Risk factors for occult nodal metastasis in patients with stage ⅠA peripheral non-small cell lung cancer

Objective To study the risk factors of mediastinal lymph node metastasis in patients with ≤3 cm peripheral non small cell lung cancer. Methods From January 2000 to December 2010,a total of 281 patients with NSCLC [152 men and 129 women,aged (60. 31 ± 12. 13) years; ≤ 3 cm in diameter]underwent lobectomy or partial resection with systematic mediastinal lymphadenectomy in hospital. Clinical data included age,gender,

Predictors of nodal metastasis in sinonasal squamous cell carcinoma:A national cancer database analysis

Objective:We present the largest population based study of sinonasal squamous cell carcinoma(SCC)to identify risk factors for presentation with nodal metastasis.Methods:The National Cancer Database(NCDB)was used for this study.Location codes corresponding to the nasal cavity and paranasal sinuses and histology codes representing SCC malignancy were queried.Logistic regression analysis was performed to identify factors associated with presentation with nodal metastasis.Results:6448 cases met inclusion criteria.Nodal metastasis at presentation was seen in 13.2%of patients,with the sinus subsite(19.3%)being a significant risk factor for nodal metastasis at presentation when compared to the nasal cavity(7.9%).Logistic regression analysis showed black,uninsured and Medicaid patients were more likely than white and privately insured patients,respectively,to present with nodal metastasis.Conclusions:In sinonasal SCC,the sinus subsite has a significantly increased risk of nodal metastasis compared to the nasal cavity.Black race,uninsured and Medicaid patients are more likely to have nodal metastasis at presentation.

Unusual locations for differentiated thyroid cancer nodal metastasis

Lymph node metastasis is common in differentiated thyroid cancer especially papillary thyroid cancer.Presence of lymph node metastasis does not have an impact on survival in younger patients.Therapeutic central and lateral neck dissection in the presence of clinically or radiologically evident lymph nodes has resulted in good overall survival.However,disease persistence in the lymph node/early recurrences may be seen in patients owing to lymph nodes that may be missed during the initial neck dissection.These observed locations are retropharyngeal and parapharyngeal nodal location,retro carotid location,sublingual,axillary,and intraparotid locations,supraclavicular and superficial to the sternothyroid muscle.We aim to highlight these locations with the goal to minimize persistence or early recurrence of disease at these locations.

Collision nodal metastasis of bladder cancer and melanoma:The first reported case and literature review

Collision metastasis is a rare phenomenon of concomitant localization of 2 or more different tumors in the same lymph node.In most cases,primary malignancies are synchronous carcinomas arising in the same organ or area of the body.A 82-year-old man presented with hematuria and acute renal failure;he had undergone dermatological consultation ten months ago because of a large deep brown skin lesion in his dorso-lumbar region,which was not excised upon patient's request.He underwent radical cystectomy with extended pelvic lymphadenectomy due to nonpapillary high-grade urothelial carcinoma,with focal squamous features,infiltrating the bladder wall and prostate gland.In one left iliac lymph node,small foci of metastatic urothelial carcinoma(positive for P63 and CK34betaE12)were close to melanoma cells(positive for HMB45).The patient refused further treatment and died of metastatic disease 12 months after cystectomy.There is no specific clinical feature for nodal collision metastasis.A polymorphic histologic appearance poses the suspect,but immunohistochemical stains are needed to define the primary tumors.Collision metastases are thought to carry a poor prognosis.Their clinical relevance is linked to the fact that the patient faces 2 different metastatic tumors that may require specific multidisciplinary approach once diagnosed as metastatic.We present,to the best of our knowledge,the first case of collision nodal metastasis from bladder cancer and melanoma,and describe its clinical and histopathological characteristics to raise awareness on this rare occurrence,which portends a poorer prognosis than each single tumor.

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.

Current controversies in the management of neck node metastasis in differentiated thyroid cancer

The incidence of nodal metastasis is quite common in well-differentiated thyroid cancer.However,its clinical significance is generally quite minimal.The adverse pathological features need to be recognized.The debate continues over prophylactic central compartment dissection.However,it needs to be re-evaluated in terms of complications of elective procedure.The extent of lateral neck dissection is standardized from level II through level V.Recurrent nodal disease is more likely to be persistent nodal disease.Appropriate preoperative imaging is very crucial.Surgery for recurrent disease needs to be considered based on nodal prognostic factors and location of the disease.The approach of using active surveillance and continuous monitoring is reasonable,especially for recurrence below 1 cm.

Diagnostic accuracy of MRI and PET/CT for neck staging prior to salvage total laryngectomy

Aim:Lymph node(LN)metastases are associated with poor outcomes in patients with recurrent larynx squamous cell carcinoma(LSCC).Neck dissection(ND)is therefore commonly performed along with salvage total laryngectomy(STL).Here,we assess the rate of occult LN metastases and the diagnostic value of MRI and PET/CT for detecting them in recurrent LSCC.Methods:This retrospective study included patients with recurrent LSCC after primary(chemo)radiotherapy[(C)RT]who were re-staged by MRI and/or PET/CT and treated with STL and ND between 2004 and 2019.The histopathology of ND samples was used as the reference standard.Results:Forty-one patients were included.The prevalence of occult metastases in MRI-negative and PET/CT-negative neck nodes was between 3.2%and 6.1%.Negative predictive values of neck node re-staging were 93.9%for MRI,96.8%for PET/CT,and 96.2%for MRI and PET/CT combined.Conclusion:Both MRI and PET/CT afforded good negative predictive values for nodal staging in patients with recurrent LSCC after(C)RT prior to STL.In selected patients,these radiological modalities,particularly PET/CT,could help to avoid unnecessary surgery to the neck and its associated morbidity.

Review on applications of metastatic lymph node based radiomic assessment in nasopharyngeal carcinoma

Nasopharyngeal carcinoma(NPC)has a distinct geographical prevalence in Southern China and Southeast Asia with a high overall survival rate(>90%)in the early stage of the disease.However,almost 85%of patients suffer from the locally advanced disease with nodal metastasis at diagnosis.The overall survival rate would drastically drop to 63%.In addition to the generic tumor,nodal,and metastasis(TNM)staging,radiomic studies focusing on primary nasopharyngeal tumors have gained attention in precision medicine with artificial intelligence.While the heterogeneous presentation of cervical lymphadenopathy in locally advanced NPC is regarded as the same clinical stage under TNM criteria,radiomic analysis provides more insights into risk stratification,treatment differentiation,and survival prediction.There appears to be a lack of a review that consolidates radiomics-related studies on lymph node metastasis in NPC.The aim of this paper is to summarize the state-of-the-art of radiomics for lymph node analysis in NPC,including its potential use in prognostic prediction,treatment response,and overall survival for this cohort of patients.