Deep learning-based automatic pipeline system for predicting lateral cervical lymph node metastasis in patients with papillary thyroid carcinoma using computed tomography:A multi-center study

Objective:The assessment of lateral lymph node metastasis(LLNM)in patients with papillary thyroid carcinoma(PTC)holds great significance.This study aims to develop and evaluate a deep learning-based automatic pipeline system(DLAPS)for diagnosing LLNM in PTC using computed tomography(CT).Methods:A total of 1,266 lateral lymph nodes(LLNs)from 519 PTC patients who underwent CT examinations from January 2019 to November 2022 were included and divided into training and validation set,internal test set,pooled external test set,and prospective test set.The DLAPS consists of an auto-segmentation network based on RefineNet model and a classification network based on ensemble model(ResNet,Xception,and DenseNet).The performance of the DLAPS was compared with that of manually segmented DL models,the clinical model,and Node Reporting and Data System(Node-RADS).The improvement of radiologists’diagnostic performance under the DLAPS-assisted strategy was explored.In addition,bulk RNA-sequencing was conducted based on 12 LLNs to reveal the underlying biological basis of the DLAPS.Results:The DLAPS yielded good performance with area under the receiver operating characteristic curve(AUC)of 0.872,0.910,and 0.822 in the internal,pooled external,and prospective test sets,respectively.The DLAPS significantly outperformed clinical models(AUC 0.731,P<0.001)and Node-RADS(AUC 0.602,P<0.001)in the internal test set.Moreover,the performance of the DLAPS was comparable to that of the manually segmented deep learning(DL)model with AUCs ranging 0.814−0.901 in three test sets.Furthermore,the DLAPSassisted strategy improved the performance of radiologists and enhanced inter-observer consistency.In clinical situations,the rate of unnecessary LLN dissection decreased from 33.33%to 7.32%.Furthermore,the DLAPS was associated with the cell-cell conjunction in the microenvironment.Conclusions:Using CT images from PTC patients,the DLAPS could effectively segment and classify LLNs non-invasively,and this system had a good generalization ability and clinical applicability.

Malignant proliferative ependymoma of the neck with lymph node metastasis:A case report

BACKGROUND Malignant proliferating trichilemmal tumor(MPTT)is an infrequent malignant neoplasm originating from cutaneous appendages,with only a handful of documented cases.This report delineates a unique instance of MPTT situated in the neck,accompanied by lymph node metastasis.A comprehensive exposition of its clinical trajectory and imaging manifestation is presented,aiming to enhance comprehension and management of this atypical ailment.CASE SUMMARY Patient concerns:A 79-year-old male presented with a longstanding right neck mass persisting for over six decades,exhibiting recent enlargement over the past year.Diagnoses:Enhanced magnetic resonance imaging of the neck unveiled an elliptical mass on the right neck side,characterized by an ill-defined border and a heterogeneous signal pattern.The mass exhibited subdued signal intensity on T1-weighted imaging(T1WI)and a heterogeneous high signal on T2-weighted imaging(T2WI),interspersed with a lengthy T1 and T2 cystic signal motif.Close anatomical association with the submandibular gland joint was noted,and intravenous gadolinium diethylene triamine pentaacetic acid administration facilitated conspicuous enhancement.Substantial enhancement of the solid segment prompted an initial preoperative diagnosis of malignant nerve sheath tumor.However,post-surgery histopathological and immunohistochemical analysis conclusively confirmed the diagnosis as malignant hyperplastic external hair root sheath tumor.Intervention:Complete excision of the tumor was successfully executed.Outcomes:The patient experienced a favorable postoperative recovery.CONCLUSION Malignant proliferative trichilemmal tumor external hair root sheath tumor is a cystic-solid lesion,appearing as low signal on T1WI images or high signal on T2WI with enhancement of the solid component.Suspicions of malignancy are heightened when the tumor border is indistinct,tissue planes are breached,or when linear or patchy high signals are observed in the subcutaneous tissue on T1 liver acquisition with volume acceleration enhanced images along with intermediate signal on T2WI and restricted diffusion on diffusion-weighted imaging images.Strong consideration for malignancy should arise if there are signs of compromised adjacent tissue relationships or direct invasion evident on imaging.We have incorporated the above-mentioned content into the entire manuscript.

T1 rectal mucinous adenocarcinoma with bilateral enlarged lateral lymph nodes and unilateral metastasis:A case report

BACKGROUND There are a few cases of lateral lymph node(LLN)metastasis(LLNM)of T1 rectal cancer.Moreover,LLNM is easily missed,especially in patients with early-stage rectal cancer.To our knowledge,the possibility of bilateral LLNM before surgery has not been reported in previous studies.CASE SUMMARY A 36-year-old woman underwent endoscopic submucosal dissection at a local hospital owing to a clinical diagnosis of a rectal polyp.The pathology report showed a diagnosis of T1 rectal mucinous adenocarcinoma.She was considered to have bilateral LLNM after the examination at our hospital.Laparoscopic total mesorectal excision plus bilateral LLN dissection was performed and the pathological outcomes indicated unilateral LLNM.The patient received longcourse adjuvant chemoradiotherapy with no recurrence or metastasis observed during the 1-year follow-up period.CONCLUSION T1 rectal cancer could lead to LLNM and possibly,bilateral LLNM.Therefore,adequate clinical evaluation is essential for these patients.

Predictors of occult lymph node metastasis in cutaneous head and neck melanoma

Objective:To use the Surveillance,Epidemiology,and End Results(SEER)database to verify the findings of a recent National Cancer Database(NCDB)study that identified factors predicting occult nodal involvement in cutaneous head and neck melanoma(CHNM)while identifying additional predictors of occult nodal metastasis and comparing two distinct cancer databases.Methods:Cases of CHNM in the SEER database diagnosed between 2004 and 2014 were identified.Demographic information and oncologic data were obtained.Univariate and multivariate analysis were performed to identify factors associated with pathologic nodal positivity.Results:There were 34002 patients with CHNM identified.Within this population,16232 were clinically node-negative,1090 of which were found to be pathologically node-positive.On multivariate analysis,factors associated with an increased risk of occult nodal metastasis included increasing depth of invasion(stepwise increase in adjusted odds ratio[OR]),nodular histology(aOR:1.47[95%CI:1.21-1.80]),ulceration(aOR:1.74[95%CI:1.48-2.05]),and mitoses(aOR:1.86[95%CI:1.36-2.54]).Factors associated with a decreased risk of occult nodal metastasis included female sex(aOR:0.80[0.67-0.94])and desmoplastic histology(aOR:0.37[95%CI:0.24-0.59]).Between the SEER database and the NCDB,factors associated with occult nodal involvement were similar except for nodular histology and female sex,which did not demonstrate significance in the NCDB.Conclusion:Regarding clinically node-negative CHNM,the SEER database and the NCDB have similarities in demographic information but differences in baseline population sizes and tumor characteristics that should be considered when comparing findings between the two databases.

Sentinel Lymph Node Biopsy as Guidance for Lateral Neck Dissection in Patients with Papillary Thyroid Carcinoma

Introduction: The surgical management of lateral lymph nodes in differentiated thyroid carcinoma is controversies. Therefore, we analyzed whether sentinel lymph nodes (SLN) biopsy of the first draining nodes in the jugulo-carotid chain is an accurate technique to select patients with true-positive but nonpalpable lymph nodes for selective lateral node dissection. Materials and Methods: From January 2009 to December 2009, 12 patients with solitary papillary carcinoma measuring 2 cm by ultrasonography were included in this study. After the thyroid gland was exposed to avoid injuring the lateral thyroid lymphatic connection, approximately 0.2 ml of 5mg/ml indocyanine green was injected into the parenchyma of upper and lower thyroid gland. Some stained lymph nodes in the jugulo-carotid chain could be identified following the stained lymphatic duct and dissected as the SLN. After that, thyroidectomy with modified neck dissection was performed. Results: The mean tumor size was 22.1 ± 4.6 mm. Identification and biopsy of stained SLN in the ipsilateral jugulo-carotid chain was successful in all 12 cases. In 6 cases, histopathological analysis of SLNs revealed metastases of the papillary thyroid carcinoma. Among them, 2 cases had additional metastatic lymph nodes in the ipsilateral compartment. Of the 6 patients who had negative lymph node metastasis (LNM) in SLNs, all patients had negative LNM in the ipsilateral compartment. Conclusions: The method may be helpful in the detection of true-positive but nonpalpable lymph nodes and may support a decision to perform a selective lateral node dissection in patients with papillary thyroid carcinoma.

Lateral pelvic lymph nodes for rectal cancer:A review of diagnosis and management

The current status and future prospects for diagnosis and treatment of lateral pelvic lymph node(LPLN)metastasis of rectal cancer are described in this review.Magnetic resonance imaging(MRI)is recommended for the diagnosis of LPLN metastasis.A LPLN-positive status on MRI is a strong risk factor for metastasis,and evaluation by MRI is important for deciding treatment strategy.LPLN dissection(LPLD)has an advantage of reducing recurrence in the lateral pelvis but also has a disadvantage of complications;therefore,LPLD may not be appropriate for cases that are less likely to have LPLN metastasis.Radiation therapy(RT)and chemoradiation therapy(CRT)have limited effects in cases with suspected LPLN metastasis,but a combination of preoperative CRT and LPLD may improve the treatment outcome.Thus,RT and CRT plus selective LPLD may be a rational strategy to omit unnecessary LPLD and produce a favorable treatment outcome.

Selective lateral lymph node dissection after neoadjuvant chemoradiotherapy in rectal cancer

BACKGROUND Lateral lymph node metastasis is one of the leading causes of local recurrence in patients with advanced mid or low rectal cancer.Neoadjuvant chemoradiotherapy(NCRT)can effectively reduce the postoperative recurrence rate;thus,NCRT with total mesorectal excision(TME)is the most widely accepted standard of care for rectal cancer.The addition of lateral lymph node dissection(LLND)after NCRT remains a controversial topic.AIM To investigate the surgical outcomes of TME plus LLND,and the possible risk factors for lateral lymph node metastasis after NCRT.METHODS This retrospective study reviewed 89 consecutive patients with clinical stage II-III mid or low rectal cancer who underwent TME and LLND from June 2016 to October 2018.In the NCRT group,TME plus LLND was performed in patients with short axis(SA)of the lateral lymph node greater than 5 mm.In the non-NCRT group,TME plus LLND was performed in patients with SA of the lateral lymph node greater than 10 mm.Data regarding patient demographics,clinical workup,surgical procedure,complications,and outcomes were collected.Multivariate logistic regression analysis was performed to evaluate the possible risk factors for lateral lymph node metastasis in NCRT patients.RESULTS LLN metastasis was pathologically confirmed in 35 patients(39.3%):26(41.3%)in the NCRT group and 9(34.6%)in the non-NCRT group.The most common site of metastasis was around the obturator nerve(21/35)followed by the internal iliac artery region(12/35).In the NCRT patients,46%of patients with SA of LLN greater than 7 mm were positive.The postoperative 30-d mortality rate was 0%.Two(2.2%)patients suffered from lateral local recurrence in the 2-year follow up.Multivariate analysis showed that cT4 stage(odds ratio[OR]=5.124,95%confidence interval[CI]:1.419-18.508;P=0.013),poor differentiation type(OR=4.014,95%CI:1.038-15.520;P=0.044),and SA≥7 mm(OR=7.539,95%CI:1.487-38.214;P=0.015)were statistically significant risk factors associated with LLN metastasis.CONCLUSION NCRT is not sufficient as a stand-alone therapy to eradicate LLN metastasis in lower rectal cancer patients and surgeons should consider performing selective LLND in patients with greater LLN SA diameter,poorer histological differentiation,or advanced T stage.Selective LLND for NCRT patients can have a favorable oncological outcome.

Clinical value of regional lymph node sorting in gastric cancer

BACKGROUND Increasing evidence have shown that regional lymph node metastasis is a critical prognostic factor in gastric cancer(GC).In addition,lymph node dissection is a key factor in determining the appropriate treatment for GC.However,the association between the number of positive lymph nodes and area of lymph node metastasis in GC remains unclear.AIM To investigate the clinical value of regional lymph node sorting after radical gastrectomy for GC.METHODS This study included 661 patients with GC who underwent radical gastrectomy at Tianjin Medical University General Hospital between January 2012 and June 2020.The patients were divided into regional sorting and non-sorting groups.Clinicopathological data were collected and retrospectively reviewed to determine the differences in the total number of lymph nodes and number of positive lymph nodes between the groups.Independent sample t-tests were used for intergroup comparisons.Continuous variables that did not conform to a normal distribution were expressed as median(interquartile range),and the Mann-Whitney U test was used for inter-group comparisons.RESULTS There were no significant differences between the groups in terms of the surgical method,tumor site,immersion depth,and degree of differentiation.The total number of lymph nodes was significantly higher in the regional sorting group(n=324)than in the non-sorting group(n=337)(32.5 vs 21.2,P<0.001).There was no significant difference in the number of positive lymph nodes between the two groups.A total of 212 patients with GC had lymph node metastasis in the lymph node regional sorting group,including 89(41.98%)cases in the first dissection station and 123(58.02%)cases in the second dissection station.Binary and multivariate logistic regression results showed that the number of positive lymph nodes(P<0.001)was an independent risk factor for lymph node metastases at the second dissection station.CONCLUSION Regional sorting of lymph nodes after radical gastrectomy may increase the number of detected lymph nodes,thereby improving the reliability and accuracy of lymph node staging in clinical practice.

Lymph node metastasis from non-melanoma skin cancer

The management of non-melanoma skin cancers metastatic to the neck is challenging due to variability in biological behavior and patterns of regional lymphatic spread.Metastatic non-melanoma skin cancers to the parotid and neck often behave aggressively,with a high incidence of local recurrence after treatment and reduced five-year survival outcomes.Patterns of lymphatic spread are different from those seen in mucosal squamous cell carcinoma,with higher prevalence of disease in the parotid and superficial lymphatics.These factors require that treatment is individualized to achieve optimal outcomes.Traditionally,the management of non-melanoma skin cancers metastatic to lymph nodes has involved surgical excision followed by adjuvant radiation therapy.However,novel systemic therapies are showing promising results and their role in the management of these cancers is evolving.

A review of clinical and histological parameters associated with contralateral neck metastases in oral squamous cell carcinoma

Oral squamous cell carcinoma （OSCC） has a high incidence of cervical micrometastases and sometimes metastasizes contralaterally because of the rich lymphatic intercommunications relative to submucosal plexus of oral cavity that freely communicate across the midline, and it can facilitate the spread of neoplastic cells to any area of the neck consequently. Clinical and histopathologic factors continue to provide predictive information to contralateral neck metastases （CLNM） in OSCC, which determine prophylactic and adjuvant treatments for an individual patient. This review describes the predictive value of clinical-histopathologic factors, which relate to primary tumor and cervical lymph nodes, and surgical dissection and adjuvant treatments. In addition, the indications for elective contralateral neck dissection and adjuvant radiotherapy （aRT） and strategies for follow-up are offered, which is strongly focused by clinicians to prevent later CLNM and poor prognosis subsequently.

Lingual lymph nodes:Anatomy,clinical considerations,and oncological significance

Lingual lymph nodes are an inconstant group of in-transit nodes,which are located on the route of lymph drainage from the tongue mucosa to the regional nodes in neck levels I and II.There is growing academic data on the metastatic spread of oral cancer,particularly regarding the spreading of oral tongue squamous cell carcinoma to lingual nodes.These nodes are not currently included in diagnostic and treatment protocols for oral tongue cancer.Combined information on surgical anatomy,clinical observations,means of detection,and prognostic value is presented.Anatomically obtained incidence of lingual nodes ranges from 8.6%to 30.2%.Incidence of lingual lymph node metastasis ranges from 1.3%to 17.1%.It is clear that lymph nodes that bear intervening tissues from the floor of the mouth should be removed to improve loco-regional control.Extended resection volume,which is required for the surgical treatment of lingual node metastasis,cannot be implied to every tongue cancer patient.As these lesions significantly influence prognosis,special efforts of their detection must be made.Reasonably,every tongue cancer patient must be investigated for the existence of lingual lymph node metastasis.Lymphographic tracing methods,which are currently implied for sentinel lymph node biopsies,may improve the detection of lingual lymph nodes.

甲状腺乳头状癌超声图像表现在预测颈部Ⅵ区淋巴结转移危险度的临床价值

目的 分析甲状腺乳头状癌(PTC)超声图像表现在预测颈部Ⅵ区淋巴结转移(lymph node metastasis in the cervicalregion Ⅵ,CLNM-Ⅵ)危险度的临床价值。方法 选取2022年4月~2023年6月在河北省沧州中西医结合医院接受手术治疗并经病理证实的350例PTC患者,根据术后病理结果,将患者分为CLNM-Ⅵ组和非CLNM-Ⅵ组。收集并对比两组术前超声图像表现及临床病理特征,应用Logistic回归分析PTC患者CLNM-Ⅵ危险因素,受试者工作特征(ROC)曲线分析PTC超声图像表现对CLNM-Ⅵ的预测价值。结果 单因素分析显示,CLNM-Ⅵ组男性、实性或囊实性、年龄≤45岁、低回声、甲状腺背景正常、点状强回声的构成比均大于非CLNM-Ⅵ组(P均<0.05)。Logistic回归分析显示,男性、实性或囊实性、年龄≤45岁、低回声、甲状腺背景正常、病灶内可见点状强回声是CLNM-Ⅵ的独立危险因素(P均<0.05);进一步经ROC曲线分析显示,以上预测CLNM-Ⅵ的AUC分别为0.565、0.580、0.529、0.585、0.582、0.582,联合预测AUC为0.708。结论PTC超声图像表现在CLNM-Ⅵ风险评估中具有重要意义,可为PTC的预后判断提供一定的参考依据。

腹膜返折以下直肠癌患者侧方淋巴结转移情况预测模型的构建

目的探究腹膜返折以下直肠癌患者侧方淋巴结转移情况并构建预测模型。方法纳入2020年1月至2023年4月该院收治的102例腹膜返折以下直肠癌患者作为研究对象。根据是否存在侧方淋巴结转移(LLNM)分为转移组(n=31)与未转移组(n=71)。对比两组患者一般临床资料、肿瘤病理特征及实验室检验指标[癌胚抗原(CEA)、糖类抗原199(CA199)、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、转化生长因子(TGF)-α、TGF-β1]的差异。通过Spearman相关性分析及Logistic回归分析筛选出腹膜反折以下直肠癌患者合并LLNM的危险因素,构建预测模型并评价模型的效能。结果转移组患者平均肿瘤最大径、侧方淋巴结短径、低分化患者比例、T3~T4分期患者比例均显著高于未转移组患者(P<0.05),转移组患者平均TGF-α、TGF-β1、NLR水平均显著高于未转移组患者(P<0.05);Spearman相关性分析、单因素及多因素Logistic回归分析表明,低分化、T3~T4分期、肿瘤最大径及侧方淋巴结短径较长、TGF-α、TGF-β1、NLR水平较高均是腹膜返折以下直肠癌患者发生LLNM的独立危险因素(P<0.05);受试者工作特征(ROC)曲线分析表明,基于上述危险因素构建的预测模型曲线下面积(AUC)为0.915(95%CI:0.847~0.984),具有较高的预测效能。结论发生LLNM的腹膜返折以下直肠癌患者往往肿瘤最大径、侧方淋巴结短径较长,同时患者TGF-α、TGF-β1、NLR水平较高,针对具有上述特征的患者应积极开展侧方淋巴结清扫,并及时监测是否在术后仍存在淋巴结转移,为提高腹膜返折以下直肠癌LLNM的诊断提供一定临床依据。

高分辨MR成像联合ADC值预测直肠癌新辅助放化疗后区域淋巴结转移的价值

目的 探讨高分辨MR成像联合表观扩散系数(ADC)值预测直肠癌新辅助放化疗(nCRT)后区域淋巴结转移的效能。方法纳入青岛大学附属青岛市中心医院2020年5月至2022年5月收治的93局部进展期直肠癌患者为研究对象,于nCRI前、结束时6~8周接受高分辨率MRI T2WI、弥散加权成像检查并在1周内行全直肠系膜切除术。根据术后病理结果分为淋巴结转移组(n=24)和未转移组(n=69)。比较两组nCRT前、后淋巴结短径、长径、ADC值及其变化百分比绝对值(Δ%),分析高分辨MR成像联合ADC值预测直肠癌nCRT后区域淋巴结转移的价值。结果 转移组nCRT前后淋巴结短径均大于非转移组,nCRT前ADC值均小于非转移组(P<0.05);转移组Δ短径%、ΔADC%值均小于非转移组(P<0.05);但两组nCRT前后长径及Δ长径%值比较,差异无统计学意义(P>0.05);经Logistic回归分析显示,Δ短径%、MDC%是直肠癌患者nCRT后区域淋巴结转移的独立预测指标;绘制受试者工作曲线(ROC)显示,Δ短径%、ΔADC%单独及联合预测直肠癌患者nCRT后区域淋巴结转移的曲线下面积(AUC)分别为0.748、0.852、0.879,具有一定预测价值。结论 高分辨MR成像联合ADC值预测直肠癌nCRT后区域淋巴结转移具有一定的价值,其中淋巴结短径与ADC值变化可有效提示nCRT后区域淋巴结转移情况。

磁共振成像对直肠癌盆腔侧方淋巴结转移的诊断价值分析

目的:分析磁共振成像(MRI)对直肠癌盆腔侧方淋巴结转移(PLLNM)的诊断价值。方法:选取2020年3月—2022年2月新乡医学院第三附属医院收治的80例直肠癌患者作为研究对象,所有患者术前均接受MRI检查及病理活检确诊,均行直肠癌切除及盆腔淋巴结清扫术。以病理结果为金标准,计算MRI对直肠癌PLLNM的准确度、敏感度、特异度及一致性,比较不同性质淋巴结的MRI图像特征。采用Pearson检验分析MRI图像特征与直肠癌PLLNM的相关性,采用多因素logistic回归分析模型分析影响PLLNM的独立危险因素。结果:80例直肠癌患者经病理诊断共检出PLLNM 29例,未转移51例;MRI诊断共检出PLLNM 35例,未转移45例,两者的诊断一致性良好(Kappa=0.845)。PLLNM患者的边缘模糊及型号不均匀占比显著高于未转移者,淋巴结短径显著长于未转移者,差异有统计学意义(χ^(2)=12.342、8.136;t=13.857,P<0.01)。Pearson相关性分析结果显示,直肠癌PLLNM检出率与淋巴结短径、边缘模糊及信号不均匀具有正相关性(r>0,P<0.001)。多因素logistic回归分析结果显示,淋巴结信号是影响直肠癌PLLNM的独立危险因素。结论:MRI对直肠癌PLLNM的诊断效能较高,不同性质淋巴结的MRI图像特征存在明显差异,其中淋巴结短径、边缘模糊及信号不均匀与PLL-NM密切相关,淋巴结信号是影响直肠癌PLLNM的独立危险因素。用MRI测量淋巴结短径是诊断直肠癌PLLNM的可靠参数,对PLLNM的早期预测具有积极作用。

基于MRI探索用于术前预测直肠癌侧方淋巴结转移的短径截断值

目的:探讨基于侧方淋巴结(lateral pelvic lymph node, LPLN)短径预测术前进行新辅助治疗和未进行新辅助治疗的直肠癌患者LPLN转移的诊断标准。方法:回顾性收集分析自2012年01月至2019年12月中国侧方淋巴结协作组的机构数据库中行全直肠系膜切除术(total mesorectal excision, TME)+侧方淋巴结清扫术(lateral pelvic lymph node metastasis, LPLND)的临床怀疑LPLN肿大的直肠癌患者的临床病理资料。结果:共纳入446例患者,根据不同术前治疗策略,将所有患者分为新辅助治疗组和无新辅助治疗组。新辅助治疗组患者病理pCR/T1(9.0%vs 2.7%,P=0.013)和N0(41.9%vs 55.3%,P<0.001)的比例与无新辅助治疗组患者差异明显。此外,相比于无新辅助治疗组患者,新辅助治疗组患者手术时间明显延长(300.7 vs 277.4 min,P=0.018)。新辅助治疗组与无新辅助治疗组分别有40例(25.8%)和78例(26.8%)患者病理诊断为LPLN转移。髂内淋巴结是新辅助治疗组(16.1%)和无新辅助治疗组(15.8%)患者最常见的LPLN转移位置。新辅助治疗组患者平均转移LPLN短径(1.0 vs 1.4 mm,P=0.015)和无转移LPLN短径(0.6 vs 0.8 mm,P=0.005)明显短于无新辅助治疗组。无新辅助治疗组和新辅助治疗组患者分别以9 mm和7 mm作为LPLN截断值时,AUC值分别为0.817和0.745,有着较好的一致性。结论:接受新辅助治疗和未接受新辅助治疗的患者分别以7 mm和9 mm作为LPLN截断值时,有着最佳的预测LPLN转移的能力。

双能CT定量参数对甲状腺乳头状癌颈侧区淋巴结转移的预测价值

目的探讨双能CT(DECT)定量参数对甲状腺乳头状癌(PTC)颈侧区淋巴结转移(LLNM)的预测价值。方法回顾性分析216例(LLNM组174例,非LLNM组42例)经手术病理证实的PTC患者DECT影像资料。比较两组间DECT定量参数差异,包括平扫、动脉期和静脉期碘浓度(IC)、有效原子序数(Zeff)、能谱曲线斜率(λHU)、标准化IC(NIC)和标准化Zeff(NZeff)。将差异有统计学意义的参数纳入二元Logistic回归分析LLNM的独立预测因子。通过受试者工作特征曲线(ROC)评估独立预测因子及其联合对LLNM的预测效能。结果与非LLNM组比较,LLNM组具有更低的平扫NIC(Z=-2.279,P=0.023),更高的动脉期IC、NIC、NZeff、λHU和更高的静脉期IC、NIC、Zeff、λHU(P均<0.05)。二元Logistic回归分析显示,平扫NIC(P=0.006)和静脉期NIC(P=0.002)是LLNM的独立预测因子,其联合模型的预测效能最高,曲线下面积(AUC)为0.672(95%CI:0.605~0.734),敏感度63.79%,特异度66.67%;其次是静脉期NIC(AUC=0.634)和平扫NIC(AUC=0.613)模型。结论DECT定量参数可在一定程度上辅助预测PTC患者有无LLNM。

中国直肠癌侧方淋巴结转移诊疗专家共识(2024版)

侧方淋巴结是中低位直肠癌常见的转移部位,亦是术后局部复发的主要原因。目前国际上针对直肠癌侧方转移的诊断、治疗尚存争议。本共识在《中国直肠癌侧方淋巴结转移诊疗专家共识(2019版)》的基础上,结合国内外最新研究成果,国内42位结直肠癌研究领域的专家针对直肠癌侧方淋巴结转移的诊断、治疗策略、随诊以及复发处理4个方面进行修订,提出18条侧方淋巴结诊疗相关共识,并采用美国预防医学工作组的评价标准进行等级推荐,旨在进一步规范直肠癌侧方淋巴结转移的诊断标准及治疗策略。在本共识中未解决的相关问题,尚需进一步临床实践,并积极开展高质量的临床研究逐步探索和解决。

中下极甲状腺乳头状癌颈部淋巴结跳跃转移危险因素分析

目的探讨中下极甲状腺乳头状癌(PTC)患者颈部淋巴结跳跃性转移的临床特征及危险因素。方法收集2022年1月至2023年12月于江苏省中西医结合医院接受甲状腺叶切除术及中央+颈侧区淋巴结清扫术的PTC患者资料,分析肿瘤位置位于腺叶中下极PTC患者淋巴结跳跃性转移的临床特征及危险因素。受试者工作(ROC)曲线用于分析年龄的最佳截断值。结果中下极PTC发生颈部淋巴结跳跃转移者15例,跳跃性转移的发生率为11.45%(15/131)。颈侧Ⅲ区和Ⅳ区在单区和二区转移中最为多见。年龄(OR=1.143,95%CI:1.055~1.238,P=0.001)、肿瘤最大径≤1 cm(OR=0.086,95%CI:0.014~0.515,P=0.007),TSH较低(OR=0.403,95%CI:0.168~0.967,P=0.042)是中下极PTC跳跃转移的独立危险因素。中央区淋巴结清扫数目(OR=0.858,95%CI:0.741~0.994,P=0.041),颈侧区淋巴结转移数目(OR=0.520,95%CI:0.286~0.891,P=0.018)增加与中下极PTC淋巴结跳跃转移呈负相关。根据ROC曲线显示,预测跳跃转移的最佳年龄截断值为35.5岁(敏感度=93.3%,特异度=41.4%,曲线下面积=0.816,95%CI:0.717~0.915,P<0.001)。结论中下极PTC淋巴结跳跃性转移并不少见,当患者肿瘤位置位于中下极,年龄>33.5岁,超声提示肿瘤最大径≤1 cm时,术前应对患者颈侧Ⅲ+Ⅳ区淋巴结转移情况进行更细致地评估,必要时可术前复核B超。

面向头颈部肿瘤转移性淋巴结分割网络

头颈部肿瘤是我国常见的恶性肿瘤,其预后主要受颈部淋巴结转移的影响,医学上通过核磁共振成像技术对转移性淋巴结成像后再进行诊断,然而,核磁共振技术成像存在病灶形态信息丢失,病灶区域对比度低和病灶边界模糊的问题。针对这些问题,提出面向头颈部肿瘤转移性淋巴结分割网络协助医生进行诊断。首先,设计跨层跨视野注意力模块,其接收深浅层的特征信息后利用自注意力机制分别突显深浅层的转移淋巴形状,通过不同感受野的深层特征图学习到更好的语义上下文特征,将浅层特征图与深层特征图逐像素融合,增强转移淋巴病灶区域的形态信息。其次,设计多尺度特征融合模块,在特征金字塔的初始位置融合不同尺度的特征图,丰富转移淋巴病灶区域的形态信息。然后,设计增强注意力预测头模块,通过对预测前的特征图使用并行的自注意力与门控通道转换模块,凸出病灶区域,细化病灶边界。最后,使用临床淋巴结转移医学图像数据集验证网络的有效性。实验结果表明,所提网络对于淋巴结转移病灶分割的APdet,APseg,ARdet,ARseg,mAPdet和mAPseg分别为74.88%,74.12%,63.11%,62.28%,74.64%和74.04%。该网络实现对淋巴结转移病灶区域的精确检测分割,对辅助淋巴结诊断具有积极意义。