A comparative study of dosimetric parameters of 3D-printed non-coplanar template-assisted CT-guided iodine-125 seed implantation brachytherapy in patients with inguinal lymph node metastatic carcinomas

PURPOSE

To compare the pre-plan and post-plan dosimetric parameter differences of 3D-printed non-coplanar templates (3D-PNCT)-assisted computed tomography (CT)-guided iodine-125 (125I) radioactive seed implantation brachytherapy (RISI) in patients with inguinal lymph node metastasis (ILNM).

MATERIAL AND METHODS

This was a retrospective study of 15 patients with ILNM carcinomas treated with 3D-PNCT-assisted CT-guided RISI between May, 2015 and April, 2018. All patients underwent prior external beam radiotherapy (EBRT) or surgery. Dosimetric parameters included D90, D100 (dose delivered to 90% and 100% of the volume, respectively), V100, V150, V200 (percentage of target volume receiving 100%, 150%, and 200% of the prescribed dose, respectively). Quality parameters included conformal index (CI), external index (EI), and homogeneity index (HI). Paired t-test and Bland-Altman analysis were applied to compared pre-plan and post-plan parameters.

RESULTS

The median gross tumor volume (GTV) in the pre-plan was 8.7 ml (range, 0.8-185.1 ml). There were statistically significant differences in V100, V150, CI, and EI (p < 0.05). Bland-Altman analysis indicated that accidental error of RISI was small. In 1 of the 15 cases, D90 and D100 exceeded the prescribed therapeutic accuracy. In 1 of the 15 cases, V150, EI, and GTV were outside the specified accuracy range (95% confidence interval).

CONCLUSIONS

3D-PNCT-assisted CT-guided RISI is a safe, accurate, and feasible choice in ILNM treatment. The procedure of RISI has significantly improved. The pre-plan can be accurately executed by 3D-PNCT-assisted CT-guided RISI.

18F-Fluorodeoxyglucose Positron-Emission Tomography/Computed Tomography Detected Inguinal Lymph Nodal Metastasis from Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) usually metastasizes to the regional abdominal lymph node, lungs, and bones. Nonregional lymph node involvement by HCC in the absence of regional lymph nodes is rare. We describe the ¹⁸F-fluorodeoxyglucose positron-emission tomography-computed tomography findings of an HCC patient with histopathologically proven inguinal lymph nodal metastasis in the absence of regional lymph nodal metastases.

Predictors of inguinal lymph node metastasis in penile cancer patients: a meta-analysis of retrospective studies

Purpose

Inguinal lymph node metastasis (LNM) is one of the most significant prognostic factors for patients with penile cancer. This study aimed to identify potential predictors of inguinal LNM.

Patients and methods

A comprehensive search of the PubMed, Embase, and Cochrane Library databases for studies that reported predictors of inguinal LNM in penile cancer was performed. Finally, we selected 42 eligible studies with 4,802 patients. Accumulative analyses of odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were performed. All analyses were performed by using Review Manager software version 5.3.

Results

Among the 4,802 patients, 1,706 (36%) were diagnosed with inguinal LNM. Predictors of LNM included two categories: tumor-associated biomarkers and invasive clinicopathologic characteristics. Biomarker-specific predictors: the program death ligand 1 (PD-L1) overexpression (OR=2.55, p=0.002), higher neutrophil-to-lymphocyte ratio (NLR) (OR=4.22, p=0.010), higher C-reactive protein (CRP) (OR=4.78, p<0.001), squamous cell carcinoma antigen (SCC-Ag) overexpression (OR=8.52, p<0.001), P53 protein overexpression (OR=3.57, p<0.001). Clinicopathological predictors: positive clinical lymph node (cN+) (OR=5.86, p<0.001), high-risk histopathological subtype (OR=14.63, p<0.001) and intermediate-risk subtype (OR=3.37, p<0.001), vertical growth pattern (OR=1.97, p=0.020), higher stage (AJCC: OR=3.66, p<0.001; UICC: OR=2.43, p<0.001), higher tumor grade (OR=3.37, p<0.001), tumor size (>3 cm) (OR=2.00, p=0.002), LVI (OR=3.37, p<0.001), invasion depth (>5 mm) (OR=2.58, p=0.002), nerve invasion (OR=2.84, p<0.001), corpora cavernosum invasion (OR=2.22, p<0.001), corpus spongiosum invasion (OR=1.73, p=0.002) and urethra invasion (OR=1.81, p=0.030).

Conclusion

Current meta-analysis conclusively identified valuable predictors of inguinal LNM for patients with penile cancer. However, high-quality studies are warranted to further validate our conclusions. The intrinsic link between these predictors needs to be further investigated to create an accurate mathematical prediction model for LNM.

Histological subtype is a significant predictor for inguinal lymph node metastasis in patients with penile squamous cell carcinoma

The present study aimed to investigate the relationship between histopathological subtype and the probability of inguinal lymph node metastasis (ILNM) in patients with penile squamous cell carcinoma (PSCC). The clinical records of 198 consecutive patients with PSCC were analyzed retrospectively. Primary lesions were reevaluated according to the 2016 World Health Organization (WHO) histopathological classification. We retrieved the clinicopathological factors from the medical records including age, clinical lymph node stage, pathological tumor stage, lymphatic invasion, and nerve invasion. Uni- and multivariate logistic regression analyses were used to explore the risk factors of ILNM. Multivariate analyses identified clinical lymph node stage (P = 0.000), pathological tumor stage (P = 0.016), histologic grade (P = 0.000), and risk group of histological subtypes (P = 0.029) as independent predictors for ILNM. Compared with the low-risk group of PSCC subtypes, the intermediate- (HR: 3.66, 95% CI: 1.30–10.37, P = 0.021) and high-risk groups (HR: 28.74, 95% CI: 2.37–348.54, P = 0.008) were significantly associated with ILNM. In conclusion, the histopathological subtype of the primary lesion is a significant predictor for ILNM in patients with PSCC.

Testicular and inguinal lymph node metastases of medullary thyroid cancer: a case report and review of the literature

BACKGROUND

The involvement of the testis by metastatic medullary thyroid carcinoma has never been described before. We describe the first case of metastatic medullary thyroid carcinoma affecting testis and inguinal lymph nodes.

CASE PRESENTATION

A 73-year-old Caucasian man was referred to undergo urologic surgery due to a painless nodule in the right testis and an homolateral inguinal lymphoadenomegaly. The patient had a history of medullary thyroid carcinoma with relapsing disease to the spine and lung nodules. Serum calcitonin and CEA levels were 175 pg/ml and 22 ng/ml, respectively. With suspected testicular cancer, the patient underwent radical right orchiectomy with the excision biopsy of the right inguinal lymph node. Histopathology and immunohistochemistry revealed that both the lesions were due to metastases from medullary thyroid carcinoma.

CONCLUSION

Metastases to the testis and inguinal lymph nodes may be due to various solid and hematological tumors. This case, despite its rarity, suggests that testis and inguinal lymph nodes should be considered as potential secondary sites of medullary thyroid carcinoma as well.