Predictors of the necessity for lymph node biopsy of cervical lymphadenopathy

Accuracy of ultrasound-guided fine-needle aspiration for small cervical lymph nodes: A retrospective review of 505 cases

Purpose

The overall diagnostic value of fine-needle aspiration (FNA) is not as excellent as that of core needle biopsy (CNB). Limited research has investigated small cervical lymph nodes inaccessible to ultrasound-guided CNB due to technical challenges associated with their small size. Therefore, this study aimed to evaluate the accuracy of ultrasound-guided FNA in determining the etiology of small cervical lymph nodes.

Methods

A retrospective analysis was conducted on patients who underwent FNA between May 2018 and May 2021 at our hospital. Cytological, histopathological, and clinical follow-up data were analyzed. The diagnostic yield of FNA was assessed based on sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy calculations.

Results

This study included 505 patients, each with a small cervical lymph node under evaluation (total number of lymph nodes: 505). The average maximal diameter of the lymph nodes was 14.6 ± 6.2 mm. According to the Sydney system, the cytology results were as follows: Category I in 26 lymph nodes (5.1 %); Category II in 269 (53.3 %); Category III in 35 (6.9 %); Category IV in 17 (3.4 %); and Category V in 158 (31.3 %). We identified 212 malignant cases (203 metastases and 9 lymphomas) and 293 benign lymph nodes. FNA achieved high sensitivity (88.8 %), specificity (99.6 %), PPV (99.4 %), NPV (91.8 %), and overall accuracy (94.8 %) in determining the etiology of small cervical lymph nodes.

Conclusion

FNA cytology is suitable for small lesions inaccessible by CNB and provides a diagnostic basis for implementing clinically appropriate treatment measures.

Au nano-cone array for SERS detection of associated miRNA in lymphoma patients

Based on Au nano-cone array (Au-NCA) and a three-segment hybridization strategy, a novel SERS biosensor is proposed for the ultrasensitive detection of the microRNA miR-21. The uniform, stable, and reproducible Au-NCA was prepared by the single-layer colloidal ball template method. Subsequently, the target was hybridized with sequence 2. The resulting target-sequence 2 complex was then hybridized with sequence 1 anchored on Au-NCA. Thus, a three-segment sequence complex was formed. SERS measurements can be performed without the need for complex purification and amplification steps. Due to the ability of miR-21 to perform specific complementary hybridization with two sequences, SERS biosensors have superior specificity for miR-21 without interference from other miRNAs. Under the optimal conditions, the SERS biosensor was applied and the limit of detection (LOD) was as low as 3.02 aM. This method has been successfully used to the detection of miR-21 in the serum of lymphoma patients and healthy volunteers. The results are consistent with the traditional test methods. Therefore, this novel SERS biosensor shows excellent clinical translational potential in the detection of lymphoma.

Computer-aided diagnostic models to classify lymph node metastasis and lymphoma involvement in enlarged cervical lymph nodes using PET/CT

BACKGROUND

It is a clinical problem to identify histological component in enlarged cervical lymph nodes, particularly in differentiation between lymph node metastasis and lymphoma involvement.

PURPOSE

To construct two kinds of deep learning (DL)-based computer-aided diagnosis (CAD) systems including DL-convolutional neural networks (DL-CNN) and DL-machine learning for pathological diagnosis of cervical lymph nodes by positron emission tomography (PET)/computed tomography (CT) images.

METHODS

We collected CT, PET, and PET/CT images series from 165 patients with enlarged cervical lymph nodes receiving examinations from January 2014 to June 2018. Six CNNs pretrained on ImageNet as DL architectures were used for two kinds of DL-based CAD models, including DL-CNN and DL-machine learning models. The DL-CNN models were constructed via transfer learning for classification of lymphomatous and metastatic lymph nodes. The DL-machine learning models were developed by DL-based features extractors and support vector machine (SVM) classifier. As for DL-SVM models, we also evaluate the effect of handcrafted radiomics features in combination of DL-based features.

RESULTS

The DL-CNN model with ResNet50 architecture on PET/CT images had the best diagnostic performance among all six algorithms with an area under the receiver operating characteristic curve (AUC) of 0.845 and accuracy of 78.13% in the testing cohort. The DL-SVM model on ResNet50 extractor showed great performance for the testing cohort with an AUC of 0.901, accuracy of 86.96%, sensitivity of 76.09%, and specificity of 94.20%. The combination of DL-based and handcrafted features yielded the improvement of diagnostic performance.

CONCLUSIONS

Our DL-based CAD systems on PET/CT images were developed for classifying metastatic and lymphomatous involvement with favorable diagnostic performance in enlarged cervical lymph nodes. Further clinical practice of our systems may improve quality of the following therapeutic interventions and optimize patients' outcomes.

Comparison of Ultrasound-Guided Core Needle Biopsy Under the Assistance of Hydrodissection With Fine Needle Aspiration in the Diagnosis of High-Risk Cervical Lymph Nodes: A Randomized Controlled Trial

A randomized comparison of ultrasound (US)-guided core needle biopsy (CNB) under the assistance of hydrodissection with fine needle aspiration (FNA) was performed to evaluate the feasibility, safety and effectiveness for the diagnosis of high-risk cervical lymph nodes. Patients from December 2018 to May 2020 were randomly assigned to the CNB group and the FNA group at a ratio of 1:1. This study protocol was approved by the Ethics Committee of our hospital and registered in the Chinese Clinical Trial Registry (ChiCTR1800019370). The feasibility of CNB for high-risk cervical lymph nodes was evaluated by observing and recording the separation success rate (SSR) and technical success rate (TSR) of the CNB group. Safety was evaluated by comparing the incidence of major complications in the two groups. The diagnostic efficacy was evaluated by comparing the diagnostic accuracy, sensitivity, and specificity of the two groups. A total of 84 patients (84 lymph nodes) were randomized into the CNB (n = 42) and FNA (n = 42) groups. All patients in the CNB group achieved successful hydrodissection and biopsy. The SSR and TSR were both 100% in the CNB group. There were no major complications during or after the process in the two groups. Compared with the FNA group, the CNB group was significantly superior in terms of diagnostic accuracy and sensitivity (100% vs. 81.0%, P = 0.009; 100% vs. 79.2%, P = 0.035, respectively). The specificity of the two groups was 100%, and there was no significant difference. Compared with FNA, CNB under the assistance of hydrodissection is a feasible and safe method but is more effective for the diagnosis of high-risk cervical lymph nodes.

Evaluation of the predictive role of neutrophil/lymphocyte ratio in the diagnosis of lymphoma in patients with asymptomatic and ısolated cervical lymphadenopathy

Introduction

The diagnostic approach to patients with isolated asymptomatic cervical lymphadenopathy varies between excisional biopsy and follow-up. When the anamnesis, physical examination, laboratory and imaging findings are not sufficient to identify the etiology, an excisional biopsy is performed for the differential diagnosis between early-stage lymphoma and infectious or reactive causes. If the excisional biopsy, which may have some complications, is not performed, it may delay the diagnosis of lymphoma. This diagnostic challenge could be avoided by predictive markers.

Objectives

This study was planned to determine the predictive value of neutrophil/lymphocyte ratio in the diagnosis of Hodgkin and non-Hodgkin limphoma in patients with asymptomatic, isolated cervical limphadenopathy and underwent excisional biopsy.

Methods

A total of 90 patients between the years 2016 − 2019 admitted to our clinics due to asymptomatic isolated cervical lymphadenopathy, present in at least 4 weeks with lympho nodes in pathological dimensions persisting in the cervical region, were included to our study. An excisional lympho node biopsy was performed in all 90 patients.

Results

Of the 90 patients who underwent excisional biopsy; 34 were diagnosed as reactive lymphadenopathy 30 were non-Hodgkin linphoma, and 26 were Hodgkin linphoma. A total of 56 (62.2%) patients were diagnosed as lymphoma, either Hodgkin or non-Hodgkin, while 34 patients (38.8%) were diagnosed as reactive lymphadenopathy. The median age, total whiteblood count, neutrophil count of the lymphoma groups were significantly higher than reactive lymphadenopathy group, whereas the lymphocyte count was significantly lower in the lymphoma patients. The median neutrophil/ lymphocyte ratio was 1.7 in the reactive lymphadenopathy group, 3.5 in the non-Hodgkin limphoma group, and 3.0 in the Hodgkin limphoma group (p <  0.001).

Conclusion

According to the results of our study, neutrophil/lymphocyte ratio was significantly higher in patients who were admitted with isolated asymptomatic lymphadenopathy and were diagnosed with lymphoma, and who were diagnosed with early-stage Hodgkin and non- Hodgkin lymphoma compared to those who were found to have reactive lymphadenopathy. Neutrophil/lymphocyte ratio, which is a low-cost, fast and easy-to-access test, has a predictive value in the diagnosis of lymphoma in patients with asymptomatic lymphadenopathy.

The Predictive Value of Neutrophil-to-Lymphocyte Ratio for Hodgkin's Lymphoma Diagnosis in Patients with Asymptomatic Cervical Lymphadenopathy

In patients with asymptomatic cervical lymphadenopathy, the physician often has to choose between evaluation via follow-up or open biopsy. Follow-up evaluation may lead to a delayed diagnosis of lymphoma, while an open biopsy is associated with surgical risks and costs. This dilemma can be avoided using predictive parameters. In the present study, we aimed to investigate whether neutrophil-to-lymphocyte ratio (NLR), a parameter which can be assessed quickly with ease and at low cost, has predictive value for Hodgkin's lymphoma diagnosis in patients with asymptomatic cervical lymphadenopathy. A total of 46 patients with asymptomatic cervical lymphadenopathy who underwent open biopsy were included in the study. Based on the biopsy results, the patients were divided into two groups, Hodgkin lymphoma (26 patients) and reactive lymphadenopathy (20 patients). The mean NLR in the groups was calculated and compared based on the results of complete blood count performed before biopsy. We found that mean NLR (P = 0.022) and mean neutrophil count (P = 0.046) were higher and mean lymphocyte count was lower (P = 0.054) in patients with Hodgkin's lymphoma compared to those in patients with reactive lymphadenopathy. Our results indicate that a high NLR may have predictive value for Hodgkin's lymphoma diagnosis in patients with asymptomatic cervical lymphadenopathy.

Infection, Oxidative Stress, and Changes in Circulating Regulatory T Cells of Heart Failure Patients Supported by Continuous-Flow Ventricular Assist Devices

The objective of this study was to investigate the changes in oxidative stress (OS) and circulating regulatory T cells (Tregs) of the immune system in patients supported by continuous-flow ventricular assist device (CF-VAD) with or without infection. We recruited 16 CF-VAD patients (5 with infection and 11 without infection) and 7 healthy volunteers. Generation of reactive oxygen species (ROS) from lymphocytes, superoxide dismutase (SOD) in erythrocyte, total antioxidant capacity (TAC), and oxidized low-density lipoprotein (oxLDL) in plasma were measured. Circulating Tregs were evaluated by flow cytometry. Heart failure (HF) patients had elevated OS than healthy volunteers as evident from higher lymphocyte ROS, elevated oxLDL, as well as depleted SOD and TAC levels. At baseline, HF patients had decreased percentage of Tregs (5.12 ± 1.5% vs. 8.14 ± 3.01%, p < 0.01) when compared with healthy volunteers. Postimplant patients with infection illustrated 35% and 44% rise in ROS and oxLDL, respectively, 31% decrease in TAC, and marked rise in percentage of Tregs (14.27 ± 3.17% vs. 9.38 ± 3.41%, p < 0.01) when compared with the patients without infection. Elevated OS and rise in Tregs were more prominent in CF-VAD patients with infection. In conclusion, OS and compromised immune system may be important indicators of systemic response of the body to CF-VAD among HF patients with infection.