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Yang X, Yang J, Li J, Leng J, Qiu Y, Ma X. Diagnostic Performance of Node Reporting and Data System Magnetic Resonance Imaging Score in Detecting Metastatic Cervical Lymph Nodes of Nasopharyngeal Carcinoma. Clin Med Insights Oncol 2024; 18:11795549241231564. [PMID: 38571681 PMCID: PMC10989040 DOI: 10.1177/11795549241231564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 01/20/2024] [Indexed: 04/05/2024] Open
Abstract
Background The Node Reporting and Data System (Node-RADS) is a recently proposed classification system for the categorization of lymph nodes in radiological images. This study was conducted to retrospectively evaluate the diagnostic accuracy of the Node-RADS score for metastatic cervical lymph nodes on magnetic resonance imaging (MRI) of patients with nasopharyngeal carcinoma (NPC). Methods We retrospectively analyzed cervical lymph nodes of NPC cases. Two radiologists independently evaluated each lymph node on the MRI scans using Node-RADS. Interobserver agreement between 2 radiologists for Node-RADS score assessment was evaluated by linear weighted kappa statistics. The correlation between metastasis and the Node-RADS score of each lymph node was analyzed using multivariate regression analysis. To investigate the diagnostic performance of the Node-RADS score, we further conducted receiver operating characteristic curve analysis. Correspondently, the sensitivity, specificity, positive predictive value, and negative predictive value of each different cutoff (>1, >2, >3, and >4) were computed. Results In all, 119 patients with NPC were assessed, including 203 cervical lymph nodes consisting of 140 (69%) of 203 metastatic and 63 (31%) of 203 benign. The kappa agreement between the 2 readers for the Node-RADS score was 0.863 (95% CI = 0.830-0.897, P < .001). Node-RADS score on MRI scan was shown to be an independent predictive factor of lymph node metastasis after multivariate regression analysis (odds ratio [OR] = 6.745, 95% CI = 3.964-11.474, P < .001). Node-RADS achieved an area under the curve (AUC) of 0.950 (95% CI = 0.921-0.979) in diagnosing metastatic lymph nodes. When Node-RADS >2 was identified as the best cutoff based on balanced values, the sensitivity and positive predictive value were 0.92 and 0.94, respectively. Conclusions Our study suggests that the Node-RADS score has high accuracy in predicting NPC cervical lymph node metastasis. Nevertheless, this conclusion requires confirmation in a larger cohort of patients with NPC.
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Affiliation(s)
- Xinggang Yang
- Division of Biotherapy, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Jiaqing Yang
- Division of Biotherapy, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jia Li
- Division of Biotherapy, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Junyan Leng
- West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yu Qiu
- West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xuelei Ma
- Division of Biotherapy, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
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You-Syuan W, Yun-Ying S. Synchronous Papillary Thyroid Cancer and Asymptomatic Cervical Lymph Node Sarcoidosis: A Case Report. Ear Nose Throat J 2024:1455613241241111. [PMID: 38509710 DOI: 10.1177/01455613241241111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
Sarcoidosis is a systemic inflammatory disease characterized by the formation of immune granulomas in multiple organs. The cause of this disease is not yet clear. Papillary thyroid cancer (PTC) is the most common malignant endocrine tumor and is often associated with cervical lymph node metastasis. Assessment of risk factors associated with a poor prognosis is crucial in PTC. The coexistence of sarcoidosis and thyroid cancer is rarely reported in the literature. We describe a case of a 54-year-old female diagnosed with PTC and asymptomatic cervical and thoracic hilar lymphadenopathy due to concurrent sarcoidosis. This case will remind clinicians to be aware of the multiple potential causes of lymphadenopathy and realize the importance of the differences in the features of neck lymphadenopathy in patients with suspected head and neck cancer. Overall, careful workup and pretreatment screening enabled us to provide the patient with the most suitable treatment modality and avoid total thyroidectomy.
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Affiliation(s)
- Wu You-Syuan
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - She Yun-Ying
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Jung HN, Ryoo I, Suh S, Lee YH, Kim E. Evaluating the Elasticity of Metastatic Cervical Lymph Nodes in Head and Neck Squamous Cell Carcinoma Patients Using DWI-based Virtual MR Elastography. Magn Reson Med Sci 2024; 23:49-55. [PMID: 36529497 PMCID: PMC10838712 DOI: 10.2463/mrms.mp.2022-0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/10/2022] [Indexed: 01/05/2024] Open
Abstract
PURPOSE The assessment of metastatic cervical lymph nodes in head and neck squamous cell carcinoma patients is crucial; as such, many studies focusing on non-invasive imaging techniques to evaluate metastatic cervical lymph nodes have been performed. The aim of our study was to assess the usefulness of elasticity values on diffusion weighted imaging (DWI)-based virtual MR elastography in the evaluation of metastatic cervical lymph nodes from head and neck squamous cell carcinoma. METHODS Two head and neck radiologists measured the elasticity values of 16 metastatic cervical lymph nodes from head and neck squamous cell carcinoma and 13 benign cervical lymph nodes on DWI-based virtual MR elastography maps. Mean, minimum, maximum, and median elasticity values were evaluated for lymph nodes between the two groups and interobserver agreement in measuring the elasticity was also evaluated. RESULTS The mean, maximum, and median elasticity values of metastatic cervical lymph nodes were significantly higher than those of benign cervical lymph nodes (P = 0.001, 0.01, and 0.002, respectively). Diagnostic accuracy, sensitivity, and specificity of the mean elasticity were 82.8%, 93.8%, and 69.2%, respectively. Interobserver agreement was excellent for the mean and median elasticity (intraclass correlation coefficients were 0.98 for both). CONCLUSION Estimated elasticity values based on DWI-based virtual MR elastography show significant difference between benign and metastatic cervical lymph nodes from head and neck squamous cell carcinoma. While precise modulation of MR sequences and calibration parameters still needs to be established, elasticity values can be useful in differentiating between these lymph nodes.
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Affiliation(s)
- Hye Na Jung
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Inseon Ryoo
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sangil Suh
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young Hen Lee
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Seoul, Korea
| | - Eunju Kim
- Philips Healthcare Korea, Seoul, Korea
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Burioka H, Yamamori U, Nagano N, Ue A, Tamaki Y. Radiation Therapy for Breast Cancer With Oligometastatic Cervical Lymph Nodes: A Case Report. Cureus 2024; 16:e51617. [PMID: 38313990 PMCID: PMC10837370 DOI: 10.7759/cureus.51617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 02/06/2024] Open
Abstract
Stage IV breast cancer is difficult to cure and is mainly treated with systemic therapy. However, when distant metastasis is oligometastatic, proactive treatment including local therapies for the primary lesion and distant metastases has been reported to improve prognosis. We encountered a patient who had left breast cancer with ipsilateral cervical lymph node metastases. The metastases were oligometastatic, and we treated them curatively. The patient was a female in her 50s who had been aware of a lump in the lower inner quadrant of the left breast for a few years. A biopsy was performed and left breast cancer was diagnosed pathologically. Radiological examination showed metastasis to ipsilateral axillary and cervical lymph nodes. The cervical lymph node metastases were oligometastatic, suggesting possible improvement in prognosis by multimodality treatment including local therapy. The multimodality treatment in this case comprised mastectomy with levels I and II axillary lymph node dissection, systemic therapy (including chemotherapy, endocrine therapy, and molecular targeted therapy), and postmastectomy radiation therapy. The left chest wall and left supraclavicular lymph node region were irradiated. Furthermore, following the postmastectomy radiation therapy, the cervical lymph node metastases were treated with radical radiation therapy. The cure was achieved, with recurrence-free status maintained for two years and four months after the completion of radiation therapy. This case suggests that, for breast cancer with oligometastatic involvement of cervical lymph nodes, locally treating these distant metastatic lesions with radical radiation therapy as part of multimodality treatment is beneficial.
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Affiliation(s)
- Hiroshi Burioka
- Radiation Oncology, Shimane University Faculty of Medicine, Izumo, JPN
| | - Unta Yamamori
- Radiation Oncology, Shimane University Faculty of Medicine, Izumo, JPN
| | - Natsuko Nagano
- Radiation Oncology, Shimane University Faculty of Medicine, Izumo, JPN
| | - Atsushi Ue
- Radiation Oncology, Shimane University Faculty of Medicine, Izumo, JPN
| | - Yukihisa Tamaki
- Radiation Oncology, Shimane University Faculty of Medicine, Izumo, JPN
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Laaker C, Baenen C, Kovács KG, Sandor M, Fabry Z. Immune cells as messengers from the CNS to the periphery: the role of the meningeal lymphatic system in immune cell migration from the CNS. Front Immunol 2023; 14:1233908. [PMID: 37662908 PMCID: PMC10471710 DOI: 10.3389/fimmu.2023.1233908] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
In recent decades there has been a large focus on understanding the mechanisms of peripheral immune cell infiltration into the central nervous system (CNS) in neuroinflammatory diseases. This intense research led to several immunomodulatory therapies to attempt to regulate immune cell infiltration at the blood brain barrier (BBB), the choroid plexus (ChP) epithelium, and the glial barrier. The fate of these infiltrating immune cells depends on both the neuroinflammatory environment and their type-specific interactions with innate cells of the CNS. Although the fate of the majority of tissue infiltrating immune cells is death, a percentage of these cells could become tissue resident immune cells. Additionally, key populations of immune cells can possess the ability to "drain" out of the CNS and act as messengers reporting signals from the CNS toward peripheral lymphatics. Recent data supports that the meningeal lymphatic system is involved not just in fluid homeostatic functions in the CNS but also in facilitating immune cell migration, most notably dendritic cell migration from the CNS to the meningeal borders and to the draining cervical lymph nodes. Similar to the peripheral sites, draining immune cells from the CNS during neuroinflammation have the potential to coordinate immunity in the lymph nodes and thus influence disease. Here in this review, we will evaluate evidence of immune cell drainage from the brain via the meningeal lymphatics and establish the importance of this in animal models and humans. We will discuss how targeting immune cells at sites like the meningeal lymphatics could provide a new mechanism to better provide treatment for a variety of neurological conditions.
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Affiliation(s)
- Collin Laaker
- Neuroscience Training Program, University of Wisconsin Madison, Madison, WI, United States
| | - Cameron Baenen
- Department of Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin Madison, Madison, WI, United States
| | - Kristóf G. Kovács
- Department of Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin Madison, Madison, WI, United States
| | - Matyas Sandor
- Department of Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin Madison, Madison, WI, United States
| | - Zsuzsanna Fabry
- Department of Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin Madison, Madison, WI, United States
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Bran W, Sahli‐Vivicorsi S, Cadieu R, Alavi Z, Leclere J. Ultrasound-guided hookwire localization of non palpable cervical lymphadenopathy: A case-control study of operative time. Cancer Med 2023; 12:16054-16065. [PMID: 37317644 PMCID: PMC10469735 DOI: 10.1002/cam4.6257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE We aimed at evaluating the impact of ultrasound-guided (US) hookwire localization of nonpalpable cervical lymphadenopathy on operating time. DESIGN AND METHODS Retrospective case control study (January 2017 and May 2021) of 26 patients with lateral nonpalpable cervical lymphadenopathy undergoing surgery with (H+) and without (H-) per operative US-guided hook-wire localization. Operative time (general anesthesiology onset, hookwire placement, end of surgery) and surgery-related adverse events data were collected. RESULTS Mean operative time was significantly shorter in H+ group versus H- group (26 ± 16 min vs. 43 ± 22 min) (p = 0.02). Histopathological diagnosis accuracy was 100% versus 94% (H+ vs. H-, p = 0.1). No significant between group difference in surgery-related adverse events was reported (wound healing, p = 0.162; hematomas, p = 0.498; neoplasms removal failure, p = 1). CONCLUSION US-guided hookwire localization of lateral nonpalpable cervical lymphadenopathy allowed a significant reduction in operative time, comparable histopathological diagnosis accuracy and adverse events compared with H-.
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Affiliation(s)
- William Bran
- Radiology DepartmentBrest University HospitalBrestFrance
- ENT DepartmentBrest University HospitalBrestFrance
| | | | - Romain Cadieu
- Radiology DepartmentBrest University HospitalBrestFrance
| | - Zarrin Alavi
- INSERM, CIC 1412Brest University HospitalBrestFrance
| | - Jean‐Christophe Leclere
- Radiology DepartmentBrest University HospitalBrestFrance
- ENT DepartmentBrest University HospitalBrestFrance
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Bhattacharya K, Mahajan A, Vaish R, Rane S, Shukla S, D'Cruz AK. Imaging of Neck Nodes in Head and Neck Cancers - a Comprehensive Update. Clin Oncol (R Coll Radiol) 2023; 35:429-445. [PMID: 37061456 DOI: 10.1016/j.clon.2023.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/08/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023]
Abstract
Cervical lymph node metastases from head and neck squamous cell cancers significantly reduce disease-free survival and worsen overall prognosis and, hence, deserve more aggressive management and follow-up. As per the eighth edition of the American Joint Committee on Cancer staging manual, extranodal extension, especially in human papillomavirus-negative cancers, has been incorporated in staging as it is important in deciding management and significantly impacts the outcome of head and neck squamous cell cancer. Lymph node imaging with various radiological modalities, including ultrasound, computed tomography and magnetic resonance imaging, has been widely used, not only to demonstrate nodal involvement but also for guided histopathological evaluation and therapeutic intervention. Computed tomography and magnetic resonance imaging, together with positron emission tomography, are used widely for the follow-up of treated patients. Finally, there is an emerging role for artificial intelligence in neck node imaging that has shown promising results, increasing the accuracy of detection of nodal involvement, especially normal-appearing nodes. The aim of this review is to provide a comprehensive overview of the diagnosis and management of involved neck nodes with a focus on sentinel node anatomy, pathogenesis, imaging correlates (including radiogenomics and artificial intelligence) and the role of image-guided interventions.
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Affiliation(s)
- K Bhattacharya
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - A Mahajan
- The Clatterbridge Cancer Centre, NHS Foundation Trust, Liverpool, UK.
| | - R Vaish
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - S Rane
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - S Shukla
- Homi Bhabha Cancer Hospital, Varanasi, Uttar Pradesh, India
| | - A K D'Cruz
- Apollo Hospitals, India; Union International Cancer Control (UICC), Geneva, Switzerland; Foundation of Head Neck Oncology, India
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Abbasian Ardakani A, Mohammadi A, Mirza-Aghazadeh-Attari M, Faeghi F, Vogl TJ, Acharya UR. Diagnosis of Metastatic Lymph Nodes in Patients With Papillary Thyroid Cancer: A Comparative Multi-Center Study of Semantic Features and Deep Learning-Based Models. J Ultrasound Med 2023; 42:1211-1221. [PMID: 36437513 DOI: 10.1002/jum.16131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/01/2022] [Accepted: 11/06/2022] [Indexed: 05/18/2023]
Abstract
OBJECTIVES Deep learning algorithms have shown potential in streamlining difficult clinical decisions. In the present study, we report the diagnostic profile of a deep learning model in differentiating malignant and benign lymph nodes in patients with papillary thyroid cancer. METHODS An in-house deep learning-based model called "ClymphNet" was developed and tested using two datasets containing ultrasound images of 195 malignant and 178 benign lymph nodes. An expert radiologist also viewed these ultrasound images and extracted qualitative imaging features used in routine clinical practice. These signs were used to train three different machine learning algorithms. Then the deep learning model was compared with the machine learning models on internal and external validation datasets containing 22 and 82 malignant and 20 and 76 benign lymph nodes, respectively. RESULTS Among the three machine learning algorithms, the support vector machine model (SVM) outperformed the best, reaching a sensitivity of 91.35%, specificity of 88.54%, accuracy of 90.00%, and an area under the curve (AUC) of 0.925 in all cohorts. The ClymphNet performed better than the SVM protocol in internal and external validation, achieving a sensitivity of 93.27%, specificity of 92.71%, and an accuracy of 93.00%, and an AUC of 0.948 in all cohorts. CONCLUSION A deep learning model trained with ultrasound images outperformed three conventional machine learning algorithms fed with qualitative imaging features interpreted by radiologists. Our study provides evidence regarding the utility of ClymphNet in the early and accurate differentiation of benign and malignant lymphadenopathy.
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Affiliation(s)
- Ali Abbasian Ardakani
- Department of Radiology Technology, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afshin Mohammadi
- Department of Radiology, Faculty of Medicine, Urmia University of Medical Science, Urmia, Iran
| | - Mohammad Mirza-Aghazadeh-Attari
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Fariborz Faeghi
- Department of Radiology Technology, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - U Rajendra Acharya
- Ngee Ann Polytechnic, Department of Electronics and Computer Engineering, Singapore, Singapore
- Department of Biomedical Engineering, School of Science and Technology, SUSS University, Singapore, Singapore
- Department of Biomedical Informatics and Medical Engineering, Asia University, Taichung, Taiwan
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Joshi K, Agarwal M, Pasricha S, Singh A, Garg S, Rai S, Tandon S. Macroscopic Extranodal Extension In Oral Squamous Cell Carcinoma-A Subgroup With Poor Survival. Laryngoscope 2023; 133:588-593. [PMID: 35567419 DOI: 10.1002/lary.30158] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/07/2022] [Accepted: 04/25/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Oral cancer portends a significant cause of morbidity and mortality worldwide. Cervical lymph node metastasis with extranodal extension (ENE) is associated with a poor prognosis. There has been accumulating evidence regarding the extent of ENE to be associated with prognosis and survival. AIM This observational study was performed to analyze the prognostic implication of macroscopic and microscopic ENE in metastatic cervical lymph nodes of oral cavity cancer patients. METHODS A total of 92 oral cavity cancer patients with pathologically detected ENE were included in this study. Both the groups (macroscopic and microscopic ENE) were compared in terms of overall survival and disease-free survival by using Kaplan -Meier. The pattern of failure was determined by Fischer's exact test. Univariate and multivariate analyses were calculated to determine the significant risk factors of death. RESULTS The 2 years of disease-free survival and overall survival rates for the whole cohort were 51.2% and 53.9% respectively. The 2-year survival rate for the microscopic group (≤2 mm) and macroscopic (>2 mm) was 72.6% and 0% respectively, while the distal failure rate in microscopic ENE group and macroscopic ENE group was 22.22% and 44.83% respectively (p-value = 0.026). CONCLUSIONS Macroscopic ENE (>2 mm) in oral cavity squamous cell cancer represents an aggressive entity with early regional and distant failure as compared to microscopic ENE (≤2 mm). Thus, macroscopic ENE (>2 mm) warrants a distinct subgroup with special consideration for intensification of treatment. LEVEL OF EVIDENCE 3 Laryngoscope, 133:588-593, 2023.
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Affiliation(s)
- Kiran Joshi
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Mudit Agarwal
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Sunil Pasricha
- Department of Pathology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Abhishek Singh
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Sunil Garg
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Shreya Rai
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Sarthak Tandon
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
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Khunteta N, Makkar A, Badwal JS, Katta P, Choudhary D, Viswanath M, Malhotra H. Patterns of Neck Nodal Metastasis from Oral Cavity Carcinoma. South Asian J Cancer 2023; 11:326-331. [PMID: 36756101 PMCID: PMC9902093 DOI: 10.1055/s-0041-1733348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Nitin KhuntetaObjectives The aim is to study the patterns of lymph node metastasis from various sites in oral cavity cancer and determine the risk factors for metastasis. Materials and Methods It is a prospective observational study. The inclusion criteria were-245 patients of carcinoma buccal mucosa, anterior two-thirds of tongue, hard palate, oral surface of soft palate, floor of mouth, vestibule, and alveolus. The exclusion criteria were-patients who had received preoperative chemotherapy or radiotherapy and patients with recurrent disease. Statistical Methods All data were analyzed using SPSS 18.0 and Graphpad prism 7 software for statistical analysis. Count data have been expressed as percentages (%). The χ 2 test was used for univariate analysis of the risk factors of cervical lymph node metastasis. The odds ratio value (with 95% confidence interval) was used to express the risk of cervical lymph node metastasis. p -Value of <0.05 was considered as the difference with statistical significance. Results The most common site involved was buccal mucosa. Patterned lymph node metastasis was seen in 93.5% cases. Skip metastasis was seen in 4.31% cases. Level I b was the most common site of nodal involvement for all primary subsites of oral cavity cancer. The incidence of positive nodes on histopathological analysis was highest in cases of lower alveolus (63.15%), followed by tongue. Conclusion In our study, patterns of lymph node metastasis for oral cavity cancer were comparable to other studies with large number of subjects. The incidence of skip metastasis or aberrant status was low. On multivariate analysis, depth of invasion of tumor, pathologic grade, pathologic T stage, and morphologic type of growth were found to be independent predictors of risk for metastasis.
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Affiliation(s)
- Nitin Khunteta
- Department of Surgical Oncology, Sri Ram Cancer Centre, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India,Address for correspondence Nitin Khunteta, MBBS, MS, MCh, DNB Department of Surgical Oncology, Sri Ram Cancer Centre, Mahatma Gandhi University of Medical Sciences and TechnologyJaipur 302022, RajasthanIndia
| | - Ayush Makkar
- Department of Surgical Oncology, Sri Ram Cancer Centre, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
| | - Jaspreet Singh Badwal
- Department of Surgical Oncology, Sri Ram Cancer Centre, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
| | - Prakhar Katta
- Department of Surgical Oncology, Sri Ram Cancer Centre, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
| | - Dinesh Choudhary
- Department of Surgical Oncology, Sri Ram Cancer Centre, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
| | - Mohinder Viswanath
- Department of Surgical Oncology, Sri Ram Cancer Centre, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
| | - Hemant Malhotra
- Department of Medical Oncology, Sri Ram Cancer Centre, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
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Al-Diwani A, Theorell J, Damato V, Bull J, McGlashan N, Green E, Kienzler AK, Harrison R, Hassanali T, Campo L, Browne M, Easton A, Soleymani majd H, Tenaka K, Iorio R, Dale RC, Harrison P, Geddes J, Quested D, Sharp D, Lee ST, Nauen DW, Makuch M, Lennox B, Fowler D, Sheerin F, Waters P, Leite MI, Handel AE, Irani SR. Cervical lymph nodes and ovarian teratomas as germinal centres in NMDA receptor-antibody encephalitis. Brain 2022; 145:2742-2754. [PMID: 35680425 PMCID: PMC9486890 DOI: 10.1093/brain/awac088] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/22/2021] [Accepted: 01/24/2022] [Indexed: 01/14/2023] Open
Abstract
Autoantibodies against the extracellular domain of the N-methyl-d-aspartate receptor (NMDAR) NR1 subunit cause a severe and common form of encephalitis. To better understand their generation, we aimed to characterize and identify human germinal centres actively participating in NMDAR-specific autoimmunization by sampling patient blood, CSF, ovarian teratoma tissue and, directly from the putative site of human CNS lymphatic drainage, cervical lymph nodes. From serum, both NR1-IgA and NR1-IgM were detected more frequently in NMDAR-antibody encephalitis patients versus controls (both P < 0.0001). Within patients, ovarian teratoma status was associated with a higher frequency of NR1-IgA positivity in serum (OR = 3.1; P < 0.0001) and CSF (OR = 3.8, P = 0.047), particularly early in disease and before ovarian teratoma resection. Consistent with this immunoglobulin class bias, ovarian teratoma samples showed intratumoral production of both NR1-IgG and NR1-IgA and, by single cell RNA sequencing, contained expanded highly-mutated IgA clones with an ovarian teratoma-restricted B cell population. Multiplex histology suggested tertiary lymphoid architectures in ovarian teratomas with dense B cell foci expressing the germinal centre marker BCL6, CD21+ follicular dendritic cells, and the NR1 subunit, alongside lymphatic vessels and high endothelial vasculature. Cultured teratoma explants and dissociated intratumoral B cells secreted NR1-IgGs in culture. Hence, ovarian teratomas showed structural and functional evidence of NR1-specific germinal centres. On exploring classical secondary lymphoid organs, B cells cultured from cervical lymph nodes of patients with NMDAR-antibody encephalitis produced NR1-IgG in 3/7 cultures, from patients with the highest serum NR1-IgG levels (P < 0.05). By contrast, NR1-IgG secretion was observed neither from cervical lymph nodes in disease controls nor in patients with adequately resected ovarian teratomas. Our multimodal evaluations provide convergent anatomical and functional evidence of NMDAR-autoantibody production from active germinal centres within both intratumoral tertiary lymphoid structures and traditional secondary lymphoid organs, the cervical lymph nodes. Furthermore, we develop a cervical lymph node sampling protocol that can be used to directly explore immune activity in health and disease at this emerging neuroimmune interface.
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Affiliation(s)
- Adam Al-Diwani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK,University Department of Psychiatry, University of Oxford, Oxford, UK
| | - Jakob Theorell
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK,Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
| | - Valentina Damato
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK,UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Joshua Bull
- Wolfson Centre for Mathematical Biology, Mathematical Institute, University of Oxford, Oxford, UK
| | - Nicholas McGlashan
- Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Edward Green
- Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Anne Kathrin Kienzler
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Ruby Harrison
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Tasneem Hassanali
- Translational Histopathology Laboratory, Department of Oncology, University of Oxford, Oxford, UK
| | - Leticia Campo
- Translational Histopathology Laboratory, Department of Oncology, University of Oxford, Oxford, UK
| | - Molly Browne
- Translational Histopathology Laboratory, Department of Oncology, University of Oxford, Oxford, UK
| | - Alistair Easton
- Translational Histopathology Laboratory, Department of Oncology, University of Oxford, Oxford, UK
| | | | - Keiko Tenaka
- Department of Animal Model Development, Brain Research Institute, Niigata University, Niigata, Japan
| | - Raffaele Iorio
- UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Russell C Dale
- Kids Neuroscience Centre, Children’s Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Paul Harrison
- University Department of Psychiatry, University of Oxford, Oxford, UK
| | - John Geddes
- University Department of Psychiatry, University of Oxford, Oxford, UK
| | - Digby Quested
- University Department of Psychiatry, University of Oxford, Oxford, UK
| | - David Sharp
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, London, UK
| | - Soon Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - David W Nauen
- Department of Pathology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Mateusz Makuch
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Belinda Lennox
- University Department of Psychiatry, University of Oxford, Oxford, UK
| | - Darren Fowler
- Department of Pathology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Fintan Sheerin
- Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Patrick Waters
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - M Isabel Leite
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK,Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Adam E Handel
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK,Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Sarosh R Irani
- Correspondence to: Professor Sarosh Irani Oxford Autoimmune Neurology Group West Wing, Level 6, John Radcliffe Hospital Oxford OX3 9DU, UK E-mail:
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12
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Teng D, Dong C, Sun D, Liu Z, Wang H. 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. Front Oncol 2022; 11:799956. [PMID: 35096601 PMCID: PMC8793772 DOI: 10.3389/fonc.2021.799956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/21/2021] [Indexed: 12/07/2022] Open
Abstract
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.
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Affiliation(s)
- Dengke Teng
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Chunhui Dong
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Daju Sun
- Department of Pathology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhuo Liu
- Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
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Li P, Fan J, Zhang K, Wang J, Hu M, Yang S, Xing C, Yuan Q. Interstitial 125I Brachytherapy as a Salvage Treatment for Refractory Cervical Lymph Node Metastasis of Thoracic Esophageal Squamous Cell Carcinoma After External Irradiation With a CT-Guided Coplanar Template-Assisted Technique: A Retrospective Study. Technol Cancer Res Treat 2022; 21:15330338221103102. [PMID: 35656785 PMCID: PMC9168871 DOI: 10.1177/15330338221103102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose: To analyze the outcome and prognosis of patients with
refractory cervical lymph node metastasis of thoracic esophageal squamous cell
carcinoma after external irradiation, who underwent interstitial 125I
brachytherapy as a salvage treatment with a CT-guided coplanar template-assisted
technique. We also want to compare the dosimetry of 3D printed coplanar
template-assisted interstitial 125I brachytherapy preoperative and
postoperative, and to explore the accuracy of this technology. Material
and methods: We retrospectively collected and analyzed the results of
32 patients with refractory cervical lymph node metastasis of thoracic
esophageal squamous cell carcinoma after external irradiation, who underwent
interstitial 125I brachytherapy as a salvage treatment with a
CT-guided coplanar template-assisted technique from January 2012 to December
2017. Results: The actual D90 were 114 to 240 Gy, and the median
postoperative dosimetry assessment was 177.5 Gy. The local control rates at 3,
6, 9, and 12 months were 87.5%, 59.38%, 40.63%, and 31.25%, respectively. The
median local control time was 7.5 months. The median overall survival time was
10.5 months (95% CI, 8.9-13.4), and the survival rates of 1- and 2-year,
respectively, were 43.75% and 9.38%. There were 36 lesions in 32 patients. By
performing a paired t-test analysis, there was no significant
difference in D90, D100, V100, V150, V200, GTV volume, CI, EI, and HI between
preoperative and postoperative (P > .05).
Conclusions: Interstitial 125I brachytherapy can be
used as a salvage treatment for patients with refractory cervical lymph node
metastasis of thoracic esophageal squamous cell carcinoma after external
irradiation. With the auxiliary function of 3D printed coplanar template, the
main dosimetry parameters verified after the operation can meet the requirements
of the preoperative plan with good treatment accuracy.
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Affiliation(s)
- Peishun Li
- Department of Oncology, Tengzhou Central People’s Hospital,
Shandong, China
| | - Jing Fan
- Department of Oncology, Tengzhou Central People’s Hospital,
Shandong, China
| | - Kaixian Zhang
- Department of Oncology, Tengzhou Central People’s Hospital,
Shandong, China
- Kaixian Zhang, Department of Oncology,
Tengzhou Central People's Hospital, Tengzhou, Shandong 277599, China.
| | - Junjie Wang
- Department of Radiation Oncology, Peking University 3rd
Hospital, Beijing, P. R. China
- Junjie Wang, Department of Radiation
Oncology, Peking University 3rd Hospital, Beijing 100191, P. R. China.
| | - Miaomiao Hu
- Department of Oncology, Tengzhou Central People’s Hospital,
Shandong, China
| | - Sen Yang
- Department of Oncology, Tengzhou Central People’s Hospital,
Shandong, China
| | - Chao Xing
- Department of Oncology, Tengzhou Central People’s Hospital,
Shandong, China
| | - Qianqian Yuan
- Department of Oncology, Tengzhou Central People’s Hospital,
Shandong, China
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Krarup Sigaard R, Wennervaldt K, Munksgaard L, Rahbek Gjerdrum LM, Homøe P. Core needle biopsy is an inferior tool for diagnosing cervical lymphoma compared to lymph node excision. Acta Oncol 2021; 60:904-910. [PMID: 34003078 DOI: 10.1080/0284186x.2021.1916999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND In Denmark, fine needle aspiration is the standardized tool for obtaining tissue samples from lymph nodes (LN) of the neck. However, because of a low specificity toward lymphomas, LNs suspicious for this disease are often surgically removed and examined. International studies have implied that a core needle biopsy (CNB) is sufficient for detecting lymphomas, thereby potentially avoiding surgery. However, all studies have been conducted retrospectively and the goal of this prospective study was to find the true sensitivity of CNB. MATERIAL AND METHODS Fifty-seven patients were enrolled in the study, one was excluded due to lack of CNB material. LNs suspected for lymphoma were surgically removed from the neck, whereafter a CNB was obtained from the removed LN. The CNB and the remaining part of the LN were sent to the Department of Pathology for further processing and the samples were blinded and examined by two pathologists separately. A consensus diagnosis was reached in cases with divergent diagnostic proposals. Sensitivity of the CNB method in comparison to whole tissue sections for lymphoma diagnosis was calculated. RESULTS The CNB method gave the correct diagnosis in 66% of lymphoma cases, was inconclusive in 14% and gave an incorrect lymphoma subtype in 18%. In 2% the CNB wrongly resulted in a benign diagnosis. CNB was correct in all the non-lymphoma cases; thereby retaining a specificity of 100%. CONCLUSION This prospective study found a sensitivity of 66% for diagnosing lymphoma with a CNB. As the CNB in this study was obtained under optimal conditions, unlike in clinical practice, we conclude that CNB cannot be recommended as a standard tool for diagnosing lymphomas.
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Affiliation(s)
- Rasmus Krarup Sigaard
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - Kasper Wennervaldt
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - Lars Munksgaard
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark
| | - Lise Mette Rahbek Gjerdrum
- Department of Pathology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Preben Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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15
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Su GY, Xu XQ, Zhou Y, Zhang H, Si Y, Shen MP, Wu FY. Texture analysis of dual-phase contrast-enhanced CT in the diagnosis of cervical lymph node metastasis in patients with papillary thyroid cancer. Acta Radiol 2021; 62:890-896. [PMID: 32757639 DOI: 10.1177/0284185120946711] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Computed tomography texture analysis (CTTA) provides objective and quantitative information regarding tumor heterogeneity beyond visual inspection. However, no study has yet used CTTA to differentiate metastatic from non-metastatic cervical lymph node in patients with papillary thyroid cancer (PTC). PURPOSE To evaluate the value of texture analysis of dual-phase contrast-enhanced CT images in diagnosing cervical lymph node metastasis in patients with PTC. MATERIAL AND METHODS Metastatic (n = 27) and non-metastatic (n = 32) cervical lymph nodes were analyzed retrospectively. Texture analyses were performed on both arterial (A) and venous (V) phase CT images. Texture parameters, including mean gray-level intensity, skewness, kurtosis, entropy, and uniformity, were obtained and compared between groups. Receiver operating characteristic (ROC) curves analyses and multivariate logistic regression analysis were used in our study. RESULTS Metastatic lymph nodes showed significantly higher A-mean gray-level intensity, A-entropy, and lower A-kurtosis and V-kurtosis (all P < 0.001) than non-metastatic mimics. The ROC curve analyses indicated that A-kurtosis demonstrated an optimal diagnostic area under the curve (AUC; 0.884) and specificity (92.59%), while the A-mean gray-level intensity showed optimal diagnostic sensitivity (90.62%). Multivariate logistic regression analysis showed that A-mean gray-level intensity (P = 0.006, odds ratio [OR] = 24.297) and V-kurtosis (P = 0.014, OR = 19.651) were the independent predictor for metastatic cervical lymph node. CONCLUSION Dual-phase contrast-enhanced CCTA-especially A-mean gray-level intensity and V-kurtosis-may have the potential to diagnose metastatic cervical lymph node in patients with PTC.
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Affiliation(s)
- Guo-Yi Su
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Xiao-Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Yan Zhou
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Hao Zhang
- Department of Thyroid Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Yan Si
- Department of Thyroid Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Mei-Ping Shen
- Department of Thyroid Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Fei-Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
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16
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Xia S, Chen Y, Zhan W, Zhou W. Ultrasound-Guided Fine-Needle Aspiration Versus Fine-Needle Capillary Sampling in Evaluation of Lymph Node Metastasis of Thyroid Cancer. Front Oncol 2021; 11:642142. [PMID: 33937044 PMCID: PMC8079778 DOI: 10.3389/fonc.2021.642142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background To compare the sampling adequacy and diagnostic efficiency of ultrasound-guided fine-needle aspiration with 22-, 25-gauge needles and capillary sampling with 22-gauge needle in the biopsy of cervical lymph node. Methods A total of 130 cervical lymph nodes from 103 patients were consecutively included in the prospective study. Each suspected lymph node was aspirated with a 22-gauge needle, capillary sampled with a 22-gauge needle and aspirated with a 25-gauge needle. The adequacy rates and nondiagnostic rates of obtained specimen were calculated. Results Of the 130 suspected lymph nodes, there were 77 lymph nodes<6.0 mm and 53 lymph nodes≥6.0mm in the smallest dimension. Both FNA22G and FNC22G got significantly higher sampling adequacy than FNA25G for the total lymph nodes. For lymph nodes<6.0 mm, the sampling adequacy was significantly higher with FNA22G than with FNA25G for each parameter and the cumulative score (all P<0.05), while no difference were seen between FNA22G and FNC22G, and between FNC22G and FNA25G. There were higher nondiagnostic rates for FNA25G compared with FNA22G and FNC22G in all lymph nodes and in each size subgroups. FNA25G yielded more diagnostically inadequate specimens than FNA22G and FNC22G did in the total lymph nodes (P=0.002), in lymph nodes<6.0 mm (P=0.014), and in those ≥ 6.0 mm (P=0.000). Conclusions FNA22G and FNC22G obtained more diagnostically adequate specimens than FNA25G in cervical lymph nodes. FNA22G and FNC22G may be more suitable than FNA25G in diagnosing cervical lymph nodes. FNA22G and FNC22G may yield specimens with similar quality.
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Affiliation(s)
- Shujun Xia
- Department of Ultrasound, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yilai Chen
- Department of Ultrasound, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiwei Zhan
- Department of Ultrasound, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Zhou
- Department of Ultrasound, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Ultrasound, Ruijin Hospital/Lu Wan Branch, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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17
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Abstract
The reason why dopamine neurons die in Parkinson’s disease remains largely unknown. Emerging evidence points to a role for brain inflammation in neurodegeneration. Essential questions are whether brain inflammation happens sufficiently early so that interfering with this process can be expected to slow down neuronal death and whether the contribution from inflammation is large enough so that anti-inflammatory agents can be expected to work. Here I discuss data from human PD studies indicating that brain inflammation is an early event in PD. I also discuss the role of T-lymphocytes and peripheral inflammation for neurodegeneration. I critically discuss the failure of clinical trials targeting inflammation in PD.
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Affiliation(s)
- Vidar Gundersen
- Section for Movement Disorders, Department of Neurology, Oslo University Hospital, Oslo, Norway
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18
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Tomita H, Yamashiro T, Heianna J, Nakasone T, Kobayashi T, Mishiro S, Hirahara D, Takaya E, Mimura H, Murayama S, Kobayashi Y. Deep Learning for the Preoperative Diagnosis of Metastatic Cervical Lymph Nodes on Contrast-Enhanced Computed ToMography in Patients with Oral Squamous Cell Carcinoma. Cancers (Basel) 2021; 13:cancers13040600. [PMID: 33546279 PMCID: PMC7913286 DOI: 10.3390/cancers13040600] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/23/2021] [Accepted: 01/31/2021] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Cervical lymph node (LN) metastasis in patients with oral squamous cell carcinoma is one of the important prognostic factors. Pretreatment cervical nodal staging is performed using computed tomography (CT) as the first-line examination. However, imaging findings focused on morphology are not specific for detecting cervical LN metastasis. In this study, deep learning (DL) analysis of pretreatment contrast-enhanced CT was evaluated and compared with radiologists’ assessments at levels I–II, I, and II using the independent test set. The DL model achieved higher diagnostic performance in discriminating between benign and metastatic cervical LNs at levels I–II, I, and II. Significant difference in the area under the curves of the DL model and the radiologists’ assessments at levels I–II and II were observed. Our findings suggest that this approach can provide additional value to treatment strategies. Abstract We investigated the value of deep learning (DL) in differentiating between benign and metastatic cervical lymph nodes (LNs) using pretreatment contrast-enhanced computed tomography (CT). This retrospective study analyzed 86 metastatic and 234 benign (non-metastatic) cervical LNs at levels I–V in 39 patients with oral squamous cell carcinoma (OSCC) who underwent preoperative CT and neck dissection. LNs were randomly divided into training (70%), validation (10%), and test (20%) sets. For the validation and test sets, cervical LNs at levels I–II were evaluated. Convolutional neural network analysis was performed using Xception architecture. Two radiologists evaluated the possibility of metastasis to cervical LNs using a 4-point scale. The area under the curve of the DL model and the radiologists’ assessments were calculated and compared at levels I–II, I, and II. In the test set, the area under the curves at levels I–II (0.898) and II (0.967) were significantly higher than those of each reader (both, p < 0.05). DL analysis of pretreatment contrast-enhanced CT can help classify cervical LNs in patients with OSCC with better diagnostic performance than radiologists’ assessments alone. DL may be a valuable diagnostic tool for differentiating between benign and metastatic cervical LNs.
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Affiliation(s)
- Hayato Tomita
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan;
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan; (T.Y.); (J.H.); (S.M.)
- Correspondence: ; Tel.: +81-44-977-8111
| | - Tsuneo Yamashiro
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan; (T.Y.); (J.H.); (S.M.)
| | - Joichi Heianna
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan; (T.Y.); (J.H.); (S.M.)
| | - Toshiyuki Nakasone
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan;
| | - Tatsuaki Kobayashi
- Department of Advanced Biomedical Imaging Informatics, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan; (T.K.); (Y.K.)
| | - Sono Mishiro
- Department of AI Research Lab, Harada Academy, 2-54-4 Higashitaniyama, Kagoshima, Kagoshima 891-0113, Japan; (S.M.); (D.H.)
| | - Daisuke Hirahara
- Department of AI Research Lab, Harada Academy, 2-54-4 Higashitaniyama, Kagoshima, Kagoshima 891-0113, Japan; (S.M.); (D.H.)
| | - Eichi Takaya
- School of Science for Open and Environmental Systems, Graduate School of Science and Technology, Keio University, 3-14-1 Hiyoshi, Kohoku-ku, Yokohama, Kanagawa 223-8522, Japan;
| | - Hidefumi Mimura
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan;
| | - Sadayuki Murayama
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan; (T.Y.); (J.H.); (S.M.)
| | - Yasuyuki Kobayashi
- Department of Advanced Biomedical Imaging Informatics, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan; (T.K.); (Y.K.)
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19
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Iqbal MA, Wang X, Guoliang Z, Moazzam NF, Shahid AD, Qian X, Qian W. A comparison of the efficiency of diagnostic ultrasound and magnetic resonance imaging of cervical lymph nodes in papillary thyroid carcinoma. J Xray Sci Technol 2021; 29:1033-1044. [PMID: 34511478 DOI: 10.3233/xst-210927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To compare and evaluate diagnostic capabilities of preoperative ultrasonography (US) and magnetic resonance imaging (MRI) in the cervical lymph nodes of patients with papillary thyroid cancer. METHODS A retrospective dataset involving 156 patients who had undergone thyroidectomy and preoperative US and MRI was assembled. Among these, 69 had cervical lymph node metastasis and 87 did not. At least four radiologists unilaterally and spontaneously investigated the US and MRI attributes of the cervical lymph nodes. The efficiency of diagnostic imaging for cervical lymph nodes, including their true-positive rate or sensitivity, true-negative rate or specificity, positive predictive value, negative predictive value, and predictive accuracy were analysed and assessed. RESULTS In the assessment of cervical lymph node metastases of papillary thyroid cancer, the diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of diagnostic US vs. MRI were 58.0% vs. 79.7%, 69.0% vs. 83.9%, 59.7% vs. 79.7%, 67.4% vs. 83.9%, and 64.1% vs. 82.1%, respectively. The accuracy consistency of the two imaging modalities was 83.5%. CONCLUSIONS MRI is more effective than US in diagnosing and assessing cervical lymph node metastases of papillary thyroid cancer.
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Affiliation(s)
- Muhammad Asad Iqbal
- Department of Otolaryngology-Head & Neck Surgery, Affiliated People's Hospital of Jiangsu University, (The First People's Hospital of Zhenjiang), Jiangsu Province, China
| | - Xian Wang
- Department of Ultrasound, Affiliated People's Hospital of Jiangsu University, (The First People's Hospital of Zhenjiang), Jiangsu Province, China
| | - Zhang Guoliang
- Department of General Surgery, Affiliated People's Hospital of Jiangsu University, (The First People's Hospital of Zhenjiang), Jiangsu Province, China
| | | | | | - Xiaoqin Qian
- Department of Ultrasound, Affiliated People's Hospital of Jiangsu University, (The First People's Hospital of Zhenjiang), Jiangsu Province, China
| | - Wei Qian
- Department of Otolaryngology-Head & Neck Surgery, Affiliated People's Hospital of Jiangsu University, (The First People's Hospital of Zhenjiang), Jiangsu Province, China
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Zhang Y, Liu Z, Liang Y, Chen E, Zhang H, Gao Z, Wang J. The effectiveness and prognostic factors of radioactive iodine-125 seed implantation for the treatment of cervical lymph node recurrence of esophageal squamous cell carcinoma after external beam radiation therapy. J Contemp Brachytherapy 2020; 12:579-85. [PMID: 33437306 DOI: 10.5114/jcb.2020.101691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/17/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To analyze factors influencing the efficacy of 125I seed implantation in the treatment of in-field cervical lymph node recurrence of esophageal squamous cell carcinoma (ESCC) after external beam radiation therapy. Material and methods We conducted a retrospective review of 36 patients with in-field cervical metastatic lymph nodes recurrence of esophageal squamous cell carcinoma (CML-ESCC) after external beam radiation therapy treatment, who underwent 125I seed implantation in our department from 2013 to 2019. Previous cumulative external irradiation dose ranged from 20 to 66 Gy (median, 60 Gy). The post-implant efficacy was evaluated by response evaluation criteria in solid tumors (RECIST) version 1.1, and an adverse event was evaluated by the Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer Late Radiation Morbidity Score (EORTC). COX proportional hazards model was used to analyze risk factors affecting effectiveness. Results Among 36 patients, 31 patients (86.1%) received fluorouracil-based chemotherapy (1-6 cycles) after 125I seed implantation. Local control rates at 3, 6, 12, and 24 months after implantation were 51%, 30%, 30%, and 18%, respectively, with a median of 9 months (95% CI: 6.106-11.894); survival rates after 3, 6, 12, and 24 months were 55%, 41%, 22%, and 22%, respectively, with a median of 8 months (95% CI: 5.753-10.247). Multivariate analysis showed that D90 and short-term efficacy were independent factors related to local control and survival rate (p = 0.005, < 0.001, 0.010, < 0.001). There were 2 cases (5.6%) with grade 1 skin toxicity, 1 case (2.8%) with grade 4 skin toxicity, 3 cases (8.3%) with grade 1 mucosal ulcer, and 3 cases (8.3%) with grade 1 xerostomia. Conclusions 125I seed implantation as an effective salvage treatment shows definite efficacy and safety for patients with in-field cervical lymph node recurrence of ESCC after external beam radiation therapy.
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Marttila E, Keski-Säntti H, Hagström J, Snäll J, Wilkman T. Sentinel lymph node biopsies in early stage oral and oropharyngeal carcinoma: a retrospective single-centre experience. Br J Oral Maxillofac Surg 2020; 58:1078-1083. [PMID: 32522437 DOI: 10.1016/j.bjoms.2020.05.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 05/15/2020] [Indexed: 11/19/2022]
Abstract
The aim of this retrospective study was to analyse a consecutive series of patients with oral and oropharyngeal carcinoma who had had sentinel lymph node biopsy (SLNB) at our hospital during 2008-2017. A total of 70 patients with clinically and radiologically confirmed primary oral (n=67) or oropharyngeal (n=3) carcinoma, with no signs of metastatic lymph nodes preoperatively (clinically N0) were included. Patients' clinical and personal data, characteristics of the tumours, sentinel lymph node (SLN) status and outcomes were recorded. Eight patients had invaded SLN. Two patients with clear sentinel lymph node biopsies had recurrences in the cervical lymph nodes with no new primary tumour as origin. The negative predictive value (NPV) and sensitivity for SLNB were 97% and 80%, respectively. The depth of invasion was an individual predictor for cervical lymph node metastasis (p=0.043). Single photo emission computed tomography (SPECT) detected fewer SLN in patients with invaded lymph nodes than in patients with clear lymph nodes (p=0.018). Our data support the use of SLNB as a minimally invasive method for staging the cervical lymph nodes among patients with cN0 oral and oropharyngeal carcinoma. Our results further confirm that greater depth of invasion is associated with cervical lymph node metastases.
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Affiliation(s)
- E Marttila
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, PO Box 220, FI-00029 Helsinki.
| | - H Keski-Säntti
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, PO Box 263, FI-00029 Helsinki.
| | - J Hagström
- Department of Pathology, Helsinki University Hospital and University of Helsinki, PO Box 400, FI-00029 Helsinki.
| | - J Snäll
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, PO Box 220, FI-00029 Helsinki.
| | - T Wilkman
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, PO Box 220, FI-00029 Helsinki.
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Song E, Ahn J, Song DE, Kim WW, Jeon MJ, Sung TY, Kim TY, Chung KW, Kim WB, Shong YK, Hong SJ, Lee YM, Kim WG. Modified risk stratification based on cervical lymph node metastases following lobectomy for papillary thyroid carcinoma. Clin Endocrinol (Oxf) 2020; 92:358-365. [PMID: 31630423 DOI: 10.1111/cen.14115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/11/2019] [Accepted: 10/16/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Evidence for American Thyroid Association (ATA) risk stratification stems largely from studies involving patients undergoing total thyroidectomy. We aimed to assess the risk of recurrence according to the present ATA risk stratification system in patients who underwent lobectomy. DESIGN Retrospective cohort study. PATIENTS Patients who underwent thyroid lobectomy for 1-4 cm-sized papillary thyroid carcinoma (n = 571). MEASUREMENTS Disease-free survival (DFS) was compared according to the ATA risk stratification, and specific lymph node (LN) characteristics were evaluated to modify the ATA criteria with a higher predictability for recurrence. RESULTS Based on the ATA risk stratification, 439 patients (61.1%) were classified into intermediate- or high-risk group, and consideration for completion thyroidectomy is suggested by ATA guidelines for these patients. However, no significant differences were found in DFS among the low-, intermediate- and high-risk groups (P = .9). In contrast, when patients were stratified according solely to the LN criteria from the ATA risk stratification, only 127 patients (22.2%) had intermediate risk (intermediate-N1a) and exhibited significantly poorer DFS than those with N0 disease (P = .035). Modifying the intermediate-N1a criteria by adding the extranodal extension (ENE) status and omitting the clinical nodal disease enabled the subclassification of 19 patients (3%) with a high risk for recurrence. CONCLUSIONS The present study suggests that risk stratification based solely on LN metastases is more reasonable for predicting structural persistence/recurrence following lobectomy than that based on the overall ATA criteria. Considering the ENE status can assist in selecting patients with a high risk of recurrence to minimize further treatments.
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Affiliation(s)
- Eyun Song
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jonghwa Ahn
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Eun Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Woong Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Ji Jeon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Yon Sung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Yong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki Wook Chung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Bae Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Kee Shong
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suck Joon Hong
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yu-Mi Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Gu Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Sim JK, Lee JY, Hong HS. Differentiation Between Malignant and Benign Lymph Nodes: Role of Superb Microvascular Imaging in the Evaluation of Cervical Lymph Nodes. J Ultrasound Med 2019; 38:3025-3036. [PMID: 30945325 DOI: 10.1002/jum.15010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/21/2019] [Accepted: 03/10/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES This study aimed to assess the value of Superb Microvascular Imaging (SMI; Canon Medical Systems, Otawara, Japan) for distinguishing between benign and malignant cervical lymph nodes (LNs) and to compare SMI with power Doppler ultrasound (PDUS). METHODS Power Doppler ultrasound and SMI examinations were performed for patients' cervical LNs. The distribution of feeding vessels, number, and appearance of internal vessels were analyzed by 2 readers, and the results of PDUS and SMI were compared. Interobserver agreement was assessed. A subgroup analysis was performed to assess differences in vascular patterns between metastasis and tuberculous lymphadenitis and between Kikuchi disease and lymphoma. The diagnostic performance for distinguishing between benign and malignant LNs was calculated. RESULTS In total, 147 patients with 147 cervical LNs (85 benign and 62 malignant) were assessed. Interobserver agreement was moderate to strong for SMI. There were significant differences in the vascular patterns between benign and malignant LNs on SMI (distribution, number, and appearance, all P < .001), but not on PDUS. In the subgroup analysis, SMI showed a significant difference in the vascular patterns observed between metastasis and tuberculous lymphadenitis (distribution, P = .012; number, P = .014; and appearance, P = .005). Superb Microvascular Imaging detected significantly greater numbers of vessels in lymphoma than in Kikuchi disease (P = .012). The sensitivity of SMI was significantly greater than that of PDUS in distinguishing malignant from benign LNs (86.9% versus 54.1%; P < .001). CONCLUSIONS Superb Microvascular Imaging yields more detailed information about nodal vessels than does PDUS by enabling visualization of small nodal vessels. Superb Microvascular Imaging is useful and feasible for differentiating between malignant and benign cervical LNs.
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Affiliation(s)
- Joo Kyung Sim
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Ji Ye Lee
- Department of Radiology, Eulji Medical Center, Eulji University College of Medicine, Seoul, Korea
| | - Hyun Sook Hong
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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Wagner JM, Monfore N, McCullough AJ, Zhao L, Conrad RD, Krempl GA, Alleman AM. Ultrasound-Guided Fine-Needle Aspiration With Optional Core Needle Biopsy of Head and Neck Lymph Nodes and Masses: Comparison of Diagnostic Performance in Treated Squamous Cell Cancer Versus All Other Lesions. J Ultrasound Med 2019; 38:2275-2284. [PMID: 30593702 DOI: 10.1002/jum.14918] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/01/2018] [Accepted: 10/29/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To evaluate the diagnostic performance of ultrasound (US)-guided fine-needle aspiration with optional core needle biopsy of head and neck lymph nodes and masses, with attention to differences between biopsy of treated squamous cell carcinoma (SCC) and biopsy of other lesions. METHODS Institutional Review Board approval was obtained, and the need for consent was waived for this retrospective study. All 861 US-guided biopsies of head and neck lymph nodes and masses performed between March 1, 2012, and May 16, 2016, were reviewed. RESULTS Of the 861 biopsies, 53 targeted SCC with residual masses after treatment. The biopsy procedures yielded benign or malignant pathologic results in 71.7% (38 of 53) of treated SCC and 90.7% (733 of 808) of all other lesions (P < .001). A reference standard based on subsequent pathologic results or clinical and imaging follow-up was established in 68.4% of procedures. In cases with benign or malignant biopsy results and a subsequent reference standard, the sensitivity values for malignancy were 87.5% (95% confidence interval, 64.0%-96.5%) in treated SCC and 98.3% (95% confidence interval, 96.0%-99.3%) in all other cases (P = .047), and the specificity values were 63.6% (95% confidence interval, 35.4%-84.8%) in treated SCC and 99.5% (95% confidence interval, 97.3%-99.9%) in all other cases (P < .001). There were no major complications related to the biopsy procedures. CONCLUSIONS Excluding treated SCC, US-guided fine-needle aspiration with optional core needle biopsy of head and neck lymph nodes and masses has excellent diagnostic performance. Needle biopsy of head and neck SCC with a residual mass after therapy has a high rate of nondiagnostic samples, suboptimal sensitivity, and poor specificity.
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Affiliation(s)
- Jason M Wagner
- Departments of Radiological Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Natosha Monfore
- Departments of Radiological Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Austin J McCullough
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Lichao Zhao
- Departments of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Dr Zhao is now affiliated with Pathology and Laboratory Medicine Services, Central Texas Veterans Health Care System, Temple, Texas, USA
| | - Rachel D Conrad
- Departments of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Greg A Krempl
- Departments of Otorhinolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Anthony M Alleman
- Departments of Radiological Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Li N, Wang G, Jiang X, Huang M, Tian H, Xuan F, Zhang Y, Lv Y, Hu M, Wang Z, Ren P, Xu M. Merkel cell carcinoma metastatic to cervical lymph node in a patient with rheumatoid arthritis: a case report. Onco Targets Ther 2019; 12:1395-1400. [PMID: 30863106 PMCID: PMC6388979 DOI: 10.2147/ott.s188403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare, aggressive skin malignancy that has a propensity for local recurrence and metastasis to the lymph nodes. In this case report, we discuss a 54-year-old female with rheumatoid arthritis (RA) who had received treatment with prednisone (15 mg/day) for symptom relief and management. The patient visited our hospital with complaints of a nodule in right preauricular area. Computed tomography (CT) scans revealed no distant metastasis. The patient underwent surgical resection and histopathological evaluation of the nodule led to the diagnosis of MCC. The patients received post-surgical treatment with 6 MeV electronic wire radiotherapy. Six months later, CT of the head, neck, abdomen and chest demonstrated a right cervical lymph node mass at the C2 level. The patient then underwent cervical lymph node biopsy and pathological diagnosis confirmed metastatic MCC. One month after the lymph node biopsy, the patients received postoperative intensity modulated radiation therapy in the biopsied area. The patient did not experience any adverse effects to the therapy. In conclusion, the MCC patients with RA can tolerate radiation therapy. As MCC is a highly malignant neoplasia, considering the immune checkpoint inhibitors can lead to immune-related adverse events, detection of MCC at earlier stages is associated with better survival. The treatment decisions of MCC patients with RA continues is still challenging.
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Affiliation(s)
- Na Li
- Department of Pathology, Jiaxing University Afffiliated Women and Children Hospital, Jiaxing Maternity and Child Health Care Hospital, Jiaxing University, Jiaxing, Zhejiang 314051, China
| | - Guodong Wang
- Department of Radiotherapy Oncology, Zhuji People's Hospital of Zhejiang Province, The Zhuji Affiliated Hospital of Wenzhou Medical University, Zhuji, Zhejiang 311800, China,
| | - Xiaohong Jiang
- Department of Pathology, Jiaxing University Afffiliated Women and Children Hospital, Jiaxing Maternity and Child Health Care Hospital, Jiaxing University, Jiaxing, Zhejiang 314051, China
| | - Minguang Huang
- Department of Radiotherapy Oncology, Zhuji People's Hospital of Zhejiang Province, The Zhuji Affiliated Hospital of Wenzhou Medical University, Zhuji, Zhejiang 311800, China,
| | - Huanyong Tian
- Department of Radiotherapy Oncology, Zhuji People's Hospital of Zhejiang Province, The Zhuji Affiliated Hospital of Wenzhou Medical University, Zhuji, Zhejiang 311800, China,
| | - Feng Xuan
- Department of Radiotherapy Oncology, Zhuji People's Hospital of Zhejiang Province, The Zhuji Affiliated Hospital of Wenzhou Medical University, Zhuji, Zhejiang 311800, China,
| | - Yufeng Zhang
- Department of Radiotherapy Oncology, Zhuji People's Hospital of Zhejiang Province, The Zhuji Affiliated Hospital of Wenzhou Medical University, Zhuji, Zhejiang 311800, China,
| | - Yanting Lv
- Department of Pathology, Zhuji People's Hospital of Zhejiang Province, The Zhuji Affiliated Hospital of Wenzhou Medical University, Zhuji, Zhejiang 311800, China
| | - Mengjun Hu
- Department of Pathology, Zhuji People's Hospital of Zhejiang Province, The Zhuji Affiliated Hospital of Wenzhou Medical University, Zhuji, Zhejiang 311800, China
| | - Zhen Wang
- Department of Radiotherapy Oncology, Zhuji People's Hospital of Zhejiang Province, The Zhuji Affiliated Hospital of Wenzhou Medical University, Zhuji, Zhejiang 311800, China,
| | - Peng Ren
- Department of Pathology, Jiaxing University Afffiliated Women and Children Hospital, Jiaxing Maternity and Child Health Care Hospital, Jiaxing University, Jiaxing, Zhejiang 314051, China
| | - Maoyi Xu
- Department of Radiotherapy Oncology, Zhuji People's Hospital of Zhejiang Province, The Zhuji Affiliated Hospital of Wenzhou Medical University, Zhuji, Zhejiang 311800, China,
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Frank SJ, Ahn SJ, Surks MI. Virtual evaluation of selected cervical lymph nodes with three-dimensional ultrasound in thyroid cancer patients after thyroidectomy. Head Neck 2018; 41:748-755. [PMID: 30536820 DOI: 10.1002/hed.25427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We evaluated the usefulness of three-dimensional (3D) ultrasound of cervical lymph nodes (LN), when two-dimensional (2D) ultrasound evaluation is not sufficient to clearly evaluate lymph node characteristics, in thyroid cancer patients being followed after thyroidectomy. METHODS Two readers retrospectively analyzed 2D and 3D images of 147 LNs; LNs were categorized as normal, reactive, suspicious, or indeterminate, and confidence level was rated. Results were compared to cytological/clinical data. Inter-reader agreement was calculated. RESULTS Addition of 3D ultrasound significantly increased specificity (0.787 with 2D ultrasound vs 0.905 with 2D + 3D ultrasound for reader 1, P = .009; 0.701 with 2D ultrasound vs 0.898 with 2D + 3D ultrasound for reader 2, P = .01). Addition of 3D ultrasound significantly increased confidence level of readers (P < .001). Inter-reader agreement in LN categorization was almost perfect with 2D + 3D ultrasound. CONCLUSION 3D ultrasound of cervical LNs enables better demonstration of imaging features that are important in differentiating benign and malignant LNs. These improvements can potentially obviate the need for FNA in post thyroidectomy cancer patients.
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Affiliation(s)
- Susan J Frank
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Se Jin Ahn
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Martin I Surks
- Department of Medicine and Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, New York
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Frank SJ, Koenigsberg T, Gutman D, Koenigsberg M. Applications of 3-Dimensional Ultrasonography in the Neck, Excluding the Thyroid. J Ultrasound Med 2018; 37:1791-1806. [PMID: 29288583 DOI: 10.1002/jum.14514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 09/27/2017] [Accepted: 09/30/2017] [Indexed: 06/07/2023]
Abstract
Ultrasonography (US) of the neck is an accepted, useful imaging modality for many applications beyond its usefulness in thyroid disease. Two-dimensional US has been effectively used for evaluation of many types of neck conditions, and now, 3-dimensional US can be added to the imaging armamentaria. Three-dimensional US is useful in the evaluation of cervical lymph nodes, recurrent/residual thyroid neoplasia, parathyroid glands, parotid and submandibular glands, as well as thyroglossal duct cysts and other assorted palpable and visible abnormalities because of its unique capabilities, including multiplanar reconstruction, accessibility of the coronal view, volume calculation, and regularly spaced incremental slice evaluation.
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Affiliation(s)
- Susan J Frank
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Tova Koenigsberg
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - David Gutman
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mordecai Koenigsberg
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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Li L, Li Y, Zhang J, Wu Q, Yu H, Li Z, Xie C, Zhou Y, Zhong Y. Optimization of cervical lymph node clinical target volume delineation in nasopharyngeal carcinoma: a single center experience and recommendation. Oncotarget 2018; 9:26980-26989. [PMID: 29930744 PMCID: PMC6007460 DOI: 10.18632/oncotarget.23723] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/28/2017] [Indexed: 11/25/2022] Open
Abstract
Nasopharyngeal carcinoma (NPC) are characterized by distinct lymph node metastasis patterns. In order to minimize cervical lymph node irradiation volume, 379 NPC patients with metastatic cervical lymph nodes were eligible for geographic mapping. All lymph nodes were mapped into simulation computed tomography images of a template lymph node negative patient. The proportions of retropharyngeal lymph nodes (RLNs), Level Ib, II, III, IV, Va, Vb and supraclavicular (SCV) lymph nodes were 6.9%, 0.5%, 55.25%, 20.4%, 8.2%, 4.9%, 3.1% and 0.75%, respectively. Based on their distribution profile, we proposed the following modifications: 1. the lateral border of RLNs clinical target volume (CTV) be the medial edge of the internal carotid artery above the level of mastoid process, the medial border be adjacent to the cervical vessels below the free edge of the soft palate; 2. the submandibular gland should not be included in Level Ib; 3. Level II should include the posterior belly of digastric muscle, and the space between the posterior edge of submandibular gland and the anterior edge of sternocleidomastoid muscle; 4. the anterior border of Level III and IV should gradually shift backwards and the CTV only include part of the cervical vessels below the level where the thyroid gland appears; 5. the space of the posterior edge of trapezius muscle also should be included if there are metastatic lymph nodes in the transverse cervical vessle plexus. Our recommendations might adequately encompass metastatic lymph nodes while sparing the organs at risk and reducing adverse events.
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Affiliation(s)
- Li Li
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.,Hubei Cancer Clinical Study Center, Wuhan University, Wuhan, Hubei, China
| | - Yi Li
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.,Hubei Cancer Clinical Study Center, Wuhan University, Wuhan, Hubei, China
| | - Jun Zhang
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.,Hubei Cancer Clinical Study Center, Wuhan University, Wuhan, Hubei, China
| | - Qiuji Wu
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.,Hubei Cancer Clinical Study Center, Wuhan University, Wuhan, Hubei, China
| | - Haijun Yu
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.,Hubei Cancer Clinical Study Center, Wuhan University, Wuhan, Hubei, China
| | - Zheng Li
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.,Hubei Cancer Clinical Study Center, Wuhan University, Wuhan, Hubei, China
| | - Conghua Xie
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.,Hubei Cancer Clinical Study Center, Wuhan University, Wuhan, Hubei, China
| | - Yunfeng Zhou
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.,Hubei Cancer Clinical Study Center, Wuhan University, Wuhan, Hubei, China
| | - Yahua Zhong
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.,Hubei Cancer Clinical Study Center, Wuhan University, Wuhan, Hubei, China
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Mizuta M, Kitamura M, Tateya I, Tamaki H, Tanaka S, Asato R, Shinohara S, Takebayashi S, Maetani T, Kitani Y, Kumabe Y, Kojima T, Ushiro K, Ichimaru K, Honda K, Yamada K, Omori K. Unknown primary squamous cell carcinoma of the head and neck: retrospective analysis of 80 cases. Acta Otolaryngol 2018; 138:590-596. [PMID: 29310489 DOI: 10.1080/00016489.2017.1422141] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The management of patients with cervical metastasis in head and neck cancer of unknown primary (HNCUP) remains controversial. This current multicenter retrospective study investigated the treatment outcomes of patients with HNCUP. METHODS The study included patients who were treated curatively at 12 institutions in Japan from January 2006 to December 2015. RESULTS Eighty patients with HNCUP were included. The median follow-up period was 34 months. The three-year overall survival (OS), disease-specific survival (DSS), regional relapse-free survival (RRFS), local progression-free survival (LPFS), and distant metastasis-free survival (DMFS) rates were 72.5%, 80.3%, 74.0%, 89.7%, and 86.9%, respectively. Nodal status was a significant factor for OS, DSS, RRFS, and DMFS; and extracapsular extension (ECE) was significant for OS and DSS. There was a distinct difference between the survival rates of patients with N1-2a and N2b-3 disease. RT was a significant positive factor for LPFS (3-year LPFS, RT 93.0% vs. no RT 83.0%, p = .043). CONCLUSIONS For N2a as well as N1 disease without ECE, a single treatment modality, including ND or RT alone is acceptable. When ND alone is performed, thorough monitoring should be continued during follow-up to identify the emergence of the primary lesion.
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Affiliation(s)
- Masanobu Mizuta
- Department of Otolaryngology – Head & Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Otolaryngology – Head & Neck Surgery, Kurashiki Central Hospital, Okayama, Japan
| | - Morimasa Kitamura
- Department of Otolaryngology – Head & Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ichiro Tateya
- Department of Otolaryngology – Head & Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hisanobu Tamaki
- Department of Otolaryngology – Head & Neck Surgery, Kurashiki Central Hospital, Okayama, Japan
| | - Shinzo Tanaka
- Department of Otolaryngology – Head & Neck Surgery, Japanese Red Cross Osaka Hospital, Osaka, Japan
| | - Ryo Asato
- Department of Otolaryngology – Head & Neck Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Shogo Shinohara
- Department of Otolaryngology – Head & Neck Surgery, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Shinji Takebayashi
- Department of Otolaryngology – Head & Neck Surgery, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Toshiki Maetani
- Department of Otolaryngology – Head & Neck Surgery, Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Yoshiharu Kitani
- Department of Otorhinolaryngology – Head & Neck surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Yohei Kumabe
- Department of Otolaryngology – Head & Neck Surgery, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | | | - Koji Ushiro
- Department of Otolaryngology, Japanese Red Cross Otsu Hospital, Shiga, Japan
| | - Kazuyuki Ichimaru
- Department of Otolaryngology – Head & Neck Surgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - Keigo Honda
- Department of Otolaryngology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Koichiro Yamada
- Department of Otolaryngology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Koichi Omori
- Department of Otolaryngology – Head & Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Gjurašin B, Lepej SŽ, Cole MJ, Pitt R, Begovac J. Chlamydia trachomatis in Cervical Lymph Node of Man with Lymphogranuloma Venereum, Croatia, 2014 1. Emerg Infect Dis 2018; 24:806-808. [PMID: 29553338 PMCID: PMC5875274 DOI: 10.3201/eid2404.171872] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report an HIV-infected person who was treated for lymphogranuloma venereum cervical lymphadenopathy and proctitis in Croatia in 2014. Infection with a variant L2b genovar of Chlamydia trachomatis was detected in a cervical lymph node aspirate. A prolonged course of doxycycline was required to cure the infection.
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Miranda Galvis M, Reis LAD, Santos-Silva AR, Vargas PA, Corrêa MB, Lopes MA. Hodgkin lymphoma diagnosed during dental treatment: the importance of neck palpation. Gen Dent 2017; 65:65-68. [PMID: 29099369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Hodgkin lymphoma (HL) is a malignant lymphoproliferative disease that originates from alterations in germinal center B cells. HL generally affects cervical and supraclavicular nodes, and the most common clinical presentation is adenopathy. It can be symptomatic and detected by the patient or asymptomatic and identified during a physical examination. This article reports the case of a 17-year-old girl who was diagnosed with HL during dental treatment, highlighting the importance of a complete physical examination in dental practice.
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Zhang J, Hao X, Yang Y, Yan CS, Ma C, Xiao M, Gu LS, Wang Y. Evaluation of supplementary diagnostic value of contrast-enhanced ultrasound for lymph node puncture biopsy. J Thorac Dis 2017; 9:4791-4797. [PMID: 29268551 DOI: 10.21037/jtd.2017.11.90] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Contrast enhanced ultrasound (CEUS) is an effective way to evaluate the distribution of micro vessels in organs with little invasiveness. The qualitative evaluation and differential diagnosis of lymph node is essential for a number of clinical situations, including appropriate examination selection, oncologic staging, therapy and prognosis beyond diagnosis itself. The purpose of this study is to investigate the contribution of characterization of cervical lymphadenopathies on CEUS as an indication for lymph node puncture biopsy. Methods Records of 157 lymph nodes from 103 patients who had undergone CEUS examination were studied retrospectively, and enhancement patterns and characteristics were evaluated. The diagnoses obtained by means of core-needle biopsy examination or surgical removal, or patients were closely followed-up for at least 6 months. Of the lymph nodes examined, 94 were benign (48 lymphadenitis and 46 tuberculosis) and 63 were malignant (55 metastases and 8 lymphomas). The vascular characterization of lymph nodes was compared with results obtained by pathologic examination. Results The study using CEUS showed 55 (54.5%) cases of "peripheral" enhancement in group A and 47 (83.9%) cases of "hilar normal or activated" in group B. Inhomogeneous "spotted or cycle-like" enhancement in the equilibrium phase was seen in 80 (79.2%) cases of group A and only 11 (19.6%) cases of group B. The specificity, sensitivity and accuracy of CEUS examination result as an indication for puncture biopsy were 80.4%, 81.2% and 80.9%, respectively. Conclusions Centripetal perfusion in the early arterial phase or inhomogeneous spotted or cycle-like enhancement in the equilibrium phase of the cervical lymph nodes during CEUS can be used as an indication for core-needle biopsy with a high degree of accuracy. Conversely, for lymph nodes with more variable appearances, surgical removal or closely followed-up of nodes may be more appropriate.
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Affiliation(s)
- Jie Zhang
- Department of General Surgery, General Hospital of Tianjin Medical University, Tianjin 300051, China
| | - Xin Hao
- Graduate School of Tianjin Medical University, Tianjin 300070, China
| | - Yang Yang
- Department of Radiology, Tianjin Children's Hospital, Tianjin 300134, China
| | - Chang-Shuai Yan
- Graduate School of Tianjin Medical University, Tianjin 300070, China
| | - Chao Ma
- Department of General Surgery, General Hospital of Tianjin Medical University, Tianjin 300051, China
| | - Ming Xiao
- Department of General Surgery, General Hospital of Tianjin Medical University, Tianjin 300051, China
| | - Li-Shuang Gu
- Department of Ultrasound, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yong Wang
- Department of Ultrasound, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Suzuki S, Honda K, Nanjo H, Iikawa N, Tsuji T, Kawasaki Y, Yamazaki K, Sato T, Saito H, Shiina K, Ishikawa K. CD147 expression correlates with lymph node metastasis in T1-T2 squamous cell carcinoma of the tongue. Oncol Lett 2017; 14:4670-4676. [PMID: 29085466 PMCID: PMC5649530 DOI: 10.3892/ol.2017.6808] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 03/03/2017] [Indexed: 12/14/2022] Open
Abstract
Cervical lymph node metastasis causes a poor prognosis in cases of stage T1-T2 squamous cell carcinoma (SCC) of the tongue. Recent studies have reported that cluster of differentiation (CD)147, also known as extracellular matrix metalloproteinase inducer, contributes to tumor progression. The present study evaluated the role of CD147 in the tumorigenesis of SCC of the tongue in vitro, as well as the association between CD147 expression and cervical lymph node metastasis in clinical samples of SCC of the tongue. Tongue SCC cell lines were used to evaluate in vitro tumorigenesis. In addition, 41 patients with clinical stage T1-T2 tongue SCC were assessed with a histopathological analysis. Univariate and multivariate analysis were performed to investigate the risk of cervical lymph node metastasis associated with histopathological findings. In the in vitro study, cell invasiveness was upregulated by S100 calcium-binding protein A9 (S100A9) stimulation and downregulated following CD147-blocking antibody treatment. The univariate and multivariate analyses identified CD147 expression in the invasive tumor front as an independent risk factor for metastasis. It was concluded that CD147 induces tongue carcinoma cell invasion through its interaction with S100A9. Thus, an evaluation of the extent of CD147 expression in cancer cell nests at the invasive tumor front may help in predicting cervical lymph node metastasis in patients with clinical N0 T1-T2 tongue SCC.
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Affiliation(s)
- Shinsuke Suzuki
- Department of Otorhinolaryngology and Head and Neck Surgery, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Kohei Honda
- Department of Otorhinolaryngology and Head and Neck Surgery, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Hiroshi Nanjo
- Division of Surgical Pathology, Akita University Hospital, Akita 010-8543, Japan
| | - Nobuko Iikawa
- Department of Otorhinolaryngology and Head and Neck Surgery, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Tadahiro Tsuji
- Department of Otorhinolaryngology and Head and Neck Surgery, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Yohei Kawasaki
- Department of Otorhinolaryngology and Head and Neck Surgery, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Kazuharu Yamazaki
- Department of Otorhinolaryngology and Head and Neck Surgery, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Teruyuki Sato
- Department of Otorhinolaryngology and Head and Neck Surgery, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Hidekazu Saito
- Department of Otorhinolaryngology and Head and Neck Surgery, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Kazuhiro Shiina
- Department of Otorhinolaryngology and Head and Neck Surgery, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Kazuo Ishikawa
- Department of Otorhinolaryngology and Head and Neck Surgery, Akita University Graduate School of Medicine, Akita 010-8543, Japan
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Liu X, Jia W, Huang S, Sun G. A case of pulmonary cryptococcosis with large pericardial effusion diagnosed using cervical lymph node biopsy. Clin Respir J 2016; 12:820-823. [PMID: 27873481 DOI: 10.1111/crj.12581] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 08/21/2016] [Accepted: 11/01/2016] [Indexed: 12/21/2022]
Abstract
Pulmonary cryptococcosis (PC) is a relatively rare infectious disease. It mainly involves the lungs; however, in some patients, the infection could spread to other parts of the body. PC mostly occurs in patients with immune deficiencies. However, PC infections have been reported in non-immunocompromised patients. The diagnosis of PC is challenging in patients without immune deficiencies. Here, the case of a 27-year-old immunocompetent woman who was diagnosed with PC was report. She had unexplained fever and a history of close contact with poultry feathers. Lesions were observed in the lungs, pleural cavity, pericardium, and cervical lymph nodes. Biopsy of the cervical lymph nodes helped in the pathological diagnosis of PC. She was treated with fluconazole, and the lesions disappeared. They present this case to encourage detailed inquiry of medical history in such patients, improve the diagnostic awareness of clinicians, and help reduce the likelihood of misdiagnosis.
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Affiliation(s)
- Xuchun Liu
- Department of Respiratory Medicine, Chizhou Clinical College of Anhui Medical University, Chizhou People's Hospital, Chizhou, Anhui, 247100, China
| | - Wei Jia
- Department of Respiratory Medicine, Shanghai Integrated Traditional Chinese and Western Medicine Hospital, Shanghai, 200082, China
| | - Shubin Huang
- Department of Pathology, Chizhou Clinical College of Anhui Medical University, Chizhou People's Hospital, Chizhou, Anhui, 247100, China
| | - Gengyun Sun
- Department of Respiratory Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, China
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Xing J, Luo Y, Wang X, Gao M, Sun M, Ding X, Fan T, Yu J. Anatomic distribution of supraclavicular lymph node in patients with esophageal cancer. Onco Targets Ther 2016; 9:5803-5808. [PMID: 27703379 PMCID: PMC5036650 DOI: 10.2147/ott.s111800] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Definitive chemoradiation therapy remains the standard of care for patients with localized esophageal carcinoma who choose nonsurgical management. However, there is no consensus regarding delineation of the nodal clinical target volume (CTVn), especially for lower cervical lymph nodes. This study aimed to map the location of metastatic supraclavicular lymph nodes in thoracic esophageal carcinoma patients with supraclavicular node involvement and generate an atlas to delineate the CTVn for elective nodal radiation of esophageal squamous cell carcinoma. PATIENTS AND METHODS In this study, the supraclavicular regional lymph node was further divided into four subgroups. The locations of the involved supraclavicular nodes for all patients were then transferred onto a template computed tomography (CT) image. A volume probability map was then generated with nodal volumes, and was displayed on the template CT to provide a visual impression of nodal frequencies and anatomic distribution. RESULTS We identified 154 supraclavicular nodal metastases based on CT image in 96 patients. Of these, 29.2% were located in group I region, 59.7% in group II region, 10.4% in group III region, and 0.7% in group IV region. CONCLUSION On the basis of our study, we suggest that the appropriate radiation field of CTVn should include the group I and II regions and the CTVn exterior margin along the lateral side of the internal jugular vein may be suitable.
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Affiliation(s)
- Jun Xing
- Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University
| | - Yijun Luo
- Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University; School of Medical and Life Sciences, Shandong Academy of Medical Sciences, University of Jinan, Jinan, People's Republic of China
| | - Xiaoli Wang
- Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University; School of Medical and Life Sciences, Shandong Academy of Medical Sciences, University of Jinan, Jinan, People's Republic of China
| | - Min Gao
- Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University
| | - Mingping Sun
- Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University
| | - Xiuping Ding
- Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University
| | - Tingyong Fan
- Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University
| | - Jinming Yu
- Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University
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Leng XF, Zhu Y, Wang GP, Jin J, Xian L, Zhang YH. Accuracy of ultrasound for the diagnosis of cervical lymph node metastasis in esophageal cancer: a systematic review and meta-analysis. J Thorac Dis 2016; 8:2146-57. [PMID: 27621871 DOI: 10.21037/jtd.2016.07.71] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Esophageal cancer is considered a serious malignancy with respect to its prognosis and mortality rate. Cervical lymph node status is one of the keys to determining prognosis and treatment methods. However, published data vary regarding the accuracy of ultrasound in the diagnosis of cervical lymph node metastasis. We performed a meta-analysis to assess the efficacy of ultrasound for detecting cervical lymph node metastasis in patients with esophageal cancer. METHODS The PubMed/MEDLINE, EMBASE, Web of Science, and Cochrane Library databases were searched to identify studies related to cervical lymph node metastasis, and 22 studies comprising 3,513 patients met our inclusion criteria. We used a bivariate meta-analysis following a random effects model to summarize the data. We also explored reasons for statistical heterogeneity using meta-regression, subgroup, and sensitivity analyses. Publication bias was assessed with a Deeks funnel plot. RESULTS The area under the receiver operating characteristic curve was 0.97 [95% confidence interval (CI): 0.95-0.98], and the pooled diagnostic odds ratio was 121.00 (95% CI: 47.57-307.79). With cut-off values of 5 mm and >5 mm for cervical lymph node size, the sensitivities and specificities (95% confidence interval) for ultrasound detection of cervical lymph node metastasis were 84% (67-93%) and 93% (90-95%); and 94% (76-98%) and 98% (89-100%), respectively. CONCLUSIONS We show for the first time the diagnostic accuracy of ultrasound for predicting cervical lymph node-positive metastasis in esophageal cancer. Our analysis shows that ultrasonography may be an effective and reliable approach to detect cervical lymph node metastasis in esophageal cancer. However, to accommodate heterogeneity, high-quality studies are needed to further verify the efficacy of ultrasound detection.
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Affiliation(s)
- Xue-Feng Leng
- Department of Cardiothoracic Surgery, the Affiliated Hospital of Chengdu University, Chengdu 610081, China
| | - Yi Zhu
- Department of Ultrasound, Sichuan Cancer Hospital, Chengdu 610041, China
| | - Ge-Ping Wang
- Department of Cardiothoracic Surgery, the Affiliated Hospital of Chengdu University, Chengdu 610081, China
| | - Jian Jin
- Department of Cardiothoracic Surgery, the Affiliated Hospital of Chengdu University, Chengdu 610081, China
| | - Lei Xian
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Yu-Hong Zhang
- Department of Gastroenterology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
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Byun BH, Kwon SY, Chong A, Kim J, Yoo SW, Min JJ, Song HC, Bom HHS. Both F-18 FDG-avidity and Malignant Shape of Cervical Lymph Nodes on PET/CT after Total Thyroidectomy Predict Resistance to High-dose I-131 Therapy in Patients with Papillary Thyroid Cancer. Asia Ocean J Nucl Med Biol 2016; 1:6-13. [PMID: 27408836 PMCID: PMC4937673 DOI: 10.7508/aojnmb.2013.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective: Resistance of metastatic lymph nodes (LNs) to high dose I-131 therapy is associated with high morbidity in patients with differentiated thyroid cancer. We evaluated the role of F-18 FDG PET/CT in the prediction of resistance to high dose I-131 therapy in patients with papillary thyroid cancer. Methods: The subjects were 307 patients who underwent total or near total thyroidectomy followed by high dose (5.55-6.66 GBq) I-131 therapy. We divided the patients into three subgroups by visual assessment of regional LNs: FDG-avid LNs with a malignant shape on CT (PET/CT-positive group), FDG-avid LNs with a benign shape on CT (PET/CT-intermediate group) and no FDG-avid lesion (PET/CT-negative group). We measured the maximum SUV (SUVmax) of FDG-avid LNs in each patient. The presence or absence of focal increased uptake of I-131 was evaluated by whole body scan (WBS), and was denoted as WBS-positive group or WBS-negative group, respectively. Resistance to therapy was defined as presence of thyroglobulin (Tg) in serum (Tg ≥1.0 ng/ml) 3-6 months after I-131 therapy. Univariate and multivariate analyses were performed to determine the relationship between resistance to I-131 therapy and various clinico-pathologic variables. Results: PET/CT-positive, intermediate, and negative groups included 20 (6.5%), 44 (14.3%) and 243 (79.2%) patients, respectively. The mean SUVmax was significantly higher in the PET/CT-positive group than that of the PET/CT-intermediate group (4.6 vs. 2.7, P <0.001). Univariate analysis revealed that the PET/CT-positive group (P <0.001), T2-4 stage (P <0.001), N1b stage (P = 0.001), lower dose (5.55 GBq) of I-131 (P <0.001), and the WBS-positive group (P = 0.029) were associated with resistance to therapy. In multivariate analysis, the PET/CT-positive group, lower dose of I-131, N1b stage, and T2-4 stage remained significant with odds ratios of 10.07 (P <0.001), 3.82 (P <0.001), 3.58 (P = 0.001), and 2.53 (P = 0.009), respectively. Conclusion: FDG-avidity and malignant shape of cervical LNs on pre-therapy FDG PET/CT were a strong risk factors predicting resistance to high dose I-131 therapy. A lower dose of administered I-131 (5.55 GBq) and more extensive tumors (T2-4 and N1b) were also associated with resistance to high dose I-131 therapy.
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Affiliation(s)
- Byung Hyun Byun
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Jeollanam-do, Republic of Korea
| | - Seong Young Kwon
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Jeollanam-do, Republic of Korea
| | - Ari Chong
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Jahae Kim
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Su Woong Yoo
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Jeollanam-do, Republic of Korea
| | - Jung-Joon Min
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Jeollanam-do, Republic of Korea
| | - Ho-Chun Song
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Henry Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Jeollanam-do, Republic of Korea; President, AOFNMB
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Zhang J, Wang Y, Yu B, Shi X, Zhang Y. Application of Computer-Aided Diagnosis to the Sonographic Evaluation of Cervical Lymph Nodes. Ultrason Imaging 2016; 38:159-171. [PMID: 26025577 DOI: 10.1177/0161734615589080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We initiated an observer study to evaluate a computerized system developed in our previous study for automatic extraction of 10 features and estimation of the malignancy probability of cervical nodes in sonograms. In the present study, five expert radiologists and five resident radiologists interpreted the sonograms of 178 nodes. The malignancy rating and patient management recommendation (biopsy or follow-up) were made without and then with the computer aid. Under these two reading conditions, the performances of radiologists and agreement among a group of radiologists were evaluated by using the receiver operating characteristic (ROC) analysis and the κ statistic, respectively. With the computer aid, the performances of radiologists improved significantly, as indicated by the increase in the area under the ROC curve (Az) from 0.843 to 0.896 (p = 0.031) and from 0.705 to 0.822 (p < 0.001), for the expert and resident groups, respectively. Agreement among all 10 radiologists improved from slight to moderate as indicated by an increase in the κ value from 0.195 to 0.421 (p < 0.001). The average performance of residents with aid (Az = 0.822) was close to that of experts without aid (Az = 0.843). Results indicate that computer-aided diagnosis is useful to improve radiologist performance (especially that of inexperienced radiologists) in the ultrasonographic evaluation of cervical nodes and to reduce variability among radiologists.
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Affiliation(s)
- Junhua Zhang
- Department of Electronic Engineering, Yunnan University, Kunming, People's Republic of China
| | - Yuanyuan Wang
- Department of Electronic Engineering, Fudan University, Shanghai, People's Republic of China
| | - Bo Yu
- Department of Ultrasound Diagnostics, First People's Hospital of Yunnan Province, Kunming, People's Republic of China
| | - Xinling Shi
- Department of Electronic Engineering, Yunnan University, Kunming, People's Republic of China
| | - Yufeng Zhang
- Department of Electronic Engineering, Yunnan University, Kunming, People's Republic of China
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Bandoh N, Goto T, Akahane T, Ohnuki N, Yamaguchi T, Kamada H, Harabuchi Y, Tanaka S, Nishihara H. Diagnostic value of liquid-based cytology with fine needle aspiration specimens for cervical lymphadenopathy. Diagn Cytopathol 2016; 44:169-76. [PMID: 26748563 PMCID: PMC5066749 DOI: 10.1002/dc.23402] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 11/17/2015] [Accepted: 11/24/2016] [Indexed: 12/22/2022]
Abstract
Background Cervical lymphadenopathy is a symptom that is frequently seen among outpatients, and it is important to differentiate malignant lesions from reactive lymphoid hyperplasia. Fine needle aspiration (FNA) cytology has been widely used for the diagnosis of cervical lymphadenopathy. However, some limitations of the diagnostic accuracy using conventional smear (CS) cytology have been pointed out. The diagnostic value of liquid‐based cytology (LBC) with FNA specimens has not yet been fully proven. Methods Forty‐two patients with cervical lymphadenopathy who underwent FNA with CS cytology from 2007 to 2011 and 123 patients who underwent FNA with LBC utilizing LBCPREP2™ from 2011 to 2015 were studied. Diagnostic values were compared between the CS and the LBC groups. Results Of the total 165 patients representing the combined CS and LBC groups, 81 (49.1%) were diagnosed as benign lymph node and 84 (50.9%) were malignant diseases including 37 (22.4%) of metastatic carcinoma except for thyroid carcinoma, 30 (18.2%) of metastatic thyroid carcinoma, and 17 (10.3%) of malignant lymphoma. The overall statistical values including sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the CS were 75%, 100%, 100%, 78.9%, and 87.1%, respectively, whereas those values for LBC were 91.2%, 100%, 100%, 90.7%, and 95.3%, respectively. The sensitivity of LBC for malignant diseases tended to be higher than that of CS cytology (p = 0.081). Conclusion LBC with FNA specimens from cervical lymphadenopathy is a useful and reliable method for the diagnosis of malignant diseases, especially of metastatic carcinomas, due to its increased sensitivity compared with CS cytology. Diagn. Cytopathol. 2016;44:169–176. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Nobuyuki Bandoh
- Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital, Obihiro, Hokkaido, Japan
| | - Takashi Goto
- Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital, Obihiro, Hokkaido, Japan
| | - Toshiaki Akahane
- Department of Biology and Genetics, Laboratory of Cancer Medical Science, Hokuto Hospital, Obihiro, Hokkaido, Japan
| | - Natsumi Ohnuki
- Department of Biology and Genetics, Laboratory of Cancer Medical Science, Hokuto Hospital, Obihiro, Hokkaido, Japan
| | - Tomomi Yamaguchi
- Department of Biology and Genetics, Laboratory of Cancer Medical Science, Hokuto Hospital, Obihiro, Hokkaido, Japan
| | - Hajime Kamada
- Department of Neurosurgery, Hokuto Hospital, Obihiro, Hokkaido, Japan
| | - Yasuaki Harabuchi
- Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Shinya Tanaka
- Department of Pathology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Hiroshi Nishihara
- Department of Biology and Genetics, Laboratory of Cancer Medical Science, Hokuto Hospital, Obihiro, Hokkaido, Japan.,Department of Pathology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
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López F, Rodrigo JP, Silver CE, Haigentz M, Bishop JA, Strojan P, Hartl DM, Bradley PJ, Mendenhall WM, Suárez C, Takes RP, Hamoir M, Robbins KT, Shaha AR, Werner JA, Rinaldo A, Ferlito A. Cervical lymph node metastases from remote primary tumor sites. Head Neck 2015; 38 Suppl 1:E2374-85. [PMID: 26713674 DOI: 10.1002/hed.24344] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 09/14/2015] [Accepted: 10/17/2015] [Indexed: 11/08/2022] Open
Abstract
Although most malignant lymphadenopathy in the neck represent lymphomas or metastases from head and neck primary tumors, occasionally, metastatic disease from remote, usually infraclavicular, sites presents as cervical lymphadenopathy with or without an obvious primary tumor. In general, these tumors metastasize to supraclavicular lymph nodes, but occasionally may present at an isolated higher neck level. A search for the primary tumor includes information gained by histology, immunohistochemistry, and evaluation of molecular markers that may be unique to the primary tumor site. In addition, 18F-fluoro-2-deoxyglocose positron emission tomography combined with CT (FDG-PET/CT) has greatly improved the ability to detect the location of an unknown primary tumor, particularly when in a remote location. Although cervical metastatic disease from a remote primary site is often incurable, there are situations in which meaningful survival can be achieved with appropriate local treatment. Management is quite complex and requires a truly multidisciplinary approach. © 2015 Wiley Periodicals, Inc. Head Neck 38: E2374-E2385, 2016.
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Affiliation(s)
- Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,University of Oviedo, Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,University of Oviedo, Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
| | - Carl E Silver
- Departments of Surgery and Otolaryngology, Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Missak Haigentz
- Departments of Medicine (Oncology) and Otorhinolaryngology-Head & Neck Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Justin A Bishop
- Departments of Pathology, The Johns Hopkins University, Baltimore, Maryland
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Dana M Hartl
- Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France.,Laboratoire de Phonétique et de Phonologie, Sorbonne Nouvelle, Paris, France
| | - Patrick J Bradley
- Department of Otolaryngology-Head and Neck Surgery, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham, United Kingdom
| | | | - Carlos Suárez
- University of Oviedo, Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Marc Hamoir
- Department of Head and Neck Surgery, Head and Neck Oncology Program, St Luc University Hospital and Cancer Center, Brussels, Belgium
| | - K Thomas Robbins
- Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Jochen A Werner
- Department of Otolaryngology, Head and Neck Surgery, Marburg, Germany
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group
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Shakeel MK, Daniel MJ, Srinivasan SV, Koliyan R, Kumar JV. Comparative analysis of detecting cervical lymph node metastasis with fine needle aspiration cytology. J Nat Sci Biol Med 2015; 6:S7-9. [PMID: 26604624 PMCID: PMC4630768 DOI: 10.4103/0976-9668.166050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: We correlated the results of cervical lymph node (LN) status by T-tumor size, N-nodal metastasis, M-distant metastasis (TNM) staging, and fine needle aspiration cytology (FNAC) in oral cancer patients to assess the discrepancy index (DI) between nodal metastasis (N) and FNAC results of cervicofacial LNs. Materials and Methods: A total of 63 patients (29 females and 34 males) aged from 30 to 85 years were included in our study. Cervical LN status through TNM staging and FNAC results were matched and DI was calculated. Results: DI in case of nodal status was 64.10% and 43.47% for TNMN1 and N2, respectively, indicating that tendency for observation of positive result on FNAC increased from N1 to N2. Conclusion: Hence, we suggest that relying solely on clinical examination and routine diagnostic tests like FNAC may not be appropriate and additional diagnostic imaging modalities should be considered.
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Affiliation(s)
- Mohammed Kamran Shakeel
- Department of Oral Medicine and Radiology, Mahatma Gandhi Postgraduate Institute of Dental Sciences, Puducherry, India
| | - Mariappan Jonathan Daniel
- Department of Oral Medicine and Radiology, Mahatma Gandhi Postgraduate Institute of Dental Sciences, Puducherry, India
| | | | - Ramadoss Koliyan
- Department of Oral Medicine and Radiology, Mahatma Gandhi Postgraduate Institute of Dental Sciences, Puducherry, India
| | - Jimsha Vannathan Kumar
- Department of Oral Medicine and Radiology, Mahatma Gandhi Postgraduate Institute of Dental Sciences, Puducherry, India
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Oishi M, Okamoto S, Teranishi Y, Yokota C, Takano S, Iguchi H. Clinical Study of Extrapulmonary Head and Neck Tuberculosis: A Single-Institute 10-year Experience. Int Arch Otorhinolaryngol 2015; 20:30-3. [PMID: 26722342 PMCID: PMC4687992 DOI: 10.1055/s-0035-1565011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 08/30/2015] [Indexed: 11/23/2022] Open
Abstract
Introduction Although the incidence of tuberculosis (TB) in Japan has been decreasing yearly, Japan remains ranked as an intermediate-burden country for TB. Objective This study aims to investigate the current situation of head and neck extrapulmonary TB (EPTB) diagnosed in our department. Methods We retrospectively reviewed the clinical records of 47 patients diagnosed with EPTB in the head and neck in our department between January 2005 and December 2014. The extracted data included sex and age distribution, development site, chief complaint, presence or absence of concomitant active pulmonary TB (PTB) or history of TB, tuberculin skin test (TST) results, interferon-gamma release assay (IGRA) results, and duration from the first visit to the final diagnosis of EPTB. Results The subjects consisted of 20 men and 27 women, and age ranged from 6 to 84 years. The most common site was the cervical lymph nodes (30 patients), with the supraclavicular nodes being the most commonly affected (60%). Histopathological examination was performed on 28 patients. TST was positive in 9 out of 9 patients and the IGRA was positive in 18 out of 19 patients. We observed concomitant PTB in 15 out of the 47 patients. Mean duration from the first visit to the final diagnosis of EPTB was 56 days. Conclusion The clinical symptoms of TB, especially those in the head and neck region, are varied. Otolaryngologists should be especially aware of the extrapulmonary manifestations of TB to ensure early diagnosis and treatment from the public health viewpoint.
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Affiliation(s)
- Masahiro Oishi
- Department of Otolaryngology and Head & Neck Surgery, Osaka City University, Osaka, Japan
| | - Sachimi Okamoto
- Department of Otolaryngology and Head & Neck Surgery, Osaka City University, Osaka, Japan
| | - Yuichi Teranishi
- Department of Otolaryngology and Head & Neck Surgery, Osaka City University, Osaka, Japan
| | - Chieko Yokota
- Department of Otolaryngology and Head & Neck Surgery, Osaka City University, Osaka, Japan
| | - Sakurako Takano
- Department of Otolaryngology and Head & Neck Surgery, Osaka City University, Osaka, Japan
| | - Hiroyoshi Iguchi
- Department of Otolaryngology and Head & Neck Surgery, Osaka City University, Osaka, Japan
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Takano S, Matsushita N, Oishi M, Okamoto S, Teranishi Y, Yokota C, Iguchi H. Site-specific analysis of B-cell non-Hodgkin's lymphomas of the head and neck: A retrospective 10-year observation. Acta Otolaryngol 2015; 135:1168-71. [PMID: 26113048 DOI: 10.3109/00016489.2015.1061700] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION B-cell non-Hodgkin's lymphoma (B-NHL) in the head and neck most commonly affected the oropharynx and the cervical lymph node in sexagenarian patients, with more than 70% of these cases being diffuse large B-cell lymphoma (DLBCL). Accordingly, B-NHL should be considered one of the most important differential diagnoses of head and neck malignancies. OBJECTIVES It has previously been reported that the majority of head and neck malignant lymphomas are B-NHLs. This analysis aimed to assess the site-specific profiles of B-NHL of the head and neck. METHODS The medical records of patients with B-NHL of the head and neck diagnosed between January 2004 and December 2013 were retrospectively reviewed. The clinical parameters of these patients, including age, sex, site distribution, and histopathologic sub-type, were analyzed. RESULTS A total of 153 cases (95 males; 58 females) were included in this analysis (male-to-female ratio = 1.64:1). The patient age at the time of diagnosis ranged from 30-92 years (median = 68 years). The oropharynx was the most commonly affected site (40.5%), followed by the cervical lymph nodes (33.3%). The most common histopathologic sub-type was DLBCL (71.9%), followed by follicular lymphoma (11.1%), and extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (9.2%).
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Affiliation(s)
- Sakurako Takano
- a Department of Otolaryngology and Head & Neck Surgery, Osaka City University Graduate School of Medicine , Osaka, Japan
| | - Naoki Matsushita
- a Department of Otolaryngology and Head & Neck Surgery, Osaka City University Graduate School of Medicine , Osaka, Japan
| | - Masahiro Oishi
- a Department of Otolaryngology and Head & Neck Surgery, Osaka City University Graduate School of Medicine , Osaka, Japan
| | - Sachimi Okamoto
- a Department of Otolaryngology and Head & Neck Surgery, Osaka City University Graduate School of Medicine , Osaka, Japan
| | - Yuichi Teranishi
- a Department of Otolaryngology and Head & Neck Surgery, Osaka City University Graduate School of Medicine , Osaka, Japan
| | - Chieko Yokota
- a Department of Otolaryngology and Head & Neck Surgery, Osaka City University Graduate School of Medicine , Osaka, Japan
| | - Hiroyoshi Iguchi
- a Department of Otolaryngology and Head & Neck Surgery, Osaka City University Graduate School of Medicine , Osaka, Japan
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Abstract
We report, to our knowledge, the first cases of sonographic and real-time elastographic findings of cervical lymph nodes in patients with Kikuchi disease. Cervical lymph nodes had probably benign findings on grayscale sonography and real-time elastography.
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Affiliation(s)
- Kwang Hwi Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - JiHwa Ryu
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
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Xu D, Xu HM, Li MK, Chen LY, Wang LJ. Feasibility of fine-needle aspiration biopsy and its applications in superficial cervical lesion biopsies. Int J Clin Exp Pathol 2014; 7:5165-5170. [PMID: 25197391 PMCID: PMC4152081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/15/2014] [Indexed: 06/03/2023]
Abstract
The aim of the study was to investigate the feasibility and value of clinical application of fine-needle aspiration histological biopsy via ultrasound-guided thyroid nodule and enlarged cervical lymph node fine-needle aspiration histological biopsy. Fine-needle aspiration cytological and histological biopsies and surgical treatments were performed on 982 patients with thyroid nodule and 1435 patients with enlarged cervical lymph nodes. A comparative study of the histological and cytological examination results and post-surgical etiology results was subsequently conducted. Among the 982 thyroid nodule patients, the acquisition rates were 89.8% (882/982) for fine-needle aspiration histological biopsy and 96.2% (945/982) for cytological biopsy, while among the 1435 patients with enlarged cervical lymph nodes, the acquisition rate for fine-needle aspiration cytological biopsy was slightly higher than that for histological biopsy, with values of 95.7% (1374/1435) and 91.4% (1312/1435), respectively. For the thyroid nodule patients, when the acquired histological and cytological biopsy results were compared with the post-surgical etiology results, the sensitivity, specificity, and accuracy of the histological results were 98.5%, 100%, and 98.9%, respectively, whereas those of the cytological results were 86.8%, 82.9%, and 85.6%, respectively; the differences between the 2 biopsy methods were statistically significant (P < 0.05). For the patients with enlarged cervical lymph nodes, when the acquired histological and cytological biopsy results were compared with the post-surgical etiology results, the sensitivity, specificity, and accuracy of the histological results were 96.3%, 99.8%, and 97.6%, respectively, whereas the those of the cytological results were 76.8%, 92.1%, and 82.2%, respectively; again, the differences between the 2 methods were statistically significant (P < 0.05). In conclusion, Fine-needle aspiration histological biopsy is a reliable and highly accurate examination method. It is simple and feasible, thus facilitating the discrimination of malignant and benign thyroid nodules and enlarged cervical lymph nodes and playing an important role in the establishment of reasonable clinical therapeutic regimens.
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Affiliation(s)
- Dong Xu
- Department of Ultrasound, Zhejiang Cancer HospitalHangzhou, China
| | - Hai-Miao Xu
- Department of Pathology, Zhejiang Cancer HospitalHangzhou, China
| | - Ming-Kui Li
- Department of Ultrasound, Zhejiang Xiaoshan HospitalHangzhou, China
| | - Li-Yu Chen
- Department of Ultrasound, Zhejiang Cancer HospitalHangzhou, China
| | - Li-Jing Wang
- Department of Ultrasound, Zhejiang Cancer HospitalHangzhou, China
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Windfuhr JP. Malpractice claims and unintentional outcome of tonsil surgery and other standard procedures in otorhinolaryngology. GMS Curr Top Otorhinolaryngol Head Neck Surg 2013; 12:Doc08. [PMID: 24403976 PMCID: PMC3884543 DOI: 10.3205/cto000100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Septoplasty, tonsillectomy (with and without adenoidectomy) and cervical lymph node excision are amongst the most common 50 inpatient operations in Germany. Intracapsular tonsillectomies (i.e. tonsillotomies) are increasingly performed. The aim of this study was to evaluate technical traps and pitfalls as well as alleged medical malpractice associated with tonsillectomy (TE), adenoidectomy (AE), tonsillotomy (TT), septoplasty (SP) and cervical lymph node excision (LN). METHODS A questionnaire was sent to the Regional Medical Conciliation Boards, Medical Services of the Health Insurance Companies (MDK) and Regional Institutes of Forensic Medicine in Germany to collect anonymized cases of complications following TE, TT, AE, LN and SP. The results were discussed in the light of the contemporary medical literature and published trials and verdicts in Germany. RESULTS The response rate of our survey was 55.9%. The Institutes of Forensic Medicine contributed nine cases, 49 cases were submitted by the Regional Conciliation Boards and none by MDK. All forensic cases were associated with exsanguinations following tonsillectomy including two children (5 and 8 years of age) and seven adults (aged 20 to 69 years). The fatal post-tonsillectomy hemorrhage (PTH) had occurred 8.7 days on average; four patients experienced the bleeding episode at home (day 5, 8, 9 and 17, respectively). Repeated episodes of bleeding requiring surgical intervention had occurred in 6 patients. Three Conciliation Boards submitted decicions associated with TT (1), AE (4), LN (3), SP (16) and TE (25). Cases with lethal outcome were not registered. Only three of the 49 cases were assessed as surgical malpractice (6.1%) including lesion of the spinal accessory nerve, wrong indication for TE and dental lesion after insertion of the mouth gag. The review of the medico legal literature yielded 71 published verdicts after AE and TE (29), LN (28) and SP (14) of which 37 resulted in compensation of malpractice after LN (16; 57%), TE (10; 37%), SP (8; 57%) and AE (2; 100%). There were 16 cases of PTH amongst 27 trials after TE resulting either in death (5) or apallic syndrome (5). Bleeding complications had occurred on the day of surgery in only 2 patients. 16 trials were based on malpractice claims following SP encompassing lack of informed consent (6), anosmia (4), septal perforation (2), frontobasal injury (2) and dry nose (2). Trials after LN procedures were associated exclusively with a lesion of the spinal accessory nerve (28), including lack of informed consent in 19 cases. 49 cases (69%) were decided for the defendant, 22 (31%) were decided for the plaintiff with monetary compensation in 7 of 29 AE/TE-trials, 9 of 28 LN-trials and 6 of 14 SP-trials. Lack of informed consent was not registered for AE/TE but LN (11) and SP (2). CONCLUSION Complicated cases following TE, TT, ATE, SP and LN are not systematically collected in Germany. It can be assumed, that not every complicated case is published in the medical literature or law journals and therefore not obtainable for scientific research. Alleged medical malpracice is proven for less than 6% before trial stage. Approximately half of all cases result in a plaintiff verdict or settlement at court. Proper documentation of a thourough counselling, examination, indication, informed consent and follow-up assists the surgeon in litigation. An adequate complication management of PTH is essential, including instructions for the patients/parents, instructions for the medical staff and readily available surgical instruments. Successful outcome of life-threatening PTH is widely based on a proper airway management in an interdisciplinary approach. Electrosurgical tonsillectomy techniques were repeatedly labeled as a risk factor for bleeding complications following TE. Institutions should analyse the individual PTH rate on a yearly basis. Contradictory expert opinions and verdicts of the courts concerning spinal accesory nerve lesions following LN are due to a lack of a surgical standard.
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Affiliation(s)
- Jochen P. Windfuhr
- Department of Otorhinolaryngology, Plastic Head and Neck Surgery, Kliniken Maria Hilf, Mönchengladbach, Germany
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Tuncer E, Onal B, Simsek G, Elagoz S, Sahpaz A, Kilic S, Altuntas EE, Ulu Kilic A. Tularemia: potential role of cytopathology in differential diagnosis of cervical lymphadenitis: multicenter experience in 53 cases and literature review. APMIS 2013; 122:236-42. [PMID: 23763361 DOI: 10.1111/apm.12132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 04/18/2013] [Indexed: 11/27/2022]
Abstract
Tularemia is a zoonosis caused by Francisella tularensis. Tularemia outbreaks occurred in Central Anatolia during 2009 and 2011. We evaluated the clinical characteristics and cytomorphologies of fine needle aspirations (FNAs) from cervical lymph nodes in serologically confirmed tularemia cases. To our knowledge, this is the first large series concerning FNA morphology of Tularemia. FNA smears of 53 patients of the 290, diagnosed by microagglutination tests and PCR, were evaluated at three Pathology centers. FNAs were performed by cytopathologists or ear-nose-throat surgeons. Of all patients, 17 had also lymph node resections. FNAs showed the presence of suppuration and abscess. Rare epithelioid histiocytes and granulomas, seldom phagocytosed bacilli-like microorganisms were observed. On histopathology; granulomas, necrosis, and suppurative inflammation extending extracapsular areas were seen. Tularemia is endemic in certain areas of the Northern Hemisphere. The benefit from cytopathology is limited and cytological suspicion should be confirmed by serology. However FNA cytology is helpful in differential diagnosis of tularemia and other diseases presented with suppurative, granulomatous cervical lymphadenitis. It is also useful in providing the material for PCR and culture in early phase when the serology is negative and the treatment is more effective.
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Affiliation(s)
- Ersin Tuncer
- Pathology Department, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
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Mulla M, Schulte KM. Terminology inaccuracies in the interpretation of imaging results in detection of cervical lymph node metastases in papillary thyroid cancer. Endocr Connect 2012; 1:78-86. [PMID: 23781308 PMCID: PMC3681322 DOI: 10.1530/ec-12-0050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 09/04/2012] [Indexed: 11/26/2022]
Abstract
UNLABELLED Cervical lymph nodes (CLNs) are the most common site of metastases in papillary thyroid cancer (PTC). Ultrasound scan (US) is the most commonly used imaging modality in the evaluation of CLNs in PTC. Computerised tomography (CT) and (18)fluorodeoxyglucose positron emission tomography ((18)FDG PET-CT) are used less commonly. It is widely believed that the above imaging techniques should guide the surgical approach to the patient with PTC. METHODS We performed a systematic review of imaging studies from the literature assessing the usefulness for the detection of metastatic CLNs in PTC. We evaluated the author's interpretation of their numeric findings specifically with regard to 'sensitivity' and 'negative predictive value' (NPV) by comparing their use against standard definitions of these terms in probabilistic statistics. RESULTS A total of 16 studies used probabilistic terms to describe the value of US for the detection of LN metastases. Only 6 (37.5%) calculated sensitivity and NPV correctly. For CT, out of the eight studies, only 1 (12.5%) used correct terms to describe analytical results. One study looked at magnetic resonance imaging, while three assessed (18)FDG PET-CT, none of which provided correct calculations for sensitivity and NPV. CONCLUSION Imaging provides high specificity for the detection of cervical metastases of PTC. However, sensitivity and NPV are low. The majority of studies reporting on a high sensitivity have not used key terms according to standard definitions of probabilistic statistics. Against common opinion, there is no current evidence that failure to find LN metastases on ultrasound or cross-sectional imaging can be used to guide surgical decision making.
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Affiliation(s)
- Mubashir Mulla
- Department of Endocrine SurgeryKing's College HospitalDenmark Hill, London, SE5 9RSUK
- King's College LondonLondonUK
| | - Klaus-Martin Schulte
- Department of Endocrine SurgeryKing's College HospitalDenmark Hill, London, SE5 9RSUK
- King's College LondonLondonUK
- King's Health PartnersLondonUK
- Correspondence should be addressed to M Mulla Email
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Abstract
Using a sensitive infant mouse bioassay to detect infectious virus, the pattern of mouse hepatitis virus (MHV) JHM dissemination in blood and other tissues was examined during the first 5 days following intranasal inoculation. MHV replicated in nasal turbinates of both susceptible BALB and resistant SJL mice from days 1 through 5, but BALB mice had higher titers on days 1 and 2. Viremia was detectable on days 1 through 5 in BALB mice, but only on days 3 and 5 in SJL mice. Transient virus replication occurred in the lungs of both mouse genotypes at 1 and 2 days, then ceased. This correlated with more consistently demonstrable virus in blood collected from the left atrium of the heart, compared to jugular vein, portal vein and right atrial blood. Virus was associated equally with the plasma and cellular fractions of blood on day 3, but was primarily in the buffy coat of the cellular fraction on day 5. Interferon-alpha/beta was detected in serum and spleen, but not liver or brain of BALB mice or in any tissue of SJL mice. BALB serum and spleen interferon was first detected at 36 h, peaked between 48 and 72 h, and was undetectable by 108 h. The distribution of virus in nose, cervical, axillary and mesenteric lymph nodes, spleen, Peyer's patch, thymus, bone marrow and liver was examined at 1, 2, and 3 days. The resulting pattern suggested lymphatic spread of virus to cervical lymph node and mesenteric lymph node as pathways of dissemination in addition to viremia.
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Affiliation(s)
- S W Barthold
- Section of Comparative Medicine, Yale University School of Medicine, New Haven, Connecticut
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