breath hold (DIBH) were evaluated. A technique for monitoring patient position during DIBH is the surface guided radiation therapy (SGRT) as Vision AlignRT. The aim of this study was to estimate setup accuracy with AlignRT compared to AlignRT Advance in a cohort of patients undergoing DIBH treatment of breast cancer.Materials and methodsOne hundred and fifty‐four patients were studied. Patient positioning was informed using SGRT and verified by cone beam computed tomography (CBCT). Patients were divided into groups (G) based on treatment volume and version of Vision AlignRT. Comparison was performed by two tailed t-test. Data were deemed as statistically significant if p < 0.001.ResultsThe setup error for all patients treated with DIBH radiotherapy (RT) was calculated by CBCT. For left breast treatments, the interfractional displacement in the longitudinal and vertical directions was significantly (p < 0.001) reduced in patients positioned with the advanced version. For breast and supraclavicular lymph node chain and/or internal mammary chain treatments, interfractional displacement in the lateral and vertical directions was significantly (p < 0.001) reduced when the advanced version was used, while for longitudinal displacement the reduction was not significant.ConclusionsPositioning with AlignRT Advance is more accurate for either left breast only or left breast and supraclavicular lymph node chain and/or internal mammary chain treatments.

A 64-year-old man underwent endoscopic submucosal dissection (ESD) for squamous cell carcinoma in the upper thoracic esophagus. The resected specimen was histopathologically diagnosed as esophageal squamous cell carcinoma with pathological invasion to the T1a-lamina propria mucosae without lymphovascular invasion and was determined to have been curatively resected. Twenty-six months after ESD, the patient had an increased serum carcinoembryonic antigen (CEA) concentration of 14.0 ng/mL. Comprehensive examination revealed multiple lymphadenopathies. A biopsy of the right supraclavicular lymph node confirmed metastasis of squamous cell carcinoma. Immunohistochemical study for CEA was focally positive in the primary ESD specimen, whereas nearly all tumor cells in the metastatic lesion were positive. Therefore, it was considered that the metastatic lesion originated from the CEA-positive subpopulation of the primary tumor. This is the first case of lymph node metastatic recurrence detected based on an increased serum CEA concentration after ESD for esophageal squamous cell carcinoma with invasion to the T1a-lamina propria mucosae. Serum CEA measurement was useful for detecting the recurrence. Furthermore, this case suggests that CEA immunohistochemical study may be useful for the assessment of metastatic risk following curative ESD for esophageal squamous cell carcinoma.

Introduction Systemic lupus erythematosus (SLE) is a complex autoimmune disease. Its diagnosis is based on clinical and laboratory criteria, with mandatory exclusion of other differential diagnoses. Paraneoplastic syndrome is a rare disorder in which there is an underlying malignancy, causing symptoms not directly related to tumour metastasis or local invasions. Paraneoplastic rheumatic syndrome closely resembles the rheumatic disease and may be accompanied by the presence of autoantibodies. Case description A 45-year-old woman was admitted to the Rheumatology Ward following a previous suspicion of granulomatosis with polyangiitis (GPA) and an inconclusive diagnostic evaluation during outpatient treatment. Patient’s medical history included generalised joint pain with oedema, weakness, occasional low-grade fever, and recurrent epistaxis with nasal perforation. Histopathological examination of the nasal mucosa excluded findings characteristic of GPA. The patient has been treated with methotrexate and glucocorticosteroids. During the current hospitalisation, physical examination revealed no joint or upper respiratory tract inflammation. However, supraclavicular lymph nodes were enlarged, and the patient reported newly onset of dysphagia. Laboratory tests showed mildly elevated C-reactive protein, lymphopenia, positive antinuclear antibody with a homogeneous pattern and a titre of 1 : 3,200, positive anti-dsDNA and mildly elevated carcinoembryonic antigen. The patient was referred for a lymph node biopsy, which concluded third--grade adenocarcinoma. Computed tomography showed gastric wall thickening and multiple enlarged lymph nodes in the abdominal area, followed by diffuse nodules in the lungs. Gastroscopy revealed a pathological, cauliflower-like infiltrative lesion involving a greater part of the gastric body. Histopathological examination of gastric biopsy specimens confirmed gastric adenocarcinoma. Due to the advanced stage of cancer, the patient was qualified for palliative treatment. Conclusions Paraneoplastic rheumatic syndromes pose a diagnostic challenge because they can closely mimic SLE while presenting with few unusual features. Therefore, the exclusion of other differential diagnoses is crucial. This case highlights the necessity to reconsider the diagnosis in patients with atypical presentations, even when other diagnostic criteria are met.

Adult T-cell leukemia/lymphoma (ATLL) is an aggressive lymphoma with a poor prognosis. The human T-lymphotropic virus 1 (HTLV-1) is associated with immunodeficiency and increased extranodal involvement in patients with diffuse large B-cell lymphoma (DLBCL). We report on a 47-year-old woman with spastic paraparesis and hepatitis B who was diagnosed with the acute form of ATLL. The clinical picture reveals peripheral generalized lymphadenopathy and splenomegaly. Findings on a hematologic exam indicated leukocytosis with lymphocytosis. A bone marrow biopsy/aspiration confirmed 50% T-cell lymphoid infiltration. Biochemistry results revealed hypercalcemia and a high lactate dehydrogenase value. Results of a CT scan indicated abdominal and thoracic adenopathy as well as moderate splenomegaly. A supraclavicular lymph node biopsy established a DLBCL diagnosis. The final diagnosis was composite lymphoma, DLBCL, and ATLL. The CHOP (cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate [Oncovin], and prednisone) regimen was chosen due to the patient's ECOG performance status. Multiple infectious complications were diagnosed during chemotherapy-induced secondary aplasia. A complete remission, confirmed via PET-CT imaging, was obtained. After 1 month, a skin tumor on the upper right thigh was discovered and biopsied, and the histopathological exam and immunochemistry findings indicated Epstein-Barr virus-DLBCL lymphoma. The association of 2 aggressive lymphomas in a single HTLV-1 carrier is a rare report, and the evolution was severe, complicated by opportunistic infections, and unfavorable.

The management of Stage IIIB non-small-cell lung cancer (NSCLC) is complex. The current staging system does not distinguish between ipsilateral and contralateral supraclavicular lymph node involvement, although this distinction may impact prognosis. This study investigates the differences in prognosis between these two presentations of N3 disease. This study presents a retrospective analysis of 113 patients diagnosed with Stage IIIB NSCLC who had supraclavicular lymph node metastases and underwent chemoradiation therapy. Patients were categorized based on whether their supraclavicular involvement was ipsilateral or contralateral to the primary lung tumor. Survival outcomes were calculated and correlated with various factors. Patients with ipsilateral supraclavicular metastases had a median progression-free survival of 12 months, compared to 9 months for those with contralateral involvement. The median overall survival for the two groups was 17 months and 14 months, respectively. Poorer survival outcomes were associated with contralateral nodal involvement, older age, poor performance status, and exclusive radiotherapy treatment. Contralateral supraclavicular metastases are associated with a worse prognosis compared to ipsilateral involvement in Stage IIIB NSCLC. These findings suggest a need to reevaluate their classification within current staging systems and to consider systemic treatment for these high-risk patients. Phase III randomized controlled trials are needed to validate this observation.

The Implication of Failure Patterns After Neoadjuvant Chemoradiation Therapy With Small Involved Field in Esophageal Squamous Cell Carcinoma.

Consolidative Camrelizumab Following Definitive Concurrent Chemoradiation Therapy With Involved-Field Irradiation in Locally Advanced Esophageal Squamous Cell Carcinoma: A Single-Arm Phase 2 Trial.

Ovarian dysgerminoma is a rare, highly chemo-sensitive germ cell tumor usually presenting early. We report a FIGO stage IVB case with supraclavicular lymph node metastasis and peritoneal carcinomatosis in a 31-year-old woman. Diagnosis was based on classical histopathology. Cytoreductive surgery followed by BEP chemotherapy achieved a favorable clinical outcome.

Background and Objectives: The benefits of prophylactic supraclavicular lymph node dissection for esophageal squamous cell carcinoma (ESCC) remain controversial. This study investigated whether prophylactic supraclavicular (cervical) lymphadenectomy improves the long-term outcomes of patients with upper or middle thoracic esophageal squamous cell carcinoma. Materials and Methods: This retrospective, single-center study included 290 patients who underwent thoracoscopic esophagectomy between January 2010 and December 2017. Patients treated with two-field lymphadenectomy (2FL) were compared with those who underwent prophylactic three-field lymphadenectomy (p3FL) after propensity score matching based on age, tumor location, clinical T and N stage, and preoperative treatment. The primary outcome was overall survival (OS), and secondary outcomes included postoperative complications and recurrence patterns. In a secondary analysis, the long-term outcomes were assessed in patients with solitary postoperative cervical (supraclavicular) lymph node recurrence in the 2FL group. Results: In the overall cohort, statistically significant differences were observed between the groups with respect to age, tumor location (p = 0.0002), cT and cN stages (p < 0.0001 and p < 0.0001), preoperative treatment (p = 0.02). No significant differences were observed between groups regarding age, organ for reconstruction, or postoperative complications. After propensity score matching, no significant differences were observed between the 2FL and p3FL groups in terms of overall survival or postoperative complications. Six patients (4.4%) in the p3FL group had pathologically confirmed supraclavicular lymph node metastasis, whereas four patients (2.6%) in the 2FL group developed solitary postoperative cervical lymph node recurrence. Patients with isolated cervical recurrence achieved favorable long-term survival following additional treatment. Conclusions: Prophylactic cervical lymphadenectomy did not improve the survival of patients with upper or middle thoracic esophageal squamous cell carcinoma. Given the low incidence of isolated cervical lymph node recurrence and the favorable outcomes achievable with additional treatment, routine prophylactic supraclavicular dissection appears unnecessary when two-field lymphadenectomy is feasible.