Metastatic lymph nodes and prognosis assessed by the number of retrieved lymph nodes in gastric cancer

BACKGROUND The prognostic value of quantitative assessments of the number of retrieved lymph nodes(RLNs)in gastric cancer(GC)patients needs further study.AIM To discuss how to obtain a more accurate count of metastatic lymph nodes(MLNs)based on RLNs in different pT stages and then to evaluate patient prognosis.METHODS This study retrospectively analyzed patients who underwent GC radical surgery and D2/D2+LN dissection at the Cancer Hospital of Harbin Medical University from January 2011 to May 2017.Locally weighted smoothing was used to analyze the relationship between RLNs and the number of MLNs.Restricted cubic splines were used to analyze the relationship between RLNs and hazard ratios(HRs),and X-tile was used to determine the optimal cutoff value for RLNs.Patient survival was analyzed with the Kaplan-Meier method and log-rank test.Finally,HRs and 95%confidence intervals were calculated using Cox proportional hazards models to analyze independent risk factors associated with patient outcomes.RESULTS A total of 4968 patients were included in the training cohort,and 11154 patients were included in the validation cohort.The smooth curve showed that the number of MLNs increased with an increasing number of RLNs,and a nonlinear relationship between RLNs and HRs was observed.X-tile analysis showed that the optimal number of RLNs for pT1-pT4 stage GC patients was 26,31,39,and 45,respectively.A greater number of RLNs can reduce the risk of death in patients with pT1,pT2,and pT4 stage cancers but may not reduce the risk of death in patients with pT3 stage cancer.Multivariate analysis showed that RLNs were an independent risk factor associated with the prognosis of patients with pT1-pT4 stage cancer(P=0.044,P=0.037,P=0.003,P<0.001).CONCLUSION A greater number of RLNs may not benefit the survival of patients with pT3 stage disease but can benefit the survival of patients with pT1,pT2,and pT4 stage disease.For the pT1,pT2,and pT4 stages,it is recommended to retrieve 26,31 and 45 LNs,respectively.

Application value of multi-slice spiral computed tomography for imaging determination of metastatic lymph nodes of gastric cancer

AIM:To evaluate the application value of multi-slice spiral computed tomography(MSCT)for imaging determination of metastatic lymph nodes of gastric cancer and to explore reasonable diagnostic criteria.METHODS:Sixty patients with gastric cancer underwent 64 MSCT scans before operation.Gastric cancer samples and perigastric lymph nodes were obtained after operation,formalin fixation and haematoxylineosin staining.The metastatic conditions of gastric cancer and perigastric lymph nodes were determined under a light microscope.A total of 605 lymph nodes were grouped and assessed according to distribution,size,shape and degree of lymph node enhancement.Then,the findings were compared with the postoperative pathological results.RESULTS:Among 605 lymph nodes,358 were confirmed as metastatic,accounting for 59.2%.A total of535 lymph nodes were detected in original axis images combined with multiplanar reconstruction images of MSCT.The metastatic lymph nodes had specific signs in computed tomography.This study showed that the long diameter of lymph nodes≥8 mm indicated metastasis;the sensitivity and specificity were 79.6%and78.8%,respectively.The difference of the mean value of lymph node enhancement density≥80 Hu indicated metastasis;the sensitivity and specificity were81.6%and 75.6%,respectively.The ratio of short diameter to long diameter of lymph nodes≥0.7 indicated metastasis;the sensitivity and specificity were85.6%and 71.8%,respectively.CONCLUSION:MSCT is a non-invasive and reliable method for preoperative examination of gastric cancer.Sensitivity and specificity for prediction of lymph node metastasis are high.

Histological evaluation for chemotherapeutic responses of metastatic lymph nodes in gastric cancer

AIM: To investigate the effect of preoperative chemotherapy(pre-CTx) for metastatic lymph nodes(MLNs) of gastric cancer(GC). METHODS: A retrospective cohort of patients with advanced GC, who underwent pre-CTx followed by gastrectomy, was reviewed. The histological tumor regression grade(TRG), which considered the percentage of residual cancer in the visible tumor bed, was applied to primary tumors and individual MLNs: G1a(complete response), G1b(< 10%), G2(10%-50%) and G3(> 50%). The clinical response to pre-CTx was retrospectively evaluated using only MLNs information, and we compared the histological and clinical evaluations of MLNs.RESULTS: Twenty-eight patients were enrolled. A total of 438 MLNs were retrieved, and 22(5%), 48(11%), 63(14%) and 305(70%) LNs were assigned as G1 a, G1 b, G2 and G3, respectively. Stratification of the residual MLNs based on the TRGs was as follows: 28 G1 b MLNs(9%), 48 G2 MLNs(15%), and 253 G3 MLNs(76%) in the D1 region; 20(23%), 15(17%), and 52(60%) in the D2 region, respectively. However, no significant correlation was found between TRGs in MLNs and clinical response in the subgroup for which evaluation of clinical response was available.CONCLUSION: Pre-CTx does not provide any outstanding histological benefit for MLNs, and an appropriate D2 lymphadenectomy should routinely be performed to offer the chance of curative resection.

Targeted delivery of docetaxel to the metastatic lymph nodes:A comparison study between nanoliposomes and activated carbon nanoparticles

The objective of this study is to compare the targeting ability of activated carbon nanoparticles and nanoliposomes,which are used as carriers for delivering docetaxel(DTX)to the metastatic lymph nodes.In this study,we first prepared the DTX-loaded activated carbon nanoparticles(DTX-AC-NPs)by modifying the activated carbon with nitric acid oxidation and absorbing DTX in the concentrated nitro-oxide nanocarbon.We then prepared DTX-loaded nanoliposomes(DTX-LPs)by the proliposome method.The physiochemical properties of DTX-AC-NPs and DTX-LPs were carefully evaluated in vitro.The metastatic lymph node uptake and the injection site retention were investigated by analyzing the DTX concentration in metastatic lymph nodes and injection sites.The result showed that DTX-AC-NPs and DTX-LPs with suitable and stable physicochemical properties could be used for in vivo lymph node targeting studies.DTX-AC-NPs significantly increased DTX-AUC_((0-24)) and prolonged DTX-retention in metastatic lymph nodes compared to DTX-LPs and non-modified activate carbon in vivo.This study demonstrated activated carbon nanoparticles may be potential intralymphatic drug delivery system to preferentially target regional metastatic lymph nodes.

Deep neural network-assisted computed tomography diagnosis of metastatic lymph nodes from gastric cancer

Background:Artificial intelligence-assisted image recognition technology is currently able to detect the target area of an image and fetch information to make classifications according to target features.This study aimed to use deep neural netAVorks for computed tomography(CT)diagnosis of perigastric metastatic lymph nodes(PGMLNs)to simulate the recognition of lymph nodes by radiologists,and to acquire more accurate identification results.Methods:A total of 1371 images of suspected lymph node metastasis from enhanced abdominal CT scans were identified and labeled by radiologists and were used with 18,780 original images for faster region-based convolutional neural networks(FR-CNN)deep learning.The identification results of 6000 random CT images from 100 gastric cancer patients by the FR-CNN were compared with results obtained from radiologists in terms of their identification accuracy.Similarly,1004 CT images with metastatic lymph nodes that had been post-operatively confirmed by pathological examination and 11,340 original images were used in the identification and learning processes described above.The same 6000 gastric cancer CT images were used for the verification,according to which the diagnosis results were analyzed.Results:In the initial group,precision-recall curves were generated based on the precision rates,the recall rates of nodule classes of the training set and the validation set;the mean average precision(mAP)value was 0.5019.To verify the results of the initial learning group,the receiver operating characteristic curves was generated,and the corresponding area under the curve(AUC)value was calculated as 0.8995.After the second phase of precise learning,all the indicators were improved,and the mAP and AUC values were 0.7801 and 0.9541,respectively.Conclusion:Through deep learning,FR-CNN achieved high judgment effectiveness and recognition accuracy for CT diagnosis of PGMLNs.

Differential diagnosis of metastasis from non-metastatic lymph nodes in cervical cancers： pilot study of diffusion weighted imaging with background suppression at 3T magnetic resonance

Background Diffusion weighted imaging with background suppression （DWIBS） is potentially useful in detecting metastatic lymph nodes. This study aimed to evaluate the efficacy of DWIBS at 3T magnetic resonance （MR） for diagnosing metastatic lymph nodes in cervical cancer.Methods This retrospective study included 25 patients with cervical cancer who underwent MR examination and were treated by hysterectomy and lymphadenectomy. The metastatic and non-metastatic lymph nodes were histologically proven by operation. Apparent diffusion coefficient （ADC） values, long-axis diameters, short-axis diameters, ratio of short- to long-axis diameters of all the identifiable lymph nodes were measured and compared.Results Twenty-five primary tumor lesions, 17 metastatic lymph nodes and 140 non-metastatic lymph nodes were pathologically confirmed in 25 cases with cervical cancer. The difference of ADC values between primary tumor lesions,metastatic and non-metastatic lymph nodes were statistically significant （F=7.93, P=0.001）. There was no statistically significant difference between primary tumor lesions of cervical cancer and metastatic lymph nodes （t=-0.75, P=-0.456）,and the difference between primary tumor lesions and non-metastatic lymph nodes was statistically significant （t =4.68, P〈0.001）. The ADC values, long-axis diameters, short-axis diameters, ratio of short- to long-axis diameters of metastatic and non-metastatic lymph nodes were （0.86±0.36）×10-3 mm2/s vs. （1.12±0.34）×10-3 mm2/s, （1.51±0.41） cm vs.（1.19±0.36） cm, （1.16±0.35） cm vs. （0.77±0.22） cm, 0.78±0.17 vs. 0.68±0.19 respectively, and statistically significant difference existed between two groups.Conclusions DWIBS at 3T MR has the distinct advantages in detecting pelvic lymph nodes of cervical cancer.Quantitative measurement of ADC values could reflect the degree of restriction of diffusion of metastatic and non-metastatic lymph nodes. The combination of size and ADC value would be useful in the accurate diagnosis of metastatic lymph nodes.

Retrieved lymph nodes from different anatomic groups in gastric cancer:a proposed optimal number,comparison with other nodal classification strategies and its impact on prognosis

Background:The optimal number of retrieved lymph nodes(LNs)in gastric cancer(GC)is still debatable and previ-ous studies proposing new classification alternatives mostly focused on the number of retrieved LNs without proper consideration on the anatomic nodal groups’location.Here,we assessed the impact of retrieved LNs from different nodal location groups on the survival of GC patients.Methods:Stage I-III gastric cancer patients who had radical gastrectomy were investigated.LN grouping was deter-mined according to the 13th edition of the JCGC.The optimal cut-off values of retrieved LNs in different LN groups(Group 1 and 2)were calculated,based on which a proposed nodal classification(rN)simultaneously accounting the optimal number and location of retrieved LNs was proposed.The performance of rN was then compared to that of LN ratio,log-odds of metastatic LNs(LODDs)and the 8th edition of the Union for International Cancer Control/American Joint Committee on Cancer(UICC/AJCC)N classification.Results:The optimal cut-off values for Group 1 and 2 were 13 and 9,respectively.The 5-year overall survival(OS)was higher for patients in retrieved Group 1 LNs>13(vs.Group 1 LNs≤13,63.2%vs.57.9%,P=0.005)and retrieved Group 2 LNs>9(vs.Group 2 LNs≤9,72.5%vs.60.7%,P=0.009).Patients staged as pN0-3b were sub classified using this Group 1 and 2 nodal analogy.The OS of pN0-N2 patients in retrieved Group 1 LNs>13 or Group 2 LNs>9 were superior to those in retrieved Group 1 LNs≤13 and Group 2 LNs≤9(All P<0.05);except for pN3 patients.The rN clas-sification was formulated and demonstrated better 5-year OS prognostication performance as compared to the LNR,LODDs,and the 8th UICC/AJCC N staging system.Conclusions:The retrieval of>13 and>9 LNs for Group 1 and Group 2,respectively,could represent an alternative lymph node retrieval approach in radical gastrectomy for more precise survival prognostication and minimizing staging migration,especially if>16 LNs is found to be difficult.

Prognostic impact of metastatic lymph node ratio on gastric cancer after curative distal gastrectomy

AIM:To investigate the prognostic impact of metastatic lymph node ratio(rN) on gastric cancer after curative distal gastrectomy.METHODS:A total of 634 gastric cancer patients who underwent curative resection(R0) of lymph nodes at distal gastrectomy in 1995-2004.Correlations between positive nodes and retrieved nodes,between rN and retrieved nodes,and between rN and negative lymph node(LN) count were analyzed respectively.Prognostic factors were identif ied by univariate and multivariate analyses.Staging accuracy of the pN category(5th UICC/TNM system) and the rN category was compared according to the survival rates of patients.A linear regression model was used to identify the relation between rN and 5-year survival rate of the patients.RESULTS:The number of dissected LNs was related with metastatic LNs but not related with rN.Cox regression analysis showed that depth of invasion,pN and rN category were the independent predictors of survival(P < 0.05).There was a signif icant difference in survival between LN stages classif ied by the rN category or by the pN category(P < 0.05).However,no signif icant difference was found in survival rate between LN stages classif ied by the pN category or by the rN category(P > 0.05).Linear regression model showed a signif icant linear correlation between rN and the 5-year survival rate of gastric cancer patients(β = 0.862,P < 0.001).Pearson's correlation test revealed that negative LN count was negatively correlated with rN(P < 0.001).CONCLUSION:rN category is a better prognostic tool than the 5th UICC pN category for gastric cancer patients after curative distal gastrectomy.Increased negative LN count can reduce rN and improve the survival rate of gastric cancer patients.

Prognostic assessment of different metastatic lymph node staging methods for gastric cancer after D2 resection

AIM: To compare the prognostic assessment of lymph node ratio and absolute number based staging system for gastric cancer after D2 resection. METHODS: The clinical, pathologic, and long-term follow-up data of 427 patients with gastric cancer that underwent D2 curative gastrectomy were retrospectively analyzed. The relationships between the metastatic lymph node ratio (MLR), log odds of positive lymph nodes (LODDS), and positive lymph nodes (pN) staging methods and the long-term prognoses of the patients were compared. In addition, the survival curves, accuracy, and homogeneity were compared with stratification to evaluate the prognostic assessment of the 3 methods when the number of tested lymph nodes was insufficient (< 10 and 10-15). RESULTS: MLR [hazard ratio (HR) = 1.401, P = 0.012], LODDS (HR = 1.012,P = 0.034), and pN (HR = 1.376, P = 0.005) were independent risk factors for gastric cancer patients. The receiver operating characteristic (ROC) curves showed that the prognostic accuracy of the 3 methods was comparable (P > 0.05). Spearman correlation analysis confirmed that MLR, LODDS, and pN were all positively correlated with the total number of tested lymph nodes. When the number of tested lymph node was < 10, the value of survival curves staged by MLR and LODDS was superior to those of pN staging. However, the difference in survival curves between adjacent stages was not significant. In addition, the survival rate of stage 4 patients using the MLR and LODDS staging methods was 26.7% and 27.3% with < 10 lymph node, respectively which were significantly higher than the survival rate of patients with > 15 tested lymph nodes (< 4%). The ROC curve showed that the accuracy of the prognostic assessment of MLR, LODDS, and pN staging methods was comparable (P > 0.05), and the area under the ROC curve of all 3 methods were increased progressively with the enhanced levels of examined lymph nodes. In addition, the homogeneity of the 3 methods in patients with ≤ 15 tested lymph nodes also showed no significant difference. CONCLUSION: Neither MLR or LODDS could reduce the staging bias. A sufficient number of tested lymph nodes is key to ensure an accurate prognosis for patients underwent D2 radical gastrectomy.

Superiority of metastatic lymph node ratio to the 7th edition UICC N staging in gastric cancer

AIM:To compare and evaluate the appropriate prog-nostic indicators of lymph node basic staging in gastric cancer patients who underwent radical resection.METHODS:A total of 1042 gastric cancer patients who underwent radical resection and D2 lymphadenectomy were staged using the 6th and 7th edition International Union Against Cancer(UICC)N staging methods and the metastatic lymph node ratio(MLNR)staging.Ho-mogeneity,discriminatory ability,and gradient mono-tonicity of the various staging methods were compared using linear trend χ2,likelihood ratio χ2 statistics,and Akaike information criterion(AIC)calculations.The area under the curve(AUC)was calculated to compare the predictive ability of the aforementioned three stag-ing methods.RESULTS:Optimal cut-points of the MLNR were cal-culated as MLNR0(0),MLNR1(0.01-0.30),MLNR2(0.31-0.50),and MLNR3(0.51-1.00).In univariate,multivariate,and stratified analyses,MLNR staging was superior to the 6th and 7th edition UICC N stag-ing methods.MLNR staging had a higher AUC,higher linear trend and likelihood ratio χ2 scores and lower AIC values than the other two staging methods.CONCLUSION:MLNR staging predicts survival after gastric cancer more precisely than the 6th and 7th edi-tion UICC N classif ications and should be considered as an alternative to current pathological N staging.

Distribution of solitary Iymph nodes in primary gastric cancer:A retrospective study and clinical implications

AIM： To investigate the distribution pathway of metastatic lymph nodes in gastric carcinoma as a foundation for rational lymphadenectomy. METHODS： We investigated 173 cases with solitary or single station metastatic lymph nodes （LN） from among 2476 gastric carcinoma patients. The location of metastatic LN, histological type and growth patterns were analyzed retrospectively. RESULTS： Of 88 solitary node metastases cases, 65 were limited to perigastric nodes （N1）, while 23 showed skipping metastasis. Among 8 tumors in the upper third stomach, 3 involved right paracardial LN （station number： No.1）, and one in the greater curvature was found in No.1. In the 28 middle third stomach tumors, 10 were found in LN of the lesser curvature （No.3） and 6 in LN of the left gastric artery （No.7）; 5 of the 20 cases on the lesser curvature spread to No.7, while 2 of the 8 on the greater curvature metastasized to LN of the spleen hilum （No.10）. Of 52 lower third stomach tumors, 13 involved in No.3 and 19 were detected in inferior pyloric LN （No.6）; 9 of the 29 cases along the lesser curvature were involved in No.6. CONCLUSION： Transversal and skipping metastases of sentinel lymph nodes （SLN） are notable, and rational lymphadenectomy should, therefore, be performed.

Prognostic impact of metastatic lymph node ratio in advanced gastric cancer from cardia and fundus

AIM: To investigate the prognostic impact of the metastatic lymph node ratio (MLR) in advanced gastric cancer from the cardia and fundus. METHODS: Two hundred and thirty-six patients with gastric cancer from the cardia and fundus who underwent D2 curative resection were analyzed ret- rospectively. The correlations between MLR and the total lymph nodes, positive nodes and the total lymph nodes were analyzed respectively. The influence of MLR on the survival time of patients was determined with univariate Kaplan-Meier survival analysis and mul- tivariate Cox proportional hazard model analysis. And the multiple linear regression was used to identify the relation between MLR and the 5-year survival rate of the patients. RESULTS: The MLR did not correlate with the total lymph nodes resected (r = -0.093, P = 0.057). The 5-year overall survival rate of the whole cohort was 37.5%. Kaplan-Meier survival analysis identified that the following eight factors influenced the survival time of the patients postoperatively: gender (χ2 = 4.26, P = 0.0389), tumor size (χ2 = 18.48, P < 0.001), Borrmann type (χ2 = 7.41, P = 0.0065), histological grade (χ2 = 5.07, P = 0.0243), pT category (χ2 = 49.42, P < 0.001), pN category (χ2 = 87.7, P < 0.001), total number of re- trieved lymph nodes (χ2 = 8.22, P = 0.0042) and MLR (χ2 = 34.3, P < 0.001). Cox proportional hazard model showed that tumor size (χ2 = 7.985, P = 0.018), pTcategory (χ2 = 30.82, P < 0.001) and MLR (χ2 = 69.39, P < 0.001) independently influenced the prognosis. A linear correlation between MLR and the 5-year survival was statistically significant based on the multiple lin- ear regression (β = -0.63, P < 0.001). Hypothetically, the 5-year survival would surpass 50% when MLR was lower than 10%. CONCLUSION: The MLR is an independent prognostic factor for patients with advanced gastric cancer from the cardia and fundus. The decrease of MLR due to adequate number of total resected lymph nodes can improve the survival.

Metastatic recurrence to a solitary lymph node four years after hepatic lobectomy for primary hepatocellular carcinoma

This report describes a patient that developed recurrent metastatic hepatocellular carcinoma(HCC) to a suprapancreatic lymph node four years after being treated for primary HCC via complete left hepatectomy. Metastatic HCC was proven by pathologic confirmation. The report addresses the role of surgical resection as a treatment modality for recurrent HCC to solitary lymph nodes. The role of biological chemotherapy as adjuvant treatment is also addressed.

Correlation between metastatic lymph node ratio and prognosis in patients with extrahepatic cholangiocarcinoma

AIM: To investigate the prognostic value of metastaticlymph node ratio(MLNR) in extrahepatic cholangiocarcinoma(ECC) patients undergoing radical resection.METHODS: Seventy-eight patients with ECC were enrolled.Associations between various clinicopathologic factors and prognosis were investigated by KaplanMeier analyses.The Cox proportional-hazards model was used for multivariate survival analysis.RESULTS: The overall three- and five-year survival rates were 47.26% and 23.99%, respectively.MLNR of 0, 0-0.2, 0.2-0.5, and > 0.5 corresponded to fiveyear survival rates of 28.59%, 21.60%, 18.84%, and 10.03%, respectively.Univariate analysis showed that degree of tumor differentiation, lymph node metastasis, MLNR, tumor-node-metastasis(TNM) stage, and margin status were closely associated with postoperative survival in ECC patients(P < 0.05).Multivariate analysis showed that MLNR and TNM stage were independent prognostic factors after pancreaticoduodenectomy(HR = 2.13, 95%CI: 1.45-3.11; P < 0.01; and HR = 1.97, 95%CI: 1.17-3.31; P = 0.01, respectively).The median survival time for MLNR > 0.5, 0.2-0.5, 0-0.2, and 0 was 15 mo, 24 mo, 23 mo, and 35.5 mo, respectively.There were statistical differences in survival time between patients with different MLNR(χ2 = 15.38; P < 0.01).CONCLUSION: MLNR is an independent prognostic factor for ECC patients after radical resection and is useful for predicting postoperative survival.

A clinical analysis of risk factor with lymph node metastatic recurrence in patients with N0 esophageal cancer after Ivor-Lewis Esophagectomy

Objective To investigate the risk factors with lymph node metastatic recurrence in patients with N0 esophageal cancer after Ivor-Lewis Esophagectomy. Methods The subjects were 82 patients with pN0 esophagea cancer who underwent Ivor-Lewis esophagectomy from January 2001 to January 2005. By using RT-PCR,VEGF C mRNA was detected in tumor issues,and Mucin (MUC1) mRNA was detected in lymph nodes. The Kaplan-Meier method was used to calculate the survival

多排螺旋CT影像特征与多参数测量在鉴别结直肠癌肿瘤沉积与转移性淋巴结中的应用价值

目的探讨多排螺旋CT(MSCT)影像特征与多参数测量在鉴别结直肠癌(CRC)肿瘤沉积(TD)与转移性淋巴结中的应用价值。方法回顾性分析2018年1月至2022年4月湖南省直中医医院87例经病理学检查确诊的CRC病人临床资料,其中CT检查发现且病理证实的TD病灶45例为A组、转移性淋巴结42例为B组,比较两组影像特征及CT参数的差异,采用受试者操作特征(ROC)曲线分析各CT征象与参数值诊断TD的效能。结果A组形态不规则、边缘模糊、分叶征、毛刺征检出率(73.02%、60.32%、57.14%、54.84%)高于B组(29.51%、31.15%、21.31%、18.03%)(P<0.001;);A组结节长径(1.33±0.38)cm、短径(1.21±0.31)cm、最大径(1.29±0.41)cm均大于B组(0.98±0.35)cm、(0.77±0.33)cm、(0.95±0.38)cm(P<0.001);A组长-短径比(1.09±0.05)小于B组(1.28±0.18)(t=8.06,P<0.001);A组平扫CT值(28.84±5.03)、动脉期强化CT值(32.85±6.93)与静脉期强化CT值(51.36±8.94)均大于B组(16.82±4.68、19.19±5.38、39.74±7.75)(P<0.001);ROC曲线分析显示,形态不规则(AUC=0.72)、边缘模糊(AUC=0.65)、分叶征(AUC=0.68)、毛刺征(AUC=0.68)是鉴别TD与转移性淋巴结的重要因素(P<0.05);CT多参数均是鉴别TD与转移性淋巴结的重要因素,其中长-短径比(AUC=0.79)以及平扫CT值(AUC=0.82)、动脉期强化CT值(AUC=0.89)、静脉期强化CT值(AUC=0.86)诊断TD的效能较佳(均P<0.001)。通过logistic回归将形态、边缘、分叶征、毛刺征,各MSCT测量值进行计算后得出联合预测值,AUC为0.98,灵敏度为95.6%、特异度为100.0%。结论TD的CT影像特征主要表现为形态不规则、边缘模糊、分叶征、毛刺征;MSCT各项参数中长-短径比以及平扫、动脉期、静脉期强化CT值对TD具有较佳的诊断效能。

超声、磁共振成像对乳腺癌患者腋下转移性淋巴结的诊断价值

目的 探讨超声、磁共振成像对乳腺癌患者腋下转移性淋巴结的诊断价值。方法 选取2020年2月至2023年2月山东省第一荣军优抚医院收治的90例乳腺癌患者作为研究对象,经病理学检查,转移性淋巴结68例,非转移性淋巴结22例。对所有患者分别进行超声联合磁共振成像检查,比较两种类型磁共振成像检查结果、超声结果。结果 转移性淋巴结超声中以2级以上血流分级为主,血流类型主要为周边型和混合型;非转移性淋巴结超声中以1~2级血流分级为主,血流类型主要为门型和分散性。转移性淋巴结与非转移性淋巴结的Adler血流分级及血流类型比较,差异有统计学意义(P<0.05)。转移性淋巴结磁共振成像中L/S>2、皮质厚度>3 mm。转移性淋巴结磁共振成像中L/S、皮质厚度、ADC值,以及边缘不规则、脂肪间隙不清晰、高DWT、强化不均、未见淋巴门占比高于非转移性淋巴结,差异有统计学意义(P<0.05)。结论 超声、磁共振成像检查可有效诊断乳腺癌患者腋下淋巴结转移,可以依据检查方法的特点为患者选择合适的诊断方法。

结直肠癌中FOXA3的表达及其临床意义

目的探讨FOXA3在结直肠癌中的表达及其与临床病理特征的相关性。方法采用RT-qPCR法检测31例结直肠癌组织和癌旁正常组织中FOXA3 mRNA的表达水平;采用免疫组化EnVision两步法检测120例结直肠癌组织中FOXA3蛋白表达,分析FOXA3蛋白表达与淋巴结转移等临床病理特征的相关性。结果结直肠癌组织中FOXA3 mRNA表达水平明显高于癌旁正常组织(t=2.952,P=0.0061);FOXA3蛋白表达与结直肠癌患者性别、年龄、发病部位、肿瘤大小均无关,与组织分化程度(P=0.006)和淋巴结转移相关(P=0.002),FOXA3表达与组织分化程度呈负相关,与淋巴结转移呈正相关。生存分析显示,FOXA3表达水平越高,患者总生存越差(P<0.0001),FOXA3是结直肠癌患者预后的独立危险因素。结论FOXA3在结直肠癌的发生、发展中可能起促进作用,FOXA3有望成为诊断结直肠癌和预测转移及预后的生物学标志物。

能谱CT在诊断胃癌分化程度及转移淋巴结中的应用

目的探究能谱CT在诊断胃癌分化程度及转移淋巴结的应用价值。方法选取2021年1月至2023年4月新余市人民医院收治的60例经胃镜及病理学活检确诊为胃癌的患者作为研究对象,所有患者均行能谱CT检查并进行常规重建及能谱多参数、定量重建。将所有患者按分化程度分组,其中低分化组18例、中分化组23例、高分化组19例。比较不同分化程度及伴或不伴淋巴结转移胃癌患者CT影像学征象差异与能谱CT量化指标的差异。结果低分化组使用常规CT及能谱CT的局部胃壁增厚、胃腔狭窄、浆膜层毛糙检出率均高于中、高分化组(P<0.017);同组内上述各CT征象的比较,能谱CT的检出率均高于常规CT,差异有统计学意义(P<0.05)。低分化组的碘浓度、标准化碘浓度(NIC)不同能量区间的能谱曲线斜率均高于中、高分化组,且中分化组的碘浓度、NIC、不同能量区间的能谱曲线斜率均高于高分化组,差异有统计学意义(P<0.05)。能谱CT结果显示,淋巴结转移组的淋巴结长短径之比、NIC、CT平扫值[亨氏单位(HU)]均高于未淋巴结转移组,差异有统计学意义(P<0.05)。结论低分化胃癌常可见局部胃壁增厚、胃腔狭窄、浆膜层毛糙的CT征象,且不同分化程度和伴或不伴淋巴结转移患者在碘浓度、NIC等能谱CT量化指标方面均有显著差异,故能谱CT能为胃癌分化程度及是否发生转移淋巴结提供有价值的诊断。

原发肛管杯状细胞腺癌伴肛周Paget病的组织学及分子病理学研究

目的探讨原发肛管杯状细胞腺癌(GCA)伴肛周Paget病的组织学及分子病理特征。方法选取2例原发肛管GCA伴肛周Paget病患者作为研究对象,对其临床资料进行回顾性分析,并采用HE染色、免疫组化、二代测序研究其原发病灶、肛周Paget病、淋巴结转移灶的组织学和分子病理特征。结果2例患者均为肛周肿物渐进性增大入院,显微镜下具有GCA的典型组织学和免疫组化特征。其中肛管原发GCA多呈条索状和实性片巢状排列,肿瘤细胞巢周围可见大量“黏液湖”样结构,似经典黏液癌;可见单纯或复杂腺管样结构,似经典结直肠管状腺癌;部分细胞核偏位、细胞浆富含黏液样物质的肿瘤细胞呈单个散在浸润性生长,似经典“印戒细胞癌”。肛管GCA继发肛周Paget病可见大量细胞核偏位、细胞浆富含黏液的“印戒样”细胞在复层鳞状上皮内原位浸润性生长伴局灶鳞状上皮乳头瘤样增生和Pinkus纤维上皮瘤样增生。淋巴结转移癌与肛管原发病灶组织学类型相似,组织形态相对单一,肿瘤细胞间异质性较低。病例1、2各部位肿瘤组织均检出ErbB3基因突变,未检出Kras、Nras、braf基因突变,未检出肿瘤组织微卫星不稳定现象(MSI)。结论肛管GCA在组织形态、免疫表型和分子病理等方面与阑尾多发的同类肿瘤相似,具有与经典管状腺癌、黏液癌、印戒细胞癌相似的组织学结构,同时伴有神经内分泌肿瘤的组织形态及免疫表型特征。