Underwent Lymph Node Dissection Research Articles

Development and validation of a machine-learning model to predict lymph node metastasis of intrahepatic cholangiocarcinoma: A retrospective cohort study

Lymph node metastasis in intrahepatic cholangiocarcinoma significantly impacts overall survival, emphasizing the need for a predictive model. This study involved patients who underwent curative liver resection between different time periods. Three machine learning models were constructed with a training cohort (2010-2016) and validated with a separate cohort (2019-2023). A total of 170 patients were included in the training set and 101 in the validation cohort. The lymph node status of patients not undergoing lymph node dissection was predicted, followed by survival analysis. Among the models, the support vector machine (SVM) had the best discrimination, with an area under the curve (AUC) of 0.705 for the training set and 0.754 for the validation set, compared to the random forest (AUC: 0.780/0.693) and the logistic regression (AUC: 0.703/0.736). Kaplan-Meier analysis indicated that patients in the positive lymph node group or predicted positive group had significantly worse overall survival (OS: p < 0.001 for both) and disease-free survival (DFS: p < 0.001 for both) compared to negative groups. An online user-friendly calculator based on the SVM model has been developed for practical application.

Lower extremity lymphedema in patients with gynecologic cancer: Validation of the Gynecologic Cancer Lymphedema Questionnaire (GCLQ) in German language and investigation of lymphedema real-world treatment

Abstract Purpose The Gynecologic Cancer Lymphedema Questionnaire (GCLQ) is an established patient-reported outcome measure for lower extremity lymphedema (LEL) in gynecologic oncology. We aimed to validate the GCLQ in German language (GCLQ-GER) for lymphedema detection in German-speaking patients and also investigated real-world patterns of lymphedema treatment. Methods The GCLQ was translated from English into German in accordance with the standards of a professional translation process. Subsequently, the questionnaire was administered in a prospective observational study including 102 patients who had undergone lymph node dissection (LND) within gynecologic cancer surgery. Various test quality criteria were calculated for the GCLQ-GER. As gold standard of testing methods, patients were clinically evaluated for LEL, and limb volume measurements were taken. Further data for lymphedema treatment were collected in patients with lymphedema diagnosis. Results Patients with LEL had increased GCLQ-GER total scores (mean 7.27) compared to patients without LEL (mean 1.81), p &lt; 0.001. High diagnostic accuracy was indicated by the large area under the receiver operating characteristics curve (AUC) of 0.874 (95% CI 0.802–0.946). Based on sensitivity and specificity values ≥ 79.0%, the GCLQ total score ≥ 4 was determined as the optimal cut-off value to identify LEL. Excellent internal consistency was demonstrated by Cronbach’s alpha of 0.876. The clinical examination revealed a LEL prevalence of 48.0% (n = 49), and 85.7% (n = 42) of these patients received treatment. Conclusion The GCLQ-GER is a valid and feasible patient-reported outcome measure for lymphedema detection in German-speaking gynecologic cancer survivors. Its clinical introduction could improve secondary prevention of lymphedema and real-world treatment.

The Role of Lymphadenectomy in the Surgical Treatment of Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis.

Background: Lymphadenectomy in the operative management of hepatocellular carcinoma (HCC) remains controversial, with no recommendation for routine practice. Our study aimed to assess the effects of lymphadenectomy in addition to hepatic resection (HR) compared to HR alone for adults with HCC. Methods: This systematic review was conducted according to PRISMA guidelines until March 2023, searching and selecting the relevant literature comparing lymph node dissection or sampling, combined with HR, and with no lymph node removal. Critical appraisal of the included studies was performed using the ROBINS-I tool. Fixed- or random-effect meta-analysis models were carried out, and inter-studies were assessed for heterogeneity. Results: Fourteen studies were selected during the screening process. Data from eight studies containing 32,041 HCC patients were included in the quantitative synthesis. In total, 12,694 patients underwent lymph node dissection (LND), either selectively for preoperatively diagnosed or intraoperatively suspected lymph node metastasis (LNM) or unselectively (i.e., regardless of suspected LNM). According to LN status, 1-, 3- and 5-year mortality rates were higher in the LNM group with respect to both clinically negative LN (OR 3.25, 95% CI 2.52-4.21; p < 0.001; OR 3.79, 95% CI 2.74-5.24; p < 0.001; OR 3.92, 95% CI 2.61-5.88; p < 0.001) and proven LN0 (OR 1.75, 95% CI 1.0-3.04; p = 0.05; OR 2.88, 95% CI 1.79-4.63; p < 0.001; OR 2.54, 95% CI 1.33-4.84; p < 0.001). Moreover, the summary estimates of two controlled trials showed no significant difference in overall survival between LND groups and those without LND for negative LN patients. Conclusions: Lymph node dissection does not appear to improve overall survival, according to the available literature; thus, this does not support its routine adoption as part of standard liver resection for HCC. A case-by-case decision remains advisable.

Development of a nomogram based on whole-tumor multiparametric MRI histogram analysis to predict deep myometrial invasion in stage I endometrioid endometrial carcinoma preoperatively.

The depth of myometrial invasion determines whether International Federation of Gynecology and Obstetrics stage I endometrioid endometrial carcinoma (EEC) patients undergo lymph node dissection. However, subjective evaluation results relying on magnetic resonance imaging (MRI) are not always satisfactory. To develop a nomogram based on whole-volume tumor MRI histogram parameters to preoperatively predict deep myometrial invasion (DMI) in patients with stage I EEC. This retrospective analysis included 131 EEC patients and a training/validation cohort of 92/39 patients at a 7:3 ratio. The histogram parameters were obtained from multiple sequences (ADC mapping and T2-weighted imaging) within volumes of interest. Univariate analysis, least absolute shrinkage and selection operator (LASSO) regression, and multivariate logistic regression were used for feature selection. The performance of clinical model, histogram model, and histogram nomogram was evaluated by calculating the area under the receiver operating characteristic curve (AUC). Age and two morphological features (maximum anteroposterior tumor diameter on sagittal T2-weighted images [APsag] and the tumor area ratio [TAR]) were selected to construct the clinical model. Five histogram parameters were selected for the creation of the histogram model. The nomogram, which combines the histogram parameters, age, APsag, and TAR, achieved the highest AUCs in both the training and validation cohorts (nomogram vs. histogram vs. clinical model: 0.973 vs. 0.871 vs. 0.934 [training] and 0.972 vs. 0.870 vs. 0.928 [validation]). The MR histogram nomogram can help predict the DMI of patients with stage I EEC preoperatively, assisting physicians in the development of personalized treatment strategies.

Correlation of Histopathological Characteristics of Nodal Metastasis with Clinicopathologica Features and Survival in Breast Cancer Patients

Background: Involvement of lymph nodes is a significant predictive marker in breast cancer, impacting both patient results and therapy strategies. It is crucial to comprehend the pathological alterations in lymph nodes that are linked to breast carcinoma in order to maximize care for patients.Objective: This study aimed to examine histopathological changes in lymph nodes related to breast cancer and their clinical implications.Materials and Methods: A retrospective observational analysis was conducted from the time duration of 21st November 2022 to 24th April 2023 involving 100 diagnosed breast cancer patients who underwent lymph node dissection. Patient data, including demographics, clinical history, five-year survival rates, and histopathological findings, were collected from medical records. Descriptive statistics and multivariate analysis were used to analyze the data.Results: In a study of breast cancer patients, 60% had macrometastases and 45% had extracapsular extension, indicating aggressive disease. Micrometastases were observed in 30%. Patients with lymph node metastases had poorer outcomes, with lower 5-year survival rates (60%) and higher recurrence rates (35%) compared to those without lymph node involvement (85% and 15%, respectively). Multivariate analysis showed lymph node involvement as a key prognostic factor (hazard ratio 2.5), while larger tumor size and higher histological grade also predicted worse outcomes. Subgroup analysis revealed that isolated tumor cells had the highest 5-year survival rate (75%), while micrometastases and macrometastases had lower rates of 65% and 55%, respectively.Conclusion: The presence of histopathological alterations in the lymph nodes associated to breast cancer is important for predicting outcomes and treatment plans. The number of affected lymph nodes can determine the survival rates of patients, which underlines the importance of proper lymph node assessment for breast cancer treatment.Keywords: Breast cancer, Histopathology, Lymph node involvement, Prognosis, Treatment.

Lymph node dissection after neoadjuvant chemotherapy improves overall survival in clinical stage III endometrial cancer

ObjectiveTo investigate whether performing a lymph node dissection during hysterectomy improves overall survival in patients with clinical stage III endometrial cancer who received neoadjuvant chemotherapy.MethodsThe National Cancer Database was queried...

Predictive factors for lymph node metastasis in papillary thyroid cancer patients undergoing neck dissection: insights from a large cohort study.

This study aimed to investigate the risk factors and metastatic patterns in papillary thyroid cancer (PTC) patients undergoing lymph node dissection, offering guidance for clinical practice. A total of 924 PTC patients who underwent thyroidectomy with central neck dissection (CND) or lateral neck dissection (LND) between January 2021 and November 2022 were included in the analysis. The study investigated the relationships between clinicopathological characteristics, lymph node metastasis, and various risk factor. Among the 924 PTC patients, the cervical lymph node metastasis rate was 59.1% (546 patients). Of these patients, 381 had central neck metastasis (CNM, 41.2%), while the remaining 165 patients had lateral neck metastasis (LNM, 17.9%). Factors associated with increased risk of CNM and LNM included larger tumor diameter, presence of multiple tumors, and capsular invasion (p<0.05). Male sex, age <55 years, larger tumor diameter (>0.85 cm), multiple tumors, capsular invasion, and absence of Hashimoto's disease were identified as independent risk factors for CNM (p<0.05), with an AUC value of 0.722. CNM, maximum diameter >1.15 cm, and multiple tumors were independent risk factors for LNM (p<0.05), with an AUC of 0.699. These findings suggest that tailored neck dissection based on individual risk factors is crucial, particularly in cases of suspected LNM with larger tumors, CNM, multiple tumors, and capsular invasion.

Histological Risk Factors for Lymph Node Metastasis in pT1 Colorectal Cancer: Does Submucosal Invasion Depth Really Matter?

After endoscopic resection of colorectal cancer with submucosal invasion (pT1 CRC), additional surgical treatment is recommended if deep submucosal invasion (DSI) is present. This study aimed to further elucidate the risk factors for lymph node metastasis (LNM) in patients with pT1 CRC, especially the effect of DSI on LNM. Patients with pT1 CRC who underwent lymph node dissection were selected. The Chi-square test and multivariate logistic regression were used to analyze the relationship between clinicopathological characteristics and LNM. The submucosal invasion depth (SID) was measured via 4 methods and analyzed with 3 cut-off values. Twenty-eight of the 239 patients presented with LNM (11.7%), and the independent risk factors for LNM included high histological grade (P=0.003), lymphovascular invasion (LVI) (P=0.004), intermediate to high budding (Bd 2/3) (P=0.008), and cancer gland rupture (CGR) (P=0.008). Moreover, the SID, width of submucosal invasion (WSI), and area of submucosal invasion (ASI) were not significantly different. When one, two, three or more risk factors were identified, the LNM rates were 1.1% (1/95), 12.5% (7/56), and 48.8% (20/41), respectively. Indicators such as the SID, WSI, and ASI are not risk factors for LNM and are subjective in their measurement, which renders them relatively inconvenient to apply in clinical practice. In contrast, histological grade, LVI, tumor budding and CGR are relatively straightforward to identify and have been demonstrated to be statistically significant. It would be prudent to focus on these histological factors rather than subjective measurements.

Study of PD-L1 Expression in Papillary Thyroid Carcinoma and its Correlation to the Clinico-Pathological Characteristics

Abstract Background Thyroid carcinoma is the most common endocrine malignancy, diagnosed annually worldwide. Papillary thyroid carcinoma (PTC) is the most common histologic subtype of thyroid carcinoma, accounting for around 90% of new cases. The expression of PD-L1 is investigated as a potential prognostic and predictive biomarker of the clinical outcome. Aim of the Work The study aimed at assessing PD-L1 expression in patients with PTC and its variants, also to determine its correlation with clinico-pathological parameters. Patients and Methods This is a cross-sectional study conducted on 50 patients diagnosed with PTC and treated at the Head and Neck Clinic, Ain Shams University Hospitals in the period from 2020-2022. Results We assessed the PD-L1 status by immunohistochemistry on formalin fixed and paraffin embedded surgical tissues of 50 patients diagnosed with PTC and its variants. Monoclonal Mouse anti-Human PD-L1 clone 22C3 from Dako Company was used to detect the PD-L1 status in tumor cells using the clone 22C3. PD-L1 positive expression was detected in 16/50 patients (32%) at a 1% threshold. The clinico-pathologic factors over a median duration of 17 months was studied and its correlation with the PD-L1 status. The mean age of the study population at diagnosis was 43 years with 92 % of cases were female patients. All patients underwent total thyroidectomy with 21 patients underwent lymph node dissection. The most common stage was stage I, and the most common histopathologic subtype was the classical PTC subtype. Most of the study population received radioactive iodine (84%). Median disease free survival was not reached as only 7 patients developed recurrence in the follow up period. In our study, statistically significant correlation was found between patients with PD-L1 positive tumor cells and higher T stage (p = 0.021), and positive pathological lymph nodes (p = 0.01). All the 16 patients who were found to have PD-L1 positive expression, received RAI (p = 0.034). Whereas no association was found with age (p = 0.197), sex (p = 0.584), multifocality (p = 0.566), lymphovascular invasion (p = 0.061), extra-thyroid extension (p = 0.725), thyroiditis (p = 0.135), histological variants (p = 0.520), margins (p = 0.410), post-operative thyroglobulin (p = 0.120), and disease free survival (p = 0.239). Conclusion PD-L1 expression correlates with T stage and pathological lymph nodes and may be used as a prognostic marker for PTC patients. Further follow up needs to be done to confirm the prognostic value of PD-L1 expression in PTC.

Surgical management of papillary thyroid carcinoma coexisting with Hashimoto's disease: a single-center retrospective cohort study.

The mechanism and impact of Hashimoto's disease (HT) in patients with papillary thyroid carcinoma (PTC) remains a subject of ongoing debate. The optimal extent of thyroid resection is also controversial in cases of low-risk PTC. To investigate the clinical outcomes and prognoses associated with different extents of surgical resection in patients diagnosed with PTC coexisting with HT. We retrospectively analyzed data on the clinical features and treatment outcomes of patients with PTC concomitant with HT who underwent lobectomy with isthmusectomy and those who underwent total thyroidectomy at Peking University International Hospital between December 2014 and August 2023. Twenty-one patients in group A underwent lobectomy with isthmusectomy and prophylactic central neck dissection, whereas twenty patients in group B underwent total thyroidectomy with prophylactic central lymph node (LN) dissection, except one who did not undergo LN dissection. Group A demonstrated shorter surgery time (105.75 min ± 29.35 vs. 158.81 min ± 42.01, p = 0.000), higher parathyroid hormone (PTH) levels on postoperative day 1 [26.96 pg/ml (20.25, 35.45) vs. 9.01 pg/ml (2.48, 10.93), p = 0.000] and a shorter postoperative hospital stay [2.95 d (2.0, 4.0) vs. 4.02 d (3.0, 5.0), p = 0.008] than those of group B, with statistically significant differences. Both groups exhibited similar recovery patterns in terms of PTH [32.10 pg/ml (22.05, 46.50) vs. 20.47 pg/ml (9.43, 34.03), p = 0.192] and serum calcium (2.37 mmol/L ± 0.06 vs. 2.29 mmol/L ± 0.19, p = 0.409) after 1 montsh following the surgery. According to the Kaplan-Meier curves, no significant difference in the 5-year disease-free survival rates were observed between patients in group A (100%) and group B (97.1%) (Log rank test: p = 0.420, Breslow test: p = 0.420). Lobectomy with isthmusectomy and prophylactic central neck dissection is a safe and feasible treatment option for patients with low-risk PTC coexisting with HT. http://www.chictr.org.cn, identifier ChiCTR2300079115.

Analysis of risk factors for lymph node metastasis in patients with CN0 papillary thyroid carcinoma

Objective:To explore the risk factors of lymph node metastasis and multiple lymph node metastasis in patients with stage CN0 papillary thyroid carcinoma. Methods:The clinical case data of 3 099 patients with CN0 papillary thyroid cancer who underwent lymph node dissection at Xijing Hospital of Air Force Medical University from January 2013 to December 2022 were retrospectively analyzed, univariate and multivariate logistic regression were used to analyze the risk factors of lymph node metastasis and multiple lymph node metastasis. Results:Male gender, age<55 years, multifocal lesions, and lesion size ≥2 cm were independent risk factors for lymph node metastasis in CN0 patients（P<0.05）, while diabetes was an independent protective factor for lymph node metastasis（P<0.05）.Age<55 years, capsular invasion, and multifocal lesions were independent risk factors for the presence of ≥3 lymph nodes with metastasis （P<0.05）. Conclusion:In CN0 stage PTC patients, special attention should be given to the possibility of lymph node metastasis when they are male, aged <55 years, have multifocal lesions, or have lesion size >2 cm.

Lymph node metastasis in grossly apparent early-stage epithelial ovarian cancer: A retrospective clinical study at a tertiary institute.

This study aimed to evaluate the incidence and predict the risk factors of lymph node (LN) metastasis among patients with grossly apparent early-stage epithelial ovarian cancer (EOC). We retrospectively reviewed the clinicopathologic data and follow-up information of 266 patients who underwent LN dissection for apparent early-stage EOC between January 2018 and September 2022 at the Obstetrics and Gynecology Hospital of Fudan University. Among 266 patients, 44 (16.5%) showed LN metastasis, of which 65.9% and 59.1% presented in the pelvic region and para-aortic region, respectively. Univariate analysis revealed higher LN positivity in patients with high-grade serous carcinoma (HGSC), preoperative imaging suggestive of LN metastasis, bilateral adnexal involvement, lymphovascular space invasion (LVSI), positive peritoneal cytology, and clinical stage IIA. LN metastases were identified in 7.9%, 10.2%, and 39.7% of clinical stage IA/B, IC, and IIA disease cases, respectively. Multivariate analysis confirmed significantly higher LN positivity rates in patients with HGSC, LVSI, and clinical stage IIA. In clinical stage IIA EOC, the 3-year progression-free survival (PFS) rates were 65.8% and 77.4% (P = 0.360) for LN-negative and LN-positive groups, respectively. In clinical stage I EOC, the 3-year PFS rates were 93.5% and 59.4% (P < 0.001) for LN-negative and LN-positive groups, respectively. High-grade serous histology, LVSI, and clinical stage IIA disease are predictive factors for LN involvement in early-stage EOC. In addition, LN metastasis appears to be associated with worse PFS in clinical stage I EOC compared with clinical stage IIA EOC.

Mapping of lymph node metastasis from esophageal squamous cell carcinoma after neoadjuvant treatment: a prospective analysis from a high-volume institution in China.

The study aimed to describe the prevalence of lymph node metastases per lymph node station for esophageal squamous cell carcinoma (ESCC) after neoadjuvant treatment. Clinicopathological variables of ESCC patients were retrieved from the prospective database of the Surgical Esophageal Cancer Patient Registry in West China Hospital, Sichuan University. A two-field lymphadenectomy was routinely performed, and an extensive three-field lymphadenectomy was performed if cervical lymph node metastasis was suspected. According to AJCC/UICC 8, lymph node stations were investigated separately. The number of patients with metastatic lymph nodes divided by those who underwent lymph node dissection at that station was used to define the percentage of patients with lymph node metastases. Data are also separately analyzed according to the pathological response of the primary tumor, neoadjuvant treatment regimens, pretreatment tumor length, and tumor location. Between January 2019 and March 2023, 623 patients who underwent neoadjuvant therapy followed by transthoracic esophagectomy were enrolled. Lymph node metastases were found in 212 patients (34.0%) and most frequently seen in lymph nodes along the right recurrent nerve (10.1%, 58/575), paracardial station (11.4%, 67/587), and lymph nodes along the left gastric artery (10.9%, 65/597). For patients with pretreatment tumor length of >4cm and non-pathological complete response of the primary tumor, the metastatic rate of the right lower cervical paratracheal lymph nodes is 10.9% (10/92) and 10.6% (11/104), respectively. For patients with an upper thoracic tumor, metastatic lymph nodes were most frequently seen along the right recurrent nerve (14.2%, 8/56). For patients with a middle thoracic tumor, metastatic lymph nodes were most commonly seen in the right lower cervical paratracheal lymph nodes (10.3%, 8/78), paracardial lymph nodes (10.2%, 29/285), and lymph nodes along the left gastric artery (10.4%, 30/289). For patients with a lower thoracic tumor, metastatic lymph nodes were most frequently seen in the paracardial station (14.2%, 35/247) and lymph nodes along the left gastric artery (13.1%, 33/252). The study precisely determined the distribution of lymph node metastases in ESCC after neoadjuvant treatment, which may help to optimize the extent of lymphadenectomy in the surgical management of ESCC patients after neoadjuvant therapy.

The Role of Neoadjuvant Immunotherapy in the Management of Merkel Cell Carcinoma with Clinically Detected Regional Lymph Node Metastasis

BackgroundImmunotherapy is emerging as a promising option for certain locally advanced and metastatic cutaneous malignancies. However, the role of neoadjuvant immunotherapy (NIO) in Merkel cell carcinoma (MCC) with clinically detected regional lymph node metastasis (CDRLNM) has not been fully elucidated.MethodsFor this study, MCC patients with CDRLNM who underwent surgical excision were selected from the National Cancer Database (NCDB). Those who received NIO were propensity-matched with those who did not, and Kaplan-Meier analysis was used to compare overall survival (OS).ResultsOf the 1809 selected patients, 356 (19.7%) received NIO followed by wide excision (n = 352, 98.9%) or amputation (n = 4, 1.1%). The rate of complete pathologic response for the primary tumor (ypT0) was 45.2%. Only 223 patents (63.4%) also underwent lymph node dissection (LND). The complete pathologic nodal response (ypN0) rate for these patients was 17.9%. A pathologic complete response of both the primary tumor and the nodal basin (ypT0 ypN0) was seen in 16 of the 223 patients who underwent both primary tumor surgery and LND. Subsequently, 151 pairs were matched between the NIO and no-NIO groups (including only patients with LND). Kaplan-Meier analysis demonstrated a significant OS improvement with NIO (median not reached vs. 35.0 ± 8.0 months; p = 0.025). The 5-year OS was 57% in the NIO group versus 44% in no-NIO group (p = 0.021).ConclusionThe study suggests that NIO in MCC with CDRLNM provides improved OS in addition to promising rates of primary complete response, which could change the profile of surgical resection. This supports ongoing clinical trials exploring the use of NIO in MCC.

Effectiveness of Lymph Node Dissection in Women over Age 70 with Stage I Ovarian Cancer

Background: Considering the possibility of surgical intervention affecting the survival benefit of elderly patients, the relationship between lymph node dissection and the survival of elderly patients with stage I ovarian cancer (OC) was retrospectively analyzed. Methods: This was a retrospective cohort study using the database in Surveillance, Epidemiology and End Results (SEER) which was queried to identify 8191 women with stage I OC treated with surgery from 1975 to 2016. Frequencies and percentages were presented to describe the categorical data. Pearson χ2 test was used to compare the correlation between the patient characteristics and lymph node dissection. Kaplan–Meier test was used to analyze the relationship between overall survival (OS) and patients at all age levels. The log-rank test was used for pairwise comparisons of OS. Cox proportional hazard regression analyses were performed to determine the association between lymph node dissection status and the OS in women with stage I OC. Results: There were 8191 stage I OC patients in this study. Among all patients undergoing lymph node dissection, 11.23% patients were older than 70 years. However, 17.44% of the patients over 70 years of age did not undergo lymph node dissection. Lymph node conservation was associated with a higher mortality risk compared to lymph node dissection. Kaplan–Meier analysis revealed that patients had a worse prognosis with lymph node conservation in people older than 70 years. Univariate and multivariate analysis showed that age and lymph node dissection both remained independent prognostic factors for improved OS with stage I OC. Conclusions: Lymph node dissection was an independent predictor of improved long-term OS in stage I OC patients and had a significant benefit in women over age 70.

Cervix uterine Cancer with Axillary and Neck Lymph Node Metastasis: An Unusual Finding

Background: Cervix uterii cancer is the fourth most common female malignancy. It commonly spreads by direct extension or lymphatic dissemination within the pelvis into the regional lymph nodes. Distant lymph node metastasis remains exeptionnal. To our knowledge, synchronous cervical and axillary lymph node metastasis from cervix cancer have never been reported. Here we report a case of cervical and axillary lymph node metastasis from cervix uterii cancer. Case presentation: A 51-year-old woman diagnosed with cervix uterii cancer and treated with cocomitant chemoradiotherapy, presented 8 months after the initial diagnosis multiple round masses located at the left side of her neck. F-18 FDG PET/CT revealed pathological axillary and neck lymph nodes. Histopathology and immunohistochemistry confirmed the metastatic nature of the lymph nodes. the patient underwent lymph node dissection before undergoing chemotherapy, followed by radiotherapy to the affected cervical and axillary lymph nodes. Conclusions: Metastases from the uterine cervix to the neck lymph nodes are extremely uncommon. Lymphatic drainage and the lymph node jump phenomenon can explain the possible mode of cervical cancer tumor cell spread to the neck area. The mechanism of axillary lymph node metastasis from cervix uterii cancer can be explained by the communication between neck lymph nodes and axillary lymph nodes due to the alteration of the centripetal flow causing a retrograd spread. Distant lymph node metastasis in cervix uterii cancer are associated with a poor prognosis.

Extended Venous Thromboembolism Prophylaxis after Robotic Staging for Endometrial Cancer.

Our objectives were to estimate the incidence of venous thromboembolism (VTE) after robotic staging for endometrial cancer and to compare the incidence of VTE in patients who received a single dose of preoperative prophylaxis of enoxaparin with those who received extended postoperative prophylaxis. This study is a retrospective chart review of patients who underwent robot-assisted surgical staging for endometrial cancer. Patients were categorized into two groups: preoperative prophylaxis (PP), patients who received a single dose of enoxaparin preoperatively, and extended prophylaxis (EP), patients who received 28 days of enoxaparin postoperatively. In total, 148 patients were included, with 117 patients in the PP group and 31 patients in the EP group. The overall incidence of VTE within 30 days postoperatively was 0.67%. No significant difference was found between the PP and the EP groups (0.9% and 0%, respectively; P = 1.00). Most patients in the cohort had endometrioid adenocarcinoma (78%) with low-grade disease (70%), although there were a greater number of patients in the PP group with uterine serous carcinoma compared with the EP group (17% vs 10%; P = 0.034). The PP group had higher estimated blood loss (106 vs 81 mL; P = 0.009) and longer operative times (178 vs 151 min; P = 0.028) compared with the EP group. Significantly more patients in the PP group underwent lymph node dissection compared with the EP group (32% vs 7%; P = 0.008). The incidence of VTE following robot-assisted surgical staging for endometrial cancer in this study was 0.67%. No significant difference was found in VTE incidence between the PP group compared with the EP group. Mechanical prophylaxis plus a single dose of preoperative pharmacologic prophylaxis may suffice for low-risk patients following robotic surgical staging for endometrial cancer.

Risk factors of occult lymph node metastasis of levels Ⅲ and Ⅳ in papillary thyroid carcinoma

Objective: To investigate the potential risk factors for occult lateral cervical lymph node metastasis (LNM) to levels Ⅲ and Ⅳ in patients with papillary thyroid carcinoma (PTC) and the necessity of super-selective lateral lymph node dissection for patients harboring these metastases. Methods: This prospective study included PTC patients who were operated by the same surgeon in the Department of Head and Neck Surgery of Cancer Hospital, Chinese Academy of Medical Sciences from October 2015 through October 2019. Preoperative ultrasound and enhanced Computer Tomography (CT) did not denote suspected enlarged lymph nodes in the lateral neck. All patients underwent lymph node dissection in levels Ⅲ and Ⅳ on the basis of original thyroid collar incision after LNM to level Ⅵ was confirmed by preoperative fine needlebiopsy or intraoperative frozen pathology. Results: Of all 143 patients, 74 (51.7%) had occult LNM in levels Ⅲ and Ⅳ confirmed by postoperative pathology. The average number of metastasized lymph nodes in levels Ⅲ and Ⅳ was 2.64±1.80, and that in level Ⅵ was 3.77±3.27. There was a significant linear positive correlation between the number of metastasized lymph nodes in level Ⅵ and that in levels Ⅲ and Ⅳ (r=0.341, P<0.001). That the metastasized lymph nodes in level Ⅵ equals three was the best predictor of occult lateral LNM to levels Ⅲ and Ⅳ. Univariate analysis showed that age <55 years, tumor size ≥2.0 cm, number of metastasized lymph nodes in level Ⅵ ≥3, and percentage of metastasized lymph nodes in the total number of dissected lymph nodes in level Ⅵ >50% were associated with occult LNM in levels Ⅲ and Ⅳ (P<0.05). Multivariate analysis showed that number of metastasized lymph nodes in level Ⅵ≥3 was an independent risk factor for occult LNM in levels Ⅲ and Ⅳ (P=0.006). Conclusions: Age, tumor size and LNM in level Ⅵ were associated with occult lateral LNM in PTC patients. Lymph node dissection in levels Ⅲ and Ⅳ could be considered for selective patients, since it will help to avoid secondary operation for residual tumor or recurrence resulted from insufficient treatment without increasing the incidence of complications or affecting patients' appearances.

Deep learning prediction model for central lymph node metastasis in papillary thyroid microcarcinoma based on cytology.

Controversy exists regarding whether patients with low-risk papillary thyroid microcarcinoma (PTMC) should undergo surgery or active surveillance; the inaccuracy of the preoperative clinical lymph node status assessment is one of the primary factors contributing to the controversy. It is imperative to accurately predict the lymph node status of PTMC before surgery. We selected 208 preoperative fine-needle aspiration (FNA) liquid-based preparations of PTMC as our research objects; all of these instances underwent lymph node dissection and, aside from lymph node status, were consistent with low-risk PTMC. We separated them into two groups according to whether the postoperative pathology showed central lymph node metastases. The deep learning model was expected to predict, based on the preoperative thyroid FNA liquid-based preparation, whether PTMC was accompanied by central lymph node metastases. Our deep learning model attained a sensitivity, specificity, positive prediction value (PPV), negative prediction value (NPV), and accuracy of 78.9% (15/19), 73.9% (17/23), 71.4% (15/21), 81.0% (17/21), and 76.2% (32/42), respectively. The area under the receiver operating characteristic curve (value was 0.8503. The predictive performance of the deep learning model was superior to that of the traditional clinical evaluation, and further analysis revealed the cell morphologies that played key roles in model prediction. Our study suggests that the deep learning model based on preoperative thyroid FNA liquid-based preparation is a reliable strategy for predicting central lymph node metastases in thyroid micropapillary carcinoma, and its performance surpasses that of traditional clinical examination.

Comparison of survival outcomes and survival prediction in patients with primarycolorectal MANEC and primary colorectal SRCC: a population-based propensity-score matching study.

Primary mixed adeno-neuroendocrine carcinoma (MANEC) and primary signet-ring cell cancer (SRCC) are two rare but highly malignant tumors in colorectal cancer. Therefore, we attempted to compare the tumors' survival outcomes, identify risk factors, and ultimately evaluate the prognosis by developing a nomogram. We identified 755 MANEC and 5836 SRCC patients of colorectal cancer. PSM was used to balance the influence of baseline clinical and pathological differences. Kaplan-Meier method was used to compare the prognosis of different pathological grades and AJCC stages. Cox proportional hazards model was used to identify potential prognostic factors for the two groups. Finally, we developed a nomogram and evaluated the feasibility of the model. After PSM, the median OS and CSS of MANEC patients were significantly better than those of SRCC patients in stage III-IV (P < 0.001) but similar in stage I-II. The median OS and CSS of MANEC patients in each pathological grade were also greater than those of SRCC patients. Patients with MANEC and SRCC who underwent lymph node dissection in more than four areas had longer survival time. MANEC patients benefited from postoperative chemotherapy and radiotherapy; among SRCC patients, those who received preoperative and postoperative comprehensive chemotherapy and radiotherapy had benefits in OS and CSS. Both MANEC and SRCC are often diagnosed in advanced stages, highlighting the importance of early screening. Despite the better prognosis of MANEC compared to SRCC, both types of patients require the formulation of personalized treatment strategies based on different risk factors combined with column charts.